Life is happening

It has been over a month since I was diagnosed with Metastatic Breast Cancer. It essentially means that despite having had 16 rounds of chemotherapy, a mastectomy and 33 radiations and follow up treatment with Tamoxifen and Zoladex, some of the cancer cells were able to survive in my body and took root this time in my liver.

It is still considered breast cancer and not “liver cancer”. It can also be called Stage 4 cancer of the breast or secondary breast cancer.

Stage 4 Breast cancer isn’t automatically considered a death sentence. However, it is considered incurable. Incurable sounds pretty much like ” we give up”, ” we don’t know how to make this completely go away” in lay terms. However, in reality it is not giving up.

Based on the receptor profile of the secondary cancer, it is possible to use treatments to stop or delay “progression”. There are significant number of alternatives out there that are able to accomplish this task.

The regimen I have been prescribed is a combination of Zoladex, letrezole and Ibrance. Zoladex is once a month shot given in my belly, the function of Zoladex is to stop my ovaries from making any hormones. Since Estrogen fuels the growth of my kind of breast cancer, it is detrimental that I have any estrogen in my body. Estrogen is also made in the body fat so it is best to not be over weight.

Letrezole is a drug taken by mouth and helps further cutting back on the hormone by halting the function of an enzyme.

Ibrance is considered oral chemotherapy but differs from traditional chemotherapy agents.It is a very new drug that was approved by the FDA about 1 year ago.It has shown to extend survival of pateints like me by at least a year.

Ibrance carries a risk of lowering my white cell count which means that I can get really ill should I have a low count and get some kind of infection. There fore my blood counts are monitored for such change. Ibrance is taken in “cycles”. What it essentially means is that I take it for 21 days and not take it for 7 days and then start again.

It is an amazingly costly drug and the out of pocket cost for this is about a hundred thousand dollars a year.

The toughest part of living with Stage 4 cancer is living with this shadow of death behind you every day. It is known that cancer treatments do stop working after a while and the cancer outwits the pharmacology of  drugs.

It could happen. Knowing this is the toughest part.

If that happens, we move on to another drug regimen.

Once diagnosed with metastatic illness, you are tied to the hospital and appointments. All life plans and thoughts include cancer in it. Cancer may disappear from the body at least temporarily but sits in your mind. It is like that itch that you want to ignore because you cant scratch your self “there” in front of people. The more you try to ignore, the more annoying it gets.

I am choosing to itch my self. I am choosing to see it as being there. I want to live despite.

Life is happening, here.

Yep and that annoying itch is still here.

To the radiologist who was supposed to read my films…

Hi Dr.

You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of report as you mumble report after report into the system. You will never know my story. I am my organs to you, organs will anomalies that you have to squint and sometimes lean back to look for.  You look for lesions and growth and progression on my scan. A body riddled with cancer. It can be quite challenging to look through all the cuts of the CT scan, day after day, hour after hour.

 In each of those films, is a story hidden beyond a 40 some year old woman with metastatic breast cancer. A story that starts a whole month before the upcoming scan appointment when she starts to wonder what her scan will show this time. She pretends to ignore those thoughts because her cancer is incurable. She secretly wishes that everything disappears this time. She looks at her young kids and hopes that your scans aren’t able to see cancer this time. She hopes that her treatment continues to work. She stays up at night and contemplates various scenarios should things change. She wonders if she will see thanksgiving next year. She wonders how many more CT scans she has left in her life time. She wonders if she can just cancel all her appointments and move to another country where she will pretend she didn’t have cancer. She then shakes her head and gets busy.

Then the day before the scan arrives, she is more nervous than usual. Kids irritate her and she loses her appetite. All she can think of is the possibility of her life changing after 24 hours. She wonders if she gets another extension for 3 months on her treatment. She barely sleeps that night. She wonders and thinks.

