Mostly crying, with a few belly laughs.

That's basically what I've been doing since my last post. Someone should check on Joe.

I've been all over the place emotionally as we near the end of the Big Six and gear up for the next phase of my journey. Chemo is overwhelming by itself but for the last three and a half months I've had the luxury of taking it one day at a time. Now, everything seems to be moving so fast again and it's impossible to not think about how surgery will define the next several months and years ahead of me. I jump from thinking about surgery, to dreading the recovery, to my six weeks of radiation, to the reconstruction process, to where I'll be this time next year/2 years from now/5 years from now. Would I try to get pregnant again someday? Could I get pregnant? And what if I miscarry again? What if the cancer comes back? Will I have side effects from the medication I'll be on for the next 10 years? I've gone from taking everything one day at a time to having ALL the thoughts.

So that's where I've been the last few weeks.

I hate that with cancer, not one thing is easy. Not one thing just happens and then it's done and then we move on.

• It's - your hair will grow back...but it's going to take years.

• It's - (thankfully, only) six rounds of intense chemotherapy...but after that you still need to come in every three weeks for a year to continue receiving less hazardous drugs.

• It's - well, you can choose to do a lumpectomy and manage the anxiety of being imaged and monitored like a hawk for the rest of your life, or lose your breasts at 35 years old.

• It's - you can maybe try and get pregnant again someday...but not for years.

• It's - experiencing the hardest year of your life to try and get rid of the cancer...but then being induced into menopause for 3-5 years and put on medication for 10 years, after the hardest year of your life.

Cancer is million other shitty things too.

***

On Wednesday, April 21, 2021, I met with my surgeon again, the first time I'd seen her since my port surgery. She walked me through the two surgery options again, how each procedure would go, what reconstruction would look like for each. She explained how they would use a radioactive dye to identify the lymph nodes that were affected by the cancer and that I would have at least 1-3 removed, potentially more if they can see that the cancer had spread further. She gave me a quick exam, feeling for the tumor and checking my lymph nodes. I think her exact words were: "Yeah, I'm not feeling anything." And I let out a small breath of relief. And hope.

I was really focused on the numbers. Choosing a mastectomy over a lumpectomy decreases the risk of recurrence or a new breast cancer by about 2%...but is that a big 2%, or a small 2%? How should I look at that? And with negative genetics, I wasn't at a higher than normal risk, so could I get away with a lumpectomy? My brain could overthink this for years if I had the time.

The last thing we discussed were the logistics: covid testing, pre-op physical, an appointment with radiology, a follow up with the plastic surgeon, and they want me scheduled for surgery mid-June. It was overwhelming to say the least, so I cried - my body's natural response to most situations these days, happy or sad.

I hated that it was up to me to make a decision on surgery. When I'm with my oncologist, I lean toward the lumpectomy, but by the time I had finished with my surgeon that day, I was 95% sure I would do a double mastectomy. 2% might just be 2%...but in my mind, I would know I had done everything I possibly could to lower my risk of doing ANY of THIS ever again.

When this all started, I was waaaay more concerned about losing my hair than my breasts. Surgery was the last thing on my mind. But now that I have to make a real decision, it's actually incredibly sad. I assume having to make the decision to lose your breasts at any age can be difficult, but at 35, I personally think it's awful. I welcome all the jokes about implants and perkiness - but actually going through it and having to navigate what it means to literally cut off your breasts just plain sucks. It's so much more complicated than I can put into words. At least in my over-thinking brain it is. The chance of breastfeeding ever again is off the table. Dull sensation (or no sensation) to touch. Scars where nipples once lived. Boobs aside, I could write a whole post about the things I wish I could go back and tell my pre-cancer body. That I should have appreciated it more. That I should have been kinder to it. That I should I have let go of the flaws. Now in a matter of months, my body's been battered by cancer and chemo side effects and some days even I'm in awe of how hard it's working for me right now. My post-cancer body will get a BIG thank you.

