The Background

Three weeks ago, I found a lump in my breast.  It wasn’t that apparent until I was lying on my side, when it became easily felt.

I stewed about it for a few days, then went online to make an appointment with my doctor.  Luckily, she had an appointment available in just a few days.

May 18 – Doctor Appointment: My doctor is easily able to feel the lump. My last mammogram had been some 18 months ago.  Normally, she sends me for one every year, but it had fallen through the cracks and the normal schedule at my HMO is every two years, so it hadn’t come up as a test that was due. She got on the phone and the terminal and began making appointments for me.  She scheduled a mammogram and an ultrasound, but could only get different days.  She handed the paperwork to me and told me to take it directly to the mammogram department and try to get them to change the appointment.  The clerk was very helpful and punched a lot of buttons on her screen and I was able to get a combined appointment the following Wednesday.  That afternoon, I received a call to set up an appointment with a surgeon.  That was set for the day after the mammogram.

I didn’t want to talk about this yet.  I needed time to process the possibilities.  Why worry my husband, the rest of my family?

At some point over the weekend, I told my husband that I had found a lump.  The first words out of his mouth were, ” I will always be here for you.”  He could not have chosen a more perfect response.

May 25 –  Mammogram & Ultrasound:  I had let my husband know what appointments had been made.  The mammogram and ultrasound were simply tests, and there wouldn’t be any reason for him to come with me.  I did want him to come to the visit with the surgeon.

The mammogram was … thorough.  My breasts are large and dense anyhow, and the lump was at 10 o’clock on the outer edge of my right breast, so it was imperative that I get really, really friendly with the machine in order to ensure a good image.  They took approximately 8 shots of the right breast, including some that were magnified. She also did the normal 2 shots of the unaffected one. The technician was wonderful – business-like but caring.

The ultrasound was fairly routine, although I’ve never had one done of my breast before.  I was told by the technician that there was something and I was to wait for the department coordinator to come and talk to me.

K took me into her office and handed me a pamphlet on breast lumps. She explained that they would be doing a core needle biopsy and the earliest appointment was in 10 days.  I told her that I already had an appointment with a surgeon the next day and she said that she’d coordinate with him.   She was very kind and told me that she hoped that it would be a benign fibrocystic lump. I ask how large the mass is and am told that it is 2.7 cm, or about an inch, as there are around 2.5 cm to the inch (Actually, there are 2.54, but then again that’s the nerdly engineering part of me that we don’t need to get into).

When I got home later that day, there was a call from my regular physician, Dr. J, on the machine.  She said that she’d seen the images and hoped that I was doing ok.  She knew that a biopsy was next and asked me to call or email her if I had any questions.

Nobody is saying anything, but I am starting to get suspicious.  Are they all so kind because that is the nature of what they do in their routine work with women with lumps, or is it already apparent to their trained eyes that there is a problem?

I tell my old college roommate, who lives across the country, via email that I have found a lump and am going through tests.  She lost her sister to ovarian cancer several years and is just very pragmatic about things.  It is a relief to have someone to talk (or text!) to.

May 26 – Meeting with Surgeon: We meet Dr. S in the surgery department.  He has clearly reviewed my chart in detail, and we chat for a few minutes about a difficult surgery performed on me by one of his colleagues a few years ago.

We get down to the discussion at hand, and he called in a nurse before doing a very detailed exam of my breasts, armpits, and lymph nodes in my neck.  We talked about the need for a biopsy, and his opinion is that I should go back to the Women’s Radiology department so that it can be done by a radiologist who will be using an ultrasound to guide the needle.  He has been in contact with K, the case manager there, about me and they will both be part of the coordination of my care. He gets onto the computer and finds that there is an appointment the very next day.  Let’s go for it!

As we finish up, I am again showered with caring and kindness.  Dr. S tells me that whatever happens, we will know for sure and then figure out what to do.

I remain confident and reassured about the quality of my care, but lean more and more towards there being a consensus amongst the medical professionals that they will be seeing a lot more of me …

May 27Hollow Core Needle Biopsy: Friday before a long weekend.  My husband is told that he can’t come in with me and will need to stay in the waiting room.  I change into a gown and am brought to the procedure room by a nice young technician.  Front and center in the room is a screen displaying an image from the ultrasound.

Oh shit.  Anything that big and ugly cannot be good.

The tech bustles in and out, getting everything set up.  On one of her trips out of the room, I whip out my cell phone camera and snag a shot of the screen.  I know that my husband will want to see it. I know that this isn’t the classiest move, but we are nerds in my house.

