surgery plans

So we finally have a plan for surgery. I met with the doctor and the rest of the orthopedic team on Thursday. By far, this will be the worst one yet. The fusion didn't take. So they will be shortening the second and third metatarsals and putting in screws in those bones, to hold them in place. They will also be removing all the hardware that is currently in my foot - a plate and 6 (broken) screws. Because there's an excellent chance of not having much bone left after that, I will give consent for them to take bone from my left hip. The other option is a cadaver bone - which we did last time and it didn't work. It is much more likely to take, if it is my own cells and bone. After that, he will re-do the fusion, putting in a larger plate and "as many screws as he can fit," as he said (somewhat jokingly…I hope). I will then have a cast (my first one EVER) for 2 months, and absolutely no weight-bearing for that long. Which is significantly different than my last 3 foot surgeries. He wants to make sure this works, and works well. After 2 months, I guess I graduate to a boot. So the recovery process is going to be loooooong. He was straight with me; he said it will be painful, both the foot and the hip, but I will be given analgesics, obviously.
I'd be lying if I said I wasn't nervous. Or upset. Or scared, a little. I know how bad the pain is with bunion surgeries. The last surgery was especially painful, and this one will be a lot worse. This will be challenging, to say the least.
The one bright spot is that at least I can work from home. I can write and edit anywhere I have an internet connection. That is the only bright spot right now.

it's in the genes.

So...I went to the student health center here for my foot the other day, and it was less than ideal. Mainly because the doctor was more concerned with the computer and everything else except for the patient. I think the actual physical exam was less than 5 minutes. Which was especially disappointing because he was a DO. I understand that he's not a specialist and that I needed a referral for an orthopedic doc - but that doesn't mean you don't give your patient your attention and basic respect and consideration.

And of course, they had to get my family health history - although we fill out all those forms before getting here - don't they enter all that info into the computers? Shouldn't it already be there? Anyway. He asked about family members and cancer....and I told him about my grandfather's lung cancer, my grandmother's breast cancer and my aunt's ovarian cancer. And that's when he finally looked at me and was like, breast and ovarian cancer? I said yes, and then he asked if they were on the same side of the family, and I said no, and explained the situation. And granted, this is probably projection, especially since my aunt's experience is still so fresh, but I swear I could practically see the thought bubble over his head that said, oh man, girl, you are FUCKED. Yes. I know this is projection. But having worked in the ob/gyn field and oncology field, I know that my family history is not ideal. Especially since I am an Ashkenazi Jew. But, we do not have a BRCA mutation that we know of, and the diseases were on opposite sides of the family, including the Roman Catholic side. But still. It's a little hard not to worry, because it just doesn't sound good when you tell it to a health professional. Less than a month and half after my aunt's death, that horrific experience is still being replayed in my mind's eye, and I will do anything I can not to be in a similar situation. So how do people do this? How do those with breast and ovarian cancer in their families not think about it and obsess over it? Regular screenings, taking care of yourself, and maybe even preventative surgeries. But it's a lot to think about.

I feel like I'm getting to an age where I'm suddenly not "too young" for things anymore. I mean, Jesus - in 4 years I will be "advanced maternal age" when I get pregnant (which is total bullshit, but whatever - how come they don't call teens and immature 20somethings who get pregnant "too young to know what you're doing age"?), and in less than 10 years I will start getting mammograms. Being a Type-A personality, working in the field and watching numerous friends and family members deal with cancer would make anyone a little anxious.

fixing what is broken.

To anyone who's read this blog for oh, more than a few posts, it's obvious I still have a strong interest in medicine/oncology. And believe me, if I were good at science, I'd be in med school or nursing school in a heartbeat (ahem, see spring 2010). But that is not the case. I still read Atul Gawande, Jerome Groopman, Perri Klass and Danielle Ofri, and whenever I go into a bookstore I usually go to the medical section first, to see if any doctor, nurse or student has written a new book I might like. If I'm completely honest, a tiny minuscule piece of me still would love to be a pediatric oncologist. So it's safe to say I have strong feelings about medicine and the kind of doctor I like, and would want to be.

My nephew and I were in the car today; I was driving us to meet my dad so we could go to my aunt's house to visit her. I had asked my nephew if he knew my aunt was sick and going to Heaven soon. I reassured him that he would not go to Heaven for a verrrrrrrry long time, and neither would his daddy, Aunt JJ or anyone else, and that my aunt was sick with something called cancer, that the doctors cannot always fix. There was a pause, and then this little voice from the back of my Jeep says, "But JJ, I thought doctors fix people and make them better. They can't make Aunt Edie better?" I explained that they want to make people with cancer better, but sometimes it is very hard. But geez, kids have a way of saying the most starkly important things in such a matter-of-fact, innocent way.....because isn't that what we all, at our most basic level, wonder when someone we love is ill? You're a doctor; doctors are supposed to make us better. And kids say it out loud, with no anger, embarassment or anything. There's something refreshing about that, and I think it's why I loved working in pediatrics.

