Lost in Translation



"Diagnosis"

I wrote this piece the year after my double mastectomy with reconstruction. Before my surgery, I was already grappling with body-image issues due to a lumpectomy-disfigured breast. I thus decided to enroll in a figure-drawing class to help me work out these issues. I would then interpret the drawings that seemed to translate to breast cancer and convert these sketches into oil paintings. I anticipated that this exercise would heal my psyche after the double mastectomy, but I was in for a surprise, as this narrative relates. The oil paintings are my own works of art.

I’m sketching a nude female in my figure drawing class. Each pencil stroke evokes waves of grief and despair. Tears flood my eyes, and I no longer see her clearly.



Just as well.


Pre-double mastectomy, this model was my favorite one to sketch. She has full breasts and a sculpted athletic body. She is better than a supermodel – she’s the Super Natural Woman with a Shakira-hips-don't-lie body. Boasting distinguishable shapes and forms, she is an artist’s dream.

A year after my reconstructive surgery, I finally feel physically and emotionally well enough to go back to class.

Or so I think.


Scratch, scratch, scratch, scratch. Students are frantically drawing. Some male students are greedily eyeing her. Between her poses, they even converse with her. She laughs, tossing back her head with confidence. Renewed grief and envy roll down my cheeks, as I think of my extensive torso scars. 

I'm not exactly a work of art.


I fidget at the easel, lost, wondering if the model appreciates her body, wondering if she feels lucky that she still has the breasts she was born with. Wondering why I can no longer remember what my life was like pre-cancer diagnosis.


I tell myself I should be feeling happy; after all, I’m alive. That I should be grateful for the energy to draw again, let alone be back in art class.


I reluctantly glance back at the model’s breasts and wince, as I recall that a double mastectomy was not my original choice at diagnosis years ago. I had opted for a lumpectomy plus radiation rather than a mastectomy. Until faced with the choice of whether to remove my breasts, I had never realized how important they were to me. I wanted to keep them. My doctors would monitor me closely, and there would be ample routine follow-ups.


But my follow-ups were anything but routine.

My doctors and I had not anticipated the many false alarms during the years following my treatment. We also could not anticipate that, in my case, mammograms and other diagnostic tests would prove inconclusive – thanks to my dense breast tissue. After all, a mammogram had missed my tumor just months before diagnosis, and my self-exam helped me discover the malignancy. I had already slipped under the medical radar once. Given my breast cancer history, keeping my breasts was akin to playing Russian Roulette.

So now, after a year of recovery and physical therapy, I find myself back in my figure drawing class. Yet, from the time the model removed her robe, I feel awkward. I feel

like a fake

like a fraud

like a freak show

I was created in a plastic surgeon’s image of what a woman should look like. While cancer didn’t steal my life, it robbed me of my authentic breasts, replacing them with doctor-created substitutes. To my plastic surgeon, my breasts are art – his artificial creations made to look like the real thing. And I'm his living sculpture. Before surgery, he drew marker lines all over my torso. I admired his wonderful sense of line at the time.

Now those lines are forever etched into my flesh.


I realize, though, that, like my doctor, I’m an artist. And that struggling with a drawing is much more pleasant than struggling to stay alive. I breathe deeply, close my eyes.

"Hoping for Hope"

I made the right choice, I tell myself. I should be grateful, I tell myself. But today is not the day for gratitude. Today is the day for a pity party.

Break time. My fellow students walk out quickly, hoping to catch a snack, smoke, or bathroom pitstop. I'm having a panic attack and having trouble breathing. I quickly snatch my pencils, pad, and gather my other supplies and make a beeline for the exit. 

My instructor stops me and asks why I'm leaving. I tearfully tell her that she's a great teacher, but I'm having body-image issues. She understands.


As soon as I arrive home, I run to the dresser mirror, I slowly peel off all my clothing, so delicately as if I’m made of glass. No one would ever want to sketch me, I think.

I crawl into bed and cry myself to sleep.

Do you have body-image issues as a result of breast surgery?

How did/do you feel physically and/or emotionally after surgery?


