Nov. 17, 2022

Day 160: Cancer Free But Now What?

Day 160: Cancer Free But Now What?

It’s been two weeks since Natasha’s lumpectomy and because no evidence of cancer was found during surgery, she has been declared “cancer free” by her surgeon.

It’s been two weeks since Natasha’s lumpectomy and because no evidence of cancer was found during surgery, she has been declared “cancer free” by her surgeon.

The day of surgery was long and a little emotional from the anesthesia, but recovery has been less painful than expected. Food has flavor again and in her words, “it’s about bloody time!”

The road ahead includes more hormone blocker infusions every three weeks, radiation in two weeks, and going back to work next week.

As she problem solves how to fit daily radiation into her work routine, she recognizes a new and deeper understanding of the fear and challenges her patients feel.


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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 Vengler (00:03): I'm Kristen 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 Sheie (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 Vengler (00:23): Her name is Natasha. This is a story about what happens when you have breast cancer told in real time.

(00:34): First of all, how are you feeling?

Natasha (00:36): I'm really tired. It's been two weeks. And today, I had no energy. I'm not waking up refreshed. I think the first week post surgery, because it was nowhere near the drama that I expected it would be.

Kristen Vengler (00:52): Right.

Natasha (00:53): So, I felt fine and I was doing great and I had very little pain. But I know from myself that anesthesia can really bring me down, and I think maybe it's that, maybe I'm just tired, I'm not sure. But I had a weepy weekend and was on the phone with my mom for mom therapy, and it was just... I don't know. It's the anesthesia or-

Kristen Vengler (01:18): Really, could be your body. Visually, you're seeing that you should be better, right?

Natasha (01:25): Yeah. You and I had talked, in the days after my surgery, that I had this huge dressing that they had put on kind of the size of a sheet of paper, and they said, "Oh, you can take it off tonight or tomorrow, whenever you..." It's not really a dressing. We've just put something on there for you to go home with. And I kept it on for I think almost a week because I was really scared of seeing what they had done. I'd had some conversation with my surgeon immediately post surgery, but I've no recollection of anything from that at all. So, finally when I took the dressing down I was like, oh, that's really actually insignificant. I mean, there's a big scar right under my boot, but they've done such a good job that you actually can't see it just from face on.

(02:16): And then I think what's bothering me more, that I actually didn't realize I had an incision there, but is the one under my armpit. And they've stitched it so beautifully, the plastic surgeon, that I really didn't see it until about three or four days ago, partly because it hurts a little bit to raise my arm, so I'm not doing it that much, but that's bothering me a little more now. And just this sort of strange feeling down the side of my arm and under... that sort of sensitive skin under my arm down to my elbow. So, it's-

Kristen Vengler (02:49): Did they take a lymph node? They took the whole lymph node?

Natasha (02:52): They took three, actually. They took the sentinel, and then two neighbors.

Kristen Vengler (02:57): Okay.

Natasha (02:58): Which I don't know if three is a lot compared to what other people have taken or... I have no idea. Because I think because I only found this second incision, I haven't really been babying that arm, and I think I should have been a little more careful. I had all the instructions, but I mean, not that I was carrying heavy things, but I was just like, oh, it looks like it was a small surgery. I think I'm fine. And today or this morning, I moved over in bed a little bit, and I was like, ow, that actually really hurt.

Kristen Vengler (03:31): But let me back up just a second, because we talked to you the night before surgery.

Natasha (03:36): Right.

Kristen Vengler (03:36): And you were expecting to spend the whole day there. And so who took you? How was that pre-surgery? And how are you feeling? Did you sleep the night before?

Natasha (03:47): I was ready for it. It felt like this is everything that chemo had been leading up to, but I took an Uber there. And it was a long day but it was kind of an interesting day. So, just before the surgery, what they did was they numbed me up and they took a biopsy needle and they went back into the area and they put these little sort magnetic markers in there. It looks like the lead of a pencil, and they put it right next to the other markers that were there. And it took a while and was a little bit... I think they numbed me up with some [inaudible 00:04:25], but it was just... And I always loved to watch it on the screen. So, I'm watching this needle kind of poking and digging around.

