Sharing a Story with Angelina Jolie

Photography by Annie Liebovitz for Vogue

Somehow I never thought I’d be writing a post about Angelina Jolie.  And while I loved how tough her character was in Salt, I’ve never imagined lauding her in a public forum for her toughness.  Last night I tried several times to start a post about my surgery—trying to figure out how to share the process.  It’s a strange thing to share with a big audience.  I’d type, I’d delete.  I’d type again, let myself get distracted, then I finally gave up and headed to bed.

I woke up this morning to emails from two friends who’d already seen the news—the first complimenting me on being ahead of the trend yet again.  The second, from a friend who walked this road before me, commenting that we have been preempted as the cool faces of breast cancer. Reading Angelina Jolie’s op-ed piece in the Times about her decision to have a double mastectomy and reconstruction left me in unfamiliar territory– I’m truly impressed by this celebrity.  Granted, I’m sure someone helped her find the eloquent words to share her story.  But still,it’s her story, and it’s not an easy story to share.

My story is not the same as hers.  I did undergo the same genetic testing, not because of a strong family history, but because I was diagnosed with aggressive cancer as a young woman, and I was so thankful for the negative result.  And the story of my surgery is not identical to hers, either.  My trip to the surgeon was not by my own choice, it was a medical necessity.  But while surgery was necessary, the decision to have a bilateral mastectomy was mine.  It is not a decision to be taken lightly, but one that I never questioned.  Last night I was searching for the words to explain what I went through without being graphic and without sugar coating it, either.  It seemed important to share that first and foremost, reconstruction following a mastectomy is a process.  The process is started during the original mastectomy surgery, but it’s not complete for months, after weekly or biweekly appointments with a plastic surgeon and between one and three more surgical procedures.  In her piece, Angelina Jolie (what do I call her? Angelina seems too familiar, Ms. Jolie sounds ridiculous.  AJ, maybe?) also debunked one big fear from years past.  This surgery does not leave one deformed, it doesn’t steal a woman’s beauty or femininity.  A talented surgeon can achieve great results but it takes time and patience.

I talked before about the fact that I did the genetic testing early on after my diagnosis.  AJ mentioned the great cost of this testing and the fact that cost makes it inaccessible to many.  While I don’t think that it’s fair for companies to make obscene profits at the cost of someone who is sick, I can appreciate the work that sequencing those genes requires, not to mention the cost that went into the discovery of the gene and the development of a test that can be run on nothing more than some mouthwash that’s been swished around a patient’s mouth for a minute or two.  But what AJ failed to mention is that not everyone needs this test.  In fact, not everyone whose mother or aunt or sister has died of breast or ovarian cancer needs this test.  Many large cancer centers have genetic counselors on staff who spend hours discussing cancer risk and the implications of a positive test with patients before testing will occur.  Some early fears of the implications of a positive BRCA test have dissipated (inability to get a job or insurance chief among them), but the decision to even be tested is not one to be taken lightly. And in the case of those who are truly at a high risk of being BRCA positive, many insurance companies will now cover the test.

Last night, as I struggled to write this post, I would have never imagined that Angelina Jolie would help me write it today.  But I think given a difficult circumstance, she made a good decision for the right reasons, and I applaud her boldness to share it.  Even as one who will never face the same circumstance, I appreciate that she had the toughness to share her story, and that she helped me share mine.

Perfect Timing

This has the potential to be a very long post.  We’ll see how this goes…

Of course, no one ever wants to get cancer.  I’m sure most people would say there’s no good time to get cancer.  But I have to say, I disagree on that one.  If I had to get cancer, I don’t think it could have come at a better time.  I’m so thankful that my diagnosis came after Turner was in kindergarten, having to get him to and from preschool would have made my schedule much trickier.  I was diagnosed at the beginning of the school year, which was also good.  The only part of my treatment that I won’t finish before they’re out of school is the final surgery of my reconstruction, and that can wait until September if I choose.  I’m so fortunate that I hadn’t gotten a job, full time or otherwise.  Staying at home gave me the opportunity to head to the doctor appointments and nap while the kids were at school so that I could try to keep things with them as normal as possible.

