Saturday, April 13, 2013

Day 1,025: "Cancer Ennui" or Depression?

One of my all-time favorite google searches that led someone to this blog was "cancer ennui." That phrase is so apt! Going through this process brings a decent amount of absurdity to your life and makes you suddenly appreciate words like ennui and verklempt. And what is this process? Well, it's being really sick, dying even, and not having a clue. It's cutting, poisoning and burning what appears to be a totally healthy body because if you don't you will probably not live past 35. This process means dealing with the aftermath of those decisions. It's losing friends and feeling isolated. It's going back to feeling healthy only to live every day with the knowledge that you will never be "cancer free," "cured," or "in remission," because all that there is for your cancer is the notion of "no evidence of disease," or, more accurately, "you could still have cancer in there but right now we can't see it and if it has spread to a distant part of your body we cannot cure you and you will die sooner or later but probably sooner."

And, remarkably, most of us do pretty damn well living with that reality. I have felt sad, scared, angry, wistful, resentful, and a lot of other emotions as a result of cancer. It's fair to say, however, that it has never made me depressed.

That's surprising, actually. Cancer is depressing. It is especially depressing when you are at a stage in life that should be about just about anything other than cancer. But something being depressing is different from depression itself.

I know this, because I am going to admit to something here that I haven't admitted to anyone over the past year until last night. I am battling depression on and off, and it is related to cancer, but only tangentially. And it's really, really hard. It's especially hard because it's new to me. I have always been a fairly happy-go-lucky, content, even-keeled person. I have been called "ultra-sane." I get pissed off and cranky, but I don't get depressed.

I've written about the absurdity of going through puberty in my 30s as a result of coming out of chemo-induced menopause. I've written about how my new, short, perfectly regular cycles have brought with them a huge range of PMS symptoms that I've never had in my life, even though I got my first period at age 11. One of those things, I've figured out, is a regular depression related to hormone changes in my cycles.

For a few days every month, I experience this crushing feeling of hopelessness. I am not talking about being irritable or moody. I'm not talking about having cramps or being bloated and feeling fat. Suddenly, I am useless. I have no friends. I'm a terrible mother. I'm worthless at my job. I've never been good at anything I've ever tried to do, except maybe writing, but even that is questionable. My kids don't like me. My husband doesn't really love me, he just wants me for sex. I will lose my job and sit at home doing nothing but make the world a worse place to live in. The pain in my chest is mets to the sternum. I won't live to be 40. My life is over.

Notice I did not say that I FEEL these things. For those days, these things are absolutely true to me.

Even if I chart these feelings, use my intellect to try to discern a pattern, I cannot escape them or think that those feelings of worthlessness are feelings when I am in the middle of it. When those days happen, that is my truth.

I've recently realized that these days coincide with extra pain in my chest, extra feelings of breathlessness, and extra weight. On the worst day or days I weigh the most. Three or four days ago, I weighed 121 pounds. I know that is not heavy, but it just gave me one more reason to hate myself. I am not just worthless but ugly, fat and covered in stretch marks and scars and lopsided breasts and I'm just a fucking mess of a woman. Then, the next day, I weigh a pound less. The day after that, I pee about 72 times and lose another pound and a half. The next day--today--I weigh under 118 pounds and I feel, well, normal.

I don't feel normal because of my weight, or because all of that water that was crushing my lungs has left my body. I feel normal because I am no longer depressed. Now that I feel normal, I can see those previous feelings as the abnormal part of life, not the reality. I have some perspective that is just lost in those moments of loss.

My life is the same. The things that are disappointing and hard are the same. A hard week at work is a hard week of work. My mammogram still looms. All of these things are normal parts of living life, well, except for the cancer part. But even that is the same--I had cancer or could have cancer on days when I'm feeling normal and days when that alien being invades my body. The difference is in how I interpret those things.

I still worry about mets in my chest, but it doesn't seem like such a foregone conclusion that I tell my husband that I need to get a pet scan and a chest xray because I know it's bad news and we have to turn in the life insurance policy and I'm going to die. I don't feel such sadness when I see my kids that I am unable or unwilling to put them to bed at night. I don't cry while taking walks, while sitting in the house alone, I don't cry at all because goddamn it, Katy Jacob doesn't cry and that's one of the things that makes her Katy Jacob. If Gabe comes up to me and kisses the back of my neck when I'm washing the dishes, I smile or playfully swat him away. I don't say things to him like "you're only nice to me when you want to fuck me." I see my totally normal for a working mother social life as a good trade from the times when I was younger and still busy but mostly with people my age.

I don't have an intense desire to engage in what would be self-destructive behavior if I was a different person or in a different stage in life. During those days of depression, I could be talked into any bad habit out there. I want to get mind-numbingly drunk. I want to have sex, almost desperately, sadly. I want to have a cigarette, drive a car too fast, leave everyone I know and move to a cave in Mexico. I begin to understand why other people do drugs. I want to do anything that will make me feel something other than that hopelessness, anything that will enable me to see my body as something other than an aging and diseased bag of bones. I want to feel life in the face of the reality of death, which looms over me as surely as the feeling of metal at my temple or the coldness that coursed through my veins courtesy of the Red Devil.

