Halloween

Halloween has come and gone. It is my favorite festival in America. Grown-ups get to be kids, and kids get to be themselves. No questions asked. They go door to door, and even the most reserved of people open their doors to them today.

Yet Halloween will always also bring sadness because of what I vividly remember thinking last year.

Uzma used to love Halloween. Mainly for the joy on the faces of all kids — not just our own. She would always go to our kids’ Halloween event in school. She looked forward to accompanying the kids when they went trick or treating. Last year she felt too weak and tired to go.

After being out for one hour with the kids last year, I remember thinking, “Two years ago, Uzma was with our kids the entire time. Last year she went for only about thirty minutes and then wanted to go home. This year she couldn’t come at all. I wonder…” I didn’t want to finish that thought. But I knew what I feared. She made it to 92 days after that.

This Halloween, I could find only one of our Halloween decorations. Though I was the one who put all of them away last year, it was my first year doing that. I couldn’t even find the kids trick-or-treating pails. It didn’t turn into a disaster because Gauri agreed to take a cloth bag, and Shuja decided to skip trick-or-treating altogether.

It snowed three inches on Halloween. It was cold, wet, and slippery. Shuja said, “I don’t want to be miserable out there. I would rather not go.” We barely had ten kids come to our house. Typically, the homes in our neighborhood, with its arrangement of smallish houses with small yards, attracts tons of kids. But I guess snow-covered jack-o-lanterns and Halloween decorations are uninviting.

The tradition in many Indian families is to not participate in festivals and celebrations until after the first anniversary of a loved one’s death. The kids look forward to Halloween so much that I had decided that we will make it an exception. But it felt today as if the gods didn’t want us to celebrate too much either. They were the same gods that made the night of Uzma’s passing the coldest night in Chicago in decades. I know I shouldn’t personalize a natural event, but that’s how it felt today.

Halloween also happens to be the last day of Breast Cancer Awareness month in the US. Last year, it was also the eve of Uzma’s book launch. Uzma deliberately chose Nov 1 to launch her book. She said, “Breast cancer awareness doesn’t end on Oct 31. For us, survivors and our families, it is a hard daily reality. I want to launch my book outside of the awareness month.”

She would have loved to see the incredible reviews her book gets. She would have loved to go on tour to promote it. She would have been impressive at it.

Halloween was when I first realized that she would not get to do any of that.

It will always be a fun festival. And a bittersweet one. Forever.

 

On Thoughtful Giving For Breast Cancer

My wife Uzma died of breast cancer eight months ago. It was stage 4 breast cancer, also known as metastatic breast cancer (MBC), that took her.

According to the latest data from the American Cancer Society, over 250,000 American women will be diagnosed with breast cancer in 2019, and over 40,000 will be diagnosed with MBC. Less than 10% of women with breast cancer have MBC at initial diagnosis, but eventually up to a third of women with early-stage breast cancer will go on to have MBC. 100% of deaths due to breast cancer are due to MBC. And almost all women with MBC will die of MBC.

Normally functioning cells in our body have two key features: First, they don’t keep reproducing (make copies of themselves) indefinitely. Second, they stick to their own kind. Liver cells stick to the liver. Lung cells remain in the lung. Breast cells remain in the breast. And so on.

Cancer happens when a genetic glitch in a cell removes the restraint on reproduction. One cell begins reproducing without paying any heed to the need for more clones of itself — reproducing without restriction results in the growth of a tumor.  Cancer becomes stage 4 when another genetic glitch causes cancer cells to lose the stickiness to their own kind. It’s as if they have become adventurous, straying far and away from their native organs. Cells from the breast, for instance, think nothing of making a home in the liver. Cells from the kidney may decide to dwell in the lungs.

Most cancer research aims to stop cells from reproducing without limits. Relatively little goes towards preventing cells from losing their stickiness. Most stage 4 cancer patients, including MBC patients, receive one trial after another of chemotherapy drugs developed to prevent tumors from growing in size,

Less than 5% of the national research funding goes to MBC. Let that sink in. Almost one-third of women with early-stage breast cancer go on to have MBC. All breast cancer deaths are due to MBC.  But less than 5% of research funding goes to figuring out how to stop cancer from spreading and from killing our mothers, daughters, sisters, and wives.

