What I did when I was away / at the Mothership / on bridge

One of the wonderful things about my job with the State Department is how supportive they are.  Most other jobs -  if you had to be gone for 9 weeks -  you’d just be out of luck.  You’d use up all your sick and vacation time and then you’d really be in a bind.

But – not only did the wonderful MED Foreign Programs facilitate my returning to the US for treatment, they also facilitated my doctor’s appointments in DC.  And since my treatment (after surgery) was in DC, I was able to work when I wasn’t getting treatment.

The folks at MED are very supportive of people working while on Medical Leave if they feel up to it.  It helps you stay connected, stay involved, and it also can preserve some of your precious leave.

My CDO (Career Development Officer), helped me find a bridge assignment – it’s what they call temporary assignments that are between two other assignments.  He found me a spot in the Bureau of Consular Affairs.

What is that you ask?

The mission of the Bureau of Consular Affairs (CA) is to protect the lives and interests of American citizens abroad and to strengthen the security of United States borders through the vigilant adjudication of visas and passports. CA contributes significantly to the USG goal of promoting international exchange and understanding. Our vision is to help American citizens engage the world. The Bureau issues the travel documents that allow Americans to travel the globe and lawful immigrants and visitors to travel to America and provides essential cycle of life services to American citizens overseas.

There is a really good website http://travel.state.gov/ that has tons of information.  It’s the first place you should go when you’re thinking of travelling internationally. 

I got to work in the Crisis Management section helping the folks who help you when there’s a crisis overseas.  Here’s some more information about what that can entail:

http://travel.state.gov/travel/tips/emergencies/emergencies_1212.html

One of the best ways you can help take care of yourself is by enrolling in the STEP (Smart Traveller Enrollment Program). http://travel.state.gov/travel/tips/registration/registration_4789.html   By enrolling in STEP, you get all the travel alerts and updates – really important information – especially in a crisis.

There are a lot of people working really hard to make sure that US citizens have the freedom to travel the world, and the information and support to stay as safe as possible.  I wish more people out there knew how many folks there are watching out for them when they’re overseas.  It’s like having a whole set of aunties and uncles who just want to make sure you have a nice time and are safe.  It’s a good feeling.

The Hardest Part

With all that’s been going on, people often comment on how hard it all must be – the surgeries, the radiation, the multiple doctors.

But that’s not what’s hard.  And not to minimize anyone else’s experience.  But I do surgery well.  And thus far, the radiation treatments haven’t been horrible.  The doctors are all very nice and very helpful.

What’s hard is being away from my family.

I have never been away this long from my family – ever.

By the time I get home, I will have been gone 9 weeks:  3 weeks for surgeries, 3 weeks for recovery and 3 weeks for radiation.

I will have been away from my family in Brazil longer (9 weeks) than we were together in Brazil (4 weeks).

We had only been in Brazil for a month when I had to leave.  We were just beginning to get settled and were still living out of suitcases.  We’re still living out of suitcases since stuff can take a long time to get to Brazil.  And of course I’m living out of suitcases as I’ve been here and there.

But all that is doable as well.

It’s been hard on me and it’s been hard on them.  K. has to cope with being a single parent (which is insanely difficult), while being in a foreign country, with a new language, and the emotions of kids who are missing their mom - not to mention his own feelings.  I get to deal with all this health stuff all alone - without my family near me.

The worst part is when one of us has had a hard day.  I can’t pull my kids on my lap and hold them while I listen to all their thoughts and fears.  I can’t give my husband a hug when it all becomes too much for him.  And they can’t hug me when I get scared.

I do have something to hug though:

The kids brought these back for us when they went to Camp Grandma and Bompa last year.  So we’d have something to hug the next time they went.  I’ve been putting them to good use.

Third Time's a Charm

So - all in all, I ended up having three surgeries to get it all out. 

The first one was the expected one.  The second one came about because the margins weren't clear - just needed to clean it up.

The third one came about because the second surgery showed that the cancer went a little further than they had expected.  I was given a choice.  I could have one much more involved surgery where they'd take everything and be done with it.  Or, they could go back in and try to get this last part - but if that didn't work, they would have to then go back and do the big surgery - it was up to me.

Luckily, I am one of those rare people who doesn't get horribly bothered by surgeries - I don't get sick, I don't get nervous.  I just relax and try to enjoy a day with people attending to me, lots of pain killers and the occasional hospital graham cracker, cranberry juice and if you're really lucky - jello.

I also didn't want to lose any more of me than I had to.  I wanted to keep as much of my feeling and self intact.  So - I opted for a third surgery and kept my fingers crossed.

