Sept. 1, 2022

Day 0, Part 2: The Pathologist Never Calls With Good News

Day 0, Part 2: The Pathologist Never Calls With Good News

As a nurse, it was easy for Natasha to think of all the things the almond-sized lump in her armpit could be other than cancer, so she moved along with her busy life. When she realized it was not going away, her doctor sent her for a mammogram.

As a nurse, it was easy for Natasha to think of all the things the almond-sized lump in her armpit could be other than cancer, so she moved along with her busy life. When she realized it was not going away, her doctor sent her for a mammogram.

It took six weeks to get there and then her busy schedule delayed it again. The mammogram saw nothing in either breast, but since they could see it and feel it, they sent her for an ultrasound. When the pathologist called, she knew it was bad news before she even answered the phone.


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About Breast Cancer Stories

Breast Cancer Stories follows Natasha Curry, a palliative care nurse practitioner at San Francisco General Hospital, through her experience of going from being a nurse to a patient after being diagnosed with breast cancer.

Natasha was in Malawi on a Doctors Without Borders mission in 2021 when her husband of 25 years announced in a text message that he was leaving. She returned home, fell into bed for a few weeks, and eventually pulled herself together and went back to work. A few months later when she discovered an almond-sized lump in her armpit, she did everything she tells her patients not to do and dismissed it, or wrote it off as a “fat lump."

Months went by before Natasha finally got a mammogram, but radiology saw nothing in either breast. It was the armpit lump that caught their attention. Next step was an ultrasound, where the lump was clearly visible. One painful biopsy later, Natasha found out she had cancer; in one life-changing moment, the nurse became the patient.

This podcast is about what happens when you have breast cancer, told in real time.

Host and Executive Producer: Eva Sheie
Co-Host: Kristen Vengler
Editor and Audio Engineer: Daniel Croeser
Theme Music: Them Highs and Lows, Bird of Figment
Production Assistant: Mary Ellen Clarkson
Cover Art Designer: Shawn Hiatt

Breast Cancer Stories is a production of The Axis.



Kristen (00:03): I'm Kristin Vengler. And our mission with this podcast is to help you and the people who love you through the shock of diagnosis and treatment.

Eva (00:11): I'm Eva Sheie, and the incredible woman whose story you're about to hear is a nurse practitioner in San Francisco who has dedicated her life to caring for patients more vulnerable than you can imagine.

Kristen (00:22): Her name is Natasha. This is a story about what happens when you have breast cancer told in real time,

Eva (00:35): How did you find out that you had breast cancer?

Natasha (00:39): So I officially found out about a month ago, actually. Yeah, a month and a day. Just looking at the date, the 17th of January. It's very interesting when you listen to women's breast cancer stories. So many of them start with this scenario in the shower and it's so true.

Eva (00:58): Why are we all playing with our boobs in the shower?

Natasha (01:02): Somebody has to. And also we're washing our armpits, I think I that's, I'm not sure. But this was longer ago. I mean, this is where, you know, they say healthcare providers are the worst patients and I did everything I would never tell one of my patients to do. In the shower, maybe three or four months prior to my diagnosis under my right armpit, there's something, there's a lump and it, it's not small. It's about the size of an almond, like a big almond. And I found that and I was like, oh, that's not good. But I had so much going on at the time that, you know, we can talk about a little bit later that I was able to explain it away. I told myself, well, I probably cut myself shaving, cuz I've had like a little ingrown hair that turns into like a bumpy thing that many of us may have had.

Natasha (01:57): And, and then it's one of those things of having too much information to be able to explain things away. So I said, oh, it could be a lipoma that is like a, sort of a benign fatty deposit in my armpit. So I just wrote it off and completely ignored it. And then was aware for a couple of months that it hadn't gone away. Um, so finally made an appointment with my primary care provider who, you know, didn't even palpate it like medical term for like feel me up under there. And he's like, ah, we see this all the time, but it's time for your mammogram, so let's just send you anyway. And um, it took about six weeks for me to get a mammogram and then they managed to schedule it at a time when I was away in England for the Christmas holidays to visit my family.

