Monday, October 30, 2017

Please Don’t Look Away for Goodbye


While birth and death are two things that unite every single being on this planet, our society tends to celebrate one and fear the other regardless of its inevitability.

My friend Ellen died on October 4th. Metastatic ovarian cancer killed her. Unlike many of my other “cancer friends” she is someone I was friends with BEFORE cancer was diagnosed in either of us.

She called me when she found out in 2015.

We shared all the appropriate swear words. I answered as many of her questions as I could and connected her with individuals and organizations that could help us find answers for the rest. I gave her head covers and peppered her with details about the clinical trials she was interested in learning more about. I met her oncologist to help ask some of the questions she was concerned she wouldn’t remember and I sat with her during one particularly frustrating chemo treatment. But I didn’t even begin to imagine the most valuable gift I would give her, and she would give me, would be our final goodbye.

She rocked surgery and chemo but knew something was off about four months after her treatment ended. A scan six months later revealed a recurrence. And that recurrence was soon metastases. And then we began searching for trials in earnest.

We saw each other only occasionally but we texted each other often.

She was a force to be reckoned with on so many fronts and her approach to putting cancer in its place was no different.

As treatment after treatment failed, we started to talk about her hopes, her fears and how to get the people she loved most to address those with her. She didn’t want to die but she sure as heck had ideas about how she wanted to go.

After some particularly debilitating side effects, she looked forward to finding the ever elusive next potential treatment after October 1st when she had recovered from a cancer-related surgical procedure. But cancer is a wily beast and a number of complications put her in the hospital and on a ventilator just days before that appointment could happen.

While I expected she would not respond, I wanted her to know she was on my mind so I continued to text her in the ICU. And one day, she responded.





I cackled aloud receiving her text, imagining her slyly sneaking her phone and trying to text around the ventilator I knew she was still not happy about being attached to, and I responded that I'd love to see her if she had the energy. 

I am always cautious about inserting myself into situations where I may be more hurtful than helpful. When someone’s time on planet is so limited, I want to respect there is a priority order to energy and time spent with others.

But, after a few days and a message from her husband that she was moved off the ventilator and breathing on her own, I stormed the hospital.

I found her in the courtyard with family. She was unable to speak (not aphasic, just throat irritation from being intubated) and visually aged.

But she was lucid. And she smiled. I’ll never know whether the tears were happy or sad but I imagine they were a little bit of both – much as my sobs were on the way home.

I was able to tell her I loved her. I was able to tell her I was proud of her. I was able to tell her a short story about how my children were absolutely ready to look out for her son.

And I was able to tell her goodbye.

There were no illusions; that 90 minute visit would be the last time I would see her. She was afraid I would leave and so I stayed until we had shared our words and hand signs and her eyes began to close. That is a powerful moment - the extent to which I am unable to convey in words. Minutes of no words, just eye contact. Just facial expressions. Just being with someone and assuring them you remember all the things from all the conversations. Promising that you will continue to advocate on their behalf. 

Just seeing, feeling, holding space for and with an amazing energy and touching a soul for the final time.

I walked away with tears but so full of gratitude for the opportunity to say ‘all the things’.

I texted her the next day, well aware she would likely never see the text.
But she did. And she sent me one in return.



An advocate until the absolute end.*

She died fewer than four hours later.

I am grateful beyond words to have been there until the end. So grateful for the chance to say goodbye.

So please, never turn away. Bear witness to life. While that shell of a body may not be the body you remember, that person you love is inside. Be with them until the end and that time will be a gift for you both.




*I have convinced myself, and no one can convince me otherwise, her words are “You get it.” And with those words and that image, she’s reminding me to continue to speak the realities of ovarian cancer to catalyze more efforts around improved screening and treatments.


Thursday, September 28, 2017

Even Superwoman Needs to Feel all the Feels


Today actress Julia Louis-Dreyfus announced that she has been diagnosed with breast cancer.

