Firefighter Fighting For Time

Photo credit: KTVU News

This morning I woke to several messages pointing me to the same upsetting story. It is the story of San Francisco firefighter Janette Neves Rivera.

Janette is 44 years old, the mother of two young children, and next week she is scheduled for breast cancer surgery.

I happen to believe that firefighters are among our truest heroes. So how did Janette’s colleagues respond? Well, it seems some of them, about 700 of them actually, offered their own sick leave to give Jeanette the gift of time. Time to prepare. Time with her young children. Time to heal.

Beautiful, right? Not exactly. The city of San Francisco denied Janette’s request, and just days before her scheduled surgery Janette is back on the job… Why? According to the article, Janette’s illness is not considered “life-threatening.”

Is your blood boiling yet?

First, let me say I plan to do my next set of scans in San Francisco, where they are diagnosing the non-lethal kind of breast cancer. Anyone care to join me?

Photo Credit: stevec77 via flickr

But seriously, there are so MANY things wrong here.. My thing is this: knowing nothing about Janette or her diagnosis, and assuming the article is accurate, I don’t think it’s hard to draw a line from the pink “early detection” rhetoric and what is happening with Janette. And it’s all right there in the media — front and center in the coming weeks no less. But here we go again…

  • “Mammograms save lives.” WRONG. First, despite headlines to the contrary, mammograms don’t prevent cancer. EVER. Mammograms detect cancer. SOME cancer. We don’t even know if they detect MOST cancer. We do know they don’t detect ALL cancer.
  • “Early detection saves lives.” MAYBE. SOMETIMES. But then again we don’t know whose lives it will save. We don’t know who will be over-diagnosed. We don’t know whose cancer would never spread. And we don’t know whose cancer has ALREADY spread. Early detection leads to earlier treatment. It may extend 5-year survival rates, but we don’t know the degree to which it saves, or even extends, life.
  • “No one dies from breast cancer anymore.” This one was actually brought to me by a DOCTOR. Tell the 39,510 women expected to die of metastatic breast cancer in 2012 alone that no one dies of this disease. Tell their grieving families, their children, their friends, tell all the people who were touched by their lives that no one dies from this disease.

These myths and others are truly dangerous. And they are perpetuated by breast cancer organizations and the media constantly.

Someone in an administrative office somewhere in the bureaucracy that is the San Francisco government has decided that Janette will be just fine. Someone seems to have had an Big Gulp© of pink Kool-Aid©. Even assuming Janette’s doctor chimed in on the decision, none of us know Janette’s fate. What we know is she has breast cancer. What we know is that her surgery is scheduled soon. What we know is that she has young children who are likely to be as anxious as she is about the coming weeks. What we know is that her department, her colleagues, are prepared to step up in support of her. What we know is that the City of San Francisco is not.

Presumably the city has nothing to lose. Other firefighters will cover her shifts. There is no economic impact; no extra money outlaid for her sick leave. In fact, it’s a lot less expensive than replacing and training someone new. I’ll be following this one, and hoping that a city as progressive as San Francisco will re-think their position, and soon!

Meanwhile, my prayers are with Janette and her family for a quick and complete healing.

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31 Comments (+add yours?)

  1. chemobrainfog
    Sep 14, 2012 @ 10:41:00

    Yes, Lori…

    To answer your question, my blood is BOILING… I will be sharing this with a few friends in San Francisco….. along with the rest of the twitter-verse….

    This is disgusting, disgraceful, deplorable….. maybe we need to get a few of the docs who happen to be IN SAN FRANCISCO as I type with our own Dr. Attai to head to city hall????

    I AM PISSED….

    Reply

  2. Facing Cancer (@cancer2gether)
    Sep 14, 2012 @ 11:34:48

    I’m shaking my head reading this post. Absolutely nuts to mark a surgery like this as not related to one’s life being threatened. That’s crazy! People don’t slice up their chest without cause, without the fear of cancer tearing apart their life. I’m glad she’s surrounded by supportive co-workers, and very sorry to hear that they amazing gesture of care has been denied.

