Hours after a needle fed another round of toxic chemotherapy into her veins, Sandra Knott wondered aloud whether she would survive to don the crisp uniform of a state correctional officer again.
"I can't die before I win this," she said on a recent afternoon, her face pale, her head covered by a polka-dot scarf.
For the past two years, Knott has been fighting parallel battles: metastatic cancer, and her supervisors at California State Prison, Sacramento, where she has been a correctional officer for 25 years.
The medical fight continues. But it looks as though Knott has succeeded in her effort to keep her job even as she fights Stage 4 breast cancer.
Earlier this month she and her lawyer, Jill Telfer, reached a settlement with the state Department of Corrections. The agreement awards Knott damages of nearly $1 million and mandates that the agency create a statewide policy to accommodate employees with medical conditions or disabilities that interfere with their ability to do their jobs.
Knott's story is a powerful illustration of the dilemma that employers face when a worker becomes desperately ill. If an employee cannot perform her regular duties, what obligation does a company or agency have to find another place for her, with the same perks and pay?
It is an area covered under California's Fair Employment and Housing Act. Under the law, employers cannot discriminate against someone "in compensation or in terms, conditions or privileges of employment" based on a medical condition. But the measure does allow employers to discharge someone who "is unable to perform his or her essential duties," even with accommodations.
"Unfortunately these kinds of cases happen a lot," said Eugene Lee, a Los Angeles lawyer who blogs about employment law. "The cancer cases are especially tragic, because these are people who may have a limited time on the planet. They don't want to spend whatever time they have left litigating."
The Corrections Department declined to discuss the Knott settlement, which spokeswoman Terry Thornton described as tentative. But legal papers lay out the agency's position.
Telfer has argued that the Fair Employment and Housing Act requires the department to provide Knott with "reasonable accommodation" by giving her a less strenuous position during treatment, allowing her to keep her correctional officer status and seniority and work toward retirement.
The department, which like most state agencies is facing a budget crunch, said it had no obligation to do so for a correctional officer with cancer who is unable to perform "essential functions" of the job.
As the case dragged on, Knott said, she became convinced that the agency was deliberately delaying resolution in hopes that she would die, thereby avoiding a costly settlement. Agency officials insisted they were working hard to come up with a plan that was fair to both Knott and the department.
Some fine points of the agreement have yet to be worked out, but Knott said she can see the finish line.
"I'm ecstatic, for myself and for all of the other cancer patients out there," she said, sitting in her lawyer's office, her eyes welling up.
"I just want to get back to work."
In some ways, working at the state prison formerly known as New Folsom prepared Knott for her cancer diagnosis and the harrowing treatments that followed.
The prison is a sprawling maximum-security facility that houses more than 3,000 of the state's worst male offenders. They are killers and rapists and gang members, many of whom have been deemed "management problems" at other institutions.
Knott, a Utah transplant, was 23 years old and one of few female officers when she began working on the prison's housing units in the late 1980s. Women faced open hostility from male officers, she said, and catcalls and worse from inmates.
"It was horrible. Sink or swim," she recalled. "I thought, 'Oh my God, what did I get myself into?' "
But Knott liked wearing the uniform, appreciated the good pay and benefits, and relished the occasional chance to have an impact on the life of a criminal.
As she reported to work each day, Knott first gathered her equipment. Pepper spray. Baton. Radio. Handcuffs. Keys. Wearing a "stab proof" vest under her uniform, she monitored inmates, checked for weapons, alcohol and other contraband, and worked to keep things calm.
"I always try to find something positive," she said. "I have told inmates, 'If you do nothing else while you are in here, get your education because at some point you might get out and build a life.' "
In 2001, Knott's life took a scary turn when, during a routine checkup, a doctor found a mass in her left breast.
A scan showed that it likely was benign, and Knott charged forward with work and life.
Following a quiet graveyard shift one morning, Knott went home, disrobed, and glanced in the mirror. She saw a lump under the skin of her breast, in the same spot where the suspicious mass had surfaced years earlier.
Tests revealed it was cancerous.
After the diagnosis, Knott looked at her boyfriend, a correctional officer whom she later would marry, and sobbed. Then she began to research her options.
She decided to travel to the Cancer Treatment Center of America in Seattle, which offered holistic care in addition to standard chemotherapy and radiation. Once a week for three months she received chemotherapy at the Seattle hospital, while also consulting with an oncologist in Sacramento and working full time.
The treatments sapped Knott's energy and made her stomach churn. The first week, she lost 7 pounds. The second, she lost her hair. Her feet cracked and bled, making walking painful.