She gets to radiology and gets a number. She looks at others who look much older and much sicker. She wonders if that would be her in few months. She gets called and is rushed off to the changing room. She wonders if her kids made it to school. She thinks of her husband in the waiting room. She changes into her gown and with her clothes hangs up her control in the locker. She then waits again. Until another rushed technician gives her a vat of barium to drink. She sits and sip the barium listening to Anderson Cooper complain about a mosquito bothering his sleep to Kelly Ripa. She sips some more barium. She tries to cope with the nausea caused by anxiety and barium and wonders when she will get called so she can be done with this ordeal.

She lies down in the scanner. She has an IV in place for which she was poked 3 times and was called a “hard prick”.

She has a pillow under her knees and she is slid into a giant machine in a cold room. She holds her breath when instructed, lets it go when told. She hears the machine and the circular gadget spins around. She is being seen by the technician in the other room, both from inside and outside. She lays as still as possible. Nausea and anxious she lays there.

Then the contrast is pushed and a bolus of heat travels through her body till it hits her lower body and it feels warm as if she just peed in her pants but this is her umpteenth scan so she knows that it is the contrast. She knows also to drink 6-7 glasses of water that day to keep her kidneys flushed. That’s what the nurse told her who put her IV in. She knows that she will later have diarrhea due to the barium she drank and the goddamn mocha flavor has ruined the flavor of her favorite latte for her.

But she does all this. Just to live, to survive metastatic breast cancer with scans every three months. The machine stops. The IV comes out and she is let go. She quietly goes back to the locker and changes tired from this morning of scans. She still has to go to nuclear medicine to get her bones scanned, perhaps another 45 minutes to get scanned. Another machine to make friends with.

Then she goes home and she waits. The clock ticks slowly. She tries to distract herself. She could never decide if the bone scanner moves slowly or her life.

Now it’s more than 24 hours later, she is barely breathing with anxiety. Those who love her also wait. Her life is on hold. She wants to sign up for another art class but not sure if she would be on same treatment or not. She needs to do Christmas shopping but she cant get herself to go out. She needs to sign her kids for classes but isn’t sure how available she will be. She needs to respond to that job offer that came through.

And when she can’t take it anymore, she gets her oncologist paged who is slightly short with her.

It has not been reported by radiology.

She tries to breathe. There is another night ahead of her, while those films sit in your office to be read.

She has cancer, this is her life, and she has to cope.

You must be really busy, you have a life too.

So when tomorrow you look at those lesions, you will at least know what it would mean to her to get her results. You will know what she went through to hear your “impression”. It may be just another scan to read but when you read, she can resume that fragmented thing that she currently calls life.

Please dear doctor, give me my results, my life is on hold.

Conserving Emotional Energy

I have often through my career as a psychiatrist remarked to my patients, “You need to work on conserving your emotional energy”. Too often, I have heard from patients, I am overwhelmed and tired and can’t think straight anymore!”

While depression and anxiety can become psychiatric disorders needing professional treatment, being overwhelmed is usually something that requires active management of life circumstances.
We either take too much on, don’t get enough rest or down time or are holding on to long term unresolved emotional issues. We currently are a nation of overwhelmed folks, one crisis away from a complete breakdown( if it hasn’t already occurred) . And it is because we have cumulatively exhausted our emotional energy.

Now let me explain what I mean by emotional energy. Emotional energy is the energy that controls the ability of a person to connect with their own feeling without it being clouded by extraneous factors. This is the force that assists us in coping with difficulties and understanding and processing meaningful emotions. We all have a reserve of emotional energy. It is the emotional energy or lack there of,  that in turn impacts our mood and subsequently our behavior.

 Presence of emotional energy is like a soft cushion that absorbs the jarring and daily falls in life and therefore we bounce back.

As we take on more and more and spend less time in self care, this cushion thins out, the less the thickness, the lesser the ability to bounce back and more hurt we feel when we fall. After going through the election season, we are all falling on thinned out cushions. Is there any surprise that our joints hurt and we are short and angry?

