by Karla Wilson
From the age of 19, Primary Care Paramedic (PCP) Janet Rygnestad has worked in numerous first aid ‘helper’ roles and embraced a healthy and active lifestyle. A graduate of the University of Victoria with a degree in microbiology and biochemistry, Janet’s volunteer and career path has taken her to search and rescue operations, wilderness and avalanche rescue with her devoted dog Rory, ski patrol in winter — and working as a PCP with BCEHS.
So, when Janet went to her GP in 2020 about a swollen lymph node in her armpit, she was shocked when just days later, she received an advanced breast cancer diagnosis.
“I am a really healthy individual. I barely get headaches, I have no family history of breast cancer,” Janet says. “This wasn’t on my radar at all.”
Janet was further diagnosed with stage four metastatic breast cancer (MBC) in 2022. But throughout her cancer diagnosis, chemotherapy, lumpectomy surgery, radiation and ongoing pharmacological treatment, Janet also studied, trained, and became licensed as a primary care paramedic (PCP). She now works for BCEHS on a casual basis at Station 120 Nanaimo South.
Pictured L: PCP Janet Rygnestad during her Rope Rescue Technician 2 exam, days after she found out her cancer had metastesized.
Pictured R: Janet was the first female hoist technician in B.C.
“When one of us is hurt, everybody jumps in to help. We are the helper people – that’s what we do. If somebody around you needs help, we just help them. My SAR community from across the province raised $30,000 for me. My SAR teammates started a blog for me to document my treatment (
www.rescueourrescuer.ca), hosted a ‘Fill the Freezer’ event so Andy and I wouldn’t have to cook, people sent me funny dog memes to get me through the low energy points of treatment. I am so proud to be part of this community.”
- Janet Rygnestad
As a self-described ‘lifelong learner’, Janet did her emergency medical responder (EMR) certification in 2012 when she was in her 40s. At the time, as a single mother to one daughter, Janet couldn’t afford to leave her full-time job at an engineering firm or work away from her home community of Nanaimo. So, she put her paramedicine hopes on hold.
Five years later, an advanced care paramedic (ACP) friend of Janet’s encouraged her to take the PCP course for her own interest. At the time, Janet was on the hoist team with Comox Valley Search and Rescue (SAR) and as a professional ski patroller on Mount Washington and felt the extra PCP skills would be useful.
By December of 2019, while working full time for Ecofish Research, an environmental consulting firm, Janet finished her PCP course. With COVID-19 stalling precepting, she didn’t finish precepting until October 2020, then wrote the COPR exam in November.
Pictured: Janet Rygnestad and her American Field Labrador, Rory, on the last day of the 2023/24 ski season.
Two weeks after writing the COPR exam, Janet went to her GP and received her first cancer diagnosis: advanced breast cancer.
“Sometimes, when I get the flu, I get swollen lymph nodes – and I had a swollen lymph node in my left armpit,” Janet says. “My GP felt it and immediately asked, ‘Do you mind if I do a breast exam?’”
Janet, who had no family history of breast cancer, agreed to the exam. Just three days later, the diagnostic investigations continued with a mammogram, ultrasound and biopsy – then a subsequent CT scan in the same week. By the end of that week, Janet’s GP contacted her to let her know that although the biopsy results weren’t in, the specialists assumed she had breast cancer that had spread to her lymph nodes. Janet’s GP told her she’d have a bone scan and MRI the following week.
“I’m a first responder, so my first thought was ‘What’s next? Now what?’” Janet says.
“I put down the phone and called my now-husband Andy. He came home from work, and I just cried,” Janet remembers. “That’s one of the only times that I’ve cried hard through this whole journey. It’s the only time where I felt overwhelmed. I’m used to taking care of everything. I’m organized. That’s who I am in the family.”
After the confirmed diagnosis came in, the next year would see Janet experiencing a rash of treatments – including 16 weeks of chemotherapy, followed by lumpectomy surgery, and radiation treatments. She lost all her hair, eyelashes, and eyebrows within a month after starting chemotherapy. But treating her cancer wouldn’t keep her down.
“In the break between chemo and surgery, there was a big search on Salt Spring Island, and I phoned up the SAR Manager and asked if I could come,” Janet recalls. “He agreed I could do radio communications instead of being in the field. It was so good for me to be in my SAR community and to be in that moment. It ended up being super therapeutic.”
Pictured L: Janet documented shaving her head before her hair fell out from chemotheraphy, going bald from the treatments, then having her hair grow back.
Pictured R: Janet on her last day of chemotherapy treatments with the pink celebratory wig.
Janet soon went into surgery and continued to pursue her PCP licensing afterwards. She wrote the jurisprudence exam in between surgery and radiation treatments and tried her best to complete her practical exam in September 2021.
