“Breast Cancer in Pregnancy” – Part A

Jamie tells her story of receiving a breast cancer diagnosis late in her pregnancy and complications from preeclampsia. After her diagnosis, Jamie explains how she and her medical team planned for a lumpectomy, delivery, and egg freezing, and her experience learning she couldn’t carry more children after treatment.

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Dr. Fox: Welcome to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into the life-changing experiences of pregnancy, fertility, and childbirth.

All right, Jamie, welcome to “High Risk Birth Story Podcast.” Thank you so much for coming in.

Jamie: Thank you.

Dr. Fox: We’ve known each other a while now. And obviously, I know the story of your birth and you know the story of your birth. But it’s such an amazing, in many different ways, the word amazing story. And I’m just really appreciative that you were willing to come and talk about it.

Jamie: Thank you. It’s cathartic for me.

Dr. Fox: I do believe that. I think for the podcast, that’s been my experience, that women come in to talk about their own stories is cathartic. Everyone has a story. And some of the stories are somewhat straightforward. And some of the stories are very complicated with a good ending. And some are very complicated with a bad ending, unfortunately. But I’ve just found that women don’t have that outlet to tell the story in completion. People just say, “You had a baby. The baby is fine. Everything is good. Have a good day,” and that’s it. But it’s important. There’s so much to learn. I mean, from listening to these stories, they’re so unbelievable, and so impressive, and so impactful.

Jamie: Yeah, I look forward to sharing.

Dr. Fox: So, Jamie, we’re talking about the birth of your daughter almost three years ago.

Jamie: Correct.

Dr. Fox: We’re coming up on her 3-year-old birthday.

Jamie: That’s right.

Dr. Fox: Amazing.

Jamie: Unbelievable.

Dr. Fox: Yeah, and I’m feeling old as all these years pass and…

Jamie: You look the same.

Dr. Fox: Thank you.

Jamie: Frozen in time.

Dr. Fox: My body is not frozen in time. I have aged terribly. Just tell us where were you coming into pregnancy, sort of, where you were in life, and what was going on.

Jamie: So I actually was pretty much a newlywed. I was 33 years old. My husband and I got pregnant very, very quickly. We were very fortunate. And I had a pretty standard normal pregnancy, I would say, up until around six months. I was at a regular OB, not a high risk clinic. And they started noticing I was having some issues with my blood pressure riding a little bit high. There was some thought that maybe I did have chronic hypertension, which meant I was a person who had blood pressure that ran higher pre-pregnancy, still open for debate. There were issues controlling my blood pressure. It was running on the higher side. So from about six to seven…my six-month of pregnancy, so the seventh month, we were dealing with trying to manage my blood pressure and control it. And obviously, from the OB’s standpoint, you can probably talk more about it, the concern with the hypertension. The blood pressure is pre-eclampsia or eclampsia, which is a very unhealthy situation for mother and baby. So they were watching me closely.

At some point, when I got closer to my seventh month of pregnancy, my husband and I, we felt, like, maybe we weren’t getting as close attention as I could have been getting as far as my blood pressure was concerned. I had a couple of visits to labor and delivery for high blood pressures. And we felt, like, maybe after having a consultation with the high risk clinic that maybe the high risk team might be a better team to manage what I had going on.

Dr. Fox: Right. At the time, and just for disclosure, you and your husband are both physicians.

Jamie: Correct, young physicians.

Dr. Fox: What did you say?

Jamie: Young.

Dr. Fox: Young physicians. Okay.

Jamie: Yeah, not, like, senior.

Dr. Fox: Understood. Okay.

Jamie: We don’t wield the big stick or a lot of power.

Dr. Fox: You wield a stick that’s big enough. Was that part of it, meaning that you sort of felt, “Well, I’m a doctor, I know about preeclampsia?” Was it led by that or just not even related to that?

Jamie: As you’ll see the story unfold, I think flipping the switch from being the doctor to being the patient is a very difficult flip to switch especially in something that’s very vulnerable like pregnancy or cancer, as we’ll get to that. And so, for me, I think there was a lot of I wasn’t really sitting in the doctor’s office as a patient.

Dr. Fox: It’s tough. You’re a patient, you’re a colleague, you know more, which is sometimes good, sometimes not good.

Jamie: Sometimes not good.

Dr. Fox: Okay. And other than the issues with your blood pressure, did you have any specific concerns in pregnancy that you entered with or was it just sort of, “Hey, we’re pregnant. This is great. This is exciting?”

Jamie: I really didn’t have any specific concerns. My health in general was okay. I didn’t have any history of any major medical issues besides from maybe mild asthma, which wasn’t active at all during my pregnancy. I didn’t have any problem conceiving. Everything had gone well, and we didn’t have any major red flags. So we felt confident and happy. We really had no idea what was coming down the pipeline.

Dr. Fox: And so, ultimately, you did transfer your care formally to the high risk practice, our practice…

Jamie: Correct.

Dr. Fox: …which is happy to say we then got to have you…

Jamie: The best practice.

Dr. Fox: Thank you. Why would you whisper that?

Jamie: I know.

Dr. Fox: Say it loud. So you came aboard, and what was that like? Was it a relief, or was it a little scary that you got, sort of, like…

Jamie: Absolutely relief.

