It’s two days following my second chemotherapy treatment and I am deep into a migraine. A more apt description, perhaps, would be to say that the top of my head is on fire. I am pink from the steroids that must be taken with the treatment. And my hair, which started coming out on Christmas Eve, is falling out strand-by-strand-by-strand. It is time for a second guest blog. This one is from my friend Kathy C. I met Kathy twenty-three years ago when we worked for the same publishing house. She is a freelance writer and has covered everything from travel to parenting.

It is very difficult to write this blog entry because I do not feel worthy to be stepping on this page. I mean, it is my dear friend Juli’s blog, after all, and her story and her suffering. But here goes . . .

My initial idea for this blog item was to post a mini collection of insights from women I know who have survived cancer (and I know more than a handful). I e-mailed them and expected an overwhelming response filled with encouragement and pithy quotes. But I only heard from one person, two others I never got a response from, and the last friend told me she just could not write about the topic at all.

It was just today that it occurred to me that breast cancer must be the most intimate, awkward, and shocking disease out there. It hits with little to no warning, and it hits the most female part of a woman’s body, and it makes some people feel very uncomfortable to know someone with breast cancer because they don’t know what to say or they wind up saying something quite stupid.

From that minute sampling of friends who didn’t write back to me, their non-response spoke volumes about the aftermath of cancer and how emotional healing will take some time. I have the utmost respect for women going through the torture of “treatment” and Juli, your continued openness about what is happening to you and how you feel about it seems to be excellent therapy to release that complex array of feelings associated with this.

What you write about, Juli, helps me and many others to understand what you are going through. The rawness of it all is painful for me to read about, but I thank you for sharing your soul. I hope your blog opens the doors to more women, especially those who are having a difficult time coping. I hope that this blog will encourage other cancer patients to give themselves permission to rant and cry online and laugh as well. Thanks, Juli, for being real.

I’ve asked friends to fill in for me during the “bad” days of my chemotherapy treatment. This is one of those, as I’m going in for my second session. On these days I’m not only too distracted to write, I’m completely wired as I’ve been told to take five steroid pills the night before. The steroids have to do with the body being better able to absorb the chemicals.

Susan K., a friend and colleague since the mid 1980s, is today’s guest blogger. She is currently managing editor of a Northern California magazine called South Bay Accent.

It’s hard to fill in for Juli since this is clearly meant to be her voice. But I can’t help but think of her during all the controversy about changing the frequency of mammograms. Count me in as one who is upset that the test is being minimized. I’ve had a mammogram every year since my late thirties even though I have no close relatives with breast cancer. As my doctor said, why not? This is a disease that doesn’t just depend on family history or environment. It seems to silently sneak into people of all walks of life and at any age.

Why wouldn’t you want to find out early? I had a false positive one year, and it was tough, having to go in for extra tests, with that pit in my stomach, wondering if my luck had finally run out. Fortunately it hadn’t. But in a strange way, that fear made it even more obvious to me, even more important, to continue the annual routine. What if I had been diagnosed? Just like wearing a seat belt, the test lets you hedge your bets. Sure you might still drive into a wall, but at least you’ll survive to drive another day.

I was shocked at Thanksgiving when my friend Anne, a big-wig lawyer at Kaiser, launched in on how unnecessary annual mammograms are. She said that frequently the cancer would just go away by itself if people didn’t know they had it. Her argument was that the test creates more surgeries that are in themselves more dangerous than the disease. Even my friend Kara—a mellow jewelry maker from wine country—joined in and supported Anne’s opinion. I felt betrayed by the sisterhood.

I asked Kara if she had any friends with breast cancer. No, she said. But when Kara started imagining how she’d feel if any of her friends, several of whom were seated around the holiday table, developed cancer, she suddenly wasn’t so sure of herself.

Juli’s not the first person I know who’s had breast cancer, but I can hope she’s the last.

The problem with the new recommendations is that they do sound too much like another insurance industry ploy to cut costs and reduce benefits. The same day the mammogram recommendations made the news, I got my yearly letter from Blue Cross, telling me that in order to serve me better they’re raising my rates, this time by a whopping twenty-five percent. Does having too many tests lead to higher costs? Perhaps. But I’ve always had ridiculously high rates because years ago I was diagnosed with high cholesterol, and I take Lipitor. Apparently, from the insurance perspective there’s nothing worse than to be diagnosed early and to take steps that minimize future serious consequences. The message is that ignorance is bliss. Oops, sound familiar?

Yes, medical recommendations change all the time. But to pretend that it’s better not to know, that it causes too much stress for us poor women to handle—that just sounds paternalistic. I have my annual mammogram next week. Wish me luck. I just hope Anne and Kara never put off having a mammogram.

Juli, all the best to you.

My father likes to say, “Everything happens for the best.” He’s had five major surgeries, one of them for cancer, in five years. And he still says that.

One day I mean to ask him what he took from each of his surgeries that was for the best. In the meantime, there’s something indomitable about that kind of spirit. Father still does volunteer work, still works out at the gym. He whistles and sings, tells jokes, and sends funny stories over e-mail. This month he celebrated his eighty-second birthday.

Dad and my husband are alike in their outlook on life. They have a curiosity about the world, an eagerness to see what new invention, what fun thing, lies around the corner. More than that, they have kind hearts, a willingness to extend a hand to a neighbor, to help a friend or a stranger in need.

It’s an attitude I should like to carry into the new year. I will make more time for friends and more time to be a friend. I will try to carry the Christmas spirit with me year round, for Christmas is not what parties we attend or what gifts we give and receive. Christmas is a warmth, a generosity of spirit we keep forever in our hearts.

So let me not bemoan my health at Christmastide. I will enjoy the lighted drummer boys who stand at the gate of a neighbor’s house. I will savor the last of my mother’s delicious stollen bread and look forward to her spritz cookies on Friday. I will delight in the presence of all my family members who, somewhat worse for the wear this challenging year, are intact and happy to celebrate the season together.

Merry Christmas Everyone!

Three days before Christmas I called my oncologist. Is it possible, I wanted to know, to reduce the intensity of chemotherapy? I described the symptoms following my first treatment: four days of bone pain, fatigue to the point of not being able to cross the street, and the two-day migraine that flattened me. The doctor said these were side effects of the neupogen shot I’d been given to raise my white blood cell count. On the next go-round, December 28, 2009, we’re going to try not giving me that shot. I hope it works.

I’m thinking, in particular, of the two-day migraine I experienced. At its worst, I realized I had no medicine in the house to treat a migraine and was too incapacitated to fetch it. I had a doctor at my HMO telephone the prescription into the pharmacy. My mother picked it up and delivered it to my bedside.

When my mother arrived that day, we both burst into tears. “Two days ago I was trying to have a day of normal activity,” I told her. “It’s so frustrating. One normal day lands me in bed with migraine.” She hugged me, then sat and chatted for a while about everyday things.

Others in my life have provided me with exceptional stability and good humor during my bout with breast cancer. But I cannot imagine going through it without my mother as my friend. Some years back, a dear friend of mine lost her own mother. “When that happens,” she said, “you’re never the same.”

The women on my mother’s side live into their nineties. My grandmother reached the age of ninety-one. My mother’s sister, my aunt Mary, is ninety-four. I hope my mother lives well into her nineties. I am, in fact, counting on it.

I’ve just finished reading Boats in the Night. A slender but stirring volume, it’s about the Danish resistance to the Nazi occupation of their country during World War II. The book is special because it was given to me by a Danish friend whose own father was a resister. The central figure in Boats in the Night is a man who today, it turns out, resides in the same Northern California town I do. His name is Knud Dyby, and he is ninety-four.

The story begins on the ninth of April, 1940 when German army units cross into Denmark. German paratroopers land throughout the country. A German merchant ship full of soldiers docks in Copenhagen. All this happens at 4:15 a.m. while the Danes are asleep. To avoid casualties, Denmark’s King Christian X and his government capitulate. A negotiated occupation exists from 1940 to 1943 during which Denmark assumes the role of “model protectorate.” Acts of sabotage to damage the German war effort are routine at this time.

The resistance takes hold in earnest in late 1943 when word leaks out that Danish Jews will be rounded up and transported to Nazi concentration camps. The Danes are able to negotiate safe harbor for the Jews in Sweden. It’s getting them across the channel to safety that’s treacherous, and where Dyby plays such an important role.

Dyby serves as a go-between who arranges passage for Jews and resisters hunted by the Germans. He helps skippers prepare their boats to secretly transport the Jews. Should the Germans catch them and their human cargo, all would certainly be killed. Dyby even makes one boat passage himself. By war’s end, most of Denmark’s 8,000 Jews have been rescued and sent to freedom.

There’s a photograph in the book of Knud Dyby pointing to his plaque on the commemorative wall in the Avenue of the Righteous of the Nations at Yad Vashem in Jerusalem. His eyes look like they’ve seen much. In the book’s final pages, he recalls his resistance friends and colleagues who died during the war: “They are dead now,” he says. “I speak to their memory.”

I learned, as I researched my novel, The Still Voice, that those gentiles who helped the Jews during the second world war are called “righteous.” In my story, Sophia and her fellow Edelweiss Pirates never consider themselves righteous. They know what they are doing is right and, like Dyby, they keep on doing it.

May your days be merry and bright . . . My head hits the pillow filled with the strains of Christmas music. In my dream, I’m standing in the shower. The songs of the season are piped in. Suddenly, I’m wrapped in a black sticky shroud. It’s my own hair, and it’s melted over my body. Such are the happy holiday dreams of this chemotherapy patient.

Every breast cancer patient comes to know that the most widely used chemotherapy drugs cause hair loss. What she also comes to know is that losing one’s hair usually follows the second treatment in the cycle. My second treatment is December 28, 2009. Wild horses will have to drag me back.

A friend told me that her mother, a licensed psychotherapist, practiced something called desensitization to lure her to the second chemo. In psychology, desensitization is used to lessen someone’s fear of a situation by exposing them to it either in reality or in their imagination. As my friend and her mother lived some distance apart, her mother “conditioned” her by telephone. She’d spend twenty minutes having her daughter visualize a beautiful garden. The next twenty minutes, she’d have her picture herself taking the chemotherapy. So it went, back and forth until she felt able to keep going.

