Meeting with the Surgeon

Monday afternoon

For Christmas Dean had given me a gift card for a local spa. Last week I scheduled myself for a one hour massage and foot scrub. That was before I knew I had cancer. Before I knew that later today I would be meeting with my surgeon and oncologist for the first time.

Today I laid on that massage table, crying silent tears while the massage therapist did her thing.

When my massage was done I didn't feel all tingly like I usually do. My tense muscles didn't feel any different than they did before. Stupid cancer.

I picked up Dean from work and we drove to the breast center in relative silence. I knew what was going through my mind, but what was going through his? Disbelief that he is living through this again? That lighting can, indeed, strike twice?

They called our name and brought us back to a small conference room. "We're going to leave Dean here while we do another ultrasound. The MRI showed another small area we need to take a closer look at."

For real?

Stupid cancer.

The radiologist dug around my breast with the ultrasound probe. Finally she found the spot they were looking for, buried deep in the breast tissue. She studied it carefully for several minutes. "It looks like an intra-mammary lymph node. They are usually nothing concerning, but when you have your surgery we'll probably look at it closer."

From there I was brought to an exam room and a few minutes later Dean was brought in too. Then my surgeon entered and introduced himself. He started with a breast exam. It suddenly occurred to me I will have more breast exams in the next few months than I've had my entire life. The words of my friend came back to me, "Say goodbye to your modesty."

Dr. S. sat down and tried to get to know us a little bit, then finally said he was trying to get an idea where our understanding of biology was. Dean laughed and assured him I probably know almost as much as he does. I laughed, feeling a bit embarrassed. Dr. S said he had gone over the MRI images with the radiologist, along with the new ultrasound of the intra-mammary lymph node, and invited us back to the conference room so we could discuss everything. We were introduced to one of the clinic nurses who would be taking notes during the meeting. Wow..a notetaker? I've been through many very intense meetings with medical specialists before, and never been provided a notetaker. Did I really need that? I almost said, "Thank you, but I don't think we'll need you to take notes." But a tiny voice in the back of my mind stopped me. "For once, let someone else do the work for you. This is your first lesson in accepting help."

I sat back and tried to concentrate on what the doctor was explaining. He stared at the moment of conception, explaining cell biology, mitosis, meiosis, and DNA replication. I wanted him to hurry up and get to the cancer part. Finally he got to epithelial cells, and what goes wrong in their duplication and how they become carcinomas.

I have two types of cancer:

Ductal Carcinoma In Situ, which means the cancer is still within the ducts, and Invasive Ductal Carcinoma, which means the cancer has broken through the lining of the duct and is spreading to other tissues. These invasive cells can travel to the lymph nodes, sending them to other parts of the body.

My cancer is 2 cm, which makes it a stage 1 cancer. However, if at the time of surgery it is found to have spread to my lymph nodes, this will change. 

My cancer is estrogen positive, which means it is estrogen fed. Removing estrogen from my system means cutting off the energy source for this type of cancer. I'll have to take medication for the next several years. The medication turns off the estrogen receptors. It will put me into menopause, or have my ovaries removed and take a different medication. (this is more probable because I have a significant family history of strokes) 

My cancer is HER2 negative. That means it is not producing a specific protein. HER2 positive cancers are much more aggressive than mine.

Twice during the meeting my phone rang. I had to keep it on because Noah was at our house getting the kids off buses. Twice there were calls because of issues at home. It gave the doctor a good sense of what our life is like, and how I'm always "on call". 

At some point the doctor asked me, "When you were told you had cancer, what was the first thought that came to mind?"

I started to cry. One of those cries I couldn't really control. Finally I said, "The first thing I thought was, "I don't have TIME for f-ing cancer." He looked me in the eye, "I'm glad to hear that. I'll tell you that over the years I have learned some things. Everyone has instinctual responses. I've learned that for people who's first thought is something related to death and dying, they have a much more difficult time with treatment, no matter what the treatment, than those who are a bit more stubborn about things. You'll need to learn to take care of yourself, but I think this will be just a speed bump in your life, and nothing more."

He continued to explain all the different surgical options that go along with various stages of breast cancer. Right now I will need only a lumpectomy followed by six weeks of radiation along with several years of medication to block the estrogen receptors. A few weeks of treatment, and then I'm done. With this protocol my cancer has a 5% chance of recurrence. 

And  here is where I get irritated with cancer again. I had already decided I would have a mastectomy in a few months, but the surgeon assured me this is not necessary with this type of cancer, that it doesn't change the outcome. So even though I have breast cancer, I don't get to buy the t-shirt that says, "Yes they're fake, the real ones tried to kill me." This should be a good thing, I know. But my mind is doing funny things right now. 

Nope, I don't even get a boob job out of the deal! The Dr. explained I may have some shrinkage on one side from the radiation, but that I don't really need a breast lift at this time because I have no sagging. Ok, normally I would have taken this as a compliment, but in this context I was a bit annoyed. "What? I don't even get a boob job out of the deal?"

And yes, I know more about boob jobs than most who haven't  had it done. I have done drains and a 27 inch incision from hip to hip. I know I'd rather have a mastectomy and reconstruction done preventatively than in a more urgent manner. 

Well, because I have breast cancer, I can talk to a plastics person anytime I want, and I could even get a boob job if I wanted. Its just part of breast cancer. But I think I'm pretty lucky I get to keep my natural boobs and will leave them alone. However, I reserve the right to change my mind.

When the meeting was done I was given a 3-ring binder full of information, including the contact information for everyone in the clinic and what their roll is. Its almost like they've done this before. I was also given the 4-5 pages of notes the nurse had taken for me. 

On Weds, April 2nd I'll be having a sentinel node biopsy followed by a lumpectomy. This is outpatient surgery and I'll only be at the hospital a few hours. I was told, "Because of the size of the lump and its location, the incision will be small and you'll be back in the trenches the next day without restrictions."

Really? With Dean sitting right there the dr. couldn't even give me two days of "stay off your feet and rest?" 

Stupid cancer.