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Chapter 2

One Hundred and One

November 2017

It sounds cliché to say I came home “changed” in 2015, but it’s also true. My body returned to California but, in a very real sense, my heart remained in the mountains of Japan. Each time I thought about that summer trip or looked at the photographs, my throat felt tight with longing.

I had to return.

And I did—in the autumn of 2016, and again in 2017 to celebrate Christopher’s college graduation. Shortly after the graduation trip, I made the decision to take a sabbatical from law practice, travel to Japan, and attempt to become the first American woman over 45 to climb the hyakumeizan in a year.

My family supported this wild decision. Christopher was already searching for employment in Japan, and my husband Michael (a stay-at-home dad) agreed to sell our house and trade California suburban life for a year in Tokyo. His knees would not allow him to join me on any of the mountains, but he understood and supported my need to climb.

It was exactly the kind of thing I read about other people doing but would never do myself . . . and yet, I started making plans.

I wanted to begin the climbs on March 26, 2018, my father’s birthday and the 10th anniversary of his death. He had taught me many important lessons, some of which had made me strong while others—including my abiding fears of risk and change—had enslaved me all my life. I hoped that climbing the hyakumeizan would help me break the cycle of fear that governed my father’s entire life and the first half of my own.

In early November 2017, a month before I was scheduled to leave for Tokyo to sign my visa application (which I had to do in person because I had no Japanese sponsor), I went in for a routine mammogram.

* * *

Afterward, I had barely reached the changing room when the tech knocked on the door. “Don’t get dressed. The doctor would like more images.”

My stomach dropped. “Is something wrong?”

“It happens. Sometimes the images aren’t clear.”

The tech took two more images and asked me to wait in the changing room for an ultrasound tech, who would come and get me soon. I didn’t worry—much. A lump I’d found in my right breast the year before had turned out to be merely a duct exposed by the 50-pound weight loss I achieved through a year of diet and exercise. I expected this would turn out to be something similar.

The ultrasound tech spent less than a minute scanning my right breast and only a little longer on the left. Then, to my horror, she moved the wand into my armpit.

I started shaking.

She paused the exam and looked at me. “Are you okay?”

“We both know I’m not,” I said, “because you’re looking at my lymph nodes.”

She stammered an apology and stood up. As she left the room, she said the doctor would be in momentarily.

Those two minutes were the longest of my life.

Please, God, I prayed, don’t let me have cancer.

I had lived my life with many fears, but cancer terrified me more than all the others put together.

Breast cancer was a specter that had shadowed my life since it stole my beloved grandmother, Peggy, when I was twelve years old. I still remember visiting her at St. John’s hospital in Santa Monica, California. The night before the visit, I finished a needlepoint of a dog that I’d been working on for months. Mama Peggy had taught me to needlepoint, and I wanted her to see this one, complete, before she died. I needed her to know the skill she taught me would live on after she was gone.

My parents tried to prepare me, but when I entered the hospital room, with its sharp smell of antiseptic, I saw that cancer had transformed my pleasantly loaf-shaped grandmother into a hairless, withered shadow of the woman I remembered. Fighting tears, I showed her my needlepoint. She praised it, and her smile made me proud.

Mama Peggy died a short time later, and I miss her to this day.

Her death was my first experience with cancer, but not my last. In the years that followed, cancer stole my paternal grandfather, two aunts, my father’s brother, and, possibly, my father too (his official cause of death was a massive cardiac arrest, but the evidence suggested he had undiagnosed cancer at the time).

Peggy’s death had another impact on me, too: from the moment I developed breasts, I believed that someday they would try to kill me.

On November 2, 2017, that fear came true.

The radiologist, Dr. H., said he saw an unusual spot on my mammogram, which the ultrasound confirmed. He couldn’t diagnose cancer without a biopsy but warned me to expect that diagnosis. He felt so certain that he scheduled not only a biopsy on the following day but also an appointment with a cancer surgeon early the next week.

I held my terrified tears in check until I left Dr. H.’s office, but the moment I reached my car, I lost control. Sobbing, I called my friend Kerry Schafer, a breast cancer survivor who was diagnosed several years before, shortly before the release of her debut fantasy novel. I begged her to tell me that I could survive breast cancer too. I was drowning in terror and clung to her survival like a lifeline.

