Monday, January 30, 2012

Are at Least Three Legs Still Attached?

Here and there about town are small pipes sticking up out of the sidewalk, usually right next to buildings, often fitted with toadstool-like caps. In fact, many have been painted with spots to enhance that effect, which is whimsically charming. On Saturday, as I walked over to see my hospice visitee, I saw a tiny girl who was walking with her parents spot one of these faux toadstools, back up to it, and sit down. It fit her perfectly, and it was about the cutest thing I’ve ever seen.

Today I took Hammett for his annual checkup. He sees one of two different vets, depending on my mood. One is earnest and sweet and thinks it’s important to give your pet the best quality food. The other has a rather dashing air and thinks there’s not one bit of difference between the fanciest organic chow and the cheapest crap they have at Safeway, which I find rather scandalous.

The first carefully follows up on every symptom: “Maybe we’d better do an ultrasound.”

The second is casual about pretty much everything: “He’s not vomiting? Then I wouldn’t worry about it.”

I don’t know if this is the foremost criterion in choosing a vet, but the casual one happens to be quite attractive, so while Hammett may or may not need to see him on a given day, sometimes I need to see him, so we saw him today. But, happily, because he doesn’t get exercised over every little thing, it also was a lot less expensive than I thought it would be, only $55. He said it’s been two and half years since Hammett was vaccinated, and that while the recommended interval is three years, he personally thinks four years is fine.

While leaving my cube for the last time was harder than I expected, my first couple of days of unemployment have been much easier than I thought they would be. I thought I’d feel bereft, purposeless, culled from the herd, but I have a lengthy to-do list and no job to interfere with actually getting stuff done. I always did think I’d just about have time for my hobbies if I didn’t have to work. In sum, what's not great about doing exactly what you feel like doing all day every day? Why didn't I ever think of this before?

As much as I appreciated that my ex-job was fantastic in many ways, I also thought I was going to feel sort of lousy when I arrived at retirement and realized I’d spent 30 years at a corporation whose goals have little overlap with my own.

I received an email from a friend saying I’d better start looking for a job this second, because people don’t want to hire you unless you already have a job. A week ago, that would have plunged me into gut-twisting fear, but today it just seemed like his view of things and, instead of panicking, I decided not to discuss the matter with this person anymore.

The day before my last day of work, a surprising thing happened. In 1998, when the dot-com boom was happening, it occurred to me that I might be able to weasel my way into an entry-level technical job and trade up from there. One objective was to do this without paying for any more education. I was temping at the time, and found myself working for a technical recruiter, which places IT professionals in contract and full-time positions. I asked one of the recruiters what she thought about my idea, and she offered to see what she could do with my resume, and then they sent me to the company that just laid me off, for a two-week assignment doing something just about anyone could do.

My boss and I hit it off—he was a really great guy—and next thing I knew, I was an employee. My plan worked just as I had hoped. I remained pals for several years with the recruiter who did me that giant favor, but otherwise lost touch with the recruiting firm. Thirteen years passed, and then last Wednesday, the very day before my job ended, I got an email from the same recruiters asking if I’d be interested in a certain job! I was flabbergasted. Naturally, I turned it down posthaste, because it’s not in San Francisco, and I really, really don’t have time to commute (well, I guess I do right now), but the timing was certainly encouraging. Once I get my resume polished up, I’ll send it to them to replace the ancient one they have.

My mother blanched when I told her on the phone that I’d said I wasn’t interested in the job. At least, I thought I heard a faint blanching sound. Which is a lot better than a falling sound.

Not long ago, my mother said very casually, “Whenever I fall down, I’m always afraid I won’t be able to get up.”

I was horrified and demanded to know, “When do you fall down?”

“Whenever I feel like it,” was the smug reply.

Thursday, January 26, 2012

Fire Music

This morning I spoke with SFMC’s nurse educator and told her that medical oncologist Dr. W.’s numbers were way out of line with anyone else’s, that he hadn’t peered into my chart, and that he could not be persuaded to answer my question about who should follow my breast cancer, and so now what? I don’t want to make critical decisions entirely on my own, but I don’t trust this fellow, and would prefer not to pay for another opinion, especially since he was supposed to be the even-handed oncologist. My surgeon has said a couple of times that he doesn’t think tamoxifen would make that much difference in my case, since my recurrence risk is quite low. Would it be stupid just to proceed per that?

The nurse educator said it would not be stupid to go with what my surgeon said, that he is knowledgeable in this area. She said I could run Dr. W.’s numbers by him and see what he makes of them. I could also call Dr. W. and ask him where he came up with the 13%. She said ideally I would get a second opinion from another medical oncologist, though she understands why I don’t want to do that. She said that if I still wouldn’t take tamoxifen even if my recurrence risk actually was what Dr. W. said it was, then there may not be anything else I need to do.

