Monday, December 12, 2011

Secrets of the Afterlife Now Revealed Here!

Oh, sorry, make that not revealed here, for the main and simple reason, as Booth Tarkington's Penrod would have said, that I don't know any.

This past Saturday I had a very nice moment, sitting in a sunny spot in the laundromat, when I looked up from The New Yorker and realized it had been quite a number of minutes since I’d thought about having breast cancer.

Today I met with Surgeon Number Three, Dr. P. I liked him and felt that he liked me. He does nothing but surgery for cancer, 75 to 80 percent of which is for breast cancer. Before I could ask about the new thing where they do one blast of radiation during surgery, he brought it up himself, and when I asked what radiation oncologist he prefers to work with, he named the very one I already have an appointment with tomorrow, a pleasing confluence of factors.

Dr. P. explained the Van Nuys scale, which is used to predict DCIS recurrence with a numerical score of one to three, three being worst, in four categories: age at time of diagnosis, size of the tumor (stage), how fast it’s growing (grade), and if clean surgical margins are achieved—X number of millimeters showing no trace of malignant cells at the edge of the tissue surgically removed.

I’m stuck with a three for age because I’m six months from turning 50—the younger you are, the worse, because you have that much more estrogen and that many more years in which to have a recurrence—and a three for grade, but I get a one for stage and, if clean surgical margins are achieved, which they dad-blasted had better be, I will get a one there, giving me a total score of eight. Which I’m going to secretly think of as a score of seven, because if I’d had the screening mammogram just six months later, I would have been 50 when I got the DCIS diagnosis.

Dr. P. thinks my chance of recurrence would be 2% with mastectomy (removal of the entire breast), 4% with lumpectomy and radiation, and 10% or less with lumpectomy only. He said survival rate remains the same across all three options, which is because having a recurrence isn’t the same thing as dying: You can have a recurrence, or multiple recurrences, but continue to live on, with additional treatment.

Whereas a standard lumpectomy can be done using local anesthesia, surgery with intraoperative radiation therapy (IORT) would require general anesthesia, and would take about 90 minutes. The IORT adds about 40 minutes to the surgery.

Dr. P. said 75% of recurrences will be close to the original tumor location, and 25% will be elsewhere in same breast, so IORT should reduce the chance of recurrence by 75%. He added that tamoxifen further reduces recurrence risk by a third, but if risk of recurrence is only 4 or 6 percent to begin with, maybe it’s not worth it to take tamoxifen, another thing I was happy to hear.

Before I left, he performed a brief exam and asked, “Do you work out?”

“Why? Does it seem like I do, or like I need to?”

He said it seems like I do, because my heart rate was low, particularly at a moment when most people are nervous. He said he thinks I can withstand a surgery of any length and said it will be his pleasure to work with me, or to assist in any way he can if I end up choosing another surgeon.

When I first found out I had any form of breast cancer, of course I regarded it as a death sentence. I’ve always assumed I would die of some kind of cancer because all four of my grandparents did, two at fairly advanced ages, but the other two in their 50s.

Dying at 49 would be rather untimely, but every day babies and children die, by which standard 49 would be fairly luxurious, and it is, after all, something that happens to us all sooner or later. It’s not a special punishment reserved for the hapless few.

I thought of my current hospice visitee, a lovely man of nearly 90 with lung cancer. His room is bursting with candy and flowers brought by friends, and stacked with magazines and CDs. His bulletin board is plastered with colorful greeting cards and a couple of photos of himself decades ago with friends, quite a handsome young man.

He has asked me once or twice, very casually, what I think happens after we die, but most of our conversations are about books, music, movies, film stars of now and yesteryear, food, traveling, our families, his friends and past partners. A former language arts teacher, he is a pleasure to be with.

I have concluded that if he can do it, not to mention all my other former hospice visitees, so can I. If absolutely necessary.

As for what happens after we die, I have no idea but I hope the answer is: nothing whatsoever.
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