2017 Post-Apocalypse: This Is My Life Now

It hasn't quite been 6 months since my last post but I feel like I've aged 30 years. Around this time last June, I was preparing to begin 6 weeks of daily radiation treatments in the wake of my lumpectomy and sentinel lymph node biopsy.  Radiation was surprisingly easy.  The main side effects are skin changes (redness, itching, swelling, etc.) and fatigue.  Because my rad onc opted to give me a lower dose over a longer period of time, my skin held up surprisingly well.  I noticed a slight pinkness after the first 2 treatments so I was bracing myself for the worst sunburn of my life as treatment progressed, but it kind of leveled off after the halfway point.  It was itchy and uncomfortable but nothing I couldn't tolerate.  I did my best to combat the fatigue by staying as active as possible.  I walked to work every morning, walked from work to the hospital for my treatment at noon, walked back to work after, and then walked back home. Plus I continued my thrice-weekly workout regimen.  I never felt a dip in my energy during the day, although I did notice I was falling asleep an hour or 2 earlier at night.  The treatments usually took about 20 minutes each (as long as the machines were functioning properly, which wasn't always the case) and all I had to do was lie on a table with my arm up in a holder while the rads team positioned the machine around me, then they stepped out of the room and pressed a button.  The machine buzzed for about 20 seconds, rotated around to the other side and did the same thing, and that was it.  There was nothing painful about it at all, save having to lie on a table topless in a room full of strangers.  It's amazing how normal that becomes after a while and how much shame you lose in the process.  (This is my life now!)

My last treatment was August 17, after which I had a happy hour to celebrate.  The following weekend was the annual beach camping trip.  I was under strict instructions not to expose the radiated area to the sun for at least the rest of that year, so I had to be very careful about keeping it covered, but it didn't hinder my ability to enjoy my weekend with my friends. The Monday after my last treatment (August 21), I met with my medical oncologist and we discussed the next phase of my journey: the hormone suppression phase.  For pre-menopausal women with hormone receptor-positive cancer, Tamoxifen is the drug of choice and it's not without its side effects.  The most common of these are hot flashes and mood changes (i.e. depression/anxiety), and the others range from as minor as joint/muscle aches to as serious as blood clots and even uterine cancer.  (Yes, I could actually develop cancer in my effort to prevent...cancer.)  My oncologist assured me, though, that he's treated around 1,000 women with Tamoxifen in his lifetime and has seen blood clots happen in only 2 or 3 (all of whom already had other risk factors) but had yet to see any of his patients develop uterine cancer.  All in all, though, I was more worried about the mood changes.  I'm a pretty happy person in general and didn't like the idea of that being messed with.  Well, I've been on it for nearly 4 months now and I can definitely tell a difference, but it's hard to say whether that's from the Tamoxifen or from outside influences.  (I've been under an inordinate amount of stress since the end of September so I may never know the true culprit.)  The hot flashes are very real and frequent, usually at night.  I've woken up in the middle of the night feeling like my skin is on fire.  Some nights, I'm boiling hot and freezing cold at the exact same time.  It's the most otherwordly sensation ever.  Between the hot flashes, random shooting pains, the increased moodiness, and my hair falling out at twice the rate as before, I feel like some little old crazy lady.  I already can't wait until I can stop taking this stuff.  This is my life now.

Cancer taught me many life lessons.  The most jarring one is that, no matter what stage you were diagnosed or how successful your treatment was, it's always going to play a part in your life.  Right before my diagnosis, I was endeavoring to become a homeowner and had put offers on a couple of different properties that I ultimately lost out on.  But I know that was for the best since I don't think I could've handled having surgery and radiation while worrying about going to closing, then packing and moving.  After active treatment ended and the dust was starting to settle, I figured I would start looking again after the first of the year, once I've had my annual merit raise and year-end bonus.  Unexpectedly, I got a call on November 2 from my boss telling me they were so pleased with my performance, especially in light of everything I'd just gone through while continuing to work full-time, they were giving me my raise 2 months early and it would be effective retroactively as of November 1!  You know how they say timing is everything?  Well, this news opened up the doors for me to resume my house hunt ahead of schedule.  At my realtor's urging, I put an offer on a place that following Monday, November 6.  It was accepted!  After a year and a half of looking, I was finally about to become a homeowner!