Awareness campaigns are everywhere during October — Breast Cancer Awareness Month. Pink ribbons are on a range of products. Pink banners are in a host of stores. The message everywhere is, “Do your mammograms!” There is not the same volume or intensity to the message that one in five screening mammograms are false negatives, i.e., they fail to detect cancer. Younger women and those with dense breasts are at higher risk of false-negative mammograms. Uzma was one of those women. She had several annual negative mammograms, the last one of which was about three weeks before she found a lymph node in her armpit.

The other message that doesn’t get highlighted during Pinktober is that almost one-third of women whose cancer is detected by mammograms will go on have stage 4 breast cancer. And that right now we don’t know how to stop that.

As we open our wallets this month to give to charities that fight breast cancer, let’s give some thought to whether our money flows consistent with our values and preferences. Different organizations see their missions differently and spend accordingly. Before donating, it is not a bad idea to check out an overview of the charity at Charity Navigator. I compiled the tables below from data easily available on that website.

Program Expense Distribution of Selected Breast Cancer Charities*

Metavivor, a relatively new charity, not as big as the other two in the tables above. However, its program spending is growing the most rapidly. And its spending is exclusively focused on MBC. Metavivor believes that 30% of funds given to breast cancer organizations should be dedicated to MBC. Remarkably, of the three charities, it spends the least amount of money to raise more money — less than a penny to raise every dollar. BCRF, while not exclusively focused on MBC, spends 100% of its program funds on research. Its administrative expense, as a percentage of its budget, is the lowest of the three charities above. It spends eight cents to raise every dollar. In 2017, Uzma modeled for an Ulta Beauty campaign to raise money for BCRF.

Komen, which needs no introduction, is a fundraising juggernaut. Of the three charities above, it spends the highest proportion of its budget on administration. It also spends a lot of money to raise more money — 14 cents to raise every dollar. Fundraising expenses are 12.5% of its total spending; they are 8.7% and 1.1% of expenditures at BCRF and Metavivor, respectively. Of the three organizations, as a percentage of program expenses, Komen spends the least on research. Charity Navigator gives a Charity Navigator Score to all charities based on a combination of financial and accountability & transparency measures. Komen’s score is the lowest of the three charities.

Is one of these three charities more worthy of our money than the others? That’s for each of us to decide based on what is most important to us. Is it more important to us that all of our money goes to research? Do we want more of our hard-earned cash to go towards making more women aware of the importance of screening? Or do we prefer that more of it go to research.? Do we want it to go research focused on stage 4? Do we care how much our cash a charity uses for administration and fundraising?

The answers to each of these questions may well be different for each of us. We don’t need to limit ourselves to the three charities in the table above. A search on Charity Navigator will reveal other charities specific to any other cause dear to any of us. All we need to do is to make sure we review that information and give our money to the charities that most match our values and preferences.

 

 

A Cancer Widower’s Call To A Newly Diagnosed Friend

Running Into Worry

While standing in the ordering line of a locally famous ice cream shop, I ran into an acquaintance. She pulls me aside and whispers, “I have bad news.” Her face has lost all color. My first thought is that it must be about her parents. Like my parents, they are at an age at which lousy news would shock only the immediate family. Everyone else would say platitudes like, “She had a full life,” or “He got to see all his kids settled.” But this isn’t about her parents. “I just got diagnosed with breast cancer,” she clarifies.

“I am so sorry,” I say while attempting to comfort her. My life with Uzma, from first meeting her, making good memories and not so good ones, and to her death from cancer flashes before my eyes in an instant. The terrified woman says, “All I can think of is Uzma.” Her son and husband, standing a step or two behind her look frozen. All I can say there is that I am sorry for what she is going through. Observing that the noisy ice cream shop was not the right place to have this conversation, I take her number down and promise to talk to her another time.

What can a person in my shoes say to a person in her shoes? Cancer took my wife. One of the world’s top breast cancer specialists treated her at a premier university hospital. Uzma was one of the best patients a doctor could ask for — well-informed, asking many questions, but then taking every dose of every medicine prescribed unless the doctors told her to hold it. She added complementary approaches to standard treatment to improve her life. She practiced gratitude and a positive attitude. Still, she died. What meaningful thing can I say to any woman newly diagnosed with breast cancer?