We are literally the sum of positive and negative energies driven by emotions. Happiness, contentment and peace add significantly to the reserve of our positive energy while anger, lack of satisfaction and sadness are extremely draining to the reservoir of emotional energy. Even though we have no control over external factors that control our lives, we retain the ability to manage our emotional responses to these agents. A lot of people find refuge in externalizing the blame and finding the person at “fault” to deal with their angry emotions and make an effort to focus the anger on the said party. It may make us feel a little better for a short period of time but it is unable to bring us to a resolution emotionally because that situation and its residual emotions still persist.

Once angry without resolution, we behave like loaded guns responding to any minor provocation as if it were a major crisis. Most people experience unresolved anger as persistent low grade irritability and get annoyed easily. Again the issue is that anger very quickly depletes emotional energy and then we are fall hard and fall painfully.

Disappointment is another very hard emotion to cope with. Disappointment usually comes with a mixture of anger and sadness. It may be a situation or an expectation that did not turn out as we had hoped. This often leads to us generalizing our anger or disappointment on to other situations and instances and an expectation that things will get worse. This apprehension feeds the cycle of fear and anxiety, another duo of emotions that then lead to loss of emotional energy.

In this very interconnected and immediate world of ours, we don’t have space for ourselves. Our minds are flooded with bytes of information that may or may not be relevant to our lives. Our shortened attention spans get in the way of properly processing our own thoughts because someone just wrote an article about exactly how we “should” be feeling after this election.

It is prudent though that we connect with our own feeling about an issue and understand them fully. We cannot do that unless we replenish our emotional energies.

Last weekend, I took a step back from Facebook myself. There was intense affect everywhere. A whirling storm of anger, insults and disagreements and posts about hate crime were flooding in. I do care very deeply about the political direction this election took and now the country will take but at the same time reality of my own life remains vivid. I live in a world of incurable cancer and perpetual treatment with grave uncertainty. Getting through each day is an exercise in positivity.

So Friday I logged off of Facebook . I decided I would not post any statuses for a whole week neither would I comment on anyone else’s . It has been two days. I have removed myself from the duel between the supporters of the two candidates rather I put myself squarely in the middle of my own life. I took a step back to rehabilitate myself emotionally. Being on social media and disclosing aspects of your own life always comes at the cost of vulnerability. Opening yourself to affect of others which is constantly with you can be exhausting. My face book feed was a combination of grief and gloating, of anger and insults, of rational people losing their sanity over petty things and catastrophizing over situations . I asked myself, “Do I need to expose myself to this?”

I love being able to connect with people. I have grown so much by being able to reach and connect with breast cancer survivors all over the world. I have had such opportunity to have dialogues with people about their most intimate thoughts and fears and the honor to help them and sustain them. Social media is an amazing medium. But its toll on emotional energy can be very hard.

With a surgery looming in front of me, a long overdue elective procedure for removal of my ovaries,  I needed to work towards filling up my emotional energy reserve. I have many friends who fill me up with happiness on social media however after the elections, the virtual world was adding to stress, negativity and apprehension, none of those that I need in my life riddled with cancer and its accompanying uncertainty.

Friday evening I sat and chatted for a while with my mother-in-law while my daughter ran her “bakery”. Saturday we had a meal with conversations that had nothing to do with elections and then watch a live show. Sunday was full of errands and chores. Pretty normal weekend activities but the extraneous windows open in my mind were closed. I wasn’t peeking and neither was anyone else. I did have a strange sense of privacy and it felt good. I laughed at my kid’s jokes and not on Obama and Biden memes. And that was alright. Social media is an important part of my life and activism and will remain as such. But I do think it’s great to take a break every now and then.

I hope to return actively on Facebook after my surgery but I wanted to say, that I am glad I am taking this break and I don’t believe that people as wonderful as Americans, are a nation full of racist, bigots and sexist. I will hold on to hope and optimism as long as I can. I hope you can too and I hope that we can all stand together as one to support each other irrespective of color, religion, race or nationality. I hope.

October for me isn’t just about Breast Cancer, its about living life.

