A rom-com that thoughtfully addresses death, grief and breast cancer risk? We’re in! Alison, the protagonist in the romance novel “Four Weekends and a Funeral,” is pretending that she was still dating her ex-boyfriend at the time of his death. (It’s complicated.) On top of that, she’s recently undergone a double mastectomy after finding out she a gene variant that puts her at high risk for breast cancer. Author Ellie Palmer, who has the same variant, and Mayo Clinic expert Dr. Jessica Fraker join us to talk about navigating breast cancer risk and life post-mastectomy.
Episode summary: A rom-com that thoughtfully addresses death, grief and breast cancer risk? We’re in! Alison, the protagonist in the romance novel “Four Weekends and a Funeral,” is pretending that she was still dating her ex-boyfriend at the time of his death. (It’s complicated.) On top of that, she’s recently undergone a double mastectomy after finding out she a gene variant that puts her at high risk for breast cancer. Author Ellie Palmer, who has the same variant, and Mayo Clinic expert Dr. Jessica Fraker join us to talk about navigating breast cancer risk and life post-mastectomy.
This episode was made possible by the generous support of Ken Stevens.
We talked with:
Can't get enough?
Got feedback?
Four Weekends & A Funeral Transcript
Dr. Denise Millstine:Welcome to the “Read. Talk. Grow.” podcast, where we explore women's health topics through books. In the same way that books can transport us to a different time, place or culture, “Read. Talk. Grow.” demonstrates how they can also give a new appreciation for health experiences. Books can provide understanding of health topics and provide a platform from which women's health can be discussed.
At “Read. Talk. Grow.,” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my friends, my professional colleagues, and now with you.
Our book today is “Four Weekends and a Funeral” by Ellie Palmer. Our topic today is breast cancer risk related to BRCA mutation or gene variant, including surgical risk reduction through mastectomy. Ellie Palmer is the author of “Four Weekends and a Funeral,” a carrier of the BRCA1 mutation and a prototypical Midwesterner who routinely apologizes to inanimate objects when she bumps into them.When she's not writing romantic comedies featuring delightfully messy characters, Ellie's at home in Minnesota, eating breakfast food, watching too much reality television, and triple texting her husband about their son.
Ellie, Welcome to the show.
Ellie Palmer: Thank you for having me.
Dr. Denise Millstine: It's so great to have you with us. Our second guest is Dr. Jessica Fraker, who's a board-certified Internal Medicine physician who works in the multidisciplinary breast clinic at Mayo Clinic in Arizona. Dr. Fraker's clinical practice is focused on the care and evaluation of patients with breast concerns, including breast symptoms and abnormal imaging. She also sees patients with elevated risk for developing breast cancer and assists in decisions regarding screening, imaging for early detection, as well as strategies to reduce risk of breast cancer.
Jessi, welcome to the show.
Dr. Jessica Fraker: Thank you for having me. Excited to be here.
Dr. Denise Millstine: “Four Weekends and a Funeral” is a romance novel featuring the recently dumped Alison, whose ex-boyfriend Sam passes away unexpectedly. Caught in a lie at the funeral, Alison finds herself spending weekends cleaning out Sam's apartment with his best friend Adam, who seems pretty displeased by their time spent together. Alison has recently undergone a double mastectomy after her mother received breast cancer treatment, and then both of them were found to carry a high-risk BRCA1 variant.
Ellie, congratulations on your first book. How does it feel?
Ellie Palmer: Feels great. It's been a bit of a whirlwind with it coming out, but I've really enjoyed connecting with readers and it's been so fun.
Dr. Denise Millstine: You're getting such great acclaim. Even Abby Jimenez blurbed your book on the front cover. It's great to see a debut have so much positive feedback.
Ellie Palmer: Yeah, it's been incredible.
Dr. Denise Millstine: Jessi, tell us your reaction to the book.
Dr. Jessica Fraker: It's great. I really like rom-com type books and so I felt like this fit really well in that genre like other books I've read along a similar vein, plus obviously incorporates the conversation about BRCA. I thought very seamlessly and just fit really well and everything.
