Gratitudes

I have been extra grumpy possibly because of:

1. delayed reaction to cancer experience
2. sudden-death menopause
3. exotic post-op infection
4. hurricane-force antibiotic
5. decision to go off pain pills because dang! they're getting to be a little too nice

so I decided to count my blessings, which always helps:

1. cancer contained and removed and now miles away in some pathology lab
2. NO MORE BLEEDING! I haven't celebrated this enough yet. I am grateful, grateful, grateful for no more tampons, no more pads, no more accidents, no more "I've got to stay next to a restroom," no more soaking underwear in cold water, no more flooding when I stand up, no more black trousers only, no more jumping out of bed for the bathroom in the middle of the night (well, the hurricane-force antibiotic keeps that going, but only for 9 more days)
3. John, my support , friend, and lover
4. my beautiful garden which I spend hours in every day, thanks to Amy, Jamison, and John
5. water retention over with (I weighed 18 lbs more when I came home from the hospital than I did when I went in four days earlier--now it's gone)
6. light at the end of the tunnel--swimming at the BYU pool! walking around the block or up to the cemetery! hiking! camping--even backpacking!
7. Chris, who is just--it's like living with a young Jim Morrison, an aesthetic experience in and of itself.
8. my psychotherapy practice and patients I'm starting to miss.

I have a great life. Maybe that's the main point--I have a life. Three times now I've made it into more years via surgery, brutal, hacksaw treatment that it is. I'm grateful for that.

Biopsy

My Cylon gynecologist came by this afternoon and said, "let's check to see if your biopsy results are in," and I didn't even have time to get scared. The endometrial cancer had formed a 2 cm tumor inside the uterus, and had penetrated 2 mm into the 3 cm uterine muscle wall, so it wasn't Stage 1a, but it is close. The edges of the tumor were distinct, including where it had invaded the muscle tissue, which is good, and the cancer cells were grade 1, which is also good. There was no evidence of cancer in the ovaries, fallopian tubes, cervix, abdominal cavity, or lymph nodes.

My Cylon gynecologist said that she thinks they got it all, although she'll have to check with the cancer specialist who helped with the surgery. She doesn't think I'll need further treatment--surgery, radiation, or chemotherapy. Amy was with me and asked all the sensible questions, as I was not quite comprehending what was going on. Abdominal surgery is a giant pain, like getting bayonetted in the gut, and I have been sick for awhile (that's why I'm not home yet), but hopefully tomorrow I will be home with everything functional that I wanted to hang onto, but cancer-free.

And uterus-free, the added bonus. 'Course now I get instant menopause, but that's a small price to pay. Uterus, you served me well but I'm glad to retire you.

We're Going to Have a Wake

Everyone with an interest in my uterus will be invited--past interest, alas, as my uterus and its accouterments are now on their way to the biopsy lab, where we will discover if the organ which is now dead has any chance of coming back and biting me on the butt. That would be the Zombie Uterus.

I think I'll bake a Uterus Cake, since the original will sliced, diced, frozen, and unavailable for viewing. With pink and brown frosting, and Red Vines licorice for the fallopian tubes. We will each tell stories of our experiences with my uterus (to a point), and maybe sing a dirge. Amy and I were trying to pick a song last night. Maybe "Suite Judy Blue Eyes:"

It's getting to the point

Where you're no fun anymore.

I am sorry.

Sometimes it hurts

So badly I must cry out loud.

I am lonely.

I am yours. You are mine.

You are what you are---

And you make it ha-aa-aard.

Sunday morning, Tuesday in the afternoon.

What have you got to lo-o-ose.

Friday evening. Please begone, I'm tired of you.

What have I got to lo-o-ose, & etc.

For those of you not familiar with 70's rock and Crosby Stills Nash & Young, check the Youtube link above.

Well my lunch is here (at Utah Valley Regional Medical Center) and John is eating my jello, so I'll continue this later. Thanks to all for your best wishes and prayers.

Anxiety

I don't sleep well. This along with having trouble focusing on complex, tedious tasks (writing psych reports) are the only symptoms of anxiety so far. Maybe also overanalyzing--but that's my standard defense mechanism and I have no intention of giving it up at this point.

I figured out why last night, after remembering how things were when Lucy died. I remember several times dreaming that she died just before I woke up in the morning. I would wake up crying. One morning I didn't remember until after I woke up, and it was like her death hit me all over again. Now, I think I wake up early to remember--oh yeah, I have cancer, right. I can deal with it, I've figured it out, I have my defensive structure in place. But it isn't just sleep that can make me forget. I found the new True Blood season and watched the first episode (trash vampire TV series), but in watching it, I forgot. When I remembered afterward, it was like getting punched in the stomach.

I am able to deal with it--the uncertainty, the nearness of death--when I keep it in mind, have a memory trail to it, am prepared. It costs spontaneity and mindless relaxation. I'm a fortress waiting for the inevitable onslaught--war has been declared but not yet joined. I see the campfires of the opposing army on the horizon. I can't run. I can't go out to meet it. So I marshal my forces and watch from the walls.

I also realize the silliness of an ordinary, fat, privileged, middle-age white woman thinking in such martial metaphors, but what the heck, we survive to the end however we can.

Chances

Here's a quote on survival from the NIH.

"The survival statistics presented here are based on relative survivalX Close
A measure of net survival that is calculated by comparing observed (overall) survival with expected survival from a comparable set of people that do not have cancer to measure the excess mortality that is associated with a cancer diagnosis., which measures the survival of the cancer patients in comparison to the general population to estimate the effect of cancer. The overall 5-year relative survival for 1999-2006 from 17 SEER geographic areas was 82.7%.

Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
1999-2006, All Races, Females

Stage at Diagnosis	Stage Distribution (%)	5-year Relative Survival (%)
Localized (confined to primary site)	69	95.5
Regional (spread to regional lymphnodes)	19	67.5
Distant (cancer has metastasized)	8	17.1
Unknown (unstaged)	4	55.5"

So my chances actually look pretty good.

Thoughts on Cancer

My chances of survival are exactly the same as everyone else's--that is, 0%. I'm always struck by how we know this fact but are able to simply not believe it. The only other time death has been a big deal to me was after Lucy died, and I remember then realizing that my attraction to death was the result of severe psychological injury, and that to some degree I could measure my recovery by how quickly and completely I regained my irrational denial of my own death.

My chances of dying sooner rather than later have gone up. I will have a better notion after the surgery. Will it be 30 more years, a more or less normal lifespan and what I would expect if cancer were not involved? Will it be six months, three years, ten years, dealing with cancer and its horrendous treatment throughout whatever time is left?

I remember some years ago thinking about some of the more degrading and painful deaths possible, and idly considering methods of suicide if I found myself on the road to such a death. "I'd have to do it while I still had enough autonomy to manage it," "it would have to be an 'accident' and undiscoverable," "it would have to be quick," etc. I have discovered that I am not up to suicide. I don't really want to "fight" cancer (as in "after a long and courageous battle with cancer, _______ passed with her family beside her"), but I also don't want to hurry it up. I'll go out like a passive resister being arrested by the authorities while practicing civil disobedience--no flailing or yelling or violence, but no helping it along either. I'll be a dead weight (ha!) I'm interested in observing the process--witnessing it.

Amy caught me reading the obituaries. "Why are you doing that?" she said suspiciously, as if an interest in death made it more likely. Before, I morbidly read the obituaries looking for evidence of young suicides, particularly gay suicides. Now I look for "lingering illness," "courageous fight," etc. To add to this morbidity, nearly everyone I tell (not many yet--the opportunity doesn't come up in casual conversation, oddly enough) relates their personal cancer stories back to me. "My sister had cancer..." "When my mother-in-law died of cancer..." and so forth. Usually they stop just after giving the gruesome details, with a somewhat sheepish look. It is similar to the time after Lucy died, in which I found myself comforting and reassuring all my loving acquaintances as they didn't know what to say and said it. It was exhausting then. I'm not to that point yet, but I am a little more panicky than after Lucy's death, simply because by the time I realized her death it was already over, while mine is in the future--uncertain, but on the horizon.

People also don't know what do say or how to deal with it, and I feel a tiny bit avoided. That's OK too. In some ways my analogy to the passive resister is inaccurate. I have an obligation to be here for the people I love for as long as I can, and to help them deal with my death as well as they are able.

Despite my habitual stance of proactive pessimism, the diagnosis was a surprise to me. (That was a surprise to me too). But I found that I could finish my patient appointments of the day, tell my family calmly, and proceed with my life. It feels like denial, but it's more just practicality. I remember when Dave was burned, how grateful I was to all the medical personnel (at least after we got him to the burn unit) for their cheerful, practical, matter-of-fact competence. I'm sort of treating myself that way.

I'm sure I'll have hysterics at some point--in fact I had an argument with my Cylon gynecologist about stopping the aspirin two weeks before the operation. "If I have a ministroke before August 9th, I'll let you know!" I said. "All right!" she said. "You're not going to have a stroke. But take your aspirin if it will make you feel better. Just let me know ahead of time." So I recognize this as a function of anxiety--I have cancer, I'm facing major surgery, I've never had a blood clot, but I pick this issue to obsess about rather than any other? (And I still think they--the medical community--have no clue what anticardiolipin antibodies mean or how they originate--but the aspirin anxiety is probably irrational).

Another issue--perhaps not so irrational--I've had the same symptoms for at least the last two visits to the gynecologist's office. Last time I even had an "inconclusive" biopsy and ultrasound, but no one suggested further exploration or treatment. Certainly no one mentioned cancer. I'm sure I misheard or misunderstood, but my take-home message from the last two visits was "lose weight, and then we'll talk." What was the difference this time? I wonder if it has something to do with the fact that I never saw the same practitioner twice--Cylon gynecologist, then physician's assistant, then nurse practitioner, then another nurse practitioner. My Cylon gynecologist can't even remember that I saw her first.

On the other hand, I really can't afford to consider "what ifs." After Lucy died, it was no use thinking, "if only I went to the doctor 24 hours earlier." No one has total control over all the chances of life, and pining over or being angry over lost possibilities would cost me too much.

A Medical Aside

I went to the hematologist at UVRMC on Monday, and he said he doesn't think I have an anticardiolipin antibody problem (although I do have the antibodies and test "moderately positive") because I have no evidence or history of a clotting problem. He said he would send an email to the blood guru in SLC to ask about precautions with surgery or cancer treatment. He was the one who called him the "blood guru," which is kind of reassuring, actually.

I have another appointment with my Cylon gynecologist on this coming Monday to talk more in depth about diagnosis and treatment options.

I keep thinking all this stuff about blood and illness and cutting and femaleness and so forth is very linked to the whole vampire/werewolf world.

Life Is A Mortal Condition. There Will Be No Survivors.

Just diagnosed with endometrial cancer. There was not a tumor two years ago when I had an ultrasound--now there is, like a peanut-sized fetus in my womb. I have surgery August 9th to see the extent of it and take out my well-worn reproductive system.

Very steadying to the mind, but it does interfere with my early morning sleep. (I should go to bed sooner--that might help).