Marking the Day

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A birthday. A milestone of time? Yeah, but what else? Hash marks on calendars? Crow’s feet on the face? A skirmish with the forces of gravity? In its sum, what does celebrating “a birthday” mean?

A compelled moment to take stock? Hmm…new year celebrations and anniversaries allow (if not insist) for that.

A reminder to be appreciative for last year and look forward to the next? Too Hallmark-ish.

A time for tolerated narcissism? A time to be personally recognized for our basic essence…that is, being US…ME? Maybe.

Why do we want, no need, to have the anniversary of our birth actually mean something? Is it because we are a narcissistic species who like to believe ourselves capable of appreciation, reflection, optimism and therefore recognition? Probably getting closer to the truth.

From where I sit, I think it may simply mean that, today on the marking of my birth, I have the scoring advantage. . . .

“Visitor (Reaper) -0- / Home (Me) -49-“ 

For today, that’s enough.

Artemis' Stealth

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. . .is not to be underestimated. Her strikes are random. Unexpected. Her aim is impeccable. Depending on her ire, it can be a barrage of excruciating proportions. Or, there are times that her presence is just a whisper, that teases like an ill-intended promise. A promise served hot and always with debilitating resolve.

Artemis' Silent Assault

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The arrow pierced through my chest wall unnoticed. A minor twinge that only slightly drew my attention away from the tasks at-hand. What literally dropped me to my knees was the unceremonious way in which the arrow, on its own volition, began to withdraw.

The head of the arrow must have been either larger than it initially appeared, jagged in its property, or dipped in some form of venom. Whatever the case, the pulsating burning throbs that gripped me just over my left pectoral muscle lit the entire area on fire. I tried to breathe deeply and send soothing energy to the area. To no avail. Each time I caught one deep cleansing breath the arrow tried to dislodge itself again – sending a barrage of concentrated fiery spasms.

I focused on the determination of the arrow, trying to discern its pace and pattern. I was trying to intellectualize the battle raging in my chest. As the spasms finally became less frequent and subside in intensity, I was able to unbutton the top of my blouse – curious to see if I could find the exit wound left by this unexpected assault and retreat. A prominent, raised vein was twitching across the upper pectoral, across the roundness of the breast, and was at least five inches in length.

I considered it for awhile. Reset the tempo of my breathing. Noted that the garage need a sweeping out from the prior days’ storms. Remembered, and then rescued dinner.

I did wonder, however, what I had done to piss-off Artemis?  

Nurse Tracy Calling

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Four Winds Oncology, can you hold?

Of course

May I help you?

May I speak with one of Dr. Obenchain’s nurses?

I’m Nurse Tracy, I can help you.

Oh hi Tracy. I don’t believe we have met before. This is “TC” I got a letter from SMIL stating they it was imperative they do additional studies, to supplement my breast MRI last Tuesday. I have called them. They want to do a mammogram on my right breast and an ultrasound on my left. They will need the doctor to fax over orders. But, I have a couple of questions that I need answered before we proceed.

Of course. Tell me what they are and I will talk to doctor and get back with you, and I will talk to her about the orders.

Thank you, my questions…concerns, rather are (1) since the MRI is a more comprehensive diagnostic exam than either an ultrasound or mammogram – even a diagnostic mammo, why do we need to do either? SMIL said that the MRI images were perfect in clarity; and (2) what is SMIL seeing on the MRI that makes them (a) want to do additional exams, and (b) what less comprehensive exams tell us that the MRI can’t?

I can’t answer those questions, I will have to request the report, have doctor review it and call you back.

Yes, I realize that, thank you. I would appreciate you following up with the doctor, thank you.

4 hours later….

Ms. TC, this is Nurse Tracy calling from Dr. Obenchain’s office. I have your answers. SMIL says that they do not have a current mammo on your right breast and want it for their records, so that is the reason for that follow up exam. Regarding the ultrasound, because the scar tissue from the sentinel node biopsy is greater in size than your last PetScan they want to make sure of what is there. That is the reason for the ultrasound request. The doctor said that's fine, and I am preparing the orders to fax over to the lab now.

Oh. What about my initial question?

What was that?

My question of necessity. Since the MRI is a more comprehensive diagnostic exam than either an ultrasound or mammogram– even a diagnostic mammo, why do we need to do either?

