Jessica Fein: Welcome. I'm Jessica Fein, and this is the “I Don't Know How You Do It” podcast, where we talk to people whose lives seem unimaginable from the outside and dive into how they're able to do things that look undoable. I'm so glad you're joining me on this journey, and I hope you enjoy the conversation. 

Welcome back to the show. Today's guest is Gila Pfeffer, author of Nearly Departed, Adventures in Loss, Cancer, and Other Inconveniences. When Gila was 30, She was the oldest living member of her family. When she got married and started having kids of her own, she knew she had two choices.

She could live in fear or she could take action. Gila chose the latter and then wrote about it with wit, wisdom, and a [00:01:00] boatload of humor. In today's conversation, Gila shares her journey of being both a previvor and survivor, and how she managed to find laughter even while navigating a preventative mastectomy, chemotherapy, and raising four young children.

She opens up about choosing to shield her children from her diagnosis, The friends who showed up in exactly the right ways and how and why she chose to parent differently than her own mother did. This is a conversation about facing our fears head on, finding humor in dark places, and the power of both taking control and letting others help when we need it most.

It's my pleasure to bring you Gila Pfeffer.

Welcome to the show, Gila. It is such an honor to have you here. 

Gila Pfeffer: I'm thrilled to be here and I can't believe we actually found time right off the jump in 2025. Go us. 

Jessica Fein: Yes, go us. This is my first episode that I'm recording in 2025. All right. I love your book. Nearly Departed, Adventures in Lost [00:02:00] Cancer, and other Inconveniences.

So right from the outset, we get a sense of your tone, and I love that you frame what happened as adventures, and also as inconveniences, because I could think of a lot of other words to describe what you have been through, and I'm not sure if those would have been top of my list. So tell me about your title.

Gila Pfeffer: Yes, you hit the nail on the head. The tone was intentional. And I am aiming to bring humor and levity to a very difficult topic, the topics of loss, grief, illness, and things that blindside you in life, which you yourself would be no stranger to. And you also bring humor to the way you tell your story. So I'm happy that we're having this conversation.

I took my editor and I about a hundred tries, and that's not an exaggeration, to get the subtitle right. Nearly Departed seems like the best way that I can talk about death. I lost both my parents young to cancer. I tried not to get cancer. I got it anyway. Like whenever people ask me what my book is about and I say [00:03:00] that, I see their faces just start to drop, melt into the ground.

And then I do jazz hands and like, but it's funny. And like, that's not enough to convey it. So the title was important, but then the subtitle, which as you know, as an author is important in conveying what your book's about again, how do you include the word cancer in a subtitle and make it funny? And we had a whole argument back and forth about whether or not to include the word cancer.

And I think. When we whittled it down to about five out of, I'm not exaggerating when I say a hundred, I even tried Chat GPT and we are in no danger of that thing taking over our creative selves because it was serving up the absolute worst. Something about the word adventures is ironic and funny and inconveniences.

Also, as you say, What can you say about terrible things that happened to you that, you know, makes everyone understand that you're okay with them? So yeah, an inconvenience is obviously me being a bit sarcastic, but as my editor pointed out when we were going through this grueling never ending process of finding a subtitle, She pointed out that around the middle of the book, when I'm speaking [00:04:00] to my oncologist about, you know, finding out that I'm going to have to undergo chemotherapy, which is the very thing that I'd set out to avoid and being preventative.

The oncologist says, I know it's a huge inconvenience, which must have somehow planted a seed in my brain 15, 16 years ago, because I thought what an absolutely ridiculous word to use about chemotherapy, which is actually horrendous. And so my editor liked the fact that I'd circled it back around. It was almost like a preview.

But yeah, that was my intention. My intention was to let people know you're going to read about tough things. You're gonna laugh and it's gonna be fine. 

Jessica Fein: I love that. And it is such a challenge. I mean, we don't want to scare people away. And you're right. I mean, I had this exact same thing with my book, which you know is very hard to say, you’re not going to end up on your bathroom floor in a puddle like crying hysterically through the whole book because it's such heavy and tragic subject matter. But it is true that humor is a real survival mechanism. And as we on this show talk about, I don't know how you do it. I know that humor is a big way of [00:05:00] how you get through.

Gila Pfeffer: Yeah. And that's one of my core messages. You know, I talk a lot about, and when I say talk a lot about, I mean, in my writing, on my website, certainly on my Instagram. I talk about breast cancer prevention and empowerment and agency and how rather than being afraid to find something out about your genetic background or what risks lie ahead for you, I want people, women in particular, to feel empowered.

And that alongside humor are like the double whammy with which I attack what's still a tough subject. I'm a breast cancer previvor and survivor. I still go for twice annual exams. I still check myself monthly. I do as I say, which is my feel it on the first campaign. Every month on social media, I show up holding two spherical objects to my chest with a big weirdo smile on my face.

It's. to lemons, to frying pans, to basketballs. For Hanukkah it was donuts, and earlier December I did Christmas decorations. [00:06:00] But the idea is to take the fear and the worry and the horrible parts out of what I think should be an empowering tool that we have. And alongside with that, that's where the humor comes in.

