By Laura Dukes Beck
Laura D. Beck
Lawyer with Shumaker, Loop, and Kendrick, LLP and Charleston County Magistrate
The diagnosis of breast cancer is one I honestly never thought I would hear. And yet, in late 2017 I received the news that shook me and my family to our core. I know my story is not unique, as the incidence of breast cancer in the general public among women in the United States is approximately one in eight. Chances are every person reading this has had a friend or family member who has faced the diagnosis of breast cancer.
So how can I use this experience to better myself and maybe help someone along the way? During October, “pink month,” I decided to reach out to others from the South Carolina Bar or whom I knew in law school at the University of South Carolina who are practicing law and who have also been through breast cancer treatment. Each of us has had a different path and has different information to share. I hope that these interviews offer insight and will be informative, educational and inspiring.
Before I share the answers, I want to teach you what I have learned about the causes of breast cancer. I have spent hours wondering what the cause of my cancer was, but even knowing that I check some of the boxes for risk factors, no doctor can tell me exactly why I ended up with breast cancer. The risk factors for breast cancer according to the Centers for Disease Control and Prevention (CDC), over which none of has really has very much control, include: being over age 50, heredity (such as the BRCA 1 or 2 genes), reproductive history - including early onset of menarche or late onset of menopause, dense breasts, family history of breast cancer, past radiation treatment, and taking or having a mother who took DES to prevent miscarriage. But did you know there are also risk factors we can control according to the CDC? These include alcohol use, obesity/being overweight, taking hormones (including birth control pills, and hormone replacement therapy, and possibly IUDs and hormonal implants), never having a full-term pregnancy, waiting to get pregnant until after age 30, not breastfeeding, and possibly also smoking, working the night shift, or chemical exposure.
Stress is also attributable as a cause, and interestingly, there is literature out therethat states that women with high job demands have a higher rate of breast cancer. Stay-at-home moms tend to have lower rates than women who work out of the home in high pressure jobs in positions of authority. So as women lawyers, did we set ourselves up at some level? How can we manage the stress, take better care of ourselves, and thereby reduce our risk? Some of the answers below, as well as the resources listed, delve into this.
Publications for lawyers, and mental health and substance abuse Continuing Legal Education (CLEs) talk often about alcohol use by lawyers. We are missing the opportunity to realize and discuss that not only is drinking a coping strategy that can have negative consequences on our relationships and on our job, but it can also have huge consequences on our risk factor for breast cancer. Did you know that alcohol use is directly correlated to risk? That nightly glass or more of red wine is increasing the chance that you, too, will someday face a breast cancer diagnosis.
The financial impact of breast cancer on career earnings can also be huge, especially if diagnosis is made at a younger age. A recently released study by RTI Press called Young Breast Cancer Survivors: Employment Experience and Financial Well Being examined the impact of breast cancer on the career paths and financial soundness of women diagnosed prior to age 50. This is a great publication to read if you fall into this age range, or know someone who does, even if they are not a lawyer. The survey participants reported statistically significant declines in employment, and more than half reported a financial decline. There was a direct correlation with whether the survivor had a Stage II or higher cancer diagnosis, or reported a comorbidity—including depression, cardiovascular conditions, migraines, thyroid issues, back problems, arthritis, circulatory problems, and vision issues, among others. The importance of health insurance from employment, the ability of younger women at the beginning or height of their career path to negotiate flexibility or sick leave, and whether or not the survivor had a spouse or significant other contributing to the finances were all circumstances that could influence the outcome on financial stability. This piece also sets out the importance of financial planning and greater policy discussions for younger survivors of breast cancer. It influenced some of the questions I asked of the survivor group—knowing that we are all lawyers, what decisions were made about work may indeed have an impact on our future financial, as well as physical, health.
I asked each lawyer the same seven questions: 1) Tell me about your experience practicing law while going through treatment. 2) What changes did you make professionally following diagnosis, treatment, and upon your return to work (if you returned)? 3) Share a “war story” if you would like - anything goes…as long as it can be told to a professional publication. 4) What advice do you have for lawyers going through breast cancer treatment? 5) What do you wish you had done differently now that you can look back on the experience? 6) How long has it been since your diagnosis and treatment were completed?, and 7) What changes did you personally make following diagnosis, treatment, and upon your return to work? I have only lightly edited the answers and have basically left the wisdom and words as they were said to me.
Should one of you end up a “sister survivor,” know that that we are all here for you.
