Saturday, August 2, 2008

Walking On Thin Ice

Everybody knows this Yoko Ono song, right? Elvis Costello covered it many years ago but I cannot find that version on iTunes. I don't know the lyrics. Maybe it's not really about walking on thin ice.

But that's what I'm thinking about as I contemplate my next move in my treatment. On July 10, I went to see Dr. Popular to discuss my scans. His office had phoned me and told me they were clear, but I thought, hey, this is worth more than a phone call. Let's talk. He tells us that the CT and the MRI did not show any evidence of residual cancer and the bone scan is clean. They can see my prior surgeries and my gall stone (yes, isn't that yucky? I have a gall stone), but that's it.

Huh, I say. Okay. I guess I still go get surgery anyway. Yes, he says.

The next day we go see Dr. Solemn, the surgeon. He needs a new nickname. He comes into the examining room and he's animated, excited, bouncing off the walls. This is great! he exclaims. Your MRI is normal, your CT is not suspicious, this is all as good as possible!

Yes, but … what is YOUR deal? I'm thinking. He leaves the room so I can take my top off and my husband and I briefly confer over Solemn's new demeanor. "I guess he's just being upbeat but doesn't want to go, 'Hey! When are we doin' that mastectomy?!'" I offer, as I pull on that adorable capelet thingy. Still, we can't understand his behavior. I've got cancer, for Pete's sake.

Solemn returns eventually (he's taking and making phone calls outside the room, he's a busy guy) and examines me and tells me he feels no masses in either of my breasts. That's also great. I get dressed again, and after a while he comes back in the room. He suggests I consult immediately with the radiation oncologist. He says there's no advantage or disadvantage to doing surgery after radiation. But I could have my lumpectomy (partial mastectomy) anytime and a plastic surgeon can clean up the tissue …

Wait, we say. What? We thought we were in here to talk about my mastectomy and, well, we were gonna go all the way here and make it a bilateral (that's the term, NOT "double mastectomy") and be done. I have cancer, and I was told it was not good. I had a tumor that was over 8 cm in length, kind of a cigar shape, and I had a tiny bit of cancer in my lymph node. We talked about this in January when we first saw you, Solemn, and again in April. This is what we thought we were going to discuss today.

Whatchu talkin' bout, Willis???

Oh, you can still do that, he says. But a partial mastectomy is no better or worse than a total mastectomy. Solemn/Willis tells me my risk of local recurrence is low (4-6%) and a new recurrence in my other breast is also low. He tells me a bunch of other stuff that I stop listening to because I am stunned by this new information.

Okay, I say, cautiously, What you're saying is, I have options. Yes! You're in the best shape you can be, he says. Does this happen to a lot of people? I ask. No, he says. And then tells me to see the radiation oncologist and consult a plastic surgeon and formulate a treatment. We stumble out of the office in a daze.

The next week we meet the radiation oncologist. I need a clever nickname for him. He wears no dress shirt and tie, no jacket, no starched medical coat with his name embroidered on it. Just casual. It would be easy to mistake him for someone who just works there, not the doctor. He's kind of hilarious and quirky. He looked at my personal info, noted that I put down one or two alcoholic beverages a day as my consumption rate and winking, says, "Ah, good. You can't be an alcoholic if your doctor drinks more than you." Unlike Solemn/Willis, he prefers I get surgery first, then come to radiation. He thinks I will need 28 treatments of radiation to my lymph nodes and tumor bed. I will need 10 more treatments if, for some reason, I still do not get negative margins in my next surgery (that means: if they still find cancer cells in my excised tissue, even though I am supposed cancer-free).

Thus, the overworked thin ice metaphor. Apologies to Yoko.


Mardel said...

I get the metaphor. We are going through a lot of similar stuff between doctors, except at this point there is no original plan even, or agreement on diagnosis.

Roseana Auten said...

Isn't it something? Go to a different doctor, and you get a different opinion. Every time. Read "How Doctors Think" for more insight into this. It really helped me.