Poetic License

So it begins again…maybe.

This afternoon I am having 3 biopsies taken from the “good” side, the side that did not have cancer previously. I went for a screening mammogram (which they noted as “overdue” on my order) for the first time since finishing treatment last May. To be fair, I had an MRI in August that just showed some fat necrosis and scar tissue in the cancer side. Nothing to be concerned about. As cancer survivors, we will always look over our shoulder to see if it is coming again. We will always have to check the Yes box next to “Do you have or have you ever had cancer?” on medical paperwork that always makes me want to write, “I don’t have it now!” Every anomaly will always be suspicious. We will have lots of follow-up appointments and are always poked and prodded by a variety of specialists all the time. It gets old.

The day I had the scan (two days ago) was an incredibly inconvenient time to have any appointment. Work was very busy this week, as it was our quarterly planning week, full of meetings and activities. But I had in my hand the paper that said “Overdue screening mammogram” with the date and time of my scan written in ink. I postponed every other appointment that was scheduled for this week, but I knew this one had to be done.

“I can go get it done and be back in an hour, hour-and-a-half tops,” I told myself. Basically no more than a lunch break. Blocking the time on my calendar, I thought about grabbing some lunch on the way back so that I could eat during the afternoon business activities. There was no time to eat ahead of the appointment. The last thing on my mind was having the tech say, “The radiologist wants to have another look.”

While I signed the registration papers at the clinic, the clerk and I chatted about the fact that some guy had wrecked her day earlier by arguing with her about vaccines. He told her that it’s the government trying to control us. Meanwhile, this 20-something young woman was just trying to stay healthy while taking care of all of us who can’t postpone tests any longer. Poor girl looked tired and stressed out. I wished her a good day full of smart patients who believe in science and went to the mammography waiting room.

When I walked into the room, I stared at the chair where I had sat while waiting to talk to the nurse navigator last time, when I first learned I would need a biopsy in April 2020. You remember things like that, amazingly enough. I couldn’t remember what I had for dinner the night before, but I knew which chair I sat in almost two years ago while waiting to step onto the cancer treadmill.

Turning away from that unlucky chair, I sat on the opposite side of the room. “I’m not tempting fate,” I thought. We tend to develop superstitions about such things.

A technician in happy breast cancer pink scrubs called my name in a friendly tone. She took me to a comfortable dressing room, where I took off everything from the waist up and put on what I like to call the super-shero cape. It’s a terribly immodest, flowered cape with a single snap at the neck. You have to be careful walking around in that cape, because if you’re not careful, the cape will float up from your sides and it’s hello Dollies! Honestly, the paper gown would be better, with its plastic tie-belt, but the cape lets them just flip it out of the way. I’ve spent a lot of time in those super-shero capes over the last two years.

The only thing I was afraid of that day was the pain of the compression. The cancer side has so much scar tissue that it hurts to have any pressure on it at all. It is tender all the way to the bottom of my rib cage. But I told myself that I could handle it, to not be a baby about it, so in I marched and stood bravely before the boob-smasher. The technician put a pink, 1/4″ thick pad with a sticky back onto the bottom plate of the mammography machine and draped it two inches over the front side. This is described in the “About 3D Mammography” pamphlet as “a warm, soft pad that makes the mammogram more comfortable.” Yeah, right! The technician was very kind and had warm hands, thankfully. She positioned me for each of four views–two on each side. I was right. It hurt, but I was able to handle it.

Whew, that’s over!

After a mammogram, they take you back to the dressing room and hand you the disposable pink pad to hang onto. It is your pad, and they will use it again for you if they need additional views. They tell you to wait to get dressed until the radiologist has reviewed your films. So I sat in the chair and started to daydream about what I wanted for lunch. Lately I’ve been craving protein, so I thought, “Maybe I’ll stop at Five Guys and get one of those big, juicy hamburgers.” My mouth started to water, and my stomach started to growl. (When coming home from chemo sessions, in which I had a mega-dose of steroids, I would often crave those burgers. My son would happily drive us there. I would eat lunch and then nap.)

After what seemed like forever, the knock came on the dressing room door. I was halfway to a standing position, locker key in hand, when the technician stepped in and said that the radiologist wanted to have a closer look at something on my left side.

“On the left side?” I asked. I was expecting anything bad to be on the right side again, but as my surgeon told me last year, there is “a 0.001 percent chance that you’ll get cancer in that breast again,” presumably because they radiated the shit out of it. I feel all kinds of lumps on the right side, but the doctors have told me that it is scar tissue and fat necrosis from the surgery and radiation. It makes me wonder how I would know if I had a lump that was something.

