Surg and surge

I've got a date for surgery: September 3. It's a Wednesday.

Now that I know plenty about my whole diagnosis & treatment routine, and it's all settled down into a waiting game, I have sort of a low-level nervous panicky thing going on. It's lower and milder than test-taking anxiety, more like pre-breakup anxiety, and not even that strong. It's like the under-tension when somebody I know/love is in trouble or suffering or sick, and there's nothing I can do but think about them and rehash the details of the story, and half dread, half look forward to talking to them soon. I very much feel like I have volume control on this nervous panicky thing, but not an off button. (If I needed an off button, that would be bad, from a sobriety angle.)

But nervous and panicky are bonafide emotions, and I'm glad to be having some that are not quite predictable. I know too much about all this - about powerlessness, expectation, and disappointment, about prognoses and outliers and longitudinal studies, support groups and survivorship, receptor sites and S phase. Disease is profoundly interesting to me - I like to read books about Ebola and tuberculosis on beach vacations - so I don't have or want time to be emotional about what's happening as long as there's new data about disease coming in. And now that there's a pause in the data flow, I'm feeling some emotion. Not much, but some.

If this was happening to somebody I love, I would be focused on my loved one's emotions, their ability to survive it, to not be crippled by doubt and fear, to not feel alone. I think I see that in some of my loved ones' faces lately, looking to see what I need and where I'm at risk. I think I'm making things difficult for my loved ones by not giving them enough to do. I am guilty of having a pretty good time having cancer so far.

I'm used to hearing people who have a similar diagnosis, or who are new in sobriety, go through one or more classic denial stages. The words "deserve" and "fair" come up a lot. As in: "I don't deserve this." "This isn't fair." As normal and human as these feelings are, I don't have them, don't want them, don't need them. If I don't deserve this, that means somebody else does. If it's not fair for me to have cancer, that means it's fair for somebody else to have it. Entitlement BOTHERS me. Cancer does not care about fair, and nobody deserves it. It's a neutral event. Even if I die of it. The only part that I get to vote on is how I behave through it. Which is plenty to work with.

In other news, my Florida landlord found new tenants right away, so I'm getting an unexpected month of rent refunded on the beautiful little house that I don't get to live in. And I forgot to report that I got a registered letter from Nova last week, granting me acceptance into next fall's class. All is tidy.

July 25: Cancer Report

After 6 hours at the Seattle Cancer Care Alliance today, here's what I know:

1. My MRI was boring. This is excellent. By "boring" I mean that nothing unexpected was found. The tumor size is 2.0 cm at its widest. It's only 2 mm from my skin, but not "involved" in the skin, which is good.

2. My biopsy (the one that really hurt) was worth it. They ran a bunch more tests than I thought they would. My "prognostics" are:

.....very strong findings for estrogen and progesterone receptors. These are the garden variety, super-well-understood markers for tumor cells that respond to super-well-figured-out chemo, like Tamoxifen.

.....no HER2/neu found. This is a truly nasty bugger to have; I'm delighted to not have it. They will do more tests to be more sure later.

.....15% Ki-67. The presence of Ki-67 means the tumor is growing. When they read this again after surgery, the comparison of the two numbers will help determine what chemo I get.

3. My surgeon is from South Africa and I totally dig him. He gave me every shred of info I wanted. Lumpectomy should be scheduled within a month. The details on this, and on the way he'll pick a lymph node to pull out, are fascinating. Best case: done in one day, one lymph node comes out with the tumor, 2-3 days recovery. Worst case: bunches of lymph nodes have to come out, overnight stay, I'll wear a drain in the incision, and much systemic badness follows.

4. My medical oncologist is a woman older than me and I totally dig her too. After surgery, she'll run the diagnostics to figure out what, if any, chemo I need. There's no real way to predict what kind or how long, and she said not to assume that I'd lose my hair or start menopause. Best case: no chemo. Worst case: up to a year on cell-killing, baldifying, nasty stuff with a port in my chest, and THEN I'd start radiation while I have hot flashes.

5. Radiation! Not sure how I had myself convinced that this wasn't part of the story. When they do a lumpectomy instead of a mastectomy, after chemo, they do radiation to clean up any cookie crumbs still lying around. Radiation is a for sure, then, and it's a 15 minute deal every day for some 6-8 weeks. After chemo, if any.

