Introduction to Cancer: Part One

On New Year’s Eve I burst into tears for no reason, which you might find hard to believe when you learn that I had just looked in the mirror and seen exactly how fat I have gotten. But I don’t think it was that. I think I was lonely.

For no reason. Noone had dumped me in at least three months, my daughters were calling me, even my ex-boyfriend Frank had been calling at regular intervals.

The next morning I was sitting at my computer minding my own business when suddenly I heard a loud click on my email system. A very loud click. Full of portents. It appeared to be a letter from some guy on a dating site that I thought I had become invisible on.

You had better be careful about that visibility option on these dating sites. This is especially true if you are a double clicker. You know what I am talking about if you are an old fashioned person over fifty who clicks twice instead of once to make things go. If you click that button twice on the dating site visibility option, then just when you think you are disappearing from the prying eyes of your colleagues, boss, employees, ex-boyfriends and every other man in Oklahoma City, Kansas, Texas and Arkansas, especially if you need some time off from having your heart broken and/or need to get some work done (which are often related exigencies), you might magically appear again. Accidently.


Laptop


Dear Diane: the email said.

For some reason we seem to have lost touch. How are you? I would be delighted to start writing to you again.

Sean

Then there was a picture of him at the bottom. Homely, nerdy, adorable. My type.

OK. Some Irish guy was oogling my accidently visible profile and he clicked on his letter to someone named Diane by accident.

This was an amazing coincidence if you think about it. I was visible by accident and now he was writing me a letter by accident. Even though I was visible. Which I should not have been.

Dear Sean: I wrote back

I received your very nice letter, and I would be delighted to correspond with you, too if I were Diane. Unfortunately for me, I am not Diane. Good luck in finding her.

Della.

Almost immediately he replied:

Dear Della:

Sorry, I thought you looked familiar, maybe we were writing to each other before and I only thought your name was Diane.

Sean

Dear Sean: I replied

Nope, I would have definitely remembered you. But if you write me back I will answer you. On the other hand, if you don’t then neither will I, and this will have to be goodbye.

Della.

He wrote me back.

I wrote him back.

He googled me.

I could tell. Some facts about me slipped out in one of his e-mails.

So the man knew how to use a computer. I googled him.

Wow. This was the first man I ever met on the internet who was a google star like me. Although, let me rephrase that. This was the first man I ever met on the internet who could be found at all with google, outside of the county court records that is. And, remarkably, he was also a google star, like me.

No kidding. He had a lot of hits. And he had his picture in some newspapers and on some billboards.

He said he was some kind of executive for an energy company that was based in Texarcana but had offices in Oklahoma City. I believed him because you could google all about it. It is easy to tell lies on the internet but it is very hard to get them googled.

Try it. Google this blog.

Sean called me on my cellphone. We started talking every night. He kept bragging about how much exercise he was doing so I started working out twice a day.

I figured I had a few weeks before we were likely to meet up, so I planned to drop at least ten pounds. And wear spanx.


spanx.















Let me tell you about my workout tape. It is called Kathy Smith and she is some kind of tall Nordic woman who videotapes herself in some gym with a roomful of happy, fit people who say “whoooooo” everytime she comes up with a new torment. For example she gets you doing deep lunges that almost crack your knees open along with the military press that almost dislocates your shoulders, and they all say "whoooooo." Then she makes you stand on one leg while holding two five pound weights and lifting your other leg in front of you and then, while leaning over at a ninety degree angle swinging the leg out behind you and squeezing your fanny without falling on it. And they all say "whooooo." Then she does this other thing where you have to do a three step jig from side to side at ninety miles an hour while everybody says “whoooooo” and after that, as I double over, gasping for air, the happy fit people applaud me. Or more likely her.

Who cares? The whole thing is over in a half an hour and if you grit your teeth and force yourself to do it twice a day you can lose a dress size in two weeks. Depending on what you eat. Which was my goal.

Kathy Smith: Build Muscle Shrink FatKathy Smith workout

I know about three diets that work.

1.) Healthy diet. This works fine if you have nine months to lose ten pounds. The advantage of it is that you can live a normal life and it is easier to stick to. Except that I don’t.

