How to survive a jump off the cliff

Whoops! I guess I’ve been misspeaking by calling my CML drug chemotherapy. The daily medication I’m on is not technically a chemotherapy. My tyrosine-kinase inhibitors (TKIs) are actually called targeted therapies. They stop my CML-causing genetic mutation from producing leukemia cells, and they really work. At last count, there were very few of these deadly cells hanging out inside me.

The only problem with TKIs is that they have side effects that can render them intolerable for some patients. I’ve had few difficulties with the medication–I barely notice I’m on it–with occasional exceptions. While it effectively inhibits my cancer cells, my TKI reduces the production of my white cells and platelets as well. That’s why my white blood count is much lower than it used to be, which is not a bad thing. It’s the TKIs’ platelet-lowering effect that is proving to be problematic of late.

When my liver was misbehaving a few weeks back, Dr. Blood Lite was concerned about my lack of platelets. There just weren’t enough of those sticky cells swimming around. This makes me vulnerable to bruising and bleeding. I had noticed small changes that I had attributed to the perils of travel. I always come home bruised from vacation, mostly due to my clumsy suitcase handling. This time I was covered in black and blue, although I hadn’t had any major incidents like falling or walking into walls. I must have been going through a sensitive period.

My bruises started healing upon my return, and indeed my platelet counts had risen when last assessed. Over the past few days, I may be having a little backslide, however. One bruise I can attribute to yesterday’s gruelling dolphin pose in yoga class. God did not intend for my body to mimic the dolphin. Dolphin pose puts a lot of pressure on my elbows, so the bruising is almost expected.

Only this morning’s repeat blood test will confirm whether my platelets have tanked again. If they are low, Dr. Blood Lite may insist I suspend my TKIs for a few weeks to allow my bone marrow a reprieve. As he said, my drug has been working so well that a few weeks off should not be a problem.

A drug holiday is not a problem for him, I’m sure, but how about me? If you were on a medication that was keeping you alive, would you want to tamper with it? To me, this feels like bungee jumping with a faulty cord. Oh, and a deadly fear of heights. I know rationally that a break from my TKIs will not make my leukemia cells proliferate wildly, but I’m not always rational at times like this.

If the doctor suspends my TKIs, I will take that leap of faith since I trust him with my life. I will close my eyes and jump. I may know that I’ll be fine with a short reprieve, yet I’ll feel better once I can resume treatment again. To me, it will feel like being back on solid ground.

In the meantime, no more dolphin poses for me. Better safe than bruised.

woman bungee jumping in midair


Celebrate your milestones, whatever they are

3 Light the Night walkers with their Survivor t-shirts

We leave on our big vacation in 12 sleeps. When we were first planning this vacation, J. told me her rush of fall weddings would end immediately following Thanksgiving. We could be on the plane already, except I didn’t want to miss the annual leukemia walk. Which would you choose, a trip to Israel or a leukemia walk? Don’t answer that.

This decision to delay the vacation may not make sense to you; I’m a little bewildered by it myself. Going on this annual walk, hanging out with my fellow leukemics, wearing my guest-of-honour SURVIVOR t-shirt, has become a significant event in my year. I’ll try to explain.

My definition of a milestone has changed over my five years with leukemia. After I became so sick, I was proud of being able to walk unassisted and to tie my shoes without falling over. I vividly recall my first post-diagnosis yoga class, which I survived despite falling over a few times. I remember cooking my first real dinner post diagnosis, and seeing my first client. Being alert enough to drive again was another milestone.

As time passes, the goals have shifted. There’s the annual Cancer Centre’s Christmas gift-basket draw, which means I’m alive to lose my money again for a good cause. I don’t hate my birthday anymore, and the importance of cancerversaries is self-explanatory. For whatever reason, this leukemia walk has taken on an odd significance in my annual calendar. It’s my prize for getting leukemia and not dying from it.

This year’s will be all the more special because I will finally receive my 5-year pin. Now you know the real reason I delayed my vacation: I wanted a silly little commemorative pin. Frankly, I could have lied about how many years I’d had the illness and received this pin anytime–no one asks for a doctor’s letter–but I’m too honest for such deception.

This coveted pin is nothing to speak of. It’s the shape and colour of a drop of blood with a 5 on it. The blood-drop symbol is almost identical to that used by Canadian Blood Services. When I wear my pin proudly, people may well assume I am a blood donor (I selfishly only take blood), and not a leukemia survivor.

