Friday, June 5, 2009

Don't be such a boob

I've been trying to write about this for a while now but it's difficult. It's difficult because I'd rather write a good news story where the worry turns out to be nothing and in retrospect, we can all learn blah blah blah. It's difficult because it still doesn't seem real. It's difficult because facts like "Only 4 of 10 people who get cancer are expected to be alive five years after diagnosis" are floating around out there, scaring the shit out of me. Granted, that's a figure for all types of cancer, but it's still a scary number.

I suppose I'll start at the beginning. I found a lump. I wasn't particularly looking for one, but I found it nonetheless. I told myself that it was probably nothing, and that if it was something, I'd rather not know. If it was going to kill me anyway, I'd rather not go through the pain and drama of dealing with it. It would be much easier to let it take its course.

But it was probably nothing. I'm young. I'm not on any sort of hormone therapy or even the Pill. There's no history of cancer, breast or otherwise, in my family except for one great uncle.

After a bit of time spent ignoring the goddamned lump, I drunkenly and off-handedly confessed its existence to a friend. (Hey, look at that - alcohol may have saved my life!) This friend has had too much experience with cancer to let my admission slide, so the next thing I knew she booked me in to see her doctor. My appointment was for April 7.

After poking at my boob for a while, the doctor tried to offer comfort. She told me not to worry until I had something to worry about, but I heard her instruct her assistant that she wanted me in for an ultrasound as quickly as possible.

That day after I went back to work, I told my manager that I was going through something medical that may or may not turn out to be something. I let him know that I may have to leave for appointments without much warning. He was wonderful and told me to do what I needed to do, no questions asked.

At home that night I threatened the lump that it better fucking well be nothing. I yelled for a while at Righty and told her that she might just be out of the will. I told Lefty that she was now officially my favourite.

On April 17, I went for an ultrasound and a mammogram, and 3 days later I was back at the doctor's office. She told me that they couldn't tell yet if the lump was cancerous or benign. She told me I needed a biopsy done and that the cancer centre would contact me with a date. I read the words possibly cancerous lesion on my chart while she was busy filling out another form and decided to walk the 3 km back to work, silently freaking out the whole way.

On April 27, I went to the cancer centre for my biopsy. I wasn't particularly worried about the procedure, but rather the possible results, so I waited calmly and patiently. An older woman in the waiting room entertained me, griping about the awful hospital gowns they make us wear, the pain of having to drive into town for these procedures, the awfulness of the MRI. I told her I hadn't had an MRI yet and she told me I was lucky. During the procedure, I stared at the upper left corner of the room and took deep breaths. The biopsy was unexpectedly painful, and the bumpy bus ride home didn't help. I called my boss to let him know I was taking the rest of the day off. The people at the cancer centre said I should have my results in 5-7 business days.

The next day I had an appointment with yet another doctor. I wasn't sure what it was about or who he was, but I went anyway. The appointment was in the medical offices wing of the hospital just across the alley from where I live, so I walked over. After a short wait, the doctor called me into his examining room and poked at my boob. He told me I could put my shirt back on and then he said that their goal with a breast cancer diagnosis is to have the patient in for surgery within 3 weeks.

My heart stopped. What? Did he just tell me I have cancer? He must have seen the shock on my face because he stammered a bit and said that he didn't need to wait for the biopsy results. Because of the location, size, shape, and feel of the lump, they can tell it's not benign.

I immediately started to cry. He offered me tissues and asked if anyone was there with me that we could call into the room. I told him that I hadn't told anyone because I didn't want them to worry if it was nothing. He was very kind and patient and advised that I should tell at least my family so that I have some support. He told me his wife was also 33 when she was diagnosed with breast cancer and they just celebrated her 53rd birthday. He said she had been cancer-free for almost 20 years and that these days, a diagnosis is not necessarily a death sentence.

He then pulled out a booklet that provided information about my options: mastectomy vs lumpectomy, axillary dissection vs sentinel node biopsy, post-surgery treatments.

Before I continue, I'm going to give a little crash course in breast cancer surgery. A mastectomy is where they remove most or all of the breast. A lumpectomy is where they remove the tumor and a surrounding margin of breast tissue. A lumpectomy is also called breast conservation surgery.

Axillary dissection is where they remove most or all of the lymph nodes under the arm. This is done because if the cancer has spread, it spreads to the lymph system first. They examine the nodes for cancer cells. If there aren't any, then the nodes were removed for no reason. If there are cancer cells, good thing they got all the lymph nodes.

A sentinel node biopsy is where they remove only the first 1-3 lymph nodes. Radioactive fluid is injected into the breast the morning of the surgery and it travels along the lymph system. They use a special camera to detect first few nodes and the surgeon removes those. The sentinel nodes are examined for cancer cells. If they are clear, excellent - no further surgery is needed. If they find cancer cells, another operation is required to remove the rest of the lymph nodes.