APRIL WOODWARD SAMPSON - South Carolina 5th Circuit Deputy Solicitor
I was diagnosed in August of 2013 at my annual OBGYN appointment. She found the lump and told me it was probably just a cyst. I was a little concerned, but not too worried because this had happened before. I was scheduled to start a Stand Your Ground Hearing the following Monday, so they scheduled me for a mammogram early Monday morning. After they looked at the mammogram, they did an ultrasound and asked me to stay so they could do a biopsy. I immediately said, “No, I don’t have time for that. I have to be in court this morning.” They looked at me like I was crazy, then told me I could leave but only if I returned the next morning for the biopsy. You would think that would have clued me in that something was wrong, but I was focused on my hearing. At the time, Stand Your Ground hearings were just starting to be held, and I had one where an innocent 18-year-old had been killed when a homeowner shot at someone he believed was shooting at his home.
We started the hearing when I got there, and the presiding judge was Diane Goodstein. I had to ask for permission to start late the next day due to the biopsy, but I really didn’t want to tell everyone why. After we finished for the day, Judge Goodstein asked me to come to her chambers. She then explained to me that she had just went through this experience herself and had completed her treatment for breast cancer. She assured me that if I needed to take the whole day or more time, she would grant a continuance. I was adamant that I could do the hearing, but that I just needed to come late the next day. She was so accommodating and willing to talk about it, that I decided then and there that not only would I complete the hearing, but that if it was cancer, I would be as open and helpful as her. Which is exactly what happened. I completed the hearing Wednesday morning, and on Wednesday afternoon heard the dreaded words, “You have infiltrating ductal carcinoma. You have breast cancer.”
After the diagnosis in August, I had a double mastectomy followed by 16 weeks of chemotherapy and 33 rounds of radiation. I opted for breast reconstruction and had a DIEP flap procedure, which means the plastic surgeon used fat from my stomach to create breasts. Unfortunately, due to a complication, the procedure only worked for one breast, so I now have one breast made of belly fat and one that is an implant.
I worked as much as possible during my treatment and after the surgeries. In total, I had four surgeries with varying recuperation times. I was able to work from home most of the time. I was determined to be as normal as possible for my kids, who were 8 and 14 when I was diagnosed. It was hard, and when I look back, I wish I had taken more time to just be, to listen to my body and rest. But I didn’t, mainly because the more I worked, the less time I had to focus on what was going on with my body and the fact that I could do all the surgeries, chemo, and radiation, and still die from cancer. I wore a wig while at work so that it wasn’t obvious that I was going through treatment. Because I was an assistant solicitor, I did not have to ask for protection when I was recovering from surgery. The only real change I made was that I put a sign on my door and told people they could only ask me how I was doing the first 15 minutes of the day. After that, they couldn’t ask how I was doing, how treatment was going, etc. I did this because while I work, I would start to forget about being sick or feeling bad, but the minute someone brought it up, I had to mentally deal with it all over again, and I didn’t want to do that. I did not do any trials from the time I had surgery until after I completed chemo. However, I did schedule a trial to begin during the period between chemo and the beginning of radiation.
In hindsight, I would not do that again. I was tired from chemo and definitely dealing with chemo brain, and although I don’t believe it affected my abilities in court, it took its toll on me mentally and physically. I lost weight and was short-tempered.
As for war stories, other than what happened during my diagnosis with the judge, I have two that people have merged into one and has been passed around like some urban myth. My chemo treatment was every other week, and the week that I didn’t have treatment, I normally felt okay. So, we scheduled a Stand Your Ground hearing for one of those weeks. The case involved a female who had stabbed her boyfriend and was claiming she should be immune from prosecution because it happened in her home.
During the hearing, there was testimony that the victim had pulled her hair out and there were pictures showing the hair on the floor. What she had not bothered to say was that it was clip-on extensions and not her actual hair. While examining one of the male investigators who had insisted the victim had caused her significant harm by pulling her hair out, I asked, “So you don’t know the difference between hair that is growing from her scalp and hair that she purchased?”
He agreed he did not. I then asked, “And you would agree with me that pulling someone’s hair out of their head and pulling fake hair that is clipped on would not cause the same damage, right?”
He said he didn’t really know the difference or didn’t understand what I was asking. So, I put my hand on my wig, moved it around and all but pulled it off, and said, “This is a wig. I can easily move it around without causing any damage, right?” He agreed.
I then said, “So again I ask you, you would agree that pulling fake hair does not cause the same damage as pulling someone’s hair out of their scalp, right?” He then agreed and we moved on. Fast forward to the trial I mentioned earlier, that we had between the end of chemo and the beginning of radiation. As I said, I was tired and felt like crap due to that but went on with the trial. During the trial, the defense had dressed the defendant up so that he looked way different than he had when he killed my victim.
