From Darkness To Strength

[Today is my 39^th birthday and I’ve spent it doing what I love most (aside from spending time with my family).  I’ve spent it writing, writing this blog post that I hope you will find ultimately uplifting.  Thank you for all the incredible messages of support.  I’ve not been able to respond to most of those messages but I will try to get back to everyone.  Thank you in particular for all the offers of help.  I will let you know when I need to accept those offers. 

As a quick medical update, I went into the infusion center two weeks ago, fully expecting to start Folfox, but Dr. A.C. had spoken to Dr. Marshall, and Dr. Marshall advised against doing Folfox and instead proposed a gentler and easier regimen of Xeloda (the oral version of 5-FU) and Avastin – 1000 mg of Xeloda twice a day for five days on and then two days off and an Avastin infusion every 3 weeks.  Dr. Marshall likes this regimen a lot because even though it tends to just maintain the disease rather than shrink tumors, it keeps patients relatively healthy for a long time and therefore good candidates for surgery and clinical trials.  Dr. Marshall wants me to look for immunotherapy clinical trials—the hunt for immunotherapy clinical trials will be a joint effort between me and Dr. A.C.  He felt that I should save the Folfox for when I really need it because it is a pretty harsh treatment.  I’ve heard from others that Dr. Kemeny at Sloan likes Xeloda and Irinotican for lung mets while Dr. Lin at Seattle Cancer Center likes Folfiri .  Dr. Marshall, Dr. Kemeny and Dr. Lin are all famous for their treatment of colon cancer.  It’s very difficult to deal with so many opinions, although ultimately it’s just evidence of how no one really understands this disease.  My oncologist is not a specialist in colon cancer.  He’s more of a generalist in solid tumors and is most famous for lung cancer.  So I’ve wondered whether I should switch to Sloan.  At this point, I’m unwilling.  I may try to get a formal second opinion from Dr. Kemeny at Sloan but I really like the quality of care I’m receiving at NYU.  I can get a hold of my oncologist easily.  I email him and call him on his cell phone.  He’s incredibly responsive to my concerns.  From what I’ve heard from others, that’s simply not the norm at Sloan.  And most importantly, Dr. A.C. and my other doctors at NYU are invested in me.  That counts for a lot in my opinion. 

I got the Avastin infusion 2 weeks ago (which takes only 30 minutes).  Because of the holidays and some incompetence at the NYU Cancer Center, I did not receive my Xeloda pills until last Friday.  Had I been on my game and in a good emotional state, I would not have allowed such a delay.  I was late in dealing with the incompetence.  In fact, it wasn’t until New Year’s Eve day that I sent a nasty email to my oncologist telling him that the delay and incompetence of certain members of the NYU staff was entirely unacceptable.  The mail-order pharmacy called me a couple hours later and told me the Xeloda would be shipped to me and arrive on the next business day.  I started taking the Xeloda Friday night.  Thus far, there’s just been a little fatigue.  I had been having terrible headaches before I started the Xeloda and during the weekend.  I decided that it was either brain tumors, a cold that the girls had given me, the stress of getting used to living with an incurable cancer diagnosis or anticipatory side effects.  The headaches stopped yesterday.

The day I got the horrible news, I learned of a laser surgery performed in Germany and London to deal with up to 100 lung mets.  In fact, I know of people who have gone to Germany to have the surgery done.  Although the surgery has been performed for 10 years, it is not available in the United States because the FDA has not approved the equipment.  I asked my oncologist what he thought of the surgery and what the lung tumor board thinks.  He and they think my tumors are too small for the surgery, that a surgeon would not be able to see the tumors during the surgery.  Dr. A.C. does have a patient he is sending to Germany to have it done but he said that in her case, the surgeon would be able to feel her tumors.  I might get a second opinion about this.  The surgery costs 11,000 Euros per lung.  Yikes! 

Now, on to the point of this post.  Many have been asking how I’ve been doing.  This post answers that question.]

