today my bruises streak green down my breast. i've had a real heaviness under the medial incision in particular and have had more pain than yesterday, though i didn't take any tylenol or darvocet today (yet...). we cancelled going to thorsten's birthday party because i thought i should go home instead. was i right! halfway up my drive home on 280, i started feeling sick. once i was turning off on san jose, i was feeling pretty nauseous, which navigating dolores with its ups and downs didn't help. but the curious thing happened -- since i had to drive, i think i also managed circumnavigate getting sick. the saltwater taste in my mouth passed, and then i felt like i was going to make it home and parked and up the stairs, which i did.

so therefore ... i'm on the lookout for infection. susan love says if infection occurs, it's usually one or two weeks after the surgery. my surgery was exactly a week ago. (she also says it's more a nuisance than anything, and just takes a little antibiotics to clear up, if it occurs). nausea is only one sign, though, and it sounds like i'd have to be red and swollen and feverish too, which i'm not.

we'll see how i feel tomorrow. perhaps i'm feeling just tired. perhaps i'm sick because of the pain (but the pain doesn't seem that extreme). perhaps my body is rallying to fight an infection. or maybe it was something i ate! at any rate, dr grissom gave us explicit instructions about how to reach her or her staff, 24 hours a day, so we know what to do.

the medial breast mass (top right area of breast) is 4 x 3 x 1.5 cm and weighs 12.5 gm. that's about the size of a truffle from maison du chocolat -- 1.5 x 1.2 x .5 inches and weighing in at half of an ounce.

the lateral breast mass (lower left area of breast) is 7 x 5 x 2.5 cm and weighs 47.6 gm. that's about the size of a small bar of soap from l'occitane en provence (though not as heavy) -- approximately 3 x 2 x 1 inches -- and weighs 0.10 pounds (or a bit less than 2 ounces).

so send soap and dark chocolate truffles to moya!

a quite fascinating if brief "surgical pathology report" arrived in the mail today. it is just over one page long, and i quote:

CLINICAL HISTORY:
     Calcifications left breast
     Postop Diagnosis:  Same
     Operative Procedure:  Left Lu Bx with NL

TISSUES:
     1.  Breast Biopsy after Needle Localization Mass - medial
     2.  Breast Biopsy after Needle Localization - lateral mass
___________________________________________________ 

FINAL MICROSCOPIC DIAGNOSIS:

     Breast, left medial, needle localization biopsy
       -- benign breast tissue.
       -- calcifications identified within benign ducts 
          (slides G and H).

     Breast, left lateral, needle localization biopsy
       -- fibrocystic changes with focal ductal proliferation.
       -- calcifications identified within benign ducts 
          (slides K through N).

     Comment:  There is no atypia or carcinoma in either 
          biopsy sample.

___________________________________________________ 

ORC:  2 specimins received #1 -- medial area.  #2 -- lateral.  X-rayed.  
Clusters of calcifications identified in each fragment.  Surgeon notified.  
H. Kamal, MD

GROSS DESCRIPTION
     The specimen is received in two parts.

     Part 1 is received fresh from the Operating Room, is labeled "medial" 
     and consists of a 4 x 3 x 1-1/2 cm portion of fibrofatty tissue weighing 
     12.5 gm.  The specimen is unoriented.  It is inked entirely in black ink.  
     The specimen is serially sectioned and submitted entirely in 
     cassettes A through J.

     Part 2 labeled "lateral breast mass" is received fresh from the 
     Operating Room and it consists of a portion of fibrofatty breast tissue 
     measuring 7 x 5 x 2-1/2 cm and weighing 47.6 gm.  The specimen is 
     unoriented and it is entirely inked in black ink.  The specimen is 
     serially sectioned and laid out on paper.  The cut surfaces do not reveal 
     a distinct mass.  The slices are x-rayed.  The x-ray shows calcifications 
     in slices 1 through 4.  Representative sections are submitted in 
     cassettes K through W as diagrammed on the x-ray.  Cassettes K through 
     O contain areas of calcification.  Approximately 60 to 70% of the specimen 
     is submitted for microscopic evaluation.

and that's it!
my initial thought on reading this was how well susan love describes this report, what it should contain, and what questions you should ask about it, in her breast book pp. 161-164.

my immediate thought thereafter (besides once again the relief at the "no atypia") was: holy cow! 7 x 5 x 2.5 cm?? why that's as big as ... and then we went off to hunt for a centimeter ruler and could not locate one; in fact, we can't find any ruler. but that sounds like a huge hunk-o-change to me.

leanne seemed more impressed that i collectively lost 60.1 grams (and no dieting!). we were just beforehand looking at my breasts and noticing the left breast seeming much higher. typically one of my breasts was slightly higher than the other, but i wonder.

there's the part about definitely seeing the calcifications themselves on the slides they biopsied - which is good.

then, there's the somewhat thrilling "gross description".

and finally, there's the matter of "fibrocystic changes". as the report points out, neither sample showed any 'atypia', which is what susan love says is a good thing. but "fibrocystic changes" still -- extra cells lining the ducts... how does it get there? what's this all really about?

though i am curious about what it means to be "unoriented", and i wonder why the difference between the lateral and medial pathology, i think i've asked all i know to ask and am at rest with the procedure and the results. but i'll be on the lookout for more information as time goes on, that's for certain.

I think they just wanted to cause a scene to get more attention  :)

there is some pain underneath both of the incisions. just a little bit, coming with the occasional throb, sometimes enough to say "ouch". the bruises are now mostly a light amber color and cover a large area, but they themselves don't seem to hurt. there's a really large, meatty red area of bruising under the lateral area of incision, where my breast flops over. i haven't taken darvocet since monday. i think i'll take a tylenol and be on my merry way to the dentist and then to work today...

today i soaked up some negative ions from the ocean at tennessee valley. under my favorite puffy white clouds against a blue sky, i walked just far enough to smell the waves crashing against the cove. on my way back i saw three deer cross my path to a field of yellow daffodils, and just afterwards i passed what looked like a great egret -- a snowy white S balancing on spindly legs ending in wide claws which barely made an impression in the long grasses -- standing right by the trail, perhaps overwintering in the valley. when i got home after seeing dr kaymen and dr mulder, i had several emails from friends who were happy about my breast. i am so lucky...

as leanne said, nima grissom called tonight with an early and good report. there are extra cells in my ducts, but they are not a problem. as susan love suggests to do in her breast book, i asked if the pathologists were sure to actually see the calcifications on the slides, since we know they were actually removed, and she said yes. not all the calcifications were removed -- she said i actually have them scattered throughout my breast, which we didn't realize. we understand that the more scattered they are, the more typically benign they may be. originally we thought they were localized into those two places. also, there was no difference in the pathology of the two separate locations, which reinforces the idea that it's a benign process all over my breast.

