Intersection of Visible & Invisible Disability: Life with Cerebral Palsy & Metastatic Breast Cancer

“Best to institutionalize her. She has no rehabilitative potential.” This is what a neurologist told my parents 47 years ago, after I’d failed to meet developmental milestones related to movement. I was diagnosed with cerebral palsy (CP). In a moment that changed the trajectory of my life, my parents found me a different doctor, a doctor who recognized my full potential. CP is a developmental brain injury that has gifted me with garbled speech, abnormal walking, and reduced fine motor skills. My disability is obvious to people who meet me. They may not know the name “CP,” but they know there’s something up. Often, they assume I am not intelligent or capable.

Growing up, school was a great opportunity for my intellectual growth, and for teaching me how to live with an obvious disability. Particularly at my transitions – starting at a new elementary school, moving on to middle and high schools – I learned the importance of educating others about my CP. Education was the key to acceptance. My mom would come visit my class after I’d moved to a new school. We would tell the story of my life with CP: the multiple muscle and bone surgeries I’ve had to straighten my legs, the frustration of not being able to speak clearly, and the reality that I’m not much different than other kids. Each time we offered one of these educational visits, my life at school rapidly improved. Kids stopped teasing me. I made more friends, and felt less lonely. People simply got it. I became more outgoing, more involved in school activities.

My everyday life with CP is quite ordinary. I take out the trash. I do laundry. I sleep late on weekends. To me, my body is normal, my life is normal. My speech sounds perfectly clear in my head. I’ve built a life convincing people that my visible and audible “impairments” do not affect my intellect, my potential, or my freedom. These simple facts seem to mesmerize many folks.

I went to college, then graduate school, usually being the only student in class with an obvious physical disability. I earned a PhD in neurophysiology – the study of how the brain works. Now, I run a research laboratory at an ivy league institution in New York. The goal of my lab is to develop innovative interventions to help people with CP optimize fine motor skills. Together with many wonderful colleagues, we have made substantial gains in understanding how the brain controls movement in people with CP, from which we can build more effective interventions. Not only do I strive to help kids improve their movement, but I also hope to show them and their families that they can live happy, generous, exciting lives. I want kids with disabilities to know that even if society judges them for their visible disability, they will derive abundant joy from proving people wrong.

Then, in July of 2018, I had a sudden bout of severe back pain. After a couple months of inconclusive medical testing, I was diagnosed with metastatic breast cancer (MBC). Before a tumor was visible on a mammogram, breast cancer cells had found a home in my spine. As a friend with MBC characterizes the diagnosis: do not pass go, do not collect $200. Now what?

While early stages of breast cancer are curable, MBC is not. It is terminal. As my wonderful oncologist described it, once cancer cells metastasize beyond the breast, we MBC patients have “cancer dust” forever circulating in our bodies. Eventually, these dust bunnies claim eminent domain over our organs. Thus, we must be on strong treatments for the rest of our lives. The average longevity of a person with MBC is about 2-3 years, although many live longer.

I’m very lucky. I’ve already beaten the odds. MBC treatments do not cause some of the stereotypical chemotherapy side effects. I haven’t lost all my hair, and I haven’t lost weight. MBC isn’t throwing me any bones. My MBC is mostly invisible from my appearance, but on the inside, I struggle with joint pain, nausea, fatigue, and more. On one treatment, I lost my fingerprints. My medications make it even more difficult to speak clearly, which further isolates me, when there’s so much I want to say.

I’m now in a world that contradicts the lessons of my life with CP.

Quite the conundrum. I’ve spent my life proving to people that my disability does not affect my intellect or potential. CP is a highly visible disability that doesn’t much impact my quality of life. MBC is an invisible, terminal condition that affects multiple aspects of my life.

Christine Miserandino popularized the “spoon theory” description of life with chronic illness. Energy is represented by spoons. Let’s say that a healthy person has 30 spoons of energy per day. Dressing and showering may take two spoons, a workday may take ten spoons, and so on. People with health challenges might only have 10 spoons per day. We have to make careful choices about how we spend our spoons. If going to a doctor appointment takes five spoons, then we have to figure out how to accomplish the rest of our day with only five spoons left.

I’ve tried to use my favorite childhood tool, education, to improve my relationships while living with MBC. I’ve educated people about what my diagnosis means, my prognosis, my treatment plan, and my needs. However, some don’t believe it – “But you look fine!”

MBC is isolating. Not to mention that I’ve now spent more than half my diagnosis in a pandemic, exacerbating the loneliness. In my work, I continue to write grants for projects I may not live to complete. I feel driven to make as big an impact as possible in the world, knowing that my window of opportunity can close at any moment. I want to be remembered as the “cool aunt” by my nephews and nieces, though I’m their only aunt who doesn’t have a dog. It may be a hard sell.

I’ve maintained an active life after my MBC diagnosis. Nearly a year into my diagnosis, I earned my black belt in taekwondo. Still, MBC is a beast. When my MBC is visible to others, it is awkward – I think it’s a reminder of mortality. I’ve lost several meaningful friendships of people who, I’ve been told, can’t bear a front row view to my struggles. I get it, though it stings, as if their discomfort overrides their value of my friendship. With both CP and MBC, one thing I’ve known: my true friends are the real deal. Their love, acceptance, and good humor keep me afloat.

Here I am, needing folks to understand the severity of my MBC diagnosis, after spending a lifetime teaching people that my CP does not affect my abilities. This has gifted me with several lessons. Talking about health issues should not be taboo. Whether a person has a visible or invisible health issue, listen to us. Everyone is carrying struggles of some sort. Acknowledging our needs, our talents, and our mortality gives us all space to live authentically. We all deserve this sacred gift.