The C(ourtney) Word

Dumb Mistakes I Vow Not to Make Again

2009-02-11T00:01:00.004-05:00

1. Perming my hair
2. Serving salt in the sugar bowl at a tea party
3. Neglecting to wash my hands thoroughly after using self-tanner
4. Leaving myself only one hour to make a 30-minute drive to the airport (without traffic) AND to return a rental car
5. Putting rolls wrapped in tinfoil in the microwave
6. Going on vacation without backup contact lenses or glasses
7. Storing melatonin pills in a Tylenol bottle and then leaving them in my medicine cabinet and forgetting about it (Matt to me while staying at our apartment: "I don't understand why I can't stay awake today!")
8. Hitting "Reply All" without checking really, really carefully who the "All" includes
9. Running out of diapers at 11:57 p.m.

I'm just back from a short jog to rectify number 9, fueled by the adrenaline produced when I realized that not only had I used the last of the stack that we keep beside Alex's changing table, but also I had neglected to replenish the stash in my diaper bag following a particularly, ahem, productive afternoon out. Thank goodness for the kind gentleman at Pricewise on 82nd and Broadway, who kept the store open a few minutes past closing for me when I called tonight in a panic.

And as for the 9 instead of 10 above, I may not have proven myself to be the sharpest tool in the box tonight, but I am smart enough to know that plenty of other dumb mistakes are lurking out there, just waiting to be made.

Ladies' Man

2009-01-07T00:14:00.005-05:00

The last thing I want to do is start screwing Alex up in his third month by projecting all kinds of ideas and expectations on him, but it's really hard to avoid completely, especially around the holidays when the grandparents are there to play along (Look at the long fingers - he'll play piano! Listen to him make noises while we sing - obviously a musician! Can you believe all the kicking? It must mean he'll be a great soccer player!)

Even more obnoxious is referring to other babies as his future girlfriends, so I won't, but I can't resist posting two pictures from our trip to London (yes, Alex has a passport. It's the same size as a grownup passport, but somehow I doubt he will still resemble his photo in 5 years, when it expires).

Caroline (first photo, in the navy and white) is the daughter of two friends we introduced to each other and is just a few weeks younger than Alex. Emily is a week older and is the daughter of Michael's oldest friend. One day I'll have to remember to delete this entry and hide these photos so he can't accuse me of being manipulative, or worse, decide he doesn't want to be friends with our friend's children at all. But for now, I can't help but think how cute they are (although I must say that from the looks of the photo of him with Emily, with Alex asleep high in his stroller throne, it looks like chivalry is dead in the baby world...)

The Inevitable Question

2008-11-15T23:17:00.000-05:00

My oncologist’s nurse gave me the pin at my first appointment – a small pink ribbon, about an inch long. I did my best to avoid cringing, stuffed in into my purse and forgot about it. What was I supposed to do, wear it on my coat? In the middle of October, when the whole world was painted pink, I was already plenty aware, thanks very much. Wasn’t the fact that I would be bald in six weeks enough of a sign of my status? Did she really think I wanted to advertise it to the rest of the world?

Although I still don’t wear a Livestrong band on my wrist and the only pink items in my wardrobe are the free t-shirts from Race for the Cure, my visceral response to such things mellowed over time, as I got used to my diagnosis, progressed through treatment, and ultimately started being able to see that I might get through this alive. I also grew to understand the value of the awareness raising campaigns on a broad as well as a personal level, as even my hairstylist told me the other day that I inspired her to make an appointment for a mammogram. Nevertheless, the pink ribbon pin sat collecting dust in a tray on my dresser until a few weeks ago, when I decided to put it to use as an amulet.

There are many social activities for new mothers – lunches, lectures, playgroups – that one somehow becomes immediately aware of moments after the baby arrives. At any of these gatherings, talk tends to focus on sleeping and eating patterns. Just as college freshmen ask “what’s your major?” in their getting-to-know-you conversations, the new mother shibboleth is “are you breastfeeding?”

Enough of my friends had been through this initiation ritual that I knew what to expect, and dreaded it. I feared the judgment that I imagined I would see in people’s eyes when I bought formula, the comments strangers might make as I fed my baby a bottle in the park. Since there is nothing I could do about it, I avoided reading the over-the-top scare stories about how formula-fed babies are destined to be shorter, dumber, uglier and more ill-behaved than their breast-fed brethren, but I knew that once he arrived, I would have to face the music and confess to the self-righteous La Leche leaguers that I was a bad mother from the moment my baby arrived.

Short of tattooing “my mom is a breast cancer survivor” on Alex’s face, I couldn’t think of a way to preempt the comments. Until I remembered the pin. One night while drifting off to sleep, I decided that was the best way to stave off judgment and criticism and vowed to pin it on my diaper bag the next day.

Which I did, and which of course was completely misguided. Not because the pin is a little small to be noticed in a sea of stroller toys and diaper cloths (which it is), and not because everyone is too busy cooing at my baby to notice my diaper bag (which they are). Instead, it’s because I underestimated the tact of the people I would be meeting. Over the past few weeks, I have found the best response to the inevitable question to be a simple “No, I can’t.” Nobody has pressed for reasons why yet, but if they do, I am more than happy to tell them – not in the defensive “I can show you my mastectomy scars” way I rehearsed in my darkest imaginings, but in a way that I hope might be educational, or is at least polite.

Meanwhile, the pin remains, and with every smile Alex gives me, I am reminded that he is much more than what he eats.

A Thousand Words

2008-10-19T23:22:00.003-04:00

Or in this case, 39,000.

There is lots I want to write, about the delights of life with Alex, the anxiety that breast cancer awareness month spurs in me each October, the relief of passing my two year milestone this week. But there is only so much you can type one handed while holding a baby with the other. For now, photos will have to suffice:

http://www.flickr.com/photos/reucassel/sets/72157607469774654/

A Whole New C

2008-10-05T06:42:00.005-04:00

There were several times last fall that the topic of having a baby came up: the fertility clinic we had used unsuccessfully to try to harvest and freeze my eggs prior to chemo needed us to update our records, a friend suggested subscribing to the “Adoption After Cancer” mailing list to start researching that long and complicated process, and Michael checked with our health plan to see if egg donation was covered using a flexible spending account. We resolved that 2008 would be the year that we would start making the decisions we needed to make in order to grow our family and to move into the future without dwelling on the past. In mid-December, I ordered an ovulation prediction kit online, figuring that a good place to start would be to get some handle on what my body’s rhythms were now that I was through my chemically-induced menopause.

It turns out that my body was already way ahead of me. Just days after writing my last blog entry in late January, I found out I was pregnant. With no fancy science experiments but pure calendar-driven guesswork, timing suggests that this was the best Christmas present ever, well worth the 41 weeks of pregnancy, 24 hours of labor, 90 minutes of pushing and ultimately the 20 minute caesarean section it took to finally get him here. Alexander Hagen Wilson was born at 12:21 a.m. on Wednesday, September 24, weighing 7 pounds, 3 ounces, and measuring 20 inches.

Over the past nine months, I have made and broken many vows to update this blog with the news. We dutifully documented my growing belly in photos and I composed many entries in my head that attempted to do justice to the overwhelming joy and relief we felt at getting to this point less than two years after my diagnosis.

But I couldn’t bring myself to post anything. It wasn’t just the blog. I also completely stopped logging in to check on the Young Survival Coalition message boards that had been my lifeline during treatment, even though I knew that just writing a brief update about my own happy story – pregnant just 9 months after finishing chemotherapy – would offer hope to many newly diagnosed women.

Looking back, I recognize that a number of reasons kept me away. I do most of my writing late at night, and pregnancy had an amazing way of eliminating my 4 a.m. insomnia bouts. (Confession: if you go back and check posting times for previous blog entries, my nocturnal tendencies may not be so obvious. More than once, I manually altered the time of a post to a more socially acceptable 11:43 p.m. or 12:38 a.m. to prevent family and friends from worrying about my sanity and wellbeing.) I also found myself focusing intensely on my work, trying to achieve a year’s worth of results in the nine months I knew I had in the office before spending the remainder of the year on maternity leave. When I wasn’t sleeping or working, I was studying for what will be a never-ending graduate course in child care, one that will come with no degree but hopefully will result in a happy, healthy and well-adjusted boy. Also, I wanted to make sure that friends, family and colleagues heard the news from me rather than from my blog, and tradition and paranoia kept me from spilling the beans widely before April.

But most importantly, I knew I needed to stay positive, and I was afraid that updating the blog might pull me back into a world of worry about recurrence, blood tests and five-year survival rates. And while dwelling in those dark places is still something I need to avoid, I am so awash in joy, love and relief that the time finally felt right to come back to this, just a few weeks shy of nine months after my last update, to write about what I believe is not a happy ending but a wonderful new beginning. (And, truth be told, I have found a comfortable position with the baby on a pillow on my desk, my arms around him and chest holding him in place, that still allows my hands to reach the keyboard. Since I am quickly becoming reacquainted with the late night shift, this lets me help him through the post-feeding “gas fussies” without losing my mind.)

So welcome to a new era of The C(ourtney) Word, where the most important C of all is the child whose eyelids are fluttering back to sleep as I finish typing and prepare to do the same myself.

First Fears

2008-01-25T00:07:00.000-05:00

In the third column on Page 60 of the February edition of Marie Claire magazine, in an article on hair thinning and hair loss, the author writes the following:

"I spoke to 34-year-old breast cancer survivor Courtney Hagen, who revealed that when she heard her diagnosis, her first fears were for her golden locks."

Far be it from me to stomp on anyone's artistic license. I understand the power of a pithy soundbite. But I do feel that I have to defend myself at least a little from being perceived as a moronic airhead nincompoop, and also to share a bit of the less glamorous, less kicky, less "Marie Claire" parts of this disease.

My first fears? I am going to die, much sooner than I thought. I am never going to have children. My wonderful husband will grow old without me. My parents will suffer the horrifying fate of burying their child. There are places I have always wanted to see that I never will. I will die without having truly added anything to the world, without having made a difference, without contributing to something larger than myself.

The worst part of this disease is that even now, after treatments that did not make me sick, after surgery from which I bounced back in just a few weeks, after enjoying the benefit of being able to go braless for the first time since I was 11 years old, those fears never entirely disappear. Because even though my prognosis is excellent and chances are outstanding that I will live to see and do and achieve many more things, I am not "cured."

A friend recently shared the sad news that her mother has been diagnosed with breast cancer. In a natural reaction, especially for someone as bright and analytical as she is, she had been in a research fog for three days straight, soaking up all the information she could about the disease. "Only now do I truly realize the long term emotional impact of this for you," she said, as I imparted what little wisdom and experience I could over the phone. "The fear never goes away, because once you have had this disease, it's always there."

Like my scars, the fear fades with time, as every week takes me farther away from the diagnosis and closer to the magical "five years out" mark, as my hair grows back and my chest muscles grow more flexible, as I allow myself to believe in the statistics a little bit more every day. But the fears have not disappeared entirely, nor do I expect they ever will. But I firmly believe that there is more to be gained from looking into the future than from lingering in the past.

Which is why I just rolled my eyes when I saw the sentence, distilled from a 35 minute conversation the author and I had on the phone in late summer. Although my self-righteous, "I'm no airhead" defense holds a little less water upon reading the rest of the paragraph, a direct quote my friends will immediately recognize as accurate: "I had a double mastectomy, but I was more traumatized about losing my hair." A statement even my doctors will vouch for.

Runway(s)

2008-01-07T19:14:00.000-05:00

Project Runway, the least annoying reality show on television, already had me as an unashamed member of its fan club even before last week's episode. The ironing board was set up in front of the TV and I was happily, compulsively multi-tasking when the delightfully starchy Tim Gunn announced that the designers' challenge was to create a garment using only materials available at the Hershey store in Manhattan. They had 5 minutes to load up anything they could carry, from Kisses to window decorations, in a mad "Supermarket Sweep"-style dash through the store. The chocolate icing on the peanut butter cake? Hershey will donate all proceeds from the auction of the fashions to the Young Survival Coalition and the Tour de Pink.

I'll take a competition that hinges on talent and creativity over one that relies on deceitful antics and the fickle fingers of teenaged text messengers any day. And the fact that this one involves fashions judged by snarky-cum-constructive designers, editors and models? All the better.

And some of the fashions were indeed delicious. Irritatingly smug and dramatic though Christian can be, his Reese's peanut butter cup wrapper dress was chic and fun (although I can do without the off-center beanie). I loved Chris's sophisticated, graphic strapless dress that is both familiar and yet could also be a fun dinner party game if you did not immediately recognize the materials. Rami's ultimate winner is the kind of bold, high-fashion dramatic piece I dream of wearing to a party, if only I had the balls (oh, and the size 0 figure).

Here's to their successful auction once this season of Runway is over, and to raising lots of (chocolate chip cookie?) dough for the YSC. It would be great to hear that some of the dresses even managed to get worn out in real life once or twice.

Despite the January date, it's just about warm enough for these to pass muster as seasonally appropriate in my current location - Chicago, where I am briefly in town for a business trip, is a balmy 64 degrees at midnight. Hence the plural title of the post, which was mostly written while I waited out Hour 3 of what was ultimately a 4 hour delay, parked on a plane that had just pushed back from the gate at the airport due to the bizarre midwestern tropical storm. Thank heavens for portable WiFi. American Airlines, I'm sorry, but as Heidi would say, you are Auf.

Bring on 2008

2007-12-30T23:30:00.000-05:00

This new year is much less about resolutions than it is about new beginnings. After the 2007 we have had, with 6 chemo sessions, two surgeries (mine and Mom's) and a long recovery, I am confident that 2008 can only be an improvement.

So you can bet that we will be toasting to life, love and the future this New Year's Eve. Although I am not sure the catharsis (or the hairstyles) will be as dramatic as in the event from which we drew the photo that graces our holiday card this year, I can assure you the spirit of celebration will be even stronger. Happy new year.

C for Christmas Cards

2007-12-16T22:44:00.000-05:00

Ever since 40 of my most fabulous friends got together to help me celebrate the end of chemo over karaoke and way too many drinks, I have been threatening to use one of the more damning photos from the night as a tongue-in-cheek Christmas card. I deliberated over whether it's self-indulgent to send a photo card when you are married, in your thirties and don't have kids - I worry that even without the dreaded "long list of amazing things we have accomplished this year" letter accompanying, it smacks of self indulgence: "Here we are having a fabulous time on the slopes in Utah!" "Check out the beautiful place we ate lunch in Provence!"

Nevertheless, I love the photo cards from friends that start landing in our mailbox this time of year, giving us an annual window into their lives, or at least keeping us relatively current on how big their children are getting. So I ordered a small number of custom-printed cards to send to the friends who had been a part of the evening, or who I thought would get the biggest kick out of the joke, even plumping for the pre-printed envelopes (it you're going to do something, why go for half measures?)

Of course, being an amateur in this area compared to the mothers out there, I did not get it together in sufficient time to make the overseas mailing deadline, so our more far-flung friends and family will receive the standard card with a more conservative photo tucked inside. But now that all of the cards have been sent, I am starting to regret my decision to limit the distribution list. So I will post the photo that made the final cut once I am fairly sure the cards have made their way to their recipients, but for now, here is one of the rejects. Who needs matching Santa hats when you have mardi gras beads, wigs and bunny ears?

Déjà vu

2007-12-09T19:10:00.000-05:00

It was the same startlingly small, 40-room hospital I stayed for two nights in April. The same green jello on the dinner tray, the same blue and white gown soft from many washings, the same red-haired nurse capably bustling around taking vitals before the same two doctors started the same surgical procedure to remove two breasts and replace them with smaller, perkier, and far less threatening silicone models.

And yet it is very different when your mother is the one in the bed. When she seemed to need reassurance, I told her how quickly the anaesthesia put me to sleep and how I was not in pain when I woke up. When she needed distraction, I talked about the places we could shop for clothes afterwards, once her new body was feeling up to it. But once they wheeled her to the elevator, pushed by the doctor himself (in what was either VIP treatment or an expression of the hospital’s limited personnel), all I could do was wait.

It took longer than my surgery did, because Mom opted for prophylactic ovarian removal at the same time. “One stop shopping,” said the doctors. Dad and I ordered breakfast from the coffee shop, and I got to experience first-hand the glacially slow, albeit extraordinarily friendly, service from the octogenarian volunteers that staff the place that Michael and Mom had laughed about during my stay in April. Twenty minutes and a lukewarm bagel later, we idly scanned the newspaper, talked about Christmas plans, and waited for news.

There is nothing as reassuring as a smiling doctor. The gynecologist came out first – the salpingo-oopherectomy (removal of ovaries and tubes) was finished, they had been able to complete it laproscopically (making recovery easier), and everything looked normal. This being the part that was most unknown since I had not been through it myself, we enjoyed a few moments’ relief before settling in to wait for the next report.

The hospital is so small that the “waiting room” is a collection of three couches and two chairs inside the front doors. I sat there with my laptop open, fully intending to catch up on blogging since it had been so long and since many of our friends and family knew that was Mom’s surgery date, and I wanted to let them know the good news. When I found that I could not concentrate enough to formulate coherent sentences, I switched to online Christmas shopping.

Dad had his brave face on, but his agitation showed in his inability to be out of sight of the operating room’s exit – rather than joining me in the seating area, he chose to stand in the hallway, leaning against a wall, ready to spring to some sort of action when the doctors emerged.

