‘Hell and Back’

Do we really need another book about a cancer survivor describing her trials and tribulations?

Hell yes, we do, and the book “Hell and Back: Wife & Mother, Doctor & Patient, Dragon Slayer” is more than just another book on the topic. It helps cancer survivors and their loved ones to navigate the complex issues of a breast cancer diagnosis and treatment. Written from a physician’s and young mother’s perspective, “Hell and Back” provides insight into the medical issues but also peels back the emotional side and the day-to-day logistics of dealing with cancer and its aftermath.

As both a young mother and a medical doctor, Tali Lando Aronoff (known professionally as Dr. Tali Lando) had some unique challenges, but she also tackled issues common to all cancer patients and their families.

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Dr. Lando, 42, who lives in New York’s Westchester County, is privileged to have access to top medical care and the support of her husband, Alex, and the very involved Jewish community. Both of those helped her deal with many situations she encountered, but also presented her with special challenges. As a medical doctor grappling with a serious disease, she admits that she was not always the easiest of patients. And having a supportive community was a boon, except when there was too much of a good thing, and she needed some privacy. She lays out her challenges with candor and some humor — and there were many challenges and great need for a sense of humor.

“I found a lot of things to be ironic and funny,” Dr. Lando said. “There are dark times too. There’s a big mix when you’re going through a major life change.”

Tali Lando Aranoff was diagnosed when she was 37, just months after the premature birth of her third daughter, and eight days after learning that her father had terminal brain cancer. Imagine having a premature baby, a father with malignant brain cancer, and a lump in your breast, all within months. This is what Dr. Lando faced five years ago. Talk about a full plate.

Her tale drives home the point that any woman, at any age, is at risk, and you cannot predict who and when breast cancer will strike. One in eight of us, that is 12 percent of American women, will develop breast cancer.

In the wake of this tidal wave of stress, Dr. Lando had no choice but to battle all those dragons at once. They say if you want something done, give it to the busiest person you know, and Dr. Lando was just that person. In addition to being mother of three little girls — the oldest was 4 —she was working full time as an otolaryngologist — a pediatric ear nose and throat doctor. So this very busy mother, wife, and physician took on new challenges of her own cancer treatment, while overseeing her father’s medical crisis and her three small children.. She also took the time to write, composing sections of “Hell and Back” as she experienced the journey through diagnosis and treatment.

“I always loved to write,” Dr. Lando said. “And I had insomnia from the steroids,” which gave her time to fill. In the wee hours of the morning she perused Netflix’s collections of compelling TV series but also spent time documenting her experiences, blow by blow. “The first time something surprising happened I started writing. These things kept happening. I realized I had a story to tell.” She started by emailing her experiences to a few close friends. Writing about the challenges of cancer therapy helped her get through rough times. “It was cathartic,” she said.

“I kept writing about little vignettes — things that were happening. Three things kept me functioning during chemo. First, I used writing to get out of the house. It helped me feel I did something purposeful.

“Another huge project was designing and building a home,” she continued — she was talking about her dream house in White Plains, N.Y., which was completed just before her father died. And the third focus of her life “was what was going on with my father — his appointments” and his other needs, medical and otherwise.

Alex pitched in with care of the children and just about everything else that was needed, Dr. Lando said. “He handled all middle of the night wake-ups and feeds” when she was not strong enough, she writes. He encouraged her throughout the ordeal, rooting for her with “You can do it, babes.” Alex’s support was critical to Tali’s ability to juggle all the complexities of the life of a young mother with cancer.

The book was 30 percent written when she finished treatment, Dr. Lando said, “but when I finished chemo it was too raw, and I couldn’t deal with it.” It took time for her to process the experience and regain her strength and stamina. “After a year and a half I was coming back to myself, with the belief that I was going to be okay.”

That’s when her chief resident called and told Tali that she had also been diagnosed with breast cancer. She’d had twins within that year. As Dr. Lando recounted in “Hell and Back”:

“She was lost and petrified because she didn’t know what to expect. Instead of explaining over the phone, I found myself emailing her weekly installments. She said it helped her to feel more prepared. As humans, we crave connections through common experience, the comfort of hearing someone say, ‘me too.’”

“I thought maybe I could help busy working women who are trying to deal with it all,” Dr. Lando said. “I started really writing again.

“The subject matter has been talked about so much. But I felt I had a difference perspective to share, a doctor/patient perspective.” She wanted to reveal “elements of what people don’t say.”

Dr. Lando reports the blow-by-blow steps from first discovering the lump in her breast, to receiving the news that it had spread to her lymph nodes. And as a young breast cancer patient she had to consider genetic causes. She needed to know, “Do you have THE gene?” referring to the BRCA mutation found in 1 in 50 Ashkenazi Jews. In the book she confesses “Every time I gave my girls their baths, I couldn’t stop looking at their adorable little nipples and thinking of them as ticking time bombs that I needed to defuse.” To her relief, the test was negative for the BRCA mutations, meaning that the girls were not at risk for inheriting that cancer gene.

