part0016

Claire Brice thought it was the perfect way to end a weekend away: her young son and daughter peacefully sleeping in the back seat of the van, her husband dozing next to her in the passenger seat. She relished the fact that she could play her soft music on the radio and have no one complain. It was dark, and the music helped her to focus.

On the right shoulder of the highway was something moving just ahead … the wind blowing some brush around, she thought, or an animal. Just as her headlights panned across the area, the answer became clear … the largest (and only) black bear she had ever encountered.

It was too late to avoid the bear. Had she been so stunned that she couldn’t steer out of the way? Or was she too close in the first place? It didn’t matter, she struck the bear, and as the van swerved and lurched after the impact, chaos penetrated the quiet night.

The kids awoke with a start. “What happened???„ Her husband straightened himself up. “What did we hit?„ As she braked and pulled onto the shoulder, she replied, “I hit a bear. I looked him right in the eye.„

“Mom, I think he’s dead,„ Claire’s son replied. “Okay dear, just sit tight while your Dad and I step out and see about the bear,„ Claire responded.

Her husband rubbed his eyes. “I think it was a porcupine.„ Claire looked at him, surprised. “How would you know? You were asleep!„ Claire’s husband stepped down out of the van and looked at the newly-dented front fender, “That was one big porcupine.„

The truck behind them slowed down and stopped along the shoulder as well. “You guys alright? That’s one big bear you killed!„

“Told you it was a bear,„ Claire scoffed at her husband. She had been quite certain. “I looked him right in the eye.„

The next morning Claire awoke with a grimace. “Ow, ow, ow!„ Her husband was already awake and getting dressed. He saw her place her hand on her chest. “From the seatbelt, looks like. I have the same thing.„

But he didn’t have quite the same thing. As she pressed against her chest she became aware of something in addition to the soreness … a lump within her breast. She thought to herself, “Huh. Never noticed that before. What is it? … A lump? Maybe I’ll have my doctor check it out.„ Claire felt it again: hard like a marble, only the one. “I’ll just have to put it out of my mind until I see her,„ she resolved.

Claire sat in an examining room at her doctor’s office. “I hate these gowns,„ Claire thought. “Thirty-six years old and I still can’t get used to them.„

I knocked on the door and walked in. “Hi Claire! I hear you hit a bear?„ Claire just realized how incredible the story was, “Yep. I did. But the accident isn’t the reason why I’m here … I found this …„ Claire removed her gown and pointed to the area of her breast that she had been worried about.

“Mind if I examine it?„ I asked. “No, not at all,„ said Claire.

I palpated the area. It was the size of a small grape, round and hard. There was give to it like breast cysts usually have. The borders seemed regular, but I couldn’t be sure. “Any others?„ I asked. Claire shook her head to indicate no. “Perhaps I could examine both sides and under your arms, just to be thorough?„ Claire was in agreement. She didn’t want there to be any others.

“Well, looks like there’s the one lump,„ I said. I was worried but didn’t display my concern. “How about we arrange a few things – a mammogram, an ultrasound, and a biopsy.„

Claire’s mounting anxiety became apparent. “Do you think it’s something serious?„

“Difficult to say, Claire. But there are some features of it that make me think we shouldn’t just leave it alone. What do you think?„

Claire’s eyes became wet with tears. “I’m scared. I wonder if it’s breast cancer. I don’t have a family history though …„ as her shaky voice trailed off.

I handed her a tissue and rested my hand on her shoulder, “How about we proceed as planned and we’ll find out exactly what we’re dealing with.„

Claire sighed heavily, “I just want those tests to reassure me that it’s nothing, just a cyst or something. My sister has those.„

In closing I suggested: “Why don’t we schedule a visit right after those investigations?„ As Claire dried her tears, she nodded, thanked me and left.

The investigations occurred within the next week and the pathology report soon followed. I read it and thought to myself, “DCIS – it did feel suspicious. I can’t believe someone so young with no risk factors has breast cancer! I’d better have her come in right away.„

Claire was accompanied by her mom and sister at the next appointment. The three of them sat together holding hands. Claire dried away more tears. “They never call you in urgently for good news,„ she thought as she waited for what seemed like an eternity.

Another knock on the door, “Hi Claire,„ I said and then greeted her mom and sister. “I’m glad you’re here too.„ “So, what’s the word?„ Claire pointedly asked. “Do you want just one word?„ I replied.

Claire quickly responded, “Just the bottom line, please, doctor.„

Slowly I said: “Okay Claire… It’s cancer.„

There were more tears, this time from Claire as well as her mother and sister. I slowly took a seat and waited. A jumble of thoughts filled my mind beyond the clinical significance of this encounter. Such a young patient, no family history, young children … doesn’t seem fair … not that it’s fair for anyone who has cancer, but somehow more unfair in this situation. I waited and held Claire’s hand.

“I guess I knew it … What’s next, doctor?„ Claire dried her tears and looked stoic.

I explained the referrals, tests and potential interventions, then paused and asked, “Do you have any questions or anything you want to talk about?„

Claire quickly responded, “No … thanks for offering though. I think I already knew … I just really want to get rid of it.„

Within two weeks, Claire was seen by a surgeon. “Did you really hit a bear?„ Her surgeon asked, surprised. He arranged for a lumpectomy and a speedy referral to the cancer center. The surgery was performed without any complications, and the lymph nodes were negative. Even so, Claire was offered chemotherapy and radiation by the cancer center because of her young age. “I’ll do everything to get rid of this cancer,„ she told them. Her medical and radiation oncologists asked the same question, “Did you really hit a bear?„ And she replied to them all. “Yes, I hit a bear.„

Weeks of nausea, fever, poor appetite and general malaise followed. I received update after update from the cancer center that I read and filed in her chart. I reflected, “ Looks like she’s having a tough time. I wonder if I should call her. „ I did and left a message to come in when Claire felt she was able. I wondered if it might be helpful to reflect on this experience together.

Claire came for a follow-up appointment with the expressed intent of ensuring I was up-to-date on everything that had happened. “I’m doing fine, doctor,„ she reassured me. “Radiation is planned. I can’t wait to get on with that and have this all over. Chemo is a nightmare … but I’m getting used to it. What a terrible thing to say, don’t you think? Even the nausea isn’t bad anymore because I can anticipate when that’s going to happen, and I know how to manage it, so it’s not that bad. They tell me my hair will grow back.„ She rubbed her fuzzy bald head and laughed.

I didn’t say much, but welcomed learning about Claire’s experiences. I was relieved to hear that she was coping well. Claire looked very different from her usual self, but her resolve was very evident. She drew much strengt h

from her family. Even her two young children had been encouraging to her. She was proud of all of them and felt lucky for the wonderful people in her life who were helping her through this journey.

As the visit came to a close, I reflected, “I’m so happy to hear you have so much support to help you through it.„

“Thanks … You remember how you asked me if I really hit that bear?„ said Claire.

“Yes, I do. It was a remarkable story!„ I exclaimed. “Well, everyone I met in the hospital, nurses, doctors, nutritionists, everyone keeps asking me the same question! Did you know that my son’s nickname has been ‘Bear’ ever since he was born?„ asked Claire.

“Really? That’s interesting …„ I said.

Claire continued, “And everyone keeps giving me bear angel figurines as presents now! They are thankful for that bear. Had it not been for him …„ Claire’s voice trailed away.

“…we never would have known about that lump,„ as I completed her thought.

“I looked him right in the eye. You know, black bears usually don’t come out at night like that,„ said Claire softly.