As you know, I am trying to establish new exercise and mindfulness habits. Today, I did the daily mindfulness practices for the week, a body scan (basically paying attention to each part of your body while doing relaxation breathing) and a “mindful meal.” During the meal, I tried to experience all of the flavor, texture, smells, etc of the food as I was eating it instead of just gulping everything down while I am fiddling with my smart phone or with my computer. (I don’t do this at family meals, just lunch.)

When my 9:30 testing case cancelled at the last minute, instead of driving straight home, I thought “I was going to take a walk around my office after I was done with this testing. If I go home now (testing takes a couple of hours and I didn’t have anyone scheduled until the afternoon), I know I’m bound to go inside and start working instead of going for a walk. I’m going on the walk now.” So I walked over to Red Cup Espresso. Gina and Samir made me a delicious latte, which I carried with me while I took a walk for an hour and a half. By the time I got back to my office, I felt great.

I drove home and started some cooking. I am also trying to prepare healthy meals ahead for freezing as part of my new eating habits. When it’s John’s turn to cook, he usually gets take-out. I’m trying to avoid that kind of food. It’s either fattening or unsatisfying or both. He has been working at top speed on building a deck so he is not going to be cooking frequently again any time soon. I also wanted to put away some food for my friend, Brian who had major surgery for sarcoma on the 13th. He will be coming home from the hospital soon.

When the mail arrived I noticed that there was an envelope from our insurance. We get a lot of these as you can imagine. I opened up the envelope and it was the Explanation of Benefits for my $28K hospital bill (please save rants about hospitals overcharging people for other venues) for my mastectomy. They said that they were paying $0 because the hospital had not obtained a pre-authorization. Aaaaaah! I took a deep breath and then went through John’s stack of mail because I know I had seen a pre-authorization for the mastectomy. I got the pre-authorization letter, a pen, and the Explanation of Benefits form. I let my fingers do the walking and called my insurance. The customer service representative was quite nice. (I do a lot of talking with insurance companies for my job. This is not always the case.) I asked her why the claims were denied even though I had a pre-authorization letter. As it turns out, insurance had already been in contact with Swedish Hospital about this. Apparently, they had a question about one of the charges and when that happens, it holds up the entire claim! As she noted that this inquiry had been made a couple of weeks ago, it would have been nice had they written something about this in their notes instead of just writing that the whole thing wasn’t covered. Phew!

Good thing I’m good at breathing!

Not that Crying Game, a different one this time. Although I have been doing really well, I know that I’ve been through a lot and have a lot of surgery and adjustments still to come. Some of the most difficult times in my life have been after weathering stressful life circumstances rather than during. Because of this, I started going to therapy with a psychologist who has a lot of experience with people with serious medical conditions. I’ve had two sessions and now we have about a month break because she is having a major surgery. (She’s okay, just taking care of a chronic health issue.)

When I last saw her, she challenged me a bit. I had told her that I wanted to make sure I grieved and processed my experience so that I could remain healthy rather than getting depressed or super anxious later. She agreed with my goal but also said that the way to do this may not fit comfortably with my active coping style. She said, “It’s probably going to mean crying a lot.” She later said something along the lines of “How screwed up is it that you got cancer.” My reply was something like, “Well, I know you want me to cry (she started laughing at this point), but I know that bad things happen. I have so many things in life that have been wonderful. On the balance, I don’t feel like my life has been unfair.” She also challenged me to consider a “worst case scenario” future in which my cognitive functioning (my memory and stuff, which has been a struggle lately) never came back to where it was before and how that might impact my identity, especially related to my family (since I am in charge of remembering everything) and my work. (I don’t think she really meant “worst case” because there are way worse outcomes with cancer.)

On the one hand, if it turns out that I am unintentionally keeping myself from thinking the difficult thoughts and feeling the bad feelings, this is a good line for her to follow. On the other hand, I have worked hard in my life not to “borrow trouble”, not to ruminate on what “might be” when I can’t do anything but wait and see what happens. To me, if my mind does not totally come back due to the impact of stress or medication side effects, I can deal with it when and if the time comes. Further, I like the way I feel now. I like having a positive attitude. I like being funny. I like smiling at people and they smile back. I like the reasonable part of my mind that keeps me from getting overwhelmed with my catch phrases like, “patience persistence peace” and “almost every problem has a solution.”

My therapist says that a common challenge among breast cancer survivors is how cancer impacts their identity. I have certainly thought about this and continue to do so. How does my having a serious illness impact my identity as a strong and healthy person? How does losing a breast impact my identity as a woman? How does trusting others to take care of me impact my identity as a self-reliant nurturer? How does cancer impact my identity as a wife and mom? I have had many tests to my identity in the past that seemed a lot harder than this. Maybe I am kidding myself. I have a voice in my head and heart that says, “I know who I am. I am not completely defined by what happens to me. There is a core me that doesn’t change.”

