The persistent beeping interrupts Megan Mendoza midsentence. “Sorry, that’s my insulin pump,” she says, picking up the palm-size device that’s attached to her stomach by a thin tube. “It’s a new one, and I think it’s malfunctioning.”
Megan explains that a chemotherapy drug she took as a child permanently damaged her pancreas and caused her to become diabetic. She pulls out the pump’s user manual, which proves useless, then calls the manufacturer.
“Welcome to my world,” she says with the cheerful indifference of someone adept at troubleshooting such glitches.
It’s early June, roughly three months into the pandemic, and Megan, 34, is doing a FaceTime interview in the living room of her Rockville home. Her husband, Mauricio, is working in the house behind closed doors, and their almost 4-year-old daughter, Gabby, is napping, exhausted from splashing around in her new inflatable pool. The state of Maryland recently relaxed its stay-at-home order, but not much has changed for Megan, a registered nurse. If she’s not home, she’s at Potomac Pediatrics fielding calls to the medical advice line. At her colleagues’ urging, Megan agreed to stay away from patients for her own safety because COVID-19 poses serious risks for people with diabetes. She’s worked there for nearly three years and is bummed to be on the sidelines.
“I did not become a nurse to talk on the phone. I became a nurse because I love interacting with kids,” she says. “I really want to be on the floor with the patients.”
Most of those patients and their parents don’t know that Megan is a cancer survivor. She was diagnosed with acute lymphoblastic leukemia (ALL) when she was 11 and underwent chemotherapy for about 2½ years only to relapse when she was a freshman at Richard Montgomery High School. That led to more chemo, a bone marrow transplant, bouts of depression, and complications that kept her in and out of the hospital for a sizable chunk of her teen years. At Potomac Pediatrics, Megan doesn’t usually talk about when she had cancer because most of the kids she sees aren’t experiencing a life-threatening illness. Even during her eight years as a nurse in the pediatric intensive care unit at Children’s National Hospital in D.C., where she underwent treatment about two decades ago, Megan told families only when she thought it might comfort them to know that she could relate.
“Wait, I want to show you something,” Megan says. She disappears and returns with a brass cowbell on a leather strap that used to sit by her bed when she was a teenager. She rang that bell—a souvenir from her grandparents’ trip to Switzerland—to get her parents’ attention one night in August 2001, three months after her bone marrow transplant, when she woke up coughing and saw blood. A common fungus that’s harmless to healthy people had ravaged her lungs. She’s also holding a stuffed Dalmatian she got from the Germantown volunteer ambulance crew that rushed her to Shady Grove hospital in Rockville that night, before she was airlifted to Children’s National.
When she first got there, Megan didn’t realize that she knew two of the kids in neighboring rooms—a boy about her age and a young girl with fiery red hair who’d once observed Megan undergo a session of radiation because she was nervous about her own. Both kids had received their bone marrow transplants within a week of Megan’s. She’d never spoken to them, but she was used to seeing them around the small transplant unit. Now they too were in the ICU suffering from infections. They both died just as Megan was transitioning out of intensive care. In moments of deep depression, Megan would ask herself: Why them? Why not me?
“I’ve had 19 years to process all this,” she says. “And a lot of therapy.”
As Megan talks, a soft voice calls from the distance. Her little girl, a Disney Princess fan, is snuggled on a couch in the family room wearing a blue Cinderella gown. “Come meet Gabby,” Megan says with a smile, carrying the computer screen to her daughter.
There were times Megan wasn’t sure she would survive either the cancer or the sadness that came with it. The two are so closely intertwined, she says, that it would be impossible to tell her story without connecting them. She now understands that her depression has been closely tied to her deep-rooted guilt, but that insight and clarity come only in retrospect.
“There’s no logic to depression. It twists how you think. It makes you believe you’re being extremely logical when you’re not,” Megan says. “People can point out how blessed you are, what a beautiful house you live in, what a lovely family you have. But someone with depression will twist it and think: I don’t deserve any of this. It’s a beautiful life, and I shouldn’t be in it.”
The American Cancer Society reports that about 1 in 4 people with cancer struggle with clinical depression. An evolving body of research specifically focused on adult survivors of childhood cancers shows that they can suffer long-term mental health problems. One peer-reviewed study suggests that these survivors are more at risk of anxiety and depression than their siblings, while another found that for a wide range of mental disorders, including depression, they report more mental distress compared to control groups.
