Monday, March 21, 2016

My Conclusion for Breast Cancer

My Conclusion for Breast Cancer

It is possible that there is no more beautiful place in Washington during the Christmas
holidays than the White House. Each year the president and first lady open up the mansion
to thousands of visitors, including the press, to celebrate the season. In a rather
extraordinary twist of fate, exactly one year to the day after learning about my cancer while
standing on the driveway outside the press briefing room, I returned to the White House to
attend one of those parties. Since that chilly evening a year earlier, I had undergone a
mastectomy, the awfulness of chemotherapy, reconstructive surgery with more to come,
drugs as a daily part of my life, not to mention the sometimes demoralizing adjustment to
my looks. In my darkest moments I hadn’t looked too far ahead, certainly not to a year
later and a return to the White House.

Despite the fact that I was to undergo another surgery in a week, it was a delight to revel
in the joys of the season. The decorations in the White House are a sight to behold, bright
and bold, meaningful and merry. From the tree honoring military personnel in the Blue
Room to the cameos by the first dog, Bo, in every room in the house (including a Bo made
of buttons and a Bo made of garbage bags), everything was lovely. I tried to remember
everything I saw because the last time I’d been in the White House was such a blur. But
the thing I remembered most was that I was standing here, with a good prognosis in front
of me and blessed to have endured the previous year.

It is a strange thing about cancer: even after all your treatment it never quite leaves you,
at least in the metaphorical sense. I see doctors regularly. I take drugs daily and will
continue to do so for the next few years. And always in the back of my mind there’s the
nagging question: Will it come back? That, of course, is unknowable. But having endured
once, I’ll know a little of what to expect. For those of you who are enduring now, I hope
that this book will have provided some comfort and solace. Everyone’s cancer is unique,
but my hope is that this book has provided a little something for each of you.

ZZZ' Sleep in Breast Cancer Survivors

Catching some zzz’s is a cartoonish way of describing sleep. In fact, it was the only way
for a cartoonist to connote sleep (and not death) almost a century ago. Capital ZZZ’s,
maybe punctuated by an exclamation point, were supposed to replicate the gentle sound of
snoring. So simple and so effective when you see them in a cartoon panel.

Sadly, there is nothing comical or simple about your relationship with sleep when you
become a cancer patient. In fact, it seems as if there is a vast conspiracy allied against you
and your ability to sleep. Your mom always told you that you needed a “good night’s
sleep,” and there’s plenty of research to support the idea that sleep is one of the most
restorative things you can do to maintain a healthy body and mind. And admit it, sleep is
probably something you have always aspired to in the hurly-burly of your daily demands.

Ah, to sleep, perchance to dream? Actually, I’d take sleep without any dreaming. Sleep
deprivation seems to be the affliction of modern America, and it is even more common
when you enter Cancerland. The cabal lined up against your sleep is pretty formidable,
thwarting every effort you may have in mind. You enter a vicious cycle of sleep you can’t
get to heal and then your inability to sleep compounds itself, and the cycle continues.

So who exactly are these conspirators stymieing your best efforts? A veritable alphabet
soup of challengers, many of which you have met in the pages of this book.

There is A for Anxiety, your companion from the first moment you feel a lump or learn
about an irregular mammogram; C for Cancerland—a place you never, ever wanted to
visit, but now that you are there it keeps you up at night; D for the Drugs—you are taking
so many of them, and some make you tired, some make you nauseous, some make you
buzzed, and some you hope are killing the cancer; G for the Guilt you are feeling about so
many things, like What did I do wrong to deserve this?; I for Indignities, of which there are
so many once you start on this breast cancer odyssey; M for Mastectomy—it hurts so
much that it defeats sleep at every turn, including, literally, if you want to sleep on your
stomach; R for Reconstruction—so many surgeries, messing up every natural rhythm that
your body ever possessed; S for the Sex you feel bad about not having because you feel
like crap and hurt like hell; X for the eXhaustion you are feeling throughout this whole
ordeal but are too exhausted to sleep.

And of course sometimes these conspirators form a tight-knit brigade, like Anxiety fed by
Guilt, which is exacerbated by not wanting Sex. You get the picture: so many forces
marshaled against your ability to sleep.
So where are the opposing forces, ready to do battle against the formidable enemies of
sleep? Well, you’ve met some of them in the pages of this book too. D, that traitor, can be
found on both sides of the battlefield, because you can get Drugs to help you sleep. Don’t
worry about becoming addicted, get some sleep; they may not always work perfectly, but
they’re a start. P for the Pillows that can make you a little more comfortable while M for
Mastectomy is doing its darnedest to thwart you and your efforts to sleep at every turn. K
will help you sleep too—the Kindness of others will soothe the darkest moments that are
feeding your anxiety; thinking about V for Vacation can take you out of the Cancerland you
are visiting now to a place where you really want to be that will replenish and rejuvenate
It is important to remember there will be replenishment and rejuvenation. But it will not
happen fast, and it will not happen the way you think it might. Dealing with breast cancer
happens not on your timetable but on the timetable of the disease. What you do have
control of is how you deal with it and how you want to cope. And getting some shut-eye,
however you can, is one of the best ways of all to cope.

ZZZ' Sleep in Breast Cancer Survivors

You in Breast Cancer survivors

You in Breast Cancer survivors

I don’t think I am a particularly selfish person. I have a husband and two children, so I
consider three other people in my life every single day. Growing up in a house with three
siblings meant that even on the days when I might have wanted things to be about me, they
weren’t. I work in a business where absolutely nothing gets done without the collaboration
of so many others. This has made me conscious of people around me and able to interact
in myriad situations with myriad individuals.

When you are diagnosed with breast cancer, however, it is all about you. This is the
most rare of situations when you have permission to be selfish and self-centered and maybe
even a bit demanding. This doesn’t mean you should turn into a bitch. It means you should
surrender to the fact that you have this terrible diagnosis and you really need to focus on
you and what you need. What you are feeling at any given moment is the most important
thing during this period. Give yourself permission to get comfortable with that.

A focus on you can take many forms. For your family, your disease and treatment
become the “thing,” the dominant force in your family’s life. For our family this meant a
calendar chockablock with appointments and tests for me, many of which my husband had
to be a part of, sometimes because I needed someone to bring me home, sometimes to be
the second set of ears, listening in on every conversation with every medical professional
(see “N Is for Notebook”). So his focus had to be on me. It meant my siblings and my
sister-in-law and my father all came from overseas just for me. Not as they had so many
times before, to see my growing children, or to take a vacation from work and see the
cherry blossoms in D.C., but to see me and help me with whatever I needed.

There were more mundane ways in which my focus on myself was felt by all. Beware
my wrath if you finished up the only ice cream flavor that I could eat. Okay, maybe I was
a bitch about that. If I didn’t want to have people drop by, I could just say no without a
sense of guilt or obligation or impropriety or anything else. If I wanted to spend the
afternoon in bed crying, well, that was okay too.

My recommendation to you is to embrace you, which is harder than it sounds. At many
points in your life, perhaps in a moment of quiet reflection, you might have admitted to
yourself that what you wanted to say was “to heck” with everyone else, here is what I
want to do. Breast cancer gives you the perfect excuse to do this, although going through
with it will make you feel terrible. Terrible because you feel that this disease is now a
burden to so many other people and you feel guilty about it (see “G Is for Guilt”). You
might feel a little timid about being demanding. Don’t. It is perfectly appropriate to have
your world turn its direction toward you. It is a useful advantage of carrying the cancer
card—use it to its utmost benefit.

Sunday, March 20, 2016

Xhaustion (exhaustion) in Breast Cancer

Xhaustion (exhaustion) in Breast Cancer

We have all been tired in our lives. I have given birth to two children. I have traveled the
globe to cover stories where you land and start working immediately, time zone be damned.

I have worked without pause, forty-eight hours, seventy-two hours in a row, just going as
the adrenaline somehow keeps me pumped, and I will not be defeated by my body’s
greedy thirst for rest. I have gone on hikes with my husband that I have not wanted to do,
when I feel that one foot will not reach in front of the other and I will be stuck on a
mountaintop until an air rescue mission arrives. I am tired. Leave me alone.

When you undergo chemotherapy, the doctors will tell you about the fatigue. Or as my
oncologist put it, “You won’t be living that Washington professional working mother life for
a while; something has to give.” She means you will be exhausted. Not fatigued like a
delicate Victorian damsel. You will be exhausted in a way that you cannot think is humanly
possible. It is a strange kind of tiredness. At times your body cannot hold itself up. You are
a rag doll. Your brain says yes but your body flops rather than flipping to attention. The
poisons are coursing through your system; that wretched chemotherapy makes itself felt in
every part of your body. You can’t grip because your fingertips tingle from the drugs; your
toes tingle too. Your joints have no adhesion. Does my knee really join my calf to my
thigh? I can’t tell. I want to knit but my wrists and elbows have their own ideas.

Throughout it all my brain is completely and utterly awake. I have to take “rests” in the
afternoon because my body won’t keep up with the inside of my head. My thumbs can
occasionally work on the BlackBerry; my fingers can sometimes dial a phone.

I want to fight through the exhaustion. In those early weeks of the chemotherapy, I
would take a walk around the block, propped up by my husband or one of my daughters. It
is one of the most counterintuitive things—walk through the exhaustion, just to keep the
circulation going. I was diligent about this, but it didn’t stop the exhaustion; I guess it just
kept some tone in my body. It is an accomplishment to sit downstairs at the table for
dinner. As the body acclimates to the treatment, the fatigue takes hold. Day 4 or 5 after a
day of chemo infusion was the worst for me. The chemo, the post-chemo drugs to build up
your white blood cell count to stave off infection, the fact that eating does not feel good or
taste good—all these things conspire to drag you down, and this time your exhaustion feels

You are not being a wuss. You are undergoing a radical chemical assault on your body.