    Catherine
    http://www.facingcancer.ca

    Reply

  3. Elaine Schattner
    Sep 14, 2012 @ 12:13:10

    Hi Lori, Thanks for covering this story.

    I do think, though, that the evidence for mammography is pretty strong as a life-saving strategy, far stronger than NBCC (which positions I generally respect) “teaches” advocates. The sensitivity of mammography is usually around 80%, which means that when done properly it picks up the overwhelming majority of cases. The problems with mammography include that too many are done by inexpert radiologists, which harms individual patients and dampens the data showing a small survival benefit at the population level. If 20% are missed in expert hands, that’s far too many – but at least it helps “catch” the cases early in most women who choose to be screened. As you know, unfortunately from the flip side, the prognosis differs completely for early and advanced tumors. (Which is all the more reason for this woman to get her surgery soon.)

    The idea that invasive breast cancers don’t need treatment is simply not true, especially in younger women. That is a myth, extended somehow from the literature on prostate cancer and drawn from mathematical models of breast cancer in some populations. There are no findings I know of that some breast cancers regress or don’t grow – that is a theoretical possibility that has been raised and defies clinical experience with this disease. The questions are what to do about Stage 0 (non-invasive) and precancerous conditions. Those, I agree, are often over-treated.The questions are what to do about Stage 0 (non-invasive) and precancerous conditions. Those, I agree, are often over-treated.

    I am 100% with you that we should aim for BC prevention, which would be far better than screening or treatment by any method.

    Reply

    • Lori
      Sep 14, 2012 @ 12:38:20

      Wow Elaine, thanks so much for taking the time to share some great information!

      On the point of mammography – I don’t argue that it is a valuable screening tool, and I certainly wouldn’t do away with it. Being the exception to the rule, my cancer was initially found on a baseline mammogram at the age of 35.

      However, and a minor point, I don’t think mammography is the be-all-to-end-all, and I think we need to strive for better. More importantly, and the point I had hoped to make, we must remember that mammograms SCREEN. They DETECT. They don’t treat, cure or, on their own, save lives.

      Thanks again for your wonderful perspective!

      Reply

      • Elaine
        Sep 14, 2012 @ 13:05:48

        Thank YOU, Lori, for blogging and speaking out. We all agree that there is too much BC and that prevention is the goal. Best, Elaine

    • Marjorie Gallece
      Sep 14, 2012 @ 18:58:23

      No matter how strong or sensitive mammography or any imaging modality becomes, it does NOT predict or prevent how that detected cancer will respond to treatment. The myth that early detection will somehow change what cancer cells might do in the human body is a myth that needs to stop being perpetuated. Look beyond the 5 year data and start looking at the 15 year data. Early tumors can be just as deadly. The truth is not pleasant but no progress will be made until we face it and tell it.

      Reply

  4. Scorchy
    Sep 14, 2012 @ 12:55:37

    RAGE!

    Reply

    • DrAttai
      Sep 14, 2012 @ 14:24:06

      Thank you for posting this! I’m attending the ASCO Breast Cancer Symposium in San Francisco and just did an interview for the local San Francisco news http://www.ktvu.com. The station and the patient have been flooded with calls in support of the patient. They will run the story on tonight’s 10pm local news (and they live-stream their broadcast).

      Reply

      • chemobrainfog
        Sep 15, 2012 @ 00:19:07

        YOU were SPECTACULAR! Lori’s blog made a guest appearance…. and I think I may have seen “my blood is BOILING” float across the screen, too. Well done BOTH of you!

  5. Nancy's Point (@NancysPoint)
    Sep 14, 2012 @ 17:29:20

    Lori,
    Thanks for posting. You are truly making a difference!

    Reply

  6. ButDoctorIHatePink
    Sep 14, 2012 @ 18:48:40

    Okay, so before the rage starts, I (as a person with metastatic breast cancer) have a few questions. This woman describes herself as tough and brave. I have no doubt that’s true. But, she has been off work since June and apparently has had no treatment? Why has she used up all her sick leave so quickly? If she has had treatment, why haven’t they mentioned it? This is a story designed to tug on your heartstrings, so they would have said she was home doing chemo or something – they didn’t.

