It's amazing how quickly things can change. On Sunday, I was a doctor, taking care of our neurology patients on the floor and bracing for the impending COVID disaster. By Wednesday, I was a cancer patient.
Let's back up a little. As some of you may know, my maternal grandmother was diagnosed with first breast and then ovarian cancer which she sadly passed away from before I was born. I always knew that cancer "ran in my family," particularly breast and ovarian cancer. But it wasn't until medical school that I learned what that really meant. We were in a genetics class learning about mutations associated with increased risk of cancer when the professor started talking about BRCA - the gene that dramatically increases the risk of breast and ovarian cancer, especially amongst those with Ashkenazi Jewish ancestry. While the blonde hair and blue eyes I inherited from my dad might throw you off, I am of Ashkenazi decent on my mom's side and things clicked immediately. Our family must carry the BRCA mutation. I suggested this to my mom, who said this was interesting and she'd think about it. My mom is a self-proclaimed (but certainly not board-certified) doctor and can rattle off hundreds of medical "statistics" followed by "yes, I definitely read something like that somewhere, I think maybe on Mother Jones." I brought it up a few times that she should get tested until finally one day she called me. "You know sweetie, Angelina Jolie just wrote this whole article about BRCA and I think we should get tested!" Great, my mother taking her medical advice from a celebrity instead of her medical student daughter. Just kidding mom, I love you :)
As you can imagine, my mom tested positive, prompting my own testing, which was, of course, positive as well. We decided to take things head on. My mom underwent prophylactic mastectomy and prophylactic oopherectomy within the next year. I was 25 at the time, but I convinced my physicians that I understood the risks and benefits. I wanted what BRCA "previvivors" refer to as the "ticking time bombs" gone ASAP. So, after finishing Step 1, while my classmates all went on celebratory vacations, I go to celebrate with some propofol and oxycodone and underwent my prophlylactic mastectomy followed by reconstruction later that year. Then it was smooth sailing for a while - my plastic surgeon did a great job, I got some fantastic nipple tattoos and it felt like this was all behind me.
Fast forward to 2020, which I will hereby be referring to as the shit year. Coronavirus began devastating the world and all my co-residents and fellow hospital employees started bracing for the storm. Meanwhile, NYC and the rest of the country finally caught on and began shutting down. I turned 30 on March 15th and had the unique pleasure of having to cancel my upcoming vacation to Sri Lanka with Merrill, cancel my birthday plans with my friends and family, and go to work on my birthday. I was feeling an appropriate level of self pity so it seemed only fair that my luck was about to turn around....wrong!
While showering that night I felt a lump near my left implant. Happy birthday to me! I immediately feared the worst and started frantically texting my oncology fellow friend, my breast surgeon, my plastic surgeon and my OBGYN. As if feeling a lump in a BRCA1 patient isn’t scary enough, our hospital was rapidly shutting down all clinics and ORs to prepare for COVID and I knew things needed to move quickly. Thanks to some incredible advocacy from my friends, doctors and colleagues, I got an expedited work-up. Well I should first mention that I was temporarily on COVID quarantine and desperately refreshing my patient's chart praying to god (well not god, we all know I'm an atheist, but like the four-leaf clover next to the the pot of gold at the end of the rainbow not near any black cats) that it would be negative and I would not need 14 day quarantine. And finally, some good luck, she was negative.
Once cleared to return to the hospital, I saw my surgeon on Tuesday, who walked me across the hall for an ultrasound which showed a suspicious mass. The interventional radiologist came in and immediately biopsied it. By that night, I had an appointment with an oncologist specializing in BRCA patients. By the next day, pathology was back - definitely cancer. And as we would soon find out, not the kind you want (but the kind you expect with BRCA) - Triple Negative Breast Cancer. *Just to add to the joy of the current situation, the lifetime risk of developing breast cancer after a prophylactic mastectomy is ~0.5%. So I'm definitely overdue for some good luck moving forward!*
Ok, I think we're all caught up now. After a whirlwind of tests, here I am on Wednesday as a cancer patient. And sadly placed on immediate medical leave from work :( For those of you who don't know, I really love my job and my colleagues and one of the worst things about this whole situation is not being able to be there with them. But unfortunately, nothing I can do about it right now.
The plan is surgery ASAP, then hopefully retreating to my childhood home in the middle of the woods away from the NYC COVID epicenter, then in a few weeks chemo which will last ~20 weeks and then probably radiation and the rest is TBD. As my oncologist pointed out several times, we are being aggressive upfront with a goal of CURE.
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I have had such an amazing outpouring of support and I want to keep everyone updated. But its a bit challenging juggling group chats and emails and phone calls, so I am going to try to post updates to this website instead. I still would love to hear from people but just understand if I'm not responding, its hard to keep up with. I love you all!
Oh and p.s. I have already informed my family, but I will be expecting an epic 31st birthday - minimum a week-long, preferably with many separate parties and including a trip to Sri Lanka that doesn't get cancelled this time :)
