Wednesday, March 30, 2011

Winning? By Whose Playbook?

Nancy Brinker, CEO and founder of one of the largest breast cancer fundraising organizations, resplendent in a pink pantsuit, recently addressed a crowd of 1000-strong at the Susan G. Komen for the Cure Affiliate Leadership Conference in Fort Worth Texas.  As reported by the Star-Telegram;
Brinker said that during her travels she is most often asked whether the war on breast cancer is being won.
"You bet we're winning," she said. "The five-year survival rate has increased from 74 percent in the 1980s to 98 percent today."
Firstly, I have addressed this often quoted "98 percent" statistic in a previous post, so I'll say no more about it, except that I believe it's a misleading, erroneous, arrogant and dangerous position to take, by the self-styled global leader of the breast cancer movement.  (Click here to read my views on this statistic).

Nope the real clincher for me today is the statement, "You bet we're winning".  Really?  By whose playbook?

It sure didn't feel like I was "winning" when my dinner-and-a-movie-Friday night turned into a nightmare of epic proportions, starting with me being wheeled to the emergency room on Friday afternoon following a big-time fail on a heart test.

Everything happened very quickly, but during my couple of hours in the ER, I was seen by at least five doctors, and the decision was made to operate on me that evening.  By 6pm I was kissing my beloved goodbye, trying to shout instructions about what to do with my body if I didn't come through the operation, and being wheeled into the operating room, having received an emergency slot at the expense of some other poor soul who was bumped to accommodate me.

To cut a long story short, it turns out that I was walking around most of last week with a ticking time bomb inside of me.  My heart had filled up with fluid and I had some breathing difficulties as well as some other uncomfortable symptoms.  In medical parlance this is known as a Pericardial Effusion.  It's a serious situation and if left untreated can cause heart failure and death.  To put some perspective as to how bad my situation had become my surgeon put it like this.  The normal heart sac holds about 30cc of fluid before it's "full".  My heart sac had 1000cc of fluid by the time I got to the operating table.

How did it get this bad you ask before we caught it?  I'd been having some symptoms like fatigue, stomach ache, feeling a bit full, and a bit short of breath.  But of course I never connected the dots, thinking it was all just the usual cornucopia of mystery side-effects from chemo, and since my blood pressure never dropped I guess everybody else missed the seriousness of the situation until I showed up for the echocardiogram on the Friday.

I really like Diagram B.
So in order to treat me, the surgeon went in around my sternum, cut a small window (or a Pericardial Window) in my heart sac, and then inserted a drain, drained off the 1000cc of fluid, and the drain was left protuding out of my chest to let remaining fluid drain into a plastic box that was left at the foot of my bed.  I spent the night in the Intensive Care Unit hooked up to every beeping machine ever invented.  Late Saturday afternoon I turned a corner and I was taken off the machines, untethered from the IV's and sent to the general oncology ward to continue my recuperation.  My stay in hospital was dependent on when the fluid stopped flowing, and the drain could be removed from my chest.  And of course that I could walk further than 6 feet without feeling like I was about to be taken by the Great Pink Spirit in the Sky.

Why did this happen?  I'm not yet willing to speculate publicly on the causes of this particular nightmare as I'm still waiting on the pathology report.  However I think it's fairly likely that this is cancer-related in some way.  How sinister is yet to be determined.

My point in relating this story is two-fold.  One I'm talking about it, so I guess I'm dealing with it.  But two, this IS cancer.  It's sneaky.  Just when you get comfortable and think you know where you're headed, something like this appears out of nowhere and shakes you to the core, making you forget everything you thought you knew about your particular cancer beast.  One minute you're thinking "I can do this", "I'll get through this", to all of a sudden "Shit I really might die, and maybe sooner than I think".  That's cancer.  It's cruel.  Plain and simple.

And for Nancy Brinker to stand up on a stage and proselytize to her deluded evangelicals that "You bet we're winning" seems to me to me to be at best, an extreme error in judgement and at worst,  self-serving and just plain cruel.

It's time Ms Brinker walked an oncology ward.  Read a few blogs (The Assertive Cancer Patient, Ashley: Warrior Mom, Dancing with Cancer, Living with Cancer (now deceased) etc). Talk to the organizers of the Metastatic Breast Cancer Network and Metavivor.  Talk to the members of the cancer community living with metastatic disease.  Talk to the members who, although show no evidence of disease right now, fear recurrence at any point.  Talk to the spouses, partners, families and friends who are the caregivers, the bereaved.  Talk to the medical community who are in the trenches everyday trying to save their patients with the best medical science has to offer.

