Today might be the day.
Today might be the day, my life could change again,
Today might be the day; it starts all over again,
In a different way,
Its hard to say,
May be worse,
Much more worse,
May be not.

You hold my hand,
And tell me,
It will be alright,
I accept reluctantly,
My fate, my share,
My vessel of anxiety,
In which I float every day.
Some days I see the surface,
And glance like a master,
Some days, I struggle.
I struggle to breathe
the breaths
that may be numbered
To take in gingerly
What may be pre-determined.

Today I might find out,
How many?
How many breaths?
How many days?
How many years?
My fate, my share!

Yes, take a look
One more time,
At my rebellious body,
With your fancy machine
Look!
Look closely!
Do you see ?
Bits of happiness on the film?
Or shreds of my mental peace?
Or perhaps all my feelings?
In black and white
While my life is grey forever?
Tell me what you see?
Tell me what is likely?
Tell me what cannot be ruled out?

What does it say today?
How many more?
Scans, days, moments,
Can you see what I have lost?
Can you see what I have gained?
Can you see it all?
Or perhaps repeat in six months,
A twisted sense of time
very long and very short.
Until another six months,
While I remain suspended
in my vessel of anxiety
in my vessel of hope.

This year for October, I was planning to write a well researched thought over article about Breast Cancer. I was aiming to get the statistics and figures, do some fact checking and present varied point of views regarding money spent researching cure for Breast Cancer. Cure is what all survivors want. We are desperate for someone to tell us that its actually all over for us.We never get to hear that. We don’t get a conclusion to our misery unless death bails us out from this chronic uncertainty.

So we party at the end of chemotherapy or the end of radiation or just because our life was spared, we celebrate “remission” or “NED” ( no evidence of disease status). We grieve the loss of our health, we endure the “collateral damage” and we keep moving while science slowly inches to this hope we have called “cure”. We are willing to walk , run , race and gallop to it. The society getting drowned in pink in October is being told that a cure is coming. But is it near?

We ,survivors , want to hear, “Go live your life, you are cured!”. But cure remains elusive. We have the monster of Breast Cancer but no hero to slain it and show us the head severed  from its body or strangulated by the very same pink ribbon that is all around.

We want the pink ribbon to be the noose around the neck of Breast Cancer and leave it gasping  for air just like every woman who hears for the first time” You have cancer” . We wish for the eradication of the disease that takes mothers, sisters and daughters away. We want to life without fear and apprehension and insurmountable stress.

All the pink walks combined have not paved the pathway to cure. It still remains a dream, the fantasy of every  breast cancer patient.

I was planning to write about all of it. The funding, the controversies, the pink washing and the sisterhood.

I wanted to get my thoughts together so I can write a refined and polished piece. And then I got a migraine headache. A headache that lasted 5 days which didn’t respond well to the migraine medication I usually take. This lead to a neurologist visit which lead to a Brain MRI which lead to finding of a spot on the brain that no one knows what it is. Alarming as the finding is, it is just another day in my life . So I get recommended  ‘the wait and watch ‘ approach. Wait to see if it grows, wait to see if its cancer.

This is what living with cancer is , Wait and Watch. Do all treatments recommended and hope for the best while doctors watch over you and you wait anxiously to get through the first five years. Some get through, some don’t. No one knows, which group you fall into. Unknown and unpredictable, that’s  the gestalt of life with cancer.

Every symptom occurs after cancer needs to be assessed for the possibility of it being a cancerous lesion. And it will remain so until we have a cure.

And a common side effect of having had cancer is losing time. Weeks to increased surveillance after having a new  symptom, waiting in doctors offices, anxiety , fear, frustration and sadness , therefore that spot on the MRI  took away from me the time I had set aside for my article.

The loss of time and money remains enormous in the life of a survivor.I can only imagine the actual cost of these life time of investigations and scans done on every single breast cancer patient. The PETS, the MRIs and the CTs. My insurance told me that the MRI of my brain was 2,500 dollars. I will need a repeat in 6-8 weeks. So far in the last 2 years, I have had one PET and probably a dozen MRI’s and CT scans combined. And this will continue for the rest of my life.

