Let’s backtrack for a quick minute.
I’m at the breast surgeon’s office. I’ve had my mammogram, ultrasound, and bone density test at a brand-new center, and they referred me upstairs to the third floor to meet the breast surgeon. I’m not sure why I need to meet the breast surgeon if I have calcifications on the lower left side. I don’t know what any of this means.
I’m speaking with the doctor’s nurse, a nice lady named Elaine with pretty hair.
She was arranging an appointment for a needle biopsy to be performed the following week. I asked if I would have the appointment on a Wednesday, since I have started taking that day off. My original intention of taking that day off was when I realized that I was approaching retirement age and I wanted to ease myself out of the work system. I had that thought back in December 2020 while I was sitting in the dermatologist’s office waiting for my lupus appointment with the PA, a nice lady named Beth.
Elaine left the room to make the appointment, and when she returned, she said that she was able to get a Wednesday appointment at 9:20AM, but it would be in Beaufort. Needle biopsies at the new center were on Tuesdays and Thursdays, so it looks like I’m going to Beaufort the following week. Then I realized that the following Wednesday was the same day I had an appointment with the dermatology PA, an appointment that I had made back in December 2020. I decided to change the dermatology appointment, but I needed to keep it soon because I was almost out of Plaquenil and the refill required a doctor’s authorization. That appointment was in the afternoon, but I’m not sure that I can go from a needle biopsy appointment in the morning to a dermatology appointment in the afternoon at 1:15. I might be feeling under the weather by the afternoon.
Elaine gave me a sheet of instructions. She said that I could eat a light breakfast the morning of the biopsy. No aspirin or other pain relievers besides acetaminophen, because we don’t want to promote bleeding. She made sure to write her name and phone number on the instruction sheet.
On the way home, I call the dermatology office and ask to reschedule my appointment. The earliest appointment was for a month out, and I don’t need to go 1 month without Plaquenil. Even though I know the appointment is going to be a follow-up and take about 15 minutes from start to finish, there are no openings. I ask to be put on a waiting list, and was told that they don’t have a waiting list and that I have to keep calling back to ask if there is an opening.
Now, don’t even get me started on how inefficient it is for an office to not have a waiting list. All large modern medical offices use up-to-date electronic programs that are internet-based or networked with their other offices. You click a button on the appointment screen to add someone to a waiting list. Boom, it’s done. All the manpower and time and annoyance of your patients calling to ask if there are openings available is avoided. So I decided to drive in to the dermatology office since it’s on the way home and present myself front and center.
I received the same exact treatment at the office. Granted, the young receptionist looked terrified and helpless. She checked with the woman next to her to see if there was something they could do so that I could be seen sooner. I asked for a waiting list. Nope. I asked for a telehealth exam. Nope. I asked for another appointment in the near future. Nope. I asked to leave a message for the PA. Nope. I even said sotto voce “I am having a needle biopsy that morning” in the hopes that could shake something loose on the schedule, but it didn’t so I left.
*****
Leslie and I had a discussion about whether he should go or not. I said no. He said yes. I said that we could be gone all day, and that could be hard on his schedule. He said he was going.
The day dawned and we went off to Beaufort. Elaine had told me to eat a light breakfast and to take my usual meds, but not to take any meds that would promote bleeding. She said to make sure I ate something because they wouldn’t want me to pass out. I thought that was a strange statement. Maybe she thought my blood sugar would drop.
Leslie agreed that he would wait in the car. We found the entrance to the building and he dropped me off. The imaging center was just inside the entrance off to the left. I got checked in, presented my ID and insurance cards, and filled out the paperwork, and proceeded to wait.
