Leaving the Burning House

The other day, driving home from work, my mind troubled, I looked up and saw a flock of redpolls twisting scattershot across a field, shape-shifting over the road.  I thought, there is another world, apart from all that’s human: what a relief.  Car after car passed on the white-topped asphalt, carrying imperatives and purposes, and that redpoll flock disappeared over a rise.  It shifted my perspective by lifting me up out of myself.  My world can feel so small, wrapped tight around my concerns.

My friend reminded me today of the serenity prayer.  “Turn it over,” she said, meaning those things I can’t control, the paths my loved follow with their lives, my fate, my future health.   I thought of pages turning over in a book.  I thought of a bird flock, the way it moves, turning inside out like a wind-blown sheet.

I imagine people go to church to be reminded of something bigger than themselves.  Others carry divinity within, maybe just close their eyes and breathe to remember:  this world is not about my troubles.  It’s always been the wild earth for me.  I guess it’s my religion.  A bird flock catches my eye and it’s a glimpse of some kind of earthly heaven.  What poet Adrienne Rich called “a threadbare beauty.”  Ordinary birds above an ordinary snow-covered field.  Vincent van Gogh fired a gun to incite crows to rise above a wheat field.  Maybe he did it not just for his painting.  Maybe he did it to startle up out of himself.  Perhaps it was a moment of liberation.  Tonight, at dusk, I took the dogs for a walk through the woods behind my house.  The sky was dusty blue. A sliver moon shone bright and high above the birches.  And it was only 4:30 pm.  We’re in the dark time, and I love it.  Our cold spell broke and it was a few degrees above freezing.  I love to walk at dusk when the dogs disappear in shadows, when branches are sharply outlined against an evening sky.  The woods smell good again, the snow heavy and wet, the air damp against my face, not biting sharp as it’s been these last several weeks.  I looked into the net of branches for the shape of an owl.  There’s been a pair calling early in the mornings.  The dogs were on the trail of something at the edge of a swale, and I sat on a fallen birch tree waiting for them, feeling grateful.

When I went to my bookshelf just now, I pulled out The Ink Dark Moon, poems of the ancient court of Japan, and opened to one by Izumi Shikibu.

Should I leave this burning house

of ceaseless thought

and taste the pure rain’s

single truth

falling upon my skin?

Yes I should.  There’s a single truth to a flock of redpolls.  Turn it over, and I find a set of coyote tracks in the snow.  Turn it over, and an owl calls.  So why is it so damned hard to leave the burning house?  When truth waits for me in the woods?

Swimming for a Rescue Ship

Finally the temperature rose above 20 in Homer.  A storm gathers force out in the Gulf, approaching the coast.  It might even rain this week, though we hope not; it will ruin the snow pack.  We enter a pattern the weather forecaster calls “lively.”  Last week, my nature essay students wrote about the weather.  Naturally, they wrote about incessant change.  Change, if you’re a Buddhist, is practically a religion.  Perhaps that’s why weather, to my ear, rhymes with reverence.  These big winter lows roll over us, one by one, and we’re no more than twigs to that indifferent god.  Does weather also rhyme with health?  Our bodies, who art in perpetual states of weather.  Our bodies, weathered habitations, ruined chapels, slumping huts.

I’m thinking today about a friend who feels like nothing.  At least in a low moment felt that way.  Cancer made me feel that way.  Just a feather some storm could blow away, and who would be the wiser, after years and years?  The living live on.  Day by day growing more feathery.   What’s a feather made up of?  A shaft.  A vane.  A rachis.  Afterfeathers and downy barbs.  And a whole lot of air and translucence.   

Getting treated for cancer far from home was a humbling experience.   Returning home was like stepping onto an escalator.  It hadn’t stopped escalating while I was gone, it doesn’t stop escalating if I’m scared or tired or obsessed or paralyzed.   I take my place among the escalating living, my little life one of many, and no two the same.  “What is it you plan to do with your one wild and precious life?” poet Mary Oliver asks.  Oh she asks me almost every day, her poem “The Summer Day” replaying on the whisper-ma-phone (remember the Lorax?) in my brain.  What does it all mean?  Cancer is a macro lens.  So is any way life falls apart.  Why are we here on earth anyway?  Every day I pray for an answer.  Receive only the first light in the forest, the temperature of the air, the forecast, updated every six hours. 

