Why me? This is the common lament of those whom illness, accident, and other misfortune strikes. Have I the answer? Absolutely not, although, I admit that I have searched deep inside myself and deep into the literature on the subject to no avail. I don't believe in a God who decides who shall experience disaster or in a God who punishes us for sins. If that were so, it wouldn't make sense that one of Al Capone's most notorious henchman recently died a peaceful death as an old man in his eighties. Yet, on every Yom Kippur, one of the few days of the year that I always attend synagogue, I, like many other Jews around the world stand breathless during the part of the service which states, on this day, it is decided who shall live and who shall die...
Last Yom Kippur, October, 1992, I could barely breath when that prayer was recited. I didn't know at the time that my breast cancer had not been checked by surgery and seven months of chemotherapy. The potentially deadly cells had loosed their bounds and were threading their way up and down my spine. What amazes me now is that my thoughts were not on whether or not the cancer had been checked or would reoccur--I had every confidence even then that I was well--but rather, my thoughts were on what a narrow escape I (thought) I had experienced.
My breast cancer story began on December 19, 1991. Even though I was 44 years old at the time, my life was still governed by school's timetables. As a college professor, my life's rhythm revolved around semesters' beginnings and endings. Routine things to be done such as doctors appointments and carpet cleaning were often squeezed into school breaks.
My yearly mammogram fell into this category. On Thursday, December 19th, I turned in my semester grades and headed for the radiologist's office--one more item I would be able to check off my list before I left with my family for our holiday in the Blue Ridge Mountains of North Carolina.
Sitting in the outer office waiting for my mammogram the thought did cross my mind that this could be the time I wasn't as lucky as I had always been in the past. I flirted with the idea of what if? The farthest my mind would take me was the loss of a breast. I remember thinking that losing a breast wouldn't be all that bad. I thought of a poem I had written about a high school English teacher I knew who had died the preceding May in an automobile accident. The poem talked about a person's essence. I remember thinking that my essence, like the teacher I had written about, wasn't tied to my body or, for that matter, to any particular body part. But still, this was all hypothetical. Within the next few hours the hypothetical--the abstract--would become reality. I would become a statistic--one in 500.
After the mammogram, the technician asked me to wait until she looked at the film before I dressed. This was standard procedure. I had been through it every year since I was 40, even though in my age group many doctors recommend only every other year and many insurance companies only pay for a mammogram every other year.
I suspected that something was wrong the minute the technician came back in the room to take a follow-up X-ray. This had never happened to me before, although I'm told it happens to many women who do not have breast cancer. "Did you see something?," I asked in a businesslike tone. "There's something here I think the radiologist would want a closer look at and since she's out right now I'll just go ahead on do it on my own; I'd hate for you to have to make another trip down here." The technician, who knew what a healthy mammogram looked like, was not convincing and I was on alert.
"What happens if there is something suspicious?" I queried.
It's standard for the radiologist to send the report to your doctor, who will let you know.
"I know that, but is that what happens even if there's something suspicious?
"The radiologist will call your doctor if there's anything suspicious."
"I'm going out of town tomorrow night. I need to find out if there's something I should attend to," I replied, as much to myself as to the technician.
When I checked out, I asked the receptionist if the radiologist was back. She was, so I asked if I could speak to her, explaining that I would be leaving town the next day and my doctor might not be able to reach me in the event there was something to tell. The receptionist went away. Returning, the receptionist stated, "The radiologist is on the phone with your doctor, now." My heart sank, but my adrenaline propelled me into action. I left the radiologist's office and drove straight to the office of my family doctor, without an appointment. When I was able to see my doctor, her face told it all. From this point on, there were no veiled responses to questions, no hedges, and no lies. For this I was grateful. Both Alan and I are the type who want to know.
My doctor confirmed that the mammogram showed what looked to be a tumor and it very possibly was malignant. She recommended the exact surgeon I would have requested, and called to see if she was available. She was, and I rushed straight over to her office. I still hadn't called Alan, but I had called Jennifer to tell her I had to see another doctor and wouldn't be home at the scheduled time. When Alan called Jennifer he, too, was on the alert.
By the time I reached the surgeon's office, Alan had tracked me down by starting with the radiologist's office. I'm surprised at myself now to think that I hadn't taken time to call him, but there were questions I had to have answered and I was on a one- track mission.
