Fighting Breast Cancer

Dr. G scheduled me to have a new bilateral mammogram (meaning both breasts) with ultrasound, as well as a chest x-ray and bone scan.  The Mayo Clinic does all of their blood work and radiology tests in house, so I should get all of my results by tomorrow.

The mammogram was a lot like the first one I had, except more thorough.  The technician took 4-5 pictures of each breast.  I found it particularly painful because she was trying to smash my arm and chest in the machine such that she would be able to get a view of my lymph nodes.  Sometimes the physiology of a large breast can be limiting.  I mean, there is just so much mass that the machine can view at once.

The chest x-ray was no big deal.  That just took a few minutes.

Finally, I was ready for my bone scan.  One of the nurses led me to a room in the radiology dept. where they administer the radioactive dye.  The nurse prepared the syringe with the radiation warning signs on it.  She tied off my arm and shot the dye in a vein.  (Visions from the move Trainspotting dancing in my head.  Don’t ask me why.)  I was then led to a different room where a technician asked me to lay on a long thin table.  He asked that I lay as still as possible while a machine was lowered within inches of my face.  Over the next 30 minutes, the machine inched it’s way down towards my feet, giving the technician an image of my skeleton on his computer screen. 

When the scan was complete, I was told to drink as much water as possible so that I could pee out the radioactive dye.

My pee is radioactive from the injection for the bone scan.  The technician suggested that I “flush twice” after I use the toilet.  Like I don’t have to do that already.  Ha ha, just kidding.

My husband, Mr. Stable-Minded, has insisted on coming with me to get the results of yesterday’s scans.  I don’t want to use the word “crazy” to describe his state of mind, but let’s just say that I didn’t trust him to drive to the appointment. 

We arrived at the Breast Clinic and were ushered into an examination room.  Dr. G walked in wearing a very well tailored suit.  (I noticed this before.  It seems that the Doctors at The Mayo Clinic should win some sort of “Best Dressed” award.  They all dress impeccably.)  He sat down and pulled up the radiology images on his computer.  The mammograms and ultrasounds that were taken showed a much clearer picture of the tumor in my breast.  The tumor is approximately 3.3 inches wide.  The bone scan showed a strange shadow in my pelvic bone and two vertabrae in my spine.  This does not necessarily mean that the spots are cancer, but we need to investigate some more.  The chest x-ray came back clear.

The doctor examined me again, paying close attention to the lymph nodes in my arm pit.  My husband, looking a little bit shaken, started firing questions at Dr. G.  “I know you can’t formally stage Karen’s cancer, but based on the information that you have now, can you do a clinical staging?”

Dr. G helped me sit up as he addressed Michael’s question.  “I would clinically stage her at Stage 2b“ 

“Oh my God, Karen!  2b??!!!  2b???!!!  That means it’s spread to your lymph nodes!!  Oh this is bad.  This is bad.”

Obviously, Dr. G didn’t realize that he was dealing with a hypochondriac who probably reads more about disease than the average family practitioner.  Michael had been compulsively Googling cancer since I first felt the lump.  (Before he had my lump, Michael spent his spare time reading about infectious disease, you know, for fun.)  Sensing Michael’s rising anxiety levels, Dr. G quickly interjected, “I meant to say Stage 2a.  Really, I misspoke.  I would say 2a at this point.” 

“2a?  Are you sure?  Because you just said 2b.  I very distinctly heard you say 2b!  Which is it?”

(Again, the attorney routine.  The doctors are going to grow tired of this.  This is a consultation, not a deposition.)

Honestly, I think Michael was beginning to unnerve Dr. G.  Thankfully, having been married to Michael for 4 years and having known him for 11, I’ve developed an immunity to his antics.  I had to tell him what I’ve told him so many times over the years.

“Michael, really.  Just cope and adjust.  Ok?”

We left shortly after that.

Dr. G wants me to get a few more tests.  He thinks that I could benefit from a CT scan of my lungs.  (We still need to get to the bottom of what is making me cough so much.)  He also wants a CT scan of the shadowy spots that showed up on my bone scan.  Finally, he ordered a Breast MRI.  This sucks.

