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Right after the diagnosis, Cassie started looking for resources online to learn more about metastatic breast cancer and to learn from the experience of others. She started following roughly six bloggers on a regular basis. (Three of those women have recently died. Such is MBC.)

On one of the blogs Cassie follows, we came across this quote: 

“Oncoming death is terrible enough, but worse still, is oncoming death with time to spare, time in which all the happiness that was yours and all the happiness that might have been yours becomes clear to you. You see with utter lucidity all that you are losing.” — Yann Martel, Life of Pi

Every time we read this we cry. Every time. But, we wanted to share it because it really sums up what we are going through. 

We are so grateful that we still have time together to try and enjoy life (many people with late stage cancer wind up with little to no time). Yet metastatic breast cancer is a lonely road. You can look fine on the outside but feel crappy on the inside. It can seem like life is normal when it is anything but. It is hard for people to understand. This isn’t – go through treatment and you’ll be cured. It is ongoing. Relentless. You are always living with the knowledge that unless you get hit by a bus or something crazy, that this is what will kill you. You don’t know when exactly (although 75% of those with MBC don’t live beyond 5 years.) But it’s coming. 

Everyday it’s a challenge to stay positive. Our mental frame is something we work on together from the moment we wake up. It’s difficult not to focus on all that we are losing. It’s difficult to avoid asking ourselves — every time we do something fun — whether this could this be the last time? It’s difficult to explain to our friends and family what this is like day-after-day because we only see them episodically and because we don’t want talk of cancer to dominate every interaction.

The one thing that makes any of this tolerable is that we also have utter lucidity about what matters most right now. We know we want to spend our time with each other and with friends and family. We know we need to practice self-care and we know that we need to match the relentlessness of the cancer with our own relentless and sustaining love. In this way, the clarity of what we are facing is both a daily burden and a blessing as it helps reveal and keep us grounded in the things that matter most.

One of the most challenging things about this diagnosis is the lack of control and lack of structure it has brought to our lives. How do we make sure that we own each day and create some structure for ourselves while also recognizing that Cassie has many days where low energy levels require her to do less? How do we learn to be okay with days that are filled with less doing and more being?

It’s strange to ever write the word lucky in relation to a late stage cancer diagnosis but we both feel lucky that we have been able to step away from our jobs. Cassie is not working at all and Dan has cut back by around 90%. However, without full-time work to occupy our days, we find ourselves making it up as we go along. Some days we have the energy to do a lot and keep a pretty full schedule. We exercise, see friends for lunch, work on a house project, go to a movie, etc. Other days taking a shower is about all we accomplish. (Some days not even a shower!) We are realizing that we have to be OK when we are not actively out doing things even though we are both doers and are both used to active and busy lives outside of our home. Learning to just be is new and hard but also grounding, liberating in some ways, and absolutely essential given our current situation.

This is made all the more difficult by the fact that we both almost always wake up feeling sad and like our lives have gotten really small revolving around the cancer. Fortunately, along with this morning sadness, we both have the most energy early in the day and we now know that we often have to deliberately focus this energy on re-centering and re-framing for the day ahead.

We’re coming to learn that each day (whether a doing-day, or being-day) is best with a little structure and intentionality. We try to have regular scheduling meetings to talk through the week ahead and the weeks to come. We have designated our mornings “self” (thanks Browns) where we each schedule whatever we want. For our afternoons and evenings, we try to plan something from at least one of our “buckets” and we try to have a couple of fun hanging-out “projects” in our back-pocket. For example, we recently completed watching every movie in the Marvel Cinematic Universe in story (not release) order.  On being-days, even just naming that we are going to stay in and read or do a crossword puzzle is helpful. Maintaining this level of intentionality about our days though is much easier said than done.

