Month: August 2019

Welcome back, dear readers. It has been a week since I last posted, which at least for me, feels like a long time! My baby boy was not sleeping well this past week, so I was using my free time (aka his nap time) to sleep instead of write.

Furthermore, the prednisone induced mania has completely worn off, so I am not suffering from insomnia at the moment. I am both happy and bummed about this. I like my sleep, but I also like being productive and having energy. If I could have any superpower it would be to not need sleep – so that tells you a lot about my priorities right there. Note, that with this superpower I could still sleep if I wanted to, but I wouldn’t require sleep for energy. Wouldn’t that be great!

Anyways, I thought that now might be a good time to introduce myself to you all. I am still guessing that most of you know me personally, however I know that at least a few of you have never met me, which is so cool! I’ll nerd out about that later, though.

Without any further ado… I am the reluctant eternal optimist. Nice to meet you all.

Why am I reluctant to be eternally optimistic? Because, oftentimes I think it would be easier to be pessimistic. Which, is why I have flirted with pessimism throughout my thirty one years on this planet. Many of you who know me might even be surprised to see that I am actually quite optimistic.

But, I am. I think that things will typically work out. I think it is really hard to irrevocably ruin your life. I don’t think that it is over until it’s over. I also think that most people are good. I am pretty sure this is just my innate way of being.

I remember when my mom was first diagnosed with ovarian cancer, I honestly (and probably naively) thought that it would turn out to be for the best. My family would have a newfound appreciation for each other. This experience would bring us all closer. It seemed as though my mom would survive, so no harm no foul right?

Well she did not survive and it fucking sucked. That is when I started my on again off again relationship with pessimism. I also became intimately involved with pain, sadness, and grief at that time. Unfortunately, depression tagged along as well and remained with me for years to come.

After my mom died, I trained myself not to cry. How I was able to do this I do not know. But, I repeatedly told myself that there was no point in crying if no one was there to comfort you. Of course, just because my mom had died didn’t mean there was no one there to comfort me. I still had my two older brothers and my dad. But, that’s besides the point, and it also wasn’t the same. They weren’t my mom.

It took me years and years to be able to cry again. For those of you reading this – I do not recommend this at all! Crying is healthy!! It does not make you weak. It can be cathartic. It is a healthy way of releasing your emotions. Go watch a sad movie and cry! My go to movie for when I need a good cry is Life as a House with Kevin Kline and Hayden Christensen. Even if you don’t need or want a good cry it is an amazing movie and you all should watch it! I highly recommend it!

But again, I digress. One might think that being diagnosed with cancer at such a young age would make me pretty angry. I mean, yeah, part of me is pissed off. But for the most part I just feel this overwhelming sense of clarity and gratitude.

There is something eye-opening about being reminded of your mortality; of having this awareness of your fragility that makes you appreciate life more. Or at least that is how it has been for me.

I feel like I just get it now. I get what is important. Love is important.

I love my life. I love my family. I love my village of people that I am fortunate enough to be surrounded by. I love all of you for reading this blog and bearing witness to this journey that is my life.

I get that I still have so much to be grateful for. I don’t have to worry about where my next meal will come from or where I will sleep at night. I know that I am safe in my day to day life. I don’t even have to go to work for all of this! My husband goes to work and I get to stay at home with my baby boy all day.

Plus, I reluctantly am still optimistic. It would probably be easier if I wasn’t. My heart sinks every time I get bad news regarding my diagnosis/prognosis. But, I honestly just can’t help but feel hopeful.

I think it will be fine. And, even if it isn’t fine and I die, I honestly think it will still be okay. I don’t know. I just do. As my wise older brother says, it’s all just carbon anyways.

As I write this, I realize now that maybe I am not too reluctant about eternally being optimistic. But, it is too good of a title for a blog, so I’m not going to change it now!

That’s it for now dear readers. I’m going to go enjoy the rest of my evening. I hope you all reading this enjoy the rest of your day as well. As always, love and light to you all.

Now that I am done with my course of prednisone, I will probably be posting more sporadically. My goal is to still do at least one post a week, but if you want to know when I post a new entry please add yourself to get email updates for this. Also, I seem to be reaching my new equilibrium with my new medication – the extreme exhaustion I wrote about last week seemed to be more from a crash that resulted from finishing my prednisone taper than from my new medication. Yay! The aches and pains I have been having have seemed to subside as well. But, you could all probably tell I’m feeling better by the tone of this blog entry! More love and light to you all!

Hi dear readers. It feels like it has been some time since I last wrote, although in actuality I think I posted on Saturday.