I had to be at The Mayo Clinic at 7:00 this morning.  This means, that I had to wake up at 5:30 to get there on time, and I was still about 10 minutes late because I underestimated traffic.  I don’t know how people do it every day.  I had road rage just from driving in traffic once.  (Oh, I should say that I work from home.  So it’s not like I don’t drive; I just never have to do it in rush hour.)  My anger might have something to do with the fact that I was told to “fast” this morning before my CT scans.  I don’t do very well with fasting.  Just ask my husband.  He’s in charge of my feedings.

Anyway, today I had several tests, and I don’t mind telling you that I’m exhausted.  When I arrived, I ran down to the Lower Level Radiology Department and checked in for my first CT Scan.  A nurse called my name shortly after and handed me what she called my “morning hour cocktail”.  She lied; there wasn’t any booze in there at all.  I sucked down a thick and disgusting white banana flavored Barium “drink”.  Then I was told to wait. 

Nearly 30 minutes later, I was led to an area so that I could change into a gown.  Then a nurse sat me down so that she could administer an IV.  (An IV?  Nobody told me there would be needles involved!)  Apparantly with CT scans, “contrasts” are used to help outline different areas of the body.  The barium drink that I was given would help my digestive tract to show up on the scan.  An iodine IV would help my blood vessels and lungs to show up on the scan.  I was pricked in the arm with the IV and they capped it off.  Then they led me to a room where the CT Scan was located and I was instructed to lie down.  I was positioned on the table and the nurse hooked up the IV line to a bag of saline.  At the opportune moment, the iodine would be fed through my vein causing me to feel flush and to feel like I just peed my pants.  Goody!

The nurse left the room and the scan began.  The table moved into the tunnel of the machine.  I just closed my eyes and waited.  A women’s voice (was it the nurse?  was it a recording?  I couldn’t tell…) was instructing me to breathe in, breathe out, hold my breath, and so on.  Finally, the Iodine injection came and a flash of warmth raced through my body down to my bladder.  I was absolutely certain that I pissed myself. 

Again, the voice badgered me about breathing and not breathing and then it was all over.  The nurse un-hooked my IV and removed the needle from my arm.  I jumped down off of the table and made a bee-line for the bathroom, but to my confusion I was completely dry.  No accidents after all! 

With that test out of the way, I had some time to kill before my next appointment.  Thankfully, my fasting was officially over, so I went to the cafeteria to eat. 

On a side note, I would just like to say that The Mayo Clinic has the best cafeteria in the world, ever.  I mean, this isn’t your average hospital crap.  My husband actually says he wishes it wasn’t 30 minutes away, or he’d eat there every day.

2 eggs cooked to order, hash browns, bacon and a Snapple:  $3.85

My next test was an Echocardiogram and EKG.    I have a great pulse and blood pressure, so these tests were no big deal.  I actually found it to be quite relaxing.  The tech placed several nodes on my chest and basically took an ultrasound of my heart.  She had the lights dimmed while I layed there and I would have fallen asleep if she hadn’t have had to smear the cold ultrasound gel all over me. 

When that test was finished, I had about another 2 hours to kill.  I visited the gift shop and wandered around looking at all of the art on the walls.  Then I sat in the lobby and listened to the piano player in the main lobby while I read.  Finally, at long last, it was time for my Breast MRI.

Another IV.  Just great.  This time, at least the dye wouldn’t make me feel like I needed a diaper.  MRI’s are very very loud.  I was given a pair of head phones along with a list of CD’s to choose from.  The test would take about 30-40 minutes, so they wanted me to be as relaxed as possible. 

This time, I was told to lay face down on the table with my gown opened so that my breasts would fit into an opening of the table (there was something very perverted about that table).  My arms were raised over my head so my position was like that of a topless Supergirl.  My IV was hooked up and the nurse positioned the headphones on my head.  I could barely hear Sarah McLachlan over all of the MRI racket. 

At long last, my day of cancer testing was over.  I drove home and took a nap.  All of that waiting around to be poked by needles can really wear a person out.

Today I received my test results from Dr. G.  The breast MRI showed that the tumor was  much bigger than we thought.  In fact, it shows that the tumor is actually comprised of two tumors next to each other.  The MRI also showed that the cancer has spread to the lymph nodes under my armpit. 