    Second, her treatment seems to consist only of a mastectomy, which leads me to believe that she has a very early stage cancer, Stage 0 or Stage 1, which is NOT life-threatening. The fact that something may become life threatening (or not) somewhere down the road, does not make it life-threatening now. NOBODY died of DCIS. Everybody who dies of cancer dies of Stage IV cancer, like I have. Only about 20% of early stage women become Stage IV and only about a half a percent of women with DCIS end up that way (and that’s probably a generous figure).

    I have been on catastrophic sick leave, when I had to have half my liver removed due to cancer invading it. It does cost money for the city/company, it doesn’t just come out of other people’s pockets. They do need to save these things for people – like me – who actually DO have a catastrophic illness. So far, this lady does not seem to. Seems like she used up her sick leave and now wants more on the taxpayer dime.

    For the record, I worked for 3 years after my cancer diagnosis, 2 1/2 years on chemo. I did take time off for surgeries but I worked up until the day of my surgery, I didn’t take months off before. I had half my liver removed and didn’t need four months off. A mastectomy is not that difficult a surgery; I’ve had one.

    Of course, my heart goes out to any woman who has cancer and anybody who has to deal with this awful disease. But there are questions about this story and until I know the answers I”m not going off on the city of San Francisco – who by the way, are very liberal on their sick leave policies.

    When news stories report things in this manner, they are using you to try to get rage going, to try to make you feel something. There are zero facts in that report, it is all heart-wrenching stuff. “Mom, firefighter, breast cancer, mastectomy, denial” with absolutely nothing about the facts of her disease, why she’s been off, why she was denied, etc. So please use logic before emotion when responding to this story.

    Reply

    • Lori
      Sep 14, 2012 @ 23:47:42

      Hi Ann, thanks so much for your comments. I appreciate the perspective that there is more to the story than we can get in a brief TV interview, but I’m not sure it’s fair to make assumptions or fill in the blanks. There is every chance Janette has undergone other treatment (I did neo-adjuvant chemo myself) and no evidence that she was diagnosed at Stage 0 or 1. We just don’t know. And in the absence of that information, I am more comfortable relying on the 700 of her colleagues who felt it worthwhile to give of their own sick leave than I am reading between the lines.

      As for mastectomy not being a difficult surgery…the team of doctors who were with me through my 13 hours surgery and the family and friends who sat at by my hospital bed for 6 days while I recovered would probably disagree. Everyone’s journey is a challenge… I’m so very sorry for all you went through, and for all that any of us with mets will endure, but I’d like to think we are here to support one another, not one-up each other.

      And finally, I do think my thoughtful and clearly articulated comments about the negative impact of the pink ribbon culture were all quite logical…. Logic and compassion are not mutually exclusive.

      Reply

  7. Jan Baird Hasak
    Sep 14, 2012 @ 19:05:41

    I can’t believe these myths. Especially the one that says no one dies from breast cancer anymore. Can you say denial? Yes, my blood is boiling. The very nerve! and in San Francisco, the heart of sensitivity, of all places! xx

    Reply

    • Lori
      Sep 14, 2012 @ 23:25:59

      I was surprised about that too, Jan. Obviously there may be parts of the story we’re not hearing…but anyone who says breast cancer isn’t life-threatening just isn’t paying attention! Dr. Attai gave a great interview tonight. Let’s hope it makes a difference!

      Reply

  8. Pinkunderbelly
    Sep 14, 2012 @ 19:11:45

    I’m speechless. This is shameful. I’d never before made the connection between the pink rhetoric and a woman’s treatment options, and if the “early detection” brigade allows our treatment options to be truncated, we are in big trouble. I’ll be following Janette’s story, and my heart goes out to her and her family. A BC diagnosis is stressful enough without bureaucratic nonsense to boot.

