First Time for Everything

I wonder what would have happened to Sleeping Beauty had she slept for, oh, say 20, 30 years or so, but continued to age. I'm thinking Shrek, but with the change preempting the story instead of driving it. And what if she was not only wizened with time (like a hag, not like a man), but she also had her lady bits unceremoniously removed, leaving her sexless in all but desire. I imagine Prince Charming, also older and wiser, mounting the steps to her room to greet her and quietly gazing down at her sleeping there with laugh lines created as she dreamt each night and age spots from the sun peaking in her window during the day, and her hair sticking to her head a bit from the hot flash that steeped her in sweat at the most inopportune moment, as it always does.

Would he embrace the woman laying prone, thus saving her life, or would he cringe a bit, think better of it, and then tip toe away?

It's a weird place to inhabit to have been a bit of a princess, sometimes with more than one suitor offering a selection to choose from and the ability to make decisions about whom to sleep with and when, to suddenly wake up and be hidden from, avoided. To go from Ariel to Ursula in the blink of an eye with age, illness, and an absolute inability to give a shit about fashion.

And then poor Sleeping Beauty has to slip past the dragon on her own, not to avoid being seen as edible, but to avoid being seen as undesirable. How embarrassing!

I've never been stood up before, and it kinda sucks. It's not as bad as movies make it out to be, but it's definitely annoying.

It was my first date in almost this century, and could have possibly been my first kiss in a full decade. I ventured into online dating after a friend, recently engaged from an online encounter, explained that for every ten people you say "Hey" to online, one will likely lead to a conversation. And every ten conversations will likely lead to a date. And every ten dates will likely lead to one relationship. It's a numbers game, apparently, and it would only start, if you do the math, with 1,000 "Hey"s. It's all about persistence. I just let batchelor buttons completely overrun my back garden, so I'm not sure if persistence is my strong suit.

But he didn't show. My son thinks it's because I'm so awkward with people, but this dude didn't have a chance to see just how truly awkward I could be. AND I was far more awkward in my late 20s and early 30s, with two little ones in tow, and I had zero problems finding a date back then. My potential suitor also didn't have a clue about my leftist politics or my feminism or the extent to which environmental concerns and basic morality affect my day-to-day lifestyle. He was good to go online, the initiator of the event, spurred on by well-angled photos, until he beheld my outer casing waiting for him, all three-dimensional and poorly lit, and he silently demurred.

LUCKILY, I had brought a book to rescue me from the tedium of waiting, and I welcome a respite form the heat. I arrived thirty minutes early to get through a chapter or two, and I sat by the door to be the found rather than the finder because I am the worst at facial recognition. I was in a bar full of soccer fans watching the match on many screens, and I would have had little chance of picking him out of the crowd. All people generally look alike to me. I thought I was just not paying attention to people until my kids came to my school, and I couldn't find them in the hallways either. It's a thing. Anyway, I was one of very few females in the place, and alone, and with a book and a beer, acting like I was just there for the A/C; I'm pretty sure I stood out.

I waited two hours.

It was exactly enough time to finish Kate Manne's Down Girl: The Logic of Misogyny. I didn't bring it purposefully, and I kept it flat on the table to avoid frightening my potential suitor with the cover; it just happened to be what I was reading at the time. And it was delicious. All about that another day.

What makes it all an an annoyance rather than a tragedy is that, unlike Sleeping Beauty, I don't need to be saved. I'm not waiting to be awakened. I cast my net from time to time when everyone's busy with their partners and I can't find a canoe buddy. Sometimes I recognize that I'm missing out on the benefits of being first on someone's list of people to please. While it's been a while since I've been seized passionately, a warm embrace is always within easy reach. And the fortuitousness of reading that particular book on that particular day helped make me roll my eyes instead of feel pathetic as it reminded me of the inane social dynamics we've accepted as normal: the princess scenarios, the authority of maleness, the routine of giving to instead of sharing with. It's not about not being chosen, not being worthy, and therefore losing the race for a mate, but about not fitting that time-worn stereotype. It's not that men are lacking because they don't rise above the superficial, but that, in our society, it's amazing that any of us are ever able to see outside of the dominant perspective of what a mate should encompass.

He messaged that he had been there, and I simply wasn't to be found, but then he neglected to responded to my reply offering another time and place with my phone number to prevent another madcap mixup. Of course I apologized for not being sufficiently visible. My son (and dating coach) is pretty sure that's all bullshit. It's just so much easier for the guy to say he couldn't find me than to say the other thing. You know: you're not really up to my standards, or you're not my type, or, even, you're uglier than I thought you'd be. So, only eight more crappy dates until I get a good one, if the odds are in my favour, and if I'm up for it.

I have a lot of books to read. We'll see how enticing the prospect of A/C is this summer.

Swimming Lessons

"As for our bodies, there comes a time when no one wants to come near them." ~ Mr. Perlman speaking one of the saddest line from the lovely film Call Me by Your Name.

I took my youngest daughter to the gym with me one Saturday. She wanted to use the treadmill, but there were actual other human beings in the room, so she just used the bike. She's not confident with the treadmill yet and doesn't want to look stupid. I told her, "Don't be silly; nobody in the room will even notice how you look on it!" But, apparently, I just don't understand.

Well, she's young, right? She'll get over that feeling of being observed and judged.

Right?!

The very next day, I headed to my first swimming lesson in about forty years. I mean my lesson, not one for my kids.

On Fostering Illusions and the Qualitative Leap

What do you do when well-meaning people dear to you advise you to ignore your doctors? (And what if the doctors are wrong?)

I generally rally against non-scientifically verifiable medical claims. I'm pretty open minded and willing to try anything, but I also scrutinize any available research before I write off some new thing as the next solution to everything, like coconut oil or vitamin D. A year ago I wrote about people trying to peddle naturopathic cures to me after I was first diagnosed, but more recently I've been challenged by some scientifically-minded friends and family over some of the changes I've actually adopted in my life after all that cancer stuff.