Who of these people would so flippantly say "You bet we're winning"?

Playing the Breast Cancer Game: Winners vs Losers

Wednesday, March 23, 2011

What Do You Want?

I feel like someone has removed my brain, stomped on it and reinserted it into my head.  So might you if you've been following the debates raging on Facebook and the breast cancer blogosphere over the last week or so.  From critically analyzing the societal worth of campaigns like  "I <3 Boobies" and "Feel Your Boobies", to a blog post improbably titled, Breast Cancer: Let’s Fight The Disease – Not Each Other, which actually seemed to tacitly disparage the National Breast Cancer Coalition's mission to stop breast cancer by 2020, and then ironically erupted into a war of words in the comments section; I feel exhausted yet also emboldened and motivated.  

On one hand it was disheartening to see the blatant ignorance that still exists in considering the breast cancer culture, and indeed the censorship that went on with one incident when confronted with breast cancer truth.  But on the other hand, I saw spirited discussion, energy for new ideas and deep questioning of the breast cancer status quo which gives me hope that change might be coming to the breast cancer movement.

But there's one point on which I am still very confused.

CBS News recently ran a story called "Breast cancer mommy; Brave, beautiful.....and bald". Essentially it was a fluffy little piece about cancer patients losing their hair, and how they can "rock their baldness" and still be "brave" and "beautiful".  Yep heard all this before. I get it.  Hair doesn't define you.  Hair loss shouldn't affect your self worth.  Cancer can't take away the essence of you; yada, yada, yada.

Then I read the author's biography, and I felt my blood pressure beginning to rise to something past a slow simmer;
"Meredith Israel, 37, was diagnosed with stage 4 metastatic breast cancer in June, 2009. She says she's in the fight of her life, determined to prevail for the sake of her family, including her 3-year-old daughter, Niomi, and her husband, Gary. Meredith found her breast cancer through self-examination and a mammogram. Since being diagnosed, she has raised more than $100,000 for breast cancer research and has been a vocal proponent of self-exams and early detection."
Now don't me wrong.  My heart aches for this woman.  I understand only too well the devastation of a Stage IV cancer diagnosis and to throw children into the mix as well?  Well, it goes without saying that cancer is never a good news story.

According to the story, Ms Israel "has raised more than $100,000 for breast cancer research and has been a vocal proponent of self-exams and early detection."  Now I really hope this story was reported correctly and the $100,000 really did go to research, and if that's the case then I applaud Ms Israel for her efforts.  It's a wonderful achievement.

Then  my mind started working overtime.  I wanted to know what kind of research?  The kind that could possibly result in treatments or yield findings that could potentially help Ms Israel with her prognosis?   Or did the money go to research that, although might eventually be helpful to others, won't help further knowledge about metastatic breast cancer?    Then I wondered why would someone with metastatic cancer openly advertise themselves as a proponent of breast self-exam and early detection?  Neither causes are scientifically proven to offer any guarantees as either reliable methods of screening, nor indicators of whether a person will go on to develop metastatic disease.  Further, neither of these causes have really been shown to impact mortality rates from breast cancer, which remain barely unchanged in decades.

It is at this point I should clarify where I'm going with all this.

Many of the breast cancer fundraising campaigns we see today are invariably founded, or have  involvement at some level, by breast cancer survivors.  The "I <3 Boobies" and "Feel Your Boobies" campaigns are good examples, and indeed Susan G. Komen for the Cure's founder, Nancy Brinker is a breast cancer survivor as I'm sure are many of the staff and volunteers.

But here's what I don't get.  I have Stage IV breast cancer.  It's a bad situation.  Right now I'm focused o n trying to get the best treatments and give myself some sort of a fighting chance (whatever that means).  I'm well aware that in order to truly survive this disease I need some sort of a miracle.  One that might, just might, come out of a research laboratory.  But it's going to take time, money and focus by all relevant stakeholders.   I've also come to realize that getting research funding to focus on metastatic cancer is a pretty tall order.  It's not a popular mission for myriad reasons, and it's a fight to steer money in this direction.  So what can I do?  I can donate.  I can tell my friends and family to donate.  And I can use this blog to speak out on the topic and try to get people to think more deeply about this issue.

