Note to self: never get cancer in July

Once I settled the boob-removal, it was time to enter the reconstruction phase. I talked to Dr. Whang and she highly recommended Dr. White, and mentioned he is an artist--both in the OR and out, as he sculpts in his free time. This sounded incredibly promising, so I called the receptionist and got an appointment without having to play 20 questions. Fabulous!

Since they worked me into his schedule so quickly I barely had time to do my homework on reconstructive surgical options. I did read enough to learn that I much rather have a tram or DIEP flap in lieu of implants. I know, I know...this is all too complicated and kinda gross. Imagine how I feel. But here's the bottom line: If I had to go through all this surgery and long recovery I didn't want to have to be in the OR once and again over the course of my life. 40% of all women who get implants have them removed or re-adjusted within 5 years. Most require adjustments every 7 to 10 years depending on physical activity. This was the statistic that sold me on the tram--that and the fact that I'd get a tummy tuck AND new boobs, for free...can't beat that deal!

It was probably the HOTTEST day of the year when I made my way to Dr. White's office, notes and questions in hand. I generally make it a policy to meet and talk to doctors while clothed, and thankfully Dr. White and his staff obliged. Since I wasn't getting into a gown I had a bit more time to read the numerous plaques in the office: Two best of the Bay Area Doctors covers ('04-'05), and one Best Breast Reconstruction Surgeon (in the country!) 2001. Looking pretty good!

When Dr. White finally walked in he apologized for his sweaty shirt, and we talked about the abnormally hot weather for a bit. He was kind, had a great smile and a steady hand--all good things in a surgeon. I also liked this "bed side manner" as he took the time to talk to me about my options, including implants, just to make sure I understood there are some advantages despite my reservations.

I didn't even have to ask for pictures or past patients' names when he pre-emptively volunteered some names (and contact info!) so I could judge the results for myself. He also mentioned I should never have any problems getting in to see him as he'd be glad to squeeze me any time. Finally, he had OR privileges at Stanford and had worked with Dr. Dirbas before. All the pieces were fitting together.

Though I had a great feeling about Dr. White, I still wanted to talk to his patients, see the cosmetic results, and ask some key questions to finalize my decision. This is how I met Aletha. She not only returned my call immediately, but 24 hrs later I was sitting in her living room asking her all kinds of questions about her experience, Dr. White and the type of tram she'd had. She was so incredibly open and giving, and was even willing to show me the results or her reconstruction. She raved about Dr. White and gave me names of even more patients I could talk to. But I was sold, no need to shop around for more names. Dr. White it was!

Except, surgeons have to go on vacation some time. Sadly summer is generally that time. After talking to the schedulers for Dirbas, Whang and White we came to the conclusion that not even divine intervention could make the schedules work to allow a surgery (and appropriate time for post-operative care) before Dr. White's sabbatical. Back to square one. Poopy!

And so I started the search again, only this time my first question was: "Will you be on vacation any time during the month of July or August?" It seems like a VERY popular time to relax, especially if you are a highly qualified reconstructive plastic surgeon. Which really stinks when you have cancer in July. But fortunately, after many, many, phone calls and much background research (thank you Allie!) I settled on Dr. Gurtner. Thankfully not only was he NOT going on vacation, he could perform a DIEP flap which would conserve my stomach muscles intact, thus speeding up recovery and allowing me to continue my amateur triathlon career. YAY for microscopic surgery!

Now all we need is an open OR for a 10 hr. surgery that coincides with the times both surgeons, the anesthesiologist and the staff are neither in clinic, nor asleep. Easier said than done, even with 21 (yes...Twenty-ONE!) ORs to choose from. And you thought finding the surgeons was the tough part! I am still waiting on a final surgery date...sigh.

I get a second opinion

Life is full of unexpected situations. Getting cancer at 31 is certainly one of them. But the most unexpected part of this journey has been the sheer amount of homework you need to do as a cancer patient. Since my diagnosis I have spent countless hours reading about my disease in an effort to more intelligently guide my treatment. Of course, the docs have the medical expertise, but not all docs are created equal...or so I am told. It's always best to vet your sources and get confirmation, so after speaking with Dr. Whang and at Dr. Schneider's urging, I looked to the Stanford Cancer Center to get a second opinion. This, incidently, could easily qualify as Chinese torture.

