The Waiting Game

 

“Of all the hardships a person had to face none was more punishing than the simple act of waiting.”

Khaled Hosseini, A Thousand Splendid Suns

 

In this powerful quote Khaled Hosseini, the author of The Kite Runner and several other internationally acclaimed novels, speaks of the pain of waiting. Throughout my cancer journey waiting, along with uncertainty and fear, have been my constant unwelcome companions. Of course there have been the endless hours spent in doctor’s waiting rooms and waiting in diagnostic imaging departments for CT scans, MRIs and a multitude of tests. I can’t believe how accustomed I’ve become to these environments and to the monotonous routine that they now so strongly represent.

I close my eyes and I can visualize the waiting room chairs, the reception desk, sometimes a television for distraction, and always the tired and worried looks on the other patients’ faces. Some attempt to engage in small talk with other patients or with the caregivers who have accompanied them, others sit silently or try to read or distract themselves with electronic devices. My waiting time at the outpatient clinic at the Tom Baker Cancer Centre is typically half an hour to an hour. It’s common knowledge that Calgary is in dire need of a new cancer centre, as the Baker Centre is more than thirty years old and way over capacity with the volume of patients it now must serve.

waiting room

My memories of waiting for chemotherapy sessions in the late winter and early spring of 2012 are still extremely vivid in my mind. I can laugh now, but at my first appointment I was worried that some of the veteran chemotherapy patients might be able to tell that I was a newbie. They would ascertain that I looked too healthy and had all of my hair! When I arrived, I noticed that the people around me seemed to have many types and stages of cancer; what is more, a good number of them exhibited full heads of hair. After a short wait of approximately 15 minutes, a nurse led my mother and I into the Baker Centre’s large daycare treatment area. My heart beat faster as we reached my assigned space and I settled into a recliner by the window. The nurse explained what she was doing as she inserted my IV line and then attached some anti-nausea medication in preparation for the potent cancer-fighting drug, carboplatin.

As unpleasant as waiting for physical examinations and chemotherapy appointments can be, for many cancer patients it’s anticipating a future over which they have little control that seems so much more ominous and stressful. I live with the constant pressure of waiting for outcomes that I cannot completely control. When I was originally diagnosed with endometrial and ovarian cancer three years ago, I was referred to the Tom Baker Cancer Centre where my case was reviewed by the Gynecologic Oncology Tumour Board. This team of doctors and specialized pathologists reviews all new referrals to ensure correct diagnosis and to recommend the best treatment plan. Almost instantly I became the patient of one of Western Canada’s most renowned pelvic cancer surgeons, Dr. Prafull Ghatage.

hourglassMy first consultation with Dr. Ghatage now seems like a lifetime ago. In a few months I’m scheduled for another routine checkup at the Tom Baker Cancer Centre. It’s essential that I be monitored regularly for a possible recurrence or any signs of malignancy; ovarian cancer has a notoriously high recurrence rate. Many women with the disease face at least one recurrence within five years of their first diagnoses. Without resorting to an abundance of medical jargon, I’ve been diagnosed with stage IIIC2 adenocarcinoma of the uterus and stage IC adenocarcinoma of the ovary. As I await my next appointment on February 10, 2015, the encouraging news is that I’m currently in remission—at least I am to my knowledge—and my chances of a complete cure are better the longer I remain in this state. The Canadian Cancer Society defines remission as a decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. According to Ovarian Cancer Canada, 80 per cent of women diagnosed with ovarian cancer will achieve remission.

However, it is unknown if the cancer will come back or how long before it comes back. These unanswered questions linger in every woman’s mind that has ever been diagnosed with cancer and all we can do is wait for the resolution. In the meantime, I’ve made my health my primary focus—a nutritious diet, an appropriate exercise routine and getting enough sleep have never been more important. Obviously I’m careful to take my daily medication; I’ve been prescribed the drug Megace (generic name megestrol), it has been known to reduce recurrence rates in uterine, ovarian and breast cancer patients. Finally, hope and my steadfast determination to live each moment of my life fully and completely remain my allies in this dreadful waiting game. “How much of human life is lost in waiting,” wrote the 19th century transcendentalist Ralph Waldo Emerson. As I continue to face the many realities of cancer in the 21st century I can strongly relate to this long ago observation.

timepiece

 

 

Mindfulness and Cancer

Managing psychological stress when you have cancer can be extremely difficult. How can you experience moments of stillness, relaxation and contentment when your mind is constantly preoccupied with your disease and what impact it might have on your future?

