I heard the phone ring but I was running out the door so I didn't answer it. No worries, business phone. It's a University holiday, I'll catch them later. I didn't think about the missed call again until I was in my office the next day and saw the message light blinking. "This is Anne at Kaiser, you came for a mammogram yesterday. The radiologist wants to get more pictures of your left breast, please give me a call." She called at 1 pm Thursday. I got the message on Friday, New Years Eve. I rushed to the phone to call them, as if I might catch them before they rushed out the door for the holiday. No answer at the 3 numbers she gave me. That meant I needed to wait 3 days to reach them. At that very moment it occurred to me, I have a choice. I could get myself pretty worked up; after all I could have breast cancer. Or I could decide that I will wait and see how this plays out. I took a deep breath.
Within minutes my husband came home from his yoga class. As I went to the door to greet him I noticed my hands were shaking. I tried to act normal. I asked him about class but he could hear it in my voice, something was wrong. He asked, "What is wrong?" We've been married 16 years, we are best friends, and I can't hide anything from him. I told him about the phone call from Kaiser and the need to wait until Monday for more information. He got a worried look on his face.
Over the next few days I couldn't help but "go there". What did they find? Were they just bad pictures or did they see a mass? What if I have cancer? What will they want to do next? I decided it was not worth it to keep on this train of thought; it really didn't help. I would just try and enjoy the New Year's holiday. But throughout out the weekend I found myself having crazy thoughts. One morning I was brushing my hair and all of the sudden I thought "I wonder if I will need to cut my hair really short because many women do that before that get chemotherapy." A couple of years ago an NP colleague of mine died of breast cancer. Like many women, I have friends and family members who are survivors, will this be my path too? "You're crazy", I told myself! "Why are you thinking like this?" In my limited Buddhist training, I know the importance of being in the present moment and how unhealthful it can be to be stuck in futuristic thinking. I tried again to ground myself in the present moment.
Later in the weekend my feelings turned from anxiety to anger. "Why did they call me on my office phone? How irresponsible during a holiday week. They never call me on that phone." Then I thought about my experience as a health care provider, have I ever left a message for a patient on the wrong phone? Did I leave enough information about why I was calling or maybe too much information? Perhaps there is a lesson in this experience for me as a provider.
My husband and I carefully made our way through the rest of the weekend trying to avoid the many questions we wanted to ask each other; all of them beginning with "what if...?" Thankfully my husband reassured me that we were going to get through this together. I was very grateful; it's hard not to feel all alone under those circumstances.
Monday morning I was relatively calm when Kaiser called. We were able to schedule a diagnostic mammogram and an ultrasound appointment for the very next morning. I was relieved that I could get in that quickly! I asked her what the results of my mammogram were and she told me I would need to either email or call my primary care provider or Ob/Gyn. I knew that the chances of reaching them by the next morning were very slim. I needed to be patient. Not my strong suit!
Tuesday morning my husband and I got in the car and drove to Kaiser. I had told him that he didn't need to cancel his meetings to go with me but I think he knew that I really didn't mean it, I needed him there. He had assured me he was going to be with me no matter what. In the car I reviewed with him how I thought things would go. "If the diagnostic mammogram shows a mass I will go to ultrasound. If the ultrasound does not rule out a cyst, I will need a biopsy." I was doing my best to prepare for anything and everything that could happen. But could I really do that?
We arrived for the appointment so early that we needed to wait for what seemed like hours to be seen. I still did not know the results of my mammogram. Then it occurred to me that the answer might be contained in the paperwork that they had given me for the radiologist. There it was, "6.5 cm from left nipple 2.5 cm mass, ?cyst". OK, that is why I am here, they found a mass. Breathe.
Suddenly I was quickly whisked off to the mammogram room. I was told to undress before I had a chance to tell them I had a question. I reluctantly undressed and waited for the tech. When she came back I told her I had a question about whether I should get the diagnostic mammogram at this time of my cycle when my breasts were very lumpy. There was an edge to my voice, I was clearly anxious and trying to gain some control of the situation. Again, I can't help but think of the many patients that I take care of that appear angry but are really feeling anxious about their tests. She went and got the radiologist. The radiologist told me that there was no research evidence that the time of the cycle influenced the quality of the pictures. On the other hand, I could wait to have the mammogram if I wanted to. Trying to align myself with the UCSF evidence-based clinician I profess to be, I chose to have the mammogram. After the pictures were processed the radiologist went over them with me. She showed me that one view looked normal and the other view showed something that looked like the edge of a mass. The next step was the ultrasound. I asked her if I would need to have a biopsy if they found something on the sonogram. She said, "it all depends on what they see, I can't tell you that". She sounded defensive; she clearly didn't want to discuss it with me. I remembered by Buddhist teaching again, "be in the present".
I dressed and waited again for the ultrasound. I reviewed with my husband what I had been told and we tried to pass the time with chit chat. Finally, they called me for the ultrasound. Fortunately my husband was allowed to go with me. The ultrasound tech found the mass right away. I looked over at the picture nervous about what I was going to see. In true clinician form I turned to my husband and said, "see, the borders are very well circumscribed, I think it is a cyst". Then the radiologist came in and she looked at the picture, "looks like you have a cyst", I exhaled, "but I want to take a look myself to be sure". I held my breath. Then she told us it was a benign cyst. We were so relieved. What a blessing!
So often when we get good news like this we sigh with relief, let go of the experience and quickly move on with our lives. That really seems easiest. But I wonder if I can hold on to this experience and learn from it. Can I savor the gratitude that I feel right now? Can I carry with me the empathy that I feel right now for the other women (including my patients) who have gone through experiences like this? Although I did not receive a life threatening diagnosis of breast cancer, perhaps this experience will instill in me some important lessons that make me a better health care provider and human being. It's all about the journey, right?
