(Almost) Six Months on Letrozole

WARNING: IF YOU ARE STARTING ON AN AROMATASE INHIBITOR, I highly recommend that you not read this and instead give yourself the chance to gauge the medication’s effects without being influenced by someone else’s experiences. Note that I started letrozole just out of menopause, so my side effects from this drug have been more dramatic than they might be for a women who’s been postmenopausal for longer.

First a bit about aromatase inhibitors: according to breastcancer.org, “Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells.” Think of this as starving a hormone-positive cancer of its food.

Aromatase inhibitors have been shown to be more effective than tamoxifen, with fewer serious side effects, although they are certainly not risk-free as they can cause “more heart problems, more bone loss (osteoporosis), and more broken bones than tamoxifen.” (breastcancer.org)

When it was time to start letrozole, I took a different tack than when I began tamoxifen. For the latter drug, I did all the research I could, researching relevant studies, digging into possible side effects and visiting lots of forums to learn about what other women were experiencing.

I wish I hadn’t. I think all the negatives affected my perception and made me anxious about taking the medication.

The letrozole pill looks so teeny and cute – how bad could the side effects be?

So after two years of tamoxifen, when my hormone levels suggested that I was postmenopausal and it was time to switch to an aromatase inhibitor, I stayed away from clinical literature about letrozole. I decided to give it a chance, since my oncologist felt that I had confused the effects of anxiety about taking tamoxifen with the actual effects of tamoxifen.

Okay, then. As I was leaving my oncologist’s office, letrozole prescription in hand, he added that some women complain of “joint pain”. I think he felt it was his duty to warn me.

My experience? I’m finding it harder to recover from workouts. I train with free weights and am a rower (currently, indoor) and the change in my resilience and stamina is striking. In 2018, a year after finishing up chemo, I was able to power through tough workouts and felt like I’d gotten most of my pre-cancer strength back.

Fast-forward to now, just two years later, I feel old. My joints are creakier and I’m having increased muscle pain and overall stiffness. I’m experiencing bone pain in the leg that I broke skateboarding when I was 12. Yeah, I push through workouts, but they’re taking their toll on me.

I’m fortunate to have a full complement of gym equipment at home, so the COVID-19 lockdown didn’t hinder my workouts. To get some fresh air, I incorporated more hiking into my routine, in addition to my regular workouts.

It was too much and left me with hip pain that made it difficult to fall asleep. So I took a rare break from vigorous workouts and for two weeks incorporated more gentle movements and focused on yoga, which I had been doing intermittently.

When I started ramping back up, I didn’t feel rested, I felt weak! Weights that had been easy to lift a couple of weeks before felt challenging. I had to restart the process of building my strength. You could pass it off as simply “age”, but I’m only 54, and the drop in strength and energy has felt precipitous, even demoralizing. While it’s true that I went through menopause during the last two years, it was a medication-induced menopause and I was literally shoved through the change.

Letrozole has been shown to be very effective in preventing cancer recurrence, presumably because it works to keep estrogen levels low. However, most women on letrozole are in their 60s and have been postmenopausal for a number of years. For a woman in her 50s, the aging effect of estrogen suppression has felt dramatic.

My libido dipped even lower than I’d experienced with tamoxifen, something I was warned about by my GP and gynocologist (both females). My male oncologist didn’t talk about it. I believe this is a seriously underreported side effect of aromatase inhibitors and one that many women suffer from in silence, because they don’t feel comfortable bringing it up.

Likewise, I feel my appearance changed. Now, this may simply be my perception of myself, as my post-chemo hair transitioned from super-cool and spikey to thin and limp (and, now, untrimmed!), and my eyebrows never recovered. But it’s not just in my head: A bus driver recently tried to offer me a senior citizen discount, whereas four years ago someone had told me they thought I was in my late 30s! That’s a big difference. The fact that the lack of estrogen is making me look like I’m older than I really am has become distressing:

And that difference is felt in my relationship with my family. There have been times that I’ve looked at my husband (four years my junior) and my high school-aged kids, and I feel like don’t belong with them. I feel like a stranger, an old lady that’s just hanging around. That hurts a lot.

