But you can make do with just one.
***
It was mid-October and I was at my ob-gyn's for my annual visit. We were having a good moan over the economy and were panic-struck that Caribou Barbie might actually swing the election away from the guy we both wanted (it's always nice when the doctor who has seen more of you than your own mother shares your political views). My doctor observed again what she had observed a year before, a thickening in my upper left breast. Not a lump. Not a mass. Just a thickening."Look," she said, "I know we added an ultrasound last year, and I'll concede that your mammo still looks perfectly ordinary, but I'd just feel so much more comfortable if our breast surgeon takes a look. If he agrees it's nothing, I'll quit worrying."
I yawned. I love my ob-gyn, but she's the panicky sort. However, I do take these matters seriously. Nearly thirteen years ago, when I turned 40 and had a new baby on my hip, I resolved to do better where my health was concerned. I started flossing every day. I booked my first mammogram. My mother assured me this was crazy. Since breast cancer didn't run in our family, what was the point of getting your boobs crushed in that infernal machine? Like many people, she clings to the notion that some individuals are just marked for cancer. And since she's not marked for it, I can't be marked for it. The discovery of leukemia in the bones of her beloved first grandchild, some twenty years ago, did nothing to change my mother's opinion that patients should diagnose themselves and not listen to anyone with a medical degree.
Being a master at ignoring my mother, I've had my boobs crushed faithfully and largely on schedule, every year. By the time I was 45, the radiologist started seeing little grains of calcium in one breast. Tests were scheduled. Observations were made. I panicked. Nothing ever came of all the scrutiny. So when Dr. Ortique had me schedule the visit to the boob doc, I thought I was humoring her. Again. Just like last year. To me, what my ob-gyn was feeling was just the same old gnarly, fibrous matter she'd been feeling for years.
The hospital's new breast surgeon turned out to be a terrifically nice guy from New Orleans. Dr. Brown wasn't worried by what he felt as he palpated the suspicious area. The tissue certainly didn't fit the disturbing pattern of a roundish but irregular mass. "But let's do another ultrasound," he said. "Just to be sure."
More yawning. More irritation. By now, Thanksgiving is closing in and I really do not have time for this. But dutifully I go to the radiologist for the ultrasound. Anyone who has contact with the medical community knows that radiologists are the odd birds of the medical world. They spend hours a day in a cave, mumbling into recording devices and looking at images of various kinds. People skills aren't a big thing for them, not usually. So when the radiologist planted the ultrasound wand on the same area she had examined a year before, I wasn't sure how to react to her announcement: "What I see is very troubling." She succeeded in making me anxious, though. Of course, she wouldn't be able to do a biopsy for several days, owing to her three-day work week. I'd have the weekend and then some to stew on things.
My husband was away in New York. I didn't want to panic him, so I called up my sister and did my best to worry her, too, though as a former hospice chaplain and the mother of a cancer survivor, she's a professional when it comes to avoiding panic. She kept me sane, a bit, but I worked hard to bring her into the pit with me. I reminded April that the majority of breast cancer patients have no family history of the disease. She countered that, for a radiologist, a good day is one where she does find something and when she can't actually find anything, she'll make do with feeding a patient's doubts and fears. After talking to April, I breathed a sigh of relief, hung up the phone, and went back to my normal routine of bike rides, house cleaning, and the care and feeding of a thirteen-year-old. And I waited for the pages to turn on the calendar.
***
The assistant covered me in goo, waved her wand, took her pictures, and called the radiologist in. The assistant and the radiologist seemed to have an excellent rapport, but damned if I could figure out why it took two of them to study my case. The radiologist just seemed to repeat the technician's actions. My old programmer's eye couldn't stop looking for opportunities to streamline someone else's business. But this useless fog of thought was quickly banished by the radiologist's next words, spoken in her soft Irish accent: "It's cancer we're looking at."
My first question was: Why did my mammograms, which she had been reviewing for some six years now, show nothing? The radiologist declared that this was probably a case of invasive lobular carcinoma. This kind of cancer, which characterizes about ten percent of all breast cancers, can go undetected for a long time. She took three biopsies and immediately made an appointment with the breast surgeon. That's how convinced she was that there was a problem. The appointment would be for the next day, at 2.30. She said she'd probably have the pathologist's report back in the morning.
