SUMMIT, NJ - Natalie Rivera, DO, was in the zone.
She was focused and immersed in completing her medical residency at Summit's Overlook Medical Center while balancing being both a wife and a mom to her young daughter. Busy doesn't even begin to describe her days, which included an hour-plus commute in each direction.
Life intervened in a way that many would say was both devastating and cruel; however, Rivera responded with determination, optimism, grit and a new appreciation for the possibilities that life holds.
Rivera, 30, always knew breast cancer might be part of her story. “My mother had breast cancer when she was 40, my grandmother had breast cancer -- it’s strong in our family,” she said. At 19, she underwent genetic testing and learned that she was positive for the BRCA1 gene, which indicated that she was likely to be diagnosed with breast cancer at some point. She began getting screened, going every six months for a mammogram and MRI throughout college, medical school and new motherhood.
She and her husband and young daughter relocated from the Philadelphia-South Jersey area to central New Jersey in 2017 so that she could begin a residency in family medicine at Overlook. The family settled in Elizabeth, but finances soon prompted them to move to Howell so that they could live in her mother’s house. Overwhelmed by the demands on her time, all of Rivera’s diligent screening went out the window.
“There was just no time,” Rivera said. “I honestly was not caring for myself during this period. It was just go, go, go.” She justified the lack of screening by reassuring herself that although cancer was likely in her future, it wasn’t going to strike while she was still in her twenties.
Early in 2019, Rivera felt a mass in her breast. She wasn’t concerned, because she already had a benign fibroadenoma in the other breast. However, unlike the fibroadenoma, this mass was not fluctuating in size with her menstrual cycle but steadily enlarging. She also began experiencing night sweats and weight loss. Finally, she consulted a physician, who sent her to see Margaret Mary Sacco, MD, an Atlantic Health System breast surgeon. A mammogram showed what looked like cancer, and a biopsy confirmed that Rivera had invasive ductal carcinoma, stage 2.
“This threw me for a loop,” said Rivera said. “It was like, ‘This is so real.’” Rivera was referred to Bonni Guerin, MD, an oncologist and breast specialist at Overlook Medical Center’s Carol G. Simon Cancer Center, and she was immediately struck by Dr. Guerin’s concern for all facets of her well-being. “Dr. Guerin was asking what I do to take care of myself,” Rivera said. “She took a whole-person approach, and I just loved her so much.”
When she spoke to Dr. Guerin, Rivera realized that self-care needed to regain priority status. The stress of her medical residency, combined with her responsibilities as a wife and mother, had left her depleted at the end of every day. Rivera knew that if she was going to beat cancer, she couldn’t continue at her former breakneck speed.
She arranged to take her residency at a slower pace, working part-time, and soon embarked on the first of 16 rounds of chemotherapy. She finished her chemotherapy in October 2019, but her life-altering journey is not yet over, with a double mastectomy and reconstructive surgery scheduled for November with Dr. Sacco and a plastic surgeon.
Depending on whether any cancer remains in her lymph nodes, she may undergo radiation, as well.
While Rivera remains as focused and driven as ever, what has emerged is a new awareness of what is important. Despite all she’s been through and the challenges that lie ahead, she exudes a remarkable optimism and positivity.
“In hindsight, getting cancer has been the best and worst experience. I was going, going, going, and I was going to have a breakdown if I didn’t stop," she said, adding, "This disease forced me to slow down and take care of myself and my family.” Rivera also was able to gain perspective on events in her past that affected her. For instance, her father had taken his own life the day after her wedding and a week before she began medical school, and she realized that she had never really grieved that loss.
The awakening also included the realization that becoming a doctor doesn't have to mean ignoring other passions in her life. As she settled into her reduced work schedule, Rivera began writing poetry and blogging about her experience. She created multiple videos for other young cancer patients, offering advice on how to do hair and makeup while going through chemotherapy, medications she found effective and foods she had to avoid in order to keep her stomach settled. She also joined with another young patient of Dr. Guerin’s to create a Facebook group geared towards young adults with cancer.
Rivera’s latest project has been a partnership with the Breast Cancer Research Foundation (BCRF) on its 'Research is the Reason' campaign. She participated in a photo and video shoot discussing why her breast cancer experience is so different from that of her mother, who didn’t have access to treatments such as targeted therapies or chemotherapy before surgery. “Through the BCRF, I’ve been able to educate other people,” she said. “I’ve realized that’s a passion of mine, and I wouldn’t have known that if it weren’t for cancer.”
Rivera admits that it took her a little time to have a positive outlook about her situation. “I had a poor attitude in the beginning, but I’m not going to let this defeat me. I look at it like, ‘What can I do with this?’”
She gives an enormous amount of credit to her husband, Joseph, a full-time caregiver to their five-year-old daughter, Penelope. Joseph also faces his own health battles - - he was diagnosed with multiple sclerosis in 2012. “He’s such an uber-positive person, almost to a fault,” she said. “If he sees me upset, he’ll give me my space for a little bit, but then he’ll pull me out of the hole. He just holds it all together. He’s grounded me - - he’s been there through it all.”
Penelope also has been a source of joy and inspiration for Rivera. After consulting with a social worker, Rivera was honest with Penelope and told her that she had cancer and that her hair would fall out, which made Penelope cry. “But when my hair fell out, she loved it!” Rivera laughed. “She called me ‘Baldy’ all the time and I called her ‘Hairy.’ She would kiss my head. Now that my hair’s growing in again, she doesn’t like it.”
Rivera is especially grateful to her doctors at Atlantic Health System, as well as colleagues in her residency program. “They never made me feel guilty or bad,” she said. “They checked on me. My attending would text me. They would sit with me during my chemo. It’s just such a supportive place. It’s made me realize it’s okay to ask for help and you should ask for help.” Her experience has also made her a better, more empathetic doctor, she said, now that she’s been on the other side of the exam table.
Although Rivera will not graduate in June 2020, as she originally planned, she anticipates finishing her residency just a few months later, in the fall. Then, she’ll take stock of her situation and move forward from there. “I took lemons and made lemonade,” she said. “I don’t know where my efforts will lead, but I just want to get my experience out there. I’m finding myself again.”
Natalie Rivera's blog is available by visiting nxr016.wixsite.com/websitethesickdoc.