Kristen (00:04):
This is a story about what happens when you have breast cancer told in real-time. I'm Kristen Vengler and our mission with this podcast is to help you and the people who love you through the shock of diagnosis and treatment.

Eva (00:18):
I'm Eva Sheie, and today's episode marks the start of our second season and our second story. The incredible woman whose story you're about to hear is a nurse practitioner in San Francisco who has dedicated her life to caring for patients more vulnerable than you can imagine.

Kristen (00:35):
Her name is Natasha. Like me, she also navigated breast cancer on her own and her cancer wasn't detected with a mammogram either. But as you'll soon learn, that's about all we have in common.

Eva (00:48):
When Natasha discovered an almond-sized lump in her armpit, she did everything she tells her patients not to do and dismissed it. Months went by before Natasha finally got a mammogram, but radiology saw nothing in either breast. It was the armpit lump that caught their attention.

Kristen (01:05):
Later it was determined to be stage two breast cancer. In one life-changing moment, the nurse became the patient. Her story starts in the days just after her diagnosis, before any chemo or treatment began.

Eva (01:22):
Throughout Kristen's journey. We met a lot of people, and we reached out to the audience asking for others who wanted to tell their story. And privately between Kristen and myself, we agreed that whoever this person was, the main criteria would need to be their only goal was to help others. And that is how we found Natasha. Natasha reached out to Kristen, and here we are. So welcome to Breast Cancer Stories. Natasha, we're so glad to have you.

Natasha (01:50):
Thank you so much. Good to be here.

Kristen (01:52):
Good morning.

Eva (01:54):
Just tell us a little bit about yourself, your background.

Natasha (01:58):
Sure. So people can probably tell within a couple of seconds that I have an accent. And I'm originally from England, a beautiful small town up in the Northwest of England called the Lake District. When I graduated, I actually worked as a journalist in London for a couple of years, then ended up working as a journalist in Istanbul in Turkey, which is a much longer story. We can do another podcast on that one. And then met my soon-to-be and now soon-ex-to-be husband from Berkeley, California, who was also living and working in Istanbul. We moved back here to San Francisco, actually in '97. I ended up actually going back to graduate school and getting my license as a clinical psychologist. Worked in a hospital for a long time, doing meth counseling, HIV counseling. I loved the hospital environment so much.

Natasha (02:50):
To everybody's shock and horror, I went back to school again and got my license as a nurse practitioner. And so for about the past 10 years, I've worked in San Francisco Bay Area as a nurse practitioner specializing in something that's called palliative care, which often gets confused with hospice. It's actually a very different modality of care, which really focuses on patients' quality of life. And the vast majority of my patients are cancer patients. And I'm very proud to work at San Francisco General Hospital. I think it's one of the gifts that San Francisco has. And that's kind of me in a nutshell. Oh. I've also worked with Doctors Without Borders for a couple of times too. I've worked in Amman in Jordan as a pain specialist. That's one of the things that palliative care really focuses on. And most recently, I was actually the medical lead for a cervical cancer project in Malawi. Came back in July of last year to... I have a bunch of surprises that we can talk about later.

Eva (03:55):
How does being a trained clinical psychologist help you as a nurse?

Natasha (04:02):
To me, it's the bedrock of my nursing foundation. It's about communication. It's about being comfortable with silence that I think a lot of patients need. I think too often, doctors and other healthcare providers just talk over patients and don't give them time after they're given a difficult diagnosis to actually sit with it, and will immediately start problem-solving. And I think a lot of patients need some silence so they can digest what they've been told. It also teaches... It taught me, I guess I should say, to make a rapport with somebody that I haven't met before. It sounds arrogant to say quickly, but it's a way of finding a joint way of communication and to help with very difficult conversations, and teaches you to read body language to a certain extent too, which has been more difficult in the days of COVID because a lot of my patient appointments are now over the phone. So it's been pretty challenging. But I really don't think I would be the nurse practitioner I am if I hadn't worked as a therapist for a while.

Kristen (05:08):
As a nurse, what were your thoughts and experiences with cancer before your diagnosis? Because I imagine you see it a little differently.

Natasha (05:17):
I mean, there's definitely a way when you work in palliative care that you see the difficult cases. The hospital I work at, anybody with a stage three or stage four, any cancer really is referred to me for symptom management. And then in a way, a lot of what I do with the patients has a very strong therapeutic flavor. So we have the difficult conversations about how do you want to live the life that you may have left? I don't do a lot of prognostication, meaning telling people how long I think they have to live. I generally leave that to the cancer doctors unless they are really incapable of doing that, which some cancer doctors really struggle with.

