Decisions, Part 1: Ice, Ice Baby

I've had to make some really big decisions this fall.  Weird decisions.  Life-changing decisions.
I suppose this is common for anyone facing a recent cancer diagnosis, or any illness for that matter.  In my case the decisions started small...like the long list of doctor names -- which ones do I choose?  Which ones are the best?  Which hospitals are they affiliated with?  Male doctor or female doctor?  However, they snowballed into decision after decision, each one increasing in size and heft.

Next I was debating bigger decisions such as "lumpectomy or mastectomy?", "single or double?", "genetic testing or no genetic testing?" and "implants or natural reconstruction?"  And it's not like I had the luxury of time to figure all of these things out either.  But I made each decision one by one, after a little bit of [hastened] soul-searching, rational pros/cons lists, talking to others...and, ultimately, going with - or going back to - my initial gut reactions.

While the decision to have a mastectomy was a very big one, it was one of the easier decisions I had to make.  The medical, practical and aesthetic concerns all pointed me to the same decision, which was to remove the affected breast tissue completely. There were other decisions that were harder to reach, as well as ones that had much broader impact on my life...and the lives of others.

One of the major decisions I faced was whether I wanted to take steps to preserve my fertility - that is, freeze my eggs.  While I'm blessed to have caught my cancer early enough to prevent the need for chemotherapy (i.e., the cancer has/had not yet broken out of the milk ducts or become invasive cancer), which can cause infertility, and I'm most likely avoiding radiation on account of the mastectomy, I will be placed on a hormone-blocking drug called Tamoxifen for 5 years following my surgery.  This drug blocks estrogen, which was fueling the growth of my cancer. It doesn't necessarily rule out my ability to have children, but I am not allowed to become pregnant while taking the drug.  And since, I'm the ripe old young! vibrant! sexy! age of 35 and still very much want to have children, I had to decide if I wanted to take my chances 5 years from now*or if I wanted to freeze my 35-year old eggs now as insurance for the future.

*Or 2-3 years, if I come off the Tamoxifen temporarily and under guidance to try to conceive naturally.  After which, i would go back on the Tamoxifen for another few years.

My gut told me I needed to do it.  Boyfriend, friends and family were supportive and all told me I may regret not doing it. Doctors encouraged me to pursue the option, adding that "after all, 35-year old eggs are both greater in number and less risk of complication than 40-year old eggs" and....tickticktickticktick....Yes, I got it. I'm not getting younger. I already heard that annoying alarm clock in my head before all of this. And now someone threw a little cancer on top of the "childless-35yearold-anxiety" and the ticking grew deafening.  I had to do it.

With referrals from two of my doctors, my boyfriend Michael & I headed to Reproductive Biology Associates (RBA) of Atlanta for a free consult with Dr. Pavna Brahma to discuss what would be involved in cryoperservation for fertility preservation (costs, etc).   I have to admit, I didn't know much about the process at all other than it was expensive and probably not covered by insurance.  After a really great meeting with Dr. Brahma I knew much more about the process to make a more informed decision of whether or not I should cryopreserve my eggs.  I knew the cost (think used-car prices, but financing is available...also like used cars!).  I knew the process (lots of shots and pills followed by an easy surgery).  I knew the side effects (think PMS, but worse). And I knew the rates of success (pretty good for my age, decreasing significantly past 35).

However, i had a new decision on my hands...or on our hands, rather.  I/We were faced with the decision on whether we wanted to preserve embryos instead of, or in addition to, eggs.  Embryos have a higher success rate in the thawing process of cryopreservation than eggs do. So here's the tricky part....Michael and I aren't married.  Had we talked about marriage?  Yes.  Had we talked about our desire to have kids? Yes.  With each other?? Yes, silly, yes. However, here we were skipping a couple of steps. All of a sudden, it was on the table to make babies - or as I began to call them, "maybe babies"....and in a very odd way.  Or at least "odd" in those "This isn't they way I imagined it," and "Dammit, we're skipping the fun step of this process" kinds of ways.

There were many conversations between the two of us about it...about the costs, about how it differed from how we had dreamed we would create a family, and about what our families would think, too.  There was much to consider.  We kept coming back to feeling like it was just right.  It was what we felt we needed to do.  And we - together - were right, so who cares if this particular part of our journey together came somewhat "out of order"?

