Transcript generated from the episode’s audio. Speaker names are identified from the context of the conversation rather than from recorded speaker data, and automatic transcription may misspell names and terminology. Please refer to the video for the authoritative version.

David Raubach: Thank you so much for joining us on today’s episode of the Cancer Project podcast. We are really privileged and blessed to have a good friend of mine, Sarah McLean, on today. She’s a two-time breast cancer survivor and she’s also the executive director of Project 31, which is an amazing charity that operates here in Oklahoma and provides support services for women that are going through breast cancer treatment. And so we’re going to talk a little bit with her today about her experience going through cancer and then how she’s giving back through her role as the founder and director of Project 31. So Sarah, thank you so much for joining us today.

Sarah McLean: Thanks for having me. I’m excited to be here.

David Raubach: So, for those of you that, or for our guests that don’t know you that well, tell us a little bit about yourself, your family. I know you have two kids. I think they’re both off in college now. Is that correct?

Sarah McLean: Yes. So, yeah, I have two kids. I was actually diagnosed when I was 26 years old. So, I was just telling you before we started that Steve, my husband, and I, we had just moved to Oklahoma City from the Dallas area. And we rolled up on our anniversary. We unloaded the truck and we went to dinner and then 6 months later I was diagnosed. I had done self-exams since I was 18 years old just because that’s what the doctor had taught me to do. Honestly I didn’t think there was any reason for it. But when we first moved here I didn’t know any doctors and I needed to go for an annual exam. So one of my friends that I had met she referred me to a doctor and just like a lot of young women I was turned away. I had noticed a lump and she told me it was probably a cyst just to stop drinking too much caffeine and that kind of stuff. And so I just I believed her, you know, she was my doctor and I didn’t really know anything else. And so six months later I noticed that it was growing. I could feel it more and it was tender to the touch. And so I went back again and being so young obviously insurance didn’t cover it. So I was really going to have to advocate for myself to be able to even get a mammogram.

Sarah McLean: Steve went with me and the doctor I felt like she treated me like I was being a hypochondriac. And so she finally gave me the referral and I really I didn’t go because I thought well maybe I am overreacting and so I waited still a little bit longer. Finally once I was diagnosed we did catch it early thankfully. At the time it was 2003 so there really wasn’t a lot of emphasis on psychosocial needs of patients and so really you we call it the pink ribbon roller coaster. So basically at that point I got on the roller coaster and you’re just doing what you got to do to get it out of your body. And I went through a survival state at that point. Didn’t really even know that’s what was happening. And so we did a lumpectomy. We’re going to have radiation and I was going to move on my with my life and be done with it. Like I said, Steve and I had only been married a year, no kids. I was working full-time at a local church here in Oklahoma and I got to the end of that and they biopsied the surrounding tissue and it had already started to spread through the cavity.

David Raubach: Oh wow.

Sarah McLean: So at that point their recommendation was to do a double mastectomy and in my mind my mindset was just take them off. Do whatever you got to do to get it out of my body. And now being in this world for so long realizing as a patient you don’t know what you don’t know. And it’s so important to have community around you of other people who’ve walked the walk that we’ve walked. And so at that point, I didn’t know anybody and I was terrified. And so Steve and I made the choice, yeah, I’m going to go ahead and do the double mastectomy. And you’re you’re forced to make these life-changing decisions that there’s no way for you to know the repercussions of these decisions that you’re being forced to make in such a short amount of time. And so I chose to go ahead and do it. It was November of 2003 and I went through the mastectomy and I decided to do implant reconstruction. I didn’t really understand what all that was going to entail either. That’s its own, you know, journey itself. But I got to the end of it and I was so grateful to be cancer-free. And I thought, man, you know, this has been a long journey. I mean, cancer is such a long ride anyway.

Sarah McLean: And so at that point I thought all right let’s move on with life you know and I was going to get back to normal not realizing again I didn’t know what I didn’t know that there’s a new normal and so I found myself imploding emotionally and I didn’t know how to put words to what I was feeling. I’m definitely more of an introvert by nature. Definitely more introspective. But my husband and I you know we were still fighting over silly things. the toothpaste, the toilet paper, you know, that kind of silly stuff. Well, I didn’t know how to get out what I was feeling when I looked in the mirror. I wasn’t the same person anymore. I didn’t even know how to relate to myself. So, I didn’t know how to say that to him. And, you know, and I’ll I’ll be vulnerable and just say as a Christian woman, I think I had a lot of pride, too, that I should be able to handle things a certain way. And I put a lot of pressure on myself that because I am a Christian, I believe in God, I have faith and but yet my emotions this felt really hard and I didn’t know how to reconcile that.

Sarah McLean: And so my husband was calling everywhere trying to find a resource for us to go speak with someone because nobody had talked to me about that. I felt like the doctors did an excellent job of diagnosing me, of helping me to have options, of getting it out of my body, but beyond that, I’m a full person here. Mind, body, spirit. there was nothing beyond the physical part to give us resources of how to walk through this journey. And so finally Steve found a psychologist who happened to be a survivor and he was like we’re going and I was like no we’re not. And so it was like definitely a fight and I went like kicking and screaming really. And so the day that we went into her office, I remember sitting there and honestly she just started to share her story with me and it was so eyeopening because everything that she was saying that was me and she was basically validating everything that I had been going through and I’ve been grieving and I didn’t know it. I didn’t understand that there’s a lot of layers of grief that come along with the cancer journey.