My dad came up again.  The man is a saint.  He's come up the last three weeks.  Driving from LA on a Thursday, taking me to the hospital and attending to me on Friday and Saturday, and then driving back home on Monday.  Not to mention putting up with my dragging him to various fabric stores and spice stores and forcing him to eat at all these restaurants.  Well - that last part isn't true.  I've never had to force him to eat a restaurant.  He's been my willing partner in our eating binge.  We've had loads of fun - I took him to the latest hipster bar (where he almost got a PBR), and the famous Berkeley Cheeseboard Collective to get pizza, as well as other, fancier places.  It's been nice just the two of us.  We've had some great times - it reminds me of the time we drove across the country together.  It's amazing when it's just the two of us together, how much we are alike - quirky and weird in many of the same places.  I didn't get to see my mom during this time, which would have been nice, but I really appreciate the gift she gave my dad and me of spending so much quality time together.  She really took one for the team.  And besides - she's promised to come and visit me in DC - so we'll get our alone time as well.

This third surgery was very hard on my family.  For them - stuck in Brazil without me, it felt like yet another delay in a seemingly endless set of delays that was keeping us apart.  The slow torture of it could push anyone over the edge.  Luckily, with a little rest and time, balance and grounding does comes back.

The results came back a week later - as usual.  Luckily this time it worked - they got it all!!!!

I now am headed to DC for the next stage of my treatment and will also be able to work at the Mothership.  One step closer to being with my family!

My Week(s) of Medical Procedures

I am so lucky to work for such a great employer and have such great insurance. I shudder to think if this had happened last year when we were unemployed with only catastrophic insurance!

So - I arrived in the San Francisco Bay Area to get this lump taken out.  After traveling 30 hours, I arrived at my doctor's office with all my luggage.  Everyone was super nice, letting me call family to let them know I had arrived safely (cell phone not yet hooked up to US carrier) and giving me a place to store my luggage.

My doctor spent a lot of time with me making sure that I understood everything that was going on, and that could go on.  I am really impressed at the effort he made to ensure that I am well educated about the situation and am able to make informed decisions.  The only problem was that after all that travel - I was not really in a place to hear it all.  I had left Brazil thinking I'll just zip in, get this taken out, and zip back - no big deal (I know - sometimes I don't really take in the whole picture).  Sitting in his office learning about different types of cells and their reactions to hormones and the body's life cycle - not to mention discussion of survival rates - was all a bit much.  All I could think of was that I wanted a Manhattan, a nice baguette and some good pate (foodie to the end!).

When my appointment was over, I used their phone to call my good friend A.  All I had to do was say "Come get me" and he was there, whisking me away and finding me a good Manhattan and a great burger (pate being hard to find, and burgers being my go-to survival food).  A. and his husband D. and their two great children enveloped me in their cozy home and made me feel so much better.  If I couldn't be with my family, it was nice to be with theirs.

The next day, I had an MRI to determine the location of the cancer and the extent of it.  They give you a contrast that under the MRI makes the cancer cells light up - kind of like streets and cities at night from an airplane.  I've heard many stories about MRI's - how it's claustrophobic and people often panic.  The folks at the imaging center couldn't have been nicer.  They hooked me up and got me in machine, giving me earplugs and headphones.  The hardest part is that you have to remain still.  But since I was face down - it felt like a massage table - I just shut my eyes and was grateful I wasn't claustrophobic.  The machine makes a lot of very loud noises that are somewhat rhythmic and I found oddly soothing.  There was even one sequence that sounded like the beginning of the song "CarWash" (the part with the jackhammers).

After the MRI I had another mammogram and then was free until the next day when I had to do all my pre-op stuff.  That day, I made the rounds (kind of like a scavenger hunt).  I had blood drawn and X-Rays and EKGs - they need to make sure that everything is in order before they take you to surgery.  Then we met with the surgeon again.  I say "we" because my wonderful dad drove up to be with me for all of this.  Not only was it nice to have my family here (especially since K. and the kids were back in Brazil), but since my dad is a doctor, I had someone with me whose eyes wouldn't glaze over with all the detailed medical talk.

The next morning we were up bright and early to have all the procedures.  My dad got breakfast, but I couldn't eat past midnight (it always comes back to the food!).  First we went to the MRI center where I got another MRI.  Since the cancer isn't totally obvious to the naked eye, they needed to mark the cancerous area with wires so the surgeons know where to cut.  Unfortunately, they couldn't put me to sleep for that.  I did get a local anesthetic, and once again, the nurses were amazing - giving me little massages in between times in the MRI.

After the wires were in place, they took me to the hospital where they got me ready for surgery.  They give you this great paper blanket that gets filled with hot air - very cozy.  And I got these cool leg wraps that massage your calves - very nice.  The anesthesiologist came and made everything go away and the next thing I knew I was waking up and having a great conversation with the post-Op nurse about the best restaurants in Oakland (the foodie part of me just doesn't stop!).  Soon after that, they took me to recovery where I got to see my dad and Skype K. (I am so thankful for modern technology!).  Once I was able to move around, they let me leave with my dad.  I'm very lucky in that anesthesia doesn't leave me sick like some people.  The drugs they gave me left me happy and silly - so I was quite amusing to my father as we picked up my prescriptions and headed back to the hotel.

