The courage to live with radical uncertainty

What's the worst that can happen?

Almost exactly 10 years ago,

I was sitting in an exam room
that was way too cold

waiting to meet my new oncologist.

I was terrified.

Even though my partner at the time

was sitting right by my side,

I felt completely alone.

I had just been diagnosed
with breast cancer,

and it seemed at the time

that a single bright spot
on a scan of my right lung

meant that the cancer had already spread.

I had metastatic breast cancer.

I had no medical training at this point,

but I knew what it meant if it were true:

incurable breast cancer.

Terminal breast cancer.

I was 27 years old,

had just been accepted to medical school,

and I wondered if I was already
at the end of my life.

My new oncologist was not a warm person.

She dealt in simple facts,

as many brilliant physicians do.

"Our body is made up
of cells," she started.

I stopped her.

"I'm starting medical school soon.

I know."

Instead of taking this as a signal
to go backward, to start again,

she went forward.

She said that I would need
to start on chemotherapy

to control the cancer.

She launched into the details
of the drug and the side effects

and the schedule.

I reminded her that we hadn't even yet
biopsied the bright spot on my lung,

and I asked if she was sure
that it was cancer.

I remember viscerally how she seemed
almost frustrated with my question.

Perhaps she thought I wasn't
following along with her explanations,

or, worse still, I was in denial.

I simply wanted her to understand
that, as her patient,

the biopsy was not just a mere formality
to prove an already foregone conclusion.

It was a steel needle
through skin, muscle and bone

that would deliver a deep piece of me
to the surface and answer a question

I wish didn't have to be asked.

Before the biopsy, I could be
a 27-year old woman

who might have metastatic breast cancer,

who probably had metastatic breast cancer.

This is a critical distinction,

but it's not one that's emphasized
in the most elite oncology training.

Instead, I was dismissed
with an appointment to start treatment

in just a few weeks.

So much has happened
since that first visit.

Ironically, the biopsy was not
just a mere formality.

My former oncologist was right.

It did show cancer,

but it was a totally separate lung cancer,

and as crazy as it sounds,

this was great news.

I did not have metastatic breast cancer,

I had two different cancers,

but both of them were localized,

and so the lung cancer
was localized enough

that it could be removed.

And so the onslaught of treatments began
with a lung surgery,

continued with chemotherapy,

and ended with a breast surgery
just after my 28th birthday.

And then two weeks later,

I started medical school.

My new oncologist,

who deals much more fluidly
both with facts and their implications,

very reasonably suggested

that I should defer my acceptance
to medical school for a year,

take some time to rest, to recover,

and I trusted her advice.

I felt terrible during the intensive
chemotherapy sessions.

And so I wrote to the Dean.

I explained my circumstances,

and a deferral was speedily granted.

But as the chemo fog lifted,

I wondered what I was going
to do with a year.

Should I go to the beach?

I wasn't really a beach person.

(Laughter)

And how many years did I have left anyway?

I really wanted to go to medical school.

It seemed like a missing
piece of my puzzle.

So instead of going around
and around with indecision,

I asked myself, what's the worst
that could happen?

Well, I could be too weak
or too sick to do the work.

It could be too hard for me emotionally.

I could fail out of medical school.

But then I remembered, that wouldn't be
the worst thing that happened to me

even that year.

So why not get started?

Why not continue living
the way that I wanted to live?

So I did.

Bald and rail thin,

I put on my best earrings
and my favorite dress,

and I started.

I pretended to belong,

and I began to.

There is no way to describe
how hard it was.

Some days it felt impossible.

It felt as I was doing things
that would never matter in the future.

But every day, I asked myself,
are you still enjoying this?

Is this still what you want to be doing?

And every day, the answer was yes,

sometimes a very qualified yes,

but a yes.

And then, just as I
was getting comfortable

and feeling like I might not necessarily
fail out of medical school,

I received even more devastating news.

I learned that I had a mutation
in a gene called TP53, or P53 for short.