Learning How To Cope

It has been 7 weeks since I learned about my progression. It has been 6 weeks since my first Faslodex shot. I am still not reacting... I am not crying, I am not worrying, I am just flat. This doesn't mean I am not alive actually. I am enjoying the garden which is flourishing out there. I am enjoying the fact that Leslie is spending more time with me as I cook in the kitchen. I have enjoyed our weekly trips to the Farmer's Market.

But, I have no true joy. I am not investigating Rails with the extra time I currently have. I am not finding little projects to do around the house. I simply can't find even a little bit of ambition to work with. I even have some paid work that I am having trouble 'getting to.' And trust me, it isn't because I don't have the time. And it isn't because we don't need the money.

I am still sticking to my "not tell anyone" strategy. I didn't realize how hard this would be. Not telling people, the same people I am closest to, about what I spend at least 40% of my brain time thinking about. Though I know this isn't technically lying, it sure feels like it. Something like I am telling the truth, but not the whole truth, if that makes sense.

One thing I am really enjoying is contact with other people. Of course, I spend most of each day in my own little office without another chatting friend in sight. My Seattle friend is close. I email her constantly, but face-to-face is better. I need to work on figuring out how to find more folks to just chat with, out there, in the real world.

In Memory Of....

This speech defines so much of what I have been feeling. Lilla Romeo, a bcmet advocate, died on June 9th after living for 10 years with mets. Heartfelt warmth is extended to her family.

What follows is the talk that
Lilla Romeo gave at a press briefing for the
Global Advocacy Working Group on September 19,
2008. Sponsored by Pfizer, this group of many
organizations from a number of countries has been
working on an initiative to expand services and
research for women with metastatic disease. Lilla
works at SHARE and is active in the
Metastatic Breast Cancer Network (MBCN).

