A physician, with a loving husband and two grown children, Crystal was used to life working for her as hard as she worked for it. Then came a diagnosis of breast cancer.
I was having a routine mammogram and kept being called back for another image. Naturally, I started thinking something was wrong. The radiologist showed me two large calcifications but suggested it could be benign. I had a biopsy the next day, and then had to wait for the report to come back a few days later. During this whole time, I assumed I had cancer, that it was my time to be diagnosed. I was already worrying what stage it would be and what would follow. The anticipation of chemo was very upsetting — the hair loss and potential for nausea. I tried to put it out of my mind and drew on my medical training to read a lot about breast cancer and assure myself that it wasn’t a death sentence today.
From the biopsy, I went straight to a conference and didn’t think about it. I kept very busy. When the doctor called and said, “I have good news and bad news. The bad news is it’s cancer, the good is, it’s in situ,” I was relieved. It was Ductal Carcinoma, stage zero, so I wouldn’t need chemo or radiation, just surgery. But, if they hadn’t caught it then, it could have been worse. My husband, who is also a doctor, said, “It’s non-invasive cancer, you’re going to be fine.” And that helped. If I had been told it was invasive it would’ve been more concerning. I didn’t want to stop working but fortunately it would be a brief interruption.
Since I had done my medical training at a large hospital in New York City, I got a recommendation there for a breast surgeon. It turns out that the tumor was actually in two quadrants of my breast, so they recommended a mastectomy. And when I met with the plastic surgeon, he suggested I would be more satisfied with the reconstruction if I had a double mastectomy. The only way to deal with the anxiety was to have a plan. Once I had a plan in place, I felt calm. I knew the cancer would be taken care of. Turns out, it was a very good thing that we decided on a double mastectomy because I actually had cancerous lesions in the second breast as well.
The surgeon performed a skin-sparing, nipple-sparing surgery and the plastic surgeon prepared me for the implants. When I woke up from the anesthesia, I had two drains and thought I was having a nightmare. But then I remembered, this was my reality. I had seen pictures of drains online, but this was different. This was me. I never worried it was life-threatening and didn’t worry about losing my breasts — I thought I would be okay no matter what happened. But it was hard to lose such an important part of my body and my identity. I approached it with a clinical perspective, but it bothered me anyway for three or four months.
Perhaps the hardest part was adapting to not having breasts and the diminished function of my chest muscles, the loss of my mammary glands. It just felt different. One of my nipples was inverted and I worried about keeping it, but it recovered. I don’t have any sensation in the nipple anymore, but I knew to expect that. My husband handled my care clinically, took care of the drains and he was really there for me. But he didn’t get the emotional stuff, the loss of breasts. Still, he was very agreeable and helpful, not at all fearful of the disease, and was very patient with me and with the drains, which was so helpful to me.
Once home, I kept myself busy with tasks and reading about other women with different types of breast cancer. I had great support from family and friends, including some who had breast cancer and chemo. I had a lot of support from my colleagues, women doctors who were members of the American Medical Women’s Association. One of my sons who lived nearby visited often to help. (My other son lived on the other side of the country, so he was there in spirit, but not in person.) But I wasn’t able to do my work or shower or drive for a few weeks, which was disconcerting. I was used to being so independent and productive. I was very distracted by the cancer and the pain. At one point, I had gained 9 pounds from the fluid that accumulated after the surgery. It took over a week to drain.
A Wake-Up Call
The tissue expanders were put in at the time of surgery. They waited until the nipple incisions healed, then they started the expansion. It was very painful, every week for four weeks. I wanted to have smaller breasts and didn’t want to go for the expansion. It really hurt, especially the first couple of times. After the reconstruction, I was told it would be at least a year until all the pain resolved. I’ve been going to PT, but I still need to work on strength and range of motion. Just getting out of bed was hard and painful. I slept with a pillow on my chest for weeks.
When people visited or sent flowers, I realized people care about me. I didn’t expect it, a new surprise, it made me value my life more. I had gone through things in the past, but the experience with cancer made me think about other diseases and the fact that loss is so prevalent. When I was a medical intern, I did a rotation at a big cancer hospital. The first patient I saw had metastatic breast cancer and came in to die. It made an impression on me. No one visited her. Seeing that, I made a point of talking with her every day. When she became critically ill and had very little time left, I sat next to her bed until she had her last breath. How lucky was I by comparison? But it also reminded me that we only have one life. We have to decide carefully how we spend it. It’s a wake up call that we are mortal.
Life Had Other Plans
My life is always very planned. I tend to be a control freak, so it troubled me that life had other plans. I needed to be at a conference five weeks after surgery, that’s why I had to do the surgery right away so I would be ready in five weeks to go. Luckily cancer came at a time when I could adjust, but regardless, it would’ve been a priority. I started working at home about an hour a day almost three weeks after surgery and then built up from there. If you checked in with my friends, they would have said I seemed normal, but I used to be a high-energy person. I tried to make the best of it, enjoy what downtime I had, but I needed to get back to work, even though I was exhausted and had to take naps every day.
Work is a good distraction, but you don’t want to deny your emotions. I didn’t grieve about the loss of my breasts right away, but I’m glad that I did eventually. But, I didn’t want to ignore it. I don’t think I felt emotionally okay until two years later.
Traveling is still hard, but that first trip was a shock. Because of the implants, I always have to have a pat down. And I can’t put my luggage in the bin overhead. One airline attendant didn’t understand and was not at all sympathetic, refusing to help. So, I had to change the way I travel. I bought different luggage and have even booked a wheelchair so that I didn’t have to carry anything.
Now that I have recovered, I still feel it was a life-changing illness. You realize how valuable friends, family even acquaintances are, and the need to prioritize. Things don’t bother me as much, I’m not as stressed. It had a good effect on me. I would have preferred not to have had the experience, but I see the benefits. When I first started traveling to meetings again, I felt like a cancer patient. I was self-involved. Now, I feel more normal, but wiser too. I learned about myself. I no longer feel like a breast cancer patient. Instead I think of myself as a physician, wife and mother who had breast cancer.
Cancer is not top of mind, but I do tell people what I went through. I feel lucky as a doctor who had an experience that helped me understand patients better. I am a patient now, so I can see what it what it might feel like for a patient to lose control over life. I’ve always had empathy for my patients, but now even more so.