How Does It Feel to Have Cancer?

Learning that I had cancer may be the scariest thing that has ever happened to me.

My first personal encounter with cancer (that I can remember) was the wife of someone my dad worked with when I was about 13. We were invited to a party, she was there with her obviously-bald head wrapped in a colorful silk scarf that hung down like a ponytail. Someone told me, in a whisper: “She has breast cancer.”

I got the strong impression that I should feel very, very sorry for her, and that she was very brave to be at a party when she must be feeling very ill, though she looked as if she was enjoying herself.

Some time later (months? a year?), I was not surprised to hear that she had died.

Because that’s how it was: you got cancer, you died. Probably after a long, agonizing “battle” involving surgeries, chemotherapy, and other horrors.

Whatever we see as children, we tend to assume that’s “how the world is”. Years of experience may never quite override our instinctive assumptions based on the “natural facts” that we learned when young. So, for my generation, a diagnosis of cancer feels like a death sentence – even though we know that much has changed in recent decades. Cancer treatments and survival rates have improved tremendously. As one nurse said to me: “This is not your grandmother’s breast cancer.”

Nonetheless, cancer still feels like “the big one”. The thing that, from a certain age, you do routine tests for, and each time heave a sigh of relief: “Whatever else may be wrong with me, at least I don’t have cancer.”

Well, now I do. It’s almost a letdown. I no longer have to worry about the worst possible thing that could happen to me: it has!

Of course, there’s always a next worst thing. “I have cancer, but as long as I don’t have to have chemo, it won’t be too bad.” Guess what? Chemo starts next week.

So, what’s left? “I have cancer, and I’m about to have chemo, but as long as I don’t end up dying young in long, drawn out, terrible pain…”

Here’s hoping.


Physically, I have no cancer symptoms, nor any reason to have them. I may not even have any cancer left in my body: the tumor was removed intact, and there is no evidence of spread. (So why am I doing chemo? Statistics: to reduce the chance of recurrence.)

Emotionally, this has been a hard ride ever since the biopsy in October. I’d already been through a cycle of suspicious mammogram and biopsy years ago, but this time there was something I could feel. As much as I denied it, to myself and others, this time it seemed much more likely to be cancer. Of course that thought was with me constantly. I was standing on an emotional precipice. Receiving the diagnosis was the push over the edge. I’ve been falling ever since, with occasional moments when I do manage to forget all this and just enjoy my life. Being in Australia for a month helped with that, but cancer takes a lot of forgetting.

If you talk to me about cancer, I will immediately go into in fact-sharing mode. I’ll tell you everything I know, which feels like it’s already quite a lot. But this knowledge has been difficult to acquire. The topic is so frightening that, every time I start reading about it, my brain just wants to run away and hide in a corner. I can only take in so much before I freeze and choke and nearly start crying. I guess this is a common reaction: almost every medical person I’ve dealt with has said: “I know this is a lot for you to absorb right now.” (They have everything printed out, so you can read it again later.)

While I want to understand what’s happening, and keep control over what’s done to me as far as I can, learning about cancer has not helped me much in dealing with the associated emotions. Cancer treatment has improved since I was young, but it’s still bloody awful. And you can’t refuse knowledge about even the uncommon side effects, because you need to watch out for their symptoms, e.g.: “In rare cases, people getting this drug have had their spleen grow very large or even rupture, which can cause death. Let your doctor know right away if you begin to have pain or swelling…”

So, for the moment, I feel emotionally exhausted, while paradoxically physically ok. The latter, of course, is about to change, as the doctors start treating me to within an inch of my life.


For those who have asked what they can do for me – which I very much appreciate! – I can always use more reading material. Suggestions for Kindle books and other miscellaneous items from my Amazon wish list can be seen here. I’ll also very happily take suggestions for free Kindle books that I might not have found for myself yet on Amazon or Project Gutenberg, as well as any other good sources of free ebooks.

“You Can Always Go to a Startup”

“You can always go to a startup.” Job seekers in the Bay Area hear this refrain, especially from people with no experience of startups (or tech, or the Bay Area). Startups are seen as the sexy option. Some startup employees even dismiss those who stay in “safe” jobs at bigcos: “You must lack the guts or the talent to be out on the tech frontier, boldly disrupting the establishment!”