Dr. L comes in and we begin.  I can see on the ultrasound machine where the mass is and the needle going in. My breast is very gently numbed and then the biopsy needle is inserted.  I have been warned in advance that it makes a clicking noise.  It appears to be spring loaded, so it is positioned at the edge of the mass, then it punches through the core and is extracted.  I am also informed that they will be placing a tiny titanium marker at the spot, and can see that being inserted.

After the procedure, I have to have a “gentle mammogram” to check the placement of the marker.  A bit of an oxymoron, that.  The technician is gentle enough, but I am very sore from all of the squishing that was done two days earlier and although it’s not as compressed as usual, it wasn’t the most comfortable procedure.

The results will be ready in 5 days.  I am booked on a conference call with K, the patient coordinator, at 11 am on June 1st.

After seeing the ultrasound photo, I am pretty much convinced.  I decide to let some of the rest of my family know.  I start with my brother, with whom I am very close, and who, for convoluted reasons, holds my medical power of attorney. He is calm but concerned.

I make it through a day spent visiting my father, who has been readmitted to the hospital, then a family BBQ and birthday party, where I wish for a few minutes that we weren’t such a huggy family.  The biopsy site is on the outer edge of my breast, and I am still pretty sore!

The day before the results, I tell my younger sister over the phone.  Unfortunately, it is within the context of other difficult things:  I am also scheduled for an exploratory gyn procedure on June 1st; and we have just made the remarkably difficult decision to bring my father home from his latest hospitalization and to call in hospice.  I only tell her because I want to keep all of this from my mother, and  we are about to start making decisions about my father’s care and how much I can support my parents through this.  At this point, it’s still a pretty big unknown.

June 1 – Unrelated GYN surgery: I call and leave a voicemail for K, who is supposed to give me the biopsy results at 11 o’clock, and explain that I will be in outpatient surgery then and will not be available.  I tell her that I would like to hear sometime after 3 pm, and if she can’t schedule it, maybe Dr. S can.  When I check in for my surgery, I can see that K has scheduled an appointment with me for 4 pm.

I have been taking medication for 2 weeks for my gyn procedure. I am prepped and brought in to the procedure room. My gyn, Dr. G, comes in and we talk briefly about what has been going on since we scheduled this a month ago.  I tell her that I will be getting the test results that afternoon, and that right now I just want to concentrate on what we are doing now. She says that she has seen what’s been going on in my chart, and reassures me that the breast care team is a fantastic one.

The procedure has some issues, and Dr. G calls in a colleague to assist her.  Although I am pretty drugged up on Fentanol and Versed, I am not very out of it and clearly hear all of my history that is being passed on, including the word … positive.

It is not a surprise.  I am calm enough, and just want to focus on finishing this thing before moving on to the next thing.

We are not able to complete the procedure. Dr. G and I are both disappointed, as it’s the second time we’ve tried to do it.  She tells me that we will talk later in the week or early next week to decide on next steps.

I come home and rest for a bit.  As it gets closer to 4, I finally begin to get nervous. Finally, the call comes.

K has a lot of information for me. First we go through the findings.  I am going to call it Stage 2 Invasive Ductal Cancer.  There are still some tests that are being run, which could have an effect on deciding on a course of treatment.

Next Wednesday, my husband and I will meet with the care committee with a few other patients for a presentation, then we will rotate through individual conferences with the oncologist, surgeon, coordinators, etc.  Treatment options will be presented and discussed.

I explained to K about my situation with my father, and asked if she could run me through a few likely scenarios so that I could prepare for my meeting with the hospice folks tomorrow.  Chemo was mentioned a few times. Lumpectomy vs. Mastectomy is likely.  She offered to send me the lab report, and I had a copy of it within minutes of her call.  There are a lot of words and terms that I don’t understand yet.  Probably the scariest is the word aggressive.

It has been probably the most difficult 24 hours I’ve ever been through, encompassing the hospice decision, the gyn surgery, and the official breast cancer diagnosis.  I am taking it one breath at a time.

There have been some basic decisions that needed to be made.  I talked with those whom I’ve told, and we will not tell anyone else until after next Wednesday, when I have an actual plan to discuss.  This includes my 3 children, my other sister, and my mother.

Tomorrow the family and I meet with the hospice team, then we begin the process of telling our extended family that my dad’s remaining time is short.  I am just compartmentalizing like mad right now.

I am scared, a bit. Part of me wants to just get on with dealing with it, and to start the fight. I will need to marshal every scrap of my not inconsiderable stubbornness to counterattack this assault.  Another part of my mind strays to the friends I’ve already lost to this horrid disease, and I start going down scary paths in my mind that lead to scary outcomes. K recommended meditation.  I think that it’s time to plan my mental and emotional roadmap.  Part of that seems to be writing this blog. Tired now, and tomorrow is another long day.

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