By Elizabeth Allen
Dear Northern California,
I was just passing through and I wanted to thank you. Thank you for your doctors, artists, nurses and researchers, oh and your clam chowder, famous wine, windy ocean and magical forests.
I’ve always felt rather possessive of Northern California, and without any personal connection. In my early twenties I felt sure I would move here, having never even seen it (obviously never did). In my thirties I thought I might retire here, “maybe Petaluma,” I said confidently after a few days in wine country. I think now, it was a foreshadowing of this unforgettable interlude. Perhaps if this place hadn’t already called me for years, I might have missed a beautiful opportunity.
My visit is more specific than I implied. I came here to get a little help in healing my breast cancer, but I do so love to wax on poetically, I hope you didn’t mind.
I’m convalescing in a cabin in the redwoods in the Russian River Valley. All of my recent memories crowd for attention, but let me collect myself and start at the beginning.
I was laying in bed one night with my arm thrown across my chest when I realized my hand was perched on top of my breast like a little bird. I tapped it and it was hard. I tapped the other and it wasn’t. I felt alarm shoot through me. I decided I should just casually have a mammogram four years late and not mention it to my husband. Of course the tech saw micro-calcifications and a cascade of events unfolded.
I was sent to a breast clinic for an ultrasound/biopsy which landed me in a virtual meeting with a local surgeon who wanted to do a lumpectomy. It was too fast. I requested a physical exam which led to an MRI, which revealed a mass twice the size they had originally estimated… so she revised her plan to a mastectomy, which drove me to find a second opinion offering a complicated option, which borrowed me enough time to scour the internet for my diagnosis, ductal carcinoma in situ (DCIS).
Ductal carcinoma in situ is one of the most treatable/curable breast cancers, but mine had concerning characteristics. It was high-grade DCIS, I had a large (greater than 5 cm) palpable mass and abundant T-cell infiltration, it was hormone receptor negative (less than 1%) and Her2 positive, and I was diagnosed under age 45.
In DCIS, all roads of progress lead to Dr. Laura Esserman, the director of the Breast Care Center at UCSF. And so I came. She taught me to count chickens before they hatch, so you can always count them, and she convinced me that she’s possibly more curious than even I am.
Her curiosity has led her to the doors of those who hold the money to fund research. Her late-night phone calls with me were filled with all of the possible scenarios racing through her mind to find the key to the sometimes-miraculous cures with immunotherapy, and sometimes complete resistance. While my curiosity led me to her, it was no match for the curiosity that led her to head a research team with 20 interns, all racing to explore the viability of scenarios.
I do rather hope her children read this story and decide who will take one for the team and give her the grandchild she deserves… but I was overjoyed to become patient number 9 of 11 in the third arm of her clinical trial to treat DCIS with intratumoral immunotherapy injections (mRNA-2752). I made three quick trips to San Francisco and then one long trip after the trial to have surgery to remove and donate my tumor to research and get my dream “four babies later”: breast reduction.
When surgery time came, I brought my family and we wandered all over San Francisco a few days beforehand, experiencing its charm. One day at the Embarcadero, I scanned a local photographer’s work when he noticed me connecting with one. It was a shot he had taken of a painting of a doctor done by a famous street artist with live pigeons flocking around the painting. He pointed at the doctor and said, “Who is this?” I said, “God?” He said, “Yes, and who are these?” now pointing at the pigeons. I said, “People?” He said, “Yes, the people come to God for help.” I had felt God guiding me through this entire health journey without question, but the timing of this man’s natural affirmation warmed me.
He flipped to a picture of the Golden Gate Bridge. He said, “Do you see the clouds and the sun together in this photo?” I said, “Yes.” He said, “This was a golden moment, it never happens.”
I thought about my upcoming surgery, with two of the very best breast surgeons in America caring for me in tandem, improving my odds of a favorable outcome and reducing my surgery recovery exponentially. It was more lucky than a golden moment. I bought the photographs, moved by the divine appointment, treasuring the mementos of my pilgrimage to San Francisco.
Two days later, I was sitting in pre-op. My very well-known plastic surgeon, Dr. Robert Foster, arrived with about five female interns and told me they would be observing. I nodded seriously and announced they would see a great example of ptosis today, and the observers erupted in laughter while the doctor merely shot me a glance with a glint of humor.
Dr. Foster knelt down in front of me, collapsing his giant frame to accommodate my short stature, and drew diamonds on me. “My husband will be thrilled with diamond-shaped areolas!” I crowed. Again the girls all laughed, and he remained undistracted. I asked him if his job is easier when women are 5’ 10” and he paternally smiled and said “It’s OK, I’m adaptable.”
The girls were clearly a captive audience, so I continued my comedy act. I said, “You know when I met with a plastic surgeon in Denver, he was a tall gorgeous man from Greece with a very attractive accent. He examined and measured my breasts in a very clinical, professional way, but he kept saying ‘ptosis’ to the nurse taking notes, so I finally asked what it meant. He said, ‘Excellent question, I’m measuring the sag of your breasts.’ I gazed into the middle distance and thought, ’This is a moment.’” The girls were now helpless with giggles, but Dr. Foster remained the consummate gentleman and finished with great precision, giving me only an enigmatic smile. It appeared my show was over so I bid them all farewell.
When Dr. Laura Esserman (The Singing Surgeon) blazed in, she had been listening to the song I chose for her to sing me to sleep with, and she was all in a tizzy. She burst out, “Elizabeth, he dies! You aren’t going to die!” I smilingly feigned ignorance of her implication and said, “I’ve always been a fan of tragic romance.” She wrestled for a moment with my absurd song choice and declared, “Well, the tumor will die! Felina it is.”
They wheeled me into operating room 11, put a mask over my face, and Dr. Laura started singing a song my father had sung to me hundreds of times. Without warning, grief filled my chest and tears ran down my cheeks as I mourned the man who cancer had taken from me over a decade ago without a fair fight. Dr. Laura tenderly wiped my tears with the corner of a blanket while she sang and then I was asleep.
What happens in the OR stays in the OR, unless you find tape on your forehead and grow curious enough to read the surgery notes. Apparently they do all kinds of things with you, even putting you in a sitting position during surgery, which is quite funny to me, but I came out with prettier breasts than I’ve ever had, thanks to the magic hands of Dr. Foster, so who am I to question these mysteries? At my request, Dr. Laura sent me a picture of what appeared to be a chunk of burnt chicken that evening (it had dye on it).
I sat in my hospital room and gazed at the offending object, intrigued by its grisly shape. As I looked more intently, I realized that I knew those curves. After tracing it for six months with my fingertips, begging it to shrink, melt, die or crumble, it was a very familiar enemy indeed. It was right where it belonged: in the hands of a doctor with a team of researchers determined to unlock its secrets.
At present, we await the final pathology so Dr. Esserman can create my future treatment plan. We don’t want radiation to disrupt the lymphocytes being stimulated by the immunotherapy to prevent future cancer, so it will be groundbreaking stuff and I love it. Despite a background noise of people who questioned the process, God took me down a path less traveled with a handful of other women.
Dr. Esserman inspired me by stating a bold goal: to put herself out of business as an oncology surgeon. My experience with cancer became a thing of purpose, to contribute to progress in medicine. I also left a little piece of me (that looks like burnt chicken) to pave the way for the women who come behind me so they can experience a cure without a knife.
I’m just passing through. Thanks for the memories and the perky little boobies, No-Cal. I’ll be back soon.
Read More:
On the Podcast: Breast Cancer Conversations
Building a Strong Relationship Between Patients and Their Medical Team
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