I can understand the feeling, too. When my friends Erik and Sophia were sick in middle school from leukemia and a brain tumor, respectively, even at the age of 12 or 13, walking around CHOP, I realized that something wasn't right - why isn't everyone going home, I thought doctors could make kids better. When friends or family members get sick, we all have that first irrational thought of, why can't they FIX THIS NOW. And if they die, we think this wasn't supposed to happen. We rail against G-d, doctors, each other, ourselves.....because sometimes things break. Sometimes things fail. And even four years of college, four years of med school and subsequent years of internship, residency and fellowships cannot fix everything that is broken, no matter how much we wish it would.

living and love.

How cute is this??

I'm going up North in a few days and cannot wait to see my beautiful nephew! Sometimes I marvel at how we got so lucky to have him. He really is an amazing, thoughtful, loving little boy. My mom told me that when they were at Blockbuster last week, he saw the little toys they have there and threw a fit and refused to leave until they bought Aunt JJ something. I just melted when I heard that. And wouldn't you know it, he picked something Hello Kitty. I love Hello Kitty. How Trey knew that, I have no idea. I certainly have never told him. But that's him, full of surprises. I am so happy and thankful to be his Aunt JJ.

Being that I recently blogged about this, both here and on sheknows.com, I figured I'd mention that this week's New Yorker has an excellent article by Atul Gawande on end-of-life care in America. He writes about the same themes I, and other articles, have touched on - how much is enough, when do we decide to stop, medicine's reluctance to admit defeat, etc. I really think we need a whole new way of looking at illness and death and hospice and living. How that should come about, I have no idea. It's a process, I guess, and different for everyone. But I think many aspects are universal - dignity, quality of living, chances to say goodbye and say what you need to, etc.

"The idea is to write it so that people hear it and it slides through the brain and goes straight to the heart." - Maya Angelou

treated to death.

I have talked ad nauseum about hospice, end-of-life care and death with my friend Carolyn, and today I came across an article that was so wonderful. And it talked about many of the things she and I have discussed. Namely, Americans are being treated for incurable cancers til right before they die, rather than having those hard conversations with their doctors and urged to pursue hospice or palliative care. And many of those patients suffer and experience pain, and do not get to live their days out like they would have liked. They cited that 12 percent of patients who died from cancer in 1999 received chemo in the 2 weeks before they died. The article mentioned that Americans use sports and war metaphors in dealing with disease and cancer, instead of talking about death and how it is a natural part of life.

I have seen this myself. I saw how my grandfather was treated, time and time again for his mesothelioma and lung cancer, though we knew it wasn't making much of a difference. He got his chemo treatments, his Procrit, lost a ton of weight, lost his bowels and bladder in public, and in the process, lost his dignity and enjoyment of life. I was living in Florida at the time, and had a feeling he wasn't going to live til Thanksgiving, when I was slated to come up to NJ next, so I flew up Halloween weekend, after not seeing him since July. He was a shell of who he had been. He was just put on hospice, after years of treatment. He could barely eat, could barely drink, could barely breathe. He had moments of lucidity and moments of....well, it wasn't delirium, but it definitely was some sort of supernatural end-of-life thing. We talked about how he was "watching the wind" because he "couldn't go" until it was a certain way. Make of that what you will. It wasn't until he was on hospice that he finally got permission to relax and let go. I left that Sunday to fly back to FL; he died the following Saturday. He was on hospice for little more than a week. This isn't too far from the national average for hospice stays.

He missed so much because he was sick. He was too sick to go to my college graduation. He was in and out of care facilities. The day before I moved to FL, we had to take him to the hospital because his lungs were filling up with fluid. In my heart, I know it could have gone down a totally different way.

So when do doctors, nurses and nurse practitioners talk to their patients? How do we get the point across that palliative and hospice care isn't "giving up"? How do we convey that it's a way for the person to enjoy their life and the time they have left, rather than missing out on family gatherings, Christmas dinners and seeing their grandchildren? How do we admit that the treatment they are on might not be working, or may be of minimal value when compared to the painful side effects? There is no easy way. I know this as someone who has provided counseling to cancer patients, some of whom really needed help talking to their family about death. I know this as a health researcher, a patient advocate and a family member. It is not an easy set of conversations to have, and each person has to make a personal choice that is right for them at that time.