Dr. Fox: …you got bumped up to the next level?

Jamie: Absolutely relief.

Dr. Fox: Relief. Okay.

Jamie: For me and my husband, it was absolute relief. We had met a lot of the team here already because, during the course of my issue with my blood pressure, they had been sending me for consultations with the high risk doctors. And so we had met a lot of them. And so I felt very confident that I was going to get the absolute best care.

Dr. Fox: So you come over to us, and again, that was, as I recall, sort of, the beginning of the third trimester.

Jamie: Correct.

Dr. Fox: The 6, 7 months, 27, 28 weeks. And you come over to our practice, and we’re ready to have you, and we know you, and we’re all excited, and tell us what happened.

Jamie: So actually, it was an interim period between the time that I was being transferred from the previous practice to the high risk clinic. It was about a week-and-a-half where I was just, sort of, chilling at home. And I mentioned I have asthma, so I’m kind of a little bit of an allergic person. I have also a history of eczema. Throughout my pregnancy, I, sort of, had the pregnancy itch. I was getting flare-ups of my eczema. And so, my eczema actually was centered around my torso. So I had very dry skin on my arms, on my chest, on my breasts, my whole upper body, and I would scratch, scratch, scratch all night. And in that week period, between the time I was let go by my previous OB team and moved here, my husband was like, “This is ridiculous. Your skin looks like crap. You have scabs everywhere. You’re itching, like, crazy. Come on, you know better. You need to do something. Put something on your skin.”

And so I started really making a point of trying to moisturize after the shower morning and night. And it was then when I was really taking time with my skin along my breast area that I felt something that was different. And I would literally sit with my husband every night and I said, “Feel this. Feel this one spot.” It’s the two of us sitting on the bed. A tiny spot, I would say less than half an inch by half an inch on my left breast, on the outer area. I was covered in eczema, which is basically, like, a very rough, excoriated rash. We’re both sitting there thinking, putting on our doctor hats, “Is this, like, an inflammatory…what is…?” It was a small, little firm area. Nothing was distinct. It didn’t feel like a pea. It didn’t feel like a ball. It was just an area of the skin that literally if you press on this table right here, it just felt a little hard. It just felt different. My husband said, “Oh, it’s nothing. Don’t worry about it.” And every night, I would sit and I would touch it every night in that week period.

Dr. Fox: Did he really think it was nothing, don’t worry about it, or was he saying that just so you wouldn’t worry until you saw somebody else?

Jamie: So it was a week period where literally we were convening every evening and touching it. He would say, “I think it’s nothing but…” He said, “You know what, we’re going to see the new doctors anyway this coming week,” I don’t remember if it was Monday or whatever, “let’s bring it up.” And I was a person like, at that point, I was already coming with my list at every appointment of all my questions and especially with a new practice, going over different things, especially I knew my situation already with my high blood pressure that there were going to be some changes probably as to when I would deliver and stuff like that. So I had my list. And the last thing I put on my list to discuss was, oh mention this spot on my breast.

Dr. Fox: Last on the list.

Jamie: Last on the list and almost forgotten, by the way.

Dr. Fox: After all the critical things, like, you know what hair dye can I use…

Jamie: Right. Exactly.

Dr. Fox: …and can I have a Diet Coke, all those important things. Yeah, exactly.

Jamie: Yeah, exactly, those important things. But I mean, our first visit was with Dr. Romero, Julie Romero, who was great. And she actually ended up delivering me in the end. And she was telling me about my blood pressure. I learned some things there that I may have not been anticipating that I may not go to full term, that we may consider inducing me early. I still would probably be able to have a natural delivery, but they might not let me go all the way because of the risks of pre-eclampsia. So I think I was a little bit distracted. And we were all like, “Done. Thank you so much.” Getting out of our chairs, and the last little thing on my list, I said, “Oh, wait, wait, wait, Dr. Romero, wait,” I said, “this last thing, I’m so sorry to take your time. I just have to spot on my breast. I don’t know. I just felt it. I have a lot of rashes and eczema. I don’t know if you mind checking it out.” “Of course, we’ll check it out.”

My husband, and I, and her went to the examining room and she examined it. And her, and I, and my husband all sat there and we all looked at each other. And we all said, “You know, it’s probably nothing. But let’s err on the safe side and let’s get an ultrasound.” So for some of the listeners, and maybe you can maybe touch on it more, for different types of breasts and different ages, you do different types of imaging. Ultrasound is often the first stop for younger women. Me, personally, I happen to have, at that time, very large breasts that were also very dense. So ultrasound was my first stop.

Dr. Fox: And also, people sometimes get concerned about mammograms because of the radiation in pregnancy.

Jamie: Oh, right.

Dr. Fox: Although you can do them, clearly you can do that. But some people do that and also they’re certainly more uncomfortable to undergo a mammogram. And often if the ultrasound…someone in your age group at the time, if they find it’s a cyst, just filled with fluid, no one’s gonna think it’s a concern. Maybe they’ll put a needle in it and, sort of, aspirate it. But that’s ultrasound. That’s easy. And so, typically people will start with ultrasound. But you should actually leave it to the radiologist. Frequently, they know what they’re doing. Did you know Julie before this pregnancy?

