Weekend to end breast cancer

Capt. Leslie Picht was about to fight the battle of her life against an enemy she couldn't see, but could feel.

The first battle shot was fired the night she performed a breast self-exam--her first--and discovered a lump in her right breast. She had just watched a television drama dealing with breast cancer.

"You know you're supposed to do it," said Picht, a KC-135 pilot with the 93rd Air Refueling Squadron at Fairchild Air Force Base, Wash. "That night I went to bed and did my first exam. The lump was large enough that any idiot would have found it.

"I had the normal flashes of death," she recalled of the discovery. "I sat there very upset and had these horrible thought processes. The next morning I went into the flight surgeon, and he said, 'Yep, that's a lump.'"

The captain had undergone her annual breast exam six months earlier while attending pilot training at Columbus Air Force Base, Miss. Nothing was found.

The flight surgeon at Fairchild referred Picht to a doctor in the general surgery clinic.

"Of course it's a Friday afternoon, and I couldn't get in until the next week, so I sat over the weekend with [more of] those bad thought processes," she said.

Her thoughts were made heavier by the fact her maternal grandmother had died of breast cancer at age 42. The captain was 29.

One thing she didn't think about was her career as an Air Force pilot.

"I was more worried about my health than my career," she said. "At that point, it wasn't 'I'm not gonna fly,' it was 'I'm gonna die.'"

Had she been thinking about her career, she would've remembered that day back in seventh grade when she realized she wanted to be an astronaut.

"Recruiting folks came to my school," the captain recalled. "My brain snapped, and I said, 'That's it, I'm going go to be a pilot. I'm going to go to the [Air Force] Academy. I'm going to be a test pilot, and I'm going to be an astronaut.' The whole agenda was just laid out."

Although the agenda didn't go exactly as planned, she was slowly fulfilling her goals. She graduated from Embry-Riddle Aeronautical University in Prescott, Ariz., and became an Air Force officer, but spent her first six-and-a-half years as a communications officer before being accepted for pilot training. After pilot training at Columbus, she attended aircraft training at Altus Air Force Base, Okla.

The battle begins

She arrived at Fairchild in late October 2000 to start mission qualification training and discovered the lump in early November.

Picht had an ultrasound, and a couple days later it confirmed a complete solid mass. The doctor recommended waiting a month to see if there were any changes.

On Dec. 13, doctors removed the mass and did a biopsy. "On the 15th I went in, and the paper with the results was upside down [on the desk]. I knew it wasn't good," Picht remembered. "[The doctor] told me it was cancer extending to the outside edges--there was more [cancer]."

The battle had just become a full-fledged war, and the enemy was playing dirty.

Picht, who's single, knew it was time to call in reinforcements.

"I immediately went back to the squadron and called my mom," the captain recalled. She told her mom the news and asked her to travel from Huntsville, Ala., to Fairchild as soon as possible.

"Again, it's a Friday so she has two days to pack for what we thought at the time would be six months," Picht said. "Kudos to her. Not only was she in shock, but she transplanted her whole life in the span of two days."

Picht started her own "war college." Her sister Jeanne, a lawyer, visited for two weeks at Christmas, and the three women learned all they could about cancer.

"We gathered as much info as we could so we could go to consultations armed to ask intelligent questions," the captain said.

Air Force doctors gave her the option of having surgery on- or off-base. She chose off-base treatment.

"Statistically speaking, success depends on how much experience a doctor has in a specific procedure," Picht explained. "And experience correlates to numbers, You can be the best general surgeon in the Air Force, but, statistically speaking, how much experience could you have with this, because how many women are in the military under the age of 35 with breast cancer? It's got to be small. And those women would have to go to the same surgeon for him or her to get the experience.

Picht believed her survivability would be directly related to the number of cancer-specific procedures a doctor had performed.

"I immediately said, 'I don't want it done here on base."

It was back to the library to look for the best cancer centers, looking up procedures, and reconstructive surgery options such as implants or using her own tissue. Because of her size, the latter wasn't an option because she didn't have enough fat.

"It was the only time in my life where being thin was a disadvantage," she said.

She met with a plastic surgeon about reconstructive surgery just in case. That was probably her worst experience.

"It was awful," she said. "There I was looking at these pictures in portfolios of folks who he had worked on. And to me the pictures were just awful. One, because I was still in shock, and two, because the pictures were of people who didn't look like me. I wasn't intelligent enough or in the proper state of mind at the time to recognize that a large percentage of these women were 60 or older. The older you are, the more scarring you're going to have because you don't heal as quickly.

"I told the doctor, 'I don't mean to offend you but these are hideous! We can send a man to the moon, but we can't reconstruct a breast?' Obviously I wasn't in the right state of mind. It was one of the few times I just cried."

Making progress

But she kept on marching and searching for the right surgeon. Fortunately, her research led to the leading surgical oncologist in eastern Washington, Dr. Ryan Holbrook. But he had to pass her test first.

This was war, and Picht wanted her battle commander to listen to her.

"When it comes to medical treatment, you are your strongest advocate, period. End of story. Some people choose to abdicate that," she explained. "But I'm the one who comes in with the checklist of 20 questions, and the doctor will answer every one of them before I leave.

"I know my mind, and I know my spirit better than anybody else. It's a team effort. Between the two of us we can do this, do it safely and aggressively, taking care of business. I would never ask myself to do surgery, but I would never ask him to fly a plane either. There's a mutual respect there, but there's not an awe and reverence."

Fortunately, she found a doctor who accepted those conditions.

"My doctor knew to expect the checklist," she said. "He gained energy from it."

The captain went in for a lumpectomy Jan. 3. Battle plans called for her consultation before any other drastic measures were taken. She told the doctor, "If you get in there and all hell breaks loose, then you're going to wake me up, and we're going to discuss this. Then you knock me out, and we'll do the rest."

All went according to her checklist.

"He did a nip, a tuck and rearranged here and there, and lucked out with a lumpectomy. With a sentinel-node biopsy, he took out 10 nodes instead of 25."

She focused on recovering and her family while waiting for the pathology report.

The captain didn't realize how anxious she was until the report came back negative.

"I nearly dropped the phone. I didn't realize until then how relieved I was that the cancer was gone. They didn't think it had spread."

But then there was chemotherapy.

"I found out the University of Washington in Seattle was the best place around when it comes to chemo," she said.

She decided on a six-month chemo protocol and remembers radiation treatment as being "anti-climatic."

"It takes longer to get undressed than to go in there so they can zap you on one side, flip you over, and zap you on the other side," she said.

She did lose her hair, so she wore a wig. Also, she took a drug that made her eyes water so she constantly seemed on the brink of tears until finally her eyes just overflowed.

Getting back in the air

Following all her treatments, Picht's Air Force career was in the hands of a medical board. She wrote a letter explaining she wanted to stay in the military and fly.

"So many people go through something like this and come out of it, and they have to make so many changes because they weren't doing what they wanted to be doing in the first place," she explained. "I was fortunate. I was doing what I wanted to be doing."

The board approved her for military duty, but not flying.

"The rule is, you have to wait a year after your last chemo treatment because the drugs are so toxic, and they do so many things to your body and have so many side effects," she said. "I couldn't even be aboard [a KC-135]."

She continued her duties as an executive officer, which she had been doing since her diagnosis.