As I have no psychotherapist in my hip pocket, I’ve chosen to visualize the Aegean Sea. My husband has promised me a trip to Greece when this is all over. I’m already planning it in my mind. The Aegean is a deep blue-green. I’m on a sailboat, in a new swimsuit, with a figure better than I had in my twenties. I’m a golden brown. And I’m sipping bubbly drinks while munching raspberries and brie. A white shroud, made of a light chiffon, shields me from the sun’s rays. Breast cancer is in the distant past, an evil cast out of my life forever.

. . . And may all your Christmases be white.

When I started this blog, I was reaching out for moral support after my breast cancer diagnosis. When I wanted to quit writing, my surgeon told me she thought it was helping a lot of people. So I’ve stuck with blogging. It’s been tough to do since the chemotherapy regimen began. I’ve been vertical two days out of the past ten.

I keep thinking about the main character in my novel, The Still Voice. Sophia contracts scarlet fever at a regional sports fest in 1941. Highly contagious, she winds up in the hospital over Easter. This is the scene with Sophia in the hospital during the holiday. Her mother Brigitte, and sister Petra, have come to visit. Sophia is trying not to feel sorry for herself:

They both looked so pretty, Brigitte in her blue knit suit and Petra in her apple green dress with lace collar and cuffs. Sophia squinted through the tempered glass to bring them into better focus.

“Happy Easter, honey,” said her mama. “We brought you something. The nurse will bring it in to you.” She held up a basket brimming with colorful eggs.

Squinting, Sophia could make out a stuffed rabbit and an oversized lavender bow. Easter was the second most important holiday in Germany, after Christmas, and one of her favorites. She thought of the year they’d spent it at Petra’s, sitting in a kitchen filled with crocuses and daffodils, learning how to decorate eggs with liquid wax. Afterward, when they’d dyed the eggs, the wax designs had popped out against the richly colored shells.

“Did you go to church?” she asked.

“We went to the Marktkirche,” said Petra. “We said a prayer for everyone. My prayer for Hans was already answered, of course. He’s been transferred to the campaign in Greece. Much safer. I’m so relieved. We miss you. How are . . .”

“The organ in the Marktkirche is so beautiful,” said Brigitte. “You can hear it loud, and with the choir . . .”

Petra peered through the door at her sister. “How’re you feeling, Sophia?”

“I’m getting better. Where are you having lunch?”

The answer was as she’d expected. The family would gather at the home of her brother’s in-laws. She tried to refocus, not feel sorry for herself. “We had to hide in the basement when the bomb fell. Did you see where it landed?”

Brigitte pinched her lips together. “Near the train station. Couple of houses were slightly damaged. No one was hurt.”

Sophia recognized the look in her mother’s eye. She wasn’t being truthful about no one being hurt. No matter, she doubted she was ready for the truth.

“Sis, are you listening to me?” Petra interrupted her thoughts. “When you’re released, you’ll come stay with me in Wieseck. The country air will be good for you. Would you like that?”

She nodded. “I’d like that. After I finish school.”

“Of course,” smiled her mama.

Her visitors chatted a while longer and wished her a full recovery. Then the nurse brought in her basket, and Brigitte and Petra disappeared down the long corridor to the stairs.

Sophia set her gift on a tray at the foot of her bed and walked to the window. Four floors below, she saw her mother and sister standing on the patio near the hospital fountain. They waved and blew kisses. She waved in return, her cheeks wet with tears. It was Easter, and they both looked so pretty.

I had an uncle I never knew. His name was Helmut, and he was an older brother of my mother’s. Helmut served on a German destroyer off the coast of Norway during World War II. He lost his life in one of the last sea battles of the war when an English destroyer fired on his ship. Helmut is buried in a mass grave somewhere near Bergen. Mother tried to find the site during a visit to Norway some years ago. The Norwegians were not so eager to divulge information. Mother never found his grave.

Once, when Helmut came home on leave from the war, he presented a snapshot of a beautiful Norwegian girl. “This will be your daughter-in-law one day,” he told my grandmother as my mother looked on. The story of his visit led to this scene in my novel, The Still Voice. It takes place in 1941. I think it’s appropriate for Christmas.

Brigitte shoved a cookie sheet into the oven, wiped her hands on her apron, and went to join her daughter in the living room. “Oh,” she glanced at the advent wreath on the end table near her chair. “Sophia, would you be so good and bring the matches in from the kitchen? I just sat down.”

Sophia brought in the matches and lit one of the four candles on the wreath. “Advent is late this year, don’t you think?”

“Why do you say that?”

“Because the first Sunday is already the seventh of December.”

“Speaking of late,” a crafty smile came over Brigitte’s face, “I need to change if we’re going to look at windows.”

“No rush.” Sophia looked, puzzled, at her mama. “We can go after coffee time. In fact, downtown’s nicer when it’s dark out and everything’s all lit up.”

Her mother flitted into the bedroom to change clothes. Sophia inhaled deeply, taking in the aroma of baking Pfeffernuß (peppernut) cookies.

On the sixth, St. Nicholas Day, her mama had filled the shoe she’d left in front of their bedroom door with Lebkuchen (gingerbread) and Zimtsterne (cinnamon star) cookies. They were both in an unusually festive mood, she thought. Probably because they loved Christmas.

“Aren’t you going to change?” Brigitte emerged from their room in her best dress.

“Ma, it’s just window shopping.” Sophia got up from her chair and started for the bedroom when a knock at the door stopped her.

“Would you get that?” asked Brigitte. “I have to turn off the oven.”

There was the sly smile again. Sophia went to answer the knock.

“Wolfie!” She threw the door wide open and flung her arms around his neck. “No wonder Ma’s been grinning like a monkey all day.”

“I told her to keep it secret,” beamed Wolfie. “I wasn’t sure until the last minute if I’d get leave.” He handed his mother a paper sack. “I stopped to get chestnuts.”

“They’re still warm,” said Brigitte. She poured them into a bowl, sat at the table, and cracked one open.

“Ma, in your best dress . . .” frowned Sophia.

“You have to eat them warm,” said Brigitte. “Sit a minute. There’s plenty of time for shopping.”

“Actually,” said Wolfie, “I made us a reservation at Café Maldaner, so we shouldn’t fool around too long.” He split open a chestnut with his thumbs. “These are good.”

“Tell us about Norway,” said Sophia.

He unfolded his wallet and laid a snapshot in front of Brigitte. “This will be your daughter-in-law one day.”

“Let’s see.” Sophia leaned across the table. “She’s as tall as you.”

“Almost,” he beamed. “She’s classic Norwegian. Very blonde. Long legs. Her name’s Finna.”

“So, this is the one.” Brigitte nodded. “And she will live in Germany?”

“I think so,” said Wolfie. “As for Norway, what a clean, beautiful country . . .”

“Will you have to go back soon?” asked Sophia.

“Yes,” said Brigitte. “How long do we have you for?”

“My leave is quite generous, actually,” said Wolfie. “I have until the twenty-eighth. I’ll miss your birthday, Sis. I’m sorry.”

“That’s all right. I’m just glad you’re here for Christmas.” She hoped her disappointment didn’t show. People were usually around for her birthday as it fell on New Year’s Eve. She wondered why the navy needed Wolfie over the holiday.

“We’ll have fun.” He handed Sophia a peeled chestnut. “Any word from Max?” He looked, meaningfully, at his mother.

Brigitte clasped and unclasped her hands. “No. We just hear on the radio that our ‘men are fighting bravely on the Eastern Front.’ Of course, we know it’s a very cold winter.”

“I’m sure he’s fine,” said Wolfie. “When the war is over, I want to show you Norway. Bergen is a nice harbor. It’s the second biggest city after Oslo. Green. Brick buildings everywhere. Ma, I know how you love brick. And the fish market! You should see all the types of fish . . .”

While Wolfie waxed on, Sophia changed clothes, making sure to bring out her fox muff.

“I remember that muff,” smiled Wolfie when she came out of the bedroom. “You’ll need it, too. It’s quite crisp out. Are we ready?”

The threesome linked arms as they sauntered toward the medieval city center.

“Wolfie,” asked Sophia, when they’d stopped at a Glühwein (mulled wine) stand near the Marktkirche, “what’s the Bruno Heinemann doing in Norway?”

“We’re there to keep the shipping route open for iron ore from Scandinavia,” he said. “Ah, there’s Hertie up ahead. I always like their window.”

Standing in front of Hertie, Sophia didn’t know where to look first. There was a train that carried Santa through an elaborate village, a rotating Ferris wheel, and a hot-air balloon whose bountiful basket rose and fell with little puffs of air. Everywhere, white lights twinkled and reflected off glittering snow.

“See how everything moves,” laughed Brigitte. “Even the angels turn around the top of the pyramid.”

“I hope Helga has her pyramid out this year,” said Sophia. “Hers is fantastic.”

“That reminds me,” said Brigitte, “Helga wants us to be there at six o’clock, Christmas Eve. She’s putting up Rebeka and Georg, of course. I can’t believe she’s offered to put up Petra and the twins.”

“There’s not much choice, is there?” asked Wolfie. “She can hardly send them packing.”

“It sure is different with the men gone,” said Brigitte.

“What am I?” asked Wolfie. “Cold potatoes?”

“No.” She took her son’s hand. “You said you wanted to stop at Hettlage. We should do that before they close.”

Wolfie’s former coworkers were as glad to see him as he was them. His onetime boss recommended several items for Sophia, including boots and mittens. For Brigitte, there was an assortment of coats. One after another, Hettlage’s employees stopped by to visit.

“Bergen is beautiful,” Wolfie repeated to each one. “It’s west of Oslo . . .”

“Wolfie, how about this one?” Brigitte modeled a black cloth coat.

“Isn’t there one with a fur collar?” He turned to talk with a former colleague. “Now, Tromso is much farther north . . .”

“That’s Petra’s style,” said Brigitte. “Anyway, there aren’t any. I’ll take this one.”

“We’re having record cold this winter,” said Wolfie. “No furs?”

