Editor's note: Judge Rebecca Stern agreed to tell her story through her friend, Karen Nazor Hill, a staff writer for this newspaper.
The bouts of weakness and fear she could handle.
But Rebecca Stern clung to hope that she wouldn't lose her hair.
Having her own hair made her at least look normal, even if the chemotherapy left her feeling miserable.
Then one evening it happened.
She was in the shower, shampooing, when she felt clumps of her shoulder-length blonde tresses coming out in her hands. She watched as thick strands circled the drain.
Just weeks earlier, Stern, 50, a Hamilton County Criminal Court judge, learned that she had breast cancer, a diagnosis she long had feared after losing her maternal grandmother to the disease.
But no one is ever prepared for the news.
"It shocked me," said Stern.
For the next seven months, Stern would juggle her courtroom schedule with hours of chemotherapy and radiation treatments at Erlanger Cancer Center. Stern's cancer was caught in 2009 in its early stages, so her prognosis was positive. Still, the experience exacted a toll on her body and her emotions, but not on her will to live, she said.
Every year in the United States, an estimated 261,100 women are diagnosed with breast cancer, suffering through many of the same agonies as Stern. In Tennessee, about 4,700 new cases are reported annually.
But far beyond just detailing the physical and emotional trauma, Stern's story illustrates how much progress has been made in the uphill fight against breast cancer.
An estimated 39,480 women in the United States die from breast cancer each year, and it's the leading cancer killer among U.S. women ages 40-59.
Even so, after increasing for more than 20 years, female breast cancer incidence rates decreased nearly 20 percent from 1998 to 2007.
The five-year survival rate for breast cancer, when caught early before it spreads beyond the breast, is now 98 percent, compared with 74 percent in 1982.
And death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50. The decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.
Even Stern's reaction to losing her hair illustrates what has become a more matter-of-fact way of dealing with the complications of breast cancer.
She tried a close cut, then a wig, but ultimately chose the bold approach.
She went bald, and sometimes wore a bandanna, particularly when she was in court.
Today, Stern has been treated successfully and is back on the bench full time.
"Cancer brings things to perspective," she said. "I appreciate every day."
And her hair is growing again.
Stern was driving downtown to meet friends for dinner in December 2009 when she received her diagnosis by phone. She pulled off the interstate, turned around and headed home.
"I didn't cry," she said. "I just needed to process it.
"My first objective was to make a plan that would keep my work routine as normal as possible," she said. "My first chemo treatments would start in three weeks, so I scheduled all treatments on Fridays because we get off work early on Fridays. I wanted to miss as little work as possible."
Stern's reaction to the diagnosis is typical of women today, said Janet Kramer-Mai, Erlanger Health System's Cancer Support Services manager. Kramer-Mai was diagnosed with late-stage breast cancer in 2001.
"Firstly, most women who are diagnosed don't have the option of 'checking out' for the next year of treatment," Kramer-Mai said. "We phase it in to our day-to-day existence to make it work."
Chemotherapy and radiation treatments can be scheduled so their sometimes-debilitating side effects - nausea, fatigue - can be "hidden" at home. Wigs can cover missing hair or, like Stern, women can simply embrace the baldness.
It also helps that women diagnosed with breast cancer today have a huge support system, Kramer-Mai said.
"Look how far we've come in the last 10 to 15 years," she said. "It's women taking care of women - pink power, Breast Cancer Awareness Month. It's about surviving, and that's a powerful thing. You don't sweat the small stuff and after going through the treatments, you've been given a second lease on life. It's a prestigious thing to be a survivor. We pull together."
Stern said her support system at work and home were incredible, noting that fellow judges and attorneys covered for her on the days she couldn't work.
"Judge Stern is a strong woman," said Shelley Ellison, Stern's judicial assistant. "It's hard to watch someone who's in control all the time to suddenly have no control with what's going on in her own body."
Breast cancer in America
Risk: One in eight women will be diagnosed with the disease.
Most at risk: Women ages 40-59.
Five-year survival rate: 98 percent, when caught before it spreads beyond the breast, compared with 74 percent in 1982.
Breast cancer and men: An estimated 1,970 new cases will be diagnosed this year in men.
