The car was silent as the three occupants drove to Community Hospital South.
Donna Hacker was scheduled for surgery that morning to remove a small tumor from her left breast. She was going to be one of the first people in Indiana to receive a state-of-the-art radiation treatment at the same time, and she was terrified.
Her husband, Doug, and daughter, Rachel Fitch, rode with her. The pressure of the situation seemed to squeeze them inside the car.
Then, Doug Hacker made a move. Flipping on his iPod, he played the party song “Red Solo Cup,” which his wife had been singing almost nonstop since it came out.
Type of cancer
Stage 2 invasive ductal carcinoma
Lumpectomy, intraoperative radiation therapy
What has cancer taught me
I felt the love of my family more than ever, even coming from different states such as Ohio and Florida. And there is always a “silver lining” to every bad thing that happens, it seems. It brought me closer to God, family, and friends. My back no longer hurts from the front weight I carried in that area, because the plastic surgeon reduced my size after the cancer surgeon removed the lump. I also realized there is a whole community of people, strangers, a lot who became instant friends.
How has cancer changed me
It has made me so thankful that my cancer developed at a key time and place, when Indiana got their first state-of-the-art radiation machine that was able to concentrate on the specific area where the cancer was, so I did not have to endure several radiation treatments, but just one.
What I would tell someone
diagnosed with cancer
I would tell them to be positive. I would suggest that they try to learn as much from the doctors as they can, so they understand each and every step they will go through. When I looked at it as a research project, it took my eyes off “me” and helped me focus on what “it” was, and how “we” were going to deal with it. That took away a lot of my fear. And that I and many others I’ve met are available to help them get through it. And to look for the “silver linings” in it all.
“He played that song, and I actually smiled. I started singing so loud to take my mind off of the operation,” Donna Hacker said.
Throughout her ordeal with cancer, Donna Hacker leaned heavily on her family to support her. They helped her get over the initial shock of diagnosis, almost two months of waiting to be treated and the stress of being one of the first women in Indiana to have her cancer treated by an innovative new radiation therapy.
Without them, Donna Hacker said, she doesn’t know how she would have emotionally survived the ordeal.
“It’s overwhelming. I’m a survivor,” she said. “I never thought about being on the other side of the coin with cancer, but it meant so much to have the people that love me be part of that.”
For the first time in almost a year, Donna Hacker has had time to deal with an onslaught of joyous events as opposed to bad news.
Her oldest daughter, Alison Fitch, 20, was married in September. The summer was a flurry of dress fittings, floral arrangements and catering preparations. Youngest daughter Rachel Fitch, 19, started her first year of college.
In addition, she has settled back into her job as an order entry specialist with Faurencia Technologies, a truck manufacturer in Columbus.
Those responsibilities have kept her busy, she said, but she’ll gladly take that compared to the fear and uncertainty that came from being diagnosed with breast cancer.
Checkup reveals mass
A thick mass in the upper corner of her left breast was detected during a regular checkup.
Hacker had scares with breast cancer in the past. Though her family had no history of the disease, she had dense breasts, and doctors twice found small masses.
But each time the thicker tissue was deemed nothing. She continued to get a yearly mammogram, which is how doctors found the tumor in November.
Additional scans were inconclusive. A needle biopsy, in which a thick needle was used to draw tissue samples from the breast, finally established what Hacker feared — breast cancer.
She was grocery shopping with Alison Fitch when a nurse called to tell her.
“The phone rang, and I had my daughter answer it. She said it was the doctor’s office and handed me the phone. She just stood there staring at me, waiting to hear what they were going to tell me,” Hacker said.
The diagnosis was Stage 2 invasive ductal carcinoma. The cancerous tissue had broken out of the cells but appeared to be centralized in one spot in her breast.
As one of five female siblings in her family, Donna Hacker had worried what would happen if one of them were diagnosed with breast cancer.
“With that many siblings, you just wonder, ‘Who is going to get it first?’ In a way, I’m glad it was me instead of them,” Hacker said.
Within a week, her primary physician set her up with the Community Breast Care Center.
Dr. Erin Zusan, one of the center’s breast surgeons, met with her, her husband and daughters to explain the process they’d be going through. Zusan mapped out everything from the size and location of the tumor, how breast reconstruction would work, and how Hacker’s tumor had developed due to a reaction to estrogen.
Hacker had options, Zusan said. She could have a lumpectomy to remove the cancerous tissue and surrounding tissue, or a mastectomy to remove the entire breast.
Removal came with only a slightly better chance that the cancer wouldn’t reoccur, so she went with a lumpectomy.
That meant radiation treatment, Zusan said. The traditional method was for hourlong radiation sessions every day for six or seven weeks, depending on how the tumor responded.
Community Health Network was on the verge of acquiring a new treatment for radiation. Intraoperative radiation therapy works by sending a focused beam into the precise area where cancer is removed. After a breast surgeon has cut out the tumor, the radiation applicator is set inside the breast.