Prevention as an Ounce of Cure

Here's an update on what I've learned about lymphedema after an ALND. It's way less scary now that I know how to manage it, but it's still a drag. It takes about an hour away from me every day. I'm just in the earliest stages, and it possible to stay here forever, but not without a bit of effort - something breast cancer surgeons should make sure patients understand. It's all about retraining the lymph flow to take a different path through the body. Lymph nodes collect and clean out toxins (infection, etc.) from segments of the body. The body's divided into 'watersheds' which all get sucked to the closest lymph nodes, but, with some missing, some areas have to be redirected. Here's what's working for me right now, and what I wished I had known straight out of the hospital - just ten things!:

Chest Tattoo with a Side of Lymphedema

As a means of healing and prettying up my mastectomy scars, I looked forward to a chest tattoo. I envisioned never wearing a bathing suit top again! After my mastectomy, I asked my surgeon about it. His only concern was that it wouldn't look good when I finally gave in and got reconstruction. But, if I'm absolutely sure I don't want recon work done, then I could get the tattoo as early as six weeks after surgery. That would have been done in December, but we were just about to go to Costa Rica, so I postponed it for after the trip. And then I found out I needed more surgery, so I postponed again. I asked the second surgeon if he had any concerns about a chest tattoo, and he said the same thing, just to wait six weeks post-op. He didn't even have concerns about me tattooing my arm if I were so inclined. He said women regularly get nipple tattoos after surgery, which are perfectly safe.

So I had an artist friend draw up this amazing sketch for me based on a pile of random ideas I threw at her:

On Regret

I've taken many questionable risks in my life. I lean toward leading a life that's lived fully over a safe and secure existence. Most I bounced back from easily from typical childhood falling from trees when I've climbed too high to dropping out of high school and somehow ending up with a Masters. Sometimes it's gone extraordinarily well for me. When an elderly woman next door to me died, I went deep into debt to buy and flip her crumbling house only to find it packed with cash. People thought I was crazy for my efforts to save my school from the chopping block until it all worked, and I'm still there. People were adamant that I can't possibly hold my head high as a teacher and unwed mother back a few decades when premarital sex was shameful, but I ignored them all with the most delightful results. And when my third pregnancy was fraught with complications, and doctors strongly advised me to terminate because of a high risk of Edwards syndrome, I, still single, took a chance and have another healthy daughter to show for it. I've been very very lucky over the years.

But then there are the times that didn't go as well. That time I was convinced I was overinsured and cancelled the insurance on a property, then it promptly went up in flames. That time I got scared of my debt load and hastily sold the slightly charred land - 24 acres with 2000' of waterfront, then soon realized there's nothing else like it out there in my price range. And that time I was convinced by a couple doctors, in opposition to others doctors, equally educated, to get an auxiliary lymph node dissection (ALND), and only afterwards found out about, and succumbed to, the risks of lymphedema.

Like most people, I imagine, I have an easy time ignoring my luck and a really hard time coping when my decisions don't pan out as well. Regret is a bugger.

So I wrote to Stoic advice columnist, Massimo Pigliucci, explaining my surgery situation in very general terms so it could be applied to and/or understood by more people, and I made it sound worse than it is to get a response to the worst case scenario. In general I asked "How were the Stoics so able to get on top of these types of thoughts so well?"

On the Year that Kicked My Ass, and That Time My Ass Kicked Back

Well, it's starting to kick back, ever so slowly.

I went on another Wild Women adventure, this time to Georgian Bay to try my hand at kayaking for a change. I was with a whole new group of women, our ages spanning three decades and from a wide variety of professions and backgrounds (and photographic skills - all the pics here are from them). It's always a treat to be on the water surrounded by the giant slabs of rock and tall trees rooted in the tiniest crevices with people concerned for the health and well being of the water, air, and land. We wash on the ground well away from the lake, compost as we go, forgo campfires, and practice no-trace camping. Meetup groups aren't always as environmentally minded. The guides on the trips are exceptional, well practiced in both tripping and diplomacy, and the food is better than anything I typically eat at home.

Wearing the exact same clothes as last time!

On the last trip, I went in order to challenge myself to solo a canoe through the portages so I could travel alone. I've been on my own for almost a decade, and I'll need at least to be able to take the lead if I hope to ever get any of my not-so-canoe-y friends on board. In order to do the things I most enjoy, all by myself became a bit of a mantra.

And then this year of surgeries happened.

Total independence is no longer my goal - can no longer be my goal. I have to work towards working with others in order to get anywhere. This trip came just when I needed it as I teetered precariously on the brink of succumbing to self-pity. My dad, who also left me this year, always saw my quest for independence as a barrier and encouraged me to "let other people shine" by asking for help and sharing the load. I tried to asked for help, and for things forgotten, and for time for a break without feeling sheepish or ashamed of my blunders and inabilities. Interdependence is a hard one for me. And, through it all, I was still pushing myself, able to feel just enough muscle strain at the end of the day.

"Purely physical fatigue, provided it is not excessive, tends if anything to be a cause of happiness; it leads to sound sleep and a good appetite, and gives zest to the pleasures that are possible on holidays." ~ Bertrand Russell

A Referral for a Referral for a Referral

I'm curious: what must have happened to provoke the powers that be to make the health care system so inanely bureaucratic that wait times for life-saving surgeries are dramatically increased because of all the referrals for referrals required? Who could it possibly benefit?

I've written before about the system. After seeing an oncologist, to get a second visit to arrange to get a referral to a surgeon requires another referral to the oncologist from a family doctor. The same is true of many specialists.

It makes sense to have the family doctor as a first step to point people in the right direction. Some people might call an oncologist direct because they have a headache and think it's a brain tumour. I get that level of primary intervention. But how many mistakenly call their oncologist for a follow-up appointment?? That just doesn't make sense.

Imagine the savings to the health care costs if, on the first visit to the oncologist, you were given your options WITH the names and numbers of various doctors to see depending on the decision you make, and then you were allowed to actually call them all by yourself! So once you decide to go with the hysterectomy before the mastectomy, then you DIRECTLY call the gynecologist!!  That would be amazing!!  But instead, it's a bizarre, circuitous route from the family doctor to the oncologist to the family doctor to the oncologist (who says this should have been done months ago) and finally to whatever surgeon you need to save your own life.

AND the support staff of the family doctor and the necessary specialist set up an appointment time without having a clue about your schedule, so sometimes you end up having to change it, which pushes it all back even further. My daughter has a weird skin thing going on, nothing life threatening, but it's a similar set-up. Months ago, the family doctor said she should see a dermatologist. Just last week we got a call out of the blue from the dermatologist with a reminder for an appointment time for this week. I don't know who slipped up and didn't call me about the appointment in the first place, but it's not the first time that's happened. These receptionists are crazy busy! This week is way too late in the term for me to take a day off, so I asked for another appointment time. Next November is the best they can do.

Here's the thing. Sure it's a problem that some doctors can't see patients for six months. It will cost a fortune to get more doctors in the system, so I see why that could take some time and political wrangling to change. But it could actually SAVE money if patients could be allowed to make some of these appointments directly instead of having a separate appointment that prompts support staff to make arrangements on their behalf that end up not working for them anyway.