Jamie: I did not. No, I’d never met her.

Dr. Fox: Right. And did you know her before that meeting?

Jamie: No.

Dr. Fox: So the first time you’re meeting, you’re doing everything, and then you’re all…

Jamie: Correct. Yeah. I’ve met a handful of the doctors in your practice before but not Julie. She said, “Let’s get you scheduled. We’ll do it. Of course, we’re going to check it out.” She was very reassuring, which, of course, who would think, like, why? I have no family history of breast cancer. I have no family history of ovarian cancer or anything that could even raise an alarm that somebody my age should have such a problem. And so, all right, something in me was weighing very heavy on me. I had a little bit of trouble getting an appointment. I had about two weeks until the ultrasound appointment, and I was extremely anxious. Obviously, I was pregnant, all of those things.

Dr. Fox: Do you feel the mass changing over those two weeks?

Jamie: No, I did not. No.

Dr. Fox: Right. That would have been even more scary, obviously.

Jamie: Yeah. No, I didn’t it. And the truth of the matter is that when you talk to other people and in retrospect, these things don’t grow quickly. It’s not something that appeared overnight. And so, in the two weeks, it’s kind of, like, a drop in the bucket really in the scheme.

Dr. Fox: Medically, but not emotional.

Jamie: Not emotionally, for sure, but medically. So no, I don’t feel any kind of way about it. It was just anxiety-inducing.

Dr. Fox: Sure.

Jamie: So I was calling every day to see if they had a cancellation, and they didn’t. And then we showed up on the day for the appointment. And you go in, and it’s a very small room, and this is pre-COVID, but you actually can’t take your spouse in the room because the room is very small. So they have the spouse wait outside. It’s not only a cancer imaging place. It’s for all kinds of things. So they don’t automatically assume that you’re going to need some type of support.

Dr. Fox: And the doctor who you were supposed to see, didn’t that person book out?

Jamie: Yes. So I had Google imaged the doctor who was supposed to be doing my ultrasound. I don’t even remember his name to this day. But as my husband and I were sitting in the waiting room, we saw him getting his bag and his umbrella and going to the elevator. And I said to my husband, “What is going on here?” I said, “I need this done today. I don’t care what happens. I will drag him out of his car. He needs to come do this today.” So ultimately, when they called me in, they said he had a family emergency and I had a different doctor. It’s actually first the tech does the ultrasound, and then they call the doctor in. I have a medical background. I’m watching the screen as they’re doing the ultrasound. I could immediately see that there was an irregularity there. I’m not a radiologist, but for my untrained eye, semi-trained eye, I could see that there was a different in the…

Dr. Fox: Right. And you could see they’re taking 46 pictures of a 1-cm space versus 2 pictures of everything else.

Jamie: Yeah. I’m alone. I’m pregnant. I’m basically over seven months pregnant at this point, sitting on this bed, alone in this tiny room with this tech. And she said, “I’m going to get the doctor.” I said, “Okay.”

Dr. Fox: So, the techs, they can’t tell you what they think because you don’t want them to say anything wrong either direction.

Jamie: Yeah. I don’t blame them.

Dr. Fox: You don’t want them to say it’s fine when it’s not, or say it’s not fine when it is because that’s a disaster. We have the same issue with pregnancy, with babies.

Jamie: I feel bad for them.

Dr. Fox: It’s very hard for them.

Jamie: Yeah, it’s very hard. So the doctor came in, lovely lady, and she actually got my husband. So he came into the room. We’re all huddled in this tiny room, the four of us, me, the tech, my husband, and the doctor. And she said, “It really looks suspicious. It doesn’t look good.” I said, “You think it’s cancer?” And she said, “I can’t say for sure. But it looks very suspicious for cancer.” And I just sat on that bed and I just was bawling. I was crying. I said, “So look, what do I do? I don’t even know where to start. What do I do?” She goes, “Well, you need to get a biopsy done. We can’t get you in here…” this was a Friday. “We can’t get you until Monday.” I just begged her. I said, “Please, I’m begging you. I’m begging you. Please do it today. Please, please, please.” I’m begging her, not knowing what she could do. And she walked out, and she came in, and she, sort of, gave me a smile and a wink. And she said, “Oh, we just had a cancellation. I’m going to do it for you right now.” A lot of humanity. It’s a lot. It was a lot.

Dr. Fox: She did what she could under the circumstances.

Jamie: Yeah, for me.

Dr. Fox: Those three days, it’s a big deal. It’s a big deal.

Jamie: Yeah. By having the biopsy done on Friday, I was actually able to get the results on Monday.

Dr. Fox: Who called you with the results?

Jamie: So actually, she had told me to anticipate a phone call from her. But it was getting close to 4:00 on Monday and I hadn’t heard. So my husband and I, just me and him, we haven’t had the baby yet, so we’re pregnant, we’re sitting, and we’re looking at each other going, “Is this a good sign or a bad sign?” Like, meaning if she hasn’t called, does this mean everything’s good or, you know? So it was 4:00 and imagine that the clinic closes at 5:00 or 5:30, I decided to just to call. So I actually called her and she’s like, “Oh, I was meaning to call you. Do you have a minute to talk?” I said, “Of course.”

Dr. Fox: “You bet I do. I just called you.”