However, the Monday after that (November 13), was my 6-month post-op unilateral mammogram.  I went in, as usual, expecting to be out in 30 minutes. As usual, the universe had other plans.  I was barely 6 months out from surgery and 3 months out from radiation so they couldn't possibly find any new abnormalities, right?  Wrong.  The radiologist on duty that day informed me that I had a brand new cluster of microcalcifications on that side, near the same spot as last time.  He was recommending a stereotactic biopsy.  I thought maybe he was kidding at first.  I can't even tell you how much my heart broke hearing this news.  I never wanted to repeat the hell of a stereotactic biopsy, especially so soon after the last one.  And what if it came back positive for cancer again?  How was I going to move forward with buying and moving into my soon-to-be new home while recovering from more surgery and/or going through more radiation??  Those little words he spoke carried with them the potential to derail everything I'd been working towards for the past 18 months.  I was so distraught, I couldn't even see straight.  I met with both my surgeon and med onc the following Wednesday for my periodic follow-up appointments.   Neither of them seemed too concerned about this new abnormality (although that was every physician's stance last time).  In the words of my med onc, these things "tend to happen" after radiation and "more often than not" they're benign.  Again, the same scenario as last time so small comfort.

The biopsy was scheduled for Monday, November 20.  I was somewhat glad about that because Victoria would be in town that week for Thanksgiving and staying with me, so I'd have someone around in case anything were to go wrong.  But I was also not so happy about that because, with my doctor's office being closed for the holiday on Thursday and Friday, I probably wouldn't learn the results until the following Monday, which meant 2 full weeks of stressing and not knowing if I'd be able to move forward with my home purchase.  Remember when I said waiting patiently has never been my forte?  Well, that's probably the one thing in my life that cancer hasn't changed.

If there's anything positive I can say about having to go through another stereotactic biopsy merely 7 months after the first one, it's that it didn't hurt nearly as bad the second time around.  (Nothing like radiation beams to toughen your skin up like leather!)  Also, the results came back much sooner than I was anticipating.  I had the procedure done Monday afternoon.  On Wednesday morning, I got a call from my surgeon's office informing me that everything had come back benign.  It was kind of surreal hearing those words when I was so used to hearing differently, but I'll take it!  Now I could close on my house without the additional stress of a new cancer diagnosis and treatment looming ahead of me!  I spent Black Friday weekend at Burke's beach house in Rehoboth, just like I'd done the weekend after my previous biopsy.  Only this time with much less depressing news.

However, it simply isn't in my nature to not challenge myself or push myself to the limit.  In addition to dealing with this new abnormality, preparing for closing, finding a sublettor to finish out my current lease, traveling out of state for the holidays, then packing and moving, plus my existing workload at my full-time job, I also agreed to perform in a Christmas concert at the Slovenian embassy the day after my closing date.  And not just as a chorister but as one of the featured soloists!  So on top of everything else, I was now tasked with learning music and juggling a rehearsal schedule. So this is what the last couple weeks of my most transformative year to-date will look like: Dress rehearsal (and Kirby's 13th birthday!) today, closing tomorrow followed by a small celebratory happy hour, concert on Saturday, annual Christmas party/gift exchange at Rob and Christina's house on Sunday, begin packing on Monday, move small things on Saturday, fly to Ohio on Sunday, fly back to Virginia on Wednesday, finish moving furniture and big items on Thursday, clean my old place on Friday (including having the carpets professionally cleaned, as per the terms of my lease) and do a final walk-through at some point, then possibly travel somewhere for New Year's weekend Friday or Saturday.  Just these next 4 days are more action-packed than some people's entire months!  At this rate, I won't even be unpacked and settled into my new place until mid-January, if that soon!  I'm hoping to have a housewarming party sometime before my birthday, but who even knows.

As I stated earlier, one thing I've learned this year (and over the past month especially) is that cancer will always play a part in your life.  Whether it's dealing with the long-term side effects of treatment, the fear of recurrence, or the anxiety of what could be lurking below the surface at every yearly screening, you're never completely free from it.  I went in for my 6-month scans thinking the whole ordeal was behind me only to find out differently.  I've realized that you should never talk about cancer in the past tense because it's never in the past.  In a way, being diagnosed is like being reaped for The Hunger Games in the post-apocalyptic world of Panem: There are victors, but there are no real winners.  You may best the other tributes, but you never get off that victory train.  And someday, when you least expect it, you could get pulled right back into that arena to fight all over again. 

