One Year Ago

Annabel, August 2012, at the "Pi-wit Ship Pway-gwound" 

Same beautiful girl, same place, August 2013

This Friday night, the first Friday in August, a group of Brian’s alumni hockey players will come over to our house for a cookout. I’ll be on my way home from work when they arrive but somehow, Brian will have everything prepared, and I’ll walk into trays of delicious BBQ, a pot of homemade clam chowder, and a whole bunch of boys that my son thinks are superheroes.

We didn’t plan it this way, but it turns out that last year’s alumni cookout was the first Friday of August, too. Last year, that was August 3rd, and it was the night I first felt my tumor. For the record, I'm not feeling for any lumps this Friday; I'm just going to eat a lot of my husband's great cooking, enjoy some good company, and go to sleep. 

*  *  *

I’ve already written about finding the lump, and I don’t mean to bore you with the details again. But I do need to rehash some things for myself about last August. It’s kind of like a game of dodge ball -- I know these memories and emotions from one year ago are going to be fired at my head; I can either try to catch them and stay safe in the game or avoid them and eventually be knocked out.

When I first felt my tumor, I was worried. My hypochondriacal history, however, helped to ease my mind a bit because nothing else I had ever built up to be cancer had actually been that. Sure, it'd be a neat story if I had a unique feeling that this lump was different but I didn’t have any such thing. I just had a feeling that I should get it checked out to be sure; just like I had had swollen glands and calcium buildups examined before.

If left alone, I would have made an appointment a few weeks or a month down the road. But Brian (secretly) worries more than I do, and he insisted that I schedule an appointment as soon as I could.

On Monday morning, I called my doctor's office. My PCP was on vacation for the week, but another physician in her group could see me that Friday at two. I put it in my calendar, which usually made me feel better. Oddly enough, however, this time, it didn't. 

On Monday night, I started to worry more. I didn’t feel the tumor more than a few times because I hated the thought of what could be going on inside my body. I just kept wondering, Why would there be a lump on one side and not on the other?

I called my doctor's office back again on Tuesday morning. I told the secretary that I was worried about the lump in my breast and that I’d really like to come in sooner than Friday. She said they had a cancellation and I could come in that afternoon, at 2pm.  It just happened that there was a train home that would get me to the appointment perfectly on time.

Brian must have arranged for someone to watch the kids because he was with me at that 2pm appointment but the kids weren't. I remember lying on the exam table topless as the covering physician massaged my pathetic excuse for a boob. Does this hurt when I press on it? she asked bearing down on the lump.

Kind of, I answered.

Good, I’m pretty sure it’s just a cyst, she explained, It wouldn’t hurt if it were a tumor. Either I’m a total wimp or her textbook needs a footnote.

As soon as the doctor said cyst, I was fine. No cancer. No worries. This was just something to add to the list of worries-turned-fine; just like when I went in for a persistent headache and my doctor told me it was due to excessive teeth-grinding; just like when the suspected pulmonary embolism was a broken rib. I was going to be fine and I celebrated that for a minute or two amidst the embarrassment I felt for my overreaction. Then I just got inpatient and wanted to go home.

The PCP decided that she would send me for a mammogram and an ultrasound to confirm her assessment. What a waste of time and money, I thought. The doctor punched something into the computer and handed me a little card to take down to the radiology department. Reluctantly, I did.  

The guy at the radiology scheduling desk was new. He managed to schedule my mammogram with ease (for the very next day), but the ultrasound gave him some trouble. I was getting really antsy and I told him to not bother with the ultrasound. If they see anything in the mammogram, I'll book an ultrasound, I told him trying to push my rudeness back down to its hiding place. I was sure that the mammogram would confirm that the lump was a pesky little cyst but the scheduling guy was loyal to the rules like any good rookie and he told me that he had to schedule the two appointments together. 

Five or ten minutes later, with the help of his most unhelpful colleague, the scheduler had my ultrasound set for just after the mammogram. I thanked him and said I'd be there, even though I planned on ditching the second appointment.

I didn’t think about that lump for another minute after Brian and I walked out of the building holding hands.

The next morning, Brian took the kids to a little zoo just north of the Rhode Island border. He had asked me if I wanted him to come with me to the follow up appointments but I insisted that he not waste his time.

