When Two Life-Defining Realities Collide:

Life will always throw you new curveballs, ones you never thought about happening, just like I told my story of how I got a concussion when I was gearing up to prepare for the Ontario Bar exams, dealt with grief of lost family members during my early part of my legal career, and now I want to walk you through dealing with another health crisis that I never expected as a young millennial lawyer. My hope is to inspire, relate, and connect to others in a tough time. If you unfortunately also received such a diagnosis, I will tell you the realities of navigating a cancer diagnosis as a lawyer — especially for those of you wondering whether you can keep going, whether you can still work, and how you might get through it. Let me give you my story, even though yours may look different and you may decide things differently. Everyone’s cancer journey may be different. You’re battling those realities, that you’re a lawyer, you’re focused on your career, and this isn’t supposed to happen.

The Diagnosis: When Your World Shifts Overnight

No one prepares you for that moment when you find out “it’s cancer.” You’ll cry, and cry a lot during this whole process, that’s normal. Maybe not right at that moment when you see what appears to be cancer cells, but as it hits you and you start to worry, or when you’re telling others, that’s when the waterworks happen.

So what happened to me and how did I find out? What was my diagnosis? It started with this lump on my neck I felt. I could feel a bump sticking out on my neck, and it wasn’t painful, it’s just when I went to touch my neck, it didn’t feel right. I thought it would go away and I didn’t think too much of it, until it got harder. When I went to get it checked out, it was thought that maybe I had mono, or that it had come from a previous infection, so I didn’t get too worried as I am someone who has previously gotten sick regularly whether it’s with influenza or other respiratory infections. It wasn’t painful to swallow or anything, so I didn’t worry too much about it for some time. When over a month passed and it didn’t go away, I got an ultrasound on my neck and the bump wasn’t too hard and still a little fluid like. The report from the ultrasound detected more than 1 bump but stated that it was thought to be leftover fluid from a previous infection and to maybe monitor it. When several months passed, it felt like one bump was getting bigger, and there were some more lumps popping up smaller around when I would feel around one side of my neck behind. I had another ultrasound and a soft tissue x-ray on my neck in which they detected at least 2 in the back of my left side, and a main one jutting out directly on my left side of my neck, plus I think a small one starting to form in front. The main side one felt like it was getting really hard and it felt like there was a small bump forming on top of the big bump. I also did a blood test in which I found out that I had Epstein-Barr Virus in the past which supposedly can link to things like Mono or more likelihood of getting lymphoma. The blood test and ultrasound however couldn’t figure out what was going on exactly and why I was getting more lumps or why it was getting harder. So I received a referral to see an Ear Nose and Throat doctor (ENT) at a hospital. The ENT specialist examined my neck lumps and told me he was most concerned with the smaller ones starting to pop up along my collar as it could be cancerous. He did a biopsy. A biopsy is where they will insert an instrument to take a sample of the tissue.

I remember lying back in the reclined chair, getting a freeze needle to locally freeze the area, and then came this pen device to poke at my neck. It was actually more of a jab. Even though I had local freezing anesthesia, I could feel that sensation as he tried to pluck out a piece. It was really hard, and as I laid my head back tilted, it felt like he was pushing this rock against the middle of bone or spine neck and trying to really break a rock inside my neck. I remember the doctor apologizing for having to push so hard, since it was really hard at the time. He snapped a few pieces out and put them in a bag and I was bandaged up. The tissue went to a lab that day.

I was sore for over a week after and I remember talking to my brother over the phone telling me that it was normal to be sore still as I was just assaulted in the neck. Not everyone gets stabbed in the neck regularly. Then sometime after, I got notice that the biopsy report came in and it told me it was a small sample however it appeared to have detected some “Malignant cells”. Malignant cells?? I google searched to remind myself of the difference between benign and malignant cells. Malignant cells are the bad ones, the cancer cells. The comments in the report stated that it was highly suspicious for Hodgkin’s Lymphoma however given the small sample size and how likely rare the cells are, it was recommended to get a bigger sample from an excisional biopsy. I remember seeing the report while I was in the office and feeling like my world was tumbling down. I sent a message to my immediate family that I got the biopsy result back and it detected malignant cells and sent them a copy of the report, and one of my brothers responding how it was going to be very important I go to the follow-up consult with the doctor after. I remember telling one of my coworkers privately in the boardroom and starting to cry being worried about it being cancer.