 

It has been about eight months since I have been living with metastatic breast cancer. I had thought I had done a lot of reflection and growing up when I was diagnosed with breast cancer three years ago. I thought I had a better understanding and appreciation of life. I thought I had learned the harder lessons. I was more patient, more insightful and more understanding of the suffering of my patients and my fellow human beings. Little did I realize though that there was still a long, long way to go and when metastatic breast cancer came knocking on my door (yeah I should have not answered) and I faced my mortality in a much closer and clearer way, I realized that there was a whole universe of understanding that had awaited me. When someone puts a time period on your life, mine being an average of 3 years, things get emotionally hectic. It is truly a hurricane that starts to swirl and one has to prepare for the landfall some day. I tried to sometimes close my eyes and not see, but the high winds woke me out of my pretend sleep. It is here it is now and there is no denying it. My life has an expiration date as well all do, except it’s etched in my retina and I can’t removed it from my field of vision. It’s there all the time.

When October rolls around, everything turns pink. There are reminders for mammograms, walks and races and pink socks and pink eggs. Heck some are sitting on pink toilets to fund raise. We are all different. However, they wish to spread awareness about a life threatening illness. I hope someday we will have a cure. I just hope for some life awareness in the month of October. The thought that “What would I change, if I got cancer?” Not just get a mammogram, and when it’s normal forget about living for a whole year.

I want women to see a normal mammogram as a reminder that they got another chance to live life on their terms.

That getting a normal mammogram is also a reminder to take care of you. Don’t wait to be retired and old to live life. I am not going to go over the need for mammograms and self exam, since you better be doing that, I will say, take an inventory of what is truly important in life. Make hard decisions. Get out of that sucky relationship. Let go of that idiot. Make changes. Travel. Spend time with your friends. Read a book that you so wanted to. Take a day off for you. Hire a sitter. Go for a date with your husband. Hang out with girl friends. Ready trashy magazines and catch up on gossip. Help someone. Love yourself. Get a haircut. Change the look. Sleep well at night. See a therapist. Stop smoking. Don’t drink too much. Back off from that recreational stuff. Ask for help. Whatever it is, do it. For me October isn’t just about breast cancer, it’s about life. Go live it. For as they say to me all the time, tomorrow isn’t guaranteed for anyone of us.

Reflect on your actions, meditate. Find your faith and what you believe in. Don’t just flow with life, command your flow and swim in the opposite direction if you need to. If you believe, you were born for a reason, go find it. It is somewhere in your universe that you are shying away from. Don’t spend time looking at what someone else has created, it’s your life, you have every right to create it in a way that suits you. Don’t endorse something that is not you. Don’t care for what haunts you later. Don’t embrace toxic people in your life. Do not feel guilty for taking care of yourself. Work hard and play hard. Retain your ability to enjoy and if you can’t find happiness, ask those who look happy. For God’s sake, don’t embrace a dull boring status quo that leads no-where. There is a path somewhere. If you are grieving, share, if you are hurting, share. Come out and tell your story and I promise someone will join you.

Cancer pushed me to find my path, it haunts me but I keep walking because now what I am doing is bringing me peace and joy. I make an effort every day to heal. Every day I make a choice to live some more. Life is as much about death as death is about life. They are related paradoxically and that is why I have more zest for life because I know that I will die. I see it up close and clearly every single day. To not die is to embrace life in present, to guard your thoughts and to hold on to peace within. Cancer deaths are usually prolonged and painful, I know that, but it’s not happening today to me and neither to you. I am building a life knowing I will likely die in few years. I could decide, it’s futile to go to my art class, or lose weight or eat healthy or even just burst out in laughter. I could be depressed about what is going to happen and what I have lost. Yes, that would be easy because those thoughts live inside my head and never leave. They are a part of my reality. I have to shake them off, every single day for these are powerful and vile thoughts that take me down a very painful and gloomy path and make it very hard for me to run back from them. So I just avoid them like the plague. I do grieve, every single day but my grief is mostly turned into action of healing and kindness towards myself and others.