“Can I have this?” Sophia was captivated by a blown-glass ballerina.

“Boots would be more practical,” said the saleswoman.

Crestfallen, Sophia put the ballerina down.

“If she wants the little figure, we’ll take it,” said Wolfie. “It’s Christmas, after all.”

“Hettlage isn’t the same without you, Herr Brandt,” said the saleswoman as she folded Brigitte’s coat in tissue paper. “What’s it like?”

“Well, Norway is . . .”

“No,” said the young woman. “Serving on a destroyer. What’s it like?”

“The war has gotten serious,” said Wolfie. “More than that, I’m not allowed to say. I do miss the pretty girls, like yourself.”

The saleswoman blushed as she handed them their purchases.

“Thank you for my present, Wolfie,” said Sophia as they cycled through the revolving door.

“You’re most welcome. Now, on to dinner.”

“Just like old times,” said Sophia. She and her mother linked arms with Wolfie for the walk to their café.

As they passed Karstadt, they stopped to press their noses against its display window. A sleigh ferried Saint Nicholas above a small village where lighted wreaths twinkled red and green in the shop windows. The bell in the chapel tower swung to and fro and, everywhere, flakes of shimmering white snow contrasted sharply with the brown slush under Sophia’s feet.

“Come, you two,” said Brigitte, “I’m hungry.”

At Café Maldaner, Sophia dawdled near the display shelves at the front, where tins of tea kept porcelain Santas company. The host appeared and led the trio to a table below the carousel horse.

“I’m famished,” said Wolfie. “Everything on the menu looks good.”

“I know what your sister and I are having,” said Brigitte. “Let’s order.”

“Ah, Mama,” said Sophia, “I’d like to choose my own.”

“Well, little Miss Independence,” said Brigitte. “You have a few days to go yet before the stubborn teenage years.”

Wolfie cupped his mother’s hand in his. “Let her go. There’s our waiter. Make up your minds.”

When the waiter had taken their order, Wolfie turned to his sister. “I’m amazed by your letters. Ballet, acting, singing. How do you keep up with it all? Have you thought of perhaps focusing on one? Actually, if you chose one to excel in, you might get ahead faster.”

“Let her have fun,” said Brigitte. “She’s just a kid. Maybe she won’t end up doing any of those things. Maybe she’ll be an executive secretary.”

Sophia scowled. She loved her family, but on this they needed to butt out. She was going to be a ballerina. Or perhaps a famous soprano like Erna Sack, the German Nightingale, who sometimes stopped in at the Baba Bräu restaurant. She hadn’t yet decided which.

***

The fact that one of the drugs administered for my chemotherapy, Cytoxan, is a derivative of mustard gas intrigues me for a couple of reasons. The obvious first is for the mere fact that something so toxic is used as a medicine. The second reason takes some explaining.

In researching my novel, The Still Voice, I spent some time boning up on the first world war, or the Great War. That sounds like a paradox as my story is set during World War II. However, one cannot study the second world war without looking at the first as the seeds of WWII were sown in the Great War. And it was the Great War that saw the first use of mustard gas.

It is commonly believed the German army was the first to use nerve gas. In fact, it was initially deployed by the French against the Germans in August 1914. Germany learned well, though, and became the first to use chemical weapons on a large scale.

Mustard gas was first used by the German army in September 1917. It took twelve hours to effect its victims and blistered their skin in big mustard-colored pocks. The eyes of those exposed became sore, and they began to vomit. The gas attacked the bronchial tubes and caused internal and external bleeding.*

So onerous was the use of poison gas that in the Geneva Gas Protocol of the Third Geneva Convention, signed in 1925, the signatory nations condemned it as uncivilized and agreed not to deploy it in future wars.

As a child growing up in Germany during WWII, my mother remembers her own mama receiving instruction in putting on a gas mask, then donning the mask to run through a gas-filled room. The Germans were that afraid, so many years later, of that type of warfare. My mother was to receive the training at a later date. It never happened. And nerve gas was not deployed as a battlefield weapon in WWII.

So how does a mustard gas derivative work as an anti-tumor drug? It is used to treat breast, ovarian, and other cancers by damaging the DNA of the cancer cells when they are in their “resting phase” (not dividing). Because Cytoxan disrupts their division, the cells die. However, since the drug cannot distinguish good cells from bad, it affects normal cells in the blood, mouth, digestive tract, and hair follicles. Cytoxan is said to have a less drastic effect on the normal cells because they “divide more slowly and are better able to fix DNA breaks than cancer cells.”**

One of my friends received the same regimen I am getting. She is a sixteen-year cancer survivor. Evidently, it works.


*Source: http://www.spartacus.schoolnet.co.uk/FWWgermanA.htm
** http://breastcancer.about.com/od/chemotherapydrugs/p/cytoxan.htm

The week following my first chemotherapy treatment was pretty much a lost one. There were a few debilitating days and a few with little energy, save for the mind racing with “was gonnas.” I was gonna decorate a bit more for Christmas. There was the sturdy box I was gonna buy for the present I’m bringing to my book club gift exchange.

I am pleased with the things that did get done. Though it felt silly to put our tree up right after Thanksgiving, my husband and I did. Now, I’m grateful to have it to look at. I bought gifts and wrapped them earlier than ever. The cards were sent out three weeks ago. I’ve never gotten them out so soon.

This coming week is one for rebuilding strength. I’m still learning things that will carry me there. For example, I was surprised to learn from the chemotherapy nurse that the toothpaste I use for sensitive teeth has alcohol as an ingredient. Apparently, most toothpastes contain alcohol. For someone with an intolerance to the stuff, like me, it’s good to know of a “safe” toothpaste. It’s called Tom’s of Maine.

The nurse also surprised me by recommending teas to help with digestion, constipation, etc. Imagine an HMO suggesting tea. The brand I’ve tried is called Traditional Medicinals. I still giggle when I think of the night my husband and I brewed their “Smooth Move” blend. Try it sometime. It works.

Lotions to keep the skin from drying out have always been too much of a bother for me. They’re necessary now as the chemo is a dehydrating agent. One lotion that quickly goes into the skin and is fragrance-free is Lubriderm. Of all the designer moisturizers, I like this plain one best.

The Whole Foods supermarket chain has an article on its website that’s useful, too. It lists foods that build the immune system. Shitake mushrooms have been found to increase white blood cells, and these “shrooms” are very yummy. Beef is a source of zinc, which helps white cells and antibodies reproduce more quickly. Bacteria found in yogurt helps fight the bad bacteria in the digestive tract. The Whole Foods article can be found at http://www.whole-food-supplements-guide.com/foods-that-build-your-immune-system.html.

Yes, siree. It’s good to be back among the living. I look forward to seeing you around the neighborhood.

Of all the possible side effects from chemotherapy, the one I wound up with following my first treatment was bone pain. The pain is caused by one of the chemical agents in the chemo, Taxotere, and an injection of a drug called Neupogen. The Neupogen shot boosts the white blood cell count so the patient is able to fight off infection. Interestingly, Neupogen is made using the bacteria E coli. I’d received two of the three scheduled injections following chemotherapy when I told my oncologist that the bone pain was debilitating. Thankfully, he cancelled the third shot before I received it last night.

Funnily enough, it was a story about cancer of the bone, told me by one of my sisters-in-law, that reinforced the wisdom of taking chemotherapy. A woman in my sister-in-law’s circle had not had chemo following her bout with breast cancer. The cancer returned to her bones. I know how painful that would be.

When the surgeon reports she got all of the tumor out, the lymph nodes are clear, and tests show no metastases elsewhere in the body, that does not mean the cancer is gone. When I met last week with Dr. Frank Stockdale, co-founder of Stanford University’s Combined Modalities Breast Cancer Program, he noted that the average woman with stage one breast cancer has a twenty-five percent chance of it recurring anywhere in the body. A woman with a high grade tumor such as mine (grade three), has a one-in-three chance of having it return within a ten-year period. That makes the case for chemotherapy. Period.

Dr. Stockdale noted that in Europe, surgery, radiation, and hormone treatment only would be given for a stage one tumor less than two centimeters in size. I asked what sort of results Europeans are getting with this. “They’re willing to accept a fifty percent reduction in risk of recurrence,” he said, “where in the U.S. we’re getting a seventy percent reduction in risk. So they’re willing to accept that. There are lots of reasons. Some are economic and some are philosophical.”

I asked Dr. Stockdale about long-term damage to the body from chemotherapy. “You have to realize,” he said, “you only get four treatments. Most of the toxicity that is long-term is in the cumulative phenomena. It’s total dose related. The cumulative doses for the treatment your doctor has recommended for you are tiny.”

Only four treatments. I wish they were already behind me.

Two days after my first chemotherapy treatment, muscle fatigue has set in. I feel as though I’ve exercised strenuously and pulled every muscle in the body. The one thing my husband and I didn’t purchase for me was the powder that helps deal with that. Ah well, such is life in Chemo City. I asked friends to fill in for me on days like this. One such is Julie P., a woman I met when we worked for the same publishing house twenty-some years ago. Julie went on to work for the Los Angeles Times and Forbes Magazine. Today she lives and freelances in San Francisco, Calif.


I’m filling in for Juli while she’s having chemo treatments. I was touched that she would ask.

I have to confess, my reaction when I heard of Juli’s diagnosis was all too standard: shock that a friend—a contemporary—had cancer. After all if Juli, who had been healthy, took care of herself, and looked at least ten years younger than her actual age, could get cancer what about me? Compared to JC, I’m a slacker. Mine was a typical boomer reaction, both narcissistic and delusional. (How can we get sick? We’re not that old.)

Never mind that the Bay Area reports a higher than average rate of breast cancer, one that scientists still insist is mere coincidence. And that cancer runs in both my mother and father’s families. My paternal grandmother died of pancreatic cancer when she was only forty-seven. Her daughter, my aunt, received a clean bill of health at her annual physical only to discover a few months later that cancer cells in her cervix had spread to liver and would kill her before the age of fifty. And, six years ago I cared for my mother, a non-smoker, who was terminally ill with lung cancer. Her longtime doctor had said her coughing spells were due to asthma; by the time cancer was found she had only months to live.

