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)...
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