One particular challenge is that we don’t know in advance whether it will be a doing-day or being-day as this depends on how Cassie is feeling and her energy level. So ideally we would have two plans for each day but instead we are lowering the bar and just trying to take the being or doing as it presents itself. Within all this uncertainty, one thing we know for sure is that for us, every day is better when it includes multiple things that keep us connected as a couple. This could be a dog walk or a game of cribbage or entertaining friends. We have learned the hard way that unless we focus explicitly on connection we can easily drift into just doing our own things. And for us, right now in particular, living parallel lives simply does not work! Whether doing or being, togetherness is key. 

So we are both oldest children. When you look up characteristics of firstborns you often see things like independent, assertive, controlling (bossy?), self-sufficient and more of the like. Throughout our marriage, we have somehow successfully navigated having these common traits even though we both usually think we are right. It’s probably worked because deep down we both know that being right and/or keeping score doesn’t really matter and simply doesn’t work when it comes to being married. 

So high amongst our shared characteristics is that we hate asking for help. We like to be self sufficient, keep our own counsel and muscle through tough spots on our own or by leaning on each other. We love helping others and are grateful when friends and family ask for what they need. But, we can both be pretty stubborn (just ask our siblings) and self-reliant to a fault.

This diagnosis has forced us to start changing our ways and we are finding it really hard. Cassie  can still do and wants to do most things but her energy level has decreased (on a good day it’s probably 30% less than before). Conversely, Dan has a lot of energy and wishes he could transfer it to Cassie but it doesn’t work that way. So every task is weighed against other tasks, activities and uses of our time. We can still do a lot but at what cost? Is plowing through our to-do list as we have always done the best use of time and energy? Which projects really matter? What fun do we wind up sacrificing in an evening because we insisted on muscling through in the morning? Can we let go of some things or, god forbid, can we imagine not doing everything or not doing it all ourselves? 

We are incredibly blessed to have a support network of family and friends who are willing to help us — who ask us continuously what they can do. We, on the other-hand, are not so good at taking our community up on these offers. Part of that is because, even though we are living in a “new normal,” we want our life to remain as normal as possible for as long as possible. This might mean cooking for ourselves (which Dan enjoys) or continuing to walk Doc which is so grounding (at least when it’s not 30 below). But this desire for normalcy isn’t the main reason we don’t ask for or accept more help — we’ve come to realize that we don’t do it because we aren’t that good at it. Period. 

We are working on evolving though and we are working on it together. We have to remind each other constantly that it’s ok to ask for help and we often switch roles in terms of which one of us is encouraging the other. We are practicing too. We tried a meal train for a few weeks last fall and while it felt awkward at times it also made life SO much easier during a particularly busy stretch where Dan had some big projects for work. We had a group of friends tackle all our yard projects in a single day this spring and that was so generous and helpful and provided us with an incredible sense of relief.

We are practicing now because we know that we are likely going to need a lot more help down the road. However, when it comes to asking for help we are pretty sure that for us, practice won’t ever make perfect. As typical firstborns, we will probably always try to retain some semblance of control. That said, we are learning all the time that this is one situation where self sufficiency isn’t sufficient. 

Spoiler Alert: This story has a happy ending.

So about two weeks after Dan’s mom died we got some potentially scary news about Cassie’s health. She’d just had a routine doctor’s appointment. So routine that she hadn’t even wanted Dan to attend (a first). No scans. No test results. Just some blood work and a short visit with the doctor. Purely routine.

Then they called. Cassie’s blood work had come back. Her kidney counts were way off — her creatinine levels were elevated much higher than they should have been. They told her not to panic (thanks) and that it might just be that Cassie was dehydrated at the time of the tests. They instructed her to drink a lot of water, lay off Ibuprofen and come back in a week to be re-tested. 

Left unsaid was that it might not be alright. That this might be the start of something new. Something bad. That maybe we should panic. The internet is not your friend at times like this. You know there’s that joke that if you look up an illness online you are always “three clicks from death.” Well that’s not as funny when you have metastatic breast cancer. When Cassie googled high kidney counts and MBC much of what came back was really scary. Some people do develop kidney trouble — not good. Sometimes that’s caused by the meds — also not good because we want to stay on these meds as long as possible. 