Eva (06:04):
I think people are really familiar with hospice and what that involves. So is there an easy way to tell us how they're different?

Natasha (06:12):
Yeah. I would love to actually get that out. If somebody signs up for hospice, your entire healthcare is handed over to the hospice agency. So hospice is a philosophy of care that is for people who are estimated to have six months or less to live. So for hospice services, if you are a cancer patient, you agree to give up any further disease-directed therapy, which means no more chemotherapy, no more radiation, no more visits to your primary care doctor or your oncologist. Everything happens through the hospice team. Palliative care, I try and describe to patients, if you take the root of the word, palliate means to relieve. And so it's really focused on quality of life regardless of what treatments you may or may not be going through. And so the oncologists will be managing the disease and what I say is I help take care of the person.

Natasha (07:15):
So I always work with a team. I have a fantastic chaplain. And my appointments are always an hour long. And there's some symptom management. I've got pain. My mouth is ripped apart from this chemo. I've got this neuropathy. So the symptom management from that side. But also working again as a therapist, really looking at how this disease is impacting your life. And one of my classic phrases is if you knew your life was going to be shorter, would you be living it differently right now? And there's a lot of people don't have an immediate answer to that, but it can be, sort of, a wake-up call to... I hate the phrase "the bucket list", but it's like, let's start living rather than just being a disease. You can be both at the same time.

Eva (08:04):
I'm struck by your description that the kind of nursing you do is really not very tactical, much more emotional and supportive.

Natasha (08:15):
Yeah. When I worked as a therapist, I worked in the harm reduction world, which is all about meeting people where they're at. I worked in the HIV community with gay men struggling with crystal meth. And it was a big change in San Francisco away from the 12-step model, which definitely works for a lot of people. But for some people, it really didn't. And so harm reduction, it was again about meeting people where they're at. And that's a lot of the approach I have right now with my patients is like, let's just sit in a room and meet you where you're at.

Natasha (08:47):
Kristen and I were talking about this last night. One of the challenges of working at San Francisco General, which is what we call a safety net hospital, my patients are staggeringly poor. We don't take commercial insurance. We only take Medicare medical, and some of them will say to me, "Oh. The cancer's the least of my worries. I have no food for my kids for tonight, and we're getting evicted, and we can't sleep in the car again because we keep getting moved on." And it's a very different skill set than, for example, if I worked at the Stanfords or the UCSFs where things are a lot more straightforward psychosocially for patients. So it's a pretty much all-encompassing position that I do.

Eva (09:28):
When you find yourself with those kinds of problems in front of you, do you actually step outside of your nursing lane and try to resolve them or?

Natasha (09:37):
I do. I play a social worker sometimes just to try and figure things out. San Francisco's a wonderful city for the resources that we have, but it's hooking people up with those resources that is really problematic. And I often have the secret phone number to get through to various food delivery services. And we have it's something called the HOT team, H-O-T, the homeless outreach team, and they can actually go and do wellness checks on patients that I know are struggling in the street or somewhere else.

Eva (10:10):
So you have patients who actually live on the street?

Natasha (10:12):
Yes.

Eva (10:14):
What percent of your patient base would you say is in that homeless situation?

Natasha (10:19):
Homelessness is really difficult to define because you can be homeless, but sleeping on a friend's couch for two nights, and then on the street for a couple of nights, and then your car for a night. We do our best as the San Francisco hospital network to try and get people, especially people with cancer, off the streets. We have an amazing resource called medical respite that is like a shelter for people undergoing medical treatment, where you don't get thrown out into the streets at 7:00 AM. You actually get to spend the whole day in the shelter. But it's pretty rough, and COVID obviously was a huge challenge for these facilities. It's been very hard.

Eva (10:57):
I can imagine. So similar to Kristen, you're going at this alone-

Natasha (11:03):
Yes.

Eva (11:04):
... your full-time job? Are you going to stop working at some point?

Natasha (11:09):
I've really been going back and forth on that. It's a little difficult because the department I work in is actually just me. At this point, I'm the only palliative care provider at San Francisco General. So I run my own clinic. It's a little bit like being a teacher. If you don't show up, the kids are going to sit in an empty classroom. So I don't have an option not to show up for work.

Natasha (11:31):
So my plan right now is to take the whole first month off on sick leave to see how I do, just to get my ducks in a row. And I've no idea how I'll react to the Taxol. I've seen patients who are fine, keep working, a little bit of nausea. They're proactive with any medications that help with symptoms, and life kind of goes on as normal, but with a wig or a cute hat. And then other patients who really, really have a hard time.