Oh, as I said, because SMIL says that they do not have a current mammo on your right breast and need it for their records. And, because the scar tissue from the sentinel node biopsy is greater in size than your last PetScan they want to make sure of what is there.

Right, I understand what you are relaying as SMIL’s reasons, but isn’t it true that the MRI, that was just conducted 6 days ago, is a more comprehensive diagnostic exam than either an ultrasound or mammogram– even a diagnostic mammo. And as such, that it should give both SMIL and Dr. Obenchain the information they need to determine what is going on with the scar tissue as well as the status of the right breast?

Ms. TC, you haven’t had a diagnostic mammogram on the right breast in over a year. With your history, you need to have a diagnostic mammogram at least annually.

Tracy, I don't think I agree. I am not so sure that is necessary, in light of my history. The mammograms are not as effective as detecting ILC as an MRI.  My individual history includes the sequence of diagnostic events, in order of certainty, as: (a) diagnostic mammogram; (b) ultrasound; (c) biopsy; and (d) MRI. Knowing all this, I raise the question - isnt doing a mammogram now going backward, diagnostically speaking? And, therefore unnecessarily exposing me to radiation?

Ms. TC, radiation exposure to mammograms is minimal. You got significantly more radiation exposure with the MRI.

Um…Tracy. I don’t believe that is completely accurate. My understanding is that an MRI does not involve exposure to ionizing radiation. Doesn't an MRI use magnetic fields and radio frequency pulses – not radiation. Mammograms, on the other hand, do indeed use ionizing radiation – I know the radiation levels are not astronomical but it is certainly higher than an MRI. Besides, aren’t there more risks of false positives with mammograms than MRIs?

(Pause...heavy sigh...) Ms. TC, it is your choice as the patient, if you do not want to have the mammogram that is just fine. I will note that you are declining the mammogram here in the file. Is there anything else, otherwise I do need to attend to other patients.

What about the necessity of the ultrasound? My understanding is that the MRI would be more conclusive in determining what is going on with the scar tissue than an ultrasound.

Again, Ms. TC, it is your choice if you do these exams or not. Doctor has signed the orders. Just let our office know what you decide. Have a good day.

I hung up and immediately started writing. Since the beginning of this journey I have always kept a journal when meeting with or talking to any and all medical professionals. There is too much information and bias that is thrown out there, and taking notes is the only way I can properly process and distill everything in my own time and context. With the second conversation, four hours later, I was keeping copious notes. I wanted to confirm for myself whether or not my questions had indeed been answered - or not. It is entirely possible that I am suffering some residual effects from last week’s concussion and was just not "hearing" Nurse Tracy. Though, I am fairly certain - upon review, that the substance of my questions were never addressed.

Thank you, Nurse Tracy, you have a good day too!

Monday's Random Thought...Thank you D.C.

****** "Does cancer enter us or do we, falling ill, enter the revelation of the universal cancer?" - Guido Ceronetti, Silence of the Body.

Black Hole Sucking Light...

The letter

******

October 1, 2010

Dear TC:

Re: Your breast imaging exam done on September 28, 2010 - Report sent to Robin L Obenchain, M.D.

We have reviewed your recent breast exam (yeah...three days ago, what took you so long? ah...but I wax facetious) and find that we need additional imaging to complete the examination. While the majority of such additional images show nothing of concern, (that's what they said before last year's biopsy...ah...now I wax cynical) it is imperative that they be taken to fully complete your study. Please call our office at ....or your own physician to schedule the needed additional imaging as quickly as possible.

....blah, blah, blah...

We are sorry for this inconvenience, and hope you understand that we need the additional imaging to accurately evaluate our findings and complete your study.

Sincerely....
Scottsdale Medical Imaging

Why do I have this repetitive Beach Boys lyric running through my head each time I read the stupid letter:

And she'll have fun fun fun now that daddy took her T-bird awaaaayyy!

As my 18 year old constantly reminds me, even from 2500 miles away...I am SO weird! but I'll have fun, fun, fun........................