Being only 32 with no family history of cancer and no other risk factors, my August 8th mammogram was my first one. I remember undressing and putting my clothes in a little locker by the small internal waiting area. I remember being cold. But not scared.

Until last year, I thought mammograms were like ultrasounds -- performed with a wand on a patient lying down. I had no idea that a mammogram (or at least, my mammogram) was done standing up, or that it would involve propping my pancake of a boob up on a cold metal plate and pressing another plate down on it from the top. It was kind of like my boob was squished in the middle of a cold panini maker. Did it hurt? No, although I'm not saying it tickled. But it was quick and life-saving and I would strongly discourage anyone from scaring a woman into avoiding a mammogram.

As the rad tech (who I will call "Jean") repositioned my pancake and the hidden rotten blueberry between the panini plates, I started to feel like something may be wrong. I asked her if she saw anything bad. She hesitated and her answer was vague.  

When we were done, Jean told me to wait in the waiting room. I heard her talking to the radiologist (Dr. Berman) in his windowless office nearby. I could tell that Dr. Berman was showing her something on the image. And I heard him say that he wanted more pictures. 

Back to the plates we went. They felt so much colder the second time. No doubt, now I was scared. 

My memory of time for the rest of that day gets a bit fuzzy. I don't think it could have been more than 10 minutes before Jean came back to the small waiting room to retrieve me and whisper that Dr. Berman wanted to do the ultrasound right away. 

Dr. Berman told me that he saw cancer within minutes of placing the gooey wand on my chest. At the time, his language was completely foreign to me but I know now exactly what he saw and what he said -- invasive ductal carcinoma, as well as ductal carcinoma in situ (DCIS). The invasive part was the tumor. The DCIS was a four-inch-in-diameter growth of cancer that was still inside the ducts. 

Believe it or not, I can recall precisely the first thought that I had after Dr. Berman told me that he saw cancer -- If this is only breast cancer, I will beat this. At the time, I didn't understand that breast cancer that has reached the chest or the bones or the brain is still breast cancer. So what I meant in my own head was, If this hasn't spread, I will survive. 

I don't usually put too much weight on that gut instinct, especially because within seconds, I felt cancer all over my body. And I don't mean it to suggest that people can't beat cancer that has spread. Even then, I knew that people could beat cancer even after it had traveled to several parts of the body (OK, maybe Lance Armstrong was my only example, but I needed only one instance to know that it was possible). Still, in a few of my dark moments, I have returned to that very first reactionary thought and I have chosen to believe it. 

The next step was the biopsy, but before that, Dr. Berman had to gather some materials (or sneak in another patient, who knows). Jean gave me her office to call Brian. 

For some foolish reason, I thought I could tell him about Dr. Berman's pseudo-diagnosis without crying. But the moment I sent the words, He thinks he sees cancer, from my brain to my mouth, the tears came too. I was in shock, trying hard to stay standing on a ground that felt like it had fallen out from underneath me. 

I sat back down in my johnny in the small waiting area. At one point, I started crying again, and a young woman asked me if I had ever had a mammogram before. I could barely respond. I have a family history so I've gotten lots of them. It's not that scary, she explained trying to comfort me. 

Yeah, it's the hearing you have cancer part that's scary, I laughed and cried. She apologized, stunned. That was the first time, but definitely not the last time that I saw that holy-shit-shocked look. Later, I worried that I had been too flippant to a kind woman who was just trying to help. 

The biopsy part was just messy; literally. Dr. Berman numbed the area and then used some sort of device that made loud clicks and spit out tiny globs of some liquid (blood?) or solid (chest flesh?). It didn't hurt at all, but it was terrifying because I knew then and there that I wasn't going to be catching my train to work that day; I knew that my whole life was about to change. 

Dr. Berman tried to comfort me. Will I see my kids grow up? I asked him in order to induce him to say, Of course you will!

But he said something much more doctor-ly. This is very treatable now, he explained. Little did he know mine would even be curable! A few months ago, I went back to tell him that but he had already retired. I saw Jean and she started to cry when I told her I was doing really well. Her niece had just been diagnosed and clearly, she was having a lot of trouble processing that. I told her that her niece would do great. 

When Dr. Berman was done with the biopsy, he told me some vague timeline of events (which I didn't remember) and handed me a card with a phone number for new breast cancer patients. 

