Thursday, April 26, 2012

What To Expect When You're Expecting

For as long as I can remember, I have needed external validation for just about anything that I do. When I was in school, I always wanted to be the top of my class. I would come home with an 86% on a math test and my mom would jokingly say 'Where's the other 14%' because she knew that I wasn't happy with only 86%; it's not 100%.

This external validation has driven me to achieve many goals. Every time a boss of mine says 'Great job' or 'What would I do without you', I always want to work harder to show that I'm 'the best' or 'worth it'. Keith jokes that I do well with a gold-star system - meaning every time I do something well, I expect a gold star and that respond well to positive reinforcement. By the time I was 24 years old, I had earned three degrees, one of which is a master's degree and I have always prided myself in being the youngest person to ever... or the best person to ask about... or the funniest; I like being known as the funniest.

Breast cancer is no different really because I usually am the youngest person that anyone has heard of getting breast cancer - I realize that I'm not the youngest person to ever be diagnosed but very few people know of anyone who was as young as 26. I guess in some respects, breast cancer has met my previously mentioned criteria; I'm the youngest, the best person to talk to (I've had a few people say 'Talk to Katie about [insert breast cancer topic here], I know she's dealt with that') and I have used humour a lot in the past year.

I think my need for external validation has morphed into projected expectations that I assume others are putting on me. So, what I mean is, because I rely so much on others to value my worth, I think when it comes to me meeting an expectation, I assume that others are putting as much pressure on me as I'm putting on myself and by assuming this, it only adds to my own expectations.

I think when I was diagnosed and even while I was in treatment, I felt like I got a bit of a free pass to react to anything, any way I wanted. Like if I was to cry all day, no one would say anything because it's to be expected. Or if I cursed like a sailor about not having a breast, no one would try to calm me down because it's understandable. On the days that I didn't leave the house, I rarely got pressure from anyone to go for a walk because they knew that I was physically drained. But now, now that the physical side effects of treatment are fading, I feel like the expectations are increasing.

I constantly hear that I need to lose weight - by the doctors, the professionals, strangers and that little voice in my head. I feel like I need to eat perfectly, not properly but perfectly - I feel like outsiders look down on me if I eat out because of the 'stuff' in our food these days. Do you know how much pressure there is to be a health nut now that I've had cancer? I feel like I'm expected to be back in action at work when really my brain is getting such a work out. Maybe I feel this way because I used to have expectations on individuals who had cancer, I thought when treatment was over, cancer was over but now I understand that there's no way to stop having cancer, instead it just moves from your body to your mind. Everyone seems to have an opinion as to why I had cancer (even though my whole oncology team couldn't figure it out) and the reasons range from stress to what we eat to genetics to our environment and it's hard to not feel like 'they' are blaming me for having cancer. In other words, 'If you didn't have so much stress in your life, you wouldn't have gotten cancer.'

A few weeks ago, after only being back to work for two or three weeks, I had a bit of a breakdown. Everything was making me cry and nothing could stop me from crying. I think because I felt so tired after only working 5 hour days, I felt like I was failing. No one said anything to me or even implied that they were disappointed in me but because I wasn't able to jump back in to the swing of things, after being off for a year, and after going through cancer, treatment and now being on cancer drugs that make me so tired, I felt like I was failing at returning to work. And by not getting a daily dose of 'Wow, 5 hours a day, that's so impressive. How do you do it?' I felt like I wasn't going back to work 'properly' or 'good enough'. I sound crazy, don't I?

I know not everyone seeks the external validation that I do or puts as much pressure on themselves, but I think the expectations of others do start playing a role in everyone's cancer journey so if you know someone who is going through treatment, returning to work, or celebrating their 20 year cancer-free anniversary, try not to put any expectations on them, maybe even tell them how proud you are of them because this cancer thing is so unpredictable and we put enough pressure on ourselves.

Wednesday, April 18, 2012

It's What's On The Inside That Counts, Right?

This past year has really changed my perspective on a variety of aspects of my life, one being the definition of beauty. I don't feel beautiful anymore and cancer has a lot to do with that.