And then, especially since I was feeling no pain - and was super hungry - we went out to dinner to one of my favorite places.  The following day, my sister came to join us and we all hung out as I rested and started mending.  Since I was doing so well, my dad headed back home to his life after a few days and I continued to rest and recuperate and see some friends. 

But, at my follow-up doctor's appointment where I had expected to get the "good-to-go", I learned that the good news was that I only had DCIS - no invasive cancer, but that the bad news was that the margins were too small (1mm) and that I had to have another surgery.

So - we did a repeat of the previous week.  My dad drove up again (the man is a saint - the best dad ever!) on Thursday and I had surgery again on Friday.  Luckily, I didn't need the MRI wire procedure again.  Other than that - the same plan, hopefully the same recovery, and hopefully I'll head out to DC at the end of this week for radiation.

My dad and I even went to the same place for dinner on Friday.  We joked about our Friday tradition - surgery and dinner at Oliveto's - but it's not a tradition I want to start.

What to do at LAX at 2 in the morning

So - I find out I have to medevac out and my super organizing / control freak nature kicks in.  The next days become a flurry of arrangement making - flights, hotels, locations to purchase US sim cards so my cell phone will work, friends to stay with for the nights that there's no hotel room in the entire Bay Area (glad the convention business is booming!)  I've got confirmation emails all over the place, bags packed for the various possibilities and then we head to the airport.

My first flight is fine - long and boring - but no big deal.  And I have an hour and a half to make my connecting flight.  No big deal I thought.

Oh - how wrong I was!

Not only is Miami International Airport huge, but the signage can be a bit confusing.  You walk forever, and then take a mini-train, then walk a forever again before you get to the Homeland Security check-in.  And then of course, I picked the wrong line to stand in.  It looked short, but I got behind several people who required significantly more scrutiny from the DHS people who keep us safe.

Finally I was through and headed to get my bags to go through customs.  I still didn't think I had a problem.  Usually when the airlines are concerned people won't make their connecting flights, they have agents standing by to facilitate the process.  Since there was no mention of any of that, I wasn't concerned - but I should have been.

After getting through customs (again stood behind the wrong people), I followed the yellow dots to the connecting flights area.  But - what's this??  A woman is shouting at me that people going to San Francisco need to go someplace else.  Huh?

Well - it turns out that my flight had already loaded and boarded and was taking off in 15 minutes.  There was no way to make it.  And it was the last flight of the night.  The very relaxed airline agents told me I could take a flight the next morning at 10 AM.  10 AM - that's when my doctor appointment is - West Coast time!!  I explained my situation, trying to keep my emotions in check (stress, annoyance, frustration, sadness, tiredness - you get it).  The agent got me on the LA flight with a connecting flight at 7 the next morning to SF.  But - no hotel, no nothing.  Oh - and the LA flight was starting to board in about 10 minutes and I still had to check in my bags and go through domestic security.

So I'm off - again trying to find my way through Miami airport as fast as I can.  Also trying to login to the airport WiFi as I'm walking along so I can at least Skype my family to let them know what's going on and that I've made it part way.

I get to my gate as they're halfway loading the plane, quickly Skype my husband (not my best conversation - I was way too stressed).

I had to revise my plan - since I wouldn't be getting to SF and checking into a hotel where I could get some sleep, I thought I'd try to sleep on this leg of my flights.  That way, I wouldn't need to sleep from midnight to 5 at LAX.  As luck would have it, I sat next to the screaming baby that everyone dreads on night-time flights.  I felt so sorry for his mother - she did everything she could, but he was having none of it.  But since I'd had a super screaming baby - and he wasn't mine, I was able to sleep through it.

So now, here I am, at LAX waiting for morning and my flight to come.  Everything shuts down here.  The best place to be is the International Terminal.  There the McDonalds stays open until 2 AM and T-Mobile has WiFi spots and there's some lounge type chairs.  And then at 3:30, the security guys reopen the domestic side and I can head back to wait by my gate.

The lucky things are that I was able to sleep for probably 4 hours or so between Miami and LA.  And since I'm still on Brazil time, I'm pretty awake.  2 AM LA time is 7 AM Brazil time - about the time I arrive at the Consulate.  And I got to properly Skype my family this morning and apologize for my crankiness last night.  And I'll be setting a new personal record - 30 consecutive travel hours.

What a week it's been

So - I got my results back from my biopsy and they weren't exactly the "it's all good" news we had all thought they would be.  Seems as though it's more of a "hmmm - this doesn't look so good" kind of news.