When I did post on Saturday, I failed to mention that August 10th was the 1 year anniversary of my initial diagnosis of breast cancer. I cannot believe it has been a whole year.

I vividly remember getting the news. If you are up to date on my blog, then you know that I wasn’t called by a physician, but instead a receptionist, who called to schedule an appointment for me with an oncologist.

I remember logging onto the electronic medical records and looking at my own pathology report from the core biopsy they had done the day earlier. I was sitting on the blue couch in the living room, with my laptop resting on my legs.

My husband was gone for the day. He had left the day prior to go to his friend’s lake-house for the weekend. He and some of his friends make a pilgrimage out there one weekend every summer. I wouldn’t tell him the news until he came back the next evening. I didn’t want to ruin his trip. His last trip before the world came crumbling down upon us.

When I did finally tell him, he just uttered “no.” I can still hear it. It broke my heart, but I had to be strong. I’ve always felt like I have to be strong.

Back to that day; the day that I found out. I cried. I sat on the couch, with my pregnant belly distended in the air, and I cried. I cried and I cried and I cried.

I cried the way you do when you are a child. When you gasp for air because you can’t catch your breath. I used to call that kind of crying “animal sounds” when I was a kid. I fundamentally understood that it was a vestige of our animalistic nature.

I didn’t cry as much when I found out the cancer had spread to my lungs. I don’t even remember the date off the top of my head. A quick look on my calendar in my phone tells me that it was August 1st, 2019 – the date of my CT guided FNA.

There wasn’t the same shock value when I found out it was stage four breast cancer. I already knew there was a high chance of recurrence. I already knew this was a possibility.

I didn’t even get a full year before I found the cancer had metastasized. I didn’t get any period of remission or break in treatment. But, that doesn’t matter. None of it fucking matters. The only thing that matters is that I live, which of course I have very little control over.

Our friend’s two daughters had a birthday party yesterday. They had one last summer, too. Both, unfortunately, are temporally marked in my head by their relation to my diagnoses. First breast cancer stage 2, now breast cancer stage 4. I told my friend that at this rate I will be dead for the girls’ next birthday party.

I hope that isn’t the case.

Love and light to you all!! Don’t let this post fool you! I am not super duper depressed and I am doing just fine! I am significantly less exhausted than I was when I wrote the Tired post and my back isn’t aching as much – thanks to scheduling my Tylenol doses. Just writing this helps me work through all this S.H.I.T! And, hopefully it helps all you readers, too! More love and light to you my dear readers! Until next time!

Okay readers – brace yourselves – we are about to get a little trippy. Or as my husband and I would say – I am about to get a little hippie dippie.

Up until my last post, some of you readers were probably surprised by how well I have been doing considering my diagnosis. Some of you may even think I am in denial. Not that it really matters, but I am not in denial. I am well aware that my time on this earth is limited.

The fact of the matter is, though, that it is hard to feel like you are dying when overall you feel healthy and well. Which, up until a few days ago I did.

Having cancer is a funny thing – not funny haha more like funny hmm. At first it doesn’t typically make you feel ill. It is not until the cancer cells have reached a critical mass in your body that it starts affecting you symptomatically. For example, if your cancer cells spread to your bones – at some point you will have debilitating bone pain. If they spread to your lung lining – like it appears that mine have started to – you can have some serious pain with breathing.

I did have pleuritic pain, which is the fancy medical term for pain with breathing. That is what initiated the testing that ultimately showed my cancer had spread to my lungs. It is better now – either because of the steroids I took for 30 days or ideally because the medicine I started on Saturday is working and causing those cancer cells to undergo apoptosis or die.

Anyways, this is all a lot of words to say that when I physically feel fine I typically mentally and emotionally feel fine. My social worker/therapist and I talked a lot about this during my chemotherapy infusion sessions. On the days where I was cooped up in my bedroom unable to do anything but sleep or watch TV I was angry and sad. I was depressed on those days. I felt closer to death. I felt more hopeless. But, on the days where I felt well and was just a normal mom taking care of her baby boy, I felt happy and hopeful.

How you physically feel affects how you mentally and emotionally feel. This should be common sense, but at least in my experience, until you live it firsthand it is hard to wrap your brain around. Or I may be dense – both seem equally likely to me.

This connection is beaten into medical students’ brains during their four years of medical school. Or at least this seemed the case at my specific medical school. I went to an osteopathic medical school, where they focused more on the mind-body connection. I think that this is becoming increasingly more mainstream and is a topic at all medical schools these days.