A nice technician came out to get me. She told me her name, but I can’t remember it so I’ll call her Sarah. She led me back to the undressing room outside the mammogram room and we had a little chat. There was more signing-off to do, and she told me that the reason for the needle biopsy was because the mammogram shows some calcifications, about the size of grains of salt, and Sarah took her pen and made some dots on the upper left corner of the page to show me how big the calcifications were. She asked me about any food I had eaten or meds I had taken. I told her that I had eaten toast at 6:30AM and taken 1 naproxen sodium the night before for pain relief for knee inflammation and arthritis. She got very still and stared off into the distance like she wasn’t sure about the naproxen, and asked me if I had taken one that morning. I said no, and she stared off again. Her eyes were bright like she was wearing contact lens, or maybe she was just tired and her eyes were bright with fatigue. Maybe she had a small child, maybe two, and she was worn down with the fatigue of life and work, and now she had me in front of her who had taken a naproxen sodium more than 12 hours prior. She tapped her pen on the clipboard and thought about it and said that she would tell the radiologist.
She said that I would be seated for the procedure, and that they would get me positioned to take some views to make sure that I was in the right position. The radiologist would give me several injections to numb the site, the needle would be injected to take a sample, the sample would be taken next door to the lab to make sure they had what they needed, and when that was okayed, the would withdraw the needle, and the procedure would be over. She said the machine, which was like an auxiliary unit on wheels, makes a lot of noise and some strange clicking and popping and they would let me know before an exceptionally loud pop would take place. She placed her right hand behind my left shoulder as if to brace me to show me how they would let prepare me and tell me that the pop was about to happen.
Sarah gave me the gown to wear in place of my blouse. I asked for a ladies room, and she directed me around the corner. I sent a final text to Leslie in the car, telling him that I was in the ladies room, then back to the changing room to get ready for the biopsy.
I got back to the changing room, got changed, and saw the bag of cheddar bunnies in my handbag. It was mid-morning and that’s my hungry time of day. I contemplated the cheddar bunnies, but decided against it, even though I really, really wanted some.
A nice lady named MaryBeth opened the door of the mammogram room to check on my progress. She said they were getting everything ready and that the radiologist would be in to speak to me. She asked me where I lived, and said that she lived nearby and at one time her husband worked for the police department for 20 years, but he was retired. Typical small-town conversations of total strangers making connections.
The radiologist came in, a nice doctor named Eric, and he told me they were going to be taking a needle biopsy to obtain calcifications to determine if I had DCIS. He told me that it stood for Ductal Carcinoma In Situ. All I heard was the word carcinoma.
He left, and I went into the mammogram room with Sarah and MaryBeth where they asked me to sit in an exam chair while they got me settled in. MaryBeth decided that the mammogram machine was in the wrong position like the compression would be from right to left, so she changed with machine 180°. Sarah produced a folded sheet which she draped over my lap in case I got cold, and a large absorbent pad across my lap in case there was bleeding. I thought it was an unusually large pad. They wheeled me up to the mammogram machine which was the elephant in the room, sitting there like a giant vice-grip, with a unit like an ice chest on wheels attached to it with electronic connections. The chair was a bit wobbly, and I thought, “Great, I’m in a wobble chair while part of my body will the clamped immobile.”
I was positioned; they took a view. It wasn’t adequate, so they repositioned me.
Another view, inadequate, and another repositioning. MaryBeth stepped on the footcontrol which increased or decreased the pressure, inadvertently increasing the pressure. I winced; she decreased and apologized. They demonstrated with loud popping which sounded like the cork on a champagne bottle popping out.
I noticed during the periods where the device was clamped on that there was a digital gauge in my near vision that was turned to my left, perhaps so that a person monitoring on the left side of the machine could view it. I couldn’t take a deep breath and I wanted to yawn but I couldn’t get enough air in my lungs. The part of the gauge that I could see said 9; when I breathed in and expanded my chest, it went to 10 or higher. The tiny words read something about pounds of pressure. So I figured that I had been compressed with approximately 10 pounds of pressure. I experimented with breathing in and out and watched the numbers change.
Another view, perhaps okay. They asked me to state my name, date of birth, and the location where the needle device would go in. I stated my name, date of birth, and “left lateral”. They called the radiologist. He came in the room, and I was able to turn my head to the right just enough to see him at the computer station. He said it was the wrong location for entry and to reset to the opposite side of the breast. He left the room. Nice Sarah asked me if he had actually come over to look at the location. I said that he had not.
