A Friend Like This

Last week, Spouse mentioned that he made plans for us to go out to dinner on Saturday night.

My nephew and his fiancée were on board to watch the kids.

I thought that we’d just been out to dinner, but when I did the math, I realized it had been nearly six weeks (longer?) since we’d eaten a meal together, just us.

[And before that? NOVEMBER. Sigh. We have work to do].

But, Saturday got away from me.

I was feeling well and decided to take the dog for a walk. I went too far and became tired.

Next, I attended my daughter’s fifth grade orchestra concert. I was nodding off by the end.

And then I was done.

I contemplated telling Spouse that dinner was off. Rest was all I could muster.

An hour of napping later, though, and I was refreshed and ready to go.

We drove to the restaurant, Spouse gave his name at the host stand, and we were shown to our booth.

And seated there was one of my dearest friends in the world.

G. and I started as physicians at the same academic medical center within 3 weeks of each other in the summer of 2008.

We quickly figured out that our birthdays are within days of each other. We both had to do a Meyers Briggs personality test as part of our work orientation and discovered that we had the same profile, one of the rarest, ENTJ. Our friendship sparked from day one and grew to wildfire levels.

And then, eight years later, we went separate ways.

For different reasons, the academic center was no longer for us.

I went into private practice.

He became wildly successful as an executive physician at a pharmaceutical company.

I missed seeing him every day but we were able to maintain our friendship.

Our paths still crossed several times per year, but there was no event that had him scheduled to be sitting in that restaurant booth on Saturday night.

That was pure love.

Turns out, Spouse and G. had been crafting this plan for weeks, knowing it would cheer me up.

It did.

Big gestures are not required for friendship, but wow! This one was marvelous.

Everyone should be lucky enough to have a friend like this.

I Probably Need To Go Back To Work

There have been signs that I’m ready to go back to work.

For one, I’m driving.

^^^ This was not me. I swear.

Two: I am watching an embarrassing amount of daytime TV.

This includes not only the usual suspects like Hoda and Jenna, but also deeper cuts like Magnum, P.I., reruns and many, many Hallmark Channel movies.

Three: I am basically stalking our mail carrier and felt like I’d hit the lottery the day that SEVEN magazines arrived in one fell swoop.

Four: I became bored enough to cook. I made curried carrot soup and a butternut squash quinoa dish (below). I made peanut butter and banana baked oatmeal cups.

Five: I spent 45 minutes at Whole Foods. I walked out with $22 worth of freshly cut fruit. This is a lot less fruit than you would imagine.

Most medical sites suggest that mastectomy recovery requires 4-6 weeks off of work.

I’m giving myself 2.5.

While work has successfully gone on without me, I know that my partners and staff are picking up a lot of slack. This cannot be an indefinite strategy.

I also derive a lot of my identity and personal satisfaction from my job, and I miss the patient interactions, professional collegiality and intellectual stimulation.

I know that when I return, there has to be a New Normal.

What this looks like, I don’t know.

I know I will need intermittent time off as I undergo chemotherapy. There will be more surgeries. Possibly the cancer will only progress and not regress. Maybe I will have a recurrence. Perhaps there will be many.

And if I use this diagnosis as a time of personal reckoning, I should also consciously craft a New Normal where work is not the primary thing that gives me identity and satisfaction.

I hope I can find a balance, but odds are I’m not going to figure this out before Rush Hour on Monday morning, when I’ll be slowly crawling along 494W with the rest of the commuting crowd.

For once the gridlock will feel good.

The Breakdowns

I break down every day.

Sometimes, more than once.

The triggers vary.

Like watching this song being performed on the “Today Show.”

I am generally neither sappy nor a fan of country music, but wow! These lyrics.

This puppy also made me cry, and I mean THIS SPECIFIC PUPPY.

Her name is Tina.

Last summer I was walking in our neighborhood and saw a tiny, adorable fluffball that looked like the puppy version of When the Gremlin Was Still Good.

