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Feb 9th- I get an email from the county. I can schedule the first vaccine appointment! I was super attentive and managed to get my name on the list by 10 am the first day the list opened in my county- not gonna lie, I probably refreshed my browser 50 times that morning. Within 3 days they had 100,000 names and could only administer 10,000 vaccines per week. I managed to get on top of the list. My kids have a return to school date. My husband cheered out loud when he heard. Feb 14th - Valentines day. I get my first COVID vaccine shot. My husband says its the best valentines day gift ever. The county is super organized, everything goes really smoothly. He is Brazilian comments that it is convenient when a county can assume 100% of people have a smart phone and a car. He's right- perspective. My oldest daughter gets a 6 year old gentleman caller from school. He brought over her valentines day cards from all the kids. He misses her. Feb 15th - We email the girl's school principal with info on how they are doing and a return to school date. We agree on a return plan/communications and my oldest will start zooming into 'circle time' with her class. The principal will do individual interviews with them to see how they're doing psychologically, but from what I told her it she said it sounded like they're doing okay. It is a luxury to be in a private school system with only 80 students. I'm thankful for that extra support system right now. I get a text message, one of the parents at the school had nominated me for Lasagna Love. Feb 17th - Dad picks me up and drives me to JH. Day 1 round 2 of intense chemo. It's an exact repeat of round 1- nothing new. The nurse was really funny we laughed a lot. She's an oncology nurse but is scared of needles! Life is funny that way. She's from India too, we talk about India. I go home, my symptoms track almost to the minute what I experienced with round 1. The doctor said some patients can 'set a clock' by the symptoms. It's reassuring, I know what to expect now. I get a 45 minute walk in with my husband in while mom babysits the girls. Feb 18th - I call CIGNA and find out my leave options. It's been on the list for a while. I'm eligible for Intermittent FMLA. That means I can take up to 2 days off per week for 6 months without pay, but on top of my PTO. So if you can afford to go without pay, my company has to let me take extra time off. I have a tone of use it or lose it PTO, I probably can do most of the time off with pay, but it's nice to know. Another privilege. Also, after reconstruction I'm eligible for Short Term Disability - for me that's an additional 8 weeks at 100% pay. I email my boss to tell him my leave plans. He is 100% on board with me taking it. Feb 19th - My hair starts falling out. Bummer. That's just it. It's a bummer, but it'll grow back. Of every thing I've been through this is the least of my concerns. I have some cute millennial hats I plan to sport. I call the head of sales, I have to tell her and she has to tell her team... get out ahead of the rumor mill. She tells me to have fun with it. Get a pink wig, get tons of fun wigs. Enjoy it the best you can. She lives in LA. She gave me a big video conference hug. Just keep swimming.

So basically, chemo is pink mushrooms and you have been high for 3 days?.... Chemo needs a rebrand! Nobody feels good when they hear the word chemo. - a close friend Feb 1: I get an echocardiograph, it takes about 1 hour to get all the images and sound recordings. The technician starts vocalizing what she is doing and why, I learn a lot about my heart. The upshot is my heart is great - beautiful and strong. Actually substantially stronger than the average heart. She can quantify it - I'm a (-23) the standard is (-19) - that's fantastic. I'm a (68%) the standard is (50%). "Your heart will be fine." I'm thankful for a lifetime of sports. I leave. Feb 2. More lab work - weight and blood work. This is so the pharmacist can mix my chemo cocktail for tomorrow. My blood work is still straight down the center- beautiful blood work. I'm thankful. They can't administer chemo if you are low on certain components of blood work. I meet with the medical oncologist (Dr. W) one more time. She reviews everything and says I'm good to go for treatment tomorrow. Day 1 of chemo. She does a physical exam of my incisions - she asks me to lift my arms over my head. I can't. She tells me my range of motions is..."not where we'd expect it to be." I sigh. She says, "PT- get on it." Okay, more hospital visits.... Feb 3- Day 1 of "Intense chemo". My dad picks me up as I cannot drive and takes me to JH. He can't come in. Normally w/o COVID chemo patients can bring a support person. I enter alone, but the nurse is right there to take me back to the infusion room. It looks kinda like a spa, with a lot more machines. I have a private suite with a TV, a view of a garden, coffee, cookies, warm blankets, a reclining chair. I'll get 5 different infusions in the course of 2.5 hours. 