I think that staying active during my treatments really helped me.  I have to imagine that it probably improved how I dealt with the treatments, even if it didn’t make a difference in how those treatments affected the cancer.  Two years ago, I wouldn’t have been able to stay active during the treatments though, as the most active thing I did was chase around toddlers.  I’m not saying that’s not work, but it’s just been in the past couple of years that I’ve started running and working out in earnest. God knew what my body would have to go through, and  made it strong enough to withstand months of poison and the physical effects of surgery.

But there are other timing issues that I would have never imagined were at work, even years in advance. When I applied to graduate schools, I was not looking for a cancer program, I merely wanted a program that focused on translational science—science that would quickly (relatively speaking) impact patients’ lives and their clinical outcome.  Initially, Georgetown was not even my first choice, but the program’s affiliation with the Lombardi Cancer Center meant that most of their research was translational, and it was a very attractive program—no teaching requirements!  Many of the labs focused on breast cancer, and I was drawn to that research.  I began attending the Clinical Breast Conference where oncologists, surgeons, radiation oncologists and even researchers discussed especially unique breast cancer cases and which treatment courses would give these patients the best outcome.  I quickly realized that I enjoyed the interaction with the clinicians and patients’ cases (though of course I had no interaction with actual patients) far more than I enjoyed the daily intricacies of lab work.  Towards the end of my doctorate, I even got in touch with several breast cancer advocacy groups, hoping that I could use my scientific expertise to be an asset to their groups.  I was never able to secure a position with such a group, and when Emma Clare was born, I was happy to be able to stay home with her.

Probably the craziest timing ever?  The week after surgery I got a message asking me to get in touch with my graduate mentor, who I hadn’t heard from since just after my defense.  That was just after a delightful discussion with my oncologist who had encouraged me to find a way to work with a breast cancer advocacy group, telling me that my unique combination of education and experiences would make me an asset to any organization. I was able to tell my mentor that I had a clean bill of health, no cancer remaining at all, and once I had recovered I hoped to look for a job with an advocacy organization.  To my delight, she quickly responded that a researcher at Lombardi has started a volunteer patient advocacy group, and she thought I would be a perfect fit in that group.  After talking with the researcher who runs the group, I’m looking forward to my first meeting with the Georgetown Lombardi Breast Cancer Patient Advocacy Council at the end of the month!

I don’t think that God gave me cancer.  But I believe that he knew it would become part of my story, and I am amazed at how He arranged my circumstances so that I would be uniquely prepared to make a difference in the lives of breast cancer patients, doing something that I really enjoy.

Back in the Game

back in the game

Six weeks past surgery and I got the official go ahead—and I didn’t waste any time heading out for my first run.  Sally and I met up in Old Town and ran along the river.  I don’t know that either of us realized how much we’d missed that time until we started running.  Meeting at least weekly during chemo to run was so much fun, we caught up on a lot of things and solved lots of the world’s problems.  We weren’t fast—but ran the first mile pretty hard before taking a break to walk.  After we finished our four miles and stopped at Starbucks, I could already feel my legs getting sore.  But it’s a great sore.  In the immortal words of Sally, I’m back in the game y’all.  “Cancer can suck it.”

Take me out to the ballgame

ballgame

The Cardinals were playing the Nationals tonight, so we all headed out to Nationals Park to cheer them on.  Clay wore his Nats cap, but I’ve managed to make Cards fans out of the kids!  It was a fun game and the Cards won!  (Plus, check out the hair growth—it’s still super soft and fuzzy, but you can at least see a hairline now!)

