Friday, May 26, 2017

I Am Still Screaming (Even if Not on My Blog)

With each one of these false starts, I feel like I owe you all an apology for being gone for so long. I haven't meant to disappear, and I haven't even given up on blogging, I don't think. My friend Sandi says that sometimes she closes her journal and moves on to another one, whether the pages are full or not. Sometimes, she's done with that chapter of her life and needs new pages -- and a new journal -- for whatever's next. I don't know if that's where I am with this blog, but I like her approach. Am I done with this chapter in my life? In the sense that I am no longer a full-time patient, yes. In the sense that I am fired up and trying to advocate for a better world for cancer patients and survivors, not even close.

So what's my excuse for being away for so long?


Well, there was the whole issue of teaching international law to actual students, which meant reading and dissecting case law and contextual background and news (SO MUCH NEWS) enough to be able to explain the materials in a mostly coherent way twice a week for the spring semester. That is done now except for some final grading, so we'll see how they -- and I -- did. We all did okay. Mad props to my husband for professor-ing full-time for more than seven years now. That shit is not easy. And I didn't even have to apply for grants.

Side note: Don't get me started on funding for science. I will point to the fact that it was 99 degrees here yesterday, 14 degrees above average, and it's STILL APRIL. See? I started this post ages ago. Now it is hotter and I am angrier. For example: WHAT THE FRESH HELL IS UP WITH THIS ADMINISTRATION'S BUDGET PROPOSAL? 

But what I'm most angry about this spring is the four vibrant, beautiful, young friends I've lost to metastatic breast cancer in the last couple of months, and how the issue of cancer death is only going to be exacerbated by this White House's policies toward healthcare and science (not to mention its general disdain for women).

In a super emotional state last week sometime in April, through uncontrollable sobs, I texted my friend Deborah to ask, "Why me? Why did I survive?" She wrote back exactly what I needed to hear: "As for your friends dying - I don't know why you're ok and they're not. And I don't know why you lived in a reality where you had mets and your friends did, too. Then you didn't have it but they still do and now you have to watch them all die of this thing you were going to die from...that's fucked up. I can say all the good things like how you can advocate for them and since you're not going to die, you can keep fighting for funds and research but really? It's just fucked up. You're going to relive this over and over and it's not fair. It's awful."

It is awful.

I look at Mandi's last post from the beach, or the posthumous entry by her husband (grab your tissues), and I hate that she didn't have more options. Breast cancer got into her spinal fluid and there was basically nothing left her doctors could do, even though they tried a number of drug combinations. I think of how she counseled ME through the uncertainties that arose with my diagnosis change last spring, before I'd told anyone else in the community, how she assured me even as she faced pain and drug failure after drug failure.

I look at Anna's beautiful video,



which I can hardly watch past the point where it shows her artwork that says, "but I have two small children" (5:02). But you should watch it. Watch as these women joke about setting up a dating profile for Anna's husband, or writing a letter, "to the future mother of your children." Too many children are losing their mothers. I remember my conversations with Anna about how hard it was to parent with metastatic cancer, but we just did our best to appreciate every exhausted moment, even when we felt like shit because of treatment. I remember how she walked me back from crazy-town when I thought a terrible headache meant brain mets. She had brain mets, and that wasn't what hers felt like, she promised.

I look at Louise's obituary, and think - she was only 42, which sounds at once so young and also so very old in the mets community I know, where most women are in their thirties and praying to see forty. Weez, as she was known, lived with mets for more than seven years. When she was still on Facebook, she cheered whenever I posted a "no evidence of disease" status.

I look at the tributes to Beth, and remember how we laughed at sharing the same birthday. I wasn't as close to her as some other women were, but I had so much respect for her calming, steadfast presence in the world of MBC advocacy. That's the thing about MBC advocates, though -- eventually, most of them die of the disease they're trying to end.

*****

In March, I went to Oakland to attend my FIRST Young Survival Coalition Summit. I'm part of YSC's 2017 class of RISE Advocates, which I'll write more about later, assuming I can find my focus this summer. I hadn't made it to a YSC Summit in the past because they always coincided with Quinn's birthday, which I wasn't willing to miss. This year, the summit was a weekend later, so I went. There is nothing quite like finally being able to hug a friend in person after knowing them online for years. But I realized I am still very much straddling two worlds, or trying to find my way in one as I no longer quite fit in another. I'm part of the "survivor" crowd now, though I don't know if I'll ever be comfortable calling myself that. I got a lanyard colored to indicate more than five years since my diagnosis. I did not get a metastatic-colored lanyard. But the majority of my friends fall into that group. They're the ones I joined for dinner.