Deaths: An estimated 39,480 women and 390 men will die from breast cancer this year.
Number of survivors: 2.5 million, the largest group of cancer survivors in the nation.
Source: American Cancer Society
National Breast Cancer Awareness Month stresses the importance of early detection. Since the program began in 1985, mammography rates have more than doubled for women 50 and older, and breast cancer deaths have declined.
Breast cancer resources
* American Cancer Society 800-227-2345, cancer.org
* National Breast and Cervical Cancer Early Detection Program 800-232-4636, cdc.gov/cancer
* National Breast Cancer Coalition 800-622-2838, natlbcc.org
* National Cancer Institute 800-422-6237, cancer.gov
* Sisters Network 866-781-1808, sistersnetworkinc.org
* Susan G. Komen for the Cure 877-465-6636, komen.org
* Breast Cancer Network of Strength 800-221-2141, networkofstrength.org
* People Living with Cancer/American Society of Clinical Oncology, 888-651-3038, plwc.org
Ellison said it took weeks after the diagnosis to see her boss show any emotion about the breast cancer.
"She was talking to a family member, and I finally saw her cry," Ellison said. "I was relieved."
Stern said she dealt with the cancer, at first, on an intellectual level rather than an emotional one.
"I've had some real lows every now and then, and other times I felt normal," Stern said. "I had a fear of the unknown. I didn't know how my body would react. Sometimes I was so sick I couldn't get out of bed. Sometimes I'd get so upset, I'd throw up.
"Getting up in the morning was a drag - a constant reminder that you have cancer," she said. " I didn't like looking in mirrors."
A friend or family member accompanied Stern to each of her chemotherapy treatments at Erlanger.
The spacious treatment room, surprisingly inviting, resembles a living room divided into vignettes, each containing an oversized leather recliner, nightstand with a lamp, a TV, and chairs for guests. There's also a kitchen.
The only indication that patients are here to receive treatments are the intravenous machines to administer chemotherapy. Each session lasts about two hours.
The radiation room doesn't look as welcoming. Several huge machines, programmed to take images tailored for each patient, dominate. Patients must lie down on a table in several uncomfortable positions for the technician to get exact measurements and images of the cancer-stricken area.
Though the span of time in the room was only about 10 minutes, it was a thoroughly distressing time, Stern said.
"I heard a lot of stories about chemotherapy and radiation treatments before mine began," Stern said. "But what I learned is that everyone reacts differently."
Ellison, Stern's assistant, accompanied her to most of the treatments.
"I tried to make it fun to keep her mind off the treatments," Ellison said, noting that she routinely brought her boss Starbucks coffee and a leopard-print Snuggie, a blanketlike wrap, to keep her warm.
Stern had a network of family and friends, including "former and future" husband, Doug Curtis, 43, who stood by her throughout the treatments.
Though she exuded confidence in public, most notably in her courtroom, Stern didn't mask her emotions at home, Curtis said.
The actual chemotherapy treatments weren't painful, she said, but the side effects kicked in a day or two later, often leaving her weak and ill.
"My legs would shake," Stern said. "I would have to hold onto things. I was always so tired. I'd make it through work, come home and lie down on the couch. I didn't change clothes. I'd just take off my shoes and stay on the couch. I would try to do chores, such as the laundry or make the bed, but couldn't."
Curtis said he often felt helpless during those times.
"It scared me," Curtis said. "The TV made her sick. Lights made her sick. Sometimes she stayed up all night, and sometimes she didn't want me to talk to her. She wanted to be left alone. It hit me all at once what she was going through.
"When I was 14, my mother was diagnosed with breast cancer," Curtis said. "She didn't go through chemo, but I remember her being real emotional. I remember my stepfather being patient with her and how much that meant to her. That's what I wanted to do for Rebecca. I wanted to be there at every moment she needed me."
At work, Stern, who didn't want to be seen as weak, had to put up a tougher front.
"Sometimes I thought I'd never make it through this. I felt sad and would be weepy all day long," she said.
After work, she'd just want to rest, despite the best intentions of friends.
"People wanted to come to my house and visit me, but I didn't want a pity party," she said. "I didn't feel sorry for myself. I just felt tired."
The 36 radiation treatments were easier than the three months of once-a-week chemotherapy, but they had their own problems, Stern said.
