A.C. - February. Looking Back. That Thursday in September

I found the lump on a Thursday night in the shower. A nighttime shower was unusual for me, because the twins typically fight sleep, and I almost never get time to myself at night until late. But it had been a hot Indian summer day and a long day in the clinic seeing patients that day, and the twins fell asleep early. I needed that shower. I had been having pain in my left breast for about two weeks, and I had been mashing and smashing the tissue there, trying to find something, to no avail. But when I raised my arm in the shower to wash my hair that night, I pushed at the top of the breast, near that tender spot, and there it was - a pea sized lump. It hurt when I pressed, and to be sure, I pressed hard again. Yes, it was definitely there. I took a deep breath. Suddenly, I went cold, in spite of the hot water beating down on me. I switched off the water, not even sure if I had finished washing my hair. I felt fear overtake me and I needed to sit down... and think. I wracked my brain and tried to think back to my medical school teaching on painful breast masses. I was an orthopaedic surgeon, so painful breast lumps were not in my every day wheelhouse. I tried to be clinical, objective. My beating heart pounded in my ears and I felt anything but clincal.

'47 year old white female, healthy, overweight, type A, poor diet, 3 years out from In Vitro and a twin pregnancy.' I mentally checked off the boxes. The cancer word was circling my brain, like a neon sign, signaling 'Danger Danger.' I thought about the things that were in my favor. I had breastfed my oldest and the twins, too. I had no family history of breast cancer. I was young, well, I guess, young-ish... not super young in years, but physiologically young and so strong. Even though I had a bit of extra weight, I had always prided myself on being strong. I would go out of my way to choose the hard things. I decided early on as a kid that I wanted to have a life with lots of amazing things, trips, houses and incredible experiences. I learned soon after college graduation that my degree in psychology wasn't going to provide this life, so I set my sights on medical school, and orthopaedic surgery was my answer for how I was going to make this life for myself. I loved being a surgeon. I loved the gratification of helping others get better and restoring function. I loved the idea of fixing things. I most definitely was the Fixer in the family.

I got dressed after completing my mental assessment. My heart was still pounding, but slowing a little now. I walked into the living room, where my husband was watching some mindless TV show. I sat on the couch silently and he didn't really even look up. I sat staring at the television, not seeing or watching, but looking straight ahead. I had a thought then, how this moment was probably going to change the course of our lives. I had a bad feeling. I was pretty sure, after all, that this painful lump was not going to be a good thing. I was pretty sure I had just found a breast cancer and I was terrified. My twin girls were just 3. I had a 10 year old daughter too, just starting to enter the beginning stages of puberty. My husband and I as a couple had just gotten over the trauma of 5 years of miscarriages, infertility, a failed IVF and then a successful IVF ( but a very difficult twin pregnancy.) There had been so much emotional upheaval with all of that. My orthopaedic practice was just now recovered after the personal time away, dealing with my health. We were finally coming out of the tunnel of lost wages and lost time. The kids were finally in a routine, sleeping better, and manageable. We had talked just the other day about how we were just feeling like we were able to relax a little bit, that we were entering such a great time in our lives. We were keenly aware how lucky we were to have healthy kids, a beautiful home, no worries except where to go for holidays. It was all about to change, again. I hated to even say it out loud.

I gulped and swallowed and gripped the edge of the sofa. I sat forward, tense, and I took a deep breath. "Honey, hey - could you turn that tv down for a sec?" He looked up, surprised. I could see him looking at me, leaning forward. I could see the concern on his face at my tone. I pressed on. "Okay, so I don't really know how to say this, so I will just blurt it out. I was just in the shower and I found a lump in my breast... and I am kind of worried."

"What?" he said. His voice was shrill in my ears. "You found a lump? In your breast?" he repeated my words. I felt nauseaous. I nodded and I didn't know what else to say. He just looked at me, needing more. I nodded again and cleared my throat.
"Yes, I did. I need to call in the morning and schedule a mammogram, but I have been having a weird pain in the top of my left breast for a couple weeks. I thought I might have pulled a muscle lifting the girls, or dragging luggage through the airport when we came back from the beach last month, but I found this lump tonight, and now I think it is something more."

It was his turn to process. He set the remote down on the side table and looked at me. He was not a medical guy, but he was smart. He could hear the unspoken 'cancer' word loud and clear and it was evident from his face, he was worried too.

I spoke again, "I just need to call and get scheduled for the mammogram. We won't know anything until we get that done. But I just had to tell you what was going on."
He nodded his understanding. "But you are going to be ok, right? I mean, you are young and healthy, so this probably isn't..." His voice trailed off. "Breast cancer...", I finished for him. "I don't know. It might be. I pray no, but why else would I have a lump?"

There it was. We had spoken it out loud and now the cancer card was on the table. Just like that, our normal September Thursday night had turned into a night we would never forget. The cancer train had entered the station and we had just gotten on.

