Time to meet the care team.
I’ve got appointments with the cancer nurse, oncology surgeon, radiologist, social worker, and plastic surgeon. At the same time, the hospital is dealing with its first case of coronavirus. No problem, I’ll just make sure I wash my hands. Who can worry about a pandemic at a time like this! My good friend is with me to navigate this overwhelming and somewhat scary process. I was ready to go at it alone because that’s what I do.
Our first stop is to meet the breast cancer nurse. We immediately hit it off. She loves my attitude and chuckles at my unexpected perspective. We go through the exhaustive binder I’ve carried in with all my possible questions. It will come as a surprise to no one that I’ve done my research. As we wrap up, she tells me to hold tight to my decisions which strikes me as odd. Things clear up when I meet with the surgeon and he starts to lay out his plan. Apparently, my cancer is very small – only 1.2 cm in size – and could be easily managed with a lumpectomy. He is very pro-conservation and supports his position with detailed stats, percentages, and charts. He’s sure this is the best choice for me.
I, on the other hand, have already decided on a more aggressive approach. I will go straight into a mastectomy, avoiding the chance of reoccurrence, subsequent lumpectomies if the borders aren’t clean and cancer remains, and then the very real possibility of having to undergo radiation. We are not aligned and I walk out of that appointment feeling torn. The road ahead seemed so clear but now I question if I’m being too extreme for such a small cancer.
Next up, is a chat with the plastic surgeon who is very much in favor of mastectomy with reconstruction; a position he supports with different data. A double mastectomy eliminates the chance of cancer further down the road and the possibility of cancer in the other breast. Radiation corrodes implants, and they are not compatible treatments. Considering all these factors, the plastic surgeon recommends:
1. Bilateral mastectomy (that’s both boobs for the uninitiated).
2. Tummy tuck to harvest the fat needed for reconstruction.
3. Tissue transplant reconstruction using that tummy fat.
In other words, the cancer is removed, I get new boobs and a flatter stomach. I have this sneaky feeling this is all too good to be true! I mean, I didn’t choose cancer but if this is how it’s going to go, I can definitely find that silver lining. And yet, I also wonder if my preferred approach is too drastic and I’m becoming concerned about whether the insurance companies will even be willing to cover what I want. So much exhausting back and forth going on in my head.
It’s too much to decide on my own so I turn to my trusted advisers. Over a 45-minute lunch, Tonia, Fleurette, and I review all my options. Lumpectomy versus mastectomy. Single versus double mastectomy. Breast reconstruction using implants versus reconstruction using no implants. Lymph removal versus radiation. So much is at stake, I have so little time to decide, and I’m not operating with a clear head. My friends are helpfully debating each choice with me but I'm not finding much clarity. Through this fog of confusion, I look to the heavens and say, “I’m torn, Mom.... what do I do?”
Before any final decision can be made, I need an ultrasound because there are two suspicious spots near my tumor. The care team doesn’t think there’s anything there but they want another opinion. If I have more than one lump, the decision is simple and the most aggressive approach will be taken.
I head to ultrasound. In walks the most energetic MD that I have met in a while. She bubbles with energy and understanding. Her first question is about what brought me in to have a mammogram in the first place. “I was getting reminder letters and I was getting annoyed, so I just went ahead and scheduled it. I think something was telling me to do it.” She informs me that the hospital administration is trying to stop sending such letters to women under 50 and asks if I would be willing to write to them to explain why these letters are so important and why they need to continue. “Had you not come when you did,” she said, “we’d be having an entirely different conversation.” This last comment sends a chill up my spine. She asks me what I’ve decided to do and I start to explain my dilemma. Before I’m even done with my story she weighs in, “Get rid of them! I’ve seen it time and time again, the most frustrating and concerning thing for women is the anxiety of the unknown, the uncertain. Of having to be rechecked all the time when they’ve only had a lumpectomy. Just get rid of them and get new ones.” With those words, my decision is made. I asked for an answer, a sign from my mom, and now this doctor telling me exactly what I need to hear!
We begin the drive home. To my surprise, a sense of relief is washing over me.