This is the ebb and flow of life and relationships. You can’t control who stays, or who resurfaces if your story isn’t complete. Certainly some friendships are longterm - personally, most of my closest friends have been in my life for decades. We’ve grown and evolved together, and have remained compatible, and make a consistent effort to engage in each other’s lives. But there are plenty of people who were a reliable presence in my life at one time with whom I’ve lost touch - the lovely woman I took semi-private weekly riding lessons with for awhile, castmates from summerstock contracts, siblings-in-arms when I worked in restaurants.

One of the greatest lies social media ever sold us is that we not only can stay in touch with everyone we’ve ever met forever, not only that we should be doing this, but that we have an obligation to do so.

We are supposed to lose touch with people. Our social relationships are not meant to be passive. We aren’t supposed to be staying updated on our friends’ lives by scrolling through Instagram at 1am. If we never formed a deep personal friendship, is it crucial to witness the OOTD of someone we worked with for a few months twelve years ago? Is it so offensive if we gently, without an announcement or hard feelings, sever that tie?

Certainly there are people I doubt I’ll ever see again but for whom I have a deep fondness, a nostalgia for the time our lives intersected, who I’ll probably desire to stay at least lightly connected to for a long time. Understandably, it can sting if you realize that person feels differently, has moved on, and is happy to leave that time fully in the past. But you don’t have to let it change how you feel, or what the memories mean to you. If you’re open to hearing a “no” without taking it too personally, there’s also nothing stopping you from reaching out to properly catch up, or invite them for tea next time you’re in the same city.

Outside of our closest circles, many of our social relationships are steeped in a shared context. Eventually that context will change - someone leaves the company, moves to a different city, switches gyms, loses interest in the hobby. While in some cases you do form deep relationships outside of that context, for the most part, the lack of context reveals that it was the primary element of bonding, and that you may not have that much in common otherwise. If you’re capable of actively maintaining longterm friendships, then others fading isn’t a sign of avoidance or a failure, it’s simply how relationships are meant to work.

There’s also a comfort to the idea of how people flow in and flow out. It’s a reminder that to most people, you are a stranger, and so is everyone in the social ecosystems that surround you. If you’re having a weird interpersonal situation, go for a walk outside or to a cafe and look around. While life can be interconnected in strange ways, chances are nobody else there knows any of the people stressing you out, and they don’t care. It doesn’t mean your experience isn’t valid, it’s just a form of perspective.

It’s also a reminder to live in the moment, cherish your time with people, and trust the flow. Some of these people will be in your life forever, but most will become memories. If you’re living laughing loving, look around from time to time and remind yourself that these are the good ol’ days. And if you’re having a hard time, just remember that eventually, you’ll flow out of this and into something more aligned.

So take the photographs and still frames in your mind
Hang it on a shelf in good health and good time
Tattoos of memories and dead skin on trial
For what it's worth, it was worth all the while
It’s something unpredictable but in the end it’s right
I hope you had the time of your life
Green Day, “Good Riddance (Time of Your Life)”

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When skill, status, and social hierarchies come into play, an environment can stop feeling entirely free. Even if you’re not personally invested in any competition or drama, those dynamics have a way of permeating the space. What was once a simple escape from adult responsibilities can start to feel like another arena where performance, comparison, and social navigation matter.

Last summer, someone I know through a hobby - one that sits more on the fringes of my interests and thus allowed me a bit of an outsider perspective - was feeling consistently excluded from what she saw as the core friend group within the social ecosystem of that space, and whether or not that’s accurate, it is at least a very visible group that is active on social media. A few things stood out to me:

• The friend group that formed is in their mid-20s, she’s in her mid-40s.

• The friend group that formed is straight, she is queer.

• The friend group that formed is neurotypical, she is neurodivergent.

In so many ways, it’s simply a mismatch. Zoe* craved inclusion from a particular social circle despite likely having more natural points of connection elsewhere in the community.

That being said, there does appear to be a central Mean Girl™ figure who derives social capital from being the unofficial queen bee of the space. Some instances of exclusion were likely intentional; others may have reflected Zoe’s perceptions or expectations rather than deliberate actions by others. Not every social omission is exclusion. Sometimes people follow the lead of a high-status person and leave someone out; other times, friends are simply making plans within their existing circle.

As adults, we generally know to go where it feels warm socially, stay friendly or at least cordial with everyone else, and avoid getting pulled into drama. But in Zoe’s case, those dynamics took on outsized importance because, as she put it, “this is the only thing I do socially right now.” The hobby, the space, and the people in it had become disproportionately central to her identity, and with so much riding on that one community, every interaction and perceived slight felt magnified.