“Radiation took a lot out of me,” Janet says. “I crashed emotionally and physically. That was really tough. I reached out to licensing and asked to push it to October. They told me that by legislation they couldn’t extend it.”
But, as luck would have it, being locked out of precepting for six months during the COVID-19 pandemic ended up being a stroke of luck. Licensing called her back and offered her a six-month extension for her practical exam. “I enlisted my PCP friend Robin Colby to help get me ready in a month. That was key to my success. I had been out of school for almost two years at that point.”
“In November, I went to Victoria and did my practical and I kicked ass,” Janet says, proudly. “Afterwards, I was sitting with my examiner and she said something about my hair because it was so short. She told me I carried the short hair well. When I told her, what I had been through, she leaned across the table and said: ‘You are a [expletive removed] warrior woman.’”
“I bawled the whole way home from Victoria to Nanaimo,” Janet continues. “There was so much stress getting through licensing and it was finally over. I pulled up at a friend’s house and she and I had a dance party in the driveway.”
On October 7, 2022 – the Friday before the Thanksgiving long weekend – Janet received a diagnosis of metastatic breast cancer. Tests had revealed spots on her liver, with the largest area of metastases being four centimetres. She also had areas of metastases on her iliac crest, on her spine and skull.
“We had three SAR calls over that weekend – two involving helicopters,” Janet says. “We were super busy. I was the medical lead on two and team lead on the other. I didn’t have time to feel sorry for myself or think about the MBC diagnoses very much all weekend. I was surrounded by my SAR teammates, and we were busy helping people.”
Pictured: Janet doing a SAR callout the day after she found out her breast cancer had metastesized.
Pictured: After Janet finished her primary cancer treatments, her SAR teammates took her into the mountains to celebrate.
This focus on helping others is how Janet manages her mindset.
“I wasn’t worried about dying when I was first diagnosed– I was about how my family was going to handle it,” Janet says. “I never ever thought I was going to die. Through my whole primary diagnosis and treatment, I never thought for a second that it was going to be unsuccessful.”
Janet’s ongoing regime now includes daily medications, including Ribociclib – a medication that prevents estrogen from binding to the tumour cell receptors and stimulating their growth. Each month, she gets a Fulvestrant injection at the Nanaimo hospital’s cancer clinic. Every three months, she gets an infusion of Zoledronic acid to slow down bone cancer. Janet has blood work done once every three months and a CT scan every four. She also has a brain MRI every four months to monitor a 3 mm lesion that was found in her cerebellum.
“My body loves the regime I’m on and there are no side effects,” Janet says. “The Ribocyclib did not exist five years before I started on it. If I had this just ten years earlier, I would be on something else and who knows how my body would handle that. One day it’ll stop being effective and I believe that there will be something to take its place that doesn’t exist now.”
Throughout her diagnosis and treatments, Janet continued to stay involved in her ‘helper’ roles with SAR. She had met BCEHS Unit Chief Pat Lawley and PCP Mark Blachuras on SAR calls and precepting over the years. Both encouraged Janet to join BCEHS, with Pat encouraging Janet to work as his station when he became the UC for Station 138 Qualicum Beach.
“I was able to get a job 45 minutes away from my house working in a casual position picking up alpha shifts in Qualicum Beach. That meant being paid my full wage,” Janet says. “That’s what brought me in. It’s a great station but I just took a lateral transfer to Nanaimo in September so I’m working eight minutes from my house now. I know a lot of people joining BCEHS now because they have opportunities in their own communities.”
Pictured: Working with BCEHS PCP Mark Blachuras on a Nanaimo SAR call in 2021
“It also perfectly corresponded with that time in my life when I can back away a bit from my full-time job as a project manager,” Janet continues. “I feel like I am more compassionate and can connect better with patients now that I have more life experience. I also understand what it’s like to just be tired of being sick and going to medical appointments. It gets to you after a while.”
The word ‘determined’ doesn’t even begin to describe Janet’s tenacity – a characteristic that has helped her on her journey – both in her career and with her cancer diagnosis.
“I think it's important for us as health care providers to understand that advances in breast cancer treatment mean that a stage four MBC diagnosis doesn’t have to be an immediate death sentence. It can be managed in some cases as a chronic disease, not unlike diabetes.”
As for approach to life, Janet had the words ‘It’s not time to be tired’ tattooed on her right forearm in 2017. This, along with the life philosophy she and her daughter share– ‘Go be excellent’– are Janet’s words to live by. They are also the words her daughter shared with her classmates in the final lines of her valedictory address from UBC’s Allard School of Law.
“It means you don’t do things half-assed,” Janet says. “You do them full gas or you don’t do them at all.”
Without a doubt, Janet Rygnestad has always and continues to live her life with her foot on the gas pedal, driving forward with positivity and hope.