Because we have no cure, we wait and we watch. We watch 40, 0000 women die every year from Breast Cancer and we wait. We wait and we watch, we watch and we wait.

We are all aware, I am not sure there is anyone who doesn’t know what the pink ribbon stands for. Come October every thing from soup cans to cement mixers, turns pink like it was submerged in a giant vat of peptobismol.

Breast Cancer Awareness. Everyone is attune to the presence of this deadly cancer amongst us. But this awareness leads to at the most, early detection.

We are not preventing cancer by spreading awareness. Get your mammograms isn’t the answer. The mammogram awareness can lead to early detection, it doesn’t not stop a cancer from growing. We are to a point where we can diagnose breast cancer very early with mammograms.However, we also know now that we are over diagnosing and aggressively treating DCIS( Ductal Carcinoma in Situ), more than it needs to be.Thought processes about management of Ductal Carcinoma in Situ are changing.

Mammography has significant limitations most notable being increased breast density. Women with dense breast are repeatedly failed by mammograms and their cancers can go undetected for a long time unless an Ultrasound is done in conjunction with a mammogram to achieve better imaging. Sometimes both can miss the cancer, which in my case was about 7 cm when first detected on an MRI.

Young women tend to have more aggressive cancers, young women tend to have dense breasts. Therefore, we are not gaining much edge here with mammogram screening. The 3D mammograms seem to offer better resolution but currently aren’t being used extensively.

MRIs that offer very high resolution remain reserved for those that are high risk and insurances fight tooth and nail in approving those even for high risk patient.  They ,of course , carry risk of false positives and over investigation and therefore are not considered good screening tests. Having had breast cancer, I do  get a breast MRI every year.

In the U.S., breast cancer is the second most common cancer in women after skin cancer. It can occur in both men and women, but it is very rare in men. Each year there are about 2,300 new cases of breast cancer in men and about 230,000 new cases in women.

We don’t know what causes breast cancer. Certain risk factors are known.

National Cancer Institute’s web side states the following

“Studies have identified numerous risk factors for breast cancer in women, including increasing age, personal history of certain benign breast diseases or breast cancer, early menstruation, late menopause, never having been pregnant or having a first pregnancy after age 30, use of oral contraceptives, family history of breast cancer, presence of certain inherited genetic changes, history of radiation therapy to the chest, long-term use of combined hormone therapy, use of diethylstilbestrol (DES), increased breast density, alcohol use, and obesity after menopause.”But they are risk factors not direct causes. Breast Cancer is likely multi factorial in causation.

We do realize that there has been significant advancements in treatments and management of Breast Cancer in the last 100 years. Women are no longer subjected to elaborate surgical procedures  that donot help increase the survival rate. Gone are the days of Radical Mastectomies and the accompanying  disfiguiring complications.. We now have data that lumpectomy can improve survival similar to  a mastectomy in cases of early disease. There are more choices available to a woman today surgically than before.

Recently a very rare gene identified in women of Polish and Canadian French descent that increases Breast Cancer risk. A few other mutations are now known to increase the risk but their clinical application remains limited.

We also understand that all breast cancers are different from each other based on their cell type and receptor status. There is significant variations among breast cancers. We are just entering the world of genomics in medicine and are at the brink of utilizing how to target cancers with more precise treatments and immunotherapies.

We maintain the insight  that cancer is a hard disease to beat since it has high ability to change and mutate. Mutation is  the biggest challenge in treating any kind of cancer. Breast cancer thus is no exception. It changes , it morphs , it hides. It can recur and metastasize to other organs. Metastatic Cancer is the kind that kills by spreading into the other organs out side of the body. Women who die of breast cancer die of Metastatic disease in their other organs.