I didn't totally panic. I knew that until the pathologist analyzed the tissue samples, nobody knew anything. I didn't want to frighten Mike, so I kept my own counsel. I worked in the yard and started a diet right then. At the very least, I reasoned, we'd be looking at surgery of some kind. And I believe in preparing for surgey the way you prepare for a marathon. I knew I'd do so much better if I went in as fit as I could be.
Morning of the next day came and I waited by the phone, my panic growing. "It's bad news," I thought to myself. If it were good news, she'd call. By the time I was back at the hospital and in the surgeon's waiting room, I was convinced that the news would be awful. Dr. Brown came in and announced quickly, "It's not cancer. In some ways, it's worse."
And thus began my immersion in the nebulous world of cancer terminology. Dr. Brown explained that the biopsies showed Ductal Carcinoma In Situ (DCIS). In other words, the cancer had not yet invaded any surrounding tissue. This was good news! I kicked myself for reading so much into the fact that no one had called me that morning. I kicked myself for being sucked into the radiologist's sweeping diagnosis of my condition. I was so busy kicking myself that I completely misunderstood Dr. Brown's "In some ways, it's worse." I talked myself into believing that he meant worse in some obscurely technical way, one beyond the concern of mere mortals who'd just been told they didn't have cancer. He cautioned me that now I would have an MRI, and that this was likely to lead to more biopsies, possibly unnecessary ones, because the noise-to-signal ratio of an MRI is so much higher than with ultrasound. I rushed home and read everything I could on the internet about DCIS, my heart feather-light now that I didn't have cancer. I cursed the radiologist for being soooo wrong.
My first question was: Why did my mammograms, which she had been reviewing for some six years now, show nothing? The radiologist declared that this was probably a case of invasive lobular carcinoma. This kind of cancer, which characterizes about ten percent of all breast cancers, can go undetected for a long time. She took three biopsies and immediately made an appointment with the breast surgeon. That's how convinced she was that there was a problem. The appointment would be for the next day, at 2.30. She said she'd probably have the pathologist's report back in the morning.
I didn't totally panic. I knew that until the pathologist analyzed the tissue samples, nobody knew anything. I didn't want to frighten Mike, so I kept my own counsel. I worked in the yard and started a diet right then. At the very least, I reasoned, we'd be looking at surgery of some kind. And I believe in preparing for surgey the way you prepare for a marathon. I knew I'd do so much better if I went in as fit as I could be.
Morning of the next day came and I waited by the phone, my panic growing. "It's bad news," I thought to myself. If it were good news, she'd call. By the time I was back at the hospital and in the surgeon's waiting room, I was convinced that the news would be awful. Dr. Brown came in and announced quickly, "It's not cancer. In some ways, it's worse."
And thus began my immersion in the nebulous world of cancer terminology. Dr. Brown explained that the biopsies showed Ductal Carcinoma In Situ (DCIS). In other words, the cancer had not yet invaded any surrounding tissue. This was good news! I kicked myself for reading so much into the fact that no one had called me that morning. I kicked myself for being sucked into the radiologist's sweeping diagnosis of my condition. I was so busy kicking myself that I completely misunderstood Dr. Brown's "In some ways, it's worse." I talked myself into believing that he meant worse in some obscurely technical way, one beyond the concern of mere mortals who'd just been told they didn't have cancer. He cautioned me that now I would have an MRI, and that this was likely to lead to more biopsies, possibly unnecessary ones, because the noise-to-signal ratio of an MRI is so much higher than with ultrasound. I rushed home and read everything I could on the internet about DCIS, my heart feather-light now that I didn't have cancer. I cursed the radiologist for being soooo wrong.
***
And I would come to curse the internet, too. There are people like my surgeon, who only use the word 'cancer' for invasive carcinomas. And there are other people who insist that DCIS should indeed be called "cancer", but cancer at stage zero. Busy as a buzzard on roadkill, I tried mightily to ignore anything I didn't want to hear and paid too much attention to all the benign descriptions of DCIS. DCIS could become cancer, or at least reside right alongside it. I read the testimonies of women who had 'multi-focal' instances of DCIS in the same breast and hence had to have the entire breast removed. Some of these women were informed that small invasive tumors had been masked by the DCIS. I was quite able to read all this and believe that at the very worst, I would have a lumpectomy. I could not possibly be one of those ladies who would have to undergo a mastectomy. Or chemotherapy.