The ENT referred me to the lymphoma clinic at Princess Margaret Cancer Centre after the report and about two days or so after I received notice of a consult right away with an oncologist there. I went with my father to the appointment and while I was waiting in the waiting room, I messaged some of my closest friends, and Mandy, one of my best childhood friends got a ride to the hospital.

Prior to this consult, I remember looking up how I should prepare and brought along a notebook to take notes. It was a very scary day full of questions. I remember being checked by the nurses, getting my weight measured, and seeing doctors, including ones asking if I would participate in a cancer study and donate my previous biopsy tissue and give a blood sample. I spoke to my referred oncologist’s fellow doctor then. I was handed a copy of a guidebook for Hodgkin’s Lymphoma which according to my biopsy report said it was suspicious of, however I was told then that they couldn’t be sure or confirm my treatment plan until the pathologists could take a bigger tissue sample. The doctor only gave me general information about what it would be like and told me they couldn’t finalize the treatment plan yet. I received referrals to further doctors then. I am so grateful for the amount of resources and referrals I received however. One of the best ones was to the Adolescent and Young Adult (AYA) program for cancer patients. I had so many questions and I was worried about my future, and all of a sudden facing what kind of future I would have now. One of the things as a woman I thought about was whether I could have children. Earlier that year, I was seriously considering and thinking about saving up to freeze my eggs but I hadn’t committed to it yet due to the cost, and having felt like I had just gotten back into full time work as a lawyer for just over a year. I was suddenly feeling panic and worry and even shame that I stalled on moving forward with trying to preserve my fertility.

I remember giving my blood samples, and then going out for lunch in the city with my best friend that came with me to the appointment. I then got the call from the coordinator of the AYA program, and getting a referral request put in by them to Mount Sinai’s fertility clinic. It was a relief to know things were moving quickly by the doctors and referrers, but I also felt the scare that it wasn’t moving quickly enough, that I only had a short time frame to get my fertility preserved before cancer treatment potentially.

I remember walking with my friend in the city to get coffee, talk some more and then crying while looking at Lake Ontario. I don’t know why that view specifically broke me open — maybe because it was so still and so ordinary, and nothing about my life felt either of those things anymore. It was all so scary and not being sure what would happen to me, and how I would be able to handle treatment. I just felt like I was getting my life back on track with working, and had just secured a raise and a contract extension right before this news.

I was booked for a full PET and CT scan and the ENT tried his best to fit me in for an excisional biopsy as soon as possible to get a confirmed diagnosis so they could begin to give me a treatment plan right away. An excisional biopsy is a mini surgery, where he took a scalpel to make a slight cut into my neck to pull out a full swollen lymph node out. I will never forget how I laid on the reclined doctor’s office chair, and as I turned away from him, he sliced into my neck. I received local anesthesia again, a freezing needle and he drew a line where he would cut. The cut itself wasn’t as bad, but once he went into my flesh it was something else. I could smell the burning flesh as he sawed around and tried to pull out pieces. He wanted to be sure he got enough of a sample so I wouldn’t have to come back to do another biopsy. I was glad for his attitude there as I really did not want to do another incisional biopsy (stab in the neck) even, let alone an excisional (cut). I remember not being able to stop myself from wanting to scream in pain as he injected me with more freezing needles to finish sawing off the flesh. I saw nice pink looking tissue bits in multiple plastic bags on the counter that he was preparing to send to the pathology department.

A week came by, and then I received the pathology report confirming Hodgkin’s Lymphoma. I also got my PET scan done, and the results showed a lot of swollen lymph nodes around my neck, mostly on left side but some that had spread to my right side as well as heading into my front collarbone area. It was definitely a lot more than what had been detected from the ultrasound, and more than would have liked to show up, however the oncologist assured me it was a good thing that it was kept to mostly the neck area and hadn’t spread below my chest and other areas from the scan. I also did a CT scan also to confirm that it hadn’t structurally spread to my abdominal and other organs so I was advised that it was considered relatively early stages caught. With classic Hodgkin’s lymphoma, the cancer was spreading predictively as well and wasn’t spreading in unpredictable, scattered ways like non-Hodgkin’s lymphoma might.

