Laughter Through Loss: Gila Pfeffer's Cancer Journey

What happens when life hands you the ultimate plot twist? For Gila Pfeffer, it meant discovering that her "preventive" double mastectomy wasn't preventive at all—surgeons found early but aggressive cancer hiding in her breast tissue. By age 30, she had already become the oldest living member of her family, having lost both parents and her grandmother to cancer. Instead of retreating into darkness, Pfeffer chose humor as her weapon of choice, wielding wit and candor to navigate the treacherous waters of genetic predisposition, surgical recovery, and premature menopause. Her memoir "Nearly Departed: Adventures in Loss, Cancer and Other Inconveniences" proves that sometimes the best medicine really is laughter—even when facing life's most sobering realities. In this raw and revealing conversation with Amy Cohen Epstein, Pfeffer shares how she transformed personal tragedy into a platform for advocacy, one laugh-inducing social media post at a time.

Amy Cohen Epstein: Gila Pfeffer. I'm really excited. This was actually one of those podcasts that came together really quickly, so I have a good feeling this is going to be really good and juicy. And I feel like in many ways we're long lost soul sisters. We have a lot of things in common that might not be great, good things to have in common, but I think we've made a lot of lemonade out of lemons together.

Gila Pfeffer: Absolutely.

Amy: That's a good way to live our adult lives. So we both have cancer in our family. We both are what this new term of "previvor," we've both taken preventive care really seriously. We've both decided to spend a good majority of our adult lives using and creating platforms to help educate ourselves and educate others... and to sort of dive into this world of what does it mean to go through really tragic times and make the most of it, and to not wallow and stick our head in the sand. I mean, that's sort of the lightest way to put it all. And on top of all the other things that you've done, which we'll just sort of dive into, you also wrote an incredible book called "Nearly Departed: Adventures in Loss, Cancer and Other Inconveniences," and it's like the best title I've ever heard in my life.

Gila: Thank you very much for saying that.

Amy: Yeah, it's exactly what anyone would write who's been through similar circumstances. So let's just dive in. Please just give me your life story. Break it down.

Gila: Well, it's in my book. "Nearly departed," but I'll give you... first of all, thank you for having me on the show and for doing it quickly. I don't know what the rush is other than that we obviously needed to meet and we just couldn't wait any longer. I actually found you through Dr. Elizabeth Komen, who also is doing tremendous work in the women's health breast and ovarian cancer space. And I'm excited to be here and I do want everyone to know that we spent 20 minutes trying to get sound and visuals just right, so you really better be enjoying this podcast in both audio and video form.

My name is Gila Pfeffer. I am an author, a humor writer, a public speaker, a breast cancer survivor and prevention advocate. And essentially my story is that I lost both my parents to cancer quite young. My mom died of breast cancer at 42. Her mom died of breast cancer at 49, and then my dad died of colon cancer at 55. So by the time I was 30 years old, I was the oldest living member of my family. My grandparents were gone. I've got four younger siblings. And so from a young age I understood that prevention and being very proactive was going to play an important and life-saving role in my future and in my siblings' futures.

At each stage, my mom died in the nineties, and this is where I connected with you because you talked about your mom being diagnosed in 1993. Mine was diagnosed in 1992. She passed away in 1994. So this was a pre-internet age. This was not a time when people were doing genetic testing. So as time went on, I went from doing the traditional self exams and seeing a breast health specialist for checkups to learning about genetic testing. I tested positive for the BRCA gene, which is no surprise given my family history and the fact that I'm an Ashkenazi Jewish woman. And then at 34, which was in 2008, I had a preventative double mastectomy, which I'm now told is called a risk reducing double mastectomy. And today that sounds maybe a little bit routine, but actually back then it was five years before Angelina Jolie put it on the map. So it was quite... I don't want to say extraordinary, but it definitely was a big deal.

Amy: It was a big deal.

Gila: It was a big deal for anyone doing it. It was terrifying and necessary. And the minute I heard of the existence of the procedure, I said, "I'm doing that. There is no other way. I'm not waiting for cancer to come and get me." And sure enough, in that preventative mastectomy, my surgeons found...

Amy: Cancer.

Gila: Early, but aggressive cancer growing in one breast and they said, "Wow, this wasn't preventative. You saved your own life."

