Survivor: (noun) one who outlives another; an animal that survives in spite of adversity; a living organism characterized by voluntary movement; a human being. Visual Thesaurus, Ver.3
The word ‘cancer’ isn’t found in this definition for survivor—however both words are encapsulated in the definition “ human being’, simply part and parcel of life. And in those moments of life, when mortality looks you directly in the eye and questions your next move, the word survivor takes on more meaning than mere words can convey.
In September 2005, I received a diagnosis of invasive ductal carcinoma (breast cancer) stage 1, grade 1, her2 5% from a 1.5 cm tumor they removed. That was a little over four years ago and I was 54. Survivor wasn’t the first word that came to mind. I survived to be the third of nine children, the 60’s, divorce, discrimination, poverty, superwoman malady, and thought that I’d come through these lessons fairly well.
There’s a rhythm to the music of life. After all my hard work, I was ready to dance into the last stages. I prepared for retirement, utilized the best resources for analysis and constructed comprehensive spreadsheets, what if A—what if B—what if C, to sustain those golden years. In my youth, I was athletic and thought that translated to healthy. Most of my working life centered on business practices, the last 20 of the 35+ years worked were in the health care industry—a bird’s eye view as a physician practice administrator inside hospitals. I felt certain that could only help in my retirement years.
There is always something more to learn, I used the 70% rule that the experiences I accumulated to that point were sufficient to help me navigate what lay ahead. Then came the words “your diagnosis is cancer” and everything changed. Consider too that I was told in Italian, “la vostra diagnosi è cancro”. I hoped that my translation was wrong. I spoke some Italian, not fluent and arrived to Italy only four years earlier. Italy became my new home in retirement with my husband of three years before the diagnosis.
My husband asked if I wanted to go back to US for the surgery. My answer was no—I didn’t want to be away from him. The surgeon told me during my preliminary exam that she did a rotation in Philadelphia with surgeons who I knew. Also, I emailed back and forth to physician friends in US who confirmed that the recommended course of therapy was international standards of care. Equally important to me was the friendship and support that my former colleagues sent my way. Probably some of the best advice they gave me was to find online support from a site that was founded by a doctor in Philadelphia—hometown assurances. The trusted medical information combined with discussion boards of people in similar circumstances was priceless.
The sum of these virtual communiqués gave me the confidence to go forward with my decision to remain in Italy for surgery. I created my own three-page patient profile, including picture, and translated it into Italian the first year that I arrived. I knew the information that doctors wanted and needed. This profile became part of my documents file for the hospital visits and gave it to every doctor I encountered. They offered sincere appreciation for the information. My patient profile (identification, emergency contact numbers, previous illnesses, family history, past and current medications taken and detailed studies performed, color-coded, dated and paginated), became a topic of conversation among the hospital staff. In fact it became a conduit of conversation and a bright spot in otherwise grueling days of therapy. They wanted to practice their English as much as I wanted to practice my Italian—school was in session! And that three-page patient summary is now twenty with tabs for lab results, sorted by year. I never travel without it.
For the three months that followed my diagnosis, the languages of science, math and statistics roared in my head and sent it spinning. The roar turned murmur only when I phoned my family to give them the news. The murmur converted to tears that streamed with reluctance down my face and sometimes seemed unstoppable. It was enough to look across the table to my husband, or hear my children or sister’s voice on the phone. The hardest moment was to hear my 86 year-old mother ask if I wanted her to come to help, then commence to sing me a lullaby on the phone the night before surgery. We were on a pay phone in the hallway of the hospital—my husband arranged the phone calls. I sobbed like a baby. Spreadsheets be damned!
The day before surgery, the professor arrived on rounds with the residents speaking Italian. The professor saw the book I was reading and said in perfect English, “Women Who Run with the Wolves – a good book. You’ll be the first case tomorrow morning. We’ll see you then.” I was too nervous to respond much beyond “My husband recommended the book. Glad I’ll be the first case.” The first case on Monday morning is good news. Everyone is back fresh from the weekend.
My work at the hospital was with anesthesiologists—I knew the OR well. Monday morning a nurse arrived with the OR gown and instructions of use. I swallowed hard—I was the patient! Next a man arrived with a cup of water and a vial of medicine and asked me to drink it. First I asked who he was. They weren’t accustomed to patients who ask questions. He answered that he was the anesthesiologist—the medicine was Valium. I asked if I could remain awake until I entered the OR—I wanted to see how they were set up. After I provided a little more background information he smiled and agreed. My husband admonished me for this but I assured him that they didn’t mind the question.
We took the route to the OR and my husband was in front of the bed all the way down the halls, in the elevator and up to the big blue doors. “I’ll be right here when you come out”, he said. Then he let go of my hand. I continued into the labyrinth, passed one familiar door after another, until I arrived at the set up room before the OR suite. The rooms were the same as I’d seen hundreds of times. I chatted with the nurse prepping the IV lines. She thought that the hospitals in US must be better. I assured her that they were not. After my intravenous lines were in place she rolled me into the OR. The anesthesia machine was familiar—a team of radiologists, surgeons, anesthesiologists, and nurses were ready. The surgeon walked over to the table and with a wave of her hand said, “time to sleep”.
My husband never let me forget he was near to me. His was the last face I saw going into the OR and the first one I saw when I came out. He put my wedding band back on my finger.
I remained in the hospital another day. We ladies bonded through our similar circumstances, each story unique in as many ways as similar. The anesthesiologist came by and we talked about the collaborative research they were doing in Belgium—I welcomed the distraction and familiarity. The next morning I was discharged.
I wanted to be normal again as soon as possible. I loaded dirty clothes in the washer while my husband made lunch. We drove to greet our rental guests and I apologized for being late. Denial was getting deep. I hadn’t yet realized there was a new normal.
Follow up appointments and therapy forged their way passed my denial walls Tatoos for rads, bone scans, a frozen shoulder that impeded the start of therapy. Eventually 33 treatments ended. My sons arrived from LA to do the last of them with me. I continued to educate myself about this disease, at least as much as my estrogen deprived brain allowed. Eventually I accepted the encouragement I’d heard—“avanti”—“ahead”. It was mine to walk.
The first steps aren’t forgotten especially with so many people along the way to help—one step at a time. We walk in the footsteps of all who went before us and all who come after us. Since then I was diagnosed and treated with low-grade bladder cancer in 2008. I take pause when a follow up exam comes due, now times two. However, those paused moments are integrated sooner into the rhythms of my new normal life. Shall we dance?
When I think to what I’ve lived and think to all that is yet to come, I’m content to be present in every one of those moments.
“Never fun faster than your guardian angel can fly.” These words (in Italian) and a picture of Padre Pio were stenciled on the back door of a truck that we followed home from the hospital in bumper to bumper traffic—the kind of traffic that sometimes gives you too much time to think about too many things. Probably it was intended for the infamous Italian driver…or maybe for someone like me…a survivor.