When I think of a beautiful woman, I picture Beyoncé or Scarlett Johansson or my mom and all of these women have beautiful curves, the hair that women dream of, working-women-parts and two breasts. I on the other hand don't possess such beauty. I have so much extra weight on me, my curves have turned into blobs. I have tried to lose weight but between the exhaustion of post-treatment and now going back to work, the weight-gain side effects of Tamoxifen, and being predisposed to being overweight because of PCOS, it is becoming inevitable that I will be overweight forever. My hair is, well, I have hair... but I think what makes it hard is that my short hair is a constant reminder that I had cancer and chemo and I don't have a choice in my hairstyle right now - cancer has given me THIS hairstyle. The working women's parts are to be determined and we won't know until I try to have a baby in 4.5 years - I'll keep you posted. And finally, only having one breast, in a world where we are bombarded with sex, sex, sex, and breasts, breasts, breasts, and cleavage, cleavage, cleavage, I have one breast. My breast(s) aren't even sexual to me anymore, Lefty looks like a breast but doesn't feel like one (I lost all sensation after I had a reduction to try and even them out) and Righty is just a lump (currently with an expander). I feel like I have lost my sex appeal; I feel like I've lost my womanhood.

I have recently tried to focus on my 'insides' and all that I have to offer that you can't see. I am proud of myself for who I have become and I know I have a lot of great traits but when I'm walking down the street, or going to a job interview, or meeting a friend's new boyfriend, in the back of my mind I always wonder 'Can he tell that my right breast is currently a face cloth stuffed into my mastectomy bra to even me out?' and 'I wonder if he's seen pictures of me with long hair - I looked prettier with long hair' and 'I used to weigh a lot less - don't judge me at the weight I'm at now.'

It's easy for me to recognize my good characteristics but it would be nice to be told I'm pretty... and to believe it. I am very lucky to have people all around me (including family, friends and the Amazing Keith) who tell me how beautiful I am, but I have gotten to a place where I don't believe them because I don't feel very womanly anymore. What's that saying, 'you can't expect someone else to love you if you don't love yourself'? I think this kind of falls under that category.

There is so much support for our physical needs when we are cancer patients, your oncologist, your nurses, your pharmacist and your drugs are all trying to balance the cancer-killing drugs with the anti-nausea, anti-anxiety drugs but I have to say, especially near the middle of treatment, I started wondering 'which of these 13 lettered prescriptions will cure my heartache over having cancer?' and 'Is it this little white pill that will help grow my breast back? No, no, wait, it's to take care of my fear of recurrence.' My point is, there is not enough support for the psychological side of cancer. How am I supposed to deal with cancer's impact on my self-image? How do I face the fact that the odds of me having cancer again, is quite likely? How do I deal with the fact that I think about my funeral - probably more than I should?

I know, deep in my heart, that it is what's on the inside that counts. I know that breasts, and hair, and being 'skinny' shouldn't be my priority and most of the time they're not but every now and again I get pretty pissed off that cancer robbed me of all of it.

On the other hand...

I met someone at work today who, after finding out that I had cancer, shared that his dad was currently in chemo. He started asking questions about my cancer and I told him about surgery and treatment to which he replied 'Oh good, you had surgery'. I thought 'Oh ya, it was great, I love not having a breast. What a weird thing to say.' He then told me about his father who had esophagageal cancer and they couldn't operate unless they collapsed a lung, broke his chest cavity and then removed part of his esophagus, all with having a 10% chance of success. So instead, he stays in chemo, so that he can eat and so he can stay 'comfortable'. He's damn right that I was lucky I had surgery. I get so angry with myself sometimes for feeling sorry for myself for not having a breast when some people are living with cancer and they would do anything to hear 'We've found a way to remove your cancer. We're going to operate tomorrow.'

Wednesday, April 11, 2012

Singing a Different Tune

So often we hear about how awful our healthcare is and it’s not hard to find someone who bitches about his/her job, employer, or co-workers. Well, I’m here to sing a different tune.

Being diagnosed with breast cancer at 26 years old has certainly turned a few heads. When I told my family doctor about the lump that I found, she assured me that it was probably nothing (based on my age and family history) but certainly took it seriously enough to order the tests that needed to be ordered. Following that, I had 2 radiologists look at 2 different ultrasounds and neither one of them were concerned. In January, my oncology surgeon assured me that I didn’t have cancer and it was in March that I was diagnosed. It took a whole medical team 6 months to diagnose me with cancer.