I'm writing a book titled Calling the Shots: Coaching Your Way Through the Medical System. Please feel free to subscribe to this blog by clicking the orange subscribe button. I am a professional writer and have published numerous academic and magazine articles, as well as an essay on my breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. I can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

Breast Cancer and Loss of Control

I know this comes as a big shocker, but there is yet another organization interested in breast cancer awareness for the 40-and-under crowd. Founded in 2001, ironically, the same year I was diagnosed, this entity's goal is to "infuse sass and style into the cause" and say "Adios [to] fear-based campaigns."

I was younger when I was diagnosed, but I didn't feel sassy nor sexy. My world was too busy spinning out of control. 

OK, I'll say it ad nauseum: Breast cancer is not sexy, cute, fem, sassy, and stylish. No other disease is associated with these terms. And I take offense to this because such levity toward breast cancer shows disrespect to people afflicted by this disease.   

The authentic breast cancer experience is one of absolute fear, chaos, anguish, and loss of control.

Here are just a few ways we in the breast cancer world have lost control of our world:

Body Betrayal, Part I: Our bodies have betrayed us. We are in the prime of life -- until we find out that something has gone awry and now threatens our lives. We have cancer. 

Body Betrayal, Part II: Treatment causes the body to betray itself -- from hair loss to vomiting, from fatigue to intestinal and bladder problems. I'll spare you all my details, but suffice it to say, rather than feeling sexy and sassy, I was beyond ill, even though I didn't lose my hair. I had chemotherapy and radiation simultaneously and could barely function.

The chemotherapy caused cognitive dysfunction. I used to take my brains for granted, until my brains turned to mush from treatment. Depression and anxiety set in. To make matters worse, my white blood cell and red blood cell counts ran amuck, another thing that was out of my control. 

One of my best friends whom I met through a breast cancer support group was Stage IV. I took her to many of her chemo treatments. Turns out the chemotherapy was hardly therapeutic: My friend's bones would break and the cancer raged on. I got to see firsthand how much she suffered before she died. I will always miss her. 

Medical Schedule Syndrome:  One of the hardest parts for me was shelving my life to fit in all the medical scheduling. It didn't matter whether I had a meeting or deadline at work; I was to drop my entire work and personal life to come in for chemotherapy and radiation and for bloodwork and doctor's appointments. My life was no longer my own and centered around the monthly medical calendar the oncology nurse gave me.

Rejection Syndrome: Oh, and while we are going through the hell of being diagnosed and treated, some of our friends decide to reject us. They forever leave our lives, just when we need these people the most. Most of my friends were wonderfully supportive, but I experienced the heartache of people rejecting me. I remember thinking at the time that the rejection was worse than the disease itself.

Body Image Syndrome: The lumpectomy is designed to conserve breasts, but too often, the lumpectomy disfigures them. That's what happened to me. Truth be told, I wasn't feeling too sexy about my body. Eventually, I got a preventive double mastectomy with reconstruction. Some individuals were more than envious that I would get "a boob job and tummy tuck" at the same time. A few insensitive idiots jokingly asked if I could get an upgrade.

After spending hell in ICU, I had a long recovery process. In fact, I am still in constant pain, and even though my doctors did a great job at reconstructing my torso, every day my scars remind me of cancer. Oh, and our breast-obsessed society reminds me, too.

Mind Games: Whatever the medical outcome, mind games and triggers continue to plague us, where we wonder whether any ache or pain is due to cancer.

I don't think any of these "infuse sass and style into the cause." Yet society keeps telling us otherwise.

This posting is an excerpt from my upcoming book, Calling the Shots: Coaching Your Way Through the Medical System. To obtain these excerpts regularly, please subscribe to this blog by clicking the orange subscribe button. I am a professional writer and have published numerous academic and magazine articles, as well as an essay on my breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. I can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

An Empowering Cancer Recovery Boutique



Four years ago today, December 1, 2006, I was undergoing a 10-hour preventive double mastectomy with reconstruction. I am choosing this special anniversary to share a gem I recently discovered, a cancer recovery boutique for women undergoing cancer treatment, as well as long-term breast cancer survivors.

Second Act in Chicago, IL, is an amazing place. Downtown Chicago's only accredited cancer recovery boutique, Second Act offers post-breast surgery garments, such as specialty bras and prostheses, as well as a nice selection of wigs, hats, and scarves.