In the end, we were both really happy - excited, really - about our decision to freeze embryos in addition to my eggs.  It felt like the right decision to maximize our medical chances of success, and it felt like the right decision for our future together.  I'd like to say that was the last big decision we had to make, but it wasn't.  There were more right around the corner.  Though, that's all I'll write about for tonight.  I'll cover "Decisions, Part 2: On Personhood, Property and Possibility" later.



[As an aside, I can't tell you how many Shake and Bake-Later (TM) jokes i made about our maybe-babies. It was a lot. The Vanilla Ice reference from the title only came to me recently, but you better believe that's what I'm singing every time the maybe-babies' icy storage comes up in conversation. BELIEVE.]
 

Keeping you a-breast of my news

Where does one begin?  When the last five weeks have been a whirlwind of out-of-the-blue news, appointments and heavy-hit-you-in-the-gut decisions, where do you begin?

Many of you already know this news, if you've been following along on social media, but for those who haven't heard the full story yet...where do I begin??

I suppose I start at the beginning.

Five weeks ago, today, I went for my annual "well-woman visit" to make sure all the lady parts were in fine, working order.  I went feeling rather proud of myself for not putting off the appointment this year, and I was also pretty happy that this year was the first time it would be co-pay free. (Partisan-aside: Thanks, Obamacare - I liked saving that $25-50!) I went in fully expecting everything to be normal.  I'm in good health, a decent weight, no problems that I know of...so no biggie, right?

That's when the doctor -- who, by the way, is on my heroes/heroines list right now -- discovered something "off" on my breast exam.  She felt a large ridge of density on the top of my right breast that she didn't feel on the left side.  Now, like a long line of females in my family, I have really dense breast tissue and a history of cysts...it's what I like to call my "bumpy boob" condition.  Yes - I could probably do a lot about this by adjusting my caffeine consumption, but let's not get extreme here, people. Mama needs her coffee, ok?

Since the ridge felt different than the rest of my "bumps,"  my doctor suggested I go to a breast clinic on the 4th floor of the building to get an ultrasound "just to rule something more serious out" and "for piece of mind...I'm sure it's nothing."  I figured I was already running a little late for work, so I obliged.  I headed upstairs and checked in for my ultrasound with a nurse practitioner (NP) at the breast clinic's office.  During the ultrasound the NP, Anna, saw some calcifications on the right breast that caused some concern.  She pulled in one of the doctors to check it out, as well.  They both told me "it could be nothing," but they wanted me to get a mammogram - my first - right away.  They said they would most likely want to follow up with a biopsy of the area, so we scheduled one for 2 weeks later.

I ended up having the mammogram the very next day. I can't say it was the most comfortable experience, but everyone was so kind at Piedmont's Breast Center that it really wasn't terrible. I felt a bit like a cow being milked from all angles, but aside from that not bad at all.  MOO..........

The radiologist pulled me into her office and confirmed what I already knew - I needed a biopsy to check things out.  Despite her grave face, I still wasn't concerned.  I'm young! My mom and grandmother have had cysts checked out! That's all it is, right?  Bring on the biopsy in 2 weeks.  I can pass this test.

Cut to the next morning: I received a call from the NP Anna who had just received the mammography results.  She asked me if I would be willing to come in THAT DAY to have the biopsy instead of the appointment two weeks later.  Suddenly, I became concerned.  Why the rush?  Suddenly, my gut told me something wasn't right.  At that moment, I knew something was wrong.  I tried to tell myself it wasn't anything and to assume the best, but my gut already knew.  Something was very wrong with my breast.  I agreed, and headed back to Dr. Richardson's office for a core needle biopsy that afternoon.

The biopsy procedure is supposed to be an easy one that takes about 20 minutes.  Lordy, was I unprepared.  I guess that for many people it's an easy procedure, but mine required the doctor to biopsy two different areas, leaving my whole breast a bruised mess.  And when I say "bruised," I mean BRUISED. Bruised like an Offensive Lineman stomped on my chest, cleats and all.  Black. Blue. Magenta. Green. And the pain, oh the pain....I couldn't even let a seatbelt touch my chest without wincing.  Purse strap? Fuggedaboutit. The next week was a painful blur of sports bras, Arnica gel, the occasional Lortab...and major worries about the results of the biopsy.  Was this cancer? 

