Kelly Mitchinson, businesswoman and a mother of two daughters, was only 37 when she was diagnosed with aggressive cancer. After surgery to remove her breast, she still faces months of chemotherapy and exhausting treatment. Yet she finds joy and pleasures in her life, as Dawn Picken discovered.
Kelly Mitchinson awaits a three-drug chemotherapy cocktail, and it's not even lunchtime.
She was due to start a two-and-a-half-hour visit to Bay of Plenty Cancer Centre at 10, but routine bloodwork shows elevated liver enzymes. Nurse Cathy Towne draws blood from a catheter in Kelly's chest so staff can re-check her liver, to ensure it can withstand today's chemo.
It's part of the hurry-up hold-up cancer patients and their families face.
"Yesterday, we went for Kelly's surgery [for the catheter] at 11 and they didn't take her until four. She was fasting all day, so I didn't eat, either," says her husband, Garth.
A surgeon installed the chest catheter because the superficial veins in Kelly's arm can't take more chemo. "Last time it [burned], only because we didn't know I had a blood clot in my arm. It was sitting in the vein for too long, and that shouldn't happen."
Pain was Kelly's first warning something was wrong. In late July, she says she ached - horribly. "I thought it was chest pain, 'cause I'm an asthmatic." The interior designer and mother-of-two was working at her homeware store in Tauranga. "The pain got so bad that I was losing my breath. When I got home that night, I was having a little bit of a feel around my chest and I found a really big lump. Like honestly, it was about the size of a golf ball. It was huge, and then I freaked out."
Kelly saw her GP the next day who told her it was probably a cyst. Garth, recalling Kelly had been elbowed in the breast playing netball months earlier, told her it was probably a cyst.
It wasn't a cyst.
The afternoon following the doctor visit, Kelly had a mammogram, an ultrasound, three biopsies of the lump and two biopsies of the lymph node. The Mitchinsons waited three days for results.
"That was awful." Kelly's voice breaks.
"My husband and I couldn't work, couldn't think."
Later that week, they learned Kelly, 37, had stage three breast cancer.
"Even my doctor was in tears, she just couldn't believe it. She said the odds I would get it were so low, because I was young and healthy and fit. I have no family history and it was also a grade three cancer, which is a really aggressive one."
A surgeon removed Kelly's left breast within two-and-a-half weeks of diagnosis. She says her lymph nodes came back clear, and the surgeon removed a 2mm margin around her 3.5cm tumour. "It's tiny, but it's still a margin," she says. Kelly started chemotherapy three weeks later.
Her doctor told her it would be quicker to access healthcare through the public system rather than pay privately.
"We're just really lucky in New Zealand to have such a good health system."
Kelly's care will be almost entirely government-funded. "It's been better than I've expected," says Garth, "and I expected it to be very good. It's efficient and people have been caring the whole way through."
But even members of a caring community fumble sometimes.
She said the odds I would get it were so low, because I was young and healthy and fit. I have no family history and it was also a grade three cancer, which is a really aggressive one.
Kelly has learned to brush off well-meaning but insensitive comments about cancer. She's learned each case is different, just as each of us is different.
"Often people don't know what to say. I totally understand that. But sometimes, you're better just to say nothing than to say something dumb."
Kelly remains upbeat about the future. "I am pretty sure my prognosis is very good and I will receive regular screening on my other breast and will continue to live a healthy life with a whole lot less stress."
Bay oncologist Dr Richard North (who's not treating Kelly), says, "We used to think cancer was one disease and it's become apparent it's not one disease, it's a myriad of diseases all of which have different genetic mutations and patterns of behaviour."
Dr North says he encourages some patients to have tissue sent away for genetic testing to determine the likelihood of recurrence. "We can say that some are almost certainly cured, through to the type of breast cancer that's very likely to recur elsewhere."
Dr North says these mutational analyses allow doctors to decide who should get chemotherapy. "It's not standard practice at Tauranga Hospital and it's not government-funded. It's an example of something oncology is moving towards," he says. "Rather than treating all breast cancer the same, high-risk cases will get more aggressive treatment and low-risk cases will get less aggressive treatment."
