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Thursday, February 16, 2012

Boobs in Paradise

Boobs in Paradise
Another Ordinary Day in Aoteroa

*Some people and place names changed

I’m holding the underside of my friend’s arm while a doctor plunges a needle into her breast. I’m not looking at the needle. Must-not-look-at-needle.
            “Do you faint at the sight of needles?” Dr. B had asked.
            “No,” I said. “Because I never look at the needle.”

I had sat beside my late husband, Sean, two years ago, while nurses and technicians pierced and poked him.  His four-and-a-half month hospitalization featured daily testing. Everything was checked and re-checked. Despite aggressive, expensive medical intervention, Sean died in-hospital due to complications of surgery. All the kings’ horses and all the kings’ CT machines…

Call me skeptical, ungrateful – call me whatever you like – anything except “patient.” I’ve been stuck with more syringes than you can shake an IV pole at.  Far more than the average 41-year-old. By age 30, I’d already endured dozens of scopes and scans – in one end, out the other… Each test peeled away another layer of dignity. I won’t belabor the misdiagnosis that followed these many procedures, but I will tell you the whole shebang has conferred upon me a healthy mistrust of Western medicine.  It’s also dispensed a whopping dose of empathy. And gratitude. Family, close friends and not-so-close friends have sat beside me, delivering pizza and jokes during hospital stays (mine and Sean’s) and outpatient testing (mine).

Thanks to these ministers of mirth, I’ve learned to offer the same presence to another during a health trial. No one should hear the words, “…found something suspicious,” or feel the pressure of a biopsy or sting of a needle without a friend, partner or family member close by. Hell, I’d take Bugsy the Clown if it meant I didn’t have to face the White Coats alone. Anything to distract from the hum of the scanner or click of the needle as it finds and extracts its millimeter of flesh.

One of my running friends, Rebekka*, had been called by the breast health center February 6th, Waitangi Day (a holiday in New Zealand). Her first mammogram, at age 45 (the recommended age to start screening in NZ), had turned up something requiring further investigation. The next day, over coffee at Providores, Rebekka tells our table of a half-dozen runners she must return to the radiology center for a second screening the next day.
            “Is someone going with you?” I ask.
            “Well, they did say I might want to bring a support person,” Rebekka says. “You don’t have to come, though.”

Yes, actually, I do. I think of my friend, Cheryl, who cracked jokes while I waited to climb onto a steel table to get my midsection CAT-scanned.  The test, suggested by two well-meaning general practitioners, turned out to be entirely unnecessary (according to my specialist, who later asked, “Why did you get this done?”)  I had panicked beforehand, thinking the results of this particular exam would scuttle my BIG WORLD TRIP. Bastards. I’ll show ‘em. I’ll run away and perish on an outer island of Fiji, far from medical machinery. I’ll drink kava and eat coconuts, get cancer and die.

Then, there’s Mom. One of her yearly mammograms revealed a one centimeter lump deep inside her breast near her armpit. It’s the kind of small, sinister nodule she couldn’t have discovered herself. Early detection saved her breast and spared her chemotherapy’s horrors. Ten years later, she’s clean.  So yes, testing can save lives.

It can also scare the shit out of you. The doctor tells Rebekka they’ve found six or seven microcalcifications, small calcium deposits in the soft tissue of the breast. I later read online 80% of microcalcifications are benign, but the way the tiny dots cluster can indicate a form of cancer called ductal carcinoma in situ (abbreviated as DCIS, it’s cancer in the milk ducts that has not yet invaded nearby tissues).  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001911/ Rebekka’s clinicians during her first biopsy failed to mention the cluster/DCIS connection, leaving us to wonder why my friend was being screened so aggressively for dots we could only see via magnifying glass.

            “Another radiologist might have missed these, “ Dr. B says, pointed to barely-perceptible dots on the black and white film, which he’s clipped to a light box on the wall.
            “I’d like you to have a biopsy,” the doc tells Rebekka.  “We can’t do it here – you’ll have to go to Waikato, to Hamilton” [about one hours’ drive]

            Because these salt grain-like dots are so small, I ask if my friend can watch and wait.
            “You can’t leave it for one year,” says Dr. B. “One month is okay, though.” He turns back to Rebekka:  “You also have a fibroadenoma, which is usually benign. We can biopsy that here right now.”
Rebekka’s lip starts quivering. She thought she was returning to radiology for another scan, not to endure getting stabbed twice in the left breast with a large needle. Dr. B tells Rebekka the biopsy at Waikato will take about 20 minutes and be performed four or five times. Four or five needle plunges. Bloody hell.

Tears roll down Rebekka’s freckled cheeks. This is so NOT FAIR. I later tell her she got ambushed. She had no time to mentally prepare. Or down a shot or two of vodka. I ask Dr. B if he ever prescribes Valium before a biopsy.
            “No,” he says. “Because we don’t know how it’ll affect the patient. She might fall over, or something.”

This pisses me off. It sounds like the no-drugs stance is for the doctor’s comfort, not the patient’s. While I was willing to endure drug-free child birth, I’m firmly in the “Make-me-stupid/drug-me-up” before an icky medical procedure camp. Blame nerves. And too much experience as Patient Pincushion. I once underwent a bone marrow biopsy (where a large needle is used to pierce the hard outer layer of hip bone using pressure and twisting).  Despite an injection of local anesthetic, the procedure felt like Dr. Feelbad was trying to wrench the bone from my hip. I rank it on the child birth scale of pain. It required Lamaze-style breathing. I could hear the crunch of needle-on-bone. I later ask the doctor if he ever dispenses narcotics before the procedure.
            ”Yes,” he says. “We sometimes give intravenous sedation. But the test is over fairly soon and sedation would have you out of commission for the rest of the day.  I know you’re a busy mom…”

Hey, doc, I decide whether I’m too busy for drugs. I am NEVER too busy for narcotics where a painful (described by most clinicians as “uncomfortable”) medical procedure’s concerned.