He even started crying during my cross, although there were no actual tears. So, when I started my closing, I said, “Behind every beautiful lie, there is the ugly truth. The defense wants you to believe the beautiful lie they have created. It started when they had the defendant wear his Sunday best to court every day. It continued with his testimony, where he tried to convince you that this was self-defense. Well, the ugly truth is he murdered the victim. The ugly truth is on the 911 call, where he tells the operator it is about to go down, never once asking for help. I’ll give you another example. You have seen me every day this week, looking fine and healthy. But underneath that is the ugly truth…I am sick and feel bad and have no hair underneath this wig. But I’m here making sure you see the ugly truth of this case, which is that the defendant is guilty of murder.”
The two stories have been merged and people say that during closing argument, I took off my wig to prove a point to the jury.
“The only real change I made was that I put a sign on my door and told people they could only ask me how I was doing the first 15 minutes of the day.”
SUZANNE HAWKINS - Family Lawyer and Solo Practitioner, Hawkins Law
I am a solo family attorney. I was diagnosed in April 2018 and my last surgery was October 2019. I was terrified when first diagnosed. But my experience was amazing. Clients, opposing attorneys and judges were all extremely supportive and cooperative.
During diagnosis/treatment period, I got more support and didn’t take on nearly as many new cases. I was very open and honest with clients, opposing counsel, and judges, and they allowed me to be human.
I went to family court for two scheduled hearings on the Friday after getting the second round of red devil chemo (dose dense) on Tuesday. Anyone who has been through chemo knows that three to four days later is the crash. I ended up being pulled into two more hearings while there, keeping me there all morning. I went straight home and slept all weekend. Months later one of my clients from that day popped up, unhappy. I immediately feared I’d made a mistake…checked the transcript. I was amazed and relieved that I did fine. I was so amazed as I had very little memory.
The only way out is through. It will change your life, and if you allow it, the change will be for the better. Also, reach out to survivors. We all want to help those coming behind us. I will bend over backwards for someone going through it and be thrilled to do it. I got so much help, and paying that forward is one of the most fulfilling and gratifying experiences of my life.
I don’t have many regrets, other than the fear and worry.
Changes I made include extreme self-care: daily exercise and meditation, eliminating alcohol, and holding boundaries against workaholism.
LAKESHA JEFFRIES - Family Law, Personal Injury, and Worker’s Compensation Practitioner, Jeffries Law Firm
I was diagnosed with triple negative breast cancer toward the end of November 2019. I am coming up on a year. I completed chemo in July and radiation in September.
When diagnosed, I immediately went into planning mode. I notified my clients that I would be out of the office for a substantial period of time and did not want to jeopardize their case in any way. I was able to posture several files and maintain, and there were others that I obtained orders relieving me as counsel. I did not accept any new clients until May 2020, and even since then I’ve been hyper-selective of the types of cases I accept. I am not accepting any cases where the potential client’s expectations are unreasonable or difficult. I don’t want the extra stress, and my tolerance level for BS has waned substantially.
I am working more remotely as opposed to in the office. I am taking advantage of remote mediations/depositions, which definitely helps with time management.
I travel with a fan to work. Be careful though with the neck fan and don’t get your wig caught up, unless of course, you have time to unravel the hair from the mini blades.
Disconnect from your office for a while and focus on your mental and physical health. Do so properly, however, so that you’ve not jeopardized your client’s matter. Do the things that bring you joy. Rest when you need to. Feel the feelings. Eat what you want. Whatever your religion or faith, connect with our creator and pay attention to the signs and wonders of this lifetime. Learn the lessons of this journey so that you can share with your clients on overcoming difficulties. Often times, our clients are approaching us at their lowest. Marriages either at or near disaster, children harmed, catastrophic injuries, etc. As you are healing, think about the ways you can help your client. I’ve always looked at the practice of law as my life’s ministry. This journey is allowing me another way to minister and help my clients. If I could do things differently, I would not bring work home or become so overly consumed with the issues raised. I made the mistake of taking on my clients’ stress and do believe that played a contributing factor in my diagnosis.
I am working more remotely and being very careful not to over-extend myself.
“Disconnect from your office for a while and focus on your mental and physical health. Do so properly, however, so that you’ve not jeopardized your client’s matter. Do the things that bring you joy. Rest when you need to. Feel the feelings.”
CHRISTY TINNES - Principal, Groom Law Group (Washington, D.C.)
I kept working but at a reduced schedule. I got tired much more easily. Before, I could always push through if I really needed. During and after treatment, I did not have that reserve and would just hit a wall. I am just now feeling back to normal (five years later). It has been five years since first surgery, four years since second sur gery, almost one year since I stopped tamoxifen.
The biggest change is that I started working remotely (which was daring in the pre-COVID world, at least at my firm). My husband and I had talked about me taking a semi-sabbatical when he retired so we could travel. But after breast cancer, we decided to seize the moment and go for it on a more permanent basis. I negotiated with my firm to work remotely from wherever I happened to be, so we could travel and I could still work. There was a lot of head-shaking, and the firm had to have a two-hour partner meeting to discuss, but they grudgingly said ok. I made it work – and now with COVID, that’s basically what everyone is doing!
