2025 B.C. and A.D.: The Sequel (Part 3)

When I received my second breast cancer diagnosis on May 15, 2025, it became my prayer that all of the right doors would open for the surgery and treatment path I was supposed to take.  However, what I'd failed to consider at the time was that the right doors opening also often means the wrong ones slamming shut.  The plan had become so clear and felt so doable.  All of a sudden, a complication arose and the whole thing was thrown in jeopardy.  

 

My pre-procedure mammogram the morning of my Magseed placement had revealed two brand new suspicious microcalcifications, both on the same side as my previous diagnosis.  On the day of what should have been my 2nd lumpectomy, I found myself once again at the radiology clinic, face-down on the Table From Hell, undergoing my 4th and 5th stereotactic biopsies simultaneously.  (These were actually my 5th and 6th biopsies in total, but one of those had been ultrasound guided, rather than stereotactic.)

 

So far, I was 1 out of 4 on my biopsies coming back benign.  With that track record, it was hard to feel optimistic.  My most recent biopsy on May 13th had gone so poorly, too.  I'd bled so badly, they couldn't even do a post-procedure mammogram to verify the clip had been placed correctly.  They eventually sent me home with ice packs and gauze packed tightly under a sports bra.  Six weeks later, I was still very sore and bruised all over, and the giant hematoma that had formed underneath the incision was still quite large.  How much worse was this going to get before my eventual surgery?

 

Fortunately, my procedures that day went much better than the previous one.  I don't know if it was because I was more prepared, or if the radiologist I had that day was just that good.  It took less time to do those 2 biopsies than the Women's Imaging Center had taken to do just one.  The funny part is: when it comes to biopsy clips, there are only 3 shapes to choose from in order mark each site.  My first 2 clips from 2017 had been removed during my lumpectomy, but I still had the one from my benign biopsy later that same year, plus the most recent clip from this past May.  Now that they were adding two more, they had to double up on one of the shapes by using 2 side-by-side, just to distinguish it from the other site with that same shape.  I was really amassing a collection in there!

 

Brian came with me to the appointment and waited outside in the waiting area.  I emerged roughly an hour later, bandaged up in ace wrap with ice packs underneath, but feeling relatively OK.  I was actually surprised how little discomfort I was in.  Still, Brian felt I deserved some post-biopsy ice cream, and I agreed.  It's wonderful having a man who tends to all of your needs like that!

 

Brian's mom had flown in for a 3-week visit on June 21st and was staying with us through July 13th, so she was able to watch Avery while he and I were at my appointment and subsequent ice cream "date."  My mom had wanted to come down for my anticipated surgery date on the 3rd, but an emergency surgery on my uncle followed by a death in the family shortly after kept her from being able to do so.  With Mom and her sister now solely responsible for taking care of my grandma, who needs 24-hour care, my uncle needing surgery meant my aunt KoAnn would be preoccupied with that, so Mom had to wait to come down until after he recovered, freeing KoAnn up.  Mom ended up buying a one-way plane ticket from Ohio to Virginia on Saturday, July 12th.  The plan was for her to stay 2 weeks, with my brother Rob driving down on the 19th and staying for the second week, then he would drive the two of them back up on the 27th.  This was all decided prior to my surgery being postponed, though.  Unable to change her plane ticket, my mom kept the original plan and hoped my surgery would either get rescheduled for while she was here, or that she could come back whenever it ended up happening.  

 

I spoke to my breast surgeon shortly after my Magseed placement got cancelled in light of the radiologist's findings the morning of the 30th.  She admitted she was surprised by this sudden turn of events, but said she trusted his opinion and felt he was probably being overly cautious due to my history.  She said we would reschedule my lumpectomy at the next soonest time her schedule aligned with my plastic surgeon's, and proceed with the current plan unless something changed.  I asked her how often something like this happens and it turns out to be benign.  All she said was she sees it happen a couple of times a year.  No answer on how often the new findings are benign vs. malignant.  That seems to be the forbidden question no one wants to answer.  

 

My surgery being postponed also meant needing to postpone my post-op follow-up with my radiation oncologist.  When I contacted their office to reschedule that, I also asked whether my DCISionRT results had come back yet or not, just out of curiosity.  I was told that they had but the doctor would need to be the one to go over them with me.  So we kept my appointment as-is but made it a telehealth visit just to discuss those results.  I also scheduled a telehealth visit with my breast surgeon for Friday, July 11th to discuss the biopsy results, assuming they would be in by then, and go over my surgery options.  The holiday weekend on the 4th likely meant a slight delay in getting those results.  But I still checked my patient portal every single day, often several times a day, hoping to see some results uploaded.  

 

I was already losing hope that I would be able to have the breast-conserving surgery I had worked so hard to secure.  And the more days went by without the results, the more that hope faded.  I felt that if it were good news, I would have heard something already.  Besides, what benign conditions pop up in the span of four weeks like that?  I was mentally preparing myself for needing a mastectomy.  This boob was all but a goner.  

 

The one nice thing about my surgery being postponed from the 3rd was that we could use the tickets I'd bought for the "Celebrate America!" concert at the Kennedy Center that night.  I wasn't sure how rough I would feel after having a double biopsy earlier that day, but I was surprisingly OK.  As long as I kept the ace wrap on, swapped the ice packs regularly, and kept up on the extra strength Tylenol, I was in fairly good spirits.  It was our third time attending that annual concert and, as usual, it was incredibly enjoyable.  However, I was battling a summer cold and had almost completely lost my voice, so I couldn't sing along during any of the audience participation numbers.  Something inside me had to wonder if this was by design.  

 

In my head, I'd been equating having a mastectomy with my dad having a laryngectomy, since both were irreversible yet necessary surgeries that had profound effects on the patients' personal relationships for the rest of their lives.  Being unable to sing along at the concert was like a short glimpse into the frustration my dad must have endured for 30+ years.  If I ended up needing a mastectomy, it would undoubtedly be life-altering and deeply painful, both physically and psychologically.  But not nearly as bad as not being able to talk or sing ever again.  A mastectomy you can hide, a laryngectomy you can't.  Was this summer cold I was battling really my dad poking his head out from clouds and reassuring me that losing a diseased breast maybe wasn't the death sentence I was imagining it to be?  Perhaps there are worse things.

 

During the week of waiting on my biopsy results, I learned that my lumpectomy had been rescheduled for Wednesday, July 23rd.  This meant my mom would be here for it.  However, that could potentially interfere with Brian's and my vacation plans on the 31st.  Brian said we could change the date if needed, or we could just turn it into a low-key weekend of R&R.  I definitely did not want to change the date since we'd been planning it since Christmas and I'd already put in for those days off from work.  Plus, not knowing the biopsy results yet meant not knowing whether my surgery would even go forward as planned or if they would have to push it out even further since it could end up being a much larger operation.  So many things hinged on these test results.  

 

The morning of Friday, July 11th, I arrived at work and immediately logged on to my patient portal.  It had been over a week now.  Surely something had to be in there!  

 

Nope, still nothing.  My telehealth appointment with my surgeon was scheduled for 1:15 that day, so I was getting nervous we wouldn't even have the results before then.  I was also starting to wonder if maybe they were withholding them from me for some reason.  I kept refreshing my screen every so often, just in case something got uploaded, all while trying to get my work done as normally as I could.

 

At precisely 11:51 a.m., my phone buzzed with an email notification.  It was from MyChart.  I had a new test result.  

 

"Oh, God.  This is it."  I said softly to myself.  My hands shaking, I clicked on the link in my email and logged on to my patient portal.  I went to the test results tab, clicked on the newest one, and downloaded the pdf containing the pathology report.  I took a deep breath and a huge gulp of air as the document popped open on my computer screen, the results leaping out at me in bright red italic font.

 

Specimen #1 - Diagnosis: "Ductal Carcinoma in situ, intermediate to high nuclear grade, clinging pattern, with associated necrosis and calcifications."  

Specimen #2 -  Diagnosis: "Ductal Carcinoma in situ, intermediate nuclear grade, solid and cribriform patterns, with associated necrosis and calcifications."  

 

Fuck.  

 

More cancer, more cancer, more FUCKING CANCER!!  

 

It was over.  There was no way I could still do breast-conserving surgery now because there was no way I could do partial breast radiation.  Three separate cancers in three different areas (plus whatever else was in there that just hadn't shown up yet) would render that impossible.  So what now?  I needed to take a walk to clear my head.  

 

I grabbed my purse and just started walking.  I went outside the office building and made my way onto the W&OD trail where I started putting one foot in front of the other with fury.  My mind was racing.  I was going over every possible scenario in my head and every possible outcome.  Finally, I had to tell myself to stop thinking and just wait to see what my surgeon said when we spoke in an hour.  I'm not sure exactly how much ground I covered during that time, but according to my FitBit it was 2.3 miles.

