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Why You Should Read When Breath Becomes Air

I highly recommend reading Paul Kalanithi’s bestseller, When Breath Becomes Air, especially if you’re dealing with a cancer diagnosis. At the age of 36, on the verge of completing a decade’s training as a neurosurgeon, Kalanithi was diagnosed with inoperable lung cancer. One day he was a doctor treating the dying, the next he was a patient struggling to live. When Breath Becomes Air is a life-affirming reflection on facing our mortality and on the relationship between doctor and patient. I was often mesmerized by the author’s writing skills, almost a little envious that he could be both a talented physician and such an outstanding creator of non-fiction. There are passages in the book where Kalanithi perfectly captures what it’s like to suddenly be living with cancer.

“Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters—and more like someone had just firebombed the path forward.”

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Jocelyn P. Newark, R.N. talks with Dr. Paul Kalanithi at the Stanford Hospital and Clinics in February 2014.

I was also struck by a section in which Kalanithi expresses his desire to make the most of what time he has left. One frustrating irony for many of us with cancer is that the physical limitations of the disease don’t allow us to engage in fast paced or frenzied activity.

“Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.”

As a neurosurgeon, the author is able to examine the doctor-patient relationship from both sides. His illness also helps him to assess his values, including some of the ultimate objectives of medicine and those who practice it. A dying Kalanithi writes eloquently about his profession and why he chose to dedicate himself to such a demanding field.

“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”

“Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

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Dr. Lucy Kalanithi and Dr. Paul Kalanithi with their daughter, Elizabeth Acadia.

When Breath Becomes Air is a heartbreaking and ultimately beautiful reflection on the meaning of life as well as our own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? These are the issues that many people with cancer are confronted with and that Kalanithi writes about so passionately and eloquently.

“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”

Paul Kalanithi died on March 9, 2015, surrounded by members of his large and devoted family. While mourning her husband, Kalanithi’s wife helped to see his manuscript through to publication. Thanks to When Breath Becomes Air, those of us who never met the young doctor will both lament his death and benefit from his extraordinary life.

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Poetic Discourse

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. National Poetry Month began in the U.S. spearheaded by the Academy of American Poets on the steps of a post office in New York City. There, the story goes, Academy staff members handed out copies of T.S. Eliot’s poem, “The Waste Land,” which begins, “April is the cruellest month…” to individuals waiting in line to mail their tax returns.

Those of you who follow The Teal Diaries are aware that I write prose, however I’ve been inspired during my cancer treatments to pen a small collection of poetry. Here I’ve chosen to share two of my short poems. My compositions Patient’s Lab Results and A Visit to the Emergency Room both explore the life altering power of a cancer diagnosis.

 

Patient’s Lab Results

The sun is preparing to set on a late autumn afternoon,
its rays hold me together as I fall asleep dreaming of
my immaculate incision. Scarcely a week since my surgery.
I almost laugh to think I was such a novice.
Such a common virgin.

I pass through sliding doors to a point of no return.
Then I enter a vacant waiting room,
a place that is sinister, foreboding.
How many women have waited in these chairs?
How many innocent lives transformed?

“The ultrasound shows a growth on your ovary.”
“You need surgery to remove your uterus and right ovary.”
“You have cancer.”

Ultimately, he arrives, seeming anxious to print the pages.
“Here, this is for you.”
His words turn to ice as he offers me the pathology report.
Warmth as he grasps my hand, lending some reassurance.

My world dissolves as I take ownership of a disease.
The rapidly dividing cells, the cancerous tumors,
the abhorrent malignancy.

“Adenocarcinoma of the endometrium”
“The uterine cavity is completely filled with light tan neoplasm.”
“Right ovary with synchronous endometroid adenocarcinoma”

 

Immunotherapy one

 

A Visit to the Emergency Room

Riding unending waves of pain and nausea,
I take a secret pride in my endurance.
The sign over the door says MINOR EMERGENCIES.
Should I draw attention to this irony?

The young nurses seem aloof, peering out from
behind their curtain. I sense that we are to be
endured until morning comes. Around me
are the homeless, the destitute the addicted.

The fluorescent lights have been turned low,
casting a pale greenish tinge across the room.
Beeping monitors and moaning
patients provide the soundtrack.

I wonder if these souls feel entirely unaided,
abandoned, alone amid the chaos.
Each of us is fighting a singular
and solitary battle.

A torrent of frustration, then drowning I panic.
I want to scream that I’m a cancer patient
and my bowels are blocked.
I long for them to have evidence.
When will they be convinced?
I’m a bloated organ about to rupture.

