“Miriam’s Story: Cancer in Pregnancy, Part 1” – with Miriam Goldman 

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy and wellness.

All right. Miriam Goldman. Miriam, welcome to the podcast. It’s so nice to see you, so nice to have you. Thank you.

Miriam: Thank you for having me.

Dr. Fox: This is terrific. We came in today, I was all confused because I was like, wait, you’re supposed to be here at 2:00. You’re like, no, 1:00. Here’s the email where you said 1:00. And then, I got confused. Then I realized, because I thought today was Tuesday when in fact today’s Monday and I said, “This is what you have to look forward to as you get older, where you just don’t know what the hell day it is.”

Miriam: Welcome to the week.

Dr. Fox: Yeah. So, but it’s all good. But you’re here. We’re in person, which is really a delight for me because a lot of people do it remotely. But you live local and you work in the city at Mount Sinai. And here we are, face-to-face. Good. How are you doing today?

Miriam: Good. I just felt this was a really intense story, so this is a good person, face-to-face type of story.

Dr. Fox: It is an intense story. It is better face-to-face. Thank God it sort of end well, and so that’s good. But we’re gonna get into some pretty deep stuff, I guess. So I guess, just for our listeners, give us a sense of, you know, who you are, where you’re from, what do you do and how did you come to volunteer your story.

Miriam: Sure. So my name is Miriam. I live in New Jersey, married with a family there. From New Jersey, moved back to the same town after I had kids. Plus my parents were in the same town as me. I work in New York City at Mount Sinai as a hospital social worker. I’ve been doing that for 11 years in the inpatient side. So I’ve kinda been on the provider side for over 10 years now, which kind of, like, plays into this. And I was kind of just listening to your podcast and I was just, after my six-month mark, I was like, I’m ready. I’m ready to share my story. I’ve processed it enough and I’m ready to hopefully reach out to anyone else who’s gone through this and that they could know that it was done, know that there are people that have done there and just take strength from anything they hear from today.

Dr. Fox: That’s amazing. Now you left out one important piece here, which is “The Toast.”

Miriam: Oh, my God. I love “The Toast.” I actually am a patient in your practice and then I also heard you on “The Toast” because I love “The Toast.” And then, I kind of it all combined from there.

Dr. Fox: Right. Good morning, millennials. Yeah.

Miriam: Yes. I’m a millennial.

Dr. Fox: God bless you. All right. So great, and I guess, we’re gonna be talking mostly about your pregnancy from last year, I guess for 2024, so you said you baby’s 9 months old now?

Miriam: Nine months old today.

Dr. Fox: Amazing. But let’s go into your first two births just to get a flavor of what your reproductive career was like from the outset. So tell us about your first pregnancy, first delivery.

Miriam: Sure. So I have a 6 and a half year old son now. He’s my oldest. Got pregnant a few months after trying. Total normal pregnancy. Nausea, but nothing, like, crazy and no complications. Super easy. Had him two days past his due date. And it was really a vaginal delivery. There was really no, like, I was totally normal. He was totally normal. There was super low anxiety the whole time and that was kind of it.

Dr. Fox: And you delivered in the city at that time. Were you living in the city?

Miriam: I was living in Queens but working in the city, so I delivered in Lenox Hill because that was kind of in between both.

Dr. Fox: Right in between. Perfect. All right. So that went well. Things are going good. You’re a new mom and you decide to do it again.

Miriam: Three years later. I needed time to process, three years later.

Dr. Fox: Good time.

Miriam: Let’s try for another one. Tried again, took a little bit longer, but we were like, this is okay. Got pregnant and by now I lived in New Jersey, so I switched to Englewood Hospital.

Dr. Fox: Sure, know it well.

Miriam: Got my own room there. Super easy pregnancy. It was during COVID though so that made things a little complicated because I was working in a hospital. Always worked through it. But then, when I was ready to give birth, I didn’t have COVID. My husband didn’t have COVID. It was the easiest labor I’ve ever had.

Dr. Fox: So this is 2020.

Miriam: Yes.

Dr. Fox: What month?

Miriam: July.

Dr. Fox: Oh, so this is really, like, in the throws of COVID.

Miriam: Right.

Dr. Fox: Was this right, this must have been right after the time when people thought they’d have to deliver alone. That was more, I think, April.

Miriam: That was, like, March, April. This was July, so my husband was there but we did have to wear a mask during delivery.

Dr. Fox: That’s annoying.

Miriam: Well, I lowered it when I was actually pushing because I didn’t care.

Dr. Fox: And also was a time of no visitors.

Miriam: No visitors except my husband, but he could only leave once. He had to stay with me, left just to get the carseat and then that was it, and then we left the hospital.