In that poem, Mary Oliver also admits “I don’t know exactly what a prayer is.”  I don’t either.  Still, each morning for a month now I climb a ladder into my meditation loft, light two candles and a scrap of incense, close my eyes and pray.  For what, for whom?  For the little things, for the feathers I know who are hurting in some way, and so many people I love are hurting.  Does my prayer matter, does it change a thing out there, an outcome, save a world, does it change the direction of the wind?  Does it cause a butterfly on Cape Cod to flap its wings?  But I find, at the end of each day, that the humblest prayers are answered.  They are the ones for myself, for guidance, for balance, for focus.  I pray to be a better friend or listener to this or that person in my life, to let go of ego when I respond to a student’s work.  Whatever is before me that day.  No more grandiose prayers:  to get a book published, to get a grant, or death to cancer.  I don’t pray anymore for what’s out of my hands.  I don’t pray for a particular kind of weather.  Should I?  I stick to the prayers I love best, the prayers that set my intention for my little day.  My little life.  My one feather.  “Doesn’t everything die at last, and too soon?” Oliver asks.  Is it enough to simply love the life we’re given?  Love it fiercely, every blessed cup of coffee, every square of chocolate, every bowl of soup, every falling flake or leaf?  “We’ll all be gone tomorrow,” my friend David sings.  That’s what binds us together.

I had a terrible bout of fear of cancer last weekend, and in my meditation loft, I prayed for relief, and then I voiced the fear to my friend M, visiting for Thanksgiving.   Just to voice it was relief.  Just to have it heard.  But what amazed both of us was how my prayer was answered all through that day and the next.  First, a random encounter with another breast cancer survivor at a gallery.  She was twelve years out, but still understood fear.  Then, an encounter with a woman treated for colorectal cancer last year.  She sometimes emailed me from the infusion center, an IV pumping chemo into her vein.  In a loud voice, in the health club locker room, she said,  “Here we are, getting our bodies back.”  And I felt a little proud when others turned to look.  Later, in a quiet voice, she confided her anxiety and insomnia. 

    

I woke the other morning from a dream that I’d thrown myself into the cold Pacific at night, as kind of trial run, and was swimming toward a rescue ship, a giant tender.  It seemed to be Resurrection Bay, not far from Seward.  I know.  There is no trial run.  Maybe we’ve all been thrown into this same cold, deep water, in the middle of the night.  Maybe we’re all swimming blindly toward a rescue ship we heard about and hope exists.  Maybe we’re all swimming toward some kind of idea, of resurrection.  In the dream, when I was pulled aboard my rescue ship, the deck was bright under sodium vapor lights.  My rescuers were just a bunch of ordinary guys in flannel shirts and Carhartts.  They were nobodies, doing nothing out of the ordinary.  Just doing their job.  Just doing what the living do, best as they can.  They saved my life.     

Seeds Under Snow

November 16

This is not the usual month to think about seeds in Alaska.  But whether I think about them or not, seeds are everywhere.  Seeds are doing what seeds do best:  hunkering and waiting.  Self-contained, encased in protective shells, seeds lie under four inches of snow in the woods around my house.  Seeds nestle down among dead alder leaves.  Seeds hide under of collapsed, brown fern fronds.  Pushki seeds cling, maybe, to the hock-hairs of a footloose moose.  Seeds are imbedded in the nuggets of a ravenous moose that doesn’t chew his food.

In my entryway, sad to say, are bags of bulbs I bought in September.  “Too busy” to plant them, my nose to the computer screen, my eyes seeing nothing but the deadline date for my book draft, I kept putting off planting those bulbs.  One day I even got a shovel.  One day I even cleared collapsed perennials off a patch of earth in the rock garden.  But then, as it does here in late October, the ground froze hard overnight.  I never got around to planting the bulbs, and some are starting to sprout.  I’m going to have to figure this out, I know.  They need their dark, hunkering time in frozen earth to think, to ponder what they want to be when they grow up:  Tulip?  Crocus?  Daffodil?  I know how they feel.

Now that the first draft of my book is in the editor’s hands, I feel this urgency to sprout the seed of the next writing endeavor.  Though working toward a book deadline while recovering from cancer treatment has been a bit stressful, I’ve also loved it, to meet each day with such clarity of focus, brewing my coffee, lighting a candle, settling in for work.  It was so clear to me after my diagnosis what my focus should be, a voice in my head saying “finish the whale book,” and for the last year, it’s been the sun I’ve grown toward every morning. 