(04:33): And then when that was done, I had a mammogram to check that everything was in the right place, and that felt a little strange, to be having a mammogram. And then the worst thing they did was, directly into my nipple, they pushed this blue stuff that basically follows the lymphatic system and shows the surgeon which is the sentinel lymph node in the cluster. And that was just a very odd thing to... You just watch them do it. It's like, are you really going to put that needle into my-

Kristen Vengler (05:06): It was a big freaking needle. Am I right?

Natasha (05:09): Yes, yes it was.

Kristen Vengler (05:09): Yeah, that was the weird needle procedure Eva and I were talking about.

Natasha (05:12): Yeah.

Kristen Vengler (05:12): Yeah, that was ridiculous.

Natasha (05:14): Yeah. And no numbing, no nothing. It's just like, "Oh, we're just going to jab this." And there was a little bit of me afterwards, it's like, why couldn't you wait until I was asleep to do this? I didn't understand why I had to be awake and looking down as they stuck a needle in there. And then because I've worked in surgery, I'm always fascinated by all the toys that they've got to play with. So, I lay down... And I think it, because I was actually going to be intubated, I was going to be on the breathing tube, they started me with the gas, you know, take a couple of breaths, and obviously I was out within seconds. It was about a two and a bit hour surgery, which is longer than I expected. And coming round is always such a weird thing. I was fighting it, but I had no pain when I came around, which was really nice.

(06:02): And they were very careful about nausea. They gave me a lot of anti-nausea medicine. They gave me that little patch that you put behind your ear. It was very thoughtful. And then I do remember my surgeon coming. And I couldn't remember what she said, but I'm remembering what I was saying. "Did you get it all? Did you get it all?" And she said... I think she said something like, "We did our best." And I said, "Well, if you didn't, will you go back in and get the rest," or something like that? And she's like, "No, no, no, we don't do that." And in this sort of drowsy state, I'm like, "So, do I need radiation?" She's like, "You're just coming out of surgery. Let's talk about that-

Kristen Vengler (06:39): Let's make a plan. Come on.

Natasha (06:41): It was great. And then there's that sort of moment when you realize... So, I'm trying to text Antonio who's coming to pick me up. And it was very sweet. They'd given him sort of updates through the day. And I look back on the text that I sent and they make no sense whatsoever. And anesthesia's so funny, because then all of a sudden I realized I'd cleared it and I was actually... It was time. I was good to go. So, then they do that embarrassing thing of pushing you down in a wheelchair into the parking lot, and then you sit and wait. And he brought me home. And they'd called some medication in that he went to pick up, but I really didn't take very much. I took a couple of ibuprofen. I never really had that much pain. I slept. I think I was home by about 4, 4:30, slept the rest of the day, and felt kind of fine the next day, actually. I was so anxious about the surgery and it was really such not a big deal as you had predicted.

Kristen Vengler (07:37): Well, no.

Natasha (07:37): I mean, it's a big deal in one way, but I didn't wake up with, you know, bleeding into the bed covers with, like, hooked on Oxycontin. It was like take an ibuprofen.

Kristen Vengler (07:48): Well, and that's the thing, is that every surgery is different. When your surgeon gets in there, that's when they make some decisions.

Natasha (07:55): Right.

Kristen Vengler (07:55): And so I couldn't tell you to not be afraid, but it was kind of a fancy biopsy, right?

Natasha (08:01): Yeah, yeah, if that. What did they take out? They took out the three lymph nodes, and then just sort of a bit of a mess of stuff where the tumor had been.

Kristen Vengler (08:14): So, you got the pathology report?

