The "how" of it all

Genetics, East vs. West, not quite coming to terms, and more biopsies

For those looking for a peppy Christmas post, know that I'm in a macabre mood along the lines of "on the first day of Christmas, my cancer gave to me...one itchy balding scalp...". Feel free to come back to this post when your mood suits you, as I completely understand the desire to remain in good holiday cheer. In fact, let me say it now - for those who celebrate, Merry Christmas! I sincerely hope you're enjoying this time away from work, and are celebrating with family and friends! I've been at home relaxing with family, and trying my best to get into a bit of holiday spirit.

I must say though that it's hard to find my holiday spirit when my days blend together. One day for me looks much the same as the others. In fact, I feel like I'm losing track of time and so while the calendar says it's Christmas, it just feels like another day in this long fight. To be clear, I'm aware of the fact that there's a tiny violin playing somewhere to a song whose lyrics must include "woe is me". I don't take my good fortune of being able to take time off to focus on this fight lightly. In fact, I count that blessing on a daily basis, especially as the side effects continue to take their toll.

For now, I won't bore you with the details of side effects (that's for another post), but I did want to give an update on some of the latest developments in these last couple of weeks.

Genetic Testing

Due to the lack of cancer history in my family and the young age of my diagnosis (my back and the remaining white hairs on my head beg to differ about "young"), my doctors suggested getting genetic testing done to determine if I have any of the genetic mutations linked with a higher risk of breast cancer. For those of you who recall Angelina Jolie's decision to have a preventative double mastectomy after testing positive, these are some of the types of mutations they were looking for. You've likely heard references to BRCA1 and BRCA2, both of which are mutations that result in a significantly higher chance of developing breast cancer and ovarian cancer. There are other known mutations out there, but BRCA1 and BRCA2 are two of the better known mutations in part because of the Angelina Jolie association.

It was important to determine if I tested positive for any of the currently known mutations for a variety of reasons including:

1) My mother and my sister would both need to be tested immediately to determine their risk

2) My parents would both be tested to identify which side of the family the potential mutation came from in order to warn other women in the family about increased chances

3) This would be input into my future treatment as I would then need to make decisions about having a second mastectomy and potentially removing my ovaries to reduce the chances of a secondary cancer

In addition to all of the very good reasons above, I wanted to know if I had any of the mutations because it would have finally given me a "how" to explain all of this.

Fortunately on 12/19, I found out that I tested negative for all known mutations associated with breast cancer! It was, and still is, a reason for relief. My whole family was finally able to release a breath that we had collectively, but unknowingly, been holding in. I was therefore surprised to feel an infinitesimal twinge of disappointment. In that initial moment of hearing the news, awash in the feeling of deep relief, I couldn't or didn't want to unpack that unexpected twinge and pushed it away. Why in the world would I be disappointed by what can only be described as very good news? Am I a masochist seeking trouble?

East vs. West

Given a few days to think about all of this, I think I can finally explain that twinge. See, growing up in the West, there's always a question of accountability. If there's a "problem", there must be a "cause" for it or someone responsible for fixing it. And while I'm aware that life doesn't work under such nice, neat parameters, it's hard not to want to find a reason to explain all of this.

How did this cancer happen? What responsibility do I bear for my cancer? Is it caused by my hectic lifestyle? Are there things that I could have done to avoid it? Essentially, what share of the blame for my cancer lies with me and my actions?

On the other hand, being raised in a pretty traditional Indian home, Hinduism has been an ever constant presence in my life. Hinduism's more "Eastern" thinking would have me simply chalk the cancer up to my fate. This was the path that I was meant to walk on, either because of my karma from a previous life or simply because it is.

Sidebar: Can I vent for a second? I need to talk about how unhelpful it is to hear trite statements about how fate only hands you that which you can handle. I'm flattered that people think I have the strength to face this. But let's be clear, I have absolutely no desire to be facing this, irrespective of my strength to do so or not. Tell me that it sucks and that you're here for me. That's all I need!

Clearly, neither approach, West nor East, provides a satisfactory answer. As stupid as I know it is, having one of the genetic mutations would have provided a very convenient scapegoat. While it wouldn't have been ideal, I could have come to a sort of terms with my cancer. I'm instead left with a series of unanswerable questions (though very grateful that I am in fact negative for any known genetic mutations).

Ultimately my mental struggles are a philosophical exercise at best. I suppose I'm sharing it because what's the point of being a pseudo-philosopher if I can't philosophize for a moment to a willingly captive audience?

Another Biopsy

In other, not so positive news, I have another biopsy scheduled for Friday, 12/29. My surgeon was reviewing the images from my breast MRI with a radiologist, and they want to be extra sure about something that was noted in my left breast (the currently non-cancerous side). My surgeon's suspicion about the left breast is low, but the desire to conduct a biopsy is clearly borne from some concern. They called on Friday, 12/22 to let me know that they would be scheduling an additional biopsy.

I must say that not being able to find my footing is definitely starting to drag me down. Each time that I think I know my status and can move forward with focusing on the fight, a new question comes up. I can only hope that it turns out to be nothing. I don't have the same deep gut instinct that I did for my right breast, but I'm hardly a cancer expert.

I will of course keep you posted on the outcomes. But perhaps I can ask that for those of you who believe in some form of a higher being, in whatever religious context that may be, please say a prayer on my behalf. I can use all the positive thoughts and energy that can be mustered!