The funny thing about life after breast cancer is there is no permanently altered state of mental clarity, at least not for me, no bucket list, no check marks beside numbered goals.  It’s just life again, the next goal lost in a fogbank up ahead.  One seed sprouting, one plant arising, flowering, dying back.  And then another seed.  It’s just gardening.  It’s just life.

Which reminds me of an encounter I had last week.  I’d just walked dreamily out of my morning yoga class.  In shivasana, corpse pose, at the end of class, this thought had popped into my head:  “I really think people who see me around town now don’t think “breast cancer” first off.  I really think it’s changed.  I’m just me again.”  It was a very liberating feeling, as though I’d just poked my green tip from a crack in a seed and was feeling the sun for the first time.  But boy does "the universe" or whatever just love assertions like that!  Putting on my coat, I spotted an acquaintance; I’ll call her D.  She smiled, so I walked over.

“I read your poem at the museum,” she said.  “I really liked it.”  My poem is part of an exhibit of art and poetry at the local museum called “Who Has Lived Here?”  “I can really understand how you feel, what you meant in the poem.  There’s been cancer in my family, too” she said.  “And they want to live each day to the fullest, appreciate each day . . .” I’m not remembering her exact words after that because my brain froze.  Shit.  Branded by Cancer.  At the same time my brain froze, my heart clenched into a tight fist, and I had to swallow back anger.  Anger at the kind words of an acquaintance who’d read into my poem something clearly present, though at the time of its writing, not intended.  I pushed the snarl back and said,

“Actually, I wrote that poem years ago, when I first moved to Homer.  It had nothing to do with cancer.”

“Really?” she said.

And it was true, in a way.  It had nothing to do with cancer, specifically.  Here is the ending of the poem (I call it my "chicken poem").  It's about collecting eggs from my hens.   (I think I actually posted the whole poem on this blog once):

Walking back the dog waited for me,

the egg was warm in my pocket.

My house was there.  And I was there,

and the egg for my family.  Death was

nowhere foraging in the cottonwood trees. 

Now I kneel in front of the stove

raking the ashes for a few live coals

to start the evening fire.  I just walked

to the chicken coop and back.

That was all.  I placed an egg in the tray

that marks a string of days laid out like that.

A life lived out, egg by egg.  It was pretty good.

  

You can see why she thought the poem had been recently composed.  But what I wanted to say to her was, “Actually, no, I’m not living each day to the fullest!  I’m exactly like you, like everyone else.  I try, but still I waste lots of precious time reading New York Times articles online, watching Breaking Bad episodes (about a guy who gets diagnosed with terminal lung cancer and turns his life around – by becoming a truly BAD person), worrying, shopping, procrastinating, lying on the couch.”  Oh it was a bad seed that sprouted from my heart.   Thank goodness I didn’t vent at this well-meaning, lovely person.  Because it's true a cancer diagnosis impacts everyone around us; it asks all of us to consider how we're spending our "one precious life" (in Mary Oliver's words).  But maybe I just didn't want to be the "Life is Precious" poster child for that day.

Which brings me back to seeds.  My counselor asked me a couple weeks ago, in that casual, offhand but penetrating way she has, “So how’s your daily spiritual practice?”

“Um,” I said.  “I go to yoga three times a week …”  (More evidence that I am less than enlightened post-cancer).

So since my talk with her, I’ve climbed up into my loft each morning to light candles and incense and set my intention for the day and to pray, send good energy out to people in my life who might need it.  Last week, after I sent my first draft off to my editor, I picked an “Osho Zen” Tarot card after meditating on my desire for direction, for a sense of purpose now that the book is in the polishing stages.  What next?  I guess I don’t have a Bucket List.  I just have a bucket.  So I reached in a grabbed a card out of that imaginary bucket.

But before I tell you what the card said, I have to relate that just a few minutes ago, looking for inspiration for this blog post, I grabbed a book of poetry by Hafiz off my shelf, opened it at random, and found a poem called “God’s Bucket.”

If this world

Was not held in God’s bucket

How could an ocean stand upside down

On its head and never lose a drop?

