Cancer, kids and the science of living longer and healthier

In 1938 Harvard initiated an audacious research project to discover the predictors of human health and longevity. The study started with 268 Harvard sophomores, 19 of which are still alive today. This project analyzed these men extensively, from what they ate, to how much they slept, to their political affiliations, to their marital history and marital happiness. The quantitative and qualitative data collected is extensive, and includes frequent MRIs, biological samples, friend and family interviews, self-questionnaires, neuropsychological testing, labs, detailed reviews of medical records, and more.  The study has expanded over time to include a control group of 456 underprivileged men from inner-city Boston, and over 1,300 children and spouses from the original cohort. Some of the men in the study went on to become presidents, JFK was in the study, and some became drug addicts or committed suicide.  I would have predicted the outcomes in health and longevity were associated with genetics, socioeconomic status, family history, privilege, race, gender, weight, smoking status, alcohol intake.  Some of these things may be somewhat true.  However, there is one compelling variable that trumps all others when it comes to predicting how long we live and how healthy we are during our lifetime: the quality of our relationships.  This finding is stunning.  People that lived in community with others, had happy marriages, engaged positively with friends and family- these people were and are far more likely to live longer and healthier.

Going forward after a cancer diagnosis, I have been stewing on this amazing research.  This study gifted me with a new perspective on how I think about my health and the health of my children.  After cancer happened to me, a tribe of friends and family supported me that I never knew I needed so badly.  My children were lovingly cared for because my father flew across the country..  Friends brought us meals for 3 weeks and asked to care for my children.  I had a remarkable friend who stepped up to quarterback the situation for me.  I never had to ask, she just did it. Amazing. She texted me every day to ask what I needed, and handled anything I didn’t want to. (A side note- I highly recommend recruiting a friend to quarterback this type of thing if you ever go through something like this.)  One friend organized a professional family photo shoot for us 2 days before my surgery. Another friend brought me 3 weeks of groceries the day before my surgery.  I am eternally grateful to these agents of grace, and their love illuminates the Harvard study results.  What if we had no tribe?  What if I was a single mother with no support? How would my children have been cared for? How would I have made decisions in the storm? How would I have healed? Many people face illness totally alone, all-the-time.

Like most people, I have historically loved friends and family for who they are, things I learn from them, personal qualities I admire about them and how they make me a better person.  But I am a product of a mom from urban New Jersey and a Dad from inner city Boston.  I exude generational New England sensibility and stoicism. Social initiation makes me uncomfortable. I like to think I could make it alone if I had to. But, per the data, that is just wrong.  I need other people and my children need me to need other people.  I try to buy organic food, avoid processed products and limit refined sugars for my kids. I teach and model being physically active for Aden and Connor.  These things are important. But amazingly, they are not as important for health and longevity as living in relational community and working on a happy marriage.  This is true for me today, but it also has generational implications for my children’s longevity and health for decades to come. I am looking for a church, this is hard being a socially progressive Christian in the relative south with an agnostic husband, but I am trying to get over my lame excuses and petty judgements.  I am working on being more outgoing, reaching out more, instigating more, being a visionary of potential friendship.  I have always loved my friends and family, but they are even more precious than I previously recognized.  More than anything else I could do now to achieve good health- how I value my tribe, expand our community and love my husband has the most significant impact on my own health and longevity.  And more importantly, on the health and longevity of my children.  Science reveals John Lennon was right on what humans require.

Breast cancer with little kiddos- Part 5: My story is good, bad and ugly

My dad has been very supportive and came to help with the kids after surgery, which was critical.  Recently, he has complimented me for the great decisions I made in advocating for my health. He understands my situation better than anyone else, he was also there through my mom’s disease and passing.  He knows this like I know it, from the traumatic N of one.  The thing is though, compliments and praise about my medical decision making instantly make the underbelly of my skin want to peel away and run from my innards.  I know that is such a lie. I want this to be a post about advocating for yourself as a young woman, because that is how you advocate for your young family.  I want there to be a hero, me, who saved the day for her small children.  But sadly, I just can’t get myself to bite into that story; it tastes so sourly disingenuous.  In contrast, this story reflects the nebulous role of fate and the hard reality of health disparities in America. 

