Once More Unto The Breach
Tales of my second go-round with breast cancer before the age of 40, and everything since.

Nine Years Later

I wrote these words in the days immediately following 9/11, in the short period before that term was coined and then quickly became the universal signifier of an event too calculatedly evil to comprehend, when we needed symbols to convey what our suddenly beggared language couldn’t. Here they are, unedited:

We watch the news and keep hearing all these scary words:

    terrorist
    attack
    fear
    danger
    peril
    threat
    bomb
    explosion
    hijacking
    crash
    tragedy
    casualty
    wounded
    injured
    evacuate
    war
    triage
    rubble
    ground zero
    collapse
    trapped
    burned
    bodies
    fire
    inferno
    mourn
    victim
    death toll
    trauma
    grief
    nightmare
    vigil
    missing
    body parts
    suicide
    black boxes
    debris
    surreal
    suspect
    presumed dead
    siren

And mixed in are just a handful of reassuring ones:

    hope
    hero
    miracle
    survivor
    rescue
    escape
    safe
    home

We’ve been told to go outside, eat in restaurants, shop in stores, spend time in the parks—to resume our normal lives as much as we can, to prove to the perpetrators that they have not cowed us.

But it feels disrespectful somehow to try to pick up where we left off.

It seems irreverent to do anything but focus on the tragedy—watch the news, read the papers, check on loved ones, share stories with friends and strangers, try to find something—anything—to do that might help the rescue effort, the injured, the families of the victims and the missing.

Going to work helps in that it is reassuring to see colleagues, to hear that nearly all have been spared personal tragedy, but it is impossible to do any actual work, and it is heartbreaking to hear of the few who have not been spared: one who has lost a brother, several with friends that are unaccounted for.

The same questions are asked over and over: Which building? What floor?

We cling to the bits of good news we have heard: of people above the 90th floor who got out, of those who overslept or missed their trains or were out of town on that day, of the five firefighters rescued on day three.

Then the news that this last is not true. A cruel hoax?

No, just a heartbreaking misinterpretation of events.

There are bomb scares, evacuations, the inability to get through to cell phones or land lines, the maddening inconsistency of internet access, of web sites jammed and inaccessible, of subways not running, the horror of acrid smoke traveling five miles, through closed windows into our eyes and lungs.

The video clips shown over and over of planes crashing into our tallest skyscrapers, of those buildings coming down like houses of cards in great clouds of black smoke.

The horrific photos of people jumping to their deaths, choosing impact over incineration.

The heartrending accounts of last phone calls from hijacked airplanes and from high stories of the doomed towers.

Of pregnant women now widowed.

Of upcoming weddings that no longer have a bride or, in some cases, a groom.

Of those who didn’t work in the building but were there for a meeting and others who delayed their plane trips from the day before—people who should have been safe but weren’t.

And the e-mails urging us to donate blood and money, to pray and light candles, to attend vigils, buy flags, and wear red, white, and blue. And always to forward the messages on to everyone we know.

And the insistent, unrelenting television coverage with frightening images of mountains of rubble, twisted steel, billowing smoke, ash-covered survivors, exhausted rescue workers, grief-stricken family members, and the eerie sight of personal effects strewn all over the ground.

The politicians’ rhetoric, promises of retaliation, the auguries of war.

The inevitable comparisons of incomparable tragedies.

The need to cite victims once- or twice-removed from us in order to feel connected.

The absence of traffic, the shops that are closed, the police cadets stationed on midtown streets, the signs mandating ID be shown for admittance.

The hospitals staffed up with doctors and nurses, supplied with gurneys and IVs, everything but patients.

The flyers with pictures of the missing posted on payphones and lamp posts.

The stories of children who cannot comprehend what has happened, whose parents are trying to shield them from this horror, who have nightmares from the images they glimpsed on TV, who ask, “Do they blow up houses, too?”

The panicked phone calls from friends halfway around the world.

The new fear of flying.

The fruitless calculations of which buildings are likely to be future targets.

The need to carry a handkerchief as a precaution against the polluted air.

The names of other, more attenuated friends that gradually come to mind—are they safe?