Sarah McLean: But as she was sharing with me, obviously it was comforting to me, but at the same time, she was basically interpreting to Steve everything that I had been feeling that I didn’t know how to get out to him. And so it was eye opening for him as well. So he was like, oh, that’s what’s happening here. So then through our time with her, I really felt a burden to come alongside other survivors and their families. I was like, why is nobody talking about this? Why did not anybody say anything to me that this was going to be maybe a part of my journey? just to know that I’m not crazy and that there are other people who understand and it’s okay to not be okay. And so at that point we went to her for quite a while. And I got pregnant at the same time.

David Raubach: Okay.

Sarah McLean: And so I didn’t even know if I was going to be able to have kids and thankfully I got pregnant and I had my son in 2004 and then when he was six months old I got pregnant again.

David Raubach: Okay.

Sarah McLean: And I had my daughter in 2006. So, I’m just bopping through life at that point. We’re going to counseling. Really feel like I’m getting some healing in my own life. Have kids. I’m working full-time, but there was still something missing. I just felt like there have to be so many people out here that are hurting that need to be aware of resources that could be available to them through counseling. And so, in 2007, Steve and I decided, you know, we need to do something to give back. And so we honestly just took money out of our savings and got established as a 501c3. And initially what I wanted to do was to provide an opportunity to survivors and their families because I realized this just wasn’t me. This was my husband as well and but for other families who did have children, it was their kids, too. It was a whole family being impacted in their own unique way.

Sarah McLean: And so I just was like, you know, we all need to be able to have an opportunity to be able to have healing. And so we got established and at that point because of HIPAA, I was like, “Okay, what am I going to do to be able to meet patients?” And so I just started having these little gatherings of people who were in my life, sharing with them kind of what I was wanting to do and how I wanted to give back to others. And surprisingly, people started giving me money. And I was like, “Okay, God, what do you want me to do?” And I was like, “Okay, great.” And so I realized, you know, I felt like at an imaging center or an oncology office would probably be the best connecting point for survivors coming, you know, year after year for their scans or for mammograms. And so I just started sending letters across the state and saying, “This is who I am. This is what I’m doing.” I had created a care package basically as a bridge to be able to give to the center. they basically would give the gift to the survivor and then they would give them a release so that way I could contact them.

David Raubach: Okay.

Sarah McLean: And so it was very like organic, very slow. And that was okay because I was still going through my own journey. I think we always are, you know, but for me at that point I didn’t have a lot of emotional margin to give any more back than that. And so at that point I started getting some phone calls and I just started sending these packages out and I was like, “All right, this is great.” And honestly, it really gave me purpose in my pain. I feel like not everyone, but I think a lot of people they it needs to mean something. You don’t go through this for nothing. And that’s what I needed, right? And so in fast forward to 2011, I was approached by one of the cancer centers here in the city and they asked me if I would consider leading a peer support group.

David Raubach: Okay?

Sarah McLean: And to be quite honest, I was like, “No.” Right? Heck no. I don’t want to do that. Because honestly, in my own mind, I had really stereotyped a support group to be a place that was really more negative, toxic in nature. And I was like, that’s not really what I’m about. I really want to create environments where people are educated, where they’re empowered, where they’re given hope. And regardless of their stage, stage 0 to four, like we can still have hope to the very day that we meet Christ, you know. And so I thought about it and I was like, you know, I really felt like I was supposed to do that. And so in 2011, it was May, we show up to this cancer center and I was like, all right, I don’t I know how to lead a small group. I was like, we’re just going to do the same thing there. And so 20 plus ladies came that night. And for me, I was like, “Wow, there are hurting people out here and they want to talk about their story and they need a place to come amongst other women who understand what they’re going through.”

Sarah McLean: As patients, I feel like a lot of times we hold a lot in because I know for me, I was protecting my my husband and my children emotionally and I didn’t want to share everything sometimes because I didn’t want to upset them any more than they already were. And so I needed a space to be able to be vulnerable and honest but also to gain comfort and encouragement too. So we show up and it was a great night and I was like, “All right, we’re going to keep doing this.” And so it was one group at the time. So fast forward to that August of 2011, I continued to do self-exams even though I had had a double mastectomy. I knew that they couldn’t get every cell. And so I had noticed something on my right side over here. I thought it was scar tissue, right? And I thought, you know, I’ll just tell them. They said, “Have you noticed any changes?” And I was like, “Well, yeah, I noticed this spot over here.” They were like, “Well, let’s go ahead and ultrasound that before we do your MRI.” I was like, “All right.” So, ironically, I was in the same room I had been in eight years before.

David Raubach: Oh, wow.

Sarah McLean: So, I’m laying in the room and she puts the ultrasound on there and I could tell by the look on her face, she knew that it was cancer.

David Raubach: Wow.

Sarah McLean: And so, she’s like, “I’m going to be right back.” I said, “Okay.” And so I just laid there and I looked at the ceiling and I was just like in disbelief honestly. I was like I don’t understand this. And so she comes back in and she’s like, “We can go ahead and biopsy it.” And I said, “All right.” And so she’s like, “We’ll call you in the next couple days.” I was like, “Okay.” So the next day I was in Target and I was shopping for care packages. I was just buying stuff to make these care packages and they called me and they said, “Sarah, I’m so sorry. But it’s cancer again.”

David Raubach: Yeah.

Sarah McLean: And I said, at that time I was 34. And I said, “Okay.” And she just explained to me what the next steps would be. And so I went to the car and I just sat there for a while and I just talked to God and I was like, “I really don’t get this.”