I zeroed in on one guy--Frederick Dirbas--rumored to be the cream of the crop as far as removing breasts go. Unfortunately, Dr. Dirbas' staff didn't take after their leader. Here's how the first call to his office went:

"Hi, I'm a breast cancer patient at the Palo Alto Medical Foundation (PAMF) and would like to set up an appointment with Dr. Dirbas for a second opinion."
"Dr. Dirbas works at the Stanford Cancer Center."
"Correct. Would it be possible for me to get an appointment?"
"If you are being seen at PAMF, why do you want to see Dr. Dirbas?"
"For a second opinion"
"But you are being seen at PAMF, that's where your doctors are"
"Yes. But I'd like Dr. Dirbas to review my case"
"Are you a patient at Stanford?"
"No. I just want a second opinion"
"I am still unclear as to why you need to see Dr. Dirbas"
OF course.

After several calls that sounded pretty much like this, and Dr. Schneider's intervention I was finally able to get an appointment 3 weeks later.

"THREE WEEKS?" I was flabbergasted.
"Yes, that's all I have available"
"Is there any way to move this up?"
"Everyone we see has cancer"

Well, that certainly put things into perspective. Not that I was trying to play the cancer card, but my special status was the norm here. Too many cases, too few specialists, and certainly too little time.

Fortunately, the universe has a way of making things work. After the first MRI they noticed there was a sizable tissue extension attached to the tumor. Dr. Whang wanted to test the tissue to learn whether the cancer had spread and to what extend. It turns out the only doctor in ALL OF STANFORD medical center who could perform this biopsy was out on vacation for another week. A week to receive the results would put me right against my visit with Dr. Dirbas. Without this last piece, Dr. Dirbas couldn't really review the case fully. The delay wasn't unnecessary after all.

After the second biopsy (which came back negative for cancer, by the way) and an entire afternoon spent PERSONALLY tracking down and delivering lab results, tissue samples, x-rays films and pathology reports to Stanford, I finally met with Dr. Dirbas. We talked at length about my particular kind of tumor, its location and the possible surgical outcomes given his plan for extraction. He also mentioned that given the size and location, he expects that the cancer has spread to the lymph nodes--crap! He has also apparently been to every single conference there is on the topic, so he talked liberally about the absolute latest findings on the standard of care. After this conversation and a quick check for a ring on his left hand (there was none) I realized this guy LIVES to work--perfect! I then asked if he'd like to remove my breast. He agreed...we had a moment.

The sisterhood of the cancerous boobs

As many of you know, I have never been a "girly" girl. In fact this has always been a point of contention with my mother, who to this day, doesn't understand what the appeal of triathlons are. Our first conversation on the topic went something like this:
"Guess what mom, I've joined a triathlon team. I'm sooo excited!"
"Where? Are there single men?"
"Hmmm, didn't really ask. We are going to train all summer."
"Train? For what? What are you doing again?"
"TRI-A-THLON mom. Swim, bike, run to raise money for cancer research.
"Hmmm, wouldn't it be just simpler to write a check? You are going to grow muscles all over your legs again..."
Sigh...

It turns out my grandmother was a serious tom-boy too. I had heard stories of this pretty governor's daughter in early 20th century Colombia disguising as a boy so she could leave the house and play with the street kids. She routinely smashed her imported porcelain dolls and preferred climbing trees to mandatory charming school lessons. Apparently I had inherited her aversion to bows and all things pink and frilly. My biggest nightmare as a child was having mom buy me dresses that made me look like a meringue...a very fluffy, ribonny, pink meringue! So I'd accidentally-on-purpose stain, rip, or in any way damage these ribbony torture chambers to avoid having to wear them. I was successful only some of the time unfortunately. (Sorry mom! Please don't get mad now.)

My aversion to girliness was most explicitly manifested in my deep fascination with sports, particularly track. My mom, who still believes that it's not lady-like to sweat was horrified--and to her credit, incredibly supportive. She had already tried ballet, music lessons, and all sorts of other girl-appropriate activities to no avail. Unfortunately for her, standing in front of the mirror looking like a pink shower-gel puff repeating position 1, 2, 3, endlessly could never match the thrill I got out of running with the boys. Running was exciting and kick-ass; ballet was delicate, slow and soooooooo boring! My competitive nature just couldn't take it. I finally joined my school's track team and become a junior national champion. Mom understood and tolerated my passion, but never really *liked* it.