“Living involves being exposed to pain every second—not necessarily as an insistent reality, but always as a possibility,”

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Pain is often referred to in philosophical discussions concerning the fundamental nature of human experience. The meanings and consequences of pain, and/or suffering, have been a topic of writing by philosophers and theologians alike. The experience of pain is, due to its seeming universality, a very good portal through which to view various diverse aspects of human life. (Wikipedia)

“Living involves being exposed to pain every second—not necessarily as an insistent reality, but always as a possibility,” writes Arne Vetlesen in A Philosophy of Pain, a thought-provoking look at an inevitable and essential aspect of the human condition. Here, Vetlesen addresses pain in many forms, including the pain inflicted during torture; the pain suffered in disease; the pain accompanying anxiety, grief, and depression; and the pain brought by violence. He examines the dual nature of pain: how we attempt to avoid it as much as possible in our daily lives, and yet conversely, we obtain a thrill from seeking it. Vetlesen’s analysis of pain is revealing, plumbing the very center of many of our most intense and complicated emotions. (Review - University of Chicago Press)

Pain is a noun (person, place or thing). Pain lurks in the shadows, but never quite leaves me. It has become an insidious, but loyal companion for the last year. Pain was first associated with the post-surgical discomfort from the mastectomy. As my body healed from the surgery I was subsequently assaulted with a different, and more persistent Pain, associated with the four rounds of reconstruction surgeries and procedures. Since I have more or less accepted the ladies “as is,” Pain has taken on a different manifestation.

Pain is with me daily now, but not continuous. Pain now appears to have taken up residence within my chest wall. The width of my chest is just 10 inches. Despite these close quarters, Pain is still a selfish lover. Pain strokes me hungrily underneath the implants –which are shoved below the pectoral muscles. It demands my attention by piercing through my sternum. At times it startles me. Taking me by surprise in a shooting moment. Other times, it snuggles up to me for the day, a dull reminder that my body has gone through a metamorphosis, and as a result must embrace a new paramour. And, like any passionate paramour, Pain at times seems to envelope my whole self, leaving me spent, trying to catch my breath.

CHOICES

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Individually we do not choose to develop cancer. (Arguably carcinogens and cancer cells are within and without us. Since, as a species we suck at the "holistic sustainability" thing it would appear that the carcinogens are outnumbering us. But I digress....) Again, individually, we do not choose cancer. Those of us may smoke too much (of any/many substances). Those of us may drink hard and too much. Those of us may be addicted to processed food. On and on...etc, etc. etc. But at no time as we indulge in these human frailties do we say: HEY…CANCER, let’s do it!

Okay. So, then we do develop cancer. Whether it be breast – ductal, lobular, invasive, non-invasive, HER+, HER-, BRCA1 or BRCA2…blah…blah…blah; prostate; lung; pancreatic; colon. You get the picture. So, there we are. Now what?

The NOW WHAT is when our choices become more poignant. The NOW WHAT is when our choices become more individualized then we could ever anticipate. And, the NOW WHAT is when our choices have an unimaginable impact on those who know and love us (and probably those who don’t like us so much either… certain opposing counsel, you know who I am talking about!).

Are there wrong choices?

Are there smart choices?

Are there self-destructive choices?

Are there plain old stupid, idiotic choices?

Probably. Maybe. Certainly. Human. . .right?

The only thing I know with absolute resolve and certainty is that there are only individual choices. Colored within the context of our own psyche and circumstances.

Do our choices show who we are?
Of course.
Should I judge or be judged by my choices?
Get a life!
Am I different than everyone else.
Of course.
Are my choices right for you?
Only YOUR choices are right for you. If our choices happen to overlap, then maybe we are kindred spirits. (I met a kindred spirit recently who had a tremendous impact on me. A kindred spirit is quite a fabulous find.)

But if our choices repel against each other, my only choice is to respect and champion you and your decisions.  Ah, if only human nature could be as accommodating, regardless of the context...but that is fodder for another blog.

Disclaimer:  On my way back from the 1.5 hour breast MRI on Tuesday I was rear-ended, in rush-hour traffic, on the highway by a car going approximately 30 mph. I was dead still (NO pun intended) stopped for the traffic in front of me. For the science majors our there, the velocity and impact of a stationery vehicle with one going moderate speed is substantial. Among other things, I appear to be functioning (debatable) with a concussion. If the above musings do not make sense, you can choose to attribute it to the concussion - or - I may just be too damn esoteric. I choose the latter.