06.16.2013
The Shehecheyanu blessing (Hebrew: שהחינו, “Who has given us life”) is a common Jewish prayer said to celebrate special occasions. It is said to be thankful for new and unusual experiences.[1] The blessing has been recited by Jews for nearly 2000 years. It comes from the Talmud. — from Wikipedia
During the six months in between my diagnosis in September 2009 and the day I got re-staged after my mastectomies in March 2010, I pondered my mortality on an almost daily basis. My oncologist was never less than honest with me, so I knew the facts on the ground.
If the chemo didn’t work, my stage III aggressive cancer gave me a 10% chance of being alive in 5 years. We wouldn’t know how well it worked until they surgically removed the cancerous breast and did a pathology study of it.
When she gave me this dire news, one of the first dates I calculated was my eldest daughter’s bat mitzvah, about 3 1/2 years out.
I needed the chemo to work. If it didn’t, I very likely would not live to see that day. If, despite failed chemo, I managed to hit the outside range of the life expectancy and make it to that day, I would very likely be seriously ill: the mom doing a hora in a wheelchair.
When I suffered side effects, when I really felt like I could not continue after the allergic reaction in the 4th dose, when I thought I could not endure any more assaults to my poor system, I would think about these odds and how much I needed to change them, and I would climb back in the chemo chair and subject myself to another round of hell.
When my pathology report came back, I was re-staged as Stage I, dramatically changing my prognosis. My 6 cm tumor had melted away to less than 1 cm, giving me a 90% chance of living 5 years.
Last weekend, I got to see the day that frequently preoccupied my heartbroken ponderings of my mortality and inspired me to persevere.
The prayer referred to at the start of this post, the shehecheyanu, is one that we say any time we feel gratitude for a moment, particularly for firsts.
I had been told by other parents that I would not believe the unbridled joy and pride of seeing my daughter through this first rite of passage.
They were right. In addition to my awe for the young woman she is becoming, I felt like the day was one enormous shehecheyanu. I did not take my presence for granted. Alongside the joy and pride I felt in my daughter, my heart was overfull with gratitude. Throughout the weekend, the prayer would play like a soundtrack in my mind, bringing tears to my eyes.
Blessed are you, Lord our G-d, who has granted us life, sustained us, and enabled us to reach this occasion.
And to this I say, Amen.
Tags: chemo, chemo rollercoaster, courage, daily life, doctor-patient interaction, gratitude, grief, parenting, survivorship
Posted in Survivorship | 8 Comments »
05.19.2013
My bloggy friends have really hit some important notes about Angelina Jolie’s prophylactic bilateral mastectomies, a decision she made public in a recent editorial in the New York Times.
Jackie called out those who were judging her decision.
Marie wrote a good explainer about the BRCA gene and why its presence might lead to such a choice.
Nancy took up the issue of gene patenting and how the prohibitive cost of the BRCA test limits women’s choices.
Philippa reminded us of the stark global inequities in breast cancer care, telling some stories from Sri Lanka and Timor.
What could I possibly have to add?
Like my friends, I was asked by many to offer my opinion about Jolie’s choice. (I fully support it.) But since I have been hanging back on blogging, I was delighted to know so many smart and articulate people who cover the big issues when these Cultural Moments in Cancer happen.
Something struck me, though, amidst the media frenzy that has been less central to the ensuing conversation.
Women’s self-hating chatter about a radical surgery.
First there was a BRCA positive celebrity on an entertainment news program who talked about anticipating her prophylactic mastectomies. She told the interviewer laughingly:
It’s like a deluxe boob job!
Here is another exchange from a Facebook thread. Both women are educated –– Woman A is a doctor –– but the attitude is the same:
Each time, my stomach dropped. This trivializes a body-altering operation.
I had a preventive mastectomy. A tumor presented in one breast, but I had to decide about whether to remove the healthy one as well. After genetic counseling, I was tested for the BRCA genes as well as a known mutation prevalent among Ashkenazi Jews. My genetic tests revealed no known genes, but the multifocal presentation of the tumor in my breast, my young age, and my ethnicity led four clinical oncologists to suspect some unknown genetic origin. Although I did not get a definitive risk like Jolie –– 87% is pretty clear cut in the medical world –– all these doctors recommended a prophylactic mastectomy.
