The Real Evil Undead

My new Macbook has a built-in camera, which gives me endless opportunities to be horrified by my own aging process. The craned-neck pose is good for disguising a softening jawline. Another observation: my hair doesn't seem to be growing. I mean, it IS growing, but at a glacial pace. At this rate, my bangs should reach my eyebrows by early 2010.

Recently a few people have asked me how I'm doing, always with penetrating eye contact and an emphasis on the first syllable of "DOing." I had my six month post-treatment mammogram in November, and saw my oncologist in December. There was no detectable sign of cancer. Each milestone is cause for hope, but I'd prefer to hold off on the high-fives for now. It's not that unusual to be "cancer-free" right after chemotherapy and radiation.

Cancer is kind of like--you know how in horror movies the undead appear in the context of their pre-zombie jobs? It adds some macabre humor, especially if the contrast is extreme. For example, there might be a zombie ice-cream truck driver staggering around his vehicle (which is still playing a continuous loop of "Turkey in the Straw") wearing a blood-spattered white uniform. Cancer cells, like zombies, once had perfectly normal jobs. My mammary gland cells were given the assignment to wait around for hormonal signals to start producing milk. Since I never gave them the go-ahead on that, they used their spare time creating painful little lumps and bumps of calcium in my girls. And then, some of them turned into cancer.

Normal cells are supposed to eventually die, a process called apoptosis. A cell with damaged DNA may not go into apoptosis, and the immune system has to detect and then assassinate it. Recent research hints that we all have had cancer, but in most cases the body's own death squad hunts down and kills it before it is detectable.

As I mentioned, my breast cancer used to be normal mammary cells. Unfortunately, once they become "zombies," cancer cells not only refuse to die, but multiply rapidly. They may also wander into the lymphatic and blood streams, which carry them to other body systems, where they continue to multiply. This is called metastatis, and it is how cancer of a non-vital organ system, like mammary glands, kills. Breast cancer, because of its previous legitimate "job," is especially attracted to calcium. Because of this, metastasis sometimes occurs in the bones.

Cancer is still maddenly difficult to detect until it's almost too late; after treatment, there's no way to know if it is really gone for good. It is ironic that a management regime is in place for a relatively new disease, HIV/AIDS. Although the disease and the drugs used to treat it are debilitating, HIV patients can live for nearly normal life spans. Perhaps instead of wearing pink t-shirts plastered with corporate logos and "walking for a cure," we cancer survivors should look to the examples of AIDS activists. We can chain ourselves to gates and scream at health officials and otherwise become so disagreeable that someone will figure out how to give us our lives back for good.

Caution: Dad may be hazardous to your health

Here's another risk factor for breast cancer: having a middle-aged father. Chromosomal abnormalities in older maternal eggs can increase the incidence of birth defects; this connection is well-established. Now it seems that sperm also has a "Best Used By" date, despite the fact that men can sire children well into their senior years.

Recent research has linked advanced paternal age to increased incidence of dwarfism, schizophrenia, autism, and both prostate and breast cancers in offspring. These conditions may be caused by chromosome duplication errors which occur after decades of sperm cell creation. Since men don't experience a defined end to their reproductive years like menopause, how old is too old? In the case of the breast cancer data, pre-menopausal women with fathers who were over 40 at time of conception had nearly twice the chance of developing breast cancer as women with fathers less than 30 years of age.

My dad was 47 when I was born. Since there's no history of breast cancer in my family, I've been reduced to trying to identify environmental or behavioral causes. Not enough exercise? Too many glasses of wine? Maybe standing in front of the microwave was not such a good idea. In an odd way, it would be a comfort to know that I got it because some of my genes are all hinky.

"Association of paternal age at birth and the risk of breast cancer in offspring: a case control study." BMC Cancer [Link]

"Older fathers appear to raise risks of genetic disorders." International Herald Tribune [Link]

No, YOU move beyond cancer

Nota bene: a brief article in the New York Times Science section, "Having Cancer, and Finding a Personality," by Ruth Pennebaker. Her description of post-cancer malaise is right on.

"The last time I visited my oncologist after my treatments were over, I felt lost. The image that kept recurring in my mind was that someone with a gigantic pair of tweezers had picked me up, shaken me and tossed me back down. Now what?"

