Drama Act Two

Instead of going to the radiologist for the biopsy, I was referred to a breast surgeon... who had cared for both of my regular doctors (internist, gynecologist) who had both had breast cancer, believe it or not. So, he was a doctor's doctor. As he was preparing to do the biopsy, he kept trying to hide the biopsy device from view, which I didn't really sense at the time, and I kept trying to see it. He finally asks "What the heck do you wanna see this thing for??" and I was all, oh, I wasn't really trying, but I guess I was. They fire this nuclear needle device several inches into your flesh followed by immediate injection of painkiller locally. He had to do it twice. I cut off all circulation in the assistant's hand which was offered in kindness. All those people, from the receptionist, to the office manager, to the tech, are such sweet, kind people. The doc basically told me it was cancer from the ultrasounds alone, and that I needed a lot of tests done on the biopsy and on the rest of me.

Then began a whirlwind of MRIs, PET scans, CT scans, blood draws, and another visit to my internist to reassure the surgeon that I and my apparently "needs checking" body would be cleared for surgery. Now I graduated from medical school 23 years ago, and I have done nothing but newborns for the past 20 years. Breast cancer treatment 20 years ago was not only dim in my memory, but completely outdated, with only a bit of an update years ago when my mom was treated. I am COMPLETELY CLUELESS as to what constitutes staging, the need for different modalities of treatment, surgery, etc. I really felt like a real patient! It's hard! This really hit me when the surgeon emailed me the afternoon that I had the PET and CT scan done, and told me that there was no evidence of metastases (spread to other sites) which is a life and death distinction. I read the email, and proverbially, literally, "burst" into tears and sobbed into my hands for half an hour. I guess I was just doing a really good job of denying the possibility to myself up to that point. Exhausting to cry like that. I had to take a nap right away.

My next step was to meet with the surgeon after all tests were reviewed and presented at the weekly management conference with all specialists present. That was a long wait... and my surgeon, being the type of guy he is, said he would stay late the day of the conference to see me at 6:30.. this guy works so hard.... his patients are always in crisis. I appreciated this gesture so much. I am really learning how to be a better doctor. Communication is sooo important and I can always strive to become better at it.

So, Annie the Bellissima came with me and heard the news.....the tumor (yes TUMOR) was estrogen and progresterone receptor positive (GOOD)--opens up the treatment arena to drugs the utilize this receptor, and HERprotein negative (GOOD). Of course I had no idea what all these meant, I have since educated myself. The biopsied node was also positive (BAD). I would need a full mastectomy, axillary node dissection (the kind that leaves you with a puffy affected arm) and chemo, and radiation, and recontruction after that. Estimated time... 8 months (before reconstruction). And....he thought I should stay OUT of NICUs--too many horrible, resistant bugs. He kind of whined....do you HAVTA work?......really do you HAVTA? I got the message.

Yikes. I had a lot of 'splainin' to do to a lot of peeps on my schedule. I don't like backing out of scheduled work. Oy-as they said at Sinai. More to follow.