Afterword

Write about it.
____________________

From: Laura
Date: Thursday, March 20, 2008 3:47 am
To: Jennifer
Subject: Looking back

Hi Jen. I haven’t written you a middle-of-the-night email for a long time. So many stories to tell!

It’s been a tough six months since I went into remission. I was exhausted and went into a depression that lasted for several months. While you’re getting chemo, you’re highly focused and the adrenaline is pumping. All of your energy is geared to fighting cancer, which has got to be one of the world’s best enemies. There’s no time or energy to reflect. The agenda is simple: survival. You hang on for dear life. Then the battle ends, and some people think that once the cancer is in remission, you’re done, and you can go back to business as usual. They’re wrong. Surviving cancer is like weathering Hurricane Katrina: after the storm has passed, you need time to survey the damage and begin to rebuild.

The post-chemo depression took me by surprise. It’s hard to accept that your body isn’t the same as it used to be. Before cancer, I had been highly energetic: picture the Eveready Bunny (“it keeps going and going…”) in the hospital, juggling multiple activities at once, and that was me. After chemo, I had to learn to live with fatigue and with a new cognitive style: I could no longer multi-task. I’ve since spoken to lots of cancer survivors, who tell me that the loss of multi-tasking ability after chemo is fairly common. Changes in your body or persona can be experienced as a loss, and as with any loss, you may grieve. It helped to view the depression as a foggy beach, with the sun hidden behind it; I knew that somewhere in there the sun was shining, and that eventually I’d find it. I also used my hospital’s survivorship program when I could, although sometimes it wasn’t possible—for example, one night they had a lecture on “Coping with Fatigue after Cancer Treatment,” but I was too tired to go!

The chemo part of my treatment is over, but I’m continuing on maintenance therapy for at least two years. Once every two months, I get an infusion of Rituximab, the monoclonal antibody against B lymphocytes that had been the R of the R-CHOP regimen that I received during chemo. I’ve kept the port in my chest, so they can give the Rituximab through that. Because the Rituximab compromises my immune system, I continue to take a slew of pills to prevent infection. The chemo put me into menopause, so I take hormone replacement—until I started taking it, I was constantly throwing open the windows on freezing cold days, and David would have to go put on a warm pair of socks.

A surgeon I know once told me that as a working mom, you juggle three things: (1) work, (2) family, and (3) taking care of yourself; at any given time, you get to focus on two out of three. Item (3) is especially challenging when you’re dealing with ongoing treatment and the aftermath of chemo. To accommodate my body, I now work four days a week (80%): two in the Women’s Office and two in Radiology. I’ve resumed seeing patients and doing procedures. Thursday is my day off and it fills easily, with doctors’ appointments, music, reading, tea with Q, and naps. I sleep for most of the weekend to recover from doing clinical work on Fridays.

Having cancer changes you in unexpected ways. I selectively use my experience to help patients. Sometimes if I tell a patient that she has cancer and she takes it hard, I tell her that I’m a cancer survivor, that I beat it and so will she. I tell her what I learned about finding your friends, asking for what you want, and “playing the cancer card.” I also give lots more anesthesia for procedures than I did before. It’s odd how when I was first diagnosed, I felt like a doctor pretending to be a patient. Now, sometimes I feel like a patient pretending to be a doctor. The other day, I did a biopsy on a woman with a breast lump, and when I signed the consent, I signed as the patient!

Sometimes friends ask me how I stayed so calm during chemo—why didn’t I “lose it” more often? (Funny, my super, Jesus, never asks me that.) The survival techniques I summarized in the lists I sent you were incredibly helpful. In addition, cancer gave me something I hadn’t ever given myself—a break. I’d always been an intense workaholic. Having cancer forced me to slow down and look around, and once I looked around, I liked what I saw. If I had to have cancer, I’m glad that it happened when both of my kids were still at home so I could spend time with them. I can’t redo the past, but I can use my experience to find a better balance in the rest of my life and to help other people find balance in theirs. Now that’s a real silver lining.

After I finished treatment, I spent several weeks cutting and pasting all of the emails I had written about my experience (mostly to you) into a Word document for the book I’d planned, but when I finally put it together, the book was 951 pages long. The idea of cutting that massive tome into a book of manageable size was daunting. The information was so raw and fresh that I didn’t feel I could cut any of it—it was all too important—so I put it away for awhile. Now, six months later, I’m still exhausted but the fog of depression has lifted. I started thinking that I’d like to turn the book into a series of interconnected short stories, and that it would help me accomplish that if I met other writers off whom to bounce ideas.

Nate went online with me to look for writing classes. He found the Gotham Writers’ Workshop, a funky New York group that has writing classes all over the city. I found a course that meets on Wednesday nights on the Upper East Side, about halfway between work and my house. I thought that would be perfect, especially since I’m in the Women’s Office on Wednesdays so I shouldn’t be as exhausted as after a day of biopsies. Also, I don’t work on Thursdays, so if I’m inspired by the workshop on Wednesday night, I have the next day to write.