David Raubach: Yeah.

Sarah McLean: And I really felt like God spoke to me in that moment and he said, “Sarah, this is not a hobby for you. This is a calling on your life.” And I believe that, you know, we’re all created for a purpose. And God knows every moment that we have here on this earth. And for me, it’s to give him glory and to spread his hope to all his people. And this was going to be a way for me to do that. And honestly, I felt really inadequate to be able to even step into that space because like who am I? Like so many young women around me, their journeys are so much different than mine. At the same time though, that doesn’t mean that we can’t share hope. That doesn’t mean that we can’t still encourage one another and walk with each other. And so at that point, I was like, “Okay.” So I finished treatment and I gave my notice at the church where I was working and I knew that I was going to start moving forward to dedicate my life to this journey.

David Raubach: Yeah.

Sarah McLean: And so from then until now, I can proudly say that we collaborate with over 10 hospitals across the state of Oklahoma. Providing peer support through small groups and communities in each of these hospitals. We have a leadership team of over 20 survivors on the team. We do online communities now. We have a group specifically for thrivers who are stage four patients.

David Raubach: Okay.

Sarah McLean: Also expanding just outside of the state now with our our care packages and also with different people who were able to log in, you know, honestly through COVID, I was a little bit nervous because I was like, I don’t know how this is going to work. But we were able to go online pretty seamlessly because we had already had private Facebook communities of over a thousand women online. So, it was really easy just to jump on. And honestly, people need more support than ever during that time. Obviously, because you’re being diagnosed, you’re still treating, but you’re alone. And so we grew more than we ever had during that time. And so it’s just continued to grow throughout the years. And I’m just so proud and glad to be able to bring people together and allow them to share their stories and to be able to encourage each other because this is never about me. It’s really just honoring and lifting others up to be able to share their own story to have purpose in their own story, right? And thankfully it’s working.

David Raubach: Yeah.

Sarah McLean: So, that’s kind of where we’re at now. But yeah, like you said, back to your original question. So, that was amazing. It was a long answer, but I my kids are 19 and 20 now. They’re in college. I’m so grateful to be here to see them and to see them flourishing, too. It’s pretty awesome season.

David Raubach: So going back to that point in 2003, I think is when you said you were first diagnosed, one of the things that I know that you talk a lot about with the women that come into Project 31 now is how to communicate to your spouse, right, and your loved ones?

Sarah McLean: Yes.

David Raubach: What was it like talking to Steve, your husband? Because I mean you get like you said you’re in your mid20s, you just got married, you’re excited about life and then suddenly there’s this massive interruption. What were those conversations like? And then maybe what are some things that you’ve learned over the years that you communicate to women now about how to talk to your spouse and your family about what you’re going through?

Sarah McLean: It’s a good question. I feel like obviously we’re all unique and so it’s going to be different for everyone. I think it does matter how long you’ve been married. I think because I have noticed a difference between younger patients versus women who’ve been married a long time. There is definitely a difference there. However, I have noticed across the board that whatever trauma you’ve experienced in your life prior to your diagnosis, it usually is a catalyst to come out, okay, at that time. And all that to say it can be very overwhelming because you have all this emotion and it might not even be just attached to the cancer. It might be all this other unprocessed stuff. And so for me I think being an introvert like I said I would definitely recommend for people to find a therapist to work with to be able to not only identify what are you feeling in the moment but to give it words.

Sarah McLean: Because I do feel like there’s a huge disservice to caretakers. they are going through their own trauma and there’s literally no attention given to them most of the time, they’re just kind of in the background but still taking care of the family, still trying to like work and, you know, provide for their family. So I feel like there needs to be an awareness that we’re going through this together. Yes we are the ones doing the treatment and yes we are, you know, feeling a lot of pain, however our family members, they’re giving a lot too and they’re experiencing a different kind of pain. So I think just an empathy for one another, I think grace for sure to each other. I think because there it’s obviously so highly emotional and highly triggering and so depending on how you communicated prior to this. Unfortunately I see a lot of couples that it doesn’t work and it makes me really sad and like that’s why it is important to me to bring awareness to it first of all and if you know that you’re struggling find help.

Sarah McLean: Make sure that you go and get some tools because nobody knows how to do this, right? Like it’s not like you got a cancer 101, you know, workbook. So, find some help. Try to learn some communication skills. Extending grace to one another. I know like for Steve and I, second time, we got a second time to figure it out.

David Raubach: Yeah.

Sarah McLean: I knew the second time like if I was having a hard day because I would take out my emotion on him a lot of times and he’s like, “What did I do?” And I’m like, “Okay, I’m having a hard time right now.” So he might take the kids after school and go get ice cream or whatever because I just needed some moments to myself and then he could come back around and I had words to it this time whereas the first time I would just react and so but all that came from going to counseling and learning some tools. I think the grace part because it is really scary you know and breast cancer I feel like is a little bit different too because of the way that it affects your intimate relationship. So, you’ve heard me say, I feel like it just tries to steal every part of who God designed us to be as a woman from our hair, fertility, breast, intimacy, everything of how he created us to be as a woman, but then how we relate to one another.

Sarah McLean: And so, I think it’s really important to continue to be open and honest and ride the roller coaster because from moment to moment you’re feeling one way, you know. I think it’s important to give your partner space to be honest, too. I think because sometimes they don’t want to be honest with their fear because they’re afraid they’re going to scare us, right? But I think that it’s mutual respect of where are we and checking in with each other. It was weird like I looked through my phone. I don’t know. I was cleaning my phone up and my second time I decided I was gonna like video I was vlog it.