Natasha (08:17): I did get the... Well, I had been looking for the report and looking for the report, and it actually didn't load into the UCSF MyChart, which concerned me.

Kristen Vengler (08:29): Sure.

Natasha (08:29): But I had a Zoom meeting with my surgeon and she came on screen. She's like, "Have you seen your pathology?" And I was like, "No, I haven't." And basically everything they took out, there was no cancer in any of it. The chemo took care of everything. So, the lymph nodes were benign, the sort of little bit of tissue where the tumor itself had been was benign, and there was really nothing else concerning.

Kristen Vengler (08:58): Wow.

Natasha (08:59): Yeah.

Kristen Vengler (08:59): Wow.

Natasha (09:00): Yeah. And she actually... She was great. She looked me square on. She said, "You can now consider yourself cancer free." And I just started crying. I couldn't-

Kristen Vengler (09:08): Of course, you did.

Natasha (09:10): Yeah.

Kristen Vengler (09:10): Because you've spent eight months. No, I'm sorry, six months.

Natasha (09:15): Six months.

Kristen Vengler (09:16): Six months, not knowing what you were going to hear, not knowing what was growing, what was shrinking, what was happening in there.

Natasha (09:23): Right.

Kristen Vengler (09:24): And so people know, from my story, how I reacted and how I was feeling during that time. But can you talk about a little bit of that journey in going from, "Holy shit, I have cancer" to "Holy shit, I don't have any cancer."

Natasha (09:42): I mean, it's one of those strange things, and we talked a little bit about this, that I never really felt that I did have cancer because I never had pain from the tumor. It's hard to explain what I'm trying to say. It was like I was never really aware of what I was being treated for. I knew intellectually, but I didn't start to feel better when I was getting chemo. I actually felt worse. And so that was a surreal moment. Also knowing that I still have treatment that I'll be going through until March of next year. So, it's like, yay, I'm cancer free, but I'm... But I have a meeting with radiation oncology, but I'm pretty sure radiation's going to be part of the package, and I have to be on the hormone blockers until March.

(10:30): So, it's not that I walked away from the surgery without anything else. And there's little bit of me, it's like the whole thing feels like a dream. Did this really just happen? Yes, obviously, I mean, I couldn't be happier that she came on and said cancer free, but I never really felt like I had cancer in the first place.

Kristen Vengler (10:53): I really feel like it's all we can emotionally do, to go to those appointments and to make the decisions and to do the things we need to do. And I think we think we're processing it, but we're just getting brave enough to go do the things we need to do that are recommended by the professionals.

Natasha (11:16): Yeah. And I think angers me about breast cancer as a disease, I mean, partly what you were just saying, is like it can be so different for so many people, but I think it can also just be so insidious. It's like it can just be there growing. A lot of other cancers, like a stomach cancer or... There are more symptoms. Breast cancer doesn't really throw you out many symptoms to deal with. So, in a way, that's why, when I look back to January, when I was diagnosed, it was like, it was it just because there was a painless lump under my arm. That's it.

Kristen Vengler (11:55): Right.

Natasha (11:56): I hadn't lost body weight. I wasn't in pain. There was nothing else than this lump that saved my life. But I think of other people who have their disease diagnosed on a mammogram where it's even less obvious. That must just be so strange and kind of hard to accept and believe. It's like, prove to me that this is cancer.

Kristen Vengler (12:23): The other thing that is insidious about it is that yours was not found on a mammogram.

Natasha (12:28): Right. Yeah. I always forget that little bit of... Yeah.

Kristen Vengler (12:33): And so I'm glad that you got it taken care of. And regardless of how big yours was, if you're cancer free or whatever, you still are going through this. And those feelings that you're having, there's only a small group of us that have those.

Natasha (12:51): And I'm worrying about recurrence already, and I've only been told for a week that I'm cancer free. And I'm thinking, well, it's really good that the chemo works so well, because when I need it next time... I've already given myself a recurrence.

