My Most Difficult Challenge

Five years ago I was too out of shape to walk my dog all the way around the block.  This was no surprise to friends who remembered me as "the kid who gets picked last" in gym class, and to my family who remembered my refusing Mom's orders to pull weeds because I didn't want to get dirty or sweaty. Since 2006, I have completed countless running races, including three marathons, several long bike rides, including a century ride (100 miles), two endurance swimming races and countless triathlons, including three half ironman triathlons and, most recently, a full Ironman triathlon, thought to be one of the most difficult athletic achievements one can undertake.  This spring, I was awarded the "triple crown" by the Leukemia and Lymphoma Society's Team in Training, celebrating my completion of a marathon, a century ride and a triathlon, all while fundraising to help find a cure for cancer.
And, this fall, for the first time in five years, I wasn't sure what to do next.  I was tired, so so tired, and did not want to do another full Ironman.  Among other things, I wanted to spend more time with my husband, Steve.  At the same time, I realized that I would not be content doing short, local races.  I needed some big challenge.  My challenge needed to be something a triathlon buddy of mine calls "epic."  What was it?  I began to pray for God to tell me what my next challenge was to be.  Please, God, make it something big, I asked.  God answered my prayers. 
I have breast cancer.  This answer was not what I was looking for.  Steve suggested that my mistake was praying to the Old Testament God, the God who turned Sarah into a pillar of salt and sent down the plague of locusts.  He implored me, "don't do that any more!"  I prayed again, more specifically, carefully and pointedly, couldn't my challenge be to run an ultramarathon (a running race over 26.2 miles long), which would be quite enough!  I promised to raise money to fight cancer, other people's cancer, please.  Please.  But it was too late.  My challenge is to fight cancer directly.  And I have come to understand that God has given me this challenge because I am strong enough to take it on and because I am meant to tell this story.  And so I shall.  If you do not want to hear the story, I understand, but consider sharing it with your wife, your girlfriend, your sister.

Discovery.

After a "clean" mamogram in May, I discovered a little lump in my breast in August, while on vacation.  I usually check once a month, but I always have assumed that I could not feel anything even if it appeared.  Or even if I felt it, would it feel out of the ordinary?  Probably not.  Months have gone by when I didn't check.  After all I do get a mamogram once a year.  And breast cancer is not in my immediate family--my great aunt and her daughter, my father's first cousin, are the closest relatives who have had breast cancer. 
But there I was, noticing something different.  Was it there in July?  No, it was not.  I did not think it was cancer, though, but I was scheduled to see my doctor upon my return anyway, so I would show it to her, "just to be sure."  She, likewise, thought nothing of it, and surmised it was a harmless cyst, but she scheduled me for another mamogram and a possible ultrasound "just to be sure."  I rather thought it was a waste of time, but I went, late on a Friday afternoon, to be tortured by the pressing machine. 
This was my 10th mamogram, and by far the worst.  They marked the spot where I felt the lump and squeezed it many times over, admonishing me "do not move, do not breathe."  Time after time, I thought I was finished, only to be told that the doctor wanted another shot.  Finally, this torture ended and I was taken to another room for ultrasound.  A doctor conducted the ultrasound, and without saying anything about what she saw, told me she was working with another doctor, who would be joining us.  The second doctor, older than the first, came in and repeated the same examination.  All of a sudden, I had a really bad feeling.  Why was it necessary to repeat this exam? 
Dr. Ellison, the more senior radiologist, told me it was not a cyst and that she would like to do a biopsy to find out what it was.  "We can do it right now," she said,  "or you can come back next week."  Holy cow, let's find out now!  They performed the biopsy that afternoon, but I would not learn the results till the next Tuesday.  But by Sunday, I knew that it was cancer, and I knew something else.  I knew I would survive.
On Tuesday, Dr. Ellison confirmed my suspicions.  Breast cancer.  "Yes, I know," I said to her.  It is a "infiltrating ductal carcinoma, high nuclear grade," according to the pathology report.