What I didn’t say aloud was, “FUUUUUUCK!” I was thinking that very loudly, though. Suddenly I wasn’t so hungry anymore, at least not in my mind. My stomach continued to growl while I followed the technician back to the mammography room.

This time the pressure was intense. With a diagnostic mammogram, they amp up the pressure on the area they need to see more clearly. I gritted my teeth and willed away the tears. It was over rather quickly, but my breast was sore afterward. Thank goodness it wasn’t on the really painful side.

Afterwards, I was led back to the dressing room a second time, and again I was told to wait and not get dressed yet. Suddenly I was reliving my nightmare. I started talking to God. I didn’t ask him to take it away from me; I just said, “Please God, help me to handle whatever you have in store for me.” Honestly, that was my prayer. It even surprised me that I wasn’t begging for my life. I thought that would be horribly selfish. Women go through this every day.

I waited another long stretch of time. This time I got my phone out and texted a couple of people at work to let them know that I was delayed but would be there soon. I was still hoping it was nothing. Most women have been through the experience of “the radiologist needs to see more” waiting. Usually the technician will come back with a sheet of paper checked “normal” and “dense breasts,” because that is so common. (That’s the same result I had 6 months before I found the lump.) While I waited, I also texted a friend who is living with metastatic breast cancer, because I know she understands how scary this all is. She has become an amazing ally in my fight, though we have yet to meet in person. Trying to distract myself, I then played a game on my phone, while my mind wandered to what I needed to do at work. “Of all days to get stuck here,” I thought.

The knock came at the door again.

“The radiologist would like for you to have an ultrasound,” the technician said. “She saw something that we need to have a closer look at, so just grab your things and follow me over to the ultrasound dressing rooms.”

You could have heard a pin drop. It took a beat before I stood up this time. I clumsily gathered all of my clothes and my bag from the locker. As I hugged my belongings against my chest, I noticed that my hands were shaking.

I joked, “I knew I should have had lunch before I came!”

The technician offered to get me a couple of pieces of candy, but I declined because I thought it might not stay down. My stomach was suddenly tied in knots. Still, I held onto a sliver of hope that the ultrasound would clear up this awful mistake. I just couldn’t have cancer again, could I? I just finished treatment 8 months ago!

The ultrasound dressing rooms are not as nice as those in the mammography suite. They only have a small bench, no locker, and just a thin curtain to shut out the rest of the world. The technician pointed to the bathroom across the hallway but cautioned me that I needed to be aware that the cape didn’t cover much. I don’t think I even sat down on the little bench in that room. Instead I stood there feeling around to see if I could find a lump in the good breast. Nothing.

The next technician came to get me and bring me into Ultrasound Room 2, where I put my things on a chair in the corner and laid on my right side on the bed. While she put the warm goo on me, we chatted about the upcoming winter storm and how she (the technician) wouldn’t have to deal with driving in it much longer because she is retiring soon. I politely told her that she looked too young to retire, and the banter went on that way. And then the ultrasound went on and on. She took a small disposable paper tape measure from a pad of them and measured, clicked. Measured, clicked.

“Oh God,” I thought. “She’s confirming it.”

“Is it just one spot?” I asked.

“I’m looking at two,” she said, and she carried on in silence.

Afterward, I was allowed to go into a private restroom to clean myself up with fresh towels. I was finally allowed to get dressed. All I wanted to do was to run away. My entire body felt clenched, and my mind started to race. I walked back into the ultrasound room and then followed the technician toward the mammography waiting area.

Before we even got to the waiting area, the nurse navigator met us and led me into her office. For those of you unfamiliar with this process, the nurse navigator takes care of everything from the initial abnormal findings up to the point at which you have the biopsy. She answers questions, does the scheduling, and acts as point person until someone else takes over. Like last time, it was Renee (who is probably also getting close to retirement), and she greeted me warmly.

She closed the door of her office, and we sat down at a small table where she glanced over a report fresh off the printer. With a knowing smile, she patted my hand.

“They want you to have a biopsy as soon as possible,” she said. “One spot appears to be a papilloma, which isn’t cancer but can become cancer. The other one is bigger. Not a papilloma.”

“Let’s do it,” I said, and I took the first available appointment. She put a copy of the report into a folder with the hospital’s logo emblazoned across the front, along with a sheet listing my appointment time and date, as well as information about the biopsy itself.

“Instructions are in this folder,” she said, “and a sheet where you will enter all the medication and over-the-counter drugs and supplements you take. I’m sure you know how this all works now. Oh, you’re not on any blood thinners, are you?”

I shook my head. This can’t be happening…this can’t be happening.

