The Last Word

I had the last word today during a visit with 20-some University of Florida medical school applicants. They were gathered on campus to complete a day-long interview process, structured to give them a glimpse of a day in the life of a med student, and on the agenda was me — a real, live patient.

I told my 8-year-long story from beginning to end in about 20 minutes (whew!) in a freezing-cold room in the basement of Shands Hospital (I was actually shivering at times), and my favorite oncologist, who serves as the assistant dean for the College of Medicine Admissions, said it went very well. I think it did, too.

It was my job to deliver the last word to the folks sitting with me in a circle formation, the individuals who will likely one day be charged with the responsibility of delivering health care to sick people. “Practice medicine with sensitivity,” I told them. “Even if you must fake it,” I said, “show some compassion because it can make a huge difference.”

Then, I read from a hand-written note that was mailed to me by the surgeon who performed the needle biopsy on my suspicious left-breast mass. He’s the one who called me at home the day before Thanksgiving 2004 to inform me that “unfortunately, cancer cells were found.” His note read:

Dear Jacki,

Just a brief note to let you know that I regret being the messenger of bad news, but know that you will come through this difficult time healthy & strong. I & my staff wish for you a smooth & speedy recovery.

Dr. Mac

That note mattered. It made me feel less like a statistic and more like a cared-for individual. That note still matters; that’s why I keep it at close reach, so I can forever remember that there are doctors who really do care.


That was my last word.

I’m Perfect — At Not Being Perfect

My mom recalls with such clarity my elementary school teachers sharing with her how one itty-bitty mistake in my universe sent me into an I-must-start-over-again tailspin. Imperfect handwriting was not OK, coloring outside the lines was not good enough, and if my ponytails and braids were lopsided, I was inconsolable. Perfection is what I sought. Always.

Danny is nothing like me—when he showed me how he accidentally smeared the marker drawing on the cover of his fourth-grade writer’s journal, he said, “I’m just pretending that it’s water dripping down the front.” What a healthy response to a minor error. What did I see when I spotted the goof, which was topped with bubbled-up sticky laminating wrap? I saw imperfection. I wanted to re-do that project. And fast. But I didn’t. It wasn’t my problem to fix. It wasn’t a problem at all, in fact.

Perfectionism is not all bad. I suspect it’s the character trait that allows me to stick with exercise routines, clean diets, organized schedules, and healthy routines. It’s not all good, either, though, and honestly, I know deep down that it’s mostly detrimental to my well-being. I’ve long been aware of this, and through cancer-related therapy and anti-depressant treatment, I achieved some success curbing my pursuit of all-the-time greatness.

Then I became an editor.

What was I thinking?

Writer and editor Laura Hale Brockway says, “As an editor, the kick in the head is that no matter how hard I try—proofreading backward and forward, fact checking, checking sources, etc.—simple, preventable errors still occur.”

I know. I know. And it’s killing me.

I chose a career I love—one that kinda, sorta, pretty much requires perfection. Clients hire me to fix what they’ve missed. If I don’t catch their flubs, then I’m not really doing my job. Or so goes the story in my head.

What I must learn is that I am doing my job. And I’m good at it. I’ve been told by those who pay me to proofread that I’ve exceeded their expectations, I’ve helped them score good grades, I’ve taught them so much about the written word. Still, that missing comma or extra quotation mark, discovered long after I’ve delivered a project back to its owner, haunts me.

Perfect is an impossible goal. I am human, and humans make mistakes; therefore, I am set up to fail with every task I tackle. Sure, there may be times when I achieve 100%, but can I keep up that gig for all of time? Not a chance.

Brockway cites Joseph T. Hallinan, author of the book “Why We Make Mistakes,” who reports that humans have design flaws that set us up for mistakes. We are efficient, but also error prone. We are just wired that way, and the sooner I get over my hang-ups about getting everything right all the time, the smoother I will sail through life. Am I capable of such an undertaking? I’m really not sure.

According to the experts at the University Of Illinois At Urbana-Champaign’s Counseling Center, I should experiment with my standards for success. “Choose any activity and instead of aiming for 100 percent, try for 90 percent, 80 percent, or even 60 percent success,” they say. “This will help you to realize that the world does not end when you are not perfect.”

Yea, I realize the world will not come to a screeching halt just because I stumble when I intend to soar. My concern is that maybe editing is not what I should be doing in this world. The pressure to perform at such a high standard is just so consuming.

I don’t intend to make any big career moves at this very moment. I’m just soul searching, trying to find peace in my body so that I can enjoy more happy and less haunt.

And you do know that I’ve proofed this story about a zillion times in hopes of catching all of my blunders, right? Did I leave some behind? I’m sure I did. But I’m moving on. Really, I am.

