How are you?

“Miten voit?” (“How are you?”) asks the occupational health doctor when take a seat in her office. Her question does not come as a surprise.  On the contrary, I have braced myself for questions like: How are you? How is life? or How are you doing? 

Questions like that, generally used as a routine greeting, can become uncomfortable if you’ve recently dealt with a serious illness or with loss for that matter.

What should you say? I'm fine, thanks. How about you? It would be the end of the conversation. I need to come up with something better. She is my occupational health doctor after all. Deep inside I hope for a follow up question but if that stays out, I will have to lead the conversation.

*

Weeks ago, when I started researching the topic, I realized how complex a simple question like how are you can be. Do people really want to know about my cancer journey or are they just trying to be polite?

Responding to family and friends who’ve walked along this year is easy.  I kept them informed after each chemo treatment. But I’m ready to go out in the world again and I surely will meet with people who have heard about my illness from someone who heard it from someone else. 

The how are you question makes me feel uneasy. How long should my answer be? Which words should I use or what details do I want to reveal? Do I need to tell the same story over again? Cancer has completely changed my life but do people really want to hear about it? 

I asked my friend Alana if she’d experienced awkward moments with the how are you”question after a long sick leave. 

“I made the mistake of assuming that one person wanted details but when they started to look uncomfortable, I stopped, made a joke about it and then changed the subject.  It's a difficult line to see sometimes,” she wrote. 

From Alana’s reply I get that it’s up to the receiver to formulate a response and estimate how much the inquirer can handle. That’s a significant task. Would I be capable of steering a gawky conversation in another direction?  Or should I try to pave the way for a genuine discussion? 

*

With my friend Karin I had an email conversation about the how are you question.” It’s best to stay in the present,” she advised. It sounded great but anticipating my visit to the occupational health doctor, I wonder how I possibly can stay in the present. I’m emotionally sucked up by the events of the past eleven months and at the same time planning my professional future.

On the other hand, a fellow chemo patient also once advised me to practice living in the present. “Live the day,” she said. “If your condition gets worse, try to live from meal to meal or if that’s too difficult to oversee, live from coffee break to lunch,” she advised. Her tip helped me to keep my worries at bay, to stay focused and it made me feel grateful for little pleasures such as a pancake with strawberry jam or the view of a woodpecker in the yard.

“Here and now” is a Gestalt therapy concept where “the emphasis is placed on understanding present feelings and interpersonal reactions as they occur,” says Google.

So, I should focus on what’s happening in a specific moment. According to some Harvard researchers, a deep breath and focus on an artifact in the room might help. The first steps seem easy. I have a good eye for my surroundings. 

*

Forward in time. As soon as I walk in the office of the occupational health doctor, I identify a window behind her and two large sized computer screens on a relatively high desk in front of her. After I have taken a seat on the chair before the desk, I notice that her face goes hidden behind one of the computer screens.  I need to move the chair and bend my body to the right to make eye contact.

The Harvard research also talks about the ACT criteria: before you start a conversation, think of “authenticity, connection and a topic that will give them a taste of who you are,” it recommends.

Taking my time before opening my mouth and reading people’s faces or body language shouldn’t be a problem either. I’m a sensitive person after all. Also, generally, in Finland people weigh their words before speaking. I never feel I need to rush into a conversation.

But the next step, articulating thoughts into words could be a challenge? If I were a fast thinker or an enchanting speaker with a sexy voice, I would have started a podcast instead of a blog.

*

Reframing the question might be a first step to stay in the moment and take control of the situation, claimed another website. 

“How are you? It’s a hard question to answer but is it OK if I tell you how today has been,” I reply. It is an example of one of the options I had written in my notebook before the meeting. This answer will help me to stay in the moment and give me time to check if she cares. Talking about the blood count results, stoma issues or my tiredness would give any doctor enough information to start a proper conversation, I guess.

As an alternative, "It's been tough, but I'm getting through it. Some days are harder than others, but I'm taking it day by day and try to stay positive," I could have replied if I didn’t want to share too much information. 