As a woman just over four years out from my own diagnosis day, I am filled with only empathy, love and light for Ms. Louis-Dreyfus. I don’t know her or her work (yes, I am one of perhaps four people on the planet that has not seen an episode of Seinfeld) but I know she has just joined a community that she never wanted to join and therefore only partially understands and may not even know exists. She is likely in that whirlwind time where everyone is trying to figure out up from down.

Cancer is sneaky bastard and all-consuming in that way.

I respect and applaud her openness with going public with her diagnosis. With one tweet she educated thousands, if not more on a single stark reality of breast cancer – it affects one in every eight women.


Sharing your story to educate others is a powerful too and being vulnerable to the world with your private reality is well… a vulnerable kinda place. I’ll leave my gratitude here for her and for all of those that lend their voices in an attempt change the cancer narrative.

As one would expect, messages of hope & strength permeated the tweets aimed at or in support of Ms. Louis-Dreyfus (what is WITH my formality today?!?! Julia, I’m calling her Julia) but one tweet caught me in particular.


And so my fingers typed what was in my heart and mind.


Cancer sucks. We all have choices on how we walk, run, dance, roll through the days of diagnostic testing to determine and begin a treatment plan. There is no “right way” to do cancer. And any way is hardwork. As someone who grabbed onto the cancer arse-kicker personality, I also know that maintaining that front can be challenging. Dealing with your own fear, managing the fear of others around you and trying desperately to ‘win’ is exhausting.

Balancing work, family, friends and personal sanity through life in general is hard. Really hard. Balancing all that in addition to facing your own mortality can, some days, feel like an exercise in existential Tiddlywinks.

Four years ago I fed off of positivity. And yet I had, and still have, those days. On those days, especially after all of the well-meaning but pressure-filled “You’ve got this girl” messages, it is hard to show and share your fear. And some days those messages feel impossible to live up to.

To put it bluntly, cancer is a mindf*!k.

Some days you feel like a cancer patient, other days you feel like a rock star. Some days you do feel like you’ve ‘got this’ and other days ‘this’ absolutely and unequivocally has you.

In my opinion, the absolute, without-a-doubt best ever support you can provide anyone going through a serious illness is to allow them to feel all the feels. Allow them to share their desperation with you. It can be hard to listen to. It can be hard not to try and make yourself feel better by blowing verbal perfume up their ass.

But you don’t have to have the words. You just have to have the space. You, as a supporter, need to sit with your own uncomfortability sometimes. Just listen. And then, when the time comes tell me what you know I need to hear - that you heard me, that you listened.

Tell me you’re proud of me. Ask me what I hope for. Ask me what I’m afraid of. Ask me what I think I need – and be fully prepared for me to have no flipping idea.

Love, light and glittery unicorn flatulence is awesome. But all of us need those souls in our lives that can suspend their own fears and anxiety to just listen, to just sit, to just validate fears, anger, confusion and fatigue. Can you be that person to someone else?


I sure hope so because even Superwomen wants and needs to be seen, heard and held.

Sunday, August 27, 2017

I Quit.


For the past few months, my inside voice has been saying, “I can’t even.” The decline and death of handfuls of friends to cancer and the sad and infuriating realities of current events in our country and beyond have made me want to (in the words of my children) “rage quit.”

But I don’t quit things. 
Quitting is for, well, quitters. 
And I’m not a quitter. 
Quitting is bad.

Except when it’s the very best thing to do.

Yesterday my husband and I took the tandem out for what was to be another stupid human trick. Together and separately, we’ve been engaging in athletic stupid human tricks for decades. Our recent flavor of fun is the double century circuit on our tandem. We rode our first two years ago and I became hooked.  

The course of the Carmel Valley Double Century was intended to leave out of Carmel, ride down the picturesque coast to Big Sur, cut in up the famed Naciemento Road (which we’ve descended and ascended before in fine yard sale style) and then ride back into Carmel via the windy and hot Central Valley.