I have met a lot of other youngins (women in their 20s and 30s) who have had breast cancer who were faced with a similar situation. I for one do not hold any anger towards my doctors, for a few reasons. First of all, they are doctors not perfect; they are human and liable to make some mistakes here and there. My oncology surgeon told me back in January (prior to my diagnosis) that if I did have cancer, I’d be the youngest woman she’d ever seen with breast cancer. Well, now I AM the youngest woman that’s she’s ever seen and let’s hope it stays that way. BUT here’s hoping that she will not tell another woman that she doesn’t have cancer until she has the pathology reports telling her so.

What good what it do to hold any anger towards these physicians who were basing my case on their past education and experience? I won’t get my breast back and I certainly won’t be able to reverse the effects of chemo. Yes, maybe if I would have been diagnosed in September of 2010, I would have been at stage I instead of stage II OR maybe I didn’t have cancer in September and instead it turned malignant in January, we will never know but being angry at someone isn’t going to turn back the clocks and stop my cancer from happening.

Once I was diagnosed, I had incredible care. I had an MRI ordered on March 16th and I had the appointment on the 19th. I was diagnosed on the 11th of March and I had surgery on the 28th. My oncologist would call me at 7pm – well after her day was over – to see how I was feeling. Actually, she called me on the Friday of the Victoria Day Weekend to tell me that my results came back from a test that was performed on my tumour. When she said that my tumour was even more aggressive than they had thought and that we needed to be more aggressive with chemo, she used the phrase ‘Well, if you were my daughter, I would be ordering another 2 rounds of chemo, too’. I knew right then that I wasn’t a number to her, I wasn’t just another patient, she treated me (both emotionally and physically) the same way as she would treat her daughter.

The nurses, I mean let’s give a shout out to all the nurses out there, were amazing. I had one nurse approach me and say ‘My 29 year old cousin was just diagnosed this week with breast cancer, can I give her the link to your blog?’. I was very touched because she recognized that although she could support her cousin as a family member, as a friend, and as a nurse, she couldn’t provide the same support as a fellow cancer patient could and she looked to me to fill that void. The nurses calmed me when I needed to be calmed and laughed when I needed someone to laugh with. Here’s a special ‘thank you’ to all you nurses!

I guess my point is, if you were to type in ‘Healthcare Canada’ into Google, I would assume that you would get more hits about the negative side of hospitals, nurses, and medical teams but in my case I am very grateful to my medical team. During the scariest time of my life, healthcare professionals made is bearable. In my case, it wasn’t just my cancer that was treated, it was me.

Now to work – I returned back to work on March 26th, exactly one year after my last day (March 25th, 2011). I was anxious about my fatigue, my stamina and mostly I didn’t want to be the cancer girl at work. I didn’t want anyone to feel like they couldn’t approach me with an issue because they didn’t want to overload me. I am in the middle of my third week of work and am loving every minute of it. The first day that I saw my boss he gave me a great big hug and now a few times a week he very sincerely calls me ‘Trooper’ and I secretly love it. I am very aware of my limitations and as my gradual return to work progresses, I think my energy levels do too. For the first two weeks, I worked 20 hours a week and now I am onto 25 hours a week. I plan to increase 1 hour a day for every new week.

Last week, I was walking to the bus stop; the sun was shining and all I kept thinking was ‘I’m going to work. I’m going to WORK! I’M GOING TO WORK!!’. What a fantastic feeling after thinking ‘I’m going to chemo. I’m going to CHEMO. I’M GOING TO CHEMO!’. It feels so good to have a routine again. It feels so good to think about bank recs and not cancer wards. It feels so good to feel needed again. I couldn’t be happier that I am back. I couldn’t be happier that I work for such a great company (Shoppers Drug Mart) and I couldn’t be happier that my fear of being the cancer girl at work was totally unwarranted.

As I said, I took a year off and I am very grateful for all those around me who made that financially possible (friends, family, co-workers, my employer, etc.) because I wouldn’t have been ready to come back any sooner. After treatment is over, you need that time to physically heal but then overwhelming you realize that you have just gone through cancer and chemo and you don’t have a breast any more. I think once the initial shock of hearing ‘you have cancer’ wore off, I became so focused on each individual day that my plans didn’t usually go beyond that. You become so consumed with making it through the nausea of today or the appointment tomorrow morning that next week doesn’t matter and the fact that you have cancer isn’t allowed to impact your mentality at the time because you are so focused on surviving. Then, when treatment is over and your doctor visits shift from once a week to once every 3 months, the urgency of today fads away and the realization that you just had cancer starts to sink in. It’s a lot to deal with once treatment is over.

