The first time I had breast cancer, in 1993, I thought I'd die. Everyone around me thought so, tooespecially people who knew people who'd died of it.
My mother tried to console me, saying, "The further you get from this, the safer you'll feel." But I didn't believe her. Two years later, my physician ordered a bone scan after I complained of nagging hip pain. Its results revealed a suspicious spot on my hip bone that indicated the possibility my breast cancer had metastasized.
In the anxious days that followed, I shared my worries with another cancer survivor who told me how she coped with worry. "I saved a couple extra chemo pills," she said. "Whenever I feel anxious about a recurrence, I pop one." We both laughed, but something eased within me. I suddenly recognized the need we cancer survivors have to battle one of the disease's most invasive side effects: the fear of its return.
Thankfully, after my physicians identified the hot spot on my scan as a stress fracture, not cancer, I vowed to slip the grip of fear by making the most of every cancer-free day I had. I'd make more time for people. If my daughter, son, or friends called, I'd drop what I was doing to talk with them. I'd say no to projects I once enjoyed but were energy drains. I'd stay on a low-fat diet for health reasons, but allow an occasional indulgence, such as a hot-fudge sundae. I'd get more sleep, read better books, spend more time in prayer. I decided to see cancer not as a death sentence, but as an invitation to live.
Then an abnormal mammogram in May 2001 indicated I had to take on my foe again. While round two of breast cancer initially knocked me for a loop, I wasn't down long. My systems for coping were already in place. Here's what has helped meand can help you, too, if you ever have to face breast cancer or know someone who does.
Don't rush the process.
In my grandmother's time, a malignant breast lump meant unconditional surrender to what followed. A woman might awaken from a surgical biopsy minus the lump, breast, axillary nodeseven chest muscle. In addition to facing an ugly slash and hollow where her breast had been, she coped with minimized movement, increased risk of infection, and painful swelling in the adjacent arm.
By the time I was treated for breast cancer, things had changed. Thanks to women's advocacy groups, enlightened surgeons, and a host of studies, the radical Halstead, described above, had been replaced by a modified radical, which leaves the muscle intact. In many cases, women are offered the choice of a mastectomy or a lumpectomy plus radiation, in which small lumps are excised with cancer-free margins.
The first time around, I wasn't given a choice. The size of the lump in my left breast (3.8 cm, or golf ball-sized) eliminated the lumpectomy option. Fortunately, my mastectomy was justified by the results: In addition to the primary lump, the pathologist reported two others, plus "abundant fibrous breast tissue showing fibrocystic alteration." Five of my 16 lymph nodes were malignant, meaning I'd have to have six months of chemotherapy.
Still, I wondered if I should have gotten a second opinion. A different surgeon might have echoed the first's advice, but even that would have assured me I was doing the right thing. The point is, don't rush to judgment. Breast cancer grows slow enough for you to make an informed decision about how to treat it. When my mother-in-law was diagnosed, she recoiled at a surgeon's advice to have a mastectomy. At my urging, she sought a second opinion. She's cancer-free today after a lumpectomy and radiation.
Research the dickens out of it.
Some people want to hear only what they have to about a medical problem; anything more terrifies them. For me, information is power; it offers a sense of direction through something that threatens to rob me of all sense of control.
My second round of breast cancer was easier to deal with, partly because of what I'd learned from the first. My work with breast-cancer support groups such as Reach to Recovery and Expressions for Women had put me in regular contact with survivors. I'd read everything I could get my hands on, crowding my bookshelves with classics such as Dr. Susan Love's Breast Book, Living Beyond Limits by David Spiegel, M.D., Cancer as a Turning Point by Lawrence LeShan, and MAMM, a magazine for women with cancer. I'd researched dozens of Internet sites. I knew so much about breast cancer, I was bored by it.
But like a bolt of lightning, my abnormal mammogram in May 2001 recharged my interest. I surfed the Net for information on mammogram findings, core biopsies, and treatment for recurrent breast cancer. I was back on the phone with my breast-cancer buddies. And what I learned eased the tangle of stress inside me so I could think rationally about big decisions I'd soon have to make, such as: Would I need a mastectomy in my right breast? Could I get by this time with a lumpectomy and radiation? Should I have chemotherapy again?
Lean on the professionals.
Personal research is helpful, but it can only go so far. God gave us health-care professionals for a reasonto help guide us through a mass of information toward a reasonable solution.
When I was diagnosed with breast cancer the second time, my surgeon suggested a conference at which my husband and I and various physicians would discuss my case to determine the best treatment course. I leaped at the opportunity.
The conference at a nearby hospital began with slides of my cancer cells and two treatment options: mastectomy or lumpectomy with radiation. The choice narrowed after I mentioned I'd also been diagnosed the previous year with non-Hodgkin's lymphoma. I was in remission but deeply concerned about how breast-cancer treatment might affect my immune system's ability to cope with the lymphoma.
With that revelation, the discussion shifted. The oncologist said he preferred getting rid of all breast tissue to avert possible recurrence. The surgeon argued for mastectomy, too, saying it would be better to do everything now rather than in stages. Within minutes, a consensus emerged.
I left the conference with a clear sense of direction. My questions had been addressed. I'd been a full participant in the discussion. Everyone in that room had helped me decide a mastectomy was my best choice.
Don't settle for less than the best.