Dr. Fox: Wow. That was a very stressful time. All right. Good. Yeah. Post-COVID, in COVID, pre-vaccine. That summer. It got a little calmer later when the rates dropped, but that was still pretty harrowing.

Miriam: And we’re also [inaudible 00:04:50] 2 and a half year old with no childcare and I was like, what am I gonna do with him? So that made it more stressful, but we got through it.

Dr. Fox: Fair. All right. So you have two kids. You’re doing well. You’re living in Jersey and now you decide we’re going for number three.

Miriam: Yes.

Dr. Fox: We love people like you. So God bless.

Miriam: We really wanted to try for a girl, but we got a boy anyway and that’s okay.

Dr. Fox: Okay. That’s fine.

Miriam: So we’re like, let’s go for number three. Got pregnant really right away, no issues. And I was like, great. This is gonna be super easy. So I go for my 8-week-appointment, which is kind of the first one that you get verified, you’re pregnant. They find the heartbeat and we’re like, okay, this is it. And you do your a million vials of blood. I was ready for that. I do that and I get a call…and everything looked fine. Great. I get a call.

Dr. Fox: And you’re a low risk, young, healthy, what we call, para 2, two prior babies. You’re, like, the best of the best, the lowest of the lowest risk that anyone could have. Thank God.

Miriam: Right. I’m also under 35 still and I personally have very low anxiety. So I was like, totally not nervous. I was like, ah, this is easy. I could do this. I get a call a few days later from the OB that something in my lab work didn’t look good. He said, “Your platelets are extremely low. I am not an expertise in bloodwork. You need to follow up with a hematologist.” I said, “Okay. What can it mean?” He’s like, “I genuinely have no idea but they were, like, critical low so you need to follow up.”

Dr. Fox: Did you get the sense at the time, obviously they don’t really know, did you get the sense at the time to, like, I don’t know but it’s bad, or I don’t know, but I don’t know?

Miriam: So I was having severe exhaustion and I brought up to all the doctors. They’re like, you’re pregnant. You have two kids. You work full time. So I was like, maybe this is why I’m tired and it won’t be a problem. I didn’t really think it was a problem. I was just, like, maybe this will solve this exhaustion. I was exhausted.

Dr. Fox: Right. Was your blood count also very low or just your platelets?

Miriam: They were, like, a little low but nothing, like, red flag.

Dr. Fox: Got it. Nothing crazy. okay.

Miriam: When the lab work comes back, this was in the reds and I work in healthcare so I’m like, reds are not good. Of course, the hematologist couldn’t see me for, probably, like, four weeks later or something. So I’m like, okay. We’ll just keep going on. I think at, like, 12 weeks, I had my hematologist appointment. Of course they take more bloodwork. The numbers keep dropping. She could not figure out what it was, so I spent about four weeks going two times a week to give bloodwork. She did every test in the book. We couldn’t figure it out, and my numbers kept dropping and now all my numbers were dropping and dropping and dropping. At the same time, so now I’m, like, 12, 13 weeks pregnant, I go back to my OB for my NITP.

Dr. Fox: PT. Yeah.

Miriam: PT to test for the chromosome issues, the Down syndromes, which I don’t know if anyone knows this, but all Jewish woman do. So I was like, okay, yeah, I’ve had this before. I’m not surprised. We’re at, like, 14 weeks now. I get a call from my OB that the NIPT…

Dr. Fox: Bingo.

Miriam: …came back abnormal. But he didn’t really explain what that meant. So I kind of…and I should have looking back, asked more. I kind of understood that it was, like, the specimen was tampered on the way because I guess they send it to California in this specialized lab. He’s like, “It’s not a big deal. We’re not really sure why it was dirty. We’ll just do another one.” So I come back in. Meanwhile at this time, I’m giving, like, twice a week blood at the hematologist. I’m going back to the OB. I literally just kept giving blood and we send it out again to the lab. Still going to the hematologist. So then, the second NIPT comes back and he basically calls me and explains that they found abnormal DNA, which of course is why they can’t even test for all these chromosome issues, because the DNA is abnormal. And I was like, what does that mean? And he’s like, “Honestly, we don’t know. We don’t know if the abnormal DNA is on you or on the baby.”

Dr. Fox: Right. So just to pause for our listeners, when we do the NIPT test, essentially it’s a blood test on the mother. And in the mother’s blood, there’s always FRE pieces of DNA, F-R-E, FRE pieces of DNA. Most of it, let’s say 95%, is the mother’s, 5% comes from the baby through the placenta. And so, they use it to sorta say, okay, is the baby a boy or a girl, right. Because if there’s a Y chromosome floating around in your blood, presumably you’re having a boy, and if there’s no Y chromosome, presumably you’re having a girl. Or if there’s extra 21 chromosome, presumably the baby has an increased risk of Down syndrome, and if there’s not, so be it.