3 are actually nausea meds and 2 are actually chemo. We do the 3 nausea meds first- one basically puts my gut to sleep for 4 days. After that she says she'll be back with the chemo and comments about a new outfit. A few minutes later she walks in with a double bagged set of syringes and another IV drip bag. She's wearing head to toe plastic protective cloths and gloves. They're not joking around. Another nurse walks in and they do formal review of the meds and recalculate the dosage. It all adds up. The other nurse approves the chemo and leaves. My main nurse sits in a chair and pulls out two syringes (I'd guess 1.5 inches in diameter and 6 inches long- BIG!) They're filled with a hot pink gel. (aka The Red Devil) "This is the A, in AC" she says. She will administer it manually by pushing the syringe into my IV. That pink gel was going straight into my jugular. It's scary, really scary. Every few seconds she stops and asks what I feel like. She's clearly listening for something - I suspect an allergic reaction. It goes fine. I feel nothing odd. She hooks up the other IV and says she'll be back in 30 minutes. I try to read my book. I pick up the 96 page chemo user guide they gave me and flip to the section on A in AC. It's made from mushrooms. I go home feeling okay actually. I track my symptoms all day. No nausea and no vomiting. Not what I was expecting. So far, it wasn't so bad. Actually I feel all hyped up and kinda loopy. Mom was there, she can tell you. My mom and the girls were super sweet and had put flowers in a vase. Happy yellow ones. The girls were in unicorn pjs and were dancing around the kitchen. There was still a light dusting of snow from the night before. One of the nausea drugs says I shouldn't sign legal documents while on this drug. Hmmmmm. Feb 4th - The next day is my oldest daughter's 6th birthday. It's a COVID birthday and we try to make the best of it. Feb 5th - I video chat with my sister and a good friend of ours. She's in PR. We start talking and I tell her "Chemo is pink!" I tell her about the symptoms and she says "So basically, chemo is pink mushrooms and you have been high for 3 days?.... Chemo needs a rebrand! Nobody feels good when they hear the word chemo." She's currently interviewing to get a communications job at <>, but says if she doesn't get it, she'll take a sabbatical and rebrand chemo. We laugh, but honestly, I think that would do a lot of good for a lot of people. Feb 6th to Feb 9th - I track symptoms. The Dr. W calls me at 9am on Saturday morning. "How are you doing?" I tell her. She's thrilled with how I'm holding up. She makes some suggestions for my diet and at home meds. By the weekend, I'm out hiking and doing 45 minute endurance rides on my Peloton. I'm going to PT for 'cording' and range of motion. Basically, my body has built a cast around my left arm to keep me from moving. Body work (massage) and stretching is the only way to improve it. I'm seeing a PT twice a week. I get an at home exercise where I 'walk my fingers up and down a wall." I'm standing in the kitchen doing my PT when my 3 years old comes up to me and looks at me, looks at the wall and starts to sing. "The itsy bitsy spider when up the water spout, down came the rain and washed the spider out, but out came the sun and dried up all the rain and the itsy bitsy spider went up the spout again." I just stared at her... kids are so smart sometimes. We sang the song together and she likes itsy bitsy spider time (aka PT). Just keep swimming.

Jan 29th - I'm getting a port. Maybe I should have asked prior to the day of the procedure, but there was so much going on.... I really had no idea what exactly a port was. I'm checked in and they take me back to the pre-op staging room. I've fasted for 12 hours, no water. The nurse tries twice to get an IV in me. I can only use my right arm- the left is not an option. She tries in two places and doesn't get good 'flash back'. She goes and gets the head anesthesiologist. He comes in, a very jovial man. He see my arm and immediately looks at my left arm- I have a huge pink bracelet that says COMPROMISED LIMB. He sighs and picks up my right arm and looks for a vein. He sees the two places the nurse already tried. He sees the still healing places from all the other IVs I've had. He sits on the floor and starts tapping my wrist. He looks at a few places and picks a spot. While sitting on the floor he inserts the IV, he gets okay 'flash back', he flushes it with saline and says there isn't any pooling. He determines it good enough. All this time I have to look way. I'm at a new emotional low- there aren't even any places left in my veins to get an IV in. I'm tired of treatment. Just keep swimming. They wheel me down to the procedure room and a physicians assistant comes out to ask me if I understand the procedure and to sign a consent form. I realize I don't actually really know what they are about to do. She explains it to me. It's a permanent IV to be used for all the chemo treatments- no more finding veins. Clearly I now understand the value in that. But, it's sutured to my chest and the IV is directly into my jugular above my clavicle bone. I already have tissue expanders for reconstruction - that's 12 sutures already in my chest wall - what's a few more. An IV- directly to my jugular. Go straight for the jugular. I sigh. Why not. She tells me the surgeon is like a bull in a china shop- he has a big personality, but he really is the best. They wheel me in and the surgeon is seriously the caricature of an Disney butcher. He was funny and loud, but also clearly super on top of everything. He saw my pink COMPROMISED LIMB band and started repeating "everything on right, everything on right'. I had to slide from the one bed onto the operating table. Post mastectomy I have no real use of my upper body- I can't lift more than 10 lbs. I say "This may not work well." He replied, "It's never pretty, just get over there the best you can." I manage... with some help and some appreciation for a lifetime of core strength building. They whirl me around and put up a tent- I'll be alert for the whole procedure, but unable to see it. The actual surgery is only 10 minutes, the other 40 are prep. I hear how the surgeons talk to one other, how they communicate. It's kinda interesting to hear. I feel something like a bee sting and then a lot of pulling on my chest. I'm done. I go home 30 minutes later. Just keep swimming

