Elizabeth Kubler-Ross

I seem to get my deepest thoughts either just before I fall asleep or when I first wake up.

This morning, I was thinking about Elizabeth Kubler-Ross's "On Death and Dying."

No, I am not dying except in that metaphorical sense in which we are all dying once we are born.
In her landmark book, she talks about the stages of grief. Denial, anger, bargaining, depression and acceptance. I realized this morning that I am cycling through these stages. Almost like a merry-go round, I am hitting them over and over again.

I thought I had jumped from the shock of the diagnosis to acceptance very quickly. I remember the shock vividly. It happened on April 18, when I saw the cancer on the mammogram. I knew what it was. I knew there was no chance it was benign, even if it didn't have all the telltale features. I had decided within the previous 3 yrs that my risk for breast cancer was no higher than anyone else. Suddenly, I knew I was wrong. I knew I had cancer. I was definitely shocked!

Shock moved very quickly into action. I made the calls. I set up appointments. I got my own results and made sure they got to those that needed them ASAP. I started to do whatever it was that had to be done so that I could get this cancer out of my body. I thought I was moving back into the concept I had grown up with. That breast cancer was certainly something that could happen to me someday and I would have to deal with it and get it taken care of. Period. I thought this was acceptance. Now, I am not so sure. I realize that the shock was part of denial. If I moved quickly and took care of what needed to be done (after all, what else is there to do??!!), I could almost pretend it wasn't happening. Little things would happen and then it would hit me that this was real, it's was happening to ME! Dropping Rachel off at Patria's. Sitting in the private holding room at CARES. Having to actually climb on the OR table. (Hate that part. I love surgery and love walking into an OR, just don't like being the patient!!!) Having my port accessed. Planning my surgery date so I can be there for the first day of school. Those are the moments when I cannot pretend this is not happening. I've been cycling through denial. The funny part is that I have been denying that I've been in denial at all!!! I think it also comes when I am surprised by my reflection or when I see my shadow and don't realize at first that it's MINE. For all the acceptance I thought I had, I've been living in denial.

I've also spent the last few days, maybe the last 2 weeks, cycling between anger and depression. I've been on edge and irritated. I'm sick of being sick. I'm tired of being tired. I'm so irritated, annoyed and ANGRY that this has happened to ME! I hate feeling like this. I like to blame being off birth control pills for some of it (the return of PMS! LOL! what happened to the chemopause? I'm STILL fertile!!). I know it's not the whole picture. I'm overwhelmed at what comes next. While it's not as frightening on some levels as the unknown that chemotherapy once was, I'm still scared. I just never considered chemotherapy having a place in my own life. Surgery, yes. Chemo, no. As a surgeon, maybe surgery is easier to accept. Or, is it that I had considered these surgeries as prophylaxis in the past? Probably both. It doesn't change anything though. There's an undercurrent of anger over the idea that there is still more big stuff left.

Another piece from Elizabeth Kubler-Ross that I remember is that we all travel through at least 2 of the stages as we move towards acceptance. And, we don't necessarily hit the stages in order. I'd love to stop cycling and simply live in acceptance, but I don't know that it is ever possible. There are things in my life that are permanently changed. Breast cancer is never truly considered cured. Formally, it's just "no evidence of disease." It's not like some cancers where if you make it 5 yrs without a recurence, you are cured. I did chemotherapy not because I am at any significant risk for the next 5 yrs. My cancer staging carries with it a 96% survival rate. We forget and many don't know that survival rates are quoted for FIVE YEARS. That's it. Sometimes, it's 10 yrs, but most published rates are for 5 yrs. I did chemo bc of the risk of this particular cancer raising it's head again within the next TWENTY YEARS. Yup. That's not reflected in my beloved 96% at all. I'm having the bilateral mastectomy and the oophorectomies bc of my future risks of cancer. I'll be bringing all these risks down to a nice low level once I am done. Will that bring me acceptance? A permanent, comfortable acceptance?

I don't know. Maybe I really don't know what acceptance is after all.