We started joking darkly about kidney failure. Visions of dialysis ran through our heads. It was too much, but what could we do? Cassie started a “water project” of at least 64 oz daily. She avoided intense workouts and rested more. We also told a lot of people because we were scared and this was our current reality.

And then everything was fine. We went back to the doctor (together this time). They did the test and asked us to stay for the results. We sat anxiously in the waiting room and then Cassie’s nurse came out and gave us the all clear. Probably just dehydrated she said. Keep drinking water. Nothing to look at here.

Whew, what a relief. But also what a ride. A true roller coaster of a week and certainly not the last one by a long shot. That got us thinking how do we handle these rides? How do we react but not over-react? How much do we share, when and with whom? We don’t want to shut out our family and friends but we also don’t want to scare them unnecessarily. Also how do we incorporate these regular ups and downs into our life as a couple? One of the things that is becoming increasingly clear to both of us is that as much as we ever thought we were “in control” of our lives before, we certainly aren’t any more. In so many ways, the MBC roller coaster is in control and we are just along for the ride. That doesn’t mean we don’t have lots we still get to decide on a daily basis, but it does mean that almost all of the big things are out of our hands. Makes us think a lot about the illusion of control we were operating under before. 

We are realizing (as with so much of this whole journey) that how we handle things will likely vary on a  case-by-case basis and that the bigger thing is to try and emotionally prepare ourselves for the constant ups and downs. That’s just part of our new reality which is too bad because Cassie really hates roller coasters.

Having cancer is stressful. Not just the physical aspect, but the emotional and social aspects, too. 

Every party or outing we go to we think about who else will be there. Do they know our situation? How much or how little? Do we share the diagnosis or not? Do we have the energy for the “talk?” Mostly though we try to prepare for the inevitable question: “How are you?” 

Given how often this comes up and our professional backgrounds we have talked about developing our own cancer “elevator speech” (we have heard from others in our situation that they have done that) but haven’t done it yet because it’s actually pretty challenging. How do we best communicate how hard living with metastatic breast cancer is but also that we are doing as well as we can? We have shitty days. We cry. We question. We stay in bed with the covers over our heads. But, we also laugh, enjoy each other and our friends and family, take on new adventures and think about what new restaurants we want to try next.   

We’re finding how these conversations go just depends. It depends on how well we know the person and what we know they know about where we are in life. Cassie’s desire to tell every single person (like the person who owns the boutique she likes, the yoga instructor, and the manager at a restaurant we love) has subsided as the disease has become a more regular part of our lives instead of this piece of shocking news. But there is the question of authenticity. How can we best genuinely share where and how we are without taking every conversation down a long dark path? 

For us, we think about “how we are doing” on both a large or more macro scale and on a smaller or day-to-day scale. On the macro scale we are heartbroken, terrified, overwhelmed and incredibly sad almost all of the time. On the smaller, more day-to-day scale, we are often okay – which might mean we’ve slept well, gotten a workout in, are experiencing limited physical side effects and are looking forward to tomorrow. Another day we might be really struggling – haven’t slept well, experiencing side effects from the medication, and are feeling very emotional and like our lives are stuck or too small. We can have good days and bad days within the larger ugly context of metastatic breast cancer. We can be both okay and not okay at the same time depending on the scale or lens we are using to answer the question.

Another part of this is that we are learning about the importance of regularly checking in with each other on the related question of “how we are doing.” As a couple. Are we connected? Are we focusing enough on our buckets? Are we helping each other slow down? Are we in sync? This requires a degree of intentionality that we both find enormously challenging but that we are coming to realize more and more is absolutely essential. We can both be doing all right as individuals but not as well as a couple so we have to ask and answer the question both ways.

After losing her husband, Sheryl Sandberg talked about how jarring she found it when people asked how she was doing. She suggests re-framing the question from “How are you?” to “How are you today?” While we can’t, and really don’t want to, have a say over what people ask us, we can take control over how we answer the question. Today, we are okay.