A small metal disc protects the rest of the body from the beam. After 20 to 30 minutes, the radiation applicator is removed, and the surgery wound is closed.
The treatment nearly eliminates radiation exposure to healthy breast tissue and underlying organs, as well as the burns that can result from traditional treatments.
“Going every day for six or seven weeks was pretty hard to do. But this made it easier,” Hacker said.
She met the physical requirements to receive the treatment. The clinical trials showed the therapy most effective on women who were older than 45 and who had tumors that are smaller than a paper clip, Zusan said. The cancer must be restricted to one spot in the breast and must be located in a breast duct.
But even through she was eligible for the therapy, it wasn’t guaranteed that she would qualify for it, Zusan said. If the tumor were larger than expected or it had spread, she would need to undergo traditional radiation treatment.
Still, Hacker remembers walking out of Zusan’s office feeling confident that they had a plan.
“I didn’t want to walk out of there thinking, ‘Oh my God, I’m going to die,’ or ‘How are they going to help me?’” she said. “I needed to know everything, in order to let my brain handle it.”
During the 47-day wait for her operation, Hacker met with the team of physicians who would be treating her. Dr. Tracy Price, a radiation oncologist, explained how the therapy would work and what to be prepared for the day of the surgery.
Dr. Thomas Jackson met with her to go over the reconstruction on her breast. He explained how he would ensure that both breasts were balanced and appeared as they did before, albeit slightly smaller.
The surgery would be done underneath and to the sides of the breasts, meaning that her scars wouldn’t show if she wore a low-cut shirt.
Choosing intraoperative radiation therapy came with a downside, though. Community Health Network wasn’t going to receive the proper equipment until mid-February, meaning that Hacker would have to wait more than a month to get the procedure.
Surgeons and staff needed to be trained to use the radiation machine, and that would take additional time. Hacker was third on the waiting list to receive it, and her surgery was scheduled for March.
“I was ready to go in and cut it out myself. That waiting was the hardest part. I didn’t want it to spread anymore, to make itself bigger and make it worse,” she said.
Doug Hacker tried to make life as normal as possible to help his wife avoid dwelling on the treatment. They went out to dinner regularly or would go out for a drink on the weekend.
“It’s not like we could lay down and quit. We continued our lifestyle like we had,” he said.
Above all, they relied on faith to keep their morale up during the wait. The family would pray together and used the Bible to find examples of people finding strength in the face of severe challenges.
When she needed to cry, they wept with her.
For her family, this was a reversal of roles, said Fitch, her youngest daughter. Donna Hacker had always been the one to care for everyone else, to bring them soup when they were sick and to bandage up their scrapes and cuts.
“She wanted to take care of her kids. Now, she was the one hurting, and we needed to be there for her,” she said.
Her memories of the surgery are a blur of pain and anesthesia-induced fog, Donna Hacker said. From the time she left her home, she felt like she was being poked and prodded continuously. She needed to go to Zusan’s office first, to have a wire implanted in her breast directing the surgical team where to cut.
She hadn’t been able to eat or drink anything since the day before and was feeling woozy as her blood sugar level dropped.
“There was pain. There were tears. I felt like I was ready to pass out,” she said.
At the surgical center, those feelings intensified. In order to guide the radiation machine and check her lymph nodes, doctors had to inject a gamma solution into her breast.
Four long needles were inserted deep into the breast, where the tumor was growing. No painkillers were given because most women don’t feel more than a slight discomfort.
“I could have gone through the roof. It was so painful, excruciating,” she said. “I’ve had three kids. I’ve handled pain before. But I’ve never felt anything like that.
“It was the worst thing I went through in the entire process.”
The surgery took close to eight hours to complete. Zusan removed the tumor, surrounding tissue and eight lymph nodes. Before the wound was closed, Price adjusted the radiation therapy machine and gave a 20-minute dose of direct gamma rays.
Hacker was sore and groggy for the next week, cared for by her husband and sister, Lou Ann Legato. She wasn’t allowed to raise her arm above her shoulder, for fear of reopening the surgical incision. They had to bring her food and drink, propping her up on the couch and forbidding her from moving.
Legato was there when Zusan called to let them know that all of the tissue around the tumor had been clear of cancer cells. It appeared the surgical team had removed all of the cancer.
Additional monthly scans were required to ensure the cancer didn’t appear elsewhere. A dark spot in her chest had doctors concerned, but it had disappeared by her next scan.
Back to normal?
Donna Hacker has been back to work since early May. The soreness is gone, and her scars are fading. She still suffers from sleeplessness due to the medication she’ll need to take for the next year, but otherwise she considers herself back to normal.
She still holds on to the mementos that helped her get through the ordeal. A purple shirt that reads, “Cancer Fears Me,” is one of her favorites. She wears it regularly to emphasize her status as a survivor.
Her family also keeps reminders. The day of the surgery, Rachel Fitch bought a leather bracelet with the word “Faith” written on it. She wears it every day.
“She had to keep her faith, and we all do, too. We all struggle with why things happen, but faith let’s you believe that they will turn out,” she said.