People may see it as "giving up hope", but I don't think it is. I think it is merely a shift in what we are hoping for. Let's hope for days free of crippling fatigue and vomiting. Let's hope for being healthy enough for holidays, or trips to places you've always wanted to go. Let's hope for quality time with loved ones and friends, days where honesty is spoken and we say everything we need to. We can hope for living life, not just prolonging survival.

remembering.

I was walking to my car after meeting with my Microbiology professor about a test that I bombed, and I saw a bumper sticker that said Remember who you wanted to be. That struck me, because my teacher and I were just talking about the difficulties I was having taking tests, which she feels stems from my lack of confidence in my abilities regarding the material. And she's right -- I have been so intimidated by these classes. I'm in a new environment, the hard sciences, as opposed to the behavioral sciences, and it scared me. She said I need to believe in my abilities and believe I can do it, that I can be a "gunner" like the others. She's right, I know she is. My family has said this to me many times. I think the issue of self-confidence has been a nagging one especially since last spring, when I did not get into the UNC Health Behavior/Health Education PhD. I mean, that devastated me and totally pulled the rug out from under me. I think it was then that I really began to start to doubt my intelligence, my abilities, and my success. Seeing this bumper sticker made me think, who did I want to be? Not someone who doubts herself, I can tell you that. I have not earned 2 graduate degrees with self-doubt.

This also tied into something that's been nagging me, and I know I've blogged about this before. I love oncology. But geez, could I have picked a more emotionally challenging field? Sometimes it is hard, because cancer is everywhere in my life, personally and professionally. I have a friend whose metastatic rhabdomyosarcoma has not slowed down despite amputations, chemo and radiation; he's going to try a new chemo regimen, but the doctors have had "the talk" with him and his wife. He is 32. I have another friend who has leukemia; he just had another recurrence, despite chemo and a bone marrow transplant. His boyfriend is battling Hodgkin's disease. He was supposed to start a PhD at Stanford in the fall; now he is making videos and writing letters for his younger brother to remember him by. He's 25. I have a family member with end-stage cancer. But then I remember all of my friends who have overcome their cancers, and who are living and thriving.....but it's hard. In some ways, I wish I could be less emotional about it -- but at the same time, I think it's my emotion that illustrates just how passionate I am about the field, and patients can sense that. Patients can sense when a provider is "just doing a job", as opposed to loving what they do. I want to love what I do. I want them to feel my passion for making a difference.

I worked in an ob/gyn office for 6 years and loved it. Sometimes, when oncology gets to be too hard, I wonder if I'd be better suited to being a nurse midwife. Delivering babies. Pink and blue and happiness. Or a women's health NP. But then I remember my reasons for going into oncology, and go back again.

When I remember who I wanted to be, I remember I wanted to be a passionate, determined, never-give-up health educator and oncology person. I wanted to forge connections with patients and make a difference. I wanted to be optimistic and believe in the best outcomes, and believe in miracles. And this is all still possible. I just have to remind myself of that. I just have to believe.

role reversal

So in less than a month, the tables will be turned and I will be the patient. I am having foot surgery to correct my bunion...again. Same foot. Yep, the first surgery, which was 2 days after my college graduation, only shaved the bone bump off. And the bone continued to curve, resulting in a nifty half-moon shape that is throwing the sesamoid bones (in the bottom of the foot) "off track". The bone needs to be broken and the tendons realigned. The surgery is Friday, 3/26, and I'm hoping to be back to school by Wednesday 3/31. The thing I dread is not being able to run for 8-10 weeks. Looks like I will be getting in some pool and biking time for the tri, huh?

This is the last week before spring break...I just have to get through this week, and then I can relax....sort of. I'll be studying over break, but at least I won't have classes and new material. School is going okay. Much to my surprise, A&P is actually not interesting me so much right now, but Microbiology is. I think it's because now we're studying immunology, and I find that so fascinating. Plus, I think immunology is related to oncology in many ways, and that's familiar to me.

Anyway...not much else is new. I've been studying and making notecards for my classes and studying some more, and writing for the ACS blog and articles for livestrong.com, so my life hasn't really felt like my own. Not to mention I need about 12 more hours in a day.

this kind of work.

"This kind of work, it changes you....and it IS too easy to lose your way." These words were just spoken on Grey's Anatomy by the Chief of Surgery. He was talking to the physicians and telling them about his experience with a person with AIDS back when AIDS first came on the scene. And though Grey's is often far-flung from the truth, there is truth to these words. Hearing him say them...well, it sounds cheesy, but it reminded me why I am on this path and why I continue to slog through, despite setbacks and failures and struggle, despite having to take undergrad classes at the age of 29....I do it because I love it. I love oncology, and it feels right working in the field. I honestly cannot see myself doing anything else but something in oncology. There is something humbling in working with people and families living with cancer. Many days, you are the one being taught. There is something magical in the human spirit, that is amazing to watch and be a part of. Though it can be depressing work, the relationships and resilience and hope are also a huge part of it.