Knott began to worry about what might happen if a fight or riot erupted. Would she be able to respond?
She was unsure. So she requested, and received, permission to be transferred temporarily to a job in which she would have little contact with inmates. James Walker, the warden at the time, allowed her to be assigned to office work but keep her officer's pay and benefits.
"Continuing to work gave me a sense of normalcy," Knott recalled. "I wasn't sitting at home wondering if I was going to die."
In December 2004, doctors declared Knott free of cancer.
"I felt I had beaten it," she said.
With her disease seemingly under control, Knott found herself dealing with other crises.
Her mother developed lung cancer, and Knott cared for her for 18 months until she died. Knott's marriage crumbled.
She developed a persistent cough, which at first she dismissed as allergies. Weeks later, a scan revealed that her cancer had returned.
While continuing to work, Knott began taking the drug tamoxifen, which suppresses estrogen, and her tumors started to shrink. But the side effects, she said, were "hellacious," including hot flashes that drenched her with sweat even on cool November evenings.
After various treatments, she once again went into remission in August 2009. She was ready to return to her job on a housing unit.
In March 2010 the cancer roared back.
Knott surrendered to another round of chemotherapy which, among other things, triggered neuropathy that caused pain and weakness in her legs.
Once again, she asked for reassignment to an area in which she had no direct contact with inmates. Continuing to work was not only good for her morale, she said. It also would keep her on track for retirement at age 50.
Under the prison's new warden, Tim Virga, her request was denied.
Corrections officials said they offered her several jobs, but Knott refused them because they required walking long distances or responding to emergency alarms. Knott, they said, clearly was unable to perform the "essential duties" of a correctional officer.
"We do not provide light duty to correctional officers unless they are pregnant," prison business manager Laura Eldridge responded in a September 2010 exchange with a personnel official about Knott's case.
The facility had at least 50 officers out on sick leave, Eldridge wrote. "We can't possibly bend the rules for each case."
This time, Knott felt she had no choice but to take medical leave. She also contacted a lawyer.
Attorney Jill Telfer felt pressure to resolve Knott's case quickly. But Telfer, a disability rights specialist, knew that bureaucracies rarely move fast.
"She was fighting for her life, and all she wanted to do was get back to work," Telfer said. "It was a hard case, but I knew I had to do this."
After several attempts to persuade the Corrections Department to accommodate her client, Telfer filed a civil lawsuit charging employment discrimination.
Communications between the two sides were contentious.
In response to a query from Knott about possible job openings, Jan O'Neill, chief of the Office of Employee Wellness, was succinct.
"Your letter makes it sound like your need for medical treatment is of concern to me," she wrote. "My only concern is your ability or inability to safely perform the essential functions of your peace officer classification."
The department offered Knott one position that required walking the perimeter of the prison, she said, and another as an armed "gunner" in one of the facility's towers.
Knott tried the gunner position, but it proved too physically demanding, she said. She again took leave.
As the two sides continued to bicker, Knott used up her medical leave benefits, lost her house to foreclosure and ultimately filed for bankruptcy. But she was buoyed by her former colleagues, who donated unused leave time to her, allowing her to pay rent and buy groceries.
"That gave me some hope," she said. "It made me want to dig in my heels and keep fighting."
Knott stashed her beige and green uniform in a closet in her Folsom apartment when she last left the prison at the end of March.
Meanwhile, her lawyer prepared for trial.
Knott was 16 months from retirement when the state agency's attorneys contacted Telfer this month and said they wanted to work toward a settlement.
The department agreed to settle for $995,000, which the court will distribute, less taxes, to Knott for pain and suffering and Telfer for attorney's fees. The agency also has agreed to give Knott a job that will meet her medical limitations, such as records technician or account clerk, and restore leave time donated by her colleagues. She will keep her job classification and pay.
Most important to Knott, the agency has promised to create a "temporary disabled employment policy" that will protect sick or disabled employees in the future. As of Friday, the department and Telfer had yet to agree on specific language for the policy, which will apply to institutions across the state.
At her apartment last week, Knott, who is taking weekly chemotherapy, said she is more than ready to put on her uniform again.
"I can't wait to get back," she said. "I feel like I really accomplished something."
As for the cancer, only time will tell whether the latest treatments will save her.
While on leave, Knott has filled her time reading books with titles such as "What to Eat if You Have Cancer" and "Living Consciously, Dying Gracefully."
She is prepared, she said, for whatever might happen.
"I don't know if I'm going to beat this," she said with a smile, "but I have hope I'll live with it for a long time. I always have hope."