Zoe’s experience, along with the recent conversation in my friend’s kitchen, left me reflecting on a few principles that have helped me over the years, especially since barn culture in the equestrian world can be rife in social drama:

1. This is voluntary.
   If a hobby begins to feel like an obligation, it’s a sign something has shifted. It might be time to take a breather, explore other parts of your life, try the hobby in a different space, attempt to reconnect with why you fell in love with it in the first place - or find something new!

2. This is not your central friend group.
   A hobby can house one of your friend groups, and it can be a place where deep connections form. However, it’s easier to communicate directly, set boundaries, and leave unhealthy dynamics when a hobby space isn’t carrying your whole social world. This isn’t about avoiding friendships, but about maintaining relationships outside of one activity. It’s easy to assume that a shared interest automatically signals deeper compatibility, but that isn’t always the case. Shared enthusiasm doesn’t necessarily mean aligned personalities, values, or needs. Sometimes a book club really is just a book club: a place for good conversation, shared laughs, and connection around one specific thing, without needing it to be more than that.

3. This is not central to your identity.
   If a hobby becomes your primary source of validation and sense of self, every setback can start to feel existential. It’s tempting to orbit around a hobby, especially one that feels new and exciting or one that is expensive and time-consuming, but it should never overshadow the whole beautiful person you were before it and will be when you move on from it. Evolving and discovering new parts of yourself is a good thing, but no single pursuit defines you. You’re too cool and complex and layered to be put into a box.

4. You do not have to participate in groupthink.
   If everyone finds Gigi annoying, thinks Lauren doesn’t have a good sense of style, or decides Alex is “just weird”, you can ignore that and form your own opinions. If it’s frowned upon to be friends with Gigi, Lauren, or Alex, but you genuinely like them, then befriend them anyway. If that choice costs you other social connections, you’ve gained valuable information about the character, values, and rigidity of those beholden to hierarchy within a social ecosystem. (Remember, none of this actually matters, and you’re all supposed to be having fun.)

5. You do not have to take on other people’s battles.
   Avoid inserting yourself or being pulled into every conflict, defending every opinion, choosing sides, or managing dynamics that aren’t yours to resolve. People are adults and can sort out their own problems. You also have every right to remain neutral or friendly with all parties, as long as there is no violence or abuse involved. If someone is upset that you remain friendly with multiple people, that’s a reflection of their expectations around loyalty - usually steeped in social hierarchy - not a requirement you need to meet.

6. You can keep the stakes low.
   You don’t need to be the best, the most popular, improve the fastest, monetize or “go pro,” or make something your identity in order for it to be worth doing. In most cases, hobby longevity depends on pacing yourself and keeping the stakes low. Not every interest needs to become a goal, a brand, or a path to mastery. If an opportunity to showcase, perform, or compete adds more stress than joy, opt out. Keep it light.

7. You can have more than one primary hobby.
   You don’t need to choose one single defining passion. Diversifying your interests keeps any one space from carrying too much weight. Things were tense at adult beginner gymnastics the last two Mondays? It won’t feel as significant when you also have jewelry making on Wednesday and run club on Saturday. When all of your creativity, community, identity, or achievement lives in one space, stakes start to creep in. Multiple hobbies creates perspective, reduces pressure, and makes it easier to stay connected to joy.

Diverse hobbies help us build a life as adults that is dynamic, fun, and connected to our inner child. They offer social outlets, foster creativity, help us learn new skills, and provide a way to recharge from the stresses of daily life. They’re also key components of physical health and mental well-being.

That’s why it’s crucial to not only protect your energy within them, but pay attention to who is leading a hobby space, as well. While complex social dynamics can arise in the most well-run spaces, getting caught up in an unhealthy one can lead someone to abandon a treasured hobby altogether. Unless you live in a remote area or the hobby is highly specialized, there are usually multiple options for participation, and you can choose environments that feel relaxed, healthy, inclusive, and expansive.

Some common leadership red flags I look out for:

• Spaces socially centralized by design.
  If a leader or organizer explicitly or implicitly encourages the idea that this should become your primary or only social world, rather than one of many, the environment can start nudging people toward deriving most of their social identity from a single space. This concentration of attachment makes people easier to pressure, since so much feels at stake.

• Spaces with controlled access to belonging and clear favoritism.
  If friendships, opportunities, or “insider” status are mediated through the leader - especially when certain people are consistently treated as favorites - it’s often a sign that the primary focus of the space has shifted away from the hobby itself and toward the leader orchestrating social dynamics and rewarding “loyalty” with proximity.

• Spaces where boundary-setting is penalized and “unity” is prioritized over honesty.
  If expressing needs, opting out, or not conforming to the social rhythm leads to distance, tension, exclusion, or punishment, the space is likely overly controlled by its leader. In healthy environments, boundaries are part of participation, not something that puts belonging at risk.

