It was a terrible, horrible, no good, very bad year, but I will be A-O-K

This is a litany of only the main events but you'll get an idea of how hard it was, at times, to get out of bed and put on my game face.

A mentsh tracht und Gott lacht. A person plans and God laughs.

Quoted in A Review of Emanuel Derman's New Book: Models.Behaving.Badly. Francine McKenna, Forbes, Nov 14, 2011.

It was still 2022 when I noticed the lump, the size of a ping pong ball, in my right breast, mostly under my arm. My sister and her family were coming to Philadelphia to spend the Thanksgiving holiday with me, since I was now teaching full-time for Wharton, the core financial accounting course for MBAs, and my class schedule did not permit a visit home to Chicago until Christmas.

I had moved in May 2022 for the new job. I backed up the moving truck to the storage locker we had dumped the contents of my Washington D.C. apartment into when I went to my sister's rural Michigan cottage on a lake and sent the same moving guys to Philadelphia. I had brought only a few suitcases of clothes and some books to Michigan but it turned out to be an extended stay in the woods for the worst of the pandemic. I was close enough to family in an emergency but far enough away to maintain some solitude. My excuse for staying away was the need to stay healthy enough to continue to teach international business to American University MBAs remotely and grow this newsletter enough to support myself after leaving MarketWatch in October 2019.

I put the lump out of my head over Thanksgiving 2022 and then made an appointment with a new primary care physician in early December. Our short appointment was enough to establish there was something possibly serious to address as soon as my Wharton class was over, final exams given and graded, the final class grades posted, and the Christmas holidays in Chicago were over.

I would not be back in Philadelphia until early January 2023 because I was going to Hawaii, for the first time, to present our academic paper on the PCAOB. My sister was coming with me and we were looking forward to some sun and sea. So I did not say anything to her about the lump.

Talking about accounting research using the GE case

February 2023 was full of doctor appointments — first a mammogram, then a biopsy, a breast ultrasound, and inevitably it seemed the oncologist. I also endured a series of MRIs and scans to make sure the cancer had not spread anywhere else at this point. Spring classes had started and I was teaching three sections, back to back with no lunch, twice a week Mondays and Wednesdays.

All I wanted to know from the doctors was how bad was it, what the treatment process would be, how sick would I feel, and could I continue teaching. Once I knew there was no genetic marker and no sign of spread a treatment plan was established. I'd do six chemotherapy treatments, once every three weeks, on Thursdays so I had the weekend to recover before teaching again Monday. Surgery would follow a few weeks after my last infusion in early July, and then a series of radiation treatments to lock in what was hoped to be a "complete response" to treatment.

I ordered a case of high protein smoothies and granola bars and braced for the worst while hoping for the best. It was at that point that I finally told my sister and four brothers. I wanted to have the answers before I worried them and knew I would be unlikely to be able to travel to Chicago for Easter, or probably for the entire summer, once the treatments started. As the oldest of the six of us, I wanted them to understand why my support for the increasingly difficult care situation for my 92-year-old mother would have to be phone only for a while.  

I started chemotherapy at Univ. of Pennsylvania Hospital a mile from my apartment in early March — an all-day infusion of six sequential drugs, so powerful I was assured they would make me horribly sick and cause my hair to fall out. A routine was established. I was never so glad I had selected a full-service building in downtown Center City, a 10 minute bus ride from campus and a 20 minute walk to the hospital.  

By this time my sister and a group of close friends had insisted I establish a group text to coordinate support. The two young women in my building who walked my dog Hailey were part of this team — one of them a pre-med student — since they would see me every day and were willing to help if needed. My sister came to be with me when I had a port/catheter implanted in my chest to ease the burden on my veins given all the IVs for infusions, blood draws, and other tests.

They all took turns sitting with me at the chemo sessions. My hair did fall out and I was steered into buying a very expensive wig that the insurance did not pay for but which did count against my annual out-of-pocket. I wore it twice. Thank goodness I did not fall for the cold pack hair preserving treatment pitch. Even the nurses said it is a racket. All I had to see were the numerous disclaimers on the website in the assessment questionnaires, "How well do you handle disappointment?' ten different ways. Paying thousands for a process that was not covered by insurance and that added hours to the infusion process was not for me. 

Despite the enormous power of the drugs I was given — the lump was imperceptible after the third treatment — I never really felt sick. I started to feel guilty for all the time and support everyone was giving me.

