Reflecting on my year as a cancer patient, 2023 was one of the happiest years of my life.
Strange, right?
Arthur Brooks, Harvard Business School and Harvard Kennedy School Professor and renowned happiness expert, defined happiness on the January 17, 2024 Diary of a CEO podcast (https://podcasts.apple.com/us/podcast/no-1-happiness-expert-if-your-friends-get-divorced/id1291423644?i=1000642058696) as “having agency and a sense of power and control over what happens to you. Despair comes from a feeling of helplessness. Learned helplessness is when one takes on the identity of a victim. That identity will degrade your quality of life, make you less happy, and (statistically) reduce your life expectancy.”
Cancer is a curveball. It's easy to feel like a victim. Initially, I tried to reverse engineer what I could have done differently in our lives so that I wasn’t a cancer patient. I lamented delaying my prophylactic surgery. I questioned if I should have done a single surgery rather than a breast reduction to reduce my risk of skin necrosis. Professor Brooks advice is if you want power, start by managing yourself, not trying to handle the outside world.
So many cancer patients lose sight of their power in the turbulence of tests, biopsies, doctor's appointments, scheduling, insurance, and fear. Choosing to focus on things that make you happy while facing cancer felt like condoning cancer, saying it's okay that I have cancer. News alert - cancer doesn't care if you approve or not. It's mutant cells causing trouble. It's not conscious. I didn't do anything wrong. It just happened. It's a curveball.
After feeling all the emotions and shock that naturally arise when a doctor tells you, "I'm sorry. It's malignant," there are choices to make. There are medical teams and treatment choices. There's also the happiness choice. Per Professor Brooks (and Oprah), happiness is not a destination; it's an ongoing, lifelong quest. It isn't a feeling; instead, feelings are evidence of happiness. During the cancer journey, I chose to pursue happiness while I also pursued a complete obliteration of my cancer.
No one wants cancer. No one is happy about having cancer. I wasn’t happy about having cancer. I permitted myself to be happy while facing cancer. I didn’t want this, but I can do this. I will do everything I can to lead to a positive outcome, and then the result will be what it should be.
Context
In many ways, my cancer diagnosis came at a good time. I reduced my workload in preparation for my scheduled prophylactic surgery. My husband's company had good health insurance. We had built financial reserves if we needed them. Two of my kids were in college, and my daughter was on the cusp of receiving her driver's license. She was already independently mobile. I wasn't a caregiver for a sick parent, spouse, or child. My sister-in-law was in town from Boston to support us through my surgery and pivoted to being an excellent wingman for the first few days of cancer turbulence. I could imagine many times in my life when cancer would have been much more disruptive to my life and family.
I build solid friendships and show up for the people I love. My friends know they can reach out anytime, and I’ll put everything else on hold to listen, laugh, and support. My professional colleagues always have an open invitation to brainstorm, strategize, and explore possibilities. I believe in making continuous deposits in people's emotional bank accounts. It makes people feel good, and when I need to withdraw, I do not risk an overdraft. I have lived in the same community for over twenty years and experienced births, b'nai mitzvahs, graduations, medical challenges, and deaths with them. My sister lives 15 miles away. My roots run deep here. I am grateful for the community locally and at a distance who quickly ensured my wish list became a reality and lightened my load.
I've talked with people who don't know anyone else like them who have had cancer, and it's isolating - this was my sister's experience at 29. I met a veteran who was recently discharged and living in a new city as a single civilian for the first time upon diagnosis, and she felt very alone. I had my sister, my mother, my sister-in-law, friends, and introductions to new people who all survived cancer and had pretty incredible lives. I didn’t need or want to talk to lots of other cancer patients to build my confidence - my mother and sister were the most significant confidence boosts I could imagine.