Even when the apprehensiveness over a cancer diagnosis is taken out of the equation, getting our mind to embrace a sense of calmness is often difficult. If you start paying attention to where your mind is from moment to moment throughout the day, chances are you will find that considerable amounts of your time and energy are expended in clinging to life’s memories or regretting unfortunate things that have already happened and that are over. And you will probably find that as much or more energy is expended in anticipating, planning, worrying and fantasizing about the future and what you want to happen or don’t want to happen.

Cancer only exacerbates this inclination; in particular there is the fear and uncertainty. Having cancer means facing the unknown trajectory of the disease, the side effects from chemotherapy or other treatments and the possibility of death. Even thought the doctors have reassured me that I’m in remission, I’m often consumed with anxiety. Like thousands of other women in my situation my mind seeks answers to the inevitable questions. How long will I remain in remission? If I have a recurrence, how can I possibly find the physical and emotional strength to contend with going through everything all over again?

Yoga

I’ve discovered that one of the best ways to quiet my mind and focus my attention is a technique called mindfulness. Jon Kabat-Zinn pioneered using this method with cancer patients and other groups battling chronic pain or illness at the University of Massachusetts Medical School. Mindfulness is basically just a way of paying attention, a way of awakening our minds and being present in the here and now. With principles found in Buddhism, mindfulness teaches us to live moments in each day rather than focusing on what might lie ahead.

Although mindfulness mediation is frequently taught and practiced within the context of Buddhism, it has been argued that its essence is universal. Mindfulness is universal and transcends nationality or culture because it’s essentially a technique for looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced by cancer patients without appealing to Asian culture or Buddhist authority to enrich it or authenticate it. Advocates contend that mindfulness stands on its own as a powerful vehicle for self-understanding and healing.

Kabat-Zinn

Jon Kabat-Zinn

So how do you learn to live in each moment and remain focused on what is occurring in the present? How do you become skilled at practicing mindfulness? According to Jon Kabat-Zinn and other teachers mindfulness can take a lifetime to fully master. However, getting started isn’t difficult if a person is motivated to practice and doesn’t expect some magic resolution to life’s problems or to all of their cancer related issues. Its been said that the most insidious enemy of any type of daily practice is our North American culture’s relentless celebration of immediate gratification. Below I’ve listed some of the essential principles of living mindfully:

  • When a cancer patient approaches mindfulness formally in a group or classroom setting one of the first things that they will learn is how to use focused breathing techniques. This helps them to discover their body and how it responds to stress and other emotions. By concentrating on their breath, they can also gently pull their mind back to the present moment when it wanders.
  • Mindfulness is cultivated by simply observing our experiences and not judging them. The natural human tendency is to categorize or label almost everything we see. These judgments often come to dominate our minds, making it difficult to ever find inner peace.
  • Some cancer survivors choose to practice mindfulness meditation or gentle yoga. A study just published in the Journal of Clinical Oncology found that women with breast cancer who practiced yoga had lower levels of stress hormones. They also reported less fatigue and a better quality of life. It’s generally recommended that you ask your doctor if you can participate in yoga, then find a yoga instructor with experience leading a class that includes cancer patients.
  • In our overwhelmingly goal oriented and results driven culture mindfulness is one of the few practices that is essentially a non-doing. It has no other goal than for you to be yourself. For example, when you meditate you’re encouraged not to set specific goals such as I’m going to relax now, I’m going to become more enlightened or I’m going to control my pain. You have nothing to strive for, except perhaps a better recognition and appreciation of the present moment.
  • Acceptance and letting go are crucial components of mindfulness. A philosophy of mindfulness encourages us to come to terms with our life, even difficult experiences such as a cancer diagnosis. Acceptance means seeing things as they actually are in the present. Mindfulness doesn’t require that you have to like your situation—you don’t have to assume a passive attitude toward suffering or life’s unfairness. However, you must come to terms with things as they are and accept them, whether it’s a diagnosis of cancer or learning of someone’s death.

