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Open Letter to The Rogue Cancer Cells

Dear Cancer,

Believe me, you aren’t dear to me but I am just sticking to literary convention. You have enjoyed the stay in my body, my temple for much too long and have overstayed your welcome. I would like you to pack your stuff (wanted to say another word that also starts with “s”) and leave. My body has better things to do than to fight with your megalomania. There is an exit sign that you are ignoring.

There is a lot that this body needs to accomplish to ever turn itself over to you.You have lodged yourself in a place where I need room to accommodate the love and caring that life has to offer. I need the room vacated so it can be filled with joy and peace and contentment.

I need my energy to so that I can live to see my children grow. My son needs you to leave so he can grow up to be a man but still have a place where his tears are not seen as weakness and his laughter infuses life. My daughter needs you to leave so she is assured that she can be taught all the “girly” things that she needs to learn in life and be all that she needs to be.

I need you to leave so I can grow old with my loving husband. He needs you to leave so he can have his life back. He needs you to go so he doesn’t have to be the mother and father. He needs you to leave so he can lose the anxiety of losing the love of his life.

I think you have been trying to suck the energy out of my existence for far to too long – bit by bit, and piece by piece. You don’t scare me and I can look at your sick crazily mitotic nuclei in the eye and say, “I am not afraid’. I just need to you to leave.

I want you to leave so my friends can rejoice, and my family can breathe freely. I need you to leave so that my patients can rest assured that the one person they feel that truly understands them is still there and they won’t have to start over. They need to heal. I need to heal.

I want you to leave so I can look at those who abandoned me during cancer and say, “Thank you for helping me realize that you never mattered. I won this battle without you!”

I need you to leave, for I have learned all the lessons that I needed to learn after looking at death in the eye. I have learned not to take anything, or anyone for granted. I have learned to take each moment as it comes. To find meaning and hope in every day life. To make things happen and not wait. To be myself and trust myself. To be honest and forthright. To endure.

I have learned the meaning of pain and suffering, that a peaceful night’s sleep is a blessing, being able to digest food is a treat, to be pain-free is a miracle, to feel energetic is a gift, to feel beautiful is an internal feeling and to appreciate life is hard work.

I am ready to move on from the lessons I have learned so I would like you to move on. Leave me alone. And the next chemo, when the Taxol infusion is flowing through my blood, I would like it to find you and tell you so.

It’s time to move on. It’s time to heal. It’s time to recover. It’s time to start over.

Yours(not really!!),

A cancer survivor

Just Brows-ing

I used to consider my self a bit of an artist till I had to face the dilemma of drawing eyebrows on my face. Its a cliche but cancer does make you appreciate a lot that you take for granted. Eyebrows are a good example. I have always appreciated nice eyebrows on others but never paid a lot of attention to my own. Fortunately, I didn’t have the bushy ones that require grooming or the uni-brow or any other variant that require regular upkeep. They were light, nicely shaped and just right.

Cut to chemotherapy, and a faint line of abandoned stubborn hair hangs out on the supra-orbital ridge. Never realized until lately, the contrast the brows brought to the picture. Being a regular to TV shopping channels, I thought when the make artists said, brows frame the face, I doubted their intentions. But I think they are right. So after much research online, I went and bought an eyebrow pencil. How hard could it be to draw two eyebrows? Obviously, I had no idea.

The key challenge of course is – they have to match! It’s easy to fill gaps but creating brows out of nothing at all is tough. Can you imagine seeing a psychiatrist who has an eyebrow perpetually raised. Hmm, yes, I realize now, ill-positioned eye brows can cost me my practice. “Doc, I was so hurt by my mom’s comment.” Then imagine the poor patient staring at raised brow, creating all sorts of self esteem issues from the empathic failure of the therapist. Brows too high, I seem amused by every story, a little too low and I appear more depressed than the patient. Press the pencil too hard, and I look ready for my juggling act.

Most folks with cancer rant about their scalp hair and I have too but I am learning that the little insignificant nose hair are a blessing too. Yes, you lose those too with chemotherapy and that leads to an ongoing love affair with the nasal saline. Sniffling and cleaning the congested nose and a not so occasional nose bleed. Never did I appreciate the functional aspect of the lashes, yes they are there for a purpose too not just to fund the cosmetic industry. But you got to adapt, every step of the way. Allow nature to take its course of redesigning your face all over again.