Today, on the eve of my becoming a homeowner, I'm feeling both excitement and dread.  After having to move 4 times in 12 1/2 months a few years ago, it still feels too soon to be boxing up my entire life and doing it again.  Once that's behind me, hopefully I can relax a little and enjoy no longer being a renter.  But who knows what 2018 will have in store for me?  It boggles my mind to think about everything that's transpired in just the last 8 months.  I always said I like to keep busy, but this is an awful lot of busy-ness, even for me.  Despite all I have or soon will accomplish, I will never look back on 2017 as having been a "good" year.  Momentous, yes, but the bad and the good carry equal weight, in my opinion.  However, I'm happy to at least be ending it on a high note.  And how many other people can say they beat cancer and bought their first home in the same year?  Not too many, I'd wager.  In the words of John Locke on "Lost": "Don't ever tell me what I can't do!"  Facing challenges and rising above them: this is my life now.

2017 B.C. and A.D.

Friday, April 28, 2017 is a date that will remain etched in my memory because it's the day my life changed forever.  It was the day my "probably nothing" became a huge "something."  It was the day I knew I could never go back to being the person I was so used to being up until that point.  It was the first time I'd heard those dreaded words spoken to me instead of to someone else.  It was the day I joined the greatest sisterhood I never wanted to be a part of.  It was the day of my cancer diagnosis.

2017 B.C. (Before Cancer)

It was the evening of April 5, 2017 when I found The Lump.  I remember the exact date because the first thing I did was text my mother, so the date is not only fixed firmly in my own memory but is also eternally time stamped in the Cloud.  I also remember it because it was a mere 6 days after my annual physical, where my primary care physician had dutifully performed all standard examinations yet felt nothing amiss.  I don't quite remember how I found it, though.  I was sitting in front of my television watching "Jeopardy!" (oh, the irony!) and just happened to have my hand in the right place at the right time.  I wasn't performing a self-exam or anything laudable like that.  I believe I was mindlessly scratching an itch or something.  It was small (just slightly larger than a pea) but palpable and non-painful.  It's the kind of thing you always train your brain to be on the lookout for, but don't expect to actually find.  Regardless, I was more curious than alarmed.  It was located just distal to my underarm, near my axillary lymph nodes, so I figured it was probably just a swollen node.  My text to my mom was to that effect as well.  She assured me there are plenty of things in that area that can get blocked or swollen and, with more than 30 years of nursing experience under her belt, I had no reason to doubt her.  I was also busy rehearsing for an opera performance coming up that weekend, so rather than calling my doctor, I waited a few days to see if it would go away on its own.  Needless to say, it didn't.

The following Monday (April 10) was when I finally called my doctor and not even to schedule an appointment but to find out if she had made any notes in my chart at my last visit that might explain what the lump was or where it came from.  She hadn't, so her medical assistant advised me to make an appointment to come in and have it checked, which I scheduled for the next morning.  I still wasn't concerned at that point.  I was mainly just tired of wondering what it could be and interested in finding out what it was.  When my doctor felt it, she didn't seem worried either.  She said it was "probably nothing" but gave me an order for a breast ultrasound just to be sure.  When I called to schedule the ultrasound, they offered me a time the next day but I was reluctant to take time off work 2 days in a row, so I selected an early morning appointment for the following week on Wednesday, April 19.

I thought I'd be in and out of that appointment in 30 minutes.  Instead, the tech was hesitant to do the ultrasound before doing a mammogram first, which I didn't have an order for.  She explained that mammograms often pick up things an ultrasound does not, so they attempted to call my doctor's office to obtain an order for one but were unable to reach her directly.  I sat in the waiting area for two hours while they continued to try to reach her.  I was draped in a drab, sterile hospital gown and surrounded by dozens of anxious women (most of them many years my senior) and growing more and more annoyed by the delay.  Eventually, they decided to just proceed with the ultrasound while they waited.  The mammogram order came in via fax while I was on the table having the ultrasound done, so I went straight from there into the mammogram room.  

At 38 years old, I'd never had a mammogram before and was extremely apprehensive since I'd heard so many horror stories about how painful they are.  Well, those fears turned out to be completely unfounded because there was nothing painful about the procedure at all.  However, the images revealed an additional abnormality: a cluster of microcalcifications near the palpable lump.  They ended up calling me back in to take additional images with higher magnification and some in 3D.  The radiologist on duty didn't seem to like what he saw, but didn't mention the "C" word just yet.  He just said they weren't sure what it was but there were things about it that concerned them, so he recommended I have both areas biopsied "sooner rather than later."  The lump would be an ultrasound-guided biopsy, and the calcifications would be a stereotactic-guided biopsy.  (Stereotactic = a mammogram done by lying face-down on a special table with your womanhood hanging down through a hole and squished between 2 paddles with X-ray vision.)  Those were scheduled for the following Monday, April 24, and would necessitate taking an entire afternoon off work.  A couple business days after the mammogram, I received my first ever BIRADS categorization via the report uploaded on my online patient portal.  It was Category 4: "Suspicious abnormality."  I'd spent 4 years working in an OB/GYN office.  I'd seen reports like that many times, most of which came back fine.  Statistically, a category 4 only comes back positive for malignancy 30% of the time.  The report was unsettling, but the odds were still very much in my favor.