So what does this have to do with having breast cancer? Patience, people...patience. Given my dislike of all things girly including activities that most girls engage in, I grew up around boys: my brother, half-brothers, and tons of boy-cousins at home; lots of boys on the track team at school; and then a ratio of 10 boys : 1 girl at my high school. Though I had "girl-friends" as a little girl, it wasn't until college that I learned that other kick-ass non-frilly girls are out there. Needless to say I befriended many of them and they remain in my life to this day.

But despite this realization, I hadn't really understood the power of "sisterhood" until I was diagnosed a few weeks back. Counselors, survivors, doctors, nurses, friends of friends, and all others in-between have opened up their arms and souls to help me understand my breast cancer. Women I have nothing in common with, and whom I hardly know have opened their homes and given me invaluable advice. Some have even shown me their mastectomy scars or reconstructed boobs. It's been overwhelming and quite surprising to know that someone will instantly offer their hand once they hear the words: "I have breast cancer." It makes me think we should all be more like this, all the time. I, for the first time, feel like a "sister" and it's amazing.

Telling my mom is harder than having cancer

For those of you who've had the privilege to experience my mom "live" this portion of the saga will not at all surprise you. Many of you only know her through my stories--and I must confess that though they are all absolutely real, I do, on occasion avail myself of hyperbole for effect. Having said that, I'd like to emphasize that what follows is as true an account as I can muster, that it is in no way exaggerated, and that no small animals (though many Kleenex) were harmed.

So you think that hearing the news that you have cancer is hard, right? But when you have the peculiar mix of over-protective-non-cooking-yet-exceedingly-maternal-Jewish-Italian mother I do, telling *her* becomes the actual challenge. The moment the words "cancer" came out of Dr. Schneider's mouth, my first thought was: "How do I tell mom without given her a heart attack?" Oh surely Paola is exaggerating. Normally I'd mean that metaphorically; in this case, I meant it quite literally. Let's examine the precedent.

My mom's version of handling an emergency--particularly anything involving her children and bleeding--ranges from screaming, crying, fainting to completely freaking out. I first learned this at the age of 12 when upon slashing my knee open in the shower I called for mom to come to my rescue. When she entered the bathroom and saw the blood geyser emanating from my leg and running down the drain she stopped breathing, brought her hands to her face, and sat on the toilet weeping.

At that point I realized not only that I was on my own with the bleeding and the piece of ceramic stuck in the wound, but that I also had to get my mother's breathing under control. So, I fished in the fleshy opening for the ceramic wedge while instructing mom to put her head between her knees. I then proceeded to wash the wound clean as I counted off her breathing intervals to avoid hyperventilation. I held the wound shut, reached for a towel, dried off and went to find a paper bag for her. Note to self: Mom--excellent business woman, lousy EMT.

Sadly, there's been no observable improvement over time. A mere three years ago, when my little brother Stefan got his head slashed open in a friendly game of street baseball, mom's reaction, once again, was to hyperventilate and totally FREAK OUT. This time two ambulances were called: one for Stefan, one for mom. He got stitches, she got Valium. I knew there was no getting around it, mom just can't handle any kind of harm to her children, no matter how slight. I was afraid my cancer announcement might actually kill her.

So, like a general going into battle I gathered intelligence and planned the attack. Step one, tell dad. As expected, his reaction was rational, collected, thoughtful and strategic: "Let's not tell your mom." Excellent choice dad, but she may wonder a) why I can't come home for Christmas b) may not buy the, "hey, it's the latest rage in California to shave your entire body, eyebrows and eye lashes included" excuse and c) may seriously consider physically harming you--or worse yet, instituting permanent silent treatment for both of us. "Good point. Can we wait until you know more?" Sure. How much more. "How about A LOT more."

A LOT more came the following week after my meeting with the surgeon, the oncologist, two MRI's and a second biopsy. Dad didn't agree. So I reminded him of point (c) above. It was 10:30 pm in Miami. He proposed we tell her the next morning. I convinced him this would unnecessarily prolong the number of hours he'd have to hear her cry. Once again, dad saw the wisdom in my strategy. If we tell her now, she'll have to go bed at some point, most likely within 2 hours. Tomorrow, she could potentially cry all day. I pumped him up like a boxer heading into the final round of a championship match: You can do this. Take the phone, go into the bedroom, get the kids to leave and call me back. "Ok."

