The Conundrum of Cancer: or, ruminations of the past year

A year ago, I was diagnosed with endometrial cancer. I’ve been trying to sail to a shore of solid ground on which to stand, yet, I am still sitting in an ocean with the emotions and feelings of diagnosis, surgery and prognosis. Or rather, I am finally learning how to lean into them. 

If seen on the street by a stranger, that person wouldn’t know what ails me. Most people who know me don’t know, either. There is hair on my head, flab and rolls on my body, color in my cheeks, and I’m still alive. It’s easy for others to forget. For me, the reminder of my condition comes with every breath.

From the outside, there are no discernible changes, other than a weight-gain that will take a year or two to lose. I have the same job, live at the same location and have the same friends. I do have a new car, but that was inevitable as the Saturn has over three hundred thousand miles on it and was becoming unreliable. I guess that means I, too, have over three hundred thousand miles, and maybe I am equally questionable. There IS a fog that has come with menopause that is more noticeable to me than anyone else. At least, that is my hope.

Planning for the future has mostly stopped. Leaving Sonoma County and California are no longer considerations. Nor is finding a job outside of my current organization. Medical insurance has become precious—perhaps too precious, but I’m not willing to let go of that ever-binding ring of security. My writing feels solid… or at least, the practice seems so. My priorities are creativity, health, and loved ones. Travel, if it’s affordable and manageable. I go to work, run errands, exercise when I can. There is a simplicity to my life that creates a path to my center.

Still, there is an indescribable unease. Unheimlich, but not uncanny—English doesn’t have a true word. Am I serving the world by sitting on a boat in the middle of the sea? Am I serving myself? I am writing and that is my calling… is that enough? Or is that the problem? I have been anchored for too long with being too much or not enough. Neither are relevant, but they act as phantom limbs, mooring me. I know this tension will go away, but there is a fine balance to being at home with oneself, and it’s easy to capsize.

A friend and I were talking about feelings the other day. She asked if my life was creating joy and peace. I had to pause and consider the question. I don’t strive for joy and peace. Or bliss. Or happiness. They are no longer considerations. I strive to make my body healthy, and to put words together that sound good and convey meaning on a page. To eat well, exercise, go to work, and add value to my world. But I don’t aim for particular feelings. Sorrow lives in my chest, waiting for test results cause my lungs to catch and hold, a full moon lights my entire body, writing satisfies my fingers and soul. Loving and missing my daughter sometimes breaks my heart with their weight. Sitting on a boat in the middle of the ocean has given me time to be—with everything. There is no need to create circumstances—feelings and emotions are already there in being alive.

The Conundrum of Cancer: or, redefining self-care

Radical self-care doesn’t look like a spa day—it feels selfish and awkward, although I remain unapologetic in this practice.

It is sitting still on a boat for one, in an ocean of emotion and unknowing, with no land in sight. I peer into the water, scrying for glimpses of my future, and into the sky to find navigation. The fish, reflections, sun, and constellations remain silent. I do not know when I will reach shore or what I will find.

As I rock in my boat, I start to say yes to serving the world. I feel the gentle hand of My Muse on my shoulder, and in a quiet voice says, “No, not yet. You have to learn to serve yourself before you can return to serving others.” 

My Muse is a jealous muse, demanding that I honor her before all others. In the commandments she has placed into my hands, my writing comes first. I will not be dissuaded from this belief, no matter how hard the boat rocks.

An hourglass sits on the edge of the boat, but the sand doesn’t move. Loved ones on the shore leave footprints as they drift away, and I let them go. In solitude, I hear the story of my heart.

There is a wildness that hums and throbs where my womb used to be. I do not know its name or nature, but I must feed and protect it through gestation. When we reach solid ground, this wildness will birth, then we will burn together in the boat, meld into one and fly.

The Conundrum of Cancer: or, sitting still in the dark

Years ago, after I had my first bout of depression, I wondered if that is what the Greeks meant by the hero’s journey: going into the darkness (labyrinths, hell), fighting monsters and demons, then coming back to the light, victorious. As I contemplate depression and cancer, I’m beginning to see the similarities. The bleakness. The inability to plan for the future. The obsessing. The lack of control. Feeling lost and disconnected. Knowing that I need to do something, but not knowing what it is. Traveling to meet Hades.

However, this journey is different from the one Greek men and demigods experienced. I may be floating down the Acheron into the Underworld, but I’m not pushing away or pulling into the boat the swirling figures in the water. Rather, I am quietly observing my demons with curiosity: cancer, familial relationships, failed friendships, heartbreak, depression, regrets, mistakes, sorrows, the past, the future. I am sitting still, lest I fall into the river and drown amongst the monsters of my creation. The boat keeps propelling me further into the unknown, and I’m not trying to turn it around or stop it—that would be futile and folly. This is the voyage I’m on, even though I didn’t opt to step off the dock.

