My friend and I were really looking forward to hearing the results of my surgery at post-operative outpatients appointment. I had a fabulous clinical nurse specialist and wonderful breast surgeon who each communicated with clarity and empathy. “Well Marie” …. my clinical nurse specialist looked concerned as she moved in a little closer to the foot of the examination couch … “You know how nurses can be complicated when they are patients? You … are … complicated … Marie. The Grade 1 infiltrating ductal carcinoma is out & the operation went really well … BUT we also found something that we weren’t expecting. There was a completely different cancer in 1 of your 3 sentinel lymph nodes … one called Triple Negative Breast Cancer. I wouldn’t go looking around on the Internet if I were you because it can be pretty depressing. This is a game-changer. It will be Grade 3 and rather than just following up with radiotherapy as planned, we will probably need to do further surgery and add in chemotherapy”.

I stared at her with disbelief. How could this possibly be happening to me? I didn’t know what to say. My heart was crying but I didn’t want to outwardly, at least not now. My friend was scribbling down notes trying to follow this extraordinary conversation. “So what this means”, uttered my surgeon as he deftly peeled away my wound dressing, “is that I want to get in here under your armpit and remove these lymph nodes. This is a second primary in your breast and we need to find it. I have booked you in for an MRI tomorrow morning. We need to move aggressively with this. I am going to present you to the breast meeting this Friday. How would you feel if we needed to remove your breast?”. Up to this point I thought that everything was going so well and that, other than the delay to our retirement plans caused by the follow-up radiotherapy, complete recovery would be a certainty. What did she mean by saying, “it can be pretty depressing”?

As it turned out, the MRI the next morning didn’t find the primary Triple Negative Beast Cancer (TNBC). The team of breast care experts who met on the Friday recommended a radical right mastectomy, including wide removal of lymph nodes. I wasn’t prepared for what I read on the Internet regarding TNBC. Initial reading seemed to indicate that recurrence would most likely be within 3 years. The overall survival to 5 years is 65% and somewhat of a predictor of longer-term survival. WOW

Click on “The Gift” below, to discover how I felt…..

As an academic you would expect that I would start searching immediately for information about Triple Negative Breast Cancer (TNBC), and so I did. But the clinical nurse specialist was right, every site and statistic I read was depressing. Triple-negative breast cancer differs from other types of invasive breast cancer in that they grow and spread faster, have limited treatment options, and have a worse prognosis. “Triple negative” means that the walls of the cancer cells do not have any oestrogen, progesterone or HER2 receptors that are needed for hormone-blocking treatment to be an option. Chemotherapy is the only treatment available and, for my cancer that had already spread to at least one of the closest lymph nodes, the survival rate was 67% at 5 years.

It is hard to explain the mix of emotions I felt.

• Yes of course I wanted a mastectomy to get rid of this breast that was threatening to shorten my life … and all the lymph nodes. “I can tell you now”, I said to my surgeon, his eyes softly penetrating my fog. “I don’t need you to take my case to the breast meeting. Take the breast … take it … do whatever you need to. How soon can you do it?” “We need to wait for this wound to heal first”. His hand on my arm and his compassion were hugely comforting. In that moment It also helped that my clinical nurse specialist provided some certainty, re-entering the room with a surgery date pencilled in for the 18th November; just 4 weeks away.
• I have always poured 100% effort into my work. I had repeatedly reassured my nurse-lecturer colleagues that I would be giving my 100% effort right until December 17th, the last working day of my nursing career. I wanted to have the satisfaction of knowing I had given my best. But what now? I would have already taken 6 weeks off for my wide-excision surgery. Radical mastectomy including high-level removal of lymph node surgery would require at least another 6 weeks. I didn’t want my career to finish this way … somehow disappearing down the back stairs without a trace. I had end-of-year updating on my course to complete and wanted to hand it over to my successor well-prepared and easy-to-teach. My hope of being professional right to end was melting away.
• My colleagues were all united in shock and how terrible this tragedy was to befall me just as I was retiring and getting out there to live my dream I had had talked about so often. This wasn’t helped by my cardiologist who responded with shocked expression, repeatedly saying, “Oh Marie, I am sooooo sorry …. I am soooo sorry …. this is so terrible …. I am sooo sorry”. I felt like he was speaking to and looking at the walking dead.
• And our yearned-for motorhome trip couldn’t happen because of chemotherapy, radiotherapy, subsequent enduring fatigue and frequent follow-up appointments at Palmerston North Hospital. It felt like such a loss. My husband and I felt so sad … words can’t describe how that felt.

The gift.
As crushed and sad as I felt during those first days, something deep within me, a quiet calmness that I have come to know as the wrap-around presence of the Holy Spirit, impressed on me again that this is “a gift” to me. I can only describe this feeling as “the peace that passes all understanding … that guards your heart and mind” described in Philippians 4:7 in the Bible. I shouldn’t be feeling calm, but as each day passed I increasingly embraced this scary cancer journey as a gift. I held on to those scriptures in Psalm chapter 23 and Proverbs chapter 2 that reassure me that I don’t need to fear. And hope … why shouldn’t I be one of the 67% who survive 5 years!

I see this as my first gift. I may be scared, but I do not need to be fearful. I have chosen not to be afraid of what this Triple Negative Cancer could take away from me or my family. John 16: 33 in The Passion translation of the Bible says, “Everything I have taught you is so that the peace which is in me will be in you and give you great confidence as you rest in me. In this unbelieving world you will experience trouble and sorrows, but you must be courageous, for I have conquered the world”. I know that when the going gets tough in this journey, God is with me.