She was so young. A mother of 13 year-old twins, she had rapidly developed abdominal swelling. There was no pain and her appetite was only slightly different, but it alarmed her. At first she thought she was pregnant, though the rapid development of swelling told her that wasn’t what was happening. She went to her doctor that week and her doctor ordered a CA-125. “She did it just to be sure,” she said—not anticipating that it could be abnormal (typically, it is below 35). “It came back at 1,250... I almost fainted when I found out.”
Now she was in my office, with a new diagnosis of ovarian cancer. I had expected her to be hysterical— mostly, because I knew it is how I would’ve reacted. Instead, she asked questions:
- “What stage am I?”
- “How did this happen?”
- “What’s next?”
Along with my surgical colleague, we talked about ovarian cancer: the epidemiology of the disease and how it is staged, the different types of ovarian cancers, standard surgical treatment, and the role of chemotherapy. We told her that her cancer was at initial presentation, that we would do everything we could to cure her, that cure was possible.
Throughout our conversation she took notes, her eyes going from me to my surgical colleague, and then to her husband. When we were done talking, it was her turn.
“I hear what you say and I will do what you tell me. I want to live and I never want to go through this again, so cure sounds great. But, I have no time for cancer. My kids need me, my husband needs me, and I have my career. So, I will let you treat me, but I will never use the word ‘cancer’ and would like you to never use it again either. We can call it ‘Candyce’ and when I am done, I plan to kick her out of my life like a bad habit. We will keep this here between us. I don’t want anyone in my life finding out about it, least of all my kids. So, whatever you can do to help me get through Candyce and not look like I am sick, I will appreciate.”
I sat there speechless. She clearly was not in denial—she knew it was cancer. She was choosing to approach it, though, by simply not acknowledging it, and I felt she needed us to go along with it. I started to worry then because I could not avoid the side effects of treatment: the hair loss, the nausea, the fatigue, and maybe even the neuropathy. I felt obligated to address these with her and so, I started to talk about the side effects of chemotherapy.
“I plan to use cold caps to prevent the hair loss. I’ve heard it works well—not a guarantee, but better than nothing. And I know you have good medications to prevent/reduce the nausea, so that’s good. I plan to eat right and exercise. Mind over matter, as they say,” she said.
After meeting with her and her husband, we agreed to proceed. Because the disease was too advanced for surgery, we started with chemotherapy. She would come in exactly on time, always dressed up as if she were going to a business meeting or a power lunch. She brought her cooler with her, and true enough, after the first few cycles her hair loss was minimal. She made it through each cycle without a complaint, stoically submitted to exams, and ended each visit with, “She is on her way out, Candyce—I can feel it.”
Following the third cycle I wanted to know how things were at home, wondering if her kids were aware of the diagnosis and that she was on chemotherapy. I wanted her to know of the amazing resources we had in place for parents and for their kids.
“Oh!” she said. “They don’t know anything. I’ve told them I have an infection that requires me to come to Boston. Nothing serious. After all, why have them worry about me? I’m supposed to be the parent, right? I can protect them.”
I once more was speechless. She had cancer, and it could kill her. It was fine that she called it “Candyce,” and it was absolutely reasonable to use other means to help prevent hair loss from paclitaxel. But to deny the disease to her kids was too much. I felt they deserved to know what was happening, the seriousness of the situation, that she was going through chemotherapy, not antibiotics—and that yes, she could die.
But, I was not her husband or her kid, and I was not her. I could not possibly understand her family dynamic, the role she played in it. I knew better than to act on my thoughts, and instead, just be there, for my patient. However, I wanted her to know she need not go through this alone. Parenting with cancer is not easy, and the questions she might have can be painful, difficult, and frightening.
“Well, if there is a time when you talk with them about it, or they ask, please know that we have an amazing resource in the Parenting At a Challenging Time (PACT) program available here. It’s been useful for others, and I think you and your family would benefit from them too,” I said.
“That’s okay. We’re fine.”
She ultimately was able to have surgery and fortunately, it was successful. She had no residual disease at the end. She then continued with chemotherapy and, following her last cycle, we proceeded with a reimaging evaluation.
“No evidence of disease,” I told her. “It looks like you are in remission.”
At that point she started to cry. “I know I seemed strong, but this whole thing has been terrifying. I just want my life back.”
I suddenly realized how she had shouldered so much, and did it only with the support of her husband—no friends, no neighbors, not even her children. It was by choice, and it was the way she wanted to get through her treatment, but it was a heavy weight to carry.
She once more showed me how strong women with cancer are, and how many roles they play in our society: wife, mother, friend, professional, confidante. It did not matter if I agreed or disagreed with how she lived, and continues to live, with cancer. Ultimately, the job of the oncologist is to treat and support, with understanding, and without judgment.