Kenalog Injection

On Friday, I went to see Dr. T to get a series of Kenalog injections for my 'hypertrophic scarring.' I've been doing all sorts of stuff to try to reduce the scar (massage, cocoa butter + vitamin E, silicone strips), but apparently the whole Asian skin thing (a thick dermis, according to Dr. T) is going to be a perpetual curse to my scar. I figured the injections were worth a shot, although I'm starting to realize that a recurring theme in my personal medical saga is that by the time Friday afternoon rolls around, I'm never in the mood to drive 60 miles to see Dr. T. This past Friday was no exception, as I was having the most bizarre day in which every little thing that could go wrong did go wrong, and I was anxious because I needed to get home and pack because we were heading out of town that afternoon to go skiing. I was supposed to be packed already, but... I wasn't.

As Dr. T was preparing the syringes, I told him I had been dreading the appointment all day, to which he responded, 'I'm not going to sugar coat it; this is going to hurt.' When I lay down on the table and exposed myself, Dr. T reached over casually and grabbed my foob to cop a feel, commenting on how it looked good, and how nicely it had softened up. It practically feels like a real breast. The level of familiarity we now have with each other is amusing and alarming all at once - I think nothing of a strange man reaching out and grabbing my boob, yet the fact that this happens so naturally is rather creepy, if I really think about it.

Then he started the injections. They were not fun, but at least I was prepared for the fact that they would suck. It ranked right up there with getting a cortisone injection. Individually, each injection wasn't as bad as a cortisone injection, but because the scar extends from hip to hip, Dr. T did multiple injections all along the length of the scar as well as in my off-center belly button (which I finally complained about to him, haha), and the overall unpleasantness was up there. And there is something about needles in the belly that's just gross, grosser than needles in other parts of the body. I lost track of how many injections he actually did, but it was probably around 10. Some hurt more than others, because I have varying levels of numbness throughout my abdomen, ranging from no feeling to full feeling. Supposedly the feeling will come back eventually, but when I asked Dr. T how long it would take, he said 'about six months.' And... after a quick calculation, I realized it HAS been six months, so... whatever.

During one series of injections toward my side, where I have full feeling, I almost started crying, although that might have been as much due to weeks of stress and fatigue as actual pain. At one point, Dr. T instructed me, 'I need you to breathe. I'm afraid you're going to pass out.' LOL. He worked his way across my scar, and eventually got to the side that's actually not that bad. As he remarked that that part of the scar wasn't bad, I quickly said, 'Yeah, it's fine,' and pulled the gown back over me. 'I think I've had enough.'

On a side note, as I lifted up the gown so Dr. T could do the injection, he commented, 'I see you've lost some weight.' I was somewhat taken aback, because, hello, it is rude to comment on a lady's weight like that! But then I realized he was using his concerned doctor voice on me, not his 'I'm making casual conversation with you' voice. Did I detect a hint of criticism in his tone? 'I have?' I asked. I'm not usually aware of my weight, except insofar as it affects how my clothes fit, and I haven't noticed any drastic changes as of late. I shrugged the comment off, and told Dr. T I had been really busy, and really stressed. That seemed like enough of an explanation for him, and we left it at that. However, later on he told me that Pamela, his new PA, had found a really good barbecue place in the town where I live, one that does Texas-style barbecue. (Both he and Pamela moved here from Texas, and apparently like the way Texans do barbecues.) I immediately guessed which restaurant he was talking about, and he said, 'Yes! That's it!' Then he asked me if it was good. I told him I didn't know, that I'm not a big fan of barbecue. So then he asked, 'What type of food do you like?' Before I could answer, he gave me a sort of funny look, then said only half jokingly, 'Do you even like food?' Geez, have I really lost that much weight?!

As for the scarring, Dr. T cautioned me that the injections wouldn't have an immediate effect, and that I'd need to come back to repeat this in 6-8 weeks. UGH! I told him that almost made me hope that the feeling in my abdomen never comes back! 

