April 24, 07. In the Beginning…

Due to the fact that I began writing the 'story so far', in a Word file, there's an inconsistency in the chronology of the blog links for June. First of all, all the entries in June have two dates: June 12 - the day on which I transferred the contents of my Word file to the blog - and the date that the event actually occurred. Because I'd set up the blog to show the newest item first, I had to upload the last item first in order to present events in the order they occurred. That explains why the Older Posts link actually leads to a newer post.

The easiest way to go through the items in their order of occurrence is to use the links in the Blog Archive on the left side of the page. The last link for June (June 11 to end-June) contains a number of events occurring on different days.

From July onwards, the first item describes the latest development - and clicking Older Posts will actually display a previous post.

I never self-examine. Whenever I ventured to do so, I inevitably found an errant bump - and endured the consequent tension until it was pronounced meaningless. I gave myself over completely to the apparati and doctors to identify the lumps and bumps in my body and to reach decisions on their significance. In February, my annual mammogram failed to turn up any aberration - out of mind until July, I thought, when it's time for the surgeon's physical exam.

On the morning of Israel's Independence Day, I dried off from my morning shower and liberally applied moisturizing lotion over my upper body. Here was a rare opportunity to pamper myself on a weekday and I intended to take my time smoothing the silky cream over my arms and breasts, working down towards my belly button. Moving my hands to my sides, my fingers, rendered sensitive by the cream, felt something in my left breast that could not be ignored.

Family and close friends know that I am the only one of my siblings to reach the age of 60. My sister Jo died from breast cancer in 1985 at the too-young age of 47. My brother Tony died from kidney cancer in December, 1999. He was four months short of his 60th birthday. Although genetic testing showed that I do not carry any known breast cancer genes, the spectre of cancer hovers over me like the sword of Damocles and I have maintained a strict schedule of mammogram testing followed six months later by a manual check for the last 15 years or so. At the end of each round, I would take a moment to register relief - and then continue with my life. The morning I found the lump, I went cold and my stomach churned with fear.

May 2, 07. Well, What a Relief

The following day, I made an emergency appointment with a surgeon. Dr. Agbaria pummeled, manipulated and poked my breasts, paying particular attention to the lump, and then pronounced me healthy. He explained that a cancerous tumor does not have well-defined edges and does not move around - and my lump was well-defined and was very mobile. I cried tears of relief. To be absolutely sure, he told me to make an appointment for an ultra sound.

I made the appointment for a week later and practically skipped back to work. The heaviness of the last two days lifted and I smiled at the world.

May 4, 07. The Results

*Nachum drove to the Herzliya Medical Center to pick up the results of the ultra sound I’d had two days earlier, while I stayed home to prepare for our weekend at Jacob's Ladder (an Anglo music festival for ageing hippies and progeny). I waited for him to call me and tell me that everything was OK, to put a final period to the whole unpleasant and frightening experience. In fact, I was so confident that it would turn out to be nothing; I'd gone ahead with my plans for setting up a Swinging 60s group and written a script in which I'd referred to the lump as being nothing more insidious than a cyst.

I was in for a shock. I heard the words, 'It's not good news' and that the lump was possibly malignant.

Angry! I was enraged - I went from room to room, yelling and cursing. Sitting on the bed, suddenly deflated, I began to cry. And then, amazingly, I picked up the paper and went on reading. It's probably some stupid mistake, I thought. The doctor who looked at the pictures wasn't wearing her glasses, or entered a comment meant for someone else.

Nonetheless, a pall spread over our fun weekend.

*Nachum is my husband.

May 6, 07. Up Again,,,

Sunday, I was back at the clinic for another emergency appointment. Dr. Rosenblatt looked at the ultra sound pictures and examined the lump. 'I would've sent you away and told you to come back in three months time,' he said. He couldn't fathom why the doctor who checked the ultra sound pictures thought my lump was suspicious but because he admired her professionalism, he took her recommendation seriously and referred me to an oncological surgeon.

Life on an emotional roller coaster. I'd been down, I'd been up, then down again - and now, I was almost afraid to hope.

May 7, 07. And Down Again

The following day, I met the oncology surgeon, Dr. Sigal Librant. She too examined my lump. "Even if the ultra sound had been OK, I'd say it's suspicious.' She explained that to use a needle to extract a sliver from the lump would be difficult to do because the lump was small - also, it would take three weeks for the results. Instead, she recommended removing the lump in its entirety. She got no argument from me, I was heartily sick of the lump by then and wanted nothing more than to excise it from my body. She made a note to herself, marking it Urgent, and gave me her phone number. She would set up an operation within the week, she said.

I called her on Thursday and she told me to be ready to come to the Herzliya Medical Center on Tuesday evening at 6.00. I was to fast from midday.

