Don't hit me!

Used to be if you claimed that you got cancer because you were hit there (wherever on the body there was), people would scoff. Now researchers are looking into the possibility that a blow or wound could lead to cancer, and paying special attention to the cells around tumors. If the cells are weak, they allow the cancer to spread. You can read about new respect for old ideas here in the New York Times.

Living While Black/O, the Tribune

[Is this breast black or white?]

For a while, there's been the term DWB--Driving While Black--African-American drivers report being pulled over for this offense. Now we're finding out (again) that it's dangerous to be LWB, especially in Chicago. Today's Tribune reports on a study that showed that the African-American death rate from breast cancer in 2005 was 99 percent higher in Chicago than for white women, a fivefold increase since 1990.
This is not new. Chicago Magazine reported on this a couple of years ago, or a version of this--a previous study by the same researchers at the Sinai Urban Health Institute. The same bad news: Chicago is worse than other cities. The gap between black and white health here is widening. The Trib is careful to quote an African-American doctor who partly blames the victim--the problem is partly lifestyle, she says; partly it's poverty; and partly lack of knowledge about health.
Hmm, says Cancer Bitch to herself, why is it that this is the only person in the story who's identified by race? Could it be that everyone else quoted is "normal," i.e., white, and so doesn't have to be identified?
The health study was published online yesterday in the American Journal of Public Health, the Tribune avers. It identifies Steve Whitman (no race), director of the Sinai Urban Health Institute as the author of the study. The conclusion drawn from the study, according to the journal abstract: Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible.
You can find the abstract of the piece here. You can get the article for 30 bucks from the AJPH site.
Along these same lines, but even more depressing: A Rush University Medical Center study published in November showed that Chicago's black and white breast cancer mortality rates were the same in 1980. This was also in the Chicago Magazine story. From that piece, by Shane Trisch:
We've arranged things in this country so that the darker your skin, the shorter your life will be--Steve Whitman.


Soy has been another one of those things--unclear whether it's bane or boon to women whose tumors feed on estrogen. The reason is that soy has estrogenic properties. Thus, Dr. Keith Block, who practices integrative medicine, advises women with estrogen-positive tumors to eat soy no more than two to three times a week. On the other hand, the very mainstream oncology bigwig from Fancy Hospital said that women with estrogen-positive tumors could have soy a couple of times a day. He said this at the Town Hall meeting this fall, but he didn't quote any studies that led to his recommendation.

Now comes a study from Vanderbilt and Shanghai. Researchers looked at 5,000 women with breast cancer. They found that those with the highest intake of soy protein had a 29 percent lower risk of death during the study period, and a 32 percent lower risk of breast cancer recurrence compared to patients with the lowest intake of soy protein. Women with both E-positive and E-negative tumors had positive results.

“I would say that this study would indicate that women with breast cancer should (eat) soy products,” says Dr. Xiao Ou Shu, an epidemiologist at Nashville's Vanderbilt University Medical Centre who authored the study. “I think that it shows there is protection there.”

So bring out the edamame, which I'd been eschewing all this time, and let's cut up the tofu, which I've always maintained is the original manna.

How do you solve a problem like tamoxifen?

I take it and don't think about the side effects very often because I can't bear to. The oncologist said to take it so I take it. I know there's a chance of developing endometrial cancer, so I get checked out by the Smooth Gynecologist Who's Younger Than I Am But Acts Like She's Older. What tamoxifen does seems so direct: It cuts off the absorption of estrogen, which is what my tumor grew on. In August the New York Times told us that tamoxifen can cause the formation of a non-estrogen-sensitive and hard-to-treat tumor. And Tuesday's NYT tells of omission bias, a term for the phenomenon whereby a person worries more about a low risk of harm from something they do than about a higher risk of harm from doing nothing. In the story, the worry was about tamoxifen. The Times reported that women are afraid to take the drug. Out of 632 women in a study, 80 percent said they were worried about side effects, and most of the women said they wouldn't take tamoxifen.
At rowing practice (indoors) Monday night someone was complaining about tamoxifen's side effects, including weight gain. I feel like a fool to take it. But the good it can do is significant. Though now I read now that there's a chance of cataracts and blood clots. My polycythemia vera puts me at risk for clots, and I take hydroxyurea for the p. vera, even though the drug could cause leukemia, because the condition itself could cause leukemia, and my inhaled steroid for asthma could combine with my other drugs to make me even more liable to develop blood clots. But the hydroxyurea lowers my red blood cell count, which makes me less likely to have a clot. Red blood cells are those round red spheres in the image above.

It is a difficult, difficult thing to be alive.

The papers pile up and the news gets worse and there's another surge, the world is dangerous and the wind chill here at the moment is four below. The house is creaking from the cold. I'm wearing a flannel nightgown from Austria and L is asleep between flannel sheets with sketches of snowmen on them.

On the one hand, on the other hand, on the other other hand.

[shrug image from]

Ducks in a Barrel

OK, it's not fair to attack the Tribune twice in a row--it's too easy, but I had to point this out. An editor was sleeping when working on an astute review of Jonathan Safran Foer's book, Eating Animals. The lede is: Looking forward to your turkey dinner? Think twice. It's time, argues Jonathan Safran Foer, to stop lying to ourselves.
How smart do you have to be to know that you need to change this if it's running the Monday after Thanksgiving? Why not change it to: Did you enjoy your Thanksgiving turkey?... The editor had heard that you're supposed to cut from the bottom, but I guess never learned to change the top if it's not applicable any more
It was written by LA Times Staffer Susan Salter Reynolds, published in the Times on Nov. 8, when readers (there must still be readers, right?) were looking forward to their Thanksgiving meals. To read the original review, click here.

All solutions are individual.

That's what I learned from reading the Chicago Tribune today, specifically, a little wrap-around page touting itself. But wasn't it preaching to the choir? It should be boasting to people who don't have the newspaper in their hands.

First problem: A pizza deliveryman was mugged and carjacked. Solution: "...people from as far away as South Korean and Germany sent in more than $16,000" so he could return to his pizza route, which I would bet doesn't supply him with health insurance. But that's not mentioned.

The second problem: A reporter wrote about a family living in a storage faculty. Solution: the "generosity of friends, family and Tribune readers touched by their troubles" provided money to put the family up in a motel.

Whew. Problem solved. Don't look to the left or right to see if there's anybody else homeless.

Third problem: A kid was in foster care and he got himself more than $1 million in scholarship offers. I remember reading about this kid. It was a feel-good story. It was the kind of story to make you think, Why don't all the kids pull themselves up by their bootstraps?

Also of note: The Tribune tells us it is "[s]hining a light on the persistent and often ignored problem of youth violence...." Persistent? Yes. Ignored? By whom? Not by the kids who are killed each year and their families. Not by people who live in violent neighborhoods.