I got dressed, walked to my car, and called Mark to tell him I wouldn't be coming into the office. I told him why, and I felt so badly that I had to give him news that would upset him. 

Then, I drove home without turning on any music. I never do that.   

One Nurse's Power

I've written before about how I have a terrible sense of direction and about how sometimes that missing part of my brain can cause me real embarrassment. Last Wednesday was one of those times.

After my labs were drawn (more below) and my Mom and I waited almost an hour for my next appointment up on Yawkey 9, a nurse took my vitals and put us into an exam room that we had never been in before. For all of my other appointments with Dr. Bunnell or Danielle I've been in an exam room with a small painting of a blue sky and an orange rooftop that makes me think of a retired persons' neighborhood in Florida. From that room, I know my way back to the waiting area -- right turn and straight out (I think).

We met with Danielle for a solid 45 minutes on Wednesday, discussing all sorts of different things, both mental and physical. When we were done, my Mom and I headed calmly and confidently to my infusion. I took a right, walked straight, and opened the big wooden door in front of me.

Only it wasn't the waiting room. I recognized the space immediately as the consult room where I usually meet my therapy lady. My first thought was, How did they move the consult room to the waiting area? I really scare myself with my own stupidity sometimes.

The worst part was that the consult room wasn't empty. Dr. Fasciano was sitting there (where I usually sit) with a patient (where she usually sits). (Which totally makes me wonder if I've been sitting in the wrong place all along. My goodness, so much embarrassment!) Anyways, they both looked at me with shock and confusion that could only be rivaled by my own parallel expression.

Oops!  I thought this was the waiting room! I exclaimed, looking to the back of the door as if there was a sign to justify my mistake. There was a sign, next to the door, but apparently the "Consult Room" plaque wasn't enough to make me question my sense of direction.

Dr. Fasciano and her patient were both too stunned by the fool (me) to laugh. OK, well, Hi Karen! I said laughing. I'm going now. She smiled and said Bye. 

When she was done with her appointment, my Mom and I were still waiting to be called into the infusion suite. Dr. Fasciano came right over to us and we had a good laugh at the expense of my ridiculousness.

*  *  *

Last Wednesday was a long day at Dana-Farber despite that I didn't even have an appointment with Karen. I knew I was already going to be there for five hours so I decided to delay our meeting until next time. 

The day began a few hours later than usual -- at 9:30am -- at the lab on the second floor. Every few months now, my oncology team has the nurses in the lab draw blood to be sure that it contains whatever it's supposed to contain. It's a really easy part of my treatment so I didn't have any apprehension about it. 

When the cheerful, middle-aged nurse (who I will call "Elaine") called out Tara S, I told my Mom I'd be right back. When I emerged from the back 10 minutes later, I was a mess. What in the world happened back there in such a short time? you may ask. My Mom asked the same thing.  

Elaine was very kind. She was talkative and good natured and meant well. But Elaine had one fatal flaw -- she didn't understand her own power.

When I sat down and she looked at my chart, she asked me, So how many do you have left? 

I'm done at the end of October, I explained, and even though that sounds far away, given the three week increments, it means only about six more treatments. 

Wow! That's so exciting! Congratulations! You must be so happy! 

Yes, I am. But it's scary, too. It hard to think about being without the Herceptin. 

Oh, why's that? 

I don't know. I guess just because I really don't want the cancer to come back and it seems that the Herceptin is the key to making sure it doesn't.  

I know, that is scary. It's scary to think about what you've had to put into your body. I mean, it's all poison and the chemo can do real harm down the road. I've seen many cases of that. But what's the alternative? 

I froze. She chattered on while she inserted my IV and drew six or seven vials of my blood. As she stuck the little printed labels of my information onto each vial, I watched her. I didn't hear her, although she was still talking. I was a ghost again; my body in the chair and my arm extended but my mind somewhere else. Somewhere far away. Terrified and defeated. 

I held it together (barely) because I had an errand to run. But while we were in the Friends' Place donating the wig I never wore, I broke down and told my Mom what Elaine had said. My Mom felt so bad but I was too upset to feel bad that she felt bad.