Amy: I want to just pause for one second. So first of all, just to let you know, almost every single woman that I know that had a preventive double mastectomy during the surgery, surgeons found cancer. They found pre-cancerous cells or early cancer, every single woman I know, which is sort of extraordinary in that sense. And unfortunately I know a lot of women that have had that surgery because they tell me... I'm the person they tell or friends of friends of friends or emails or whatever. In addition, I want to ask a question right now, which is how did you make that decision and whom did you make that decision with? Was this something you discussed because you didn't have your parents, you didn't have your grandparents? Were you married at the time? Did you have children yet? Did you talk to your doctor? Where were you living? Who was your doctor? Was it a breast oncologist? Was it your gynecologist? Can you dive a little bit deeper into that? This was a big deal and extraordinary. I don't want you to sort of diminish that. It was extraordinary, especially at the time, this was early two thousands like you said. It was unusual. This wasn't sort of a normal thing that people were doing.

Gila: And I got some pushback like, "Oh, why would you... Why would you be so drastic? Why wouldn't you just wait and see what happens?" I just knew... I guess I have good instincts and I guess I'm just naturally a person who doesn't wait for things to happen to her. And I'm so thankful that I did decide to have the risk reducing double mastectomy. I have to say, not a whole lot of thought went into it. My close friend Stephanie, who is a year older than me, lived in the same neighborhood. We lived in New Jersey at the time and her mom had had breast cancer in her twenties, thank God survived. She's still alive and well today. And Stephanie told me... we were close. We had kids the same age. Yes, I was married at the time and yes, I had four little kids at the time. They were born really close together because I understood in a world where there already was an internet and things I could look up and doctors I could speak to that exposing myself to more estrogen, which comes with pregnancy was something I wanted to limit.

So I wanted to be done having kids by 35. As it turned out, I was done by 33. Stephanie said she was having her breast tissue removed and a reconstruction with implants at her back muscle. I said, "What are you talking about? What is that?" And the minute I heard that it planted this seed in me. I only had two out of my four kids at the time, but the minute I heard about that, I said, "I'm doing it. That's happening when I don't know, but it's happening." My mom was diagnosed at 40, so at the time, I think I was about 30, 31... in my brain, I had calculated that I have a lot more time not really understanding the way cancer works or how long hers might have been sitting in her. I just had this number 40 in my head. So my husband and I went on to have two more kids, thank God.

And it was at that point that I said I was 34 and I felt like we're getting to the point where I want to have a good buffer zone between when I decide to do it and when I turned 40. Also, my husband for work reasons got this great offer to move to London. So as a family, we were planning on moving to London in the summer of 2009, and that also sort of lit a fire under me and I understood that let's get this massive surgery with reconstruction out of the way. Now by the time we moved to London, 10 months later, I'll be healed back on my feet. And I was excited to share my story with my new community about prevention and this big thing that I did in the way of prevention, never thinking that the story would blow up bigger than that. I did speak to my breast surgeon. I didn't have an oncologist because I wasn't supposed to have an oncologist.

I spoke to my regular doctors, of course I spoke to my husband Phil, who was nothing but supportive. I wish a Phil on anyone ever going through cancer or anything difficult because if you do read the book, anyone who reads the book will see. He really is actually the hero of the book. This is what he does. He fixes things and certain things he couldn't fix, obviously the medical side, but boy did he show up and we decided together this is what I would do. And yes, there would be a lot of scarring involved. I used my stomach fat and muscle from having cranked out four kids in six years for the reconstruction. So there was going to be a lot of my body involved in this. And again, I didn't run it by Phil and say, "How do you feel about that?" because I just knew that he was the kind of person that would never... that would be like number 70,000 on the list of things that are important. I'm important to him. And so there wasn't a lot of discussion about if it was more, when is the right time to do this? It was a decision to move to London that woke me up and said, "Okay, let's give myself time to heal afterward." And as it turned out, it was good. I didn't wait any longer because had I waited longer, my prognosis might have been worse.

Amy: Okay, so then you had your surgery and you had a reconstructive surgery...

Gila: All at the same time because it was at the time. Yeah, it's called a TRAM flap. They don't really do that anymore. Now they do a DIEP flap, which is more microstructure where they remove the stomach fat and muscle and then replace it with reconnect all of the nerves and vessels. Mine... I can't make the camera show you the whole thing, but it looks like I had the world's biggest C-section, which ironically I never had. They took my stomach fat and muscle and tunneled it up under my midsection and brought it back out here for boobs. So my midsection's pretty numb still today, 16 plus years later, I have a big hip to hip scar and gave me a very natural look. But 15 years on, there are some issues with it where things start moving around and there's scarring, but they don't really do that method anymore.

