Let Us Begin

Being a cancer survivor is about marking time. Nearly two years since my diagnosis. A year and a half since my surgery. A month until my next scan. Tick-tock, tick-tock.

Today’s milestone was finally getting the chemo port extracted from my chest. It was a no-big-deal surgery—wide awake, lots of lidocaine, 40 minutes total in the O.R. And it was the first time I’d actually seen the plastic cherry-tomato-sized orb through which they poured chemotherapy drugs into my body. I could have left it in there “just in case,” my oncologist said. Just in case I ever need treatment again.

I was initially reticent about removing it, as if doing so would jinx everything. But protruding below my collarbone and visible in the mirror every morning, the port bound me psychologically to the past. Taking it out signifies our shared optimism that I will never need to visit an infusion clinic again.

I joked with the nurses about whether or not I could keep it as a souvenir. In truth, I’d be thrilled to watch them incinerate it. I am all about scrubbing my life of the unwelcome traces of that time.

Goodbye, little guy. I won’t miss you.

[Goodbye to You, Scandal]

One year ago tomorrow, I had surgery to remove the tumor on my pancreas. It seems not that long ago. I remember almost everything, from the sleepless night before, and the post-surgery morphine haze, to the rogue visit with Matt to other hospital floors, and the week of unrelenting day and night visits from nurses to check vitals and take blood. And the boredom; good God the hours and days in that hospital room dragged on and on and on.

This week, I underwent my latest CT scan to check for cancer recurrence. And as if to deny me a simple milestone celebration, Kaiser made me wait two full days for the results. Two. Full. Days.

Then, the results…when they finally came, they said: “known evidence of recurrent or metastatic disease in the abdomen and pelvis.” Layman’s terms: your cancer is back.

Wait a second. That’s the summary; the detailed report shows no such evidence. I know this because I’ve read at least half a dozen of these reports before, and I scoured this one 67 times trying to understand the disconnect.

I furiously email my oncologist: WTF is going on?

Realizing my freak-out level, Dr. E. (who rarely calls) phoned seven hours later to reassure me: There was a dictation error and they dropped a word. It should have read: “no known evidence of recurrent or metastatic disease in the abdomen and pelvis.” They dropped the Most Important Word in the Whole Sentence.

Good grief. And phew.

So now, yes, we celebrate a big-deal one year of cancer freedom.

[Time is on My Side, the Rolling Stones]

One of the biggest struggles during this cancer ordeal has been my relationship with faith. Not faith in a higher power. But faith in my doctors.

It’s been especially challenging since my surgery nine months ago. I am in “surveillance” mode now. Every three months, I get a CT scan that looks for visual evidence of tumors, and a blood test that looks for evidence of CA19, a protein that can indicate whether my body is developing new tumors. Together, they tell the story of what’s happening inside.

With my tests in May, the first after my surgery, my CT scan was clear, but my tumor marker number was higher than normal. Not super high as with some cancer patients. But higher than it had been even at my sickest.

Wait. What? Why?

My oncologist said not to worry. The CT scan is the most important test (true), and there are good reasons why the CA19 might be high so soon after surgery. Three months later, same result: an above-normal CA19 number, but clean CT scan. Grrr. Now the CA19 is giving me fits. Is it picking up something that the CT scan can’t see?

My oncologist says, again, not to worry. We are looking for trends, up or down. Stasis is OK. Hmm. Dr. Google says one thing, she says another. Who to believe? For the sake of my mental health, I tuck it in the back of my mind and don’t think about it (and pat my neurotic self on the back for my maturity).

Fast forward to last month. This time the number has shot up even higher, and it’s caught the attention of my oncologist. In a late-night message, she doesn’t sugarcoat anything. She’s concerned enough that she orders a second CA19 test and moves up my scheduled CT scan.

Even with the reschedule, I am forced to wait two weeks for the tests. Two weeks of sleep-deprived nights and the encroaching worry about mortality—again. I seek relief in morning meditation and try to keep everything in perspective. We don’t know what we don’t know.

But I’m angry. Why did my doctor dismiss the first two CA19 results? Now her indifference is coming home to roost. Something is growing inside, I tell myself, and we should’ve caught it earlier.

I keep this development to myself. No need to draw attention or worry anyone else. I even decide that if the worst comes to pass and I go back for treatment, I won’t tell anyone right away.

On the morning of November 6, I go in for my scan on just one hour of sleep. I’m tired and hungry, which helps suppress my anxiety. As I lie prone staring at the Nemo decals on the ceiling, they drape my body in a heated blanket, inject the contrast dye into my left arm and slide me into the loud, whirring cylinder. The familiar disembodied voice tells me when I can and cannot breathe. It’s a reminder that, for now, I’m still a cancer patient.