It all comes down to the fact, that I want something better for myself.  There I said it.  Selfish me.  Wanting to live a long life as well.  Wanting to live the dream of the victorious cancer survivor.

And yet, still we throw money at fundraising campaigns whose main priorities are breast cancer education, awareness and so-called early detection programs.  Research is treated like the ugly step-sister and invariably gets pushed down in the priority spectrum, or just not even funded at all, in favor of the glitz, sass, sexiness and glamor of more cutesy breast cancer "awareness".  How much more awareness do we possibly need?  We're stuck in a rut that's not moving the fight forward to end this disease.  We're just screening and diagnosing and feeding the cancer machine, with not enough thought as to how we can stop the machine and how we can help the people stuck inside it.

Well, I'm sick of it.  Where's the anger people?  Why don't we want something better for ourselves?  Why not be advocates for research that might actually help those of us currently dealing with this disease AND those still to be diagnosed? What's wrong with being selfish?  It's our lives we're talking about here.

And for those selfless people who continue to work so tirelessly to fund raise for these awareness campaigns; I thank you for your efforts, but I implore you to ask yourselves who all this awareness is helping. Consider the questions raised by Gayle Sulik where she asks "What Good Is Awareness If...."  

We're stuck in a dangerous rut that values breast cancer awareness and early detection as some kind of holy grail never to be criticized.  Awareness and early detection will not make any difference to my life or my outcome, nor the thousands of others dealing with this disease and the 40,000 women or so statistically slated to die from breast cancer this year alone.  Sure, awareness and early detection campaigns might help get someone diagnosed, but then what?  Successful treatment? Maybe, maybe not.  The bottom line is this.  Science still can't tell us who's going to draw the short straw.  It could happen to anyone at anytime.  Regardless of early detection, breast-self exams and no matter how much more money we throw at breast cancer awareness.

We can and should be doing better.

Awareness DOES NOT EQUAL Breast Cancer Cure.

Ask yourself, if you were me, what would you want?

Wednesday, March 16, 2011

Komen By The Numbers: 2010 And Still No Answers

Stewardship: the conducting, supervising, or managing of something; especially : the careful and responsible management of something entrusted to one's care.

In September 2010, Susan G. Komen for the Cure® ("Komen"), proudly announced they had received a four-star rating from Charity Navigator, a popular charity evaluator whose reports are accessible by the general public.
“Achieving Charity Navigator’s highest rating for fiscal soundness is an incredible achievement for even one year during these economic times,” said Ambassador Nancy G. Brinker, Komen’s founder and CEO. “But to garner this rating four consecutive years is a true testament to the hard work of our entire Susan G. Komen for the Cure family. My gratitude also goes out to our Affiliates, our volunteers and our staff, who have proven once again to be responsible stewards of our contributors’ money as everyone continues to try to fulfill our promise of saving lives and ending breast cancer forever.” 

Essentially, Charity Navigator  evaluates charities based on their "organization efficiency" and their "organizational capacity",  which speaks to how sustainable an organization is. Charity Navigator then uses the results of this evaluation to assign rating stars;  zero stars being the lowest  to four stars being the highest. A four-star or "exceptional" rating means that a charity "exceeds industry standards and outperforms most charities in its Cause".  In the words of Charity Navigator;
"By utilizing our ratings, givers can truly know how a charity's financial health compares with other charities throughout the country. Givers can be confident that in supporting those charities rated highly by Charity Navigator, they will be supporting organizations that are fiscally responsible and financially healthy."
This all sounds very nice, but what does all this really mean?

In the case of Komen, the award of a four-star rating tells us that it is a highly-rated fiscally responsible and financially responsible organization. Not whether it lives up to its mission, aligns its programs and allocates funds to its mission, buries overhead within program budgets, uses evidence-based practices, etc. In essence, the ratings say nothing about how effective Komen has been in fulfilling its mission of "saving lives and ending breast cancer forever". These are fair questions and should be part of any independent evaluation. To say that an organization is "efficient" and has "capacity" says absolutely nothing about whether an organization is doing right by its donors, nor the cause(s) it purports to aid. And it should.  Although, if one bothers to read the methodology  statements on Charity Navigator's website, it states that a "..limitation to our ratings is that we do not currently evaluate the quality of the programs and services a charity provides." This seems like a pretty important omission in the ratings system to me.

