Marian Vallotton was diagnosed with Hodgkin lymphoma at just 18 years old. More than three decades later, she faced another diagnosis of thymic carcinoma. Here, she reflects on her journey and shares how she overcame her fears for the second time.

I was having a flashback. A former memory nudged at me as music streamed through speakers behind me. It was a bizarre yet welcome sound in the cold, sterile room lined with machines, monitors and miscellaneous equipment.

The nurses were focused on their task at hand, while thin hospital sheets covered my chest as I lie waiting. They had used a local anesthetic, so I was awake by numbed.

Fear simmered beneath my closed eyelids as I tried to shut out reality. I worked to steady my breathing, a tool I often used to calm myself, but it felt distant and out of reach. My chest, heavy with pressure, emitted a shallow, raspy sound as my mind wandered.

It was hard for me to believe that just 24 hours ago, I had been hiking with Steve, my husband of seven years, and my eldest stepdaughter, Julianne. We had decided to take a day trip to a historic park along the Wissahickon River, just a few miles from Philadelphia's Center City. My daughter Melissa, who was about to be a junior in high school, and my other stepdaughter, Caroline, were both otherwise occupied with summer jobs.

It had been a hot day, the sun high in the sky and greenery at its peak along the glistening water. The three of us traversed a trail tucked against the river's edge, following the twisty and sometimes steep route. Even as the trail continued to climb up and down, we were content – hiking was one of our blended family's favorite pastimes.

But as we made our way back along the other side of the river, something felt different – I was not quite right. I could feel it in my chest: a subtle pressure, though absent any pain.

My mind went to the call I had made to my doctor's office the week before. As I talked to the nurse practitioner, I explained my symptoms: face swelling every morning, along with dark and swirly veins that were evident just beneath the skin between my neck and breasts. I wanted her to tell me not to worry.

The nurse did just that, knowing I had a CT scan scheduled for when I returned from a work trip to California. I was off to a conference planned six months prior, where I was scheduled to present to a peer group of human resources and learning professionals. She gave me her blessings to venture to the West Coast, so I pushed the symptoms below the surface and out of my head. I wanted to enjoy the moment as the sun was shining.

Pain shooting down my neck quickly pulled me back to my current reality in the operating room. As I was prepped for surgery, I realized my trip and presentation weren't going to happen. A call was made to the conference organizer to cancel. This was just before the procedure, where a team of professionals were to excavate a major artery in my chest. I had gone to bed the same evening as our hike, prepared for my trip the next morning. Instead, Steve had rushed me to the emergency room. As the doctors began the procedure, the cool tendrils of fear grabbed me again.

This was not the first time I had experienced this type of "take-your-breath-away" fear. Even now at age 55, I could clearly remember my mom standing over me after I fainted as doctors performed a similar procedure when I was just 18 years old.

I was a freshman in college home for Thanksgiving when they found the lump. This first diagnosis was Hodgkin lymphoma. They treated me with radiation, performed surgery and called me cured. Who knew that more than three decades later I would experience major side effects?

A feeling of déjà vu washed over me. I could clearly see myself as a teen, prone on an identical operating table – but instead of the surgeons now working on the vein in my neck, I remembered the medical warriors from my past hovering over my feet attempting to inject dye into veins that were so minuscule they kept missing the mark. The short procedure planned for just an hour went on for several as they probed for hair-like strands in which they were determined to inject dye.

My younger self shivered with fear, while my current self was once again jolted back to reality. I glanced down at my feet – still lined with scars from my teenage surgery – as they peeked out from under the sheets.

As the doctors completed my current-day procedure and wheeled me back to the ICU, I contemplated fear. To me, fear is an interesting phenomenon – both friend and foe. As my companion, fear can help protect me from harm; like when walking on an isolated street, fear will intercede to choose the right turn. As a foe, fear pummels me with its gloveless fists, rendering me incoherent and unable to string my words together or decipher incoming information.

Following my first cancer diagnosis, my younger self was devastated, frozen in space and unable to cope with the enemy of fear. Now, I thought to myself, "I faced this before, and I would and could face it again!"

This time around, I had to face a diagnosis of thymic carcinoma. But I was also more mature and had seen the ups and downs of this vast world. I made a decision to look at fear as a partner, one I would lean into instead of run from. I thought, "I got this! I can do it! Fear is not going to get the best of me."

It may sound impossible to choose to look at your fear and fully experience it. But denial of your feelings will only backfire, like a simmering pot ready to boil over. Pema Chodron, a Tibetan Buddhist nun who has written many books on spirituality and mindfulness, says, 

"The next time you lose heart and can't bear to experience what you're feeling, you might recall this instruction: change the way you see it and lean in. Instead of blaming our discomfort on outer circumstances or on our own weakness, we can choose to stay present and awake to our experience, not rejecting it, not grasping it, not buying the stories that we relentlessly tell ourselves."

This is priceless advice that addresses the true source of fear. When I first learned this practice to "lean in," it felt counterintuitive, but what actually happened is similar to when we put pressure on a tight muscle: it releases.

Leaning into my fear has taken both focus and courage, but the payoff has helped me win. I believe this quote from Eleanor Roosevelt sums it up very well:

"You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, 'I have lived through this horror. I can take the next thing that comes along.' You must do the thing you think you cannot do."

Today, as a patient of the Abramson Cancer Center, my doctors Joshua A. Jones, MD, and Roger B. Cohen, MD, have overseen my recent recovery. Through the arduous path of chemotherapy and proton therapy, I have battled back and am now two years out from diagnosis – and going strong.

Many thanks to everyone who has been part of my journey at Penn Medicine.