Not having a cure means 1 in 8 families will suffer at the hands of this disease for the rest of their lives. Some will go bankrupt because of medical bills. Some will have the children suffer and live without a mom. Some will leave grieving families with elderly parents. Not having a cure means, all survivors live in the fear and anxiety of having no cure. Once diagnosed with cancer, the uncertainty is ever present.

Not having a cure means, going through scans and tests for the rest of your life. Not having a cure means living in the shadow of mortality.

Cure, a hard reach. Cure our utmost desire. Cure

But I also grasp as a physician that finding cure is a high aim. In medicine,  we don’t have cures for many chronic illnesses. Cancer is a chronic illness. It can be managed and treated like Diabetes and HTN.

Medicine is most effective in curing infections. We do not have cure for Diabetes or High blood pressure , we have ways to manage them and we can attempt to prevent them. We have lots of research available to link the high risk factors leading to these particular diseases and devise a plan of action.

To cure , we need more understanding of the risk factors, the process of the cancer proliferation and spread and ways to stop the cells from becoming cancerous and eventually  effective treatments to eradicate all cancer cells from the body, active and dormant. We are getting better at all of it  but at a pace that is disproportionately slower than the fatal wrath of this illness.

So here we are in October , the breast cancer awareness month. Aware that one in eight women will be diagnosed with breast cancer in their life time. Aware that once cancer is diagnosed, there are very harsh treatments for it. Aware that there is an alternate life path after cancer peppered with  fear and residual damage, should we be luck enough to survive. Aware that a significant number of women will die of  breast cancer despite early detection and treatment.

I am aware that two years ago, I was diagnosed with a potentially fatal illness that has no cure. There are millions like me. We will live our lives worrying about new symptoms, recurrences, getting scans and seeing oncologists. If our aim was to eradicate breast cancer, we continue to fail miserably. The gap between awareness and cure remains wide.

Despite extra ordinary advancement in the field of cancer and having even the first anti cancer vaccine, we are away from the cure of breast cancer. We all have pink t shirts and pens and bracelets and egg cartons with pink ribbons on them, we need a cure. Until then, we wait and we watch.