David Raubach: Okay.

Sarah McLean: just for myself personally, like a vlog journal. And I went back and I realized Steve and I, what we would do in the evening time, we would sit down in bed and we would just turn the phone on and we would kind of recap the day, okay? And it was really weird, you know, to look back at that and to see our facial expressions and just to see where we were emotionally. But I felt like that was really healthy though because it helped us to process. keeping it out is really important. I know that’s a long-winded answer, but I just I feel like there’s no amount of tools that you couldn’t learn to be able to be a better communicator in your relationship, right? And a little bit of it is just taking it day by day because each day moment by moment by moment, right?

David Raubach: Shoot. What are some things that you and Steve because I know Steve does a great job too of talking to spouses and make hey these are the things that I screwed up and these are the things that maybe I did well. What are some of those things that you would recommend or that Steve would recommend to spouses to be thinking about? You mentioned, hey, just take the kids and go get ice cream. Give me a few me few moments alone. What else are recommendations?

Sarah McLean: I’m laughing because I know exactly what he would say. He’s going to say just get naked. He would say he and it’s true because I remember one of our first groups we were in, he was telling the girls like as soon as you get comfortable being naked in front of your in your own new body, it’s going to help him to feel more comfortable, right? And I know it sounds weird, but it’s true because we’re both getting used to this here, you know, and so I would say that, but secondly, men I feel like he would say they try to fix it, control it, or they have nothing to do with it, right? And you know, as our our partners and our spouse, obviously, God’s designed you guys to be our protectors. And so, I can only imagine how hard that must be.

Sarah McLean: And to know like sometimes if there is something you want to fix, our home is like our sanctuary, right? You know, we are the wife and the mother. And I know for me, like I have I like my home in a certain order. And when you’re trying to recover, you can’t do all the things that you want to be able to do. So, I think being attentive to her, how does she want her home? Like Steve would say, like, I like the dishes done a certain way. I like the laundry done a certain way. Like, don’t do it your way. Do it her way. And she’s the CEO of that house. And so, when you come in, don’t try to fix her process. Come in and appreciate her process. And so, I would recommend that. Ask her what is it that I can do for you?

Sarah McLean: It’s a hard part too for survivors, for us to come to a place. I know for me it’s really humbling to know that you can’t do everything that you did before. But a lot of time I try to encourage girls to like get to a place of where you allow people the opportunity to be a blessing to you because they want to do anything they can to be helpful. So the same way with your husband like and even the kids like so for my kids I tried to include them to be a part of the process. So like the second time giving them jobs to do. So Tatum, she would do my drains and she’d get to log it every day and so she knew that was her job.

David Raubach: So and she would have been what? Seven.

Sarah McLean: Oh, five.

David Raubach: Okay.

Sarah McLean: Yeah. She I missed her first day of kindergarten. I was in surgery. So letting them be a part of it, giving them something to do. Don’t take away opportunities for them to be the blessing. The control part I think is just that comes back to that communication is really important. And then allowing them to be a part of it with you. I feel like a lot of times because there is so much emphasis on us that like I said they get pushed to the wayside and so that’s why I think sometimes that disconnect can happen. They become a little bit disconnected. Invite them to the treatment with you. Let them be a part of it. Include them because sometimes you’re like no I can do it. No well okay like you don’t need me. No we need to reiterate I need you. We are in this together. And so I think it’s that constant encouragement of one another.

David Raubach: I think one of the things that I picked up on there was just a vulnerability on the part of both people, but also it sounds like on the part of the patient. I mean, you kind of joke about well getting comfortable in your own skin, but that is a that’s a real thing.

Sarah McLean: Absolutely.

David Raubach: What are some pieces of advice that you give to patients as they’re thinking about going through the horrors of getting cut on and carved up and chemotherapy and losing hair? How are you telling people to try to approach that?

Sarah McLean: That’s a hard question. Yeah. Again, everybody’s different, of course, but I would say the vast majority of people that I get to talk to, I think it depends on what you’ve done in your treatment process, too. So, some do chemo, some don’t. Some have reconstruction, some don’t. Everybody has personal choices, but I would say just generally across the board. Being naked, of course, getting comfortable with yourself. But if you’re done reconstruction, I would recommend looking at doing areola tattooing. I hear a lot of girls say, “Well, I don’t need that.” And I’m like, “Well, he might not, but what about him?” That might help him to feel more comfortable. And to my husband’s credit, like it wasn’t about him, right? It was me, right? I was the one that had a problem. I couldn’t get comfortable with it.

Sarah McLean: But when I once I did did that, it helped me feel normal. It doesn’t look normal. It doesn’t feel normal, but in in the mirror, it’s like this illusion. And so, psychologically, it just helped me to embrace myself a little bit better. I tell girls sometimes, I know a lot of people wear wigs, some don’t. I think being honest with your your partner, like you said, the vulnerability part is important because we both have needs, but I think it’s appreciating where we are. If you don’t feel well, obviously, you’re not going to lean into that. But there’s a lot of resources available to you. We work with a lot of, not a lot, I would say several sex therapists that help you because a lot of the treatments that we do specific to breast cause vaginal atrophy.

