"What are your priorities?" An interview with Tracy Cushing, MD MPH

Honored to be interviewed for YouTube channel FLATworks with Sarah Nash. Always happy to share my reasoning and thought process behind choosing aesthetic flat closure, and as I soon mark the two year anniversary of that choice, I remain convinced it was the right one for me. Thanks for letting me share my story! 

The Emperor of All Maladies indeed

Next up on the cancer reading list: "The Emperor of All Maladies" by Siddhartha Mukherjee. An absolute must read whether you are a physician, a cancer patient, or just love biographies. This one is a doozy. 

The entire history of cancer - from its first appearance in hieroglyphics, to the development of the radical mastectomy, to the most recent drug advances - this book chronicles it all. If you don't understand cancer biology, you will have a better understanding after reading this book. If you don't understand how drugs and treatments are developed and tested, you will after reading this book. 

Cancer has been around as long as humans have been. What makes it such a terrible and terrifying disease is that it is not an other - not a bacteria, a virus, a parasite, a poison. It is US - our own cells, our own genetics gone haywire, our own bodies betraying us. And this "US"-ness of cancer is what makes it so hard to cure or treat. We can't kill cancer without killing us, so far, and that is what makes cancer the emperor of all maladies. 

If you are scared that cancer research is languishing despite its funding, and that there haven't been many broad, meaningful breakthroughs since immunotherapy was developed, you will find reasons for your fear in this book. 

If you are a clinician, you will be fascinated by the trajectory of this disease, as old as humanity itself, and by our inability to crack the code of cancer. It is a humbling, educating, daunting read. I only cried once, on the last page. For a cancer patient, getting through a 400+ page book about cancer without crying was a big feat.

Most patients don't want to read about cancer in their "free" time, and honestly there were days this book was too heavy - literally and figuratively - to pick up. But I learned a lot from it, and on the days when I could handle it, I'm so glad I did. 

Another Loss

Today I am struggling. A fellow physician, a lobular cancer patient, a fellow LBCA board member, died from metastatic lobular cancer. 

I sent her smoothies 2 weeks ago when she was DIAGNOSED as metastatic. We were previously chatting about meeting up at a breast cancer conference, or a women in medicine retreat. She was only diagnosed a year ago, stage 2. And now she is gone. 

This is a fast series of events, even for a disease as cruel as breast cancer. I am struggling to comprehend how this could happen so quickly. I long ago gave up trying to comprehend why - the biological why still interests me, but the rest of it - there's no answer. Why this particular badass woman surgeon, wife, mother? There is no answer. Cancer, and biology, do not care one little bit about whether you are good or bad, young or old, whom you might leave behind. 

But since there is no answer to the why, there is only the immediate grief and sadness for her loved ones - and then the overwhelming, gut punching fear: what if that's my fate, too? Just when you manage to put cancer in a corner and move on with your life, it has a way of smashing back into consciousness, ready or not. 

I don't know how to process this loss. A woman with whom I had so much in common beyond breast cancer, and whose life was taken by the disease that stalks my every waking moment. I hate cancer so much. I hate that medicine has so very little to offer for recurrence prevention, and that lobular breast cancer in particular is sinister in its occult spread. I hate that I have to be afraid of this every single fucking day of my life. 

I tried hard to enjoy the sun on my face and a swim in the pool today. I felt grateful to be alive and with my human and canine families. But it was such a bittersweet gratitude - overwhelmed by sadness for another loss, and another family's grieving. And I am still struggling. 

(graphic courtesy of FC Cancer Foundation)