Living with Breast Cancer

Finale

2008-04-24T10:57:00.000-07:00

Today marks the day one year ago that I discovered the lump. Due to the discrepancy between the Jewish and Gregorian calendars, the Hebrew date of discovery is some two weeks away, marking also Israel’s Independence and 60th birthday.

Regardless of the culture that defines the time period, the completion of the seasons’ cycle behoves me to reflect on the last year and to take stock - what is called in Hebrew, a heshbon nefesh.

For sure, the discovery of a life-threatening disease and its aftermath makes its mark on one’s life on a physical, emotional and mental plane. How could it not? Death had been way down the road and here it was threatening to take up residence right next door. Initially, the changes were primarily physical, while the soul and the psyche struggled with the existential import of what the body was forcing them to endure.

One year later, the physical remnants of that horrendous diagnosis are mellowed but extant. My breast bears the faintest scar, which will no doubt continue to fade over time. It is still swollen from the radiation, though to my eye, grown obtuse from over-familiarity with its contours, the swelling is barely discernable and to the casual eye, is a perfect match of its twin (perhaps it is necessary to point out that I am using a turn of a phrase because no casual eyes have in fact been scanning my breasts). Ironically, the breast, despite being the source of all the trouble, is the least physically affected part of my body. Rather, my left arm, with its lymph node population reduced by 15, is still sensitive in that lying on it or moving it beyond still unascertained boundaries causes pain, or at least, discomfort. Some areas of my upper arm are still numb and it is uncertain whether normal feeling will ever entirely return to it. I continue to heed the warnings of various medical practitioners and in my exercise class, I lift weights only with my right arm and limit my left arm’s participation in various other exercises. In a way, this vigilance seems a little specious as I use no such discrimination when picking up my granddaughters or the groceries, all of which are individually much more than the mere one kilogram of an exercise weight.

I am certain that for most of my adult life I have experienced physical discomfort in various areas of my body which I have ignored, subliminally secure in the knowledge that a twinge is here today and gone tomorrow. However, as I have written earlier in this blog, there is little the body can serve up nowadays that is not processed by a mind still bewildered by the trauma that befell me, as a possible new symptom of the disease that will not go away. Some symptoms are more worrisome than others but their disappearance within a few days reassures me that the body is merely shifting and adapting its aging parts, rather like a house settling in for the night.

To all appearances, the disease has indeed gone away - but there are still those moments when I am conscious of the sword of Damoclese that hovers over me, threatening my sense of well-being and confidence in the future. Part of the reason for this lapse in absolute optimism lies in the years during which the cancer was slowly and insidiously invading my body while I proudly perceived myself as a woman of robust health. Under the circumstances, a cancer diagnosis can be compared to a demonic harlequin gleefully intoning na nanna na na. And now that the disease has been scooped out of me, I choose to continuously question the validity of my perceived health and latch on to each and every bodily quirk as the disaster of the moment rather than enjoy the knowledge that the robust health that I had once believed was mine but was not, is now indeed mine to enjoy.

I once asked Sigal, my surgeon, when I can stop worrying about metastasis and her answer was between five and 10 years, an answer that had value for its truthfulness, but was not one designed to induce equanimity.

Control of my equanimity and restored confidence is totally mine and I spend most days dealing with life with nary a thought of cancer and its attendant unpleasantness. At times, I even find that I have to remind myself in a resolute manner that I’ve had cancer, because it still seems to be so very impossible. Such reminders unfortunately do tend to curtail whatever plans I had been happily in the process of forming until the fear recedes. During the last year, I have heard and read about so many cancer stories, mostly breast, that I realize that not having had to undergo chemotherapy places my experience at a totally different level than those who lost their hair and spent 10 days out of every month vomiting. Sometimes I wonder if my survival would be more assured if I’d suffered more - and then I quickly crush the thought and focus on being grateful that chemo had not been necessary.

I’ve often been asked during this last year how having cancer has changed me as if change were a prerequisite for recovery. In fact, as far as one woman, an astrologist, was concerned, any failure on my part to dig deep, dig true into my psyche would constitute an invitation to the loathsome little green cells to return - although she didn’t say how I was to accomplish this, nor how I would know when I had completed digging. But there has indeed been a change in my weltanschauung and that is simply a relaxing of my erstwhile, fondly held superstitions, nurtured and refined over a lifetime, and used as a source of reassurance. My superstitions had simply let me down. I had gone through all the time-honored rituals and I still had cancer. A thought that began as a whisper and became a clamor finally convinced me that neither numbers nor incantations have the power to change what has already been set in motion. I can now quite happily relinquish these nonsensical props and enjoy the sense of liberation their absence brings. I can also save on my annual astrological forecast bill.

My zeal for healthful cosmetics and toiletries has relaxed somewhat - not because I don’t believe that it is preferable to use products that do not contain known carcinogens but because of the difficulty of finding products that do not contain any toxins at all. It seems that the cosmetics industry cannot fulfill its mission to maintain soft and clean bodies and hair without using at least some toxins but while the ingredients are listed openly, their quantities are not. When I turned to the web to guide me on the relative safety of different products, I was distressed to discover that the shampoo and soap products of Pantene and Dove respectively contain very high levels of harmful toxins.

Nowadays, when I scan the ingredients of a shampoo, I’m looking for sodium lauryth sulphate or sodium lauryl sulphate, which began life as an industrial degreasant and garage floor cleaner.

This substance is found in virtually all personal care products, even those sold in health stores and purport to be superior to common or garden toiletries one buys at the supermarket or pharmacy. In fact, I was disappointed to find that the health store that seemed to answer my need to smear only healthful substances on my body, teeth and hair, stocks pretty much anything in addition to the quasi-healthy stuff, all of which contains some ingredient with a long and chemical sounding name. What is the point of inundating lip salve with plant extract if it also contains petrolatum?

(The jury is out on how dangerous sodium lauryl sulphate is; this site gives a good overview: http://www.health-report.co.uk/sodium_lauryl_sulphate.html).

I’m still eating goat’s and sheep’s dairy products but I believe that it won’t be long before these too will be subjected to hormones and/or antibiotics, as they become more popular (thus rendering the products less healthful, in which case they will become less popular).

Occasionally, I eat cheese derived from a cow, always accompanied with the comment that I do not wish to be a fanatic. Otherwise, my eating habits haven’t changed very much. I ate healthily BC, and although all the mounds of broccoli, almonds and apples I devoured were ineffective in keeping cancer at bay, I don’t see any reason to start wolfing down Big Macs. My major culinary sin, it appears, is enjoying burnt food - aka toast, crispy barbecued chicken - as the heterocyclic amines (HCAs) that are produced are known carcinogens.

But nobody really knows - not the doctors, not the drug companies, not the intrepid medical reporters who go out there and tell you to swallow vitamin E for its antioxidant components and then a year later tell you that vitamin E supplements might in fact kill you. The body is one mighty mystery, the last frontier for human discovery where the firmly held beliefs of yesteryear are the idiotic notions of tomorrow. To all intents, purposes and statistics, I will survive cancer and die in a freak accident 30 years from now. Within the realm of current knowledge, the doctors can be more or less confident that this is where my story ends.

This time last year I celebrated by 60th birthday and I was in the process of completing plans for a year-long celebration when fate intervened and determined that I would spend the past year acknowledging my life in a totally unexpected way. Although I would have preferred it had been different, not all the experiences of the past year were negative. Writing this blog has been an intrinsic part of the cancer experience as by verbalizing all that happened to me brought the fear that at times bordered on hysteria under control. Many a time I was able to distance myself from the unpleasantness of treatment, for example, by formulating the sentences that I would later add to my blog. In fact, it seems that in many cases, breast cancer triggers a woman’s creative juices. I’ve attended a play by a woman who interjected song into her monologue of discovery, treatment and recovery. Another woman detailed her cancer story in comic strip. And there are, of course, numerous poems, books and blogs on and by the subject.

It’s time to wrap this up. I’m focusing on new ways to express myself professionally. I’m looking forward to building the extension we’re adding to our house. I’m eager to welcome more grandchildren into the world. I’m anticipating with enthusiasm spending time with my family and friends. In short, let Gabi be right when she said that the cancer was a detour in my life - because I’m feeling pretty gung ho about life right now and want nothing more than to just get on with it.

Appointment Looming

2008-04-05T03:20:00.000-07:00

The countdown to my next appointment with the oncologist on April 13 begins. The appointment was arranged shortly after my last visit to Dr. Sarid so I was surprised to receive a second referral in the mail, shortly after the first had arrived. All the details, date and time, were the same, but the name of the doctor had changed. When I inquired, I was told that Dr. Sarid has left Rambam and that my new oncologist was a resident. I must admit to feeling slightly abandoned by Sarid, despite never having formed that close relationship with him that all the self-help books recommend. But there was something about having an oncologist whose name was Sarid, which in Hebrew means 'survival.'

My new doctor is a year behind Gabi. I hope that her lack of experience is counterbalanced by the desire to perform twice as hard - rather like those Avis ads from years ago.

I've been so involved with this disease, that it's with a slight jolt that I realize that this time last year I was still ignorant of what was growing inside me. The date of discovery was getting closer, though.

Hypochondriacs Forever

2008-03-05T05:58:00.000-08:00

As I’ve written elsewhere in this blog, a cancer diagnosis renders every twinge, ache and slight abnormality suspicious. A headache is never just a headache; a pimple is never an innocent zit, but the harbinger of a new disastrous malaise. In the last few months, I’ve submitted my body and its organs to a slew of tests, which have served to eliminate any specific cause for anxiety. I am now reassured that my heart is in good condition (despite a mitral valve prolapse which I’ve been aware of for over 20 years), and that my carotid arteries are clear. Sometimes, a worrisome symptom - one that has me scouring the internet and obsessing about - just disappears over time, such as the discomfort I felt on the right side of the effected breast whenever I drew a deep breath or moved in a certain way. I can now dismiss the pain in the back of my neck once an X-ray showed no signs of cancer in my upper spine. The one test that would soothe my deep-seated fears doesn’t exist; despite a preponderance of advanced technology, there is still no way to know for sure if any of the little green bastards broke away from the primary tumor and is even now, wending its way to my bones.

