CHAPTER 7: FINDING OUR "-NESS"

But with life we never know
When we’re coming up to the end of the road
So what do we do then, with tragedy around the bend?
We live, we love, we forgive, and never give up
Because the days we are given are gifts from above
And today we remember to live and to love
“We Live” by: Superchicks

The other day I heard about a 16 year old boy who died during a trip to the Grand Canyon…he jumped into the Colorado River with two other boys wanting to get a cold dip from the summer heat, and never came back home.

It got me thinking…we never know when our last day on earth is going to come… we don’t know if I that day will arrive unexpectedly or after a long time of unwanted suffering. That young boy never had a fighting chance for his life. Whereas, as horrible as cancer is, and as sickening as the experience of going through it may be, at least I get a fighting chance…at least I get a chance to battle for my life.

Some people’s lives are taken away in the blink of an eye, and what sometimes we humans may judge to be prematurely. These people never get a chance to make a list of the things they want to do before their time on earth is over. They never get a chance to re-examine the relationships in their lives and decide which ones are worthy of their time, and which ones need to be kicked out the door. They never get a chance to remind the people they care about how much they really love them. They never get a chance to decide to not care about mean/obnoxious/rude/unpleasant people that they encounter, but to instead try their best to ignore such people in an effort to make their own lives more fulfilling and healthy. They never get a chance to relax and enjoy the little things rather than rush through life. These people cannot vow to enjoy every sip of their Starbucks cup of coffee while quietly and serenely reading a good book. They cannot vow to appreciate the shining sun and cool breeze outside more, or to take pleasure in the neighborhood park. Yes, it is very unfortunate what some people never get to experience, or rather experience more thoroughly without letting stress or unwanted people to get in the way, because their lives get taken away from them without a warning.

I used to be one of those people who wanted to die quickly, painlessly, and without prior knowledge of it (I believe this was my exact description a couple of years ago). However, things have changed and I have changed my mind as well. Of course, I still would like to die painlessly (and when I am a very wrinkly old woman!) Yet, being diagnosed with cancer has opened my eyes to so many things. Mortality becomes a part of reality when diagnosed with cancer. Death is not a remote concept anymore. The thoughts of dying at a young age before accomplishing much are undeniably scary, but the determination to fight for life also becomes stronger than ever.

Not only that, but I am also more determined now to live most of my days surrounded by happiness and enjoying what good things life has to offer (and there is plenty of loveliness that can be experienced once we decide to slow down and open our eyes.) Don’t get me wrong, I still have my crappy don’t-dare-get-near-me-or-I-will-blow-up-in-your-face days (I do have cancer after all-that’s when I like to play my cancer card), but seriously I am actively trying to limit those days, and heal my soul…with practice I hope to limit those unpleasant days to a minimum, or dare I even say completely eliminate them? (thereby becoming Monk Nancy) After all, they do say that practice makes perfect.

The point of this post is not to freak any of you out by talking about death. I know it is a very sensitive topic that can send many people running in the opposite direction. Rather, the point of this chapter is to call on all of you busy-bees guys and gals out there, who are rushing through life not enjoying any part of it (all the while convincing yourself that you will slow down once you reach that goal, get that promotion, have a family, or reach professional success). STOP DOING THAT! Life is happening now all around you. Stop waiting for that moment when something is accomplished before you can start enjoying it. You know as well as I do that day will never come, because there will always be something more that needs to be done. So, why not start enjoying life now while you still have it? It is all about adjusting your attitude, and then you will realize you can actually LIVE and be grateful for every day of your life. Life is happening now, while you’re busy thinking of the future. I am just as guilty of this as any of you. Why does it have to take something major and life-altering as a cancer diagnosis to get our wake-up call?

So, that is why I write this post…that is why I decide to share this chapter…in hopes that some of you will hear this call before it’s too late. So tomorrow morning when you wake up, try to listen to the birds’ chirping outside, try to enjoy the smell of freshly-brewed coffee, and try to look at a gorgeous blue and sunny sky (or a cloudy and rainy one if that’s more your thing). I hope by taking these small acts you will truly be able to alter the direction of your day. If you are happy and energetic that is when you will be the most efficient. Even better, hopefully your positive energy will emanate to others around you…after all, who says only negative forces have to spread like California wildfires? GO ON, I DARE YA! Spread that positivity and see if it doesn’t change you for the better.