And on my worst days, I feel dark clouds rolling in, bringing with them frustration and hopelessness. Is it letrozole or menopause? Does it even matter? Take a woman, throw her in a bag, tie it to a tree branch and then beat it with a stick. That is how I feel when I have to take a pill that does these things to me. No control, no future, lots of pain. The longer that I continue with medications like this, the more I feel that they are pointless, since I’m starting to not care whether or not the cancer comes back. And that’s the worst side effect of all.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

So, this blog is about being honest about the cancer experience. But it’s also about mindfulness. I have to open the door and let the negative feelings into the room so that I can offer them compassion and a kind ear. I sit with them for a while, and eventually, I feel better.

Floating Above It: A Visualization

Sometimes, you really need to get away.

I’ve written about pulling back to get perspective, but this isn’t about that. There are times that you can’t handle looking at a situation, and even less getting close and curious about it. Once in a while, you need to cut your losses and allow yourself to check out for a bit.

From time to time, I have dreams in which I’m fighting an adversary (like a monster), and I leap up into the air and float over the baddie’s head. Not all the way up into the sky, but just-just-just out of reach of their clawing hands, where I’m safe.

That’s what it feels like to release my hold on the earth and allow myself to imagine floating upwards. It is a freeing and positive feeling, often helped by music containing binaural beats and a gentle relaxing drone, as if I were being softly cradled and rocked by the sounds.

Be a bird, just for a little while.

And then I travel. In my mind, the most pleasant view is that over the water, as if a camera had been set free to follow a broad river, meandering along its twists and turns. Or head across the sea towards the shimmering horizon, as the sun descends to kiss the earth in the late afternoon.

Or letting go of gravity and rising upwards into bright, puffy clouds, so far up that the landscape below blurs into purples and blues as you float high above.

This is not about being present and grounded. There will be other opportunities to sit with difficult emotions and create space for them. This is about being able to give yourself what you need during the more difficult times and escape for a short while, breathing into the spaciousness of being somewhere else.

Take a deep breath and enjoy your flight.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

While it is true that avoiding difficult emotions is not a recommended practice, consider this your glass of wine. Just for today, just to catch your breath.

Please, Wear the Mask

This post is not about politics. It’s about compassion.

Wear the mask.

I have an 18-year-old daughter who works at a local bakery-cafe. While most of her hours were cut, she’s started to get calls to come in again. She’s there to take your order for chicken soup and salad and fresh-baked baguette. She also wears a mask and gloves, for your safety. As her mom, I’d appreciate it if you wore a mask for hers.

She’s not to blame for what’s going on. She didn’t create the virus nor does she have any control over how long the country will be closed down. She’s also not getting hazard pay, nor does she get an allowance. She earns all the money she has. Her job was to pay for fencing lessons, which she has had to stop, but now she’s saving up for college expenses.

My daughter is there to serve you. If you come in without a mask because you feel it’s your right not to wear one, she’s not going to toss you out the door. She’ll give you your food. You risk giving her a virus.

And by extension, giving the virus to the rest of us in her family.

Just wear the mask.

We do this for your family, too.

For a few minutes, when you’re in the cafe, wear the mask. It’s not a political statement. It’s a statement of caring and compassion and understanding that we are all inextricably linked to each other. What is good for one of us is good for all.

And I mean, for all of us down here on the ground level. We’re not the movers and shakers, we’re simply the doers and the survivors. We’re not the millionaires who quarantine in luxurious surroundings and get to break the rules with indemnity. We’re your neighbors who share your concerns.

You’re angry? You have the right to be. But you have no right to take it out on my child.

So please, wear the mask. Compassion looks good on you.

Rethinking “Essential”

