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Happy Birthday to Me!

July 15th is the day that I heard the words that pushed me from a life of carefree existence to a lifetime of spiritual liberation. “I am sorry, it’s cancer” are the words that were uttered from the other side of the line. A phone call that I had been dreading all weekend. My lymph node biopsy was done on a Friday leaving me about 60 plus hours to contemplate what life held in store for me.

I had read almost all  medical articles that I could find online on causes of lympadenopathy ( swollen lymph nodes) in the axilla (arm pit)  and the physician part of me had concluded with some audacity that the primary resided in breast.

Normally weekends feel short and are over in the blink of an eye but that weekend lasted a life time. I had already “seen” my funeral, my mastectomy, chemotherapy treatments, the sickness, all of it. No movie was entertaining enough that weekend, no company was distracting enough. I was walking towards the edge of the cliff and I knew it.

I wish I could have been as optimistic as my internist who was “rooting” for a phyllodes tumor. After diagnosis, I did go back to her office and told her ” I am here to get my phyllodes”, she hugged me and teared up.(Phyllodes tumors are usually benign)

My mind was constructing and deconstructing scenarios all weekend, my hope wasn’t that it not be cancer (a lttile too much confidence in my knowledge and diagnostic abilities) but perhaps the least sinister and early stage kind. It isn’t easy when you know that a swollen lymph node if caused by breast cancer is already stage 2. I hated having that knowledge. I wanted to be someone who could have been blindly hopeful thinking that swollen lymph node came from a nail infection and “the doctors” just wanted to be sure its nothing. I wanted to be someone who didn’t know what having cancer meant in terms of the gruesome treatments, I wanted to be someone who didn’t know that if her biopsy samples sank in the container, they are likely to be cancerous.( which they did).

Yes on July 15th, I was told, that your life will be interrupted for a whole year to make room for being a ” patient”. And that from that day on, you will just have to believe that you will be OK. That you will look for good ‘omens’ to reassure you, that you will lean on faith more, that you will feel helpless at the loss of control, that you will accept cancer and survivor ship as a part of your life, that you will go through an “experience” that will bring awareness to you.

That you will now have to live your entire life is tied to the word “cancer” with strings , strong transparent strings like the ones that hang the puppets, you cant see them but they are there, part of every movement, every gesture, every turn.

Yes July 15th, your life will start in a different way. A rebirth to a life of awareness that wasn’t there before. An awareness of the darkness that comes with truly realizing how alone a human being is, and what it means to be born alone and die alone. An awareness that you are willingly going to get cut , poisoned and burned because you do love life that much. An awareness of how each moment of life carries value. An awareness that good things come at a cost. And awareness of the strength that resides within you, the kind of strength that bubbles to the surface only when the pressure is intense and there is only one outlet outwards, flowing out like hot molten lava burning everything in its path, only to bring vitality after cooling down.

Yes July 15th is my other birthday, its start of my new life. A life, much like any life any where, to be celebrated, appreciated and be thankful for. A life where I have more faith, more belief, more love but less control, less expectation, less frustration and a whole lot of peace!

Happy Birthday to me and I sure hope to have many more and if I do , I certainly promise they will be celebrated !

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Here and Now

I was pretend traveling on FB when a friend of mine asked me “so where are you?” .My reply was “in the moment!!”. That is exactly where life needs to be, in the moment in the present, free of the past and liberated from the future. Just here, just right now. The goal is to appreciate the moment you are currently living in without shadows from the past or apprehensions from the future. When this happens, I breathe easy, I smile more, I laugh a lot.

Cancer leaves a person with fear of the future. I was discussing this with a patient recently who noted that someone he loves may die. My response to him was, that is true for all of us. We all may and will die. It really isn’t new information. If the present is lived well, it helps the future be the future and not become the present.