Still, ever vigilant as all good hypochondriacs are, I became aware of a sense of swimminess in my head, which, as others seemed to be experiencing pretty much the same thing, I put down to a virus. It persisted on and off however, and was joined by a vague feeling of dizziness. This nebulous sense of instability was particularly pronounced in the office when I finished reading my email and playing the M-W Word Game of the Day and conscience would force me to begin working. Occasionally, when eating, I had the impression I would fall if I were to try to leave the table - though I never fell. Naturally, it didn’t take long before I was convinced that a tumor had taken root in my brain.

Imagine my joy to discover that the cause of all this lightheadedness was a lack of symmetry in my hearing. Prior to this revelation, I had undergone a horrendous ear-cleaning operation. The ENT doctor poured some liquid into my ears and when the liquid began to foam, vacuumed deeply entrenched wax from them. I was reminded what real dizziness feels like. What was truly remarkable was how seriously the doctor took my complaint and proceeded to send me for a hearing test, which revealed the lack of auditory symmetry, and an electronystagmogram (ENG), a test that measures eye movements, and checks the level at which the eyes, inner ears, and brain maintain balance and position. The ENG is scheduled for next week, but the truth is that ever since the revelation of my auditory asymmetry, I’ve been feeling just fine.

The reason for the imbalance is still to be ascertained. According to the technician, it could be a lump of wax, some fluid or something scientific-sounding that I didn’t catch. I confided my fear of a cancerous lump in my inner ear to my ENT doctor and again, remarkably, he assured me that he understood where I was coming from, but that ear cancer is so very rare, he’d never even seen a case. Of course, he is so very young.

I'm Fine

2008-03-05T05:55:00.000-08:00

The absence of any entry for over a month can be interpreted to suggest that something seriously untoward has upset my life’s rhythms or that, conversely, life is too normal to warrant any entry at all. Happily, the latter is the case. Life has indeed changed since I received that horrible diagnosis, but, after all these months, it is obvious only in the details. I swallow Tomoxifen each morning instead of an HRT pill. I drink yoghurt derived from the dairy products of goats, rather than that of cows. In addition to the calcium tablet I’ve taken for many years, I now swallow two vitamin E capsules, drink green magma, chew a calcium pill and release four drops of vitamin D onto my tongue. (I gave up the black cohosh because it wasn’t making a dent in the frequency or intensity of the hot flushes.)

Vitamin D is the latest weapon of choice in the war against cancer. Various studies support the contention that vitamin D helps protect against many forms of cancer as well as other diseases. As a blood test revealed that I do indeed have a vitamin D deficiency, I’m happy to chew the pill and drink the drops to prove the theory.

Doctors' Visits

2008-01-17T04:29:00.000-08:00

Over the last few days, I completed a battery of tests and check ups with a coterie of doctors. An appointment with Sigal, the surgeon who operated on me in May and was the original bearer of bad tidings, finally put to rest any lingering fears of IBC and I am now convinced that my swollen breast is due solely to the radiation therapy. To celebrate, I bought some new bras. Ironically, the afflicted breast is rounder, more firm and generally nicer looking than other one, which is smaller and tends to droop.

However, by the following Sunday, I was ready for additional reassurance from my oncologist. Dr. Sarid did the usual pummeling, poking and prodding and pronounced me lump- and IBC-free. He explained how the tissue had been fried and the molecules rearranged and that it could take not just months, but even years for the swelling to subside. Now that IBC is off my mind, I can go back to obsessing about metastasis. Dr. Sarid agreed with me that the threat of metastasis is everpresent, which was not very comforting. It's incredible that our advanced technology hasn't yet developed any means of honing in on aberrant cells en route to wreaking havoc in the body's vital organs.

My next appointment is in three months' time.

I also had an appointment with the endocrinologist, who has added vitamin E to my daily intake. My morning routine now includes swallowing Tomoxifen, black cohosh, vitamin E - which serves as a major antioxidant - and a glassful of green magma.

Despite some pressure from the social workers, I have resigned from the breast cancer support group. It suddenly seemed absurd and wasteful of precious evening hours to spend time traveling to and from Tel Aviv just to discuss cancer with people who are not my bosom :-) buddies. There's a sense of artificiality in meeting once a week with a group of people with whom the only unifying factor is that we've all suffered from the same disease. There is a limit to how much one can talk about it.

Breathing Freely

2008-01-07T06:52:00.000-08:00

My mammogram and ultra sound results are back and everything is OK. For about an hour before Nachum phoned from the Herzliya Medical Center with the good news, I was incapable of coherent thought and did nothing but play mindless games on the computer. Working was impossible. As a bonus, it appears that my bone density test actually shows improvement in my thigh bones.

Battery of Tests

2008-01-04T07:25:00.000-08:00

I have begun a battery of tests preparatory to my next appointment with Dr. Sarid on January 13. Yesterday I had the dreaded mammogram, which was particularly painful on my afflicted, still-swollen left breast. I also had an ultra-sound, the test which had confirmed the presence of cancer only eight months and a lifetime ago. I’ve decided to throw in a cardiologist and a dermatologist in addition to all the other tests I’m doing for a full and comprehensive inspection of all my body parts. Because Tomoxifen can cause cataracts, I’ve also checked my eyes and happily, they are in good condition, apart from a few annoying floaters that have been around for a while.

Support Group

2008-01-04T07:22:00.000-08:00

I joined a support group through the One in Nine organization and the weekly meetings began a few weeks ago. Strangely, I was first interviewed by the two social workers for suitability; apparently, having had cancer does not automatically qualify one to join a support group. From among the seven or so women who apparently also passed muster, I was particularly struck by the wide range of cancer experiences. Three of them have had radical mastectomies - one woman, with a tumor half the size of mine, but with a higher oncotest rating, had opted for chemotherapy and a full mastectomy.

This is the first time I’ve joined a support group and I wasn’t sure what to expect. The overall rationale is that as fellow sufferers, we can say things to each other that only we can understand or appreciate. Now, after four or five meetings, we’ve exchanged our cancer stories and added some personal information. The social workers, who monitor the meetings, occasionally pipe in with an observation or two. I’m not sure what their role is; whether it’s to guide our chat in a certain direction, to summarize what we’ve talked about in order to draw conclusions or if they are just there to lend an air of officialdom to the proceedings. Some bonding should be taking place and indeed some of the women have formed friendships ‘after hours’, but at the last meeting I had an acute feeling that, as a group, we really didn’t have that much to talk about.

Unfortunately, I know enough women with whom I can discuss the different angles of our cancer and even those friends who have not personally experienced the disease are there for me to offload an angst or two. Add to that the fact that I don’t get home until after 10.30, I have good enough reasons to consider resigning.

Seventh Sense

2008-01-04T07:19:00.000-08:00

The medical establishment is my first line of defense in my personal war against cancer, but once that's covered, I'm open to anything that alternative treatment has to offer, even if on the face of it, it sounds outlandish. I would hate to find myself in a position where I failed to avail myself of some remedy only to discover too late that it was key to a complete recovery.

Some weeks ago, a colleague told me how a woman called Sigalit, using a method taught to her by a cardiologist who’d gone looking for the soul, had helped her, so I made an appointment.

Dr. Nader Butto is a cardiologist at the Rabin Center. He has “...developed an energetic method that tracks down emotional conflict (and its state) which has caused the energetic block and that has eventually evolved as a physical illness. This unique method opens the energetic block and washes the body with a flow of life, energy, and vitality.” (See a demo.)

Sigalit began by examining the palm of my right hand and asking me what had happened eight years ago. My mother had died eight years ago amid circumstances that still cause me feelings of guilt, not least because the opportunity to have been a better daughter to her is forever gone. Sigalit also noted that I had undergone an emotional experience five years ago, although under happier circumstances with the birth of my first grandchild. She told me that the turmoil of my mother’s death had been the trigger for the cancer, which, based on the number of documented cases of cancer which appear to have been accelerated by a profoundly emotional experience, seems a reasonable assumption

Treatment consisted of me lying down with legs bent and slightly apart. I was to inhale through the nose and exhale through the mouth. Sigalit dug her fingers deep into my diaphragm which was extremely painful. Apparently, this is the location of fear and she waited to hear the click which would indicate that fear had flown my body. She pressed her hands at points above my breasts, which was also quite painful, and circled her hands over my head. Occasionally, she gently slapped my legs, which should have been shaking uncontrollably by now, but were hardly quivering. At a certain point, she suggested calling it a day and told me she wouldn’t take any money. But I was determined to get as much out of this as possible so we both strove valiantly on.

However, apart from a small flutter, my legs remained obdurately steady, although they were getting extremely uncomfortable being held in a somewhat unnatural position. At the end of the session, we acknowledged that nothing of any significance had taken place, that my fear remained invulnerable to exile. Sigalit gave me a few exercises to do which would open some chakras and a book called Cancer as a Turning Point by Lawrence LeShan. The book is excellent.

Cosmetics and Food

2007-12-25T09:05:00.000-08:00

Life has settled into a groove. I swallow Tomoxifen in the evening and hope that it does its job of preventing estrogen from binding to the cells in my breast and causing another cancer. My breast is still swollen and despite reassurance from Sigal that the swelling is due to the radiation, the fear that there are other, more sinister, causes is ever present, occasionally leading to a minor anxiety attack. Its dimensions apropos the other, hopefully healthy, one reminds me that we should be careful what we wish for - I'd always wanted to be more buxom but my hope extended to both breasts sharing equal proportions; the devil is no doubt enjoying a prolonged snigger at my lopsidedness.

The hot flashes are still a major annoyance. Last month, I had an appointment with a gynecological endocrinologist with an unpronounceable name (Dr. Zlotsover. try it out loud) who prescribed a natural, over-the-counter remedy based on black cohosh. Black cohosh apparently improves the functionality of Tomoxifen and recoups bone mass lost as a result of taking Tomoxifen, However, according to several reputable sites I found on the internet, the jury is out on black cohosh - not only are there conflicting conclusions from the many clinical trials, but it might actually be contraindicated in breast cancer patients (http://ods.od.nih.gov/factsheets/BlackCohosh.asp). Apart from that, it doesn't seem to be helping - there are days when I feel that the flashes are less frequent and less intense but the next day, they're back, with increased vigor. However, it takes about six to eight weeks for the black cohosh to do the job, so I'll give it the benefit of the doubt.