Everything was off today. Ask Amy said that doctors should always be called by their titles because of their expertise. Hell, I'm an expert and my students call me by my first name. This is America, talk-show-etiquette America, where everyone has a first name but maybe not even a last. I call some of my doctors by their first names. Sometimes I have to force myself because of all the years of calling doctors doctors but if they call me by my first name, I do the same, especially if they're 20 years younger.

But we subscribe and we read the Tribune and it does give us some information about the city. And suburbs. Even though it is so so embarrassing how every other story seems to be based on a TV show. We can't be treated like real adults; we have to be able to relate our news to broadcast (or digital?) fictional dramas and comedies. We are amusing ourselves to death.

Which is the title of a book by Neil Postman, in which he writes: "What Orwell feared were those who would ban books. What Huxley feared was that there would be no reason to ban a book, for there would be no one who wanted to read one. Orwell feared those who would deprive us of information. Huxley feared those who would give us so much that we would be reduced to passivity and egoism."

...and now Pap smears...

["Curiouser and curiouser."]

Holy Toledo! Now we don't need Pap smears as often. Have we been (the equivalent) of navel-gazing in the past, getting ourselves checked out too often? Our society is paranoid about cancer. Screenings make us feel like we're doing something, like we're being (that horrible corporate word) pro-active. As Sen. Arlen Spector told the New York Times, That is curious.
The past recommendation had been for young women to have Pap smears three years after becoming sexually active. Now the guidelines are to wait until age 21, no matter when a girl started having sex. The numbers bear this out: only two new cases per million teens (15 to 19 years old) per year in the U.S. What if you are one of the two girls? Everything makes sense, statistically, but not if you're one of the statistics.
The old tension between the individual vs. the community.
Cervical cancer is slow-growing, and pre-cancerous conditions often don't turn into cancer. Surgery for the pre-cancerous conditions could lead to premature births, says the Times.
This is the same thinking that went into the decision to recommend mammograms less often. The mammograms picked up non-cancerous tumors, which led to biopsies and more tests, for nothing, I guess you could say. And anxiety. Everyone is worried about our anxiety. I think most women would vote for a little surgery and anxiety so that their anxiety about cancer would be lessened. At least most women who have the choice.
A student of mine this fall thinks she has mono but can't afford health insurance or a visit to a doctor. She assured me last night she was no longer contagious. But she wasn't absolutely sure about the diagnosis, which had been delivered by a guess-timating nurse.
We all need the health insurance coverage that our federal elected officials get. Don't we deserve that?

Everything They Told Us Is Wrong...

...or at least it seems so. Now they say that self-exams aren't necessary and that you don't need a mammogram until age 40. I'll have more about this. In the meantime, you can read the study and recommendations here.
If you found your cancer via under-40 mammogram or breast self-exam, please comment! Of course, all comments are welcome, by survivors and non-, as long as you're a real person, not a computer program.
Meanwhile, Our Bodies Our Blog concurs with the guidelines, and explains why, providing important history and perspective, with excellent links. Check it out.

Horrors! Woman touches own breasts on TV!

{Sorry--I couldn't figure out technically how to capture a still of the woman examining her breasts. It is much less sexy than this stock picture from }

It took a while, but I finally found the un-blurred video from the ABC News local WJLA in Washington, DC., which showed--horrors!--a pretty 28-year-old woman with cancer (before surgery) examining her small, perky breasts. Reporter Gail Pennybacker, thank goodness, warns us beforehand that "Images are going to be graphic." Gosh!! Nipples!! Nipples, which are obscene, are going to be shown. Lock up your women and children! Your children will be traumatized by seeing nipples! Of course, they are not affected by daily, hourly images of war and mutilation--or "action" movies and videos.
The news station brought this all on itself by happening to air this during sweeps week, when viewership is measured. If WJLA wanted to be as blameless as Caesar's wife, it would have run this earlier in the month.
Meanwhile, conservative groups have criticized this display. The AP tells us: The Parents Television Council reacted cautiously to news of the series but suggested it saw the potential for problems.

"We hope that WJLA-TV is not using a crucial public health issue as a ratings stunt, and that the station has fully considered what is appropriate to tell this important story to the public in the most suitable manner possible," the group said in a statement. That might mean different versions of the story at 5 p.m. and at 11 p.m., it added.

I wish the reaction were more outlandish so I could make fun of it. It's also annoying that that first thing that pops up on the PTC web site is a study that says that images of violence against women are on the increase on TV. Really, how can anyone find fault with an organization that cares about violence against women (at least representations of it)? If you read further, you find the organization is Mrs. Grundy-ish (Does anyone say "Mrs. Grundy" any more?) about "indecency" and cursing and sex on TV. Yeah, a lot on TV boils down to immature sniggling about sex, but that's not my most pressing issue.

It's easier to make fun of another critic, Concerned Women for America, which strives "to protect and promote Biblical values among all citizens - first through prayer, then education, and finally by influencing our society - thereby reversing the decline in moral values in our nation." But reading about them makes me more scared than sarcastic. Separation of Church and State, anyone?

[Mrs. Grundy by Walter Crane, 19c]

[not to be confused with Miss Grundy of Archie Comics, pictured at top]

Breast cancer is one thing I do think about a bit. And I was and am lax on breast self-exams. Mostly, the hoopla about the news report is serving to remind me that I need to examine my right breast, that I shouldn't just rely on the six-month mammograms and doctor exams. So ladies, go to it! See instructions and illustrations at this site.

Click here for visuals that are really adult and graphic and for which our country is to blame.

"Murder is a crime; describing murder is not. Sex is not a crime. Describing sex is. Why?" Gershon Legman wrote years ago. I know, I know, this weakens all of the above, because my implied argument is that showing a breast exam is not a smutty, sexual event, but it seemed apropos.

Breast Cancer Drove Her to This

[Imagine a red slash through the smiley face]

The pinkness and cheeriness of the breast cancer industry made Barbara Ehrenreich note the pervasiveness of exhortations to be positive. This is from Saturday's New York Times, by Patricia Cohen:

.....In “Bright-sided,” [Barbara Ehrenreich] traces the roots of the nation’s blithe sunniness to a reaction against Calvinist gloom and the limits of medical science in the first half of the 19th century. Starting with Phineas Parkhurst Quimby, perhaps one of the first American New Age faith healers, she draws a line to Mary Baker Eddy, the founder of Christian Science; the psychologist William James; Ralph Waldo Emerson; Norman Vincent Peale, who published “The Power of Positive Thinking” in 1952; and the toothy television minister Joel Osteen, who preaches the gospel of prosperity.