But that is what I opted to do, and I like the fact that the reconstruction happened at the same time. I didn't have to go back in for implants and expanders and filling them with saline and whatnot. And it was really fortunate that I did have it all done in one go because I thought the next move was going to be me recovering in a chair for six weeks with nobody bothering me and just living my best painkiller life. And a few days after the surgery, as I lay there with drains coming out everywhere and in quite a lot of discomfort, my surgeon called me and said, "You're not going to believe this. Your pathology came back and we found two tiny cancers in one breast. You saved your own life," which then led to another surgery to explore my lymph nodes, assuming there'd be nothing in there. There were micro metastases in there, so we caught it as it was happening. But again, instead of following the trajectory of major surgery, healing, never think about it again. It was major surgery, more surgery. "Uh oh, found the cancer," eight rounds of chemo over six months, and then my ovaries out to ensure that there was no more estrogen production, which of course is closely associated with breast cancer. The type of breast cancer I had was also estrogen positive... Estrogen's not my friend. Then two months later we moved to London. So not the year I was planning, but that's the year I got.

Amy: And you went into menopause, so tell me about that.

Gila: So it's interesting, I'm 51 now and all of my friends are in the throes of menopause. And on the one hand I'm kind of kicking back a little bit arrogant like, "Oh yeah, I remember those days." But fun fact, there are a lot of symptoms that show up that have nothing to do with estrogen necessarily. I'm getting foggy brained and mixing up words and putting my car keys in the freezer and maybe I should have that checked out. So menopause is not only the stop of estrogen, but my ovaries were removed and that did completely bring to a grinding halt my estrogen production.

Amy: Did you only have your ovaries out or did you have a full hysterectomy?

Gila: Only ovaries. Only ovaries at the time. I can't say that I noticed a lot of symptoms because I think the chemo also has a lot of similar symptoms. It stopped my period, it gave me hot flashes. I remember feeling hot and cold all the time, so I was coming right off the chemo, right into the ovaries being removed, so I couldn't really distinguish between the side effects. What I do know is that psychologically I felt really empowered by having my breasts removed because it was my choice and I brought that to the table and was really proud of my decision to do that. Whereas the ovary removal felt... of course it was my choice. I could have said no, but I felt a little bit more backed into that and eventually I would've had them taken out anyway because of my BRCA1 status.

But I thought I would do it at around 40, maybe closer to the typical menopausal age or perimenopause. It was emotionally harder for me to have the ovaries removed. I associated those more with my femininity and my ability to bear children than I did my breasts. My breasts were... I'm finished nursing. The kids don't need these anymore. Plus now I have nice perky new ones. The ovary removal was more emotionally difficult and actually came with its own side effects... it's a laparoscopic surgery, but I remember this agonizing pain afterward of the gas moving through me and the air moving through whatever it was. I think because it was a decision that was sort of made for me and not so much one that I made, I viewed it differently.

Amy: It's really fascinating. It's really fascinating and not intuitive for me because, and I think women will react differently to that one because breasts are outside and so they're like, everyone sees them. And people I think in general associate our breasts with being really feminine and that you can see them and you show them. And even when I'm getting dressed, am I showing my cleavage? Am I not? And certainly our breasts change with our age, and if you have children, they deflate. They're so different. I was having a procedure done yesterday, actually not a procedure, like a scan, and I had to wear an open robe and the woman was like, "Do you want to close your robe?" I'm like, "What do I care? I've had three kids, whatever you've seen." She's like, "Oh, that's so interesting. I'm really shy." And I said, "Oh, I have three kids, whatever you've seen." She's like, "I have five, but I'm still really shy." And I was like, "Oh, that's interesting. Maybe I grew up with sisters." And she was like, "No, I'm just really shy." And I was like, "Oh, okay." And I thought to myself, that's so fascinating to me. These things are like they aren't what they used to be. I don't care if she sees them. And so I think of breasts are so part of our womanly figure and when I want to feel sexy, I'm quite conscious of how my boobs look, let's put it that way.