Eight of the ten women in this photo live with metastatic breast cancer. Can you tell who? They are my tribe, even as I am no longer one of them. And even if it's not always through blogging, I will keep doing my part to be a voice for them.


Want to help? Please raise your voice to talk to your Senators over the next few days and weeks, to tell them to reject the terrible House legislation that would allow states to end protections for those of us with pre-existing conditions. How? I have my Senators' local and DC office phone numbers programmed into my phone. I call them regularly. I am polite, but make sure I relay my point. I don't always know if it's effective, so I also make a point to send the occasional letter. There are apps who will reach out for you, too. Whatever method you choose, please just get involved. My friends' lives are on the line, and I'm really tired of being angry.

Monday, March 13, 2017

Six

My Lovey,

A week ago you turned six. SIX. My incredulousness at your getting older never ceases.


Photo credits: Lara Agnew Photography
As I think I say every year, the passage of time is so strange. It’s now been more than a year -- since about a week before you turned five -- since my last chemo infusion, and I realize with an odd sadness that you may never remember how sick I once was. Will you recall how often we snuggled on the couch watching movies in the days after my infusions? Will you know how often I fell asleep with you at night after tucking you in because the steroids had worn off and I couldn’t keep my eyes open past 8 o’clock, and how the warmth and heft of your little body rooted me solidly to this world when I wasn’t sure how much more I could take? Do you know how powerful your love is?

And here we are, cancer and the fear it brought to our lives not such a tremendous cornerstone anymore. Do you feel the shift?

It has been a year of tremendous adjustments for all of us. 2016 brought some earthquakes to our world, but here we are, still standing. Watching the dust settle. Exhaling. Finding our footing on new ground.

Photo credit: Lara Agnew Photography
You started kindergarten and have learned to really read this year: all of the signs along the road as we’re driving, and books to me at night, which still makes me tear up with pride and astonishment that I’m here to see this unfold. 

You're riding your bike (without training wheels) to our neighbors' house to see if they can play for the entire afternoon, as you should be. You want to be a ninja and a policeman and an astronaut. You played your first season of flag football as a Seahawk, much to your dad’s chagrin. You are interested in trying everything -- though still wary of most vegetables. Karate, rock climbing, ice skating, Lego club, Spanish, your school’s Variety Show, skiing. We have always loved your zest for life.

Still, I have to reign you in a bit because, truthfully, I miss you. 







You are six, and underwear jokes are funny. "Mom! Look under there!" you exclaim. And if I'm caught off guard (or playing along), I'll respond, "Under where?" which makes you giggle every time.  "Haha -- gotcha!" you say. You make up games constantly: let's pretend the floor is hot lava; let’s play the “weird word” game in the car, where you make up a word and try to guess how it's spelled; here’s a game called Toyota collect, where we have to count the Toyotas we pass; this one's called shark attack, and we yell "shark attack" when we see a yellow car; let’s find the colors of the rainbow in order as we drive (purple is always the hardest); now 20 questions or “I spy.” Your creativity and boundless energy astound me.

You’ve lost two teeth and have been visited by the tooth fairy. She leaves you tiny notes reminding you not to eat too much sugar, that you have to take care of your adult teeth now because these are it for the rest of your life. Around the corner is Easter, and with it the Easter bunny, and you've started asking questions about what Easter means, and why in the world eggs and bunnies would have anything to do with Jesus rising from the dead. Rebirth, I try to explain.

Please stay here just a bit longer, in this time and place where you still run to greet me at the end of the school day, where you love and marvel at mud puddles, and still choose a favorite stuffed animal as your show-and-tell item when it's your week to be Star Student.

Six means one-third of the way to eighteen, and I’m not close to ready for it. Time is short, even when you've been given the miracle of more of it. But I can’t write this without acknowledging how flipping lucky I am to be here for any of it. I think I am the luckiest mom who ever was. 





The other day you asked me what an angel was, and I tried to explain that some people believe they're spirits who watch over and protect us. You looked promptly at me and said, "Mommy, you're my angel!" And just when I didn't think my heart could melt any more, you said, "And I'm yours." Yes, love, yes you are. You always have been.