I'm fortunate that I had access to a world-class cancer center with a dedicated breast cancer team that delivers state-of-the-art treatment. We discovered my tumor before it had the chance to spread, and the first course of therapy obliterated it. Part of why my cancer year was one of the happiest of my life is because even during the treatment process, I could see so many years in the future of my life without cancer!
Developing an Approach
No one welcomes a cancer diagnosis. It’s unwelcome. Scary. The air left the room. It is a train derailment of your life. My psycho-oncologist shared that many cancer patients initially respond by denial, such as avoiding mammograms to confirm a diagnosis, guilt & shame feelings that you caused your cancer (you didn’t), or paralysis by the number of appointments, doctors, tests, and new vocabulary you suddenly need to master. That paralytic anxiety is exhausting at the very moment when you need energy to persevere.
Denial and avoidance are dangerous strategies to succumb to for any extended period. Early detection and treatment save lives. Everyone likely has their unique path to whatever level of acceptance they can find. I found it very powerful to accept something I didn’t want. Only after accepting that I had breast cancer, which happened very quickly for me, could I assess my situation, evaluate options, and launch into decisive action. I think acceptance is a state. I accepted my diagnosis. Once I met my oncologist, I accepted her treatment plan. And when she couldn’t feel the tumor, she and I discussed the risks and rewards of determining if I could forgo AC. At that point, I accepted the first course of chemotherapy, but I didn’t want to take the second course except if it was necessary. There’s a famous saying - that which you resist persists. That which you accept transforms. By accepting my cancer and treatment plan, I was in a position to transform (some) of my experience into the shape I wanted.
My mother's and sister’s cancers prepared me well for this moment. Since my mother’s initial cancer 40 years ago, I knew there was a strong probability that I would face this disease. My preparation included developing an explicit approach for when I ultimately heard the news that a biopsy was malignant. Here were the seven steps I swiftly executed to set myself up to crush the curveball and be as happy as possible.
When the doctor calls to say the pathology is malignant, don’t resist or doubt it. It’s real. Aggravating. Inconvenient. Scary. Real. Let myself feel whatever I was feeling. Don’t resist the feelings; let them run through and over me.
I know I didn’t cause the cancer - a misbehaving gene triggered errant cell growth. Let go of guilt.
Find the best medical team by asking for referrals. You need an oncologist as the quarterback of this team. Preferably, an oncologist specializing in your type of cancer will be the most up-to-date on protocols and alternatives. Ensure I had insurance that allowed me to exercise choice in my treatment team.
The current standard of care for my breast cancer turned out to be chemotherapy before surgery. That gave me ample time to research surgical approaches to know what I wanted. In my case, I did that research before diagnosis and knew I wanted a bilateral mastectomy (DMX) and DIEP Flap.
I realized that I could not interpret the pathology, labs, and radiology reports, so I shouldn’t be anxious about things I imagined I saw when I looked at the reports.
Even with acceptance, I was my advocate. There is power in asking if there is a better/faster way to do something or ensuring it's something to accept or transform. Advocate for appointments as soon as possible and bring all my data, questions, a note-taking mechanism, and another person.
Ask for help - I don’t have to do this alone. I don’t have to know everything. I cannot control everything, and the more I trust my medical team, friends, and family, the more freedom and happiness I will experience.
Throughout my cancer journey, I questioned what I was accepting as a limitation or constraint and what am I not accepting as a constraint. Those questions guided my acceptance, actions, and advocacy.
Enjoyment
"Pleasure becomes enjoyment when you add people and memory." Arthur Brooks.
I leveraged the lessons of my mother's and sister's cancers to specify the support I needed from my friends and family. Knowing what is essential and trivial to you is crucial. For example, I am not a foodie. Food is fuel to me, although I appreciate people who are excellent cooks. So when I asked for people to provide meals, I was pretty open to whatever people wanted to cook with some guidelines about ingredients we don’t eat and guidance from my oncologist regarding spicy or undercooked/raw food. I did not expect anyone to do anything specific and cast my net reasonably wide. I trusted that people genuinely wanted to help and would participate in how suited them. Seeing what people chose to do and who I would spend time with each week was fun.
