"The Coincidence" — Brenda (Part 1)

There's a version of this podcast I imagined making before I started. I'd sit across from strangers — people I'd never met — and ask them to trust me with the hardest thing that ever happened to them. And they would. And it would be meaningful. And I would be the host, and they would be the guest, and there would be a clean line between us.

This is not that episode.

My name is Dr. Randi Paynter. I'm a cancer epidemiologist. I've spent my career studying the systems that determine who gets care and who gets left behind. And for most of my life, cancer was something I studied. Something I understood professionally. Something that happened to other people's families.

And then it happened to my sister.

Her name is Brenda. She is fifty-two years old. She is funny and stubborn and honest in a way that makes you want to be more honest yourself. She works in human services — she has spent her career trying to do right by people the system overlooks. She has a dog named Lucy who thinks she is a superstar. And she has metastatic breast cancer.

When we sat down to record her story, we captured both audio and video. You might even hear Brenda reference the camera or the fact that she’s being watched on a screen. But as her editor, and her sister, I’ve chosen not to show you the video footage. Cancer demands a public performance of vulnerability far too often. Instead, we are stepping back to let you simply focus on the weight of her voice, and look at the images of her life.

Brenda asked me to tell her story. Not because she couldn't tell it herself — as you're about to hear, she absolutely can. But because she trusts me with it. And because she believes that if it helps even one person feel less alone, then something good will have come from all of this.

I believe that too. So here we go.

A standard disclaimer: I am a cancer epidemiologist, but I am not your doctor. The experiences shared here are personal and should not be taken as medical advice.

Before we get into what cancer did to Brenda's life, I want you to know who she was before it. She was born in Montana, to a Native American mother and a white father, and raised in Helena — the state capital. She grew up with the governor's kids at school, wearing hand-me-downs, and believing she was part of the same world that they were. It took her years to understand the distance between how she saw herself and how the world saw her. That gap, and what she did with it, is part of why her cancer story sounds the way it does.

Brenda had moved 1,500 miles from Michigan to New Mexico, a little over a year before her diagnosis, for her husband Kevin's job. She started a new job of her own — in human services, working with children and families in need — on December 28th, 2023. Two and a half months later, as she took a shower, she noticed something different on her body.

My cancer was self-detected. I found it during a shower. While using soap and cleaning myself, I felt it on my right side, on my right breast and, there was just, a lump that felt hard. And it was something that I had not ever felt before. And I immediately knew it was, abnormal because I had done, self breast exams previously, and that feeling that, that hard, tumor-like, thing was not there before. When I tried to make an appointment for a diagnostic mammogram, I learned that in my area I was going to have to wait at least two months, no matter where I called. The wait for an appointment was over two months, and I was frantic because I knew what I had detected was not normal, was not normal for me, and I really wanted to find out what it was, because what if it was cancer? So I started reaching out to my own personal support system, to gather ideas. How do I get a mammogram sooner than two months? How do I get a mammogram very soon? And we bounced ideas around, as far as leaving the state to try and find a provider that would do the mammogram. I actually went to an urgent care facility and had an exam done there. And at the end of the exam — it was at a hospital — I thought they would send me to go get the mammogram, but the answer was, we can give you a referral. You'll be contacted to make an appointment, which when I was contacted, it was over two months out, so that didn't work. And about the time that I was ready to go to the emergency room and see if I could plead my case there, which may or may not have been effective, they very likely would have told me the same thing. We can make a referral out for an appointment.

I was frantic, I was frantic, I knew something was wrong. I could feel it and no one was listening except for those who love me. Which of course, thank you to those who love me. But, I knew that I needed help immediately, and I was being dismissed as just another. And it was frustrating. Angry-making. I was not my best self at that time because I was so full of emotion of the unknown, the possibilities of how bad is this? And why doesn't anyone care? And how — why am I less important than somebody else that is just having a routine mammogram tomorrow? Why can't I get an appointment? It was really, really frustrating to try and work the system in that situation.

What finally got Brenda in wasn't the system. It was a coincidence — a connection between her mother in Montana and a nurse practitioner whose husband worked in radiology in Albuquerque. A phone call. A favor. An appointment the following week.

I had an advantage that I didn't even know I had, first of all, and, I didn't expect that I had, but that most people would not have had. I don't feel like that was something that was owed to me, or that I was... It's important that I got to jump the line and somebody else didn't, and I'm very thankful for that pathway that opened up for me. But also, I'm keenly aware, that that was a unique situation that I was able to walk into and that it's not normal for huge swaths of society and women that would find themselves in the same situation. And I have since then learned that there are women that are waiting months at a time for an appointment to get a diagnostic mammogram, and it's a matter of resources, and in the area where I live, it's difficult to keep doctors in the area. Waitlists continue to be long for diagnoses on a lot of different cancers.