Dr. Fox: Yeah. And she said it was positive for cancer. You can’t necessarily see the stage at that time, but you can say what the pathology is. So meaning, early-stage could be, like, DCIS and then invasive, which is more of the cancer side is invasive ductal carcinoma. So that’s what I had.

Dr. Fox: Right, because the stage is more how far it’s spread, and you can’t know that from a biopsy. The biopsy tells you the cancer we’re looking at, how gruesome is it? There’s different levels of how bad of a cancer.

Jamie: So the biopsy can tell you basically…

Dr. Fox: The grade.

Jamie: …the grade. It can tell you the hormone status, or HER2 status. But it can’t tell you anything about your lymph nodes. It can’t tell you anything about distant issues in your body, God forbid. So, she said, “This is the diagnosis, and I’m really sorry, and as soon as possible…” I said, “Well, who’s my first stop? Who do I see? Am I talking to an oncologist? Am I talking to a surgeon?” And she said, “Your first stop is a breast surgeon. It’s your first stop.” So she gave me some names. So we got off the phone. In all honesty, my husband and I, we sat there and we cried for a very decent period of time. And actually, now that I’m remembering, the doctor who did my biopsy, she actually reached out to a couple of the surgeons. So she actually took that job off my plate so that I could really have some time to absorb. So she’s told me to hang tight for her email to see who was going to be able to see me the soonest.

Dr. Fox: Over the weekend between the biopsy and the results, were you assuming it was going to be cancer, or were you assuming not, or were you already reading up on it and trying to learn about it or you were like, “I’m just going to mark it out and let’s find out?”

Jamie: No. I definitely felt a pit in my stomach that something was wrong. I felt that. I felt my intuition, and I don’t know, I just felt that something was off. So that’s how I got my diagnosis. So we sat and we really cried. You get all the feelings, “Why is this happening to us? What did we do wrong? It doesn’t make sense. Could there be a mistake?” And then, obviously calling my parents and telling them, which was a whole other level of…

Dr. Fox: Your poor parents.

Jamie: I mean, it was devastating.

Dr. Fox: I can’t imagine.

Jamie: It was devastating.

Dr. Fox: I mean, listen, I can’t imagine it happening to yourself but also happening to your child.

Jamie: It was absolutely devastating. I mean, I got the diagnosis on Monday, and my mom was already…my parents, they don’t live in New York. My mom was already with me by Wednesday for my appointment with the breast surgeon. It was very difficult. I would say I didn’t sleep, I wasn’t eating, just a lot of fear, a lot of fear of the unknown. I didn’t know what this meant for me. Was I going to survive? Was my baby gonna survive?

Dr. Fox: Did you have a sense at all of what it meant in terms of pregnancy? And obviously, you had an idea conceptually just, as doctors, it’s breast cancer, it’s probably surgery, and maybe chemo, maybe radiation, it depends. You, sort of, understand the brackets of what’s going on here. But pregnancy is, like, a whole vacuum to most doctors. Like, what the hell happens in pregnancy? So did that even enter your mind at first or was it all cancer?

Jamie: It did enter my mind. It did enter my mind. And I’m very much the type of person that if somebody gives me a problem or a diagnosis, not only for myself, even in my practice with my own patients, I’m very much about reading, and learning, and going into as much detail as I can to try and understand. And I felt like for my own situation, the only way to really, not get out of it necessarily, but the best way to handle it was to educate myself the most. And so, in that brief period of time, before I saw the breast surgeon, I already understood that in breast cancer, if you’re diagnosed while pregnant, there’s three stations, and those three stations, first, second, and third trimester, that really determine what your treatment is going to look like. And so because I was on that cusp between second and third, I had a feeling that there was a chance that I might get chemo while I’m pregnant. That fact, by the time I went to my appointment, I, sort of, was thinking…

Dr. Fox: Right. It was on the table.

Jamie: I was thinking, “Is that what’s happening?” Not like, “Am I getting chemo,” but, “Am I going to have chemo whille I’m pregnant? And what is that going to do to my baby?” Scary stuff.

Dr. Fox: It is scary stuff. And, again, when someone’s reaching towards the end pregnancy, you’re, sort of, making the decision, is it better to wait, deliver the baby, and do everything afterwards, or is it better to start beforehand? And if you start beforehand, are you just doing surgery when you’re pregnant? Are you doing surgery plus chemo when you’re pregnant? And, sort of, figuring that out, and there’s no one answer, obviously…

Jamie: There is not.

Dr. Fox: …because it depends on exactly how far pregnant…what’s with your pregnancy? What’s with the baby? What’s with the cancer? All these things then have to be discussed. And I know that there was a lot of talk about that after you met with the surgeon.

Jamie: Yes.

Dr. Fox: So, you met with the surgeon, I guess was it a few days later, on Wednesday?

Jamie: Yeah. So diagnosed on Monday, met with the breast surgeon on Wednesday.

Dr. Fox: I’m gonna ask you how that went, even though I know how it went. How did that go?

Jamie: Yeah. So pre-COVID, I could have my family with me, which of all things that I’m grateful for that it didn’t happen to me during COVID because I cannot imagine going through any of this and being alone in talking about these things. But there I was. I was seven months pregnant and change, sitting in a breast surgeon cancer clinic with my new husband and my mother who lives out of state. I’m like, “What is happening?”