Today, Dr. G mapped out my plan of attack.  Based on all of the testing that has been done so far, this is his recommended course of strategy for my War with Cancer:

Battle 1:  The Chemical War Offense–  Considering how large my tumor is, Dr. G has recommended that I begin chemotherapy.  As soon as possible.  This will hopefully achieve 2 goals: A.) Shrink the tumor in my breast such that I will be able to have a lumpectomy instead of a mastectomy.  B.) Immediately stop the cancer from spreading through the rest of my body.  This battle will be the hardest.  I will have to endure one cycle of chemo every three weeks.  I will lose my hair.  I will be very sick.  I will suffer many unpleasant side-effects.  But, like all wars, I may have to suffer through some “losses” (i.e. my hair, my energy) in order to win the battle.

Battle 2:  Operation Surgery–  Assuming that I win the first battle (and I will win the first battle) my next course of action is to undergo surgery.  I will hopefully be a candidate for a lumpectomy.  With a lumpectomy, only the tumors will be removed so that I won’t have to lose my whole breast.  I may also have to have the lymph nodes removed from under my armpit. 

Battle 3:  Nuke Any Possible Survivors–  After I recover from the surgery, I will undergo 6 weeks of radiation of my breast.  The radiation will “sterilize” my breast tissue by killing any miscilaneous microscopic cancer cells that may not be visible at the time of surgery.  This will reduce the possibilty of the cancer returning by a considerable amount.

Battle 4:  Sanctions Against the Enemy–  Cancer violated and invaded my body.  Now I will starve and kill the cancer.  A Hormone Receptor Test (this is a test that was performed on the sample taken from my biopsy) has shown that the cancer takes signals from and “feeds” off of my body’s estrogen.  Hormone Therapy (a pill taken every day) will block the estrogen in my body and “starve” any cancer cell that may be in my body. 

Timing is of the essence, so Dr. G has requested that I meet with my Chemo Oncologist, Dr. N, today.

I met my Chemo Oncologist, Dr. N, this afternoon.  He’s a very confusing fellow.  I don’t think I’ve ever met anyone as stoic as he.  I guess that’s a good thing.  You don’t want your Oncologist playing the “got your nose” game with you or telling you, “Lighten up!  You’ve got cancer.”  It’s just that when I’m nervous, I make jokes or I try to say something that will break the tension in the room or get a rise out of somebody.  When Dr. N told me that I would be starting chemotherapy right away, I told him, “Good!  At least I’ll be Chemo-Skinny!”  Instead of cracking a wan-looking smile at my gung-ho spirit, he looked disturbed.

“Actually, Karen, you will most likely gain weight during chemo.”

“……….huh?”

“You should probably count on gaining between 20-30 pounds.”

“You’re kiddng me.  That can’t be right.”

He went on to tell me that I will experience many other symptoms:  Hair loss, nausea, anemia, my immune system will be compromised, pain, fatigue, shortness of breath, menopause, hot flashes…the list went on and on.  He told me that I would have one round of chemo every 2 weeks.  This is because I was young and strong and could take a  more frequent dose than the standard “one round every 3 weeks”.  All in all, he expected me to have chemo every other week for the next 6 months.  Now remember, Dr. G told me that I would be getting the standard every-three-weeks dosage.  I knew I must be in trouble, because already, they were upping my dosage.  (This, of course, would also mean that my husband would need to up his dosage of his little blue calming pills- his doctor put Michael on Valium because of my cancer.  We both get prescriptions.  Yea!)

“So, Doctor N-  Is there anything that I can do to not gain so much weight?”

“Not really.  Weight gain is a side effect of the chemotherapy.  The chemo will also shut down your ovaries and force you into menopause which will also cause weight gain.  But that’s really the least of your worries, Karen.”

“Wait.  Hold on a second. You’re telling me that I’m going to be bald and fat?”

At that point, I think the doctor thought my priorities were a little out of whack.  He gave me a strange look and then continued…

Dr. N told me that I would start chemo the upcoming Thursday, which was in 3 days.  He then told me that he wanted me to have one last test before I began chemo.  The test was called a PET Scan.  A PET Scan is the most sensitive cancer detecting test available at the moment.  This test will clearly show if my cancer has spread and where.  At this point, there are a couple of “suspicious shadows”, but the cancer could still be isolated to my breast.