2.) No fat diet. This is great if you can’t control your appetite. As long as you stick below 1 gm fat for every 10 gm carbohydrate you will lose 30 pounds in three months. Works every time. Great for yo yo dieters who travel a lot and don’t mind gaining all the weight back between September and December.

3.) Soup diet. Just eat soup. Homemade soup, Campbell’s soup, V8 soup, Healthy Choice soup, Progresso soup, it doesn’t matter. Eat the 100 calorie/serving diet soup for lunch. Eat the hearty version (240 calories/serving) for dinner. Or eat the hearty version twice. No problem. For each meal you can have the amount of soup that is in one can of Campbell’s or Progresso. They call that two servings, but you will be full while always coming in well under 500 calories. Trust me. It is very, very hard to stay fat if all you eat is soup.

















It was wintertime and we had a string of blustery weather so I chose the soup diet.

Oh, I almost forgot. Sprinkle some hot red pepper on the soup. It curbs the appetite.

So for one week all I did was eat soup and work out to Kathy Smith and talk to Sean on the phone every night.

And work. But that goes without saying.

He was obviously very smart, and he knew a lot of facts about local history and current events and politics. More than facts, he was analytical and insightful. And he was critical about some of the dumb things I said, he called me on some of my most blatant nonsense, in a knowledgeable, thoughtful, non-egotistical way. I admired that. I don’t like to dance rings around a man. Especially when they don’t notice it.
But he did not flirt with me.

Sometimes I would say something offbeat and he would laugh, but then he would give some kind of serious reply. No flirting.

He seemed to be trying to figure out if he liked me, and even looking for things to like in me, but there was no sex involved. Nothing in his voice to insinuate he had anything on his mind but a tentative, and meaningful friendship.

Which turned me on like crazy!

Also, he said some really stodgy things that normally would have fallen very flat with me, like “My neighborhood is fun, but not prestigious” or “I drive a Lexus, but I have trouble with women who spend money without thinking,” to which I immediately had to reply “my neighborhood is rundown and my house if falling down around my ears,” and “I drive a Ford Focus with a dent in the back, and I buy a lot of worthless junk.”

But then to his stunned silence, I continued, “but I do pay my credit cards in full every month. My ex-husband taught me to do that.”

“Why did you have to be taught?” He immediately retorted, boring right through my artifices to the heart of the matter.

“Guess I had never thought about it until I got married and took out a credit card,” I demurred, leaving out the part about how, after graduating from Vassar, I was a go-go dancer in New York City and traded primarily in cash before settling down, marrying a psychologist, and applying to six Ivy League Medical Schools, most of which accepted me.

Except Harvard.

50 Successful Harvard Application Essays, Second Edition: What Worked for Them Can Help You Get into the College of Your Choice

Eventually, the go-go dancer thing might need to be discussed, but first things first. He still didn’t know that I am still legally married to my husband, or had cancer and bilateral mastectomies eight years ago. Symmetrical issues, all.

Perhaps it is time to explain about my missing breasts. I may look like a plump, 59 year old woman to you now, but I once had the most beautiful, round, perky breasts on the planet. Yeah, my nose is crooked, my chin collapsed when I was forty, my eyes crinkle into filo dough when I am screaming bloody murder at my staff, but up until eight years ago, my breasts looked like they belonged on a twenty year old.

Then I found the lump. Then they were gone.

After long negotiations with a plastic surgeon who was paranoid that if he followed my explicit instructions I would end up with a uniboob, I got a fake set put in that somewhat resemble the old glory days. In order to get silicone layered saline implants (the good kind) I had to enter a clinical trial and sign an informed consent, acknowledging the debunked myth that silicone implants might cause lupus.

Pretty amusing for a lupus doctor. Especially since I once refused to help the lawyers for the plaintiffs in that case.

Breast Implants: Everything You Need to Know

You may be wondering why I chose to get bilateral mastectomies. And a hysterectomy. And take unapproved chemo that was stronger than anything anybody had recommended. Here is what happened.