Dr. Fox: And just to set the stage, you’re seeing someone who’s at a major academic medical center who sees breast cancer all the time, sees pregnant women with breast cancer. This is not some, sort of, random clinic that’s never seen this before, right?

Jamie: A hundred percent.

Dr. Fox: You’re in the best of the best.

Jamie: The best of the best, for sure. But I will probably maybe correct one thing that you said, not necessarily corrected but modify it, I’m not sure that all breast surgeons are comfortable taking care of pregnant women with breast cancer.

Dr. Fox: I didn’t say comfortable. I said they’ve done it.

Jamie: And I don’t know. I don’t know. I know it’s not uncommon. I know it’s not uncommon. But I feel like it’s not their bread and butter. It’s not what they’re dealing with all the time.

Dr. Fox: Well, most doctors have a phobia of pregnant women.

Jamie: A hundred percent.

Dr. Fox: They’re terrified of pregnant women, and they don’t want anything to do with them because it’s…

Jamie: A hundred percent.

Dr. Fox: But there is definitely experience there in pregnant women.

Jamie: Yes, for sure. Yeah. Before I even met with the doctor, I had a mammogram done, which they reassured me would be fine while pregnant. So that was actually the first good bit of information that I got after I had them…they covered my stomach to make sure that the baby would be fine with the radiation, that my cancer was only in one spot. I didn’t have satellite lesions. I didn’t have any other lesions in the other breast, any other lesions in the same breast. It was one spot, which for me, that was, you know, I’m looking for any…I’ll take any silver lining I can get.

Dr. Fox: Under the circumstances, that’s best-case scenario.

Jamie: Yeah. So meaning it wasn’t…there are different types of lesions that are extending out. There was no chest wall involved, all that kind of stuff. Thank God. So I met with the breast surgeon, and she said, “Look, I’m just going to give it to you straight, how this is going to be. You have cancer, but you’ll most likely survive. You will most likely survive this,” which I was like, “That’s great news, right?” And then right after she told me that, she said, “But it’s just something you need to know that you’ll never be able to carry another baby again.” And I was just, like, tunnel vision. We all just sat there dumbfounded. And I was like, “What? What do you mean? Why?” You just told me I’m going to survive. I’m going to thrive. I’m going to do great. Why shouldn’t I be able to get on with my life after this?

Dr. Fox: You’re not taking out my uterus, are you?

Jamie: Right. Yeah. She said, “Well, your cancer’s hormone positive.” My cancer was ER-positive, which is estrogen and progesterone positive, HER2-negative, for people that are interested, which means that my cancer, the gas that was fueling my cancer was the female hormones, estrogen and progesterone.

Dr. Fox: Which is probably why it popped up when you were pregnant.

Jamie: But it didn’t appear, meaning…

Dr. Fox: It grew because you’re pregnant.

Jamie: It grew because I was pregnant. It wasn’t created because of pregnancy.

Dr. Fox: There’s actually a lot of debate about, as a side note, whether pregnancy increases the risk of breast cancer overall.

Jamie: Oh, I have a lot to say on that, Dr. Fox.

Dr. Fox: And most of the data say it doesn’t. It actually…

Jamie: It does not and in fact…

Dr. Fox: Yeah, it probably saves lives by showing the cancers that are otherwise, sort of, hanging out and hiding. You get pregnant, they grow, but then you can take them out.

Jamie: That’s right. And then I have actually have a lot to say on that also because I’ve learned a lot since this whole experience. I would say that we were floored. And the doctor kept talking, but I was still on this. I wasn’t thinking about cancer anymore. The dreams of the family that I wanted to have and the life I wanted to build, I felt like it was all gone in an instant.

Dr. Fox: And it’s so interesting…

Jamie: Not because of cancer.

Dr. Fox: Not because I may not survive cancer, it’s like, “Well, I’m gonna survive, but now I can’t have kids anymore?”

Jamie: She was trying to talk to me and, “We’re gonna do this. We’re gonna…” And I’m like, “Can we go back to that?” She’s like, “Why do you want to keep talking about this? This is what it is. This is how it’s going to be if you can…you know, maybe one day somebody else will be…you know, hopefully, you can freeze your embryos, maybe, if we have time and somebody else can carry a baby for you one day.” Nothing against that. I don’t have any feelings on surrogacy, not pro or against, whatever. It’s just not something that I ever thought about for me. And I was just floored. I couldn’t wrap my brain around it.

Dr. Fox: Did you have a feeling, at the time, that that may not be correct, meaning that you’re like…were you skeptical or just shocked?

Jamie: I think I was mostly shocked. And I would say that going back to what we were talking about flipping the switch between being a provider and being a patient, my brain and my heart were fighting because I didn’t know how much to challenge the doctor on it. Since then I’ve learned a lot. And if you want an opinion about something, go to that specialist. So a breast surgeon might not be the best person to talk to you about risks related to fertility. There are other specialists for that, like oncologists and fertility specialists that can give you a better risk assessment about what those challenges might look like for you. But at the time, my life was over, not because of the cancer. I felt like all my…we’d mentioned that I have a medical background. I’ve spent majority of my adult life not focusing on my personal life, focusing on school, and training, self-advancement, and I felt like, “Now is my time. Here I am. Now is my time. I’m gonna pop out three kids back to back.” We had a plan, and it was all gone in an instant from one sentence that somebody said. It was crushing. It was soul-crushing, absolutely soul-crushing.