Dr. B swabs brownish-yellow iodine on my friend’s breast and extrudes a bit of tissue using a fat needle and gloved hands. Meanwhile, a technician rolls an ultrasound paddle over the suspect breast. This is how the doc can see what he’s stabbing, since he tells us he can’t feel the fibroadenoma. In lieu of watching the needle, I glance down at Rebekka’s toned frame – she has a runner’s strong legs, a nipped-in waist and full breasts for someone so wiry. Rebekka has a body most 25-year-olds would wish for. Just a few days ago, she ran 18 kilometers (11 miles). She’s a tough chick with prematurely graying hair whose face has reddened with shock and pain. Tears continue forming in the corner of her light-blue eyes. I have no words. I remember what my friend, Rev. Jeff, said during Sean’s illness when I asked how he knew what tell families in crisis.

“God gives me the words,” he said. “But mostly, it’s not words we need. It’s presence. Being there is what counts.”
I am present. I stroke Rebekka’s forearm to remind her I’m there. Images of Sean in hospital, of my mom before her lumpectomy, flicker in my head.  Flash: I’m standing with Sean, holding his weakened body upright for a CT scan. Flash: I’m standing over my mom, who’s wearing sunglasses before her breast cancer surgery because staff told her she couldn’t wear make-up. Flash: My friend, Lucinda stands across from me while we flank Sean’s hospital bed. She is telling me to “Just breathe,” (You and your damned breathing), I’d later joke. Flash: Kathleen sits beside me in a hospital corridor, holding my hand before we enter Sean’s room. The presence of loved ones during these hellish medical experiences is proof the world is not an entirely evil place constructed to torture our frail human bodies.

A technician wipes away spots of blood on Rebekka’s breast and gives her an icepack to minimize bruising. Rebekka puts her top back on. We walk upstairs.

We sit across a desk from Allison, whose name tag reads, “Breast Nurse.” Allison asks my friend if she’d like to wait until soreness from today’s procedure eases before undergoing the next biopsy. Otherwise, Waikato may have an open appointment tomorrow.
            “I’d prefer to go tomorrow” says Rebekka.  “I just want to get it over with.”

Allison tells my friend she’ll be clamped in a mammography machine for 45 minutes: “They use mammography to line up the needle to get it in the right place,” the nurse says. “We sent another lady over in a similar situation [with microcalcifications] and she was fine.

Rebekka shouts me (treats me to) coffee and a dark chocolate chili biscuit at a café afterwards. We have about an hour to kill before she’s due to see the breast surgeon.

            “Just because we have you talk to the breast surgeon doesn’t mean you’ll have surgery,” Allison says.
We see Mandy, another runner, and her friend who has a months-old baby. In the safety of the sweet/roasted-bean-smelling café, we talk of other things: clothes and work and running and mutual friends. It’s a 60 minute time-out.

Rebekka has already called her partner to deliver the news. He’ll accompany her to Waikato for the next series of biopsies.

We return to see the breast surgeon, Dr. C. He says,
            “I’m not too concerned at this stage. The fibroadenoma is usually a benign growth. It doesn’t become cancerous or increase your risk. And calcifications are quite common in the breast. If the biopsy is benign, you can forget about this. If it’s fine, in two years, you’ll have another mammogram.”

I later ask Rebekka how much she expects to pay for the mammograms, the doctor visits, the biopsies…
            “Nothing,” she says. “It’s part of the government health system.”

Bloody  socialized medicine. Why should Kiwis, or anyone else, get off with subsidized health care when the same woman in America endures several shockwaves: the agony of diagnosis and treatment, followed by medical bills: “You owe 20%...30%... 50%...” Or, with no health insurance, 100%. At least in this instance, Rebekka won’t be stalked by a series of letters invading her mailbox (like Cancer’s second coming) in the weeks or months after treatment.

The surgeon feels up Rebekka in another room (we later joke the doc could’ve at least bought her a drink before getting fresh) while I scan a magazine article about pop singer Brooke Fraser’s happy life. In one photo, Brooke wears a sheer shirt over a clingy under layer. Her breasts look tiny. I wonder how they’d maneuver those suckers into a mammography machine. The boob talk makes you think of your own breasts. Even if they don’t point skyward, even if they’re a hindrance while running and no longer feed anyone, they’re still yours. They’re intact. If only for today.  You appreciate these sacks of skin, blood and fat because you know they may not be yours forever.

Rebekka had a second series of biopsies one day after her first biopsy. She says she was clamped in a machine for 45-minutes and got jabbed with a needle NINE TIMES. She waited to cry until the procedure was over. She must wait five days for results. We, her friends, watch and wait with her. It’s what we’ve learned to do.

*Postscript: Rebekka was diagnosed with ductal carcinoma in situ, or DCIS. She’s awaiting dates for an MRI and surgery. Meantime, we’ll keep running with her.    


8 comments:

  1. Dawn- I am sending your friend lots of good healing vibes. You are a strong friend to have during a difficult time. Love, R

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