The worst thing about waiting was that it was Labor Day weekend.  It was Labor Day weekend, and Michael was out of town.  I was alone and anxious.  Thankfully, friends and neighbors kept me occupied by taking me on walks, out for coffee, fed me dinner, and laughed with me for hours.  I did whatever I could do to stay distracted from the worries.

I also tried to stay off the internet.  I failed miserably at that attempt.

"STEP AWAY FROM THE MEDICAL SITES, KRISTEN."  I was told this over and over.  However, I knew the look on the doctor's face when she told me what she expected the result to be ("I'm not telling you you have cancer.  But it really looks like cancer.")  I needed to prepare myself for bad news, while hoping to be surprised by good news.  Besides, my gut already knew the answer anyway.

I made Michael come home to be with me.  It was getting ugly inside my head, and the quiet house amplified the crazy.  I needed him more than ever.  And bless him, he came home...two weeks before I was supposed to see him again, and two weeks he needed to be in Florida for work... but bless him, he came home.

Tuesday morning, we got the call.  My gut was right.  I had cancer -- or "pre-cancer" -- or stage zero cancer....technically it's Ductal Carcinoma In Situ (DCIS) Stage 0 with Comedo Necrosis, Grade III.  Grade III means it's high-grade, aggressive growth.  "In Situ" means it hasn't broken out of the milk ducts into the rest of the breast tissue, which is great news.  That's why it is considered "stage zero" and not yet an invasive cancer.  This means I don't need chemotherapy, which is also fantastic news.  But what it does mean is another surgery. Let me tell you what: That's NOT great news. And that pisses me off something righteously.

After all I have been through in my life, here I was with this new slap in the face -- cancer (sort of)...and another chance to go under a knife.  Because, really -- getting hit by a car, breaking my spine, injuring the spinal cord/bladder and almost being paralyzed wasn't enough fun for one lifetime. Nah, let's test those comeback skills again.  So yeah -- my reaction to the news was anger.  Not sadness. Not self-pity.  Not denial.  Just some grade-A Anger.

Over the next week, I simmered down a bit and I took a bit of time to process the information.  I had an MRI, and the MRI showed no signs of a spread to the lymph nodes.  It confirmed the current diagnosis of DCIS-Stage 0, which is, all things considered, good news.  We also got results back showing the cancer was 98% ER-positive and 63% PR-positive, which means it's fueled by the hormones estrogen and progesterone.  This also means that after surgery we can prevent recurrence with a five-year regimen of hormone-blocking drugs like Tamoxifen. All good news.

Except, you know....the SURGERY.

I'll write more on the surgery updates in later posts, but for now I'll say that my option was pretty much limited to mastectomy due to the nature of the areas affected by DCIS. I'll be facing a single mastectomy and reconstruction surgery later this fall.  I've come to terms with that reality, but it doesn't mean I like it.  And if I seem matter-of-fact and calm/collected when I talk about it, it doesn't mean I'm OK with all of this.  And it doesn't mean I don't have my moments in which I break down crying.  But I know this is something I have to face head on or else things can get a lot worse, so a girl's gotta do what a girl's gotta do.

So...in light of the first day of "Breast Cancer Awareness Month,"  you are all now aware of my breast cancer diagnosis.  Is that how that's supposed to work?  Or am I just supposed to buy a pink spatula and feel better about all of this?  Because quite frankly, I can't "Think Pink" right now.  I just "Think This Stinks."  But stink or pink, it is what it is..whether I like it or not.

Tattoos

I have a tattoo on my wrist that I got when I was 20.8625 years old. This is fairly obvious to anyone and everyone who has ever met me. It's not anything I really hide nor flaunt. It's just there.

Most people seem to like it, save for my father, but I think it's in a father's job description to be opposed to these sorts of things. And for those who mention that they like it there are usually two follow-up questions: 1) what does that mean? and 2) do you have any others?

The first question "What does that mean?" is a rather loaded one....What did it mean to me when I got it? (Probably had to do with a boy.....) What does it mean to me now? (Absolutely nothing to do with a boy, I mean come on. I'm an independent woman...)* Oh! You mean what does the symbol mean?  Answer: Borromean Rings. As for THAT meaning? Let's just say I haven't had much luck explaining Borromean Rings to the drive-thru cashier or that drunk old man at the bar who keeps offering me Swedish fish and poking my wrist like a button.