• Spaces where the leader identity is fused with group identity.
  If the space revolves around a person rather than the activity, disagreement or independence can create a rupture in belonging. Your participation is less about your enjoyment of the hobby and more about affirming the leader’s status.

Healthy hobby spaces make it easy to come and go, support multiple overlapping connections, and keep the activity itself at the center of the experience. They don’t overly control how people participate, connect, or respond, and allow relationships and experiences to develop organically.

So, is the “ick” avoidable? Yes and no. You can’t control how other people lead or engage within a space, and their behavior can shape the culture in ways that make it less enjoyable. What you can control is where and with whom you participate. More often than not, the “ick” stems from a particular environment rather than the activity itself.

The right hobby space should bring you joy and expand your life, not consume it. Don’t lose yourself, and protect what made you fall in love with it in the first place.

I’m gonna have myself a real good time
I feel alive
And the world, I’ll turn it inside out, yeah
I’m floating around in ecstasy, so
Don’t stop me ‘cause I’m having a good time, having a good time
Queen, “Don’t Stop Me Now”

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This is how Stevie Nicks closes out many of her shows, after singing “Landslide” as an encore, including Live In Concert: The 24k Gold Tour, the double vinyl that begins most of my mornings, but especially my natal day.

In the mists of time (the early aughts), two friends and I would convene in their room, draw crescent moons on our faces, and lie on the floor listening to Stevie Nicks for hours. We were the gypsies that remained, we were just a wish, we were sisters of the moon, we were on the edge of seventeen. Around this time The Chicks announced they would cover “Landslide,” and we were aghast.

“Nobody should cover Stevie!” we lamented. One late evening a few months later, wandering the aisles of the Blockbuster video that used to shine its neon lights onto 94th & Broadway, we heard the cover on the radio piped through the store. Dramatically, we shielded our ears (we were teenagers studying theatre, after all) and waited it out.

While I have grown to appreciate that cover, in general I stand by what we insisted all those moons ago. Stevie’s songs are more than music and lyrics. They are memories and they are spells. Only one can harness their power.

And so, every year as I’m getting older, too, I sit and ponder those lyrics, and ask myself the same questions:

Oh, mirror in the sky, what is love?
Can the child within my heart rise above?
Can I sail through the changing ocean tides?
Can I handle the seasons of my life?

My senior year of high school, I completed a college-level astronomy class, which was as much philosophy as it was physics. Although I explore the evergreen questions of humanity through art, what a delight it was at seventeen to sit as a peer with those using science to understand our place in the Universe. I realized then what I’m rediscovering now: science and art are requisite companions through space and time, holding hands on the journey to seek the most elusive answers. As Camille Hernandez noted, “Both are pursuits of wonder.”

While I mostly rely on the arts to bring me whimsy and magic day by day, on my most recent solar return, four poets and star sailors were circling the moon, in a mission named after the goddess Artemis, reminding us all of the beauty of humanity and our spinning blue orb.

Astronauts have taught us that time is relative, not absolute, proving Einstein’s theory. There is no universal now. Time belongs to each of us, and our own personal path through space. My relationship with time, and aging, has evolved over the years. Growing up in the entertainment industry, I was terrified of the number creeping upwards. Funny that age itself, paired with a few instances of life-threatening trauma in my case, is the only balm.

What a gift it is to have sunshine, and birdsongs, and morning coffee. How lucky are we to have today and hopefully tomorrow, and tomorrow, and tomorrow. For all my sisters who returned to stardust far too young, I carry you with me, and getting older is an honor.

To the gypsy
That remains
Her face says freedom
With a little fear
I have no fear
Have only love
And if I was a child
And the child was enough
Enough for me to love
Enough to love
Stevie Nicks, “Gypsy”

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On an episode of The West Wing from Season 2, which aired in November of 2000, Chief of Staff Leo McGarry’s daughter Mallory, a public school educator, antagonizes Deputy Communications Director Sam Seaborn on the purpose of space exploration. Aaron Sorkin often expressed his own thoughts through the character of Sam, who had this response:

“Because it’s next. Because we came out of the cave, and we looked over the hill and we saw fire; and we crossed the ocean and we pioneered the west, and we took to the sky. The history of man is hung on a timeline of exploration, and this is what’s next.”

Throughout my experience with cancer, I often explored the intersection of science and art, especially when it came to reconstructive surgery. Eventually, I incorporated this concept into a larger photo project, my body the canvas that weaved them together. Surgery is science, but when carefully crafting a rendering of breasts, being mindful of natural placement, texture, movement, and shape, there’s no clear line where science ends and art begins. They are inextricably and forever linked within me.

