Finding needs more study.

We recommend that you have further images taken. The letter was dated March 17, 2011 and came from the Univ. of Washington Medical Center/ Seattle Cancer Care Alliance (SCCA).

I received it on the next day, Friday, and wasn’t sure what to think.  I’d gone for my annual exam earlier in the week, and my ARNP had suggested getting a mammogram that same day. I hadn’t done the usual prep (no lotion, no deodorant), so maybe that’s all that this was about.  I’d never had an abnormal read before on a mammogram and had no family history of breast cancer, yet the letter and what it could mean made me feel quite anxious.

I booked an appointment for Tuesday, March 22. Further images were needed of the left breast, I learned. Calcifictions, or small bits of calcium, were present and the doctors wanted to take a closer look.  The radiology tech took three or four mammograms, and then I went back to a room to change out of the robe, and back into my clothes.  A little while later, someone came and took me to a room, and said the radiologist would be in to discuss the results.

I didn’t ask for reading materials, so I looked at my phone.  Then, I looked on the desk in the office.  There were pamphlets under a box of kleenex: Breast core needle biopsy – instructions for care.  That didn’t seem like a good sign. I waited.  My boss called, forgetting that I was at my doctor’s appointment.  It was a short call, interrupted by the staffer coming back in to say the doctor was on her way.

The radiologist came in, then, accompanied by a resident.  My first thought was, “Oh, great. I have something unusual and people are now interested in my case.” But working in an academic medical center, I should have realized it’s part of the training situation.  The radiologist was young, blonde and sporting knee-high suede boots.

She said, yes, that they wanted a biopsy of the calcifictions.  It wasn’t anything that looked like cancer, like some calcifications do, but they just needed to rule that out.  They had an appointment available in one hour, or I could come back later in the week.  She said there was no rush to stay today and have the biopsy.  She gave me the pre-biopsy instructions and asked about medications I might be taking, including ibuprofen on a regular basis.  “You’re too healthy,” she said, with a chuckle and a big smile.  The resident smiled and laughed, too.

I opted to come back on another day, and would hopefully see the same doctor.  After the appointment, I called and emailed my friend, Elizabeth, who had lost her son to cancer. She immediately offered to take me to my appointment. “Oh, I was just going to walk over,” I said.  “This is not about transportation,” she replied. “It’s moral support.”  Won’t you be fired for being gone for hours, I asked.  “I run this place,” she said.

When I talked with her later on the phone, I said that it might scare me if she came with me. “This is about me and not you,” she jokingly admonished.  I appreciated that so much, later on.

My appointment was scheduled for Wednesday, two days after the second set of mammograms. I had dinner with girlfriends the night before, and decided I would limit who I would tell until I after I got the results.  My parents were in Florida, for example, and I didn’t want to freak them out unnecessarily. We didn’t talk about personal things all that often, so it was better just to wait.

But at dinner that night, my friend L said she had to go in the next day for a repeat mammogram.  I decided to spill the biopsy beans.  She was going in for the right breast and me, for the left.  We decided to send each other positive boob karma from opposite angles.  We promised to text each other the next day and to keep our other dinner buddy informed. Her appointment was at 8 a.m.

I told two people at work, and they both had stories of either having to go back for a repeat mammogram or even a biopsy, or friends who had gone in for the same procedure.  One friend had cancer, said my boss, but they caught it early, which is what is important.  I started to wonder if skipping last year’s mammogram in support of new public health guidelines was the right thing to do.  Was this my punishment for being a health policy wonk?

Elizabeth picked me up at work on the 23rd a little after noon. My appointment was at 12:30, close by at the SCCA.  We joked a lot beforehand and I recapped the latest 30 Rock episode that spoofed reality TV shows and portrayed Alec Baldwin’s character as being gay. I am always after Elizabeth to watch that show, and I was happy to have the distraction of sharing silly stories.

When I was called for my appointment, I changed into a gown that opened in the front.  The physician/ resident came in, introduced herself and talked me through what would happen. The procedure sounded different than what the radiologist had explained, and I wouldn’t be seeing the same doctor that day (even though I’d been told she’d be there when I called to make my appointment).

I would be lying facedown on a table, with my breast hanging through a hole in the table. The table would be elevated high above the providers’ heads, so that they could do their work. My breast would be placed in a mammogram-ish device, a few more slides would be taken and when it was time for the biopsy, I would first get a shot of lidocaine to numb the area, and then they would go in and take out the cells to study.

After the procedure, they would place a titanium clip in the spot where they took out the cells, to mark the spot in case it did end up being cancer. Titanium in my breast – I guess that sounded sort of cool.  The doctor said it wouldn’t be detected at the airport or cause problems in metal detectors. She asked if I wanted any reading material, and I said no, that I was okay.