When we left the little shop and got to the foyer on the first floor, my Mom hugged me and apologized for what Elaine had said. I explained to her how scared I am that the Herceptin will end up being toxic to my heart or that there could be some other terrible side effect that they discover years down the road that will land me back in treatment. Herceptin is so new, I argued from my dark place that I go to only very rarely. They don't know what it could really do to people! 

My Mom didn't argue, but she did explain that she thinks they do understand the biology of Herceptin. Then she said something even more helpful. Hon, I could walk outside right now and get hit by a car. None of us know what's going to happen tomorrow. 

I know, this really isn't something that I'd expect to bring me comfort, either. But it did; a real sincere comfort. I've wondered why that was, especially since if I really thought about it, my Mom being hit by a car would send me into a mental tailspin. But I didn't really think about it. I just felt better. Later, I decided that was because my Mom had reminded me that I'm not alone in my vulnerability. And I think that the feeling of being alone is the scariest feeling of all.

*  *  *

I know that people like clean and happy endings; I love romantic comedies starring Hugh Grant, too. So I know that Elaine and everyone else, including me, wants the end of my infusions to feel like pure victory. Sometimes, I'm sure it will. But I just don't think the story -- any story -- is all that simple.

A few weeks ago, Andy forwarded me a New York Times article about how anxiety lingers long after cancer treatment has ended. Not that I want anyone else to feel the lingering anxiety that I feel, but I have to admit that it's comforting to know that they do.

I wonder if Elaine has read this article. I wonder if she knows the power that she holds as she sits there tapping patients' arms to find their best vein. I'm not saying her job is easy because it's not. Anyone who works with vulnerable populations -- patients, kids, the mentally or physically disabled, the elderly, the poor -- they hold more power in their hands than the CEO of Wal-Mart, at least in my humble opinion.

Because those people have the power to give someone hope or give them doubt. And when you're feeling weak and vulnerable and scared, I don't know what is more valuable than hope or what is more scary than doubt.

I know very well that what Elaine said was true. I know Robin Roberts' story and that my chemo could cause me more cancer down the line. I have met several woman now who were treated for lymphoma years ago and as a result of their treatment have battled breast cancer or been forced to take drastic steps to avoid it. I know what Herceptin could do to my heart, even years from now. And I know that there was no alternative to putting my Allies into my body to fight the cancer. But I also know that sometimes, hope is more important than truth. And it would have been a lot easier if Elaine told me that she knows I will be OK even though she doesn't. Or she could have just made small talk about the Red Sox. That'd have been easier too.

Maybe Elaine just slipped up, like I did when I busted in on Dr. Fasciano and her patient. Or maybe she joins a lot of us who sometimes just need a gentle reminder of how powerful our words can really be. 

Life's Depths

When I got really sick after my second chemo treatment, I found myself at Brigham & Women’s Hospital where I learned that my absolute neutrophil count (the number of useful white blood cells) was zero. My first reaction to that news was, Excellent! If the chemo killed all those good cells, it must mean that it killed all the bad ones, too.

Later, when my fever spiked again, I felt totally frustrated by my own stupidity. I wished that I had respected the power of germs as I had heard chemo patients were supposed to do. But instead, I had hugged lots of people at the Thanksgiving Day football game and I had eaten snacks out of the same bowl that the kids were digging their unwashed little fingers into.

When I explained to a very kind doctor that I was regretting not taking many (any?) steps to avoid germs, he explained to me that I should ditch the frustration. You have bacteria in your body naturally so even if you had been in a bubble, with an ANC of zero, you’d have gotten sick. And so I waited for my body to fight its way out of the hospital. It only took five days, which felt long until I remembered Ashley.

When I arrived at the Brigham that late November night, Ashley had already been there for several months. She had received new lungs and while the lungs had been miraculous, one thing lead to another and an infection in her body caused Ashley to suffer multiple strokes. Doctors operated on her head to control the swelling and when I met her, Ashley was learning how to talk and stand up again. She and her mother, Joy, told me all of that the very first day I met them from behind my mask in the hospital gift shop.

When I left the Brigham just before December, Ashley remained. Since then she had a few stints at rehab and one at her home in Maine, but otherwise, Ashley and her family spent most of 2013 in the ICU at the Brigham. A tiny and beautiful young woman, Ashley defied all odds, battling through surgeries from which her doctors warned she may never wake up and fighting through countless obstacles like no one thought possible. She loved God, her brother, her big family, music, greasy food, her doctors, and so many other things that I don't even know about since I barely even knew her. I missed out, but those who feel the most grief right now feel that pain because they didn't. 