In my quest for optimal health (having been so cruelly deprived of the illusion that that's what I had all these years the cancer was surreptitiously growing inside me), I've begun paying more attention to what I put on my body, not just in it. I've recently discovered a supermarket close to my office that sells organic vegetables and fruit alongside non-organic produce as well as rows of spices and herbs that claim health-inducing properties, every type of pasta on the planet, freshly-made bread with whole grains, goat's milk ice-cream, a soup bar, and so on and so on. The ambiance is rustic as establishments emphasising health tend to be, although the effect is somewhat marred by containers of Osem chicken soup powder at the entrance to the store. At the back, there is a shop selling all manner of toiletries that purportedly contain no harmful properties and were not tested on animals. In fact, the range of lotions, moisturizers, shampoos, conditioners, deoderants, etc. is overwhelming, as indeed are the prices. But who wouldn't hand over a few more shekels to promote good health!

The question is, does it? The market is cashing in on the current obsession with good health. (There's a furniture store near my office called Green Furniture, as if to deny that their furniture is depleting the rain forests. On the other hand, the proprietor's family name could well be Green.) How much of it is a scam? Do we assume that the labels on products are telling all the truth? Is the literature telling us to avoid products with sodium lauryl sulfate, propylene glycol and petrolatum based on substantiated proof that these substances, even if they don’t cause cancer, are harmful to our bodies in other ways? Is the absence of harmful ingredients from the packaging sufficient indication that the listed ingredients are indeed good for you, or at least, will not cause you any harm? How is a simple consumer with no training in pharmaceuticals or chemistry supposed to make intelligent decisions?

The sales assistants project an air of knowledge about their products and are seemingly sincere in their belief that the products are not harmful but that's what they have been trained to do. Notwithstanding the sincerity of the manufacturers and sales staff, the possibility that some substance hitherto believed to be harmless could become toxic in combination with other substances cannot be precluded. These questions might seem obsessional but I find it hard to accept the superiority of a product, a food or a belief just because people with persuasive skills tell me to.

In spite of the questions and doubts, I've decided to to err on the side of conventional wisdom and buy the toxin-free products gradually, choosing those that suit me, and phasing out those containing ingredients identified as harmful. And if these products are indeed all they are purported to be, I hope that my current habit of mixing them - such as the healthy, pomegranate-smelling shampoo with the unhealthy conditioner, and vice versa - will not cost me any brownie points.

The Cancer Notebook by Julia Chiappetta provides a pretty full breakdown of which cosmetic ingredients to avoid - in fact, it contains quite a lot of useful information; highly recommended.

Scepticism also describes my approach to what I put in my body. Every morning, Nachum and I down a glass of green magma, a bright-green powder smelling of grass, mixed with water (http://www.greenfoods.com/products/green_magma.html). Based on barley grass, this tasteless mixture lays claim to promoting good health by supporting cardiovascular function and supplying the body with a generous dollop of antioxidants. Efforts to locate independent research on the efficacy of green magma proved fruitless but I was directed to http://www.greenfoods.com/news/#1 by the manufacturers of Green Foods. My conclusion was that so long as it does no harm, the worst that can happen is that it does no good. In the meantime, I wrote to Sloan Kettering to ask if they had ever conducted research on green magma, but apart from an auto-generated acknowledgement, I have not yet heard from them.

I have begun to eat with abandon and in the last few months, have gained around seven kgs, which makes me feel clumsy and uncomfortable. Having eaten according to the rules for so long and yet falling foul of cancer, I have thrown caution to the winds and, although our fridge now contains goats' dairy products, I have eaten cows' dairy products that were high in fat, aware that dairy foods cause mucus in the body and that cancer cells thrive on mucus. I have eaten cookies and cakes, aware that cancer cells thrive on refined sugars. On the other hand, Nachum has been making me a weekly portion of soup of carrots, yams and squash because I was advised to eat orange food.

In the battery of tests scheduled over the next few weeks, I've included a dietician to help me streamline my eating habits. She will no doubt dispense advice based on current conventional wisdom.

Panic

2007-11-10T01:34:00.000-08:00

It’s a known condition of human nature that we appreciate what we have only when we’re faced with losing it. I’ve spent so much time bemoaning the lack of well-being that characterized my life BC (before cancer) that I failed to notice a gradual process whereby a facsimile of that well-being was developing in its place.

And then, that was shattered.

I’d become aware that my bra was pressing against my flesh, especially on the left side, but put it down to having put on weight. During the week, however, I realized that my breast was swollen. I remembered it had swelled during radiation but I’d had a vague notion that it had settled down to its normal dimensions some time over the last two months, since completing therapy. But now, my breast obtruded whenever my left arm brushed against my side, a situation that was not reflected on my right side. By the time I became agitated enough to call Hannah, my old companion, the churning stomach, was back.

Hannah told me to contact the surgeon. She said that the swelling could be due to the radiation, but it scared me that she could entertain any other possibility. (It’s unclear to me why she suggested I contact the surgeon instead of Dr. Sarid, my oncologist. She said that she didn’t know Sarid’s schedule for Wednesday, when he would be at the hospital, but I still wonder why she couldn’t have made an emergency appointment for me.)

Genuinely alarmed now, I tried to contact Dr. Sigal Librant and left a message on her voicemail. Next I made an emergency appointment to see her on Thursday afternoon (made possible by Nachum running to the doctor to obtain an emergency referral).

By the afternoon, I had calmed down. I’d surfed the net and spoken to Sally, my granddaughters’ former nanny, whose young daughter is a cancer survivor. It seemed that even months after radiation therapy, the breast can remain swollen. My problem was that I couldn’t remember if it had ever returned to its original smaller proportions.

I remained relatively calm until Wednesday evening when I noticed small black spots on the aureole around my nipple. Thursday morning, I ran a search for inflammatory breast cancer or IBC and what I read sent me into an unprecedented realm of panic (http://www.mayoclinic.com/health/inflammatory-breast-cancer/DS00632). My symptoms met some of those of IBC, although they could just as well be related to the effects of radiation. IBC is rated as Stage 3B or Stage 4 if it has metastasized, and survival rates are low. I believed with my whole being that the fight was over and that I was now facing death.

We reached the clinic early and when Sigal arrived, she told me that she’d heard my voicemail message only that afternoon. She examined me, told me the swelling was indeed due to the radiation but that I had one of the best recoveries she’d seen, that the black spots were pigmentation, also from the radiation, and that I certainly was not suffering from IBC.

I wondered, and still wonder, why I wasn’t immediately lifted out of my sense of doom by a feeling of relief. I think it’s because I’d given up. I had cried with uncontrolled hysteria, I’d screamed with fright at the horror of imminent death, I'd rued the time I hadn’t spent feeling grateful for my life as a cancer survivor. Mentally, I had gone to the brink of the abyss and it took a while to step away from it. How fragile my ability to cope with it all is and how wonderful life is when I can.

The next day I drank in the beauty of the world, and was back to complaining to Nachum, dispenser of indispensable TLC during that horrible period, about his driving.

How Am I Physically?

2007-11-04T07:46:00.000-08:00

I'm tired. I don't know if I'm tired because radiation destroyed some of my cells and my body has to work overtime to recreate them, or I'm tired because we're in a transitional season and I'm working long hours. Everything becomes cancer-centric even when a connection to it is farfetched.

I sometimes forget that I still have limited use of my left arm. This is the arm from whose armpit 15 lymph nodes were extracted and although I'm getting some sensation back - for example, I can feel myself applying deoderant - an area of my upper arm is still numb. Sometimes, such as when I stab my electronic card at the parking entrance at work, I overreach and then my arm hurts. I've been told not to lift anything heavy in this arm, including weights. For the rest of my life, blood tests, injections and anything involving the active use of an arm and its contents must be done from my right arm. I wonder how much more time will pass before I get full feeling back.

I've put on weight. Initially, I put on weight because I tend to overeat but I should've been smart and lost a few kilos before beginning the Tomoxifen. Now my jeans pinch around the waist and the thighs. I don't know if there's any point in even trying to diet.

I have hot flushes. When I stopped taking HRT, I began to get a few hot flushes a day. They didn't last more than a minute or two and were more or less bearable, even those that left a faint line of sweat on my upper lip. It was, after all, summer and there were times when I didn't know if I was having a flush or it was just damned hot. A hot flush, for those who have never had one, begins in the depths of the body and spreads itself all over while concomitantly increasing in intensity. It has been referred to as 'cooking from the inside'. I think their frequency has increased since I began to take Tomoxifen - a spot check over the last four hours shows I was getting one every hour on the hour for the first three and the fourth one a mere 50 minutes later. If it gets worse than this I'll be dressing for summer in the depths of winter.

Musings

2007-11-02T06:48:00.000-07:00

I have been a hypochondriac since childhood. Whatever ghastly illness of the week I was suffering from, the inevitable panic was sometimes allayed by a visit to a doctor, where more often than not I felt like an idiot, or it just dissipated with time as I found that I had no real symptoms and I was still alive. As I matured, I found that although I was still apt to take on board the most rare and deadly disease possible, I was far more sanguine about my state of health. In fact, I suspect there was an element of 'it can't happen to me', because until then, it hadn't.

Now I find that, in common with almost every cancer patient I know, anything that is even slightly awry is cause for panic. A little over a month ago I watched with horror the appearance and daily growth of a mole-like object on my leg. It started as a small, white bump that morphed from a pale pink to a darkish brown. I was convinced that my body was breaking out in melanomas but people who should know what a melanoma looks like put my mind at rest. The mole or whatever it was, darkened, hardened and has since disappeared. But this is the way it is - an unexpected twinge where there had never been a twinge before, a bout of gas, fatigue, a pimple, all become the focus of a fear that my cancer is manifesting itself in a new and dangerous way.

Liron (my erstwhile psychologist) had asked me to assign a number to my anxiety level on a scale of one to 10, (10 high) and I'd said four, which is probably why he decided I wasn't really in need of his ministrations. However, those moments when I feel something amiss, my anxiety levels are off the chart.

I watched carefully for side effects from the Tomoxifen and sure enough, just under a week after beginning with half a pill, I suddenly had a vaginal discharge. As the leaflet accompanying the medication clearly states that in the event of a discharge, stop taking the medicine immediately and call a doctor, I went into panic overload. I don't know Sarid's number so I called Hannah, who didn't seem very concerned - she just told me to go to the gynecologist. There was no recurrence and, a few days later when I kept my appointment, the gynecologist's examination calmed me down completely. It was nice going back to the old days when a visit to a doctor ended with a clean bill of health. I'm resolved to steer clear of unfamiliar toilets. A few days later, the day after I began taking the pill whole, I woke up with pain from mid-buttock all the way down my leg. Again, the leaflet sent me into a cold panic because it seemed I was having a bad reaction in my pelvic region. However, an hour or so later, the pain was gone and it hasn't yet returned. Either my body was having an initial response to the medicine - or we simply need to buy a better mattress.