Does it matter that the pin will have meaning only to me? Of course not. If anyone asks, I can always set them straight. (Ha ha. “Gay person sets unknowing one straight.” And they say we’re out [no pun intended, truly] to convert people!)

When I was first diagnosed with cancer, I never envisioned reaching goals like these. Now, planning for my next milestone keeps me hopeful that leukemia is not going to take my life. No wonder cancer-related goals, however insignificant, have become so important to me.

Then, two days later, J. and I will leave for Israel. Who ever thought I’d get any doctor’s blessing to travel so far? Yet another cause for celebration. That and anticipation of the best hummus and falafel anywhere. I can almost taste it….

A plate of hummus with falafel balls in the middle

Sometimes it’s best not to keep score

Newspaper on doorstep

First, let’s get the Facebook page out of the way. To those of you who have kindly sent me Friend requests, I am not ignoring you; I am simply paralyzed by my ineptness. I learned the hard way that there is a difference between a Facebook account and a Facebook page, and had to shut my first attempts down. I will get back to you when I manage to sort my page out.

Now a question for those of you who have your paper delivered: did your newspaper arrive at your doorstep this morning? If it did not, I think I can explain. I received it. Ever since I left those stale banana chocolate chip muffins out for Mr. RAK, we have awoken to one or sometimes even two newspapers on our doorstep. I may have to rename Mr. RAK Mr. DAK (as in “Daily Acts of Kindness”) because he has been so generous with us.

You can imagine that I, who am prone to guilt in much lesser circumstances, am overwhelmed with this current situation. This man receives no financial compensation for his generosity toward us, and I genuinely believe he is not trying to encourage us to reinitiate our subscription. My gratitude is killing me.

Of course I keep a mental tally of the give and take in any relationship. If I feel I’m giving too much over time, either I try to address the inequity with the person directly (when I’m in a grown-up mood) or, if I’m feeling more child like, I withdraw from that person. According to my usual tally system, I’m always in the red. Always. So a situation like the one with Mr. DAK, where I’m getting a lot more than I’m giving, torments me.

I am trying to practice allowing someone–in this case, Mr. DAK, to be kind to me. But in order to rebalance things just a bit, as soon as I finish this post, I will be baking a batch of oatmeal cranberry cookies to leave for him tomorrow morning, when he will be dropping by with an extra newspaper for us. I give thanks to you, Mr. DAK.

I was discussing the newspaper situation with a neighbourhood friend who happens to pay for her daily paper delivery. She mentioned that every so often, maybe once a month, her newspaper does not arrive. As she was discussing this with me, she said, “Hey, wait a minute….” We agreed that maybe Mr. DAK, in a Robin-Hoodish manner, is stealing from the subscribers and giving to the nonsubscribers. So if you’re my neighbour and your newspaper doesn’t arrive, feel free to take ours. God knows we haven’t paid for it. Consider it your way of assuaging my guilt.

Happy Thanksgiving. May you all have much to be grateful for this weekend.


P.S. I’ve had a few enquiries about this year’s Light the Night Walk for Leukemia on Saturday, October 21. You are more than welcome to join us. The team name is Annie’s Anemic Leukemics, and the registration link is here. If you are interested in celebrating my fifth cancerversary with me, come on out. All the better if you’re an Olympic weightlifter: you can carry me over the finish line if I get too pooped to walk.

Remission by any other name….

Did you notice I popped the R word into the last blog post? Perhaps it would have been more accurate for me to write “complete molecular response”. What is this, you ask (or maybe you don’t, but since I think it’s kind of interesting I’m going to tell you anyway)?

As I explain, please understand as I dumb this math down for myself. Math isn’t my strong point. Did I ever tell you my high-school math teacher, after tutoring me for months, suggested I drop the course before the exam to spare me an F on my graduating report card? Thank you, Mr. Fox.

The very smart hematologist who suspected I had CML took a bone-marrow biopsy, both to confirm her diagnosis, to stage the illness, and to get a baseline count of how many mutated cells I had. She determined, from this information, that I was in the chronic phase of the disorder, which is the first of three stages. Forget the F in math; thanks to this doctor, I received an A in CML. Now, every three to six months, I undergo genetic testing of my blood (commonly known as a PCR in CML circles) to determine how many cells with my special Philadelphia chromosome are coursing through my blood.

