top of page

Upcoming
events

Third Time’s A Charm

By Elizabeth Brodbine Ghoniem



I was diagnosed with breast cancer a couple of years ago; I was sixty-six. Was I surprised? Not really; I’d already had two other breast cancer scares. “Third time’s a charm” didn’t apply. Or perhaps it did. One oncologist called me “lucky.” 


They discovered the cancer early. It had not spread. Only surgery followed by radiation would be necessary—no chemotherapy. There would be medication to take for five years, but I could worry about that later. 






It started with my annual mammogram. The radiologist found suspicious activity in my left breast. Unlike the calcifications she was already watching, these new masses had jagged edges (pleomorphic). The next step would be a stereotactic biopsy. Since I had had two biopsies before, I thought it was no big deal. But the radiologist kept looking at me suspiciously, repeatedly asking if I had any questions. That should have been my first clue.


Later, I decided to look it up online. Only a man could have designed this process. Yes, it is exacting, but imagine you are lying face down on a specialized table with your breast hanging through a hole, your head to one side, your arms fixed over your head. You’re told to hold still for 20 to 30 minutes, while your breast is squeezed like a lemon until the last drop of juice. Then the doctor inserts a needle to suction a sample, and inserts clips to mark the location of the area in question. 


It was the worst mammogram I’ve ever had. 


Apparently, patients used to sit in a chair for this, but many passed out, so now they opt for a table. Improvement? Really? 


I searched online and found one vendor’s website showcasing the device. The patient and doctor were smiling; they appeared happy (before the procedure?). The process was described as “comfortable patient access.” That should have been my second clue. 


After all, the company sells to doctors, not to patients like me. 


Don’t get me wrong. I am grateful for advancements in technology that allow doctors to discover cancers much earlier and save lives—mine included. But perhaps the same efforts that our tech billionaires put into launching rockets to Mars could be redirected to fund development of better, more patient-friendly diagnostic machines, instead of this medieval torture device. Maybe then, fewer women would avoid mammograms, and we’d have fewer late-stage diagnoses.





The call came while I was on Zoom with my writing group. I muted the meeting and left the room. A nurse had the unfortunate task of delivering the results: cancer. My hands shook. Even though I had prepared myself for the diagnosis, it was still shocking. Fortunately, my husband was home. He stood beside me as the nurse rattled off: DCIS, grade 3, ER+. 


The ductal carcinoma in situ (DCIS) diagnosis meant that it had not spread outside the ducts in the breast. It was grade 3—meaning how different it was from other cells within the grading system of 1-3, with three being the worst, and was estrogen-receptor positive (ER+), indicating that estrogen was feeding the cancer. We didn’t know enough to probe beyond “what’s next?” 


We met with the surgeon the next day, who explained more. The plan: breast-conserving surgery—aka lumpectomy—followed by radiation, and then hormone reduction therapy.


One in eight women will be diagnosed with breast cancer. Because of that awful statistic, I was able to reach out to friends and family who had breast cancer, including my younger sister. Everyone assured me that it would be okay. After all, everyone was still alive 7 and 10 years after the diagnoses and treatments. Even my doctor friends, including a retired breast surgeon, were quick to reassure. They had caught the cancer early. I was “lucky.”





Surgery was routine. The only annoyance. No exercise for three weeks. My excellent surgeon insisted upon that multiple times. Please don’t get the impression that I’m an exercise nut because I’m not. But this was summer, and I vowed to get back into shape. Kayaking? Not allowed. Swimming? Off the table. Even walking longer than a couple of miles was discouraged. My husband, normally a drill sergeant, insisted on joining me for any walks. Instead of “walk faster, you’re too slow” I got “too far, turn around.” 


I may have sneaked in a few extra steps. Just don’t tell him.


Thanks to a ruling from President Obama’s administration, the medical profession must release test results as they become available. Helpful? Yes. Scary? Absolutely. 


My phone pinged with my surgical pathology report. Of course, I had to look: 2mm margins, DCIS with solid and cribriform types (intermediate grade) with necrosis. Two pages of results that I did not understand. I searched online and found an article by the American Breast Cancer Foundation and tried to decode my fate while I waited for the doctor’s call. Thanks to my care team, the doctor’s office called shortly after. Another surgery was not needed; they had gotten all the cancer. The margins were clear, at least 2mm. I guess I missed the pre-surgery discussion of potentially more than one surgery. At least it was irrelevant. But what about the other results: necrosis, tubular, a decrease from grade 3 to grade 2? Did this mean I could skip radiation? 