Which they did, smiling. Everything had gone smoothly, no complications, and they would be wheeling Mom upstairs within the hour, once the anaesthesia had started to wear off. Truly relieved, we beat the coffee shop’s 2 p.m. closing time by 5 minutes, celebrating with painstakingly constructed tuna melt sandwiches before joining Mom in her room.

“Whose idea was this anyway?” she muttered, stirring as we approached her bedside. I had been tasked with making sure the doctors obeyed her wishes to be smaller – they assured me that the implants they put in were a third the volume of what they had removed. “You’re going to be able to wear whatever tops you want!” I said encouragingly. “I’m going to be able to stand flat up against a wall,” she groaned, trying to find a comfortable position in spite of the drains, wires and circulation socks restricting her motion.

Dad and I alternated turns spending the night in the room’s spare bed, there to help her out of bed to the bathroom and to ensure she had all the ice chips, water and graham crackers she needed. I remembered the monotony and waiting to feel better being almost worse than the physical discomfort itself, and it was no different for Mom. The boredom was lifted by a very unexpected visitor - our dear family friend Joseph surprised us all by jumping on a plane, braving the Newark airport rental car parking lot, and navigating his way to Dobbs Ferry in an incredibly generous and appreciated act of friendship.

After three nights, we’d all had enough of hospital beds, and fortunately Mom felt well enough to negotiate her way down the hall, out the door and into the car under her own steam. For the past week, she has been recovering here in our apartment, slowly getting to the point that she can get out of bed on her own, gradually feeling good enough to brave the trek across Broadway to Barnes & Noble for coffee and a quick scan of the magazines before returning home for a nap.

“When did you start feeling better?” she’ll ask, and I try to remember. It took a few days before I could concentrate on more than television, a week before I had any desire to leave the house. It felt like weeks before my drains came out, months before I could sleep on my side again, ages before I felt human. In reality, recovery happened much faster than that - my credit card statement will prove I was out shopping by day 10, and I was back to work in a month.

People ask if watching Mom go through this is hard on me. It is, but not because it brings back bad memories of my own surgery and recovery, which was equally as smooth. Rather, it’s hard to see Mom in pain, unfamiliar to be in the role of her caretaker, bizarre to help fit her into a new bra. All things she did for me when I was growing up.

Many people move from being taken care of to being the caretaker for one’s parents as time passes. The thought used to scare me, but now I see it as an honor. Although my surgery was a necessity since I had cancer, hers was a choice to avoid the disease down the road, a measure to help extend her life, and in many ways an unforgettable and overwhelmingly generous gift to me.

Back in Blonde

2007-10-25T02:00:00.000-04:00

Now that I have had 4, count 'em, 4, haircuts since losing it all in December, I decided it was time to play with the color a little. I have always wondered what it would be like to do something radically different than the golden highlights I started doing in college and always feared stopping ("So much grey!" Milla would tsk tsk as she applied the foils, from around the time of my 27th birthday). After being talked out of red by Michael (anti-Ginger bias seems to be not only common but socially acceptable among the English), I decided for something more dramatic than the blonde highlights I had been sporting in my mousy brown base color since late August.

Being released from jury duty a few hours earlier than expected gave me the perfect window - knowing that Milla would probably not support the decision, I decided to cheat on her. Never a true monogamist when it comes to grooming, I headed back to a salon in my neighborhood I had not visited in a year or two.

After talking me out of truly light ("If you go platinum, you'll be in my chair every two weeks," Megan warned), I ended up bleaching it all to a "warm blonde" shade with buttery highlights. A week later, it reads a little too orange to me - I am heading back in to lighten it up again next week. Because why not? It's not like the threat of "what if it all falls out" holds a lot of influence. But I'll turn to my virtual beauty consultants out there in the ether for your thoughts and suggestions..

Cancerversary

2007-10-15T23:58:00.000-04:00

In the past 12 months, I have...

Leaned where to buy the most beautiful bouquets of flowers in New York
Lived through two "Breast Cancer Awareness" Octobers without letting the color pink nauseate me
Gone from shoulder length hair to a short crop without the use of scissors
Had my skin pierced with dozens of small needles to stave off hot flashes
Rediscovered what my ribcage looks like
Undergone the first and second surgeries of my life
Gone through menopause and come back out the other side
Discovered I carry a gene that will influence most of my future health decisions
Managed to average just over one blog entry per week
Gained back all 7 pounds I lost during the chemo-induced period during which I lost interest in sugar and alcohol, plus a few more (I blame all the celebrating since April's successful surgery)
Lost and then regrown my eyebrows and eyelashes, as well as almost all their other hair on my body
Grown accustomed to seeing myself without nipples
Bought several fabulous hats and scarves that look even better with a little real hair underneath them
Confirmed that I have the most caring, loving and generous friends and family that anyone could wish for
Successfully obliterated a 2.5 cm tumor growing in my breast
Become comfortable using the word "survivor" to describe myself at last

Tour de Pink in Pictures

2007-10-03T23:51:00.000-04:00

As predicted, it's been a busy week - getting back into the swing of things at work and home after a few days away is never easy. But my legs are recovering, my bike short tan lines are fading, and I am determined to post up more photos before it gets too late. The leftover adrenaline must be clouding my judgment, given that I am already thinking about doing another ride this weekend - I don't anticipate the seat will be any more comfortable than it was riding home through Central Park on Monday morning, but right now it sounds like a plausible idea.

Apologies if I massacre your name in the captions or just plain don't know it - feel free to drop me a note, or just remind me next year!

Tour de Pink Days 1 and 2

Tour de Pink Day 3

Tour de Pink Finale

2007-10-01T22:58:00.000-04:00

In what was possibly the hairiest quarter-mile stretch of our entire 220 mile ride, the Tour de Pink battled its way through Manhattan commuter traffic to our grand finale outside the Fox studios this morning. A balloon arch, free massages and friends and family were there to greet us. As this is television, things weren't necessarily as spontaneous as they had been on the ride ("Group 2, we're gonna need you to ride around the block one more time...and again...") but they were possibly more photogenic, as many of the female riders realized that we weren't working up enough of a sweat to ruin our makeup, so it was a brighter-eyed crew than you might have expected for 7:30 on a Monday morning after a long three day ride (seen here: Jennifer and Jason, both looking rosy, although I'm certainly implying that either had cosmetic assistance!).

The enthusiasm of the crowds and the volunteers also helped add to the festive mood - as did the Au Bon Pain coffee and pink Panera bagels (which were actually really good!) The Fox anchors came out to greet us before the interview, and one even hopped on the chair for a quick pre-interview massage, nuch to the dismay of her makeup woman, no doubt. Although I have not been able to get the video link to work on the Fox & Friends site, Tour de Pink and YSC co-founder Lisa Frank's interview is available there to anyone who is more tech savvy than I am.

After much cheering for the cameras, riding of bicycles around the block and through the balloon arch and taking of official and unofficial photographs, we grabbed our bikes and headed back to the hotel. Having narrowly escaped a few close scrapes with cabs and delivery trucks on our way to the studio, most of us chose to walk our bikes the 5 blocks up Sixth Avenue back to the Hilton for brunch.

Tour de Pink Finale

I promised a lot of people a lot of photos, and I am gradually getting them loaded up. But although some of my fellow riders were witness to my obsessive-compulsive Blackberry checking from the rest stops, I still have a mountain of emails and voicemails waiting for me back at the office that feels only slightly less intimidating than the Grade 3 Eagle's Nest from Day 1 of the Tour. Therefore I am hoping the link to my online album from today will work - check back later this week for more photos from the rest of the ride, and to see if I ever get around to sharing more stories from the road!

Tour de Pink, Day 3, Part 1

2007-09-30T22:11:00.000-04:00

Yes, I know I still owe Part 2 from Day 2, but given that it is now the end of Day 3, and that tonight's blog is being written from bed instead of the bar, I need to make this one quick and hope my readers will forgive some stories coming out of order.

You know you've put in some hard days when the thought of a 53 mile ride sounds comparatively easy. After a rousing send-off from Trenton's town officials (who have promised us 50 people riding with us out of town and cheering if we come back next year!) we enjoyed a police escort through town and out into New Jersey. The ride leader encouraged us to stay together ("think of the last day of the Tour de France - they all ride in a group, enjoying the experience") which mollified the speed demons to an extent, and made for quite a sight as the 100-strong pink peloton made its way through a bright, crisp morning to Rest Stop 1 20 miles down the road.

Here things split up a bit more, as some riders stopped for a quick water-bottle reload and were off again, and others took advantage of the services of the masseuse and Dr. Mark the chirpractor for an adjustment. Leaving this stop, a group of us fell in with "Team 7," aka Joe's Harem, as "The Major" led a group of 6 female riders 20 miles through headwinds and past traffic to deliver us safely to the lunch stop. This was our last time to be checked in by Charlie, our youngest volunteer and top-notch checker-inner, whose calls of "Can y'all plee-uz sahn ee-un?" will be fondly remembered.

As Team 7 finished lunch ("We're leaving as soon as I hit the latrines," ordered the Major) and prepared to leave, we joined up with another group to ride the last 15 miles to Atlantic Highlands, our last stop before Manhattan. Ignoring a few flipped birds from New Jersey's impatient drivers (Pennsylvania definitely wins the congeniality award!), we rode as a group of 25 or so, led to the finish by the fabulous Sarah (recent survivor and #1 fundraiser - although I think Mitchell will continue to give her a run for her money from now til the end of December) and her wonderfully supportive sister Chris.

From there we boarded buses for Manhattan, where we checked in to the Hilton before heading off to various local bars and restaurants for dinner, and in my case at least, home to sleep in my own bed. Tomorrow morning we start bright and early for our triumphant ride to the Fox studios on 7th Avenue between 48th and 49th Street - look for us on your Fox affiliate between 8 and 9, or come on down between 7:30 and 9 tomorrow to cheer us on if you're in the area!

Tour de Pink, Day 2, Part 1

2007-09-29T21:53:00.000-04:00

Part 1, because I am blogging from the bar after another gorgeous, hilly day, and I keep getting distracted. By the fabulous survivors around me doing vodka shots, by the riders talking about tomorrow's course and by the general sense of camaraderie and achievement we are all celebrating as we go into Day 3.

We are at the Marriott in Trenton, a town whose bruised-pride civic motto - "Trenton Makes, The World Takes" - is right up there with New Hampshire's faintly threatening "Live Free or Die" for overall awesomeness. We had a beautiful ride along the Delaware River, past picturesque Bucks County towns (if anyone is looking for a lovely little atelier for artistic inspiration, I highly recommend Lumberville, PA - lots of great real estate available now!) My husband will be relieved and my mother shocked to hear that I managed to make it through New Hope without buying a single thing - although I must admit I was tempted to stop at the little antique stores along the way, as I am my mother's daughter after all.

Tonight's moving, funny and inspirational dinner and awards ceremony deserves its own entry, and I will add more about it tomorrow. But for now, suffice to say that, thanks to a little help from my friends, I was the #3 "survivor fundraiser" with over $9000, for which Giant for Women generously awarded me a $750 gift certificate. Those lines are still open - donations gratefully accepted through the end of the year!

I'm off to enjoy the evening with my fellow riders and survivors, so for now, I am including a couple photos from the road - one of the "Fantastic Five" (Brian, Karen, Chris, me and Lina) who rode most of the day together, and one from the kickoff this morning with Karen and Lina (and Greg from Hershey hamming it up in the background).

Tour de Pink, Day 1

2007-09-28T17:28:00.000-04:00

This is the most energizing, exciting, exhausting and inspirational day I can remember. We started at Hershey's Chocolate World (where we also had dinner last night - you should have seen the dessert table!) with a ceremony and presentation of a check for $300,000 from Hershey to the Young Survival Coalition. We were also asked to take part in a few photo ops - one of Hershey's PR people approached a few of us before the ceremony to ask if it would be violating any rules of bicycling fitness to partake of a pink-wrapped and -centered York Peppermint Pattie for the cameras before the ride - as it is indeed one of my favorite candies (apparently also the leading candy for women ages 18-34 - I'm so predictable!), I was happy to comply.

After a send-off from hundreds of employees and supporters, all dressed in pink, lining the starting line and cheering us on, we hit the road. Last night's rain burned off into a partly cloudy morning that turned into a stunning sunny afternoon. We pedaled through picture-perfect rolling Pennsylvania countryside, past farms and homes, through several small towns, and past several Mennonite churches and schools, where the kids waved and cheered for us.

This is an incredibly well-supported ride - we had police escorts through towns, motorcycles blocking traffic at many intersections, and three rest stops with peanut butter sandwiches and all the Lara Bars we could pack into our jerseys along the way (and, of course, more chocolate).

We also had hills, and lots of them. Last night, they had warned us about the two-mile hill at mile 33. I was riding with two women, one from Hershey and one fellow survivor from New York. We saw the ridge ahead and I had a sinking feeling that this was what we were going to be tackling - I mentioned it and they scoffed. But indeed, that was our hill - I was in my easiest gear for at least a mile of it, and kept promising myself I could stop and walk...once I made it to that tree...as soon as I got to that telephone post...when I passed from the sun into the shady spot. But I didn't have to - although I can't say it did anything good for my average speed, I am incredibly proud to have made it to the top, on the bike the whole way. (You can't tell how steep it was from this photo, but believe me, it was steep! I'm pictured here with Karen, who is such a rockstar that she made it all the way to the top, and indeed all 73 miles today, on a fat-tire mountain bike.)

There are 27 Hershey employees who have joined us for the ride, several of whom I credit for getting me through the toughest parts of the day. Bruce and Jim scooped me up when I had fallen behind (although not actually OFF the bike, luckily!) the girls I was riding with due to a little mechanical issue, and led me along at their blistering 20 mph pace for 8 miles or so til I caught up again. Brian came up behind me on another tough, steep section, motivated me to the top, then made the next 6 miles go a lot faster as he asked me about my story. And Lina was a fantastic pace setter and rode with me almost all day, and was certainly the reason that I made it back to the hotel before 4!

I will share more stories tomorrow, but first there are a few people at home who deserve a shout-out - Matt for getting me the awesome bike I am riding, Liz for her secret fundraising initiative today that pushed me up over $9000, Kyle at Equinox for putting me through jump squats and lunges the past 3 months in our weekly training sessions, Annelise and Andrew for being my "big ride" lunch destination earlier this month, and Michael for not minding losing me for a few hours every weekend to ride. And probably most importantly, I'd like to thank the state of Connecticut for being such an incredibly hilly place to train - Pennsylvania has nothing on you!

Tour de Pink, Day 0

2007-09-27T16:29:00.000-04:00

Thunder and lightening is raging outside the window of my hotel room near Hershey World as we prepare to take off tomorrow for Day 1 of the 3 day Tour de Pink. Fifty riders left on a bus from New York this morning, stopping to pick up some New Jersey riders along the way, and arrived this afternoon, where we are meeting with the rest of the group - I believe there are about 150 of us in total.

Lots of inspiring stories here - many women who are years out of treatment as well as some who have finished even more recently than I have. Fathers who are riding for their daughters. Brothers riding with their sisters. One woman who have never been on a bicycle until she heard about this ride and started training earlier this year. I suspect I may not be able to keep from crying as the sea of pink jerseys streams off tomorrow morning.

Work has been too hectic to allow me to get in as much training as I would have liked this summer, plus I am battling a cold this week. And oh yeah, I just had surgery 5 months ago, so maybe I should give myself a break and just accept the fact that I will hardly be setting any records this weekend - for me, success will be finishing. But as another young survivor pointed out on the bus this morning, this experience is about far more than the ride. It's about about celebrating our health and strength, raising awareness, learning to trust our bodies again, and helping other young women fight this disease.

And on that front, so far, we have raised over $300,000, with Hershey still to kick in a check for another $300,000. Donations are still gratefully accepted! (In fact, I think the site will be open for donations through the end of the year) I have nearly doubled my original goal of $4000 thanks to everyone's support and generosity, but now you can help nurture my competitive streak - I am in danger of falling out of the Top 10 fundraisers at the moment, and I think hitting $10,000 would secure my place there for sure! So if you have not yet had a chance, please visit my fundraising page.

I will know more after our briefing tonight, but it sounds like Monday's TV appearance has changed - we are now scheduled to be on Fox & Friends between 8 and 9 ET, so please tune in! Also, for any New Yorkers who happen to be working in that area, come cheer us on (and enjoy the pink bagels they will be handing out - I'm sure they can't be as gross as they sound) on 7th Avenue between 48th and 49th. And check back for more details from the road!

C for the Cure

2007-09-18T22:50:00.000-04:00

Exactly one year ago last weekend, Michael and I were finishing a Sunday morning run in Central Park and noticed that Central Park West was eerily quiet. We looked down the block and realized the road had been closed off because Race for the Cure was about to start. We stood at the corner of 81st Street and watched as hordes of men and women in Ann Taylor, American Express and countless banking team t-shirts ran the first segment of the 5K run. We watched for at least half an hour as thousands of people started the race, the ones toward the back walking, carrying handbags, and even talking on cell phones.

Many wore "In Memory Of" placards on the back of their shirts in addition to the numbers on the front. I remember wondering why there were some women at the start of the pack who had five minutes' lead on those following - I knew there were some "elite runners" at the front, but some of the women I saw were doing a 12 minute mile at best. It took me a few minutes to realize that they were being honored as survivors.