The class started in early March, and I love it. The teacher, Tania, got her Master’s at Columbia, and will publish her first novel in the fall. There are 12 students, six women and six men. It’s a diverse crowd, ranging from a kid Nate’s age to a woman about to retire. Other students include a TV producer, a guy who writes advertising copy, a woman who teaches high school English, and a couple of people who work at Barnes & Noble. Another student is a woman in her twenties who takes pole dancing (when I told Emma the story, she rolled her eyes and said that pole dancing is popular; many celebrities do it for exercise. Who knew?). Most of the students want to write short stories but one man is working on a novel.

The best part of class is called “Booth.” When it’s your turn for booth, you have to give copies of 15-25 pages of original writing to all class participants. They take it home to read and give comments the next week. First, we go around the room and everyone gives a positive comment, and then we go around again and everyone gives an “improvement” comment. They needed a volunteer for week one, so I raised my hand. I had already decided to write about the hats Emma and I went to buy at the beginning of chemo. I thought I’d tell it from a third person point of view, lulling the reader with lush language describing the hats’ colors and fabrics, and not revealing until the end that the woman is buying the hats because she is about to start chemo and lose her hair (and possibly her life). A surprise ending, like in “The Necklace” by Guy de Maupassant.

I went to the computer and opened my file marked “Book” and browsed through it for the first time since the fall. Amazing—what had looked so daunting to me before now seems absolutely manageable. It stands together as a book, and I’m going to write the book. When I look at the first draft carefully I see that sometimes I tell the same story several times to different people in different emails, so often I have multiple drafts of the same material. The redundancy makes it easier to trim and lets me choose the best elements of the story to combine into a cohesive whole. So when it’s my turn for Booth, I bring in 15-25 pages of the book.

Since I’ve resumed writing, I’ve been waking up again from 3-5 am, now without the help of steroids. Maybe in writing the book I’m putting myself back into the frame of mind that I had during treatment, and maybe that will help me recreate the story. It will be a huge job. Even with the distance of six months, some of the stuff seems so precious that it’s hard to cut, even if it doesn’t serve the story. A writing teacher named Carol Winkelman once told me that when you’re editing, sometimes you have to “slaughter your darlings,” meaning cut something you wrote that’s close to your heart. She suggested that rather than deleting, you simply cut and paste the section you’re omitting into another file (I call mine “out-takes”). This technique makes it easier to edit because material isn’t being destroyed, just relocated. Sometimes I think that my father wanted me to be a doctor and a writer—he used to tell me that Chekhov did both.

It seems appropriate that the end of my book is written about a year after treatment began. I’m spending more time with my family, and they’re doing great. Nate will hear from colleges soon, and will graduate from high school in two months. Emma loves art and writing and is planning what she’ll do this summer. David and I go to jazz clubs, and love to discover new musicians. My hair is growing back; last week I had my first bad hair day, and it was glorious! For spring break, the four of us are going to Sedona, Arizona, where we’ll hike the red rocks together.

My cancer experience reminds me of the quote below from the great book, The Hours, by Michael Cunningham. Have you read it?

"Yes, Clarissa thinks, it's time for the day to be over. We throw our parties; we abandon our families to live alone in Canada; we struggle to write books that do not change the world, despite our gifts and our unstinting efforts, our most extravagant hopes. We live our lives, do whatever we do, and then we sleep—it's as simple and ordinary as that. A few jump out of windows or drown themselves or take pills; more die by accident; and most of us, the vast majority, are slowly devoured by some disease or, if we're very fortunate, by time itself. There's just this for consolation: an hour here or there when our lives seem, against all odds and expectations, to burst open and give us everything we've ever imagined, even though everyone but children (and perhaps even they) knows these hours will inevitably be followed by others, far darker and more difficult. Still, we cherish the city, the morning; we hope, more than anything, for more. Heaven only knows why we love it so."

Jen, I can't thank you enough for being my “gentle reader” through all of this. Parts of it were very scary, especially in the beginning, and it helped that no matter what was going on I could write to you and I knew that you would read it, care, and respond. Once I had one dose of all the different kinds of chemo it was less scary, and once the mid-chemo re-staging tests were OK I felt like I could conquer the world. And you were always there, through all of it.

Being able to write to you about my cancer helped me for so many reasons. I got to express myself, to understand how I felt by writing about it, and to create something to leave behind even if I didn’t make the 50/50 shot. Also, writing this book allowed me to feel that my cancer served a purpose: I produced something that might help others, either by offering suggestions on how to deal with cancer or by simply providing distraction during those long days of treatment and recovery. And I hope I can hold on to what I learned about savoring celebrations, even if the cancer is gone for good.

I wonder—what’s next?

Love
Laura