But my ovaries, I feel like they're so hidden inside. I don't really associate that. And I've had my fallopian tubes removed because actually newer research has shown that the majority of ovarian cancers start in your fallopian tubes. In fact, 98% of ovarian cancers start in our fallopian tubes, which is new research that a lot of women don't know about. In fact, even in the medical community, which is a really easy surgery to have, it's done laparoscopically. But interestingly, same thing, after you have them done because of all the gas they pump in you to separate your organs, you really feel it afterwards, right? It's weird. You have this... it's a bloat you can't really describe and you feel like your organs are moving around for a few days afterwards.

Gila: You feel like Violet Beauregarde in Charlie and the Chocolate Factory where she starts expanding and becomes this big sphere. That's what I thought. I was going to start floating away.

Amy: Yeah, it's terrible the way your doctor explains it to you. He's like, "You might be a little bloated afterwards because of the gas, but it's fine." And you're like, "Oh, okay. I'm going to be a little gassy. I'll just toot it out." It's a different kind of situation. You're not going to fart three times and be fine. It's a very invasive gas. It's not like you ate too many beans. It's a different situation.

Gila: Yeah, it's hard. It's like when you're giving birth, you're going to feel a little pressure. I'm like, "Is that a little pressure? That's more than a little pressure."

Amy: That's pressure. That's like smashing.

Gila: You should look up "little pressure."

Amy: And so I understand that point of view. And so I get it that it's invasive and it feels different. And so I understand the counter intuitiveness of that... it didn't feel like it was your choice. And it also felt like, "Wait, you're in my insides removing something." And that something takes away your ability to be fertile. And I also remember even when I had my fallopian tubes removed, they had to stop before they did it and make sure I signed this other form... almost signing my life away that you're going to be infertile multiple times. It was like, "Wait, don't wheel her in yet." And I was like, "I get it. I know I'm done."

Gila: I'm good. It's just the lawyers being lawyers.

Amy: That's what they do. Totally. But it was such a thing. They don't do that when you're going to have your breasts removed. They're like, "Are you sure? Are you sure?" I understand where you're coming from, even though maybe you wouldn't think that at the beginning, if that makes sense.

Gila: It absolutely does. I actually had never thought about the internal external aspect of it. But again, for me it was less about the body parts themselves. And you're right, the breasts are very outward and for better or for worse public facing and the ovaries... who sees those, who thinks about them. But it was more about the circumstances under which I made these decisions. And I can say also that there's a religious aspect to it. I'm an observant Jewish woman. I grew up in a Sabbath observing kosher home, and we've raised our family that way. And I write about this in the book, and it was difficult to write about because I wanted to write about it authentically without over explaining or making it weird. But I used to go to the mikvah, which is a ritual bath.

And that is something that a married woman does as sort of a purification ritual. It's actually quite delightful. It's like a spa... plunging into a little pool once a month at some point after our periods are done. And I actually used to resent having to go once I had kids because it's hectic, who needs one more thing to do? And the fantasy was like, "Oh, I can't wait to be done with all this when I'm in menopause." And there I was at 35, be careful what you wish for. And suddenly this thing that I would've been happy to cast aside became rare and precious to me. And I can still remember and I write about it quite poignantly. That was a difficult passage for me to write... that last time ever that I went to the mikvah and understood it was going to be my last time. And there's that association too. So even though ovaries and tubes are such a tiny little thing, they're actually quite powerful. I mean, that's the source of our estrogen, that's the source of our womanhood.

Amy: And it's the ability to give life. I mean, it's a really powerful piece of our body that we have that men don't.

Gila: Estrogen giveth good hair, giveth skin, giveth sleep, giveth estrogen, and estrogen taketh away. But that's an interesting question. I'd never considered that aspect. So that was cool to talk about.

Amy: How have you been faring... hormone replacement therapy?

Gila: Well, I haven't because I'm not allowed to take hormone replacement therapy. I had estrogen positive, HER2-negative breast cancer. So after my ovaries were removed, that's what they refer to as hormone therapy because they're changing your hormone status. And then I went on something called Arimidex, which is a very low dose pill that squashes any remaining amount of estrogen in your body. There's a gland... I forgot where in the body it is, that still produces some tiny amounts of estrogen, I guess like a backup system. So not only were the ovaries removed and that production was stopped, but the backup factory was squashed as well. And I was supposed to take that first for five years. Then 10 years, I just finished the 15 year mark and my doctor and I agreed that in the cost benefit analysis, it was okay to stop taking that. So there has been no hormone replacement therapy. I'm just a very strong-willed, strong-minded person who has somehow gotten through.