I recognize that if patients can call specialists directly, the problem would become how to differentiate the patients that are allowed to call directly from the ones that still need to be assessed by the family doctor. That will be tricky. But the question is, then, would the increase in the number of patients who slip through and directly call a specialist unnecessarily cost more than is saved by the decrease in the number of doctor visits set up just to be allowed to get permission to see the specialist that's actually needed? How many people would actually call a surgeon directly because they have a headache? And how many people have two or three extra doctor visits that are solely to get permission to see the doctor they need to see?

There should never be an appointment with a family doctor that's just to get them to sign off on a referral without the patient actually needing an examination or assessment to figure out which specialist is needed. In other words, if the doctor's specific skills aren't being used, then that appointment is a waste of the taxpayers' money. When an oncologist tells me to come back with a decision so we can get started with surgery, then it's a sham to force patients to make three different appointments with three different doctors before getting to the actual surgeon.
    

Lymphedema: A Research Study Overview

I'm cancer free, but very anxious about lymphedema. It's become a bit of an obsession, so, for anyone googling it, here are all the studies that I really should have researched before consenting to the Axilliary Lymph Node Dissection (ALND) surgery that half my doctors told me I didn't need, and the other half convinced me I should have had done months ago. In all that back-and-forth discussion, nobody gave me the harsh facts about lymphedema. They were all too focused on the cancer, so much so, that I really wasn't able to give informed consent based on their cheery consolations: "We don't see that so much; I wouldn't worry about it." The risk is small, but it's about as small as having cancer in my lymph nodes to begin with (somewhere between 15-30%). And the potential effect on my life is enormous. As far as I can tell, I basically agreed to risk being permanently disabled in order to have peace of mind that my cancer won't spread. Writing about it at least will briefly keep me from insanely measuring the circumference of my arms over and over.

My surgeon has taken a very Epicurean approach. He's quite convinced that there's no rhyme or reason as to why some people get it, so I should just live my life, without a compression garment, and not worry about it unless it becomes a problem. I asked about booking a kayaking trip eight-weeks post surgery, and he gave me his blessing. However, while it's true that there are risk factors beyond my control, there are also some things I can do to prevent this condition - things that patients should be told to do to decrease the risk. I believe he's negligent in not sharing the latest research. All of these doctors were. It shouldn't be up to patients to seek out studies to determine how to proceed. That's why they get the big bucks!!

Taking Comfort in Stoicism

When thing take a turn for the worst, no philosophy helps me like re-reading the writings of Epictetus, Seneca, and Marcus Aurelius.

I had a dream last night that I was at a bike show (about bicycles, not motorcycles), talking to a distance rider, when, after a long conversation, I noticed that his one arm ended just this side of the elbow. He had a prosthetic, but nothing fancy, just something to help him grip the handlebars. And I felt so sheepish for whining about my trivial issues.

What, then, is to be done? To make the best of what is in our power, and take the rest as it naturally happens. (Epictetus Discourses B I, Ch I)

We have to figure out what's in our power to control, then stop griping or trying to fix what's not in our power to change. It is what it is. So, right now, I can't change the fact that I had this surgery and that things went wrong. That's in the past where I exercise no control. But then we have to learn to affect what we can control with courage. I can control my behaviours: how well I do my painful stretches and care for my wonky arm, and I can certainly control my attitude, but most importantly, I can control my perception of things (which will, in turn, affect my attitude and behaviours).

Before I get to controlling perceptions, be aware the tricky part isn't actually changing how we see things, but that earlier bit: knowing what's in our power to control. Does it makes sense to rally against powerful interests in order to shift energy consumption in order to save the planet? Is saving our habitat actually within our control? Likewise, in this situation, does contacting my MPP about the problems with the current health care system, which I've done, actually do a hill of beans to change anything? It's harder than it looks to have the wisdom to know the when to accept our lot and when to have the courage to fight for change. We have to take a chance and fight for what's right, yet not hang on to the outcome, not have any expectations that our actions will see results in our lifetime.

A recent interview with contemporary Stoic author, Massimo Pigliucci, sums it up well:

We should very much try to change things for the better, that’s the whole point of the Stoic discipline of action, and that discipline is connected to the virtue of justice. But we should also be rational about it, and understand that sometimes things go our way, and at other times they don’t. We have varying degrees of influence over external events, but the only things truly under our control are our judgments and actions, for which we are morally responsible.

My disposition leans towards fighting anyway, so I'm more likely to need to be reminded to accept those things so obviously outside my limits. It is what it is.... It is what it is....

To change our perception of things, we just need to be grateful for what we have and remind ourselves of those worse off than us. Regularly imagine the worst thing possible happening, and consider how you could cope with it, and then we'll be ready for anything.

No prospect of hardship comes to me new or unexpected I anticipated it all and have rehearsed it in the privacy of my mind....And so a wise person gets used to future misfortunes, and what other people make bearable by long suffering he makes bearable by prolonged thinking. (Seneca Letters from a Stoic 76)

I'm very good at preparing for the worst when it comes to big things. I had a new will drawn up last September and showed my kids where to find all the important documents, just in case. But it's the minor annoyances of life that we sometimes overlook and allow to build up until we're in a tizzy.

When stretching is painful, and I note an ounce of self-pity because I haven't prepared myself for the unexpected pain, then a quick mental image of Franco playing Ralston in 127 Hours can do the trick to help me get over myself and recognize how minuscule my troubles really are - and how much much worse they could be.

We're also advised to remind ourselves that if this were happening to an acquaintance, we wouldn't be so affected by it, so it's silly to be affected by it when it happens to us.

For example, when our neighbor's boy breaks a cup, or the like, we are presently ready to say, "These things will happen." Be assured, then, that when your own cup likewise is broken, you ought to be affected just as when another's cup was broken. Apply this in like manner to greater things. Is the child or wife of another dead? There is no one who would not say, "This is a human accident." but if anyone's own child happens to die, it is presently, "Alas I how wretched am I!" But it should be remembered how we are affected in hearing the same thing concerning others. (Epictetus The Enchiridion 26)

I know if it happened to another, I'd think, "It's unfortunate and frustrating, but it's not the end of the world, for heaven's sake!" This too shall pass. Just thinking like this, a little each day, affects our attitude towards things, makes us less upset at minor annoyances. And that in turn affects our behaviours, making us far more patient and understanding with one another.