Dr. Denise Millstine: So let's jump right in. So Ellie, the story is personally inspired, as we mentioned in your introduction, as you do also carry a BRCA mutation. Alison is otherwise a fictional character, but what else inspired her? And did you have a reader in mind as you were writing this book?
Ellie Palmer: Yeah. So I mean, I really was inspired to start this story after I was preparing for my preventative mastectomy, and I was reading so many fantastic romances, partially because I wanted happy endings. I didn't want to have to read books where there was some sort of cancer plot twist. I wanted to feel just kind of wrapped in joy while I was reading.
But I noticed when I was reading and that so many of these stories that center women's bodies and their experiences, they weren't experiencing things that I was experiencing because I was preparing for that mastectomy. And I was, you know, weighing the pros and cons of sparing my nipples. And I wanted to see someone who had had these experiences, who was on the other side of them, and was at the beginning of their story of love and joy and happiness and not the ending.
So when I was thinking about writing a rom-com, I really wanted someone like Alison to be on the other side of it, but still dealing with some of the emotional components of a surgery like that, and some of the ways that hereditary cancer can affect your family relationships as well.
And the reader, I really wanted to make this a romance in particular, because I wanted someone who had this variant to be able to read this book and feel safe and know that this person was going to be better than they found them, and that they could kind of see themselves reflected on the page without having to worry about them.
Dr. Denise Millstine: I love that so much about romance that you are promised everything will be OK at the end. It doesn't necessarily be in the couple gets together, but everything is going to wrap up in the end in a positive way. And so I do find it gives authors of romance some leeway to go to some pretty challenging and difficult topics, which we definitely appreciate on “Read. Talk. Grow.”
Jessi, can you talk about even what a BRCA mutation is and whether or not that's the term that you're using in clinical practice or that we should be using?
Dr. Jessica Fraker: Yeah BRCA there's one and two. They're tumor suppressor genes. So in somebody who has a normally functioning gene, they help kind of keep cancer at bay by working properly. And so when someone has what we've kind of commonly referred to as a mutation, but now we're starting to refer to more as just a variant, or we use the term pathogenic or likely pathogenic to mean harmful or likely harmful. Those variants stop those genes from working appropriately, which increases the risk for getting certain types of cancers.
Dr. Denise Millstine: Yeah, I think it's confusing because we all have this gene. The question just is whether or not you have a variant of the gene that's working the way we think it's intended to work, or whether it's gone haywire and it isn't doing its protecting as efficiently. Ellie, you had Alison find out about her BRCA mutation because her mother had breast cancer, and this is actually a pretty common way that women will come to know.
Can you just talk about the background of setting the story up that way?
Ellie Palmer: Yeah. So that's similar to how I came to know about the variant in my family. My mom had cancer when I was about 8 or 9, and at the time it was still uncommon to kind of receive, I think that they might have identified this genetic variant at this point, but it was still pretty uncommon to get the test and pretty cost prohibitive at that point, too.
And so it wasn't until my aunt was diagnosed with cancer several years later that everyone in my family, all the adult women in my family, were tested and I was still under age. So I wasn't tested until later on. But it was something that I spent my whole life knowing was a possibility. And all of the women in my family kind of spent their life knowing this is something that could happen to them, and there's kind of a particular type of dread that I hadn't really processed until I was receiving that surgery, that I thought I wanted to find a way to capture that experience in a book of having something really quite horrible happen to your loved one, and you're trying to help them cope. You're trying to be with them through that experience, but you're also feeling this anxiety in your head of OK, does this mean that I have the genetic mutation? Is the same thing going to happen to me? And kind of that complicated relationship you end up having with that family member, whether or not you do have that mutation.
Dr. Denise Millstine: Yeah. And it goes both ways, right? You're thinking about that and then your mother or your aunt is probably thinking about that. Alison's mother, the way that would work is she would get panel tested for these gene variants. And then when and if she was diagnosed or detected or they detected a variant, then the child could be tested just for that single variant.