This is what I need to keep in the forefront of my mind when I get discouraged with my classes, or overwhelmed with memorizing. This is what I need to remember when I find myself thinking I'm crazy for doing this and not taking a job that is simply satisfactory but pays the bills. I need to remember my grandmothers' gratitude when I explained her pathology report to her. I need to remind myself of my dad's "thank you's" when I broke down my aunt's medical records in everyday language. Or R's pleased surprise when I call to see how she's holding up with radiation. I need to remember Erik, Sophia, Pop-Pop, Jennifer, Jaime N, Kendal....and all the other wonderful people I have in my life who have been affected by cancer. I am tired of hearing that someone else died, or someone has a recurrence. I'm frustrated that the scale is not tilting in a different direction with cancer.

But I guess that's why I chose oncology.

Or why it chose me.

"If children have the ability to ignore all odds and percentages, then maybe we can all learn from them. When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up, or fight like hell." -- Lance Armstrong

strong in the broken places.

Things have been busy. I got the part-time job I interviewed for at the UNC School of Nursing; I start next Tuesday. It's a research job working on a study of survivors of acute childhood leukemia. I think it's a great opportunity and I'm really looking forward to starting it. I need something I'm passionate about right now.

I started 2 classes - I'm not in an academic program, but I am a part-time student taking prereq's that an accelerated BSN would need. Right now, I'm not even sure my brain works this way. It's just that all the health educator jobs I saw, wanted a NURSE health educator. Didn't matter that I had my MPH; they wanted a clinical degree. I was pretty discouraged. I still look at PhD programs in health psych and public health, but not sure what path will get me to what I want to do. Which is work in oncology, doing patient advocacy and education, and psychosocial oncology research. There are just hurdles, like to do original research, in most institutions, you need a doctorate. Even lots of research jobs I saw at UNC needed a PhD. Frustrating. I think more experience working on research will help me, and these classes will let me know if my brain works in a scientific way. The PhD program at UNC that I had applied to last year seemed to incorporate it all; we all know how THAT turned out. And I didn't have the heart to apply again this year, because I hadn't done any research since then to boost my application, so I didn't think it would make a difference. If I continue to do research throughout this year, I might apply in December...but that's a long way away. Lots can change before then. I think my goal this year is to get research work experience, mainly. I guess I will reevaluate in July/August about reapplying.

The 2 classes I am taking are Anatomy & Physiology, and Medical Microbiology. They are kicking my butt. My brain is on overload. I like the material, but I've never struggled in school like this before. I never studied much before, ever. Now I'm studying for hours each day. Science requires a whole new way of thinking; the homework isn't analytical or asking how I *feel* about anything -- it's very black and white, definite right and wrong answers, and enormous amounts of information. It's like trying to take a sip of water from a firehose. I've been studying every spare minute of the day, but not sure if I'm retaining anything. We'll see, either way, I guess. I've just never felt so inept at school in my life. For someone whose identity is wrapped largely in her academic ability and achievements, this is a bitter pill to swallow.

So, we'll see. I'm just looking forward to my job, which will place me in an area I am comfortable with and knowledgeable about - pediatric cancer. It is familiar, and a passion of mine, so I think I will be okay with that.

"The world breaks everyone, and afterwards, many are strong in the broken places." - Ernest Hemingway

What do you do?

How did we get to this place? What is there left to do when you see a doctor omitting information to the patient, and the patient isn't willing to hear what you have to say? What can you do when, just because you don't have an MD, your information isn't valued? What do you do when you are watching poor decisions being made - on both the physician's part and that of the patient - that will negatively impact someone's life and care? What do you say when you know quality of life and quantity of life might not measure up? What do you do when you see someone not living up to the Hippocratic Oath? Isn't it "First, do no harm?" I thought so, too.

In this case, there's nothing left to do.

All the consent forms have been signed, whether it's "informed" or not remains debatable; all the well-meaning friends have sat in on meetings, although they couldn't tell you IP from IV from subcutaneous; all the available lines of communication have been tried, to no avail.

It is a helpless, frustrating feeling, this place. All of my psychology training has left me with not knowing what to do or what to say, how to react next week....because it is different when it is not a patient/client. It is different when you have a personal, familial stake in things. When you watch someone offer themselves up for sacrifice in the hopes of gaining time, under the false impression that studies have shown benefit, because they've been misinformed by the provider they trust....and chosen not to hear the information you've provided.....it is hard. It hurts.