In spite of everything, cancer can be a wake-up call to the value of life, an incentive to live the life we want or believe we were meant to live in the time we have left. Mindfulness, with its emphasis on the present and living each moment fully, can help guide some cancer survivors through this profound journey.

Ralph-Waldo

The Blame Game: Guilt and Cancer

One of my New Year’s resolutions for 2014 is to more effectively manage the guilt or shame that I sometimes feel concerning my cancer. It seems unfair considering all the other unpleasant emotions that cancer triggers, but guilt in its various forms is a constant enemy waiting to attack cancer survivors and their caregivers.

It’s been well documented that many cancer survivors have feelings of shame or guilt, particularly around the notion that they may have played some part in causing their cancer. Certain cancers, for example lung cancer, have especially strong stigmas attached to them in this regard. “He smoked heavily, so what did he expect?” When it comes to cancer we often subtly, or not so subtly, blame the person for his or her disease. Friends, family members or strangers often do this unwittingly, in an attempt to rationalize a painful reality and to cope with it better themselves. Human psychology being what it is, whenever we can construct an explanation for something, it makes us feel a little better. Experts, such as renowned scientist and author Jon Kabat-Zinn, emphasize that blame only robs an individual with cancer of the present by directing their attention on the past—it undermines them when they most need to focus their energies and face the reality of having a life-threatening disease.

guilt

While gynecological cancers don’t involve the same degree of stigma as lung cancer or some other forms of the disease, I’ve still experienced times when I’ve felt that I might be to blame for my illness. Leading up to my diagnosis, I was having symptoms that could indicate uterine and/or ovarian cancer and my doctor recommended surgery. At first I was somewhat hesitant due to fear and denial of my situation. I had never been hospitalized or had any type of surgery before, now I was being informed that I should have a total abdominal hysterectomy as well as the removal of my right ovary. My gynecologist had to “twist my arm” to a certain degree. I ultimately consented to the procedure when I realized that it was in my best interest. What would the outcome have been if I had chosen to have the operation sooner? Would my endometrial cancer be less advanced, lower than the stage III that I am currently diagnosed with? Would it have had time to spread to my lymph nodes and affect my right ovary?

There is no way to determine these things for certain, but I do regret my hesitancy to take action. Everyone has done things that they wish they hadn’t. My argument is that there is a difference between taking responsibility for the consequences of actions and feeling like you deserve to be blamed. It may be true in some cases that our lifestyle or health care choices increase the odds of getting cancer or contribute to cancer progression. No doubt in such circumstances changing certain behaviours may improve your health. However, allowing yourself to absorb blame and feel shame will almost certainly make matters worse. Instead, it’s better for cancer survivors not to let shame and guilt keep them from moving forward, getting the support they need and deserve, and living in a healthier way. Shame and guilt are unnecessary burdens to carry. From everything that’s known about the emotions and health, acceptance and forgiveness are what we need to cultivate and enhance healing, not self-condemnation and self-blame.

Guilt-2

This having been said, there are numerous other ways in which guilt manifests itself in the lives of cancer survivors. Guilt takes sinister forms for us, like feeling shame for the envy we feel about those who are in good health; feeling guilty about the disproportionate amount of attention we receive, and even guilt about surviving cancer when so many others have not. I remember feeling guilt-ridden when I was undergoing cancer treatment and unforeseen complications occurred. My condition ultimately caused me to spend over a month and a half in Calgary’s Foothills Medical Centre. As my primary caregiver, my mother had her life completely turned upside down. Although she is semi-retired, she took a leave of absence from her part-time job and rearranged her daily schedule to visit me. My brother also took some hours off work at the law firm where he practices. Suleika Jaouad, a young American fighting leukemia, describes herself in similar circumstances:

“I feel guilty when I start feeling sick or get a fever. I want to apologize, for I know I will soon make the life of my loved ones hell. My mother will have to drive four hours in the middle of the night to take me to the hospital in New York City. Family will have to take sick days from work. After long days at the office, my boyfriend will spend night after night sleeping between two hospital chairs. My father will “hold down the fort” at home (this translates to lonely nights spent worrying by himself and feeling very far away from my hospital room).”

