The Path Report, At Last

I did decide, after all, to call every day to see if the pathology report was ready. This shows, I guess, that when I have a conscious choice to know the truth, I will choose to know, whereas unconsciously I have sometimes been a champion denier about my own life. (The prime example that leaps to mind is the belief I cultivated for many years that my marriage was a happy one.)

As for the path report, which was supposed to take the classic 7-10 days, I was told it was "not available" on Day Seven or Eight, and Day Nine, the snowstorm hit New York and the doctor's line didn't get answered at all. So that brought me to Day Ten, when I had my post-op check-up with Dr. C, the surgeon, anyway.

Anxiety built during those last three days, I'll admit. My fantasy was that the report was in, but was so bad the doctor wanted to give me the news in person (even though I was told all the bad news over the phone at the time of the first, invasive cancer, from the same doctor's office). Fortunately, I didn't really believe this -- I do know I'm susceptible to this kind of "What if"-ing. But when Dr. C. strode cheerfully into the examining room on Friday morning and greeted me with, "Hello! How are you feeling today?" I wanted to yell, "Cut the crap and tell me how the path report was, please!"

I'm well-behaved and didn't, and right after, he said, "Well, the path report was good..." -- "It WAS?" I cried, but he went on, "But I do need to go over it with you." Never a good sign.

First we admired his handiwork, which really is quite amazing (more on that another time), and then he showed me the detailed report. The good (going on fabulous) part: no invasive cancer found, DCIS (ductal carcinoma in situ, which means localized) only. The not-so-great part: three margins were nice and clean, but one showed a little bit of DCIS half a millimeter from the margin of the incision. "Clean" margins, the ideal, are more than a millimeter (which is damn small, if you look at a ruler). The point of clean margins is that the chances of having missed a patch of cancer cells is better. His comment: "Some of my colleagues who are conservative would say this requires re-excision [i.e. another surgery to take more tissue, as I had eleven years ago], but my judgement is that it's a low enough risk that we can stop where we are and just monitor it."

Oh. That was deflating, and a little scary. I wasn't sure how scary, so confusing, too.

He went on to discuss the possibility of radiation ("This hospital has been experimenting with re-radiating the same breast but the benefit seems very small, so let's set up a consultation with a radiologist for you to discuss the benefits and side effect"). I asked about going back on hormone therapy, and he thought my old oncologist should decide that. I was given three more appointments in the next month -- radiologist, oncologist, and another check of the incision by Dr. C -- and sent home.

Calling my family to tell the good news was excellent. But I didn't tell my children about the "dirty margin" (as they call it), though it's always tempting to share every single feeling with them. Dr. C. said the risk of recurrence was low, so why trouble them with this vague possibility if I'm not going to have more surgery? And it gave me such pleasure to hear their excited voices when I told them the report was good.

On the other hand, while the percentage of recurrences is low (I think he said 3%), the percentage was also low for getting a recurrence eleven years ago, not to mention for getting Paget's Disease (only 2-5% of breast cancers), or even getting breast cancer at all (I'm the only one among my friends who has had invasive cancer). Here I'd been hanging all week on Good (a fine path report) or Terrible (a bad one), and this leaves me with more mixed feelings than I thought I'd have. I've noticed life is like that so often: just when you think it's a drama of Yes or No, Good or Bad, What I Want or Don't Want, it turns out to be more complex than that, no simple denouement.

And so this morning I woke up feeling down for the first time in quite a while...how odd that in the last weeks of anticipating surgery and the path report, I have been very anxious but quite cheerful, not depressed at all...I suppose because something was always happening next, and there was always the hope that good news would make it all go away.