Cancer vs. The Optimist

Since the day I found out, I have been drawn to write. Driven to write. But I haven’t really found the time. Amazingly, life marches on even after you find out you have breast cancer. This is both devastating and comforting.

Instead of reflecting on and recording my experience with the beast, I have been the busy mom I always am. I sat through several of the reds’ rehearsals (the reds are my youngest two children, a red-headed son and daughter, who have roles in our local theater company’s production of The Sound of Music), attended a Young Women’s Presidency meeting, went out to lunch with three girlfriends and was glad to find there are many other subjects to discuss besides cancer. I volunteered in Sophie’s kindergarten classroom, wrote my article for the Enterprise Record, edited a few Terillion blogs, had a meeting with the principal about possibly helping out with some interventions for struggling students, and played a mean game of broom hockey with the ward. Today is Saturday. I found out on Tuesday.

I did miss Mutual on Wednesday night because my dear friend offered to take over for me. It meant I didn’t have to put on make-up and a happy face. What I did instead was go over to my sister’s house and try on six garbage bags worth of clothes that our other sister has recently gotten rid of. I ended up taking about a garbage bag worth, and it feels great to have a (sort of) new wardrobe. Ironically, many of the items were things she got rid of because they emphasize, rather than minimize, her large breasts. I passed on them as well, because I too have large breasts. Maybe I should’ve put them aside for when I don’t.

I said I found out on Tuesday. That’s actually not correct. It was told to me on Tuesday. The mind is an amazing thing. Mine did not let me hear what was told to me. I misunderstood. I just wasn’t prepared to accept it. I’m such an optimist. I so easily suspend judgement until further information is available. Once it began to sink in on Wednesday, I thought the sonographer and radiologist had communicated poorly. I was prepared to give them some feedback on how better to approach such a telling. Thursday I fully understood because I got my hands on the actual reports. Friday I pieced it all together and realized they told me everything pretty clearly on Tuesday. It just took my ever optimistic brain this long to get it.


Sometime in the Fall I was lying in bed talking with my husband. Casually, while speaking of other things, I did a self exam on my breasts. I felt a thick spot in the right. It felt like a swollen duct---like it feels when you have a clogged milk duct when you’re nursing. But it was deep, and not painful. I mentioned it to my husband, let him try to feel it, but he couldn’t really. I noted it and thought I’d check it again at a different point in my cycle to see if it changed. I didn’t give it much more thought than that.

I checked it again some time later. Because I didn’t know it mattered, I really don’t remember how much time passed. It was different. More squishy maybe. Not as noticeable. I wrote it off.

Again, time passed. I checked myself in the shower one day. There it was. Same spot. Noticeable again, perhaps more so than the first time. Sometime around then I told my sister I had a lump in my breast. She told me I should get it checked out. “With what money?” was my answer.

My husband and I have three part time jobs between us. They all pay quite well, as far as part-time jobs go. But as you may imagine, none of them comes with medical benefits. We’re really not doctor people anyway. We’re at the doc in the box to get antibiotics maybe once a year between the five of us. Three years ago my daughter broke her arm, last Thanksgiving that same daughter got a rash that needed treatment, and of course, I’ve birthed three children. And that’s about it for us as far as contact with the medical world is concerned.

Our income is too high to qualify us for standard medicaid. At one point we did qualify for it with a share of cost: roughly $1700 per family member, per month. And because we qualified for this share of cost, we didn’t qualify for Healthy Families. But our income is not the same each month. Because my husband is associate faculty at a college, he only gets paid when classes are in session. A sympathetic case worker took advantage of that loophole and qualified us during a low income month so that our children, through one in the labyrinth of programs out there, could have basic dental and other preventive care available to them for one calendar year. The trade off is that we adults qualified only for that one month, and now do not qualify even for the share of cost benefit.