To Ms. Ehrenreich, the reliance on one’s personal disposition shifts attention from the larger social, political and economic forces behind poverty, unemployment and poor health care. “It can’t all be fixed by assertiveness training,” she said wryly.

Ms. Ehrenreich found that the more she listened, the surlier she became. All that shiny optimism, she said, was “like sitting in a warm bubble bath for too long.” Luckily she found other churlish comrades, scholars and doctors who were similarly skeptical of undimmed positivity.

“We began to call ourselves the Negatives,” said Micki McGee, a sociologist at Fordham University and the author of “Self-Help, Inc.: Makeover Culture in American Life.” The group would meet on occasion and discuss their research and the news of the day. The thread of positive thinking that runs through self-help culture says, “If you dream it and believe it, it becomes reality,” Professor McGee explained. “That kind of thinking contributes to the economic bubble that we just saw explode in enormous ways. Barbara’s take on it is very important.”

Richard Sloan, a professor of behavioral psychology at Columbia, is a more recent member of the Negatives. He has written at length about the absence of scientific evidence showing links between prayer and healing in his book “Blind Faith: The Unholy Alliance Between Religion and Medicine.”

“There is some relatively recent evidence of the benefits of positive affect, but not the simplistic approach that is advocated by coaches that all you need to do is be happy,” he said. “There is no evidence that trying to put on a happy face makes a difference.” Rather, those who are characteristically more optimistic may have an advantage over those who aren’t, but, he said, “you just can’t change who you are very easily.”

Janet Maslin didn't like it so much: (My linking thing isn't working.)

Self-conscious Narrators

L took the picture of me above and it didn't seem to look like me. It reminded me of young Leonard Michaels (1933-2003), whom I talked about in class on Thursday. He was known for reading student stories aloud and then stopping when they ceased to hold his interest. Then he'd ask the class to explain why.

I always get him mixed up with Leslie Epstein, who is alive and well and heading the MA-turned-MFA program at Boston U. They don't look alike, though, do they?

I was writing stories in little pieces when I was a grad student writing by instinct. At Iowa I was like an outsider artist with no training in fiction. I had a bachelor's degree, a GRE score but I didn't have any of the basics that everyone else had. I didn't know that a story should have suspense at the beginning, I didn't think about whose story it was, or if the ending was "earned." My friend E read my story in little pieces and said I would like Leonard Michaels' collection, I Would Have Saved Them If I Could, which had stories in pieces. Was I even thinking I might learn from him? Was I looking for a kindred spirit? I don't remember.

I don't remember when I read Leslie Epstein. Maybe it was before I went to grad school. I read The Steinway Quintet plus four. I still remember a line from it, more or less: "Gentlemen, I believe that these are not Jews," said by an elderly member of the quintet when they're about to be robbed. Maybe I read it because I was reading books by faculty at the schools I was applying to. I didn't apply to Boston, though, because it required the literature GRE, and the deadline was late, so I figured I'd wait to see if I heard from any others, and I was accepted by others before the BU deadline. I was successful at applying to grad schools, which in my day was a simple enough thing, once you got your transcripts and test scores sent in, and got the recommenders to send their letters, and all you had to write about yourself was maybe a line or two. Plus of course you sent two stories. Nowadays, you have to write a personal statement and there are dozens upon dozens of MA and MFA programs, and all around the country kids are wringing their hands and worrying and asking each other teeny tiny questions on the MFA blog. They make the Kremlinologists of old look like pikers. There you can also find aceptance rates, so you can figure out if you want to apply to a selective school or very selective school. It is all quite scientific. (Whenever I talk about the olden days, I remember this from a high school play, rendered in a shaky old voice: "I can remember when there were Indians in this very territory. We had to put boards across the street to walk across."--Long Christmas Dinner, Thornton Wilder). And I wasn't even in the play.

There are at least three MFA guidebooks around and several blogs. If we'd had the technology back then in the olden days, would we have asked the same questions and worried as much as these young'uns worry now? I don't know. I do have to say that I don't like the sample personal statement provided on the MFA blog. In case anyone wants to know what I think, after having participated in more than 25 admissions committee meetings, I will tell you: Tell me what you read and what you've learned from what you've read. Tell me what you admire. Tell me how your work has grown up to this point, and tell me how you want your work to grow in our program. Be specific. Do you want to work on point of view, for example? If you're trying to brown-nose us by mentioning our faculty, please be sure to spell their names correctly.

I saw Leslie Epstein on a panel about bad Jews (I think; or did the panelists all claim they were bad Jews?) at a Tikkun conference in Boston in 1990 or 1991. I think it was Epstein. It could have been Michaels. You can read about "Lenny" in Wendy Lesser's book Room for Doubt. Also on the panel was E, my Iowa grad school friend.

I think I got into MFA program(s) because I submitted a story in second person. This was years before Jay McInerny's whole novel, Bright Lights, Big City, was published. It was told completely in the second person. I was influenced by Mary McCarthy's The Company She Keeps, which is one of my favorite books. It's a collection of autobiographical short stories and is clever and brilliant and features a self-conscious narrator. One story,
"The Genial Host," is in second person ("When he telephoned to ask you to do something he never said baldly, 'Can you come to dinner a week from Thursday?' First he let you know who else was going to be there..."). I discovered the book in a neighborhood library in Paris in 1976 or 1977 when I also fell in love with another self-conscious narrator, Christopher Isherwood.

Mary McCarthy

Epstein grew up around LA and his father and uncle wrote the screenplays forCasablanca and Arsenic and Old Lace. Leonard Michaels is the other one, the one who went from East to West, not the other way around.

The Need for Health Insurance

At present the United States has the unenviable distinction of being the only great industrial nation without universal health insurance.

Health insurance is like elementary education. To function properly, it must be universal and to be universal, it must be obligatory.

Certain interests which think they would be adversely affected by health insurance have made the specious plea that it is an un-American interference with liberty. According to the logic of those now shedding crocodile tears, we ought, in order to remain truly American and truly free, retain the precious liberties of our people to be illiterate, to suffer accidents without indemnification, as well as to be sick without indemnification.

It is by the compelling hand of the law that society secures liberation from the evils of crime, vice, ignorance, accidents, unemployment, invalidity, and disease.
--by Irving Fisher, The Progressive, Jan. 1917

Maybe I'm wrong.

Maybe I'm wrong about the reason the original oncologist didn't give me Cytoxan. Maybe there was another reason, which I forgot in my chemo-brain-ness. But I must have been wrong for two years. In June 2007 I wrote: L reminded me that I'm not taking Cytoxan, which is one element of the usual ACT chemo brew--Adriamycin, Cytoxan, Taxol--because I have a platelet disorder. Cytoxan could cause a blood clot, which is more dangerous than the cancer.
I am confused.