Happy SIXTH birthday, buddy!

Love,
Mom

Friday, February 3, 2017

The End of the World As We Know It

I have quite clearly been at a loss for words these past few weeks. Well, I've had words, but most of them aren't fit to print. "WTF?!" doesn't exactly make for constructive dialogue.

As I transition out of my role of full-time cancer patient and into whatever comes next: survivor, I suppose, though that is still such a strange word for me; advocate, about which I hope to write more soon; and adjunct law professor teaching international law twice a week (yes, really), I'm still trying to find my footing in a post-MBC world, and now, also, in a post-factual one, too.

And while this is a breast cancer blog that's sometimes about parenting or research or even finances or sexuality or grief, I cannot ignore my past as a lawyer/lobbyist and the dire threat to healthcare -- and our constitution itself -- that now exists. So this may also become a blog about policy and politics, too, to some extent. Just a fair warning for my readers because I'm sure that not all of you share my voting record or worldview. I hope you'll stick around regardless. At the end of the day, we're all in this together. I welcome debate here (or in person!); just please keep it civil.

For those of us who are friends on Facebook or other social media, you might have seen my statement shortly after the election that Trump's win felt oddly similar to being diagnosed with cancer. The cold fear was familiar to me, as was the sense that I had just lost control and my innocence in one fell swoop.


Here's the deal: I am not a "snowflake," as some people are characterizing those of us expressing our sadness at what our country is facing: the potential loss of the rule of law and human rights, or respect for free speech and science. Our grief is warranted. I am no withering petal.

No one gets through nearly 5 years of cancer treatment without some deep resolve and fortitude.

My opposition to the new administration is not a partisan matter. I am a patriot. I studied history and the law, marveling at our founding fathers and the lasting power of our Constitution. I grew up in a military household where the Fourth of July was almost as important as Christmas. I can't really carry a tune (ask Chris), but I hummed along to Lee Greenwood's anthem with tears of pride in my eyes every summer.

This American "experiment" we've been involved in for the past 240 years? I want to see it endure. I believe in it, flaws and all.

One of my students asked me the other day whether I thought the new administration's actions were hurting our standing in the world, and if so, what we could do to correct this course. My answer was strangely similar to what I'd tell a newly diagnosed cancer patient, and at least one (conservative) author seems to agree with me.

I told her we need to continue to speak up for our beliefs and interests. I would tell a cancer patient she has to be her own best advocate. The protests and boycotts and what one friend tells me are hundreds of thousands of calls per hour to congressional phone lines are making a difference. We are being heard. It is an uphill climb, but I'd argue our lives and liberty are worth it.

Elliot Cohen writes:

[A]ll can dedicate themselves to restoring the qualities upon which this republic, like all republics depends: on reverence for the truth; on a sober patriotism grounded in duty, moderation, respect for law, commitment to tradition, knowledge of our history, and open-mindedness.

On the other end of the spectrum, all of this advocacy, just like being a patient, can be exhausting. It is SO important to engage in self-care. Get enough sleep, even if it means resorting to a tablet of Benadryl (note, I am NOT a doctor, and this is not meant to be medical advice). Exercise regularly. My guess is boxing classes will be filling up quickly as more and more of us feel the need to punch something. Eat plenty of vegetables, even when you feel nauseated. It is important to refuel yourself to get back into the arena, for this will be a long, drawn-out match.

We don't want to burn ourselves out. We have so much work to do. We have been knocked down (and I don't mean liberals, I mean our very democracy). We must stand up again and again and again, like the old Japanese proverb says. Ask any cancer patient.

Saturday, December 31, 2016

So Long, 2016

A lot of people in my circles can't wait to see the end of 2016. And it's not just my circles, is it? By so many accounts, 2016 was a dumpster fire of a year:

So ingrained had 2016-cum-terrible-horrible-no-good-very-bad-year become in our broader consciousness that it came to stand in for something larger than itself: 2016-ness. On Election Day, British writer Owen Jones captioned a GIF of a mushroom cloud: “Just how 2016 is 2016 prepared to be?” He added later, when the early results were favoring Trump: “2016 currently thinks there is ample 2016 to go. 2016 is currently saying ‘heyyyyy! Look how 2016 I can possibly be!’ ”

Other people are all over Twitter talking about celebrity deaths, which were exceptional in 2016, I'll give you that. George Michael, Carrie Fisher, Prince, David Bowie. Us children of the '80s grieved the stars of our childhoods. But every year, women I know and love are dying, too.

