Wednesday, February 27, 2013

10. We're Having Trouble Finding It

I had two assignments that day - get my blood drawn for pre-surgery tests and get the redo biopsy of my right breast. I've had blood drawn before and I've even donated blood at a blood-drive. Needles didn't bother me much so I was able to quickly, and rather painlessly, cross off my first assignment of the day. With my cotton ball and bandage around the prick wound on my arm, I made my way from the lab back to the radiology department. I was becoming something of a regular there.

As the ultrasound-guided core-needle biopsy was unsuccessful in collecting an accurate sampling of my mass (we all knew it was a tumor, but for now, we'll call it a mass ... wait, is there really a difference?), I was going to have the stereotatic biopsy this time on the right breast. Once again, I was face down on the exam table, this time with my right breast hanging down through the hole. And, once again, there was Tammie, hand on my shoulder, consoling the patient with physical touch as she, and everyone in the department, had been trained. Also there to assist Dr. M with the pending procedure was Joanie. She talked with me during the procedure, asking questions about my tattoos, family and anything else that would help me focus less on the needle in my breast.

The mass, as seen on both the mammogram and ultrasound, was located in the upper, outside quadrant of my breast (near my armpit). It was easy to locate on the prior exams, so there was some concern when, after repeatedly repositioning me on the table, moving my arm and shoulder into incredibly awkward positions, they still couldn't find just the right place to push in the needle. (Wait, maybe my positive thinking had actually worked, I thought to myself. I pretended it wasn't there and they suddenly couldn't find it. I was powerful!) 

We took a break. Time to reposition me, again. Tammie went out into the lobby to let Craig know what was delaying this procedure.

"We're having trouble finding it," she told him.

"Huh? You're having trouble finding what? Her breast?" he questioned, ever the smart-ass.

"No! No, we're having trouble finding the mass so we can get the needle in just the right spot," she quickly replied.

They eventually got me in a position that allowed them to get a decent amount of tissue to biopsy. Dr. M took more than he really needed, but he wanted to ensure they got an accurate sampling of my mass and thus avoid having to biopsy that breast a third time. Curiosity got the best of me and I asked to see the tissue samples in the plastic container. The nurse showed me a round container with several departments, each containing several tissue samples. I called them worms. It looked like a hundred little worms in a dish! It was cool, in a twisted, sick, way. The nurse was going to personally deliver the dish to the lab and as she walked out the door, I asked her for a favor. 

"Hey, can you show that guy in lobby, Craig, the dish? Show him how weird and cool it is!" 

She obliged. Craig has yet to forgive me for that. 

I headed out the door, steri-strip on my wound and little, pink ice-pack in place. Despite having been through this twice before, something wasn't feeling right. I was in much more pain that I had been with either of the first two biopsies. I attributed it to the fact that my breast was still bruised from the original invasion two weeks before. As I gently eased into the passenger side of the car, I cried. (Note this as occasion one of maybe two where I cried during this entire cancer journey.) 

"I'm tired of being poked and prodded! It hurts! I don't want to do this!" I yelled at Craig between sobs. Through my puffy and watering eyes, I noticed a tear trickle down my driver's cheek. "I just want to go home and crawl into bed!"

I managed to get into bed, but with pretty intense pain. (That was when I first got a glimpse of just how involved your chest muscles are in every single movement you make. Getting out of the car hurt. Walking up stairs hurt. Pulling down the covers hurt. All this was just from a biopsy and here I was signing up to get both my breasts cut into just a few days down the road. What was I thinking?!) As I pulled the covers up over my legs, I saw that blood had soaked through my white, zip-up hooded sweatshirt. At first I thought the steri-strips had fallen off, but no, they still adhered to my skin. Only, they were now soaked with blood. 