    Reply

    • Lori
      Sep 14, 2012 @ 23:31:17

      I agree Nancy….this is scary for Janette, but also scary for all of us. The rhetoric is beginning to obscure the message. When breast cancer becomes a celebration the seriousness of the disease is diminished. The more I think about it, the more angry I get. I’m sure you’ll be hearing more soon!

      Reply

  9. chemobrainfog
    Sep 15, 2012 @ 00:09:08

    I am reading through these comments after seeing the piece on the local news just a little while ago. My comment now is for but doctor I hate pink….

    Ann….. you know I love you and I know you have had an exceptionally rough time over the past several months. I think the bigger point here is not about comparing surgeries but about all of the circumstances.

    I live in NY. I have always known there was a brotherhood among firefighters. Having just watched the 9/11 memorial ceremonies at the World Trade Center site, I am reminded of that brotherhood so all of this is fresh in my mind. The “brotherhood” among firefighters that is like nothing I have ever seen. WE, those of us with breast cancer, share a bond. Some of us feel that bond very deeply. I have never presumed to understand what it means to deal with metastatic disease. I do whatever I can to step in and help however I can….. but no, I do not understand what it means to live on borrowed time. I empathize the best I can.

    What I can state without hesitation, our bonds pale in comparison to what is shared among our firefighters. They live together for days at a time. Three days on, two days off. The firehouses truly are homes. Add to that the nature of the job and perhaps it provides a small glimpse into how such deep bonds are formed. These men and women are running into burning buildings and counting on their “brothers” for their safety…. for their lives.

    The fact that these firefighters were willing to step up and donate their time is not surprising to me. It’s the nature of their brotherhood. If someone is willing to give their time to another, I don’t see where the city of San Francisco has ANY RIGHT to stop that from happening. Here’s why.

    First of all, this woman has two small children. No, we do not know where her cancer has been staged. However, when I was diagnosed (with a stage 1 invasive lobular… or stage 2…. ) I had more doctor appointments and tests than I can even count crammed into the period of time between April of 2006 and September of 2006 when I finally had my mastectomy. My kids were in college. If I were still a taxi-mom, dealing with homework and after school activities, it would have been impossible for me to keep up with the doctors, my kids AND a job. Something would have had to have been removed from the equation. Logically, it would have to be the job. Perhaps this woman is in the same situation. I don’t think it’s fair to judge her circumstances based upon the severity of her illness. It’s a simple function of only having so many hours in a day.

    I understand your surgeries were far more difficult than a mastectomy but ***for a firefighter*** it presents a very big issue. Ditto working through chemotherapy. Firefighters must be in excellent shape or OUR lives are on the line because they can’t perform properly. It’s a bit different for this woman than it was for me working at a desk primarily from my home. Her work is physical and rigorous and dangerous. She will need to fully heal before she can return to work–for the safety of those she is being paid to protect, for the safety of those she works with and for her own safety, too. This surgery IS a big deal and it will likely be many MONTHS before she can engage the muscles necessary to perform her job safely and effectively.

    I understand why this may have upset you, but I don’t think it’s up to any of us to judge her circumstances or to question the kindness of her “brothers.”

    Reply

  10. Marie Ennis-O'Connor (@JBBC)
    Sep 15, 2012 @ 01:50:11

    Speechless….

    Reply

  11. ButDoctorIHatePink
    Sep 15, 2012 @ 12:07:44

    My point is the media gives no facts – they just try to stir emotion. And, everybody falls for it. We are all reading our own situations into this woman and maybe your read is wrong? There is NOTHING but the words “breast cancer” to hang your hats on. For all you know (and what is likely) is that they offered her a desk job for the duration.

    AnneMarie, you say, “If I were still a taxi-mom, dealing with homework and after school activities, it would have been impossible for me to keep up with the doctors, my kids AND a job.” It wouldn’t have been impossible though because I did it, as have millions of women. I have kids, I had a job, I had a zillion appointments. You can do it. I did it – that’s what sick leave is for. You take 2 hours off work, pick the kid up, go to the doctor, take your 2 hours of sick leave. They are probably in daycare, so you make your appointments while in school or daycare – It adds up but why take 4 months off when you know you need that time down the road?