Within 12 months of treatment, I had attained a 4-log reduction (apologies to any mathematicians if I’ve written this incorrectly) in these cells, which means I had 1/10,000 of the leukemia cells I’d had upon diagnosis. Most CML patients who are diligent about taking their special Philadelphia-busting medications fall within this range or even lower within the first year of treatment. I am nothing if not diligent. I imagine you would be too if a doctor told you that carelessness could result in your leukemia progressing and potentially killing you.

So here’s the $128,000 question (inflation and all): If CML patients are in remission, a.k.a., at the stage of major molecular response, what would happen if we stopped taking the medication we were initially told we’d have to remain on for the rest of our lives? Sounds like an interesting research question, doesn’t it?

Normally I’m first in line to try something new. Hot new restaurant in town? I may not eat there, but I’ll know all about it. Hot new clothing store? I’ll tell you where it is. Hot new park in town? Let’s check it out, Jelly.

How about a hot new study for CML patients who want to rid themselves of the nasty side effects of their medications and are willing to stop taking the drugs altogether just to see what happens? No thanks. I’ll pass.

I’ve been a guinea pig for physicians in training over the last 17 years now. I can’t tell you (and not simply because I’m terrible at math) how many hands have palpated my ginormous spleen. That being said, I’m perfectly happy with my major molecular response, thanks; some other brave CML patients can step up to this plate and ditch their drugs in my stead. Once you docs are sure my leukemia won’t return or even progress to a more dangerous stage without my medication, maybe then I’ll consider going drug free. Good luck finding subjects!

Guinea pig

This is the old me.


Ah, ha, ha, ha, stayin’ alive


Did you miss National Cancer Survivors Day yesterday? Not to worry, so did I. I scored nary an invite to any of the festivities. I’m not even sure I am a cancer survivor; all I know is that my cancer hasn’t killed me yet.

Turns out I’ve got a good cancer, if there is such a thing, one that people can live with for many years. And since most of the time I’m in complete denial about my co-existing conditions (my impaired liver and my polycythemia–Happy 17th Polycythemaversary, by the way), I can pretend I too will be one of these people who will live a long life.

One of the main reasons I don’t feel like a true survivor is that I still take daily medications to keep my leukemia at bay. Oh, and my regular visits to the Cancer Centre. There’s nothing like hanging out amongst my cancerous peers to remind me I’ve still got the big C.

Unlike many other cancerous folk, I have very few leukemia cells now, according to most recent testing. So few that, in a CML patient booklet I just read, I am considered in remission. No one has used the R word with me before; in fact, when I was first diagnosed, I was told people with CML don’t go into remission. I was as surprised as you may be. If I’ve misled you, I did it unintentionally.

I also learned from that informative booklet that, with the advances in treatment of CML, many of us are living to a ripe old age. The focus of intervention has shifted from treatment to our quality of life. That part I get, now that I have reached Day 7 of The Wrath of the Gouty Finger. The leukemia isn’t so bad; it’s the symptoms and medication side effects that I find challenging.

So I’d like to suggest a new day of celebration more appropriate to those of us with CML. Let’s call it National Cancer-Symptoms Survivors Day. We’d be celebrating maintaining our quality of life while living with the threat of a potentially terminal illness hanging over our heads. We gatherers could compare notes on our various medication side effects and how we have survived them. We could share information about the interventions we’ve added on to manage those side effects.

I can think of many ways such a get together could benefit me. I’m sure there’s a CML survivor out there who would know how to manage yoga postures that require my lying on my belly. “Do you also have to rearrange the position of your football-sized spleen when you lie down?” I’d ask. Or how about our unrelenting fatigue? “Do you too fall asleep during matinees? How do you keep yourself from snoring?” Then there are the challenges of taking all those drugs. “How do you manage to time your medications to minimize all drug and food interactions?” The possibilities are endless!

We’ll plan our special day to coincide with the National Cancer Survivors Day. Then those of us who feel left out will have somewhere to go where we feel a sense of belonging. We all need to feel we belong somewhere.

Cut out figures holding hands

Selective attention in the terminally anxious patient

I don’t go to many doctors’ appointments alone since J. likes to be there for support. She insists on coming along for Dr. Blood and Dr. Liver. It’s a good thing she does because she usually leaves with a completely different impression of the meeting than I do.

