The Nightmare - Part 4 by Tina Wagner Mattern
An Impossible Decision
"I'm going with you to the doctor tomorrow." Our fifteen-year-old daughter, Summer's, reaction to my cancer diagnosis was typical for her, loving, worried sick and dealing with the disaster in pretty much the same way I've always dealt with crises: Okay, this sucks, but it can be fixed if I just know all the right information. . .the old know thine enemy philosophy.
"You have school," I said weakly.
Summer snorted, "What the hell does that have to do with anything? Like I'm going to be getting anything done, sitting there worrying about you! I'm GOING. Period!”
Fred agreed with her, saying it was her right and of course, it was. I looked at Aaron. He shrugged helplessly. I told him, "You don't need to come, honey. There won't be enough room in the office anyway." Looking uncomfortably relieved, he nodded.
I don't think any of us slept that night. I tried. Finally, instead of counting sheep, I shot poison darts at the butts of tiny little Mercys’ and Dr. Hrongs jumping over my bed. It didn't help me sleep, but it gave me something else to focus on.
* * *
Waiting in Hrong's office, I mentally went over and over the diatribe I planned to level against him: "You told me before surgery the chances of my lump being cancer were slim to none. You were wrong! And how could you let me find out I had cancer from anyone but you? What kind of a chicken-shit doctor are you anyway?"
Fred and Summer flipped through magazines with empty eyes, stopping every few minutes to check their watches. I stared at the door, trying to breathe around the lump in my throat.
When Dr. Hrong finally knocked and then entered, I went blank; every thought I had gathered disappeared from my mind. He looked uncomfortable, but not chagrined, embarrassed or abjectly apologetic as I had thought he would. I waited for him to tell me he was sorry. But he didn't, so I finally said, "Looks like I was right, huh?"
He nodded, then attempting a positive note began to tell me the good things about my cancer, "It was small, only one centimeter, a stage one -- and," he smiled at Summer and Fred, "We got it early.”
Yeah, thanks to me insisting on the surgery! I thought angrily. Don't you dare try to take credit for that!
Fred looked at me, and then asked Hrong what we all wanted to know, "Now what? Where do we go from here?"
The surgeon, back on safe, comfortable ground smiled again and began to outline treatment possibilities. "First," he said, "There's mastectomy."
At our stricken looks, he added quickly, "With reconstruction. They've come a long way with that. They can make you a breast now that looks almost like the real thing."
All of us must have been wearing sheep in a slaughterhouse expressions because he quickly went on, describing the wonderful work plastic surgeons were doing in this area.
“And as small as your lump was, there probably isn't much chance for lymph node involvement, so if you have a mastectomy, you won't need to follow up with chemotherapy or radiation."
Fred spoke up, "What other options does she have?" I should have asked that question myself, but I frankly was struggling to control an almost overwhelming need to dissociate myself right out of the room and into a nice sunny buttercup-dappled meadow somewhere. I could almost hear a nearby brook babbling my name.
"Well," Dr. Hrong said, looking back through my chart, "You could opt for a lumpectomy with radiation.”
“She just had a lumpectomy,” Fred countered. I bobbed my head in agreement. I had! And I was wearing a bandage to prove it.
“No, I simply removed the lump, it was an excisional biopsy,” he corrected. “A lumpectomy would be where I go back in and remove a much larger amount of tissue from the area. Our attempt is always to get what we call ‘clear margins,’ that’s when there’s no evidence of any remaining cancer cells in the tissue left behind. And check your sentinel lymph node for any chance of spread.” He referred to his notes. “Your cancer was within microns of the edges of the tissue sample I took. Do you know what a micron is?”
Fred, the engineer, spoke up grimly, “Yeah.” To Summer and me he explained, “That’s about 100 times smaller than the thickness of a sheet of paper.”
I swallowed around a big lump of oily fear that had suddenly lodged in my throat. Summer and I both whispered, “Whoa…!” at the same time.