I am a physician, so I am trying to understand the data behind what I am dealing with.  I feel like an atheist astrophysicist who is smacked by the creative hand of God when science illuminates the infinite abyss, and the impossible unlikelihood of the whole thing. The risk of a 36-year-old getting breast cancer is 0.2%. But that is the tip of the iceberg. Women diagnosed with breast cancer under age 40 are diagnosed at later stages of disease because we don’t get screened and nobody thinks we have cancer, so there is a delay in diagnosis. Also, women with breast feeding changes have impossible lumpy breast exams. Tumors in recently pregnant women tend to be large, these women are usually diagnosed by symptoms of advanced disease. My son is 1 years old, I stopped breast feeding less than a year ago. The data suggests that for breast cancer patients at my age, there is only a 3% chance of being diagnosed as early stage as I was.  The math on that is pretty astounding: 3% x 0.2% = 0.006% chance of this happening to me. You have a 0.008% chance of getting stuck by lightening, which is notably more likely than the situation I find myself.  Basically, I won the super shit lottery and also won the most valuable Powerball of all time- at the same time!  WTF!

This is how I got here: My mother was diagnosed with stage III breast cancer at age 50, which is the earliest age at which you are put into the “low risk” category for genetic breast cancer. Her physician recommended against genetic testing; she did not get it. She passed away 2 years later.   4 years after that, I had nipple bleeding while breast-feeding my oldest son Aden.  Anyone who has nursed knows nipple bleeding is super common and nothing to write home about.  I very halfheartedly mentioned the nipple bleeding to my Gyn/Ob doctor at some point. The doctor was less halfhearted. She got a mammogram that resulted in a biopsy which showed a very common benign tumor with zero risk of cancer. Done. But somehow, I had gotten an appointment scheduled with the breast surgeon that was never cancelled, so I went.  I didn’t need to see her, was all she said, but she serendipitously referred me to the high-risk clinic at UVA. I am not sure exactly why this happened. Was it the intuition and diligence of UVA physicians? The fact that I am a physician? Mistake?  Either way, the physician in the high-risk clinic, after I had negative genetic testing, offered me early aggressive screening. Reading the guidelines for screening now, I realize this was a very aggressive clinical decision. There are multiple validated and expert consensus guidelines that all would have suggested I didn’t need screening, and just one that recommended offering it.  Many good clinicians would have recommended against screening until I was 10 years younger than my mother’s age of diagnosis, or age 40. Given the aggressive characteristics of my breast cancer, I strongly suspect I would have presented with late stage metastatic disease if I had started screening 4 years later at age 40.  The physician at the high-risk clinic literally saved my life because she recommended more aggressive screening than most of her great colleagues would have.  I am a physician, and I didn’t understand this at the time.  I was just a leaf blowing in the wind.  Getting early screening was an unlikely miracle.  This required the perfect collision in time and space of a benign tumor, nipple bleeding while breastfeeding, my mother’s sacrifice and an aggressive doctor in a high-risk screening program that exists only at large academic medical centers, of which I happen to work at and live only 15 minutes away from.  Like I said, I feel like an astrophysicist examining the chances of cosmic existence.

The rest of the story is somewhat morose in implication.  It illustrates the soul-crushing reality of the health disparities equation, of which I get to occupy the very top. I am overwhelmingly grateful, but this is also laced with the nausea of knowing your undeserved and unfair privileges. After my screening MRI showed cancer, I had my biopsy done and pathology read by a specialized team of breast cancer experts at a large academic center, again, which is 15 minutes from my house and where I also happen to work. As a physician, I easily understood everything about my diagnosis and treatment options. I seamlessly made treatment decisions and got to pick my surgical and oncology teams.  My surgery was done in a timely manner, and I have been able to easily and responsibly manage my pain and minor post-operative healing issues. I speak the language of a physician. I am White. I am not poor. I am disgustingly educated.  I have a supportive community of family and friends who represent similarly privileged demographics, they can financially afford to take time from work and family to help me.   I have every unfair advantage, and the data says it makes a difference.