Anyways, how you feel affects how you feel. My husband experienced severe sciatic pain the first few months of my son’s life. This was highly annoying to me, because not only did we have a new baby, but I was enduring cancer treatment. The pain seemed to be relentless. It exhausted my husband and I think it depressed him as well.

Now that I am experiencing back pain, likely from this new medication I am on, I have a newfound empathy for what he was going through. Back pain sucks! It is also very common. I think it is one of the most common chiefs complaints for a primary care physician to see.

I find it interesting that most of my symptoms from chemotherapy are pretty mundane. They are not unique to me. Back pain certainly isn’t. Nor is fatigue. I saw both in my short time of training. I tried to be compassionate, but at the same time in my head I was thinking well it can’t be that bad. Just take some Tylenol. Just sleep a little bit more. Buck up. Pull yourself up by those bootstraps!

I don’t sound very empathetic or compassionate. I am ashamed to admit this, but I think honesty is important. Accountability is as well. If I knew what I know now I like to think that I would have been more understanding. It is hard to be in a good mood when you are in constant, unrelenting pain. I get this now.

Looking at me you wouldn’t know that I am exhausted or that my back constantly aches now. You probably wouldn’t even know I’m a cancer patient. My hair has grown to a length that it looks like I have a pixie cut that is on purpose.

I have a chronic, invisible illness. There are many of these. To name a few: rheumatoid arthritis, type I diabetes, crohn’s disease, fibromyalgia. The list goes on and on. Many people aren’t up front about these chronic illnesses because they don’t want to be treated differently. Maybe they don’t want to think about their illness. It’s their prerogative.

It is interesting to me though, that my symptoms are in no way unique. The only thing that is unique is that I may die sooner. Or I may not. No one really knows. My oncologist doesn’t know. I certainly don’t know.

I don’t want to get too preachy. But, please just bear with me for a second. Maybe we could all be kinder to one another, because we don’t truly know what is going on beneath the surface. As my dad would say, we don’t know what demons another person is fighting.

You all certainly didn’t know what I was going through until less than a week ago. Sending love and light to you all. Until next time dear readers.

If I am going to be truly open and honest with you dear readers, then I have to share the bad with the good. And, that is what I plan to do. So, I will tell you all that today and yesterday I have felt tired.

I like to put things in perspective – so let’s do that. I am familiar with feeling tired. I have completed an internal medicine residency, I was pregnant for 37 weeks (many of those weeks were during the tail end of my residency), and I am a mother to an 11 month old boy. Oh, also I have undergone some serious chemotherapy, while caring for a newborn no less. I almost forgot that part!

Okay, so I think I am qualified to talk about the subject of feeling tired or being fatigued. Side note, fatigue is one of my least favorite words. It also happens to be a side effect of seemingly every single chemotherapy treatment. Ugh.

I have been fortunate that I have tolerated chemotherapy quite well. To the point where my oncologist always seemed surprised when I saw her and told her that I, in fact, felt fine. She probably thought I was lying. I wasn’t… well only as much as I was lying to myself.

Let’s delve into that a little bit. I expected to become a non-functional zombie during chemotherapy. Honestly, because that is what I mostly remember from when my mom was sick. A lot of what I remember from that time was my mom sitting in the green chair in my parent’s bedroom watching TV. I have one vivid memory of her sitting in that chair and watching The Simpsons. She didn’t even like The Simpsons!

Those of you that knew my mom know that she really didn’t watch TV much. This was highly out of character for her. My dad told me that in reality my mom only did this on her bad days, which was only three days out of every couple of weeks. It’s funny how memories work, especially our memories of our childhood.

Anyways, back to me! I was pleasantly surprised when I learned that I was only out of commission for a couple of days with each cycle of chemotherapy. I would rest when I needed to rest and then I would go back to doing everything I would normally do. So, from my perspective, I was doing fine!

The exhaustion from each type of chemotherapy was different than the sleep deprivation I had accrued during residency, or the fatigue I felt during pregnancy.

For those of you that are curious, adriamycin, which is the most potent chemotherapy I have been exposed to at this point, made me feel the most fatigued. I would sleep an excessive amount and even when I couldn’t or didn’t want to sleep anymore I was still tired to my core. My social worker/therapist told me that this is pretty typical for that specific chemo drug.

Fortunately, I am done with that chemotherapy. It also looks like it didn’t fucking work, so I will never have to take that chemo again. Yay for me!