Minor stalking later, the owner told me it is a Havashu, which is a designer dog cross between a Havanese and Shih Tzu.

These dogs are not easy to find, but a random Google deep dive led me to Tina, who was available at the beginning of the year, right around the time of my diagnosis.

Spouse – who probably would have done almost anything to cheer me up – offered to make Tina part of our family.

That idea was wildly impractical for so many reasons, but the one that hit hard was the fact that Tina’s life expectancy – 16 years – may exceed mine.

Cue the waterworks.

Lost professional opportunities are also hard to swallow. From a career standpoint, 2019 was a banner year, and 2020 held infinite promise. It is hard to decline invitations and cancel plans for speaking gigs or conferences. I fear that my professional stock has fallen now that I am sick and broken. I see it already. Maybe I will not come back – ever – to where I was B.C. (Before Cancer). People will whisper, they will be sad, I remain a Cautionary Tale.

But I am saddest when I think about my children.

While I have not shared this here before, my son – MGM – has autism. There is a distinct possibility that he will not be able to live independently in the future. Until now, I thought my predicted longevity and earning potential would be a cushion for him as he grows older. His vulnerability is nearly too much to consider.

And my daughter. Oh, my daughter. She is so smart, strong and independent – and honestly, she probably would be with or without me. However, the thought of her college entrance essay’s theme of “My Mother’s Death” is a loop I cannot stop playing in my head.

I hate that movie.

The Time I Scared Them Away

Can there be cancer humor? I think so.

Picture this: I was home last week, resting and recovering from my bilateral mastectomy, watching the Hallmark Channel like nobody’s business, when I heard someone at the front door.

I thought it was our dog walker, and I jumped up to unlock the door lest she have to wrestle to get the key out of the lockbox.

Turns out, it was two twenty-something, incredibly earnest young women on my doorstep.

Earnest Woman (EW) #1: “Good morning. We are missionaries visiting all the families in this area because we are concerned about the state of the world and our future.”

EW #2, stepping forward: “Are you concerned about your future?”

Me (with enthusiasm): “Yes! I am home today recovering from major surgery for cancer, and you can believe I am EXTREMELY CONCERNED about my future.”

This was definitely not on script for these two.

Their eyes widened. Their nostrils flared.

EW #1 (very flustered): “Oh my god, oh my god, I am so sorry. This is obviously not a good time. We will leave.”

(Both hastily retreating.)

Me: “You can pray for me if you want.”

EW #2 (weakly): “We will.”

So, to sum it up: my situation is so awful that I scared away door-to-door missionaries.

But I wouldn’t mind it if they followed through on those prayers.

What Do I With My Head?

^^^ Spouse jokingly advocated for this look

With chemotherapy looming, it appears that hair loss is both inevitable and fairly predictable.

Much of what I read about one of the drugs I will be taking says that hair loss occurs 12-14 days after the first dose.

While there is something available called a Cold Cap to attempt mitigation of hair loss, it doesn’t sound like it works well enough to bother. The principle is that you freeze your scalp – and, presumably, hair follicles – while the chemotherapy drugs are being infused and the cold-induced blood vessel restriction “protects” the chemotherapy drugs from entering the blood supply to the scalp.

(Sidenote: this principle is also applied to icing the hands and feet before chemotherapy to prevent peripheral neuropathy. I am 100% doing this).

Data from the Cold Cap therapy suggest that about half of women lose only half of their hair.

This also means that for half of the patients, it doesn’t even work that well.

Anecdotal information from several patients who have Cold Capped seems to be summarized as follows: it didn’t work but they were glad they tried it.

Considering that you have to start icing your scalp an hour or so before chemotherapy starts, plus you have to keep caps on dry ice, PLUS you have to swap the caps out every 30 minutes AND it apparently causes a continuous ice-cream style headache, the end doesn’t seem to justify the means.

Will I wear a wig?

I downloaded this picture to my phone. It is a Cameron Diaz wig that is currently on sale for $305.