Kristen Vengler (13:05): It's like there's something sitting on your shoulder that you're just like, I want it to go off but it's never going to get off.

Natasha (13:11): Yeah. I've had a lot of the conversation in my head and with... They didn't get it all. There wasn't any to get. When they went in and the surgery, there was no cancer there. And so the logical question is, so what on earth are they radiating? But it's like, I don't want any, oh my God, I should'ves in five years time. And the chemo concoction that they gave me worked. I have no regrets about the surgery. I'm just going to do as I'm told.

Kristen Vengler (13:42): Because if you were going to be starting radiation, it's usually what, four to six weeks after surgery?

Natasha (13:49): That's my understanding, yeah. And I don't know why I love this, but my radiation oncologist is also female. So, I had a female oncologist, a female surgeon, and now a female radiation oncologist.

Kristen Vengler (13:59): I love that.

Natasha (14:00): Yeah, me too.

Kristen Vengler (14:00): I love that.

Natasha (14:01): Yeah.

Kristen Vengler (14:02): When is your radiation appointment?

Natasha (14:04): It is in about two weeks.

Kristen Vengler (14:09): I'm betting... And you being a nurse, I found it fascinating, I kind of pretended it wasn't happening on me, and found it fascinating what they were doing, and that there was a physicist that was in there. And it's all nuclear medicine. It's kind of cool.

Natasha (14:27): Yeah, it's very nerdy.

Kristen Vengler (14:28): It's super nerdy.

Natasha (14:30): Just six weeks sounds like such a long time. I mean, six cycles of chemo felt like a long time, but every day for six weeks, I can just imagine being halfway through week two and just being like, "Oh my god, how much more of this?" And I'm going back to work next week, so I'm going to try and fit it in hopefully, like the end of the work day so I can go to work, then get the therapy and then go home.

Kristen Vengler (14:56): But that's what I did.

Natasha (14:57): Yeah.

Kristen Vengler (14:58): I wanted it at the end of my day, so when I was finished, I was finished.

Natasha (15:02): Yeah, me too.

Kristen Vengler (15:03): So, quick question on that. Because you work in the hospital, is there a facility where you could go directly there from where your office is?

Natasha (15:14): So, the hospital I work at is the poor county hospital. So we don't do radiation there, so I'll be going to the new fancy hospital at Mission Bay, which is where I've had all my treatment.

Kristen Vengler (15:22): Okay.

Natasha (15:24): I'm happy to go there. And I also... Knowing myself, if mine was first thing in the morning, I would find every excuse not to go.

Kristen Vengler (15:34): Yeah.

Natasha (15:35): So, if they did me at a 7:00 AM, I would miss some. I know that. And I don't have a car. I have a scooter, so it's going to be scooter and bicycle to get there.

Kristen Vengler (15:48): Wow.

Natasha (15:49): Or friends.

Kristen Vengler (15:49): Yeah. Well, people take you too. The thing that kept me going was that... It wasn't like I could call in sick for it. They just tacked it onto the end. I had 30 treatments regardless. So, I could either get it finished by a certain date or I could just keep tacking it onto the end.

Natasha (16:08): That's good to know. Okay, so you can't escape it.

Kristen Vengler (16:12): No, it's just going to come later.

Natasha (16:14): Right.

Kristen Vengler (16:15): And so radiation is next. You've got an all clear.

Natasha (16:20): I did.

Kristen Vengler (16:20): You have beautiful hair.

Natasha (16:22): It's starting to grow back in all the places that it fell out of. So, I've got stubbly legs. It's interesting just to watch... I had no idea how slowly hair grows, because I haven't had chemo for... I can't remember. It's been at least two months, yeah.

Kristen Vengler (16:40): And my armpit hair has still not grown back much.

Natasha (16:44): Yeah, no, mine hasn't even started to grow back. That's interesting. I'd forgotten about armpit hair. That would be nice if it stayed away.