Dr. Fox: It’s so crazy also. I mean, I think back, I know that between that day and the next couple of weeks, we spoke several times at length about…because we spoke, you spoke with one of my colleagues and there’s a lot to discuss, obviously. But I don’t recall that that was even part of our discussion. I don’t remember. When you told me that today that you were told that you wouldn’t be able to have kids, I don’t recall that I ever knew that someone told you that.

Jamie: No, I don’t think you did.

Dr. Fox: Yeah. I mean because we were talking about, “Okay, you have cancer. What’s the plan? Are we going to do surgery first?” And that was the big discussion, talking about what to do with the pregnancy.

Dr. Fox: I don’t know how much Julie remembers, Dr. Romero, which I don’t know how much you want to build up to my delivery. Ultimately, when I came to deliver, which we can get to the circumstances of that, I just was begging her to make it go my way. And I said, “You know that this might be my last shot. I’m not going to get to do this again. Please don’t make me have a C-section. Please. Please.” And I was begging her, like, a normal person. So we can get to that. I think I felt like also I didn’t want anybody else to tell me no at that point, meaning that doctor had told me that but I don’t think I was at a stage to discuss it with so many providers to be like, “Yeah, that’s true. You’re screwed.”

Dr. Fox: You met with the breast surgeon, you met with us, you also met with an oncologist.

Jamie: So I actually did not meet with an oncologist early on. Actually, after I met with the breast surgeon…your team, actually, I don’t think was involved in the conversation just yet. I actually went for a couple of other consultations to different academic facilities…

Dr. Fox: Right, that I remember, definitely.

Jamie: …to get different opinions. And what the doctor at my initial consultation had said was, “The baby needs to come out. We need to get your cancer out, but the baby needs to come out first.” I said, “But I don’t understand. I’m seven-and-a-half months pregnant.” “But we have to get the cancer out.” It didn’t even occur to me at that time to say like, “Why can’t the two things go together? Why can’t I stay pregnant and you take the cancer out?” She was talking about needing to be induced so that I could go on to have this lumpectomy. So a lumpectomy is where you take out whatever portion of the breast has the cancer plus the borders that are hopefully clear, not a mastectomy, which is the whole breast. Now I know a lumpectomy is not a major surgery. Women that are pregnant even have appendectomies, which are much more invasive. And so that’s what prompted me to get a couple of other opinions. And in that time is when you and I and the team here really started putting our heads together to figure out what’s going on and what we’re going to do.

Dr. Fox: It’s not something that any one specialist can come up with a plan because it’s something where the…what we do, the MFM doctors, we have to talk to the surgeon, and we have to talk to maybe the oncologist. And again, it’s, sort of, based on this cancer, can you operate, how extensive is it going to be, how long is it going to take, what’s going to happen, what’s the blood loss going to be, when you have to do chemo, which chemo do you have to give, how soon, what if it’s delayed two weeks, four weeks, six weeks? And everyone’s got to, sort of, figure it out and come up with the right plan for the right person. And also, there’s decisions to be made where there isn’t a right or wrong answer. And it comes on to you, which direction do you want to go? And that’s hard, obviously. But it takes a lot of conversations. And it really has to be a team approach. And it’s hard. This is hard stuff, obviously.

Jamie: I would say that at that moment in time, I don’t recall a sense of what do I want, which was a very difficult thing for me, A, having type A personality, a medical background, of always being in control. And I would say that the provider, the breast surgeon, was reluctant to operate on me while pregnant.

Dr. Fox: Right. But we twisted her arm.

Jamie: Yes, we did.

Dr. Fox: I remember speaking to her…

Jamie: It was a very tumultuous two weeks

Dr. Fox: …saying, “No, no, you can do it. It’s fine. Don’t worry. We’ll monitor the baby. It’s all good.”

Jamie: That’s right. And when that plan was solidified, I took such a huge sigh of relief because I’ll never forget Dr. Fox saying to me, “We don’t need a sick mom and a sick baby” And when you said that to me, something just clicked and I was like, “This is the plan,” because whatever is gonna happen with me is gonna happen with me, but for something so small like a lumpectomy, there’s no reason why she can’t get her shot to go at least to somewhat full term and have less complications later.

Dr. Fox: Usually the surgeons, they don’t even realize it’s an option. They’re like, “How…?” And we say, “Listen, you’re not operating anywhere near the baby. Unless there’s the craziest complication in the history of lumpectomies, nothing’s gonna happen to anybody. And we’ll monitor the baby just in case.” And if you induce the labor and deliver the baby, you’re talking about a baby that’s been in the NICU for a month and probably will be okay, but there’s a lot of stuff. Then, you have cancer and you’re recovering from it, and now you have a baby in the NICU. And also from a mental health perspective, it’s tough. And so I think the plan we ultimately had, which of course got blown up, the plan was we were going to do the surgery at 32, 34 weeks, and then after the surgery was done, we’re going to deliver the baby so that you could get your eggs frozen so that you can then have chemo.