You have to acknowledge the exhaustion and just go with it. There will be days when you
feel great. On the days you don’t, just let it be. It is not about you, it is about the
chemicals. Of course, the more chemo you have, the worse it gets. The effects are
cumulative. And what you are not quite prepared for is that it stays with you well after your
last chemo session. How long? Six months? A year? Two? It is different for everyone.

Your exhaustion is not a reflection of you or of any weakness on your part. It is a
testament to the power of the drugs that are out there chasing every one of those bad cells
away. Unfortunately, they chase the good cells too. Cut yourself some slack and take as
much rest as you need. You deserve it.

Warrior in Breat Cancer Survicors

Warrior in Breat Cancer Survicors

I am not a warrior.
I am a journalist—my profession.
I am a wife—my status.
I am a mother—my devotion.
I am not a warrior.

However, as a breast cancer patient I am deemed to be a warrior in an army made up
entirely of conscripts. I have been pressed into battle, part of the “war against cancer.” We
patients are the frontline infantry in this fight. We (breast cancer patients) have benefited
enormously from the extraordinary effort made by millions to put breast cancer on the
map. Our insignia is the pink ribbon, and we must wear it proudly. The language evoked is
inevitably military. I will battle this disease. I will defeat it. I will kick the enemy’s ass. But
even conscripts in a regular army get some training. We, on the other hand, start our fight
the second we are diagnosed. No training sessions, no time for mental preparation. I am a
warrior now, a reluctant one, but desertion is not an option. I am now engaged in a war.

Who is going to help me with the battle plan? How will I strategize my victory? Who is
going to finance this war? Who is going to be my logistics team? I must gird myself for the

But I am not a woman warrior. I am just a woman, a woman who has been diagnosed
with a horrible disease; a woman who has gone through brutal surgery; a woman who has
had her body poisoned to “kill” the disease. Can I just be a woman who is going through
that? Can I not be a woman warrior? Please?

Vacation for Breat Cancer Survivors

Yes, I know vacation is the farthest thing from your mind. You are already visiting this
strange new place called Cancerland, a foreign destination hard to navigate, a place you are
never really going to leave. How could you possibly be thinking about a vacation? Well, I
consider a vacation an admirable goal to strive for during the worst of your treatment. I did,
and it was worth it.

When you are diagnosed with breast cancer, your doctors and larger medical team—
there are so many of them—will become among the most important people in your life.
There are so many appointments to keep; so many tests to undergo; so much pain, nausea,
and discomfort to endure. I certainly felt that I wanted to be close to my doctors at all
times, day or night. The anxiety of the what-ifs is palpable. When you are undergoing
treatment you are, well, sick. Sometimes you might get so sick that you need to go to the
hospital. I ended up in the emergency room twice while I was undergoing chemotherapy,
glad that the hospital was just a short ride away.

There are ups during each cycle of chemotherapy, when you tell yourself you are feeling
better and you can do anything. But then you remember that your immune system is
completely and utterly compromised. I once entertained the thought of attending an event
in New York during one of these upswings. I was sure I had the energy and thought that
taking the train from Washington, D.C., to New York would be less taxing than flying.

Then I started to think about the circle of germs I would encounter on that trip—touching
door handles, breathing in the same air as a train car full of people, arriving at Penn Station
and encountering the full panoply of what New York City has to offer at that particular
crossroads of humanity. (For the uninitiated, it is not the most welcoming of major city
train stations; in fact, it is old, and murky, and dirty, and thoroughly depressing.) Since I
couldn’t guarantee a Purell perimeter zone with me in it and everyone else out of it, staying
close to home seemed to make most sense for me.

So, would I ever get beyond a three-mile radius of my house? Well, it turned out that
eventually I would. What I needed was a goal. For years I had wanted to visit Istanbul. In
fact, one of my earliest thoughts upon diagnosis was I’m going to die and I’ve never been
to Istanbul. So for me, finally taking that vacation was a worthy thing to strive for. During
the real lows of my treatment, it seemed the most unattainable thing possible but also, on
some days, the only thing I might get out of bed for. Ah, the paradox of cancer treatment.

But your vacation doesn’t have to be in a destination as exotic as that. A change of
scenery is a great thing, even for a day or two, but it must be a vacation for you. I made
the mistake of making a work trip out of town too soon and ran myself ragged and had to
come home early. A few months after chemotherapy the first pleasure trip I took was to
visit friends in Massachusetts. Here are the things I remember about that trip: I was leaving
home, so I was leaving my cancer behind for a while; they were really good friends and
there were no expectations on either side, they just wanted me to get away for a break and
I wanted to be somewhere different; I was really tired; I spent a lot of the weekend on the
couch in their living room, the sea visible through the screen doors, and I let the salty
breeze drift over me; I let my friends look after me (see “K Is for Kindness”). It was fortyeight
hours of bliss (see “T Is for Therapy”).

There has been much talk of America’s inability to take a vacation. We take less time off
than any other developed nation. And we are continuously “connected” when we are
vacationing, so are we really vacationing anyway? When you are undergoing cancer
treatment, the restorative and rejuvenating powers of a vacation suddenly begin to make
real sense. Whether for a few hours, a few days, or a few weeks, when your mind and
body are ready to take that vacation—take it.

I did get to Istanbul eventually. It was everything I’d hoped it would be and more. It was
my vacation from Cancerland.

Vacation for Breast Cancer Survivors

U for Un- in Breast Cancer

Yes, I know, this is a prefix. But here’s the thing: I couldn’t decide on which un- since
there are so many! The first one is understanding. There are so many things you need to
understand when you have breast cancer. You need to understand that it is unfair and it is
uncertain and it is unpredictable and it seems unending.

It is unfair. On hearing your diagnosis, this will probably be one of your first thoughts.
You will not think about that list of possible factors for breast cancer (see “G Is for Guilt”),
you will just think about the cruel hand of fate that has dealt you this blow. The reality is, it
is unfair that you have breast cancer. There is no logic to it. In the majority of cases there
isn’t even a genetic explanation for it. It just is (see “O Is for Odds”). The cosmic answer
to “why me?” is “why not?”

Uncertainty will pursue you in Cancerland, nipping at your heels like an irritating,
yapping little dog that you actually want to kick away but can’t. Should I get a second
opinion? Should I shave off my hair? Should I have a prophylactic mastectomy? Should I
have the most aggressive treatment even if the pathologies are inconclusive? At some point
you will be uncertain about every single decision that you make.

How you are going to react to your treatment is somewhat unpredictable, at least to
begin with. If you are having surgery, it might take you longer to bounce back than your
doctor tells you. Everyone’s reaction to chemotherapy is different too. Your doctor can list
all the possible side effects that come from the chemo, and she may even sound like one of
those disclaimers they throw on the ends of commercials for drugs while she does it. Yet it
is hard to predict which ones will hit you. If you understand this seeming unpredictability,
you might find some patterns. After your first chemo session, keep notes on how you react
and when. You’re likely to see a pattern as you progress through the sessions, and
understanding that goes halfway to helping you deal with it.

Every single thing about going through breast cancer will, at some point, strike you as
unending. And indeed, when you are going through all this crap, it is unending. As I’ve
mentioned before in this book, the constant round of medical appointments seems
unending, and that’s before you’ve even started your treatment. Once you’ve gone through
surgery and chemo, you might face weeks of daily radiation—that can seem unending.

And then when you’ve gone through all your treatment, the uncertainty of whether the
cancer will come back again is unending and thus something you have to manage. All I can
tell you is that you will get to the other side. It may not seem like it when you are in the
thick of it, but it is true. Some of this crap really does come to an end.

So, what you need most in your life, at this time, is some understanding in all its
meaning. Obviously you need to understand what is happening to you, the status of your
disease, and the plan to treat it. You can also look for some understanding from those
around you as you go through your treatment. Help them understand what you are going
through and what you are feeling. This is the only way for everyone to get through it.

U for Un- in Breast Cancer 

Therapy in Breast Cancer

My love affair with Downton Abbey began when I was diagnosed with breast cancer. It
was during that interminable period after your biopsy confirms what you feared but before
you know exactly what the doctors want to do about it. It was also that interminable period
between Christmas and New Year’s. Almost everyone is away and you are awaiting the
results of more pathologies from more tests and all you are able to do is hurry up and wait.

My friends at PBS had sent me an advance screener of this new British costume drama,
which was to premiere in the new year. I have a soft spot for such things, and since I didn’t
have much to do but fret about the what-ifs, I threw the disc into my computer and started
to watch. Resting comfortably on my bed, my laptop perched on a breakfast tray, I
proceeded to indulge in what is now commonly called “binge viewing.” One episode after
another, I got lost in the scandalous saga of Lady Mary and Mr. Pamuk and Lady Sybil’s
idealism and Mr. Bates’s repression and Lord Grantham’s propriety. There were dark
clouds on the horizon (for the inhabitants of Downton Abbey as well as for me), but for
now we could be consumed by trifles that took on such profound meaning. No doctor
could have ordered this escapism for me. It was probably the best therapy I could have had
at that particular moment. And yes, I watched it twice!

My point is, when you are diagnosed with breast cancer, you face months of therapy,
maybe years. But here’s the thing: there are all sorts of therapies, and my advice would be
to avail yourself of them all and whenever necessary.