The biopsy was scheduled for the next day. Still, I felt the worst thing that would happen was that I might lose a breast. The die (no pun intended) had landed and I would deal with it if need be. That night, when I told my 78 year-old mother of the impending biopsy, she let the remark slip, "I wish it could be me instead of you; I've lived my life."
"I'm not going to die, Mother! I may just have breast cancer." She was apologetic and said she didn't mean to imply that I would die. I didn't know then that 50% of women who are diagnosed with breast cancer do, indeed, die from the disease. According to one statistic, a woman dies of breast cancer every five minutes.
But I was convinced that if I did everything right, maintained a good attitude, followed my treatment to the letter, and expected to get well, I would. Although at some level I knew the seriousness of the statistics, almost a year went by before I let those statistics enter my conscious mind. After all, I was told that I had an 80% chance for cure. That was the only statistic I let myself believe. 80% was a "good" statistic, although I do remember remarking to Alan at some point that if our daughter knew only 80% of the material for a test we would not think that was a "good" statistic. As it turned out, I never really had an 80% chance for cure because my body was keeping secrets from my doctors.
The next seven months went by in a blur. I continued to teach, while going through a regimen of chemotherapy--two Fridays on, two Fridays off, all the while taking Cytoxin, an oral chemotherapy drug, which in itself is enough to make some people lose their hair. Chemotherapy made me very sick until I was given a wonder drug for nausea, Zoftran. I cut back professional obligations, although I did manage to go to Paris for a week in March to present a paper I was scheduled to give. My doctors were very supportive about the trip. My oncologist, rearranged my chemotherapy schedule to have me "propped up" and feeling good for the trip. When I expressed the slightest apprehension about the trip to my surgeon, she said I was going if she had to go with me!
If attitude could cure a person, I should have gotten well. My spirits were high most of the time and I fully expected to get well and stay that way. I looked at these months as something I would get through on the way to the rest of my life.
When I first told my best friend, Wendy, about the impending surgery and probable hair loss, I added that I was just about as upset about the loss of the hair as the loss of the breast. She agreed that she would feel the same way. But I even managed to maintain a good attitude about the hair. When it began to fall out, I decided I didn't want Jennifer , then 13, to remember the event as a trauma. Instead, it turned out to be a "good" memory. I told her we were going to have fun with this and to pretend I was one of her old Barbie dolls whose hair she was so fond of cutting. I let her cut my hair as short as she could and then I went to a hairdresser and had the rest "buzzed" off. By then I had a wig that looked exactly like my hair had looked and very few people could tell the difference. My oncologist remarked it was one of the best wigs he'd ever seen, and he could spot one across the mall. So even the hair loss didn't throw me. However, I did have a few dark days during that first bout.
One of my low points came early on in the chemotherapy treatment schedule. One day during this period prompted the first in a series of what I have come to call my Watermelon Poems:
- Watermelon Winter
- January 26, 1992
- In the dead of my worst winter
- I bought shoes...
- Watermelon shoes.
- That's what the salesclerk called them,
- Magenta snakeskin toes and purple snakeskin heals
- Connected the flimsiest of light airy net.
- And at just the place on each side
- Where my arch might be, two watermelon halves
- Broke through.
- Bright green semi-circles with hot pink
- Snakeskin center
- reminded me of juicy times past and hinted that,
- This winter may one day end
- And summer come again.
- Watermelon shoes.
- I squinted hard to see what the clerk saw
- And finally saw it, too.
- Bright green rind cushioning hot pink fruit.
- I took off my heavy woolen socks,
- And for a minute,
- Just a minute,
- I glimpsed the summer that will come again.
- Then I took off the shoes,
- Putting them carefully away,
- And slipped back into my woolen socks.
- For now, the image of that box will
- Have to do
- As I dream of
- Watermelon shoes.
And so my "Watermelon Winter" came and went. School ended and I looked forward to the end of treatments ,which I thought would signal, if not a complete cure, at least a few years where the themes of my songs--my poetry and my life-- would not be illness. But that was not to be.
Jul 1, 2010 - Immunosuppressive treatment with cyclosporine A, rather than tacrolimus, with dose level monitoring two hours post-dosing or in patients age 50 or younger appears to have a significant association with the development of de novo cancer after liver transplantation, according to research published in the July issue of Liver Transplantation.