We went to bed. He held my hand, and I felt comforted. Yet, in just moments, he was asleep and I was left alone with my racing thoughts. In the darkness, I gingerly moved my fingers over the top of my breast. Again and again, I examined that firm blob of tissue . My mind reeled and I tried to slow down my thoughts and my breath. Fear pulsed through me and I shivered in the darkness. I protested, to no one, to God, "This cannot be real." The stillness of the lonely night answered me with the harsh reality that it was. Somehow, some way, I finally slept, dreading the day to come.

The next morning, I promised my husband I would call him the minute I knew anything. I dropped the girls off and drove to the clinic, mentally preparing myself for the phone call. I got to the parking lot 5 minutes early and I called my own hospital and spoke to the operator, "Hi, this is Dr. Freehill, I need mammography please." I waited on hold less than a minute, then a cheerful young woman answered the phone. "This is the Breast Health Center, how may I help you?" I inwardly cringed. I was calling about an issue that I was pretty sure wasn't about "health". I answered back, "Yes, hello. This is Dr. Freehill, I am calling about a personal matter and I would like to schedule a mammogram please." She asked my birthday and I could hear her fingers clicking the computer keys in the background. She piped back up, "Yes, I see here that you had one last December, so we can schedule you for December of this year. Your insurance will only pay for one mammogram a year, Ma'am."
"Um, no. That is not going to work. I have a concerning lump that I found and I can't wait that long. I need to come in today." She paused, and my heart nearly bounded out of my chest. "We do not have spots today, Doctor, and to get a quicker appointment, I would recommend you call your primary care physician to get the order. We would need to do a focused mammogram with possible ultrasound-guided biopsy the same day and we need an order for that."

I hung up. I had a sudden realization of helplessness. I was not in charge here. I was suddenly a patient, on the receiving end of the health care system and bureacracy. I was at the mercy of the schedulers, the receptionists, the secretaries. I was not able to direct all of this to my liking, unlike my every day gig. I had to follow the rules and make the calls and do what everyone else had to do, to get my scan. I didn't like it.

I dialed my primary physician's office. I asked for her nurse, when the receptionist picked up. I was late for my office hours now, but I had to get this taken care of. "Tammy, this is Angela Freehill. I am calling about a personal matter. I found a breast lump last night and I need an order for a mammogram with a possible ultrasound guided biopsy sent over to the hospital please. I am very worried it might be breast cancer, and I need it ASAP. Can you do that for me, please?" My voice broke as I squeaked out my last word, and I felt the tears rushing to my eyes for the first time. Why me? Why now? How could this happen? Questions and fury were swirling inside me and I knew I just needed to calm down. She was so kind, "Oh sweetie, I am so sorry. Let me call over there. I will send the order right now and let me see what I can do for you. I will call you back, OK?" I was able to murmur ok and I hung up. I walked into clinic, smiled at my nurses and started my day. Just like that, I turned it off, tuned it out. I felt like I might vomit, but I was not about to let anyone know. I was strong, remember?

Later that afternoon, I got the call. My mammogram was scheduled for Wednesday morning at 8 am. It was the Friday of Labor Day weekend, and Wednesday was the absolute earliest they could get me in. I had no idea how I was going to wait that long.

That night, my kids jumped on my lap and my husband made a meal. We swam an end-of-summer late night swim, and we watched a movie. Nothing was different at all, and yet everthing was changed for me. The smallest moments made me catch my breath. One of the twins fell asleep in my arms, and as I tenderly carried her up the stairs and laid her in bed, I whispered a plea to heaven, "Please God, let me live. Please, oh please, let me be ok. I cannot leave them."

Several times over the weekend, my husband and I locked eyes and he hugged me extra tight, each time, with tears springing so quickly to my eyes. The days passed in an anxious blur and I kept hoping it was just a bad dream.

Finally, after what seemed like a year, Wednesday morning arrived. Wednesday was my usual day in the OR, and I had bumped my cases back to 10:30. I was late for my appointment; I was always late to things, mostly because I wanted to spend the time with the kids in the mornings, dropping them off, but they were an extra challenge that day. I rushed in to the Mammogram center, frantic, breathing hard. I wrote my name on the sheet, and looked around. I had never been inside this space, and yet I walked by it every day. It was pleasant, bland. There was an advertisement jingle blaring on the tv. I waited.

The tech fetched me. She dropped me in the room and I wrapped the pink papery gown around my shoulders, open in the front. She ushered me in to the mammography suite and it was dark and hushed inside. She was efficient, confident, but gentle and kind. As she kept positioning my left breast in different angles against the cold machine, I had a vision of this horrible spiculated mass, with long fingers reaching across the expanse of my breast. Finally, we finished and she asked if I wanted to see the images. I did. When I turned my eyes to the screen, I could see the mass from across the room. A small, ovoid grape, right at the top of the breast. "That's it?" I asked. She nodded her assent and I thought to myself, "Well, that doesn't look so bad." It was little, maybe one centimeter, oval with no irregular edges, no spiculations, no long reaching fingers. She said, "The radiologist will be right in." She scurried out of the room.