I asked if I need someone to follow my ductal carcinoma in situ (DCIS) specifically, or do I just do my annual mammograms? She said if I did take tamoxifen, I would typically be followed by my medical oncologist, but if I don’t, then I would typically be followed by my ob/gyn. You’ll notice I got that detailed answer for free just by asking.

If I get a new breast cancer or have a recurrence, I inquired, it will be caught before it’s metastatic cancer and has reached malign fingers into my brain, right? The nurse educator said some breast cancers can grow quickly, but typically they develop over years, so regular clinical exams, self-exams and yearly mammograms should catch it if it happens.

And would I then perhaps have a bilateral mastectomy and more radiation and be done with breast cancer for once and for all? She said that even with a bilateral mastectomy, the risk is never 0%, because the skin and scar tissue remain, etc., but the risk would be pretty darn low. Typically they don’t do radiation after a bilateral mastectomy.

Today was my last day at work. Last Friday, my group met on the phone for the last team meeting I will attend, and yesterday I went to another agreeable goodbye lunch, again at Henry’s Hunan, with Jan, Jun and Raymond. I’ve gotten very nice notes and phone calls from my peers and team lead, plus other co-workers from across the years. Bill, in my group, said that my leaving is almost as sad for him as it must be for me; he wondered who he’ll go to now when he gets stuck, which was flattering.

I have let everyone I can think of know I am leaving, collected contact info, taken home final electronic copies of the thousand pages of documentation I wrote, and identified several peers who said they’d be happy to give me a reference, which managers at this company aren’t allowed to do.

Months ago, I’d prepared a list of computer-related tasks, such as deleting my browsing history (in both IE and Firefox, on both my computer at work and the company laptop at home) and removing bookmarks, and so forth. I’m glad I thought that through in advance and had a checklist ready to go with detailed instructions.

This morning, I did all that on the laptop and then took it downtown via bicycle and used my card key to get onto my work floor, went to my cube and sat in my blue Herman Miller Ergon 3 chair in front of the big picture window, all for the very last time. Right across the street is a very busy fire station. When I moved from a lower floor to that cube, not all that long ago, Venkata asked if I thought the “fire music” would bother me.

I don’t know if all Asian Indians do this, but he refers to paneer, as featured in paneer makhani, as “cubes” and advised me that if one eats too many of them, one will need a “special design” chair.

I repeated the cleanup tasks on my desktop computer at work, took my card key to the administrative assistant on our floor, said goodbye to my neighbors, and departed for the last time. It was sadder than I thought it would be.

Tuesday, January 24, 2012

Lackadaisical Pedestrian Carelessly Misplaces Entire Job

Normally I carry around ten one-dollar bills and give one to just about anyone who asks for money. When I lost my job, I assumed I would give this practice up, and the next time I was asked for money—fifty cents, to be precise—by a small Asian woman with grey hair and red lipstick, I said, “I’m sorry, I can’t. I’ve lost my job.”

“Where did you lose it?” she asked, as if I might have absent-mindedly let it fall from my backpack as I walked.

I told her the intersection where it had last been seen, in an office building near MOMA, and she offered such sincere condolences that I walked away feeling kind of like a heel. I could easily have given her 50 cents or a dollar. Refusing her, however politely, made me feel steeped in lack, and I decided that, at a time when it's necessary to plant as many positive seeds as possible (is it ever not?), I can’t afford not to give away these small bits of money.

Not long after, taking a constitutional up 18th St., I saw a woman to whom I’d given a dollar or two in the past, someone I think is strikingly attractive. As I unzipped the pocket of my backpack, I asked, “Would you mind if I asked you a question?” After she said it would be all right, I said, “Forgive me for commenting on your appearance, but how does someone as beautiful as you are—how did you end up here?”

Well, she said, everything happened at once: she got cancer and she got thrown off Social Security because one of these days, she will be receiving an inheritance of $200,000 and somehow that information ended up in the system. She said the thing that keeps her going is her dog, Buddy, who was cradled in her lap. She is due to move into housing in three weeks; in the meantime, it costs $10 a night for her to sleep indoors, plus $5 for Buddy.

Having already been terribly nosy and overly personal, I went ahead and asked what kind of cancer she has. This could have been a prelude to telling her I have cancer, which might have partly excused my asking. We didn’t get that far in the conversation, but she didn’t seem to mind the question. It started out as Hodgkin’s disease and now is wrapped around her spine and has reached into her brain. It’s painful; it even causes her feet to hurt at this point.