There are benefits and drawbacks to both options. It takes longer to recover from axillary dissection than a sentinel node biopsy and there is a greater chance of lymphedema. However, with the sentinel node biopsy there is always the chance that a second operation is needed, and there is a 5% chance that even though the first node is clean, a lymph node farther up might be cancerous.

End of lesson.

The doctor advised me that I should probably make decision right there and then so that I could get on the waiting list for my surgery. He explained the difference between the lymph node surgeries and told me that I was a good candidate for a lumpectomy because of the size and location of the tumor.

Tumor. It wasn't a lump anymore. Now it was a tumor. I hardly heard anything else he said, but managed to agree to a lumpectomy and the axillary dissection. I signed a consent form and slowly walked back home.

I spent that night sobbing on my couch. The next morning my eyes were so swollen that it looked like I was on the losing end of a fight. I desperately wanted my mom to know, but I dreaded telling her. How could I tell my favourite person on the planet that I have a potentially life-threatening disease? Before I knew anything I had decided that until I had confirmation, I wouldn't tell her. Except now that I had that confirmation, I discovered too late that it would have been easier to tell her that I might have breast cancer than to tell her I do. Ah, hindsight.

Three long days after my appointment with the surgeon, I finally told my mom. There were tears and hugs. I told jokes. There were more tears. We told my step dad and my sister. There were more tears. It was a rough week. I told the rest of my family, my boss at work, and all my friends.

Everyone was wonderful to me and then next thing I knew, it was May 5 and I had an appointment for an MRI. They wanted to make sure it was only one tumor and they wanted to get a clearer picture of its size and shape. I was taken into a room and a nurse told me she was going to give me an IV so they could inject dye into my system for the procedure. I had to sign a consent form that advised me of all the 834 possible side effects of the dye, including death. I could die from dye? That seemed ridiculous. At the bottom of the form, it said that despite all these side effects, they believed the benefits from the procedure outweighed the risks. Easy for them to say. But I signed the form. The nurse came at me with a needle and I told her I wasn't going to watch. She laughed and said that was okay, she would watch. I smiled and told her that was a good way to do things.

The MRI wasn't as bad as I thought it would be. I think that was because instead of being on my back, they had me face down on the table. My head rested on an opening, much like you'd find in a massage table, and my boobs dangled out of two holes. I couldn't even tell I was in a small claustrophobic area. The machine was incredibly loud, even with the ear plugs they gave me. The radiologist spoke to me throughout the 45 minute procedure, letting me know when one series of images was finished and when the next one was beginning. Halfway through they injected the dye and a cold, awful feeling washed over my arm. Before I could panic too much, I pictured diving into a cool, refreshing pool and after 30 seconds or so the cold feeling went away.

On May 7, two days before my 34th birthday, my surgeon phoned to let me know I was booked for surgery on May 14. If you're keeping track of all these dates, that's 1 month and 1 week after my initial doctor's visit. I've heard horror stories of the Canadian medical system - of people waiting months for diagnoses and years for surgery dates. For me, things were moving so quickly I didn't even have time to think.

I did, however, have time to do some reading. I learned more about lumpectomies and mastectomies and was satisfied with my decision. I also learned more about axillary dissections and sentinel node biopsies and began to doubt my decision to have the former. I advised my surgeon that I had changed my mind and he said that unfortunately, I wouldn't be able to get in for the radioactive fluid injections the morning of my surgery. I either had to stick with my original decision and have all my lymph nodes removed or receive a later surgery date and have the new operation. I decided to wait and was given another surgery date of May 21. One month and 2 weeks after my initial doctor's visit.

That weekend I had a birthday bash where I got as hammered as I could with 30 of my closest friends and family members.

At 9:00 on the morning of my surgery, my mom picked me up and we walked over to the hospital. My first stop was the oh-so-scary-sounding Nuclear Medicine. A lovely nurse applied numbing cream to my nipple and surrounding area and answered my silly questions with a laugh. After the injection, will I glow in the dark? (No.) Will I be worth more radioactive? (No.) If I get bit by a spider, will I turn into Spider Woman? (Not that she knows of, but I should call her and let her know if it happens.) Then a doctor came and poked me with 4 needles right around my nipple. It was insanely painful - not the actual needle, but rather the fluid. It burned and stung for 10 minutes after the injections. After that I went for photos which I thought would be quick, but ended up taking about an hour. Two of the photos lasted 20 minutes each and 4 lasted 5 minutes each. Like the MRI, I had to be completely still.

After the photos were finished, my mom and I were whisked off to pre-surgery. The nurses there were wonderful and funny and gentle with me. They inserted the IV and talked me through what was going to happen. They asked me questions and then asked me the same questions again. They checked my blood pressure and oxygen levels and offered me warmed blankets and slippers for my feet. I asked them to please let the anaesthesiologist know that I didn't want to be inadvertently turned into a vegetable. They laughed and told me they try to avoid that - too much paperwork.