This Saturday I started a drug called Olaparib/Lynparza. It is a PARP inhibitor and has been shown to be effective for some women with breast cancer that are BRCA1 mutants, like myself. Let’s hope it works! If I could use emojis on this thing – I would put a fingers crossed emoji at this point.

Of course, one of the side effects of this new medication is… you guessed it! Fatigue.

Well, up until yesterday I felt great. Then yesterday my son woke up at 7 am and I didn’t have it in me to wake up with him. “Please just let me sleep for another hour” I begged my husband. He knows that unless I really need it I don’t ask for help, so he got up with my son and took care of him while he got ready for work.

At 8 am I forced myself to get out of bed, but I was still exhausted. Today is going to be a hard one, I thought. My husband asked if I needed him to work from home for the day, sensing that I was feeling off. Stubborn as ever, I assured him I would be fine and told him to head off to work.

I was not fine. I was dead tired. I hate that phrase, because it reminds me of death, but it really does describe how tired I was.

Every mom knows how hard it is to take care of a baby when you yourself are exhausted. I mean thats what most of motherhood during the first year is. So, this is not unique or specific to my situation.

It is also probably not unique or specific that on those days that the mom is tired, the baby seems to act out more, most likely in response that mommy isn’t being nearly as fun as usual. My sweet baby boy kept going towards things in the house that he knows are off limits. The vent that for some reason is in the living room floor was very interesting to him yesterday. He is surrounded by a room-full of toys, yet that vent and the cat toy are typically what he wants to play with.

He also wanted to be carried around more than typical yesterday. At some point in the morning I asked a close friend to come and watch my baby so I could get some rest. She said sure, she could be there around noon.

Okay, I just have to make it to noon, I thought. I can do that. At noon, my friend texted and said on my way. She lives about an hour away. My son, A, had yet to go down for a nap. I lost it. Many expletives were said. I did not spell them out. You guys, I was really tired!

Have you noticed that you are more emotionally labile when you are tired? I have! I told my friend not to bother. I was too angry at her at that point. I know this is irrational, she was doing me a favor by coming to help. I didn’t spell out how much I needed that help. I assumed just the fact that I was asking indicated that I really needed her. My social worker would tell me that you have to spell things out – people can’t read minds! She is right!

Anyways, I was tired and cranky. Fortunately, after telling her not to bother I gave my son a bottle and he fell asleep. Yes!!! Now I could sleep. I went to bed and went straight to sleep. Well no, I fucked around on my phone for a bit and then went to sleep. I mean, I’m a millennial, what did you expect from me? I’m addicted to my phone.

I got an hour of glorious sleep before my son woke up. Oh okay, I feel better, I thought. That lasted for maybe twenty minutes before I felt exhausted again. Well, this isn’t good. My husband and I had been texting throughout the day and he offered to come home early. I accepted his offer, which is also very unlike me.

He got home at 4:45 pm. I know this because I was watching the clock anxiously waiting his arrival. He gave me a hug and I went straight to bed. I slept another 3 hours. I woke up and I still felt tired.

Fuck, how am I going to do this? I don’t know. I went to bed at 10 pm last night and woke up at 6:45 am today. My son, A, woke me up. Fortunately, my sister in law was already planning on watching A today, so I had built in nap time for the day. I am writing this after my 3 hour nap. I still feel tired.

I am hopeful that part of this is from the sleep deficit I racked up while on prednisone (for a whole month) and the subsequent insomnia that followed. I am also hoping that once my body gets acclimated to this new drug the fatigue will subside. Most women who have taken this medication say the first month is the hardest – I will need extra sleep. After that it gets better.

Okay, I can survive for a month. You can do anything for ten seconds – shout out to anyone who gets that reference from The Unbreakable Kimmy Schmidt!

Well, you all are probably tired from reading this long post. And, like I have said, I’m also very tired.

Love and light to you all. Follow me on Twitter @reluctantoptim. Also, if you want to get email updates of when I post a new entry – you can sign up for that on the home page!

I went live with this blog a little over 24 hours ago and I have been floored by the outpouring of love and support that I have received since then. Wow! Thank you! It means the world to me!

Some of you dear readers have praised me for my writing, which is wonderful to hear and read. It is also slightly surprising, because I’m pretty sure I never learned grammar? I straight up have no recollection of learning grammar during my childhood or adolescence. I know that must be wrong. Fellow Norfeldt Elementary School, King Philip Middle School, and Hall High School alum, please tell me that my memory is wrong. I mean we must have been taught grammar!