The guilt of not thinking of them sooner.

The guilt of having been far from the attacks, never truly in danger.

The guilt of good fortune, that our families and friends are safe when so many thousands of others are devastated with grief.

And the Winner Is . . .

There is an old medical aphorism that holds that if you hear hoofbeats, you should think horses, not zebras. In other words, when confronted with symptoms, the simplest explanation is usually the correct diagnosis.

It’s now been three weeks since my joyful day in the ER, where the hoofbeats in question were some kind of WBT (weird breathing thing) and chest pressure.

After putting me through several tests—of both the stress and stressful varieties—to rule out heart attack, tumor, and pulmonary embolism, the ER docs sent me home.

Other hypotheses? Acid reflux, atypical gallstones, and whooping cough, of which there is currently an epidemic in California.

Three follow-up visits to three different doctors later, the reigning theory is that I have . . . bronchitis.

Anticlimactic, isn’t it?

But reassuring in its banality.

And reminiscent of my bout with bursitis, a relatively benign diagnosis that required a heavy-duty bone scan to rule out a much more ominous one.

I’ve now finished a round of antibiotics and week on an inhaler, and I definitely feel much better—not great, but much better.

So I am trying to be patient with the pace of my recovery, hoping that the diagnosis is right and reminding myself that my body has a knack for medical misdirection.

Poor old, drab, overlooked horse.

Those graphic stripes commandeer the spotlight every time.

This Time with Photo

I’ve discovered that the title of this post might have been a bit unclear. Hint: If I had planned things better, the post would have included three pictures. Does that help?

Meanwhile, let me share Zach’s photo of my latest culinary experiment:


Cauliflower and Kale Salad

I had to leave out the garlic from the recipe (garlic is a guaranteed heartburn trigger for me, and I’m not taking any chances until I find out what’s going on with these crazy symptoms).

We both thought the salad was good but needed . . . something.

When in doubt, marcona almonds are a pretty good something!

The Eagle Has Landed

When I was a young child, my parents co-founded a synagogue with four other couples in our town. My dad was an early president of the congregation, and we belonged to the temple until we moved back to New York about 15 years later.

Forty years hence, that synagogue has grown to include almost 700 families. In the early days, however, it was a much smaller institution—and a nomadic one at that. Without our own building, we would hold services in members’ homes, in area churches, even in the local firehouse.

For a time, my father was one of the congregants responsible for transporting the torah safely to wherever services were being held that week. He and his fellow chaperones worked out a system through which whomever was delivering the torah would call to let the others know that their precious cargo had arrived safely. Taking a page from the recent Apollo 11 mission, they would simply say “The Eagle has landed.”

Last Wednesday, our two embryos safely made the journey from our fertility clinic in New York to our fertility clinic out here.

This was the one part of the process that concerned us most, because it was completely out of our control. And, of course, because we have only these two embryos, and no way to make more.

During our first visit to our new fertility clinic, we were so anxious about transporting the embryos that we could barely talk about it with the doctor without choking up. To his great credit, he saw that we needed serious reassurance and introduced us to his embryologist, who proceeded to give us a tour of the lab and show us exactly how our embryos would travel across the country—in an impressively sturdy tank that looked like a cross between R2D2 and a fire hydrant.

He also showed us the kind of vial in which our embryos were stored and how the vial fit into the tank, and then assured us that they would remain frozen inside for up to 10 days—long enough to withstand flight delays, LA traffic, and any other complications our overactive imaginations could conjure.

He also told us that they shipped and received frozen embryos all the time, to and from clinics all over the world, with no problems, and that this was absolutely routine. So routine, in fact, that they used FedEx for the shipping, at least in the U.S.

We walked out of the clinic feeling completely reassured, confident that we and our embryos were in good hands. And ever since, whenever we’d see a FedEx truck, we’d point and say, “Look! Our embryos could be in there!”

When it came time to have the embryos transferred, we were surprisingly serene. Still, Zach double- and triple-checked the arrangements on both ends. We even had to have the requisite paperwork notarized—everything was very carefully controlled.