It’s a story I feel compelled to tell. It may be therapeutic for me and possibly others. It’s a story that need to be told. But I hesitate. I fear the stigma. I am afraid of being judged. I fear breaking the silence. I ruminate about the potential repercussions.
What if I, a psychiatrist, wrote about my own emotional conundrum after a patient chose to end his life?
Can I open the private vault of personal grief that filled me with his untimely and unnatural departure? I want to narrate the tumultuous aftermath of patient suicide, the distressing combination of grief sans closure, perilous self doubt and professional impotence to undo it.
Suicide is the tenth leading cause of death in America and every 40 seconds someone commits suicide. It happens and it happens a lot. But it’s hardly talked about by the “treating survivors” of patient suicide, the psychiatrists, therapists and others mental health care providers who cared for them, the ones that lost their lives via suicide.
The hesitation and the apprehension is real. Suicide is also the number one cause of lawsuits brought against mental health providers.
Should I take a chance and disclose this vulnerability?
Should I disclose that I had played our last appointment over and over in my head to look for clues for what I could have done differently? That I had stressed my brain to recall all details of that half hour in the office. His mannerisms, what I had said, what he had brought up, my responses, the color of his outfit, the time of the day, the pauses between his sentences.
Is it okay to say that I had questioned my ability to assess suicide risk despite all my training and experience? Could reveal that I had reviewed quietly in my head, standard of care that I had provided?
Should I say that I cried? Should I say that I mourned?
It is customary in a psychiatric appointment to ask an individual about suicidal ideations and thoughts. This is especially true when treating individuals with depression. Suicide is often a complication of depressive illness. Depression which envelopes an individual in a cloud of darkness that swirls around them day and night, with no access to the light of the outside world. It’s visible through the eyes of the depressed and you look for that glimmer of hope to reassuring you that they will hold on to life. They , sometimes, verbally reassure you, ” Doc I am not going to do anything, I won’t be the patient you will get the call about”.
You reassure them that they will get better, the appointment ends and they leave with another appointment card.
Then, you pick up the next chart and get busy with another life and another story.
But then you do get the call one day.
The call that is mechanical yet doom-ridden. It can be from an ER or police department asking if you knew this person. The past tense in knew, makes your heart stop and sink. Your mind flashes to the last appointment.
The film reel starts to run. Beginning to the end. 30 minutes that get burned in your memory for you relive them so much that they singe any other comforting thoughts trying to crowd them. Despite everything you did, you keep asking yourself, “Could I have done more?”
You experience sadness and loss but you can’t disclose why. You feel anxious, isolated and apprehensive. You are engulfed by grief and fear simultaneously. Grief of the loss and fear for you couldn’t stop what you think you were hired to prevent.
It’s a grief that must be felt in private just like those sessions are, private and confidential.
May be your own family understands your dilemma but the confidentiality of your profession stops you from openly talking about it. Sometimes the malpractice attorney tells you to stay silent. You think about calling the family or going to the funeral, you try to do the right thing.
What if I admit that I have doubted my professional abilities after since I heard it had happened? I even wondered if I am in the right line of work.
Is it okay to say that I took a week off after it happened to regroup? Can I justify in writing those pangs of anxiety I had felt every time a depressed patient left the office?
Losing a patient to suicide affects how one treats subsequent patients. The perceived “reasons” of what might have caused it remain at play.
Sometimes there is the overcompensation to ask each and every patient depressed or not , if they are feeling suicidal at every appointment even though it annoys some of them. Sometimes its avoidance of patients with suicidality.
” Are you having thoughts of harming yourself?”
” I told you, suicide is not an option, I don’t want to go to hell.” or ” I would never do that to my kids”.
But in your heart do you really trust the monster of depression not take the best of their fragile frame of mind? Those few moments before they actually do something, they aren’t rational. When they pull the trigger or take the pills or take that knife to their wrist, their decision making is impaired , that’s what the research says.
You focus on the trivial.
May be the number of suicide hotline should be enlarged more and put at more places in the clinic? May be the waiting room needs more literature on this topic? May be I should attend another training on “Suicide Risk Assessment”?
You question your treatment choices. May be they never filled the prescriptions.
May be the medications taken did not work? May be they worked too soon.
The risk of suicide with antidepressants in highest in the initial two to three weeks, when treatment improves energy enough to follow through with a suicidal plan but the mood is still profoundly sad.
Can I say that I had a hard time sleeping in wake of such an event? Is it okay for a physician to accept their vulnerability and write about it?
What if I wrote his story? What if I wrote about how it changed my own story?