The pre-dawn hours break like a fever
and I emerge from my delirium.
The kind eyes of the doctor and the
contrite look on the nurse’s face.

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Finding the Resilience to Face a New Year

This is the sixth New Year that I’ve celebrated since my cancer diagnosis, and each one brings with it a mixture of hope, fear and uncertainty. For many cancer survivors watching everyone plan for the future is difficult, it can produce mixed emotions and make the dawn of a new year extremely challenging.

That’s why I’m not going to use this blog to give a lecture about New Year’s resolutions or to suggest that you make elaborate promises to yourself. I realize that living with cancer often renders such gestures trivial and that your life is probably being planned week-by-week or month-by-month. Instead I’ve chosen to share some of my favourite quotations about resilience.

I hope the meditations that I’ve selected make the beginning of another year a little less daunting for you and provide you with strength and inspiration for your cancer journey. As someone once said, life doesn’t get easier or more forgiving, but we can choose to get stronger and more resilient.

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“Resilience is accepting your new reality, even if it’s less good than the one you had before. You can fight it, you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something that’s good.”

— Elizabeth Edwards

 

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I’ll rise.

— Maya Angelou

 

“My scars remind me that I did indeed survive my deepest wounds. That in itself is an accomplishment. And they bring to mind something else, too. They remind me that the damage life has inflicted on me has, in many places, left me stronger and more resilient. What hurt me in the past has actually made me better equipped to face the present.”

— Steve Goodier

 

“You all know that I have been sustained throughout my life by three saving graces—my family, my friends and a faith in the power of resilience and hope. These graces have carried me through difficult times and they have brought more joy to the good times than I ever could have imagined.”

— Elizabeth Edwards

 

“Those who make us believe that anything’s possible and fire our imagination over the long haul, are often the ones who have survived the bleakest of circumstances. The men and women who have every reason to despair, but don’t, may have the most to teach us, not only about how to hold true to our beliefs, but about how such a life can bring about seemingly impossible social change.”

— Paul Rogat Loeb

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Unit 42 Haiku

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. Those of you who follow The Teal Diaries are aware that I don’t normally write poetry, however I’ve been inspired during my cancer treatments to pen a small collection. There are few experiences in life as distressing or traumatic as being hospitalized for cancer surgery. In December 2011, I underwent surgery and was cared for on Unit 42 at Calgary’s Foothills Hospital. Many of the events that transpired are represented in the poetry that you will read here. I’ve chosen to write haiku because of the format’s simplicity and it’s ability to convey powerful emotions or striking images.

blue slippers and gown
an eternity passes
in the pre-op room

when he cuts me open
no tumour for my collection
crave smooth healthy organs

anesthesia mask
a few deep breaths are drawn
on my way to oblivion

recovery room
the bright lights overhead
I’m dropped into darkness

conscious, I arrive
the darkness welcomes me
on a winter night

the room is spinning
I long for perfect stillness
let this voyage end

van-gogh-starry-night

I have nurse Crystal
the post surgery hours pass
finally, the dawn

they manage my pain
senses are dulled with morphine
the standard dosage

compression bandage
covers my fresh incision
my surgeon’s trademark

first blood transfusion
my outstretched arm is waiting
for type O to come

my blanket is thin
comfort of warm flannel sheets
during the still night

this building is old
mid-twentieth century
these rooms are vintage

generations past
have walked slowly down these halls
now I follow them

19th Century Surgery

I have a roommate
a Dutch Lutheran woman
her prognosis is grave

new complications
nausea, fluid leaks out
doctors seem unsure

hard recovery
my progress has been so slow
a mountain each day

my carcinoma
hides under a microscope
in some nearby lab

the truth will ooze out
why conceal my pathology
daze me with a pill

he stops by my room
cancer spread to one lymph node
the truth is laid bare

too much of this place
even the walls scream go home
find the strength to heal

past empty wheelchairs
through the lobby Christmas Eve
out hospital doors

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It Takes Lady Balls

As an ovarian cancer patient I’ll admit that I often feel overwhelmed by the dismal survival statistics and apparent futility of fighting such a deadly disease. Approximately 2,800 Canadian women are diagnosed with ovarian cancer each year and five women die from the disease every day. Currently, there are more than 17,000 of us in Canada living with the disease. The relative statistics are similar in the United States where 21,000 women will be diagnosed with ovarian cancer this year, and 14,000 will die from it.

Because the symptoms are usually subtle and there is no reliable screening test, ovarian cancer is frequently misdiagnosed or not discovered until it has reached an advanced stage. This makes treatment difficult, which is a key contributor to its high mortality rate. Ovarian cancer has a five-year survival rate of around 46 per cent, compared to nearly 90 per cent for breast cancer.