I Wrote a Letter

That video “Parenthood” character Kristina made for her kids — I did that. Well, I wrote a letter; it was essentially a goodbye message written when I was sure I would not survive cancer. I wrote to John, too. My boys never received their letters. Thank goodness!

Today, It Happened (Well, 8 Years Ago Today)

It wouldn’t be a proper day before Thanksgiving without mentioning that 8 years ago at almost this exact time, I was diagnosed with breast cancer. I remember where I was standing when the phone call came in (in the kitchen, leaning on the counter), what I was wearing (a white, long-sleeve shirt and shorts), what I was doing prior to the dreaded announcement (managing the chaos of my little boys and a baby girl whose mom was busy at work), whom I called immediately after the devastation (John, who was at work, then my mom, who came rushing to my house), and the numbness turned terror that consumed my entire holiday weekend. Man, that was horrible. And while I can’t say that the days that followed got a whole lot better — cancer delivers some pretty crappy moments — life did turn around, and while I was not very thankful on that pre-Turkey-day 2004, I am way grateful on this 2012 Wednesday for the mere fact that I am alive and that these baby boys (ages 3 and 18 months in the photo) are now 11 and 9.

Colonoscopy — Normal

Yesterday, I had my first colonoscopy. The test was ordered to rule out malignancy as a cause of my recent tummy troubles. My GI doc was pretty sure cancer was not a culprit, but she wanted to cover all the bases given my history. And now I know — no colon cancer.

Something else I know — the test itself is a breeze; the prep, which includes near starvation for more than a day and the guzzling of a thick, laxative-type drink that can induce vomiting (in my case, anyway), is not so fun.

The good news, besides the no-cancer result, is that I won’t have another colonoscopy for 10 years (whew!). The bad news is that I still don’t know what’s wrong with my insides. My self-diagnosis, in the absence of answers from all my tests is either (a) something food-related, (b) something chemo-drug-related, (c) something scar-tissue-related due to past abdominal surgery, or (d) something pelvic-floor-related due to problems that have already been diagnosed.

Nothing like narrowing down the problem, right?

Raw October — Day 30 (‘Parenthood’ Poll)

Raw October: raising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

If you’ve been tuning into “Parenthood” lately, you know that a breast cancer storyline is weaving its way through the Braverman family dynamics. The TV journey stems from personal experience — show creator Jason Katims’ wife is a breast cancer survivor — and so, it would seem, the topic should be portrayed pretty realistically. What do you think — is the “Parenthood” storyline rockin’, floppin’, or is it a so-so representation of a real-life experience. Cast your vote in the poll below, then share your thoughts in the comments.

Raw October — Day 29 (This Never Gets Old) (VIDEO)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

the power of songThis never gets old, and it never ceases to make me cry. This man sang to me during one of my chemo treatments — he sang to every patient in the infusion room on this January 2005 day.

You know how I mentioned in yesterday’s post how my mom and Jordan sat with me during each session? This is one of those times.

Click on the image to start the video. See if it makes you cry.

Raw October — Day 28 (My Survivor Reminder)

Raw October: raising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

My niece Jordan is my survivor reminder — she was born in October 2004; I was diagnosed with breast cancer in November 2004. Every time she turns another year older, I tack on another year of survival. She just turned 8 — that means I am about to celebrate 8.

Jordan’s age is not the only cancer connection she and I share. We also have memories (well, I do; she doesn’t) of infusion-room bonding. Jordan was 6 weeks old when I started chemo, and she sat with my mom and me every time toxic drugs dripped through my veins. My recollections of sickness and despair are tempered by the vision of that sweet, new baby in my mom’s arms — the baby who now has beautiful long hair; perfect freckles; a mean volleyball serve; and a huge hug to share whenever she sees me.

Thanks for being my survivor reminder, Jordan. I love you!

Raw October — Day 25 (Cancer Talk Coming Up)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

On January 4, 2013, I will talk about cancer — not that I don’t spout out about it all the time as it is, but I will officially discuss the disease that is now 8 years behind me when I join my favorite oncologist at Shands Hospital for an interview session with prospective med students. My doc will highlight how the school/hospital operates from a patient-centered perspective, I will share my patient story, and the students will get to ask me questions. In all, I will give about 2 hours of my time. I know I will enjoy every minute of it.

Raw October — Day 24 (Recurrence Will Not Happen)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

What a difference a year can make. Last November, I nearly lost my mind after a bogus MRI revealed a possible malignancy. Yesterday, I learned that I pretty much have a zero chance of breast cancer recurrence.