As a credentialed yet sporadically employed teacher, I have had access to medical benefits on and off through the years. It’s always my assumption that it will again be available at some point. If there are medical issues to be dealt with, I tend to “save them up” until such time as we have coverage. But this period of time when 40 is getting further and further behind my husband and me, more things than usual are cropping up. Nothing too serious. Aches. Pains. More difficulty maintaining healthy weight. Oh. And a lump in my breast.

I let money stand in the way of a mammogram. Frankly, fear played a role as well. I mentioned I have large breasts. I don’t know if all large breasts are also very sensitive breasts, but mine are. I have dreaded the idea of a mammogram ever since I learned what one was. I resolved to put it off for as long as possible. Having no medical insurance and no regular doctor when I turned 40 made that very easy to do.

Until one day as I undressed, my undershirt stuck to my right nipple. I pulled it away to find blood there. I must not have dried off well enough after my shower, I thought. Moisture must have adhered my breast to my garment, and the bleeding was due to the quick pulling away of the fabric. Again, I ignored it.

Then one morning, I woke up to find my undershirt stained in about a dozen different spots with blood.

As I had shifted in the night, I had bled onto the garment in a variety of places. The lump was still there, and I was bleeding. Some days there was also pus. I knew I had to go in. Surely I’m not the only uninsured woman to ever find a lump, I thought. What do people do? So I called the American Cancer Society to ask that very question. I called them not because I thought I had cancer, but because I figured they would know how to hook me up with a mammogram.

They sent paperwork in the mail. They gave me a list of three providers in my area who could perform a breast exam and refer me for a mammogram. One had the words “Feminist Health” in the title. I ruled it out. Not because I’m anti feminist, but because it seemed so agendized. Why go to a place whose very title announces a negative attitude toward men and traditional values? Some reading this may argue that feminism is not anti man or anti traditional values. It may not be. But everyone knows there are many stripes of feminism (I am certainly a stripe myself), and that the word is charged. By choosing to put Feminist Health in their name, they are targeting a specific clientele. I didn’t choose that one.

The next option was Planned Parenthood. I’ve never been to a Planned Parenthood, and I can’t be sure the awful anecdotes I’ve heard about them are true. But it’s plain they are heavily associated with abortion (despite whatever other good they may do), and I am decidedly not pro-abortion. I think even those who are fiercely pro-choice would agree that abortion is just plain icky. I couldn’t go there. That left me with the County Public Health Center.

When I got there, I realized I had left my paperwork at home---that carefully gathered and snail-mailed paperwork from the American Cancer Society with a heading that read “Every Woman Counts.” I asked the receptionist if I should go home and get it. She asked me a few questions and decided The Family Pact was a better plan for me, and sent me to the waiting room to fill out the paperwork for that.

These are the pamphlets that surrounded me in the waiting room.

(Was this UTI lady actually experiencing burning with urination AS the photo was snapped?!)

Once my paperwork was finished, I sent my sister the following text message:
   

I’m at the stupid health center

            for this stupid appointment.
            I had to fill out all these forms

asking me about anal sex, street

drugs, abortions, whether I’ve

had multiple partners since my

last visit, and if I “feel safe” in my

current relationship. And how’s

this for a weird one...Do I have

sole control over my identification

documents? What?? I guess

philosophically I’m glad these

places exist for those who need

them, but I HATE being one of them.

   
My appointment was with Sandee, a PA who (at the risk of sounding extremely snobbish) I am happy to report treated me with dignity inconsistent with the signage and paperwork I encountered in the waiting room. When she examined my right breast, she said she found nothing unusual. I guided her hand to the lump. When I did, she palpated it for quite some time and while she did, she spoke. “No, this doesn’t alarm me. The worrisome lumps are usually fixed either to the bone or to the skin. This one feels free floating. Then she palpated some more, her brow furrowed up a bit and she said, “Then again, I can feel the edges of it.” She palpated more. “Hmm. They’re pretty jagged.” She got out her measuring tape and took some measurements on the surface of my breast. “You’ll definitely want to have this checked out.”