With metastatic breast cancer, for me, every month is October, for me every day is today. What are you doing today?

I said to her, the one in eight

I have been sitting here thinking of coming up with something meaningful to say. All I can say is hope is living each day well, courage is being yourself when odds are stacked against you, strength is waking up and telling yourself I cando this. This, cancer, is a heavy burden to bear but look around and see the phenomenal women who are here and living to fullest and fulfilling their purpose. You will too. However long or big. You own your life with your attitude, don’t allow cancer to whisper other wise . Hugs . I am so sorry you were put on this path by life, just keep walking. The only way to go. 💕💕💕

First Day of School

A family is outside, wishing their fourth grader bye as he gets on the school bus. It’s a crisp Midwest morning, the sun is shining and everything is rich in color and drenched in sunshine. The parents look tired and a little out of sorts while the kids have their backpacks and wonder in their eyes.

The crossing guard has arrived at this spot and parents are relieved to see the same guy from last year. A cheerful and chatty man who waves at everyone with lots of heart.

There is lunch in the back pack and carrots with the ranch dip. There are random conversations about weather and school that have nothing but superficial value.

There is transition and amazement in this day today.

The first day of school.

Families are expecting a return to the routine. The pools will close soon. Activities will start. Classes will begin.

As the bus pulls over, kids line up and there is sudden commotion. Good byes and hugs ensue. As kids get on the bus, it slowly drives away.

All moms get back home to finish their coffee and get settled.

One mom sobs profoundly. She cries and she wails in pain. Her husband holds her for as long as she cries. She wants her pain to turn into tears and leave her so she can also finish her coffee and pretend that it’s alright. She is successful in doing that most of the time. But today, she couldn’t.

She is unsure how many of these days she will have.

I don’t know either.

As they say, “Make memories”. I made some more today.

And stay hopeful that there will be another first day of school for this mom.

The mighty “flu”

I have written a lot about cancer, treatments and the trauma that one has to deal with. But today I write about the Almighty “flu” … not real influenza but the routine upper respiratory infection. It’s an experience that is common to all of us and it is a miserable experience. We all know the sore throat, cold, aching sinuses and hacking cough. This may or may not be accompanied by a fever.

If cancer is the emperor of all maladies, upper respiratory infections are the queen. They make the feeling of misery very common. Everyone has experienced it at one point or the other. Queen grants much more appearances than the emperor does. I have met both.

It follows a typical pattern. You are having a good day and suddenly you just don’t feel so well. It’s hard to articulate what isn’t right but a feeling that you would love to lie down and rest. You don’t appear sick but internally feel that something is a bit off. Few hours later the throat feels like someone grabbed a sand paper and rubbed it nice. Pretty soon the eyes feel like they are a wee bit dry with a little burning feeling in them. And soon enough, all mucosal linings of the head and neck engage in a rebellion synchronized  where they are either secreting stuff or dry as heck . Gradually the burning feeling takes over and oops, there is the fever. Now the entire body is aching and you are sick. It feels like the end of the world but it’s really not and you know it but it certainly feels like there is no point carrying on. I get very depressed with colds. I find it funny that I run around with stage 4 cancer while on treatment or that I worked through my chemotherapies but a cold and 100.4 fever is what gets me miserably laid up.

And because of the cold the nasal septum hurts and feels sore. I can’t stand when the sinuses hurt. It’s a dull malicious pain in the forehead and the bones in the cheek as if your face is pressed into a hard surface. This package of misery at its peak usually lasts 1-2 days and you get surrounded by advice to drink lemon ginger tea and chicken soup. Amazingly hot liquids do help so much, so does a hot shower and a little TLC from the family.

And then you cough, a nasty hacking cough reminiscent of someone at the sanatorium. And with the cough, you feel your brain move and the sinuses that feel full get jostled and the head hurts some more.

And then slowly things get better. Albeit some of us, transition to a bacterial infection and need antibiotics.