Natasha (12:03):
So it definitely feels strange. I feel so healthy right now, and it feels strange that in three weeks, the treatment's going to make me potentially not feel great. But it feels very important to me to continue working as much as I can. I mean, partly I need the income, but also, most of my friends work, and I realize that I feel strong enough to manage this physically. I'm anxious about managing it emotionally. And I think sitting on my own, in my house... And I love my house, and I love being in San Francisco, but sitting alone and being what I often call being a professional cancer patient can become a very small life and a very sad life. So I want to keep working as much as I can. We'll see. I really don't know at this point.

Natasha (13:00):
It's been very interesting since my diagnosis because obviously, it's not something I'm sharing with any of my patients at this point. A couple of days after I knew my stage and what the plan was, to get a new patient on my clinic schedule with a stage two, a newly diagnosed breast cancer who's coming in for me to talk them through their treatment options and their goals of life, their quality of life planning. Are you kidding me? It's like, yeah.

Eva (13:33):
Do you think you'll ever share it with patients?

Natasha (13:36):
I've talked about that with my own therapist. I'm not sure. Maybe in three years time when I'm through this and I can say, "Yes, this is what I went through," but I don't think I'm going to share anything while I'm going through it. But we'll see. I'm not sure. I mean, I'm actually going early next week for a wig fitting. It depends how closely my wig is going to look to my normal hair or what's like... People are shrewd. Summer's coming up. I'm going to have a port that may be obvious through a shirt at some point. But I really don't want to make my appointments with other patients about me.

Eva (14:18):
If you think the port's going to be obvious, you should see Kristen's boobs.

Kristen (14:25):
Well, that's a whole other situation.

Natasha (14:29):
Coincidentally, we're actually meeting up in San Diego next week. I'm doing a long weekend in San Diego with my best friend before treatment starts, and Kristen and I are going to meet up. So I'll be sure to ask to see her boobs.

Kristen (14:40):
Oh. You won't be able to miss it unless I'm wearing a scarf. I was going to... Because this is something when you and I talked that I have not been able to get over. And I want you to tell us where your office is located. Isn't it right near the infusion center?

Natasha (14:59):
Oh, absolutely. No. My clinic room is in the cancer infusion center. And so yeah, we were just talking the day after my diagnosis when I went into work. And it's not new. I've worked there for many years. But suddenly I'm looking at the skinny, bald headed women pushing their chemo poles around. And it was such a mix of emotions of like, "Oh, my God. That's me in a couple of months time." But also, such a sudden love for these women. I'm getting the chills just thinking about it. The stuff that they have gone through and also remembering back to the patient population that I see at San Francisco General, these are often people who are struggling in life as well.

Natasha (15:54):
I have a number of patients who have not told any of their family members that they have cancer, and not because of the... I don't know in the US, but in England, there was a certain shame to having cancer. It used to be like, "She got the cancer." Kind of my mom's generation. She's in her 80s, but definitely in my grandma's generation. But my patients are not telling their families because they don't want to be a burden.

Eva (16:21):
Oh, boy.

Natasha (16:22):
And I've been very open about my diagnosis since the beginning, and it's part of... I haven't quite figured out how I want to be an advocate for this because there's a lot of advocacy for breast cancer. I don't know that they need one new patient who thinks she can change the world of breast cancer. But just with friends of like, "Yeah, this is what I'm going through." And so people have rallied around and they're all talking about helping me through because again, I'm doing this alone without a partner helping me through things that I didn't even think of, like wonderful American phrases like meal trains. Didn't know meal trains were a thing.

Natasha (17:01):
Kristen and I were laughing a few days ago that after my original diagnosis, I couldn't figure out why so many people are bringing me food. My fridge was just full of lasagna for 36 and a carrot thing. But apparently, it's an American thing. You bring people food. But I felt 100% fine. And I was like, "Hey, guys. There will be a time when I need the food, but right now, please come and eat the food with me because there's too much here."

Eva (17:28):
People don't always know what to do, and the food is like a mechanism that we use to [inaudible 00:17:35].

Natasha (17:35):
I don't mean to sound ungrateful. To get a ring on the doorbell and somebody's handing you something is remarkable. But again, I'm so aware of my privilege to have a community that can bring me food. An amazing community of women here. And just thinking of the lovely 43-year-old patient I saw last week who's got three kids who hasn't told the kids or the husband or her parents. Yeah.

Natasha (18:05):
I'm in a situation where if I go out on disability, it's a salary cut, but I can make it. A lot of the patients I work with, if they don't work, they don't get a penny.