Astronauts are pioneers, visionaries, explorers. They are also the tender-hearted scientists. Space exploration is rooted in so many of the principles that serve as the foundation of art, and astronauts are trying to answer the questions art and philosophy are so often asking.

What is the meaning of life? What is our significance? What is beyond us? Why are we here?

It seems the further astronauts travel from Earth, the more powerful their appreciation for our spinning orb. Even as our four explorers prepared to cross the dark side of the moon, they remained fascinated by the small crescent out the other window. The spec in the vastness that hosts Earth’s beautiful blue oceans, her cotton candy cumulus clouds, long rivers snaking through lush rain forests, and most importantly, that within her is every single person they’ve ever loved.

She is home.

In some statistical anomaly, we’ve not only managed to maintain life on this planet, but we’ve created over 31,000 languages through the course of human history. We’ve built pyramids and cathedrals and temples and bridges and the Taj Mahal. We’ve created art and music and poetry and books and dancing and opera. We’ve built statues and castles and the Great Wall of China. We’ve taken flight, we dove to the ocean’s depths, we’ve illuminated the darkness.

When I was going through treatment and would walk home from chemo through Central Park, soaking in those late summer afternoons, I thought often about how much I would miss everything. Everything. The way the slanted sunlight dappled through the trees, the specific scent of grass in August, dogs playfully chasing each other, the squirrels and the birds, and the outdoor Baby & Me music classes sitting in the grass, notes of their joyful songs and infant giggles dancing through the air.

The history of humanity is also wars and false borders and violence. It’s pollution and deforestation and trash barges in our oceans. Science is advancing as I write this, but perhaps one of the most important achievements of this mission is reminding us that no water-draining AI data center will ever fully capture all the beautiful joy and pain and poetry that is the human experience. May we all gain some perspective from those who have been further than anyone before who, at 252,757 miles away, can’t help but look back at us and be awestruck. May we protect our home, and each other.

We may all be made of stardust, but how lucky are we to have landed here, where we can stand at the edge of the sea and feel the pull of the moon.

There’s a starman
Waiting in the sky
Look out your window
I can see his light, ay-ay
David Bowie, “Starman”

On my first follow-up appointment after my mastectomy, those words from my reconstructive surgeon, in reference to my breast surgeon, echoed in my mind.

He was part of that surgery, too. Not the oncological side of it, but in laying the foundation for breast reconstruction. However, since it was my breast surgeon’s operating room, she’s the one who performed the closure.

And apparently, it was art.

My surgeon’s remarks planted the seed that reconstructive surgery is somewhere on the cusp of science and art, intertwining the two, which deeply intrigued me.

The concept rolled around in my consciousness for awhile. I was already working on a project with Paulo Netto, a series documenting the different phases of my experience through breast cancer, and ultimately turned the idea of science as art into an exploration of scars as Kintsugi with Jackie Abbott.

When I was first diagnosed, I just wanted to wear a wig until my hair was long enough for extensions, reconstruct my breasts to a natural size for my body, and eventually do 3D nipple reconstruction based on photos of my own nipples while I had them. Before my metamorphosis, I looked in the mirror, and just wanted to hurry up through the process of surgeries and chemo and look like myself again.

That was the former me, though. My old self. Any trauma changes you, and cancer deeply does. I’ll never look like her again because I’ll never be her again. Not that I hadn’t experienced trauma in my life prior, I most certainly had, including a life-threatening incidence of gun violence, but breast cancer just hits diff, y’all. Something behind your eyes changes when you’ve endured a cancer diagnosis. I can see it in myself, I can see it in others. While I was wise and withered by life beforehand, my eyes were those of a sweet summer child compared to now.

Breast reconstruction with implants is, at best, a very beautiful facsimile of breasts. They don’t actually look, feel, or move like breast tissue, but under clothing or swimsuits or lingerie, they provide the appearance of breasts. Very early on after my reconstruction, I stopped yearning for them to feel like a natural part of my body, and have considered them to be art.

I managed to surprise myself many times along the way. I loved my short hair era, everything from buzz cut through bob. For awhile I thought I might keep my hair very short intentionally, a wild departure from the woman who once tied so much identity into long red hair that I cried more over the idea of losing my hair than I did anything else. Ultimately, it only took one dance class about a year into hair regrowth, once it was long enough with the tight chemo curls to move a tiny bit with a head flip, for me to decide no, I’ll be growing this out for the hairography. My hair is now down past my shoulders, but I never thought I would have embraced every phase it took to get here.

After my reconstruction was complete, I asked my surgeon when I could have my nipples reconstructed.

“If you decide to do that, you can just call me and schedule it any time.”

If.

I was speaking about it as though it were inevitable, as though there were no other options. Mentally, I was still on the treatment conveyor belt. “If” reminded me that there was choice, there was agency. “If” empowered me to make this a conscious decision.