If we can affect our perception of things, then we're well on our way to want what we have and not want what we don't, and actually be content for a moment - that is, when we can remember all this!

He who fails to obtain the object of his desire is disappointed, and he who incurs the object of his aversion wretched. If, then, you confine your aversion to those objects only which are contrary to the natural use of your faculties, which you have in your own control, you will never incur anything to which you are averse. But if you are averse to sickness, or death, or poverty, you will be wretched. Remove aversion, then, from all things that are not in our control, and transfer it to things contrary to the nature of what is in our control. (Epictetus The Enchiridion 2)

The sooner we can accept that some pain and suffering is part of life, and that death is coming for all of us, the sooner we can get on with things and enjoy each day.

And then we can use these seemingly unfortunate events to a greater purpose by using them for self-improvement, like bombarding parliament with letters of concern about the state of our ER departments, or, more to the point, by acclimatizing ourselves to greater troubles. Look how much I can tolerate!

With every accident, ask yourself what abilities you have for making a proper use of it. ....If you are in pain, you will find fortitude. If you hear unpleasant language, you will find patience. And thus habituated, the appearances of things will not hurry you away along with them.  (Epictetus The Enchiridion 10)

Aurelius predated Nietzsche's, "What doesn't kill you, makes you stronger" somewhat with this bit:

Everything which happens either happens in such wise as thou art formed by nature to bear it, or as thou art not formed by nature to bear it. If, then, it happens to thee in such way as thou art formed by nature to bear it, do not complain, but bear it as thou art formed by nature to bear it. But if it happens in such wise as thou art not formed by nature to bear it, do not complain, for it will perish after it has consumed thee. (Meditations 10)

This won't consume me. I was formed by nature to bear it!

So, that one day when my daughter changed my dressings and the blood shot out from my side a little like this:

I was a little traumatized that we had to catch it all in the sink - not just woozy, but made quite afraid to take the bandages off again. But I'm still healthy and active, living and breathing and using my arm a little more every day. And, like my dream reminded me, some people don't even have two hands to work with. I'm very much one of the lucky ones!

Then again, I lieu of reading the Stoics, it helps just to keep this song in mind: 

Another Trip to ER

Me: So, I have a letter from my doctor. I was hoping that would make things go faster. It still took two full hours to get to this point, though.

Triage Nurse: I wish family doctors would come to the hospital once in a while. They have no idea how things work here. A letter doesn't do anything to move you faster. That all depends on the volume of people and the number of doctors available.

Me: It'd be nice if there were some way to be called on, with an automated phone call or something, so we could leave and come back. Last time I waited nine hours without food or water because the volunteers told me I'd lose my turn if I left.

TN: (annoyed) Your health care is your own responsibility. If you're hungry, then you should have left. Someone would keep your place for you.

Me: They were very clear with me that I wasn't to leave or else someone would call me and, if I wasn't there to answer, then I'd be dropped from the roster.

TN: You just come to one of us. We would have held your place for you.

I gave up this line of discussion because it was futile to indicate that any attempt to walk directly to the triage nurse area would always be circumvented by a string of people. It's not possible to just poke in your head to get them to watch our for you personally. That's such a ridiculous suggestion! Or it wasn't possible for me last Friday, at any rate. Not at all.

TN: How's your pain level?

Me: It's not too bad. It's tolerable. It's a lot of pressure, like elastic bands around my arm and armpit and chest. I'm really just here because the doctor told me to get checked out if the hematoma doubled in size, and it has. So I saw my family doctor, and there's still a lot of bleeding, and she was like, "Woah! You should go straight to the ER!" I have to change my dressing leaning over the sink, it bleeds so much. So here I am.

TN: So low pain level, but your irritation level's at a ten!

And then, so uncharacteristic of me, I started crying. Once one tear escaped my hold, then it snowballed. I acted like it wasn't happening and just kept answering questions, surreptitiously wiping my eyes as if maybe I had an eyelash curing inward or something innocuous needing some tending to. Last time I was reeling in pain, and it was 90 minutes to the triage nurse, followed by five hours before I actually set eyes on a doctor, and then two and a half hours of tests and waiting for test results before I could go home. I was just hoping for a script for more Tylenol 3s to help me sleep through a night, but they only gave me Advil anyway, and then told me the name of my condition. My time there was completely fruitless. This time it took even longer to get to triage, which had me worried. And I wasn't in enough pain to want to be trapped there all night again.

TN: It shouldn't be long now. There are just a few ahead of you.

Me: Last time they said the same thing. Less than an hour, they said. And I'm not even sure I need to be here. I think I should just go.

TN: But it's better to wait. Then you'll know for sure if everything's alright.

I sat in the other waiting area, the one further from triage and closer to the droning of the TV. There are captions running along the bottom of the screen; do we really need the volume cranked as well? Only one baby crying today. Last time there was a few. The man next to me came in at the same time with a severed finger - like, completely severed. He didn't get in any quicker. They didn't even offer him ice. I felt like I was wasting everyone's time and taking up a spot that someone else should have. And then they called me to a bed to wait.

Instead of sitting alone on a bed for hours, it was just minutes. I can't help wondering if my sudden emotional outburst had any effect.

Doc: I'm going to check the hematoma, and... just wait! Wait!

He motioned with his hand for me to stop unbuttoning my shirt and called for a nurse.

Doc: (his back to me, leaning just his head out of the curtained doorway) I just need you for a minute. No, he can wait. Just come here right now for a minute!

I felt bad dragging someone away from another patient, and it also made me nervous that I was suddenly such a high priority.

Nurse: Do I need gloves?

Doc: No, I just need a chaperone.

Me: What the f...  Are you serious?! I don't even have any boobs anymore!! What do they think's going to happen behind a curtain? Do you really have to take up the time of another person for this?

Doc: it's just in case.

In case of what?! It was weirdly flattering, though. Like I still vaguely resembled a woman. Or maybe I just looked voracious, and he was concerned for the harassment to go the other way. I mean, it's been a while. He checked out the bulges of blood clots collecting under my skin, the skin so taut it looked about to burst. Of course he was concerned about something happening between us.

Doc: You're scheduled to see your surgeon tomorrow. You could wait to see the surgeon here, but it's probably best to get advice from the surgeon who operated on you.

Me: My doctor told me I should be seen today.

Doc: It's up to you, ultimately, but it could be some time to see the surgeon here, and I think you'll be fine for the night.