30 minutes later I was beginning to lose my patience. How long does it take to send two teenagers with their own TVs, playstations, computers, PSPs, magazines, books, and phones to their own bedrooms? It's not like they'll be bored...Seriously! *Ring* Mom's caller ID flashed on my cell phone. I had been dreading this moment for two weeks, but I was ready:
"Halo"
Screaming
"Halo?"
Screaming followed by wailing.
Shit! He told her.
"Mom? Listen to me, breathe. Please breathe.
Whimper, scream, Kleenex, garbled, completely unintelligible Spanish
"Mom, please breathe. I can't understand what you are saying."
More garbled speech interrupted by wailing
"Mom, you have to come down. Please"
This went on (albeit completely in Spanish) for about 45 minutes. After she was able to regain her breath she was very angry I hadn't told her immediately upon leaning the diagnosis and barked angrily at dad and I:
"What are you hiding from me! Tell me! How bad is it. Tell me the truth"
So I did, and she sobbed, and listened, and I consoled her for another hour.
Then, something remarkable happened--complete silence.
"Mom, are you there? Are you ok? DAD! DAD!"
"I'm here" her voice heavy with sorrow, gravely from crying. She had finally stopped crying, but I could tell she was heartbroken--the future she'd envision for me vanished. The grandchildren she'd always wanted evaporated. All she could see was the painful road ahead. She knew our lives would never be the same and she mourned.

The revenge of the mutant Jewish genes

Next stop, Dr. Leibowitz--medical oncologist extraordinare. To be honest, I really wanted my entire cancer team to be composed of girls. After all, they have boobs and they know the special relationship we have to the "ladies". However, perhaps a male prespective was also needed. So I decided to give Dr. L a try. (Additionally, his schedule was open and he came highly recommended!)

As a good little cancer patient I did my homework before going to our first meeting and had all kinds of hard-hitting questions ready for him. Example: What's your favorite color? Correct answer: pink. Ok, so that was just a compatibility question. But seriusly, I really wanted to give this guy a run for his money and let him know that I was in charge. I was pleasantly surprised when he opened our conversation with (and I quote) "I am here to lay out the numbers and give you my opinion, but I am not going to force you to do anything you don't want to do. The treatment course is entirely in your hands." I liked him immediately, a doc with 35 years of experience in medical oncology who'd actually LISTEN to me...beautiful!

With that, I started my interrogation:
"What can possibly cause a perfectly healthy 31 year old to get breast cancer?"
"A number of factors", he said in a very conforting paternal tone, his wide arms crossed, the reflection of the office lights on his bald head competing with his gregarious smile.
"Mostly we can attribute it to family history. Did you say your mom had cancer?"
"Actually my grandmother too, and my aunts, and cousins, and random other males on both sides of my family tree"
"I see"
"Were they all breast cancer?"
"For the ones with boobs, yes. The men were mostly liver. They drank a lot. We area happy bunch."
Subdued laughter.
"Have you considered genetic testing? It could definitely complete the picture and give us more information for your treatment plan."
"Most definitely. Do you want to draw blood now?"
"Hmmm...the nurses do that. But it's just a precaution; the marker genes are mostly prevalent in jewish families"
Smerk
"Hmmmm" I pointed my index fingers inward and made small circular motions at my head. "Guess what..."
"Really?" His eyes got really big.
Circular gesturing continued.
"REALLY?" He emphasized.
"Really. My ancestors were kicked out of Spain by Queen Isabel and promptly migrated to South America. Turns out the Spaniards had franchised the inquisition there too. My real last name is Brosntein--Sanmiguel is just the town they came from"
Laughter
"We are definitely testing you." At that point he quickly turned around and typed frantically on the terminal. Google poped up. A second later I was staring at a table indicating the likelihood I was a carrier of the cancer gene given my family history: 70%!
"Seriously?"
"Seriously"
And there it was. Apparently you don't need to be practicing--on in any way a believer--to take advantage of the many jewish gifts: hypocondria, razor sharp self-depricating humor, neurosis, wit, sarcasm, cooking prowess and mutant genes.

> More on the genetics of Breast & Ovarian Cancer

So, how bad is it? I talk to the surgeon.

I must confess that the fourth of July holiday (Friday-Tuesday) wasn't nearly as interminable as I had predicted, given that my first appointment with the surgeon after my initial diagnosis was scheduled for July 5th. It actually gave me some much needed time to reflect and crystalize my bottom line. I walked into Dr. Whang's office with a clear perspective and a ton of questions.