    The other point here is this is public funds. Not private money. They aren’t taking up a collection, giving it to her and the city is trying to take it away. Catastrophic sick leave is still public funds. I gave a day at the beginning of the year, as did everybody who wanted to participate. Then if you get a catastrophic illness, you can use those days -with pay – for an extra three months. It still comes out of the California Budget – it comes from the fire department budget. It isn’t a donation TO HER. If they start giving that extra leave to everybody who doesn’t have a catastrophic illness, than their budget won’t be able to function. Everybody is going to be taking it. Hell, even the flu can lead to death, you know that right? Unless she was diagnosed Stage IV, she doesn’t deserve public funds for catastrophic leave. She got four months sick leave and used them before treatment even started. That was her time. Now she has to go unpaid.

    And, if she was Stage IV, why aren’t they using phrases like “dying mother.” You know they would, to manipulate you even more.

    I’m not heartless, I’m just practical. I am the laziest person in the world and if I could make it to my appointments, take my kid to Science Bowl, Speech & Debate, friends houses, hold down a job and make dinner for my family, so can a strong and brave firefighter.

    And, just because I have cancer too, doesn’t mean I must feel sorry for her. Right now, I feel sorry for the State if Ca and the City of SF. Until I hear further facts, that is.

    Like I said, so far, we don’t have any facts, and yet people are hysterical.

    Reply

    • Lori
      Sep 15, 2012 @ 14:42:32

      Ann,

      Just as you correctly urge us not to read our own facts into Janette’s story, it’s important that you follow your own advice. You may have been super-woman going through treatment, but not everyone can be. And you invented the idea that they offered her a desk job as well… As I said earlier, there are lots of missing pieces to this story, though I would argue the letter from the city deny her request is more than just hearsay. I choose to continue to believe in the best of people until they have proven themselves undeserving, and hope the City of SF will do the same. I simply do not agree that “…(u)nless she was diagnosed Stage IV, she doesn’t deserve public funds for catastrophic leave.” That sounds remarkably harsh to me. Without the facts, NONE of us are in a position to judge.

      As for being “sick enough” for catastrophic leave…I really have to take issue with your comments. Stage IV is meaningless in this regard. Someone needing extra leave has to be evaluated on the merits, not told her cancer isn’t “bad enough” yet. I have been living with cancer for nearly 11 years, I’ve probably had mets for 3, and been diagnosed at Stage IV for a year now. I am UNBELIEVABLY lucky that right now my disease is stable and not yet debilitating. I thank God for my doctors every single day in that regard. But I suppose means I’m not sick enough to be part of the “mets club” either…

      I don’t think anyone here is hysterical. I think many of us feel for Janette and hope that she gets the support and care she needs at what we remember as a trying and tumultuous time in our own lives.

      Finally, thanks for sharing your contrarian opinions; I’m sure your experience in school administration has informed your view, but our difference are what makes the world go round!

      Reply

      • jelebelle
        Sep 16, 2012 @ 09:47:27

        If I may interject as well….
        Stage 4 isn’t a death sentence. I’m stage four and saddened by your comments. As well, it seems there is a lot of anger in your words. Ann, I hope that you can muster compassion for other people in our situation, if not than why fuel this already heartbreaking journey with such fire. Some people simply have less energy than others. Some people, though strong still have trouble with balancing the demands of healing.

      • Lori
        Sep 16, 2012 @ 12:30:33

        Beautifully said…thank you for your comments.

