I’d be lying if I told you that the minute I felt that lump under my arm, I knew it was cancer. Because I’d felt it several times and in fact, thought it was just some new form of peri-menopausal premenstrual torture that my body had devised to confuse me, throwing me off course yet again on my journey to God knows where before I reached the final destination for middle-aged women: invisibility and ultimately death.
So, yes, I had a flair for drama when it came to the many surprises that peri-menopause was delivering. I faced these “gifts” with both wonder and dread, a fear of loss and of the unknown. But I figured that I’d face this like all the other challenges I had faced throughout my life. That I’d get to the other side a more enlightened person, maybe a bit wiser.
I also figured that I had several years to really deal with all of this since I was only 47 years old. And when I felt that lump, in June or maybe July of last year, I did not panic. I got practical. I’ve been an ob-gyn for 14 years and have additional degrees in integrative and holistic medicine, so I put my training to use. I monitored the mass over the course of a few months, assuming it was some hormonally sensitive tissue in the final grips of my reproductive years.
Sure enough, it swelled and was palpable before my period and shrank after that. But three months later, it just seemed odd: a bit hard and crunchy, sort of asymmetrical, the size of a peanut with a conjoined twin. Was it tender to the touch? I really don’t remember now. Although cancer was a possibility, I just didn't think that it was. I wasn't a person who gets cancer.
Also, I had a major event coming up. My daughter’s bat mitzvah was weeks away. Did I really want to take the time to deal with this and risk the stress an evaluation would bring? No, I did not. I wanted to experience joy.
Ten days after my daughter’s wonderful event, the lump was back. Still, I really did not think this was a big deal, but I knew it was time to do something. So I did what any responsible adult with professional connections would do. I called the radiologist three months early for my annual mammogram and scheduled myself a visit. And I didn’t worry about it. I slept just fine that week and even had dinner with a dear friend the night before without mentioning the doctor's appointment I had planned for the next morning.
I drove myself to Dr. Goldberg’s, and when the mammogram became an ultrasound became a physical exam, I wasn’t surprised. My dense breasts always led to these prolonged visits. Even when he consented me for the core biopsies and did three of them, I was shocked by how uncomfortable they were despite the lidocaine, but I wasn’t yet thinking I was screwed. I figured he was covering all the bases. As a surgeon, I know you don't biopsy everything you feel, but you biopsy stuff you aren't sure about or need to prove is benign or malignant.
All I could do was wait for the results of the biopsy. That turned out to be stressful. All of a sudden I realized my many tactical errors. Doing this on a Thursday might mean waiting for results over the weekend (48 hours of additional anxiety!), having the radiologist do this instead of the surgeon (another dear friend and colleague) seemed like an added layer because WHAT IF THIS WAS CANCER? I'd still need to see her and get her input. Which pathologist should read the slides? The ones I knew personally and professionally would be let in on my personal medical history and that made me feel WAY too vulnerable, but sending them to another hospital might mean I was just another anonymous faceless blob of boob. I started calling around to my colleagues “just in case.” The consensus was: “You’ll be fine! You’re the picture of health, it’s gotta be benign!”
Was I being melodramatic to connect with the fear that in fact this might be “something bad”? I’d always been one of the “lucky ones.” Things just seemed to go my way. I worked hard, but I also was so often at the right time at the right place. NEVER in a million years would I have articulated that bad things happened to other people because they brought it on, attracted it or invited it in (I didn’t really believe in The Secret.) But I did believe that I deserved what I had achieved. So was giving in to this physical anxiety a show of weakness, a loss of faith, or just a normal reaction to uncertainty? And what happened to one of my most prized characteristics: My INTUITION, which had a been a guiding force in most of my major life decisions. In retrospect, I wonder if my intuition went on a little hiatus.
I know many of you will seriously question my judgment or even my ability to connect with my gut. But in reality, most of the time, when a patient comes in with a worrisome breast mass, what I feel isn't cancer, and I am so not about making fear-based decisions for my patients or myself.
