Monday, June 24, 2013

Cancer Bombs: Hoopla

[Note: The first of this series can be found here. All previous (and subsequent) installments of this series can be found here.]

If I wanted preventative surgery—namely a prophylactic double mastectomy—I needed to jump through a few hoops.

The first of which being learning how NOT to snort every time someone said the word prophylactic.

I wish I was kidding.

My brain goes somewhere entirely different and less significant than, um, major surgery when it comes across the word. Spoken, written... and it doesn’t really matter by whom or where it’s encountered—I laugh.

Seriously, my inner fourteen-year-old boy would trip and fall victim to the giggles every time he stumbled across the term.

[stage whisper] It’s like people don’t even realize it’s a synonym for condom... pfft. [/stage whisper]

The double-edge sword (sword... condom... heh) of the problem would be that yes, I had to speak to people—technicians, surgeons, counselors, assistants (read: professionals)—about the procedure.

I heard the word a lot.

And unfortunately, I got it into my head that I had to look, erm, balanced psychologically so that these professionals would clear me for the next step in the process...

(If you’ve read this blog you understand how truly challenging this undertaking is.)

Which meant these people were repeatedly saying the word “prophylactic” in appropriate conversation, and I was afraid to laugh in fear I wouldn’t be approved for the prophylactic (heh) surgery.

The crux being that everything’s funnier when you’re not allowed to laugh. Right? Right.

It was even worse when “prophylactic” was said with utter gravity by anyone in a white lab coat.

Seriously. Doomed. Brain = elsewhere.

Oh, how I struggled to rein in the insanity, lest there be potential derailment of the proposed surgery I so desperately wanted. Truly, though, I didn’t encounter anyone who seemed put off by my, um, unique approach to life, even when it managed to spill everywhere and make a mess.

So. The hoops. After I retrained my inner 14-year-old-boy managed to get it together, I had appointments. Many.

First off, Mary had arranged an appointment in January 2012 with Dr A, a general practitioner who volunteered her hours with the genetics department. I believe her clinical breast exam counted as one of my two needed in a year within the Ontario Breast Screening Program’s requirements.

Dr A had only one true hoop to jump question. Based on my response, I would be referred to the general surgeon (yay!) or not (boo!).

Picture me sitting in a generic cotton surgical gown, on a generic exam table covered with generic paper, within generic exam room walls, babbling about how I hadn’t known there was a quiz or I would have studied for it...

Dr A is a blur of soft colours and kind tones, holding a clipboard. She says this:

“How would you respond if I said we could drop your risk of breast cancer to lower than the natural risk of any other woman walking this Earth?”

Anything but a generic question.

My face crumbled. I had no answer. My mouth moved but nothing came out, my eyes warm with tears.

I remember she smiled, wrote on her clipboard, and said she lived for those responses.

Dr A referred me to Dr D, the general surgeon who would be preforming the prophylactic double mastectomy. Before I saw Dr D, though, I had to have a breast MRI, as part of the Ontario Breast Screening Program, and to ensure I wasn’t already carrying breast cancer.

No point in scheduling preventative treatment when I needed reactive treatment, right?

Here’s the thing: in Canada our healthcare is covered. If your problem isn’t critical it’s a notoriously long waiting list. I wasn’t fooling myself. MRIs can be a four to six month wait if you have a problem.

I wasn’t ill. Not even a teensy bit.

So I was floored when I found myself with a Saturday morning appointment for a breast MRI in March 2012, barely five weeks after I’d seen Dr A.

I was worried about that MRI.

I’d never had one before, and had no real frame of reference except for the knowledge that you’re not allowed to move, and that my mother had discovered she was claustrophobic during an MRI when she was undergoing treatment for breast cancer.

My MRI was scheduled to be 45 minutes long.

45 minutes.

45 unmoving minutes.

Truthfully, I was more worried about boredom than I was about revealing hitherto undiscovered claustrophobia.


Nerves infected me. My lack-of-filter verbosity was in true form that day. The MRI medical history questionnaire had me twittering inanely... questions about jewelry, piercings, previous accidents, surgery, potentially embedded plates, screws, false joints, and my personal favourite: shrapnel.

Yes, shrapnel—everyone knows stay-at-home-moms are riddled with it (heh).

Turns out I’m pretty goddamn boring; I suppose it’s in a good way.

Then when the MRI technician told me she was prepping my catheter, I maybe babbled relief because I drink so much tea I tend to use the bathroom a lot, and my secondary fear (after mind-numbing boredom, and despite refraining from caffeine that morning) was the panic of needing to pee mid-MRI.

The technician found this endlessly entertaining of course, because this particular catheter was to be placed in my arm for MRI dye, and had nothing to do with bodily functions.


I blame the nameless person who should have and yet neglected to tell me there’d be dye injected during this MRI. (Erm... and my big mouth. Whatever.)

The two technicians got a good chuckle from that, and by the end of my MRI, I wasn’t quite sure if they’d let me leave—apparently my nervous babbling was endearing, because they were threatening to adopt me.