> ===
>
> Good Morning,
>
> If I asked each one of you to hold up a glass of
> water, I don't think you would have any
> problem. But if I asked you to hold it up for an
> hour without putting it down, you might find that
> more difficult. What about for a day, a week or
> a month? It would seem not only painful but
> nearly impossible. Now think how a person with
> metastatic breast cancer feels, living with a
> relentless disease that offers no respite.
>
> Most of us in this room know someone who has
> dealt with, or is dealing with breast
> cancer. You may have spoken with them as they've
> gone through chemotherapy and know how unpleasant
> it can be. An average breast cancer patient sits in the chemo chair 12
> times.
>
> I have sat in that same chair over 200
> times. But believe it or not, I am one of the
> lucky ones. I have been metastatic for 8 ½
> years. Current statistics tell us that most
> metastatic women will not survive 8 ½ years.
> Cancer.org lists the survival statistic at 2-3
> years saying that only 10% will live for 10 years.
>
> 185,000 women will be diagnosed with breast
> cancer this year. What many people don't realize
> is that breast cancer does not kill women, or men
> for that matter. What kills is metastatic breast
> cancer and statistics tell us that metastatic
> breast cancer will take the lives of 40,000 women and 400 men this year
> alone.
>
> For all our best intentions, we are afraid to
> really know about metastatic breast cancer. We
> like to think that it only happens in rare cases
> and that it's not going to happen to us, our friends or anyone in our
> family.
>
> In fact, 25-30% of all invasive breast cancers
> become metastatic. I say this not to frighten
> you but to underscore the importance of research
> in the area. According to Dr.William Gradishar
> at Northwestern University, Chicago, there are
> 155,000 women currently living with metastatic
> breast cancer. By 2011 the number is projected
> to be 162,000. Doesn't this sound like a big
> enough number for all of us to pay attention? Do
> these statistics sound like 'rare cases'?
>
> The traditional breast cancer community focuses
> on the Cure. Believe me, WE are all for the
> cure, but our immediate concern is research that
> will extend lives. Thanks to new targeted
> treatments, men and women with metatatic breast
> cancer are living longer. Many of us are able to
> lead full and productive lives but too many are
> not and are dying when they are far too young.
>
> We need the entire breast cancer community to
> join with us to push for life extending
> treatments. Metastasis is a frightening
> word. It's even difficult to say. What's easy,
> is seeking comfort in avoidance: "if I don't see
> it, talk about it or hear it, it won't
> exist." But it does exist, and we need
> everyone's help to find a way to live with it.
>
> It's the elephant in the room that leads to the
> feeling of isolation that so many of our
> metastatic women and men experience. Why else
> would so many feel the need to keep their
> condition a secret from friends and family, let
> alone employers? It is only through getting it
> out into the open that the feelings of shame that so many have can be
> calmed.
>
> Shame? Why on earth should anyone with metastatic disease feel shame?
>
> Perhaps it starts with doctors talking about
> patients "failing" a drug or a trial, rather than
> the drug or the trial failing the
> patient. Perhaps it's about frequent media use
> of words like "terminal" to describe our
> disease. Perhaps it is the incessant talk about
> the importance of a "positive attitude" or a
> "strong immune system." But mainly it is the secrecy.
>
> If you're old enough to remember what things were
> like in the 60's and 70's with regard to cancer,
> you'll have a good idea of what I'm talking
> about. Back then, it was called the "C word" and
> whispered, out of the earshot of children or the
> person dealing with it. No one ever asked the
> patient how she was doing; no one wanted to know
> the truth. That is where we are today, forty
> years later with metastatic disease.
>
> MBCN (The Metastatic Breast Cancer Network) is
> made up of women and men living with Stage IV
> disease. We have about 900 active members in our
> database, but we remain a small
> organization. And yet, we have held impressive
> national and local conferences, dealing strictly
> with metastatic disease. So far we have had
> conferences at Sloan Kettering, NYU and MD Anderson.
>
> Our original mission was to bring together
> doctors and researchers to tell those of us
> living with Stage IV disease what was going on in
> the world of metastatic breast cancer, which
> treatments were available, which were in the
> pipeline--the premise being that education is our greatest tool.
>
> When the attendees gathered at the first
> conference, the chemistry was undeniable. People
> were comparing treatments, talking about side
> effects and offering each other tips on dealing
> with them. It was the first time many of them
> were able to openly discuss their treatments, the
> first time many realized they were not alone in
> their struggle. The feeling of isolation was temporarily abated.
>
> Over the years, many of my concerned friends have
> asked, "So, when will you be finished with your
> treatment?" or they say, "I've never known
> anyone on chemo so long, you look fine, are you sure you still need it?"
>
> Our conferences have been a place where the heart
> can sing just looking out at an audience of
> people who understand that treatment only ends when it stops working.
>
> Unfortunately conferences only reach a small
> proportion of the metastatic community. To help
> broaden our reach, we are working with SHARE of
> New York City to train more metastatic women to
> take hotline calls, offering comfort and
> understanding to those who've received a metastatic diagnosis.
>
> So, how do we talk about metastatic
> disease? Most of you are professional
> communicators, so you know the power of
> words. In this setting, words have a
> particularly profound effect on attitudes.
>
> Let me illustrate. A friend told me that she was
> asked to be part of an advisory questionnaire for
> a major breast cancer organization. One of the
> questions posed was "Are you still in treatment or are you a survivor?"
>
> The world often uses the term 'survivor' as a
> label for someone who has 'had cancer and beat
> it.' Like a compliment, it gives the impression
> that there has been a battle and the warrior has
> emerged victorious. It gives the appropriate
> closure to a very unpleasant experience and the
> promise of getting one's life back. It's a badge of honor.
>
> But what about those whose battle never
> ends? How should we talk about "survivorship" in
> that setting? What about those of us who can
> never put down that glass of water? Who have no respite from treatment?
>
> The Sicilians have a wonderful expression for
> describing how they face the trials and
> tribulations of life: "Ci Difendiamo," we defend
> ourselves. Perhaps that expresses our situation best.
>
> Another emotionally charged expression in this
> setting is "chronic disease." How often do we
> hear that metastatic breast cancer has become a
> chronic disease? How many chronic diseases do
> you know of with a life expectancy of 2 to 3 years?
>
> Believe me, making it a chronic disease would
> give our community incredible happiness. And yet, we are far from it.
>
> Yes, there are the wonderful cases where someone
> "Dances with Ned" NED being "no evidence of
> disease." But usually the doctor prefaces the
> statement by telling the patient that NED doesn't
> mean the cancer is gone, it means it's lying
> dormant. The time bomb is waiting to
> explode. But what we all wouldn't give for a
> little twirl around the dance floor with Ned!!!
>
> As October approaches and the spotlight will be
> on the pink ribbons (another hot button but I'll
> save that for another time) we will all be
> reading articles in the media and hearing
> breaking news on television about how close we
> are to finding the cure. There'll be the
> heartfelt stories about women dealing with chemo
> while working and raising children, about
> celebrities - actors, newscasters - who've had
> their brush with breast cancer and moved
> on. There will be emotional tales of support
> given by friends and family through a difficult
> time, maybe even a few friends donating their hair in support.
>
> And that's all wonderful feel good stuff, but
> there will be very little said about women dying
> from metastatic breast cancer or even living with it.
>
> MBCN has made it a priority to bring awareness to
> those living with advanced breast cancer in the
> month of October. Last year 4 cities declared
> October 13th as Metastatic Breast Cancer Awareness Day.
>
> This year we can already count 18 cities and 7
> states that have issued the same proclamation. It
> has even been recognized by the Department of
> Health and Human Services. We are hoping this
> begins to ease some of the isolation felt by our
> community while the country is awash in pink.
>
> The available data on metastatic breast cancer is
> virtually non existent. Pfizer is initiating a
> Global Metastatic Breast Cancer Survey to better
> understand the gaps in resources, information and
> psychosocial support experienced by the
> Metastatic community. A very much needed piece to the puzzle.
>
> But in the end, it all comes down to supporting
> research that helps extend lives.
>
> A few weeks ago, my husband and I went for a walk
> in Central Park. In spite of the heat, there
> were thousands of men and women "Running for the
> Cure." It struck me that the metastatic
> community isn't so much running for the Cure as racing for survival!
>
> Thank you.
>
>
> Lilla Romeo
> Metastatic Breast Cancer Network
> www.mbcnetwork.org

