Breast Cancer: An Unexpected, Yet Common Journey

 

I wasn’t thinking about Breast Cancer Awareness month when I scheduled my last mammogram. I took the next available appointment and forgot about it until the day came in early October. By then Breast Cancer Awareness month was in full swing. There were pink pumpkins among the apples at the grocery store and pink ribbon adorned exercise clothes on the shelves at the gym. I didn’t need all this pink to convince me to get a mammogram. A faithful adherent to the breast cancer screening guidelines, I had been getting stretched, twisted, and compressed every year since I turned 40. I was not going to let any cancer cells infiltrate my breasts without me knowing about it.

On the day of my appointment, I brought my laptop with me to the hospital, prepared to settle in for the afternoon. Mammograms only take about 20 minutes, but when you add in registration, changing into something less comfortable, and the possibility of needing additional images —10 percent of women do—it can take significantly longer. Ever since I’d been flagged for a “benign abnormality” in a previous mammogram, which resulted in two more appointments and a biopsy, I’d opted to stick around for same-day results.

Sticking around turned out to be a good choice. The radiologist reading my images ended up ordering additional views. After viewing them, she recommended a biopsy to assess a suspicious cluster of microcalcifications in my right breast. I wasn’t too worried; I knew that 80 percent of biopsies are benign. I had been one of the 80 percent just two years before. However, when my radiologist called me two days after the biopsy to let me know that I had early stage breast cancer, I was shocked. I wrote down everything she said because, although I could hear her calm and reassuring voice, I wasn’t taking in what she was saying. After hanging up, I tried to make sense of what I’d written down:

I had cancer. How was this possible? I didn’t have a family history of breast cancer or the BRCA gene. I’d nursed my kids, got regular exercise, didn’t drink much alcohol, was not terribly overweight, and maintained a healthy diet. This was not a good time for cancer. I had just started a new job, my husband was changing careers, and each of our daughters was transitioning. This cancer was curable. The treatment was likely to include surgery, radiation, and hormone therapy—no chemo unless the cancer had spread. I’ll be fine. This doesn’t have to be a big deal. We just have to get through it. Right?

cancer-390322__180Things move fast when it comes to a cancer diagnosis. During the next few days I had chosen and met with my surgeon, in whom I had full confidence. My brother had nicknamed my cancer “Isis,” and it had stuck. I was scheduled for an MRI and mammogram to determine whether Isis had spread and to locate the pink-ribbon marker embedded in my breast that identified the cancer site—it was hidden behind a lime-sized hematoma, a byproduct of the 14-gauge spring-loaded needle used in biopsies for non-palpable cancers like mine. We also had a tentative date for the surgery and appointments lined up with the rest of my oncology team—who knew it would take a small army to get rid of a little cancer? Thankfully, the hospital scheduled all of these appointments for me. I just had to rearrange my life and find time for what was quickly becoming a part time job.

Although everything was going according to protocol, things were not going according to my plan. In my mind, this cancer thing wasn’t going to be a big deal, but I already felt overwhelmed. The week before, I had been healthy, enjoying a new job, and managing my daily life. This week I had cancer, was canceling business trips for doctor visits, and was flummoxed by the decisions in front of me. Mastectomy or lumpectomy? Four or six weeks of radiation? And what about hormone therapy? What would it be like to have the estrogen sucked out of my system all at once? On top of it all, it was Breast Cancer Awareness month; pink-ribbons reminding me of my diagnosis were everywhere.

My plan also didn’t include the incredible outpouring of support and concern from friends and family. Somehow I imagined that since my cancer was curable, we’d just handle it on our own. When beautiful flowers, homemade meals, and favorite books began arriving at our door, we were deeply comforted, knowing that we were not traveling this journey alone. However, their kindness also made my cancer very real. While we had met with multiple doctors, at that point I didn’t feel sick and hadn’t started treatment. I didn’t fully appreciate what was in front of us. I also wasn’t sure if I had “enough cancer” to warrant this attention. And then there were the thank-you notes…

Two cancer survivors put me at ease. One shared that in her experience, “Cancer gets easier once you make peace with it.” The other, a friend who had survived breast cancer three times, gently said, “Lisa, you were diagnosed with cancer. That’s enough. Besides, people are not here for the cancer, they want to be here for you.” They also assured me that cancer patients get a temporary pass on thank-you notes.

When you have your pre-surgery MRI, you hope that you the contrast dye injected into your body doesn’t reveal additional cancer sites. Fortunately for me, it didn’t. As a result, a lumpectomy was in order; the following week we’d remove Isis and leave some of my right breast intact. Our family celebrated with a weekend in New York where we toasted the upcoming surgery with Shakespeare’s highly apropos phrase, “Out damn spot.”