The one year anniversary of Cassie’s MBC diagnosis is today, July 13. In some ways, we can’t believe a year has gone by. In other ways, we can’t believe it’s only been a year.

Reflecting on the past year is difficult. We still cry every time we start to think about where we’ve been, what we’ve lost and what is ahead. So we’re keeping this post simple. To mark July 13 and this anniversary (cancerversary) that we wish we didn’t have to acknowledge, here are 13 things we’ve learned over the last year.

13. It’s best to have difficult conversations at a brewery.

12. More than one night apart from each other is too many.

11. MBC is relentless. 

10. Slowing down and being intentional about every day is super hard for us.

9. MBC research is underfunded. Less than 10% of all money raised in support of breast cancer research goes toward a cure for metastatic breast cancer. 

8. How we see ourselves in the world is changing. 

7. Cassie can nap. Really.

6. A good therapist is key.

5. As shitty as this all is, we are so grateful to have good insurance, great care and flexibility with work because so many people don’t.

4. Our support network is deep and wide.

3. We’ve got to be patient with each other.

2. We can be okay and not okay at the same time.

1. Our love is very strong

Almost immediately following Cassie’s Stage IV metastatic breast cancer diagnosis, she started thinking about her death. Not so much “is there a heaven and hell” but more logistics – like will she be cremated? Buried? What will the memorial service be like? What music will we have? How do we reconcile our different religions? What will her obituary say?  

It turns out that Cassie has been focused on her own funeral since junior high. She still has a sketched-out version of her funeral program that she did in 7th or 8th grade. (So, to her friends from Cotter Junior High, she is officially rescinding your pallbearer invitations. Sorry.) And, Cassie’s mom told her that many years ago she had selected scripture readings for her funeral that she had written out and given to her for safekeeping. So to Kay, we should probably get those back. 

To Dan though, this all seemed way too soon and way too sad to think about. He knew we were going to have to talk about it at some point, and plan it all out eventually, but to him that meant later. In a few years. Certainly not so soon after the diagnosis.

Conversely, Cassie realized that her fixation on the details of death, while upsetting to Dan and probably unnerving to friends, actually gave her a much needed sense of control. So much about the illness was (and still is) beyond our control, but this wasn’t. And Cassie is an organizer and a planner and planning for her own death felt aligned with her natural tendencies and strengths. 

This was one of the first times where we saw things really differently. 

So knowing how important this was to Cassie, we came up with a compromise, which like many other things in our lives right now was developed with a heavy dose of dark humor. Here’s the deal we made with each other. We would start talking about the end of life issues but we would always have the conversations at a brewery to take some of the edge off. It’s not a perfect solution by any means but it makes the hard conversations just a little easier.

As we started talking about end of life plans other differences emerged. Dan expressed his desire to have Cassie buried. Cassie felt strongly about being cremated. So, we decided she’d be cremated and then buried. We toured a couple of cemeteries. Cassie is Catholic and Dan is Jewish so it is important for us to find a cemetery that is non-denominational and welcoming for both of us. We also want something near St Paul and easy to get to. 

(Here’s a tip – when you’re just trying to get a feel of a cemetery, don’t make an appointment. Just drive or walk around. Check out the grounds and views. See how it feels. For the first place we visited we made the mistake of making an appointment. The cemetery man was akin to the worst car salesman you’ve ever met. “What can I do to get you to buy a cemetery plot today? I can talk to my manager and get you 20% off.”  Seriously it could have been a f***ing SNL sketch. We spent the entire time kicking each other under the table and suppressing giggles.) 

We talked about funeral music, where we might have the service, and whether or not Dan could do a version of a Shivah at our home. We talked about our religious differences. Cassie had preliminary discussions with her parents about their thoughts (not an easy conversation but none of this is and they were awesome, by the way) and we even talked to two potential officiants. 

Then Cassie slowed her roll. As she became more settled into her illness and into how to live with metastatic breast cancer she feels less of the need to focus on end of life planning. But then something strange happened — we reversed roles after Dan’s mom died. Seeing how suddenly Dan’s mom’s health deteriorated and how she went from being fine to not being able to answer even the simplest of questions Dan became terrified that the same might happen to Cassie at some point. Not likely but possible. So now Dan feels some urgency to dive into more of the death details.