Tammie, the mammography supervisor who had been with me during every procedure thus far, had compassionately given me her cell phone number and said to call or text her if I had any questions. I have always hated asking for help, but I was desperate. I was in pain. There were tears! Tears, for me, mean one of the following: 1) it (my body) hurts 2) my heart hurts or 3) my sisters are making me laugh too hard and I can barely breathe. My tears that night were clearly a result of number one - it hurt. 

Fortunately, I had my cell phone in the pocket of my sweatshirt. I texted Tammie.

Me: Hi. It's Cherí. Is it normal for the wound to continue to bleeding this long after the biopsy? Why does this time hurt so much more than the others? Sorry to bother you so late! (It was maybe 8-9pm. If you know me at all, you recognize that is late for me.)
Tammie: No bother at all. Have you taken a pain pill and tried icing it?
Me: Yes, I've done both. Hasn't helped. (A tear dropped on the face of my cell phone.)
Tammie: Take another pill in a while and text me after a bit and let me know if it helps at all.

Two pain pills and I was out. The next morning, with dried tears gluing my eye-lashes together, I saw that Tammie had sent me a text after I had fallen asleep. 

Tammie: Come by the office right before 8am and text me when you get here. We'll bring you in through the back and get the nurse to redress it for you and check it out.

She saw us walking up the entryway to the clinic the next morning, 7:59am sharp. I was still hurting and was really tired of being in this pain. They ushered me through to an exam room and put me on the examination table. Craig stood way in the back corner, behind Tammie, the nurse, and Dr. M. As my protector, I sensed he didn't want to let me out of his sight while I was in such pain. Yet, he was way back in the corner ... either chivalrously protecting my sense of modesty or in an attempt to avoid seeing me cringe and cry.

The nurse pulled off the steri-strip bandage and I instantly felt something of relief wash over my body. 

"Wow, yeah, looks like you are allergic to steri-strips! It's been, what, 12-18 hours, and you are already blistering!" the nurse told me. Seriously? An allergic reaction to band-aids? That's what this pain was all about? That settles it for me. Childbirth is not ever going to happen for me.

They cleaned the wound, applied new gauze and used paper tape to adhere it to my skin. A note, in bold permanent marker and highlighted, was added to my patient folder - ALLERGIC TO STERI-STRIPS! PAPER TAPE OK.

I walked out of the clinic feeling exponentially better. I hardly had any pain. But I still got a tiny, pink ice-pack, just in case. I was feeling so much better I would have settled for a purple one!
 

Tuesday, February 26, 2013

9. Where's The Instruction Guide?

First-time parents often wish their newborn came with an instruction manual.I've heard many mothers and fathers say with disbelief, "I can't believe they just sent me home with this thing, this baby that I was totally responsible for keeping alive! What were they thinking?!"
 
Similarly, despite the many bookstore shelves and online storefronts lined with books about how to concur, destroy and outlive cancer, when you are diagnosed with cancer, you, like new parents, are not given a manual. (And those previously mentioned so-called informational brochures are practically useless. They just show people smiling, hugging one another, and tell you to talk to your doctor. Awesome, thanks for the advice.) Sure, there are books available on many aspects of dealing with cancer; I've purchased, borrowed, and read most of them. Topics from how juicing and natural foods as part of an organic-diet are the true answers to beating cancer to inspirational stories shared by survivors offering their opinions as the only way to battle cancer, well, there is no shortage of information out there, I concede. However, there is no master guide that tells you exactly what you should do, what questions to ask, explains every possible type and stage of your cancer, and details every treatment option available. The reason for this is simple. No two cases of cancer (and all that accompanies that diagnosis) are identical. There is no one way, one best-path to beat it. So, you rely on the experts - the doctors - to guide you on the best path for you. You put your trust in them and do what they say. (Right?)