I was sitting in my office at the Ardmore Medical Research Foundation, typing on a grant, completely absorbed in my experimental plan, and I realized that I had just put my hand up to touch a very painful spot on my chest.

“What was that?” I thought, startled.

It felt like a lump. It had seemingly appeared out of nowhere. I had taken a shower just a few hours before without noticing anything.

And it really hurt.

“Oh well,” I figured. “If it pops up suddenly and really hurts it must be a benign cyst.”

Or an abcess.

But at least it couldn’t be cancer.

Then why was I so scared?

My heart was beating in my throat. I walked back from my office to the clinic which was empty, it being Saturday, and found a needle and a syringe. I stuck the needle smack into my own chest to see if the cyst would drain.

Serous fluid would mean benign cyst, and if you really poke around you can collapse it and make it go away. Pus would mean an abcess, and I could take a scalpel or a razor blade to it and....

Nothing. I poked some more. Nothing. I was close tearing it open. Nothing.

My chest was screaming in pain so I took mercy on it and ran away.

I rushed to my car and, pulling out of the parking lot, wishing I knew how to screech the tires, I saw Joe Hatfield walking towards me. At the time I, like every other woman in a two mile radius, was wild about him, but don’t worry that’s over with now, usually.

I rolled my window down.

“What are you doing on our campus?” I teased.

“Hi he said,” leaning on my car, “Did you send me your CV yet?”

There was a grant deadline coming, and all of us at Ardmore and over at the University where he works write our own grants and beg each other for CVs.

“Nope, “ I smiled. “I sent it to your secretary, since you never read your email.”

“Thanks,” he said.

Too bad this isn’t a movie. In the movie version the actors would say these lines while ravishing each other with their eyes. Except that right in the middle of me gunning my engine, but lingering with my foot on the brake under his wolfish goodbye gaze, my heart was sinking and I was wondering what that thing on my chest really was.

“See you tomorrow,” he said flirtatiously.

“Hope so,” I said in a gravelly voice, wondering to myself if I actually had cancer.

But as I drove away, I had a suspicion that he might have mistaken my sound of fear for some kind of throaty love call, because he appeared a little discomfited at last glance.

Deep emotion is deep emotion, dear reader, and if you think you can tell the cause of great passion by any facet of its display, dream on.

I spent the rest of that weekend doing extremely bizarre things, such as driving to the grocery store and driving home to get my purse and driving back to the grocery store and driving home to change into more comfortable shoes and driving back to the grocery store and leaving my full basket in Aisle Seven because I realized I could not possibly cope with the long lines snaking up to the cash register. I spent most of Sunday planting flowers in front of my house, an aberration of behavior that has never since been repeated. The flowers ended up being the scariest flowers you ever saw, some kind of hardy but hideous succulent that still comes back every year to mutilate my front yard. I have sworn to remove them, the next time I have a real crisis.

On Monday, I made an appointment at the Lutheran Hospital Women’s Center for Friday. Then I got upset about having to wait so long, and my nurse, Kathy, who found me crying in front of my computer called over there and explained “who I was” and got me added on as an extra patient at three that afternoon. She walked over there and stayed with me for the duration, a very Oklahoma thing to do. Which is how I gratefully interpreted her actions. Then.

So there I was, walking in to a large waiting room crowded with women. I wondered how many of them were there for a routine checkup, and how many were there for their routine radiation therapy. I stole surreptitious glances at the faces, but I could not pick out who might have cancer, and hoped it was not me.

The lady at the desk called my name, “Dr. Sugar,” and several people looked up. Embarrassed, I walked over to the intake area.

“Here for your mammogram?” the lady said.

“No,” I explained. “I have very dense breasts and….”

“Age?” she asked.

“Fifty two, but….”

“When was your last mammogram?”

“Three years ago, but they always do sonograms because….”

“Fifty two. Then you need a mammaogram, don’t you?”

“No,” I said. “I have very dense breasts, mammograms don’t work for that and besides….”

“You have to have a mammogram first,” she declared, handing me my papers. “If the doctor thinks you need a sonogram then that’s what you will do next. Now, I know you forced your way in here today so I hope you will have the courtesy to sit down and wait your turn while I try to get to everybody else.”

