BrittLee Bowman had a huge decision to make as she lined up at an elite cyclocross race. Cyclocross is a sport that throws obstacles at you, from sand pits to staircases to knee high barriers. And this one, alongside the Hudson River in Queens, N.Y. was no different.

Bowman pedaled. People cheered. And if you saw her that day… you probably had no idea what she was wrestling with. That decision she had to make: Do I have both my breasts removed?

It all started with a tiny lump. “Sometime in October I just you know was touching my boob and felt a lump,” she says. “It was about the size of a pea.”

She immediately called her mom, Sara Bowman. Her mom says she was probably more concerned than her daughter, but she didn’t let on.

Bowman made an appointment with her doctor. And the doctor thought it was best to do an ultrasound. And the ultrasound showed another lump. Two total. And that led to a biopsy. And the biopsy led to waiting.

“I’m telling you,” she says. “In my mind, I did not have cancer.”

So Bowman went on with her life. She was out shopping when she got the call.

“You have breast cancer,” she says the doctor told her. “And I was like, ‘Wait. What!?'”

The doctor clarified her statement, telling Bowman the result came back positive. She had stage one multifocal invasive ductal carcinoma, ductal carcinoma in situ, and lobular carcinoma in situ all in her left breast. Her right was unaffected. She called her mom.

“I don’t even remember what I said,” Sara Bowman says. “I was just trembling.”

For BrittLee, the cancer diagnosis just didn’t make sense.

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Rachel Rubino and Bowman at a recent cyclecross event. “A lot of people in my family have had cancer,” Rubino says. “My mom passed away of breast cancer when I was 22. So for me it hits this really deep place. You know? It’s like being a woman and being an athlete. This can happen to any of us.”

Courtesy of Dan Chabanov

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Courtesy of Dan Chabanov

“You can exercise everyday of the week for an hour-and-a-half — except on Sundays, you need a rest day. Be pescatarian for six years. Eat lots of fruits and vegetables all the time. Drink green juice all the time. You know, you can be pretty healthy and live an active lifestyle and still get cancer,” she says. “It sucks.”

Bowman started researching her particular cancer: medical journals and anything she could get her hands on. Meanwhile, there were more tests. Her doctor gave her options: lumpectomy, single mastectomy, or double mastectomy.

“So basically, if I chose double mastectomy and then take care of everything right now then I hopefully will not have a recurrence of this cancer,” she says.

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Becca Schepps visits Bowman in the hospital.

Courtesy of BrittLee Bowman

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Courtesy of BrittLee Bowman

Thirty-four and single, she wanted the option to have kids. Some treatments impact fertility. Then there were a host of other concerns, including how it could impact her athletic career, and also, how she looked at her body.

“I’ve always been a very comfortable person with my body… And I know that a lot of women struggle with their bodies and don’t love them,” she says. “And so I had this fear that the surgery would change that about me. It wasn’t totally the fear of it changing my body, it’s like more about like the fear of it changing how I felt about my body.”

She continued to research and read. But sometimes journals feel impersonal.

So she looked up #doublemastectomy on Instagram. “And they’re posting everything. They’re showing: This is what it looks like right after surgery. This is what it looks like when you have a bad reconstruction that you’re sad about and that makes you want to get surgery again. This is what it looks like when you’re happy that your surgery went well. This is what it looks like when you have radiation. And so just finding that on Instagram was actually really helpful for me to see other women my general age going through this experience.”

She soon had her surgery date. But still hadn’t decided which surgery to get.

“It was the thing I thought about every moment.”

All that was going through her head when she entered that cyclocross race in Queens.

***

That day, Bowman powered through the course, battling for second place with rider Rachel Rubino. The two are competitors and also friends.

“Hey, I’ve been thinking about you so much all week, Rubino told her as they raced. “I love you so much.”

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Rachel Rubino finished in second place and Bowman took third in the Rainey Park race.

Eric Lee Bowman


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Eric Lee Bowman

By the last lap, Rubino was in second and Bowman had third place wrapped up. They’d get to stand on the podium together. It meant a lot for Bowman. But it meant a lot for Rubino, too.

“A lot of people in my family have had cancer,” Rubino says. “My mom passed away of breast cancer when I was 22. So for me it hits this really deep place. You know? It’s like being a woman and being an athlete. This can happen to any of us.”