If your life was not contained in God’s cup

How could you be so brave and laugh,

Dance in the face of death?

Hafiz,

There is a private chamber in the soul

That knows a great secret

Of which no tongue can speak.

The card I drew was called “Courage.”  The image on the card was of a green sprout emerging from a crack in cold, gray stone, growing toward a warm sun.  The seed is that "great secret," in the "private chamber in the soul." 

But I know that the next sprouting is still to come.  For now, it's winter, time to nurture the seed, whatever’s contained within:  Tulip?  Crocus?  Daffodil?

Post or pre-cancer, or never-to-be-cancer, aren’t we all the same?  Aren't we all dancing with death?  Isn’t it just seed after seed after seed?  I’m just one of you, right?  And by the way, last Friday, when the exhibit at the museum opened, the poets read their poems, including me.  Reciting, I looked up at the audience, and there she was, D.  Our eyes met briefly.  And I saw an amazing, transported, glowing, sprouting look on her face.

Here’s the end of the Hafiz poem:

Your existence my dear, O love my dear,

Has been sealed and marked

“Too sacred,” “too sacred,” by the Beloved –

To ever end!

Indeed God

Has written a thousand promises

All over your heart

That say,

Life, life, life,

Is far too sacred to

Ever end.

(That is from The Gift:  Poems by Hafiz the Great Sufi Master, translated by Daniel Ladinsky).

Hey, You, Get Off 'A My Cloud

Some people have gently or not-so-gently suggested I change the name of this blog.  Afterall, am I not out of Cancerland?  And isn’t it somehow morbid?  The world of IV infusions, radiation beams, nausea, a life scheduled and shaped around treatment – isn’t that almost a year in the past now? 

What they don’t understand is that Cancerland isn’t the 9^th floor of Beth Israel Hospital.  Cancerland isn’t populated with infusion nurses, oncologists, social workers, and support groups.  Cancerland is populated by ghosts.  Cancerland is an inner landscape.  It’s windswept and cold.  Its weather is unpredictable, like autumn weather in Alaska, one low pressure center of fear following another, with brief periods of calm between.  Cancerland lies along the seismically active Pacific Rim of Fire, with sudden tremors and frequent eruptions of anger.  It’s a place where, even if aberrant cells no longer proliferate, aberrant thoughts and emotions do.  Cancerland feels sometimes like a Superfund site, contaminated, leaking barrels of toxins rusting on the tundra.  And of course, I want out.  I want a Caribbean island.

I’m a few days away from turning in the first draft of my book to my publisher.  I got the contract to write the book while I was undergoing chemotherapy treatment, in the throes of the Red Devil.  

For some crazy reason, I told my editor that I could finish the book in a year, even though several months of that year, I was still undergoing treatment.  Part of it was the way a cancer diagnosis, regardless of prognosis, clarifies one’s priorities with the force of a huge wave of frigid North Pacific saltwater to the face.  I knew this book was something that I had to finish.  What does such conviction mean?  It doesn't help that I'm superstitious.  Cancerland is a highly superstitious place.  Cancerland is this:  a deep, crazy, irrational fear arising from underground, often at 3:30 am – unstated until now – that as soon as I send the manuscript off, my life’s purpose will be over, and cancer will return, and I'll die.  That agreeing to one year as the rather unrealistic timeline for finishing a book about two decades of my life following orcas was because of some deep knowing.   A fucking premonition.  That kind of "thinking," right there, is Cancerland.

Cancerland is also adding my social worker’s daily blog called “Living with Breast Cancer” to my “Favorites” bar, when often, reading the entries taints my day.  Not because it isn’t valuable stuff, compassionate, smart, up-to-date.  The social worker is a breast cancer survivor – she had it twice – and she facilitates support groups and counsels people in and out of treatment, people surviving and dying and scared.  She’s awesome, and beautiful, a force.  She’s a pragmatist.  She knows breast cancer isn’t pink in any way:  not feminine, not gentle, not benign.  Breast cancer doesn’t wear nipple-pink, baby-cheek pink, but black – black nail polish, black lipstick, black leather.  Breast cancer has safety pins in its eyebrows and lips.  Breast cancer is a sociopath.  It has hollows under its eyes, and it listens to hard-core thrasher music and watches dark, violent movies.  The social worker's posts are often sobering.  No cure, no certainty, no pink fog to calm the nerves.  If only I had a bar for ‘Least Favorites” on my browser screen.  When I’d click on the button, I’d get an “access denied” message.  Because the Least Favorite of all is the part of myself who daily checks to see what’s new in Cancerland.  A cure?  A vaccine?  A new, preventative concoction, perhaps a flax seed-aspirin-coffee-red wine smoothie.

