This Might Surprise You – A Breast Cancer Story

by Janet Chan

Hayley Gullen’s This Might Surprise You details her journey being diagnosed with early onset HER2 positive breast cancer. She starts with finding her breast lump and takes us through her experience being diagnosed and enduring multiple treatments. Breast cancer is one of the most diagnosed cancers in women globally with an estimated 2.3 million women diagnosed in 2022 (WHO, 2025). Early onset breast cancer is when breast cancer is diagnosed before age 50 and its incidence is on the rise (Brown, n.d.). HER2 positive breast cancer is a quickly growing cancer that accounts for about 20% of breast cancers (Adams, 2022). Haley’s graphic novel will be relevant to a number of breast cancer patients and those close to them.

Gullen has created a graphic novel that is like talking to a good friend. She doesn’t shy away from the topics that might be considered embarrassing or sensitive. When having a biopsy in which she must lie face down, her nose starts to drip onto the floor, but she is not supposed to move (p.43). She navigates having sex with her husband and the PICC line in her arm for her chemotherapy (p.49). She tackles these topics with a direct attitude that doesn’t leave any room for embarrassment or discomfort. It is simply part of the process.

Two themes that are interwoven through the novel are the importance of communication and of caring for yourself. Speaking up when you don’t understand or need to advocate for yourself can be difficult, but the payoff can be worth working through your discomfort. Hayley illustrates the difficulties in talking to her doctor by drawing him sitting above her on a cloud with large speech bubbles dominating the conversation (p.14). Working through her confusion, she finds the courage to speak up and ask a question. The doctor climbs down from the cloud and patiently explains the information to her. She learns this again when being booked for surgery with a doctor she doesn’t know. Asking for the surgeon she wants gets her an earlier surgery date (p.87). She also shares her experiences of trying to advocate for herself and being brushed aside by her nurses. Her persistence results in getting the help she needs but also in getting backlash on her next oncology visit. Being your own advocate is not always easy, and Hayley illustrates the fears that can occur when standing up for yourself. When speaking to a member of her care team, she says “I’m worried the nurses will treat me differently if I complain” (p.145). Ultimately, the nurses listen to her complaints and make changes for improvement.

Hayley also learns that it is ok to care for yourself. She deals with the changing side effects of the different chemotherapy treatments, finding ways to cope and reenergize. Initially, she struggles with feelings of not being there for her young daughter and all the extra work her husband is doing. This persists through her treatment and surgeries. When she is nearing the end of her physical treatment, she acknowledges that she can finally address her mental health. Mental health therapy sessions help her to work through the dehumanizing aspects of cancer treatment and give her new ways to cope with her feelings.

The illustrations are fine black and white drawings. The characters have prominent eyes which are emphasized during the clinical scenes where they are wearing masks. She is refreshingly honest about her illustrations. On the page of her biopsy, she writes “Don’t expect me to draw a biopsy. I wasn’t looking” (p.6). Hayley uses a mixture of speech balloons to differentiate between what happened in the past and her current insights and thoughts. This technique gives the reader the impression that you are having a conversation with her. She also uses a technique where some information is darker in the foreground and lighter in the backdrop. This gives the reader what is currently happening in the bolder illustrations and text and the relevant background information on the situation. I found this to be an effective strategy to communicate a lot of information.

I was delighted by the last panel of Hayley sitting at a table with a cup of coffee. I realized that my impression of talking to a good friend was what she seemed to intend all along. Great job Hayley- you did it! This Might Surprise You is an honest portrayal of breast cancer and will make an excellent addition to a graphic medicine collection.

Note: Excerpts from This Might Surprise You were published in the Journal of Medical Imaging and Radiation Sciences (Gullen, 2024).

Adams, M. HER2 positive breast cancer: What it is, diagnosis and treatment. The University of Texas MD Anderson Cancer Center. https://www.mdanderson.org/cancerwise/her2-positive-breast-cancer–what-it-is–diagnosis-and-treatment.h00-159542112.html

Brown, J. (n.d.). 5 facts about breast cancer in younger women. Breast Cancer Research Foundation. https://www.bcrf.org/about-breast-cancer/breast-cancer-young-women/

Gullen, H. (2024). This might surprise you. Journal of Medical Imaging and Radiation Sciences, 55(2),169-177. https://doi.org/10.1016/j.jmir.2024.02.001

World Health Organization. (2025, Aug 14). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer

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Janet Chan, MLIS, AHIP, RN is a research and education librarian at the University of South Florida Health Libraries. Her research areas include bibliotherapy, graphic medicine, and digital health.