I want to pause on this, because as an epidemiologist, I often look at the macro data about healthcare access. What Brenda ran into is what we clinically refer to as an "oncology desert" or diagnostic bottleneck. In the American Southwest, and specifically New Mexico, retaining specialized medical staff and radiologic technicians is an ongoing structural crisis. A two-month wait time for a diagnostic mammogram on a self-detected hard lump isn’t just a scheduling inconvenience — it’s a critical systemic failure. The data show a direct, undeniable correlation between diagnostic delays and up-staging, meaning a tumor that could have been caught early has weeks or months to advance into deeper tissue and lymph nodes. Brenda had a support system, health insurance, and a fluke maternal connection to bypass that line. But what happens to the women who don't? We know the answer. They end up in the lethal gaps of our statistics.

So I went in with the woman that ran the mammogram machine, and she was very friendly, very professional, very kind. She got me positioned, took the first picture, and she never really spoke directly to me again. And that's how I knew something was up, because immediately all the friendly and happy was gone. And it was just work, taking a lot of pictures that I'd never had to take before. It was way more than a normal mammogram. And at that point, that's when I knew I’ve got a problem, because I'd never had that happen before. We got all the pictures done, and then they took me into a very small room, like a little closet with a little perch on it. And they said, please wait here. And they drew a curtain. And that was the first time I kind of lost it. I was stuck in the closet by myself, and nobody was around me. And I hadn't been able to bring anyone with me inside the exam room. And I knew something was wrong and I just didn't know how wrong. But I suspected it must be pretty bad, because of her reaction. And I don't fault her for that. I thank her for it because it was informational to me. So when the doctor came in who had looked at the pictures that had been taken, he told me, and I can't say it word for word, I don't remember because my head was still spinning, but I remember they never used the word cancer. They always used the word suspicious. There are suspicious areas and we would like to biopsy five of them and that number seemed extreme to me. And I said, five? And they said yes, five.

Five biopsies, two days later. One in the lymph node. Four others — because the tumor wasn't just the bump Brenda had felt. It was a large mass covering almost the entire face of the right breast, pressed toward the chest wall. She couldn't have felt it. Nobody had.

And the time between getting a biopsy done and getting results is beyond torture. I don't know how they… there's a term for it — scanxiety, they call it. And it's beyond anxiety. It's like sleepless nights. It's going down every rabbit hole, every consideration that could come back. It's too much. It's too much to wait for appointments, and it's too much to wait for results. It was more than a week. It was at least ten days, and I didn't get a phone call. I was checking my electronic portal like, I don't know how many times a day to see if anything had dropped in the portal. And that's how I first saw it. It's when the doctor — where I'm at, when the doctor gets the result, the patient can also see the result on the portal. And so we got them at the same time. It drops a report that I... is in another language. Right? I'm not a doctor. I have no medical background. I have very little science background. So it dropped this report and it had a lot of numbers and letters, and the only word that I understood on it was likely carcinoma. I knew what carcinoma meant. So I was not surprised to see that word, to be honest. I just didn't know what it was, how bad it was. I didn't know anything beyond, you have cancer, from that report, and I found myself googling things like HR+. What does that mean? HR+? And, and my coworker was also trying to Google things, trying to figure out what this report said. What? And parse out all these little pieces that were in there. But ultimately, I have a very educated sister who knows and has a background in some of these things.

Brenda's cancer was invasive ductal carcinoma — HR positive, HER2 negative, Grade 3. That last detail matters: Grade 3 is the highest grade. Which means, it’s the most active. The most aggressive. Her Oncotype score, when it finally came back, was 52 — anything above 25 calls for immediate chemotherapy. Her tumor was already Stage III. There was never any question about what came next. The only question was how fast could they get there.

So I met with my team, with my oncologist, for the first time, and, I didn't feel 100% comfortable with him, but also I didn't have a reference point for an oncologist. And so I leaned toward, give him, give him a chance. This may be, he may be the best doctor around. Who knows? But there were some things in his communication that were concerning to me, but I thought, well, maybe he's a brilliant man with poor communication skills. I would not want to throw away the brilliance if he has that. But it did not take long for me to realize that it was not a matter of brilliance, with communication problems. It was simply someone that maybe had too big of a caseload of patients that was not paying attention to my case and not giving me the answers that I was requesting. Even just by email, to try and make it as easy as possible for him. He told me that he was waiting for a test score that I had read was not necessary in order to start treatment. Nobody was doing anything. And nobody on my team seemed to care, and I'd had enough of that already.

The test he was waiting for was that Oncotype DX score. But for Brenda's specific tumor size, grade, and lymph node status, the clinical guidelines explicitly state that chemotherapy is indicated without waiting for the genomic profiling. The first oncologist was prepared to wait up to six weeks for a number that wouldn’t change the treatment plan. Brenda was not.