So, big day at the SCCA. Kinda serious, kinda fun, and now back to waiting for the next thing to happen. Surgery. Sometime in August.

If you're gonna have a tumor...

...mine's a fine and lovely one to have. HERHER2/neu-negative, baby! I LOVE MY PATHOLOGIST.

I hacked onto the PC in my exam room to update my blog because I AM A DORK. I might be here for four more hours. I'm sitting here in my open-back hospital robe waiting for more doctors to come by.

Further bulletins as events warrant.

(insert Jeopardy theme here)

Oh hey look, it's still not Friday yet. We're just sitting here, hanging out, me and the tumor, knowing nothing new. Nope, still not Friday yet.

There's an online comic strip, XKCD, that I adore, and this morning's strip makes a reference to the arcade video game that was based on the movie Tron, from 1982. That I immediately recognized this reference is equal parts disturbing and thrilling. Tron plus Florida equals me content.



I took a final exam this morning, which means that I've (gulp) actually completed my very first class in Spanish since junior high. I'm no longer limited to the (quite fabulous, really) curse words I learned working in LA restaurants. I'm no longer limited to saying "pongoselo en su sarpullido" (put this on your rash) or "donde le duele" (where does it hurt) from medical trips in Mexico et al. No, now I actually can use verbs in THE PAST TENSE. They call it a preterite or some garbage. I can almost use direct and indirect pronouns correctly - although I have to draw a map most of the time. My class used the Destinos soap opera format. Although I doubt I will have time to take the next 2 classes, I kind of want to know what happens. I'm betting Raquel dumps Arturo for Angel, and shows up in (her client!) don Fernando's hospital room pregnant with his grandchild. With massive 1982 shoulder pads tightly secured to her maternity vestiza.

Still not Friday yet.

Cushy face pillows

MRI's done. I'm being treated at Seattle Cancer Care Alliance, which, compared with the one data point I have from Group Health, is almost like going to a spa.

This data point is a woman I met about 22 hours after I got my diagnosis. She was a complete stranger with whom I was about to spend 3 hopefully-not-interminable hours in the car on the way to the Police concert last Saturday. Because the world is tiny (TINY) she has the same kind of cancer I do, same demographic as me, and she was recovering from surgery. So the concert was like cancer camp. She's one very, very cool chick.

So I more or less knew what to expect from the MRI: we lie face down with our bosoms in a trough, hands above our head for 20 minutes (or it gets the hose again). At Group Health you are on your own to figure out what to do with your face. But SCCA has a lovely massage-table-type face cushion for us elites. Plus earplugs, plus headphones with soothing-but-not-Enya music. It put me in a mood to think of the IV-delivered goo as gladiolus instead of gadolinium. (Yep, it's an element, #64, had to look it up.)

If there are visible lymph nodes in this MRI, make plans to come to my funeral, because they didn't shoot anywhere near my armpits. I'm really wanting clean lymph nodes. I'm really wanting unharmed axillary nerves after they pull a node out, so that I can still maybe be a surgeon. I'm really wanting a piece of paper from Dr. Silvagni that officially grants me a deferral at Nova.

Oh, forgot to mention: the whole Chemo Weight Loss Plan is a myth, according to my data point referenced above. On average, chemo doesn't really make you all that sick anymore, and they don't particularly want you dropping weight during treatment. Back to the Tapeworm Weight Loss Plan.

The Police were outstanding. A Viagra commercial, sure, but they made me very happy.

Brief update

My MRI is tomorrow. Ideally, this won't tell me anything new; it'll just tell the surgeon where to go. (One of the surgeons I currently live with draws a smiley face on the body part she's going to work on.)

Nova has verbally granted me a deferral to start in Fall '09. I'm another piece of paper on the dean's desk at this point.

My landlord in Fort Lauderdale put my house back on the rental market. Sigh. It's so pretty. Hopefully it'll be available again next summer. Yes, that's a lavender seahorse on the chimney.

memoir titles

Working list:

"Cancer and the Cynical Gal"

"Chemo is Easier than Med School" (current favorite)

"Hard to Kill"

"Living Life Backwards"

Suggestions? I think I have a little bit of time before this needs to be locked down.