Years ago, I went through earthquake disaster training at work. I was designated a point person for our floor of the building, and therefore given a sticker for my ID that read, “Essential Personnel”. A friend of mine, upon seeing this, quipped, “Does that mean they dig you out first?”

~~~~~~~~~~~~~~~~~~~~~

Three months ago I would have never imagined getting a rush from finding a bag of flour tucked way back on a store shelf.

We now have a new measuring stick by which to judge what is “essential” to our lives. Clearly it’s not the trendy shoes or sporting events that we think we can’t live without. It’s the doctors and nurses that we take for granted, mail carriers and Amazon delivery people that we gripe about when our package is late, grocery store clerks and restaurant cashiers to whom we don’t give the time of day They are the blessings in our lives.

When we return to normalcy, take some of this back with you.

These days, leftovers are perfectly acceptable. The food long ago shoved into the back of the freezer transforms into a delicious dinner. And the unexpected shipment of hand sanitizer at the local warehouse store brings immeasurable joy.

How refreshing to truly appreciate these seemingly little things that we have, right now, in this moment.

Eventually, we’ll emerge on the other side of this. And I hope, in the midst of all the finger pointing and contentious debates, we pause and think about what has transpired. Consider how quickly our realities changed. Consider those who have lost jobs, lost loved ones, lost hope. Consider the people who have dedicated themselves and risked their lives to keep things moving, keep others healthy, keep you fed.

As we resume our busy lives and the din of the city increases again, I hope and pray that we don’t lose this appreciation. Respect and gratitude are not partisan concepts, so we should stop acting as if they are.

I can assure you, I will never take cleaning wipes for granted again.

Finding A Path Through It

There are few things more terrifying than the unknown.

I experienced this with my cancer diagnosis, although it would be the same with any catastrophe that significantly alters your life, such as losing a job when you’re already financially strapped. You’re hit with the news and then…everything stops. It doesn’t matter who else is talking or what other information is relayed, because the gravity of the situation stops up your ears and you hear nothing else.

A powerfully negative event throws up a wall that you cannot see around. When the future is undefined, it can take any form. This is a positive and liberating concept when you’re embarking on a new venture — “the sky’s the limit!” But in the case of something that’s painfully life-changing, our minds race to frightening prospects, often culminating in a terrifying extreme that we can’t see our way out of.

This is where you pause and breathe. Get your facts together and see what your options are. Things get easier when the darkness in front of you parts and you see a path to follow. After my cancer diagnosis, it was when I met with the oncologist who explained the possible variations of my condition, what the treatments would be for each, and yes, even what the potential outcomes were.

Once you get a grip, the climb gets easier.

Sitting there, digesting the information, I finally felt like I had something to hold on to. If the diagnosis was a hulking monolith, smooth and slippery, blocking my way, my doctor’s words gave me handholds with which to climb.

Right then, the future looked more manageable. I still desperately wished that it had been different, but I saw the path through the ordeal and it gave me something to follow as I strode forward.

~~~~~~~~~~~~~~~~~~~~~~~

April 27, 2017 was a Thursday. It was also the day of my first chemo infusion. If you’ve ever gone through chemotherapy, you’ve sat through the full disclosure of all potential side effects. There’s so much that it can be disorienting.

But on that Thursday when my husband and I went to the infusion room, I learned that there was a process. Everything doesn’t hit you at once, you take it in steps as you make your way down the path.

I’m still walking. But at least I’m still walking.

Can’t Let Go? Try Setting It Aside

With everything that’s going on right now, it would not be surprising if you were having trouble sleeping.

I myself have an internal alarm that wakes me up around 3am, giving frightening thoughts a chance to land hard punches. It’s far easier to keep negative emotions at bay during the daylight hours, but our defenses are down when we’re groggy. Before I know it, I’m already on that hamster wheel, getting nowhere and working up an anxious sweat in the process.

Ok, nighttime. Wanna go?

There’s a lot to worry about in the time of COVID-19. Take your pick of stressors: finances, physical health, relationships, emotions. At night, our brain wants to fix everything that we’re hit with during the day, but obviously, that’s not the time for it. Few things are as critical for dealing with stress as a good night’s sleep, which you won’t get if you’re trying to calculate how many months’-worth of rent you have left.

The mistake we make is trying to let go of things completely. When “danger is imminent”, as in, the worst-case scenario is a distinct possibility, it’s unrealistic to pretend it’s not. I promise you, as a former cancer patient, I had terrors breathing down my neck. I could not simply “let go” of them. They were life-changing and oh-so real. But with a little effort I could loosen their grip on me.

Your concerns need some respect. So instead of trying to avoid them, try gently putting them aside. You know they’re still there, they know they’re still there, but you’re not butting heads. This may take some mental calisthenics.

Even the tiger needs some shut-eye.

Ask yourself, “Can I do anything productive right now?” If the answer is no (hint: unless the house is on fire or there’s a tiger loose in your bedroom, the answer is no), then create a mental shelf for your anxious thoughts. You can build one for yourself, right there lying in bed, no hammering required.

Find yourself a jar with a secure lid. I know you have one somewhere in your mind. Scoop your thoughts in there, screw the lid on tightly and place the imaginary jar on that imaginary shelf. This may take several tries — unpleasant thoughts are slippery — but that’s okay. Make sure the shelf is across the room from you. The jar will still be there in the morning when you wake, thoughts swirling inside. But in the darkness, you’ll have some space between them and yourself.

