Cemetery walks and playwriting: How I found healing after breast cancer

Last year at this time, I was a child psychiatrist, wife, mother, and daughter. I’m all those today, but with three key additions: breast cancer survivor (thriver some people say), playwright, and actress. My new roles are making me a better doctor and will, I hope, encourage change in the medical community.

My diagnosis came, as diagnoses often do, out of the blue. I had just completed a very challenging hike with my family in the Pacific Northwest. Before leaving, I had squeezed in a mammogram to appease my daughter, who was worried that we had breast cancer in the family. A few days after we returned, my doctor told me I had a “suspicious” mammogram. I entered the agonizing waiting zone that so many women face. I had a biopsy, which the surgeon told me is “like looking through a keyhole.” That look was enough to show that I had ductal carcinoma in situ, an early form of breast cancer, with abnormal cells inside the milk duct in the breast.

I eventually had a lumpectomy. The surgeon wasn’t able to get “clear margins,” which means that cancer cells were seen in the border of tissue around the cancer that was also removed. The next step was a mastectomy. Fortunately, the cancer had not spread through my breast and invaded nearby lymph nodes, so I didn’t need chemotherapy or radiation therapy. Ductal carcinoma in situ is a treatable condition. Even so, this identity shift from doctor to patient came with a profound sense of vulnerability.

After my mastectomy, I couldn’t do my usual exercise — long-distance running to prepare for the Boston Marathon or swimming across Walden Pond (“God’s puddle,” I call it). Instead, I took long walks though Mount Auburn Cemetery with my close friend, Meg. With its focus on death, a cemetery may seem like a strange place to heal. But Mount Auburn was the first rural cemetery in the US, built as much like a park as a cemetery. Many of its patrons commissioned monuments, like the 40-ton sphinx guarding the main entrance, and sculptures such as angels in flight, mothers with babies, and a caterpillar turning into a butterfly.

My favorite place in the cemetery is the Dell, a natural amphitheater surrounded by looming firs and oaks where Supreme Court Justice Joseph Story, who had lost his 10-year-old daughter to scarlet fever, helped consecrate the cemetery in 1834, describing for the 2,000 people in attendance how places like Mount Auburn could tranquilize fear.

During my strolls, I began to write a play in my head, casting myself as the lead and the cemetery in the supporting role. Writing began revealing more and more personal truths until I took the plunge to truly write a play and perform it. As it came together, I hired a director. She taught me that if I spoke one line while anticipating the next, I would lose my audience. The trick, she told me, was to stay grounded in the present. That also turned out to be good advice — perhaps even a survival lesson — for living with the fear of breast cancer recurring and the unsettling awareness that my future was uncertain.

I learned about “beat changes” and how I needed to seamlessly and convincingly move from one emotion to the other — the shock of diagnosis, the anxiety about biopsy results, the exasperation of trying to keep up with my husband on a bike ride while I was still convalescing, the anger at the limitations of my own body, and the fear that I had become damaged goods. In acting out my experiences with the disease and conveying both the humorous moments and the vulnerable ones, I gained the flexibility and the mastery to move forward. Acting helped me truly acknowledge that breast cancer did not define me.

The first performance of my play, “Regeneration,” took place fittingly enough in Mount Auburn’s Story Chapel. From there, I am taking the show to hospitals and medical schools where I’ll perform it for doctors and doctors-in-training. The first of these is next week at Harvard Medical School. My goal is to help them see how their own vulnerabilities can nurture their capacity for empathy and motivate them to provide the small acts of kindness that mean so much to their patients and give them the strength to cope with a serious health challenge.

The job of healer is sacred. Sadly, that’s easy to forget with the demands of health care systems that focus on productivity, billable hours, and electronic record documentation. It can become almost routine to counsel patients who suddenly become ill with breast cancer, a heart attack, depression, and the like, though these are anything but routine for the patients.

What I realized in my hopefully brief foray as a patient — and what I want to convey to my future audiences of physicians — is that providing comfort to others can seduce you into thinking you are protected from getting sick or dying. It doesn’t. Yet the irrefutable fact of our shared mortality can help us connect honestly and compassionately with our patients when we give them difficult news.

Nancy Rappaport, MD, is associate professor of psychiatry at Cambridge Health Alliance and Harvard Medical School, and author of “In Her Wake” and “The Behavior Code.”