Then again if my identity is so strong, it surely will not crumble if I challenge it. So here is my plan. Since I am one of those people who cries at movies and books, I am going to do some cancer reading. I’ve done some but it has all been medical stuff to help me make good decisions and know more about breast cancer as well as it’s treatment. I mean that I’m going to read some breast cancer memoirs. I’ve chosen a group of books and loaded free samples on my Kindle. Some of the authors lived and others did not. We’ll see what this reading dredges up for me.

As for my other goals, I still plan to get those going. I started taking walking breaks last week at work and will continue to do so this week. I am continuing Weight Watchers and regular massage. I am also in the process of scheduling an initial consultation with a naturopath who specializes in oncology. I want to make more consistent use of mindfulness meditation practices so I have downloaded an 8 week mindfulness course for cancer patients onto my Kindle and will follow it.

Let the games begin.

Warning: This post is not for the squeamish, that is for any of my brothers who do not like reading about their sister’s breasts, even though nearly half of you are old enough for membership in AARP. Apparently, it does not matter that as a sister to five boys, I was regaled with endless tales about your boy parts (“Look, I can write my name in the snow!”) as well as your less than scholarly fascination with GI tract functions. But I’ll stop teasing now because you all have been particularly nice to me lately. But consider yourselves warned!

Last Thursday, I had an appointment with Dr. Beatty. This was my first appointment with him since my mastectomy due to his vacation schedule. As I mentioned previously, due to the location of the incision from prior surgeries, he had to perform his first “upside down mastectomy.” Ordinarily, the incision would be below the breast but he had to work from the top for mine, which is apparently a rarity and a first for an extremely experienced breast surgeon. I was pretty sure that Dr. Beatty’s first question following “How are you?” was going to be “How is your nipple?” (Guys, I told you that this post might be too much for you and it’s going to get worse before it gets better.) This was not a surprise to me since he was concerned about necrosis (cell death) of this area because he saw a little on the underside during surgery, which was one of the reasons I was instructed not to use ice after this surgery. He wanted me to promote blood circulation by keeping the surgery site warm, which not hard during that mini heat wave we had in early August. In the healing process there was an area of superficial skin (including the nipple) that did not look so good for awhile, to put it mildly. Let’s just say that from an aesthetic standpoint, I disliked it both in terms of color and texture. By the time I saw Dr. Beatty, it was obvious even to me that everything was going to be a-okay.

He was very pleased and also told me that doing the upside-down mastectomy was “kind of fun.” He also asked me if he could show off his handiwork to a colleague, Dr. Hanson. That was just fine with me. I don’t know if Dr. Hanson just happened to be available or if Dr. Beatty had given him the heads’ up earlier in the day. Dr. Hanson was also suitably impressed and told me that Dr. Beatty had done a great job. I thought it was nice to see two people very experienced in their profession still be so enthusiastic about their work. I know that for myself, I love what I do but occasionally worry that I won’t like it as much in 10-20 years, so this was encouraging to me.

At the end of the appointment, Dr. Beatty told me that he wanted to see me again in six months. Waaah! Six months? I knew this time was coming and it means that I am getting back to a more normal life. But Dr. Beatty and the other kind folks in the clinic, Martha, Rhea, Candace, Penny, Alysia, and Chris, have all been there for me from the very beginning, just one day after learning about my cancer diagnosis. Thanks so much and you can only imagine how much you helped me stay calm, make good decisions, remember to breathe, think positively, and keep joking through a very frightening and totally unexpected challenge in my life. A couple of people said that they would miss me, which was really sweet. I guess there’s not a lot of laughing at the cancer institute. I told them I’d laugh extra loud from the 5th floor (Dr. Rinn’s office) and maybe they’d hear it on the 6th floor. I also noted that my normal laugh volume might break through the sound insulation between floors. (It has been raised to my attention, a time or two. My college Italian professor, Franco Masciandaro described me as “Signorina MacKenzie of the explosive laughter.” My laugh is not always met with affection. Most notably was the concern raised by two of my grad school advisers. They had only heard me cutting up in classes and were perhaps concerned that when interacting with patients I might say, “You’re depressed? Ha ha ha ha ha ha ha!” Over time, two years to be exact, they kept hearing good things from my clinical supervisors and let it drop. Maybe they experienced some happiness related childhood trauma. I kid, I actually liked both of them quite a bit.)