thoughts on cancer

So, the other day, Elizabeth Edwards, Lance Armstrong, and Steve Case (AOL's founder) testified before Congress for them to renew the war on cancer that Nixon started. Because Bush cut funding for the NIH last year (or the year before, I can't remember) for the first time in decades, the NCI also lost money. This means less money to fund potentially life-saving grants and trials, less money to pay up and coming brilliant researchers - less money overall. Which leads to (most likely) less progress. (Did you know that what we spend in Iraq in 9 months equals the cumulative budget of the NIH for the past 30 years?) Elizabeth Edwards holds a fascination for me - I saw her at the LAF Summit in Austin in 2006, and she was amazing. Honest, authentic, hopeful.....and when her cancer recurred and was found to be metastatic, I was heartbroken. She and her husband live in Chapel Hill, but I haven't seen her yet!

There is a wonderful article in the NYTimes about how cancer can be a chronic illness, not the death sentence it is usually thought to be.

possibly one of the most amazing days of my life

 "The essence of relationship is that in the encounter, both persons are changed." - Rollo May, an amazing existential psychologist

Today was an amazing day. And I feel like I've said that a lot lately, but today was really great. Today was a Fellows' Symposium - clinical and research fellows presented on a variety of topics, and it was so interesting. My 2 favorite presentations included the one on long-term psychodynamic psychotherapy with cancer patients, and the other one was on "my most meaningful patient". This one was very striking. It was presented by a clinical DO psychiatry fellow, and the patient turned out to be a psychiatry intern who ended up passing away because of a pulmonary embolism after surgery, and the fellow brought up the idea that when the boundaries between patient and doctor blur, is that always a bad thing? This patient was a fellow colleague, yet here was this fellow acting also as her psychiatrist, but she was also her friend. Many people in the therapy world would cringe at this, the whole taboo of dual relationships. Based on comments the fellow made about the support (or lack thereof) from her fellowship cohort, it was very interesting to think about the shifting roles, and how people see their role in the therapeutic and medical relationship. I think some people - physicians, psychologists, therapists - are so hell bent on maintaining boundaries, which are definitely necessary, I'm not discounting them - but some people fail to see that sometimes a blurring of boundaries can be more therapeutic - for both parties involved. Sometimes, as clinicians, we are so afraid of self-disclosing, that I think a crucial human element of the essence of relationship gets lost. 

Another reason today was so great was that not only were many people I've read about from MSKCC's psychiatry department there today, but the founder of psycho-oncology, Jimmie Holland, was also there. She is a psychiatrist at MSKCC, and basically pioneered the field. Ever since I read her handbook of psycho-oncology 4 years ago, I have been in awe of this woman. Her book The Human Side of Cancer is one of my favorite and most read books, and I just have the utmost respect and admiration for her. Years ago, I even told a doctor who worked at MSKCC that I wanted Jimmie Holland's job! And I was only half-kidding. To see her, in the flesh, was amazing. I will probably see her throughout the summer at various things and/or at the office, but today it was like....wow. 

MCHers love the kids!

My nephew and I on Father's Day.

One of my favorite quotes, by an unknown author, goes like this: To decide to have a child is to decide to have your heart walk outside of your body forever. When I first read that quote, years and years ago, it struck me, but in a much different way than it does now. Being older, having nannied with several families (all of whose kids I love, still), and having a relatively new nephew have all illustrated how much that quote really is true. And being in maternal-child health, we work with women and children and families, which this quote really gets to the heart of, in my opinion. At MSK, I am working with my supervisor on a lit review of psychosexual issues and young adults who had childhood cancer. Many people don't know that chemotherapy, radiation, and especially bone marrow transplants can cause premature ovarian failure, or abrupt menopause, bringing a whole new host of issues to an individual who is already dealing with a life-threatening illness. Some people might be thinking, yeah, but infertility is a small price to pay for survival. Well, it's not that simple. Yes, surviving and living through cancer are paramount. But why should having biological children be any less important? Why should they have to possibly make that sacrifice, without their knowledge (many people say they aren't aware of possible risks to their fertility until after treatment)? Yes, there is always banking sperm, freezing eggs, using surrogates, and ART (assisted reproductive technologies), but these are not always feasible or available to everyone, and it's still a very emotionally and psychologically taxing experience. The opportunity to bring a child into this world is such a special, sacred experience - and I feel like it's incredibly unfair for cancer to take that choice away from someone.

Fertile Hope is an organization based here in NY, founded by cancer survivor Lindsay Nohr Beck, and it's a really great group. They have information about all the options for cancer survivors and their significant others, and it's presented in a very matter-of-fact, pity-free way. 

On that note, I'd like to post the Lance Armstrong Manifesto video below. Every time I watch it, I get chills and my eyes tear up. 

And below is the song "Maybe Tonight, Maybe Tomorrow", by the band Wide Awake. They played at the LAF Summit on Survivorship in Austin in 2006, and they were amazing. This video makes me cry everytime I watch it! 

the first week........