They had to unclamp me, push the chair back, reposition the machine 180°, and start the process all over again. At one point I heard the word “lavage”. During the re-clamping, I realized that they had to be really precise and they were very serious. Another woman came into the room to make sure another computer gauge was set properly.
The radiologist came back in the room, approved the location, and started the procedure. They were going to go in at a 8 o’clock position to get to the site at a 6 o’clock position. I was sterilized at that area and the injection site was marked.
This is my impression of what happened. MaryBeth showed me on the machine where I could place my left hand to get a grip.
I was injected with two injections of numbing solution, then the radiologist made a cut in the skin for the needle to go in, then the big device, as big as a gigantic screwdriver attached to giant water pic, that was attached to the actual mammogram machine in a stationary position was injected, and the process began.
The hollow needle, the thing that’s as big as a gigantic screwdriver was injected. I could feel the pressure and a sensation of the deeper numbing solution being injected. They told me that the machine was going to make a loud pop. It did, and I realized the popping was a pneumatic release to send the needle further in. A horrible sensation of burning warmth flooded the lower side of my breast, like a power washer. Have you ever heard a vacuum cleaner? There was a vacuum feature inside me, also, vibrating and extracting. This was the most intense painful feeling, and someone in the room started moaning. I realized that it was me, and thought perhaps we were nearing the end, because Dr. Eric said this would take about 12 minutes, because really, how much more must this take? I had to exhale another moan and another, and I was counting how many times I was breathing, and I realized I had to get in control, and I remembered that cats purr to make themselves feel better. Once I was working in an exam room with a vet who was examining a cat who had been hit by a car and his skull and body were badly damaged, and the vet recommended euthanasia, and the owner said, “But he’s purring.” They purr to make themselves feel better. I exhaled another breath, trying to make it purr-like, trying to breathe through it, and it took 3 more breaths, which probably sounded like groaning instead of purring. MaryBeth was to my left, patting and rubbing my upper arm to say that it would be over soon, and they were so sorry that this was hurting.
The sample was extracted but the needle had to stay in while the sample was taken next door to pathology to see if they had an actual sample. I waited, still seated and clamped to a machine with a needle injected that I couldn’t have gotten away anyway. I had an image of a still-living butterfly, with pins in its body and wings, pinned to a display board under glass, still breathing and fluttering a bit. I thought I was going to be sick, right in my mask. It was a feeling of sickness, not nausea, not like I’d ever had before. There was a high bright feeling in my upper stomach, and the same feeling went into the back of my throat. I wondered how they would handle someone vomiting in their mask all over the mammogram machine.
It was determined that they had the sample they wanted, and a “clip” was injected to mark the site. The breast surgeon said this was in case they needed to go back in. At that moment, sitting under glass in the chair, I thought if I have breast cancer, I might just have to die with it if the procedures are this painful. They took more mammograms to make sure the clip was in the right spot. It was.
The needle was retracted, and the radiologist left. I was unclamped and wheeled back a bit because they had to reset the machine to take more views. Sarah put surgical tape closures on the mark where the needle went in. I must have looked a bit green, and I told them I might be sick. They reclined my chair back, and I now understood the need for the giant pad across my lap. It was meant to catch any variety of body fluids. Sarah brought me a ginger-ale, and I was genuinely relieved that I hadn’t eaten any cheddar bunnies.
They took 3 more views, and Sarah called Leslie and told him he could be at the front in 5 minutes for pick-up. I wasn’t sure who he would be picking up in five because there was no way I could get dressed and outside in 5 after having part of my breast vacuumed out. She led me outside, and he was waiting in the lobby. He was parked close to the door, and I walked with him out.
*****
The surgeon called 2 days later to say that the biopsy results had come back. He took a breath, and I knew what he was going to say.
I have DCIS, and the surgeon says this is not necessary bad news. It’s stage zero. If it leaves the ducts and enters the breast tissue, it can be considered a higher stage. He said that I would be getting phone calls for appointments from the oncologist and the oncology radiologist and the breast care consultant, and that we would come up with a plan.
He called it pre-cancer, but I still hear that word carcinoma in the description. So it’s off to do some research.