UAB Medicine

December 4, 2012

Not Just Another Survivor

October 24th is a date UAB RNICU Nurse Juliet Haikes, RN, BSN, will never forget. That day in 2011, she received humbling news: a carcinoid tumor—a very rare and aggressive form of cancer—had been detected in her appendix. A year later, she celebrated 365 days of survivorship at a surprise party thrown by her coworkers in the UAB RNICU.

“When I walked in that morning, I thought, ‘Oh, we’ve decorated for Halloween, this is so neat!” But when I came into the unit and saw a huge blow-up zebra, which is kind of the mascot of carcinoid cancer, I realized, this is for me.” I called my friend Terri Johnson in the Center for Nursing Excellence and said, ‘You’ve got to come over here and see what they did. This is why I want to work here.’ I wanted to brag to her and say, ‘Look at how they take care of me.’”

Juliet’s coworkers pooled their talents and hung banners, adorned their unit with zebra-striped decorations, cooked soups, baked cakes, and gifted her with a black and white “knots of love” blanket made with knots tied by nearly everyone in the RNICU. 

“People asked me, ‘Don’t you want to take your year anniversary off?’ But for me, it was a day that I wanted to be at work to celebrate with the people who brought me through a time that nobody is prepared for,” Juliet says. “In the RNICU, we don’t just take care of our babies; we take care of each other. When something happens to any one of us on our unit, we are there for each other.”

The Shocking Diagnosis
In October 2011, Juliet had recently celebrated her 42nd birthday, bicycled across France with her mother and sister, and fallen in love with road biking, logging 30 miles every day. She was—and still is—engaged to a supportive and loving man and the mother of two intelligent, loving sons. “I was really at the highlight of great times in my life,” she says.

For years, Juliet experienced symptoms of Irritable Bowel Syndrome and was having more and more abdominal pain. As her discomfort grew, she and her doctor suspected kidney stones or uterine fibroids. During an urgent surgery, on October 21, 2011, her surgeon removed what was noted as a “funny-looking appendix.” The pathology report revealed a carcinoid tumor.  

UAB Taught Me the Difference an Expert Makes
Juliet and her fiancé Andrew began researching treatment options, and found that according to The Carcinoid Cancer Foundation (CCF), the nearest carcinoid cancer specialists were outside New Orleans at the Ochsner Neuroendocrine Tumor Program

“To step outside of UAB, where I went to nursing school and worked for so many years, was very difficult for me,” Juliet says. “But being at UAB has taught me the difference an expert can make, and I knew it was the right choice for me.” 

According to the CCF, carcinoid is a neuroendocrine cancer that can originate in the gastrointestinal tract, lungs, appendix, and thymus. The cancer can also occur in the lymph nodes, brain, bone, ovaries, testes, and skin. Though most carcinoid cancers are slow-growing, Juliet learned that her already rare cancer was even more unusual due to its fast-growing nature.

A Decision to Fight
“From that moment that I was diagnosed, I consciously made my decision that I would fight this, and no one in the RNICU has let me forget,” Juliet says. Her coworkers Page Paradise and Amanda Estes immediately ordered 100 buttons that read “No One Fights Alone” and “Fight Like a Girl.” “’No one fights alone’ just meant so much,” says Juliet. “To see them still wearing the buttons when I came back from treatment, that their support is just as strong as when I left over a year ago, is amazing.

“The night that I left for surgery at Ochsner, it was really hard for me to tell my coworkers goodbye, even for just a short period of time. I stood there looking at them as they held my hands, hugged me, and told me that they would be there every step of the way. They have kept that promise. They are the real heroes and have been there on the good days and the hard days.

“My one year anniversary was so important to me. I wanted people to realize that today is what really matters. Even the small things, like text messages from friends on my unit saying, “Thinking about you. Do you need anything?” were so important and meaningful. Most people live their whole lives and never really know how deeply people care about them. I am so lucky, because I got that.“ 

Odds—Just a Statistical Probability
As an RNICU nurse, Juliet cares for UAB’s tiniest patients. “In my job I have seen tiny, 23-week-old babies fight and beat the odds every singleday. I am a person just like them, and this cancer is something I’m going to fight.” 

I’ve seen what your attitude and your support system and all of those things day to day and moment to moment, when you are so vulnerable, can do to help you make it, because I see that every single day at UAB.” 

Why Zebras?
The medical analogy, “When you hear hoof beats, think horses, not zebras,” is commonly taught to help healthcare professionals think logically to reach a diagnosis. In other words, the correct diagnosis is usually the most obvious (horses) versus uncommon (zebras). Because of carcinoid cancer’s rarity, the zebra has become a mascot of sorts.

“If you read about the zebra, one thing you’ll learn is that when a member of the herd is injured, its family will form a circle around it so no one else can hurt it,” Juliet says. “In my case, my herd circled around me immediately. I was not alone, and even though carcinoid cancer is rare, I had something more rare—I had heroes in my life: My family and my UAB family, and now they were there for me.” 

What it Means to be a Survivor
Today, Juliet says she is doing well. “The symptoms of carcinoid are not easy to deal with, but I personally decided that I would not accept defeat, that failure was not an option,” she says. “I joked that in my first exam that I got a “C” for “carcinoid,” but I warned that from now on, I’m bringing my A game. 

“I feel like that the best thing I can do is to take steps every single day to make it the best no matter what the circumstances are. I’m thankful to be a survivor. While cancer has changed a lot of things in my life, it doesn’t define me. I have a great life, and part of that is now just being able to educate people about what carcinoid is, and I’m not going to give up. I feel very fortunate that I have such a team around me, and I think it truly makes all the difference in the world. 

“As I like to say, statistics are just calculated odds, and people beat them all the time.”

Follow Juliet’s Journey
“Surviving for me is about embracing your life ... no matter the circumstances ... and finding some happiness today while hoping for a better tomorrow.” – Juliet’s blog. Follow her journey in her own words at Juliet, Living with Carcinoid Cancer.