During my first round of breast cancer, a surgeon made a suggestion for which I've always been grateful. "You're so young, you ought to consider immediate reconstruction," he said. I was 48 at the time.
A few days later, I met with a plastic surgeon to discuss how to rebuild my breast. He explained several options, including a TRAM-flap reconstruction (Traverse Rectus Abdominus Myocuta-neous flapalso called the "sit-up muscle" of the abdomen), in which he'd build a breast entirely of my own tissue, scavenging muscle and fat from my belly. This option required more surgery and recovery time, but the results were more natural than an implant. Best of all, I'd wake up from surgery with a new breast already in place. I chose the TRAM.
For the most part, I was happy with the results. But several months later, when I attended a Reach to Recovery seminar and saw the slides of a plastic surgeon who specialized in breast reconstruction, I began to wonder if my plastic surgeon had really done so well. What would this specialist think of my reconstruction? From what I could see, my left breast couldn't compare with what was on screen.
When I faced a second mastectomy in 2001, I tried calling that plastic surgeon. While waiting for a response, I researched the list of physicians provided by the American Society of Plastic Surgeons. No one stood out as a breast-reconstruction specialist.
I even met with a local plastic surgeon. But his answers to my questions were hardly reassuring. When I asked about back-flap construction, he said, "I see no point in going through all that when you can get the same results with an expander-implant" (a deflated plastic balloon-type insert with a flange in which the physician adds saline weekly until it reaches the required size).
Question: "What about skin-sparing surgery?"
Rephrase: "What kind of incision is made?"
"Ah!" The wedge he drew made me dive for the exit. Forget the inconvenience; I wanted a physician I could trust. And I wanted a breast I could live with the rest of my lifewithout having to dodge eyes in a locker room. Most of all, I wanted something I could show to other women as proof that breast cancer didn't have to leave anyone maimed or disfigured.
A week later, I made a trip across two states to see the specialist whose work I'd seen. "This is quite a challenge," he said after examining the first plastic surgeon's work on me. He then outlined what he'd do. Along with repairing a hernia left from the original TRAM, he'd repair the hollow area above my left breast. And to rebuild the right breast, he'd use muscle from my back. "We'll create a breast that looks better than the one you had," he said.
From the time the bandage came off, my new breast looked so natural I didn't think of mourning the one I'd lost. Best of all, I no longer had breast tissue to tempt another round of cancer.
See cancer as a gift.
When people ask why God would give me breast cancer twice, I often say, "Why would he give me health? One is no more deserved than another."
I go on to tell them how God's used cancer for good in my life. For one thing, it's brought the reconciliation of my son and daughter. Sibling rivalry ruled through childhood, teenage years, and well after both left home. But the day we learned the spot on my hip might be metastasized breast cancer, my son and daughter reached out for each other. As I watched them embrace, tears ran down my cheeks. If this is what cancer could accomplish, I was willing.
There have been other blessings, too, such as priceless memories of my post-operative care. I think of how my daughter bathed me and washed my hair in the hospital. How my mother fixed tea and fetched me pillows, how my sisters dropped off meals, how my stepdad stocked the birdfeeder to entice the finches I love to watch. How friends kidnapped me for lunch. And, finally, how my husband helped me into the car for the long ride home. All the while, I was buoyed by people who were praying for me at work, at church, and in various support groups.
But the sweetest blessing is how cancer makes me cling to God. Life can be so busy, it may take something such as cancer to teach us that regardless of how rewarding our job, family, friendships, and church responsibilities are, nothing's more precious than time we spend with God.
Live like a winner.
Several years ago, Betty Rollins wrote a book titled First You Cry. I agreethere definitely is a time for tears. You cry on the elevator ride from the doctor's office after he's put you at the top of his "hit list" for surgery. You cry when your husband wraps his arms around you, trying to ease the blow of a biopsy report. You cry on the phone when you're telling your kids. You cry when Mom tells you, "I wish I could have this instead of you."
But there's a time to stop mourning, too, and get back to life. One way to do that is to get back to whatever it is God's called you to do. Work is therapeutic, I've found. It focuses attention on what you can do rather than on what you're powerless to control. It makes you productive and useful. And if you're blessed as I am with believing coworkers, it plugs you back into a network of daily support.
Another way to get a grip on cancer is to start helping others. You can't mope around feeling sorry for yourself if you're out shopping for hats with someone about to start chemo. Or be paralyzed by worry if you're chugging off to the hospital to deliver flowers to someone who's just had surgery. The beauty of such helping, of course, is that in helping, we find ourselves being helped.
But the best way to beat back the enemy is to put every fear into the hands of the God who made us, sustains us, and controls whatever happens to us. He knew I'd have cancer. In his unfathomable wisdom, he allowed it to happen for reasons that are only beginning to become apparent to me. And in his boundless grace, he's not only using cancer to bless me but to bless those around me.
Will I have cancer again? Most likely. The lymphoma I have is the type that will return, and the breast cancer of nine years ago might still metastasize to other parts of my body. Even if it does, though, it won't have the power to conquer my spirit. For I know that even if cancer so ravages my body that I no longer have the strength to go on living, I'll still win the battle. As Philippians 1:18, 21 so beautifully says: "I will continue to rejoice for to me, to live is Christ and to die is gain."
Phyllis Ten Elshof is an editor at Christianity Today International who lives with her husband in the Chicago area.
Copyright © 2002 by the author or Christianity Today/Today's Christian Woman magazine.
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