I asked if she will make it until she gets her inheritance. She said she will not. Her cancer is stage four. All I could do was say, “I’m sorry,” and mean it, and give her $20 so she and her dog could sleep inside that night. I said, “I won’t be able to do this every day, but I can do it today.”

She reached up an extraordinarily filthy hand, a hand that proved to be sticky with grime, and shook mine, and told me her name. I couldn’t exactly not shake her hand, though I’m not always crazy about being touched regardless of the cleanliness of the other party. I wasn’t asleep the day they covered cooties in second grade, which, come to think of it, was every day.

With relief, I remembered that the hospice where I volunteer was close at hand and I could go there and wash up. I’m not proud of it, but, amid the rash of opinions and exaggerations presented here, I do also try to tell the truth, and the truth is I went and washed my hands.

That woman must be worried sick about what will happen to her dog after she’s gone. I’m a little worried about it myself.

Monday, January 23, 2012

Important Worrying Inadvertently Delayed

I am delighted to report that meditation teacher Eugene Cash was back with us last night, almost four months to the day since his bicycle accident and traumatic brain injury.

At the beginning of the evening, he introduced himself, then introduced himself again a few moments later, and then said, “I’m not sure if I said this already: I’m Eugene Cash. I think I might have said that.” But that was literally the only thing that revealed what his poor head had gone through. While he had much to say about what he’d experienced, remarkably, he sounded as lucid as ever in recounting it. He spoke about the sudden loss of his accustomed identity, to which I could relate, and about realizing that his long-practiced habit of mindfulness was continuing post-crash as if on its own, without his conscious effort, and how helpful that was.

(His wife reported on his Caring Bridge page that, early on, when a doctor asked Eugene if he knew where he was, he promptly and correctly answered, “Here!”)

Today I had lunch at Henry’s Hunan with Alan, Carolyn and Jim, who were in my first group at the company I’ll be leaving soon. I was fresh from two years of temping and showed up in a wool skirt, which I wore frequently at first; it was probably the only garment I owned for the lower half of the body that constituted business attire. Then one day my eye fell squarely on Alan and I realized he was wearing jeans, a t-shirt, and tennis shoes—my sartorial hero! “Then why do I have to dress up?” I thought, and that was the end of that, so he saved me a tremendous amount of time and money.

After lunch, I went to see medical oncologist Dr. W. and learned that I’ve been obsessing about the wrong thing for all these weeks. The thing I should have been worrying about (though I guess there’s still time) is a brand new cancer, for which my risk is now doubled or tripled, depending whom you ask.

Dr. W. joined me 40 minutes after our scheduled meeting time and apologized for the wait, which I appreciated, but it was downhill after that. He asked if I’m planning to have radiation and when I told him I’d already had intraoperative radiation (IORT), he said, “Really!  Interesting.” He obviously hadn’t been able to find 10 seconds to open my chart, whereas every other doctor I’ve seen lately was fully conversant with the pertinent details before our first meeting. It would be one thing if Dr. W. didn’t know what my maternal grandfather died of, though that’s in there, too, but my having completed radiation treatment already is fundamental. He does seem to consider IORT to be equivalent to external radiation, which is good.

To quite a number of my questions, he answered, to paraphrase, “Dunno.”

He said I’ll need a doctor to follow my case. I asked if that could by my ob/gyn. He said, “It’s your choice.” I said, “Is the person people sometimes choose their ob/gyn?” He said, “It’s your choice.” I said, “Is an ob/gyn a reasonable choice?” He repeated his answer, but by now with his teeth gritted and looking like he wanted to murder me.

At $500 for 45 minutes, and after waiting 40 minutes to have this conversation, I think a clear answer was a very reasonable expectation, something more along the lines of, “No, people don’t usually choose their ob/gyn; they usually choose their [whatever],” or, “Yes, you can choose your ob/gyn, and in fact, most patients do just this.”

He went on to make a strong case for tamoxifen—he thinks my risk of a recurrence is 5% over five years, twice what my surgeon and radiation oncologist said, and he said my risk of a whole new breast cancer is 13% over five years, which seems absurdly high, but that if I take tamoxifen, this would go down to 8%. He pointed out that since I’m only 49, I have a long time in which to get cancer again, a gloomy thought I have fairly often myself.

Dr. W. did say that other kinds of cancer don’t have any bearing on breast cancer and that I’m not doomed to die of cancer because all four of my grandparents did. He also doesn’t think I should have my ovaries removed to reduce production of estrogen.

Given that this was the oncologist my surgeon billed as evenhanded, meaning that the other would push even harder for the tamoxifen, and also given the sizeable deductible I now have, I’m probably not going to seek a second opinion, so my company’s diabolical plan has worked to dissuade me from “overusing” services.