The radiologist that day was a colleague of mine. I often called him to review an MRI I was unsure of. I trusted and liked him. His boy went to school with my oldest. He walked in and said hello and we got down to business. "Angela, this looks like a cyst to me on mammography. It is round and has no irregularity. I think we can just watch this and maybe have you come back in a month for a follow-up scan."

My heart dropped. I thought about just running out of there, carrying on with my life as if this lump was not even there. I felt the familiar stab of pain I had been having over the last month, and my words tumbled out, "No way."

He was taken aback, it was clear. I was assertive, and cut right to the point. "I have been having pain here for a month and I just found this lump last week. I will not be able to rest until I know this is not breast cancer. We are getting a biopsy... today, now. I mean, please..." I looked up at him, then. My jaw was set and I could feel my teeth clench together. He said, "Don't you have surgery today? Why don't we do this another day? You could come back next week? You will be sore today if we do this now."
"It's ok if I am sore. I truly just want to get this over with. I am staying until we get this done. I will deal with the rest of my day later."I had stood my ground and he looked at me quizzically, just for a second. Then, he nodded, "Ok then. Let's go."

He guided me to the ultrasound room and the tech there smiled at me. I knew her too, from my oldest's school. I felt like the whole town was going to know the intricacies of my breast issue before long. I signed the papers and we made small talk about the weekend and the weather, while I impatiently waited for some insurance guy on the other end of the phone to give his approval.

Finally, we were underway. As the radiologist went over the lump with the ultrasound wand, I squinted hard, trying to determine if there was blood flow. I didn't think one time about modesty or embarrassment. My eyes were laser focused on the screen. I saw the dark shadow of the lump, but I couldn't see much else. "OK," he said. "I am going to aspirate this with a needle and see if I can get fluid out. If we don't get fluid out, then we will take a sample of the tissue and send it off." He numbed me up and plunged the needle into the top of my breast. I watched to see the needle pass right into the mass on the screen, and then, nothing. There was no fluid. It was clearly solid. He cleared his throat. "Ok, then, this was not fluid filled, like I thought. I am going to take some tissue samples now." I was numb, physically and emotionally. I just wanted it over with. I wanted to run away. We finished and once the radiologist left the room, I sprinted upstairs, clutching an ice pack to my chest.

My surgery day was difficult. I was distracted and the cases were not easy. I made it through, but it was not my best work that day. I felt human and fallible all day, vulnerable and exposed.

The next morning, I dropped off the kids and then walked into my office. I started my day,seeing my scheduled patients, but every time my beeper or my phone went off, I jumped. I knew that my fate was laying on a pathologist's desk and I was itching to know, to face it. By 9:30 that morning, I could not take it any longer. I slipped out of the clinic area and wandered down the hall to my office and I closed the door. I picked up the phone and dialed the hospital.

"Pathology please," I inquired when the hospital operator answered. She clicked me over and I believed I could feel the hum of the phone line in my veins. The pathologist answered gruffly, "Hello."

I stammered, "Um, yes, hello. This is Angela Freehill. I am calling on a personal matter. I had a breast biopsy yesterday and I am pretty sure my slides are on your desk and I would just love to know the results, please."
He answered back quickly, "Yes, I have your slides right here. I have read them." He continued on, "This is highly unusual though. We usually have the nurse call patients with the results. This is not my job."
I did my best to control my irritation. I tried not to sound hysterical. "Well, yes, I know it is not your job. I am calling to ask for a personal favor, so I do not have to wait all day for this.If you could just tell me... Please," I finished.

The world stood still. The pause was thick with his tension and my fear. I was dizzy with anxiety. He spoke quickly then, and without emotion. "Invasive ductal carcinoma, high grade. Tumor markers have been sent and they will take a week to come back." I sucked in my breath and I looked at the clock. 9:37 am. I muttered, "Ok then, thank you so much, I will talk to you later then." The first thing I thought as I hung up was that it was a stupid thing for me to tell him I would talk to him later. I never wanted to speak with that man again. The second thing I thought was that I was now a woman with breast cancer. Yesterday, I had hope. This morning at 8:34 and at 9:12 and at 9:33, I still had hope. Now, I was a woman with breast cancer and it was the loneliest and most hopeless feeling in the world. I dialed my husband and all of a sudden, I was sobbing into the phone. He told me to breathe and I realized I had a clinic full of patients waiting for me, a roomful of nurses and receptionists, just going on with their normal days, waiting for their doctor. I told my husband to just wait, that I was coming home.

I stood up and felt the warm tears falling down my cheeks. I realized I had never understood the warrior analogies I had heard before, of women dealing with cancer. But I felt like I understood, all in one epic moment. I wanted to live. I wanted to fight and do whatever it took to see my children grow and to hold my husband's hand, night after night. I felt like I was ready to go to battle and to do whatever it took to slay the monster. I was afraid, but I would not run. As I got out of my chair and walked down the hall, the hot tears were still coming. I squared my shoulders and decided, yes, I was going to fight. I wanted to live and I would fight as long as I had a breath. I wanted to LIVE.