Platitudes Don’t Give Hope

My first instinct is to say something that gives hope. But I remember how hollow and empty comments such as “everything will be alright” used to sound when Uzma was first diagnosed with cancer. “How do they know when even our doctors don’t know?” Uzma and I would ask each other. Everything may be alright in the long run. Ultimately no one is indispensable. Eventually, people learn to live without loved ones who die. But that’s not the goal of the people doling out hollow reassurance. They are trying to instill hope in the near-term. Towards that end, such comments were a big miss with us.

When the shock of those three words, “You have cancer” hits, it feels as if the very ground under the entire family’s feet has vanished. A free-fall begins — scenes from one’s past whiz by with a feeling of unreality. Visions of alternate futures appear and disappear with a sense of immense sadness. You realize that some of those futures will never be. Sometimes, it feels as if the falling will never end. At that stage, everything seems surreal. All because of three words.

How can any hollow platitude give real hope at that time? Some people have a hunch that this might be the case. They try to give their superficially hopeful statements a shot in the arm by first trying to learn more about the victim’s cancer, their diagnosis, and treatment. They pepper the patient or her family with questions — what, where, when, why, and how? It usually backfires. No matter how much detail we learn about how the person found their cancer, what the test results show and what the doctor said, none of it changes the fact that uncertainty haunts the home and the mind of the newly diagnosed.

The Phone Call

I prepare for my phone call by practicing saying this, “Cancer sucks! I am sorry you have to deal with this. There is nothing I can say or do that will make you feel less nervous right now. But I do want you to know that Uzma’s cancer story is only one type of breast cancer story out. There are others out there, in many of which recurrence does not follow remission. No one can tell you today whether or not your cancer journey will ape hers. The best thing you can do for yourself right now is to make sure you have the right doctors on your side — doctors who are right because of their competence and because you trust them. Then let them guide you. Let me know if there’s anything I can do to help you on that front.”

I know before the phone call that this will be a dialogue, not my monologue. But practicing what I wanted to say ensured that I told everything I wanted to say. More importantly, it will lower the odds of anxiety making me blurt out something insensitive. I make the call. I don’t ask a single question about the diagnostic process, the treatment recommended, the test results, and all the other information to which I had no right. She shares some of this information on her own.

That part of the conversation is followed by the only question I want to her, “How are you sleeping?” She tells me she is having a hard time since the diagnosis. I recall our days after Uzma’s diagnosis. I remember Uzma deciding, after a couple of weeks of poor sleep, that she couldn’t afford to go on like that. She told her doctor, “I need rest. I have a lot of information to absorb right now, a lot of challenging decisions to make. I can’t do myself any favors by being sleep-deprived and tired all the time. Can you give me something to help me sleep?” I share this memory with our friend and urge her to consider doing the same. She replies, “I hadn’t thought of that, but it makes sense.”

Calling The Husband

Later that day, I call her husband. The first part of that conversation is similar to the first part of the conversation with his wife. I empathize with the burden placed on their lives by cancer and the uncertainty accompanying it. I ask him if he would let me give some unsolicited advice. When he approves, I say, “This is a time when you will need all the help you can get. For a variety of reasons, most of us find it easier to help others than to ask help for ourselves. But this is a time when asking for help is the thing to do. There is no shame in it.”

I also suggest that they consider getting as much paid help as they reasonably afford. Paid help can provide predictable daily support to do things that need doing every day. Even if one is wholly preoccupied with cancer and its treatment, the dishes and clothes still need cleaning. At this moment some or all of the money one spends on vacations and entertainment is better diverted to getting paid help.

I share with him that it was not easy for us to make the shift. It’s easier to give than receive help because receiving makes us feel exposed and vulnerable. Especially when dealing with a serious illness like cancer, we also know that we may never be able to return the favor. All we may be able to do is express heartfelt gratitude. And that’s okay. We eventually grasped that even if we can’t return the favors received, we can pay it forward by helping others in our shoes.

