Amanda Kovattana

Middle-aged musings in interesting times

Monday, August 27, 2012

A Disease of One's Own

Apologies for the gallows humor in the title, but it does rather suit my state of mind. Diabetes doesn't have quite the stature of cancer, and pre-diabetes even less so—more a storm in a tea cup— but it did give me an idea of what I would be like as a patient. Plus it opened the door to a wealth of information that would convince me that carbohydrates were the cause of the "diseases of civilization", the ones that frighten us the most—cancer, coronary heart disease, Alzheimer's. 

As we sat in the waiting room of the infusion lab, the cheerful volunteer lady came around pushing her cart of snacks, asking if we'd like some saltine crackers or apple juice.

"Have you got any medical marijuana brownies in that cart?" Catherine asked her wryly from under her rakish fedora. The lady burst out laughing and a woman waiting with her sick husband looked around appreciatively. (Just about everyone we asked, who had been through chemo, said that they couldn't have gotten through it without marijuana. I suspect it's a huge underground movement, one the medical establishment has chosen to ignore.)

At lunch time when I asked Catherine if she'd like me to bring her anything, she asked for a grilled cheese sandwich. Then she ate it while sitting in the infusion chair. We marveled at what a difference her experience was this time and hoped the clear sailing would hold. Her oncologist had been pleased with how well she had tolerated the first round of this chemo. Everyone who had cared for her remembered the wretched time she had with the first chemo. It had even had an impact on my health as well. I had lost 12 lbs (down from 115). Adrenaline, I would learn, forced fat from your body plus we had been on a starvation diet for six weeks.

Blood Work

The week before Catherine's surgery I went in for blood work as follow-up to my annual physical. The results came back with the news that my blood sugars were worse and the doctor wanted to see me. When I picked up the message on my cell phone after my morning client, the lovely in-the-moment high I was enjoying crashed spectacularly. I was seething, the beautiful day forgotten. How could this be happening to me? I was fit and skinny. I felt like my inheritance had been taken away from me.

Luckily, I was headed to a friend's house. She hadn't had lunch yet. Was I hungry? I was hungry all right. I hadn't stopped being hungry since Catherine's chemo regime started two months ago and I had already eaten the sandwich I packed. I told my friend of my news about being pre-diabetic and now even more so — (6.0 on my A1C test up from 5.7 in six months. 6.5 was officially diabetes). She told me she was in the same boat with the diabetes/pre-diabetes thing. 

This was such a serendipitous coincidence that my mood was immediately mollified. She offered me a pork chop with refried beans. I cheered up considerably and, after lunch, began to accept my new status.

I did not call my doctor; I had no intention of coming in. I had heard enough discussion with doctors in the last month that I couldn't bear the thought of it. Of being so clueless about what was happening and being talked down to in that way that doctors have when they assume you wouldn't understand anything technical and only want to give you orders based on facts that only they can confidently assert. 

All my doctor could tell me, at my physical in November, was to avoid white foods. The year before she had told me my cholesterol was too high. I offered to give up ice cream. She also wanted me to eat less cheese. We ate vegetarian at home; if we gave up cheese, what would be left? Besides that would mean changing Catherine's diet as well. I gave up my egg for breakfast and replaced it with an English muffin. That turned out to be the wrong thing to do. 

"I'd rather you had stayed with the egg," she had said. Now I was suspicious. Why did I have to care about cholesterol when it made things so much worse for my blood sugars? 

"Don't eat white rice", she advised me, "especially Jasmine rice". 

"So why do all the recipes call for Jasmine rice?" I asked her. 

"Because it tastes good, " she said slightly exasperated. This was fast becoming the most ridiculous conversation I had had in a medical context, especially with a doctor who was so nicely plump, her long frizzy hair giving her the silhouette of a persian cat. Her Indian heritage called for loads of Jasmine rice as did mine. 

"There's a higher incidence of diabetes in the Asian population now," she said as if that explained everything. 

I'm only half Asian I wanted to say, but decided not to quibble. I liked Dr. V. I liked her quite a lot. She was only half Asian herself, had a white mother just like me. She and a colleague had opened a private practice so they could offer their patients much more than the five minutes the HMO system would allow. Catherine had found her and persuaded me to see her as well. That was over a decade ago. We had seen quite a lot of her lately and she had been so caring and helpful during this cancer ordeal of Catherine's. In fact I was feeling rather neglected, but I was damned if I was going to let her reprimand me for eating too much "white food". 