This year started out for me as so many Januaries have since my diagnosis, with the death of my friend and advocate extraordinaire, Holley. At the time, my nurse told me that deaths tend to spike in January, patients having held on through the holidays. Without giving it much reflection, I can immediately think of five other good friends of mine who died of metastatic breast cancer in 2016: Colleen, Amanda, Michelle, Lesley, Jody... And the mushroom-cloud GIF embodiment of 2016 doesn't seem that far-fetched.

Holley & me at the opening of A Story Half Told in NYC, in October, 2015, 3 months before she passed away

On the other hand, a hand I envision rising out of the ashes of the bomb that was this year, I can't close out 2016 without reflecting on what a miraculous one it was for our family. 2016 will always be the year I was told I don't have metastatic cancer. 2016 was the year I got to celebrate my 20-year high-school reunion and had my port removed after almost five years of chemo infusions. This year I got to see Quinn start kindergarten, learn to ride a bike without training wheels, and lose his first tooth. 

And this was the first holiday season of Quinn's life that I haven't constantly wondered if it would be my last. 

***

For the past several years, we've participated in a winter solstice ritual introduced to us by our friend Kaye. Some years, she hosts a gourmet, multi-course meal at her home, and over after-dinner drinks we write our wishes for the coming year on scraps of paper. We don't share our wishes with each other, though I suspect everyone in the room always knows what my wish for the coming year is. Some years, I was bald. (Hint: I never wished for hair.) Kaye would say some words about the significance of the solstice and the coming of the light, and we would all light our wishes on fire, unspoken, rising to the heavens to be doled out from there.

I've had some setbacks over the years since my diagnosis, but my wish always seemed to hold. I imagine it is the same wish of most people with a diagnosis of metastatic cancer. This year, we didn't get together with Kaye, but we had friends visiting from DC and shared our new tradition with them. We lit our wishes on fire on our back porch, laughing that some didn't seem to launch far from our patio table. Of course, I hope they still come true, whether they made it to the heavens or not.

The winter solstice was my in-law's wedding anniversary. My father-in-law died of metastatic pancreatic cancer in the fall of 2009, just shy of what would have been their 35th anniversary. Six years later, my mother-in-law died of complications from Parkinson's disease. Sometimes, when we light our wishes on the winter solstice, I wonder if my in-laws aren't still looking out for us, granting us another chance to wiggle a loose tooth or play Santa for our boy.

***

On December 23rd, I paused to remember that same date in 2011 when I was told for the first time that the chemo had worked and there was no evidence of disease. Earlier this month, I was officially re-staged. After a clean scan mid-month, my oncologist told me I'd probably been stage 2B. My sister-in-law commented that I was probably the only person ever to be happy about a stage 2 cancer diagnosis.

2016 was the year I got to wipe the slate clean and say I've probably been in remission since December 2011 -- 5 years now. While that number doesn't hold much meaning for me in terms of magical cancer milestones (I've seen far too many people recur after reaching five years "cancer-free"), I am in awe that I'm still here. I pinch myself nearly daily at the twist my life has taken this year, at the new chances I've been given. 

It was just the three of us -- Chris, Quinn, and me -- this Christmas, we spent it in our pajamas until dinner, playing with new toys and eating Santa's leftover cookies. It was a pretty perfect celebration of life and re-birth, even if we're not churchgoers.

Tonight, we'll ring in the new year and say good-bye to 2016 with some friends and champagne. I'll make a toast to what a crazy, mixed-up, sweet, miraculous, dumpster fire of a year it was. I'll hope for many more miracles in 2017. Cheers, my friends. I love you guys.

Photo by the exceptional Lara Agnew


Monday, November 21, 2016

Cancer Advocacy Update

My friend Beth has been denied the chemotherapy drugs her doctor is recommending she get to treat her metastatic breast cancer. Her insurance company, +Blue Cross and Blue Shield Service Benefit Plan doesn't think she should have them. They did a cost-benefit analysis, apparently, and decided Beth's life wasn't worth it. I think that about sums it up.

I am angry, and you should be too.

***
Supermoon over DC
Photo by Stan Mouser

I flew to DC last week and spent all day Thursday at a policy roundtable to discuss the future of cancer policy post-election. What happens to the Patient Protection and Affordable Care Act (ACA/Obamacare)? Will Vice President Biden's Cancer Moonshot still get funded? Is Paul Ryan going to be successful in privatizing Medicare? Will the Medicaid expansion go away?

