Thursday, March 26, 2015

March 26

When I was twenty-eight I was diagnosed with a rare, aggressive type of breast cancer. After my surgeon explained my options to me, I asked, “What would you do?” She was silent for a moment, and then she replied, “I don’t know. I can tell you what I think I would do, but I can’t possibly predict what I’d do if I were truly in that moment.” I remembered her words when I learned, at the time of my second cancer diagnosis seven years later, that I carry a mutation in the BRCA1 gene. I had to decide how I would manage the risks that are part of my DNA.

Experts don’t agree on the exact lifetime risk of breast cancer for women with a mutated BRCA1 or BRCA2 gene, but estimates have ranged from 55-89%, with the most recent research suggesting about a 65% lifetime risk, compared to a 12% lifetime risk for the average woman in the United States. Women with a BRCA1 or BRCA2 gene mutation have a lifetime risk of developing ovarian cancer estimated at 15-40%, while women without a BRCA mutation have about a 1.8% lifetime risk.

I chose to have risk-minimizing surgeries. I had bilateral mastectomies and reconstruction after I completed chemotherapy for my second breast cancer. A year after that, when I was thirty-seven, I had my ovaries, fallopian tubes and uterus removed. My body and psyche underwent changes as a result of these surgeries, but I can now say I feel happy and comfortable in my body. I don’t regret anything. My boys won’t have to say, “My mom died of breast cancer,” or, “My mom died of ovarian cancer.”

A few months ago, Dr. Mary-Claire King, the geneticist who discovered BRCA1, published a piece in the Journal of the American Medical Association advocating for population-based screening for the BRCA genes – that is, screening of these genes in every woman, at about age 30, in the course of routine medical care. To identify a woman as a carrier after she develops cancer is a failure of cancer prevention. About half of women who inherit mutations in BRCA1 or BRCA2 have no family history of breast or ovarian cancer and have no idea they are carrying cancer-causing mutations.A recent survey revealed that only 19% of US primary care physicians accurately assessed family history indicating a need for testing. Whether or not Dr. King’s wish comes true, genetic screening will continue to become more common, and as a result many more women will be faced with making difficult decisions.

A couple of days ago Angelina Jolie Pitt wrote a New York Times op-ed on having her ovaries and fallopian tubes removed because she, like me, carries a mutation of the BRCA1 gene. Two years ago, she famously shared her account of undergoing a preventive double mastectomy. She lost her mother, grandmother, and aunt to cancer. In Tuesday's op-ed, Jolie described the procedure she had last week and explained that it put her body in an immediate menopause (something that happens to every woman whose ovaries are removed). “I feel at ease with whatever will come, not because I am strong but because this is a part of life,” she wrote. Because of her celebrity status, what she has shared is like a public service announcement that will empower many frightened women to take steps to save their lives.

Saturday, March 21, 2015

March 21

Cal has been studying Buddhism as a part of his fourth grade’s unit on world religions; the pictures are from a field trip to a Buddhist monastery earlier this week.

The other day, as I was putting together a batch of oatmeal cookies, Abbott asked to interview me for his humanities class. He wanted to know about how my life, now, is the same as, and different than, it was before he was born. I said, “For the record, a good day in my book has always involved baking.” We laughed.

I was a graduate student when I was pregnant with him; I finished my thesis weeks before his birth. Just like I do now, I went to bed early and woke up at an hour that never quite felt late enough to qualify as morning, trying to stay warm while I read and typed. The evenings grew longer as my belly distended. Daffodils opened. We slept with the windows open, and the air coming in had a sweetness to it. Day after day, the sky was blue. The sidewalks were baked warm by the sun. Every bird in flight seemed to promise something.

I told Abbott that, in addition to him and his brother, I now know all sorts of people I didn’t before I was a parent. I’m more compassionate than I used to be.

I relax more and I’m also busier; usually, now, I feel as though there is always some leak in the house that needs fixing.

In the years since I became a mother I have learned that how you spend your days is how you spend your life.

(Also: Being 12. (via Jenny))

Salted Oatmeal Cookies
Adapted from The Washington Post June 13, 2007

I’ve probably made a dozen versions of oatmeal cookies; this one is our favorite because it really brings out the earthy flavor of oats.

The dough will keep, refrigerated, for several days. The cookies can be stored in an airtight container for up to 1 week.

12 tablespoons (1 ½ sticks) unsalted butter, at room temperature
1 cup light brown sugar
½ cup sugar
1 teaspoon baking powder
¼ teaspoon baking soda
¼ teaspoon ground cinnamon
2 large eggs
1 teaspoon vanilla extract
1 ¾ cups flour
2 cups rolled oats (not quick-cooking)
coarse sea salt, for sprinkling (like Maldon)

In the large bowl of a stand mixer fitted with the paddle attachment, beat the butter for a few minutes on medium-high speed until light and fluffy. Scrape down the sides of the bowl. Add the sugars, baking powder, baking soda and cinnamon, beating until the mixture is well blended. Reduce the speed to medium and add the eggs and vanilla extract, mixing until well incorporated. Reduce the speed to low and add the flour and then the oats, scraping down the sides of the bowl as necessary and mixing just until they are incorporated. Cover the bowl with plastic wrap and chill the dough for at least an hour before baking.

Preheat the oven to 375 degrees. Line a large baking sheet with parchment paper.

Form the dough into golf ball sized balls and place about 2 inches apart on the baking sheet. Sprinkle sea salt generously on top of each ball of dough. Bake for 15 minutes or until the cookies are puffed and beginning to turn golden, being careful not to overbake. Transfer the cookies, still on the parchment paper, to a wire rack to cool completely.