Anyway. At least Dr. T is a lovely person with whom I enjoy visiting, which makes the appointments bearable. Throughout the appointment, we talked about our families, about traveling, about skiing, about my career change, about his upcoming talk at my school. He said that he was going to Costa Rica for spring break, although he didn't know where in Costa Rica, because his wife arranges everything. However, next year he is taking his family to Korea and Thailand, because his daughter is almost 15, and 'pretty soon she won't want to travel with us.' He said he wanted to show his children the type of village that many people in Korea still live in, despite the fact that Korea is industrialized. Then he said that when he was in college, he used to wait tables at a Thai restaurant, and during that time he gained a great appreciation for Thai food, Thai people, and Thai culture. I told him we weren't going anywhere for spring break, then said jokingly that it was because I had spent all my money on medical bills. 'Sorry about that,' he said with a grin, not looking too sorry. LOL. I did mention that we were going skiing, though, so we talked about skiing, the best places to go skiing, and how insanely expensive skiing is, the latter reason being why I never skied much as a kid. He said he never skied as a kid, either, because his family was very poor - We were a typical immigrant family, with three families living in a two-bedroom apartment. (Not to mention, he grew up in Virginia, which isn't exactly the skiing capital of the U.S.) He said he only started skiing as an adult, six years ago, and while he was interested in learning to snowboard, he didn't want to break his wrist. (Yeah, wouldn't it be annoying if he had a surgery planned, and had to cancel it due to a broken wrist?!)

While some of the conversation was surely his attempt to distract me from the unpleasantness of the injections, most of it was like talking to an old friend, and it filled me with an inexplicable sense of ironic awe. Something like this: Wow, I am so unlucky to know this incredible man so well, but at the same time, I am so lucky to know this incredible man so well. Life is funny that way. As my colleague put it, it's the bright side of a dull gray cloud. But clouds are okay. Clouds bring rain, and rain allows us to grow food and pretty flowers. Despite what Dr. T may think, I love food. And flowers, too. :)

What if you only had six more years to live?

I've been thinking quite a lot these days about priorities. Although I'd love to be a model cancer survivor and attribute this to cancer, in all honesty it's something I contemplated a lot even before cancer. Of course, cancer has helped me understand priorities in a different way than before. I've always tried to make time for things that are important to me, and live my life in a way that would leave me with no regrets, but there was always an underlying assumption of a normal timeline for my life, one in which I would live to be at least 80, and where my early 40s would truly be 'midlife.' There was always the 'what if?' element, for sure, but in the past that 'what if?' scenario usually involved some statistically improbable freak accident that I couldn't really plan for anyhow, so why waste time thinking about it, other than maybe buying extra life insurance? Now that 'what if?' scenario is much more tangible, much more real. The possibility of having limited time isn't just some crazy scenario I conjured up in my mind; it could actually happen. And if it does, there's a very real timeline attached to it.

What moved me to write this entry was an article I read this morning. I've mentioned that I teach biology. One of my colleagues sends out a 'Biology of the Day' e-mail every day that is a round-up of all of the major biology news, from mainstream news sources such as CNN to major science journals such as Nature to obscure journals like the Journal of Eukaryotic Microbiology. It's actually an amazing resource for me that helps me stay current in my biology knowledge and oftentimes gives me interesting material to share with my students. Unfortunately, I rarely have time to click on all of the links in the e-mail, so I pick and choose based on my own interests and what I'm in the mood to read about at the particular moment in time I happen to open and read the e-mail.

One of the links in this morning's e-mail was to this article, about a project called 'Photo Ark,' which is a project to capture portraits of all of the world's animals, especially endangered species. I clicked on it because... well, okay, I'll admit it, I like looking at pictures of animals (and so do my students!). And once I clicked on it, I saw that the photos were by Joel Sartore, and I was even more interested. Joel Sartore is a photographer for National Geographic magazine who lives in Lincoln, Nebraska. I first became familiar with his work while I was living in Lincoln, Nebraska, and read a piece that he wrote about Nebraska in National Geographic. After a minor amount of stalking investigating, I realized he lived very close to me, and somewhat marveled at the fact that this world-renowned photographer hailed from the town I was living in, yet received virtually no attention. (Nebraskans are much more into their football heroes.)

Anyway. The point is that if it had been anyone else, I probably wouldn't have scrolled past the gorgeous picture of the African white-bellied tree pangolin. But it was Joel Sartore, so I read the article. The article explained how his 'Photo Ark' project had started. It explained how he was always traveling around the world on photo shoots, while his wife was staying at home with their three kids, until... his wife was diagnosed with breast cancer in 2005, and had to undergo chemotherapy, radiation, and surgery. So he had to stay at home and help out for a year. And while he was at home, he started photographing animals in the local zoo, and the project was born. 