 

Eventually, I made my way back to the office.  It was one of my coworker's last day at the firm, so there was a bit of a send-off party with cake happening in one of the conference rooms.  I had no appetite for any of it, though.  I couldn't even eat lunch.  Fortunately (or unfortunately), news travels quite fast in that firm, so pretty much everyone had already heard about my test results by the time I came back from my walk.  The partners had all been very understanding and accommodating throughout my first bout with cancer, and later my pregnancy and maternity leave despite it coinciding with the pandemic.  My boss sensed my distressed mood that day and gently led me back to my office, where she assured me they would work around whatever time off I needed for surgery and recovery.  She then practically ordered me to take the rest of the day off without even marking myself out or using PTO.  "This one's on us!" she said.  Typically, I would've just powered through the rest of the day and pretended everything was normal.  But since Brian was working from home and his mom was visiting, plus I had a telehealth appointment starting in 15 minutes, I decided I may as well get some family time in.  First, though, I needed to talk to my surgeon. 

 

After I shut everything down in my office and bid my departing co-worker one last farewell, I went into one of the restrooms and huddled down in the large stall on the end.  I logged on to my patient portal and clicked on the prompts to join the telehealth call.  My surgeon entered the call shortly thereafter.  

 

"So, we got your biopsy results." she began.

 

"Yes, I know.  I saw them."  I told her.  She seemed surprised that I'd already seen them.  (She apparently didn't know me well enough yet to not know that, when it comes to things like this, I'm a borderline stalker.)  

 

"Unfortunately," she continued, "this is going to change the plan."

 

I knew that, too.  With 3 new cancers now growing inside my ducts plus my prior lumpectomy site, not only would there be so little breast tissue left after a lumpectomy, but it would not even be safe to leave any remaining tissue behind.  For whatever reason, my boob was on the warpath and the only option was to stop it dead in its tracks.  I needed a mastectomy.  Period.  Hard stop.  The only thing up for debate was...

 

"What about reconstruction?" I asked shakily, reminding her what my other surgeon had said about me not being a candidate for implants due to their tendency to adhere to radiated tissue, leaving DIEP flap my only option.

 

"Well," she replied, "I've found that silicone implants are safe even after radiation, so we should be able to go with that."

 

Wow.  Another opinion that differs entirely from what I was originally told.  Still, it was like choosing between a rock and a hard place.  None of the reconstruction options available sounded remotely appealing.  But I suppose a silicone implant was the least unappealing one of all.  The recovery time was much shorter than DIEP flap (2-4 weeks as opposed to several months), and silicone tends to feel more natural than saline implants.  However, there are still risks involved like leakage, rupture, encapsulation, and infection, and the need to have them swapped out, which would require additional surgery and recovery.  No matter what, I will be a plastic surgery patient for the rest of my life.

 

I asked my doctor how often I would need to have an implant swap and she said that, although the recommendation is every 10-15 years, nobody really does that.  She did recommend meeting with my plastic surgeon again to discuss all reconstruction options, so I said I would call his office that afternoon to set that up.  Fortunately, my surgery on the 23rd could still proceed as scheduled since the whole procedure would only take about 2-4 hours (as opposed to a whole day for DIEP flap).  She would just change it from lumpectomy to single mastectomy.  I expressed concern over the date being so close to my planned vacation in Michigan.  She said she remembered me telling her about that, but said she felt I should be OK to still go, as long as I took it easy and didn't push myself.  The surgical drains, though, might be a bit of a hindrance.  I had to keep them in for 2 weeks post-procedure and empty them twice a day, plus record the output.  Spending a romantic vacation on Mackinac Island is decidedly less romantic when you have to wear a surgical bra with tubes and drains hanging from it, and record how much fluid is leaking out of them.  I would also not be able to swim, soak in a hot tub, or even wear a bikini.  It was shaping up to be a very low-key weekend with maybe a few light walks.  Not what I had pictured at all.  

 

My doctor then went over the options I had for checking for any lymph node involvement.  Since I'd already lost 4 lymph nodes during my lumpectomy, I told her I didn't want to lose any more if possible.  My prior surgery had required a Sentinel Lymph Node biopsy since my cancer was invasive.  However, with a mastectomy, they can do a Magtrace injection, which is a non-radioactive lymphatic tracer injected into the breast tissue that travels through the lymphatic system to the sentinel lymph nodes.  It stays inside the body for a month before being filtered out by the kidneys and naturally expelled.  So rather than removing any lymph nodes during surgery, they would just remove the breast tissue and have pathology check for clear margins.  If the margins are clear with no invasive disease, no further action is needed.  If they aren't clear, they can go back while the Magtrace is still in the body and remove any sentinel nodes for biopsy.  Sounded like a good option to me.  

 

She also mentioned nerve grafting, which my old surgeon had brought up the day of my consultation with her, but I was too upset to pay any real attention.  Basically, they would attempt to reconnect some of the nerves severed during the breast removal process in order to restore some sensation to the breast and chest area.  However, since nerves can take up to a year or more to regenerate, we wouldn't know how successful it was for at least that long.  That part was towards the bottom of my list of concerns, though.

 

I asked about the surgical drains.  She assured me they weren't huge and that I could hook them onto my surgical bra to keep them somewhat hidden. I tried to picture how that would come into play during vacation, but it was hard since I had no real clue what they looked like.  In my head, I had so many other questions, but couldn't muster the energy to ask them all right then.   I was just anxious to call my plastic surgeon's office to make sure I could be seen before my surgery, so I called as soon as I hung up from my breast surgeon.  They were able to get me in for a follow-up consult the following Friday, July 18th at 3:15.  Brian was scheduled to be home that day, so he could come with me to be a second set of eyes and ears while my mom watched Avery.  

 

My mom flew into Virginia the following afternoon, then Brian's mom flew back to Michigan the morning after.  During the weekdays that followed, I scheduled my pre-op anesthesia interview for 7:30 a.m. on Tuesday the 22nd, the morning before my surgery.  I also canceled my follow-up with my radiation oncologist for the 14th, stating her services were "no longer indicated."  I asked her about my DCISionRT results, though, just to satisfy my own curiosity.  I was informed that, as was probably no surprise to anyone, the results had come back showing I was in the highest risk category, so radiation would have been an absolute necessity if I'd been able to have a lumpectomy.  

 

I also scheduled a haircut since I didn't want to deal with super long hair during my recovery.  I told my stylist to take off 3-4 inches and do some layering, but she apparently started with 4" and kept on going.  It was quite shorter than I was used to.  But on the upside, it was less hair to have to manage with only one fully functional arm.

 

Brian accompanied me to my appointment with my plastic surgeon on the 18th.  The nurse clearly felt the need to make sure I was OK with him being in the exam room with me.  "He's your...?" she asked, trailing off as she waited for me to fill in the blank.  I replied, "Yes, he's...uh, mine."  That appeared to be satisfactory.  After I'd changed into yet another open-in-front exam robe, Brian and I waited in the exam room for a few minutes, lightheartedly joking about various bodily enhancement procedures we could have done there.  The mood turned somber, however, as soon as my surgeon entered the room.  I hadn't paid much attention to what he'd talked about during my initial surgical consult since I was so determined not to have to need him, so it felt more like an initial consultation than a follow-up.  

 

He echoed most of what my breast surgeon had already told me, like being under general anesthesia and the surgery would take 2-4 hours total.  The surprise twist was when he said I would be getting an expander put in first rather than going directly to implant.  I had not been prepared for that, and my disappointment with this revelation showed.  He then backtracked slightly, stating there was a small chance I'd be able to go directly to implant depending on what happened during surgery (mostly with regard to how thin and elastic my skin was), but the most likely outcome would be an expander first, then a second surgery three months later to swap it out with the actual implant.  That meant I'd be going under the knife again right around Halloween.  So much for being able to enjoy that holiday this year.  He did assure me it's a much, much easier surgery and recovery than the mastectomy would be.  But still, I was not happy at all with this news.  I'd already lost out on fully enjoying the Fourth of July, and possibly our pre-planned vacation.  The other upsetting revelation was that, as long as I had this foreign object inside my body, I would be much more susceptible to infection, so I would need to take prophylactic antibiotics for pretty much every future medical procedure, including a routine dental cleaning!  All these little annoyances were really piling up, reminding me why I fought so hard to avoid having this surgery in the first place.  

 

I asked him about the periodic implant swapping process, which my breast surgeon had downplayed by saying no one actually does it.  He responded that my implant will be monitored regularly to check for problems and if there's nothing wrong, they will leave me alone.  They only swap it when there's a problem.  I was starting to have a feeling that the first sign of a problem would likely be my last.   I wasn't ready to do DIEP flap or go completely flat at this stage of my life, but I could already sense the day coming when I would want to be done with all of this implant nonsense.  