Last year the inaugural ride course was rerouted due to active fires and our views of the ocean were severely limited. This year, due to excessive and epic winter rainfall, a collection of mudslides and ultimately the destruction of the bridge at Big Sur, required another reroute. Instead of seeing the ocean, we were to leave Carmel Valley, ride through King City, ride up to Hesperia Hall and  then turn around an come home. Not picturesque. Not even pretty. But the organizers are such fabulously fun and supportive people, we wanted to support the ride.

On the way south Friday evening, Brandon said, “We can do whatever you want this weekend. We don’t have to do this ride.”

Some people may have heard, “Hey hon, I know you’ve been fighting a cold and have had an incredibly challenging few days with me traveling and about to leave on another trip so, if you want to bag this and have some fun instead of digging through a hot double, I’m totally game.”

What I heard:
  • “I know you have a cold, so you probably can’t hang.”
  • “It’s going to be really hot, so you probably can’t hang.”
  • “We haven’t spent enough time on the bike, so you probably can’t hang.”

Evidently, I am a 44 year old woman with the enormous yet fragile ego of a teenage boy. And, when I feel challenged, I do the obvious, I double down.  

We rolled out of the hotel at 4am, rode to the start off of Carmel Valley road and began our journey. Beginning in the dark is always a little disconcerting but the coolness in comparison to the 100+ degree temperatures we were anticipating was welcome. Pedaling in the dark with a sky full of stars and packs of coyotes was awesome, if slightly ominous at one point. 

Rolling out at 4:10am - enjoying a chilly start


A new day has dawned!

Our first fifty miles went off without a hitch, seventy was easy but I was definitely suffering some anxiety around Brandon’s constant reminder regarding temperatures exceeding 110 degrees and I had no positivity with which to combat his concerns. I tossed a couple of “At least we’re together” comments out but his response was, “We could have been together somewhere else.”

True.

Somewhere after King City we entered the warm, exposed area that would have us climb to Hesperia Hall. Road temps rose quickly from a comfortable 75 to a less comfortable 90. At the Lockwood stop at mile 90, I opted to break into the ice socks for the big climb. At one point, his Garmin showed a 105 road temp and we took a shade break before we summited. Even with the break, we made great time and pulled into lunch at Hesperia Hall before the food had arrived. Our goal was to ‘cool down’ so we spent awhile sitting before realizing that if the ambient temperature was 100 degrees, cooling off was likely not going to happen.

Ice Socks!

So we headed back down the hill with fully loaded ice socks. We’d stopped speaking with each other, just pedaling and going to our separate mind spaces.

We pulled into the King City rest stop at mile 134. We’d made it through the heat but neither one of us was having fun. The obvious thing about the tandem: it takes two. Usually this works to our advantage. My biggest struggle tends to be early in the ride (mile 60) when the 200 goal feels so far away. Brandon is incredibly strong here both mentally and physically. He wanes somewhere between 80 and 120 and I’m all too happy and capable of picking up the “This is Fun and We Can Totally Do It” torch. At mile 180 I am all about “getting off the effing bike” and he says amusing things like, “Just sit in honey, I’ve got this.” 

But on this day, at mile 134, no one was happy. And I didn’t have the inner fortitude to do a damn thing about it. Brandon made noise about how he wanted to throw in the towel at the first rest stop when he heard the revised 118 degree forecast. And so I imagined that was it, we were giving up. We sat for ½ hour but we got back on the bike because it’s rather challenging to SAG out a tandem. No one was thinking straight and no one was happy so we headed out pedaling together but feeling totally separate into the headwind.

At mile 140, we pulled off into a broccoli field for a stretch and I said, “This sucks.” For hours it was apparent that Brandon was not interested in being on the bike. On top of the regular, rolled down a hill feeling I’d normally have at mile 140, I felt guilty for making him endure something neither one of us was really into.