I vowed when I started this blog that I would endeavor to be brutally honest about who I am and what it is for me to battle cancer, that I would strive against my very human egoist tendencies to prop up some persona of myself as perpetually inspiring, strong or wise.  Why was this so important to me?  In part, I made that promise to myself because if this blog were to become the principal means by which my children would come to know my innermost thoughts and feelings after my death, I wanted them to see my real self, a self that, in addition to experiencing many moments of joy, gratitude and insight, was often tormented by fear, anger, hurt, despair and darkness.  In part, I also made that promise because I disliked tremendously those bloggers who always presented in the face of a life threatening illness images of pumped fists and unending positivity and determination.  To me, such portrayals were disingenuous, an insult to the intelligence of readers and, above all, disorienting and potentially harmful for those like myself who were newly diagnosed and felt more darkness than light.  I wanted to detail and explore that darkness, to let others out there who I knew experienced a similar desolate and lonely darkness know that they were and are not alone.  There is a natural intuitive fear of darkness; people who are gripped by it are ashamed to speak of it, while those who are free of it for however long wish to run from it as if it were a contagious plague.  If the cost of my brutal honesty about my darkness is a highly unflattering picture of me that repels, so be it.

I have known a nightmarish darkness during the past 2.5 weeks a thousand times worse than anything I’ve ever experienced.  I managed to get through Christmas and then the full force of the darkness hit me the day after Christmas.  It left me broken and crumpled on the ground, both literally and figuratively, my rage-filled screams ringing in its wake and a husband and children utterly shocked at the madness they were witnessing and had never thought possible in this woman who was supposed to be their steadfast wife and mother.  Yes, Josh has seen me angry and despairing before, but never like this, for this frightened him; this made him afraid for his own and his children’s safety because I was like a deranged animal devoid of reason, hope and light.  I yelled and hurled things, not at Josh or the children, but at the heartless gods who would do this to me, and in the absence of those gods, at the painfully unjust cruelty that is an inherent part of the human existence.  Why me? I demanded of those nameless gods.  Hadn’t I already borne my share of trials and tribulations?  Hadn’t I already known enough suffering?  Hadn’t I lived a good and moral life?  The absence of any divine answer arising from the chaos of my thoughts made me even more crazed.

Through heaving sobs, I begged Josh to let me go, to let me leave him and our girls forever for all I wanted to do was flee, get on an airplane bound for unknown parts where I could die alone with a setting sun.  In the state I was in, I was a completely unfit mother and wife, an unfit human being for that matter.  I tried to convince Josh that my leaving would be for the best, that he is still a young, handsome man with a successful career and he would be able to find someone to replace me easily, that any woman would love our girls, that the girls are so young they would grow to love their new mother easily enough.  I wanted not to fight, but to flee to a place where I could die.  I told Josh I didn’t want to live like this, with this diseased body that had failed me one time too many, with the specter of death looming ever closer, that this was no longer a life worth living, that whatever good that would come from now on, whatever laughter, whatever joy would be poisoned by the cancer, and I didn’t want a life poisoned by cancer.  I wanted to start over.  I wanted to find escape and rebirth in death.

Even as I made these pleas, I grew angry at the image of this other woman who would have the time and life I should have had with Josh and my girls.  I hate her, this woman I don’t even know.  I hate her now and I will hate her for eternity.  And yet, I also want her, need her, to come into their lives, to take care of my husband and children.  I need her to love them as well if not better than I do, for as long as Josh and the girls are okay, then I know I will be okay.  As much as I hate her for myself, I love my family more than I love myself and I need them to be okay.  I need them to mourn me, to remember me for a time, and then I need them to move on and live their lives with joy and abandon.  This is what I want for them above all else.

[I must pause here to leave a message to any woman who comes into my family’s life, including the second wife – I like to call her the Slutty Second Wife.  I’ve stated in this blog once before which I reiterate now, I vow that if any woman does wrong by Josh and my children, I will hurt her.  I will come back as a poltergeist and hurl books and vases and anything heavy and painful at her head.  This I promise.]