I went ahead with the surgery. I got reconstruction, although mine was more complicated than Jolie’s because of the radiation I received as part of my treatment.
I have the new tatas that the women seem to joke about.
And you know what?
I really miss my old ones. We had a history together. I nursed three children with them. They fit my middle aged body. They felt much more than the ones I have now.
As I tend to do when something in CancerLand raises my ire, I posted the following on my Facebook page:
As you can see, this got a lot of “likes.”
On that thread, somebody generously shared the following:
Immediately prior to formal diagnosis (i.e., after the lump was discovered but before the second biopsy), I found the idea of a “deluxe boob job” (and tummy tuck, woo hoo!) to be very comforting. When talking to friends, that’s how I framed it, because breast cancer was much easier to talk about in those terms.
I really appreciated this honesty. It gave me insight into this “boob job” framing.
And here is what it reveals about our culture and breast cancer:
It is more socially acceptable for us to dislike our bodies to the point of wanting to surgically alter them than it is to grieve the loss of identity and sensation that mastectomies require.
I notice that folks are not chatting as playfully about the oopherectomy (ovary removal) that Jolie plans to undergo. There is no soft-pedaling that operation. An oopherectomy means a sudden, surgical menopause. Friends of mine have described it, and it is not pretty. There is no femininity-preserving (or, to hear some women describe it, femininity-improving) reconstruction.
So my question is:
When women with ambiguous cancer risks undergo preventive mastectomies, how much does their own culturally acceptable body-loathing play into that “choice”? Can we call it a choice when there are obviously such strong messages that downplay the loss and pain and overplay the body improvement aspect of this surgery?
For information on genetic risks and breast and ovarian cancer, please visit FORCE: Facing Our Risk of Cancer Empowered.
Tags: appearance, body issues, boobs, cancer culture, courage, essay, identity loss, reconstruction, social media, vanity
Posted in Treatment | 23 Comments »
04.14.2013
Who are we? What makes our lives what they are?
These are some of the essential questions of our humanity.
Some answers to this question place a lot of emphasis on free will and merit, that our lives are largely the result of our deliberate action and inherited talent. Other answers emphasize the social forces that come into play, like poverty and access to education, that shape our life chances.
I had been heavily steeped in these sort of debates, but these conversations did little to prepare me for cancer.
When we fall ill, there is no escaping the profound connection between our bodies and our biographies. Social scientists Anselm Strauss and Jennifer Corbin illustrated this body-biography connection in different illness scenarios:
The dashed line represent an individual’s unfolding life story and the solid line represents the body’s path, both over time. The top diagram shows a chronic illness situation, with the body having its ups and downs, the biography dipping sometimes and holding steady others. The second diagram shows sudden catastrophic illness, with both the body and biography taking a drastic, irrecoverable dive. The last shows an acute illness and recovery, with the body and biography in sync.
I have been thinking of what the picture of my body-biography would look like. I think I would need to have different color lines for the different subplots in my biography; some aspects of my life have recovered better than others. It’s that very disconnect that can make day-to-day life uncomfortable: my external body looks recovered (well, with my clothes on anyway), but my energy and psyche are not back to their baseline.
This past week, my feeling of returning to my old biographical path got a boost.
As many of you know, I am a professor. One of the great parts of my job is that I get to have a sabbatical now and again. I haven’t yet had one in my career, and had really looked forward to taking my family abroad for some stretch of time. Travel has always been a great learning experience for me, and I was excited to share that with my children.
Things have fallen into place: my sabbatical request was granted, the visiting scholar fellowship came through, and we are off to Israel for a couple of months next Fall. There is still a lot to be worked out, but what a delightful disruption this will be.
It has me hopeful that, someday, my biography will feel like it’s mine again, like I am authoring the story and not simply having to maintain a sense of myself in the face of the loss of illness. This is a big first step.
Tags: appearance, attitude, body issues, changes, coping, daily life, gratitude, identity loss, parenting, survivorship
Posted in Survivorship | 1 Comment »