Let’s use my last visit with Dr. Blood (it was actually Dr. Bloody Resident) as an example. Every three months, I undergo a special blood test to determine how well my chemotherapy is suppressing my leukemia cell counts. If my counts are low, as they have been for a long time, my chemo is doing its job.

Dr. Bloody Resident decided that, since my leukemia cell counts have been so low for so long, this blood test could be decreased to once every six months. So of course I asked him whether he thinks I’ll get my 5-year pin. (If I survive 5 years of CML, the Leukemia Society will give me a special pin that looks like a little drop of blood with a 5 on it. I want that bloody pin.) Dr. B.R. said: At this rate, you’ll get your 10-year pin (this is the part J. heard), unless your leukemia progresses in some way, which we’d know by blah blah blah. (Anxious Annie started listening after “unless”, somehow blocking out everything else the doctor had said.)

If my leukemia progresses? Why would it progress? Won’t my chemo keep it at bay forever? I’m assuming, based on what Dr. B.R. said, that at some point, the bone marrow will develop a mind of its own, and the CML will progress despite the formerly-effective chemotherapy. No one told me about that part, and I have wisely chosen not to ask.

Maybe someone did actually tell me about this you-have-no-control part, but I promptly and intentionally forgot. My diagnosing hematologist handed me a CML 101 pamphlet when she gave me the news. I glanced through the informative pamphlet while I was still in shock, felt my anxiety rise exponentially, and promptly tucked it away, only to recycle it months later. From my brief perusal of this informative booklet, I learned that CML has three phases: chronic, accelerating, and blast crisis. My CML was caught in the first (chronic) phase, which is a good thing. I can’t tell you anything about the other two phases because I have chosen to put my head in the sand, until Dr. B.R. so rudely yanked my head out.

Maybe I should seek more information on the internet. Nah, forget it. If you’ve followed my blog, you know I don’t consult the internet for answers to health questions because what I find only exacerbates my pre-existing anxiety. As it is, I haven’t been sleeping well the past few weeks.

J. and I debriefed after the appointment, as we always do, even though we both know exactly what the other is thinking. J. summarizes her hopeful take on the meeting and I predict doom.

I spend too much time worrying about what could happen in the future; time to appreciate what is happening now. The sun is shining and Jelly is wagging her tail in her sleep. Life is good.

Basset hound sleeping on back ledge of couch

On the couch? Not our Jelly!

Am I a weak person because I still have cancer?

You knew that all of this blog frivolity would have to end sometime. Serious Annie is back today to talk about the controversial fundraising ad for Toronto’s Hospital for Sick Children.

In the ad, sick kids are presented as warriors overcoming a variety of illnesses, including cancer. Some parents with children with chronic, insurmountable or even terminal illnesses find this message dismissive. I may be an adult, but I too dislike the ad’s insinuation. What about those of us who, however hard we try, can’t conquer our illnesses in a boxing ring?

When I first saw the ad, I had just finished Tig Notaro’s I’m just a person, an autobiographical account written following her recent bout with invasive breast cancer. In her book, she highlighted the absurdity of the courageous cancer battle, as if those people who succumb to cancer are lacking will or determination or have brought their condition on themselves.

Why are people lauded for beating cancer? What about people like me who are living with cancer until we die? Does this reality make us weaker or less courageous than those who overcome their illnesses? Am I not fighting my battle hard enough? And how about those people whose bodies are saddled with chronic or progressive ailments? I can’t imagine Huntington’s disease is a lot of fun. Does someone with Huntington’s deserve his unfortunate outcome? Of course not.

People who learn I have leukemia often ask me if I’m in remission. Every such query reminds me that CML does not go into remission. It’s always there. I’d even call it clingy, and nobody likes clingy. Having cancer until the day I die makes me furious some days and sad others.

I certainly wish I didn’t have cancer anymore, trust me. If I could divorce my illness I would, but it just won’t leave. I should be grateful to be alive, yet I resent my CML, and I shamefully admit I resent people who’ve waged their courageous battle with cancer and won. Then I remember the courageous ones may spend the rest of their lives dealing with the side effects of brutal cancer-killing treatment or worrying about a recurrence, and I feel like a terrible person.