My doctor says she knows this because of my type of disease — my tumor was ER/PR negative and HER2 positive, which happens to be aggressive, but only for the first 5 years. After 5 years (I’m at almost 8 years), there’s pretty much no risk of recurrence either locally or to distant organs. That’s not to say another cancer won’t ever pop up, but the one I had should not ever, ever, ever return. I will not, therefore, be a woman who says 20 years down the road that her cancer came back.

I should find great peace and comfort in this news, said my doctor. I do, I assured her. I really, really, really do, and while I kept my composure in her office as this gift of information swirled in my brain, tears fill eyes as I adjust to my newfound relief.

More good news — no more annual MRI. It’s not the standard of care for someone with my risk, and that makes it just not necessary. No more annual blood draw, either. It’s also not the standard of care, and the results tell my doctor nothing about my cancer-related health. My future line-up, then, is one annual follow-up with this doctor (she’s my medical oncologist), one annual follow-up with my radiation oncologist, and one annual mammogram.

Sounds good to me.

All of it.

Raw October — Day 20 (Radiation Round-Up)

Raw October: raising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

Another year, another radiation follow-up appointment. Yesterday’s check-up went well, and my doctor sent me home with a clean bill of health.
She and I didn’t even discuss breast health too much, actually — our discussion was mostly focused on my tummy troubles, which still have not been fully diagnosed (maybe my November 8 colonoscopy will deliver some answers). Our chat was a good one, and I walked away once again thinking that perhaps chemo is to blame for my aches, pains, bloating, tightness, and pressure. My GI specialist suggested this months back, a colorectal doc disagreed, and now, my radiation oncologist says I should not underestimate the power of chemo to do damage. No underestimating here; I truly believe anything strong enough to kill cancer while simultaneously stealing my hair and wiping out my white blood cell count can surely muck up my insides, even 8 years post-cancer. The question is: Is chemo the definite culprit, or is it something else? I’m not sure I’ll ever know. Something tells me I may need to be OK with that.

Raw October — Day 18 (It Could Be Worse)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

I wrote the following post in August 2008. At the time, I had survived cancer for a little longer than 3 years.

Joey’s new mantra: It could be worse. He uses it to excuse his questionable behavior — like when he was playing at the dinner table recently, waving his arms all around like we tell him not to do, and he knocked over his cup of milk. “It could be worse,” he announced after locking eyes with my frustrated gaze. Not exactly my preferred response — “I’m sorry, mom, I know I shouldn’t have been horsing around, and it won’t happen again” would have been my pick—but hey, the kid is 7. How much can I expect, really? Besides, he’s right. It could be worse.

Sometimes Joey is wise beyond his years. The kid always gives me something to think about. Once Joey told his dad about the grandfather he never knew (he died before Joey was even born): “Don’t worry that your dad can’t see you anymore. He’s in the sky now and the clouds are his eyes.” He told me 3 years ago that cancer is “medicine and love.” Pretty good way to sum it up — I got lots of medicine and lots of love. I’m not sure in hindsight that I’d describe it much differently.

It could be worse. I keep thinking about this and realizing Joey is right on with this perspective.

Back to cancer.

I found a lump — early. It could have been worse. It could have spread. It could have been larger.

I had a lumpectomy. It could have been worse. I could have had a mastectomy.

I had chemo, and it made me sick. It could have been worse. My cancer could have been so bad chemo wouldn’t have worked.

I was hospitalized twice during treatment. It could have been worse. I could have been hospitalized three, four, five times.

I had radiation, and my skin burned slightly. It could have been worse. My skin could have been left sizzled and scorched. I could have been in pain. I wasn’t.

I had more drug therapy. It could have been worse. I could have been a non-candidate for the treatment (Herceptin), which could be the very thing saving my life.

I went to counseling for more than 1 year and took an anti-depressant, too. It could have been worse. I could have denied these forms of help and could be battling depression and anxiety at this very moment. I’m not. I’m happy.

I could go on and on, but I think you get my drift. I hope you get how this applies to your life, too. Try this next time you’re down in the dumps — tell yourself: It could be worse. See if it makes a difference. It does for me. And Joey, too.

Raw October — Day 16 (Tips From Survivors)

Raw October: raising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

No one gives better breast cancer advice than survivors. Keep reading, and you’ll see what I mean.

Katie: Get “wigged” out — find a wig that matches your personality and have fun with it! There’s no other time in our lives when we can have a blonde pixie do one day and long flowing brown hair the next.

Kimberlee: Always take someone who is emotionally strong with you to your first few appointments. You will be inundated with information and will most likely be too overwhelmed to remember everything. Taking someone with you who can jot down pertinent information, while remaining a shoulder for you to lean on, will be extremely helpful.

