Jill's Blog #9-The Insidious Nature of Fear

I began this blog three months ago and this is the 5th time I’ve come back to it, hoping this time the words will come to me. Since it has been so difficult to formulate, I know it must be a core issue of mine, and for which I have a hard time gaining insight.

What I do know, is that I sometimes fear the unknown; am wired for a fight or flight response, ever ready for “the next shoe to drop;” and have a keen imagination. Not always a healthy combination of attributes! Since my surgery, I have struggled with an insidious fear of breast cancer recurrence. I don’t consciously think about it, but I know it must be an issue because I am reluctant to do a breast self examination, (BSE). It’s my form of denial. If I don’t feel lumps, then I don’t have to address it.

About a month after my surgery, following three days of psychically preparing myself, I did a breast self examination. I was so relieved to not palpate any unusual lumps or bumps. I was also felt proud of myself that I took a proactive approach instead of allowing an insidious fear to take hold, preventing me from taking action.

A month passed, so I knew it was time to do my monthly BSE. This time I wasn’t as hesitant. As I palpated my breast, I felt lumps that hadn’t been there the previous month. My worst fear came true…Immediately numerous scenarios raced through my head. The rational side of me acknowledged that it was unlikely breast cancer since it developed so quickly, and it made most sense that they were benign cysts which I’ve contended with my whole adult life. Then the insidious fear slithered its way into my conscience. What if it was a rapidly growing cancer? What if all of the doctors who assured me that my cancer was cured were wrong? Then the familiar self doubt crept in. Was I mistaken the previous month that I was lump free? Was I really feeling lumps? Was I simply being paranoid, allowing it to get in the way of my healing process?

After spending a week ruminating about what I should do, and meanwhile my night-time hot flashes had escalated because of my stress, I asked my husband to palpate to see if he felt lumps, which he did. After discussing it with Todd, I decided to make an appointment with my breast cancer radiologist, but first I had to play the insurance game to be seen. I’ve been fighting with the insurance company since my breast cancer diagnosis. They initially denied all of the bills because they weren’t “properly reported”. (That’s a future blog). Anyway, because I have HMO insurance, I had to first see my primary physician who indeed confirmed there were lumps, who then referred me back to my specialist. The process delayed me from seeing my specialist for three weeks. I had plenty of time to become a quagmire of irrational fear.

Fortunately after a mammogram and ultrasound, the radiologist assured me that the lumps were due to post surgical changes and would eventually resolve. She told me that this was my new base-line topography for BSE. I asked her if she recommended doing breast self examinations, since it is no longer recommended that women perform their own BSEs, since mammogram screenings can pick up masses undetectable to palpation. She said that she’s had patients who’ve discovered their cancer during BSE, so she encouraged me to continue.

Yesterday it was over a month since I saw the radiologist. It was time for my BSE. I know my baseline, but what if I felt new lumps? If I didn’t do a BSE, then I couldn’t feel new lumps, but then I’d allow insidious fear to raise its ugly head. ..So despite being I 53 years old, I am determined to change my modus operandi. I vowed I would do my BSE.

Today I can report that I did my BSE and there are no new lumps or bumps. It feels good to be taking one day at a time, celebrating all that I have to be thankful for, and taking at face value, each real challenge which passes my way. It’ll be a slow process changing my ways, but a middle aged mom can learn new tricks.

Blog # 8-The Inequalities of Health Care

I volunteer at The Good Neighbor Clinic in White River Junction, Vermont. It has been some of the most fulfilling work I’ve had over my 20 year career as a nurse practitioner. Every time I work, I am reminded how fortunate I am to have health insurance. You see, this clinic serves the working poor. People whose employer’s don’t offer health insurance coverage; who can’t afford to carry an insurance premium; and because they work, don’t qualify for Medicaid. Most of them at some point in time have had health insurance, but due to extenuating circumstances, have lost their insurance coverage.