[Link]

I had my own rimshot moments during treatment. Satire can be used to divert aggression; in my case, joking was more productive than punching a hole in the wall. During my last radiation appointment, the nurse gave me a going-away present: a videotape titled "Moving Beyond Cancer." I told her I'd really prefer it if she gave Cancer a videotape called "Moving Beyond Elisa."

Breast Cancer Comics

The New York Times recently reviewed the graphic novel "The Bottomless Belly Button," by Dash Shaw. An astonishing 720 pages, the story follows an extended family as they react to the news that the grandparents are getting a divorce. There's a lot of buzz around "The Bottomless Belly Button;" New York magazine called it the "graphic novel of the year." And, there's just as much interest in the author and artist, 25 year-old Dash Shaw. For such youth, he's prolific, having already inked critically acclaimed "The Mother's Mouth," and several shorter works.

When I Googled him, I was surprised to see his name attached to a search result for "Breast Cancer Comics," from the web site MyBreastCancerNetwork.com. Readers submit their stories, and Shaw (who looks about fourteen in his profile photo) interprets them in graphic form. Perhaps it was a good gig for a starving artist. I somehow have the feeling he's about to become too famous for this kind of work.

"A Week at the Beach, With a Divorce Imminent" Book of the Times. [Link]

Breast Cancer Comics [Link]

Dash Shaw's website [Link]

How to turn a pear into an apple

Just had my first mammogram since my surgery, and I'm relieved to say that the radiologist saw nothing out of the ordinary.

My oncologist recommended taking aspirin or ibuprofen about half an hour before the screening. Mammography is a low-dose x-ray of the breast while compressed to the thickness of luncheon meat. I have some internal scar tissue, and the muscles leading from my armpit to my ribs are pretty tight. On top of big squeeze, it felt like my entire right side was being slowly pulled apart like taffy.

What's with all the food analogies, you ask? I blame my current anti-cancer drug, tamoxifen. I gained about fifteen pounds during chemo, and put on another five during radiation. I don't eat more than I did a year ago, and my activity level is about the same, so what gives? My oncologist said "Some people blame tamoxifen, but it's probably just menopause." I have noticed that doctors are reluctant to admit the extent of drug side effects. This kind of dismissal always drives me straight to MedLine, which is why I'm such a pain-in-the-ass patient.

There's some relatively recent literature linking tamoxifen to excess visceral fat. Visceral, as in gut. I'm trying to get used to my new belly. Ever since I hit puberty, off-the-rack pants ballooned around my waist, even while they were too snug in the hips and thighs. I guess I should thank tamoxifen for transforming me into a more conventionally-shaped fat woman.

"Relationships between tamoxifen use, liver fat and body fat distribution in women with breast cancer." Intl. J. of Obesity. Feb. 2001. [Link]

Bone/CAT Scan #2

I had my second round of bone and CT scans earlier this week. The previous scans (in January) indicated a lung nodule and a problem spot in my left hip joint, both of which could be signs of metastasis (spread) of cancer. However, both can also be attributed to events not related to cancer, like scarring from a respiratory infection and osteoarthritis. I just received a call from the oncologist's nurse, who said that neither problem area had increased, and there weren't any new issues--good news, in other words. Now if I can get through my post-treatment mammogram in June, I can breath easy for a few months. Then, we do this all over again.

Health Insurance

Yes, I have it...thank god. We filed an extension on doing our taxes, and I finally added up all of my medical bills from last year. The cost of my cancer treatment in 2007: $114,000.00. That's not counting my drugs, and miscellaneous costs like transportation and purchasing Elisa Jr.* If I had to pay out of pocket, it would have wiped out my life's savings.

*my wig

Weather Report

Gahh!! Once again, for about the kajillionth time this winter, the skies dumped a load of snow on our city. I shoveled the wet stuff as quickly as I could, pausing to reflect that I had a lot more energy than when I was on radiation. I talked to my sister-in-law yesterday, and she mentioned that I seemed to have dropped cancer as a topic in this blog. I have neglected to tie up the loose ends of my treatment, the more aggressive part of which ended a little over a month ago.

