Shock & Awe

The word ‘biopsy’ is not a happy one. When it enters your personal space, it immediately brings to mind the word ‘cancer,’ which is an even more unpleasant word. A biopsy, however, is at least a spin-able concept. Technically, it’s a diagnostic tool, like getting an injection in reverse, a means by which a piece of your tissue can be sent to a pathologist for analysis. So, you can spin the whole idea in a positive way, focusing on the fact that it’s a process, not a conclusion. It’s a means to an end, and you are being a conscientious patient by getting one, and most of the time, it will merely confirm that you are just fine. On the other hand, it might not. And when it doesn’t, it means you have some kind of cancer. And that is not a spin-able concept.

I must admit, I wasn’t horribly nervous a year ago when I first met the woman who would end up saving my life. I felt that I was simply being a conscientious, sensible, pro-active, savvy consumer of health care by seeing an expert for this biopsy, so that, just in case there was a problem, she could take care of that, too. You know, one-stop shopping. But of course, there wasn’t going to be a problem.

Dr. Doreen is first off an ob/gyn who logically enough got involved with breast health and breast surgery. She came highly recommended by friends as a warm, caring physician and a smart, competent one as well. That’s what you want — competence and compassion — when you tiptoe even remotely within the reach of cancer. So, I drove up to the ‘big city’ in my small state to meet her. Now, I know this has nothing to do with anything, but Dr. Doreen happens to be completely adorable. She is fit, petite, and very attractive, with a beautiful smile and a nurturing manner. She looks fabulous in the very chic dresses and bitchin’ high heels she wears during regular office hours. The woman is stylin’, there’s no two ways about it, but she doesn’t overdo it. Call it a chick thing, but I like that in a doctor. It’s so refreshing to be able to have a little conversation about clothes and shoe-shopping before you talk about whether or not you might have cancer.

So, I asked her where she got the terrific dress she was wearing (Anthropologie, natch’), and then we got down to business. She placed the copies of my diagnostic mammogram images on her light board and explained why I was referred for a biopsy. This is when I started to get a sick feeling in my stomach. She used language that attempted to be non-committal, but after all it was my breast whose calcifications we were inspecting, not some photos in a textbook. Pointing to a constellation of tiny white specks that looked like nothing so much as dandruff, she explained why the configuration was suspicious for ductal carcinoma in situ, an early, non-invasive form of breast cancer. “The good thing,” she emphasized, “is that it’s highly curable. There’s no indication that there are any lymph nodes involved, so we can get it all out of you, and you’ll be fine.” And that’s when she offered me her cell phone number.

When I think of that cell phone moment now, I want to faint, because now I know what signals I was subconsciously picking up from her that this moment confirmed for me. As she stood at that light board, pointing and explaining, she was not speaking as a physician looking at something highly ambiguous, that couldn’t be nailed down until the pathologist got a good gander at it under a microscope. She was speaking as a physician who knew exactly what she was looking at, who knew exactly what it was, who had seen it many times before, and who believed that the pathologist was only going to confirm what she already concluded. It makes me nearly swoon now just to relive those moments. In one corner of my mind, I knew then that she knew then. But I wouldn’t, couldn’t let it take hold of my conscious mind. I had to hang onto the possibility that it wasn’t what she thought it was. Suddenly, I had a faith bordering on religious fervor in the pathologist’s future assessment. That assessment would be my salvation, my freedom. It would keep the tsunami from sucking me off my feet and tossing me adrift. It would yield a report concluding with that gorgeous word ‘benign’ and I could go on with my life.

“I’m going to make you an appointment for a procedure called a stereotactic biopsy,” she said. “I know this whole thing can be nerve-wracking, so I’m going to give you my cell phone number. Call me anytime, if you have any questions or you’re just anxious. I’ll also be happy to write you a prescription for something, if you think you need it to get through the next week or two.” I began to feel numb. Part of my brain, the part I was trying to ignore, was ready to implode with the implications of all this. The other part, the part that grew up in a household where self-reliance was a necessary survival strategy, the part that reacted splendidly in emergencies, the part that has a master of science degree, zeroed in on accepting her cell phone number, hand-written on the business card she handed me. How incredibly kind, I thought; not many doctors would give you their cell phone number! I allowed the warmth of her gesture to wash over me. I focused on how good it made me feel, how cared-for, how lucky I was that my friends had referred me to her. Let’s not mince words — I clung to this gesture like it was a plank in a roiling ocean after the tsunami had gotten me.

The rest of the visit was a bit of a blur. She palpated my fibrous breast, even as she explained that ductal carcinoma was generally not palpable at this stage. She passed an ultrasound head over my breast, to check my lymph nodes and double-check for other problems. She sent me off with the assurance that I would be hearing very shortly from her or her nurse with a date and time for the biopsy. I clutched the card with her phone number in my hand, stumbled to the reception desk, and wrote a check for the co-pay. Somehow, I made it home.

When I got home, naturally I called my girlfriends. “How did it go?” they asked. “Do you know,” I said to them, most of whom were my health care colleagues and fully acquainted with the vicissitudes and shortcomings of the System, “she actually gave me her cell phone number? Isn’t that amazing?” We all marveled warmly and approvingly at her thoughtfulness. And they all readily traveled with me down the optimistic path l spun out of the experience, which of course would ultimately yield nothing but good news.

I would not have survived my childhood had I not learned early on the difference between scrupulous forethought and pointless anxiety. I wasn’t quite sure which category they belonged in, but I decided to file away those signals I had picked up from Dr. Doreen to be reinterpreted at a later date. I decided for the moment to hang my hat on the pathologist. If you don’t have all the information yet, why worry? Time enough for shock and awe. I intended to enjoy being a woman without cancer for as long as possible.


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This entry was written by Kathi, posted on Tuesday, July 14, 2009 at 12:07 am, filed under Diagnosis, Recurrence, Screening, Health & Healthcare, Nitty Gritty, Survivorship and tagged , , , , , , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

One Response to “Shock & Awe”

  1. I can only imagine that it was like watching a movie of yourself. Almost an out of body experience. Surreal. I probably would not have been able to sleep for days until exhaustion took me over and dragged me into the land of crazy dreams.

    I have had these moments but it wasn’t about me. It was over someone else’s health issues that were not good.

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