All of this has made us realize how we have to be open to each other’s timelines and evolving priorities. Nothing about this can ever really be written in stone. There is no right way or time to discuss any of this. We both just have to commit to communicating about what’s important to us and when — even if that changes often. So now, having recognized all that, we are proceeding — not at a crazy pace but we are letting ourselves go there and think and talk about the end when either of us needs to. And we still try to do it at a brewery.

When Cassie was diagnosed there was so much we didn’t know about metastatic breast cancer. Since then, we have often found ourselves facing a common set of questions and/or misconceptions so we thought it might be helpful to share some basic facts.

What is metastatic breast cancer?

MBC, also known as Stage IV, is breast cancer that has spread to other parts of the body–most commonly to the bones, liver, brain and lungs.

But if it is in your lungs, isn’t it lung cancer?

No. It is breast cancer in the lungs. It is not considered lung cancer.

How did it go from the breast to your lungs?

Most likely, it traveled through the bloodstream to create tumors in the lungs.

When will Cassie be finished with treatment?

Unfortunately never. While treatable, MBC cannot be cured. Scans, blood tests, and treatments will be ongoing. The goal of the treatment is to stabilize the disease — prevent the cancer from growing and spreading to other parts of the body and to prolong life. Once a treatment stops working (i.e., the cancer grows or spreads) the oncologist will switch Cassie to another type of treatment. This will go on until all viable treatment options have been exhausted.

What is the prognosis?

Some people with MBC live for a long time. We’ve read about women living for ten years! New treatments are being developed all the time. One of the drugs Cassie is taking is relatively new and the impact on survival rates is not yet known but appears positive. However, current general stats say the five year survival rate for stage IV breast cancer is 22%; median survival is three years.

But Cassie looks healthy. How is this possible?

Cassie’s current treatment doesn’t have visible side effects. But, please know that just because she looks normal doesn’t mean she feels well.

If Cassie fights really hard and stays strong, she’ll beat this, right? She is a survivor.

There is no cure for MBC. No matter how hard she “fights” or how positive her attitude this disease will kill her. Just the fact of the matter. We’re trying to stay away from referring to this illness as a battle or a fight as that language suggests that if one fights hard enough the cancer can be defeated. It just doesn’t work like that.

What else should you know? We found this video (https://youtu.be/QDQ0FjP7J-c) done by an MBC patient (who has since died) to be very helpful in wrapping our heads around the disease and some of the common perceptions and misconceptions that arise. Check it out but be warned it’s pretty emotional.

One of the hardest and most surreal parts of Cassie’s diagnosis has been dealing with what we have been calling “living grief.” It’s the grief we feel right now for the life we lost, for the dreams we fear we have to give up and for the sadness and emptiness that we carry around. It’s there every single day and at this point, doesn’t appear to be lessening at all. It’s heavy.

On Sunday, May 12 (Mother’s Day) our living grief met new grief when my mom died. She had been suffering from a serious blood condition for some time but her death was sudden and unexpected. In fact, the day before she entered the hospital, we were together celebrating her granddaughter Mimi’s second birthday. Mom was in rare form and good spirits. She was making plans for the future, arguing with me about driving and seemed so vibrant and full of life. Then, just seven days later, she was gone.

My two brothers and I were at her side for those final days. We got to say goodbye and we celebrated her life with family and friends at a beautiful service in her hometown of Chicago. We shared stories. We looked at pictures. We ate heartily at two Shivas (which is basically a Jewish wake with bagels, cured meats and smoked fish) and we rejoiced in what a wonderful mother,  mother-in-law and grandmother she had been. Then all the “doing” stopped and the grief hit like a freight train.

