The Anomaly

From the Other Side — Introduction

I spent four decades as a prosecutor—the last thirty-six of which were spent as an Assistant U.S. Attorney in the Southern District of California. It was a career built on gathering facts, following evidence, and reaching conclusions. The system, for all its many imperfections, was built on the idea that truth was immutable and answers were possible.

In the fall of 2020, I encountered a different kind of uncertainty. The kind that doesn’t resolve so cleanly. The kind that requires you to keep living inside the question, without any assurance it will ever be answered.

What follows is a journal I began after I was diagnosed with blood cancer—written for my family, my friends, and anyone else who finds themselves standing at a similar threshold. It is not a medical chronicle, though medicine is everywhere in it. It is written as honestly as I can manage about the reality of this experience: the fear, the clarity, the unexpected humor, the long stretches of waiting, and the strange gift of being forced to pay attention to your own life.

I am still writing it.

The story is not finished.

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Chapter One

The Number

TThe first clue was a number. It sat there—unnoticed—buried in a routine blood test. One of those annual checkups that feels more administrative than medical. I didn’t feel sick. I wasn’t tired. Nothing hurt. If anything, I felt better than men my age had any right to feel, a fact I took quiet satisfaction in pointing out to anyone who’d listen.

My wife Marcia had just retired from teaching science at Muirlands Middle School, a career she’d spent trying—with mixed results—to convince twelve-year-olds that the natural world was more interesting than their cell phones. She has a calm, self-possessed presence and is deeply warm and generous, without fuss or display. She is quietly self-effacing—inclined to deflect credit from herself and, when possible, from our family as well. She approaches people the way a careful observer might—attentive, curious, and unassuming.

I was in my early 60s, working out every day—no negotiation—and cycling more than 200 miles a week. I had just stepped away from a 40-year career as a prosecutor, the last 36 of which were spent as an Assistant U.S. Attorney in the Southern District of California. Our three sons (Griffin, Moose, and Gator) were grown and launched, each seemingly constitutionally incapable of doing anything ordinary. I fear the names we gave them didn’t help.

By any reasonable measure, it was a good moment to exhale.

The number in question was my platelet count. It was initially brought to my attention by Dr. Ottar Lunde, an internist at the University of California at San Diego (“UCSD”), who was my primary care physician. Dr. Lunde was methodical, detail-oriented, a doctor who easily integrates wildly disparate specialties when evaluating my health. He brings a Norwegian’s quiet precision to medicine, speaks plainly, and approaches clinical problems without drama. He is tall and spare, with an easy, unforced manner. He also shares my passion for single malt whiskey—an important credential in my view. On my annual visits, I’d bring him a small sample of something unusual—occasionally a bottle I’d aged myself—as a token of appreciation. He was not, and is not, the kind of doctor who gives one pause.

In 2013, my platelet count was 280,000—comfortably within the normal range of 150,000 to 450,000. No one mentioned it. I didn’t ask. Life moved on.

But numbers have a way of accumulating quietly.

Year after year, mine crept upward. Not dramatically. Not enough to trigger alarm. Just enough to be noticed—but only if someone was looking closely. By December 2018, my count had nudged just above the normal range to 500,000. Dr. Lunde thought it was worthy of mention, but nothing to worry about—noting that I had worked out hard the day before and attributing it to the rigors of endurance training. Ironically, I may even have been a touch proud and thought no more of it.

In October 2020, my annual checkup revealed that my platelet level had reached 712,000. Dr. Lunde was not pleased. He noted in his clinical records that he could not account for the excess—“thrombocytosis of unclear cause”—and referred me for a consultation with the UCSD Hematology Department.

The timing was, at best, inconvenient. I had retired only days earlier, and not quietly. My departure from the Department of Justice had taken the form of an op-ed in the San Diego Union-Tribune—captioned, with more than a little fanfare, “I Won’t Work in Attorney General William Barr’s Justice Department Any Longer”—which promptly went viral. I was in the middle of late-night national television appearances, fielding calls from producers I’d never heard of, and doing my small part to stand up for the rule of law. Meanwhile, my platelets were quietly staging their own insurrection. An appointment with a hematologist barely registered.

Unfortunately, the follow-up tests proved less easy to dismiss. My red and white blood cell counts were no longer quite right. Then came another result—one that didn’t just raise questions, but rewrote them entirely. A genetic mutation: JAK2 V617F. Not inherited. Acquired. The kind of change that accumulates over time, quietly.

I learned quickly that this mutation often appears in a group of diseases called myeloproliferative neoplasms (“MPNs”), a shorthand for blood cancers that would soon become uncomfortably familiar—conditions in which the bone marrow produces blood cells in ways it shouldn’t: too many, too few, or simply the wrong kind.

Up to that point, the situation was little more than a distraction. It felt abstract—numbers, terminology, a few raised eyebrows from doctors who spoke in measured tones. But somewhere between that referral and the first real conversation about what might be happening inside my bone marrow, the abstraction fell away.

Blood cancer.

It’s a broad term—almost deceptively so. More than 100 distinct subtypes—leukemia, lymphoma, myelodysplastic syndromes, and others I would soon learn far more about than I ever wanted to. Some are aggressive. Some move slowly. Some can be managed for years. Others cannot.

The words carried weight, but not urgency. There was nothing to be done except note their presence and wait for what came next.

I did not tell Marcia. There was, I told myself, nothing definitive to tell—no reason to worry her before I had something concrete. I mentioned, casually, that Lunde was puzzled by my platelet levels. I soft-pedaled the whole business. Or maybe I just ducked it. It would not be the last time I’d make that choice—the rationale being similar: I was protecting her. Whether that was entirely true, or even fair, is another matter.