JOLT!

In the past six weeks, ever since I was told that I had a progression and was now a Stage IV patient, I haven't always known how I feel. The best way that I have been able to define this new reality to myself is suspended animation.

I have not responded emotionally like most of the Stage IV women in my online support group. So far, I haven't experienced anger, or fear, or anxiety. Just a leadened "well of course" and emptiness. The one response I have had that felt 'normal' is a knee-shaking sadness. Sadness that I will probably leave my husband all alone and sadness that I won't see as many chapters of my daughter's life as I would like. But I haven't felt sad for me.

By nature, I want to know everything. I want to have contingent plans, know what forks will be approaching and have the knowledge to make the correct decision. But, for this new reality, I am not doing that. Instead, I have decided that I need to live one progression at a time. I do fear that if I look down the road too far, I might go crazy.

And so I live in this state of suspended animation where is it hard to concentrate. My billable hours are way down while the medical expenses are going way up.

In amongst all of this has been my stupid gallbladder. In fact, the pain from my gallbladder is one of the triggers that led my oncologist to order so many scans. Two weeks ago, I had a very invasive procedure with high risks which was totally worthless. Yesterday, I found the right doctor... a GI surgeon. Dr. Dana spent a ton of time with me. It was actually wonderful [but that is a different story.] During our talk Dr. Dana let me know that my primary, who has been out on a medical leave, will in fact be retiring. As I explained that this meant I would be looking for a new primary since I haven't been happy with my primary's partner at all, Dr. Dana started to write a name down on a post-it note. "This woman is just a wonderful internist. She is intuitive, warm, smart and has worked closely with Hospice for many of her patients."

JOLT! Hospice? OMG. We are talking about end of life, NOW?

And my state of denial, of suspended animation was burst in that one moment. Dr. Dana isn't wrong. If you are going to switch primaries, it does make sense to have a primary who has helped thousands of HIV patients die gracefully, but I guess I just wasn't ready to hear that just yet.