***

Days after the race, Bowman made her decision. She’d have surgery to remove both her breasts. On the day of the appointment she went to the hospital with family and a friend.

“It was just a long wait a long wait in there …” says Sarah Bowman.

Finally, it was time.

“So they they placed the I.V. in my arm while I was in the holding area with my family,” says Bowman. “And they walked me down a hallway. And there was an elevator. And I was with the nurse. And I had to say bye to my family. So I go into this elevator. The doors close. And I was like in the elevator with the nurse and I was just crying. … It’s just scary. You know you don’t want to have to do that, but you’re trying to fix the problem.”

She walked into the operating room in her gown, past a table of surgical tools. She climbed onto the table. And she stared into silver lamp lights.

***

Three weeks after her surgery, she was still healing and feeling hopeful about racing again.

“I got on my bike on a 28-degree day here in New York City. And I rode laps in Central Park,” she says.

Athletes are like that: Tough. But Bowman is quick point out that she only had stage one. She’s young. There’s a lot of women dealing with far worse. That said, there’s still radiation ahead, healing from reconstructive surgery, and five to 10 years of tamoxifen to ward off a recurrence.

“I’m like did I survive yet? I don’t know. Do I still have cancer? I’m a little unclear on that right now. Maybe I do still have cancer? Or maybe maybe it was all cut out of me? I’m not quite sure,” she says.

You can see the wear on Bowman’s face, but also the resolve. She’ll wake up. Roll out of bed. Do her treatment. Get on with her life.

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A new report published by the Centers for Disease Control and Prevention details the harrowing story of a child in Oregon who contracted tetanus because he wasn’t vaccinated.

The boy was playing outside on a farm in 2017 when he cut his forehead. Six days later, he started having symptoms: a clenched jaw, muscle spasms and involuntary arching of his neck and back. When he started struggling to breathe, his parents realized he needed help and called for emergency medical services.

Doctors diagnosed the 6-year-old boy with tetanus and administered a dose of the vaccine, but it took 57 days in a hospital, including 47 days in intensive care, to restore his health.

“It was difficult to take care of him, to watch him suffer,” says Judith Guzman-Cottrill, a pediatric infectious-disease physician who co-authored the article in the CDC’s online journal Morbidity and Mortality Weekly Report.

At first, he asked for water but couldn’t open his mouth. The boy had to spend weeks in a dark room on a respirator. He was able to walk 20 feet, with help, after 50 days.

At a time when preventable outbreaks are making headlines in the United States, Guzman-Cottrill tells NPR that she has met many families who hesitate to give their children vaccines.

“These days, there are so many different places parents can go to for vaccine-related education and advice that many families struggle with knowing who to believe.”

The Internet and social media have made it harder for people to distinguish fact from fiction, she says.

The boy’s infection marked the first pediatric case of tetanus in the state of Oregon in more than 30 years, according to the researchers.

After allowing the first dose of vaccine, the parents refused a second dose for their son, despite doctors giving them information about the advantages of being immunized against tetanus. “I did provide education about the benefits of all pediatric vaccinations and that was also refused,” Guzman-Cottrill says.

The report of his illness comes after outbreaks of measles occurred this winter in the Pacific Northwest. Measles is also preventable with a vaccination.

The rise in measles cases, spurred by the anti-vaccination movement, is pushing authorities to address the issue.

On Tuesday, 18-year-old Ethan Lindenberger told lawmakers that his mother prevented him from getting immunizations because her Facebook feed turned her into an anti-vaxxer.

Facebook itself announced Thursday that it is using vaccine hoaxes identified by the World Health Organization, the CDC and other global organizations to address inaccurate information plaguing the site.

“As a parent myself, I understand that parents are trying to make the best decision for their child,” Guzman-Cottrill says.

“This illness could have been prevented with five doses of the tetanus vaccine, for $150,” she adds. Instead, the ordeal cost $811,929.

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Oklahoma has been making progress in fighting the opioid epidemic. But there’s still a lot of work to be done.

While the death rate from prescription opioids is on the decline here, the number of opioid prescriptions written in the state continues to vastly outpace the national average. Also, deaths from heroin overdoses have been climbing — up by more than 50 percent between 2015 and 2016 — and that could be a byproduct of stricter state regulations that aim to curb opioid prescribing.