In the immediate aftermath of a year of extreme medical intervention, I realized I didn’t want even an in-office procedure for a beat, I didn’t want to deal with even a few days’ recovery period. I went off and lived my life and used prosthetic nipples if I wanted the effect under clothing.

A year and a half went by, and I was enjoying not worrying about nip slips. In an appointment with my reconstructive surgeon, now just brief annual check-ins, he asked if I’d decided one way or another.

“I don’t think I will reconstruct my nipples,” I heard myself saying with confidence. “It’s so much easier without them.”

“A lot of my patients who weren’t candidates for nipple-sparing mastectomies end up making the same decision,” he validated. Then we laughed about how it turns out the nipple is freest when it is in a medical waste bin.

For about 10 months after that conversation, I just figured I’d be a person who had mastectomy scars and no nipples. Remember, I’d long since let go of anything looking or feeling like a real breast, and physically (or mentally or emotionally) pretending it never happened didn’t interest me. I know some survivors in the dating pool find it challenging to navigate, and while I do understand that, from my perspective if you’re dating me, you’re dating all of me, including my scars and lack of nipples.

Scars can be sexy, they help tell a life story.

My incredible dermatologist had offered to do complimentary laser scar removal if I ever wanted that, and while I initially jumped at the offer, I found myself never getting around to scheduling the appointment. I don’t loathe my scars, I’m grateful that much of that experience is in my rearview, and despite writing about it and creating art out of it, I don’t necessarily think about cancer much in my day-to-day life.

One day recently, an idea popped into my mind. Many survivors get mastectomy tattoos, using their reconstruction as a canvas. I didn’t want the full area tattooed, but if I’m embracing my scars, and if I view this part of my body as an artist’s rendering, why not layer the art?

I booked a consultation with a tattoo artist who also has experience in medical tattoos, so I was confident she can work with scar tissue. She understood my concept immediately, and together we came up with a design of gothic Victorian rose vines staked along my scar lines. The idea isn’t to hide the scars, but rather to incorporate them into the art.

The outcome feels so natural to me, as if the tattoos have always been there, as if this is always the way my body was meant to look. Perhaps, just perhaps, it was.

Now that your rose is in bloom
A light hits the gloom on the grey
Seal, “Kiss from a Rose”

PS - These tattoos were expensive and not covered by insurance as medical tattoos (nipples) would have been. If you enjoyed this read and are able to support my Substack as a paid member, I would appreciate it! You can also show my Venmo some love @C-Scott. I’m a freelance creative and cancer survivor just trying to get by in a capitalistic hellscape.

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In a departure from my usual slightly whimsical thinkpiece, I thought I’d share in somewhat vague terms (for now) a creative project currently in post-production. Perhaps in a way some might do on social media, but if I’m online these days I prefer it to be in more intentional ways. (Unless this counts as social media? But longform written content is surely the antithesis of it, so I think we’re safe. For now.)

I recently wrote about the importance of art in society, as well as the importance of dance and movement to me, especially in the context of recovering in mind, body, soul, and spirit from a cancer diagnosis, cancer treatment, and its aftermath.

Last year I teamed up with artist and curator Jessica Duby, in a continuation of a series she’s been working on exploring the body as a site of devotion. I was first introduced to Jess in 2021 by our mutual friend Maya Contreras, an artist and advocate who was running for Congress at the time.

Jess reached out late last summer about collaborating and I was thrilled to work on a project that incorporates dance. Even more special, I brought in another treasured friend (fellow breast cancer survivor and founder of OncoBallet) Anna Wassman-Cox, to serve as movement director.

While the overall piece thematically includes my experience with breast cancer, it was important to me that the dance be full, dynamic, and engaging regardless. It had to be able to stand on its own and be compelling without that element of the storytelling.

The creative process is often a nonlinear harrowing deep-dive into the inner trenches of your mind and soul, discovering beauty and uncovering madness, standing in the wild and whirling confluence of the Id, the Ego, and the Superego. Regardless of the outcome or the reception of anything I work on, as long as I’ve learned things and grown as a person through the experience, there’s been success.

If you’re curious about the ways I’ve turned cancer into art in the past, you can peruse Project: Self, the multi-part series I shot with Paulo Netto and Jackie Abbott during and immediately after treatment.

This is a waltz thinking about our bodies and what they mean for our salvation.

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In my late 30s, with no family history of any cancer, my doctor found a lump during a routine check-up at which I was mostly concerned my white coat syndrome was high blood pressure. My doctor wasn't overly concerned about the lump, but she is thorough, and she sent me for imaging.