Once my friend comprehended and accepted that yes, 'twas I with the lump and not my beloved canine child, she insisted on accompanying me to the consultation with the surgeon. I sat in the tiny exam room with both my friend (Beth) and my driver, uh, I mean Craig on either side of me. Dr. L knocked and entered the room and introductions were made. His brow raised a bit as he studied my file. "You're how old?" Yeah, I know. Too young for this kind of thing. "And your grandmother had breast cancer?" Yeah, she was 34 when diagnosed and had a mastectomy at 35. "And I see your mammograms and tests reveal bilateral cancerous findings, hmm."

To the authors of the beating cancer textbook (that doesn't exist), here's where you raise a very important HUGE red flag to your patient/reader. Patient is 34 years young, has a grandmother who had cancer, cancer is bilateral - a general surgeon is not the right surgeon for this patient!

But indeed, the office in which I sat, discussing plans for a double-lumpectomy and possible radiation, was that of the county hospital's general surgeon. The three of us in that room without medical degrees thought boy, are we lucky to have such a nice doctor, he must know what he's doing. He even said this is what he'd do if this was his daughter. He must deal with this kind of thing all day, every day, so let's do it! Heck, he says with a double lumpectomy and radiation it'll all be just fine and it'll be just as effective as, and less invasive than, mastectomy. He must be the best. Wonder if he graduated top in his class.

(Side note here. My comments here about this particular doctor are not meant as anything personally negative about the man. He was, indeed, kind and professional. As I'd learn in the days, weeks, and months to come, he was not, however, the doctor to whom I should have been referred. We'll get to that later, too.)

The surgery coordinator/scheduler put the caller on hold and shifted her attention to the lurking Dr. L. "She's here with her parents, let's get her scheduled," he told her. (Yes, both Craig and Beth heard that and shuttered. My parents are in Utah and these are my friends, but I didn't feel the need to explain all this to the scheduler.) "And we've got you scheduled for the right side redo biopsy on Thursday at 1pm," Dr. L informed me.

"How does June 24th work for you?" the scheduler asked of me. I turned to Craig, "How do you feel about spending your birthday in the waiting room while I have surgery?"

I reported, as instructed, the next day to the pre-surgery consultation at the hospital. I filled out the requisite forms, nothing major, just my Advanced Directive (!!) and such, and was given instructions to not eat or drink anything after 6pm the night prior to surgery. The kind lady gave me two stuffed pillows, shaped like hearts. A local charity organization makes them for the hospital to distribute to breast cancer patients for comfort during recovery. I had no other questions for her and prepared to leave. Almost made it out the door before Craig spoke up and asked the question I was not going to ask. (If I didn't ask, she couldn't tell me no. Made sense to me.)

"Oh, question for you. She's scheduled to get a tattoo. Is that okay to do before surgery?" Craig inquired.

"Well, it's best if she waits until after surgery. If she were to get infection, that would put off surgery until the infection cleared up and you don't really want to do that," she replied. You had to ask, eh Craig?! I had scheduled my appointment already for 4pm that day and I was so disappointed to think I'd have to cancel.

I got my very first tattoo a few years before then, while visiting my sister in Arizona. It was a small one ... just the initials of my nieces and nephews. After that, I got the tattoo bug. (When you hear that tattoos are addictive, trust me, they are.) After that first tat, I added a Scottish flag and thistle to my back/shoulder, a tribute to my late grandmother on my other back/shoulder, a sentiment to my sisters on my inside wrist and, well, maybe one or two others as well. 

While I was (and remain) incredibly proud of each of my tattoos, I'm most proud of the one on my outside left ankle. Chris (shoutout here to Chris at River City Tattoo in Old Sac) did a great job with the color and detail in the words. Best of all, my pink-ribbon tattoo was totally healed-up (okay, and hidden with the hospital socks) come the morning of June 24th. 