Phew, I’ve become good at this inspirational talk. Maybe I need a change of career? Maybe, I should become a motivational speaker instead…I will find my “Nancy-ness” and help others find their “-ness” as well like Dupree in the movie “You, Me, and Dupree”! (If you have not seen this movie yet, go watch it NOW-it will give you a good chuckle)…

I have told you this so that my joy might be in you
And your joy might be complete.
This is my commandment:
Love one another as I love you.
John 15:11-12

CHAPTER 6: TURKEY DAY PLANS

My strength is almost gone, how can I carry on, if I can’t find you?
As the thunder rolls, I barely hear you whisper through the rain “I’m with you”
And as your mercy falls, I raise my hands and praise the God who gives and takes away…
You are who you are, no matter where I am
Every tear I cry, you hold in your hand
You never left my side, and though my heart is torn
I will praise you in this storm!
“Praise you in this Storm” by Casting Crowns

Thursday Nov. 27th, 2008: America is busy cooking turkeys, mashing potatoes, and baking pumpkin pies in preparation for Thanksgiving dinner; whereas, my family and I were preparing for my first chemotherapy session. While the rest of America was busy eating home-cooked food, I was busy enjoying my first-taste of the delicious ABVD combo. What is the ABVD combo? And where can you get some of that goodness? Well, I’m glad you asked; that is what I am here for-to tell you! ABVD stands for the 4 chemotherapy drugs most commonly used to treat Hodgkin’s Lymphoma (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine)…you got them memorized? Good, because I am going to quiz you on them next time around. As for your other question of where you can get this tasty combo, well I apologize, but we Hodgkin’s folks like to keep that as our little secret-the only way to get a taste of this treat is by developing Hodgkin’s and then you can get back to me and I will gladly share the secret with you.

Anyways, I was going to receive only my first session of chemotherapy in the hospital, the rest were going to be outpatient. They prefer to do the first session inpatient to monitor the body’s reaction to it, especially Bleomycin which can cause pulmonary (lung) problems or an allergic reaction in some people. They tested a small amount of it on me first; I did not develop an allergic reaction -bummer! Now there was no escaping receiving the combo (ok fine, I did kind of want to get the treatment if it was going to cure me). Speaking of cure, this has become like my favorite word (NOT really). So, Hodgkin’s has a very high cure rate, about 75% of cases are completely cured (with no future relapse I believe). But this becomes a slightly annoying fact, especially when everyone likes to remind me of that statistic every time I question their optimism-the doctors, the medical staff, family, and friends. It is as if the stats make the whole experience easy, just because there is a chance I am going to be cured. Yes, I know 75% is a high percentage, but it is not the same as a 100%. It is not a guaranteed cure, which means the doubts, the fear, and the uncertainty that comes with any cancer diagnosis is still present. Plus, I still had to go through chemotherapy AND radiation, so the experience of cancer is similar to any other cancer whether curable, temporarily treatable, or not. Oh, and to tell someone with Hodgkin’s something along the lines of “this is the good kind of cancer” or “if someone was to have cancer, this is the one they would pick/want” is absolutely ridiculous! Cancer is bad, all of it, in all of its forms, shapes, names, etc. No one wants to have ANY kind of cancer, no matter how curable it may be. Yes, I understand there are some cancers that are more bearable than others, but please do not ever tell someone they have the “good” kind of cancer, got it? Ok, I am done lecturing now.

My first chemotherapy session is not that memorable, besides the fact that I was in the hospital on Thanksgiving Day and I did not want to be. The oncology floor nurses at MC were amazing! Most were extremely nice and sweet, thus making my 5-day hospital stay a lot less miserable. The nurse who was administering my chemotherapy talked to me throughout the whole thing so I did not even notice the passing of time. Since this was my first chemotherapy session, I was not really nervous. I know that sounds paradoxical, but the fact that I had not experienced its side-effects yet meant I could not completely fathom what they were going to be like. It did not matter how many times the words nausea/vomiting/hair loss etc. were mentioned-hearing the words is completely different from actually experiencing them. Still, I was a little worried about the side-effects that were to come, but these days they have some pretty awesome anti-emetic drugs (drugs that counter the nausea/vomiting) that help tremendously.

In medicine we study about the five stages of grief that everyone goes through (or SHOULD go through) when dealing with any difficult situation (death, illness, divorce etc.) The stages are taught to occur in the following order: denial, anger, bargaining, depression, and finally acceptance. I believe that these stages do occur and are in fact needed, but they don’t occur in that same order necessarily-at least not in the case of cancer (or perhaps any chronic illness). Because I knew about the five stages of grief, I was consciously looking for their appearance in my life post-diagnosis. I was looking for the day when I would get to the acceptance stage and everything will become perfectly fine, cancer and all. Well, it does not exactly happen that way. I think I have hit the acceptance phase multiple times already in the past six months, along with the other stages as well. I keep going through the stages over and over again. I have experienced anger, depression, and acceptance too many times already. As for bargaining I do not always notice myself doing it, but I think it happens a lot during my prayers. I think I only experienced denial in the very beginning; after the definite diagnosis, it is hard to deny the fact that I have cancer especially while going through the treatment. My mom tried to take me down that route a couple of times as she voiced her concerns, telling me that maybe I should get a second opinion or maybe there was a mistake in the medical reports. I would consider it for a moment, but then refuse to go down that path of doubt. I trusted MC, and I trusted my doctors. I was in the medical field already as a student and it was easy to spot incompetence, and MC was definitely not one such place! (As if they needed me to certify that for them; as if they did not already have the worldwide recognition they deserved anyways).