i don't even need to schedule a follow-up appointment with dr grissom, and i don't need to get another mammogram for another year! since not all calcifications are removed, they will probably show up on subsequent mammograms, and she says they'll know what to do with them then. i'm not sure what would make me need to repeat a similar kind of biopsy. not sure i'd like to, but so far this hasn't been as painful as we feared. the cuts seem to be fixing to heal nicely ... eventually. no real pain yet -- lots of capacity for sleeping, though...

susan love describes different stages of extra cells in the ducts on p.260/breast book:

You'll recall that I've described the breast as a milk 
factory, with two parts-- lobules that make the milk, and 
ducts, like hollow branches, that carry it to the nipples...
Over the years, you can get a few extra cells lining in the
branch--sort of like a fungus.  This is called intraductal
hyperplasia, which simply translates to "too many 
cells in the duct."  In itself, this is not a problem. 
Sometimes the cells can begin to get a bit strange looking,
and this condition is called intraductal hyperplasia with 
atypia ..."

so i have extra cells lining the duct, but they are "normal" and not "atypical."

just to be clear, i asked dr grissom was there any "atypical hyperplasia", and she said no, and confirmed that what is there is not an indication of subsequent risk of breast cancer.

i hope to carry this feeling of being well-taken-care of for a long while. as unpleasant as a biopsy is, i've had good soups, chocolates, pendants of amber, fine company, family, felines (and even a canine or two) and friends, which might not make me healthy, but it doesn't hurt! thanks for that to all who are reading this.

in deference to the awesome work and life of Gerry Rogers, i'm renaming my weblog from the original "my left breast", respecting the namespace of her important film, at www.myleftbreast.com. check it out...

pathology results back a day earlier than expected and moya's calcifications from both piece of tissue are declared benign normal hyperplasia. whee! yay! relief! more later ...

Starting at 10am on Friday, February 21, just before we left to go to the hospital, our dear friend Michael Hackett arrived bearing tulips and chocolates and music and movies (Foxes starring young Jodie Foster and Bar Girls, which is just the distraction needed when healing from surgery!).

We arrived at CPMC at 10:30am and parked in the parking garage which had an entrance right to Floor 2 where the breast center is (maybe this is too many details? I took copious notes!)

registration
Moya registered on the 1st floor then went to the 3rd floor where she was assigned to room 384 and promptly instructed to strip and clothe herself in a flimsy gown and sock-slippers with non-slip bottoms. We take pictures of Moya in said flimsy gown (perhaps we'll post a photo album later!) and Moya inquires, "how's my hair?" (it's gorgeous). She wore one of her new sports bras to the hospital -- it doesn't fit super well. We have had a difficult time finding sports bras to fit Moya since she has a small chest size and a large cup size. Almost all sports bras for "larger-breasted women" only go up to cup size DD or DDD ... or they expect you to have a large chest if you have large breasts. There's a market space that is practically empty -- sports bras for sizes like 34FF.

waiting
We were sitting and waiting for further instruction when Ali called to see how we were doing. Ali, the rock star gal that she is, was in Houston on her way to Belize for scuba diving and will be in San Francisco briefly on Thursday and Friday. We miss Ali (she moved to NYC a couple years ago and lives in Brooklyn now with her sweetie Elise). While on the phone with Ali, a nurse arrived at 11am and accidentally whacked me on the head with her clipboard -- turns out I was sitting too close to the curtain ("closed door" says the nurse). Oy!

IV trouble
Moya's blood pressure was taken (104/78 - "perfect" says the nurse). Nurse goes away to get something and Moya takes a look at her chart (whoops, we learn later after being chastened that we aren't supposed to read her chart -- liability and all). Nurse starts the process of inserting IV needle and Moya's calm and doesn't feel the needle but starts getting lightheaded. So she lies down. She gets clammy and the nurse wraps her up in blankets and fetches some valium and says "You're diaphoretic" -- that's our new word for the day. Moya looks really miserable -- having gone into a bit of shock from the needle. Nurse removes that IV (from Moya's left hand) since it didn't get in a vein, and tries to put an IV in the other hand. She can't find a vein, the needle is just under Moya's skin, her skin bubbles up as the fluids from the IV bag go in. Nurse removes it and says she'll let the anesthesiologist get the IV needle in. Now Moya has bandages on both hands and a swollen area around one of the bandages (that finally went away by the next day).

bad bedside manner nearby (not for us!)
The woman sharing the room is being yelled at by her doctor because she didn't stop drinking water at the right time. The doctor is reasonably upset that she didn't follow the pre-surgery rules but his attitude and behavior are lousy. I'm glad he's not Moya's doctor.

the worst is almost over
By this time I'm feeling a bit helpless -- Moya's been in shock, stuck unsuccessfully in both hands with needles, had some valium, and she hasn't even had the needle localization yet!

That was the worst part -- it all gets better from here.

off to needle localization
11:30am arrives with Sofia the CRT who talks with us about what will happen during the needle localization and says they'll do the lateral "easy" needle first (underneath and to the left of the nipple) and see how Moya does and then do the more difficult medial needle. I inquire about whether or not Moya wants to listen to music on my MP3 player (no, she doesn't, she wants to be alert!) and Sofia looks at me quizzically -- I explain "MP3 player."

Sofia thinks she knows Moya but isn't sure where they've met before (I love San Francisco). She explains that the 2 spots are far apart (where the calcifications are) and that she'll take mammogram pictures and there will be a hole that Sofia will mark and then the doctor will put some Novocain there and insert the needle, some blue dye and the wire. We ask if I can come along and Sofia says of course. Wow! I've never seen a mammogram before and didn't realize they'd let me be in the room while they did the mammograms and inserted the needles. I think it gave Moya some extra comfort and distraction.

Take the wheelchair! I recommend to Moya. Sofia brings a wheelchair and Moya wraps herself up in blankets and curls up in the chair. We go from the same-day surgery area on floor 3 to the breast health center on floor 2.

mammogram, needles, mammogram, repeat
By now it's Noon and we're in a mammogram room with a chair for Moya to sit in facing a window that looks out on California St. Not a fantastic view but better than a view of an alley or another building. And the fresh air from the open window feels good.

Nadine, the director of the breast health center checks in to see how Moya is and introduces a volunteer who is there to hang out and keep us company and help Moya from fainting from the needles. Dr Susan Denny comes in to say hi and "I'm the one who got you into this mess" (she read Moya's last mammogram and recommended biopsy). We adore Dr Denny.

So it's a needle localization party -- Sofia, volunteer, Nadine, Dr Denny, Moya, me, and, later, Aida!