Biopsies are never pleasant but a stereotactic-guided one is the closest to hell on earth I've ever been.  For the ultrasound-guided one, the area was numbed first with lidocaine so I didn't feel the spring-loaded needle going in, but I felt the impact of it punching through my skin and hitting my rib cage.  I also felt it every time they took a piece of tissue (4 or 5 in all) and it was like someone punching me in the side hard enough to knock the air out of my lungs.  The radiologist immediately looked at the tissue samples under a microscope.  He was hoping they would also contain bits of the microcalcifications and therefore eliminate the need for the stereotactic biopsy, but they didn't.  Again, the area was numbed with plenty of lidocaine, but lying on that special table was excruciating.  The hard plastic edges of the hole kept digging into my clavicle and sternum and there was so much pressure on my chest wall, it was hard to breathe.  But I couldn't move even a little bit or they would lose sight of the area being biopsied.  I used my left thumb to press down on the table just enough to take some of the pressure off my bones, but it did very little to alleviate my discomfort.  I felt the pinch of that needle going in, too, even through all the lidocaine.  After taking a few samples, they checked them under a microscope to verify they contained parts of the calcifications while I continued to lie on the table with a needle hanging out of my chest, "Pulp Fiction"-style.  The entire appointment lasted more than 2 hours, after which I felt like I'd been pushed to the ground and kicked repeatedly.  The radiologist said the results should be in by the end of the week and he'd call me with them as soon as they came in.

The morning of Friday, April 28, I got a call, but not from the radiologist.  It was from my primary care doctor's office and it was her medical assistant on the other end.  She informed me my doctor wanted me to come in to discuss the results of the biopsies "sometime today."  That was the first time I felt any fear or trepidation.  Having worked in the medical field, I know how these things are done and I knew this was not good.  I said that out loud, too, but the M.A. played it off, claiming she didn't know (which is what I used to say to people and the truth was: I knew but I wasn't authorized to give results over the phone).  I started freaking out and called my mom as soon as I hung up the phone.  She agreed this was probably not good, but didn't feel like I should panic just yet.  She did suggest I have someone go to the appointment with me, so I called Heather.  She graciously agreed to accompany me and even drive me to it.  My appointment was at 12:30 so I left for lunch at noon, stopped home to let Kirby out and meet Heather, then we continued straight to my doctor's office.  I can still remember my heart pounding inside my chest the whole time.  I remember the nurse taking my vitals and me getting a glimpse of her laptop sitting on the counter with my chart open and the words "Abnormal Lab Results" leaping off the screen at me as the reason for that day's visit.  I remember the moment my doctor walked into the room with a large manila envelope in her hand bearing my name in crude but ominous black sharpie ink.  Most of all, I remember her bracing me for the results and the utter disbelief I felt upon hearing her say, "Unfortunately, both biopsies came back positive for cancer."

I've studied 6 foreign languages in my life.  I'm fairly proficient in 4 of them, minored in one, and know at least a basic phrase in over twenty more.  Yet, in that moment, I could only think of one word.  One word in all forms of discourse that adequately summed up my shock, horror, disbelief, and plain disgust upon hearing this news: "Fuck!"  My doctor seemed optimistic, though.  She said she'd already scheduled me a consultation with a breast surgeon for the following Wednesday and that I would most likely have a lumpectomy followed by radiation, and assured me that my cancer was the most common and treatable kind of breast cancer.  Even so, I knew I wouldn't be able to go back to work that day.  Heather invited me back to her and Jesse's house so we could spend the rest of the afternoon sipping wine and decompressing, so that's what we did.  Sneha joined us later.  Once there, I jumped on my phone and started reaching out to people I knew who had gone through this, asking for advice or any kind of heads-up they could give me on what was to come.  Between their encouraging words and being surrounded by such an awesome and supportive group of friends, I knew right then that I would not be going through this alone.  But the worst part wasn't knowing I had cancer.  It wasn't wondering if I could beat it.  I knew I could beat it.  The worst part was not knowing what I would have to go through to do just that.  I had very few answers at that point and could do nothing but wait to find out.  Waiting patiently has never been my forte.  Well, I was about to discover new reserves of strength beyond anything I ever realized I was capable of.