I remember the day before when my oncologist (Dr. Scotty) spoke to me about the biopsy results and the treatment plan. I had just been brought up to the room post-biopsy, and I was still pretty groggy. I was trying so hard to keep my eyes open and listen to him speak, but the whole time I was thinking to myself: “why can’t you wait until I’m fully awake to come talk to me, when I’m actually able to focus and communicate!” The next day when Dr. Scotty came to see me during his rounds, I made sure to ask him a bunch of questions most of which he had probably already addressed previously, but oh well, it was his fault for talking to me when I was half-conscious. Dr. Scotty was the kind of doctor you instantly liked; with his Scottish accent, perpetual smile and optimism it was hard not to like him. He explained to me that I was going to have a chemotherapy session once every two weeks for a total of eight sessions (4 months) followed by radiation as they determined necessary. He also seemed to save his biggest goofy smile for when he reminded me, pointing to my long hair, that I will be losing it all during chemotherapy-just seemed a tad bit inappropriate to tell me that with a smile plastered across his face (but that is another story I will get to later).

“When can I leave the hospital?” was what I wanted to know. I was told I could leave the next day-so I just had to slightly modify things in 2008 and celebrate Thanksgiving Day on a Friday…

Have no anxiety at all, but in everything, by prayer and petition,
with thanksgiving, make your requests known to God.
Then the peace of God that surpasses all understanding
will guard your hearts and minds in Christ Jesus.
Philippians 4:6-7

CHAPTER 5: LET THE FUN BEGIN!

You only get just one time around,
You only get one shot at this,
One chance,
To find out,
The one thing that you don't want to miss,
One day when it's all said and done
I hope you see that it was enough,
This one ride,
One try,
One life,
To love.

"One Life to Love" by 33 Miles

My eyes opened, blinked a couple of times to try and re-focus the blurry image, and looked around barely moving my head…hmmm, ok I guess I'm in the post-op recovery area. "Man! My lips are so dry I could drink an ocean!" I thought. Just then a nurse noticed me moving and came towards me; she confirmed what I suspected, I was in the recovery area and the biopsy went fine… "Can I have some ice chips please?" I asked knowing that water is not allowed. After popping a few of the delicious ice chips in my mouth I drifted back into sleep (or more like being half unconscious). Not long after, I felt my hospital bed being wheeled upstairs to the oncology floor where I was to remain a resident for a few more days.

Things had moved quite fast once I had arrived to Arizona on Saturday. Since it was the weekend, I had to wait until Monday morning to call and try to get an appointment. I was lucky enough that one of the renowned cancer treatment centers was located in the phoenix area (I will refer to it as MC)-I decided after I did a lot of research on the web that this is where I should go, after all it was world famous on its cancer research for a reason! I was so glad that things worked smoothly for me. When I called MC Monday and asked for an appointment as soon as possible, the lady told me that she may be able to schedule me in for next week…next week?! Sheesh I cannot wait that long knowing there is a tumor roaming around in my body-well it wasn't really roaming thank God; it was just sitting there chilling and being rowdy sometimes but still! So I begged the lady ever so nicely to please try to find something for me that same day or the next day if possible. I explained to her about the mass and the thrombus and how urgent it was that I see someone pronto, but I did not know exactly who to see or where to start. She put me on hold. Dum dum da dum doo da…music playing…I hate it when they play music while putting people on hold, because you focus on the music and forget how much time has passed. Anyhow, phone lady comes back and tells me she scheduled me in to see a general Internal Medicine doctor who will then refer me to the appropriate doctor/department. Halleluiah for small miracles like getting same-day appointments when your life depends on it!

I made it to MC that afternoon with my sister not knowing what to expect or how things were going to turn out. The first good sign was the building itself. It was so beautiful and clean and airy that I did not feel like I was in a clinic. Second positive sign was the doctor herself whom I was scheduled to see (Dr. #1). Dr. #1 was so nice and understanding, and her physical exam was so thorough-due in part to the fact that she found out I was a 3^rd year medical student, and I would notice if she just put the stethoscope on my lungs and moved it before I even took a breath…so she actually listened to my lungs! (Ok it could also be because she is an excellent doctor who is working at an exceptional clinic, but she was going to refer me anyways and having been introduced to the clinical world myself and seen how doctors work the first reason for her thoroughness made more sense).