Jan 13th- It's mid afternoon and I get an email that says I have new test results in my JH app. I open it, it's the full biopsy report. At that top it says, 'These results were automatically released, you may be seeing this before your provider." There is so much information in here. It's way worse than I had expected. 6 not 3 lymph nodes! Ductal not Lobular? Intravenous involvement. What does this all mean? I text message the medical oncologist Dr. W. She responds back quickly, "Can you come to my office on Friday the 15th at 8am?" I'm sitting in my at home office upstairs, there's a comfy chair away from my computer. I'm trying to process all the data from the biopsy report. I get a text message from my boss. "Do you have 5 minutes?" I reply "Yes." He video calls me. "I'm leaving the company." Me. "What?" Him. "We're reorganizing and I've decided this is a good time for me to move on to something else. I'm not the person to lead the next phase, you are." Me. "What?" Him. "You can do this. You'll report directly to the head of the business unit. You'll have more teams under you. You had an amazing 2020. Don't worry I'll pay you a shit ton (his actual words) of money on my way out.' I say "I suspected this was coming. Timing's not ideal." He says. "I know, you can do this. Your new boss he knows too. Take it slowly." We talk a bit longer and get off the phone. Try to process the two massive amounts of information I got almost simultaneously. I decide "fuck work, it can wait" I start googling 'breast cancer staging' and find a medical paper with a proper staging key. I follow the chart with each of my components T =2, N=2, Grade = 2, Estrogen = Positive (100%!) Progesteron = Positive (100%), HER2u = Negative M = ?. We did a CT of my torso but not my head. Lobulars spread 80% of the gut, but Doctuals can spread to the brain. We didn't check the brain. I assume M= 0 no spread. My stage is 1b - WHAT THE FUCK????? How is that possible. Every other combination on the pages gets you to stage 3. I remember "we like the type of cancer you have." I call my husband into the room. I make him do the same thing and ask him what he got. He starts plugging in the numbers. He's starting to smile, he's asking about HER2u "YOUR GOING TO LIVE" is all he says and walks out. The 10 year survival rate for stage 1b is 90%, survival is correlated with obesity, diet, exercise, stress, sleep and a bunch of other controllable things. My surgeon calls me around 6pm that night. Good news, we reconfirmed 1 cm margins. Yes, 6 not 3 is not ideal, but we knew you were doing chemo anyway." I ask her about the staging. She says, 'staging is really complicated now your T = 2 (left, early stage), N = 2 (right, late stage), but I'll leave it to Dr. W to determine the stage. Do you have time with her?" I say yes. She says 'Good, that's the right next step. She's really your primary doctor now. I'll see you in two weeks to check on the incisions." Jan 15th - My husband and I head to Dr. W's office. He's waiting in the hallway of the hospital and I ask her if we can call him so he can listen. She leaves the room and a few minutes later a nurse brings him in. She asks if I have questions. I ask her about the stage and she says she hasn't staged me yet - I suspect in her view it is either 4 or not 4, and I'm clearly not 4. I ask her about a brain scan- I'm having headaches, lots of headaches. She shakes her head "Ms. W, I'm not worried. I'm very optimistic about a brain scan. But, if you would feel better if we do one I can order it. I'll have to reword why we're asking it, if I tell them what you told me they'll deny the brain scan as being unnecessary." I tell her I'd feel better knowing for sure. We move on. She tells me we're going to do dose dense AC-T. It breaks up into two parts - 8 weeks of 'intense chemo' and 12 weeks of 'mild chemo'. 5 months total, but that it's really important to see it as two different phases. Dose dense means they'll administer to me in 2 weeks what they normally give someone in 3 weeks. It's 30% more effective at killing cancer - hit 'em while their down - but I have to be strong enough to rebuild white blood cells in 2 weeks not 3. She's looked at my bloodwork and it's a straight line down the center- I have beautiful blood work. She says she thinks I can handle it and she'll give me a booster to help. She explains the cell cycle and tells me when to eat protein/beta-carotene (Days 1 - 3 after chemo) vs. vitamin c/bone marrow broth (Days 8-10 after chemo). I suspect she normally doesn't go into this level of detail. She starts telling me all the things I need to do to get ready - 4 at home prescriptions, a port (whatever that is...), a echo scan for my heart, more blood work, chemo