The Overwhelming Kindness

^^^ Not sure who’s the Babysitter and who’s the Babysittee, but this faithful buddy has constantly been by my side.

Even in these early days, I have been humbled by the outpouring of love and support from friends from every stage of my life.

And let’s be honest, after 47 years, I have cycled through quite a few stages: early life and high school, college, medical school, residency, fellowship, my first job post-training, my current iteration.

(And I’m not ready to call it quits yet!)

The nature of my life has been to put my head down and soldier on. One year I spent 135 nights in a hospital, working.

I know because I counted them. That was not a good year.

And I’ve said it before, but Time is now my most precious commodity.

It is scary to see it passing – I still have dreams where I am in college, facing a final I forgot to study for, then wake up remembering that I am solidly middle aged, Ugh – and the cancer diagnosis sharpens the focus that Time may not be on my side the way I’d assumed it was.

Time has also gotten in the way of cultivating my relationships. I am ashamed of this; I know so many wonderful people and I am furious with myself that I didn’t tell each and every one of them every day how I love them and what they mean to me.

And so, My Dear Friends, I Love You.

Thank you for being an important part of my life, whether you gave me a ride to school sophomore year when I didn’t have a driver’s license; when your friended me on Day 1 of Biocore while I was a perpetually floundering college student trying to find her way; when I was delivering a baby in the OR at 3 AM and you let me stand on the Good Side during a c-section; when I really didn’t need the calories but you made the Cookies You Know I Can’t Resist and brought them to work (they were delicious).

Above all, I hope I have (mostly) been the kind of Friend to you that you have been to me.

Much love.

329 Days

If you have an Apple Watch, you’re likely familiar with the obsessive act of Closing Your Rings, meaning that you reach specific daily goals for exercise, calories burned and standing.

Your watch will also conveniently chide you if you are falling short. Sample message: “Check your rings. Your movement and activity rings are usually further along by now.”

Or this gem: “You can still do it! A brisk 65 minute walk will close your movement ring.”

In early 2019 I started getting messages that I had set my longest streak for closing all three rings.

Soon I had closed my rings every day for a month. Then two. Then six.

Sometime mid-2019, I decided to Close My Rings every day for a year.

This meant occasionally waking up at 4 or 5 AM to get in a hotel or pre-flight workout while traveling, late night dog walking in the rain, jogging in place for 45 minutes during a blizzard and other absurdities, but I did it.

I closed those rings 329 times, until I had to undergo a six hour surgery last week and all the wheels came off the bus.

Cancer has already taken from me. I will not reach my 365 day goal.

But I will start anew.

Tell Me What You Need

“Tell me what you need.”

Many people generously reached out after my diagnosis with this sentiment, and to be honest, I did not have an answer.

My standard line: “I don’t know yet. I’ve never had cancer before.”

And I absolutely did not mean that to be trite or rude; I simply think cancer is such an Earth shattering situation that you can’t know what you need until you are in the thick of it.

In no particular order, things that have been particularly helpful include:

  • Food. It is well known that I hate all domestic chores, including cooking, and two separate families prepared and brought over meals for us. Both were absolutely delicious. If left to my own devices, I would have probably had cereal for every meal, so this was a real step up.
  • Magazines.
  • A list of shows on streaming TV that I might like. I blew through everything on our DVR over the weekend and with time on my hands, I am open to a Netflix binge. A few friends sent ideas.
  • Book recommendations. I also received an Amazon gift card to buy more books from coworkers, and reading has been a great escape.
  • A fresh robe and slippers. There was a zero percent chance that I was not taking fancy slippers to the hospital with me.
  • A basket of luxuries. Ok, this sounds vague, but the people I work with gave me a large crate (also nice in and of itself) filled with things like lip balm, mints, hand lotion, fuzzy socks, colorful pens and a beautiful journal, plus a card signed with heartwarming messages.
  • Flowers. I have not left our house in five days and it is freezing outside. Flowers are a ray of sunshine.
  • A soft faux fur throw. This is seeing a lot of use!
  • Designer shoes. Oh, wow, these are so over the top fabulous. This is a wildly generous gift from a friend who knew that this would cheer me right up.
  • Prayers. Many people of various faiths have said that they are praying for me. I am humbled by this and covet the good thoughts going out into the Universe.