Sadly, his wife's cancer returned in 2012. The article did not elaborate on this, of course, because it was really not an article about his wife's cancer. I'm sure I'm, like, the only person who read it who was more interested in his wife's cancer than of his pictures of naked mole rats. But the article concludes with the following: 

Kathy’s cancer came back in 2012; she had a double mastectomy. That same year, their son Cole, who was 18, was diagnosed with lymphoma. Both recovered, but the illnesses have left their mark. “We don’t get uptight about too much anymore,” Sartore says.

Photo Ark has changed him as well. “It has made me very aware of my own mortality,” he says. “I can see how long it’s going to take.” If he can’t finish the job—he still has thousands of species to photograph—Cole will take over. “I want the pictures to go to work,” Sartore says, “long after I’m dead.”

Perhaps this struck a particular chord not just because I've been contemplating my mortality a lot lately, but also because I've been working on a major career change at the same time. And I want to be clear: the career change has nothing to do with cancer. I was working on it long before the cancer. Interestingly, cancer has added a new sense of urgency to this goal, while at the same time making me doubt whether it's something I should bother pursuing. On the one hand, there's that voice inside me saying all sorts of clichés to the tune of 'just do it!' On the other hand, this career change involves up to three years of schooling for me, which is not trivial, especially considering I am 41 years old and have a family, who will be greatly affected by this. My husband and I have discussed this at length, many times over, and agree that long-term, this will be good for the family, and we can make it work, and in the large scheme of things, three years is not a long time. 

But that 'three years is not a long time' mentality assumes I've got, like, 40 more years in me. Of course I hope that I do, but what if I don't? What if, say, the cancer comes back? The good news of my prognosis is that there's supposedly a good chance the cancer won't come back. The bad news is that due to my age and variables that are not well understood at this point in time, if the cancer does come back, there's a good chance it will come back as metastatic, terminal cancer. 

If I weren't contemplating this major career change, I'm sure I wouldn't be spending nearly the amount of time thinking about this as I am now. I'd just go about my job and home life trying to make the most of each day, checking items off my bucket list, and working toward that 'life with no regrets.' And while I see no compelling reason to derail my plans for the future by convincing myself of a worst-case scenario, it's hard not to ask 'what if?' Are the plans that I have for my future what I want to be doing if I only have, say, six more years to live? I'm not sure why I chose six years, but I guess I'm giving the cancer a few years to come back, then figuring I'll live a few years after that.

Six years, it's reasonable. 

Then I ask myself... suppose all goes as planned, and next summer I'm in school for my new career. What if, at some point, during school or immediately afterward, I discover that the cancer has come back, and it's metastatic? What would I do? If I'm still in school, would I finish school with the optimistic hope that I will beat the odds and live for many, many more years, or would I immediately drop out of school and spend every precious last minute doing the things that 'really matter'? If I've already finished school, would I be angry that I spent the last three years of my life working toward a career I'll never have, or will have for only a few years?

Ultimately, I've decided to go ahead, full force, with the career change. Although it goes against my pessimistic nature, I am also a scientist who believes in data and statistics, and data and statistics tell me there is no reason to be pessimistic. But the decision comes with some caveats, and those caveats center around worst-case scenarios. My new litmus test goes something like this: suppose in the near future, I find out I have terminal cancer, and will likely only live for a few more years. Would I regret how I spent the previous years? If the answer is yes, it's not okay. Whereas before, I saw a reasonable amount of suffering as some path to a better future, I'm not willing to risk that anymore. If the experience is truly unpalatable, it is not worth my precious time, regardless of whether I'm going to live for six more years or sixty. Of course, no experience can be 100% positive 100% of the time, so it's not as if I'm going to say, 'Oh yeah, I had a shitty day/week/month, so I give up!' I'm just thinking that for me, no matter what, there needs to be some reward in the process; that the process must not just be some means to an end... because there might not be an end destination, other than an untimely death. Maybe the present is all there is.

The neurotic, control freak in me needs to have a plan for everything. It's a strength and a weakness. And although I know there are no easy answers, I leave you with some questions. What if you knew you only had six more years to live? Would you live differently than if you had 20, 30, or 40 more years to live? Or... what if you were told you only had one year to eighteen months to live? What would regret?

These are the things I think about a lot these days.

I can't go on. I'll go on.

Something bad is happening, I'm afraid. Whether I'm in the midst of falling apart mentally or falling apart physically or both remains to be seen, but whatever the case may be, I don't like it.

