What My Cancer Diagnosis Taught Me About Leadership

There’s no manual for how to have cancer and run a business – much less any significant health or life issue. I’ve had my fair share of them. Prior to my cancer diagnosis, I was running at lightening speed in 18 different directions. I was leading a business I had recently acquired, running a side business speaking to college students, while also building a third business in my extremely limited free time. I was doing too much and delegating too little. My to-do list was never ending and I was a bottleneck for a number of things my staff and business partners were trying to do. I wasn’t asking for help. I wasn’t being transparent about how overwhelmed I felt. The levee was about to break.

And then I got cancer.

But instead of the levee breaking, the rain stopped and the flood waters receded.

Here’s what I mean. When I was diagnosed with cancer, I was honest about it. My staff, my team, and my business partners were some of the first people to know about it. I was honest about the road ahead. I put every doctor appointment (and what it was) on my calendar. I was honest about how I was feeling. I communicated with them when I needed their help when I had to crawl back in bed because the exhaustion (and nausea) was too much. I shared openly in meetings about my treatments, my reactions to it, and how I was feeling. I know they’re grateful for how open I’ve been.

I’ve always valued transparency and honesty as a leader. That’s not a new trait for me. They have been among the core tenants of how I lead, for much of my career. I believe that honesty, vulnerability, and transparency fosters trust and limits the false narratives that are sometimes created in the absence of information. It allows people to trust you as a leader, trust that their experience working for you is real, and believe they know where they stand at every moment. It took my cancer diagnosis to remind me how important these things are in leadership and to the people I was leading.

Being vulnerable, sharing personal stuff (and frankly business stuff) openly and honestly with people often seems counter to how we should lead. However, I know it’s one of the most important things we can do to create an environment of trust among the people who work for us and with us.

But here was my unexpected lesson: It taught me to trust, too.

What happened in response to my honesty about my cancer, was that my staff and my partners showed up for me. I didn’t have a choice to let go of some of the work I was holding on to. I didn’t have the physical capacity to work at the pace I was. It taught me that I can delegate, I don’t have to do everything myself, and that I have a lot of really talented, really capable people surrounding me. It allowed me to let go of all the work I was holding onto “in the weeds” and focus on the big picture stuff that really mattered.

Suddenly, my to-do list was shorter and the things that I hadn’t finished, were suddenly getting done. We were moving forward faster, yet I was moving slower. It was like a slap on the back of my head; Why hadn’t I done this sooner?

I know this is often the case for small business owners, entrepreneurs, and even lots of leaders. The transition out of the “doing” and into the “leading” is a hard one. Trusting people to get the work done can be difficult – and sometimes it feels easier, better, and quicker to just do it yourself. We become micromanagers, our staff gets frustrated because we “won’t let them do anything themselves” or we become the bottleneck slowing performance, productivity, and outcomes down.

The lesson I learned was to trust the talents of the people I had put on my team – that’s why I hired them (or work with them) isn’t it? To let go of the need to control and I know they have my back. Turns out I needed to get cancer to learn that lesson.

Regardless of my cancer diagnosis, these lessons were important for me to be reminded of and learn. I’m grateful for that. I recognize that being honest and transparent is hard – and trusting others is even harder. I know attempting to lead with trust and transparency will look different for every leader. I also know, how important and powerful it can be. I’ve seen the results across my leadership experiences time and time again. I encourage you to give it a try.

“Plastics”

Warning: I talk openly and honestly about my consultation for reconstruction post-mastectomy (read: boob job). I find the process and information fascinating and want to share it with you all, however, conversations about my boobs might make you uncomfortable. You’ve been warned.

After the meeting with my breast surgeon (the one doing the mastectomy), I was left with a checklist of tests and appointments that I needed to accomplish before treatment could start. I was determined to get it all accomplished as quickly as possible, so when the scheduler called and said, “plastics can get you in with the doctor at 4:30 today, if you can make that work.” I jumped at the appointment.

When I arrived at the “Plastics” Group office for my appointment, it was 4 p.m. on a Friday afternoon. The waiting room was empty and you could tell they added me to the end of the schedule, as the week was winding down. As I sat, waiting to be called back, the receptionist would banter and talk with each patient as they left – some of them bald, all of them with boobs. As they filed out, I wondered where they were in their reconstruction journey. Were they just starting like me?