When patients are scheduled at The Good Neighbor Clinic, many have lived with their condition for a while. They haven’t sought treatment at a private clinic because they worry about medical bills that they can’t afford to pay. Many arrive at our clinic through word of mouth.

With my recent diagnosis and treatment for breast cancer, I have a heightened empathy for women with breast issues. On my patient schedule it said, “Patient with a discoloration on her breast”. In two weeks through her current work, the patient would be eligible for health care, but heard that we offered free health care, and was worried enough about her breast symptoms that she didn’t want to wait two more weeks. The patient told me that her last screening mammogram was two years ago. She said she had to have a repeat mammogram because of worrisome findings, which ended up being benign, cystic breast changes.

In the examination room, she described over the past month how her left breast felt fuller, and in the last two weeks developed pain and hardness in her breast. She also noticed that the appearance of her nipple and skin surrounding the hardened area had changed over the past several weeks. Potentially very worrisome symptoms, but I was hopeful that she had mastitis which with antibiotic treatment, would make her symptoms resolve. I took her temperature which was normal. If she had mastitis, she most likely would have a fever…On physical examination, almost the entire outer aspect of her left breast was rock hard and her nipple was inverted.

She was scheduled for a mammogram and ultrasound that day. The preliminary report indicates that she has advanced breast cancer. Hearing about her preliminary results caused a spectrum of emotions to well up inside of me. I felt thankful that my breast cancer was diagnosed and treated early. I felt angry that because this woman didn’t have health insurance coverage, her cancer was diagnosed at an advanced stage. I felt guilty that I am among the privileged to have health insurance and to be able to seek preventive care. As I ride my bike across the country this summer, I will be able to advocate early detection and treatment for breast cancer, but what do I say to all of the people who can’t afford health insurance to pay for preventive care?

Blog #7- Color Prejudices

My sister felt that the appearance of my blog was too bland so she decided to dress it up with some pictures and added color. She asked me what my favorite colors were to know which ones to add, which over the years have consistently been blue and green. I’d have to say that I’m in a rut. Occasionally a different color such as purple might show up in my wardrobe, but that piece of clothing is rarely worn. I don’t know why, but I feel more authentic when I wear green or blue clothes.

This afternoon, I showed my 17 year old son Bryce, my blog site. He asked if he could spice up the appearance of it. I said, “Sure.” After about 15 minutes, he handed it back to me see what I thought. It has a dark pink background, and he pasted on it one of those pink breast cancer ribbons. I refrained from showing my visceral reaction, auk, pink! Instead I tried demonstrate the maturity of a 53 year old mother, and told him that it looked great, which it did, and stifled my desire to comment about the pink color.

I’d have to wager it wasn’t until I reached the mature age of thirty that I deliberately stopped stereotyping the color pink. I associated pink with being weak and helpless. It’s more fitting with my ideals to be inclusive and to accept diversity. I am proud to say that I occasionally get out of my blue and green rut, and wear pink clothes. But it’s apparent from my reaction to the color of my blog site, that I still have some residual prejudices.

My ten year old daughter Mallory won’t get near the color pink. I could give a lecture about the injustices of labeling, but I’d be a hypocrite. I remember when Bryce was about four years old; he went through a phase that pink was his favorite color. Then societal influences turned him away from it. My husband Todd, for years wore a pair of hot pink biking shorts. They were washed so many times and faded by the sun that they turned into a light pink color. They eventually shredded in a biking wipe-out. I was impressed and proud that he wasn’t fazed by societal norms despite living in a conservative town.

I am hoping that Bryce will make a graphic design to put on a t-shirt which The Cyclo Healer team can wear during the cross country ride as well as in the Prouty. I’ve been wrestling with the t-shirt color. Since I’m a breast cancer survivor, it seems appropriate that it’d be pink, which wouldn’t normally be my first choice. Who knows, maybe by the end of the trip I’ll associate pink with strength and courage, not that I’m doing any kind of labeling…