And so back to that car ride.

When Brandon said, “We can do whatever you want this weekend. We don’t have to do this ride.”
He MEANT, “I don’t really want to do this ride. Neither one of us likes heat and the course doesn’t seem very pretty. Why don’t we ride down the coast instead.”

Yep, married for almost 18 years and sometimes we still need a translator because we don't always say what we mean.

When the tears came, they surprised me. This was not the hardest thing that I’ve done by a long shot. Only after a few minutes did I realize the source of my sadness. I said a couple of years ago I felt that together Brandon and I could do anything. I said it in connection with the tandem but meant it as an allegory for life. And now, this ride was an ‘anything’ and we were not doing it together. We were on the same bike but not together. And it was apparent that headwinds, hill climbs and residual Central Valley heat was not going to bring us together.

I know my role when he’s on the bike and I’m the SAG. I validate his fears and miserableness, gauge whether or not permanent damage is possible, and then talk his ass back on the bike. It’s different when you’re both on the bike.

I didn’t desperately want to finish, I desperately wanted to feel part of a team. Our team.

“Honey, we do doubles for fun. This isn’t fun,” he said.

And, just like that, we turned around, now with the wind at our backs and headed back to the King City stop. A few miles later, before we reached the stop, we found a SAG vehicle on the side of the road and asked if his truck could cart our tandem. Ironically he wasn’t course support, but supporting his wife who was finishing her 50th double. And, more than ironically, he actually had a tandem rack.
 
These things felt like the universe letting me know that the decision to bail was the right decision.
Jim West took us to mile 173 and dropped us off near the top of the hill. We rode into the final rest stop, explained that we’d gotten a 30 mile lift and would ride the remaining 30 miles back to the start/finish. Again, no looks of condemnation. No “oh I’m so sorry” from this husband wife crew. 

Apparently $hit happens and no one is judging except my own little juvenille psyche.

We rode strong, in the top 20 all the way until we bailed. Could we have finished? Um, yes. Of course we could have. But on a tandem it takes two and riding across a finish line isn’t the same as finishing together.

All in, we rode 175 miles yesterday and, if lives had depended on it, or if it had been critically important to either one of us to finish, we could have finished 203. The reality, in the dawn of a new day, is we didn’t want to finish – we wanted to be done. And, most importantly, we weren’t riding together. So we quit. And then we rode another 30 miles, waved to the finish line and continued riding to the hotel. We racked the bike and headed to dinner.


I still believe together we can do anything but, for me, this thought is idealistic beyond the bike. It encompasses the hard times of life, not just the world of double centuries. 

So we quit yesterday – but we quit together.

Tuesday, July 25, 2017

Radiology & Patient-Centricity


Patient-centricity in healthcare has become a buzz word. But what does it really mean?

Patients, caregivers, advocates, health practitioners and providers alike seem to agree that the term references designing a system or service around the needs of the patient. Specifics of what makes something “patient-centric” may vary by service or system but all models and flavors of patient centricity seem to favor stronger communication around patient goals and needs.

So, what happens when patient and practitioner never meet?

At the end of May, I was prescribed a chest MRI to check the status of my now 3-year old breast reconstruction silicone implants. Evidently this is protocol (FDA recommendation) to check for silent rupture, so I made my scan appointment, showed up on time and had my scan. My summer travel schedule was intense and, because I had no immediate concerns about my implants, I assumed results would flow in whenever they were available.

Four weeks later I was still waiting for results.

In my patient portal, I could see that my provider was on vacation so an email seemed like wasted effort. I called the radiology office (not on the campus of my other providers) and no one seemed to know who had my results. I had no ability to contact my radiologist via my portal or even determine who “my” radiologist was. Eight weeks later, I finally emailed my plastic surgeon explaining that I was frustrated and that all I was looking for was a YAY or NAY on my scan. He responded very apologetically with something to the effect of “I thought you’d get an automated message through the system.”