Natasha (02:45): So I had to reschedule. And then the day it got rescheduled for, I had a really, really busy Workday and they called me from the clinic and said, actually, you're gonna have to cancel that medical appointment. And I was like, oh, so I called to cancel and they said, oh, the next appointment is like three or four months away. So then the sensible person in me kicked in and I said, you know, I really, I, I think I need, I need to come in today. Went in, and it was, it was a very interesting, like I can sort of step back and look at this objectively and clinically, which sometimes helps the fact that it's actually happening to me. So they did a mammogram, both breasts and saw nothing. What they did see was this lump under my arm. And one thing I hadn't thought of, which was probably me in total denial, that it was an enlarged lymph node.

Natasha (03:36): And so then we went to ultrasound and they were able to find the breast mass on the ultrasound. But to this day I remain horrified that it didn't show up in a mammogram. And then they sent me for a, it's called a fine needle aspiration. So they stick a very sharp needle in and they pull some cells out. And that was, it was kind of interesting to watch it on the, the screen as they're doing that. They did about four or five takes sort of smooshing the cells out. And then they put a bandaid on your armpit and send you home. And about three or four days later, I was on the phone with one of my patients. And I saw a call come in from my primary care provider who left a message saying, "hi, Natasha, um, gimme a call back. We can review your results.

Natasha (04:24): We just got a call from the U C S F pathology department". And even before I called her back, I knew pathologists. don't call primary care providers with a benign report. So I took my phone out. I'm lucky enough to have a, a nice garden in San Francisco. I took it out. I took some deep breaths and it was very kind, actually it was a, a nurse practitioner with a medical practice that I see. And she said, "yes, we've got the results. It's adenocarcinoma", which is a cell type, but it didn't tell me very much about where the primary cancer was, which is something that's very important or really anything other than the cell type. So then I kick into clinician mode and like, well, I know where that cell type can come from. It can be breast, it can also be lung. It can be GI or uterine. And so then the wait starts. Almost from that instant, I had shortness of breath and a cough. I was convinced it was lung cancer. Both my parents smoked when I was a kid. So it was just, then you go in with the long, the long waiting process to get things figured out. It also, I got this news about 20 minutes before a realtor was coming to give me an estimate on the house.

Eva (05:50): I imagine you with a realtor coming in 20 minutes. Like it's almost looks like a movie in my head.

Natasha (05:55): Yeah. Yeah.

Speaker 2 (05:57): What, how did you react when the realtor showed up? Did you just go into like, uh,

Natasha (06:01): I just went into, let's put it on one side. Oh yeah. There were no tears at that point. And I think what was interesting for me, you, you know, you can often hear other people's stories and even, um, you know, even just the general media, there was something on the radio the other day where it's like the three worst words in the world to hear are you've got cancer. And I really hate that idea of like, this is the worst thing that can ever happen to anybody. But I think what's interesting is that because my call came from a nurse practitioner who knew that I'm a nurse practitioner, nobody said the words you've got cancer. She said, it's adenocarcinoma, which may just be semantics. But it, my relationship with that message felt different. It felt academic, which kind of worked for me because then I was able to go into sort of academic mode rather than personal mode. So yeah, the realtor came and I gave him a tour of the house and I didn't mention anything. And, um, he's actually a friend of mine. And then a couple of days later, I told him, you know, what had just happened before. And he's like, "wow, I like, you should have told me not to come, you should have". But it felt like life had to keep going on moving forward.

Eva (07:22): Do you now find yourself sort of switching back and forth between two versions of yourself?

Natasha (07:27): Absolutely. I do. Yeah. I mean, unfortunately I've had to do an awful lot of advocacy and work for myself to get the appointments set up and I'm still, I still haven't actually met my oncologist. That happens next week. But the number of things that I needed to be on it almost became a full-time job, right from the beginning. The pathway of how this should have been handled was not correct. So my very first appointment that I had after being told that it was an adenocarcinoma, I was told I was meeting with breast surgery. And so I called them up and I said, look, we don't know if this is a breast cancer. We don't know if it's metastasized there's been no other imaging. I don't want to wait three weeks to meet with breast surgery because I know what they'll say is we can't do anything without any imaging. Imaging, meaning like a CT scan or a pet scan or something else along those lines.