We live in this world with many micro organisms and URIs are a gentle reminder that we share this space with others and must be respectful of those we co exist with. We are reminded the facts that size does not matter, the fact that life comes with interruptions and recovery. Its pause and go.

Pause for me. Cancer is treating me nicely for now, recent scan showed everything looked stable. But a little virus has gotten me to my knees.

But then, of course if I can get through 16 cycles of chemotherapy, I sure can get through this.

Here is to Chicken noodle soup and to friends who feel like such on hard days.

I am sorry I didn’t beat cancer

Yep, sorry, my apologies, with a diagnosis of metastasis four months ago , I didn’t beat cancer.

Every one said, “You are going to beat it”, some said, “If anyone can, you can!!”. They cheered me on as I endured one treatment after another and I kept fighting “like a girl”. I was told I will kick cancer’s ass and will show cancer who is the boss. I rode the wave of positivity and determination. I believed that I will beat it too. I thrived on the fantasy of the cancer submitting to my will and strength.

Songs, inspirational quotes, memes, greeting cards and stories, all led to me to the one end point, “beating cancer”. Being very much a type A personality, I accepted the challenge, I said to myself “I will beat cancer”. Except for one open book exam, I have hardly failed at something in life. So why not this!

However, two and a half years after my first breast cancer diagnosis, I was diagnosed with metastatic disease in the lymph nodes in my chest and some spots in my liver. Shocked and traumatized only begins to define of what I experienced. It was a very hard and exhausting process to come to acceptance.

Broken and beaten, it felt like a failure as if I let down every one who thought I would “knock the shit out of cancer”. I was no longer the example of how stage 3 can be a success story and inspiration.  As a doctor I understood that it was nothing that I did, to bring back my cancer. But I still felt a sense of shame.

Statistics indicate that 30 percent of those are diagnosed with early stage cancer will develop metastasis. I had just held on to 70 percent much more dearly. Medical science currently doesn’t know the exact mechanism through which cancer cells find home in other organs of the body.

The time had come to let go of being a “survivor” and on to a “thriver” or a “lifer”, the terms preferred by metastatic community since we ultimately end up not surviving the disease.

When I was diagnosed the first time, one of the things that helped me very much was supporting others with breast cancer. I did this so their journey could be easier and smoother through the knowledge and experience I had. I wrote blogs and participated actively in online groups.

Since the recurrence happened, I often wondered if I scared other survivors, if they looked at me and worried about getting metastatic cancer and sometime I even wondered if they actively avoided me. I, the face of incurable metastatic cancer, everything that everyone  diagnosed with breast cancer is worried about. The fear of dying of this terminal illness that has no cure. I have no cure.

Having metastatic illness is an emotionally isolating experience, and a lot of women I know tend to withdraw from others after metastasis because it is hard for others to understand our subjective experience…the experience of living life with an incurable, relentless illness with never-ending treatments. It is so overwhelming for others; they don’t want to hear much as it reactivates their own fears of mortality. I have experienced that from some of the survivor friends who want to keep the distance from me but I understand that they want to contain their anxieties of ending in my shoes. I didn’t want to horrify others.

I often wondered what people think when they look at me and if and how sorry they feel for me. I imagine something to the effect of … “Oh this poor young woman with young children who has this illness that has no cure”.

Me and my metastatic cancer.

I remembered when I was newly diagnosed, the word “metastasis” used to send chills up my spine. I used to dread my facebook feed on Mondays, which are  #metsmonday. I did not want to be reminded that my cancer could metastasize, although at stage 3 with high grade cancer cells, I knew inside that the odds of it happening are very high.

One of my stage 4 friends has lived on with bone metastasis for 11 years, she gave me hope but I still would at times try and block her out of my mind, for my own sanity, so I could worry less about me. It sounds selfish but the fear of recurrence is haunting.