For Megan, the depression was most intense after her cancer relapse and again as an adult. Her cancer and depression fed off each other. “The depression became much more exacerbated by the cancer and made it so much more difficult to face the cancer and the recovery process the second time around,” she says.
Dr. Adelaide Robb, chief of the division of psychiatry and behavioral sciences at Children’s National, says the likelihood of experiencing severe and persistent depression when dealing with a major illness increases for patients who have a family history of depression, as Megan did. Certain drugs, including the cancer-fighting steroids Megan took, can also contribute to mood disorders. Because children do not have fully developed coping skills, they’re even more vulnerable to depression and anxiety than adults when faced with a major psychological stressor such as cancer. “Kids will be in a center with other kids their age. They’ll be on the same cycle of treatment, maybe once a week on Mondays, so they see each other a lot,” says Robb, who did not treat Megan. “Then you look to the right and left of you and realize that you’re not all going to make it. When you’re feeling bad about yourself, you think: Why did I get lucky?”
Megan was in fifth grade, competing in a regional swim meet in Princeton, New Jersey, when cancer upended her life. She was sharing a hotel room with her mother and older brother, Dan, also a swimmer. The night they arrived, she felt a pain in both of her legs unlike anything she’d ever felt before. It kept her awake and persisted the following morning as she watched the early events from the poolside bleachers. Her coach massaged her legs and iced them. Megan felt short of breath and kept telling herself to suck it up. “But when they called my name, I walked to the check-in and I started crying,” Megan says. “I knew there was just no way I could swim.”
While others suspected nerves were at play, Megan knew better, and so did her mother, Suzanne Cardy. Her daughter was a tough kid with a high tolerance for pain who was used to performing under pressure. She’d been swimming competitively since she was 4, when she was selected to compete with the 5-year-olds on a Montgomery County Swim League team. “So when Megan said, ‘I hurt too much to swim,’ I knew something was terribly wrong,” Cardy says.
Cardy took her daughter home to Germantown that Saturday in March 1997, then to the emergency room at Children’s National the following day when Megan was still writhing in pain. Megan had been to Children’s recently for a battery of tests on a stubborn lump in her neck just below her left ear. The enlarged lymph node had been diagnosed as a localized infection, and Megan had been taking antibiotics for months to treat it. When it did not subside, her doctor suggested a biopsy, but agreed to wait until after the swim meet.
In the ER, doctors ran tests and gave Megan morphine. The following day they performed a needle biopsy on her neck but could not extract enough cells for a diagnosis, so they surgically removed the node. By then, Cardy and Megan’s father, Tom, were bracing for bad news. Still, it felt like they were “run over by a truck” when the results showed that Megan had a blood cancer, Suzanne Cardy says, either leukemia or lymphoma.
Four days into Megan’s hospital stay, a bone marrow biopsy confirmed acute lymphoblastic leukemia, the most common childhood cancer. According to the Centers for Disease Control and Prevention, more than 3,000 new cases are diagnosed each year in patients under 20, with the highest rates among kids ages 1 through 4. This form of leukemia, which starts in the bone marrow and spreads quickly, was practically a death sentence in the 1950s. When Megan was diagnosed, doctors told her parents that the survival rate for children had improved to 80%. But the odds for Megan were closer to 70%, they said, because she was older than a typical ALL patient, which put her in a higher risk category. She would need stronger chemotherapy for a longer period of time.
A team of doctors, a social worker and child life specialists—nurses who focus on the emotional well-being of children—gave Megan the news after speaking to her parents. They all gathered in a family conference room, and as Megan sat wedged between her mom and dad, a doctor told her that she’d need to take a lot of medications that would make her feel bad in order to treat the disease.
For how long? Megan asked. When could she swim again?
She had more questions later, particularly about the tube hanging out of her chest, a Broviac catheter that doctors had inserted into her body during the bone marrow biopsy. It served as an entry point for the chemotherapy drugs she’d be taking. Cardy tried to soothe her daughter. “But I didn’t sugarcoat anything,” she says. “I didn’t want her caught off guard by anything that was coming.”