Jamie: After the surgery, you were gonna let me carry to 36…

Dr. Fox: Right, 36.

Jamie: …just about 36 weeks.

Dr. Fox: You have to recover anyways before you get the chemo.

Jamie: Right. Exactly. At that time, actually, they didn’t know if I was gonna get chemo or not. That’s an interesting thing. That was actually determined later by something called an oncotype test.

Dr. Fox: And that plan would have allowed you to get the lumpectomy sooner and deliver a little bit later. And were you to need chemo, you would have had the time also to do some fertility, store some eggs because…

Jamie: Right. And also would not be pregnant when I get my chemo.

Dr. Fox: Correct. Yeah.

Jamie: Not that it’s unsafe. I just want to say that there are many women who get chemo while pregnant, especially in the second trimester, and the side effects are little to none.

Dr. Fox: It’s okay in the third trimester too. People think it’s much more dangerous to the baby than it actually is. The reason you don’t normally do it in the third trimester is by that point, you can usually just wait until after delivery. But it’s doable.

Jamie: Yes.

Dr. Fox: Okay, so that was the plan, and we were ready.

Jamie: So that was the plan. And I felt like, man, I had this rock star team. I had the best breast surgeon in Manhattan, and I had the best maternal-fetal, the best high-risk pregnancy doctors. And we just felt so relieved and confident. But I had a lot going on internally and emotionally. And going back to my blood pressure, it was being affected by all of this stress. And I would say that to say that I was in my right mind at that time is probably an absolute lie. Sitting before you today is, like, a normal, composed person. But I would say that I definitely was going through an emotional breakdown, for sure, just the reality of it all that I wasn’t going to be able to have more kids or carry a child. I didn’t think the cancer was going to kill me. I just thought my life was over, meaning for my hopes and dreams for my family with my husband. And I was a mess. I just was a mess.

Dr. Fox: As an outsider, you did look like a mess in terms of…but, sort of, as expected. I mean, none of us were saying, “Oh, my god, she’s losing it.”

Jamie: [crosstalk 00:33:13.929]

Dr. Fox: No. We’re like, “This is really hard. She’s trying to juggle all these things and deal with all these things.”

Jamie: I definitely think I did the best I could, honestly…

Dr. Fox: No, you did great.

Jamie: …with that I had.

Dr. Fox: You did as well as anyone could do under those circumstances [crosstalk 00:33:27.339].

Jamie: Yeah. I can tell you 100% looking back now, 100% I can tell you that I was in a completely dissociative state to the point where…and this is where the plan got blown up, is that I basically came in to the clinic for my pre-op appointment, for this lumpectomy while pregnant that everybody, the gold star team is on board to help me, and my blood pressure was like…

Dr. Fox: New plan.

Jamie: Yeah. And they said, “All right. Well, you have to go to the hospital now.” Looking back now, in the time between that the plan was put in place and the time that I came in, I was not well, meaning, like, I wasn’t feeling well. I could say looking back that I definitely was ignoring signs of being sick, for sure. But my mind was so wholly focused on getting to the lumpectomy and carrying my baby to full term, to the point where that sounds crazy. Like, I’m a physician, how are you ignoring signs that you are medically ill to the diagnosis of preeclampsia, which is there’s no logical sense behind it because preeclampsia can be life-threatening for the mother and for the baby. So there’s no logic behind it. But all I can say is that I was not in…I was in a fight or flight mode for sure, evident by my blood pressure. I just felt completely defeated when I was admitted to the hospital to have the baby.

Dr. Fox: Right. Right. So that was the plan. We said, “A, it’s not safe to have surgery when you’re like this. B, it’s not safe for you in general. C, it’s not safe for the baby.” So when it’s that bad at 34 plus, we would have done that anyway. Cancer, no cancer, at that point we’re like, “All right, it’s time to deliver. It’s safer for you, safer for the baby.” We said, “Okay, you’ll deliver, and then you’ll have the lumpectomy, and we’ll just, sort of, just change the order of things.” Do you, sort of, feel like, “Well, at least this was taken out of my hands,” in a sense, that, “I didn’t choose when to deliver the baby and when to do this. This is just, sort of, dictated,” or did you feel, like no control was taken away from me?

Jamie: It’s a very complicated question. And I’ll say that some of it…

Dr. Fox: This is a tough podcast. We really get into it.

Jamie: Some of what you said right now, I did feel, but not in relation to the delivery. So for example, ultimately when I needed chemo, in between the time that I had the baby and then I had the lumpectomy. They take out the tissue. They send it for a special test called oncotype, which basically determines whether you’re going to have chemo. If the number is low, you don’t need chemo. If it’s high, you for sure need chemo. If it’s moderate, in the middle, it’s like a discussion between your doctor and you decide. And I was so anxious, so anxious that I didn’t want chemo. I was so, so, so anxious. And then when I got the result that my score was high and I needed chemo, the wave of relief that I felt…because I felt, number one, the decision was taken from me, like, this is the number in black and white, you need chemo. Number two, I felt like, let’s just throw everything at it. We are just gonna throw everything at it, like, chemo, whatever. Whatever, we are gonna do it, so in that regard.