I had turned to brown rice and replaced the English muffin with whole wheat bread. Then when Catherine was too sick to eat, Dr. V suggested white rice with broth. On days when she felt up to it, she sent me out for mac and cheese or pork fried rice. She ate just a little, so I ate the rest. I stopped cooking much, made a baked potato, at most, and veggie sausages (wheat based). I ate a lot of toast with marmite and English muffins because Catherine wanted them, but wouldn't eat them if they were a week old. I had no time to worry about feeding myself and I was hungry all the time. I was the human garbage can. I ate everything. The weeks I took her to the infusion lab every day, I packed sandwiches. It was painfully obvious to me why my blood work was worse. It was nearly all carbs.

The Friday that I got the news, I spent the evening on the internet reading about diabetes. A book was referenced—Dr. Bernstein's Diabetic Solution. By Saturday I had it from the library. My obsession had begun; similar to the cancer one that blots out every other interest because you've just been given a life threatening diagnosis. 

The following Monday, on the day of Catherine's surgery, I called Dr. V's office from the hospital, to report that she had come through the surgery and was doing well. The receptionist, recognizing me, asked if I would like to schedule my appointment to see the doctor myself about the results of my blood work.

"No," I said, not even "no thank-you"; I was already mad again.

"But Dr. V wants you to come in," she said.

"Every time I come in the situation deteriorates," I said, which was as diplomatic a statement as I could muster. "So I'm going to do my own research," I declared having already gained confidence from Dr. Bernstein's story of being a medical outsider. (He had started his career as an engineer, but after discovering an improved treatment for his type 1 diabetes had become a doctor.)

"Can you hold a minute?" said the receptionist and put the nurse on. It took me 15 minutes to get around the nurse interviewing me, my cellphone warming in my hand. I assured her I was on the right track, I was cutting rice out altogether. She would report our discussion to my doctor, she said. When I got home there was a message saying the doctor had approved my not scheduling a visit. Smart doctor. I wouldn't have to fire her after all.

The Big Fat Lie

When I told Catherine how much I weighed now she, too, was stunned. She had guessed that I had lost 5 pounds max not 12. I had no intention of losing weight. Being thin was not the sort of attention I wanted. I designed my clothes to make me look bigger in the hopes of beefing up my presence, so to speak. And a skinny hug offered so little I felt naked and preferred padding. Plus I already had so little weight with which to pin my opponent to the floor in jujitsu. Soon I would be no match for even the 12 year olds. 

I read the nutrition chart on the side of every cereal box in the house. I recorded everything I ate and added up my daily carb intake. But it wasn't until I got my own glucose meter that these numbers became meaningful. (My chiropractor, who turned out to be diabetic, after many years of keeping his levels down to pre-diabetic with this device, told me which one to get, and to order the test strips on e-bay where I'd get the best deal.) 

"You're going to test your own blood?" said Catherine slightly horrified when I showed her my nifty pocket size kit. Even the nurse had thought a glucose meter was jumping the gun a bit since I wasn't officially diabetic.

"Yes, I'm the doctor now," I said defiantly. This was my idea of Do-It-Yourself authority. Obviously the medical establishment knew nothing about me, I told myself (not to mention my own ignorance). But with my handy truth-o-meter I would find out. Toast was definitely out I decided. It shot my readings up and toast was what I had been eating the most. So much for whole grain, I thought. It wasn't even a white food. Hah.

In Dr. Bernstein's book I read about the medical establishments misguided obsession with fat and cholesterol. That was the answer to my question. The doctors had it wrong. It was actually okay to eat saturated fat, even bacon because fat had no effect on cholesterol. It had just been a theory and no one had managed to prove that eating cholesterol or fat made your cholesterol higher. But did they give it up? No, for years more research money was thrown at it and when contrary evidence came up implicating carbohydrates was the problem, they chose to ignore it, said those results were too ambiguous. It conflicted too much with what had, for years, been taken as gospel.

Meanwhile, in response to public demand based on the fat-is-bad prophecy, all sorts of man made fats were put in food as substitutes, that could then be labeled as non-fat. Thus margarine. These trans fats even made food less likely to spoil, a plus for industry. The industry created fats would cause havoc in the body because the molecules were too big to be digested and bonded chaotically to proteins, creating large floating junk in the bloodstream—much more likely to cause heart attacks.