Building a Team
I didn’t wait until I had cancer to build a community and know what roles different people in my life would play best. There’s considerable evidence that having multiple close relationships is Advantages to life expectancy and mental health. Common sense is that life is more enjoyable when you share it with people, AND different people bring different things. I’m also an extrovert and genuinely enjoy being around people. That said, I don’t usually affiliate with social groups or cliques. Instead, I have close friendships with individuals from different parts of my life.
Jonathan, who always cared deeply about my safety, especially when I traveled during chemotherapy, is the grandson of my grandfather’s best friend, the son of my father’s closest childhood friend, and my friend since birth. Julian, the texter, is my closest friend from high school. Shira, who came to stay with me during part of my chemotherapy, is my best friend from college. Neal and I met in business school as sectionmates. Tracey is my sister, and we’ve cultivated a close relationship. Heather is Neal’s sister and became a dear friend once I started dating. Jessica and I met when we were six months pregnant with our firstborn children, and our friendship blurred the lines between friend and family as we raised all six of our children (three and three) together. Over the last ten years, and significantly reinforced during COVID, a small group of 5 women from my business school class texted, enjoyed quarterly dinners, and had weekly COVID calls during the lockdown. We’ve supported each other through professional and personal challenges - my cancer was another one on a robust list.
If you want a friend, you must first be a friend. These people, and the many others who bring color to my life, are important to me. Reaching out and staying in touch with people always makes me happy. I endeavor to show up and be there for my friends. When I needed them, they showed up for me.
The different people in my life have different strengths. Neal is a resilient optimist who is an endless source of ideas. Tracey is an intuitive, natural communicator with cutting-edge best practices to live a healthy and robust life. Jessica is an incredible and committed organizer who likes structure and invests heavily in building community. Heather is calm, compassionate, and fantastic at translating medical-speak into English. Knowing which skills, talents, and interests aligned with roles on the team made it much easier for me to ask the right person for the proper support.
I asked Heather to fly to California to support Neal during my prophylactic surgery, and she was pivotal when we were processing the cancer diagnosis. Jessica knew my quirks and helped me understand what I needed and from whom. She and Tracey quickly allied to support me and each other while Tracey helped me keep our parents informed and comforted. Neal’s job was to save our lives every day as possible for the kids and me while being the person who was always available for a hug. Julie, who became a very close friend during my cancer journey, was an advocate, thought partner, and always ready with something to make me smile - often a photo of her crazy dog.
I invited more people to be part of my journey through writing on CaringBridge, where I also shared the ever-changing timeline. Fortunately, Jessica is a logistics quarterback I knew would care more than I would about the details of my support. Through years of experience with births, parties, fundraisers, sicknesses, b’nai mitzvahs, and shivas, I knew that Jessica was a detail-oriented planner who would believe me when I said I didn’t care about something. I was confident that my community would engage with the sign-up lists that Jessica was sending out. Jessica knew what to ask because she knew me very well. She knew I wouldn’t give specifics about food because I’m not particular, so she provided prompts that generated some parameters regarding meals, visits, and driving. I tried to control the calendar in a wrestling match with UCSF as they scheduled infusions, and I would persuade and charm them to attempt to minimize extra visits to the hospital. Jessica facilitated asking people to drive me to and from treatment, to stay for the treatment (until I realized that I slept for most of it - then I revised the request to keep me company for the delay between labs and pre-treatment). I think the people who drove me and held me company found the experience surprisingly enjoyable because I was happy to see them, and I created a routine that made chemo day a good one.