I was jolted back alert from my introspection when the nurse called my name and I was escorted down a long hallway to an exam room. She handed me a gown and asked me to “strip from the waist up with the gown open in the front”. At this point, I had become all-too-familiar with these instructions and this gown – a short-sleeve number that is a delightful color of 1985 mauve and hits just above your hips like you’re a 25 year-old instagram influencer in a trendy crop-top. In the last week, I had slid a gown on like this, no less than 5 times.

As I sat on the exam table waiting for the doctor, I closed my eyes, began to breathe deeply, and chant a mantra I had be using to manage my anxiety since my diagnosis, “Have faith. Trust God. All joy.” Over and over again, “Have faith. Trust God. All joy.” I was jolted back alert, when the doctor entered with a nurse and introduced himself. The doctor, a shorter, older gentleman, reminded me of an older Rick Moranis from Honey I Shrunk the Kids. He carried an old-school digital camera, in a leather case with him, like a dad at Disney World with the kids for the first time. He asked me a bunch of questions about my health history and then instructed me to open the gown, put my arms down, and let the gown fall down to my wrists.

I was officially uncomfortable.

I tend to make jokes when I’m uncomfortable and strongly considered making a comment like, “Doctor we just met,” but decided against it.

The doc then proceeded to pull out a measuring tape, like one a seamstress would use, and measure my breasts – nipple to bottom, nipple to top, side to side, top to bottom, size of the nipple – each time shouting measurements back to the nurse as she feverishly wrote them down. Then, he asked me to close the gown, stand up, and stand up against the blank white wall at the back of the exam room. As I stood up against the wall, he said, “okay now open the gown and let it fall back to your wrists again,” as he pulled out the digital camera and proceeded to snap photos of me from variety of angles.

I am certain that I have never been more uncomfortable in my life.

Until it got worse.

The doctor then instructed me to pull my pants down to my bikini line as he took another set of photos from a variety of angles. I was not ready for this. As all of this is occurring, the nurse is just standing there jotting down everything the doctor is saying as I’m dying a slow, painful death of mortification on the inside.

After he was done, he asked me to cover back up and take a seat in a chair next to the exam table. The doctor pulled up a stool and sat down as the nurse closed up my file and left the room. The doctor then began to describe the two recommended options for reconstruction:

One: Using your own tissue. As he described it, they essentially make an “old-school c-section” incision across your abdomen and remove tissue from your belly to replace the tissue that was removed at mastectomy. The benefit is that it is your own tissue and not something like silicone in your body. It is a more difficult surgery with a more difficult recovery. The downside is that the breasts would age like normal breast tissue would over time. The doctor then said to me, “You’re not a candidate for this though, as you do not have enough fat on your belly.”

I looked at him as said, “That’s the nicest thing anyone has every said to me. Could you write that down?” He chuckled as I thought to myself, “I could kiss him right now, but I’m topless and that feels inappropriate.” [jokes].

Two: Implants. The second option, is more familiar – a silicone or saline implant. These implants would be placed at a date after the mastectomy, over the muscle. They used to do under the muscle to help hold the weight of the implant, but they looked less natural because they move with a woman’s arm movements. Now they place them over the muscle, just under the skin, with the help of cadaver skin (read: sanitized skin from dead people) to hold the implant in.

This option would include a “delayed-immediate reconstruction” during the mastectomy. Since I am not scheduled to have radiation, they can place a “balloon-like” tissue expander in after they remove my breast tissue. Then starting at two-weeks post-op, they begin inflating the expander incrementally until it is at the correct size. This allows me to avoid the painful re-stretching of skin that can occur when they don’t insert the expander at mastectomy. After my tissue is allowed to heal and my treatment is complete, they will go in and replace the expander with a silicone or saline implant.

After we discussed my reconstruction options, we then discussed topics that no one dreams of talking about with strangers – much less your closest friends – like the shape, size, color, and proportion of my nipples to my overall breast and if I would like to keep my nipples or have them removed. This is something I’ve never thought about and felt wholly unprepared to make a decision on. After being largely uncomfortable with the discussion of my nipples and the pressure to make a decision, the doctor shared, “most women are happier with their reconstruction when they have their nipples removed”. Okay done. Remove them. We then discussed nipple tattoos as an option post-recovery to replace my absent nipples. I don’t have strong feelings either way, but if you’re feeling brave, Google image search “post-mastectomy nipple tattoos”, you’ll be amazed (NSFW).