When our meeting was over, Dr. N threw his arms around me in a very awkward bear hug.  I didn’t know how to react.  It was completely unexpected because up until that moment he personified stoic professionalism.  Dr. G never acted this way.  We always closed our meetings with a friendly handshake.  This contact, this hug, made me very worried because I realized on the way home that Dr. N…..felt sorry for me.  Uh oh.

I’ve been sitting here thinking about today’s appointment with Dr. N.  When I got home today, my husband grilled me about every moment of my appointment.  I’ve been going to the appointments by myself because my husband and I are self-employed with a very busy mortgage company.  (By the way, if you need a mortgage in Michigan, Iowa, California, Arizona, New Mexico, Utah or Wyoming- we would truly appreciate it if you would consider using us.  877-551-8188, ext 83 to speak directly to me- ext. 88 for Michael.  We will beat the best deal that you can find.  Ditech-schmytech.)  

My husband has to stay behind to process the loans and take care of general business stuff.  This arrangement makes him terribly anxious and upset because he wants to hear everything that the doctor has to say to me.  If he had the equipment to ”bug” my conversation with Dr. N, I’m sure he would.

Anyway, I was thinking about some of the things that Dr. N had said.  He said that I was going to lose my hair after the second round of chemo.   He then wrote me a prescription to have a wig made so that my insurance will cover it.  I’ve been thinking about the possibility of losing my hair for a while, and I don’t think that I want a wig.  In fact, I think that I’m going to just shave my head before I start to lose it.  My life is spinning a little bit out of my control and shaving my head is my way of letting the cancer know that I decide when I lose my hair.  I also don’t think that I will wear a wig.  Wigs creep me out.  When I was a kid, my brother hid my mother’s platinum blond Doris Day wig on the floor of the closet and told me it was a dead rabbit.  Also, I live in AZ where the temperature can get as hot as 115 degrees.  Wearing a wig would make me feel like I have a hot, dead rabbit on my head. 

When I made it known that I was going to shave my head, I was surprised at the mixed comments that I received.  My husband and parents were behind me 100%.  But, I had to convince a few other people that it was a good idea.  One friend told me that I shouldn’t shave my head because I might not lose my hair from the chemo, afterall.  Her grandmother had to have chemotherapy last year and didn’t lose her hair.  I didn’t know this before either, but it turns out there are several different types of chemo.  Indeed, there is some chemotherapy that will not cause hair loss.  Dr. N assured me, though, that I would be experiencing hair loss from my chemo. 

I thought some more about Dr. N.  Could I really put my trust in this man?  While he was giving me the gruesome details about all of the side effects that I would be experiencing, he would scan my face and look at his computer, but he didn’t really look me in the eye.  He spoke very calmly, but very deliberately, in a clear and somber tone.  Physically, he was about an inch shorter than me and (I hate to admit it) about 15 pounds lighter than me. 

In other words, I could take him. 

“Dr. N.  Are you absolutely sure that I need chemo?  Isn’t there anything else that I can do?  Any natural therapy I can try?  This just seems so ridiculous to me!”

“Karen, countless doctors at our facility have reviewed your file.  We all agree that this is the best course of treatment for you.  Please believe me when I say that the last thing that I want to do is take this beautiful girl (awwww, shucks.  Dr. N thinks I’m beautiful) and make her bald and sickly from chemo.  You do have the right to refuse treatment, but I can promise you that this is the best course for you right now and I recommend starting the chemo.”

“Okay Doctor.  I’ll do it.”

I’m going to do it.  I’m going to start chemotherapy.  I’m going to defiantly shave my head.  I think it will be good to let go of my vanity.  For my whole life, I’ve washed, conditioned, brushed, colored, high-lighted my hair.  I’ve spent countless dollars at the salon.  I’m going to let it all go.  I’m going to shave my head and be bald for a while.  I’m going to be free from caring about my looks so that I can concentrate on the essential:  Getting Well.

I just wanted to take a moment to reflect back on my previous post.  If you read yesterday’s post, you’ll see that my doctor told me that “countless doctors” have looked at my file.  This is the difference between going to a ”learning” hospital that specializes in cancer- like the Mayo Clinic- and just seeing your local oncologist, who probably makes all of the decisions on his own.

The Mayo Clinic in Scottsdale has teleconferences with the Mayo Clinic in Minnesota and Florida- all the best breast cancer doctors in the U.S. discussing my file with faxes and television monitors and maybe even heated arguments- who knows?  Like, maybe Dr. House was there, telling all the other doctors that they are wrong and that I am definitely lying about something.