But my next thought was that I wanted to jump up, slap him silly and yell, “If you had believed me in the first place and had done the lumpectomy as asked, I wouldn’t be needing more surgery!”
He continued placidly, “So of course, if you do choose not to have a mastectomy, you would definitely have to let me go back in and do a lumpectomy. . .followed by radiation, as I said. The problem with that would be your breast implants; (implants I had had for many years) you'd have to have the implant removed first.” His brow furrowed. “Radiation would harden the skin around it, tighten it to the point where it would be very uncomfortable, maybe even cause it to burst, and of course that would affect the other breast, aesthetically speaking, so you would need to do some adjusting there as well. . .but listen, there is an excellent plastic surgeon right here in the building that I refer to all the time. His name, (the name I’ve decided to give him, anyway) is Dr. Jesse Lopitov."
He leaned back in his chair, crossed his legs and looked at us as though he were about to place the Holy Grail itself into our hands. "If you like, I can see if he's available for a consultation. No matter what you decide; mastectomy or lumpectomy with radiation, he will be able to answer most of your questions better than I."
I crawled reluctantly out of the meadow, back into the room and looked helplessly at Fred. He gave me a feeble half-shrug then turned to Hrong, "What are we talking about. . .today, tomorrow. . .or what?"
"Just let me go check on Dr. Lopitov's schedule; he might be able to do it now."
The surgeon left the room and the three of us just sat there staring at the door as it closed behind him, seconds ticking by until suddenly we all exhaled collectively, a huge sigh, as though each of us had been holding our breaths until that moment.
Summer was the first to speak, "Mastectomy? Mom!" Her angelic fifteen-year-old face had taken on the pallor of a much older victim of some debilitating illness. I hardly recognized her. Her visible shock and fear were a sucker punch directly to my gut.
Fred leaned over, eyes glazed, and put his arm around her but she sat forward in the chair, reached out a hand to me, needing my comfort, my reassurance that the world was not crumbling into chaos as it seemed.
I didn't know what to say. What the hell could I say; none of this was any more real to me than it was to her. I got up and walked over and took her in my arms. Fred, face buried in his hands, said simply, "This can't be happening.”
Minutes later though, the door opened, Hrong breezed in and we had to accept that, yes, it was happening. And it seemed that no matter how hard any of us wished it wasn’t, for the moment at least, it was only going to get worse.
"Okay, folks, we're in luck! Dr. Lopitov has a little time right now, so I'm going to send you downstairs to talk with him, get your questions answered etcetera. Then afterwards, come back up here and we'll formulate some kind of plan. How does that sound?"
He nodded benevolently at Summer, Fred and me as if he had just single-handedly come up with the solution for World Peace. Dazed, we nodded back as one.
Fred and Summer flipped through magazines with empty eyes, stopping every few minutes to check their watches. I stared at the door, trying to breathe around the lump in my throat.
When Dr. Hrong finally knocked and then entered, I went blank; every thought I had gathered disappeared from my mind. He looked uncomfortable, but not chagrined, embarrassed or abjectly apologetic as I had thought he would. I waited for him to tell me he was sorry. But he didn't, so I finally said, "Looks like I was right, huh?"
He nodded, then attempting a positive note began to tell me the good things about my cancer, "It was small, only one centimeter, a stage one -- and," he smiled at Summer and Fred, "We got it early.”
Yeah, thanks to me insisting on the surgery! I thought angrily. Don't you dare try to take credit for that!
Fred looked at me, and then asked Hrong what we all wanted to know, "Now what? Where do we go from here?"
The surgeon, back on safe, comfortable ground smiled again and began to outline treatment possibilities. "First," he said, "There's mastectomy."
At our stricken looks, he added quickly, "With reconstruction. They've come a long way with that. They can make you a breast now that looks almost like the real thing."
All of us must have been wearing sheep in a slaughterhouse expressions because he quickly went on, describing the wonderful work plastic surgeons were doing in this area.
“And as small as your lump was, there probably isn't much chance for lymph node involvement, so if you have a mastectomy, you won't need to follow up with chemotherapy or radiation."