I want to say a lot more to both of them. Ignore the avalanche of bullshit dietary advice about to head in your way, I want to say. I want to tell them about the people who will vanish from their lives during their most challenging time. And tell them of the strangers who will step up to help. There’s much, much more. But I decide against it. Just because I want to tell them all this doesn’t mean it it is the right time for them to hear it.

As I end the conversation, I find myself wishing that her cancer responds so well to treatment that she and her family will eventually look back at this time as nothing more than a bad dream.

Post-script

I don’t know if this was the best way to handle this. I used what I have learned from Uzma’s and our family’s cancer journey. There were three most important lessons that I learned about those early days of the cancer journey.  First, no matter what anyone says, the hand early days (and often later ones too) are days deep uncertainty. Second, early on, cancer patients are often tired of sharing their stories repeatedly with different healthcare professionals and family members. Sharing them with yet another person with whom sharing is not essential is not something they relish. Third, exposing one’s vulnerability by asking for help is hard but necessary to navigating cancer.

Cancer And Blogging: Why I Keep Writing Part 2

It seems having cancer puts you at higher risk for blogging, breast cancer even higher. Or perhaps with a cancer diagnosis emerges a need to talk or find an audience, a team or group to listen. The need to be heard is a pretty basic psychological need, unmet in many cases but I guess having cancer gives you some authenticity about knowing life and its ups and downs, so people will listen.

I listen, listen a lot, it’s part of my job and has now become second nature, I hear about very personal things, intimate thoughts, even thoughts that people are unwilling to admit as their own.

What makes it useful is the feeling of being heard. That someone out there understands what you are going through.

[Commentary by Dheeraj Raina: This is a previously unpublished post of Uzma’s. To read my approach to her unpublished work, read this. Uzma had left the draft of this post untitled. I see it as a complementary to another previously unpublished post Why I Keep Writing. That’s why I chose this title. Besides that my contributions to this post include fixing punctuation and making paragraphs for comfortable reading.]

The Mixed Feelings Book Sale

Even before her own breast cancer diagnosis, my wife Uzma began having mixed feelings about Breast Cancer Awareness Month. Those feelings got even more mixed once her cancer came back and became stage 4. “I don’t mind the fundraising,” she explained, “But I sort of think that much more needs to be spent on funding research into treatment than we are doing now.”

She agreed that awareness campaigns are important to keep educating women about the importance of screening mammograms. According to the CDC, more than one-third of women over the age of 40 report not having a mammogram in the past two years. The message of journal articles like this one, published after Uzma’s death, must be summarized in simple language for all women. Women with dense breasts need education on the poor value of mammogram screening for them. Some women need sensitive education to help them overcome their anxious avoidance of breast cancer screening.

In 2011, two years before her cancer diagnosis, Uzma discovered that the charity then known as Susan G. Komen for the Cure was only spending 15% of its program funds on breast cancer research. Since then the charity has dropped the phrase “for the Cure” from its name. However, the non-profit and its affiliates still host hundreds of “Race for the Cure” events every year. Komen has since increased its funding on research to almost 29% of its program funds. Uzma believed that as the 800-lb giant in the breast cancer charity universe, Komen has a responsibility to spend much, much more to fund treatment research.

Since then we found other organizations, smaller than Komen, that spend a greater part of their program expenses on research. Breast Cancer Research Foundation spend 100% of its program funds on research. Metavivor, a much smaller charity, spends almost 90% of its program funds on research focused on stage 4 breast cancer. Komen’s size gives it an outsize impact. For that reason alone, it remains an organization worthy of our support. But those of us who want more of our support to go towards research must explore other options.

Those who want to keep funding advocacy and education ought to consider how to make those activities more focused. For example, research studies since at least the 1990s show that mammograms are falsely negative twice as often in dense breasts compared to less dense ones. Negative mammograms will give a false sense of security to some women with dense breasts. Focusing at least some of the awareness funding on the issue of dense breasts is worth considering.

As October approaches, I ask myself, “Uzma wrote a book to help people gain a visceral understanding of the breast cancer experience. What would she do with her book if she were still around?” I think she would make people ponder how to channel their donations according to their interests — awareness vs. research. She would reduce the price of the book for breast cancer awareness month. She would urge everyone who buys it during this time to donate the money they save to their favorite breast cancer cause.