I tend to catastrophize, but made a concerted effort not to in this case. (The irony.) I’d just returned from a tropical beach vacation with a friend, I was feeling good and nursing a very stupid sunburn. I’d just been swimming in the ocean, riding horses, and sipping frozen margaritas in a hot tub. I was young, healthy, fit, strong. I responsibly kept up with all my annual check-ups. How could I have cancer?

However, the vibes were off the day of my mammogram and ultrasound two weeks later, a grim and grey Friday in late March. A kind radiologist let me know the lump would need to be biopsied. "You'll chat with Yvette at the far end of the check-in desk, she schedules all of the biopsies."

Okay, thank you, doctor.

The mammography technician, a very sweet and small and stern Eastern European woman, was waiting outside of the room. "You're going to speak with Yvette?" It wasn’t really a question. "I'll take you to her."

I'm assuming some people get so freaked out they run right past Yvette and out the door in a blur? I'm also now aware that the lump was so clearly malignant on imaging that I was prioritized as urgent. I was personally escorted to Yvette, and the technician stood over her shoulder while we scheduled my Tuesday morning biopsy.

Deep down, I knew this was my final weekend as a normal, "healthy," non-medically traumatized woman. I wanted to put pajamas on and crawl into bed and turn the world off. I walked home, stopping by my doctor's office to pick up the prescription for the biopsy on my way. Only two more blocks until you can cry in peace and privacy at home, I told myself. Just hold it in until then.

Ultimately, I decided to take advantage of this extraordinarily weird weekend. It was my last taste of freedom, in a way. The end of my old life. I told no one what was going on. I didn't want to be seen as a cancer patient until I officially was one. I went on a hike upstate with a friend, then out for a cozy two nights in the country with the person I was dating at the time. As we returned to the city the night before my biopsy, I quietly stared out the car window. I knew our complicated romance wouldn't survive the cancer even if I did. How do you pre-grieve so many things at once?

On the day of my biopsy, as I lay in an imaging room with one arm up, the radiologist and ultrasound technician were communicating with silent nods, points, and the occasional "hmm, uhm-hmm."

I knew. They knew.

I completely disassociated from my body, and the remainder of the appointment is a bit of a blur. My memory of it is from the perspective of floating above the scene, off to the left, looking down. They asked me if they could also biopsy a lymph node.

Yes, of course, doctor.

I slammed back to earth when the radiologist calmly explained he was writing down the names and numbers of some breast surgeons. "I think you'll need one."

After I changed back into my street clothes, the radiologist brought me into a dark room with screens and showed me my imaging. He empathetically told me why he believed it was a malignancy, and again urged me to make an appointment with a breast surgeon.

"If you don't end up needing it, you can cancel. But good to have one on the books."

"Is that ... who does reconstruction?" I asked, my voice shaky as I desperately tried to remain calm. If breast tissue was going to be a problem, I wanted a mastectomy, I wanted it gone. I wasn't even sure I wanted reconstruction or if it was possible to stay small-chested, as I was naturally.

My goal was to exit this experience with as close to the same body as I possibly could.

I went home and I waited. I changed into pajamas and didn't change out of them for two days. I ordered many vanilla milkshakes for delivery from the local bodega. I kept an appointment later that week with my new gynecologist, and wondered how to start the conversation about what was going on. Just wait until she sees the Steri-Strips and deep biopsy bruise? There's no box on an intake form for, "Nobody in my family has ever had cancer and I don't even have a diagnosis yet but anyway, I probably have breast cancer."

I spent my time in limbo, waiting for pathology results, trying to be proactive. I called breast surgeons and filled out paperwork, but couldn't schedule appointments without the pathology results. I did wig consults. It was the wigmakers who let me know not every cancer patient needs chemotherapy, and if I did, how to get it covered by insurance. They were so kind and helpful, and wouldn't sell me anything until we knew I'd need one. They prepared me that with breast cancer, I might not even know right away.

Six days after my biopsy, a spring morning in early April, I received a MyChart notification at 6am. It wasn't really a debate on whether or not I’d wait for the radiologist to call me and tell me what we both already knew - I had cancer.

I opened the pathology report.

CLINICAL INFORMATION:

Highly suspicious irregular breast mass, left breast 4:00;

Suspicious axillary lymph nodes with thickened cortex, left axilla

GROSS DESCRIPTION:

The specimen is received in 2 parts.

A. Breast, left 4:00, needle core biopsy:

1. Invasive ductal carcinoma

B. Breast, left axilla, needle core biopsy:

Lymph node, portions of, negative for carcinoma.

There were a lot of other words and descriptions I didn't understand at the time, but would come to know well. I had what I needed to schedule appointments with breast surgeons, however, so that's what I did.

A few hours later, the radiologist called me. He talked me through the results, checked in on whether or not I had appointments with breast surgeons, walked me through what I could expect from those appointments.