This was my introduction to The Big Fat Lie as the science and health writer, Gary Taubes, put it. It took me three weeks of serious reading to get through his dense 600 page book Good Calorie, Bad Calories, (460 actual pages, 140 pages of footnotes and index). Once I slogged through it, I had the science I needed, along with the story of bias in the medical hierarchy obfuscating the science and making Western medicine into a faith-based religion. 

The Paleo diet people were right, humans were not meant to consume huge quantities of grain because we had evolved as hunter gatherers and agriculture was a mere 10,000 years old. Grains—carbohydrates, simple or not,—turned so quickly to sugar once in the stomach, that it raised blood sugar to toxic levels—hard on the kidney and liver to process. The body was smart though. It had a hormone, produced by the pancreas, to get rid of the sugar. This hormone, called insulin, was the heavyweight body guard that expelled blood sugars. It knocked at the door of muscles and the liver, and facilitated the transference of sugar to these tissues. Once satiated, the tissues refused to open the door and became "insulin resistant", but there was always the fat tissues, the last to turn Mr. Insulin away.  And that is how carbs make people fat. Obviously not working for me, unless I was 15 lbs overweight and no one noticed. (This is actually a claim of researchers regarding Asian diabetics.)

Once I learned about insulin, I understood the adage I had been hearing from several sources that "sugar feeds cancer". This had even been explored on 60 minutes recently (on April Fools Day, heh) with that handsome Indian fellow Dr. Sanjay Gupta. Nearly a third of cancer cells, including breast cancer cells, have six or seven times more receptors for insulin. This means when the insulin body guard comes knocking he gets a good reception at the cancer cell hotel. Lots of sugar molecules are allowed into the cancer cell, a big party ensues and it grows and grows into a block party, a tumor, producing insulin of its own even. 

Cancer cells are an ongoing mutation event in the body, what researchers now believe to be errors in the replication of DNA, but the body has ways of policing and getting rid of them. Excess insulin, as I could now see, doesn't help. In fact just the very presence of insulin, gets in the way of other hormones doing their work to regulate the body such as allowing fat to exit fat tissue and the brain to clear away amyloid protein, the build-up of which causes Alzheimer's. 

Insulin levels could not be detected in the body until late in the game, long after the scientist, Ancel Keys, initiated a crusade to persuade the country that eating fat was the cause of an alarming increase in coronary heart disease. President Eisenhower had just had a heart attack, so must be true, reasoned the public. 

During World War II, farmed meat wasn't available in some European countries and mortality rates there dropped which led Keys to believe that animal fat was the cause of heart disease. Sugar was also rationed, but that was overlooked. And not enough petrol for cars, so more people walked, but that was beside the point, at least his point. He was so convinced of the evils of fat that he didn't wait for the research to back his theory and his crusade. The thinking of his era, that he generated, was frozen in time by Senator George McGovern and his government campaign to create Dietary Goals for the nation. This, in turn, gave us the famous food pyramid and our current low fat, complex carbohydrate, government sanctioned diet!

Fighting Cancer: The Warfare Model

After reading this story I was convinced that the medical establishment would be the last to find a humane way to treat cancer, let alone find a real cure or learn how to detect it soon enough to reverse it. Western medicine was determined to do battle with cancer as though it were an invading enemy and not a part of the daily life of the body. Focused on warfare to obliterate cancer, such treatment would in turn kill off a lot of body function, not to mention grossly disfiguring it. So proud they were of saving lives, that it didn't even cross their minds that their approach was so barbaric that it nearly wasn't worth doing. Sure they said it was temporary, but not completely. They took your body, occupied it for close to a year and gave it back to you in worse condition. I would as soon have a tribe of cockatoos rent my house.

The following weekend, on my camping trip with 13 lesbians, I met a breast cancer survivor who had walked away from chemotherapy. Briahn was a friend of my long time friend Stacy, and was a practitioner of Chinese Medicine. When it came her turn to run the gauntlet of treatments for cancer, she opted for surgery and refused chemo. As it turned out she had the same aggressive triple negative cancer as Catherine had. Her oncologist warned her that it would be back within 18 months. 

"Well, if it did, I would just do surgery again", she reasoned. Then she got herself a Chinese medicine doctor specializing in cancer, started on a regime of herbs, exercise and diet and had been cancer free for three years. Not quite long enough to prove herself cured, but still impressive. I envied her her confidence and good health. She was happy to share with me her story, but warned me that the medical establishment would fight such a decision every step of the way. I could see she was an inspiration to everyone who knew her story. Such examples were ignored by Western medicine, not even recorded.