And I left. Just one more sleep before I can see the surgeon about this bloody mess! But isn't it curious how all these decisions, to wait in triage, to see the surgeon tonight, they're all so adamantly MY decisions to make. It's been the case from the first moment it was suggested I might get surgery. It takes all the responsibility off the health care staff, but it often leaves the patient at odds as to what's best. I was pleased at least that this doctor made it clear which way he'd go, even though it's still completely up to me (aka not his fault if I happened to get worse overnight). But it's really too bad my family doctor couldn't have make that call.

More Doctors and Nurses, Less Waiting

I went to the CCAC yesterday after my surgery on Tuesday - the Community Care Access Centre - an agency I only heard about when they had a local whistleblowing scandal a couple years ago questioning the decision to reduce case managers instead of front line therapists, and then more recently, when they spent money to send employees to a conference, which turned out to be largely funded by donors. It's a very necessary agency that cares for people after surgery among many other things, and it's a concern if funding is mismanaged.

It's also a concern if funding is reduced.

It's a complicated system to an outsider. After my surgery, I felt fine and declined homecare, but changed my mind once the drugs wore off, and it took many phone calls to relay that decision because homecare is under a different umbrella than the regular CCAC on-site work staff. This article says the system in Ontario is, "plagued by inconsistent standards of care, byzantine processes and a troubling lack of transparency for both patients and family caregivers." And apparently they're all going to be shut down soon anyway to be replaced by LHINs: Local Health Integration Networks.

Whatever they're called or do, I haven't really followed it all, but they are ABSOLUTELY NECESSARY.

Or something is necessary.  I don't really care how they operate so long as they exist - so long as something's in place when you leave the hospital. It would be kinda nice if it was your own surgeon who could answer questions, but their costs are too high and their time too valuable. Or something like that.

I got my drainage tubes out this morning. When we got there, the cab driver questioned my intentions: "Carpenters?! Is this a union office? Are you part of a union??" No, silly, Care Partners. Well, yes, actually, but that's a longer story, and what's it to you, bub!?

Anyway.

The CCAC nurse warned me that I might faint because the drain was "right up in there." I didn't, but it was significantly worse than with my mastectomy. The armpit has a bevy of nerve endings. My surgeon was right: boobs are just blobs of fat - easy peasy. Lymph nodes are much more integrated and involved in things. The nurse had concerns. I was reporting more pain that I should have at this stage, but maybe I'm just sensitive. But the blood in the drain was more thick and dark than is typical, so she expected a clot, but couldn't find one, and I had way too much bruising way too far from the site, and it shouldn't be swollen right down to my wrist! She removed the tube anyway (thank God), but told me to see my doctor immediately.

Before I left, I asked her about aftercare. Shouldn't I be doing exercises of some sort? I had a booklet to take home after my mastectomy. She thought the surgeon should have given me something, but the day surgery staff was pretty sure CCAC should have something for me. There are too many cooks stirring this soup!! Thank god for Google (and here too). We're on our own, here, kids.

I called my surgeon, but he, as with most of the doctors I try to see, lives behind a protective wall of receptionists or assistants or a "care team" of some sort. They told me I don't see him for that kind of thing, and that I couldn't see him anyway because he's not in on Fridays. It's my family doctor from here on in. So I called her, but she also doesn't see patients on Fridays. Okey dokey. I know her well enough to know that she wouldn't know what to do with my engorged black and blue arm anyway. So, her receptionist suggested emerg was my best option. Middle of the afternoon, how bad could it be, right??

I went to work in the afternoon because I'm out of fully paid sick days from my surgery in the fall - yes, I've got a strong union, but the public perception of being allowed to carry over sick days was deadly to that clause of our contract. God forbid we piss off the public. That fear also ensures every PD day is spent in useless meetings rather than being allowed time to prep classes and mark work in a timely fashion. That part of our job is to be done on weekends and evenings. But I digress.

Okay, one more thing. When I had surgery last semester, I went part time for a week. I had all my classes in the morning and my prep in the afternoon. So I taught A, B, C, 3/3 of my courses, then went home to fall into a mild coma. That counted as half time because I was only in the building for half the day. This time, new semester, I have two classes in the morning, and one in the afternoon. I decided I'd come for the afternoons and teach that one class and stay for my prep. But that doesn't count as a half day. This time it counts as 1/3 day because I'm only teaching one out of three classes. Hmmm.  Doesn't that seem a little fishy to count by day portion or number of class, whichever is less? . . .  Whatevs.

So I went to the hospital right after my class instead of staying for my prep period, because I'm going to do all my marking at home anyway. I half expect to be docked 1/6th pay for publicly acknowledging leaving early - that's fair, teach one of three classes for 1/6 of your pay. And I'll be spending my weekend prepping for the supply teacher and marking even though I'm on sick leave because supply teachers aren't mandated to mark or prep anything. IF I PUNCHED A CLOCK.... Blarg!!

So I got to the hospital at 1:40. It was packed. I finally met with the triage nurse at 3:00. He said I should be seen within an hour because the section I needed to go to was moving pretty quickly. I asked about my meds, which I was scheduled to take at 3:30. A different nurse insisted that the hospital needed to dispense all that rather than my kids coming to deliver them. After an hour of figuring that out, and being given only an Advil because they can't actually dispense Tylenol 3s or any of the other nerve repair drugs and aromatase inhibitors I'm on despite insisting they must be the only dispensing physicians while I'm in their care, I called my daughter to bring me my plethora of pills.

At 6:00, I won the lottery and got called on to move TO A BED, which was very exciting. I thought it meant I'd be seeing a doctor!! But hold yer horses. All in good time. I hadn't had anything to eat or drink since 11 in the morning  - I was terrified to leave the waiting room in case I missed my turn, and the water from the sinks in the hospital tasted horrible. I work right next door and drink the tap water there all the time. I'm not sure what makes the difference, but I tried to force down a few sips out of the tap while I waited. At 7:30 the doctor came to check me out. He said I have a hematoma, blood collecting under the skin, which was causing the extra special pain this time round. This called for an ultrasound to check for clots in the veins which could cause all sorts of problems. His turn was over for now, and he left.

At 8:40, I saw the ultrasound technician in a dark and creepy part of the hospital. We were the only ones there. After tracing all my veins with her gooey magic wand, she told me someone would come to take me back up, and I was left all alone in a hospital gown, open at the back, and my jeans. A thin coating of goo remained down my left side despite attempts at cleaning it all off. It's tenacious stuff. While I waited, I tried to wipe a bit more with a kleenex, and it was quickly saturated with thick, dark red globs. The sticky dampness I felt was pretty much all blood. My escort arrived and told me a nurse would redress that wound. Back in my curtained room, I scrubbed the blood from my jeans with the paper towel eroding as I rubbed, leaving traces behind in a bigger mess.