Research shows that there are two main groups that are at much higher risk of breast cancer recurrence. Women under age 35 and African American women.  Younger women have more aggressive tumors and are diagnosed at later stages, this doesn’t explain everything- but this does leave an impression of common sense.  But for African American women, the prevailing theory is that health disparities, unconscious bias and access to care might mostly explain the increased risk.  There are similar disparities driven by socio economic status and education. Living in a rural community versus near a specialized medical center is also a notable inequity.  Care is not equal in America. I know I should not expect complete equipoise, but it still seems we can do better. The questions of how, even for just more equitable access to high risk early screening for young women, are swirling in my brain.

While I got cancer when it seemed impossible, I also had an improbable diagnosis made and timely, world-class treatment.  I can tell you a story about advocating for myself and my children, but it would be a cheap exercise in cognitive dissidence.  The uncapturable grace and mercy of God, or fate if you see it that way, combusting with the privileged side of the health disparities equation brought me here today.  As you can probably tell, I am still trying to jerk my head out of the washing machine of what just happened to me. This is a lot to process.  I am still melting with unspeakable gratitude and disbelief, it’s hard to stand up straight and know that I know something.  Tonight, I am going to sit outside on a lawn chair and watch my children play together innocently in the sprinkler while the sun sets behind the blue ridge mountains. This makes sense. This is where heaven meets earth.   


How to do breast cancer with little kiddos, Part 4: The toughest family planning questions

Recently I heard a podcast featuring a well-known profession runner named Lauren Fleishman.  She made several strong statements against giving advice about pregnancy and parenthood while pursuing competitive running. “Everyone is just an N of one,” she said. Meaning that women’s experiences are so different it is impossible, and even irresponsible, to give others advice about how pregnancy and parenting affect competitive running. I agree and appreciate her candor.  The following post is my experience, an N of one. I share this with the intent of promoting solidary and connection among families facing illness and challenge; this is not written to give anyone advice or make political statements…

Right before my diagnosis,  my husband and I just started trying to get pregnant with a 3rd baby. Fortunately, we did not. I escaped the unimaginably difficult decision that some women must make between terminating a pregnancy versus a delay in cancer treatment.  This situation is not uncommon. I have both patients and friends that have faced this exact decision.  One woman I knew who made the brave decision to delay treatment ultimately left behind this world and 3 very small children.  Her story doesn’t fit in well to the political rhetoric of abortion in America. 

Those that know me now might be surprised to discover that for almost 10 years of my life I was a pastor’s wife, mostly in the conservative Southern Baptist Church.  I finally got divorced at age 30, after delaying separation for many years, partly because of my role in the church.  Now, my husband and children are God’s greatest blessing in my earthly life, and divorce delivered that blessing to me. This is complicated.  I am a person of deep faith who also carry’s the burden of skepticism about the American church.  I believe the salvation story of Jesus, but I am also convicted that our perception of God is a mere reflection in a mirror of a shadow. Scripture tells us this in practically every book of the Old and New Testament.  I have not found my church community yet. I wish I could see it all in black and white, but I cannot.

After I became pregnant with Aden, there was never a world I could imagine where I would have terminated a pregnancy.  I have always voted for women’s right to choose and believe that abortion is a moral issue that a woman herself, not the US government, should define. But when I saw Aden’s heart beating on the ultrasound and felt him kicking, I knew I could never terminate the pregnancy. At 6 weeks of pregnancy, after the first of three major bleeding events, doctors discovered a sub chorionic hemorrhage. There was a large blood clot in my uterus that would either grow and terminate the pregnancy, or it would reabsorb or bleed out and the embryo would be viable. Then we had a second scare on Aden’s 16-week ultrasound which showed abnormal calcium deposits in the heart associated with Downs Syndrome.  We did get genetic testing, but I knew the results would not matter. Aden was going to be our child no matter what and he was ultimately born a completely healthy baby. One year later I was pregnant with Connor, and this is when the story changes.