Two days later my husband and I met with the radiation oncologist. During the exam, the doctor remarked on how my anatomy was ideally suited for radiation; she liked the separation of my breasts. Should I be flattered? 


Radiation, like chemotherapy, is meant to kill any remaining cancer cells to reduce the risk of migration and recurrence. But nothing comes without risks. All I could think of was Marie Curie, the first woman to win the Nobel Prize for her breakthrough research on the chemistry of radioactive substances. She had died from too much radiation exposure. 


I wasn’t Marie Curie, and this wasn’t the early 1900s. But when you are told that radiation will be beamed into your body to kill cells, wouldn’t you also worry? 


The doctor understood my hesitancy. A new test, DCISionRT, could be done to determine my individualized risk for recurrence and benefit from radiation. “Tests are good,” my husband uttered. Unlike our first call, he had come prepared with questions. He did not earn his PhD and become a professor at MIT without his fair share of research. “Just one more question,” he said and asked a slew more, which the doctor patiently answered. 


The results from this new test would take two weeks. In the meantime, I was stuck in limbo, unable to plan my future. The doctor understood and agreed to schedule our next appointment as if we were moving forward with radiation while we awaited the results. This was prophetic because, sure enough, I was at high risk for recurrence, and radiation would reduce that risk by more than half. 





To prepare for radiation, you first undergo mapping. This process is conducted using a CT/simulator, which scans and maps the breast area to be targeted and the areas to be blocked (your heart and lungs). Tattoos are applied in strategic locations; these are small freckle-sized markings that the radiation technicians will use to align your body during radiation therapy. I have four of these: one on my left side, one on my right side, one in the middle of my front, and the last in the middle of my back, all aligned with my breasts. This involves a pin prick into the skin. It was uncomfortable but certainly tolerable. However, I will forgo getting any decorative tattoos, as I can only imagine how this multiplied by 10,000 pin pricks would feel. I leave that to others. After the mapping session, the team—the radiation oncologist, physicist, dosimetrist, radiation technicians, and nurses—meets to discuss the optimal dose and transmission of the radiating beams, as well as your position during treatment, whether you will be prone or supine. 


I don’t know why I struggle with the terms “prone” and “supine.” I know that one means lying with your face down and the other with your face up, but I get tripped up sometimes. It’s like when someone says to lift your left arm and you lift your right one instead. I was interested in the etymology of the terms. It beats searching for something about cancer. 


“Prone” originates from Latin pronus, meaning to bend forward, lean forward, bend over—your face not up. “Supine” originates from the Latin supinus, meaning lying on the back, bending backward, obviously face up. Yet I’m not alone in my confusion. James Joyce in Ulysses writes: “He lies prone, his face to the sky, his hat rolling to the wall.” And, I wonder if Flannery O’Connor was equally confused or just wanted to be ambiguous when she wrote in one of her letters: “I too have been prone on my couch this week, a victim of the common cold.” Wouldn’t you visualize someone lying on their back, face up? 


A week after the mapping, on a Friday, I had my pre-treatment session, which included the team’s decision on my treatment. I would have eighteen radiation sessions, Monday through Friday, with weekends off. For sixteen sessions I would be prone, my left breast hanging down through an opening in the table. It sounds awful but really it’s not that bad. Unlike the stereotactic biopsy, your breast hangs free—no compression. For the last two sessions, I would be supine for a “cone down,” the radiation field narrowed for an extra boost, not necessarily a higher dose. 


The radiation technicians—always two, sometimes three—introduced me to the linear accelerator. You can undoubtedly research this machine, which I did, but simplistically it is the device that beams the radiation on you. The technicians had me lie prone on the x-ray table, aligning my body to the exact position recommended for treatment, and took additional pictures. All of this was recorded, and the machine was programmed to know exactly where to radiate its beams. Radiation treatments would begin the following Monday.


The doctors and staff thoroughly explained the process, discussing in detail the short- and long-term side effects; none were serious, except for those rare instances that occur only once in a million. I wouldn’t go there.