The volunteer holds some ice on Moya's forehead and neck. Moya looks out the window. They take mammograms, develop them, examine, mark Moya's breast with a blue pen, and Moya sits calmly with her breast smashed in the machine. She says it doesn't hurt ( the volunteer says it really hurts but she has small breasts so what does she know about Moya's experience anyways).

I'm fascinated and I'm so glad Moya's not bothered by the needles going into her breast. Dr Denny puts in the first needle (lateral) and then they mammogram to see if the needle is in the right place. Then she inserts blue dye and the wire. Then they all talk about how to get the medial needle in -- since the spot is above and to the right of Moya's left breast, it's hard to mammography (is that a verb?)

A little clear plastic cup is taped over the lateral needle and wire to protect it while they wedge Moya's breast into another position to put in the medial needle.

is that really my breast?
There's a lot of "wait, don't move, relax" while Moya's breast is wedged in between a plastic piece (with a rectangular hole in it) and a sheet of metal. It's something like mammogram, mark, needle, mammogram, do over.

We took a lot of pictures of the mammograms (Moya says she didn't realize her breasts were so large before she saw them in photos!) and the needles and wires because we didn't know what a needle localization would look like before this happened ... so we'll post the pictures sometime soon with warnings on the links about what they are.

no time for waiting
By 1:05pm I'm caffeine-deprived and hungry and hadn't realized we'd been at the hospital for 2 1/2 hours because it's so incredibly neat that they let me watch the mammogramming and needle poking.

By 1:30pm both needles are in and it's time for surgery. We'd been warned by the doctors and by friends that there would be a lot of waiting around. So I packed a carryon bag for the flight. Oh, well, it felt like I'd packed for a flight (lots of waiting). I had MP3 player with fabulous playlist queued up, 3 magazines (literary, semi-trashy, very trashy), a book of short stories, and my treo gadget with web access and games in case I was really feeling antsy. But, as you can tell, we were busy busy busy from 10:30am til 1:30pm with needles and shock and more needles and mammograms and more needles!

off to surgery
Jerry had a bed for Moya and he pushed her into the elevator and brought her down to surgery on Floor 1. I followed her down and kissed her goodbye before she went through the double doors. She still didn't have an IV -- turns out that the anesthesiologist got it in on the first try with no trouble. I was feeling so bad for her that she had been poked so many times already.

1:45pm: Up to floor 3 to the same-day surgery waiting room where I found her parents (Norma and Richard) and rediscovered my hunger and caffeine deprivation. We whisked ourselves up the street to Peets Coffee and flowers at Bryants and then to A.G. Ferrari for a sandwich and Pelligrino and back to the waiting room to wait for Moya to come back from the O.R.

2:35pm: Dr Nima Grissom (Moya's surgeon) called to report that everything went fine, the tissue removed was x-rayed to confirm it was calcifications and ... "just in case Moya doesn't remember, I told her that pathology's running a bit late so I'll call on Tuesday to let her know if the results are or aren't available" -- what a fabulous doctor!

moya's rockstar recovery (and amnesia)
By 2:45pm Moya was sailing by the waiting area with her thumbs-up in the air looking as though she'd just had a facial and a massage instead of a biopsy. We followed her into her room where she teased the guy who was pushing the bed and asked for a back massage. She was very chatty but she's already forgotten being pushed in the bed and getting out and into the chair. She started dictating to me as follows ... she wanted to remember everything:

• after being wheeled through the double-doors to surgery, she was rolled into a sort of holding-area room. a pretty plain room.
• someone named Pilar in a red, white and blue cap came in
• she was given a little blue 'shower-cap'-like hat to wear
• the anesthesiologist, Dr Michael McGehee, arrived and met with her on any potential health issues ("do you smoke? anything?")
• dr grissom was there briefly as well
• she was wheeled into surgery, where she was a little surprised that she had to get up and get onto the surgical table all on her own (once they wheel you around, you can actually get up and move?)
• the surgical table was narrow and otherwise not unlike a massage table - she might have asked if she was getting a massage again
• two huge silver circles hung over her - the lights
• dr grissom was there and asked if she got her phone message. moya thinks she tried to say something entertaining.
• moya gave her the cellphone number to call with pathology results.
• dr mcgeehee had no trouble inserting the IV -- pop, and it was in
• a clip went onto her right index finger, to monitor her oxygen
• dr mcgeehee explained all about the automated blood pressure thing as he put it on
• he also put an oxygen thing at her nose -- a plastic tube that wrapped under her nose, with two little pipes into the nostrils. pleasant air came through it.
• two other people were fussing around on the edges and moya tried to meet them and get their names, but they seemed busy
• her left arm was spread-eagled onto the left-arm-platform
• moya looked at the clock - 1:45
• having successfully established the IV, dr mcgeehee dripped something into it, then told her there was "a little versed going in" and she felt coldness going up her arm
• she remembers dr mcgeehee saying something like 'it's actually not cold - it's room temperature. it just feels cold because your body temperature is warmer' -- or maybe she made that up. that's the last she remembers.
• dr mcgeehee said 'moya you can wake up' - and apparently he had shaken her to wake her up.
• she looked at the clock; it was 2:30
• they wheeled outside the surgery room, and dr mcgeehee talked to her for a little bit. all she remembers is that he said "you might not remember this conversation."
• she didn't realize there was an elevator ride and doesn't remember it (surgery on 1, recovery on 3)
• she was very pleased to see juice and water and crackers in her room but she really wants to eat sushi.
• she said she had the best sleep ever and felt refreshed when she woke up!

instructions instructions instructions
The nurse (Blossom) says she'll get Moya a prescription for Darvocet -- that it probably won't hurt like the dickens but it will be sore and then she gave me some instructions for Moya since "Moya probably won't remember this later if I tell her" (the M.A.C. has an amnesiac side effect):

• no pushups or sit-ups or strenuous exercise for 2 weeks
• the steristrips on the incisions (under the dressing) need to stay on for 10 days.
• no showers or baths for 2 days after surgery
• on Sunday (after 2 days), take off dressing and leave the steri-strip tape across the incision. Soap up hands and clean/rinse over the steri-strips but don't shower directly on the incisions (it'll hurt). Pat dry and leave steristrips as they are -- exposed to air -- to help scab and heal.
• after 10 days, peel off the steri-strips in the shower -- get them really really wet and then peel off. Don't peel off dry because skin/scab will peel off (ew!)
• if it feels uncomfortable (now) take Darvocet -- don't wait until it's really painful because the Darvocet will take 1/2 hour to kick in
• call Dr Grissom next week to make followup appointment for 10 days after surgery
• wear bra for support -- it's better not to let breast move around -- keep it supported

Around 3:45pm we all left to bring Moya home -- she went with her parents and I went to Walgreens to pick up her pain medication.

back home!
Moya's an excellent patient and she's healing super well. She's also taking the pain meds every 4 hours so she doesn't feel any pain (preventative medicine!) and she's very disciplined with icing the incisions every 1/2 hour. I've been cooking up roasted squash and garlic, sauteed mushrooms in wine and butter, and smoky eggplant ‘bharta' (indian dish).

