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

there's no place like home....

The Old Well at UNC

Much of the time, I find myself missing New York. More specifically, Manhattan. I lived there twice; once on the Upper West Side when I went to Columbia for a year, and once on the Upper East Side, when I interned at MSKCC. I consider New York to be one of my homes...it is one of the few places where it immediately, instinctually felt like home the minute I arrived. Whenever the "homesickness" gets to be too much, I find myself reading the NY travel guides I have. Despite having lived in North Carolina for over 2 years, I still subscribe to New York magazine and regularly buy Time Out New York, when I can find it. No cupcakes here will ever live up to Buttercup Bake Shop or Crumbs, no bagel here will be half as good as H&H, and don't even think about giving me a black and white that isn't from the city.

Though not a native New Yorker, I am definitely a Northerner, born and bred. I walk fast, talk fast, can be an aggressive driver, and often find myself (unfortunately) short on patience. So how on earth did I find myself making Chapel Hill my home? When I applied to grad schools, I mostly applied to Northern schools, with GW and UNC being the exceptions. Oh yeah, and Emory. I was headed to GW when I got the acceptance to UNC, and found myself south-bound, not quite sure what to expect. The friendliness was disarming at first, and the unspoken social rules hard to decipher. The fact that many people don't lock their house doors until they go to bed at night blew my mind. I'd never been to a school the size of UNC before, and never lived in a college town like Chapel Hill. When I first got here, I liked it, but was pretty sure I would move back North when I graduated.

Long story short, over the 2 years of my MPH program, I found myself liking the slower pace here, liking the friendliness, LOVING the affordability, and feeling...well....feeling like I could adopt this town as a home. Graduation came, and I knew I would stay in the South, unless a dream job in NY opened up - and even then, it would have been a tough decision.

Chapel Hill is often called "the Southern part of Heaven", and I can see why. I love my neighborhood, which is a New Urbanist neighborhood (although some people think it's too Stepford-esque), I feel safe here, and there's a quaintness to the town that I can't fully place. When I first got a Chapel Hill address, I loved the fact that I could write "Chapel Hill" - it had been a place I'd heard of over and over, with Tar Heel sports, but actually living there was something different. Although I read NY Magazine, I also find myself regularly reading Chapel Hill Magazine. Over the past 2 and a half years, I have made this town my home. I have found favorite restaurants, cupcake haunts, and people who remember me at coffee shops. Though I miss my family often, I know they are a short plane ride away. Last summer I had the opportunity to show both my mom and my grandparents, and my dad, around Chapel Hill and where I have lived, and yet nothing I showed them could adequately portray why I like it here so much. I can never fully explain to people up North the intensity of the UNC-Duke rivalry. Or why, when basketball season rolls around, I suddenly turn into a sports fan. (although the fact that my other fave team, UMiami, is also in the ACC, sometimes poses a problem).

My driver's license, registration, voting record, and in-state tuition status all point to the fact that I am a bona-fide North Carolinian. Am I a Tar Heel born and bred? No, not exactly. But right now, I am a Tar Heel, and that's good enough for me. In fact, I just found this article written by - of all things - a native New Yorker who goes to UNC. She describes many of the same sentiments.

Maybe my sweet nephew will become a Tar Heel - he already loves Ramses the ram!

year in review

Wow. So it's the end of 2009. The past decade has been chock-full of change. From starting it at the age of 19 to now, at 29, my life has turned out to be nothing like I had expected it to be or planned on it being. And maybe that's exactly how it's supposed to be. This decade has brought me a Bachelor's degree and 2 Master's degrees, living in Manhattan twice, a stint in South Florida, losing a grandparent and gaining a nephew and new baby cousin, and watching 2 people in my family meet cancer face to face.

