biopsy – Still Life, Beyond Cancer

This is a happy story. Just keep reading.

This coming Friday, I will celebrate my fifty-first birthday. And make no mistake, though it will just be Steve and me at home with the cats, there will be a full-on party taking place in my heart.

One year ago yesterday, a Saturday, I was at The Stone House owned by Black Dog Salvage, preparing for my “Fifty and Fabulous” birthday party. We’d been planning the party for a while, and I was excited and looking forward to the evening’s festivities. But my joy was tempered by news I’d received two days earlier. On that Thursday I’d been taking part in an annual holiday craft fair sponsored by the women’s organization at Roanoke College. I had arranged my table of wares for sale: origami tea-light lanterns, notecards that featured prints of my watercolors, and a few original watercolor cards. I’d just gotten things set up to my satisfaction when I saw I’d missed a phone call from my breast surgeon’s office. I knew it was likely to be about the results of a recent punch biopsy from a red patch that had developed just above my left armpit. I slipped into an empty classroom, sat down in a desk, and returned the call with shaking hands and clumsy fingers. I wanted to know, but I didn’t want to know. I was worried.

When the nurse practitioner came on the line, she asked me if I was sitting down. I pretty much had my answer in that moment. Then came the gut punch.

“I’m afraid I have some really bad news,” she said.

Wait, what? Even in my state of heightened anxiety, I felt like something was off in the way she was framing things. But it was all I could do to keep breathing. “Okay.”

“The biopsy does show breast cancer.”

“Shit.“

“I’m so sorry. I know you were hoping for a different result. We all were.”

Breathe, Sandee, Breathe. I asked her something about next steps, what tests I’d need. She told me they’d refer me to my medical oncologist, and I’d need scans, then likely chemo and/or radiation.

Then she said, “Unfortunately, most of the time when we see it in the skin, it means it’s already everywhere.”

Every cell in my body clanged like a fire engine heading to a five-alarm fire. No. No, no, no, no, no. We ended the call, and I walked, stunned, back to my exhibit table. I’d brought some paints and blank cards with me, and the only thing that saved me running screaming from the room was making art. I put my head down and started drawing, one tiny line after another tiny line, until they formed a flower. Then another. This. I can still do this.

I kept it mostly together until I delivered a pack of notecards to a colleague I knew, though not well, on my way back to my office. She asked how I was doing, and the dam broke. She sat with me in a back room until I calmed down, then I headed to my office and on to a scheduled hair appointment. I cried to my hairdresser, who is a wizard with both hair and human. How on earth was I going to get through my party? I didn’t want it to become all maudlin and weepy. I wanted it to be a celebration. In many ways, perhaps, I needed to celebrate more than ever.

Steve was traveling on business and driving back from Tennessee that day, and I didn’t want to upset him and then have him be on the road, so I held off calling him. My parents were scheduled to arrive late that afternoon. I expected to burst into tears the moment one of them put their arms around me to hug hello, but it didn’t happen. And then something shifted in me, and I didn’t want to be the daughter with cancer. I just wanted a nice, normal afternoon, pleasant conversation, party talk. At some point I decided I would hold the news unless or until one of them asked me directly about the biopsy. That didn’t happen until after dinner, shortly after Steve came in, when we were all sitting in the living room together. My mother asked if I’d ever heard back about my test. I whispered–all I could manage, suddenly–“Yes. Yes, I did.”

I’m still angry about the editorializing that framed the report–you don’t tell a patient “I have really bad news,” which essentially tells them “be scared” and adds to their trauma. Using I-language, something like “I’m sorry to have to tell you that…” helps the patient understand it’s not good news, but doesn’t impose emotions on them. And it was way out of line that I was told skin metastasis is often a sign of widespread disease. It was pure speculation, terrifying, and utterly unhelpful, as neither I nor my doctors could confirm or deny where the cancer was or wasn’t until I had more tests. Because of that statement, I had to do the extra labor of carrying that possible story around while I waited to know. One of the most important aspects of self-care you can exercise as a cancer patient is to distinguish what you know from the stories you might tell yourself about what you know, and all we knew was that I had a small patch of cancer in the skin above my left arm. That news was hard enough to hear without the commentary. We would later find out that it wasn’t everywhere, only in the skin and a few nearby lymph nodes.