class. There's a lot, she says the next two weeks will be really busy. My first infusion will be Feb. 3rd. She pauses and asks, "Do you want more children?" Both of us respond, "No, we're good. Full house." Okay, "Chemo will likely make you infertile. If you want to potentially have more children, than we need to freeze eggs." Sigh. "No, no more children." She smiles, "That makes this a lot easier." I ask, "Oh wait, our kids are in private school now. They go in person. Can they keep going?" She sighs. "It's up to you, normally yes. But, with COVID. I don't know. If you get COVID you can't enter the cancer center, that would disrupt the chemo cycle which follows the cell cycle. I don't think COVID would kill you, but disrupting the chemo cycle would reduce the long term effectiveness of the chemo. It's up to you." I sigh, "We'll discuss it." She's quiet for a moment. "The vaccine? Your homework is to get the vaccine. Once you have it, it's fine to send the girls back to school." We leave, within an hour I'm already getting visits scheduled in my JH app. Things are moving, there's a lot. Jan 21st - Jan 22nd - Chemo Class. I sit in a room with a 'nurse navigator' two different ones on two different days. They review my files, they review my appointments, they review everything. Day 1 is more informational for me. Day 2 feels like a test to see if I understood. Both days they notice something missing or wrong in my schedule, they get visits reschedule so dates align (e.g. my echo scan was scheduled a day too late). I keep thinking "This is the chemo version of tech grooming- I'm ready for DEV!" The nurse navigator sees the brain scan - "Why are we doing a brain scan?" she asks. "I reply, cause I'm nuts and convinced the cancer has spread to my brain." She replies, "Oh, okay. We're used to that, Fine, if a brain scan helps you feel better, than we'll do a brain scan. Done." (Nice to have insurance, right? That scan was probably $5K....) Jan 25th - We leave the kids with mom and my husband and I drive to Baltimore to get a brain scan. I have my first sugar in 6 weeks, a small reward. A woman calls while we're in the car. She's from CIGNA. My company, pays for a special concierge service that I'm qualified for. She's an oncology nurse and my 'special case manager' she is my one point of contact at CIGNA and will work out anything I need on my behalf. Basically, my company is paying to take bureaucracy off my plate. It's a true luxury, I know that. She confirms for me JH is taking a very good and comprehensive approach. She's already reached out to my dermatologist, dentist and GP to get a 'full picture' of my health. She can connect me with a therapist, an oncology social worker, a nutritionist... anything I need, just ask. Jan 27th- My second COVID test this month. Just keep swimming.

Jan 12th - I do a follow up visit with M the physicians assistant - "You look great, you're healing really well." I'll see her once a week for a while. OMG. Surgical grains. SOOOOOOOO gross. There are no other words. Other than they're only in for a really short period of time. Just try to get through. The photo is curtesy of a company ANAONO that sells gear for post surgery recovery. Just keep swimming.

Next time I tell you a massive surgery should only take 45 minutes, ignore me. Sorry..... - me Jan 1 to Jan 4: We wait, I get pre-op stuff done. I swear I can feel the cancer growing inside me. We count down days to surgery. Jan 4th: My surgeon has prescribed Gabapentin the night prior to surgery as it reduces the need for narcotics after surgery. I take it. 45 minutes later my throat starts to itch. My husband and sit up for 2 hours listening to podcasts waiting to see if I have trouble breathing. Eventually we decide I'm okay and we go to sleep. Jan 6th: He drops me off at the hospital. Nobody is allowed in other than patients, no waiting outside the operation room to hear how it went. Oh, cancer in the age of COVID. I enter and immediately get a hospital grade face mask. I fill out paperwork and wait. A nurse comes out and brings me into the back where I put my stuff (including my cell phone into a locker). I hand her a piece of paper the plastic surgeon (Dr. D) had said was my 'passport to surgery' without this, no surgery. She takes it. We go through the typical -name, birthdates etc. She asks about allergies. I tell her shellfish (specifically bivalves) and then about he Gabapentin. She looks at me with big eyes, the other nurse turns. Instantly I have a big red arm band with the words ALERGEY ALERT on them. She looks at me and says "We don't screw around with itchy throats." I wait a bit in my little cubby with a bed and curtain. Doctors and nurses come in and out. They come in and start asking me if I understand the procedure I'm about to get. It's more a quiz than anything. I ask how long, remember I'd said 45 minutes? She responds, "5 hours maybe 6. There are two different surgeons each doing different parts." I think, oh shit I told mom and husband 45 minutes. I don't have my phone. Later the nurse asks me if there is anyone she can text message updates to, I thank her and tell her my husband's number. The breast cancer surgeon (Dr. O) comes in, I barely recognize her in her scrubs and head gear. She covers the plan again and needs to inject some contrast into my armpit to help the lymph nodes 'light up like blueberries." She says I can call her any