2017 A.D. (After Diagnosis)

Cancer patients often divide their lives into pre- and post-cancer eras.  Once you've been diagnosed, you understand why.  Nothing is ever the way it was before hearing those words.  Not everything is worse, but everything is definitely different.  They even refer to it as "The New Normal."  You start to think differently.  You question every decision you've ever made, wondering if it played a part, and you second guess every new decision you make for the same reason.  You feel differently, too.  You exercise the utmost self-care.  Minor aches and pains are suddenly a huge threat and a sign of recurrence or metastases.  You also become very, very busy.  You're physically and emotionally drained because of just how busy you are and how much time and attention your diagnosis commands.  It's a very high-maintenance disease and it takes over your life (and mind) completely.  And there's also the anxiety of knowing your very own body has turned against you.  I used to think not feeling safe in my own home was the worst feeling imaginable.  I never even considered not feeling safe in my own skin.

My first few days after diagnosis were actually pretty pleasant.  I spent them at the beach with Burke and we busied ourselves with painting the back deck of his beach house and sipping wine on the shore.  The weather was perfect and the salty aroma of the Atlantic ocean rolling up onto the sand was both soothing and purifying.  I almost forgot all about that thing growing inside my body.  The knot in my stomach returned immediately after starting the drive home and got tighter and tighter the closer we got to D.C.  I was dreading everything that was waiting for me back there, especially having to face the people at work who were probably wondering why I didn't return after leaving for lunch on Friday.  I used to feel "icky" talking about health issues with anyone other than close friends or family.  I didn't know yet if I wanted to "come out" with this or not.  I wasn't sure if I wanted to share the worst news I've ever gotten with people I didn't know all that well, or how open I wanted to be about it.  It's an extremely personal thing and posting anything about it to the public felt akin to reading my diary out loud on national television.

Wednesday, May 3 was my first appointment with my surgical oncologist.  I'd had 5 days to absorb the initial shock, now it was time to start learning.  One thing that comes with a diagnosis of cancer is a bit of a crash-course in medicine.  Luckily, I already had a head start having worked in the field and taken correspondence courses in pathology and medical terminology, so I put those skills to good use in the days leading up to my appointment and studied everything on my report closely, looking up anything I didn't understand right away.  At my appointment, I learned not only what everything on that report meant, but how it would affect my treatment plan going forward.  

There were 2 diagnoses on my report: Ductal Carcinoma In Situ (DCIS) and moderately-differentiated Invasive Ductal Carcinoma (IDC).  The calcifications that had appeared on my mammogram were the DCIS.  Basically, at some point in time, abnormal cells had begun growing inside one of my milk ducts.  The lump I'd felt was the IDC and it was from those cells breaking out of the duct and infiltrating the surrounding tissue.  The moderately-differentiated part meant it was grade 2, not the most aggressive or fastest growing cells (grade 3) but also not the least (grade 1).  The tumor was just under a centimeter in diameter when it was biopsied.  My lymph nodes had appeared normal in all my diagnostic scans so there was no suspected lymph involvement at the time.  That and the tumor's small size gave me a preliminary staging of Stage 1.  The pathology lab had tested the tumor for hormone receptors and found it was >90% positive for both estrogen and progesterone receptors, meaning my own hormones were heavily feeding the tumor.  That, however, is actually a good thing because it means hormone suppression therapy will be very effective at preventing recurrence.  And the high percentage of those receptors was a good indicator that this was very early stage because receptors often start to die off the longer a tumor stays in your body.  They also tested it for a protein called HER2 which aids the tumor's growth and found it was negative, which is another very good thing.  So far, everything was very promising.  My surgeon explained that the first thing on my To-Do list was an MRI to rule out any other abnormalities lurking below the surface.  Assuming everything came back normal, we would do a lumpectomy to remove the cancerous tissue and also a sentinel node biopsy to check for any lymph node involvement.  The surgery itself would be wire-guided and those wires would be inserted stereotactically, which meant lying on that godforsaken table once again and reliving the hell of the stereo-guided biopsy.  About 4 weeks after surgery, I would most likely begin radiation therapy which would be done every day for 3 1/2 to 6 weeks, the total length of time depending on whether there was any lymph node involvement at the time of surgery or not.  Once radiation was complete, I'd start taking a pill every day called Tamoxifen to shut down the estrogen receptors in my breast tissue in order to prevent a recurrence.  That would be the longest part of my treatment plan because I would be on it for at least 5 but most likely 10 years.  I also would need to visit my OB/GYN as soon as possible to have my Nexplanon implant removed from my arm.  Because my tumor was hormone receptor-positive, I will never again be able to use any birth control containing hormones.  That was a slap in the face after working so long and hard to find a birth control method that gave me the results I wanted without debilitating side effects, but I had bigger problems now.