May 15, 07. Operation #1

As it turned out, the operation was moved up and I had to be at the hospital at 4.30, having fasted since 11.00. For once, not eating wasn't a problem - I was so nervous I could barely get any breakfast down. Nachum and I arrived at 4.00 and *Gabi and **Yaniv a little later. When we checked in, the clerk asked what operation I was scheduled for and she answered her own question saying, oh yes, breast cancer. I was too jittery to argue with her that that had not yet been established. We moved through the bureaucratic procedures with lightning speed with the only hiccup being that the insurance covered less of the cost than I'd originally thought.

The waiting room contained a TV screen on which the status of each patient (in surgery, in recovery) was displayed. I tried to read a book but I couldn't concentrate. I was very aware of the beating of my heart. About 15 minutes later, I was called to a room and shown to a cubicle where I was directed to remove my clothes and jewelry and don a hospital gown and robe. At this point, my mind caught up with reality and my psyche grasped that cancer was a probability and it was happening to me.

I answered a series of medical questions from a nurse, who also verified my name before allowing me to put on a plastic name bracelet and then, after kisses and hugs from my family, I was led through the corridors to a room where I was to meet the anesthetist. Gabi came with me in the hopes of meeting Sigal and asking some questions - we were actually running late because Sigal had been held up in traffic.

I sat on the bed waiting for the anesthetist,I was so nervous, my heart was thumping so loudly, I assumed the position and began to meditate. Regulating my breathing served to minimize the heart thumps and I began to relax. I was brought out of the meditative state by a nurse tapping on my shoulder and asking if it was OK for the anesthetist to talk to me–apparently, he’d ventured into my cubicle but faced with a patient sitting cross-legged and with closed eyes, had scampered out at a loss at what to do.

Feeling almost light-headed – probably the result of whatever substance was been fed into my right arm – I was wheeled into the freezing operating room, where, after moving over to the operating table, I was covered with what appeared to be heated rubber pads. I’d being trying to identify the anesthetist’s accent and I asked him where he was from. Transylvania, he answered. I don’t know if I managed a puny joke about Dracula before finding myself back in the cubicle, trying desperately to open my eyes. Clearly, the operation was over and Sigal was smiling down at me, telling me that it had gone well.

* Gabi is my daughter. She's a pediatric resident at Rambam Hospital and the mother of my two amazing granddaughters.

** Yaniv is my younger son. He lives in a kibbutz in the north of the country and is active in a nation-wide youth movement.

It Pays to go Private

I was wheeled into a four-bed ward with just one other woman occupant. My bed was placed next to the window, with a wide sill, looking out on to rows of well-tended flower beds (rather than the sea-view promised by the brochure, but esthetically pleasing nonetheless so I decided it was probably inappropriate to make an issue of it). On the wall opposite was a flat screen TV. A nurse appeared carrying a tray with a light meal accompanied by a vase containing a red carnation and baby’s breath. She was very concerned that I stuff my belongings into the drawers of the bedside table rather than have them easily available on the window sill. In fact, after returning from the private bathroom, I found she’d taken some items I’d placed on the window sill for easy access, and put them back in the drawer. Why she should imagine anyone would steal my toiletries is anyone’s guess.

I went home the next morning with an adhesive bandage covering the stitches on the top left side of my breast. I felt fine and even optimistic that all would turn out well. My lump was under examination in the lab and the results would be available in four days time.

Black Thoughts…

Fact is, I am a superstitious person. I’ve developed and evolved my superstitions over a lifetime; they constitute the conversation I have with myself and my intrinsic truth. Time after time, I’ve found that dwelling on an outcome will almost guarantee it will not happen and so I set forth with great determination to imagine the worst. In my mind, I heard Sigal’s voice telling me the bad news, I fantasized going through debilitating chemo therapy and agonized over the loss of my hair.

…vs Positive Thinking

Fact is, I’m also an optimistic person. I couldn’t help allowing a fantasy of hope to intrude on my dark thoughts. My dreams, which have traditionally turned out the opposite, were happy, non-events – I simply didn’t dream about cancer, lumps or any news, good or bad. I yearned to return to my life and leave this histrionic period in the past.

I’ve always regarded myself a lucky person, living a charmed life, born on the 18^th day - which in Jewish gematria represents life - in the first month of the zodiac. I perceived myself immune to true calamity, exempt from it – and it was inconceivable, despite the respective tragedies of my siblings and my dedication to hypochondria, that I too would succumb to this disease.

Furthermore, I was proud of my health – I never felt so healthy as when visiting the sick, especially in hospital. I would feel such an affirmation of my own robust state of health that I would be imbued with extra doses of energy. Such hubris, so deserving of its comeuppance!

I’d now been overtaken by events that threatened my sense of me, my essence and my self-image.

Waiting for News

Those four days are mostly a blur in my mind – a blank. I have no idea, apart from my almost obsessive dark imaginings and occasional optimism, how I functioned, if I ate, what I read. I do remember going to friends for dinner on Friday night where the world of cancerous lumps seemed remote, irrelevant and even slightly ridiculous.