I’ve never worn a wig before.

Well, maybe as part of a Halloween costume when I was a kid, but it’s been a while.

Wigs seem to come in several hair types (real human hair, high quality synthetic, low quality Halloween-types, etc) and wildly varying price points. They also are definitely a Try-Before-You-Buy item, meaning that blindly ordering the above number and hoping it both fits and looks good is not advised.

One surprising thing that I am learning from other cancer patients is that many of them bought wigs but ended up not wearing them.

The reasons: itching, discomfort, feeling overheated, and the fact that a wig still looks like a wig, so why try fooling anyone?

But here’s the thing: Baldness is the sine qua non of cancer. Nothing screams “Cancer Patient” more.

There are two situations where I am most nervous and make me want the option of wearing a wig.

The first: around patients. Patients who are aware of my situation have almost universally shown an outpouring of support and love. To my knowledge, no one has fired me as their physician due to my diagnosis.

Or at least my staff has done a superb job of hiding it from me.

Still, I get it: it could be potentially scary to put your trust in someone who is clearly going through a health crisis. Will I be there for their appointments? Darkly – will I die halfway through their treatment?

The second: for my kids.

If I am honest, my biggest fear is that my kids will feel shame or embarrassment about how I look.

While neither have specifically expressed this, they are both tweens and I am sure they already see their parents as mortifying enough without tacking on the baldness.

Two options I am considering:

  • A partial wig from my own hair. Chemo Diva makes something called a Halo Wig using your own hair. Their website shows it best, but basically this is a tight cap with hair sewn around the edges. You need to wear it with a hat but it is your own hair poking out from below. The appeal of this is that it is your own hair and the turn around time is quick (around a week). The cost is roughly $400. You send them at least 7″ of hair and it must be hair that has been cut, as they cannot work with hair that has been collected after falling out. From a timing standpoint I could theoretically have my first chemotherapy infusion and then get my hair cut in the limbo period between treatment and anticipated hair loss. Because they only need 7″ of hair and mine is longer, I could also get my hair cut shorter now and still have a cute-ish short cut (and less hair to clog drains throughout my house when the time comes.)
  • A whole wig using my hair. Compassionate Creations is a company that specializes in this. The obvious upside is that you can have a wig made from your own hair, but there are serious downsides. Cost is one – this wig is roughly $900 – but that’s minor compared to the long delivery time (8-10 weeks) and the fact that you have to cut your hair all the way to the scalp to send them as much to work with as possible. The fine print on their website also says that few people send enough hair to craft an entire wig. Typically 2-3 heads of human hair are needed for a single wig. They offer the option of supplementing what is sent with their stock of synthetic hair or sending hair from more than one person.

Coincidentally, there is one person in my life who might have enough hair to make a wig:

^^^ And this was AFTER getting nearly 8″ cut.

Trixie’s ponytail is thicker than a baby’s arm. Her hair is a pretty caramel color and has almost never even been blow-dried, much less processed to within an inch of its life like mine.

Last week I jokingly suggested that she cut and donate her hair to my wig effort.

I could immediately tell that I’d called this wrong.

A look of fear crossed her eyes.

“Mom, please don’t make me cut my hair.”

Tears sprang.

I felt terrible.

I retracted the comment and tried to write it off as a joke, but the damage was done.

A few days later I saw her measuring her hair.

I re-iterated that I did NOT want her hair, but I still feel like some old fairy tale witch who’s trying to steal the Essence of Youth from a maiden.

And in the end, I am not going to go the Compassionate Creations route for a very practical reason, namely the delivery time of 8-10 weeks. My chemotherapy is expected to be around 12 weeks. This means I would (hopefully) be almost finished with treatment by the time a wig arrived.

Maybe I’ll make do with this instead:

I think I could rock it.

Vacillations

I’ve been vacillating lately between two dichotomous moods: YOLO and Why Bother?