There is, of course, the biggie—chemotherapy. Generally you don’t get a choice in the
matter; your genes are calling the shots here. If you have a mastectomy or any other kind
of surgery related to your breast cancer, then physical therapy is in your future. I guess you
could choose to forgo this particular therapy, but that’s probably not wise (though your
insurance company may make this a challenge). There’s also the other drug therapy after
the chemotherapy, you know, the one that is supposed to stop the cancer from coming
back. These are all the therapies where your doctor is in the driver’s seat.

And here’s another one that is on your doctor’s dance card—psychotherapy. That’s one
that doesn’t get a lot of attention in the gauzy breast cancer world of pink ribbons and sexy,
glamorous cancer warriors fighting back. You will tire of the bromides about your being
able to kick the ass of this disease and vanquish it, or whatever other martial language
people want to use (see “W Is for Warrior” ). Well, breast cancer is a bitch. Being able to
say that out loud to someone, someone who will help you cope and even help you mourn,
is a huge help (see “A Is for Anxiety” ). So psychotherapy is nothing to be ashamed of or
reluctant to embrace. It is all part of the healing. You were diagnosed with an insidious
disease, your body has been maimed and poisoned and your hair has fallen out, and you
feel like crap. Really, it’s a wonder you didn’t think about talking through all that right from
the get-go.

So what else works for you? Retail therapy perhaps? Yes, this is one of those therapies
for which women get a bad rap. Well, I have some good news: this is the kind of therapy
you never have to feel guilty about when you have breast cancer (see “F Is for Fashion
Accessories”). I can vouch for the therapeutic benefits of shopping for particular items that
will make you feel better about yourself. Honest. Along with my pillow therapy (see “P Is
for Pillows”), we bought a new mattress. That’s one of those things we’d thought about for
ages. Now I knew I was going to spend a lot of time in bed recuperating and resting, why
shouldn’t I have a comfortable mattress? Indulgent? Maybe. Therapeutic? Absolutely.

I will admit that there have been times in my life when I have found eating to be
therapeutic. This one is a little tougher when you are undergoing chemotherapy. Your taste
buds have undergone a strange chemical metamorphosis that plays havoc with flavor and
texture and smell. But when the moment strikes you and you must eat (fill in the blank),
have at it. My nutritionist wanted me to eat whatever I wanted and whatever stayed down.

For the first time in my life, guilt-free ice cream! Just what the doctor ordered.

Here are some other things that were incredibly therapeutic for me: flowers, friends,
serialized television dramas like Downton Abbey and John Adams (because I had no energy
to watch a whole movie in one sitting—I had to watch Eat, Pray, Love in three sittings and
wish I had stopped after Eat), every single member of my family who came to visit,
especially my toddler nephew, my work (when I was up for it), reading when I could, and
crying, seemingly at random.

Therapy is all about healing, and the beauty of healing is that it can apply to your body,
your soul, your mind, and your surroundings. And finding therapy the doctor doesn’t have
to prescribe and insurance doesn’t have to pay for is probably the best of all.

Therapy in Breast Cancer

Saturday, March 19, 2016

Sex in Breast Cancer Life

Cancerland is a place where, as the late Christopher Hitchens put it, “there seems to be
almost no talk of sex.” In the case of breast cancer, he was right. Now I don’t want to get
all cancer competitive on you, but the discussion of prostate cancer is often accompanied
by concerns about its impact on a man’s sex life. With breast cancer, if there is any
discussion of sex at all, it is likely to be if you are of childbearing age, and it is more likely
to be about fertility than it is about sexuality. Your sex life doesn’t come up much.
If this is not an issue for you, I applaud you and recommend you move on to “T Is for

If this is an issue for you, let’s talk about it. As you’ve gleaned from the preceding pages,
when the complete embodiment of your womanhood—your breasts—becomes diseased,
this is not an easy thing to deal with. In fact, sex is so far from your mind that you might be
asking yourself, Why is she bringing this up at all? The National Cancer Institute reports,
“About half of women who have long-term treatment for breast and reproductive organ
cancers … report long-term sexual problems.” So if you are going through any sexual
challenges during treatment, you are in good company. But every year, hundreds of
thousands of women are treated for breast cancer and come out the other side. While sex
may be on hiatus during treatment, it doesn’t have to stop forever.

Lots of things can affect your sex drive when you are diagnosed with breast cancer.
First, you’ve been diagnosed with breast cancer (see “A Is for Anxiety” )! There is nothing
that can prepare you for the number that does on you mentally. This is news that you need
time to cope with, and really, all your attention can be focused on that for as long as you

Second, if you have breast surgery, you hurt. You hurt physically because some or all of
your breast or breasts have been removed. That is a whole lot of hurt (see “M Is for
Mastectomy”), not to mention bandages and drains and general yuckiness. I’ve tried to
think of any way to interpret this immediate post-surgical period as sexy, but I really can’t.
Please let me know if I am wrong. You hurt emotionally too. Not only are you in mourning
for the previously healthy you, but you are in mourning for a part of your body that may
have helped define your sexiness, appeal, attractiveness. It is really hard to get aroused
when you are in that kind of state.

Third, you might have to undergo chemotherapy and/or radiation. How do I begin to
describe the unsexiness of that? Your body is being pumped with toxic chemicals and
countless other drugs to counter the effects of the toxic chemicals. Here are some of the
side effects that were possible from the particular chemo that I was taking:

• Fluid retention with weight gain, swelling of the ankles or abdominal area
• Peripheral neuropathy (numbness in your fingers and toes)
• Nausea
• Diarrhea
• Mouth sores
• Hair loss
• Fatigue and weakness
• Infection
• Nail changes, including in extreme cases nails falling off

Nothing sexy about any of that list!
So you go through the weeks and months of surgery and recovery, followed by
chemotherapy and recovery, maybe followed by radiation and recovery. During that time
you will want to be loved and hugged and calmed and comforted, and maybe you will want
to have sex. But maybe you won’t. This is where the U Is for Understanding (see “U Is for
Un-”) comes in on the part of your partner. Your partner may not feel that you are
deformed or unsexy or unattractive. In fact your partner may be working hard to convince
you of the exact opposite, that you are as beautiful and lovely as you were when love first
struck, that a surgery like this, and the resultant nine-inch scar across your chest, and your
baldness and your bloating, changes none of that. Your partner means it. You just might
not be in a condition to hear any of it.

One of my doctors did bring it up with me actually.
DOCTOR: How is your sex life?
ME: Um, nonexistent.
DOCTOR: I know it’s hard but…
ME: It’s really hard, I feel like crap.
DOCTOR: I know, but it’s like a muscle, you have to keep using it!

There you have it, the view from a medical professional. So while not many people talk
about it, a lot of the cancer literature will deal with the question of intimacy. It’s important
enough that the National Cancer Institute lists intimacy as one of the parts of your life that
can be severely affected by a diagnosis of cancer. And that is the first step, recognizing that
your sex life, sort of like your taste buds and your energy level and your hair, is affected by
your treatment. Like all of those things, it comes back. It just comes back on its own
timetable. And I speak from experience.

Sex in Breast Cancer Life

Friday, March 18, 2016

Reconstruction in Breasts Cancer

Reconstruction in Breasts Cancer

If you have had a mastectomy, the wonders of modern technology mean that you can get
your breast rebuilt. It’s important to remember that breast reconstruction is not the same as
having a boob job. You are not someone on a bad reality TV show, looking to make up for
what Mother Nature couldn’t provide. This is not about vanity; it is something much more
profound than that. This is an attempt to make you whole, at least cosmetically. You will
actually become familiar with terms like nip, tuck, reduce, liposuction, fat graft, implant,
tattoos—all in an effort to rebuild your breast and, indirectly, you.

My advice is to look upon your plastic surgeon as an artist who works on individual
commissions, your very own Michelangelo. Every single breast he rebuilds is an original,
and he will treat yours as such. Soon enough he and everyone in his office is looking at
your breasts. He will ask you about size, shape, nipple, areola (that’s where the tattoo
comes in). He will describe how the rebuilding happens in stages.

Since it was unclear what treatment I would be going through, my doctors and I made
the decision not to reconstruct at the time of the mastectomy but to get a temporary implant
instead. It would be filled with saline solution, a little more each week to allow the skin to
stretch to somewhere near the size of the new breast. Spoiler alert. The temporary implant
feels awful. It rides high in the chest and is kind of hard. One friend described it as “like
having a Fisher-Price toy stuck in your chest.” That pretty much says it. The good news is
it is temporary.

As you think about reconstruction, your breasts will become the center of everything,
regardless of whether you gave them any thought before (see “B Is for Breasts”). They will
be touched by many people in the medical profession, and you will start to touch your
breasts more yourself. You will eventually look in the mirror more. Doctors will stare
intently and assess your torso like a blank canvas, artists or sculptors eyeing everything
before making the first stroke.

After your treatment (chemo or radiation, or both) is done, it’s time to get the permanent
implant, and the doctor takes to his canvas. He is creating a work of art he knows cannot
be completed in one sitting. You will discuss the size of the permanent implant and how the
contours of your new breast will fall. This may require several surgeries, and you prepare
yourself for that. Every time he operates on you, he proceeds like a fine architect or
builder. His drawings are done with the aid of nothing more complicated than a Sharpie and
experience, and your chest is where he will demonstrate his skills as an artist. He will mark
up what needs to happen on your chest—no measuring tapes or spirit levels, just his expert
eye. And when he takes the knife to you, it should be right the first time. A few months
after the implant he builds a nipple from your skin. After that he’ll tattoo an areola.

He knows he cannot replicate exactly what you had, but the effort to eradicate the visual
reminder of what has happened to you is quite extraordinary. You have lost your breast, of
course. There is no feeling. There will be no feeding. Other doctors will marvel at the good
work he has performed—clean incisions, tight stitching, fast healing. Every day you look in
the mirror, as the scarring begins to fade, it is not a deformity that faces you but a
remarkable work of art.