So, how bad is it? "Well, it's certainly not good". She then proceeded to explain that the tumor is about 3.5 cm x 3.5 cm and it's tucked uncomfortably close to the axilary lymph nodes--AKA close enough to the arm pit to cause some serious harm, while still wedged within the breast tissue. A bit of a janus-faced tumor, if you would. Perhaps it had a difficult childhood and couldn't settle his identity entirely? Maybe it's going through therapy right now to find its inner-cancer.

At any rate Dr. Whang estimated that we are most likely looking at stage IIB if no cancer is found in the lymph nodes. If the little bastard cells collonized the armpit, then I get upgrade to stage III. Ok, so what does this mean? "Given your age, the tumor's size, and how fast it seems to be growing..this means we'll give you the most aggressive treatment we can." There really is no middle ground with me is there; not even my cancer could be mild. Danm it!

Since I am a triathlete in excellent health--cancer aside--and very strong, this means surgery to remove the tumor,3-6 months of the most aggressive chemotherapy possible, and maybe radiation and hormonone therapy after that. Before we do that, let's get at least two more MRIs (one for each girl), a chest X-ray, pregnancy test, and a whole lot of other blood work too. "Well, then. Who do I talk to about slowly poisoning my body?" Dr. Leibowitz.

> More on cancer staging.

Quality vs Quantity: A question of balance

Once you know you have cancer, your view point shifts radically and time collapses into a shorter spectrum. The now, today and next week are prioritized more than you ever have. Tomorrow, next month, next year and 20 years from now are no longer a certainty but rather a goal. I guess this is the way time works for all of us, but it unfortunately takes a marshmellow-sized tumor in your left boob to force you to face the reality of time--your time--and prioritize accordingly.

I have been thinking about time a lot, and I have come to the conclusion that the quantity of time I can remain cancer free is not as important as the quality of my life during that time. This is not to say that I am not willing to go through hell to achieve cancer-free status, but simply to clarify that once I get to the promised land, I still need to be able to enjoy the things I love: triathlons, travel, drinking, eating, dancing, writing, adventure, friends and family.

Of course, there are side-effects I will willingly accept: loosing my hair, eyebrows, eyelashes, boobs and maybe even my ability to procreate. Cancer does and will leave its mark. The trick is to be able to fully re-engage while bearing these battle scars. I refuse to sit on the side lines. And I have told my doctors this. Whatever treatment they recommend must render me able to live, really LIVE--otherwise, I will happily pack my bag, laptop, camera and passport and go roam the world until I keel over.

From my perspective, a few years of fabulous far outweight a life time of blah.

What Now

Though I have always done my best to live in the moment, our culture--and without a doubt my own ambition--have certainly gotten in the way. I can't even recount the number of weekends I have spent working, the dinners I cancelled to stay in the office, not to mention all the personal emails and phone calls I postponed--often indefinitely.

So what of all that time? I still don't know how I feel about that, but I know this: It's not too late! Even if I have yet to achieve my own standard: live wihout regret. Happily, while I do have some regrets, mine are mostly pretty minor. And perhaps that's the reason the shock of the diagnosis was swiftly followed by deep serenity--peace, even. That, and a call to action to take control of the situation and focus on the immediate, immediately!

To that end, I threw myself head first into research (I'd be an overachiving cancer patient!). With Jana (councelor from the cancer center), my Cancer handbook (Jana gave me my own copy now that I had joined the club!) and "Googles", I set off to put all my graduate school research skills to good use. I flipped and clicked, read and highlighted, and came to the conclusion that being a cancer patient takes a LOT of reading. Who knew there'd be this much homework?

Like a good academic I sought to determine my approach to this process, a theme if you would. I wanted to prepare for my first meeting with the surgeon immediately following the long 4th of July holiday weekend. I wanted to be clear in my heart about my wishes before learning the full extend of my particular cancer. At this point, all I knew was that I had non-differentiated, invasive ductal carcinoma. I also knew that statistically, due to my age, my cancer was aggressive and would progress very quickly. So I formulated my bottom line: Quality over Quantity.

28 June 2006: The Diagnosis

So what do you do between a biopsy and the dreaded results call, you ask? My answer, Counting Crows concert and beer. Ok, so the concert didn't last 2 full days, but it's too boring to recount my daily routine (though I could actually dig up the Google menus for those days if you are really curious). It's also more fun than sharing how very painful it is to have your boob impailed with a large needle...did I mention it was hu-freaking-mongous? But I digress.