But she still had to explain the situation to her girls. Their mother was very, very sick through surgeries, chemotherapy, and radiation treatment.

“They were 5 months, 2 and 4 years old, very young, not aware enough to be scared,” Dr. Lando said. “I was really honest with them. They were part of the reality… Now I talk to them about when I had cancer.”

Dr. Lando covers many topics from her journey through cancer treatment, in short, easily digestible chapters, covering everything from talking to small children about cancer (“A Boo-boo in My Boobies”) to talking about death (“Mocking the Grim Reaper”).

In the book she recalls a Chanukah celebration with her family, where she mixes her laments with a healthy dose of optimism. “Trying to celebrate the Festival of Lights is rough when you’re smack in the middle of Cycle 4 of Adriamycin,” she writes. Turning the scene around to more positive notes, Dr. Lando recalls, “Amidst lively discussions of figure skating competitions, battle of the bands and slam poetry, I could almost believe that none of it had ever happened…. Everything was OK. I lost myself in that sweet thought for a minute as I watched all the cousins play together.”

Dr. Lando sensitively approaches some compelling issues husbands have to face in “What About the Husband?” Alex, who probably could write his own book on being the spouse of a cancer patient, is a hero of the story. “He’s super cool that way and never fell to pieces even when I needed to verbalize my scariest thoughts,” she said. “I must hand it to the guy — he doesn’t spook easily.”

In “Broken and Bald,” Dr. Lando reports on her lowest point in the battle. “I was a patient myself, timid and weak, slightly broken and completely bald…. I believe most people undergoing treatment for cancer reach this same place. This is The Lowest Point. It is the depth you just cannot see your way out of when the waves are crashing above your head and you are drowning no matter how well you can swim… It is the time to finally ask for professional help.”

The tough road of reconstructive surgery is tackled in several chapters, including informative discussions of nipples and implants. (“Gummy bear implants…maintain their shape even if the implant shell breaks.”). She shares the Evite invitation to her pre-radiation celebration arranged by her close friends, “Come celebrate with Tali and her ‘new girls.’ Let’s get radioactive before she does.”

The first steps in Tali’s journey back to normalcy were darkly shrouded by the loss of her beloved father, Dr. David Lando, a prominent physical chemist and ordained rabbi. “While he began dying, I was starting to return to the business of living…. While I was regaining my strength and the faith that I would live, I raged at God for stealing his.”

She continues, “I remained standing because I was anchored by the needs of my very young family. Moving forward wasn’t bravery; I simply had no other choice.”

Dr. Lando moves forward every day, continuing to grapple with uncertainty. “The scary thing about breast cancer is you never felt bad, so you never know if something is brewing,” she said. “Initially I was given really scary statistics. Stage IIIC cancer has a very high risk of recurrence. I was told the risk is for decades.” Fortunately, she reports, five years out, “I have no evidence of disease.”

Meanwhile she finds immense satisfaction in her medical career, her growing family and supportive husband, and from her book. “People reading it say it helped their family and friends to understand how to be there for the patient,” she said.

“I just called a pediatric surgeon, and at the end of the call he said he wanted me to know it’s really helped him deal with his mother and sister, who both have cancer. Seeing me and knowing me helped him to see how you come out from the other side of this.

“It is helping patients — young women with busy lives, and people who need to deal with others going through this,” she added.

When she first was diagnosed, Dr. Lando did not reach out to Sharsheret, the Teaneck-based organization that supports young Jewish breast cancer patients. “Because I was a physician I felt I had strong support,” she said. “I didn’t feel at the time I needed a support structure.” In retrospect, however, she saw that Sharsheret would have helped her. “I think I was very wrong,” she said. “They would have helped get me through some rough patches.” Now she has made connections with Sharsheret and plans to serve as a peer supporter for the organization, helping other young women navigate the challenges of breast cancer.

Tali Lando Aronoff is living life with a “new normal,” which includes 10 years of treatment with the anticancer drug Tamoxifen, and lifelong monitoring.

“Cancer changed me profoundly, physically and emotionally,” Dr. Lando wrote. “My short hair makes me feel brazen, like a strong female warrior ready for battle.”

Information on “Hell and Back: Wife & Mother, Doctor & Patient, Dragon Slayer” (Archway, 2018) is at www.hellandbackbook.com.

Dr. Miryam Z. Wahrman of Teaneck, the Jewish Standard’s science correspondent, is a professor of biology at William Paterson University of New Jersey and author of “The Hand Book: Surviving in a Germ-Filled World.”