I switched, providers, I switched doctors, I got a new team, and the doctors that I met with, that had received my file said we need to start as soon as possible. And that is what I wanted to hear. And she listened to me, and she communicated with me and was all the things that I had hoped the other doctor would be. And so, I immediately felt comfort in my decision to switch, and later found out that I was not the only patient who has had that experience with that doctor. And so I'm glad I made the decision that I made. I was clear to both my oncologist and my surgeon that I wanted cooperation. If I was going to work with two different providers in two different teams or not really teams, they were all part of my team. I wanted them to work together, and they assured me they would. And it went pretty well.

Brenda started chemotherapy on May 2nd, 2024. Fifty years old, two months into a new job, the only employed person in her household, in a city where she’d lived for just over a year, with no local family. She compartmentalized to survive. But the system doesn’t just let you focus on clinical survival. It demands your focus in the billing department.

I said, I'm not paying this. I didn't ask for this. I didn't know at the time that it was ordered that it was not necessary. I'm not doing this. And it that was our first big insurance hurdle. As soon as you hear carcinoma, boy, it's like a roller coaster that never ends. It's taking you in all these different directions. And in the meantime, you're just like, I have cancer? What? You’re so stunned by it. But that $1,700 bill woke me up really, really quick.

That seventeen-hundred-dollar bill wasn't an anomaly. In public health, we have a term for this: "financial toxicity." It’s the objective financial devastation and subjective psychological distress caused by the costs of medical care. Studies show that over 40% of cancer patients exhaust their life savings within two years of diagnosis. Brenda had to keep working because tying health insurance directly to active employment during an aggressive medical crisis is an impossible, systemic paradox. If you are too sick to work, you lose your job; if you lose your job, you lose your insurance; if you lose your insurance, you die.

They filed an appeal for that test bill. It was denied the first time. A hearing was eventually scheduled. Brenda was notified a few days before her first surgery that the hearing would take place while Brenda was having surgery. She would not even be able to represent herself at the hearing.

Along with the financial weight, the social landscape of Brenda’s life began to shift under the pressure of the diagnosis.

Cancer is not new. And, just having cancer as an individual is new, to me and probably to you if you're watching, and there's a term for what happens that has developed since social media started, and it's called cancer ghosting. And, that's when you expect someone to step up for you. And then you let them know and you never hear from them. And it's surprising and shocking and confusing and, like, emotionally hurtful, at times and something that you end up having to work through, as an individual. As I've worked through a few of those ghosting experiences, I've come to the point that if I had any comment for it, it's that I understand now better than before, that there are folks that just don't know what to do. They're so afraid of doing or saying the wrong thing that they get scared into doing nothing. They're just statues in your life. There are also folks that are so scared themselves of what's coming for you as an individual that they can't handle their own emotion, because they're going to have emotions about it and they retreat back, and that's okay. That happens. The best part is that some people surprise you in the best ways. That's going to make me cry because people came out of my… like my history, my, you know, from back in my life from times that were decades ago. And they just emerged back out of the woodwork and said, I'm still here. I'm still your friend. And that is an amazing surprise to have your… to have your network just rise up. Just, if you want to be supportive, just keep being present and don't wait to be told. What can I do? Because sometimes we don't know. We're just going from appointment to appointment and falling asleep, you know, and so, do you want a meal? I don't know, what do you want? I don't know. Just do it. If you want to do it, just do it.

I want to draw attention to Brenda's phrase: "statues in your life." In oncology research, we know that social isolation isn't just an emotional side effect; it’s a clinical risk factor. Data show that breast cancer patients who experience high degrees of social isolation have a significantly elevated risk of total mortality and disease recurrence compared with those with robust, active networks. When people "ghost" a patient, they often think they’re giving them space or avoiding saying the wrong thing. What they are actually doing is withdrawing critical infrastructure when the patient needs it most.

Despite the bills and the social shifts, the physical treatment rolled on relentlessly. Sixteen rounds in total. Four rounds of the "Red Devil" — doxorubicin — every two weeks. Followed by twelve weekly rounds of Taxol. She scheduled infusions on Thursdays so the pre-medications would carry her through Friday. By Saturday and Sunday, when they wore off, she could collapse. And on Monday, she went back to work.