Occasionally, a light-bulb would go off and I would think of Mother and her near-mystical belief that some people just aren't marked for cancer. Despite all my research, I was guilty of the same magical thinking. On the basis of biopsies, which are essentially small samplings of a fraction of the diseased tissue, I had come to conclusions that my surgeon had never encouraged. He had laid out best and worst cases, but all I could hear was his terminology: It's not cancer. Therefore I'd at worst have a tiny scar.
After that first visit to the breast surgeon, I went for an MRI. The results from the MRI suggested that biopsies in the right breast were warranted. This job was assigned to the ultrasound radiologist, who basically balked, unconvinced that the MRI radiologist had spotted anything at all. She referred me again to the MRI radiologist, because the one area she agreed might be worth a biopsy would require her to completely penetrate the breast from one side to the other, and her office wasn't set up for such a procedure. Another delay! And of course the MRI radiologist would have an annual week-long booze-up and conference to attend before he could get back to me. Another ten days passed as I waited for a biopsy with an MRI-assist. And more days passed, waiting for the pathology.
But I wasn't really concerned. I was already hearing my surgeon's voice: "Right breast is normal. Left breast has this tiny problem. See you after Christmas". Yes, this had all taken so long that Thanksgiving had come and gone and Christmas was bearing down like the Polar Express.
Occasionally, a light-bulb would go off and I would think of Mother and her near-mystical belief that some people just aren't marked for cancer. Despite all my research, I was guilty of the same magical thinking. On the basis of biopsies, which are essentially small samplings of a fraction of the diseased tissue, I had come to conclusions that my surgeon had never encouraged. He had laid out best and worst cases, but all I could hear was his terminology: It's not cancer. Therefore I'd at worst have a tiny scar.
After that first visit to the breast surgeon, I went for an MRI. The results from the MRI suggested that biopsies in the right breast were warranted. This job was assigned to the ultrasound radiologist, who basically balked, unconvinced that the MRI radiologist had spotted anything at all. She referred me again to the MRI radiologist, because the one area she agreed might be worth a biopsy would require her to completely penetrate the breast from one side to the other, and her office wasn't set up for such a procedure. Another delay! And of course the MRI radiologist would have an annual week-long booze-up and conference to attend before he could get back to me. Another ten days passed as I waited for a biopsy with an MRI-assist. And more days passed, waiting for the pathology.
But I wasn't really concerned. I was already hearing my surgeon's voice: "Right breast is normal. Left breast has this tiny problem. See you after Christmas". Yes, this had all taken so long that Thanksgiving had come and gone and Christmas was bearing down like the Polar Express.
***
When Dr. Brown walks in and says, "Good news! There's no sign of disease in the right breast." I want to get up right there and go back to the Irish radiologist and say "Nyah, nyah, nyah!" to her smart-ass conclusions.
As Dr. Brown continues talking, it's clear that the tidy little lump I've imagined in my left breast doesn't fit that description at all. He has me get up on the table again and again he palpates the suspicious area. "What I'm feeling is what I'm also seeing on the MRI," he says. The lesion isn't lumpish at all. It's a diffuse, fern-like object, a corruption of the milk ducts in nearly 50% of the breast, or more. With a classic lump, you remove it, plus a centimeter of surrounding healthy tissue. But at this microscopic level, it's not clear where the healthy margin really starts. And having half a breast is worse than no breast at all.
Slowly, I realize what he's talking about. Now I understood what he meant when he said, a month before, that DCIS was in some ways worse than cancer. A tidy, stage 1 lump, treated with lumpectomy and radiation has a very high cure rate. But such a large, diffuse carcinoma would have had so many more opportunities to become invasive. And you can't just flick it out with a nail-file. At the very least, Dr. Brown was advising a mastectomy. And the final pathology, if it uncovered cancer in the lymph nodes or tiny invasions into the fat near the milk ducts, might well indicate chemotherapy as well.
Wow. For Dr. Brown, "good news" is clearly a relative concept.
