My (Very Personal) Career
in the World of Cancer
BY LUANNA CROW,
DIRECTOR OF
CTRC CORPORATE COMMUNICATIONS
When you work at a cancer center, you
don’t envision yourself as one of the
patients.
I started work at the Cancer Therapy & Research Center
in the fall of 2006, looking forward to using my journalistic
skills to promote the cause of conquering cancer. As a
young adult I had been diagnosed with Hodgkin’s disease,
a circumstance that led to my acquiring some medical savvy
and a little medical vocabulary. Eventually I tried my hand at
medical writing and loved it.
By the time I signed on as director of corporate communications
at CTRC, the Hodgkin’s was decades behind me
and I was the mother of three grown children. I thought my
own experiences as a cancer patient — albeit long ago and
in another city — allowed me to bring something extra to the
job. Who knew that cancer could become my career?
I set to work learning about my new employer, and before
long, I was writing about the pertinent facts. I knew CTRC
was founded in 1974 as a 501(c)(3) nonprofit corporation
and freestanding outpatient clinic dedicated to providing
state-of-the-art radiation therapy. I knew that CTRC had
grown to handle more than 1 million patient visits from all
over the world and, through our partnership with The
University of Texas Health Science Center at San Antonio,
had evolved into one of the nation’s leading cancer centers.
CTRC had entered a period of accelerated growth, and
my work in publications was to support both our accomplishments
of the past as well as rapid-fire changes. I
quickly learned about our Institute of Drug Development
that conducts the world’s largest oncology Phase I clinical
studies — that’s the first time these new anti-cancer
drugs are given to humans. I also learned about our supplementary
services, our programs and protocols and our
connection to the prestigious National Cancer Institute. I
had all the usual “PR stuff” down pat.
As I settled into my new job, October found me writing
about breast cancer awareness month. I felt a guilty twinge,
knowing I’d skipped a mammogram. I knew that I’d feel
really idiotic if that omission turned out to have serious consequences — especially considering my job.
Some months later — after two mammograms and a
stereotactic needle biopsy — I learned that I had ductal carcinoma
in situ. The good news was that DCIS is highly curable
and that I would be just fine. But I was no longer just an
employee at CTRC; I was now a patient, too. As such, I
would learn much more about the heart of the organization
through the people I turned to for help: surgeon Alex Miller,
genetics counselor Jill Cortada, oncologic psychologist Joel
Marcus, dietitian Barbra Swanson, outreach director Ronni
Chozick and even Dr. Karen Fields, who is CEO for CTRC
as well as a breast cancer expert and a compassionate soul.
No, I wasn’t scared. Been there, done that. And, although
the cancer was classified as “high grade,” it was really tiny.
My reaction was that of bewilderment: I can’t believe this is
happening again. And I was angry. I’d known for several
years that the old-style radiation treatments I had for the
Hodgkin’s could cause long-term side-effects. One of them
is an increased risk of developing breast cancer.
Now I had cancer again. And this time I had to face it,
not as a vigorous 22-year-old, but as an overweight middle-
aged woman with compromised cardiac function,
multiple surgeries, a cancer history and an oddball
immune system. In doctor-talk, that makes me a “complex”
patient. It was pretty depressing.
Also depressing was the realization that my predicament
had no clear solutions. Typically, DCIS would be treated
with a lumpectomy and full breast radiation, followed by a
five-year course of tamoxifen or raloxifene as a preventive
measure. Nothing else would be necessary. But guess
what? I’d already endured a lot of radiation to my chest,
and none of my medical professionals thought that more
external beam radiation was a good idea.
I met first with Dr. Alex Miller, an oncology surgeon. After
being asked if he had a treatment recommendation for me,
he said, “Not just yet.” He still wanted to see my old medical
records if they could be tracked down (they couldn’t)
and the final, complete report from the needle biopsy. There
was something very comforting in that honesty.
I went on to conduct some research on my own, and
Dr. Miller set me up to see a plastic surgeon just in case I
decided on a mastectomy. I remember thinking my head
would explode as I weighed my options. Not a perfect
candidate for anything, I was hugely relieved to finally
decide on a lumpectomy followed by brachytherapy,
which is internal, site-specific radiation that would affect
only the small area of probable malignancy.
Unfortunately, the lab report from my lumpectomy failed
to show the desired “clear margins.” At the same time I learned, through sheer happenstance, that “the breast
cancer gene” runs in my family. The implications were
enormous. If I carried the gene, it meant not only that
bilateral mastectomy would be my best option, but also
that I should undergo a complete hysterectomy. And it
would mean that I could have passed the wretched gene
on to any or all of my kids.
Dr. Miller sent me directly to Jill Cortada, M.S.N., R.N.,
the in-house genetic counselor at CTRC. Distraught as I
was, I managed to absorb her explanations and to provide
information on cancer within my family tree. Dr.
Miller’s nurse drew a blood sample to be shipped to an
out-of-state lab, and I left armed with a handful of
brochures and a DVD. The wait for results would be three
or four weeks.
That was when I thought I might implode. I’d invested
so much effort into convincing my very supportive family
and others in my life that I would be just fine, that I hadn’t
indulged in a bang-my-head-against-the-wall hissy fit
that probably would have been quite cathartic. Instead I
concentrated entirely on simply moving forward and
reassuring everyone around me. On the inside I felt awful.
Happily, I had another resource at CTRC to call on:
Joel Marcus, PsyD, our oncologic psychologist. With
him, I could just talk, gnash my teeth or bemoan the
medial trajectory that started so many years ago. It
helped enormously. Where I needed direction, he offered
it, and when I just needed to unload, he listened. Both my
family and my friends would have listened, too, but I
couldn’t bear to add to their distress.
When my genetics test came back negative for the
defective gene, it was almost anticlimactic. I was relieved
that I couldn’t have passed a genetic burden onto my
children and that a hysterectomy wasn’t in my immediate
future. But what to do about the breast cancer?
I decided on a bilateral mastectomy with reconstruction
because I figured, it probably would mean less surgery
in the long run. Dr. Miller, whose areas of expertise
also include genetics, told me that my own cancer and
radiation history put me at higher risk for further breast
cancer even if I didn’t carry “the gene.” Another factor
was my own lack of confidence that cancer wouldn’t
develop on the other side — it was irradiated, as well. I
wanted to be finished with it.
After a month off for surgery (less emotionally traumatic
than I’d expected), I was back to writing about cancer
again. My perspective had undergone a subtle shift,
probably because the impact of cancer, although always
personal, was again prominent in my consciousness.
I felt another shift in how I viewed my fellow employees,
especially those on the front lines who interact with
patients on a daily basis. I now have a greater appreciation
for the place where I work and for the work we do as
a unit. Cancer is a career – and a calling – for most of us.
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