Our clinic in New York actually has blackout dates and only ships on Tuesdays, and then only one couple’s embryos per day, so we had to select our ship date several weeks in advance. Tuesday, August 3, would have been Zach’s father’s 78th birthday, and it seemed a propitious date to choose.

So last Monday, our LA clinic shipped an empty tank—like the one we’d seen during our visit last year—for the New York clinic to use. And on Tuesday, the technicians strapped our embryos into the closest thing to a lunar module we’ll ever see and launched them on their journey.

On Wednesday morning, Zach got the call from the LA clinic, letting him know that our most precious cargo—literally cargo—had touched down safely. He hung up and phoned me right away.

“The Eagle has landed,” I instantly thought to myself when I heard the news.

And I know my dad would have said the exact same thing.

Ker-ching

Last Friday, Zach and I went to the fertility clinic we’re going to be using out here in order to undergo FDA-mandated screening for communicable diseases. (Not that there are any studies showing that such diseases, were we to have them, could be transmitted from an embryo to a gestational surrogate, but why quibble with the FDA?)

We each gave a few vials of blood and some fresh urine (so much better than the stale kind) and headed out of the lab, ready to go on our merry way. (In case you’re wondering, yes, I did pee on my hand in the process, even without the over-engineered specimen cup. That’s just the way I roll.)

Our way was slightly less merry when we saw the $860 bill for the lab work—well, most of the lab work. Some of the samples were sent to an outside lab, which will bill us separately.

Which means we will probably have spent a cool grand on these tests when all is said and done, exactly what it cost to store our embryos in the freezer at our NY fertility clinic—for a year. Speaking of which . . .

And a Third

I hesitate to post this, since I fear that it will cause undue worry and possibly result in perfectly well intentioned yet amateur diagnoses (not to mention prescriptions), but here goes:

I spent all of last Monday in the emergency room, for the first time in my life as the patient.

I started having a weird breathing thing (yes, that’s the technical term) after my spinning class the previous Friday. I felt fine during the class—it was strenuous, but no more than usual. Afterward, however, I felt some kind of tightness or at least unusual awareness whenever I took a deep breath. Kind of how it feels when you breathe deeply in very cold weather, but minus the cold.

Anyway, I felt fine the next day and went off to ballet class, which was relatively intense as ballet classes go—we spent 30 of the 90 minutes away from the barre, doing a beginner’s version of Agnes DeMille’s Rodeo—but I was no more winded than any of my classmates. After class, the weird breathing thing (WBT) returned, then abated.

I took Sunday off from exercise, but the WBT came back. Then it went away. Then it came back.

When I woke up Monday morning, I had not only the WBT but the distinct feeling of a hand pressing on the center of my chest, as if holding me back from a fistfight. It did not feel like an elephant sitting on my chest, and the pain did not radiate anywhere, but it was a palpable sensation.

I couldn’t get through to—or in to see—my internist, and after waiting a while for him to call me back, I told Zach that I thought we ought to go the emergency room. Even as I said it I felt ridiculous, but I also didn’t want to mess around. My family history is not great in the realm of the heart (heart attack, quadruple-bypass surgery, valve-replacement surgery, angina, high blood pressure, high cholesterol, atrial fibrillation, need I go on?), and I know that heart trouble is underdiagnosed in women and that, unlike men, women can have heart attacks with few, if any, symptoms.

So off we went.

The ER was quiet when we arrived. I was triaged and taken inside right away. I provided a urine sample using the most over-engineered sample cup I’ve ever seen—tragically, one that did not prevent me from peeing all over my hand. A nurse started an IV (painfully, unfortunately) and took a bunch of blood along with my vitals. In short order I had a chest X-ray, an electrocardiogram, and a bunch of labs. The X-ray was negative. The cardiac-enzyme test was negative. My blood count was normal.

The ECG was abnormal. I predicted this, because my last two routine ECGs were abnormal, and both times specialized follow-up tests were normal. The last one, an echocardiogram, was done in May of this year.

The ER doc consulted with my internist (funny how ER docs can get people on the phone) and proposed that I have a stress test.

I hadn’t had any exercise in a couple of days, so I figured the stress test would kill two birds with one stone, and off I went.