Amy: How have your other hormone levels been?

Gila: Pretty normal for my age and station in life, pretty normal. At 50, I did go see a doctor about it to find out what's hormonal, what's just aging. I don't know what's normal because everything happened off schedule for me. Are you on HRT? How's that going?

Amy: I'm not. I'm at the height of perimenopause, which you sort of bypassed in many ways. It's awful. And I was taking hormone replacement for a little bit. I have migraines and somehow I was taking progesterone and the progesterone was skyrocketing my migraines and they were through the roof. So I went off it for a while. So right now I'm not on anything, but it's not great.

Gila: Well, this is it. It's constantly a balance with women's health, and I'm so happy that it's getting so much more attention and it's in the news and people are writing books about it... there's huge Instagram accounts about it addressing all of these million little things that we as women have suffered with because we're strong and we're tough and we can, but if there's something we don't have to suffer with, then we shouldn't. I remember when we moved to... I'm still in London now. I split my time between London and New York. At this moment I'm in London. And when we moved here, I was still wearing a wig and a hat and nobody knew. It looked kind of natural, but I was dealing with a lot of things and I noticed that I just wasn't sleeping well. I used to sleep pretty well. And it wasn't just having little kids thing where they wake up at five in the morning. I really wasn't sleeping well. And I suffered with that for probably three or four years till I finally went to the doctor here and I said, "I'm not sleeping and I'm losing my mind." And she was horrified that I hadn't come to her sooner and hadn't thought to get help because I don't have estrogen. Of course, I'm not sleeping.

So now I've been on prescription medication. It's not exactly a sleeping pill, it's more of an anti-anxiety, but it serves as a sleeping pill and it gets me to sleep. And in many cases it keeps me sleeping. As of late, there's been some breakthrough... needing to go to the bathroom at three in the morning. Okay, that's normal, but I can always increase the dose a little bit. But I remember so clearly sitting in her office and her asking me, "Why did you wait this long? Why have you suffered?" And I think this is what we do, that we just bear it and we bear it and we bear it until we can't bear it anymore. And it doesn't have to be that way. So whatever symptoms you're experiencing, I hope that you find another way around it. I hope you find another solution because yes, the migraines are worse, but why should you have to suffer with God only knows what you're suffering with?

Amy: Oh, a hundred percent. I mean, I do. And I mean, I'm like the advocate on the same level as you. And I agree. And that's what I constantly am telling women is... and we're like that a hundred percent, which is why I think your story and what you've been through is so... it's so great that you're telling it on such a huge platform because so many women don't do all the things that you've done. So many women don't take their own health and wellness in their own hands and don't deal with it and are not proactive. You said at the very beginning, you don't wait for things to happen. You don't do that. You're proactive. You're the opposite of that. And in general, women don't do that. We sort of wait and we put everyone else first and we put whatever's happening in our life kind of on the back burner. That's just in a lot of ways, that's our nature as women, especially women with a lot of kids and a busy life and women... I've lived a similar life as you have. We've moved a lot. We travel a lot. And that's just the way it goes. But if you can't be healthy, if we're not healthy and we're not putting our mask on first, everything else crumbles. It's not just about being healthy, it's also raising the bar on the level of comfort and what we're willing to tolerate as well.

Gila: I'm out there banging on about "Feel It on the First." I have this campaign. I love it. "Feel It on the First" where every first of the month I show up with a picture of myself, and it's designed to make people smile and laugh because I want to break the fear and break the stigma and get the conversation going. So I'm holding two bowls or two balloons or two...

Amy: Basketballs, beautiful flowers. You just did flowers.

Gila: Donuts on Hanukkah, whatever it is. And I've created... it's led to this real community of women from around the world will send me their own DMs of, "Oh, I saw this. I saw two water towers and thought of you." Or "My kids' breakfast was on the table, and before I went to cut the pancakes, I left and took a picture." It's getting into their subconscious. It's becoming more a part of their thought process. And for me, it's always a part of my thought process. But I want people to first and foremost think about breast health, which will then lead to checking breast health, which will then lead to action. It's hard to get someone to go schedule your mammogram, do your self exam, do this, do this, do this. Whereas if you can make somebody laugh or smile, that's a much better delivery system to get into their brains and then it will seep in. And I get DMs all the time from people saying, "Thank you for your 'Feel It on the First' campaign because of your posts. I check myself, and I never used to do that. And because of your posts, I check myself, I found something and I went to the doctor."