I never missed a class, although the students who were office hours regulars noticed the scarves and baseball caps I started wearing with a mini hairpiece in April. I had to sit on a tall chair for some of the lectures because I would get winded but otherwise I thought I was keeping up. Our final exam was April 24. Later that week I traveled to Austin for the Consensus Conference sponsored by CoinDesk and then posted grades the first week of May.

I wore the wig at Consensus and that was a mistake. It was so hot and it kept sliding off. But that was nothing compared to the idiocy of two of the Big 4 firms related to my assignment to lead a panel regarding crypto and auditors. You can read more about that here if you are a paid subscriber.

It's times like that you may be tempted to pull the cancer card, to call people and tell them life is too short to be idiots, and that maybe they could be kinder and more compassionate. Instead, I was grateful to my friend Marc Hochstein who told the Deloitte and EY executives to go jump in the lake and supported me. I bit my lip which, like the rest of my skin and nails was parched and cracking, and forged ahead with a bigger and better panel that was well received.

When I returned from Austin I still had three more chemotherapy treatments to go before surgery. If all continued to go well, it would barely be a lumpectomy, since apparently nothing of the tumor remained.

I forgot to mention that one week after getting the diagnosis in March 2023, the accounting department chair came to my office at Wharton and told me they had enough "standing" faculty for fall 2023. He could put me on call for filling in and consideration for fall 2024 but, otherwise, my contract would not be renewed. To say that was a punch on the gut, again, was an understatement. I told him that at this point in my life I needed more control of my schedule so, "No thanks!"

Again, some may have pulled the cancer card, asked to stay on in any capacity to retain the amazing UPenn faculty health insurance, but that is not my style. I never told them I was sick. Once the term was successfully over I did email a few colleagues to say I would not be back and, maybe, it was for the best since I had bigger things to focus on.

I did reach out to a few other academic contacts to see if I could line up fall teaching but, in reality, even March was too late to talk to anyone about fall 2023. The academic calendar and staffing is typically set at most schools by December. And I felt uncomfortable committing to a new program given the uncertainty I was facing.

Fortunately, summer is expected to be free time for professors and I started getting calls for other consulting work. That has sustained me in addition to my paid subscriptions.

I considered not following through with radiation treatments after successful surgery in early July but wise friends who have been through similar treatment protocols said I would be foolish not to take advantage of everything available to me, especially with such great care and insurance from UPenn. The best bet is to trust the incredible doctors who got me this far and use all resources to seal my "complete response" to reduce the likelihood of a recurrence.

I am so grateful to the amazing doctors and all the staff at UPenn Hospital Abramson Cancer Center. I feel blessed to have gone through such an illness with some financial security, great family and friends, and the good fortune of being able to trust my doctors and have great care nearby.

The chemotherapy/infusion process took place in private in curtained cubicles, with warm blankets and lots of caring nurses, who were incredibly super conscious of quality control, HIPAA protocols, and your feelings. Once you were hooked up, you could munch on snack bars and yogurt, work on your laptop, drink lots of Dunkin' and, six hours later, it was all over. "Infusion" center sounds like we were there for smoothies rather than chemical cocktails.

The waiting room for radiation treatments was much more of a kick in the teeth. The basement level radiation waiting room was full of patients, most seemingly a whole lot sicker than I was. Some were in for twenty or thirty treatments. I would see the same people each morning and our growing familiarity with each other necessitated polite acknowledgement of our shared fates and, eventually, comparing notes. It was the first time I let depression creep up on me, despite being almost done with it all and knowing I was lucky, that I had had an easy time and a great result.

The radiation sessions were quick but the set up was precise and you had to hold still and be moved around like the piece of flesh you are. Again, the nurses and technicians were incredibly professional and kind, but the process itself is mechanistic and dehumanizing. Each day your flesh is burned a bit more until you realize it has the texture of a shriveled strawberry.

I will write more later about the drugs, the machines and devices, and the overall technology that is the modern cancer industry. It is a racket in some cases but truly miraculous for many.

The day after my last radiation treatment, September 20, Hailey dog and I drove home to Chicago. My mom, who lives alone in our family house on the south side of Chicago since my dad passed away in 2017, had fallen on Sunday night August 20. She was outside checking her gardens and did not allow neighbors who found her to call an ambulance or any family. She stubbornly sat alone with a fractured arm, bleeding, all night.  

One of my brothers came next morning for a regular check-in and found her on the living room sofa with a bloody towel wrapped around her arm, and took her to the emergency room.