So I have more than a passing acquaintance with cancer. I have seen the terror in the eyes of those who are diagnosed, how it devastates the body, and I have felt that strange mixture of relief and grief when a loved one dies of this ugly disease. I remember when a hospice doctor asked me if my mother had made peace with death. The man was young and earnest and I liked him. But his question made me angry. No, she hasn’t made peace with it, I told him. She wants to live and she thinks if she prays hard enough she will have a miracle and be spared. The young doctor backed away. I don’t know whether he was shocked by my answer or the ferocity with which it was delivered. He wanted my mother to have a tidy end. As her daughter and one of a clan of fierce women, I knew she would not go quietly.

So how do I explain that I had my first mammography this year at the age of fifty, even though my health insurance would have paid for screenings after forty? I rationalized that since no one in my family had been diagnosed with breast cancer, I was safe. I have since discovered that most women diagnosed with breast cancer have no family background of the disease. Juli who is more sensible than I when it comes to her health, caught the cancer in its earliest stage and her prognosis is good. I will cheer her on as she undergoes treatment and I will take better care of my own health. I will not let my dumb luck run out. I owe it to my husband, a kind and loving man, and my nine-year-old daughter who has yet to hear all the stories of our fierce women.

When I was a child my family lived for a time in northern Maine. Once in a while little carnivals would come around. Pitched in a field on the edge of town, their amusement rides were rickety, their animals bedraggled, and their trappings slightly tatty. We loved every bit of it.

One thing I recall in particular were the “sideshow” exhibits, which are probably illegal today. They featured—invariably—the bearded lady, a two-headed boy, and pygmies with snakes. I expected, on my first day of chemotherapy for breast cancer, to feel a bit like the sideshow freak. “Step right up. See the diseased lady hooked up to the IV. Watch her dance around the room in delirium.”

Well, yesterday’s treatment wasn’t anything like that. From the start, the nurses and doctors were all fun and cracking wise. Everyone on the floor was there for the same purpose and was extremely kind. My husband, with his relaxed sense of humor, stayed with me all day. And it was a long one. We were there nearly six hours.

I did get off to a rocky start, I have to admit. When my nurse couldn’t find a good vein for the IV and had to remove it, I cried. My oncology doctor came in and asked how I was doing. “Terrible,” I told him. “I hate every bit of this, every step of the way. I still resent that this has happened to me.” My husband lightened up the mood by telling a funny story. When the treatments began we were all smiling. That’s the kind of day it was--up and down.

The actual treatments through the IV were all in clear bags and looked like gels. The slow drip began with a saline solution to flush things out. This was followed by Pepcid, to guard against acid reflux from the chemo. The next drip-drip was a mixture of steroids and sleep agent (go figure). Actually, the steroid was to reduce inflammation in the body. The sleep agent was to relax the patient for the chemotherapy drugs, which were delivered last. Along the way, the nurse explained a lot of things, gave me a two-pocket folder of information, and sent in a pharmacist to explain the raft of pills I was to take home. So far, the day after chemo, the only pill I’ve taken is Tylenol. Hooray!

I am a bit woozy, my face and neck are flushed from the steroids, and I’ve visited the bathroom a few more times than normal. I also keep looking around in a sort of paranoia. When do the other possible symptoms show up? The doctor talked about mouth sores, discoloration of skin and nails, hair loss, nausea, vomiting, rash, fever, fatigue, fluid retention, low blood cell counts, shortness of breath, poor appetite, bladder irritation and bleeding.*

I’m to use an electric razor, so as not to nick the skin and cause infection. I’m to avoid crowds and gatherings where I might catch a cold. Yet, the nurse said they don’t want me to “live in a bubble.” Ha! And happy holidays to you, too!

*Today's blog may contain more information than some want to know. I’ve included it because part of the reason for the blog is to help anyone newly diagnosed with breast cancer. One really has no idea what to expect. It is, indeed, a life changing event.

We are fortunate, here in the San Francisco Bay Area, to have access to some of the most brilliant minds and research centers in the world. This week, I was lucky to be able to meet with Dr. Frank Stockdale, co-founder of Stanford University’s Combined Modalities Breast Cancer Program in Palo Alto, Calif.

The time spent with Dr. Stockdale, whose focus has been on breast cancer for the past forty-two years, answered many questions, raised even more, and went by much too quickly. I would’ve loved to have spent some time asking why, for example, the incidence of this cancer is high in some parts of the country and not in others. Much of what we discussed had to do with my particular case. But there were some items of broader interest.

I asked why breast cancer comes. Dr. Stockdale said, “Most, eighty-five percent, are sporadic. There is no reason.” This much researchers do know: The mammary glands are stimulated to grow with the estrogen (menstrual) cycle. After the cycle, the glands regress. After so many cycles of growth and regression, little errors in the DNA can creep in. These errors are replicated each time the glandular cells grow and shrink back. The end result can be cancer—the more cycles, the more years of growth and regression, and the higher the chance for errors to creep into the DNA.

I wondered whether birth control pills could cause breast cancer. Doctor Stockdale said there is no evidence to suggest they have an effect on breast cancer. He said, “They do probably prevent cancer of the ovary.”

Can a breast cancer patient ever really be cured, I wanted to know, or is there always a chance it will return? His answer was, “There’s always a chance it will come back. But you markedly reduce those chances by taking treatment now. If you look at the national data on deaths from breast cancer, since about 1985 they’ve been going way down. The only real explanation for that is adjuvant treatment because the disease is the same disease.”*

“I think you’re going to be cured,” he told me. “Your chances are approximately between eighty-five and ninety percent. That’s pretty good for a serious disease.”

Thank you, Dr. Stockdale. I’m glad for the opportunity to meet with you.


*Adjuvant therapy usually refers to hormonal therapy, chemotherapy, radiation therapy, or immunotherapy added after surgery to increase the chances of curing the disease or minimizing symptoms. Source: www.healthsystem.virginia.edu/uvahealth/peds_oncology/glossary.cfm

A good neighbor, Chris, is of Dutch ancestry. She’s been following the fears I have posted on this blog related to undergoing chemotherapy treatment for breast cancer. She sent me the message below through e-mail. I shall take it to heart.

One of the last things my dad wrote (he died at age 93) was found in a notebook. My brother framed it, and I have it on the wall in my office. The saying, in Dutch, seems to rhyme and so Dad must have remembered it from somewhere (he had a pretty good memory for such things). I asked the priest at St. John’s in Ross, Calif. if it was a biblical reference about God not allowing us to bear more burdens than we could undertake. But the priest said he was not familiar with such a reference, and Fra Bart had a fantastic memory. I have a bible with cross references for specific words and I could not find anything quite like this saying under “burdens.”


“Een mens lijd dikwijla het meest,
door het lijden dat hij vreest,
dus heeft hij meer te dragen
dan God te dragen geeft.

Een leed dat is, is niet zoo zwaar
dan vrees voor allerei gevaar,
en komt het eens in huis
dan help God altijd mee te dragen naar zijn kruis.”

“A person's burden is often heaviest
for the suffering that he fears
thus he has more to bear
than God can give.

A sorrow that is, is not as heavy
than dreading all sorts of peril,
and if it once comes home
then God always helps one to bear the cross.”

I asked several friends in my writers' circle to guest blog for me as I recover from chemotherapy treatments. Though my treatments begin next week, I find myself too agitated and unfocused to compose much today. So I'm running the first guest blog. It's from my friend Keri, an award-winning reporter I met seven years ago.

Today I started a new program, “29 gifts in 29 days (www.29gifts.org).” I have to give away something—anything—to someone else at least once a day for twenty-nine days. And I’m supposed to journal about it, and also keep a “gratitude” list.

I won’t go into why I would need such a program—that’s probably a topic for my own blog (soon to appear at www.KeriBrennerCommunications.com). Suffice it to say that my daily life’s “background soundtrack” has been focusing too much lately on what I perceive as my lack or failure or problems. By focusing on giving, I hope to turn off the negative feed and instead add juice to the part of me that is abundant and has something to offer.

So Juli, my dear fellow writer friend for the last seven years, the first gift goes to you: this blog post. You invited me to be a guest blogger for The Still Voice while you are recovering from chemotherapy, and I agreed. So the timing of this gift feels perfect.

Juli, I am so struck by your clear and passionate writing, as well as by your courage in facing your breast cancer diagnosis head-on and with a determination to be proactive in your treatment and your research. But, even you had some doubts about my e-mail recommendation that I was “sending you white light.” What was that, anyway, you asked?

Here’s my best extremely technical scientific answer: white light is the opposite of worry. I’m not sending you worry thoughts; I’m sending white light.

In my understanding of the world, thoughts are the energetic seeds that grow the stuff of physical reality. If your thoughts are full of worry, then you create more worry in the world. Thoughts of white light are for love, good health, abundance, happiness and joy.

I tell my mother in Philadelphia this all the time. When she says, “I’m worried about you,” I tell her, “Don’t send me worry; send me white light.” It took a while to convince her. But now, she does.

And so, in turn, do I to you.

Recently I e-mailed a friend that beginning chemotherapy treatments on Pearl Harbor Day felt like going to one’s doom. She wrote back, “No, no, no. Pearl Harbor Day was the beginning of our fight against the enemy. Look at it that way.”

I can’t help it. When the treatment prescribed for a condition spawns whole books on likely side effects and how to manage them, I still say it feels like doom. The National Cancer Institute (NCI) has produced one such publication. It’s called Chemotherapy and You. This little book lists nineteen potential side effects. Here they are:

• Anemia
• Appetite changes
• Bleeding
• Constipation
• Diarrhea
• Fatigue
• Flu-like symptoms
• Fluid retention
• Hair loss
• Infection
• Infertility
• Mouth and throat changes
• Nausea and vomiting
• Nervous system changes
• Pain
• Sexual changes
• Skin and nail changes
• Eye changes
• Urinary, kidney, and bladder changes

According to the booklet, some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells. The red blood cells carry oxygen throughout the body.

