DR. NAOMI BAUM.
(photo credit: Courtesy)
Of the world’s nearly two million women (and some men) diagnosed annually with breast cancer, apparently just one is a psychologist specializing in trauma therapy who decided to write a personal diary with professional advice while overcoming it.
Three years after beginning treatment and more than two after getting a clean bill of health, Dr. Naomi Baum of the Israel Center for the Treatment of Psychotrauma has published her 221-page, paperback account of the journey. The potential audience for Life Unexpected: A Trauma Psychologist Journeys Through Breast Cancer is large: patients with this and other types of malignancies; their families and friends; family physicians and oncologists, radiologists and surgeons; and ordinary people who will become more grateful for their lives after reading about Baum’s ordeal.
“There have been other personal memoirs about surviving breast cancer and others with facts about treatment, but I think I am the first who combined their personal experience with professional insight about coping emotionally, spiritually and physically,” Baum told The Jerusalem Post after the book’s publication in print and Kindle (ebook) form (www.naomibaum.com).
Although the psychologist from Cleveland (and before that Brooklyn, New York and other cities) has relatives in her extended family who had cancer, she was not at high risk for breast cancer. The 57-year-old resident of Efrat and her husband Mike have seven children and several grandchildren (years of breastfeeding reduce the risk) and is not a carrier of a BRCA mutation that greatly raises the risk. She also ate properly, became a vegetarian five years ago and exercised regularly.
She is also modern Orthodox – faith of any type as well as social support have been proven a positive factor for life expectancy. It was her husband Dr. Michael Baum – a physician at the private urgent-care clinic chain Terem and one of the original group that established it with the late Dr. David Applebaum – who broke the bad news, while she was consulting with psychologists in a Beduin town. She made excuses and quickly drove home in tears.
In June 2011, she had noticed swelling in a lymph node under her right arm, and the biopsy results showed she had a malignancy, with several lymph nodes affected.
When Mike read to Naomi from her medical file, she recalls, “I became extremely present and aware. I could feel every muscle and bone in my body. I can recall exactly where I sat, what the room looked like, what time of day it was and how quickly my heart was beating. Everything was in sharp relief, an almost out-of-body experience.” A “condensed version” of her life whizzed by her.
She quickly disposed of the “why question” on the reason for her being “chosen” to suffer from the disease. “I decided to try to let go of blame, guilt and shame, while holding on to the question of what I could learn from the experience.”
She decided to tell each of her seven children individually, due to the range of ages and personalities.
The last of them to hear was a son who had planned to go to summer camp; a delay she later regretted.
Then came other relatives, colleagues, friends and sometimes casual acquaintances.
SHE DECIDED from the outset not to hide her condition.
“I first updated the children and other relatives, then, when I got tired of repeating it, I decided to send to all the people who cared about me – between 100 and 150 people – uniform emails. Their responses were very kind, supportive and caring.”
These emails evolved into a diary or journal, which turned into the published volume.
“More than one person suggested that I write a book. I always liked to write. After nine months of treatment, my walking partner said: ‘After nine months, what have you given birth to,’ and I decided finally to write the book.”
Working on a shoestring budget and without publicity, she is pleased that 3,000 people have in recent months already downloaded the Kindle version.
The author ends most of the 18 chapters with scientific facts and personal tips to advise fellow travelers, such as keep a semblance of your daily routine, explore using guided imagery, ask your doctors as many questions as you want, find things you’re grateful for, be prepared for a lot of waiting and red tape; accept donations of food or help and try to enrich your spiritual life.
Her lists of tips include “How to talk with cancer patients.” She found some people who meant well were downright annoying, or worse.
Healthy people who heard of a cancer diagnosis always got nervous as they think it could happen to them, too. “Remember when you speak to the cancer patient [that] it is not their job to make you feel better or allay your fears. They have had enough of their own and don’t need yours,” Baum advises. Visitors and friends should not suggest that they got cancer because of bad habits they had or that a “positive attitude cures cancer.” This only triggers guilt.
Don’t tell the patient about people you know who had worse experiences, suffered much pain and died.
And don’t ask soon after treatment: “Are you cured?” Just stick around, be a friend, and let the patient know he or she is not forgotten, the author advises.
She states clearly that every individual who faces cancer is different and will have to make choices on how much information to demand from the doctors, how much information about the illness to seek on the Internet, what type of treatment to accept and whether to hide their condition or be open.
Baum turned over and over in her mind the choice of undergoing only a lumpectomy to remove the tumor and the 22 affected lymph glands (recommended by her oncologist at Shaare Zedek Medical Center) or a complete mastectomy (one side or even two) to “get it all over with!” But after consulting and thinking, she understood that a mastectomy would not protect her from a recurrence and that a lumpectomy (followed later by another one to remove more healthy tissue on the edges) was preferable.
“The smaller, less invasive surgery won out, and the die was cast. Lumpectomy it would be.”