Once I was dressed again, she told me Every Woman Counts was indeed the better plan for me, as it covered special diagnostics, not just routine screenings. We also discussed birth control, as I thought I might be in the market for a new method. Lastly, I filled out the EWC paperwork (the same paperwork I had left at home) and turned it in. The receptionist clacked at her computer for a time, the printer hummed, and I was given an 8 1/2 by 11 sheet of white printer paper with a no color insurance card printed on it for Every Woman Counts. “You’ll have to take that to all your future appointments,” she said.

“All your future appointments.” I skimmed past that, didn’t even hear it. But now I know what it meant: mammograms, ultrasounds, MRIs, lumpectomies, chemo treatments, mastectomies, radiation, oncology, reconstruction. Maybe I shouldn’t have folded it up tiny enough to fit in my wristlet. And boy am I grateful for that cheap, makeshift, creased piece of paper.

The other thing I left with was a copy of the order for mammography. It reads, “Mobile lump detected at 8:00 position on right breast.”

Out in my van, I called the local imaging center and made an appointment for January 8th, which was 20 days away. Life went on. Christmas and the New Year happened. The weekend before school started again, the children and I drove to Fresno to visit family. The appointment was just two days away and it was on my mind again. My sister who lives in Fresno is an RN and I felt to share with her what was coming up. Together, we did some searching online and we decided I probably had a papiloma---the cyst of the milk duct as I had earlier guessed. I also told my mom, making sure to minimize where possible so as not to worry her.

Dave came with me to the appointment on the 8th. They asked me to fill out a brief form. Is this a routine mammogram? No. If no, check all that apply: I can feel a lump. Check. Bloody discharge from the nipple. Check. Abnormal breast exam. Check. Family history of breast cancer. No check. Three for four! After a short wait, I was called back. Dave was told he couldn’t come with me just then, but would be brought back to me when I was finished with the mammogram.

The standard mammogram was not actually painful. It wasn’t what I would call comfortable, having a stranger handle my breasts like so much play doh, but the compression wasn’t nearly as intense as I expected. And then they did the special diagnostic imaging of the right breast, and that lived up to my dread in every way. It was crushingly painful.

I was told to turn my hospital smock so the opening was in back, and I was led to a little waiting room. A little frame was displayed on a bureau with a quote that went something like, “From the moment of discovery forward, you are a survivor.” I thought it rather insensitive to display such a quote in rooms where people like me who don’t have breast cancer wait. I definitely did not self identify as a ‘survivor.’ I still don’t, come to think of it.

Dave arrived. He found another curious display. It was a plexiglass brick which contained the tiniest of labeled artifacts. They looked like miniscule metallic pipes in various configurations. We couldn’t for the life of us imagine what they were, or that they had anything to do with us. I was unconcerned enough to pass the time submitting moves in my many Words with Friends games. I also casually texted the following to my girlfriends:

Standard mammogram was fine.

Special pictures of affected area

about killed me. Waiting for

ultrasound now.

Soon we were escorted to the ultrasound room where we met Carine, who was very kind and personable. She told us she’s worked there for 24 years. I removed the right sleeve of my smock, uncovering my right breast, and she propped me up on a foam wedge and asked me to relax my arm on the pillow behind my head. With my left hand, I reached to where the lump was and was alarmed to find it more prominent than ever. That position made it protrude, I guess. She covered my breast in warm gel and began the scan. Immediately a dark figure was visible.

I’m not sure how people in that profession are able to keep the alarm out of their voices and off their faces in cases like mine. Knowing what I know now, she had to recognize this immediately as the beast that it is. 

Yet she conversed with us casually, sometimes about what she was seeing and other times about unrelated things. She told us about her children and we told her about ours. She did say the lump looked solid to her, and was not a cyst. She placed a terry cloth hand towel over my gel-smeared breast, and went to “show the pictures” to the radiologist. I asked her if I should get dressed. She said, “No. He sometimes likes to do additional scans.” Alone again, Dave and I speculated. I thought he was overly concerned. A little while later, Carine came back in saying she had forgotten to scan the left breast. Again, knowing what I know now, I wonder if what she saw alarmed her so much that it made her forget to scan the other breast. Off the smock came, the wedge was switched to the other side, and the warm gel generously applied. There was nothing much to see on the monitor for that breast. She placed a cloth over my left breast, and went out again.