When I had had the biopsy on a Friday last year, I remember the exact moment when this thought crossed my mind….”If its cancer, what will I change about the rest of my life?”. At that point, content as I was, I said “nothing really’. One year later, I still think, no major changes except for staying grounded in the present.

One of my friends said to me during treatment, “Tragedies need not be rehearsed” that is exactly true. Every thing has a time, I have no desire to live that sooner than I need to. As far as I am concerned, its over, I have my life back and I am in the moment!

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Dye another day…..no, not another day

Who would have thought that after a year of grueling cancer treatments, the step that would feel like THE conclusion to the process would be some hair dye in a bottle. Yesterday I said bye to cancer hair. I woke up and decided this is the day to end it.

End what? In my mind, an official end to the cancer tenure in my life. I was finished with treatments but it hadn’t felt like the end until now.

I am amazed at the power this has had. I feel well again, I feel “undiseased”, I feel “normal”. I was unaware of how much I couldn’t stand the gray.May because it whispered “cancer cancer cancer” as I looked in the mirror. May be it reminded my of the time when my life had lost color. May be it was familial.

My grandmother who has passed away now, used to have her hair dyed way into her 90s. It was a routine to go to grandmas every two to three weeks to help dye her hair. As I got older, I became the assistant to my mom in the process. She had long beautiful hair and I enjoyed combing it very much especially as she got older and could no longer sit up, so she would lie there and I would comb her hair spreading it out as I pleased. It was a wonderful connection between 3 women and 3 generations. My mom has always kept her hair short but she also is militant about keeping up with the color. So it was but natural for me to have lots of ambivalence about the gray hair received as a parting gift from the cancer treatment.

It seems that some memories had gotten woven into the silver that I no longer wanted to reflect on, braided in were the glimpses of nausea, fatigue and melancholy and  this silver needed to be tarnished so it was no longer vividly potrayed times that were painful, times that were sad, times that were challenging.

I wanted to join in with the mainstream women. Women that get hair cuts and go to the salon and chit chat with the hair dresser, not the chemo nurse. As the stylist was combing my hair, he asked “Am I hurting you?”, an innocent question but nonetheless a trigger to  flooding thoughts of IVs being put in mixed in with the question “Am I hurting you?”. I smiled at him and said, “Absolutely not! “.

I had never imagined that dying my hair would be such an emotional celebration and would feel like such a triumphant ending, as if I have prevailed over cancer. I will admit that I was a little startled when I looked at myself with the dark brown hair I used to have, I hurriedly  looked away and then I looked again. This time I saw my self, just my self . That is all I wanted to see, no more no less.

 

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Going Back

A year has passed since I had a normal mammogram and a normal ultrasound. It was time to go back  last week.

A few weeks ago I had received a generic letter explaining to me the importance of mammography screening and how I needed to make an appointment to get one! Yeah right, the medical betrayal of sorts ,the false security that a normal mammogram have given to my surgeon and I, that test. The test that for lucky ones leads to early diagnosis and treatment, the test that can diagnose stage 0 or 1 cancers.

I thus grudgingly returned to the breast center. What I was unaware of was how much of a disturbing process it was going to be.

 I have treated many patients with Post Traumatic Stress Disorder, very aware of how places, things even scents can trigger memories, memories that the mind tries to suppress but instead they flood with overwhelming intensity. Being a psychiatrist did not render me immune to such processes  my self, whether I understood it theoretically didn’t affect didnt matter.

I was calm until I changed into the gown, put my stuff in the locker. This time as I hung up a bra that was a mastectomy bra with a prosthesis.I slammed the locker shut but it didnt do much to the gates that were starting to open.

Then I sat in the waiting room. As I sat and waited, a wave of emotion started to rise, a scalding mix of anger and melancholia , at odds with each other, the kind of emotions that ball up in your throat to the point that the windpipe can no longer freely move and the air struggles to go in and out.

The kind of emotions that get the whole body riled up in mutiny, with muscles being tense and the stomach in knots. A “why” slowly tried to rise in my mind which my rational brain promptly suppressed.