But I also recall receiving a phone call from the Herzliya Medical Center on Friday morning, asking me for my credit card details to pay for a laboratory test not covered by the health fund, a test they called Rh2. The little I could glean from the internet indicated that Rh2 inhibited cancer cell production. I think I knew what the answer would be on Sunday.

Otherwise, all I can remember of those four days was waking each morning with a churning stomach and ODing on DVDs.

May 20, 07. Sunday Morning

Sigal called a few minutes after 8.00. Nachum had woken me at 7.00 and I’d managed to down a cup of coffee. The recharged phone was on the bedside table. I couldn’t make any sense of the newspaper. My stomach was in serious churn mode and my body gave occasional spasmodic shakes.

Her opening words were an invitation to meet her at the clinic at 12.30. In a voice that was so steady I could hardly believe it was mine, I said, I guess that means the lump was cancerous. We need to talk face to face, she replied.

Nachum, Gabi and Yaniv and I decided to go out for breakfast before the appointment. The passion fruit seeds in Gabi’s order of yogurt and muesli looked exactly how I’d imagined the cancer cells - greenish with a black center – which Gabi said was pretty close. My negative thoughts are becoming the stuff of prophecy.

Yaniv had prepared a folder for me with section dividers for lab reports, doctors’ letters, and so on.

By the time we’d all piled into Sigal’s office, I was very calm – after all, my doubts were now resolved. There was no more fluctuating between dark and positive thoughts. Now I knew.

But the news wasn’t all bad. The lump was grade 2 and considered small, 1.3 cm (I don’t really understand why that is considered small, it felt enormous to me, like a mid-sized qumquat), and the surrounding tissue, from which she’d extracted some 3 cm. overall, was clean of cancerous cells.

The next stage will involve checking if the cancer has spread to the lymph glands. Lymph glands are conduits through which fluids are distributed throughout the body. If affected, the cancerous cells can then potentially spread elsewhere in the body and metastasize.

Sunday Afternoon

It was time to inform friends and family who had not yet been privy to what I had been going through. The date was May 20, almost a month since I’d first discovered the lump – but it felt like half a lifetime.

I’d gotten in the habit of simply telling any friend and acquaintance I happened to come in contact with during the waiting period, which led to some strange anomalies. Our chiropractor and pedicurist knew, but close friends with whom there had been no recent contact didn’t know. *David, living in the UK, knew nothing about the hell of the last few weeks because I saw no reason to burden him with something that might still have had a happy ending. But I’d made it a habit to tell people I’d met by chance, whether close friend or mere acquaintance, because the issue was a constant presence in my mind and I felt uncomfortable and slightly dishonest not sharing it.

Naturally, I’d informed my boss – and I’d been surprised by a lovely bunch of flowers from work.

I spent the afternoon at home, calling friends, responding to the masses of emails I’d received from people who were waiting anxiously with me for news. But before anyone, I called David, who said he’d get the first plane out.

*David is my elder son. He's finishing off his post-doctorate in neuro-psychology in the UK before going taking up a post-doc position in New York.

Sunday Evening

The full impact of the morning’s news – plus, I suspect, the relaxing of the tension under which I’d been living since discovering the lump’s existence – suddenly overwhelmed me and I sobbed and wailed until I wondered if I’d ever be able to stop.

May 21, 07. Radioactive and Color Dye

Sentinel nodes, which were discovered around 1996, are the first node in a string of lymph glands and if the sentinel is not affected with cancer cells, neither are the nodes behind it. In order to identify which node is the sentinel, a combination of radioactive dye and color dye is injected into the armpit in order to isolate the sentinel from the rest of the nodes.

The next day, I went to Hillel Yaffe hospital in Hadera to be injected with the dye. Sigal led me into the room where Dr Itamar Ashkenazi proceeded to explain that he would be injecting me four times, each time for about 10 seconds and that I might feel some pressure as the substance coursed into my body. He also warned me to not get up too quickly from the table where I was lying to avoid banging my head on the cupboard nailed to the wall above me. Pondering on where they could relocate the table in the small room so that the cupboard wouldn’t constitute a danger kept my mind off the injections, which were bearable – unpleasant, but bearable. I considered asking why they didn’t just move the bed or the cupboard but I didn’t really care that much.

The next step was to X-ray my armpit to make sure the dyes were doing their job. I stood in front of a machine with my shoulders awkwardly pressed against a sheet of paper, the kind that cheap toilet paper is made from. I stood there for so long with no-one shouting instructions, I wondered if I’d been forgotten. After what seemed like an age, my armpit was X-rayed from various angles and then I was told me to wait outside.

I still had to talk to the anesthetist so Nachum and I went up to the ward. We’d been there about an hour when I got a message from the X-ray unit that they’d set up the machinery for some more pictures only to discover I’d disappeared. They took their pictures then told me I was done. Apparently, because the lump had been so close to the armpit, it was difficult to isolate the sentinel. Sigal and Itamar assured me that the newly injected dye, which was creating a lot of noise in the area, would dissipate in time for the operation, scheduled for 8.00 the next morning. Itamar warned me that my urine would be blue.