But every now and again, they find something abnormal, but it’s not from the baby, because the assumption is the mother’s DNA is all normal. So anything that’s unusual is from the baby. But every now and again, there’s a mother who has an unusual chromosome, either she has herself some chromosomal abnormality or something else, that we’ll get into. So that’s sort of they’re trying to sort out what is this thing that we’re finding. Is it mother or baby and it was obviously not, like, typical finding. It was something that they have to sort of dig into.

Miriam: Right. So he left me with the impression that they believe it’s the mother is the problem, but kind of just, like, left me and said I’ll get a follow-up call in a day or so. And the reason that is is because the lab in California is associated with the NIH, which is the National Institute of Health in the government’s health system.

Dr. Fox: And they need to do a deep dive.

Miriam: And they have a study that this lab knew about that if there’s abnormal DNA in the mother, they suspect metastatic cancer in the mother.

Dr. Fox: Right. Crazy. Crazy.

Miriam: And he tells me this and I’m floored. I’m like, I don’t know what you mean. I’m young. I go on the Peloton. I eat salads. How could I have metastatic cancer? So he’s like, the NIH will call you and they’ll kind of go over this.

Dr. Fox: Right. This is your OB telling you or the lab telling you?

Miriam: It was, like, the OB and then a little bit the lab, but no one really would share anything.

Dr. Fox: No, it is known that every now and again, this NIPT test will pick up cancer in the mother. It’s rare because cancer in the mother is rare to begin with, but it sometimes happens that the way you find out is only because of this blood test. Now obviously, you were having other things going on at the time. Your low blood counts, you’re not feeling well, [inaudible [00:10:47] hematologist trying to sort it out. But this is sorta like a red flag on a red flag, so to speak.

Miriam: Right. So the NIH, the genetic counselor called…

Dr. Fox: Did you put it together at the time, I’m being followed by hematologists for this weird blood stuff and this?

Miriam: No.

Dr. Fox: Okay. That’s fine.

Miriam: So when the NIH called, they said that it’s also usually a solid tumor cancer. And I was like, I would know. I could feel. I just was like, I would know. There’s no way. I’m also all friends with doctors and Ps that work and I’m like…

Dr. Fox: You work in a hospital. Yeah.

Miriam: They’re talking to me everyday. I’m like, look at my blood work. And I had blood work for twice a week, every day so I’m like, there’s no way. So basically, the NIH is like, if you’re okay, you can come down to Maryland and do all these tests to see what it is. So I schedule that for, like, a few weeks in a row because that was their first availability. Meanwhile the hematologist, she still can’t figure out what’s going on so she says, “Let’s do a bone marrow biopsy.”

Dr. Fox: That’s unpleasant.

Miriam: But, like, on the spot. It’s like, Thursday morning and I’m like, okay, I’m here for my 8:00 appointment. I’ll go to work. She’s like, let’s do one right now. And I’m like, I think I should call my husband, because I know what this implies. But she said, “Let’s just do it. I’m available. It’s a holiday weekend. Let’s get it over with.” I’m like, okay, fine. Bone marrow biopsy is…beyond being painful, you have to be on your stomach. And I was like 16 weeks pregnant.

Dr. Fox: Right, so not easy.

Miriam: And she was like, I don’t really know how to do it if you’re not on your stomach. So I was like, fine. It was immense pain. It was horrible.

Dr. Fox: Did you get, like, an epidural for that or something?

Miriam: I don’t know. It was so painful. But besides that, the minute I flipped over, I vomited everywhere because of the pressure of the baby. I couldn’t lie on my stomach at that point. I was, like, too pregnant. Knowing me, I didn’t tell anyone this was happening. I go back to work that afternoon, which was definitely a mistake. But, like, it started sinking in and she was like, “We’re testing you for leukemia.” And I’m like, that’s bad. So it was President’s Day weekend. The whole weekend, I’m like, freaking out that I have leukemia and I’m pregnant. What does that mean? She calls me on Monday. She’s like, “You don’t have leukemia. I still don’t know what it is.” So I’m like, okay.

Dr. Fox: Meaning the bone marrow’s normal.

Miriam: Right. And at this point, my husband’s cousin is an oncologist so we’re getting him involved. But no one knows what’s going on. So I go down to Maryland at about 18 weeks pregnant. Me and my husband take off, like, two days of work. We find childcare for my two kids at home. We spend the whole day in the NIH building, which is gorgeous. I do maybe 12 vials of blood at this point and I do a full body MRI because that’s the only thing you can do pregnant. And then, they’re like, okay, wait for the oncologist. I was so sure I was fine because I’m so healthy, I call my mom. I’m like, we’re gonna meet with the oncologist for five minutes. We’ll come back. We’ll come pick up the kids tonight. No worries.

