Jessica Boesmiller, now 38, was 34.5 weeks pregnant with fraternal twins – a boy and a girl – when she had her right eye removed. She'd been diagnosed with ocular melanoma, a rare eye cancer that had the potential to spread and cross her placenta to infect the babies in vitro. Here, the Cornelius, North Carolina, mother, who also has one 7- and one 9-year-old son, shares her story to inspire others to get their own eyes checked.
I'm sitting in the passenger’s seat next to my mom at a Wendy’s drive-thru when the employee working the window notices my glasses, which have one clear and one blackened lens. "Did they come from the manufacturer like that?" he asks. The poor guy probably expected an easy answer like, “I wanted to be a pirate today!” or, “A kid threw a ball at my head!” Instead, I told him I'd recently lost my eye, but not to worry, I'd be getting a new one next month. I was amused when he responded, "Oh. I didn't know," as if he should have.
In November 2017, I was driving home from an evening staff meeting at the YMCA in Cornelius, where I’m the healthy-living director, when I realized vision in my right eye was blurred. At the time, I was 31 weeks pregnant with twins in what had been an eventful journey: After a year of trying for a third child with my husband of 10 years, Mark, 41, and I conceived via intrauterine insemination (IUI). I was 37 at the time.
Beginning in week 10, though, I bled for 16 weeks – like the longest period ever – because there was blood where my placenta attached to the wall of my uterus, and it needed to drain. Then, around the 20-week mark, I developed hip pain so severe that I needed a walker to get around.
Worried that, on top of everything, the blurred vision I noticed during my third trimester was a sign of preeclampsia, a pregnancy complication often marked by this symptom, I called my high-risk obstetrician several days after I first noticed it.
My OB-GYN reassured me it wasn’t preeclampsia and sent me to the eye doctor, who referred me to a retina specialist I saw on Tuesday, November 7. It was then I was diagnosed with ocular melanoma, a rare eye cancer that can spread and become fatal quickly, although doctors couldn't predict the severity of my condition at that point, before testing the tumor. The condition tends to affect adults older than 55, but I’d heard about the disease after it mysteriously appeared among younger women in my area over the summer. (Researchers are still trying to figure out why.) Still, I hadn’t gotten checked for it because I could see well enough to forgo the glasses I had for night vision – plus, you never really think something bad is going to happen to you.
The moment I left the doctor’s office with my husband, we both started Googling, and I really began to freak out about possible outcomes. The retina specialist referred me to an ophthalmology oncologist at Duke University Hospital, and I went in on November 15 with my parents and husband. I was 33 weeks pregnant. That day, after a series of tests, a fellow was examining me when I noticed his computer screen out of my left eye. I could just make out a box that said, "Recommendation: enucleation." Because I'd already Googled treatment options, I knew this meant eye removal. I began to process it in my own way – by asking questions about what the procedure would entail.
I actually felt strangely prepared to move forward with this course of treatment: Although I rarely watch videos on Facebook, coincidentally, just weeks before my diagnosis, I’d watched an entire clip featuring an ocularist – someone who fits eye prosthetics – at work, so I knew there was a way for me to look “normal” again. I’d be fine, I thought. I’ll get over it.
Instead of focusing on losing a portion of my body, I thought of being able to live and be with my children – I knew my appearance wouldn't affect my ability to be a mother.
Shortly after I spotted my fate on the screen, the doctor came in to explain the treatment to my family, who was seated across the room, and me. Everyone kept their cool in front of the physician, and I was actually OK until I saw my parents begin to cry quiet tears, subtly breaking out the tissues. I was still sitting in the examination chair, so my husband came over to hold my hand. It was only after the doctor left the room that we all embraced.
Although there were alternative treatment options, such as radiation therapy, we learned this would involve monitoring the tumor's size constantly and the ever-present fear that it was spreading – much more stressful, in my opinion, than removing the entire mass. Due to the size of my tumor, if I kept my eye, I'd likely lose my vision anyway, and it would damage the muscle surrounding my eye, which is important to keep intact for good movement (and a "normal look") when using a prosthetic.
There was no question eye removal would be the smartest, safest approach to keep the tumor away from my babies, since melanoma is one of several cancers that can cross the placenta, which is rare but can be fatal for an infant. We wouldn't know whether the cancer had spread elsewhere in my body, and had reached the babies, until after delivery when we could test the placenta.
To explain the situation to my sons Connor, 7, and Caleb, 9, we used a metaphor: We compared the tumor to weeds in a garden that had to be removed. We also talked about how cool I'd look wearing a pirate patch while I healed. Then I showed them YouTube videos of ocularists making prosthetic eyes, with before and after photos. They totally rolled with, as only kids can do.