Megan started chemo the next day, and for six months she was in the hospital roughly four days a week on an outpatient basis. “Little Miss Social” as her parents called her, the confident girl who organized playground games for her classmates, could barely muster the energy to get through most school days as fifth grade wrapped up. At Takoma Park Middle School in Silver Spring, where she was accepted into the Mathematics, Science, Computer Science Magnet Program, she quickly lost her hair and decided to wear a wig, which made her hot and self-conscious as it shifted on her head. She gave up on it when a sixth grade classmate pulled it off. Her once reliably fit body could no longer handle swimming and soccer, her biggest passions. She was depleted, immunocompromised and dealing with weight fluctuations as she went on and off steroids. Meanwhile, the onset of diabetes meant regular insulin injections throughout the day. By seventh grade, Megan was attending school more regularly and transitioning off the chemo.
The day her daughter was diagnosed, Cardy remembers sorting through the 30 or 40 pages detailing Megan’s course of treatment and thinking: Why am I giving these awful drugs to my child?
“But the alternatives?” Cardy says. “Well, there were none.”
At Richard Montgomery, Megan was part of the International Baccalaureate program and was named co-captain of the junior varsity soccer team in her freshman year. She made new friends. Her curly brown hair had grown back and she was finally looking and feeling like herself again, though she developed some stiffness in her shoulder that fall and figured it was tendinitis from soccer. But on Thanksgiving Day, she woke up with back pain so severe that she ended up in the hospital again.
A blood test showed that the leukemia had returned, 18 months after she’d finished chemo. She and her mother cried. That day, Megan found herself back on the oncology floor at Children’s surrounded by familiar faces—the same doctors and nurses, the janitor, the phlebotomist who always drew her blood. Her doctors laid out two options: Megan could do chemotherapy for another three years at a more intense level with different drugs, or undergo a bone marrow transplant. They told her that the chances of beating the cancer were roughly 10% with the chemotherapy and 40% with the transplant, if she survived the complications often associated with the procedure.
“In other words, the chemo might not work and the transplant might kill me,” she says. “That put me in a bad place mentally.”
The relapse at age 14 was more frightening than her original diagnosis, she says. When she was younger, death was a fleeting concept. She believed in heaven, and she believed that her paternal Greek grandmother, whom she affectionately called Yaya, was there. “But at 14, you’re more scared,” she says. “You question things more.” Will I really go to heaven, she wondered. Will I die quickly or slowly? Will I die in the hospital? Will it hurt? Can I go to the beach to die?
With her parents’ blessing, Megan opted for the transplant because she dreaded the thought of more chemo and didn’t think it would work. “The three of us talked at length, and it came down to: Which awful choice do we make?” Cardy says. Megan wanted the procedure to be done at Children’s, close to home with doctors and nurses she trusted.
The process would involve destroying Megan’s diseased bone marrow—the spongy tissue inside the bone where stem cells develop into blood cells—and replacing it with the healthy stem cells of a bone marrow donor. “But finding a match is tricky because there are hundreds of thousands of tissue types,” says Dr. Naynesh Kamani, who was director of the blood and marrow transplant program when Megan was being treated. Immediate family members, specifically siblings, are typically the best candidates. Yet the chance of finding a match in a family is no higher than 30%, says Kamani, now a pediatric immunologist at Children’s National. No one in Megan’s family was a viable candidate, including her brother and her older sister, Andrea. So the search for alternatives began.
The goal was to find an unrelated donor who was a good fit—or to locate a reasonably well-matched cord blood unit, the stem cell-rich blood collected from the umbilical cords of newborns. Family and friends organized drives, put up flyers all over the community and placed ads in small local papers in the hopes of finding an unrelated donor. An event held at a community center attracted hundreds of people who volunteered to do the blood test.
For six months, while she waited, Megan had to undergo treatment to keep from getting worse. “It was the same type of chemo they would have been giving me if I wasn’t getting a transplant,” she says. “I again went through all the things that chemo does. Losing my hair. Throwing up. Losing and gaining weight. No school.”
It was one day during that wait that Megan collected all of her medications and emptied them onto her kitchen counter. She contemplated swallowing as many as she could, but didn’t. After telling her mom about it, she began seeing a psychiatrist and started taking antidepressants.