And I'll always tell them, "Please, if you don't mind, keep me posted. Let me know how that goes." And they'll write to me some weeks or months later. "Everything's fine. Just want all clear." I don't know these women, but I care. And I want them to understand that they have done something on their own that's very powerful and very lifesaving because less frequently, but still sometimes I get that same message trail. But it ends with, "And we found something and we caught it earlier, and I wouldn't have caught it earlier if I wasn't busy thinking about you holding up two dinner plates to your chest or disco balls or whatever it is that I do." And I just want to keep it as part of the conversation without making it terrifying or overwhelming. It's just... we go to the dentist, we check our teeth, we check our eyes, we check lots of parts of ourselves. We have our cars checked, we have our homes inspected. Your breasts are a separate part of you, and it is easily detectable. And as you know with your mom, the difference between... she had stage three ovarian cancer, the difference between detecting something earlier versus later is the difference between...

Amy: Life and death.

Gila: Life and death. And I think you and I grew up around the same time, and I think if you remember on the backs of all the doors in our... usually it was in the PE locker rooms, there used to be those posters of girls checking your breasts. And then they all went down because it was decided that it was too many false positives and too many false negatives. And it's such a shame. And it was a national campaign of how to do a self breast exam. And somehow, for some reason... I don't want to say the NIH or the NCI, it all went away and it was something you just stared at when you were going pee. If you remember... in my high school, it was when you were in high school, you would just be going to the bathroom. You'd look up and you'd be like, "Oh, okay. That's what I need to do." And it was a huge part of just health education growing up. And girls don't grow up with that anymore. And there's this sense of a couple things... one, it's just not part of your health education. And two, there's also this, "I'm not doing that. I'm not going to touch myself or I'm not going to be comfortable with myself in that way," really. Which is sort of interesting because girls nowadays are so comfortable with their bodies and there's such an idea that they can wear anything and walk around half naked, which I find sort of interesting, but they won't touch their boobs.

Gila: Where are you hearing that girls don't want to...

Amy: There's a young... it's not like twenties and thirties and 40 year olds, but it's like a young teenage thing, like teenagers into their late teens and college. This sense of self-breast exams is not a thing. It's not like a norm thing that they're... it's not a normal thing that they do once a year, once a week, once a month.

Gila: Look, I will say that at that age, it's still pretty young, but by...

Amy: 17, 18...

Gila: By your twenties, you should get to know your body. And as I like to explain to whoever is in my line of vision and whoever I can ensnare, it's not about looking for something, right? We know it's about just getting...

Amy: No, it's about knowing your normal. It's about knowing your body. It's about understanding what feels, looks, and seems like your norm a hundred percent. What are the signs and symptoms that are outside that norm?

Gila: You've had Dr. Elizabeth Komen. Dr. Eleanor Linsky has a terrific TikTok and Instagram, Robin Roth of The Booby Docs. There's so many good, reliable resources for breast cancer information and breast health that I'm actually envious of this generation, the next generation, that they can look up any granular detail of what they need to know. Often they can DM these people and they'll get a DM back because there's real people behind these accounts. So I'm hopeful for where things are headed. Every time I read an article about some new innovation, new breakthrough, new technology, new... this dog can sniff if you have cancer, like, "Okay, let's all get that dog. That's cool." Yeah, there was some AI technology that was able to determine five years before you would've been diagnosed at risk of or prone to cancer. I do think we're heading in the right direction. It would just be nice to see these things implemented more quickly.

Amy: Yeah, I agree. I think there's so much information out there. I think it's guiding people to the right place, and hopefully they're going to those right places. I agree. I think there's an incredible amount of information out there, and there's really, really good information.

Gila: Well, speaking to people like you and me who've had our own personal experiences, not everybody wants the medical side of it. I've been on panels with geneticists and breast surgeons, and I'm the regular person. I'm the like, "Hey, I don't have a medical degree, but I'm going to tell you my personal story and what a regular person did to save my own life. And here's what you can do too." And often women want that... to meet people where they are and not in this big, scary medical environment. And both sides of it are really important.