Tuesday, March 8, 2016

Quitting in Breast Cancer

Quitting in Breast Cancer

“I give up.”

How many times have I said that to myself or thought that during this long, arduous
thing called “breast cancer”? If I had actually tried to keep count, I’m sure I would have
lost track.

Quitting comes up a lot. I don’t mean in a melodramatic way of leave me alone here to
die. I just mean in the getting up every day and putting one foot in front of the other as you
deal with the enormity of your news and the incredible busyness of managing your disease
and treatment and then actually going through the treatment. Oh, yeah, and the rest of your
life continues without interruption (see “E Is for Epiphany”).

In the early part of the process, the sheer number of appointments will give you pause.

You need to be checked out for all your doctors—the breast surgeon, the oncologist, the
plastic surgeon. It is a lot to keep track of, especially if you are one of those people who
has been pretty healthy and only saw the doctor once a year.

“We need to draw blood for X.”
“You need an MRI.”
“We need to draw blood for Y.”
“You need another biopsy, there’s another mass.”
“We need to draw blood for Z.”
“You need to go to nuclear medicine for your MUGA scan; we want to know if your
heart can stand chemo.”

“Oh, yeah, we need to draw blood for X, Y, and Z.”

On and on it goes, and your thoughts range from You people need to quit poking me
with needles to Yes, I do mind if a medical student practices drawing blood from me.

That whole keep-moving-through-your-tiredness thing (see “X Is for eXhaustion”) is
another point where quitting seems to be the most attractive option.

YOU: I can’t walk further than this block.
VOICE IN YOUR HEAD: You have to keep moving, just another block.
YOU: Okay, I made it to the end of this block. I need to quit now.
VOICE IN YOUR HEAD: Will yourself through the tiredness.
YOU: But doesn’t turning around and walking the same distance back count?

I will confess, that whole keep-moving thing was incredibly hard for me. The days I did
it I felt a tremendous sense of achievement; the days I didn’t I tried to cut myself some

If you lose weight during chemo, my theory is that it’s not necessarily because you are
throwing up. The advancement in antinausea medicine is truly extraordinary, and while I
felt plenty nauseous, I didn’t throw up once during chemo. I think the real culprit is your
taste buds, which have been blown to smithereens by the poison. “You need to proteinload,”
the nutritionist told me. That’s all well and good, but taste, texture, smell, everything
is out of whack. I took to eating with plastic utensils because everything tasted like the
metal of the silverware. The texture of yogurt did make me feel like I wanted to barf.

Almost everything I ate left a salty taste in my mouth, including mint–chocolate chip ice
cream! And the things I usually enjoyed, like the smell of broccoli stir-fried in garlic? No
thank you. And the thing I love most, a nice cup of tea, was completely off the menu. I
didn’t drink tea during my treatment at all, and prior to that you could have described me
as an addict. My day could not get going without a cup of tea. Really, why even bother? I
should just quit eating and drinking.

Is there ever an acceptable moment to succumb to the desire to quit? Well, if you believe
the combative rhetoric surrounding the breast cancer movement (see “W Is for Warrior” ),
then I guess the answer would be no. In a real-world example of cognitive dissonance, that
combative rhetoric is often coupled with a gossamer pink lens through which the soldier
looks at her adversary. From this vantage point, attitude is all. As if somehow your bad
attitude gave you breast cancer, now a good attitude will cure it. By this logic, your attitude
should be Don’t quit, keep fighting, keep pushing, and you can beat this thing.

Well, sorry to be contrary, but yes, there are times when it is okay to quit. Maybe for an
hour, maybe for the day. The whole doctor appointment and testing regimen thing—can’t
really quit that. Other things, though, hell yeah, you can give yourself permission to say no.
There will be days when you will not be able to walk through that eXhaustion. That’s
okay. It won’t be forever, and maybe taking a break will make you feel well enough to
walk a bit further the next day.

Well-meaning family and friends will be plying you with “good, healthy food” that will
actually make you want to puke. Just politely tell them you are quitting eating that for now
and find what works for you and eat it to your heart’s content. For me, it was peanut
butter, crackers, and Gatorade. It’s funny, it’s a little like pregnancy; weird chemical
distortions are happening to your body, and you think you will change forever. However,
like pregnancy, this, too, shall pass.

And the odd day when you want to quit the world completely—no contact with anyone,
getting lost in a chick flick or a book or just your own company—that is the most satisfying
quitting of all.

Pillows in Breast Cancer

Pillows in Breast Cancer

Pillows are decidedly decadent. Nothing evokes sybaritic pleasures like the sight of a luxury
hotel advertising its dreamy beds with a fluffy cloud of pillows. A pile of soft marshmallows
that you just want to dive into and that can’t possibly be good for you, can it?

Pillows date back to ancient Egypt. They’ve been found in tombs buried with the dead.

They were decorative works of art. In ancient China they were made of hard materials like
porcelain, jade, and wood, each a solid block with a half-moon cut out at the top where
you could rest your neck but keep your head off the floor. Their usage has spread over the
millennia, though in Tudor England they were thought to be good only for weak men and
women bearing children. I’ve had lots of fights about pillows with my husband—how many
do we really need on the bed if we can’t use them all? What’s a decorative pillow? Do you
really need a pillow when we go camping? What’s wrong with stuffing your clothes in a
stuff sack and using that as a pillow?

Well, who knew that my cancer treatment would allow me to enter guilt-free pillow
indulgence? In fact, therapeutic pillow indulgence was exactly what I needed and I didn’t
even know it.

Breast removal is a brutal assault on your body (see “M Is for Mastectomy”). I imagined
it would hurt, but it really hurts. Try this exercise. Raise your arm to your mouth, fingers
clenched like you are holding a toothbrush. That uses pectoral muscles. Hold down a loaf
of bread with one hand and try to grip a knife and slice the bread with the other. Same
muscles. Lie flat, then try to raise yourself without using your arms (I’m assuming you
don’t have abs of steel; I don’t). Raise your arms and pull on a T-shirt, or take off a T-shirt
for that matter. This is the moment you discover how important those muscles across your
chest are, and as one of my doctors said, they “really do a number on those muscles” when
they remove the breast.

In the post-surgical haze of my recovery room, the first thing I was conscious of was the
fact that I felt so flattened you could probably have peeled me off the stretcher. Like
something out of a Looney Tunes cartoon or the children’s book character Flat Stanley,
whom you could put in an envelope and mail to someone. That figure of speech “being run
over by a bus” had real meaning for me now.

They did manage to peel me off the stretcher and transfer me to a hospital bed. But
those beds have buttons that allow you to recline or elevate. I realized pretty quickly that I
would need to be elevated all the time. Those pectoral muscles could not take lying flat.

Sadly, with no such contraption at home, this angle was not going to be easy to replicate.
But lo and behold, an amazing delivery. My friend Jennifer, herself a double-mastectomy
patient, delivered a giant foam wedge pillow. If you’ve seen fans of the Green Bay Packers
with their famous Cheesehead headgear, you’ll know what I mean when I say it is shaped
like a giant wedge of cheese. So when we came home, I was able to lie in bed with my
torso elevated at just the right angle. Really, in a million years I never would have known
this. It has been a lifesaver, the anchor pillow in a group of pillows that contributed to my
comfort during the worst periods after surgery and during recovery.

Another useful little pillow came courtesy of the American Cancer Society. A delivery
from them included an enormous amount of literature and this three-by-six-inch pillow.

What was I supposed to do with this? It might work for a big doll, but really? Well, turns
out it fit pretty snugly in my armpit, where the surgeons had been ferreting around checking
out my lymph nodes, and the pillow really eased the pain. The soft pillow my daughter
made as part of a sewing project? Very handy to place under my side where I no longer
had a breast but had plenty of pain and tenderness. Firm pillows, soft pillows, large pillows,
small pillows, wedge, circle, square. The architecture of my pillow arrangement was a vital
part of my treatment and recovery. I spent an inordinate amount of time in bed during my
period of surgery and treatment, and I would have been lost without my pillows. In a time
of enormous discomfort, pillows are an indulgence that you can afford, and they actually
make a huge difference. Who knew?

Odds in Breast Cancer

Odds in Breast Cancer

If I told you that you had a one-in-eight chance of winning the lottery, you’d probably run
out and buy a ticket right now. Those are extremely good odds. Odds worth acting upon
for, say, betting on the Triple Crown, or the World Series or the lottery! So it is sobering to
think that the odds are very good that if you are a woman in the United States of America
you will get breast cancer. In fact the odds are one in eight that you will get breast cancer.

Once you are diagnosed with breast cancer, you suddenly realize that you could get
really interested in statistics like that or, as my friend Linda calls it, “medical math.” The
two most common risk factors for breast cancer are being female and getting older. So
once you are one of those one in eight, you become really interested in trying to understand
odds a little better. Because actually every decision you make once you are diagnosed is
predicated upon understanding the odds and acting upon that understanding. Understanding
the odds of attacking the cancer if you have a lumpectomy versus a mastectomy.

Understanding the odds of recurrence if you have chemotherapy followed by oral drugs
after your mastectomy or if you just have the mastectomy and nothing else. Once you start
the drugs and you start feeling the side effects, you begin thinking about what your odds
would be like if you stopped taking the drugs so you could get some relief from the side
effects. You are always thinking about the odds of the breast cancer coming back in five
years or ten years or fifteen years. Wow, that’s a lot of math to think about.

