Missed My Calling

Today I learned 3 things:
  • I’m right basically all the time.
  • My preventative mastectomy was a huge waste of time, money, and a lot of people’s energy.
  • And, I should’ve been an oncologist.
This morning, my husband and I met with Dr. McAuliffe to find out prognosis and treatment plan. The cancer is stage 2A (not terrible; totally treatable). After looking at scans and pathology from 2013, she is pretty certain that this is the same cancer (just as I suspected) I had then — as many DCIS cells as possible were removed during my mastectomy. But the doctors always said they can never remove every single cell. I like to make this analogy – it’s like a carton of ice cream. Even after you scoop out all of the ice cream, there’s still a little bit of ice cream residue that remains in the carton. Same thing here – they made a cut in the bottom of my breast, scooped out all of the breast tissue, but there was always going to be a little bit of residual tissue remaining. The chances of that tissue becoming cancerous are practically nil, but hey, they took a chance on me won the jackpot! It only takes one rogue mother fucker; this one hung around, grew, and now it’s invasive and is spreading throughout my breast. I suppose, luckily, I felt it before it did too much damage; it is not in my lymph nodes or elsewhere in my body. Still, we are going to treat it aggressively because I am not going through this a third time.
Definitely in my future: surgery to remove the tumor, radiation to kill any other lurking rogues, and hormone therapy (most likely tamoxifen since aromatase inhibitors cause joint pain, and Dr. McAuliffe doesn’t want to wreak havoc on my RA). Chemo is a possibility because of the high Ki-67 (just as I thought).  We talked about doing oncotype testing (yep – thought they might do that) to see if chemo would be required and how effective it would be. She wasn’t quite sure about the order that would make the most sense for these processes – chemo first then surgery? Surgery first then radiation? Put your left leg in, your right leg out? Let’s call the whole fucking thing off. Whatever.
Because my case is complicated (and nearly fucking unheard of) she will present it to the hospital’s multi-disciplinary oncology conference this evening. There will be surgical oncologists, medical oncologists, and my plastic surgeon will attend. Because I’m such an an interesting specimen, these people will all weigh in on the best way to proceed (I have to say, I LOVE this idea – I mean, who wouldn’t? All these brilliantly over-ivied brains getting together to talk about the best way to cure me!!! – I can’t wait to hear what they have to say).
My situation is complicated by a few of factors. My rheumatoid arthritis will likely make some of this harder on my system than it already would be on a typical person.  Also, she would like to remove some axillary lymph nodes to ensure there are no rogue cells in there. But, my anatomy is kind of screwy because of the wack-a-doodle surgery I had in 2013 where they made my stomach into breasts, and it’s unclear if my lymph nodes are where they should be and what lymph drainage pathways I would have if she removed the ones she finds (tbh, I’m making this part up a bit – it was confusing – but I think I’m getting the gist). There is already the risk of causing lymphedema by removing those axillary lymph nodes, so she wants to be cautious with that. They’re going to try to figure all of that out at the conference, and there is some kind of further testing they can subject me to in order to view the drainage pathways (I’m sure it involves dye I’ll get to drink or radiation they’ll inject into my veins while I lay in yet another confining tube listening to persistent banging for at least 45 minutes  – either way, fun!). Dr. McAuliffe is going to call me either this evening or tomorrow with details from the conference.
I tell her I am going to Philadelphia to the Basser Center to meet with their director for a second opinion on July 22. I didn’t get a second opinion in 2013, and I regret that now. Fool me once, cancer twice…. something like that. She looks a bit stunned, but continues our conversation. I’ll have the biopsy of my abdomen next week, I will also meet with medical oncology at some point, she mentions the emotional aspects of this and describes a program where I can see a psychologist in the building who specializes in oncology. Sign me up.
I send a similar version of this post to some friends and family. Their responses are overwhelmingly full of love and support. Some ask me how I’m feeling about all of this, and to be honest, I don’t feel anything. I did feel pretty nervous this morning before the appointment, but Dr. McAuliffe was so caring and thorough, and I think my preliminary research helped me see this as an academic enterprise and keep some emotional distance from it. I diagnosed myself after all – no huge surprises in the exam room today. All I need to do is keep showing up where I’m supposed to be, swallow whatever they tell me to swallow, let them stick me with a few needles, and all of this should be over before I have time to finish my med school applications.

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