Sarah McLean: And so, not only are you dealing with this part and the hair part, then your vagina dries up. So, then you’re like, what am I going to do now? And so, again, it’s that vulnerability. Nobody wants to talk about that, right? But you’ve got to. That’s how you have healing. That’s how you continue to grow in your intimacy, I think. because if you’re not talking about it, then it’s just getting swept under the rug and that’s just causing more distance. And so, like you said, you have to keep it open. So, that would be what my recommendation would be.

David Raubach: What do you tell somebody because a lot of what you’re talking about, these are sensitive, private topics.

Sarah McLean: Absolutely.

David Raubach: And I think you talked a little bit about it was actually Steve who had to convince you to go to a psychologist early on after the first diagnosis. What do you tell women that are like, “Ah, I don’t want to do the support group thing. I’d rather just get through treatment and then move on and not really talk about all these things that are happening.” What’s your advice to someone who’s coming at this process with that approach?

Sarah McLean: That would have been me, right? I wouldn’t have done that. But you know honestly now over time what I’ve realized is that there’s healing that comes a certain level of healing I think that comes only through community. So that’s why support groups are so important to me. And yeah a lot of girls are like I don’t need that. I don’t really want that. But sometimes it’s because I don’t think they give it a chance either because we’re we don’t the way we design our groups it’s not about just coming and singing kumbaya. We have intentionality behind it. So, you’re going to come and you’re going to hear from an expert in whatever subject matter we may be talking about that night. But it’s through that time that you start hearing stories. You start hearing different perspectives. You start hearing how people have approached different things.

Sarah McLean: And through that, it gives you encouragement. It gives you things to try and you’re like, “Oh, man. Okay.” And you’re validated also. And so, I would really recommend and you know, honestly, like originally when I said, you know, your body naturally goes into a survival state. I love for girls when I first meet them that they will engage in our community from the get-go. I feel like it really can change the trajectory of what the journey could look like rather than waiting until the end because for me I got to the end of the physical part and then all this emotional start this part comes to the surface and I’m like what do I do now? So it was a year later when I started imploding and so if I would have been learning this stuff along the way I could have been kind of processing as I went rather than it just blowing up.

Sarah McLean: So people are intersecting at different points. Ideally I want them at the beginning so we can help them have these tools but if not maybe they come at the end because sometimes people reach out to us and they’re like I’m still struggling. I’m like, totally get it and that’s not foreign and you’re not crazy. But I would recommend people just to give it a try. At least see what we’re about because I think you have to overcome the stereotype, too. Because I think so many times people are like, “Oh man, I just don’t want to hear people whine about cancer.” But I promise you that’s not what we are about. We really want to be an encouragement to you. And so and the caretakers as well. It’s not just about survivors. Like husbands are welcome to come too. And it’s so awesome when you see the husband coming with his wife and he he’s able to hear other perspectives but also he’s able to interject too. And I love to see that.

David Raubach: Right. What talk to me a little bit about the survivorship process. You were diagnosed and treated in 2003. There’s probably a point after that treatment where you think, “Okay, it’s not coming back.” Then it does come back eight years later, but then now you’re still on this survivorship journey where you’ve gone through treatment twice. And there’s always that little voice in the back of your head, scaring you, maybe thinking, “What is this side effect? What is this symptom? What is this lump?” What is that like for somebody who has not gone through cancer treatment? try to explain what that’s like going through cancer treatment and then living with that right beyond treatment.

Sarah McLean: As you know, I’m passionate about survivorship and I don’t think that term hasn’t really been a hot topic for several years now. It’s just I feel like becoming more prevalent. But survivorship really in our world is once you finish active treatment. So what does and for thrivers going to be for the rest of their life. So survivorship to me is what am I doing to maintain wellness and quality of life for the rest of my life? Like you said, yeah, I was diagnosed 2003, but this will affect me for the rest of my life. Is it at the forefront of my mind every day? Not necessarily. Obviously, it’s a reminder because I see it in the mirror, but for example, I’m what, 22 years out from my first diagnosis. I just had reconstruction in November, right? So there’s residual effects that come from different treatments we do, different surgeries we do.

David Raubach: And explain again for those that have not gone through this journey that are trying to understand the reality of what you have gone through. What did that mean? So you had to do this reconstruction.

Sarah McLean: Yeah.

David Raubach: Why did you have to do that? What was that process like?

Sarah McLean: So in 2003 I did it because and again everybody has a personal choice. There’s multiple different options of different types of reconstruction you can do. There’s implant reconstruction. There’s people who want to stay flat. Then there’s also different kinds of flap surgeries where they’re going to take tissue from a different part of your body and create breasts out of your own tissue. So I chose implant reconstruction. Well, typically those don’t really last beyond 10 years. You want to continue to have MRIs, make sure that the integrity of the implant is not breaking down. Well, over 10 years I got diagnosed again, right? Well, when I radiated a reconstructed breast, I knew that I would be high risk for what’s called capsular contracture. So basically, when that radiation is on an implant, it’s a foreign object in your body, that radiation can cause the scar tissue around that implant to start to thicken and harden. And so over time, it just starts to squeeze and it gets really painful and hard.

Sarah McLean: And so in 2014, I in my mind I thought, okay, I’m just going to let this go as long as I can and then I’ll just go in and again, as a patient, I’m in my mind making up this whole scenario what I think they’re going to do to me. I’m like, I’m just going to wait as long as I can and then I’ll go in and they will just cut the implant out, clean all that scar tissue out, put a new implant in, and then they’ll sew me up and I’ll just move on. Right? That’s what I thought I was waiting for. So, I go to have a consultation in 2014 and the surgeon was like, “Well, no, that’s not how it’s going to work because you’ve been radiated. That radiation kills the blood supply to that tissue.” Okay? And so if we were to take the implant out, try to put a new one in, and then sew your skin, it’s not going to heal because there’s no blood supply to heal the tissue.