And so you mentioned it being cost prohibitive. Of course, costs have come down from where they were in the past. But Jessi, I see you nodding, but our audience can't. Are you agreeing with the way I stated that? And do you want to just add to that?
Dr. Jessica Fraker: Yeah, absolutely. I was agreeing with what you were saying, that if you presented for evaluation and because of a family history a lot of time or because of personal history of breast cancer, a lot of times you'll get this big panel testing nowadays when we do genetic testing, and that includes a lot of different genes for different types of cancer, including specifically breast in a case like this.
But you're right that if you know there’s a genetic variant in the family, we can test specifically for that one. Testing has become a lot more accessible, which is the good news. Unfortunately, it does sometimes depend on where you're having your testing done and your insurance as far as how much testing gets covered financially. But it is becoming easier to be done for people who would really benefit from it.
Dr. Denise Millstine: And we're going to switch to talking about risk-reducing surgery or what's sometimes called preventive surgery. But, Jessi, can you talk through, let's say there's a woman who knows she has a BRCA high-risk variant or mutation, and she hasn't had the surgery yet. At which point should she start having screening tests? We see Alison complain a little bit about the number of tests that she's had, but I think that's the reality of it, too. Would you just give us the details of that?
Dr. Jessica Fraker: Sure. So and this is where many women or patients in general, individuals who carry a genetic variant like BRCA, it's difficult decision-making because you have to think about balancing the risk of getting cancer versus the risk of doing surgery, the risk or stress of doing a lot of imaging for potentially many years. So typically, once we've identified someone as having a BRCA variant, we will start what we call high-risk screening.
And so the typical routine and what we're doing today is if somebody is the age of 25 to 29 and is identified as having this, they would do a breast MRI every year through that time frame. And then starting at age 30 and up, would do a breast MRI and a screening mammogram. And that tends to be alternating every six months, along with different schedules, but usually some kind of every six months getting breast exams with a doctor. And so that's a lot of follow ups and a lot of testing up until if they ever do decide to have a preventative surgery.
Dr. Denise Millstine: Yeah, sometimes I get the question, I'm having an MRI, do I have to have a mammogram? But it really looks at the tissue both ways. So yeah, we saw Alison make comments about the number of tests that she had. And then she also had her yearly BRCA appointment day, Ellie, I loved that. I think that's maybe something Jessi should institute on Sundays so her patients can come and see them.
Let's shift to talking about the surgery. Ellie, I thought this was really a telling comment from Alison. She says the physical pain of a surgeon carving out my breast tissue, removing my nipples, and inserting expanders was more than I anticipated. I don't want to scare any of our readers, but this is a major surgery. Can you talk about that?
Ellie Palmer: Some of these observations about the experience of the surgery and symptoms after I kept pretty close to my own experience, just because I'm not a medical professional. So the only way that I knew I could kind of make it an honest experience is to keep that a little bit closer to what I had had.
I do remember when I was first discussing surgical options with my surgeon at the time, I had thought it was going to be similar to like a breast lift or a breast reduction, or something that I was more familiar with just because I had known that my family members had major surgeries, but I was younger, and it was harder for me to process at the time, and I didn't really know what to expect going in.
And it was a major surgery. I mean, the recovery was challenging. I had multiple surgeries. I didn't anticipate that when I was going into it, and I think that I wanted to give an optimistic perspective on this diagnosis and the treatment options, because I do think there's a lot to be optimistic about. There are moments when I really wanted someone to be honest with me, and so I wanted to offer a bit of that as well, where it is challenging in the recovery on the other end can be really great. The results can be great, but when you're in the thick of it, it's a lot.
Dr. Denise Millstine: Yeah. No, absolutely. I could see where it would be easy to think that it's going to be one of these simple, straightforward, kind of same-day surgeries that you just bounce right back from. And indeed, it is clearly major surgery that needs a plan around it.