As far as we can discern, the sole purpose of human existence is to kindle a light of meaning in the darkness of being.  - Carl Jung

Well, I survived my first week, and loved it. Every day, when I get on the subway to come back uptown, my head is swimming with information and ideas. Usually I crash when I get home and take a nap for a little bit because I'm so exhausted, but I love it. Like my supervisor said on Friday when we met again, "The world is your oyster" - and that's exactly how I feel at MSKCC. My only problem right now is actually narrowing down and focusing on something specific to concentrate on. 

Monday is the Fellows' Symposium, and I can't wait to go. Here are just some of the topics being presented:

A Case for Long-Term Psychodynamic Psychotherapy in Advanced Cancer (this one I am REALLY looking forward to!!)

My Most Meaningful Patient

Sense and Significance:How Bereaved Parents Make Meaning of the Loss of a Child (this one sounds really great, too)

How do Palliative Care Families Benefit from Sessions of Family-Focused Grief Therapy? A Preliminary Investigation of Therapeutic Process

So as you can see, there will be a variety of topics on monday, and I am super excited to hear all of them. I think it's also interesting that the one on "my most meaningful patient" isn't being presented by a PhD or MD, but a DO. hmmmm. 

Anyway, being in NY is great. Expensive and tiring, but great. It's been a tiring week, with all the walking and getting used to a new environment and job expectations, but I feel very satisfied at the end of the day. My brain might be overloaded, but I'm filled with inspiration and ideas. It's also really great to be back in the city, among so many different people and so much energy. I do miss NC, though. People are just friendlier down South, but we all knew that already. This weekend will be a weekend of relaxing, I think. Catching up on sleep (since I don't seem to get much sleep during the week), doing some work for internship, and just relaxing are the plans so far. 

High point of today: finding a Chinese restaurant right across from my apt and Jamba Juice on 86th and Lex

Low point: the cuts on my Achilles tendons from my shoes, being "dripped on" from a/c units in buildings

come here often?

Isn't my nephew the cutest thing ever? 

Anyway.....
Only in NY. Only in NY would a creepy guy try to hit on me if I were an oncologist. I swear to G-d, today, on my way home from work, I get on the subway, and by some miracle, there's space for me to sit. So I slide onto the bench, and I realize I'm still wearing my ID tag around my neck. The man next to me (probably in his 40s) looks me up and down a few times (I'm wearing a polo and a madras skirt), looks at my ID tag, and says lasciviously, "So.....are you an oncologist?", with a creepy grin. And though I wish I could be an oncologist, I smiled and said, "No, I'm in public health." And with that, he promptly looked away and didn't acknowledge me for the rest of the trip. Strange.

On Monday, the Psychiatry/Behavioral Medicine fellows are participating in a Symposium at the main hospital, and I get to go! I'm so excited for 6 hours of cancer talk. I'm excited to see what interventions they've researched and what programs might be in the works for patients. Every day I am amazed yet again at the brainpower under one roof. And it hasn't been a rare occurrence to be reading articles for my lit review and suddenly realize that the authors of the article work at MSKCC. I'm still a little starstruck. 

I've been thinking a lot about cancer, even when I go home after work, and many times I wish we could do more for patients. I have a friend who is a pediatric oncologist at Hopkins - here's his blog -  and he told me about a patient of his whose cancer came back. She has medulloblastoma, which is the most common malignant CNS (central nervous system) tumor in children. It is a cerebellar tumor, and the cerebellum is a part of the brain that plays a role in sensory perception and motor control. She has had one bone marrow transplant (BMT) and is preparing for a second because of the recurrence. It just breaks my heart. You can read about BMTs here - they are incredibly taxing. And this 11 year old little girl is going through this. It just doesn't seem fair. For a second, it gets discouraging. But paradoxically, that is the very same thing that inspires me and reinforces why I am doing what I am. 

workin' 9 to 5

You know it's been ridiculously hot when you look on weather.com and feel overjoyed to see that the temperature will be 88 degrees...it's been super hot here, but today we got a slight break. Yesterday I was able to finally get my MSKCC ID, and since there's a shuttle from the main hospital at 68th (where I got my ID) to the Rockefeller Outpatient Center at 53rd (and the Counseling Center is at 54th), I decided to take the shuttle to work. Bad idea. We were informed there was no a/c on the shuttle, and it ended up taking a half an hour to go 15 blocks, since it was morning rush hour. It was excruciating, let me tell you. I met with my supervisor, and any nerves I had about being at MSKCC were alleviated, because our meeting was wonderful. We talked about all the research she's doing, funding disparities among types of cancer, fertility and cancer, plans for next year, and various people in the cancer advocacy community we both knew (the world of cancer tends to be small, as I am finding out!). I am working on several studies, and will have the opportunity to speak with patients about their cancer experience. Basically, anything I can think of, is most likely possible here. I feel like the resources are unlimited and the opportunities are endless. I'm like a kid in a candy store, and can't wait to dive in. 

Right now I'm doing a literature review on psychosexual issues among survivors of childhood cancer, and though I spent hours reading and researching today and my brain is spent, I am incredibly happy with what I'm doing. There's just so much to learn, and still so much more to be explored. 