May 21, 07. Meeting the Anesthetist

We waited until past 3.00 for the anesthetist to appear and when she did, I felt any remaining residual of optimism begin to flag. She could barely speak Hebrew, so much so that when I asked if I could brush my teeth in the morning (I’d been told I had to fast from midnight), she thought I was asking her if I had to remove my dentures. It took a nurse with both Russian and Hebrew speaking skills to clarify matters and explain that my teeth are all my own. The encounter with the anesthetist succeeded in depressing me still further.

May 22, 07. Operation #2

I had to be at the hospital by 6.30 and I got up around 5.15 just as Yaniv arrived, having picked David up at the airport. It was still dark outside, adding to my general feeling of misery. When we got to the hospital, we discovered that we’d forgotten to bring a certain form and Nachum and Yaniv went back home to fetch it. I was getting more nervous by the minute – David and I sat in the corridor of the surgical ward, or rather I sat on a bed but he was reprimanded for doing so and had to stand.

By the time we reached the pre-op room, I was a mess. Hillel Yaffe is the mirror image of Herzliya Medical Center: where everything at HMC is designed to ameliorate an unpleasant experience, Hillel Yaffe’s dilapidation and general air of neglect just seemed to highlight it. I put on the hospital-supplied gown and tried to meditate but found it impossible to focus. At the edges of memory, I recall being approached by a chirpy Russian doctor who slipped a needle in my arm. Everything is a blank until what seemed to be merely minutes later, but was in fact three hours later, and I woke up to find Gabi at my side. She told me that they’d all been so worried because it had taken so long but the surgeons hadn’t been able to isolate the sentinels, so they’d removed 15 nodes. One by one, my family appeared at my side. My legs were shaking, I found it difficult to take a deep breath, my eyes felt crusted, my throat was full of phlegm and I was aware of something alien taking up space around my left armpit.

Itamar appeared at some point and told me that all the lymph glands were very small, the largest being around 5 mm. It was a good sign.

I was wheeled into the ward, again one with four beds, but this time all beds were occupied. I felt like hell and it hurt where a tube jutted out of my body. The tube ended in a small bottle which was filling up with the bodily fluids that would normally have been drained by the lymph glands. It was totally gross.

May 22, 07 Chag Shavuot, After All

That evening, I managed to haul myself out of bed and, pushing the IV stand in front of me, joined Nachum, David and Yaniv in a small area off the corridor for pizza – after all, it was erev Shavuot – finishing off the meal with an apple cake Gabi had brought. I had a minor hysterical episode when I found the IV tube between my hand and the saline solution was full of blood and the nurses were patronizing and dismissive.

It hurt to sleep on my side, either left or right, and I finally fell asleep on my back, only to be rudely awakened by the nurses changing shifts. A small group of them flounced in, putting on the lights and talking loudly. I was too confused to protest.

Picnicking

The next day, Nachum, David and Yaniv came over with food left over from the Shavuot meal at Gabi’s in-laws. I managed to walk down the two flights, past the smokers billowing smoke in the non-smoking areas, through a labyrinth of corridors to a patch of green where we sat and enjoyed our picnic. It was almost idyllic – that I was wearing an ugly pink hospital gown and had a tube protruding from my body somewhat spoiled the illusion.

May 24, 07. Going Home Again

The next morning – after another night of sleep disturbed by changing shifts – my family came over to pick me up. Both Sigal and Itamar had come to visit me earlier and from each I had tried to extract some guarantee that the small size of my lymph glands was an undisputed sign that they were unaffected with the cancer, but they remained non-committal and insisted that we wait for the lab results, due some 10 days later. It was only later that I could appreciate their professionalism and honesty.

The pain in my arm, the discomfort of the tube and my general misery underscored the realization that I was now a victim of cancer and I began to cry. While my family tried to comfort me, from the bed opposite mine, the Arab lady with the strange patchwork of bright red, white and grey hair slipped out of bed and brought me some paper towels to dry my tears. This simple human gesture transcended the realities of the world outside the hospital. Despite its very obvious shortcomings, Hillel Yaffe, like all Israeli hospitals, dispenses medical treatment to all without discrimination. Arab and Jewish medical staff tend to Muslims, Druze, Christians and Jews in islands of neutrality with total disregard of the provenance of their patients. We are all, the patients, our families and the medical staff, united against the common enemy of disease to the extent that the issues of the non-sick become irrelevant. Hospitals are a place where humanity reigns in pure form.

Gabi helped me dress and we left the hospital, the tube dangling from my armpit.

Good Grief

Throughout this ordeal I have been exhorted to think positively. Since Sunday, the only thing I can be positive about, that is certain of, is that I have cancer. On Sunday, Sigal’s call could have returned me to my life; instead, she gave me information that made it impossible to do so. In the course of four days, I received devastating news that changed my life, was injected with foreign substances and had glands that performed a significant bodily function removed from by body. A tube dangles from my armpit culminating in a bulb where excess bodily fluids collect and my upper arm is numb and painful to move. I am overcome with sadness by who I am now and I fully intend to allow myself to grieve for the person I was.