Kelly had a triple-negative tumour (TNBC), which means the breast cancer does not express the oestrogen receptor (ER), the progesterone receptor (PR) or the human epidermal growth factor receptor 2 (HER2) receptor. Doctor North says chemotherapy is the only drug treatment available to women with TNBC.
Chemotherapy caused Kelly to start losing her hair within two-and-a-half weeks of treatment.
She says it started falling out in clumps and patches while she and her husband were on holiday in Australia, "so I hung my head over the basin in the hotel and he got the clippers out and just went for it".
Facebook photos show Kelly, with friends and family, trying to blast cancer's cloud with humour. There are pictures of Garth getting his head shaved, of her and her brothers bald, and the photo she calls her "fuzzy chick" look - a mostly bare head with wisps of hair.
I just don't like the pity looks. People act differently toward you when you've got no hair or got a head wrap on.
Before cancer, "My hair was so much a part of my identity." Yet Kelly says she sports a wig mostly because society expects it.
"Sometimes I just wanna take it off and cruise around with my bald head. I was so worried about my hair falling out but once it did, I was like, 'Oh, it's not that bad'. I just don't like the pity looks. People act differently toward you when you've got no hair or got a head wrap on."
What Kelly wants is normalcy, with a dash of celebration, a dose of reward. Small pleasures, such as coffee and wine, and nails painted with pink ribbons. Pricier treats such as the diamond and sapphire ring she commissioned as "compensation" for surgery.
Black and bawdy humour accompanies cancer treatments much as a saline flush precedes chemo. "We went out for dinner the night before the surgery with some really good friends and that was a farewell dinner for the shitty titty. That was a bit of fun," she laughs.
Kelly's century-old villa in central Tauranga, where the Bay of Plenty Times Weekend meets her the first time, is clean and clutter-free. Is it because we're here? "No," she says. "I don't like clutter and I don't like mess."
But cancer is messy. The Mitchinson's schedules are crammed with doctor appointments and chemo. "Our calendars were full before but we've cleared them. It's quite a weird thing for me to just let go of all the stress and all the busy-ness and just sort of take a step back.
I've got great staff there that are looking after it [the business] and they're doing a really good job."
Garth says, "We were busy before but in a good way because we were taking the kids to gymnastics and to the beach. A lot of people have said 'you'll learn to appreciate life and cut the chaff' - we did that years ago. We're not gonna change a heck of a lot."
He worked four days a week at his pharmacy in Tauranga before Kelly's diagnosis. The first two months, he didn't work at all. Garth says insurance covered finances for both businesses after Kelly's diagnosis, allowing him to attend every doctor appointment, every chemotherapy session. He says he's learning to accept gifts graciously - the tsunami of support from friends, family and acquaintances who bake, leave gifts, clean toilets, vacuum floors and watch kids. "It's hard for proud people to accept all this help, but you have to because it's given so genuinely."
Lea Lehndorf, service manager with Breast Cancer Support, Tauranga Trust, says it's crucial to let people help, though she's talked to women who thought they could go it alone. Lehndorf says, "One woman didn't want to tell her family at all. She didn't realise how busy she would get with treatment and it's not possible to hide it. It's hugely time-consuming and will consume your thoughts, too."
The Mitchinsons say they've hidden nothing from their daughters. Nine-year-old Emma stayed with Kelly during her mammogram and biopsies. "She sat there making the radiologist a flower loom ring. It wasn't until we got home that night that we sat and told them I had this done, and we just weren't sure about what was going to be the outcome."
After surgery Emma and her sister, 11-year-old Jaime, visited their mum in hospital. Garth says his medical background and experience as a pharmacist has helped him talk about Kelly's cancer and treatments.
"I explained about drains and blood and bandages. And they went 'okay' and they looked and that's exactly how it was. They've responded really well."
While the kids have asked big questions, such as 'Is Mum going to die?' they also oversee day-to-day comforts for their mum. Small pleasures. Big love. Garth says Emma told him before chemo, 'You have to take good care of Mummy today'.
