Did You Smoke?

bluesmokeWhen I was initially diagnosed with lung cancer, I was shocked.  Truly.  Even though I did smoke for many years, I had quit smoking about 15 years earlier.  I’m not saying that I thought my chances of suffering any of the health effects smoking causes had vanished completely, but I thought that they had greatly diminished.  My maternal grandmother died of lung cancer and my mother had recently been diagnosed with it also.  They both had a history of smoking; however, Mom quit over 25 years before. In addition, a cousin, who never smoked, was also diagnosed with Stage 4 lung cancer. Subsequently, my mother and cousin have also lost their battles with this disease.

I am lucky in that when I was diagnosed, I had a tremendous support system: family, friends, colleagues, and neighbors.  All of these wonderful people assisted wherever they could, responded whenever I needed them, and emotionally helped me to get through some really dark times.  I was facing a formidable disease that required various treatments.  I received  chemotherapy for three months, radiation simultaneously during six of those weeks, and two lung surgeries.  I am so grateful for all the compassionate people in my life at that time, including doctors and nurses who made this hell bearable.

What was irksome, however, was when I would tell someone that I had lung cancer, more times than not, the first thing they would ask was, “Did you smoke?”  What difference does it make? Of course the implication is that I did something to deserve this horrific disease.  I’m sure that the people who ask this question don’t intend to purposely imply this, but, it is exactly what the question suggests.

I can understand, to some degree, the psychology involved, even if it is subconsciously, to believe that people cause their own health problems.  If you believe that, then it eases the worry you might have about suffering the same fate.  For instance, I can see believing that if you have never smoked, then you won’t have to worry about lung cancer (not true by the way), or that if you are obese you are responsible for all of the ill-effects obesity has on your body.  It makes people feel secure–as though they have control over their own fate: “If I take care of myself, then I won’t need to worry about suffering the consequences of not leading a healthy lifestyle.” To some extent this may be true, however, there are so many factors to many diseases that are not yet discovered.  Just look at how often a new scientific study is published contradicting something that another study previously stated.  Is coffee good or bad for us, what amount of red wine is beneficial, do Omega-3s really improve heart health, are there any benefits to taking vitamins? We are bombarded with information that isn’t the ultimate word–there are always more studies to be considered. Even though we want to be in control of our health, this is not necessarily possible.

A great essay on this subject that delves even deeper is, “Hating the Sick: Health Chauvinism and Its Cure” by Fred Pelka, published in The Prose Reader, The: Essays for Thinking, Reading, and Writing – See more at: http://catalogue.pearsoned.co.uk.

Yes, there are certain actions that we can associate with diseases: smoking increases one’s risk of lung cancer. Period.  But what else does? What about exposure to radon or asbestos?  What about genetic factors?  Why do some people smoke  their entire lives and never get lung cancer and others have a history of smoking just a few years long ago and get it?  What about all the people who have never smoked–not even socially?  How do we explain their suffering?

One evening, I was discussing this with my husband, and it occurred to me that what made me so angry was that I felt that I was being judged, and that felt unfair.  Then and there I decided that in the future, whenever anyone asked me if I ever smoked, I was going to lie and say, “No!” We laughed about it and said, “That solves that.”

Not long after, I was at the Cancer Center for radiation.  I was scheduled everyday at the same time, as were the people receiving treatment before and after me.  This particular day, there was a new woman in the waiting area.  We introduced ourselves and made small talk while waiting for our turn to be “zapped.”  She asked me what type of cancer I had, and I told her, “lung.” (I have to tell you that she reeked of cigarettes).  Her eyes widened and she asked, “Did you smoke?”  I didn’t have the audacity to tell my lie, and, so, I told her that I had, years ago.  “Oh,” she was very sympathetic.  I asked her what type of cancer she was being treated for and she responded, “Anal.”  I don’t know what came over me, but I started to giggle uncontrollably. . . all I could think was, “Did you sh*t?”  She responded with a nervous laugh, and then, thankfully, I was called in for my treatment. I know I behaved badly, and should be remorseful about it, but somehow I found that encounter liberating.