 

My surgeon closed out our appointment by telling me I was 100% making the better choice by having a mastectomy and I would be much, much better off down the road this way.  Always easy to say for someone who's not facing this surgery.  I wanted to say that it absolutely was not MY choice.  I'd been backed into a corner by my own body turning against me yet again.  My flight-or-fight response had simply changed gears from 'flight' to 'fight.'  Nothing about this was fair, or voluntary.  

 

For the next 5 days, I felt like everything I did was my last hurrah.  My last anything with two breasts.  It was almost like a countdown clock to Judgment Day.  I wanted time to stop so my surgery would never have to come.  But at the same time, I was so emotionally spent from worrying about it, I wanted to just put it in the rear view mirror already.  I was tired of wondering what might happen and wanted to see it actually play out.  As they say: anticipation of death is worse than death itself.

 

The morning of Wednesday, June 23rd dawned as expected.  I had to arrive at the hospital at 6:30 a.m. for pre-op registration, with a surgery time of 8:30.  I set my alarm for 5:00 a.m., but I was awake long before it even went off.   

 

The morning of my lumpectomy, I'd had to apply a special lidocaine cream so they could inject the radioactive dye before the procedure.  There was none of that this time.  I just had to shower and clean the surgical site with hibiclens, a special anti-bacterial soap that doctors often use when scrubbing in.

 

As I was getting dressed after showering, I was trying to find the perfect outfit to wear for my last few hours as a two-breasted person (as if such an outfit exists).  I dug through my shirt drawer and pulled out a shirt that had been gifted to me by a coworker 8 years ago, after I received my first diagnosis.  I didn't get to wear it much but, when I did, it always drew praise.  It was a simple black crewneck t-shirt with gray letters on the front that spelled out "Hey Cancer, Fuck Off!"  I asked Brian if he would be embarrassed or offended if I wore it to the hospital.  I was completely expecting him to say yes, so I was surprised when he shrugged his shoulders and said, "No, that's fine."  My man totally gets me!

 

Just before 6:00 a.m., I knocked on Avery's bedroom door.  My mom was in there sitting up in the twin bed with her Bible open, while Avery slept peacefully in her toddler bed.  Mom asked if we were leaving for the hospital now and I nodded yes.  She reminded me she would be fasting and praying along with her church prayer group all day from 6:00 a.m. to 6:00 p.m.  I leaned over Avery and gave her several deep kisses on her forehead, as if it would be the last time I saw her.  Then I turned and walked out of the room, closing the door behind me without a word.  At the top of the stairs, I suddenly stopped and paused.  It was almost like an ethereal voice spoke to me with three simple words: "Hug your mother."  I hesitated a minute before turning around, then marched back into Avery's room,walked over to the twin bed, and hugged my mother.  "I know you'll do fine." She assured me.  I couldn't even respond except to wave my hands, wishing it all away.  That was the first of three times I cried that morning.  

 

I had never been to this surgical facility before.  Since I'd consulted with my surgeon in Leesburg, I'd been under the assumption my surgery would take place there, too, but I'd been mistaken.  My pre-op instructions sent to my patient portal informed me my surgery would actually take place at the Falls Church location.  The Inova Fairfax hospital campus was a giant maze of multiple buildings with color-coded parking garages.  Much bigger and more complicated than Reston.  We'd been instructed to park in the blue parking garage and go to the Professional Services Building.  Even with GPS, we still got lost and went to the wrong garage.  It was 6:45 by the time we found the garage we were supposed to be in.  Right as we were pulling in, the hospital called me to see where I was.  I let the woman on the phone know we were parking right now and would be there soon.  I still had to keep her on the line so she could direct me to the right place, on the third floor surgery suite.  

 

There were two ladies at the registration desk.  One complimented me on my shirt right away.  Upon checking in, they handed Brian a form with my patient number handwritten on it.  They explained that he would be kept apprised on my status all during pre-op, surgery, and post-op via a giant screen in the waiting room indicating by patient number which stage of the procedure I was currently in, so he could follow my progress along.  I quipped that it was like ordering a pizza from Domino's.  We both got banded with our respective "patient" and "visitor" wrist bands bearing my patient number.  After about 15 minutes of waiting, they called me back.  Brian was not allowed back there with me just yet, so we kissed and hugged good-bye before they led me away.  Upon reaching my pre-op room with the bed on a stretcher, they asked me all the usual questions (name, date of birth, what procedure are we doing, which side) and proceeded with their usual branding of the correct side with purple marker.  

 

There were a lot of people that came and went during the next 90 minutes or so.  Several nurses, my anesthesiologist, and of course both my surgeons.  While sitting in the pre-op room and lying on my bed answering their many questions (and thereby being forced to admit out loud what I was having done that day), it became the second time that morning I started crying.  The nurse in the room with me at the time simply handed me the box of tissues sitting on the stand next to her.  I'm guessing it happens fairly often.  

 

When my anesthesiologist came in, he had more personality than I was expecting from someone whose job is putting patients to sleep.  He asked about my medical and surgical history, allergies, current medications, etc.  I said I'd been put under general anesthesia many times and always did very well.  I asked him what drugs he was planning on using on me and he gave me the full list, including Fentanyl as a premedication to help me relax.  I mustered up enough humor to quip that it wasn't every day I got to tell people I'd had fentanyl in my system.  

 

After my anesthesiologist bid me adieu until the OR, it was my plastic surgeon's turn.  His role was fairly crucial since he has the onerous task of ensuring everything looked as symmetrical as possible.  He had me stand up straight with my arms stretched out to my sides, then he opened my gown from the front and began marking me all over with purple marker.  He marked me up on both sides, his brow furrowed with concentration, like Michelangelo sculpting David.  I inwardly laughed at the realization that this man, sitting there and marking up my whole chest and torso, was literally at work right now. 

 

The last face I saw before the procedure, although I didn't recognize her at first all masked up and with a surgical cap covering her hair, was my breast surgeon.  It wasn't until she mentioned being grateful for the radiologist discovering the two new abnormalities that it clicked in my head who she was.  She went over the details of the procedure, explaining how she would make the incision in the inframammary fold and remove all of the breast tissue, all the way up to my collarbone and over to my sternum.  Since we were doing a nipple-sparing mastectomy, they would have to leave some tissue behind inside the nipple in order to keep it viable, which necessitated first checking the tissue immediately behind the nipple to make sure no disease was present.  She said she would do that right away and hand it to "Frozen" who would check it on the spot under a microscope.  If it was clear, we could proceed as planned.  If not, nipple sparing would no longer be possible.  She also reiterated the plan for nerve grafting, assuming they could find a good nerve to graft.  So there were still plenty of variables at play.  It all sounded so incredibly intricate and complicated, I couldn't believe they only estimated the whole thing to take 4 hours.  

 

By the time my surgeon exited to go prep for the surgery, it was right around 8:15 a.m. and Brian was finally allowed back to my room to see me one last time.   I gave him my purse to hold onto (much to his chagrin) along with my phone and whatever personal items I didn't want the hospital to lock up.  He kissed me one last time and wished me good luck.  I gave him a mournful look, knowing the next time I saw him, I would essentially be an amputee.  Time was both moving too fast and too slowly.  The nurses then pushed me out of the room, my IV in tow, and began to roll me down the hall towards the OR.  I was immediately taken back to the evening of my emergency C-section, feeling like I was being led to the executioner, but with slightly less urgency this time.

 

They turned towards the right and wheeled me into Operating Room 6 (Brian's lucky number, for what it's worth).  The room was freezing, as usual.  The nurses had me slide from my bed over onto the operating table, then draped a few warmed blankets over me.  The rest of the room was abuzz with activity.  The weight of knowing what was about to take place began to really set in, thus leading to the third and final time I cried that morning.  

 

Eventually, the anesthesia nurse placed an oxygen mask over my face, which made me feel like I was being suffocated, so I pulled it away slightly.  My anesthesiologist soon appeared above me and started making small talk, asking about any destinations I was planning on going to or would like to visit someday.  I knew he was trying to get me to talk so I would breathe in the gas, so I played along, obediently.  I told him about Brian's and my vacation plans to Mackinac Island, scheduled to happen in just 8 days.  While I was talking, the gas in my mask took on a vile taste and odor, which I balked at while trying to keep talking and breathe it in anyway.  Then everything went black.  

 

My Judgment Day had arrived and I had absolutely no idea what to expect when (and if) I woke up.  

 

To be continued in part 4... 

2025 B.C. and A.D.: The Sequel (Part 2)

I've mentioned before that I tend to base important decisions on how much of a "no-brainer" they are to me.  In other words, it needs to feel 100% right or I tend to hold off on making any moves.  Back in 2017, when my breast surgeon laid out her treatment plan, it was very much a no-brainer.  I was completely on board and ready to get started immediately.  This time around, I was anything but.  I felt absolutely no peace about it and, in fact, was opposed to it at a very visceral level.  I couldn't quite explain why I was so viscerally opposed to it, though.  Until I suddenly remembered that I had already seen this scenario play out 40 years earlier.  It feels pithy to use the phrase "childhood trauma" but that's pretty much what it is.