Accept it and keep moving. These are minor inconveniences for the promise of a cancer free life is the prize. Worth it? Totally! Additional bonus – finding yourself and your strength along the way. Sometimes just hiding the weakness is strength. It’s hard to stay focused on the goal when your body is protesting with fatigue and the end still seems far away. There are still days of exhaustion, itchy palms, episodes of diarrhea, pain all over the body, aching bones and joints between you and the end of chemo. You weave in and out of life, 3 days to rest and recover, 3 days to live and then back to chemotherapy. Trying to keep the fabric of your life intact. Being hands-on with kids on good days and then letting it go for the days you can’t. Sometimes browsing, sometimes more invested. Zooming in and out of the window of your life, hoping to stay there.

It’s a bumpy ride. All other goals are secondary. The first one is really the one that matters…to stay alive and fight. For in a fight, the strength isn’t measured by anything but the belief that you will. I will.

Memories of the Mammaries

Some days the most significant accomplishment of the day for me is flip through a Victoria’s Secret Catalog and not drop a tear. One of the downsides of having a mastectomy is the feeling of being excluded from something that you were a part of for a long time. I used to circle the lingerie section at stores just to check out what is there, but now I feel like I don’t belong there. That my wishes are tied now to matronly specialty stores offers crowded by ladies my mom’s age.

Nothing against them, but as they say chemo ages a person 10 years. Sometimes I feel like I am living the life of a 50-year-old. The hot flashes confirm the suspicion. I  had never thought the I will have hot flashes at 41. Suddenly, a bunch of 50 year-olds and I are chums because we can both bitch about hot flashes and night sweats.

Losing a breast isn’t easy, I always feel like taking a right turn (don’t have the left boob) because I feel that is the direction my body wants to go, as if 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 make me hungry, and after chemo there is only so much salad and cucumber a gal can eat before you open 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. Gauri 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 Shuja was born. I wanted to breastfeed 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 fear. I breastfed both my children for at least one year. Those are some of the beautiful memories of the mammaries, and the love and bond they created between my children and me. I feel the loss, and I think they do too, in their way as if one of their favorite childhood comfort toys 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.

A Balancing Act

Who knows being off balance than a mono-boob but that  is what keeps me mindful of my balance, physical and mental. Having cancer has been a reminder of the importance concept of “balance” in my life. Well, being a psychiatrist and all, its something that I don’t think has ever been far from me but certainly cancer has reinforced its importance some more. Balance, between work and play, between love and distance, between self and other, between healthy and unhealthy. Every day presents with so many choices, from do I take a nap or spend time helping my son solve a crossword puzzle, or watch Dora with my little girl, do I eat what I like or choose what is more nutritious? Do I think about the 30% women who don’t make it to 5 years after their diagnosis or 70% that will ? Its a balancing act all the time. However, unlike being on the balance ball, I am not getting abs that are stronger. A stronger mind? May be!

In my attempt to regain balance, I headed to the intimate shop that fits for prosthesis and mastectomy bras last week. I had an appointment with an older lady who has been doing this for 25 years, she told me. She handed me a silicon prosthesis (fake boob) and said “feel it”. Yep, that is what had been missing in my life, feeling a silicon boob, “doesn’t it feel like real?” she said with excitement, ” I want you to get comfortable with it”, so despite my modesty and reservations, she plopped this thing in my hands. I wasn’t sure for how long or how much did the “feeling” need to occur. The good thing , someone called for her and she excused herself. Seems like someone needs a lesson in diversity as this thing was very pink, very unlike my skin color. Anyways she returned, this time with a variety of bras in different sizes. She had me try one of them with the prosthesis of course, I must have had a puzzled look on my face, ” The first thing they notice is projection, and I think its just right”. Well you got me sold lady! So for about an hour and half between this lady and the seamstress staring at parts of me that were once reserved only for private viewing, I came home with a pink carrying case of “balance”.

And that is okay, because sometimes its OKAY to get some help from others, when you feel out balance. After all life is a balancing act!

Long Flight

I don’t know how many of you have taken trips to far away lands, but being an immigrant I have had my share of being in cramped airplanes , sitting down for hours . This has prepared me well for chemotherapy. Getting Chemotherapy feels like being on a plane for long, long flight. There is a clear destination. Journey if its comfortable is celebrated, if not ,its still worth the trouble as long as you get where you wanted to. I imagine myself to be on a plane when I get chemo with all the other patients as my co-passengers.The cancer center is my airport.There are delays happening, and  there are cancellations too, when the white count isn’t what it should be.

I have to say though that the check in for chemotherapy is easier than checking in for a flight. And there is no security check point. Just a whole bunch of insecure and disturbed folks waiting to get on board.I hate the cancer center’s waiting room. Its too quiet. If I  had my say it would have blaring music and a strobe light with a big neon sign saying “Welcome aboard and enjoy the ride!”.