We go to the room. I remember exactly the oncologist. I even know his name and he walked in. He was like, “I’ve seen your MRI. You have metastatic lesions everywhere.” And I couldn’t breathe. And my husband’s like, “Oh, isn’t that okay?” Because he’s not in healthcare. He’s in finance. I’m like, metastatic is, like, the worst. And he starts going through all the organs that it’s already in. And I’m like, sweating. I can’t breathe. I know what he…I know what this means and I’m, like, freaking out. And then, he explains that it’s lymphoma and there’s just, like, cancer in my lymph nodes. I mean, I can say the parts. It’s in my stomach, my liver, in my spleen and in the bones in my spine. And I’m like, oh my God. So he does a full body workup. He examines me and he finds them that are by the skin. And I’m like, oh, my God, I feel them. That’s crazy.

Dr. Fox: Loves some bumps.

Miriam: Right.

Dr. Fox: When he dropped that news on you, I mean, take me to that five minutes of time. He drops it to you. Are you able to even process what he’s saying at that time? I mean, he just dropped the C word on you. You know what I mean? And you’re pregnant and you have kids and take us into your headspace. Literally for those first few minutes, is he just, like, speaking wah, wah, wah, wah, or are you listening? I mean, what is it?

Miriam: So I go, I can’t breathe. I have to take of my mask. Because we were masking. And he was like, oh, you totally could. So I lower mask and I just, like, take a few deep breaths. And I’m like, they kind of asked for clarifying, what does this mean? what type? And then, I just start, my voice cracks so I start crying because I’m like, holy crap. And then, he stops and he actually takes my hand and my husband’s hands and he puts them on top of each other and he’s like, “You guys need this moment to just take this in.” And I just kind of crying but this is the point that my husband doesn’t think it’s bad. So he’s like, it’s okay. He’s like..

Dr. Fox: I’m a husband. We’re limited.

Miriam: And he’s not in healthcare at all.

Dr. Fox: Nope, but all of us are limited. We do our best.

Miriam: So that’s when I was like, it spread and I think he turned white and then we took a minute and then I’m very, like, let’s…

Dr. Fox: What’s the data.

Miriam: …where is it? Are you sure? What’s your proof? And then, he, like, pulled up every lesion and every size and where. And after we do the body exam, he’s like, “I’ll be back in a few minutes” and he leaves. Probably, like…

Dr. Fox: Not a terrible strategy to give you guys some time. That’s actually very kind of him not to blast you with stuff, to give you a moment to process.

Miriam: Right. And we already spent, like, 30 minutes with him. Probably 10 minutes later, somebody comes in with a bag of lunch and I’m like, this is bad. I’m like, when they’re bringing you lunch because you’re gonna be here awhile…

Dr. Fox: Right, you’re checking in.

Miriam: …I’m like, this is bad. Granted the lunch was not edible, so, like, I’m like, we’re not hungry now. My mom is calling me constantly, like, when are you leaving Maryland? Where are the kids? I’m like, I can’t talk, Mom. My mom’s like, “What’s going on?” I’m like, “I can’t talk.” They bring in, probably 30 minutes later, five doctors and I’m a healthcare worker. I’m like, this is bad.

Dr. Fox: They just flew in a team from Vienna. That’s not good.

Miriam: And it’s, like, all these fellows who are on this study that the NIH is having, because now I, like, perfectly fit this study. And I kinda prove the study right. And they go over what type of cancer they anticipate it is…

Dr. Fox: Just based on the imaging and the blood test results and the bone marrow…all the data they have this far. Because they would need to biopsy one of these lesions to know for sure.

Miriam: Exactly. So they explain, they can’t say for sure because they need to have a biopsy. But form the data, from my body, from, like, past women that have had this, this is the type of cancer they anticipate. This is the type of treatment. They do think that I could have this baby while this treatment is going on. And it’s pretty high survival rates because lymphoma rate is a pretty good survival rate.

Dr. Fox: Because of the response to treatment.

Miriam: Right. So I then said, “What stage is it at?” And he said, “Stage 4.” And I thought I died. I was like, I’m gonna die. And he was like, because it’s a blood cancer, Stage 4 isn’t the same as, like, a solid tumor cancer Stage 4. It just means that it spread everywhere. But it’s still the same treatable, like, it’s still treatable. You’re not gonna die from it.

Dr. Fox: Right. The stages, again, are typically are how far in your body has it spread. And so, if you have a solid tumor, like you have a golf ball somewhere and it’s just confined to that golf ball, it’s gonna be Stage 1. Maybe Stage 2 if it’s bigger. And then, if you have little marbles or golf balls in other parts of your body, that’s Stage 3, Stage 4 and it’s much, much worse. But if it’s in your blood, it starts in your blood, your blood’s everywhere. So there’s no such thing almost, I mean, there could be a Stage 1 tumor in your blood, but almost always it’s gonna be spread by the time you find it because that’s where it is. But still fortunately, he was saying these things tend to respond to the treatments they have.