Fred spoke up, "What other options does she have?" I should have asked that question myself, but I frankly was struggling to control an almost overwhelming need to dissociate myself right out of the room and into a nice sunny buttercup-dappled meadow somewhere. I could almost hear a nearby brook babbling my name.
"Well," Dr. Hrong said, looking back through my chart, "You could opt for a lumpectomy with radiation.”
“She just had a lumpectomy,” Fred countered. I bobbed my head in agreement. I had! And I was wearing a bandage to prove it.
“No, I simply removed the lump, it was an excisional biopsy,” he corrected. “A lumpectomy would be where I go back in and remove a much larger amount of tissue from the area. Our attempt is always to get what we call ‘clear margins,’ that’s when there’s no evidence of any remaining cancer cells in the tissue left behind. And check your sentinel lymph node for any chance of spread.” He referred to his notes. “Your cancer was within microns of the edges of the tissue sample I took. Do you know what a micron is?”
Fred, the engineer, spoke up grimly, “Yeah.” To Summer and me he explained, “That’s about 100 times smaller than the thickness of a sheet of paper.”
I swallowed around a big lump of oily fear that had suddenly lodged in my throat. Summer and I both whispered, “Whoa…!” at the same time.
But my next thought was that I wanted to jump up, slap him silly and yell, “If you had believed me in the first place and had done the lumpectomy as asked, I wouldn’t be needing more surgery!”
He continued placidly, “So of course, if you do choose not to have a mastectomy, you would definitely have to let me go back in and do a lumpectomy. . .followed by radiation, as I said. The problem with that would be your breast implants; (implants I had had for many years) you'd have to have the implant removed first.” His brow furrowed. “Radiation would harden the skin around it, tighten it to the point where it would be very uncomfortable, maybe even cause it to burst, and of course that would affect the other breast, aesthetically speaking, so you would need to do some adjusting there as well. . .but listen, there is an excellent plastic surgeon right here in the building that I refer to all the time. His name, (the name I’ve decided to give him, anyway) is Dr. Jesse Lopitov."
He leaned back in his chair, crossed his legs and looked at us as though he were about to place the Holy Grail itself into our hands. "If you like, I can see if he's available for a consultation. No matter what you decide; mastectomy or lumpectomy with radiation, he will be able to answer most of your questions better than I."
I crawled reluctantly out of the meadow, back into the room and looked helplessly at Fred. He gave me a feeble half-shrug then turned to Hrong, "What are we talking about. . .today, tomorrow. . .or what?"
"Just let me go check on Dr. Lopitov's schedule; he might be able to do it now."
The surgeon left the room and the three of us just sat there staring at the door as it closed behind him, seconds ticking by until suddenly we all exhaled collectively, a huge sigh, as though each of us had been holding our breaths until that moment.
Summer was the first to speak, "Mastectomy? Mom!" Her angelic fifteen-year-old face had taken on the pallor of a much older victim of some debilitating illness. I hardly recognized her. Her visible shock and fear were a sucker punch directly to my gut.
Fred leaned over, eyes glazed, and put his arm around her but she sat forward in the chair, reached out a hand to me, needing my comfort, my reassurance that the world was not crumbling into chaos as it seemed.
I didn't know what to say. What the hell could I say; none of this was any more real to me than it was to her. I got up and walked over and took her in my arms. Fred, face buried in his hands, said simply, "This can't be happening.”
Minutes later though, the door opened, Hrong breezed in and we had to accept that, yes, it was happening. And it seemed that no matter how hard any of us wished it wasn’t, for the moment at least, it was only going to get worse.
"Okay, folks, we're in luck! Dr. Lopitov has a little time right now, so I'm going to send you downstairs to talk with him, get your questions answered etcetera. Then afterwards, come back up here and we'll formulate some kind of plan. How does that sound?"
He nodded benevolently at Summer, Fred and me as if he had just single-handedly come up with the solution for World Peace. Dazed, we nodded back as one.