Finally, as I’ve alluded to, some cancer patients experience the discomfort of what is termed survivor guilt. I’m aware through various sources that I’ve outlived several of my former cancer ward roommates. Perhaps it’s only human nature to occasionally wonder why I’ve been fortunate enough to achieve remission, when so many women diagnosed with my form of cancer have lost their agonizing battle.

Shame

For more information regarding guilt and cancer or to seek professional advice contact the psychosocial oncology department at your regional cancer centre or reach out to other cancer resources in your community.

It’s All So Trivial: Emotional Isolation and Cancer Patients

loneliness

In my introductory blog post, Survivorship 101, I defined the concept of cancer survivorship. Survivorship refers to the physical, psychological, social, and economic issues of living with cancer, from diagnosis until the end of life. In this post I would like to delve deeper into some of the social and psychological aspects of having cancer. For example, a major cancer diagnosis often causes you to view the world differently—things that once seemed enormously important may lose significance and become almost trivial. Personally, I’ve discovered that physical attractiveness, material possessions and social status all matter less to me now. These things frequently seem to fade into irrelevance as I confront a life-threatening illness. Meanwhile, my relationships with other people, discovering ways that I can make a difference in the world and learning more about the essence of who I am are currently at the forefront of my agenda and have an extremely high priority to me at the moment.

Like many people dealing with cancer I’ve sometimes felt isolated from those not going through a similar experience. Relatives, friends and acquaintances mean well, but they are unable to fully empathize or to understand certain aspects of what I am going through. Many cancer survivors will attest to the fact that there are times when they are surrounded by people and still feel very alone. This type of emotional isolation occurs when you discover that you can no longer relate to people in the same way you did before. Things that were important to you in the past are no longer important to you, and your friends and family don’t understand why you have changed so much. I’ve noticed that the books I read, the movies or television that I watch and the activities that I like to participate in have all changed a fair amount since my cancer diagnosis, so have the topics that I prefer to discuss. This transformation has affected my personal relationships and how I feel about those closest to me.

loneliness bench

According to the Alberta CancerBridges team, such deep-seated feelings of isolation have been well documented in the cancer care literature. There is even a term that has been created to describe this experience—it’s known as survivor loneliness. Last summer I watched a rare long-term survivor of ovarian cancer address the crowd at an Ovarian Cancer Canada fundraiser. I admire her ability to speak eloquently in public about her decade long struggle. Throughout her speech she had nothing but praise for her friends and family, I could sense that she is profoundly grateful for the unconditional love and support that they have given her over the years. But paradoxically, the former nurse also characterized her personal battle with cancer as a “long lonely journey.” Survivor loneliness can take many forms and occur for a number of reasons. It’s typically felt as a profound sense of isolation from the people around you. As one battles cancer, this sense of isolation can arise from a feeling that you are alone in your awareness of mortality.

Since my cancer diagnosis two years ago, I’ve been required to think about my mortality. I’ve also had to tend to many practical matters that I didn’t anticipate that I’d have to deal with until I was much older. While everyone around me carries on with their lives, I’ve had to stop and reflect on some of the deeper questions of life that others have the luxury of ignoring. Individuals diagnosed with cancer often find themselves contemplating existential questions. Why am I here? What is the purpose of my life? Who am I? These issues are brought to the forefront of your mind when facing a potentially deadly disease. Sometimes I feel frustrated by the fact that most things that my friends and family care about seem fairly trivial to me now. For example, they got cut off in traffic, they had a disagreement with a coworker or their favorite esthetics studio is getting ready to raise its prices.