Art of Living

2007-11-02T06:44:00.000-07:00

I'd been looking forward to this course, which was conducted within the framework of research, and was open to anyone who had contracted breast cancer within the last five years. Art of Living appears to be an international organization - launched by one Sri Sri Ravi Shenkar - with the usual claims of reducing stress, increasing awareness, and promoting better health, energy, personal and global peace. A number of courses on its effect on cancer patients was concurrently underway in Jerusalem and Tel Aviv. (See http://www.artofliving.org/)

The course I attended consisted of 16 women, the trainer, Dafna, and two additional women whose presence was not totally clear - I think they were there to help us perform the exercises or tend to someone in case of distress. The women were of all ages, some shockingly young, from different walks of life. Our common denominator was that we had all suffered breast cancer, ranging from the minimally treated for early stage cancer (one woman's lump had been only 0.5 cm., less than half the size of mine) to those who'd gone through the hell of chemotherapy. One young woman revealed she'd had a recurrence.

Following the initial meeting, I was struck by the impact of that seemingly innocuous statement - we'd all had breast cancer. My diagnosis and ensuing treatment had been so very dramatic and I have been totally focused on my feelings, my treatment, my health care practitioners. As I have moved through the process to recovery, I have immersed myself in learning about the disease and its remedies, exchanging stories with women who shared the process with me, and riding the emotional roller coaster of trauma, fear, panic, despair and acceptance. It had been, it still is, a very personal, intense and all-encompassing experience.

The 16 women assembled in the room with the Indian ambiance and yoga mats, could have been anyone you see in street, the mall, driving to work - and yet, each and every one of us has lived through the same drama. It's almost surreal to contemplate that we all experienced the same gamut of emotions; the anxiety punctuated with intermittent hope waiting for results, the horror, fear, panic, despair and tears on receiving the devastating diagnosis, the bewilderment of submitting our bodies to the various machines, the resilience needed to confront the fear.

The course was exhausting. We filled out forms, learned to breathe in different rhythms (we learned to recognise each rhythm by its Sanskrit name), we looked into each other's eyes, we informed each other when we arrived on the planet and how long we intend to stay here, sang a song to an alien god, shared our feelings, and thankfully lay down on the mats to sleep as soon as we could complete the requisite breathing exercise. We drank a lot of water. Strangely, the subject of cancer was almost a stranger in the room, rarely becoming a topic of our interchanges.

We did this every evening from 7.00 to 10.00 from Sunday until Thursday - I got home every night after 11.00 - and again on Friday morning and the following Sunday evening. Despite two major sources of tension in my life at this time, I felt quite relaxed during the whole period I was attending the course but I'm not sure how much was due to the exercises or to tiredness from the sheer relentlessness of the schedule. I have failed to keep promises I made to myself to continue the breathing exercises at home or at work, but there is an open invitation to attend a session every Saturday and, for the next five weeks at least, on Friday morning.

I asked Dafna what happens physiologically when we breathe in different rhythms. Surely there is a purpose in taking long, drawn breaths as compared to short, panty ones. She insists it cleans the system, but cannot say how or why. Whenever I ask questions such as these, a common response is Why do I want to know. Seems to me a more relevant question would be, why would I not want to know.

Hiatus

2007-11-02T06:42:00.000-07:00

The period between the cessation of treatment and my appointment with the oncologist was, despite predictions to the contrary, almost tranquil. With no treatments to undergo and no medication to remind me of what I'd had, I was almost able to enjoy the illusion that life was returning to normal.

I returned to work on October 16, after Rosh HaShana. I approached the day with a sense of heaviness, resenting the need to fling myself back into the pressure of a profession that I'm becoming increasingly less enthusiastic about. Although I work in a small company, most of my colleagues don't seem to know about my cancer and just assumed I'd been off on a carefree vacation for three weeks. By Monday, I was feeling better about being back, the workload not being particularly onerous. My boss, who had shown patience and understanding while I was undergoing treatment, seemed to expect me pick up where I'd left off pre-cancer as if I'd suffered nothing more than a particularly nasty bout of flu that had now passed. The CEO, who'd regaled with me with horror stories of the cancer experiences of a close friend of his, told me that he'd almost called to convince me not to take time off during the radiation treatments, for my sake, he averred, not the company's. I told him that the emotional as well as the physical effort of traveling daily to the hospital had taken its toll and I had been correct in taking the time off. All in all, my employers have been supportive and considerate.

I'd contacted the 1 in 9 organization a few weeks earlier and the very sympathetic and knowledgeable volunteer I'd spoken to had told me that many women have an emotional crisis during the month-long period between the end of treatment and their next visit to the doctor. I remember the period between learning I wouldn't have to undergo chemotherapy and beginning my radiation treatments as being emotionally difficult because for the first time since receiving the devastating news of my cancer, I was faced with downtime - no test results to wait for, no appointments to keep, just timeout for contemplation. The lack of action forced me to confront my mortality and go to the next stage emotionally, Now, during this longer, one-month hiatus, I found, unlike that earlier time, I began the day with a smile, which I more or less maintained until flaking out in front of the TV at around 9.00 in the evening, waking up around 11.00 in time to go to bed.

Medication Begins

2007-11-02T06:38:00.000-07:00

I've allowed a whole month to go by without updating this blog, not because nothing happened in October, but because I didn't have the time or the mental energy to sit down and write it.

At 10.10 am on 10 / 10, I had my third appointment with Dr. Sarid, my oncologist and, as expected, he prescribed Tomoxifen.

Tomixifen is the medication of choice for hormonal-receptor positive cancer treatment. It received FDA approval in 1978 and its role is to block estrogen from binding to its receptors in the breast. There are some unpleasant and even life-threatening side-effects and I was curious to know why I wasn't being given Arimidex, which the informative lady at the 1 in 9 organization had told me is generally prescribed for post-menopausal women, such as myself. Arimidex is an aromatase inhibitor that prevents the conversion of steroids produced by the adrenal gland into estrogen and it has its own set of unpleasant but not necessarily life-threatening side-effects; however, it is thought to be superior to Tomoxifen in terms of preventing recurrence.

Dr. Sarid explained that Arimidex is very expensive and is not included in the basket of services in the first two and a half years of recovery from cancer. If I survive the first two and half years, I can expect to then be prescribed Arimidex, always presuming that it won't have been dropped entirely by then. Regardless of the cost, I wanted to know which medication was more likely to keep me alive. He said that in some cases, when the cancer was more advanced than mine, he recommends that the patient undertake the burden of paying for Arimidex. He seemed so convinced that I am going to survive that he was almost dismissive in asserting that Tomixifen is good enough for me. He wasn't receptive to the idea that I seek a second opinion, which the 1 in 9 lady had recommended. I managed to ask a few more questions before deferring to the feeling that I was taking up time he should be spending on other patients. I am now on a schedule of 3-monthly checkups. Perhaps at my appointment in January, I'll be able to ask another few questions. Prior to that, I'll need to have a blood test, a mammogram, ultra sound and check my bone mass.

Still feeling uneasy about the medication, I went to talk to Hannah, the nurse, and asked her if she thought I should get a second opinion and if so, what should I do if it differs from that of Dr. Sarid. She reminded me that Arimidex has been around for only about five years, compared to the decades that Tomoxifen has been in circulation, and that the long-term effects of Arimidex have still not been determined. Say no more - Tomixifen it is. She suggested I begin slowly, taking a quarter of a pill for two weeks, then half a pill for two weeks and working my way up to a full pill in a month in order to give my body time to adapt to it. In cases where there is a extremely unpleasant reaction to Tomoxifen, Kupat Holim (health fund) might be persuaded to switch funding to Arimidex.

In the end, I found that the pill itself is so small, chopping it into quarters is more trouble than it's worth. I began with half a pill which I took in the evening for two weeks. A few days ago, I began taking the pill whole.

Self-Pity or What?

2007-09-28T04:04:00.000-07:00

I've become aware of a new phenomenon. Occasionally, and not preceded by any particular thought or event, my throat fills and my eyes well with unshed tears. Is this self-pity? Or perhaps it's a rush of gratitude that I discovered my cancer at an early stage and have a good chance of surviving it.

The tears don't fall and the moment passes.

No More Therapy

2007-09-26T07:55:00.000-07:00

Last Thursday (September 20), I had my fourth and final session with Liron the psychologist. Although the sessions were slated to continue for three months, I could only agree with Liron that my anxiety was mainly under control and that the turmoil I’d felt that had caused me to seek psychological help in the first place was settling into broad acceptance of my fate. I guess there are patients who are unable to ‘hold’ their anxiety - as Liron put it, cupping his hands to indicate how anxiety metaphorically nestles - as well as I seem to be doing and therefore need his services more than I do. Also, if my fears and anxiety threaten to overwhelm me, I have several other options. In October, I’ll be beginning a yoga course called the Art of Living which has been adapted especially for breast cancer patients. (I understand that the difference between this course and the standard one is that we breathe more!) I’ve also made contact with the 1 in 9 organization and hopefully will be joining a support group very soon. I meditate and once a month have a session with Eran.

So the opportunity to plumb the depths of my sub-conscious and discover if there is anything there that contributed to my cancer is unavailable for now. Clearly, if I knew what thoughts and perceptions I have buried there, they would no longer be in my sub-conscious. I do think that the theory of flooding the mind with positive messages (I will survive, I am unique, and so on) to neutralize any sub-conscious negativity is seriously flawed. Any messages of this type would set up residence in my conscious mind rather than dislodge the contents of my unconscious mind.

But what if my sub-conscious is harboring massively positive, life affirming thoughts? I remember one afternoon in the waiting area for Accelerator 4 how one young woman was describing how her treatment was extended because the machine broke down so often and the thought that immediately leapt into my mind was, Well, that won’t happen to me! Of course it did, the very next day, and it hadn’t been repaired in time for my treatment the day after either. However faulty they might be, why would I want to expel such perceptions from my sub-conscious where all they are doing is making me happy and optimistic?