The last time I saw my medical oncologist, he made a comment about me going back to my life after radiation therapy was finished. I didn’t tell him this, but there is no returning to my former way of being. My body and outlook have changed, and my priorities have shifted. The plans I made for this year have dissipated—at least, most of them. The two that remain, ironically, are my health and writing. And, ironically, both force me to sit still. Radiation leaves me fatigued, and it’s difficult to write while in motion. So, I wonder what lessons are to be learned, and ponder how to shape my life—do I dry dock and disassemble, or do I stay on the boat and flow with the currents?

This conundrum currently has no resolution. Charon is rowing, while I maintain balance. We still haven’t reached the light.

 

The Conundrum of Cancer: or, the D word no one talks about

I have cancer and I am depressed. Or maybe I should say, Depressed. I was doing okay with my diagnosis and recovery. Returning to work wasn’t ideal, but I was coping with the stress. And then I was told that not only was I anemic, but that my iron levels are low (half of the low end of the normal range). The thoughts that passed through my mind included, “FFS, not something else,” and “what if there is something wrong with my bone marrow—what if the cancer has spread there?”

I don’t know that anything is wrong with my bone marrow, but until March 1, I didn’t have cancer. I didn’t even consider it a possibility because my doctors didn’t mention it. Now it’s everywhere, even if it isn’t. And it’s depressing.

Granted, I didn’t start down this path suddenly after getting my test results. It began while I was home recovering: “What is the point of going through treatment? I’m going to make it through this, then in another year or two, it’ll be something else (this “something else” has been a consistent pattern since I moved to Sonoma County in 2000, but that’s a blog post for another time). Maybe I shouldn’t do the radiation and take my chances with the cancer. With any luck, maybe it will kill me and I can be done with life.” This thought started becoming more frequent, along with waking up every morning with a desire to stay in bed and cry all day. I didn’t, and I sought help, but that’s not the point.

What I’ve come to realize is that the world I live in, generally speaking, is concerned with the physical. When people ask me how I’m doing, what they are saying is, “how is your body after surgery,” and “how is the radiation treatment making your body feel.” My doctors never mentioned that cancer patients slip into depression and that I might want to pay attention to my emotions as I go through this process. Them and their staff don’t check in to see how I’m actually dealing with the experience of having cancer and being treated for it. Neither does anyone else. 

This isn’t a criticism or chastisement. People aren’t conditioned to ask about mental and emotional issues. It’s taboo and uncomfortable. No one wants to hear about the impact of depression for a wide variety of reasons. The only time there is open discussion about this subject is when a celebrity commits suicide. Beyond that, it’s quiet. Even as I type, I wonder if I should post this to my blog and share it, and I question my point and the relevancy of my words. However, I think that helping to create an awareness, and maybe a dialogue, is needed. I don’t know what the right phrasing is for someone to ask the question, but it still needs to be asked, sincerely and without judgement. Depression isn’t a weakness—it’s a symptom.

Addendum: This isn’t a cry for help, but more of an observation that depression does not get talked about in the context of cancer, or anything else.

The Conundrum of Cancer: The Prologue

I wasn’t going to write about how this all started—it seemed irrelevant. Then I was asked about my symptoms by a friend because she was experiencing symptoms similar to mine. However, this prologue is about more than just the symptoms—it’s the entire experience with the medical field leading up to diagnosis. I don’t know if this will help any other women or not, but here is what I know to be true about my circumstances. If you don’t want to read all the way through, I’ll bullet point my specific symptoms and thoughts at the end.

In 2013, my heavy periods became increasingly heavier. Given my age (45), this seemed appropriate. My uterus was doing its job and preparing my body for menopause. No one thought otherwise. Sure, I had some abnormal paps, caused by HPV, but not the HPV that causes cervical cancer.

In 2015, my gynecologist at one facility wanted to do a colposcopy because of some abnormal cells were found. She was quick to say in her email that the cells were not cancer. She didn’t even suggest they were pre-cancerous. I scheduled, rescheduled around my menses, rescheduled around a medical emergency she had, tried to schedule again, but by then she left the organization. I gave up and knew I was changing medical insurance anyway, so I didn’t worry about it.