I grieve for no longer being the woman of robust health I prided myself on being. I grieve for the loss of confidence that allowed me to plan a week or six months ahead in the knowledge that nothing more serious than a cold or stomach virus would deter me; I grieve for having to acknowledge the illusion that the choices I make control my life and exempt me from the fate of my siblings. I grieve because I am now tarnished by cancer, that damaged cells multiplied in my body, uninvited by and unbeknown to me, and even though I have a very good chance of surviving it, nothing can undo what that cancer has already done to my body, to my mind, or to my self-image.

That week I gave myself over entirely to self-indulgence, to succumbing to whatever dark thoughts my mind conjured up, to crying, raging or giving in to fear and despondency. I allowed myself to wallow in despair.

May 27, 07. Tubeless

On Sunday, the contents of the bottle were less than 20 cc so I went to the clinic in Hadera where Sigal removed the tube. It was such a relief not to have to think about it anymore. When I showered, I was always afraid that its weight would pull the tube out of my body and at night, I was afraid that I’d roll over on to it and inadvertently yank it out.

With the tube and its obnoxious appendage gone, I allowed myself one day more at home and a chance to be with my granddaughters and then on Tuesday, May 29, two weeks to the day I'd undergone the lumpectomy, I went back to work.

May 30, 07. More Tests

On Wednesday, I left work early to meet Nachum at Hillel Yaffe hospital, returning to the X-ray department where Itamar had injected radioactive material into me just over a week before. Now I was to have some other substance injected into me – thankfully, only one injection and it wouldn’t make my urine blue. I was told to go home and drink a liter and a half of liquid then return an hour later.

I began drinking as soon as I got home but it wasn’t easy to drink so much is such a short time. I asked David to take some photographs of me for this blog, but although I stretched my mouth, I couldn’t make my eyes smile.

We went back to the hospital and now, dying to pee, waited to be called for the bone mapping test. My mood at this point was very down and I waited with a great deal of trepidation for what was to come.

The test is not so terrible but in my current state of mind I found it very difficult. I lay down on a table and the technician wrapped a wide belt around me to keep my arms at my side. Above me there was a thick platter which the technician began to lower towards my head. I was reminded of those 1920 movies where helpless maidens were tied to the railway lines as trains trundled menacingly towards them. The imagery I was conjuring up combined with my awful mood brought me to the point where I couldn’t stand it any long and I practically screamed at the technician to stop, even though I knew that the closer the platter was to my body, the sharper the resolution of the picture. Nevertheless, he complied and as the platter moved down over my body, I began to relax slightly.

The whole process was repeated with my head on the side. By the time it was over, I felt emotionally shattered and supremely dispirited.

The next morning, I went to the clinic in Binyamina for a blood test and to have my stitches removed. Nachum had arranged the appointment so that I would have time to get to the clinic in Hadera for a stomach ultra sound. While the nurse was setting up the blood test, I reminded her that Nachum had asked her to attend to the stitches so that I could be on time for my next appointment. Since the bone mapping experience the previous evening, I had felt so demoralized that when she said she had to check if anyone else was waiting for a blood test first, I began to cry. I had became alarmingly prone to tears, which was quite embarrassing – in this case, I was lucky that the nurse was sympathetic and reasonable.

We arrived a few minutes late for the ultra sound in Hadera and then waited an unconscionable time before going into the doctor’s office for the scan. I wonder if doctors / technicians realize that the numbers they bark out to their assistants while moving the jellied joystick over our bodies strike fear in the patients being examined. Apparently, I have a cyst on my right kidney which is common in people my age. Recalling that my lump had been originally misdiagnosed as a cyst didn’t help to improve my mood. However, my liver and all my other internal organs were deemed in good condition.

On Friday, I received the results of the bone mapping and there was nothing more insidious than some sinus problem and an age-related anomaly in my upper vertebra. That was a major relief because breast cancer, when it metastasizes, does so in the bones. It’s what caused my sister’s death.

June 4, 07. Lymph Node Results

I hadn’t been dwelling on it, but occasionally during that 10-day period, I woke up with my old companion, the churning stomach. If the nodes had been affected by the cancer cells, I would without question be a candidate for chemotherapy. However, the happy news was that my lymph nodes were clear. There was more good news when I learned that my lump’s receptors were estrogen-progesterone based, rather than the more aggressive HER2.

Thinking Positively

There’s a dissonance between the life-threatening nature of this disease and a feeling of physical well-being. Apart from some numbness and pain in different parts of my upper arm, I feel physically very well – in fact, most of the time, especially in light of lymph node and other results, I was actually quite cheerful. I am working – not very productively – and for long periods of time, the idea that cancer and I have any relationship seems farfetched.

