Trying in 2014--Cancer Dancer

In September, Rowena had a mammogram with a question mark. That led to an ultrasound, a biopsy and ultimately the finding of a malignant tumor in her right breast.

“I have cancer,” Rowena told me with a brave smile that still contained fear and disbelief.

The diagnosis shocked us, I imagine more than it would many people, because of how in-touch Rowena is with her body. As a dancer, a mover, and a student of anatomy, she’s prided herself on knowing herself physically. And medical professionals have on multiple occasions over the years suspected problems with her “dense breast tissue”—only for those suspicions to prove false. Rowena was confident this latest scare was more of the same. And I trusted her intuition as well.

But the docs were right this time. We sent a sample of the tissue to Arizona, where a physician pal of Rowena’s doctor brother Carty confirmed the cancer.

It was “a good find,” according to the Kaiser docs—meaning that they’d discovered the tumor when it was small and that the prognosis was likely to be good. And indeed, Rowena’s situation proved to be about as good a version of bad news as you can get when it comes to cancer. “Grade 1” cancer cells that tend to grow slowly. An MRI that showed no other cancer in the breasts. A “lumpectomy”—what has to be one of the least scientific-sounding medical terms, if one of the most descriptive—to remove the tumor that succeeded. No cancer found in the surrounding breast tissue or lymph nodes.

But there was plenty of strain along the way. Part of it was fearing that Rowena would die. But given the relatively hopeful prognosis from the start, worry that I would soon be a widower was less pronounced than anxiety about uncertainty itself—a known source of great discomfort for human beings generally.

The doubts included our decision to have surgery. For years, Rowena has criticized Western medicine as overly invasive and blind to other options. And we discovered descriptions of natural treatment alternatives—primarily focused on nutrition—that had us wondering if the conventional route with surgery was right for us.

In the end, we went the Western medicine way.  And we’ve been very happy with the skilled, kind, funny doctors and nurses at Kaiser. But we fit into what one study called the “deliberator” category of breast cancer decision-making, given the abundance of information we considered before choosing a course. And the study noted that “deliberators experienced lingering doubts about their long-term outcomes—none was absolutely certain there was a best choice.”

Our reservations reached a peak the day of the surgery. To prepare for the operation, Rowena had to have an intravenous line inserted into her arm, and the saline dripping into her made her chilly. Then, because of congestion in the surgery room, her hour on a gurney in the pre-operation room lengthened into two hours.

Rowena gave birth to both of our kids at home without any medications. Dancers like her have the greatest pain-tolerance of any professionals. But here in the hospital, she felt cold, powerless and afraid. Despite efforts by nurses to bring warm blankets and connect with us, it felt like Rowena was on a conveyor belt to be sliced up. She began to cry. “I’m scared,” she said. I held her hand, brushed aside the tears. But it was hard for me to see her so vulnerable.

It was a great relief that the surgery went well. And I was surprised by how elated I was the following week when we heard that the “margins were clear”—meaning no cancer cells in tissue surrounding the tumor and that the lymph nodes also were cancer-free. Rowena, still recovering from operation, wasn’t in a mood to celebrate that night. But I had too much energy for a quiet night at home. I opted to take BART to my friend Jason’s home in the East Bay and a night out playing Frisbee golf.

But we weren’t out of the woods with cancer qualms. Rowena and I hoped she might be able to avoid chemotherapy—especially given the small size of the tumor and all the tests showing no cancer anywhere else. But an analysis of the tumor’s genetic makeup—the Oncotype Dx test—indicated there was a relatively high risk of cancer recurrence: 20 percent within 5 years. Chemotherapy would reduce that risk by 7 or more percentage points. The survival rate of recurrence, meanwhile, was a not-very-reassuring 50 percent.

In effect, chemo would be an insurance policy. A carpet bombing campaign of poisons in case one or more cancer cells from that tumor in her breast somehow slipped past the lymph nodes and were going to cause mayhem in her spine, liver or somewhere else.

We were in a gray zone—the oncologist said she wouldn’t think Rowena was crazy if she opted not to have chemo. But after much deliberation and the counsel of physician friends, Rowena opted for it. I was glad she did.

But it hasn’t been easy. I’d heard that chemo is hell, and I knew my mother went through it herself some 20 years ago. But the day-to-day reality nonetheless knocked me off balance. Multiple drugs are given to mitigate the worst side effects of the two anti-cancer drugs—Taxotere and Cytoxan—injected into Rowena. Drugs to prevent nausea and avoid vomiting and to boost the immune system and avoid potentially serious infections.

But this toxic cocktail—however well-intentioned—takes a toll. Rowena seemed fine the first few days after her first chemo infusion on a Thursday in mid-December. But by Monday, she could barely finish one of her fitness classes. And that night she had a headache that she described as “skull-crushing.” She cried as she sat in the couch, cuddling with Skyla. The headache eased a bit by the next morning, but it persisted for three days in total.

Labor was worse, Rowena says. But at least when she’d weathered the pains of childbirth, a newborn baby was the result. To me, the chemo trauma was harder to witness, given the lack of clear, tangible payoff. The tears from Taxotere and the rest could be in vain—what if cancer were to come back nonetheless? If the 7 percentage point benefit wasn’t quite enough? Or what if we were going to be fine without chemo in the first place--safely within the 80 percent non-recurrence population? 

Could we be wasting precious weeks of life trying to avoid dying rather than living?