In sleep, I found a reprieve from my nightmare for in sleep I did and do not have cancer.  In sleep, I live the life I wanted.  I’ve half-convinced myself that death will be like my dreams.  In death, my soul will travel to a different dimension where I will get to live my ideal.  There, I will no longer be plagued by the limitations and hurts of this body, but I will have the compassion and wisdom gained from the painful experiences of this life.  There, I will know what it is like to see the world perfectly, to drive a car, fly a plane, play tennis.  I will get to live a full and complete life with Josh, my great love of many lifetimes.  With him, I will travel more of the world and have our two girls and more children.  I will cook grand feasts for them and fill the house with the smell of freshly baked breads.  Our home will ring with the sounds of innocuous yelling and mundane dramas and warm laughter.  And there will be so much love, always so much love.

Every time I woke from sleep, the first thought I had was that I had incurable cancer with a prognosis of several years (and probably less given the seeming aggressiveness of the cancer), and I wanted to scream at the loss of my dreams in my waking hours.  Waking was like mourning the loss of my dreams again and again and again.  Torture.  Agony. Crushing.  It’s enough to make you want to die so you can go live the life that you’ve half-convinced yourself awaits.

Josh wouldn’t allow me to lie broken on the ground.  He yanked me up by the arms, screaming right back at me, “I will not let you give up.  Do you hear me?  You will not give up!”  In the next breath, he was begging me to fight for him and the children, if not for myself.

I honestly think Josh and the girls would be better off starting over sooner rather than later.  No one has been able to convince me otherwise.  I don’t want to be a burden.  I don’t want my family to see me die a slow painful death.  I don’t want them to live through my emotional roller coaster.  In no way am I minimizing the love Josh feels for me.  It is very real and deep, but I also know that time heals all wounds, that he is capable of loving someone else, that he should and will need to love someone else.  And perhaps, that love will be equally profound, if not more so.  He is a good and wonderful man and I have been inordinately lucky to have him.  Even with respect to the children, I know that they are resilient, that they will withstand my loss and thrive regardless.  They are after all my children and I like to think the best of me flows through their veins.  I know that so many will step in to help Josh raise them and that so many will tell them about their mother.  I know they will be surrounded by love.

So no, if I choose to keep fighting, it won’t be because I think Josh and the girls really need me or that somehow more time with me will make much of a positive difference in their ultimate destinies.  Nor will I fight based on some delusional hope that I will somehow still miraculous beat this or that I will have a lot more time than I expect – I have always had a tumultuous relationship with the concept of hope and I still do.  I’m not a believer.  I will leave the hope stuff to all of you.

Even so, I do choose to keep fighting.  It’s taken me nearly two weeks to make that affirmative choice.   It’s taken me nearly two weeks to recover from the lows of that day after Christmas, to pull myself out of that darkness.  It happened with the help of Josh and my girls, my beloved, long-time therapist and the words of my even more beloved sister, Lyna, and best friend, Sue.  They helped me to see important truths about me and how I want my life and legacy to be viewed now and after I am gone.

When I did poorly on a test in high school – and by poorly I mean by my nerdy standards a 92 instead of a 95 or a 97 instead of 100 – I would come home tearful, convinced that this unacceptable grade on a test was the greatest tragedy of my young life, and, indeed, it was.  My parents were not the typical crazy Asian American parents who put pressure on us.  Yes, my dad would pay us for every A we got on our report cards, but there were never any demands or threats.  In response to my crying, my mother would ask in her broken English, “Did you do the be’t you can?”  Of course, I had.  “Then, that’ all you can do,” she would tell me