Natasha (08:29): And I just wasn't willing to wait another three weeks. So I had to do a lot of calling around. And actually this is one of the things that I've struggled with is because I, I know the hospital that I'll be treated at. It's actually the parent company I'll be treated at U C S F, which oversees San Francisco General Hospital. But I know a lot of the players there. This is something Kristen and I have talked about. It's like accepting my privilege, that I do know the people and I can email them and they'll email me back and I have the back line for some of the, you know, the cancer navigators, has been difficult for me to accept that I have that privilege to do that. And at the same time horrifying to know that lay people don't have that privilege. They don't know the knowledge that things aren't going in the right order.

Natasha (09:21): It's been very challenging to arrange my own healthcare, but just sort of shocking to think what other people must go through.

Kristen (09:30): I think that's why you're here wanting to help people too, because you see that aspect of it.

Natasha (09:34): Yeah, absolutely. I mean, it's the amount of work that average cancer patient has to do to advocate for themselves is really unbelievable. And these, we're not talking medical mistakes things, for example, when my MRI was scheduled, they messed up and they scheduled it for March instead of February. And so I had to be on it in a second and I happened to know the radiologist and I was able to call him and he was able to change it. And I also like, you know, I have the balls to do this because that's who I am. But I think, you know, in a lot of the world of like, you know, doctor knows best, let's not rock the system. It's a very different story for people. So yeah. I mean, one of the reasons I really want to do this with you guys is to, to really empower other women to advocate for themselves. And there's a fine line between like, if I can swear, but like being a bitch and advocating for yourself,

Eva (10:29): You never wanna be the bad patient. You know, we don't wanna be like the trouble patient because I think you recognize having, you know, experienced the healthcare system as an adult in any capacity that if you're not a nice patient, they will actually make your life harder. So I think it's really problematic that this is only our second story. And we're hearing how challenging the system is to navigate this is why there are navigators, right?

Natasha (11:04): Yeah.

Speaker 2 (11:05): But even the navigators, they can't do everything. You still have to do a fair amount of stuff for yourself.

Kristen (11:11): One thing I came upon was that there's a lot of compassion when you say, "I may be overreacting, but I have a recent cancer diagnosis and I'm just really stressed. Can you help me?" And that's me though, being vulnerable and honest. And there are a lot of people who aren't willing to do that in my case. Now it's completely different., I'm sure with the patients that you've worked with over, you know, at San Francisco General.

Natasha (11:39): Yeah. I mean, I think the difference is that San Francisco General has so few resources. We have a few navigators, it's not enough. Again, I really love the hospital. I feel so proud and so honored to work there, but it's a lot of leaving voice messages. And we know that it's, for some reason, it's become acceptable professional etiquette that you don't have to return a voicemail. So far, I'm impressed enough at U C S F that a human being picks up the phone in the breast cancer department, which is so nice. And they often can't resolve what you need, but at least you get a human being, which is so important.

Speaker 2 (12:18): They must have done a peer reviewed study that said picking up the phone, increased patient satisfaction,

Natasha (12:23): Funded by a 30 million dollar grant from the NIH, I'm sure.

Kristen (12:34): So you didn't know if it was breast cancer yet, right?

Natasha (12:37): That's right. So I was able to advocate for myself before meeting breast surgery to get a pet scan, which is one of those scans, you guys probably know where it's a head to toe scan. They shoot you up with a lot of glucose. And they're basically looking for active areas because cancer cells by their very nature are rapidly dividing. And so they take up glucose, which is essentially sugar, much faster than any other cells in the body. So the head to toe pet scan really looks at like are there any other active areas that might indicate that there's a cancer brewing. And so the pet scan came and two areas lit up, as they say on the pet scan, which was the lymph node that we knew about. And then about a one and a half centimeter. So a little less than an inch tumor on the outside of my right breast. And then they did a breast MRI that confirmed and allowed them to measure the size of the tumor in the breast.

Speaker 2 (13:45): When you say it's outside, do you mean,

Natasha (13:47): Oh, I'm sorry. Yeah, no, it surface. No, it's actually closer to my armpit. So medical term would call it lateral. It's like, it's not near my other boob. It's very close to my armpit actually.