They kind of go hand in hand. If I was just showing up every month saying, Remember to do a self exam and get a mammogram, everyone. Like, shut up, Gila. You're boring. Stop saying the same thing. 

Jessica Fein: Backing up to something you said a minute ago, what does it mean to be a previvor? That's not a word I'm familiar with.

I mean, it sounds a little self explanatory, but what is it? 

Gila Pfeffer: It's actually not self explanatory. And I love that you right off the bat said you didn't know what a previvor was, because that's the thing. My favorite thing to lecture about. Whenever I give a talk, I start off by saying, who here knows what a breast cancer survivor is?

And everyone raises their hand. And I asked who knows what a previvor is? And hardly anyone does. And usually the people who do are the people who knew me before. And I did not coin the term, but I grabbed onto it with both hands furiously. A previvor is somebody who preempts a health risk or [00:07:00] a diagnosis that they are prone to having or at a high risk of getting by taking preventative measures.

So in my case, in the case of breast cancer, I, well, I'll give you a bit of background. My mom died when she was 42 and her mom died when she was 49, both of breast cancer. I knew my grandmother for a whopping three months. I knew my mother for 20 years. So when she died, I was the oldest of five kids. So I was 20, my youngest sister.

was three. And even though nobody seemed to really talk about breast cancer in my family, which probably would have been a good idea for them to do, it was very much not spoken about. And if it was, it was sort of whispered in hushed tones, as was the way in the 80s and 90s. She died in 1994. Something in me registered that breast cancer was a threat and a risk to me, a very clear and present risk and threat, even if no one else was saying so.

So, at 20 years old, I sought out a breast specialist. I can't remember if it was a surgeon or someone who specialized, you know, not just an OBGYN, but somebody [00:08:00] who would do an exam on me, a manual exam on me, and advise me and give me guidance. with whatever medical technology was available at that time.

This was before gene testing had come into play. But we did know about family history. We also knew that Ashkenazi Jewish women had a higher incidence of breast cancer. There was no internet. I had nothing to Google. I had no one to ask. You know, I had ninth grade bio and figuring it out for myself and commercials on TV for the Evelyn Lauder Foundation.

So as time went on, I kept doing breast self exams and seeing my specialist twice a year. And then when I was 30 years old, my dad died of colon cancer. He was 55. So that's two parents gone. All four of my grandparents at this point are gone. And. I've got no one else to ask about my family history, but right around that time when I was 30, I went for my first mammogram, which sounds young, but when you consider my mom dying at 42, my breast specialist at the time, who was at Memorial Sloan Kettering, sort of the, [00:09:00] you know, end all be all of cancer people said, get that mammogram.

It was not easy for me to get. I tried to book it. I was told you have to be 40. I said, I'll be dead by 40. Give me that mammogram. And I got it. And that was my baseline. In the middle of all this, I got married. I had some kids. You know, there was more understanding. There was the internet. There was more understanding around what poses greater risks to people for breast cancer.

I knew that estrogen exposure could be a problem. I knew that I should have my kids as young as I possibly could because pregnancy comes with a high estrogen. Estrogen, I was putting the pieces together. Which was great, because information is really what saves us at the end of the day. And then in my early 30s, I was being still very vigilant about breast cancer.

In between each pregnancy, I'd make sure that everything was fine through MRI, ultrasound, mammogram. I heard about gene testing. It was 2005, and around then is when gene testing became available to the general public. You know, and it's not the spit test that we know today, which where you get a little kit in the mail, you spit, you send it off and you find out that you're like 0.

02 percent [00:10:00] Eskimo. Yay. Exciting. Like I'm a Viking. Hooray. We're all Vikings because they reaped and pillaged everyone. So we've all got a little Viking in us. Now it's so much easier to do. And that's not to say that that's the way that one would conduct a proper medical gene test, but it is much more prevalent today.

When I did it, it was expensive. I did it privately because I didn't know if my insurance would deem me as having a pre existing condition if it came back positive. I was testing for something called the BRCA gene, B R C A, which the B R is breast and the C A is cancer. At the time it was only three variations.

There's two BRCA1s and one BRCA2. Today they test for a much wider panel, which I'm sure you know about, but at the time we just wanted to find out if I was BRCA or not. To be honest, it didn't matter to me if I was BRCA or not. With my family history, I knew that I had to watch out for breast cancer. So, two things happened at the same time.

I found out about the gene testing, and a friend of mine had something called a preventative double mastectomy. I'd never heard of that before. And it's not that it was new, this was the early [00:11:00] 2000s. I think they've been around since the 1980s. But until Angelina Jolie put them on the map in 2013, no one heard of them.

So when my friend, Stephanie, whose mom had had breast cancer said, I tested for BRCA, I am going to get a double mastectomy. I said, what are you talking about? And where can I get one? Because I just thought in terms of being preventative and a previvor, which was, this is a long answer to your short question.

What can I do to preempt breast cancer? What can I do to stop what is inevitably coming for me? So I tested positive for BRCA in 2005, went on to have one more child. And then in 2008. And I signed up to have a preventative double mastectomy a full five years before Angelina Jolie. So people thought I was being a bit drastic, a bit over the top.