Amy: They a hundred percent are. We've done a number of events where someone like you has come and spoken alongside a doctor, and it's very powerful and it's very important. And it's humanizing... anytime you want, my wheels in my brain are turning a hundred percent. So I just want to end on... tell me about how you wrote this book and what your process was.

Gila: Yeah, I still haven't come up with a solid answer to how long did it take me to write it? It depends where you count from. Do you count from 16 years ago when I was in my oncologist's office thinking, "This is crazy. I'm going to write a book." Do you count from when I bought a new laptop seven years ago and said, "This is going to write the book for me," or do I count from when I got really serious about it and started connecting with an audience by starting a public blog and public Instagram. I can tell you that I've been wanting to write this for a very, very, very long time. And lots of people perhaps want to write a book, but writing a book is not publishing a book is not marketing a book is not selling a book. They're very, very different things.

And it took me a very long time to figure out the path to turning my story and my passion and what I wanted to say and the tone in which I say it, which is equal parts... it's heartbreakingly hilarious. I don't know how to be any other way than funny, but I was always very careful to balance the humorous side and the moving side. I never wanted to be too flip about something, but I never wanted to become morose. So I was always checking myself to make sure that... on a BOSU at the gym, like teeny tiny little adjustments, make sure that you're packaging it just the right way. You're saying it the way you want it to land. Finding people to read your stuff is key because whatever you think sounds great, may not. So I made friends with some wonderful, amazing writers.

I actually worked with a professional writer who helped me with a proposal because again, I have a very voicey style of writing, but writing a proposal, which includes chapters and an outline and a marketing plan... like publishers want to know how are you going to physically actually sell copies of this book? She helped me really put out a polished 80 page proposal, which landed me an agent. And actually the book was originally called "Great at a Shiva," which is one of my chapter titles. I am really great when I go to a shiva, which is a Jewish house of mourning. I know what to say, I know what not to say, I'm your wingman. Call me, I'll go with you. She suggested that we go out with a more accessible title that wasn't necessarily so niche and specific to the Jewish world, and I agreed with her.

So when you said you liked the title at the top of the show, I was like, thank you. I blew through about a hundred different title options before landing on that one. And ultimately I learned that writing a book is so hard and not for the reasons you think... it's just physically hard. I slipped a disc just sitting all the time. I was hunched over my laptop till three in the morning. But what I can tell you is that I am going to hold it up now. I'm really proud of the book I've written, and that's saying a lot because I think I could easily have been, and maybe some writers look at what they've done and look back and say, "Oh, I wish I would've changed that sentence or written that differently." I wouldn't change a word. I've read this book and every time I read it, I'm proud of telling the story the way that I wanted to tell it.

I'm grateful that I had a publisher that let me tell the story the way I wanted to tell it, and that my editor Mira Rosenblum, really, we were on the same page. She really understood what I was trying to get at, and she was ruthless about saying, "Cut this out, this doesn't matter." The whole first chapter went and she was really right about telling me where to start the book, which is when I was 18, and where to take it in for a landing. When do you stop writing a memoir? Right now? And now I'm writing the end of my memoir right now in this moment. Every story needs an ending. And she was phenomenal. And I'm really also pleased with my cover. I love my cover, and I know so many authors who maybe don't love their cover so much and their publishers aren't perhaps as accommodating or flexible. And mine really, really listened to me and went through so many iterations until I got the cover that expressed my tone, my story, really encapsulated what I wanted to say. So the process was expected in some ways, surprising in other ways, really, really hard. I don't know any other way to say it. When people say, "Oh, marriage is hard work." You don't know what that means until you get married.

Amy: You don't know what it means until you're married for a long time and you stick with it and you work through the hard shit.

Gila: We're about to hit 26 years, so it's hard work.

Amy: We're about there at 25.

Gila: We're literally the same person. We're twins.

Amy: I want to ask one last question. This might be really emotionally deep, but I've been thinking... this is a question I've been really deeply thinking about lately, which is, for me, it's this foundation that I've been running for my entire adult life. And for you, I think maybe it's the book and everything you've been through... did this process also help you learn about who your mom would have been had she lived in some ways? Does that make sense?