 

In early 1985, my dad was diagnosed with laryngeal cancer.  His doctor told him his best chance of survival was a total laryngectomy, which meant he would never talk or sing again.  He'd been a singer and musician his entire life, so this diagnosis hit him harder than the average patient.  In addition, he was self-employed at the time and had no health insurance.  My mom worked part-time as an LPN while going to school at night for her RN.  She had to drop out of school after my dad's diagnosis and ended up never going back.  Money was very tight and the weight of uncertainty in our house was palpable.  My older brother Toby was in his teens, but my brother Rob and I were 3 and 6, respectively.  My parents tried to explain to us what was happening in a non-scary way that we could understand, and they did their best to shield us from their stress and worry, but we still felt it.  We both knew something bad was going on, and it showed when Rob and I would start fighting with each other whenever we were taken to one of my dad's doctor appointments.  My mom tells me that we once drove past his oncologist's office and I pointed to the building and exclaimed angrily, "I don't like that place!"

 

My dad's laryngectomy happened shortly before Easter weekend that year.  The Sunday before his operation, he sang "Flee as a Bird" to our church congregation as his final vocal performance, accompanying himself on the piano.  I remember being there for that but, at the tender age of 6, I did not understand what the occasion was or why no one clapped for him afterward.  I just remember the whole sanctuary being dead silent.  I know now that the lack of applause was because everyone was in tears, knowing they had just heard him sing his last song.  Days later, Dad went into surgery and woke up a different person.  He beat cancer, but he never stopped grieving the loss of his voice.  His grief and frustration showed through plenty of times while I was growing up.  It shrouded him.  He carried it with him until the day he died.  To this day, I have very few memories of his actual speaking voice and they're very faint, usually mixed in with the "burping" voice he later learned to use while breathing through the stoma in his throat.  

 

Forty years later, I'm finding myself reliving those same events, but from my dad's perspective as a parent.  He knew he would be having a surgery that would save his life but at a very steep price, and that it would have a profound effect on him and his whole family.  After being told I would need a mastectomy, I struggled with how and what to tell Avery about what was happening to Mommy.  When I asked Brian, he felt that we shouldn't tell her anything at all.  But as the child of a former cancer patient, I knew there was no way to completely hide it from her.  Kids are very intuitive and they pick up on so much more than we give them credit for, especially our little inquisitor.  By the third appointment she accompanied us to, she was already asking, "Why does Mommy see so many doctors?"  Brian just told her, "To keep her healthy!"  But how was I supposed to explain to her that I couldn't pick her up or hold her for 6-8 weeks straight, or why I had giant stitches and surgical drains in two places?  Even worse, there would be no shielding my grief over the loss of a significant part of my anatomy from her.  It would be a dark cloud hanging over me for the rest of my life.  I would never recover psychologically and Avery, not just I, would likely bear the brunt of that, too.

 

I often wondered if only my dad had gotten cancer even a year or two later if he may have had more treatment options that might have spared him from having that surgery.  Just recently, I asked my mom that same question.  Was radiation even a thing back in 1985?  She doesn't remember all the details since it was so long ago and she was too upset to process it at the time (I can relate).  But she did say he was given an option of a partial laryngectomy with cobalt radiation, or a total laryngectomy.  However, he was told the more conservative treatment would give him a 60-65% chance of survival, whereas a total laryngectomy would bump that up to 85%.  He chose the option with the highest chance of keeping him around.  I think I probably would've done the opposite if I's been in his shoes.  I would have exhausted every alternative before submitting to the most extreme option.  Perhaps my dad later regretted his decision.  Maybe part of the grief he felt was the aspect of "what if?"  I wish I'd thought to ask him these questions while he was still here, but I never did.  

 

Remembering all of this, I think my opposition to the mastectomy largely stemmed from the impact my dad's surgery had on him, and on our family.  It affected him professionally as well as personally.  He was discriminated against when it came to things like finding jobs.  He was told his voice was "offensive" so anything with phone work was out.  Other kids made fun of how he sounded--to me, to my face.  But the worst part was the times I watched him break down in tears, longing to be able to sing again.  He told me more than once that his dream would have been playing Jean Valjean in "Les Miserables" opposite me as Cosette.  We could have been a real-life father/daughter duo had cancer not interfered.

 

Cancer had already taken too much away from my family.  I just could not accept that same outcome for me and Avery.  I was determined to save as much of my anatomy as possible so she would never have to grow up dealing with the same parental grief I did.  Was I taking a risk by doing this?  Hell yes!  But I could live with the risk far more than I could live with the regret.  

 

On Monday, June 2, I had a Zoom meeting with the radiation oncologist for the clinical trial in Cleveland.  We talked for about 20 minutes.  She explained what exactly the trial was studying, the criteria for qualifying, etc.  Basically, they were looking for women with a history of invasive breast cancer who'd previously undergone a lumpectomy and whole breast radiation, then later experienced either a local recurrence or a new primary cancer in the ipsilateral breast.  The affected area had to be smaller than 3 cm (mine was right around 2 cm according to my scans), and the lumpectomy cavity needed to be <30% of the total breast volume to minimize the possibility of complications, including toxicitiy and poor cosmetic outcome.  I seemed to fall under all those categories.  She did caution me, however, that most physicians aren't comfortable performing this treatment on women under the age of 50 since the younger you are, the more years you have left for the cancer to come back (something I've heard many times before).  Most physicians, however, are fairly comfortable treating women over 50.  I was 46, which put me right on the cusp.  But the factors in my favor were the size of the area being treated, the fact that it was in a completely different place than last time, it was still in situ, it was located in the front rather than in the back near my chest wall, and it had been more than 5 years since my previous radiation.  What it really came down to was whether I could find someone willing to do the lumpectomy on me, and what my final surgical pathology would be. 

 

She offered to reach out to my surgeon to discuss my candidacy for the study, which I readily agreed to.  I also told her I would be getting a second opinion on Wednesday, then meeting with my oncologist on Friday just to see his thoughts on this.  She then asked how far away I am from VCU.  I quickly checked Google maps and found I was only 1-2 hours away (depending on traffic, of course).  She said she has contacts there who would very likely be willing to do a repeat lumpectomy, including one physician who is co-writing an initiative with her to codify the standards for repeat radiation after second lumpectomy.  She also told me the surgeons at her hospital did them frequently and are "very motivated" to do breast-conserving surgeries whenever possible.  So worst case scenario, I could have treatment either in Richmond or Cleveland, then do the trial.  We left things at: "Let's circle back after you've had surgery!"  Knowing this trial was officially an option was a HUGE weight off my shoulders.  The only hurdle left was finding out whether I was really a candidate for repeat lumpectomy, and finding a surgeon who would agree to do it.

 

On the morning of Wednesday, June 4, Brian and Avery drove with me to my second surgical consultation.  This one was in Leesburg, so a bit further away than right down the street, but not unreasonable at all.  The hospital was beautiful!  The one in Reston really pales in comparison.  Also, much to Avery's delight, there was a Starbucks kiosk right outside the cancer center's suite!  (No, my 4-year-old does not drink coffee yet, but she sure loves her cake pops!)  Brian waited with Avery in the waiting room when I was called back.  The nurse took my vitals, then led me to an exam room where I gave her some of my background and confirmed the information they had on all the medical records I'd already sent over.  She then instructed me to put on a gown and the doctor would be in shortly.  

 

To say this surgical consultation went better than the last one would be a huge understatement.  This doctor, after speaking with me a little more about what we were dealing with, was more than willing to do a second breast-conserving surgery on me.  She felt I was a great candidate for it since it's DCIS rather than invasive disease (assuming that doesn't change between now and my surgery date), in a completely different area than the original, and a relatively small size.  I had to make absolutely sure I was hearing this right, so I asked her if she really was 100% willing to do a repeat lumpectomy.  She answered, "Oh, yes!  I do them all the time!"  I was completely elated to hear this news, but also quite confused.  My previous surgeon had told me it would be malpractice if she were to do another lumpectomy on me.  I could understand if she just wasn't comfortable with the idea, but to go from "malpractice" to "I do this all the time!" made absolutely no sense.  (This absolutely underscores the importance of seeking a second or third opinion!)  

 

While we were talking, there was a light knock on the door.  The doctor opened it slightly and saw the nurse standing there with both Brian and Avery in tow.  I was surprised since I thought they were going to stay in the waiting room, but apparently the nurse thought it was important for them to be in the room with me for support.  That was fine.  I was able to introduce Brian to my new surgeon, stating their shared academic and geographic connection.  They chatted about Michigan stuff for a minute, then we brought Brian up to speed on the new plan.  (Avery had been given some crayons and pages to color by some ladies in the waiting room, which she happily busied herself with on the floor.)  The surgeon asked if I had met with a plastic surgeon yet and I told her I had, giving her his name.  She said, "Oh, I know him.  I work with him all the time!  Would you like to have him there for the surgery to assist with any cosmetics if needed?"  I told her it couldn't hurt.  So she said she would have her surgery scheduler coordinate with his, and I should be able to get it done within a few weeks.  Talk about feeling overjoyed!