I repeat back everything he says to me, to make sure I understand what's at stake. Unlike many surgeons, Dr. Brown has fine people skills. Instead of making me feel dumb for repeating his information (not that I'd ever fire a doctor just because he made me feel dumb--that would be truly stupid), he says that he does the same thing when people are briefing him. He gently advises that I take time to think about all that he has said. He did not try to hurry me at all and he gave me the feeling he'd sit with me for as long as it took.
As Dr. Brown continues talking, it's clear that the tidy little lump I've imagined in my left breast doesn't fit that description at all. He has me get up on the table again and again he palpates the suspicious area. "What I'm feeling is what I'm also seeing on the MRI," he says. The lesion isn't lumpish at all. It's a diffuse, fern-like object, a corruption of the milk ducts in nearly 50% of the breast, or more. With a classic lump, you remove it, plus a centimeter of surrounding healthy tissue. But at this microscopic level, it's not clear where the healthy margin really starts. And having half a breast is worse than no breast at all.
Slowly, I realize what he's talking about. Now I understood what he meant when he said, a month before, that DCIS was in some ways worse than cancer. A tidy, stage 1 lump, treated with lumpectomy and radiation has a very high cure rate. But such a large, diffuse carcinoma would have had so many more opportunities to become invasive. And you can't just flick it out with a nail-file. At the very least, Dr. Brown was advising a mastectomy. And the final pathology, if it uncovered cancer in the lymph nodes or tiny invasions into the fat near the milk ducts, might well indicate chemotherapy as well.
Wow. For Dr. Brown, "good news" is clearly a relative concept.
I repeat back everything he says to me, to make sure I understand what's at stake. Unlike many surgeons, Dr. Brown has fine people skills. Instead of making me feel dumb for repeating his information (not that I'd ever fire a doctor just because he made me feel dumb--that would be truly stupid), he says that he does the same thing when people are briefing him. He gently advises that I take time to think about all that he has said. He did not try to hurry me at all and he gave me the feeling he'd sit with me for as long as it took.
I leave his office, my thoughts blurry with fear and despair. I still have to pick Mike up at the airport. He'll be wanting to hear what Dr. Brown said the second he sees me. I think up a statement that is the truth but not the whole truth. I practice the statement while driving in the car.
***
When I picked Mike up, I recited my line: "I'll have to have surgery, but there's no disease in the right breast and no reason to revise the original diagnosis of DCIS." He's all but skipping to get back to the car. Once in the car, I burst into tears and tell him that the surgery we're talking about is a mastectomy. I can't bring myself to tell him the other troubling bit of information, that one of the lymph nodes in my armpit is swollen. The swelling could be just from the biopsies, or it could be the first sign of an already invasive cancer. Nothing will be known until the sentinel lymph nodes and the diseased breast is removed and can be examined fiber by fiber. Mike hugs me and shows no signs of sharing my fear, for which I'll always be grateful. I make arrangements with dear friends to have Jesse out for the evening, so that Mike and I can go have a meal and spend some time together.
The next day, I research what other DCIS patients have to say on the issue of mastectomy. I can't find anyone who has been diagnosed with "multi-focal DCIS" and who is refusing what appears to be the always-recommended treatment of mastectomy. One woman with this type of DCIS says she saw three breast surgeons and all recommended the same treatment. In one of my dumber moments, I wonder why I shouldn't just demand that they do biopsies until they find some evidence of invasive cancer. But isn't the whole point of a mastectomy, in this type of case, to remove tissue before it becomes invasive?
The question finally comes down to one of quantity, of how much tissue it's feasible to remove. If I'd wanted a second opinion on anyone's analysis, it would have been wise, perhaps, to seek out another pathologist. Maybe it's not a carcinoma. Maybe it's just blocked milk-ducts as my mother kept insisting. But I remembered what Dr. Brown had said in that awful and quite long conversation, that because the DCIS had been in my boob for so long without throwing off any of the tell-tale micro-calcifications that radiologists look for (I had some, but in the other, disease-free boob), my case was already being presented to the hospital's tumor board and was already getting a high degree of scrutiny.
And I'd had other surgeries at this hospital and had always been impressed both by the professionalism of the staff and the abundant and effective use of automated record-keeping. My level of trust was very high with this hospital generally and at the end of the day, I'm no more competent to pick one pathologist over another than I'm competent to design a rocket. I'd read enough about breast cancer to know that I would certainly insist on an oncologist who was either a recent associate or a current fellow of one of the major cancer research oganizations -- MD Anderson, Sloan-Kettering, the Mayo Clinic -- but as regards this stage of the disease, the treatment seemed fairly uncontroversial: lumpectomy followed by radiation, and if the disease is multi-focal, all disease-prone tissue should be removed, possibly avoiding the need for radiation at all. Most breast surgeons, I came to conclude, would recommend this treatment.
