In the Mountains, I am Free

by Nicole SmithSurvivor, Papillary Thyroid CancerFebruary 8, 2022View more posts from Nicole Smith

The golden sun warmed the brown and gray mountains. Short alpine grasses leaned into the wind and reached for oxygen at the high elevation, always finding a way to bloom. I was sitting in the passenger seat of my mom’s car with the windows rolled down, so I could take in the sweet smell of pines and the crisp Colorado air.

We drove up to the top of Trail Ridge Road in Rocky Mountain National Park, probably my favorite place on earth. We didn’t stop much, and when we did, it wasn’t for long. I had surgery less than a week before and couldn’t hike for miles like I usually would in this place.

All week I was practicing breathing deeply to recover from anesthesia and intubation. Being here, out in the mountains, it was like second nature. There was something about watching the light change on these huge, solid formations and noticing the shape of rocks shift as we drove that made it so easy to just be. These mountains have been here for hundreds of years, changing with the weather but always remaining the same underneath.

I wasn’t expecting to be diagnosed with cancer. I found a lump in my neck earlier that year, but didn’t think anything of it. At 24, I was young and naive — I still felt invincible. A biopsy over the summer showed no evidence of disease. The doctors told me there was still a small chance the tumor could be cancerous, but they wouldn’t know until surgery. The plan was to have the left lobe of my thyroid removed and keep the right intact, to continue doing the organ’s job. While I was still under anesthesia, they sent the tumor to the pathology lab and immediately knew they’d be going back in to remove the other lobe of my thyroid. It was cancer after all.

I was diagnosed with papillary thyroid cancer, something physicians assured me would be easy. “We already took out your thyroid, so now you just take a pill for the rest of your life and go back to normal.” It seemed like my cancer journey was done before it even started. That was fine with me, and I was eager to get back to normal.

Two months later, I was back in the mountains. A few days after Christmas, my family went on a short hike at a nearby state park. The red foothills dipped into the deep blue water of the reservoir. The ground was so dry and sandy that it looked like another planet. I was waiting on a call from the endocrinologist. My tumor was large, slightly over the threshold of 4 centimeters, making me at higher risk for metastatic disease.

Getting outside and away from all the doctor’s offices was a relief. I was new to this world, and it was overwhelming. There were big decisions to be made, and I wasn’t ready. I thought this was supposed to be simple after surgery. I thought the cancer was gone and the hardest part was over. It was a welcome escape to walk across the rocks along the edge of the water with my siblings. For a little while, I was almost able to not think about treatment.

It was there on the edge of the water that I got the call. My mom grabbed my hand as I spoke to the nurse. The doctor wanted me to proceed with the next step: radioactive iodine treatment. This is a targeted treatment for thyroid disease. I would starve my body for iodine for two weeks, making any remaining thyroid cells hungry to eat up the radioactive iodine, ultimately killing them off. It’s a common treatment for thyroid cancer, but there are risks involved, including infertility and secondary cancer from the radiation exposure. It was not a decision I was going to take lightly. I was already in the process of getting an appointment with one of the country’s leading thyroid cancer experts in Boston, where I moved before my thyroidectomy.

The endocrinologist reviewed the hard copies of my medical records I brought with me — operation notes, pathology report, blood work results, and ultrasound notes. She performed her own ultrasound and printed out a picture of my empty thyroid bed for me to take with me to Colorado. I did more blood work and her second, expert opinion was conclusive. I was headed for radioactive iodine treatment.

Radioactive iodine is a uniquely bizarre experience. I was handed a thick, steel cylinder with a vial containing one radioactive pill. The technician was in a hazmat suit and stepped back while I took the pill, careful not to let it sit on my lips or tongue for too long. Within minutes, my body began to absorb the material, and I became physically radioactive. When I got home, I headed straight for the basement of my mom’s house, where I had my own living space, kitchen and bathroom. I needed to quarantine for a week to protect others from the radiation my body was emitting.

I became restless and bored. The first morning, my salivary glands were swollen and ached, but otherwise I felt fine. I spent hours watching TV shows and working on puzzles and coloring books. But the best moments were when I could be in the sun. I would sit outside on a swinging bench, absorbing the rays and letting myself process what I had been through.