Catherine's doctors told her that if there was a recurrence of this triple negative cancer there would be no cure. Her only option would be to do chemotherapy for the rest of her life. So even though she could very well be cancer free now, with the removal of her tumor, they could't know for sure. So it was best to obliterate any chance of a recurrence with 12 weeks of Taxol and likely more treatment after that. 

Taxol had all sorts of debilitating side effects documented on the net by patients. Catherine made me read up on it; accounts of chronic joint pain, neuropathy (numbness) in the feet and hands and impaired cognitive ability; symptoms that hadn't gone away for years. It just made me angry. But Catherine was not one to risk walking away; she would do this regime because she had no other choice. The parallel universe of alternative medicine was used only to clean up the damage. We were lucky to have that much with acupuncture.

Catherine asked that we do a ceremony for the Yew tree from which the Taxol drug was obtained. I read up on it. The tree was a conifer from the Pacific Northwest. The drug was made from a substance under the bark of the tree. It had been discovered in the '80s. Scientists had nearly obliterated the tree population in their eagerness to harvest all they could for research. Now I felt sorry for the tree. (Later the drug was synthesized from cultivations grown for the purpose.) I had new appreciation for the forests of the Pacific Northwest and for forests in general for what cures to cancer that might be hidden within.

I walked around the neighborhood looking for yew bushes and clipped a few small boughs to represent the yew tree. In our ceremony we asked the Taxus Brevifolia to be gentle and effective. I acknowledged its plight as an endangered species and we thanked it for its contribution. I no longer felt angry and was on board for the treatment.

The drug made her incredibly fatigued after the first day and she slept day and night, but there was no pain and only slight nausea that came and went. We were so grateful for that. The second week, the oncologist dialed back the accompanying steroid and that gave her a little more energy. A little pain was creeping in and the usual chemo brain. He said it was in the first two weeks that we would know what level of pain she would have. So far so good. We also knew that these drugs were cumulative. She still had tinnitus, ringing of the ears, from Carboplatin in the first chemo regime. 

A Diet Of One's Own

On a sunny day at high noon I took out the oven rack and put it in my extra large solar oven, over a cookie sheet. Then I proceeded to lay out a whole package of bacon in a nice row across the rack. (Uncured bacon so no nitrites.) Just doing so made me feel sinful—so deeply ingrained was the notion that this was heart attack food. I felt the same way about the heavy cream I began to use in the recipes I was learning from The Primal Blueprint Cookbook, part of the trendy Paleo way of eating; the book serendipitously introduced to me by a friend. It basically resurrected lots of hearty European foods—cabbage and sausages, pot roast, boiled chicken as well as favorites from Asia rich in coconut milk and lemon juice.

Both the heavy cream and bacon reminded me of England in an unexpected, deeply emotional way that I identified as grief. I was back in my grandmother's kitchen eating bacon for breakfast. I loved my grandmother and remembered how she cared for me. I had never smelled bacon cooking until visiting England that summer of my eighth year. But even more luscious was eating the bread dipped in hot bacon grease.

And cream teas with chocolate biscuits. What could be more English? My grandfather, by the way, lived until he was 94. (My grandmother had a head injury and dementia after that so didn't quite make it to her 90s.) This longevity was what made me skeptical of the health foods and fad diets of California. In adulthood I had never felt much enthusiasm for food one way or the other, and assumed I didn't care. I was a social eater, an assimilationist. I ate what people offered me in order to appear to be worldly. Now that I was on a fat-seeking food quest, I could eat such an array of subversive food. This new diet obsession made Catherine a little nervous.

"What is this food?", she asked, "you're eating like you're in Nova Scotia." This in response to the sardines I had laid on a pair of rye krisp crackers.

"Shall I make a veggie stir fry or do you want to eat the cabbage and Keilbasa sausage I made last night?" I asked. She opted for the cabbage dish, said she had developed a hankering for it. 

Every new dish I made from the cookbook was equally well received. Catherine hadn't been able to cook since her illness. She had been the reigning foodie in the house. With this breakthrough I was the new chef in town. Hah.

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Friday, August 03, 2012

A Caretaker Notes: Grace

Our journey continues to engage the healing path in the run up to surgery.

