October 19: Nine days after surgery

TL;DR: a cancer timeline.

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It goes like this: 

I schedule my regular mammogram for the beginning of August. Per my insurance, I have to wait 365 days from my last mammogram to reschedule. I complete the annual squishing ritual, and then, when Will and I are in San Diego for our 25th anniversary, I get the notification on my health app that the mammogram uncovered an "abnormality" and I would need to schedule a diagnostic mammogram. I sit with this news under a pleasant breeze. It is probably nothing. 

I have had mammogram recalls before, because I am part of the population with "dense breast tissue" which has nothing to do with size, but everything to do with how hard it is to read the imaging, due to fibrous tissue that appears white on the screen. I tell my sister in law, who has been dealing with this too, and she comes with me to the mammogram. If the diagnostic confirms what they saw in the original mammogram, I will get an ultrasound on the spot. H and I commiserate and gossip in the waiting room, and then I go back first for the diagnostic, and then, half an hour later, for an ultrasound. I shiver under an A/C vent in my thin gown until the technician comes back to tell me that something appeared on the imaging, and I'll need to schedule a biopsy. 

H is with me in the scheduling room, and chides me when I turn down the first available appointment, which is coincidentally the first day of my fall classes. What's more important, Paula? But it doesn't seem real to me -- it could still be nothing -- and it's a pain to communicate with students before class begins. I can imagine the flood of emails from anyone who didn't read the online announcement, the confusion of some lost first years wandering the halls, and so I take the second available date, a Monday. 

Will comes with me, because this is getting serious, now. The technicians joke with me while my right breast is balanced on a clear plate, presented like a delicacy. The doctor injects a numbing agent and then performs the biopsy, inserting a titanium clip. If the biopsy is negative, it will be a marker for my future mammograms: nothing to see here. If it's positive, it will be a roadmap for where the surgeon should cut. Afterwards, one of the technicians has to put pressure on my breast for about twenty minutes; it's intimate and awkward and we make small talk about movies, books, nothing at all while she presses against my breast and I brace against the pain. Either way, positive or negative, I'll receive the results in person, so an appointment is scheduled. 

It could still be nothing, even though it's getting harder to convince myself of this possibility. 

On September 9, K comes with me to the hear the results. She's a nurse, trained in understanding both the body and how to deliver/receive bad news. I learn that I have invasive ductal carcinoma (a cancer originating in the milk ducts and spreading to the surrounding tissue) in my right breast, and I learn its type: ER+ (estrogen receptor positive) and PR+ (progesterone receptor positive). This means nothing to me yet, but the nurse practitioner assures me it's a very treatable cancer. Early and treatable, she stresses. K and I hold onto each other and cry. My mind immediately goes into an unhelpful spiral, and I can't even think of questions to ask, so K takes over. Future appointments are scheduled. I have the feeling of something being set in motion, of being swept into a larger arena full of spectators, all of them in blue scrubs or white coats.

We had planned to go out to lunch afterwards, either to celebrate me not having cancer or to make plans for how I will fight it, and so we end up at Village Baking Co and order soup and sandwiches and tea and I try to chew and swallow and make a list of people to notify. Will is the first. Even though I don't want to tell him and have him drive the hour home with this information, I call him. I repeat exactly what was said to me, trying to keep any sound of tears out of my voice.

On September 11, we meet with my surgeon, Dr N. I have told only a couple of people at this point, so it feels like a secret assignation, albeit in room with comfortable chairs and state-of-the-art imaging screens. She shows me my cancer on the screen, which looks like a little spot of nothing in a sea of graininess. I ask questions. She draws me a picture on the back of a handout that I will later stuff into my already overflowing cancer binder. Will asks more questions. She recommends a lumpectomy, stressing the early, small nature of this thing growing inside me, but she also orders an MRI to check on a second spot not yet biopsied. Whichever option I choose, lumpectomy or mastectomy, my surgery is scheduled for October 10. A clock starts ticking.

At 8:30 am on September 16, I lock my clothes in the provided locker and follow the radiologist down the hallway. I've had MRIs before, but I would count this one among the worst experiences of my life. I lay upside down, my breasts falling into two strategically placed holes, my face pressed into what can best be described as a hockey mask. It's horrifyingly loud and the 40 minutes are endless. When the tech says, "I'm going to inject the contrast now; you're halfway there," I almost scream. But this feeling is replaced by a sudden, overwhelming urge to vomit -- it's the taste of the contrast in the back of my throat. "Don't move," she reminds me, but I have to keep swallowing and swallowing, and tears are streaking down my face, falling off my nose. After two minutes or so, the nausea passes. I have never felt so alone. 

The MRI reveals a second spot of cancer, which changes the tentative game plan. On September 23, I meet with Dr A, a plastic surgeon, who examines my breasts, talks about size, shows me the tissue expanders (often step 1 in reconstructive surgery and highly uncomfortable). I can still choose the lumpectomy, but it will mean removing a significant amount of breast tissue, and some plastic surgery will need to be performed on the left side for symmetry. I'm still wavering between options, but more and more, it seems like a mastectomy is the way to go. And if I'm doing one... I should probably just do two. 

I begin "prehab" with S. on Tuesday and Thursday mornings at 7:30, before my other appointments. And the other appointments are constant: there's bloodwork, genetic testing, a follow-up with Dr N, a follow-up with Dr S, my regular skin cancer appointment, meetings with my nurse navigator C. But on Tuesdays and Thursdays, I have brief moments of feeling in​ my body, not an outside observer, as I strengthen my chest and arm muscles and learn the post-surgery exercises that will allow me to regain mobility. 

On Sept. 24, I meet with a therapist (A) who specializes in oncology. It's just in time; I haven't been sleeping. I'm juggling the bookstore and my teaching job and a million appointments and looming decisions, and I'm not doing any of it well. I don't know how to tell people outside of my inner circle that I have cancer. I don't know how much time to ask for on my academic leave. I don't know how I'm going to not be able to do basic things for weeks, and so Will needs to take family leave from his job, too. It's too much, I tell her. A lets me talk, offers reassurances that everything I'm saying and feeling is normal. We agree to meet again weekly. 

On October 2, I meet with a geneticist, who takes detailed notes of my family history, and draws a chart as we talk. My testing has revealed I don't have the BRCA gene mutation associated with breast cancer, but the geneticist sees a number of "red flags" -- breast cancer on both sides of my family, including two family members who have died from it. My cousin's cancer at a young age. My own cancer, diagnosed before age 50, is considered "rare." She tells me to notify my siblings, and have them notify their children, that my cancer qualifies them for free genetic counseling. It's sobering, to say the least, but I'm also fascinated by it. 

I meet with Dr A again. I continue pre-hab. I see my therapist A. More blood draws. Phone calls where I have to answer a million pre-op questions. I finish grading final drafts for my students, my last contact with them for the semester. H comes over to help me deep clean the kitchen. I haul the last heavy boxes of book returns to UPS. Will and I take care of as much business as we can. I hold my regular book club meeting. I participate in a panel discussion about banned books. We take my mom out for Thai food. The night before, I don't sleep for a minute. 

October 10: bilateral mastectomy.