But I digress: Think about that.  Please, please, please don’t go “just anywhere” if you are ever diagnosed with cancer– and I hope you never are…but if you are ever in my shoes, think Mayo Clinic; think Northwestern University; think University of Michigan; think Harvard; think M.D. Anderson.  Going to your local hospital is just nuts- unless one of your local hospitals is known as one of the best in the world. 

This is your health.  This is your life.  This is cancer.  Do it right the first time.

“Steve McQueen without hair?  It’s a blessing he died young.” ~ Dr. House

See, that’s one way to look at cancer…

Today I went to Mayo so that I could have a PET Scan done.  A PET Scan is the most sensitive cancer detecting scan available.  If you have a cancer cell in your body, the PET Scan will find it.  In order for it to be effective, I was not allowed to do any strenuous activity or lifting for 24 hours.  I also had to fast.  I hate fasting, because I get really edgy and cranky.  Anyway, I was given an information sheet that explained how the PET Scan worked.  In a nutshell, it said that I would be given a radioactive glucose solution intraveneously.  Cancer is a sugar feeder, so it “feeds” on the sugar solution faster than any other cell in my body.  (Think about that the next time you have a piece of cake.)  As the cancer ”eats” the sugar, it absorbs the radioactive element.  Once this step is complete, I will be led to the scanning machine.  The areas on my body with cancer will glow yellow and orange on the scan’s image.

PET Scans are great, but a lot of times it’s difficult for cancer patients to have one because the machines are so expensive that many hospitals do not have them.  In fact, the Mayo Clinic’s PET Scan is a mobile unit that they lend out to different hospitals around the valley.  Each PET Scan costs approximately $5000…at least, that’s how much they charged me.  Could be more or less somewhere else.

Anyway, I went to the Mayo Clinic early that morning for my appointment.  I was really cranky because I couldn’t eat and I had to drive in rush hour traffic.  I was probably also a little cranky about dishing out $5000 that morning- on the spot.  By the time the nurse called me, I was starting to feel really antsy because I wanted to get this test over with so I could eat. 

I was led to a room with several vinyl reclining chairs.  This is when I learned that the nurse was going to have to put the IV in my foot.  She told me it was because the Doctor needed the dye fed at the opposite end of my body.  Since the cancer was in my right breast, the IV needed to be inserted in my left foot.  I had a real problem with that.  I do not like the thought of needles being dug into my feet.  Still, I didn’t have a choice.  The nurse reclined me back and began to look for a vein in my foot.  She wasn’t having much luck.  When she thought she had finally found one, she began to dig the needle in.  She kept missing the vein so she had to keep digging.  It was very painful and I started to feel like I was blacking out.  My ears started ringing and I broke out in a cold sweat.  Slowly the blackness washed over me and I passed out.

When I woke up, I was confused.  Then I felt embarrassed.  There were nurses standing over me talking to me, but I couldn’t figure out what they were saying.  I thought I had fallen asleep when I wasn’t supposed to.  Then I noticed something really strange:  I was fully reclined in the vinly chair, I had an oxygen mask on, and I couldn’t put my arms down.  They were clenched straight up in the air, and I kept thinking to myself, “Now that’s weird.  Why won’t my arms go down?”  I was too dizzy and confused to formulate this question to one of the nurses (who was now yelling at me, but I still couldn’t hear what she was saying through the ringing in my ears) so I just looked at her, kind of smiled and said, “Hi!”

The moment I spoke, the ringing in my ears began to fade and my arms relaxed enough so that I could rest them on the chair.  Then one of the nurses explained what happened.  I had passed out, and I had had a seizure.  That was why I couldn’t put my arms down.  I hadn’t noticed before, but two nurses had been holding my legs.  The nurses had called for a doctor to come in and examine me quickly.  Once he reviewed my history, he looked at me and told me that he wanted me to have a CT Scan of my brain, right then and there. 

“Why?”

“Considering that you have cancer and you just had a seizure, we need to see if [the cancer] has spread to your brain.”