Creating a happiness-infused infusion routine
My chemo day routine started with being able to wash my hair. I could only wash my hair once a week as part of the cold-capping protocol from Dignicap. I enjoy the feeling of water running over my head and the scalp massage from washing and conditioning my hair. That was a self-care moment at the start of my day. After breakfast, my ride arrived, and I had a 20-minute visit with a friend. It was great to hear about their lives and spend time together. After my port draw for labs, I had an hour-long wait. I’d read my letter from Taylor. I’d get a text from Julian and reply. I’d open my binder to my prayers and start my iPad YouTube channel to listen to a few prayers I enjoy. Then I’d start the playlist from Ben. I’d share all this with my friend and chat some more.
After my labs came back all clear (and I was lucky that they did every week for all 12 weeks), my friend and I would go to my chair in the infusion center. I’d kick off my shoes and put on my fluffy slippers that I only wore on chemo day. I’d remove my aromatherapy locket and dab a little lavender or bergamot. Then, I put it over my head. I’d take out the small wooden cylinder from Shira that had twelve hearts of reasons she loves me and place it on my side table. I’d place Stego on the side table next to the cylinder and put my ID bracelet on Stego’s neck. My water bottle sat next to Stego. My computer or iPad was on the other side of the table. And then I sat in the recliner, elevated my feet, asked for some heated blankets, tea, and saltines, and settled in for my day. Usually, I chatted with my friend, the medical assistant, and the infusion nurse. I was happy to see them because this was a day when we were all actively trying to obliterate the cancer. After the medical assistants affixed my Dignicap and infused the Benadryl, I drifted into a lovely nap interrupted by my hands being too cold in the ice mittens or my feet being uncomfortable in the ice socks.
Hundreds of people held me virtually and physically, and their support, comments, humor, prayers, news, and love gave me strength. I felt happy on my chemo days, and that happiness was buoyed by having minimal side effects. My nurses and doctors wondered if my minimal side effects resulted from the enjoyment of the people and the memories I wove into those days. We'll never know.
Satisfaction
Satisfaction often comes from joy after a struggle, and Viktor Frankl’s Man’s Search for Meaning is the penultimate example of finding joy in the most difficult of situations. When I read Frankl after my treatment, his philosophy that both struggle and love are viable creators of meaning resonated deeply with me, as enduring and reshaping the struggle of chemotherapy and treatment was meaningful to me. Amidst the happiness of being cancer-free, I felt unmoored when all the therapy ended. The continued opportunity to love and be loved by people is the tether that lifts my spirits and focuses my energy.
Professor Brooks emphasizes that satisfaction is a formula dividing what you have by what you want. Every philosophy and faith has a version of this lesson: He who is rich is happy with what he has. Cancer is a struggle. For those of us who require chemotherapy, immunotherapy, surgery, and radiation (I didn't need radiation, but my mother, sister, sister-in-law, and Jacqueline did), it's not fast. I didn't know if the treatment was working until my oncologist examined me after three weeks and felt the tumor had shrunk. Shrunk wasn't gone, so I looked forward to seeing Dr. Chien every three weeks, chatting about what I was experiencing, and learning what she could feel from examining me. I didn't know it was gone entirely until the pathology from my surgery was complete.
One of the life lessons of my mother’s cancer when I was fifteen is that most stuff is small stuff. Cancer is big stuff. Cancer can alter the trajectory of your life. I realized when I was 15 that in comparison to cancer, a bad grade didn’t feel that important because there would be another test. It's the same with competition. Or a date. Cancer offers a gift of perspective and gratitude. I’d still rather no one I love ever have it, but that’s not an available choice. Cancer also impacts time because, during treatment, someone else dictated my calendar. So, I focused on the days I could control and what I wanted to do with my time outside of UCSF.
My mini-milestones of going to Florida to see Spring baseball, attending my daughter's lacrosse games after surgery, and being healthy enough to ride a bicycle through Burgundy over the summer were all pursuits of joy after a struggle. They brought me enjoyment and satisfaction because I shared them with people I love. After all, I was staying strong and healthy enough to do them.