She's sleeping okay though it's hard to find the right position to lie in to avoid putting pressure on the incisions. I woke up every few hours to look at her and make sure she was okay. Given all of the prep talks we had with doctors and friends about possible pain and discomfort, she's doing extremely well.

good friends and shopping and food
We have a stack of rented movies and kitchen full of food and an amazing amount of support and help offered from friends. Wow!

We went out for brunch this morning with Moya's parents and then to Dema and Home Remedies in the Mission for browsing before Moya got tired and we went home for a nap.

Sylvia and Karin brought vegetarian borscht (which I ate and liked even though I don't generally like beets!) and we shared it with David and Kathy who dropped by for the evening.

And tomorrow maybe a little walk around the neighborhood or Crissy Field and plenty of lounging about and napping.

more later ...
We'll have pathology results sometime during the week and will send out an update. Thanks for all the good wishes!

it went great. more later. moya's at home being as charming and witty as ever.

tomorrow

it's all set - i pre-registered by phone (with 'winnie') on tuesday. i just got off the phone with 'mitzi', the surgical nurse, this morning. mitzi had a battery of health questions for me, covering seemingly any conceivable disease or disorder: "any heart disease, any glaucoma, any diabetes...how much do you weigh?" my favorite: "any female problems?". does fighting with my girlfriend count? no actually - leanne is quite my guardian angel in this, and has gifted and project-managed me quite well. all that's left for me is to show up.

1. 10:30 am: show up at 3698 california
2. register and dole out insurance card at the desk downstairs
3. get sent to the third floor
4. wait
5. 11:30 am: needle-localization. get mammogrammed and get needles inserted for dr grissom to target (eve said they look like guitar strings...)
6. wait some more
7. at some point, get administered monitored anesthesia
8. 1:30 pm: surgery with dr grissom
9. 2 or 2:30 or so: get rolled all woozy in a wheelchair to leanne, mom, and dad who then prop me up, take me home, and carry me up three flights of stairs!
10. afterwards:
    • start with clear liquids, crackers, or toast if you are nauseated- but i'm already craving a burrito just thinking about starving myself overnight
    • darvocet is the most commonly prescribed medication
    • you can expect some bruising and swelling around your incision and sometimes involving distant parts of the breast or chest - use an ice pack on and off
    • the outer gauze dressing may be removed 24-48 hours after biopsy. leave on the steristrip (small white tape strip) in place for 7-10 days; it may be removed then or left to fall off
    • occasionally patients are wrapped with an ace wrap to help decrease bruising and swelling - this may be removed after 24-48 hours
    • after the (outer) dressing is removed, you may shower and get the incision wet, but don't get in a tub for 10 days
    • pathology reports should be ready by next tuesday - friday at the latest

and that does it. everyone is saying 'keep calm', or 'the anesthesia is the worst', or 'the waiting is hardest'; perhaps because i've never gone through it, i don't have any anticipatory dread, and i'm feeling just fine. the whole thing seems like it should be a big medical experiment for me. i might as well remain naive as long as i can. besides, i rode my bike to work today and onto the train, so i feel a bit like i've gone on a trip to a foreign country.

• buy crushed ice (it molds better to shape of breast for icing painful spots) and ziplock bags
• wear a loose button-up shirt on friday -- easier to put on after surgery
• sometimes the nurses/doctors/etc will give information about "most patients" which might not apply for women with large breasts so ask if there are things to keep in mind for large breasts (such as stitches stretching from weight)
• nurses/doctors might urge you to leave earlier than you feel ready, but you don't have to leave if feeling dizzy or nauseous from the anesthesia -- suggest ... sticking around in the hospital bed til you feel well enough to walk up all those stairs to get home
• "take the wheelchair!" says abbe
• if incision is under breast and weight of breast makes it ache, it might help to hold arm folded under breast to support it
• might have bruises from the surgery -- could ask if might be bruising
• and notes for leanne ... ... respect, suggest, don't tell or demand, and procure chocolates and cheese. yum.

word of the day

i am happy with merriam webster's word of the day:

hale \HAIL\ (adjective) 



: free from defect, disease, or infirmity : sound; 
also : retaining exceptional health and vigor 



Did you know?
When you need a word to describe someone or something in good 
health, you might pick "hale" or a synonym such as "healthy," "sound," 
or "robust." Of those terms, "healthy" is the most general, implying full 
strength and vigor or simply freedom from signs of disease. "Sound" 
generally emphasizes the complete absence of defects of mind or body. 
"Robust" implies the opposite of all that is delicate or sickly and usually 
suggests muscular strength as well as the ability to work or play long 
and hard. "Hale" applies especially to robustness in later life. The phrase 
"hale and hearty" is often used to describe an older person who retains 
the physical qualities of youth.

white amber and bras

janice wrote more about the white amber piece i get to carry in my pocket to surgery:

it is believed to have more medicinal powers than the clear types and 
also to have more magical properties.  I tell people that the reason I am 
so healthy is that I am around so much amber so much of the time!  
Anyway, it is believed in "amberland" to have great healing powers 
and the people of the Baltic use it in various ways (I even have some 
lotion), mix it with tea to drink, burn it as incense, etc.  Have heard 
some even more far-fetched uses.  (remind me to tell you sometime).

pretty interesting. yesterday, leanne and i got me fixed up with some sports bras from the sports basement, which should be less painful on the cuts in my breast after surgery. now... the reason i haven't been fixed up already with sports bras is not so much that i don't jog, although i don't, but because i've never found one to contain me. we found a couple xl's (maddeningly scarce), and they seem to work ok, didn't need to choke me while wrestling over my head and shoulders, and don't feel like rubber bands around my body. the lovely glitter-adorned package on friday night contained a special lacy bra from the lovely alla prima... just to make me feel better! now that one is a good fit, of course. it would seem like my biopsy is single-handedly saving the local economy.

in my dreams last night, it was a very hot day and i was fixing to climb up a mountain. i was trying to figure out what shoes and shirt to wear. i was having trouble tieing my shoelaces. it was so hot, i hoped i had enough water. but i remember the feeling of how good it was going to be to hike up that mountain.

it's a bright sunny day in the city today after hard rain on the chinese new year's parade last night. it looks like a good day for marching.

voicemail from dr grissom

my biopsy is in exactly a week, and i called and left several questions for dr grissom today on her voicemail. she called just a little bit later with all the answers i asked for -- it's all on voicemail:

(yes, i left off the question about the sushi and the tissue bank - and the cancer and the breastfeeding, feeling both a little premature!).