Twenty-four hours after being informed of my grim choices, I was already bent on getting better, on getting past this ordeal. I talked to one of my oldest friends, Paula, a sharp and very research-oriented nurse by training. We talked about treatment options, about what clothes I should pack, what precautions to take. Such conversations were vital in helping me wrap my mind around the relative safety of what I was planning. Talking to Paula reminded me of how it sometimes feels when I step on a plane. I'm nervous and a little sweaty in the palms, but the sight of the flight attendants briskly moving through their routine reminds me that what I'm about to do is not so extraordinary. Painful, yes. Horrifying on some level, too. But I've seen what it is to lose a child and to have one threatened by disease. Mastectomy doesn't even come close to the terror I'd feel if my daughter's doctor ever so much as mouthed the words: "Let's run some blood work. Just to be sure."
In extreme optimism, I even fasted on Sunday night, hoping the surgery could be organized on Monday. My breast surgeon had said that Monday could be possible. But, you know surgeons. They generally have to share operating theaters with other docs who have their own priorities. Dr. Brown's opinion of what was possible was not the same as the hospital staff's. I hung by the phone, waiting to get a time for my operation, and eventually was told that the surgery was scheduled for Thursday afternoon. I rang my sister, who informed me that her hysterectomy was scheduled for the same hour! Fortunately, we weren't going to be in the same hospital.
It made me think how problematic these lady parts can be. Like most professional women of my generation, it find it offensive to suggest that females shouldn't have combat roles in the military. But I also realize, particularly now, that just being female is soldiery enough for many of us. The estrogen that made it possible for me to do my bit in pulling the species up to the next rung in the evolutionary ladder is also over-binding with other cells and making them go haywire. The scars will be permanent. The task is possibly no less noble than whacking the enemy when he tries to step on your shores. The benefits are just longer term than your average military victory.
The next day, I research what other DCIS patients have to say on the issue of mastectomy. I can't find anyone who has been diagnosed with "multi-focal DCIS" and who is refusing what appears to be the always-recommended treatment of mastectomy. One woman with this type of DCIS says she saw three breast surgeons and all recommended the same treatment. In one of my dumber moments, I wonder why I shouldn't just demand that they do biopsies until they find some evidence of invasive cancer. But isn't the whole point of a mastectomy, in this type of case, to remove tissue before it becomes invasive?
The question finally comes down to one of quantity, of how much tissue it's feasible to remove. If I'd wanted a second opinion on anyone's analysis, it would have been wise, perhaps, to seek out another pathologist. Maybe it's not a carcinoma. Maybe it's just blocked milk-ducts as my mother kept insisting. But I remembered what Dr. Brown had said in that awful and quite long conversation, that because the DCIS had been in my boob for so long without throwing off any of the tell-tale micro-calcifications that radiologists look for (I had some, but in the other, disease-free boob), my case was already being presented to the hospital's tumor board and was already getting a high degree of scrutiny.
And I'd had other surgeries at this hospital and had always been impressed both by the professionalism of the staff and the abundant and effective use of automated record-keeping. My level of trust was very high with this hospital generally and at the end of the day, I'm no more competent to pick one pathologist over another than I'm competent to design a rocket. I'd read enough about breast cancer to know that I would certainly insist on an oncologist who was either a recent associate or a current fellow of one of the major cancer research oganizations -- MD Anderson, Sloan-Kettering, the Mayo Clinic -- but as regards this stage of the disease, the treatment seemed fairly uncontroversial: lumpectomy followed by radiation, and if the disease is multi-focal, all disease-prone tissue should be removed, possibly avoiding the need for radiation at all. Most breast surgeons, I came to conclude, would recommend this treatment.