Active Advocacy
I knew that if I developed breast cancer, I was going to need a medical team that I trusted, and then I needed to follow their advice. I was also a strong self-advocate. For example, when my original breast surgeon told me in November/December 2022 that I needed a mammogram and ultrasound before my surgery, I asked her why. I was curious because when my mom and sister had cancer, the first step on their journey was surgery. What was the purpose of pre-screening? The surgeon explained it was the protocol, and sometimes, rarely, they discover cancer, and the medical team changes their approach. I scheduled the mammogram for the first day after returning from a winter holiday with my family. I didn’t want anything hanging over my parents’ 55th anniversary; in my mind, this was perfunctory.
When the mammogram and ultrasound showed something suspicious, I advocated for an MRI immediately. MRIs are the gold standard for cancer screening, and I knew the radiologist would order one. Because I’ve had 20 years of MRIs, I learned to ask the radiologist to submit the order immediately because a doctor’s order is required to schedule an MRI. She did, and then I immediately called MRI scheduling and said -
“It’s January 3. I have major surgery on January 10. There’s something suspicious on my right breast. Can you please get me in as soon as possible?”
I was kind and pleasant while I shared my concern, vulnerability, and need. The scheduler helped me, and January 4 was my bilateral MRI. If you don’t share why you are asking for something, people cannot prioritize helping you. The radiologists read the MRI the same day and wanted an ultrasound-guided, core needle biopsy. Initially, the scheduler offered me a biopsy the following week.
I was more insistent on this call when I said, “That just isn’t work for me. I have a 13-hour surgery planned for January 10, and it's very complicated to arrange all the doctors and all my support team for this major surgery, so I only want to cancel/rearrange if this is cancer. So I need an appointment ASAP. Is there anything you can do to help me?”
Again, by openly sharing my context and timeline with the scheduler, she empathized and became creative in exploring options with the radiology team. I was kind and explicitly appreciative. She called me back within a couple of hours and said they could do my core needle biopsy the following day, January 5, at 8 am. My pathology came back the day before my surgery only because of my efforts to accelerate the screening/biopsy timeline. Unfortunately, it was malignant, and we did need to cancel the surgery, but I felt better canceling it knowing there was a good reason.
There were many other moments on this journey where I had to advocate for myself collaboratively with the team. When UCSF asked for help expediting my slides (see The Slide Saga) from Peninsula Hospital for UCSF’s required pathology review, I called and explained the situation to Peninsula Pathology. Often, I had to call multiple times to reach a human rather than leave a message. I always prefer waiting to talk to someone when something is urgent. The slide saga was frustrating because I couldn’t fix it the first day I tried. After all, it was already 4 pm, and the pathologists had left for the day. I needed to sit with my frustration for an evening, and I was scared that the slides would delay my treatment because of some administrative snafu outside my control. Once I accepted that I had done everything possible on January 18, I relaxed and recharged for the next day’s strategy. By 1045 on January 19, I had my slides in my hands.
Dr. Chien told me my chemotherapy would be weekly, and initially, her scheduler set up my chemotherapy appointments. Dr. Chien recommended infusions on Tuesdays or Wednesdays because those were her clinic days, and I could see her in the clinic and then proceed to my infusion. When the scheduler shared my first infusion, it was on a Thursday.
“I thought Dr. Chien wanted Tuesdays or Wednesdays.”
“She does. But there’s no availability on Tuesdays or Wednesdays.”
“What do you mean - every seat is taken?”
“No…but you are doing Dignicap, so you need a Dignicap seat. There are only three Dignicap seats per floor on our three infusion floors. There isn’t a Dignicap seat available until Thursday.”
“Can we book the next few weeks so that I can do Wednesdays?”
“I don’t know. I cannot see the schedule. I need to call the infusion center and ask.”
It blew my mind that a scheduler within the same center didn’t have access to schedule in a different department (oncology versus infusion center). However, solving the efficiency problems of a significant healthcare center was not my priority.