In May 2001, Megan received a transplant using cord blood found at a public cord blood bank. It took about 30 minutes to intravenously infuse the blood into her body. The agony came before and after. In the week leading up to the transplant, Megan had to endure total body radiation and even more intense chemotherapy to eradicate her diseased bone marrow and kill off any stray cancer cells. The treatments made her feel sicker than ever, she says, and led to infertility. By then, it was unclear if Megan’s eggs were even viable given the chemo she’d undergone for years before the relapse. But even if they were, the technology for freezing a woman’s eggs wasn’t widely available, and Megan wouldn’t have had the time to do it because her treatment had to start immediately. She went into menopause at the age of 15 and learned that she would not be able to have a biological child.
If all went as planned, the transplanted stem cells would travel to the bone marrow spaces in Megan’s body, take residence there and produce new blood cells. Slowly, her blood cell count started to rise, and it was high enough for her to leave the hospital about six weeks after the transplant. But for the next year or so, Megan was in the hospital often to deal with complications. “Treating every one of those involved heavy-duty drugs that created more problems,” Cardy says. “Our dining room looked like a warehouse because it had boxes and boxes of medical supplies. There were times when I was running two or three IV pumps for her at home.”
Megan’s lung infection in August 2001 landed her in the hospital. But the biggest problem was her inability to keep food down, a yearlong issue that doctors eventually resolved after determining that she had a rare digestive condition linked to her dramatic weight loss. Toward the end of her sophomore year, Megan still looked emaciated, but she was adding pounds and feeling well enough to attend a few classes. She took on an increased workload in her junior year.
“Everybody knew me as the girl with cancer,” she says, “but it was fine.”
Maddy Conroy knew of Megan through one of the flyers she’d seen at school, then spotted her in the hallways rocking the knitted beanie look to cover her short hair. The two were briefly locked in a rivalry over the same cute boy, Conroy says, but that ended once they actually met and grew to become the closest of friends within a tight-knit group.
“We were that crew of girls that was going to change the world—social work, education, nursing. That’s what we wanted to do,” says Conroy, now a special education teacher in North Carolina. “Megan had been talking about working at [Children’s National] since we were 15. That was her endgame. She admired the nurses she owed her life to so much that she wanted to get back there and do the same thing for other kids.”
When it came time to graduate in 2004, Megan didn’t have enough credits. She put on a happy face as her friends prepped for the ceremony and got ready for college, and then she pressed forward with her fifth year of high school. She was working part time as a waitress at Applebee’s and taking three classes. But she felt left behind, especially when her friends returned for winter break with stories about campus life. “They were going back to college, and I had to go back to high school,” Megan says. “I was thinking: I’m going to be behind my whole life.”
The night before her holiday break ended, Megan attempted suicide, then told her mom about it the next morning. Her mother drove her to the hospital and she was admitted for three days. As a condition of her release, Megan had to commit to seeing a psychologist regularly.
The episode motivated Megan to find a new psychiatrist, too. She began to wean off the antidepressants she was taking, she says, because they clearly weren’t working for her. Despite the challenges, Megan graduated from high school summa cum laude in 2005 and took off for the University of Pittsburgh to pursue the nursing degree she always wanted, inspired in particular by the nurses who cared for her after her relapse. They had a knack for downplaying awkward moments, she says—like the time her catheter kinked in the middle of the night. They knew how to lighten the mood on dark days, popping their heads in to say hello and wave to the Matthew McConaughey poster—a gift from a friend—that hung on the wall of her room at Children’s.
“The doctors you see here and there, but the nurses make or break your day,” Megan says. “They can make the worst day of your life feel a little better.”
In Pittsburgh, Megan threw herself into her studies. Her parents fretted about how she’d manage her diabetes on a school meal plan, and whether her immune system was strong enough to avoid getting sick. Megan got a single in the dorm to avoid potential infections. Looking back, she was mildly depressed but managed, she says. Most of her fellow nursing students knew she’d had cancer because she would ask lots of questions in class, framed in a way that applied what she was learning to her own hospital experience. “I’m sure they were annoyed,” she says.
