When a nurse walking her from the registration desk to the pre-op area calls her Dr. Teal, she quickly corrects the woman: “It’s Christy. I’m the patient today, not the doctor.”
Teal, 44, chief of breast surgery at George Washington University Hospital, is here to undergo a prophylactic double mastectomy. She doesn’t have cancer or the genetic abnormalities known to increase risk. She has never had a cancer scare. She’s here because her mother, Nancy, was recently diagnosed with an aggressive form of breast cancer and she’s worried she’s going to get it, too. She’s here because she has a seven-year-old daughter and five-year-old twins and she doesn’t want breast cancer to get in the way of watching them grow up.
She’s not as nervous about this surgery as she was for her mom’s, Teal says. She had pork tenderloin for dinner last night and enjoyed a glass of wine. She read to her little boy, Nick. She prayed for God to guide the hands of her colleagues as they operate on her. Earlier that day, she’d seen a patient in her twenties with breast cancer, a young woman whose mother she had treated years earlier. She has no doubt she’s doing the right thing.
“Have you had anything to eat or drink?” a nurse asks as Teal lies in a hospital bed. Her instructions were to fast after midnight.
“All I had was a pancake this morning,” Teal jokes.
Colleagues stop by to give her hugs and wish her well. A surgical resident is wearing a string of faux pearls she got as a gift from Teal’s kids. Teal always wears necklaces, but not today. The resident tells her, “I figured someone should have on pearls in your OR.”
A nurse takes Teal’s blood pressure and starts an IV. “I kept thinking I’d wake up and this would all be a joke, like last summer never happened,” Teal says. Tears fill her eyes. It was two days after the Race for the Cure in June 2010 that her mother called from Pennsylvania to say she felt something under her armpit. A week later, Teal was looking at an MRI scan of her mother’s breast. Then she made the decision about her own body that even a few of her colleagues couldn’t believe.
Teal’s mother, Nancy Brown, told her when she was in seventh grade that she should think about becoming a doctor like her grandfather. When Teal was pregnant with twins and didn’t think she’d be able to handle it, her mother kept her spirits up. She taught her the value of patience, how to cook, how to do ten things at once.
Her mother, a former home-economics teacher, had early-stage breast cancer in 1997, which was treated with radiation. Doctors put Nancy on a drug called tamoxifen, which helps prevent recurrences and new cancers by interfering with the activity of estrogen, and she stayed on that for five years.
Teal and her mother talked at the 2010 Race for the Cure about how lucky Nancy was and how she’d dodged a bullet. One in eight women develops breast cancer, and Teal considered her mother’s cancer to be one of the easy ones. Nancy had been cancer-free for 13 years. When she called about the lump, her daughter told herself it was going to be nothing.
In ten years as a breast surgeon, Teal had seen plenty of benign lumps. About 80 percent of these lumps don’t turn out to be cancerous. This one was on her mother’s right side; the first cancer had been on the left. Chances were slim that her mother had developed a new primary cancer in the other breast.
The radiologist looking at Nancy’s MRI at GW the following week didn’t have to tell Teal how bad her mother’s cancer was; Teal walked into the radiology reading room, looked at the films, and saw for herself. The tumor appeared to be four centimeters. Her 74-year-old mother had Stage III breast cancer, an invasive type that had spread to the lymph nodes. Stage IV, cancer that has spread to other organs or distant lymph nodes, is the worst.
This cancer was different from the first one. That was smaller and was picked up on a mammogram; this one didn’t show up on a mammogram or an ultrasound, only on an MRI. The first cancer didn’t involve lymph nodes—the more lymph nodes affected, the more serious the disease—as this one did.
Teal was surprised that her mother’s second cancer was so advanced yet so hard to detect. She trusted mammograms and saw them catch cancers every day, but if they didn’t work for her mother, she wondered if they’d work for her. She’d treated thousands of patients and rarely saw cancers behave like this—in her mind, this cancer was acting like the kind that ran in families.
Minutes after seeing her mother’s test results, Teal walked back to her office in GW’s Medical Faculty Associates building on Pennsylvania Avenue to talk to a colleague, Dr. Anita McSwain. She’d hired McSwain, a former Air Force trauma surgeon in Iraq, two years earlier as an assistant professor of surgery. She was about to say something she knew might sound extreme.
“I want you to do my mom’s mastectomies,” Teal said. “Then I want you to do mine.”
Next: Life before breast cancer was on her radar