Thank Goodness

It’s only been about a month since they all fell out, but my eyebrows and lashes are pretty much grown back.  Since they all fell out at the same time, they all grew back in at the same time, so I’ve even waxed my brows to clean them up a bit!  Such a relief—putting on those eyelashes really took some time and getting used to.  I liked the way they looked, but just slathering on a coat or two of mascara is so much faster!  And while I’ve really gotten to like using the Anastasia brow kit with the wax and two toned powders, the brow gel really is a lot faster.  I think I’ll probably go the wax/powder route when I’m really “doing” my makeup, but the gel is nice when I just want to throw on something quickly to get out the door.  Even better, I think that my brows have come in a little darker, so I don’t have to strain to see them before I get around to dressing them up. Gotta take the perks when I can. Speaking of which, my hair is still coming in, it’s so soft—Emma Clare loves to rub my head.  But it’s still so light, not quite white blonde, but so  much lighter than it used to be.  Now that I have super short hair and don’t have to spend ages on my brows and lashes, I’m finally getting back to a pretty low maintenance morning routine.  I could get used to this!

The Show and Tell Box

My friend, Marcia, and I have decided that the plastic surgeon needs a show and tell box in his office.  It turns out that when I didn’t know what to expect, my mind came up with something so much worse.  The drains were not nearly as bad as I’d thought.  They were really easy to empty and I only had to do it twice a day.  I could shower starting the day after I came home, and it wasn’t a problem cleaning around the sites.  It was harder to dress around them, they were pretty bulky hanging around my abdomen.  It was hard getting a straight answer about how long I’d have them.  I had three, and got one taken out each week after surgery.  Which means it was three long weeks with at least one drain.  But I survived and went out a lot, without looking like a total freak.  I think.  The incisions didn’t look so bad, either.  I didn’t have any bruising, and there was only a little discoloration where the dermabond (much like superglue) closed the incisions; there were no stitches.  And as soon as the dermabond started flaking off, there was nothing left but nice, pink scars.  The compression bra was probably as bad as I’d thought.  Big, ugly, and lace trimmed.  Velcro all down the central front closure and on the front where the straps which come up over the shoulders attach, which leads to some pretty ugly flaps that are bulky under clothes.  Wearing a scarf around my neck worked to conceal the ugly parts of the bra that no shirt could cover in the early days.  Later, I took to wearing a sports bra over the compression bra to keep the strap tabs in place so that I could at least wear a somewhat normal shirt.  I did get a compression bra at Nordstrom, the one suggested by my doctor.  But it turns out it wasn’t really as great a bra as I’d hoped, it didn’t provide enough compression in some places, and so it didn’t get a lot of wear.  Thankfully, though, I’m almost to the magic six week mark when I can ditch the compression gear all together.  Since that’s also when I can head out for a run and start building up arm strength, that magic mark can’t come soon enough!

Adding Insult to Injury

brow set

I mentioned it before, but within 24 hours of arriving home from the hospital, all my eyelashes and eyebrows had fallen out. Seriously? Somehow it never bothered me to go in public without a wig or even a hat, but it killed me to even go around my house sans lashes and brows. Thankfully, I already had a set of false lashes I’d bought in the fall (pre-cancer) to play with. They’re not easy to put on, but I got quicker with practice. Eyeliner became super important—lining first with a good dark liner (I used a liquid water proof liner by L’Oreal that I found at Target. Like this but waterproof) gave me a little room for error so that I didn’t have to be quite so perfect in my application. And that same eyeliner did a good job defining my eyes so that I could skip lashes on days when I just didn’t care enough to put in the time. The Anastasia brow gel that I loved to darken my super blonde brows didn’t quite do the trick once the blonde hairs were gone. So I headed back to Nordstrom and asked for their help. They pointed me to a different Anastasia product (brow express) that does a fabulous job of faking brows. It takes a while to do my brows since they don’t exist—using a stencil and several other products. But to me, it’s so worth it. And I can already see some little lashes and brows starting to grow back in, so hopefully the long process won’t be necessary soon.

Happy Easter!