Cancer experts and psychologists generally agree that the most effective way to combat isolation and survivor loneliness is to connect with other people who are undergoing a similar ordeal. There are numerous support groups and organizations throughout Canada specializing in the extremely complex social and emotional aspects of cancer.

loneliness-2

Cancer shakes your illusions of immortality. It robs you of the sense of invincibility and innocence that once protected you. But what replaces that feeling is infinitely more valuable: a new awareness and a mature understanding of both life and death.

From Picking Up the Pieces: Moving Forward After Surviving Cancer
by Sherri Magee and Kathy Scalzo

Ottawa Cancer Survivor Redefines Beauty

Kelly Davidson’s photos go viral on the Internet

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In my introductory blog post, Survivorship 101 published in January, I introduced the concept of “embracing the new pretty” in the wake of my uterine and ovarian cancer. Basically this involves trying to come to terms with the physical changes to my body due to cancer treatments, an issue that all women who have had a major cancer diagnosis experience. For many survivors the changes can be profound and emotionally devastating. In the event of uterine or ovarian cancer, transformations to a woman’s body will typically include a permanently and severely scarred abdomen as well as the removal of her internal reproductive organs. Meanwhile, breast cancer patients face mastectomies, biopsies or lumpectomies. Embracing the new pretty involves accepting these physical changes and also questioning our culture’s popular notions about femininity and beauty. In my opinion, an Ottawa woman has exemplified my concept and taken it to a new level!

Kelly Davidson, 34, has battled three bouts of cancer. After surviving Hodgkin’s lymphoma, breast and thyroid cancers she had a double mastectomy and opted for a tattoo instead of reconstructive surgery. Davidson caused quite a stir recently when she posted photographs of her chest on the Internet, she has gained notoriety and been interviewed by such media outlets as the Toronto Star and the CBC. She is proud of her chest. Much of the surface between her collarbone and ribs has been transformed into an intricately inked enchanted forest, complete with beautifully drawn butterflies and a fairy releasing them into the sky. The tattoos cover the surface where her breasts used to sit, now removed to make sure her breast cancer never returns.

When it came time to consider reconstructive breast surgery, Davidson knew precisely what she wanted—and that didn’t involve a new pair. Rather than get reconstructive surgery, she opted for a tattoo. She had already been inked a few times and chose a fantasy scene with butterflies to symbolize the cancer leaving her body. “I decided to turn this negative thing into a positive, and put a beautiful piece of artwork in place of something that to a lot of people is really devastating,” Davidson says. “They were just breasts. They weren’t me—I don’t need to have breasts to be feminine or sexy,” she recently told the Toronto Star.

Taste in tattoo artwork is highly personal and individual, Davidson envisioned herself sporting a tableau that would include butterflies, creatures to represent the cancer retreating from her body for good. Proud of the finished result, she uploaded a photo of her chest to Why We Ink, a Facebook group dedicated to sharing images of those who have gotten tattoos inspired by the fight with cancer. Some of these tattoos are body mosaics, like Davidson’s, to symbolize beauty where there was once the threat of death. Others post pictures of their tattoos that honour loved ones who weren’t as fortunate.

“It’s my badge of honour and strength,” Davidson writes of her tattoo on Facebook. “It reminds me every day of the battles that I’ve overcome. I’ve won this war and hopefully I’ve beat it completely. My tattoo symbolizes a transformation, my metamorphosis, like a butterfly I changed on the outside but remained the same on the inside,” she explains.

Since uploading her photo to Facebook, Davidson’s image and story have gone viral, generating more than 700,000 “likes” and receiving 95,000 shares across the social media site. And so far, Facebook’s arbitrary nudity police have left the image up, many believe that this is a definite improvement over the furor caused when they removed a similar image of a tattooed cancer survivor’s bare chest in February. Whether the image stays put or not, Davidson has already derived great satisfaction from the messages of love and support that have poured in as a result of her bravery, strength and vulnerability. She plans to carry that strength forward this summer as she weds her fiancé, all the while knowing that her cancer could return.

I don’t have any plans to have my stomach tattooed in the near future, but I have great respect and admiration for Kelly Davidson. She stands as an inspiration to women who are fighting breast, ovarian or uterine cancer.