Miriam: Right.

Dr. Fox: Okay. Got it.

Miriam: And then, I was like, now that you diagnosed me-ish, because I need my biopsy, I live in New York, New Jersey. I have a family. I have a job. And he was like, no, our goal isn’t to treat you. It’s to find this evidence and then you can go back to New Jersey, New York, and do all, everything you need to do there. And he gives me all the paperwork and it must have been, like, four or five hours now and they let us go.

Dr. Fox: Wait, they did the biopsy and they let you go?

Miriam: No. They just gave me all the MRI, the blood work, they handed me over everything.

Dr. Fox: Oh, so someone else will do the biopsy. Fine.

Miriam: They were like, you can follow-up with us or you can go back to where you live. And I was like, of course I’ll go back to where I live. I can’t move my whole family.

Dr. Fox: Right. And it’s not like you live in some rural area. You’re in New York, New Jersey. You probably can’t throw a rock without hitting somebody who could take care of you. Yeah. Okay.

Miriam: So we get in the car. It’s been hours so we text my mom and I was like, we’re in the car. We’ll be home in, like, five hours, because that’s how…four hours. And we’re like, we gotta eat something because it’s, like, 5 p.m. We want to get on the road. We go eat. We start processing. We’re like, we have to call people and tell them what’s going on now. So our first call was to my husband’s cousin, who’s an oncologist. We sent him, like, all the MRIs, everything and he responds with a strong curse word. And he does not curse. And I’m like, that’s bad. If the oncologist is using a curse word, not great. And then, we spent the whole car ride just calling our parents, our siblings, kind of being, like, this is what’s going on. My parents, who are watching my kids, like, had to leave the room and they were crying. But they were like, we don’t want your kids to see it. My husband’s parents were in Florida. They’re like, okay, we’re buying tickets. We’re going to come up right away. His brother, who lives in Chicago, was like, we’re flying in also. So everyone was like, okay, we need to rally. We need to figure out a plan. And we also had this four or five-hour car ride, which gave us time to be alone and process it and be like what’s our plan. We still have these two really young kids. We have a pregnancy. We gotta figure out everything.

Dr. Fox: Right. At this point, again, day one, you just got a diagnosis.You’re planning. But do you remember at that time, were you optimistic? Like, all right, this pregnancy is gonna suck but I’ll be okay on the other end and my baby’s gonna be okay. Are you thinking, it’s game over for me. Or I’m gonna lose the baby. Again, on day one, what are you thinking?

Miriam: I was in full denial.

Dr. Fox: Full denial in terms of this isn’t real?

Miriam: Yes.

Dr. Fox: Biopsy’s gonna be negative.

Miriam: Yeah. I said, I remember calling my sister, who’s a doctor, and I said, “They said I have cancer but I’m telling you it’s not true.”

Dr. Fox: Wow.

Miriam: She’s like, “What else could the lesions be?” And I was like, “I don’t know, but there’s no way I have cancer.” I was like, I’m so young.

Dr. Fox: Right, and you’re a social worker. So you’re thinking, all right, anger’s next?

Miriam: Yeah. And I knew I was in denial and I said, “Until that biopsy…

Dr. Fox: Here we go. Let’s start. [inaudible 00:21:14]

Miriam: Yeah. And I was like, “Until that biopsy comes in, I’m gonna hold onto denial.” I would be like, guys, they say I have cancer. I don’t believe it. Like, that’s what I told my sibling. And everyone’s like, oh, what else could it be? I was like, no, no. They’re guaranteed it’s cancer, but I don’t have cancer. That’s literally how I spoke about it.

Dr. Fox: right. You’re like, I’m going with denial. Yeah.

Miriam: Totally.

Dr. Fox: Okay.

Miriam: The next day was a Jewish holiday, of Purim, which is the happiest holiday. And I, like, was putting on this brave face for my kid but would go to the corner and cry. I was seeing all these people I haven’t seen in so long and they’re like, you’re pregnant. I’m like, yay, great. And hiding everything inside. I called my best friend’s husband, who was an oncologist at Mount Sinai and I said…and he was helping me throughout this because he’s a leukemia specialist. So he was kind of like in the blood work and he was like, “I’ll call the surgeon. I’ll get you a surgery.”

Dr. Fox: For the biopsy.

Miriam: Right. So I called my friend on the Tuesday and I was scheduled to have surgery on Monday morning, which was pretty quick in the New York world. I also was like, I gotta get out of New Jersey because I want to be in a big healthcare system that I could do OB and oncology together.