Jessi, can you talk about the body changes after mastectomy? Describe for our listeners what a woman's chest or what an individual's chest would look like after the surgery, and then maybe finish by just mentioning the timing of the surgery, which you started talking about. But if we can talk about that a little bit more.
Dr. Jessica Fraker: So it may depend on what type of surgical approach you would have and your reconstruction approach. And so there are options depending on, you know, where you have your surgery.
So one option is what we say is to “go flat,” meaning that all of the breast tissue gets removed. There's basically just a like a flat chest with a surgical incision. There may be plastic surgery techniques to kind of build up a little bit of tissue there, like with fat, but I would say that's less common. So it would be just kind of a flat chest essentially. Lots of good prosthetic options and things like that out there for wearing a dress and things. But if you're looking at the naked body, that's how it would look.
Probably one of the most common reconstruction options that I see, in particular in my young gene-variant carriers is exactly, it sounds like Alison went through, which is essentially that you would have the breast tissue removed, but then implants placed in place with some variation on whether or not nipples get removed. So I know with Alison that was part of the story: her lack of nipples or getting used to a body without nipples. But that's something that there's some discussion about whether or not nipples should stay or get removed. And so you may or may not see natural nipples or tattooed nipples, reconstructed nipples, but then would still see some scar and then implants, kind of reconstructed breasts.
And then another option would be flap surgery, which is less common, but is happening where tissue is being taken from other places, like the belly where you get skin and fat to recreate what is supposed to be a more natural looking breast. But there is, it's a longer surgical process. So, you know, again, can sometimes result in scar tissue and things like that as time goes on.
And then to speak to the timing. So that's always a very hard conversation because there isn't really a strong recommendation on exact timing right now, in terms of when we look at like our high-risk screening guidelines and optimal timing.
So a lot of times when I have those conversations with patients, we're talking about their goals long term, in terms of, first of all, for somebody young, what does childbearing look like or is breastfeeding going to be an important part of that? We may wait until after breastfeeding to think about that surgery. We also look at ages of diagnosis of cancer in the family, and so that sometimes … We like to think about really focusing on high-risk screening and risk reduction and things when we can, like 10 years before a family member was diagnosed. Nothing is a perfect estimate, but that sometimes is a way to judge maybe a good time to think about something like that.
Dr. Denise Millstine: No matter when it is. It's always a hard decision.
Ellie, I'm so glad that Jessi brought up nipples. There is a lot of nipple talk in this book. Of course, sensation is lost after someone has bilateral mastectomy, and there's a chapter where Alison comments that she never really noticed the pair of nipples on her chest, but she's definitely noticing them in their absence. And so can you just talk about how important it was to you to have this character call out the importance of nipples, or the reaction, or just that notice noticing the absence?
Ellie Palmer: Yeah, well, that was really, that really came from my experience reading romance and being struck by the way that nipples are so often casually described as like these characters of their own. We're like, they're pinked, they're purple, they're perked. There's all these different ways to describe the experience of having nipples on your chest, particularly in romance novels.
And it was something that I thought would be interesting to discuss with a romance heroine who does not have a pair of nipples on her chest, and the experience of falling in love and the physical sensations of falling in love, and maybe not noticing an absence of that, but sometimes you do notice an absence of that. And so I created this idea of these, like phantom nipples that exist outside of her.
And sometimes things happen and she wonders what they'd be doing if they would be pinked and purpled and pinched and how they would be experiencing the world. I use it as like kind of like a comedic relief sometimes in these moments. But also just to kind of remind us that her experience of dating, she is really aware of how her body is different. Even when she is fully clothed and just interacting with someone she has a crush on, she's noticing that about herself, and she's wondering if that's like a different experience. And I really wanted her to process those feelings in a little bit with a little bit of humor, too.
Dr. Denise Millstine: Yeah, I thought that was so important. And it wasn't always necessarily in a negative way. She's wearing a t-shirt and she's like, oh, I don't have to worry about, you know, that it's cold or I'm with this person I don't know very well because it's not just sexual, but it's also responding to weather and that type of thing.