I felt crestfallen.  The idea of the cancer spreading to my brain made me feel so depressed and dejected that I started to cry.  I couldn’t do this.  Who the hell am I to think that I can handle something as big as cancer?  I was all alone at the hospital, sobbing like a baby.  It was all too much.

Mary was the name of the angelic nurse who hugged me and helped me to calm down.  I allowed her to put an IV in my arm for the CT Scan and she wheeled me in a wheelchair to CT Scanning room.  I had stopped crying, but I couldn’t shake the overwhelming feeling of dread.  I allowed the technicians to help me onto the scanning bed and hook up my IV.  Then I layed there very still while the machine slid the bed into the CT tunnel and took images of my brain.  Soon it was over and Mary was waiting for me with the wheelchair and a warm blanket.

Because of the urgency of the situation, a radiologist immediately reviewed the images of my brain.  For 20 gruelling minutes, I sat with my head lowered in the wheel chair, trying not to cry.  At last, some good news.  My brain was free of cancer! 

It’s amazing how a little bit of good news can make you rebound from the depths of despair to the highs of heaven.  After I processed the relief of having a clear brain scan, I agreed to press on and have the PET Scan.  I was so amiable, that I even agreed to let the nurse have another shot at my foot.  Pun intended.

This time, I was too tired from the seizure to get worked up about the IV in my foot.  She found the vein and popped it right in.  Then, a gal named Melissa wheeled me to the PET Scan Unit.  The scan was located outside in what looked sort of like a giant tour bus for the Rolling Stones, complete with a wheelchair lift.  Melissa pushed me onto the lift and I was raised and pushed inside.  The unit was divided into three rooms.  The main entrance  was the “control center” where the technicians monitored and operated the scan.  The room to the left was where the actual scan was located.  I was led to the room to the right. 

Before the scan could begin, I had to have the radioactive sugar solution administered through my IV.  It was imperitive that I sit very still in the recliner provided for me while the solution ran through.  I don’t know if this was important to the test, but the room they had me in was so cold, I thought I was going to die from hypothermia.  Melissa had wrapped me in 4 warm blankets and I was still freezing.  I tried to doze off but it was even too cold to sleep.

After about 45 minutes, Melissa retrieved me and removed the IV from my foot.  Then she wheeled me back inside the Clinic so that I could pee out the excess radiation in my bladder.  Then, it was back up the lift and into the room on the left where the scan was located. 

This scan was a lot like the others:  I had to lay very still on the bed while the machine moved from top to bottom.  This took approximately 20 minutes.  At long last, I was free to go. 

Mary, the nurse who cared for me after my seizure, asked me to sit and stay for a little while longer to make sure that I was okay to drive.  After about 30 minutes, I convinced her that I felt “worlds better” and was capable of driving myself home.

On my drive home, I listened to the messages on my cell phone.  There were 5 missed messages, all from my husband.  I called him back and told him about the PET Scan, the brain scan and, “….oh yeah.  I had a seizure today.”

By the time I got home, Michael was sufficiently inebriated.

My husband is very old fashioned with the way that he deals with stress.  He tends to try to drink them away.  Cancer is different though.  No matter how much time he spends pickled, I still have the disease.  This is posing a problem and not just for the obvious reasons.  On top of him being drunk and shirtless all the time (yes, I said shirtless), he has been in an extremely emotional state.  His drinking has been giving way to crying fits and bouts of extreme rage.  He even outran our local police in an episode I don’t care to discuss in detail, because it’s just too embarassing.  (He was “real proud” though.)  Since I’ve been diagnosed, I honestly feel like my husband is losing his mind.  He’s a licensed banker and really good at what he does.  Now, he turned into a shirtless redneck overnight.  All of his acting out is really starting to take it’s toll on me because tonight….my parents arrive from Michigan.

I have been back to Michigan several times in the four years that I have lived in AZ.  During one of those trips Michael came with me (this is a rare event because we are self-employed and one of us has to stay behind to answer the phones) and he was on his best, sober behavior. 

I just don’t know how my Mom and Dad are going to react to this side of Michael.  You know– the crazy, shirtless side.  For a while I told him to sit in a quiet room and chant “cope and adjust” over and over as a calming exercise, until I found out he was bringing a fifth of Captain Morgan in the room with him and passing out.

One thing is for sure:  I don’t want my parents to worry any more about me than they have to.  It’s bad enough that my cancer is turning the family upside down.  Michael had better get his act together quick.