The test results come back almost right away. I stare for a long time at my patient portal, afraid to click open…

---

A friend recently gave me a packet of five little booklets that she picked up from a cancer survivor in Joshua Tree. Jillian’s booklets are about being NERD, a medical acronym for “no evidence of recurrent disease.”

Being NERD, which I am, is a good thing.

It also means carrying around worry of becoming not NERD should the nasty cancer cells come back.

As Jillian writes, being in surveillance mode “means measuring one’s life into three-month or six-month blocks.”

For about two weeks approaching my quarterly tests, generalized anxiety takes hold. I don’t talk about the background worry because of my foolish attachment to stoicism, and because…what’s the point? There’s nothing anyone can say to relieve the anxiety. It comes with the territory—and will for the next five years.

Outwardly, we say what we think people want to hear and what we want to believe about ourselves: that anxiety and uncertainty helps us appreciate life and live in the present.

But a lot of times, Jillian writes, the actual reality is:

“I put my fear into a neat box so no one, including myself, has to touch or feel it.”

Until it doesn’t hold…

---

I finally open the test results.

First the CA19 level. It’s dropped dramatically almost down to normal. Wow.

Now the scans:

Overall stable appearance of the chest. No evidence for metastatic disease. Overall stable appearance of the abdomen and pelvis. No evidence for recurrent or metastatic disease.

Relief washes over me. I exhale for the first time in two weeks. I want to flee the office, go to the beach, watch the waves and deeply breathe in the salty sea air.

“I am grateful for being NERD,” Jillian writes. “Most days, I accept the uncertainty and find it clarifying. It really does help me appreciate life and be in the present. And some days, I’m scared, which is clarifying in its own way.”

So, what did I learn about faith in my doctor? This time, everything turned out OK. My trust is renewed. But what if it hadn’t worked out? Would I resent her for not taking action when those first alarm bells went off in my head?

I can’t worry about the what-ifs or dwell in negativity. I’d drive myself crazy. I’m determined to live life as worry-free as possible and refuse to let the specter of cancer paralyze me with fear.

Again, I turn to joy and daily gratitude for being here, alive and healthy. All I can do is put one step in front of the other, remember to breathe, and have faith that my body and my doctors—and maybe even a higher power—will look out for me.

[PS: The CA19 number is a blessing and a curse. It can point to problems. But so many things can drive it up and down that it sometimes ceases to be useful and provokes unwarranted anxiety. In my case, my oncologist says “it’s anyone’s guess” as to why it jumped around. I resolve not to put too much weight on it in the future.]

[Faith, George Michael]

We had a work retreat recently, and one of the activities involved writing ten characteristics of yourself on ten stickers and tacking them to the front of your shirt. Then we mingled with colleagues, discussed each other’s attributes, removed a couple of stickers with each conversation, and mingled more until we were down to one sticker.

One of my ten chosen characteristics was “survivor,” and it’s the one I left stuck to my shirt till the very end. Some colleagues knew what it meant; newer ones did not. It felt radical to call attention to it.

Technically, in medical parlance, I am a cancer survivor, meaning I had cancer, but am currently cancer-free. But I am not “cancer-cured.”

The only way I can get a “cured” designation is by undergoing regular CT-scans and blood tests with clean results for five years. Yesterday was a scan day. The scans themselves are relatively quick and easy, especially now that I have more than half a dozen under my belt. But the days leading up to scans, and the hours afterward are nail-biting. I try to be Zen. I have no control over the outcome. But still, it’s a judgment day. What has my body been up to over the past three months?

It’s a reminder that survivorship is a journey.

Calling yourself a survivor is a nice post-treatment perk if you can achieve it. But I’m tentative with the word, even as colleagues, friends and family cheer me on and remark on my recovery. I know the risks of this cancer, and though I am hugely relieved to be alive and in good health, one eye peers anxiously at what might lurk around the corner. I don’t want to jinx anything by boasting about my survivorship.

This thinking must be common, and I assume it will subside over time. Maybe, though, instead of waiting, I should decide myself to control those anxious thoughts.

As I walked past the oncology department yesterday, I recalled my mornings in the chemotherapy infusion clinic—the near constant worry about whether the treatment was working, if my blood levels were up or down, and my vulnerability to infections. The medication smell, the nausea, the insanely annoying beeping of the universally despised (and frequently malfunctioning) pump machines. Everyone in that infusion clinic right now would do anything to be in my shoes. To be called a “cancer survivor.”

I need to honor the struggle, and my accomplishment and milestone. It’s time to fully, proudly and unreservedly own the word SURVIVOR and all it stands for. I worked hard, and I freaking beat cancer, and I will keep beating it day after day, week after week, year after year.

I guess I’m going to need some more stickers.

Update: Yup, still beating cancer this morning. The latest CT-scan came back clear. “No evidence of recurrent or metastatic disease within the chest or abdomen.” Six months down.

[I Will Survive, Gloria Gaynor]