With Connor I elected to get early genetic testing 6 weeks into the pregnancy.  And now, with a baby at home to nurture, I did not have the same conviction that the results would never matter. Fortunately, genetic testing was normal, and Connor was also a healthy baby. But, as most mothers-to-be do, I had to think about the what ifs.  I don’t know what I would have done if Connor’s genetic testing was abnormal for something that would have required life-long intensive resources. I only knew my heart was set to nurture and resource Aden.  I could now imagine a world where I might consider terminating a pregnancy which, given my personal history and prior moral convictions, is shocking.  What I learned about myself was that the instinct to love and protect my child was a stronger force than moral conviction. Yikes.  I am not saying that is good or bad, I don’t know, it just is. By the grace of God, I count myself a blessed woman to never have faced this decision.

In the last 2 weeks, I have gotten incredibly good news from both my surgical pathology reports and my oncology doctors. I don’t need chemotherapy or radiation. I am pretty much done with my treatment. My charge now is to live my life and manage my anxiety about the very low chance of recurrence responsibly.  I did discuss having another child with an oncologist.  He said it was probably ok, but because my particular cancer was fueled by estrogen and pregnancy is a high estrogen state, the increased risk is not zero. He does not know what this risk is. Nobody does. There are a few studies on pregnancy after breast cancer which suggest it might be ok, but the numbers in these studies are small.  As someone who is trained to read medical literature, I cannot hang my hat on this. We have decided not to have another child.  I am driven to this decision by an inescapable instinct to protect and be here for my two children.  Even if the increased risk is low, I cannot do it. Just like complex decisions about abortion, with or without cancer, this decision is right for our family. We are just an N of one.  My husband and I still see an empty chair at our dinner table. We both ache with a sense that our family is not yet completed. Fortunately, we are both flexible personalities. We plan to start researching adoption options next year.

Through this process, God has covered us in a blanket of mercy and blessing. I have not had to face the gut-wrenching decisions of many younger women with cancer. I am still recovering from surgery, but this will pass. I get to continue a life with my family that is so beautiful, it frequently breaks my heart with joy and the knowledge that I could not possibly have deserved or earned this.

Aden throws pine needles instead of posing with us for family pictures, best laid plans….

Dear Aden and Connor: The secret to getting the girls (or boys) is to become a caring, thoughtful nerd

It is hard to remain an unapologetically curious nerd when you are growing up. It is difficult to define yourself as a kind and caring person right now. It is a challenge to learn how to respect women, and others different from you, from their perspective.  American culture in 2019 is good at promoting cruelty, dehumanizing others, bullying, misogyny (I hope you know this word or learn it soon), racism, tribalism (learn about this too), bigotry.  These traits will ultimately make you miserable, unsuccessful (even if you have tons of money) and very alone (even if you are with a supermodel who just desires your money).  The evolution of the human brain and mind have delivered us from these primal and destructive instincts.  But if you follow the crowd without thoughtful intention, you may find yourself captivated by these primal instincts and on a path to misery no matter how “successful” being a jerk makes you.  I pray by the time you are in middle and high school that you read about President Trump and our current culture in text books with shock and awe at how Americans used to behave. Growing up on a small isolated island near Seattle, I read about Jim Crowe and the Civil Rights Movement with disbelief.  When I moved to Texas as a young adult,  I was shocked by both the overt and discrete racism that appeared culturally acceptable.  Then I realized the only reason I didn’t encounter overt bigotry in my youth was because I grew up with all white people. Even if you are incredulous about the ugliness of 2019 culture, I suspect you will have a similar experience to me. I expect it will still be a problem. We will still be human and broken in many ways.

If you ultimately want the amazing girl (or boy) and a successful, happy life- figure out how to be kind, caring, thoughtful of others.   Figure out how to respect women, and anyone else different from you, the way they want to be respected.  And btw, there isn’t one way to respect any particular group.  Focus on how to best respect the person in front of you. Maintain your curiosity about the world. Don’t be scare to be a nerd. Ultimately, nerds are incredibly attractive to romantic partners, and just to people in general.  You will probably cringe as this is written by your mom, but smarts are super sexy. Focus on these good things. You will be delivered out the other end of this washing machine called adolescence with everything you are actually trying to achieve and more.  Run from the primal path of putting your boot on other peoples necks just to make yourself feel big and important- that is the path to sure misery and loneliness.  Other people on this path will want you to follow them because it makes them feel less miserable and alone- don’t fall for it. In this story, be the superhero with the partner of your dreams who saves the world with your geeky intelligence and generous, thoughtful spirit. This will take a lot of courage but you are quite brave enough son.