When I watch this unfold, it reminds me of why I feel (still) so strongly about being an oncologist. So things like this don't have to happen to another person and their family. Because in medicine, decisions don't just affect the patient. You don't just work with the patient in front of you; you work with their family, whether you ever meet them or not. And this....this.....this just blows my mind. On a professional, medical, and human level.

waiting rooms

Sometimes it's easy to forget about "civilians" who don't work in oncology, and what the cancer experience is like for them. This hit me today when I went to the new UNC Cancer Center to give a mentor of mine a recommendation letter form. She's a pediatric oncologist, and I went to the pediatric heme/onc clinic, and sat in the waiting room while she finished up with her patient. I saw parents and grandparents, both alone and with their children, and I realized, once again, that people who don't work in the field can experience this in a much different way. It's too easy for me to forget that, and I need to work on that. I saw the look of badly-disguised fear in one mother's eyes, and the half-hearted attempts at distracting themselves by family members. I forget that people are terrified of cancer, and not everyone turns toward learning information - many people turn away from learning about cancer, because they don't understand it, or it's just too frightening. For me, the more scared I am, the more I read about it, because learning and knowledge helps me to reign in my fear. But that's not for everyone. I choose to surround myself with information about cancer; most people do not, they are thrust into the world of lumbar punctures and chemotherapy and radiation and blood counts and talk of stages and remission and metastases unwillingly. And when I think about that, that must be terrifying. And I cannot allow myself to forget that. Not at all. Whether I eventually become a pediatric oncology nurse practitioner or a health psychologist, I cannot forget the human side of cancer, as Jimmie Holland (my own personal favorite oncology rock star) said. I can't forget the fear or the desperation or the raw hope that many people need just to face the day or another doctor's appointment.

I have chosen to immerse myself in a subject that most people try to avoid with every fiber in their body. I thought about this as I sat in the waiting room. And for a split second, I did think, Jaime, what on earth are you thinking? Look at these children, look at their parents. This field is full of sadness and tears and pain. But then in the next second, I knew that I wouldn't want to do anything else. I don't turn away from this. Yes, it scares me when I let it. Yes, it makes me sad when I let it. But I also know that one day, I will be able to make a difference, even if it's for one family a day. For me, that makes it all worth it.

reason #456 I love Chapel Hill

Tonight I witnessed something so small but so heartening. It was like "paying it forward", in person. Walking up to the store, a woman held the door for me, even though I was far away when she looked back. Then I held the door for another woman, who was far away, and she held the door for a man who was far away. It was something so so so small, but it was nice to see. That's what I love about Chapel Hill.

Reading: Outliers by Malcolm Gladwell

Listening: "Smooth Criminal" by Michael Jackson, "On Nature" by Matisyahu

a sweet and sour way to begin the Jewish new year.

Happy Rosh Hashanah! It is the Jewish New Year and I am very thankful for the people in my life. Though my life right now is not exactly as I imagined it would be, I am hoping that this year will bring me a purpose, and help me find my way. I hope that I am able to build upon my faith this year. Right now, I'm not so sure. I am a person of science, which makes it a little difficult to fully be a person of faith (for me, anyway), yet I cannot shake the belief that there is something more, like a Higher Power, or G-d. Honestly, though, sometimes I feel like he's got a whole hell of a lot of explaining to do.

It is hard for me to watch someone who is very ill, and believe that G-d will heal her. Last time I checked, he wasn't in the chemotherapy suite. It is hard for me to share that faith and fully understand it. My instinct is to find the best damn doctor there is, in the best facility, and fight like hell through surgery and chemo and whatever needs to be done. I don't count on miracles. I can't. Do I pray? Yes, I do. But do I believe that that is enough? Not a chance. To me, it's like that story where the guys are stranded in a flood or something, and the one guy keeps saying, "G-d will save me, G-d will save me", and he dies -- and when he meets G-d, he says, "Why didn't you save me?" And G-d replies, "I sent you a plane, a raft, etc etc". Sure, believe in whoever you want to believe in, whatever religion works for you -- but don't use that as an excuse to be passive. Especially when you're in the fight of your life, literally.

And you know what? Maybe that belief system works for me. It makes it easier to deal with cancer. Just focus on the rogue cells that are multiplying out of control, and focus on what needs to be done and what can be done. I can't focus on the "why her" thoughts, or be angry at G-d, because in my mind, it has nothing to do with him - it's pure science. I struggle with issues of faith constantly; maybe that is an occupational hazard of being in the healthcare field. I don't know. Maybe it's the result of 9 years of religious private school. Maybe it's just the result of being overanalytical and obsessive. There are no right or wrong answers to this, and Lord knows, we could talk about this forever and still have a billion different opinons and answers and options. This one's mine, for now.