No More Radiation

2007-09-12T07:03:00.000-07:00

Today I had my final radiation treatment. Out of a set of eight booster treatments, three had to be deferred because of a breakdown in the accelerator, bringing my last treatment right up to erev Rosh HaShana, a fitting start to the new year. Any cancer cells lurking anywhere in the vicinity of my breast should have been thoroughly nuked and expunged after the 33 treatments, leaving me, it is hoped, completely cancer-free. That’s the plan.

The angry-looking redness of my breast has now morphed into a rather nice tan color, with only slight redness around the scar, under which the lump, the original cause of all this trouble, was located. I was lucky that, unlike some women, I suffered no pain, no blistering or burns.

My next appointment with the oncologist is on October 10. On Sunday evening, on my first day back at work, I’ll be attending a meeting of participants in a yoga course for breast cancer patients called Art of Living.

Why?

2007-09-07T06:05:00.000-07:00

Why? This is the question I’ve asked since my diagnosis was confirmed. Not a plaintive ‘why me,’ but a practical question with tangible answers that can help identify the cause so that I can do or not do whatever it was so that it won’t happen again.

Is it the food I eat, the air I breathe, the electromagnetic emissions from computer, cell phone and remote control units I absorb? Does the plastic from the bottle leach into the water I drink; do the toxins in my deodorant, shampoo, conditioner and make-up silently attack my cells? Is it pressure from the tuck in my bath towel that I wrap around my body?

Is it due to a traumatic experience from childhood? Is there something I need to ‘get off my chest’? Do I have a range of negative thoughts which sent my cells on a frenzied journey of malformation? Am I not loved enough or do I not love enough? Am I subconsciously depressed, repressed and stressed?

I believed I had my life under control, that I was treating my body, mind and soul well and that I would be repaid with continued good health. I haven’t smoked for 22 years, I eat vegetables and fruit, fowl and fish, and have abjured eating the flesh of antibiotic and hormonally-fed cows for at least four years. We do not own a microwave oven. I exercised. I meditated. I worked and exercised my brain. I enjoyed fulfilling relationships. I rarely suppressed an opinion but exercised restraint—well, mostly—within the boundaries of acceptable social intercourse. I felt empowered, untrammeled by the insecurities of past years and was willing the remaining years before retirement to pass quickly so I’d could begin to really enjoy myself. Not since I was a teenager did I want time to move so fast. In short, my life was a perfect picture book example of the healthy lifestyle that self-help advocates urge us to adopt after contracting cancer! What irony. Clearly, it wasn’t enough to combat the risk factors...

I belong in quite a few high-risk groups: I am over 50; I have close blood relatives who contracted the disease; I began menstruating early, at the age of 11; and finally, I’d been taking HRT (hormone replacement therapy) for almost 11 years. For most of that time, the HRT was estrogen-based; in the last few years I took a non-estrogen-based therapy. However, cancer develops slowly over a long period, and in all likelihood the provenance of my cancer dates from those early years when all that concerned me was not to endure another hot flush. A combination of all these risk factors with HRT providing the clincher to cause all other risks to shrink and shrivel before it, seem to have outweighed the benefits of the healthy lifestyle that played by all the rules.

It’s been suggested that my cancer was inevitable and that my healthy lifestyle actually deferred the onset of cancer by many years. If this is the case, then I appear to have being doing everything right and all I need to do to live a long life free of cancer is to continue with more of the same - minus the HRT.

I have used various terms throughout this blog to describe myself in regard to living with cancer, most frequently as ‘cancer victim’. As the cancerous lump was scooped out of me by the surgeon, I am presumably cancer-free and all the subsequent treatments are designed to ensure that none of those pesky little cells remain in my body and that new cancerous ones will not develop. I think a more appropriate term is ‘cancer patient.’ ‘Patient’ implies endurance with an unavoidable process while ‘victim’ suggests bitterness.

I do not dismiss the body, mind, spirit connection. One of the women I meet during radiation treatments believes that stress from the Second Lebanon War precipitated the onset of her cancer. Conversely, my brother Tony defied predictions and lived for two and a half years following diagnosis instead of the year that the doctors gave him. I am convinced that my mother, who was almost completely blind, willed herself to die as she felt the increasing frailty of my brother when she hugged him, unable to face the death of yet another child.

If stress is the main factor in triggering cancer, I have never in my life undergone such intense stress as that emanating from contracting the disease itself.

Coping

2007-09-07T06:04:00.000-07:00

The internet is awash with advice and stratagems to prevent or cure cancer. Much of it is contradictory, unproven or unattributed. Serious sites, those that belong to or are endorsed by recognized institutions describe, inter alia, a range of clinical trials, the results of which frequently present conflicting evidence. The world of information, whether via the net, professionals in the field or the grapevine is a morass of confusion which no person who wishes to maintain a modicum of sanity can hope to fully navigate with inpunity.

From the beginning, I have tried to understand the facts of cancer and to find a path to follow that would best ensure my continued survival. Some of the questions I ask either have no answers or have answers I would need a degree in medicine or biology to begin to understand.

However, there was no doubt in my mind that I would entrust myself to the medical establishment and conventional treatment. Whatever the shortcomings of modern medicine and the fact that much about cancer remains mysterious, new information about the disease and innovations in treatment are constantly evolving and survival rates of cancer patients are increasing.

There are myriad alternative treatments out there on the internet, ranging from the practical to the mystical to the crackpot. Although I investigate and might even adopt an approach here and there, none of these treatments are subject to the intense and objective research of medical science. They therefore remain unproven and any examples of their purported success are anecdotal, unsupported by accepted norms of scientific research.

Whether I gravitated towards technical writing due to my almost obsessive need to understand the fundaments of any given issue or the profession simply honed my skill in doing so, my coping strategy has been to dissipate the fog that suffused me when I first received my diagnosis. Educating myself with solid data about the disease and the treatments I undergo promotes a semblance of control. I try to be methodical, but digressions, especially on the internet, are so tempting. Nonetheless, developing additional strategies to play a supporting role in my treatment is an ongoing process as their effectivity is tested over time.

I am still at a crossroads in terms of my eating habits. I find myself skipping from one nutrition authority to another, with no clear idea of what to adopt and what to eschew. In the meantime, I’m trying to maintain what is referred to as a well-balanced diet, and to eat plenty of salad greens and vegetables, limited but varied fruits and plenty of protein; to shun cow’s dairy products; reduce dairy and sugar intake. Some websites recommend eating only wholewheat products while others prohibit eating wheat at all. It’s very confusing.

I aim to introduce more harmony into my life. When going to work each day became a burden halfway through my radiation treatments, I decided to take a break until they were finished and felt an immediate lightness. In November, I will attend an Art of Living course, a yoga workshop specifically designed for breast cancer patients. I also spend more time meditating than in the past. This morning I tried a visualization exercise whereby bright, white little muscle-men killer cells hunted down ugly little bilious-green cancer cells and found a couple of them copulating behind a lobule. Unfortunately, the buzzer rang indicating the meditation session was over before the muscle-men could pulverize the bad guys. And I took Eran’s advice to cease double-checking the equipment and interrogating the technicians and instead had a conversation with God during my radiation treatments. It was actually very liberating but I’m relieved that the conversation remained one-sided.

I have been very gratified by the number of people who have offered to include me in their prayers. The intensity of the warmth I experience each time a request for my mother’s name is made must, at the very least, be equal to the efficacy of the act itself.

As for repressed childhood traumas and suppressed memories, well, they’re repressed and suppressed so I guess they’ll continue to remain unidentified until they present themselves in some recognizable form.

Caring people with the best of intentions need to draw on deep resources of sensitivity when offering suggestions, and recognize that we cancer patients are emotionally vulnerable. Sometimes it takes a while to find the path that is right for us but in the end, we adopt coping strategies that are based on our personal choice and inclinations, in the same way that we reach decisions regarding our religious beliefs or the way we style our hair. New insights and open discussion are stimulating, but there is a thin line between giving supportive advice and invalidating another person’s choices, for some, arrived at through painful and time-consuming enquiry. Confidence in our coping strategies can be fragile and their invalidation can cause us uncertainty and stress.

One of the best articles I’ve read on the web touches on this point: Being Positive

My Sister Jo

2007-09-07T06:02:00.000-07:00

Jo (Josephine) was my elder sister. She died in 1985 at the age of 47 after the breast cancer she contracted three years earlier had metastasized to her bones and other parts of her body. When I think of what happened to her, I am gripped by fear because I am afraid it will happen to me. The way I’ve chosen to cope with this is to try to furnish myself with as much information as possible about her cancer and the procedures and treatment she would have undergone in 1982 in the hope that I will discover why she died and why, 22 years later I won’t. There is no-one alive today that I am aware of who has any information about her, not even where she was hospitalized.

There’s not much I remember about her cancer. At the time, the word inspired such fear (it still does, but the subject is discussed so much more and there is such a glut of information about it that the word loses some of the mystique of earlier times), I had no idea what to ask or even how to digest what she’d told me.

I knew nothing about her illness until the day I received a letter from her informing me that she’d had an operation and that the tumor had been encapsulated. She described how for six months, she had to cover her breast and not allow it to get wet when taking a bath. When I visited England some time later, I remember her telling me that she was going into early menopause and that her breasts were becoming very large. I remember my mother mentioning it in worried tones.

At the time, our family doctor told me that an encapsulated tumor presented the best chance for survival and when I asked why in that case Jo had died, she theorized that a cell must have escaped. From the little information I have, it seems likely that Jo too underwent radiation treatment and that she was also taking hormonal treatment, probably Tomoxifen—which I will be taking in another month.

My questions focus on the differences in knowledge about the disease and the efficacy of diagnoses and different treatments in 1982 and 2007. Although there is no way of ever finding out, I wonder if an errant cell escaped and metastasized or did Jo have a recurrence which remained unidentified? This question is as imperative today as it was then.

I would assume that laboratory techniques for analyzing tumors in 1982 were less sophisticated than they are today. What would they not have known then that they regularly test for today?

I don’t have to avoid wetting the radiated area, on the contrary, I’m supposed to smother it in creams. How do radiation treatments differ in the last 22 years? What radiation treatment is it likely she received?

Have the components of Tomoxifen improved over the last 22 years or has it remained essentially the same?