Please vote.

Dear Cancer Bitch readers,
I will relate a scenario to you and I'd like you to vote on my response.

Today I went to a town hall sponsored by Fancy Hospital. My oncologists (past and present) were there, as well as my surgeon, and they all spoke and the audience asked questions.
I went to the mic and asked two:
1. For chemo, I took Adriamycin and Taxol, but not Cytoxan, which usually goes with them, because of the fear of blood clots. Is there any research on the effect of using just Adriamycin and Taxol?
2. What is the research about drinking milk with Bovine Growth Hormones?

I'm going to 2. first. The only person with a clear answer was the nutritionist on the panel, and she said she recommends that you avoid milk with BGH. My surgeon said that organic milk is expensive.

Now for 1. My erstwhile oncologist said that he doesn't know why someone wouldn't prescribe Cytoxan, but he thought that a chemo regime without it would probably be effective. (I wanted to ask, Then why do you include Cytoxan, if you can do without it?) So here's the question. I really wanted to say, You prescribed the chemo regime without Cytoxan. (Because it's true.) But I didn't say that.
Should I have? Please vote in the Comments area. I have a blood disease that gives me, in essence, "thick blood," which makes me more likely than the average person to get a blood clot.


D called at noon when I was finishing up my morning sun salutations and we decided to meet for lunch at 12:30. I rushed out and got into L's car because it was closest to Clark Street and would get to Ben's Noodles faster. I'd gone about 20 feet when I noticed some noise and bumping. I pulled into the nearest alley to check it out. As I was getting out, a guy ran into the alley and told me I had a tire as flat as a pancake and to park my car on the left and he would fix it. Then he disappeared behind a gate.

It was true--the tire was flat and the guy returned and fixed it. Just like that. He was wiry and a cop. He showed me the badge to prove it. He's a detective in the organized crime division. He showed me more proof. I believed him before he showed me anything, but I think he wanted me to be street-smart and require that he show me proof. He was quick and said he owns the apartment building across the street from us, and he was doing repairs and improvements. He was fast-talking. When I told him my last name, he asked if I had good holidays, and said his wife was Jewish. I said we would have invited them to our break-fast (dinner when you break the Yom Kippur fast) but he said they go to the Standard Club. I asked if his wife was German Jewish. He said Russian. Ashkenazi. This is a standard misconception. I asked the German question because the Standard Club was started by German Jews--Jews who came to the US in early waves, were often assimilated and middle class. You used to have to be a German Jew to join, I'm told. I'm part of the unwashed masses who came over in the first quarter of the century. I mean my grandparents and great-grandparents were. We were the Eastern European Jews who were typically more religious and poorer than the (snobby) German Jews. And Yiddish speaking. And historically the Eastern Jews (Ostjuden) have embarrassed the Westjuden, because we were unassimilated and allegedly smelled of garlic and the shtetl. I grew up without being able to discern the difference between us and them, but my parents were quite aware. And in Germany, especially, in the late 19th century and early 20th, there was a big divide.

Now the misconception: Most of us from Northern Europe are Ashkenazi--those from cities as well as shtetlach (plural of shtetl, little Jewish town). That means we speak Yiddish (again, our foreparents) and eat certain holiday foods--gefilte fish, matzah balls, tsimmes (carrots), kugel (noodles), apple haroset on Passover. (Hmm, these foods seem Eastern European. What a coincidence.) We are the Jews you know, because we vastly vastly outnumber the Sephardic Jews in the US. They are generally from Arabic countries, speak Ladino instead of Yiddish, don't divide themselves up among Reform, Conservative, and Orthodox branches, and have cooler traditional clothes--shinier, for one. This is a generalization--there are Sephardic Jews in and from Spain and Italy, the former Yugoslavia, Bulgaria and other Christian countries. Many or all Sephardic Jews descend from Spain, which had a little thing called the Inqiusition where they killed all the Jews they could.

Jewish Yemenite bride

A great story about the tension between the assimilated and the unassimilated is Philip Roth's "Eli, the Fanatic."
Roth is writing about the Western Jews (assimilated Ashkenazi Jews) and Easterners (unassimilated Ashkenazi Jews who survived the Holocaust and are religious). Europe is, after all, east of the US.
And us Ashkenazim, you may recall, are more likely than the Sephardim and the general population to have the BRCA gene mutations linked to breast and ovarian cancer. Whether we're assimilated or not.
I was walking later this afternoon to L's car and it was raining. It was medium-heavy, not oppressive. A woman with a large, deep umbrella gestured for me to get under it with her. We agreed that the rain was muy frio. I said something about invierno, hoping it meant winter. When we got half-way down the block, she wanted to walk me across the street to my car but I said it wasn't necessary. After I started the car, I realized I should offer her a ride. I drove up next to her, rolled down the window, asked her, but couldn't get her attention. I turned and drove away.
I was running late. If I was a nicer person I would have made sure she saw me and understood my offer.

Where's your wife?

Cancer Bitch recommends that you do not ask this question. She has asked it twice in the last 2 years and it was awkward in the first case. So why did she ask it again? She is a slow learner.

In spring or summer of 2007, she greeted one of her husband's co-workers at a fundraiser by asking where his wife was. He said, I don't know, and Cancer Bitch quickly understood that something was amiss. She asked her husband L, Why didn't you tell me? and he said he'd just found out himself. L is never the bearer of good gossip; he doesn't ask enough questions. The co-worker and wife are still separated.

At the Kol Nidre service at the hippie congregation, the rabbi asked everyone to introduce themselves to their neighbors. The man in front of her turned and they realized they knew one another. One of Cancer Bitch's pre-Prozac boyfriends (read: angst-ridden relationship) was friends with this man, M, and Cancer Bitch would always talk to the wife L when they ran into one another. Cancer Bitch remembered the wife describing how she photocopied her dissertation at her husband's office and sent out copies of the manuscript to agent after agent. Or was it publisher after publisher? And it was published. L sang in Hebrew and Yiddish and had red-frame glasses and a New York accent. Her husband told C Bitch: She passed away. Four months ago.

After services M said that a year ago she'd had a seizure while singing in California and they'd found out that she had lung cancer that had gone to her brain.
She returned early to Chicago so she could sing on Yom Kippur with the hippies. She died at home, her sons sniging to her till the end.

