On Monday I had my second opinion at the large, nationally-ranked cancer center in New York. We had pulled a lot of strings to get this appointment, and both Christian and I were looking forward to meeting with the doctors and getting a plan put into action. Arriving was surreal, which seems like the new normal. When is it going to stop feeling like that? I keep asking myself. We showed up, did some paperwork, and waited. I had been anxious prior to the appointment that I would be a small cog in a large cancer wheel at this facility, since my cancer was, to our understanding at the time, not particularly advanced or unique.
After meeting with the nurse who took my vitals, we had a long chat with the nurse practitioner, who took a detailed history and did a physical exam. She was very pleasant, and I started to feel more at ease with the level of care there. After she left, the surgeon, Dr. M, came in. We had heard excellent things about her, and she is one of the top breast surgeons in the world. Her manner was brusque but professional, and I felt in good hands with her. She also did a very thorough physical exam, and then started talking about possible treatment plans and surgery, but then said “I’m not doing anything until you meet with Oncology and have a round of chemo.” She had palpated an enlarged lymph node that our previous hospital had missed, and explained that doing surgery first would require the removal of all of my lymph nodes, (an axillary node dissection), which would then put me at a very high lymphedema risk. Further, research in the last several years has shown that chemo prior to surgery for women with node involvement can eradicate the cancerous cells in the lymph nodes, thus allowing the surgeon to spare the lymph nodes and decrease the likelihood of lymphedema. Shocked at this new information, we agreed to the new action plan and went off to meet the Oncologist.
As soon as our Oncologist, Dr. G, walked in, we felt at ease. She was friendly, cheerful, and soft-spoken, and immediately I sensed that I was at home with her practice. It was a pleasant surprise. She spoke to us for a few minutes and conducted another very thorough physical exam, and then ushered us to her office where we could speak more in-depth about treatment options. Once seated, we began discussing chemo and surgical procedures and she answered our questions easily and thoroughly. Then she began to review our MRI findings, and commented that my enlarged lymph nodes and the sternal lesions did concern her.
Excuse me, what?
Sternal lesions? This was new information. Coupled with the new lymph node involvement, this appointment was painting a very different, much scarier picture than we had received before. Dr. G explained that the MRI taken at our previous hospital had shown some lesions on my breastbone and she wanted to do a PET scan to see if they showed markings of cancer. Those markers had been clearly shown on my previous MRI, but had been missed by the radiologist. She elaborated that there was no telling without further testing whether they were cancerous or benign. However, if they are cancerous, they would mean that my cancer is no longer considered early-stage breast cancer, but has metastasized into my bones. This means that it would then be considered inoperable and at this point, incurable. Both Christian and I broke down in tears at this news. We were horrified, devastated, frightened. How could they have missed this? How did this happen? What now? Words fail to describe the sickness I felt in the pit of my stomach.
Dr. G bore had more bad news: due to the hormone profile of my cancer, I would be unable to ever have more biological children, as any levels of estrogen in my body would cause my tumors to go haywire and multiply further. She mentioned that the treatment for this would be either hormonal suppression of my ovaries or surgical ovary removal.
However, at this point, there were not many answers, only more questions. The appointment we had heralded in out minds as a resolution to so many questions left us feeling more scared and confused. We didn’t know what the sternal lesions were and didn’t have a sense of the likelihood of either outcome. Living in that deep gray area is a special section of hell that I would wish on no one. We wrapped up the consultation in shock, and agreed to return to meet with Dr. G in mid-December, following a PET scan and biopsy of the sternal lesions. Numbly, we scheduled the PET scan for the following morning, shuffled down for more blood work, and retrieved the car.
In the car, we broke down, tearful and afraid. What does this potentially mean for us? Truthfully, the first thought on both of our minds was this possible impact on my life expectancy. Everyone knows of an acquaintance, a friend of their mother’s co-worker’s aunt’s in-laws who knew a young woman who received a devastating cancer diagnosis and too soon, was gone. We felt like we were staring down the barrel of a loaded, cocked gun and didn’t know what was waiting in the chamber.