I don’t know how much time went by, and I’m forgetting details about the information Carine gave us, because she really was very informative about terms and trends, but soon she returned with the radiologist, Dr. Brandon. Remember, my assumption was that he might be doing additional scans. I was lying on my back wearing only jeans and two slimy rags over my bare chest.

“You have a mass,” he informed me with some gravity. My mental response was, “No duh. That’s why I came, remember?” Other phrases I remember him saying are “My best guess is that it is a cancer” (note the indefinite article ‘a’), “We won’t know definitively until pathology comes back,” “You’ll want to have it removed either way,” “14 millimeters” and phrases containing the words ‘biopsy,’ ‘stereotactic’ and ‘breast MRI.’ He asked me who my doctor was. I admitted I didn’t really have a regular doctor. Carine piped up with the name of the ordering physician on the mammo referral, a Dr. Lundberg, whom I’d never heard of. He told me the imaging reports would be sent to the ordering physician, so I made a mental note to set up a time to meet Dr. Lundberg. Dr. Bradford mostly conversed with Dave, who had a lot of scientific questions. When it became clear he was going to do no further scans, I really wished I were dressed and sitting in an upright position to participate in this conversation.

At this point my understanding was this: I have a mass. I already knew I had a mass. Biopsy is recommended. Seems logical. The word ‘cancer’ refers to cells that don’t belong, and can be either benign or malignant. We won’t know whether mine is benign or malignant until pathology on the biopsy comes back, and that is in the future, not now. I was optimistic. The one thing I knew more than I did when I came in was that the next step would be a procedure to biopsy the lump. I had every confidence it would come back negative.

Before he left the room, Dr. Brandon said something like, “I’m so sorry to dump this on you all at once like this.” I couldn’t make sense of that statement. Why was he sorry? Nothing was definitive. It was still a 50/50 proposition in my mind.

Carine stayed in the room with us. At the time I thought this was just a sort of ushering through. I didn’t know she was there to comfort and console. I remember there was discussion of the word ‘in situ,’ and she told us the following story.

Early on in her 24 year tenure there, there was a doctor who said to a patient, “If that’s malignant, I’ll eat my hat.” Well, it turned out to be malignant. Carine said ever since then, she never puts 100% stock in a doctor’s pre-pathology findings. In the time I had spent with Carine that day, she had been very conversational, very friendly. I thought, “Cool story, bro.” It was just an anecdote. I didn’t know what she was really saying was that Dr. Brandon was completely sure that my mass was malignant, but that we should reserve just a shred of hope, because a doctor was wrong once before.

I asked her if we could see the mammogram pictures. Once I was dressed, we went into what I can only describe as a ‘control room’ where several large monitors were lined up next to each other with very large x-rayish images of my breasts on them. The ultrasound images were also displayed. 

He pointed out the borders of the mass. I understood it was a concern that they were so irregular. He also pointed out ‘calcifications,’ which looked like little electric confettis in the pictures of the right breast, and said he wanted to biopsy those, too. He said calcifications in and of themselves are not indicators of cancer. They can commonly occur, but they are often present alongside cancer. He said they can be indicators of age. Dave pointed out that it was not likely these calcifications were signs of age, because they did not appear in both breasts. I hadn’t thought of that, and I was a little miffed that Dave pointed it out. It was a dark spot in what had thus far been neutral territory for my mind. I said, “Let’s not get ahead of it. We have to wait for pathology.”

On looking back, I think I remember a look being exchanged between Dave and Dr. Brandon, as if they knew something I didn’t. They did.