Eva (18:17):
The last thing I want to ask you to tell us about is similar to Kristen, I know there was a trauma that occurred in your life quite a bit before you found out that you had cancer. And wonder if you can tell us that story.

Natasha (18:34):
Yeah. So it didn't start off with the intention of being a trauma. As I mentioned earlier, I really have a commitment to doing humanitarian work. The first thing I did, I volunteered in Haiti after the earthquake. I've done some work in China and I've been lucky enough to work with Doctors Without Borders a few times. And so actually, almost a year ago to the day, after a lot of discussion with my husband, I took a position in Malawi, which is in Southeast Africa. It's just above South Africa. Beautiful, beautiful country. One of the poorest countries in the world, which actually has the highest cervical cancer death rate in the world. And so I was going to be running on being the medical team lead for the cervical cancer project there. It was challenging. Any humanitarian work is challenging. But I absolutely loved it.

Natasha (19:33):
My husband and I were in close contact. We had talked a lot about the reasons I wanted to go, and he was very, very supportive because this is what makes up my personality, to do this kind of work. And then about a month before I was scheduled to leave, we're having a regular Saturday night text, chat, FaceTime, and by text message, he told me that he had met somebody else at a party a couple of weeks previously and was moving on and moving out. So I was almost catatonic with shock. I had not seen this coming. And he had been able to spin a story about how he became the victim, which was very interesting. I was this mean manipulative woman. So I talked to my head of mission, which is what they call the people who run the project. And I just said, "I have to go home." I was completely useless to the project. And I came home.

Natasha (20:35):
And this is where women step up for each other. He was actually not here when I got home from Malawi. A group of friends sent me a limo to the airport, took me up to the wine country, got me completely drunk, fed me champagne, put me to bed with a Klonopin, which doctors who are listening, I know champagne and Klonopin is not a good idea, but it was great, and just loved me to pieces.

Natasha (21:00):
But I eventually came back home into San Francisco. We had a really terrible two or three days together, and he was just not open to negotiation. It was a done deal. And he, within about three days of me coming back from Malawi, got on a flight to France to go and have a vacation with his new girlfriend.

Natasha (21:21):
And I went to bed for two months and lost a ton of weight and really, really was not taking care of myself, and was just beginning to crawl out of this and feel... rely on my community and not be so terrified of being alone because I realized I actually wasn't that alone. And then I got the diagnosis, and it was just like, what next? I mean, I think I got my diagnosis about five months afterwards. And we're still in a situation where we are trying to... We own a house together. So finalize who gets the house and just these very unpleasant meetings together. His lack of interest in my diagnosis and lack of concern has been really hurtful on top of everything else.

Kristen (22:11):
My mouth is still dropped open about all of that.

Natasha (22:15):
Yeah.

Kristen (22:17):
And I think we talked about the silver lining in that. And you're nodding your head. So you want to talk about that?

Natasha (22:23):
I wonder if we're talking about the same silver lining, but it was actually my mother's theory, who basically said a lot of men leave women when they go through cancer treatment. And I have seen that with my patients at work. And she said, "How much hurtful would it have been if he'd left in the middle of your treatment?" Whereas now, he left before. And I had some time to become stronger about dealing with this on my own.

Kristen (22:51):
That's the one I was talking about.

Natasha (22:52):
Yeah.

Eva (22:54):
Another Pollyanna.

Eva (23:03):
Thank you for listening to Breast Cancer Stories. To continue telling this story and helping others, we need your help. All podcasts require resources, and we have a team of people who produce it. There's costs involved and it takes time.

Kristen (23:18):
If you believe in what we're doing and have the means to support the show, you can make a one-time donation or you can set up a recurring donation in any amount through the PayPal link on our website at breastcancerstoriespodcast.com/donate

Eva (23:33):
To get the key takeaways from each episode, links to anything we've talked about and promo codes or giveaways from our partners, sign up for our email newsletter.

Kristen (23:42):
You'll get notes and thoughts from me related to each episode and links to the most useful resources for all the breast cancer things. So if you have chemo brain, you'll be able to just go read your email, find anything we talked about on the podcast without having to remember it.

Eva (23:56):
The link to sign up is in your show notes and on the newsletter page at breastcancerstoriespodcast.com.

Kristen (24:02):
We promise not to annoy you with too many emails.

Eva (24:07):
Thanks for listening to Breast Cancer Stories. If you're facing a breast cancer diagnosis and you want to tell your story on the podcast, send an email to hello@theaxis.io. I'm Eva Sheie, your host and executive producer. Production support for the show comes from Mary Ellen Clarkson, and our engineer is Daniel Croeser. Breast Cancer Stories is a production of The Axis, the axis.io.