* * *
Dr. Lopitov was a young, good looking man, but when a guy is telling you that he’d like to cut your breast off so that he can build you a new one of his own design, it sort of nullifies any attraction you might have initially had to him.
I sat, fighting nausea, as he explained the surgical procedures and then pulled out a book with full-color photographs of breast reconstructions for us to look at. Horrified and fascinated, we turned page after page. I looked at the pictures, taken from the neck down and wondered who these women were, these valiant anonymous women. Closing my eyes, I saw them there in my mind, before the photographer, averting their frozen-gazed faces, showing their scarred chests so that one day women like me could see that yes, life goes on and yes, these are not the breasts we had when we were perfect and whole but oh, it is better than death.
I swallowed the fear rising into my throat.
“Pretty amazing what we can do now, isn’t it?” Dr. Lopitov beamed, flipping the pages slowly so that we could see the different methods he utilized in his reconstruction artistry.
The three of us tried to look appropriately amazed, but I knew my expression reflected Summer’s and Fred’s; the expressions of people who had somehow stumbled upon the aftermath of a tragic accident. Seeing the wounded pieced back together was, of course, wonderful, but no less heartbreaking and traumatic. Picturing myself there in the wreckage, repaired or not, was devastating.
I looked again at the photographs, touched my finger to the page, to the incisions on the women's chests, swollen, bitter red gashes across fragile tissue. I sensed an echo of pain in my own flesh, and felt like crying, for those war-torn survivors. . .and for myself.
“I think what would work best in your case is the tissue expansion method,” Lopitov said after turning another page. He pointed to another collection of photos.
I leaned forward, looking closer as he described what this method was and how it would be done. Fred took my hand, squeezed. Summer’s eyes glazed dangerously over; I hoped she wasn’t going to pass out. I nudged her, forcing a smile.
“After removing your breast, we would place a special empty silicone bag under the skin, under the muscle of the chest wall. This bag has a small valve attached which we’ll fill partly at the time of surgery with a sterile saline solution.”
He indicated one of the photos. “Then over the course of several weeks or months, we inject more into the bag through the valve which “pumps up” the expander. It stretches the skin gradually until the designated size is reached, at which point another surgery is performed and the temporary expander is replaced with a ‘permanent’ silicone gel or saline implant.” Dr. Lopitov’s perfectly manicured fingernail pointed to another photograph, showing a full, well-shaped breast. . .minus the nipple.
“Something seems to be missing,” Summer muttered.
Relieved, I thought, oh good, she’s not going to faint, she’s going to get pissed off.
My daughter is so much her mother’s child; frustration and helplessness annoys more than depresses her, usually. And frankly, I, too, was beginning to feel the first stirrings of that same futile anger. None of this was “acceptable.” Nothing about this was “okay.” Nipple-less breasts were not amazing, dammit. . .they sucked! Before I could add my agreement to her observation, the doctor turned the page, indicating the final picture in the series with a dramatic flourish, the full well-shaped breast now sported a dandy, sort of-real-looking nipple complete with an almost-nearly-authentic areola.
“This is more like it, right?” he said jovially. “It’s the second-to-the-last part of the procedure to be done, usually not until three months after the main breast reconstruction because the breast will sag over time; initially it will usually be higher than the other side, and if we put the nipple on too soon, it might end up too high or too low.”
Sighing, I thought, Of course! Wouldn’t do to have my new nipple positioned up to watch me pluck my eyebrows or located down where it could observe any leg-shaving transactions. I blinked away the images, asking, “So how exactly is this done?”
Dr. Lopitov described the procedure enthusiastically, “There are several ways this is done, but the method we prefer is where we take two small triangular pieces of tissue from the reconstructed breast, twisting them around each other, then sewing them together to form the nipple.”
I tried to picture this procedure and failed miserably.
“Afterwards,” he continued, “You’d wear what we call a ‘bumper guard,’ a protective kind of 'donut' over the area until the new nipple heals and scars. See?”