Were lymph nodes automatically removed in the case of an encapsulated tumor? Is it possible that hers were not removed and that the cancer had already migrated to her lymph nodes?

According to a document published by the Breast Cancer Campaign called The History of Breast Cancer, the gene HER2/neu and its role in aggressive breast cancers had been discovered in the 1980s, although it’s not clear during which part of the decade and whether its discovery impacted in any way on my sister’s treatment.

Locating hospital records from 1982 is problematic. So far, I’ve learned that she was not hospitalized in St. Mary’s or St. George’s. I’m still waiting to hear from the Royal Marsden.

Jo was my senior by nine years. She didn’t take much notice of me when I was a child but we began to establish a rapport around about the time I was 12 and she was 21, or, more precisely, when I began to exhibit an interest in boys and make-up. She was fun, her wit made me laugh, she was tall and elegant and always seemed so confident. If any facet of her personality stands out, it was her sense of humor.

She chose not to die in a hospital. I arrived too late to find her alive at the home of her friend Sylvia, who, with incredible charity and compassion, had lent her home to Jo in her last days. Sylvia told me how she broke the news to Jo that her situation was terminal but she refused to accept it, saying she would go kicking and screaming. When Sylvia suggested that Jo call her place of work, she declined, saying, What if they take away my car and then they find a cure!

I often think how Jo would have enjoyed the world of advanced communications we live in today, how she would have been amongst the first to take advantage of the internet. She was an artist, though she claimed she wasn’t a very good one because our parents tried to force her, a left-hander, to use her right hand. Instead of art, she built a career in public relations and at the time of her death was doing PR for a firm producing 5.5 in floppy disks. She never had children of her own but was a perfect aunt to my three kids and my brother Tony’s son, Jonathan.

Jo’s death left me shocked. It dispelled any notion I might have had that death didn’t exist, at least, not in my family. And inevitably, the reality of her death brought into question my own mortality. For years, her lifestyle was the talisman I conjured to rationalize why I would not suffer her fate. She smoked, she’d never given birth, she ate mainly unhealthy restaurant or pre-packaged meals, she’d been on birth control pills for over 15 years. I’d given up smoking, I’d had three children, I ate healthy home-cooked meals and I used an IUD.

How smug I was! Today, in order to avoid smugness, I fall foul of the other side of the coin which is fear of meeting the same fate.

About nine months before she died, Jo and I had an argument as a result of some miscommunication. I remember writing a long letter to her explaining exactly why she was wrong and I was right and then I threw it away. But I was surprised, and not a little distressed, that for the first time, Jo didn’t send David a birthday card. At the time, I thought it was because she was still angry with me. Now I realize that it was more likely an oversight and that it was not in her nature to be spiteful to a child because of differences with his mother. When I returned home to Israel after her funeral, I found an anniversary card from her in which she wrote that I should expect a letter from her soon. Of course, there never was a letter from her ever again.

My Brother Tony

2007-09-07T06:01:00.000-07:00

Tony was older than me by seven years. Our relationship was not particularly close but, like Jo, he made me laugh. He’d been married twice, had one son and at the time of his death, was in a close relationship with his live-in girlfriend. He was a partner in a firm of solicitors and had been an extraordinarily successful musician since his teens. He played keyboard, saxophone (alto and contralto) and clarinet.

As with Jo, I knew nothing about his cancer until I received a letter from him with the bad news. Later, visiting the UK, he described how one day he’d felt a hardness in his side and had been pleased because he’d spent some time working out and he thought it was having a effect. A few weeks later, he peed blood and soon after was diagnosed with very advanced cancer of the kidney.

Like Jo, Tony refused to acknowledge that he was dying, continuing to go to work everyday and lead an otherwise normal life. This superhuman determination is probably what led to Tony surviving at least a year and a half beyond the year the doctors' had predicted. The last time I spoke to him was about a fortnight before he died. It was clear that the cancer had already metastasized to his lungs as he tried to fit as many words as possible into each exhaled breath. He was looking forward to the new millenium but died a mere 16 days before it.

A few weeks before my own cancer diagnosis, I’d thought how ironic it was that I, the bratty little sister, living in a country beset by the dangers of war and terrorism, was still alive while my sister and brother were not.

Booster Days

2007-09-05T01:15:00.001-07:00

I’ve completed the 25 radiation treatments and started a series of eight booster treatments. The boosters are carried out in Accelerator 4 and differ from the treatments I had in Accelerator 2 in a number of ways. First of all, the ray is electronic and directly targets the location of my erstwhile lump, instead of photon, which, if I understood the explanation correctly, bores deep and spreads in the area until it meets the resistance of the inner contours of my breast. Secondly, instead of the reflection of interlocking red guidelines on my body, a yellowish light is beamed directly on to my scar and there is only one, 20+-second blast, instead of two. And most significantly, the radiation team in Accelerator 4 seems to favor a more upbeat background music than their colleagues in Accelerator 2, who preferred the gentler rhythms of Julio Iglesias and Beethoven; I need to remind myself to remain still and not to twitch in time to the music.

A small coterie of women, with whom I compared lump size and respective treatments, has migrated with me from Accelerator 2 to Accelerator 4 where we continue to wish each other luck.

My breast looks like it’s been left out in the sun too long. It’s red and patchy and I faithfully apply the creams that the nurse, Rahel, recommends—so far there’s no discomfort or blistering. It’s also larger than its twin, although I accept that the lack of symmetry is discernible only to myself. I tire easily and disconcertingly, tend to drop off while watching movies that, now that I’ve taken a break from work, I have the time to watch.

I view everything through the prism of my emotions. I’m quick to tears and feelings of anger and frustration. The slightest aggravation or disappointment can trigger any one or all of these emotions. When my first appointment in Accelerator 4 was cancelled due to a malfunction, I felt so let down I could barely resist the impulse to burst into tears and stamp my foot. My daily treatments, while a pain in the ass, bestow a sense of being cared for. They also serve as a framework within which I function as if my life were normal and any deviation from it disproportionately undermines my ability to cope. A cancelled appointment is equivalent to a loose thread that threatens to unravel the fabric of my life.

The hospital allocates three months for therapy and I have had three sessions to date. My psychologist’s mission is to help me regain the well-being I had before my diagnosis and to combat my fear that I meet the same fate as my sister.

Between them—the doctors and radiation technicians, Liron the psychologist and Eran, my mediatation guide—I would seem to have body, mind and spirit covered.

Radiation Therapy: The Routine

2007-08-11T02:47:00.001-07:00

From Sunday to Thursday, I leave work around 2.45 and drive to Rambam. As my appointment is after 3.00, I can park for free in the employee’s parking lot - the guards at the gate now recognise me and don’t bother asking for the letter confirming the appointment. I no longer lose my way to the Oncology department and my card with its magnetic strip is ready at hand to pass under the scanner when I arrive.

I then round the corner and take a seat in the waiting area and wait, freezing from the excessive air-conditioning. There seems to be a regular turnover of patients waiting for treatment but some have become familiar faces: the Russian guy with the baseball cap, whose treatment now seems to precede mine; the young and always animated Asian boy, whose brightly colored head covering would indicate that he’s undergone chemo; the youngish Arab woman with a passing resemblance to Sandra Bullock; the woman whose baby doll, blond and curly hairstyle appears incongruent with her heavily-lined and overly made-up face, perhaps yet another victim of hair fallout from chemotherapy.

When my name is called, I am buzzed through one of the double doors and I make my way to the technicians’ station, where I hand over my magnetic card. I go into one of the changing rooms, remove my top and bra, take a dusty-pink robe that matches the dusty-pink doors - probably coincidentally - and then lock the door behind me. By this time, the technicians have swiped my card to display my details on the PC screen. The details include the photo that was so mysteriously taken of me when I underwent radiation planning.

The radiation room is usually dark when I emerge from the changing room, indicating that the previous patient has not yet completed treatment. When he or she appears, we sometimes exchange smiles of camaraderie. Lately, this has been Dmitri, the guy with the baseball cap, who does not acknowledge the camaraderie of a shared experience.

By the time I enter the room, the table has been adjusted to accommodate my specifics. The reclining head/arm rest is put in position and the bar where my bottom comes to rest is placed at 8. If I were shorter or taller, the bar would be adjusted accordingly. All this is done to ensure that I lie in exactly the same position at every treatment. A paper sheet is placed on the table and I climb on to it and raise my arms above my head until they’re resting more or less comfortably in the arm rests. A technician dabs my breast with a black marker, and begins to raise the table. Music plays in the background.

The machine, which I now know is called an accelerator, begins to whir. The gantry, or arm which supports the disc-shaped plate through which the radiation is beamed, cranks and groans into position on the right side of my body. I stare up at the red interlocking lines on the ceiling which are mirrored precisely across my breasts. There are a few more whirs and a few whizzes, and then the radiation spurts, during which time I remain very, very still to avoid the beam hitting vulnerable parts of my body. Inevitably, I'm conscious of an overwhelming need to scratch my nose, but I don't dare and the feeling passes. The radiation burst is anything between 20 to 26 seconds. The gantry then cranks and groans its way over to my left side, whizzes for a few seconds, then there’s another burst of radiation lasting from 19 to 22 seconds. When it’s over, I don’t move, never quite sure if it’s safe to do so, until the technician comes back into the room to lower the table and release me.

During the 13 treatments, I think I’ve been attended to by the full complement of eight or more oncological radiation technicians, who mix and match their partnerships on any one day. That is, one day, the young, blonde girl might be teamed with with older, thickset man, who is teamed the next day with the technician with wild red hair and heavy bright blue eye makeup. They are generally pleasant, more often than not ready to answer my questions, though some express surprise at my interest. Sometimes I get the feeling that they’ve been primed to indulge the nosy British woman, to just answer her questions and maybe she’ll shut up.

Each patient is assigned what is called a radiation dose rate, which accounts for the variation in seconds in each treatment. The dose rate is measured in units of 100 to comprise a minute - the dose remains constant but might be delivered at different speeds due to concurrent activity on the network. Radiation delivery seems to function pretty much in the same way that information is delivered over internet networks. The monitor above me registers the number of time units it took to deliver my dose and it usually hovers around 55 / 46.

The dabs of black marker are made by technicians whose eyesight is challenged to find the marks that were tatooed on my body during the simulation and planning sessions. The beams are directed to optimally miss my heart and as much of my lung as possible. Apparently, it’s impossible to avoid the lung completely and the beam encroaches about a centimeter into it. However, I was told that up to two and half centimeters is permitted without any threat of undue damage.