A few things that are specifically helpful after a mastectomy:

  • Pajamas that button up the front. Following surgery you cannot lift your arms above your head for a few weeks, so a front-opening top is necessary.
  • Mastectomy garments with drain pockets. Here is an example. I have already complained about these from a style standpoint, but they are really a requirement for this particular surgery. Most patients could use both camisoles and hoodies. I was fortunate enough to get both from generous friends. I have been wearing them every day.
  • Wedge pillow. I ordered this from Amazon. I received a lot of advice from post-mastectomy patients that side sleeping is out of the question and it is helpful to sleep on your back at an incline. Many post-op patients sleep in a recliner or adjustable bed. I have neither and decided to order this pillow. It has really helped me sleep. The one night I did not use it I woke up in a lot of pain and could not even move enough to get out of bed.
  • A ride. Or rides. There are several post-op appointments I need to attend and driving my Jeep Wrangler with its stick shift is not in the cards at the moment. A few people have offered to give me rides and I plan to take them up on the offer.
  • Babysitting. My daughter got invited to a sleepover and my nephew took my son skiing one day. They are affected by my diagnosis, too, and having something fun to distract them was a gift.
  • A blowout. The no-lifting-your-arms-above-your-head restriction also applies to hair washing. My stylist offered to wash and style my hair. Also helpful: dry shampoo.
  • A water bottle with a long re-usable straw. My T-Rex arms make it difficult to reach for a drink. Having a water bottle nearby that is easy to drink from is key. The one I am using most was a work freebie and has a wide silicone straw.

And finally: Acknowledging the elephant in the room with simple messages like “I’m sorry. Thinking of you” have also been sustaining me. A cancer diagnosis is a time of reckoning. People from all parts of my life have reached out and I know I am lucky to have this support. I am also glad to be alive in the time of texting; I would not relish repeating the same story over and over via telephone but being able to receive and respond to texts on my own time/terms has been wonderful.

Thank you to everyone for your love and support.

Cancer: How Did I Get Here?

Ok, I know this is not my best look.

Later I found out that I had a substantial dreadlock in the back of my head, adding insult to injury for the above photo.

I also took a moment to toss this on the way home from the hospital:

But let’s back up a bit.

December 10, 2018: Routine screening mammogram = Read as normal

December 18, 2019: Routine screening mammogram = Read as abnormal

The picture above was taken at Christmas 2019, when I knew the mammogram report wasn’t normal but I didn’t yet know why. I got a call a few days before Christmas that the radiologist needed to compare the recent images to old ones, then a call on December 26th that I would need to come in for more images and possibly a biopsy.

With the holidays in full swing, I had to wait until January 2nd. I would have gone the same day if I could have.

I returned to the radiology imaging center and for the first time, I learned that there were two areas of concern, one on the right and one on the left.

The technicians pointed out what they were observing. The left side showed a scattering of what looked like seven grains of salt – tiny calcifications – on an otherwise dark background.

The right was different. I could see that there was a larger area and it was right up against my chest wall. This scared me, both in size and location. It looked like it would be difficult to access and seemed like it could easily spread into the underlying muscle.

After about 45 minutes of additional images, I was advised that I would be getting an ultrasound of the worrisome area on the right.

The ultrasound technician started the scan on the right and immediately I could see it was a cyst. It was smooth, like a jelly bean, and had clear fluid within it. Although breast imaging is not my specialty, nearly 20 years of performing OBGYN ultrasounds has made me capable of identifying a cyst. I knew this was benign and that was a relief.

The left side was another story.

The small area of calcifications – those seven grains of salt – could signal cancer and I was advised that I should get a biopsy. I was offered to have it done on the spot or to make an appointment and return.

I wanted the answers now.

The biopsy was a more complicated process than I expected. There were parts that reminded me of doing an OBGYN procedure called a D&C, one I have done hundreds of times, where a thin tube with suction attached takes pieces of tissue and collects them in a small filtered container. The tissue pieces have to be X-rayed to ensure the calcifications are present in the sample (parallel to floating products to my OBGYN friends), and if the sample seems sufficient, a pressure dressing is applied.

And then you wait.