Yield: about 18 cookies

Wednesday, March 11, 2015

March 11

Though we live ten minutes from downtown Seattle, our home feels more remotely located than anywhere I’ve ever lived. The base of a bluff abuts one side of our street; Elliott Bay, the other. At our juncture of woods and sea there is an amalgam of life. Blackberries grow maniacally down the bluff to the edge of the road, infiltrating our yard on every side. Cockle and clam shell remnants crunch underfoot on our decks and street; gulls’ litter. Occasionally an eagle lets a fish slip from its talons onto our roof, our deck.

Over the weekend, motivated by a stretch of gloriously sunny, warm days, I inspected everything outside, then got to work weeding and thinning and trimming back. Our herbs are going strong, and it looks as if we're going to have strawberries, rhubarb, and blueberries, too, before we know it. It’s a constant challenge beating the birds to the berries. Over the years we’ve lived here I’ve tried my hand at growing a lot of things; I’ve learned which parts of the yard get what kind of light. Around Memorial Day, I’ll buy a sungold tomato plant and one or two other varieties and install them in pots on our deck. Tomatoes grow famously in our southwestern exposure.

I’ve benefited from a garden’s bounty, flavor and nutrition most of my life. My maternal grandparents grew or raised just about everything I ever ate at their house. In the heat of the arid Texas panhandle they grew corn, okra, snap peas, black-eyed peas, squash, tomatoes, beets, turnips, green beans, yellow wax beans, and sometimes watermelon and cantaloupe. My grandmother made watermelon rind preserves by cutting the rind into cubes and cooking it with sugar and whole cloves. Those preserves were good on hot biscuits. My grandparents also grew lamb’s quarters – sometimes called Poor Man’s Spinach – and poke salat – wild plants cooked similarly to turnip greens – and pinto beans, which they picked before they were fully mature and then cooked like green beans. The pinto beans were outstanding. Their yard also had a small orchard with peach and apricot trees. One of their farms had wild plum thickets that produced very tart plums, perfect for jelly and jam. Every summer, my grandmother canned and froze enough of everything to feed an army.

When my family moved to Alaska around the time I started school, my parents, both children of farmers, transformed our backyard into a garden. The summer sun never dropped below the horizon enough to achieve astronomical night, and with all that light whatever we grew became enormous: broccoli, cauliflower, zucchini, carrots, cabbage and other things I’m forgetting, and scallions, which were my favorite thing to snack on. My sister and I dared each other to eat the mouth-puckeringly sour gooseberries that grew wild in our yard.

My experience with growing food at our home in Seattle is relatively modest; nevertheless, we’re able to appreciate the bounty of our surroundings all year. We try to make enough jam with our berries to get through a school year of peanut butter sandwiches. We freeze our excess of tomatoes to use later in sauces and stews and such. We use the herbs we grow year round. My boys know the value of food and where it comes from, whether it be the side of the road, our garden, the farmers market or purchased elsewhere, and they understand a thing or two about self-sufficiency.

Monday, March 2, 2015

March 1

Yesterday felt like it ought to be March 1. As Alexi prepared for work – occasional weekend work is just one of those things most physicians have to do – Nelly and I went for a walk in twilight that barely illuminated the light frost on rooftops; the magnolias and camellias and their petal snow. In the face of the seasonal juxtaposition I couldn’t shake the sense that I was still dreaming. The house was dark and quiet when we returned home. Nelly went back to bed. I made pea soup and oatmeal cookies.

Later, after our lunch of soup and cookies the boys settled in to play video games, and I finished Henry Kissinger's latest book, World Order. You won’t sleep any better after reading it, but I highly recommend it. It’s an important book, with plenty to debate and disagree with, and I hope it becomes influential.

At the end of the afternoon, we went to a nearby waterfront park that has both playground equipment and a beach. (I LOVE LIVING IN THE PACIFIC NORTHWEST.) As we left the parking lot I noticed a station wagon with a stiff, brown-limbed Christmas tree tied to its top. Had the tree been there since December; did the family never get around to bringing it inside and decorating it? Or were they just now, March 1, seeking to dispose of it? It was a fascinating spectacle. As we prepared to leave, I spotted that Christmas tree again. It had been moved to the beach and was partially dismembered, on the sand next to a bonfire. A family sat around the fire made from the tree, sort of like Easter in reverse.


PS - Did you see VICE’s Killing Cancer? The documentary investigates the most cutting-edge cancer treatments. It takes a look at how HIV, measles, and genetically engineered cold viruses are being used to strengthen immune systems and kill cancer cells without damaging people’s bodies the way chemo normally does. These experimental techniques are already saving lives. If you missed this inspiring program when it aired, you can watch it online here.

Pea Soup with Mint

I could eat soup every day; I never get tired of it. I don’t believe in soup season. The flavor combination of peas and mint is one of my favorites, which is why I am in love with this soup.

1 pound frozen green peas
2 shallots
3 tablespoons olive oil
2 cups chicken stock
2 tablespoons crème fraiche
1 cup whole milk
Salt and pepper, to taste
Chopped mint, for garnish

Bring a large pot of salted water to boil. Add the frozen peas and cook until just warmed through, about 2 minutes.

Dice the shallots, and then sauté them in the olive oil until soft, 3 to 4 minutes.

Put all the ingredients, except the milk, in a food processor or blender, and blend until smooth. Season to taste. Stir in the milk, and heat until warm. Garnish with chopped mint.

Yield: 4 large servings