Easy for you to say. For many of us, working for a startup is not a realistic option. Not because we lack guts or talent (many of us have worked at startups before) but because most startup jobs are – by design – suited only to a very particular demographic. This limits employment prospects for the many who are not part of that group, but it also hurts the startups themselves.

If you’re a startup founder, you may think you don’t care about this particular problem, but you should.

The Lifecycle Barrier

I am not (for the moment) talking about the sexism and racism rampant in tech today. These are real problems and I in no way dismiss them, but there’s another barrier to job mobility, one that sooner or later everyone may face. I’m referring to the human lifecycle which, for many of us, looks like this:

  1. childhood
  2. college
  3. relationships / marriage
  4. babies
  5. kids growing up
  6. kids in college
  7. empty nest
  8. retirement

For the first phase or two of this cycle, we usually have others providing for us. From phase three, we start providing for others, including our future retired selves.

The financial onus of a traditional middle-class family lifestyle today is staggering, more so in real estate markets like the Bay Area. People with families need decent salaries, good benefits, and humane hours: basic working conditions that are not met by most startup jobs.

The Trouble with Startups

Startups tend to offer lower salaries and skimpier benefits,  while expecting long working weeks. As an employee, you are asked to invest a lot of time and brainpower in a venture which is extremely unlikely to pay off for you. The bait is lottery odds of getting rich on stock options, or a (usually illusive) sense of participation in “changing the world”.

It’s tempting to believe that startups and the VCs who fund them rely on the naïveté of young techies to fill these jobs. Regardless, most older employees can’t follow a startup dream even if we’d like to: we simply can’t afford the financial risk while we have responsibilities to provide for others. This is what I call the lifecycle barrier.

The lifecycle barrier is not exactly the same as ageism. It is possible to be older and less encumbered – e.g. divorced, kids grown, retirement funds safely socked away. But then ageism does come into play: many startups and VCs won’t even look at older people anyway.

Why You Need Lifecycle Diversity in Your Startup

The lifecycle problem harms startups in at least two critical ways.

First, it reduces the pool of candidates available for hire by startups. There’s huge demand for young people willing to work (and be compensated) startup-style, and every company is competing for a limited pool of such. Hence the increasingly strained attempts to stand out in cheap perks like free lunches, designer coffee, and employee drinkups.

Even if you manage to hire all the bright young things you want, you’ll still be missing something: your team will lack the perspective that diversity brings. The kind of perspective that comes with different cultures and experiences, sexes and sexualities, and just plain years of life and work. If the intended users of your products include any demographic other than young techies, you’re at far greater risk of failing (with a company, a product, or a feature) through lack of life experience and empathy. You risk death by groupthink.

And then… young employees do get older, and eventually start to care about mortgages and school districts. If your financial model relies on your staff working 80 hours a week for relatively low wages, you may be sitting on a time bomb: can you cash out before key employees leave because they can no longer afford to work on your terms?

Fixing the Problem

If you’re a founder or investor, what could you change? What could you do to attract the diverse range of employees that your startup needs?

It probably requires rethinking your financial model and compensation structure, and thinking about what it means to be a desirable employer to a broad range of people. It requires thinking about company culture and how it is expressed, and whether yours is welcoming to more people than the stereotypical [young, male] startup employee. Myself and various middle-aged friends have had the experience of walking into a startup office and thinking: “I would not fit in here. Nor would I even want to.” Does this describe your company? Fix that.

So here’s a challenge: Think you’re a disruptor? Prove it. Start by disrupting the startup employment model. A whole bunch of smart, capable potential employees will be watching. And you might even persuade some of us to come work for you.


PS

As for me, I now work for Ericsson, arguably the most multinational company in the world, and run with the long-term welfare of its employees in mind. People who join Ericsson tend not to leave.

People with families do, of course, sometimes found and work for startups. But those who can afford to do so often have already achieved sufficient financial security (perhaps having been winners in an earlier startup lottery) to take the risk. To be a serial entrepreneur, you have to have had a success somewhere along the line.

For more reasons and ways startup culture needs to change, read Shanley Kane’s YOUR STARTUP IS BROKEN: INSIDE THE TOXIC HEART OF TECH CULTURE. It’s uncomfortable reading. I highly recommend it.

Thanks to Melinda Byerly for very useful comments on this piece!