Eva (14:00): Close to that lymph node?

Natasha (14:00): Close to the lymph node. Yeah.

Kristen (14:03): So is the reason that you didn't know what type of cancer that was or where it had come from because the lymph system carries things throughout your body. So it could have really come from anywhere and just landed there. Right?

Natasha (14:17): Exactly. I mean, one of the crazy things was, you know, I was hoping it was lymphoma, which is a cancer of the lymphatic system and is, caught early enough, it's really very, very treatable. But when they told me the cell type, the adenocarcinoma, then that ruled out lymphoma. And again, it's just sort of pointing to these different organs that I've been mentioning, the breast, the lung that has this cell type of adenocarcinoma. So an elevator pitch of how that happens, you have these organs that have their specific adenocarcinoma cells. They start multiplying like crazy, which is what happens in cancer.

Natasha (14:59): They travel around in the lymphatic system and they deposit themselves under my arm, in my armpit. And actually it's interesting, it's not a tumor under my armpit, it's an enlarged lymph node. So the cancer cells went from the breast lump, which is very, very close to the armpit. And as my cancer doctor said on the phone to me, they squirted some cells out into the lymph node. And to me what's been really interesting, sort of both as a patient and as a nurse practitioner, is that the mass in my right breast, even when we knew exactly where it was, they put a clip in it from the MRI. Cuz I, I ended up with a bunch of biopsies from that too. It still never showed up on the mammogram, even though we knew where it was. And I talked to the radiologist and I said, you know, this is actually kind of terrifying because for all of us, you know, one of the messages to all my girlfriends has been, please keep up with your mammograms.

Natasha (16:01): And here is a known mass that even now does not show up on a mammogram. And she said about 15% of breast masses can be called what she referred to as radiographically occult, which means it doesn't show up on a mammogram, which is terrifying. And so what a number of people and, you know, the healthcare providers have said to me, it's like, I'm lucky, which is not a word I like to use with cancer very much, but I'm lucky the fact that it irritated this lymph node, because if I hadn't had this enlarged lymph node, I would've gone for my mammogram. They would've said everything is clear and I would've had a tumor there that was growing. I mean, I, you know, by the time it could have really been found, it could have been a much, much later stage.

Eva (16:51): So your stage number right now is?

Natasha (16:54): They've told me it's a stage two, cuz at this point there's just these two areas that we are aware of. But as a lot of people know, like it just takes a couple of cancer cells to wreak havoc. So that's why we can talk about what I'm anticipating my treatment plan to be. I haven't met with my oncologist, but I'm, I pretty much know that I bought the whole package of chemo, possibly surgery looking like a lumpectomy, but it depends how things react to the chemo. And then the lovely six weeks of radiation after that.

Eva (17:27): This could be fun, like a game show kind of like Natasha's treatment plan versus the oncologist who will mm-hmm

Natasha (17:34): mm-hmm yeah.

Kristen (17:38): Yeah. I just wanna point out that we are two for two with mammograms missing tumors.

Natasha (17:43): Yeah.

Kristen (17:44): It's more terrifying when I look at that and I think about that.

Natasha (17:49): Yeah. I did ask the radiologist. I'm like, so, you know, what's the deal with this? Like if mammograms are missing breast cancer and we're told to get mammograms, like what's the message for people? He's like, well, the message still is get your mammogram. From my experience, the message is make sure you feel yourself up in the shower as much as you can.

Eva (18:07): If you don't do it, no one else will.

Natasha (18:09): well, right?

Eva (18:12): At least in my house, that's how it works.

Natasha (18:15): yeah, my house too these days. Yep.

Kristen (18:17): Same

Natasha (18:21): But what did find the, you know, the eventual tumor was the MRI and you know, if insurance companies weren't so, use the four letter word I'm thinking of, but if they were a little kinder, women would get more MRIs than mammograms because an MRI's going to pick it up. I'm very claustrophobic. The joy of San Francisco's breast MRI, and maybe it's everywhere. I've never had it, is you're face down with your boobs in some, I don't know exactly what they're in, but you're face down and this is so, so San Francisco, they asked me which aromatherapy I wanted while I was getting my MRI. And then they asked me which Pandora station I wanted to listen to. And I, I don't know if I'm proud or horrified, but I listened to Van Morrison. I was my

Eva (19:09): Interesting choice.