I had my first post-radiation appointment with the oncologist on February 14. While I was in the waiting room, I noticed a man sitting across from me. He wasn't a kid, but was obviously younger than me, dressed in business casual and checking the messages on his cell. Maybe he was waiting for an elderly parent? We kept casting glances at each other and finally struck up conversation about the complimentary beverages. "I didn't discover the coffee until my seventh chemo," I told him. "Oh, did you finish treatment? I'm just starting."

Brian had just been diagnosed with Hodgkin's lymphoma. He was taking a shower when he discovered a lump near his collar bone. "I guess we caught it early; it hasn't traveled below my pelvis." Hodgkin's lymphoma, a cancer of the lymphocytes, or white blood cells, has a cure rate of over 90 percent. "It's the cancer you want to get..." he said, adding "...though I'm sick of hearing healthy people tell me that." Brian is only 38, and was just starting a second career when this hit. We exchanged cards, promising to keep in touch.

Dr. T., the resident working with my oncologist Dr. C., was the first to see me. I secretly hoped that Brian had the same oncology team, because her appearance would have brightened the mood of any heterosexual male. Dr. T. is HOT, as in Gray's Anatomy hot, and on Valentine's Day, she kicked it up a notch: wine-colored wrap dress, boots and fishnet stockings. "You look cute," she said to me, taking in my outfit. "So do YOU!" I answered. "Everyone has commented on my appearance today. They keep asking me if I'm going out tonight." Was she? "No. This is my only chance to look pretty today." And give male cancer patients heart-attacks.

Dr. C. came in after a few minutes. We discussed my post-radiation treatment. "I'm going to put you on Tamoxifen for a year," she said. She explained that since Tamoxifen was only effective at blocking the action of estrogen, most of which is produced by the ovaries, it wasn't ideal for post-menopausal cancer patients. "We'll test your hormone levels in a year to confirm that you're really in menopause." If confirmed, then I'll switch to an aromatase inhibitor, a drug which is believed to be more effective with menopausal women. "Tamoxifen increases your chance of developing cervical cancer, but the risk is very small. It most likely will increase the incidence of hot flashes. But, nobody has ever died of a hot flash." True, but I could kill someone while I'm having one.

So, I'm taking an anti-cancer drug, and will see the oncologist once every three months. In addition to physical check-ups, I need to order a mammogram for May, and also meet with my surgeon again. The rest of my body, neglected for a year, is overdue for a tune-up. I might as well get used to doctors' offices.

Public Service Announcement

Graduation Day, June 1981. L to R: Mom, 22-year-old knucklehead, Dad

The flurry of correspondence among my former art school classmates is heating up. I just had nice convo with my ex-sorta boyfriend, who reminded me of stories and people I haven't thought of in 25 years. The brain is a funny thing; how can something so profoundly forgotten suddenly be accessed? Now, I'm starting to dream about art school.

A call went out for old photos, and I found the above. If I remember correctly, I had terrible problems in 1981: A "C" in Design II (or was it III?), a guy had dumped me, and I had a pimple on my chin. Not to trivialize the angst of youth, but I can't help but make a comparison to my current situation. I've just survived eight months of cancer treatment. And, I'd give anything to hug my Dad again.

This is where the public service announcement comes in. My father died of metastasized prostate cancer. We just recently lost a friend to the same, at the young age of 57. Gentlemen, please go and get a checkup and a PSA test. I know a lot of men put off getting an examination because it's unpleasant, but prostate cancer is very insidious. If it isn't detected early, it can easily spread to other organs. Remind yourself that you're doing it for everyone who loves you.

Thank God It's Naughty Friday

Since Cancer, the most important character in my dramatis personae, is on vacation, I have to create some gimmicks to thwart writer's block. So, I do a music post every Sunday, which is pretty low-pressure and indulges my obsession with obscure Europop. I think Friday needs a theme, as well...something which requires almost no effort, yet immediately draws eyes to the blog.

Yes, Sex! It will be fun and challenging to find something sexy, yet not too NSFW. After all, my mom reads this. (Mom, NSFW means "Not Safe For Work")

I sometimes lurk at the message boards of a website for young cancer patients called Planet Cancer. I mostly just lurk because I am, er...well over 40. The people who post in the PC forum are heroic in their struggles with the disease, and also in their determination to lead normal lives. And, an important part of being young and normal is to be sexual. In the Dating, Relationships & Sexuality forum a woman wrote:

Hi guys, I'm a little embarrassed to admit to this, but I think it is so funny and amazing, that I just have to post it, thanking the internet for the anonymity...