 

The doctor then stepped out for a minute to grab some information for me and confer with her staff about a few things.  While she was gone, Brian asked me, "So are you excited?"  I told him 'excited' wasn't quite the right word.  How could I be excited about being cut open again?  But knowing I would be able to save my breast from amputation one more time was a huge relief.  

 

The visit was somewhat comical since they kept acting like I was a first timer, offering me all sorts of literature on life with breast cancer and survivorship (most of which I already had with me in my tote bag), and explaining everything in simplified terms.  Something new I did learn, though, was that wire-guided lumpectomies are a bit outdated now.  My second lumpectomy would be guided by a tiny magnetic metal seed called a Magseed, which would need to be inserted a few days prior to my surgery.  This seed would basically act like a metal detector to guide them to where the tumor is located.  Much easier and less cumbersome than the giant wire guitar strings I'd had during my first surgery.  Amazing how quickly medical technology can evolve in just a few years!  

 

At the end of my consultation, the doctor said she would refer me to a radiation oncologist at their facility, and that I should hear something soon regarding a surgery date.  She also said the tumor board was meeting on Monday and she would present my case to them, just for confirmation that I was a candidate for repeat lumpectomy and partial breast reirradiation.  Assuming they agreed with her assessment (which she felt strongly that they would), we were good to go.  For the first time since my mammogram results, I was feeling more at peace.  This was a surgical plan I was on board with!  However, there was the other aspect of treatment I knew would be coming after that I was already dreading.

 

A funny thing about breast cancer reoccurrences is that the second cancer can often be a completely different type from the first.  My original cancer had been moderate-grade and over 90% positive for both estrogen and progesterone receptors.  This new one was high-grade, only 40% estrogen positive, and progesterone negative.  But regardless of the change in percentage of estrogen receptors, the long-term treatment for estrogen sensitivity is the same.  This new cancer meant I would most likely have to go back on Tamoxifen.  Talk about the low blow that comes after the huge kick in the groin.  Although I'd been reveling in no longer having to take that stuff, at age 46 I had now entered perimenopause so I was officially in the twilight years of my fertility.  As my natural estrogen supply started to dwindle, a lot of the side effects I'd had on Tamoxifen were beginning to come back.  Being permanently barred from ever taking hormone-replacement therapy, I'd actually started taking an herbal supplement back in January called Estroven to ease some of the symptoms, as recommended by my PCP at my annual wellness exam that month.  It was a total game-changer!  I felt 10 years younger on it!  Since it was 100% herbal and hormone-free, I hadn't even thought to ask my oncologist whether it was OK for me to take.  That oversight came with a startling blow at my appointment with him on Friday, June 6.  

 

On the afternoon of my appointment, my oncologist gave me both good news and bad news.  The good news was he not only agreed that it would be acceptable for me to do a second breast-conserving surgery with partial reirradiation, he also spoke very highly of my new breast surgeon, even calling her "excellent!"   The bad news, though, was that he confirmed my fear that I would have to go back on estrogen suppression therapy.  He was sympathetic to how miserable I'd been on Tamoxifen, but unwavering in his opinion that I had to take it.  He even floated the idea of inducing menopause and putting me on something even stronger.  The idea of making all those side effects permanent was just incomprehensible.  Clearly any hope I had of enjoying my remaining pre-menopausal years was now gone.  And since I would be on it for at least another 5 years, meaning I would be 51 before I could go off again, there would be virtually no chance of Avery ever having a younger, full-blooded sibling.  

 

I hadn't particularly been trying to have another baby and wasn't staking my future happiness on it by any means, but I'd been enjoying not having to worry about it one way or another.  After 40+ years of either actively avoiding pregnancy or deliberately trying for one, I was finally at a place where whatever happened happened.  For the first time in my entire life, I was both off Tamoxifen and in a stable, long-term, committed relationship.  It was wonderful not having to worry about pregnancy either way.  But all of that was about to change.  And for the rest of my pre-menopausal life.  

 

As I was lamenting all of this news inside my head, I mentioned the fact that I'd been taking Estroven to my oncologist.  He was unfamiliar with it, so he did a quick look-up on his phone, asking if I knew exactly what was in it.  I told him it was just rhapontic rhubarb root, so it didn't contain any hormones.  He said, "Yes, but do you know exactly what is in it?"  Not having the package on me right then, I could not answer.  He turned his attention to his phone momentarily as he researched it, then announced, "Yeah, I would stay away from it."   

 

Dumfounded, I asked why.  He explained that even though it doesn't contain any estrogen, that particular herb still acts like estrogen by binding to the receptors in the breast tissue, which makes it a potential recurrence risk.  My stomach dropped hearing this.  Not only was my one avenue of relief now no longer an option, but I'd been taking something unsafe for several months now!  What if....?  Could it be this is why I got cancer again?  Did I do this to myself??  

 

"Unlikely," my oncologist answered when I asked him that very question.  Since I'd just started taking it in January, my cancer probably started growing before then.  Still, I needed to stop taking it ASAP.  Small comfort for me.  That little herbal remedy had been so wonderful to me.  I had more energy than I'd felt in a long time, my mood was more stable, I was losing weight, and it had even cured the chronic neck pain I'd had for over a year.  But apparently it can also kill me.  There is literally nothing I can take to improve the side effects of mother nature and father time.  This was just the most unfair thing ever.  My one consolation was that I had managed to avoid mastectomy, the only irreversible part of this whole mess.  Hormone suppression sucks, but it's still reversible if I absolutely cannot bear it at some point (and I anticipated that point would come sooner than later).  

 

I was still quite distraught as I drove home.  The nagging thought that even if I hadn't caused but possibly contributed to my current state of affairs was distressing.  Now I just had to pray that things didn't get any worse between now and my surgery date, whenever that ended up being.  It was another week of waiting until I learned when that was.

 

The following Friday the 13th (ominous, again), I was outside doing my lunch hour walk when I got a text message informing me of a post-op appointment on July 18th.  There was nothing in it about the actual surgery, though.  Confused, I checked my patient portal to see if there was any additional information there.  There I found that my surgery had been scheduled for Thursday, July 3rd.  That was both good and bad.  Good because I could take the long holiday weekend to recover and likely return to work on Monday, plus Brian's mom would be visiting then and on hand to help with Avery in the event my mom wasn't able to come down for it.  But bad because I would be in recovery mode during my favorite holiday, and I'd be unable to attend the "Celebrate America!" concert at the Kennedy Center I had tickets for that same night.  All in all, I was just glad to have something on the books.  I felt better knowing my lumpectomy was officially on the docket, as if that kept me one step further away from mastectomy.  

 

On Tuesday, June 17th, I had my consultation with my new radiation oncologist.  Of all the physicians I had met with since forming my new plan, she seemed the least enthusiastic.  While everyone else kept assuring me I was a great candidate for this, her thoughts were more along the lines of, "Well, you're going to do what you want, so I can't force you."  She went the protocol for partial-breast reirradiation.  It sounded a lot easier than whole breast radiation, and it was a lot shorter duration (every day for 3 weeks as opposed to 6).  She also informed me that there's yet another new test they can do that's similar to the OncotypeDx and the Breast Cancer Index.  This one is called DCISionRT and, like the others, it checks for various genetic markers on the cancer to determine whether the patient would benefit from radiation or if lumpectomy alone is enough.  If I could avoid radiation entirely, even better!  Chances are, since my DCIS was high grade, my test would come back in the high risk category, meaning radiation is still necessary.  However, she said that about 15% of the time, she's pleasantly surprised, so it was worth it to run the test on me just to be sure.  They could even use the tissue samples from my biopsy, so I didn't need to have another procedure.  The only thing was that it takes about 2 weeks to get the results and my surgery was only 16 days away, so we had to cross our fingers that it would come back in time.  

 

My Magseed placement was scheduled for first thing in the morning on Monday, June 30th, 3 days before my surgery.  I had to wake up before the sun was even up to get ready and drive out to Leesburg by 7:30 a.m.  My biopsy site was still very sore and swollen with a sizeable hematoma underneath, so I wasn't crazy about being manhandled there again, but at least it should help them identify the correct area.  

 

The first thing they wanted to do was a mammogram in order to ensure the biopsy clip had been placed correctly.  (That's usually done immediately after the biopsy, but my inability to stop bleeding that day prevented that from happening.)  So I did that first, then waited in the dressing room while the tech ran the images back to be read by the radiologist.  A few minutes later, she called me back into the imaging room, stating that the doctor wanted to double-check something, then she pulled out the high-resolution paddles.  I started to get a bad feeling in my stomach.  She took a couple more images, then told me to wait there in the room while the radiologist read them.  I waited for a few more minutes, pacing nervously.  When she came back in, she directed me into another room so the radiologist could go over his findings with me.  That bad feeling in my stomach was starting to get even worse.

