Overcoming Fear of the Unknown When It's Cancer

I’m a planner, a forecaster, someone who can come up with a lot of scenarios, both good and bad. It’s a superpower professionally, but I’m the same way in my personal life. People like me are uncomfortable with the unknown because we feel out of control.

I’ve passed this skill onto my oldest, Maddie Killian , although she’s sometimes a catastrophizer. She brings an extraordinary level of empathy to every situation which causes her to imagine the worst and experience how everyone feels along the way. But point her to a complex systems task, and she’ll blow your mind with the level of detail. Just ask our wedding planner.

Allie Polk , on the other hand is the master project manager who produces elaborate spreadsheets with intricate details. Allie is headed to Durham/Chapel Hill after her post-bac program to pursue medical school in 2025. Overnight, she built three detailed spreadsheets: ?20+ job/clinical volunteer opportunities with links, 30+ contacts at UNC and her strong connections from there, and a full assessment of 12 med schools ranking their level of safety or stretch. I love her spreadsheets – a thing of beauty.

But the planner behavior goes out the window when cancer shows up.

March 2024 began with the standard mammogram and ended with a diagnosis of what is early breast cancer.

It’s the unknown that’s the worst.

When you grow up in a family of surgeons (general/breast, heart, plastics and surgical oncology), you think you know a lot. Trust me, nobody really knows cancer as well as the people who’ve been through it.

I did the most unexpected thing while I waited for the unknown to become known: I didn’t create the scenarios. But once they ordered a biopsy in early March, I called in my experts. I am one of the rare divorced people who, after some early misery, has rebuilt the relationship we started in 1983. Married 27 years, divorced for 12 and great friends for most of it, he called in the cavalry. And he told me constantly, “You’re going to be fine. This is very small. It’s just going to be a pain in the butt.” He explains that all his cancer patients feel the way I felt after diagnosis and before a final treatment plan. The unknown is the worst. He says even aggressive treatment plans offer patients comfort and the chance to prepare. My good friend Sloane Scott describes it this way: "Consider the unknowns a bad next-door neighbor. Sometimes you just need to let them move in. They are always there, but there's nothing you can do about them."

My physician/provider cavalry is 100% female – how about that for extraordinary luck: PCP, surgeon, breast radiologist and all her staff, medical oncologist, and radiation oncologist.

I want to elevate this conversation over the next several months because the more vocal we are as patients, mothers, friends, and entrepreneurs, the less the next person suffers from the unknown. In fact, the breast MRI technician and I spoke at length about how she encourages people to talk more, build awareness, and dispel the fear.

Here’s how I started to understand the unknowns.

I called one of my closest friends to share my diagnosis. She arrived in 15 minutes, and we talked for two hours. I’d watched her march through every possible breast cancer misery eight years ago, and my assumption was that it was just short of torture, and she must be the toughest woman I’d ever known, something I didn’t believe I could be. And she said this: “It’s not that bad”, recalling one indignity after another, repeating that claim, and “You can do this.” For some people, it is that bad, and I don’t want to minimize that reality for others. But for her, it wasn’t, and I’m sticking with that theory for myself.

Her position was reiterated by another close friend who is five years out. “You can do this” is possibly the best hope-filled message I could hear from friends who know exactly what it’s like.

Telling more people close to me, particularly my daughters, was the scariest part of the process because I assumed it wouldn’t go well. Since I was calm and had already addressed many of the unknowns, they eventually became calm too.

I had surgery 4/24, and on tonight on 4/29 I received the BEST NEWS EVER:

• No lymph node involvement
• Clear margins
• 11 mm lesion - Type 1a

Today, I am relieved, grateful and lucky. Timing was everything in the early part of this journey.

Here’s what I know:

• Early and small are some of the most important words you can hear, and as patients, we must be actively engaged to improve the chances of early detection by seeking regular imaging, self-exams, attention to changes, not to mention diet and exercise and luck. Don’t put this vigilance off for later.
• I have dense breasts. If you have been told that, advocate for earlier and more robust mammography, like 3D mammogram and ultrasound. You might not get it approved without a reason. But if you don’t ask, you don’t get.
• I was lucky that my regular screening mammogram caught a sense of something, but it took the 3D mammogram and ultrasound to really see it. Dense breast tissue is often harder to assess on mammogram. You also will have a breast MRI when a biopsy shows cancer. The 3D mammograms are worth the upgrade even if it’s out of pocket.
• Do your monthly self-exams. I honestly never did them very often. Dense tissue makes a lump so hard to feel, and early lesions are hard to find anyway. But there's no excuse, ask your PCP to show you how to do it right.
• Gather data from the experts, not Dr. Google – there are too many varying opinions about literally everything.
• No two patients or cancers are the same, but finding someone who’s been through it before you is critical.
• Tell your kids as soon as you have a definitive diagnosis. They are stronger than you imagine (another unknown).
• I will be talking about my breast cancer journey, so don’t be afraid to ask. Don’t make up a story about my situation or anyone else’s without talking to me/them. It might not be “as bad” as you imagine.
• Don’t worry about me, I promise to ask for help when I need it. I’m so blessed with so many loving friends who are standing by.

Here’s where I’m placing my priorities:

• On March 11 just before I knew where things were headed, I began a 12-week climate learning journey at the Climatebase Fellowship that has allowed me to engage my mind with something new. I’m now connected to 650+ fascinating people across the globe, and I am learning every day, participating in 4 different projects and hoping to be part of the solution instead of the problem.
• We’re celebrating Maddie and Pat Killian’s wedding in December – the cake tasting was the best part so far, but there will be so much more.
• I’m upping my travel game now, not later.
• In summer of 2025, I’m going on Safari with ALL the camera gear, and when I get home, I’m getting Lulu (my labradoodle) a puppy – we’ve discussed it.
• I’m saying YES as often as I can, but I’m also saying No more quickly when it doesn’t support my priorities.

When faced with unknowns, we need one another. Thank you for reading this long monologue I've been building over the last 60 days and for being there for me, now and in the future.

I’m going to be just fine.