Before leaving for lunch, per the weather forecast, I’d suited up completely for rain, as if I’d left one item off, it would have poured. Thanks to being fully prepared for precipitation, I made it downtown, to Dr. W.’s office, and home again on my bicycle without encountering a drop.

Saturday, January 21, 2012

Instant Loser

I often feel gloomy lately when I wake up, again in the world where I soon won’t have a job. Though I wake up in the same place as always, put on the same clothes and do many of the same things, it feels completely different. I have a low-level chronic fear now of falling to the bottom rung of the social order and then losing my grip on even that.

In a society that so explicitly values wealth, it’s a blow to the self-esteem to lose one’s income. I have severance pay, and I have savings, and if I didn’t my situation would be a lot worse, but severance pay and savings aren’t quite the same thing as income. Because I lived well within my means and therefore was able to put money away regularly while still being able generally to buy whatever I felt like buying, I thought of myself as rich, and now I think of myself as poor.

I’m also seeing homeless people, who are everywhere, in a different way now. I was never scared of them, as some are, but now I find I feel uneasy, not because I’m afraid for my safety, but because I’m wondering if that will be me sitting on a Tenderloin sidewalk in a wheelchair on a cold, rainy night.

I have received a nice offer of lodging in a certain basement in Ypsilanti, MI, and thank goodness for that. Several steps remain between me and the wheelchair on the sidewalk, yet it’s been jarring to see just how quickly seemingly solid supports can dissolve. Given the insurance ramifications, the DCIS strikes me as having been a substantial step down, ditto losing the job, and that they happened in such temporal proximity has vividly brought home the point that nothing is permanent.

I was in tears by mid-morning today. This insurance business is harder than anything else that has happened. I feel trapped, as if in all directions there is a door slamming in my face.

For instance, I have often thought about moving to Michigan to be closer to my parents, and the job I’m just losing would have facilitated that perfectly, as it’s entirely virtual. My co-workers all live wherever in the country they prefer to; all that’s needed is an Internet connection.

But now, because of the insurance issue, I’m going to have to have a job that offers it, which is unlikely to be a job where I’d be welcome to live 2500 miles away, and if and when I get that job, I might need to hang onto it until I’m 65 and Medicare kicks in. As mentioned, there are options for those with cancer but without insurance, but I suspect that any savings the person has must be used up before benefits are received, which makes sense, and I also know that my parents would feel that they should mortgage their house to help me, so making sure to have insurance is a way of keeping what I’ve saved over the years, which I will probably need in my dotage, and protecting my family as well.

I’m only 49, which means I have to somehow come up with at least 16 years of health insurance, or more, if they push the Medicare age back, and what kind of crappy country is this that I’m lamenting that I’m not 65 already?

I went to see my hospice visitee today and was still there when the delightful Charlie arrived for his shift, sweeping in with all the glamour of a movie star, and it’s possible that his patients are as excited to see him as I’d be if I found myself face to face with Vincent Rottiers. (See I’m Glad My Mother Is Alive. And, while you’re at it, Handsome Harry, though Vincent Rottiers isn’t in it.)

Afterward, I took Muni downtown—there’s definitely more Muni in my life than there used to be, as I resist the temptation to take cabs—and met Venkata to see Mission Impossible: Ghost Protocol in the IMAX theater at the Metreon. It takes place in Dubai, a country I’d like to visit, and was absolutely, completely excellent. Then we had Indian food in the Tenderloin. I sat facing the window and had a fine view of some particularly wretched souls who will probably be my closest companions a year from now.

Thursday, January 19, 2012

This F*cking Cancer Has Wrecked My Life and It’s Not Even Cancer

Sorry this is now the blog that swears all the time.

I woke up anxious this morning and then got to thinking about the wisdom of posting one’s health information online. I do believe everything we put on the Internet—every post to a forum, every blog comment, every email—is aggregated somewhere and I wouldn’t be a bit surprised if insurance companies have ways to find our files and make use of them, or will in time.

On the other hand, your health history is your health history, and if you have diabetes or heart disease, that’s in your record whether you mention it online or not. It seems to me it would only be a problem if it was something you intended to conceal from a prospective insurer (probably not such a great idea).

From there it was a short hop to wondering if I’m going to have problems getting insurance because of having had cancer. The day I found out I was losing my job, a woman from HR reminded me about COBRA, under which your health insurance continues for 18 months after your job ends, but she said people often find it cheaper to buy their own coverage. Currently, I pay X amount for my health insurance and my employer picks up the rest; under COBRA, I’d pay the entire monthly premium, plus a two percent surcharge, or about four times what I currently pay.