After a few treatments, radiation of my left side was interrupted by the taking of an X-Ray to check that my coordinates, defined during the simulation and planning sessions, were correct. Apparently, they were, and I’m grateful that my anxiety that the beam is not always as precise as it should be were allayed.

Basically, radiation treatment can be compared to being micro-waved whereby the nuking begins in the center and spreads outward. After 13 treatments, my breast has assumed a rosy hue. I’ve been told to expect that it will redden and swell, burn and blister like any lump of meat placed in a micro-wave oven, but so far, apart from its rosiness, I don’t see much difference between the two breasts. I apply a cooling cream both morning and evening in the hope that doing so will preclude - or at least retard - burning. As for the swelling, do I buy a bra with larger cups and stuff the non-radiated side with cotton wool? Reminds me too much of puberty!

I retrieve my card, smile at the next patient on the reverse path to the treatment room, dressed like me in the dusky pink gown. I get dressed, and, no longer mistaking the storeroom door for the exit, leave. The whole process, from the time I first swipe my card to announce my arrival to the time I reach the parking lot, takes about half an hour. The rest of the day is mine.

August 11, 2007: My Father’s Death (July 25, 07)

2007-08-11T02:44:00.000-07:00

It’s almost a month since I last blogged and I have now had 12 radiation treatments. The first one was on July 22 and since then, the formalities, the procedure itself, and all other aspects of this treatment have become a way of life.

En route to the hospital on July 25, the day of my fourth treatment, I received a phone call from my nephew Jonathan to say that my father had been taken to hospital and that his death appeared to be imminent. As I was at the beginning stage of my treatment, Dr. Sarid agreed that I could travel to England for the funeral.

My relationship with my father was complex and the effect of his death has increased the turmoil that cancer introduced into my life. However, this blog is not the place to examine the implications of his death on my life other than to say that with the passing of my father, I am the sole survivor of the family I grew up in, the one that provided security for me as a child. This fact adds to my general sense of precariousness now that I too, like my siblings, am a victim of cancer.

Radiation Treatment Begins

2007-07-22T08:22:00.000-07:00

The atmosphere was different today - more pleasant, kinder. The secretary showed me how to pass a card under a sensor to announce to the radiation technicians that I'd arrived. While I waited for them to call me, Alison, the radiation nurse I'd met a few weeks ago, passed by, chatted for a bit with me and Gabi, then went to see how long it would be before I was called.

The same two technicians greeted me with broad smiles and explained exactly what they were going to do and how long it would take. Again I lay on the table, arms raised, and again I experienced the illusion of heavy machinery moving towards me when in fact, I moved toward it, suspended once again above the floor. I was zapped from one direction and then zapped from the other. Strangely, the angle of the circular platter that was presumably the zapping agent, seemed to point at my right breast, rather than the left. Once I'd been lowered and could move again, I asked why it appeared that the wrong breast was in the line of fire. The technician said that the instrument was precisely aligned in order to minimize contact with my lung. That took me aback a little - I knew that they try to avoid the heart, but I didn't realize that my lung was going to be, even minimally, affected.

The whole exercise took about 10 minutes and was much less onerous that the two previous sessions. As my appointments are in the afternoon, we were able to park in the employees car park for free and within half an hour of arriving, left the hospital.

I have my first appointment with a psychologist, scheduled for July 31. Yay!

July 19, 07. Whatta Day!

2007-07-21T04:07:00.000-07:00

Eating Right

Mirit the dietician confirmed Liora’s claim to nutritionist bilbul (confusion). The rule of thumb for a healthy diet seems to be to eat as many non-processed foods as possible (or as few processed foods that is feasible), and to reduce quantities of dairy and sugar-laden products. Tuna should hail from the ocean where there is less mercury begriming the waters. As glucose in fruit is natural and takes longer to be absorbed, I should continue to eat about three fruits a day. To all my questions, such as the hormonal and antibiotic content of cattle feed, she gave the equivalent of a verbal shrug; research into what we consume is so dynamic it’s beyond a mere dietician to know more than a mere cancer patient. I cannot in any way fault her attitude - she could only dispense information that has been proven today in the knowledge that it might be disproven tomorrow.

I won’t be making many changes to my diet - for years I’ve followed what could be deemed an essentially healthy regime with occasional forays into the high-fat cheese and cake departments. Before cancer, I frequently mentally patted myself on the back for my adherence to good eating habits, regarding it an adequate talisman against such horrendous diseases as, well, cancer. In fact, a few weeks before my diagnoses, there was a report on how eschewing beef can reduce the risk of cancer. I haven’t eaten beef for years - I originally stopped eating it because of Mad Cow’s disease, but once the crisis was over, I was never even tempted to start eating it again. I’ve also considered giving up chicken considering what is probably put into their feed to say nothing of the unsavory way chickens are bred. I was amazed, therefore, when Mirit said I should be eating red meat, beef, three times a week, in order to maintain B12, folic acid and iron levels. I’ll have a blood test to determine if I have any deficiencies and then make a decision.

For years I have eaten several almonds daily based on something I read over 30 years ago. Edward Cayce, aka the Sleeping Prophet, was an illiterate man with no medical training whatsover, who claimed that while in a deep sleep, his psyche travelled around the body of what he referred to as an entity and located whatever was awry in that body. He would then prescribe some herbal remedy, from which, according to the book, the entity recovered. Cayce claimed that three almonds a day would protect against cancer.

Incidentally, Cayce also claimed that our planet would not end with a big bang of a nuclear explosion but would whimper to an end through ever-increasing occurrences of drought, famine, pestilence, floods, volcanic eruptions and earthquakes, all due to increased pollution. And that was in the 1940s.

Hmm! He was wrong about the almonds!

I showed Mirit a list of suggested natural remedies from the internet. This particular article, although well written and seemingly authentic had no attribution, nor was there any official endorsement from a research or medical facility. Articles such as these cause me no small amount of turmoil because they induce guilty feelings. If imbibing, smearing or swallowing one or many of these items would ensure my continued survival, then I am clearly not acting in my best interests by ignoring the advice. On the other hand, these very same items, taken in incorrect, or even recommended, proportions or in conjunction with other preparations, could in fact be injurious to health. Medicine Man Tea and Blue Green Algae will have to wait until I’ve exhausted other, recognized, options.

_____________________________________________________

What Do You Have To Do To Get A Psychologist Around Here?

The day took on a Pythonesque twist. The week before, I’d asked Liora the social worker to arrange for me to consult a dietician and a psychologist. Mirit had phoned a few days later but as no psychologist had yet contacted me, I called Liora to remind her. She gave me a phone number she said I could call to make an appointment. As soon as I’d taken my leave of Mirit, I called the number but I got an answering machine inviting me to leave a message for one of three doctors.

As I was already in the hospital, I thought it would be a good idea to go along to the department and try to make an appointment directly with a secretary or nurse. No-one in Reception knew where the Psychology department was so Nachum and I went over to Information.

The clerk behind the window didn’t know where the Psychology department was either, and, noting my meaningful glance at the sign above her head proclaiming Information in Hebrew, English and Arabic, protested that she didn’t know everything that happened in the hospital. She went to ask the ‘girls’ but they didn’t know where the Psychology department was either and, clearly feeling that she had made a supreme effort, indicated that my query had been dealt with to the maximum of her ability and would I now just go away.

The deputy manager of the Reception department came out of her office to see what the altercation was about and invited us into her office. She tried to help by calling a few numbers, the upshot of which had us running back to Oncology to look for Room 31 where we would find Shlomit, a social worker who apparently was responsible for psychology appointments. Room 31 turned out to be a room containing a doctor and a patient who appeared justifiably disgruntled at being interrupted so we followed the signposts to Social Workers and found Shlomit’s office (Room 30) just as Hannah emerged from it. We told her that we were trying to locate the Psychology department and that Anat in Reception had sent us to Shlomit. She went off to find out some more details and a few minutes later, a dismayed Liora appeared in front of us, puzzled as why I would want to consult Shlomit about something she and I had discussed at length only a week earlier.

It seems there are only three psychologists attached to the Oncology department on a part time basis and they are usually not available to answer a phone. At Liora’s suggestion, I phoned again and left a message, which I probably should have done in the first place. But if no-one had contacted me after Liora passed on my request a week ago, how will leaving a message now make a difference?

One can go nuts trying to get an appointment with a psychologist around here.

_____________________________________________________

Radiotherapy Planning

At 3.00, I returned to Rambam for radiotherapy planning. When I entered the room, a technician pointed a digital camera at me and took a picture of me. It is something I am wont to do in social situations but I felt that under these circumstances, a friendly explanation would have been in order.

I was told to remove my top and bra - behind the curtain naturally - and then lie down on the table, arms raised and resting in the grooves of the bright red blocks. When I queried what was about to unfold I was told that they were going to ‘apply the simulation’, referring to the simulation I had undergone on June 20. I was under the impression that this would take only a few minutes and, thinking they were done, started to get down from the table. This was clearly a mistake as the two technicians told me to lie back, keep still and breathe deeply - this was going to take 20 minutes.

The room grew dark. I was lying under a sort of giant, 2-pronged propeller with a massive circular platter above me and a square one to my right. The circular platter appeared to move towards me and hovered at about half a meter above me. It whirred a few times as the technicians shouted out numbers at each other. Inexplicably, the table I was lying on occasionally shuddered. Lying as I was, stretched out with arms above my head staring at the ceiling, I could make out very little in my peripheral vision. At some point, the circular platter revolved to the left and the square platter appeared in my line of vision on the right. Suddenly, one of the technicians applied something to my breast and I raised my head, only to quickly lower it when she shouted at me. She repeated her action and the second technician laid something that felt like a cord on my body. I had a sensation of being captive to a bunch of lunatic aliens. I was aware only of bobbing heads somewhere in the periphery of my vision as, mystifyingly, the technicians, appeared to be going about their tasks on or about my body while seated on very low chairs.

About 15 minutes into this activity, one of the technicians told me that Dr. Bernstein (the radio therapist) was going to mark a place on the scar on my breast and in a voice reminiscent of a drum roll, announced that Dr. Bernstein had entered the room. Totally misunderstanding, I lowered my arms and began to sit up. Again I was told - brusquely - to lie down and Dr. Bernstein, who was barely visible in my peripheral vision, made a mark on my scar, also seemingly from a sitting position.

