Some moments in life become embedded in your memory like a freeze frame in a movie. Is there anyone over 55 who doesn't remember exactly where they were when they heard that Kennedy had been shot?
For me, one of those indelible moments will always be the phone call telling me I had breast cancer. It came at 5:30 on a cold December Monday afternoon last year as I was in the kitchen making hors d'oeuvres for 10 dinner guests who would be arriving in an hour and a half. I picked up the phone with sticky fingers.
"Carol, it's Gordon." I'd seen Dr. Gordon Schwartz, an old friend, a week earlier following a guided needle biopsy that had been taken from a suspicious mass in my breast discovered on a routine mammogram. He was calling me with the results. "It's malignant," he said bluntly. I was totally stunned, as if my body had been thrown into an ice bath. Schwartz, director of the Breast Care Center at Thomas Jefferson University Hospital, is a superb surgeon but not one for sugar-coating bad news. In a daze, I scheduled an appointment with him a few days hence, then numbly climbed the stairs to tell my husband and collapse in tears.
It was too late to cancel the dinner party so I pasted a smile on my face, repaired my runny mascara, returned to the kitchen and prepared to play the role of hostess. Lucky for me I'd had some drama training in high school. Looking back, I realize that night established a pattern for how I would deal with my unwelcome membership in the "pink ribbon club." Cancer would not dominate my life. I would not succumb to the role of victim.
Maybe the timing had something to do with my attitude. Just a few weeks earlier, my beloved baby sister, Patsy, had learned that she was soon going to die of metastatic breast cancer. Every treatment option had been tried. Her journey with cancer was coming to an end just as mine was beginning. My relationship with Patsy — my best friend and biggest booster — was the inspiration for my best-selling book Sisters. She was 57 when she discovered a lump in her breast, 61 when the cancer first spread to her bones and not quite 67 when she died — barely five weeks after my diagnosis, the hardest five weeks of my life. Much as I wanted to, I couldn't focus on myself now. I needed to spend these weeks saying farewell to my sister as she prepared to join our parents in wherever it is we go from here.
For the last decade I'd had a front row seat to the tragedy of breast cancer. The emotional seesaw from hope to depression to grief. The ravages of chemotherapy. The hair loss. The weight gain. The nausea. The exhaustion. The pills. The pain.
And, of course, the tension of repeated CT and MRI scans–had the tumors shrunk or spread? If you're lucky, you get the good news that you're cancer-free, and and then you hope to never get the bad news that the killer has returned. When that happens, the whole miserable routine starts all over again, until the doctor sadly says he has nothing left in his bag of tricks. No more regimens. Nothing to offer.
Somehow, through all the years of my sister's ordeal, I'd held on to a wholly irrational conviction that I would never get breast cancer. Was I stupid, naïve or just fooling myself? While neither Patsy nor I carried the BRCA genetic mutation (the marker for inherited breast cancer) and none of the women in our family had had the disease, I'd chosen to play the odds and stayed on hormone replacement therapy for more than 20 years. Once, I'd tried to stop, but the hot flashes and the sleepless nights were intolerable. So I resumed, fully aware that HRT hormones increase the risk of breast cancer. In retrospect, that was probably a bad throw of the dice.
Before Patsy slipped into a coma, we used to jest that this was the winter of our discontent. My life felt surreal. I ricocheted between doctors, tests and procedures while driving back and forth to Cherry Hill to sit by Patsy's bed and hold her hand. Once before Christmas and once after New Year's I had surgery. The first removed the tumor (a big thank-you, Gordon Schwartz, for a scar so small and unobtrusive that it wouldn't prevent me from visiting a nude beach, were I so inclined). The second dissected the sentinel node from the lymph glands under my arm to determine if the cancer had spread. Miraculously, it had not. That classified my disease as Stage 1, which meant I would be spared chemotherapy and only need radiation. My tumor was small and estrogen-positive, another favorable factor because estrogen-receptive tumors respond well to a five-year program of medication that improves the odds against reoccurrence. My oncologist, Dr, John Glick, former director of the Abramson Cancer Center at Penn (who had also attended my sister), assured me that there was no reason not to expect I would fully recover. If getting cancer was a stroke of bad luck, my prognosis gave me every cause for optimism.