I’d been starting to think, with anticipation, of putting together a life made up of bits of this and bits of that: teaching, writing, a part-time job as necessary, paying for my own health insurance, as many do, but today it was off to the insurance website to read their treatise on pre-existing conditions, and the answer is yes: a cancer diagnosis will make it impossible to purchase your own coverage.

But surely not if it’s Stage 0 cancer, considered by many to be pre-cancer? I called my surgeon and my ob/gyn and both offices confirmed that, in the eyes of insurance companies, I’m out of luck, which simultaneously plunged me into despair and opened up a whole new area of research. So many things to learn lately!

After several hours on and various other websites, I’ve concluded that the crucial thing is to avoid having a break in one’s health coverage, and I’ve realized that what I’m going to need is a job that offers insurance via a group policy, almost certainly a good old full-time job. The group policy works because the members all pay premiums in an amount presumably calculated to account for the fact that some will need more services and some will need less. If we’re part of a larger whole, it works out financially if I have cancer and you never get anything worse than the sniffles, or vice versa. This is why President Obama wants to require all of us to have insurance, so that we form one giant group and pre-existing conditions don’t matter.

So never mind the bits of this and bits of that. I’m disappointed, but must take into account the facts that have emerged and amend my plans accordingly. There will probably be many course corrections as the days unfold and new things are learned: it’s a process.

But not a very fun one today, though it’s not one hundred percent gloom. Once the HR lady mentioned individual insurance generally being cheaper than COBRA, I’d assumed I would go with the individual insurance, but my surgeon’s assistant reminded about COBRA today. It will be there if necessary, at least for a time.

I also called the nurse educator at SFMC to see what happens if someday I have cancer again but no insurance, and there are options.

By the way, I finally figured out that doctors A. and P. probably both recommended radiation oncologist Dr. L. because, as the chair of the department of radiation oncology at SFMC, he might be the only person at SFMC who does intraoperative radiation. 

I sent Emily at work a note assuring her I’m not mad at her because she remains employed while I soon won’t be, and then we spoke on the phone and I found out that, far from having casual feelings about what has happened to me, my co-workers are perturbed. Right after my manager gave me the news, he met briefly with my immediate group to let them know, and Emily reported that one of my peers was so upset, he announced he was taking the rest of the day off.

So I give them As for empathy, after all, though they’d have gotten better marks for bedside manner if they’d called me up in tears. Of course, maybe they were just upset because what happened to me made them afraid their own displacements are coming soon, in which case, Fs all around.

Wednesday, January 18, 2012

Failure to Chuckle Results in Customary Punishment

The basic project now is just to do the next thing. I’m also using the technique of “noting,” quiet mental labels for events as they occur: “Opening the cat food can. Stirring the potato soup. Pouring soup into a bowl.”

I thought of what teacher Steve Armstrong said at the meditation retreat I attended last year: “All phenomena arise from causes and conditions over which we have little immediate control.” All I can do is plant positive seeds, for instance by doing metta practice, and take whatever constructive actions I can think of, and I can try not to indulge in frightening stories about the dismal future.

My soon-to-be ex-co-workers seem to be acting kind of strange. My manager hinted that their turns are coming soon, but I’m the only person to be “displaced” so far, and I think that if the tables were turned, I would be calling the soon-to-be-jobless person, asking how he or she was feeling and offering reassurance, but I’ve not heard a peep from my team lead (different from my manager), nor from my four peers, with one exception: Bill. He has totally been there, and I have a theory about that. His quest for romance is endless, meaning that he has been out with probably 500 women so far, which seems to have given him the hang of offering sympathy and kind words, bless his heart.

Over the years, I’ve been to several emergency meetings called with just a few minutes’ notice to announce that someone or other has been laid off, so I asked my manager if there would be such a meeting for me, but he said no, that his boss had suggested keeping it quiet, perhaps to avoid panicking others. Besides my particular tool going away, the company has significant “redundancy” due to a major merger in the past couple of years (not an unusual word for this business situation, but it always sounds odd to me when applied to human beings), so many have been and will be displaced. The lack of such a meeting felt a little strange, as if after being at this company for 13 years, it’s best if I now skulk out like a thief in the night, like someone who has done something wrong.

But there’s not much I can do about that, so I’ve been thinking about what else I might want or need before my last day at work, which will be toward the end of this month. I’m going to line up some references, to collect any contact info I’ll want in the future, and, because no one else in my group works in San Francisco, I’m going to ask if my own team can meet on the phone to say goodbye. I have two goodbye lunches scheduled with co-workers from groups where I worked in the past, and I’ve gotten a lot of warm, encouraging notes from various colleagues and managers from over the years.