My doctor would need my final decision by May 10th to get everything and everyone coordinated and scheduled. *breathes into paper bag*

***

Tuesday, April 27th, 2021, was my second to last chemo treatment (!!!) and I brought in the big guns: one of my oldest girlfriends and one of the only people on this planet who can make me belly laugh. She tragically lost her sister-in-law to breast cancer last summer after a three year battle, and has been with me every step of the way on my own journey. After swirling around a toilet bowl of emotions the prior week I needed her light and her spirit with me that day even more than I realized. And as expected, we belly laughed from the minute we walked in to the minute we left. It's the best way to do chemo, in my opinion.

My labs came back perfect and my oncologist is still kind of blown away at how well I'm managing most of the side effects. Sure, physically I'm doing ok. Mentally, I'm about a 4/10, borderline nutjob right now. She knew I was having a hard time with the surgery decision. I recapped my appointment with the surgeon and told my oncologist I was mostly sure I wanted the double mastectomy. And then before I knew it, my mind was being swayed back to lumpectomy. She talked about the progress I'd made with chemo, the medication I'll be on for the next decade, and the radiation that would accompany a lumpectomy - all things that, theoretically would give me about the same outcome as a double mastectomy. My oncologist reiterated that it's a personal decision. There's no right or wrong or better or worse option. So all of a sudden a lumpectomy was sounding better. The recovery would be a hell of a lot better. But it was the the reality check she gave me toward the end of my meeting with her that solidified what I would do: "The way I would think about this is, how well you'll be able to manage the long-term follow up. You'll be in every six months for imaging and they are going to watch you like a hawk. There will inevitably be callbacks for more imaging, likely a handful of biopsies, and all the anxiety that comes with that. Plus you're young, you have a lot of years of this ahead of you. Can you handle that?"

I knew when she said that that I would do the double mastectomy. The biopsies I've had this year alone were hard enough, and I think the PTSD of hearing "positive for breast cancer" twice already would do me in if I had to have more for the same suspicious reasons. I couldn't imagine having those scares - those stomach drops - as part of my normal life moving forward. I wanted to be as free as I could possibly be from all of this, and for me the mental game is a huge part of that freeness.

***

I've done my best to stand up tall and smile through all of this but I fell apart yesterday after I confirmed my decision with my surgeon's office. They're working on getting me scheduled for surgery now. So it's happening. A double mastectomy. I'm holding on to every shred of strength I have left to not look back. I know millions of women have gone through it and are probably 1000% less dramatic about it than me. They're a lot stronger than I am. When I hung up with my doctor's office, I sobbed uncontrollably in a Home Goods parking lot. I was scared, sad, overwhelmed, and for the first time since I was diagnosed, I felt really really angry.

And then I felt guilty. Guilty for feeling so bad for myself. Thank God it was breast cancer - the most funded and researched cancer in the world - and I was early stage at that. At least I had a fighting chance. I think of my friend's sister-in-law almost daily. She was already stage 4 by the time they found it and her breast cancer had spread to all corners of her body. She knew from day 1 that her life was on the clock. I just saw on Facebook that the father of someone I knew in high school passed away from pancreatic cancer just 10 weeks after he was diagnosed. And I thought to myself - come on, Courtney. Things could be so much worse. Guilt.

Cancer is an emotional bastard. Just know that even when your friends with cancer say they're doing ok, they're definitely not doing ok. Even if they're having an ok day. Sorry for lying.

But there I was, blubbering in the Home Goods parking lot and rotating radio stations. Trying to find a sad song so I could cry even harder. And the three channels I flipped to were playing these songs in order:

• The Way It Is by Bruce Hornsby and the Range

• Save Your Tears by The Weeknd

• Free Your Mind by En Vogue

I took the lyrics as a sign that after these past two weeks of fear and doubt and sadness, I need to pull my shit together and find my joy again.

• I made my decision - that's just the way it is, things will never be the same (*ugly cries*)

• Save your tears - and go do some retail therapy (check)

• Free your mind, and the rest will follow - well here's hoping...

So that's what I'm working on. Less crying. More belly laughs.

In the meantime, my sights are set on May 18th, my LAST CHEMO TREATMENT!!