This year I joined them. It was not about the money donated (since my primary fundraising efforts are for the bike ride for Young Survival Coalition, although I did raise a couple hundred dollars for Komen). Nor was it about the physical challenge (although Michael and I are both very proud to have finished the 5K in around 27 minutes, about the times we achieved in a couple of races last year).

Rather, it felt important to be a part of it to help raise awareness - after all, it was thirty minutes after watching the start of last year's race, back at home in the shower, that I first felt the lump in my breast and decided to take it seriously. So although when the Cure itself comes along it may be a little late for me personally, I will always be grateful to the Komen organization for giving me the Curiosity to look for and question what I found, and the Confidence to push my doctors not to brush it off.

Shameless Fundraising

2007-09-01T17:23:00.000-04:00

It's been 10 months since my breast cancer diagnosis. I'd like to think that throughout, I maintained a brave face. As promised in The King and I, the results of the deception have had the desired effect - the "happiness in the tune" I've been whistling have (mostly) convinced me that I was not afraid.

Many of my colleagues and acquaintances had no idea that I was undergoing chemotherapy from December to March - not totally surprising, given that a good wig, makeup and attitude meant that this is the version of me they saw every (seen here with Mom on Mother's Day, just two weeks after my surgery and two months after my last chemo treatment).

But now is the time in the telethon broadcast when Sally Struthers comes on and the tone turns serious. As many of you know, I am doing a major fundraising bike ride for the Young Survival Coalition at the end of September. The YSC provides research, community and information to women under 40 with breast cancer, and has been an invaluable resource to me in my education and my fight this year. All the funds I raise for the 200 mile, 3.5 day ride go toward the programs offered by the YSC.

Although women under 40 account for a small percentage of overall breast cancer diagnoses, breast cancer is the leading cause of cancer death in women age 15-54. While being "young and healthy" when I was diagnosed might possibly have contibuted to making it easier for me to handle some of the nastier side effects of chemo, it also meant that my cancer was more aggressive and further along than it likely would have been if I had been in my 50s. Fortunately my doctors did not blow it off when I mentioned the lump, but a lot of women I have met through the YSC were not so lucky - it's shocking how many of them were dismissed as being "too young to worry about this" when they raised concerns with their doctors, and were sent away. A year or two later with a larger lump, they would finally be sent for a mammogram, at which point the cancer was more advanced than it would have been if they had been taken seriously in the first place.

The YSC works to raise awareness of young women's breast cancer in doctors and the public, and also provides research on related topics that are most relevant for this population, such as risks to fertility as a result of treatment, genetic predisposition to the disease, and long-term survivorship issues.

Many of you are aware of the event and have contributed generously, and I am grateful for your support. I am plugging the ride again in this post because I anticipate a few new visitors to the blog, as I am sending out a broader fundraising email this week. And since I know a few people may be surprised to hear that I was sick at all, this is the "seriously, I was really sick, even though you may not have been able to see it on the surface" photographic evidence taken the day after my surgery (and the day before what little remained of my brows and lashes finally gave up the fight).

They are back, as am I, strong as ever. The support I got from YSC made a big difference to my mental health, and now that my physical health is back, I want to return the favor. If you would like to contribute, please click here.

Assuming that I a) make it in before dark each day and b) am not too exhausted from riding up hill and down dale just 5 months after my surgery, I am planning to blog from the road. Our first day of riding from Hershey, PA is Friday, September 28. On Monday, October 1, we do a ceremonial ride from Central Park to the CBS Early Show plaza for a special appearance around 8 a.m. ET. I will keep you posted on the details in case anyone wants to join live to cheer us on, or to tune in to the show.

And now we return to our normal scheduled broadcast...to include current updates, photos and a travel report just as soon as I can get through my usual 100-item-long to-do list, which now prominently features a few last minute training rides!

Bearded Woman

2007-08-15T21:59:00.000-04:00

"Turn your face a bit more to the left. That's it...now tilt your chin up so your face catches the light," Michael instructed. A photo shoot? No, nothing so glamorous, I fear.

"Okay, now stick your tongue in your cheek like this so it stands out," he requested, pantomiming his own morning ablutions. As he brought the razor closer I had to control a guffaw - I've had plenty of self-conscious moments the past six months, but needing my husband to shave my face had to top the list of humiliations. Especially since he was the one who (very gently) pointed out that the white-blonde, downy hairs on my cheeks were starting to rival my head hairs in length.

"So it's not just the head hair that falls out - it's everything?" a colleague asked recently. "I mean, arm hairs too, for instance," he rushed to clarify as I arched an eyebrow in response.

Everything. From the convenient (leg hair) to the less convenient (head hair), the obvious (eyebrows) to the hidden (those little hairs inside the nose). And it all grows back at different rates. I spent 5 months in a wig but barely remember being without brows and lashes - less than a week after everything fell out, I started seeing stubble, which took only days to turn into respectable-looking features.

The appearance of facial hair was not greeted with such open arms. Apparently this is very common in women who go through chemo - you don't even notice the loss of the hair on the face, but it grows back in with a vengeance. All it takes to bring it in line is a light once-over with a razor for the do-it-yourselfers, or a wax for the anal retentive, but you still have to overcome the shock that results when you look in the mirror one day and see yourself sporting Wolverine's sideburns.

"There - beautiful as ever," Michael comforted me, putting the razor down and giving me a reassuring kiss on my (now hairless) cheek. Just one more way my wonderful family and friends have helped keep cancer from making me feel like a circus freak.

Ka-Boom

2007-07-19T08:44:00.000-04:00

It started like a thunderclap but then it didn't stop. Our offices, with their million-dollar views down Park Avenue South, provided a frighteningly good view of the roiling smoke clouds billowing over the skyscrapers from what turned out to be a steam pipe explosion, but we did not know that at 6 pm last night. After a few frozen moments gaping at the skyline, my colleague and I agreed it was time to get the hell out of Dodge.

Evacuations are flustering. Do I turn off my computer first? Should I put on my running shoes? Do I have my house keys? No, no and yes. Saying a quick prayer of gratitude to the fashion gods for decreeing that ballet flats are in for 2007, I hightailed it down 23 flights of emergency stairs to the street.

Controlled chaos. One woman was crying, but most people were heading away from midtown, trying to get their cellphones to go through, asking police officers for updates. A woman I passed was broadcasting her phone conversation with her mother in New Jersey to all within hearing distance: "The news says it's a transistor explosion or something. It's not terrorism. A building did not collapse."

I was due to meet Michael way down at the South Street Seaport for a show an hour and a half later. Having no idea at that point whether the subways were running or if this would bring all of New York to a halt for a few hours, and not wanting him to be waiting there for me with no idea of when and whether I would turn up, I called his office to track him down ("In a bar, naturally," I chided teasingly. "For work drinks with the new recruits!" he defended himself.)

The show did indeed go on - we took the west side subway lines downtown and made it in time to catch Absinthe at the Spiegeltent. (Think avant garde cabaret meets low budget Cirque de Soleil, with a healthy dose of Las Vegas by way of Williamsburg.)

Which provided a good couple hours of distraction from the internal reflection the event seems to have caused for me. After everything else that has happened this year, you'd think that fleeing from a building wouldn't throw me for a loop. But it did cause a "little wobble" (Michael's words) that made me realize that perhaps I am skipping a few steps of healthy self-reflection in the rush to get back to a "normal" life. I don't expect to come up with the answers in the space of a few hours, or even months, but I am committing to myself to dedicate more time thinking about the questions.

Measuring Up

2007-07-17T00:49:00.000-04:00

Weeks since last chemo: 18
Weeks I have been feeling "back to my old self" after surgery: 9
Number of airplanes I have been on since surgery: 6
Number of nights last week I made it home from work before 9:30: 1
Number of countries I am traveling to on vacation next week: 3
Number of doctors' appointments I am having this week: 5
Days until my big 200 mile bike ride: 72
Number of (outdoor) miles I have ridden since surgery: 42
Number of people I have told "I keep meaning to post photos but haven't had a chance to get around to it yet!": 34 and counting

So here is one in the meantime, a more current hair photo, taken with Michael at the "Taste of Litchfield Hills" festival in Connecticut a couple of weeks ago. For those playing along at home, after 2 haircuts I am right around 1.75 inches. They say hair grows about half an inch per month, so considering the cuts (mostly to keep back and sides neat, but also adding some texture on the top) I am right on target.

As for the other measurements....as you can see, I don't need to worry about being called "Ironing Board" anytime soon. I am giving myself the summer off surgeries (all the aforementioned appointments are followups, plus a "normal" trip to the optometrist and the dentist), so for now I am happy to live with the .25 inches I am lower on one side than the other.

Fake ID

2007-07-03T01:05:00.000-04:00

As a student at a women’s college in a dry town, a fake ID was crucial to having a social life. Mine was more for the getting into bars than for the drinking once I was there, given that I waited until my sophomore year to have a single sip of alcohol (even after fighting cancer, I can’t imagine surviving the crushing guilt I would have felt if I had started drinking in high school, whether or not my parents caught me at it).

But at Wellesley, we generally had to go where the boys were – Fort Lauderdale being a little too far for the average Saturday night, we settled for the Crimson Grill, the Boathouse, the Spaghetti Club. On a good night, we’d hit the clubs on Landsdowne Street or on small backstreets near Chinatown, assuming I could convince my friends to pay the cover charge and spend the night dancing instead of standing around a bar, pretending to find electrical engineering fascinating so some 5’8” guy with a complex (his real ID claimed 5’11”) would buy our drinks.

Not one to tamper with state or federal documentation, I chose to break the law the old-fashioned way – by pretending to be someone I was not. Susan Gregory (names have been changed to protect my unwitting accomplice) had kindly passed on her old ID before she graduated, and it had ventured into Boston in the purses of several other minors before making its way to me. She had two inches and four years on me, but she was blonde with green eyes, and most bouncers only expected a half-hearted stab at accuracy (same gender would suffice at the Grill.) Always the overachiever, I nevertheless memorized her birth year (1969) and sign (Capricorn) as well as her street address in Georgia. I was even confident that I could produce a reasonable facsimile of her signature, should anyone ask.

It’s rare to get carded in New York, at least as long as you avoid the bars around NYU. But tonight, dropping by Arlene’s Grocery on the Lower East Side to check out live Rock’n’Roll Karaoke (a subculture that merits its own blog entry some other time) with some girlfriends, the bouncer stopped us and asked to see ID. “You look like a whole different person,” he said, holding the picture up while squinting at my face.

“Oh, the hair,” I said. “Yeah, it’s a pretty big change. What do you think?”

“Looks good. But has Momma seen it yet?”

“She likes it better this way,” I assured him, as we laughed and walked inside to the strains of Aaron from New Jersey wailing “Welcome to the Jungle.”

Sometimes I forget that this is what I look like now. The reflection in the mirror no longer takes me by surprise, but when I look at group photos, I still look for the girl with the shoulder-length blonde hair. At a recent global conference for work, I had to reintroduce myself to several people with whom I talk on the phone regularly, but who had not seen me in person for a few months.

At least the height, eye color and face shape on my ID was convincing enough to get me past the doors tonight, and I think I can probably manage my zodiac sign (which is what, you ask? Cancer. Of course.) But I may start practicing my signature again, just to be safe.

Back in the Saddle

2007-06-12T00:10:00.001-04:00

During chemo, I vowed to maintain some semblance of a workout routine. I didn’t have as much energy as normal and I was trying to compensate for the days I missed at work by working extra-hard when I was there, so it wasn’t easy. Add self-consciousness about my bald head to the mix, and I think I managed to get to the gym about six times between Christmas and my last session in mid-March.

But at that point, I started worrying. I knew I faced at least a few weeks of inactivity once I had surgery in April. I had made it this far without the dreaded “chemo bloat” that many women experience as a result of taking the steroids that help you tolerate the other drugs. As you can tell from my obsessive posting about my eyebrows and hair, I am more than a little concerned with the physical effects of all this, and weight was the one thing over which I felt I had a smidgen of control.

So I went back to spinning classes. My first time back at the gym, I wore my “Warrior” pink ribbon t-shirt to help me appear braver than I felt. Aware that I looked a bit like a sixth grader trying to hide her new bra, I got undressed while starting intently into my locker, leaving wig removal to the last possible moment. Wanda looked a bit forlorn on the hook as I tied on my bandanna and closed the door.

As I entered the spinning room the routine came back naturally. Water bottle in the cage, towel across the handlebars. Lower the seat and adjust it forward slightly. Step onto the bike, tighten the pedals, and start circling my legs. Pick up my pace as I start to feel my muscles warm up. Find the rhythm of the music and time my pedal strokes and breathing to the beat.

Given that my surgery was only a few weeks after this, I didn’t have time to get into fabulous shape or to see major results, but it did remind me that exercise is something I enjoy when I make time for it, and it gave me the confidence to get back to the gym several weeks ago once I got the all-clear from my plastic surgeon.

Which was good timing, because I need every workout session I can squeeze in between now and September 27, when I will be riding the “Tour de Pink” to benefit the Young Survival Coalition. This four-day, 200-mile bicycle ride goes from Hershey, Pennsylvania to the Hershey store in Manhattan (any guesses who is sponsoring?) The ride raises money for the Young Survival Coalition, an organization that advocates on and raises awareness of issues surrounding breast cancer in women age 40 and under.

It is impossible for me to put a value on the support network and information this organization has provided throughout my diagnosis, treatment and ongoing life as a young breast cancer survivor. In addition to knowing that a defined fitness goal is the best motivation to get to the gym, I want to support this organization and the women who benefit from its work by raising at least $4000. One hundred percent of the money I raise as a rider will go to the YSC.

To donate, please visit my newly-created fundraising page; for more information on the ride, check here. Thanks for your support, and be sure to wave when you see me doing laps around Central Park!

C for Crewcut

2007-05-31T00:01:00.000-04:00

Years ago, when I lived in London, there was a very chic salon around the corner from our flat in Shad Thames. One day, on a whim, I stopped in for a haircut. The stylist, hip in her black clothes and asymmetrical haircut, asked me "What would you like?" In the mood for a change, I said, "Just do what you think would look best." Mind you, I had never met this girl before. She knew nothing about me, my life, my style, my hair. To this day, I don't know what possessed me to give her carte blanche with my tresses.

Midway through the cut, she took a phone call. I reached around and touched the back of my head and burst into tears. My cute, boring bob had been shorn completely - I had about 3 inches of razor cut hair left in the back.

I managed to keep the crying in check until I got home, where Michael claimed that he liked it and Jacob also showed support, but couldn't help pointing out that I should have expected such a result, given that the salon's name was "Man and Boy."

Currently, my "style" is even shorter, but is already starting to look a little scraggly around the ears. On Tuesday, I stopped by to give my old stylist in Murray Hill a look under the wig. She is convinced that, with her coloring help, I will be confident enough to go wig-free once the mercury hits the mid-90s in New York.

Meanwhile, the photo is the progress as of last week - note the grey "highlights" and seriously full brows. I am trying not to romanticize my six months off from maintenance appointments and be grateful that everything came back as it was before, but I can't help but wish that at least the Brazilian had been permanent.

Travel Advisory

2007-05-24T23:40:00.002-04:00

Would you let this woman through customs?

Me neither.

Although the drains are out, the elastic band and sports bra combo is still on, making dressing for work in 90 degree weather a bit of a challenge. Add the wig on top of that, and it's one sweaty commute.

But what a difference a month makes - since these photos were taken, the brows are back, and the hair is thick enough that I won't even have to put sunblock on my scalp when we are hanging around outdoors celebrating the start of summer in Connecticut this weekend (no airports required!) My brother Matt, however, may want to keep the SPF3o handy:

Have a great long weekend!

Arch Enemies

2007-05-21T22:57:00.001-04:00

At Wellesley, you could tell how stressed out I was by the thickness of my eyebrows. It wasn't that I neglected my grooming as my workload increased; on the contrary, plucking was a stress reliever. Tackling a paper on how Vaclav Havel's politics were foreshadowed in his plays seemed to go much more smoothly after a good session in front of the mirror with the Tweezerman.

My eyebrows disappeared completely just days after my surgery, only to sprout back again, seemingly overnight. I spent the last two weeks recovering in the country with nobody but Michael, Mom and the wild turkeys in the yard to see the regrowth process. Toward the end of last week, preparing to return to the city and to head back to work this week, I caught sight of myself in the mirror and wondered what those caterpillars were doing onto my forehead, which was the catalyst for me to go see somebody about this - although they are not back to their old length, they are coming in at full force thickness.

As a possessor of brows that are more Frida Kahlo than Marlene Dietrich, waxing, tweezing and threading have long been part of my grooming routine. Depending on how much time I have, my level of hirsute urgency and my budget, for the past 8 years I have visited various hair removal sites in the city - Shobha, Bliss, and the $10 quick threading place across the street from my apartment - for my brow maintenance. So I am used to working with different people, but this time, when the woman at the local day spa in Litchfield asked me what I wanted, I did not know what to say. I'd done this a thousand times, but never before with brows that were only just starting to grow back in. What if she is too rough and takes too much? What if the stubble is still too short for her to get a purchase on it? In the end, I opted for a "clean up, but not too thin."

Better, but in the bright bathroom lights back at home I realized they were still on the thick side. As I stood before the mirror, carefully plucking one hair at a time, checking for symmetry every few minutes, I found a familiar but different kind of comfort in the sharp pull of the tweezers. Like mascara wearing, shampoo buying, and bra fitting, eyebrow tweezing is yet one more mundane activity that brings me closer to normal, and I welcome it.