Living on the Upper East Side is pretty good. My neighborhood is cute, relatively calm compared to downtown, and my living situation is pretty much like a dorm. My roommate, Jessica, is a college senior who is interning as a wedding planner, and she's incredibly nice. She's originally from TX, and Regina - she loves Paula Deen! In some ways, I feel like I've regressed back to my undergrad years - think about your college dorm experience, and that's how this is, complete with communal bathrooms and shower cubicles, etc. I haven't lived in a dorm since 2000, so this is a fun little flashback for me. Everyone on my floor seems pretty nice, although people pretty much stay to themselves. 

Being back in NY is good, and although I was apprehensive about returning after being in Chapel Hill for a year, where people actually have manners and thank you for holding the door for them and strike up conversations with you in line, I've found that many people here are very responsive to kindness. They might not initially smile at you or start a conversation, but if you hold the door for them or wish them a good day, you'll get a smile and a "thank you" in return, and they somehow open up a little more. It makes the city a little less robotic and a little more personal. 

"Although the world is very full of suffering, it is also full of the overcoming of it." - Helen Keller

why you should not wear sandals in the city

High Points: Lunch at pinkberry, working in the air conditioning, the nice people I met today

Low Points: the 97 degree sweltering city heat, my dirty feet (due to both my shoes and the sheer reality of going sockless in the city)

Today was my first day of practicum, and because my supervisor was working from home today because of a conference she had attended, it was pretty much an intro day. I learned about one of the studies I will be working on, the retinoblastoma study, and learned about and used the database used for the study, and also am reviewing articles for my supervisor. Tomorrow I get my ID and (hopefully) an mskcc.org email address, and since my supervisor will be onsite, I should know more about my daily routine and projects I will work on, etc. 

It is so hot here that supposedly, there will be some brownouts on the UES because of the demand on the power system, or something like that. Good times. 

summer in the city

New York is a tough city. It is complex and beautiful. Cities are amazing and brutal. We love cities. They survive, we survive. Each individual finds a way alone or with the help of others....To be in a city like New York or Los Angeles or Mexico City is to be in a dialogue with a community of people that inspire and inform one another...." - from the book "Letters to a Young Artist"

Last night I went to the best candy store ever, and hopefully soon I will go to my favorite place for cupcakes. It is HOT in the city today, and everyone looks like they just ran a marathon. I still haven't found hangers, and am trying to avoid going all the way downtown today to get them. Plans for tonight include going out for dinner with my friend Jessi, whom I haven't seen in 2 years, so I'm looking forward to that. 

I've found a new obsession, Pinkberry. It's a frozen yogurt place that sells 3 kinds of yogurt - pinkberry, coffee, and green tea - and various fruit/cereal toppings. I went yesterday and got pinkberry yogurt with bananas and blueberries, and it was heavenly. Especially since it was over 92 degrees. The fro-yo is sort of yogurty tasting; more so than regular frozen yogurt, and though I'm not a fan of regular yogurt, it was super good. I have a feeling I will be eating lots of it in the next 8 weeks.

Tomorrow is my first day of practicum, and I'm not quite sure what to expect, but I'm very excited, albeit slightly intimidated. 

American Cancer Society - friend or foe?

I'm part of i2y (imtooyoungforthis.org), which is a great organization that focuses on young adults living with cancer, and the founder, Matt Zachary (an awesome guy) sent us an email about the American Cancer Society. It turns out it might not be the great organization everyone thinks it is - here's an article about how wealthy the ACS is, though it is a non-profit, and here is an article that shows that only 2% of their 2006 expenditures went toward patient assistance services. And of the cancer research grants that they DO fund (14% of their 2006 expenditures), NONE are for young adults. The 2006 salary for the CEO of the ACS is $656, 000, with an expense account of $500,000. 

Doesn't it seem like something's off? And if young adults are the one demographic group that has not had a decrease in mortality in decades, shouldn't at least SOME research grants be devoted to this??

Move-In Day

So I am finally in Manhattan, and for the most part, settled in. My room is small (the picture above is pretty much nearly the whole room, for two people), and I haven't met my roommate yet. But it's airconditioned, has a doorman, and has a laundry room right down the hall, which, by NY standards, was worth every bit of the $2400 it will cost me to live here for 8 weeks. Yeah. I'm at a Residence which is part of the 92nd St Y (a cultural mecca on the Upper East Side). It's one of those places where parents sign their kids up for the preschool here when they're still embryos because of the admissions waitlist, and there are talks and concerts and classes, which are all pretty neat. There's a Dunkin' Donuts right across the street, and a Starbucks around the corner, as well as a supermarket next to the DD. So it's a decent location, and the neighborhood is cute. 

I like mail, so here's my address:

de Hirsch Residence

Box E-21

1395 Lexington Ave

NY, NY 10128

My mission today: go food shopping, go to the drugstore for odds and ends (like hangers and plastic baggies for lunch), and eventually meet up with my friend Emily and also go to Dylan's Candy Bar and stock up on candy for the next week or so.