Square Two

Ah, the long-anticipated visit to the radiologist today. The idea was to see if my breast-conserving surgery could be given a radiology boost to make another recurrence less likely down the line. As Dr. C., my dashing surgeon, had explained, you usually can't re-radiate breast tissue: it tends to shrink or collapse or do something dreadful under the rays a second time. But with new techniques, it might be possible to do "targeted" radiation and get away with it. A study is underway at Sloan-Kettering, and he thought I might be part of it.

I was sort of hoping not to do it, actually: the idea of trooping an hour each way to the hospital for lengthy periods of time is pretty unthinkable right now. But then, who wouldn't want a boost to one's chances?

This idea was pretty much crushed when the radiologist Dr. M., who is doing the study of re-radiation I would have been part of, announced on meeting me that she'd just reviewed my chart and had news: their "protocol" says they can't radiate after Paget's Disease. She told me why, but to tell the truth, I forget, and I had the impression she wasn't sure herself. It had something to do with the skin, but all I remember is that she remarked that the skin on my breast above the scar was quite good: soft, with a smooth appearance. What a strange thing is the mind, or at least this one: I'm such a compliment hound that I didn't retain the reason for not radiating, but do remember the random and totally irrelevant praise for the surface of the top half of my mutilated breast! Really astonishing.

Then came the bad part. She wanted me to know that since I won't have radiation, and the DCIS was close to the margins of the excision in two spots, I really should have a mastectomy, with or without reconstructive surgery. Dr. C. had warned me that she would say that. But here's the thing: this is what Dr. L, my oncologist said too (the "gold standard"). I asked for hard statistics: she said that would be difficult to come up with. So I asked my Big Question: how come Dr. C. says there is no survival advantage to mastectomy, when there's a greater risk of recurrence? This is what's confusing to me.

Her answer: My close margin indicates there could be DCIS left in my breast: Dr. C. said 10-20% chance of recurrence. DCIS, left untreated, will turn into invasive cancer half the time. So take the recurrence statistic and slice it by one half, because a recurrence of DCIS isn't a big deal. Then take the half that is invasive and say you most likely will catch it early and treat it with the usual stuff (mastectomy and chemo, if necessary). That will grab most of it. But a very small percentage of that will not be cured by the treatments and metastasize, threatening life, killing you sooner rather than later. That's the risk: a percentage of a percentage of a percentage. It's probably life-threatening to only a few, so statistically it doesn't show up when compared to a recurrence after mastectomy.

What's disturbing is that the pro-mastectomy gang clearly feel: why are you hesitating for a breast that's "asymmetrical in size" (as Dr. M. put it) and doesn't even have a nipple? Whereas Dr. C., the surgeon, spins it the other way: why not hold onto the breast and play such good odds?

Now what? I've progressed past Square One = Know Your Pathology, but I feel like I'm solidly back in Square Two = What To Do.

One Order of Gratitude, Please

I sharply remember a moment soon after the diagnosis when I confronted the brutal possibility that this new cancer could be a death sentence for me. It was one of those Lifetime Movie Moments, when you go all Elizabeth Kubler-Ross and bargain : I'll do anything to live. If You (God, fate, the Universe, the cancer itself, those teenage boys in outer space who are using me as their avatar in their amusing video game) will only let me live, I will be grateful... So grateful that I will have a proper sense of perspective on all complaints about the woes of my life, the annoyances and sad absences and worries, the relatively minor discomforts of other ailments and such.

This seemed like such an epiphany that after the tests and pathology report came back with news so good that many patients would rejoice to hear it, I said to my friend, "You know, everyone should go through the interesting experience of thinking your life may be over." He kind of snorted, so I added, "That is, if it turns out it's not." This may be true. It certainly seemed true for a while.

Because here I am, 10 weeks or so past that moment of recognition about the larger perspective that cancer can bring, and I can tell you in all honesty that I cannot hold onto it. It's slipped out of my fingers like smoke and disappeared into the overwhelming desire -- need -- for the mind to orient itself to the normal and everyday. The truth is I am not any more grateful than I used to be, except in small moments when I shake myself and scold that I have got to stop bitching about the usual stuff (as on Valentine's Day, when being no one's Valentine seems particularly, if ridiculously, oppressive). I do not revel in the incredible excitement of just being alive, damn it...except for other small moments, when I actually do.

So much for all those books and movies and guests on talk shows telling us that they "now realize" something-or-other, which "saved" their miserable lives, and how that empowered them to never do Whatever again, which explains why they are So Happy now. I am here to say it has not worked for me. And I can't say I much want to try it again so I can get it right next time.

A Dream, It's Only a Dream...

The title quotes a song by Neil Young...if only. What I mean is that some corner has been turned in my heart, and I have returned to the probably deceptive feeling of normalcy, with its small cares and joys, that I had before the diagnosis two and a half months ago. I no longer feel in crisis, and while my brain tells me that I could be in danger of dying of a recurrence of breast cancer in the future, my mind (more plastic than the brain) says "La, la, la" sort of blithely and refuses to wrap itself around the statistics. Too many other items on the list of worries: will my students give me good evaluations? Will I finish the book, and will the editor laugh derisively when I do? What are the chances I can find the money sometime to help my daughter buy the house she so much wants? Is it possible to protect my five beloved grandchildren from future harm by worrying about them night and day? How do I program THREE reality shows on my DVR at the same time?

Yes, I think I do worry a bit more about my health in general than I used to, and I still do lament that I have some reasons for worry. Plus I'm seeing the radiologist on March 18th, and that should be blog-worthy, as I suspect I'll have to make yet another burdensome and anxiety-filled decision that will have an impact on my life and health. But in general I've returned to floating through the days, doing just enough to keep up with what must be done while never quite feeling I've done enough. In other words: regular life.