You started to talk about her relationship. So when Alison has her risk reducing surgery, she is not partnered and so she then enters back into the dating world. And she has a variety of experiences and the initial one at least is not good. So we've talked about the physical effects of mastectomy, but let's talk about how that impacts how you perceive your body and its effect on, you know, how you picture yourself as being sexually desirable.
Jessi, can you take that one? Not an easy question.
Dr. Jessica Fraker: Yeah, and I'm not speaking from personal experience like Ellie might be able to, but it's something I hear a lot. You know, I would say, thankfully, I think in our modern world with more of a focus in medicine on women's health and female empowerment, that I'm hearing more and more women saying that that is important to them, but maybe not the most important thing that they're thinking about. But it is still very important. And I think in terms of both the physical sensation in how it plays into our sexuality and sexual arousal, that is something I have had patients tell me, that's one reason that they wouldn't do the surgery, because that's so important to them.
And then in terms of like cosmetic appearance, you know I feel grateful that a lot of my patients often come to these appointments with their partners and are very much encouraged by their partners, like, this is not the reason I love you, but that is something that comes up. Insecurity like, will they still think I'm beautiful or feminine or, you know, this is like a super important part of my body image. And so I can only imagine it would be a really difficult decision to make from those perspectives as well. And I'm sure Ellie can comment on that.
Ellie Palmer: Yeah, it was definitely a journey I went on with the way I saw my new body. I did not have a nipple sparing surgery, so it visually is different and it was something that I had to get used to and I wanted to have that be a part of the book in a small way, where she is on a journey with accepting the way that she looks and that her breasts aren't going to look the same as they used to, no matter what, you know, surgical possibilities there are. And that part of it is just her accepting a new body, which I think is pretty relatable to a lot of women who have had, you know, maybe they've breastfed, or they've had a baby or they've had other body changes where you do have to go on a journey of self-acceptance. And that was something that I wanted to illustrate, too, in her journey.
Dr. Denise Millstine: I love the way you phrase that so much, Ellie. And I also love in the book that you didn't back away from it. You could have made it just that everybody, you know didn't react to her and was loving and kind, but I really thought it was authentic.
With her first experience where she has a conversation with this young man, and he is basically like, I'm not going to care. It's fine. Like he's liking her. And then when they're actually intimate, she can tell he's responding differently to her. And I appreciate that you then have her actually intentionally navigate, “Okay, what am I going to do with how I feel about my own body, how people are reacting to me?” So I just again, think it's really important that we're seeing all sides of it … We're not just romanticizing, “Oh, it'll be fine. Everyone's going to treat you as is, just what they were expecting to see when you took off your clothes,” because that might not be the case. And also, I think it was smart to give the option that she had this surgery when she wasn't partnered. And yeah, she does have some moments, which is like, “Oh, maybe I should have waited.” But you know, it's not a reason to get married, listeners, just because you're waiting on your breast reducing surgery. Right?
Ellie Palmer: I really also wanted her relationship to her breasts to be separate from the way that men saw her breasts. Those were two things that existed, but they were separate journeys where she was never going to, you know, go back to the guy where she felt like he was a little affected visually by the experience and that she was moving on and by the time we meet the love interest in the book, she feels good about her body. Her insecurity is about that moment when someone looks at her and then having to watch them kind of puzzle together, how it looks different than they expect. That's more of where she's settled at this point, so she's not getting any sort of self-confidence or self-acceptance from her partner, enjoying how she looks. She's already there, and this is just a nice experience for her, where she gets to see that this person is unaffected by it.
Dr. Denise Millstine: But you mentioned that we do see a struggle in Alison. And Jessi, I wonder if you'll talk about these mixed emotions around having escaped cancer because you were found to have this variant and you took the step to reduce your risk by having surgery. How do you see patients navigate that?