On the way to reception, Carine showed us the room with the stereotactic table in it. It is a table with a hole in it. The patient lies on her stomach, with her breast down through the hole. The table is then raised, and the technicians work underneath, like mechanics at a quickie lube. Ha! The imaging that is done using this table is useful both to pinpoint biopsy sample sites, and for subsequent surgery. It maps the breast in a way the computer can make 3D so that everyone knows exactly where everything is.

At the reception desk, we met Whitney, who is young and sweet, and began to make an appointment for the biopsy procedure. She went over some information with us in preparation for the procedure, including the fact that tiny titanium tracers would be left in my breast at the sites where tissue is removed. She produced that same plexiglass brick we had seen in the first waiting area. Then she looked at the appointment calendar and offered 8:00 a.m. on Monday the 21st. I said, “Is that the soonest you have?” She said that it was, and explained that it’s difficult to schedule when both rooms need to be available during the same appointment---the room with the stereotactic table and a nearby room where an ultrasound guided procedure would be done. As she wrote on my chart, my emotions spilled out and I began to cry. I wasn’t crying for sadness or lack of optimism at that point. I still felt very hopeful. I think I was crying because I would have to wait two whole weeks for biopsy. The waiting is the hard part; I already knew that. I can’t imagine that I am the only woman who has ever cried at the reception desk in that building, but somehow it touched Whitney, and she ran off to see if anyone would be willing to work overtime so that we could move this appointment up. I thought, “I should break down in tears more often.” She worked magic somehow, and the appointment is set for January 14th at 1:00 p.m. At a certain point, Whitney comforted/informed us that roughly 90% of biopsies come back benign. This confirmed what I already believed: breast cancer only happens to other people.

Dave and I went to Great Harvest for lunch. I conversed with my sister by text about what I thought were the outcomes of the appointment:

ME:      Cancerous mass. Biopsy scheduled

for Monday to determine whether

malignant. Either way, I’ll have to have

it surgically removed.

HER:   You mean there’s something besides

malignant cancer? There’s cancer

that’s not malignant?

ME:      From what I gathered, yes. Dr used the

word cancer to refer to the mass. In other

words, abnormal or foreign cells. Malignant

refers to the rate of growth and potential

to spread, which can only be determined

by tissue biopsy.

Isn’t it amazing how capable we are of molding information into the shape we want it?! The conversation continued:

HER:    Hmm. How are you?

ME:      Holy sh*t.

HER:    No kidding.

ME:      I’ve decided we can joke about it. They’re

going to leave titanium markers in me

where they do the two biopsies (one at the

site of the mass and one at the site of some

calcifications they found). Finally. Titanium tits!

“The only way to get through life is to laugh your way through it. You either have to laugh or cry. I prefer to laugh. Crying gives me a headache.”
― Marjorie Pay Hinckley

For the rest of Tuesday and into Wednesday, Dave and I analyzed extensively the words of Carine and Dr. Brandon. Dave also did research on the terms we’d learned and the coming procedure. Slowly and by degrees it sunk in that I had breast cancer.

Like, actual breast cancer.

For some reason, those words are like a sonic boom in their poignancy. Breast Cancer only happens to other people. I have no family history of it. I have no risk factors for it. I’ve never been a smoker. Bad things don’t generally happen to me. The ones that do I can handle. But this?

And those two words are also the ones that sit on my shoulder and wait in silence for me to engage in something that makes me forget---a good movie or a fun interaction with the kids, or a conversation with another parent at the school. Then, without warning, they whisper a scream into my ear: BREAST CANCER!


I called the public health clinic to see about meeting Dr. Lundberg, who I assumed would be coordinating my care. I was informed Sandee would see me. Apparently Dr. Lundberg is just the doctor under whose license the clinic operates. So then I assumed Sandee would be coordinating my care. I went to see her on Thursday with a long list of questions. It turned out she could answer very few of them. Her role is only to do with screening, referral and funding. She assumed I would be assigned an oncologist. But she went over the results of the imaging with us, and we got copies of the reports. After reading them, it was clear what Dr. Brandon had actually been saying. The report described the mass as “highly suspicious of malignancy” and recommended biopsy and a breast MRI as next steps. The report also placed the mass in BI-RADS category 5. On the way home from that appointment, I searched on my phone for what the heck BI-RADS category 5 meant. This is what I found:

Greater than 95% malignant. That’s me. I may or may not have cursed heavily.

