by Wendy Marsden, CPA CFP®
In May, 2021 I was diagnosed with breast cancer. After an eight month course of treatment, in December, 2021 I had a bone scan and my six-month follow-up with my surgeon, both of which declared me having “no evidence of disease”. (No one declares someone “cured” with my type of breast cancer; there’s a non-zero chance that micro-mets escaped treatment and can recur. But it’s highly likely that I actually AM cured at this point.) I don’t like the term “remission”, either; that’s for people who have Stage 4 cancer where it’s going to be a constant in their lives, which mine hopefully is not.
I didn’t tell most people for several reasons: I never found that talking about ME was a good use of meeting times. Nor did I want people to hesitate to contact me with their issues. And, to be honest, some of the time I wasn’t quite ready to answer questions about continuity, etc. But now that it’s in the past tense, I’m happy to be an open book about it.
Reflecting back on my cancer journey as it comes to an end, I realized I’ve learned a dizzying amount. Lifelong learning – especially personal growth & development – is one of my core values. This essay is for me to consolidate and to share what I have learned and how that makes me more helpful to my people.
I’ve learned about medical financing:
- There are things called “prescription grants” that help with drug costs. Ask about NeedyMeds or SimpleFill.
- Specific drug companies offer coupons for expensive drugs like Neulasta if your insurance rejects it.
- Insurance out-of-pocket and out-of-network are things to understand clearly.
- COBRA might be a better plan than you can buy on the exchange.
- Insurance companies need to be fought, so someone on your team needs to be able to spend a bunch of time on hold.
- All sorts of charities offer help for people who are less well off.
- There are support groups for everything, and studies show that they improve survival chances!
- Health insurance counseling is available through the Health Insurance Navigator network.
- There’s a social worker at your cancer center who can help you apply for Family Medical Leave Act benefits and other smaller grants you might not know about.
- Social Security Disability is automatic approval if you’re stage 4 (but unlikely to be approved if you aren’t).
I already knew how to plan to spend down for Medicaid eligibility (which is less effective than you wish it to be) and how to tap the equity of your house to pay for care.
I’ve learned more about grief. I’ve read and listened to Kate Bowler and read “The Bright Hour” by Nina Riggs and learned about how you face your own mortality and navigate times when everything is just NOT fine. The main lesson to take to my people here is that kindness matters. It matters SO MUCH when you’re wounded or grieving.
I learned about how gobsmacked you are by a cancer diagnosis, even if it’s a curable one. There’s a realization that comes at a visceral level that we’re mortal. I mean, duh, but somehow we forgot or something and this reminds us in a really rude way. I’ve been thinking back to an exchange I had with one of my people who told me about her brand new cancer diagnosis and surgery, caught at an early stage. At the time, I said that it was totally survivable and would probably not even impact her life very much. Nor would it even be a financial hit. I thought I was reassuring her. I came across as cold. She later sent me some very valuable feedback that she felt I had minimized her experience, that I recommended things totally inappropriate for her, and I undermined her agency by counseling on a topic she’d already made up her mind about. She gave me some things to say INSTEAD as my initial response (followed by “and then shut up and listen” for each item):
- Well, that stinks.
- How are you feeling?
- Where are you in this process?
- Do you have concerns about how this might affect your financial circumstances?
- What would be most helpful for you right now?
I replied to her thanking her for educating me. But, honestly, I still didn’t totally understand the emotional whammy of hearing the word “cancer” applied to your own life. Then, BAM, karma came and did its thing.
I learned how incredibly common cancer is, and how unlikely people are to bring it up. I’ve been hesitant to tell my people about my cancer. At first it was because I was trying to get a handle on how bad it was. (Bad enough that they put me through chemo, but not bad enough that it’s likely to kill me turned out to be the answer.) Then I wanted to wait to see if I could triage each day successfully enough at work. (I dropped my “Four on Friday” and a background project and stopped taking new clients.) Then I didn’t want to bring it up because I didn’t want to make my meetings with people be about ME. I also never wanted people to feel like they couldn’t ask me for things because I was sick. In a few instances I had to confess that I didn’t get to something in a timely way, so I had to tell the person what was going on and ask for grace. But what surprised me is how often the people I told replied back that they had ALSO gone through the same thing. Two of my people were regularly visiting the same oncology practice! Three separate women mentioned they had also had breast cancer. By telling you this about me, I’m hoping to normalize talking about it. This is everyday stuff, folks, and I had no idea!