This past year has brought the remission of my grandmother's cancer, the diagnosis of my aunt's cancer, the devastation of not getting into a doctoral public health program, figuring out who I am and what I want to do with my life and finally taking my writing seriously and earning money from it. This year has also brought the Stage IV breast cancer diagnosis of a friend of mine, numerous new friendships into my life, and the end of some unhealthy friendships. I have had to reconcile what I thought I wanted with what I *really* want in life, and am realizing that everything I planned might work out in the end, but not the way I thought it would. Am I always 100% happy and okay with this? No, it's a struggle. But I'm slowly becoming okay with the roundabout way my life has gone. I've learned a lot from every experience, and have met people on every step of my journey that have taught me and that enrich my life. These people in my life are constantly surprising me with their kindness and generosity.

What will happen in 2010? I guess we'll see.....

dancing in the rain

The day after Christmas....although I do not personally celebrate Christmas, half my family is Roman Catholic, so we usually go to my aunt's house for Christmas dinner and to exchange presents. Despite the fact that she was in the hospital this year, we still went to her house, where my cousin and his wife had been staying for the past week. We had homemade lasagna (which was excellent), vegetables, potatoes, etc. It didn't feel like the holiday, though, because my aunt's absence was palpable. I think there were a lot of feelings that were like an undercurrent to the day. We did go to the hospital after our gift exchange. Given the circumstances, my aunt looked good. She had been walking around, eating some solid food (although not as much as she needs to; even her doctor told her she especially needs protein after surgery and during chemo), and not in too much pain or discomfort. I have to admit, it was jarring. And being in the field, I hate that I was taken aback. But the last time I saw her, she had been wearing a wig and had eyebrows and eyelashes....and yesterday she wore a surgical cap and was bald, with no eyebrows and (to me) no visible eyelashes. It brought the whole emotional aspect of cancer home, real fast. But despite that, I think she looked okay. She got an IP (intraperitoneal) port during the surgery, and the plan is to start IP chemo 2 weeks after surgery. I worry about that; IP chemo is notoriously hard. According to the Manual of Clinical Oncology, the majority of ovarian cancer patients do not end up completing all 6 rounds of IP chemo because of the side effects and toxicities. It's harsh. For patients with Stage III ovarian cancer, it has been shown to extend survival, but for patients with Stage IV ovarian cancer, it is not clear whether there is significant benefit. I don't just want her to have extended survival - I want my aunt to have extended *quality, pain-free or low-pain* survival. Survival where she knows who her family is and isn't on massive amounts of medication for pain. Survival where she can travel or go places and do what she wants and not be homebound or bed-ridden. Survival where she can laugh with her grandson and my nephew. This is what everyone wants for their loved ones; quality time. And hopefully, once IP chemo is over, this will happen. That is my hope right now. Hope. Hope. Such an intangible thing that bears the burden of so many wishes and dreams.....

It's been good being up North. I do miss Carolina, and when I go back, I will start 2 classes....Intro to Medical Microbiology and its lab, and Intro to Human Anatomy & Physiology and its lab. I'm terrified and exhilarated. I am taking these classes, and if I do well, I will take one more over the summer - these are prerequisites for the accelerated BSN. Nothing is set in stone, though, and for all I know, I might fail spectacularly. We'll see. I also have an interview for a research assistanship on AYAs and cancer. *fingers crossed*. It sounds amazing, and exactly what I study and what my main focus is.....so hopefully it will work out!

2010 is a week away....this year, 2009, has brought surprises, disappointments, bad news, good news, the end of some friendships and the making of new ones, and taught me a lot about myself. Am I where I thought I'd be? Nope. Am I following the path I thought I would? Not right now, but we'll see in a few months. As one of my mom's holiday cards said, Life isn't about waiting for the storm to pass; it's about learning how to dance in the rain.

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.