A nurse came and cleaned me up. She tried valiantly to find a pamphlet of exercises for me, but had no luck. The day surgery staff was long gone. She told me to call my surgeon on Monday, even though that first week after surgery is most important for aftercare, and I already know the surgeon doesn't take my calls. But don't worry - Google's got my back.

While I waited for the results of the ultrasound, I read every word of every poster in the room. One in particular warned people that they might get a call asking them about their experiences. They want to know what would make the emerge experience better. I'll tell you. It's one thing. There is one answer to that question: We need more doctors and nurses available. Just MORE. That's it. It's not complicated and doesn't require a survey. We need more money to pay for more staff so we have shorter wait times. No matter how it's organized and where little bits of money are misspent or where there's an overlap of services or cracks between them, those are all important issues and all, but nothing will get better until we have more staff to be able to take on more patients. But not just in emerge. We need more staff everywhere. It took me months to get in to each surgeon to find out I should have had surgery months ago. Take money from education if you need to. Cut my salary in half if that's the only place we can find a buck. I mean God forbid we raise the marginal tax rate or anything. I don't even care right now. I just want the Ontario health care system to be swimming in cash, at least enough for some quality water fountains so we're not so monopolized by Timmys to quench our thirst. This level of care is ridiculous. I feel like I live in the states!

Anyway, at 9:50, the doctor came back with the results. No clots in the veins! Hurray! I just have that hematoma that needs regular surveillance. Come back if it doubles in size or the swelling gets significantly worse (what does significantly look like??), or if it gets hot or I get a fever. All that jazz.

My incredible, beautiful, precious children had dinner ready for me when I walked in the door, eleven hours after leaving for a half day at work - ahem, a one third day at work. It's questionable for me to be back at work at all. I was advised to take two weeks off; I should be spending my days resting. I decided I could manage one class that's presenting seminars to me. But I should have been resting those other nine hours today instead of sitting upright in a hard chair lacking arm supports, in a crowded, noisy room full of contagious germs, with no access to food or water or necessary meds, and no accurate timeline of events - not even a reasonable guess - on offer.

My kids took pics of the hematoma so we could document any changes. You don't want to see that. [ETA - it's here, for the morbidly curious.]

Okay, it's amazing that I had access to an ultrasound tech immediately (relatively immediately). And of course there were a few patients screaming and growling in the triage area and an old guy too drunk to understand why his police escort wouldn't let him have a cigarette. We need more money in mental health services and addiction treatment. Absolutely. And whenever I felt impatient, I watched the number of people there with little ones. Sitting for hours in pain is nothing compared to sitting for hours with a child in pain. They should always get bumped to to the front of the line.

No. Scratch that. There shouldn't BE a flippin' line!

Another Surgery Down

I feel like a pro at getting surgery now. That's probably not a good thing. It occurred to me it's kind of like travelling. The first time in an airport is a bit terrifying. It's confusing and chaotic and nothing seems to make sense. Then after a few times, you learn the drill and get used to the types of weird requests made: when to take off your shoes, how to make the bag check tag machines work, and whether or not you can make it to the bathroom once they announce "now boarding."

Getting surgery means explaining who you are and what's about to happen to you over and over to each new person. I assume there have been some serious mishaps in the past to necessitate that level of triple and quadruple-checking. It's really scary walking in there the first time, but it's so much easier once you know the kinds of things that are likely to happen: what the O.R. looks like, how many people will be milling about in there, how it feels to be put under, what it looks like when you wake up in recovery, and then again on the ward with family around.

This time it was an axillary node dissection to see if the cancer's spread to my lymph nodes. Weirdly, my kids and I were re-watching a bit of Archer the night before, and we landed on the one where Archer gets cancer. It was an uncomfortable coincidence. I didn't register the event in the series, just the jokes, so it took me by surprise.  It's not funny when it's so close to home.

I had zero nausea after surgery, which was awesome, and I felt great while I was in the hospital. But then the heavy drugs wore off, and it was a rough night. The pain was out of this world. Yes, it was worse than labour. I took the maximum pain killers allowed, but they seemed to do nothing. It was as if my whole armpit and shoulder area was filled with molten lead, hard and fiery. I imagine it's pretty much how Wolverine felt. I moaned and rocked pathetically for hours instead of roaring like this:



Then, suddenly, it got better. Today, just 36 hours later, I feel great again. Well... human at least. I still have to get my kids to open my many pill bottles. I won't be able to expect much of my left arm for a while. Luckily, after years of toting a rotation of toddlers on my left hip, I learned to do everything one-handed. But why all meds come in child-proof containers is beyond me.

The doctors and nurses were all lovely, but many of them seem to come from a different era. Or something. Before the surgery, I was sitting with my two oldest kids in the waiting area when the nurse called me in. She told me only one of my kids could come in. I exclaimed, "Oh no! It's just like Sophie's Choice!" and people in the waiting room laughed. My daughter stepped up because my son had sat with me for the last one. But then the nurse gave my kids a little lecture about taking care of me. She thought they were hoping to stay behind, but they both wanted to come with. We've gotten that throughout: people surprised or confused at my kids taking care of me so well. After a few minutes in an empty ward, my daughter texted my son to sneak in. We're rebels like that.

Then after the surgery, the nurses told my daughter I wouldn't be able to do any housework so she'd have to do all the vacuuming. We don't even own a vacuum. But, once again with the lectures. And why all directed at my daughter? I hate to think it's a necessary part of their job because most families don't help each other without being told. And it also sucks that it appears so female oriented. It's still seen as women's work to do all the caretaking and cleaning. That's dumb.

I might be able to get my drainage tube out tomorrow, which is more exciting that you can know! It's disturbing having a bulb of soupy blood clipped to the bottom of your shirt while you're out and about, trying to be a normal person.

And then we just wait and see.

On Becoming a Woman - Mid-Life Edition

When I was around ten to fourteen, we were all inundated with information about our bodies - all the ins and outs of the magical, wondrous things that were just around the corner for us. It happened at school, but it was also the purview of some of the After School Specials that everyone watched, intrigued, then later mocked. We only had twelve TV channels to choose from, and most of them were soaps at that time of day, so they had a captive audience. And then there were dogeared copies of Judy Blume books to help us get our heads around it all. We were well-prepped.