Anyways, grammar aside, I can write because as the title says “I got it from my mama.” Those who knew my mom, Carolyn, knew she was a talented writer. She occasionally had a column in the Hartford Courant. In one of them she wrote about using pesticides on lawns. For those of you that remember her, you may recall that this really riled her up! I was raised never to walk on a lawn that used pesticides! It probably would give me cancer!

Well, fuck. I got it anyways, but cancer isn’t the topic of today’s post. Not really.

No judgment to anyone who uses pesticides on their lawn. My mom wouldn’t approve, but I don’t have strong feelings on the topic. Although, if you do use pesticides on your lawn, I will not walk on the grass. I was raised not to!

Honestly, she may not have even written an article on this… I think she did but when I google her name the only article that shows up is “Literacy Program Helps Adults Read, Succeed.” If you are interested in reading this article, this is the link.

Now, she was a beautiful writer! She was also a beautiful person – inside and out. At some point, I will talk about being a BRCA1 Mutant and how I also got that from my mama, as well as my mama’s mama. But, today, I just want to talk about how awesome my mom was.

She was really fucking awesome. Side note, she would certainly not approve of how much I am swearing in this blog, or in general. A good friend told me that my son’s first word will be fuck. Hopefully it won’t. I have started to spell out swears when I say them now. I still get that nice emotional release, but hopefully my son won’t swear excessively like his mama does.

Okay, back to my mom. Have you noticed I get distracted a lot! My mom was the best. She was loving and kind. From as long as I can remember I wanted to be just like her. I wanted to be a writer like her and a mother like her.

I was an anxious child and have grown into an anxious adult, but she would always know how to calm me down. All she had to do was say “everything is going to be okay” and I would immediately relax. I knew at the end when she was very sick and she didn’t say this that things for the first time really weren’t okay.

All of my best attributes, I believe, I got from her. I am kind, because she was kind. She truly wanted to help others. My dad told me that once she received an inheritance check for about $1,000. Instead of spending it on herself, she donated it all. Dad, if you are reading this, I got a lot of awesome attributes from you as well.

When my mom got sick she started writing a book. It was never published. I don’t think she ever finished it. I have read a few pages of it years and years ago. It was beautiful, just like all of her writing was.

My mom taught me one simple lesson about writing. “Write from the heart.” I’ve noticed that I am happy with my writing every time I follow this advice.

It has taken a lot of therapy and time to make peace with my mom’s death. You know, as much as you can make peace with your mom dying when you are eleven years old.

Although, I am not religious, I am spiritual. Bleh, I’m such an annoying millennial! The way I think about it is this. My mom died, but she lives on in me. In some of my mannerisms, in my appearance, and in my actions.

When she died a little piece of her remained in my heart. And honestly, I think a little piece of my heart went with her, wherever she may be. That is why my heart hurt so much when she left. Part of it was ripped away to go be with her. That way we are always together; always connected.

Moms, you will understand this. On a visceral level; you know this. When my son was first born it felt like a part of myself was living outside of my body. I think that is how most mom’s feel. I’m sure that was how my mom felt.

Let’s leave it at that. Love and light to you all.

Also, for those of you that personally reached out, thank you thank you thank you! I loved it all! I will get back to you, but I typically like to write something meaningful back and that takes a bit of time! I truly appreciate it all, though!

More love and light to you all. Remember, you can follow me on Twitter @reluctantoptim.

My husband and I have a phrase that we say to each other. It is that we aren’t selling the horses yet. This phrase needs a bit of background to understand. No we do not have horses. We do have two cats and if you worked with me during my residency you probably saw more than your fair share of cat pictures. Sorry about that or you’re welcome, depending on where you stand on the topic of cat photos!

Since I got diagnosed with breast cancer I have joined countless Facebook support groups for women with breast cancer. They all have a different schtick – my favorite one is called kick ass cancer mamas. It is a group for women who were diagnosed with any sort of cancer during pregnancy or in their first year postpartum. Last I checked there were more than 600 members. That both warms and breaks my heart simultaneously. Another group is specifically for women with triple negative breast cancer, which is the type of cancer I am living with.

Women post all sorts of things in these groups. We post photos of our children, ask questions about side effects and treatment plans, complain about our significant others… you name it, we talk about it. This one woman, who will remain nameless (out of respect and because honestly I don’t remember her name at all!), wrote a panicked post one day. She basically said that since she had Stage 1 triple negative breast cancer, she was definitely going to die, so she decided to sell her horses so they would be able to live a good life.