Dr. Fox: Yeah, not Englewood at that point.

Miriam: Totally not. So I was between Mount Sinai and Columbia, but I knew this guy at Mount Sinai. So at work, everybody knew what was going on at work because they were like, helping me through it. And my co-worker was like, “Oh, there’s this high risk OB that you have [inaudible 00:22:33]” which is how I actually part of your practice and I see your…

Dr. Fox: Right. What name did you have, Andrei?

Miriam: Andrei Rebarber.

Dr. Fox: It’s always Andrei. He’s the goat.

Miriam: So that week I think I already had a consultation with Dr. Rebarber on Zoom who’s so supportive and so helpful. Of course, made me cry just because I was like, someone cares.

Dr. Fox: No, he’s the best. There’s no one like him for these things. Yeah.

Miriam: He was great. And then, that week my OB from Englewood called me to break up with me.

Dr. Fox: And they would say, “Go see us.” We work with those guys all the time. So yes.

Miriam: He was just like, I can’t do anything with you. Of course, said stupid stuff that was super not helpful for my spot. But I was like, oh, I already found a new OB. Don’t worry about it. Just transfer all the medical records. So then, Monday, I go…I’m also working full-time, so I’m still trying to take off of days to get stuff done. So I go in for a biopsy on Monday and I’m pregnant, keep in mind. So I can’t do a regular surgery. So first they had to get OB to clear me in the hospital before surgery. So OB was in the OR doing the ultrasound of the baby. They couldn’t do general, not general anesthesia, they couldn’t do the regular anesthesia.

Dr. Fox: I don’t know if it’s an anesthesia issue. Maybe normally they use some sort of fluoroscopy or radiation. I don’t know. Because that would be the thing, because you can get general anesthesia when you’re pregnant.

Miriam: So not like the intubating one. The one that you’re…

Dr. Fox: Oh, they can’t just sedate you, so they have to actually intubate you. Yeah, that makes senes.

Miriam: Right. So she basically said we could do local, where you’re fully awake, or we can…

Dr. Fox: Fully asleep.

Miriam: No, fully awake.

Dr. Fox: Right, you could do fully awake or fully asleep. We can’t be in between.

Miriam: Yes. And as a healthcare worker who works in the ICU, I was like, I’m not getting intubated if I don’t need to.

Dr. Fox: So fully awake.

Miriam: I was fully awake. General, so I totally wasn’t in pain but I was totally awake, conscious, you know, they put a sheet in front of my face like when you’re having a C-section. OB was in the room and it ironically turned out to be a friend of mine, which was very weird. But she really held my hand the whole time and made me get through that surgery. And after he took it out, I looked at the surgeon and I said, “Can I see it?” I was like, “I’d like to see it.” And he, like, showed it to me and then I said to him, “Does that look like cancer to you?” And he gave me some vague answer and I’m like, it does then because if it didn’t, you would say no.

Dr. Fox: I talk to surgeons all the time. I know, I know what you say.

Miriam: Exactly. So I go home. And then, my friend, who’s the oncologist, calls me the next day and he’s like, do you want me to call you with the results or wait for the surgeon? I was like, I need to know immediately. I need to know everything.

Dr. Fox: Right. Was your friend acting as your oncologist at the time?

Miriam: Yes. But he informed me that once…we knew it was some type of lymphoma and he’s a leukemia specialist.

Dr. Fox: He’d figure out who to send you to.

Miriam: Right. He’s like, you’re not gonna be my patient. Also he’s like, one of my best friends so he’s like, I would never be your doctor. But kind of getting me in the right…

Dr. Fox: Got it.

Miriam: So he called me on a Thursday night and he’s like, I have it. Are you ready? And I said, “Yeah.” And he said, “You have nodular lymphocyte predominant Hodgkin’s lymphoma,” which is a super rare type of Hodgkin’s lymphoma. We all thought it was gonna be…everyone told me it was non-Hodgkin’s. So he’s like, it’s actually Hodgkin’s, so it’s a little bit less of a survival rate, but it’s still in the 80 percentile. Your chemo will just be different. And that was Thursday and then he got me an appointment with a lymphoma specialist on Monday morning.

Dr. Fox: At Mount Sinai.

Miriam: At Mount Sinai. Well, during the day, my lunch break because I was still working. So my husband comes up from lunch. His lunch break, my lunch break, and then my mom was like, I want to come in for this one too. And I was like, totally fine. And I’m probably like, 20 weeks pregnant by now. I’m showing. This baby’s moving already.

Dr. Fox: Yeah. How are your poor parents doing with all this? I mean, you’re a parent, I’m a parent. I mean, the only…

Miriam: They were horrible.