I’ve learned about how the threat of illness flaring up is a whole new character that can join your life. It’s like walking alongside the Grim Reaper every day. He’s not come for me… this time… but his gaze could always shift. The dose of mortality I got early in the diagnosis process – before we knew how bad it was – has been a good companion for me. The “memento mori” idea helps to make sure I live in line with my values. The right time to see a friend is RIGHT NOW. The amount of time I want to waste of my “one wild and precious life” on debugging printer problems is ZERO. The reminder of mortality is nice for me. But the looming drama of a recurrence is just icky and I wonder now how many of the people I serve also live with this specter? I’ve never asked before, but am open to talk about it if it would be helpful.
I’ve learned the importance of focusing on wellness. The specter of Recurrence is driving a whole lot of my wellness projects these days. I’m doing a bit of body-weight resistance training, a bit of yoga, but mostly my exercise has been walking in the sunshine at noon. I’ve learned that women with low Vitamin D levels, particularly below 40, are more likely to get breast cancer recurrence. Around 70 is supposed to be protective. That’s a big ask for those of us in the North: New England has the highest regional incidence of breast cancer in the U.S., plausibly because of low Vitamin D levels.
I’ve learned that “plant-based whole foods” is evidence-based eating. I’ve been struggling with the evidence that I need to cut out meat and dairy, and wasn’t inclined to join what I felt was the religion of being vegan. I had been doing intermittent fasting to lose weight and had been happy with a pound a month. But after the cancer diagnosis I realized I needed to pick up the pace. Again, recurrence rates are lower in women who are less overweight. So, I began working with a support group and checked in weekly with a nutritionist about the foods I logged every day on the MyNetDiary app. It’s a continuous journey to undo habits that got me overweight to begin with. Cancer provides an impetus that was somewhat missing for me. It’s not easy, though, but I figure it’s easier than going through chemo again. I’ve been learning to eat Dr. Greger’s BROL bowls, to add tempeh and natto to my diet, to use nutritional yeast instead of parmesan cheese… it’s a journey. I’m reading Dr. Greger’s “How Not to Diet” and watching his NutritionFacts.org and appreciating the evidence-based elements of it. I’m also appreciating how much better it is for my waistline to eat less calorie dense foods. I am healthier and it’s better for the planet, too. I don’t think I’m particularly advanced on the journey to eat a plant-based whole foods diet, but I’m someone who can model it for people even newer to it than I am.
I’ve learned the benefits of meditation. I’ve really focused on equanimity: just being okay with whatever is true, just being present in the now. A meditation I find helpful is, “No regrets (don’t flog yourself for your past), no resistance (don’t fight reality), no anticipation (don’t borrow trouble from the future), there is only now.” To this I have added (because I’m more about doing than being) “The only thing you can do is the next right thing.” I’ve found that the challenges of the day are surmountable each and every day. But when I try to string all the future days together? That’s overwhelming. I need to scale it back to right now. Sometimes I have to do a centering meditation using my five senses to tell me I’m fine RIGHT now. (Ask me if you want a copy!)
I’ve learned about how helpful it is to have an R.N. in the family, or at least someone who can go with you to visits to the doctor, someone who knows when a symptom needs attention. I’ve grown closer to my sister through this. It’s amazingly wonderful to have someone go with you to appointments, even when you don’t actually NEED them to be there. I’m thinking of the way my husband drives me to radiation, but also remembering how very grateful and loved I felt when he stayed overnight in the hospital room with me the night after the mastectomy. We’re social animals and being alone makes everything harder.
I’ve learned how important it is – and how relatively easy it is – to ask friends for small favors. I’ve found that in nearly every case it has been something they’re HAPPY to do for me. One friend joins me for regular walks on Sundays and Thursdays as our schedules allow – but we’re defaulting to assuming we can make it work. Another friend let me invite myself over to his house for dinner as I was going to be in the area and seeing his family was the very best use of that chunk of my life just then. I asked a neighbor kid to make me a paper chain to count down my radiation visits and he and his sister and mother wrote lovely inspirational quotes in each link. Another neighbor has alopecia and when I asked for help she taught me everything she knows about being bald. I asked my church to get the men’s group started back up – I’m supported, but Ben wasn’t and he needed his friends. Everyone has been happy to make tweaks to their schedules to help a friend in need and foster deeper connections. I’m in awe of the power of asking for help.
