How a breast cancer diagnosis taught me the difference between looking fit and being healthy

“I have to tell you,” the doctor says, “I don’t think I’ve ever seen anyone at your age in better shape than you.” He holds his hands out in front of him, gesturing at me like a preacher. “Look at you!”

I’m in my late 30s, weigh 132 pounds and wear a size 4. My BMI – body mass index, a weight-versus-height calculation that doctors have been using for more than a hundred years to determine overall health – is on the low side of perfect: 20.7.

I know what he sees, but still, I glance down at myself, taking in my sculpted arms and muscular curves. I am proud of myself and all of the work I’ve put in, at the gym, on the road and in the kitchen. I’ve been mastering the math of being fit since starting my kinesiology degree more than a decade ago, counting weight and distance and calories, seeing my progress unfold in the mirror and on the scale. I mentally pat myself on the back for that seven-day juice cleanse I managed to complete last month. I am on fire.

A few months later, I’m in my room, struggling to get out of a sweaty sports bra. The clawed fingers of my right hand brush what feels like a marble shoved inside the fabric covering my left breast. Did I drop something in there? Stranger things have happened. I spend large parts of my day rolling around the floor of a boutique gym in Venice Beach with all manner of moms and dogs and babies. I’ve come home with gummy bears glued to my back; why not a marble in my bra? I pull it over my head and shake it in front of me. Nothing falls out. Weird. Topless now, I touch the spot. Something is there, hard and round and small, but it’s underneath the skin.

“Babe,” I say to my husband. “Come feel this.” Soon, he’s pressing down on the bump with his thumb, making me jump. “Does it hurt?” he asks. When I nod, he tells me to make a doctor’s appointment. “Just to be on the safe side,” he says. I agree, but I’m not worried. I’m fit.

My G.P. asks me when I first noticed the lump. Last week, I tell him. Right before I called to make the appointment. He stares over my shoulder while he palpates it. “I’m sure it’s nothing,” he says. “But I’m going to send you for an ultrasound. Just to be sure.”

He makes an appointment for me for the next day. “That was fast,” my husband says. I shrug. “Maybe there was a cancellation.”

At the clinic, they give me a locker and a gown. Once I’m ready, someone leads me to an interior waiting room. Four other women are already waiting. One of them is knitting, another, reading. All of them are older than me. I flip through a magazine until my name is called.

At the end of the ultrasound, the doctor tells me she wants to do a biopsy. I have to come back. I think about my mother. Didn’t she have a benign lump removed? I make the appointment and a mental note to call my dad. I am anxious about the biopsy, but only because it will hurt. A few more days and it is done, and I’m on my way to teach a bootcamp class, confident in the physical fortress of the body that I’ve built.

It is next week when a friend calls, asking after my results. I tell her I haven’t heard anything. “That’s good,” she says. “They only call with bad news.” I’m agreeing with her when I hear the beep of my call waiting. It is my G.P. asking me to come in. When I press him, he says, “I don’t want to give you this news over the phone.”

And right then I realize that I have cancer.

The pathology report is full of numbers. It’s math I can’t seem to wrap my mind around. My husband takes over. I don’t want to think about stages and tumor markers, don’t want to talk about prognosis.

I am super fit. This can’t be happening.

But it is. I have Grade 3 Invasive Ductal Carcinoma. An aggressive form of breast cancer that spreads rapidly and often comes back, regardless of treatment. My calendar fills up with doctor’s appointments instead of fitness classes. I am fast-tracked into a PET CT scan to see if the cancer has spread. They find a suspicious spot on my lung. I am scheduled for a lung biopsy. I make it all the way into the room. I’m lying face down in the machine and waiting to feel the needle pierce the skin of my back when the doctors decide the dangers of the procedure outweigh the possibility that the cancer has spread. There will be years of PET CT scans, but first a double mastectomy and reconstruction, a blood transfusion, five days in hyperbaric oxygen, six months of chemotherapy. I will lose a few toenails and the feeling in some of my fingers. I will lose every hair on my head including all of my eyelashes and both of my eyebrows.

I will lose my last chance at motherhood.

I will look sick.

Maybe it is this unavoidable change in my appearance that finally wakes me up to the fact that looking fit and being healthy are not the same thing. After my cancer diagnosis, that math no longer makes sense. I was growing that tumor for years before that day in the doctor’s office when he applauded me for being so fit. I “looked like” the picture of health, but the truth is: I was sick.

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This story is part of a collection of stories printed Sunday, September 25, 2022.
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People can’t be simplified into an equation. Especially not one as simplistic as the Body Mass Index. Fit does not always equal healthy. The calculation of height and weight is meaningless. Those numbers don’t tell any kind of story. They leave out all of the ways we punish ourselves to achieve an ideal – like smoking cigarettes as an appetite suppressant, or the cycle of feast or famine courted by calorie restriction, or binge drinking because you’ve waited all week to indulge and now you only have an hour or two to really “let go.”

How do I know this? Because it’s exactly what I did. As if some socially agreed-upon appearance of health could keep me safe from real illness. It doesn’t. It can’t.

I’m going to let you in on a well-guarded secret I’ve witnessed firsthand: A lot of athletes, fitness professionals and other heralded “experts” are engaging in incredibly unhealthy behaviors to fit into the shape of that ideal physical form.

A decade after my diagnosis, I am still learning to prioritize the journey over the destination – actually being fit instead of just looking it. It’s required me to change a lot about how I live. I gave up drinking and smoking and staying up late. I started meditating. I move because it makes me feel good, and I eat my vegetables for the same reason. I am the healthiest I have ever been, and it has nothing to do with what I look like in the mirror.