One night when I was in the hospital and my counts were really low, I think I was having some sexual dreams or something, and since I was awake at 4 am, I um...pleasured...myself. It was the first time in a long time, and definitely the first time since I was diagnosed with cancer. But let me tell you, it must have done some medical good because my blood counts shot up the next day! The doctors were stunned, but I didn't have the guts to tell them why!! I really think that short bit of happiness did some healing to by body and blood!

A mini-experiment followed, with her fellow posters trying to replicate the results before their scheduled tests. Their blood counts improved, too. So, not only will it not make you blind, but it may actually boost your immune system. Have a great weekend!


Photo: Jackie Farry. Order a Fuck Cancer hat Here

Radiation: The end is near

Sorry for the spotty posting. Radiation has been kicking my butt, and I haven't felt like doing much of anything other than sleep. Fortunately, my last treatment is on Monday. I don't know about you, but I like my Elisa done medium-well. I now have a dark tan in my armpit, and a dusting of tiny blisters on my chest. Compared to other patients, my skin is doing great. One woman, who looked to be in her late 20's, told me that her incision had opened and was infected. I asked her how long it had been since surgery, expecting a relatively recent date. "In August," she said. She had sixteen cancerous lymph nodes, so they decided to give her a second blast of chemotherapy, before starting radiation. She looked drawn and frightened, her baldness covered by a bandana.

Late twenties sounds awfully young for breast cancer, but I have discovered that it's not that uncommon. Nia*, a woman who has her appointment right after mine, is only 33. We both had time after our treatments last week, and lingered in the waiting room. She overheard me saying to a nurse, somewhat bitterly, that HIV can be managed better than cancer. The nurse countered "well, we need give you a pep-talk, and then maybe you can feel more hopeful!" No, she's right, Nia said. She's an oncology nurse herself, and the daughter of a woman who died of breast cancer at 29. Her mother was diagnosed when she was 25, and had a metastatic recurrence barely a year after her mastectomy. Nia has two young daughters, both terrified that this could lie in their future. To make matters worse, her long-time boyfriend broke up with her two weeks earlier. "He stood by me through surgery and chemotherapy, so I couldn't believe it when he ended it." Her eyes filled up. "I'm so tired of people telling me to be brave. They don't have to go through this." We are both near the end of our treatment, and now the waiting begins. Waiting to prove a negative, to not have it come back.

Another patient, Barbara*, said to me "Every time I get a headache, I wonder-is it in my brain?" In a way, isn't it, already? The young woman wearing the bandana had the same facial expression one sees in photographs of war refugees: the fifty yard stare of deep trauma and hopelessness. I've been there, and will probably visit again. The only solution for me has been anger, a deep burning rage. Why do they have to wait until a bone breaks before diagnosing metastasis? Unacceptable. Why are young women getting breast cancer? Completely fucking unacceptable! Why isn't there a cure? WHY ISN'T THERE A MOTHERFUCKING CURE?!!

*Names changed

Radiation: Week Two

The dressing room in Radiation is a busy place at 8:15, early morning being a convenient appointment time for most patients. I meet the same women every day: the youngish Lincoln Park matron with the Vuitton duffle, the petite grandmother who walks ten blocks to the hospital, and a lady of perhaps fifty who wears skin-tight spangled jeans and an extravagant long wig. It was the last woman who gave me the head's up on what to expect in the next two weeks. "What number are you on?" she asked me. I told her I was on 14, so not quite halfway through. She was getting treatment number 20, and her skin was very sore. She warned me, "Don't put any cream on before. It's like basting a turkey." She showed me the area on her chest and armpit where her radiation was targeted. Her normal color was a medium brown, but the area under her arm had been burned to nearly mahogany. My skin is starting to show a radiation burn, as well. Poor breast: scarred, dented and now broiled until it turns red...Frankenboob, I call it. I hope holding on to it was worthwhile.

Second Opinion

Last week, the new oncologist's nurse phoned me. "Can you come in next Thursday?" That was quick. I took it as a good omen. My husband worked from home that day so he could accompany me.