Mostly, I listened, because there were some serious wonks on those panels, women and men who've spent their entire careers focused on healthcare policy and how to improve the system. I also asked a few questions. 

Deep into a discussion on "high-risk pools" and the need to draw in "young immortals" to decrease overall insurance costs, I raised my hand. 

"Hi. I was one of those 'young immortals' until I was diagnosed with metastatic breast cancer at age 32. Metastatic cancer in young people is on the rise, but people are also living longer with cancer. Cancer is expensive. What about lifetime and annual limits, which are currently prohibited under the Affordable Care Act?"

To which the response was, essentially, "Your life matters. I'm sorry for your experience. But trade-offs will have to be made."

Trade-offs. This is what we're up against, folks.

***

Here is what I learned, although nearly every speaker admitted we are all trying to read tea leaves at this point. No one really knows what a Trump administration is going to look like, but we do know that the Republican Congress of the last several years has voted to repeal the ACA more than 60 times

One panelist likened it to a dog who finally caught the car. The question is what does the dog do now? 

  1. Repeal and replace was just a campaign slogan. The general consensus was there is not currently any republican agreement on what to replace the ACA with. So there will be efforts to repeal, possibly with a phasing in of something else down the road. There are legislative tricks up those republican sleeves, including a way to repeal without the requisite sixty-vote majority typically needed in the Senate. Get poised to hear budget reconciliation a lot. And if you don't currently have insurance coverage and think you might want it, APPLY FOR COVERAGE NOW. Keep current on your payments. Those with existing coverage may be grandfathered in to new legislation, if and when new legislation is introduced.
  2. Medicare (and Medicaid) as we know it is at risk. Speaker of the House Paul Ryan has repeatedly made it clear he wants to overhaul Medicare (likely to privatize it, similar to what happened with our prison system. That didn't work out so well.) Another panelist said she'd be shocked if this happens in the same year as a repeal of Obamacare, but it's still at risk. While many panelists cautioned that republicans gut Medicare -- and potentially alienate the AARP crowd -- at their peril, Paul Ryan and company seem determined to move on this one. And if the ACA is repealed, so goes the Medicaid expansion. 
  3. Cancer Moonshot funding is a concern. Congressional appropriations for fiscal year 2017 are at a stand-still because of the election (with another continuing resolution expected before December 9th), and didn't include specific funding for the moonshot anyway. At least one advocacy organization is urging its followers to reach out to Congress and demand a vote on NIH funding this year, rather than flatline the funding at 2016 levels. Another opportunity for funding the moonshot is the 21st Century Cures Act, which increases funds in exchange for decreasing regulations at the FDA. But prospects for that legislation during this lame-duck session are murky. I feel like I'm giving you answers straight out of a Magic 8 Ball: reply hazy try again. 
  4. Speaking of the Moonshot, MATCH Trials have begun. These clinical trials aim to analyze patients' tumors for genetic abnormalities for which we already have targeted therapies. We might have data from these trials in as soon as one year. The current acting director of the National Cancer Institutes is planning on staying on in this administration as long as possible. Typically, it takes new presidents about a year to replace these appointees.
  5. Advocacy is more important than ever. Every speaker mentioned it. We need to tell our stories and show that we are more than just a cost in the cost-benefit analyses that Congress and insurance companies are doing. We need to talk about why the Affordable Care Act is important (protections against prohibiting coverage for pre-existing conditions and bans on annual and lifetime coverage limits are my two gems). Is the ACA important to you? TELL YOUR STORY HERE. And write, email, or tweet Congress to tell them your concerns. 
***

After a full day of policy information that was admittedly bleak, I went with a representative from MetaVivor to meet a friend on Capitol Hill. We talked about how her office can help us in the cancer community. We have allies on the Hill who understand how expensive treatment is, who know women (and men) are dying by the hundreds every day, and who want to keep the protections that have been in place for several years now. They (and I) also understand the current system isn't perfect, but we don't believe the answer is cutting off protections and coverage for millions of people. 

People like my friend Beth cannot afford gaps in insurance, let alone insurance that isn't working for them and denying treatments. Another friend told me she would stop treatment rather than bankrupt her family, if she lost her access to Medicare. My friends are having to think about making the choice to die or pay their bills.

We have work to do.