The sessions would take no more than fifteen minutes from start to finish. I asked if it hurt. They said it wouldn’t, but I’ve been given that same answer before and I was skeptical. I thought I had a high level of tolerance for pain until experiencing excruciating pain during a dental visit. The dentist, now my former dentist, said Novocaine was unnecessary as she yanked off a temporary cap to replace it with a permanent one. “It will only take twenty minutes,” she said as she continued to yank away, and I gripped tighter and tighter to the side of the chair. Twenty minutes turned into two hours. Finally, she asked if the cap fit okay. I lied. No way was I going to let her continue and no way was I going back. So yes, I was skeptical when the radiation oncologist assured me it would not hurt.


Day 1 came the following Monday. I was petrified, and I didn’t sleep the night before. It also didn’t help that my appointment was during rush hour, it was raining intermittently, and it was the first full week of school. Traffic couldn’t have been worse. Waze kept redirecting me and I eventually gave up and ignored their instructions. My husband was in a separate car on the phone, trying to calm me, assuring me that they would wait for me if I were late. Assuring, another word that was becoming all too familiar. Its meaning: to make sure or certain. At least that was true; I made it to the lab with two minutes to spare. 


I was greeted warmly by the receptionist, nurse, and the two radiation technicians whom I had met the previous Friday. I changed into a lovely blue waist-length gown and looked back at my husband, who seemed more anxious than me as the technicians led me away. Tossing off my sandals and the gown, I climbed onto the table, lay face down (prone) and started breathing deeply. The technicians guided my body in place, smoothing down my shoulder blades, asking me to “relax my shoulders.” Okay, really! I am lying half-naked face down on a table in a freezing room, where there is a big machine hovering above me, and I am supposed to relax. Yes, they kindly gave me warm blankets for my lower body and arms, but I was still cold, and my claustrophobia was getting the better of me—more deep breathing. After the technicians assure me I am in the exact position, the machine is lowered and positioned inches away from my body. The technicians leave the room. 



Moments later, I hear noises, some clicks and then a louder, longer, screeching sound. I try yogic breathing. In for ten and out for ten, but it feels more like the beginning of hyperventilation. The machine rotates across my body. More clicking and again longer, screeching sounds. Then it’s over. The doctor was right: no pain. I learned the screeching sounds were the radiation beams doing their job, one side and then the other. Fifteen minutes later, I am dressed and on my way home. And just in case you were wondering, I am not radioactive. Note to self: next time wear socks.


Day 2. After battling with my husband over when to leave—he’s known for barely making flights—I win, and we leave about fifteen minutes earlier, which makes a huge difference. Same routine. I jump on the table, this time wearing socks. Warm blankets, of course, and the machine moves around me. There’s no pain, but later that day, I felt some twitching in my breasts. I visualized red, androgynous figures, swords and shields raised, battling the beams as they came in, struggling to survive and proliferate. 


Day 3. My husband and I arrive early. Treatment is delayed. The server is down. Did the warriors win? We meet with the radiation oncologist. My husband raises the concern about the twitching in my breasts. She assures us that the twitching is likely a remnant of surgery and could last days, months, or even years. But what if she is wrong, and there are truly cancerous warriors inside me, battling to survive as I fought to rid myself of them? 


Later that day, I received a call: the server was up. Could I return for my treatment? The warriors better be prepared because the radiation beam was coming for them again.


Treatments went smoothly after that, but my mind still came up with all sorts of conspiracy theories as I lay there being beamed down upon. Besides the little red warriors—I still believe they do exist—I lay there wondering what would happen if one of the technicians moved the beam to my eyes, blinding me or my brain and wiping out all my memories. Of course, none of this happened, but my strongest recommendation is not to binge-watch four seasons of Stranger Things while undergoing treatments.


Radiation is over. I can return to my routine—whatever that even means now. Cancer changes you. Even though my prognosis is excellent – 97-99% survival rate, I realize that life will end at some point.


I still hesitate before making plans too far in advance, and I find myself analyzing every ache and wondering. However, I also buy that ridiculously expensive dress I’ve been coveting in the store or that perfectly matching necklace. I don’t wait for “the special occasion.”


Life itself is the occasion.





Read More:






On the Podcast: Breast Cancer Conversations

Understanding Nurse Navigation: Support and Resources for Cancer Patients





Share your story, poetry, or art:


SurvivingBreastCancer.org Resources & Support:










bottom of page