Kristen Vengler (16:51): I know. I know. I'm going to be interested to know if your armpits stop or start stinking, because I had the case where on the side where it was radiated, I had no odor. And then the other one, I would take a shower, I would scrub, I would whatever. And I would get out, keep brushing my teeth, and I'd be like, "You smell a field worker. What is going on here?" It was ridiculous. And then just in the past couple of months, the sticky arm stopped stinking and the other arm came back with a vengeance.

Natasha (17:26): The one thing for me that has come back, which is such a joy, slowly, slowly, my sense of taste is coming back. So, I'm enjoying eating again, things have flavor. That's been really, really nice. About bloody time.

Kristen Vengler (17:40): Oh, yeah. Yeah. Did you get a break at all from your hormone blocker infusions with the surgery?

Natasha (17:45): No.

Kristen Vengler (17:46): No? Okay.

Natasha (17:47): No, everything's scheduled, just that happens every three weeks. So, I guess it's next week. I'm not sure. I can't really keep up.

Kristen Vengler (17:53): How has that been going to that without the chemo and the DigniCap?

Natasha (17:58): It's a much easier day. It's still a longish day. I think each one is half an hour, and then they have to wait for it to come up from pharmacy, and I have to go in earlier for blood work. So, it's still a good half a day. Yeah, it does a little bit of the trauma of like, oh my God, I'm still in this infusion center. So far, touch wood, I have not had any side effects from just getting the hormone blocker. It's been, no, pretty benign. It's actually... Ridiculously, it's like it's three hours where I just sit and read a book, which is kind of nice.

Kristen Vengler (18:38): I am so relieved that you're not having side effects from that because I remember that that was what was giving you so much trouble and dehydrating you and all of that. And I was thinking, oh my gosh, I hope she doesn't have to keep going through that. It's like this reminder that, oh yeah, I'm still doing something that's making me feel sick.

Natasha (18:54): Right.

Kristen Vengler (18:55): And then there'll be a point where you'll get to get your port out too, which is going to be... That's going to be fun too.

Natasha (19:01): It's so funny. I've almost forgotten that I have that. I went out at the weekend. And we almost had some sunshine in San Francisco, so I had a shirt where the port was very obvious. And at one point, I was like, oh, am I going to change? And I was like, nah, no, I'm not, actually. I almost want somebody to ask me what it's for.

Kristen Vengler (19:19): Little badge of honor.

Natasha (19:21): Yeah, and to normalize it. Yeah, absolutely.

Kristen Vengler (19:24): Yeah. Oh, wait, how were your bras? We talked about bras.

Natasha (19:29): Oh.

Kristen Vengler (19:30): How'd that work with a lumpectomy?

Natasha (19:32): So, not great because the scar is right under the boob, and the bras that I bought, they don't come far down enough. So, anybody listening, the ones that they suggested I buy, the Fruit of the Loom, which are kind of soft, nice cotton, they come way too close to that boob fold, so get something that's lower.

Kristen Vengler (19:53): So, maybe something that's more like a bralette or almost like a sports bra, like a soft sports bra that comes down to the middle of your ribcage.

Natasha (20:03): Yes.

Kristen Vengler (20:04): They have those tops that are super supportive. Was it a big deal for you to be able to attach it in the front? Did you have any limitations with that, I guess?

Natasha (20:14): No, I didn't. And I've got almost perfect range of motion from the beginning with my right arm just because they didn't do that much. I'm still wearing them. They're nice to wear at night. I'm still wearing it at night. But yeah, don't do what I did, anybody listening, because it's right on the fold and it's not a great idea.

Kristen Vengler (20:37): Yeah. And everybody has... For people who have not gone through a lumpectomy, they're in different spots. They go in where the tumor is.

Natasha (20:46): Yeah. Yeah.

Kristen Vengler (20:48): But it's fairly common for them to do something with a lymph node, like to check it or something like that.

Natasha (20:54): Yeah.