How I Knew I Had Cancer

One common reaction to saying “I have cancer” is that people want to know, though they don’t quite like to ask, how I realized I had it. Here’s how it went:

April 2014: Had my yearly mammogram (“difficult breasts” mean I’ve been having mammograms, and often follow-up ultrasounds, at least yearly since age 35). All clear.

Late Sept/early Oct: (I was on a business trip in Stockholm) I had been having a lot of breast tenderness, which seemed to be getting worse over the last few months (most likely menopause-related). Now I felt a different pain, deep in my right breast, as if I was being stabbed with a pin. It wasn’t constant, but it was persistent.

I don’t do routine breast self-exams precisely because my breast tissue is so dense and lumpy – it’s hard to know which lumps I should worry about. But I have a good general idea of what my breasts feel like and, when I was trying to locate the source of this new pain, I could feel something new in my outer right breast, a lump which felt sharper and more defined than the surrounding breast tissue.

I made an appointment with a gynecologist in my new hometown in the south bay. I believed there to be no history of cancer in my family (later learned I was wrong about that), so I wasn’t particularly worried, but there were other things I wanted to talk about anyway (like my damned periods coming every 16-18 days! With cramps like I had in high school! Menopause sucks).

Oct 20: The gynecologist suggested I schedule…

Oct 24: A mammogram and ultrasound. The mammographer saw some calcifications and denser areas he didn’t like the look of, and scheduled me for…

Oct 30: Core needle biopsies on two areas of my right breast. An in-office procedure, but nasty. I lay down on a table with my right breast dangling through a hole, whose hard plastic edge cut into my ribs. There’s a mammogram machine under there, which squeezes the breast as usual. They take an image, and then you have to stay in exactly that position (the plastic squeeze plate holds your breast) so the doctor can guide the biopsy needle to the correct area. He injects local anesthetic, then goes in with something that makes a noise like a drill but he said was a vacuum. I was turned to face the wall; if I had not met the doctor during my previous visit, I would have had no idea what this person doing this horrible stuff to me even looked like. To distract myself, I contemplated linguistic questions, like the fact that the very kind and competent assistant (Russian ?) spoke perfect English, but used no articles: “I will call doctor now.”

NB: In any medical offices where you’re going to spend significant time, make sure you like the nurses and technicians; you’ll be seeing more of them than the physicians.

The first area hurt when he stuck the biopsy needle into it; perhaps the anesthetic hadn’t fully reached that deep. I was tense and scared when he started the second one, but that time it didn’t hurt. He took more samples from the second area, perhaps because of what he had already seen in the mammogram and ultrasound.

Nov 1: I flew off to the OpenStack Summit in Paris. My breast hurt inside and was bruised outside from the biopsies, a constant reminder that maybe there was something going on that I should be worried about. I became more worried as the week went on. But I had lots of good distractions: I was busy with the conference, colleagues, former colleagues, and friends from across the tech industry, and an old friend who came to visit from her home in Switzerland. And, of course, Paris! Though I didn’t have time for tourist stuff – just lots of walking, talking, good company, food, and wine.

Nov 6: I finally spoke with the gynecologist. (“I was about to call you,” she said.) One of the biopsied areas was clear. The other wasn’t. She said: “It’s very early, very small, we’ll be able to take care of this easily.” [NB: It turned out to be not very small at all.] She gave me the name of a surgeon back in California. I called and scheduled an appointment while I was standing outside a restaurant waiting for colleagues to join me for dinner. I was still in shock, so I told two teammates and one completely extraneous Ericsson colleague what was going on (they were very good about it). Ate a great meal and drank a lot of wine.

The next week, when I was back in the US, I met with the surgeon…

In sum: I have been having mammograms as often as doctors tell me to, but that’s not how this cancer was found. This tumor apparently grew quickly, within six months after a clean mammogram. It announced its presence through pain.

“About 5 percent of all target zone breast pain is cancer. So it’s worth having your doctor check it—if only for the relief of being sure…” – Dr. Susan Love’s Breast Book

…I didn’t read this until later. In fact, the websites I checked say that pain in the breast is “unlikely” to be cancer.

5% is unlikely, true, but if it’s a different kind of pain than you’ve ever felt before, pay attention.

That pain persisted until the tumor was removed – I could feel it, a slight burning sensation, as if something with small, sharp teeth was gnawing away inside.