The Fourth Chakra

Breast cancer is a disease associated with the fourth chakra, the heart chakra. Because of this association, I saw the disease through the lens of love as a missing ingredient somewhere along the way in Catherine's life, that now had to be replenished, particularly the consistent, unconditional love of a mother. (Her mother had died just over two years ago.)

And so I took particular care to imbue my role as caretaker with all the consistency and care of a mother's love. I made sure Catherine knew where I was at all times, so that she would never feel a sense of abandonment. I came home when I said I would or called. (As a partner I had not always been good about that. Stuff happened, I was in the moment somewhere else. I was independent that way.) Catherine, in turn, noticed my steadfast attention and thanked me often for this care and told me of her deep gratitude for my sticking by her. 

In my caretaker role, I organized myself around meals and driving Catherine to doctor's appointments. I upheld the culture of the patient by deferring to her preferences and served her requests without questioning them. It was a different kind of love than I had shared with her as a partner. It was not the give and take of compromise or the call and response exchange between lovers. It was about being a channel for healing.

This role also allowed me to receive love from others since it didn't threaten my independence. It transcended it because this, too, was a part of the love being channeled towards Catherine's healing. So when my colleagues and friends offered to help in any way I accepted with gratitude, mostly by letting them take me out and feed me, offer tea and sympathy. Others wrote asking how things were going. Many, at my request, sent pictures of otters and other cute animals to give moral support when we were at the infusion lab.

One colleague I hardly knew mentioned that she, too, had been seriously ill and extremely anxious. When I asked her to tell me how she had overcome her anxiety, she bolstered me with her story of slow, but gradual healing and gave me some useful tips on what she did to facilitate her progress. Then she followed up a week later with an offer to make a meal for me to take home to Catherine (whom she had never met). I was profoundly grateful and realized that she was paying forward the love that her community had offered to her and her husband during those months of debilitating illness.

This quality of rising above personal autonomy allowed me to feel intensely connected to the life force and to the gifts that people were offering. One morning on the dogs' walk, I told my spirits that I was worried about Catherine's lymph nodes and could they do something about that. I immediately felt guilty for asking and then forgot about it completely. 

Later that morning at the end of my session with my chiropractor, for tendonitis in my ankle, he said he had something he wanted to give me. He then asked me to think of something that was making me anxious while he did a muscle test on me. I held out my arm and he pushed down on it. (The muscle test is the chiropractor's tool to determine what the body needs.) Sure enough when I thought of Catherine's lymph nodes the arm went down like a knife through cheese. He then took out an electric hammer and hammered up and down my spine telling me to continue to think about the distressing thought. When he finished, I held out my arm and he pushed down on it to test again. The arm stayed strong, resisting the pressure. 

"Good," he said, "at least now the stress won't take it out on your body." I was dumbstruck then amused. The spirits had answered my request in a way that would help me directly, rather than try to convince me everything would be fine.

"Thanks," I said, "that's exactly what I needed".

The rest of the day continued to roll forward with equal measure of helpful attention. It made me feel downright high.

At gatherings, people who had not seen me in some time, showered me with attention and were intently interested in what I had to say even beyond news of Catherine. This had the affect of feeding my creative energies enormously and inspired me with thoughts of putting some of the stories I was telling into a book. 

On the way home from such a gathering, traffic was stopped and I saw, to my amazement a regal, multi-colored rooster crossing the street. This was a suburb as busy as a city, not the country; free range animals did not saunter out into the street. The sight of a chicken crossing the road struck me with cosmic belly laughs. I shouted out the window at it.

"Hey chicken, why did you cross the road?" The rooster turned briefly in my direction, then headed on its way down the sidewalk leaving me with one of life's existential questions. Why are we here, if not to cross the road?

My moments of awe were propelled by the seriousness of our situation. I was so grateful when nothing dire was happening that ordinary life was imbued with a bittersweet appreciation for its very rightness. 

I also had some ugly days (though few). Relatively small frustrations sent me into a rage I hadn't felt since I was young. One phone call with a clueless vendor frustrated me so much I was seething and then the car door opener wouldn't work, likely jammed by my electrical energy. (It only worked for the front door, but later it was back to normal.) The day unravelled from there when I left a $68 bag of Orgain (an organic liquid meal replacement) in the parking lot of Whole Foods and didn't notice it was missing until Catherine asked about it at bedtime. The store had called me to say they had it at customer service, but I didn't understand the message and it was too late to return the call. It took me an hour to write down everything that had annoyed me that day.