My 2.5-hour enucleation procedure was scheduled at Duke University Hospital for November 30. The babies would be 34.5 weeks old; in case there were complications that called for an emergency C-section, they'd be able to survive with just a few nights in the newborn intensive-care unit. There’s a picture of me wearing a red cap in my hospital bed right before my surgery, and I’m smiling. I wanted the tumor out of my body and away from my babies, and was happy to get it done. Although I really wasn't scared, I had a flashback to our 2007 wedding as I was wheeled into the operating room and parted ways with my husband. I realized it was the last time I would be able to look at him with both eyes.
I was put to sleep and woke up about 1.5 hours after the surgery with no pain, since I'd received an anesthetic nerve block. When I opened my remaining eye, I found a nurse monitoring the heartbeats of my babies through my belly. I got to listen and finally was reassured they were completely fine.
When the block wore off the next day, the pain in my eye and head was excruciating and required strong pills for relief. There was lots of swelling in the area, and at first I avoided looking in the mirror. When I did, several days later, I recoiled. My first thought was, “My poor husband – this is what he’s had to look at,” since he’d been helping me apply antibiotic ointment since the surgery.
Where my eye had been, I saw a blood-red spherical object about the same size as an eyeball. It's a lens wrapped in my own skin and muscle from within my eye socket. When I heal enough to get a prosthetic – hopefully at the end of January – it will attach to the lens and move naturally in tandem with my left eye.
Although this is typically an outpatient procedure, I stayed at the hospital the night before and after the surgery so the babies could be monitored. When I got home, my sons weren’t fazed by my missing eye – their biggest concern was my pain. When they first saw me without a patch, they hugged me and kept asking, "Does it hurt?" I told them I was fine, and they were relieved.
Two weeks after I was released, my lingering headache subsided, but I put myself on bedrest. I’d become increasingly uncomfortable carrying 12 pounds of babies inside me, my hips hurt, and I doubted my left eye's depth perception after missing the glass when pouring from a pitcher a couple times. My husband became my home nurse.
My C-section was planned for December 22, so my parents came over the night before for an early Christmas celebration. Everyone had begun to open their gifts when, suddenly, my water broke. I was excited because I hadn’t experienced this with either of my previous deliveries – my first son was late so they had to induce him before performing an emergency C-section, and I scheduled a C-section for my second child.
Later that night, I had a healthy baby boy, Mason Dare, and girl, Piper Marie, via C-section. Delivery left me swollen everywhere, which initially affected the fit of the large contact lens I wear in the right socket to help glide my eyelid shut. (It's a movement I still have to work for.) The contact lens sometimes falls out.
Now that I have two newborn babies to care for, though, I'm glad I had my eye enucleation while I was pregnant. To be laid up in a hospital recovering from eye surgery on top of my C-section would have taken me away from the twins and affected my ability to breastfeed. It would have been impossible for me to take care of them with the kind of post-operative pain I had experienced in my eye and head.
Overall, I've been recovering well from both my cancer and C-section, largely thanks to support from friends and family. At this point, I’m getting used to seeing out of one eye and plan to return to work in February. Because I’m a little self-conscious about the way I look right now, I wear an eye patch or glasses with one lens blocked out. I try not to sleep with either, so the first thing my husband sees when he wakes up every day – and four times throughout the night when I nurse the babies – is my lens, which has turned pink as it's healed.
Last week, my ophthalmologist delivered test results that revealed I'd had the worst kind of tumor, but it was removed before it spread to the tissues around my right eye socket. Although placenta testing suggests the cancer didn't travel to the babies or to other parts of my body, there's still a 50 percent likelihood of it metastasizing within the next three years. The chance drops slightly in the five years that follow. The way I think about it: A 50 percent chance the cancer will spread is also a 50 percent chance that it doesn't.
Soon, I'm hoping to find a clinical trial to help prevent my cancer from resurfacing. My insurance won't pay for experiential preventative treatments or for travel to treatment centers, so we'll use money raised via GoFundMe to pay for that, plus scans every three months for the next few years, since insurance won't cover such frequent testing.
I want to make sure I’m here for a very long time for my children and will do everything I can to make that happen.
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Correction: An earlier version of this article misidentified Boesmiller's eye surgery as a manipulation and described the specialist who fits eye prosthetics as an oculist. The procedure is actually called enucleation, and ocularist is the correct way to categorize this specialist.