nasty name I can think of, she's heard it all and it will hurt. I breath through it. She tells me I have a high tolerance for discomfort. She sees the incision markings the plastic surgeon has given her, she initials my armpit and leaves to get ready. The nurse comes back, she's running down a checklist in my folder. "Do you have a living will?" I reply, "Uh... no" She says, "Sometimes people bring a living will to surgery." the implicit 'yeah know, incase you die' is obvious. I say no. She asks me what it would be, I say 'my husband makes the decisions.' she responds, "okay, that's the standard anyway." I start to wonder if maybe I should be more anxious than I am. For whatever reason, surgery never made me nervous, not like chemo. Two nurses are talking, something sounds wrong. I listen and they're asking if anyone has seen the plastic surgeon. I ask why, they say he needs to make the incision markings and sign the release form. I said, "He did that two days ago and the other surgeon already signed my armpit. The form is in the notebook." They stare at me, "Ms., I'm so glad you are so on top of things." They look in the book and at my armpit. The nurse flips the front cover of the folder to the green side. She says. "You're good to go to surgery." The wheel me in, The room is big, cold and has lots of light. Dr. O is standing there along with a physicians assistant named M whom I'll get to know later. The last thing I see is Dr. O standing over me smiling. Everything goes dark. I wake up around 8pm the night of the 6th in a recovery bay. The first thing I hear is two nurses talking, "And then, the mob stormed the Capital..." This Johns Hopkins hospital is in DC, though easily 10 miles from the Capitol. I roll over, this can't be real. I'm going back to sleep. They see I'm awake and bring me food and my bag (with my phone). I text my husband -"I'm awake" I text my boss too. He texts back. "Good, now whatever you do, don't turn on the TV." I reply I have not intentions of doing so. (It was 1/6/2021 and I'd been in surgery the whole day.) Jan 7th: I spend the night in the hospital with the standard 3 hour check-ins from the nurses. Around 10 am Dr. O comes in to check on me. Everything went really well, she got at least 1 cm margins. That's what we needed. She did need to remove the 'full packet of lymph nodes." That means I have no lymph nodes in my left arm. For the rest of my life I will wear a bracelet that says "No Blood Pressure, No Needles, No IVs in this arm" Fine. She checks the incisions and drains, everything looks good. She checks my vitals and says "I have no justifiable reason to keep you here. You can go home whenever you want. We're not kicking you out, but... with COVID and all..." She asks if I had already met with the medical oncologist (Dr. W). I say yes, and tell her she had already told me if there was ANY lymph node involvement I would do chemo. The surgeon replies- "That's really the right decision. We already know it's in at least 3. Fully biopsy will tell us more." She pauses. "Ms., chemo is no walk in the park, but you really are young and strong and you will handle it. In 6 months it'll be done and you'll be so glad you did it." I try to smile. I know it is the right thing to do. Two hours later my husband picks me up (with flowers in hand!) and I have instructions for at home care. Jan 12th - I do a follow up visit with M the physicians assistant - "You look great, you're healing really well." I'll see her once a week for a while. Just keep swimming.

Dec 29th - I meet the lead oncologist. She is taking my case personally. She's been treating breast cancer patients for 40+ years and is the Clinical Director for the Johns Hopkins Breast Health Innovation Center. She walks into the room, my husband is standing next to me and I'm sitting on the exam bench. "The cancer hasn't spread. No sign of distant metastasis. Full cure, we're working towards full cure. I need you to understand that. Only good news today." She gave me time to cry, which I started to do immediately. In retrospect, really that is the only way to start this type of conversation. We covered a lot of ground and agreed surgery was the right first step. Based on the full biopsy we'd determine the treatment plan. Me, "Will I do chemo?" Her, "Chemo is incredibly effective and we have a lot of years to protect with you. See hormone treatment only stops cancer from growing. Chemo kills existing cancer and stops it from growing. We can do 10 years of hormone treatment, but chemo will protect you for 20+ years. If you have ANY lymph node involvement I'm going to prescribe chemo. You're young and healthy, you can handle chemo." She does a manual exam, she thinks she feels lymph node involvement. I get out a note book and start sketching a timeline on it. I ask her how long the chemo will last. She says it depends on how many lymph nodes are involved. She looks at the paper and sees the timeline, "Oh, I see what you're doing. I'll give you worst case scenario. 6 months intense chemo. Then 12 weeks radiation. Then surgery. Then 10 years of hormones." I sketch it out- it takes me to almost 1 full year of active cancer treatment. Just keep swimming. We get a call from the nurse navigator on the way home from the hospital. I have a surgery date, Jan 6th. I need a pre-op physical, a COVID test and more blood work. She has dates for all of it. Just keep swimming.