In the past two entries, I wrote that I've been sick. I've been sick for the entire month of February - not falling down sick - but anywhere from low-level annoying under-the-weather sick to thinking I am going to pass out in the middle of a lecture sick. I've dealt with each day as it's come, and mostly kept up a normal schedule, simply because normalcy is what I crave, and because I've got too many irons in the fire right now to drop the ball. (Wow, how many idioms can I fit in one sentence, lol?) I've chalked a lot of what I'm feeling up to pure exhaustion, the type that seeps into every tissue in your body and lays you out flat when you lie down to go to bed a night. The type of exhaustion where you don't wake up and get out of bed in the morning, you peel yourself, one limb at a time, off the bed. But I've kept going, because that is what people do: they keep going.

Then yesterday, something happened. I woke up feeling terrible, the falling down sick kind of terrible. My daughter woke up with a sore throat but wanted to go to school anyway, and we let her, because she didn't have a fever and because we both had to work. I dropped my son off at daycare, and fumbled my way into work. I answered about a dozen e-mails before I got a call from the daycare saying that my son had a 102.7 degree fever and needed to be picked up. It was 9:00 in the morning. Somehow in the morning chaos, between my own illness and my daughter's illness, my son had been overlooked. It was suddenly too much for me to handle, and I literally just sat there for a good five minutes staring at my computer screen, trying to figure out what to do. My husband, who normally has a flexible schedule, just started a new job, and over the weekend, we had just had a lengthy discussion about him needing to put the pedal to the metal for the next year or so. But I had to teach, so what's a working mom to do?

Eventually, we worked it all out, as we always do, but the process exhausted me, way more than it should have. After coughing my way through a lecture about pathogenic bacteria, I came home to tag team with my husband, who had taken our son to the doctor and then brought him home. By the end of the day, my son, my daughter and I had all been to the doctor, and we all had prescriptions for antibiotics. My kids: strep throat. Me: unknown. As I had sat talking to my NP about what type of antibiotic to try next, she rattled off all the other things I should try to get better: sterilize my toothbrushes, wipe down my computer, take a probiotic, gargle salt water, and so on. Then finally, she asked me, 'Rest? Is there any way you can rest?'

I just looked at her. What a dumb question. Of course I can't rest. Who has time for resting? No one I know. But in that brief moment before I responded to her, it dawned on me that I really need some rest. Not as in, yeah, I should try to take it easy. As in, I really need some rest. As in, something bad is going to happen if I don't. I guess I've been ignoring all signs of my body rebelling against me and demanding rest because I already feel like I'm not doing enough. I've had to start going to bed around 9:30 every night, whereas not long ago, my goal was to be in bed by midnight, and I considered lights out at midnight an accomplishment. I simply can't do that anymore. I go to bed early and sleep late, relatively speaking, anyway. I've always been the type who would rather trade morning rituals for an extra hour of sleep, so I can pop right out of bed at 6:30 and be ready to be out the door in 20 minutes. Giving up those few hours of work every night, which used to be my most productive time, has not been trivial, and dammit, that should be enough. But it's not. For whatever reason, it's not enough. I need more rest, no matter how ridiculous it might seem to me.

So today, I did something I've never done before, and canceled my classes and stayed home with my sick kids (who are now acting totally fine) to try to get some rest. In the seven years at my job, I've been pretty dang sick, my kids have been pretty dang sick, including calls to 911 and hospital stays, and I've never canceled class. This latest bout pales in comparison to other things we've weathered, but somehow I felt some urgency this time. I can't keep going in this state I'm in; something's gotta give. Just trying to keep up my normal, everyday routine is physically sucking the life force out of me, and I'm overwhelmed with this feeling of I cannot do this anymore. I'm not sure if this is my body in pure rebellion mode, or my mind falling apart from stress. Either way, I don't like it. It's unsettling. The idea that it's possible that I'm physically not capable of achieving all the goals I've laid out in my mind is not acceptable.

Of course, given my recent medical history, it's hard not to think of worst-case scenarios. I'm not going to lie. I also, in my brief convalescence yesterday afternoon and today, read from start to finish When Breath Becomes Air, a memoir of a 36-year-old neurosurgeon who dies of lung cancer. While it was a truly amazing reflection on how we must face our own mortality, I'm not sure it was the best choice for me in this very moment in time, when I'm already feeling so fragile emotionally and physically. But the author of the book, Paul Kalinithi, frequently repeated the words of Samuel Beckett to himself, so I'll do the same. 'I can't go on. I'll go on.'