Kristen Vengler (20:54): I haven't, I don't think I've heard of anybody who's had a lumpectomy who hasn't had something out of their armpit where it's either a biopsy or a lymph node taken.

Natasha (21:03): But if you hear that it's going to be under the boob, it's a pretty big incision. I would say it's probably... It's like four or five inches. It's almost the length of the boob, but it's right... You can't see it because the boob folds over it.

Kristen Vengler (21:18): So, what you're saying is that your range of motion wasn't so bad that you couldn't have slipped over maybe a sports bra.

Natasha (21:25): Right, exactly.

Kristen Vengler (21:27): Well, the last thing I wanted to touch on is that there's been some emotions. What was going on?

Natasha (21:35): It was strange. It was a lot of why me. Coming on the tail of my husband walking out, why me? Almost like the word cancer just repeating itself over and over in my head, just, you have cancer, you have cancer, even though... I'm trying to think if this weekend I had even... Yeah, I'd had the phone call that said, you're cancer free, but I'm still tripping on this, and just fear and a sense of I have a great group of friends and meeting youth through this, people to talk through this, but it's lonely still.

Kristen Vengler (22:19): That's what I was going to mention, is that you and I have the common thread of being single and living alone, basically. Yeah. And that feeling of there's not that one person, that when I'm feeling this way, I can just let it all go and sob into his or her sweater.

Natasha (22:44): For me, it feels like the safety net has gone. Losing my marriage, and then what, for some people, is the worst thing that can happen. And I feel I've actually got off really lightly with this. I really do. But still, it's like... It's very hard to put words to. I think that's why when I found your podcast, it's like, oh, here's somebody putting words to what I'm trying to say.

Kristen Vengler (23:12): Yeah. I'm so honored that you reached out and that you trusted me and Eva and have been so vulnerable. There hasn't been a question I've asked that you haven't been willing to answer. So, thank you. Thank you for trusting me.

Natasha (23:31): I was thinking earlier today, actually. So, I'm now cancer free. I didn't want this relationship to have to end just because I don't have cancer anymore.

Kristen Vengler (23:45): Well, you're stuck with me.

Natasha (23:47): But also, I'm like, how interesting is my story now? I'm just getting a hormone blocker and radiation. Maybe I need to invent some side effect.

Kristen Vengler (23:57): No, no, no. But I'm super relieved and happy that you don't have a long story, and we still have to get together.

Natasha (24:09): Yes, we do.

Kristen Vengler (24:10): And for those of you listening, Natasha and I have never met in person. She lives up in the San Francisco Bay area and I live in San Diego. And you've heard Eva on here periodically, and she's in Austin. So, through the power of Zoom, we've been able to do this podcast. And I said it was the last question before, but this is more a... It's a huge difference between you and I, and it's also I think what's extremely intriguing and troubling about your story is, from the nursing angle, how has this been? And having been able to let yourself be the patient?

Natasha (24:47): Not entirely. And in some ways, it's been to my advantage, and in some ways, it's been a disadvantage. I've had to be reminded by my providers that I'm their patient. Definitely at the beginning, I think I was very much the nurse taking care of it. I think I've got better as time's gone on, but I'm going to work next week. I'm going back to work, and I work in palliative care with cancer patients. And people are feeling protective of me already. It's like, if it's too much, we can switch you to something else. I mean, it's going to be different, and I don't know if it's going to be... I mean, in some ways I know it's going to be harder because I'll be, again, talking about cancer all day, but with my own sort of perspective there too, but I hope that it doesn't become all about me. I hope I've been able to process enough that I let patients have their own story as well.

Kristen Vengler (25:54): Well, I think that the difference, and it's a huge difference, is empathy versus sympathy. Because with empathy, you've been there, not exactly where they are, but those feelings and some of those procedures are there or have been there. And so you'll get back to a routine.