then, dr. grissom said she'd talk to me next week and if there was any problem or more questions till then just to let her know. it's really great to have such a responsive surgeon. leaving that list of messages on her voicemail i felt a bit silly and sheepish, but her message, which addressed all the questions, made me feel not foolish at all. that's awesome.

i saw a little note by leanne's side of the bed this morning to get little bendy straws for me -- "so that i can get my liquids"! it's a little odd to be expected to be an invalid!

it's been the most decorated valentine's day i can remember. we received valentines from everyone from my parents to delancy street movers! die familie enders sent along a lovey hand-made valentine. and leanne-- leanne got me the spicy dark chocolates i craved from donnelly in santa cruz. in fact, she requested them from richard directly! jane siberry wrote with global wishes of healing and light; then there was the 50th anniversary gala for del and phyllis last night - a sweet movie and a drink afterwards with sylvia and karin. all-in-all, a great week, even if leanne and eve were looking at me as if i'm about to be devastated. i feel we're in great hands; the world itself should be so lucky -- but is left this week to rely upon duct tape and plastic.

leanne just walked in with a package decorated in glitter that says: "healing beauty for moya's left breast"!!!

package from mom

questions for dr grissom

• why did you recommend me to read susan love's chaper on DCIS -- are you thinking there's more of a chance i'll have it?
• do calcifications, if benign, ever disappear, or are they permanent?
• how does the biopsy affect future mammograms? does it itself leave calcifications? how many additional biopsies can i look forward to in the future - how can i tell when to need to biopsy any calcification that remains?
• what affect does having a biopsy have on breastfeeding?
• what can i do in advance to prepare my skin?
  • is it true if you coat your skin all week in advance with olive oil the scars will be minimized?
• where are my scars going to be?
• what bras do you recommend as most comfortable while the incisions heal
• how will you contact me with the results? cell?
• how is the biopsy day scheduled? (how much idle time can i expect to wait, and when)
• thanks to komen.org, "If cancer is found, who will tell me the results and discuss treatment options? How soon do I need to make a decision on treatment choice? Where can I get more information?"
• what happens to the tissue you remove?
  • after you are finished with cloning me, can you save the leftovers in a tissue bank?

susan love says they're trying to encourage the use of tissue banks for future research on my own little tissues. eve says they look like sushi. mmm.

of course, since it is five a.m., i had just awoken from a dream. in it, several people i know are suddenly getting mammograms and biopsies. in my dream, though, i knew i was somehow 'special' amongst them - and there it is, my fear of cancer. so all the questions stack up from my 'bedtime reading' - a mere five hours ago - of dr susan love's tome, and i must excise them and biopsy them themselves before i can safely return to sleep.

obviously, i need different bedtime reading.

post from email

lisa

and lisa wrote to leanne with some good information:

... So sorry to hear of Moya's up coming surgery. It is horrifying
and depressing no matter what your odds are going in. I actually had 2
surgerys. The first in April 1999, then had the same open surgery on
the other breast in April 2001. The first time there was just one "fibro
adenoma" ( benign fibrous tumor) removed the second they removed 5. Of
course they did not know that they were fibro adenomoas until the
pathology came back. I had a great  breast surgeon as well, one of the
top in the field. The surgeries went great. They used conscious
sedation instead of general anesthetic, which means a quicker recovery as you
are not as deeply sedated. The pain was very minimal for me, only took a
couple of vicodin with the second surgery. With the first I tried to
take ibuprofen, which is my pain reliever of choice. But oops, also a blood
thinner, so needless to say I panicked when I began gushing blood from
my dressing. I also had a really hard time healing. Throughout both
procedures we found out the hard way that I am allergic to every type
of suture material. So my breasts kept filling up with blood and fluid,
then it would force the stitches out of my breast. I had to go in every
couple of days for 2 weeks after both surgeries to have fluid drained off with
a needle. Dr. Johnson and her collegues were very impressed with the way
my body was just spitting out the sutures. They were supposed to
dissolve, but no way. My scars are not noticable, she made the incision just
along the aereola, so scarring was not an issue, I just used vitamin e oil
for a month or so after I finally healed. The hospital will give her an
ice bag. Just remember that ice to any area of the body for over 30
minutes at a time can cause rebound swelling = pain. So break from the ice
every 30 minutes or so.



I am sure that Moya will get through this fine, but probably not without
preceeded anxiety and fear. I am certain that you will pamper her
throughout her recovery. The waiting for the results of mammograms,
ultrasounds and pathology was much harder on me than the surgery
itself. I will be thinking of her in the next couple of weeks and will be
sending thoughts of benign results her way...

note for leanne:

"I am certain that you will pamper her
throughout her recovery." 

ted

ted sent some sweet words last week:

I heard from your woman about the surgery. I know two (2) women down 
here who have had similar procedures with very little fuss or muss, so I 
hope you are not troubling your pretty little head about it too much. 
Magnificent breasts such as yours require periodic maintenance, like a 
powerful yet temperamental Jaguar coupe, it is all to be expected.

is there any doubt his book will be a great success?

to babble or not to babble

rudy says he thinks a breast scar would look sexy!

i've been thinking a lot about leanne's comments. for the record, i don't think this is *not* a big deal. but it doesn't seem as much in my character to worry about the things that *are* happening. seems i'm much more comfortable dwelling upon all those things that aren't happening but that might happen given any set of bizarre, tragic, and/or esoteric circumstances. just visit me before i fly to know this. or ask my mom and dad about my sheer terror over the toaster those nights in sacramento. just like ruth reichl, which i might say with just a hint of pride, i sometimes panic before the bay bridge and need to visualize atlas holding it up just to cross it. but when it all comes down to it and i finally get on that bloody plane, i tend to be quite calm (ok... so there's valium to blame too).

so i'm not as anxious as i was - in particular - in the long days after i got that first letter last july. the letter was so naggingly vague, and made clear that i could do absolutely nothing until i scored the next appointment for a mammogram. i had no idea what they noticed going on in my breasts, hanging like two dark and mysterious orbs. i feared it was something really bad.

but now, it's like light shining into my left breast. i feel an idea of what might be going on inside, and have an appointment to find out for certain. and i am promised a brand not unlike valium for a 'monitored' anesthesia. i have met the surgeon and she has looked directly in my eyes. i feel like she's seen every kind of thing moving into this gigantic and growing circle, this non-exclusive club of people to whom calcifications and biopsy have happened. the more i talk about it, the more women say "me too" or "my friend so-and-so" -- nobody DOESN'T seem to know someone with this. i'm not alone. and there's eve, who's water glass i must have drunk out of. and there's leanne, taking notes on the whole thing. so there's company.

also, and this might sound strange, but i like the attention. a biopsy - as validation (?!). and i feel taken care of.
or at least terribly common.