Then we talked about my breast size. In my discomfort, I said, “well my husband would like them to be bigger,” to which he chuckled. As it turns out, however, you really can’t go bigger and you really can’t go smaller (except maybe a 1/2 size). Okay cool. As they are. Fine.

As the conversation went on, it became clear to me why he took the pictures and measurements, and I slowly felt at ease. It was clear he was a professional and his ultimate goal was to make something that is pretty traumatic for most women, as easy as possible. That his ultimate goal was to get you as close to “original” as possible.

As I left, I felt a sense of calm about the reconstruction process; still totally mortified, but calm with a sense of humor about the whole thing. I know the mastectomy and reconstruction is a long road and its absolutely no cake walk, but I have a sense of what the process will be like and I honestly appreciate the level of choice and control I have in the matter. I get to order up the boobs I want, nipples and all. If that’s the positive of getting breast cancer, I’ll take it.

As I got into my car, I chuckled to myself about the whole thing, and smiled as I remembered my mantra: “All JOY.” (and then promptly group called my girlfriends to tell them all about what. just. happened.)

All joy.

XOXO

The Big Fuss About Hair

Let me start by saying this: It’s taken me most of my life to get good at doing my own hair. The irony that my hair is now mostly gone and what remains is rapidly falling out like a rainstorm, is not lost on me.

When I was diagnosed with cancer, I lived in the false illusion that I would be able to “save my hair”. I held tightly onto that belief until my oncologist determined my protocol and a quick Google search confirmed my worst fear: my chemotherapy medications cause total hair loss. As I grappled with that loss, I quickly bought trendy headwear and a menagerie of wigs, determined to not look like a cancer patient.

Two weeks to-the-day from my first treatment my hair started falling out in clumps. The clumps piled up in the shower drain and the bathroom sink the morning of my second chemotherapy, and as I set down my bag to step on the scale at the doctor’s a clump of my hair came with it. The next day, I shaved it off live on Facebook (as many of you watched).

In the moment, I was determined to take control of something that felt out of control. I was ready to embrace the cute hats and the variety of wigs. I was headstrong and determined to not let this part of my cancer journey rattle me. It didn’t – for approximately 18 hours.

The next morning, as I walked into our bathroom, I caught my bald-headed reflection in the mirror for the first time – and my heart sank. The outpouring of support from my head-shaving left me feeling brave and confident in my decision from the day before, but now reality was setting in. My head is a great shape, yes, but I’m still bald and now I officially look like a cancer patient. There’s no hiding it anymore.

That same day, I had back-to-back video meetings with clients and virtual speaking engagement that afternoon. I grappled with what to do about my hair. Do I go bald? Wear a hat? Put on a wig? If I don’t wear a wig, will they know I have cancer? Will that make them uncomfortable? Do I care? Do I want to have a conversation about my cancer with these people? Do I want to see another human give me the side-tilt pity face that everyone inevitably makes when you tell them “I have cancer”? If I wear a wig, will they be able to tell?

I weighed those questions until the final moments before my meeting when I inevitably slid on a wig and pretended everything was okay. Thirty minutes into the meeting I was in agony. I was having a full blown chemo hot flash and dying in the wig. As I jumped off for a different video call, I quickly told the client I had cancer, that I was wearing a wig, and promptly took it off in front of him on video. The release was like taking off a pair of jeans that were just a little too tight after wearing them a little too long. I was too distracted by my own relief to notice if he was horrified, confused, or impressed. I’m not sure I cared.

That was a week ago and honestly, I’m still struggling with the bald head-hat-wig decision. I mostly wear a hat these days because my remaining stubble is falling out rapidly and needs to be contained – otherwise my desk looks like someone shaved their beard on it. Aside from the hair loss, my scalp is so tender the idea of sliding on a wig makes me want to vomit. Nonetheless, every morning I grapple with the decision of what to do about my head, not because of how I feel about it, but because of how other people will.

When I was first diagnosed my husband looked at me and said, “How can I support you on this journey?” I remember looking at him plainly and saying, “Don’t treat me like a cancer patient.” I chuckle at that sentiment now, but in the moment I know why I said it. I feel it every morning now as I walk my daughter to school. I see the parents in their cars pulling away after dropping their kids off, looking at me, like a cancer patient. I see the pity-filled looks at the grocery store, the post office, and the bank.

But it’s not the pity. It’s not the sad side-tilted face people make when you tell them you have cancer. It’s not even my hair.