Indeed, it was recently reported by Information Today, Inc. that Charity Navigator is adjusting its ratings to respond to such limitations;
"In 2011, it plans on incorporating criteria that analyze the charity’s effectiveness. Charity Navigator CEO Ken Berger said it’s responding to its audience since 85 percent of its users surveyed “thought knowing something about a charity’s effectiveness was important.” 
But Charity Navigator doesn’t have the resources to hire staff to review 5,500 charities and therefore must find cost-effective ways to evaluate them. It will train an “army of volunteers and graduate students” to evaluate charity’s effectiveness, says CEO Berger. Its new rating system will be based 33% on financial health, 17% on accountability, and 50% on results, though it hasn’t made it clear how it will judge results."
So how "effective" is Komen?  Given that breast cancer remains incurable;  breast cancer mortality rates have remain unchanged in decades;  early detection does not guarantee that anyone will avoid metastasis at any point after diagnosis; available treatments are of questionable efficacy; acceptable screening methods and their effectiveness are still being debated; and awareness and education programs have yet to prove that anyone can escape diagnosis in the first place, Komen's "effectiveness" rating in my book would be not very.

But will Charity Navigator concur when they update Komen's ratings under their new evaluation system? What will their indicators of an organization's "effectiveness" consist of? Perhaps effectiveness criteria* for a non-profit like Komen might include;

  • how successful an organization has been in accomplishing its stated mission;
  • how efficiently it raises and invests funds, and how it then uses those funds;
  • whether the organization is a source of satisfaction for its founders, employees, volunteers, sponsors, donors, other stakeholders and society as a whole;
  • how adaptive the organization is to new opportunities, information and challenges;
  • how capable the organization is of developing and evolving in the face of change;
  • how capable the organization is of surviving in a world of uncertainty
(*Criteria adapted from an Indiana University Northwest educational resource)

In judging "effectiveness" close attention should be paid to an organization's financials, to see how it's spending ties with it's mission.  In previous instalments of this series (Komen By The Numbers, The Context of Research, and Education In Focus) I have analyzed Komen's financial statements to make my own judgements about how "effective" Komen has been in spending it's precious resources.

Komen recently released audited financial statements for the financial year ended March 31, 2010, and today I continue my evaluation of how Komen's spends it's donors funds.

The first chart summarizes how Komen spent the $389.3M it received in Total Public Support and Other Revenue ("revenue").  As in previous years, Education received the highest allocation of $140.8M or 37% of revenue; Research $75.4M / 19%; Screening $46.8M / 12%; Treatment $20.1M / 5%; Race for the Cure and Other Fundraising Expenses were $36.1M / 9%.  The remainder was spent on Affiliate Relationsand Other Administrative Expenses of $40.6M / 10% and increase to Assets of $29.3M / 8%.

The second chart, compares the results of 2010 in total dollars to all prior years for which financial statements are available from Komen's website.

Once again I have to question the level of Komen's investment in it's Research program.  In 2009 the Research program received $70.1M or 21% of total revenue, and in 2010 it received $75.4M which, although a slight increase in terms of dollars, only represents 19% of total revenue.

As this third chart shows, relative to dollars earned, allocations to the Research program (purple line) seem to be on a definite downward trend, whilst the other programs remain fairly flat, and Administrative Expenses (orange line) seem to be on the increase.

Analyzing further the financials for Komen's Research program, I find that from the $75.4M allocated to the Research program, that only $62.7M was spent on actual research awards and grants with the remaining $12.7M spent on Professional Fees expense of $6.3M; Salaries and Benefits of $2.8M; and other Operating expenses of $3.6M.

To recap; although the Research program was allocated 19% of total revenue only 16%  of total revenue was used to fund actual research!  And why the need to spend $6.3M on Professional Fees expense, which is generally fees like accounting, legal, public relations, financial management etc.?  16% to Research is significantly less than the 25% Komen repeatedly claims is used to fund research.  And the annual Research program allocation percentage, when compared to total revenue, keeps decreasing!