The chemo suite offers a plane like chair, “in flight” entertainment and you can get pretzels by pressing a button . The “crew” is present to get you through. The only difference, they ( “chemo nurses”) are actually trying to keep you grounded so you won’t “take off “.This time my nurse checked me in, we were in a room that is on the opposite hallway of where I was to get my chemotherapy and told me “Ok I will see you on the other side”, I said immediately, “Not on the other side!’ She cracked up. Having been with me for the last 3 chemos, she now knows me well.

The Barf bag is another thing common to both settings and one hopes to God that you don’t get to use it. For those who have been to hospitals for deliveries or other reasons, very well know that blue bag ( the one that looks like a wind sock) that’s presented when they see you retching. I get easily nauseated. I vomit easily too. Thus chemotherapy and I aren’t a match made in heaven. I throw up with a migraine, I throw up with the flu , I throw up just like that, when I am feeling blue. I have thrown up during labor, I have throw up post -op, there are  things that make me vomit, there are things that make me not. If only I was an alcoholic, I would have had much less nausea than I had to suffer through. Apparently alcohol use beats up the Chemo-receptor Trigger Zone in the brain pretty good so its not as sensitive to chemo therapy agents. May be its time to take up drinking. This time when I was nauseous, the nurse asked me, “do you want Ginger ale” , I told her not unless she wanted to ‘blue bag it’. I don’t like ginger ale at all. Unfortunately the drink cart there doesn’t have much else on it.

I have 11 more flights to go and I am racking up frequent flyer miles.Once I am done with the remaining 11,  I hope I never earn a free flight and they would ban me forever from getting on. That is my destination and that is my hope.

Hair today, who cares!

How can I blog about cancer and not talk about hair, right? The quintessential image of cancer patient is that of a bald, pale, hairless ,tired looking ashy grey individual. So lately I have heard, ” you look great a lot! ” . I have been told,  I should say special prayers to ward off the evil eye. Really? I already have cancer, what else would evil eye do, make me bald? make me  loose my eyebrows? Put me at risk for heart failure? Infections? lymphedema?  I am already at risk for it ( thanks to cytotoxic drugs). I guess some people think evil eye has a leg up on cancer.

So my hair story starts with the fact that in my teen years I decided not to cut my hair any more, and they started to grow. They grew and they grew and they grew until they were past my hips. I became known for my hair in college. I got suggestions that may be I should do a hair product commercials. Folks asked me for suggestions about their hair and how to make it prettier. My brother noted that there wasn’t much to me besides my hair, acknowledging in ( looking back) a condescending way, that I did have beautiful hair. Gradually it became a liability, an insecurity and a hindrance to my self esteem. Then came medical school and residency and the stress that comes with it. As it took a toll on everything, it took a toll on my hair. I started to loose hair. I was frantic, since it had become such a part of my identity. I would try home remedies , blame evil eye or “Nazar” as its called in our culture for it. Eventually I got fed up of having long straight hair and cut a little bit shorter. I still remember that my grandma questioning me whether I had cut my hair or not. My hair wasn’t mine any more.

Then I got married and now my mother in-law started to cherish my hair and was visibly upset when I cut and highlighted it to shoulder length. As you can tell, I had become highly ambivalent about my hair.( My husband, thank God, never got attached to my hair or its length). Now that i am typing this with a bald head, I have a smile on my face. So who cares that I am bald ( except I am not looking forward to winter). I see my face clearly, I am not distracted by what sits on top of it. I know who I am without that strands of alpha keratin. I don’t have bad hair days any more. Yes sometimes I miss having hair but a lot of times I don’t, and for this new found courage and confidence, I have to thank chemotherapy .Bald head, smile and the weight I am gaining around my tummy, I might get soon get a job outside an Asian restaurant !

Build A Bear

These days getting ready to go out feels somewhat like a “build a bear” experience. Getting ready and dressed is one thing but when you get into putting things together to complete yourself, its a whole different ball of wax.