The next morning, my doctor called to say that I had cancer. I was walking up to the cafe where I had a lunch meeting. I sat down, stunned: “I have breast cancer.” Luckily this meeting was with trusted friends who embraced me in the most loving and amazing way.
Despite the way I questioned almost every move I made, what I DO know is that nothing different was meant to happen and that my story has unfolded in the way it should have. I don't regret the process or my decisions, and though I don't love the diagnosis, I had cancer, but I AM NOT cancer. In fact, this was spontaneous my mantra during the MRI I had later that day and which resulted in the discovery of a second small tumor deeper than the first. The first tumor was my messenger. I felt it and it saved me from the second one growing quietly 1 centimeter from my chest wall.
In the five months since that day, I have undergone a raft of genetic tests, a surgery, and radiation treatment and now am on an estrogen blocking medication, which I will take for the next 10 years. I knew enough to understand that my particular diagnosis was not a medical emergency. I took a full month to gather all my medical data and formulate a plan based on my trusted doctors’ best advice.
And I also took that time to re-connect with the healing modalities that resonated most with me. I received weekly Ayurvedic body therapy, I re-examined all my herbs and supplements with my integrative internal medicine doctor. I took another hard look at my diet, ate more healing foods (like warm milk with ghee, rose petal jam, coconut oil and classic Ayurvedic chavanprash) and I ate less animal protein. I backed off on the harder-core aspects of my exercise regimen in order to nourish my whole self. I stopped hot yoga and running and rededicated my daily mediation practice.
I invited only those I trusted most into my inner circle and felt no guilt about excluding anyone whose energy disturbed or did not support me. I prepared my mind body and spirit for surgery. As it turns out, I am one of the lucky ones, because I have the “good “ kind of breast cancer. The kind that is least traumatic to treat and has a lower recurrence and mortality rate.
But guess what? I STILL have breast cancer! How did I wind up here? Statistically speaking, women in my age group face a mounting risk of breast cancer. By the age of 40, one in 68 US women will be diagnosed with breast cancer. By age 50, that number shoots up to one in 42. I was 47 when I was diagnosed.
But why me? OK, I had my babies at 31, which could have raised my risk (women who have their first child at age 30 have twice the risk of developing breast cancer as women who have their first child at age 20) but I did breast-feed for a total of 37 months (which should have reduced my risk).
My family history is “interesting,” (lots of prostate cancer and a smattering of breast cancer) but I’m not a carrier of BRCA or any other known genetic mutations. I’ve had an active meditation and yoga practice for almost 20 years, I have been a vegetarian on and off for years, eat clean and local and organic. I don’t smoke, I rarely drink, I am not overweight and I take anti-inflammatory supplements and avoid almost all processed foods. I am trained in herbalism and eschew pharmaceuticals whenever possible in place of lifestyle practices. In fact, my oncologist tells me that I am “in perfect health,” which is pretty fucking funny coming from your oncologist.
I’m also not obsessive about health and feel this attitude is a stress reducer. I have tried to apply the practices of mindfulness and surrender that I teach, write and speak about to my own life. I don’t take myself too seriously, I practice gratitude, participate in community activities, which bind me to people, places, history and rituals that I care deeply about. I laugh. A LOT. And I make people laugh. A LOT. Like, every day. I love and am deeply loved in return by my kids, my husband, my family and friends, by my patients, co-workers and colleagues and even by relative strangers. I am in love with life. I try new things, take risks, get my hands dirty, swear and don’t hold my feelings in too much. Do I have stress? Hell yes! Do I do things to relieve it? Every day!
So what happened? I got cancer anyway, and — not to put too fine a point on this — you could, too. Because here is another one of my beliefs: there is no magic unicorn that will you guide you through the fantasy kingdom of “doing it right” or “being natural.” A positive perspective is NOT a perfectly protective shield against bad shit happening. But it sure does help in shaping your perspective on that bad shit and how you move through it.