Behind Enemy Lines: A Personal Perspective by Tracey Moffatt T he doctor nods to me, as he excuses himself from the pastel-coloured examining room and pulls the door tight behind him with a piercing double-click of the latch. It is a mystical door that changes lives in an instant; a door you step through as an individual seeking consultation, and one you exit as a person living with cancer. I sit in silence and wait, as Jane, a single middle-aged woman, struggles with an accumulation of unspoken thoughts and emotions. I hesitate slightly, and roll my stool closer to her in an effort to fill an emptiness. I am acutely aware of Jane’s trepidation, as my fingers fidget with the ballpoint pen secured to my lanyard. I know she needs to hear she is not alone. Jane looks to me with fear welling in her eyes, and desperation filling her voice, “What would you do?” she whispers. When I first began working in the melanoma department, as a research nurse in clinical trials, I joked with my colleagues that I was the poster child for melanoma: red hair, blue eyes, fair skin, multiple moles, and vulnerability to sunburn easily. As a young healthy woman, the thought of having skin cancer had never crossed my mind; that is until the freezing from my biopsy started to wear off. For as long as I could remember, I had a dark mole in the centre of my chest, just under my bra line. After being introduced to the melanoma department and learning I was at an increased risk for melanoma myself, ABOUT THE AUTHOR Tracey Moffatt, RN, BScN, MHSc(C), CCRP, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9 416-946-2000 [email protected] I decided to have it biopsied. “I would rather have a biopsy scar,” I said, “than have melanoma.” Unfortunately, I ended up with both. “I’m so sorry, it’s melanoma” stopped me in my tracks. My thoughts scrambled, “How can I tell my dad I have melanoma? Mom died nine years ago today from breast cancer!” as I spiraled into a sobbing mess. My melanoma experience was a whirlwind that left me with little time to process my thoughts. Less than a week later I was on a friend’s couch with a fresh railroad of stitches stretching across my chest; the anesthesia gently wore off as I struggled to pretend I was dressed for Halloween. The days after surgery felt like an eternity, as I awaited my pathology results. The news finally arrived only a few days later: the cancer was caught early. I was lucky. Even so, the diagnosis left me trapped inside my head, having difficulties focusing on anything else. I saw myself mirroring my mother’s fate. Diagnosed with cancer at a young age, dying a few years later; I believed her destiny would soon become my own. I promptly became fearful that cancer was not finished with me and had further moles removed. To this day, I continue to find it difficult to appreciate how a piece of me could have been cancerous. It had been a part of me for as long as I could remember, yet this mole penetrated my defense system. It betrayed my body like a spy infiltrating enemy lines. It was especially devious because my dermatologist’s well-trained eye had not been the least bit persuaded the mole was suspicious. Going back to work was horrible. I would see my patients’ biopsy reports and ruminate over comparisons with my own. Around every corner I would glimpse reminders of my own mortality. Canadian Oncology Nursing Journal • Volume 26, Issue 4, Fall 2016 Revue canadienne de soins infirmiers en oncologie Four years later I remain cancer-free and have come to terms with my diagnosis. Returning to melanoma clinical trials, with a new perspective and first-hand experience allows me to advocate for my patients’ best interests. It offers me a powerful motivation to ensure they receive the care they deserve, as I know what care I might want in the future. I find inspiration in knowing the tables can be so easily turned. “Jane, I understand that you are scared and would do almost anything to fight this cancer, you need to ask yourself what is right for you.” I explained that, “Melanoma is a very deadly skin cancer, which, until recently, did not have many treatments and results were almost always poor. But now there are options, with improved outcomes,” I reassure her. “Jane, I’m sorry I don’t have the answers you are looking for,” I say, as I place my hand softly on hers, “I wish I did.” I counsel Jane to decide what risks she is willing to take and strongly recommend she consider her own personal situation. My key message is simple and I press it further, “Jane, even though I’m sitting here with you, please don’t feel obligated to accept treatment because we’ve presented a few options. It’s important for you to choose because it’s the right thing for YOU to do.” Our society focuses on fighting and conquering cancer, but it is rare for patients to hear that it is okay to step back to focus on their priorities. I may never reveal the true intimacy when asked, “What would you do?” but I will support Jane’s decision-making process; ensuring she has the information to make a well-informed medical decision. 365 FEATURES/Rubriques PERSONAL REFLECTIONS