Written by: Jennifer Appel
“Stop resisting what is and start leaning into what now.”
Some days in CANCERLAND are like healthcare’s version of the Tower of Terror--a straight, sharp, drop off the edge of a cliff. Other days it feels like a bad trip on Space Mountain. You mentally prepare yourself for twists that leave your stomach turned completely upside down but have no idea when they're coming since you’re completely in the dark.
I’ve been through every human emotion in the past months, some of which I wasn’t even expecting. My journey began when my tumor was first biopsied. The biopsy showed signs that the outcome was going to be a long year of treatment. The tumor was large, active, and aggressive which meant it was fast growing and likely to spread throughout my body. When I first met with my oncologist he warned me that this was going to be a long, hard process.
Before surgery, we anticipated the tumor had attached to my chest muscle and predicted that it probably had spread to at least two lymph nodes if not three. There was even a possibility that cancer might have spread to other parts of my body. At this point, I was still considered stage 2 breast cancer but there was a possibility that I was at stage III or worse.
Going through bone and CT scans of my body to see if cancer had horrifyingly spread to other organs was the longest most agonizing waiting period I’ve ever experienced. Positive thinking and pride in how quickly I caught it kept me grounded to optimism and hope as I not so patiently waited for my treatment of fate. Finally, we got the results back and were relieved to discover it had NOT spread or metastasized! Indeed, I was incredibly grateful the cancer was isolated to my breast.
Gratitude is finding the wisdom in the middle of life’s lesson.
When we met with my oncologist he predicted after surgery we would see at least two to three lymph nodes positive for cancer. Lymph node positive would have been an indicator that cancer had spread making radiation and chemotherapy mandatory.
Once again, I found myself waiting for CANCERLAND'S ROLLER COASTER...
I elected to choose the most aggressive form of surgery and opted for a bilateral mastectomy, where my surgeon removed the large tumor in my breast, two lymph nodes as well as both full breasts. My doctors were so sure of planning for the long game of chemo that my surgeon placed a chemo port in my chest so I’d be ready for the next phase of hell.
The good news was that my tumor had not attached to the chest muscle so radiation might not be necessary. Tumor and nods were sent for testing and again the waiting began. After two weeks of recovery and optimistic rumination, we finally got the test results back on my lymph nodes.
Miraculously, my lymph nodes were negative for cancer--which was HUGE NEWS! However, the sentinel node, closest to the tumor, had little sprinkles of cancer cells. [Side note: I feel like sprinkles is such a misleading word for cancer. Sprinkles should be a colorful surprise found in a confetti cake or a glittery mess oozing out of a birthday present. Aren’t sprinkles good? Maybe it’s just me].
My oncologist was concerned about the sprinkles, size, and grade of the tumor and thus we scheduled chemotherapy for 3 weeks later. Setting up months of chemotherapy was an overwhelming task. In order to determine the duration and type of medications to be used, the oncologist sent the nodes off to California to perform a special test called Oncotype DX. Oncotype DX generates a metaanaysis score that takes into account all risk factors (I.E age, genetics, tumor size, type, etc.).
This test analyzes the genes in your tumor and basically gives you a score from 0 to 100. The lower the score the less likely cancer will return. Anything above 45 and you’re on a path with the most intense form of chemotherapy. Basically, you’re hoping for a score as close to zero as possible.
My friend Malaika compared the score to that of a golf score--and I was shooting for par. The oncologist was expecting my score to be way over par--in the 30s and 40s which meant strong chemo but was also preparing me for an even higher score and longer version of chemo. Clearly, he wasn’t as confident in my golf game.
However, in the back of my mind, I was thinking, it’s still POSSIBLE TO get a low score, RIGHT? I remember Hans asking my doctor “but what if she gets a really low score” of which my oncologist basically blew off saying "we’ll talk about it, if that actually happens." While the best case scenario seemed to be 3 months of chemo before starting 3 months of radiation, all the experts around me believed more intensive treatment was still on the table.
Sometimes YOU have to be your own ray of sunshine.
I couldn’t kick this pesky belief that I might be the outlier. During those weeks of waiting, I reflected on things being a little better than my oncologist believed. Each time he set the bar of expectation, I seemed to hurdle over it in all the best ways. And maybe...just maybe...I might surprise him one more time. Practicing a JOYFUL mindset to ride the bumpy turbulence of CANCERLAND is a three step process:
The Oncotype DX results normally take three weeks, which would land on Friday (just under a week before the start of chemo). Friday came and passed with no results. Monday--no results. When Tuesday arrived again with no results, I pressed my nurse to call the company. Apparently, insurance had not approved the test yet. Despite having the claim for over 3 ½ weeks, it hadn’t gone through.