What’s more, if I would have felt intimidated, I could have said that I’m happy to be alive? Such a reply would certainly be the end of the conversation. Maybe “thanks for asking, yes, I’ve had a tough year,” would be a better reply to test the water for instance with colleagues at work.

Another website suggested using an unexpected word to see if folks are really interested. 

“How are you?” 

“Thanks for asking, I feel discombobulated,” I could say and then wait if a reaction would follow. Dismissing people seems straightforward. 

*

But much to my relief, the doctor nods after I tell her about the blood count results and my tiredness. She immediately opens the door for a proper conversation:

 “A surgery, chemos and Covid, you’ve had a rough autumn,” she acknowledges my health struggles of the past months. 

“How do you feel about returning to work?” 

 

 

Ovarian Cancer, the Silent Killer

 

The cancer no longer shows in scans or in blood test results, so I’m carefully trying to re-adjust to “living a normal” life. I resumed my voluntary work, challenged my brain with proper literature (a book from André Brink, a South African novelist), and  met my friend Kaija for a walk in her neighbourhood and a facemask-less kaffeeklatsch at her house. Visiting her place after such a long time felt at once strange and familiar and gave me a wonderful sense of freedom. Also, next week I will meet with the occupational health provider to talk about a return to the office.

Nonetheless, I’m not carefree. There might still be cancer cells in my body and cancer recurrence is probable. Only about 40% of women with ovarian cancer stage 4 live longer than five years. From now on I should pay close attention to any signals from my body. 

*

Friends sometimes ask me if I’d noticed anything unusual before I got ill, and during the last year I’ve often wondered myself if I’d overlooked any signals my body had given me. 

In retrospect, yes there were vague symptoms. I didn’t ignore them but misinterpreted them and hoped that my discomfort would gradually disappear. These are the signs I should have looked out for:

Weight Loss

On November 22, 2022, I met my friend Hélène over lunch in the Netherlands. “You look great,” she said after we’d hugged. She knew I’d been dieting for some months and I was pleased she noticed I’d lost weight. “Thanks, it’s been easy-peasy,” I joked. While we were enjoying our fresh buns with cheddar cheese in a cozy restaurant, I told her how great I felt since we had decided to cut down on sugar. Six months earlier, my husband had been diagnosed with type 2 diabetes. We both decided to rigorously control our sugar intake. The scale in the bathroom confirmed that I was fleetingly losing weight.

In retrospect, my diet went too easy and too fast. Cancer cells can take energy and losing weight is often one of the first signs of ovarian cancer. On top of the ten kilos I’d lost before the diagnosis, I eventually lost another eight after it.

Swollen Belly

Back in Finland, in early December I resumed my  gym sessions. Dressed in purple sport Lycra, I noticed for the first time that my belly was swollen. “I look as if I’m pregnant,” I bantered to Mitra, my friend and gym buddy. Sweaty and satisfied after a fit moves’ session, we both looked in the wall mirror at my belly.  Mitra nodded in agreement. “Maybe bloated,” I wondered. It puzzled me and I remember making a mental note about the size of my belly. 

A swollen belly can be caused by ascites, an accumulation of fluid in the abdomen from where metastasis can spread to other locations. During my first stay in hospital, more than a month after my banter with Mitra, a whopping seven liters of ascites were removed via a drain  from my abdomen.

Changes in Bowel Habits

Days later I felt an unpleasant pressure in my stomach. My stool had changed, and I had an increased need to urinate especially at nighttime. I suspected salmonella for obvious reasons. 

One of our chickens, the last one

from our first flock, had fallen ill. One day I found “Tarja Halonen” lethargic in the henhouse. She  could hardly walk, and it looked as if she’d suffered from a stroke.

Within days she was degraded lowest in the pecking order. Being unable to move she no longer could reach food and water.

Winter approaching, I decided to take her into the house and take care of her. I knew she would ultimately die; I also apprehended I should slaughter her but I’m a fainthearted chicken myself. She was my favorite; unlike the other chickens she ate out of my hand, and I bathed her on hot summer days. I like to think we had a bond. 