And in that sense, I was a previvor. When I woke up from surgery, I had become what's known as a previvor. I had theoretically prevented breast cancer before it happened. Six days later, I became a [00:12:00] survivor. When my doctor called and said, you're not going to believe this. We found early but aggressive breast cancer in one breast. You saved your own life. That's the second half of the story. 

Jessica Fein: That is a pretty powerful second half. I mean, that was like the other shoe dropping when you get to that point in the book.

Gila Pfeffer: Big time. But that's a previvor. Anyone who takes any kind of steps to prevent a genetic disease or a disease that they are more inclined or more predisposed to can consider themselves a previvor.

You're being a preventative person. 

Jessica Fein: It's so interesting you note that, you know, at age 30, you were the oldest living person in your family at age 30. And there were a lot of little ones that you had to kind of look out for in Shepard, not to mention the fact that you then had several of your own children.

And what was interesting to me about it is that the way you chose to share. What you were going through with the younger people in your family, most notably with your own children, was wildly different from how your mother shared with you. I mean, can you just tell us about that [00:13:00] scene at the airport when you find out your mother has breast cancer, and then how that informed the way you shared with your own children?

Gila Pfeffer: Yeah. So my book opens with a very dramatic scene of me getting on a plane for a continued half year of study abroad. And my mom, as I'm getting ready to go through the gate, blurts out, I think I have breast cancer, which, you know, if you had to write a book about how not to tell your kids, it That you think you have breast cancer or any bad news, that's going to be the gold standard.

I really wasn't sure how to react. I won't be giving too much away by saying that I ended up saying nothing, turned on my heel and boarded. And that tells you a lot about the nature of our relationship. You know, I was 18, but you, you kind of get a lot of history between us in that one scene. And I just was so aware of how little either of my parents understood about child psychology and talking. We were not an open talking family. We didn't talk about our feelings. My father was an immigrant from [00:14:00] Hungary. His parents were Holocaust survivors. My mother's parents were Holocaust survivors. They grew up in a very different alternate, So my mother was American, but she might as well, for all intents and purposes, been Polish or Czechoslovakian like her parents.

All four of my grandparents had a number tattooed on their arms by the Nazis. So I don't know what world they grew up in, but there wasn't a lot of emotion. a lot of talking. None of my grandparents spoke about the Holocaust. When I needed to find out something for myself, I had to do a bit of digging and research in other ways.

So that must have sort of trickled down to them. And all I know is that there just were not, not just around cancer, around anything. There were no emotional conversations. We didn't say, I love you a lot. We weren't huggy. So this was sort of like, One more thing that I thought, well, you're getting that wrong.

And I made a mental note to one day when I had my own family come about it from a different way. And that's not to criticize her. I think a lot of where I landed in life is sort of doing the opposite of what my parents said, but that's a good [00:15:00] way to learn too. My dad was the only child of two Holocaust survivors.

His dad had lost a wife and all of his kids at the hands of the Nazis. So he was a very Eastern European guy trying to make it big in America, which he didn't. So there, there was a lack of emotional openness and that led to, I think, things just not being dealt with well. Fast forward to when I had to tell my kids, when I was diagnosed, my kids were one, three, five, and seven.

So they were really little. And by the time I was diagnosed, it was a bit after the fact. I was diagnosed from the tissue that had already been removed from my body, right? I got breast cancer backwards. I had a prevented mastectomy. Then I got the diagnosis when they looked at the tissue. Then they checked my nodes.

In the nodes, they found micrometastases. They took those out. I had eight rounds of preventative chemotherapy. Like nothing was happening the way it happened in the movies. Like I'm trying on a bathing suit. Oh no, I felt a lump. Now I go to my doctor. Like there's a trajectory that things follow. And mine, classic me, did not do that.

And so when I first set out to have the preventative [00:16:00] surgery, look, I was terrified. I'm not going to pretend that I skipped into the OR. I can still conjure that feeling of raw fear. Like I'm getting cold armpit sweat thinking about it. It was terrifying. I'd never had surgery before. Now I'm a pro, you know, now I'm like, Oh, general anesthesia.

Great net for me. Don't mind me. Like who doesn't want that? But I told my kids at the time, Mommy's going to have an operation on her stomach to make sure she stays healthy. I said stomach because we used my stomach fat and muscle for the reconstruction. The procedure was called a TRAM flap, T R A M.

That's not really done so much anymore. Now they do something called a DIEP or DIEP flap where they remove the stomach fat and muscle and with microsurgery reattach it to the chest. Mine was tunneled up. But I thought it was easier to explain to them stomach than breasts and I said, look, I'm mommy's gonna be in a like a lounge chair, lazy boy type thing for about six weeks.

You can visit me in my room, but you have to be gentle and careful. And it seemed like an easy conversation to have because the key points [00:17:00] were staying healthy, stomach, everything at home is going to be the same. We've got friends, family, help. We've got, you know, everything sorted. The harder thing for me to decide with, along with my husband was when that diagnosis came back and I was now going to have to undergo eight rounds of chemotherapy over four months.