I nodded, feeling slightly hysterical, picturing a raspberry-filled Krispy Kreme plastered to my chest. Blinked the vision away.
“You said this was the second to the last part, what’s the last?” I asked.
He placed a fingernail on the page next to the areola. “The finishing touches are done about six weeks later. The nipple color and surrounding area color are tattooed on. Cool, huh?”
Fred groaned, then with his usual dry sarcasm attempted to lighten the conversation. “That’s great! My wife will have a tattoo. . .maybe I should buy her a Harley and some leathers for Christmas!”
Summer rolled her eyes.
“Maybe he could put a matching one on your bald spot, honey,” I commented dryly. “Then you could get a bike too and we could call ourselves the Hell’s Nipples!”
I sat, fighting nausea, as he explained the surgical procedures and then pulled out a book with full-color photographs of breast reconstructions for us to look at. Horrified and fascinated, we turned page after page. I looked at the pictures, taken from the neck down and wondered who these women were, these valiant anonymous women. Closing my eyes, I saw them there in my mind, before the photographer, averting their frozen-gazed faces, showing their scarred chests so that one day women like me could see that yes, life goes on and yes, these are not the breasts we had when we were perfect and whole but oh, it is better than death.
I swallowed the fear rising into my throat.
“Pretty amazing what we can do now, isn’t it?” Dr. Lopitov beamed, flipping the pages slowly so that we could see the different methods he utilized in his reconstruction artistry.
The three of us tried to look appropriately amazed, but I knew my expression reflected Summer’s and Fred’s; the expressions of people who had somehow stumbled upon the aftermath of a tragic accident. Seeing the wounded pieced back together was, of course, wonderful, but no less heartbreaking and traumatic. Picturing myself there in the wreckage, repaired or not, was devastating.
I looked again at the photographs, touched my finger to the page, to the incisions on the women's chests, swollen, bitter red gashes across fragile tissue. I sensed an echo of pain in my own flesh, and felt like crying, for those war-torn survivors. . .and for myself.
“I think what would work best in your case is the tissue expansion method,” Lopitov said after turning another page. He pointed to another collection of photos.
I leaned forward, looking closer as he described what this method was and how it would be done. Fred took my hand, squeezed. Summer’s eyes glazed dangerously over; I hoped she wasn’t going to pass out. I nudged her, forcing a smile.
“After removing your breast, we would place a special empty silicone bag under the skin, under the muscle of the chest wall. This bag has a small valve attached which we’ll fill partly at the time of surgery with a sterile saline solution.”
He indicated one of the photos. “Then over the course of several weeks or months, we inject more into the bag through the valve which “pumps up” the expander. It stretches the skin gradually until the designated size is reached, at which point another surgery is performed and the temporary expander is replaced with a ‘permanent’ silicone gel or saline implant.” Dr. Lopitov’s perfectly manicured fingernail pointed to another photograph, showing a full, well-shaped breast. . .minus the nipple.
“Something seems to be missing,” Summer muttered.
Relieved, I thought, oh good, she’s not going to faint, she’s going to get pissed off.
My daughter is so much her mother’s child; frustration and helplessness annoys more than depresses her, usually. And frankly, I, too, was beginning to feel the first stirrings of that same futile anger. None of this was “acceptable.” Nothing about this was “okay.” Nipple-less breasts were not amazing, dammit. . .they sucked! Before I could add my agreement to her observation, the doctor turned the page, indicating the final picture in the series with a dramatic flourish, the full well-shaped breast now sported a dandy, sort of-real-looking nipple complete with an almost-nearly-authentic areola.
“This is more like it, right?” he said jovially. “It’s the second-to-the-last part of the procedure to be done, usually not until three months after the main breast reconstruction because the breast will sag over time; initially it will usually be higher than the other side, and if we put the nipple on too soon, it might end up too high or too low.”
Sighing, I thought, Of course! Wouldn’t do to have my new nipple positioned up to watch me pluck my eyebrows or located down where it could observe any leg-shaving transactions. I blinked away the images, asking, “So how exactly is this done?”