After a few days, my body shed enough radiation, and I could spend short amounts of time with my mom, as long as I stayed six feet away. We went on walks through the neighborhood. I relished the chance to be somewhere outside of the same four walls and to stretch my legs. She walked six feet in front of me and led me away from neighbors on the same path.

A week later, I was free to re-enter society. I needed to get outside, back to my mountains. My friend and I drove up through the winding canyon to Rocky Mountain National Park. We did a short loop around Estes Park, stopping for my favorite view of Longs Peak from Lily Lake. A few months after I was diagnosed, I got a tattoo of Longs from almost the same viewpoint. Life gave me a permanent mark I didn’t choose — my thyroidectomy scar. I decided to counter it with a permanent mark I did choose — my tattoo of the mountains, which were now with me every step.

Treatment went on fairly routinely for a while after radioactive iodine treatment. My endocrinologist did regular blood work and ultrasounds to monitor everything. At first, there wasn’t any concern about my thyroid levels. For many people, their levels drop off pretty quickly after radioactive iodine, but some people take more time. Maybe I was one of those people. After a year and a half, it seemed like there was more to the story. My levels were going down, but not nearly enough.

More than two years after diagnosis, a PET-CT scan revealed I still had cancer. It was likely a persistent disease in my lymph nodes that had been growing slowly since the surgery. Removing the surrounding lymph nodes is fairly standard practice for thyroid cancer, but my surgeon hadn’t expected to find cancer. It was hard for me not to think about what my treatment would have been like if I had picked a different surgeon.

I was headed for surgery again, this time a left-central neck dissection to remove the suspicious lymph nodes. My anxiety climbed as the operation loomed. This was in the spring of 2021, a year into the COVID pandemic. I was able to work from anywhere and needed to clear my head. I reached out to my friend Maggie, who had been working remotely from her parents’ beach house periodically since March of 2020. I packed up my work laptop and beach clothes and made another escape into nature.

I spent two weeks there, letting my thoughts roll with the waves. It was mid-March, before most people returned for the summer surge. Oftentimes, I had the beach to myself. Maggie’s dad had throat cancer years before, and she always asked thoughtful and genuine questions about my cancer journey. Most evenings after we shut our laptops for the day, we would grab beers and beach chairs and spend hours sitting on the sand — sometimes chatting, sometimes letting the sound of the waves soothe our thoughts.

The day of surgery came, and I couldn’t wait to have drugs in my system, softening the world. I was so nervous and ready to be on the other side, recovering. I vaguely remember being moved into the operation room and onto the table. Then, it was over and I was waking up. Before I had the chance to speak with my surgeon, I was already flooded with relief. I slurped up several watermelon popsicles, enjoying the simple fact it was over with.

Surgery went better than expected. The surgeon removed 19 lymph nodes, six of which were positive for cancer. One of them was about 2 centimeters, half the size of my original tumor. It had not shown up on the PET-CT scan, and I was so grateful my surgeon was able to find it and remove it. My levels plummeted after surgery and an enormous weight lifted from my shoulders. The burden of uncertainty grew steadily since my diagnosis, and I didn’t realize how heavy it had become until it was gone.

While I was recovering, I relied on walks through the neighborhood to exercise my lungs. At first, the walks were short — to the end of the street and back, then down a few blocks and back. Then I was taking long walks, up to an hour without needing to stop. I wanted more. I was feeling stronger and had a lot to celebrate, but also a lot to process. I needed the mountains again.

I packed up my tent and sleeping bag and drove north to the White Mountains for a night of camping on my own. Since I moved to New England, I wanted to see the waterfalls at their highest volume in the early summer.

I sang along to my favorite songs on the drive — a celebration of the fact that my vocal cords were unscathed by surgery. I did a few small hikes along creeks, water pouring over the rocks and down into the valley below — a celebration of how strong my body was, how much it carried me through over the last few years. I set up my campsite, journaling by the fireside — a celebration of how much I had grown since diagnosis, all the ways I learned how to deal with what came my way.

The golden sun filtered through lush green leaves and sparkled off the babbling brooks next to the trail tracing up the mountain. The water was inviting and cool, sliding over a bed of slippery rocks. Early wildflowers were finding their way through the grass and trees, splashing color at the base of the green and blue landscape. I was still climbing, in many ways much stronger than I had been before.

featured photo by Nicole Smith

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