If Cancerland’s primary weather is fear, its geology is rage.  That one’s life is now infected by morbid thoughts, and toxic language like "five year disease-free survival” and “risk of recurrence” and “osteoporosis” and “mastectomy,” and “arimidex” and “see you in six months.”  You want to take a scalpel and extract that icky thread of language that’s insinuated itself into your inner landscape.  It’s like someone else’s hair in your soup.  You want it out, but even after you get it out, do you still want to eat that soup?  Your favorite soup, which was your oblivious, pre-breast cancer life.  Oh how good it looks, that island, as seen from afar, from the shore of this new one, CancerIsland.  Welcome, indeed.

 “Put it behind you,” is the message beneath people’s questioning of my blog post’s title.  If only I could.  I know the point is not to remain on any one island, Pre, Present or PostCancerIsland, but to clean and then weave that unasked-for, reviled thread into the mosaic of a whole, evolving life.   On my better days, in the calms between storms, I live that process.  It’s what most of my blog posts are about.  But some days, like this one, with 17,000 words still to cut from my manuscript, and an Arimidex-induced ringing in my ears, and a fog of fear rolling in from the west, and flashes of foot-stomping anger, I want to put on some music that sounds like razor blades and broken glass.  I want to put on my black books and leather.  I want to dye my hair magenta, stick a safety pin through my earlobe, and become my own weather, with hurricane force winds.  I want to meet that bitch, that cancer diva, and dance her off this planet, this island, this cloud.

Thank You Tina Fey

9:30

Back in the radiology waiting room at the hospital in Boston for my six-month follow-up mammogram and ultrasound.  I just walked here in the pouring rain from the little inn on Beacon Street.  Out on the streets, I think I was the only person not carrying an umbrella.  Well, a guy on a bike wasn't carrying an umbrella, so I'm exaggerating a little.  But I felt a bit foolish.  Like showing up for an Alaska hippie sauna wearing a bathing suit.  In Alaska, carrying an umbrella, even in an autumn deluge, means you're a wimp.  (You cover yourself head-to-toe in rubberized rain gear and wear rubber boots instead).  My friend Kelly (not a wimp) lives in a town in Alaska where it rains almost 200 inches a year.  It's been his personal mission for decades to convince Cordovans that umbrellas are a great invention.  Years ago, he convinced me, so I do walk around in Homer in the rain carrying my umbrella, eliciting incredulous glances from drivers.  Last time I was in Cordova, in September, during a storm, I didn't see anyone carrying an umbrella.  Kelly, undefeated, showed off his extra-fancy unbreakable model that is stronger than a North Pacific gale.  I wish I had that umbrella today.

But this is what -- displacement behavior?  I'm clearly distracting myself.  This is me trying not to think too much ahead.  Wisely, I didn't buy a latte on my way up here this morning.  Because of course as soon as I stop thinking about Kelly and umbrellas and Cordova and rain, within me arises, just under my solar plexus, an inner fritzing, like a television screen in an electrical storm, aka, anxiety.

Next to me, a woman talks to her friend about how she's going to pay for cancer treatment.  Her friend reminds her to stay positive.  Another woman, fine new hair growing sparsely back on her bald head, texts someone after a consultation.  Getting up to go to the exit or one of the examining rooms, women grab fistulls of hard candy from a basket on the table.  Another kind of displacement behavior, maybe.  I see they got rid of the Lucky magazines.  Here we are in the waiting room, individual in our anti-anxiety drugs of choice:  paperback, Us magazine, cell phone, daily planner, New Yorker, arms crossed protectively over the breasts, and me:  tapping away on laptop.

9:40

Just got out of the mammogram room.  All those extra views because of a fibroadenoma, a benign nodule, in my left breast; it caused me a scare last time.  This time, I'm more prepared.  A very nice woman with a pink ribbon pin squished my breast between the machine's plates.  Hold your breath she said, as if I had a choice, while the machine whined and clicked and beeped.  She kept me chatting.  "We're here to reduce your anxiety," she said.  "Cancer hits good people in bad places," she said.  Actually, it's not like Santa, it doesn't care if you're bad or good, holy or profane, organic or chemically preserved.