Those of you reading this are probably slightly confused. Huh? She has stage 1 breast cancer, that should be curable… why does she think she is going to die? I could go into a psychoanalysis of why she posted this. Trust me, I have thought about this and talked to my husband about it at length. Originally, I was diagnosed with stage 2 breast cancer and was told the intent was to cure. Note, that this is not the same thing as saying that this is curable. But, I digress.

Some women were supportive of her post – they told her not to worry, there was no reason to believe she wouldn’t live a long and otherwise healthy life. She ultimately was kicked out of the support group, my guess is for causing unnecessary drama and frightening the “masses.” Having stage 1 breast cancer seems pretty awful for people without cancer, but for people with cancer it is like winning the lottery. Oh, your cancer is only stage 1, lucky you!

This metaphor has really stuck with me, though. It was probably the right decision for this woman to sell her horses – it seems like a lot of work to take care of them, and she was being treated for breast cancer while still working a full time job as an ICU nurse. But, for me, I’m not ready to sell my horses just yet.

This has come up multiple times over the past year. After my mastectomy, when my husband and I learned that I only had a partial response to the brutal chemotherapy I had endured and there was still cancer present in 2/20 lymph nodes, we decided not to sell the horses. When we learned, furthermore, that not only was my cancer triple negative, but also metaplastic with squamous features – a subset of breast cancer that is even more aggressive than the already aggressive triple negative, we decided it was still not time to sell the horses.

I did fly down to MD Anderson to meet with one of the foremost experts on metaplastic breast cancer at this time. She suggested I participate in a double blind study that had a 50/50 chance of me getting a parp inhibitor as opposed to a placebo. I decided not to participate in the trial and go with the standard of care treatment, again, because it wasn’t time to sell those horses. There was no reason to assume that I would progress or recur, although I knew there was a 50% chance in the next 3 years that this would happen.

When my PET scan came back “highly suspicious” for metastatic disease, it seemed like maybe it would be time to sell the horses, but it still didn’t feel right. There are still treatments available and I still overall feel well, other than the pleuritic pain that I can mostly ignore.

I have an 11 month old son, so I don’t think it will be time to sell the horses until I really have no other options. It would probably be different if it was just me. If it was just me, I might have sold those horses from the beginning and spent my time drinking dirty martinis on a beach in Mexico. I don’t know, though. I suspect that it is in my nature to not sell the horses until the bitter end. It’s not over until it’s over.

I have plans for if and when it comes time to sell the horses. Where they will go. More specifically, where I will go. I am not disillusioned that my prognosis is poor. I know that if it comes to it I will transfer my care back to where I trained. If I get to the point where there are no more treatment options, I will return to my roots of residency.

I want to be buried in a Jewish cemetery, even though I am not religious and would describe myself as an agnostic jew. Are there even Jewish cemeteries in Ohio? I don’t know. Hopefully I won’t have to find out.

The point of this post isn’t to get too morbid. Although that ship may have already sailed. The point of this post is that I am not going anywhere just yet. Any of us could get hit by a bus at any moment, or more likely be killed in a mass shooting. I’ve broadcasted that I am Jewish twice now, so that may become even more likely.

Sometimes we tend to eulogize those living with illness before they have even passed. In a way it is nice, who doesn’t love hearing how wonderful people think they are! I certainly love it! But at the same time, I’m not dead yet, and I don’t plan on dying anytime soon. I’m not selling those fucking horses yet. Or my cats. Don’t even think about me selling my cats.

I told my oncologist this metaphor when we met to discuss the next game plan. I looked at her in the eyes and told her that I need her to tell me when it is time to sell my horses. I will let you all know if and when that time comes. Hopefully it won’t be for another 50 years and we will all be living in Canada by then because of all the climate change.

Until next time dear readers. Love and light to you all.

Fun fact, oxytocin is better than fentanyl. That is in my personal experience. I experienced both yesterday.

If you are up to date on my blog, you will know that I had my CT guided FNA of a nodule in my right lung yesterday. The interventional radiologist that performed the procedure was kind, gentle, and lovely. But the procedure still hurt like a mother.

The area was numbed with lidocaine and initially I felt no pain, but once the needle got to the nodule, I experienced one of the worst physical pains of my life. To put this in perspective, I have gone through over 24 hours of induced labor, had a C-section, had a laparoscopic hysterectomy/bilateral oophorectomy/salpingectomy (what a mouthful!), and a bilateral mastectomy. I have been poked and prodded at over the past year, so I am somewhat familiar with physical pain. I am also familiar with emotional pain, which I think is far more potent.