Dr. Jessica Fraker: Yeah, I actually thought that was a really interesting piece to include. I'll be honest, I don't hear that that much. And that doesn't mean that patients aren't experiencing that. I just meant they may not be sharing that with me. I think most of the time when I'm seeing patients who've had the surgery postoperatively and we're following them for their annual, you know, checkups, they are one, I think, very, you know, grateful that they've done it and that they have been able to find about this early enough to prevent from getting cancer and two, I think they're despite having the surgery and we know really significantly reducing the risk, I do think there's still anxiety that comes with, “What if we find something on my check up,” I still think it's very nerve-wracking to come in and see us and getting used to even just breast exams. You know that we talked about the Sunday clinic and that scene, which I thought was very acute, but that was being on the other side of that as the doctor in that situation, patients tell me all the time, it's just different now when you're doing my breast exam, I can't feel what you're doing as much. And for some that's nice because it's not an uncomfortable breast exam. And for some it just kind of causes a level of stress, I think. And so that's what I usually am hearing in those visits.
I don't hear as much, patients sharing with me feeling maybe some guilt or feeling like they've cheated death or cheated cancer, you know, in the same way that I think it's remarked on in the book. But I actually thought that was really interesting. And I think something I'll take with me into future encounters, wondering if that is something going through people's brains.
Dr. Denise Millstine: See Ellie, your book is teaching breast specialists to look at that. I could totally picture what you were describing, but it was new to me as well. Ellie, this is tension between her mom having had cancer, and that's how she was able to take steps to hopefully prevent a future cancer. Also, talking about being in an oncologist office, Dr. Fraker works in a breast clinic, which isn't only for patients with cancer, but I think many of these women are seeing a breast surgeon or, you know, being seen in an office where the focus really is on cancer.
And I know you've talked a little bit about survivorship and can you just comment on all of that.
Ellie Palmer: So yeah. So I think that was really based in this idea that when you are being treated and you are undergoing a preventative mastectomy, you're in a lot of cancer spaces and you're kind of sharing an experience with a lot of people, but it's very different.
And in my family, in particular, I was the only woman who had had a preventative mastectomy at the time. Everyone else in my family had a mastectomy because they had cancer. And I noticed very early on that I was changing the way that I was talking about the experience, because I knew that I was talking with people who then had cancer, and I was really focusing on all of the gratitude: “I'm just so grateful that I get to have this surgery. I'm so grateful I have this information,” and I was really judgmental of myself whenever I felt angry or sad or frustrated that I had to go through this. I have a young child. It was a lot on our family, and as much as I was grateful that I had the information so that I could potentially not have cancer in the future, especially with my young child, I was grieving something and I was frustrated and I was angry, and there was very early on in the process, I was very judgmental of myself whenever I felt those feelings and told myself I shouldn't be feeling that way, because I should feel so grateful that I had the information. And it wasn't until I was discussing this with my mother that I really realized that what I was expressing was kind of a form of survivor's guilt. I felt guilty that I was feeling anything other than grateful because she had experienced cancer in order for me to have this information, and we were able to talk that through. And I was also seeing a therapist at the time, which I really recommend to anyone who is going through this.
But it was kind of when I was thinking about this story where a woman is an imposter at a funeral. I thought it would be very interesting to dig into those feelings of feeling like an imposter in your own health journey, which felt like kind of a unique situation to this world of hereditary cancer, where you get this information because someone you love had something pretty awful happen to them, and unlucky, and you get to be the lucky one.
Dr. Denise Millstine: Yeah, definitely thought provoking. And I appreciated how then Alison felt like she owed the world something, like it wasn't enough to be quiet homebody. She had to be hiking all over the world or, you know, chasing other people's dreams because there was. What did she go through all this for? And, you know, that's really the journey of the book.
Jessi, will you talk about the other risk-reducing surgeries? So in the book, we see Alison and her mom have a lot of tension about having some ovarian or tubal surgery. Will you talk about what that refers to.
