by Joan Lunden
My upcoming lumpectomy would bring me much closer to the finish line.
So yes, this was one year I ought to consider celebrating.
And yet I didn’t really have it in me.
A month before my birthday—well before I knew about the outcome of my chemo or the birth of Parker Leigh—I happened to mention to Jeff that I didn’t want him to buy me anything. I just wanted to go to New York City for a night out with him.
I wanted a date night with my husband. “Dinner and a Broadway show?” I said.
I needed an upbeat, happy, irreverent show with great music. I’d heard from so many people that Kinky Boots was exactly that: a terrific, rousing performance. I thought it would be the perfect medicine for me.
Just before we left for the city, Sarah called us into Jeff’s office, where she was working on his computer. It turned out that she had the one thing we were all waiting for . . .
THE picture.
The BALD picture.
The picture for People magazine.
Apparently, earlier that afternoon, Kate Coyne had emailed Sarah the following with the final image attached:
From: kate_coyne
Date: Friday, September 19, 2014 at 3:02 PM
To: Sarah Krauss
Subject: At last!
Hi there—
So, attached, please find the image we’ve selected for Joan’s cover. It is, in fact, one of the ones we looked at when we were all together in her house, and we think it is really stunning. As you’ll see, Joan looks healthy and radiant and happy—not sick, struggling or like a victim, and one of our staffers even pointed out that the shape she’s making with her hands is almost like a heart. So fantastic! And that twinkle in her eyes . . . all there.
As I said earlier, some color correction is still ongoing, and the resolution and color you’re likely to see on your computer screen likely won’t do justice to what the final print of the image will look like. But this is essentially it: a beautiful, striking, empowering image that I just know is going to strike a chord with so, so many women. I mentioned to Joan when we met that I lost my grandmother because she refused to have chemo because she didn’t want to lose her hair . . . I honestly think that if she’d had something like this to look at, she might have felt very, very differently.
Thank you again for all of your support and input and assistance; if there is anything else at all that you need, or if there’s anything you want to discuss, don’t hesitate to call me over the weekend on my cell.
My very best to you and Joan,
Kate Coyne
I looked at the picture on the computer screen with Jeff by my side. There were no words spoken for several seconds between us.
“I think it’s going to be a good thing,” I said.
Jeff loved what he saw, too. Without missing a beat, he said it was beautiful, striking, that I should be very pleased to look that beautiful with no hair.
As we stood there taking it all in, I think we were both surprised by the image that Ruven Afanador had captured.
Then Jeff turned to me and said I should be so proud of what I was doing.
I won’t lie. I thought it was pretty awesome.
I came home later that night and found wonderful birthday wishes everywhere I looked. There were flowers and letters all over the house. They were there before we left for the city, but I was absorbing the meaning and the love and the reach of each and every one only in that moment.
When I popped open my laptop, I was heartened once again to find many more birthday wishes from people on Facebook and Twitter. The number of messages was mind-blowing. At first glance, I felt like I wanted to sit right down and try to get back to each and every one of them, but I soon realized that would be impossible. All I could do was sit back and appreciate them.
Maybe birthdays don’t suck.
I began writing an email to several colleagues who had worked with me on different projects. Something inside me felt compelled to do it now, while it was on my mind and in my heart.
When I first went public with my diagnosis, Lindsay made sure to reach out to the CEOs of the companies I had long-standing relationships with, including Dr. Howard Murad, of Murad skin care, and Sean Kell, the CEO of A Place for Mom. I asked Lindsay to assure them that I would still be fulfilling my work responsibilities throughout my cancer care, although I wouldn’t recommend any photo or commercial shoots until I had a chance to grow back some of my hair. The reality of what I was going through, chemo and complete baldness, would be evident with the cover of People hitting newsstands. They would see the evidence of my disease in living color, and so would everyone else. I had represented my skin-care line, Resurgence, for Dr. Murad for close to a decade; I swear by it. I feel it has kept me looking as young and vibrant as possible, and I knew it was helping me get through my chemo. I constantly hear from women on social media that they have breakouts and terrible skin issues from the treatments, and I was experiencing none of that from mine. I was the face of his products, so I felt enormous pressure to always represent them well.
Surely the photo would speak for itself, wouldn’t it?
Even so, I worried over how my important business partners would feel about seeing my bold bald shot. When the cancer treatment ended and my hair grew back, I still wanted to have those business relationships. Was I doing everything I could to preserve them?
And what about other people I did business with, such as agents and various speakers’ bureaus? What about my friends and colleagues? I thought I should say something to them, too, before they walked through their supermarket and saw me smiling back at them with no hair.
I want to let you know ahead of time that I am going be on the cover of the People magazine coming out next week—with no hair. Yes, that wasn’t a mistake; I was photographed for the cover with no hair. It was a tough decision for me, certainly not a comfortable one for me—to be seen bald—but I felt it was an important one in terms of empowering women across the country. I did it to make a statement: Chemo causes temporary hair loss—but it saves your life!