Dec 21st - A bone scan. A nice Indian woman is the technician doing the scan. We get to chatting and she shows me pictures of her adopted daughter. She's nervous because they have no family medical history for her. I tell her about genetic testing and she decides to do it. We talk about India because I know lots of Indians and have been there multiple times. She likes me. She asks if I have children. At the end the screen lights up and she spins around and pushes some buttons. She spins back around. "Ms., I've been praying for you this whole time. You have young children. I'm a mother, I understand. I'm not supposed to say this, but your bones look good. I don't even need to take more images. No signs of cancer.' I thank her. I'm partially relieved, but I know 80% of Lobulars spread to the stomach lining. So good news, but I'm not out of the dark yet. Later that night, I get an email from the Geneticist, all clear. We looked at 47 potential gene mutations that cause the major cancers. I'm negative on all of them. She tells me to try and enjoy Christmas, this is good news. Dec 25th - Did I mention it's Christmas? Dec 27th - CT scan. A nice young technician is super chirpy and makes jokes while I'm getting ready for the scan- the whole thing only takes 5 minutes. The scan's over, instead the older radiologist comes out and unhooks my IV. He says nothing other than to drink water and that I'm "all set here." The young nice technician is sitting staring at the computer screen, he won't make eye contact. I walk out thinking 'Don't overthink this, don't overthink this." I go home with no additional information, other than the technician's face and knowing 80% of Lobulars spread to the stomach. We go to the farm and wait. (My boss was right, I should have stayed off Google.) Just keep swimming.

Dec 16th - We're in the car and the surgeon calls. "Ms., it's Dr. O. Are you driving? I can hear a car noise, is now a good time?" Me "Now is good, my husband is driving." The surgeon continues "Okay, remember that panel I was going to present to? Well, we met today and the lead oncologist wants to meet you. She says there's just such a big range here and it's possible to have more information. So, she wants to get all the information possible. We scheduled you an appointment for a bone scan and a full torso CT." I'm quiet, M they're testing for M, stage 4. Terminal breast cancer. Average life span 18 months from diagnosis. "I'm scared." I say. She responds, "We don't expect anything, we're just ruling it out. Don't be scared. It's just that 7 cm is impressively large and younger women tend to have more aggressive cancer." Bullshit. I'm scared. Impressively large aggressive cancer. We pull up outside the house. Mom's babysitting, we don't go inside, instead we drive to a nice path for an outside walk. I text my best friend. "Are you free? Can you come over? I need to talk" I get an instant reply. "What's wrong? I can be there at 5:30. Earlier if you need, I'll move a meeting." Me. "5:30 is good." She has been my best friend for 25 years. In October her mom found out her stage 3 lung cancer had returned. It's terminal but, they have a new drug in trial that may or may not allow them to manage it like a chronic disease. If everything goes perfectly she'll be off chemo in 3 or 4 years. I'm dreading telling her. I don't want to dump this on her. She comes over and walks into the mud room. She sees the blue Johns Hopkins Patient Care binder. She turns around and walks out the door. I find her crying next to the car. "Is it the little one? I had a dream something was wrong with your youngest." Me. "No, I have cancer. I don't know my stage. I have more information if you want to know." We COVID distance walk. I tell her everything. She is a devout Catholic she says she can point to at least 10 things in my story that could only be God. Then she says, "I'm going to replay to you exactly what you told me 2 months ago... Figure out your A state (you have cancer) and your B state (you want to be a cancer survivor) now find out what it takes to get from A to B and execute it flawlessly. That's what you told me to do with my mom. Now you have to follow your own advice." I remembered saying that, that's exactly the type of thing I would say. I feel better. A to B, execute flawlessly. Get data. This, this I can do. Just keep swimming.

Dec 11th - We meet the surgeon, it's a treatment planning meeting and for once my husband is allowed in with me. First, she does a physical exam- I have to raise my arms over my head and she seems to be focused on the movements of my muscles. She feels the lymph nodes- shakes her head. She says she can't feel anything. We switch rooms and my husband joins us. She hands me a binder with information, phone numbers and 3 pages where she circled information specific to my case. She tells me we won't have a final stage/prognosis until after the surgery, but based on what we do know we can plan treatment. She shows me the MRI, the ultrasound and mammogram. She circles a bunch of stuff on the paper. Down the center of the pages is a line - to the left is early stage cancer, to the right is late stage cancer. We start with tumor size (T) - well actually we don't know it could be 3 cm (left) or 7 cm (right), we move on to lymph nodes (N) - well actually we can't tell, one node is on the margin- inconclusive, so maybe left or right. We gloss over distant metastasis (M) we've only done local scans. We talk further and the surgeon says she thinks the first right step is surgery (the norm). But, she says I'm 'interesting'. See, the range of potential treatment is huge - I could get by with surgery only, or I may do intense chemo. Also, I'm really young with no family history, statistically I shouldn't have cancer. She wants to make me a case study and present my case to the Johns Hopkins breast cancer panel - it's the lead surgeon, radiologist, oncologist, medical oncologist, geneticist, plastic surgeon, and nutritionist. She'd present my case next Thursday and they'd collectively decide the next steps. She gives me homework - do a genetic test to see if I have BRAC 1 or 2 and pick a plastic surgeon. She gives me two names, and says one of the two is 'the best in the country.' I go home and call both plastic surgeons offices to schedule consultations- get two opinions, that's what I was told. I call one, no new appointments until January. I say "I'll take it, but we'd hoped to do the surgery the first week of Jan." She responds, "Wait, do you have cancer now?" Me. "Yes." Her, "We can see you at 11:30 on Monday, cancer patients always come first." Just keep swimming.