Kelly-Davidson

Kelly Davidson’s chest is a work of art.

Living With the Risk of Recurrence

For me personally, the greatest stress of living with cancer has involved making difficult medical decisions regarding my course of treatment. There is also the constant pressure of waiting for outcomes that I cannot completely control. When I was diagnosed with endometrial and ovarian cancer in late 2011, I was referred to the Tom Baker Cancer Centre where my case was reviewed by the Gynecologic Oncology Tumour Board. This team of doctors and specialized pathologists reviews all new referrals to ensure correct diagnosis and to recommend the best treatment plan. Almost instantly I became the patient of one of Western Canada’s most renowned pelvic cancer surgeons, Dr. Prafull Ghatage. I’ll never forget our first encounter with Dr. Ghatage, as my mother and I sat in stunned silence, he calmly explained that I required surgery as soon as possible. This news was overwhelming, especially since I had just undergone a total abdominal hysterectomy performed by my gynecologist. “I just had a hysterectomy and now I’m dying of cancer,” I tearfully blurted out. “You’re not dying, I’ll inform you if you are dying,” a voice immediately responded. These rational words jolted me back to reality, and before we left I signed a consent form for a laparotomy—a specialized procedure in which abdominal organs are removed, biopsied or repaired and a definitive diagnosis can be made.

That first meeting with Dr. Ghatage now seems like a lifetime ago. In a few weeks I’m scheduled for another routine checkup at the cancer centre. It’s essential that I be monitored regularly for a possible recurrence or any signs of malignancy—ovarian cancer has a notoriously high recurrence rate. Many women with the disease face at least one recurrence within five years of their first diagnoses. Since my cancer is considered to be fairly advanced, the standard course of treatment that was recommended included a month and a half of radiation therapy. Originally over twenty rounds of external beam radiation were advised and were to follow my cycles of chemotherapy. My understanding is that following through with this proposal might have reduced my odds of recurrence to as low as five or 10 per cent.

Last fall I made the excruciatingly difficult decision to forego treatment with radiation, opting for observation instead. The risks of pelvic radiation include the possibility of rectal bleeding—in addition some patients will experience a bowel blockage or a permanent change in bowel habits after their treatments are finished. In some cases undergoing radiation can result in bowel or bladder damage serious enough to be permanent or to require surgical intervention to correct. For most cancer patients the benefits outweigh these serious risks, which are comparatively small. But due to my personal medical history it’s almost certain that radiation would have posed a substantial danger. The radiation oncologist informed me that due to my previous bowel blockage the possibility of acute complications occurring would be much higher than average. Besides, I was undeniably exhausted from three consecutive abdominal surgeries in addition to five cycles of Carboplatin, at the time I felt I could endure little more.

simulator

As I await my appointment on May 23, the encouraging news is that I’m currently in remission—at least I am to my knowledge—and my chances of a complete cure are better the longer I remain in this state. The Canadian Cancer Society defines remission as a decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. According to Ovarian Cancer Canada, 80 per cent of women diagnosed with ovarian cancer will achieve remission. However, it is unknown if the cancer will come back or how long before it comes back. These unanswered questions linger in every woman‘s mind. In the meantime, I’ve made my health my primary focus—a nutritious diet, an appropriate exercise routine and getting enough sleep have never been more important. Obviously I’m careful to take my daily medication; I’ve been prescribed the drug Megace (generic name megestrol), it has been known to reduce recurrence rates in uterine, ovarian and breast cancer patients. Finally, hope and my steadfast determination to live each moment of my life fully and completely remain my allies in this dreadful waiting game.

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God Bless the Child

When I go to appointments at the cancer centre I notice that I’m surrounded by women in my own fortysomething age range. However, many of them are not patients themselves, they are there as caregivers and are accompanying a cancer stricken elderly parent. Sometimes as I walk in with my support person, my healthy and totally independent 72-year-old mother, I feel bitter and confused at our obvious role reversal. All at once I’m aware of how much the relationships in my life have changed since my diagnosis. Cancer has made me more dependent on family members, a multitude of health care workers and a number of government agencies. Throughout my ordeal there have been lonely days when I’ve yearned for a larger family or an abundance of close friends. Above all having a chronic illness has shown me what it’s truly like to be forced to rely on other individuals and revealed to me who is willing to stand by me in my time of greatest need.