That's a lot harder to hide. You know, what's up with mom's bald head was a question I had to circumvent or plan for. Ultimately, I decided, and my aim was always to protect my kids, to shield my kids. There's a lot of discourse. I wrote an article for Today about why I kept my cancer secret from my kids.

And the comments, some of the comments were downright nasty. And I knew that they'd be coming. Well, we tell our kids everything. Well, we believe honesty is the best policy. I'm like, congratulations. I'm sharing my story with you. So that's what happened. I felt that I could shield them from pain and trauma and fear because what I was doing was preventative.

If I could keep my head somehow miraculously covered 24 seven in a way that they wouldn't notice. [00:18:00] Which I did, but I felt that it was really two things. One is I wanted to shield them from having to carry any extra additional fear and trauma while they didn't have to. And I would tell them eventually.

The other was for me, I was carrying enough, man. We were also getting ready for a move to London. So I've got these four little kids. I'm trying to keep things normal at home. Now I'm going to be going through chemo, which not only will alter my appearance, but will probably, and it ended up doing so, make me feel weak and unable to, you know, show up as the mom that they're used to having around.

I'd given up a career in fashion to be a stay at home mom, and I, I love that, and I wanted to do bed and bath time and dinner and all the things. So, ultimately, the decision not to tell them was as much to protect them as myself. And I'm really happy that I did that. And when I did eventually tell them 10 years later, it was from a place of safety when everything was behind me.

I was going to give a keynote speech in New Jersey with Sharsheret, this amazing organization, and share my story about survival. They were gonna ask me why I was leaving. Where are [00:19:00] you going mom? Okay, I guess I better explain that. So I sat them each down individually and told them and that in and of itself was a beautiful moment because I was speaking to them as teens, tweens, young adults.

But that was my driving force. My driving mantra was protect them wherever you possibly can. Share what you need to in a way that is thoughtful about how they will process it. And I learned that by experiencing the opposite of that. 

Jessica Fein: You talk about how there was no buffer for you when your mother had her diagnosis and you wanted to give the buffer to your children, but I love that it's also what was going to be best for you because I think so often as parents, as mothers, we're putting the kids first and you were thinking what's going to work for me in this situation.

Gila Pfeffer: Yeah. And I, and I talk about that as well, both in the book and when I'm guiding people one on one or in a more public forum. How do you show up for someone, for a friend or family member going through a difficult time? And how do you show up for yourself? And I think that there's a lot of martyrdom still [00:20:00] happening around making everyone feel included in your crisis.

And giving out jobs, you know, everybody wants a job, everybody wants to feel important. And if somebody's coming to me asking how they can support their friend, I'll say, You know what? Sometimes doing nothing is the most supportive thing. 

Jessica Fein: It may be, but I have to tell you that I was blown away by your friends, particularly Hayley and Effie.

I mean, I talk all the time about how to support somebody who's going through, you know, hard things. And there were two examples in particular in the book that stuck out to me, but I'd love for you to share how they so gorgeously showed up without being asked and just knew what to do. Can you tell us a little bit about that?

Because I think it gives such an insight to people who are listening who are saying, I want to be useful, but I don't know what to do. 

Gila Pfeffer: Yeah. So everyone seems to love Haley, Effie and also my friend Tamar, and Phil, of course, my husband. 

Jessica Fein: A lot of people to love in your book. Let's just put it that way. 

Gila Pfeffer: Yeah.

But there's also a lot of people whose names aren't mentioned who played their own roles in one way or another, and whether they showed up one [00:21:00] time with a pair of fuzzy socks or a container of soup, or just sent a message. Those all contributed. to my well being and my feeling of being supported. In terms of Hayley and Effie, I didn't deliberately set out to choose them, but they kind of naturally presented themselves as good choices for me, both because of their natures of wanting to be good friends, but also because of their competitiveness.

And I sort of in the back of my mind thought, Oh, this is going to be fun watching them sort of compete for who can bring better, you know, chemo treats when they take me. When it came to going to chemo, there were eight rounds. So I split those into four. I didn't want Phil to come with me. I didn't want him to see me like that, not for his own protection, but for mine.

I did not want that image in his head. And again, that's me calling the shots. So while he might have felt upset or left out or whatever the word is, like many of my other friends who said, Oh, can I drive you to chemo? And I said, you know, thank you very much. But no, I had a million rides. It wasn't about that.

It was about who did I want sitting there with me? Who did I feel comfortable being [00:22:00] my disheveled. Pathetic self in front of when there was some some dark moments of tears or nausea You know, who do you feel comfortable doing that in front of so Effie and Haley? Essentially, they each got four slots and they would consult with each other to see what it was that would make me feel better What did I want?

What did I not want? Who were the staff members to avoid, to like sort of make sure they steered clear, get, get away from me and who were the nice nurses or, or whatever. And I was just at a time when I was at my lowest and frustrated because remember, I was going through something that I had set out to avoid.

It didn't blindside me in that I didn't see it coming. It blindsided me in that I did everything right. I did everything to avoid this. And here I was having the exact same chemo cocktail as my mom, who was not preventative, who did not have mammograms, who buried her head in the sand, probably because she was terrified.