Fair enough, he thought I would be informed by someone else or some other process.

So let’s just assume for a moment that had happened.

I would have received an email with something akin to “Congratulations, your MRI was negative.”

But what exactly DOES a “negative” result mean? In this case, it meant no evidence of rupture.

But what if I had questions?

As it so happened, I did have questions. “What is the status of and size of the seroma in the pocket of my left implant?” I asked via email to my plastic surgeon.  

Dr. H is a fabulous guy but, as he succinctly stated in his response back to me, imaging is not his forte. “A seroma was not mentioned in the report by the radiologist. Do you feel that the seroma is still there?”

*sigh*

Through this experience, I am realizing the numerous additional challenges radiology has in designing with patient needs in mind and wondering how we might improve the overall patient experience by making stronger connections.

Please join me and fellow patient advocate Andrea Borondy-Kitts on Twitter to discuss “What does patient-centered medicine in radiology mean to you?” during the #JACR tweetchat Thursday, July 27th at 9amPT/12noonET.



For additional background on this topic, please read Andrea's June 2017 JACR blog post Patient Engagement One Radiologist at a Time.

Monday, July 17, 2017

“What Are You Really Doing?”


After four years in the social media cancer community, I finally felt the sting of an antagonistic, non-productive comment. But, as with most things social, it certainly got me thinking.

Last week, along with 40 other breast cancer advocates, I attended a training in San Diego to learn about cell biology; mechanisms of metastases; immunology and immunotherapy; systematic review and meta-analysis; policy advocacy and much, much more. We now make up the ProjectLEAD Class of 2017 and will each take our learnings back to our respective communities to further enhance and accelerate our advocacy work.

When I posted a photo of this incredible group, a friend, a staunch advocate for metastatic research and an incredible human being asked me publicly via Facebook comments to make sure the needs of the metastatic community are added to the conversation.

I expected this request.

Metastatic breast cancer continues to kill ~110 women each day and yet receives minimal funding from key sources.  I assured her that, “My goal every single day is to find a way to stop premature death from all cancers and to preserve the highest quality of life along the way.”

What I did not expect was a comment to my reply from another individual, “How! What are you really doing?” This and a couple other comments (that have since been deleted by the commenter) had me feeling a bit defensive.

Okay, REALLY defensive.

But it did get me thinking. What in the heck DO I actually do?

I realized the question was likely rhetorical but felt that I should still be able to answer the nuts and bolts of my day to day.

So I did what I typically do in times of mental and emotional turmoil, I brewed and extra pot of coffee, gave it some thought and then went to the gym to shed the frustration and find my words.

Rather than list out the research projects I’m collaborating with and how they play a role in either improving quality of life or improving therapies; or share the roles I play in defining and evolving patient services; or even explain the new realm of health policy advocacy I’ve been lending my voice to; I thought I’d share the basics.

So THIS is what I have been doing for the past few years and this is what I do EVERY. SINGLE. DAY.:

I share. I share my story to help demystify the realities of receiving, understanding and dealing with a cancer diagnosis. Some shares are more challenging that others but I share the clinical and emotional details of my treatment and survivorship in the hopes that, as knowledge breeds understanding and empathy, we can collectively transform the system to meet the unmet or unspoken clinical and holistic needs of the over 15M cancer survivors in the United States. And then I freely share my knowledge, my resources and my connections.

I listen. I listen to other patients, caregivers, family members, healthcare providers, healthcare innovators and health policy makers. I listen to learn. I listen so others might feel seen, heard and held. I listen to understand the care abouts of each audience so that I can help find our common threads and stitch together bridges that can help us cross our divides.