so i realize these might be illusions just the same, but they're a better reality than i could otherwise dream up.

now that i've made the flight analogy, i've been lost combing through my old posts and my babbling capacity for psychofear, but again, about those things that aren't happening (yet). and yet, yet i do distinctly remember walking up a hill in sf in june or in august 2001, looking at the skyline, and being terrorized by the hallucination of a plane crashing into it.
and what am i doing up so early on a Sunday!

thoughts from leanne

a few thoughts from leanne who loves moya and her breasts but not just for her breasts :)

i get anxious and sad and nervous and fearful about *s-u-r-g-e-r-y* (such an ominous word though it seems like it'll be such a minor event) for biopsy and anxious about the results and glad that there's something being done to better define the calcifications. isn't it ironic that they're called "calcifications" and the thing my bones lack are enough calcium and here moya has extra calcifications. okay so calcium for bones isn't the same as calcifications.

i hear from and talk with all these people who think it's not that big of a deal to have your breast sliced into in two places and it's oh-so-common and happens all the time and you go back to work the next day and ... well ... never happened to me before so it feels oh-so-uncommon to me and i think it's a big deal. i feel like i'm having some overly dramatic emotional reaction. i'm struck by something to do with loss. perhaps the loss of a few grams of body tissue? or the loss of certainty of health (not that certainty really exists)? that we're healthy until proven otherwise.

i'm also grossed out by the description in dr susan love's breast book of making an incision and digging through tissue to get the calcifications out and all those stitches (and, oy, the picture of pulling tissue out makes me nauseous -- and i don't need any more nausea these days).

i know the anxiety is not at all rational and logical and doesn't take into account the facts and information about the probable results of the biopsy -- that dr grissom is extremely talented and experienced; and that it's fabulous these are found early and can be removed instead of waiting for lumps and bumps; and it happens to 20% of gals; and "they" (the experts) know a lot about what to do even with uncertainty about what to do; and, being a stats geek, i know that 90% benign is really superduper high odds, and, anyways, i get weepy over the thought of a surgeon slicing pieces out of moya.

dr. nima grissom

i went to see the breast surgeon today. it's great to have the first appointment of the day, when you don't have to wait and you feel you're the only one your doctor needs to deal with at all. for nima grissom, that is certainly not the case. she must be one of the busiest surgeons in the world; she must see tons of breasts every day. maybe literally! i understand she is a "diplomate". i wonder what it's like to be a breast diplomate.

leanne came with me; we were whisked almost immediately into the exam room by the receptionist who wore surgical gloves (i tried not to let that make me feel infected). for fashion, dr grissom's office gives you little short halter-top smocks, open in the front of course. i looked like a cross between some bad britney wannabe and a football player. i asked leanne to take notes, and said immediately that i wanted the fashion commentary in the logs.

dr grissom arrived right away and was noticeably better dressed. there was no surgical gown or white smock. there was a comforting thick navy cardigan. it was cold. i was hot. she was direct and yet attentive. i had a quick lie-down on the table, quick breast exam, then i got to say goodbye to the halter top and get back into italian polyester as she addressed what to do about my left breast.

to the point: my calcifications are very small, and she recommended "stereotactic needle-localized biopsy". here are some of leanne's notes - in their fairly raw form - about what dr grissom said:

• calcifications are quite common: 20% of all women
• of those 20%, 10% are malignant but not necessarily invasive (DCIS)
• my calcifications are too faint to biopsy with the 'computer version' of biopsy
• stereotactic, open surgical biopsy:
  • do in xray
  • under sedation
  • pinpoint and remove in strips with needle
  • is most accurate
  • normal duct doesn't have dead cells in center
  • take out piece of tissue to look at
  • littlest chance to miss
  • can't see or feel - rely on needle placement from xray
  • an xray after will immediately check what was removed to make sure it has the calcifications in it
  • the majority are benign
  • a mammogram thereafter in 1 year might still have calcifications - not a big deal
  • just a little sedation, not general anaesthesia

it strikes me today that i felt like i received a lot of information, in a short time, while feeling listened-to at the same time. that's an excellent quality: to pay attention while talking. dr grissom expained things in a very attentive way, looking directly at me, being clear and level but with a good sense of humor in spite of my interruptions with awkward jokes. obviously quite experienced yet accessible, happy to answer questions and to plow through my pile of research from the Internet, even writing notes for me on my papers. i hauled out my chart from imaginis.com - link quoted in below entry. she explained that this was the same as the "open surgical biopsy" last on the list at that link. that link definitely does not put this procedure in a good light, yet dr. grissom scoffed at the "golf ball" sized description and "two-inch" incisions. it takes me aback slightly that there will be two incisions (one for each area of calcification), and that there will be about a half-inch "permanent scar" for each, yet contrary to the imaginis document, it will not make future mammograms difficult to read, says she. dr grissom also assured me that there will not be any divets left in my breasts. in additon, she went over the reasons for making incisions as close to the sites as possible. it's clear she's done this kind of thing before...

the thing to rule out is this DCIS. ductal carcinoma 'in situ'. it again makes me feel special to speak latin. i understand that the 'in situ' - if that is the case - is the important part about it. the upside is the highest rate of certainty in the results. the additional if ironic upside for me is the sedation. i think it's better i do these sorts of things under sedation. i tend to faint at the sight of any needle, so i might as well be sleepy already and lying down. i'm only concerned what sorts of babbling i might do under sedation. i hear it can be quite embarassing...

dr. mulder says it's not surprising dr grissom opted for the needle localization since she's known for getting quite "to the point" as soon as possible about biopsy. she's glad dr grissom opted for that course of action. the results will be the most conclusive and convincing.

the date is set for friday, february 21. in advance, dr grissom recommended, like nearly everybody else i've ever met to speak about breasts, dr. susan love's breast book. she says i should read the part about calcifications and DCIS, and skip the others, and she doesn't even know i'm a hypochondriac. i have lots to learn and understand in the next two weeks. perhaps most understandably, dr grissom's day is nearly empty next friday, on february 14th -- i suppose it's not everybody's idea of a good valentine's date. i would have just as soon done it then, but this sort of biopsy is meant to be no rush, and i have myself booked in the "bw reporting and analysis" class all week next week anyway. i know, i'm the envy of my block with that one.

on the way out, a peculiar lite-rock version of "freebird" was playing on the office radio. as leanne left, she was weeping in advance for the scars in my breasts. i hadn't really considered that yet. from what i understand, this is the best way to be 100% certain and early, which is the best way to preserve my breasts and me entirely, so i hope she loves them just the same! when i got home from work tonight, dr susan love's breast book was waiting on the couch.

my first mammogram

it started last year, i think in early june, when i was once again insured with a yet-a-different health insurance company - several in the last few years (a ramification of changing jobs) - and though it was time for that annual pap, the insurance flavor of the month, Cigna, did not support UCSF and my pap doctor for years!

frustrated, i wrestled to overcome the beginning of the 'health' phase of temptation towards overwhelmance, and did what i always do these days when i don't know how to find something - i got on the Web. after a few choice keywords sent to google, i found dr. madelyn kahn.

weeding through comments from google summaries like "Madelyn Kahn's characters name was Eunice ..." (a misspelling, it should be pointed out) i found the real Madelyn Kahn MD was praised by the Wellesley Club, rang a bell from a recommendation from a friend in the past, and came endorsed by BA-Sappho with stuff like:

> who is accepting new non-pregnant patients. ([ so and so ] and Dr. Madlyn
> Kahn both came recommended, but I can't get in to see them.) I checked the
...
> Too bad about Dr. Kahn as she's great.

so i forged ahead, got on the phone, disregarded the setback of weeks of a wait, and secured an appointment (a feat not unlike winning the lottery, i think) for sometime in early July.