And I'm like, well, what do I get? Why, why am I dealing with this? But the way they showed up for me was to get more and [00:23:00] more outrageous with each visit. The first visit, I'm a germaphobe, so I don't want to touch anything, even in a hospital that's obviously been sanitized. So I sit in that chemo chair the first time and I'm just like, I don't want to touch anything.

So Haley was the first one, was with me at the first appointment, and she communicated to Effie that Gila does not like sitting in gross hospital chairs, even really nice Upper East Side hospital chairs. He showed up with brand new, fresh out of the box, like 400 thread count sheets. And before I could sit down, made me a little throne and draped it over, lest my precious, any part of my skin have to touch any of the chair.

Magazines, uh, laptops with DVDs, this was before we had iPhones. Anything to entertain me, to make me laugh. Effie found out that I love Calvin and Hobbes, he went out and bought, in his very Effie way. All of the Calvin and Hobbes books, which is a lot, and The Far Side. Haley saw that I had a very bad interaction with this one nurse who in the book I call Rose and I was like, Haley, this woman is, she's saying all the wrong things.

She was just, I asked her why she was wearing so [00:24:00] much protective gear and she looked me dead in the eye and said, Oh, because if any of this toxic chemicals gets onto my skin, it will burn me through to the bone. I'm like, who trained you to do this lady? And Haley just got right in there and went to the nurse's station and said, I'm not Please keep this particular staff member away from Gila.

Like they really went to bat for me and there's lots of other cute scenes about what they did. At one point I challenged Effie and I said, Oh, I really want a falafel from my favorite place in Jerusalem, which was ridiculous because we were in New York. And the next time he took me there, I was holding a box that he presented to me that was postmarked from Israel.

And it felt like it had weight to it. And I'm like, you did not have a falafel shipped from Jerusalem to New York and expect me and immunocompromised person to eat it. That is disgusting. I'm not doing that. And I opened it up and it looked surprisingly intact and fresh and it turns out that he had had his brother ship an empty box to him, bought a fresh falafel, put it in the box.

So this is what I mean. 

Jessica Fein: Talk about amazing friends. And I loved the first time that you went to chemo when you thought, Nope, I got it. I don't need anybody to come with me. And you end up there by [00:25:00] yourself. And then realized you were wrong. 

Gila Pfeffer: It's so on brand for me. I'm such a Capricorn Gen X product of my environment.

But Phil drove me to that first appointment and he worked in New York City at the time. And for the 800th time offered to come in with me, he said, I'll sit with you. I said, no, I got this. We like, I'm fine. It's not, it's really not a big deal. I tried to make it into not a big deal. This was before the days where we were being more honest about our feelings and like allowing ourselves to, to feel the feelings.

I was like, This is fine. I'll be done and I'll come home. I wanted to do it myself. I didn't want witnesses to my decrepitude. This low, low moment in my life. And I felt like so much agency had been taken away from me. Like, I'm someone who really likes to have things planned out. I didn't control. And one by one, control was being taken away from me.

And I just thought for Phil, I just didn't want him, something in my gut told me that I didn't want him seeing me in this environment. I wasn't going to lose my hair that first day, but just that chemo space, whatever it looked like, I didn't know what it looked like yet, was holy and sacred and to [00:26:00] be entered by a very select few.

And those few would be selected on my criteria, my criteria alone, and nobody could question me because it was my party. Yeah. So I went in there, and And this horrible nurse, who Haley had to get rid of later, set me up. Haley was scheduled to take me home that day. And I said, I'll be a bunch of hours, you know, I'll text you when I'm almost done.

And at some point, things just went terribly awry. And the nurse was saying all the wrong things. And the reality of my situation was hitting me. Like I sort of, I watched the red sludge of the chemotoxic cocktail, Snaking its way slowly through the tube into my arm. It's like those scenes in the movies with the evil person is like Unnecessarily slowly administering the torturous punishment or whatever the good guy is about to endure And you're like, why is this taking so long?

Like just nobody moves that slowly in real life And I said they go. Oh, yeah, it's things do move that slowly in real life I have to watch this red thing almost every day Almost, almost, and like at any moment I could have just ripped out the IV and gone running out the door and saved [00:27:00] myself from it, you know, I had those visions, and when the reality of it hit me, and I just let the emotion take over me, I called Haley in hysterics and said, how, you know, when can you be here?

She goes, Oh, I've been parked around the corner. I'll be right there. She was there in five minutes. And it's that kind of thing, you know, the day after my first chemo, there was a snowstorm and they got my period. And so, you know, I've got four little kids, three of whom should be in school. I don't need them at home on top of my head when I'm trying to pretend I'm fine, when I'm clearly not, I'm, you know, doubled over in bed feeling like I've swallowed an entire truckload of cement.

And Haley just showed up and said, give me their snow suits. And, you know, a couple of things they need, I'm taking them out for the day. And she did, except for the baby who stayed home with the babysitter. She didn't. It was all these ways in which my friends just showed up. And again, there were people who would have liked to have been more involved and been given more jobs, but I didn't have jobs for everyone.