Defying Gravity

2007-05-07T13:55:00.000-04:00

They're a little bruised and sleeping in a bra is no fun at all, but there are a lot of good things to be said for the new rack. They don't fall into my armpits when I lie on my back. I can no longer see the stretch marks earned from triathlon training two years ago and many years of less strenuous but equally scarring physical activity. Cleavage is possible without a bra. No one but me has to know if I am cold. And, of course, they are 100% cancer-free.

Positive Visualization

2007-05-03T18:45:00.000-04:00

Back in October, when I was originally diagnosed, my mom and her group of wonderfully warm and supportive girlfriends got together for lunch. At the end of the lunch, Mary, a seven-year breast cancer survivor, mentioned that she had found visualization exercises to be helpful in getting through her surgery and treatments, and suggested that the women at the table all join hands and hold a positive image about me in their minds for several minutes.

First, Mom had to determine which image they should all focus on. She closed her eyes and thought for a minute or two. “What image do you see?” they asked when she opened them.

“I see Courtney coming out of the hospital carrying a piece of paper that says ‘Clean Bill of Health.’ She hands me the baby they were able to have…and I’m thin!”

It’s still too early to tell on visions 2 and 3, but we know at least the first part worked: my doctor called with my pathology report. I showed 100% response to the chemotherapy. There was no sign of the tumor when they dissected the breast tissue, and no evidence of cancer anywhere else in my breasts.

This means that even if any rogue cells escaped from the tumor at some point in the last few years (which itself is unlikely since there was no evidence of cancer in the lymph nodes, and no sign of cancer on the whole-body PET/CT scan), chances are excellent that the course of treatment I just went through took care of them. I will continue to be monitored carefully, but it is safe to assume that chances of a recurrence are minuscule.

It’s wonderful to say I no longer have cancer. And although the blog name will remain The Courtney Word, it will be easier every day to think of it without parentheses.

The Slow Lane

2007-04-29T23:58:00.000-04:00

I am one of those New York commuters who gets irritated when people stand on the left side of the escalator, blocking my way as I climb the steps. If it’s rush hour, I will even say something. (But nothing ruder than “excuse me” – I am from Iowa, after all!) I cross before it says “Walk,” leap over puddles, nip into the street if the sidewalk is full and run for buses in high heels. I move quickly.

But not right now.

Since returning home on Friday afternoon, I have to concentrate on each movement. I am not supposed to use my arms to lift anything over five pounds for the next few weeks. I use my core muscles to lift myself from lying down to sitting, then swing my legs to the floor to get out of bed. Michael, Mom, Dad and Matt are pressed into service to bring my laptop to me, set it in my lap, and then take it away again when I finish. Gentle movement is good for my recovery, so I do little laps up and down the hallway in my apartment, from the bathroom, past the bedrooms, through the living room and into the kitchen. Turn. Repeat.

It is painful, but my progress is encouraging and my tolerance for discomfort fairly high. My range of motion is increasing every day – I knew I was better this morning when I could apply my own eyeliner. I can open my sock drawer (and even put my own socks on!), but the lower, heavier pajama drawer still requires assistance.

The “straight to implants” reconstruction technique means that my profile is also heartening. Rather than the partially-inflated balloon that expanders resemble until they are filled over a period of weeks or months, my new breasts are already at their final volume. Still a bit swollen, they will continue to take shape over the next few months, helped by time, supportive bras, and a distinctly uncomfortable piece of three-inch-wide elastic I have strapped under my arms and across my sternum, pushing things into place.

The four drains that carry extra fluids away from the surgery site are still in place and will remain until at least mid-week, when my doctor will remove them. These are what have so far prevented me from leaving the apartment – the combination of the strap across my chest and the drains hooked to a belt around my waist make me look lumpen when hidden under one of Michael’s old shirts, and like a terrorist in my own clothes.

Michael reassured me that the drains could be mistaken for the waist-pack water bottles worn by runners in Central Park. I don’t think anyone would be convinced. But even a few days of inactivity has left me longing to join them in laps around the Reservoir – an impatient patient, I am anxious to be on the move again.

24 hours

2007-04-26T21:57:00.000-04:00

Just over 24 hours since Courtney came out of surgery and she's doing great. Off the drip and oxygen, managed to eat some light food and did a couple of laps of the hospital today (admittedly a rather small hospital). Not too much pain (though we've been told it will probably get worse before it gets better). Sorry that's note the witty prose you've come to expect from this blog but I think we were woken up about every 90minutes last night in the hospital and i feel like i've done a redeye flight.

24 is also the name of the excellent TV series we started on today. All of season 1, all 20hrs of it, awaits Courtney over the next few weeks (though she's under strict instructions not to leave me behind). So any of you that have already seen it or are up to date please don't spoil the plot for us!

Courtney will be back in NYC by midday tomorrow (we hope), recuperating under the expert care of family and friends.

Michael

Awake and talking (unsurprisingly!)

2007-04-25T17:50:00.000-04:00

Please excuse the bad grammar, spelling and construction, this is Michael writing.
A quick posting to say that Courtney is awake and talking in the recovery room and we should be able to see her soon. The surgery went smoothly and both surgeons were very happy with the procedure. Do i hear a big collective sigh of relief. I'm currently sitting in the doctors office updating this blog so i'll keep it short and sweet. I'll try to update tomorrow.

D-Day

2007-04-20T17:24:00.000-04:00

1. Military. The day, usually unspecified, set for the beginning of a planned attack.

2. June 6, 1944, the day of the invasion of western Europe by Allied forces in World War II.

3. Informal. Any day of special significance, as one marking an important event or goal.

Okay, so Definition 2 doesn’t make a lot of sense in this context, but definitions 1 and 3 certainly apply. In my case, however, the day is not unspecified – my surgery is this coming Wednesday, April 25. I do love the image of the “planned attack,” as I am ready to destroy this tumor and restake my claim to my body. And there is no question that this day marks an important event or goal. Although perhaps, given that I get to choose the size I will be, maybe we should call it C-Day. Ahem.

In the end, I have chosen to go with a plastic surgeon who specializes in immediate, or “one-step,” reconstruction using implants. Dr. Salzberg pioneered this procedure, which allows women to skip the step of expansion, which can be painful and requires an additional surgery to exchange the temporary expanders for permanent implants. It also means that when I wake up on Wednesday, my new breasts will be in place, albeit under bandages and slightly swollen and bruised.

Switching doctors does mean that I have to go to the hospital with which he is affiliated, which is a small (50 bed!) community hospital in Dobbs Ferry, NY, about a 30 minute drive from our place in Manhattan. It feels slightly ridiculous that, despite living within 2 miles of 4 of the nation’s top research hospitals, I am having surgery at a place that is probably 1/20th the size of Methodist Hospital in Des Moines, Iowa. I just keep reassuring myself that this is the procedure in which they specialize. As long as Mom and Michael remember that the café’s opening hours are only from 9 a.m.-2 p.m. and bring provisions to make up for that, we should be okay.

The doctors predict that I will only need to be in the hospital for one night. Since I should be home by Thursday, we are asking that people not come to visit at the hospital. Michael will run visiting hours at our apartment over the weekend, so please give him a call or drop him a note if you want to stop by, in order to make sure that I am not asleep or insane from the pain meds (one woman I spoke with ordered multiple pizzas in the 72 hours following her surgery, but recalls none of them). I will be recuperating for several weeks, and am planning to be off work until May 21.

Thanks to everyone for your supportive calls, notes and comments. As I have told many of you, I am not scared about the surgery – I am ready. I look at this as the next big step toward my healthy future. Although I will have a few additional things to take care of in the coming months (I never thought I would type the words “nipple tattoos,” but here we are…), I am done with chemo, I don’t require radiation, and I will need no other major surgeries related to this cancer. When I wake up after surgery on Wednesday, I will officially be cancer-free. And that sounds like victory to me.

Painted Lady

2007-04-17T23:48:00.000-04:00

Eyeliner and mascara were never major tools in my cosmetic arsenal. Concealer for my undereye circles, bronzer to appear less ghostly in midwinter and lipstick to complement my mood or my outfit were my desert island essentials. No longer. Nearly five weeks out from my last chemo session, I am down to five eyelashes on the bottom of my left eye, and eight on the right. That count will probably go lower half an hour from now when I remove my painstakingly applied eye makeup.

About two-thirds of my upper lashes are still hanging in there, although I am not holding out much hope for those either, as I watch them wash down the drain or rub off onto a towel each night. I’ve also developed eyebrow bald patches, although admittedly I had some to spare. If I thought I was hopeless with eyeliner before, an eyebrow pencil was an even more laughable idea. But thanks to my friend Gretchen the makeup junkie’s generosity, as well as several makeup companies’ official participation in the “Look Good Feel Better” program for cancer survivors and the day of beauty St. Luke’s, I have amassed an impressive collection of pencils and wands in various shades and have started experimenting with creating some approximation of normal. If that doesn’t work, I can always hide behind Wanda’s long bangs. I only need the lashes and brows to make it through the end of this week, my last week of work before next Wednesday’s surgery, after which I will have a few weeks off to recuperate and regrow (to clarify, I'm referring to hair here - they're surgeons, not miracle workers) before I regularly present my public face to the world again.

The irony is that as the hair on my face is disappearing, the hair elsewhere is making a comeback. I had to shave my legs yesterday for the first time since January, and I’m at half an inch and counting all over my head. Texture and color are still TBD, but I’m holding out hope for straight, and resigning myself to mousey. Needles in my scalp have become part of my biweekly acupuncture routine – who knows if I would have had the full-head stubble coverage I am sporting now without it, but I see no reason to take chances. But despite the fact that the lack of lashes bothers me more than the bald head, I think I’ll venture to Sephora rather than Chinatown for help in that department.

Chemo Sabes

2007-03-31T06:48:00.000-04:00

We have been overwhelmed with the support of friends, family and strangers, near and far, over the past few months. I can't begin to tell you how much your letters, emails, flowers, gifts, phone calls, and comments on the blog have helped us find the humor, patience and strength that we have needed to get through the last six months with grace and courage.

This past Thursday was the first time since December that I did not have to show up at the hospital for my biweekly infusion. Several people have heard me joke that in a way, I have been grateful to chemo for giving me the gift of an uninterrupted block of time every two weeks to catch up with my girlfriends. But I know that nobody loves hanging around a hospital watching people get stuck with needles, so I wanted to single out for thanks the women and men who surrounded my aqua recliner at St. Luke's with love and support. To my "chemo sabes" Sarah, Molly, Mom, Dad, Sabina, Jessica, Anne W, Anne G, Laura, Katrina, Sophia, Katherine, Sivan, Jeanne, Anne M and Michael, thank you for your company and your stories, for the lunches, snacks and little care packages you brought, for distracting me when it hurt, for putting up with my drug-induced narcoleptic episodes, and for making the time go so quickly. I wish I had remembered to take photos of all of you, but as the security guards at the hospital will attest, I was not to be trusted with cameras or other valuables, as I seemed to leave something behind almost every week! I am also grateful to the doctors and nurses at St. Luke's, especially Caitriona, Marianne, Sarah, Dr Grossbard and Dr Rosenbaum Smith, for their great work and good humor.

And to everyone who volunteered but never got on the official chemo roster (Anne T, Annelise, Rachel, Michelle, Emily, Ursula and many others I am forgetting) I will keep you posted on post-surgery visiting hours at our apartment in late April, where we can commandeer more than two chairs at a time without feeling like we are taking over the place!

C for Cinnamon*

2007-03-15T06:35:00.000-04:00

Dark cinnamon, to be precise. Two weeks ago, I met a lovely woman named Anne who is also going through chemo for breast cancer. She invited me to be part of a "Day of Pampering" program hosted by the St. Luke's hospital's breast cancer resource center team, which was conveniently scheduled for yesterday, the day before today's final chemo session. Thanks the the generosity of Bobbi Brown cosmetics, Pantene's Beautiful Lengths wigs-for-cancer-patients charity, and celebrity hairstylist Mark Garrison's support for that program, at least 20 women had a terrifically girly day of makeup, hair, and laughter.

Pantene's Beautiful Lengths program works with women (and men) all over the country to encourage them to donate a ponytail (at least 8 inches long) to be made into wigs that are distributed to women with cancer via the American Cancer Society. For all you long-haired girls out there, what a great excuse to try a new look! I was open-minded about going with something different as I will likely be in wigs for at least the next 6 months - and what do I have to lose since I am already bald? I tried on a Jessica Simpson-esque curly blonde wig (too yellow, and a little slutty), a funky Meg Ryan style layered and highlighted short cut (cute, but made me look a little too old) and a blonde straight wig (too much like Wanda).

The overwhelming consensus in the room was that the Dark Cinnamon mid-length wig was The One. Redd, a very cool stylist from the Mark Garrison Salon, painstakingly layered, styled, cut and curled it into the funky, rock-n-roll cut you see here. Robert from Bobbi Brown did my makeup, which was so good that I think I can even be brave enough to post the latest bald shot (although there will be no true, circles-under-eyes and blotches-on-skin "before" shot here - I have lost much of my modesty, but not all of my vanity!)

I'm looking forward to surprising the nurses today with the new style, and I think it may be time to let my doormen in on what's going on, lest they not let ME in to my own building with all these disguises...

*Look for more "C for" entries as part of my resolution to write more in general, and to try to broaden my topics beyond the Big C (admittedly, I haven't gone too far away with this one!)

Pincushion

2007-03-12T22:07:00.000-04:00

This is a whole different kind of hot. It comes from nowhere, five minutes after I put on a hat because the wind is blowing, or worse, just as I think it's safe to put on my wig and head out the door to work in the morning. Several times each night over the past few weeks I wake up to a slightly damp pillow, covers thrown off, seeking coolness. This is not delicate, ladylike "glistening" or "glowing" - this is unadulterated rivers of sweat requiring multiple tissues and, ideally, sticking my head out the window.

Michael used to accuse me of being ectothermic - rather than one of those people who is always hot or always cold, I picked up the temperature of my surroundings. I was always the one bundled into hiking socks and extra sweaters in the winter or fanning myself on the subway platform in the summer.

At least that was predictable. Hot flashes are new and strike several times each day and night. Thanks to the drugs I am taking to minimize the effects of chemotherapy on my future fertility, I am currently in "chemopause." This temporary menopause and its accompanying side effects, of which the hot flashing is just one of a long and alarming list (osteoporosis at 33, anyone?), should abate in a few months, once the drugs have had time to work their way out of my system. With my final chemo coming up this week, I am in no hurry to pump my body full of yet more drugs that could help with the menopausal side effects, but which come with side effects of their own.

Which is how I find myself picking my way past the storefronts hawking fake Fendis and counterfeit Chanels to a nondescript building on Canal Street in Chinatown. A friend recommended this acupuncturist, who is also a certified M.D. The insurance forms are written in both English and Chinese characters. A nurse dressed in jeans walks into the reception area and says she will take my blood pressure while I wait to see the doctor. No fancy digital equipment here, just the old-school cuff, pump and stethoscope method, which she uses to take my reading while children play with the water cooler.

After 20 minutes, I am ushered into the doctor's office. He spends time learning my medical history, taking my information and comforting me with his knowledge of my chemo regimen. "Since you have one more Taxol to go, no herbs yet," he says. "Just the acupuncture and green tea extract."

I guess I had half-expected something spa-like, with robes and oils and the sounds of waves crashing on a beach piped in. Instead, I walk into a spartan room with a paper-covered examining table, a space heater on the floor, and the sound of rush hour traffic crossing from the Williamsburg Bridge to the Holland Tunnel. I look around for a gown. "Just take off your boots and tights and pull down the waist of your skirt."

I obey and lie down on the table, taking a deep breath - although I am used to being stuck with needles from all the poking and prodding I've endured the past few months, I have no idea what to expect. But I am comforted by the fact that I have heard no whimpers or screams coming from the other rooms, and given what I have observed of the office so far, soundproofing is not something they are likely to have invested in.

Working quickly, the doctor pats an alcohol-soaked pad over several points on my skin and begins. Tearing open a new packet for each tiny needle, he inserts one in each ankle, one along each shin, one in each knee, two along my stomach, and one in each wrist and hand, finishing with a single needle in the cartilage of my right ear. The entire process takes maybe 45 seconds. I feel slight pressure in some of the points, but no more than if I lightly pressed the spot with my own fingernail. "Now just relax," he says, turning off the lights and closing the door behind him.

And I do. I listen to the sound of the traffic below and think about how lucky I am to be feeling this good at this point in the process. My energy is slightly lower and I need an extra hour or two of sleep each night, but it has not been nearly as bad as I had feared it might be. I even seem to be keeping my eyebrows and the majority of my lashes until the bitter end, although I know they may disappear in a cruel, delayed farewell a week or two after my final treatment on Thursday.

My breathing slows down and I am startled out of a near-nap when, 30 minutes later, the nurse comes in to remove the needles and send me on my way. The doctor said that this treatment will require two visits per week for several weeks, but that I should start noticing at least some difference right away. And indeed I have - my daytime hot flashes are less frequent and less severe, and last night I slept all the way through the night without waking. At my next treatment tomorrow, I may even be brave enough to open my eyes.