Dec 4th: I call imaging scheduling to get an MRI date. A woman answers and asks the typical name/birthdate etc. When I tell her I need a breast MRI, she says "Oh, is today the first day of your period? You'll need to call back on the first day of your period." My stomach hits the floor, that was definitely at least 3 weeks away. I respond, "I need this back by Dec. 11th for a visit with the surgeon." She responds, "Ms. we can only do the imaging on days 10 to 12 after the first day of your period or the results aren't accurate." She pauses. "Do you know for sure the first day of your last period?" Me, "YES! I track it on my iPhone! It was Dec. 1st." She sighed. "Okay, I can get you in on Dec.10th at 2pm- that's the absolute earliest we can do it." I ask, "Will the surgeon have results by noon on the 11th?" She responds "It's like a digital photo, we'll have it immediately" I sigh, and thank her. My emotions are somewhere in numb disbelief that worked out so well. (Total side note- yes, I am that crazy data person that tracks my period on my health app even though I have no fertility issues nor do we want more children, what can I say. I love data.) Dec 7th: The radiologist calls, we're in the car. "Ms., we got the biopsy results back. As expected it is positive. But, there's a lot of good here. We don't like that you have cancer. But, we really like the cancer you have." I'm prepared for this, her face had already told me everything during the biopsy procedure. I tell her, "I did my research, I know the stats. I can handle stage 1, 2, or 3. I don't think I can handle stage 4." She says, "The biology is very good. You have invasive lobular carcinoma. It's 100% estrogen positive, 100% progesterone positive and 0% HER-U2. Even if it is stage 4, there's a lot we can do. This is very treatable." We get off the phone - I can do this. We get home around 5pm, I text my boss "Do you have 5 minutes?" That's modern office lingo for I have something bad to tell you. He instantly texts back, "I'm free now." I video conference him and open with "I...I...I've been diagnosed with cancer." Him, "Oh God, I'm so sorry. My wife had cancer 5 years ago. Put an out of office message up. Work comes second, take as much time as you need. I don't care if we don't hear from you until January." I start with, "We have to tell the team, they'll all know when I do chemo anyway." Him "Whoa, chemo. Slow down. You don't know what the doctors will say yet. Put the out of office up, forward anything on your plate to me and I'll take care of it. And, I know you. As your friend, I'm telling you to STAY OFF GOOGLE! It is not your friend when it comes to cancer, trust me." Dec 8th: I tell one of my direct reports. He's also 37, is married and has two sons each exactly 1 year younger than each of my two girls. We're on video conference and he starts tearing up as soon as I tell him. I suspect he's thinking "What is this were my wife!?!" He shakes his head. "Your going to live. I've worked for you for 3 years. You'll approach this like you do everything. If there is anyone in the world who is going to survive cancer, it's you." Me, "Thank you". I call another direct report who lives in India. She's the modern Indian version of Margaret Thatcher - rules with an iron fist in a lace glove. We get along so well. I tell her. "You're going to live. My grandmother lives in rural India and she had chemo 20 years ago, she's still alive. You're going to live." conversation done. Dec 10th: I sign in with the imaging services room. It's in the basement of the hospital, not a very friendly place. My husband later explains the super sensitive imaging machine can be invalidated by upper floors swaying in the wind, plus they're really heavy. The technician with pink hair and glossy lips on her face shield greets me. She says she likes it down here- it's quiet. I change and the radiologist comes out to put an IV in my arm- the first of many. He asks me if I know why I'm there, I say "Yes, I have breast cancer, they're trying to figure out how big it is." He responds. "You already know you have breast cancer?" Me, "Yes." Him, "You're handling this very well." I've never had an MRI- I don't like them instantly. They try to coach me through it and tell me I'll be in the machine for 20 to 30 minutes, they may or may not need extra images. I ended up needing extra images. I'm starting to not like needing extra images. I go home with no additional information. Just keep swimming.