Let’s face it. There is a lot of sad and traumatic stuff that happens all across the globe. Children murdered, killed and molested, women burnt and raped, men killed and mauled in acts of terrorism, barbarism and crime. Our every day is filled with tragic news and depressing information. It’s all right at our finger tips, easily accessible and very close.
This ongoing sadness can put a hole in everyone’s emotional resources. Every emotion has a cost and serious impact. When we enjoy things and spend time with those we love, we replenish our emotional resources with positive, loving energy. Every piece of distressing information robs us of our emotional energy. When we feel emotionally drained, we are likely to experience sadness, anxiety and fatigue.
Among other things that cancer has taught me, I have learned to be very mindful of how and when I spend my emotional reserve. I have also become selective of who is deserving of this. Call it a bit narcissistic and selfish but I am more apt to walk away from drama and craziness that doesn’t belong in my world. In that context I live in a constricted world than before and it’s OK.
I am in no way encouraging insensitivity to social and emotional pain of others but one has to develop the ability of “zooming in” and “zooming out” of life. By the time I finish writing this, it is likely someone got assaulted or killed somewhere in the world. It’s infinitely sad that this is the world we live in. Humans have become brutal and murderous. There is rage all around us. But if one gets consistently preoccupied with every tragedy and every misfortune, it is likely to affect the mood in very negative ways.
Here are ten tips I have to preserve your sanity in midst of bad news all around:
1) Practice Gratitude: Take a mental note of all the things that you are thankful for and review all your blessings in your mind. This will distract you as well as have a positive effect on your mood.
2) Recognize your limitations: You must realize that you have limits on what you can do and feel. You will still have to go home and cook a meal or attend a meeting or read for school even though someone died brutally in some country far away.
3) Practice Compassion: You may not be able to influence ISIS or the Palestinian conflict, but you sure can help someone right around you. Look for a way that you are helpful to others.
4) Try deep breathing or meditation: you can close your eyes for few minutes, visualize a positive image and send good vibes to those you fear are suffering. If you are a religious person, pray for the folks you want good to come to.
5) Make a donation: Send some money to a cause that is close to your heart. This way you won’t feel completely helpless and isolated but connected to some greater good.
6) Try listening to some music: Music has a very soothing and calming effect on a distressed mind. Listen to few favorite tunes and turn off the news. Better yet, go for a walk while listening to music. This will help clear your mind and engage your other senses.
7) Smile at others: You will be amazed how much positive energy you can gather just by smiling at others.
8) Put the phone aside or log out of the app that your are addicted to. If there is too much bad news, take a break from FB or twitter.
9) Call a friend or family member you have been thinking about. Never underestimate connecting with people that make you feel good about yourself.
10) Believe in yourself and your abilities: You may not be able to make a change today but that’s ok. If you are honest to a cause, an opportunity will arise that will translate into action.
Life is a dynamic situation, navigating each day is hard but there is beauty in life and in every moment. If you are not paying attention or distracted by negativity, you will miss the real treasures, the ones that linger in the memory for a long time.