In late 2016, I started becoming increasingly fatigued, to the point that by February 2017, I was scheduling a doctor’s appointment. Unfortunately, I couldn’t be seen for an annual checkup until April. So, in mid-February, I stopped by the doctor’s office to drop off my new patient paperwork and to see if I could be seen sooner—I was barely able to function. My primary care physician (PCP) wasn’t available, so I opted to see the nurse practitioner a few days later. When I described my symptoms, she thought it was likely my thyroid, and ordered a full panel. There were no concerns about my periods. A day later and two hours after I went to the lab for my blood work, I was called by a now slightly panicked nurse practitioner, who told me,“there really was something wrong with me,” and that my hematocrit and hemoglobin were too low. She sent me to the emergency room. From there, my blood was tested again, and I had a stool sample tested, as well as an abdominal sonogram and vaginal ultrasound. The only thing found was a thick lining of the uterus. I moved forward with my two-unit blood transfusion and it was recommended to have my endometrial lining biopsied. My pap in April came back negative, but my PCP wanted me to have a colposcopy, along with the other biopsy. I was referred to a gynecologist for both of the aforementioned procedures. However, this doctor’s main concern was my anemia and bleeding, so she recommended an endometrial ablation to stop or slow down my periods. She was less concerned with the biopsies.

From there, it took months to schedule the ablation. The surgery scheduler would call with one date, which inevitably didn’t work with my schedule or my cycle. I was told I’d be called back within three or four days with a new date, then I’d never get a call. So, I called a week or two later. And on and on. My PCP suggested I ask about the anesthesia and whether or not the procedure needed to be scheduled around my cycle. The periods weren’t an issue, but the anesthesia was and I was trying to schedule around work. And then I got tired of the phone tag and lack of responsiveness. I gave up for a while. And then the fires happened in October. By then, I was over having heavy periods and always needing to wear a pad. And then I lost two of my staff in early December.

Finally, on 27 February 2018, I went in for the ablation, and two days later I was diagnosed with cancer.

Here were my symptoms, prior to diagnosis:

  • Heavy periods for at least one to two days. Sometimes changing thick pads a couple times an hour, sometimes a little less often. The entire period would last around 8 days.
  • Cycles where I would go through about 20+ pads over the course of two to three days.
  • Spotting between periods over the last year or so.
  • Sloughed pieces of tissue that were not endometrial lining.
  • A few skipped periods.
  • A watery-bloody discharge between periods, starting November 2017 or so (this is a definite symptom of uterine cancer).
  • Anemia (to the point of needing a blood transfusion)
  • Over-production of estrogen (although I didn’t know this was happening or was a symptom)

Not one medical professional, over the course of five years, suggested I have my hormone levels checked or told me that abnormally heavy periods are caused by excess estrogen, and excess estrogen causes cancer. Now I know.

If you are exhibiting these symptoms as a perimenopausal woman, and you are ignored or are getting blow-back from your doctor, push for hormone tests and biopsies anyway. Bleeding after the onset of menopause is abnormal, so cancer is usually caught sooner. If your doctor isn’t concerned, make sure she/he is.

The reason I shared the entire story was to help other women understand how long it took to get my needs met, and that my symptoms, albeit not entirely ignored, didn’t concern enough doctors. If I had pushed harder and been seen sooner, I may have been in the pre-cancerous stage, or early cancer stage. Instead, I have had a radical hysterectomy, and will most likely be undergoing both chemotherapy and radiation, with treatment starting soon. My chance of recurrence without treatment is 25%. If any of this helps one woman under the age of 55 (or over, if need be) get diagnosed early, then all of this will have been worth it.

The Conundrum of Cancer; or, initial thoughts on a new lifestyle

I’m still sorting out the details of my new lifestyle, which started on March 1, 2018. Prior to that date, I didn’t have cancer. At least, I didn’t know about it and didn’t consider it a possibility.

Specifically, I have endometrial/uterine cancer. Even more specifically, I have endometrial adenocarcinoma. Endometrial and uterine seem to be interchangeable. They sort of are, I guess.

From March 1 through April 9, I went from diagnosis, to consult, to hormone therapy, to CT scans, to surgery (radical hysterectomy and lymph node dissection). What started out as a two centimeter, FIGO grade 2-3 tumor, turned into a two centimeter, FIGO grade 2 tumor after surgery. The final pathology I received on May 3, 2018, shows cancer cells in my blood vessels; and a tumor that was five-plus centimeters and FIGO grade 3 (most aggressive). And yet, my cancer is Stage IA (almost as good as it gets—one location, no spread). The irony isn’t lost on me.

I need radiation to reduce the chance of recurrence (see above for the three high-risk factors) from 12-15% to 6%. The research I’ve done on cisplatin (chemotherapy treatment) suggests that it is best taken off the table and left on the fence where my gynecologic oncologist put it. I haven’t gotten a third and fourth opinion from the radiation and medical oncologists yet. Based on my research of endometrial cancer, the prognosis is poor with recurrence.

In starting my new lifestyle, I’ve also learned over the last two months:

The healthcare system is indifferent. It cares about patients when they are in front of a doctor. Otherwise, people fall through the cracks like sawdust on a shed floor. That’s not to say all doctors are detached. Some are caring, supportive and available, like my primary care physician. However, if I hadn’t advocated for myself as strongly as I did, I’d still be waiting for surgery, and closer to dying from cancer.