Experience had taught me that, when someone gets cancer, the news tends to spread like wildfire and it's often full of inaccuracies. Moreover, because most people are uncomfortable around cancer, they get tongue-tied and awkward about how to respond. I wanted to spare my circle from wondering what they should or should not do or say, and I wanted to be in control of my message. My solution was to create an email chain where I regularly sent updates about my progress. That way, I avoided fielding endless telephone calls, caring or otherwise. Friends could email back if they chose to, which many of them did. By opening my heart, I invited people in and was rewarded by an outpouring of affection that surprised and uplifted me.
Patsy was buried on an inappropriately sunny January day. How could the world be suffused with light when my precious candle had been snuffed? By mid-February I began radiation. I chose Dr. Lydia Komarnicky, the compassionate chair of the department of radiation oncology at Drexel University College of Medicine. At our first meeting in her office at Hahnemann Hospital, she gave me her email address and said to contact her whenever. I liked her immediately. Standard radiation treatment is around 33 doses, given Monday to Friday for approximately seven weeks. (Apparently, cancer takes the weekends off.) Because Hahnemann is about a mile from my apartment on Rittenhouse Square, I was determined to power walk both ways so I could maintain my fitness routine. Every day I trudged back forth in the snow and the rain and the bruising cold; each trip was a small triumph.
Radiation itself is quick and painless. I left my house at 8:15 every morning and was usually home an hour later, ready to plunge into my day. As I lay on the table while a deadly beam entered my body to eradicate any remains of cancer in the vicinity of the tumor, I marveled at how such a seemingly benign zap could be so powerful–and produce so few side effects. Except for a mild burn on my breast which disappeared later and some annoying fatigue (by the third or fourth week I usually needed a brief afternoon nap), I sailed through. On my last day, I baked cookies to thank the staff who'd been so kind to me. As nicely as possible, I said I hoped to never see them again!
About three weeks after my treatment ended, my husband and I took a short vacation which ended in Sedona, Ariz. The majesty of the red rocks, the glory of the vast sky and the infinite horizon and the crisp, fresh air were a tonic for my spirit and soul. As we drove back to our hotel after our second day of vigorous hiking, I suddenly realized that I was full of energy and not the least bit tired. I felt like myself again. "I'm back!" I shouted. "It's over."
But of course, it's never really over. I will be checked by my oncologist regularly for several years to come, and I am prepared to wish I took Valium every time I'm due for a mammogram. Cancer is a wily enemy. One never knows when or where it might strike again. I don't think about that very often because I tend not to brood. I'm the type who sees the glass as half full, not half empty. What I do think about, however, is how cancer has affected me in some positive ways.
I am keenly aware that, on any given day, my life could drastically change. That is why, as I write this, my husband and I are preparing to leave for a month-long trip to Southeast Asia. I've never been content to nibble at life's smorgasbord. Now I don't want to put off anything for tomorrow that I can do today. I've become more conscious about spending quality time with my children and grandchildren and telling them how much I love them. To my surprise, cancer deepened my understanding and appreciation of friendship. Illness of any kind can be lonely and isolating. Unlike many people stricken with this disease, I needed little in the way of physical support — meals, carpools, driving assistance, etc. What I didn't realize was how much I would be comforted by emotional support. When it poured in, I was overwhelmed. To be upheld by so many loving hands and embraced in an outpouring of affection and concern was a truly unexpected blessing. Finally, cancer was a dart that pierced the armor of my security and reminds me daily that we cannot control what happens to us. All we can control is what we do with that. And I plan to go on doing — and being — just fine.
Carol Saline is the chief medical correspondent for Special Sections.