Matters of the Flesh

2007-02-27T23:57:00.000-05:00

Shirtless and with the top of my jeans pushed down below my hipbones, I stood before the plastic surgeon’s studied gaze. Photos were taken from all angles. As he prodded gently at the flesh around my hips and buttocks to assess whether the fat there could be used to construct a new breast, I tried concentrating on the posters on the wall and feigned composure. But the most awkward moment was yet to come.

“Lie on the exam table and raise your feet and legs slightly,” he requested. He stood over me, both hands on my stomach, thumbs alarmingly close to my belly button, and pulled my fat up toward the ceiling. This is as scientific as it gets for plastic surgeons when it comes to judging the ability to use a patient’s own tissue for breast reconstruction, apparently. Never a fan of having my stomach touched even at the best of times, I focused all my energy on not squirming as he assessed his potential materials.

“The issue is that there is quite a bit of, er….volume in your breasts...” he began awkwardly.

“Oh! Right – no, no, I definitely don’t want to be as big as I am now,” I said, relieved that he had at last released his grip on my stomach fat. “Smaller is fine. In fact, I see the ability to stop needing to safety pin the gaps in my button-down shirts to be one of the big benefits to come out of this whole experience.” Once again, humor serving as my metaphorical hospital gown as I lie flat on my back, exposed on an exam table.

After each plastic surgery consultation, I have walked away reassured that I should be able to achieve a satisfactory cosmetic result from my reconstruction. But they have also featured moments of almost comical humiliation. One surgeon drew all over me with a Sharpie, à la Dr. 90210, pointing out that my nipples should actually be about an inch higher than they are. It took the better part of a bottle of rubbing alcohol and a pack of cotton balls to scrub away the marks from that one. Another described my breasts as “long,” not exactly the adjective one hopes would characterize these particular body parts at the age of 33.

And although my first surgeon described me as “too skinny” for the stomach fat transfer alternative (I thought about asking him to put that in writing so I could frame it for posterity), that did not stop him from being able to pinch what was clearly well over an inch as he stretched my belly fat skyward.

Now that I am nearing the end of chemo, with only 2 sessions left to go, I must make my decisions about surgery, which my doctors have advised me to schedule about 4-6 weeks after my final chemo treatment. Due to my genetic status, I will be having a bilateral mastectomy. Thanks to advances in medical techniques, I can have what is known as a “skin-sparing” mastectomy with immediate reconstruction, which means I will wake up from surgery with some sort of breasts in place. In theory, these can be made from either my own tissue or from implants. In practice, since I am having both breasts removed, implants are probably my best option.

But I still have an array of choices to make over the next few weeks, which means more appointments with more plastic surgeons. Michael and I are planning to celebrate the end of chemo with a trip to Miami in late March for the wedding of friends – despite these upcoming consultations, I will probably be able to muster the confidence to avoid spending all my time there in a giant flowered muumuu, but I will definitely be packing the rubbing alcohol and my most supportive underwire bikini.

Scarfabulous

2007-02-15T04:38:00.000-05:00

There are some benefits to wearing a wig - my shampoo and highlight costs are way down, I haven't spent time blowdrying since before Christmas, and I've had lots of compliments on my new "straight with bangs" style.

But maintenance is trickier than I had expected. Since Wanda the wig is made from real human hair, it needs to be washed every 20 wears or so. In theory, I can do this myself - wash it in the sink, squeeze out the excess water in a towel, let it dry on its stand, then use a flatiron or curling iron to style.

I tried this once. Having liberated my seldom-used flatiron from the depths of the closet and with my newly purchased large-barrel curling iron at the ready, I set the wig on its stand on a dresser and quickly realized that I needed to take another approach. Any time I came near the wigstand with one of my styling instruments, it promptly fell over. So I switched to working on it while on my head. This was fine for flatironing the sections around my face, but I was hopeless when it came to the bangs. Every time I tried using the curling iron, the hair ended up caught in the barrel's catch, resulting in attractive, random 90-degree bends for portions of each section. And as with when I had real hair, I was a bit ham-fisted when it came to doing the back. I tried holding the wig on my left hand and styling the back with my right, which worked to an extent, but did not quite result in the straight, shiny locks Edward gave me when he first styled the wig in the shop and fitted it to my head.

So after wearing self-styled Wanda about 10 times, I gave up and took it in for servicing. Two days and $50 later, it came back softer and shinier (and also curlier - apparently next time I need to tell them that I want it not just straight, but "STRAIGHT straight.") Although I realize this will rapidly eat into my shampoo and highlight savings, and although I am frustrated that I can't do a better job myself, it seems like the best option to preserve both my sanity and my vanity.

But it does not solve every problem. I can't wear Wanda to the gym, or to swim in, and I need to wear something while she is "in the shop." While I don't mind going bald or wearing scarves and hats at home, I am still a bit too self-conscious for the "bald and proud" look while out and about. For our trip to Turks and Caicos, I found a great alternative - my "Scarfabulous" is a bandana made of swimsuit material, with hair attached. Since the hair is real, it can get wet. It comes in several lengths and colors, and the "warm light brown with blonde highlights" is very close to the hair I shaved off in December.

I had originally intended to cut it to shoulder length to more closely resemble Wanda, but shortly before we left, Laura and Sarah came over for the fashion show and advised me to keep it long. So "J.Lo." (as Sorrel christened her on New Year's Eve, when her shaved-headed husband Alex rang in 2007 by wearing her around our party) was my beach look, and also kept me covered at breakfast, lunch and yoga classes. In the evenings, I switched back to Wanda. If anyone noticed, including an acquaintance from business school and his wife who were also staying at Parrot Cay, they were too polite to say.

I will be dropping Wanda off again for refurbishing this morning, on my way to Chemo Number 6. Things are going well with the new drug, which I started two weeks ago - no nausea, less bone pain, and just a few eyelashes missing so far. Of course, the steroids they have me take the night before to help stave off allergic reactions are likely the reason that I am up at 5 a.m. writing instead of sleeping, but I will take that over the numb fingers and toes and overall body pain that some women feel as a result of Taxol.

So now that the side effects are not a concern, I can devote my energy to worrying about my hair. Wanda doesn't come back until Saturday. And although I am not in the office today and tomorrow, I do still have to go to and from the hospital both days, as well as to the grocery store. With snow on the ground, J. Lo feels a bit unseasonal. It's too cold for just a Grace Kelly-style headscarf, although I am planning to wear the gorgeous scarf Jeannie and Sivan gave me when we have friends over for dinner on Friday night.

This may call for breaking out the short wig I wore to play Sharon Osborne once - I have tried it on, and apart from being a purpley-red henna color that is not found in nature, it's not a bad style. It's not quite the same as Samantha matching her wigs to her outfits in the final episodes of Sex and the City, but it is a good excuse to try on a few new identities over the next few weeks and months as my hair and I embark on the long journey back.

Resemblance

2007-02-04T23:00:00.000-05:00

"Are you two sisters?"
"I knew that was your mother the minute she walked in the room."
"Do people tell you all the time that you look like your mother?"

Yes. Since childhood. Despite different eye color and haircolor, that I can get a tan while she freckles, and that the clothes she wore in her 20s were so tiny that I couldn't hope to fit into them past the age of 11, I have always been able to see how similar we are.

For some women, "you sound just like your mother" are fighting words, an accusation to be hurled and defended against. When Mom relayed the story of the London cab driver asking the sisters question when I was 16, she laughed and told her friends that she was worried I would be insulted. But I have always been pleased by and proud of the comparison.

Now, as if appearances were not strong enough, we have all the proof we need that we are indeed related - Mom has tested positive for the BRCA 1 gene mutation, as we suspected she would based on my results.

This means that she has a 56-87% chance of developing breast cancer by age 70 (vs. the 7% chance the general population has). It also means her risk of ovarian cancer is as high as 40% (vs. 2% for non-mutation carriers).

Although she has big decisions to make in the near future about measures that can dramatically reduce her chances of developing these diseases, for now we are relieved that there is no immediate concern - her mammogram and other scans came back clear. The maternal instinct may be even stronger than the genetic bond - Mom said that her first thought on getting that good news was not "Thank goodness I don't have cancer," but instead, "Thank goodness I can focus on helping Courtney get well over the next few months."

For which I am very grateful. So far, I am cautiously optimistic that the second half of my chemotherapy will go as smoothly as the first part - I had my fifth of eight sessions on Thursday, and apart from some increased sleepiness, I have been feeling remarkably well the past few days. Five down, three to go, followed by surgery in April and hopefully getting the reconstruction and recovery completed by the summer.

And now that I have finished the first chemotherapy drug combination and am on to a new drug, I am even starting to see some new peach fuzz sprouting on my head. Although it will take some time, I look forward to the day when a cab driver catches sight of us in the rearview mirror and can't help but tell me how much I look like my mother.

Thermostat

2007-01-24T23:32:00.000-05:00

I'm not sure how bald men do it. Regulating my body temperature is nearly impossible. I arrive at work sweaty-faced thanks to the combination of Wanda the Wig trapping in the heat and climbing stairs in the subway - I have not yet been brave enough to just take her off for a few minutes while I cool down, but I have certainly considered it. The light blue terrycloth hat I wear to bed is on and off at least four times in the night. Hanging around the house, I rely on a constantly rotating selection of scarves, lightweight caps and ski hats to keep me warm enough, but not too warm. Call me Baldilocks.

One of the side effects of chemo is that it can make you very intolerant to the cold - last night I got a little too chilly walking back home from the subway after dinner with Laura, Sarah and Gretchen at Gahm Me Oak in Koreatown. I shivered uncontrollably for what felt like hours before finally falling asleep. Not eager to experience that again, I have turned on the radiator in our sitting room, but thanks to the uncontrollability of New York apartment heat, I am now sitting here barefoot, baldheaded and in a t-shirt, trying to strike the right thermal balance.

Winter has skipped New York so far, but we are expecting our coldest weather yet this weekend. Which is why our timing could not be better - to celebrate being halfway through chemo, Michael and I are off for a four day trip to the Caribbean tomorrow. We'll see if it's easier to stay warm, but not too warm, when it's 82 instead of 28 degrees. Wanda is coming along, but so is the SPF50 sunblock for my head.

Halfway

2007-01-19T07:40:00.000-05:00

This is the morning after my fourth of eight treatments, and the last of the drug combination that most women feel is the worst (Adriamycin and Cytoxin, or “AC”). No “morning after hangover” fortunately – when Michael asked me how I would like to celebrate, I suggested a big glass of sparkling water (alcohol still holds very limited appeal).

I have been slow to write again after my last entry, not because I have been feeling ill or because I have been too busy styling my wig (although that is HARD! I thought that years of doing hair for Barbie as a child might help, but no luck, I still can’t master the round barrel curling iron – I had to give up and take her into the wiggery yesterday for a $40 touchup). No, I’ve just been occupied with life, which feels great.

They say that every woman with breast cancer handles treatment differently, and I am grateful to be one of the lucky ones so far. Apart from my every-other-Thursday chemo sessions and my follow-up appointments the next day, I have been at work full time (which includes late night emails, breakfast and dinner meetings, and spending most Sunday evenings on the computer getting ready for the week ahead). We have cooked dinner for friends, gone to the theater, gone to the gym. Thanks to Michael’s parents, who have been in town this week, we are also making great progress on finishing all the little jobs on the apartment left over after last year’s renovation, wallpapering, grouting and making all the small adjustments the contractors overlooked or couldn’t be bothered with – at last, nearly 2 years after we bought it, the apartment feels finished!

Apart from going to bed an hour or two earlier (which Michael, who normally needs more sleep than I do and gets up an hour earlier, says is the best Christmas present I could have given him), we are living our lives as we always have. That, combined with the ongoing support we’ve been given by our friends near and far, new and old, close and haven’t seen in years, has made an enormous difference to my mental health – and it seems to be working on my physical health too. Thanks to all of you for being such an important part of my recovery, and stay tuned for the ALL the way there celebration 10 weeks from now.

All the Trimmings

2007-01-01T22:07:00.000-05:00

"At least yours will grow back," has been the sympathetic comment from all the follicularly-challenged men in my life, foremost amongst whom is my brother Matt.

They tell women undergoing my particular brand of chemo cocktail that the hair loss is like clockwork - you can expect to start "releasing" on Day 14. Sure, I had the wig, the hats, and the variety of headpieces that can help me disguise my nonexistent strands all to hand just days after starting chemo in mid-December. But as I sat in the chair at the wig shop for my initial trimming and fitting the afternoon of Day 14, every one of my own hairs in place, I thought maybe I was going to be the exception to the rule. My hair has always grown fast, I reasoned. I am handling chemo really well so far - no nausea since the first night, normal appetite - and although I certainly don't want to jinx myself, I did allow myself the glimmer of hope that perhaps I could get out of this particularly nasty side effect as well.

Later that night, when a casual "running my hands over my hair" maneuver resulted in about 40 strands on my hands and sweater, I had to accept that this was one I would not escape.

Matt was coming to town the next day, December 23, razor in tow. I was completely prepared for him to shave my head, but also knew that this was the last chance I would have until December 27 to have the wig correctly fitted to my head (it sits differently when you have no hair). Although I could hang on with thinning hair for a few days, I didn't want to wait too long, or to find hair all over the house. When Michael discovered a few strands in the butter on Saturday morning, we all knew it was time.

After brunch at Tavern on the Green with Dad and Michael, Mom and Matt accompanied me to slightly less traditional and one-time-only (I hope!) Christmas event - we went to get my head shaved. Matt kept me company and distracted me from the mirror, assured me I looked beautiful, and briefly tried to talk me into keeping the "bangs only" look with the rest of my head bald. He was also the photographer - as you can see from the photos, there were no tears, only smiles.

I don't recommend trying this at home, but it is nice to know that my head is a normal shape - my wig stylist told me to thank my mother for turning me over in the crib as a baby. This means it's a lot easier for me to feel comfortable going bald around the house (despite the fact that standing at my shoulder tonight while I was sitting down, Mom said, "Hmm, from this angle, you DO look a bit like an alien...")

Luckily, I have Wanda. Real human hair, bangs to hide the hairline, in "harvest blonde" to help prevent my skin from looking sallow as my treatments progress. In the silver lining category, I have gone from shampooing every day to once every 2 weeks. My morning routine has been cut in half. And if I tire of shoulder-length harvest blonde, I can always pick up a new pixie platinum, brunette bob, or raven waves. Suggestions accepted below...

Shrinking

2006-12-22T03:58:00.000-05:00

"Feel this. Is that a lump?" The "real" lump is in the left breast. I am pointing to the very top of my right breast, making Michael play doctor, and not in the fun way.

"That's your rib," he informs me, almost before touching to check.

"But it feels different than the other side," I say, now poking at and rubbing both sides of my chest.

"So your ribcage is crooked," he says mildly, continuing to brush his teeth. "Beats cancer." And I laughed.

I am trying not to be an obsessive "poker" - some women conduct hourly breast self exams after diagnosis, trying to divine whether new lumps are showing up or if the tumor is growing. For me, it's best to be aware of what is going on with my body but not to torture myself. So I try to limit my checks to once a week.

Wednesday, the day before Chemo Round 2, I checked in the shower. It felt smaller. But I was aware that could just be wishful thinking.

At chemo yesterday, the news was encouraging. I'm not crazy - the doctor agrees that the tumor is smaller. It seems that I am shrinking a bit too: I managed to lose a couple of pounds, despite Christmas parties, some comfort eating, no exercise other than a few yoga sessions and my usual walking all over the city, and the evidence suggesting that most pre-menopausal women gain weight on chemo (slowed metabolism, steroids, inactivity). I credit my reduced interest in drinking and sugar for the change. Good thing Saltines aren't too terrible for you! Maybe I should dye them red and green for Christmas.

Chemo itself was not too bad either. Mom and Dad are in town for Christmas, so once again I was surrounded by love and beauty for the 4 hours of checking in, waiting around, tests, more waiting, tests again, and finally the infusions of the 2 drugs.

I have been lucky to only feel mildly ill with Round 1, and so far not at all nauseated on Round 2. I had some bad headaches the first few days and anticipate they may happen again, but drugs and staying hydrated help with that. I have not had the "metallic mouth" that many women describe, nor have I suffered from the "severe bone pain" they warn can be a possibility with the shot administered the day after chemo to keep white blood cell counts high.

I have the energy to work after I take the post-chemo Friday and the weekend off. I still have my hair, although I suspect it won't be long now - Matt is bringing his clippers and razor for Christmas.

You can see from the timestamp that I am up in the middle of the night - not uncommon with the drugs, and also since I went to bed at 9:30 pm. But that should normalize over the next day or two. If not, the perhaps I can finally manage to stay awake late enough to catch Santa.

Oh yes - my "new lump" is indeed a rib. Crooked ribs do beat cancer, and I will too.

Believe

2006-12-17T23:57:00.000-05:00

Our tree is up and decorated. We just completed the annual ritual of agonizing over the relative size of each of our 8 doormen's tips ("That one has been here for 11 more years than the other guy." "But he barely even opens the door!") I baked a pear and ginger cake to bring to a dinner party with friends on Saturday, and the smell of gingerbread lingers temptingly in our apartment.

So it's starting to feel festive, but that won't truly kick in until my parents get here on Wednesday.

My mother has always made Christmas an Event. Carol singing, tree trimming, special "Christmas pajamas," cookies and a note for Santa before we went to bed - my childhood memories of the holidays are positively Rockwellesque.