One thing I haven’t been doing is spending much time wondering why me first and not someone else—those would be wasted minutes, per the following amusing anecdote. I used to sit next to a group at work containing a fellow who was absolutely at the top of his game. He knew every aspect of the job from top to bottom and was always happy to assist his colleagues.

In the same group were two longtime employees notorious for their incompetence. If one of them received an email asking him to process two red items on Wednesday, he could be counted on to process four green items on Monday. “He got three things wrong from just one sentence of instructions!” one of his co-workers once marveled to me.

When layoff time arrived, however, reckoning day came and the company seized the opportunity to rid itself of—the highly knowledgeable fellow, which drove home that there is no evident rhyme or reason to these things.

In any event, it’s not like anything would change even if there actually was a direct cause and I could somehow guess it: “You’re right! It’s because you didn’t laugh at my joke in the team meeting last week. Displacement canceled!”

Tuesday, January 17, 2012

Hog Knee

I’ve felt euphoric about losing my job at moments, entirely delighted, though at other moments unease has crept in, and now, five days later, the balance has shifted inexorably to worry and gloom. A friend sent an email this morning suggesting I visit her for a weekend in Southern California. “Great!” I thought, before remembering I’m no longer a member of the flying class.

Before I got the job I just lost, I was pretty broke, often extremely so, agonizing over the decision to see a movie or buy a pair of socks. I didn't have health insurance. My health was cared for at community clinics, and if anything needed to be followed up on, it was a matter of sitting in a waiting room at the county hospital for hours at a time. When my ex-company hired me in 1998, I felt rich beyond my wildest dreams. I grandly told my therapist she’d be receiving a raise, though she wouldn’t let me pay at the top of her sliding scale—it seemed there were people in the Bay Area making even more than $40,000 a year.

I’ve never lived much higher on the hog than about knee level, but I loved being able to take a cab if I felt like it, to give every person on the street who asked a dollar and occasionally twenty dollars, to visit my parents twice a year and go on a meditation retreat annually, and so in the shower this evening, I finally wept for the loss of my first real, true, grown-up job.

Because of course I will never have another. I will return to being unable to visit a movie theater without saving up beforehand. It now seems obvious that abdominal surgery, DCIS, and losing my job merely presage a bunch of other terrible things that are going to happen, the final one being when I die in a homeless shelter.

Lisa M. happened to call. She asked me how I was and I reflexively said “Fine” before remembering I wasn’t. I told her a bit about my worries, and she said it will probably be good if I can avoid giving energy to such fears. That would indeed be good, but would also require a complete personality transplant. I was pretty much born worrying: my mother will die, I’ll be all alone, there will be no one who knows me or loves me.

Of course, the truth is that my situation is enviable, when I’m the frame of mind to see it that way. I’m old, but not that old. I have no mortgage, no car, no expensive hobbies or vices, no offspring soaking up my cash. I’ve been saving money for years, and I have some severance pay coming, during which period my health insurance will also continue. I’m fairly intelligent and have a motley collection of skills and talents that may be of use to someone somewhere.

But I find that kind of self-reassurance slippery. It seems a bit like trying to think the situation away, and just as easily as I can think a bolstering thought, I can think the opposite—aren't there tons of brilliant young whippersnappers who just graduated from Harvard and can't find jobs?and the entire world swings dizzyingly from perfectly fine to unbearable and back again. With all those vivid alternate universes flashing up and dying away, I forget about what Howie, my meditation teacher, says: that all of these good or bad things are happening to an imaginary version of myself. None of this is reality, which can only be found here and now.

I’ve found it better to return to my three mantras (see previous post), and, being one of the terminally lazy, was happy to note that two of them even kind of overlap: turning toward difficult feelings involves some attention to the raw data of cognition.

Sunday, January 15, 2012

My Whole Thing Is on the Fritz Here

I read online that if you have a hysterectomy, it will be six months before you go a day without thinking about it, but I can say with confidence that if you get a breast cancer diagnosis less than six weeks later, you actually will forget all about your abdominal surgery—the various kinds of pain and struggling to get out of bed and not being able to put on your own shoes, all of it.

I have now made a further thrilling discovery, which is that if you lose your job three weeks after having a lumpectomy, breast cancer likewise fades miraculously into the background!

My manager at work had scheduled a one-hour one-on-one telephone meeting with me for this past Thursday, which was unusually long and made me paranoid: is that how long it takes to go over the severance package? But when I checked with the rest of my little group, they said they’d all been invited to similar meetings, so I ceased worrying about it. Since our past one-on-one meetings have lasted about four minutes, I thought it might even be my manager's crafty way of ensuring he’d have 56 minutes to actually get some work done.

