If you are lucky, this is the way cancer treatment ends, not with a bang but a whimper.
Let's see, of the treatments listed for me in November: chemo--it's done; surgery--done; radiation--done. It remained only to go see my oncologist, Dr. James Waisman, of whom I am preposterously fond, to ask the musical question, "Is that all there is?" And so, it seems, yes.
"In my mind"--he nonchalantly shrugged--"you're cured."
Just like that.
Is that really all there is? No brass band, no banners, no diploma, no certificate of completion? The news did come on a Thursday, even as the initial cancer diagnosis itself, and the symmetry of this pleased me, but as an overachieving, compulsive reader of novels, I need something more momentous for the climax. Sure, there were fireworks all over the city just two days later, but I'm told that happens every Fourth of July.
But of course, that's not really all there is. By "cured," what Dr. Waisman really means is there is "no evidence of disease" (the phrase most preferred by cancer docs), and by that we mean the dreaded lump and everything around it has beaten a retreat.
But there are no guarantees that something more won't pop up, and so to this end I embark on a regime of Tamoxifen and a steady stream of office visits every three months, with twice annual mammograms until, well, I guess until I die of something else, which, if Dr. Waisman does his job, won't be for a ridiculously long time.
Tamoxifen, up until about this past May, has been given to post- menopausal women after their breast cancer treatment to help reduce chances of recurrence. What's changed is that it's now been declared a good idea for pre-menopausal women, the category I fall into.
The analogy Dr. Waisman used, which I found rather delightful, was of a bucket sitting on a lawn, depriving the grass of sunlight and water. The water and sunlight are estrogen and the grass is my cancer, which is prompted to grow by too much estrogen. The bucket is Tamoxifen, and it needs to sit on that lawn for quite a spell.
It will take five years of little white pills twice a day, something I felt like whining about until an HIV-positive friend gently reminded me that his current protease inhibitor cocktail requires a daily diet of 48 pills for the rest of his life, which then should be a lot longer than a measly five years.
Still, his regimen probably won't make him feel menopausal, which I understand is a side effect of Tamoxifen and means further encounters with my new pal Hot Flashes, not to mention possible weight gain. Goody.
In any event, my overall reaction to the end of this period in my life has been one of anticlimax. Dr. Waisman's pronouncement notwithstanding, since more tests and lots more medication is in my future, I don't feel precisely done just yet. And in another way, I felt done long ago, since, perhaps, right after surgery. All treatments following felt less like cure and more like sweeping up anything left behind. Mentally and emotionally, I had checked out of Hotel Worry. And as soon as radiation commenced, I resumed a full workload. This may explain why I've been so blase about "the end." In my mind, I'd already ceased being an active cancer patient.
So what have we learned from all this? Hopefully, you've learned to check your breasts regularly, or to pressure anyone close to you to do so. This cannot be stressed enough. Finding a lump early, months or even years before a regular mammogram or doctor's exam, can mean the difference between relatively easy treatment (lumpectomy, say, and some radiation) with a nearly 100% cure rate, or losing the breast entirely, adding months of chemo and watching the survival rate plummet. Learn how to do it--it's not hard--and do it early and often.
As for me, well, just a couple of months before all this began, I looked at the 100 or so books piled up by my bed and proclaimed, "I need to get sick, so I'll have the time to lie around and catch up on my reading."
I've learned never to say that.
The irony is, those books are still there. During the times I was feeling well, I worked, and when I wasn't, I couldn't concentrate enough. My compromise was to haunt the children's section at the library, reacquainting myself with some old favorites, finding there comfort food for the soul.
Some have said to me, "You should be really proud, how you've handled yourself during all this." And it's true--I am proud. It's quite an accomplishment that I never watched daytime TV once, no matter how crappy I felt. (OK, except for during the Winter Olympics, but there were one's husband and sister, spellbound daily by curling and luge, and one is only human.)
I'm getting plenty of recommendations about what to do now to keep myself healthy, with most focusing on diet and exercise. Good advice, but then I think about vegan Linda McCartney and athlete Peggy Fleming, and I do wonder. Clearly, there is no magic formula, and so I've decided to spend my days lying on the couch, eating prime rib and chocolate. Just kidding. I'll eat more soy, I promise.
However, let me just say my new heroine is Julia Child. She had a mastectomy in the 1950s. The math alone--40 years survival--is heartening, but what's more, you know what she's been eating since then? That's right. Cream sauces.
Ultimately, I feel extraordinarily lucky. Not for the reasons you might think, though that too, but because if this had to happen to me, and apparently it did, it happened at the best possible moment in my life. I have a loving, calmly supportive husband to lay some of this burden on. I have two dogs who made me laugh every day, which is invaluable for healing. I work out of my home, so I had the right kind of office to feel yucky in. Being self-employed, I could tell myself it was OK to take days off. And all the people who give me the work that I do were incredibly understanding about this, and patient until I got back up to speed.
I also had wonderful friends, who lavished gifts and grace--hats, flowers, food, videos, books and items to make me feel pretty during one of the ugliest times of my life. Actually, that's kind of a problem, because now I'm used to getting stuff.
"Forget it, that's the last thing you are ever getting from me," said Rick as he brought me chocolate to celebrate the end of radiation, and I understood.
I really won't complain much if Tamoxifen makes me gain weight, because it's better to be around to gain it than not. And to be around would not be possible without the finest of medical care. So take a bow, one and all. From the Breast Center in Van Nuys, Dr. Waisman, Dr. Silverstein and Dr. Gamagami, ably assisted by Helena, Maureen, Maryann, Lacey and Malina. At Huntington Memorial radiation therapy, Dr. Rose, Stella, Marianne and Atul.
You all absolutely, utterly and completely rock.
And then some. And then there are those of you who have read these stories. Thanks to you, when times were nasty, I could get through them by thinking, "I really hate this. How interesting--I must remember to write about it."
In return, I hope to do this one thing for you, a thing I first did inadvertently for my friend Monah. Early on, I was telling her all about the big fun I was experiencing when she suddenly interrupted me.
"You know, Mary," she said, "I've always been afraid of something like this happening to me. But I 'm listening to you now, and you sound so perky, and I'm thinking, 'This isn't so bad. I could totally do this, if I had to . . . ' "
She's right. It's not, and you could.
But don't, OK?
Mary's Story has been published monthly in Health since December, 1997.