Customers complete an online Pre-Visit Registration Form and set up an appointment with Certified Mastectomy Fitter and shop owner Pattie Cagney Sheehan. Pattie spends ample time with each client in a private fitting room.

I'm focusing this posting on the bra experience because quality bra-fitting services for women who have had lumpectomies and/or mastectectomies are exceedingly rare. It is common for women who have gone through such trauma to have body image issues, which include feeling disfigured. To add insult to injury, these women often have a really difficult time finding a bra that will meet their unique post-surgical needs. 

So many undergarment retailers claim they know how to fit us in a proper bra, but they don't. To my horror, I have found some unsavory businesses who lie about their offerings. I've gone into bra specialty shops with great reputations, only to be asked "What's a mastectomy?" and "We can't help you here." It's a humbling, humiliating experience that has caused me to leave such shops in tears.

So imagine my pleasant surprise during my appointment with Pattie, someone who perfectly understood my needs exactly and worked tirelessly and in privacy during our one-hour appointment to find the perfect bra and prosthesis for my particular body. For the first time in a long time, I felt empowerment, nurtured, and felt a huge boost of self-esteem. And Pattie treats her clients with great respect and dignity.

And here's another great fact that many would-be clients may not know about. Second Act is under contract as an in-network provider with Blue Cross Blue Shield PPO and Aetna/Cofinity PPO programs. Most post-surgery items are covered by Medicare and/or private insurance for women recently diagnosed, as well as long-term survivors. A physician's prescription is required.

And I would be remiss if I didn't gush about the ambience of the waiting area of the shop. Located as a shop within Flourish Studios' shop, the atmosphere is serene, empowering, optimistic, and supportive. Friendly staff offer you free hot chocolate and hot tea in nice cups while you can sit on comfy chairs or couches (see photo below) and wait for your appointment. I felt so pampered!

The store has a variety of self-help, holistic-oriented books and is filled with beautiful gallery-displayed artwork, cards, jewelry, and crafts -- many of them with inspirational sayings -- and available for purchasing. (See photo below.) There's also a children's section with interesting and fun children's books and toys for purchasing.

If you are looking for a stellar cancer recovery boutique, please contact Pattie at pattie@secondactchicago.com or at 773-525-2228, and feel free to visit the company's website at http://www.secondactchicago.com/.

If you don't live in Chicago, you can also plan a vacation to this beautiful city and set up an appointment with Second Act. It is well-worth the trip.

Calm ambience in the waiting area

Please feel free to subscribe to this blog by clicking the orange subscribe button. I am a professional writer and have published numerous academic and magazine articles, as well as an essay on my breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. I can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

 

Who's Afraid of the Big Bad Medical Administrator?

Answer: Not the patient.

As covered in previous blogs, when navigating the medical system, bully/incompetent doctors are just one of the many hurdles you face. Other huge hurdles that we patients face include those administrators whose job, it seems, is to make life difficult for us.

As if dealing with illness and life-threatening conditions weren't enough.

I am beginning this posting with a caveat: most of the medical staff I've encountered have been helpful and kind. Most of the time, my doctor visits have been made more pleasant and relaxing -- all because of the administrative staff -- such as receptionists, medical assistants, records people -- who do have a difficult job and often have to deal with rude patients.

However, it's more fun for readers if I trash the administrators who have overstepped their bounds.

And more than anything, I'm hoping that this posting can help you stand up to rude administrators who seem bent on placing hurdles in your way or being rude and inappropriate during your visit to the office. I speak from experience and will discuss two memorable altercations I had with administrative bullies.

Ironically, I'm grateful for these experiences because they taught me the incredible power patients have.


Show Me the Money

When dealing with a potential or existing medical problem, the last thing you need to hear is a medical staff member discussing money matters with you. This type of insensitivity to your needs is unacceptable.

In my case, I was in my surgeon's waiting room only a few days after being told that an MRI revealed something suspicious, and I was scared -- like crap in your pants scared -- that it was a recurrence. Fresh in my memory was my great friend dying of breast cancer only a few months before, and I was deep in thought, wondering if I would share the same fate. My surgeon was going to examine me and schedule a biopsy.