These types of line-item expenses buried within all of Komen's Program allocations are not captured in detail in the high-level "Program Expenses" as reported by Charity Navigator.  Although it is feasible that charities do incur expenses directly attributable to their Programs, and are correctly reported under each Program budget allocation, Charity Navigator's ratings make no judgements as to whether such expenses buried within the Program Allocations, are in fact reasonable.  If all Administrative Expenses and Changes to Assets were tabulated, regardless of the Program budget to which they related to,  for 2010 actual awards and grants across the Research, Education, Screening and Treatment Programs accounted for 40% or $156M of total revenue of $389M. The remaining 60% of revenue or $233M was spent on Administrative Expenses (about 18% for General Overhead and Increases to Assets, and about 42% attributable to Program Expenses).  Again I ask, is this reasonable?  What do we have to compare to?

Perhaps this is another criteria for Charity Navigator to consider when establishing their new ratings system.  How do the level of administrative expenses buried within Komen's Program allocations compare to other similar charities? How much does it cost to run a Research Program?  An Education Program?  How much is Komen doing in-house? How much are they out-sourcing?  Until we understand the answers to these and other questions, a four-star rating doesn't mean much in my opinion.

How can Komen continue to justify it's position on Research and honestly think that it's living up to it's mission of "saving lives and ending breast cancer forever”? From its financials, its mission seems to shout Education.  Not curing breast cancer. Are Komen really being "responsible stewards" of their contributors money? Has Komen been "effective" in the way it has spent the estimated $2Billion it has raised since 1982?  NO.

Wednesday, March 9, 2011

How To Change The Conversation

Recently, there's been a lot of talk on this blog and others, about "changing the conversation" in the way that we, as a society, think about breast cancer and the culture surrounding it.  

What's becoming clearer to me, as I delve deeper into the vast online breast cancer community, is that there is a growing feeling, and what can best be termed as a movement to demand a refocus of existing priorities within the breast cancer fundraising world, and for certain breast cancer organizations to recalibrate their messaging about the disease itself.  There's growing support for the notion that it's time to start telling the truth about breast cancer, and move away from the pink ribbons and the pretty pink feel-good breast cancer experiences that seem to have become the norm, when portrayed to the general public.   

When I have discussed pink culture and breast cancer fundraising on this blog I often receive comments from people who are demonstrably incensed and want to know how our demands for change can translate into meaningful and tangible action.  Here's a small sample;

I'm beyond angry. Your work has opened my eyes even more. What do we need to do to make a change? and make a difference. This is so frustrating! Keep up the great work.

I'm offended by the Race ad. What the f? Why are they making it seem like something women should aspire to? It's cancer! The ad should have the other photo. That's what we're fighting for. I'm sorry, you didn't hear any answers worth your time. I'm sorry Komen continues to miss the boat on research dollar allocation. What's it going to take?

Unbelievable! I'd not heard of this pink town thing. I just feel deeply weary about this.... it doesn't change anything. Awareness? Tell me who doesn't know about breast cancer?

Your snark is delicious. This campaign? Not so much. Absolutely revolting. What fund will the donations benefit? Who's supervising? What a waste of time, energy, and altruism. Keep complaining; I'm with you.

Thank you for sharing these other voices. I applaud these women for taking a stand. I don't mind the "pink stuff." I just want MORE. When the "pink stuff" gets in the way of MORE, than I DO NOT like it and it seems that is what's happening of late. "Money talks" as they say, that's why I'm trying to encourage people to ask where their donated dollars are going in my post today on this same topic. It is time to change the conversation, move beyond the "pink stuff," demand more research and get more done on the goal of eradicating breast cancer.

[W]e need to do something to call attention to our problem (breasts chopped off, horrible drugs, intense pain, you name it). The best way is do that is get traction in the actual media. We need to forward stories about this to the health reporters at regular and/or cable news networks, magazines, newspapers and Internet sites including to the reporter above. Komen does this so to why not beat them at their game. If there is walk in your town, send an announcement to the news stations that your friends are sponsoring a stay at home and sending money to a better organization. Does anyone have media contacts? Do your friends? Spread the word. What about your doctor? My doctor resigned from the local American Cancer Society board. Can't we all do some lobbying with the medical personnel that we come in contact with. We also need to start asking rude questions like why isn't there more met research. What are they doing to push that forward effort forward. Did they report you to NHI? Why don't they sponsor local trials? The unions in Wisconsin know that a good media shot is protesters beseeching the capital (truth in writing if they don't win, we all might as well ship everything to China). It is worth a lot of publicity. Where is Komen located? What if we had people picketing in front of their offices with signs that say, "Stage IV BC Where's My Cure?" The same goes for Congress. The Breast Cancer Coalition collects funds to lobby Congress. They're too polite. Wouldn't it be better for their local affiliates to request appointments back to back with their local politician on their home turf. I'd say picket but most these offices have security that won't allow it. Something a lot easier is to start is a Facebook campaign and pass that along to everyone to get people to post or like. Has anyone thought doing a Twitter campaign where everyone starts Twittering at the same time on the same topic like, "Not Pink."If we start trending on regular basis we could really pique the media's interest. Sorry about this. I am sick of swapping notes on treatments. I don't want to fade out without a damn thing to show for the screwing that I have gotten (and not in a literal sense).....

