Overlook View, October, 2011

The Fighter

Cancer has a way of sneaking up on people and catching them off-guard. There's no consideration for the things you haven't yet done or the things you're about to do. The moment you receive a cancer diagnosis—the day that you're not just a person but a patient—the tasks on your to-do list, the plans in your datebook, and the long-term goals that motivate you are suddenly put on hold. This is true even if you're someone like Atlantic Health System's Director of Neuroscience, Jane Rubin—the type of person who, quite simply, just gets things done.

In September 1999, Rubin, at the time an administrator at another hospital in the area, was a fortysomething single mom engaged to marry the man she refers to as the love of her life. One morning, as she was getting ready to visit her daughter at college, she detected a lump in her left breast. Weeks earlier she had had a mammogram that revealed nothing of concern. "My annual screening looked fine. Nothing popped up on my radar that I should have further diagnostics, and I went on with my life," she says. But here she was, alone in her bathroom, and that pea-size lump was setting off all kinds of alarms in her head.

Subsequent imaging and a biopsy shortly thereafter confirmed the presence of a malignant tumor one centimeter in diameter, much like the eraser at the end of a pencil. When Rubin's oncologist at Carol G. Simon Cancer Center at Morristown Medical Center looked closely at Rubin's family history, he saw that two of her cousins had had ovarian cancer. He ordered a blood test to detect BRCA1, a genetic mutation that leaves women vulnerable not only to breast cancer but to ovarian cancer as well. When Rubin tested positive for BRCA1, she decided on an aggressive treatment plan: a bilateral mastectomy and complete hysterectomy, then chemotherapy to destroy any remaining cancer cells. "I did what I had to do and then moved on with my life," Rubin says. "You can imagine how I thought I would be out of the woods."

An Old Foe With a New Face

Fast-forward ten years to 2009, and Rubin, by now part of the Atlantic Health System team, was about to find herself face to face with a too-familiar foe. Her oncologist had explained to her years earlier that despite their aggressive approach, there would always be a small risk of recurrence in the peritoneal wall (the membrane lining the walls of the abdominal cavity and enclosing the viscera). For that reason, her oncologist was vigilant about monitoring Rubin's blood for rising levels of CA-125, a common marker for ovarian cancer. In 2009, he detected an alarming spike.

Additional testing blew the cover off a new diagnosis—stage-three ovarian cancer this time—and Rubin's life was once again put on hold. Despite her previous experience, despite all she knew about future risks, Rubin admits she was caught off-guard. "My cancer came at me from a direction I didn't expect, but that's what happens," she says. "Initially when I got the second diagnosis, I was totally stunned. I had blocked out the first diagnosis because I didn't want to be obsessing about cancer. I had done everything possible to protect myself and was greeted with an even deadlier cancer. My chances of beating it were not as good. I was frightened for my life. I was worried about my children losing their parent."

And like so many cancer patients that came before her and will come after her, Rubin was mournful about the possibility of missing out. "I wasn't ready to see my life end," she says. "I was celebrating a ten-year anniversary with an amazing spouse. My career had matured. My three kids were through the teenage years. I felt I had this nice chapter ahead when I would see them fall in love, get married, and have children. I was disappointed I'd get robbed of the 'harvest season.' Your fifties, sixties, and seventies are the harvest years when you get to see what you grew, and I wanted to be part of it."

So Rubin did what she had done before, and she began the long fight back to health. During a full morning of surgery, doctors removed any evidence of cancer in the peritoneum and inserted ports for subsequent chemotherapy. That was followed by an aggressive chemotherapy delivered, in part, directly into the peritoneum. "It was a very intense summer," Rubin says—but she was on her way to becoming what she refers to as an "equal-opportunity cancer survivor," having now had experiences with two different cancers.

Getting it All Out

During this period, Rubin didn't feel up to returning calls from the many people who would check in by phone for updates. At night, the side effects of chemotherapy and the medication to ward off nausea kept Rubin awake around the clock. And so it was at this time, in the fall of 2009, that Rubin started writing essays that she would e-mail to friends and relatives.

"I started writing as therapy," she explains. (In fact, narrative therapy is a technique used by Overlook's Palliative Care Department to help patients of all kinds cope with the feelings associated with their diagnoses.) "It was a way to let out steam—and I had plenty of steam.

"My oldest daughter was expecting my first grandchild, and I wanted to tell my own story to her in my own words," Rubin continues. "You lose your voice if you don't do something to memorialize it. So I would just get up at night and go to the computer and start drafting an essay, and by the time I was finished my husband would be waking up. We'd have a cup of coffee and I would read him what I'd written."

The essays weren't entirely about cancer; most were about Rubin's experiences growing up, handling challenges, and becoming an adult—universal experiences with which so many people can identify. "My stories are no different than anyone else's," Rubin says. "I think that's why people responded so well to them, and encouraged me to share them."

So well, indeed. The essays that got Rubin through all of those chemotherapy-plagued nights morphed into a book, Almost a Princess. "I'm not one of those people who was destined to write a book," Rubin admits. "I was always more the mad-scientist student, not a writer. But this process worked for me."

Without question, Rubin's words are working for others, too, no doubt because of the emotions and thread of humor woven through her stories. "I come from a family where people had a great sense of humor, and I have found that humor can sometimes help me through the worst situations," Rubin says. "A lot of the essays in the book are about the funny things that have happened. Being able to laugh—and being able to laugh at oneself—is cathartic. It's an important way to heal. The book isn't about cancer, but the cancer is central to why I wrote it. It's been an unfortunate experience, but in the end, sharing my story has helped me and has helped others." (In fact, the book's publisher, iUniverse, has awarded Almost a Princess its Star designation, recognizing excellence in writing. Annually, iUniverse publishes between 4,000 and 5,000 books and offers this designation to less than one percent of those publications.)

Headed Toward the Future

It's just days short of Rubin's two-year anniversary with this second cancer, and all signs so far are positive. She has her blood monitored regularly and is enrolled in one of Carol G. Simon Cancer Center's clinical trials, led by gynecologic oncologist Brian Slomovitz, MD, to prevent recurrence of the disease. "The reason I did well with breast cancer and ovarian cancer was because they were detected early," she says. "I've done everything I can do. My strategy now is to live each day fully, shake off the small stuff, and try not to do anything that I'll be ashamed of—I try really hard to be constructive.

"Time is so precious," she continues, "and I want to live to enjoy the harvest as long as I can. I have a life worth living, and the two years since my second diagnosis is a good head-start on survivorship."

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New Jersey Jewish News, September 28, 2011

Cancer survivor shares her story with others

After two diagnoses, author offers lessons on taking control