An Unexpected Turn on the Path of Life

I've always loved September. And not just because it's my birthday month. I love the cooler temperatures, the softer light, the purple asters blooming alongside the goldenrod. The preciousness of the last days of summer, and the turn to autumn.

A few years ago, I delayed the second half of a sabbatical so I could take it in 2021, the year of my 60th birthday. Over the past 20 years, I've often been teaching on my birthday. I've never had a sabbatical in the fall because I've arranged them around the course I taught for so many years, HLTH 101, the Social Determinants of Health, which is always in the fall. I imagined using my sabbatical to write up a couple of overdue manuscripts, start a new project, and taking some extra time for long walks in the golden September sun.

But September 2021 didn't turn out anything like I'd imagined.

On the day before my 60th birthday, I was officially diagnosed with breast cancer.

By that point, I had already had a screening mammogram (July), a diagnostic mammogram (late August), breast ultrasound (late August) and biopsy (early September). The mammogram and ultrasound showed two tumours in the left breast, a small one that the biopsy showed was "in situ" and a larger one that is "invasive" - had already started to grow into the other tissues - stage 2 on biopsy. The larger tumour was found to be "spiculated" - a spicule being a "spike." Most of the time, when a mass in the breast is spiculated, it is malignant. I like the word "spiculated" much more than "malignant." Spiculated reminds me of a star.

If I didn't know what it was, I might think it was kinda cute.

I like that my friend doodled on it. Made it less scary.

When my family doctor phoned on September 13th to tell me the results of the biopsy, she had trouble finding it because it was misfiled, so she was flustered. And then she read it as it was written:

- Invasive ductal carcinoma

- Ductal carcinoma in situ (DCIS)

Though I wrote "invasive" in my journal, my mind grasped onto "DCIS" - the earliest form of breast cancer - and I ignored the rest. I couldn't understand why my family doctor said how sorry she was about the news. It seemed like GREAT news to me! It didn't occur to me that she was reporting on the two masses and I had only taken in the news about one. I thought I must have misheard "invasive." (Fascinating how our minds don't want to take in bad news.) And even though I had signed up for "Pocket Health" so I could get the results myself, I couldn't find the biopsy results (I found them later in an addendum under the ultrasound report).

I only really got the full news on 16 September, when I spent an hour with the nurse navigator, Logan, from the surgeon's office. Logan went through all the reports with me, carefully, slowly, patiently. I was so grateful that I didn't have to hear the news about the invasive carcinoma at the surgeon's appointment the next morning on 17 September.

For anyone who is interested, the tumours are estrogen receptor positive, progesterone receptor positive, HER2 negative. This has implications for endocrine treatments down the road. As it turns out, breast cancer is not a single thing anymore.

The surgeon I saw, Dr. Ross Walker, was kind, to-the-point, with a dry sense of humour. He held my gaze when he spoke, which I appreciated. When I called the examining table "a throne," he quipped that most people think of it as a torture table.

Dr. Walker ordered a breast MRI and genetic counselling. My family doc had already put me in the queue for genetic counselling when she first met me 2 years ago, but it hadn't happened, mostly because of COVID. My Dad, his brother, and his sister all had had breast cancer in their 40s; his sister died of breast cancer in her early 50s, though my dad is still with us, at 83. I had wanted to imagine that I didn't need the genetic testing because I hadn't developed breast cancer in my 40s.

The genetic testing requires only a bit of blood. And then several weeks to process and analyze it. The "expedited" process for which I'm eligible takes about 4 weeks, which means I won't have those results until end of October or early November.

The breast MRI was my least favourite test so far in terms of the process. It was the first time I'd had an MRI, and I found the different loud noises and bodily sensations quite disconcerting. For a breast MRI, you lay flat on the table that has an opening that allows your breasts to dangle. I found the pressure on my sternum and diaphragm quite uncomfortable, especially because I had to lie still for 25 minutes. The technicians put an IV in my arm to insert gadolinium, a contrast dye. They were harried, behind schedule, and didn't explain much. When I expressed concern that I was feeling light-headed afterward, one told me that "the magnets play with your water molecules."

The MRI imaging is very detailed! Pocket Health gives me access to literally hundreds of 3D images.

But it seems that one of the downsides of MRIs is that they pick up things that look suspicious but turn out not to be. In my case, the MRI picked up a 1 cm mass in the right breast, near the chest wall. So I got referred for another ultrasound, this time on the right side.

The ultrasound technician, Agnes, thought the only thing she could find, a cyst, didn't correspond with the position of the mass found on the MRI. That seemed the worst possible outcome: a mass, in hiding. But in the end, the radiologist decided that the 8 x 3 x 9 ovoid nodule was "favoured to correspond to the MRI finding" with "sonograhically benign imaging characteristics."

Well, that's good news!

I hope Dr. Walker and I will develop a treatment plan on Tuesday, when I see him next.