The whole plan sounded very doable.  I was mainly just relieved she didn't mention chemo.  The only possible hiccup was the results of my genetic testing, which she was sending me to a genetic counselor to do.  If my tests came back showing I'm a carrier of any of the BRCA or other known cancer-causing gene mutations, the stakes would be significantly raised and she would probably recommend a mastectomy rather than a lumpectomy.  It wasn't until my pre-op appointment on 12th that I learned chemo was in fact very much on the table.  There's a relatively new (roughly 10 years old) test performed only on early stage, hormone receptor-positive, HER2-negative breast cancer called the Oncotype Dx wherein they test the tumor for 21 different genetic markers (note: these are the tumor's genes, not my own) and assign it a score of 1-100 based on how likely it is to recur.  A low score is 1-18, 19-30 is in the middle, and 31+ is high.  A low score meant my treatment would consist of radiation and Tamoxifen only.  A high score would mean chemotherapy and then radiation and Tamoxifen.  A middle score would depend which end of the spectrum it fell on.  Even a smack-dab-in-the-middle score would likely mean chemotherapy since, she explained, I'm still young and have many years left for this to come back, so they will want to treat it as aggressively as possible.  So, I'd gone from thinking I was only having a lumpectomy and radiation to realizing I could possibly be facing a mastectomy and/or chemotherapy, too.  Again, the waiting and the unknowns were the most taxing and excruciating part.

They scheduled all of my necessary appointments for me at my initial surgical consultation, so I had that much less to worry about.  The first thing I did was the MRI, which came back showing only the previously-known abnormalities.  Then I had the Nexplanon removed, which meant going back to dealing with all the issues I'd had pre-birth control, but it is what it is.  I then met with the genetic counselor and was tested for the entire spectrum of known gene mutations, all of which came back negative.  Mastectomy was officially off the table!  I'd pressed for a surgery date as soon as possible and it had been scheduled during my surgical consultation for Thursday, May 18, a mere 20 days after my diagnosis.  My doctor cautioned me that operating that quickly could end up resulting in a second surgery if my genetic testing came back afterward showing a mutation.  I elected to take that gamble and, luckily, it paid off.  The day before surgery, my parents drove down from Ohio to stay with me and help me during recovery.  My dad had just completed 8 weeks of radiation for prostate cancer back in February and was still dealing with all the side effects, which is enough to give pause to anyone staring down that road.  It was like watching a horror movie right before going to bed.

The day of the surgery was very long.  The operation itself was at 3 pm and would only take 60-90 minutes, but the hard part was everything leading up to it.  Not only did I have to lie on that ungodly uncomfortable table again so they could insert the wires to guide the surgery, but they had to inject me with a special radioactive dye in order to find which lymph nodes lit up first (a.k.a. the sentinel nodes, the ones the cancer would most likely spread to first).  I had to put on a special lidocaine cream an hour before my 10:30 a.m. arrival time and cover it in saran wrap.  Then I had to go to the imaging center so they could do the wire placement.  Not only was that even more painful than the biopsy but it took 3 times as long because they had an extremely difficult time finding the right area on the paddles.  And I was in so much discomfort at one point, I shifted just a bit too much trying to alleviate it and they had to start all over.  Once they finally got the wires in, they taped them down to my skin so I wouldn't have to walk over to the surgery center with them poking out of my shirt like broken guitar strings.  Then they did another mammogram (my 2nd one ever in less than a month) to make sure the wires had been correctly placed by the area to be excised.  Then I got shuttled over to the surgery center where my nurse navigator met me at the entrance.  She led me down to Nuclear Medicine, where they would inject the radioactive dye into me.  I'm still not sure why I really needed to apply all that cream because they wiped it all off and sprayed me with an ice-cold numbing spray for 30 seconds before inserting each of the needles containing the dye (3 times total).  Then they rolled me under a fancy machine, waited 5-10 minutes as they watched the sentinel nodes light up on the screen one by one, then took me to my pre-op room and instructed me to change into my surgery gown.  By this time, it was after 2 pm, I hadn't been able to eat or drink anything all day, and I was starving and dying of thirst.  I felt a little better once they put an IV in my arm and got some fluids in me, but I still just wanted them to knock me out already so I could wake up and finally eat something.  All day long, no less than 5 different people with 5 different roles in the surgery walked into the room and asked me the same questions they are required to ask every surgery patient multiple times: What's your name?  What's your date of birth?  What's your diagnosis?  Which breast are we doing?  A couple of them even initialed the side being operated on with a marker, like they were branding me.  They said it's a way to be absolutely sure of the correct side.  I wondered how many times they'd gotten it wrong before adopting that protocol.