I have broken my own rule on trolling the Internet just to look at this question of odds.
The National Cancer Institute has a handy little calculator called a Breast Cancer Risk
Assessment Tool. According to that, my odds of getting breast cancer were 0.8 percent.

Well, that didn’t work out so well. I guess someone has to be in that 0.8 percent. Eightyfive
percent of breast cancers occur where there is no family history—okay, I think that
stat makes me feel a little better (see “G Is for Guilt”).

Once I was diagnosed, what other fascinating things could I glean from statistics?

There’s a chart for everything. A chart for survival rates—five, ten, and fifteen years—
based on the stage of your cancer. You can look up survival rates based on age. You can
examine your odds for survival depending on your race. The course of treatment to follow
is also dictated by odds. A pathology of your tumor can help assess the risk of recurrence
based on the treatment options and that pathology. What combination of treatments
reduces the chance of recurrence the most? The kind of test I took, the Oncotype DX test,
was supposed to help evaluate the chances of recurrence for me and my particular tumor
on a spectrum of risk from low to high. The course of treatment was obvious if you were
low risk or high risk. I, of course, was intermediate so had to figure out what treatment I
felt I should have, since the math wasn’t conclusive. I guess in that sense I’m a pretty runof-
the-mill breast cancer patient. I was never really good at this kind of math, and it can get

However, the dirty little secret about breast cancer is that it is all about odds. It irks me
when people ask if I am “all clear” or if I am in “remission” or if I am “cured.” These are
words I have never heard uttered by my doctors. Not ever. Once a diagnosis is made, the
doctors remove the cancer they have found, including, they hope, any microscopic cells
that may be running around your body looking for another place to lodge. Then they work
on trying to lower the odds of its coming back. Let’s remember, there is no cure for cancer,
yet. This is also why I have a problem with the word survivor. I have survived, for now.

As the years progress, I am going to be checking the math I was so engaged in at the
beginning to see how I match up. Odds that I’ll be around to do that five years after being
diagnosed? Eighty-eight percent.

Notebook in Breast Cancer

The day you are diagnosed with breast cancer is a day you will never forget. It is the
moment that your world is turned upside down forever. Nothing about you or your life will
be the same after that. It is such a defining moment, the moment when you enter
Cancerland, you think it is something that you will remember forever. You will now hang
on every word uttered to you by every medical professional you will meet. This is a big
thing—how can you forget it? Everything about this experience will be etched in your
memory forever, maybe even verbatim.

Well, the truth of the matter is, not every word you hear will be carved in stone on
tablets that you can pull from the recesses of your memory at will. You will probably
remember the diagnosis, I’ll give you that. Everything else? That’s a little tougher.

As a journalist, I try to bring my inquisitive, analytical outlook to everything I do. I
started to take notes from the moment of diagnosis, but it soon became clear that this
would not be an easy task for me. There I sat, in the sterile glare of overhead fluorescents,
a poster above my head showing a cross-section of the breast and how a ductal carcinoma
in situ becomes invasive. My professor husband sat next to me (also taking notes). I
followed along diligently, and then it happened. A tidal wave of fear and shock washed
over me. It was the moment I realized, Oh, she’s talking about me. I lost focus and passed
the notebook to my husband. He continued to scribble in my book as I tried to wrap my
head around what the doctor was saying.

It is really important to keep notes, and not just notes from the meetings with the
doctors. You will see many doctors. You will have many tests. You will be bombarded
with information. You will have more appointments than you can possibly comprehend.

You will become acquainted with many wonderful physician’s assistants and administrative
assistants and nurses and volunteers, and you will want to remember them. You may want
to write down an observation or two about something you encounter in this strange country
where you have found yourself—Cancerland. You will have lots of phone numbers and email
addresses and dates to keep track of. I have all the latest technological gizmos, and
some were quite useful to me during my treatment. However, nothing has been as
comforting as a good old-fashioned notebook. I don’t mean a journal where you pour out
your most inner thoughts. I mean a notebook. A place you can just jot.

Mine was a Jane Austen notebook. In fact, I had used it to plan a trip to Bath, England,
with my family, to pay homage to one of my favorite authors, so I have train times and a
hotel reservation noted in it. My daughter has written down something of an itinerary
—Pump Room? Fashion Museum?—and of course That took up
just the first couple of pages. The rest was blank. So rather than buy a new book, I made
this my cancer notebook. I happen to find solace in Jane Austen, so a lined notebook with
pithy quotes from her was something that provided great comfort to me.

Friendship is certainly the finest balm for the pangs of disappointed love.

Well, it also happens to be the finest balm when you are going through a wretched
disease, as I discovered. You should choose whatever works for you, but get something
that you can easily carry with you everywhere. The thing about a notebook is that it is
portable, can be beautiful, and doesn’t need a Wi-Fi signal. There were moments I could
have whipped out an iPad to take notes, but somehow that would have seemed a lot more

It is also important to realize that you will probably need a stenographer with you,
particularly for the doctor appointments. As I skim through my notebook now, I see lots of
my husband’s spidery scrawl across the pages; clearly I was not very good at multitasking
in this instance—listening and writing at the same time when my health was the topic of
conversation! Almost all of the notes from doctor appointments are in my husband’s hand.

Phone numbers, observations, appointments are in mine. We would also write down a list
of questions before an appointment so we knew exactly what to ask when we got there.
Glancing back now, I see questions like Genetic testing? Prophylactic mastectomy on the
other breast? There are the notes from various appointments like this one post-op on the
final pathology report: “found a 3rd .3cm invasive tumor … mastectomy was right call.”

There is a double-page chart sketched out by my husband on which he tried to lay out the
various possible outcomes of a test I was about to have that would determine whether or
not I would have chemotherapy.

It may seem strange to say, but this notebook has become a sort of talisman for me. As I
have moved further away from the original drama of diagnosis and the seemingly endless
visits to the hospital for treatment, I have noticed how my notebook reflects the different
stages I endured. It charts progress from diagnosis to treatment, to post-treatment. It
reminds me of the people I met along the way who made things a little easier, like Mary
Redding, the amazing volunteer at the chemo infusion unit, and Shawnette Morton, the
gatekeeper to my plastic surgeon who managed to schedule every appointment to fit my life
as well as his! As I turn the pages and see them less and less densely packed with my
husband’s scrawl and more and more entries in my hand, it reminds me that I have come a
long way. Who knew a notebook could do that?

Notebook in Breast Cancer

Mastectomy in Breast Cancer

Mastectomy in Breast Cancer

For many women a diagnosis of breast cancer will lead to a mastectomy, sometimes single,
sometimes double. Whichever it is, it is an extreme step but, for many, a lifesaver.
The word sounds benign and almost refined, mas·tec·to·my [ma-stek-tuh-mee], noun,
plural -mies. Surgery. The operation of removing the breast or mamma.

It’s a word that is certainly polite enough for company, the subject of open discussion
among friends, acquaintances, colleagues with whom you might never have discussed your
breasts before (see “B Is for Breasts”). However, if I were to describe this procedure as an
amputation of the breast, it would probably make most people recoil. Having been through
one myself now, this is how I describe it. Something that was there is now gone, something
that protruded from my body is now “lopped” off. The words amputate or amputation
never came up when I was diagnosed with breast cancer. They still don’t. The first term
used was partial mastectomy, commonly known as lumpectomy. But soon it was clear that
there was more than one tumor and the only course of action was a mastectomy.

Mastectomy is a word that tens of thousands of women hear every year, and it is a
course of action they take. It is a brutal, violent thing to have happen to you, and it is
perfectly fine to feel that it is an amputation, and don’t let anyone tell you otherwise. For
me it was easier to cope with by thinking of it in that way. On those truly dark days when
you are in real pain, and you look down and the familiar landscape of your body is no
longer there, it is a humbling and mournful experience. In my case, one side had been
obliterated, in a process akin to mountaintop-removal mining, and there was a flat, stark,
scarred space where once had resided a soft, protruding manifestation of my femininity and
sexuality. At that moment, amputation seems a more accurate description of the procedure
than anything else.

At first blush you don’t give much thought to what a mastectomy means. Mastectomy is
a medical term you’ve heard a hundred times before. In that meeting with the breast
surgeon, the overwhelming thought is that there are cancer cells running rampant in your
breast and the only course of action is to remove the offending appendage before those
little buggers get comfortable and spread throughout your body and claim squatters’ rights.

Once they make themselves at home, it is always hard to throw squatters out! Get them out
of me by any means necessary. It is a visceral reaction. My house has been invaded.

Hurry, do it right away. Can we book the operating room soon? How about now? Well, it
turned out that we could, relatively quickly, send in the cavalry to throw those invaders out.

Ten days after being told that a mastectomy was my only option, I was under the knife,
and a few hours later I was down a breast.

I must confess, I’ve never been much of a boob person. I’ve always dressed modestly
and don’t like to show any cleavage. Spaghetti straps were not an option in my wardrobe,
let alone strapless. As I got older, I had even less desire to showcase my boobs. Gravity
and motherhood certainly took their toll. What miracle of engineering would hold up my
breasts without some extravagant superstructure? I wasn’t huge, just average, 36C, but
always conscious of my not very perky breasts.

So I didn’t love my breasts, but they were mine. I wouldn’t say I was particularly
attached to them or proud of them, but nothing quite prepared me for how awful I would
feel when I lost one. There is the physical awfulness, the flattening of your whole body
(see “P Is for Pillows”). There is also the bruising and the drains from the wound.

Immediately after the surgery you are bound up like an Egyptian mummy, a surgical bra
holding you together as drains protrude out of the sides and gunk collects in little containers
that you empty every day. You can barely raise your arm, and you need assistance to lift
yourself up in bed.