I also wanted denial so bad…deny that it could happen to me. I convinced myself that I am doing everything possible to reduce the chances of my recurrence. From good diet to exercise to supplements and yoga, lowering stress and getting enough sleep and all the medications and treatments, I did all possible to lower the chance of cancer taking root within me again.

But as time went on, I also worked hard on accepting what having had cancer meant. It meant accepting life that you have no control over…Life which transitions between sweet fantasies and harsh realities. I got used to those ups and downs. I saw my friends with stage four cancers, kick each day in the butt and beat cancer on a daily basis. My denial softened gradually and I thought, “if it (metastasis )happens I will be ok” . I celebrated every clean scan and a good oncologist visit but the fear of metastasis lingered.

And then it happened. I got another, “I am so sorry “ call from my doctor and I was devastated. Besides coping with my illness, I was sad that I lost my “credibility” as a cancer warrior who had “beaten” cancer.  I was not longer a “success story”.

During all of the angst, I received this message from a fellow survivor whom I got to “know” via Facebook.

It said,

“Until I “met” you, I could not think of stage 4.

I’d panic, hyperventilate

Start to decompensate.

Then I met you.

You are showing me, with grace, passion and humor how this can be done.

You are something of a role model to me.

Doing this stage 4 before I do, if I do.

I’m not so afraid anymore. I have someone doing this ahead of me and I know how to do it.

If I ever get metastasis, I will have someone to emulate….and I will think of you the whole time.

Forgive me if this bugs you or hurts you? I just admire you so much and thank you and God for putting me in my life, but I am also so very, very sorry for your cancer.”

And then I realized I really don’t need to “beat cancer”; I have to however beat life at its game, one day at a time.

I am sorry I didn’t beat cancer but now it really doesn’t matter because I am busy kicking life and showing others how to reconcile with stage 4 breast cancer.

Dispensable Yet Hopeful

I have not written much lately. It may be a sign of my avoidance. Sometimes, writing and talking about cancer is also exhausting. Sometimes, it feels like reliving it and too much of a preoccupation. Cancer has weaved itself into my being and unwilling to abandon me much like the love and support of my friends and family.

And life is a complete package of good and the bad. I work on accepting both simultaneously as I hold on to some and let go of some.
I have been busy with the rest of my life. My family, kids and the new found freedom of not having patients to care for. I miss being a doctor very much but I also realize that being a doctor is not confined to the office. Healing is a 24/7 profession that is also incorporated in me as a person. I just don’t get paid in money for it but lots in kindness and gratitude which are the biggest gifts of all.

Recently I have been running into my patients too often on my trips to restaurants and store and wonder if it’s a sign for me to know that they are okay. We often think of ourselves as irreplaceable as people but time and time again, I have seen and experienced that we are all dispensable. I am too. Perhaps not for my kids and husband but generally, life will go on without me.

It’s a comforting thought…knowing that life will keep moving forward.

It always does. Just as those who left us after the shooting in Orlando. Heartbroken as I am, I also know that no matter how big the grief or loss is, we have no choice but to find our inner strength and keep marching and keep pace with this thing that we are trapped in, the perpetual march of life.

Tomorrows can only be better if todays are valued. With incurable cancer, today is what I have.
And today is what life offers you as well.

We all want a better future, devoid of hatred and bigotry. I do too. I may not be around to see what I plant today, to see it grow and thrive to maturity.

Not working for a better future is the loss of ultimate hope.

 Life expects all of us to be hopeful. I am too, in so many different ways.

I wish peace to all as we deal with a national tragedy.

I stand by all oppressed and distressed in this moment of grief.

But I remain hopeful. I remain grateful.

Carpe Diem or Crappy Diem

Ever since I got diagnosed with Metastatic Breast Cancer, I hear this phrase a lot, “Well no one really knows how long they have to live!” True, no one does. I don’t either. I just nod in agreement.

“You are right, no one knows.”

Sometimes, it is to be nice, sometimes to be polite.

I tell myself, “Others are trying to be supportive; they don’t really know what to say”.