“You have been terrific and helpful. Thank you. It might be easier to talk directly with the infusion center and schedule directly with them. Is that possible?”
“I guess so. Here’s the number.”
My following conversation was with Malia about scheduling for the infusion center. Malia let me know that they can only schedule three months in advance and that the limitation for me was the availability of a Dignicap-equipped seat. So Malia and I scheduled the next 11 weeks of chemotherapy for Wednesdays. I had to go to another location one week, but the rest were convenient. I also set an alert on my calendar for February 1 so that I could book May and for March 1 to book June. If I didn’t need AC, I would cancel the appointments and free the valuable Dignicap seat.
I saw Dr. Chien every three weeks during chemotherapy, and at the seven-week mark, I mentioned that I had trouble falling asleep after chemo because I felt jittery around 4 pm. I used a THC gummy or tincture to counter the jitters and sleep, but was there anything better she could suggest? She thought that the steroid I got in my chemotherapy pre-treatment to bolster my immune system was the likely cause of the 4 pm jitters. She noted that my labs were terrific and that perhaps I could try the minimal dose of the steroid instead of the standard dose. I asked if we could try it that day, and she immediately modified the prescription. From weeks 7-12, I didn’t have 4 pm jitters. It's an improvement to the process, for sure.
The decision between the second phase of chemotherapy with Adriamycin Cisplatin (AC) or surgery hinged on an MRI at week 11 or 12 of my first phase of chemotherapy. My doctor provided the order at week 8 with a requirement that the MRI be complete by April 19. April 19 was the day I would likely start AC if I needed it. I was religious about staying current in MyChart - the electronic medical record and communication system for UCSF. The day I received the order in MyChart, I followed its directions and called UCSF Mission Bay MRI. They said the earliest they could schedule me was May 6. I was confused and shared with the scheduler that my order said April 19, but the scheduler said May 6 was the best he could do. I asked about any other UCSF location, and he confirmed that May 6 was the first available anywhere. I booked it and felt stumped.
My doctor wanted a bilateral MRI by April 19, so my next step was to determine if the breast imaging center that had done my MRIs for the last 20 years had an appointment. They did! April 11. Perfect. I sent a note to Dr. Chien in MyChart letting her know that UCSF was unavailable until May 6, but Mills Hospital’s Women’s Health Center could do the MRI on April 11, and I was doing that. Somehow, UCSF found an appointment for me on April 5 for an MRI. I confirmed April 5 with UCSF and canceled April 11 with Mills, so I am back on track.
I even asked for help when I was trying to accommodate my desire to travel and enjoy life outside of cancer. My husband and I planned a six-week cancer-free “world tour” to watch our son play baseball in upstate NY, visit our other son during his summer internship in Texas, and travel to France for a week of bicycling and visiting with friends. I realized in May, while recovering from surgery that my immunotherapy was every three weeks, and I would be away for multiple infusions. I researched infusion centers in Manhattan, upstate NY, and Texas that administer Keytruda (pembro). I found one in Manhattan and one in Texas and reached out to Dr. Chien via MyChart. Dr. Chien suggested that we adapt my infusion schedule and give me a six-week dose right before I leave on the trip to keep everything at UCSF. Her experience is that the insurance companies have difficulty when you infuse in different locations. She facilitated two Sunday infusions (who knew) of Keytruda - one in early June and one just before I left on the trip. Upon my return, we also booked the Keytruda infusion to ensure I stayed on track with the immunotherapy.
I am the most focused on my timeline, treatment, and experience. Using kindness, appreciation, and persistence, schedulers, nurses, and doctors became collaborators, creating a schedule that worked for everyone. Other than the first appointment with my oncologist and new surgeon, I didn’t leverage relationships or favors to adjust my schedule - I shared why I was asking for a change and then asked for help. And I was both patient and persistent. Every cancer patient needs to be patient and persistent.