I am being constantly exhorted to think positively. Even David, my son the scientist who requires evidence based on established mechanisms, told me that doctors don’t fully understand why positive thinkers have better chances of survival. So what happens when a little runt of negativity leaves its corner and comes into the ring swinging (my sister Jo thought she’d survive – wham! How’d you know a cell didn’t escape and at this very moment is swimming with all its might to your bones – bam!). Flatten the runt, suggests David, and overwhelm it with positive thoughts. Not so, says Eran my meditation guru; be the queen of your domain, invite the negative thought inside, listen for as long as you want, then show it the door.

From the moment my cancer was confirmed, things moved quickly, drowning me in an emotional whirlpool as well as physically scarring me. As mentioned earlier, I was in a state of mourning for my previous life, the one that was untainted with cancer. It seemed inappropriate to sing when my life was in such dire straits so I resisted the urge to warble along with the radio. I’d been in the habit of walking up the stairs at work but now I used the elevator. I was behaving, David said, like a sick woman.

Perhaps that was the trigger – I began to emerge from the despondency and fear. It was just so much more liberating to behave normally. About a week after returning from Hillel Yaffe, I found that wafting around pitying myself was over-indulgent and rather pointless.

I suppose I can now be said to be behaving positively – I laugh, work and devote the major part of my mental resources and conversations to subjects that have absolutely nothing to do with cancer. In fact, most of the time, I’m not even really aware of it. Even my arm with its bruised tendons and nerves is less painful and more mobile with each passing day – although it’s a strange sensation, or rather lack of sensation, when trying to apply deodorant to a numb armpit.

I try to learn as much as I can about my disease through the internet, and talking with women who’ve gone through it. I have a pile of self-help books with different approaches to eating, breathing and loving. There’s a list of organizations all set to provide me with emotional, financial and physical help, should I need it. It’s a lot to process in such a short time. With such support, who wouldn’t think positively!

Oncology Nurse

Breast cancer patients are a privileged group. We have a specially trained nurse who is there to help us navigate through all the unpleasantness we’ll have to face while undergoing our cures. My meeting with Hannah Zohar in Rambam Hospital was in preparation for the oncologist I was to meet on the following Monday. I was also introduced to the social worker.

Thank You My Precious Family

Thank you Nachum - your life has changed together with mine - I know you’re doing your best and that you are there for me when I most need you. Thank you David for not hesitating to book the first possible flight to Israel before you’d even recovered from jetlag following your return to the UK from America a few days earlier. Thank you Gabi for deciphering medical esoterica, and for being the caring daughter my parents would have loved to have had. Thank you Yaniv for your thoughtful acts and kindness, for making the time to be with me in the hospital, at meetings with doctors and at home.

I cannot begin to imagine how I would have endured the last few weeks without all your love and support.

Thank You My Wonderful Friends

I’ve been overwhelmed by the affection of friends who’ve shared my anguish and reached out to support and comfort me with their emails, phone calls, vibes and prayers. I have had support from close friends, old friends, distant friends, almost forgotten friends, friends of friends and even virtual friends. There were times I answered the phone in despair and hung up in a spirit of hope and optimism.

For the women who’ve been through cancer and emerged healthy, thank you for your stories – each one serves to strengthen me because you’ve helped me to realize that it’s not only possible to survive but, as you exemplify, also return to a healthy and active life. Sharing your experiences makes me feel as if I’ve qualified for admission into a special club, which more and more women over time seem to be joining – it’s almost like a rite of passage.

For once, I have to admit that I can barely find the words that can adequately convey how grateful I am for you all

From June 11 to end-June, 07

Today I met my oncologist, Dr. F. I understood from Hannah that today was cancer newbie day and that I would be well advised to set aside a few hours for it. When I arrived at the oncology department, I was met by what can only be described as a hostess, a woman in civilian dress (i.e. no white coat) who greets the newbies as they arrive, and shows them where to pluck a number for the queue and which clerk they need to approach. She also led me to the doctor’s room and treated me to a short testimonial of the doctor’s stellar qualities.

Dr. F went through the history of my lump and was actually able to locate it on the mammogram. She said that some 10% of cancerous growths are missed in mammograms. Statistically, my situation is excellent and treatment will probably be radiation and hormones, or rather anti-hormones, because treatment with Tomoxifen blocks the estrogen in the body from reaching the receptors in the breast. I signed a document allowing the delivery of a sliver of my lump (I’d assumed it had been thrown away but apparently it’s kept and frozen) to be sent to America for tests to determine if my chances of survival would be substantially increased by undergoing chemotherapy. This test, called Oncotest (see and excellent animation of how this works by clicking Oncotype), is paid for only by Kupat Holim Clalit, one of the rare occasions when I am actually pleased to belong to Clalit instead of one of the other health funds. There is a slight chance, she warned, that they could discover something hitherto undiscovered in the local laboratories. The results will be available in two to three weeks. More waiting!

Dr. F did not really endear herself to me – she directed most of her comments to Gabi, probably because as she too is a doctor, she is more qualified to understand her explanations that I, a mere patient, can. Also, she started answering my questions before I’d finished asking them, which always irritates me. However, this woman’s knowledge and expertise is going to keep me alive so I’m giving her the benefit of the doubt for now.