One year, when I was 9 and my brother was 3, Mom sat with us in my bedroom, reading 'Twas the Night Before Christmas and encouraging us to "Listen! Can you hear the reindeer's hooves on the roof?" We sat up wide-eyed, eventually falling asleep, only to fitfully wake up to check the clock every 40 minutes. At 4:30 a.m., much to the dismay of the adults, we couldn't stand the excitement any longer - somehow we convinced my parents and grandparents to put on their robes to see what delights Santa had brought before the sun was up.

This year, Christmas in New York will include urban variations on our old traditions - a Broadway show, a post-prandial walk in Central Park, skating at Rockefeller Center. But in the midst of all the holiday plans, we also have to deal with the new reality: Mom and Dad will come with me to chemo on Thursday, on Friday Mom will go for her genetic test, and sometime over the weekend, Matt will shave my head, as they say my hair will start coming out in handfuls on Friday.

When I called Mom to tell her about my diagnosis, the first thing she said was, "If I could have this for you, I would." And I know she meant it. This is not the way the universe is meant to work - parents are not supposed to watch their children battle diseases that most people don't get until long after they have had children and grandchildren of their own.

But now that this is what we are facing, all I want for Christmas is for her test to be negative. My genetic counselor thinks that is unlikely - although there is a 50% chance, since the gene came from either Mom or Dad, my grandmother's breast cancer suggests the gene came from Mom's side. However, it is impossible to rule out Dad's side - he has 2 brothers who have no biological children, and his father had only one sister, so there are very few women to look at for evidence. It's possible that it has silently been passed down through his family tree with no adverse effects until now.

The statistics are imprecise, but it is believed that women with the BRCA gene have as much as an 85% risk for developing breast cancer by the age of 70, vs. the 12% risk that the average woman in the United States faces throughout her life. The gene also raises the risk of ovarian cancer from 1.8% for the population to 55% for BRCA1 carriers.

Although there is some evidence that men who carry the gene have a slightly elevated incidence of colon, skin and male breast cancer, these risks are minute compared to the risk in women with the mutation. For all of us, it would be much better if Dad turns out to be the carrier.

We have already had some encouraging news - Mom's recent mammogram was clear. I am not only relieved for her, but also, selfishly, for me - if there was ever a time that I needed my Mommy, this is it.

We are going into this Christmas positive and strong. I made it through the first chemo with very few ill effects, and they say that my reaction to at least the next three rounds should be similar. Our apartment is decorated, our shopping is done, and I have absolved myself from most Christmas-card writing duties this year (apologies to my friends and relatives!)

But most importantly my family will be here with me. Twenty-four years ago, Mom convinced us that Santa was up on the rooftop, sleigh and all. Today, her conviction that I will be healthy again and beat this the first time around gives me confidence that we will all make it through these next few months stronger than ever. Just like at Christmas, the best gifts go to those who believe.

Masquerade

2006-12-12T23:40:00.000-05:00

For the first time in as long as I can remember, I am not tempted to buy clothes. This is partly because I know my body will be different a few months from now. These changes may be both good (shirts will actually button over my chest without gaping!) and bad (they say that pre-menopausal women who go through chemo gain 15 pounds on average. Great - I can look forward to being bald AND fat).

But it's also because I have a newfound interest in accessories and makeup. Hats, sunglasses, scarves, earrings, lipgloss, eyeliner - I've bought them in multiples the past couple of weeks. I have no idea what to expect when I wake up on December 22, look in the mirror and find a hairless Courtney staring back at me. But I want to be well armed.

When I first got my diagnosis and called Kelly to tell her the news, she said all the wonderfully supportive and sympathetic things I knew I could count on her to not only say, but mean. Then in a more conspiratorial tone, she asked, "So, have you stood in front of the mirror yet with your hair slicked back to see what you'll look like bald?" I laughed - of course I had, even though it had been less than 24 hours since I had seen the doctor.

But it's hard to imagine the bald look. I do have a wig on order that will be ready this week, made of real human hair, highlighted like my own. I tried on a sample - it looked like me but with a better blowout. They can even paint in roots to make it look more realistic! (although it occurs to me that I am not sure who I think I will be fooling, since the existence of this website is proof that I am hardly a closed book...)

But people say you get tired of wearing the wig all the time. They can be hot and uncomfortable. Most women strip off the wig the minute they walk in the door, trading it it for a knit cap to stay warm inside. And on weekends running errands, I imagine I will be fine with just throwing on a hat. But I think I may need the armor of dangly earrings and fabulous sunglasses to truly feel ready for my closeup.

In the absence of bald shots or "real" wig pictures, I will leave you with one potential look - if there is a problem with the one I have ordered, I always have the option of wearing either one or both of the wigs that transformed me into Cruella deVil for Halloween*...

*shown here with Susan as a Palm Beach Bag Lady, Gretchen as a geisha, Bill as George Washington and an unidentified ghoul at the 69th Street Halloween Block Party

Cocktails as an Endurance Event

2006-12-09T16:36:00.000-05:00

The feeling that I was having the worst hangover of my life at 7:00 p.m. on Thursday should have come as no big surprise, given that I started the mother of all cocktail sessions at 9:00 a.m. that morning. And I was mainlining them.

After the check-in, weigh-in and blood draw, they settled me into one of the big aqua recliners to start the IV drip of saline through a vein in my right hand to hydrate me before the chemicals began. There are 10 recliners in the room, facing the nurse's desk in a horseshoe shape. Each can be closed off with a curtain, but on Thursday, as on any other day that I have seen this room when walking past, no curtains were drawn. Like any other ritual, chemo has its culturally acceptable behaviors, and closing the curtain seems somehow antisocial.

Although some of my fellow patients might have appreciated it if we had closed ours off or even requested a private room, anything to slightly dampen the occasional peals of laughter. Who needs the distraction of the TVs hanging above each chair when you have Molly and Sarah telling tales of their adventures in the art world? They added a bright spot to the less-than-glamourous surroundings, with their shiny blond hair, gorgeous smiles and scarlet coats.

After a little shopping and lunch, they made sure I made it home to bed. Which was exactly where I needed to be. Michael came home that night and found me grey-faced and exhausted, a little nauseated, with a splitting headache. I managed a few saltines and some water before collapsing into bed at 9.

But by yesterday, the worst had passed. I woke up early with Michael on Friday and the color was already returning to my cheeks. After a few more hours of sleep, I felt immensely better, almost normal. Today I am a little exhausted, but am working through it with a bit of fresh air and plenty of naps.

To everyone who has sent flowers and food this week, thank you for keeping the apartment bright and our sprits and bodies nourished! And thanks to all of you for your thoughtful comments, notes and emails - knowing that I am going through this with so much love and support makes this 16-week cocktail party much easier to bear.

Almost Famous

2006-12-05T01:23:00.000-05:00

Being told that the famous fertility doctor himself was going to conduct my vaginal ultrasound last Tuesday was like learning that one of your friends is bringing a Michelin-starred chef along to the dinner party you are throwing – there’s enough pressure when it’s just the usual crowd, but this heightens the performance anxiety.

“Only one, again,” he says, removing the wand and taking off his gloves. Statistically, five eggs are needed to result in one successful pregnancy later. Silently, I start to question what I have done wrong, why this has failed for the second time in a row. I feel like a 22-year-old who can’t pass her driving test– how can I be so bad at something that comes so easily to others?

The plaques and trophies that adorn the doctor’s office are not as reassuring this time as they were last time. Even one of New York’s 100 Best Doctors can’t give us the frozen embryo insurance policy we were hoping to have so that we could feel better about our chances to have children one, two, or five years from now, after the chemotherapy has done the damage that it inevitably does at the same time it does good.

Normally, women in my situation, who must undergo chemo but who want to get pregnant in the future, just cross their fingers and hope for the best. More recently, some doctors will give Lupron shots to artificially “shut down” the ovaries during chemotherapy, the idea being that it “hides” the egg reserve from the chemicals that are designed to attack fast-growing cells like cancer, hair…and eggs. Once chemo is done and you are off the shots, chances of returning to normal functionality again are greater.

Other women go through a round or two of “normal” IVF, the kind that can result in some women producing as many as 30 eggs at a time. However, there is some fear that the increase in hormones this process triggers may exacerbate a woman’s cancer.

So if you have access to joining a cutting-edge research study, cancer-specific “fertility preservation” is an option. I took a pill to suppress estrogen production at the same time that I injected myself with follicle stimulating hormones. Although this tends to result in fewer eggs (more like 4-8 in one cycle), it is considered much safer for women with cancer, although it is still being studied.

In my case, it only produced one each time, and judging from my estrogen tests, neither one would have been viable if retrieved. The doctor explained that this could be the result of a low egg reserve to begin with, which is unlikely at my age, or it could be due to a mechanical malfunction in the ovary that essentially triggers early production an egg.

He offers a ray of hope: “If it is the second, then you are a good candidate for ovary harvesting.” Sitting in his office 20 minutes after getting the news of my dominant egg, this seems like a reasonable option. It’s a simple laproscopic surgery. It is expensive, but insurance would probably cover it on the grounds that I have an increased risk of ovarian cancer given my BRCA status, and it is advisable that I remove my ovaries to cut my risk before I turn 40 anyway.

I call Michael and he comes right over from work. I start completing the paperwork before he arrives. If I am going to do this, it has to be 48 hours from now, so I fill out the forms that have suddenly become all too familiar – anaesthesia permissions, acknowledgements that all surgeries carry risk of infection, agreements not to sue if something goes wrong.

Michael arrives at the office and we head downstairs for much-needed caffeine and an attempt at clear thinking under pressure. We review the papers and talk about the risks. We are both nervous about the lack of data – it is an incredibly new technology. We joke that in addition to the benefit of being able to have children, we would also be making a major contribution to science. After agreeing that the risks of the initial operation seem low, and that the bigger decisions would come in a year or two when the time arrives to try to get pregnant, we schedule the surgery for Thursday morning.

I wrestle with the decision all day at work. I go through the motions of ordering the medicine I need to take that night from the pharmacy, but I also do more Internet research, both scientific and anecdotal, on women who have children after cancer treatments. It’s impossible to get solid numbers without a clear denominator, but I do read enough to start worrying about what I am doing to my chances of getting pregnant “naturally” after treatment if I remove an ovary.

The procedure itself is enough to freak out the squeamish. The doctor would remove one ovary, cut it into many small strips of tissue, test some and cryopreserve the rest. When the time came, we would implant several of the strips under the skin of my forearm and hope the eggs living inside the tissue would mature there, with the help of stimulating injections. Once mature, the eggs would be harvested from my arm, injected with Michael’s sperm and further matured in a test tube, and then the embryo would be implanted in my body. We would then hope I could carry to term successfully.

That night, both of us are uneasy. “We’ve made the right decision,” I say a few times, out loud, testing to see how it sounds.

It sounds wrong. We look at each other and know. We’ve had six weeks to grow accustomed to the idea that childbearing is likely to be a challenge for us after this, and we have discussed many options. We have accepted that there is more than one way to become parents, not all of which involve passing on what I already know could be a fatally flawed gene.

I have endless respect for my doctor’s work in this area – he is on the cutting edge of the little-examined consequence of premature infertility in young cancer patients. He provides hope for the future to people at a time when they most need it.

But Michael and I realize that hope is something we already have. Ignoring the siren call of being the cover girl for Reproductive Endocrinologist monthly, I cancel the surgery. I schedule my first Lupron shot for four days later, followed by my first round of chemo coming up this Thursday, December 8.

Harvard

2006-11-27T23:22:00.000-05:00

I started on a path to the Ivy League back in junior high. Now that I live in nutso neurotic New York, where otherwise reasonable parents pay consultants to coach their pre-schoolers to ace their entrance interviews, this does not seem that hard to fathom. But in Des Moines, Iowa, in 1986, it was fairly avant garde.

My mother had read somewhere that you needed a wide variety of extracurricular activities to make the cut. I already played the violin and loved writing for the school paper, so those were easy. A couple of weeks each summer at camp when I was 11 and 12 got me ready for the swim team. French classes plus a mini-internship in St. Etienne (the only useful application of a "Sister City" that I know of to date!) added international flavor.

By the time I applied for college, my knowledge of SAT averages and essay weighting in admissions decisions at various institutions of higher education was encyclopedic. To the credit of my parents and myself, I did not apply to every top-ranked school willy nilly. I sought out those schools that had outstanding English and Political Science programs, encouraged study abroad, and had low student:teacher ratios. Less nobly, I leaned toward schools that did not have rigorous math or science requirements.

I also looked for schools that had the ineffable quality of "feeling right." Could I see myself in these classes, learning from these professors, socializing with these students? Could I visualize myself walking these paths, living in these dorms, eating this food?

The obligatory "decision trip" came in March. Somewhat to my surprise, since I had never really intended to attend a women's college, Wellesley was my clear favorite of the schools to which I had been admitted. But note the qualifier - I was holding out hope for Harvard, where I had been waitlisted.

April was a difficult month. I agonized over whether to keep my name on the list, waiting to see if someone chose not to come to Cambridge after all. I wanted the halo, the sheen, the gold-plated rubber stamp of the Harvard diploma.

But deeper below the surface, I suspected there was something about Wellesley that was better for me. Whether it was that it is purely an undergraduate college, the fact that the captain of the swim team, editor of the newspaper, president of the student goverment and anyone else a first year student might look up to was a female role model, or simply that the campus is so beautiful they can charge locals membership fees to use its facilities as a "country club," I am still not sure. But my instincts told me it was the right decision. I took my name off Harvard's waiting list and sent in my deposit to Wellesley.

Living in New York with good health insurance and cancer, everyone assumes you are being treated at Sloan Kettering. Why wouldn't you? It's the best in the world, attracts leading doctors, participates in all the cutting edge trials, and has an international reputation.

After pulling a few corporate strings (again, welcome to New York!) I was able to get in easily for a second opinion immediately after my diagnosis. I had no issue with the doctors or nurses there. I can recognize the benefits the hospital offers. I can certainly understand why it is the right choice for so many people. And they do have lovely pinstriped hospital gowns.

But I don't think it's the right choice for me. Shallowly, it is a pain for me to get to - I know that complaining about convenience in a city the physical size of New York may sound ridiculous, especially to people who drive a couple of hours each way for their chemo treatments. But after living on the Upper West Side for a few years, the idea of traveling to York Avenue every other Friday sounds about as convenient as hopping a biweekly flight to Des Moines.

Much more importantly, it just doesn't feel as right. A woman I spoke to described part of what may be at the root of this emotion: "I know it sounds weird, but everyone you see at Sloan Kettering just seems so sick." My doctor told me that they provide excellent care and that I would certainly be in good hands there, but that the reason people seek out Sloan Kettering "is for the complicated, the severe, or the rare." So far, it appears that I fall into none of these categories.

I continue to get a few more opinions, but for the moment sticking with my original doctors at St. Luke's-Roosevelt and the path they have set me on feels like the right direction. Although I may be missing my chance to go to the Harvard of cancer hospitals, my gut has been right before - almost 16 years later, I still maintain that choosing Wellesley was the best decision I ever made. I can only hope I will be able to say the same thing about this decision, 6, 16 and 36 years from now.

Inheritance

2006-11-22T00:54:00.000-05:00

My father used to joke that the strong resemblance between the women in our family hints that men had no involvement in our creation. When I was eight or nine, there were four generations of women still alive - my great grandmother was a redhead before her hair turned grey, my grandmother kept her black hair for most of her 78 years, my mother was a brunette until a recent decision to lighten things up, and I am a (now chemically-enhanced) blonde. But we all look remarkably similar - same noses, same foreheads, similar mouths.

The first thing most people asked when I told them my diagnosis is “does it run in your family?” I understand why – before I had to become an armchair expert overnight, I also thought that not having much of a family history meant I had very little risk.

But experts believe that only 10% of all breast cancers are hereditary. All cancers are related to the genes, but most are “sporadic” – it’s impossible to determine why the genes malfunctioned.

But as our family photographs prove, the gene pool does not lie. I received the results of my genetic testing yesterday, and I tested positive for the BRCA1 gene.

This does not come entirely as a surprise. My grandmother had breast cancer at the age of 76, which is so late in life it is not even considered "family history," especially since women's lifetime risk is as high as one in nine. But she had a hysterectomy in her 30s, and ovarian removal could have put off the onset of the cancer. It could also have come from the other side of the family - although there are so few women on my father's side that it's hard to identify a clear pattern, the gene can manifest itself in men as skin cancer, which has plagued his uncles.

In a strange way, the news is almost a relief. There are far fewer questions about a treatment plan - I will have chemotherapy, followed by a bilateral mastectomy and reconstruction using implants. And at least I know why this has happened to me at the age of 33. It also makes it easier to answer seemingly innocuous questions like "does it have to do with diet?" (to which I occasionally want to respond, "You know, you're probably right - if only I hadn't eaten those 5 cheeseburgers the summer of 2003!")

I don't really resent the questions, though, because I understand the need to lay blame, the comfort in theorizing how to avoid it. I played the same game when I got my diagnosis - I immediately started trying to figure out "what I had done wrong." Which is ridiculous, because if we could isolate that, then we'd be a lot closer to a cure than we are today.

No, all I did was to be born into my family, which is something I would never change. Sure I inherited the gene. But I also inherited my mother's writing skills and singing voice, my father's intellectual curiosity and debating ability, my grandmother's energy and analytical business mind, and my grandfather's love of family and joy at starting new projects. I am what my family has made me, imperfections and all, and for that I am truly thankful.