I was at home with gathering facts, following evidence, and reaching conclusions when the evidence demanded them. I was comfortable with complexity. Comfortable with uncertainty—as long as it eventually resolved into an answer. This was different. I didn’t yet know where I would land on the spectrum of what was possible. But I had a sense that this was going to be less like a verdict and more like an opening statement.

The questions came unbidden. They quickly crowded out other thoughts.

What exactly did I have? How serious was it? What were my options? And beneath all of that—though no one quite asked it out loud, not yet—how much time did I have?

I had spent a career chasing answers for others. Now I was the one waiting for them.

And for the first time in as long as I could remember, I wasn’t the one asking the questions—or orchestrating the answers.n.

I was in my early 60s, working out every day—seven days a week, no negotiation—and cycling more than 200 miles a week. My wife Marcia had just retired from teaching science at Muirlands Middle School, a career she’d spent trying—with mixed results—to convince twelve-year-olds that the natural world was more interesting than their cell phones. I had just stepped away from a 40-year career as a prosecutor, the last 36 of which were spent as an Assistant U.S. Attorney in the Southern District of California. Our three sons (Griffin, Moose, and Gator) were grown and launched, each it seemed constitutionally incapable of doing anything ordinary. I fear the names we gave them didn’t help.

It was, by any reasonable measure, a good moment to exhale.

The number in question was my platelet count. It was initially brought to my attention by Dr. Ottar Lunde, an internist at UCSD, who was my primary care physician. Dr. Lunde was methodical, detail-oriented, the kind of doctor who easily appears to integrate wildly disparate specialties when approaching my health. He brings a Norwegian’s quiet precision to medicine, speaks plainly, and approaches clinical problems without drama. He also shares my passion for single malt whiskey, which I considered another important credential. On my annual visits I’d bring him a small sample of something unusual—occasionally a bottle I’d aged myself—as a token of appreciation. He was not, and is not, the kind of doctor who gave one pause.

In 2013, my platelet count was 280,000—comfortably within the normal range of 150,000 to 450,000. No one mentioned it. I didn’t ask. Life moved on.

But numbers, like facts in a case, have a way of accumulating quietly.

Year after year, mine crept upward. Not dramatically. Not enough to trigger alarm. Just enough to be noticed—but only if someone was looking closely. By December 2018, my count had nudged just outside the normal range to 500,000. Dr. Lunde thought it was worthy of mention, but nothing to worry about—noting that I had worked out hard the day before and chalking it up to the rigors of endurance athletics. Ironically, I was even a touch secretly proud and thought no more of it.

In October 2020, my annual checkup revealed that my platelet level had reached 712,000. Dr. Lunde was not pleased. He noted in his clinical records that he could not account for the excess—thrombocytosis of “unclear cause”—and referred me for a consultation with the UCSD Hematology Department.

The timing was, to put it gently, inconvenient. I had retired only days earlier, and not quietly. My departure from the Department of Justice had taken the form of an op-ed in the San Diego Union-Tribune—captioned, with more than a little fanfare, “I Won’t Work in Attorney General William Barr’s Justice Department Any Longer”—that had promptly gone viral. I was in the middle of late-night national television appearances, fielding calls from producers I’d never heard of, and doing my small part to try and stand up for the rule of law. Meanwhile, my platelets were quietly staging their own insurrection. An appointment with a hematologist barely registered.

Unfortunately, the follow-up tests proved less easy to dismiss. My red and white blood cell counts were no longer quite right. Then came another result—one that didn’t just raise questions but rewrote them entirely. A genetic mutation: JAK2 V617F. Not inherited. Acquired. The kind of change that accumulates over time, quietly.

I learned quickly that this mutation often appears in a group of diseases called myeloproliferative neoplasms—MPNs, a shorthand that would soon become as familiar to me as case citations—conditions in which the bone marrow produces blood cells in ways it shouldn’t: too many, too few, or simply the wrong kind.

Up to that point, the situation was little more than a distraction. It felt abstract—numbers, terminology, a few raised eyebrows from doctors who spoke in measured tones. But somewhere between that referral and the first real conversation about what might be happening inside my bone marrow, the abstraction fell away.

Blood cancer.

It’s a broad term—almost deceptively so. More than 100 distinct subtypes, spread across leukemia, lymphoma, myelodysplastic syndromes, and others I would soon learn far more about than I ever wanted to. Some are aggressive. Some move slowly. Some can be managed for years. Others cannot.

The words carried weight, but not urgency. There was nothing to be done with them yet except note their presence and wait for what came next.

I did not tell Marcia. There was, I told myself, nothing definitive to tell — no reason to worry her before I had something concrete to say. I mentioned casually that Lunde was puzzled by my platelet levels. I soft-pedaled the whole business. Or maybe I just ducked it. It would not be the last time I’d make that choice—the rationale being similar: I was protecting her. Whether that was entirely true, or even fair, is another matter.

I had spent a career gathering facts, following evidence, and reaching conclusions only when the evidence demanded them. I was comfortable with complexity. Comfortable with uncertainty, as long as it eventually resolved into an answer. This was different. I didn’t yet know where I would land on the spectrum of what was possible. But I had a sense that this was going to be less like a verdict and more like an opening statement.

The questions came unbidden. They quickly crowded out other thoughts.

What exactly did I have? How serious was it? What were my options? And beneath all of that—though no one quite asked it out loud, not yet—how much time did I have?

I had spent a career chasing answers on behalf of others. Now I was the one waiting for them.

And for the first time in as long as I could remember, I wasn’t the one asking the questions or orchestrating the answers.

Author’s Note: My journey continues and if you’re reading this because you’re standing at a similar threshold—wondering what comes after the number changes—I hope something here is useful.