The appointed hour arrived and my manager, who hadn’t sent an agenda, said, “I’m sure you know the purpose of this meeting,” and I said, “No, I actually don’t.” Well! I’m pleased to report it only takes about half an hour to learn the details of the severance package.

I knew this was coming eventually because the tool I work on is being phased out, but the advertised date was a year from now. While I could see things were ahead of schedule and had started to suspect it might be more like autumn of this year, I was definitely not expecting it to happen halfway through January. At the end of our meeting, my boss told me to take the rest of the day off, and explained that I will work for two more weeks, then there will be six weeks where I’m an active but non-working employee, and then several months where I’m an inactive employee, and after that I’m nothing, corporately speaking.

I felt quite calm after getting the news of my “displacement,” which is how they say it these days. I mean, being upset about it is kind of going to have to take a number at this point, but just in case, I have adopted these three mantras as a starting point:

—When I’m attending to the raw data of cognition, it is not possible to be lost in stories about the imaginary past or future. Translation: for this one moment, just feel the bottom of your foot on the ground.

—My task is to turn toward difficult feelings and experience them directly, not to turn away and not to try to rationalize them.

—Do I have everything I need right now? Yes, I do. (And I always have!)

There has even been a certain sense of liberation in some moments: I’d often thought the job and I were mismatched, and now I am free of it, with a period of severance pay during which to make a thrilling new plan!

When I shopped at Rainbow this morning, my favorite checkout person was delighted to hear the news and beamed as she said, “Awesome! Congratulations!” I departed in a glow of good humor, with her calling after me, “I love how all of this is developing!”

Monday, January 09, 2012

I’d Like Neither, Thanks

One thing I wouldn’t have expected about having cancer (or pre-cancer) is the number of fundraisers and non-profit volunteers who have suddenly come into my life. I have my “landline” attached to an “answering machine,” and normally I have the volume of the latter turned down to zero and the ringer of the former turned off, and so I learn that someone is trying to reach me when I see the little answering machine light blinking, which doesn’t take long in a studio apartment.

Lately, awaiting return calls from doctors and office assistants and the nurse educator at SFMC—that’s a wonderful resource and one I have made liberal use of—I’ve had the phone ringer on and now am learning just how many fundraisers have been longing to hear my voice. The ratio of unwanted to wanted calls is about one to one, and it has been annoying on some days. I have said to more than one caller, “I have cancer and am waiting for a call from a doctor and can’t talk to you,” a blatant attempt to induce guilt and get off the phone quickly, though one person was so extremely sweet, saying she would pray for me and so forth, that I ended up guilt stricken myself, even though what I’d said was true.

I happened to visit my dentist the day after my diagnosis—the odds that I’ll see a teeth-related professional on any given day are not bad—and of course told her and therefore her assistant what had happened, because I generally tell everyone everything, and the assistant’s eyes grew huge with dismay, and I left feeling kind of bad about it. That was more than she was bargaining for when she arrived at work that day. (I apologized the next time I saw her, and she said very kindly that it was good that I had told them, because then she could include me in her prayers, which she said she had done. That was awfully nice of her! I’m not a praying man myself, but prayers are good wishes and more than welcome.)

Today I had a follow-up visit with surgeon Dr. P. Following the lead of his colleague in radiation oncology, he had also adjusted his numbers a little for the worse, now saying that tamoxifen would reduce recurrence risk by half, whereas before surgery he had said one third.

He thinks that with the treatment already completed, the risk of the DCIS recurring is 4% over 10 years, very much the same thing Dr. L. said. When it comes to a whole new breast cancer, he thinks the risk is .6% per year, whereas if I hadn’t had cancer, it would be more like .1-.2% per year. That is, it appears my risk of a whole new cancer is about 6% over ten years and therefore actually higher than the risk of a recurrence!

I asked if I could have my ovaries removed (because my DCIS was estrogen-positive, meaning my own estrogen was feeding it) and he said yes, that is indeed an option and that he had just had another patient do this.

I’d read the procedure and pathology reports carefully, looked up every word online and created a glossary—my DCIS document, which has a nice table of contents, is now 36 pages long—but there were a few terms I was unable to get a handle on, so I asked him about those.

He said I will have a mammogram of just my left breast six months after surgery, and another of both breasts at 12 months, and then it will be back to regular yearly mammograms. This is a good opportunity to re-mention that my Stage 0 breast cancer, ductal carcinoma in situ, was only found via mammogram. There was no lump—yet. While it's possible to have a palpable lump that is all DCIS, it's much more likely that if there's a lump, the cancer is no longer Stage 0 and there is the possibility that it has gotten to the lymph nodes or metastasized to other parts of body, at which point the prognosis is much less good and the treatment correspondingly more miserable.

