Survival guilt : living among the dying

I know it sounds strange that I would claim I have survival guilt, which is typically reserved to victims of a unplanned traumatic event such a car crash, a property fire, large-scale tragedies or crisis. Yet, I believe that’s what I am feeling.

I met a woman at a local breast cancer group for young women in Calgary on July 4, 2019 for group coffee meetup. Like me, she also was a young mom. Her daughter was 11 months old when I met her. She had felt a lump in 2017, but busy with life, and soon after a pregnancy and then an infant, she didn’t have time to follow up until she found it again around 7 months after she had her daughter. That is when our paths converged through the breast cancer “club”. She told me it was stage 2b.

Ten days ago, my friend died. It boggles my mind. Statistically speaking, she should have lived much longer than me. With what they consider a locally advanced stage breast cancer, with emphasis on “locally”, she should have had a 95.6% chance of surviving the next 5 years. Unfortunately, mine was stage 4 de novo, meaning it was terminal from the time of diagnosis. My chances were only 22% for that same period. This is my second friend in 3 years who were supposed to outlive me.

Aside from the stage of our disease, she and I had the same diagnosis: triple positive, with low HER2 expression. We had same treatments and compared notes almost weekly throughout our treatments, post-surgery and radiation. We were being treated by the same doctor and she was initially three weeks behind me. Eventually, she finished her treatments first because I had an anaphylactic reaction to the second type of chemo we received, so I had to pause for 6 weeks, which allowed me to get approval to get onto a different version of the drug, one made with a bio-synthetic base as opposed to Castor Oil, which was the ingredient I was actually allergic to. That’s when she caught up, and then finished her treatments and had her surgery 3 weeks ahead of me.

I understand that we each make our treatment choices. My friend had an underlying medical issue that required her, if she couldn’t live with the symptoms of that disease, to go back on her old medication, knowing they were contraindicated given their immune-suppressing nature. She started those treatments a few months after finishing her radiation treatments. She debated whether to restart the drugs knowing they were immunosuppressants and that it opened a door up for the cancer to grow again. Unfortunately, it came back for her. She immediately moved to her second and then last line of treatment. We shared the same bone mets radiation and orthopedic oncologists. We truly were “Bobbsey twins” when it came to our cancer diagnosis and treatment. Unfortunately, between her underlying medical issue and need for immunosuppressants while in treatment, and other treatment decisions she made, her cancer continued to spread while mine didn’t. Logically, these explain why she and I have had such different outcomes, I still feel guilty.

• I think back to so many conversations we had. Did I do enough to try to convince her to listen to her doctor?
• Why couldn’t I help her more?
• Why do my kids get more time?
• I can’t sleep, other times I wake up in the middle of the night, sometimes lying still in bed and sometimes crying quietly, because I have outlived two of my local friends who were in earlier stages than me and didn’t make it.
• Why am I a unicorn? What makes me different? What do I have in me that they didn’t?

Today is her funeral. I can’t make it today because I have my kids with me and I don’t want to upset them with the knowledge that another friend of mine just died. But I don’t know that I would have gone even if my children were with their dad and I was available. I don’t know that I could look into her husband or daughter’s eye and not want to vomit on them because it makes me sick to my stomach that I am here and she is not.

Selfish? Perhaps. I think saying it’s self-preservation is more accurate.

My friend L, I’m sorry I can’t be there for your family, in particular your daughter. Know that I am thinking of you. I hope you are in a better place where there are no demons haunting you as they did here. <3

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