Dr. Jessica Fraker: Yeah. So the risk with the BRCA variance is also associated with ovarian cancer risk. And so that's something where there are also preventative surgeries available. Traditionally that has been removal of the ovaries. That's done a little bit younger in BRCA1 carriers potentially than BRCA2 because of the typical onset of cancer in those different variants. But both surgeries are recommended to be considered, both before what would be like a natural average age of menopause. And so while you're reducing the ovarian cancer risk by removing the ovaries and even potentially by some studies, reducing breast cancer risk, which are both great benefits, you're also essentially being put into menopause. And so that's something that weighing what that could do to your body and hormone replacement. We hear about that in the book as part of that decision making. You know that's a really big decision and important decision.
I'm personally less familiar with this as I'm not a gynecologist. So I'm not on the cutting edge of what's new out there. But I obviously share care of my patients with our GYN team. And I have seen that there's some emerging data about fallopian tube removal, maybe preceding later ovarian removal, which can also help reduce risk. And so that's something that's emerging and being recommended. And I've seen patients going through that surgery. So the thought being potentially not taking away the full extent of that hormone by taking away the estrogen from your ovaries, but still reducing the cancer risk. Because of that cancer risk reduction versus early menopause debate, it's also a very difficult decision about when to do that surgery for a lot of people.
Dr. Denise Millstine: And just so our listeners are clear, what we're talking about are the ovaries, which are the estrogen producing, the main estrogen-producing organs in the pelvis, and then the tube from which when the ovary releases the egg, it goes into the uterus. So removing the tubes with but potentially being able to leave the ovaries themselves in place, which would mean a woman would not be able to get pregnant. It's like what happens when you have your tubes tied, except they've been removed, right? But she would not be in menopause after that surgery.
Ellie, you created this fantastic group of people to support Alison. She had amazing friends who were also very realistic. Her mom was really well intentioned and had a big heart. But one of the points I think you made is that she was not her BRCA mutation. She's a much bigger person than that. Your mom sort of wanted to put her into this narrow topic where that's what they were always talking about, that her friends weren't letting her get away with that dominating her life. Can you talk about how important that is as well?
Ellie Palmer: Yeah, I think that I really wanted her to have this very strong group of friends that would support her and be there for her. So we knew that throughout this whole process, she was completely OK and supported, but also maybe pushed her to do things that she needed to do and maybe would knock her over the head a little bit with information when she was, you know, not noticing that this boy liked her, as they often do in romance novels.
And I also wanted them to feel like full people who had their own lives, where when they left the page, we weren't like, do they have a job? Like, where do they go? They just came in to be like, “You go girl, go get them,” and then left. I wanted them to feel like full people and part of that was making them push her to do things that are out of her comfort zone, or to recognize that she was limiting herself in the way that she saw herself sometimes.
And with her relationship with her mother, I really felt like they were two people that were maybe kind of caught in a similar loop, where her mother was very preoccupied with her guilt about passing on this variant to her daughter, and that that was dominating her thoughts whenever she was talking to her daughter, and that it would be when they kind of have a moment where they are able to sit down and discuss this, they realize that they're both they both have more in common here than they thought.
Dr. Denise Millstine: Well, Ellie, once again, I want to congratulate you on your amazing romance novel. I think this has been such a helpful conversation about BRCA mutations or gene variants and breast cancer risk. And Jessi, thanks for being on the show.
Dr. Jessica Fraker: Thank you so much for having me.
Dr. Denise Millstine: “Read.Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard-Pasque and our recording engineer is Rick Andresen.
Visit our show notes to see the books discussed today and for links to other health education materials. Follow us on social media like Instagram and Facebook, or reach out directly to our email readtalkgrow@mayo.edu with suggestions for books or topic ideas. We'd love to hear from you.
The podcast is for informational purposes only and is not designed to replace a physician's medical assessment and judgment. Information presented should not be relied on as medical advice. Please contact a health care professional for medical assistance if needed and with specific questions pertaining to your own health. Keep reading everyone!