Regarding YOLO (You Only Live Once):

Being off work has held a special danger for me: since I’ve had more time than usual to spend online, this has involved online shopping.

My YOLO streak has included a serious spending spree at Jenni Kayne – a wildly expensive brand I mentioned a few weeks ago – that netted me two sweaters and THREE pairs of shoes. [Spouse, if you are reading, please, please resist the temptation to do the math on this haul.]

I also bought a new swimsuit. Seriously, this almost qualifies for like-a-fish-needs-a-bicycle status. My reasoning: I really want to go on a long-planned vacation in March and with my recent surgery, I don’t think any of my old suits may fit or look right. It pained me, but I ordered a one-piece suit from Lilly Pulitzer that looked cuter on the model.

Speaking of that vacation, it is still kind of on the fence. I booked it over a year ago, and it is a version of the same vacation we have taken ten times already: a Disney Cruise. I only mildly apologize for the dorkiness factor that comes with taking a Disney Cruise ten times. This one leaves from Miami, which is a new port for us. I was planning to arrive two days early to enjoy some extra vacation time, but when I went to find hotel accommodations I quickly discovered that high season in Miami comes with limited options and huge price tags. My beloved St. Regis was not even available. A similar property had very little space and the rooms were exorbitant – over 4 figures per night. I suddenly remembered the huge stockpile – almost a million – of Marriott points I had been hoarding (Why? Not sure what mythical trip I was waiting for), and in true YOLO spirit, I blew 250,000 of them for two nights lodging in Miami.

Girl Scout Cookies. Normally I would avoid these like the nutritional plague, but YOLO, I have made quick work of several boxes and the cookie season is not over yet.

Regarding Why Bother?

In my darkest moments, there are thoughts of Why Bother? Boiled down it could sound even worse: Why bother living if you’re dying from cancer? New shoes don’t matter when you’re dead. That swimsuit won’t see much use if I am confined to my sofa, too ill to travel.

One of my biggest vacillations is my wedding ring.

A supremely unfortunate, albeit accidental, trip through the garbage disposal NEARLY FOUR YEARS AGO rendered my wedding ring useless.

With salvage unlikely, I quickly decided to laugh it off and patiently bide my time until I could get a shinier bauble.

Suddenly we’ve fast forwarded to now, and I’m still ring-less, which reflects nothing on the state of my marriage and is occasionally confusing for people who don’t know me well.

Why Bother or YOLO? The ring of my dreams (rings?) is comically out of reach, so Why Bother with something else? After all, I’ve survived four years already without. Or do I just move on, find something more realistic and YOLO forward? I do not have the answer.

The Hammer Drop(s)

You may think that the when you are first told you have cancer, it would be like being hit over the head with a sledgehammer.

You would be correct.

And also incorrect, because a cancer diagnosis is really more like a series of hammerings.

I discovered a new one yesterday, when I had my initial meeting with the oncologist.

But first, check out these earrings!

(These are from a jewelry designed named Catherine Thoms. I discovered her on the recommendation of another physician and she is on Instagram @catherinethomsjewelry.)

It’s still a challenge to find a top that will accommodate my drains. I picked this faux-fur number and then later regretted it as I sweated in the waiting room.

I also wore my new good luck shoes:

I liked the oncologist right away. She is appropriately confident and knowledgeable in her specialty. We figured out we are nearly the same age.

All good.

Then we talked about my cancer.

While there are a few favorable features (no evidence of cancer left behind or spread to lymph nodes, estrogen and progesterone receptor positive), there are some ugly ones, too.

These are the same things that caused me considerable agony over the past few days: aggressive grade, evidence of lymph-vascular invasion, slim margin for the area of localized cancer.

Long story short: evidence favors that in my case, chemotherapy is warranted.

There are so many details to be resolved. The first is when to start. I am 90% certain that I will start after our family returns from a long-planned spring break trip, This would delay the start by about two weeks. Will this make a difference in my long-term prognosis? I don’t know, but I think the quality of life boost from a vacation might win this battle.