That began the saga of several weeks hospital stay, then a move to a rehab facility near her house. We were all glad to see her in a beautiful place surrounded by many neighborhood friends who had voluntarily sold their homes and moved in, well cared for and safe. By the time I got there she was itching to go home but a full arm cast made it impossible to walk on her own and she needed more rehab. We were able to talk her into moving to the assisted living side in the same facility where we hoped she would stay for good.

My visit was the first time she would see me since the prior Christmas and it was time to tell her about my illness. I took off the baseball cap and showed her my bald head. She asked a few questions, was irritated that my sister knew when she didn’t and I "could have died" before she saw me. That was it. Her own ills and deteriorating cognitive capabilities limits her ability to focus on anyone else's issues.

Unfortunately, mom’s stay was short and she went back home Nov 1. We have worried ever since, in person, over the phone, and from a distance since she refuses any in-home help. These are the changes in family dynamics you have to accept as you get older yourself.

When I got back to Philadelphia in early October I was very busy. I received several requests to guest teach, to do consulting for litigation related to corporate frauds, and I took a trip out to Stanford and Berkeley. See more about that trip here:

When I returned from the California trip, one of the young women who takes care of my dog said she was limping, hesitant to go out.  She was 17 — I got her as a rescue in DC when she was 9 — and so she had slowed down quite a bit since we arrived in Philadelphia in early 2022.  Soon she could not get up at all, favoring that one leg a lot, limping, hopping, anything to not put pressure on it. An emergency visit to UPenn Vet Hospital said maybe a muscle sprain — no obvious broken bones — and try some gabapentin pain meds to see if she heals. It's funny that gabapentin seems to be a non-species specific do-it-all drug. My mom takes it for nerve pain and I heard it may help some with depression. Instead she got worse.

She had lost weight but that was not a bad thing since she was a bit chubby for her breed. Another visit confirmed, after biopsies of lumps that had emerged with the weight loss, that she had cancer all over, spread from an osteosarcoma in her leg.  I said goodbye to my Hailey in early December.

I think that is enough sorrow for one person for a year. But a lot of good happened in between all that sadness and hardship. Some of you saw the short interview I did for Ryan Beckwith on "my first byline".  It helped remind me of all the friends along the way.

I stopped posting to Twitter and started all over at BlueSky. One of the members, author Elon Green, put out a call for year-end wrap-ups. Not everyone took it seriously, others had big and little but important accomplishments to tout, and some just celebrated jumping impossible hurdles.

I remembered that I had also started a book talk series this year, in the midst of teaching and chemo and surgery and radiation. I went from looking like myself for the last 40 years to wearing scarves and, now, to the natural look I have embraced.

I may have made it through generally well, ready to see what happens in 2024, but I have noticed one subtle change. I always had a small fear of heights and of driving over high bridges or ones that swayed a lot like the Chesapeake bridge you cross on the way to the outer banks. But since my illness this fear has become more acute. I almost changed my flight back from California to Oakland from San Francisco to avoid having to drive back across the Bay Bridge from Berkeley. But I white-knuckled it and made it to the airport in plenty of time, but in daylight.

When my sis and I came back from Hawaii last January, we hit some extended turbulence over the Pacific. I was hiding my dread of what was to come with a diagnosis from her but, in that moment, we sat sat next to each other, holding hands, reciting the Memorare and accepting that if we went down we went down together. I was selfishly thinking that maybe it was a better way to go than dying later from a prolonged painful cancer diagnosis. But I knew how selfish that was, since my sister would be leaving a husband and daughter.

"Rather than words comes the thought of high windows:   

The sun-comprehending glass,

And beyond it, the deep blue air, that shows

Nothing, and is nowhere, and is endless."

Philip Larkin, "High Windows" from Collected Poems,

(Farrar Straus and Giroux, 2001). Copyright © Estate

of Philip Larkin. The Poetry Foundation.

At this point I have no reason to fear being sick or dying, but I know better than to make plans. Stubbornly, I am planning anyway to teach a custom-developed fraud case course in late spring for University of Miami and to do more guest spots and other projects.

In general, I just savor each day and hope that I remain A-O-K.

Thank you for sticking with me. More accounting, audit, and corporate governance coming up in 2024!

Living in this big blue world
With my head up in outer space
I know I'll be A-O, A-O-K
I know I'll be A-O, A-O-K

© Francine McKenna, The Digging Company LLC, 2023