The receptionist interrupted my panic-stricken what-if scenarios by calling me up to her desk. Imagine my disbelief when she looked in my tear-reddened eyes and informed me that I owed some money and would I like to pay it now or later. She started talking in a not-so-low voice about the amount I owed. In shock, I stammered something about being billed later. I couldn't psychologically deal with one more stressor.

I sat back down, crushed. I was embarrassed, wondering if others in the waiting room overheard this conversation. The tears of humiliation stung my sleep-deprived eyes.

Then my fighting spirit took over. I wanted my dignity and self-respect back. I walked back to the receptionist and told her in a not-so-low voice, "You know, I am grappling with a possible breast cancer recurrence, and I can't believe you have the audacity to discuss my bill at a time like this!" Before she could stop stammering, I added, "You and anyone in your office are never, ever to discuss anything bill-related with me in this office."

Now it was she who was crushed. I turned around abruptly and got back to thinking my fate. She and the rest of the administrative staff treated me like gold that day. One would think I was a celebutant. And I felt empowered, even though I was bracing for terrible news.


The Dreaded Record Keeper

In my posting A Train Car Named Quagmire, I discuss how I fought to get records transferred from one physician's office to another. Records departments simply amaze me. They are able to provide services and obtain records lickety-split when a doctor requests them, but not when a patient does.


In my case, the enemy was the center where I had follow-up mammograms and any pre-surgery labwork. Interestingly, whichever individual happened to be at the front desk was always rude and cold to me. I found it intimidating and passively tolerated their mistreatment and utter disrespect. Luckily, the technicians were nice, but the technicians unfortunately had nothing to do with ensuring records were delivered when they were supposed to be delivered.

My mammogram films and report were supposed to be ready for me to pick up before I saw my doctor who always wanted to see them during my visit (I did call the records department ahead of time and followed all the protocols). Yet, about 50% of the time they weren't ready, and I had to go to the doctor sans mammogram, which arrived a few days later.

And for someone who has been through a cancer experience, waiting a few days is like waiting an eternity.

I called the center to complain about the mishandling of these mammograms and, after speaking to several impolite personnel, I finally got a friendly staff member. I told her that since I already had breast cancer and very dense breast tissue, my mammograms needed careful inspection by my surgeon on time and that such mishaps could one day cost me my life.

She said, "Aw, honey, you're not likely to get breast cancer again." I volleyed back: "How do you know that? You can't tell a patient that! It is vital that your office ensures prompt and accurate delivery of my mammogram films and results." (Turns out that years later after my preventive mastectomy and reconstruction, the labwork indicated I had oodles of precancerous cells and would've had a recurrence in a few years.)

I asserted myself to my surgeon -- I politely insisted that, with my history of breast cancer, it wasn't prudent for me to to get follow-up mammograms at an unreliable place and from now on, I wanted my mammograms done at the hospital's far superior breast center. The stakes were too high, I explained, to allow this center to determine my medical fate.

He agreed, and I never had such problems again. Victory!

Fast-forward a few years later. I needed to go to this center for pre-surgery bloodwork. I was getting my preventive double mastectomy with reconstruction, so it was a stressful time for me. My doctor sent the center an electronic referral so I wouldn't need a hard copy. So I showed up a week before surgery, as directed, without a hard copy referral.

By now I was prepared for the staff's lack of respect, and I was determined to not tolerate abuse.

Sure enough, the receptionist rudely insisted I needed a hard copy referral -- even though she had printed out the electronic version! She rudely directed me to an intake person at another desk, who coldly said the center couldn't do labwork without a hard copy referral.

I told her that I was having major surgery in a week and needed the labwork ASAP. She responded that the center would do the labwork, but only if I signed a form agreeing to pay for the procedure should my insurance not cover it because the referral was electronic.

(No, it doesn't make sense to me either.)

She shoved the form toward me, and that's where my civil disobedience kicked in. I told her, "You know, every time I come to this office, I am treated rudely and with disrespect. I demand respect. I am having major surgery next week, and I followed the correct protocol. So I refuse to sign it."

Her eyes widened in shock, and then she scribbled something on the form. I asked her what she was writing, and she said "Patient refuses to sign form." Pleased with my self-advocacy, I said, "Good!"

