But the repeated trips to DHMC are beginning to disrupt my work schedule. I'm a writer at King Arthur Flour in Norwich, Vt., and my days are driven by deadlines; there's always some project that has to go out the door, ASAP. So any time away from my computer is time lost, progress delayed. I'm not quite a type-A personality, but I'm a conscientious high-achiever—a boomer who's driven, like so many of us, by the fear of joblessness, courtesy of Depression-era parents. I'll go in for the biopsy, I think, but that had better be the end of it. I'm too busy for all this bother.
On Monday morning I'm at DHMC, wearing the now-familiar backless gown, sitting on another cold table. I get a shot of Novocain. Feel a startling "pop" as the large-bore biopsy needle penetrates the skin of my breast. Dr. Steven Poplack, the personable radiologist at the other end of the needle, is sniffing and snuffling with spring allergies as he follows the needle's progress on the screen of the ultrasound monitor. The sensation is unnerving rather than painful. Roto-Rooter, I'm thinking. A nurse holds my hand, strokes my leg, tells me I'm okay. Is this part of nursing training, I wonder, or does she really care? Coddled in warm blankets, I find my attention drifting . . . And then it's over. They tell me to come back on Thursday for the results.
My husband, Rick, accompanies me to the appointment three days later. I tell him there's no need—it's just a routine, "everything's fine" appointment. But he insists; I see the worry in his eyes. Funny, I'm still not worried at all. Today is the end; I'll be able to tell my friends, when they go through this, "Yeah, I had a biopsy. It was nothing."
Dr. Poplack comes into the waiting room and beckons me into his office. "Why don't you come, too," he says to Rick.
And that's when I know. This isn't the end. It's only the beginning.
Dr. Poplack sits on the edge of the desk, swinging his foot as he begins to talk. Nice shoes, I think.
"I wish I had better news for you . . . ," he begins. Laurel Ludy, the care coordinator
Coincidentally, a colleague at work had just had her mammogram, followed by a callback, then a biopsy— which had been negative. Plenty of middle-aged women go through this, I tell myself.
in DHMC's Comprehensive Breast Program, sits in the corner, regarding me with sad, warm eyes. Dr. Poplack tells me about the tumor and outlines the recommended treatment. I know he's talking, but my mind is Teflon; nothing is sinking in. I'm still stuck on "You have cancer."
The meeting lasts 10 minutes at most, then I'm out the door, clutching a canvas DHMC tote bag filled with breast cancer pamphlets and small white appointment cards for three specialists: Dr. Kim Grafton, a surgeon; Dr. Joe Pedersen, a radiation oncologist; and Dr. Gary Schwartz, an oncologist.
Rick and I walk out through the sunny central mall, past the food court, into the
rotunda, out to the car. I should cry, I think. Shouldn't I cry? But I don't feel like crying. I don't feel anything. Rick and I hug and look at one another. We smile hesitantly, feeling the comfort born of 25 years of marriage, the knowledge that "in sickness and in health" really means something. We've been through hard times before; we can do it again. We drive home. I go back to work.
The journey begins.
The first step is to remove the tumor. The surgeon, Kim Grafton, says I need to decide if I want a lumpectomy (removal of just the tumor) or a mastectomy (removal of the whole breast). Wait a minute, I think. Aren't you the doctor? Shouldn't you tell me what to do?
I learn there's a strange paradox about cancer: though it's a life-threatening illness, decisions about how to treat it are often left up to the patient. That's because each treatment comes with its own peculiar assortment of risks and side effects, and patients' willingness to trade off risks for benefits, and their tolerance for nasty side effects, varies widely.