Adjusting

Lots of blog-worthy events transpired at Dana Farber yesterday, and I again find myself wide awake at 4:30AM, ready to share.  This morning, between now and when my kids wake up, I want to write about adjusting to what life throws at you.  I've thought a lot about this topic not only with my diagnosis, but before that too.  However, like any caring friend or relative, you likely want to skim down for more on my diagnosis, so let's start there.  In a nutshell, as the U.S. diver Katie Bell says before her dives, "I own this."  (Actually, doesn't she really say, "I own this shit!"?  I'm a little less outwardly agressive, but I guess cancer's an exception, so yes, "I own this shit.")  With Brian and my mom by my side, and the almost tangible thoughts and prayers of so many others (you!), yesterday was a good day.  So first and foremost, thank you.  You will never know the power of the words you have sent me.  Mostly through my own tears, I read your texts, comments, and emails, and with every one, I grew stronger (despite that I looked like a blubbery mess!).  I could never repay that gift, but please know that you literally helped me walk and breathe through a day I didn't know I would be able to survive.

OK, so the update.  After stopping by my office to welcome a new colleague and dear friend to the firm, and check in with the most wonderful group of people I have the pleasure of working with, Brian, my mom, and I headed into Dana Farber Cancer Institute, 450 Brookline Ave, Boston.  We laughed, nervously, as we pulled in (who knew, they valet!?!).  We agreed that we all used to marvel at the strength of people walking into that building.  Now it was us, terrified, nauseous, but on a mission like never before.

We spent over six hours at Dana Farber, visited two different buildings, traveled to five different floors, and spoke with nine different clinicians.  The real answers came from the over two and a half hours we spent with the breast surgeon, Dr. Nakhlis, a beautiful, smart, compassionate woman I will tell you much more about later, and the medical oncologist, Dr. Bunnell, a brilliant and down-to-earth doctor (aaaannnd possible man crush - move aside Coach Eric Taylor and Bob Costas).  (Don't worry, Brian's man crush on Dr. Bunnell may end up being stronger than mine, especially once he kills my cancer.)  I'm sure I'm simplifying this too much, but as I see it, Dr. Nakhlis will remove the cancer's command center and Dr. Bunnell will hunt down any stragglers in the field and make sure it never regroups.  A one, two punch.  (And, may I say, a good looking one at that!)  Anyways, onto more serious business.

After a good cry at the start of the first appointment, I surprised myself that I was actually able to listen (and later even take notes!) as Dr. Nakhlis explained my cancer.  I have two types of cancer -- invasive ductal carcinoma and ductal carcinoma in situ (the latter which they call "DCIS").  As you may guess, the cancer started in the milk ducts (not my brain, knee, or back - that was just my paranoia...phew!).  I knew I hated those damn ducts the very first time I tried to breast feed (further perpetuating my desire to start a "Breast Feeding Sucks" campaign; then again, I know I shouldn't mess with the pro-breast-feeders -- they seem to be a powerful lot).  Sorry, I digress.

I'm hesitant to Google anything related to my condition just yet, so for now I'll just guess that the "in situ" part of "ductal carcinoma in situ" means that it's just sitting around in the ducts since DCIS is the kind of cancer that has not yet broken out of the milk duct, the trench.  I like the lazy cancer.  But I don't so much like the "invasive" kind.  "Invasive" sounds energetic, vengeful, mean.  However, so far all signs are pointing to my invasive cancer as being somewhat contained.  The cancerous tumor is only about a centimeter in diameter and my lymph node in the "bad boob" tested negative.  We still talked a lot about lymph nodes yesterday and the doctors won't know until my surgery if the meanness has marched into those yet, but even if it has, Dr. Nakhlis felt confident she could remove all of the poisoned nodes (which, I learned are under my arm).  Of course, there was a bit of scary talk with Dr. Bunnell about the invasive cancer breaking through elsewhere, but the chest x-ray would tell us more about that.  Spoiler Alert -- the chest x-ray "looked great" and when that news came in around 7:30 last night, my family and I erupted in cheers, cries, and hugs.  A real gold medal moment (at Bertuccis).  Darn I love those rolls.

Again, I'm getting ahead of myself.  So once we talked invasive cancer, Dr. Nakhlis lowered her tone as if she had to deliver the real bad news.  Adrenaline rush.  Gulp.  The DCIS, she said, was widespread - "calcifications" all over the breast.  She said there was no way to "save the breast."  "Save it?" I almost yelled back (smiling), "Hell, chop that thing off today if you can!"  I'm sure every woman has a different reaction when told that they will need their breast removed.  I didn't know what my own reaction would be, but when it happened, it was clear as the yumminess of those Bertucci rolls -- take that saggy little thing and all the cancer with it!  (Depending on the results of a genetic test to determine if I am predisposed to cancer, I may also choose to have the "good one" removed too, although "good" is all relative!  Oh, and then could come removal of my ovaries a few years down the line.  Fun times!)  I think Dr. Nakhlis was expecting more of a discussion so she quickly skipped ahead in her mental agenda.  We talked about "reconstruction," or, in a colloquial sense, a "boob job."  More on that later.  That'll be a great piece to write about!  I never pegged myself as one for a boob job, but this entry is supposed to be about adjusting to what life throws as you, right?!?

Although the doctors cannot officially "stage" the cancer until after my surgery (which, by the way, will be in 2-4 weeks), they have preliminarily pegged it as "grade 1," which given its invasive nature is as good news as it comes.  They said that could change based on what they see inside -- essentially, how much the cancer has mutated and where it has gone.  But I count this as a big hurdle cleared, and this morning, I will hug my kids tight while celebrating "grade 1."

Dr. Bunnell told us lots more about my cancer.  It is hormone receptive on at least two of three fronts (although I'm probably not using that terminology just right).  As I heard it (while admiring his thick silver hair, mind you), estrogen and progesterone in my body "unlock" the cancer cells.  This is actually good news because it means that with hormone therapy, we can block the receptors and lower the risk of reoccurrance.  So one thing I know for certain is that I'll be on a drug called tamoxifen for the next five years.  The side effects seem slight, however, a woman cannot get pregnant while taking the drug which means if Brian and I wanted a third biological child, we will have to wait until I am 37.  Teddy will be almost 10.  Turns out that topic is too deep, too personal, and honestly, too sad, for my present state of mind, but maybe I'll go there one day if I think it could help readers to hear about it.

Dr. Bunnell hadn't yet heard the results of the last receptor test.  That comes back today.  If it's positive, chemo-therapy is a must, and it would begin about 4 weeks after surgery (to allow adequate recovery time).  If it's negative, surgery will determine if chemo is a go.  Today we also await the results of my blood work.  Essentially they are checking to see that none of my major organs are working harder than they should be.  If they are, I think it means that the cancer could be there.  So with a few big hurdles cleared, we'll attack a few more significant ones today.  Come on, organs, keep strong!

Hum, that was just the prelude to this entry, wasn't it?  Well, now the sun is up, and Annabel is yelling for me.  This entry was about adjusting to life right?  So I'm going to get my beautiful little girl out of her crib, and snuggle with her and her blankie while she has her bottle.  Adjustments to what life throws at you.  In the end, that's just the point of what I set out to write.