 

   

   

 

Thursday, February 21, 2013

8. Super Fast

Stereotactic breast biopsy is often used when a small growth or calcifications are seen on a mammogram, but cannot be seen using an ultrasound of the breast.You may feel a sharp, stinging sensation when the local anesthetic is injected. During the procedure, you may feel slight discomfort or light pressure. After the tissue sample has been taken, the catheter or needle is removed. Ice and pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb any fluid. You will not need stitches after the needle is taken out. Steristrips may be placed over any wound, if needed. (Source: www.nlm.nih.gov)

It was a relief to be on the exam table face down. While my left breast hung through a hole in the table, the nurse standing at my side detailed each step to me as it transpired. She kept her hand on my back/shoulder throughout the entire procedure, explaining to me that patients often found it helped keep them relaxed and less fearful of what was happening. (I'm not big fan of strangers touching my body, but quite frankly couldn't care less at this point. I realized this whole experience was going to have nothing whatsoever to do with my likes and dislikes.) As Dr. M prepared, I mentally checked out. I'd been here already and knew the drill. Shoot me in the breast, take some tissue samples, apply pressure and then a band-aid, and send me on my way with my little pink ice pack. (Joke was on me. I got a purple ice pack.)

When my older sister, Caren, delivered her first child in 1996, I discovered my life's passion. I was going to be the world's best, most devoted aunt. As I held two-day old, scrawny little Andrew in my arms, I cherished the quiet moment alone with him. 

"I will always love you, little man. I promise to always be here for you and to protect you. You will never be alone and I promise to always make sure you know just how truly loved you are," I whispered into his tiny ear.  I repeated those same words to each of my other five nephews and two nieces in the years that followed. (Caren would have five kids - Andrew, Mitchell, Avery, Callum and Bronwyn. Cheryl would have three boys - Marshall, Carson and Charlie.) These children comprised the eight pieces of my heart. They became my life, my passion, my joy. Being their aunt was my greatest role in life. When divorce uprooted my plans for the future and having children of my own, I channeled my maternal love to the lives' of these children. As it has been said, I may not have borne my own children, but I was born for these children. 

Part of my commitment to these children has always been to maintain a visible and engaged presence in their lives. As such, almost every one of my vacation days since Andrew's arrival sixteen plus years ago, has been spent with the kids. Often, travel to be with them would be justified by needing to attend a graduation, birthday or baptism. More often, however, I simply missed them and wanted to spend time with them.

There was no unique reason for my trip to Utah that weekend other than I wanted to see the boys. My flight was scheduled for 6am on Friday, June 12th. According to Dr. M, my biopsy results would be available that day and he'd like me to come in to discuss them when they were ready. I refused to delay my travel plans and I refused to wait until sometime the following week to get the results in person. I gave no value or consideration to his professional habit of preferring to not share test results over the phone. I was the patient. I gave Dr. M my card and circled the cell phone number listed. I insisted he call me. 

My cell phone rang that afternoon as I stood on my mother's front porch. It was a beautiful, sunny and mild early summer afternoon. I recognized the caller ID number and simply said hello.

"Yes, this is Dr. M. I have the biopsy results. Are you sure you want to discuss this over the phone?"

"Yep, of course. What'd we find out?" I inquired.

"Well, the pathology shows that, yes, as suspected, this is breast cancer. The good news, however, is that it's only Stage 0, DCIS," Dr. M explained to me. "But, it also makes me think we need to get another sample from the right side as I believe now that those results were not a true representation of what's there."

"Awesome! That's so cool!", I yelled out. (Oh, what I would have given to see Dr. M's reaction to what he assumed was my reply to him!) I watched as Charlie, Carson and Marshall rode their scooters up and down the driveway. "Woo hoo!"

"Oh, yeah, I'm here. Okay, yeah, breast cancer. DCIS. Another biopsy. Got it. I'll call to schedule an appointment Monday. Thanks again for calling me. Appreciate it."

I knew life was about to change. I recognized a cancer diagnosis was serious and needed immediate attention. I wasn't in denial and I wasn't procrastinating (though, I admit, procrastination has always been one of my flaws). However, I wasn't about to let a cancer diagnosis ruin my weekend with my nephews, sister and mother. I could deal with the whole cancer thing next week. At that moment, there were more important things to address.