I speak up. As I learned from an incredible advocate at the 2015 PCORI Annual Meeting, I am fortunate to have keys. I have a house key – which means I have shelter. I have a car key – which means I have transportation. I have an office key – which means I have gainful employment. I speak up for myself and I speak up for those who have no keys. I mentioned recently to a friend that there comes a time in everyone’s life where they need to use their voice. I am simply grateful I’ve had so much support in finding mine.

These three things, in every particular combination, define my advocacy work, define my consulting work and define my person.

Four years ago on this very day, I ingested my first Tamoxifen pill and felt I transitioned from cancer patient to cancer survivor. Today my personal life and my advocacy life are very much intertwined. I am gutted with every loss in our community and I am buoyed by every NED or stable scan. I am skeptical regarding news of “breakthrough” science but am an eager collaborator with those individuals and organizations taking a person-centric approach with their research. I spend hours holding space for those who are scared, angry, confused or relieved and then I spend hours on clinicaltrials.gov searching for potential treatment options for those who have exhausted the options provided by their physicians. I am grateful to have clarity of purpose (if a slightly overbooked calendar) and an incredibly supportive, brilliant medical, research and advocacy community to work with me.

That is what I am really doing.

And my goal EVERY. SINGLE. DAY. is to find a way to stop premature death from all cancers and to preserve the highest quality of life along the way.




Sunday, June 4, 2017

National Cancer Survivors Day 2017 - Celebrating the Mundane



There are over 15 million of us in the United States and well over twice that many in the world.

Events have taken place all over the country but, on this particular national cancer survivors day, I am celebrating quietly.

There are no scenic hikes, epic bike rides or long runs in my plans for today. There are no dinner celebrations and there will be no cake. I am celebrating being alive with a decidedly mundane day. Coffee and a good book, apricot picking, apricot dehydrating, refrigerator cleaning out and crossword puzzles. The day is warm and gorgeous and I could be Out Living It with other cancer survivors and supporters but not today. Not for me. Today I’m sitting with my own no evidence of disease, relishing the fact that I am here and alive enough and healthy enough to be unabashedly boring.

Facing my own mortality in such an abrupt manner at the age of 40, triggered an almost manic response to life. Most days I feel compelled to make the most out of every single moment. While living out loud has certain je ne sais quoi, it can be, and has been, absolutely exhausting. Today I need a break. And today I feel entitled to take that break.

No one in my family has recognized the day and, honestly, that feels like somewhat of a relief. Four years ago, the diagnosis was so fresh and the fear was so overwhelming that I couldn’t imagine a time of normalcy ever settling on our home again.  Basically, the fact no one besides myself recognizes this day makes me feel finally out of that needy inner circle and grateful that, in at least a few ways, my children and my husband have moved on from cancer.

I say in a few ways because we will never outrun cancer, the collateral damage it foisted on each one of us or the resentment of the fear it still holds on our household.

Today may be boring but I am celebrating. I am celebrating my life and the lives of others.

We have been called survivors, warriors, thrivors, metavivors and many other intended-to-be-complementary monikers.  

But we are just people.

And, like most people, we are brave when we need to be; afraid when fear dominates; angry when cancer steals from us, our families and our friends; anxious when facing the unknown; thrilled when we achieve milestones of NED and stability. We are all pushing forward, many of us hand-in-hand. We are there to celebrate each others’ cancerversaries, catch each other when we stumble, kvetch about the less-often discussed aspects of cancer and absolutely there to comfort each other when the world comes crashing down.

In Cancerville, so much needs to be addressed, so much needs to be corrected. More communication, more collaboration, more research, more support. But that is not what today is about.

Today is a celebration for over 15 million people, their families and their friends. Today is a celebration of life with all its imperfections. I am celebrating quietly (and deferentially with those unable to celebrate heavy on my mind) but I am celebrating.

A little bit of boring goes a long way, and enjoying my own breath will amuse me for only so long.

Tomorrow definitely requires a more overt celebration... and perhaps some flourless chocolate cake.


Monday, April 3, 2017

Advocating in Public; Crying in the Shower


My friend Beth died today.