But there is something altogether more dispiriting. This is the worst physical
manifestation of the disease. It is there every day to remind you what you have been
through. I will admit that I could not look at my naked self in the mirror for months after
my mastectomy. I knew I would be having reconstruction, but that was going to be after I
was somewhat recovered from my chemo so that I would be strong enough to go through
reconstructive surgery. I knew I was misshapen. I knew I had a long horizontal scar across
my chest where I used to have a breast. I knew that I would get a new breast, that the
doctor would rebuild a nipple and tattoo the areola. I had seen pictures of his previous
surgeries. It was actually kind of amazing to see what he could do (see “R Is for
Reconstruction”). But I couldn’t look at myself. You are covered up, of course; nobody
can really tell unless they see you naked. The only people who saw my naked chest were
my husband and my doctors. I turned my back to the mirror every time I got out of the
shower. In hotels that had walls of mirrors, I never looked up until I had covered myself
with a towel.

This may seem like crazy, irrational behavior. In my mind it is the most normal reaction
to such a brutal act.

Of course, we are incredibly blessed that in the twenty-first century we are armed with
the tools not just to diagnose and remove the cancerous breast but also to reconstruct a
breast. For much of the twentieth century the only treatment for breast cancer was what
they called a “radical” mastectomy, which also removed the muscles attached to the chest
wall. It was a painful and disfiguring treatment. Those were the days before they
approached breast cancer as a holistic disease that requires drug treatment as well as
surgery. Nowadays, except in the most extreme cases, the muscles are kept in place and it
is possible to rebuild your pectoral strength. And of course, you can get a new breast. As
my brother reminded me, “You live in America; they have the power to rebuild you.”

True, but that’s a long haul. As you wait to get the perfect boobs, you are allowed to
mourn for the lost boobs. A part of your body that defines you as a woman, and maybe a
mother, has been removed because it is now host to a disease that could kill you. I can’t
help but feel that if we called it “an amputation” the rest of the world would get that too.

Looks in Breast Cancer

Looks in Breast Cancer

Yes, at this point you might be thinking that some of the topics addressed in this book ( “F
Is for Fashion Accessories” and “H Is for Hair”) are superficial and would be at the bottom
of your list of concerns when facing a biggie like breast cancer. Well, there are many
surprises that come with a diagnosis of breast cancer, and thinking about your looks turns
out to be one of them.

We will stipulate for the record that you are careful about your looks, but not overly
concerned. You care in the I’m-a-woman-who-comports-herself-acceptably-to-societalexpectations-
and-am-thoroughly-presentable kind of way, not in the I- spend-two-hoursevery-
on kind of way. But the thing about breast cancer treatment is that it does things to
your looks, and not necessarily good things. So, whichever category you fall into—plain or
primped—you find yourself thinking: Why am I so worried about my looks right now? I’m
going through breast cancer for goodness’ sake. Well, because you are a woman, and it
matters more for women. There, I said it. I will spare me my own righteous indignation
(and yours) at this point and just accept that this is true (see “H Is for Hair” again).

I am not talking about buying into the whole “crazy sexy” cancer thing here, which is not
where my head was, and frankly you can get through cancer without embracing that
extreme. As my friend the humorist and fellow cancer traveler, the late David Rakoff, told
t h e New York Times, “It seems like the oncological chapter of the covert war on
women … often preached by women against women, which is often just a variant on the
pressure on women to not get epidurals during pregnancy and die in labor like in the
Victorian age. It sounds like, ‘You should go to chemo in sky-high Jimmy Choos!’ And if
you don’t you’re a lazy bitch who deserves to die of cancer.”

So no, I didn’t go to chemo wearing Jimmy Choos and lipstick. However, I found myself
introduced to a program called Look Good Feel Better, a collaboration between the
American Cancer Society and the cosmetics industry that provides skin care, makeup, and
grooming counseling (including wig wearing and tying a head scarf) to women who are
going through cancer treatment. At your first session, during which professionals teach you
how to make yourself up, you are handed a big free bag of makeup that suits your skin
tone, no doubt to help you look good and thus feel better.

I’m actually someone who has never worn much makeup. So I’m not one of those
people who ascribes her cancer to carcinogen-laced makeup. The last time I wore mascara
was probably at my wedding. But I have to say I learned a lot of useful things. Things like
the importance of applying sunscreen on my bald head—obvious, you say, but no, not
really, if you’ve never been bald. I learned that my nails, like so much else, would suffer.
In fact, they turned a blackish purple color, which was quite disturbing. I learned to apply
moisturizer with upward strokes and to contour my cheekbones with a powder blush. In all,
I was taught twelve steps to make myself up completely. I never did all twelve, maybe
eight or nine on some days.

Why was I doing this at all? I’ll tell you why. I looked awful during my treatment.
Really, it was not a pretty sight. My face bloated like a balloon from the steroids, the
chemotherapy made my skin blotchy, I was so sallow there was a ghostly pall about me.
And, of course, I was bald. To be completely frank, I felt like crap.

But did I need to look like crap? Like I said, I was going through breast cancer
treatment, so it would have been fine to leave well enough alone. Believe me, most days,
when just getting out of bed was an achievement, that is exactly what I did. But there were
other days when I did something about it. The days I went into work I put aside an extra
twenty to thirty minutes to apply my makeup and fit my wig or head covering just right. It
was almost like applying a shield, not letting the wider world know just exactly how sick I
was or how badly I was handling the treatment. Not because I was ashamed of it, but
because, you know, everybody doesn’t need to know all my business all the time. Going
through something like cancer treatment is hard, and it shows. Providing myself with a
mask (literally) protected me from the awkward gazes of the people around me who
couldn’t help but notice how awful I looked on the days I didn’t don that mask. It probably
helped them handle my disease better too. That may seem an odd thing to be concerned
about, but I was concerned about it because I didn’t want my handling of the disease to be
an awkward thing for anybody.

I have had male friends and colleagues who have gone through cancer treatment, and I
can assuredly say that everything I’ve just discussed was not in the slightest bit relevant to
them. I have tried to instill in my two teenage daughters the sense that looks aren’t
everything and form just a small and irrelevant part of who a person is. So how hypocritical
was I, being so concerned about my looks? Like I said, I could not have put on the “face”
every single day, or even have put on the full face ever. But there were days when donning
the mask really helped. That’s not self-centered or vain or egotistical, that’s just what
worked for me. If it works for you, great, because you and no one but you gets to decide
how you look.

Kindness in Breast Cancer

Kindness in Breast Cancer

When you break the news to your friends that you have been diagnosed with cancer, the
first thing they will do, after their initial shock and concern, is offer to do something for
you. You should think about this. Not too long. Not too hard. Just long enough and hard
enough to figure out what you need done and then let them do it.

If you are anything like me, you will think that you can handle this, that the systems you
have set in place will work just fine and people shouldn’t trouble themselves for you. Type
A personalities, in particular, take note: you should disabuse yourself of this notion as soon
as possible. People really want to help, so make them feel good by letting them and you
will feel good too.

You will receive extraordinary acts of kindness and love from people all around you,
people in parts of your life whom you might not have given much thought to beyond a
perfunctory nod or hello in the morning. You learn to accept this kindness because you like
to think that you will be as helpful to them or others should they be in the same
predicament. What’s more, you actually really need the help, even though you may not
know that to begin with.

Sara was one of the kind angels who surrounded me. Using her well-honed instincts as a
television producer, she got word out via e-mail to a large list of friends about my diagnosis
and treatment. She also used her skills to organize our meals with an online calendar,
outlining details of how many to feed and our dietary restrictions. She provided precise
delivery instructions and even put a cooler on the porch so we didn’t have to answer the
door if we weren’t in the mood! For five months our family of four was fed by Sara and
her battalion of angels, friends, and colleagues from so many spheres of my life.

This single act probably contributed most to preventing the strain that could have
disintegrated our family as we dealt with my medical challenge. Our friends all cooked
wonderful, healthy, and appetizing meals, and there was one gesture in particular that spoke
volumes. Everyone who made a salad made their own dressing! Even after all this time has
passed, it is something that strikes me as extraordinary. This seemingly small act spoke
volumes about how kind people are and how much thought they put into helping at a time
of need.

There is the kind angel who drives you places if your husband can’t be two places at
once; the immensely kind angel nurses who stay sunny and upbeat as you are going
through the most awful thing in your life; the amazing volunteers at the chemotherapy
infusion center—they are very special angels of kindness; the wonderfully kind and loving
administrative staff at all my doctors’ offices, the frontline troops in your medical mission,
handling the vital task of logistics; the parking attendant at the office who parked my car
and helped me carry things on the days I did go to work and who made me feel okay about
my baldness because under his hat he was bald too. He is an angel, and his name really is
Ammanuel. Your friend who had also gone through breast cancer and delivers a wedge
pillow that is indispensable (see “P Is for Pillows”); the amazing mothers who take your
kids off your hands when you’re in need of a break; your self-centered teenage daughters
who have enough awareness to know that no matter how much you don’t want to, Mom
really needs you to hold her hand as she takes a walk around the block just to keep her
systems running and alert. Kindness abounds in ways big and small in your life. Embrace it.

Journey in Breast Cancer

Journey in Breast Cancer

There is something about cancer that seems to invite folks to liken it to a journey, and not
just any journey but a particularly mystical journey. There are so many other diseases that
people have to live with, yet no one talks about an AIDS journey, or the journey of heart
disease or hepatitis or … take your pick. But some people take on that hushed tone of
concern when they ask you about your cancer and then you actually tell them about it!