I made an appointment for the radiation doctor. The secretary asked which breast had been affected with cancer and I asked why that was significant – was there perhaps a different doctor for each breast? – but she explained that the radiation setup would have to be adapted to account for the presence of my heart in the vicinity of my left breast. I hadn’t thought of that – the idea of fried heart is not appealing.

As chemo is carried out before radiation, I’ll have to wait to see what Oncotest will report. If they recommend chemo, I’ll have to begin it right away and then only after it's over begin radiation treatment. If they dismiss chemo, I’ll be able to start radiation treatment with no further ado.

Looking around me at the women who are at different stages of their treatments, meeting my oncologist, setting up appointments and generally moving through the minutiae of hospital and medical procedures forces me to come to grips with the fact that I have cancer – something I tend to forget or perhaps sublimate during the course of a day. It’s still frightening, my stomach still gives the odd churn or two, but I’m beginning to accept that it’s now a part of my life.

June 14, 2007. My Radiation Therapist

My radiation therapist is Dr. Bernstein. I had some idea of what to expect from today's meeting because Hannah (the oncology nurse) had loaned Gabi a DVD of a film featuring a woman who'd undergone radiation therapy and the different stages involved. I wasn't happy to see that large machines with forbidding-looking moving parts, reminiscent of the one that so traumatized in the bone mapping test, were used. I asked a mass of questions and Dr. Bernstein preceded each answer with a drawing of a breast on his post-it pad. It consisted of a large half circle on which he drew a smaller half circle, topped off by a thick dot to represent the nipple. I wondered if he'd perfected his breast doodling skills in medical school.

Radiation therapy is designed to target and destroy cancer cells that might still be lingering in the area to reduce the risk of recurrence. As Dr. F had done, Dr. Bernstein threw a lot of statistics at me. Breast cancer treatment - as with other diseases - is based on research studies which, in this case, were conducted over the course of the last 25 years. Women are divided into different groups and conclusions based on which groups produced the most survivors over the longest period of time are drawn. There are so many factors involved in determining different treatments, including whether a women is pre- or post-menopausal, the size of the lump, the type of receptors, lymph glands, age and so on. All I really needed to know was by what percentage the recommended treatment would ensure my long-term survival and would it hurt.

It seems that yet again I am lucky in that, because my lump was close to the surface, radiation will be delivered by an external beam which produces fewer side-effects than other, more invasive forms of radiation. There will be a course of 25 treatments plus a booster of eight treatments, carried out every day, five times a week. Possible side-effects include blistering and discoloration of the skin, tiredness and weakness. According to the head nurse of the radiation department, a former Brit called Alison, 70% of women who have radiation therapy continue to work throughout.

June 20, 07. Branded

I find it so hard to separate my emotions from events and be comforted by practical and rational conclusions. Instead of being calmed by the large, expensive machines that are mobilized for my treatment, the sheer grandeur of the machines causes me an even deeper sense of disquiet because they serve to underscore the life-threatening nature of my disease.

Today’s simulation was to prepare the coordinates for the radioactive beam that will be delivered to my breast during radiation therapy. As the cancer was in the left breast, the ray needs to be precisely delivered to avoid nuking my heart.

Everything proceeded just as it had been described in the DVD – with the one exception that I was not given a gown to wear to walk the distance from the changing room to the table. Personally, I never fully understood the need for a changing room if the intent is to emerge half naked anyway.

The technician instructed me to lie down on the bed and place my arms on a red plastic block above my head. A large mobile platter moved over my head and hovered over my chest. From within the platter, what sounded like metal plates began to whirl and a yellow light flashed on and gazed at me. It lasted about a minute, maybe less. The procedure was then repeated a second time. I noticed interlocking red beams on my body.

Another technician joined the first and together they tattooed three different points on my body, each the size of a pinprick. Thus branded, I went home to wait for the results of the oncotest - and the question will be: do I begin radiation immediately or start chemo. If anyone is listening to me up there, please let it be the former.

June 24, 2007. Outraged

I’m shocked. This morning, I phoned Hannah, the oncology nurse, to ask if she had any idea when the oncotest results would arrive (tomorrow will be two weeks to the day that Dr. F said she was arranging for the sample to be sent to Oncotype). One of the reasons I asked was that on the day I visited Dr. Bernstein (June 14), Dr. F, noticing me waiting in line for the secretary, had mentioned in passing that I would have to pick up what I had understood were the results of the test myself as it was private. I was mystified by the comment but assumed that I would be enlightened when the results arrived.

Hannah asked if I’d picked up the sample and now, completely baffled, I asked if she meant the sliver of lump that I’d assumed had been sent to America following my meeting with Dr. F on June 11. She said she would call me back but she didn’t. She called Gabi instead.

