SURVIVING BREAST CANCER: LESSONS LEARNED

Invasive ductal carcinoma – three words that forever changed my life. As my husband and I listened to the surgeon explain this type of breast cancer to us, I sat in stunned silence. All I could think was, “How can this be happening to me? There is so much I want to do. I don’t have time for this!”

I had a mammogram every year since age 45 and like my primary physician, I thought the pea-sized lump was only a benign cyst because of my history of fibrocystic breast disease. There was no known history of breast cancer in my family. I had healthy lifestyle behaviors. As an educator and home health nurse, I tried to be a role model to students and patients and “practice what I preached”. So how could this be happening to me? Although a nurse for over 35 years, I soon discovered this cancer experience was to be one of learning indeed. Lesson 1: Breast cancer doesn’t discriminate. Breast cancer can affect anyone; one in eight women in the United States will develop breast cancer in her lifetime. Breast cancer is the leading cause of death in women ages 20 to 59. There are certain risk factors for breast cancer and they include being female, postmenopausal (77 percent of breast cancer patients are over 50) early menarche and having a genetic predisposition. About 85 percent of breast cancer patients (like myself) however, have no identifiable risk factors. Lesson 2: Mammograms are not perfect. Mammograms detect only about 85 percent of breast cancers, but they are the best and most feasible detection method at the present time. In my instance, the tumor was detected not by mammography, but by my primary physician during my yearly checkup, and later with an ultrasound. The next step was a breast biopsy which was positive for cancer. I was devastated when the sentinel node was positive. The surgeon removed the next three lymph nodes, which were thankfully negative. He then did a modified radical mastectomy to prevent cancer recurrence and I was home in two days. The time from the tumor biopsy through surgery was less than a week. Lesson 3: Rely on experts. There is no way one can absorb the emotional and physical trauma of such a personal and life-altering event in such a short time, regardless of previous knowledge or experience. The amount of stress was overwhelming. I cannot overstate the importance of having professionals you can trust and feel totally comfortable with because at this time both my husband and I were numb and functioning on autopilot. The numbness was definitely beneficial though; it blurred the emotional pain and shock so we could get through it.  Lesson 4: Never assume you know what it’s really like unless you’ve been there. Because I had a malignant lymph node, I knew I would have chemotherapy after the mastectomy. I felt fairly knowledgeable about it since I had cared for patients with chemo both in the hospital and at home and had lectured on this topic to nursing students. I soon discovered otherwise. I had four cycles of Adriamycin and Cytoxan, two major and very potent drugs for breast cancer. The first cycle went well but the antiemetic did not work for the second one and I was hospitalized for dehydration and electrolyte imbalances. With some experimenting, the oncologist and I learned what medications worked for me and I did reasonably well after that. Eating was a challenge and my husband got quite creative at preparing appetizing meals and snacks. Of course I lost all my hair – two weeks to the day after the first treatment. I still can remember standing in the shower and crying as it fell out – a depressing day indeed. The fatigue from the chemo seemed to be incremental; I would just start to feel good again and then it was time for the next cycle. I cut back to part-time at work and did only the necessary things at home. Most of all, I learned to depend on others. Chemo can affect cognitive function. Known as “chemobrain” this syndrome affects as many as 17 to 50 percent of breast cancer patients and can include memory loss and difficulty with concentration, cognitive processing speed, attention span and spatial perception. Effects can persist for a number of years after chemotherapy treatment. I have been fortunate because I had only mild residuals but can readily empathize with the frustration of patients who have experienced it to a greater degree. Just knowing it was a consequence of chemo was comforting and doing mental exercises such as reading and crossword puzzles has helped considerably, as well as maintaining the best state of health possible. Lesson 5: Let go and let others. I don’t know how I would have survived this experience without the love and support of family, colleagues and friends. As a home care nurse I have seen what family support (or lack of it) can do for a patient’s recovery and prognosis. My husband was always there, hugging me and encouraging me to look ahead to the next day when I would feel better. Our children called faithfully or came to visit as did friends and colleagues. And it somehow seemed when I was having a really rotten day, there was always a phone call, card or gift to cheer me up. Lesson 6: Believe in yourself and always have hope. We never know the extent of our courage until we are called upon to use it. At first, there is only the numbness and denial, but these reactions serve as protective mechanisms to get us through that critical time until we can deal with reality. I cannot count the times I said, “This isn’t for real. It is only a dream and I will wake up soon.” When the reality did set in I knew I could face it because, by then, I had gained the strength and courage to do so. Sometimes the anger was overpowering (Why me God? What did I do to deserve this?), but realizing it was a normal reaction made it much easier to acknowledge and then move on. As my surgeon said, “Don’t look back.” I tried to direct all my energy toward physical, emotional and spiritual healing and becoming whole again. With each new day I tried to have hope, because hope is what keeps us going and gives purpose to our lives. Lesson 7: We can survive if we choose to survive. I don’t know what the future holds for me but neither does anyone else, for that matter. I am on daily tamoxifen for five years to prevent cancer recurrence, and I am faithful in my follow-up care. I have learned to trust in my higher power and take one day at a time, to “let go and let God”. If something doesn’t get done today, there is tomorrow and if tomorrow doesn’t come, then it’s a moot point anyway. I have become an advocate for breast cancer prevention and have done numerous presentations on it in my community. I am doing everything I can to increase my chances of survival and to help other breast cancer survivors do likewise. I am not letting the cancer control my life. I choose to be a survivor! Lesson 8: Learn from each life experience. If anyone were to ask me if I wanted to have breast cancer, the answer would be a resounding NO! I had no choice in getting breast cancer, but I do have a choice in how I deal with it. I chose to learn from this experience and make it a positive one. I believe I am now a better person and nurse because I truly can empathize with patients and say, “I know how you feel.” I have walked a mile in some of your shoes. Lesson 9: Realize what is important. Having a life threatening illness has made me more aware of the really important things: being more compassionate, less critical and really listening to others; in other words realizing that relationships and not things, are what really count. I try to see the beauty and uniqueness of each day and seize the moment. Lesson 10: Develop a philosophy of life and stay with it. This cancer experience has made me a wiser, more reflective individual. It has made me aware that we are all on a journey in this life. Some experiences will be good and some not so good. But we can make that journey easier for each other by sharing it, embracing both the good and bad times together and realizing that we are never alone. I also believe that we each need to develop a philosophy for our journey, some guiding principles to keep us on track. My philosophy is short and simple but it says it all for me: Yesterday is a done deal, Tomorrow is a maybe, But today is mine to appreciate and enjoy, And to make a difference. This article was edited for length with the author’s permission.