Sarah McLean: And so I’m learning along the way, too. So I’m like, what does that mean? What am I going to do? And they were like, well, we’re going to have to take healthy tissue and blood supply from another part of your body. So then at that point, as a patient, you’re trying to figure out, well, what’s the best option for me? I don’t know. At the time when I did it, deep flaps were not as common as they are now. So I did a latissimus dorsi flap. So we did part of my lap muscle off my back and tissue off my back and brought it to the chest and they had to reconnect all those hoses of blood vessels to make the tissue heal, right? And so then we had to like put tissue expanders in, redo the whole thing all over again.

David Raubach: Wow. So to your point, this is an ongoing thing.

Sarah McLean: So that was in 2014.

David Raubach: Well, it’s 11 years later.

Sarah McLean: Okay. So over time now underneath I had gotten a lot of nerve impingement. all these nerves got intertwined because I didn’t know I should have been going to physical therapy to break up all that scar tissue all this time because radiation keeps it’s a gift that keeps giving, right? And so it kept getting harder and harder and I didn’t know I needed to be having somebody manually break that up. Again, I’m learning along the way, too. And so, as I started working on it, I literally couldn’t touch my skin without just having extreme nerve pain. And so I was like, my quality of life, I can’t even really move my arm. Like, what am I going to do? So, I went and had a consult again and the surgeon was like, well, we can cut all that out. And so, again, I’m having to do that again. Hopefully I won’t have to do that again.

Sarah McLean: I’m trying to be more intentional about my physical therapy now because I know, okay, I need to stay on top of it. This is fresh. I know scar tissue has I learned a lot about how scar tissue lays down, how it’s thicker and harder. It’s like a weld. I’m like, I got to break that up, you know? So, I’m learning these things along the way. Again, why community is so important. You need to learn new things. And my quality of life, too. When you did a lap flap, your core is compromised. Like, my body’s like compromised at that point. Well, I didn’t know that. I didn’t understand like, okay, you need to be doing certain exercises to build your core in a certain way. Like, the residual effects of that long term can be pretty devastating if you don’t know. combined with the different treatments that you do.

Sarah McLean: To me, survivor, we should have like a baseline once you get done with active treatment or even like we were talking about before like integrative therapy, bringing things in to boost your immunity. So B12 down, D3 down, testosterone down, like all the things like what can we be doing to help you be as optimal as possible for your body to have the best environment to heal. And then beyond that, continuing to learn now, a lot of trauma work. A lot of women, they have trauma now. Learning about EMDR, what are different resources available to them that they can to work through their trauma now, right? So there’s a plethora of different things. We could go on and on and keep talking about it, but for me, the overall definition would be just really having that wellness and quality of life long term, right?

David Raubach: So that kind of segues into a term that I think is a beautiful term and it’s one that you use to describe women who are living with cancer. It’s a metastatic disease. It’s probably never going to go away. And these are the women that you call thrivers.

Sarah McLean: Yes.

David Raubach: So talk a little bit about what that means. What is a thriver and what is your encouragement and hope for these women?

Sarah McLean: So thrivers, like you said, are the women who are stage four that probably are going to have a different life expectancy than others. But the majority of the ladies that I know prefer to use that terminology rather than survivor because a lot of them have come to the realization that their life is going to look different and they believe that they are thriving every day that they’re alive. They are fighting and I respect that. And so you know, David, it’s very humbling to be in that community. I get on with our Thrivers and these are some of the most amazing people that I’ve ever met in my life. I was just with a friend earlier this week. To be honest, I don’t know how she does it every day. She’s a single mother. She’s not even 40 years old yet. and to see her tenacity, her resilience, her strength, she never complains.

Sarah McLean: But at the same time though, she is not in denial of the reality of her situation. And that’s why I say earlier like, who am I to try to even do something for these people? But that’s not the point. It’s really about community and us coming together, encouraging. I can’t say that enough because hope is transcendent and until the day that we go to heaven, we can still maintain hope. We can still trust that God knows every day that’s planned out for us. And so I learned from them. I don’t feel like I have a lot to offer them, but just showing up. I don’t feel like I think a lot of times too as survivors, we suffer a lot. those of us who aren’t thrivers, there’s a whole term called survivor’s guilt. Like, well, why them and not me? You know, and we’ll never know the answer to that. But at the same time though, I can be present. And I think that’s what I’ve learned more than anything.

David Raubach: Yeah.

Sarah McLean: I don’t have to have the words, right? I don’t have to have the answers, but I can show up.

David Raubach: Yeah.

Sarah McLean: And so that’s what I try to do.

David Raubach: Well, in your presence, I mean, I know that I’ve talked to you on some of the most difficult days because they’re days where you’re literally up at the hospital and somebody is at the point where they may not have much time left and yet you’re willing to show up and talk to them. And even when maybe family members are done, they can’t take what’s about to happen and you’re there for them. I don’t know how you do it, to be honest.

Sarah McLean: Well, I mean, you’re in this world, too.

David Raubach: Yeah.