I honestly hope you all will never have to go through this experience ever, but hands down the wait for a diagnosis is the hardest part of cancer. Dec 1: I met my general practitioner specifically for a breast health check. Within 1 minute of discussing she said, "I'm sending you for a mammogram and ultrasound regardless of what I feel when I do a physical exam. And, then we're going to do EXACTLY what the breast specialists tell us to. Okay?" It wasn't really a question, more a statement. I left her office at 4:15 that afternoon with an ultrasound order in hand and a list of radiologists in the area. I didn't even drive home, I called to schedule an appointment from my car in the parking lot. Good thing too, there was an approval missing from the GP that is needed for women under 40. Yup, remember, I'm not even old enough to get screened for Breast Cancer yet. I promptly walked back into the GP's office and asked the front desk for the paperwork. The woman had just closed her computer and said someone would be right with me. I lost it and started to cry for the first time. I had kept it together in the initial meeting with the doctor, but this was too much. I knew time was important and looked at her and said "This is for breast cancer, please help me." She immediately opened her computer up and got me the papers I needed. I went back to my car and called the radiologist back, I got the first available appointment which wasn't until January 11 - six weeks out. I took it, then drove home and researched every radiologist in the DC area. I called a few more but couldn't get through. I called Johns Hopkins (my alma mater) and got the answering machine that said their hours were 7:30 to 4:30, so already closed for the day. I was crying at this point, and for the first time in my life looked out the window and asked for help (specifically to Mother Nature). Dec 2: I woke up earlier than normal. I had planned to get a coffee and then start calling places back - I don't do anything before coffee. I have a framed slogan in my kitchen that says "Say yes to adventure... but first coffee." Instead, for whatever reason I walked straight into my office and called Johns Hopkins back at 7:25 am. A woman answered the scheduling line and said their next appointment was for Dec 11th, then she paused "Oh wait, we had an overnight cancellation, that never happens. You're the first caller we can see at 11:30 if you can make it here on time." I responded, "I'll take it! I'll be there." I'm crying at this point, relief crying. No waiting until Jan. 11th. My husband and I are walking the halls waiting for my appointment, I get a call from the receptionist at my General Practitioner's office. "Um Ms., I wanted to call to see if you needed help scheduling a mammogram." I responded "Nope, I called JH and they could see me today, I'm at the hospital now." She responded, "Oh thank God, I saw the Jan. 11th date in the system- that's unacceptable. I'm so glad you got a visit today, that's ideal." I replied, "You know, I thought the same thing." I get my first ever mammogram, the technician has pink short hair and opted to put a sticker of glittery pink lips on her COVID face shield. "Ms., this won't take long, I may or may not need to take additional photos. The radiologist will decide that."..... Well the radiologist did want extra photos. (You'll see a trend on this one.) I switch rooms to the ultrasound room. A different technician (no pink hair, no glittery lips) takes a bunch of ultrasound measurements. She asks questions like "Ms., do you have children? How old are they?" She takes more images. The radiologist comes in. "Ms., I looked at the mammogram and I'd like to take a closer look. The lump you felt, I'm not worried about that, it's white that means it's abnormal, but not cancerous. Underneath it, there's something dark there I can't really see." She takes more measurements. At this point I'd already done my breast cancer research so I knew simple staging is based on 3 factors T = Tumor size; N = # of lymph nodes involved; M = distant spread. So I ask, "How do my lymph nodes look?" The radiologist is looking at me and holding the ultrasound in her hand said, "Normally we don't look at this point, but why not." She started looking at my lymph nodes, "Good, I'm not seeing much here." She pauses and takes one measurement. She tells me she wants me to get a biopsy and that she'll get it scheduled for me. A few minutes later she walks back in, "Oh good news, we happen to have an opening right at 8am tomorrow. Can you make it?." I'm starting to suspect 8 am or noon means the doctor forced scheduling to open a spot. Dec 3: A different radiologist walks into the room at 8 am. She's the more senior radiologist and said she happened to have already spoken to both my General Practitioner and the first Radiologist. I'm thinking this was scheduled yesterday afternoon, there's no accident in her having already spoken to the other doctors. This is the Johns Hopkins version of a second opinion- and fast. She does the biopsy and also asks if I have children, we get to talking and she's also a Peloton fan, but we like different instructors. She finishes up. "Ms., normally we'd wait until the biopsy to come back before doing anything. But, I've been diagnosing breast cancer for 18 years and I don't like what I see. It's very suspicious. I called the lead breast cancer surgeon and she can see you at noon on Dec. 11th, can you make that work? I'm so happy she said yes, she really is the best surgeon at Johns Hopkins. But, you need an MRI done before she will have all the information she needs. You'll have to call to schedule that." I'm thinking - obviously I can make that work. Who are these people who can't make a visit with a breast cancer surgeon? I thank her. She turns and says more to herself than to me, "That's everything I can do, there's nothing more I can do." Just keep swimming.