Kristen (19:11): When the ladies were hanging down in the, in the handcuff holsters yep.

Natasha (19:15): Yeah. I mean, at least I didn't choose Leonard Cohen. That was my next go to

Eva (19:22): The question I'm asking is how often do mammograms miss? And you're saying the answer is the MRI can tell you the thing that the mammogram will miss?

Natasha (19:32): Yeah.

Eva (19:33): Then I start wondering like if you're listening and you're wondering, what did my mammogram miss, because something else is giving you a signal. Can you go pay for an MRI out of your pocket just to get one?

Speaker 1 (19:45): You know, I think that's so outrageously expensive, but in theory I would imagine so. But to reassure people who are listening, it's a small number that are missed on mammograms. It doesn't mean stop getting mammograms by any means.

Kristen (20:03): Absolutely.

Natasha (20:03): Yeah. Yeah.

Eva (20:05): Are there still unknowns that you're waiting?

Natasha (20:08): Yeah. So the only in person appointment I've had was with breast surgery, which seems a very strange place to start to me, but met a lovely, lovely surgeon. I was already completely in love with the nurse practitioner there because the day she got my pet scan results, she called me, it was about 6:30 at night. She got the results. And I thought that was one of the kindest things that has happened on this process so far. And I didn't know her personally, so it wasn't like a friend calling me. And I think that's when I burst into tears just because knowing that it hadn't spread to my liver and my everywhere else, where cancers can go. Breast cancer's classic for going to the bones. And I'd had some backache and I was convinced it had gone into my spine. The truth was I'd spent two weeks in bed freaking out.

Natasha (21:05): So I'd probably, I'd given myself some kind of muscle cramp or something . So then I met, like I said, I met with the nurse practitioner and the, the breast surgeon. And there was a clinical trial that they're interested in me participating in and as a clinician and as a scientist, that's something I'm very, very open to helping with. A lot of, if you look at any of the guidelines from the national comprehensive cancer network, the NCCN, they will say the best treatment for almost any cancer is a clinical trial. And a lot of people have a misunderstanding that a clinical trial, like they're going to be the Guinea pig. It is illegal on a clinical trial not to offer the gold standard of care. So there's no placebo in cancer treatment. You cannot say, you know, we'll give Jane treatment and we'll give Jill nothing and see how people do. We know how they do. The person who gets nothing won't do well at all.

Natasha (22:03): So it was an interesting clinical trial. There was definitely some interesting parts of it whereby you know, I would get an MRI every month during treatment to check if the chemo was working. Whereas generally it's about every three months. So I liked that idea. I'm still not a hundred percent convinced that I want to do the trial, but I have my appointment with the oncologist next week. And I'll listen to, to that pitch. And partly I changed my mind. One of the oncologists I work with at San Francisco general that I ran it by, she had some really great questions for me to bring up with the oncologist that I meet next week.

Eva (22:45): Is the trial something you can tell us about? Or do you wanna just,

Natasha (22:48): Yeah. I can try and explain it. So there are, they took an, a huge number of core biopsies from this tumor almost to the point where I said, you know, take a few more and you're gonna biopsy it away. They took some biopsies. They're sending the biopsies away to really look at it at a very sort of molecular level to look at sort of the personalized medicine treatment. Let's not just give patients what everybody gets. They get the Taxol, they get the AC chemo that, you know, has been talked about. With all these new medications that are coming out. Is there something that will specifically target Natasha's unique, genetic and genomic makeup of her tumor?

Eva (23:35): So they needed a lot so they could run DNA, I assume?

Natasha (23:37): Yeah. Yep. And so that's interesting to me. And then when you get randomized, like every trial has what they call arms. So it's like a group of patients will go in group A, a group will go in group B, a group will go in group C and it's not randomized. Meaning that a computer has just said, just picked people and thrown them in a group. It's actually targeted to which group they think my tumor will respond to the best. So the clinical trial it's actually called, I spy the letter. I, and then spy. It's definitely, you know, for people listening, look it up. There's a lot of information on the web about it. And basically the group one. So arm A, as they call it, is the control group where people get the gold standard treatment that any oncologist should offer any of us with breast cancer.