This last year, nothing in this room has changed, the chairs are in the same spots, the carpet looks the same, the walls and paint, exactly how I remembered and then I thought of this year as I experienced it and nothing seemed the same.

I was suddenly face to face with how life has moved on and is still the same for many and will continue to be.

The technician peeked her head calling my name. This one looked like a sub, for I had not seen her before.Excruciatingly matter of fact  and dry and her demeanor matched the feel of the room just right …cold and distant. And then “squeeze time” arrived.

My only breast, squashed between two plates like a specimen on a slide, literally. My mind flashed a picture of my deceased breast after the biopsy and the mammogram squeeze that led to bleeding from the biopsy site.I saw blood spread underneath the acrylic plate.

I so wanted this to be over. I don’t want any more mammograms please,I wanted to scream, I just wanna go home.

The technician disappeared to review the images with the radiologist as was taking shallow breaths. She reappeared still stoic, we need some additional views.

Now I really wanted to just leave. I wanted to tell her, “Listen I have seen the worst, I have gone through the worst, it wouldn’t  be fair if you saw more”

Some more squeezes later, I was let go. My heart refused to respond to any zen thoughts my mind threw towards it and it remained defiant. I was not ready to hear another sentence starting with “I am so sorry”, I have done that.This cant be happening.

.As I then proceeded to see my breast surgeon my anxiety spiked.He presented with smile and told me that “it was nothing”.

I am not sure if I did feel relieved . Is every thing really normal? That is what he said “last time” but was it… My throat was dry, my mind felt drained.

But what is the other choice? This is my fate as long as I live, monitoring and scanning, missed beats and shaky hands. It comes with the package. Fear is the side served with cancer, and periodically you get seconds even when you are full. I just hope I am done with the main course …for good.

Yes despite 33 radiation session , I neither glow in the dark nor do I emit hazardous rays. I have had many ask me if the actual process of receiving radiation is painful and the answer is no. When I was receiving the radiation, I didn’t even feel heat or warmth.The room was usually cool and they  would always ask if I wanted a blanket.

The pain that I  had was a direct effect of a burn caused by the radiation process and its cumulative.

Relationships affect us in a cumulative way too. Its never a direct burn. Its always a sum. Life is like that too. We are a net product of all experiences , good and bad, joy and sorrow, hot and cold. The math is never accurate, its approximate, it depends a lot on the one gathering the data.

Cancer teaches math well. It helps to approximate well.You tend to round things to the next whole. I see things more complete , more whole numbers, less fractions.Subtraction is easy, things and people both. Addition is valuable.

I hated math growing up. I understand now. I always looked at the bigger picture not the problem at hand. Medicine thus was a better fit. It helps me to see survival rates of cancer approximately. Just knowing that doctors believe that this an illness that you having a fighting chance against. Real numbers are too precise. Life isn’t. Miracles don’t make mathematical sense.

Life is random and vague, where sometimes blessing multiply over and over again.

 

 

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I was, I am , I will be

It will soon be a month since the treatment ended. I feel that I have returned to life. The colors, the smells and the touch. It all feels right again. It all feels familiar. Some of me is familiar, some of it is not. But I am getting used to it. There are things I refuse to get used to, like the pudgy chemo belly or the flabby arms but mostly I am accepting of who I am now. I wonder now, what do I need to be?  As I count my blessings for my life having been spared, what is my purpose?

Do what I was doing before the interruption called cancer? But do it better? or take on new tasks ? I guess that is life…. repurpose, reinvent. I survived, how do I celebrate this life? Appreciate it to the fullest?

Today the yoga instructor was talking about resilience and mindfulness, and how challenges arrive unexpectedly and will happen to all of us. How we deal with it is where its at. How does one live in the here and now and still serve a bigger purpose. Here I was obsessing before class as to what t shirt to wear that wont show the burns around my neck from radiation and now all that matters is the deep inhale and exhale, the calm and the peace.