This is the text I sent to my siblings:

            Imaging report says my mass
            is in category 5. Greater than 95%
            chance of malignancy. In related

news that I can’t decide how I feel

about, the report says my other

breast is “unremarkable.” Dave

begs to differ.

Sandee assumes the Every Woman Counts program will pay for all my treatment. But she also said that, depending on the demand for the funds, the definition of ‘treatment’ may vary. I am grateful--INCREDIBLY GRATEFUL--for every cent the program will pay for, and I recognize it isn’t a program that’s paying. It’s the taxes of all my loved ones and neighbors and friends. I’m grateful it’s there, despite the unclassy delivery system (referring to the crazy pamphlets and questionnaires).

People I have spoken to who know people who have faced breast cancer (isn’t it crazy that I literally am close to no one who’s had it? What are the odds?) say I should be aggressive. Though a lumpectomy will be recommended, I should opt for a mastectomy. Though the mass is only in one breast, I should opt for double mastectomy. Though double mastectomy will remove all traces of the cancer, I should opt for chemo anyway, and so on. I think this will be my biggest challenge: taking the reins. I’m so trusting. I tend to defer to the experts. Someone always knows better. I’m going to have to ask God to help me with that. Fortunately, I have Dave by my side. He asks the right questions. His strength is with the physiology. Mine is with the practicality. Together, we can do this.

Something worth mentioning is the sleeplessness. I have never struggled with insomnia. I usually fall asleep easily, and stay asleep until legitimately awakened. But in the two nights since I really understood this, I have awakened around 4 in the morning with panic in my soul. I can’t get back to sleep. I dream of needles and boob crushing machines and breastlessness. Oh, and death. A lot of death. Fortunately my sweet husband is there to hold me until my crying stops, remind me that thoughts occurring at such ungodly hours are not to be given credence, and reassure me that together we can beat this.

I want to say that I’m not asking “Why me?” because why not? I realize that I have grown comfortable with my few trials. Perhaps this new one is necessary to bring on needed blessings. Already it has brought my husband and me closer together. I hope there will be other perks as well. As someone who has put considerable stock in her breasts throughout her life, I have experienced considerable disappointment as they have, shall we say, fallen from glory. Perhaps one of the least of my blessings will be a fresh set, created to my specifications. I am sure that the greater blessing will be seeing God’s hand in my life. I already recognize that I have a truly magnificent support system. I am now blessed. And I hope for a continuation and increase in blessings in the difficult period to come.

Things we can laugh about (feel free to add to this list):

• Titanium ta-tas.
• How wrong the doctor is in his assessment of my left breast as “unremarkable.”
• My mother says when I lose my hair she’ll shave her head in sympathy. This is funny because she has shaved her head regularly and worn a wig for most of my life.
• I said I’ll need to borrow some of her wigs. This is funny because my normal hairstyle/color and the style/color of her wigs could not be more dramatically at variance.
• My niece says I can never more quote Arnold Schwarzenegar in Kindergarten Cop and say, “It’s not a tumah.”
• Of the Bravermans to emulate (awesome family on the show Parenthood), it’s better to choose Cristina than Drew’s pregnant girlfriend.
• If I opt for a single mastectomy, I can use the term ‘uniboob’ and mean it.
• If I opt for a double mastectomy, I will finally be able to slide belly first down a snowy hill like I've always wanted to -- okay that one’s a stretch.
• Sandee never mentioned breast cancer as a possible birth control method, yet it seems to be very effective. Breast cancer does NOT make me feel sexy.
• I’ll get to know what it feels like to be a car at a quickie lube.
• We should learn from toddlers and cry to get what we want.
• Good excuse not to fast the first Sunday of every month!