Cncer Bitch had not heard, obviously. The family took out a paid notice in the New York Times, but not in the local papers. There is too much cancer-dying these days. There was L above; and K's wife E, who also had lung cancer; and the wife of another old boyfriend, after five cancer-free years; and her friend P's cousin is dying of ovarian cancer. There are heart problems and neurological damage and it seems that absolutely everyone is getting dental implants. This is middle age and it is only the beginning of the body's decline. Cancer Bitch has finally begun calling herself middle aged. For years and years she'd considered her mother to be middle-aged, but now that her mother is 81, she has to face facts. Sunday in Evanston Cancer Bitch walked past a house on Chicago Avenue north of Dempster and as always, remembered the time in 1980 when she went there to see about renting a room, and the guy there said that a cute Southern girl with a great accent was there first and he couldn't resist. She told this to her husband who said loyally, You were a cute Southern girl. She thinks about the Southern girl every time she passes the house but Sunday was the first time the memory was accompanied by a strong swoop of sadness: the passage of time. She thought of herself in her early 20s with her whole life ahead of her. The sadness of losing that feeling of potential. She doesn't regret her choices, except her many hours of wasting time, but she is no longer young, no longer just becoming, that's the point. Yeah yeah, there was Grandma Moses who started painting late in life, but there was also Mary McMarthy who told Cancer Bitch (in an interview in Florida) that people in their sixties and older couldn't write novels any more. She was referring to herself.

C Bitch has a novel in a file cabinet in the other room and in her computer and needs to gear gear up to revise and rework it.

The Passive Cancer Patient

She said, Did you ask your oncologist what she thought about the calcifications?
I said, No, I forgot.
Then I thought better of it and thought maybe I had asked. I said, I think I did. I keep forgetting about it.
She said, It seems you either are at zero, not worrying at all, or way up here, thinking about dying. You need to be able to tolerate a 3, to do what you need to do.
She said, It takes energy for you to forget about it, because you're not really forgetting, it's in the back of your mind.
She told me how she went to four doctors who all said she didn't have cancer. The breast surgeon told her she was a hysterical female.
She waited a month or two and finally insisted on surgery and of course it was malignant.
She reported the doctor to the board of whatever, but there were no consequences.
The form the Breast Experts gave me in June and December and in June again said "calcifications that are probably benign." The radiologist in December said I could have an MRI if I wanted but warned me about false positives.
Now, she said cancer begins as calcifications, if it bothers you, you need to do something about it. She said, It's labor-intensive for them to read MRIs, that's why they don't like to do them. And: it's labor-intensive to do a biopsy using ultrasound and they don't make much profit from it. She said Fancy Hospital was on the TV news because they had a backlog of mammogram patients and they didn't have enough radiologists though they promised to get more.
A local TV station reported earlier this month that at Fancy Hospital, women have to wait between 8 months and a year to schedule a mammogram. ABC7 checked with six other hospitals in the area and all were able to schedule a mammogram within a few weeks.
Fancy says that there's a shortage of radiologists.
But it seems to be restricted to only one block in the city.
Calcifications can be malignant--they don't turn malignant, they can begin that way. "Probably benign" can mean that there's an 80-98 percent chance that they're benign. MSN reports: Please note that some specialists may prefer additional testing (breast MRI, biopsy, etc.) while others may be more conservative. A lot has to do with your personal or family breast health history.
I still think the calcifications are not cancerous. But I don't know for sure. I emailed my surgeon's nurse and asked for an MRI. She wrote back today and said that she sent over the order, that I should call the MRI division and make an appointment, that it would take a few days to get precertification, but that insurance might not pay for it.
Because it's elective, I suppose. But it's not like I'm doing it for vanity. And it's odd--usually the doctors prescribe extensive tests to CYA.
There's a blog written by The Assertive Cancer Patient.
This is not that.

Talking to a stone

I am the stone. I've heard over and over that exercise is important in keeping breast cancer from coming back. I even have an exercise book especially for bc survivors. I haven't looked at it for months and months. But I keep getting emails from our rowing coach, J, about exercise and breast cancer and on the ROW website she has links to articles that extoll the value of exercise in keeping metastasis at bay. Finally it sunk in. Monday I went to rowing practice, and Tuesday and tonight I rowed at the YMCA. I also rowed last week. I know I should cross-train but I like doing one thing over and over and over. (That must be why I created a workshop called The Joy, Joy, Joy of Repetition.) Just about everybody there except me has an iPod. I look at the TV when I'm sitting back up and leaning back. I watched part of The Office last night, and when it was over I switched it to the PBS station. Uh oh. PBS didn't have closed captioning. But I was already strapped into the rowing machine so I just watched people's mouths move. They were talking about Milton Bradley, the out-of-control Cub and I could presume what they were saying. I am interested in him because of his name. You know, like the board-game company.
Tonight I watched the Nature Channel on Colony Collapse Disorder. I learned that in Sichuan in China, where a pesticide has wiped out the bee population, people do the pollination. It's very labor-intensive, as you might imagine, and involves sticks with feathers on the ends.

One solution to the disorder is to bring in Africanized bees that are resistant to CCD. But those bees are aggressive and who knows what they might do? or what a hybrid bee would be like?
We should all be as busy as bees, and develop our own waggle dances. Or just pull back and forth, back and forth to get our heart rates up.
Alas, it appears that bees don't listen, either. New research shows that bees observing the dance often ignore it.
I need 150 minutes of exercise a week to be called moderately fit. So far I've had about 75, not counting yoga, and it's only Wednesday.

[The increasingly rare bee suit]

What's on my food?

I found a new-ish (launched this summer) website that tells you what pesticides you're ingesting with each piece of fruit or vegetable. Kind of; it tells you what was on a sampling of foods in 2007, and what damage those pesticides can do. It's part of the Pesticide Action Network. (Oh no, does that mean we gotta do something and not just complain??)


Swedish researchers found that eating foods that were high in acrylamide did not cause breast cancer. To wit: During a mean follow-up of 17.4 years, a total of 2,952 incident cases of breast cancer were diagnosed in the cohort. In multivariate analyses controlling for breast cancer risk factors, no statistically significant association was observed between long-term acrylamide intake (assessed at baseline and in 1997) and the risk of breast cancer, overall or by estrogen receptor (ER) and progesterone receptor (PR) status.
Interestingly, in looking through media reports about acrylamide, I've found many hostile responses in the Comments sections, some calling the info "junk science." How valid are the accusations? Who knows? But it seems that some researchers consider the substance to be a danger.

Hello, Sweet; Good-bye, Crunchy

First the sweet: A pot of bright tomato-red-orange lilies appeared in one of our flower beds yesterday. It seems new, since the tag is still on it, and we plan to plant it. Our across-the-street neighbor denied any knowledge of it. Did someone receive the plant and give it to us because they assumed we'd give it a good home? Someone once told me of a Dutch Jew who had to leave a hiding place (all during the Nazi occupation, but you knew that) and walked through a neighborhood and rang the bell on a stranger's house. The Jew asked the stranger to hide him/her and the stranger did, but asked, Why did you pick my house? The Jewish person said: Because your roses look so well-tended.