Now that it's far more socially acceptable to be alive in a female body, some moms have parties when their little girls become women. I can't help wondering if it's all just to spin something kind of annoying into something beautifully natural so people don't start complaining or get weirded out by it all. Nature can be pretty nasty sometimes. I didn't throw any parties because my girls just wanted to go on with their day and not think about it too much.

But at mid-life, there nothing to warn us of our changing bodies, of the miraculous transformations unfolding day by day on our special journey towards becoming... what? 

Crazy-Making Cancer Treatment

I believe my doctors mean well, I really do, but their behaviour is not dissimilar from the crazy-making type of abuse wherein the abuser keeps telling a different story until the victim starts to question their own memory and doesn't know what to believe any more. I'm really glad I write everything down (and tape record it too - but secret-like because that makes them antsy).

I saw a medical oncologist last December. She was last in a long lineup of doctors who had varying opinions about my medical condition. A panel of doctors thought I should get lymph node surgery just in case cancer spread in there, but she wasn't as convinced. She leaned towards an estrogen inhibitor instead. Just one pill a day to prevent a relapse. She left me with a package of information about the drug, Letrozole, and I wandered off to contemplate my options.

Then I came across this article, which doesn't help maintain my faith in the system:

"It is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades."

On the advice of a commenter here (and former colleague), I called CAREpath to help with all the differing opinions. They collected all the medical files generated and assessed them to come up with a comprehensive pros/cons list. Literally. They weighted heavily on the anti-surgery side, with a "risk of cure" rate of 97% without any intervention. In their opinion (a different panel of doctors and nurses that's in Toronto), surgery would only have a marginal effect and wasn't worth the general surgical risks, but the hormone inhibitors might be a good idea.

On Cancer Doulas

When last we left our heroine, she had just had an invasive tumour removed, but found out there could be traces of cancer left behind. She was left to choose between surgery, radiation, tamoxifen, or nothing. Let's see what she does next...

I had never heard of Healthcare Navigators before, and it seems they don't exist as much in Canada as they do in the more expensive and privatized healthcare to the south (except for Indigenous needs), but they're becoming more of a thing here. In Ontario, some hospitals have them, and we're apparently leading the way to integrating a navigator even before an official diagnosis, but I didn't encounter any and don't know how to find one. Believe me, I've looked. If you're pregnant, you can get a doula to help you through all the issues that come up when you're at your most vulnerable and being bombarded with contradictory information. Cancer is very similar. It's just way too confusing to navigate alone. I'd like one that comes around to appointments with me, not one that stays in the hospital. Without a partner, I've had to rely on my barely-adult children to come to my appointments and try to make sense of everything. They have exams to study for and essays to write. This isn't a burden I wanted them to take on, and there's so much I would have liked to have known.

It would have been great if someone mentioned shaving my pits ahead of time. It's not something I ever do, and they put surgical tape right up in your pits, then send you home with arm exercises. I couldn't raise my arms without ripping out the hairs, and I had to get my poor children in there with tiny scissors freeing me from my own physical constraints. It also would have been great to have someone suggest I DON'T do both surgeries at once. Yes, it's fewer times under anesthetic, but it's a longer time, which can be worse. And the after care for one (plenty of walking after the oophorectomy) was contraindicated for the other (bed rest after the mastectomy). Now I know, but it's useless information to me at this point.

And the Saga Continues

Ok, so, after getting a preventative bi-lateral mastectomy, performed shortly after both a mammogram and MRI both showed zero cancer, of course they found cancer in the breast tissue sent to the lab. The good news is it's all out, but...

They found two non-invasive tumours about a centimetre each. The surgeon isn't worried about that at all, but I'm baffled that they went completely undetected by either the mammogram or the MRI. That's pretty disconcerting. Both procedures are horrible to go through, and apparently mammograms have a false negative rate of 20% and MRIs aren't much better! Back when I had them done, the geneticist told me the idea is to do both, and then they cancel out the false negatives, but it looks like there are still some exceptions!

But the lab also found one micro-invasive tumour that is more of a concern because it's invasive, but it's not too much of a concern because it's micro. They could only see it under a microscope. It's officially stage zero cancer.

Back to Work Boobless

I'm really glad I decided to go back to work part time for a week. I highly recommend that path for anyone getting this surgery. I thought I'd be completely fine the first day, but I underestimated my level of exhaustion. Being home by noon was a godsend. Some people online recommend SIX weeks off. Two full weeks off felt right, but three might have been better. This was a good compromise.

It didn't help that Sunday night my cats either found or brought a mouse into my bed at around 2 a.m. I woke to them pouncing in unison right next to me with my chest a barely closed wound inches from all those razor sharp claws. Yikes! I kicked them off the bed then heard the squeaky chirp of some kind of small animal. A mouse, a bat, or maybe a bird? I wasn't up to an investigation, so I took my clock to the living room couch for the rest of the night. 

When my alarm rang, I turned it off and promptly fell into a deep sleep until my daughter got me up about the time I should have been walking out the door. I have never fallen back to sleep after my alarm's gone off. I made it on time, but ill-prepared for the first day back, and with my classroom keys forsaken on the kitchen table.  

I'm not in too much pain, although it's there, pretty steadily. The cold really gets to me, and I'm sitting with a scarf doubled around my chest. The biggest issue is that I feel like I've run a marathon by ten in the morning. I just need to close my eyes a little. 

I dove right in to my regular clingy clothes without prosthetics, and nobody noticed. I guess my boobs weren't as spectacular as I imagined! I feel like someone with hair down to her waist pulling a Sinead O'Connor. It's horrible when people are upset with you, "How could you do that? You had such beautiful hair!" You never really know how much people love your hair until you cut it all off. But it's also a little weird when nobody says anything as if that's how you've always looked.

But clearly this is a little different. It's uncomfortable for people to notice a change like this. It means that they noticed that I actually had breasts at one time, and that's right up there with admitting we noticed someone's skin colour. Of course we notice, but our fear of appearing sexist or racist makes it's tricky to admit that we're able to see body shape and skin tone. 

I feel a little more bottom heavy, and my little belly is more front and centre. I might never exhale again. I feel slightly out of balance and square-shaped rather than hourglass. It's not quite like I'm ten-years-old again because I didn't have hips back then, but it's not too bad. 

ETA: It was a huge mouse (or maybe a baby rat). I finally found the carcass four days later!