“Any questions?”

I thought, “Yeah, why is this happening again?” But I just shook my head.

She wished me good luck and led me out. My knees were a little shaky. When I got to my car, I read through the report she had given me. There were three spots, two of which appeared to be precancerous lesions – papillomas. The other one was hypoechoic with posterior acoustic shadowing and irregular borders. That means it is solid. (Cysts are hyperechoic and tend to have regular borders. I really should have been a doctor. This stuff sticks in my brain really well, unfortunately.)

I had been texting my sister, who lives in Texas, from the time I arrived at the center for my test until I was waiting for the ultrasound. She wanted me to let her know as soon as I knew anything at all. Neither of us had been all that concerned before my appointment. I knew I couldn’t even talk at that point. I thought I would pick up some lunch and call her once I had a chance to process all of it.

But I drove past all of the lunch places on my way home. I just wanted to go home and see my pets. A million things ran through my head. For example, I still needed to work the rest of my day, which I probably shouldn’t have done, because I couldn’t think or process information at all. I was anxious and a little out of it.

I came home and loved on my pup, who looked at me as if she knew something. She wasn’t her usual bouncy self, but then again, neither was I. I thought about how she had been sitting on the couch with me lately (instead of in her usual chair) and sticking her nose all over my chest and armpit on the left side. I thought maybe she was making rude commentary on my scent. Now I wonder. I finally called my sister and told her I was wrapped up in a blanket in bed. I felt like I was in shock. We both were.

Next week I have a regular follow-up appointment with my oncologist. It was supposed to be routine, in which she would ask me a million questions while feeling my boobs and armpits as I lay on the funny little table. I suspect that is the day I’ll find out the biopsy results.

What will I find out? What will I do if it’s cancer again? Well-meaning friends have said, “Maybe it’s a cyst!” or “It could be benign!” Yes, there is a chance that it’s benign, but I’ve looked at my scans before. This is an irregularly-shaped, odd little mass. There is nothing about it that suggests it contains any fluid at all. But I sincerely hope it’s benign. Because here’s the kicker – if the cancer is found again outside the original location or region, it is considered metastatic. According to breastcancer.org, breast cancer can spread to the lungs, the bones, the liver, the brain, “and rarely, to the other breast.”

FUUUUUUUCK.

I no longer have my son here to help me. He chose to move two states away. Though he has suggested strongly that I move to “within shouting distance” of him, I have a lot of friends here. I love where I live. He lives in the middle of nowhere, and as I told him, I need to be within “shouting distance” of a major medical facility because of my cancer history. I can no longer live comfortably in a rural area. Right now, I’m 10 minutes from a major cancer center. I can get to any of the world class hospitals in the DC/Baltimore area in about an hour. I have to think about things like that now, unfortunately. Life changed for me with that first diagnosis in April 2020.

My body knows how to grow cancer now. That’s how I look at it. I’ve had three precancerous lesions taken from another area of my body (several years ago), and several suspicious skin lesions that turned out to be benign. My dad died at my age of lung cancer. I really thought I had beat breast cancer, and maybe I have. I won’t know until I get the biopsy results. For now, I’m hanging on the fence between having cancer and not having cancer. As my former neighbor said to me, “Oh breast cancer? That’s the good kind.”

Yeah. Say that to me one more time. I just got turned down for some voluntary life insurance at work because of my history of breast cancer. I have to survive five years before I have a chance of getting the additional insurance.

Here’s what I’ll tell you. According to statistics, “About 43,250 women in the U.S. are expected to die in 2022 from breast cancer.” (breastcancer.org) Yes, women still die from breast cancer. It is not curable at later stages. (By comparison, the American Cancer Society says that 62, 590 will die from lung cancer. Cancer is the second leading cause of death right now, after heart disease, and just ahead of Covid-19.)

I have several friends who are living with metastatic breast cancer, but that doesn’t mean they are living well or that it won’t get them eventually. It means that the treatments that halt or slow the progress of the disease are still working for them and they can tolerate the side effects. We are all survivors…for now. We fight on.

Coda:

I had the biopsies on Friday. The interventional radiologist who did the biopsies also did my biopsies in 2020. He seemed upbeat and said that he would bet this lesion is just fat necrosis from my reduction procedure. I told him that I dearly hope he’s right. I wanted to ask him if he was sure enough to let me out of there without having a biopsy, but I didn’t. I wanted to know for sure.

I’m tired, I’m sore, and I’ve slept a lot this weekend. I don’t want to think too much about the results, but I’m praying the second radiologist was right. I’ll let you know when I find out.

Peace, Jude

A little music from a fellow survivor….