After she left, I began to read my medical chart.  The words and writing I saw began to make me nervous:  suspicious abnormality, UOQ, amorphous calcifications measuring 18 millimeters, overall assessment – category 4, suspicious.  I began to cry.  I also felt a little miffed when I read: Patient preferred to return for biopsy on a subsequent day, and was given instructions for scheduling the biopsy.

It would have been nice if the doctor had written: Patient was told that there was no need to schedule an immediate appointment.  Instead, what she had written made it sound like I should have stayed for a biopsy that day, and decided to leave the clinic.   Having shed a few tears, I was then led into the room where I’d have the procedure.

I asked the tech on the way in about UOQ.  It means upper outer quadrant, the place that they’d be targeting to grab those unknown cells.  I never realized that I could get so upset over a medical procedure and related unknowns, and it probably didn’t help that I had scoured my medical chart and saw all the scary words, without any real explanation.

My mammograms were in one of those viewing device things on the wall when I came in, probably for last minute review and to make sure they were targeting the right area.

I got up on the table and got into position.  It wasn’t comfortable, but it also wasn’t so bad.  What was bad, though, was when I was clamped into place, heard people come into the room, stand in the general area of the mammograms, talk … and I couldn’t hear what was going on.  My head was turned to face the wall, so all that I could see was a generic print or painting.

Tears began to stream from my eyes again.  I heard more talking but couldn’t make out what they were saying. Of course, the imagination goes to work.  “Are you trying to figure out which area you’re targeting?” I asked.

One of the doctors came over and spoke with me.  He saw that I was upset and a little while later, they had one of the staffers stand up near the table by my lower body to talk with me and to calm me down.  She placed her hand on my shoulder, which helped.  Why didn’t they just do that from the start?  I suppose they didn’t know that I would completely freak out.

I barely felt the lidocaine injection, but did feel a splash of cool water on my breast.  The resident mentioned the needle going in deeper and that I might feel something stronger, but I didn’t.  Phew.  Then some device sucked out the cells that they needed to study.  Again, I didn’t feel anything.  I should have felt comforted, but I still was very upset.

Dr. G. came around the side of the table near the wall, and he said that they got everything that they needed.  “How did things look?” I asked.  On a scale of one to 10, where one is nothing and 10 is not great, he said he thought my cells or the calcifications looked like a three.  That was pretty good, I guess.

I kept crying while the tech and some other staffers helped me sit up and tried to stop the bleeding in the biopsy spot.  One woman said, “Oh, there’s no bleeding.” But then, when I sat up, it started bleeding again.  “Do you usually bleed a lot?” she asked.  “Well, I’ve never cut my breast before,” I said.  Seriously, what kind of question is that?  It made me think: Oh, it must be a bad sign if the bleeding doesn’t stop right away, even though it probably didn’t mean that at all.

Steri strips, or really skinny thin white bandage-y material, were placed across the small wound.  I was given a cute little round icepack that could tuck into my bra, too.  The tech took a few more “soft” mammograms (no serious squishing) and, then, I was done.  This tech, Tara (I think), was the person who had put her hand on my shoulder and tried to comfort me when I was past the point of no return in tears.  It did help, even if the tears continued.

She offered optimistic words and said that what Dr. G. had told me (three on a scale of one to 10) was not something he said to everyone.  I suppose that made me feel a little better.  Results would come within two days.

I changed back into my clothes, and tucked the cute little icepack into my bra. Tara had mentioned re-freezing it and keeping it on my chest until the early evening. “I’m going back to work,” I told her, and that would make re-freezing tricky (and probably scary for co-workers).  “Really?” she said.  “That’s the first time I’ve heard that, but I’m not surprised with you.”  Wow. Even after all of that crying, she could sense some strength.  Interesting.

Back out in the waiting room, Elizabeth convinced me to not go back to work. It wasn’t that hard, considering I felt like I’d been crying for the last hour and could probably use some rest. And my freezer would be nice and close for the icepack.  I wasn’t really sore. That wouldn’t come until a week or so later, amazingly.  I even went on a yoga retreat that weekend, and didn’t feel any pain.  The post-biopsy instructions, after all, said no strenuous exercise for 24 hours.

Two days later, the day that I was leaving for the retreat on Whidbey Island, I got the call. “Benign,” said the SCCA staffer.  I figured it was a good sign that I didn’t hear directly from the doctor.  She said that they wanted me to return to clinic in about six months for another mammogram.  I felt so relieved, more than relieved.   Despite some recent heartache, at least I didn’t have cancer.  I have a healthy body that is strong enough to do yoga (do I sound like your yoga instructor?) and friends and family who love me, and a pretty darn good life.  Those are all things to concentrate on for the moment and in those future times when I struggle with the “what ifs” and “why didn’t this work out?”  Just remember:  HEALTHY.  BENIGN.   NO NEED FOR FURTHER STUDY.   I AM FORTUNATE.  AND GRATEFUL.  Yes.