Catherine, on the other hand, no longer sweat the small stuff. She had too much to think about, trying to solve the problems of her illness, to be bothered by trivial things. Nor did she have time to ask questions of chickens, but her compassion for the suffering of others ballooned. She was moved by stories of lives brought down by tragedy. Once her anxiety subsided (with enough drugs on board), she was able to benefit from her meditation practice, even meet with her spiritual group, in the city, the week before surgery. By the day of surgery, she was relatively calm. We had both had surgery before so had an idea what to expect.

To Reconstruct or Not to Reconstruct

The biggest decision for breast cancer patients is about reconstruction surgery, replacing the missing breast with an implant. Is it worth it? What complications does it engender? How is it done? The surgeon assumed that anyone still young enough to have an active life, would want reconstruction surgery. Very few of her patients even the gay ones, she said, did not. Both she and the plastic surgeon felt that being able to restore a normal form would erase the psychological scars of the illness. I had my doubts. No fake boob would erase this trauma. It had no integrity, no right. It was an impostor. Though it did have a convenience factor to it. It would negate the daily placement of a prosthesis into a pocket of a specialized bra. 

Catherine worried what I would think of her not having a normal body. I thought the whole idea intriguing. And I had always liked scars.

A writer in my writing group, Ann Davidson, had published some beautiful poems in 1990, about her cancer journey which included meeting her prosthesis after her mastectomy. I telephoned her to ask if she had any regrets. She was warmly supportive and filled me with reassurance that, though it took a period of adjustment, it had never caused her any regret; it had, after all, saved her life and she did not want the complications of reconstruction surgery. Nor did her asymmetrical body cause any public consternation when she went naked into a hot tub. But she cautioned that it was a process and would take time. She wished us well and mailed us a copy of her chapbook "Modified Radical and Other Cancer Poems". Catherine read it in one sitting looking a little sober afterwards. 

"That was intense," she said.

We went to the plastic surgeon for a consultation. I happened to know him from my days working at the Palo Alto Medical Center (as a graphic artist in public relations). I was already acquainted with implants, the strange familiarity of them, because this very surgeon had given one to my photographer friend Warren. He had it on his desk in his closet size office. He showed it to me once because we were buddies and given to sharing about women. Together we admired the life like consistency of the silicone gel under the clear plastic dome. It felt just like a real one in a futuristic robotic way, streamline without a nipple.

The plastic surgeon recognized me, but couldn't place me. I told him and then we sat down to business with three of the implants on the examination table. Catherine asked about the procedure. He explained that he would work in tandem with her surgeon the same day as the mastectomy and insert the empty implant under the extra skin she would leave for him. Then, over the course of weeks Catherine would come to his office and the implant would be filled a little bit at a time, gradually stretching the skin over the dome of the implant until it was the same size as the remaining breast. He might also have to do some adjunct surgery to get it to match. Finally a nipple would be tattooed in place. This was already too much procedure for Catherine who knew she would also be facing chemotherapy. Plus friends who had had reconstruction complained of infection and additional complications.

Catherine asked about the durability of the implant and the likelihood of it needing to be replaced. To prove its durability, the doctor picked up one of the implants and bounced it hard on the carpeted floor. We watched the translucent orb sail up to the ceiling and down again until he caught it. We were duly impressed. And no, it likely would never need to be replaced.

There was just one more question. Did the implant harden over time? Catherine had felt a friends and they were rock hard she told me. The doctor explained how the body treated a foreign object by enveloping it with scar tissue. Over time the scar tissue contracted around the implant and made it into a ball shape, he explained, showing us with his large hands. That did it. The body itself recognized the impostor for what it was. I was glad he told us that phenomena so graphically. I also appreciated that he wanted us to know all the details and was not attached to what decision we might make.

(The method Suzanne Sommer's made famous, of using the body's own fat as an implant, was not ready for prime time said her primary surgeon.)

It would still be possible to have reconstruction surgery later, the plastic surgeon assured us. It would just be harder because the extra skin wouldn't be left there by her first surgeon, so would have to be stretched even more. 

There are pictures on the web of women post mastectomy. Catherine saw one of a young woman at a Breast Cancer march, wearing a bikini top over her one breast. Something about the woman smiling, carrying on with her life, assured Catherine that she could do this. She was not alone. There was a whole tribe of one breasted women out there.