In the confines of my life and my responsibilities, of course, I don't actually do these things--not most of them, anyway. I take walks away from the family, I work out too much or not enough. I have sex with my husband, who luckily is still the same guy and not someone I don't know or don't like, so even if I am not myself there are no negative consequences of my behavior. I have a few shots of tequila or a little more bourbon than I should but then I stop because I don't want to get a headache. I buy a new shirt that makes me feel like I'm not a fat disgusting pig.

All I can say is, thank God I didn't go through this when I was 14. I would have done so many things that I would have regretted.

I know I can't lose my shit because there are little kids depending on me. On those days, that is what keeps me in line, even though I believe that they hate me anyway. The knowledge that I will come out of that fog doesn't help, because that knowledge doesn't exist, not at the time, anyway.

And then, today happens. Or, really--last night happens. I go to a friend's house for her birthday and talk to people and don't drink anything. I come home and have a drink with my husband and I want to have sex with him because I'm attracted to him, not out of some existential sense of despair. I go work out, and I feel strong and fit. I help my daughter with her homework and laugh behind her back when she's losing her mind because she's too hungry and she doesn't realize that's her problem.

And I can know something about myself--that the feelings I had earlier were real as far as feelings go, but they were not real as far as reality goes. I tell myself that I will just have to gear up for next month, when this happens again. I remind my husband that I will be insane for a full week if not more before my mammogram. I hope that he has the wherewithal to deal with me at that time and at the times when I am deep into a depression but he knows better than to tell me it's hormones, so he says things like, hey Kate, I think you will feel better in a few days. I tell my mom that I'm good for nothing and she tells me I know that's not true, though I don't know it at the time, but I hope she keeps telling me that when the time comes. I don't think I need therapy, I cannot take hormone supplements and I will not take anti-depressants, so on the normal days--and most of them are normal days, at least in that "new normal" sense--I remind myself that THIS IS NORMAL, and that other stuff is not even me, it's a sickness of a different kind. It's just another thing I need to deal with, and I can do it, with a little bit of help from people who care about me.

It's not that all the things that bothered me were fake--especially the fear of cancer recurrence part. I mean, I probably should get that chest scan. Realistically, I SHOULD worry about being short of breath. And I know a lot of people deal with depression, short bouts and long term conditions, and this thing I deal with is relatively mild. But I want to make it clear that it is not depression that makes me think about having mets, or dying of cancer, or not living to see my kids grow up. It is whatever happened in my cell biology that made those maybe realities into very distinct possibilities. What depression does is bring that reality right in front of my face so that rather than dealing with the living parts of life, all I see is the suffering and death. So let me be the first to say that that suffering and death might happen to me, regardless of my attitude or cyclical depression. It happens to women with breast cancer every day. It's just an extra issue to deal with, and a very serious one, when depression hits.

It's the perspective of life that depression changes, not the life itself.

People say things to me, and I hear their words, and I don't interpret them as roundabout ways of telling me I'm a piece of shit who is doomed to nothing but an early grave. My spinning instructor puts her hand between my shoulder blades and then touches my shoulder on the cancer side and tells me that I look so strong and that I have amazing range of motion compared to what I used to have (a post cancer compliment if ever I've heard one!); my husband tells me I'm such a beautiful sexy woman; someone in senior management tells me I did an excellent job with that meeting; my friends say they miss me; a stranger compliments my shoes; my son says "I love you."

The difference is that this time, the fog has lifted. The difference is that this time, when I hear these words, I believe them.


  1. Cancer or no (am I allowed to say that?) you wrote a very relatable journey here. Thank you so much for sharing.

    1. Definitely allowed. Though I will always be a little jealous of those in the "or no" category!

  2. How fabulous that you now get to experience the hormonal journey that many girls and women get to go through from day one. Cancer just keeps on bearing new and AWESOME gifts, doesn't it?

    I mark my calendar with "expect" and it is a huge HUGE help to remind my mind that this is NOT reality, but a huge fluctuation in hormones. Winter time only increases the depressive fall and it is only right around this time of the year that I am able to make it through a cycle without bawling hysterically.

    And that's without adding cancer to the mix.

    It totally brings new meaning to the word "depression," doesn't it? Until you've actually experienced it, you don't realize that it isn't something you can really "control" but rather something you have to just get through.

  3. Oh, yikes, Katy. What a thing to have to deal with on top of everything else you've already been through (and continue to deal with). And you're absolutely right - depression changes your ability to perceive your life accuratly, regardless of how logical you or others around you try to be. The next time it hits, come back and read this if it's any comfort (because it IS the absolute truth): You always have been and still are one of my best friends. I love you because you are one of the smartest, funniest, most realistic people I know, and despite all that, you have still been there for me through thick and thin. During those times when I know I'm worthless, it's helped a lot to know you were in my corner... that maybe I might possibly be wrong about the worthlessness, and I hang in there while it passes.

  4. Kudos to being brave and discussing depression openly. I wish for you the strength to continue through on these tough days. I am curious about one thing, you mention "no" to anti-depressants but you didn't state in this post why. (Maybe you have in others?) I am just curious what your reasoning is since lots of folks have different reasons for not wanting to take meds.

    1. I react horribly to almost all meds, of any kind; I was even told by my chemo nurse that I should "never take any medication again--like EVER--once you're done with cancer." I also had to take anti-convulsants as a child for epilepsy (Depakote, for example), and I remember what a number they did on me. Because each depression is temporary, I know I just need to work through it.

    2. Ah, that total makes sense then. I was just curious. And I agree with short depression episodes it's not like you could take them for those days only anyway.