Then, all too soon, it was time to go to the operating room. My mom hugged me. She told me she was going to get some lunch and she'd see me before I knew it. I was wheeled into a small room with bright lights. I told the person transporting me that it didn't look anything like it does on ER and he laughed. The anaesthesiologist came over and introduced herself. She said they were going to administer the anaesthetic through the IV and that I would feel a little like I was drunk. Not 3 seconds after she said that I felt like I had just done 12 tequila shots and then there was nothing. No counting backwards, no slow descent into sleep, not even darkness. Just nothing.

And then? Garfield! That was the first thing I saw when I came to again. The hospital has ceiling tiles painted with various pictures throughout the corridors and rooms and the tile above my bed was Garfield snuggling Pooky. A nurse welcomed me back to the world of the conscious and told me to rest. That wasn't a problem, since I seemed to be able to fall asleep while blinking. There was more taking of my blood pressure and oxygen levels. There was morphine. Then I was wheeled back to the pre-surgery area and my mom was at my side. She asked how I was and I told her I was fine. I asked her how lunch was and she laughed. For me, she went to get lunch half an hour earlier but for her it was more like 3 hours.

By 9:00 that night I had met the three requirements to be sent home: I had walked, I had peed, and I had kept food down. I was officially discharged and Mom took me to her place. She and my step dad had set up the guest room so that I could stay there as long as I needed. I staggered into the house and immediately went to bed. Over the next 4 or 5 days, I did a lot of sleeping. I also received dozens of phone calls, flowers, and visitors.

I've had doubts in my past whether people really like me or if they merely put up with me, but cancer has silenced those doubts. I feel so incredibly loved that I get tears in my eyes if I think about it for too long.

This week I found out that the tumor was 2.5 cm and the margins (ie, the extra tissue the surgeon removed surrounding the tumor) are clear of cancer cells. This means that the we can feel optimistic that my surgeon got it all. Also, I found out that the sentinel lymph node is clear as well. This means that the cancer hadn't yet spread and that I don't need any more operations! That would put my cancer at stage IIA. It's not stage I, but I'll take it.

I have one more week of recovering to do and then I'll be back to least until Step 2: the dreaded chemotherapy.

Cancer is more common than I ever imagined. Everyone I talk to knows someone who died from it or who is going through treatment or who is in remission. It's so prevalent that it's almost blasé. Yet my life was changed so completely by my diagnosis that I almost expected my news to be the headline in the local paper. But no, life goes on bit by bit.

One of the first things I did when I emerged out of my post-surgery grogginess was go for walk and take some photos. My mom lives two houses down from a creek that runs through the city and I walked along the bank on a beautiful spring day. During that walk I realized that I had been wrong - not knowing isn't better than knowing. Not knowing only has one end, and at least now I have a chance to delay that ending.


  1. Whew! That brought tears to my eyes. As I mentioned before, I've known a lot of people with cancer, but none were really able to communicate what they were going through quite as clearly as you have. Thank you for sharing, and thank you for keeping your sense of humor (or as you Canadians insist on spelling it, "humour"). The fact that you've been able to make people laugh throughout this process, and laugh yourself, will help you recover as much as the surgery and the chemo. My thoughts are with you.

  2. This is so beautifully written, Nat. I am so proud of you and your attitude in going through this. You inspire me and I love you so much. I don't even have the words to tell you how this post made me fee. I just know that I'm incredibly honoured and fortunate to call you my dear friend.

  3. You've done such a good job of explaining all you've been through in this post - it would, no doubt, be tremendously helpful to someone making a decision or researching.

    I hope you're doing well...

  4. You're one gutsy broad all right!!


  5. Oh, Nat! I had no idea you were going through all this or I would have been over here sooner to encourage you and give you a shoulder to lean on! As you may or may not know, I'm a breast cancer/mastectomy/chemo/radiation survivor myself. I am over here in Massachusetts cheering you on one hundred percent! And I can tell you that the chemo is not as bad as you think it will be. Losing hair sucks but you will get it back (if that is the type of chemo you will have). Anyway, let's keep in touch via email and stuff. I'm always here if you need me or want to ask anything!

  6. Thanks all for your kind words. My online friends are just as awesome as my in-the-flesh friends.

  7. That was so wonderfully written and love your strong attitude.

  8. You are being featured on Five Star Friday!

  9. I am so behind on my blog reading, my heart nearly stopped when I started reading this entry. I am so glad you're out of the woods and you're so brave and surrounded by people who love you.

    Thinking of you and rooting for you and your Rightie over here in DC.


  10. Wow, that was amazing. Thank-you so much for sharing and i am hopeful that now, more than a month later, things are still going well.

  11. I came here via blackbird -
    I hope you are well -
    I thought your piece was well written and insightful.

  12. I followed you home from May-B's blog. That was a wonderful article. Excellent writing. do more!! How is the chemo going? You obvioulsy have many people cheering for you. Now you have one more.

  13. Again, thanks everyone. Your comments truly mean a lot to me. I'm doing well - just waiting to start further treatment. They say waiting is tough but I don't mind - I imagine it's easier that chemo!