I got my bloodwork that day and didn't pay a cent.

When I relayed this interaction to my friends, they said they never knew they could refuse to sign such a form.

Well, now they -- and you -- know. While we want to be civil and treat medical staff with respect, when we find ourselves bullied by them, we don't have to passively comply.

Your voice needs to be heard, and you simply cannot tolerate disrespect from administrators.

Beth L. Gainer is a professional writer and has published an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She teaches writing and literature at Robert Morris University Illinois in the Chicago area. She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

Survivor's Guilt

This is how the story goes:

I had a friend around my age. She died. I lived.

I lived because she died.

Faun and I became fast friends, well, fast. We met at a breast cancer survivor's group, and even though I was the newbie to a well-established group, she and I hit it off. Turns out she was a teacher and a writer. Like me. And she was from the East Coast. Like me.

And she was a breast cancer survivor. Like me.

Or so we thought. Five months after we met (and five months after my last chemo treatment), she experienced a recurrence. Well, that's not exactly accurate. The cancer had never really gone away in the first place.

I'll spare you all the gruesome details, but I took her to chemo regularly and was there for her -- until the very end, about four years later. Ironically, those chemo days were good days for us as friends. We had hours to talk, and then I brought her home, sat on the edge of her bed, and we laughed and shared secrets for a couple of hours.

We even had plans to compile an anthology of essays and poems by a variety of people who've had breast cancer. And, of course, we'd contribute our work to the anthology. We would brainstorm regularly about how this book would evolve. Our dream of collaboration never happened, though.

She died July 3, 2005, at the age of 47.

Yet, she saved my life.

You see, six months after she died, my oncologist called to tell me that my MRI revealed something odd in the same breast in which I had breast cancer five years before. He was understandably very concerned. I was understandably very panicked.

I got an ultrasound and biopsy and had the abnormality removed. As I waited for the lab results, which seemed like an eternity, I became obsessed with all of what Faun went through. I wondered if dying young was something else we both would have in common.

During this time, I did some serious thinking that If I could get another chance at life -- if I could do it all over again -- I would get a double mastectomy instead of the lumpectomy I chose at diagnosis. I decided then and there that I would get a double mastectomy, no matter the outcome. Even if I never got a recurrence, I reasoned, the constant scares and mammograms did a number on my psyche. I thought of the rock group Boston's words: "All I want is to have my peace of mind."

I remember when the biopsy results revealed that the "abnormality" was benign -- simply scar tissue. I felt a tinge of happiness, but it was mostly fear. I knew if I didn't get my "evil twins" removed, I would get breast cancer again. I just knew it. Something was telling me that breast cancer would once again be in my future.

Fast forward to all the doctors I hired and fired and drama and trauma in order to get the double mastectomy, the topics of previous postings. After an 11-month battle navigating through the medical system, I finally found myself happily in the OR with a gaggle of doctors ready to remove my breast tissue and reconstruct my breasts from my post-menopausal belly fat.

The next time I saw my oncologist, he beamed from ear to ear, telling me that the double mastectomy was the right thing to do becauseI had many precancerous cells in my supposedly healthy breast. I most likely would have gotten breast cancer again in a few years.

I asked him, "So, I avoided death twice?"

He responded, "Yes."

Had I not seen what Faun went through, I might not have been so proactive and insistent on the double mastectomy. Her suffering and death had anchored itself in my mind and kept me fighting for the surgery.

Now, about two and a half years after my surgery, I still get back pain and have residual aches, but I refuse to feel sorry for myself. I refuse to be a whiner. I refuse to be a complainer. Oh, I have my moments, but I know each day is a gift.

I have recovered and gotten a clean bill of health. I'm grateful to be alive. At the end of this week, I am flying to China to adopt my baby daughter. And Faun's dream has lived on in me: I have been published in an anthology focusing on breast cancer.

Yet, I will always feel survivor's guilt. I do wonder why Faun died and not me. Don't get me wrong: I'm glad I survived, but at the same time, I feel guilty that I feel glad I survived.

But then I think that perhaps her spirit is watching over me, that perhaps she's my guardian angel who takes pleasure in knowing that I'm bearing the torch that is keeping our dreams alive.