(The urine sample was never used, by the way, but it did follow me the whole day, sometimes sitting on a counter near my bed, sometimes traveling with me on the bottom of my gurney along with my stylish Patient Belongings bag. I did not find this reassuring. Or pleasant.)

A couple of hours, some radiation, a few pictures, and some quality time on an increasingly fast and steep treadmill later, I was told that my heart was absolutely fine, and I was sent home.

The only problem was that my symptoms hadn’t changed a bit. The new ER doc (the first one had already left for the day) told me that some gastrointestinal problems can present as heart problems. And I have a history of GI problems, although none that felt like this. Plus I had been belching a lot on Monday (although not on Friday, Saturday, or Sunday).

The nurse-practitioner who supervised my stress test gave me the name of a cardiologist who specializes in women and in micro-vascular disease (the stress test only looks at big arteries). She said that if I didn’t get an answer in the ER, I might want to see this woman for a more extensive work-up.

Three days later I had a follow-up visit with a different doctor in my internist’s office. (I could have seen my own doctor if I’d been willing to wait an extra week. I wasn’t.) Another chest X-ray (different view this time) and a breathing test both came back normal. I told him about the cardiologist I’d been referred to, and he agreed that she would be a good person to see. Until then, he said, no exercise except walking.

Unfortunately, the cardiologist can’t see me for more than a month—and actually, my appointment is with her associate. So while I am waiting, and calling twice a week in the hopes of a cancellation, I am also going to see my gastroenterologist (although not for another week, which is the earliest appointment I could get). I’m more and more convinced that this is a GI issue, but that’s not making me feel any better physically. I’ve still got the WBT, and the chest pressure, and the intermittent belching. And I miss exercising, which would likely help relieve some of the stress of worrying about what’s going on.

But, everyone keeps telling me, I should be relieved that it’s not a heart attack or one of the other scary things that have been ruled out.

And I am relieved.

But I’m also uncomfortable and distracted and stressed.

And Another

So much ink has been spilled—well, it’s not ink anymore, is it? So many bits? bytes? have been published? posted? wasted? on the subject of being overwhelmed by technology that I can’t possibly add anything particularly helpful to the discussion.

Let me just say that I am among the legions of people who are feeling crushed these days, not just by technology itself—though I curse my BlackBerry—but by the losing combination of constant connectedness, vastly accelerated communication speeds, and the near-universal expectation of instantaneity (direct correlation duly noted).

But more than that, I feel particularly overwhelmed, I think, because I am someone with a wide range of interests. I find that our wired world is much better suited to the specialists among us, those with deep and abiding interests in a relatively small number of subjects. These focused folks can now quite easily find—and stay updated on—not only all manner of online resources but like-minded aficionados the world over. They can locate and then help to build vibrant communities around those subjects, much as Zach has been able to do with fellow Orioles fans, connecting in a way that allows him to simultaneously share and deepen his knowledge of—and die-hard affection for—the team. He is able to stay up to date on everything from trades to player injuries to brilliant (and not-so-brilliant) plays, he can commune with other Camden Chat denizens whether the team wins or (more often) loses, and he knows that any Orioles-related news will be found—if not broken (sometimes by him)—on the site.

I don’t follow any sports teams (nor do I lead any). I don’t collect stamps or rare coins. I don’t idolize any particular recording artist or enjoy bird-watching. In short, I don’t have highly specific interests to which I devote regular time and energy.

Instead, I am a generalist.

I’m interested in good writing in many forms—fiction, nonfiction, drama, essay, criticism, opinion, and memoir. I’m interested in food—restaurants, recipes, nutrition, good sources for hard-to-find ingredients, interesting food-related events, and food-oriented travel. I’m interested in non-food-oriented travel. I’m interested in theater and film. I’m interested in politics and current events. I’m interested in medicine, in breast cancer, in cholesterol and triglycerides, in doctor-patient relationships, in patient-centered care, in humanism in medicine, and in medical education. I’m interested in all things New York and some things Los Angeles. I’m interested in adult learning, in ongoing education, in presentation skills. I’m interested in writers’ workshops and retreats, in publishing-industry news, in local readings. I’m interested in big ideas and fascinating people. I’m interested in mentoring and teaching. I’m interested in neuroscience. I’m interested in genetics. I’m interested in gender and gender stereotypes. I’m interested in the creative process, in psychology, in behavioral economics. I’m interested in the MacArthur genius grants and the Pulitzer Prizes.