Most of the time before my diagnosis, getting ready for me meant throwing my hair in a pony tail, tinted moisturizer , gloss and go. The project has gotten more involved since the cancer. First is dealing with a prosthesis aka “Jane in the box”. I still haven’t gotten mine “fitted” yet, apparently fine lingerie boutiques perform this service. For now I have a fiber filled fake friend which seems very attractive to a toddler as a throw  toy and God forbid if I leave it lying around, my self esteem could be flying across the living room. Then, the head of course. En route to a hairless Chihuahua,  I have opted to wear a wig on my bald head and that is an enlightening experience as well( no not because I look like a light bulb). Its amazing how well these things are made. When my hair began to fall out about 2 weeks ago, I wore a wig to the salon where actually I was going in to get my head shaved. When after getting it shaved and having put the wig back on, I came out in the waiting room, I got a lot of compliments on my hair.It took a lot to keep a straight face and not giggle.Sometime though when I am feeling particularly impish, I will tell people who compliment my hair that its a wig and I am bald.

I still have some hair on the scalp and I am still conflicted about whether to shampoo my head or use a body wash on it? I have always been quite near sighted since childhood so contact lenses have been my old friends. I then wonder, if all of it is necessary? What if I step out with one boob dangling, a bald head and my thicker than the base of a beer bottle glasses? How does it really matter? Well, from a 6 yr old’s standpoint, I look like a “man” with my bald head so he is usually pleased when I dress up. But I debate, am I hiding something or do I just crave being ‘normal”?The other day I was cleaning underneath the couch and found a hair pin, which I absent mindlessly tried to put in my hair and then stopped. A part of me wants everyone to hear my struggle but  then a part of me wants to blend in and not stand out.One other assault in the looks department is the blackening and pigmentation of my nails. Apparently nail changes are common with chemotherapy and pretty soon, nail color would be another component of build a bear. I look at myself in the mirror  and there are times that I miss my old exterior self. But then in the same mirror, I hope to see all gray hair some day and many wrinkles of life experiences , and to able to see that some day, I will have deal with all of this today. I will keep putting the pieces together so someday I can feel whole again. Ending joke : ” How are chemotherapy and labor similar”?, “They are both painful and you end up with a bald person!”. Until next time….

Chemo Bipolar

Yes Katy , I am having a case of Chemo Bipolar, and I am hot and cold in my noggin’ sans hair. I have treated many with bipolar but now I am getting a visceral understanding of really what having the ups and downs means. Having no control over how you are going to feel for the next few days, actually  miserable is the forecast 3-4 days post chemo, waiting for the cloud to lift so you can have your share of the “manic” week before it starts all over again. It’s hard to believe that a week ago I chose to walk 2 miles just to get a cup of good coffee – only had decaf at home, what kind of life would that be! Today just a trip to the kitchen feels like a hike. That, my friends, is Chemo Bipolar.

I am passing the week in hope for the “bipolar switch” when the metallic taste in the mouth disappears, the “shutdown” in the alimentary cabinet is able to push out a solution, the aching in the muscles (reminding you of what you are going through) disappears, the nerves start to fire some energy beats and the corners of the mouth are able to host a smile. Such are ups and downs of life with chemo.

It’s good they give you a schedule. You start to plan your life in the “good week” – work, kids and activities. The good week is off week – off from hospital, off infusion pumps going “hee-haw, hee-haw” for 8 hours (I hear them as “you will, you will, survive”), off from smell of IV meds, off bandages, off hospital gowns, off being “the patient.” It’s life without caffeine….no buzz, no beat, just existing, waiting for the grand prize at the end, end of treatment. My mind wanders, “What will be my lithium for this bipolar – something to hold on to so I can bear it all?” Thinking like a true psychiatrist, huh?

For me, it is the “manic week” when I am able to bake cookies (OK, I admit not from scratch), go do my Target runs of mostly non-essential items, go see patients and encourage them out of their deepest depression, be silly with the kids so much that I forget it all and live in the moment and cook and taste real food. Life truly becomes a collection of moments rather days, and about having fun while you can.

Then the day before chemo comes, with anxiety and irritability, with apprehension, with hope that it will easier this time, knowing very well that fatigue is a cumulative side effect of chemotherapy, still some hope lingers, until the infusion is done and I puke my guts out – that signal from the pit of the stomach that says “This stuff would be so much better outside my body.” The day of chemo, two hours prior I “marinate” my port (IV access disc surgically placed in my left subclavian vein) with lots of lidocaine (numbing medicine), so the needle won’t hurt (not the worst pain every but totally avoidable with good marinating) and then place Saran Wrap on it. Really, Saran Wrap. Then I put on my smile and my make up, and we go.

I guess it’s all about dulling the pain as much as possible and taking the rest in stride. Especially in October. Happy Breast Cancer Awareness Month! Take care of those breast or you will miss them bad!

