The Mental Game

Cancer and chemotherapy are as much a mental game as a physical one. That might be stating the obvious. To me, though, it’s been endlessly revealing.

There is the mental game of: “How did I get this? and Could we have caught it earlier?” I was angry at first, mostly at a nurse practitioner who I realize would have had to be heroic to demand a scan when an ultrasound for a pain in my side turned out to show nothing. I still had the pain, but it went away in two weeks, after I stopped drinking fermented drinks. I had suspected it was from a bad scoby for kombucha, but now I suspect it was something else. The truth is, if she wanted a more in depth scan, I might have even resisted. Probably not, because I really did want to know what was going on, but maybe. Still, there was nothing about me, or about the pain, that suggested ovarian cancer.

A friend sent me a message and asked if I use talcum powder. There’s some television ad for a class action suit to tie talcum to ovarian cancer. My friend was worried about her use of talcum powder. I could assure her I have not used it since I was an infant. Not the cause. Not for me.

Things you fear come home– is there asbestos in the “popcorn” my husband scraped off all our ceilings? (No.) Is there something in our well water that we should have had tested but haven’t? (No.) Was it exposure to Round Up or other herbicides we have around? (No.)

With this one, as so many cancers, we just don’t know why the cells took the turn they did. Overall good health, and symptoms that are most associated with peri-menopause at age 50, might have hidden it. Asked about all the symptoms, I answer “no,” or “maybe.” Bloating? maybe. Loss of energy? I did stop doing the high-intensity workouts I’d been doing, but mostly they were just making me crabby! (Here I invoke my dad’s motto: “better flabby than crabby.”) I’ve never been known for my high energy. Loving sleep and a good nap is nothing new. If anything, my diminishing estrogen meant I had fewer menstrual cramps, less menstrual pain. I did have two migraines, and one in the summer that was more of a day of flu-like symptoms and nausea that I think was actually a type of migraine. But they came after I’d missed a few periods and were always followed by a period and “release.” And it was just the few times. Should my NP have been vigilant about that? Would that have rung a bell for anyone? I doubt it.

The talismans are part of the mental game. Last week I couldn’t have treatment because my white blood cell (WBC) count was too low. It was .7 and normal is 3.5-12. I’d been watching it go down, but since there’s nothing you can really do directly through diet to bring it up, I had to just trust it to take care of itself. I was seriously upset when I couldn’t have treatment. So disappointed. I didn’t even want to write it on the weekly update. My nurse was kind of alarmed– “most people are so happy when they get to miss a treatment,” she said.

“Not me,” I said. “I need this chemo. I’m killing cancer.”

She talked me down and tried to cheer me up with the news that my Chem 8 panel was “phenomenal.” Great kidney function, perfect liver function, glucose level very good for a chemo patient, sodium low, potassium good, all the numbers really good.

I adjusted pretty well once I got home. For one thing, it was clear I wasn’t chemo free. It was still working. My sinuses were still painfully drying out all the time, my tongue was still tingling and metallic. Taste was still dulled or off. I was still pooping rocks. I was tired on my two regular days, Thursday and Friday, and Wednesday, too, missing the pre-treatment Benadryl and steroids that prop me up most weeks. But I got a break from the heartburn medicine and the sleep aids and still have had good effect with just prunes and lots of fiber. I had more energy to cook, and by the end of the week to go on a bike ride and do a little workout at home (no weights, modified options). Which is good, because on the physical side I’m seeing the muscle loss that comes with chemo– I read about this in my cancer kitchen cookbook but saw it first in the mirror. Oh great. And I smeared a lot of frankincense on my abdomen this week. If I’d had cannibas oil, I’d have used that, too.

And then there is the heart of the mental game. I had to face in myself that in the past when I’ve seen the bald women, the gaunt women, the puffy women, the women in treatment, in church and in town, I’ve thought: “That woman is dying.” I haven’t known or understood anything about cancer or its treatment, hadn’t heard the stories of survival, the years called out: “10, 15, 25 years ago.” It’s the cruelty of the hair loss that it so alters you, and the steroids and other things make your face puffy, the chemo can give you a metallic sheen. And your immune system is compromised– I’ll be wearing a mask through the airport and on the plane next week. And people will look at me and think I’m dying. And they will wonder what is so special and important that I’m risking flying.

But I don’t think that anymore. I can’t. Because I am not dying. I am healing. And that has been the message in so many letters and cards and e-mails. I open them up and read them with one eye, I admit, fearing the words they might use. But the words are invariably, “wishing you health and healing, peace and love.” “Thought of you and your healing.” People have been sending recipes and poems. I absolutely love it.

When I saw last week another woman at church arriving in a tell-tale hat, I thought: “Look how strong and confident she looks! She seems to be doing well.” Later I wonder if I’m kidding myself and she just has hair loss for some other reason. She didn’t give me the telltale look of a “member of the tribe.” When I look in the mirror, I see that I have some color in my cheeks. I feel how easy it is to walk and get places and be places. I cook and am starting some seedlings. I visit the chickens and bring them treats. I am on top of things at work. Things happen more slowly and with breaks, but that is fine. Time is also strangely slowed down. So I can be slower and set manageable goals each day.

And the chemo, too, a break. (I do obsessively tell myself and others that most breast cancer patients go once in three weeks, and that my dose-dense regimen means this will happen.) On Sunday night my taste buds were well enough for pizza. A real celebration, I’ll tell you. Not chocolate, just canned peaches for dessert, but OK. And yes, an aftertaste about 30 minutes later, but I can remember how good it tasted. And I could know the chemo was still there, too, working away. Killing the cancer. And 13 more weeks to get it all.