Photo by Steve Comiskey
Not just any uterine cancer, but uterine papillary serous carcinoma. It’s also known as UPSC, an acronym that sounds more like a package-delivery service than a disease that accounts for less than 10 percent of all uterine cancers but nearly 40 percent of fatalities. Search for a prognosis online, and you’ll find words like “grim” and “bleak.” Other than my age—over 60—I had none of the common risk factors for the disease except, maybe, bad luck.
Eight days later, I had a hysterectomy that included lymph nodes. This time I was luckier. The cancer was confined to the uterus and designated Stage 1A. But because serous cancer grows fast and spreads aggressively, doctors prescribed 18 weeks of chemotherapy, followed by up to five weeks of radiation.
My husband Steve and I had about three weeks to make a critical choice: do nothing and risk a fatal recurrence of an aggressive cancer or have the therapy and undermine my immune system as the coronavirus ravaged the country.
In my case, the chemo and radiation are designed to reduce the risk of a cancer recurrence from about 20 percent to fewer than 10 percent. That may not sound like much. But imagine you have a plate of Oreos in front of you. Without treatment, 1 in five of the cookies would probably kill you. With chemo and radiation, less than one in 10 would do the same.
And the window for wiping out any lingering cancer cells isn’t open for long. Studies show chemotherapy is most effective if started three to four weeks after surgery. Wait nine weeks, and the benefits slip away.
While the days ticked by, my husband and I watched as COVID-19 infections soared across the U.S. and in Indianapolis, doubling and tripling every few days. We read medical studies to learn as much as we could about a cancer that was more often a footnote than a focus. We all knew by then that coronavirus symptoms were mild for most people but not for cancer patients. Statistics were sketchy, but a Chinese report showed that three of four chemo patients who contracted the coronavirus died as a result.
We cringed at news photos of spring breakers crowding open beaches in Florida and blocked Facebook friends who downplayed the pandemic or dismissed it as a hoax. After a week of sleepless nights, we set up a new rule in our house: No television news or Facebook allowed after 5 p.m.
Eventually, we decided to follow doctors’ advice and take our chances with the therapy. I started chemo at the Community North Cancer Center on March 19, three days after the first COVID-19 death in Indianapolis and the last day visitors were allowed in the clinic. In the time since my surgery, the number of U.S. cases had grown from 13 to more than 15,000.
That first chemo session calmed our fears a bit. We had our temperature checked outside the front door, and we didn’t touch elevator buttons or doorknobs or faucets. The doctor and nurses chatted with us throughout the process and even helped us order chicken quesadillas from the cafeteria for lunch.
Three weeks later, the second visit was very different. U.S. coronavirus cases now stood at 460,000, and 245 people had died in Indianapolis. This time, I had to go to the center alone. The cafeteria had closed, and I couldn’t bring along any food or drink. I had to wear a mask, and so did everyone else in the building. I walked up the stairs instead of taking the elevator and struggled to breathe through the layers of fabric. The doctor and nurses talked through muffled masks about the impact of the virus on their work and their families. The chemo session that day was eerily like the flight to Europe we had just had to cancel. I sat in a narrow leatherette chair for six and a half hours, getting up only to make my way to the bathroom. A nurse brought me packaged snacks and drinks. But at the end of this flight, there was no tour of the Alps. Just a drive home to wait for the side effects to begin.
I try to think of chemotherapy as a tough ally in the fight against the common enemy of cancer. But it’s also an ally who’s not skittish about collateral damage. For me, the collateral damage isn’t just the fatigue, the loss of appetite, the upset stomach or the mouth pain. It isn’t just losing my hair, which Steve first cut when it started to fall out and later shaved. It’s the vulnerability that comes with destroying the same white blood cells I might need to protect myself from the worst of COVID-19.
We had started self-quarantining in early March. The doctor was clear: Stay home. The same rules applied for Steve as for me. “If you get it,” he told Steve, “she gets it, too.” My three grandchildren live nearby, but we haven’t hugged them in weeks. We missed our granddaughter’s fifth birthday. We don’t go inside grocery or drug stores and rely instead on curbside pickup. We don’t open our mail for 24 hours. We wash fresh fruit and vegetables in soap and water and wipe any grocery packages with Lysol. We take walks in the cemetery next door but stay far away from neighbors and others passing by. Still, we live with a nagging fear that we’ve missed something. Could the virus have clung to a door knob? A plastic bag of mulch? A get-well card?
In a few days, I’ll be about one-third of the way through my chemotherapy. The number of U.S. COVID-19 cases has now topped 600,000, and testing still lags far behind demand. But we’re starting to see signs of hope. Health metric models suggest we may be passing the peak infection point, but only if we continue to follow social distance guidelines. A new fear is that we’ll open up the country too soon and trigger a second wave of infection.
My own prognosis will likely remain uncertain for months to come. But in many ways, I know we are fortunate. We have a comfortable home, plenty of food, access to the outdoors and, at least for now, a steady retirement income. So many other families have lost jobs and wages and face a very different kind of crisis.
My hope now is that we can move forward carefully, finding the right balance between protecting those most vulnerable and getting people back to work. A balance not driven by ego and politics, but by science and compassion.