There are times - and this is one of them - when I wonder about my ability to work in oncology. I love the field, don't get me wrong. But I also take it very hard when I can't "save", or even help people. I take it hard when I watch people ignore factual advice and receive sub-par care that will hasten their demise. It is hard for me to look sickness in the face sometimes. It is hard when I have done all I can do and have to sit back and do nothing. It is hard to face the limits of medicine, in a nutshell. Does everyone in oncology go through this?

i'm beginning to really hate the color teal.

I haven't really been blogging, and most of the time, it's because I'm not even sure how to form words to express what I am feeling. Yesterday it finally hit me (yes, it took that long to REALLY hit me) how bad my aunt's cancer is. It's pretty freakin' bad. I operate like this: when something bad happens like this, I go on autopilot - I start researching, making phone calls and connections, figuring out what needs to be done. When there is nothing more to be done, the intellectualizing and depersonalizing stops, and emotion finally surfaces. And that's what has finally happened.

Like I did when my grandmother had breast cancer, I am praying and sending a guided imagery cd and cards, but it's frustrating not to do more, all over again. It is so painful to watch events unfold and feel in my heart that an altered outcome would have happened had different decisions been made in this whole situation. We aren't talking cure, or even possibly remission. I'm talking a few more months, or the possibility of a clinical trial, or even optimal debulking, at this point. I'm talking about giving her the best possible chances, given the situation; the best possible prognostic indicators. I'm talking about the realities of the limitations of chemotherapy and the balance with quality of life. Palliation versus treatment. I am struggling with accepting the decisions that have been made. I don't understand them, but I am struggling to respect them. It is hard work. It makes me wonder if I can really work in this field......how will I react when a patient and their family chooses a course of action I strongly disagree with? Maybe since they're not family, it would be different. It likely would be very different, but it worries me. How do we evaluate decisions when it's a lose-lose situation? In your medical ethics classes and patient advocacy classes, you can debate this all you want. When you're faced with it in real life, when someone you love is the patient in question, all of that ceases to matter. Decisions aren't black and white, and sometimes, not even grey. Sometimes there is no right answer, and maybe there isn't any answer at all.

When am I going to learn that I cannot save people? That I am not Supergirl, that I cannot "fix" things. Sometimes I think that's what draws me to being an oncologist - "fixing" things. Go in, remove what's wrong, and it's "fixed". For some reason I think being an oncologist would be less hard on me emotionally, rather than being an oncology nurse.

September is Ovarian Cancer Awareness month, ironically. Teal ribbons will be everywhere. Last year, when my grandmother was diagnosed with breast cancer, it was October, and Breast Cancer Awareness month. Oh, the irony.

I am rereading a book that I'd read years ago - "help me live: 20 things people with cancer want you to know". I was lucky enough to "friend" the author on facebook recently - although I didn't realize at all who she was at the time - and decided to reread it. I would say these guidelines even apply to loved ones of the patients...as in, when I tell you my aunt has ovarian cancer, and you know about my grandmother's breast cancer, please do not get a stricken look on your face followed by pity. Do not assume I have a BRCA mutation running amok in my family, or even a HBOC (hereditary breast and ovarian cancer) issue. I worry about that enough for both of us, I don't need the reminder. When I tell you about my aunt being in the hospital for a few more weeks, please do not say to me "Do you really think she'll leave the hospital?" (Yes, horrendously enough, someone said that to me this week). Don't think that because I am living my life as usual that it's not on my mind. It is on my mind when I wake up, and it is the reason I can't fall asleep. It's okay to ask me about it. Otherwise, it's a big teal elephant following me around. And that just cramps my style.

Randoms: check out Teal Toes for ovarian cancer awareness! If you get pedicures, get your nails painted teal next month! When people ask you about it, tell them about the early symptoms of the disease.

I am still raising money for the Avon Breast Cancer Walk.....not sure if I will actually walk, do crew, or even be able to GO, but I'd like to raise as much money as I can. Please let me know if you're interested and I can send you the link! Thank you!

soul food

My nephew and I, wearing our LiveStrong bracelets. 

Laughing with my nephew.

I haven't updated in over a week, because I went up North for 7 days to visit family. I needed something to yank me out of this rut and reinvigorate me. I spent lots of time with family, my nephew, mentors and friends, and kids. It was just what I needed to restore my soul and fill up my heart. I had dinner with the family I used to nanny for, visited my former coworkers (and really realized how much I've missed them), met with 2 mentors......And now I'm back in Chapel Hill, and trying to figure things out. 

