“You’ll be fine,” Teal told her. Another 24 hours of denial was a beautiful thing.
It seemed too hard to get her daughter Ashley and twins Nick and Ellie ready for school, see patients all day, and acknowledge that her mother had metastatic breast cancer. To deal with her mother’s crisis, she turned her emotions off, which was what she had to do as a doctor as well. Most of her patients had good outcomes, but she occasionally had to tell a woman who’d hoped to hear her cancer was gone that it had spread. She had a patient at Andrews who was diagnosed just after having a baby. She’d gotten to know the young mother well, and when chemotherapy wasn’t working, the woman told Teal she wanted to stop treatment and take her kids on a cruise.
What a brave thing to do, Teal thought. The woman sent Teal a photo of her family at Disney World. A few weeks later, Teal went to her funeral.
It’s not that she doesn’t cry for her patients, Teal says, or for her mother; it’s that she does it at night after she puts her kids to bed.
The day of her mother’s surgery last June, Teal scheduled cases in the operating room. The first time Nancy had cancer, she’d chosen to conserve her breasts, as many women do. This time, she needed a mastectomy on one side and chose to remove both.
“Get them off,” she told McSwain. “I just want them off.”
Teal couldn’t sit in the waiting room all day with her father. She had to keep busy. A few hours into the surgery, she checked in with her dad and asked how he was doing. He was usually a stoic guy.
“I’m sad,” he said.
Teal came out of surgery around the same time McSwain finished operating on her mother, and they ran into each other in the hallway.
“How did her nodes feel?” Teal asked.
McSwain hesitated but knew she had to say something: “I did find some enlarged, firm nodes.” Hardened lymph nodes are a bad sign.
Teal felt some relief that at least her mother’s cancer was out now. She begged the pathologist analyzing the tissue samples to please find a few nodes that weren’t cancerous.
In 2005, when her obstetrician saw two heartbeats on her sonogram, Teal burst out crying. She’d had trouble getting pregnant the first time, so she and her husband, Dave, had gone through in vitro fertilization this time. He’d been happy with one baby, but she’d convinced him to have another. She hadn’t considered the possibility of twins and didn’t feel she was ready to be a mother of three. She put in long hours at the hospital, and Dave traveled a lot for his job at Andrews Air Force Base.
Dave reassured his wife that everything would be okay with three kids. She could always rely on him. Still, she didn’t know how he’d react to her decision five years later to have elective breast surgery. Her breasts had never mattered much to her—she’d always been small-breasted and hadn’t tried to bring attention to them. They weren’t a part of her identity, but she wasn’t sure how much they mattered to him.
Teal didn’t want cancer to get in the way of watching her children—Ashley (center) and twins Ellie and Nick—grow up. Ashley (below right) understood that her mother was choosing to have surgery “so what happened to Grandma doesn’t happen to you.” Photograph by Chris Gavin Jones
She’d met Dave on a blind date at the Officers Club at Andrews Air Force base in January 1998, and he proposed a year later. She was a general surgeon, one of the only female surgeons on staff at the time, doing everything from emergency appendectomies to mastectomies. He was a flight navigator. They agreed it would be better for Teal to get out of the military so she could specialize in breast surgery, have more time to start a family, and avoid being deployed to a war zone.
Teal came home after talking to McSwain and told Dave what she wanted to do. He’d watched his wife struggle with her best friend’s illness. If there was anybody he could trust to make the right decision about her breasts, it was Christy. His wife was an expert. To be a surgeon, you had to be decisive; he knew she wasn’t going to waver. If she didn’t have the surgery and did get breast cancer, they’d always have regrets.
“If you want to do this,” he said, “let’s do it.”
Teal was expecting people to tell her she was crazy. Two of Teal’s colleagues, both breast-cancer survivors, touched her shoulder and asked how they could help. One of her former residents reacted differently: “What? Why would you do that?”
A colleague and friend, Dr. Robert Siegel, director of hematology and oncology at GW, didn’t think she should do it. Siegel, who started seeing breast-cancer patients in 1982, had treated Teal’s mother and knew her family. “You don’t have anything on your mammograms that looks anything like cancer,” he said. “I’d think carefully before having surgery.”
Patients often asked Siegel what he would recommend if they were his wife or daughter. In Teal’s case, the answer was no surgery.
But Teal hadn’t come to Siegel for advice. Her mind was made up.
Next: When prophylactic mastectomies are the answer