Dr. Cory Donovan’s breast cancer story: The light at the end of the tunnel

The story begins with a small lump in my right breast which I firmly believed was a product of my well known, overactive imagination. I felt it during my final rotation of surgical training — trauma. I was on TRAUMA NIGHTS (Trademark pending. If you want it for a Lifetime made-for-TV movie, you will have to go through me.) I thought to myself, "FOR SURE this is a fibroadenoma or a cyst. These things are normal in people my age."  

My inner monologue continued, "Of course I would think that it is breast cancer. I'm going to be a breast surgeon. It is so round and smooth it can't possibly be breast cancer. Breast cancers are not round and smooth. This is totally going away."  

Luckily for all of my future patients, the oblivious and delusional inner monologue only applies to me. Patients are exempt.   

And so, we left Oregon behind, packing up the truck and drove to Los Angeles in intense heat. We unpacked into our minuscule but lovely apartment in hip and happening West Hollywood. I kept an eye on it. Was it getting bigger? Not sure. I started my fellowship. I walked to work under the palm trees and avoided the small mean dogs who controlled the sidewalks of our neighborhood with their scraggly hair and intimidating underbites. The mass was supposed to go away. It did not go away. I took my general surgery written boards and then got a primary care physician to help me obtain an ultrasound.   

The ultrasound revealed an angry cumulonimbus-shaped iceberg whose smooth nob at the surface only hinted at the mass beneath. They also found a dark and menacing lymph node.

I knew it was cancer from the moment I saw that node. Nothing benign has a lymph node missing the reassuring lymph node shape and structures. The poor ultrasound tech had no idea what to do with a patient who was actively reading her own ultrasound and knew what it meant. My radiologist knew it was cancer, too. He was charming and distracting and kind. I might have cried. OK, I did cry. I cried a lot. We all cried. I held the crumbs of the stale croissant he offered me in my cupped hand and cried. Some of the crumbs fell on the carpet. An innocent bystander waiting for her screening mammogram cried. I think that even the radiology techs cried. Then we had to wait. We waited for the hormone receptor status and for the PET scan. The waiting was so very hard, but my team came up with a plan. I flew back to Colorado and my family helped me breathe until we got the results. 

We could breathe again in great gulping breaths when the scans came back negative for metastatic disease. Next came fertility preservation (we have embryos in a freezer in Beverly Hills next to the Brangelinas). Months upon slogging months of chemotherapy. My hair fell out, my face grew round, my energy flagged and my skin turned the color of mustard mixed with mayonnaise that has been sitting out accidently overnight. I showered in the dark because I didn’t think the person in the large mirror extending the length of our bathroom looked like me.  

And then when all my energy was gone like my eyelashes, it was on to a bilateral mastectomy, which I chose because I was found to have a gene mutation that put me at a 50% risk of a second cancer. Then, after I recovered, finally it was radiation. It was one long 11 months.  

But in August of the following year I married my husband in front of a crowd of people who were there not only to celebrate our union, but who buzzed with the joy of survival. Next, I graduated from my breast cancer fellowship, moved back to Oregon and found out that we were pregnant with our post-chemo miracle baby who is now four years old. She is loud, dynamic with hair that was standing up straight from her head this morning and gives each one of her stuffed animals enthusiastic kisses. I am truly blessed.

I carry with me the knowledge — each and every day — that not everyone has the same journey that I have had. In fact, that is something I try and emphasize with all of my patients. We have come to appreciate that breast cancer tumor biology is incredibly complex. That there is not one kind of breast cancer. That every patient’s journey is as unique as they are. It is why I could continue to care for breast cancer patients while I was in treatment, and it is something that I want all of my patients to know.

Many people reach out to other people diagnosed with breast cancer to tell their own stories (like I am doing now) or stories of friends and family who have been through the disease. While they are trying to show empathy, my patients tell me that hearing about how Aunt Suzie died of the disease after they thought that they had cured her or hearing about the many side effects experienced from a medication is not helpful. In fact, it makes them feel afraid and frustrated. It makes them feel vulnerable and awkward. It is important to understand that their story is not your story. Ask them how you can help.  

I also learned that our crystal ball with respect to breast cancer can be very cloudy. I wasn’t at very high risk in my mind. My grandmother died of breast cancer in her early 50s but she came from a large farm family with no other known breast cancer cases. This is true for my patients as well. The majority of patients under age 50 who get breast cancer are not considered high risk. We know some things that are protective or make you less likely to get breast cancer, but they only move your risk a couple of percentage points on the scale. The two major risk factors for breast cancer are being genetically female and getting older. 

This brings me to another point. I can’t explain why most of my breast cancer patients get breast cancer. It isn’t because they didn’t breast feed for long enough or ate too little kale. It certainly isn’t because of the cupcake they had at the birthday party last weekend. The interplay between diet and breast cancer is impossibly complex, but I know enough to say that we can’t point the finger with authority. This liberates survivors from guilt that they caused their cancer (they did not). And I want women, no matter what their risk is perceived to be, to get an annual mammogram. Every year. Because the movie is more valuable than the snapshot. And men are at risk for breast cancer as well. The risk is certainly lower, but men are often diagnosed at a higher stage because men are not looking out for this disease.  

My best advice for breast cancer patients and those who love them is to acknowledge that fear and unhappiness is like a gas. It will fill any space you give it. Instead, give it little space. Then try to make happiness and joy like a gas. Let it fill a large and marvelous space in your life. It is OK to laugh. It is OK to spend time with people you love doing things that you love. I’m not saying don’t talk about breast cancer or deny its existence. That isn’t healthy. But I am saying that you should make space for the moments that fill you with happiness.