I was about to burst into tears, had not eaten all day and was too weak to fuss, so I took the papers and sat down. “She is ignorant,” I said to Kathy. “Let’s just ignore her until I can talk to the radiologist or whoever they have back there.”

After the mammogram, I was putting on my clothes and a young radiologist, maybe all of thirty years old burst into my dressing room with no preamble.

Such as knocking.

“Dr. Sugar?” she snapped tartly. “Didn’t you know your breasts are too dense to have mammograms?”

“Yes,” I said. “Which is what I told your secretary outside who told me to speak to you whom I have now met only AFTER having the unnecessary procedure.”

“Oh,” she said defensively. “Well is there any reason why you think you have any particular problem?”

“Uh huh,” I explained, opening my gown to expose the mass on my breast. It had doubled in size over the weekend and it was obviously inflamed.

“Oh,” she gulped. “You should have told me. Let’s get you a sonogram.”

They whisked me into a dark room and the Head Radiologist came in to handle me, having apparently dismissed the younger one. My breast was rapidly uncovered and exposed to the paddles, and I could see the lump on the little TV screen, which looked regular and smooth and benign.

“Shall we just biopsy it and get it over with?” the radiologist suggested briskly.

“Stab away,” I replied compliantly. Then winced because she did stab me so hard that the mass blew open and the needle slipped in her hand, I could feel it hit my chest wall.

“Ooops,” she said.

“How did it look to you?” I asked.

“Can’t tell” she said. “It could be OK, but I didn’t like the irregularity of the upper surface.”

“So you think it might be cancer?” I asked weakly.

“Let’s put it this way,” she said. “I can’t tell you for sure yet that it isn’t cancer.”

I think she believed that this would be somehow reassuring.

Kathy was staring at my breasts. She looked almost jealous.

I told you I had a great set.

“Well looks like we got a good sample,” said the radiologist, over at her counter. “We should have the path report by Friday, you can call me or I’ll call you.”

When we were walking back to our clinic, Kathy said, “You know, some people don’t like to have needle biopsies, because when they slip out the back end of the tumor like that, they can seed the cancer deeper into your breast.”

I remember thinking to myself what a terrible thing that was to say, but I had seen the lesion and I was pretty sure it was benign. Especially since the lump had gotten smaller after being punctured.

I felt badly for Kathy because I was grateful that she had taken the appointment business in hand, and had the good heartedness to accompany me on this unpleasant business. “Poor thing,” I remember thinking, without considering myself personally affected by her gaff. “She didn’t know what to say, and she must feel terrible about putting her foot in her mouth.”

I was mostly OK for the next two days, since I knew I would not find out any bad news until Friday. I worked late on Monday and Tuesday, finishing my grant, and had a lot of patients in clinic that week.

On Wednesday at 4PM there was a reception in the lobby of the Foundation for Jack Barnes, who had just been inducted into the National Academy of Science. There were some speeches and jokes, and champagne, and I was there with my friends, we were all joking around, and getting a little tipsy when my phone rang.

“Hello?” I said.

“Della.” Said Diva.

“Diva?” I said. I could not hear her very well. She was saying something odd about a malignancy.

“What?” I said. “I can’t hear very well here, let me get to a quieter place.” I was walking rapidly into my office, heart beating as if I had run a mile, “What?” I repeated.

“This is Dr. Graves,” said the person who was not, after all, Diva. “Unfortunately you have a grade 3, poorly differentiated carcinoma. Judging from the sonogram I think that mass may be at least 2.5 centimeters, which makes it a Stage II, but we need to do a workup to be sure that’s as far as it goes.”

The tears in my eyes were really salty and they burned. “OK, thanks for letting me know. I am grateful to you for calling right away,” I lied, pretending to sound calm.

“Make an appointment over here with Dr. Duke,” she instructed me. “He is the surgeon who handles later stage disease, and he will take it from there.”

“OK, thanks,” I said.

“Your’re sure you’re OK?”

“Uh yeah, I have a….great….uh….support system. I’ll take it from here.”

“Great.” She said. “Call me if you need anything.”

Sure. Like what?