Best wishes for a wonderful Thanksgiving to you and your families.

Cause for Celebration

2006-11-17T12:26:00.000-05:00

My breast surgeon called yesterday with very good news - my sentinel nodes are clear of cancerous cells. This confirms that it is unlikely the cancer has spread beyond the original tumor, which is very encouraging.

Given the tumor's size, there is still a chance that renegade cells have broken off and are somewhere in my bloodstream, which is why my doctors are still recommending an aggressive course of chemotherapy to kill the cells in the tumor and those that might be somewhere else in my body. However, the immediate risk of further spread is minimal, so this news has helped us decide to delay starting chemo for 2-3 weeks until I complete one more round of IVF. Although things can always change, I have updated the schedule post, below, and will try to keep that current.

Several of my girlfriends had already planned a "Pre-Chemo-Cocktail Cocktail Party" for last night since my first session was originally scheduled for today, so we went ahead and turned it into a "Negative Node" celebration instead - it was lovely to see so many of you despite the rainy weather! Here's hoping for more celebrations of good news to come...

Fermata

2006-11-15T01:40:00.000-05:00

A weekend of successful shopping for hats and sunglasses (treats I am allowing myself because a) I will need them to succeed with my "Greta Garbo as chemo recipient" disguise, and b) I don't have to worry about them fitting if I gain/lose 15 pounds on chemo, both of which I have heard are firm possibilities) and watching silly movies ("Borat" is every bit as offensive and genius as you have heard it is) made me forget the dull pain under my arm from lymph node surgery, and the dull pain in my head from worrying about all the decisions I have yet to make.

This week I have been distracted even further as I am attending a conference and conducting meetings in Las Vegas. Perhaps the fact that it is 10:30 pm local time as I write this in my pajamas (and admittedly rather luxe "Wynn" slippers) will serve as evidence that I am not living the high life everyone assumes I must when visiting here. Fortunately, several colleagues are in town with me, so I have actually been able to sample a few of the schmancy restaurants - normally when I am in town, it is room service for one and episodes of The Office dowloaded to my Mac. What happens in Vegas stays in Vegas, sure, but only because it is too boring to write home (or to my cozy universe on the blog) about.

I measure the insanity of my schedule when I am visiting Las Vegas for work in $9 cab rides taken from one property to another to meet candidates - from the past two days alone, I am up to $117. But the other reason I have not written much this week is that there is not much to write about. We are in a holding pattern for the next few days, a pause in the incessant appointments and treatments while we wait for the additional information that will influence my next decisions and actions. I will get my final lab results from the biopsy sometime this week. My genetic test results are due in early next week. And hopefully IVF2, Return of the Follicles, will begin around the same time.

So to expand on the musical reference from the title, now is not the part where you applaud. Instead, it is where the musicians briefly pause before continuing on with the original piece - its length is entirely at the discretion of the conductor.

Decision 2006

2006-11-10T23:57:00.000-05:00

This past Tuesday, I voted in New York. As I walked through the hallways of PS 9, the hand-lettered signs on the wall pointing the way to the polls and the smell of brownies from the bake sale to benefit the PTA made me a little homesick for Des Moines.

My dad always treated Election Day as a great opportunity to give a civics lesson. Usually we would walk to Merrill Middle School when he returned home from work, him still in his three piece suit and wing-tips. We would walk the two blocks to the school, passing the rambling brick homes of Grand Avenue, each with at least one sign in the yard promoting a candidate for whatever office might be up for grabs, and usually more. Iowa takes elections very seriously – I wonder if it is from a fear that if we did not, we might lose our position as the first caucus in the presidential primaries, and our once-every-four-years guaranteed place in the national headlines would disappear.

The curtained booths in the school’s lobby held a sense of mystery and possibility. “No, you can’t come in with me,” Dad would say solemnly. “It is the right of every citizen in a democratic country to vote without having to tell anyone for whom they voted.” As I grew older, I would cajole and argue that it was a pointless charade, that of course I knew which way he voted, that it was senseless for him to be so cagey about it. When I was young, I just wanted to push the buttons and pull the lever.

I like that New York still has these old-fashioned machines – it adds a certain element of excitement to the voting process. What if I do it wrong? What if the lever gets stuck? Who is this mysterious "The Rent Is Too Damn High" party (watch out for the funky music!) and how on earth did they get onto the ballot, their name in big letters in the first row across the columns just like all the other legitimate parties? I cast my vote and pulled the lever as instructed, my action rewarded with a satisfying “clunk” as my vote was registered.

If only the rest of my decisions that day could have been so clear-cut and final. From the polling place, I went to Cornell for my blood test and ultrasound. After the obligatory waiting room shuffle, the doctor (the fifth one I had seen there in five visits) informed me that I had one “dominant follicle.” The IVF had not worked as hoped.

The idea is that the follicle stimulating hormones I was injecting into my body would allow multiple eggs to be retrieved, usually four or five, but as many as 10 in women my age. Although my initial exams did show eight or ten potential follicles, it appeared that one “greedy egg” ate all the medicine and dominated all the others, which never grew. “Tonight you take the Human Growth Hormone, and 36 hours later you come in for the retrieval surgery,” the doctor informed me as he took off his gloves and left the room.

I knew it was not that easy. I got dressed and went out to find the nurse who had guided me through the process. She gave me a hug and a Kleenex and confirmed that each egg they retrieve has only a 50% chance of being viable. Chances that the embryo will successfully be implanted and matured eventually are 55-65%. Given these odds, we decided that going in for surgery for just one egg was a waste of time and the energy it takes to get through any surgery. It would also have delayed my sentinel node biopsy by at least a few days, as the retrieval would have had to happen on Thursday.

One option was to move things around and to have the surgery first, buying myself time before I start chemotherapy. But immediate reconstruction surgery, which most doctors prefer, provides an extraordinarily complex set of options to choose from – think Italian parliament rather than the US Senate-like choices of “lumpectomy vs. mastectomy” that characterize the primary breast surgery. I also want to have the results of my genetic test before I make a surgical decision, as I will definitely opt for a bilateral mastectomy if I test positive for the gene, and I don’t want to have to go through surgery twice.

After multiple phone calls to Michael, my oncologist and my surgeon, we agreed to wait until I had the sentinel node biopsy to make a final decision about whether or not to go through with a second round of IVF. The negative node result is a good sign that the cancer is not rapidly spreading, and both doctors assured me today that delaying treatment by what will end up being about three weeks (one and a half if I were to choose the “surgery first” option) is not a concern.

I spent most of the week feeling like I was back in the voting booth without the information I needed to make a decision about which buttons to push. It will be a few years before I know for sure whether this was the right decision, but after yesterday’s surgical results, I think I am ready to pull the lever.

Negative, in a positive way

2006-11-09T14:56:00.000-05:00

A quick update to let you all know that I have just returned from my sentinel node biopsy. They removed two nodes, and both came back negative, which means that they are fairly confident the cancer has not spread beyond the original tumor. This will not be certain until the nodes are more thoroughly examined microscopically over the next week to ten days, but it is a very encouraging sign.

I was under "conscious sedation" and woke up after the surgery, but while we were still in the operating room waiting for results back from the lab. The anaesthesiologist was saying something like "does she have a beer belly?" and apparently that was enough to rouse me - I could not resist defending myself, and awoke to inform that I most certainly did not. The doctors laughed and assured me they were talking about someone's blind date.

They then went on to talk about weekend plans - I was even able to chime in with some recommendations. I was a bit troubled that I was unable to come up with a decent restaurant in the Theatre District, but that's difficult even when I possess all of my faculties. I did however advise that I would choose The Drowsy Chaperone or The Prime of Miss Jean Brodie over Mamma Mia, if I were buying the tickets.

Michael was there when they wheeled me out. Once they released me, we headed back to the Upper West in a cab, but since I am feeling good, we walked a few blocks home from the Apthorp Pharmacy to enjoy a gorgeously warm and sunny day in the city. I am off for a nap to sleep off the anesthesia, but since so many of you sent your good wishes yesterday and this morning, I wanted to let you know that it looks like they worked.

Schedule - Revised 12/12

2006-11-06T22:52:00.000-05:00

Michael and I are such sad corporate weasels that we have worked out a system to ensure our Blackberries are always updated with my doctors’ appointments. On my calendar, they are color-coded orange. I assign each one a star rating and send them to Michael as an Outlook invitation so he knows what is going on and where he needs to be. No stars is FYI, one is I may need a shoulder to cry on after the appointment, and two stars is be there with me holding my hand.

I am not going to get so detailed here (and will not flood all of your Blackberries with meeting invitations!) but now that I am more certain about what is happening when, I wanted to post the tentative schedule. This all can change, especially since the egg retrieval date could change and throw everything off. I will keep it updated, especially since lots of my NY-area friends and prospective visitors have generously offered to keep me company in the big pink recliners on Friday mornings. But this is a rough guide at least (Updated with latest estimates on 11/10):

Thursday, November 9: Sentinel Node Biopsy (ambulatory surgery)
Wednesday, November 22: Receive results of genetic test
Thanksgiving weekend in Des Moines
Sunday, December 3: (Estimated) Egg retrieval (ambulatory surgery)
Thursday, December 7: First chemotherapy session
Thursday, December 21: Chemo 2
Monday, December 25: Christmas with the family in NYC
Sunday, December 31: New Year’s Eve (should be feeling okay, since it will be the week before chemo)
Thursday, January 4: Chemo 3
Thursday, January 18: Chemo 4
Thursday, February 1: Chemo 5
Thursday, February 15: Chemo 6
Thursday, March 1: Chemo 7
Thursday, March 15: Chemo 8 (Finito!)
Mid April (about 4 weeks after last Chemo): Surgery

Many of you have asked what you can do, and what I would love is for you to keep those lovely cards, happy emails, supportive blog comments and silly photos coming, especially on Fridays through the cold winter months!

Babymaking

2006-11-04T23:55:00.000-05:00

New York is quiet at 7:00 on a Saturday morning. I notice a few people bundled in hats and scarves walking their dogs, a guy in a baseball hat and sweatpants out buying coffee, the cleanup crews in their John Doe Fund overalls as the taxi takes me from the west to the east side.

The buzz of activity at the Cornell Center for Reproductive Medicine and Infertility comes as a shock after the calm of the still-sleeping city streets. The door opens into a room full of chairs and sofas, the 50 or 60 seats mostly occupied by couples and women in their 30s and 40s, well-groomed despite the early hour. With a coffee machine in the corner, magazines in wall-mounted racks, and people reading the newspaper, it feels like a business class airline lounge with fewer suits and more women carrying a different kind of baggage.

There is a protocol. Arrive between 7 and 8:30 in the morning. Sign the pink sheet if it is your first visit. The green sheet if you are here for hormones. The white sheet is for the regulars going through IVF. You sign your name, you sit and wait. They call you in and draw your blood. You go back and wait some more.

But the rules don’t apply to me. “I was told to ask for Kathy,” I say quietly, trying not to draw attention to myself. I feel the eyes of several women nearby on me as I ask to jump the line. I wonder if they are asking “who the hell is she?” as I am processed swiftly – I barely have time to take off my coat before the nurse who works closely with the doctor who focuses on preserving fertility in cancer patients calls me back for my bloodwork. “Don’t envy me” flashes through my mind as I pick my way through the sea of crossed legs wearing saddle-colored driving loafers or tall boots with jeans tucked in.

The special treatment continues after my blood is drawn. My chart goes to the front of the queue. I do have to sit and wait for an room to open up before I am called back again. Eventually I am guided back to the warren of examination rooms and told to get undressed from the waist down. I am relieved that Katherine and Emily arranged for us to have a pedicure at Jinsoon last Monday before dinner at Snack in the Village. Once again, I have neglected to wear socks.

They don’t bother with hospital gowns – with all the women they process during the ninety minute period every morning, 365 days a year, they have probably studied the time required to change in and out of gowns and determined they could increase efficiency by 25% by eliminating sleeves and ties. Instead, you sit on the paper cover of the exam table, a sheet protecting your modesty.

Of which there is very little left. I counted – in the past few weeks, 14 strangers have had their hands on my breasts or have been eye-to-eye with my ovaries, and there are more to come. If this were high school, my name would be in three-foot-high letters on the bathroom wall.

When the doctor finally enters, the exam is swift. Feet in the stirrups, ultrasound wand, follicles observed and measured. Later that night, after my blood count and photos are reviewed, I get my marching orders. Take two of these pills, inject yourself with this much of that shot, inject yourself again the next morning to make sure it doesn’t kick off too soon. This will go on until sometime the middle of this week, when we are ready to harvest, fertilize and freeze.

As I walk back through the waiting room, the sea of faces makes me slightly relieved that I am in the special treatment category. For Michael and me, this is still just an insurance policy – only 30% of women under 40 who go through chemotherapy go into early menopause permanently. Although it may take as long as 18 months for my cycle to return to normal, there is still a fighting chance I will be able to get pregnant naturally. And if not, I will come back to these offices, surrounded by a new group of young and not-so-young women, all of us hoping that the wonders of science will step in where nature has faltered.

Normal-ish

2006-11-01T23:50:00.000-05:00

This is probably a better response than “fine” when people ask, “how are you doing?” Everything feels normal…ish. I have been back at work since last Monday, but have been out several mornings and afternoons for doctors’ appointments. I am on the phone and in meetings with candidates and clients as usual during the day, but in between I may hear from the genetic counselor or the fertility nurse about the progress of my test or dosage adjustments. My nighttime routine now includes injecting my thigh with follicle stimulating drugs in addition to the standard “brush teeth/wash face/remove contact lenses” sequence.

Michael took me for sushi at the glamorous restaurant Koi on Thursday, but anyone listening in would have found the romantic tableau somewhat marred by the discussion of chemotherapy options. He teased me over dinner at home last week that the reason our friend Jacob is staying at a hotel instead of with us on his visit to New York from London is because I have "the lurgy," but later that night he looked at me teary-eyed and confessed that he had been hopeful the biopsy results would come back negative, that the doctor would apologize that this had all been a terrible mistake.

My friends have rallied with invitations to gallery openings, scary movie nights, Tia Pol for tapas, and Halloween street parties, and the hugs we give each other upon arrival are longer, more comforting. Phone calls with my mother still include discussions of Thanksgiving plans, but we spend more time on the roll call of people we have heard from, the generous things they have done and said.

It struck me the other day that even though the worst of the chemotherapy and surgery will be over by springtime, my life has changed forever. I am no longer the girl who can go for her pap smear and call it a year. I can no longer tick the “No” box on all the doctors’ forms. I can’t blithely assume that an enlarged node under my arm is due to a cut from shaving. I will be monitored and studied and hovered over by my family, my doctors and myself for the rest of my life. With apologies to Diana Vreeland, “abnormal is the new normal.”

But given that it’s only been two and a half weeks, I am comforted by the fact that I am over the shock and adjusting to the changes and not hiding under the covers refusing to accept reality or take charge of my life. Although I may never again experience “normal,” I am already grateful for “normal-ish.”

Superman

2006-10-29T20:06:00.000-05:00

Standing self-consciously in the hallway outside the MRI room, I start to question my vow to wear fabulous shoes to my appointments. Although they do inject some glamour into the whole ordeal, my new leopard print pumps with the gold buckles and gold heels look slightly ridiculous with my blue knee-length hospital gown.

The technician opens the door. “Just leave the shoes over there,” he says, pointing to a space in front of a rolling cart laden with syringes and sterile pads. I do, and step gingerly over to the giant metal tube I am about to enter. Climbing up onto the table, I regret that I did not wear socks as I realize that for the fifteenth day in a row, I have not managed to get that pedicure I keep promising myself. As the phlebotomist fumbles while replacing the needle in my arm with the IV, I really start to question the shoe decision. Fortunately, they are a safe distance away from the spurting, which is quickly contained.

IV in place, the technician instructs me to lie on my stomach on the table, face turned to the side, arms out in front of me “like Superman.” Sure, if Superman’s breasts had to hang into two side-by-side plastic boxes. At least the blue gown does feel a bit like a cape, secure over my shoulders and draped across my back.

Slowly, the machine feeds me into the tube, feet first. My head is just inside the mouth – I can see out, but choose to keep my eyes shut. Safely on the other side of the closed door, the technician comes on over the loudspeaker to warn me to stay still and expect a loud noise.

When I talked to Michael about the MRI, he said the one he had for his deviated septum was no big deal: “It was actually sort of relaxing – I even got to have a little nap.” As mine begins, I want to laugh out loud, but fear this would violate the “stay still” instructions and I would have to do it over again.

A noise like the most horrendous post-modern electronic one-note symphony starts, speakers turned to 11, and doesn’t stop for 40 minutes. BEEPBEEPBEEPBEEPBEEPOKOKOKOKOKOKOKOKOKOKOKOKOKOK
DUMDEDUMDEDUMDEDUMDEDUMWONKAWONKAWONKAWONKA
I distract myself by trying to identify the different patterns in a sort of Twilight Zone “Name That Tune,” and am grateful for the earplugs the technician gave me.

When it’s over, my ears are ringing and I can already see the bruise from the IV. But the next day, the news is good. The only visible tumor is the one we already knew about. There are no signs that the cancer has spread anywhere else, including the lymph nodes. Although we will not be certain about this until after my sentinel nodes are removed and tested, it is a very positive sign.

