Here Come the Surprises
Part Two of Four: When I discovered a lump in my breast, it was in an area already diagnosed as having thickened, which wasn’t a big deal. Even so, I got right in to have it checked by my gynecologist. She thought it was a cyst, but sent me to the Breast Care Center in Monterey for a mammogram and ultrasound to make sure. If it was a cyst, they would drain it with a needle. Yikes.
My husband Steph wanted to go with me for the appointment. That was sweet, but I was sure it would be fine. Even so, he charged my cell phone and reminded me to take it. “Call me as soon as you get out,” he instructed.
Carlita Miraco was my technician. We hit it off and laughed and told stories throughout the mammogram. By the time we went into the ultrasound room, I knew she was recently divorced, grew up in Monterey and has a dad who can’t imagine why she wouldn’t want to stay here forever. She knew Steph and I have been married ten years, that he is my hero and that we have the relationship most would covet and few find.
“There is always hope,” I told her. “It might take a while, but you can find your true match.”
This was far more encouraging than what Carlita told me as she studied the ultrasound screen. A large, uneven, black mass was clearly evident.
“This is NOT a cyst,” she declared. For one full second that lasted an eternity, I felt myself slip down, down, down into an ever narrowing space as though I was in a funnel. Then I crawled back up to the edge and hopped out. Already, I was okay and moving on.
“What is it?” I asked. She said Dr. Roux would have to tell me that and went to get her. Susan Roux bustled in cheerfully and said, “Looks like you got a little bit of it!” as though I’d just won a small lottery. She moved the wand around, marked the dark image and measured it.
“Half an inch!” she declared. “Great. It’s small, you caught it early; this is the easiest of all of the positive diagnosis’ I make here.”
“What about how a certain percentage of these things are benign?” I asked, fishing for an escape clause.
Dr. Roux turned to me and said, “There is a tiny chance I’m wrong, but I know I’m not. You’ve got breast cancer and we’re going to take care of it. You are going to die of old age!”
I could have a needle biopsy to confirm the diagnosis then, or later. Of course, I chose then. Dr. Roux would do the biopsy and Carlita would assist. As my breast was numbed and the biopsy cores were taken, the three of us engaged in a lively and happy conversation about any number of things─whales, men, working at the Breast Care Center, skiing, being a woman captain. The only pain I felt was from one of the numbing shots, possibly because the tumor was on a nerve. But I laughed throughout the procedure, so it couldn’t have been that bad.
The first person I saw as I left the ultrasound room was Lynette, a neat woman I’d met at a dinner party our neighbor, Neil, had recently thrown. Neil is a radiology oncologist. I knew Lynette had worked with him at Community Hospital of the Monterey Peninsula (CHOMP) and that she had transferred to another department, but not which one. I could tell by her expression she’d heard my news.
“I’ve got a great prognosis,” I reassured her. “Plus, Carlita and Dr. Roux were wonderful!”
Once in my car, I had to call Steph. I wanted to tell him in person, but he’d worry if I didn’t call soon; I’d been in there a couple of hours. I steeled myself.
Hi baby,” I said. “It’s not good news. I’ve got breast cancer, but don’t worry. We caught it early and it’s going to be a piece of cake.”
I can’t believe your attitude; are you putting this on for me?” he asked.
Steph,” I replied, “if you’d spent the last hour with the two women I was with, you’d understand. It really is going to be okay.”
That night, Steph and I sat by the fire, speaking little. Cancer.
“I just can’t say that word in relation to you,” he said softly as tears slid down his cheek. I ached for him, but I didn’t cry. Maybe I would later.
Next week Part Three: Imagining Surgery; My Worst Nightmare
Part Three of Four: Once I was diagnosed with breast cancer, I called Blue Cross to see what our insurance covered. I was pleased to find that our policy, which covers just about nothing short of a major injury or disease, considers breast cancer major. I chose Dr. Verlenden in Monterey as my surgeon, based on a recommendation by my gynecologist, Virginia Hansen. My husband Steph was actively involved from the start. He and I both went into the exam room, but he got to keep his clothes on.
Dr. V., as he calls himself, asked if I knew the diagnosis of the needle biopsy. I did. I had a low grade, non-aggressive tumor at 10 o’clock in my right breast. It’s ironic they locate the tumor in this manner; we call out the location of whale sightings around our boat the same way. The doctor took the time to carefully describe the didease and options to deal with it. He answered all of our questions and we left feeling we’d chosen a winner. This impression has only grown.
Surgery for a lumpectomy would be done at CHOMP on an out-patient basis. The day of surgery, I’d go back to the Breast Care Center where Dr. Roux, who did the needle biopsy, would mark the tumor using fine wires. This isn’t how all facilities handle it.
My friend Laurie lives near the Sierra. She went through treatment for breast cancer there late last year. Before surgery, she was put in a room with a felt pen and told to circle the lump. Really!
“That’s because they knew you didn’t have insurance,” I explained to her. “But they must have known you have money in savings. Otherwise, they’d have had you circle the lump, then handed you a bag with ‘DIYBSK’ on it. You know, Do It Yourself Breast Surgery Kit. Inside, there would be a knife and a Band-Aid.” Steph reveled in the laughter my conversations with Laurie resulted in.
Because Dr. Roux would be gone for a week, I had the option of having someone else mark the tumor, or waiting for her. I was inclined to wait because I really like her. I asked Dr. V. what he would do. “Susan Roux is tops in her field,” he said, “Wait.”
Steph joined me for the “needle loc” and was able to see why my diagnosis hadn’t been the nightmare one might expect. Dr. Roux and Carlita Miraco, the radiology technician, were like old friends. Dr. Roux numbed the breast before inserting the thin, flexible wires. As with the needle biopsy, the only pain I felt was from one shot, perhaps because the tumor was on a nerve.