The Funny Thing About Cancer

Depression-Doubles-Stroke-Risk

I have cancer.  Technically I had cancer.  I’m now at a point which is labeled no evidence of disease. I often wonder what exactly does that mean?  This term has been tossed around seemingly interchangeably with remission. Medically speaking, I’m not sure if there is any difference, but it seems to me that the powers that be (The Great Cancer Gurus at the famous Cancer Centers) think that no evidence of disease might sound more positive than remission.  According to the National Cancer Institute (NCI) remission is:

  • A decrease in or disappearance of signs and symptoms of cancer.
  • In partial remission, some, but not all, signs and symptoms of cancer have disappeared.
  • In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

There is no definition for no evidence of disease listed, therefore I’m sticking with the theory that it is a  made-up term intended to sound more appealing than remission.

I had some pretty serious lung cancer.  At first it was believed to be Stage 3b, but that was before my brain metastasis was found. So technically, I had Stage 4 Non-Small Cell Adenocarcinoma  with a brain mets. At 46 years-old I was given one of the worst diagnoses one could get.  According to the latest statistics, there was a five year survival rate of just 5.6%.  Holy shit. Imagine the moment that you realize that you’re going to die–quite possibly in the near future, and how you will die.  I felt as if I swallowed a brick. Unfortunately, I had extensive knowledge about the type of cancer I had and the various treatment options because my mother had been diagnosed with the same cancer just 10 months earlier.  I suppose stranger things have happened, but at the time we were all astonished–family, friends, and doctors.  How could this be?

When I first accepted that I had cancer, I immediately began to plan my course of action–the secret to overcoming obstacles is taking control of them, isn’t it? I consulted with most of the doctors that my mother had and they were all as shocked as we were.  I underwent weekly chemotherapy treatments, scheduled so that my mother and I could sit side-by-side to get our respective poisons.  Despite our dilemma, we had quite a bit of fun together during those long hours.  We were always hooting and hollering about something and having fun with the nurses. We were close to begin with, but now we shared a special bond. I also had daily radiation treatments for six weeks, and during the process an endless battery of scans to see what these barbaric treatments were doing to the cancer.  Forget what they were doing to the healthy cells!

Eventually, it was time for me to go to a major cancer center for the surgical portion of my treatment.  I went and had another scan to see what the final outcome of my chemo and radiation had been.  It appears that there were two new spots on the opposite lung.  The surgeon explained that they would go in and first biopsy those spots to see if the cancer had spread.  If it had, then they would not proceed with the original surgery that was planned as they could not “chase it all over.”  All of this was before they knew that it was already in my brain.

They operated, and when I awoke from the anesthesia I saw that they did not remove the main cancer on my right side.  So much for all the chemo and radiation–all for naught.  I was so sad.  That’s really the only way to describe it.  I felt sad.  Not mad, not scared–just sad.  I have always been a very optimistic person, and for the first time, I was looking at an outcome that I could do nothing about.  Even my sunny disposition couldn’t change this.

Several weeks passed, and I was scheduled to return to the surgeon for a post-op appointment.  I did not want to go.  For what? So they could check my surgical sites?  We had to go into the city; something we did often and enjoyed.  But this day, my husband had to drag me there!  I did everything but stomp my feet and refuse!  We did go, however, and were sitting in the exam room waiting when all of a sudden the doctor flies in, looking at my open file and says, “Well this is quite a surprise–turns out the biopsy came back benign–it hasn’t spread to the other lung.  We can schedule the surgery!” I was so confused.  I had accepted my fate and now, she was telling me that my fate had changed again. Of course, I was happy even though somewhat stunned.   I did have the surgery several weeks later.

A few months following, I developed some headaches and strange sensations in my left hand.  Then one night I was in ShopRite and the left side of my face wouldn’t stop twitching!  Another scan revealed the metastasis in my brain.  So, back to the city, to the neurosurgeon this time, and eventually some more scans, brain surgery and radiation.

No evidence of disease now for five years.  I go for CT scans and MRIs regularly; we have to make certain that I remain in remission.  I had one scare in which it was thought I had a recurrence in my brain, but it turned out to be necrosis (scar tissue) causing seizures.  Now I live, scan to scan waiting to see if my no evidence of disease status changes.  Cancer survivors live with the knowledge that in all likelihood they will have cancer again in one form or another.  How many people do you know who have been cured of cancer?  Oh, there are lots like me who have gone many years in remission.  The threat of its return is always there, hanging over you like a boulder waiting to fall on the Roadrunner–its always just one scan away. The funny thing is, once you have cancer, you can never not have it again. As I write this I’m thinking about the battery of tests I will undergo tomorrow and wonder if this time tomorrow I’ll still be able to say I had cancer.