But I was talking about celebrations, and I promised you a happy story. As my parents, Steve, and I sat in the living room that Thursday night, processing, after I’d answered my mother’s question and we’d all shed a few tears, Steve asked, “So, is the party still on?”

My answer: “Hell, yes, the party’s still on!”

And it was. We didn’t share the news outside of family ahead of time so we could focus on fun. And it was fun, and fabulous, full of friends and laughter and family and cupcakes and music and dancing. There were a couple of toasts, and as Steve spoke his, I looked around the room at all the people who’d filled my life and heart with so much beauty and joy. And in that moment, I knew something important.

I knew that I had loved, and I had been loved. And I would keep loving and being loved. And whatever else I would or wouldn’t do in my days on this earth, that was the deepest, truest, most wonderful gift. That was my story. That alone makes mine a life well-lived.

Then we all raised our glasses, turned up the music, and danced.

On a Friday morning in early June I kissed my husband of nine months Steve good-bye and headed to my scheduled doctor’s appointment. I was having a couple of cysts aspirated—a routine procedure for me, as I’d had benign, fluid-filled cysts making regular appearances in my breasts since I was thirty. My annual mammogram, which I’d had the week before, had been clear. I typically had a follow-up ultrasound because of my dense, and busy, breast tissue, but I’d opted out of it this time. The radiologist didn’t think it necessary, and I knew I was heading back for the aspirations, anyway. I figured it would take about an hour to drain the one or two cysts in each breast that were bothering me, and then I planned to head to the office to finish the one last report standing between me and summer break.

The large cyst in my right breast had, as they sometimes did, already calmed down on its own; I wondered whether it was even worth bothering with it. My left breast still felt swollen and tender, though, so I kept the early morning appointment.

The attending nurse and the ultrasound technician arranged me on the table, placing a pillow under my left shoulder and asking me to curve my arm over my head, lifting my chest. The surgeon joined us and asked for the location of the cyst to be drained. I pointed him to the lower outer quadrant of my left breast.

“Oh, yes, I can almost see it there,” he said. With my body contorted, the lump under the skin was nearly prominent enough to spot with the naked eye.

The doctor located the cysts, per usual, with ultrasound. I always watched the images as they appeared on the monitor next to my bed. Each breast typically featured a multitude. They looked a bit like photos I’d seen of black holes, or solar eclipses: a black center, with a clear light-ring around the edges. As the surgeon rolled the wand over my left breast, I noticed something odd on the monitor. There was a dark mass, but unlike the manifold cysts I’d seen on the screen over the years, its border was irregular, furred.

“That doesn’t have the defined outline that a cyst usually does,” I said.

The doctor kept rolling the wand back and forth, back and forth. “No, that doesn’t look like a cyst,” he said quietly. “I think we’re going to need to turn this into a biopsy.”

˜ ˜ ˜

Just a few nights before, my husband Steve and I had been lying in bed, talking about what a crazy, busy year it had been. We’d bought a new house together, moved and combined our two households, moved each of his two sons into their first apartments, planned our wedding and gotten married, and graduated the youngest son from college. We’d both worked the full academic year as professors, and there’d been some work-related stresses for both of us. Steve had, in fact, just started a new job with a research non-profit, while I was wrapping up teaching a three-week intensive learning course that included camping and rafting in West Virginia. Our new life together was good, but we were exhausted. “I bet we’d score off the charts in one of those life-stress tests,” I joked, and Steve agreed.