In the weeks that followed I had more mammograms, more ultrasounds, more biopsies, a breast MRI, a genetic panel (turns out I have a gene mutation with a moderate increased risk of breast cancer), and so much bloodwork. I chose a breast surgeon, who recommended reconstructive surgeons.

"I want to stay small, is that possible?" My reconstructive surgeon told me it was, validated my choice, and explained the surgical path to achieve what I wanted.

My mastectomy was scheduled for mid-May. Both my breast surgeon and my reconstructive surgeon would be in the operating room, working in tandem. My breast surgeon would remove my left breast first, the one with cancer, and the closest layer of lymph nodes. Due to the location of my tumor, it was recommended that my nipples be removed, as well. The lymph nodes would be sent to the on-site lab to be tested during surgery. Once my breast surgeon completed her work on the left, she'd move over to the right. At that point, my reconstructive surgeon would place a tissue expander, which he would fill with saline in follow-up appointments in the months to come, to allow the skin to slowly stretch to accommodate the implant. He'd do the same on the right side. (Eventually, the tissue expanders are exchanged for implants in a second surgery.)

If my lymph nodes came back positive, my breast surgeon would return to the left and remove more for testing. If they were negative, she'd begin closing me up.

Fun fact: Once you have lymph nodes removed, there's always a risk of lymphedema. I can no longer have my blood pressure taken, blood draws, or anesthesia administered on the left side. Any time I'm in a hospital setting or will be given anesthesia, I need to request and wear a "limb alert" bracelet, which lets medical providers know my left arm is off-limits. Physical therapy is often recommended after a mastectomy to reduce your risk of lymphedema and to help restore range of motion, which can be mildly to severely impacted. Oh, and hot tubs are to be avoided, or only enjoyed for a short period of time.

I woke up numb in my chest and upper underams due to the nerve damage that occurs with a mastectomy, and with JP drains attached to my body, which I'd need to empty multiple times per day, and track the amount of fluid each time. They could only be removed when this number was low enough. I had one drain on each side for three weeks.

My reconstructive surgeon gave me two timelines for completing the process: one if I needed chemotherapy, one if I did not.

One week after surgery, I had a follow up with my breast surgeon, where I found out how surgical pathology had staged my cancer. It was smaller and earlier than my surgeon predicted based on imaging, so we celebrated this win. It was also much more hormone receptor positive than the biopsy indicated, which was a good thing. It meant a clearer treatment path. However, the chemo question still loomed large.

My tumor was sent to a lab for Onctoyping, which examines certain characteristics to determine recurrence risk in early stage hormone receptor positive, HER2 negative breast cancers. If your score is under 25, there's no real benefit to chemotherapy. If it's over, chemotherapy is recommended to reduce your risk of recurrence.

My breast surgeon told me my oncologist would speak with me more, but there was around a 50/50 chance I'd need chemotherapy. If I did, I was a great candidate for cold capping, which is cryotherapy to help reduce hair loss. She let me know I should talk to my oncologist's team about that if I was interested. (I was very interested.)

My oncologist expanded on these odds, explaining he felt there was a 40% chance I would not need chemotherapy, a 40% chance I would and it would be a very clear and short course, and a 20% chance the Oncoscore would be high enough a more aggressive plan would be needed. "We're not going to worry about that 20% right now."

I wouldn't need radiation, which my reconstructive surgeon was happy to hear, as it tends to complicate the result of that surgery due to the way the skin tightens. It also prolongs the amount of time the tissue expanders would be in, and extends the timeline of surgery.

Five weeks after my mastectomy, my Oncoscore returned: 37. I would need chemotherapy, but it fell into his 40% chance of a clear and short course. Four rounds, spaced three weeks apart.

I ordered those wigs.

I also had to decide quickly if I wanted to preserve my fertility. Just wanting to begin chemo so I could be done with it, I opted against IVF and dove right into the sweet, sweet poison.

I underwent chemotherapy from July through September. My reconstructive surgeon finished my saline fills before I began, so we could use those two months for the skin to adjust, rather than needing to tack on additional time after active treatment.

I cold capped, but I lost about 70% of my hair anyhow. It’s uncomfortable and adds two hours onto every session, but one of the chemo drugs I was on, Taxotere, comes with a risk of permanent alopecia. I'd made peace with the idea of losing my hair as long as it grew back, and anecdotally cold capping can help preserve the integrity of the follicle, if not the strand.

When it was clear the cold cap wasn't working well for me, I struggled with deciding whether or not to continue in a modified way. When I say I struggled, I mean this was a game day decision. I was in my infusion room, delaying the start of pre-meds while I figured out what to do as I sobbed hysterically. Freeze the hair follicles too much, they could be destroyed. Don't protect them at all, and there was a chance Taxotere would destroy them. Ultimately, I decided to have the bald spots covered with gauze, and to proceed capping at a reduced level to hopefully still preserve the follicles.

