It’s Friday afternoon, April 3. I’m working from home which is my new reality these days... homeschooling, remote learning, and virtual homecare. Getting patients to complete their exercise programs while on the telephone is a uniquely challenging experience. This is time consuming, and I’m realizing just how much I preferred to do my job with my eyes. While I’m fumbling to explain knee bends and leg kicks to an uncooperative patient, I receive a call from my doctor. The hospitals have started to do day surgery procedures, he tells me. He could do a lumpectomy to remove the tumor and then complete the procedure later when they’re ready for more complex surgeries. Did I want to proceed?
My tumor is small. I’m taking Tamoxifen to slow the progression. Will the insurance pay for both surgeries? I can’t help but squirm under another change in plans. Is the universe telling me something?
“You have the weekend to decide and if you want to call the office next week to schedule, but you have be off the Tamoxifen for 2 weeks before surgery so be ready for the end of April.”
On April 28, I have the lumpectomy to remove the tumor. The surgeon is wonderful, kind, and empathetic. He’s encumbered by PPE, which I know is for my own sake.
“I’ll take good care of you Lyane. Let’s get this tumor out.” These words are floating in the distance as the anesthesia starts to take hold.
The glare of overhead lights peer behind my eyelids, and I realize I’m waking. I see Tonia, my trusted friend sitting beside me. I continue to rally my wits as the surgeon walks in.
“The surgery was smooth and uneventful. A generous amount of breast tissue was removed since a mastectomy is still your ultimate plan. You might feel a little lopsided. The tissue will be sent to pathology for the final report. We should have an answer in a week. We’ll see how you’re doing and let you know the results. You did great Lyane.”
A few days of recovery and back to work I go. Life returns to normal.
A week passes and I’m getting ready for work. 8AM and the phone rings. It’s that familiar number I’ve seen but haven’t wanted to label.
“Lyane, how are you? How are the incision lines?” Before I even have the chance to finish my sentence, he blurts out,
“The pathology report has come back this week with some unexpected news... the tumor was four times bigger than the MRI showed and the tissue margins have been invaded.”
“The sentinel node showed an extensive invasion. And the two lymph nodes that were included in the lumpectomy also showed evidence of cancer cells.”
A wave of panic. I sit on the outside steps, trying to get decent reception. Vermont mountains! My voice is breaking up.
“What does this mean?” I can’t think of anything else to say.
“It means we need to defer to the oncologist.”
“I have an appointment with her next week.”
Again he stops me.
“We don’t need to wait. I’m sure she will call you before the end of the day.”
Shit! In other words, the sucker has started to explore. Little bugger!
As this news starts to sink in, I find myself glued to the chair. Tears are streaming down my face. This is definitely a shock and not the news I was hoping for. Four times bigger!? It doesn’t seem possible. I’ve been very intimate with my right breast, thanking her every day while she keeps things contained. How did I not feel a five centimeter lump? How did five different MDs not feel a five centimeter lump? How did an MRI, and four mammograms not catch a five centimeter lump?
Minutes pass and I’m trying to collect myself. Time to compartmentalize. Can’t deal with this reality right now. I need to get the boys up for virtual school, and I can’t let them see me cry. My sense of routine kicks in and I move on with my day. I’ll wait for the next call.
My routine has changed slightly since the pandemic. I’ve learned how to strip into my skivvies in the laundry room door without my boys seeing more than they ever wanted to. The shower helps to wash away the day; the outside world seems distant, or at least on hold for now.
Then the phone rings. There’s that number again… dammit, Lyane, label it, will you?
“Lyane, how are you?”
How am I? I had nearly forgotten. My insides churn. The neat little box of worry I keep in my head is threatening to come loose.
“I guess that will depend on how this conversation goes!” I reply.
“Well, these results were quite unexpected,” he starts, “we need to redesign your treatment plan.
“At this time the surgery is not our priority and the radiation can wait. We need to start chemo at the end of the month. Will need you to heal from your first surgery and get the access port implanted then start chemo. First we’ll need to schedule more labs, a bone scan, CT scan, and echocardiogram. We can start next week. During this time your surgery date for the port will be scheduled. After those results, we will discuss your chemo regimen, which should begin at the end of the May. Any questions?”
Any questions? I’m still processing this information. Now chemo. Surgery is put off again. Radiation? When did that become part of the plan? Can I still work? I’m still stuck on how this five centimeter tumor could stay so elusive? How far did it spread?
Of course, I do like to do things differently. I teach my kids to bend the rules, to be rebellious, to embrace the unexpected; but this a little too much!
Time to box up this info and put it away for the night. I’ll tell my support team tomorrow. Right now I need quiet and normalcy. Dinner is waiting to be made.