Anyways, for physical pain, this was definitely top five. Interestingly enough, well at least for my medically inclined readers, the pain was in the front of my chest, while the needle was placed in the posterior portion of my ribs. My doctor thinks that the nodule is sitting on an intercostal nerve – I am pretty sure he was right.

“Ow, ow, ow” I said. The pain burned and stung in my anterior chest. My whole body tightened. My port had been accessed for this situation, but the fentanyl wasn’t coming fast enough. Since I was calm before the procedure, they didn’t pre-game me with fentanyl and versed.

After what seemed like eternity, but was probably at most a few minutes I received 25 mcg of fentanyl. Oh, this is why drug addicts do drugs. It feels amazing. I went from one of the most excruciating pains of my life, to feeling calm and pain-free, and just overall lovely. In layman’s term, I was pretty fucking high.

Dr. G got the sample and a pathologist came down and looked at it under a microscope to make sure they got what they needed. They did. Dr. G took another pass with the needle to ensure they got enough tissue to test. This time there was no pain. I floated away in the fentanyl. Well, not really. Obviously.

If you are paying attention, like I was, even though I was floating, you will say oh, they got the tissue they needed? Remember, the tissue is the issue. Does that mean there is cancer in that nodule?

Of course, I felt stupid asking this – I should know this! I am a doctor! Fuck that. I am a patient right now. I asked tentatively, “does this mean that there is cancer in my lungs?” Dr. G reluctantly answered “yes they saw malignant cells, I am sorry.” “It’s okay.. thanks…” I replied. What else could I say? It isn’t his fault I have cancer. It isn’t anyones fault. It just is.

Let’s take a little detour. Did you notice that he didn’t say “yes it is cancer”? I noticed. In all fairness he knew that I am a physician. When he whipped out my CT scan and started pointing out the aorta and which side was left and right I informed him that I am a doctor. Not to be rude, I just didn’t want to waste time being taught something I already know. It was boring. Yeah, I’m not great at looking at CT scans, but I know where the heart, lungs, and aorta are. Thanks LECOM!

Anyways, he said “yes, they saw malignant cells.” They meaning the pathologist. No physician has ever uttered the words you have cancer to me. No medical person has ever told me you have metastatic cancer. I doubt they ever will.

As a physician, I get it. It sucks giving bad news. We want to help and heal people. We don’t want to tell them they are dying. I have been guilty of this as well in my short time of practicing medicine. We hedge, because we want our patients to have hope. And, because we are shit at giving bad news. Not all of us, but on the aggregate we are.

Even when I was first diagnosed (8/10 will be the one year anniversary of my diagnosis), no one told me I had cancer. Do you want to hear how I learned the news? My core biopsy was the day before (8/9/18) and on August, 10th, which was a Friday, I got a call from the oncology office.

“Hi” the receptionist said… “Dr. C has opened an appointment for you for Wednesday.” My heart sank. Well fuck, I guess it’s cancer, I thought. “Dr. C. is an oncologist.” said the receptionist. I already knew this. I had worked with him for a week on my hem/onc rotation during my intern year of residency.

An actual physician hadn’t called me to give me the news of my cancer until that next Monday. By that point I had already signed onto the electronic medical records and looked at my pathology report. When my breast surgeon called me to inform me I said “I know.” She never had to tell me it was cancer, I already knew 72 hours before.

I could be angry, but honestly I just think its funny. I’d rather laugh than cry. Plus it hurts if I cry. Did I mention I had a needle stuck into my chest yesterday? Back to that… the fentanyl was lovely and it was confirmed that the cancer had spread to my lungs.

I highly recommend getting bad news while high on fentanyl – it really eases the blow. My poor husband was not so lucky and looked far more depressed than I felt.

I was more concerned with the fact that the nurse wouldn’t let me sit up – I had to lay flat for 1.5 hours following the procedure. I couldn’t go to the bathroom to pee. They wouldn’t de-access my port. I was stripped of my dignity and autonomy – I was transformed into a patient. They wanted to avoid a pneumothorax, or a collapsed lung. I get it, but it still fucking sucked.

I got a chest x-ray at 10:30 that didn’t show a pneumothorax and I was slowly transformed back into a human being. My port was de-accessed. I was able to get dressed. I could go to the bathroom! I was given home-going instructions. One of the last things I was told was – no heavy lifting.

Wait, what!! No one mentioned this to me until 5 minutes before I left the hospital. But, I have an 11 month old son! I lift him more times every day than I can even count! He is a big boy and happens to be over 20 pounds.