Dr. Kahn is in fact great. feisty and to the point. she allowed a large swath of time with me at my first visit. she sat me down in her office across from her on the other edge of her big desk and listened and talked and talked and talked. i wished i had a tape recorder, there was so much information about this and that and the other that i wanted to capture. we talked about pregnancy; she told me about freezing my embryos; then there was the question - had i had a mammogram. i had not.

"Lesbians are at higher risk for breast cancer." she talked about the recommended age with certain "risks" (turns out now they say it's a risk to not have a baby early), and bloody-well shoved me off to my very first mammogram, at 38, thankyou very much.

it should also be pointed out that my mother had been encouraging me to get an early baseline mammogram for years.

my very first mammogram was then scheduled for July 19, 2002. it was all supposed to be routine, i thought, and it was till i got the letter a few days later.

i arrived characteristically early at the facility at CPMC - up on California street, just across the street from where we brought Nooka on her last day to the fabulous people at the Presidio Way vet clinic. for my very first deal with mammography, the waiting room was packed. there weren't enough seats. clearly, this was a big business. clearly, there are a lot of people getting news of different kinds. mostly good; some not so. i attempted to breathe deeply and pretend to casually read the paper, which lost my interest nearly immediately. i saw some people go one way down the hall when their names were called, some go another. i thought it some kind of sign or prognosis. i tried not to think that.

the whole thing wasn't that bad. you get called in a group of a couple people and walk together to the changing room, really another stage of waiting room. you get a smock and go into one of two rooms to strip from the waist up. you have a locker in there and feel like you're almost going off for a spa day. there's an odd assembly of what look like metal ball-bearings taped to the walls between the lockers, strategically between the words on the signs telling us what to do with our smocks afterwards. i noticed that some people come back in the room with their "spa"-gowns on, but don't get dressed right away. usually in a few minutes someone comes in and sings or yells or overly loudly indicates "mz so and so, you can get dressed and go now!" and everybody thinks it's a happy thing. i wonder who doesn't get to go.

after another wait in the "spa-waiting-room," i was taken into the room with the big machines. it was dim - the blinds were drawn - and there were different machines i didn't understand. i stood in the middle next to the standing machine. a bee-bee got taped to my nipple - to point out where it is on the film later (and perhaps be taped to a wall before dressing!) - and then the tech started to manipulate my breasts two glass shelves. the shelves are raised or lowered like a dentist's chair. they also pivot around from horizontal to vertical, to get two different dimensions of your breasts. she then squeezed the shelves together, and there we have a breast sandwich. for me, it didn't hurt at all.

"reach around with your arm and hold on here; take one deep breath and hold,breathe out; take another deep breath and hold, breathe out; now take a breath and hold it" she disappeared behind the other side of the machine and there was a beep. she emerged and i exhaled.

one or two more angles were taken, and i got to go back to the "spa-waiting-room," but not dress again. eventually the tech came by and sang that i could get dressed and go now, and i figured that was a good sign and that the whole thing was over for a year.

my second mammogram

the whole thing was in fact not over for the year. a few days later, around july 23rd, i got a letter in the mail that said:

... We do not need to repeat the mammograms already done, but we will
need some additional special mammogram views and/or ultrasound tests
in order to complete our evaluation.  This should not cause you alarm or
undue concern but should be completed within the next month ... 
Many women receiving our request to return are understandably concerned
that we might have found a breast cancer.  This is, in fact, very infrequent 
(4 cancers per 1,000 mammograms)..."

so then i knew that i was, at least in some way, "special" and was going to get a "special" view. the letter, frustratingly if not understandably short on detail, did contain one tiny code at the bottom that caught my eye:

"BIRADS 0"

so along with my not-undue-concern in tow, on to the Internet i went again, giving me a new vocabulary for "BIRADS" but not necessarily helping me real insight or - certainly - calm. BIRADS - or "Breast Imaging Reporting and Data System" - ranks your mammogram from tame to quite bad (in my simplified view), 1 to 5 respectively. what's zero, then? google summarizes: "BIRADS 0 - the Abnormal Screening Mammogram". other google summaries were more disquieting, lumping the zero together with the bad 4 and 5: "... 112 cases had visible signs of breast cancer that a majority of the 5 panel radiologists deemed 'actionable' (ie, assessed as BIRADS 0,4 or 5). " i was getting deep into Internet speculation and it was doing me no good.

i called eve. Eve Harris is an excellent resource and fine person at that. she's intimately familiar with this whole deal, and also works in PR with breast cancer at UCSF. she wasn't pleased for me. the next day as soon as the office would take my call, i got on the phone, and got myself another mammogram - August 1st, 7:45 am.

i called dr. mulder. caroline mulder, my (kickass) therapist, m.d., told me the good thing about it is that when you go back for these "diagnostic mammograms" (the regular annual ones - my first mammogram - are called "screening" mamograms), they read the results right away, and you don't leave the office without hearing them.

august first was a friday; leanne came with me. we were at CPMC's breast health center before most anyone else. people weren't there and the elevators weren't working yet. we couldn't find any stairs. the appointment said come "15 minutes early," but i guess that doesn't work if you're first in line. much less crowded in the waiting rooms (read: empty), it was well worth the foggy cold early awakening.

when i was called from the "spa-waiting-room" and taken to the same machine, i was told that there were tiny white dots found in my left breast called "breast calcifications," and was given the pink pamphlet. the woman checked to be sure i'd had no anti-perspirant or powder before, and reassured me this didn't come from cheese or milk. i should still eat the tons of cheese i eat. thanks be to god! they were going to 'blow up' a picture of my left breast to get a better look. we did the "breathe in, hold it" drill for a bit, and i was sent back to the waiting room.

this time, i was asked back from the "spa-waiting-room" in my smock. we took some more pictures. seems they were finding the tiny white dots ok on the side view, but couldn't find them on the front view. she tried a few more blow-ups. i was sent back to the room. finally i could get dressed, and i sat down and waited again with leanne.

things were heating up now, and the waiting room, empty when i came in, was now buzzing. i wondered (of course) if there was some dire reason it was taking so long to find out results. after all that time (i forget how much), i was finally summoned - this time, leanne allowed with me - to the room with the white lightboxes on the wall and the black-and-whites of amplified breast tissue. i was taken to my mug shots and introduced to r. jacobs m.d. this man was quite busy. almost immediately after he started talking to me, a woman came in and hovered near us, trying to tell him he had to go somewhere else. i was fairly calm and trying to understand what he was saying. i only later grew resentful, moreso in hindsight with myself for letting the woman let the man need to go right away. he wound up spending about three minutes with me discussing the films, and telling me the result was i should just come back in 6 months.