I won't be going to UNCG. When I was in NJ, several people asked me why I wasn't looking at oncology nursing.....I guess I just always felt like it was so gender-stereotyped, and I didn't want to be shoved into that mold. So UNC chapel hill has an MSN oncology nursing program....but you have to have a BSN, and they have an accelerated program. It's a thought. We'll see. 

One of my new obsessions is the brand lululemon. It's a brand of yoga wear that just seems so neat. Expensive, but their stuff is reeealllly cute. 

lululemon stuff

Latest Obsessions

Music: A Fine Frenzy, Gillian Welch

Food: Haribo gummy bears

Soda: diet Sunkist

Lipgloss: Stila cherry crush

by the way, has anyone else seen that "cotton: the fabric of our lives" commercial with Zooey Deschanel? So weird. I can't believe she did that commercial. 

Sugarland, summer adventures, and medical musings

I am sick of buying cards for people because of cancer. I am sick of hearing that people I care about are getting surgery because of more rogue cells. I am getting tired of the heartbreak, of the helpless feelings, and of the non-answers the medical community has to give so many of us regarding cancer. But I also know that those IN the medical community are just as frustrated.....because, dare I say, I am one of those people. I have my MS, my MPH, I've been with the LAF and i2y...I think maybe I can say that. And maybe that's why this is such a double-edged sword for me. Part of me wants to bury my head in the sand and just not think of cancer ever again, but a bigger part of me wants to learn everything I can about it and DO something about it. It drives me to push myself toward more. 

It's been a busy week....in the span of 4 days, I worked over 40 hours babysitting - although, most of the time, it didn't feel like work, since these kids are awesome. I got to spend time at the pool with them, got tan/burned, went to Sugarland, one of my favorite places here in Chapel Hill, went to Starbucks with them, and had many domestic adventures, to say the least. But I came home every night, exhausted and worn out. And I'm trying to put together my schedule, but it's incredibly frustrating. And the financial aid stuff is stressing me out......I had somewhat of an internal breakdown the other day, because I thought, what in G-d's name am I doing? Can I really do this? Really? Is this all a big mistake??? And you know what, I'm terrified. I miss NY, I miss working at MSKCC, I'm scared of these science classes.....but I know that if I don't at least give it my best shot, I will always wonder, what if....and I'm sick of wondering that. I'm sick of regretting things. As Wayne Gretzsky once said, you always miss 100% of the shots you DON'T take. This is a journey....one that I am not familiar with at all,  and one that will be challenging. I've never really truly had to work at schoolwork. But I will have to work my butt off for this. This stuff does not come easy to me. I haven't been challenged like this before, and I think it will be good for me. 

I'm reviewing books again for Elle magazine, yay! I just got a shipment from them for the year-end prize thing, but I'm reviewing books for their October issue, but haven't gotten those yet. I'm looking forward to it. 

This weekend will be filled with moving and packing. I HATE moving. Always have. I want to settle down somewhere......but probably won't for a while. 

I've been thinking a lot about last summer in Manhattan. As I was there, I knew that it was an amazing summer. I knew what a great opportunity it was. Heck, I still carry around my MSKCC lanyard in my bag for luck. I miss it every day. If offered a job there, would I take it? Possibly. I would really give it considerable thought. I loved every day there. Is it worth paying exorbitant amounts of money to live in NY? maybe, for a short time. I do love it there. 

I don't know. I've never had so many emotions and thoughts and things pulling me in so many directions before. I don't have any easy answers here....I don't have any answers, actually. Does this make me uneasy? Of course. Do I feel untethered and ungrounded? Yes. But I have to have faith that the universe is unfolding as it should.....I just have to have blind faith, I think. 

what am I thinking?

I spent over an hour and a half trying to come up with a good combination of classes for Fall semester that don't overlap....with no luck. Apparently, UNCG's system lets you register for classes that overlap - and so you're constantly flipping back and forth between screens, trying to accomodate classes and labs. It's a huge pain. I even called the registration help desk, and they treated me like I was a complete idiot. My fall schedule will be: Bio I, bio lab, Gen Chem I, chem lab, and Physics I, physics lab. If I can't even register correctly, how the heck am I going to manage these classes? I was highly stressed, so I decided to go to the gym. 

3 miles and a lot of sweat later, I'm still stressed, but I'm not holding so much of the stress in my body anymore, if that makes sense. But I was shampooing my hair and thought, what the hell am I doing??? On one hand, I'm calling myself out on something I've been talking about for years and years, and really putting myself to the test. On the other hand, I am challenging myself in a way I've never been challenged before. I've never really been scared of school......until now. What makes me think I can actually do this? My passion and drive and love for oncology won't get me an A in physics. Can I really do this? 

baby steps.