Beth L. Gainer is a professional writer and has published an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She teaches writing and literature at Robert Morris College in the Chicago area. She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com. She also blogs on the adventures of her cats, Hemi and Cosette, at http://www.catterchatter.blogspot.com/.

"You're Fired!"

In a previous blog, I mentioned that I would share my know-how of hiring and firing doctors. Long before "the Donald" made "You're Fired!" the catch-phrase of the millenium, hiring and firing people was and is a part of doing business.

But despite all the sweet business deals to be had, there's no business more important than the hiring and firing of doctors. Your health -- and possibly your life -- depends on it.

Let's discuss the easiest part first: hiring doctors. You love a doctor and decide to use him or her. It's as simple as that. During your litmus tests of finding a gateway doctor or a specialist, you know this doctor is for you.

In more specialized circumstances -- like after you have met with a bunch of loser-doctors -- you can reveal during your interview that you are looking for that special doctor. For example, during the final planning of my mastectomy, I had the reconstruction surgeons lined up, but I needed a mastectomy surgeon.

The first thing I said to her was this: "I've got all my doctors in place -- except one. I need someone to do the mastectomy. I'm hoping you are the missing link." She laughed and said she hoped she was, too, and it turned out that she was a breast cancer survivor who had a single mastectomy and was sweet and kind and very empathetic.

I hired her on the spot.

(I didn't go into all the details about how the other two surgeons wanted to remove my ovaries and uterus and breasts. I also didn't tell her that, in my frustration with one of the organ grinders, I had the nerve to tell him that he might as well give me a sex-change operation, and alarmingly, the doctor just glared at me instead of laughing like his assistant.)

Now for the difficult part: how does one fire a doctor?

I wish I could tell you that I yelled at a doctor and pointed at him, saying "You're Fired!" as I stormed out of the office, but that would be false.

Truth is, it's always been really difficult and painful for me before, during, and after cancer to keep from crumbling under the authority of a doctor. In my previous blog, Say "No" to Thugs, I discuss how some doctors abuse their authority to bully their patients into compliance.

Here are the different ways I fired doctors (highlighted in red), and every case involved heartache and an embarrassing discovery that my mascara wasn't waterproof. You will notice that, except for a couple of times, "firing" meant simply walking away from these doctors.

**The surgeon who was so great to me during diagnosis and prognosis, but years later claimed it was unethical to do a preventive mastectomy: I flat-out told him he was wrong and that my gut instinct was right. He sneered at me, and I told him I was using another doctor.

**The gynecologist who lied to me when I was in my first trimester by telling me there was a 99.5% chance I'd carry this baby to term because he wanted to see me happy. I complained about him to his colleagues and never came back after my post-miscarriage D&C.

**The gynecologist who scolded me for my medical decision not to follow his advice. I left the office crying, but I never came back.

**The second-opinion oncologist who told me that if I didn't submit to his treatment, I'd be dead in a year -- causing me to leave yet another doctor's office crying. I called the first oncologist I saw, and he calmed me down and told me that I had no reason to believe that death was around the corner. I called the second-opinion guy and told him I would not take his advice and I was seeing another doctor.

These are just some of the doctors I fired, but they provide a very simple truth: we all have the capacity to advocate for ourselves and that firing doctors need not be dramatic -- and that sometimes the most courageous acts involve quietly walking away.

Beth L. Gainer is a professional writer and has published an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She teaches writing and literature at Robert Morris University in the Chicago area. She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

A Train Car Named Quagmire

In a previous blog, I mentioned an instance where I aired my dirty medical laundry on a train car to get what I wanted and needed from the administrative side of the medical system.

This is that episode.

The drama unfolded with me as lead actor, director, and writer of my medical destiny -- oh, and a train car packed with complete strangers who had no idea that their ticket purchases to downtown Chicago included entertainment. Well, that day, they got a lot of bang for their buck.

The situation: I had an appointment with a mastectomy surgeon the next day. Her office had squeezed me in quickly, as my surgery date would be in two months. I had just found out about the appointment that very morning. Understandably, her office needed my medical records faxed from another doctor's office ASAP.

It took a 45-minute phone fight, with me as victor, and, as it turns out, a crowd of strangers cheering for me.