The second question "Do you have any others?" should be an easy answer, but to me, this question is a bit of an iceberg.  See, over the years I have often wanted another tattoo...or 2 or 3.  I've contemplated another on my wrist  - a Fleur de Lis with "KY" and "'77" to show my Louisville, Kentucky hometown pride. Or a ring around my finger -- just four words in script "You. Can. Know. Hope."  Or the one I contemplated and planned for years....a knot on my back.

On the first couple of "big" anniversaries of my accident (1-year, 5-year) I really wanted a large "knot" design tattooed on my lower back to commemorate my recovery...survival, really...and to celebrate the strength of my back as it was "tied" back together, in a way. At the time though, my ex-husband (then boyfriend and then husband) talked me out of it. He said he didn't feel the accident was ever something to "celebrate."  I tried to explain the difference in what I was trying to celebrate (survival/recovery vs death/paralysis), but I guess he was convincing at the time, as the anniversaries came and went without any commemorative ink.

On the 10th anniversary of my accident on Jan 2nd this year, I contemplated the idea again.  This time around there wasn't anyone there to talk me out of it. But this time around I talked me out of it. I thought about it on many occasions leading up to that day.  However, one morning I realized I didn't need it anymore.

As I was showering one morning, I looked down at my side, and a light bulb went off.  I noticed something that I often forget is there -- the 16" surgical scar down the side of my torso.  The superficial girl in me will always be thankful they brought in a plastic surgeon, on account my age at the time (24) and my sex, so I wouldn't be left with an ugly back surgery scar.  The doctor did such a good job that I can wear 2-piece swimsuits and people barely notice.  (Now... if I could just get my abs looking like they did at 24 again, I'd be set to show off the plastic surgeon's handiwork more often!)

It wasn't just the scar that I realized, nor the quality of the surgeon's work, but I realized instead that I already had a tattoo that both commemorated the accident and celebrated my survival. My scar was my tattoo.

At that point in the shower I reached over to my right arm and traced along another scar -- the 12" scar from my two elbow surgeries from years of playing piano. Like the scar from my accident, the elbow scar celebrates both a victory over years of pain and commemorates what was in essence the collapse of my love of the piano.

These scars, like tattoos, serve as markers --  on my body and my life -- of pieces of my history.  They illustrate in an abstract, rudimentary way "something happened here, and it left a mark."  I look at it and remember, or I don't see it at all.  One day they mean one thing, and the next they mean something else.  Sometimes I find them ugly, and other days beautiful. Though, the latter is few and far between. They elicit the same contrasting feelings of pride and regret that I can only imagine most people feel when looking at their own tattoos.


But the difference with these tattoos is that they were chosen for me by circumstance, as opposed to me choosing them to fit my circumstance. They're mine to accept. And they're mine to give meaning versus the other way around.

So yes, I do have another tattoo. I have three of them. And like the three rings on my wrist, they're all connected.

Dear Grandma

For Christmas all the grandchildren on my mother's side of the family were asked to write a letter to our Grandma, in place of our usual gift-exchange. There were no real parameters for what this letter should be. It was more of a "Let her know what you've been up to. Let her know she's special," sort of a thing.

My relationship is somewhat unique, however, since I live in the same city as my grandmother, and we try to stay in touch frequently. Also, over the past 12 years, I have lived with my Grandma FOUR times, from periods of 2 weeks (while a small renovation project happened on my house) to 3 months (after my car accident), to 6 months (after a broken engagement)...to 8 MONTHS with my boyfriend, while my house was completely renovated. Needless to say, my grandmother has the patience of a saint. Therefore, the usual "let her know what you've been up to" wouldn't suffice. Here's what I wrote instead. *I figured I could post it here, since she probably wouldn't read my blog between now and Christmas morning, right?

Dear Grandma,

“You come by it honestly.”

How often do we utter that statement? In our list-making, our gingersnap-baking, our penchant for gift-wrapping, and the way we tear up at every emotional moment (happy, sad or MAD)…those are the traits we share. I’m my mother’s daughter, and definitely my grandmother’s granddaughter.