I'm not sure where to start. I guess I should start with the most exciting news......I will be going to UNC-Greensboro in the fall, for their premed post-bac program! I am ridiculously excited to be studying bio, organic chem, physics, and pre-calc (and that's just first semester!). That's sick. But the reactions I'm getting from most people are this: Finally! I've been talking about it and obsessing about medicine for so long, and reading medical textbooks for fun, that it's like, okay, good, you're finally going to do something with it. I was talking to a friend of mine, E, today, and he's actually a physician, and he said that I have wanted this more than he's ever wanted to be in medicine, and he has no doubt it will work out for me.....I hope he's right. Because I really do want this, with all my heart. I have wanted this since 2003, and found excuses and reasons not to do it every year.....there are a million reasons why I SHOULDN'T be doing this. But there's one reason why I should: Because my heart and soul are so invested in becoming a pediatric oncologist. How can I ignore that anymore? I don't want to regret any more decisions in my life. At the age of 28, I feel like I already have more regrets than I should. And that's going to stop. I'm finally taking the first step on a path I've been dreaming about for years, and that feels good. 

If MSKCC offered me a job, would I change my mind? I'm not sure. That would be an incredibly hard decision to make, and I would have to weigh everything very heavily -- it would most likely mean I would not pursue medicine, ever. It just wouldn't make sense. I'd be working at my dream job, but perhaps not doing exactly what I want to do. But can anyone really have it all, anyway? I don't know. 

I'm missing NY a little.....just remembering last summer. Muggy summer evenings on the Upper East Side, walking home eating Pinkberry, Starbucks runs, loving my work, still not quite believing I was interning at MSK. It's so hard to reconcile my love for NY and my love for Chapel Hill. Both places feel like home, in a way that no other places have. 

playing doctor.

How awesome is this shirt? Love it. Last night at dinner my friend R asked us what each of us were most excited about. And honestly, for the most part, anxiety overrides any of my excitement about the future. I'm not looking forward to much. Except for one thing. One thing that I don't talk about that often to people, because I don't want to seem flaky or indecisive or obnoxious. I'm excited about the possibility of maybe getting into UNCG and the post-bac program. I honestly get excited when I think about the opportunity to really dive into biology and put myself to the test of whether I really can fulfill my dream. I am eager to prove to everyone that I can do this, that it's not just me avoiding the "real world", or being flaky, or whatever. I have the rest of my life ahead of me to work -- I want to do something I enjoy. And if that comes with a large educational financial debt, so be it. That might be a small price to pay for my daily happiness for the next 60 years. I'm scared and nervous and excited and eager about this all at once. But to really surround myself with science and medicine? Amazing. I would love it. It reminds me of a quote one of my friends posted recently -- and ironically, she is training to be an oncologist. What would you do if you knew you could not fail? I think that's a pretty good barometer of what you really want to do. 

searching for my heart

A year ago tomorrow was my first day at MSKCC. I remember I was so nervous. It was wicked hot that day, and my heart was pounding so hard I thought it would explode out of my chest. I had been waiting for this for so long, and I was finally about to start my much-anticipated practicum at MSKCC. I was so intimidated by everyone there and how smart they were and how amazing the place is....I mean, for me, this was it. I mean, this was it. I had wanted this for 5 years, and here it was. And it didn't disappoint, I can tell you that. Jennifer, my attending, was (is) amazing, Rika and Dara were so much fun and brightened my day, Susan helped me even when I asked her a million questions, and everyone there was so willing to help and assist people and talk with you, even if you were a lowly intern. I met my idol, Jimmie Holland, and loved, loved, LOVED having an mskcc.org email address. Every day, coming out of the 96th st subway after my day at work, I'd be on the phone with my mom or dad, invariably telling them what an amazing day I had had. It was a lot of work, and I didn't want to let my supervisor down, and it was intimidating in the beginning, but it confirmed for me that I was in the right field, oncology. Cancer, day in and day out....and I loved it. I worked on the weekends, I read journal articles at night, I did lit searches after work.....and I honestly loved every minute of every day I was there. I miss it. So why is there such hesitance when I think about maybe returning there? 

And if I do get in to the post-bac at UNCG, can I really handle organic chem? And physics? And biology? When I think about it, I'm excited (I know, huge dork)....and I haven't been this excited since last summer. Especially after not really being proud of myself for the MPH, this new feeling renews my hope. It renews my purpose. It feels right. In my heart, science and medicine feels right. It has taken me a while to get here.....and to trust myself, my instincts, the voice inside my heart....but I'm here now. 

And isn't that what really counts?