I ended up being admitted to the MC hospital that same day. Dr. #1 thought it would be easier and faster to run all the necessary tests and see all the appropriate doctors if I was inpatient. The hospital was in a different location, and I was stunned even more when I saw the hospital building. I thought the clinic was nice, ha! The hospital felt like a 5-star hotel; they even had a piano in the lobby where a volunteer was playing some sweet music. Ok, I suppose this qualifies as good sign #3. So far so good…that is until all the poking, probing, and scanning came along…oh yeah and the ever-so-fashionable hospital gown! What is it with hospitals and trying to force patients out of all their dignity with the stupid open-back gowns? Well, I was a freaking med student and as fragile as I was at that moment, I was determined to keep some of my dignity however hard that may be. So I asked for a second gown which I wore with the opening to the front that way covering up my dignity, and I brought my scrub pants from home to wear under the gown!

Being the good medical student that I was, I had typed a history form of myself and printed out several copies to give to every doctor, resident, student, PA, nurse, or janitor who came in to question and examine me (the history for non-medical people is when the doctors ask you all these questions about your illness, your past illnesses, your social life, your ancestors illnesses etc. trust me they do that for a reason other than to annoy you!) well, I did that for two reasons: 1) it gave me something to do besides driving myself crazy with thinking during the long flight home, and 2) I really did not want to be annoyed and repeat the same story and answer the same questions over a 100 times. I wrote down everything I could think of, including any symptom I had experienced in the past few months whether imagined or real (that was for the real doctors to figure out.) I was so happy I had written that history, it saved me a lot of talking sometimes, and I got a few impressed looks and comments from some of the medical people (it was about time too for someone to tell me something positive about my medical skills after being stomped on as a med student for the past few months!)

I had such a difficult time internally accepting that I was on the other side of it-now I was the patient. Giving up control, and trying to become a cooperative patient who did not question every single thing the doctors said (whether out loud or inside my head) was a really hard task. As the months passed by though, I realized that sometimes it is easier to just be a patient. Sometimes I even hated that I knew so much, and I could search scientific medical articles and read them in the blink of an eye. I got some un-needed stress as I read about all the horrible side-effects, complications, and mistakes that could happen. This is one situation where sometimes it helps to be ignorant or at least not know so much. But on the other hand, my medical background helped me tremendously at other times (like that time when I was in the hospital and the nurse kept bringing me medicines to take that my doctor had already stopped, but they were still on my chart. I had to tell her that I'm not on those meds anymore, so she would smile, apologize and go double check!)

Anyways, I had a bone marrow biopsy and a thoracoscopy (took a sample from the mediastinal mass to analyze in lab and determine what the mass was definitively) done on Wednesday. Between the time I had checked into the hospital Monday afternoon and the biopsy on Wednesday, I had undergone numerous other tests and was seen by multiple doctors. Most of the other tests came back negative (meaning normal), which was especially comforting when it came to the Brain MRI and the Echocardiogram they had ordered. YES! At least my heart and brain were normal and functioning like they're supposed to-I have got to celebrate the little victories like these when my world seems to be collapsing around me!

That same day, on Wednesday Nov. 26^th, 2008, the biopsy results confirmed what the doctors had primarily suspected. I definitely had Hodgkin's Lymphoma; no doubt about it now after the pathology report showed that the mass sample contained Reed-Sternberg cells (which are THE cells that identify Hodgkin's.) These cells are the ugliest looking little monsters with two huge eyes that stare back at you as if mocking you and telling you "I've invaded your body, now what can you do about it?!"

I was told that my first chemo session would be the very next day! Oh joy! Ok seriously, things were not just moving fast, things were zooming past my eyes at the speed of light making it hard for my brain to digest and absorb all these new unwelcomed facts. I mean less than a week ago my biggest worry was how to impress my attending, now I'm getting chemotherapy?!!! Whoa! Actually in a way I realize how lucky I am that I was diagnosed with cancer this quickly, because most cancer patients spend months going from doctor to doctor with their symptoms before they get diagnosed. So, at least I did not have to go through that, but still I needed at least a two-week notice to be able to process all of this. Nope, no such luck!

Chemo, here comes Nancy-your newest victim…

I have told you this so that you might have peace in me.
In the world you will have trouble,
but take courage, I have conquered the world.
John 16:33