Natasha (24:32): Arm B and arm C are throwing in, I've been talking about this with friends, they throw in what they think is their magic potion. It's a stage two clinical trial, so it's already known that this is safe in humans. I think, guess they killed a bunch of rats on the way up to this and then again, arm three is another magic potion. There are some interesting differences. You know, Kristen and I were talking, that the Taxol, which is the backbone of all first line breast cancer treatment is Taxol. But in the arm two and arm three, it's actually a pill form of Taxol, which I was initially excited about because I thought it meant fewer trips to the clinic. But, you know, I did talk to somebody at work and said, what do you think about the pill version of Taxol? Is it as we call it bioavailability?

Speaker 1 (25:21): So is it as effective as the IV? And she sat and she thought for a minute and she said, "that's the assumption". I'm like, I don't know I want my treatment based on assumptions. So we'll see. And then, you know, actually something that I, I forgot to mention. So my cancer type, so people are probably familiar with the estrogen progesterone. So I was ER, PR negative, but HER2 positive. So that buys me quite a long treatment with herceptin. So that will be part of any of the arms of the clinical trial, if I go ahead with it.

Kristen (25:58): Can you talk about what herceptin is quickly?

Natasha (26:03): I don't know if I can.

Kristen (26:04): Okay. No, that's okay. No, that's okay. I didn't know if you knew what it was. Yeah. It's a type of chemo, right?

Natasha (26:10): Yeah. It's specifically for patients who are HER2 positive.

Kristen (26:13): Got you. Yeah.

Eva (26:15): Yeah. Well usually when we don't know something, we try to find a doctor to tell us about it. So maybe at some point we can go in into Herceptin mm-hmm

Speaker 1 (26:24):

Eva (26:25): I wanted to ask you, when you were talking about clinical trials, I was thinking about the HIV clinical trials, cuz I had read a book the way that the gay men were treated during the aids epidemic and that they withheld a lot of the good medication from them at the time in the name of preserving the arm.

Natasha (26:45): Right.

Eva (26:46): And so the contrast between then and now, I think you probably know a lot about that history. Did the sacrifices that those people made at that time contribute to the way those trials are run now in a positive way? Just trying to find some kind of silver lining to that.

Natasha (27:05): Yeah. I mean, I think the public has become so much more aware of their right to understand the treatment better. I hope so. And I hope anybody listening to this really gets that, that you are the boss of your own body and um, nobody should force you into doing a clinical trial. One of the most important documents in my work as a nurse practitioner is the form of informed consent. And to me, the most important word and that is informed. But if, as a patient you do not feel informed, then you don't sign that form. And there are a lot of resources online where it can help you have the right questions to ask your cancer doctor, to make sure that consent is truly informed.

Eva (27:55): That's the world I live in, but in plastic surgery. So,

Natasha (27:58): Oh yeah.

Eva (27:59): The person that I, who is my mentor professionally, was the first person to standardize informed consent and plastic surgery in the 1980s.

Natasha (28:09): Yeah. It's so important.

Speaker 2 (28:11): And then she made it available to all of her colleagues. Yeah. So they all used her informed consent system. They still use it mm-hmm 34 years later.

Natasha (28:19): Yeah. And too often a piece of paper is shoved at a patient as a stack of like 60 pieces that she has to sign and that goes, it doesn't get read. So ladies out there get your information.

Kristen (28:31): Well, fear drives a lot of that.

Natasha (28:33): Absolutely. Yeah.

Eva (28:35): The book I was thinking of was How to Survive a Plague by David France, which was like just a total page turner and I couldn't put it down.

Natasha (28:42): Yeah.

Eva (28:44): So we've covered how you found out you had it and what you know, up until this point.

Speaker 1 (28:52): mm-hmm

Eva (28:53): We can move to what's coming next, but have we missed anything in the timeline that we still need to cover?

