Monday, January 4, 2016

2015 Did Not End Like I Thought It Would: Hello Cancer! (Part 3 of 6)

January 4, 2016

The day I went in for the mammogram diagnostic and the ultrasounds, I didn't even tell Doug I had an appointment.  More denial.  It's nothing, so no need to alarm anyone.  I dropped Danielle off at school and headed to the Imaging Center.  I did have to tell the secretary at my school and have her tell my Learning Director why I wouldn't be there that morning, because as luck would have it, they needed someone to cover a class during my prep.  I told Linda, our secretary, only briefly what was going on and that my doctor was a little concerned and had ordered me to get a mammogram that morning.  Linda, a breast cancer survivor herself, said I absolutely needed to keep my appointment.  She'd find someone else to cover the class.

Some women find mammograms incredibly painful; I have never found them to be so.  Obviously they're not the most comfortable thing in the world, but certainly manageable.  I hadn't had one done in about six years or so though, and mostly I attributed that to my general avoidance of doctors coupled with something I'd read about a fairly recent change in the age at which women should start getting mammograms. (The U.S. Preventative Task Force, in 2009, started recommending women start mammogram screenings and continue every two years at the age of 50, rather than their previous recommendation of the age of 40.) As I am only 48, that seemed a reasonable justification to hold off a little longer on a task that was not painful, but generally one I considered a nuisance.  How thankful I am I did not wait until 50!

The mammogram seemed nothing out of the ordinary, but when they got me set up for the ultrasound, things got a little serious.  The technician was professional and friendly, but once she got past about the 3rd screen shot, she was all business.  I knew she was seeing something she didn't like when she kept taking images and measurements--somewhere in the neighborhood of 25, I'm guessing.  She said she'd go get the doctor who would come back and discuss the results right away.  That, too, did not seem a good sign.  I figured if there wasn't something clear, the doctor would need more time to sit and study it and then get back to me.  While I waited for their return, I tried to decipher the measurements and shorthand annotations on the screen.  It gave me no information other than outright guesses and speculation.

The doctor came into the room.  She was open, direct, and positive, for a woman who had to deliver news I'm sure she took no pleasure in.  "What I'm seeing here in your ultrasound is a long string of malignant calcifications, likely pre-cancerous, along one or possibly two of the ducts.  I wish I had seen you in here two years ago, and perhaps it wouldn't be this extensive. But as it is, these calcifications are spread along 5-6 inches of this duct.  There's no tumor there, but that's a lot of tissue that's affected."  (It was a very matter-of-fact thing, that she said she wished I had been in for a mammogram two years earlier.  It's also a matter of fact that it didn't happen; that window had closed, and I have given myself permission not to beat myself up about it.)

Malignant.  Got it.  That's not good.  Calcifications? I'm not entirely sure what the significance of that is.  Pre-cancerous--not great, but could be worse, right?  "Okay.  So what exactly does that all mean?  What happens next?"

I'll never forget what she said next.  "Well, it means I can't save the breast, but I can save you.  So that's the good news here."  Wow.  Yes, that is good news,  I can tell you that from the start I appreciated her directness.  It wasn't cold; it was honest. It never left me with a false hope that I wasn't in for some pretty significant surgery.  There's a lot less room for denial there.  "So what happens next is you come back next week for a biopsy--two, actually.  A biopsy at each end of the duct to determine if the califications have moved outside the duct or if they're contained--what the exact status is.  I think they're contained, but obviously we'll want to check to make sure.  Also, your lymph nodes don't look worrisome, but they'll check those too during the actual surgery just to make sure it hasn't spread."

"How you go about the reconstruction will be up to you and your plastic surgeon." (I have a plastic surgeon? That's pretty near the top of the list of things I never thought I'd say.) "They'll also probably put an implant in if you choose and your insurance covers it, and you will likely have to have a reduction on the other side to match it.  Those are all options you'll be discussing with your team once they've assembled."  (I have a 'team' all of a sudden?)  When she asked me who I had insurance with and I told her, she stuck out her hand to shake mine. "Congratulations--you have better health insurance than I do!" I know we have great health insurance; it's a relief to know that in the midst of some pretty scary news, the financial aspect of it all will not be an additional burden.

She kept referring to calcifications and pre-cancerous cells--she never actually said I had cancer--but she did say that the affected area was much too long for a lumpectomy to even be a consideration, so I left the office knowing that within a week or so she wanted to see me scheduled with a surgeon, and that within 30 days, more or less, there would be a surgery to literally remove a body part.  I also left the office with an appointment to come back again the following week for the biopsies.

I'm what most folks consider a big crier--I cry at sad movies, at adorable babies, at moving and touching moments in life.  My kids make me cry tears of pride and joy. I'm an emotional gal.  But for me--I usually try to hold it together when things happen to me.  I try to be objective and optimistic at the same time.  But when I got into my car, I did let loose a little--allowed myself the luxury of tears of worry and fear.  Weirdly, though, it wasn't like the old irrational fear that breast cancer was going to be the death of me.  Honestly--that never really came to the forefront.  I just knew that things were about to change, really change, and it was going to be a long process to get there.  I gave over a few minutes to being overwhelmed by that, and then I knew I had to get it together.  I had to get back to school where I had to teach a class in 20 minutes, and I needed to call both Doug and my sister to let them know.  Doug's first words: "I know you know this, but I want you to hear it anyway. I love you, and I'm here.  No matter what happens, no matter what we go through, we go through it together. I'm not going anywhere.  All I care about is that we do whatever needs to be done to get you healthy."  He's right; I did know that, without a doubt.  He's also right that that was exactly what I needed to hear out loud anyway.  Lisa, too, was a rock: "Okay, the good news is that they caught it, and it looks like they have a good game plan to take care of you.  It's going to be fine."  Also exactly what I needed.  I am sure they both had their own fears, but in that moment they knew what I needed.

Finally, I felt I needed to text a handful of close girlfriends so they could start throwing good prayers, vibes, and positive thoughts out my way.  It was a pretty small group of people at first--4 or 5, because I wanted to be able to let my kids know before they heard it from anyone else, and I needed a few more answers before I could let them know.  They'd need to know a game plan, and I didn't have all the answers to that yet.  I told those friends what I had found out, but that I didn't want to talk about it yet, and I definitely didn't want anyone to say anything to anyone else yet.  I just needed to know I had a silent team cheering me on until I had more news.

I headed back to school to start class and carried on with the rest of the day, feeling a little bit like I had a ticking time bomb in me that I had to pretend I didn't hear.

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