Posts Tagged 'breast-cancer'

Probabilities

I have now completed all the consultations and collected the expert opinions of the members of my care team. It does not quite feel like a team in my experience of what teamness is all about. It seems more like a collection of busy individual specialists who can all open my dossier from their computer and see the same data and talk about me from time to time. Apparently this ‘team’ met in mid March, after the lumpectomy, presumably on a Zoom call, and came to the unanimous conclusion that radiation was called for. Unfortunately, the medical oncologist we consulted earlier this week, had not been in on that conversations about my situation and had his doubts about the conclusion, leaving me with doubts.

I was able to get a phone consult on short notice – the radiation treatment starts next week, so that was important – with the radiation oncologist and laid out my doubts in the form of questions which she answered to my satisfaction. It’s been a bit of whiplash, yes to radiation, no to hormone therapy, no to radiation, yes to hormone treatment, or yes or no to both. It is all about probabilities, calculations that are difficult to make by someone who is not up to date on the research and remembers nothing about the Intro to Probability Statistics course that I took some 50 years ago. As I am wading into this very complex universe of the cancer cell, I am told about probabilities of recurrence. It may be local recurrence, a cancer cell left in the breast that starts to multiply, and/or a different cancer that develops spontaneously, like my breast cancer did for who knows what reason, elsewhere in my body. The radiation would take care of missed cancer cells in my left breast and the hormone treatment would make sure that any similar type of cancer would not receive sustenance any longer from certain hormones.

I have found, and in one case been told, that everyone stays in his or her lane: the breast surgeon cuts, the radiation oncologist radiates and the medical oncologist prescribes pills or infusions. Sometimes the lanes ran in parallel and sometimes one or two lanes veer off. So here I stand, looking ahead. I think it is going to be parallel roads for the next month until the radiation is done and that road veers off; after that I will stay on the hormone road for many years to come, which hormone is yet to be determined, that too is mighty difficult to decide.

Rays, early dinners and no visits in the evening

A friend of mine called me radiant when she saw me recently, in spite of my recent health challenges. Since I am going to have to start radiation treatment soon it made me reflect on the words that suggest I am emitting rays. Soon these rays will not only come from me but also from a machine. It is hard to switch my mind from radiation being harmful to being a cure. Apparently there is a minuscule chance of the radiation treatment creating, rather than curing cancer. Lawyers here tell doctors that they have to tell you about even the tiniest risks of a treatment.

Yesterday I met with the radiation oncologist. She is a young woman (most of our healthcare providers these days seem to be younger than our children). When I saw her name I asked whether she was from Nigeria. Yes, she was. We talked about my many visits to Nigeria to help Nigerian colleagues improve the performance of their local health systems. I told her that of all the countries I have visited in Africa, Nigeria was to me the most exotic, most colorful and most fascinating. She doesn’t get to hear such compliments much. For many Americans Nigeria evokes images of con men trying to get your bank account and social security numbers.

I had imagined that during our consultation she would go over the many reports and then tell me that she didn’t think I would need radiation. After all, the reports had been negative: a tiny lump of lobular cancer cells (stage 1) – now removed; the oncotype report that put it at number 8 on a 100 point scale (very low risk), and the fact that no cancer cells had traveled to my lymph nodes and that the margins were clear. Instead I learned that although the margins were clear, the space between the cluster of cancer cells and the posterior wall of where the cancer was located was not as large as it should be. It was an unpleasant surprise that changed my mind about radiation.

And so I will be starting my radiation treatment soon. From April 14 on I will present myself every (work) day until May 14 to the radiation center of the Lahey Clinic in Peabody to receive the rays that are expected to kill any remaining cancer cells that may still be present. They will prep me for that in a simulation (a ‘sim’) treatment next week. This is when they will make tiny tattoo marks to help focus the beam of rays and set up the equipment. I am told to expect a bit of sunburn and fatigue. “You will want to go to bed earlier,” she told me. I replied that I already go to bed very early, around 8PM. “Well, then you will want to go to bed around 7PM.” I sometimes already do that. So, until mid sometime mid to late May it will be ‘early dinners and no visits in the evening.’

Forced Leisure

For two weeks I had been anxiously awaiting the report from the pathology lab to learn whether any cancer cells had escaped into the lymph nodes and whether the margins from the excavated lump were clean. Yesterday I found out: the lab report was negative. In this case the word negative was good. It meant that no cells had travelled outside the lump. How this will affect the treatment plan I have yet to find out when I meet with the oncologist and radiation oncologist. Our medical professions have mushroomed into so many specialities and subspecialties that the surgeon who did the excision did just that. When I saw her yesterday she declined any comment about next steps, other than that I would receive a call from these specialists. I received no answer to my nervous question about chemotherapy. If it wasn’t for the infected scars and the considerable amount of fluid that she had to drain from them, and sending a prescription for antibiotics to the pharmacy, I would have been in and out of her office in minutes. At least she had something to do for her pay. Hopefully in 6 months when I am summoned back to her office (is that really needed?) I expected I will be in and out in minutes because her handiwork will be close to invisible.

Although happy about the lab results, the infection has been draining me – apparently I did not rest my traumatized body the way I should have. True, a week after surgery, I did carry a load of firewood into the house, I carried and moved boxes that were probably too heavy and I did go this past week, 2 weeks after surgery, to yoga and pilates as I had understood I could. I had been anxiously awaiting to resume my other exercise classes, the aqua bike and spinning classes. Now I am told to wait another 2 weeks.

My body has absorbed the upsets, disappointments and trauma in various ways: my foot problems, now including plantar fasciitis, were most likely a result of the Tai Chi retreat during which I was on my feet, practicing QiGong and Tai Chi for 7 hours a day, 6 days in a row. Then back in the US where flu and cold viruses were circulating widely, I eventually got into their paths. And then the surgery and the preparations for it: the insertion of a magseed and radioisotope in my breast, then the cutting and chafing of the scars under my arm and too many needle sticks to list. Enough already my body yelled, be quiet, be still. But I did not sit still – idleness is not my thing. And now it is payback time. Forced rest. This reminds me of one of my favorite poems about rest, written by the South African activist & poet Benjamin MoLoise, a brilliant soul, silenced by his government in 1985:

In our whole life’s melody the music is broken off here and there by rests. / And we foolishly think we have come to the end of the tune. / God sends us a time of forced leisure, sickness, disappointed plans, frustrated efforts, /and makes a sudden pause in the choral hymn of our lives. / And we lament that our voices must be silent. / Our part missing in the music that goes up to the Creator from the world.


April 2026
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