Keeping her “head in the boat,” even when she’s on dry land, has allowed Riley Mulligan to retain a sense of serenity this past year as she has faced rough waters of her own while caring for patients with cancer.

The expression, often used by rowers, means to concentrate on the task at hand and keep the boat steady, as well as to leave your problems on the dock as you push off into the water.

“I love being in the boat with three other people and you are working as one,” said the 52-year-old Loveland resident who has been rowing for six years. “You have that support and connection, and you’re out at dawn with birds and quiet and the sunrise. You have to have complete focus.”

For Riley, her time in the rowing shell has helped to fortify her, as well as serve as a reminder that her own cancer struggles do not define her – something she has always told her patients in her role as a palliative care nurse navigator at the UCHealth Cancer Center on the Harmony Campus in Fort Collins.

It’s also given her a new and very personal insight into what her patients are experiencing.

“It absolutely reaffirmed my role and my job; if anything, I get pushier with my patients because of my own cancer experience. I encourage them to walk, to exercise, to get out there. I also know which patients of mine will be reluctant to reach out and ask for help. Now, I put a reminder on my calendar to reach out to them.”

Riley can empathize with that challenge. Asking for help — and accepting it — has not always been easy for her. But reflecting on the past year since she was diagnosed with stage 2 triple-negative breast cancer, has taught her some valuable lessons.

“I learned how to ask for help. That was huge for me. I think it’s hard for many women and probably for many people in health care. But my friends were incredible. They were really there for me.”

A nurse working with cancer patients gets a cancer diagnosis

Born in Nebraska, Riley has lived in Colorado most of her life and moved to the northern part of the state more than 20 years ago to be near family. She became a nurse and went to work at UCHealth Poudre Valley Hospital, where she was a float pool nurse for 10 years. A float pool nurse rotates between different departments and units in a hospital depending upon staffing needs.

During her shifts, she became particularly interested in working with cancer patients, specifically palliative care, which focuses on quality of life and minimizing suffering and pain for patients with complex, serious and sometimes terminal illnesses.

“Oncology was one of my favorite places to work because of the supportive and innovative ways we worked with patients in trying to control their symptoms. They just want to get better so badly.”

When a position opened seven years ago on the palliative care team at the hospital’s cancer center, she knew that was where she belonged. She’s a big believer in the mission of supporting patients during what can be the most traumatic and difficult times of their lives.

“Palliative care focuses on true system support, from the moment of diagnosis to the end of life, which could last for decades. It reminds people that life is still worth living even though it might look different. It entails the whole family, whatever that means to patients, and includes symptom and pain management and making sure they feel well enough to do the things they enjoy.

“Health care is very fast paced, but in my role, I have time to sit and listen and even cry with my patients. I celebrate the wins with them and give them a safe place to talk and express their fears,” she said.

In addition to cancer being front and center in Riley’s professional life, it has also been part of her personal history. Both of her grandmothers had breast cancer, along with paternal and maternal aunts.

Because of this, Riley was conscientious about regular self-exams and annual mammograms and had a clean result from her spring 2023 mammogram. But a few months later in September during a routine wellness visit, her primary care provider found a lump.

There was a flurry of additional tests along with a biopsy, and then the result: triple negative breast cancer, which occurs in about 10 to 15% of diagnosed breast cancer cases. This is an aggressive type of breast cancer that tends to grow and spread quickly.

It is called triple negative because the cancer cells lack the three “receptors” usually found in breast cancer — estrogen, progesterone and a protein called HER2. Receptors are proteins found on breast cells that use estrogen and progesterone signals to promote either healthy cells or, when present, cancer cells.

But with triple negative breast cancer, the cancer cells don’t contain estrogen or progesterone receptors or the HER2 protein, and therefore, don’t respond to typical breast cancer treatments.

Riley’s breast cancer was stage 2, because even though it was under 2 centimeters, the surgery showed a small amount of cancer had spread from the breast to a nearby armpit lymph node.

Working in a world of cancer did not make the news any easier for her.