Grief and Hope

Someone emailed me over the summer with the words Grief and hope are not mutually exclusive, Jaime...and I've tried to keep that in mind. She said it doesn't make sense if you approach it "logically"; it's something that you have to approach from the heart. Which can be hard for me, since I like things to have reasons and explanations and clear boundries and paths. What does the coexistence of grief and hope look like? I've been trying to figure that out. Does it look like the woman who knows there is a good chance this might be her last Thanksgiving, but still pushes ahead for treatments? Does it look like the girl who is holding out hope for a miracle, but with her oncology knowledge, knows that's not going to happen and it pains her to watch? Or does it look like the man who stands silently to the side, waiting for the right moment to lay it all out on the table for her knowledge? I think we all know what grief looks like; the crying oneself to sleep, or crying in the shower, the anger and fury that comes out as a response to a seemingly random diagnosis or outcome. We are all familiar with that dazed feeling of how did I get here? was it only yesterday the world was normal? But that was yesterday, and after today, nothing is ever the same.

I am going up North tomorrow for Thanksgiving, and my bags are full of hope and grief. This Thanksgiving, I am thankful for my family that I have right now, the fact that I have three grandparents, two parents, an aunt, 3 cousins, a brother and a nephew. I am thankful they are all alive here to celebrate with me this year. I am going to concentrate on living in the moment, because that's all we have right now - that's all anyone has, really. But Stage IV cancer has that nasty habit of bringing things to the surface, and this fact is no different.

I really, really hate Stage IV cancer.

cupcakes and life lessons

This is actually the inside of Bliss Bakery!

I went to a new cupcake place last week - Bliss - and now I think I'm obsessed. Their cupcakes are yummy, and their coffee is amazing...it's French press, and so good. The first time I went with the kids I babysit, I had a Red Velvet cupcake, which is daring for me, since I'm usually a vanilla cupcake with vanilla icing girl (which is the cupcake I got on saturday with Miriam). I'm lusting after this HUGE cupcake you can buy that feeds 12-15 people....it's $45, and I think it would be WONDERFUL for a birthday. Not that I know anyone with a birthday soon.....but Bliss's cupcakes are sweet without being saccharine (like Sugarland), and light. You don't feel heavy after eating them. Which makes them very, very dangerous. Of course, do I miss Crumbs and Buttercup Bake Shop, but short of getting on a plane for a cupcake run to Manhattan, Bliss will do quite nicely. 2 years ago, my then-roommate, Sonja, had gone to Manhattan for the week, and just happened to come back to NC on my birthday. She brought me back cupcakes from Magnolia Bakery for a birthday gift! I was so surprised...I mean, to carry them on the plane and everything? That was, by far, one of the best birthday surprises I have ever had.

I was reading blog entries from last year...G-d, I was so optimistic about doctoral programs. Things seemed to be falling into place. And somehow, I went from there to here. A place where nothing is certain, I'm not sure which way to go, and I don't have a set plan right now; no trajectory. This is not where I wanted to be, and I am trying to do everything I can to change this. It's a rough and rocky road right now, and I'm just trying to clear the path enough for me to squeeze by, if that makes sense. I know that I want to do research, work in oncology, and also work with patients - doing patient education and advocacy, counseling....somehow, a mix of all that. I'm looking at two possible avenues, but I'm not writing about them until January, because I don't want to jinx anything. Superstitious, yes. But I don't care.

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

november!

wow, I haven't written in a while. Things have been busy with babysitting, writing, trying to find a job....and I went up north to NJ last week, and just got back to Carolina today. It was a good visit, and my time with my nephew was great. He has such unbridled joy with life, and when he's not being cranky or mischievious, he's actually very fun. He says the funniest things - I needed to put him to bed, and he kept saying "stay up, stay up"....where he learned that, I don't know. He cracks me up.

I don't have much to write, unfortunately, because there are so many things in my head with what I want to do, jobs I am applying for, decisions to make about future plans.....and no one wants to read all that stuff. So I overanalyze and obsess and talk myself in and out of various options again and again and again.

I did see the Michael Jackson movie "This Is It" last night (wow, it seems so much longer ago), and it was really really good - I don't know what I was expecting, but it was better than anything I was thinking of. I don't think I stopped bouncing along to the music the entire time. And knowing the outcome makes it slightly odd to watch, but ultimately...it's a good movie.