I was actually in the shower when I noticed it. My soapy hand slipped over my skin and bumped into it. A little teeny-tiny bump. Or maybe I should say "lump" since that's generally what folks refer to such things as when they occur in a breast.
So, I felt it. Right there in the upper outer quadrant. Which, if you've ever been to medical school, you learn in like the first year and a half is the breast real estate most likely to house cancers. Yup. So with my soapy finger tips I kept poking and prodding this pea-sized lump in my breast and trying my best to be objective about it.
So I felt the quality of it and asked all those things we ask the residents and students. Like, whether it was mobile or fixed and then I looked for stuff that could be associated with it like leaking or other ominous things. I got out of the shower and inspected my skin, turned every which-a-way and mashed on every aspect to try to see what I could elicit. I kept trying to decide if this was a legit lump and worrisome or was it just a not-so-big-a-deal "lump-ito" that I was overreacting about.
And you know what I quickly figured out? You cannot-cannot-cannot be anywhere close to objective when it comes to yourself and your own breasts. Especially as a doctor who feels other peoples' breasts on a daily basis. Like. . .you pretty much are guaranteed to overcall it or undercall it. Either way, you have this awful thing called knowledge that makes you form differential diagnoses and gets you doing literature searches on yourself. Which is not a habit I recommend.
Okay, and--spoiler alert--let me just come right on out and say (out of respect for those who've been affected by breast and other cancers and for my mother and little sister, who are just learning of all of this) that I've already had a mammogram and an ultrasound with all sorts of fancy-shmancy compression views and workup and NO, it doesn't appear to be suspicious for a malignancy at all. Which is medical jargon for "doesn't seem like cancer." So, yeah. Hallelujah for that.
Like, for real. Hallelujah.
I guess this got me thinking. All of this happened yesterday morning--that is, the mammo appointment situation--so it's all pretty fresh in my head. So literally, like less than 48 hours ago, I was waiting to get this lump or lump-ito in my upper outer quadrant of my breast checked out. And over and over from the moment my PCP ordered the test until I got it, I kept trying to palpate myself in every possible position as doctor me to reassure patient me that this was really no big deal. Like, really. Not even a big deal. Right?
I'm a woman. And I'm 44. I had my babies after age 30 and only had two pregnancies. So, like yeah, even though I haven't had an (immediate) family history to-date of breast cancer, by virtue of the fact that I have two XX chromosomes and hence two mammary glands encoded on them, I am not risk free. And I also know that a significant number of the women I've either known or cared for with breast cancer had no family history at all. Nope. So my point is--just being female puts me at risk. Period.
So . . .sorry I'm all rambly. . .but I'm just trying to unpack on this a bit.
Okay, so I'm driving from first dropping off Isaiah's carpool and second, going to Zachary's parent-teacher conference over to my morning appointment for a diagnostic mammogram. And somewhere in my drive it dawned on me: "This could actually be a honeymoon period. This could be my last time rolling up Clifton Road as a person who is B.C. and not A.D. (That's "before cancer" and "after diagnosis.") And sure, one could say that's a bit overdramatic, but honestly every single person who has ever received such a diagnosis had a point before getting it where everything was everything and there was plenty of room for a plethora of first world worries.
So, I recognized that. I pondered what I'd do if the doctor came in with a worried expression or if the tech wrinkled her brow too much while viewing the images she'd just taken. Like, would I immediately ask, "Hey! Does it look scary?" Or would I just wait and savor the last drops of the B.C. period for as long as possible? Would I call Harry right away? Or call my mom? Or just go out to my car and quietly pray?
And I'm serious--I thought of all of this. Because that lump was definitely there and I could feel it unfailingly each time I tried. In fact, I'd gotten to the point where I could just slip my finger in the side of my brassiere and put my finger right on it. Even thought it was the size of a pea.