It’s because I don’t want it to be true. I don’t want to have cancer. I don’t want to be sick. The hair loss has just made cancer real on the outside, as much as on the inside. Up to this point, I could hide my cancer. Now I can’t. So in total truth-telling, know that I am struggling with my hair loss, but mostly because I’m finally being forced to face the fact that my cancer is real, that this is hard, and that I am not, in fact, Superwoman (although I will continue trying to be).

It was never about not feeling pretty or feminine (dammit I have a nice head and I look GOOD in a hat). It was never about what people thought about my bald head/hat/wig. It was never about them. It’s 100% about having to face the hard truth that my cancer is real – and honestly – I still find myself occasionally in disbelief.

Nonetheless, here I am, a cancer patient.

I am so grateful for the outpouring of love and support. The cards, the notes, the comments, the gifts, the meals from my large tribe of friends and family have been so meaningful to me. Thank you all. I’m still finding joy along the journey, having faith that this wilderness is for a reason, and will turn these trials in to triumph and wisdom for the people after me.

XOXO.

Science!

Many of you have been asking the science-y questions about my cancer. Well, buckle up, but here is a science lesson you may not have know you ever wanted.

There are several types of breast cancer. The most common type of breast cancer is called Ductal Carcinoma In Situ (DCIS). In short, it means that the cancer cells are contained in a breast milk duct inside a woman’s breast. That’s a good thing – it means it hasn’t spread anywhere and is mostly self-contained inside the duct. This type of cancer is typically treated with a mastectomy and some hormone therapy (more to come on that in a minute). I have a spot of Ductal Carcinoma In Situ in the center of my right breast in a duct directly behind my nipple. DCIS is rated in three levels 1-3. 1 being new cell formation, not rapidly duplicating. Level 3 means its duplicating rapidly and on the verge of becoming Invasive or rather spreading outside the duct (bad). My DCIS is Level 3. DCIS no matter what level is considered stage 0 cancer.

My lump is in the outer lower quadrant of my right breast about 3-4 inches away from my cells behind my nipple. It is a type of breast cancer called Invasive Ductal Carcinoma (IDC), meaning it has spread outside of the duct and into the surrounding breast tissue (and in lots of cases to lymph nodes and other tissue beyond the breast). My IDC is stage 1B which means that I have both a mass measuring no more than 2mm and other small groupings of cancerous cells (behind my nipple), but that it hasn’t (thankfully) spread to lymph nodes or through my surrounding chest wall. Stage 2 would mean that it has spread to the first layer of lymph nodes beyond the breast tissue.

Breast cancer cells are also evaluated for hormone receptors: estrogen, progesterone, and a human growth protein called HER2. Every cancer starts out with both positive and negative receptors and as it grows the positive or negative receptor cells take over. Breast cancer cells that are positive for estrogen/progesterone/HER2 grow in the presence of those hormones and are often treated post chemotherapy with hormone therapy to prevent future growth. Negative cells are more difficult to treat because they grow in spite of hormones. Thats about as good as I can explain this stuff – needless to say it’s complicated, but makes treatment of breast cancer much more specified, and thankfully effective. My case, of course, is a unique one.

My DCIS (milk duct contained) is 29% positive for estrogen receptors, 26% positive for progesterone receptors, and negative for HER2. Those are particularly low levels for a hormone positive cancer and curious on their own, but my lump adds an additional curiosity. My lump is 9% positive for estrogen receptors, negative for progesterone, and negative for HER2. Its super uncommon to have two different types of primary cancer.

This is what my oncologist called “a shit pathology report”.

After my oncologist consulted with a friend a Dana Farber Cancer Hospital they concluded that we caught the pathology of my breast cancer so early that the negative cancer cells were in the process of taking over the positive receptor cells. They have effectively rated my breast cancer “triple negative” or negative for estrogen, progesterone, and HER2 receptors. This type of breast cancer is the most aggressive, fastest growing, and most likely to recur within a 5-year window. However I am SO LUCKY that we caught it early. The five-year recurrence rate for triple negative breast cancer for stage 1 is under 10%.

So, here we are. My oncologist, in consult with my breast surgeon, made the decision that we would start with chemo instead of the mastectomy. My case was right on the borderline of the protocol and they opted to attempt to stop the cancer growth and prevent spreading prior to surgery. I will require a full mastectomy (removal of the whole breast) because the two cancer spots are too far apart to effectively preserve my breast. I have opted for a double (or bilateral) mastectomy because of the cancer being triple-negative and attempting to avoid any recurrence (hang tight for the blog where I tell you all about talking to my plastic surgeon about reconstruction…full of laughs).