A black woman who waited a very long time for her ultrasound grabs candy from the basket as she leaves.  We catch eyes, smile.  "Have a good day," she whispers.

White sneakers, shiny black rubber boots with yellow trim, running shoes with pink soles, two sets of clogs, my brown suede boots.  The current composition of the waiting room.  Individualized in this moment by our feet.  Our street selves.  Boots made for walking out this door, into the regular world of puddles and crosswalks, asphalt and cement and soggy fallen leaves.  On top, we're all the same in our johnnies.

The bald woman comes out of the ultrasound room, and a voice from behind the door trails after her:  "Good luck."

10:13

Called back for one more picture.  "Everything's okay, just need one more view," she says.  It's the same nice woman who did the first views.  Now things get really intense; I practically stand on tip-toes.  Breathing, neither notion nor option.  We chat some more, about the breast cancer walk she was in the other week, about Alaska.  And then I'm back out in the waiting room.  I realize the exit sign is pink.  I think about my clothes, none of them pink, damp form the rain, hanging in the skinny closet in the changing area.  Okay, now this is strange, unbelievable.  On the table beside me there's a New Yorker magazine open to page 65.  I scan down the columns, thinking, "Wouldn't it be cool to find one sentence that speaks to me right now, to this situation?  One sentence I could quote in the blog."  With the New Yorker, anything is possible.  And there it is, on that very page, 65, halfway down:

"And what's so great about work, anyway?  Work won't visit you when you're old.  Work won't drive you to the radiologist's for a mammogram and take you out afterward for soup."  I flip back to see who this is:  "Confessions of a Juggler" by Tina Fey.

Go figure.  I think about my sister.  A consummate juggler -- mother of three, doctor, volunteer, runner, yogi -- she rescheduled half a day of work today to drive to Boston for me.  She will be here mid-afternoon, in time for my oncology appointment.

Out of the "second view" room comes a woman, thirty-something, dark brown shoulder-length hair, jeans and clogs, and she sits down next to me.  I push the magazine toward her.  "Were you reading this?" I ask.

She says yes.  I say, "Did you see this paragraph?"  She picks it up, reads, laughs.

"Did you see who wrote it?" she asks me.

"Tina Fey," I say.

She resumes her reading, her waiting, every once in awhile even chuckling at something she reads.  I'm sure, in her regular life, she's a juggler too.  I saw her studying her daily planner earlier in the morning.

Thank you Tina Fey.

11:44

Now in the hospital restaurant drinking coffee and listening to bad pop music and loving it, loving every syrupy lyric and synthesized beat.  Is there anything more sweet than sweet relief?  Because the radiology doctor told me the fibroadenoma looks exactly the same as last time.  "Normal breast tissue," she said.  I don't need another mammogram for a year.  No more ultrasounds, unless there's some change.  Then she handed the wand to a trainee.  There were two trainees, actually, one from Harvard med school, one from the hospital program.  After the blur and exhaustion-fog of med school, what will they remember, those two?  Surely not the anonymous, relieved woman lying on the examining table, her boot-clad feet hanging off the edge, her one breast covered with gel.  Here's what I will remember:  Trainee 1, a head of intricate black braids, smooth brown skin, a look of eagerness on her face, taking the wand in her hand for the first time.  "Hold it like this, the other way," the doctor said.  Trainee 2, strawberry blonde tight curls, brown eyes, pale freckled skin -- she looks 12 or so -- staring confidently at the computer screen.  And the woman doctor, white coat, mannish gray short hair, stocky voice and frame, motherly, instructing them:  "Relax your wrist, stand up straight."  Off to the side, the true expert, the dark-haired Helena, technician, catching my eye, giving me a wink.  "You are still here," she seemed to say with that look.   "You haven't disappeared."

After I walked out of the ultrasound room, clutching my johnny over my chest, I saw the dark-haired woman, still waiting for some other test.  Done with Tina Fey, she just sat there, her eyes closed.  "Take care," I said.

She looked up, startled.  Smiled.  "You too," she said.

In the waiting room, with eyes and mouths and gestures, we speak a language under the language we speak on the street.