I guess my point is that I knew if this was about to be something serious, that there would be a lot-lot-lot of white noise after that I might not be able to hear through. Not even my thoughts or ideas or fears, you know? So I tried to imagine--as macabre as it may sound--what I'd do. And you know what? That was just as futile as me trying to assess myself as a patient. Logic was nowhere to be found in it.
I go in and get my mammogram. The same lady who'd done my annual last year was the one who was doing my images this time. And I recall her being nice then but yesterday, I was extraordinarily grateful for her candor and bedside manner--way more than I was when I was just sliding in for the routine thing. I appreciated many things, actually. Like the woman who walked me back to the dressing rooms, the other woman who was also getting imaged smiling at me with her cheek sort of quivering. She looked nervous--and honestly I was, too--but in that she still decided she'd smile at me and be kind.
I was glad for the warming cabinet that the robes came from. They were toasty and comfy and felt exactly like being wrapped in a giant bath towel as a little kid. And that, I also took note of because I didn't know what was about to happen. I didn't.
When my mammogram was over, I was asked to go await an ultrasound and an encounter with the breast imaging specialist to discuss my films. I wasn't sure whether or not me having to go to the ultrasound area next was a sign of badness or just the next step in diagnostic imaging. And so. I sat there watching HGTV with five other women in toasty robes wondering their stories and wondering what the next part of my own might be.
The ultrasound technician was gentle and highly professional. She respected my body and protected my modesty throughout the examination. She didn't leave me exposed nor did she poker face me to the point of freaking me out. And you know? I appreciated that, too.
The attending radiologist and the breast imaging fellow came to talk to me next. They didn't know I was a physician--which I sort of dug--and I can also say I dug the fact that neither of them had ever rotated or trained with me. That would've been a wee bit awkward, don't you think?
Yeah. So they were both methodical and careful about explaining to me what was happening with my body. They weren't overly technical or underly so. They repeated my ultrasound, pointed out my pea-sized lump-ito on the screen and never once trivialized my concerns. And after a very satisfying encounter I walked out into the overcast misty January Tuesday. As I waited for my car in the valet area, I closed my eyes and let myself feel the dewy breeze on my face. I stilled myself and said a quiet prayer. For me and my outcome, yes. But most of it? For the women who were walking out of there A.D. or really close to A.D. And also one of thanksgiving for all of those kind professionals who someway, somehow might be making that blow to the chin land a little bit more softly for someone else.
I guess my point is that I don't want to ever take my health for granted. I don't want to drive myself up a wall of course, but at the same time, I don't want to assume that every screen is no big deal and that every work up will end in "chile, please." The fact is that the older you get, the more real stuff starts creeping up. The more those lump-itos pan out as real, true gamechangers and the more you find yourself calling you primary doctor to order you some kind of test.
And so. Today, I am sitting at my kitchen table eating a bag of popcorn and blogging. I'm looking at the clinic schedule for tomorrow and wondering what I'll have for lunch. And all of this--that is, this feeling a lump-ito and finding out the coast is clear--should technically or at least could technically be a blink on the radar and nothing more. Or even worse, I could interpret it as no more than a speed breaker slowing down all the shit I have to do. But I refuse to see it that way. I do.
I love my life. Imperfect as it is, I do. And I have stuff I want to do in it. People I want to fight for and impact. Places I want to go and faces I want to keep seeing. And there are few things I wish more than to never have my parents feel again what they've already felt before--the terror of being preceded in death or even infirmary of a child. And if I feel that way, I know that every one of my patients feels that way, too. At least partially they do.
And so. Tonight, I do the things that makes me feel most alive. I write. Then I go and kiss my boys on the tops of their heads, listen to them breathe and feel my heart wanting to explode from the love I feel for them. I look at pictures of Deanna and think of her and miss her and cry a little bit. I kiss my husband hard on the mouth and shrug when looks at me like he wonders what that was all about. I plan my next run and feel glad that my legs can.
So that's what I'm thinking about tonight. How quickly life as we know it can change in the twinkling of an eye. And how I just don't want to ever reach a point where I don't pause to savor and pay attention to its every dimension.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?