You all know that I have been a committed health advocate for years, and I knew in my heart that by sharing this challenging breast cancer journey, I could perhaps get more women to take charge of their own health and see that it’s not the end of the world to lose your hair for a while as you get treated. The hair grows back and you can continue to live your life.
My hope is that it will encourage women to get checked, for early detection is key in getting treated and surviving.
Sometimes birthdays aren’t just about getting. They are about giving, too. When I finished writing the note, I took a deep breath and hit send. I didn’t think about it. I just pushed the button. Perhaps the greatest birthday gift this year wasn’t what I got. Maybe, just maybe, it was what I was about to give.
Gosh, I sure did hope so.
Four days after my birthday, I was scheduled to have my lumpectomy. I started my morning with a quick visit to Dr. Calamari, the radiologist, who located the metal clips she had inserted at the tumor sites, and she attached two wires to them. She did this so Dr. Ward could use an MRI machine to find them inside the breast. I was very nervous, as it was not the most comfortable experience, but I was assured that it would allow for a potentially less invasive and smoother operation, so I grinned and bore it.
As I understood it, those wires were sticking out of my breast when I left the radiologist. I didn’t have the stomach to look. I wanted to get right to Greenwich Hospital and check in for my lumpectomy. I was eager to get the procedure over with. If all went well, my tumor would be gone—as in over and out—when Dr. Ward was done with the surgery.
Dr. Ward explained that the procedure would take about an hour and a half and that I should be in recovery for around the same amount of time. If everything went as planned, I would be able to go home that day.
Since the tumor was reduced to almost nothing, she reassured me that the surgery should be minimally i
nvasive. She would make an incision in my armpit, where she planned to remove the sentinel lymph node—even though the cancer hadn’t spread to any of my nodes, it is usual procedure to take a couple of the ones closest to the tumor, just for good measure. The sentinel lymph node is the clearinghouse lymph node. Some women have one while others can have up to four or even five. All the lymph from the breast flows FIRST to the sentinel lymph node. If the sentinel lymph node is free of cancer, then there is little chance that the other (30–40) lymph nodes in the armpit harbor cancer cells. This procedure has made the axillary lymph node dissection essentially obsolete.
Next, she made another incision on my breast where she would go in to remove any remaining tumor, plus margins, and the clips that had been inserted during the biopsy.
I came out of the surgery a few minutes before two in the afternoon. Jeff and Sarah were there to meet me. All throughout my experience, I had never opened my eyes without a loved one staring back. I counted my blessings every day for that gift, love, and support. The more time I spent in hospitals, the more apparent it became that not everyone had that luxury. The thought of battling cancer alone truly broke my heart.
But I also worried about those who were navigating life alone, especially those dealing with cancer or some other chronic illness. Every time I sat for one of my chemo treatments, I became aware that there were countless people who were genuinely alone during their sessions. They weren’t just sitting by themselves; they had no one to go through their illness with—no one to rely on for support or help. I heard from many of these brave women who were going through the journey on their own, and my heart went out to them every time I read one of their letters.
If you ever wanted to give the gift of your time, sit with someone going through chemo or radiation. Hold his or her hand, read aloud, perhaps take a home-cooked meal. I don’t know that I would have understood before my illness how important these acts are, but that surely speaks to the change in my outlook today. The smallest kindness or compassion means so much to someone facing a chronic illness. Even if you can’t give money to a cause, everyone has time to offer.
I was very groggy as I lay in recovery, but somehow I was finding the strength and peace of mind to be me.
What was the first thing on my mind?
Even though the holiday was a month away, I was trying to plan out my Halloween costume!
It was right around the time Dr. Ward walked by my room that I blurted out, “I want to be a surgeon for Halloween! In fact, I want to be Dr. Ward! I think she’s fantastic.”
I’m told I was really out of it and quite funny that day. I wonder what drugs they had me on!
Sarah, Jeff, and Dr. Ward sure seemed to have a good laugh.
I was really glad everyone had an intact sense of humor, because People was about to hit newsstands the very next day.
They were going to reveal the cover for the first time on the Today show.
Yikes!
Wasn’t putting it out on every newsstand enough exposure?
They would be showcasing the cover on the morning talk show, too?
OMG!
What do I do?
Should I stay home all week?
Or hide for the next couple of weeks?
Will it be embarrassing to be seen out in public while the magazine is on newsstands?
I suppose the silver lining to this dilemma was that I didn’t have to worry about being seen for a few days: I was home recovering from my surgery. I also had a family holiday dinner planned. The dinner had been scheduled long before my surgery, and I decided not to cancel it at the last minute. For the family’s sake, the fewer changes I made to everyday normalcy, the better. Besides, I had thirty-two family members coming at six P.M., and somehow this felt normal?
I know. I know.
This was something that would make most people come undone, but I loved it!
I thrive on setting a mood, creating tables that will delight everyone, young and old, and making holidays memorable.
Oh boy. “Memorable” would be the understatement of the year, especially if I had a copy of me bald on the cover of People!
Would I have the chutzpah to show everyone?
What would they think?
They were my family . . . they had to be nice about it . . . at least to my face, right?
But what would they say about it in the car after they left?