The summer after her freshman year, Megan was working for a catering company when she met Mauricio at a house party in Rockville. He saw her walk down the basement stairs in the tuxedo-type ensemble she’d worn to work that day and thought to himself: Who is that? It didn’t take long to get her name, or to pick up on her easy-going nature, or to figure out that her boyfriend was hosting the party. He backed off. Three years later, he reached out to Megan via Facebook. They went out for a drink at Chef Geoff’s in D.C., and she invited her new boyfriend along. But Mauricio bided his time, and when Megan’s relationship ended about a month later, he asked her out to dinner.
She talked to Mauricio about the cancer and her fertility issues early in their relationship, which started in August 2009, a few months after she graduated from college. None of it fazed him. Before they got married, “I told her we’d figure it out together, no matter what,” says Mauricio, now a vice president of an information technology firm in Bethesda.
During her last semester in college, Megan won a scholarship to do a clinical rotation at what was then the general medical and respiratory care unit at Children’s National, after having interned at the hospital’s pediatric intensive care unit the summer before her senior year. The scholarship guaranteed Megan a position at the hospital upon graduating, and the PICU seemed a natural fit. Soon she was helping to care for the hospital’s sickest patients. Many couldn’t breathe on their own. Some were transferred from the oncology floor to intensive care, a bad sign, so they were terrified.
“It often was not a situation where you could talk a lot to the kid,” Megan says. “A lot of pediatric nursing is about educating and working with the parents.” That means taking time to answer questions in a nonjudgmental way, she says, and respecting that some families don’t want to talk about the possibility that their child may die because they just can’t wrap their heads around it.
The work took an emotional toll at times, like during the stretch when Megan was caring for more cancer patients than usual. Three died within a few months, including a teenage girl who’d had cancer for years. The girl was back in intensive care in grave condition, and to keep her alive, her parents approved a tracheotomy, a surgical hole in the windpipe that provides space for a breathing tube. It was a move that the patient adamantly opposed. Whenever the girl woke up from sedation, she grabbed at her neck and attempted to rip out the tube. Then she stopped trying, Megan says, as if she were empty inside.
The patient died months later, on Megan’s shift. During postmortem care, Megan washed the teen’s body and wrapped it in a shroud. She removed the breathing tube, and soon afterward told her supervisor that she needed a break from working with cancer patients.
Megan and Mauricio got married in a Greek orthodox ceremony in 2010 and began talking seriously about kids. Until she met Mauricio, Megan says the idea of not being a mother didn’t affect her much. “It wasn’t hard for me until I actually wanted to have a child,” she says, “and then it got real hard.”
The couple decided that Megan should not carry a baby using an egg donor because doctors had told her that pregnancy might put too much of a strain on her heart due to the earlier chemo and radiation. They were pursuing the adoption track in 2015 when a relative (who does not want to be named) offered to carry a baby for them using an anonymous donor. After much discussion and research, Megan and Mauricio happily accepted.
All along, depression was creeping its way back into Megan’s life, and she grudgingly decided to take antidepressants again. The medications helped for a while, but interfered with her sleep, so she started taking Ambien, a sedative. “I was doing better, and then I wasn’t,” Megan says. “All this time I was working long hours and trying to figure out how to have a baby.”
When Gabby was born in July 2016, Megan says she was over the moon. The delivery was tense, a 31-hour process that left everyone emotionally exhausted. When she and Mauricio were finally alone with their baby, she says, “we just sat there staring at her, touching her toes and taking pictures. We were so happy.”
Eight months later, Megan was struggling again. She felt guilty that she’d married someone and couldn’t have biological children with him. He’s a wonderful father, and would have been a wonderful father to lots more children if I could do that for him, she’d think. She felt guilty that she wasn’t the main breadwinner, and that her medical bills were a burden. Megan figured her daughter would be too young to miss her, and that Mauricio would find a better wife more worthy of Gabby. She tried to take her own life again. “That’s the rabbit hole you go down,” she says, “and you can’t pull yourself out of it.”
Dr. Katherine Puckett, a psychotherapist in the Chicago area, says the mind has a way of structuring the negative and the positive side by side. For someone who is used to sustained grief, a dose of the positive can throw off their equilibrium, a phenomenon known as aversive reaction to pleasure. “The mind tries to restore to the balance that it knows,” says Puckett, a former director of mind-body medicine at Cancer Treatment Centers of America. “If you’ve had enough pain, you think that’s how life is supposed to be, and your mind seeks more for you.”