And I like to remind people now to take the cue from the person going through the crisis. If that person says, [00:28:00] you know, I don't need dinner, I'm good. Don't be a hero and drop off a lasagna anyway, because now the person has to figure out where to put the lasagna. Now the family's going, why is someone bringing us a lasagna?

You know, that creates more complication in my family. And another thing I say is to check on the partner of the person going through the crisis, because everyone likes to focus on me. And it's like, well, What about Phil, who has to go to work and pretend everything's fine and nobody's checking in on him?

I am so, so, so lucky in that when I say I had a village, I had 10 villages. You know, I didn't even know about. My friend Tamar was coordinating all of it. She was like the bouncer. You were not getting past Tamar. And it wasn't me being exclusive. I was trying to survive. And I was trying to survive by keeping things as normal as possible.

And in your normal life, you don't have 75 people showing up with things on your doorstep. In your normal life, you do everything yourself. So the more contained we kept it, the better I felt about myself and the more I could protect my children. 

Jessica Fein: And I will add though, that you remind people to [00:29:00] check on the partner of the person going through it.

And that's so important. I also do think paying attention to the kids. And yes, it's a delicate balance, particularly when you have a situation where they're not fully aware. But they know that mom's sitting in a recliner chair for six weeks or whatever the thing might be. And giving attention and taking that, showing up to take those kids on the snow day.

I loved that and remembering that these kids are also impacted. And I think so many of us are comfortable surrounding the person going through it. And we forget that they have this tight ecosystem that needs care and attention as well. 

Gila Pfeffer: Yeah, so my two older ones had sleepovers every, Tuesday was chemo day, every other Tuesday, but every Tuesday became sleepover day for my seven and five year old.

And now a seven and five year old are not going to ask why they're having a sleepover on a school night, right? They're just going to take it, not look a gift horse in the mouth and run with it. So things like that just made a huge difference where there were all these distraction techniques for them.

And my kids were also, [00:30:00] thank God, you know, easily distracted. Whatever questions they did ask, I did my best to answer them, you know, to circumvent the more difficult ones, which I knew I'd get to later. Keeping the head covered was the hardest. I would shower with a shower cap on because kids have a way of bursting into the bathroom.

I slept with a beanie on. Why they never asked me why I was sleeping in a beanie suddenly all the time, I don't know. I just thank God that they didn't. I think it's really important to point out that there is no one right way to deal with it. It's so personal. It's so specific to your own circumstances.

This was the right thing to do for my kids. This was the right thing to do for me. This was the right thing to do for our family. And we lived in a small community, so it was easy to get everyone on board. I instructed everyone at school, teachers, assistants, staff, principal, don't bring it up. Don't ask, how's your mom doing?

And for the most part, we're good. They listened. You know, if there were a couple of slips, my kids were so little, I kind of just whizzed on by them and they had another sleepover. 

Jessica Fein: You talk a lot about this tight knit community, and another thing [00:31:00] that I was curious about is you are a religious observant Jew, and I was wondering how your Jewish community showed up for you.

Gila Pfeffer: In all of the ways, in all of the ways. So when I say I lived in a small community, I mean both geographically, um, it was a small New Jersey community, but yes, we have a community built around the local Orthodox Jewish day school and several synagogues. So we're all very interconnected because there's quite a robust religious life.

So, you can be friends with who you're friends with, but even someone who you're not friends with on a day to day basis, when you're in a crisis, is coming through for you. And the synagogues would, if you wanted to, organize all manner of support and rides and meals and whatever, you know, if you needed.

And then I had my Jewish community beyond my geographical area. I had friends from high school, from college, my husband's family, just extended, extended, extended. And as I'm sure you know, One of the many beautiful things about [00:32:00] Judaism and about a Jewish community is that we show up. We are there for each other.

We believe in charity. We believe in community support. And not just within the Jewish community, you know, it extends well beyond, you know, who can we help? Let's find a way to make the world a better place. That concept is called tikkun olam, which is fixing the world. And so if I decided I didn't want to cook for a year, that would not have been a problem.

You know, people would have lined up to make that happen. We don't like to see each other. Suffering and we will go out of our way to ease that suffering and I'm so happy that that came through in the book, you know, I wrote the book for a lot of different reasons, but one of the many great things to come out was my ability to, in some way, even begin to thank the people by name and by community at large, thank them for the ways that they showed up for me. You can say, You can send the box of chocolates. You can write a note that doesn't touch it. Somehow immortalizing them in a book. Maybe feels like, you know, a little bit better. I wrote it in the author's note. In the beginning of the book, I wrote something along the lines of I [00:33:00] would have liked to have named every single person who was there for me and told every single story of kindness and touching moments of beauty that just made me sort of fall on the floor and cry tears of gratitude. But I joked, you know, I can't write an 800 page book. I'm not Barbra Streisand. But the point is that I would have spent 800 pages talking about all the different ways That people showed up and I absolutely do not take that for granted and I wish that so hard on anybody going through a difficult time.

Jessica Fein: Another thing that you had to face were these issues of identity and femininity. Because these surgeries were addressing those parts of us that, for many people, make us feel feminine. How did the process of those experiences shape your perspective on what makes you feel like a woman? 