 

I sat in the consultation room in my drab cloth hospital gown, fidgeting anxiously for several minutes.  The radiologist then entered the room and quickly introduced himself.  Suddenly, we both paused as a wave of recognition passed over us.  

 

"We've met before!" he said.  It was the radiologist who'd done my very, very first biopsies back on April 24, 2017!  The irony was certainly not lost on me.  The deja vu was overwhelming, not to mention unsettling.  

 

"What's going on?" I prodded him.  He then broke the news that he had seen 2 new areas of microcalcifications on my mammogram that morning, both distinct from and in completely different areas from the previously biopsied lesion.  He'd compared the images to my earlier MRI, screening, and diagnostic mammograms and neither had appeared on any of them.  Whatever these were, they had literally popped up in the span of 4 weeks.  He recommended biopsying both of them.  Unfortunately, he wasn't able to fit me in for a double biopsy right then since he had a full schedule of patients, so we would have to schedule those for a later date.  In light of this, he felt that we should cancel the Magseed placement that day just in case the biopsies came back showing that lumpectomy is no longer indicated.  

 

No longer indicated.  Med-speak for unnecessary.  In other words, he felt there was a high enough chance I would not be able to have breast-conserving surgery that it would be a waste of time to prepare for one, unless the biopsies proved otherwise.  Every physician likes to say it's "just to be safe" or "to err on the side of caution" but I've since learned that's merely a platitude.  He clearly felt these new suspicious areas were most likely DCIS and, at that point, I had no reason to disagree.

 

"FML." I told him, resignedly.  So, my Magseed placement was cancelled and my biopsies were scheduled for noon on Thursday, July 3rd since they couldn't get me in any sooner.  My lumpectomy was officially postponed, pending the results.  

 

The universe apparently was not yet done throwing me curveballs.  

 

To be continued in 2025 A.D.: Part 3 

2025 B.C. and A.D.: The Sequel (Part 1)

They say lightning never strikes the same place twice.  Unfortunately in my case, this is not true.  On Thursday, May 15, 2025, for the second time in 8 years--almost to the same exact day!--I officially became a breast cancer patient again. The good news is it was caught even earlier this time thanks to my annual screening mammogram, while it was still in situ (i.e. not yet invasive).  However, the bad news is it's on the same side as last time, which complicates things since the current treatment standard states that you can't radiate the same breast twice.  So I was told by my breast surgeon that this new diagnosis would mean a much more invasive surgery with a much longer and more difficult recovery.  Apparently, cancer wasn't satisfied with taking just a small piece of the pie last time, so it decided to try again for the whole damn thing.  I just don't understand why this disease won't f*cking leave me alone!

 

2025 B.C. (Before Cancer)

 

The warning signs had been everywhere.  My 8-year "cancerversary" was approaching and the universe seemed to be going out of its way to remind me.  I'd been seeing my diagnosis date (4/28) everywhere I looked: on court documents at work, on TV, even at the grocery store.  Just a week or two before my mammogram, I grabbed a jug of milk out of the refrigerator at Target and there it was on the expiration date.  I chuckled, amused at the cosmos' sense of humor, but then I looked up realized it was on every milk jug on that entire shelf.  The superstitious side of me found that disconcerting, but the rational side of me brushed it off as merely coincidental.

 

I'd been doing well with living my life for the past 4 years, the stress of parenthood notwithstanding.  I hadn't seen my breast surgeon since the day she recommended me for the POSITIVE clinical trial back in June of 2019.  I'd been downgraded to seeing her Nurse Practitioner for my annual follow-ups instead.  My most recent visit to their office in May of 2024 was to be my last.  The NP gave me a hug, congratulated me on "graduating" from their care, and sent me on my way, saying "Go and live your life, girl!"  That year was also the year I was downgraded from diagnostic to screening mammograms.  Instead of the images being read right away, I had to wait 5 days for the results to be mailed to me, like all the other cancer "muggles."  By all accounts, that entire era of my life was finally being packed up and stored away, almost as if it had never happened.  

 

I'd stopped taking Tamoxifen Memorial Day weekend of 2023, six months short of the expected 5 cumulative years, but under the approval of my oncologist.  The side effects had just become too much to bear, especially with a small child whose earliest memories were becoming clouded with me losing my temper over little things.  The final straw had come a few months earlier while driving in my car with Avery strapped into her car seat in the back.  I was screaming obscenities at the top of my lungs because my phone wouldn't connect to Bluetooth.  When I stopped and looked back at Avery, she was crying and hiding her face with her sippy cup, whimpering "I'm sorry, Mommy!"  (The poor thing just wanted to listen to Mickey Mouse songs!)  I knew right then that something had to give.  

 

In December of 2022, I'd requested a Breast Cancer Index text, which is a brand new test similar to the Oncotype test that was done after my lumpectomy.  While the Oncotype checks the tumor's genes in order to determine whether the patient would benefit from chemotherapy, the BCI test assesses whether the patient would benefit from 10 years of hormone therapy, or if 5 years is sufficient.  My test showed no added benefit from 5 additional years, and I was all too happy to take it at its word.  I'd planned to keep taking it all the way up to November to get to the full 60 months, but after that incident with Avery in the car, I just couldn't take the misery any longer.  I met with my onco to discuss going off of it a few months early, given my low BCI test score.  He gave his approval.  I was finally free from Tamoxifen prison!!  

 

Then came May 5, 2025 ("Cinco de Mammo," as I irreverently called it).  I had my annual screening mammogram at the Women's Imaging Center, the same facility that had done my wire placement the morning of my lumpectomy.  Afterward, I saw the images displayed up on the tech's computer screen and wistfully noted my rads makers still in their place, plus the biopsy clip from my benign stereotactic biopsy of November 2017.  However, there was something else towards the bottom of the screen that caught my attention.  Something that definitely was not there the year before.  It was a long, thin white line with a couple of small branches at one end and slightly slanted, almost like it was smirking at me.  I thought about pointing it out to the mammographer but didn't, thinking maybe it was something harmless, like scar tissue.  

 

The next day, I received a call from the Imaging Center informing me I had some new microcalcifications in my right breast and that they needed to bring me back in for diagnostic imaging.  I immediately knew it was the white line I'd seen on my image, and I was instantly resigned to this being a new malignancy.  I broke down crying as soon as I hung up the phone.  I couldn't even entertain the idea that this was something benign. Given that I was 1 out of 3 on benign biopsies, I didn't want to set myself up for that kind of disappointment.  I immediately texted Brian just to let him know.  He wasted no time in replying: "When's your appointment?  I'll be there."

 

My diagnostic scans took place the next day.  I got to sit in the patient waiting area while the radiologist read them, while Brian sat out in the main waiting room.  After a few minutes, they called me back in to speak with the radiologist (always a bad sign).  He confirmed that the white line I'd seen on my screening mammo was in fact the new area of concern and declared it "moderately suspicious."  He recommended a stereotactic biopsy.  I used my favorite curse word on him and cried in frustration, "I knew it!  It's DCIS, isn't it?!"  He didn't agree or disagree.  He just said that, given my history, they have to biopsy it just to rule that out.  But in my head, I had already called it.  Given its location, shape, and pattern (all of which are hallmarks of DCIS) and not to mention my personal track record, I would have been shocked if it turned out to be anything different.  

 

On Tuesday, May 13, I had my third (to date) stereotactic biopsy, in the same room and on the same table and almost to the same day as my lumpectomy wire placement on May 18, 2017.  The deja vu was overwhelming.  I found myself reliving every moment in sequence, right down to the "branding" of their initials on my chest with a black marker.  

Stereotactic biopsies are one of the least pleasant outpatient procedures you can go through, and this one proved no different.  My previous ones had taken about two hours to complete.  This one took three, mostly due to my inability to stop bleeding afterward.  It looked like a crime scene underneath that table!  They spent an hour trying to stabilize the blood seeping from the incision before finally sending me on my way, packed with gauze, bandages, and ice packs all stuffed under a sports bra (which I just so happened to have with me since it was a gym day).  Usually they do a mammogram immediately after the procedure to verify the placement of the biopsy clip, but after an hour of trying to control the bleeding, they decided to forego that part.  They said I should know the results within 5 business days.  As always, waiting is the worst part.  But for better or worse, I didn't have to wait very long.

 

Two days later, on May 15, 2015 at 7:16 a.m., my phone rang with my PCP's office number on the ID.  I thought that was odd since their office didn't even open until 8:00.  I grabbed my phone and answered the call, but there was nobody on the line.  "Hello?" I said several times before the line went dead.  I waited to see if they would call back, but no one did.  I was extremely weirded out by this.  I couldn't help but feel that it was an ominous sign.