Shopping Center

After having had a mastectomy, I have often wondered if the center for shopping in women resides in the breasts. I will admit that I have less urges to shop and less interest in watching QVC. Women shop for all sort of reasons. I shop for what I need, for what I think I may need, and for what I think will no longer be available if I don’t buy it right now! I own Spanx at my ideal body weight just in case that changes. Retail therapy, they call it. Unfortunately, it does work. How can the smell of new leather boots with studs and fancy buckle not perk one up? No, I am not talking about breasts, no pun intended.

Having breast cancer opens up a whole new market for shopping. Head gear, wigs, bright lipsticks to off set the bald head, scarves to look more feminine without hair, new skin products since skin dries up with chemo, some pink breast cancer awareness stuff, charms for the Pandora bracelet, inspirational necklaces, and of course a new hand bag to carry the stuff around! Honestly, its a  lot of fun.

You can probably tell that I have somewhat of a shopping addiction. Okay, I do, since I have tried to give up shopping, but it hasn’t worked. Three months is the longest I have stayed “sober.” Building the “mastectomy nest”  was also a lot of fun with a cozy blanket, reading material (gotta have new books for recovery time), spray-on lotion (my legs get itchy), fuzzy socks, front open pajamas (can’t move your arm much post op), chocolate-covered coffee beans and pain meds. Oh yeah! Besides the pain of course, it was nice to laze around in a La-Z-Boy recliner and take naps!

I know that many people get all Zen and all after having cancer. But I can’t help it, I really love my stuff. I was so happy when my daughter was born, an heir to my hand bag collection. I know its great to live simply and to have less things, but when you know that you may have fewer days, you gotta have something to hold on to. I would much rather unstuff my life of emotional baggage, of dead-beat relationships, of toxic people. That to me, is much more valuable.

Cancer does help you sort through the maze of complex relationships and helps achieve clarity of who is worthy of your time. I feel more ready to decline invitations to parties I don’t want to go to, to say no more easily to time-draining, emotionally stressful adventures, and value my time more. Yes stuff is investment of money, but what I worry about now, is investment of time and the return it will bring me. It means selling all the dead emotional stocks and freeing myself. Yes, I need emotional chemotherapy too! It takes time but I am ready like never before. As I am writing this, I notice that a clump of my hair in my hand. Oh, the shedding has begun. Gotta log off, I forgot to buy the wig liner, and I have to dye the hair pink before it’s all gone.

What Doesn’t Kill You…

Somehow this song has been doing rounds in my head, persistent just like the low-grade nausea after chemo. They say, “What doesn’t kill you, makes you stronger.” So I think, by this time I should be able to wring the neck of an elephant with my bare hands (not that I have anything against my pachyderm friends), and probably a whole herd after 16 chemo sessions. Every needle poke, every breathing maneuver, every moment in the scanner, every noise of the breathing of medical equipment is apparently making me a stronger person.

So I accept it. Not that I have a choice anyways. I was told this clearly again last week when, due to my Adriamycin allergy, I had to see an immunologist for a consultation. She is hell-bent on giving me my  Adriamycin. “What choice do you have, you need your chemo!”, says she. So in Uzma vs Uzma, the cancer fighting part of me will be whipped into shape with antihistamines and a generous helping of steroids.

I did finish a 5K this weekend. No I didn’t win, they are not giving me the steroids of the right kind – nudge, nudge, wink, wink. As I was walking, I was wondering whether I would be able to finish and really what is the finish line for me? One thing I know for sure is that I have to cross the finish line before one rogue, mutated cancer cell does, that all of my healthy cells are pitted against a small group of very extremist cells. Cancer seems like a terrorist activity of sorts. A small group with a different philosophy on growth and expansion vs. others who are living ordinary cellular lives staying in their place, not venturing to nearby organs and convincing them to join “the cause.” And chemo does not negotiate with terrorists, and boy, is there collateral damage!

Speaking of collateral, I took my daughter in for a flu shot, and guess what!  She got a blue Popsicle at the end of the visit. Makes me wonder, what happens to the guilt of doctors and nurses with adult patients. So far, no one has offered me a Popsicle anywhere. Not even a sticker. Or a sucker. Oh I get it, because it’s making me stronger. Otherwise can you imagine? “Thank you Dr. Y, you are done with your infusion and here you go –  your gallon of ice-cream and what color Porsche would you like?” Then my thoughts got interrupted by what my daughter was listening to, “Down came the rain and washed the spider out, out came the sun and dried up all the rain, and the itsy-bitsy spider went up the spout again!” Got to get ready, second round of chemo in 7 days. So stay strong my friends, stay strong!