While my chemo experience was relatively smooth all things considered, there were a few trips to the ER to rule out blood clots, a few fevers that had to be investigated to rule out neutropenia, and at one point my left tissue expander was pinching a nerve that caused chest pain we had to be sure was nothing serious.

Once chemotherapy was complete, I met with my reconstructive surgeon to set a surgery date. While we could move forward as soon as one month after my final chemo, he preferred to wait two months as the body is that much stronger and able to heal. We scheduled for November, and for the first time since March, I had a break from seeing doctors. I felt like I could breathe again, maybe even relax a little bit. My implant exchange surgery was set, I didn't need to see my oncologist until late November, and I didn't need to see my breast surgeon again until February.

COVID, Monkeypox, and Polio were terrifying New York City at that time as a neat little trifecta, so I left for a month to allow my weakened immune system to recover more peacefully. As my surgery date approached, I took every precaution to the extreme to avoid contracting COVID but, lo and behold, one week before my reconstruction surgery, I tested positive.

I cried to my breast cancer support group, composed myself, called my surgeon's office, and was told it was hospital policy to wait three weeks after COVID to go into surgery, and the earliest date he had available was late December, just before the holidays. Desperate to have this experience wrapped up before the start of a new year, I grabbed that surgery date.

That weekend, while recovering from COVID, I felt a weird bump on my abdomen, near my ribs on my left side. Suddenly I longed for my biggest problem being that I was stuck with tissue expanders for a few weeks longer. Obviously, I immediately began spiraling. The second I had a negative test, I raced to my oncologist's office. He wasn't concerned, but since I was, he suggested for my peace of mind that my reconstructive surgeon remove it during my upcoming surgery.

Just before Christmas that year, I had my tissue expanders removed and my implants put in. My surgeon removed the little lump, which ended up being nothing more than necrotic fat, which can happen after body trauma.

I spent the holidays in a compression bra and during my recovery, began getting monthly Lupron injections, in order to suppress my ovaries so they stop producing estrogen, which was feeding my cancer. Effectively, I entered immediate menopause in my 30s. I also take an aromatase inhibitor every day, which blocks an enzyme in fat tissue from turning other hormones into estrogen. I'll be on endocrine therapy for ten years.

Six weeks after my reconstruction surgery, in early February, I was released into the wild without any movement restrictions. But to do what? Who was I now? What was my style? What did I enjoy? What did I want to do - tonight, this weekend, for the rest of my life? How much time do I have?

I lost all connection with my body the day I found myself floating above her during my biopsy. I lost my hair, which had been a major part of my identity. It was growing back evenly, thankfully, with a hint of chemo curl texture starting to form. I didn’t look the same on the outside, and I wasn’t the same on the inside. Who was I now?

I did end up increasing my size ever so slightly with my reconstruction, something I went back and forth on. Reconstruction with implants isn't the same as having breasts - they soften and drop over time, but they don't really move much. It feels like you're wearing an underwire bra at all times.

I don't really consider them my breasts or part of my body, just foreign objects to make me look, from the outside, more like my peers. More like someone who didn't have cancer. It's an illusion.

My reconstructive surgeon is incredible. I recommend him to so many others going through this same nightmare. However, eventually, I do believe I'll have explant surgery with an aesthetic flat closure. Since I'm considering that, I have yet to do any nipple reconstruction, because it would complicate the result. And even if I don’t explant, I’m not really in a rush to reconstruct my nipples. I don’t have any tattoos and an areola tattoo simply cannot be my first one. I need one of my choosing first.

My hair is holding onto the chemo curl, but when blown out it's down to my shoulders now. I've got bangs, because I didn't before, and I can't look too much like her. I'm not her. She had a good run but we can't go back.

I still see my oncologist every three months, my breast surgeon every six months, and annual check-ins with my reconstructive surgeon. Once per month I head into the same infusion ward where I had chemo to get my Lupron shot and labs drawn. Sometimes I walk out with multiple bandaids, because they can only draw from my right arm, my veins are still damaged from chemo, and I require multiple sticks.

I don’t menstruate anymore. I don’t have nipples anymore. I get hot flashes. I’m much older than my age. I’m much older than my peers.

I'm still very much tethered to my breast center, and I will be for a very long time. I have to plan vacations around the timing of my Lupron shot. If I don't want to do this, the alternative is to have an oophorectomy, which I will probably do. The question is, when? Surgery comes with recovery, and it feels like I've already lost so much time.

If you've read this far, my only question to you is: Does this sound like a “boob job” to you?