Dr. Lopitov described the procedure enthusiastically, “There are several ways this is done, but the method we prefer is where we take two small triangular pieces of tissue from the reconstructed breast, twisting them around each other, then sewing them together to form the nipple.”
I tried to picture this procedure and failed miserably.
“Afterwards,” he continued, “You’d wear what we call a ‘bumper guard,’ a protective kind of 'donut' over the area until the new nipple heals and scars. See?”
I nodded, feeling slightly hysterical, picturing a raspberry-filled Krispy Kreme plastered to my chest. Blinked the vision away.
“You said this was the second to the last part, what’s the last?” I asked.
He placed a fingernail on the page next to the areola. “The finishing touches are done about six weeks later. The nipple color and surrounding area color are tattooed on. Cool, huh?”
Fred groaned, then with his usual dry sarcasm attempted to lighten the conversation. “That’s great! My wife will have a tattoo. . .maybe I should buy her a Harley and some leathers for Christmas!”
Summer rolled her eyes.
“Maybe he could put a matching one on your bald spot, honey,” I commented dryly. “Then you could get a bike too and we could call ourselves the Hell’s Nipples!”
* * *
By the time we left Dr. Lopitov’s office nearly an hour later to go back upstairs to talk with Dr. Hrong, I was overwhelmed with information, all of which seemed abhorrent. I felt surrealistically balanced somewhere between hysteria and apathy, with rage pacing back and forth in the wings, hoping for a cue.
The plastic surgeon had explained yet another method for reconstructing breasts, the Tram Flap, using a large flap of skin and fat from the abdomen, an added bonus to this procedure being a concurrent tummy-tuck. Wonderful. However I happen to be one of those people who are so thin, I can damn near wear a striped dress with one stripe. I need a tummy-tuck like Dolly Parton needs bigger boobs. Any fat that could be gleaned from my abdomen might make a nice full breast. . .for a robin maybe.
So, all in all, we had spent forty-five minutes hearing about surgical methods, the pros and cons of radiation versus mastectomy, and frightening, depressing cancer treatment survival statistics.
“What if I chose to just do nothing?” I asked at one point. “I mean, the cancer was small, and it’s out.”
Lopitov shook his head somberly. “A Harvard study showed that lumpectomy without radiation had a recurrence rate of 16%, and of course if there’s lymph node involvement, those statistics would change--for the worse. However,” he continued, with more enthusiasm, “That figure drops down to the 3 to 5% range with radiation, about the same as with a total mastectomy with no nodes positive.”
"And if there are positive nodes?"
He frowned, "Well, then that figure goes up to about 25%."
Damn, I thought, none of these stupid statistics makes me feel safe. Finally, I said, “This is all just so overwhelming.” Looking into his eyes, I pleaded, “What would you do?”
He looked up at the ceiling for a second, thinking, then smiled and said, “Well, when the whole breast is removed, you can avoid radiation. You’re done. And remember, there’s only an approximate 5% chance of local recurrence.” This was clearly his option of choice.
The elevator ride up to Dr. Hrong’s office was a silent one, each of us trying to process what we’d been told, each of us feeling shell-shocked and overcome by a sense of helplessness.
“Well well!” Dr. Hrong beamed. “You’re back! What did you think of Dr. Lopitov? Nice guy, isn’t he! And an excellent surgeon.”
“Yeah. He seems…enthusiastic,” I agreed.
Fred put in, “He appears to know his stuff, I mean, for one so young. Apparently he does a lot of these reconstructions, huh?”
The doctor nodded happily. “Oh, he’s very experienced. So, what do you think?” He leaned towards me, expectantly.
I swallowed. “I think. . .that this is all pretty traumatic, you know?” Summer slipped her hand in mine, Fred slid closer. “The pictures. . .” Shuddering, I blinked away the images that were going to be infiltrating my sleep for a long time to come. Sitting up a little straighter, I continued, “They were pretty, uh impressive. But frankly, impressive or not, I’m obviously not thrilled with the idea of having a mastectomy.”