Sarah McLean: I don’t think it would be something that we would have necessarily chosen to do. That’s why I say and I don’t say that pridefully. Because it is a hard job, you know, but I do believe that I don’t know. I mean, I you know who I am as a person and I never feel that God leaves us. We’re never alone. And if I get to be a representative of him to be with somebody and that’s what I want to do cuz I felt so alone in my journey that I never want anybody else to feel that way right and so that’s why I am going to do my best effort to be there and especially in those moments because that’s when it counts you know I mean I’ve told you before there was a woman that good friend of mine she I went to church with her and she had gone through her initial diagnosis, was doing great.

Sarah McLean: Year later it metastasized and I remember it was New Year’s Eve and I had gone to church that morning and she was on my heart and I reached out to her and just said, “Hey, how are you?” She’s like, “I’m not doing great. Could you come pray for me?” And I was like, “Sure.” So, a board member and I went to her house and she was there with her adult daughters and we were I could tell she was her body was shutting down. And so, we were just there to visit with her and I prayed for her and I really felt like there was a letting go for her daughters and for her. And so, that night the older daughter who I had been communicating with called me and she was like Sarah, she’s like, “My mom tells me she’s ready to go.” But her grandparents were here were like, “We’re here to fight for your healing.”

Sarah McLean: And she’s like, “But my mom’s saying she’s ready to go.” And I said, “That’s okay. Your grandparents just aren’t there yet.” And I said, “You can tell your mom if she’s ready. That’s okay.” And so then she’s like, “I’m so sorry to bother you.” I was like, “You’re not bothering me.” And so then we got off the phone. The next morning she text me and she said, “Hey, we’ve been up with her all night, but she’s finally resting.” She’s like, “But could you come up and pray in the afternoon?” And I was like, “Sure.” And I get off the phone and I was like, “What am I going to say?” Like, and I really felt like God was saying to me, “I want you to usher her into heaven.”

David Raubach: Wow.

Sarah McLean: And I was like, I don’t even know what that means, right? I was like, I don’t even know how to do that. Like, what? And so, I got off the phone and I called Steve and I was like, babe, I’m like, you’re going with me. So, in that afternoon, this is the first time this has ever happened. And so that afternoon we went to the hospital and I’m sure the whole family thought I was crazy, right? And so we walk in there. I don’t know any of them. And she’s laying there and her father was next to her and you know I go over and just was rubbing her little bald head and telling her how beautiful she was. And I felt like I was supposed to turn on worship music. And so I turned it on and the song was come to me. And so I just laid it by her head and the priest came in and took the whole family in the hallway. And so Steve and I were the only ones in the room with her.

David Raubach: Wow.

Sarah McLean: And I was like okay what do we do?

David Raubach: Yeah.

Sarah McLean: And so then as soon as the song was over, the priest had come in and they all gathered around as a family around her and Stephen and I just stepped back and they said the Lord’s prayer and as soon as they said amen, she passed.

David Raubach: Yeah.

Sarah McLean: And for me, I was just like, wow. It was very humbling moment. And I was just like, okay. And that day though, I felt like when I left, you know, God was like, I want you to get comfortable with the transition into eternity. And I didn’t really know what that meant. I still don’t know what that means, but time and time again now, that’s what keeps happening. And so, I don’t know. I’m just trying to walk it out just like everybody, you know? I don’t know. I just take it one day at a time.

David Raubach: Well, and the biggest thing, Sarah, again, is that you’re there and you’ve created this beautiful community of women that are encouraging each other, you’re encouraging them, and sometimes it’s just being the facilitator. I mean, you’re just facilitating these connections and these interactions. And then of course there’s the times like you just talked about where you’re literally there ushering someone in to the other side. And I— Yeah, I mean it’s I look back at your journey and it’s amazing to think about you at 26 getting diagnosed with cancer and then a few years later thinking, well, I maybe I should give back, but I don’t know what that looks like. like you were still working full-time, you had young kids, and then to see what that’s evolved into now, it’s really a beautiful story.

David Raubach: And I don’t think that there’s many stories like that across the country. And I know there’s not there’s lots of great charities across the country, but there’s very few that are like Project 31 where they’re just this organic grassroots local charity, but that’s ministering so effectively to so many people. And it’s really been you guys have been a blessing to us at the Oklahoma Proton Center and the patients that we’ve treated. And patients, we know that patients do better going through treatment when they have a community. And we tell patients that. But you are that community for women going through breast cancer treatment so that they can get through this arduous process a little bit better than they otherwise would if they if that community didn’t exist.

David Raubach: So talk a little bit about, I know one of the other things that you’re passionate about is, I’m going to say I’m going to use a term legislation, but it’s really advocacy. Advocacy. That’s probably a better term is advocacy. What needs to happen so that women continue to have the best and right access to care possible. I think we were talking a little bit about this initiative that you’re working on with national with and with Stephanie Bice, but talk a little bit about advocacy and some of your efforts there and some things that you’re really hoping to see happen over the next couple of years.

Sarah McLean: Well, first I just want to say thank you to you. I appreciate you personally your personal friend, but also Oklahoma Proton Center and Premiere have been such a blessing to us because honestly without you we can’t do what we do. And it when I say it’s a collaboration, it truly is a collaboration because of HIPAA and all of that. Like I can’t do my work. And so because you get it, that’s why we’re able to meet more patients and you’ve given us so many opportunities throughout the years in multiple different ways. And so I just want to publicly say thank you to you.

David Raubach: Well, thank you.