Gila Pfeffer: I love that question. Thank you for asking it. When I think of my mom and how she avoided, from what I can tell from her medical records, which I have and have committed to memory, she avoided [00:34:00] any preventative measures. She avoided acknowledging her family history. She avoided getting ahead of the breast cancer that, you know, she must have known was coming for her.

Ultimately, when she did find a lump, she did go for a mammogram at the age of 40, and it revealed a very, very large mass in one breast, which only revealed itself when she stopped nursing my youngest son. sister. The recommendation by her doctors was to undergo some rounds of chemo, but in her case, it was the kind that shrinks a tumor.

And when her tumor responded well to that chemo, I've got it, you know, right here in black and white in her, in her records. And it's probably the most heartbreaking thing I've ever read. And I've read, you know, A lot of memoirs, so that's saying a lot. There's a moment where the doctor says, we recommended that the patient have a mastectomy on the affected breast and she refused.

And she decided to take a more natural route and try, you know, macrobiotics and all manner of holistic remedies. This is after the chemo had worked. So I'm not God, I [00:35:00] don't know, but it looks to me like she had a moment where things could have possibly gone differently and she didn't want that mastectomy.

And of course I can't ask her that today. But now it's 30 years since she's gone and I've raised a daughter of my own and three boys of my own. And I have a lot more knowledge and wisdom and perspective. And I have to think that there was this fear around the loss of femininity. I have to think that her fear around the mastectomy was what am I without my breast?

How will that alter my body? How will I feel about myself? How will my husband feel about me? Their relationship wasn't great. Her and my dad, maybe she was thinking about potentially, you know, a future relationship with someone else. And she just couldn't wrap her head around having a mastectomy. This is me, sort of, filling in the gaps of what I don't know, but I can't think of why else she would not have undergone that, especially having watched her own mom die of breast and ovarian cancer.

And so, by the time it rolled around for me to have my preventative double mastectomy, which included removing my breast tissue, And [00:36:00] taking my stomach fat and muscle and fashioning new smaller breasts. I was a double D and I was going to go down to like an AB, which was absolutely fine with me. I couldn't wait to be able to button my shirts over my boobs.

I'm like, this is going to be the best. And my plastic surgeon kept talking about how I was going to be so happy with the result. And I was going to have such perky boobs and I was going to have a flat stomach. And I said, and I say this, I, I write about this jokingly in the book, like I don't care if you replace them with, I think I wrote like a balled up sock and a pomegranate.

Just get these two ticking time bombs off of me. There was no concern around my femininity. I had already used my breasts to nurse four babies. They were pendulous. They were not sexy in my view. They did not represent femininity to me. They'd served their purpose and I was going to send them off with an honorable discharge and a whole load of thanks, write about them in a book someday.

There was not that concern there. I didn't know yet that I'd be having my ovaries removed at 35 and that throw me into menopause. But ultimately after the chemo, my doctors [00:37:00] recommended that in the spirit of being preventative, if I wasn't planning on having any more than my four kids, which I wasn't, they said, reduce your estrogen levels drastically.

Um, By removing your ovaries and being a BRCA1 carrier means I also had a high exposure to ovarian cancer as well. So I removed the ovaries and if i'm being honest That was a much harder thing for me to do Both in terms of how it physically impacted me because here comes the menopause At 35 with four little kids when we're about to move to London.

Oh my god How did I do that apropos the name of your podcast? But also the loss of fertility. Now, it's not that I was planning on having any more kids, but there's something very feminine feeling for me about, you know, the ability to do so. And even though I didn't enjoy my periods. And in Orthodox Judaism, women go to a ritual bath called the mikvah after they've finished their period.

And I really didn't enjoy going to that either. I found that just also a huge inconvenience. But somehow it being taken away from me, rather than me having the agency to say, I am done with this, [00:38:00] or it happening at a natural time was a lot more difficult. And so when, when I think about the femininity loss, I think it was the ovary removal part that was a bit harder, but I got over it pretty quickly because zooming out, I understood that this is all for the purpose of me sticking around and being a mom to my kids and a wife to my husband and whatever I want it to be to myself.

This was my opportunity to do what my mother couldn't do, which was stay alive. So the femininity issue took a backseat, but I very much understand women and I'm in lots of different support groups, mostly for me to offer support because I've kind of like dealt with myself already. But I understand when women are concerned about and how their bodies will be altered.

And they have a lot of questions. I am the first person to pick up my shirt and show anyone who's interested for their own investigative reasons, not like on the subway, like who wants to see them, but I've had people come to me saying, I'm BRCA, I'm thinking of getting the preventative mastectomy. I can't imagine my body.

Looking different. I'm like, come into [00:39:00] this private room and, you know, lift my shirt. You can hope I'm not getting too graphic here. You know, touch them, ask me whatever you want. It's so important to have that information to inform your decision and understand that you're going to come away with something that may not look like what you had before, but you're probably going to like what you get and you will feel very much feminine.

Jessica Fein: Thank you so much for that honesty, and I think that people are getting a sense of both your humor, I mean, I have to say, I'm not sure I've ever heard breasts described as pendulous before, but I like that. 

