Spring 2020: Covid-19 or Cancer?
With COVID-19 spreading and spiking around the country, her husband urged her to call her doctor, Julie Lindsey, MD (Duke Primary Care Meadowmont ). She saw her for a telehealth appointment.
“I told her, ‘I don't think this is COVID. I don't have a fever. I don't feel fluish, and I haven’t gone anywhere,’” Garber recalls. “And she said, ‘Yeah, you know, it doesn't sound like COVID, it’s probably just stress.’”
Lindsey scheduled Garber for an in-person exam and blood work the following week, on May 27, just to make sure.
Later that night, as Garber watched a movie, missed calls amassed on her phone, which was buried in her purse in another room. Lindsey had been frantically trying to reach her. The central message — her bloodwork was “off” and she needed to go to the hospital right away.
“She did not say she thought it was cancer. She said she wasn't sure what was going on,” remembers Garber.
“I went to the ER (Duke University Hospital, Durham). Everything got rolling really fast. They did a CT of my chest and abdomen that night that came back with suspected cancer metastases on my liver. I went home around 3 A.M. I think Dr. Sammons called me right at eight and wanted to get me on the schedule.”
Garber barely knew her new oncologist, Sarah Sammons, MD, who’d taken her on as a patient when Kim Blackwell, MD, left clinical practice. She’d seen Sammons only once — in October 2019 for a six-month surveillance visit at the Duke Cancer Center Breast Clinic in Durham. But Sammons was already on the case. On May 29, they spoke on the phone about the results of her hospital scans and on June 3 they met in-person at the clinic.
It had been nearly four and a half years since her primary care doctor, the same internist who sent her to the hospital, found a lump in Garber’s left breast and lymph nodes. The discovery was made during her annual physical (February 3, 2016). After a referral to Duke, Blackwell had diagnosed her with stage 3 lobular breast cancer. She underwent a double mastectomy then several rounds of chemotherapy and radiation. Her cancer stabilized.
The initial diagnosis of breast cancer never made sense to Garber.
“I don't fit the profile. I don't smoke. I'm not overweight, you know nothing like that,” says Garber, who was 34 at the time. Neither does she have a family history of breast cancer or harbor any mutations in either the BRCA 1 or BRCA2 genes in her DNA that raise breast cancer risk.
Garber’s cancer is hormone receptor positive (HR+) — in her case both ER+ and PR+. This means that her breast cancer cells need the hormones estrogen and progesterone to grow. Hormone therapies — a go-to in advanced ER+/PR+ cancer — act to reduce the level of these hormones in the body.
After completion of chemo and radiation therapy in 2016, she’d been prescribed monthly injections of Lupron (leuprolide) and daily Femara (letrozole) pills — to tamp down estrogen and progesterone production so that any remaining cancer cells might grow more slowly or stop growing altogether. In August 2019, she’d opted for surgical removal of her ovaries, which produce the hormones, so she didn’t have to continue to pay for the costly Lupron injection and so she could avoid “the mental challenges of being on the chemo floor every month.” She continued taking Femara.
But there Garber was in June 2020, “back on the chemo floor” of Duke Cancer Center. This time she was facing stage 4 disease, in the middle of a global pandemic, no less.