Sometimes music helps me to deal with certain emotions that I’m feeling. Well before I was diagnosed with cancer or felt its harsh social and financial impact, God Bless the Child by the legendary Billie Holiday was one of my favorite songs. But lately both the powerful lyrics and her exquisite delivery keep going through my mind. God Bless the Child extols self-reliance while it condemns those who ignore us, repudiate us or treat us as inferior when we are unable to be self-sufficient. In her autobiography Lady Sings the Blues Holiday indicated an argument with her mother over money led to the song. Apparently during the argument she said the line “God bless the child that’s got his own.” Anger over the incident led her to turn that line into a starting point for a song, which she worked out in conjunction with Arthur Herzog. In his 1990 book Jazz Singing, Will Friedwald describes the work as “sacred and profane” as it references the Bible while indicating that religion seems to have little or no effect in making people treat each other better. Sadly, Billie Holiday was only 44 when she died—she had fought a long, terrible battle with alcohol and drug addiction.

God Bless the Child

Billie Holiday and Arthur Herzog Jr.

Them that’s got shall get
Them that’s not shall lose
So the Bible said and it still is news
Mama may have, Papa may have
But God bless the child that’s got his own
That’s got his own

Yes, the strong gets more
While the weak ones fade
Empty pockets don’t ever make the grade
Mama may have, Papa may have
But God bless the child that’s got his own
That’s got his own

Money, you’ve got lots of friends
Crowding round the door
When you’re gone, spending ends
They don’t come no more
Rich relations give
Crust of bread and such
You can help yourself
But don’t take too much
Mama may have, Papa may have
But God bless the child that’s got his own
That’s got his own

Mama may have, Papa may have
But God bless the child that’s got his own
That’s got his own
He just worry ’bout nothin’
Cause he’s got his own

Image

Billie Holiday

Survivorship 101

My health had always been tremendously good, and then one afternoon in November 2011 I received an unexpected diagnosis of both uterine and ovarian cancer. In hindsight words such as devastating, terrifying, and life-altering seem inadequate to describe the magnitude of that experience—my daily existence was shattered. Sometimes it’s still as if I’m trapped in an appalling dream, a nightmarish reality that to date has encompassed three major abdominal surgeries and five cycles of chemotherapy. As with countless other cancer survivors I have asked “Why me?” while I’ve struggled to find anything positive about living with such an affliction. I have accepted the likelihood that my life may never be exactly the same; I must adjust to a “new normal” as day by day I contend with the consequences of an insidious, spiteful, and often fatal disease.

In this blog I will be writing about various aspects of my cancer journey. I have chosen to call it The Teal Diaries, since teal is the colour used to represent awareness of gynecological cancers. While pink ribbons are strongly associated with breast cancer, significantly fewer people realize that ovarian cancer survivors, and those who wish to support them, wear teal ribbons. If there is less public awareness regarding ovarian and endometrial  cancer, I suspect that it’s because they are both less prevalent and have a significantly higher mortality rate than breast cancer.

I’ve waged my relentless battle for over a year now, I currently seem to have the upper hand and my doctors indicate that they are cautiously optimistic regarding my prognosis. Since the beginning of my cancer experience there have been moments of epiphany and numerous opportunities for personal reflection. Being that this is my initial blog post, I want to share a few of the survivorship lessons that I’ve experienced over the past fourteen months. According to professionals in the cancer field, survivorship is living with and beyond cancer. Survivorship covers the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life. This is what I’ve learned so far.

You never know how strong you are until being strong is the only option you have left.

I certainly don’t aspire to become a legend like  Terry Fox or to be anything resembling a saint or a cancer hero. But still, I’ve discovered inner qualities and personal strengths I never appreciated or properly acknowledged in myself. Subjected to the ultimate test, I’ve sometimes shocked myself with my capacity to overcome adversity and to confront physical pain and suffering. As one of the approximately 17,000 Canadian women living with ovarian cancer, I obviously know firsthand how it impacts a life. For survivors there is tremendous emotional pressure, along with social and financial turmoil.