And as I enter the dressing room to change out of my gown, I am glad about the shoes. Like Superman in the phone booth, returning to the comfort and predictability of being Clark Kent, I am ready to slip back into my “normal life” for a few hours. I leave the building and head off to meet Sarah to check out the (quite interesting) Ecotopia exhibit at the International Center of Photography. As I walk through midtown, I catch sight of my shoes in the reflective glass of an office building -- my small act of sartorial defiance lightens my mood, and reminds me of who I really am.

Birthday Gift

2006-10-26T22:42:00.000-04:00

My mother tells the story that when I was 15 and my brother Matt was 9, she came up the stairs to find him sitting on the floor in the hallway with our cat in his lap. He was using a hairbrush on her fur, to her purring delight.

"Matt! You shouldn't use your brush on the cat!" Mom admonished.

"It's not my hairbrush," he said, smiling serenely while continuing to stroke the cat. "It's Courtney's."

My brother and I had our share of knock-down drag-out fights as kids. As a toddler, he would take hold of giant fistfuls of my hair and pull as hard as he could. He teased me about the ill-advised perm I received at the age of 13. I retaliated by making fun of him when he had to shave his head for the swim team in high school, and took perverse delight in pointing out that it never grew back quite the same.

But now I am glad for his head- shaving expertise (although he later grew a ponytail in high school, he has been shaving it on and off since college). With all of you as my witnesses, I am giving Matt the gift I think he secretly always wanted as a kid for his birthday (albeit one day late):

When it comes time, about three weeks into my chemotherapy, Matt, you get an all-expenses paid trip to New York to shave my head. I'll even let you take pictures. Happy birthday to my big-hearted, bald-headed baby brother.

Eggplant

2006-10-24T23:50:00.000-04:00

Last Wednesday, I had a core needle biopsy and a bilateral ultrasound – the full breast on both sides and not just the lump this time. The radiologist’s assistant was the same woman who examined me a couple weeks ago - I recognized her by her hat. I have been paying a lot of attention to hats this week. The hair that sticks out beneath her floppy hat (am I imaging the flower?) looks like her own – maybe she wears a hat to show solidarity with the women she is imaging? Perhaps she doesn’t have time to blowdry? Surely it’s not just a kooky Punky Brewster affectation? Is this what people will think of me when they see me out to dinner in a hat a few months from now? At least it will be winter when I go through chemo – maybe I will be cut some slack.

She explains the procedure to me: “First we will take an ultrasound of both breasts, then the radiologist will come in to take some tissue samples.” It is my third ultrasound in three weeks – other than being a little ticklish when she runs the device (which looks like the ID scanner at my gym) over the outer sides of my breasts, it is no big deal. She even turns the screen toward me so I can see – always the student, and it beats looking at the ceiling.

Someone once told me that radiology as a specialty attracts the misanthropes - all slides, no sympathy (note to my friends in med school: I don’t mean you!) At first, this radiologist seemed to fit the mold. Lots of questions and instructions for the assistant: “Did you check the nodes? When you work with me, always check the nodes. Is the clip ready? No, I need the other kind. Where are my steristrips?”

She runs the scanner all around my left armpit, and the black and white images that appear on the screen seem to relax her. Maybe it helps that I am paying attention and looking at the screen as well: “It’s good if it looks like a horseshoe. See the white bit in the middle? That is what a normal lymph node should look like.” The news seems good. “I can only say that morphologically, things look fine. The nodes do still need to be tested microscopically.” Still, this sounds better than “You are a walking tumorous timebomb,” so I will take what I can get.

Next, she preps me for the biopsy: “You will hear a loud noise like a staple gun. But we use a numbing agent, so you won’t feel pain, just pressure.” Kindly, she suggests I may want to close my eyes while she makes a small incision for the needle. I watch on the screen as the probe finds its way to the tumor. “Loud noise,” warns the assistant. POP. I manage not to jump – the warning helps.

This happens three more times. The only disconcerting part is that two of the four times, I feel a slight splash of liquid on my chest and face when the tissue sampling occurs. The second time, I mention it in response to their standard “How you doin’?” query: “Okay, but…umm…I just felt something squirting on me. Maybe that’s normal?” Again, trying to be blasé while lying flat on my back on a table. I may need to get over that. They reassure me they see nothing. Later, as I wipe the minute bloodspots off my face in the bathroom mirror, I rationalize that perhaps they just thought I had freckles.

At the surgeon’s suggestion, the radiologist also inserts a titanium clip into the center of the lump, since sometimes tumors respond to neo-adjuvant chemotherapy by disappearing entirely. Unfortunately, this does not mean that surgery can be avoided. They still need to remove some tissue for tests and to ensure the areas around the tumor are clear. The clip ensures that they can pinpoint the tumor’s location in the event that it disappears.

I reveal that I have taken Advil in the past 7 days (after all, I was out dancing in a bar on Friday. And I thought I was in the clear!) “You can expect to see some bruising,” the radiologist warns. “That left breast could look like an eggplant in the next day or two.”

“Well, that should make for a great anniversary weekend,” I say weakly. “I guess I can just wear a nice bra.”

Suddenly, the doctor remembers she is human. “How long have you been married?”

And I can’t shut up. “Six years, but we’ve known each other for thirteen. Our anniversary is on Saturday October 21 – the same day my grandparents got married. We met in London – he’s English. I studied over there. We are going away for the weekend – I know that we are driving, so it must be somewhere cold, so at least I won’t need to wear a bikini or anything like that. Michael planned it as a surprise for me, before all this happened…”

Her hand is on my shoulder as the assistant finishes taping up the gauze. “Sweetie, you are going to be fine. You are young and strong. It’s not going to be easy, but the hard part will be over soon. Relax and enjoy your weekend.” I look into her eyes as she gives my shoulder a squeeze, and I believe her.

We did have a fantastic weekend – Michael planned a lovely getaway to Wheatleigh in Lenox, MA. We hiked, meandered around the little New England towns, relaxed in the gorgeous hotel, admired the changing leaves, and celebrated our sixth anniversary over a delicious truffle-infused dinner with our friends, Ursula and Enore.

And luckily, the doctor was wrong about the effect of the biopsy. It’s a slightly lurid yellow-green bruise, roughly the same diameter as the tumor. More like a hickey than an eggplant. Although we are far too grown up for such things, it does somehow seem appropriate as a visible reminder of a fabulous anniversary weekend.

Initial Diagnosis and Treatment Plan

2006-10-23T03:06:00.000-04:00

The facts and more detail than you would probably ever want to know

Michael and I went to see Dr. Rosenbaum Smith the same afternoon she gave me the diagnosis (thanks to Michael’s cooler head prevailing and insisting that I not stay and try to work, but rather go figure out what we had to do next). I do not yet know which “stage” I am in – until a few more tests are performed, it is difficult to tell. I have had several of the tests already, and should know more sometime around October 25. These test results will influence my treatment.

Already, I do know that my tumor is 2.7cm long. At that size, and at my age (33), aggressive chemotherapy is strongly advised. And because of the size and location of the tumor, my doctor has recommended “neo-adjuvant” chemotherapy, which means chemotherapy before rather than after surgery. The benefit is that this may shrink the lump to a size that could be more easily removed in a lumpectomy rather than a mastectomy. Because of its current size and location, removing the tumor as is would disfigure the breast.

I spent the week on a whirlwind tour of doctors’ offices. After my initial meeting with Dr. Rosenbaum Smith (the breast surgeon) on Monday afternoon, I went for a mammogram (my first) on Tuesday. This test looks for other signs of tumors; fortunately, none were found. However, this does not mean they are not there, so on Wednesday I went for a full ultrasound of both breasts (the earlier ultrasound had been only of the tumor). This also looked at my lymph nodes, which, at least in the initial imaging, look normal. The third imaging test used in conjunction with the mammogram and ultrasound is an MRI, which I will have on Wednesday October 25. All of these taken together will give the doctors a clearer picture of the tumor and the health of both my breasts.

At the same time I had the ultrasound, I also had a core needle biopsy. This removes pieces of the tumor tissue for testing – I will receive the results later this week. This test looks for the tumor’s hormone receptivity and the presence of a protein called HER2/neu, both of which will influence my overall treatment.

Since I am already fairly certain I want to pursue the chemotherapy before the surgery, I opted to have a titanium clip inserted into the tumor at the same time as the radiologist conducted the biopsy. This is because the lump may shrink dramatically during chemotherapy – in some cases, it disappears altogether. But even if this happens, the surrounding tissue must still be removed and tested, so the clip allows the surgeon to locate the original center of the tumor no matter what develops during other treatment.

I will also have to have a lymph node test to see if the cancer has spread beyond the tumor. From the imaging tests so far, it looks like the news will be good - the cancer appears to be confined to the tumor. But only removal and examination under a microscope will be able to determine this for sure. So in the next week or two, my breast surgeon will conduct a "sentinel lymph node" test, which allows her to remove and examine only the three or four lymph nodes that have the primary duty of filtering the fluid that drains from the breast. If any nodes show signs of cancer, it would start in these. This is an in-office surgery under local anaesthetic and sounds like a fairly minor (albeit important) operation.

Even the breast surgery itself is not overly worrying – as my doctor assured me in my first meeting, and the plastic surgeon reassured me when I met with him on Friday, even if for some reason I have to have a double mastectomy, they can perform reconstruction then and there, and I will wake up with the old breasts gone and new (perkier!) breasts in their place. But the chemotherapy is frightening. Given the course of medicine they recommend in my case, I will almost certainly lose my hair. I may lose eyebrows and eyelashes too, along with body hair. Although they actively work to prevent the nausea that often accompanies chemo with other drugs, I will undoubtedly be more fatigued, a situation many people compare to having mild flu…for a couple of months. Most alarmingly, chemo can have a negative effect on fertility.

Understandably, I was a little apprehensive when Michael and I met the oncologist on Wednesday afternoon to discuss the chemotherapy. But he was very reassuring. I will go in for treatment once every two weeks over probably 16 weeks (possibly 20, depending on the full diagnosis). The nausea sounds fairly straightforward to control. Most of his working patients come in on Friday mornings, so time off work is limited to about 8 days over the course of the treatment. Even the fertility issue can be helped by a drug given in conjunction with the chemo that stimulates early menopause. Although trials are limited, they suggest that premenopausal women who take this drug before chemo “protect” their ovaries and egg supply during the brief period when the treatment is administered, making it more likely that they will return to menstruation and ovulation post-treatment.

As an insurance plan, we are also pursuing in-vitro fertilization with Dr. Oktay at the Cornell Weill center in New York, who specializes in fertility preservation for young women with cancer. Normal estrogen-based ovarian stimulation (as well as normal pregnancy) can be dangerous for cancer patients, since estrogen can trigger tumor growth. Instead, in about 8-10 days, depending on my cycle, I will start taking Femara (Letrozole), a non-hormonal cancer drug that also has the effect of stimulating the ovaries to produce more eggs. The doctors will harvest the eggs and fertilize them with my husband’s sperm, then freeze the embryos so we can implant them later if needed.

Statistics around infertility and cancer are cloudy. My understanding is that I do have roughly a 30% chance of never having another period after chemotherapy, but that does not mean I have a 70% chance of getting pregnant naturally. Even if everything does return to normal after the chemotherapy, pregnancy may be delayed because of ongoing treatments. Thus pre-chemo IVF seems like a wise step, since we know we want to be parents as soon as we can after getting through all of this.

I have also met with a genetic counselor and performed a test for two genetic abnormalities in genes known as BRCA1 and BRCA2. Since I am unusually young to be diagnosed with breast cancer (.5% risk for women under 40, vs. 4% for women ages 40-59, and 7% for women ages 60-79), the presence of abnormalities in “the breast cancer genes” may explain why I now have the disease. However, these genes are only present in about 10% of breast cancer patients. Women with these abnormalities have as much as an 85% lifetime risk of developing breast cancer, and if I have them, the chance of developing cancer in my other breast is greatly increased. There is also an associated heightened risk for ovarian cancer. If I do test positive for either of these genes, I will need to consider prophylactic surgery (i.e., a double mastectomy).

So when does this all start? This week I will learn more about my test results, and will also speak with a few more doctors to get other opinions on the best course of action. The IVF treatment is time sensitive and is the first priority – it looks like that will begin this coming weekend or early next week, which means that chemo would begin in mid-November, ending in late February, with surgery in early March.

I will do my best to keep this site current with diagnosis, treatment and progress, and apologize in advance if I end up “oversharing,” as I am sure I have already done in the eyes of many, or at least one. Sorry Mom…

Why am I writing this? Because...

2006-10-23T02:57:00.000-04:00

There are so many people I love who live in so many far-flung places, and I want to make sure they can always hear from me, even if I don’t always have the time or energy to talk to them directly.
In the wee hours of the morning the day after my diagnosis, reading stories on the Internet of people in the same situation, particularly other young women, provided me with knowledge and comfort.
When I started making a list of everyone I wanted to get in touch with to let them know what was happening, it grew to over 100 names without me having to stop to think twice.
Although I am not yet tired of explaining “how I found out and what is next” to my friends, I know I might be at some point.
When I see you on the street this spring, I don’t want to have to explain why I decided to cut my hair. And I don’t want you to have to feel bad you asked when I tell you the reason.
When you see me out to dinner in New York this winter in a short red or a long black wig (both will be pulled from the costume box I have had since performing in Follies at business school, so watch for it!) I may not want to have to explain why.
When we next see each other in person, I would rather cut straight to the hug than have the awkward conversation.
This is one of those “live life without regrets” wake-up calls you never want to receive, but when you do it inspires you. And one of my regrets has been that I no longer make time to write, so now I will. Hopefully not just about cancer, but I imagine that for the near term that may be what fills many of the posts. But I promise to try to write about what makes me happy too.
I have fallen out of touch with people who have been an important part of my life, and I want them back in it.
I read a statistic (that I am too lazy to look up now) about how women who write about their breast cancer have a better time dealing with it. And I believe it.
There is a quote from an old Calvin & Hobbes cartoon (how erudite! wouldn’t Professor Finkelpearl in the English department be proud!) that I remember, something like “Nothing helps a bad mood like spreading it around.” In a much less negative way, that’s what I am doing.
All my instincts tell me to talk about this with people. To make myself feel better, to raise awareness, to perhaps find out some piece of information that will help me or someone else.
Work will help keep me busy, but sometimes I may need to do something to take my mind off my situation that is not completely divorced from it. This can be that outlet.
I want to give people who might feel awkward about calling me, because it’s been a long time since we have talked or because we are not “that close” or just because you think I might be too busy or tired to talk (which I may be) a way to get in touch with me or to just be able to know how things are going.
There are a lot of thoughts whirling in my head, especially late at night and early in the morning. Writing them down may help me calm down. And I flatter myself that you may find some of them informative, touching or (hopefully) amusing.
Sharing my diagnosis over the last few days has led to my friends and family offering wisdom, compassion, strength and love, all of which I will need in giant doses in the coming months.

The story so far: How I found out

2006-10-23T02:56:00.000-04:00

On September 17, 2006, I felt a lump on my left breast while I was taking a shower. It was big enough to feel pretty easily (I was not doing a breast self exam) and a little tender. I called my gynecologist to make an appointment, and saw her that Thursday, September 21. She was not overly concerned, but advised that I get a breast ultrasound. She said that if it was liquid-filled, it could be drained then and there. Otherwise, they might need to take a biopsy.

I had my ultrasound on Wednesday, September 27. The radiologist said that since it was palpable (to which my inner response was “yeah, no kidding, I felt it ten days ago”), he advised a fine needle biopsy (done with a little needle with no ultrasound guidance required) rather than a core biopsy (bigger needle, requires local numbing agent, ultrasound guided). I called my gynecologist and asked if I should schedule the biopsy at the same facility, but she advised that I meet with a woman she recommended who is the head of the Breast Center at St Luke’s-Roosevelt, just in case.

I could not get an appointment for the week of October 2 and traveled to Los Angeles with Michael for the weekend of October 7 to meet his brother Stuart and Stuart’s girlfriend Anna, and then went straight from there to Las Vegas for work for a couple of days. So the first appointment I could get was Friday October 13. Fortunately (unfortunately?), I am not superstitious.

Friday, I had meetings in the morning and afternoon, and left work around 3 to go meet Dr. Rosenbaum Smith at St Luke’s-Roosevelt. After an exam, she took a fine needle biopsy, and also did an ultrasound. At the time, she assured me the lump looked like a normal fibroadenoma, nothing to be concerned about, and probably would not need to be removed unless it grew beyond its current 2.7 cm size. She said she would call with the biopsy results on Monday, and we set up a follow-up appointment to check on its size in December.

Michael and I spent a lovely weekend feeling very relaxed, reassuring my parents and the few close friends I had told about the lump that it looked like I was going to be fine. We met friends out for drinks on Friday to celebrate my friend Sorrel’s visit to New York from Cleveland and her upcoming move back to London. We took endless goofy photos and danced on the banquettes at the bar. Saturday night we cooked for our friends Greg and Sophia. Sunday was spent eating blueberry pancakes and reading The New York Times with Sorrel and another friend, Karin, in New York for a brief visit before heading back to her UN posting in Sudan.

I went to work Monday feeling renewed and ready to take on the challenges of a couple of different projects now that the scare was behind me. Until I received the phone call around 2:30 that afternoon from my doctor: “I’m calling to tell you that your test came back positive for cancer.”