This “Manhattan Tale” is the first that I have written outside of Manhattan.

My wife and I are spending a few days in Washington, D.C., celebrating my brother-in-law’s 70th birthday. He and his wife live in Florida, and they have come up to DC for a chilly week to tour the sites of Washington, my hometown.

Just as the 20-degree cold we had a few nights ago gave a jolt to my brother-in-law and his wife, who are used to the tropical climate of southern Florida, this trip to Washington has given a jolt to the rhythm of my daily life in New York.

During this short trip to Washington, instead of trips to the hospital or to the gym, we have joined the ranks and rhythms of the tourists. We are staring at new maps, taking new subway lines, touring museums and monuments, and trying to get to the outdoor sites before a blizzard moves in. We have even been to two relatively new Smithsonian museums that I had not visited previously – the Museum of the American Indian and the Museum of American Art.

It is fun to have this short four-day change to my regular schedule, but it is not a particularly easy one. I had gotten used to the daily and weekly rhythms that my cancer treatments have imposed on me.

Prior to my cancer diagnosis, daily and weekly rhythms were set by the requirements of school and my job. Most weekdays I worked or went to school at 9 a.m. School and extra-curricular activities would generally end by 3 p.m. or 4 p.m., and work would end by 6 p.m. or 7 p.m. Evenings were spent dealing with home­work (either my own or my children’s). Weekends were filled with athletics, music lessons, and grocery shopping.

Four years ago, those patterns were abruptly disrupted by my myeloma diagnosis.

Suddenly the rhythms of the day were not set by work or school, but rather by the dictates of the doctor’s visits, treat­ment schedules, and the physical and psychological impacts of my chemotherapy treatments.

What days of the week would I troop up to the hospital for infusions? What days would my steroids be given, and what nights would I stay up into the wee hours of the morning unable to sleep? What days would I be “edgy” and aggressive from the steroids, and what days would I be exhausted from lack of sleep? What days would my bones ache from the myeloma, or (most recently), what days would my bones ache from the Neupogen (filgrastim) shots?

Understanding and managing the new rhythms of this intensely medical phase of my life were two of the necessities of living with cancer.

For the last few months, these patterns and rhythms of my life have been even more dominated by treat­ments than they have been over the past few years. I have been making twice-weekly visits to the hospital for various chemotherapy infusions, and the chemicals have been more powerful and disruptive than previous ones.

Luckily for me, I nevertheless have been able to integrate the patterns dictated by my treatments into other patterns that I had already established to help me deal with the myeloma -- patterns that serve to give me a sense of myself that is greater than the myeloma.

First, every time I go to the hospital, I leave our apartment early enough so that I can take the subway to a station a mile from the hospital, and then spend 20 to 30 minutes before my appointment walking through Central Park. Often I am able to leave the hospital early enough to take the same path back or a different route to a different subway line that will take me home. The walks on familiar but uncrowded paths, either among the trees or along one of the park’s lakes, ponds, or reservoirs, provide a welcome prelude and coda to the hospital visits.

Another activity that I use to establish a rhythm to my weeks is my swimming and visits to the gym. Usually I am able to get to the pool at least three times a week and spend 35 to 45 minutes doing laps. My laps may be slow, but they are steady, and I rarely end them because of fatigue. Oddly, I feel stronger and better as the swims progress. Even on non-swimming days, I go to the gym for a light regimen of stretching and working out on the weight resistance machines.

This established routine is not entirely dominated by the one set by my myeloma treat­ments. The pattern has elements that I own. Not only do my walks in the park and strokes and breathing in the pool have their own steady pace and regularity which helps transcend the pattern set by the medical treatments; the periodicity set by the walks and by the deep and regular breathing in the pool also has a rhythm that is particularly comforting.

In addition, both the walks in the park and the visits to the gym provide an opportunity for me to spend time by myself. These regular quiet times of my day allow me to observe the natural beauty around me, to review and organize the events of my days, and to contemplate the unexpected turns that my life has taken.

As I’ve mentioned in previous columns, the swimming has helped me deal with my cancer in many ways. It has helped me maintain my stamina and strength. I cannot believe that I would have been able to withstand the assaults on my body that cancer and the medicines have given me without the help of what I dub my physical therapy program.

The exercise (or perhaps the relatively cool pool that I swim in) also significantly ameliorates the neuropathy that I developed as a side effect of the medicines I have been given. Some of my friends have suggested that this antidote to neuropathy is an “endorphin” effect that many athletes feel after intense exercise. Regardless of its physical or psychological roots, it works for me, and I’m grateful for that.

Finally, the swimming, as well as the walks in the park, calm me down on the days I have taken dexa­metha­sone ^[1] (Decadron). While exercise does not help me sleep on dex days (this past week I swam a mile on my “dex” day and I was still up till 5 a.m. the following morning), I find that I do not mind sitting up reading or just relaxing at night when I cannot sleep if I have been to the gym or taken a walk through the park.

Finally, I’ve noted that I no longer get into arguments with people on the streets -- I even try to smile at the aggressive taxi drivers who turn into the crosswalks as I try to ferry myself across the streets of mid-town Manhattan. My manner must have improved, as tourists are constantly coming up to me and asking for directions. I’m not always Mr. Pleasant at home on the day after my nights sitting up awake, but my wife usually hurries me out to the gym when I’m getting irascible. She understands what I need to do in order to cope.

The patterns of these days and weeks are not ones that I would have anticipated ten years ago for my life in my late sixties. Then my children were just leaving home and I was in the midst of an active professional career.

However, the regularity and rhythms of the new patterns provide a certain familiarity and comfort. They ease the trips to and from the hospital and the assault on the more natural circadian rhythms that we were born with. And they help give me a sense of self that is not entirely defined by being a cancer patient.