But as far as the delivery goes, I would say probably not. I didn’t feel that way at the time. Looking back, I think everybody helped me to the greatest extent that they could. I was admitted and nobody told me, “You are 100% needing a C-section.” Nope, not one of the doctors said that to me, which I was so appreciative of because the only thing I could think is, this is my only chance. This is it for me. However this goes right now, however you feel, if you have a once-in-a-lifetime chance to experience something, you might want to grab on to it and take it. So it was very emotional. But I would say that they gave me the steroids to help the baby’s lungs develop. So I was given a 48-hour, kind of, chill-out period with the wonderful magnesium on board. So the magnesium is the IV medication they give to bring down your blood pressure.

Dr. Fox: And if you weren’t loopy enough, that really…

Jamie: I was, like, drunk and high at the same time. My mother was like, “Has she had a stroke?” Like…like that, two days of just chilling out. And then I was very appreciative. The team gave me a chance to try and have a natural delivery to get induced. And I felt like it was the best-case scenario that at least I could try to have somewhat…people talk about these birth plans that they have. I never really had a birth plan. I didn’t think it would ever go this way. This is, like, the worst outcome possible.

Dr. Fox: Very few people having a birth plan, “All right, then I’ll have the lumpectomy.”

Jamie: Right, exactly. But ultimately, after I got the steroids for two days, they decided, “We’ll give you a chance to have the baby naturally,” and they tried to induce me. But unfortunately, after 24 hours, I wasn’t progressing. The wonderful Dr. Romero came to tell me that, “This is not going the way we want, and we’re gonna have to go to C-section.”

Dr. Fox: Bad news Julie.

Jamie: Right. And I’ll never forget, honestly, I feel sorry for what I did to Julie because I literally just sat there and cried. I just cried and I begged her. I said, “Please, please, please don’t. Just give me another hour. Give me another two hours.” Like, what could she say? What can she do? I’m not trying to get emotional here. But I was just begging her begging, begging, begging, “Please don’t take me.” The whisperer had to come in. Dr. Fox had to come and walk me off the ledge to tell me, “It’s okay. We did the best we could. This is how it’s gonna be.” So ultimately, I had a C-section.

Dr. Fox: Was I that matter of fact and cold about it?

Jamie: No. No, you were great.

Dr. Fox: “This is how it’s gonna be.”

Jamie: No, in a very loving and caring way. And to be honest with you, in this whole process, I think I became very jaded as far as providers go just from some of…words matter. Words are very powerful, especially when you’re in a very vulnerable situation. And it’s very important to find doctors that you can connect to and so…

Dr. Fox: Choose your words wisely.

Jamie: Choose your words wisely. So, no, you were very, very kind.

Dr. Fox: Oh, thank you.

Jamie: And you were able to convince me to go to C-section. Nobody can’t take somebody kicking and screaming who’s out of their mind to C-section.

Dr. Fox: It’s certainly not ideal and potentially illegal.

Jamie: Right. So, ultimately, I reneged. I agreed.

Dr. Fox: Yeah, but it was the right thing. I mean ultimately.

Jamie: One hundred percent.

Dr. Fox: What are you gonna do.

Jamie: One hundred percent it was the right thing. I mean, my daughter who was estimated weight to be 5 pounds 4 ounces came out 3 pounds 14 ounces.

Dr. Fox: Not a good placenta.

Jamie: She was tiny. No. And I just remember I was so drugged. The resident brought the baby over me and was just like, “Here’s your daughter.” And I was so drugged. And I just looked up at her. And I’m going into my training and I said to my husband, I said, “She’s so small. She’s too small. She’s too small.” So, that was scary. But you know what? She was breathing on her own, doing everything on her own. She was just a tiny little thing. Ultimately, she did great. She did great in the NICU.

Dr. Fox: How long was she in the NICU?

Jamie: Less than 10 days, for sure.

Dr. Fox: That’s a short amount of time for 34 weeks.

Jamie: Yeah. She was just there for feeding and growing. That’s it. She literally, thank god, didn’t have any other complications.

Dr. Fox: Like, the superstars of the NICU.

Jamie: If there’s one place that’s going to reel you back into reality, you think your stuff is bad, go to the NICU. Pre-COVID, you meet other people at the NICU, other families, and by that point, both of my parents were already with me. And so we were all sitting in the waiting room together. There’s another family who has a baby who’s been waiting for a heart transplant for how long. It’s just that old story if you could throw your problems in a bucket…heartbreaking. So, NICU, a lot of good lessons there. But my daughter did great.

Dr. Fox: Yeah. And they’re amazing there.

Jamie: Amazing.

Dr. Fox: They’re just unbelievable.

Jamie: I mean, it’s unbelievable. So my daughter did great. For me, I would say that my pre-eclampsia, sort of, extended to postpartum. There’s some problems there with my blood pressure. So I had an extended stay at the hospital. I’ve had a journey since then.

Dr. Fox: If you’re interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@highriskbirthstories.com. If you liked today’s podcast, please be sure to check out our “Healthful Woman” podcast as well, where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.

The information discussed in “High Risk Birth Stories” is intended for information and entertainment only and does not replace the medical care from your physician. The stories and experiences discussed in our podcasts are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on High Risk Birth Stories have given their permission for us to share their personal health information.