Surgery got started slightly earlier than scheduled.  I remember up until the moment they said: "OK, we're turning the gas on now."  Next thing I knew, they woke me up in the OR and said everything was done and it had gone very well.  My parents met me in my recovery room with some flowers and chocolate that had been sent down by my friend and former roommate Giselle, who was working just upstairs in IMAR.  A nurse came in and fed me a Percocet even though I didn't feel any pain at that point, then they removed my IV, let me change back into my pajamas, put me in a wheelchair and rolled me outside to patient discharge and sent me home.  Burke and Heather both came over later that night to visit and/or bring flowers and even more people sent flowers and gifts the day after.  The first few days post-op were relatively peaceful and only mildly painful.  The one-week mark was the worst, when my pain and swelling were at peak levels.  I almost went to the emergency room Wednesday night since I figured there was no way this much pain this many days out could be normal.  My surgeon and her Nurse Practitioner both assured me that everything was healing normally, though.

Four days after surgery, my surgical pathology report was uploaded to my patient portal.  My heart pounded with anticipation as I read through it.  But my anxiety quickly turned into great relief when I reached the part saying all tumor margins were uninvolved (i.e. clear), no lymphovascular invasion had been identified, and all 4 sentinel nodes biopsied were negative for carcinoma.  It was some of the best news I'd read to-date.

However, at my first post-op appointment, I found out I would need to have yet another mammogram.  At the time of my original biopsies, the radiologist had left 2 extremely tiny wire clips in the biopsied areas.  I was told this was to mark them so that any future images would automatically denote those abnormalities as having already been checked (this was before they knew it was cancer, obviously).  Only one of those 2 clips had been located in the tissue excised during my surgery so they wanted to check to see if the other one was still in there.  Even though the previous two mammograms hadn't been painful, I was now extremely swollen and tender from the surgery and couldn't stand the thought of being touched near my incision, let alone squished.  My surgeon said she'd give me another week to heal before making me do it, but the idea still brought tears to my eyes.  So much so that I decided to take the whole day off work and take a Percocet the morning of the appointment.  Well, either the Percocet worked really well or they were extra gentle with me that day because it wasn't nearly as painful as I was expecting.  Uncomfortable, but not searing.  They didn't find the clip in there either, so they concluded it must have been suctioned out at some point during surgery.  I happened to catch sight of the images, though, and noticed 2 new additions appearing as white rod shapes.  I later learned those were "rads markers" (little rods inserted by my surgeon so the radiation oncologist would know where to aim the beams) and they would be in there for the rest of my life.

I had my 2-week post-op appointment later that afternoon.  I thought I'd learn the results of the Oncotype Dx at that time, but was told the test still wasn't back yet.  I was assured the wait had nothing to do with the results being good or bad, it was just a test that takes several weeks to complete.  My surgeon's office then scheduled my first consultation appointments with the 2 newest members of my oncology team: my radiation oncologist who would be overseeing all my rads treatments, and my medical oncologist who would basically be taking over my care from that point on, including any chemotherapy if needed.  The trouble was, without the Onco Dx score, we weren't sure yet which doctor I would be dealing with first.  I was so tired of not knowing the plan at that point, I was almost too mentally drained to even care anymore.

Wednesday, June 7 (less than 3 weeks after surgery), I met with my medical oncologist.  We talked more in depth about what the next 10 years or so of my life would look like and also how chemo would play out.  He was recommending a kind called TC, which is less aggressive and better tolerated than its counterpart AC.  If needed, I would have one treatment every 3 weeks, 4 in total.  There was another even less aggressive but old-school option called CMF that we discussed.  The side effects were even milder but since it was 2-3% less effective in the long-term, he would only recommend it if my Oncotype score was in the low 20's.  Anything higher than 22 or 23, he wouldn't feel comfortable going that route and would recommend TC.  My window for escaping chemo was getting narrower and narrower.  I asked if there was any sort of guess he could hazard on what the Oncotype results might be.  I was told there really is no way to predict it, but he did say he'd be surprised if my score was 31 or higher, although not surprised if it was in the mid-20's.