Twenty-four hours after being informed of my grim choices, I was already bent on getting better, on getting past this ordeal. I talked to one of my oldest friends, Paula, a sharp and very research-oriented nurse by training. We talked about treatment options, about what clothes I should pack, what precautions to take. Such conversations were vital in helping me wrap my mind around the relative safety of what I was planning. Talking to Paula reminded me of how it sometimes feels when I step on a plane. I'm nervous and a little sweaty in the palms, but the sight of the flight attendants briskly moving through their routine reminds me that what I'm about to do is not so extraordinary. Painful, yes. Horrifying on some level, too. But I've seen what it is to lose a child and to have one threatened by disease. Mastectomy doesn't even come close to the terror I'd feel if my daughter's doctor ever so much as mouthed the words: "Let's run some blood work. Just to be sure."
In extreme optimism, I even fasted on Sunday night, hoping the surgery could be organized on Monday. My breast surgeon had said that Monday could be possible. But, you know surgeons. They generally have to share operating theaters with other docs who have their own priorities. Dr. Brown's opinion of what was possible was not the same as the hospital staff's. I hung by the phone, waiting to get a time for my operation, and eventually was told that the surgery was scheduled for Thursday afternoon. I rang my sister, who informed me that her hysterectomy was scheduled for the same hour! Fortunately, we weren't going to be in the same hospital.
It made me think how problematic these lady parts can be. Like most professional women of my generation, it find it offensive to suggest that females shouldn't have combat roles in the military. But I also realize, particularly now, that just being female is soldiery enough for many of us. The estrogen that made it possible for me to do my bit in pulling the species up to the next rung in the evolutionary ladder is also over-binding with other cells and making them go haywire. The scars will be permanent. The task is possibly no less noble than whacking the enemy when he tries to step on your shores. The benefits are just longer term than your average military victory.
***
Thursday arrives and Mike drives me to the hospital. You can have no better partner in life or in a foxhole than my spouse. His manner is perfect. He's not stupidly blithe or overly anxious or hang-dog guilty. He's collected and proactive. And this from a man who lost his own mother to breast cancer! I know that his guts are knotting up, too, on some level, but he's not giving in to it.
We waited in the prep-room while the nurse filled out paper-work and started me on saline. He asked me what meds I'd had in the last 24 hours and I guiltily reply that I'd taken half a miligram of Xanax the night before. "Don't apologize," he says. "I would have taken a whole one." We all laugh. Better living through pharmaceuticals.
I put my iPhone's earbuds in and listened to some David Sedaris readings. As they wheel me in for more fancy radiography (to help the surgeon locate the sentinel lymph nodes he intends to remove, prior to the main surgery), I am laughing a lot. The medical staff look alarmed, but I couldn't help myself. Sedaris' stories of his crazy Greek American parents are too much. When they lower the machines around me, I start to really howl with laughter (Sedaris had moved on to explaining why he serves the Great Jewish Conspiracy at NPR). The startled technician, certain that I was having a claustrophobic fit, hauled me back out. I turned the iPhone off, out of concern for the staff.
More waiting. The dyes they've injected me with are slow to diffuse. The technician asks me to "manually manipulate your left breast with your right hand." What, you want me to do it? That's not part of the service? Who do these people think they are?
As instructed, I jiggle the mass of flesh and try, instead of saying goodbye to it, to focus on how much worse it would be to lose the use of a hand, or a leg, or an eye. This is one of the bodily objects you can stand to lose, I remind myself. And besides, after an upgrade on the other boob, I'll be able to wear spaghetti straps again. If I get out of this without having chemo, I'll be dancing, but not bouncing, and that's a good thing.
More waiting. I'm wheeled back into pre-op but the word is that the prior surgery went on much longer than expected. That's okay, because in the gap the phone rings. It's my daughter, my dear thirteen year old, calling up to say she loved me, something she did completely unprompted. She'd even remembered to take her cell phone to school, a rarity, just so she could make the call. How did I do so good? To have such a child? I have no inclinations towards magical thinking, but every parent, even embittered non-theists like me, must sometimes feel that there is some Universal Heart/Mind that has obviously spent eons thinking up exactly which fetus would be the right one for you. Nothing I could have consciously done could have made something so wonderful as Jesse appear.