The doctor told me the good news was that I was unlikely to die and that with the researched treatment plans for this showed I had a good outcome for remission. However, knowing that I wasn’t going to die, wasn’t what scared me the most, it was only one aspect, because it’s great I’m not going to die, but it doesn’t resolve the fear of what I would be living with, what treatment would be like to live, and how my life would be after this.

The anxiety you get after a cancer diagnosis, regardless of what kind of cancer it is or the stage it’s at is unbelievable and if you ever encounter someone effected or receive this news, be kind to them and do not tell them things like at least it’s not as bad as some other cancer or something else.

While reading the materials and guidebook I was given about Hodgkins Lymphoma, it didn’t help that my doctor said it was “curable” or that there’s a good survival rate, it was still scary to go through such a treatment. I was advised that lymphoma is not a hard tumour, and there is no way to surgically remove it. Surgery was only for my diagnosis and if the cancer spread to effect my other organs then they would remove them. My treatment course had to be chemotherapy and radiation as hodgkins lymphoma is a type of blood cancer. We’ve all seen what cancer treatments look like on tv and media, and there was no doubt that I was shit scared.

Before getting my scans and finding out that it was “early stages” I had fear about how long it would last, how long my treatments would be and whether I could do regular life things I enjoyed. Then when I was told that my treatment plan wouldn’t be as long, I would start with two months of chemotherapy and then look at radiation, it still worried me. I ended up doing four months of chemotherapy, 8 chemotherapy infusion sessions and then later 4 weeks or 20 sessions of daily radiation for active treatment. There were scans and blood work in between.

It’s been almost 10 months since my diagnosis, and I’m writing this now having finished radiation.

If you’re wondering whether you will have to take time off from work, yes, you will have to take days off at a time after your diagnosis with multiple appointments regularly interrupting you. You can try to work around, but don’t expect to be able to work fully on, as there will be a regular commitment to a lot of appointments and even if you don’t yet have side effects, you will need to now make time for regular hospital appointments.

I didn’t end up going on work leave but kept working through when I could from home. This doesn’t mean that you can work the same however. My work schedule was completely different. I could no longer pull the long days of work anymore, and often had to reserve my energy. Cancer is not only physical but emotional. Chemotherapy made me feel sick like, not so much nauseated but generally sick. The first chemotherapy session, I was fine, just ravishingly hungry as I was on steroids to prevent nausea and chemo takes a lot of energy out of you. I found that it took time to feel it. It wasn’t until the 4^th day after my first chemotherapy when I had my first terrible incident. I had what seemed like a heat stroke at the same time as nausea one night and felt helpless as the whole room went black. The second chemotherapy infusion had me in immense pain in my arm that I had the infusion in that time. I didn’t get a port installed as I was told I wasn’t getting as many infusions and because it was every other week instead of every week, the doctor didn’t want to risk me having an infection so I didn’t even get a PICC line. This however meant that my veins grew weaker and I had a new IV puncture every chemotherapy infusion. After my 2^nd infusion, I had to type with one hand as I was dealing with neuropathy and nerve pain in my arm 5 days after the infusion. Chemotherapy is a cycle, and if you have to go through with it, I would suggest keeping a diary of effects and how you feel so you can recognize the patterns and which days affect you the most. Over time with more chemo sessions, I found the effects coming in sooner and the days where I would start feeling better again were getting less before having to go for my next session. Not everyone is affected by chemotherapy the same, but I would be prepared to take some extra days off as write off days just in case because there were definitely days where the brain fog and the general ill feeling was too much for me to work that day. I worked part-time from home when I could. With chemotherapy, your immune system becomes severely compromised, so during this period I only worked from home and tuned into meetings by video, and limited my time while masked in public as I didn’t want to risk getting sick and ending up having to delay or prolong treatment. I checked my temperature everyday and I was told that if I got an infection, I would have to go to the emergency room right away. I wanted to get through treatment as soon as I could. But I’d be lying if I said there weren’t cycles where I didn’t want to go back. Where I genuinely wondered if just letting the cancer take me would be easier than continuing. I’m telling you this because I think more people feel it than say it.

I had a scan after my initial chemotherapy treatment plan in which it was found that the chemotherapy was working but it seemed I needed a little more extending 2 months of initial chemotherapy into 4. After it was found that I had a good response to the chemotherapy treatment and the cancer was more or less gone, I was given a bit of a break before starting radiation.

