As Mother's Day approached, Heather Toeppner bounced a grinning, healthy 9-month-old with clear blue eyes on a bench outside the Medical University of South Carolina.
They were an image of happiness and health. Toeppner's short cropped hair was the only sign that cancer had recently wracked her body.
Toeppner, 32, said she always liked to cultivate control and organization in her life. But her sense of order was toppled in 2017 when she was diagnosed with cancer, gave birth to a preemie, breast-fed her baby, underwent chemotherapy and radiation and struggled with postpartum depression — all within one year.
Now, two months after finishing her last round of radiation, she said she's had to learn to live in the present.
"I can adapt," she said. "It just shows how we persevere, as humans, women and moms."
Toeppner found out she had cancer after a routine breast exam more than halfway through her pregnancy last year. The tumor was removed on July 10. She gave birth to Noah a month later, a few weeks too soon, with complications. Chemotherapy and radiation started soon after.
Dr. Sara Giordano, an MUSC breast oncologist, said the overlap of pregnancy and cancer is "a very challenging situation for both the patient and the team treating her." And it's not uncommon. Giordano said about 10 to 20 percent of cancers diagnosed in women 30 or younger happen during pregnancy or the year after giving birth.
Breast cancer is one of the most common to be diagnosed during pregnancy, she said.
A spokeswoman for the South Carolina Department of Health and Environmental Control explained the state's cancer registry does not track pregnancy status, but death from cancer soon after pregnancy is rare. Health department records show just one person died of cancer between six weeks and a year after being pregnant.
Expectant mothers face many options after they've been diagnosed with cancer, Giordano said, but any treatment plan requires careful discussion. Doctors can order chemotherapy during pregnancy, depending on the case. Toeppner was able to have surgery to remove her lump before she gave birth. And she was able to breastfeed, if only for seven weeks.
Still, cancer affected Toeppner's image of herself as a mother.
"I was just scared about being a mom and a cancer patient," she said. "A lot of my aspirations as a mom were not feasible."
When she returned to work halfway through chemotherapy, she began to have crying spells. She found herself looking at other women, and wondering how they were doing it all. She didn't want to bring Noah out in public much.
Another diagnosis soon followed: postpartum depression.
She found solace at group meetings with Postpartum Support Charleston. Elaine DeaKyne, executive director of the group, said stressors like cancer or an experience at the neonatal intensive care unit are going to increase the risk for postpartum depression. Clinicians should understand that and point it out to their patients, she said.
After it was all over, Toeppner said she would rather undergo chemotherapy again than have depression.
Dr. Jennifer Beatty, an oncologist at The Breast Place, said women tend to ignore their own health while they are pregnant and when their children are very young.
Only recently, Beatty found breast cancer in a handful of women who were breastfeeding. Those sorts of cases tend to need a little more love and care, she said.
"Any woman who has children and goes through a cancer treatment is a hero," Beatty said. "To go through something like this with young children is unbelievable."
Pregnancy does not, in of itself, increase a woman's risk for cancer, Beatty said. Giordano explained pregnancy actually decreases the risk of contracting cancer over a woman's lifetime. But many women don't notice suspect lumps in their breasts while they're pregnant because they're thought to be part of the hormonal changes during and after pregnancy.
For Mother's Day, Toeppner, her husband and Noah will attend Saturday's Moms' Run, put on by Postpartum Support Charleston.
Today, she's glad to have a healthy child who won't remember his mother's ordeal. And though she lives with the knowledge the cancer could come back, she's grateful for her own health, too.