Cancer unto itself means nothing but a collection of cells running amok and causing trouble. Surviving cancer doesn't mean anything either, although I have tremendous gratitude for science, doctors, nurses, medical assistants, and psycho-oncologists who have advanced the treatment experience considerably in the last forty years. Meaning comes from coherence, purpose, and significance. Coherence is the ability to find peace in how life unfolds. I found coherence quickly with cancer when I acknowledged that I couldn't time travel and do the prophylactic surgery a year earlier, so I needed to accept that I was where I was. Purpose is the question of how your life serves others. I feel purposeful and impactful when I can help someone feel empowered when facing their cancer diagnosis and treatment. It makes me feel good when people call, text, email with questions and appreciate my perspective. In many ways, this memoir, as well as the posts, texts, and countless conversations I've had with women in those first few weeks between diagnosis and treatment, is an effort to reach and empower more people so that cancer, or another curveball, is less disruptive and possibly discovers some positive aspects. If it reaches many people and helps them, my life experience feels more meaningful. I want to help every person find happiness when they face cancer or another curveball. My career is a 25-year curveball-seeking journey, and pursuing happiness while facing curveballs made me a more decisive leader and led to better outcomes for my teams, companies, and shareholders.
Pursuing happiness increases the probability of smashing the curveball exponentially, and in the regrettable event that you don't hit the curveball, at least you spent your time in love and joy rather than despair. Significance is the knowledge that one's life matters. From the reactions to my first email with the link to the CaringBridge to the calls, texts, volunteering, and prayers, there were countless moments where it was evident that my life matters to people. And the opportunity to provide hope and perspective to other people facing cancer is something I treasure.By taking ownership and creating enjoyment in my cancer journey, I made it happier. There were natural moments where I was angry, frustrated, and flabbergasted, such as when I couldn’t get my slides and thought the slides would delay my treatment or when I was worried cancer might have spread while I waited for the results of my PET scan. Whenever I had to talk with my insurance company about coverage for cold capping, it was a thorn in my side and a severe stressor, although I am very grateful that I have insurance. Working with Sadie and using Positive Intelligence and Landmark Education practices, I developed an approach to acknowledge moments of sadness and anxiety, calm myself, and reset into what I can control. Sometimes, all I could do was express gratitude for something. For example, I couldn’t do anything about my slides after 6 pm on the first day UCSF asked me to get them transferred, but on the second day, I could show up to secure my slides and drive them to UCSF, and that reestablished my sense of power and control.
In Viktor Frankl’s Man’s Search for Meaning, Frankl expounds upon the strength and power of recognizing that even suffering and struggle create meaning. Cancer itself is meaningless, but being someone who found humor in the absurdity of cold capping and joy in the company of friends in the infusion center gave me purpose. Cancer brought my adolescent family closer when I was 15. The same thing happened to my family when I faced cancer. When I was diagnosed and asked multiple people for referrals, many sources recommended Dr. Jo Chien and Dr. Esserman. When I was lucky enough to be placed on their clinic schedule, I stressed over being late because I wanted to meet them. Once I met them and they explained my diagnosis and their approach, I gave up control to them on the approach and exerted control and influence over the pace. I wanted everything to move as fast as possible. Ultimately, I scheduled my infusions three months out myself rather than through Dr. Chien’s scheduler so that I could control my calendar better and ensure I always had a Dignicap seat. I didn’t research the protocol or get second opinions even though I think second opinions are a good idea. I trusted that these doctors would lead me to a pathological complete response (PCR). I also trusted that my community would come through with rides, company, and meals. I endeavor to stay as strong and healthy as possible through diet and exercise in the hope it would enable me to complete treatment as fast as possible with success. It was a unique experience for a self-acknowledged control freak that, with my life in the balance, I trusted the universe.