I have an appointment in the Radiology Department of the Mayo Clinic to have a “clip” inserted into the tumor in my right breast.  The clip looks a little bit like a staple, but smaller.  It’s purpose is to monitor how well the chemo will shrink my tumor, if at all.  It will provide the doctor with a “point of reference” when I have another Breast MRI down the road.

The doctor implanting the clip was actually a great guy.  Finally- someone who could crack a smile about good ole cancer!  I laid down on the table after I had changed into my Mayo Clinic robe of choice.  The Doctor first created a sterile environment by isolating my breast beneath some clean tissue and then he gave me “a local”.  He swabbed me with some iodine and prepared to insert the clip.  An ultrasound technician was on hand to help guide the doctor to the correct spot.  He had to push the clip in with a long needle-type tool. 

I confess: I wasn’t watching.  I was a little freaked out, actually.  Again, when in these situations, I tend to try to lighten the awkward mood.

As he was finishing and bandaging me up, the doctor asked if I had any questions.

Me (very seriously):  “Just one Doctor.  Is my career in Playboy over before it’s begun?”

Doctor (he can’t quite tell if I’m serious or not):  “Uh…I’m afraid so.”

Me:  “That’s too bad.  I was thinking of doing a ‘Girls Gone Wild’ type video.  Only I’d call it ‘Girls of the Mayo Clinic Gone Wild’.  It would feature women with Mastectomy and Lumpectomy scars.”

[ Yes, I realize this is probably in “poor taste” by most people’s standards…but I have cancer. ]

Doctor:  “Well, if you ever get featured in a video or magazine like that, please let me know.  I will be the first to buy that issue.”

I could seriously love this man for indulging me.

Tonight my mom and dad flew in to Phoenix to be with me for my big day tomorrow.  My mom has been afraid to fly ever since the 9/11 tragedy.  She swore she would never step foot on a plane again.  That was before her baby was sick.

My mom and dad are staying at a hotel near by.  I picked them up and brought them over to show them my house.  This is the first time they’ve ever seen my home!  Quite exciting for me, as I am very proud of my house.  It was nice to be sit and visit with them and talk about everything.  I’m so glad that they came and could be here for me. 

Tomorrow I start chemo.  I’m not really nervous about it because it doesn’t seem real to me.  I can tell my mom is nervous.  She looks like she’s been crying.  I just hope that everyone will be able to get some rest tonight.

Today I start chemo.  But, before I get my first dose my chemo doctor, Dr. N, wanted me to attend a chemotherapy “class”.  My parents waited in the lobby at the Mayo Clinic while my husband and I were ushered into a section of the Patient Library.  We were crammed into a room with 4 other couples all over the age of 60 and each given a folder with our name on it.  Inside the folder was a list of the chemo medications that I would be receiving along with the list of their respective side effects.  Just then, a nurse entered the room and began a Powerpoint slide show presentation.  Nothing like vivid text colors and silly graphics to soften the terror of chemo.   

The presentation mostly covered the side-effects of chemotherapy.  Nausea, hair loss, anemia…the list went on and on.  The nurse gave some recommendations.  “Do not use laxatives or enemas for constipation.  Use stool softeners.”  “You may have the occasional alcoholic beverage, but do not over do it by any means.”  “Do not try to conceive children while going through chemo.”  Since I was the only person still of child-bearing age, we all knew she was talking about me. 

Through out the presentation, Michael kept getting up to leave the room because he was very upset.  One of the women sitting at the table leaned over and asked me if he was going to be OK to start chemo today.  I told her that he didn’t have cancer.  I did.

Finally, the slide show was over and I went to collect the rest of my family.  I wanted to stop by the Breast Clinic to see if Dr. N had received the results of my PET scan.  That’s when my life was hit by a ton of proverbial bricks. 

Dr. N was actually looking for me while I was in the chemo class.  He had the results of my PET scan and needed to speak with me right away.  I went into the examining room with my husband and my father.  Mom elected to wait in the lobby because she was too upset and nervous to hear the news.

I knew something was wrong when the door opened and Dr. N made a bee-line straight for me and locked me in a bearhug.  This meant that Dr. N thought that I was going to need comforting.  What did that mean?  Could things possibly be worse for me than they had been up to this moment.  The answer is, yes.  Things were horribly bad.

