2 Year Cancerversary

January 27 - the day the cancer came. Specifically, Wednesday Jan 27, 2021 at 3:05 PM. The phone rang. The radiologist was calling. "It IS cancer."

January 27, 2023 - two years since that call. My entire life perspective and outlook changed on that day in 2021, and two years later, I still haven't managed to put breast cancer in the background. On a shelf. In a box. Far far away from my mind and my heart. Maybe next year, or the year after that...or maybe never. 

Two years into this journey I can honestly say I've learned - a lot. More about cancer biology and pharmacology than I ever wanted to know. More about myself as a patient, a physician, a mom, and a wife. While this day is not a celebration by any means, it is a marker of time passing, and a reminder that no one is guaranteed anything in this life. 

Two years ago today my life clock started ticking down a little faster - and yes, the threat of reduced life expectancy and early death has definitely changed the way I want to be on this Earth for whatever time is left. I no longer have tolerance for anything that is either wasting those minutes, or making them more difficult. I have a deeper appreciation for small moments, little gestures, and presence. I am ever conscious of spending my time wisely. 

I death-cleaned my house during these two years: decluttered the mess, packed up the family heirlooms, and trashed anything I didn't want my husband or daughter to have to deal with later. It was cathartic, I love my de-cluttered space, and I love knowing I can tie up loose ends before I'm desperately clutching the ropes. I wrote letters and cards to be given in the future, in case I'm not here to give them in person. I wrote my obituary, so my husband wouldn't have to. The rabbit/virgo is very pleased with this organization; the cancer patient, not so much. 

The cancer patient needed to make an even bigger leap, a bigger change, a harder transition. Today I am resigning my position as an associate professor at the University of Colorado School of Medicine. This was not an easy decision or choice, but cancer doesn't care about ease or choices. Two years after diagnosis, I can see that decades of night shift work were clearly carcinogenic (night shift is classified as a carcinogen in some countries), and bad for my health. Two years after COVID, practicing front-line medicine in the US has become a nightmare for many providers, and the patient in me finally said "Enough". 

This transition will be almost as painful as cancer - I've been an academic clinician for 15 years, and it's all I've ever known professionally. I am both terrified and excited: the rabbit and the cancer patient. I don't know what's coming next, and that makes me uncomfortable, but I know that this is the right decision for my health, both physical and mental. 

On my 2 year cancerversary, I am retiring from academic medicine. It has been an amazing career, one of which I am proud, but it's time for me to move on. From night shifts, from a broken health care system where there is little joy in practice. My daughter, my husband, my rescue pups - these are my joys, and the things I need to prioritize in my life. And my SELF. No one ever wrote they wished they'd worked harder or longer on their tombstone, and at the end of days, no one looks back on diplomas and resumes as their accomplishments. So maybe a little thank you to cancer for giving me the push I needed to make some big changes. But only a little. The rest of it has been shit, cancer, so feel free exit stage left and never come back. 

 

The First Cell - Why We Aren't Curing Cancer

     Twenty-one years ago, I graduated from medical school. I learned a lot of things, including a bunch of things about cancer. Cancer scared me before I understood what it was, because it took my grandmother away from me. Cancer scared me even more when I learned about it in medical school, because it is a sinister, brilliant  disease. I learned the names of toxic drugs and cell receptors and various terms that I rarely thought about in the subsequent 21 years while I practiced emergency medicine. 

    Then I was diagnosed with breast cancer. Almost 2 years ago exactly. Surely something - anything - had changed in those intervening years. My screening mammogram had failed to diagnose my invisible tumor, and we still don't have any better screening to find it, but OK, surely at least the treatments were better? Surely leaps and bounds had been made in understanding cancer biology and disease? 

    I was horrified to learn that the more I read, the more I felt like a second year medical student with Harrison's Internal Medicine textbook open on my lap. There had been very few breakthroughs in understanding tumor biology. The same drugs we were using twenty years ago, we were still using now. My "other" type of breast cancer, invasive lobular cancer, despite representing 15% of all breast cancers, accounts for less than 0.5% of breast cancer research. 

    And yet -  how many BILLIONS of dollars have been poured into cancer research in those 20 years? (NCI alone spends $6.4 billion per year.) We measure success in the extension of lives by weeks or months - instead of stopping malignant cells from becoming cancerous tumors in the first place. We implant human tumors into mice and expect them to act like they do in humans. We focus on "battling" cancer once it has presented itself, but for the people living in Purgatory like me, we cross our fingers and hope for the best. No one cares if I have circulating tumor cells, because if we found them "it wouldn't prolong life anyway". Maybe not. But an 18 month lead time on the beginning of the end would be a big gift - a gift of time before decisions are made about treatments. Time to travel, to quit a toxic job, to reunite with loved ones. To experience what remains of good physical health, whatever it looks like now.

    Today I finished reading "The First Cell" by Azra Raza. She is a hematologist/oncologist who put into words and verified all the things I feared: we really haven't made much progress in understanding cancer. Imagine if there was a pill I could take, like antivirals that prevent HIV from becoming AIDS, that would prevent rogue cancer cells from becoming tumors. We have turned HIV into a chronic, manageable disease within my lifetime - I took care of men dying of AIDS in the 1980's in New York, when we knew nothing about it. Cancer has existed as long as there have been cellular organisms - for all of humanity's lifetime, anyway - and we haven't made truly meaningful progress outside of screening. Billions of dollars. If you want to understand how that's possible, I highly recommend this book. It was vindicating as a physician, but terrifying as a cancer patient.