Megan checked herself into the Behavioral Health Program at Sibley Memorial Hospital in D.C. She stayed for a week, but initially progress was slow. A psychiatrist recommended another drug. Mauricio assured her that she was an amazing wife and mother. He prayed a lot. He researched depression and spoke to a social worker at the hospital. Finally, he realized that he couldn’t fix the problem because it wasn’t about him, so he visited Megan and they had what he describes as the toughest conversation of his life.
“I told her: We have the miracle child that you always wanted, and I can’t let this affect her life. I love you, but if you can’t take the steps you need to help yourself, then I have to move on because I can’t let our daughter fall victim to this,” Mauricio recalls.
Megan says her time at Sibley in April 2017 was a turning point. It’s where she realized that she needed to rethink her hospital job. Leaving home before 6 a.m. for 12-hour shifts that rarely ended on time disrupted her sleep, which exacerbated her depression. She took a leave of absence, then decided to resign. “I was lucky enough that I could stop working,” Megan says. “I realized that even though I have a lot of people who love me and want to help me out, that there’s only so much other people can do.”
Determined to find a solution that worked for her, she tried many medications and combinations of them, which made her irritable. “Luckily, I have the most supportive husband on the planet,” Megan says. She also looked into less traditional treatments for depression, including transcranial magnetic stimulation—a noninvasive method of brain stimulation. In the process, she discovered through genetic testing that her body doesn’t produce enough of the enzyme that processes folate, the naturally occurring form of vitamin B9 needed to form the neurotransmitters that control mood and sleep. She’s been taking the necessary supplement for two years, she says, and hasn’t made a change to her medications since she started it.
Emily Marshall, a friend of Megan’s since high school who’s now a clinical social worker, says she’s always admired Megan’s mental toughness. “When she hit her lowest moments,” Marshall says, “she engaged in treatment, leaned on her supports and found her way out the other side.”
Megan says the cancer and depression shaped her. “I don’t know who I would be if I hadn’t gone through what I have gone through,” she says. “I like who I am, so I don’t know that I want to change anything.”
Megan began seeing patients at Potomac Pediatrics again in July, as the pandemic wore on, but she only saw kids who were having checkups, while doctors and other nurses treated sick children in an upstairs office and tents in the parking lot. Though she misses her job at Children’s National, her work now is also rewarding, she says. She especially enjoys talking to young patients with diabetes. Sometimes those kids feel different, she says, so she’ll show them her insulin pump. “I had a 16-year-old boy with a different pump, and we chatted about how long he had it, and how he attended a convention to look at different models,” Megan recalls. “I thought it was awesome. The fact that he can talk and engage about it instead of ignoring it was very cool.”
Megan’s colleagues say she has a gift for putting things into perspective for families, perhaps because she’s seen the worst-case scenarios and can assure patients that what they’re experiencing is typically manageable. She also understands how anxious parents can get about the flu or a rash or a bad spill on a bike. “My goal is to calm them down and support them,” Megan says. “Just because I had something terrible, it doesn’t mean that what [they’re] going through isn’t terrible. …I don’t want them to ever feel that their concerns are silly.”
She now works two or three days a week, which allows her to focus on her health and her family, and to spend more time with Gabby. Her little girl is growing up: During Megan’s FaceTime interview in June, it didn’t take long for Gabby to warm up to the reporter on the screen and announce that her full name is Gabriela Aurora Mendoza. (The middle name honors Gabby’s paternal great-grandmother, not the princess, Megan explains.) As the grown-ups chatted, Gabby cuddled the stuffed Dalmatian gifted to her mother years ago. When she sensed the conversation was winding down, she stared into the screen. “Um,” she said. “Can you buy me a Tiana dress?”
Megan slapped her own forehead, laughing hysterically. Princess Tiana from The Princess and the Frog is one of Gabby’s favorite characters. “Say bye-bye,” Megan told Gabby. She squeezed her daughter and smothered her with kisses.
Dina ElBoghdady spent more than two decades as a journalist at several newspapers, most recently The Washington Post.