And in the hospital restaurant, another pop tune plays, a remake of "You're so vain."  I sip my coffee.  I'm so unreasonably happy.  I tap my suede-booted foot.    

On Being a Statistic

This post is a copy of an op-ed I submitted to the NY Times, in response to an op-ed they printed today.  I'm in the home stretch of getting the first draft of my book to the publisher, so I haven't written many posts this fall.  And now my next six-month follow-up is upon me.  I fly out on the red-eye to Boston, tonight.  On Thursday, I'll be riding the elevator of Beth Israel Hospital from appointment to appointment.  On Friday I'll be on Cape Cod with my family.  Here, in Alaska, it's glorious fall, hard frost at night, a cold disc of moon bright as a spotlight in the windows, and everywhere, warm discs of leaves spattering the grass, fluttering through the air.  The trees are adorned with gold spangles; they're loud, chattering and vibrant, barely hanging on.  The next big storm will strip the trees bare.  When I return, it will be winter.  

A year ago, I had my last chemo infusion.  One year.  Today, there is so much beauty out my kitchen window -- the maroon leaves of the chokecherry, the red berries of the mountain ash, the sun, the new snow dusting the top of Grace Ridge, the sun -- I can hardly stand it.  

Here is the op-ed:

In two days, I’ll once again be donning a hospital johnny and taking a seat in the mammography waiting room at Beth Israel hospital with a cadre of nervous women.  I’ll be distractedly leafing through a Lucky magazine, listening for my name to be called.  This is no routine mammogram.  In April of 2010, I was diagnosed with early breast cancer. Every six months I return to the hospital for the nerve-wracking regimen of post-breast cancer follow-up – mammogram and ultrasound of my remaining breast, blood work, examinations.  I’m one of those all-too-aware people for whom Breast Cancer Awareness Month is every month.  Follow-up jitters aside, I know I’m lucky to be alive and well.  To be a breast cancer “survivor.”  But I’m something else, too.  I’m a statistic.  Actually, I’m several.

I’m acutely reminded of being a statistic by new recommendations for prostate screening by the U.S. Preventative Services Task Force.  Two years ago, they revamped their guidelines for breast cancer screening too; the timing, for me, was unlucky.  Their justification:  statistics.  I’m here, as a statistic, to say that there are stories behind statistics.  There are lives. 

My first incarnation as a breast cancer statistic resides within the data on risk.  I had no risk factors.  I have no family history.  I’m thin.  I don’t eat meat.  I eat a lot of salmon and fresh vegetables.  I don’t smoke or drink.  I don’t get sick.  I went through menopause early.  Until my diagnosis, at age 44, I didn’t even have a primary care doctor.  Every year, I went to a family planning clinic for my annual exam.  In late fall of 2009, I finally made an appointment for a mammogram.  My clinical breast exam was normal, but my sister, a doctor, kept bugging me:  “You’re supposed to start when you’re forty.  Come on, it’s nothing.”  The night before my mammogram, before bed, I went online to peruse the front page of the New York Times.  There, I spotted a headline about new recommendations regarding mammography put forth by the U.S. Preventative Services Task Force.  Based on the statistics, they concluded that women with no significant risk factors could delay their first mammogram until age 50.   I read the article carefully.  And the next day, I cancelled my mammogram.  The rest, as they say, is history.  A few months later, I found a small lump in my breast.  It was cancer, Stage 2A, and it was aggressive.  I went through 8 months of treatment, and now I’m one year out, and rebuilding my life.

Would that mammogram – or better yet, one at age 40 – have detected the cancer? Saved my breast and lymph nodes?  Saved my body the ordeal of chemotherapy?  Who can say? Do I wish I’d never read the recommendations of the U.S. Preventative Services Task Force that night?  Do I wish I’d had the mammogram?  Unequivocally, yes.

In an Op-Ed on October 11, H. Gilbert Welch, a professor of medicine, has this to say: “Now let’s consider the winners — those who have avoided dying from breast or prostate cancer by getting screened. While there is some debate about whether they really exist, my reading of the data is that they do, but they are few and far between — on the order of less than 1 breast or prostate cancer death averted per 1,000 people screened over 10 years. That’s less than 0.1 percent.”  (The losers, apparently, are those who deal with false positives, not the dead). 