The next day, I met with my radiation oncologist.  It was mostly a talk visit.  I learned, however, I'd be doing radiation for a full 6 weeks.  I'd been under the impression it would only be 3 1/2 weeks since there was no node involvement, but he informed me it would be given in lower doses over a longer period of time to help lessen the side effects.  Thinking back to all the side effects my dad was still dealing with, I was actually grateful for that.  My visit ended with him saying, "Give us a call as soon as you know when you're going to be starting treatment."

Five days later (Tuesday, June 13), I finally got my answer.  I was expecting my surgeon to be the one to call me since she'd said she would at my last post-op appointment, but it was my medical oncologist.  I quickly flashed back to the last time I was waiting for results and the physician I was expecting to call me with them didn't (i.e. my biopsy) so my heart sank, expecting to hear the worst.  Why else would my medical oncologist be calling me except to schedule my first chemo infusion?  I even said to him, "You're going to give me bad news, aren't you?"  To my amazement, he replied, "No, actually I'm going to give you good news!"  My score was 10!!!  So not only was it low, but it was a solid low, not even a grey area!  Chemo was completely off the table!  I nearly burst into tears, I was so relieved!  I was still at work but couldn't help jumping up and down in my office and it took a couple hours for my hands to even stop shaking.  We ended the call with him instructing me to call my rads team and get back in touch with him once I'm finished with treatments.

I called my rads team the next morning and they scheduled me for my simulation (sort of like a dress rehearsal) for the following Thursday, June 22.  I don't think the staff had ever seen anyone as excited as I was to begin radiation, but I was still riding the high of having dodged the chemo bullet.  For the simulation, I basically just lied down on what looked similar to an MRI or a CT scan machine with my arm draped lazily above my head in a special holder while they took images and gauged where the beams would be aimed at the area being treated.  I didn't meet with the oncologist that day, just the radiation therapist.  She took the images and placed X's on my body with a black marker.  She then informed me those X's would be tattooed over (permanently) with little blue dots to ensure they wouldn't wash off during treatment.  I was stunned.  I have 2 tattoos, but they were both carefully thought out and obtained by choice.  I had just acquired a new surgical scar, not to mention additional rads markers below the surface that would be in there for life.  I wasn't wild about having any more permanent marks on me that I didn't ask for, especially ones that would be visible every time I wore a V-neck.  She offered to use the temporary marks instead and cover them with a strong adhesive, but advised that if they came off, we'd have to repeat the whole process of simulating and marking me all over again.  I made her a little deal: "Let's do temp ones first.  If they come off, then you can tattoo me."  So that's what we did.  (So far, so good!)

As soon as that was done, we scheduled my entire treatment course.  I would start one week from that day: Thursday, June 29.  I wouldn't have any treatments on July 3 or 4 since the center is closed for the holiday, but I would have 33 total through August 16.  I was happy with that since the annual beach camping trip was the weekend of August 25 and I wanted at least a week to heal.  The next day, however, I booked a flight home for my 20-year High School reunion on August 11 so I had to call to cancel that day's treatment and schedule a make-up on the 17th.

Today is my first session.  My appointments are all scheduled for roughly the same time over the noon hour, so I can go during lunch and come back to work after.  Since the hospital is just down the street from my office, it'll be a minimal disruption to my day.  The only issue is having to let Kirby out at lunch, but my parents had been looking for an opportunity to take her to Ohio with them for a while, so now they have the perfect excuse.  They plan to come down on July 9 and stay for a couple days then take her home with them until they come back down on Labor Day weekend, so I'll only have 5 treatments I'll need to rush to after stopping home to let her out.  I only started feeling slightly nervous yesterday morning, but remembering that I could have been preparing for chemo instead wipes that out pretty quickly.

It's been a busy 2 months.  Another 2 months or so of busy-ness then hopefully my old routine can resume, insofar as possible.  It hasn't been an easy road by a long shot, but a part of me feels like I got off with a slap on the wrist, having dodged every major obstacle I could have hit.  I'm not completely out of the woods, though, and, in fact, never will be as the threat of recurrence or metastases is ever-present no matter what stage you were diagnosed.  Life as I knew it is over.  But I will slowly adjust to my New Normal just as soon as I figure out what exactly that is.