 "Yes, Charlie, I'm watching you go super fast. Look Nana, look at Charlie!"

Charlie and his scooter

One of my favorite places - cuddled with the boys. A cancer diagnosis would not be allowed to ruin my weekend with them.
 
 


    

Wednesday, February 20, 2013

7. Fairytale

Having always loved music, I was open-minded and rather excited to hear this guy play. I'd never heard his name before my friend, Jill, had let me borrow a few of his CDs and said we had to go hear him play - live - on Saturday night. Tickets were sold out, as the venue was incredibly small, and we made plans rather last minute. So, we improvised. The venue was outdoors and a park was right at the side gate. We brought all the makings for a fabulous evening picnic - sandwiches, fried chicken, drinks, snacks, blankets, chairs and a football. A few other friends joined us as we casually enjoyed a summer evening concert in the park. Chloe (Jill's daughter and my honorary niece) and I tossed the football around for a bit until I caught a pass right smack in my breast. Bullseye - like a magnet, the football shot straight into my two-day old biopsy bruise! That was the end of football for me that evening. I turned my sights towards a chair, a soda and listening to the sweet tunes of Jackie Greene playing his annual concert at Fairytale town, only a few yards (and one fence) from our picnic. For a short while as I listened to his guitar and iconic voice, the world seemed rather simple and time stood still. 

And then Monday rolled around. 

I was escorted into a hospital waiting room that reminded me somewhat of a church classroom. It was quiet, and only a few chairs and some pamphlets occupied the room. (I don't recommend reading the pamphlets as you await biopsy results. "You Have Cancer - Now What?", "Breast Cancer and You" ... it was if by having me wait in that room with those brochures staring me in the face, the doctors were prepping me for what they were about to tell me. You could just picture the doctors walking into the room, glancing at the brochures, then back to the patient and asking, "Any questions?")

Dr. M and a nurse (I kid you not, her name was Sherry), entered the room and said hello to Craig, who had once again accompanied me to the appointment, and me. Sherry and I awkwardly chuckled about the coincidence of our names being so similar.

The results were not what I had expected. I knew I had cancer, but the results, as explained to me by Dr. M were somewhat inconclusive. He explained it to me by drawing a horizontal line on a piece of paper. He started at the left edge with a number one, and then numbered the line in equal part up to the number five. He continued with his explanation:

One = regular, perfectly normal cells
Two = changing cells, could be normal, but ...
Three = ADH (atypical ductal hyperplasia), cells that were changing and could become cancerous; not breast cancer, but a possible marker of it to come
Four = DCIS (ductal carcinoma in-situ), cancer in the ducts but that hasn't spread beyond
Five = invasive ductual carcinoma, cancer that has spread beyond the ducts 

While he didn't say specifically what number he had expected my results to hit, he was obviously unsettled when he explained that the biopsy put me around a 3.5. Seeing as the lumps in that breast were palpable and easily visible with the ultrasound, we all had anticipated a more definitive, accurate, and frankly, serious diagnosis. Dr. M was contemplating the need to re-biopsy the right breast after we did the left side. Something just didn't feel right about these results. 

Craig was practically giddy on the drive back to the office. (Yes, I went back to work. What else was I going to do? Catch an afternoon soap-opera and chow down on bon-bons?) I, however, wasn't feeling the same sense of relief as Craig. 

"This is good news," he told me. "No cancer!" I just stared out the window as he repeated to me over and over how this truly was good news. It wasn't. I wasn't relieved. I wasn't smiling. I wasn't happy. But I also wasn't sad or worried. I was annoyed by two things - 1) Craig's casual dismissal of it all (he was confident this was all over and there'd be nothing to worry about and this tossing aside of my reality got my goat) and 2) this non-specific and inconclusive finding simply meant I had to, once again, wait. My next biopsy wasn't until Wednesday. Another 48 hours of waiting. I think that's when I started to hate cancer.