Back at the Cancer Centre, he does. Garth and Kelly have packed their usual supplies for the chemo regime, which will happen every three weeks until mid-December: an iPad with a favourite show (Boardwalk Empire), coffee and snacks. Six of us build a horseshoe around Kelly - friends visiting another chemo patient; a neighbour delivering coffee; staff from Bay of Plenty Times Weekend . Kelly jokes, "This is my writer and photographer and the rest of my entourage."
The blood test results are back. About 11.30am, nurse Towne tells Kelly she's cleared for chemo.
"Yay!" Kelly sounds sincere. She wants to get this done. Today marks the halfway point in her treatment.
Kelly reclines in a grey leather chair, chatting and smiling while poison runs from a pouch clipped to a pole above her head into her chest. The clear red liquid, Epirubicin, is marked "Cytotoxic". This means it kills cells, not unlike venom from a puff adder or brown recluse spider. The drug is kept chilled. "It feels really cold and I can taste and smell it going in. It tastes like chemicals."
The Cancer Centre is behind Tauranga Hospital on Clarke and 20th. From the chemo room, you can see workers in hardhats completing the new Kathleen Kilgour Radiation Centre next door. It's where Kelly will likely have radiotherapy next year.
She and a friend compare chest catheters. "Did your neck hurt?" asks Kelly. "It was just bruised and uncomfortable," says the friend. She's Kelly's age (Kelly turned 38 last month), and battling bowel cancer. Kelly shows her visitor a purplish-yellow bruise about the size of a $2 coin on her stomach. It's from daily injections Garth gives to prevent blood clots.
LIVING AN ABNORMAL LIFE
Despite the support, being a patient can be isolating. "It wasn't until I walked into the Cancer Centre that I said, 'Oh, shit, I've got cancer'," she says. "I remember sitting in a cafe after surgery and chemo and I wasn't feeling so good and I was looking around at people thinking how normal their lives are and how abnormal mine is."
Garth studies Kelly's liver function tests. Some numbers are elevated, which could mean the chemo is damaging Kelly's liver; it could be the result of yesterday's surgery; it could be an anomaly.
"I told her it means she can't drink wine anymore," Garth jokes. "Bullshit," says Kelly.
The IV pump machine starts squawking. Garth explains there must be a valve that has just closed. Not only does he have faith in Kelly's doctors, in surgery, drugs and scans, he also believes in the power of the mind. "It's a powerful muscle, that one," Garth says, pointing to the stubbly head he shaved to support his wife. "Once you get nausea after chemo, it's hard to stop. I've been telling her she's on powerful anti-nausea meds; she's not gonna get it."
In fact, Kelly reports no post-chemo nausea, mostly fatigue. "A couple of days later I'm feeling a bit rotten, like I've been run over by a train, really. It's awful, but you also get those two good weeks so you look forward to those."
Her appetite improves, too. "I just can't stop eating," she says. She denies mourning her lost breast, looking forward instead to choosing a new set next year. "I've never had a big bust anyway so it didn't worry me. He'll put an implant in one side and augment the other so they'll look the same. We call it the attention-seeking way to get a boob job."
The Mitchinsons say their relationship remains strong. Cancer treatment has not killed romance. They still enjoy walks around the Mount. Small pleasures. Big love. Garth says, "She's still beautiful. I tell her that all the time. It's a completely honest answer."
"It hasn't affected our relationship at all, if anything it's only made it stronger," says Kelly.
It makes me feel like I'm not a cancer patient, being intimate. It makes me feel normal."
Garth says he can get surly, but a network of family, friends and the chance to catch up with a mate, have a beer or visit the gym gets him 'back to level again'. "There's no point feeling sorry for yourself because it's here. Treat it, deal with it and move on. Hopefully, the kids will learn some lessons from it. It's been easier because Kelly's coped with it so well."
"We'll get through this and move on," he says. "We'll take it as it is."
Preferably with bottles of bubbles, hugs from their girls, an army of friends and family. Another piece of jewellery wouldn't hurt. Small pleasures. Big love.
* Mammograms in NZ are free every two years for women with no symptoms from 45-69 years through the national screening programme. Freephone 0800 270 200 to enrol.
* More information can be found at www.nzbcf.org.nz.
Click below to view a video on the Boobops breast cancer survivor dragon boating team.