As my regimen calls for shots to be administered to boost the white blood cells, I think the white cell count is more of a worry. White cells are part of the immune system and fight infection. Apparently, about seven to fourteen days after treatment, the white cell count will be at its lowest. Fatigue and depression are common around this time. After this drop in the white cells, their numbers improve until the count is nearly back to normal. Then it’s time for the next treatment. This is, according to my oncologist, part of the reason why taking chemotherapy puts people on an emotional roller coaster.

Appetite changes can occur due to nausea, because the chemotherapy can make the mouth and throat feel sore, or because the recipient is depressed or tired. Ways to manage this include: Eating smaller meals or snacks instead of three big meals a day; drinking milkshakes, smoothies, juice, or soup; and using plastic forks and spoons. This last one surprised me. Some kinds of chemo leave a metal taste in the patient’s mouth, according to the NCI. Eating with plastic can help decrease the metal taste. Cooking in glass pots and pans is also said to help.

I’ve dealt only briefly with the first two side effects, and already I’m scaring myself. I’ll write about the other side effects another time.

A friend recently gave me a Reader’s Digest cookbook called Eat Well, Stay Well. There is a two-page table in it that lists foods that fight illness. Of course, the foods that fight cancer are of interest to me, so I’ve listed them here:

• Orange and yellow vegetables, which include tomatoes, red bell peppers, and chilies.
• Dark leafy greens.
• Cabbage family vegetables (broccoli, Brussels sprouts, cauliflower).
• Garlic and onions.
• Orange fruits (apricots and nectarines), citrus (including red grapefruit).
• Berries, grapes, watermelon.
• Whole grains.
• Legumes (especially soy) and nuts.
• Seafood.
• Lean poultry.
• Low-fat dairy products.

According to the table, the foods on the above list supply beta-carotene, lycopene, indoles, ellagic acid, other phytochemicals, folate, vitamins C and E, calcium, selenium, and omega-3 fatty acids. I’m the first to admit that about the only thing that’s familiar to me in all this are the vitamins C and E, and calcium. Okay, I have heard of omega-3 fatty acids (found in fish). But as for the rest, I will look up indoles and ellagic acid at a later date.

Somehow, it doesn’t seem right. I’ve eaten copious quantities of most everything on the list (save for watermelon, yuck), and I’m not so fond of broccoli. But I’ve consumed more than my fair share of the rest. Never smoked, don’t drink, take walks every day. Eat healthy, live healthy, die anyway. Or get cancer anyway, as the case may be.

I think, had I known that I would end up with breast cancer in my middle age, I might have done some wilder things in my youth. Maybe I would have smoked pot or dropped acid. Naw, probably not. One can’t fight one’s own nature—especially if it’s a conservative nature. But I could have shopped more often, laughed more loudly, and done more things with wild abandon. Come to think of it, I still can. Once this cancer war is won, watch out world here I come!

Pigeons were out in abundance at San Francisco’s Union Square on Thanksgiving weekend. Herb Caen called them feathered rodents. That’s the thing I miss most in the San Francisco Chronicle, Caen’s column. With his tidbits, political jibes, and assorted oddities, he made every reader feel like a city insider. Caen was known to favor three-dot journalism. I have to say the three dot business is a handy way for putting random thoughts on paper . . .

Random thought #1 . . . Other things I miss are the holiday windows on Union Square. It used to be worth a trip into the city just to see them. There were magical animated wonderlands. There’d be kittens and puppies either vying for attention or hiding from view. The merchants didn’t even try this year. Their windows were filled with merchandise: evening gowns, jewelry, perfumes. There was nothing to evoke the season’s magic for the children. Nothing to delight the child in all of us. It left me feeling sad.

Sodden thought . . . Next Monday, Pearl Harbor Day, I start my chemotherapy treatments for breast cancer. I assume the one word is comprised of two: chemicals and therapy. The night before the first session, I’m required to take five steroid pills so the body doesn’t swell like a balloon. For five consecutive days afterward, there will be shots to keep up the white blood cell count. It’s obvious that chemotherapy is toxic to the system . . . Doesn’t sound very therapeutic to me.

I’m sure whoever first said, “The cure is worse than the disease,” had cancer treatment in mind. It’s all very brutal for the body and distressing to the soul. I can’t help but think that, if more men got breast cancer, a cure would be closer at hand. At least they’d find a way to deliver treatments that wouldn’t cause the recipients to lose their hair. Talk about adding insult to injury.

Radiation treatment follows chemotherapy for me. Only two weeks ago, Jeanne Rizzo, president and CEO of the Breast Cancer Fund, mentioned at a public forum that a less risky method is needed to screen for breast cancer because x-ray radiation is carcinogenic. Why, then, is the body bombarded with radiation in an attempt to keep the cancer from recurring? I don’t get it . . .

There is plenty I’m not “getting” today. That’s what makes this a three-dot day . . .

The holiday season is upon us and with it comes the opportunity to see the San Francisco Ballet’s stunning production of The Nutcracker. When I see the television ads for it, I think back to the local ballet school I attended as a child in Germany. We put on The Nutcracker every year. Not that I had much talent. My mother, who attended Tanzschule Bier, a feeder school to the prestigious Wiesbaden Ballet in Germany, was the real ballerina. She danced with Tanzschule Bier as a young girl, before World War II destroyed everything.

In my novel, The Still Voice, the main character Sophia dances in The Nutcracker. Afterward, her mother Brigitte and sister Petra join her backstage. I thought I’d share that scene from the book today, in keeping with the season.

Tanzschule Bier prided itself on its Nutcracker ballet. Preparation for the Christmas holiday favorite began with new choreography, exacting rehearsals, and embellishment to an already lavish set. Sophia had practiced nonstop over the past three months and arrived at the studio well prepared for their one December opening.

The Biers were in a dither. Herr Bier had choreographed The Nutcracker’s “Waltz of the Snowflakes” for four girls. His wife had rehearsed it that way. This afternoon, hours before their opening performance, the lead snowflake had called in sick.

Thrust into first position, Sophia was full of confidence with one breath and tremulous with the next. While the couple revised the choreography for a trio of girls, she warmed up for the evening’s recital. When the new arrangement was in place, the wife led them through the steps until she was satisfied.

After Frau Bier had gone, Sophia ran through the routine alone. Clad in her practice leotard, her hair pulled back in a chignon, she imagined herself as delicate as the bone china cups in the Hettlage store window.

“Five, six, seven, eight.” She slowed to count out a difficult step, watching her feet in the mirror as they swept deliberately across the hardwood floor. When she had it, she resumed dancing to the phrases flitting through her head, then started for the dressing room.

On her way, she stopped to peek through the curtain. The house was starting to fill up. Unable to spot her family in the commotion, she closed the curtain and left to put on her makeup.

She was dabbing on blush when a gasp from the audience told her the performance had begun. She smiled at the reaction. Local craftsmen had carved a sumptuous and colorful set for the opening Christmas Eve scene. The company had hoped it would delight.

Sophia rocked her shoulders in time to the merry overture. When the downbeat for the march sounded, she hummed along: “Tum tata tum tum tum tum tum . . . tum tata tum tum tum tum tum . . . la da, la da, la da da . . .”

“Soph . . .”

Fellow snowflakes Steffi and Monika, the Biers’ daughter, appeared at her elbow. Could she go through the new steps with them one more time?

They rehearsed until the “Departure of the Guests,” then changed into their stiff, silver-and-white tutus. Monika helped Sophia pin her tiara in place. Then, hands and backs arched, they waited in the wings for their music.

Like wind-driven flurries, the trio whirled downstage. Oversized, tinseled flakes shimmered from above, reflecting the blues and purples of the spotlights. Fluffy theater snow swirled beneath their feet.

Sophia tilted forward on her right foot, on pointe, while extending her right arm upward. She stretched her left leg and left arm behind her. In this, the arabesque position, her body created a long, fluid line.

Using her arms for momentum, she executed a series of pirouettes. She was careful to focus, stage right, on one spot—and to snap her head quickly back to the spot as she completed each turn—so as not to become dizzy.

She spiraled and twirled in time to the music, weaving in and out of patterns with the onstage ensemble, like a splinter of ice in flight.

A subtle change in tempo brought out the principal dancers. The snowflakes guided them offstage to the Kingdom of Sweets. The curtain came down behind the players. Sophia was breathlessly in heaven.

When the second act began, she was beguiled by Tchaikovsky’s music for the “Arabian Dance” and his soaring composition for the “Waltz of Flowers.” Enthralled, she watched the performance from backstage.

When the last strains of the “Sugar Plum Fairy” pas de deux (dance for two) had dissipated, Sophia hurried onstage with the rest of the company. She held hands with the corps, blinked in the lights, and bowed. There were four curtain calls, flowers for the prima ballerina, and a standing ovation.

Sophia thought of the great companies of Europe, which often included youngsters. The famous Fanny Elssler was twelve when she became a professional. Marie Sallé debuted in London at age nine. There were the three “Baby Ballerinas” of the Ballet Russe de Monte Carlo, who’d reached stardom at the ages of thirteen through fifteen. Dared she hope to be in their company?

She was changing in the dressing room when the ballet mistress came in, followed by Brigitte and Petra.

“The performance was just beautiful,” gushed Petra. “The dancers. The costumes. The sets. Of course, the music is always wonderful.”

“You were so graceful,” said Brigitte. “My daughter, the ballerina.”

“There were several who were exceptional,” said Frau Bier, diplomatically. “But,” she said in a half-whisper, “Sophia is one I will recommend to the Wiesbaden Ballet.”

“Oh, wow,” beamed Sophia.

“Don’t get a swelled head,” said her mama. “You still have to help me clean house on Saturday.”

I asked family and friends for guest blogs, as I thought voices other than mine would be refreshing in this space. My sister Deborah is my first guest blogger. Here is what she had to say:

When my sister Juli wanted me to guest blog on her site regarding her cancer experience, I at first thought it would be interesting. Now I feel like a ghoul participating in her illness. However, most people with blogs who have cancer are all about themselves. It’s kind of nice that my sister is interested in the family point of view. I have had numerous surgeries (not for cancer) and I kept telling her that it was only sleep. Juli told me that, before her lumpectomy, she had panic attacks about being attacked with knives. The surgery and pain meds. are the best part. Recovery is what sucks. My sister has never had surgery so she was very scared.