 

Once I arrived at my desk at work, I decided to log on to my patient portal, just to see if there were any new test results or something added to my file that could have prompted the phantom phone call.  Indeed, there was a new note on my chart (likely not intended for my eyes just yet) stating that the radiologist had called and informed them that my biopsy results showed high-grade Ductal Carcinoma In Situ.  

 

Out of all the emotions I had felt the first time I'd been given this diagnosis, only one stood out this time around: Anger.  I was pissed!  How dare cancer try this again with me!!  I cursed and slammed my hands down on my desk, then stormed out of my office and into the stairwell to call Brian, then my mom.  I also called my PCP's office and told them about the phantom phone call I'd received, asking if they had meant to call me about these results or if it had been a glitch. The person I spoke with played dumb, as usual, and urged me to schedule an appointment with my PCP to follow up on my imaging results.  

 

"What for?" I demanded, angrily. "I've already seen them!  Just tell me when my appointment with my surgeon is."  She didn't offer any further information other than offering to schedule an appointment with my PCP.  But I really had no desire to take even more time off work and give their office another co-pay just for them to tell me what I already knew.  I was done playing those games.

 

Eventually, I went back to my desk and pulled up my breast surgeon's office website.  I was staring at it, contemplating whether I should just call them myself, when my phone rang with their number on the ID.  It was my breast surgeon herself.  

 

"I was just about to call you!" I told her, incredulously.  "I'm guessing you saw my new biopsy results."  She confirmed the same, and we scheduled my surgical consultation for the following Thursday, May 22.  However, the news got even worse from there.  She informed me that since this was a brand new malignancy on the same side (although in a completely different area) as the original, and I'd already had whole breast radiation on that side, they couldn't do radiation again this time.  So this would change their disease management plan.  

 

"Change it to what?" I asked, already feeling the pit of doom forming in my stomach. 

 

"April..." she began.  (Please don't say it.  Don't say it!, I thought to myself.)  "April, you're going to need a mastectomy."  

 

"Fuck..." I exhaled, letting out all my breath.  I was suddenly plunged into a living nightmare.  Mastectomy is a completely different animal from lumpectomy.  It's inpatient, not outpatient.  It means needing reconstruction, which means needing a plastic surgeon.  It means a recovery time of months, not days.  It means surgical drains hanging from me and being unable to lift, reach, or squeeze anything for weeks.  How was I supposed to take care of a very active 4-year-old when I won't even be able to lift my arm above my head?  How was I supposed to clean the house or cook dinner for my family?  Most likely, Brian and I would have to postpone our vacation plans this summer, too.  Seriously, I don't have time for this!  I DON'T HAVE TIME FOR CANCER!!  For the love of God, why can't it just leave me alone??

 

My voice quivered as I asked her whether she could at least make it so that everything still looked the same, but my brain could not fully process the idea just yet.  She reassured me that she could try and we would discuss our options at my appointment.  Already though, I felt like I was scheduling my own execution.  Eight years ago had been a slap on the wrist.  This time, I was being led straight to the guillotine. 

 

I also had to ask her the all-important question: "Why?  Why did it come back?"

 

"Sometimes it happens." she responded.  "It doesn't happen often, but--"

 

"But it happened to me." I lamented. 

 

The full impact of my surgeon's revelation didn't hit until later that night, after Avery had gone to bed and I'd had my requisite glasses of wine.  The night of my original diagnosis had ended at Heather's house, eating Chinese take-out on her back deck with her, her family, and Sneha.  So I figured, why break tradition?  (Heather had since moved back to Minnesota a few years ago, but I'd been texting her with updates all week, and she was very much there in spirit.)  Annie and I already had our standing Thursday night dinner date that evening, which Sneha agreed to join us for once I informed her of my new diagnosis.  I canceled my cooking plans and told Brian to just order Chopsticks instead.  We all sat outside at our glass-topped table on the back deck, sipping wine and enjoying the lake view.  Just like last time, but in a slightly different location and with slightly different people.  It's amazing how, as much things change, they stay the same.  It's also amazing how, despite how much my life had changed in the last 8 years, some aspects of it I apparently just can't escape.

 

After Annie and Sneha left and Brian and I put Avery down for the night, he and I went back downstairs and sat on the living room couch.  There, with all the daytime noise and chaos at a lull, I finally felt the weight of that day's events creeping up from my stomach and into my throat, slowly strangling me.  Brian said something to me and I snapped back angrily at him.  That offended him, of course, which only compounded my mounting grief.  I was already grieving the part of my body I was slated to lose.  The tears started welling up in my eyes until I couldn't hold them in anymore, then all the fear and dread broke through with them.  

 

"This is going to change everything!" I sobbed to Brian.  He calmly assured me that we would deal with it, plus whatever other hurdles life decides to throw at us.  I yelled back, "Easy for you to say!  No one's trying to chop your [testicle] off!  This is too much!  I can't do this!  I can't have a mastectomy!  I can't do this!  I CAN'T DO THIS!!"  

 

Then I did something I hadn't done since the night Kirby passed away three years earlier: I laid my head down in Brian's lap and ugly cried myself into unconsciousness.

 

2025 A.D. (After Diagnosis)

 

The week between my biopsy results and my surgical consultation was both the longest and shortest week ever.  My surgeon's revelation on the phone with me was impossible to shake off.  I was dreading seeing her in that office and having to hear it out loud, as if that would somehow make it real.  Every day at work, I sat in my office feeling like the walls were closing in on me.  Also, I was clenching my jaw so hard, my face hurt!  I just could not accept that this would be part of my fate.  It was like there had been a glitch in the matrix of my life's plan.  This was not supposed to happen!  I was not meant to have a mastectomy!  There had to be a mistake somewhere.  

 

I was seriously considering simply not consenting to the procedure at all.  I couldn't even stomach the thought of going through with it.  One morning, while at work, I asked Brian via text what he would say if I refused a mastectomy, opting only for a second breast-conserving surgery instead.  He responded, "I would ask you if you feel like this is the best choice for you and your family.  If yes, then I would hug you and support you with that choice."  He also texted me a link to an article about repeat partial-breast radiation being done on women who'd had a small local recurrence.  Then he apologized, saying, "I'm probably not being very helpful."  But the wheels were already turning in my head. Was there hope of escaping this procedure after all?  I did some Googling of my own and found several abstracts on clinical trials that had studied repeat breast conserving surgery and partial-breast reirradiation as an alternative to mastectomy.  Although controversial and not considered standard practice, it appeared that it is indeed possible and that the outcomes were very similar to the control groups in cosmesis, adverse events, and disease-free survival rates.  Although there are risks of complications from repeat radiation, my risk of recurrence would be no worse than it had been the first time around.  So why didn't my surgeon even offer this as an option?

 

The day of my surgical consultation, I could not stop shaking.  The giant boot standing on my chest got heavier and heavier the closer it got to my appointment time.  I wasn't sure how well it would go, but I would definitely plead my case to my surgeon.  I even saved the abstracts I'd found on my phone's browser app so they would be readily available if needed.  It was a busy day since I'd also scheduled my bilateral breast MRI at noon (standard procedure after a new diagnosis to rule out any additional abnormalities missed by mammogram).  Brian was teleworking that day so he and Avery were able to meet me at the hospital for that appointment, but he had a meeting during my surgical consultation that he absolutely couldn't miss.  Unfortunately, that was the appointment I really needed him for.  

 

I was close to hyperventilating the whole half-mile walk from work to my breast surgeon's office.  Upon checking in, the front desk handed me their standard depression screening questionnaire.  I declined, stating it definitely would not go very well at that moment.  The whole time I was waiting in the exam room, I'd never been more conscious of the sound of the ticking of a clock.  It was like each second represented one less second I had to enjoy my life.  When my surgeon finally walked into the room, I couldn't even look her in the eye.  Every fiber of my soul wanted to jump out through the 4th story window and run.  I could not even explain the intensity of my fight-or-flight response in that moment.  

 

My surgeon seemed surprised by my reaction to her that day.  I told her in a tearful whisper, "I don't want to be here!"  Clearly I was no longer the same person I was when I first walked into her office 8 years ago.  Back then, I was raring to get the process going.  Everything was doable and nothing was insurmountable.  This time, it was anything but.  My very soul was diametrically opposed to what she planned to do to me.  I did not see how I could ever go through with it, and I trembled every time I thought about it.  

