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Monday, April 27, 2015

Cancer: Diagnosis Part I

 I deliberated long and hard about posting this entry.   Not everyone shares my sardonic sense of humor.   (In fact, have you noticed, some people have no sense of humor at all.)  I do not want to upset or offend anyone.  I was hesitant, even with this disclaimer.  However, a friend of mine with a similar experience urged me to go through with it, so here we go.

I became apprehensive when they completed my follow-up mammogram  by walking me down the hall for one with ultrasound.  The ultrasound exam room had a lot more fancy equipment, but the exam table was the same.  I lay down on it and turned on my right side so the technician could view my left.  Her wand looked a rather like a grocery store scanner, and I asked her to turn the screen so I could see the image.   As she scanned my breast, even I could discern the distinct mass on the image.  I wanted to schedule surgery right then; if there was any kind of lump in me, I wanted it out.  The technician reasonably told me that they had to learn more before digging around. 

Two days later I was back at the hospital, a capable nurse explaining how, once my breast was numb, the guide wire would be inserted and the biopsy tool would follow, making a loud click-clack each time she took a sample.  Three truly loud clickety-clacks followed, with me craning my neck to watch the screen.  I know, I know, not everyone wants to see their medical tests being performed, but I like to KNOW!

When they called me with the results, I walked around in shock.  “I have a lump in my breast, and it’s cancerous.  I have a lump in my breast, and it’s cancerous.”  After 24 hours the news sunk in with a thud:  “Holy $*#%!   I have breast cancer!”

I had a Stage 1, non-aggressive, invasive ductal carcinoma.  In person-speak, this means the cancer began in a milk duct and then seeped out.  The lump was small and slow-growing (relatively speaking.  I learned that a on average, a breast tumor doubles every 100 days!).   This was good news as far as bad news goes. 

The speed with which medical things happen is in direct correlation with the severity of the illness.  It took me less 24 hours to get an appointment with the breast surgeon. (And just a brief note of appreciation here:  the nurse at my primary care office called me back within an hour with a recommendation that matched one from the hospital, and my physician called me that evening just to talk!)   

My breast surgeon is fantastic.  She is both skilled and nice.  I would much rather go out for cocktails with her than bare my breast, so to speak.   Her first step to removing all doubts about my diagnosis was to send me for a breast MRI.

The breast MRI is a unique and bizarre test.  I mean, I’ve had MRIs before.  I am not claustrophobic.  I crawl inside that tube with complete serenity.  I get so comfortable, in fact, that the MRI drum beat puts me to sleep.  But a breast MRI?  Oh, so different.

First of all, as I found out when I arrived at the hospital, this was an MRI “with contrast.”  I discovered that “with contrast” means they inject dye into a vein so that the MRI can be taken while the die infuses and defuses.  This might not matter for you, but my appointment was first thing in the morning, and had I known, I would have drunk two glasses of water when I got up.  When I’m dehydrated, my veins collapse like deflated balloons.  It took two technicians and four tries to get the line inserted.  And, yes, I watched every try.   It didn’t hurt much, but it was damn frustrating.

You walk into the MRI room with your IV lines dangling and arrange yourself on the platform which is slightly tilted head down.  You can’t lie on your back because then your breasts will pancake.  To get clear images, you have to lay face-down with a headrest rather like that on a massage table.  Unlike a massage table, however, there are two square openings in the platform at chest level.  “Square,” the nurse affirms, “must have been designed by a man.”  The square holes are HUGE:  designed by a man for sure.  You fit yourself into the holes, and the technician gently tugs your breast through and positions them for an optimum portrait. 

There you lie, your round pegs dangling through the square holes.  The platform slides into the MRI tube.  You feel like the star of some weird porn movie.  The machine clicks and ratchets and pounds. Your sternum hurts because it is taking all your weight between the square holes; your forehead hurts because your head is heavy.  Between rounds, you try to subtly adjust yourself, but the nurse cautions you to hold still.  This is a half hour when people pray or meditate or visualize or, you know, write blog posts in their heads. 


The test was to confirm that the cancer had not spread.   My surgeon warned me that a lot of little things show up when they do an MRI, things that are not important and they are not looking for.  She warned me not to freak out when such images were reported.   The results were due back in two days.
Waiting is the worst; at least, you hope it is the worst.  

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