Chris had two small local recurrences of breast cancer in 1997 and 1999, both spots removed with biopsies. Meanwhile her life was in turmoil – she moved several times and her daughter was the victim of an attempted kidnapping by a child molester, bringing court appearances and media attention. As the 90s drew to a close, Chris settled into an IT job and her life was stabilizing. A year later, however, her company was sold and she was laid off, so she started working temporary jobs to make ends meet for herself and her two children. Chris found herself growing increasingly tired, though, and had trouble keeping up her hectic pace. She eventually lost her job, was evicted from her home, and moved her family in with her mother.
In 2001, Chris’s port, a medical device surgically implanted under the skin by the clavicle for the delivery of chemotherapy, was causing her pain. Without insurance, she had not been able to keep up with regular port maintenance, so it hadn’t been flushed or used since 1994. As a point of perspective, my port, which I kept for a year after my treatment ended, was tested and flushed with saline about once every month. One evening, Chris’s pain was so severe she went to the emergency room. They x-rayed Chris’s chest and she looked over the technician’s shoulder at the films.
“What are all those white spots?” she asked.
“Even if I knew,” he answered, “I’m not allowed to tell you.”
Within minutes, an ER resident came in to casually ask Chris for the name of her oncologist. Chris knew the white spots were tumors.
Uninsured, Chris no longer had an oncologist.
She lived in Norwood, Ohio, a General Motors company town decimated by a plant closing in 1986. Still trying to climb back, Norwood offered limited public services. Although located in the middle of Cincinnati, Norwood has the odd distinction of being an incorporated city within an incorporated city. Thanks to ensuing bureaucratic complication, Chris was unable to take advantage of broader services available in Cincinnati.
After considerable leg work she found a cancer center and an oncologist agreed to monitor the situation pro-bono until she could find insurance. Because of her relatively early-stage original diagnosis, the oncologist did not think she had metastatic cancer, although the only way to verify that was surgically, an option financially out of reach for Chris. After five months, however, the white spots didn’t clear and the monitoring oncologist ordered a surgical scope and biopsy.
Chris was stuck in a medical system Catch-22. Since she had no cancer diagnosis, she wasn’t eligible for public disability programs but her symptoms prevented her from working. Every surgeon she contacted insisted she pay half upfront and Chris didn’t have the money. Her mom ended up negotiating a deal with a surgeon and on October 2, 2002, Chris had a mediastinoscopy to study and biopsy the area between her upper chest and lungs.
Chris awoke in the recovery room to her mother’s and sister’s bloodshot eyes. One look at them gave Chris the answer. Before she regained consciousness, her doctor had told them that he looked in, biopsied some tissues, and closed her back up because he saw cancer in both lungs and the lymph nodes in her chest.
He said there was nothing left to do but make Chris comfortable.
The pathology report of the biopsies showed that Chris had metastatic, or Stage IV, breast cancer which was both estrogen-receptor positive and Her2Neu positive. Of the mindset that she would die soon, she refused harsh chemotherapy. Her oncologist tried several of the standard drugs used to stop her body’s estrogen production, the fuel for these tumors, but none of them worked.
Experimentally, they added Lupron, a hormone disruptor normally used in late-stage prostate cancer. Combined with traditional approaches, her estrogen production finally diminished.
In September of 2004, another tumor showed up on Chris’s right side. Still stinging from the mannerisms and death sentence of her last surgeon, she called around to other provider’s offices, telling her story again and again to try to find someone to help her. One person listened to her, and recommended a surgeon associated with the University of Cincinnati.
The new surgeon performed a biopsy of the tumor and it turned out to be In Situ, stage 0. They switched up the medications and moved on.
In October of 2006, two more tumors were found – one in the right breast and one attached to a lymph node on the left side. Both tumors were stage 1 and her pathology had changed again. Neither contained estrogen or Her2Neu receptors. They changed up the medication and moved on again.
From 2002 to 2006, Chris had time to process the seeming inevitability of her fate. Stage IV breast cancer has a low five-year survival rate. While no statistic can predict any one person’s outcome, Chris knew that less than 1 in 4 people diagnosed with her stage of breast cancer live for five years. In her years of seeking treatment, Chris, a single mother in her 30s, did her best to make peace with her grim prognosis.