My nurse, who was lovely and kind, informed me that I really shouldn’t lift him for 24 hours following the procedure. I didn’t want to collapse a lung and buy myself 2 nights in the hospital, intubated no less. Well, fuck.

I could go into how wrong this is. To tell a patient this at the last minute. How if I didn’t have a helpful husband and mother in law to pick up the slack I would have had to I guess just pick him up and hope for the best. Yes, I could technically still hold him, but anyone who spends time with little children knows that you are pretty much lifting them in one way or another even if you try not to. My son will climb up on top of me and want me to lift him up. Try spending an hour with a 1 year old without lifting them, it’s really hard.

This is the worst part of all of it. Most people don’t really get it. My husband doesn’t get it. I should be upset that I have metastatic cancer. Don’t worry I am. But the more pressing thing is that I can’t lift my son for 24 hours. Which, to me essentially means I can’t take care of him for 24 hours. Which means I can’t see him for 24 hours. Because if he sees me he is going to be on top of me and then I will have to lift him.

During the evening, my husband read to my son and I sat on the couch with them. My baby boy crawled over to me and I let him snuggle in. I breathed in his scent, which is intoxicating to me. I held him close. I let the oxytocin spread over me. This is better than fentanyl, I thought. Oxytocin is better than fentanyl. I’d take it any day of the week.

That’s it for now dear readers. Until next time, love and light to you all.

First, do no harm or the Latin “primum non nocere” is a sacred and fundamental principle of medicine. Did you think there would be Latin in this blog? I didn’t! But here we are, dear readers! What a wild ride!

I am a board certified internist. I don’t get heart palpitations and sweaty palms writing this, because although I am trained as a physician, I don’t practice medicine. For those of you who know me, which I think is all of you reading this blog at this point, you know how seriously I take this phrase.

It is part of the reason that my heart rate would increase into the 120s when I was an intern. If I’m being open and honest, it is why my heart rate would transition into sinus tachycardia during more of residency than I would care to admit.

I take this saying to heart, no pun intended. Let’s not increase the suffering of those who are already suffering. Don’t kick them when they’re down.

This seems like a simple principle, but in reality and in practice it is quite complex. The medical system is difficult to navigate – both as a medical provider and a patient – I know because I have been on both sides of this equation. Also, I know this because I am confidently stating I know this, so don’t feel like you need to double check me on this.

Side note – It drives me crazy when a person confidently states something (it can be anything really) without actually knowing what they are talking about, but because they are speaking confidently everyone believes them. Pay attention – this happens all the time. It happens in medicine, in politics – hello President Trump, and in mundane, everyday life.

Anyways, how do we accomplish doing no harm? How is a physician not paralyzed by this concept? I’m asking for a friend. Seriously! Why can’t I use emojis on this thing!

If you are a human being that has traversed the medical system, or know of a human being that has, you probably know that we aren’t doing a stellar job of this. Harm – both big and small – is happening all the time.

I’ve lost track of how many women in my many FaceBook support groups were told by a physician that their lumps couldn’t be cancer. They were too young, or too pregnant, or it was a blocked milk duct. Some of those women went on to develop Stage IV breast cancer because no physician took these women seriously until in some cases it was too late. I’m fairly certain that some of those women are dead.

Well fuck. That is some serious harm.

My mentor would say that the ego is the problem. He would use the word hubris. But, he is much smarter than I am! Again, it comes back to if someone is confident most people will believe that person, regardless of if they are right or wrong. This is probably why another commonly repeated saying in medicine is “trust but verify.” Trust that your superior knows what he or she is talking about, but look that shit up.

When I started writing this post, I planned on talking about the inefficiencies and inadequacies of the medical system, but I think that is still a post for another day. Don’t worry, you will be regaled with tales of my waiting on hold to make appointments or waiting for the fine needle aspiration to confirm metastasis another day.

By the way, that is happening today. Fingers crossed it is tuberculosis!! Again, emojis would be great! It is going to be so embarrassing when someone points out to me that I can in fact use emojis on this thing!

Let’s pray that the interventional radiologist does no harm to me today, in the form of a pneumothorax (I’m told this is fairly unlikely – but I have not verified!), and that the PET scan was a false positive, and I am actually cancer free!

And if you are indeed taking the time to pray for me, please pray for all who suffer and are less fortunate than me. Pray for the people who go to bed hungry or don’t know love or who have been abused, the list goes on and on. Pray for the suffering – it’ll only take two seconds – trust me!

Until next time readers, you can still follow me on twitter @reluctantoptim. Light and love to you all.