When I had planned to go back to work teaching second semester, being done with chemotherapy and surgery, I expected the hardest part would be behind me.
I think I was wrong.
How was it possible, as awful as chemo was, that this seemed more difficult? Everyone said that radiation would be a piece of cake in comparison. What was my problem?
A little over a month before I went back to work, I started tamoxifen, the hormone blocker meant to help prevent recurrence for my hormone positive breast cancer. At first I only noticed more frequent hot flashes and night sweats than I had experienced during chemo. No big deal. Anti-anxiety medications, like citalopram, the one I had been taking for a number of years, being an anxious person all my life, can help with hot flashes. Great. But it also makes tamoxifen less effective. Not great. So, I had to wean myself off and the week before going back to work, stopped taking it. The intensity of the hot flashes and night sweats grew. They happened more frequently. My sleep was interrupted more and more. Then one day I woke up, and I couldn’t say how or why, but I was sad and my heart felt heavy and everything brought with it a struggle not to cry.
I had my radiation consult that week and fought back tears as they told me my first appointment would be at 9:20. And that I’d need to also start physical therapy to prevent lymphedema and that first appointment would be at 9:00. And my upcoming oncology appointment before my next herceptin infusion would be that same week. At 9:00. In my head I thought, But I’m a teacher and I don’t have any sick leave left and I’ll need to write sub plans and get a sub to go to these appointments. How was I going to do this? I got in my car and cried.
My body was so tense and several times throughout the day I’d find myself shaking. I walked through a week like this before I went back to work, hoping I would snap out of it in time.
I didn’t.
The first week back to work was one of the most difficult I can remember, and I remember the weeks of chemo and the week I was diagnosed with breast cancer. Those weren’t easy, yet somehow this felt harder. I don’t want to sound ungrateful for the good response my cancer has had to the treatment and the support everyone has given me, but going back to work, being among hundreds of students and faculty members all day long, was the most isolating feeling I experienced since first hearing the word cancer.
I was showered with kind comments of how good I looked and how good it was to have me back. I wanted to tell them that underneath my wig my scalp was completely covered in painful acne as my hair grew back, that half of my eyelashes and eyebrows were still missing, but I had become pretty proficient as using makeup to compensate. I wanted to tell them that it didn’t feel good being back. It felt scary and different. Nothing had changed, but nothing was the same.
When people asked how I was feeling or how the day was going, I didn’t know to respond. Do I tell the truth? That I’m struggling to get through each hour without crying? That I don’t feel like the teacher I used to be? That I feel like a fake going through the motions, without the energy, patience, or purpose that I used to have, pretending to be the person I was before? I’m not. I’m different. Honest answers were greeted with surprise or with automatic answers like, “It’ll take a few days,” or “You’ll be in the swing of things soon,” that felt casual and made me feel even more alone. They really didn’t know what I went through and I couldn’t explain it to them.
Intentions were good, I suppose, meaning to connect and relate, when people came to me to tell me about their relative or friend who had also had breast cancer and had or had not died. While I’m sorry for their losses, it did not help me to hear this.
Even the warmest and simplest of greetings, such as, “It is so good to have you back,” left me fighting back tears. While so grateful for the support, I just wanted to feel normal again. But so much was different.
The students brought with them a different set of challenges. I found myself even more short-tempered, and it took all my energy when faced with the students who simply wouldn't be quiet, didn't remember to bring a pencil, or refused to do anything other than rest their heads on their desks. I wanted to say to them, “I don’t have time for this! If I can be here while dealing with cancer, doing what I’m supposed to do, why can’t you?”
Everything put me over the edge and left me barely hanging on until the next class period, and the next, until the end of the day. How was I going to be able to do my job like this? I went home each day and broke from trying to keep it together for so long. Some days I couldn’t even do that, breaking down in tears in my office.
Everything felt overwhelming and impossible. Nothing felt like it was ever going to feel normal or good again. I was angry. I thought this was supposed to be the easy part. I didn’t understand why I felt like this.
The challenge of re-entering normal life when your entire life and sense of normalcy is forever changed is one of the most challenging adjustments of life after cancer. It is also one that I found myself to be very unprepared for, having heard very little about it. I was physically and emotionally exhausted and couldn’t foresee that fatigue ever leaving me.
Some of these challenges that I faced are common and expected. But trying to cope with these stressors without anti-anxiety medication, while being catapulted into menopause as my hormones were shut off, on top of sleepless nights, put me over the edge.
At the end of my first week back at work, I sat in my oncologist’s office trying to explain what had happened to me in between sobs when I myself didn’t quite understand what had happened to me. Thankfully, she understood and had seen it before. Not only that, but she told me that some people do not tolerate tamoxifen well. I was obviously one of those people, and she had another option for me: arimidex and ovary suppression. This regimen could be taken along with the anti-anxiety medication, which would not only help balance out my emotions, but could help ease the hot flashes and night sweats, which would mean more restful, restorative sleep at night.
All around, it sounded promising. And just knowing that this had happened before to others made me feel less like a anomaly. Better yet, I started to believe that I wouldn’t feel this way for the rest of my life.
Within days I started to feel more like myself. Now a little over two months later and two weeks after completing radiation, I can say that there are more good days than bad, that I feel my energy coming back in ways that I haven’t felt since starting chemo, and that some days go by where for a good portion of them, I forget that I had cancer.
While I think I’ll always fear recurrence and it has absolutely forever changed me, it is good to know that in many ways I can and will go back to normal life.