Wednesday, December 07, 2011

Two Things I Should Not Have Said Where the Universe Could Hear Me

One: “Great that the hysterectomy is over—now I won’t have to go to the doctor all the time!”

Two: “Boy, it’s a pain getting across town to SFMC—sure hope I never have to go there again!”

First, the good news. The stereotactic core needle biopsy on Monday was not a big deal. Basically, your breast dangles through a hole in a table and they compress it, apply a soupçon of local anesthetic, and extract some samples with a needle. I asked beforehand if the compression would be the same as when I had my recent (extremely painful) mammograms and the nurse said it would be. Except that it would be for forty straight minutes.

If it had actually been like that, it would have been extraordinarily difficult to withstand, but in fact, it was very mild compression, barely noticeable. The whole thing seemed to be over in twenty minutes. It didn't hurt. The nurse and doctor were extremely kind. Really, the worst part was having to lie still on my stomach with my head turned to one side, which produced a slight kink in the neck, soon forgotten.

I was sent home with a small bandage over the hole where the needle had entered, after making an appointment to return tomorrow to hear the results. I asked if the findings could be communicated over the phone and was told this is possible if strongly desired, but that they prefer to discuss in person.

Yesterday I arrived home after business hours to find a message on my answering machine (yes, I still have one) from my ob/gyn, who said, “Linda! Dr. M.! Got your results! Give me a call!” Surely, I reasoned, no one uses such a jaunty tone of voice to tell someone she has cancer, ergo I did not have cancer, ergo there was no need to schlep across town to SFMC.

This morning, I called SFMC and said it sounded like the news was going to be good, though I understood it might not be, so could they just tell me on the phone? And in no time, a nurse educator at SFMC called me back and told me I have cancer.

My first thought was, “Really?” and my second was, “Damn that Dr. M.” But I suppose it would have made for a sleepless night if she’d left a grave and gloomy-sounding message. It probably is better to sound cheerful in that situation.

So. I have ductal carcinoma in situ (DCIS), which is Stage 0 breast cancer, considered by some not even to be cancer, but rather a pre-cancer. “Ductal” means the malignant cells are in the ducts rather than the lobules. Lobules are where milk is produced. Ducts are what the milk travels through to get to the nipple. “In situ” means the cancer appears to be confined to the ducts and appears not to have broken through the duct walls. But this will not be certain (insofar as anything in medicine is certain, which is that it's not) until the tissue is removed and tested.

The nurse educator said I would have surgery, radiation treatment, and maybe hormonal treatment, but not chemotherapy.

As it happens, I lately bumped into a friend who told me that his wife had been diagnosed with early stage breast cancer, and that he had accompanied her to “interview surgeons,” which suggested that to be my next task, so I got the names of three surgeons from the nurse educator. I asked if I should still come in, but she said we’d just covered pretty much everything we would have gone over in person, except that they would have given me some pamphlets, which she said she could mail. I asked her to send them—one doesn't always want to get the pamphlets, but I had the feeling these might be particularly riveting.

Then I spoke with my ob/gyn and told her I'd gotten the news. She called me “my dear” and said she was pissed off on my behalf, as she knew I was hoping the whole medical era was over. She recommended a surgeon, as well, one of the three mentioned by the nurse educator, and, not wasting any time, though no one said there was a big rush, I typed up as many questions as I could think of—here’s where being a former QA person comes in handy—grabbed my clipboard and went to see the first one this afternoon. Turns out that whereas you normally can’t get any kind of medical appointment for the same day, the seas pretty much part as soon as you mention cancer.

Dr. R. was absolutely lovely, extremely calm and patient. I’d made it a point to have the hysterectomy during 2011, because when 2012 rolls around, I’ll have a $2000 deductible. Little did I know I’d also have to squeeze in a lumpectomy! Dr. R. assured me that he could do the surgery before the first of January, and explained about cancer coming in three exciting grades.

Grade 1 grows most slowly. The cancer cells are “trying to look like normal cells.” Grade 3 features “wild-looking cells” and grows the fastest. It has the highest risk of recurrence, and of becoming invasive cancer. Grade 2 is in between.

He told me my cancer is high grade.

“Does that mean it’s the best or the worst?”

Alas, here highest means worst: my DCIS is grade 3.

And there you have it. We shall see what Surgeon Number Two has to say on Friday.
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