Gabi began to explain that because Herzliya Medical Center is a private hospital they would not release a sliver from my lump to anyone but a member of the family. It transpires that the sliver, which I assumed would by now be post-analysis and my fate determined, had not even left Israel.

Two weeks of tension exploded in me. I went almost beserk with rage. I phoned Hannah again for an explanation of why the hospital had failed to inform me of the situation. Her explanation barely acknowledged hospital culpability for the screw up. I told her, inter alia, that I had asked her a question and her answer should have been directed to me – at this, she became a little more spirited in defending herself and said that as Gabi was in the vicinity, it was reasonable for her to give her a letter to fax to me. This of course is nonsense – she could quite easily fax me the letter herself - Gabi works in a different department.

As far as I can piece together, this is what happened. Hundreds of tests have been sent to Oncotype but this is the first time that anyone at Rambam tried to send a sample that had been extracted from a patient in a private hospital and they were therefore unaware of the restraints placed on them by HMC. Dr. F received a letter from Teva, which appears to be Oncotype’s representative in Israel, on June 12, one day after I’d met her for the first time, informing her that they’d asked HMC to prepare the sample and that they would let her know as soon as it was ready so that she could instruct a member of the family to pick up the sample and bring it to Teva. Dr. F’s casual remark to me while I waited in the queue on June 14 now became clear.

On June 17, Teva again wrote to Dr. F informing her that the material was ready and that I should be directed to collect it from HMC and bring it to Teva. This information was never relayed to me and if I hadn’t phoned Hannah this morning, I would still be living under the illusion that my results were imminent.

My rage is in part disappointment in a system that until now had proven itself to be so compassionate and efficient. I felt let down and betrayed and that neither Hannah, nor Dr. F, saw fit to accept responsibility and proffer an apology fueled my sense of outrage and frustration.

Nachum went to HMC to pick up the sample and took it to Teva. According to the clerk he spoke to, the results would take another two weeks.

Calmer now, I phoned Hannah again to ask her what the procedure was to change my oncologist. She suggested I wait until I get the results and then meet with Dr. F again. I suggested that I not wait because there is a total breakdown in trust between myself and Dr. F. The relationship between a patient and a doctor is of paramount importance – it says so in the pamphlets the hospital gave me – it’s a relationship where the patient should feel free to ask questions and be secure that her oncologist is acting in her best interests. Clearly Dr. F no longer fulfills that role. Again Hannah suggested that I not make hasty decisions, maybe because she feels culpable for this outrageous deficiency in performance. To my mind, Dr. F bears ultimate responsibility.

Today is June 24 – I won’t know until July 8 if I will have to undergo chemotherapy or not, more than a week longer than would have been necessary if proper procedure had been observed.

June 26, 07. Still angry as hell.

Although I entitled it Outraged, the account of the negligence exhibited by my doctor was a dry recording of events as they occurred. Two days later, I can better articulate how the breakdown in communication, the sense of betrayal, the isolation I felt when no-one would take responsibility caused me an immense emotional setback and serious harm to the coping mechanisms I've developed in order to function more or less normally.

The emotional impact it had on me was profound, more disturbing even than a negative medical report conveyed in compassionate and sensitive tones, would have been. It was an episode equal in intensity to the torrent of tears I produced on the evening after receiving my cancer diagnosis.

Tomorrow I will have recovered my equilibrium sufficiently to call the hospital secretary and take the first step to replacing Dr. F.

June 27, 07. In Limbo

Have I been rash? I phoned the department's secretary this morning and told her I wanted to change my doctor and she was taken aback when I told her that the doctor I wanted to replace was Dr. F. Apparently Dr. F has an excellent reputation and nobody has ever fired her before. She insisted I tell her why and seemed to understand that, under the circumstances, I could no longer continue with her. However, she has to bring the situation to the attention of the department head, who won't be around until next Monday and it's possible that I'll be assigned a resident and not a veteran doctor.

I asked her who would inform me when the oncotest results arrive if I still haven't been assigned a doctor and it seems it's up to me to call Dr. F's secretary. Or Hannah. I'm not sure what I anticipated (well, I was thinking positively and somewhere at the back of my mind I expected to hear, Yes, of course Ms Carmel, I'll immediately assign you to Dr. Dropdeadgorgeous Superman whose patients have a 100% survival rate), but I don't think I foresaw a situation where I would in effect be bereft of a doctor.

Everything seems to be on hold: the type of treatment I'll need, the doctor who will supervise it, my myriad questions.

I don't dare die from this. I know if I do, there will be those of you who will nod sagely and say, See, she didn't think positively!

NOTE: I have removed the name of the oncologist, and refer to her by an initial for a few reasons. First of all, the trauma I suffered at the time is receding to a mere nightmare and over time will no doubt segue into a bad memory. In relating the incident, I still come close to tears, but with less intensity and the feeling soon passes. Secondly, my unfortunate experience with her should not serve to prejudice her patients against her, especially as I would hope that the incident has put the doctor on alert and she now makes an extra effort to avoid similar incidents from occurring.