I have eight chemotherapy treatments (spaced every two weeks). The first four are Adriamycin and Cytoxan together. The adriamycin is called the “red devil” because it’s red in color, makes you pee red, and has some nasty side-effects. It’s the strongest chemotherapy there is – and it causes total hair loss, usually a few days after the second treatment (my second treatment is slated for April 5th). I’ll be rocking some sweet headgear…look out…but if anyone has suggestions for my eyebrows let me know (fake mustaches perhaps?). My second four treatments will be Taxol, which is allegedly easier, but can cause permanent neuropathy – and also total hair loss. Hopeful you all like the look of my bald head for awhile.

My chemotherapy treatments will take me through June, then I will recuperate for 4-6 weeks prior to my mastectomy, slated for sometime in August. If the pathology from my mastectomy comes back with “complete pathological remission” meaning zero cancer cells in the breast tissue, my treatment will be complete. If however, there is any trace of cancer still growing, I will require additional treatment.

There’s your science lesson for today. I probably screwed some things up – I’m not an oncologist and to be honest cancer and cancer treatment is so complex, it’s hard to keep it all straight. Until the next episode!

XOXO.

28 Days Ago.

Twenty-eight days ago, I walked into the breast diagnostic center of the hospital for what I thought would be a mammogram, an ultrasound, and then draining what my OBGYN and I both believed to be a cyst in the outer-lower quadrant of my right breast. I remember calling a friend on my way to the hospital and mostly being nervous about how bad the mammogram would hurt, but cancer wasn’t even a possibility in my mind. I’m young. I’m healthy. Cancer? Not me.

It was 28 days ago, when the radiology technician asked to take “a few more shots” of my right breast, after a long wait while the radiologist reviewed my mammogram and then escorted me to a new room for an ultrasound of my right breast. It was then that the radiologist showed me the lump and said, “It’s not a cyst. A cyst would be solid black on the ultrasound and have clearly defined edges. Do you see how your edges look furry?” He then shared that there was a second spot that appeared on the mammogram, “some calcifications”, that were not in the vicinity of the lump. Under normal circumstances those spots would be benign, but in the presence of a lump – they become concerning.

We will need to biopsy both spots. Can you stay longer so we can do that now?” Those two sentences set off my alarm bells. There was a sense of urgency without much explanation and I knew that wasn’t a good sign.

Twenty-eighty days ago I had two biopsies with nothing but localized numbing, on two different machines, in two different rooms from two different spots of my right breast. As I sat up following the second biopsy, the doctor looked me in the eye and said, “Look I’m going to be really honest with you. I’ll be really surprised if this doesn’t come back as cancer.” She put a rush on the pathology and 24 hours later she called – to tell me what heart already knew. Both spots came back as cancer.

Twenty-seven days ago, I was diagnosed with breast cancer.

In the past 27 days, I’ve seen a breast surgeon, a plastic surgeon, my OBGYN, my PCP, an oncologist, and a genetic counselor. I’ve had an MRI, EKG, echocardiogram, two chest X-rays, bloodwork, a genetic test, a COVID-19 test, and a surgery to place my port. I attended a 2-hour “chemo class” where they walked me through the drugs, the side effects, and all the things nobody talks about when it comes to cancer. I have six new prescriptions that line my bathroom sink and more paperwork than a human can fathom.

I blinked and a month of my life has passed me by. Perhaps I should be glad it’s passed quickly and hopeful the treatment passes just as fast. But I want to be present. I want to remember. I don’t want to look back consistently on my life and have this year be “the year I had cancer” and recall nothing except that it happened. I want to remember it all – the pain and the joy. The grief and the laughter. I hope you’ll all join me as I try to remember it all.

I start my chemotherapy today – and to be honest, I’m anxious. My port is tremendously sore from having it placed Friday and I know that accessing it today won’t feel incredible. Mostly, I’m afraid of the all the unknowns: How will I feel? How will the port feel? How will the medicine make me feel? Down the rabbit hole I go!

More than anything, this Level 5 Type A Control Freak is learning that I can’t control everything and that I need to let go, give it to God, trust the journey, and find the joy along the way.

Feel free to put a little joy into the universe for me today. Till next time.