By Deborah Salomon

Feature Writer

Breast cancer changes the lives of women. Breast and other cancers are the life of Dr. Ellen Willard, the oncologist whose practice at FirstHealth Cancer Center in Pinehurst includes a significant number of women diagnosed with the disease.

Willard is the only female oncologist in Moore County - and probably the world's only oncologist to win a statewide 4-H sewing contest.

Her entry: a pin-tucked, ruffled two-piece flowered cotton dress, a country mile from starched white lab coats. She is high-energy, breezy, opinionated, plain-spoken - a humanist with short, spiky hair.

You know when Ellen Willard's in the room, a colleague said.

And while a patient should not choose her doctor by gender, sometimes the comfort zone matters.

"This is a sensitive area," says Courtney Williams, RN/oncology case manager at FirstHealth Moore Regional Hospital. "If I had breast cancer, I'd rather talk to someone who knows how it feels, to explain why it's breaking my heart. They're not just boobs, you know. They are about feeding our babies, about loving our husbands. Dr. Willard is awesome."

Willard shrugs off the praise.

"I'm a farm girl, from down a dirt road," she says with a Piedmont twang.

Willard's father raised tobacco and hogs in Davidson County, near High Point.

"My sister and I did some field work and chased pigs," she says.

Willard participated enthusiastically in 4-H activities, including quilting and sewing - not only the prize-winning ensemble but, years later, her own wedding dress.

The medical bent originated with Willard's mother, a nurse.

"She was my patient care model," Willard says. "I loved science from junior high school, seeing structures and how they relate."

Medicine became her goal, early on. The UNC zoology major chose Wake Forest University School of Medicine in part because of a smaller class, and also because of "how they treated people."

An internal medicine residency led to hematology, gateway to oncology. She is board certified in internal medicine, hematology, medical oncology, hospice and palliative care, which qualifies her as medical director of the new FirstHealth Hospice House in Pinehurst .

Dealing With Cancer

Cancer, that dreaded beast, fascinated Willard, beginning with blood cancers (lymphomas): "You don't just treat a single organ system," since cancer attacks throughout the body. Medical oncology, she discovered, is pure whole-patient care using a team approach.

Lay people still equate cancer with death. What kind of physician wants to toil in that vineyard?

Willard protests.

"The stories that make the newspaper are the true tragedies," she says. "People who look at only the depressing miss the patient interaction, the success stories."

Some days, she says, resemble the thrill of victory, others the agony of defeat.

Because, Willard continues, "Medicine is all about curing and healing and victory. But there are still things we can't cure. As we make progress, cancer patients live much longer. We've made strides in understanding who needs to be treated aggressively."

Some strides are societal. In the mid-1950s The New York Times refused to print the words breast and cancer.

Now they appear on cereal boxes, T-shirts, kitchen implements, magazine covers. They are the subject of films, plays, books, TV specials, athletic events. October, once black and orange, has turned National Breast Cancer Awareness Month pink, a noble and successful effort that elicits varying opinions.

Willard calls the effort a mixed bag: "Increased awareness prompts patients to be screened." Yet, she continues, "Other cancers get the short shrift (money-wise). They don't have whole months. Lost in the dynamic is that lung, not breast cancer is the most common cause of cancer death."

Willard provides these statistics: Breast cancer is responsible for 30 percent of cancers in women, but only 15 percent of cancer deaths. Conversely, lung cancer is responsible for 14 percent of cancers in women, but 26 percent of cancer deaths. According to the U.S. Department of Health and Human Services, heart disease is still the number one cause of death among women.

"If people really want to do something for breast cancer, patients, try to be intentional about it. Find out what the money is going for," Willard says.

She mentions FirstHealth Foundation CareNet, which addresses practical needs like wigs for women undergoing chemotherapy.

Treating the Disease

Breast cancer assumes many forms. Treatment may last for months or years and involve the family, increasing the importance of a good doctor-patient match.

"The toughest part of my job is when family dysfunction plays out in the lives of my patients," Willard says.

She has witnessed extreme situations, like stealing pain medication and bickering about an inheritance. When family members disagree over treatment, she, as patient-advocate, gathers them in a room and talks it out.

"But when families are united around a patient, they are wonderful," she says.

Willard recognizes why some women prefer a female provider when discussion turns to body image, reconstruction and intimacy.

Patients have already been diagnosed when she sees them. Some are fearful, others in fight mode, a few resigned. Most come armed with information, not always complete or appropriate.

"The biggest problem with the glut is sorting it out, where it comes from, what is relevant to the patient's situation," Willard says, then shakes her head. "They expect me to have heard what was on TV that day."

Her method is to look a woman in the eye and tell the truth.

"She's amazing with spot-on impressions of who might need counseling during cancer care," says Beth Dietrich, a licensed clinical social worker at FirstHealth Cancer Center. "She assesses a patient's coping skills during the consultation."

"This is a patient-intensive business. You can't do this job if all you think about is the science," Willard continues. "By the time I retire, I'll be a qualified minister and social worker. As you talk to patients, you get a sense how they will handle information. We all say cancer is not a curable illness. But breast cancer is extremely variable; women can live for years with Stage 4 disease. It has to be the fastest changing medical sub-specialty. Some patients bond with a nurse; others will only talk to their physician. Everyone needs reinforcement."

And compassion. Willard's empathy is colored by personal experience. Her grandmother was diagnosed with early-stage breast cancer at the age of 80. Surgery halted its spread. Her father, however, died of lung cancer three months after diagnosis.

"He was a smoker. I knew what the outcome would be from the first phone call. That's hard - knowing too much," Willard says, visibly moved.

'Do the Best You Can'

Rachel Yates has experienced cancer and Dr. Ellen Willard from both sides.

Yates, a retired RN/surgical assistant, is a breast cancer survivor, owner of Hope Cottage in Aberdeen (a boutique for cancer patients) and has been Willard's patient for eight years.

"Ellen is direct but compassionate. She tells you the truth and then helps you handle it your way. She respects and listens to your ideas; she's willing to explore other things," Yates says. "She is the most intelligent woman and doctor I have ever known."

Beth Dietrich adds, "It's an honor to work with her."

After 20 years in practice, Willard retains a freshman enthusiasm for science and people, undiluted by the responsibilities children might present. Her work consumes up to 12 hours a day.

"I don't even have time for a dog," the fit, youthful doctor says. "People are surprised to see me in the grocery store, but I have to eat, like everybody else." Exercise, cooking, sewing and the outdoors relieve stress.

"My husband, Ken, is a huge part of how I can do my job," Willard says. "He makes me laugh."

Death comes hard to these physician-warriors, male and female, old-school and contemporary, whose final service is to support cancer patients when treatment has run its course.

"You do the best you can. You always see patients as people and you're faithful to them," Willard says. "Death is a process, not an event. Patients decline - there's an element of anticipatory grief. Some deaths hit harder than others. Certain days are awful; you don't feel defeated, just sad. But I can handle it."

Looking back, Willard half-heartedly wishes she had been attracted by another specialty.

"Now I can't imagine doing anything else," she says.

Ellen Willard, MD: Carolina girl, born and educated. Not your old-time hen medic. A real piece of work.

Contact Deborah Salomon at debsalomon@nc.rr.com.