How to do Breast Cancer with a 1 and 3 year old- Part 3: Sometimes the Monster by your side is better than the Ghost in the closet

The most counter-intuitive discovery we have made through this process with my older son, Aden, is that he wants to be involved in the things we want to shield him from the most.  There is a ritual my husband and I do every morning and evening where he “strips” and empties my surgical drains. Ill spare you the details but it is pretty gory, and never the type of thing one would think a 3-year-old should be involved in.  After my dad left and it was just Nick and I, we had to pretty much lock Aden out of our room to get this done. He is a very curious, wickedly smart and fairly anxious kid.  He was not going to tolerate us doing something he knew was related to my surgery literally behind closed doors.  This approach was not working for us.  We wrestled with what to do, and choose a path counter intuitive to us as parents who always want to shield our kids from harm.  We decided to involve him in this gory ritual.  This worked almost instantly, no more tantrums or anxiety fits before bedtime.

Now before bedtime every night, Aden holds the waste container while my husband strips the drain. Aden then passes the container to Nick. Nick dumps the drains and reseals them.  Then, and this is the most important part, Aden applies two band-aids, one to each of my hands.  Aden will tell you the band-aids are the most important part, and he is right. He beams with pride after applying his band-aids.  Aden takes his job very seriously; he never forgets and reminds us what we need to do every night. He feels that he is an important part of helping mom heal in an active way.  He feels in control.  He asks a lot of questions, including whether I am going to drink the drain fluid (we had a good laugh over this one), and we try to answer them honestly in his language.  Each family and child are different, this is certainly not the way for every kid.  But this counter intuitive approach worked for us. Once we opened the closed door on the gory process he feared, he adopted a sense of control, pride and even peace. For Aden, living with the monster by his side is better than the ghost in the closet.

Aden applying the important band-aid
Monster drains
Aden wanted a “doctor coat with sprinkles on it” for christmas so he could “do doctoring like mommy”, Santa delivered this lovey homemade creation

Dear Aden and Connor: Wisdom

Wisdom is like a woman shouting in the street, she raises her voice in the city squares. She cries out in the noisy street and shouts at the city gates.  “You fools, how long will you be foolish? How long will you make fun of wisdom and knowledge? If only you had listened when I corrected you, I would have told you what’s in my heart; I would have told you what I am thinking. I called, but you refused to listen. Proverbs 1:20-24

I love this proverb. Wisdom is a woman calling us to truth by just listening.

After getting cancer, I am learning to listen more. I am getting much better at it very quickly and it took this experience to make that happen for me.  I have generally been a poor listener. I want you to be a lot better at this skill than me without the pain of learning the hard way.  The older I get, the more I realize that wisdom is not linear with age or even experience. Wisdom is more linear with aptitude for listening. Pay attention. Listen to things that people both intend and don’t intend to communicate but do, you will put yourself in the fast lane to wisdom. This is way easier said than done, but I encourage you to be intentional about trying your best. I am not sure listening is a natural human instinct. For such a passive activity, it takes a lot of work.

I can offer a practical tip that I wish I had learned to do much earlier in life.  Strive to be the last person in the room to speak. If you are in a group of colleagues at work, in a conversation with a partner or close friend, or a community committee meeting- sit and just listen to everyone. This will not only make others feel heard, but it will also put you in a position to synthesize where others, sometimes others with diverging opinions, are coming from. Speak at the end. If you really listen to everyone well before you speak, your statement will often be the last because it is wise.

Don’t waste your time burying your head from wisdom, which has always been my natural tendency.  Your time and love are your most precious resources- please remember this.  Protect your time and your love as your greatest treasure- far more cherished than riches, fame or validation. You do this by pursuing wisdom through listening, watching, observing and seeking truth.

Wisdom is a woman calling you to listen.

Seek Wisdom Brothers!