Yesterday morning, Ashley passed away peacefully with her loving family by her side. My Mom, who told me months ago that Ashley’s journey was too hard for her to follow, called me at work to see how I was handling the awful news. I hadn't checked Joy's Facebook status yet that hour so I hadn't seen the post from 40 minutes prior. It was the post that I dreaded every time I waited for Joy's page to load on my computer.  

I left my office last night having successfully hidden my broken heart. It was rainy, cold, and dark, which felt so fitting. Because of the weather, I decided to take the Orange Line to Back Bay instead of walking to catch the train at South Station like I always do. 

When I took my seat on the subway, I wanted to burst into tears. I had bottled up so much emotion in that last hour and I hoped that I could contain it for my one-hour-door-to-door trip home. Turns out that I couldn’t. I cried onto my raincoat as the train shook past Downtown Crossing and Chinatown.

Then I noticed the man sitting across from me. He was probably 50 or 55, about double Ashley’s age. Thanks to a significant amount of alcohol and/or drugs, the man literally could not sit up straight or open his eyes. His friend or son or fellow addict was in slightly better shape than he was and he kept pulling on the man's dirty t-shirt to keep him from falling onto the shoulder of the poor girl sitting next to them.

I see drunk people and drug addicts on the Orange Line all the time and besides being cautious of their volatility and often, their stench, I don't dwell on them. But yesterday was different. As I sat there crying over the death of a young daughter, sister, cousin, niece, granddaughter, friend, and distant inspiration, I couldn’t help that my sadness turned to anger.

In my glasses, my LL Bean raincoat, my flip flops, and my professional-ish black work dress, I wanted to jump across the train and pummel that tilting man. I wanted to tell him that someone half his age had been fighting for her life for years; that she just died; that she deserved to reach whatever birthday he last celebrated so much more than he ever did. That God should have taken him. But I sat there quiet and still.

A stop or two later, I realized how ridiculous I was being. Life’s just not that simple. 

Then I got to wondering about what had happened to that guy that made him do what he was doing to himself. Maybe he was abused as a kid. Maybe he had been stable and then the death of his wife or young child caused him to start drinking. Maybe he had served our country and we had all failed him. I wasn’t forgiving any crimes he had committed or harm he had done to himself or others. I was just reminding myself that oftentimes, there's a lot of grey area when it comes to placing people in a good or bad category.

Sometimes, however, a person's goodness is crystal clear. Even from a distance, I can say with the utmost confidence that Ashley and her family are as good as they get. There's nothing grey about that.

*  *  *

This blog is not an attempt to make sense of a tragedy nor is it an attempt to pay my respects to Ashley. Right now, there's no way I could do either. All I can do is write about one tiny moment of clarity, one sliver of understanding, that I found as I stepped off the train last night.

The moment came from the combination of several thoughts that had been swirling like a tornado in my head -- Ashley's life, her death, her mom; my Mom; my daughter; August 8th, a road race, a pain in my stomach; the addict. A quote. 

You can't do anything about the length of your life, but you can do something about its width and depth. 

~ H.L. Mencken, writer, editor, and critic (1880-1956)

It's true; none of us know how long our life will be. Maybe, then, I should stop equating old age with proof of a life's depth. Because as horrifically tragic and unjust as their deaths have been, the people who I have seen pass far too early -- amazing young men and women like Scott and Brendan and Mary and Ashley -- they all lived lives that stretched so wide and reached so deep that most 100 year olds haven't been blessed to live a fraction of the life that they did. 

What (I Think) You Want to Know -- Part Three

...continued...

7. What were some of the most (and least) helpful things that people did for you this past year? 

I'm pretty sure the person who asked me this meant "people" as those beyond my primary caregivers, so I'll answer it that way.

When I was first diagnosed, my best friend (Brianne) set up a calendar through an incredible site called MyLifeLine. She emailed the link to our family, friends, and colleagues and they signed up for particular days to cook us dinner or drop off snacks. Each meal and each snack was indescribably helpful -- both to me and to Brian. The fact that it was organized into a nice neat schedule assuaged by type-A personality as it ensured that we wouldn't have to waste food that we couldn't consume in time. 