When I awoke the next morning, our conversation still on my mind, I searched online and found the Holmes-Rahe Stress Inventory, which assigns point values to significant changes (positive or negative) in a person’s life. Curious, I completed it—and scored a whopping 412 points. According to the inventory, any score over 300 increased by 80% my chances of having a “major health breakdown” within the next two years. I understood the score as proof positive that our past year had, indeed, been stressful and eventful. At the time I didn’t think much about whether it might actually predict my future.

˜ ˜ ˜

I went straight home after my appointment and called Steve. The doctor had completed a core needle biopsy of my left breast, taking three separate samples of the mass they’d found. In some discomfort, I decided to skip the office and work from home. I threw myself into finishing the report, then began packing. Steve and I had planned a weekend at the Peaks of Otter, a rustic lodge and restaurant off the Blue Ridge Parkway, overlooking a small lake in the valley below Sharp Top and Flat Top mountains. We wouldn’t have any answers until Monday or Tuesday, so we went ahead with our getaway.

Having the fact of your mortality plunked down in your path recalibrates perspective, turns up your awareness. We stopped on the way to the Peaks to browse art and antiques in nearby Bedford. A light breeze lifted and chuffed my hair as I rounded a corner onto Main Street. I thought: pay attention to this pleasure; you won’t have it long if you lose your hair to chemotherapy. Later, walking along a forest trail, I noticed tiny details: unremarkable mushrooms, striking patterns of bark on trees.

We tried to stay positive. I researched “benign breast tumors” on my phone, looking for descriptions of all the possible permutations that matched my symptoms. In a lighter moment, Steve looked at me with a tender smile and twinkly eye and said, “I thought of this earlier, but I wasn’t sure I should say it—I don’t mind if you have one Sharp Top and one Flat Top.” He reassured me that even if we’d known for certain we’d face this moment before we’d walked down the aisle, he still would have chosen to marry me. We’d had so little time together, and we wanted so much more.

The next morning, as we strolled the path around the lodge’s lake, we met Ranger Neas, who pulled fossils from his backpack that showed the Roanoke Valley was once an ocean, and asked us if we were familiar with Einstein’s theory of relativity and the time-space continuum. We’d asked him about trees, and ended up talking about time. Instead of understanding time as relative, he asserted, we’ve become slaves to our human construct of time and the belief that time-is-money. “But nature doesn’t do that, the mountains don’t do that,” the Ranger said. I was reminded of Aldo Leopold’s “Thinking Like a Mountain”—the mountain takes the long view, even as it understands the value of the smallest interaction. We could choose to change our relationship to time, the ranger urged. Instead of the clock being life’s measure, we could choose beauty, joy, love—the richness of the life we live. We could learn to understand, value, spend time in ways that are more meaningful.

My own relationship to fate and faith is ever-changing, but our conversation with the ranger felt something more than coincidental.

Each evening during our stay, Steve and I held hands as we sat outside on our room’s balcony, tracking the stars as they appeared to move across the firmament. We tried to describe the different shades of dark that were the sky, the water, the mountains, pondering whether reflected moonlight was silver or some other color. When I saw a single falling star, I wished, and hard.

˜ ˜ ˜

The call came, as promised, on Monday afternoon. The radiologist’s phrasing stuck with me: “I’m sorry to tell you, it is a cancer.” A cancer: singular, specific. It felt somehow less all-encompassing, stated that way—a thing that was, a thing that existed, not a blanket pronouncement of my fate. I was grateful for that, and for the kindness in his voice. “We’re going to fix this,” he said. “I hate it, since you’re so young. But we’re going to fix it. It’s a garden-variety—if there can be such a thing—intermediate-grade breast cancer. And we’re going to fix it.”

I hung up, cursed, cried. Steve and I walked a few fast laps around the park across from our house, amped up on adrenaline. After we’d burned off some of the shock, we decided to have dinner at the local restaurant where we’d shared our first date.

There, as the sun set, it created star-shaped shadows from the lamps hanging behind the window shades. There was still much we didn’t know. The waiting had begun.

Tag: biopsy

Birthday Girl

Beginnings: Biopsy

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