In their private space, they probably worry about me knowing what everyone knows about metastatic breast cancer, the harsh fact that it kills.

They know too, very well in their hearts, having lived longer lives, having saved for retirement that the odds of me getting old and seeing my grand kids are much lower than say a woman without cancer at my age. That is the reality.

Yes, no one knows, but how many really do think of dying every day?

My typical day involves hearing about someone’s disease progressing, someone getting whole brain radiation, or someone passing on with the same illness I have. I have two choices, either pretend, that “they” were not “me”, and I will be different or realize that “this could be me” and spend each day mindfully.

I go back and forth between those two thoughts. There are days that are good and full of temporary hope and there are days that haunt me for what I may have to give up and leave.

We all live lives focused on the future. Everyone conducts themselves in a way as if they have many years ahead of them. People killing themselves with stress to make money so they have “enough” for retirement as their today slips away quickly but since they are not terminally ill, they have the luxury of dreaming of a glorious retirement. There are people who are manipulating others to their advantage, because they think they are forever. Others wasting their days because they have many years ahead. Many others that are living good lives but they don’t think of death and dying. They don’t live in the fear of recurrences every day. They don’t live in the fear of “when will my treatment stop working?”  and “when will the other shoe fall?”

If all the healthy people became preoccupied with death and dying, there will be lots of work for psychiatrists because there will be a surge of panic and anxiety disorders. Thinking about death and dying is considered morbid  by the society in those who don’t have terminal illnesses and they are regarded as “negative people”.

 The reality is that those that are healthy do not live life in full view of death and dying. They may sometimes get a moment or two where they reflect about how unpredictable life is but then they return to their bliss of not having to deal with it every day.

Those with metastasis cannot turn it off, the thoughts that it’s looming and nearby persists. It’s not about losing hope, it’s their reality, and it’s my reality.
Reality determined by odds, life expectancy and mortality rates related to the illness I have, not grabbed out of thin air.

I wish for long survival but I can’t deny what is happening in my body right now. It sleeps with me and it wakes up with me every day.

Last week, a friend of mine was urging my class mates to buy life time membership to an association, I doubt anyone else besides me did the math of whether I will break even or not if I buy the life time membership. Yearly membership is 90 dollars; life time is 500 dollars, which meant I needed to live 6 years to profit from the lifetime offer. Will I? Who knows? But in my situation, would you?

Or a month ago when a lovely makeup artist was trying to sell me eyebrow powder and said, “This will last you at least three years”, I smiled. I wondered if I will outlast the eyebrow powder.

We all live lives with focus on the future…save for retirement, get better APR because it is beneficial in the long term, buy a house- don’t rent because it saves money for the future, invest in such and such, for the future. We all take for granted thoughts of “when my kids are in college, I will such and such..”

“Someday” is a popular thought for people, “someday, I will__________________” fill your favorite thought. For me and many other, the luxury of “someday” has truly disappeared. Our someday is today.

No one, even the ones who tell me to live in the moment is truly living in the moment. That is life; you have to maintain perspective for the future. That’s how the world functions cumulatively, for a better tomorrow.

So next time, before you say to a cancer survivor, “life is not guaranteed for anyone”, do think of all the things you did that day towards preserving your future and simultaneously reflect on all the changes you aspire to make in your life based on the knowledge that your tomorrow isn’t guaranteed either?

May I dare to say, that it would be emotionally exhausting to think that in a month you might be no more, and live every day as if the day is your last day? How long can anyone without a terminal illness willingly do that?

Thinking about the end isn’t putting life on hold but reflecting to make it more meaningful. My life isn’t on hold either, its moving forward and yes,  I might outlive some of you, but people bet money in a gamble , only when the odds of winning are high, my odds are very low in this gamble, you know that and I know that.

That’s how life is played, based on odds. There are miracles, the odds of which are rare, which is precisely why they are considered miracles.

Today is my miracle. I live on, despite what is inside of me.

Everyone has two choices, Carpe diem or Crappy diem. Make it a good one!