Today, Gayle Sulik, author of Pink Ribbon Blues has published a "Tools for Action"; a comprehensive list of ideas of how we can go about "changing the conversation" in our everyday lives.  I encourage everybody to take a few minutes to read this list, think about what you can do, add your own ideas, and share it with your own communities.  These actionable items are the kinds of grassroots efforts that can lead to a major sea change  and compliments the advocacy work of organizations like the National Breast Cancer Coalition and Breast Cancer Action.

Come on.  We can make a difference, each and every one of us.

Saturday, March 5, 2011

Cancer Rebels Rule!

Good afternoon readers!  Well you may have noticed that I've been MIA for the last week or so.  The truth is my new chemotherapy regimen left me feeling like I was run-over by a pink cement truck and then backed over by a pink tractor just for good measure. 

It seems my white blood cell counts dropped precariously low which explains why I felt like pink roadkill this last couple of weeks.  As a result, I didn't get chemo this week which I thought was going to mean good news for my worn-out self, but then DrWW had to go and give me the white blood cell booster shoot.  "Oh don't worry there shouldn't be any side-effects; just a bit of bone ache and maybe some muscle weariness".  Really?  Well turns out I had quite a "rare-what's-new" reaction to the booster, and I spent a couple of days writhing in agony with the worst back pain I have ever encountered in my life.  Finally in the wee hours of Friday morning I remembered the little bottle of street valuable painkillers that I had stashed away in the back of the medicine cabinet walk-in closet, and was finally able to put an end to the misery.

After that very long-winded introduction I'm pleased to say that I'm almost feeling human again.  Another week off from chemo, and then we'll do it all over again.  I really can't wait !

So today I thought I would ease myself back into the blogosphere with a quick little post.

Yesterday Chemobabe and I happened to find ourselves on Twitter at the same time.  And by serendipity we also found ourselves in the same snarky frame of mind.  We started to amuse ourselves by Direct Messaging our favorite cancer rebel fantasies.  Unable to contain the hilarity to just ourselves we decided it would be a grand idea to see if we could get the topic to trend on Twitter.  To the Twitter Luddites amongst you, let's just say that if you can get a topic to trend on Twitter, this means you earn huge street cred with all the other Twitter nerds that you virtually hang out with. 

So we created a Twitter stream called #cancerrebel and asked people to tweet in their cancer rebel fantasies.

Here were some of my favorites (okay some of them were mine):

  • Bring a bottle of jack with you to your infusion. tell the nurses it helps you "take the edge off
  •  Whenever you use the word 'cancer' swear ... a lot
  •  When you go to chemo make the nurse chase you around the room before they can hook you up. Sing na na na na!!!  
  • Call up your insurance company and ask to go through every benefits statement line by line, then at end say " oh never mind"
  • Next time someone asks if you are "all better now," look them dead in the eye and say, "no. it was cancer, not the flu." 
  • Be a page three mastectomy model, no-one would be expecting that when they opened the newspaper
  •  When they phone you, put your doctor's office on hold with cloying music and cheesy voiceovers.
  •  Next time someone says "you look great" smile sweetly and say "thanks cancer has done wonders for my life"
  •  Explain to your friends that your "medical marijuana" is important for your ongoing recovery.
  •  Mine is emptying all the pink ribbon donation boxes at grocery checkouts & saying thanks, you shouldn't have.  
  •  Telling the nurse to go find her own vein after trying for the third time to find a good one 
  • When someone asks if there's anything they can do for you, put them to work cleaning out your gutters. 

Now this is the kind of cathartic cancer therapy I need !

So what's your cancer rebel fantasy?