Star Wars faux pas!

While Darth Vader is more appropriate to a Death Star motif, it was NOT Vader that said "and now young Skywalker, you...will...die." It was Emperor Palatine, the creepy guy in the hood who, surprisingly, since he's at least 170 years old, can breathe without a big black 1976-era flashing-lights apparatus. I'm troubled; this fabulous line was uttered on one of the big pointy ships, not the spherical Death Star. I prefer the Death Star motif (duh), because it gets blown up, unlike the pointy ships, which mostly crash into each other because of the Millennium Falcon driven by the still-young-not-crusty-old Harrison Ford. So the metaphor stays mixed and fanatics can bite me.

Note for the record that young Skywalker does NOT die. The force is strong in this one.

Death Star it is

So yeah, it's cancer. It's the "good" kind, an invasive duct tumor, which is what about 80% of North American breast cancers are. So unless I'm doomed to be an outlier data point, this is survivable.

I'll be getting an MRI next week, then I go to oncology on July 25, and then they'll take the Death Star out before it can destroy the princess's home planet. They'll look for anything happening in my lymph nodes. Then depending on a bunch of stuff, including which pharm company brings lunch to tumor review that day, then I'll probably do at least one round of chemo. If there's no lymph node involvement then radiation is unlikely.

On Wednesday after my biopsy, I was crystal clear that I don't want to do chemo during med school. It can be done, but I'm not signing up for it. So med school waits. Thus, I have to call Nova and ask to defer admission to next fall. I also have to deal with calling off all the movers, and negotiating with my Fort Lauderdale landlord. I have to figure out what I'm doing this year instead of med school. I have to figure out when my UW health insurance ends (mid-September?), whether my Nova health insurance can be persisted, and what my other health insurance options are.

And at some point I'll probably be getting scared and angry. So far it all seems very rational and straightforward. It'll make me a better doctor, that's pretty obvious. I wasn't scared when I had my pulmonary embolism, more like fascinated, and the suckage was pretty minor. The suckage of chemo will be pretty bad, but I'm okay with losing my hair. This is going to redefine the term "slog" for me, I'm sure.

You know, easily more women have survived breast cancer than have iPhones, so maybe that's why it's not occurring to me to fall apart over this. I'm cracking jokes, going out, doing stuff, and I'm headed to the Gorge tomorrow for a Police concert and camping. My doc advised me to be ready for mood swings. What, more than normal? Hmmm.

16 millimeters

This gets pretty personal, so wander on if you're looking for light-hearted jesting.

Last year I had my first mammogram, like a good girl. I was all worked up because I had felt a lump in my breast. When there's actually something known to be there, they do an ultrasound after the mammogram, to get acquainted. And on the ultrasound, this lump turned out to be an 8 millimeter, smooth, liquid-filled space that could not be more benign. Or cute. It looked like a smile:



So this year I went back for another mammogram, like a good girl, to see how the smile is doing. Hmm. Above the still-cute smile, on the ultrasound, there's a bit of a Death Star, jagged, non-homogenous:



You know, this follow-up mammogram was on my list of things to do before moving to Florida, such as going to the dentist and getting my car's air conditioning flushed. I pimped the radiologists like a typical premed: "how did you know you wanted to do radiology? what other rotations do you have this year?" and letting them ooh and ahh over my starting-med-school-over-40 deal. Because I love being popular, and it is MUCH harder over 40.

A very nice third-year resident did my ultrasound, and sort of cocked her head to the side when she saw the death star, which at this point I don't know is a death star, I'm just thinking "wow I'll know what I'm looking at in another year or so." She goes out to get the nice attending radiologist, who runs the scanner around for about 10 seconds, and then makes very direct eye contact with me. Takes my hand. Didn't even have a chance to pimp her and she's telling me to make an appointment with the cancer care coordinator.

Other than mentioning that it HURT LIKE FUCK, I won't go into the biopsy experience. Results are expected tomorrow around noon.

My life is bifurcated now into what phone calls I have to make on Friday afternoon if I do have cancer, and those that I have to make if I don't. You know, Friday, tomorrow, 7 days before I might still move to Florida?