As you lie in your bed, take a deep breath, feel the weight of your body on your mattress, feel the softness of your sheets on your skin. Look at the shelf, way over there. Way, way over there, and you safe in your bed. Allow yourself to relax.

That’s what you need most in the wee hours of the morning. So rest easy now. Tackle the problems tomorrow.

We Need Mindfulness Now More Than Ever

If there were ever a time to open yourself up to being more mindful, it’s in the midst of a global pandemic. We are in foreign territory, in an unsettled state where we’ve lost our footing. Mindfulness can help us find a path through this.

Stay Healthy

Being mindful is critical now that we’ve got to remain more aware of how we move through space.

Stop. Where are your hands now?

There are things that we do automatically. Consider how often you touch your face. Don’t do that! It’s important to notice where your hands are. Are you wearing a face mask? Don’t touch the front of it. When you inhale, you’re creating suction around the mouth and nose, and if you’ve come into contact with viruses, it is more likely that the cloth covering those areas will be contaminated. Remove the mask only using the ties on the back of your head or elastics around your ears.

Going to the store? Be aware of which hand you’re using to do what, even if you’re wearing gloves. Touching door knobs or packages with one hand? Use the other to get your wallet out of your pocket or purse.

What hand are you holding your phone with? Which finger are you touching the screen with? The COVID-19 situation necessitates a focus on what you’re doing. Take a deep breath…and then disinfect everything when you get home.

Lessen Anxiety

Living mindfully, in the present, helps us let go of fears surrounding what may happen, and in the midst of unprecedented uncertainty when , most of us have those thoughts. But you don’t have to let them take you over.

Stay grounded in the moment. No one knows exactly what the future will bring, but the possibilities can be scary. Right now, however, you are safe. Feel what part of your body is in contact with the seat or floor. Come down from the frightening thoughts and listen to your breaths. Those imaginings of the future are not happening now. At this moment you are standing or sitting, breathing. Feel into your hands and feet. Can you feel the blood pulsing through them? Feel yourself being supported by the earth. Breathe.

You can meditate without twisting yourself into a pretzel.

If you don’t yet meditate, this is a chance to start, and it’s a habit that will benefit you for years to come. The good news is that you don’t have to get it “right” the first time. In fact, there is no “right”. There is just consistent practice.

What does meditation look like for you? It doesn’t have to be sitting in lotus position and chanting mantras. There are other ways to meditate. Stay in the moment. Keep your attention on your breath, noticing the quality of the inhales and exhales. When your mind wanders, as soon as you notice your loss of focus, bring yourself back to the breath. Resist jumping down rabbit holes of tempting thoughts. Just stay with your breath. That’s all.

If you need to bring yourself down to a more peaceful state, you can try a more structured breathing technique, such as the 4-7-8 “relaxing breath” espoused by Dr. Andrew Weil: inhale for 4 counts, hold for 7, exhale for 8. It is more important to maintain that ratio rather than to have a count last for a specific amount of time. Do several cycles of this, then return to natural breaths.

Does this feel too forced for you? Your meditation might be listening to a complex piece of music — truly listening to how the instruments blend together, gliding through the different layers of sound — and feeling into the sensations that it invokes in your body.

Perhaps it’s looking at nature through a window, holding a cup of warm tea, immersing yourself in the subtleties and complexities of the world.

Or constructing a jigsaw puzzle, diligently looking for pieces to match a color or pattern. Focusing on the satisfying click when they snap into place. Apparently, this is a stress reducer for many, many people, given how quickly puzzles disappeared from Amazon!

Find your own meditation. Let go of what you think it “should” be and focus on what works for you. There will not be a quiz.

Calm Stress Eating

For those prone to emotional or stress eating, a stay-at-home order can result in weight gain. This is the time to practice awareness of what goes in your mouth. Do you respect yourself with nutritious food or treat your body carelessly? Are you truly hungry or do you eat out of habit or boredom? Are mealtimes a mechanical process for you?

Slow down and savor your food.

Allow yourself the opportunity to halt other distractions and focus on what you’re eating. In a busy household, this can be difficult, but as with all mindful things, there is no “perfection”. There is simply practice: doing, and doing again.