The anaesthiologist comes in and says that Dr. Brown wants to get the surgery underway before the radioactivity in my nodes subsides, thus making them harder to locate. Dr. Brown comes in, meets Mike for the first time. I've told Mike to really listen to how people from New Orleans pronounce "aureole". It's truly bizarre! Like "Areeler". Dr. Brown, when he explains to Mike what the surgery involves, does hazard upon the quirky pronunciation, but Mike is too concerned to notice. I want to tap him on the hand, to alert him, but what would I say? Why do I find this so fascinating? I'm trying not to smile. Dr. Brown must think I've had more Xanax than I admitted to.
An hour more and someone arrives to hang a bag of happy juice on my IV pole. It is time. I get that triple-tequila feeling, and vaguely note that one of the op nurses is older than I am. Things go black for awhile.
We waited in the prep-room while the nurse filled out paper-work and started me on saline. He asked me what meds I'd had in the last 24 hours and I guiltily reply that I'd taken half a miligram of Xanax the night before. "Don't apologize," he says. "I would have taken a whole one." We all laugh. Better living through pharmaceuticals.
I put my iPhone's earbuds in and listened to some David Sedaris readings. As they wheel me in for more fancy radiography (to help the surgeon locate the sentinel lymph nodes he intends to remove, prior to the main surgery), I am laughing a lot. The medical staff look alarmed, but I couldn't help myself. Sedaris' stories of his crazy Greek American parents are too much. When they lower the machines around me, I start to really howl with laughter (Sedaris had moved on to explaining why he serves the Great Jewish Conspiracy at NPR). The startled technician, certain that I was having a claustrophobic fit, hauled me back out. I turned the iPhone off, out of concern for the staff.
***
More waiting. The dyes they've injected me with are slow to diffuse. The technician asks me to "manually manipulate your left breast with your right hand." What, you want me to do it? That's not part of the service? Who do these people think they are?
As instructed, I jiggle the mass of flesh and try, instead of saying goodbye to it, to focus on how much worse it would be to lose the use of a hand, or a leg, or an eye. This is one of the bodily objects you can stand to lose, I remind myself. And besides, after an upgrade on the other boob, I'll be able to wear spaghetti straps again. If I get out of this without having chemo, I'll be dancing, but not bouncing, and that's a good thing.
More waiting. I'm wheeled back into pre-op but the word is that the prior surgery went on much longer than expected. That's okay, because in the gap the phone rings. It's my daughter, my dear thirteen year old, calling up to say she loved me, something she did completely unprompted. She'd even remembered to take her cell phone to school, a rarity, just so she could make the call. How did I do so good? To have such a child? I have no inclinations towards magical thinking, but every parent, even embittered non-theists like me, must sometimes feel that there is some Universal Heart/Mind that has obviously spent eons thinking up exactly which fetus would be the right one for you. Nothing I could have consciously done could have made something so wonderful as Jesse appear.
The anaesthiologist comes in and says that Dr. Brown wants to get the surgery underway before the radioactivity in my nodes subsides, thus making them harder to locate. Dr. Brown comes in, meets Mike for the first time. I've told Mike to really listen to how people from New Orleans pronounce "aureole". It's truly bizarre! Like "Areeler". Dr. Brown, when he explains to Mike what the surgery involves, does hazard upon the quirky pronunciation, but Mike is too concerned to notice. I want to tap him on the hand, to alert him, but what would I say? Why do I find this so fascinating? I'm trying not to smile. Dr. Brown must think I've had more Xanax than I admitted to.
An hour more and someone arrives to hang a bag of happy juice on my IV pole. It is time. I get that triple-tequila feeling, and vaguely note that one of the op nurses is older than I am. Things go black for awhile.
***
I'm not awake but for a minute when Dr. Brown appears at my side. I don't think he's much of a poker player. He seems visibly relieved. The nodes seemed entirely ordinary, not enlarged. I'll learn later from Mike that Dr. Brown went so far as to say that he thought it wasn't cancer, a sweepingness of statement that I'd never heard from him. But I know until the pathology comes back, we don't have very much. The lab trumps everything. Dr. Brown marvels, not for the first time, at how fit I am. I take his hand. I'm wondering just how unfit his average patient is. I mean, sure, I biked 50 miles in Blanco county recently (those hills are nasty), but I was surrounded by many who pedalled faster. It's all relative.