Five days later, while I was sitting in the surgeon’s waiting room, my phone rang with the biopsy results: infiltrating ductal carcinoma.

I had cancer.

The medical group had already assigned me a nurse navigator named Marie, who met with me before I saw the surgeon. Marie became my anchor, on that day and in the weeks that followed. I don’t remember our first conversation well, but I clearly remember her saying that I had the legal right to choose any surgery I wanted, from a lumpectomy to a double mastectomy, with or without reconstruction, and that the insurance company would have to pay for it.

When the surgeon entered the room, I stood up and extended my hand.

“I’m Susan,” I said, “and I’m having a double mastectomy. How does tomorrow work for you?”

To her credit, she barely blinked before answering, “Can I examine you first?”

By the time I left the office, the surgeon’s staff was already contacting my insurance and the hospital to schedule my double mastectomy.

I also opted not to undergo breast reconstruction. For almost 30 years, the sight of my breasts had made me worry that I would die of cancer. I hoped removing them completely would help me shed my other fears as well.

On Friday, November 10, eight days and six hours after that fateful mammogram, I showed my breasts what happens when you try to kill a mystery novelist.

The novelist kills you first.

When I woke up in the recovery room, my anesthesiologist—a doctor so young and talented the hospital staff apparently called him “Doogie”—asked me how I felt.

“I feel like someone cut my boobs off,” I replied, “but otherwise, I’m fine.”

The nurses stared at me, wide-eyed, but the doctor burst out laughing.

“Well, she’s fine.”

That moment, and many others in the difficult weeks that followed, demonstrated laughter’s power to transform sorrow into something positive and strong.

* * *

Twenty-eight days later, I flew to Tokyo with Christopher—not to sign my visa application, as originally planned, but to enjoy Japan at Christmas while my son attended interviews for jobs. On December 26, I left him in Tokyo and returned to California to begin four months of intensive chemotherapy. The surgical pathology report had classified my cancer as stage 1a, with no lymph or vascular involvement, but it was also “triple negative” (not fueled by hormones) and highly aggressive, making chemotherapy my best chance to prevent its return.

I had met my oncologist, Dr. S., before my December trip to Japan. As a fellow cancer survivor, he understood my fears, and I respected his experience and candor.

That said, I didn’t like his initial treatment timeline very much.

Due to my diagnosis, he recommended the most aggressive chemotherapy available: A/C (a combination of Adriamycin and cyclophosphamide) followed by Taxol. The standard course of treatment ran six months, with infusions at three-week intervals.

To give me a chance of reaching Japan in time to complete my climbs on a one-year deadline, Dr. S. gave me the option of attempting a “dose dense” chemotherapy regimen, under which I would receive an infusion every other week, beginning December 27, 2017, and—assuming I tolerated the drugs well enough to receive every treatment on schedule—finishing on April 10, 2018.

Dr. S. described chemotherapy as my first and most difficult mountain, “making your total one hundred and one.” He encouraged me to write about the experience, because my story could inspire and strengthen others if I chose to share it honestly. It scared me to think about sharing pictures of myself as my hair fell out and, even more, to consider acknowledging my weakness (and my fears) so publicly.

Even so, I believed that he was right.

The day after that conversation, I revealed my cancer diagnosis on my blog and social media feeds. In the weeks that followed, I posted photographs of myself in chemotherapy and my “bald baby bird” head when my hair fell out. I blogged about chemo and posted daily updates on my Facebook page, encouraging everyone who read the posts to share their struggles and achievements in the comments too. The outpouring of love and support those posts received sustained me through the crushing pain of chemotherapy. As friends and strangers shared their struggles, all of us felt less alone.

That process changed the horror of cancer treatment into a meaningful experience. It was the first—though not the last—of many lessons I would learn in the coming year: With the proper attitude, shared weakness can become a source of communal strength.

Speaking up had made a difference, and I was grateful Dr. S. encouraged me to be as public with that first mountain as I would be with the ones to come.