Look at your food. Savor the aromas. Listen to yourself chew. Taste the flavors. Feel the textures. Close your eyes. Slow everything down. See if you can sense when your hunger has subsided, instead of stopping simply when you’ve eaten everything on your plate.

Create a Calming Space

Now that we’re sheltering in place, it’s not as easy to overlook cluttered spaces. Living in the midst of disorder can be very stressful, but trying to balance remote work and childcare, or beating back concerns about no longer having a job, while trying to maintain a cleaning routine is also anxiety-provoking. There is nothing normal about the situation we are in, so allow yourself the latitude to prioritize.

Mindfulness takes the drudgery out of cleaning. Stop and look. Breathe. Decide what you can take on and then go for it. Focus on one spot and stay present as you work on it. Set a timer for ten or fifteen or thirty minutes and see what you can get done within that time. I guarantee you that you will find yourself in a better place than if you hadn’t done anything at all.

Ha! I WISH my kitchen were this big. But even a small kitchen, clean and organized, can feel spacious.

This is not a punishment. It’s an opportunity to create a positive environment in which to ride out the pandemic. I spent Easter Sunday bleaching my kitchen, which seems so antithetical to what we expect to do on a holiday. But for me it was a gift, being present and scrubbing counters and appliances bit by bit, no expectations. Yes, there are still many loose papers on the dining room table, but when I enter the kitchen, I breathe a sigh.

I could say, “it’s not enough,” but you know what? It is more than enough. It’s a semblance of order in a situation that felt out of control, just as the COVID-19 situation is out of our control. We all need some grounding, and I promise you, a clean, uncluttered room lowers stress levels. When I went into the kitchen to get coffee this morning, I thought I was in heaven.

This sense of calm is still with me, even as my son has decided to bake cookies…

What a good time to take some relaxing breaths.

Don’t Call It “Social Distancing”

By now, I’m hopeful that we all understand the importance of putting physical space between ourselves and those outside of our household in order to avoid transmission of the coronavirus. According to the BBC and its broom trick, you should be able to hold out a broom and not be able to twack another person with it. That means about six feet of distance, as everyone’s been repeating.

But socially distancing ourselves in this time of uncertainty is the last thing we need. In fact, we need to be reaching out to others, trying to bridge the social isolation gap.

It should be easy enough to strengthen our social ties with all the technology that we have available, like Zoom meetings and FaceTime sessions. But all those require at least a little planning, especially when we’re living in comfy clothes, forgoing haircuts and not necessarily getting made up to go out. What we’re missing are all those little interactions that we have in our daily lives: impromptu water cooler conversations, brief chats with a cashier, a quick joke with the server who brings your lunch. There are many ways that we touch each other’s lives than we’re likely conscious of, and those have abruptly stopped.

So if you’re feeling a strange emptiness in your life, there’s a good reason for it.

Got the toilet paper, got the gas mask…but missing the human contact.

And this social isolation is significant. Research has shown that in times of stress, social support is particularly helpful in coping and resilience (for example: Ozdemir & Taz Arslan, 2018; Ozbay et al., 2007), and individuals who are socially isolated have negative health consequences (again, an example: Cacioppo & Hawkley, 2003).

Now, consider that people are being isolated at a time when many are losing their jobs, worrying about being able to pay their bills, fearing for their health and wondering when all of this is going end. The financial and health concerns are immediate and frightening, but it’s the unknown extent of the damage that continues to keep people up at night.

This is the time when we should be reaching out to our friends and family members, checking in with loved ones and re-establishing our social connections. While “we’re all in this together” might seem like a hackneyed slogan, it is a perfect description of this new reality. As distant as we might feel, particularly those who are forced to shelter-in-place alone, we are experiencing a global pandemic. Never in my own life have I been able to share in such collective concerns, ones that are literally reverberating throughout this entire planet.

This should be something that ties us together. So as you do your best to be safe and keep your distance for the sake of health, please don’t forget to bridge the social and emotional distance that this unique situation has bought upon us.

And Now We Wait…

Last Monday night my daughter and I noticed that we had sore throats. No big deal most of the time, but we’re in the middle of a global pandemic.

Of course, a sore throat can develop for a number of reasons. And we’ve been washing our hands, using hand sanitizer when soap and water aren’t available, keeping our distance from people. Nothing much to worry about, right?