I couldn’t worry myself about it any further, because what was done, was done. They’d all find out sooner or later, anyway.
CHAPTER 25
The Big Bald Reveal
Now, if I go through it again, I think I would be a lot more open about it. I admire people who have been open like Melissa Etheridge and women I see walking around facing it without wigs and all that stuff. I think I would be more courageous next time.
KATHY BATES
Actress, diagnosed with ovarian cancer in 2003 and breast cancer in 2012
Jeff and I turned on Channel 4, our local NBC station, and watched the top of the eight A.M. hour of the Today show. Matt Lauer introduced Kate Coyne, who explained to the television audience that she was there to share a very special and unique cover of People that day—one unlike anything they’d ever run before.
Then she pulled back the cloth covering the large-board mock-up and revealed the cover.
I could actually hear gasps coming from the studio when my bald image appeared.
Gulp.
Kate said that I was sharing my breast cancer journey with the world and had chosen to do this brave cover to be a voice for thousands of other women fighting the battle against breast cancer. My goal in doing the cover without hair was to show everyone that you can still be strong and that your health is more important than your hair.
Moments later, I was patched in live with Matt and the other cohosts for a quick call to see how I was doing. I explained that I was recovering from my lumpectomy but feeling strong and hopeful. I sounded a bit groggy from surgery, but it must have created an impact, because this was when things started to blow up (in a good way) in social media. People from all over the country were reengaged in my journey. It was exciting and invigorating for me to feel their love, kindness, and support, just as I did when I made my announcement earlier in the summer. I was really looking forward to appearing on Today the following week and creating an even stronger bond with the audience.
After my lumpectomy, the question remained as to what to do next in my treatment: more chemo or not.
I spoke with a couple of experts and got a couple of different opinions about whether I should go on with chemo, since my smaller tumor was completely gone and the larger tumor had been reduced, seemingly by 70 to 80 percent. Could I consider myself cured?
I emailed Dr. Tracey Weisberg, my oncologist in Maine, for her opinion. She and I had really connected over the summer, and I was eager to hear her thoughts. When I received her answer via email, it struck a chord.
Dear Joan,
I think your situation presents some real issues for consideration.
First the facts:
1.Up to 17 to 20 percent of breast cancer is triple negative breast cancer.
2.Of triple negative breast cancer, the most virulent is the basal-like subtype.
3.Basal-like subtype usually (but not always) develops in young women, frequently of African-American descent.
4.Basal-like subtype breast cancers are frequently resistant to chemotherapy.
5.Triple negative (be they basal-like or not) may have unique capacity to spread through blood and avoid lymphatics.
6.Triple negative breast cancer—more specifically, the basal-like subtype—is frequently associated with germline BRCA1 mutations.
The specifics about your cancer:
1.It is triple negative, meaning no ER/PR/or Her2neu expression.
2.The initial size was estimated to be 1.8 to 2.3 centimeters.
3.With carboplatin/Taxol, you had a PR or partial response to neo-adj
uvant therapy
4.The lymph node was negative for cancer. In triple negative, this may not be as reassuring an outcome as in ER-positive breast cancer due to the possibility of contamination of blood exclusive to lymph.
5.You tested negative for BRCA mutations.
About neoadjuvant chemotherapy:
1.Researchers are working hard to prove that having no identifiable tumor cells in the breast is a predictor of long-term survival. To date, this has not been unequivocally proven in clinical trials.
2.From current clinical trials, it has not yet been universally accepted that Taxol and carboplatin added to AC should be the standard of care in triple negative breast cancer.
3.The BRCA-negative patients should be treated with dose-dense AC followed by Taxol (or ddAC-T).
At my center, we enrolled eight women on CALGB 40603. I was lucky. None of them were randomized to ddAC-T (control arm). All received carboplatin regimen plus AC with or without Avastin. To date, none have relapsed locally or distantly. We are two-plus years into follow-up.
So . . .
1.Based upon your result of having even microscopic residual disease, it would be very difficult for any oncologist to recommend omission of AC. Frankly, it would be difficult to recommend omission of AC even if you had had a complete response to therapy based upon current knowledge base, because remember, a complete response rate has not yet been 100 percent linked with assurance of cure and failure to relapse at a distant site.
2.There is little knowledge to date with regard to treating breast cancer exclusively with carboplatin and Taxol.
So what to do . . .
1.The consequences of metastatic disease are devastating. Once cancer recurs in lung, liver, bone, or brain, there are drugs that can “hold it off” for a period of time. Those available drugs in triple negative breast cancer to date are exclusively chemotherapy and new drugs that are still investigational.
2.The toxicities of AC are manageable. They are not easy, but with good supportive care, women get through therapy with minimal “collateral damage.” The biggest concern is potential side effects on heart, but frankly, with doses used in breast cancer, the true rate of heart toxicity is low if heart function is normal at the start of therapy. This is measured with a non-invasive test called an ECHOCARDIOGRAM. The other side effects are low white blood cell count (remedied with growth factor Neulasta) and nausea (managed with Aloxi, Emend, dexamethasone).