Focusing on a good life beyond cancer

Krista Colvin slowly wakes from surgery. She slips in and out of consciousness. In this dreamy state, she thinks more about when she’ll get to see her family than about the fact that she no longer has breasts. She had time to work through the impending physical loss in the months leading to her mastectomy.

Krista, 43, was diagnosed in March with cancer. Now surgeons have removed her right breast, which had two tumors, as well as cancerous lymph nodes. Because Krista carries a gene mutation that increases the chance of cancer recurring, her healthy breast was removed, too.

After she moves out of the surgical recovery area and into a hospital room overlooking Mount Hood, her family arrives from their home in Camas. Her husband, Mike, ushers Wes, 10, and Annie, 8, into the room. They catch Krista off-guard. She’s still hooked to oxygen and an IV. Her face is pale. She’d rather her children didn’t see her this way, but she can’t help but feel glad they’re there.

She smiles.

When Wes sees his mother attached to so many tubes, tears flood his eyes. Annie reacts differently. She can’t contain her curiosity.

“Can I see?” Annie asks, hoping to peek under her mother’s bandages.

“Mommy hasn’t even looked yet.” Krista replies.

It isn’t until later, when a nurse helps Krista prepare for her first shower after surgery, that Krista examines where her breasts used to be. She removes the bandages and quickly studies her chest. Her wound is closed with tape.

“Interesting,” she thinks, yet she doesn’t feel sad.

Later, at home, she takes more time to look at herself in the mirror from all angles. Mike echoes her thoughts when he sees her scars — sort of like upside-down Ts — for the first time.

“That’s not that bad,” he says.

The expanders inserted under her pectoral muscles during surgery already give her body a bit of feminine curve.

A couple of weeks after her operation, she begins a series of appointments at her plastic surgeon’s office, where the expanders are injected with saline to pump them up. The procedure creates space for breast implants, a surgery she’ll undergo next summer.

To reduce pain, her doctor, Allen Gabriel, has injected her chest with a dose of Botox. He conducted a trial that found injecting the botulinum toxin, approved by the FDA for reducing wrinkles, minimizes painful muscle spasms experienced by patients with expanders. But each expansion appointment is still painful enough that Gabriel prescribes Valium for Krista to take an hour before her appointment.

The expanders are meant to help keep Krista from missing her breasts. She’s surprised to find there are advantages to having a smaller chest. She used to wear a triple-D-sized bra. With the expanders deflated, she might fill a B cup, although the final reconstructive surgery will leave her at a D, closer to her original size. For now, her shirts fit better.

Less than a week after surgery, Krista starts physical therapy. With 14 lymph nodes removed, there’s a risk that her right arm will swell. The lymphatic system moves fluid toward the heart, so her physical therapist, Karen Garrett, presses her hands on Krista’s arms and smooths them toward her neck and chest. She coaxes Krista to reach her arms overhead — painful after mastectomy — to help improve range of motion. Krista will have to be able to hold her arm up for the radiation treatments yet to come.

“When we work, it’s kind of an in-and-out process,” the therapist says. “In the middle of radiation, the tissue will be too tender.”

Before she can start six and a half weeks of daily radiation treatments, Krista first has her expanders deflated. Then, she reports to Northwest Cancer Specialists for a scan to map her body.

A team works together to create an image of her body and calculate the radiation dose. Every millimeter counts.

“That’s the thing — to immobilize you so we can be accurate,” technologist Derek Cunningham says.

Krista lies still on a platform that slides her into the giant white doughnut of the CT machine.

“You’re doing great. We only have a few minutes before you can relax.”

He pumps a support pillow that hardens into the shape needed to hold Krista in the correct position. She will use the same pillow for each treatment.

The dosimetrist, John Nugent, calculates the precise radiation dose to program the therapy machine that will aim radiation so it hits the area around her lymph nodes and chest.

“We come in obliquely to spare the lung,” he says.

Tiny tattoos that look like black freckles will serve as targets.

Most are obscured by clothing, radiation oncologist Dr. Carrie Gotkowitz explains.

“But it’s helpful to have one higher.”

“Whatever makes your job easier,” Krista replies.

“I’m famous for small tattoos,” Tami Fuller, a radiation therapist, reassures her.

Krista grimaces as the inked needle pierces her skin.

“My first tattoo,” she says, joking.

The weeks leading to radiation bring a flurry of appointments. The one Krista dreads is a positron emission tomography scan. Not for the procedure itself — it’s uncomfortable but tolerable — but for the gravity of it. It will reveal if any cancer lingers in her body after two rounds of chemotherapy and surgery.

Krista already feels fragile. She just read her pathology report. She realizes pieces of her were bagged as nothing but specimens and labeled “Colvin, Krista.” She never saw the plastic bags, filled with the bright-red tissue of her breasts, labeled for the pathology lab. But the details of the report created a vivid image in Krista’s mind.

She gives in to the urge to cry.

She recruits a friend to go to the PET scan with her. She knows even if the scan is clear, she has a long way to go. There’s still radiation. Every 21 days, she receives infusions of Herceptin, a drug that helps her immune system tackle cancer cells. Next spring, she’ll have surgery to remove her uterus and ovaries because she has a breast cancer gene mutation that puts her at risk of cancer in those organs. In summer, she’ll have surgery to complete breast reconstruction.

For now, she just wants to hear that every speck of cancer is out of her body.

It takes a nerve-wracking week to get the results of the PET scan. Until then, she tries to focus on life beyond cancer. She spends time with her children. She watches short stubble emerge from her bald head. She makes plans to visit her family in California for Thanksgiving.

When the day of the big appointment arrives, Krista makes chit-chat with her friend Lisa Algstam as they wait in an exam room for Dr. Kathryn Kolibaba, Krista’s oncologist.

Kolibaba charges in and gets straight to the point.

“I have good news for you: Everything is wonderful,” she says. “No suspicious spots anywhere in the body. There’s just nothing there.”

Krista’s hands fly to her face and tears flow. Relief washes over her.

The cancer is gone. But the treatment’s not over yet.

She collects herself.

“I still have to do radiation, right?”

“Yes, we have one chance to cure. We don’t cut any corners because we don’t know if it’s safe to,” Kolibaba says. “But you are healing well. Your instructions are to go out and celebrate.”

It’s been 10 months since Krista first received the news that the lump she felt by chance after a bath was an aggressive form of breast cancer. Back then, her husband told her he didn’t know how he could get through life if he lost her, especially during the holidays.

“I don’t think I could do Christmas without you,” Mike said.

So Krista makes sure to hit all the high points of their family traditions. They trek to Thorntons’ Treeland. She strings lights on the tree, even though it hurts to reach. She hauls out the decorations. Her parents come from California to spend the holiday.

Her calendar is full of activity well into 2011. She’ll plan parties for her son’s 11th birthday, her mother’s 80th, her husband’s 44th.

She, too, will have a birthday. A year ago, she couldn’t have imagined the ways she would be tested. She didn’t know then that cancer cells were attacking her body.

She met the challenge. The cancer is gone. She’s ready for a new year.