Ah, back to the good old Cancer Center. It was late afternoon, and most of the chemotherapy patients were gone for the day. The remaining patients in the waiting room looked unremarkable--perfectly healthy, actually. I guessed that many of them were waiting for regular post-treatment appointments. Outside, the snow fell in a thick curtain, blocking our view of the lake.

An oncology fellow examined me, first. She took my history and summarized the findings from the scans. "We don't see any obvious signs of metastasis in either your bone or CT scan." Tears of relief welled in my eyes. However, there were a few things which demanded closer scrutiny. The abnormalities, located in my lung, hip and uterus, were likely due to arthritis and other common, but non-lethal conditions. I was going to need further testing to eliminate any doubts.

Dr. C arrived and introduced herself. She was dressed in an attractive sweater and skirt, with black patent pumps. "I have to tell you that I'm allergic to wearing white coats. You'll never see me in one." My husband had some questions for her. "When will Elisa be cancer free?" Dr. C shook her head. "I never use the term. There is no such thing." Even with chemotherapy and radiation, she explained, there was no way to kill all of the cancer cells that may have entered my bloodstream. Therapy from now on would focus on keeping them in such small numbers that they could do no harm. After my radiation was finished, I should start taking Tamoxifen, a drug that inhibits the growth of ER+ breast cancer cells.

I think it shocks many people when they first really understand that it's impossible to "cure" cancer. Cancer will go into remission, a state where no disease is detectable, but that in itself doesn't mean that all the cells are gone. Most researchers don't hope for a cure per se; they look to a future where cancer will be manageable as a chronic disease, much the way diabetes has become.

I won't go into the rest of our visit with Dr. C, other than to say that I felt she addressed my fears with respect and candor, and yet left me with much hope. My husband asked her how she felt about my long-term prognosis. "Knowing what we do now, I am optimistic," she said, smiling.

The Gambler

For the second time this week, Kenny Roger's The Gambler was playing on the intercom in the radiation lab.

You got to know when to hold 'em, know when to fold 'em,
Know when to walk away, and know when to run.
You never count your money when you're sittin' at the table.
There'll be time enough for counting when the dealing's done.

I am far from being out of the woods with this disease. The disappearance of my oncologist, Dr. G, has only increased my anxiety and depression. When I tried to get an appointment, the soonest I could be "fit in" was February 18. I had to call his nurse to ask for orders for CT and bone scans (my idea, not his). It's not clear if he's even read my surgical pathology report, but perhaps he's too busy to pick up the phone for five minutes to discuss it with me. I'd like to thank everyone who has offered advice about second opinions, including Cancer Bitch.

Yesterday, between my scans and radiation, I struggled with the blasted scheduling staff at the Cancer Center. All I wanted was the phone number of a nurse who works for another oncologist there, Dr. C. Exhausted, and sick of being transferred and then stonewalled, I began to cry. It's sad when that works, but it did. I left a (tearful) message with the nurse, asking her if I could be scheduled for a second opinion. One of the techs at the Nuclear Medicine scanning lab noticed my puffy, red eyes, and asked me what was wrong. Trying to hold back the water works, I told her about how my doctor appeared to be missing in action. Later, she slipped a piece of paper into my hand with the names of two oncologists not associated with the Cancer Center. "They're both terrific. The second one actually gives his patients his personal cell phone number." Imagine that; a doctor who actually talks to his patients.

First Radiation Treatment

Remember when I said I get bitchy during my cancer treatment? In addition to the tattoos for radiation targets, I'm considering getting one on my forehead that says "Five Days A Week, For Six Weeks," because I have to repeat this over and over and over, sometimes to the same people. I'm getting radiation Monday-Friday for six weeks. You will be tested on this later.

Also, please don't ask me what "stage" I am. I may choose to volunteer the information, but since most laypersons don't understand staging, it's essentially just a scary number. I don't like scaring people, especially myself. Despite statistical survival averages, some Stage I cancers advance, while some Stage IV cancers go into remission. For a scientist's insight on cancer survival statistics, I suggest you read The Median Isn't the Message, by evolutionary biologist and author Stephen Jay Gould. In 1982, Gould was diagnosed with abdominal mesothelioma, a rare and, according to survival statistics, deadly cancer. He lived another 20 years, eventually succumbing to another type of cancer entirely.