Natasha (29:03): Medically? No. I mean, other than, as this became my full time job, in addition to having a full-time job of trying to make things happen in time. I was, I don't know if guilt is the right word, I just know, there's that emoji where somebody's like slapping their head like, oh duh, did I really do this? Just the fact that I let this go for three months, I felt really kind of stupid, you know? And again, like if a patient had come to me and said, there's a lump under my arm, I would've sent them straight for a biopsy. And I just sat on it for three months. But as I've sort of been intimating, I had a lot of other things going on in my life at that time. So the fact that it didn't hurt it, wasn't bleeding, it wasn't festering. I was like, I think I'll just leave it.

Kristen (29:50): So you and I have talked quite a bit, but I just wanted to know if, do you have any burning questions for me as you go into this process? Not that I have any knowledge that you don't, all I have are experiences.

Natasha (30:04): And I think to me that's more valuable than knowledge. I've got a shelf full of books on oncology and breast cancer, but I haven't opened a single one of them. I've talked to you and I've joined a wonderful Facebook group of women going through this. Well, actually I do have a question of given that I'm looking at probably starting chemo in two weeks. What should I be doing now? How can I build myself up? Pre-treatment acknowledging that it might knock me down. And this comes with a confession that I did tell Kristen yesterday, is that at a friend's house the other day we ordered McDonald's so probably not much more of that, but I'm, I, I don't know if I should be running five miles a day, eating organic quinoa, getting drunk and going to bed.

Natasha (30:51): Like I, I'm not sure what's the approach for the, the next two weeks.

Kristen (30:56): You know, it probably sounds like what a nurse practitioner or a doctor would say, you know, physically is hydrate, hydrate, hydrate. Keep moving and do whatever you can to make yourself feel good. And that doesn't mean don't have a glass of wine, if you want a glass of wine. Don't have a burger, if you want a burger. Treat yourself because your taste buds are gonna change and you're not gonna want some of those favorite things. And so treat yourself like a princess or a queen. I would say within a couple of weeks of chemo, get your haircut short and you already found your community. I'm so excited that you're taking a little trip down here and we get to meet. That's such a nice bonus, but I'm glad that you're treating yourself that way.

Kristen (31:42): I didn't do those things. I sat in fear, but I, I spent primarily the entire month alone. Mm-hmm, waiting for chemo and going to appointments and learning.

Eva (31:54): Calling people and asking for sooner appointments.

Kristen (31:56): Yes. Calling . Yeah. Harassing the, the call center. I found pretty quickly who my, who my crew was gonna be. And I think the bonus, if there is one in your divorce situation is that those people were, were there to rally around you in that situation. And so you already have that. And the biggest thing I can say is allow yourself to feel what you're gonna feel. And if you need someone to talk to, or to cry to, or to laugh with whatever, just call.

Natasha (32:34): Thank you.

Kristen (32:35): I imagine just wrapping yourself in this, It's like you're emotionally, physically, spiritually, whatever you do with that, wrapping yourself in that coziest blanket and being true to yourself.

Natasha (32:52): That's such great advice for me because what I've gone to so far is practicalities. So if you saw my kitchen pantry, you'd think we were expecting an earthquake because, which we might be sorry, San Francisco, that just, that would be the, oh my God. You know, I'm, I'm aware that when I get very stressed and anxious, I stop eating and so cooking can feel like an impossible task. So my pantry is now full of microwavable brown rice and, you know, microwavable little sachets of, of curries and beans and things like that. And I'd lost a lot of weight through the early days of the separation and have been quite significantly underweight for a while. And I I'm just trying to pack it on. But yeah, the practical side, you know, I've got, I was telling Christine this really amazing product, that's sort of a, a filofax for those old enough to remember what a filofax is,. Paper.

Natasha (33:55): It's like a filofax for cancer patients. And it's really incredible where you can list everything and it just, it gives this sort of extra level of control. So I've been trying to control everything with food.

Eva (34:08): Is this something you can find online somewhere?

Natasha (34:10): It is. It's called, um, CanPlan, I think can that cancer CanPlan and it's like $40 and it's a really, really incredible product. I was skeptical. And then when it arrived, I was like, no, this is perfect. Somebody has really, really thought this through. But yeah, I haven't quite got to the emotional side yet.