How can I possibly resent the cancer conquerors? I should be happy for them, shouldn’t I? Before I had cancer, I found it easier to be so, but now that I have a forever cancer, I find it harder. Not always, though. Some days I am genuinely happy for you for overcoming your cancer even while I’m sad for myself that I can’t.

Truth is I’m as far from courageous as one gets. I’m anxious and unsettled about my illness and I worry that every new twinge could be a sign of my imminent demise. But, wimp or not, I still don’t appreciate the message in that ad. Similarly, I may think I’m fat some days, but I won’t appreciate it if you call me “fatso”.

If you’ve overcome cancer, I’m not angry at you, but I am jealous that I can’t be in your shoes. Maybe your grass isn’t truly greener but it still looks incredible from here. On the other hand, maybe that’s because you don’t have a dog.

Lawn with dead spot because dog peed on it

How to lose followers and alienate people

The number of readers following my blog has been increasing slowly but steadily since I started writing 2-1/2 years ago. There’s been the odd jump in readership here and there, but mostly I’ve noticed a slow and steady incline. So imagine my dismay when, about a month ago, I lost three followers within one week. I was dumped.

Followers who dump me don’t have to provide a reason for leaving. No note from a parent, no far-fetched fabrication, no “It’s not you, it’s me.” I have to assume my dumpers got bored or annoyed or, possessing a better memory than me, realized I had run out of original ideas eons ago.

But there may have been another reason for the mass departure: my post title included the words “Go Fund Me”. If you recall, I was joking about soliciting funds to pay for a genetic clone of myself in order to lessen my anxiety about dying. Those who did not read past the title may have assumed I was genuinely seeking their hard-earned cash.

With that in mind, I will stress that, yet again, I am not asking you for money in this post. I’d much prefer your emotional support to your hard-earned cash. The leukemia walk is quickly approaching and my team, Annie’s Anemic Leukemics, is numbering 10 now, which thrills me. We will have a guest of honour, a fellow CMLer from out of town who did not want to walk alone, as well as a brain cancer survivor who wants to crash the blood cancer party, in addition to my beloved loyal supporters.

Let me stress that I am not trying to push you to join the team because I understand you may have more important things to do on the evening of October 15. You may be getting your nails done or catching up on your filing or getting a head start on your spring cleaning. I get that. Maybe you’re worried you lack the endurance to complete a 3-kilometer amble. I get that too. (Okay, I’m lying. Haven’t you heard that sitting is the new smoking?)

Or you may not want to participate in an event where little children with bald heads are running around having the time of their lives. I really get that. The sight of kids with cancer always makes me cry, even if those kids are just being kids, but without hair. In that case, skip the walk but sign my petition against kids with cancer. No, there’s no real petition, but I wish it were that easy.

I’m a bit ambivalent about the whole event myself–why do something that I know will make me cry?–but as a card-carrying member of the blood-cancer group, I feel showing up is the least I can do. For one night a year, I hang out with my kind, surrounded by my own amazing community of support. So if you can’t be there, feel free to join us in spirit. You can even sign up for my team for free if you want, so I can add you to my list of virtual supporters.

Consider yourself one of my imaginary friends for the evening. Of course I still have imaginary friends! Don’t you?


Picture of girl holding teddy bear with arm out as if around imaginary friend

The mystery of the missing medication

Package in cardboard box with "Urgent" in red on front

Anyone interested in the outcome of my recent postal debacle? The story could have ended so many ways. I could have died because my chemotherapy was lost in a mailroom maelstrom. My writing you today suggests that this did not happen.

Alternatively, I could have been recruited for a study of noncompliant CML patients who stop taking their medication because they don’t feel they need it anymore. I don’t qualify for that study. I’m taking my medication every day until I die, assuming it doesn’t get lost in the mail.

A third but unlikely outcome is the arrival of the package the next day. But that’s too simple. The situation must get worse before it gets better.

On Monday morning, I begged the Cancer Centre pharmacy for a week’s worth of chemotherapy until my missing meds were found. Then I called the post office for a daily update on my untrackable package. Because I am so difficult to please, again I was dissatisfied with the response. I learned that only the sender could instigate an investigation into the missing pills. Furthermore, Ms. Making Me Postal would not contact the pharmacy because she could not make outgoing calls; I would have to ask a pharmacist to call her.