As for the MRI itself, well, there was certainly no need for me to worry about boredom. Even though I wore earplugs, the knocking and zapping noise of the MRI machine was loud, thundering, deafening, enough to work its way into your skull until you couldn’t put two thoughts together!

There was no thinking. There was no nothing.

You simply lay there, face down with your breasts hanging through a special slot (the techs adjusted their placement—that was fun in an awkward way), while the machine does its thing.

It’s rather relaxing, actually. Meditative.

I won’t be worried if I ever have to do it again, that’s for sure.

I went home with a tingle of trepidation because I knew that if any breast cancer were to crop up, this MRI would show it. But no, thankfully the results were boring as hell. Apparently it pays to be boring...

April 2012, and on to the next hoop: meeting with Dr D, the general surgeon, the first half of my double-surgeon team.

My Surgical Super Team.

Dr D would be performing the my double mastectomy. That meant she’d be the one removing my mammary tissue, as much as possible—obviously a few errant cells would be left behind here and there, but overall my risk of breast cancer would be drastically reduced.

And I knew she was good. Whenever I mentioned she was my general surgeon, medical professionals who had encountered her in the field positively fawned over her in praise. She was known for proactive work. She was known for delicacy.

Best of all: she was known for skill.

Turns out she was blunt and to the point, but warm and professional. Never did I have a sense she was condescending while explaining procedures or specifics pertaining to my case. Her office had the streamlined efficiency of practiced professionalism.

Her waiting room was tiny. Her assistant was courteous and quick.

The entire package was intimidating.

Which meant meeting Dr D for the first time was nerve-wracking.

Mostly because of that ridiculous notion that had set into my brain that if I didn’t appear mentally sound (ha!) it would be inferred that I wasn’t wholly on board with the procedure (or at least not in the right head space to make such a radical decision), and I would be kicked to the proverbial curb. A curb which would mean I was back to the drawing board that is the Ontario Breast Screening Program, and high risk screening for the rest of my life...

Possibly fifty years of mammograms squishing the girls, more MRIs, and more handling of the boobage by complete strangers medical professionals.

Yeah. Screams good times, am I right?

So. Another exam room. An introduction. Another breast exam. Dr D reviewed my chart and asked me what I was hoping to accomplish by pursuing this course.

Another pop quiz. Great.

What to say—that your family history predicts you’ll die young? That you want to be around for your kids? That you don’t want your husband to have to be your nursemaid? That watching other people go through cancer—living knowing a cellular invader was slowly eating its way through them—scares the ever-living-shit out of you? That you don’t want to sit waiting for the two cancer bombs strapped to your chest to explode?

I laid it out succinctly. “My mother’s mother passed away at forty-six, when my mother was only nineteen. My own mother died at fifty-five, less than three weeks before my son was born. My goal is to meet my grandkids.”

Dr D smiled. “I like that. That’s a new one.” She scribbled something on my chart and asked me to get dressed and meet her in her office.

When I sat down facing her at the desk, she was studying my chart. She didn’t look up when she spoke with a light, conversational tone. “Are you interested in keeping your ovaries?”

[Insert sound of needle being ripped off a turntable.]

This was the first I’d heard that they might be removed. And said so... casually...

It was rattling.

Dr D explained that they routinely remove ovaries along with breasts in proactive treatment such as what was slated for me. They’d do breasts, or breasts and ovaries, but they wouldn’t remove ovaries on their own. If I chose to wait, and changed my mind ten years down the road and returned to her, she’d do it then. So no pressure or split-second decision making.

It was still pretty abrupt to absorb. I hedged. “But none of my family history includes ovarian cancer.”

“True. But arguably none of your predecessors lived long enough to have it.”

Ouch. She had me there.

Her eyes roved my file, then she grimaced. “Looking at your chart, I’d perform this based on your family history alone.”

"Pardon?" Still recovering from the question about the oophorectomy, her comment caught me off guard.

I’d fretted over particular genetic testing results only to discover that my family history landed me firmly into the proactive surgical category all on its own?

Fuck, yeah!

“Mother, and father’s sister, both with early onset bilateral breast cancer? Oh, yes.” Dr D grinned at me over the top of my file, her eyes glittering with delight. “This will be good. I’m sending you to Dr M. I enjoy working with her; she's very talented. We don’t get many proactive cases. This will be fun—you’ll be perfect as a showcase for what we can do.”

Ooh, a showcase... a fake boobage showcase. This could be good, right?

Naturally, I had many questions, but Dr D was performing the double mastectomy, and as only one half of my Surgical Super Team, she couldn’t tell me all the details yet.

Important details. Details that left me hanging.

Specifically: how many surgeries, and when.

Those details would come from Dr M, the Surgical Super Team’s second half—my plastic surgeon.

It was heartening, to hear everyone gush about Dr D, and to then experience firsthand her calm and polished manner coupled with an amiability that gave me confidence in her skills, only to have her gush in turn about her proposed surgical partner for this endeavour.

And it was once again intimidating.

Another doctor. Another person to convince I was balanced and on board.

In retrospect, there was no need to worry, because it was Dr M. Of this entire journey, she’s my absolute favourite encounter. So much so her introduction deserves its own post...

[The next post in this series can be found here.]