Dr. N pulled up the images of my body from the PET scan on his computer.  He explained that the areas of the images that glowed orange and yellow indicated cancer.  My body was lit up like a Christmas Tree.

“Here is the original tumor in your breast.”  It looked like E.T.’s heart light.  “The cancer has spread to the lymph nodes under your right armpit, the lymph nodes in your neck and the lymph nodes in your chest.  This is a close up of your lungs.  You have cancer here and here and here……”  He seemed to go on forever.  I must have had 50 or 100 tumors in my lungs.  “This is why you have been coughing so much.”  (I was starting to feel faint and light headed.)  “You have a couple of spots in your pelvic bone.  There are two vertibrae in your spine that have cancer and a couple of ribs.”

“So, my cancer is Stage 4.”

“I’m afraid it is.”

My dad looked dumbfounded.  Michael had tears streaming down his face.  He looked like he was going to throw up or faint.  Maybe both.

“What are her chances of beating the cancer?  What are her chances of complete remission?”  Michael asked.

“Karen’s cancer is so far advanced that we are not going to focus on curing her.  We just want to try to control the cancer.  She can possibly still live years…”  (He didn’t get specific time-wise, but we understood.)

“What are her chances for a cure!!!???”

“About three in a thousand.”

As soon as I heard that, I felt like a volcano was erupting inside of me.  Here I am 30 years old and the question of my mortality is being raised.  Will I live to see my 35th birthday?  How about 40?  Dare I dream to see 50?  Why the hell didn’t I insist on a mammogram last year?  Why????  I was so angry I was shaking.

This was bullshit.  I grabbed my purse and told the doctor that I had a chemo appointment to keep.  He stood up and tried to hug me, but I pushed him away and told him to save it.  Then I told my dad and Michael that I wanted to get the hell out of there.  I stormed out of the office to deliver the news to my mother while the men in my life trailed behind me in a daze.

I walked out of the office of the Breast Clinic to see my mother sitting in the waiting room looking nervous.  I was still riding the inertia of anger from my awful, metastatic cancer diagnosis!  I didn’t even stop to think as I walked up to my mother and yelled- in front of God and everybody- “Well, Mom?  I have fucking stage four cancer.  Do I look like I have Stage 4 cancer?  What the fuck is going on?”  Honestly, I usually don’t use the F-word so liberally, but when you are fifteen minutes from chemotherapy and just got diagnosed as “incurable”, I don’t think lady-like verbiage is your top priority.

My mom- who never swears and probably never heard me do it- was too heartbroken to be appalled with my language.  In fact, she had to sit down because she looked like she was going to collapse.  Her face was blank, but that was just the calm before she really lost it.

I turned around to see where the rest of my entourage was hiding.  Michael was on the phone with his mother delivering the news; he was yelling at her- God knows why- and pacing.  My dad was still talking to Dr. N and babbling on about how- when raising my brother and I- he had instilled in us his Protestant Values of no drinking, smoking or drug use (read:  No Fun.)

“So how could this happen?”, he demanded of the good doctor.

Dr. N must have thought we were a bunch of lunatics.  He still may.

My chemotherapy appointment was approximately 15 minutes away at the Mayo Clinic Hospital, different from the Mayo Clinic, Clinic.  We were running late, so I knew that I had to put an end to all the dramatics and get the proverbial show on the rode.  When I was finally able to corral my family together, I herded them to my car.  Dad and Mom sat in the back; Michael in the passenger seat.  I buckled into the drivers seat and drove us all over to the hospital.  Can you imagine?  Mother, father and husband unable to drive?  This was a very traumatic day.

Silence.  The car is so quiet.  I look in the rear view mirror.  Mom is trying to put on her ‘brave front’ which means that she is crying without sound.  It’s like somebody pressed the mute button.  Dad looks shell-shocked.  Michael is holding my hand while he looks out the window and stares in silence.

I feel like I’m voluntarily driving to my death.  I’m half tempted to turn the car around and go home, but I know that I just can’t do that.  While the prospect of enduring chemo feels like a “fate worse than death”, I know that it is a very necessary evil. 

So, I drive on until I see the walls of the hospital rise up from the desert earth.  Things are about to get worse for me before they get better.  However, I do believe that things will get better.