Imagine my surprise that someone at a call centre cannot make outgoing calls! Aren’t most telephones capable of both making and receiving calls? I told Ms. MMP I would not waste the pharmacy’s time. The pharmacists at the Cancer Centre are run off their feet doling out chemotherapy to ailing cancer patients. They haven’t time to spend on hold with an incompetent postal worker. I ended the call frustrated and with no intention of involving the pharmacy in this mess.

If I am unsuccessful at solving a problem despite my best efforts, occasionally J. jumps in on my behalf. You may be unaware that J. can be quite persuasive. In fact, just yesterday a cashier who had never met her before accepted her credit card over her friend’s to pay for lunch because, in her words, “she looks scarier.” So J. called 1-800- Making-Us-Postal again, pretending to be me (yet another benefit of a lesbian relationship,  in addition to the obvious sock sharing).

When J.’s Ms. Making Her Postal repeated the same feedback I’d received, J. asked to speak to a supervisor. Why didn’t I think of that? I was incapable of effective problem solving by then. Remember this the next time you’re too angry to think straight: take a few deep breaths before you jump back in.

J. spoke to the supervisor who, upon learning the contents of the missing package, said she would ensure it was located and delivered promptly. She suggested we’d receive it faster if we retrieved it from the mail depot once it was found, but the irony of picking up something intended for delivery prompted J. to decline politely.

Ms. Supervisor was true to her word. The next day, the package magically appeared at our house, followed by not one but two calls to confirm its delivery. Wait, I thought those posties couldn’t make outgoing calls, they could only lose outgoing mail. Will wonders never cease!

Do you think this effective resolution had anything to do with Ms. Supervisor’s being a recent cancer survivor herself? Nah, neither do I.


Sometimes the bad news bearer has good news

I love my work, but, to be honest, being a psychologist is not all butterflies and rainbows. I have had to deal with many challenging people and difficult and emotional situations, Abuse is traumatic for the client and its disclosure can be traumatic for the therapist too. My clients have survived tremendous adversity.

Often, I’ve been the bearer of bad news. Parents can be devastated to find out their child is learning disabled, or has an autism spectrum disorder, or may not become an astrophysicist. For years, I informed parents I believed their children, whom Children’s Services had removed from their care, should not be returned to them. I lost a lot of sleep questioning my own judgement.

Years of this type of work are wearying even for a competent clinician. I don’t often consider the positive side of having cancer, but I can thank my leukemia for potentially preventing occupational burnout. My work doesn’t compare to that of a physician, however. I may have said things that affected the rest of my client’s lives, but I’ve rarely dealt with life-and-death situations.

I can’t imagine informing a patient that she has cancer. That’s what that smart hematologist-on-call told me four years ago. (Happy Cancerversary to me, by the way!) The ER doctor called Dr. Diagnosis for a consultation because of my blood disorder (polycythemia). Dr. D. reviewed my past blood work, spotted some anomalies, and suggested further testing.

I can remember exactly when she told me she thought I had leukemia. After spending a long day in the ER, I was transferred to a hospital bed, so J. had just gone home. I was alone, overwhelmed, and overtired when Dr. D. came in to give me the news. Needless to say, I was beside myself. What did she know? Had she consulted my hematologist, whose care I’d been under for 12 years? Somehow she kept calm in the midst of my meltdown.

J. and I talked with this know-it-all together the following day. J. was as perplexed as I was. We challenged her and confronted her and she stayed calm. In the midst of our uproar, she told us that the diagnosis was a good thing, that she caught the illness early, and that there were wonder drugs that could stop CML in its tracks. That was the good news, and eventually we stopped fighting with her.

By the end of the week, J. and I had realized this doc had probably saved my life. Then, even though we had just met and I had caused her a full week of confrontational grief, Dr. D. facilitated my transfer from my old hematologist, whom I no longer trusted, to Wonder Woman, a.k.a., Dr. Blood.

So I don’t envy these doctors, and I couldn’t do their job. How do they describe their day over dinner? “Saved a patient’s life today, honey.” How do they manage when a patient they’ve cared for and cared about dies? Do they ever fret, or lose sleep, over their decisions? They must. If they need to maintain professional distance to survive the emotional onslaught, so be it.

Thanks docs. I wouldn’t be here today without that level of care, and caring.

Sign saying "Happy Cancerversary"