How to do Breast Cancer with a 1 and 3 year old- Part 2: The Superpowers of Teddy Bears

One of the biggest immediate everyday emotional challenges of the double mastectomy so far has been that I cannot cuddle with my 1-year old son, Connor. He is a master snugger.  Since the day he was born, I have snugged him to sleep in my arms. Our pediatrician told me not to do this, and I’m sure she is right, but it always felt like the right thing for us.  Every night he drinks a bottle on my lap, I read several books and he nestles into my chest on the recliner in his room and we rock together for at least 15 minutes and sometimes 30, just enjoying our snugs as he drifts to sleep. Most nights, I close my eyes and picture myself as an old woman. I envision my old woman self as possibly alone, probably frail, just sitting on a recliner all day rocking back and forth, savoring the memories of snugging with Connor as a young woman, and feeling joy. It is really the best.  But that is all really about me- which is not the real problem. The real problem is him.

He is 21 months old and doesn’t understand why I can’t snug with him. If fact, right now, I actually have to stay away from him and occasionally physically push him away from me with my surgical drains still dangling around my belly. I hope this is harder on me then him. Despite being the master snugger, he is also our typical cool as a cat, independent, archetypal second child.  He seems to have taken this all in stride, and his dad is getting some extra snugs in the meantime.  But I do worry about the impact of not getting any hugs from mom for 6 weeks at his age.  I am trying not go down that rabbit hole.

Fortunately, we have deployed a secret weapon to help us which seems to be working well: Teddy bears.  Before my surgery, I bought three new teddy bears. Two big teddies for Aden and Connor, and a small one for me.  After I got back from the hospital, we all sat down and we gave them the teddy bears. We explained that we were still all going to snuggle together, but we are just going to do this using the teddies.  When you want a snug from mom- you can  get it anytime by snugging teddy. This has worked wonders with my older son, Aden. He understands the concept. Every night, he gets his teddy and brings me my teddy. Aden also makes sure Connor has his teddy every night. Both kids sleep with the teddies and we will often sit on the couch, side by side, with all the teddies in laps.  I am not sure how much of this Connor understands, it is so hard to tell at his age, but he seems to be doing just fine.  I think the teddy has helped.  There is no doubt it has helped my 3-year-old, he is really into it and probably gives me more snugs through teddy now than he did before!  If nothing else, it has made me feel a lot better about not cuddling Connor and Aden right now, a lot better than I thought it would. If you have young kids you can’t cuddle right now for whatever reason, I think this is really something to consider doing. Mom-snugging teddies have been one of several superpowers for us so far.

Snugging together!

How to do breast cancer with a 1 and 3 year old- Part 1

Figuring out how to minimize the impact of this diagnosis on my kids has been my second biggest concern behind treatment. The following information is only from my experience with this so far. Every family is different, but this might be helpful for anyone going through cancer or a serious illness with small children. There is an angel who walks the earth in the form of a nurse at the UVA cancer center who gave me a lot of these ideas. Which is my first tip- ask good oncology nurses to give you advice on how to manage this with kids, they have seen your situation before.

Preparing Aden for double mastectomy

Before my surgery, I talked to my 3 year old a lot about what was going to happen beforehand. He is a very anxious kid and needs to be in the know before the slightest of routine changes- so this one required a lot of prep work. The first thing I did was lay down some context that he could understand prior to talking to him. We did a date, just he and I, to see the kids cartoon movie “Wonderpark.” The mom in this movie gets sick and has to leave her child for a while. The whole movie is about processing the sadness of the child. This was really tough emotionally for me to watch with him at the time, but it really gave him a lot of context and words to talk to him about what was happening. I would also highly recommend the movie, “My neighbor Totoro” for this too.