Its all in the mind, as long as we stay connected with it, during good times or adversity.

Its the circle of life, pay it forward, breathe, connect and stay well.

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Last mile

They say the last mile is the hardest. I agree. I have never ran a marathon but I know the last mile isn’t about the legs, it about the mind.Those who cross the finish line do so with their mental strength .A conviction in their ability to do this. I am sure they hurt as their feet pound against the ground and that wave travels up into the knees and hips, the painful vibrations and jarring with a strong urge to stop.But something makes them go on.

In the last 2 weeks of radiation , I have secretly desired to stop. There are times when I am driving to the hospital and I fantasize about taking a wrong turn. Sometimes, I wonder about going to the hospital to just hang out at the cafeteria and have coffee.The gift shop always feel a nice escape. I haven’t done it so far but the urge keeps getting stronger. I keep hearing from others, ” Oh radiation should be easy after chemotherapy!” .Yes, I should be used to adversity by now and perhaps more skilled at dealing with the crap that life dishes out at me. I have to admit though the despite being a physician I was not prepared for radiation burns.

What I did not comprehend fully,  was the fact  that the  goal of my treatment team was to actually burn the skin that has been stretched and pulled together, sewn in a crooked way with the belief that reconstruction would fix the ugliness of it. Over the weeks it gradually started to look red and angry, the protest became remarkably painful. Then it acquired an ashen tone and then it decided that it had has enough and since then has attempted to take off , piece by piece. 28 radiations and the disappointed skin has almost left, giving me a chance to start over. The big rectangle of pink erosion is the guarantee that I can.

The last step of cut, poison and burn, I should look forward to being done with treatment and be thankful of having the opportunity of thinking of a future, uncertain, nonetheless a future.

For the last seven weeks, when I check in at the desk, I would tell the friendly receptionist ” I would like it medium rare” and they would chuckle. Pretty soon it was “well done”, then ” extra crispy” and now “sushi (raw)” . Happy to have kept them entertained in midst of the darkness of cancer they deal with every day.

Nothing worth doing is painless, radiation isn’t either.

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Battle Scars

The battlefield never looks pretty after its over.There is damage and debris all over.The smell of smoke and burnt wreckage, the sensation of loss and emptiness, the echo of silence, the dampness of tears . A lot of work is needed to rebuild what once used to be. The scarring , the pain and remains of time gone by.

The toughest challenge in the fight with cancer is to work past what you used to be. The strength, the energy, the ignorance. Having seen more than you have wanted to, its hard to go back to the blissful ignorance.

How do you rebuild a house on a land that you know is prone to earth quakes? Do you really put effort to make everything again on shaky ground? Not sure whether that land has another earthquake in it…….. the one that is likely uproot all that you have put together… again.

I have no choice, its my land and that where my home is. This where I rebuild and pray for it stay intact.

I have to focus on building not what might wreck it but focus on healing from the scars of the battlefield. The ache in my arm reminds of the weight of the weaponry I once carried. The scar on my chest is my medal of honor. The stains of my nails tell me how I clung on to life through all of this . And what better reminder of war than a shaved head. All soldiers look alike in the battlefield so do all cancer patients.

Some return home , some don’t.They are both survivors in their own way, either returning to the bosom of their family or the arms of mother earth but they do belong somewhere. Somewhere where peace awaits them.

You rebuild your body , knowing its the body of a soldier, it needs to be in top shape should the call of battle come again. You build your mind, the mind of a warrior who can switch gears in an instance. Your body that has aged many years in few months, you mind has aged to the point that  death and dying are utter realities, not concepts that you wait for till ripe old age.

Just as physical scarring needs stretching and exercise , emotional scarring needs rehabilitation by stretching the mind and exercising gratitude daily. Living requires daily effort… without it , using breaths is futile .We need to do it, with or without cancer.