For Anita Bartel, annual mammograms dredge up an aching — a muddy sickness that sits in her gut, sticks in her mind until she learns for sure that the answer is No, the cancer is not back, not this time at least.
Until then, all those what-ifs awaken, churn and erupt into worries. How can I bear another positive diagnosis? What if I am not as strong this time?
Nine years ago, she had a malignant tumor in her right breast discovered early on, but it was aggressive and spreading. After a lumpectomy, four months of high-powered chemotherapy and six weeks of daily radiation, Bartel was declared cancer free.
Annual mammograms are a grim reminder, but “I will always go through with [the exam],” says Bartel, 55. She knows some women let the fear control their health. “They are afraid to hear the news again.”
Bartel finds strength in consoling others. As an assistant in Cleveland Clinic’s Women’s Health Pavilion, she can tell patients firsthand what it’s like to lose your hair, then grow back a curly black frock with a silver streak. “It was actually a lot easier to manage, and after seven months, it went back to normal,” Bartel relates, spiking pain with humor.
Bartel has worried and rallied for her mother (who was a 44-year survivor), for herself, and now for every woman who shares her diagnosis.
“A cancer diagnosis takes you from here to death without realizing there is so much in between,” Bartel says, her words punctuated with “gratitude tears.”
“Cancer is life, interrupted” she continues. “And no one likes that. I didn’t.”
Back to ‘Normal’
Finding hope to live, not just live, with cancer is what many women inherently do, says Ellen Heyman, program director at The Gathering Place, a nonprofit community support organization for cancer patients and families. “Women as a group are very resilient,” she relates.
Sometimes, this strength is silent.
Gretchen Nock remembers her mother’s discreet yet tireless approach to living with cancer. She didn’t “do” groups. “She was private and that was her coping mechanism,” says Nock, who founded OutRun Ovarian Cancer (OROC), a grassroots ovarian cancer advocacy group.
“She would have chemotherapy and be shopping at Steinmart an hour later,” Nock continues. “She lost her sister to the disease, then her husband had a stroke weeks later. She didn’t have a choice to succumb to that world.”
Nock’s mother turned to her faith. She watched her grandchildren grow up while maintaining a weekly chemotherapy schedule for 13 years. “Once, she was tubing down a river in Michigan the next day,” Nock says, translating her mother’s actions into this mantra for women: The best thing you can do is “Keep it normal.”
Bartel did this by exercising daily, which she believes curbed nausea from chemotherapy. She rarely missed a day of work during her treatment, and her colleagues kept the environment lighthearted. She wore scarves to cover her bald head and joked that her bad hair days were actually no-hair days.
“When I was finished with radiation, my co-workers threw a breakfast celebration for me where they came in with different hats on,” Bartel recalls.
Not every cancer survivor is so open about the disease, but looking forward to each day is a common trait among them. They diffuse stress, anger and fear in different ways, Heyman notes.
Take Connie French, 60, who is co-authoring a book with Nancy Heaton, wife of Plain Dealer columnist Michael Heaton, called “Where is My Teacher’s Hair?” to help children understand that people get cancer and live happy lives.
French, a kindergarten teacher at St. Raphael School in Bay Village, learned in March 2006 that she had Stage IIIC ovarian cancer, which means it had spread outside the ovaries to the abdominal lining and the pelvis.
Ovarian cancer is an “underdog,” Nock explains, because symptoms are silent and there are not diagnostic tools to identify a malignant tumor until its late stages.
“The tumor was the size of a baby’s head,” French describes. “I should have asked the doctor, ‘How old is that baby?’ I never asked the right questions.”
French spent the summer in chemotherapy, without an appetite or energy. Gift cards rather than delivered meals provided meaningful evenings out with her family. “I knew what it was like to go to my own wake: The flowers just kept coming in,” she says. “But it was wonderful.”
French looked forward to starting the school year that fall, and she did — without hair, eyelashes or eyebrows. “I think I have pretty eyes — that is one of my better features,” French shares, quietly. “When I lost that, it was rough.”
French visited the Bobbie Brown makeup counter in Beachwood mall and also purchased scarves for her bald head. She got involved with OROC, kept lunch dates with friends and started playing tennis again several months before her one-year mark of survivorship.
Heyman admits that women will drive by The Gathering Place for days before they muster the courage to enter. They will wait months before calling, and they may walk in the vestibule and crumble.
“It takes a lot to walk through the doors,” Heyman says. It takes a lot to transition from shock to acceptance to coping — hoping. Each woman does this in a different way.
But support groups provide an outlet for women who rely on the experiences of others to carry them through the tough times. Support groups aren’t depressing or focused only on pain, Heyman says. “There is a lot of laughter,” she describes, noting a camaraderie that surprises hesitant participants. One husband of a survivor changed his mind about his wife’s support group after attending several times. “This is like my family,” he told Heyman, “a safe place to talk about worries.”
Bartel acknowledges the mixed emotions of communicating about a diagnosis and the future with family members. “Your loved ones are hurting, too, and they can’t fix it,” she says. “That is a hard position to be in.”
Candid conversations with her family were tearful, but brought everyone together, Bartel says. “That was helpful. I could say, ‘I don’t want to die, I want to get through this,’ and we would share that.”
Similar mock-conversations take place in support groups, Heyman says, so survivors can plan how to break news to family and honestly express fears.
But in less structured environments, cancer survivors find hope from small blessings.
Bartel thanks faith, humor and “stretcher bearers” such as her husband, mother, sister and colleagues who carried her through treatment. So did hats, exercise, Chinese takeout, handwritten cards, holding hands with her husband Regis and running the Susan G. Komen Race for the Cure.
Nock says groups such as Komen and OutRun Ovarian Cancer provide a venue for advocacy. “You don’t want to be your disease,” she says. “You have it, you want to move on and get through it, and the way that some people do that is to ask, ‘How can I make a difference?’ ”
A Sea of Hope
The women who get angry don’t let cancer sap the life out of living, Nock says. “It’s usually the ones who say, ‘I’m not going to be defined by this,’ who get angry and survive,” she relates. “They’re mad. This cancer is not going to take them down. It’s a coping mechanism — a survival mechanism. Then, they look for a reason why, and they find a way to make a difference.”
Information, Heyman agrees, is a valuable tool for survivors. So is understanding medical treatments and advocating for health care. And today, advances in cancer therapies, such as a vaccine to prevent HPV, give even more hope to patients.
“You really do see a lot of positive outcomes,” Bartel says, pointing to the women who walk or run for a cure every year. “Part of the reason there are so many of us in pink hats downtown each year is because there is such good evaluation and imaging today, that you catch the cancer early.”
Bartel will never miss that mammogram. And she and her husband will always save the date to run with “the sea of pink hats,” as her husband describes the Race for the Cure scene. Bartel reconsiders the nickname. “The sea of hope,” she decides. “A sea of survivorship.”
Dr. Holly Thacker answers frequently asked questions about the HPV vaccine online at www.clevelandmagazine.com.