Before he could comment further, I added, “See, I’ve gotten kind of attached to my breasts. Implants or no, falling fast and all, they’ve grown on me; they're Laverne and Shirley, my droopy little buddies."
Hrong chuckled genially, “Of course. Of course,” he agreed. “It's natural to feel that way.”
Something in his chipper manner suddenly irritated the hell out of me.
"Actually, I'm not a big fan of any of the options here," I announced, donning a brittle smile of my own. "The option I want is the one where my phone rings—there’s been a big mistake—I don't have cancer at all!
And I get to sue the radiologist, the pathologist, you and the hospital for a million dollars, which I then donate to breast cancer research!"
Seeing Dr. Hrong's clearly unamused expression, I lost my steam. Weakly, I muttered, "Well, that's the option I want!"
"Yes, I'm sure," he said, frowning with crossed arms.
My moment of rebellion disappeared back into my psyche without a whimper.
“I don’t know what to do,” I said, panic suddenly rising up in my throat.
Hearing it in my voice, Fred put his arm around me, saying to the doctor, “Nothing has to be decided right this minute, does it? I mean, we’ve got a little time to talk about all this, make plans etc., right?”
“Certainly. Take a few days,” the surgeon agreed, his benevolence back in place. “And if you have any more questions, come on back in and we’ll talk. How’s that? In the meantime, why don’t you stop at the Breast Cancer Resource Center down the hall?” We all rose and he patted my shoulder. “They’ve got a library of books and tapes, all kinds of information. Cancer survivors volunteer there that you can talk to as well.”
“Okay, thanks,” I said, sincerely. “That sounds like as good a place as any to start.”
I have always been a voracious reader, for pleasure as a rule, but when I become fixated on a particular subject of interest, my usual method of operation is to read everything I can get my hands on, learning it inside and out. Now, with this subject, I knew instinctively that research could mean the difference between life and death. If I had any chance at all of manipulating the odds to my favor, it was by arming myself against this vicious enemy-- with knowledge.
Shaking hands with each of us, Dr. Hrong escorted us out. As we passed the receptionist’s desk, Mercy looked up, nodded and smiled.
I resisted the urge to tell my husband who she was (she wasn’t wearing a nametag), because I wasn’t in any shape to deal with the scene that would ensue if Fred let her have it. Instead, hearing her voice in my head, “Yes, it appears you do have a small cancer,” I looked levelly at her, smiled back and pictured her flailing about in a lake of piranha. As I closed the office door behind me, I could almost hear myself saying, “Yes, it appears you do have a small piranha devouring your right breast. . .but don’t worry. . .you can have Dr. Lopitov make you a nice new breast right downstairs, no problem!”
The plastic surgeon had explained yet another method for reconstructing breasts, the Tram Flap, using a large flap of skin and fat from the abdomen, an added bonus to this procedure being a concurrent tummy-tuck. Wonderful. However I happen to be one of those people who are so thin, I can damn near wear a striped dress with one stripe. I need a tummy-tuck like Dolly Parton needs bigger boobs. Any fat that could be gleaned from my abdomen might make a nice full breast. . .for a robin maybe.
So, all in all, we had spent forty-five minutes hearing about surgical methods, the pros and cons of radiation versus mastectomy, and frightening, depressing cancer treatment survival statistics.
“What if I chose to just do nothing?” I asked at one point. “I mean, the cancer was small, and it’s out.”
Lopitov shook his head somberly. “A Harvard study showed that lumpectomy without radiation had a recurrence rate of 16%, and of course if there’s lymph node involvement, those statistics would change--for the worse. However,” he continued, with more enthusiasm, “That figure drops down to the 3 to 5% range with radiation, about the same as with a total mastectomy with no nodes positive.”
"And if there are positive nodes?"
He frowned, "Well, then that figure goes up to about 25%."
Damn, I thought, none of these stupid statistics makes me feel safe. Finally, I said, “This is all just so overwhelming.” Looking into his eyes, I pleaded, “What would you do?”