Gila: That is such a profound question. Needless to say, I've had to think about my mom a lot. She's been gone for 31 years, so she's been out of my life for much longer than she's been in it. And my memories of her are really frozen in time, and you can only read the same letters and notes and look at the same photos over and over again so many times.

But I harbored a lot of anger and resentment towards her, certainly at the time she was diagnosed and died because I felt that she could have done more to be proactive and preventative. And in writing this book and in speaking to her friends and researching it... the research for me was speaking to people who witnessed it, my friends, my parents' friends, comparing my version of the stories to theirs, learning new things that I had in small, quiet moments that gave me some insight into what my parents were... the journey of this book for me was also about finding a way to find compassion for her. And I don't think forgive is the right word because she doesn't need my forgiveness, but to find a softer way now that I'm a mom and that I am... I've outlived her by nine years already. It has made me wonder what could have been, what kind of grandmother would she have been, how would my kids have benefited from having that grandmother around? And I take it from you asking it that you've thought about this a lot too. So I think... again, it's more now, actually.

Amy: For me, it's been more this year crossing the line into living past the age she was diagnosed with cancer. I'm not older than she was when she died yet... she was 53 when she passed away. But I'm trying to learn about who she would've been had she lived. And that's been this really interesting piece that I've been thinking about a lot.

Gila: I try to think about what it would've been like to text her. You see all these... there's so many social media accounts where Jewish moms text their daughters, or people will write tweets or threads about texts I get from my mom, and it gives me a little bit of a pang like, "Oh, my mom never even had a cell phone. What would that have been like to just have casual, ongoing text-based conversations with my mom?" These are some of my most meaningful interactions with people in my writing community, in my family, my friends overseas. What would that have been like to have that... sharing photos and memes, and "Does this dress look nice on me?" The kind of relationship I have with my daughter. But when I think about what she would've been like now, I can't even picture her in this world. The world is so rapidly changing that what would she have been?

Amy: That's the piece that I try and ponder. Who would she have grown to be in the second half of her life? What kind of relationship would she have continued to have with my dad? And your dad passed away too, which is horrible. And the person he became was quite different than the person that I think he was. And I guess in my own personal little bubble, I think about what you just said, what kind of grandmother would she have been and all the events that she's missed and I would've been a part of and in my life with my kids and my husband, who she never knew. I mean, all these things and how would she have traveled and would she still live in the same house? All these things... what would she look like, I've thought about that a lot. And then deeper, if she had known things that we know that you and I have really dove deep into preventive care and learning and genetics and things that we can control.

And I always say, there's so much you can't control. There's things that happen that you can't control, but there's a lot we can and that we should and really learn about and take control of your health and wellness in the percentage of life that we can. And so there's pieces that she ignored a lot of signs and symptoms that she was dealing with, but there were things that she could have. But I was too young to have those conversations with her, and I certainly wasn't thinking about it at 16 years old. So all those conversations, and I do think about it, and I don't think about it in an angry negative way, but I think about it in a way of what would it be like now?

Gila: You're wondering... it's almost like a fantasy and wondering in a way, to make the rest of my life more... continue to be more positive and instill those lessons into my kids.

Amy: Yeah, definitely. And all the things that I would've wanted to make sure that we do... it's not to take any of that for granted. I think that's part of the gift that I would trade in a second, but I don't take lightly that gift of never taking any of that for granted, for sure.

Gila: Yeah, I was going to say, it definitely fuels me to transmit more information and more values and have more potent, meaningful conversations with my kids because I'm like, I know what I've missed out on. I'll never know what kind of adult relationship we would've had. We didn't have a great relationship by the time she died, but I was just coming out of my awful teenagehood, and what could we have been? That's what I do wonder about. I wonder what relationship we would've had. And it makes me want to try my best to have a better relationship with my own kids, two of whom, almost three of whom are adults, and the youngest of whom is almost an adult. So we're in that era now.

Amy: Well, thank you. This has been really lovely on so many levels.

Gila: Thank you. We're going to keep talking offline. I'm telling you we need to go to dinner or something. This is not done.

Amy: I would love it. You have so many wonderful, amazing things you've put out in the world, and this book is phenomenal. I hope everyone reads it, whether you've lost someone or not. It's deeply resonating and funny and witty, which is really a wonderful way to get a deep message across. So thank you for writing it and thanks for coming on.

Gila: My absolute pleasure. Thank you.

Amy: Thank you.

This interview has been edited for length and clarity.