Right. Except that it seems like a sibling of mine had actually suffered through an illness resembling COVID-19, with first symptoms appearing over a month ago, with a gradual onset. At that point, like many in the United States he wasn’t in a position to get tested (and with a fever of 103.9, he wasn’t about to drive himself to the doctor).

Now, I haven’t been in physical contact with him for about a year. But since I had a sore throat, I casually asked him what his symptoms were. I mean, I wasn’t exhibiting the same COVID-19 indicators everyone talks about.

Here we go again.

Apparently, his illness also started with a sore throat, no other symptoms for about a week, at which point the cough started. That was followed by a shortness of breath and fever, including two days that the fever was dangerously high. Eventually, the symptoms subsided, with the sensation of an elephant sitting on his chest, along with a lingering cough, being the last to go.

This would be extremely disconcerting to me, if not for the fact the sore throats that both my daughter and I had lasted only a few days before going away.

Phew, right? Well, kind of. Because if this had been COVID-19, we would have been dealing with the monster head-on. Now, we’re prepped for a fight with no opponent. Back to being vigilant, washing hands and crossing fingers.

Sound familiar? Any cancer survivor will tell you they’ve been down this road. It’s all about the waiting, trying to shed the anxiety about cancer coming back. Trying to shed the hypervigilance. There is no “end date”, there’s just an “I’ve made it this far so maybe my risk is decreasing?”

With COVID-19, we experience that lack of “end date” on a smaller scale. Eventually, there’ll be a vaccine. But we have no idea how long we’ll be waiting and how long our lives are going to be so drastically different. However, relief will eventually come and we can exhale.

As a cancer survivor, I’m kind of jealous.

Musings from a Lockdown State

If there’s one thing that the COVID-19 pandemic has illustrated, it’s that all of us on this planet are inextricably interconnected.

In times of disease spread, this may seem like a bad thing, but it’s also an opportunity to pause and reflect that no matter where we live, we all belong to the same species. We are all vulnerable to the coronavirus, no matter whether someone is a high-profile lawmaker, a movie star, a famous athlete or the custodian at an elementary school.

So this is similarly a good time to think about the importance of sharing resources and considering the common good. I’m looking at you, Ms. “I’m-cramming-three-packs-of-toilet-paper-into-my-cart-even-though-the-limit-is-one.” C’mon, don’t be like that. Leave the stampeding to cattle herds. And the rebellious college students who feel the right to crowd beaches for Spring Break celebrations? Time to grow up.

We should be above that. And I believe we are.

As many hiccups as there have been, communities are adjusting to the changing situations at a breakneck pace. My university has ordered all “non-essential” personnel to work from home, within a week, we scrambled to move meetings online and eke out a research plan. Likewise, university courses are transitioning to an online platform, as is my kids’ high school. Restaurants have switched to take-out wherever possible. And my daughter joined her fellow fencers for a ZOOM training session with their coach last night.

This is not to say that this has been effortless. My daughter will probably lose her restaurant job, which means that she won’t have the income to continue fencing, as the classes are a financial burden on our family. But she has a place to live, food to eat and incoming college acceptance letters. Others are losing their livelihood and looking at a far bleaker future. Many of our favorite small businesses are suffering. Therefore, as much gratitude as I have for the ability to work from home and not face immediate financial consequences, I have great compassion for those who are struggling through what could be a long and difficult situation.

Blink and the numbers increase…

And this isn’t even counting the number of infected individuals, some with severe complications. These days, “hot spots” are less about internet connections and more about loss of life. Few saw this coming and we won’t see the end of it for some time to come. My heart goes out to COVID-19 patients, their loved ones and the uncertainties they all face.

At the same time, I’m concerned about a group with which I’m more familiar: newly-diagnosed cancer patients. Getting a cancer diagnosis is frightening enough; getting that diagnosis when the treatment for the disease puts you at significantly higher risk for succumbing to a global pandemic is unimaginably unfair.

This is painful, so I look for the bright spots in the world: the clothing designers distributing patterns for people to make their own masks so they don’t compete with hospitals for supplies, and the designers making gowns, scrubs and face mask covers for doctors; the local seamstresses who are firing up their sewing machines and using their skills in the same way; the alcohol distilleries and perfume producers who are switching to making hand sanitizer; the millions of dollars raised to support intensive care units. All this gives me hope that we are bigger than the virus and we’ll pull ourselves out of this.