When it comes to advocating for yourself, you must be willing to shamelessly share your situation within earshot of strangers. This is because medical staff and each of us have limited availability, and, well, you sometimes have to snatch that narrow window of time you have to make that call.

Even if you are in a bathroom stall. Even if you are on a train car.

Here's how my drama unfolded that very eventful day:

Needing my records faxed and knowing I'd be unavailable the entire afternoon, I make the call while on the train. The prissy record gatekeeper is refusing to fax my records to my surgeon's office. By the time I make the call, I am pissed off, tired, and my frustration has turned to steely determination.

MissyPrissy says it normally takes a week or two to transfer medical records, and I'm, like, "huh?" Then she scolds me for asking for the office to fax the records the day before the appointment and says that I should know better. I calmly explain that this mastectomy surgeon's office fit me in at the last minute because of the urgency of my medical situation and that's why I need the records delivered on such short notice. I just found out this morning I am seeing her tomorrow.

To my dismay, she counters that there are protocols to follow and that the office can't just fax records willy nilly whenever a patient asks for them. I remind her that the surgeon is the one who wants to see me immediately and wants my medical records before my appointment. The administrator says her office's policy is strict, and if they make an exception for me, then they are going to have to make it for every patient. So sorry, but no tumbling dice.

I say, "OK" and end the conversation. I cry quietly -- after all, it's OK for the whole train car to know my breasts are coming off, but I don't want anyone seeing me cry. (Yes, I'm train car-decorum- challenged.) I feel defeated.

Then I think of that famous and my favorite poem "Don't Quit," and I recalled a line: "Rest if you must, but don't you quit." I had the wind knocked out of me. That was my rest.

I would not quit.

I call the office again. The Records Nazi recognizes my voice and is amazed that I have the audacity to come back for more abuse. As she starts telling me her office's decision is final, I interrupt her with a blitzkrieg of my own: "I don't want to speak with you anymore. Give me your office manager."

Shocked at my irreverence, she complies.

When the office manager gets on the phone, she tells me she cannot go against the office protocol regarding sending records to a doctor's office.

Suddenly, I take a different approach: emotional manipulation -- and this is the turning point that gives me the upper hand in getting what I want and need.

Although my chemobrain cannot retain information well, I do remember our dialogue verbatim:

Me (seeming to change the subject): "Do you know I'm adopting a baby girl from China?"
She (disarmed): "Awww, how sweet!"
Me: "Well, how would you feel if she no longer had her mommy?"
She: "That would be terrible!"
Me (not wasting a minute): "Well, that will happen if I don't get my surgery. Your office's refusal to deliver my medical records today may delay my surgery and ultimately harm me. How would you like to tell my daughter that she no longer has a mommy?"
She (emotional): "Please don't talk that way! We don't want your child to be motherless. Let me see what I can do to get your records to the surgeon's office."

I thank her and literally two minutes later -- no I really mean literally two minutes -- the Records Nazi humbly calls me back and says the records have just been faxed to the surgeon's office. My surgeon's office calls me a few minutes later to confirm this.

I am exiting the train in shock at my own power to advocate for myself -- and in shock that I'm able to stand on trembling legs and that I am evoking smiles and congratulations from so many people in the car. Then a gentleman who was sitting far from me on this journey approaches me. He says, "Ma'am, I hope you don't mind, but I overheard your entire conversation, and all I can say is, 'Good for you!'"

That's when I realize how loud I must've been. I thank him and apologize for being so loud.

He says, "It was great hearing you not taking nonsense from those people. Your health is the most important thing in the world, and it's about time someone put these medical people in their place! Good luck with your surgery; my thoughts are with you."

At this point, I'm reeling. I am happy to have such a fan base, but then I wince as I remember saying the words "double mastectomy" and "breast cancer" so often during my conversations on the train. Everyone on my car had heard the sordid details.

As I leave the train, I see a Breast Cancer Awareness Month ad on the wall of the vestibule. I remember it is October. And on that train car, in front of a group of strangers, it turns out that my face was the face of breast cancer. But it was also the face of self-advocacy.

And as I walk on shaky legs, but not on shaky ground anymore, I think that perhaps I became someone's role model and hero that day. And I realize I have become my own hero that day, as well.