Cancer ran in Julie Switzer’s family. Her mother and both grandmothers had post-menopausal breast cancer. As a labor and delivery nurse and later an educator at MemorialCare Saddleback Medical Center, the then 50-year-old San Clemente resident got checked frequently for breast cancer and was often called back to do extra tests.Julie with her husband

But the imaging she had done in June 2020 turned her world upside down.

“They saw something … and then they had me come back,” Julie says.

The doctors found breast cancer that spread outside her breast duct.

The cancer was initially found on a mammogram, said Nicole Lewis, M.D., breast imager at the MemorialCare Breast Center at Saddleback Medical Center, one of eight MemorialCare multi-disciplinary breast care centers throughout Orange County with state-of-the-art technology including 3D tomosynthesis, DEXA bone density testing, breast ultrasound, breast MRI, stereotactic breast biopsy, and ultrasound-guided breast biopsy. Each breast center is comprised of caring and compassionate physicians and staff solely dedicated to the prevention, early diagnosis and treatment of breast cancer.

Thanks to Dr. Lewis’ findings and her persistence in seeking further testing, Julie’s cancer was caught early. Julie was diagnosed with stage 1 breast cancer because it had not metastasized to her lymph nodes.

Julie had a new area of architectural distortion in the upper part of the left breast. As part of her comprehensive workup at the breast center, an ultrasound was also performed. At the time of her ultrasound, a right axillary lymph node also appeared abnormal. Julie ultimately underwent a biopsy of the abnormality in her left breast as well as a biopsy of an abnormal-appearing right axillary lymph node. Once reviewed by the pathologist, we confirmed her diagnosis of left breast invasive ductal carcinoma as well as chronic lymphocytic leukemia (CLL).

Nicole Lewis, M.D., breast imager at the MemorialCare Breast Center at Saddleback Medical Center

Her CLL diagnosis was separate from the breast cancer diagnosis. CLL is a blood and bone marrow cancer. The cancer cells start in the bone marrow, but then go into the blood. The additional diagnosis of CLL was unusual as it’s rare to see a double diagnosis like this, especially since CLL is typically seen in the elderly population.

The dual diagnoses were not ideal. Julie and her husband Michael had just sold their house and moved. Their two children went off to college, only to return because the COVID-19 pandemic was sweeping the nation, virtually shutting the country down.

In an instant, Julie had switched roles—from nurse and caregiver to patient. Now she had to make sense of her diagnoses and treatment through the lens of a patient.

While Julie’s diagnoses were scary, she found solace in her two families, the one at home and the one at Saddleback Medical Center.

“It gives me tears thinking about all the things that everyone did (to help me),” Julie recalls.

When Julie was getting her follow-up breast MRI after her initial testing, she received a visit from Dr. Lewis.

“Dr. Lewis came to visit to see how I was doing after all the information she gave me and she connected me with navigator Jackie Hower,” Julie recalls. “Jackie said ‘now you’re going to do this and I got you this appointment.’ They cared and they were communicating and they were thoughtful beyond words.”

Jackie Hower, M.P.H., RT(R)(M), certified breast care navigator at Saddleback Medical Center, helped Julie navigate her next steps throughout her cancer journey and was there for any questions.

Julie’s colleagues were also there for support. When learning about her diagnoses, Julie’s managers Christine Huff, MSN-INF, RNC-OB, director, Women's and Children's Services and Brittany Grant, MSN, RNC, operations manager, Labor, Delivery, Recovery, Postpartum, sprang into action, organizing and communicating with others about Julie’s situation.

“I didn’t want to talk about it so much and I didn’t like attention, but then I would talk to Brittany, and she would say, ‘can I share this with people because they care’ and I said, ‘absolutely,’” Julie recalls.

When news of Julie’s condition reached others, she received an outpouring of support that blanketed her with a sense of security and comfort.

Julie’s colleagues went to doctors’ appointments with her, she received thoughtful gifts including a pampered night at a hotel for her wedding anniversary, and at the Saddleback Breast Center, they would hold her hand and ground her when she was apprehensive.

Julie remembers one night, during a hospital stay, when MemorialCare Saddleback Medical Center Chief Nursing Officer, Brandi Cassingham, brought food for her to bring home to her family.

Other colleagues also jumped in to help. Saddleback Medical Center Chief of Staff, Dr. Julio Duarte, and Dr. Ernest Hayward, offered to be Julie’s anesthesiologists during two separate surgeries and her breast surgeon, Nora Evans, M.D., FACS, FASCRS, prayed with her before her bilateral breast mastectomy surgery.

“It was an upheaval and a vortex of stressful things, but people doing all these things built this security net to hold me up through all of it,” Julie says. “And (there were) things I didn’t even know I needed like one of the nurses sent her son in because he worked as an aide in pre-op. She said, ‘go in to make sure she’s okay.’ He said, ‘I’m just coming in to see if you’re okay.’ Now he’s a nurse in our ER.”

Following her diagnoses of cancer in her left breast and CLL, Julie had had an operation with Dr. Evans to remove both of her breasts in July 2020.

“She had left breast cancer and she elected to have bilateral mastectomy, so the right side was prophylactic or preventative mastectomy, and the left side was for the cancer,” said Dr. Evans. “We did skin-sparing mastectomy where we saved all the skin envelope of the breast and we removed the breast tissue… At the same time, we performed sentinel lymph node biopsy removing the first lymph node(s) which are on a direct lymphatic drainage pathway of the breast, checking for spread of cancer cells to the lymph nodes. She had three lymph nodes removed and they were all negative for breast cancer spread.”

Immediately following the removal of her breasts, Julie had reconstruction by a plastic surgeon. In January of 2021, Julie had her final reconstruction surgery.

Today, Julie is doing well. To help prevent the cancer from returning, she is taking oral tamoxifen, an anti-hormone therapy given to patients with hormone-positive breast cancer as it reduces the estrogen secretion in the body. For the CLL, Julie will be monitored by her doctors.

Going through the patient experience affected Julie in many ways. She had a first-hand opportunity to experience the kindness and thoughtfulness of colleagues she knew and even those she didn’t.

Her experience made her introspective and in need of change.

She obtained her international certification for lactation consultant and is now back to work full-time at Saddleback Medical Center in her new role.

While the journey may have been unsettling at times, having her colleagues by her side enabled her to have a unique view of care at Saddleback from a patient’s perspective and that view was beautiful.

“To be a person on the other side of that, and not only just the group that I know, but other people in other departments that I don’t know, I still felt that (sense of community).” Julie said.  “I still felt that good teamwork and that kind, small things matter kind of mentality throughout wherever I went. It was really amazing."