Otherwise, the most helpful thing that people did for us was to send messages that gave us hope that everything would be OK. I never understood the concept of hope prior to having cancer. I know now that it is an indescribably precious gift. 

While it may be possible for me to list the hundreds of things that people did for us to help make a very rough time more smooth, I could never express how meaningful each of those things were to us. From bringing me homemade cookie dough (after I wrote about my doubts that I could make it myself) to dropping off scratch tickets (since it was time for my luck to change) to giving me a hug that said I care, each and every kind gesture made it easier to cope. 

The least helpful thing that people did was mention experiences with cancer that ended in someone dying from the disease. I know, those people are entitled to their stories and if I were stronger, I would have put aside my own feelings and acknowledged theirs. But before you're pushed out of the skydiving plane, you don't want to be told that the guy before you had his parachute break (sorry, I couldn't help but use a metaphor).  

8. What have you told your kids about your cancer?

That I had it in my boob; that my doctors did a surgery to take it out; that the medicine they gave me afterwards made my hair fall out; and that I continue to go to get my medicine every three weeks (like I did today) so that the cancer never comes back.

Annabel doesn't get much more than the boobie and the going to the doctor part. But at five-and-a-half, Teddy gets a lot more. About a month ago, he told me he wanted to show me something on TV. He grabbed the remote, found his way to the MLB Game Highlights on Apple TV, then scrolled his way to a baseball game (in Chicago, I think) where players used pink gloves and the crowd received free pink hats or shirts or something for breast cancer. See Mom, it's fo bweast can-sew, he explained. I had been expected a no-hitter or something like that. But him finding me that game was so much more amazing than a no-hitter.

9. Have you done anything to prepare for your own death? 

Yes, but not because of cancer. I had purchased life insurance a few years ago and Brian and I had a will drawn up after Teddy was born. I admit, a few months ago I saved a document on my computer entitled, My Funeral. It's a work in progress, and I don't work on it in any sort of morbid or time-consuming way. But if cancer or a meteor or a slip in the shower happens to take me, I don't want my family stressed over what I would have wanted. So I've laid it all out to spare them any more pain. Plus, I think they'll have a good laugh over some of my choices. Sure, most people don't play upbeat music at funerals, but if my instructions say to, please abide by them.

10. Did cancer change you? If so, how?

No. But writing about it really, really did. How? It made me so much more alive.

What (I Think) You Want to Know -- Part Two

...continued...

2. Is your cancer in remission?

Although I often hear the word remission in the regular world, I have never once heard any of my doctors or nurses use it. To be honest, I'm not exactly sure why that is and since I still refuse to research anything about cancer, I don't have any great clinical explanation. What I do know, however, is what my oncologist, the Chief Medical Officer at the Dana-Farber Cancer Institute (Dr. Bunnell), has told me (after I told him not to tell me anything bad). And Dr. Bunnell has explained to me that the "overwhelming odds" are that chemotherapy and, more importantly, Herceptin, will cure my cancer. We're not putting the cancer to sleep and waiting for it to awaken one day; we're defeating it. For good.

The first time that Dr. Bunnell ever mentioned my cancer coming back, I told him that I wouldn't have breasts anymore. So how could that happen? He explained that the cancer could come back elsewhere in my body; on my chest wall or in my brain, for example. It would still be breast cancer, he explained, but it would have metastasized. Well, crap. Was I the only fool who had assumed that cutting my boobs off meant no more chance at breast cancer recurrence? Lesson learned, I guess.

So we arrive back at that HER2+ test result. My tumor tested positive for a protein known as HER2; a protein that, if left to its own vices, will lock on to healthy cells in the breast or anywhere else, and turn healthy cells into cancerous ones. In 2005 (so says Brian who researched it), a miracle drug called Herceptin came onto the market. Herceptin changed everything for women with HER2+ breast cancers.

Herceptin includes (or is?) an antibody that is literally attracted to the HER2 protein. Once the two meet up, Herceptin prevents the protein from locking on to healthy cells. It stops cancer. For the luckiest 99% of women with tumors similar to my grade 2 tumor, Herceptin has been shown to cure breast cancer (at least, in one study that Dr. Bunnell has cited several times).