So in late February, I was one of about 60 people from across Oklahoma invited to brainstorm ideas during a one-day exercise to find solutions to the state’s opioid crisis. The Oklahoma Primary Healthcare Improvement Cooperative convened the meeting at the Tatanka Ranch in Stroud.

The cooperative was created in 2014 to help doctors and nurses across the state do their jobs better by implementing best practices as determined by medical research. It works like an agricultural extension service, with academic doctors and nurses acting like farm bureau experts and visiting local offices throughout the state to share their wisdom.

The conveners of the opioid meeting divided us into small groups and focused on two really tough questions:

• What if Oklahoma had zero overdose deaths?

• What would be expected of each of us to make that happen?

Academic physicians (like me) from the state’s two major research universities, were sprinkled among the groups, which also included community and rural physicians, some of whom specialize in medication-assisted treatment for substance use.

But what made the one-day summit unique in my eyes was the inclusion of professionals well beyond doctors, nurses and physician assistants. Pharmacists were there, as were officials from Oklahoma’s Medicaid agency and the state’s Bureau of Narcotics and Dangerous Drugs, which administers Oklahoma’s Prescription Monitoring Program.

Thirty-seven states now give health care providers access to online tools that let them see the prescriptions for controlled substances, such as opioids, that a patient has received. This information can help prevent “doctor shopping” by people seeking drugs and it can help clinicians be aware of potential overuse.

Given how disruptive opioid addiction can be for families, there were also child welfare and mental health professionals who reported on programs to help addicted mothers overcome opioids and find pathways to win back custody of their children.

The summit also included representatives from law enforcement and community-based support programs, such as a prison diversion initiative aimed at providing treatment and help instead of incarceration for nonviolent male offenders.

The strength of the meeting was that it brought together people who work on different aspects of the same broad problem, who may never have had the chance to meet one another in their day-to-day work and consider ideas from others’ perspectives.

“We’re all blindfolded people working on our own aspect of an elephant,” one person noted. “And this has allowed us to remove our blindfolds and see the whole elephant in the room.”

One set of conversations early in the day asked us to put ourselves on a complicated flow diagram of where, when and how opioid prescribing occurs.

Some people were involved in fielding patients’ complaints. Others worked in doctors’ offices or hospital emergency rooms, right on through to the dispensing of medicines in pharmacies. Still others were on the law enforcement, social service, and payer sides of such transactions.

By visualizing where each of us work along the opioid continuum, we could more easily imagine ways to improve things and implement new educational approaches to better inform the public about the risks and benefits of opioid use.

Suggestions for lessening the impact of opioid abuse included both “upstream” and “downstream” components.

Upstream refers to preventing opioid abuse and addiction before it starts. Ideas for that included more interdisciplinary and interagency cooperation, and pushing our state legislature to consider the health effects of all bills that are enacted into law.

Downstream suggestions included widening availability and accessibility of mental health and substance abuse treatment services, something Oklahoma sorely lacks. Other ideas included better data monitoring and sharing tools.

I left the meeting mulling over what we had really accomplished.

I don’t think we’ll ever realistically get to zero opioid deaths. But it’s certainly a worthy aspiration. In order for us to move in that direction, we have to treat addiction as a medical problem — not a character flaw — and place equal value on every human life.

Further, we have to accept the idea that we have excellent medical treatment for opioid addiction and be willing to provide it in all kinds of health care settings, including jails and prisons, without preconditions.

If we could achieve this mindset, people would have the chance to live longer, more productive lives. Family and childhood trauma could be greatly diminished, too.

The meeting prompted me to learn more about intranasal naloxone, an opioid antidote, and to carry it with me. If I can use it, certainly anyone can. I also plan to lobby to make medication-assisted treatment more widely available.

The attendees concluded it would be important for those of us in different sectors to keep in touch and sustain the dialogue. We also pledged to better educate each other, our lawmakers and the public.

But as inspiring as it was to be part of the meeting, it was abundantly clear that complex issues such as opioid use and abuse don’t lend themselves to one-day solutions.

John Henning Schumann is a writer and doctor in Tulsa, Okla. He serves as president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa’s Medical Mondays and is on Twitter: @GlassHospital.

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