I enjoyed a walk with a good friend the morning of the surgery before heading to the hospital for a breast wire localization. Using real-time images from a mammogram and ultrasound, my radiologist inserted a wire into my breast that would guide my surgeon to the right spot. The last thing I remember before going into the operating room was laughing with my surgeon and anesthesiology team and kissing my husband goodbye.

A week later we would learn that the surgery had been a success—Isis was gone. I would have a month to heal after which time our focus would shift to cancer prevention. One of my favorite days during that month was when our 16-year old daughter’s girlfriends visited. They were wonderfully genuine and curious, wanting to know how I was feeling and “what was left of me.” I told them that I felt great, albeit a bit tender and showed them the bandages that would keep the “new me” under wrap for a bit. Their real talk was balm.

I began radiation the Thanksgiving week.   My radiation treatments took place in a linear accelerator, which delivered high-energy x-ray beams to my chest, destroying any remaining cancer cells. For five weeks, I spent 6-8 minutes a day, 5 days a week, in this large piece of equipment, which was located in the basement in a room with walls a foot thick.

radiation-646213__180Radiation is a very precise undertaking. To facilitate radiation treatments, I had five permanent dots tattooed onto my chest that would enable the technologists to adjust my body to the exact right location. Once perfectly configured, they would instruct me not to move and they would leave the room. Invariably some part of me would begin to itch. Immediately after the door shut behind them, red lights would flash, clicking noises would commence, and the arms of the machine would start to move around my body, nailing “the spot” with radiation from several angles.
My first day of radiation, I decided I would be “fully present” during the treatment, taking in everything that was going on around me. Rather than being lost in blissful meditation, however, I panicked. My mind filled with images of Chernobyl and flashbacks of atomic bomb drills in fifth grade when we made our way to the “radiation-free space” under our desks. What was I doing choosing to be radiated, when my cancer was gone and my gut was saying, “This is not a good idea?”

The next day I tried reframing radiation in a more positive light. I focused on how grateful I was that this treatment was decreasing my chance of getting breast cancer again. I tried to envision the radiation beams as healing light. That strategy worked until the machine started moving and the radiation became audible and I went on high terror alert again.
By day three I decided that they way for me to handle radiation was to completely anesthetize myself to it. This time I closed my eIMG_0025yes before the technicians left the room and had them blast country music. And by blast I mean, in-the-pit-in-front-of-the-band loud. It worked. Three songs and the treatment was over. I’d found my strategy.

While the beginning of radiation was tough psychologically, the final few weeks were physically challenging. By week four I was burned, blistered, itchy, and exhausted. By the last week, I just wanted to ring the bell that signified that my radiation was done, and go home.

Ironically, some of the most potent healing moments took place outside the linear accelerator. My weekly check ups with my radiation oncologist always left me feeling cared for and understood; we had helpful talks about managing work, family, friends, and cancer. In the waiting room on my first day, I ran into an old friend who was also starting radiation. We had the good fortune of going through this portion of our cancer journeys together. I learned much from being with her, and from others who showed up around the same time as we did every day, people who were working overtime to find the bravery, energy, and positivity to get through their treatments and embrace whatever life held on the other side. I’ll never forget the notes that former patients left for us that read like liturgy: “I just finished 7 long months of treatment­ and you will be here one day, too.” “Be strong.” “How big is your brave?” “I have plenty of hope. I just need a cure.” And a personal favorite, “Cancer, I hate you more than the Yankees.
It’s almost Thanksgiving.  Radiation is behind me and I recently had my first cancer-free mammogram! I am also in the first nine months of hormone therapy. The cancer I had feeds on estrogen, so we are cutting off its food supply with an estrogen-suppressing drug. While about half of women tolerate their rapid reduction in estrogen well, the other half are often brought to their knees. I am one of the latter. Just when I was ready to give up on it, a friend of mine cautioned me that she wished she had stuck with it; her breast cancer came back four years later. So I’m still pill popping and actively finding ways to reduce the symptoms.

I was wrong about cancer. This unexpected journey has been a bigger deal that I ever imagined. We are still managing the effects of the treatment—and benefitting from the gifts—almost a year later. For starters, I am cancer free! We’ve also tasted the energy that is unleashed in acceptance, the strength and comfort that comes in community, and the confidence that comes from a highly competent and thoughtful medical team that really cares. These benefits continue to infuse us with newfound resources that continue to heal us in unanticipated ways and that will accompany us into the future, wherever it takes us.

This post appears in Wellesley Weston Magazine

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