They weren’t quite expecting that, and they feel they have to say something in response,
and for a lot of people that response is “Well, it’s all part of the journey.”

So I’m going to try to unpack this moniker somewhat—the journey.

In what ways is having breast cancer like a journey? Well, I guess the fact that, once
diagnosed, you embark on a path that you had no idea you were heading for might make it
seem a bit like a journey, though in this case an unexpected one. Many think cancer has a
beginning, middle, and end—diagnosis, treatment, end of treatment—as many journeys do.

People are often changed by their journeys, and there seems to be a common consensus
that going through cancer should change you. I don’t subscribe to that particular idea (see
“E Is for Epiphany”).

Why does this particular word, journey, this noun (which is also used as a verb), irritate
me so? Maybe it is because the word journey seems so completely and utterly
inappropriate and inadequate to discuss a process in which the course of treatment, despite
all the advances of modern science, is still slash or poison or burn, or some combination
thereof—cut, chemo, radiate, maybe even all three. There is absolutely nothing about
enduring breast cancer and its treatment that is like any journey I have ever taken, even the
bad ones!

I have been on some remarkable journeys in my life. The first is one I was not even
aware of. I was a mere four months old when my parents set sail on a ship from India to
England. Another extraordinary journey was the one familiar to so many immigrants, the
journey I undertook after marrying my American husband and moving here to the United States.

After a year in this country, my husband and I moved back east from California. We
drove along the southern route. I got to see the majesty of the Grand Canyon, the beauty
of Zion National Park in Utah, the endless, stark emptiness of Texas, a state that seemed to
go on forever, and the hot and humid Deep South. Now that was a journey.

I’ve traveled the deserts and mountains of northwest China. What an amazing journey,
sleeping in a yurt in the soaring Tian Shan mountains, riding horses, and getting caught in a
jam of fat-tailed sheep! I’ve visited so many places around the world, some on the welltrodden
path of travelers who came before me, others off the beaten track, but all full of
excitement and adventure. Those were all journeys.

To me the word journey describes something that is rooted in the physical world,
transporting from one place to another. To me a journey implies wonder, exploration,
perhaps a particular destination. It sometimes has romantic connotations, a journey to the
exotic and enchanting.

My breast cancer was not mystical or enchanting or exotic. My breast cancer was not
and is not a journey.

Getting through cancer is no different from getting through some other terrible disease
because that is what it is, a disease. It’s okay to treat it like one.

Indignities in Breast Cancer

Indignities in Breast Cancer

If you are aware of the breast cancer culture that has built up in our society over the last
two decades, you might think that you are entering a world of fuzzy pink gauze, soft teddy
bears, and garlands of ribbons. Generally a land of sparkling brightness personified by
women who are happy and smiling while they are “battling” this disease, the “she-roes”
(rhymes with heroes), as Dr. Gayle Sulik has caustically described them. The writer
Barbara Ehrenreich calls this the “bright-siding” of the disease. In this narrative you would
be hard-pressed to find stories that were not about triumph over adversity and how breast
cancer has made someone a better person. For some, a cocoon of cotton candy somehow
cushions this ferocious disease, making it seem nonthreatening, just another part of life’s
passage, like puberty or marriage or childbirth.

Actually, there is not much in Cancerland that is pink or gauzy, and failing to recognize
that is one of the many indignities of breast cancer. There needs to be room to
acknowledge some of these indignities, so here is my attempt to do just that.

Even those of us who have not been diagnosed with breast cancer have, of course, been
exposed to the indignity of the mammogram. Plop your breast in between two plates that
exert their viselike grip on your boob, hold your breath, take a picture. Take a breath, turn
the machine, and do it again. Just a couple of different angles, won’t take long.

Then there is the prodding and probing in the biopsy. I wasn’t sure how this was
supposed to work. A needle biopsy sounded to me as if a needle would be inserted, like a
pipette, and a tissue sample would be drawn out from the mass. Actually, it felt and
sounded more like a staple gun, inserted multiple times into the lump to remove multiple
tissue samples. Try this at home. Staple some paper together using five or six staples, one
at a time, and as you do, imagine that happening in your breast. It was the sound that really
resonated with me. Ca-chunk. Ca-chunk. Ca-chunk.

For me one of the lasting indignities was the sheer extent to which my breasts were no
longer mine. A long succession of people manhandled (and womanhandled!) me. Each
professional was perfectly nice and well meaning and above all professional, but they were
focused on my breasts, not me, almost as if my breasts were not even part of me but rather
just objects in isolation that needed dealing with. Prior to this experience, the people who
had an up close and personal relationship with my breasts were my husband, my
gynecologist, and my breast-feeding children. Now I was being photographed, perused, and
palpated by a rotating cast of doctors, residents, and sundry other medical folks.

X-rays and MRIs—more people who need to work with your breasts. Lie down on your
stomach and let your breasts drop into this Plexiglas box. Don’t move while we slowly slide
your body through this tube.

Oh yeah, I almost forgot about the lymphoscintigraphy. Lie down while we inject this
nuclear radiotracer into your nipple and you can watch the dye travel to your lymph nodes
right here on this screen. Yes, we do need to do three separate injections into your nipple
area. This was a vital procedure, it would help my surgeon as she tried to find out whether
my cancer had spread to my lymph nodes, but it did not make those shots in my nipple any
easier to endure.

After your mastectomy, drains will be hanging out of your breast wounds. The drain is
called a “grenade drain” because, yes, it looks like a grenade! A tube comes out of your
incision and empties fluids and blood into a suction bulb. Okay, I stand corrected, that fluid
that comes out of your wound? That’s kind of pinkish red, so here is the hint of pink. My
drain, which I had in for about two weeks after the surgery, was uncomfortable and
annoying. It can flop around if you don’t have it in place properly. So you spend a lot of
time organizing yourself so that it doesn’t catch on something and rip out. Yes, a small
thing in the grand scheme of things but … still.

And another thing, a nine-inch scar across my chest where my breast used to be (see “R
Is for Reconstruction”). Look, my plastic surgeon was really good and did incredibly
careful work. But a nine-inch scar is still a nine-inch scar that stares back at you if you look
in the mirror, like a gash across the landscape of your womanhood. I knew it was there, I
just didn’t look for the longest time because my relationship to the way I looked during
treatment was complicated to say the least (see “H Is for Hair” and “L Is for Looks” and
“M Is for Mastectomy”). And one thing I could not look at was the huge scar across my
chest. In fact, I didn’t look at it for months and months.

These were my indignities. Yours may be different. My point is breast cancer is many,
many things. What it is not is a fun ride. It is painful and debilitating and public, and it is
okay to feel indignant about that.

Hair in Breast Cancer

Hair in Breast Cancer

The term bad hair day was invented for women. Hair has occupied an inflated place in our
lives since we were little girls, out of all proportion to so much other stuff and certainly out
of all proportion to what preoccupies men. (Even sex? Yes!) When we were growing up,
was hair more important than breasts? I would say yes, though some may argue the two
are on a par with each other. How many hours in your life have you spent on your hair—
cutting, setting, blow-drying, straightening, curling, crying? Well, to braids, bangs, and
barrettes, add bald! If you have chemotherapy, your hair is almost sure to go. Now in the
grand scheme of things this may not be such a big deal. Kill the cancer, lose the hair. That
doesn’t sound like a bad trade-off to the rational mind. But when have we ever been
rational about hair? It is okay. You are allowed to be irrational about this one because the
hair thing is a big deal.

That wretched chemotherapy is a miraculous cocktail of drugs that zeros in on rapidly
dividing cells that are growing out of control. But it doesn’t distinguish between the bad
cells (the cancer) and the good cells—like hair. You have probably thought many times in
your life that your hair is out of control. Well, it kind of is. The cells that make up your hair
strands are among the fastest-growing cells in your body. You are right: your hair at the
cellular level is out of control, and those cells get zapped just like the cancer.

I have tried to imagine myself looking different throughout my life. When I had waistlength
hair, I wanted to get rid of it. When it was shoulder length, I had a perm. When it
grew out, I wanted to cut it right away. But baldness? That had never entered the equation.

You never imagined it either, did you?

So what to do? I have some good news. When you are diagnosed with cancer, you really
don’t have much control over anything. You think you do, but honestly you don’t.

However, I discovered one thing I could control. After talking to friends I decided to shave
my hair off before it fell out. For some, waking up with clumps of hair on the pillow is a
traumatic experience. In addition to the trauma of diagnosis and treatment, you are faced
with a hair 911 that must be dealt with right away. I was not going to take that route. There
is enough to handle without trying to muscle your way into the salon for an emergency hair

Here’s what you, too, can do: shave it off. I could tell that some around me were a little
taken aback. First step? Talk to someone else who has been through this. Get
recommendations for hairdressers who have experience dealing with cancer patients.

Believe me, they will hold your hand through this process in every way. I had a consult
with the wonderful Hans, a gentle soul with the perfect manner who was a Washington
institution among women who had gone through what I was going through. I was to
discover later that he also volunteered in a program to help women cope with their changed
looks during cancer therapy. After that consult, at which I tried on a number of wigs, I
made an appointment. Hans encouraged me to bring people along and turn it into a party.
So that’s what we did. My husband and children, my sister and my girlfriends, sparkling
cider and cupcakes in tow, forty-eight hours after my first chemo session I had all my hair
shaved off.

I will not deny that the minute he took the razor to my head I was freaking out inside.