I had a couple of surgeries and was not able to wear a bra for a while. So I got very good at wearing scarves strategically when going to the office.
Don’t listen to others. I would look at others who had gone through treatment who seemed to have it all together - they worked full-time, looked beautiful, went to the gym every day, and said it wasn’t so bad. I was more exhausted than I’ve ever been, hurt, and had trouble focusing. I thought I must be doing it wrong. So just be nice to yourself and stay in your own lane. Take advice from others lightly.
If I could do things differently, I wish I would have taken my advice! I also turned 50, so I am not sure if due to age or cancer, but I care much less what others think of me now (in a good way).
LAURA D. BECK - Lawyer with Shumaker, Loop, and Kendrick, LLP and Charleston County Magistrate
I was working for county government during my treatment, and my boss and office were definitely understanding about it all. In retrospect, I do not know how people bill hours and keep up with cases during a major illness. My hat is off to everyone who has done so. It has been two and a half years since I finished radiation. I had genomic testing done which dissuaded me from getting chemotherapy. I continue to have lymphedema issues and pain, and I will be on tamoxifen for many more years. During treatment someone told me it would take longer to recover from radiation than I originally expected. I wish I had known that sooner, and it helps me now to hear from my doctors that I am still considered “early on” and should continue to see improvements with issues and to get more energy back.
For most of my adulthood, I have been cognizant of this being my only shot at life, as it were. It is hard to live every day that way, though it is just a function of being an adult that many days are routine and work-oriented and we rarely step back to take stock of what is really important unless something comes along to force us to do so. Even then, sometimes it is psychologically safer to plow through than to ask the big questions. I decided to pursue some new career goals after getting sick and thought a lot about what I really want to do. I am still pondering these things, but I am in a different position in the county now, and I am trying to focus more on the areas of law in private practice that really speak to my strengths like Alternative Dispute Resolution and mediation.
So much of the time during treatment is hazy. I do know I fainted at least once changing dressings. I think I will always remember November 30th as it was very traumatic. My former doctor told me the lump I found was just a cyst for five months until I insisted on a mammogram. I really had to advocate for myself; remember you should, too. I had a sixth sense that something was wrong, and my parents actually went to the mammogram with me just in case. That day I went from the mammogram to an ultrasound to a biopsy to a surgeon to a lab for genetic testing to telling my kids the news. It was a terrible day.
As far as advice, accept any help others offer. I set up a cooler on my front porch so that people could drop off food for me without having to ring the bell or visit. It made it easier on them and on me—less energy expenditure. I kept my diagnosis within my circle. I didn’t tell people not to discuss it, but I also did not post it on social media. Take someone with you to every appointment and keep a notebook and take notes on what every doctor says, every call you make to your insurance company, etc. It helps you remember, and it may help you if there are differences in opinion or coverage that you need to refer back to your notes to make a decision.
I should have taken disability leave during treatment. I took two weeks off for two surgeries and that was it. I had short term disability through the county, and if I had to do it over, I would use it. I was trying very hard to project strength and normalcy for my kids, and to minimize their anxiety. I did leave early from work for radiation, but I got very worn down, and it is hard to recover when you are worn down. Financial concerns were part of why I did not, as well. It costs a lot to have cancer.
I had a huge amount of anger at my diagnosis. I joined a breast cancer survivor workout group offered through MUSC Wellness Center, and it was a great outlet. I used to be a fitness buff, and it was good to be with a group of women of all ages who had gone through more or less than I had. We were all mad at our situations, and we all had issues to deal with about our illness. I wish I had continued on with the workout group, but I broke my ankle last summer and have had some other tendonitis issues which have prevented me from getting back into a workout routine and losing weight my doctors want me to lose. Plus, COVID hasn’t made it easy! I have heard great things about Dragon Boat Charleston and am interested in seeing about that once the pandemic ends.
I think the hardest thing of all is to figure out work-life balance. This is true when you are just practicing law, not even as a cancer survivor. But all of it takes on an additional level of urgency for me now. I know that there are definable odds that my cancer will come back. I know that for my own sake and for the sake of my family, I have to exert control over those risk factors: exercise, limiting drinking, losing weight, and managing stress. I see a psychiatrist who has helped me with the anger and who is great about making me realize when I am in a situation that is toxic to me, and thus a contributor to risk. It isn’t always easy to do something about it, however, I am still trying to be all things to all people and not always “putting on my own oxygen mask first.” Sooner or later that type of behavior makes you overextended. I need to continue to make changes as to that.
See Resources here.
“I think the hardest thing of all is to figure out work-life balance. This is true when you are just practicing law, not even as a cancer survivor. But all of it takes on an additional level of urgency for me now. ”