 

My surgeon remained calm while performing her exam, marveling at how well I'd healed from radiation.  But when she asked if she could examine my abdomen, I recoiled in horror because I knew what she was thinking: DIEP (Deep Inferior Epigastric Perforator) flap reconstruction.  I'd heard plenty about them from my breast cancer support groups.  Basically, the surgeon cuts a flap of skin and tissue from the lower belly and transfers it to the chest to rebuild the removed breast tissue.  It's a major operation that also requires microsurgery in order to connect the blood vessels in the flap to the blood vessels in the chest.  I'd heard so many stories in my support groups about how painful the recovery process is.  It's two surgery sites instead of one.  This meant I wouldn't just have a drain hanging from my chest but from my abdomen as well.  It would be like recovering from another C-section, if not worse.  Call me crazy, but the older I've gotten, the less appealing the idea of being cut open has become.  Not just that, but I'd heard more than one DIEP flap horror story where the patient was extremely unhappy with the result and/or had to wear a prosthesis anyway.  Absolutely no part of me could conceive of putting myself through all of that, especially for a cancer that wasn't even invasive yet!

 

My surgeon explained that she preferred to go the DIEP flap route because I was not a good candidate for implants. Since they have a tendency to adhere to radiated scar tissue, DIEP flap would be my best option for reconstruction.  I took that opportunity to ask about the secret third option she hadn't yet mentioned: a second breast-conserving surgery with partial breast radiation, as described in the abstract I then pulled up on my phone.  She scrolled through it for a minute, but ultimately was unconvinced.  She argued that since this is not considered the standard of care, it would be malpractice if she were to even offer that as an option.  She informed me: "If you want to go this route, you'd have to do it through a clinical trial."  

 

Was that a dare?  Perhaps she'd forgotten that the last time she referred me to a clinical trial, I took her up on it.  Either way, I was too upset to even think.  She proceeded to give me the rundown on needing a plastic surgeon for the reconstruction aspect, and would refer me to one, etc. I continued to just shake my head and sob.  No way was this really happening.  I wanted no part in any of it!  She then asked if I'd like a second opinion and offered to give me the names of some other breast surgeons.  I couldn't reply other than to say I would think about it.  I wasn't sure it would even be worth my while if my request would be considered malpractice anyway.  I just wanted to get the hell out of that office and as far away from there as possible, as if that would somehow stop it all from happening.  

 

I was too devastated to return to work after that appointment.  It was a little after 4:00 p.m. by then, so I decided to try to decompress at the gym.  While I was changing into my gym clothes in the locker room, I took out my phone and hopped onto the National Clinical Trials website, just to see if there were any trials for partial breast re-irradiation that were currently recruiting.  I actually found three with locations in the United States, two of which were in the recruiting phase: one in New York City, and one in Cleveland.  Not as close as DC, but not un-doable.  The third was in Florida and not yet recruiting, but was slated to start soon.  I sent email inquiries to all 3 immediately.  Within minutes, I received a reply from the one in Cleveland, asking me to send them my medical records.  I still had everything cancer-related stored in a large tote bag in my closet.  My homework assignment for the night was clear.

 

That night, I went into my closet and pulled out my Big Bag of All Things Cancer and set it next to my purse so I wouldn't forget to take it to work with me the next day.  Once I arrived in my office the following morning, I spent a few minutes digging through it to find all relevant reports, test results, etc., then scanned them into a folder on my work computer.  I emailed everything to the Cleveland people right away.  The assistant to the Radiation Oncologist heading up the study replied within an hour, asking me to call her on her direct line.  I called her as soon as I had some time to step out into the hallway.  

 

We spoke for several minutes about the trial and my desire to avoid having a salvage mastectomy and DIEP flap reconstruction.  She said she would have the doctor review everything I had sent and, if she feels I may be a good candidate, she'll schedule a virtual meeting with me.  This was encouraging enough for me to send a message to my breast surgeon's office, asking for some referrals for a second opinion.  I noted in my message that I was particularly interested in someone who would be willing to do a second breast-conserving surgery as I was already in contact with a clinical trial about repeat radiation, and would like to go that route if at all possible.  

 

My surgeon's office staff emailed me back 3 names of other breast surgeons in the area, and I immediately went to work researching them all (office location, hospital affiliations, education, background, etc.).  One in particular stood out to me.  She was fairly youthful compared to the other two, so I was initially skeptical whether she had enough experience to handle something like this.  But she was from the Detroit area--in fact the same suburb where most of Brian's family now lives--and had gone to med school at Wayne State, where Brian got his master's.  For whatever reason, I just felt a really good vibe about her.  I called her office and explained that I was looking to schedule a second opinion surgical consultation, ideally for a repeat lumpectomy.  They were able to schedule me an appointment for the morning of Wednesday, June 4th.  Brian was "flexing" (i.e. off work) that day, so he and Avery would be able to go with me.  It was perfect timing!

 

Two other things also happened that day: the office of the plastic surgeon I had been referred to called and scheduled my consultation with them for the following Thursday, May 29th.  I unenthusiastically agreed to it just in the interest of trying to keep an open mind, but I had no desire to meet that surgeon or discuss anything about the procedure.  I also called my medical oncologist and scheduled an appointment with him for Friday, June 6th, just to get his input and guidance.  Once again, I was experiencing the whirlwind of juggling multiple appointments with multiple physicians, my phone blowing up with calls from multiple offices (often overlapping), and going into autopilot just trying to keep my life straight.  It was 2017 all over again, but with the added demands that come with having a family.  How is it even possible for one person to be so busy?

 

The following week, on the morning of my plastic surgery consult, I received an email from the clinical trial in Cleveland asking if I could meet virtually with the doctor on Monday, June 2nd.  I replied with a very emphatic YES!!  I was borderline giddy!  It was actually starting to feel a bit like online dating: So far, I'd "swiped right" on 3 different trials, and received replies back from 2, but was definitely more interested in one and hoped they liked me, too, but I was still keeping my options open with the other one just in case.  Now I was about to have my "first date" with the one I was most excited about.  

 

For the past week or so, I'd been mulling over all the different choices I would have to make in the near future.  Choosing between surgeons, surgeries, reconstruction methods, whether to join a clinical trial, which clinical trial to join, or whether to try to have everything done closer to home.  I'd also received some pushback from a few people about my desire for a second lumpectomy instead of a mastectomy.  Apparently, some felt that it would be a mistake not to go for the most extreme procedure with the most assured outcome.  I'd had a few moments of self-doubt, wondering if I would be letting my family down by not towing the line and going with the current standard of care.  But I knew in my heart I just couldn't go through with that without exhausting every other possible option first.  Some women are OK with lopping everything off and never having to worry about it ever again, but I'm not one of them.  I could not stomach (so to speak) the thought of cutting off my entire breast and rebuilding it out of abdominal tissue.  Call it Stockholm Syndrome if you want, given that the damn thing had tried to kill me twice now.  But to have no sensation on that side of my body ever again, not to mention 2 more giant surgical scars...it literally nauseated me.  And I felt like it would render everything I went through the first time around all for nothing.  I could not beat invasive cancer once only to lose my entire breast to freaking DCIS!  And what if I did go through with a mastectomy, only for repeat lumpectomy to become the new standard of care 6 months later?  I'd never forgive myself!  At least with a lumpectomy, I could always take more out later.  But I can never put anything back in.  Mastectomy was just too drastic and too permanent.

 

With all the different choices I was facing, my prayer request that week became for all the doors to open to the path I was supposed to take, and that I would know it because I would feel 100% at peace with it.   

 

Later that afternoon, I found myself in the waiting room of the plastic surgery center with Brian and Avery, feeling again like the walls were closing in on me.  The tension in every muscle of my body made it nearly impossible to fend off a panic attack.  Avery, as usual, was enjoying being in Mom and Dad's company and leafing through the waiting room literature with me.  Her carefree, happy-go-lucky personality was the only thing that kept me from jumping off a cliff.  She was the perfect distraction from the reality of what I was dealing with.  For better or worse, her constant demands for my attention left me with little time to dwell.

 

Brian and Avery stayed in the waiting room after I was called back.  I made sure to let the medical assistant know that I had zero interest in being there, or in the surgery they were proposing.  I let both her and the doctor know I would hear them out, but I was planning to seek another breast-conserving surgery at any cost, if at all possible.  He seemed sympathetic, but also matter-of-fact.  He tried explaining some of the cosmetic risks that come with doing repeat breast radiation, but I argued that even a misshapen breast would be preferable to a fake one.  I said I honestly could not understand why so many women opt to do that to themselves voluntarily.  He offered to show me before and after pictures of DIEP flaps he had done, but I declined.  I'd already done my own research and had seen plenty of those pictures, and they only made me feel even more anxious and nauseated.  

 

Of course, they were eager to get me a surgery date on the books and sent in their surgery scheduler to talk with me at the end of the consultation. I felt like I was at a used car dealership with a salesman pressuring me to close the deal.  But I held firm, letting them know I was going for a second opinion next week, as well as meeting with a radiation oncologist in Cleveland on Monday.  So the surgeon said he would wait until I've decided on a treatment plan, then reconnect with me.  I'd succeeded in kicking the can down the road, at least for now...

 

To be continued in A.D. 2025 part 2 (currently in progress)...