When I called our mom on October 9, 2009 and she said Juli had cancer, I did not want to believe it. I dropped the phone at work and cried and cried. My boss had me go into a quiet room to regain my composure. I was able to work the rest of the day. A friend from work said “Sorry for your loss.” I told him no one died. Actually I said, “My sister has cancer. No one died, you idiot!”

October 26, 2009

When I went to see Juli in recovery, her first words were, “Do I look like shit?” She did, but I said she just had a procedure. Juli cried and I held her hand. She said, “Why’d it come. I didn’t do anything.” I told her Dad had cancer. She reminded me that our dad smoked. He didn’t have lung cancer. But in Juli’s medicated state, her answer justified her meaning at the time. She was hungry and asked for food. The nurse brought graham crackers and apple juice. When Juli became nauseous, the nurse took the food away. Juli kept saying, “They took the food awayyyyy.” She reminded me of the kittens I rescue and nurse back to health. I wanted to wrap her in a blanket and make her feel safe, but that was a dumb idea. Juli is a grown person not a little cat. I noticed the word “Yes” on her breast. I guess that is where the incision was made. I told Juli, “Hey, biker tattoo.” I don’t think she caught the humor at the time.

Juli was going to have Thanksgiving this year. I know she is not strong enough for that so I am putting together a nice turkey dinner. We will meet at our parents’ house, which is closer for Juli. I just have to keep Mom out of the kitchen. I want to present a nice meal, which means an excuse for getting my hair and nails done also. You can’t present a lovely feast without looking lovely. I told my sister that when she figures out what treatment she will have, I can take her to the beauty college for a facial and massage. The students do very good work as it is part of their grading. We just need to wait to see how Juli will feel from day to day.

The sad part is Juli and I did not start to spend more time together until we got older. The last time we did something fun was window shopping and lunching in Sonoma. When I got up at the restaurant, I spilled water on her pants. They were white and she worried about them staining. That spill seems so trivial now. We still had a good day. I remember taking the ferry to the San Francisco ferry building with all of the shops. We window shopped and enjoyed the stores with their funky tchotchkes. The best time is when we saw the Bonesetter’s Daughter opera together. I never thought my favorite author, Amy Tan, would have an opera. Juli and I had such a beautiful day at the premier. I’m looking forward to more adventures with Juli. I hope she realizes that the strongest medicine is the will to survive. If she refuses to give in, she can beat this.

I love you, Juli.

Deb

Doctors are testing everyone for vitamin D. It’s the latest thing and, apparently, we are all deficient. My husband, our neighbors, me, none of us has enough. We can get it from the sun, of course. But according to the nutritionist with my HMO, the sun has to be high in the sky for that to work. Peeking-through-the-clouds winter sun doesn’t count.

I asked the nutritionist about food sources of vitamin D. Here are a few: Cod liver oil, whole eggs, mackerel, milk (fortified with D), mushrooms, salmon, and tuna fish.

Too little vitamin D is thought to be a contributing cause of cancer. Though sometimes, it seems like that’s said about everything “under the sun.”

My original intent in seeing the nutritionist was to get some ideas to help withstand the treatments for cancer. While I was there I picked up some tips for better living overall.

We talked about fatty foods. In general, plant fat is better for people than that from meats. And we shouldn’t have trans or hydrogenated fats. Sources of good fat are unsalted nuts, olive oil, and avocados. Since fats can decrease the efficient function of the immune system, the nutritionist suggested less butter, cheese, and sausage. Julia Child would have cried; she loved all three!

One thing Julia Child would have adored: Five to nine servings of fruit and vegetables a day are recommended. I don’t know anyone who can stop to eat that often during a given day. But I got the point. Eat more fruit. Eat more vegetables.

There was the usual admonition to consume less sugar. It is cumulative in the body, and one should have under 12 grams (three teaspoons) a day, including what is consumed in food. Corn syrup and high fructose corn syrups are also bad. The recommended daily sodium intake was up to 2300 milligrams a day. This sounds like plenty, until one realizes that a teaspoon of salt holds 2400 milligrams.

There was the recommendation to eat more whole grains, brown rice, and sweet potatoes (the latter are full of vitamin A and beta carotene).

Red meat once a week is all right, so long as it’s lean. And while everyone is enjoying their turkey this Thursday, we should remember to eat the white breast meat as the dark meat found in the legs and thighs is fatty. That works for me.

Last night I attended a community forum sponsored by the National Institute of Environmental Health Sciences (NIEHS) and the Bay Area Breast Cancer and the Environment Research Center (BCERC). The event was held in Sausalito, CA. What I learned can be found at the very tip of a monumental iceberg of research information. I thought I’d share the more interesting findings here.

Keynote speaker Dr. Linda Birnbaum, director of the NIEHS and the National Toxicology Program, spoke of the environmental triggers of breast cancer. She noted that it is a “major killer of U.S. women, and it’s an equal opportunity killer.” Contributors to breast cancer, she said, are obesity, stress, environmental toxins, and exposure to such chemicals as PCBs, dioxins, and BPA.*

Other factors being studied as possible causes of breast cancer include:

• Chemicals used in beauty salons.
• Exposure to diesel fumes.
• Endocrine disruptors, which influence estrogen production. These disruptors can be found in plastics and in cosmetics.
• Synthetic estrogens.
• Flame retardants, which are used in everything from furniture to computers.
• Certain pesticides.
• Exposure to truck exhaust.

Dr. Birnbaum, and six distinguished panelists who joined her on the dais, addressed a wide range of possible causes of breast cancer. They did note that it is difficult to pinpoint any one cause because there are a number of different types of the disease. Panelist Jeanne Rizzo, president and CEO of the Breast Cancer Fund, noted that radiation is a carcinogen. For that reason, and others, mammography is not the best way to screen women. According to Rizzo, a less risky, non-invasive method of screening is needed.

Interestingly, it takes twenty to thirty years for breast cancer to develop in women. This is why one study is now following girls in puberty. Researchers want to know what “environmental factors contribute to early puberty and which exposures that occur in puberty may increase breast cancer later in life.” Parents are urged to encourage their daughters to maintain a healthy weight, exercise, and avoid using plastic products where possible. (Source: Puberty, Breast Cancer, and the Environment. A report from the BCERC.)

After the formal presentations, I approached panelist Janice Barlow, executive director of the Zero Breast Cancer organization. I wanted to know whether Marin County’s water supply is being studied, because the incidence of breast cancer is so high in Marin. She told me a study expected to be released in the spring of 2010 has identified five neighborhoods in the county with uncommonly high numbers of women with breast cancer. And yes, the San Francisco Bay Area water supply is of interest because of the prevalence of serpentine rock over which our water flows. Serpentine rock contains cadmium and asbestos, known carcinogens.

For more information on this forum and breast cancer research, go to: http://bayarea.bcerc.org/ and http://zerobreastcancer.org/.

*1. PCBs--PolyChlorinated Biphenyls, a mixture of up to 209 chlorinated chemicals. Although PCBs are no longer produced in the U.S., PCBs are still found in the environment. The manufacture of PCBs was stopped in the U.S. in 1977 because of evidence they build up in the environment and can cause harmful health effects. (Source: http://www.medterms.com/script/main/art.asp?articlekey=19548)

2. Dioxins--Dioxins are environmental pollutants. They have the dubious distinction of belonging to the “dirty dozen”—a group of dangerous chemicals known as persistent organic pollutants. Dioxins are of concern because of their highly toxic potential. Experiments have shown they affect a number of organs and systems. (Source: http://www.who.int/mediacentre/factsheets/fs225/en/index.html)

3. BPA--Bisphenol A is commonly abbreviated as BPA. As the building block of polycarbonate plastic and a component of epoxy resins, BPA is used in thousands of consumer products, including food packaging. Research suggests that BPA exposure may contribute to the epidemic of breast cancer now and in the future. BPA exposure has been shown to interfere with chemotherapy treatment for breast cancer. (Source: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.2638145/k.1E45/Chemical_Fact_Sheet_Bisphenol_A.htm)

Sometimes we wonder where our donated dollar goes. Is it used wisely? Does most of it go to administration or does a healthy chunk go toward research? I can only speak for my little corner of the world, but I would like to put in a nice word for a program offered by the American Cancer Society (ACS).

The national program is called “Look Good . . . Feel Better.” The ACS bills it as a public service for cancer patients, “helping them cope with the appearance-related side effects of treatment.” I don’t have those issues yet. But according to the doctors, chemotherapy patients often lose their hair after the second treatment. When my hair falls out in clumps toward the end of this December, and the eyebrows and eyelashes begin to disappear, I believe I’ll be very glad I attended today’s seminar in Marin County, California.

The session was presented in two parts: Wigs, turbans, and hats for the newly bald, and make-up and skin care for the chemo patient’s suddenly over-sensitive skin. Both appealed to a woman’s vanity. But there was a lot of practical advice as well.

I had no idea that the skin becomes so sensitive to sun with chemotherapy that plenty of people can’t stand to be outdoors (even in winter sun) without being covered up or using creams to block the rays. Moisturizers, in general, were recommended because the skin dries out. Drinking lots of water to stay hydrated during the chemo months was also advised. I didn’t know that a sun block with SPF-15 is better for the skin as it is lower in chemicals. And I didn’t know that synthetic wigs can be cut, styled, and thinned. Now I do.

The ACS provided a goodie bag with lots of nice creams and make-up products. They also offered wigs, scarves, hats, pajamas and robes free of charge.

The ACS offers telephone-based education programs, a support network, and programs on nutrition and on managing cancer-related fatigue. Complimentary or reduced-rate lodging for patients traveling more than fifty miles to treatments is offered, too.

An especially valuable service provided by the ACS has to do with transportation. Volunteer drivers donate their time to take patients to appointments and return them home. This is a lifeline for people who become so fatigued with various treatments they cannot drive themselves. Imagine having to drive to radiation treatment five-days-a-week for six weeks and feeling too weak to do so. Even when friends and family offer their help, there are times when they can’t be there.