Feeling the time pressure of starting chemo in just a few short days, I reached out directly to my insurance company to see if there was anything that could be done to speed up the approval process. As it turned out, the approval had gone through on Wednesday and now we were back to waiting...
Thursday morning I woke up 95% sure that we’d be starting chemo and TODAY was the dreaded day. I had a pre appointment with my oncologist to go over results of the Oncotype DX and other pre-chemo logistics.
During the past week friends and family had sent me gifts, cards, and messages of encouragement as I mentally prepared to harness my inter-bravery to endure the effects of chemo. I even scheduled a last minute appointment to cut my hair really short to help lessen the shock of losing my hair altogether.
Walking into the cancer center, I once again found myself with a jovial feeling that my score on this test might have bigger ramifications. Optimism isn’t something you discover in the most intense moments. It has to be cultivated over time.
“Life is more about consistency than intensity.”
For some context, my oncologist is a brilliant doctor but he is very serious, rarely smiles, and has a clinical ‘tell it like it is’ delivery. Patient interaction and rapport are less prioritized than data, facts, and research. He’s the guy you want determining and orchestrating your treatment plan--just not the guy you want telling you about it.
In the exam room, we heard an energetic knock and then my oncologist quickly burst through the door with a report in hand. His giant smile stretched his COVID mask across his entire face while he wildly waved a report around the room. Like a kid in the candy store he was practically giddy as he bounced into our space.
Skipping over any formal greeting, he proudly paused to show us a big circled #11 on the front of the report. From our own independent research online, we knew that anything lower than a 15 meant chemotherapy was NOT recommended.
The doctor sat down and explained that the chances of any cancer returning without doing chemo is less than 3%. The general population of randomly selected women have a 13% chance of being diagnosed with breast cancer. In fact, nearly 40% of people experience some form of cancer. I could hardly believe it. NO CHEMO! NO RADIATION! WOW!!!!
Given all of my risk factors, diet, exercise, genetics, etc. I only have a 3% chance of any cancer coming back. My doctor said he was SHOCKED by my low number, “I didn’t think there was any way we wouldn’t be doing chemo--let alone radiation.”
From the initial cancer diagnosis to preparing for months of character defining treatments, I somehow managed to strengthen my resolve in trusting my own body.
Some may simply dismiss me as a medical outlier or miracle. Others might attribute my outcome to a healthy lifestyle and quick action to seek medical intervention. My doctor believes that my plant-based diet, with no alcohol, caffeine or sugar put me at a better chance of the cancer not spreading.
And there’s some truth in all of these. But as I try to make sense of my new normal, just days removed from learning I DON’T HAVE CANCER ANYMORE, I believe that searching for and finding the JOY in my innermost moments of OPTIMISM, HOPE, and GRATITUDE acted as the entry task to cancer’s most compelling lesson.
For my storm, hormone therapy begins soon. I have nothing but a positive attitude and knowledge that everything will work out.
For years, I’ve planted the seeds of good health practices, a joyful mindset, and a curiosity to seek the lesson...and these values came back to support me when I needed them most.
Stepping off the CANCERLAND roller coaster I feel a little wobby, lightheaded, and nauseous. I never waited in line, bought a ticket or even wanted to board this thrill ride; but, I’m still standing and #InspringJOY.
ABOUT THE Author
Jennifer Appel is an educator, coach, speaker, and writer. She’s the Co-host of the Award Winning Culture podcast, and the Co-Creator of Award Winning Culture. In addition to being the author of the highly anticipated sequel to Award Winning Culture, she’s the author of a line of picture books focusing on Social Emotional Learning and Character Ed which includes, “Award Winning Dog and I’m WHO.” Furthermore, Jennifer has been a contributor on two books: "Teacher’s Deserve It" and an upcoming project yet to be titled.
Award Winning Culture was created by Hans and Jennifer Appel with the sole purpose of creating an educational mindset of Positive INTENTIONALITY and ACTION; with a daily mantra to make our sphere of influence stronger through Character, Excellence, and Community. Part of AWC's mission is to highlight outstanding educators, companies, and resources that support an Award Winning Culture. Both Jennifer and Hans work at Enterprise Middle School aka Wildcat Nation. Wildcat Nation received the 2018 ASCD Whole Child Award in Washington, for its award winning culture and the 2018 Global "Class Act Award" for Kindness.