Each year at the Ovarian Cancer Canada Walk of Hope I’m proud to join a small but dedicated group of teal shirted survivors. Other participants in this key fundraising event wear white shirts— many in attendance at the walk are the husbands, children or grandchildren of those who have recently passed away. Unfortunately, since so many of us diagnosed with ovarian cancer die quickly after our diagnosis, the support network that typically forms around a cancer patient moves on quickly, creating what some have called a “leaky bucket” of advocates for the disease.

ladyballs

I was delighted this January when Ovarian Cancer Canada launched Ladyballs, their boldest and most successful marketing campaign to date. Their marketing team knew that to be successful they would need to create a slogan that could be heard above the din of other national campaigns. So rather than focusing on sad facts to illicit sympathy, the team at Ovarian Cancer Canada chose to focus on the tremendous strength of survivors and the power we all have to do something about women’s most fatal cancer.

Marketing executive and ovarian cancer survivor, Lauren Richards, spearheaded Ladyballs. Richards is a former Cossette Media and Starcom MediaVest Group executive who has operated her own Toronto media consultancy since 2013. She enlisted Canadian broadcasters, newspapers, magazines and online publishers to donate several million dollars worth of space and time for the campaign.

Those behind the promotion knew from the start that they were up against organizations that have become brands in and of themselves. For example, Movember is a brand for prostate cancer and Run for the Cure is an iconic brand in the fight against breast cancer. Knowing they had such low awareness and little money, it was a daunting task.

The Ladyballs campaign’s most visible component is a video spot in which women show their so-called “lady balls” by demonstrating chutzpah in the face of pressure or adversity. “Check out the lady balls on her,” one woman says to her co-worker after a female employee disagrees with a male boss’s decision during a meeting. “Look at the lady balls on her,” says a male announcer when another woman goes all-in during a televised poker tournament. In the concluding voiceover an announcer informs viewers that women have balls–their ovaries–and they’re always at risk. Viewers are then directed to donate to the cause at ladyballs.org.

ladyballs2

As expected, the campaign has been highly controversial. Some critics say the ad insults women by comparing a uniquely female body part–the ovaries–to men’s testicles. They say that women don’t have to stoop to that level to promote an informed discussion. However, I personally disagree with this view. I hold the same opinion as Matt Miggins, a nursing student at St. Clair College in Windsor.

“They are not mad five women a day die from this?  I find it ironic that they are mad about words. People should be mad at the fact this is happening to our mothers, sisters and wives,” said Miggins. He said he thinks people should put things into perspective. “People need to ask themselves, if the word balls saves just one life, is it then worth it?”

According to Ovarian Cancer Canada, the campaign has been instrumental in raising awareness. Ladyballs has been responsible for a significant increase in requests for By Your Side, a resource provided to women diagnosed with the disease. It’s also led to a spike in calls to offices across the country, with callers citing the campaign as their reason for reaching out. One woman who heard a Ladyballs radio commercial immediately pledged $100,000 to the organization, and the campaign has garnered approximately $60 million in earned media impressions since its January debut.

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Fresh Hope for a New Year

This is the fifth New Year that I’ve celebrated since my cancer diagnosis, and each one brings with it a mixture of hope, fear and uncertainty. For many cancer survivors watching everyone plan for the future is difficult, it can produce mixed emotions and make the dawn of a new year extremely challenging.

That’s why I’m not going to use this blog to give a lecture about New Year’s resolutions or to suggest that you make elaborate promises to yourself. I realize that living with cancer often renders such gestures trivial and that your life is probably being planned week-by-week or month-by-month. Instead I’ve chosen to share some of my favorite motivational quotations, may these compelling words make the beginning of another year a little less daunting for you and may the theme of infinite hope provide you with strength and inspiration for your cancer journey.

 

hope-hands

 

“Remember, hope is a good thing, maybe the best of things, and no good thing ever dies.”

— Stephen King, Rita Hayworth and the Shawshank Redemption

 

“I took a deep breath and listened to the old brag of my heart; I am, I am, I am.”

— Sylvia Plath, The Bell Jar

 

“It’s really a wonder that I haven’t dropped all my ideals, because they seem so absurd and impossible to carry out. Yet I keep them, because in spite of everything, I still believe that people are really good at heart. I simply can’t build my hopes on a foundation consisting of confusion, misery and death.”

— Anne Frank, The Diary of a Young Girl

 

“The best way to not feel hopeless is to get up and do something. Don’t wait for good things to happen to you. If you go out and make some good things happen, you will fill the world with hope, you will fill yourself with hope.”