So here it is: Both the paperback and Kindle versions will sell at a reduced price through October. I am calling it the Mixed Feelings Book Sale partly because of Uzma’s mixed feelings about October. And partly because of my mixed feelings about helping get her book out without her on my side.

How You Cure Breast Cancer According To Google

If you rely on google:

This is how you cure breast cancer:

Take a handful of kale and add turmeric to it then put it in carrot juice and use it as enema for 15 days then stand in a yoga pose for another five days then massage cannabis oil all over and slip and slide for two days followed by organic ground coffee enemas until you successfully shit out all the cancer. There!

Just stay in downward dog all your life with your head in coconut and avocado oil and have someone sprinkle a light dusting of matcha and green tea over you.

🤣🤣🤣🤣

Date: 19 September 2017

[Commentary by Dheeraj Raina: This was a Facebook post of Uzma’s. Read this to understand my approach to turning some of Uzma’s Facebook posts into blog posts. Upon learning that she had stage 4 cancer, some people would start asking her what she ate or start giving her unsolicited advice about what she should eat. Or should have eaten to prevent cancer. It bothered Uzma to no end. She believed in a holistic approach to health, took yoga classes, saw an integrative medicine doc, but never ever as an alternative to standard treatment. Earlier in the same year, as the following Facebook post, her frustration led her to write one of her popular posts, Diet Crazy: A Rant. This is along the same lines. I bet somebody had given her diet advice the same day.  The last line, though, is illustrative of the power of Uzma’s writing. She can make you conjure up images that make you feel what she is feeling. My addition to the post is in italics.]

 

Religious Platitudes For Cancer And Other Serious Illness

[Commentary by Dheeraj Raina: This was a Facebook post of Uzma’s. Read this to understand my approach to turning some of Uzma’s Facebook posts into blog posts.  I have edited this post’s formatting. Words I have added are in italics. Enjoy!]

* * *

This is what I hear over and over again.

I believe in prayers and miracles but these thoughts seem to have a pattern and classic content.

I hope for remission, I pray for recovery. But people do get better and some don’t.

Muslim platitudes for Illness:

1. When first sick

May Allah heal you, I will pray for you.

2. Illness prolonged

It’s not an illness , it’s a test. I will pray for you.

3. Still sick

Duas (prayers) change things. Keep praying.

4. Still quite sick

Shifa (healing) is in hands of Allah, keep asking.here are these things you should recite every day.

5.Still sick and worse.

Miracles happen all the time. I am praying for a miracle. Keep reciting what I sent you.

6. Patient suddenly better for one day

I told you never give up Hope , see how things change when you pray.

7. After 24 hours – Still sick, worse and may be terminal.

Death is inevitable. Whoever lives, will taste death.There is time to repent. Stay strong, keep faith .

8. Deathly ill

Now who can really interfere with Allah’s plans. He decides what is best. There is always a reason why prayers aren’t accepted. They wash away sins.

9. Died

We came from Him and shall return to Him. I will pray for the departed soul.

10. Someone else gets sick.

Rinse and repeat.

Coming Soon: Video Event

Uzma had planned to do a Facebook Live event on December 9, 2018. It was to be the start of a virtual book tour. Alas, it wasn’t to be. Her gradually worsening health took a sudden and quick turn for the worse on December 4. She ran out of time.

In her honor, I plan to do what she couldn’t. But I can’t do a Facebook Live event. Not yet. Yes, I become nervous when I don’t know what I am getting myself into. Like most humans, I find being physically and emotionally there for my dying spouse less nerve-wracking than being in front of a live camera. So, I will do a recorded video and hope to upload it on April 9, four months after Uzma’s original planned date for the live event.

I will read something from Left Boob Gone Rogue: My Life With Breast Cancer. I will add some commentary. The screenshot (see below) of Uzma’s announcement about the planned December 9 event shows, she wanted to answer questions from her readers. Therefore, I intend to answer a couple of questions. But since this will be a recorded video, my request to you, her readers, is to write all the questions you would have wanted to ask her in the comments below this post. Of course, it won’t be the same as her answering them, but hopefully, it will work for you all.