The radiologist who did the biopsy – and she was very lovely and professional; when she walked into the room I knew I was in good hands – called me the next afternoon and asked if I’d already received the report.

I had not.

Her message was very simple: “I’m sorry to tell you that this is an invasive cancer.”

I had to write it down. I didn’t trust myself to remember.

And then I had to hold it together to see a few more patients before I could go home and totally fall apart.

The next two weeks had a flurry of appointments: MRI, pre-op exam, meeting with a breast surgeon, meeting with a plastic surgeon, getting fitted for mastectomy garments (truly awful, and I hope you never have to wear them), etc.

The wait to surgery was excruciating. I spent my time walking on the treadmill at the gym every day for up to three hours, just to escape my brain. Even though I was told it wasn’t necessary, I stopped drinking all alcohol because it seemed like I could go to a melancholy place if I had it on board. I’ve never taken medications like Valium or Ambien so I also didn’t have these crutches. I only mention this because in general, I think I have pretty good coping skills and my career involves having difficult conversations every day, and if I was mightily struggling during this time, I don’t know how others do it. I hope that comes out the right way.

Because it seemed like the cancer was now just on the left side, I was offered a few options: a lumpectomy on the left PLUS several weeks of radiation to the remaining breast and armpit area, a mastectomy on the left or a bilateral mastectomy.

This is the point where I am obliged to say that every patient is different and everyone should make the choice that is right for their situation, but I knew that for me, nothing short of the double mastectomy would suffice.

One reason for this decision was due to recurrence risk: I was advised that if I did anything short of a double mastectomy, I would enter into a complex screening algorithm for surveillance of recurrence or a new breast cancer, and that my risk was 2% per year, or 50% over 25 years.

Another thing that everyone was very clear about: the type of surgery selected does not reduce the risk of dying from breast cancer. A double mastectomy will reduce future recurrence risk but will not save your life over a less aggressive approach. This is scary.

But here’s the real reason I chose what I did: Regret management.

I talk to patients about Regret Management All. The. Time.

Regret management is making a decision now to (hopefully) mitigate future feelings of not doing enough when the opportunity was there. In my work, it usually translates to patients trying IVF or continuing with ongoing fertility treatments before the proverbial clock runs out.

For me, I am far from feeling like I am done living, and I felt like I needed to do everything I could right now in the most aggressive way possible.

Although it felt like a million miles away, the surgery date eventually came: February 13th. I had an all female physician team: breast surgeon, plastic surgeon and anesthesiologist. Of course I loved this.

My overnight hospital stay was uneventful and I was home by noon the following day. I was told things went well, but the final pathology report is still pending and I will learn the stage and what comes next in the upcoming weeks.

^^^^ Also not my best look but I am home.

Early recovery has been … ok … I guess. The pain is more robust than I thought. I tried to avoid taking any prescription pain meds but woke up at 4 AM on Saturday in so much pain that I could not move. I had to rethink my decision for Ibuprofen-only.

Recovering from a mastectomy also has many limitations: you cannot raise your arms above your head, no lifting greater than 15 pounds, and there are two drains – one on each side – that are sewn into place but have to be cautiously avoided for tugging/pulling and must be emptied several times a day. This also translates to not being able to get a coffee mug down from the cupboard, washing your hair, driving, etc. It is strange to be so restricted.

The drains will remain in my sides until the output is low for two days straight. This usually takes a few weeks and means I am wearing my terrible mastectomy garments (which have convenient pockets for holding the drains) until then. I criticize them for their lack of fashion but they are really necessary and I am grateful for a friend who sent me one to wear. Having said that, I never want to see these again when this is all said and done.

A final comment: I had a nice sob in the middle of the night the first time I caught a glimpse of my body, which seemed very disfigured. Intellectually, I know this is far from the final product (I got temporary expanders placed in the OR), but the reality sunk in when I looked into the mirror. I am grateful for my skilled and artistic plastic surgeon, who is also a friend, and I know everything will turn out ok in the end but we are not there yet. The breast surgeon is new to me but also extremely cool, someone I could see myself being friends with, and she did an excellent job, too. I really hope the three of us can laugh over drinks sometime. My debt to these skilled women is huge.

For now, I continue to recover, physically and emotionally. I appreciate everyone’s kind words, friendship and support.