Off of my cancer soapbox and back to radiation. The radiation lab is in the basement of the Womens' Hospital. A windowless and cheerless space, the environment was considerably livened by an oldies rock station. The Beatles sang "Twist and Shout" while the radiologist and two young male technicians took setup x-rays. "I'm going to try to get your sternal lymph nodes," Dr. K told me. What about lung damage? "It will just touch your lungs, but it's an acceptable margin." The arm of the radiation machine was poised over me, its glass face reflecting an image of my naked right torso bathed in green and white target beams. Once the targets were in place, the medical staff retreated to the control room. An alarm sounded, and the "Beam In Use" warning light on the wall flashed red. I was now being exposed to large amounts of radiation. I felt nothing, at least physically.

Afterwards, I dressed and went in to the ladies room to put on some makeup. I started weeping, and had difficulty pulling it together. It will get easier, I know. I am constantly amazed at my adaptability, an apparently built-in feature for us homo sapiens. It's not that "what doesn't kill us, makes us stronger;" we already are strong, and it takes a lot to kill us.

Week from hella

Stop the world, I want to get off. Well, not really, but I'd like to pause the ride for a little while.

Early on Christmas eve, I had a festive visit with Dr. K, the radiologist. Before I consulted with her, a resident took a history and examined me. "Dr. B did your surgery? Oh, he's good. His patients usually don't have much scarring." Afterwards, Dr. K came in to complete the examination, and to describe the course of treatment. I'll be getting six weeks of radiation, five days a week. Each treatment will take about fifteen minutes.

The first step was to create a treatment plan, part of which would be to determine if it was safe to zap the lymph nodes lying along my sternum. If the lymph nodes overlap the lungs, it's a no-go, since radiation can cause damage to lung tissue. Dr. K checked the schedule that day. "There's been a couple of cancellations. Would you like to get your planning CAT scan right now?" Six months of cancer treatment has taught me a couple of things. First, if they give you a blanket, do not give it up until they allow you to get dressed again. Second, if they offer you an appointment for the same day, accept it immediately.

Off we went to the CAT scan thingy. After looking at the images, Dr. K came in to speak with me. Unfortunately, my lungs were partially under my sternal lymph nodes, so she recommended against targeting that area. Instead, they would hit my axillary, mammary and clavical nodes. A technician tattooed three blue dots at target points on my chest and armpit, and then photographed my naked torso. Tattoos and nude photos all in one hour! It was like mini spring break, only without beer bongs.

I drove home and started cleaning the house in preparation for my in-laws arrival that evening. Christmas is sort of a mixed blessing for those of us afflicted with seasonal affective disorder. I could feel my mood darkening along with the days, but the flurry of activity preceeding the holidays kept me too busy for a free-fall into the Abyss. One serious misstep was, while shopping for gifts, to purchase the book Cancer Made Me A Shallower Person, by Miriam Engleberg. I had read about Engleberg's collection of cartoons a couple months ago, and all of the reviews were right on: the book was an often very funny account of what its like to be a cancer patient. However, I secretly hoped that Engleberg was not like me. You see, she died last year, after cancer spread to her bones and brain. As I read the book, I couldn't avoid noting the eerie similarities. She had the same type of breast cancer as me. She had a lumpectomy, with chemotherapy and radiation. In 1979, we both had a boyfriend named Roger. OK, I had a boyfriend named Roger in 1980, but you get the idea. If she were alive, we would be the same age.

After I read the book, fear lay in my heart like lead. Between her first diagnosis and death, Miriam had only five years. I am already enduring the bittersweet realization of midlife. Much is behind me, and what is ahead will pass quickly. What if the cancer comes back? In Greek mythology, the three Moirai, or Fates, determine the length of life. Atropos,"the inexorable," cuts the life-thread spun and measured by the other two goddesses. I feel like I've glimpsed the shears, still without really knowing the measure.

Like my father before me, movement through space provides me some respite. If my dad was anxious, sad or angry, he would drive and drive and drive until he put some distance between himself and his troubles. Being a city-dweller, the train is my neurotransmitter of choice. Pink Line, take me away...to Pilsen, which is where I took the photo above. Pilsen is an old Bohemian (as in Czech and Slovak) neighborhood on the south side of the city. It's now Mexican, with a growing art gallery district in its eastern section. The main drag, 18th street, is heartbreakingly beautiful. Tall Mittel-european stone and brick buildings line the street, while little houses off of it reflect a more peasant vernacular, with charming, crude flowers carved in the window lintels. One is prevented from complete transport back to old Bohemia by some of the eye-popping exterior paint jobs, mostly in shades more common to Oaxaca. The colors could cheer even Kafka. And so it did me.

