Hypervigilance – Frantic Shanti

“So, What Should We Talk About?”: My Six-Year, End-of-Chemo Appointment

A little over a week ago, I had another oncological appointment. This one marked my six years since completing chemo for triple positive breast cancer.

Honestly, at this point, the conversation between my doctor and myself has turned much more social. There are not as many pressing matters to discuss. My bloodwork is normal and boring. I don’t have side effects to speak of, at least not any that I can attribute solely to cancer treatment (hello, menopause, ugh). And even my oncologist is openly positive about my future.

Wow, have things changed.

Six years ago I was dealing with the effects of a nasty fingernail infection that landed me in the ER (be forewarned before clicking that link: it was pretty gross!). But for this appointment, I was asking my doc how HE was feeling.

Our conversations have become pleasantly mundane and I enjoy catching up with him. Also, I am panicking less.

As a cancer survivor, I do not like surprises. When my doc says to schedule an exam, I’m going to do it fast!

Much less. Even when I do lapse into micro-panic, I have accompanying moments of calm. That is a definite improvement. At the same time, cancer is cancer. So when my oncologist noticed that I hadn’t had a pelvic exam this year, he told me I needed it. And then before our appointment ended, he repeated that I should get one.

For a brief instant, my emergency alarms went off.

Maybe it was the fact that he repeated himself and seemed very serious about it. After six years of hypervigilance, I still get unnerved by slight shifts in tone of voice. I think that’s hard-wired in me, seared in via anxiety, even though my days of being a hot stress-mess are behind me.

It’s so tempting to wipe my hands off and pretend that everything is normal, but cancer teaches us that some nasty stuff might be lurking under the surface of, “I’m sure it’s nothing”. My days of innocent ignorance are gone.

So, yeah, I’m fine. Still no recurrence of a cancer in my breasts. Probably not anywhere else either. I’ll remain optimistic and look forward to seeing my oncologist in six months and chatting again.

But I’m going to schedule a pelvic exam soon.

And Suddenly, Another Freakout

Last week, I had a Pap smear. If you’re not familiar with what that is, you must be either male or blissfully young. In brief, it’s a test for cervical cancer, customarily done every 3-5 years.

I knew my results would come this week, along with other lab results. I was in a work meeting today when I noticed my phone was vibrating. It was my doctor’s office…and I was too late to answer the call.

Me: It’s probably nothing.
Also me: OMG I NEED TO CALL NOW!

The doctor’s office didn’t leave a message.

And that’s when I officially tuned out the meeting. A flood of possibilities came rushing in. My boss needed to talk to me but I was trying to suppress the growing urge to call the doctor’s office immediately.

The urge won. I called and left a message and went back to work, but my head was elsewhere.

The fact that there had been no message was extremely unsettling, because it made sense that if there were really bad news, the office would want to speak with me directly instead of leaving a voicemail.

And my reaction shouldn’t come as a surprise, because having been hit with a cancer diagnosis before, I’ve become hypervigilant. Like it or not, my brain wants to prepare for the worst so that I don’t have that horrible fall from thinking that everything’s just peachy to slamming into a nightmare.

It doesn’t help that I’ve read sooo many stories of women talking about being completely blindsighted by frightening diagnoses, and all of them saying that they thought nothing of the missed call from the doctor since they knew they were perfectly healthy, blah blah blah.

Of course, I know better than this. And at least I was aware of the hypervigilance, aware of my body’s reactions and aware that I was blowing things out of proportion. But it’s that uncertainty that is so difficult to take. Even though I know my response, I know why it happens and I know that chances are everything is ok…I want that certainty.

As it turned out, the call had come from the nurse assistant to let me know that my blood work results had come in. This was a relief, although I admit I considered it a defeat that I couldn’t be mindful and breathe through it all.

Then again, as a cancer survivor, I need to cut myself some slack. Getting slammed with a devastating diagnosis once leads to understandable echoes, no matter what test results I’m waiting for.

For now, I’m calm. Of course, my actual Pap smear results aren’t in yet. Those should come tomorrow or the next day. The nurse assistant told me that they’ll probably be normal (OMG, how can anyone say that????) and they’ll be loaded onto the patient portal…unless they’re not normal. And then they won’t be.

Guess whose heart will be fluttering for the next few days?

Not mine, because I’ve got it together.

Kind of…

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To be fair, I didn’t totally freak out over this. But scanxiety over test results is getting a little old, honestly…

What If It Isn’t?

“Supposing a tree fell down, Pooh, when we were underneath it?”
“Supposing it didn’t,” said Pooh after careful thought.
Piglet was comforted by this.
A. A. Milne

So, I felt a “lump” under my left nipple, what I refer to as my cancer-side. It wasn’t the same kind of lump that I remember from cancer but when I thought of how I’d describe it (mass, thickening, etc.) I came up with cancer-sounding descriptive words.

This “lump” was also way bigger than my tumor had been.

I think I feel “something” and –BAM!– my mind takes me to worst-case-scenario land.

Now you might think that I would reason with myself. I’d had an MRI in the late summer that showed nothing. A real lump that big would have shown up.

Again, it wasn’t a lump, it was a “lump”. But in the back of my mind, a film starting playing…

I was writing letters to my friends on how much I had appreciated their friendship. Practicing how to tell my kids that I wouldn’t be around to see them graduate from college. Posting my final thoughts here.

It sounds sooo melodramatic but my brain is like a motor boat left unattended with the engine running. And it’s just heading away on its own on a course that no one plotted.

Why do I “go there”?

There is a part of the brain called the Default Mode Network (DMN), which is the area that is more active when you’re at rest and otherwise not focusing on anything. There is a nice “plain-English” explanation here (from an accompanying article to meditation teacher Jon Kabat-Zinn’s Mindfulness course on Masterclass.com). It describes the role of the DMN in “self-reflection…social evaluations…memories…envisioning the future”. And it also notes that problems within the DMN can predipose people to a variety of cognitive issues, including anxiety.

Start my motor, cut me loose…and off I go.

This would explain a lot about my personal default mode.

The article goes on to describe how meditation can “keep the mind from wandering into stressful territory, like reliving traumatic events from the past or anxieties about the future.”

Well, it’s good that I’m meditating, then. But I’ve already put a lot of practice into panicking. I’m an expert hand-wringer. I have a lifetime of experience helped along by a series of anxiety-provoking events. Meditation is chipping away at my hypervigilance, but it’s a slow process.

The main thing that has changed, however, is that now I’m more aware when the motorboat putters away. It used to blindsight me and before I knew it, I was hit by a tidal wave of anxious sensations (tightening, gripping, nausea…). I didn’t realize that this habit of automatic thoughts was driving my anxiety.

Now, when I start down the road of “what if it is…”, I can stop and ask, “what if it isn’t”?

And that comforts me.