The thing is that I cannot possibly indulge all of these interests—I either have to forfeit the great majority or resign myself to staying up to date in only the most superficial way, by scanning news feeds and Twitter streams and headlines in the printed copy of the newspaper to which I still subscribe in physical form. And both options are wholly unsatisfying to me, which I have demonstrated by trying to keep up with said newspaper plus a few magazines plus innumerable e-mail subscriptions, not to mention RSS and Twitter feeds. And I don’t even watch TV news or listen to NPR. (But I do feel guilty for not listening to NPR. So there.)

And while I am drowning in the relentless waves of information about all of the above, I am simultaneously submerged in e-mail at work and in the stacks of books and articles I want to read here at home. Not to mention the laundry that needs doing, the boxes that (still, two years later) need unpacking, and the many projects that need undertaking.

And what scares me most is that we don’t even have children yet. It’s just the two of us and one geriatric (and, fortunately, un-wired) cat.

I don’t have a solution for this (obvi, as Zach would say text), nor do I have time to try to find one right now—nor will I ever if this keeps up.

Suggestions welcome, although I can’t promise that I’ll actually be able to read them.

One Reason I Haven’t Been Posting

A very close friend of mine recently received a really tough diagnosis, and it’s fair to say that she and it have been preoccupying my mind ever since.

I’ve written before about what it’s like to be fearful and to feel helpless in circumstances like these, and re-reading those words has not made the experience any easier this time around.

I actually have been able to help somewhat—by facilitating a connection to another friend who’s the exact right kind of specialist in this case and who came through with a second opinion in the space of a few hours, and by offering some hard-earned wisdom from my own trips down this terrifying and unjust path. And I know both of those things have been valuable—maybe even invaluable.

But there is no easy way to worry about a friend and her family, to wait for updates that as often as not are no better than the last.

And there is no way to make sense of the news, even when it ceases to be new.

Of course, being far away—as I am, geographically, from nearly all of my dearest friends—only compounds the fear and the helplessness, only limits the things I can do to support my friend and her family.

And writing about it did not seem to offer any benefit.

I’m still not sure that it offers any benefit.

But I’m trying anyway.

Because it can’t hurt.

This Will Not Be 3,000 Words Long

Unfortunately, I did not snap photos of my latest culinary creations, but here’s a brief recap:

I’ve been a subscriber to Tasting Table for a few months now and really like their restaurant recommendations and their recipes (separate subscriptions). I finally tried their Crostini with Zucchini Pesto, mostly because I had planned to make a completely different zucchini dish that called for pine nuts, and Zach was unfortunately suffering from his second bout of “pine mouth” in the past year.

I hate that Zach has been suffering, but I love that this recipe is now going to part of our repertoire. The only hard part is wringing out the grated zucchini (like wringing out grated potato for latkes, maybe worse). Otherwise, it’s simple to make and well worth it—the flavor is unexpected and delicious, and the combo of raw zucchini, marcona almonds, lemon (juice and zest), and herbs is a winner. Next time I think I’ll try it on pasta. Yum!

For the same casual dinner party, I made a very simple Watermelon and Feta Salad. Couldn’t be easier to make (cut up a watermelon, add crumbled feta and pepper, sub shredded mint for the red-pepper flakes). It was good, and different, and refreshing, but it didn’t pop the way I’d hoped it would. (And this after I’d purchased fancy French feta, then decided that it wasn’t salty enough to stand up to the watermelon, so I used the Trader Joe’s feta that we keep as a staple.) Next time, I think I’ll try the Epicurious version with the balsamic glaze.