Dr. Roux inserted the needles, using ultrasound to place them. I told her our neighbor Neil Glover, who is a radiation oncologist, would handle my radiation treatments.
“I can’t believe I’m going to be baring my breast to a Republican!” I wailed in mock misery. “But Neil is a friend, he has a great reputation and if this doesn’t work out, I know where to find him.”
At CHOMP, I was prepared for surgery. The nurses were warm and friendly. A doc from nuclear medicine injected radioactive material into the breast. Dr. V. would use a Geiger Counter to locate the Sentinel Node, the first lymph node in the chain of command from the breast. It would automatically be removed and tested for spread of the disease.
Years ago, they removed as many lymph nodes as possible, but that added to the pain and discomfort. Now, they know they can be more selective. Again, one of the shots was painful.
”No wonder,” the doctor kindly remarked. “I’m putting needles where they never were meant to be!” My sentiments exactly.
Steph waited with me until I was wheeled away. I went straight into the operating room; Laurie had lain in a cold hall for two hours.
When I awoke, I felt so relieved. My recovery room nurse greeted me cheerfully and I was out of there in fifteen minutes. I’d have six weeks of radiation treatments after healing, but my sole concerns were whether the Sentinel Node was clear, if margins around the removed tumor were wide enough and whether the tumor was hormone receptive. All would become clear from the pathology reports in a few days.
I Never Expected This/What I’ve Learned
In less than one month, I found a lump in my breast, it was diagnosed as breast cancer and I had it removed. My husband Steph and I were dazzled by the doctors, nurses and technicians on my case. They made a tough time so much easier for us both.
Five days after surgery, we met with my surgeon, Dr. Verlenden. The Sentinel Node had been removed and it was clear; no cancer had spread to it. Margins around the tumor were 10 mm everywhere but in one place; there, it was only 1mm. I’d just been through breast surgery, my worst nightmare, and I knew my smartest move would be to go back into surgery to widen the margin. Dr. V. agreed and said it would be fast; I could even skip the general anesthetic.
Surgery was scheduled for the next week. Steph would take me again, but I wanted it over as soon as possible. CHOMP and Dr. V. worked to fit me in even earlier and a week after the first operation, I was back at the hospital. We had a big cruise that day, so I insisted Steph work. Our great friend, Ardie Kelly, handled transportation. She’d been a busy woman, also delivering books and home-cooked meals after the first surgery.
Claudia Conner was my pre-op nurse. We had a delightful conversation as she prepped me for surgery. In the operating room, Dr. Tackas introduced himself as my anesthesiologist. I explained numbing shots in one area had been painful and he suggested he give me something to calm me, then put me out for just that short time during the shots. Good man!
Next thing I knew, Dr. V. was working away. Bleck! To keep my mind off what he was doing, I told stories from the book I’m writing. Everyone on the O.R. team said they want a copy, which is one hell of a way to sell books. We laughed throughout the operation and by the time I was rolled into Recovery, Dr. Tackas was checking details for whale watching. Talk about multitasking; book and whale watching promotion while in surgery.
I was out of recovery in minutes. Ardie delivered me to Moss Landing where I met up with Steph and Biscuit for a beach walk. It was good therapy.
Although the oncologist comes into the picture after surgery, this doctor heads the team for the duration. Dr. V. referred me to Dr. Hausdorff, a friendly and thoughtful oncologist in Monterey who is so beloved by his staff, several told me, “You’re really lucky you chose him.”
Pathology reports confirmed the tumor was hormone receptive (HR positive), which Dr. Hausdorff explained is good. This is because we now have the drug Tamoxifen, which blocks the estrogen receptor in HR positive breast tumors. It’s considered the gold standard for reducing the risk of reoccurrence of early stage breast cancer and increasing patients’ survival rates. I will take it for years.
What have I learned on this journey so far? Apparently my annual donations to The American Cancer Society and the Susan G. Komen Breast Cancer Foundation weren’t enough to keep me safe, but I will continue to support both. So much progress has been made lately in this fight for a cure.
A woman’s risk for breast cancer increases with age. Early detection is the best protection from the big 3: chemotherapy, mastectomy and death. Breast self exams are crucial, as are mammograms. If there is any doubt from a questionable mammogram, consider an ultrasound or needle biopsy.
A huge finding for me was that we have great people out there to help us navigate breast cancer. My experience has been with Monterey doctors and CHOMP and it has been very, very good. Wherever you turn, ask questions and don’t compromise.
If someone you know is fighting breast cancer, ask what you can do to help, but be prepared to hear, “Nothing, thanks.” I believe providing a caring ear, some flowers from your garden and a meal dropped off with minimal fuss could elevate you to Godlike status, but let’s not forget humor. It helps clear the mind and ease the soul.
I chose to keep quiet with all but a few folks at first, because I didn’t want to waste energy consoling the consolers. Also, I have Steph. I wish everyone could have such a valiant partner in this fight. If you don’t, reach out to a support group (see sidebar); you’ll find gentle, caring people.
I decided to write this series─which is similar to taking one’s clothes off and walking down Main Street─because it might help someone else; I hope it does. See you out there.
Sidebar:
Breast Cancer Resources:
Explore these links to learn more about local and national resources to fight breast cancer:
Community Hospital of the Monterey Peninsula has helpful information for newly diagnosed breast cancer patients and their loved ones, including a weekly support group. www.chomp.org/class_events/pages/cancer.html#01
The Susan G. Komen Breast Cancer Foundation has a single mission: to end breast cancer. They offer a wide range of information both online and in their newsletter. www.komen.org
The American Cancer Society’s web site covers all cancers, with extensive breast cancer resources. www.americancancersociety.org