— Barack Obama

 

sunrise-hope

 

Pretty women wonder where my secret lies.
I’m not cute or built to suit a fashion model’s size
But when I start to tell them,
They think I’m telling lies.
I say,
It’s in the reach of my arms
The span of my hips,
The stride of my step,
The curl of my lips.
I’m a woman
Phenomenally.
Phenomenal woman,
That’s me.

— Maya Angelou, Phenomenal Woman

 

“When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.”

— Stuart Scott

 

“I can be changed by what happens to me. But I refuse to be reduced by it.”

— Maya Angelou

 

“I’m not a dreamer, and I’m not saying this will initiate any kind of definitive answer or cure to cancer, but I believe in miracles. I have to.”

— Terry Fox

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Five Ovarian Cancer Myths

One of the most disturbing issues for me as an ovarian cancer survivor is the lack of awareness and misinformation that persists. Only with a thorough and proper understanding can women protect themselves from this devastating, and often fatal illness. I admit that before my personal diagnosis a few years ago my own knowledge concerning ovarian cancer was quite limited. In this post I’ll examine several of the most commonly held falsehoods or misunderstandings about ovarian cancer, but first some basic details.

Ovaries are two small almond-shaped organs located on each side of the uterus that store eggs or germ cells. Ovarian cancer is a disease in which malignant (cancerous) cells are found in one or both ovaries. Thousands of women are living with ovarian cancer in Canada. It’s estimated that this year 2,800 Canadian women will be newly diagnosed with this disease. Ovarian cancer is the fifth most common cancer for women and is the most serious women’s cancer.

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Myth 1: Many people believe that there is a screening test for ovarian cancer or the related myth that a Pap test detects ovarian cancer.

Fact: According to research more than half of women think a Pap test will detect ovarian cancer. Actually the cervical smear is designed to detect precancerous changes to the cervix, and it does not detect ovarian cancer. You may be familiar with the CA-125 test, it’s used on women who have ovarian cancer or who are at high risk of developing the disease. Unfortunately according to the majority of experts, the CA-125 test is proven to be ineffective in diagnosing ovarian cancer. This blood test is used mainly as a guideline for oncologists during treatment of ovarian cancer because CA-125 (a sugar-associated protein found in the blood) often goes down if the treatment is working. However, the test is not reliable for diagnosing ovarian cancer. Researchers continue to look for a dependable screening test, but currently there is none.

Myth 2: There is often a false assumption that women who have had multiple sexual partners are at a greater risk of developing ovarian cancer or that the HPV vaccine can help prevent it.

Fact: Some women mistakenly believe that the number of sexual partners they may have had, or the age at which they became sexually active, has some bearing on their chances of developing ovarian cancer. This is incorrect. The spread of the HPV virus, which can lead to cervical cancer, is associated with sexual activity, but is not connected in any way to ovarian cancer. The HPV vaccine will help to reduce the risk of cervical cancer, but not ovarian cancer.

OvarianCancerPain

Myth 3: Many women become convinced that an ovarian cancer diagnosis is always fatal and they won’t survive.

Fact: A diagnosis of ovarian cancer is extremely serious, but it’s not invariably fatal. Combing data collected on thousands of California ovarian cancer patients, UC Davis researchers recently determined that almost one-third survived at least 10 years after diagnosis. The unprecedented findings upend the notion that women diagnosed with cancer of the ovary always face a poor chance of survival. Indeed, while the study confirmed earlier findings about characteristics associated with ovarian cancer survival (younger age, earlier stage and lower grade tumors at diagnosis) it also identified a surprising number of long-term survivors who didn’t meet those criteria.

Myth 4: It’s common to believe that if you don’t have a family history of ovarian cancer you are not at risk of getting the disease.

Fact: Only about 10 to 15 per cent of women diagnosed with ovarian cancer have a family history of this disease. Complex variables and numerous risk factors beyond genetics are usually involved and the exact reason a woman develops ovarian cancer often remains unknown.

Myth 5: Many people think that there are no early symptoms or warning signs of ovarian cancer.

Fact: It’s a widely held belief that ovarian cancer is a “silent killer” with symptoms only presenting in the later stages of the disease, even some doctors consider this to be a medical fact. However, there is now clear evidence that most women who are diagnosed with early stage disease do experience symptoms. The problem is that women often delay seeking advice about their symptoms, and their GPs often don’t immediately think ovarian cancer may be a possibility. A lot of women experience considerable delays in receiving their diagnosis and ovarian cancer is usually detected at stage 3 or 4.

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