Although treatment was over, I was still trying to find energy to go grocery shopping two months later. In retrospect, I am surprised how many people told me what I should be doing with my time. For example, ‘You should get more exercise’ at the same time as ‘You need your rest’ and ‘You need to make sure that you’re relaxed and keep stress out of your life as much as possible’ at the same time as ‘When are you going back to work? When are you going back to WORK? WHEN ARE YOU GOING BACK TO WORK?’. What I’ve come to realize is that if you’ve never had cancer, you won’t get it, you can’t get it. The flowers and cards and ‘how are you feeling’ have stopped because the physical side of cancer is mostly over (with the exception of this expander in my chest) but unfortunately the psychological side of cancer is here to stay.

Wednesday, April 4, 2012

That's Easy for You to Say!

I’ve written about what I call 'cancer etiquette' a few times now and although I have learned to expect that people will tell me about how many family members or friends that they know who have died from cancer, I just can't get used to some things that people say.

From the beginning, I have heard the expression ‘Everything happens for a reason' and I think I have figured out what I don’t like about this saying. It’s okay for me to say ‘Everything happens for a reason’ when I’m referring to my cancer but for someone else to say it to me who has never ‘been there’ has really started to upset me. I have to bite my tongue and not say, ‘Oh is that right, what reason do you have for me losing a breast? Or going through chemo? Or fearing recurrence for the rest of my life? What reason do you have for all of the mean games that cancer plays and all the psychological tricks that my cancer-mind plays on me?’ So my new rule is to try to avoid saying ‘Everything happens for a reason’ to anyone (regardless of their situation) and instead praise them for having that attitude if it comes out of their own mouth.

Another one that I have learned to hate (and I know people say it to try to be positive) is ‘Well at least [...insert chipper comment here...]). When I’m venting or telling someone how scared I was or how scared I am now, the last thing I want to hear is ‘Well at least it was breast cancer and not liver cancer’ or ‘Well at least you’ve had Keith by your side from the beginning’. Although these comments are 100% accurate, sometimes I don’t want to see the positive side of everything. I have said so many times that I am extremely lucky, and again I feel like it’s ok for me to think that way but sometimes I take offence when someone else says it to me.

The old ‘I know how you feel’ really gets me anymore too and I usually can’t keep my mouth shut about this one. I’ve been very open about my fear of infertility and every now and again someone who has never had cancer or has never gone through treatment will throw out the ‘I know how you feel’ comment. Their assumed 'relatability' stems anywhere from having a bad PAP in the past to having precancerous cells. I could be wrong, but I’m pretty sure chemo frying your ovaries and being given a 40% chance of being able to have children is a little different than, well, anything else.

Again with fertility - I was recently on a flight and the lady next to me was one of those 'I-need-to-know-everything-about-you' kinda people. So, it came out that I had cancer, that led to her telling me about her daughter's work in cancer pharmaceuticals and her focus on trying to target the cancer cells and sparing the other cell's from treatment's harsh attacks. She brought up fertility and I told her that was an issue I was dealing with. After I told her I had a 40% chance of being able to have children she said 'Well, you can always adopt.' Now, yes, I should have just said 'That's true' and then put my head phones on to avoid talking to her for the rest of the flight but instead I said 'Well, did you have to adopt?' (knowing full well that she had 2 of her own biological children) and she said 'No', and I replied 'No, because you had the choice.' I'm not trying to make it sound like adoption is a consolation but for me, it's not the same thing as bearing my child, and passing on my Dad's eyes, and my mom's beauty. I have been told 'You can adopt' a number of times in the past few months and I kind of feel like they think they are providing a solution for me that I wasn’t aware of. It's like they expect me to say 'Adoption, shit, why didn't I think of that?' Again, maybe this isn't logical, but it continually pisses me off when someone suggests it. And for the record, adoption is very difficult for many couples (who haven't had cancer) and I've been told that as soon as I tick the 'cancer' box on the medical history portion of the adoption form, they treat me as a 'high risk' client because they don't want to give a child to someone who may not be around to raise it.

I know no one is trying to upset me or be insensitive – they don’t know what to say and some of the above items may be totally acceptable to some survivors, but they are not to me.