My teenage daughters looked on bravely, but I knew it was tough for everyone. Don’t
worry. It moves fast. Your friends are there with you, and before you know it, the hair is
gone. Give yourself permission to cry at this precise moment. You’ve cried for lesser hair
misdemeanors, and watching in the mirror as your hair is being shaved off is akin to
watching a federal crime being committed. But, I thought, I have a pretty nicely shaped
head! This revelation doesn’t stop you crying, or your daughters or your sister crying, but it
does make you hold your head up a little higher. Make sure you have great earrings on and
you are made up. If you have already chosen a wig, have your hairdresser trim it to fit your
new bald pate. Voilà! Extreme makeover, cancer style.

Of course I was riddled with doubt. What if I had acted too soon? What if my hair
wasn’t going to fall out? In fact it didn’t, and I was full of righteous indignation. I had
stubble that was kind of growing almost immediately after I had shaved my head. “I’m a
hard-ass,” I told my oncologist. “It hasn’t fallen out yet. Maybe I shouldn’t have shaved
“It will,” she said, and she was right. A few days later my stubble rubbed off on my
hands in the shower. The floor looked a little like the sink does after my husband shaves,
with tell-tale stubble around. It was still a profound shock, and I cried inconsolably in the
shower. But I was grateful I wasn’t pulling out clumps of my shoulder-length hair (and
clogging up the drain).

Now how about the hair not on your head? That depends on the chemotherapy drugs
you are on. Chances are some or all of it will go. Believe it or not, it’s not as traumatic as it
could be. No eyebrows? Very bad (see “L Is for Looks”). Leg hair? Well, no waxing for
the duration of my treatment, so not so bad. The same for underarm hair. For those of us
who have inherited the hirsute characteristics of our ancestors, this was some very
welcome news.

What happens to your hair is important. There were many times when I was up in the
middle of the night and saw a scary thing in the mirror: a bald me with no eyebrows and
sallow skin and a face so puffed up from steroids that I looked like a billiard ball or
Nosferatu (see “L Is for Looks” again). But I’m here to tell you it passes and your hair
grows back really quickly once you have completed your treatment.

In the Hindu faith, there is a tradition to perform a mundan on a child’s first birthday.
The head is completely shaved to rid the child of all the negativity of previous lives, the
undesirable traits of previous incarnations, so that the child can start anew. I didn’t have
one of those when I was one year old, so I approached my haircutting as a mundan
ceremony forty-seven years delayed—the first step on the road to new, post-cancer

Guilt in Breast Cancer

Guilt in Breast Cancer

So, here are some things that might have caused my breast cancer:

  • Being a woman—guilty
  • Getting older—guilty
  • Genetic inheritance—not guilty
  • Periods before the age of twelve—guilty
  • Overweight before menopause—guilty
  • First child after the age of thirty—guilty
  • Current or recent use of birth control pills—guilty
  • Large breasts—not guilty
  • Dense breasts—not guilty
  • Not breast-feeding—partially guilty (breast-fed for only three months)
  • Not exercising regularly—guilty
  • Not having lots of children—guilty
  • Excessive alcohol use—not guilty

You get the point. You have been diagnosed with a horrible, possibly deadly, disease.
You will go through a wretched regimen of treatment and your body will be (temporarily)
wrecked as you do. The embodiment of your femininity, the breast, is the treacherous
villain in this drama, and you are the one who feels guilty. How can this be?

Well, this must have been my fault, right? Looking at that list, I tend to focus on the
things that were in my control—weight, birth control pills, breast feeding, exercise,
childbearing. Of course I must have done something wrong to cause this, and all I can feel
is guilty. With the passage of time you realize this guilt is almost irrational. But that is not
what it feels like in the moment. I think that is because not only do you feel guilty that you
have this disease you might have been able to prevent (not true, but…) but also you start to
feel guilty because of what this is doing to the people around you.

You feel guilty that your life at home (which you might have been holding together with
duct tape and chewing gum, if truth be told) is going to be severely disrupted by the fact
that you have this disease. Your family has to adjust to a new you, a sometimes needy you,
a you that isn’t really you but a vessel for this disease at this moment.

You feel guilty about how this might disrupt things for people around you outside your
family. For me it was the strain put on my colleagues who were picking up my slack. They
couldn’t have been more supportive and generous and loving, but that never stopped me
from feeling guilty.

You also feel guilty when you hear someone else’s story that is worse than yours and so
maybe you shouldn’t be feeling so bad about what you are going through. And, in case you
thought there was nothing that could compound your feelings of guilt, there is. That guilt
feels worse because everyone tells you how lucky you are compared with X. There is
probably nothing worse than someone who doesn’t have cancer telling you how lucky you
are. Luck is when you win the lottery (see “O Is for Odds”), not when you get breast

There is no hierarchy of cancer by which you must abide, where you have to be upbeat
and positive because there is someone who has a worse breast cancer than you. That logic
might make sense in some detached, objective way, though in fact it is not true. You, the
breast cancer patient, are neither detached nor objective. You are intimately attached to this
disease, and everything about it is subjective. So, permission granted to feel terrible about
what you are going through and to not feel guilty in the slightest about any of it, okay?

Here are the facts about breast cancer. It is an insidious, wretched disease, whose
treatment can be worse than the disease itself. You did nothing wrong; you are not being
punished for something you might have done in your current life, or your past lives for that
matter. The truth is we don’t really know what causes breast cancer. Ultimately there is
one thing we do know: if you have breast cancer, you have some rogue cells that decided
to do their own thing and play havoc with your body. And that is nothing to feel guilty about.

Fashion Accessories in Breast Cancer

Fashion Accessories in Breast Cancer

You have been diagnosed with a terrible disease that for previous generations was almost
always a death sentence, so it may seem a little frivolous to devote a whole section to
fashion, most especially fashion accessories. But frankly, not enough attention is paid to
fashion accessories at the best of times, and this is a moment when they come in useful
(see “L Is for Looks”).

If you undergo chemotherapy, you will soon come to terms with the fact that you are
bald (see “H Is for Hair”). Then you will spend an inordinate amount of time figuring out
how to cover your head up.

My friend Lesley calls herself a “nostalgist.” In her book Let’s Bring Back she pines for
the style and panache of times gone by. Things like handwritten thank-you notes, rolltop
desks, and tennis whites. You won’t be surprised to hear that she has a lot of time for head
coverings of all sorts—hats, head scarves, and turbans; boaters, berets, and safari hats. The
world she evokes harkens back to a time of elegance and élan. Here was a bright side. I
could use this opportunity to become as stylish and perhaps as divine as many of the
heroines of yesteryear.

Chemo headwear is big business. My chemo started in the dead of winter and continued
into the summer, so I got to go through some seasons during my treatment. I had a lot of
knitted caps courtesy of the hospital volunteers and even my own knitting. I actually
needed them, especially at night, because my head would get cold. I didn’t expect that. But
most of the time I looked like a lumberjack (maybe it had something to do with the openfront
plaid shirts I was wearing post-mastectomy) or a cat burglar!

So is there an elegant option? Turbans seemed to me to be the way to go. Elizabeth
Taylor died while I was undergoing treatment. She, of course, had a brain tumor removed
years ago, and her obituaries were an opportunity to remind us all how gorgeous she looked
bald with painted eyebrows during her treatment. Try as I might, I knew I wasn’t going to
look like Liz Taylor. However, look online and you’ll find pictures of her looking stunning
in a turban during the 1960s. Sophia Loren and Lena Horne too—carrying off their turbans
with grace and glamour. Go back further and find all those brass-balled dames of the 1930s
—Bette Davis, Joan Crawford, Rosalind Russell—they could carry off the turban look
without seeming injured or sick or just plain ridiculous. Check out some fashion magazines
from the period, and you’ll find you can’t think of anything more ladylike and chic than a
turban on your head (preferably with a large jewel smack in the middle of the front folds)
and a fox fur around your neck. Unfortunately, plain ridiculous was how it looked on me. I
don’t know what it was, maybe you needed a long neck, a larger forehead, or maybe you
just needed to see yourself in black and white. “Mom, you look like a chemo patient” was
the resounding opinion of my teenage daughters when I tried to go with the ready-made
turban look.

Don’t worry if the turban is not for you. You will not lack for inspiration—flapper caps,
floppy hats, peasant scarves, baseball hats, cloches, straw boaters, and, of course, a wig.

Scarves were my next option. I learned a few things about scarves. Silk slips off your
head, so avoid silk scarves if you don’t want to spend the whole time touching your head to
make sure your baldness is not peeking through. Scarves that are too big and have too
much fabric will bunch at the nape of your neck if that is where you have the knot, and
they will slip off too. Bandanna-size scarves in thin cotton seemed to work for me, tied in
the back not the front (unless you are going after the Rosie the Riveter look). Here is
another mystery about the whole covering-up-the-baldness thing. I had black hair. Never
colored it, just stuck with my black hair regardless of what I was wearing. Suddenly it
became imperative that my head scarves coordinate with my clothes. I had to get a peachcolored
scarf to go with my spring clothes, navy for overcast days, gray to look more
businesslike, flowery to look more relaxed. Why was I compelled to do this? Was it really
necessary that I be all matchy-matchy from head to toe?

There was a time in America when hats weren’t just for church. Hats were literally the
crowning glory. Bonnets to wide brims, pillboxes to cloches, a lady always wore a hat. I
wasn’t doing so well with the hats, so scarves were for me.

But if you can’t figure out the right head covering for you, bald may be the way to go
(especially when it is hot). I found that what really helped me with the uncovered head
were earrings. Big, bold, interesting earrings. When people see you bald for the first time,
they are a little taken aback, so earrings give them something to focus on. You have license
to go a little wild, and you are helping the people around you, giving them something to
comment on beyond your naked head. That’s my rationale, and I’m sticking to it. Hoops,
sparkles, stark, shiny—just have at it. You will feel a whole lot better.