So we prepared to say goodbye. Our dharma teacher suggested we do a ceremony for the departing breast. Catherine's therapist asked if we would make love one last time with it. That sounded good. It was more familiar territory than the former, so we did that first. 

Ceremony was more my thing and over the weekend ideas came to me. We should have a lei for the breast, I said, and we picked out a pretty necklace of pink and aqua stones. I put on one of my magical shirts of swirling blue and white with black pants and placed the lei over her left breast. I invoked the four directions and the four elements as witness. We spoke to the breast and thanked it for it's many attributes, its beauty and symmetry—the pleasure it had given. Catherine apologized to it for whatever she might have done to cause this cancer. We thanked it for making this sacrifice to save Catherine's life. 

Thus consecrated for its final task, we assured it that it would not be forgotten and that Catherine's spirit would continue to be whole without it. I was satisfied that we had properly marked this passage and released our helping elements. 

Operation Day

The day of the operation we checked ourselves into the light filled penthouse of the Cancer Center. The waiting room had nicer furnishings than most people's houses and was divided, by curved paneling, into conversational groupings. An electronic board listed the progress of each operation; some forty in all. 

Catherine was whisked off to be prepped and then I was invited in to wish her well just before they wheeled her in. Surrounded by the busyness of procedure it was in stark contrast to the calm, timeless, tension of the waiting room.

My origami animal for the day was a red Chinese dragon for good luck, which I was studiously folding on a side table, when friends Carol and then JoAnn arrived to keep me company. The rest of my network sent us their best wishes and healing light on Facebook including three women intuitives we met on our Stonehenge tour last summer. On Catherine's side, her friends were also supporting her on the spiritual plane. Christians prayed, Buddhist sent metta and a group of Shamans performed a healing ceremony for her. 

Wi Fi at the center allowed me to check in on this cadre of healers, via my iPod, and I felt how intensely we were being supported. The four hours passed quickly with lively conversation about Silicon Valley being a cancer cluster because of the chip manufacturing. Said manufacturing now imported to Asia. 

"Because we like to share," said JoAnn wryly. 

At lunchtime the surgeon came out to tell me Catherine had done very well; all had gone fine. I passed on the news, texting, e-mailing, posting, and then calling her dad before making the long trek to the hospital building where I stayed with Catherine until her brother spelled me so I could have dinner. My friend Dave and his mother Marilyn lived across the street so I had arranged to go there. My mother came by too. It was a festive day on my end.

Catherine looked better than I expected and was able to come home the next day. I went to fetch her. As I drove her home I had a momentary vision of bringing home a newborn. It was a new life she was entering with her asymmetrical body and the challenges still ahead to keep ahead of the cancer;  it could also be a new beginning.

The Next Step

The surgeon called a few days later to say the pathology report showed her lymph nodes to be clear and the margins at the site of surgery were all clear too. At the office visit, the following week, her status was officially declared Stage One, the most optimum we could have hoped for. We celebrated by going to Watercourse Way, a zen like spa nearby, and buying her surgeon and her husband a couple's massage. Catherine had been moved by her advocacy and care. She told me how the surgeon had knelt by her bed in the operating room, held her hand and looked into her eyes, holding her with her gaze until she went under the anesthesia. Women physicians bringing in a whole new healing dimension of love to medicine, despite the war like basis of modern medical intervention—the battle engaged against disease using similarly toxic weapons, knives and derivatives of mustard gas. 

Given the month since the difficult chemo treatment had been stopped, plus the two weeks of recuperation post surgery, Catherine had gradually returned to her usual self. We actually talked about subjects other than cancer, watched movies and our shows and ate regular meals.

Two weeks later we were back in the oncologist's office, his white mustache twitching like a magician ready to present a rabbit. There was the slim hope that, because the pathology had been so good, he would tell us she didn't need to do chemo, but that was not to be. This doctor was thorough; he wanted to be certain. He had a strategy derived from the latest study targeted at the triple negative cancer. He wanted to give her Taxol for three months, then the off-the-shelf standard chemo for two more months. Taxol did not make people sick, but it did cause them pain in varying degrees. It sounded better to have that option first. Later, after reading too much on the net, it sounded awful. But Catherine was game to cross this road too. In a week we would be back at the infusion lab.

In the interim, I was off to Angel Island for a much needed weekend camping holiday with a dozen women friends.

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