  12. ButDoctorIHatePink
    Sep 15, 2012 @ 12:28:42

    Oh, and maybe it’s because I worked as a high school secretary that I’m skeptical of stories like these. I’ve been on the other end. At one school, the dress code stated no odd colored hair (this was a few years back) and a girl had dyed her hair pink. She got called to the office. The principal was going to give her a week to wash it out, that was her entire “punishment.” But, while waiting in the office, girl called her mother, her mother called the media, and before the girl ever had spoken to the principal, they were reporting that the girl had been suspended and there were TV cameras on campus. On the news that night, there were hysterical, sad rants from the college-professor parents about the state of education today (the girl AND they signed the dress code rules) and her suspension – and was the school allowed to even say, “hey, she wasn’t suspended, she wasn’t even in trouble?” No, because we are not allowed to mention students and the media didn’t care. It played out exactly the way the parents wanted it to play out and the girl became a famous media star on campus, very popular. She, by the way, was a D-F student who had been in trouble before.

    The next day, I answered a zillion phone calls from people all across the country (it went national) screaming at me about how awful our school was for suspending that A student little girl over something silly like pink hair. The media had stirred them all up and they didn’t know the real story – she was never going to be, nor had she been suspended for having pink hair.

    I have been involved several times when the media is called, and they don’t care to report both sides of a story. It’s unimportant to them now, if this woman chose to use her time off knowingly ahead of surgery, if the fire department has offered accommodations that she hasn’t mentioned, if it’s in the contract that you have to have a terminal illness to use catastrophic leave – none of that will be mentioned if it doesn’t show the story exactly the way they want it to be shown – which is to make you all mad.

    It’s almost October and it’s time to fire up the pink community.

    Reply

  13. DrAttai
    Sep 15, 2012 @ 16:20:15

    It was my understanding that since Janette was going to use sick leave donated by her co-workers, it should be budget-neutral for California. I have emailed the reporter who interviewed me for the story, and will post his response as soon as I hear back.

    Reply

    • Lori
      Sep 15, 2012 @ 18:41:10

      It would be GREAT to hear back from the reporter! There are always unanswered questions in these situations, but as I said earlier, I feel my role, and the role of the #bcsm community, is to provide support where we can!

      Your interview was great! Thanks for keeping all of us informed…

      Reply

  14. Jody Schoger (@jodyms)
    Sep 15, 2012 @ 17:01:10

    Maybe we should call Janette. I’m serious. As a community of advocates we are more motivated to accurately tell her her story.

    And Lori, what a fabulous job to bring this to our attention and keep the ball rolling. If there are questions left to answered then let’s find the answers.

    You’re awesome.
    jms

    Reply

    • Lori
      Sep 15, 2012 @ 18:40:02

      Thank you, Jody. I reached out to Janette on FB, offered to introduce her to #bcsm and any help I might personally provide. From what I understand, she has been inundated…but I do plan to keep this front and center!

      Reply

      • DrAttai
        Sep 15, 2012 @ 18:54:48

        The reporter who interviewed me also confirmed that she’s been just flooded with calls and messages of support. The story originally aired on the 10pm news on Thursday, and her phone started ringing shortly after. When I was interviewed around 2pm Friday, the reporter told me that Janette was just exhausted and overcome with emotion, which is why she was featured by telephone in the Friday story, and not an on-camera interview. I’m sure she had no idea that the story would raise this much support, but she clearly touched a nerve with this. While we all want to reach out to her, I’m sure she needs a little breathing room right now., as she tries to prepare for her upcoming surgery. I wish her well.

  15. jelebelle
    Sep 16, 2012 @ 09:40:37

    I had early detection of my BC while I was pregnant, took barely two weeks off and regret it as now I am in the full throws of stage 4 mets, can’t work, can’t move, can’t swallow, can’t care for my baby alone. So let the woman heal. Who are we to judge one journey from another, compare our capacity to work with another’s experience? I feel it is extremely short sighted to assume she just decided to randomly use her sick time on other things. I had used a few of my days, how the heck was I supposed to know at the start of the year that I was gonna need them for BC surgery in June? Really? I think accepting the kindness of coworkers should be easy….Which wouldn’t come out of taxpayers pockets, that money is already there.
    I was blessed with great and understanding employers, she has to not only deal wth being a mom with BC but other people’s one sided opinions of her life. Booo. I understand the blown up media issue but the comparison to hair color & BC seems a bit off to me.
    Thanks for sharing the story. Best of health to you.

    Reply

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