Kristen (34:29): And, and it'll come when you least expect it. And I'm glad that you have those, those mini meals because I was very realistic as well. And I knew that I needed people to help me with that piece, that when I'm under stress, I'm not going to take care of myself and eat in a healthy way.

Speaker 1 (34:49): I had people who chopped up a bunch of stuff for salads for a week and brought me them in different containers to mix up, that type of thing. We've already talked about the mittens and the booties.

Natasha (35:03): Right? Yeah. Yeah. And I think I've decided against using the cold caps to preserve my hair. It's been mentioned a number of times from, um, the nurses at U C S F. And I think just some of that is from like having seen patients struggle with it. I think it looks like a lot of hassle and a lot of added anxiety in the chemo appointments. This is ridiculous. And I don't mean that I'm looking forward not to having hair, but there's a way of like, back to my idea of like, I don't want to hide this. It doesn't need to be a hidden disease.

Kristen (35:37): There's a certain bald badge of honor that you get , you know, through going through chemo. Yeah. And you do think it's never gonna grow back, but I save so much time still my hair isn't long enough to where I have to brush it. So there's a certain amount of liberation. And I've understood that we carry stress and trauma in our hair, that's something that I've been told and whether or not it's completely true, I don't know. But that to me was shaving off all of the trauma and letting it go. And it was a, um, actually a friend of mine, meditation teacher did a, um, a ceremony around it and it was beautiful. So, you know, embrace the good and the bad.

Natasha (36:22): Yeah.

Eva (36:24): So your next event or milestone, is that the beginning of chemo and,

Natasha (36:30): Well, no, I'm not even there yet. So Wednesday of next week I meet my oncologist for the first time, um, and it took me, I really had to advocate for the oncologist that I wanted. And again, like there's my privilege that I could actually do that. I knew who I wanted. And then I would expect she'll lay out the treatment plan. I'm sure we'll talk about the clinical trial. And then, then I take off to San Diego to look at Kristen's boobs and then I'll come back and I would expect the following Monday or Tuesday, I'll start treatment. And close on my house because I've managed to get the loan to buy my husband outta the house.

Eva (37:10): Excellent.

Natasha (37:11): Thank you.

Eva (37:14): Yay. Would you like to talk to us again, after you meet the oncologist? Or

Natasha (37:18): Yeah, that would be great.

Kristen (37:20): Well, I am so glad you reached out and took that step because a lot of people wouldn't.

Natasha (37:27): Me too. You know, we've talked about the background, but I, I was having a dark, dark weekend. I went to bed. I thought I would listen to some breast cancer podcasts like you do, and searched in the podcast. And I rejected a number of them within about three seconds with like, peppy. I was like, no, not feeling peppy right now. And I just, every episode you guys had, I just binged the entire weekend and yeah. It's one of the, the most informative podcasts. And also you guys have such great voices and such a great rapport, it's like, I want to meet these women anyway. .

Kristen (38:04): Thank you. Well, and that right there, that statement, that is the whole reason we do this... To be that companion for you when you needed something, you know? Yeah. And thank you so much. I am I'm, I've got chills and I've got tears in my eyes and I'm just so grateful that this is able to help you and that you are willing to, to share your story in such a candid beautiful way.

Natasha (38:32): Absolutely.

Eva (38:34): Thanks Natasha.

Eva (38:38): Thank you for listening to breast cancer stories, to continue telling this story and helping others, we need your help. All podcasts require resources, and we have a team of people who produce it, there's costs involved and it takes time.

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Kristen (39:16): They'll get notes and thoughts from me related to each episode and links to the most useful resources for all the breast cancer things. So if you have chemo brain, you'll be able to just go read your email, find anything we talked about on the podcast without having to remember it.

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Eva (39:41): Thanks for listening to Breast Cancer Stories. If you're facing a breast cancer diagnosis and you want to tell your story on the podcast, send an email to I'm Eva Sheie, your host and executive producer. Production support for the show comes from Mary Ellen Clarkson. And our engineer is Daniel Croeser. Breast Cancer Stories is a production of The Axis. the