I am still reeling of course and keep expecting her to call or wanting to call her.  She moved to Minnesota almost two years ago and lived five minutes from me and Cassie. We saw her often and talked to her daily. We shopped and ate together. We shared books. We bemoaned Trump. We laughed a lot. She was a huge presence in our lives which now feel too quiet and empty.

It’s so sad. My chest hurts. I can’t sleep. I feel slow —  like I am walking through water. I remember much of this from when my dad died, even more suddenly in 2015, but what I am experiencing now somehow seems both familiar and different and harder all at the same time.  

I think part of what makes it so hard right now in particular, is that this is our first crisis since Cassie’s diagnosis and we are both facing this new crisis already depleted. Before, when one of us was going through something bad, that person would lean harder on the other. One of us could serve as a rock in our relationship. This time we were both already in crisis when mom died. The grief I feel around the loss of my mom and the grief I feel around Cassie’s illness is also grief that Cassie is experiencing. How do we balance the need to support each other while taking care of ourselves and experiencing our own grief? Cassie’s illness impacts both of us. The death of my mom impacts both of us. Grief has met grief and it feels almost unbearable.

So what do you do when this happens? When your living grief runs head-first into new grief. I don’t know other then I guess you try to make room for it. That’s what we have already been attempting to do around Cassie’s illness — create room for our new reality even though we don’t want to.

Grief is so tangible and so heavy. You can’t ignore it but it doesn’t just fit neatly into your life. We have to slow down, name it and let other things go so we can handle the new weight that grief adds. Now with even more weight, I think we need to go even slower. Let even more things go. Create more room in our life for the sadness, loneliness and emptiness. This probably isn’t the last time that grief will meet grief for us, so we need to try and muddle through, practice extreme patience with each other and learn what we can about ourselves and our grief processes. We need to let others help us and love us. We need to grab lightness and joy when and where we can. Most of all though, I think we just need to accept that it’s going to be really heavy and hard for a while and that’s just what happens when grief meets grief.

Over the course of my career, I’ve written many job descriptions. Actually, I kind of always hated writing job descriptions. How do you capture the essence of a position and how success will be measured? But, every role should have a job description – it’s a best practice.

Right after my diagnosis, Dan went out with his close friend and mentor Kari. She told him over breakfast that he “has a new job – being a caregiver.” That got us both thinking about our roles right now. So, at the time of huge change in our lives – a terminal cancer diagnosis and both of us having different relationships with work – it seemed like we need new job descriptions to guide us.

My “new job” includes some tasks that are exciting and others that are daunting. Some can be easily be addressed in the short term. And, others are more aspirational and have a longer time horizon.  I know I’ll be better at some of my “tasks” than others. But, it’s my hope that this job description will serve to guide me in focusing my energies in this new phase of life.

Here is my new job description . . . .

Be grateful and graceful in all interactions: late-stage cancer is scary for everyone. Be kind and generous with those who put their feet in their mouths. Their words come from a place of concern and love

Look for beauty and purpose in the dying process: create opportunities for reflection

Share love freely: Tell people how you feel about them. Write some letters, send some emails, give some hugs

Comfort, support, guide and prepare my husband, parents, and sisters: be open with feelings and thoughts on end of life, talk and see each other regularly

Share my story and my learnings with others diagnosed with terminal illness: start a blog, write a book

Help educate my community about MBC: no sugar coating or skirting the hard topics

Be my own best caregiver: exercise regularly, rest when tired, take meds, keep doctor appointments, inform care team of new symptoms or side effects

Leave my nieces and nephews with memories of me and fun times together: take pictures, schedule outings, plan a big trip, send postcards and letters

Accept help: let people love and support me by bringing meals, walking the dog, cleaning the  house, etc.

Look at each day as a new adventure: use our “buckets” as a guide, plan each day – even if the plan is to do very little

Stay curious and keep engaged with the world: read, do crossword puzzles, play cards, travel to new places

Put a premium on having fun: do things that make me happy, try new things, express my wants and desires

Plan my funeral, find a cemetery and get my things in order

Overwhelm my husband with love, gratitude, kindness, and good memories

Be gentle on myself: this shit is hard