On the Meaning of Birthdays to a Cancer Survivor (aka “My first 49th?”)

When I was growing up, birthdays were always of tremendous significance in my family.  My sister and I both looked forward to our own special days all year: we loved the presents, the attention, the parties, everything about it.  But maybe most of all, we loved the excitement of finally seeing the theme my mother chose for our birthday cakes.  She always made complex cakes of her own special design, and she outdid herself every year.  We still talk about the most memorable one: the “Bucky Dent” cake, designed to look like my sister’s large blue, buck-toothed stuffed rabbit that she’d named in honor of the (very!) handsome Yankee short stop.  As a kid, I also loved that my birthday came just a few days before Halloween.  I was a painfully shy little girl, but I loved dressing up to be someone (or something) else, the spookiness of it all, seeing all the other kids’ costumes in the neighborhood, and eating far too much candy for several days.

Celebrating my 4th birthday with family and friends

But I figured that when I “grew up,” birthdays would become just another day.  And that’s definitely the case for my husband.  As one of 9 kids in an Irish-Catholic family, his parents (understandably!) didn’t have the time or energy for big birthday celebrations, particularly by the time Marty arrived (the 8th child and youngest boy).  He does reminisce about how his mother would let the kids choose their favorite meals for their birthday dinners and how that was always such a treat.  But now he encourages me NOT to get him anything for his birthday (I don’t listen) and, last year for his 50th, NOT to do anything, let alone anything special (I didn’t listen).  And just this week, when I asked if he minded that I’d be attending a grant review panel on the day of his birthday, he started laughing … “Oh my God, Deb: I’d be absolutely devastated! “Nuf said. 🙂

But the fact is that every year when the calendar reaches October 27th again, I take time to reflect–and to appreciate just how fortunate I am to BE here.  Most young adults still have at least a residual sense of invulnerability that’s hung on from childhood and adolescence:  from simply not understanding the concept of death to not being able to comprehend one’s own death, a feeling that death “can’t happen to me.”  Yet at the age of 22 years, I lost my sense of invulnerability for a lifetime.  It literally was a black-and-white moment, during which my childhood doctor and I were looking at my chest x-ray, showing one lung that appeared black (as it should have) and the other covered entirely in a frosty white.  The cause, stage III Hodgkin’s lymphoma–a diagnosis that if received just a decade before may very well have meant that I wouldn’t be celebrating many more birthdays.

And on Halloween night this year, my memories returned of another moment that similarly divided time for me.  Exactly 10 years ago, 4 days after my 39th birthday, I learned that I was facing the real possibility of not being here to celebrate my 40th.  On that Halloween day in 2003, I was walking up the stairs to my new cardiologist’s office, fighting the pain gripping my chest and stopping every few seconds to catch my breath. Once I reached the office, I carefully settled myself into a chair in the waiting room and watched in a daze as members of the office staff went about their business, all while dressed in Halloween costumes.  Normally, I would have gotten a kick out of that.  But not on that day.  I was still trying to catch my breath when the technician who had performed my cardiac testing walked right over to me, put her hand on my shoulder, leaned over, and asked if I was okay.  She then clasped my arm warmly, smiled, and went to her next patient. She was in costume as well, a frightening one actually, but the fact that she obviously recognized my fear, comforted me, yet didn’t say, “don’t worry; everything is going to be fine”–that was one of the scariest moments of my life. And it wasn’t fine.  Instead, I learned that I had 90% blockage of one of my coronary arteries.  The cause: scarring and narrowing caused by my radiation treatment for lymphoma several years before.  And, as I’ve written about previously, because of the location of the blockage, I faced a terrifying decision–whether to proceed with an angioplasty, which presented the risk of another coronary artery collapsing and a heart attack during the procedure, or whether to go right to open-heart surgery for a coronary artery bypass graft.  When I later found myself asking the cardiologist whether I should be thinking about “getting my affairs in order,” I was shocked on so many levels: that I was actually asking this question, how truly surreal the situation was, and worst of all, to hear that the answer was “Yes.”

As a young adult cancer survivor (AYA), I know that the reality is a stark one for far too many of us.  According to the National Cancer Institute (NCI), unlike overall improvements seen with older adults and younger children, the survival rates for young adults with cancer have not improved in nearly 30 years. The lack of improved outcomes can be due to a number of factors, including delayed diagnosis (since many MDs may rarely consider the diagnosis of cancer in a young adult), lack of health insurance and limited access to medical care, receipt of treatment that may not be most effective for their cancers due to limited understanding of the biology and etiology of cancers in AYAs, and the unique supportive and psychosocial care needs that come with such a diagnosis at the juncture between adolescence and adulthood.  And of course, there’s the fact that AYAs face a substantial risk of developing serious late effects of their cancer treatment, including cardiotoxicity and second primary cancers–which, in my case, includes my breast cancer diagnosis at the age of 42 years, also thought to be secondary to my radiation).

So coming full circle, although it may seem childish, I treasure my birthdays because I’ve been given the gift of still being here.  This year’s was my 49th–and next year, I won’t be describing it as my “second” 49th.  I’ll be thrilled that I’m here for 50 and for every day before and after.