Dr. Fox: The only thing worse than going through this is your kid going through this.

Miriam: Right. My parents were a wreck. My mom would cry to me a few times but she’s like, I”m the mom. I have to be strong. And I’m a very strong person so I barely cried. My parents had a hard time. My dad is very, he finds all his strength in God and he said to me, he was, like, questioning God. He was like, how could you do this to my child and grandchild? So they were having a really hard time, plus my grandparents are alive and they are much older so we didn’t know how to tell them. We didn’t want this to, like, kill them. And they knew I was pregnant.

Dr. Fox: Oh, God.

Miriam: We didn’t want the news to spread in the community because we didn’t know what we were dealing with. But things were spreading, so my siblings, everybody was taking it really hard.

Dr. Fox: Things are spreading, you mean, the news was spreading.

Miriam: The news was spreading because my friends were like…yeah, the news was kind of, like, spreading but we didn’t want it to hit my grandparents first. And everyone was trying to rally but we didn’t know what we needed because we didn’t have a plan. So we meet with the oncologist and basically because it’s Hodgkin’s lymphoma he suggested a type of chemotherapy called R-CHOP, which I have no idea what it stands for. It’s one day, one 10-hour day, and then it lasts in your body for three weeks. And it’s a six-cycle, like, you do six cycles of those.

Dr. Fox: Right. So six 10-hour days, separated by three weeks.

Miriam: Yeah. And of course, he’s like, “I’ll talk to your OB, see if the baby can handle this.” So we spent a few days deciding what’s the plan. We spoke to Rebarber at length and he was like, “This is totally okay for the baby,” and explained we have to watch the baby to make sure he grows. You’ll be coming in at least once a week throughout this and kinda see how it goes.

Dr. Fox: Yeah. People, understandably, people think that chemotherapy’s gonna be horrible for the baby. Radiation is horrible for babies. Chemotherapy, amazingly, other than a few select ones, the babies tend to tolerate it very well, which is astounding obviously because, like, the point of it is to kill growing cells. And what’s growing in you more than a new baby. But it’s just, for whatever blessed reason, for the people who have cancer in pregnancy, the chemo tends to be safe for the baby and for the mother. And we do follow certain things, but it’s much more so than one might expect. Again, it is astounding that that’s the case, but it just happen stop be the case fortunately.

Miriam: Right. And my craving in this pregnancy was raw fish and when one of the OB said I can’t have it, I was like, “I’m going through chemotherapy and the baby could tolerate that. I’m gonna eat raw fish.”

Dr. Fox: I would have told you never raw fish. You should just ask me.

Miriam: And I did have raw fish.

Dr. Fox: I just would have said yes. So that’s fine, yeah. okay.

Miriam: I was like, come on, lady. And she was like, as long as it’s a reputable place. I’m like, I’m going through chemo. I’m having my fish. So at 22 weeks, I started my first chemotherapy. It was a few days before Passover. It was scary, of course. My friends came…like, I basically…

Dr. Fox: It’s, like, an infusion center or you get admitted?

Miriam: I go to the infusion center at Mount Sinai. I’m there from, like, 7:30 a.m. to 5 or 7 p.m. It’s all blood work so you’re sitting with IVs. Of course, I was the girl who was scared of IVs before all this. Now that’s my middle name. My friends came to visit. I took naps. My husband came. My parents came. And then, they’re like, okay, you go home and you wait three weeks and you come back. And be ready for…and the oncologist prepped me for all the side effects and stuff like that. So that was my first round of chemo. Do you want me to go into the details of the side effects?

Dr. Fox: Everything. I mean, unless you don’t want to.

Miriam: Yeah, yeah. The first week was…so he said that you should anticipate no appetite and a lot of nausea. I didn’t have a lot of nausea because I was on a standing Zofran, which of course I called Rebarber and I’m like, ” Can I take Zofran at this point?” And I was on a ton of anti-nausea meds as well as other random medications, like a ton of steroids that Rebarber clear for the baby. The first week, I wasn’t so bad nausea. I had no appetite. I literally ate one food one time and it was white rice. I could only eat something with no taste, no temperature, nothing. I was at my parents for Passover. Everyone was trying to get me to eat, eat, eat. I couldn’t, I had no interest in food.

Dr. Fox: And the food sucks.

Miriam: Yes.

Dr. Fox: Passover.