So - I need to go back to the US and get this taken care of.  And just when we were finally settling in to our new home in Brazil - the kids have started school and are making friends,  I was hitting my stride at work, I've got some interesting projects that I've been tasked with.  We thought - we finally will be able to be in one place for a while.

But (insert your favorite deity here) is a merry prankster!

First, we learned that my results weren't good and that set off a flurry of phone calls and information gathering to determine what the next steps needed to be.  Luckily, we had already made an appointment with the Health Practioner for Brazil who just happened to be visiting the Consulate that week.  The next day, when we met with her, we learned that the State Department would medevac me back to the US so that I could undergo surgery.  My family would stay here, and as soon as I got the all clear, I could return to Brazil.  If we were lucky, the whole process could be taken care of in about a week or so.  I am very lucky to be working for such a great employer and have such great health insurance!

We started another flurry of phone calls and emails to arrange all the necessary appointments.  I'm lucky in that I can go back to California to my regular doctors to have this taken care of.  And my parents will be able to be there to help.  But - as we learned more about what needed to be done - we learned that more often than not, people in my situation end up needing a course of radiation.  Hmmmm - that's 5-7 weeks more . . .  That's a long time to be away from my family!  And a long time to be out of work!

Luckily, the State Department is a big organization and has experience with people needing to leave one place and work in another for a short while.  It's called TDY - think "temporary duty".  It looks as though if I do need to do the radiation, I can do it back in Washington, DC and take a temporary job at Main State - also known as the Mothership.

I'm trying to focus on the silver linings here - I get to see my family again sooner than I thought, I could get to work at Main State for a bit and get a better understanding of what goes on there.

But it's also super hard to be leaving my husband and kids for so long.  I know it's the best thing for the kids - it's important that they get settled in to their new school and begin making friends so that they can really enjoy our time here.  I'm so lucky to have such a good partner who does such a great job with our kids.  And I'm so lucky to have such a great community of friends and family who are rallying around us all to support us in any way they can.

In the meantime, things are changing pretty fast.  Every day brings new information.  Soon I'll have my plane tickets - it looks as though I'll be leaving Brazil exactly one month after I arrived.

Medical Care in Brazil

Living overseas - and especially in the Foreign Service, means you need to rethink the way you handle your medical care.  I was raised in an environment where I had the same doctor year after year. That doctor has followed my progress and kept my information.  I like that system.  It's simple and you've got someone who understands the way your body works - all it's little quirks.  But when you move to a different country every few years, it's a bit different.  Many people choose to keep there regular doctors in the US and see them when they're back for Home Leave and R&R. You still see doctors in other countries, but your main point person, is your doctor back home.

Since we were about to be overseas for two years, we made sure we took care of all of our regular check-ups when we were home in California before we left for Brazil.  It made for a few hectic days of racing from appointment to appointment, but in the end, it was nice to have it all done.

But, as luck and life would have it, on one of my regular yearly tests, there was an abnormality.  Nothing major, but definitely something you want to follow up on.  We found out the morning we were scheduled to take the red-eye to Miami before heading on to Brazil.  My amazing doctors were able to get me in that afternoon for a follow up look-see.  It added another event on a rather busy day, but I was very glad to be able to get things checked out before we left the country.

But . . . the follow up look-see showed a bit more - something that required a biopsy.  None of the professionals felt that it was an issue, but it's always better to get everything checked out to be sure.  But - when and where to do it?  At one point, we thought about doing it right then, before my flight out, but that just seemed like it was asking for trouble.  So it was decided to get it taken care of when I got to Brazil.  The medical center organized all my records and sent me off with a complete packet.

Taking care of things in Brazil couldn't have been easier (well - it could have been if my command of Portuguese was better and more geared to medical terminology and day-today living).

My Consulate has a CLO (Community Liaison Officer) and she's wonderful.  I explained the situation and she found me an appropriate doctor who also spoke English.  I was able to get in to see her just two days later for my consultation.  That doctor reviewed my files and scheduled my appointment for my biopsy.  She also let them know that I worked for the Consulate and that Portuguese wasn't my primary language.

The clinic where I went is one of the best in Recife.  They confirmed things with the Consulate (again making sure that I was understanding everything).  And when I went for my biopsy, they had someone who met me and moved me from place to place so that I didn't get lost in the system.  The doctor who took care of things spoke English and explained what she was doing.

Interesting note - unlike in the US, where once the sample is taken, it's whisked off to the lab and you only get the results from your doctor, in Brazil, they handed me the biopsy sample to take to the lab.  I dropped it off and they gave me a little card with a number on it and told me when to come back to pick up my results.

It also helps knowing what great care the State Department takes care of it's people.   A fellow blogger has shared their recent story.  It's challenging, but so nice to see how well supported we are.