 About two years ago, I wrote an obituary .It read as follows:
Lt. Colonel Mammary G(land).
The Twin of the Lt. (only surviving family) would like to report the unfortunate demise of Lt. Col. Mammary G(land). on August 8th, 2013 at the University Hospital. The services of the Lt. are acknowledged and regarded by those who knew her well. Besides performing aesthetic duties for a number of years, the Lt. served two tours of lactational duties from 2007-2008 and then again from 2011-2012 with honorable discharge both times. Lt will be recognized by the highest honor and a silicone trophy will be erected at the grave site.
In lieu of flowers, please send donations to Dr. Plastic’s office.
A soldier had fallen ! The war against breast cancer had claimed another comrade.
I became a “monoboob”.
Monoboob, odd and awkward. Mutilated and Broken. Lopsided and out of balance. My womanhood and body image was under attack.
My life stood still as I coped and recovered from losing a piece of my femininity as well as faith in my own body. Cancer happened to me. Complex information came at me with words like chemotherapy, hair loss, tiredness , radiation and reconstruction. I desperately tried to keep my head above water.
The day before, I was trying to emotionally prepare for a” mastectomy”, the fancy medical name for getting your breast lopped off, I stood in front of the mirror hiding one breast to assess what I would be sans my left breast. I was trying to process my grief. The morning of surgery, I had pictures taken, thinking one last time, I would look whole for the pictures.
It needed to happen. I had cancer in it. I had no choice. I was one in the eight women in the country that get afflicted by breast cancer. Play time was over, life got serious. Very serious.
But did I need to be serious? The answer gradually unfolded.
Shortly after leaving the oncologists office after receiving my verdict of 16 chemotherapy cycles and 30 plus radiations I made a lame joke to my husband. I said, I will no longer be stereo.( one breast being “mono”)
He laughed and looked relieved. I laughed too and before we could let all the impending trauma sink in, I was chattering nonstop, making quips about the doctor, cancer and breasts. Sometimes laughter comes easier than tears.
I needed to find things to laugh about and smile. If I didn’t I would have drowned.
Humor is a powerful defense mechanism and it works great. Ask my friends, I have always been the funny one.
My left breast had gone rogue, filled with rogue cells. What is a woman to do? I decided to laugh all the way to hell and back. I named by blog “Left Boob Gone Rogue”.
After the surgery, recovery was slow and painful. 2 years later I still have pain in my arm off and on.
Initially, the biggest accomplishment of the day for me was flip through a Victoria’s Secret Catalog and not drop a tear.
Losing a breast isn’t easy, I constantly feel like taking a right turn (don’t have the left boob) because I feel that I swayed to the right, like the right turn signal is on!
My run doesn’t have the same rhythm, the plop-plop plop-plop is just plop…plop. every time I look in the mirror, my chest winks at me.
I do thank the surgeon for leaving a small part in the middle intact so could pull together a deceiving cleavage , if I dare to bare it.
Another advantage of having both breasts is, it hides the little protuberant belly. Now with the breast gone, I get a better view of the steroid-enhanced roundness, and believe me, I don’t want to see that. Steroids stimulate appetite and after chemo there is only so much salad and cucumber a gal can eat before she opens the cookie box. It’s not me, it’s the steroids!
I remember the night before the surgery. I had showered so I would sleep better. My two and half year old daughter was laying in my lap, and then she fell asleep, cozily nuzzled between the two soft and friendly entities. And there she was breathing softly with her face burrowed in my chest and I knew that this was the last time she had this comfort. But I knew that I needed to do the surgery so she still has a mom to hug and cuddle with.
I remember when my son was born. I wanted to breast feed him right away. What I didn’t know was how newborns root for the nipple. I panicked, thought my baby was blind and couldn’t really see where to latch on. Thank God it was just a fear. I breast-fed both my children for at least one year. Those are some of the wonderful memories of the “mammaries” and the love and bond they created between me and my children. I feel the loss and I think they do too, in their way as if one of their favorite childhood comfort toy got broken.
The great thing about children is their resilience. They don’t obsess over stuff for too long. Not like adults. Something we can all learn from the little ones in our homes.
For over a year I tolerated grueling treatments and side effects but I loved myself and my life more. The scar on my chest healed with patience and openly sharing my struggles.
At the end of the day, it is just a body part. It doesn’t define me or my femininity. I am still loved by those that matter. That message was loud and clear through an entire year of treatment.
Its two years later, I have made it through and much more comfortable with my body. Cancer has pushed me to be more accepting of the here in now and the blessings of every day .
I think I have moved forward with my body image, with sass and attitude. I have my groove back , cleavage of course is a whole different story.
I am” Uni-Titty”, whole and complete with a full appreciation of life and that is infinitely sexy.

I now have the web link to my interview published in Health Monitor’s Thrive Magazine. They featured it in their ” True Insipration” section. Click here for the story : www.bit.ly/uzmamd1

I just read the dreadful news of Dr. Carolyn Kaelin passing away at 54 years of age. She was a breast surgeon who had breast cancer herself and subsequently wrote two books on the topic. “Living through Breast Cancer” was a wonderful read and so was the other exercise guide book ” The Breast Cancer Survivors Fitness Plan”. I read and re-read both.As a physician I identified with her dilemmas and struggles.

As I was going through my treatments, her words were inspiring and precise. I learned a great deal from them and I felt that she was my mentor through all of it.

Just as I was starting to wonder whether I needed to continue blogging and consider if I should or should not write a book, this event occurred. I realized with intensity that I was connected to Dr. Kaelin through her words and she will continue to heal others through her words and writing. I cried for her today.

Sharing one’s struggles openly is such an incredible gift to others. Today I experienced what some of you have told me, that my words inspired you and have helped you. I felt the strength of the connection of words tofay. I felt today like a friend died. Her untimely death  inspires me to continue sharing my journey with you all. RIP Dr. Kaelin, you live through your words.

http://www.washingtonpost.com/news/morning-mix/wp/2015/08/03/breast-cancer-surgeon-turned-patient-carolyn-kaelin-dies-at-54/