So I had no reference point for chemotherapy outside of movies. The unknown — again, the apprehension of the unknown was really difficult. I can't put words to the fear that you have to walk forward with, and in my case, I felt like I had to walk forward. I was going to fight it, but I was scared. Living with that much fear for an extended period of time is hard. It's hard for anybody. And it can be done. But I just would want to put my hand in and say, I understand if somebody is feeling that fear right now and to let you know that that's okay. And you, you will make it to the other side. So I walked in for chemo and I had this new port that was on my chest, and I didn't 100% understand how that even worked. I just knew I had a machine in my chest, and I had a tube going up into my neck, and that seemed a little Frankenstein. But that's what had to happen. The side effects are like blankets getting laid on you, and they can stack up on you and get really heavy. And what I thought was going to be the most difficult, the nausea, didn't show up all that much for me. It was fatigue and weakness that showed up and surprised me. People say they hate cancer or, you know, kill the cancer, fight the cancer. For me, it's I hate side effects. I don't feel the cancer as much as I feel the side effects of treating the cancer. Oh, I hate side effects, but that's the price. That is the price you pay to fight. Fighting is not strong punches. Fighting is getting weakened and still walking and still moving forward. It's not getting stronger and stronger to fight a bigger fight. It's getting weaker and weaker and keeping it up. 14 days after that first cycle, I lost my hair. And I've never been like, someone that lived and died for makeup and hair or clothes. And so I thought, yeah, it'll be okay. I've seen people go through that. I understand that. I'll be okay. But to be honest, it's emotionally harder to realize that all of it is real. When your hair comes out. None of this is a dream. You are really having chemotherapy because you really have cancer.

I also knew that I would need to work during my chemotherapy, so no matter what my side effects were, I was going to have to get up, get dressed and get to work. And I didn't know what that was going to look like or feel like, but I had the only income in the home, and my work provided my insurance that was covering this medical care. So it was a non-negotiable, basically in my head that I had to keep working. Thankfully, again, I had advantage during this scenario I was walking into, that I had a very understanding team that I work with and a very understanding boss that told me do whatever I needed to do and she would support me. And, they really did. I ended up compartmentalizing in my mind. When I was at work, I was at work. That was that was the Brenda that was existing in that moment. When I was getting cancer treatment, I was a cancer patient. And when I was at home, I was at home, I was a wife. And I played my roles out separately because doing it all at once, all together, I didn't know how to do that. And to be honest, I probably still don't know how to do that. I'm not that capable. I like to be capable, but I can only play those roles one at a time. And, in some ways, having those multiple roles is probably what has helped me make it to the point that I am. Because if I didn't have a job, if I didn't have a place to be, if I didn't have expectations and I just was Brenda, the cancer patient? That was the saddest of my roles. That's the one I least want to play.

After sixteen rounds of chemotherapy, Brenda was given a brief window to let her immune system rebuild enough to survive a major surgical assault. She had her surgery on November 11th, 2024.

I chose to have the lumpectomy with the reduction, thinking that I was mitigating my chances of recurrence and not placing myself in a position where I needed to have the reconstruction completely of breasts. And hopefully the cancer would be gone afterwards as well. And because I had lymph node involvement, I also knew that they would be removing a sentinel lymph node during the surgery and checking it for cancer. So I had 11 lymph nodes removed. They did on either side of, where I tested positive, find lymph nodes that were not positive. So that was the cap around it. And three did test positive. So I had three positive lymph nodes. But at least that tumor had clear margins and was removed. The reduction went fine. So all kinds of new scars and adventures after that surgery, and your body reacts, of course. And there was a little bit of lymphedema that I had to deal with afterward. Regaining my reach with my right arm, being able to put my arm up and reach into things and up, I worked really hard to do that as quickly as I could, because I had heard of people that lost mobility after the surgery, and I didn't want that to happen. I wanted my mobility. And I didn't end up having to go to physical therapy, I think because I was hyper-attentive to making sure that I was moving and that I was stretching just enough to feel the pain. Because I knew I needed to feel the pain to stretch out the muscles.

Thirty rounds of radiation followed, five days a week, starting in February 2025. Brenda went before work. Every single weekday for six weeks.

So by February, I could see the end in sight. By the end of February, I felt like I had learned a lot. In addition to enduring a lot, met a lot of amazing people, and hoped that life had just been temporarily paused, redirected, and that I would be successfully past this point in my life with the conclusion of my treatment. In January of 2024, I actually had high hopes for my 50s because I had read several articles that said that Americans are most happy in their 50s. If you’d raised kids, they were out of the nest. If you had worked on a career, you were finally in an earnings state. I was digging 50. I thought 50 was going to be it for me, finally. I’d gone through all of it and I was ready for my heyday.

She had spent her entire fiftieth year in chemotherapy. She was fifty-one now, and she was profoundly tired. But she was done. No evidence of disease. She had crossed the finish line of her treatments and rung the bell. She had kept her job, her insurance, and her life. She had made it to the other side. Hold onto that feeling.

We’ll be back next week with Part 2.

You can get show notes, links, and other information at the website, which is ChangedByCancer.com.

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