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Life after melanoma; after the physical part of conquering cancer was over, the emotional part remained - and proved even more difficult.


I had been back at work from maternity leave for a month, and things were really starting to fall into place when I was told I had cancer. That sunny autumn Tuesday marked the end of my naivete and the beginning of the most difficult and important challenge I have ever faced.

One day I noticed that a flat, brown mole on my back had become slightly raised and red. Because it was during my pregnancy, I assumed this was just another "pregnancy thing." After all, my whole body had gone berserk with brown spots and lines.

When my new baby, Megan, was four months old, I scheduled a routine exam for her and decided to have the mole checked, too. It never occurred to me that it was cancer; I just remembered from watching television shows and from reading magazine articles that "an obvious change in a wart or mole" should be checked.

The doctor did not seem terribly concerned. To be on the safe side and for cosmetic reasons, she said, the mole should be removed. Afterward, neither of us gave it a thought.

When the pathology report came back, my doctor was shocked. I will always be grateful to her for deciding to remove that little mole. She literally saved my life, for I found out as I became an "expert" on skin cancer that melanoma can travel to the lymph nodes and spread to any part of the body. Once it spreads, it is incurable in most cases. All this from a mole smaller than a pencil eraser!

My husband, Tim, received the call about the pathology report and came to my office to tell me. My initial reaction was: "Well, it's 'only' skin cancer." I was frightened, but I wasn't terrified--yet. On the way to the surgeon's office, just two hours later, I read the biopsy report: "Malignant melanoma. . . Clark's level III. . . ." I didn't know what that meant, but somehow I knew Clark's level III wasn't good.

I was numb with terror. How could I have this hideous, deadly tumor in my back? Could it be that at 32, healthy and happy, and with a new child, a young marriage, and a wonderful job, I might die from a little red mole? I could not grasp it. I felt helpless and out of control. I heard myself making bizarre but funny jokes about death while the doctor's assistant scheduled me for an immediate live scan, a chest X-ray, blood tests, and surgery. It was all the relief I could muster.

When I got home, I cried, pounded my fists into the couch, and screamed over and over, "I don't want cancer!? I called two close friends. One joked in response to my apparent light-heartedness. The other told me immediately that cancer doesn't mean death. She said she had a feeling I would be O.K. I needed that. She also assured me that Tim and Megan would be all right if I were to die. I had to know that too.

When my family doctor called, I asked her exactly what we were dealing with.

"At its worst, are we talking about death here?"

"Mary, we're talking real sick."

"Can I beat this thing? Can I win?"

Her voice cracked. "Yes."

She sounded scared and worried, but I felt she had faith in me, and that was what I needed most from her. I felt I could handle my treatment--no matter how painful--as long as I would live.

I did not yet comprehend how lethal melanoma can be. I was not ready to hear it: I needed her and every other health professional I ran into, from medical-office staff to lab technicians to physicians, to tell me I could beat it.

I bought When Bad Things Happen to Good People and started reading it in the lab waiting rooms. I started using imagery and imagining that the cancer cells were contained in a wooden picket fence. Tim and I kept saying t each other that it would be O.K., that we caught it in time, and that the pathology report was probably conservative because that's how labs operate. We decided we might as well be positive, because being negative wouldn't make the outcome hurt less.

The initial tests were to determine if the melanoma had spread. The surgeon was wonderful about getting the results to me quickly, which was very helpful. They came back negative. I sobbed with relief; I had made it over the first hurdle.

Then there was the surgery. The mole was on my upper back, behind the right shoulder. The procedure, done under local anesthesia, was to remove a large oval of skin around the infected area, to remove any cancer cells that might have begun traveling. The incision, about four or five inches long, was as deep as the lowest level of skin. The surgeon did such an excellent job that no skin grafting was necessary.

My next step after the surgery was to wait for the biopsy report, which would indicate the depth of the tumor--a crucial step. The survival rate in melanoma is determined by the size of the tumor and its depth of skin penetration.

It was a long weekend. In addition to the emotional pain, I now had considerable physical discomfort. Every time I looked at Megan, I cried. The thought of not seeing my daughter grow up was more than I could bear. Tim, as always, was amazing. He hardly left my side as I talked and talked and cried. . . .

My doctor called as soon as she received the biopsy report Monday morning. The news was good, but mixed. On the positive side, the tumor was within the size limits of being "probably cured." The other side--that the tumor had penetrated the third layer of skin--placed it in a higher-risk category. Statistically, I had an 85 to 90 percent chance of being all right. My family physician and the surgeon were elated. And a few weeks later an oncologist told me that, in her business, I was very lucky. I explained to her, "I am not used to being in your business."

I wanted more. I wanted assurances. I wanted a clean bill of health. Most of all, I wanted to return--just for a little while--to my former naivete. I wanted to be able to ignore the fact that I--that anyone--can die at any time. I wanted to go back to believing "it can't happen to me."


Today I am considered a cancer survivor--I am in a minority. I have suffered no major disfigurement or lingering physical problems as a result of the malignancy. Others see me as a lucky person who lived through cancer. I finally see myself that way too. It has taken a long time.

In spite of my good fortune, however, I cannot say that it is "over." Emotionally, I will always be recovering to some extent.

I will never be considered really cured, because no one can say with certainty that the malignancy has not spread or that I won't have another incidence of melanoma or some other form of cancer. The impact on me is that I have a weighty awareness of my own mortality. I can no longer be complacent about life.
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Author:Durkee, Mary
Publication:Saturday Evening Post
Date:Sep 1, 1986
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