He looked up at the ceiling for a second, thinking, then smiled and said, “Well, when the whole breast is removed, you can avoid radiation. You’re done. And remember, there’s only an approximate 5% chance of local recurrence.” This was clearly his option of choice.
The elevator ride up to Dr. Hrong’s office was a silent one, each of us trying to process what we’d been told, each of us feeling shell-shocked and overcome by a sense of helplessness.
“Well well!” Dr. Hrong beamed. “You’re back! What did you think of Dr. Lopitov? Nice guy, isn’t he! And an excellent surgeon.”
“Yeah. He seems…enthusiastic,” I agreed.
Fred put in, “He appears to know his stuff, I mean, for one so young. Apparently he does a lot of these reconstructions, huh?”
The doctor nodded happily. “Oh, he’s very experienced. So, what do you think?” He leaned towards me, expectantly.
I swallowed. “I think. . .that this is all pretty traumatic, you know?” Summer slipped her hand in mine, Fred slid closer. “The pictures. . .” Shuddering, I blinked away the images that were going to be infiltrating my sleep for a long time to come. Sitting up a little straighter, I continued, “They were pretty, uh impressive. But frankly, impressive or not, I’m obviously not thrilled with the idea of having a mastectomy.”
Before he could comment further, I added, “See, I’ve gotten kind of attached to my breasts. Implants or no, falling fast and all, they’ve grown on me; they're Laverne and Shirley, my droopy little buddies."
Hrong chuckled genially, “Of course. Of course,” he agreed. “It's natural to feel that way.”
Something in his chipper manner suddenly irritated the hell out of me.
"Actually, I'm not a big fan of any of the options here," I announced, donning a brittle smile of my own. "The option I want is the one where my phone rings—there’s been a big mistake—I don't have cancer at all!
And I get to sue the radiologist, the pathologist, you and the hospital for a million dollars, which I then donate to breast cancer research!"
Seeing Dr. Hrong's clearly unamused expression, I lost my steam. Weakly, I muttered, "Well, that's the option I want!"
"Yes, I'm sure," he said, frowning with crossed arms.
My moment of rebellion disappeared back into my psyche without a whimper.
“I don’t know what to do,” I said, panic suddenly rising up in my throat.
Hearing it in my voice, Fred put his arm around me, saying to the doctor, “Nothing has to be decided right this minute, does it? I mean, we’ve got a little time to talk about all this, make plans etc., right?”
“Certainly. Take a few days,” the surgeon agreed, his benevolence back in place. “And if you have any more questions, come on back in and we’ll talk. How’s that? In the meantime, why don’t you stop at the Breast Cancer Resource Center down the hall?” We all rose and he patted my shoulder. “They’ve got a library of books and tapes, all kinds of information. Cancer survivors volunteer there that you can talk to as well.”
“Okay, thanks,” I said, sincerely. “That sounds like as good a place as any to start.”
I have always been a voracious reader, for pleasure as a rule, but when I become fixated on a particular subject of interest, my usual method of operation is to read everything I can get my hands on, learning it inside and out. Now, with this subject, I knew instinctively that research could mean the difference between life and death. If I had any chance at all of manipulating the odds to my favor, it was by arming myself against this vicious enemy-- with knowledge.
Shaking hands with each of us, Dr. Hrong escorted us out. As we passed the receptionist’s desk, Mercy looked up, nodded and smiled.
I resisted the urge to tell my husband who she was (she wasn’t wearing a nametag), because I wasn’t in any shape to deal with the scene that would ensue if Fred let her have it. Instead, hearing her voice in my head, “Yes, it appears you do have a small cancer,” I looked levelly at her, smiled back and pictured her flailing about in a lake of piranha. As I closed the office door behind me, I could almost hear myself saying, “Yes, it appears you do have a small piranha devouring your right breast. . .but don’t worry. . .you can have Dr. Lopitov make you a nice new breast right downstairs, no problem!”