After laying some context, I used the images and themes from the movie to talk to him at least daily for several weeks about the upcoming surgery, being away at the hospital, that I would have boo-boos and be sick for a while and grandpa coming to help. By the time grandpa showed up 2 days before surgery, Aden was prepared and explaining to grandpa everything that was going to happen. He felt some control. The morning of surgery, my husband and I dropped Aden and Connor off at daycare. Drop off when smoothly, Aden knew the plan and his anxiety was at a minimum- which was a gift to me. Turns out that kids are scared and anxious for the same reasons we are. It is the fear of the unknown and lack of control that scares them. It was the same lack of control and the unknown driving the waves of anxiety washing over my body in the weeks prior to surgery. Preparing Aden with the context of a kids movie and then talking to him regularly about the future dampened the anxiety for both of us.

Image result for totoro mom
A Beautiful Scene from “My Neighbor Totoro” when kids visit mom at hospital
Related image
Mom and Kid play before mom leaves for hospital in “Wonderpark”

Dear Aden and Connor: Resiliency

Dear Aden and Connor, resiliency is a super important skill for a happy and successful life. It is very hard and often painful to develop resiliency, but I think it’s the most important characteristic of people that can actually change the world.  If you can keep your heart soft and your mind open to others while, at the same time, sharpening your toughness to face adversity- you can achieve nearing anything.  Practice finding some way to prosper in the face of adversity; it will make you a formable leader, friend, parent, partner and human being. For all our follies, you are born from two very resilient parents. When your father and I met, we knew quickly that we could do anything together.   We have always believed in our superpowers as a couple, because we are confident in our own and each other’s resiliency. That is an awesome feeling to have with your partner.  Seek this feeling with your important partnerships in life.

Your father lost his dad at age 8. He succeeded despite great tragedy early in life. I thrived after surviving severe life-threatening trauma as a very young adult. Early in our relationship, your dad would tell me we could do anything together; and he meant literally anything. I encourage you to marry someone who has great resiliency.  If you seek a partner who self-identifies as a victim and feels the world and life is always against them, you might waste a lot of precious time and energy. You will be a lifelong caretaker; don’t fall for this even if it makes you feel needed and wanted. You are needed and wanted without this feeling, I assure you.  My desire for you is to marry a superhero; someone who makes you better, stronger and smarter. This person should be loving and caring, don’t misinterpret me here on that. But also know that I desire someone for you who can stand tall by your side when life gets rough- because life gets rough on everyone at some point. Be resilient and seek a resilient mate. Your potential together will be limitless; your children will prosper; your life will be a wild adventure.

Dear Aden and Connor,

Aden and Connor, you are loves of my life. My mother told me this same thing days before she passed away from breast cancer. I was confused and a little saddened by this, I thought it might be some commentary on marriage, but today I realize precisely what she meant. I am obsessed with your father. I am convinced I won the relationship lottery.  He has proven to be the man better than any of my dreams or expectations.  However, my love for you both is a supernatural kind of love that cannot be named or described- an unspeakable love. I would rip the flesh from my body an inch at a time to be here for you. There is quite literally nothing in the world I would not do for you. My love for you is like breathing oxygen or the unconscious familiarity of my own arm- I do not exist apart from it.  Facing a diagnosis of cancer at 36 is daunting because of my commitment to be your mom while you grow up. This is quite certainly the only thing that matters in my world right now, all other things are just noise.  This experience has illuminated the wisdom of The Giving Tree. I don’t fear for my own mortality right now, I only fear that my absence will bring harm and hurt to you.  Facing one’s mortality this way is perhaps something that mothers of young children experience more intensely, I don’t know, but it is remarkable.

The following words are written to you with loving intention. Today you are three and one years old. Since my diagnosis on March 18, I have been possessed by a desire to share with you my dreams for your future and whatever wisdom I can impart to help you lead happy lives. I pray that these notes might bring you solace, comfort, wisdom and hope when you need it.  I also want to document this tough journey that we are on as a family right now, and share any lessons that might help other people going through this. My prayer is that we look back on this time someday and see how good it made us.

Connor, below is a picture taken of us 10 days before my surgery sitting on an ancient tree on the walk up to Thomas Jefferson’s home. I brought you here to play when a woman came over to us and asked if I had a camera so she could take a picture of us. “Moms never get to be in the pictures,” she said.  What an angel. I will never forget this random kind act. As with a lot of pictures in the weeks before my surgery, I look a little sad. I promise though, I am so happy and grateful to have this picture with you, sweet boy!