A Genius Kvetching Ring

An article, three years old, was in my facebook feed today. But it was insanely timely. It's a little lifestyle piece about how to talk to people who are sick or experiencing trauma. It's just plain common sense, but it needs to be circulated regardless!  The idea was illustrated thusly:

Beautifully illustrated by Wes Bausmith

If someone in your life is sick or traumatized in some way, then their name goes in the middle. Then closest people next, and somewhat close, etc. further and further out. Wherever you are in the circle, you're welcome to bitch and complain and lecture and ask possibly offensive questions or talk about how it's affecting your life only to people who are towards the outside of the circle (from you, out). So, if you're in the middle, you get to basically say anything! If you're on the outer circle, then keep your trap shut.

The only things that should be shared to people closer to the centre (from you, in), are words of encouragement or offers of help. What do you need me to do? How can I help? Here's a list of things I'm more than happy to do...  That kinda thing. If you're thinking of sharing your troubles or the secrets of your success inwardly, then bite your tongue.

Most people have been exceptional to me during my recovery. Most people. And I've been guilty of kvetching in myself, mainly when my mother was dying of cancer, and I was on my own with an infant and a 2-year-old, and my mom was the only person in the world I could talk to about all my troubles. Luckily she was so drugged up on morphine, she didn't really notice my self-centred ranting. But, I'm sometimes an insensitive clod, so it's definitely something I'll be checking in with myself in future!

On Missing the Girls

"Ring the bells that still can ring. Forget your perfect offering. There's a crack in everything. That's how the light gets in."
- Leonard Cohen  (Everyone's using that bit today, but they always skip the first part of the verse.)

As I started down the road towards mastectomy-ville, I wondered how weird it would feel suddenly not having breasts. I mean they been sitting there, right under my face, for decades. How would I cope with such a drastic change? It doesn't count as an amputation, but still... it's something. I mean, many MTF Trans don't feel complete without top surgery, yet here I go still being female. I've actually always wondered if it's insulting to women with minimal breasts when people insist they can't feel female without getting implants. And it's covered if it's sexual reassignment surgery, but not if you're born female but have a pretty flat chest. Curious. Anyway...

I do miss them at times. When I lie on my side at night, they're not cushioning the space between my arms. When I'm standing and I move to cross my arms, the down-scoop-up motion that nestles them atop my folded arms is now for nought. When I'm in the shower, I look straight down at my belly. When I run up a flight of stairs, I still reach up to hold them in place. When I'm waking around, if I catch myself in a reflective surface I notice the change: I seem longer in the torso without them. But the rest of the time, when I'm just milling about doing my thing, I mainly don't think about them at all. Once in a while, when I see a celeb in a beautiful outfit that accentuates their breasts, I have a tiny pang of grief, but I can still get that look as desired with external prosthetics. Except, once I'm released from this pressure camisole in another week, I expect to be excited to never again wear a bra!

At this point, two weeks post-surgery, there's just a tightness in my chest and a weird tingling sensation like a band of dull needles pressed against me whenever I get a chill (which I seem to get a lot there), or when I think about it all (because I'm still pretty grossed out by the thought of it), or maybe just randomly. From time to time I get a sudden little stabby purple-nurple feeling that usually subsides quickly. When I roll on my side at night, it's a bizarre sensation like it all shifts just under the surface. It's not really painful, but it's intense enough that I wake up every time.

I don't look that strange. I've already started to get used to it, however I've been lounging around the house in loose-fitting tops. That might be my go-to outfit for school for the first while as well. At work, I never dress to look attractive - that's subtly discouraged for teachers. I've had students ask me what to do if a teacher is wearing revealing clothes that the class finds uncomfortable: "When she bends over, we can see right down her top!" They say that in a revolted way. Teenagers typically don't want to see middle-aged booty. I'm in awe of older women who wear anything that acknowledges them as sexual beings; it's so far removed from my own experiences as a school marm. But I do try to avoid being a distraction in other ways. I don't want to gross anyone out.

I push the boundaries of taste already by having hairy legs and pits, and I wear sundresses that showcase both. I also have eczema-type areas of bumpy scaly skin that most people are good about largely ignoring. But some students are brutally honest - well, sometimes they're cruel really - and I feel like I might need to be at the ready with a comeback that's just subtle enough that I'm able to deny any intended sarcasm and insist I was giving straight-up advice. God forbid we ever take students down a notch and inadvertently hurt their self-esteem in our quest for developing a moral centre in them.

But there could also be some kind souls in the room who find it all a little unsavoury. I'm reminded of the beginning of Pay It Forward, when Kevin Spacey's character first turns around to greet his new class and his face is a mass of scars. The class is taken aback, but he soldiers on. Generally we expect that people just have to cope with our disfigurements, but I wonder if sometimes there's a call for a bit of a compassionate attitude to help people ease into radical changes.

When I was a kid, I was sometimes embarrassed by my mom because she'd do groceries in a pink pantsuit with a yellow raincoat. She didn't care what she looked like. Well, I'm not even acknowledging the idea that she might have thought she looked good!  And, as a world-weary teen, I once wished to be dead rather than care so little about how I present myself in public. Many teenagers are very concerned for people who aren't optimally attractive, sometimes to the point of anger that the broken won't better hide their imperfections.

But now I'm at the age of not giving a shit, and it's a significantly better place to be. It's not to say I've given up or grown apathetic, but that I've grown less self-absorbed. Or, at least, I'm less absorbed with how I look and more interested in what I can do.

But I still don't want to freak anyone out!

In more revealing clothes, I worry a bit about disturbing people on the beach or around town if I'm in a form-fitting tank top or bold enough to go topless. The surgery didn't leave me completely smooth. There's weird shit going on: bumps and ripples and blobs, not to mention the horizontal scar dividing the terrain in half. A buddy keeps saying it'll look better when the muscles fills in, which is baffling to me. What muscles will fill in?? If I don't suddenly start to work out (which I won't), then I don't expect to find more muscles there any time soon. I'll have to work with my tattoo artist around the new peaks and valleys of the canvas.

But then I think that maybe we're all freaks in one way or another, it's just that some people hide it better than others. That could be a rationalization on my part, but it seems to me that it's more than just for aesthetic reasons that it bothers us to see people who are a bit off. Perhaps it bothers us because it reminds us of our own broken or twisted parts that we've made such an effort to sequester and smooth over. Someone refusing to hide their flaws is like a wounded gazelle on the Serengeti. We avoid the walking wounded to keep the pack animals from noticing us too, noticing a little lump or limp or lisp that could give us away as ripe for chewing on. It takes a measure of bravery to be a bit off in this sometimes scared and mean little place. But it also takes some courage to stand with the marginalized, and that deserves acknowledgment. It might be expected of us all, but, unfortunately, it's rare enough to be praiseworthy.

Caitlin Rosberg