Finally, I saw these gorgeous baby eggplants at the farmers’ market last week and figured I’d find a host of possible recipes to showcase them. Turns out, there are tons of eggplant recipes out there, but not all that many baby eggplant recipes (that I found at least). I ended up cobbling something together from a few different sources plus some of the other ingredients we had around the house. (French feta, anyone?)

Here’s the recipe I made up and followed:

  1. Slice baby eggplants lengthwise, arrange on baking sheet, drizzle with olive oil and balsamic vinegar.
  2. Roast at 375 degrees until tender and lightly browned. (Probably could go higher with the oven temperature.)
  3. Remove from oven and transfer to broiler-safe dish.
  4. Top with crumbled (French!) feta and diced, seeded tomatoes.
  5. Broil just long enough to brown the cheese a bit and heat the tomatoes.
  6. Remove, top with minced fresh oregano and sea salt, and serve hot.

They were quite good, and I think the same basic preparation would work with lots of other toppings. Think baked-potato skins, only healthier!

And Another One

The name Esalen didn’t mean much to me—it conjured vague notions of a retreat tucked away on the California coast, maybe someplace to study meditation or participate in a drum circle or explore mind-body connections. It turns out that it’s all of those things, and much more—the Esalen catalog is filled with hippie-dippy, earthy-crunchy, enlightened-human offerings like “Bioenergetics of Emotional Healing,” “Music, Ceremony, Prayer,” and “Stoking the Creative Fires.” It seems like a mecca for spirituality and self-help, an artists’ colony, and a commune all rolled into one.

But when a co-worker mentioned Esalen to me, it was because of one very specific feature: natural hot springs that are open to the public for a couple of hours every day.

Now, those hours just happen to be between 1 and 3 a.m. (Yes, you read that right.)

And we were staying about 40 minutes south.

But when I heard that the springs overlooked the ocean and were open to the skies above, I knew that this was something Zach would want to do.

So I reserved a spot for each of us and kept the plan a secret until the evening before. When I sprung the idea on Zach, he was thrilled at the prospect—even though it meant sacrificing a good night’s sleep.

A little after midnight, we left our yurt, following the light of our flashlight to our car. We made the trip up the dark and winding Pacific Coast Highway, watching carefully for the Esalen sign on our left.

I’d been instructed to park in a small lot just before the sign, where we’d wait for a staff member to meet us. There was one other car when we arrived, and a few more pulled in shortly afterward. We all sat and waited in our darkened cars, lined up as if on some secluded lovers’ lane. Eventually, a golf cart approached, and we filed out and gave our names to the unlucky employee (or perhaps volunteer) who drew the late shift.

She consulted her clipboard, checked us off, and directed us down a dark driveway to a small security booth. The dozen or so of us whispered our way toward the illuminated booth, feeling self-conscious and conspiratorial at the same time. There we signed the obligatory waiver and then followed another Esalen-ite in silence through the compound and finally to the spa-like bath area.

We were given a brief tour of the communal changing room, opposite communal showers, and the baths themselves, including a lesson on how to add hot and cold water. Then we were left on our own.

Esalen’s hot springs are clothing-optional, and most people opt out. (For the record, I didn’t—I’m not particularly self-conscious about my body, but I am other-conscious, and I know that seeing a reconstructed breast, especially without warning, can make people uncomfortable.) Most of us got undressed pretty swiftly, but taking the requisite shower took a bit longer, and I will say that it was a bit surreal to turn around and see a naked man other than Zach showering beside me. Ahem.

The baths themselves are not lit, except for a few dim and downward-facing fixtures near the entrance, and everyone is asked to maintain a quiet atmosphere. We eventually settled in the outermost bath, which looked much like a hot tub, albeit one fed by natural springs.

We were perched over the ocean, with the breakers visible (and sometimes audible) below. There is no light pollution in that area, and the skies above were littered with stars. The Milky Way arched over us like a monochromatic rainbow, and in the course of our two-hour soak we spied half a dozen shooting stars apiece.

The entire experience was otherworldly—serene, soothing, and almost mystical. We talked a bit, in very hushed tones, but mostly gazed at the stars and the sea and each other, felt the crisp air on our faces, and soaked in the atmosphere and the healing waters.

Incomparable and unforgettable.

 

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