Metastatic breast cancer killed her. She is in no way the first friend taken by the disease and she certainly will not be the last. Even so, her death has hit me harder than many of the recent losses in the cancer community.

I wrote those words last week, on the evening that Beth actually died, but it has taken me another week to actually process her death and figure out this new normal of grieving with absurd regularity.

Beth was a self-proclaimed warrior but she was also a pragmatic who believed that the best death came through living the best life. I embrace her philosophy but I continue to rail against premature death.

And, after nearly four years in the cancer world, I find myself grieving very differently now.

A few weeks ago, I noted a new familiar pattern in my own behavior when it became obvious that her death was near. I avoided Twitter and Facebook and instead sent her photos via text from my garden. For me, my garden represents peace and life and, projecting a bit, I assumed Beth would enjoy a little of both with her limited mobility.

And I texted other friends, just to share love. Evidently honoring my expressive self, calms my inner worrywart.

So, when Beth stopped responding to texts, I continued sending the pictures, hopeful that someone on her end was either sharing the beauty or finding their own solace in my virtual garden.

When Beth actually died, I had nothing left for Facebook and Twitter tributes. I didn’t have the words and, in all honesty, I didn’t feel like sharing my grief that way. Part of me felt guilty I didn’t jump into the fray of homages but most of me knew Beth would totally understand.

I did text another friend that evening with the bare facts.

“I’m sad. Devastated and gutted.”

As someone else surrounded by the realities of cancer, she gets it. I didn’t need to explain anything. 
And that was the entirety of what I was able to express. As someone who actively processes through the written word, I was utterly devoid of thought beyond those emotions.

With the steady flow of death in the metastatic community, I feel like my own broken record when I say, “My friend died.” When people respond with the empathetic and appropriate, “I’m so sorry,” I just feel like I am stating and restating the obvious – too young, too soon, more research required. My expression feels circular. And pointless.

So I cry by myself now. Usually in the shower where no one can hear.

In the last several years, I’ve come to accept death as the natural end to life but I haven’t become inured to or at all comfortable with suffering and premature death. And yet I know it continues and will continue. The changes the advocacy community is catalyzing are real but too slow for many people I have come to know and love.

This is hard for me to accept. This is impossible for me to accept. And so the tears come for those we have lost but also for the realization that there are so many more who will die, too young, too soon.
Now with every death, I feel exhausted. And some days I feel like my own emotional burden.

There are options. I could allow myself to become numb to the deaths. But I won’t. I know that I will spend some time in every stage of grief for every friend who dies. But I will mourn in a smaller circle of support. And then I know I will pick myself up by those well used proverbial bootstraps and get back to advocating, educating and, most importantly, experiencing the joy of life.

In the process of reviewing all my text exchanges with Beth, I discovered she has given me a cut sheet for grieving the loss of her. In one of our last exchanges she wrote the following:

Thanks Stacey. 
One of side effects of not being able to ambulate freely for me is that I get a lot of time to think.
Now I need to start writing more, to share what I have learned more.
You have done and are doing that well.
As I move forward with more writing, I would love to learn more from you as to how to best amplify my voice. Are you willing to help?

I told her I was absolutely willing to help.

Rereading that message felt like re-receiving a huge compliment and being given a grief guide.

My emotion, my energy, my love and appreciation for an incredible woman who, while we interacted mostly over social channels, knew my heart and mind at a depth few others do, can now be channeled.

This is Beth’s site. It’s brief but it’s powerful. Read, learn, feel and then, if you’ve got the energy – advocate. For research acceleration; for improved treatments; for eliminating the stigma of metastatic disease.

In her journal post from January 14, 2016, Beth said, “I've wanted to be a teacher my entire life.”

You were my friend. 

You absolutely, positively, definitely were a teacher. Thank you.

Apple blossoms. And the last photo I texted Beth. On 3/28, the day she died.