Radiation is a time commitment. It’s almost every day. I was going to the hospital for radiation treatments every day other than the weekend or on a holiday. The appointments themselves however are much shorter, often 20–40 minutes long but it was still a commitment to go everyday. For some, radiation is a lot easier than chemotherapy, but for me I found radiation to be just as difficult and even harder sometimes. It was perhaps because my radiation was mostly concentrated on my neck which caused me to have difficulty eating and swallowing without pain. It also hurt to yawn or cough. The first week of radiation was alright, just nerves and then it becomes routine, however it was later after several sessions when the effects came in for me. The hospital was generally pretty accommodating too with taking into consideration a preference in schedules for radiation, more so than chemotherapy sessions which required taking the day off. Most of my radiation appointments were in the evening, so I could work in the morning into the afternoon before going for my treatments. I found I was drowsy by the 3^rd week of radiation after so I tried to do as much of my work in the morning beforehand.

Everyone is different, but you should prepare yourself by not taking on more during this time. At some point, into my 3^rd month of chemotherapy, I really wanted to stop working and go on leave to focus on just rehabilitation and recovery in between treatments. This isn’t the time to ramp up or take on more, but reduce the load and if possible, cut back. I feel really lucky being at a major hospital and in Canada and having access to a lot of cancer resources. Some of the online non-profit organizations that really helped were Look Good Feel Better which provides online workshops to learn about skincare and make up during chemotherapy or to learn about wigs and hair accessories. Also, PrehabRX I signed up with after my 5^th chemo infusion is an online exercise program to help with getting back into movement during treatment as well, where they can suggest exercises or stretches to help counter some of the effects. However while doing this, they are all time commitments you would have to fit in.

I continued to work during treatment but my work ability was significantly reduced, working part-time and less than 40 hours a week. You can chip away when you can, but you should be prepared to take some days off or have some shorter days. There were times where I tried to work in the morning and then would take a nap and then would get back to work later if I could and there were other days that were complete write offs after I got up and had breakfast.

If You’re a Lawyer Reading This

As a lawyer, if you get a diagnosis, things I would do to prepare include telling your team. Ensure everyone on your team knows whether you’re working at a firm or in-house. You can try to work with your team to see how they can assist you with some of your workload. If you’re a solo, I would try to reduce your load and avoid taking on more and just see how you can manage with your current file load. I would consider this time to be a part-time practice time. If you can offload anything, I would, and I would also have a contingency plan put in place for anything that has an urgent deadline. Have a dedicated cancer notebook. Use a notebook to take down notes on how you’re feeling, and record any side effects that occur. It helps as you’ll be able to tell your oncology team about the effects after and you’ll be able to then recognize a pattern and see which days you feel better and can do work through. You should also bring your notebook to appointments so you can take down notes from your doctors, nurses and health team including anything that may help you or things to avoid.

Give yourself grace. This one I’m still working on. We tend to be hard on ourselves, and have high expectations — but this is going to be a hard journey, and you don’t get to come out of it the same. Cancer robs you of months, maybe years. Even after treatment, you may have lingering effects, and you won’t feel like the same you. Don’t feel ashamed when you can’t push yourself as hard as you normally would. It’s very frustrating, I know.

If you’re healthier going in, you may experience fewer side effects, but it’s not guaranteed. If you don’t experience as many, that’s great, but you should still take a step back from your usual, as you learn to balance all the appointments, and the emotional weight that comes with cancer.

I’ve been lucky that my work team did their best to handle anything urgent and left me with less time-sensitive backlog — which is exactly what I needed. Chip away when you can, but without guilt when you can’t push through something urgent and you’re just not physically up for it. If you have to take a time out, take it. Health is usually an afterthought at work. Cancer makes it a priority thought.

What this experience has taught me is that I need to carve out time for my health — to take that walk, to rest, to move. It’s really hard not to get frustrated when I still need to rest, when so much of my life and joy — including something as simple as eating (because of the swallowing and choking difficulties from neck radiation) — has been taken from me. But I’ve been told over and over: give yourself grace. I’m still learning to. If you’re in the middle of this, I hope you can too.

As I transition from going through active treatment, to active recovery, to post-cancer survivor, I’ll let you know how it goes. I will write again on how it is at a later stage, but for now, I wanted to share a glimpse into my story of diagnosis and active treatment, and I hope that if you’re in the midst of your career journey as a professional, this gives you someone else’s story to hold onto.