"it's something we nearly wish we hadn't found", he said, "see these tiny white dots, in two separate areas? they're probably nothing to worry about -- most probably benign -- 98% probably -- and we're not too concerned about them for three reasons: not irregularly shaped, not lining up like protesters on their way to the lymph nodes (of course only my memory paints it this way), and we can't find them anyway on the front view." that last bit wasn't so reassuring to me. before he was whisked out, i managed to ask if it made a difference, the six-month wait, if they were really 'bad things' instead of benign? he said no, on his way out the door now, mortality rates were unaffected. i could stay as long as i wanted to look at my mammograms. great.

leanne and i stood there a bit, trying to get as much wisdom as we could from my breast photographs. it looked like something on the upper-right, and on the lower-left. it looked like black and white pictures of fibrous goo, with white dots every now and then in just a couple of places- most of which were pieces of dirt on the film. i wish i could have gifs or jpgs of them now to post here and to look at... finally we left. i had another pink piece of paper, checkboxed as follows:

 "Probably Benign Findings; follow up mammography recommended:  
left breast, 6 months".

then, on august 9th, i went to my twenty year highschool reunion.

cigna's records for me for that day tell me it cost:

"x-ray  177.96  100% covered"
"radiologist  72.00  100% covered" 

thank goodness for that!

my third mammogram

six months after august 1, 2002, fell for me last friday, on january 31st. once again i chose the first appointment, 7:45, and once again leanne accompanied me. it was a fogstorm out in the richmond. we've been on a non-coffee kick. we were cold.

something was wrong; i sat in the 'spa-waiting-room' for over a half an hour - people filled into almost every chair now, waiting lists for the lockers - and the tech came in and addressed me: "i apologize, i have a problem or process i have to correct, we're short-staffed, it'll be a little longer to wait". i was really trying not to get irritated, but it wasn't working, because that waiting and sitting before a mammogram is a particular kind of anxiety that even the benign chronicle can't appease. i asked, in as low a voice i could muster, how long it would be. maybe 20 additional minutes. but i was the first appointment slot - the second to arrive - i said. she knew. she was going to correct her problem or process. i tried to stay kind. the chronicle crossword was too bloody frusterating. the news of bush and war and iraq was annoying. i waited another half hour. i got my jacket on - as much for something to do and fidget with as for to bear me more warmth. the fogstorm obscured california street out the window. i tried to entertain myself with the idea that they had discovered something special about me and what they really were wanting to do was to clone me into several people - perhaps whole colonies on a distant planet.

leanne, meanwhile, had finished reading all of the articles in the chronicle and was thoroughly engrossed in some sort of periodical.

i went in and out of the "spa waiting room" several times, feeling quite photogenic by then, but this time the result was they either got better films, or something was becoming clearer. s. denny, m.d., was calmer and more accessible and thankfully was not being dragged out of the whiteboard room as dr. jacobs was the last time i got to discuss my mamm's. i was grateful when she said they were recommending biopsy - i thought that would put a definitive form of punctuation on the six-months, and particularly the last hour, of waiting. my checkmark on my pink piece of paper moved down a box:

Findings requiring further evaluation by breast biopsy:  
calcium deposits, L

dr. denny told me it was 94% certain that these calcifications were benign. we wanted 100%, she said. i thought that was a good idea. but my certainty, after all, had slipped four percent.

so you go back to your doctor to get a recommendation for a surgeon at points like this. this is where i started to feel like a project manager, like it was a product to ship at work - or rather like i wished this project had a project manager. fortunately, i now had a cellphone, and while i was waiting for dr. kahn to return my call, i could walk about freely at work, as if i wasn't waiting .... and waiting ...... for five hours, at all. as if nothing in particular was on my mind.

she was efficient and straightforward. she commiserated that this should happen to me with "my first one". she gave me the name of Dr. Nima Grissom, said she was an excellent breast surgeon, and that she wouldn't send anyone to anybody else.

i called dr. grissom's office, but was told there was no appointment till the end of february and i probably wanted something sooner than that - which i hadn't realized i did - after six months of 'wait and see' - did i? - and was dispatched directly to the doctor's voicemail. "i was referred... dr kahn... mammogram, calcifications, end of february, my contact numbers, etc etc etc" it was all i could do not to leave my email, my website, my weblog.

nothing by the end of friday. the weekend was going to have to be in limbo. the sort of prelimbo limbo. i called my mom and dad and they started to worry. leanne started to worry. everything becomes bizarre, like a badly-written movie. i start to not feel funny or easy or just merely taken as-is anymore. people at work make fun of my clothes. i become paranoid. others must be in on the cloning.

so this morning, i called dr. kahn's office again. the receptionist told me to demand an appointment, saying it's an emergency, and that made me feel more "special". so i called dr. grissom's office back and immediately got an appointment on february 18th, without even needing to demand. such an arbitrary turn of a phone call. this would be the 'pre-appointment' appointment - in other words, you come and meet and get looked at, then you get an appointment set for a biopsy --- of what sort, i know not. i know not even if she will perhaps recommend something else. but at least it's in motion.

eve wrote us about what it's like to have a biopsy (nothing ice or a bag of frozen peas couldn't cure), and of course, i hit the Internet. some particularly pretty pictures at http://imaginis.com/breasthealth/biopsy/biopsy_methods.asp seem to lay out the possibilities pretty well, though i'm not sure what i think about that wine cork one. i start to wonder what kind of questions i should ask. it's like a test at school or an interview for a job -- i want to be sure i do the right things -- me.

dr. mulder called to say dr. grissom was the best in the field. it could very well take a few weeks to be seen. i should keep her appraised.

but this afternoon, i received a phone call from dr. grissom's office, probably now following up on friday's voicemail: "dr. grissom would like to see you this wednesday, at 8:30 a.m." wheeee - i'd won the lottery, again! it's a relief to be "in" sooner rather than later. but what kind of prize awaits me? ...