During my trip to Dublin--independent of the tumor which at the time had been diagnosed as a hormonal malfunction--I had a moment of clarity; I decided it was time to bring some much needed balance between life and work. In that spirit, I came home early that Wednesday to catch up on about three months worth of National Geographics (and, ok, some Rolling Stone too).

I ended up catching up with Charlotte and was chatting along on the phone when *beep*, call on the other line. Hmmm, who's calling me at 7pm from a private number? Click over. "Dr. Schneider here, the biopsy was positive; you have breast cancer." Uhhh? Excuse me? I'm 31 years old. I just completed the most difficult triathlon course in all of North America. I swim, I bike, I run. How is this possible? "I'm sorry"

I am confused. Shocked. Stupefied. I believe this is what an out of body experience feels like, except I wasn't floating anywhere. I was sitting on my couch, wearing my black and pink polka dotted pijama bottoms, staring at my fireplace. Frozen. *beep* Charlotte's still on the other line...what now?

Monday 26 June 2006: The Biopsy

So it turns out that STAT doesn't mean squat in our medical system. It took over 5 days to get a "stand-by" appointment to maybe, perhaps, most likely but definitely not for sure get a huge needle inserted in my booby.

I got to the Palo Alto Medical Foundation at 7:30 am. Dutifully, like a good Googler in the middle of mid-year performance reviews I brought my laptop with me (Mary, I hope you are reading this part) and proceeded to gush over my collegues excellent performance over the last two quarters as I waited in a tiny room wearing scrubs. The nurses where very impressed by my set up: computer, headphones, ipod, phone and stylish water bottle. They were tempted to check email, I know it!

At around 11 they finally got around to me. I was lead to a room where they did a mamogram...not as painful as I thought, but it definitely feels funny to have a strange lady place your breast on a plate so it can be smooched nearly to death. Once they realized that yes, the lump was indeed not a figment of my imagination, we proceeded to the sonogram.

One of the interesting things about the sonogram (in addition to the warming gel...hmmm warming gel) is the cool imaging that allows you to see blood flow. My tumor actually was quite active in this department. Lots of blood flow, rivers of it--relatively speaking. I didn't realize that this was bad news--too busy looking at the screen like the computer geek I can be--until the radiologist came in and the tech said in a overly somber tone:"It has blood flow, look!" The radiologist's expression sank, she took my hand and asked me if she could please insert a ginormous needle in my boob. Now, I have been propositioned before, but this was too good to pass up. Dark room, scrubs, the dim light of the tumor's blood flow on the screen..."Let's do it!" I replied.

She was kind and got the procedure underway very quickly. She winced again when I told her I felt no pain as she scraped the top of the tumor in several directions to get multiple samples. I guess this is a bad sign. She reamined calm and assured my doctor would have the results within 3 days.

Friday 19 May 2006: The Journey Begins

It was a normal morning when I thought "hmmm...that's odd; I don't remember having a huge solid mass in my breast." Alien abduction? Perhaps. In any case, I was catching a flight to Dublin for a business trip. After a quick stop by the Google Doctor (yes, we have a doctor on site), I got on the plane with assurances after a quick physical exam that it was probably hormones acting up. After all, nobody gets breast cancer at 31! Still, the Google Doc recommended I get it checked out if I could still feel it upon my return.

Fast forward 3 weeks, many Guinesses and a quick stop over in Italy to spend some time with the family. I land back in SFO after an epic journey:Florence-Rome (train), Rome-Dublin (plane), lost baggage (thank you Aer Lingus!), quick cab ride to Iza's, 5 hours sleep, cab ride back to airport with very animated Irish cabby who dropped F-bombs every 2 minutes, flight to Shannon, Ireland (luggage recovered), transcontinental flight to NYC Kennedy Airport, 2 hours and a bad bagel later, second transcontinental flight to SFO. Man, I almost didn't survive the journey...sadly my little stow-away cancerous friend made it all the way back to SF--rat!

Thankfully I had made an appointment with my family doctor from Dub, so got in to see her shortly after my return. Dr. Schneider wasn't happy with the physical exam and extensive cancer family history and ordered a lump biopsy STAT! (She literally said that. Ok, maybe not; but I've always wanted to use that term...)