"With radiation treatments, I felt like I had more energy," she said. "But I had browning nails because of fungus. I couldn't wear fingernail polish to hide it because I could get an infection. My underarms turned black and itched. I couldn't use deodorant or lotions because they interfered with the treatment."
Stern said she hoped she would be one of the few women who didn't lose her hair from chemotherapy. But when she saw clumps of her hair going down the drain, she couldn't bear the sight.
So she opted for a cut that left her hair about an inch long. During the cutting session at Villa Salon in East Brainerd, Stern was still optimistic that all her hair wouldn't fall out. But stylist Sheri Bryant told her it was rare for women to keep their hair.
Regardless, Stern liked her new 'do. It lasted only a week, though, and she lost her hair anyway.
That was the most difficult part of the nine-month treatment period, Stern said, and triggered bouts of crying.
A week after her buzzcut, Stern got her head shaved, wore a bandanna home and worried about Curtis' reaction to her.
"I thought he would be horrified and would turn away," she said. "I thought he would have a hard time looking at me bald. Instead, he said, 'Come here. It doesn't matter to me.' And he gave me a big hug. It was a real relief."
Said Curtis: "I knew losing her hair was one of her biggest fears. I jokingly just told her we could be twins."
At first, Stern wore a short and sexy red wig, causing many people to think she simply had colored her hair. And though she liked the look of the wig, it caused an irritating itch, she said.
"I decided to either wear the bandanna or go bald," she said.
So bald it was.
"I thought of all the beautiful actresses who cut off their hair or shaved their heads for movies, so I pretended I was an actress doing it for a movie instead of doing it because of cancer treatments," she said.
Dr. Jeffrey Gefter, Stern's radiation oncologist, supported her decision.
"After treatment, it will grow back like a Kansas cornfield," Gefter told her. "It will start growing fast."
SAYING GOODBYE TO THE MEDICAL TEAM
Stern's last day of treatment, July 23, 2010, was met with mixed emotions. She was eager to get her life back but sad to say goodbye to the doctors, nurses, staff and volunteers, each of whom had become not only her most vocal cheerleaders, but her friends.
She brought along a basket filled with gifts to hand out to everyone who had befriended her along the way. There were hugs, laughter and tears.
"The medical team at Erlanger has been a great support system," Stern said. "Everyone has treated me so nice. I got a lot of attention."
Gefter said Stern's positive attitude was a plus.
"We have an awfully lot of women who are satisfied with what we do," he said. "What women bring to the table varies, but what they take away is openness and a good attitude. Rebecca optimized it."
Though Stern's tests have yielded good results, doctors can't assure her the cancer won't return.
"Everybody understands the reality," Gefter said. "We see an awful lot of patients who come back and are doing well. Yes, we lose some and it hurts, but that's part of it. It's not all fun and games."
Stern and Curtis recently vacationed in the Caribbean in a celebration of sorts.
"The trip was perfect. Little things that may have irritated me before no longer mattered at all. It was nonstop fun," she said. "I feel like a million bucks - like I could run a marathon.
"It's miserable when you're going through it, but now I feel confident."
Curtis said the experience has offered Stern a "brand-new start. It's made her a lot stronger. She's pretty resilient and fearless."
Before she was diagnosed with breast cancer, Stern was toying with the idea of retiring and working part time as an attorney. Cancer changed her plans.
"I'm going to run for judge again," she said. "I'm back to normal. The cancer has convinced me I've still got lots of work to do."
Stern served as Komen honorary chairwoman
Judge Rebecca Stern served as local honorary chairwoman for the 2010 Susan G. Komen Race for the Cure Chattanooga held recently at the University of Tennessee at Chattanooga and featuring 9,000 participants.
Stern began her pre-race speech on a light note.
"I told jokes, like having breast cancer can help you lose 10 pounds in two weeks, and that there is a silver lining in losing your hair. You save a ton of money on hairstyles and special shampoos. Also, you don't have to pluck out wild hairs on your chin, shave your legs or get a bikini wax."
On a more serious note, Stern told the group that breast cancer forces people to realize how precious life is.
"You also find out how many people love you," she said. "All in all, it was an incredible experience."