Waiting and Worrying.

The next step, Dr. Ellison explained, would be to have a routine MRI, "just to be sure" that I had no other cancers.  She had scheduled this examination for the next day, followed by a meeting with a surgeon, Dr. Bear.  "We will have preliminary results of the MRI when you meet with Dr. Bear," she promised.
An MRI machine is a loud thing.  Apparently a lot of people freak out when they are rolled into a little coffin-like space and subjected to jackhammering sounds.  Furthermore, if it is a breast MRI, they make you lie on your stomach with your breasts hanging down two holes that look medieval, somehow.  To add insult to injury, they jab you with a needle.
"What kind of music would you like?" the technician asked, earphones in hand.
"Jazz?" I asked, warily.
"No problem. We'll put on the Kenny G." 
Well, not exactly jazz, but you give me a little Kenny G and some loud jackhammering, and guess what I do?  I fall sound asleep.  ZZZZZZ
I had been warned by Dr. Kladder, my primary care physician, that although Dr. Bear is world-renowned, he is not known as "warm and fuzzy."  No teddy bear. He said that he had not received the preliminary results of the MRI, but we could look at it together.  He saw nothing on his laptop computer, but noted that the radiologists have much better views.  He explained that, assuming that the MRI was all clear, I could chose between a full mascectomy of both breasts, or a "lumpectomy" that removes the tumor and leaves the breasts.  With a lumpectomy, I would need a course of radiation therapy, likely to last six weeks. Treatment would occur every day.
My husband asked the doctor, "every day, including weekends?"
Dr. Bear answered, "no, only Monday to Friday."
Steve inquired, "is that because the cancer does not grow on the weekends?"
"Correct," answered the doctor.
Ha!  Not a Teddy Bear, but a man with a wry sense of humor! 
He went on to explain that, statistically, my 10-year survival rate would be the same if I chose a lumpectomy and radiation or if I chose to have a full mascectomy.  If I chose the lumpectomy, though, I might have to undergo chemotherapy too. Whether that would be indicated for me would not be known till after surgery.  He did say that they tested my cancer and learned that it responds, and grows, when fed by estrogen and progesterone, female hormones.  So I cannot take birth control pills or, later, hormone replacement therapy, and in fact I am likely to be prescribed a drug that prevents my body's natural hormones from feeding my cancer. 

So, radiation and hormone blocking drugs, and maybe not chemotherapy. 
"Which is the treatment that makes you lose your hair?" I asked.
"Chemo.  Radiation does not make you lose your hair.'
I decided to go with lumpectomy, radiation, and the possibility of chemotherapy.

But then I realized he said the MRI results were not in.  "Dr. Ellison promised me someone would have read my MRI by now," I reported.  "Oh, she promised, did she? We will call her on that!" He called and got the radiologist on the phone.  And I heard him say, "oh, I see.  Where is it?"  He moved his mouse over the mouse pad, and suddenly we saw it.  Another lump, smaller than the first, but there.  "Is that in the left breast--the opposite breast from the known cancer," I asked, sick to my stomach. 
"Yes.  We need to have this tested, to see what it is."
The "test" would be another biopsy, which could not be scheduled till the next week, and then there would be more waiting for those results.  Somehow, this wait was harder than the wait to hear whether the first biopsy was cancerous.  If I had a second cancer, in the opposite breast, then I knew the doctors would recommend a full mascectomy. I contemplated this option with some dread, until I read something that suggested reconstruction surgery takes place right away, and can result in breasts smaller or larger than the originals. 
Should I go with Dolly Partons?  Having those was a secret dream when I was a teen, though not so much lately.  What about going with flat boobs like Mirinda Cafrae.  Fast Ironman World Champion, but mosquito bites, bless her heart.  Still, she no doubt can go for a run in a T-shirt, no bra.  I did a bit of research, though, and discovered that these options came neither with the honey-like voice nor the Ironman speed of these two ladies.  So all in all, I wanted to keep the originals.  I prayed for no factory recall.  And it wasn't just a cosmetic worry, of course.  How could a second cancer have appeared in such a short time?  It would mean that I had some sort of invasive, aggressive cancer that would be hard to fight.  So I worried, and I had to wait.