I’ve learned that cancer can bring a family together. I’ve been using a group text chat to update family as I go through my cancer treatment, and have noticed that it’s brought our far-flung family together into dialogue. I love that. The right time to reach out to family members is always ASAP, but the second best time is when you’re facing a scary diagnosis. We are all better off because of the connection.
I’ve learned that I need to share more about our finances with my husband. He’s been happy to leave me – the professional – in charge of our finances. But since the diagnosis we’ve been a bit more likely to sit together while we pay the bills. As I’ve tried to bring him into it more, I’ve realized that I made everything too complex. So this has helped me to remember to SIMPLIFY. We need to close bank accounts we don’t really have to have anymore, and consolidate investment accounts, and leave one-page written notes about the financial plan. Sheesh, which one of the people I serve doesn’t crave that?
I’ve learned so much about cancer treatment. That at the start they’re largely standardized treatments so, for the most part, going to the place nearest and most convenient is probably a good move. I’ve had to go back and forth to the Cooley Dickinson / Mass General Hospital Cancer Center something like 60 times this year. Going to the cancer center 25 minutes down the road instead of the one 90 minutes away has saved me 120 hours of driving this year. As life choices go, that sounds like a good one. Unfortunately, I’ve also learned how very remedial the understanding of cancer is. The treatments they put me through work out to “cut it / poison it / burn it”: basically barbaric treatments tested over time without understanding why or how they work. There was never any understanding of whether I was being over-treated or under-treated. I had naively thought cancer was better understood than it appears to be.
I’ve learned a lot about being an advisor rather than a boss. My medical oncologist is someone who tells me what she’s decided. Uggh. I want her to inform me of my options and then let me choose. As a financial planner I’ve been trained to provide the options to people, but in practice it often looks like me musing out loud in front of them of what they can do. Often, without pausing for a breath I’d say, “but this option is better so let’s do that”. I have been rubbed the wrong way a few times too many by my oncologist doing roughly the same thing. I need to insert the pause and say, “What are your goals here?” or “How does this sit with you?” Then I need to shut up and listen, as my friend said.
I’ve learned that it’s good if you can research your OWN specific situation. Listen to JAMA Oncology podcasts. Get into the PUBMED articles and see what they’re citing (and who’s citing them). Learn the language. I discovered a newly approved drug that I was eligible for that is likely to reduce the recurrence rate by 4% in my situation. I asked my oncologist about it and she hadn’t even realized I was eligible. (It had been approved for my type just two weeks before I asked her… she might have discovered it on her own. But in my case, learning and advocating for myself is a good move.) I know this is true for my people as well: someone who works at Amazon or mined Bitcoin or is an acolyte of Elon Musk, for example, follows their particular investment’s ups and downs and issues much closer than I do. I try to bone up on specialty things important to the people I serve, but generally only after their prompting.
I’ve learned that living forever wasn’t ever going to be one of our options. One of my jobs as a financial advisor is to “help people get the most life out of their money.” Even though I fought back this illness, it turns out we’re going to die anyway (someday). Once we realize that, making sure we LIVE properly is a reasonable “goal of care” as they say in medicine. I take this lesson into my practice by thinking about what things people want to do and strategize how to get the money they have to stretch that way. Having money in the checking account until the day you die is certainly one goal, but spending as much as you can as meaningfully as you can is another that I embrace.
I learned about continuity planning and succession planning for my business. I had a theoretical continuity plan that we’d drawn up a few years ago, then refreshed when we were asked “what would happen if you caught COVID and were on a ventilator for two months”, but that version was too theoretical: it didn’t have phone numbers of who to call on it. So when I knew for sure I was going into surgery and would be totally unavailable for a bit, I beefed that up, actually submitting documents to my custodian naming names.
Then I started working on the succession plan in real terms. If I were hit by a bus my staff and husband would be running around like chickens with their heads cut off saying “OMG OMG OMG what do we do?” I created a one page plan with the first steps to take to transition the business. Along the way I discovered (again!) that I really love what I do! But I do still have more things I need to do to make the business more robust even if I’m just on vacation. Gary accelerated his CFP® courseware and will be sitting for the exam this March.
Thank you for reading this. No need to send expressions of sympathy; this was just one of those things that happens in a life. Perhaps that’s the last lesson: none of us will escape medical adventures in our life. The best we can do is to learn from them.