There is no real moral to this story because some horrible people have beautiful gardens. But still a nice story.
Then the crunchy; farewell to crunchy, crispy, roasted, well-done, crackly and blackened. I've heard for years about the dangers of charred food. Now here's a new twist, today's Tribune tells us. If you cook high-carbohydrate food at high temperatures, a substance called acrylamide is formed. When rats eat it, they develop tumors and neurological problems. The Swedes have been concerned about this since 2002, when its food administration reported on high levels of acrylamide in high-carb foods, and a link between acrylamide and cancer in lab rats.
The California Office of Environmental Health Hazard Assessment tells us that it's possibly carcinogenic to humans.
The bad news is that you can't just eschew french fries and go about your merry way. According to the Office and the FDA, reports the Trib, of 100,000 people who ingested coffee once every three days in their whole lives, one person would develop cancer from acrylamide. Pie, pizza, breads, popcorn and sweet potatoes are also culprits. So are potato chips.

In 2005, the state of California sued chip makers Heinz, Frito-Lay, Kettle Foods Inc., and Lance Inc. for not having warning labels on their bags. A year ago, the companies settled out of court by paying $3 million in fines. They also pledged to cut down the amount of acrylamide in the next three years.
The Trib advises: Think golden yellow instead of golden brown, pre-sock potatoes in water, don't store them in the fridge, trim bread crusts, toast lightly
, and eat fewer processed foods and a balanced diet with lots of grains and fruits and vegetables.
As always: be a vegan or vegan-ish, avoid processed foods. At least chocolate wasn't on the list.

Eat, drink, be merry and quick & get health insurance

The New York Times reported today on a study by the American Institute for Cancer Research. Conclusion: Women can cut their risk of breast cancer by almost half if they stay lean, exercise at least 30 minutes every day, breast-feed, and limit alcohol to one serving a day.
Not shocking by any means, just common sense, but because this is a study of many studies (about lifestyle), it has numbers behind it. Many numbers. It's the largest study of its type ever conducted, according to the Institute. The AICR's director of research estimates that nearly 40 percent of breast cancer cases could be prevented if women followed this prescription.
In other words, the AICR is blaming the victim. Sorta. It's so much easier to document what a person does than to figure out how exposure to pesticides and pollution contribute to tumors. Which is my theme song. But in the meantime, the AICR recommends a diet of vegetables, fruits, whole grains, beans. There was no mention that I could see of the difference between organic and conventional foodstuffs.
The AICR reported on another study that shows that pessimists and women with "cynical hostility" had a higher incidence of heart disease and cancer, and they died earlier than the optimists. Black women who were hostile were more likely to die of cancer.
I want to make fun of this report because I have a lot invested in pessimism. I also want to point out that there's a difference between hostility and negativity and I think cynicism can be a sign of intelligence. It can also be a sign of stupidity and paranoia.
How did the researchers spot the cynics? Besides hearing their frequent snorts of derision, the researchers "administered" a questionnaire, which I think means they read statements to the women and asked if they agreed or disagreed. Or it might mean that the women answered on paper. Sample statements: "In unclear times, I usually expect the best"; "If something can go wrong for me, it will." Cynical hostility was measured by reactions to to such statements as: "I have often had to take orders from someone who did not know as much as I did," and "It is safer to trust nobody."
These were post-menopausal women, mind you. Wouldn't you expect that women in their 50s and beyond would have a history of being under-employed?
It turned out that optimists lived in the western United States, had more education and money, health insurance, and attend religious services. They were less likely to have diabetes, hypertension, high cholesterol, or depressive symptoms.
Well wouldn't you be hostile if you were lacking in education and income, were jobless, didn't have health insurance and had diabetes or were depressed?
So you could say that having health insurance makes you healthier and happier.
I am cynically hostile to this report, which does not bode well for me.
At the top of this post is a photo of a skeptical woman, which is not quite the same as cynical, but will have to do.

On a scale of one to ten...

That's what they always ask you: Where is your pain on a scale of one to ten?
The question, of course, is, what's ten? I imagine ten to be Joan of Arc at the stake. A man being hanged. Amputation without anesthesia or even a bullet. I don't know ten. I don't ever want to know ten. And if ten is supposed to be the worst pain I've ever felt, what use is that? How can every patient's ten be the same?
The better scale is the FPS-R (Faces Pain Scale-Revised).

When Nurse L was trying to assess my Taxol-induced bone pain, I said it was a three. Then I described the pain to her and she said it sounded like ten. Again: compared to what?
Cruel and unusual, J mused when he was 12 and in the hospital for the sarcoma that eventually killed him. Unusual punishment, he said--they could put you in a room filled with butterflies. That's unusual.
And what's worse than a root canal is a dental implant, which I am in the middle of experiencing. On Thursday the periodontist pulled out the remains of tooth #19 (penultimate molar on the left side) in two pieces, and then drilled a hole in my jawbone and stuck a post inside.
Later the dentist will connect another post to the top of the internal post and then fashion a crown around it.

Meanwhile, my bone is supposed to welcome the new foreign body into my skeletal system. It will become part of me, by osmosis. (Not really, but by ossification.)

The periodontist gave me a prescription for 18 tablets of 600 mg ibuprofen (one refill allowed) and yes, 14 antibiotic capsules, a strange one I've never heard of: Clindamycin. It's a turquoise bullet. The last day my jaw has ached. How much? Sometimes in the whimper stage. That's the only way I can calibrate pain. First there's Complaining then Whining then Whimpering then the Fuck! stage and then Crying, though saying Fuck! and crying can come upon you at the same time. Then there's Weeping. Even in yoga I've felt that Fuck!/near-crying pain in my hips when we do variations of the lunge or runner's pose.
I had decided to call the periodontist and tell him about my pain. I would also have to tell him about the disappearance of the thread he used to make stitches. The thread was loose last night and then (as dumb as it sounds) I chewed on it until it broke and now there is no thread. It was supposed to dissolve.
I had decided to break out the codeine but after ibuprofen I'm back in Complaint only.
Elaine Scarry wrote about pain. I read some of her book, The Body in Pain, several years ago. From a quick look at reviews and summaries on line: She says that it is so very difficult to describe pain, that pain leads to destruction that "unmakes" the world.
The opposite of creative, generative. Pain is negative proliferation, creation turning in on itself, crabbed, deformed. Pain sounds a lot like cancer, like evil, the void taking over.
Pain, as Snoopy once said, hurts.
L's mother wouldn't take her pain pills at first. Then she did.
Our friend B had a hernia operation then came here a few days later. This was in spring. He wouldn't take pain medicine because he wanted to feel how strong the pain was.
I'm as curious as the next person but after I feel pain I want to get rid of it. Now. The ibuprofen dulls the ache some, but there's still the underlying pain. How much? Does it distract me? Yes. But then I'm easily distractable. Is it making me complain or whimper? In between. Maybe I will try the codeine tonight, left over from some other procedure. We do have well-stocked shelves of medicine, we have much to offer in the way of relief. And we will not be too proud to use them.
Meanwhile, my itching is starting up again, a side effect of my polycythemia vera, my blood disease. Sometimes the itching is mostly burning and it so painful and inremitting that I feel despair. Which is not a stage of pain, but something altogether different. And now I will take an Atarax and the itching will fade and disappear and I will go to sleep.