2013-03-31 03.31.13 023

Family pictures in front of the flower cross at church are an annual tradition for so many, our family included.  After surgery it was hard to tie the scarf behind my head, and it’s starting to warm up, so I’ve decided to give up on head covering and just go bald.  My hair is starting to grow back, though it’s so light that it’s still pretty hard to see.  We had a great a day with Clay’s parents and friends who invited us to have lunch with them.  And how could you not have a blast with such a lovely little girl and crazy little guy?

Just Plain Excited

I emailed my oncologist earlier this week with a request I knew she would deny. Can’t hurt to ask, right? I wanted to go to the Tumor Board meeting since it seemed as though there were several very educated people on both sides of the radiation decision, and I had often attended these kinds of meetings in graduate school. I wanted to hear everyone’s position, but I knew it was very unlikely a patient would be permitted to attend. I simply asked if it would be possible, but told her that I would completely understand if it were not. She is such a kind and intuitive physician, she read between the lines knowing exactly why I wanted to be there. So, even though it was her day off, she got on the phone with the radiation oncologist (one of the two suggesting treatment) and talked through all the details and nuances of my case. They discussed the scans, my history, all the pathology… In the end, he agreed with her that no post-mastectomy radiation is warranted. And the greatest thing about my sweet doctor? She immediately called me and told me the good news! We chatted for fifteen or twenty minutes– some about my recovery from surgery and future care, but we also chatted about her pregnancy and transitioning back and forth between the workforce and staying at home with kiddos. From her high heel boots to her compassion to her apparent vehement insistence that I receive proper care and information in a timely manner (she mentioned some people were tired of hearing from her regarding me!), I know we would have been friends had we met under different circumstances. In fact, I think we are friends even despite the circumstances.

As much as I like her, I’m happy to report that I don’t HAVE to see her for six months! I may try to get in touch with her office this summer to get a baby gift to her, but otherwise, my first cancer related follow up will be in the fall. I’ll still be seeing a lot of my plastic surgeon, who is also a phenomenal physician in addition to having a compassionate personality. I’ve still got some healing to do, but have been able to cut down on the narcotics and am starting some of my range of motion exercises. Can’t lift much, but at least I can turn the Keurig on by myself now!

And so this is it, I guess. I’m cancer free. I have no more significant treatment. My hair is starting to fill in (though I still look bald unless you look really close), and I’ve even got some (pathetically) short eyelashes. The false ones will still be making an appearance for a while! I’m not normal yet, but I’m on the road to normal. It’s really close. And while good news still feels a little hard to believe, I’m starting to get used to it. I’m moving from contained excitement to just plain excited!

Contained Excitement

So I know that everyone was THRILLED with the “cancer free” pathology report last week. Lots of people even cried with joy. I didn’t. I guess it sounded too good to be true– too easy. Which is ridiculous, I know. Sixteen weeks of chemo, no hair, double mastectomy– that’s easy? Oh, and the day I got home from the hospital, to add insult to injury, almost all of my eyelashes and eyebrows fell out. Perfect. So that doesn’t sound easy, I know. But really, it still has been so much more bearable than I’d expected, and after so much bad news, I think it’s hard to believe the good.

And so I went to all three appointments last week with contained excitement. All of my doctors were so pleased with the pathology reports– zero of eight lymph nodes were positive, so that’s a good sampling and a great result. No cancer left in any of the breast tissue removed– only scarring where the original tumor was located. The downside (why did I know that was coming) is that two of my four doctors think radiation is not necessary based on the fact that all the margins were clean and there was no evidence of cancer in the lymph nodes. But the other two recommend radiation based on the aggressive nature of the original tumor. Which means that on Thursday I will yet again be the subject of the Tumor Board, where my four doctors will discuss me all in the same room in the company of their fellow Oncology Department colleagues to come up with a recommendation for me. So a few prayer requests– that the doctors will make a wise decision concerning my care, and that I will make a wise decision based on their recommendation. Obviously, if they can’t agree 100%, then there is room for me to make a decision, and I want to make the right one.