I have no affiliation with the American Cancer Society. Based on my experience today, I think they are doing a world of good. Their phone number is 1-800-ACS-2345. It operates twenty four hours a day.

The other night my husband said, “Sometimes, when I’m in another part of the house, I hear you cry. It makes me feel sad because I don’t know what hurts. And I don’t know what to do.”

Naturally, hearing him tell me that made the tears flow all the more. It was such a beautiful thing for him to say.

How do I tell him that the tears are not so much about what hurts? There is still some pain remaining from my cancer surgery. It stems from the area under the left arm where the lymph nodes were removed. As I work to regain full mobility in the arm, pain shoots from the inner elbow to the shoulder. But that gets better every day. It’s not why I cry.

How do I tell him that it’s more about fear of the unknown? What will the chemicals used in chemotherapy do to the good cells in my body? Will there be permanent damage? How sick will I be? Will the radiation treatments that follow shrivel the targeted body part like a prune? The recommended five-year hormone treatments sound lethal. Will they give me uterine cancer or osteoporosis?

How to let him know it’s about loss of control? It’s about giving up half a year of one’s life to fight a disease, then changing one’s lifestyle forever to keep it in check.

How to tell him it’s about feeling like an alien on the planet? Marked. A leper.

How to tell him? Instead, I blurted out, “I don’t want to lose my hair.”

His response was as I’d expected. “It will grow back.”

Yes, of course. It will.

The number thirteen is lucky in Germany. Being of German-Italian ancestry, I’d hoped this past Friday the thirteenth would bring some good news from my HMO’s oncologist. In short, I was hoping he’d recommend radiation treatment only following my breast cancer surgery. No such luck. Chemotherapy and radiation are both on the list.

I learned that oncologists use a software program called “Adjuvant! Online” to help them with their recommendations. The program, combined with a patient’s history, pathology slides, blood work, and mammography film, are the main tools employed. But let’s face it. When a pathologist grades a tumor as highly aggressive (grade 3) chemotherapy is going to be in the mix.

My tumor received a grade of 3, and my case seemed fairly straightforward. So I was beginning to question the need for a second opinion. Then this line in the paperwork given me by the oncologist caught my eye: The need for chemotherapy among women with hormone receptor-positive, node-negative breast cancer is controversial . . . That is my profile.

I went to the www.uptodate.com internet site (from which the oncologist had printed the papers he’d handed me) and learned that whether or not to recommend chemo for women with my profile is a major area of controversy. The benefits, according to studies conducted by the National Cancer Institute (NCI), are small.

What the NCI studies do recommend is hormone therapy. My oncologist recommends it, too. There are two standard types. One blocks estrogen in the body from telling cells to grow. The other inhibits the body’s estrogen production. The problem? One recommended drug can lead to blood clots and uterine cancer. Potential side effects from the other include arthritis and osteoporosis.

I am glad I’ve stuck with my decision to get a second opinion. But I can’t shake the feeling I’ll come away from it more muddled than ever. This whole business of selecting the proper treatment is a gamble. Anyone for a game of Russian roulette?

I’ve been trying to decode the pathology report from last month’s breast cancer surgery. Given to me in advance of this Friday’s oncology appointment, I know the experts will go over it with me in detail. Already I’ve found some things I need to bring up. I like to engage in anticipatory worrying.

I understand the part about “no tumor seen in sentinel lymph nodes #1, #2, #3, #4 left axilla.” This is the most fantastic news. No cancer in the lymph nodes. But what does it mean when a node is “hot not blue?” Or what about the node that’s hot and blue? Then there’s one that’s “not hot not blue.” It’s all very mysterious.

I wonder, too, if I should be worrying about this note on the report: “Middle of tissue fell out with processing.” Did they lose something important? I gave up some body parts I was busy using during that surgery. I hope they didn’t misplace them.

There are two bits on the report that look quite serious:
--The removed tumor was grade three. According to Dr. Susan Love’s Breast Book, left on my doorstep by a generous friend, tumors are usually graded 1, 2, 3. The higher the grade, the more aggressive the tumor.
--From the looks of it, at least a portion of the tumor was comprised of comedo cells. Those sound nasty. They are cells that are stuffing the breast duct and are more aggressive.

What does all this say for the future? Oncologists base the treatments they recommend on these reports along with attendant slides, x-rays, and blood work. The forms of treatment, radiation and chemotherapy, are not to be taken lightly. Neither are the drug therapies recommended for the ensuing five years. Somehow, as helpful as Dr. Love’s book is, I cannot read much of it without becoming nauseous.

I’ve decided to give up my decoder ring for the rest of the week. It’s time to have some fun before this illness wraps me completely in its tentacles.

It’s one month to the day since I was diagnosed with breast cancer. I have two surgeries behind me and treatments ahead of me. The shock and trauma to the body and psyche remain fresh.

Details from Friday, October ninth stand out in sharp relief. I was sitting in the chair I’m in now, typing on the same computer, waiting for the results of my biopsy. I remember looking at the clock at 9:50 a.m. “Please let them call me in the afternoon,” I thought. “If they call then, it’s benign. The morning calls will be to people needing appointments for surgery.”

At 10:05 the hospital was on the telephone. “We have your results. The slide came back from pathology marked ‘IDC.’ You have invasive ductal carcinoma.” I wrote down the details of my appointment with the surgeon. I hung up the telephone and let out what would be the first of several primal screams.

The irony of being diagnosed during “Breast Cancer Awareness Month" was not lost on me. There were many coincidences that day. My husband happened to be working from home (a rarity) before keeping an appointment with his own physician. I called him with my news just as he was walking into his doctor’s office. I learned later that my husband’s blood pressure shot so high that his physician did not proceed with a scheduled physical. “This might not be the best day to do this,” said his doctor. “Let’s talk about what’s going on at home.”

There was another irony. I’d skipped my mammogram screening the previous year and thought I might wait until the spring of 2010. I felt fine. Life was good. Why put my upper body through torture? My husband and my primary care physician both harped on me to get a checkup. I went to please them.

When the radiologist called after my initial screening, she had to browbeat me to come back. (I thought she was seeing a benign area on the x-ray that had been discovered years before.) I could almost feel her hopping up and down on the other end of the phone. This did not bode well. So, I went back for another mammogram, an ultrasound, and a biopsy.

The people who browbeat me into getting a mammogram saved my life. Maybe there’s a woman you care about who is tempted to skip her yearly screening. Please don’t let her do it.

The HMO that I belong to is being very thorough. So am I. Between the two of us, my post-cancer life will be well researched.

There are appointments to be kept and lists to be made. My surgeon wants to check her work. The HMO’s oncologist will recommend a course of treatment. (His opinion will be one of three.) The nutritionist will recommend a diet to be followed during treatment and beyond.

Meeting with the nutritionist was my idea. There are so many urban legends, and myths, about substances that cause or feed a body’s cancer that I’d like an expert to help me sift through them.

Among the urban legends is an email currently in circulation and entitled: “Cancer Update From John Hopkins.” When I read the email sent by a friend, I thought, “Shoot me now.” According to the report I could not drink tea or coffee, take sugar, or eat chocolate. Milk, according to the list, was out. So was red meat. Then a red flag went up. The institution’s name was misspelled. It is called Johns Hopkins, with an “s” after the word John.

I went to the Johns Hopkins internet site and found that the “cancer update” is a hoax. So I’ve taken the liberty of copying some of the institution’s real recommendations here:*

“While there is such a thing as tumors that produce mucus, the mucus made by a tumor does not result from drinking milk. And eating less meat, while a good choice for cancer prevention, does not free up enzymes to attack cancer cells, explains cancer prevention and control expert Elizabeth Platz.

“Moderation is key, says Platz. As part of a balanced diet, sugar, salt, milk, coffee, tea, meat, and chocolate—the foods the ‘Update’ calls into question—are all safe choices, she says. The real concern with many of these, particularly sugar, is that it adds calories to a diet and can lead to obesity, and obesity is a major risk factor for cancer. A balanced nutritious diet, healthy weight, physical activity, and avoiding alcoholic drinks may prevent as many as 1/3 of all cancers. Platz recommends eating at least five servings of fruits and vegetables per day and limiting red and processed meats, like hot dogs.

“Several Johns Hopkins experts participated in the World Cancer Research Fund - American Institute for Cancer Research report Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, published in November 2007, which is considered by cancer prevention experts to be an authoritative source of information on diet, physical activity and cancer. Their recommendations for cancer prevention and for good health in general are:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don't use supplements to protect against cancer.”

*This is the link to the Johns Hopkins site: http://www.hopkinskimmelcancercenter.org/index.cfm/cID/1684/mpage/item.cfm/itemID/1016

I will never forget my father’s eyes when he came home after colon cancer surgery. Chocolate brown with long dark lashes, they were saucer huge. But it wasn’t so much the size of his eyes as it was the look in them. It was haunting. I asked him once whether he’d noticed. “No,” he said. But others noticed, too.

“Where else will the cancer spread?” his eyes seemed to say. “How bad will the treatment be? Will family and friends treat me differently?”

His fearful eyes made me want to hug him, though my father is not the hugging kind. Instead, I watched a tape my brother once made. Old and grainy images of our family, some dating to the 1950s, flitted across the screen. There were plenty of holiday gatherings, good food and drink on the table. Smiling relatives were in abundance. There were images of me as a four-year-old getting a ride on my father’s shoulders. Daddy’s girl.

I spoke with my father this morning about my upcoming oncology appointment. “Everyone’s cancer is different,” he said. “Listen to what they tell you. Ask good questions. Once you decide on a course of treatment, follow it to the letter. Bring a good book to read if they recommend chemotherapy. You’ll be sitting there quite a while.”

Thanks Dad. And thank you for letting me ride on your shoulders.

I’m convinced the second day after a surgery is the worst. The relief that the surgery is over has dissipated. The mind races with things to do and places to go. The body is unwilling to cooperate. In short, it’s a down day.

I recently read an interview with author Barbara Ehrenreich in the San Francisco Chronicle. Diagnosed with breast cancer ten years ago, she became angry at “exhortations to be positive . . . because it will make you better. It was either smile or die.”