3. When will you be all done with treatment?

I will have completed my one year of Herceptin infusions at the end of October. I'll take my daily dose of Tamoxifen until January 2023.

4. How much do you worry about dying?

Now, I can go several hours without worrying about it. I used to not be able to go a single minute, so I’ve made great progress. My worry and fear come in all different forms, from light and manageable (the common kind) to overwhelming and necessitating a good cry or, on a really bad (and thankfully, very rare) night, an Ativan.

The hardest part of the worry now is that my guard is down; my armor is under the bed, as a great friend explained to me. I’m back in the real world and there, death-by-cancer is all around. I won’t lie; it’s really hard to hear that someone died of breast cancer. When that happens, I still feel a few minutes of suffocating fear. Then, with a pit in my stomach, I carry on, and gradually that terrible feeling goes away.

Since I often have my own mortality on my mind, sometimes I kind of feel like a ghost of myself. For instance, when I get home at night and I hear Brian giving the kids a bath, I smile, but I also tear up inside. Every night, when Annabel asks, You guys going’ any-weera? my heart aches a bit and I pray to God that I’m not. It’s really hard to imagine being absent for all of that, or better yet, it’s too easy to imagine it, and I really don’t want to.

5. Do you have any regrets about your treatment or surgery? 

No. Not one. I was blessed with easy access to one of the best cancer institutes in the world (if not the best). I have the utmost faith in my core medical team. And while I have hit bumps in the road like anyone going through serious medical treatment, there’s nothing that I could have done to avoid those things.

If I had to stretch my answer into something I don’t care all that much about, I'd admit that the whole adding-the-nipples process is totally inconvenient. Sometimes I think it would be nice to look a bit less robotic in the chest area and the big scars can be reminders of times I don't want to remember. But at this stage, I wouldn't take time off of work or away from vacation so that my plastic surgeon can create new nipples for me. (Out of Office auto-reply: Thank you for your message. I will reply as soon as I have nipples. Nah, that just doesn’t work.) So if my nipple-less figure ever really starts to bother me, I know I can just call Dr. Chun and make an appointment to explore my options. For me, that’s enough of a solution for right now.

On a more serious note, I have the right kind of regret for the fact that I did not harvest my eggs prior to beginning my treatment. If I knew what I know now (that my cancer hadn’t spread and that the Taxoxifen was going to be a 10 year course), I may have done so, but life doesn’t have a rewind button. In the end, I have faith that if Brian and I want to have a third child, we will have one. He or she won’t have our genes, but I’ve come to realize that genes are a small detail to the concept of family.

6. Can you have any more biological kids? If not, why not?

Like any woman, I’m not entirely sure, but I think that it would be physically possible, yes. While the treatment I have received sends some women into early menopause, it hasn’t done that to me (at least, not yet). But it’s not as easy as that.

Dr. Bunnell believes that I should stay on Tamoxifen for 10 years and he said that I should absolutely not get pregnant while taking the drug; something about how they don’t know how it would effect the fetus, I think. Since I started Tamoxifen when I was almost 33, that means I’ll be 43 when I complete it (with faith). If I have not gone through early menopause by then, there’s a chance I could have a baby. But while 43 is not “too old” for some women, I think it’s probably too old for me.

Had I harvested my eggs, we could have tried to find a surrogate mother to carry embryo(s) that the fertility clinic could have made with Brian’s little swimmers. But we didn’t do that because, just days after being diagnosed, the process of injecting me with hormones and extracting my eggs was not a top priority. Especially when I had just been told my cancer was hormone-receptive and they did not yet know how far it had spread.

A few appointments ago, I was given a clip board of information asking me if I’d like to take part in a clinical trial at Dana-Farber. If I enrolled, I would stop taking the Tamoxifen after 18 or 36 months, try to get pregnant, then go back on the Tamoxifen once I had a baby. I do not judge women who choose to take part in that study and if I didn’t have my own children already, I may very well have considered it. But for me right now, it doesn't feel like the right thing to do. Adopting, on the other hand, very much does. And if it's a girl, I've already picked out her name.

To be continued...

7. What were some of the most (and least) helpful things that people did for you this past year?

8. What have you told your kids about your cancer?

9. Have you done anything to prepare for your own death?

10. Did cancer change you? If so, how?