Anxiety
So, what about fear? Cancer is serious. No one should feel pressure to be upbeat and happy in a severe situation. One of the things I told my husband after my diagnosis was that I needed him to be alright when I shared that I was sad, scared, or frustrated. Throughout my life, I’ve sought to improve my ability to distinguish between my reactions and feelings versus my actions. I recognize that my emotional reactions often damage relationships and continuously work to be level-headed. By the time I was diagnosed with cancer, I was very skilled at compartmentalization. And I found Sadie, my psycho-oncologist, to secure a dedicated outlet for those feelings. Logically, I knew that cancer caught early would most likely respond to treatment. Early-stage breast cancer (non-metastatic) has a 99% five-year survival rate. But like anyone else, there were moments when I was scared, didn’t feel great, or was generally annoyed that I was dealing with cancer.
There are always horror stories about cancer, as there are horror stories about driving, heart attacks, and strokes. Life is unpredictable, and no one makes it out alive. It's a choice to focus on the possibilities of success or failure. I'm inclined to concentrate on the possibilities of success. Professor Brooks defines anxiety as "unfocused fear.." I like that definition. Fear and anxiety are our alert system, and paying attention to those alerts keeps you alive. But when the alert doesn't stop sounding, it's like living in a home with a fire alarm you cannot shut off. It's maddening, distracting, and stressful. Writing - both privately and on CaringBridge - helped focus my fear.
Before my major surgery on May 4, I wrote a document, "If the unthinkable happens…parting thoughts". I believe I left it open on my browser on my computer, figuring that someone in my family would open my laptop (they know my password) and find it. Honestly, I didn't think I would die during surgery, but I had some anxiety about 13 hours of anesthesia and unexpected complications. I felt comforted by writing what I wanted each of my children, husband, parents, and sister to know. The act of writing those paragraphs focused on my fear. I wasn't afraid of the pain after surgery because I felt confident in my strength and pain medication. I wasn't scared of more cancer because the scans and biopsies were all showing a complete response. But I didn't want to leave the most important things unsaid. Having written them, I went into surgery with optimism and confidence.
Journaling has proven to be both an efficient and effective way to reduce anxiety, so when I needed to, I wrote. When I found my mind racing through unlikely but possible scenarios, I focused on my breathing with box breathing - four (4) beats to inhale, four (4) beats to hold, four to exhale, and four to keep. Fighter pilots learn the technique because three or four box breathing cycles demonstrably lower pulse and blood pressure. Sometimes, my mind would drift during the box breaths, and I learned to recognize the distraction and return to my box breath without recrimination.
The waiting between labs and being called back to the infusion center is the ideal time to start worrying. I usually had a friend with me to talk and distract me, but when the what-ifs broke through, I found that prayerful music reoriented me to gratitude. My favorites were Modeh Ani by Elana Jagoda (Uri Uri version) and Wonder (Asher Yatzar) by Rabbi Josh Warshawsky (recorded during Covid). The beauty of the melody and voices made me smile. Sometimes, I would quietly sing along but be careful not to bother my neighbors.
Emerging from surgery to my husband's smile and the report that everything went well was a moment of deep satisfaction I can recall despite the blurry grogginess from the drugs in my system. Every follow-up appointment was a step closer to being drain-free and travel-ready. My mini milestone after surgery was Mother's Day with all my kids, parents, and sister's family. Brunch at my house was full of laughter, and I didn't have to lift a finger. People + Memory = enjoyment.
Choosing Happiness
Cancer has all the ingredients for victimhood or happiness, sometimes simultaneously and often alternating between the two. It's likely that every cancer patient inevitably spends some time feeling like a victim because cancer sucks and derails your life. Adequate health insurance and access to care are blessings that should be available to everyone, and I was lucky to have them.
I hope my story and approach become a “first-day memo” for cancer patients that illuminates a path so that your cancer journey has joy, satisfaction, and meaning wherever possible. I wasn’t happy that I had cancer, but while I obliterated my cancer, I discovered happiness every day.