According to the article, Ehrenreich realized that “positive thinking was more widespread than she’d imagined. It was not only touted as a force against breast cancer, along with cheerful pink ribbons and stuffed bears, it was fundamental in our self-image and national character.”

Ehrenreich has written a book called Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. It explores what Ehrenreich calls America’s happiness industry, which she believes is partly responsible for everything, writes her interviewer, from “our slide into war to the economic crisis.”

I have not met Ms. Ehrenreich, nor have I read her book. Already, I love this woman. No one is cheerful every hour of every day. It’s not natural. And I agree that constantly promoting positive thinking can be counterproductive.

For example, I worked for a time in the marketing department of a software company. From gatherings in its conference rooms to lunching in break rooms to one-on-one meetings, cheerleading for the company and its products was not only encouraged, no other outlook was tolerated. The atmosphere was not healthy. Personnel problems could not be addressed because they often were not acknowledged. The marketing department would tout new product features in company brochures while software engineers were expunging those very features because they did not work. How positive is that?

A positive attitude can go a long way toward bettering one’s health and even growing our economy. But I do agree with Ehrenreich that “relentless positive thinking is something from which we must be weaned.”

Bringing Julia Child’s book My Life in France with me into surgery yesterday was probably not the brightest thing I’ve ever done. Her descriptions of France are wonderful; her detailed recollection of meals eaten in the 1940s is astonishing. However, instructed as I was to eat and drink nothing before my operation, I grew lightheaded when I came to the passage about sole à la normande. She calls it “a poem of poached and flavored sole fillets surrounded by oysters and mussels.” Yum!

I was having my second surgery for breast cancer in eight days. The first one removed the tumor. This second operation was to create a larger margin around the tumor site to prevent the recurrence of cancer. As the scheduled time for my operation stretched from 1:30 p.m. to 3:00 and finally 5:20, I had visions of crêpes flambées and tasty fromages flitting through my head.

Mind you, lying around on a gurney awaiting surgery for four hours is not all peaches and cream. I howled when the nurse inserting the IV couldn’t find a vein. (It took three tries, and wow did it burn.) She took my face in her hands when I burst into tears. “It’s okay to cry,” she said while she held me.

“Why so many of us?” I sobbed. “Why does it happen?”

“The good news,” she said, “is they’re getting closer to a cure.”

We discussed that for a while. Both of us were angry, knowing that too many research programs exist to perpetuate employment for scientists. There is too much scrambling for grants and duplication of effort when there should be more focus on a cure. One in eight women worldwide will have breast cancer. Every thirteen minutes a woman will die because of it.

The nurse and I both noted something else. Of the thirteen women I’ve spoken to about their own experiences, eleven have been stricken in the left breast. The nurse, one who travels “on assignment” throughout the country, has noticed the same. “Why,” she said, “is it always on the left?”

Nobody can say. And wouldn’t you know it, I’ve come to that portion of Julia’s book where she describes roasting a full-breasted duck with minced shallots and wine. How’s that for an ending to today’s blog?

Gallows Humor

Five days following surgery for breast cancer I was finally able to remove the last of the bandages. I’m convinced the hospital uses super glue to make them stick. Likewise, I was able to scrub the word “yes” from my shoulder. The word was printed there, with purple ink, to indicate the correct body part to be operated upon. I should have left it there. I have to go back for more surgery November 2, 2009.

The reason for the second operation is good. The top edge of the margin, where the tumor was, is only one millimeter. It should be at least two. The surgeon wants to take out more tissue to guard against recurrence of the cancer. I’m calling it my one millimeter operation.

Following this past Monday’s surgery I was a colorful mess: Orange from the antibacterial scrub. The purple word “yes” written on my arm. White bandages. Green, red, and purple bruises around the area of the incisions. I will not miss being a rainbow.

I’m already thinking of the radiation treatment, which I will likely have to undergo in the next few weeks. It is said to shrink the breast by one bra size. Where does one shop for a bra with mismatched halves?

Now for the cliché parade I’ve been seeing in the past few weeks: Hang in there. Keep on keeping on. That which does not kill you makes you stronger. Better safe than sorry. You’re doing great. You’ll be fine. Think positive. Relax.

A sharp-eyed friend noticed I posted a blog this morning, which I’ve taken down. Too serious. I’m more fortunate than so many who have more advanced stages of cancer, and I know it.

I’ve finished up reading The Guernsey Literary and Potato Peel Pie Society. What a delightful book! I’m so glad I picked it up the day before my surgery. It saw me through and then some. Of course, the subject matter, the occupation of the Channel Islands by the Germans during World War II, immediately captured my interest. My own novel, The Still Voice, takes place in Germany during the war.

I laughed out loud when I came to this line from the central character’s publisher in the Guernsey story: “Strings of anecdotes don’t make a book.” The first draft of my manuscript was a string of anecdotes culled from relatives about their wartime experiences. A book they did not make. Several drafts later I had San Francisco author Adair Lara critique the manuscript. She sent me an email, effusive with praise and including several pages of suggested changes--some of which I even took! She did write: “You have two books in one. You must change the ending.”

I’ve changed the ending. But I do still love the original, as it winds up with the romance that flourished between two people who became my parents.

There is one anecdote from the original ending that is dear to me. When my parents met in Wiesbaden in 1947, my father owned a huge shepherd dog said to have been a member of Erwin Rommel’s Canine Corps. My father would tuck love notes to my mother into Ivan’s collar. The dog would walk them from my father’s office to Mother’s home. One day, a friend of my father’s saw Ivan board a bus. Apparently, the dog had previously ridden the bus with his master and figured out a quicker way to deliver his notes! When the driver told Ivan, “Not you. People only,” Ivan bounded to the rear of the bus and climbed aboard. A smart but lazy character, that was Ivan.

If I ever get to write a second book, I hope I can include the romance that flourished in the rubble of WWII--and, of course, Ivan.

My favorite aunt, Maria, is ninety-four and lives in Bavaria. As I reside in Northern California, the distance between us is great. I miss her terribly.

I love the image I have of her in my mind. She’s sitting at the dinner table, eyeglasses dangling from one hand, the other hand wiping tears of laughter from her eyes. So often full of silliness, my aunt Maria loves to laugh.

I’ve managed to keep her near me by patterning a character in my novel, The Still Voice, after her. Like my aunt in her younger days, the character is a member of the Wiesbaden Swim Team. She’s adventuresome and pretty fearless.

Maria survived World War II living in a small town about an hour northeast of Wiesbaden. A story she loves to tell happened after the war was over. Her husband, imprisoned in a POW camp, had escaped and hitchhiked home from the Russian Front. He had her open a surprise he carried with him--a tin of bacon he’d managed to pick up along the way. She worked the metal key around the edge of the tin. When it sprang open, the bacon was full of maggots. What did she do? She squeezed the maggots out into the kitchen sink and fried up the bacon. The grease, she said, would make good oil for cooking!

Desperate as those times were, my aunt never lost her sunny outlook. One of her favorite sayings is, “Every day is a gift from God.” As a fifty-year breast cancer survivor, she has every right to say that.

This morning her son and my favorite cousin, Dieter, called to see how I was doing after my breast cancer surgery. I had to admit it’s a cranky day. The incisions burn a bit. My throat is sore from having had a breathing tube stuck down it. I feel weak. As I complained, I had to remember this operation saved my life. From now on, every day is a gift from God.

Three little elves left flowers and cards on my doorstep last night. My heartfelt thanks to them, and I wish I could join them at our book club meeting tonight. The spirit is more than eager. The body is feeling puny.

I’ve come through Monday’s surgery pretty well. I’m now a one-day breast cancer survivor. It’s a sisterhood I never aspired to join. Since my diagnosis, I’ve discovered we are legion. From the admitting nurse who checked me in to the nurses who cared for me, many had stories of their own to share. They held my hand and calmed my fears. I owe them a great debt of thanks.

There was good news yesterday, too. The HER2 test result, which indicates the aggressiveness of the cancer, was negative. That news, moments before surgery, gave me great relief. There was even greater relief afterward. The surgeon told me my lymph nodes were clear. It will be a few days before the final pathology report. But things are looking up.

A great big hug to my family who has been there for me and came to me right away in the recovery room. More hugs to surgeon Marla Anderson and her wonderful crew. And smiles all around to my book club friends. I think they’d be happy to know I spent the preoperative part of yesterday reading The Guernsey Literary and Potato Peel Pie Society. It’s a marvelous book given me by a friend in my writers group.

As writers doing our solitary work, we tend to feel all alone. I know now I need never feel that way again. For today it’s back to some rest, that cup of coffee denied me before surgery, and my book. I can hardly wait to read more!

What the human being can adjust to is amazing. Two weeks ago I was devastated at being diagnosed with breast cancer. Now I’m ready for my surgery. The tumor has to come out so the healing and the treatment can begin.

That doesn’t mean I’m not angry at having to go through it. Because I am. It doesn’t mean I’m not scared stiff. Because I’m that, too.

I’m looking at a rock sitting next to my computer. It’s painted with a pink ribbon and the word “courage.” I chose this rock among several on the breast care coordinator’s desk when I was at the hospital. It spoke to me as courage is the theme of my novel, The Still Voice. Years ago, when I began the research for my story, I was visiting a neighbor who handed me a book. “You’ll find this interesting,” she said, “as you’re questioning how the very young can be so daring as to stand up to their government.”

The book was called Conscience and Courage: The Rescuers of the Jews during the Holocaust. Its author is Eva Fogelman. There were a number of articles that interested me in that book. One in particular noted that, in rare instances, a young person has a keenly developed sense of justice. More likely, the youngster has an older role model in a parent or sibling. My character Sophia’s role model is her much older brother Max. The bond between the two is one I love because it is drawn from my mother’s relationship to her brother, who was twenty years her senior.

I was motivated to write The Still Voice because of family stories I’ve heard throughout my life. I’d heard many as a young girl living in Germany, and more when I visited in 2007. The stories do not grow richer over the years. They gain an added perspective. I suppose when I reach the age of ninety-four, like my aunt Maria in Germany, the year I had breast cancer will have better perspective. Right now, I can’t put how I feel about it into print. This is not a profane blog.