Me: If you need chemo, get a port — this prevents multiple needle sticks in arms and hands — and purchase a numbing cream for the skin on top of the port, unless, of course, you have a high tolerance for pain, which I do not.

Sue: Ha! I got the numbing cream too! My advice . . . if you’re not confident in your doctor or have hesitation, switch doctors. I stayed with my first onc for 4 months. After chemo and some iffy blood work, she believed the cancer came back. We got a second opinion and saw an onc who ordered the biopsy needed. It came back negative. My first onc was ready to have me do six more months of chemo. Guess which Dr. I still see, 8 years later?

Tracy: Let people help you. Give them the direction and approval to do so. Friends and family need it as do you.

Lisa: Wish I’d known about numbing cream — those port insertions hurt, and the regular nurse didn’t understand why I didn’t want to draw my counts from the port but use my arm instead! I usually drink lots of water but couldn’t because of the taste in my mouth — crystal light lemonade cut through the bad taste and helped me!

Amy: I’ve learned that everyone is different even if you have nearly identical diagnoses, so try not to compare treatment plans and try not to worry if something that worked for someone else doesn’t work for you. And drink a ton of water on the day of chemo before it starts to taste nasty!

Tina: Even though your world has just been turned upside down, nothing seems to make sense, and you feel like your world has just become filled with nothing but Dr. appts. with many different doctors, hospitals, surgeries, procedures, chemo, radiation, etc., etc. and life seems like it will never be the same, it does get better. I know it took me about 2-3 years after I was diagnosed to just feel like ME again. I was terrified I would never feel like me again, but I do. I have a new appreciation for the little things in life, and I don’t take anything for granted anymore. It made me a stronger person.

Raw October — Day 15 (Not for the Squeamish)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

There is nothing pretty about breast cancer, and CancerVacation blogger Julia Grim captures the disease in its raw form (click on this link, then Photos & Reports, then Photos). Her photos are not for the squeamish; they are for anyone who wants a peek at the realities — surgery, chemo, hair loss, weight gain — that cannot be tied up all pretty with a pink ribbon.

Here are the photos:

Raw October — Day 12 (Flashback to 2005)

Raw Octoberraising breast cancer awareness — one fact, figure, feeling, and photograph at a time.

I wrote the following post in October 2005. At the time, I was in the midst of breast cancer treatment.

On Saturday, my mom and I attended a half-day seminar on the topic of breast cancer. It was sponsored by Shands Hospital, and many of the speakers were my own medical people — a surgeon who took my blood prior to my lumpectomy for research purposes, an oncologist who treated me both times I was hospitalized during my first chemo regimen, my physical therapist, and the woman who coordinated my initial care when I was first diagnosed. I already knew a lot about what they talked about, but I learned that there is a lot on the horizon for breast cancer detection and treatment — like new radiation techniques that can limit the treatment time from seven weeks to just one week and methods for detecting the smallest trace of breast cancer before it begins to grow. My physical therapist is studying cancer-related fatigue (I think I have it!) and how to manage it. It amazes me that these medical professionals are spending their work days seeking cures and miracles. What a huge responsibility. What a noble cause. I am lucky to be in their care.

But after hearing about all the science and hope and possibilities, I am reminded mostly of one loud and clear message I heard on this day. The oncologist spoke about the components of breast cancer tumors — there are about six criteria that are taken into consideration when studying a tumor, such as age, stage, grade, lymph node status, hormone receptivity, and HER-2 status. My criteria are: age 34 at diagnosis, stage 1 (out of 4), grade 2 (out of 3), lymph node negative, ER/PR negative, and HER-2 positive. Some of this is good; some not so good — this balance has left me feeling OK about my personal situation. But the oncologist said, “even a good tumor in a young women is a bad tumor.”

I guess I knew this. My age is what qualified me for aggressive treatment — because young women have the most aggressive tumors. But to hear it spoken in a formal teaching setting and in somewhat of a grim tone, is troubling. But I’m OK. I’m not wounded by this bit of information, and I’m not anxious like I once would be. I still feel like I am winning my battle, so I can take this in stride. And if cancer comes back to me one day, I’ll just keep fighting — like this young woman who is quoted in the book “Hope Lives: The After Breast Cancer Treatment Survival Handbook“:

Why do I keep going through treatment when there is no permanent cure? I ask myself this every time. There are no options other than death, which to me is no option. It’s not that I fear death. I really don’t anymore. I just love life too much to quit. It’s a race against time. Treatment buys me time until they come up with new drugs or new ways to treat this illness. I’m not quitting.

—Robin, age 38, diagnosed 1996, 1998, 1999