My oldest son and his girlfriend arrived from the Netherlands a week before Christmas. They looked amused at the chicken in a big wooden box in the scullery but refrained from commenting on my motherly, or should I say chickenly, instincts.

Instead, in preparation for Christmas they offered to cook meals for the family. They’re great chefs but I only ate a little of their food. I felt full very quickly and was constantly apologizing for my little intake. In hindsight, this should have alarmed me as I’ve always been a healthy eater.

Bathroom routines are often changing and many women with ovarian cancer have bothersome gastrointestinal symptoms like constipation or diarrhea. Also feeling full and loss of appetite can be symptoms of ovarian cancer. 

Elevated Infection Values

Somewhat worried, I decided to make an appointment at my occupational health center. On December 30th, I walked into the downtown practice, told the doctor about “Tarja Halonen” and my complaints, and showed her my blown-up belly. Blood tests were ordered and a few days later she called. The salmonella test results were negative. “One thing, she said, your infection values are slightly elevated. I will order a colonoscopy, but it might take a while.”

The invitation letter for a colonoscopy fell in my mailbox in March, three months later. 

Elevated infection values can indeed indicate ovarian cancer. Despite my visible swollen belly, I don’t think the doctor suspected ovarian cancer.

Abdominal Pain

Early January my sister came over from the Netherlands. I was overwhelmed with joy when she arrived and had made plans to show her snowy Finland. We admired the northern lights in Kuusamo, the kaamos (polar night) views in Saariselkä and ran into a group of reindeer in Inari.

But since we’d set off from Oulu I constantly had stomach pain. Frantically googling in a hotel room, I found a possible explanation. “I might have developed lactose intolerance,” I said to my sister and decided to order lactose free food for the rest of the trip. It didn’t make any difference.

Bloating and abdominal pain are three of the most common symptoms of ovarian cancer. This can be caused by pressure from the tumour on neighbouring organs.

Fatigue

One day, climbing a snowy hill in Inari, I was out of breath. I recall the moment, standing on top of the hill and wondering why on earth I was catching breath. I was in excellent condition and that hill was peanuts. But I suppressed my thoughts and hiked on.

Fatigue, a general lack of energy and sleep disturbances have been documented in women with ovarian cancer as the body might fight the cancer. Also decreased appetite can exhaust the body.

Full of great memories, we arrived back in Oulu on the 7th of January. I still didn’t feel well. I figured I should find a way to see another doctor or get a second opinion at my occupational health centre soon. 

*

On the 10th of January I woke up with pain in my lower abdomen again. This time, I had a solution. “We should go to the emergency,” I said to my husband. “Let’s go,” I urged him.

We arrived around 9:30 at the hospital. After several tests and examinations the diagnosis fell around 16.00 that very same day. Sixteen days later, I received my first chemo treatment.

*

I don’t know what made me go to the emergency on the 10th. The complaints weren’t worse that day, but somehow, I’d understood things were not normal. Initially, I suspected salmonella, then a bowel infection and lastly, a lactose intolerance. Also, at that point my hope that my complaints would gradually disappear had vanished. Still, the diagnosis of ovarian cancer with metastasis in stomach and liver came totally unexpected. 

*

I know now that  many of the symptoms of ovarian cancer are non-specific, meaning that they can be symptoms of all kinds of health conditions. Don’t we all lack appetite or feel bloated or tired sometimes?

Also misleading, I felt full of energy that autumn. We had started renovating an old cottage and  drove up to the summerhouse in Lapland to clean and close for winter. That very same month I travelled to the Netherlands.  With my youngest I rocked at a Nightwish concert, I hiked and dined with friends. Hitherto there was physically nothing that made me think something wasn’t right. 

Still, the 6 cm primary tumor on the right Fallopian tube must have been there for weeks, months or maybe years already. 

*

Ovarian cancer symptoms can go undetected for a long time. I need to pay close attention and see my doctor immediately if I notice anything unusual.