There are ways for those without insurance to get yearly clinical breast exams and mammograms. Start by calling the health department in your city or contacting a nearby hospital.

Dr. P. gave me the name of a medical oncologist he said is “evenhanded,” and when I asked for another name just in case, he warned me that the second person is much more aggressive and would certainly push me to take tamoxifen.

Dr. P. said my risk of recurrence is low enough that it would not be a foolish choice not to take it, but it’s up to me and it depends on how comfortable I am living with the results of my decisions: if I’m going to be up at night worrying about whether I should have taken it or not, I should take it. He said if I take it and have a recurrence, I will know that at least I did everything I could. On the other hand, if I take it and don’t have a recurrence, I might feel that I subjected my body to it needlessly, and there will be no way to know for sure. Finally, if I don’t take it and have a recurrence, will I beat myself over it?

He said often people don’t like to take tamoxifen because of the side effects, not so much the small risk of blood clots or uterine cancer, but the menopause-like symptoms. He said that if I were to go ahead, I might also want to take low-dose aspirin or a low dose of a blood thinner to protect against blood clots, but then you’re taking a second medication to manage the effects of the first.

I’ve been posting about this decision on and reading what they have to say there. I’m torn, but I’m thinking the way to go is not to take tamoxifen and also not to have a recurrence.

Thursday, January 05, 2012

F*ck Off, 2011

Or happy new year, if that’s the way you want to go, but I say “Good riddance, you crappy year,” given the onslaught of health issues and not to mention that in 2011 I had a root canal fail (necessitating a dental implant), a crown fall off, and a tooth die, for a total of about 20 appointments to date with the dentist, endodontist and oral surgeon—there’s still a hole in my head where tooth or toothlike item #19 used to be and will be again in time. If you want to know how much it costs to have a root canal fail, a crown fall off, and a tooth die, it’s thousands upon thousands of dollars—if you have top-notch insurance.

For New Year’s Eve, Tom and I did the same thing we did last year: walk down to Papalote for a burrito, discover it was closed, and go somewhere else, this year to Sunflower, the Vietnamese restaurant at 16th and Valencia, and we picked up a couple of videos on our way home.

Today I saw my radiation oncologist, Dr. L., for a post-surgery follow-up. I had to wait a long, long time, but I didn’t mind. Dr. L. is really nice, and excellent when it comes to answering questions patiently.

He explained that the intraoperative radiation (IORT) is gone as soon as the applicator is withdrawn, and there is no residual radiation, but cell death can go on for a month as the effect continues to kick in. Also, healthy cells recovering can be felt as mild discomfort.

He said the radiation used was X-rays, similar to dental X-rays, but less penetrating; dental X-rays can see all the way through your jawbone. He said it penetrated about one centimeter into my flesh, and that recovery from the radiation treatment itself will take about four to six weeks, which is kind of moot, since recovery from the lumpectomy might take up to six months. I asked, “Can’t 20 gray kill you?” and he said it certainly would if applied to your whole body.

As to whether the radiation I received puts me at risk of long-term problems, he said there’s about a one in 500 chance of cancer caused by the treatment itself, which would be right where the treatment was, not elsewhere in the body.

Then I dragged him through my whole series of recurrence risk questions again, all the same ones I asked at our initial meeting, and noted that his answers had changed a bit, for the worse, but it’s still a pretty small risk: less than 5% over ten years, he (now) thinks.

He gave me the names of a couple of medical oncologists—when you have even pre-cancer, you get to have two oncologists, a radiation one and a medical one—and he gave me copies of the radiation report and surgical pathology report.

Recently I went over to a hospital near my apartment for the annual TB test required for hospice volunteering and mentioned that I’d just had radiation. They said radiation can garble the TB test results, and that we’d have to wait until I got a written release from my oncologist! I wasn’t upset, but left marveling at how the medical-related to-do list seems to grow only longer these days, never shorter.

For the record, Dr. L. said that radiation has no bearing on a TB test one way or the other, but along with the other documents, he gave me a written release and, very foolishly, his email address.

I’m letting my hair grow, which requires mashing it down until it attains a weight sufficient to cause it to sag about my shoulders rather than expand skyward, which is calculated to occur at a length of about three feet. This exciting effort is directly due to the DCIS diagnosis, which I experienced in part as a strike against my virility: I feel I must demonstrate I can grow something other than cancer cells, something at least neutral in nature.

I tried one day encasing my nascent Afro in a bandanna, which caused my hospice visitee to remark charmingly, “I like your capine,” which the Internet says is a cotton bonnet. I felt pretty good about it until I got together with Venkata the evening of that same day and he laughed and shrieked, “Linda! You have a do-rag?!”