It was such simplistic advice and yet it was so true.  Your best effort is all you can ask of yourself – no more and no less.  And once, you’ve done that, there can be no regrets.  I will continue to fight this disease – not with the same gung-ho attitude I once had at the beginning – but I will continue to fight it with an even more nuanced, deeper and realistic understanding of its deadliness.  I am an overachiever, used to doing my best at everything.  A lot of times my best wasn’t good enough to get the stellar grades.  Similarly, my best will not be enough to beat cancer, but even as I lie dying someday not that far into the future, to know that I tried my best to gain more time in this life and to live as well as possible in the face of this disease and therefore have no regrets, that knowledge will be enough for me.  It will be enough to bring peace to my soul for I would have fought cancer in a manner consistent with how I lived the rest of my life, that cancer, though it may have taken so much from me, did not rob me of that vital part of my spirit.  It will bring me peace because by the example of the totality of my life and how I chose to fight always, even in the face of such a formidable foe, always doing the best I could, I will teach my girls one of the most important lessons there can be.  I want them to understand the importance of always doing the best they can in whatever endeavor, a lesson that their maternal grandmother taught me and one that I now must teach them.

As a mother, I don’t get to just walk away from my children however much I may want to escape further physical and emotional pain or for any other selfish reasons.  I made the choice to be a mother five years ago and with that choice came sacrosanct commitments, the most important among them being to give my children the tools to live their lives, tools that go well beyond feeding, bathing and clothing them.  Continuing to battle this disease in the face of its likely outcome is about keeping the most sacred promises I made to them the day I held their little fragile bodies in my arms for the first time.

I am also making the choice to keep fighting because of all of you.  I received many wonderful messages of support and love.  Thank you so very much.  All of them lifted my spirits.  But one comment left me thinking a lot.  It was from Domitilla from Italy, someone I’ve never met in person.  She wrote:

I still believe you can beat the beast. You are a fighter, dear. You got the best reasons in the world to keep fighting. You got a loving family – husband and girls. Your parents and siblings. They all love you deeply. And then you got us, the blog people. We love you deeply, Julie, as well. Because your fight is ours. Don’t give up, Julie dear, please don’t give up. You are not fighting for you alone, you are fighting for us as well.

The idea that somehow my fight is also yours, the notion that I must continue to fight for you – the sentiments were so incredibly beautiful to me and somehow feeling like you all need me to keep fighting gives me the will to fight.  Indeed, the idea that you need me to keep fighting is in some ways more inspiring than the idea of fighting for my own family.  Domitilla’s comment made me realize that I am, just as each of you are, a vital part of the fabric of mankind.  It is as John Donne said in his poem, No Man Is An Island, “any man’s death diminishes me because I am involved in mankind.”  Yes, I suppose that my death will diminish you, but I also understand now that my living and fighting makes you greater than you are.  Indeed, anyone who chooses to live and fight and show by their example the power of the human spirit that we all share and its determination to persevere against the brutalities of what life can bring strengthens us all with a sense of the tremendous potential and fortitude that lies within each of us, a potential that is only realized when truly tested.  So I fight for myself, for my family, and least of all, for you, my blog people, for the message that my war against cancer conveys to all of you, to all of humanity, about the incredible strength of which we are all capable.  And by that same token, I urge all of you who read this blog who face your own challenges that make you want to fall into the darkness, to fight too, because you too are part of the human skein, and your fight matters and gives me and others strength when we falter.

I received many messages reminding me of how brave and strong I am.  I’ve felt anything but brave and strong during the past few weeks.  Does a brave and strong person lie on the ground crying as her children look on in horror?  Does a brave person walk through the abyss of darkness and wallow in the shadows of despair?  No, those are not images of bravery and strength.  It is what she does afterwards though that matter.   A brave and strong person hugs her daughters after the fact and tells them stories about her childhood and, even though they’re too young to understand, she talks to them about what it means to get married one day and how important it is for them to love themselves first and foremost before thinking about loving someone else. A brave and strong person pulls herself out of the abyss with the help of those who have more strength, hope and faith than she and goes about the business of living even though she doesn’t necessarily want to.  A brave and strong person goes back to doing more research as she tries to figure out what to do next.  She does all this knowing that there will be another abyss and many more moments and hours and days of darkness before she succumbs to the ultimate inevitability.