We share so many personality traits – aside from your questionable aversion to sushi, of course – that it’s clear we’re related. Some things are just in our blood, or were passed on from generation to generation that one can say, “Well, Kristen…you came by that honestly.”

But I think that, even more than the traits we share, I treasure most the moments that we've shared…as individuals, as different women.

Grandma, you have shared so much with me over the last 12 years. You have shared meals with me. You have shared your house with me….4 times to be exact! You have shared your money with me after my accident when I was out of work. You have shared showers with me when I had to have someone make sure I could support myself after surgery. You have shared your stories with me, and thoughts with me, and very looooooong car-rides with me. And most of all, you’ve shared your patience with me… and your heart with me.

With you I’ve shared snowy drives through midtown Atlanta in search of lost car keys. I’ve shared some pretty interesting pain medicine-induced conversations. I’ve shared rides behind a tow-truck after my chronic car troubles. I’ve shared many a night eating breakfast because we were both too tired to think of anything else to make. I’ve shared my successes at work, as well as my failures at life and love(s)... I’ve also shared my opinions where we didn’t always agree.

I’ve seen you angry. You’ve seen me sad. I’ve seen you healing. And you’ve seen me healing. I’ve seen you as a wonderful wife and partner to Grandaddy for all those years, and as a wonderful and amazing woman on her own for these last 12. You’ve seen me in and out of relationships, succeeding and failing…succeeding and failing; and hopefully now, much stronger than I ever have been – on my own.

I can’t tell you how much of an angel you have been to me over the past 12 years. Don’t get me wrong… you were very special to me the other 22 years of my life, as well! It’s just that in the last 12 years our relationship has grown in ways that I don’t know it ever could have had I lived elsewhere. Or had all the circumstances of my, or your, life been different. But life led us both here, together. It brought us together to share all of these moments. For that, and for you, I am eternally grateful.

You have helped me become the woman I am today. Not just in the traits I come by honestly, but in the honest moments we shared.

I love you Grandma. Thank you for everything.

-Kristen

I've been working very hard on my yard this year. At the beginning of the year, I thought I might be leaving in the fall -- to go away to school -- and that this was my last spring and summer in the yard. It was a hard realization to have because it brought home all of the transformational work I've done to the yard over the past seven years. Literal blood, sweat and tears have gone into my yard -- along with it much Advil & "recovery" cocktails after long days' work.




It hit me that I might not actually be ready to say goodbye to it yet. As much as parts of the yard -- the messes, the failures, those "problem areas" and things left undone -- as much as they frustrate, disappoint or infuriate me to the brink of throwing up my hands and saying "screw it - let me move to the city to a place without this upkeep," I realized I would really miss it. I also realized that now hile I'm on my own & not bound to opinions of others, I'm finally fully in control.


While I've always picked the plants & dictated the design in my past, married life, I still would always get distracted by the projects of others instead of addressing the areas that bugged me. I'm not putting blame on the other person in the relationship; I'm merely saying "It happens." Whenever there are two people involved, there are usually two sets of ideas and you run the risk of losing a cohesive, overall vision. Some couple have gelled (similar or cooperating) visions, others let one person direct. Other couples have competing visions.


Yet none of that is an issue anymore. If I want to fix something, I fix it. If I want to do something, I do it. Boom -- CHANGE. And I did it. In taking control of things, I also take pride...more pride. I even started taking more pride in all the work I did while in my last relationship. I'm more proud to admit: "I designed that," "I picked those color palettes," "I picked those plants." I also can admit, "I tried that. It didn't work. But I think I learned why."

I want to make things work where they didn't before. I want to learn more, do things with more thought. I want to invest in quality projects -- things that last. I'm willing to spend where it counts. These are all things I've learned this time around. And this time, I'm in control.

Of course, I'm human & I want everything "perfect" right now. But I have to remind myself it won't be and that that really takes the true gratification our of it. As I looks to the yard, at each part and say "I did that. I built that. That took 2 weekends. That took 2 years," my heart wells up. I created something -- it's an ongoing project -- but it's mine. My own little world, imperfect yet beautiful, in my hands & of my heart.

Photo 1: The backyard today, April 2011.
Photo 2: The backyard today, April 2011.
Photo 3: The backyard "BEFORE" - Spring 2004.