“It’s very surreal. There was a lot of fear, a lot of tears. It was interesting how incredibly alone I felt until I told the first person. And then, all I felt was love. The empathy I got from the people I had worked with for so long … it was very special,” Riley recalled.

In October 2023, a month after her diagnosis, she underwent a double mastectomy. Doctors removed three lymph nodes to be cautious but found cancer in just one. A few weeks later, Riley began a five-month chemotherapy regimen lasting until April that consisted of three different types of drugs for a total of 16 treatments.

“It made it a lot easier because I did trust everyone. I knew my care team, and I knew the level of compassion and empathy they had. I knew I was in great hands.”

Dr. Farrah Datko, a breast cancer specialist who treated Riley, has worked alongside her for several years as they cared for cancer patients together.

“Riley received one of the hardest chemotherapy regimens we have for breast cancer, a regimen called dose dense AC-T,” Datko said. “She had a lot of the same side effects many patients have. She was incredibly brave and strong to keep working throughout her treatment,” Datko said.

“Research has shown that women recover better when they stay active during chemotherapy and keep their same routines in place as much as possible. This includes exercise, working and hobbies. Although this makes sense, it is certainly not easy to do when feeling tired and dealing with other side effects. Yet Riley did it beautifully, often with a big smile on her face.”

After allowing her body a few months to recover, Riley underwent radiation in July and August.

Throughout her ordeal, she continued to work through the nausea, fatigue and weakness she felt. She lost her hair from the chemo. Her skin and nails suffered as well, and her chest was red and sore from the radiation, but it was important for her to be a consistent and constant presence for her patients.

“Work was incredibly helpful even though meeting patients with the same diagnosis — those days were really hard. But I had a lot of great support around me, and being able to help others helped me.”

Riley’s best friend and nursing colleague Michaela Martinez said Riley never stopped pushing herself — even during the worst parts of her cancer treatments — to deliver excellent care for her patients.

“She is the most giving and caring person who advocates for her patients, and she never stops. She was and is, truly there for what is best for them. It’s a blessing for anyone under her care,” said Martinez, a float pool nurse educator based at UCHealth Medical Center of the Rockies.

She credits Riley with being a mentor who has helped her grow and flourish in her nursing career.

“She’s always been someone I can turn to and ask questions … She is great at jumping in and helping.”

Riley’s boyfriend Howie Perko admires how she has learned to live in the moment, cherishing the time with him and others.

“She makes the most of every moment she has. She has been strong and beautiful and full of energy and hasn’t let cancer get her down,” he said.

Tips for dealing with cancer from a nurse and cancer survivor

Now cancer free, Riley looks back on the past year with some advice for other cancer patients and family members who may be similarly tested. Along with the importance of early intervention, Riley encourages people to be proactive about checkups, annual exams and recommended medical procedures.

For those who do get a cancer diagnosis:

• Get exercise. It makes a big difference to your physical, emotional and mental health.
• Work with a physical or occupational therapist to develop a routine that works for you.
• Put yourself on wait lists for all your medical appointments if you want to be seen sooner. Spots do become available.
• Connect with a counselor or therapist to help with the trauma you are experiencing.
• Ask for help and accept the help and support of family, friends and colleagues.

“My friends were incredible. Recovering from surgery, they walked with me every day I could, they brought me food, they were always checking in. They made a huge difference.”

Back in the boat

Riley began rowing in 2019 after seeing a flier for the activity at her local gym.

“I always thought it was a beautiful sport. I signed up, learned, and I instantly fell in love with it.”

She continued to row through her surgeries, chemo and radiation. Her crew members were with her with each and every stroke, rowing her around the lake when she was too tired to pick up the oars, and carrying the boat when she couldn’t do it herself.

“My team was incredible, and I was able to row most of this summer. I am definitely feeling stronger, my fatigue is getting better, and I have a lot more energy.”

Riley’s future includes travel plans — a trip to Norway is on her calendar for January — to row more, spend time with loved ones and take the advice that she has always given to her patients.

“Everybody’s journey is different, but we need to remember to actually live and not just be here.”