According to the National Cancer Institute, over 200,000 women will be diagnosed with breast cancer this year.  About 40,000 women will die of the disease.  How to contextualize 0.1 percent?  In terms of 200,000 women, it’s 200 mothers, daughters, sisters, best friends, lovers, mates, colleagues, cousins, aunts.  When it’s you, or me, or someone we love, buried in a number, in 0.1%, what does a statistic mean?

The other day, I ran into my friend Mike outside the post office.  Several years ago, when he was in his late thirties, a PSA test discovered he had aggressive prostate cancer.  It was, he was told, an exceedingly rare result.  He was a 1%.  He went through surgery and a long recovery, and now he’s fine.  What does we mean, what do we matter, two ski-loving, Scrabble-playing statistics, hugging in the warm October sun, so damned glad to be alive?

The Cormorant vs. The Chokecherry Tree

What’s the most important thing, I think, as I stress out to prepare for my class.  Well, I can’t take credit for the question.  The rain clouds just broke apart, scattered by a wind, and that wind swayed the wind chimes.  Bent over a student’s work, I mean slouched, bent, crouched as if ready to pounce – the cormorant pose as my friend Jo calls it, or maybe the vulture – the chime chimed, I looked up,  out past it to a radiance:  diamonds winked from the chokecherry tree.    Its leaves deep maroon, drops of this morning’s rain dangled among them.  Light glinted off the still-wet leaves – a chandelier, a candelabra, the wind setting it to glittering.  And the question was just there.  What’s the most important thing?

This was a different voice than the one that’s been whispering like a pusher in my ear.  I straightened up, looked for my journal, not there, so I came to the blog write it out.  Why is just after I e-mailed a fellow cancer survivor on the Cape that my fear’s subsiding, why is it right after that, the fear rears up, in full force, like a gust?  “No you don’t,” it says, shaking its shaggy head and laughing low in its throat.  “Remember the pathology report?  The cancer was small but aggressive.  Only a dumb ass wouldn’t be scared.  Why don’t you read up on that, on the Internet, if you don’t believe me.” So I do, that obsessive googling madness, and the next thing you know I’m in a straight jacket, the cormorant’s wrapped me tight in its wings, and pretty soon my back aches. 

Like someone pursued by bees, I grab my jacket and head out the door.  I go to the greenhouse.  I fill a basket with yellow tomatoes.  I eat a couple, and like the crazy person I become when I’m thick in the fear, I hiss, “Fuck you cancer.  FUCK.  YOU.”  If I were on a New York City street, people would give me a wide berth, or maybe even toss me a coin.  I pick and pick, tomatoes plunk plunk into the bucket, a few cucumbers too, and then out to the garden, broccoli, yellow squash, snap peas, carrots.  Take that, you asshole.  (Why did I have that coffee?  Maybe it’s acidifying my body, a nice cancer-loving acid-bath, what’s wrong with me?  Why not just green tea???)   I eat carrots, mud and all, munch peas like a rabbit, and on my way back to the house, I pluck service berries off the bush, stuff them in my mouth, Take that too, you prick.

This anger at it all, sudden and fierce.  And totally irrational.  No target for it.

Then the wind chime.  And the sun.  What really matters?  Will my stress prepare me to teach the ultimate class tonight in the nature essay?  Will it extend my life?  The tree outside my window sparkles like it's sprouting crystals instead of berries.  A few birch leaves skitter to the ground.  My feisty Steller’s jay neighbor lands on the railing and shrieks at me:  “More walnuts! Now!”  I shrug the cormorant off my back.  I straighten up in my chair, push my shoulders back, thrust my chest out, breath into my pectoral the way my massage therapist told me to.  I eat more snap peas and drink big glasses of water and pop my Arimidex.  Take that, scum. 

Who am I railing at anyway?  It’s not cancer I fight.  That’s a shadow demon, not anything real in my body at this moment.  I curse at the black crouching bird latched onto my back with its sharp black talons.

I think the insults just make it madder, but damn, it feels good to say, to scream even, sometimes, to chase it out the door with a broom.  The only true way to fight back though, I know, is more glints of leaves, more tomatoes bursting their own kind of diamonds on my tongue, more wind on skin.  More aliveness.

And something, something, to wake me up, to jangle that question in my ear, to jangle it loud enough so I can hear it above the hiss of fear:  What’s the most important thing?  Right now?  Today?