I do not refer to cancer by anything other than its name. It’s not the “Big C,” and I’m not at war, fighting or otherwise battling this disease. It doesn’t suck and I don’t hate it. My body made this when cells decided to live instead of die. As one with a rebellious nature, I have a begrudging admiration for these cells, while being displeased with their behavior. I will eradicate them if I can.

I measure life in terms of quality, not quantity. This became clear when I filled out and signed my advanced directive. It was validated again when I researched cisplatin (kidney damage and hearing loss are two of the potential lifetime side-effects). I’d rather live 10-20 fantastic years than 20-40 years where I feel awful all of the time. This is non-negotiable.

Most people have a hard time talking about death and disease, and are unable to be “authentic” when these subjects come into conversation. People also feel like they need to say something, anything. I find all of this sad and distressing.

One day, I am going to die. It may be from cancer, it may be from something completely unrelated. I continue to not know how or when my life will end. I spent a lot of time making preparations for my death prior to surgery. I will continue to make more plans until I am done.

I need to come to terms with having cancer. Once it shows up in the body, it doesn’t leave. There is cancer-symptomatic and cancer-asymptomatic. Cancer-free will never exist for me. Once I create an alliance with this fact, I think I can move forward with living. At first, I thought I needed to make peace with dying, but that seems to bother me less than being diseased.

Life is challenging, painful and ugly; it is also amazing, precious and beautiful. I am invested in living, and living well. Over the next few months, I will be reprioritizing my life and treating it as if it could end at any moment.

I am still learning and adjusting to my new life circumstances. The surrealness has started to disappear and is slowly being replaced by reality. I don’t know where this journey is taking me beyond the next few months, although, that is always true, regardless of the situation. And as I’ve learned, radical change is only a doctor’s visit away.

I don’t share this information to make anyone sad, angry, sympathetic, empathetic, whatever. This, as most of my writing, is my catharsis. If it helps or interests someone else, so much the better.

The Conundrum of Being a Writer: or, where is all that writing time, anyway?

I was pondering the conundrum of being a writer this morning, specifically, finding the time to write. Sure, there are a million life hacks and everyone has a piece of advice or two. Then there are the writers who, fortunately, get to focus on their craft as their day job—and they have loads of ideas on how to spend more time writing. Sadly, I am not one of those people. I have a day job, a commute, cats that make messes, and no one to cook for or clean up after me. I’ve given up calling upon Dobie’s kin, and until I have more discretionary money, I must—alas—feed myself and housekeep my home. However, something did occur to me—there was a time when I wrote. ALL. THE. TIME. Daily, mostly, and usually for hours. This far-too-brief period was as a University student and English major. I wouldn’t have made it through college without finding the time to do my homework, which was mostly reading and writing. And then it occurred to me—what if I treated my current writing like assignments for a college class? Years ago, I managed to do it—as a single mother, with a husband, and with one-two children. I had a house to keep, meals to make, kids to parent, a spouse to appease—and yet, I still managed to do all of my homework.

So, I have to ask myself, what the hell is my problem now? My answer is as simple as it is exasperating: I let other things get in the way. Rather than saying no, I spend a lot of time saying yes to Netflix, social engagements, volunteer activities, and social media. When I was working on my bachelor’s degree, my social life consisted of fellow students, all of whom had homework. Extra-curricular activities were paused for all of us so we could complete assignments. While engaged in academia, my daily life was filled with passion and inspiration as I discussed and wrote about literature. It was easy, and mandatory, to find time to do what I loved.

Now that I’m out of school, I spend a lot of time on, well, everything else, including excuses. There’s no accountability outside of myself. My grades are not going to suffer if I don’t expound upon why Othello is a play about marginalization. There is no one waiting for me to write a sonnet in order for it to be critiqued. The lack of disciplined answerability has made lazy. It’s just me, and I’ve become a recalcitrant writer, in spite of the Universe beating me over the head with a pen and pad of paper. So, if writing is my passion—what I love to do and must do—then I need to treat it like the assignment that it is. I have to be both the teacher and the pupil, and create my own grading system. This means saying “no” to what has become the daily routine (except for the day-job, I still need to pay bills) and put my writing first. The housework can wait, Netflix and social media can be paused, and a little fasting never hurt me. My friends, if they are indeed, will understand and not take “no, not right now,” personally. This is what my life looked like years—reading and writing (and at the time, kids) first, everything else second. It’s time for me to go back to “college” and give my passions their rightful place in my life—before everything else.

Addendum to this post: I managed to write this, three morning pages and one other assignment, and still clean the bathroom, kitchen, litter boxes, and part of the floor. So, yes,—I am reminding myself as I type this—it’s possible to do both.