Everything was a blur but I found Donna Faith in her office working diligently, as usual, on her books.

“What’s wrong?” she gasped, seeing my blubbery face.

“I have cancer,” I gasped. “I think it’s a bad kind.”

“Sit down,” she said, pushing me into a chair. “Now, what can I get you? Water? A Person? You want me to pray with you?”

“All of the above." I sobbed.

“Ok, let’s get you some water first,” she cried, rushing out of the room and rushing back before I even managed to stare at the walls. She handed me the cup and I put it up to my mouth and realized I could not drink anything.

“Ok, now we are going to pray, she said.”

“Just don’t ask for my health,” I said. “I don’t bargain with the Lord.”

“ OK, I understand that,” she said, bowing her head. “Dear Lord….Dr. Sugar has cancer and we both can accept your will, but she has a lot of work to do on this earth, which I know you sent her here to do, so all I am asking is that you give us all here the strength and wisdom to help her do what needs to be done and we have every faith that something in this time has an important meaning for us all. Amen.”

“Amen,” I repeated.

“Now who do you want to talk to? Diva?”

“No, she’s going to be hysterical. I’ll call her after I stop being hysterical.”

“How about your husband?”

“No, he will be too cold and practical, and he thinks I owe him money for the kids' college fund”

“He won’t bring that up.”

“A. Yes he will and B. I paid it in July.”

“Well we’ll just sit here until you decide,” she said patiently.

“Get Dr. Hatfield,” I sobbed. “He was at the party, but he left, he’s probably on his way home.”

A few blurry fits of frantic crying passed and Joe Hatfield was sitting calmly at Donna Faith’s desk wearing a take charge face, and she had tactfully disappeared. I sobbed and sobbed and told him exactly what the radiologist had said. “It’s poorly differentiated and huge and it might be Stage IV and I don’t know what to do.”

“First of all,” he said, “she doesn’t know all that from a biopsy. And second of all, I am not sure what you should do tomorrow, but I can’t leave you here now, and I have a job applicant to take out to dinner in five minutes with my wife, so you are coming with us.”

“What are you nuts?” I wailed. “I can’t go with you.”

“But I have to go,” he explained, “And I can’t leave you. So I guess you have to come too.”

“Donna Faith will take care of me,” I said. “Go ahead, I am sure I will still be hysterical tomorrow and you can pitch in then.”

“You don’t understand,” he said. “I can’t leave you. So we have to go now.”

“Joe, I’m in shock, I’m not in control of anything, you don’t want me crying at the dinner table with your job applicant.”

“Della,” he said, “you are one of us now. If he wants a job at this University, he has to accept us just the way we are.”

“You are nuts,” I laughed.

“Welcome to Oklahoma,” he smiled. "We take care of each other."

I was crying all the way through dinner, every few seconds new tears would well up, and I couldn’t eat more than a few bites, but my voice was remarkably steady. I engaged in pleasant, if subdued conversation with the others, and when Joe’s wife remarked about my red eyes and lack of appetite I said I had allergies. Joe winked at me when I did that.

After dinner, he told me he wanted his wife to drive me back to the Foundation where my car was. I wanted to get away by then, and I was grateful to go with someone neutral. Someone who knew nothing about me.

In the car, she said, “you sure have bad allergies, are you taking anything for them?”

So I immediately started crying again and said, “No I don’t have allergies, I have cancer, and you must be wondering what I was even doing at that dinner. But I just found out I have cancer, so I was hysterical and your husband didn’t have the heart to leave me alone.”

“I suspected something like that,” she said.

When we got back to the Foundation, she stopped the car and said, “Can I give you a hug?”

“Sure,” I said, knowing even as I said it that if I let this woman hug me, I must never think about her husband again. And yet what kind of a heartless bitch would deny another person a hug when they need to help you? Even if you have wronged that person in your mind. And thankfully it was only in my mind.

She gave me a great big, motherly hug and told me that if I ever wanted to, I must feel free to come over to her house and bang on her door even if it is the middle of the night. I accepted her kindness and her hug and…..her….errr….love…..and I got out of the car and went into the building.

And I stopped thinking about her husband. I really did. Most of the time.