There are moments when you have the impression that your world is spinning violently out of control. The fundamental paradox is that I’m often able to feel a sense of power, combined with courage and self-assurance. It’s as if I’m standing in life’s Category 5 hurricane and remaining resolute, steadfast and unbroken. “Okay cancer, you ruthless bastard, attack me with all the intensity you’ve got! I will still transcend you and the pure malevolence that you represent,” I sometimes tell myself. Some pundits would consider this type of resolve impressive, especially as demonstrated by a socially introverted, physically petite woman, such as myself.

Appreciate the flowers in your own backyard.

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I reached an unparalleled low physically and emotionally last year, during the spring of 2012. By May there were potentially life-threatening complications due to my rigorous cancer treatments. Vomiting and in pain, I was transported to the emergency room through early rush hour traffic. It was a bright May morning when I entered the doors of Calgary’s largest medical centre and was admitted suffering from a bowel blockage. I acknowledge that at first I literally wanted to die rather than face what was happening. Nothing had prepared me for the invasive medical procedures that I would endure in the coming weeks or for the length of my hospitalization.

Forty-eight agonizing days elapsed, during which time I received virtually all of my nutrition through a peripherally inserted central catheter (PICC or PIC line). On June 18, 2012, intestinal surgery was skillfully performed. When I awoke in the recovery room I sensed that my crisis was at last resolved. Although only half-conscious, I was filled with elation as they informed me that the procedure to correct my obstruction had been successful. The primary cause was established to be scar tissue from my previous operations and now my digestive system was expected to function normally again. Most of all, I was comforted and reassured by the fact that my cancer had not visibly metastasized to other regions of my body.

My discharge from the hospital ultimately took place on a balmy summer afternoon; the clothes I had worn nearly two months earlier felt hot and loose fitting. I was so weak from my ordeal that I struggled to walk just 10 or 20 metres, but I was in awe as I observed how the seasons had changed and nearly everything had been transformed. I can still remember the blissful journey home and my sense of anticipation during that short, but very emancipating, commute. Even the air filling my lungs was like a breath of freedom.

Upon arriving at the small bungalow where I live, something magical occurred. My eyes surveyed the backyard and the unexpected sight of poppies in full bloom completely overwhelmed me. It was as if I were seeing them for the first time. I remain inspired by their exquisiteness, vaguely encouraged by the realization that their brilliant orange petals and intricately designed purple centres will never appear ordinary to me again. I’m certain that from now on, I’ll be eagerly awaiting the phenomenal appearance of the poppies each June!

Learn how to embrace the new pretty.

There are literally thousands of magazine articles, journal studies and online resources devoted to the topic of sexuality and women’s cancers. How a woman copes and deals with the changes to her body are unique for each survivor, of course such factors as age and relationship status come into play. Studies have confirmed that the most prevalent issue for those diagnosed with uterine or ovarian cancer is a sense of profound loss. Psychologically I continue to mourn the demise of my reproductive organs and the loss of what I always perceived as an impeccably strong and healthy body.

Throughout my cancer ordeal I have felt moments of contempt, occasionally mixed with rage. I find it easy to despise a culture that is inclined to objectify women—placing intense pressure on us to possess a perfect body. I’ve become acutely sensitive to the media, the advertising industry and to what I believe are ridiculous and superficial standards of female beauty.

Belly Pic

There have been circumstances when I’ve waged war using humour or an “in your face” attitude. During my convalescence from one of my cancer surgeries I recall being engaged in a discussion with my mother while sorting through a stack of mail. I paused as I unearthed a catalogue for a major Canadian department store, cringing at the sight of the cover. Predictably it was flaunting an image of a model with an unblemished face and body. The New Pretty, the caption breathlessly announced. All of a sudden I grinned mischievously, as in one defiant move I turned and flashed my scarred and stapled abdomen. “I’ll show them the new pretty,” I boldly declared.