Learning Not to Plan.

After dutiful waiting, I got the good news that the second spot was not cancer, not at all.  "It is a Pamploma," I thought I heard the radiologist report to me.

"Good news!" I told Steve that night.  "The second spot isn't cancer, it's a Pamploma!"

"Pamploma is the place in Spain where you run with the bulls," he said quizzically.

"Oh, maybe that's not right.  Well, they said I get to keep the thing inside me that wants to run with the bulls!  Only the cancer is coming out!"

I met with Dr. Bear again the next day, to confirm to him the kind of surgery I am to have to remove my cancer, which he confirmed to me is stage one cancer.  Surgery is scheduled for next Monday, October 17th.
"Can I go back to work the next day?" I asked.
"Absolutely not!  You will be under general anaesthesia and will be loopy and unable to think on Tuesday.  You probably won't be able to work until tthe following Monday."
"Oh, wow.  When can I exercise?"
"Are we talking fitness walking or golf?"
"Triathlons!  Or, put differently, swimming, biking and running.  I ran an Ironman in June."
"Oh, I see.  Well,  I think it will be 3-4 weeks before you can return to those activities.  We will have to see."
"Okay.  When does radiation therapy start?"
"Well, this depends on......"
"Doctor!" I cried, "I want to put all my treatments into my day planner for months going out.  I really need to plan!"
"Yes, I can tell you do," he replied.  But no information was forthcoming.
I am told that I will learn to be patient, to take one day at a time.  hmmm  I am tryng!

Exuberance.

All of this news has been stressful.  I know in my heart of hearts that I can do this. I can and will survive.  But sometimes I feel a bit overwhelmed.  And sad.  I do not like feeling sad.  I always view the glass as half full, and I like to be happy.  Furthermore, I find that if you want to be happy, you can be happy.  Years ago my mother told me that if she telephoned me in a Chinese labor prison, I would report that I was "doing fine!" 

Somewhere before I was diagnosed with cancer, as I cast about wondering what my next challenge would be, I really did think it would be to run an "ultra marathon."  These races are longer than 26.2. miles.  Often they are 50K (which is about 31 miles) or 50 miles long.  Typically, they are on trails rather than on roads. 

I hike on trails with Steve on vacation, and I have always had this irrational fear of crossing streams.  It takes me forever!  Plus, I have no experience running on trails.  Years ago, I ran on trails while Steve and I were on vacation because I was training for a marathon and the park ranger told me that they'd spied a Grizzly on the road where I wanted to run, and "he'll think you are prey!"  He advised me to run on a groomed Grandma trail.  That little run resulted in bloody knees, bloody hands, and a bloody chin. 
Despite this, I had spied a 10 mile trail race in December that I thought I might try.  Now, though, with the cancer, I could not do the race.  My surgery is on October 17th, after which I will not be able to run for 3-4 weeks.  That would leave only 3-4 weeks to get back up to running 10 miles, and during that time I would be on radiation, which makes you tired, or chemo, which makes you sick. 
A friend mentioned the race again, and I was a little sad.  And then I realized I needed to sign up for it.  I need to view the glass as half full.
So what if I have never done a trail race before?  
So what if I am clumsy and usually fall down?  
So what if this race has five scary creek crossings?
So what if I am normally slow as a turtle, so I might be the last to finish in normal times?
So what if the cancer treatment will make me slower still?  
So what?  
I signed up for Bear Creek 10 miler, and at last count I talked about two dozen friends into doing it with me.
The glass is half full, and I am filling it to the brim!  I will live life with exuberance.