Miriam: Right. I was like, white rice and cauliflower, two things with no taste and no temperature were the only thing I could tolerate. But I was otherwise doing fine. I had a 5 year old, a 2 year old. I’m playing with them. What I didn’t mention is part of all of this is we had to address this with my kids. We’re like, how are we gonna tell the 5 year old? He’s so insightful. He picks up on everything and he already noticed stuff. We met with his school social worker. We met with his school psychologist about, like, how do we talk to him about it. How do we deal with this? How do they address it at school? Also so we were doing a lot of, like, on his level also of how to teach your 5 year old that Mommy is really sick, but is gonna be okay. And it’s, like, a pretty debilitating sickness. So that was just kind of part of it all that we also were like, always stressing with my 5 year old of how are we gonna deal with this, what are we gonna talk to him about. What are his questions. So week one I got through. I just really didn’t eat.

Week two, so I also worked, at work, is at week one of chemo I took off of work and then I went back to work on week two and three. So week two was, like, a lot of tiredness. But the first round I was like, okay, I didn’t really eat week two, but by week three, was my good week. I could eat. I was totally fine. I wasn’t so bad with my tiredness. So I did round two. And by now, he was like, I think you should get a port, which you could probably explain more.

Dr. Fox: Yeah. It’s basically, like, a surgical procedure where they insert, like, basically access. So every time you need to get your blood drawn or every time they need to give you an IV, so they give you chemo, they don’t have to stick a new needle in your arm. They have this little port. It feels almost like a Reese’s peanut butter cup size thing under the skin and basically you just poke a needle in that so it’s in the same spot. It doesn’t get clogged or this, that, and it’s sort of easier for you that you don’t have to keep getting these IVs and blood draws in your veins, which is quite unpleasant and it’s just also it hurts and all these things. That’s the port.

Miriam: And they were having a hard time getting access, because my chemos were so long and they were so different.

Dr. Fox: Yeah. And also the stuff that they put in can be painful and it’s toxic. And so, if you put…the ports inserted into a bigger vein, so if you insert medications and stuff into a bigger vein, it has less side effects because it’s into a bigger lumen. As opposed to squeezing it into a small vein and it hits the walls and it’s a little more…I want to ask you one question and then we’re gonna pause for this part one and then finish this with part two, because your story’s too good to be one podcast. It’s just gonna have to be two. But you’re going through this, right. So you’re talking about your chemo, your emotions, your kids, all this stuff. What, during that time period, was helpful to you? Either things or people or support, like, what was it that you found helpful? And then, the second question I’m gonna ask you next week, because you have to think about it for a few minutes, what are the things that were the opposite of helpful? So first, let’s go what was helpful?

Miriam: So I thought about this because as a social worker, I process this later, is you know, after my diagnosis, I start chemo, everybody knows. And we tell my grandparents and it spread. It spread through the buildings at work. It spread through my entire community, my entire synagogue. It spread. And I got many different responses. So one big one was that people didn’t reach out to me and then when they did, they were like, I didn’t know what to say. I was so uncomfortable. That was the wrong response. You should always reach out. You should always see how they’re doing. But it comes in a caveat of I noticed some people reach out so they feel better, and some people reached out to me so I could feel better. So what does that mean? Hi, how are you doing? Are you feeling okay today? They’re not asking me how I’m doing. They want to know I’m doing okay so they feel better about themselves. Versus…

Dr. Fox: You’re like, no, I feel like shit.

Miriam: Right.

Dr. Fox: Thanks for asking. Have a good day.

Miriam: And the truth is, the days that I felt like awful, I didn’t respond to that. Because I’m like, they’re looking for a positive answer. I can’t give it to them. I’m not gonna say anything and I didn’t answer that text. Versus some of my best friends were like, we’re really here for you. We’re really thinking about you. Hope you’re doing okay. If you want to talk, we’re here. To send a text with no need to respond is real support because it’s not about the sender. It’s about the receiver. One of my best friends from college, she was talking to me about it and I was like, she’s like, you need music. And I was like, great. So she made me a playlist of our college party songs because she’s like…

Dr. Fox: Right. The cancer playlist.

Miriam: …how could I help? It’s called curse word Cancer. And that’s my playlist that I listen to.

Dr. Fox: Yeah. Listen, there’s so much with that and it’s true with someone who’s ill. It’s true with someone who’s had a loss, right. The things that are helpful tends to be, in my experience, genuine showing of love and caring, just saying I’m thinking about you. I love you. I miss you. Whatever it might be. That. Just I’m throwing love at you. And the second thing is, I’m here to help you and not so much what can I do to help you, because then it’s like putting…like you have a job now to tell me what to do. I’m going to do this. Right? Or let me do this for you. Let me do that for you. And you could say no. Let me pick up your kid from school today. You could say, “No, I got it covered.” But you’re like, great. And so, it’s much more, you don’t put a job on the person who’s suffering to do something. You just do it or volunteer to do it as opposed to asking. Yeah, and that is amazing. Wow. Cool.

Miriam, we’re gonna have you back next week for part two and we’re gonna start with maybe some other things that people did that pissed you off.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

Man: The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of woman’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.