Cancer has left the family...

downtown Litchpatch far as we know. My mother-in-law's melanoma was removed from her leg, skin was grafted over it, and there's no damn cancer in her lymph notes. She's walking around and changing the dressing herself, which is good because her sister and brother-in-law are leaving today, and L left after a week, and I made a cameo appearance.
In all, we quintupled the Jewish population of Litchfield, IL, aka Litchpatch.

Sonia's Antibiotic

My mother is a subset of the category of Typical Jewish Mother--she's elegant and tasteful, The Jewish Jackie Kennedy, my cousin has called her for decades. She's as anxious and fearful as the stereotype, or more so, but she relays her doubts not in a whining, gratey New York voice, but in an olderish-but-not-creaky Southern Lady accent. The accent is not Deep South, and not light, but more medium Texas drawl. She has lived in only two places her whole life--Dallas (smaller, more snobby about its culture) and Houston (where she moved as a bride, and found you didn't have to wear white gloves as often).

The last person I met with a whiny-New York voice was a German with at least one American parent. So you can never rush to judgments with accents.

I was talking on the phone with my mother, who had just returned from a sibling arts-outing to Marfa, Texas, and I mentioned that I had a dental implant, my first, coming up later that day. She's had her troubles with implants, including one that made a side of her face swell up. The reason for mine is that a root-canaled crown fell off about a month ago and so the remains of the tooth (a shallow, uneven ring coming out of the gum like a worn-down wall) must be pulled, for about $300, of which my insurance will pay a portion. Then the periodontist will insert a metal cylinder into the jawbone, which will grow around the implant. Insurance will not pay for any of that, which is of course the more expensive part.
Our conversation ends. Then she calls back: She forgot to tell me [again, imagine the voice of a Southern Jewish Lady Mother] about Sonia's antibiotic. Sonia is her friend who had a lumpectomy many years ago and lymphoma recently. Sonia (or S) finished chemo about a month ago, about the same time that her husband died. S just went to the dentist for a cleaning and was chided in the office for not pre-medicating. The message is that I need to take an antibiotic before my dental surgery in order to avoid infection. I told my mother that I didn't need an antibiotic. When I was accused of having a mitral valve prolapse, I used to pre-medicate, but then some other doctor along the line asserted that I didn't have the prolapse. I reminded my mother that I didn't take an antibiotic before my root canal when I was going through chemo, that no one ever told me I needed an antibiotic before a dental appointment--not the dentist, not the oncologist. Undaunted, she said, Check it out. I said OK, which she knows is noncommittal.

She calls that night to see how the procedure went. I tell her that the surgery was postponed (because it happens to be true) because when I got to the periodontal office, the receptionist said my appointment wasn't on the office calendar. She said, We wondered why you were on the doctor's calendar, but not the other calendar. She wondered? If she wondered so much, why didn't she call me? The periodontal office person said she was on the brink of calling my dentist. Which, neatly enough, is how my family works, through indirection: If A is upset with B, A will automatically turn to C to discuss it, and maybe C will pass B's words along to A. I asked the receptionist about antibiotics and she said they weren't necessary. I tell this to my mother. But S's doctor..., my mother says; but everyone I talked to..., my mother says. She doesn't see that I am not the same as 80-something S, that my breast cancer is not S's. My mother was accidentally prescient about one piece of medical advice. Before I had cancer, when I was just your average gal with lumpy breasts from fibrocystic disease, my mother told me that S's doctor told her she shouldn't have soy, and therefore I shouldn't. I said no one had told me I shouldn't have soy, that my knots weren't cancerous, that there was no reason to do as S did.
And then I was diagnosed with estrogen-munching cancer, and my oncologist told me to avoid soy because it resembles estrogen.

A few months ago S sent me an article from the New York Times about eating to outwit cancer. I was skeptical of it because the author of the article asserted that cancer feeds on sugar, and no one had told me that. But then I mentioned this to an expert who said, yes, sugar causes inflammation which can lead to cancer. So score one for the Southern Jewish Mothers of Houston.

My surgery is planned for tomorrow, and I will not be taking an antibiotic beforehand. When I was in third grade or so, we had to write about intangible gifts, and I blazed forward and wrote many little essays about these gifts, and by the time I got to the fourth or fifth one, I was writing about the gift of worry. Worry (A), my mother (B) and I (C) go back a long way. Or maybe worry is (B), which my mother transmits, or worry is the medium through which other messages are conveyed. It is complicated.

My cousin (by marriage) D has created the term negative R--- attitude, to describe the fear and caution that my mother's family (the family R) carries in its genes. Forty years ago, my grandfather R told my cousin (the one who later married D), that he would pay for her undergraduate education if she would only opt for the University of Texas instead of the dangerous radical Northern school, the University of Wisconsin, where she was bent on going, and did in fact attend and graduate from. And she went to graduate school in New York City, and lived in Boston, before finally returning to Texas, with D. Luckily, her mother had married a man who was not afflicted with NRA and who calmly allowed his children to venture hither and yon. And yes, Madison was radical in those days and when anti-war activists bombed the physics building, a researcher died and four others were injured. NRA can sniff out danger. The problem is the bar is set very, very low.
Accents can be misleading. Last week a downtown panhandler threatened an 80-year-old Chicagoan with a knife before the cops shot him. I heard the older man on the radio and he said fest instead of fast, sounding to me like a guy with a Yiddish accent, like someone who came here straight from Ye Olde Shtetl. It turned out that the man left France at age 25 and his last name sounds Armenian, not Jewish. Many years ago my friend P wrote to me from college in New York about a conversation with a little old man with a Yiddish accent, and noted that there are fewer and fewer of these people and accents who are around. Which was true then, and true now, though now and then you hear a Soviet emigre with that accent. I'm not talking about a Slavic accent, but one spoken by someone whose first language was Yiddish. Which has been dying out, we've been told, for at least 100 years.

The bitch is rich!

I got my first royalty check ever today: 895 whole dollars, US.
I still owe money to the publishers of my other two books; the difference is that they paid advances. U of Iowa Press, publisher of The Adventures of Cancer Bitch, did not. So I have nearly $900 free and clear. The book is in its second printing. The only way to go is up.