Before being wheeled off to the operating room, she listened to guided imagery tapes. The operation went uneventfully. She didn’t feel much pain, but she did have a drain for fluids coming out of her side. Her daughter went across the street to bring her take-away sushi.
She was discharged less than 24 hours later.
But as some breast cancer patients suffer from lymphedema (a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, with tissues at risk of infection), Baum was obsessed by the possibility and became almost a hypochondriac about it. She did massage and exercises, and the complication never occurred.
During the weeks after surgery, she found herself unable to concentrate on reading books and instead spent many hours watching “mindless TV.”
As her cancer was not diagnosed at an early stage of lymph gland involvement, it was inevitable that she needed a 16-week course of chemotherapy at the outpatient oncology unit at Shaare Zedek, taking blood tests before, suffering from side effects and waiting for medical test results. Although it was grueling, the hospital nurses and doctors were supportive angels, she recalled.
Knowing that her hair would fall out, she bought a wig that resembled her own hairstyle, but she never wore it. Baum wore scarves or went without. Before the first chemo session, her eldest son cut her hair short so it wouldn’t come out in clumps on the pillow. A daughter asked to have a matching haircut.
Some of her sons shaved their heads as well. Then they all had a barbecue in the garden.
Baum wrote a pre-chemo prayer to inspire her (a copy is on her website) and bared her arm for the needles.
She compared notes with compatriots in the clinic during the infusion process. The first few days after treatment were unpleasant, and in the week sandwiched between the sessions, she went back to work part time at the trauma center and took time out for pleasant outings with her husband. Having trouble sleeping, she tried sleeping pills, which helped. She also turned to complementary treatments like acupuncture, shiatsu, massage, guided imagery and others, and felt better after some of them.
“I want to take on a complete healing. I want to lick this damn cancer so hard that it doesn’t even think of coming back,” she wrote to relatives and friends. Forced to eat on Yom Kippur instead of fasting, she devoted herself to prayer and introspection.
BAUM DEVOTES a whole chapter to radiation, which was ordered by her doctor. It is offered in Jerusalem only at Hadassah University Medical Center in Ein Kerem, and, she wrote, turned out to be the worst of all the treatments.
“The big challenge is the waiting. The way it works is that you come in and sign up, and then wait. It’s not clear to me why they don’t give you a set appointment. This is kind of like the old-style medicine that was typical forty years ago, when we first moved to Israel,” she wrote of the experience.
During the whole process, staffers were very professional but “with little warmth or caring. I missed the warm, supportive atmosphere that I had experienced in the day treatment center where I had received my chemo. What could have been a relatively minor interlude in my life was turning into an unpleasant experience.” Since the department was managed in such a haphazard fashion, she said, it was impossible to spend as little time at the Hadassah clinic as possible.
Since then, Baum has been healthy, with no recurrent cancer.
She did a 30-kilometer charity bike ride a this month, switched to freelancing at the psychotrauma center instead of working full time and is spending more time with her family.
“I have written a new ebook on overcoming one’s fears about cancer and am beginning another one on mindful aging.”
ONE OF the people the author acknowledges at the end of the book is Dr. Karen Djemal, a veteran and award-winning family doctor who is an old friend and served as her personal physician at the Terem clinic in Jerusalem’s Gdud Ha’ivri Street.
“I felt I was part of Naomi’s journey,” Djemal told the Post in an interview after she read the book. “I have had close to 100 patients who contracted breast cancer – including two men who have I now. I feel like an extension of the families. The personal physician should be a bridge to the system and explain options. Naomi’s case was typical.”
There is an 80 percent recovery rate today from breast cancer partly because of better medical technologies and medications but also “because we are very careful,” said Djemal. “We doctors investigate and remove a lot of early lesions that could remain dormant for years or could otherwise be fatal.”
Her patients’ experience also praised Shaare Zedek’s oncology department and criticized Hadassah’s radiation department.
“I know people who go there at 5:30 a.m. to find a parking space and get in the queue early for radiation. The department has to be expanded or another center should be opened in the city. And the radiation department’s staff have to show a better attitude to patients rather than putting them on an assembly line. Patients will feel better about themselves,” Djemal suggested.
Although Baum embraced some complementary techniques, Djemal said this issue is “very tricky. Nothing has been proven. Naomi gained from it, but it can easily be the placebo effect. Non-conventional practitioners are generally much better and time for giving emotional support. With the way medicine is sometimes practiced in this country, complementary medicine may give patients more a feeling of control than conventional medicine. Many people waste a lot of money. It’s good if it makes one feel better, but it has to be balanced. Some people go on an extreme ketogenic diet, which can starve them and not only the tumor.”
Instead, they need a holistic approach of eating well, exercising, taking supplements and feeling good. Djemal concluded that “this book is definitely a contribution. It empowers patients and their families. They will understand what happens before they have to go through it.”