***
I'm old enough to know that the post-op is the killer. I'm in a cold room, with two drains that look like hand-grenades dangling from my chest. I marvel that I can see my rib cage without the benefit of a mirror. How queer. It's 7 pm or so and I've been twenty four hours without food but I'm not hungry. Mike brings Jesse to see me and she gives me as much hugging as is possible given my fragile state. I am happy again. She leaves and the long night just keeps coming. I never really fall asleep. Just watch episodes of "The Closer" that I've downloaded on my Iphone. Nothing really hurts that much, but if I could sleep, I'd accept a little pain in return.
***
Next morning, I think: let the recovery begin. I realize that the mobility in my left arm is not that bad and I instantly wonder if I should ask about getting back on the bike. What if I don't like the answer? Better not to ask for advice and just do what I want. Dr. Brown arrives and says I can leave anytime, that he didn't normally approve of releasing a patient so quickly, but with my superb stats, there was simply no reason to keep me. Mike arrives and we wait to be released as soon as the nursing staff can get to us.
***
On Christmas Eve, six days after the surgery, we return to Dr. Brown's office to get the pathologist's report. He appears congenial and unhurried, and must surely know that we're almost uninterested in what he first occupies himself with, that is, studying the hand grenades attached to my chest, where all the fluid from the wound has been accumulating. His preoccupation with answering the question of whether or not the drains can come out today is, we both think, a sign that the news is bad.
"I have mixed news," he says, to the inner sound of my sinking heart. I remembered the last time we began with the "good news"; how much worse will it be beginning with the mixed news? But the good news, this time, is very good. There's no cancer in my lymph nodes. At worse, we're looking at a stage one diagnosis, very curable.
The next news is ambiguous, he admits. The pathologist is patiently going through the breast tissue, and is leaning towards a diagnosis of non-cancerous DCIS but wants to get a second pair of eyes involved. And it being Christmas Eve -- "The pathologists are all drunk and under bridges right now," Dr. Brown declares -- it could be several days or even weeks until we know more. I let go of the breath that I've been holding on to for the past two months. It could still be cancer. I could still have to undergo chemo, which I'm terrified of, but my prospects are pretty good. This isn't some weird, aggressive cancer that's going to shut me down in six months.
Dr. Brown calls that night, while we're rushing around preparing our annual Christmas Eve feast, that this year will begin with crab salad in a puff pastry. I tell Dr. Brown to get his own self home, which he promises to do, but he wanted to let me know that the tissue samples will take a while to process, because they've been sent off to the Mayo Clinic! I think the pathologist is having a hard time deciding exactly what she's looking at and wants to bring in other doctors who may have seen these exact types of cellular deformation before. There is doubt, but the doubt hovers between a stage zero and stage one diagnosis. He verifies that I've already made an appointment to see him, in a fortnight's time.
I ring off, stirring a sauce, thinking how much nicer the sauce would be if thickened by an egg. But I'll need it quickly. And warm.
"I have mixed news," he says, to the inner sound of my sinking heart. I remembered the last time we began with the "good news"; how much worse will it be beginning with the mixed news? But the good news, this time, is very good. There's no cancer in my lymph nodes. At worse, we're looking at a stage one diagnosis, very curable.
The next news is ambiguous, he admits. The pathologist is patiently going through the breast tissue, and is leaning towards a diagnosis of non-cancerous DCIS but wants to get a second pair of eyes involved. And it being Christmas Eve -- "The pathologists are all drunk and under bridges right now," Dr. Brown declares -- it could be several days or even weeks until we know more. I let go of the breath that I've been holding on to for the past two months. It could still be cancer. I could still have to undergo chemo, which I'm terrified of, but my prospects are pretty good. This isn't some weird, aggressive cancer that's going to shut me down in six months.
Dr. Brown calls that night, while we're rushing around preparing our annual Christmas Eve feast, that this year will begin with crab salad in a puff pastry. I tell Dr. Brown to get his own self home, which he promises to do, but he wanted to let me know that the tissue samples will take a while to process, because they've been sent off to the Mayo Clinic! I think the pathologist is having a hard time deciding exactly what she's looking at and wants to bring in other doctors who may have seen these exact types of cellular deformation before. There is doubt, but the doubt hovers between a stage zero and stage one diagnosis. He verifies that I've already made an appointment to see him, in a fortnight's time.
I ring off, stirring a sauce, thinking how much nicer the sauce would be if thickened by an egg. But I'll need it quickly. And warm.