By this time, even my right arm, which, unlike my left one, had not undergone an operation in the recent past, was feeling the strain of being in a constantly raised position. The circular and square platters continued to whir into action interchangeably and I was reaching the point where I’d had enough.

The whirring stopped, the lights went on and I discovered that the table on which I lay was raised a few meters from the floor, which explains why I’d only been able to make out the tops of heads from my prone position. Well, here was a lesson is perception - I had been sure that the circular platter had moved towards me when in fact, the table, had moved towards the platter. How lucky I had been that in my enthusiasm in greeting Dr. Bernstein I hadn’t leaped from the table to what would have been the floor, very far below.

This unpleasant session ended when, after lowering the table (!), I berated the technician for not informing me what they were doing while they were doing it. She asked if I meant that they should have pointed out that... and then she sarcastically reeled off a litany of activities they had performed on or about my body. I waited patiently for her to finish and said, ‘Yes, the answer is yes.’

Generally speaking, the higher up the scale the practitioner, the more the patient is treated with courtesy and given some explanation of what, why and how something is being done to them. Perhaps it is merely a matter of training in which case, radiation technicians need to be better taught to understand that the bodies lying on their tables belong to human beings with curiosity and fears, all of which could be allayed if they were to relate in a friendly manner.

My New Oncologist

2007-07-13T10:23:00.000-07:00

OK, I’ve been around, I know the drill. It’s usually done when I first enter the room - but there have been times when I was already prone, ready and waiting. Sometimes I manage to sit for a while, talk for a bit, but the end, I get up and remove my top and bra. I move over to the bed, lie down and raise my arms above my head. My breasts, both of them, are then prodded, poked, pounded and pummeled and - not to be too P-centrically alliterative - jabbed, joggled and jiggled. The whole routine is then repeated with me in a sitting position. Then the prodder who did the jiggling smiles and says, OK, everything’s OK and I get dressed again.

I’m not sure what they expect to find. It was only a short while ago that the cancerous lump was removed from one such breast. Do they expect it to come back for a return visit?

_____________________________________________

It's Thursday, July 12, and before keeping my appointment with Dr. Sarid, I met Liora the social worker. Since discovering the lump in what seems like eons ago, my life has been dominated by operations and waiting, usually tensely, for the results of various tests. Now all the labs are in, and the final piece in the jigsaw of my cancer is in place; there is no more action, just the reality of a dividing line between my life before cancer and my life after cancer. There are times when this realization plays havoc with my sense of well-being.

I want, I told Liora, a psychologist. I want to be able to pour out my emotional meanderings and find my way back to equilibrium. (Note: Even with access to a dictionary, there was no way I would be able to express that sentence in Hebrew. What I actually said was far more mundane, a linguistic compromise, if you will, but the message was the same.) Liora asked me if I had lost my appetite (no, if only!) and if I had sleeping problems, either oversleeping or under-sleeping (again no, so long as she didn’t count losing consciousness for about 20 minutes every evening in front of the TV as oversleeping). She concluded that I was not depressed, but that I was sad. That was a relief, because for a moment I was afraid that I would be denied a psychologist if I were judged insufficiently miserable.

I also asked her for access to a dietician or nutritionist because I am very, no extremely confused about what to eat and what not to eat. Tofu, for example - who hasn’t felt noble at eating tofu? They are now telling us that the phytoestrogens in tofu, instead of being beneficial, could well be a contributory factor to breast cancer. Furthermore, last week on Channel 10, there was a report on green, leafy vegetables, such as petrosilia (parsley) and cusbara (coriandar) - those we’re exhorted to eat for good health and to keep cancer at bay - and how they are saturated in carcinogenic substances. As if that weren’t enough, Liora told me that she attended a lecture where the role of organically grown produce in promoting health was impugned. Apparently, the very substance which destroys worms and other produce gnawing mites could be injurious to our health. The nutritionists themselves are very confused, said Liora. However, one concept that appears to be more or less universally acknowledged is that cancer cells love sugar: (http://www.webmd.com/breast-cancer/news/20070710/meat-sweets-boost-breast-cancer-risk). I don’t envisage cutting down on my sugar intake as a major hardship.

I got off to a rather shaky start with Dr. Sarid when he asked for my test results and I had nothing to give him. Nachum and I had gone to his secretary’s booth to confirm the time of the appointment but she wasn’t there and after waiting for about five minutes, we left because I was afraid we were late. I was dismayed and began to protest that I had no idea why he didn’t have my test results, that I wasn’t responsible for or even cognisant of administrative practices in the hospital. He calmed me down, told me that he was happy to tend to me because I was the mother of a colleague and that I should remember to bring all the documents next time. He also told me that if I continue to respond to him in that way, he'd be afraid to say anything to me, so I shut up. There was an element of warmth in him which had been lacking in Dr. F that I found compelling. I left his room feeling satisfied with my team of health care specialists.

I begin radiation treatment on July 22 at 3.55. There will be 33 treatments in all, every day, five days a week. I can expect to feel fatigued and weak as the treatments progress. On the way out of the hospital, I popped in to Steimatzky's and bought three books.

Friday, morning shower: After my breasts have been poked, pummeled and joggled, and have received a clean bill of health, I have no qualms applying moisturizing lotion to my body. I reckon if the doctors are satisfied, the possibility that I might chance on something untoward is pretty low. During intervals between breast jiggling, I tend to be reluctant to use the lotion because that is what triggered this whole drama - and there are some places I do not want to revisit.

New Oncologist, Life Returning to Normal (well, almost)

2007-07-05T03:21:00.001-07:00

Gabi took my file to Dr. Sarid, who has agreed to be my oncologist. I have my first meeting with him on Thursday, July 12, and in the meantime, I'm waiting to be invited for my first radiation treatment, which should happen around the end of July, beginning of August.

Now that my immediate future is less of an enigma, the first thing I need to do it cut my hair, something I avoided doing for no rational reason other than a vague idea that there wasn't much point if it was all going to fall out anyway.

With everything falling neatly into place, it's a little disconcerting to find that my latent hypochondria has gone into overdrive. One would think that once the disease you've most dreaded actually strikes, there would be some relaxation in hypochondriac angst.

Unfortunately, that doesn't seem to be the case. I've been anxiously examining my eyes to make sure the whites are not yellow, indicating the presence of liver cancer. The other day, I had an irritating cough and I dreamed I had lung cancer. The next day, my throat hurt and I lost my voice, so now I'm worrying I have throat cancer. Yesterday morning, I had a sudden pain in a small area of my head and felt a little dizzy - no prizes for guessing what kind of cancer I'm thinking of.

I think it's time to go back to exercising. When I left the hospital, I'd lost 3 kg., the only bright spot in the whole experience, and although I've gained back about 2 kg., the fat seems to have redistributed and my clothes are feeling tight on me. Another reason for returning to exercise class is that it would be good preparation for the radiation, which can leave patients feeling tired and weak. It's time for me to start rebuilding my strength.

July 3, 07. The Oncotype Results

2007-07-03T00:26:00.000-07:00

NO CHEMO.

Yay! My oncotest result was 8: "Patients with a Recurrence Score of 8 in the clinical validation study had an Average Rate of Distant Recurrence at 10 years of 6%" is what it said in the page Gabi faxed me from Oncology this morning. That means that something in the sliver of malignant material sent to Oncotype suggests that 10 years from now, I will have a 6% chance of recurrence - undergoing chemo would reduce that to 4%, which is considered insignificant.

_____________________________________________________

Being in doctor limboland had made me anxious that my results from Oncotype would arrive and nobody would inform me, so I'd called Teva early in the morning to find out when I could expect the answer. The answer arrived this morning and it was faxed to Dr. F, I was told by the Anglo lady who answered. She refused to tell me what the results were and told me to contact Dr. F directly.

I spoke to Gabi who was getting ready to leave the paggia (premature baby unit) and she told me she'd go over to Oncology to pick up the fax. It would take her about 10 minutes. Next I called Hannah, who was in the clinic. As the clinic is housed in a separate building from the hospital itself, it would take her too about 10 minutes to reach Oncology and pick up the fax.

I paced up and down waiting for Gabi and Hannah to converge on the Oncology ward and call me with the results. 10 minutes came and went, 15 minutes, I paced, I sat, I got up and paced, my heart pounding, my palms sweaty. Finally, the phone rang and Gabi told me the good news. The relief sent a bolt of energy coursing through my body.

Dr. F invited Gabi into her room and explained to her the significance of the result and told her she'd be happy to explain it to me. Is she really impervious to the trauma she'd caused me just over a week ago? Is she being arrogant or simply defensive in failing to acknowledge her oversight? I cannot begin to fathom her behavior.

I need an oncologist I can depend on. Hopefully, that will be taken care of in the next few days.

April 24, 07. In the Beginning…

2007-06-12T11:08:00.000-07:00

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

2007-06-12T11:07:00.000-07:00

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

2007-06-12T11:06:00.000-07:00

*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,,,

2007-06-12T11:04:00.000-07:00

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

2007-06-12T11:03:00.001-07:00

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

2007-06-12T11:01:00.000-07:00

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

2007-06-12T11:00:00.002-07:00

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…

2007-06-12T11:00:00.001-07:00

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

2007-06-12T10:58:00.000-07:00

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

2007-06-12T10:57:00.001-07:00

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

2007-06-12T10:55:00.000-07:00

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

2007-06-12T10:54:00.001-07:00

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

2007-06-12T10:53:00.001-07:00

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

2007-06-12T10:51:00.000-07:00

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

2007-06-12T10:50:00.000-07:00

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

2007-06-12T10:48:00.000-07:00

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

2007-06-12T10:46:00.001-07:00

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

2007-06-12T10:45:00.001-07:00

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

2007-06-12T10:44:00.001-07:00

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

2007-06-12T10:42:00.000-07:00

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

2007-06-12T10:38:00.000-07:00

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

2007-06-12T10:36:00.000-07:00

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

2007-06-12T10:34:00.000-07:00

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

2007-06-12T10:32:00.000-07:00

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

2007-06-12T10:31:00.000-07:00

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

2007-06-12T10:30:00.000-07:00

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

2007-06-12T10:28:00.000-07:00

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

2007-06-12T10:25:00.000-07:00

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.