Gila Pfeffer: That's because you didn't see mine. 

Jessica Fein: And also the seriousness of the issues that we're talking about.

I'd love to give people a taste of the book, and one of my favorite parts is your version of the intake form when you're going in for the surgery. Can you read that for us? Yes. 

Gila Pfeffer: I love intake form. Thank you for asking. And fun fact, when I first put together the book proposal, that was the opening, that was the beginning of it.

Eventually, the book took on two intake forms, a more generic medical questionnaire at the beginning, and then the one I'm about to read, which is specific to the [00:40:00] preventative mastectomy. And also, this piece that I'm about to read went on to be published in McSweeney's, the humorous satire site, as it is.

I think under the title, honest answers to my medical intake form before my preventative double mastectomy. All right, here we go. Presurgical intake form for a preventative mastectomy 

date, August 15th, 2008 

name, Gila Pfeffer age 34 height, five foot three. Okay. Five foot two and three quarters. 

Weight, rude.

Who referred you to see us today? My OB GYN referred me to this practice specifically, but if you're asking whose idea it was to have a prophylactic double mastectomy, that's all me. I've been wanting to do this since I first heard about it. 

Have you had a psych eval? Yes, I'm fully on board with my choice and frankly would need more of a psych eval if I was prevented from having the surgery. If you think my anxiety levels can't get any higher, oh yes the hell they can. 

Are you aware of the emotional and [00:41:00] psychological impacts of this type of procedure? Yes, I expect to come out the other side of this feeling emotionally whole and validated and psychologically strong, maybe too strong, as though I'm invincible.

Are you aware of implications of me not having this procedure? Do you understand that this procedure is irreversible? I certainly hope so, ma'am. 

What is your current bra size? Double D. 

Will you opt for reconstruction? Yes, but less because I care about what my boobs look like and more because of the tram flap reconstruction method where they take your stomach fat and muscle and repurpose them into breasts.

I've given birth four times in less than six years. If anyone can do a free tummy tuck compliments of our expensive health insurance company, it's me. 

What cosmetic result do you hope to achieve in undergoing this procedure? Look, you can replace my breasts with two frozen ribeye steaks or a pomegranate and one balled up sock.

I don't care. Just get these two ticking time bombs off me. 

Please list all operations and hospitalizations. Unless you count the dental implant surgery I had when I was [00:42:00] 13, I've never had any operations, never broken any bones. Toop toop toop. And overall, I'm rather risk averse. I'm terrified at the thought of undergoing general anesthesia or having my body cut open. I've been hospitalized four times, and each time I went home with a new baby. 

Last menstrual period. Oh, around three weeks ago, I guess. I've got four kids under the age of six. You're lucky I can remember my own name. 

Have you experienced menopause? God, no. I'm only 34. 

Were you ovaries removed? No. Were yours?

How many pregnancies have you had and how many live births? Four of each, thank God. 

Are you taking any contraceptives at this time? Yes, NuvaRing, and it's the absolute best. 

Are you a BRCA gene carrier? What gave it away? Was it the chart of dead relatives in my first intake form? My obsession over having this prophylactic mastectomy?

The way I hold my pen? 

Anything you'd like to ask the doctor? Well, off the top of my head, Will the anesthesia tube knock my teeth out? [00:43:00] What if I wake up in the middle of surgery? What if I die in the middle of the surgery that I'm having to make sure I don't die? Will you need to shave any of my body parts?

If so, which ones? And who will be doing the shaving? I've heard that surgeons have a radio station piped into the OR while operating. Are you sure this is a good idea? What if they sew me up and forget they left a surgical tool in my body, and I set off airport security alarms for the rest of my life and get detained when the TSA lady can't find any metal on me, even after a pat down, and I miss my flight?

Anything else we should know? I'm terrified. If I try to back out of this, I'm dead. Please stop me. 

Jessica Fein: I love it. I love the book. Nearly Departed Adventures in Loss, Cancer, and Other Inconveniences. The link to the book will be in the show notes. Gila, thank you so much for being on the show today. I love talking with you.

Gila Pfeffer: Thank you. I love talking with you too. Oh, this was so much fun. Thank you.

Jessica Fein: Here are my takeaways from the conversation with Gila. Number one, when you are supporting somebody through a [00:44:00] crisis, take your cues from them. Number two, remember to check in on the partner and kids of somebody going through a health crisis.

They often get overlooked and really need support too. Number three, being preventative about your health and safety. Number four, humor can be a powerful tool for processing trauma and making difficult topics more approachable. Number five, choose people you feel completely comfortable being vulnerable with, even if that means turning away people who want to help you.

Number six, trust that you know what's best for your family. As Gila showed, choosing to shield her young children from her diagnosis was right for them, even if others disagreed. And number seven, remember, there's no one size fits all approach to handling health challenges. What works for one family might not work for another, and that's okay.

Make decisions based on what feels right for you and your specific situation, not on what others think you should do. If you have a friend who you think might enjoy this episode, please forward it to them. And of course, as always, the best way to support the show is to subscribe, rate, and review. I [00:45:00] so appreciate you for listening.

I know you have a lot of choices. Have a great day. Talk to you next time.