Breasts

I visited Dr. B yesterday, and as I hoped, he removed the drain. So why do I feel so lousy? Ever since Monday, I've been afflicted with a general malaise, and more concrete symptoms, such as aching joints. Others have told me that healing from surgery can be draining. Every conversation I had today seemed to have been broadcast from some distant planet.

With the drain removed, and swelling reduced, I can better see the end results of surgery. There will be a little dent on the outside of my right breast, and any illusion of symmetry between the girls is now officially over. In fact, asymmetry is very common. When it comes to breasts, "normal" includes countless shapes and sizes. The previous link, a site advocating public breastfeeding, is probably NSFW. Breasts, despite doing unsexy things like feeding babies and getting cancer, are still officially dirty in this country.

And not having breasts is dirty, too. Twisty at I Blame the Patriarchy found that, despite having a double mastectomy, going topless while swimming was not an option. It upset the other women at the pool, apparently. Although I'm not as bold as Twisty, I wondered if I would feel self-conscious undressing after a mastectomy, even in front of other women. When I exposed my bald head in public, it most often was women who stared at me. Although some of the scrutiny was friendly, though artless, some was cold, without a spark of kindness or concern. Perhaps a cancer patient who chooses to not cover her bald head, much less her mastectomy scars, is considered to be weird and threatening.

Recovery and Gratitude

I took the last week off work for recovery, and have pretty much exhausted my ability to amuse myself. One thing that does keep me preoccupied is my drain, which clogged up on Wednesday evening, nearly ruining the shirt I was wearing. A painful but instructive visit to the surgeon cleared things up, and I now coexist more or less peacefully with my little bag o' body fluid. The upside to cancer treatment is that for every procedure you dread, there's always something, very often the end of said procedure, which you can joyfully anticipate. DOE Day, or Drain Out of Elisa Day, is expected to occur this coming Tuesday.

My recovery would have been a lot more boring if it weren't for my excellent coworkers, who chipped in for a care package. Heather, who did the actual shopping and delivery, really got inside my head--at least the part that eats. She brought me such delicacies as a box of clementines, Lebanese flat bread, baba ganoush and dark chocolate with dried cherries. Thanks for everything, my friends! You're the best.

Fuzz

My hair is now visibly returning, although it will take a while for the stuff on the head to look like "hair." Downy eyebrows and eyelashes are sprouting as well.

Other good news: Dr. B, the surgeon, called today. He had the results of the pathology reports. The perimeters showed no additional cancer. Eleven lymph nodes were removed, and of those, six were cancerous. He told me this was not surprising or necessarily bad news, since they presumed that several lymph nodes would be involved. So, in his words, "no addition excision is required." That means, no going back for a mastectomy, at least not during this particular battle with the disease. Now, I have to look forward to radiation and hope that cancer will never return.

Three Days After

I finally got up the nerve to remove the dressings and take a look at Dr. B's handiwork. Considering how much he had to remove, and the paucity of raw material (I have less than an A cup), it doesn't look too bad. I have two incisions, one on the breast itself, and the other on the inside of the armpit. The swelling and bruising has increased over time, and my right arm has limited mobility.

Now for the really gross part: the drain. The device, which I now know is called a Jackson-Pratt drain (link not safe for the squeamish), consists of a flexible silicone bulb attached to a long tube, part of which is stitched into the incision. The bulb is meant to be squeezed flat and capped, and the resulting suction helps drain the wound. That means that every six hours or so, I empty the bulb into a specimen jar and note how many cc's of stuff leaked out of me. It's a simple but ingenious device, and if I pin the bulb under a jacket, nearly undetectable. However, it's a pain in the ass to try to shower with it, as I was advised I could. I ended up binding it to my torso with the only thing I could find, some clear packing tape. Later, my husband scrounged up a little gauze and surgical tape, and we were able to dress it properly. I think sponge baths are the way to go from now on.