Thursday, January 26, 2012

Fire Music

This morning I spoke with SFMC’s nurse educator and told her that medical oncologist Dr. W.’s numbers were way out of line with anyone else’s, that he hadn’t peered into my chart, and that he could not be persuaded to answer my question about who should follow my breast cancer, and so now what? I don’t want to make critical decisions entirely on my own, but I don’t trust this fellow, and would prefer not to pay for another opinion, especially since he was supposed to be the even-handed oncologist. My surgeon has said a couple of times that he doesn’t think tamoxifen would make that much difference in my case, since my recurrence risk is quite low. Would it be stupid just to proceed per that?

The nurse educator said it would not be stupid to go with what my surgeon said, that he is knowledgeable in this area. She said I could run Dr. W.’s numbers by him and see what he makes of them. I could also call Dr. W. and ask him where he came up with the 13%. She said ideally I would get a second opinion from another medical oncologist, though she understands why I don’t want to do that. She said that if I still wouldn’t take tamoxifen even if my recurrence risk actually was what Dr. W. said it was, then there may not be anything else I need to do.

I asked if I need someone to follow my ductal carcinoma in situ (DCIS) specifically, or do I just do my annual mammograms? She said if I did take tamoxifen, I would typically be followed by my medical oncologist, but if I don’t, then I would typically be followed by my ob/gyn. You’ll notice I got that detailed answer for free just by asking.

If I get a new breast cancer or have a recurrence, I inquired, it will be caught before it’s metastatic cancer and has reached malign fingers into my brain, right? The nurse educator said some breast cancers can grow quickly, but typically they develop over years, so regular clinical exams, self-exams and yearly mammograms should catch it if it happens.

And would I then perhaps have a bilateral mastectomy and more radiation and be done with breast cancer for once and for all? She said that even with a bilateral mastectomy, the risk is never 0%, because the skin and scar tissue remain, etc., but the risk would be pretty darn low. Typically they don’t do radiation after a bilateral mastectomy.

Today was my last day at work. Last Friday, my group met on the phone for the last team meeting I will attend, and yesterday I went to another agreeable goodbye lunch, again at Henry’s Hunan, with Jan, Jun and Raymond. I’ve gotten very nice notes and phone calls from my peers and team lead, plus other co-workers from across the years. Bill, in my group, said that my leaving is almost as sad for him as it must be for me; he wondered who he’ll go to now when he gets stuck, which was flattering.

I have let everyone I can think of know I am leaving, collected contact info, taken home final electronic copies of the thousand pages of documentation I wrote, and identified several peers who said they’d be happy to give me a reference, which managers at this company aren’t allowed to do.

Months ago, I’d prepared a list of computer-related tasks, such as deleting my browsing history (in both IE and Firefox, on both my computer at work and the company laptop at home) and removing bookmarks, and so forth. I’m glad I thought that through in advance and had a checklist ready to go with detailed instructions.

This morning, I did all that on the laptop and then took it downtown via bicycle and used my card key to get onto my work floor, went to my cube and sat in my blue Herman Miller Ergon 3 chair in front of the big picture window, all for the very last time. Right across the street is a very busy fire station. When I moved from a lower floor to that cube, not all that long ago, Venkata asked if I thought the “fire music” would bother me.

I don’t know if all Asian Indians do this, but he refers to paneer, as featured in paneer makhani, as “cubes” and advised me that if one eats too many of them, one will need a “special design” chair.

I repeated the cleanup tasks on my desktop computer at work, took my card key to the administrative assistant on our floor, said goodbye to my neighbors, and departed for the last time. It was sadder than I thought it would be.
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