Natasha (26:15): Yeah, I'm looking forward to that. I mean, I feel very lucky that I've had the disability, time, and the finances to take this time off, but it's time for some routine. I do well with routine.

Kristen Vengler (26:30): Yeah, I think you'll be surprised how much different you'll feel.

Natasha (26:33): Yeah.

Kristen Vengler (26:35): But can you remind us again what palliative care is? And what does it look like when you're having a conversation with someone?

Natasha (26:42): So, palliative care is about quality of life, to give it a broad definition, a lot of people mix it up with hospice. And it's like, all hospice is palliative, but not all palliative is hospice. So, I do a lot of symptom management. What's great about the hospital is anybody who has a stage three and above is, from the oncologist, is usually referred to me. And so I will see the patient from when they arrive with all those questions that, unfortunately at an early point we don't have the answers to, but I have the space and the time for people to ask the questions. My new appointments are always an hour, and then follow up. If I think somebody needs an hour, it's going to be an hour. So, it's a very interesting work from... There's the purely medical side, when it's like, okay, you've got terrible nausea, let's see what we can do to manage that.

(27:48): And then while we're doing that, just the question of, how are you coping with all this? A lot of oncologists care, they just unfortunately don't have time to ask, because the answer, it's often a really long answer. And then I do a lot of advocacy for patients to make sure their appointments are happening on time, that the things aren't falling between the cracks. The patients who come to San Francisco General are often... It's Medical Medicare. So, it's poor patients, a lot of people struggling with financial insecurity, food insecurity, a lot of people with very insecure housing, where they'll say, "Cancer is the least of my worries. My kids and I are sleeping in the car." So, getting social work to really help, just really giving somebody a space. And I work very closely with a chaplain who is non-denominational and is just great at of holding space for people to have their fears of death and dying and what does it mean to them, and just struggles with struggles with the why me, whatever can improve somebody's quality of life for as long as they have. And we don't know.

(29:07): It could be a stage four, and 10 years later, you're still around, and I hope so, or it could be a really aggressive stage one that we can't really control. I also work in the inpatient. If I know any patient from my clinic who've been admitted, I'll always go and see them if they get admitted. Or some patients will come in through the emergency room with excruciating pain, and oh my God, we've just found that they've got metastatic bowel cancer and they're going to need your help in clinic because we're not going to keep them in the hospital. And four o'clock, most days, when I can get away with it, I take ice cream to people. It's my ice cream rounds.

Kristen Vengler (29:48): I love it.

Natasha (29:49): Yeah. It's just... I think having spent two weeks in that scary zone where I didn't know what was going on, whether I had a cancer that could be treated, where the cancer was, having gone through that, I think it makes me more accessible to patients. Not that it's something like, "Oh, let me tell you about my cancer story," but there's just sort of a deeper understanding of that sort of existential fear.

Kristen Vengler (30:22): And I am so happy you're on this other side. You're not done.

Natasha (30:28): No, no.

Kristen Vengler (30:29): You have... And again, like we've talked about before, you're never done.

Natasha (30:33): Yeah.

Kristen Vengler (30:34): But you have such a good team that's going to keep monitoring you.

Natasha (30:38): Yeah, no, they're great. And whether they mean it or not, when I went in for my surgery, the nurse who was doing all the pre-op, and she looked at who my plastic surgeon was and who the surgeon was, and she's like, "You've got the dream team." And they may say that for everybody because I can't imagine them dissing their own staff before somebody goes into surgery, but it felt great. And I think all surgeons are dream teams. I think they're amazing.

Kristen Vengler (31:04): Yeah, the miracles that they work.

Natasha (31:06): Yeah.

Kristen Vengler (31:07): I love you and I'm so proud of you that you're done, and I couldn't be happier that you're cancer free.

Natasha (31:12): Thank you. You too.

Kristen Vengler (31:13): I'll talk to you soon. Bye.

Natasha (31:14): Okay. Bye, love.

Kristen Vengler (31:16): Bye.

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