Red and Black

As a kid, it seemed that everyone else had gotten the guidebook. The other kids knew what it meant, for example, when someone asked if you were a Texan or an Aggie. They knew whether it was polite to eat fried chicken with your hands during school lunch. (They did not hunch down and eat behind their lunch kits.) They knew what the raised middle finger meant ("something about those bathroom things," H guessed in 6th grade, and I wasn't sure whether he was close or not) and how the car blinker knew when to go on. They knew what game we were playing when we wore bibs called pinneys and stood in front of "goals." They also understood Red and Black, which was a ritual at summer camp, the reason red and black bandanas were on our packing list, along with t-shirts, shorts and tennis shoes.

I think the whole camp was divided in half, and we won team points by doing activities. I barely remember, but I know I was confused. I didn't understand the purpose. I have an inkling of the purpose now: It was the last week of camp, so Red and Black got everyone all excited, knocking them out of complacency or boredom; it was a way to meet kids in other bunks and bond with them; it inculcated us into the dog-eat-dogness of the Military Industrial Complex awaiting our older selves. Red stood for Red, and Black for Black--we weren't talking Socialism and Anarchy.

And yet, the paradox is that Red and Black week was all about the communal. The Red Team worked together (I guess, but it must have been unwieldy) and so did the Black. We're talking about that sacred American institution, the team. Team spirit. Team player. The alleged ethos of our camp was carved out on a board nailed over the entrance to the mess hall: God-1, You-2, Me-3. The individual wasn't that important. Your friends were. Your teammates.

I can't remember being on a team, a real team. We must have had them so that we'd know which side of the volleyball or badminton net to stand on in gym class, but I don't remember any team consciousness. At least I wasn't always the last kid picked for a team; I should have been, since I was so ungainly and confused, but there must have been girls more outree and unfortunate than myself. I don't remember suffering in that way and I carry grudges.

In high school, for the very first time in my life, I was a little bit better than some others in a physical skill. I jogged longer and faster than a couple of other girls. I collected ribbons for accrued distances. They were printed in different colors and featured a running cardinal, our school mascot. Junior year, Title IX was passed, the law guaranteeing equality in sports, and one of the gym teachers began arranging a track team. I thought for a moment of joining, but I didn't. I have asthma that's aggravated by exercise, but I also have tremendous lung capacity. I could have been a contender.

I have rowed three times now. I do not look forward to competing with other clubs. I do not care if our scull goes faster than the other one. (I'm brought out of the boat for informal races, so that a more experienced rower can help the scull move forward--or to put it another way, so that my choppy oaring won't impede movement and others can get a workout). I'm competitive but also indifferent. If no one expects anything of me I do well. The other side of the experience is the encouragement. Practices are a mix of: Perfect! Much better than last time! and imperatives: Watch M and move when she does! Put your oar all the way in the water! Bring it on in! Watch S! Take your oar out! Push off with your legs! Sweep all the way back!

I know we should all be working together; I'm not coordinated enough to do that all the time.

Have you ever been on a team before? I asked M last week at rowing practice. No, she said, and I said No too. This is rehabilitation for us Boomers Who Were Left Out. Someone else made off with our slice of the American Dream. We want it back. No questions asked.


I am sitting at the dining room table in the house of strangers who are vacationing in Oregon. I have never met them, but they left their key for me in the shed and have encouraged me to eat the perishables in the refrigerator. They took their computers with them but they've left two TVs and a stereo and just a few earrings on the earring holder in the bathroom. (Did they hide the valuable ones?) I am in Madison, Wisconsin, and this was supposed to be a getaway weekend with L. We'd planned it around a reading and workshop I did today at Gilda's Club in Madison which is really in another nearby town. Then L's mother was diagnosed with a melanoma on her leg and he went Downstate last week to accompany her to her appointment with the surgeon. He's going back on Monday so he can go with her on Tuesday to the surgery. He had too many vacation days and now he's worrying that he won't have enough. So I am on the getaway alone. I put an ad on Craig's List looking for a Madison-Chicago house swap, and was contacted by the owner of this house, who asked if I wanted to stay there, swapping cash for her house. I said yes (still thinking it was for both of us) and now I'm get-awaying by myself.

At Gilda's Club my audience was small and I wasn't sure who they were, what their backgrounds were, so when I told about having my scalp decorated, I didn't tell them that I'd had US OUT OF IRAQ painted in the middle. I was afraid of losing them. I talked about this with J this afternoon. She does programs for corporations and non-profits and says she can't be her whole complete self in these circumstances. She's right. In nonfiction workshops I talk to the students about different levels of formality and disclosure: You're more casual and intimate with your ... intimates than with your boss or with people interviewing you for a job.

I used a page from Joe Brainard's I Remember as a template. (See Brainard's photo, above.) For some reason it is so much easier to list aspects of an experience if you begin each sentence with I remember. Or, as Georges Perec did, with Je me souviens. in his book W (dedicated to Brainard). We went around the room and read from a page in Brainard's memoir, nearly every sentence beginning with I remember. When I was in Oakland I was pretty sure that my audience was the standard-issue East Bay Feminist, so that I could use words like patriarchy without explanation. Here I didn't know where we could and couldn't connect and I was surprised at myself for not knowing. I don't want to categorize people but that is what I do.Sometimes people laugh when I read from the book about it being axiomatic for liberal Jews to be Buddhist. Either they think it's so odd they laugh or else they laugh in recognition because it's so true. I've had both responses. Sometimes people laugh when I read the part about Amelia, my ex-best friend, and our rivalry and how I wanted every book in the world to be written by me alone. Sometimes they don't. Today they didn't. I am being so self-concerned here instead of quoting the moments of revelation when they read their own sentences aloud.

Before I leave Wisconsin, I hope to effect the Great Midwestern Pill Bottle Exchange. I have some empty pill bottles and I thought it would be a waste to throw them away so I advertised on Craig's List in the Free section. An artist wrote that she was interested in them, but in quantity. I put the same ad on Craig's List in Madison, because I could easily bring my empty bottles with me in the car. I heard from one Madisonian who's been saving hundreds of bottles. I hope I hear back from her tomorrow so that I can pile the pill bottles in my car and take them across state lines, where they will be welcomed.

We don't know what stage my mother-in-law's melanoma is in. The surgeon will cut down two centimeters and will test her lymph nodes. Hers is a relatively rare form, nodular, which is fast-growing. She happened to mention that a growth on her leg was bothering her when she was last at her internist's. It seemed to come from no where and we hope it will go back there soon.

Melanomas develop most often in people with fair skin, light eyes, and a history (however short) of sunburn.