Sunday, December 18, 2011

The Ultimate Fact

It has been quiet at work as we approach the end of the year, which is fortunate. I don’t think I’d have time to be very busy at work and also have cancer, or even pre-cancer. Besides actual appointments, you have to make a lot of phone calls and spend a lot of time on Google.

Last night, Venkata treated me to dinner at Dosa on Valencia St. When we got there, they said there were no tables, but Venkata said, “Wait here,” and returned to say we were all set. I have no idea what he did, but I was agog with admiration, as my answer to “I’m afraid we’re all booked” would have been, “Oh, OK.”

I’ve been fretting a bit about the upcoming radiation treatment, and in particular wondering if going with intraoperative radiation therapy (IORT) is foolish, given that it hasn’t been studied with DCIS. Johns Hopkins does not offer it, for what it’s worth. Nor does UCSF, except as part of a clinical trial.

Post surgery, I will not have to have any other radiation, unless the pathology report finds actual invasive cancer cells. Also, if they find that an insufficient margin of healthy cells was left around the tumor, they would do a second surgery and I’d then have three weeks of external radiation, five days a week.

Side effects of radiation treatment can include redness, rash, itching, damage to skin and blistering. In some cases, a keloid scar can form. However, IORT side effects can be less, because treatment is very localized and not traveling through flesh to get to where the tumor is. Dr. L., my radiation oncologist, said it’s like a sunburn inside the breast. There can be soreness for 4-8 weeks, and redness for a couple of days.

However, this will be a low dose of radiation and shouldn’t cause any damage to heart or lungs, etc.

It has also lately occurred to me that if this doesn't prove to be Stage 0 cancer, it’s not like it would then be Stage 4 metastatic cancer—there’s no lump. I reckon that if it's actual invasive cancer, it might be Stage 1, still eminently treatable.

My meditation practice is continuing to help tremendously, certainly the actual periods of sitting in meditation, but even more so what carries into the rest of the day, the now-ingrained habit of being aware of particulars moment by moment: putting water into pot, opening box of teabags, sound of phone ringing. It helps to narrate these things silently to myself.

As my teacher Howard Cohn says, any moment we are attending to the raw data of cognition—what we can see, hear, feel, smell, taste—is a moment we cannot be lost in a story about the imagined past or future. Suzuki Roshi is getting at the same thing when he says, in Zen Mind, Beginner’s Mind, “When you are sitting in the middle of your own problem, which is more real to you: your problem or you yourself? The awareness that you are here, right now, is the ultimate fact.”

Several weeks before my first mammogram in October, I ran into a friend who mentioned that his wife had recently been diagnosed with early stage breast cancer, and that he had accompanied her to interview surgeons, which is why, upon being diagnosed, I shot out of the door to interview surgeons.

It occurred to me that it might be helpful to speak with my friend’s wife, if she was willing, and learn a bit more about her experience with the whole thing. One thing I was eager to ask her was how many surgeons she met with. Had I met with enough of them, or should you really see five or ten?

My friend’s wife said she’d be happy to talk with me, and when we spoke recently, she readily shared the number of surgeons she interviewed: one. Someone told her, “Go to this surgeon,” and that was that.

I don’t know if I completely misunderstood my friend or what, but I’m glad I did meet with more than one surgeon. Getting the recommendations and making and keeping the appointments added some time and stress to the whole process (especially Surgeon Number Two in the podiatry clinic!), but it was valuable to hear the different perspectives and to have some sense of making a choice.
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