Sarah McLean: And I you get it like and I love that about the Proton Center, too, because it’s just different. You’re able to function in a different way and I love that. And I don’t feel like anything’s too hard for you, too. You’re always willing to try new things and

David Raubach: Well, I think part of what we’ve bonded over is just a passion to make a difference. Yeah. Like things the status quo is never okay, right? like how are we continuing to get better treatments and advocacy and mental health services and integrative oncology today? It doesn’t look like it did in 2003. I hope it doesn’t look the same in 2026 or 2030 or 2040. Like we just need to continue to do better. Be doing better for patients.

Sarah McLean: Absolutely.

David Raubach: because cancer is probably unfortunately not going away anytime soon and just about everybody has been impacted whether it’s themselves directly or a family member or a friend. But it takes a team.

Sarah McLean: Absolutely.

David Raubach: And it takes people working together to accomplish the goals of women thriving during and after treatment, survivorship, and just better outcomes for patients. Early diagnosis is obviously important. Well back to your point about advocacy.

Sarah McLean: Yeah. So yes, definitely. I mean I think that’s the whole reason that I started this and it’s evolved over time like you said. And I think that I’m trying to adapt as we continue to grow. We’ve had some opportunity with the National Breast Cancer Coalition through our community now because we I think have been diligent and steadfast and building our community here in the city. It’s allowed us an opportunity to have a voice which is amazing opportunity. And so on a national level, it’s this coalition that comes alongside local organizations to represent the community to their local legislators. And so recently we’ve been working on providing metastatic patients a voice to be able to share their stories to change a Medicare bill.

Sarah McLean: Currently the way it stands unfortunately metastatic patients if they want to apply for disability they have to be metastatic for 5 months before they’re even eligible to apply. once they apply, they have to wait 24 months before they’re even able to crazy get services. So that’s nuts. So, but now we have a community so these women can get on. They can share their personal story.

David Raubach: That’s amazing to be able to do that.

Sarah McLean: I’m so honored to be able to have that privilege. But beyond that too, I keep saying it over and over again. You don’t know what you don’t know. You don’t know what you don’t know. And we have to educate people. So part of that advocacy is education. That’s why we’ve started doing an annual expo to provide more of a public kind of conference type platform for people who don’t want to come to a support group type setting. They can come to the conference and basically hear all the same type of knowledge that you would be getting there. So, and meeting different vendors in the local community, bringing people together, showing people what’s available to them, but knowing, explaining to patients, you have a voice, you have a choice. I didn’t know any of that.

Sarah McLean: And so, and oftentimes, you don’t know that until somebody’s telling you that. So, again, that’s why I’m so passionate about it because I want people to know you do have a choice. It is your body that you can look at different options. And trying to always be learning, always be aware of different things that are available so that I can be a funnel, like you said, a connector. I feel like that’s one of the things I do well, I think, is trying to connect people. And that’s what I want to keep doing.

David Raubach: And so, specifically with this legislation, what we’d like to see happen is shorten the period of time from

Sarah McLean: Yes.

David Raubach: the point of being diagnosed with metastatic cancer to actually being able to enroll on Medicare.

Sarah McLean: Absolutely. Yes.

David Raubach: Okay. Unfortunately because a lot of times the women who are in need of that aid, they might not be here by the time they’ve actually completed the eligibility time frame. Yeah. seems warped, right? That if you’ve been diagnosed with metastatic cancer, you should be eligible as soon as possible to

Sarah McLean: Well, and the importance of like I was speaking with the representative on the Hill just before I came here and she said the hard part is that, you know, Republicans think one way and Democrats think the other and Republicans want to know how much is it going to cost. Democrats want to know like, well, we don’t have the resources to be able to do that. So, it’s like they’re opposing one another, but at the same time, we need to see people and hear their voice and see the story, see the impact of someone’s life, right? And so, it’s important.

David Raubach: So, before we go, and thank you so much for your time today, Sarah, this has been amazing. What are you hoping to see happen with Project 31 over the next couple of years? What are some of your You think big. What are some of your big visions for 2026 and beyond?

Sarah McLean: Well, and you and I have talked about this before, but my vision is for us to be a national organization. Obviously that takes time and effort. It has been a grassroots initiative and definitely organic. I think it’s been kind of a slow growing process which I’m okay with because I think it’s been sustainable. I think if it would have grown too fast, I don’t know if I would have been able to stick it out. But I see us growing beyond the state of Oklahoma. I already see a few little things on the horizon that I think maybe open doors. Along with the National Breast Cancer Coalition, these different organizations that are popping up that are learning about us. I’m just kind of waiting to see how that plays out.

Sarah McLean: But ideally, I’d like us to have a national presence. I’d love to be able to partner with other hospitals, but again, because of what we do and it is peer-to-peer, I’m very selective on our leadership team. I’m, you know, these women have to go through their own journey. They have to get to a place where they are able to give back, not only physically, but emotionally and spiritually, too. So, they have to go through their own healing process. So, the vetting process that we go through with our leaders is pretty extensive and timely. And so, we don’t want to rush that either. So I’m we take our time with that, but I’m hopeful that some other partners will prop up.

David Raubach: Yeah, that’s amazing. And so, if someone wanted to access services with Project 31, what’s the best way for them to do that?

Sarah McLean: They can go to project31.com. That’s our website. And we’re also on Instagram and Facebook as well.

David Raubach: Okay. Well, Sarah, thank you so much again for your time today and for sharing and for everything that you’re doing for our patients and for patients across Oklahoma and then hopefully nationally as well in the near future. So, thank you.

Sarah McLean: Thank you for having me. Appreciate it.