A Force of Nature

Kyle and I went to meet my my surgeon, Dr. Mary Brian, for the first time last Monday. I didn't know anything about her other than what Dr. Rice had said: she's one of the best in the area, she's a breast surgery specialist, and the other doctors in her practice also specialize in breast care; the practice is the Breast Care Center of North Texas in Bedford (about 45 minutes north of my home). I had also heard from an OB/GYN friend of my supervisor's that she (the OB) would go there if she had gotten my diagnosis. Dr. Brian gave me a brief physical exam and looked at my mammograms and pathology report. We then met in her office for about 30 minutes, where she told me that her initial recommendation is mastectomy with reconstructive surgery. Wow, the good news just won't stop coming. Her reasoning seemed sound when she explained it, and she's very competent at communicating complex medical stuff. Since I have next to no knowledge of all this, I'm grateful to have a surgeon who can talk like a real person.

She tells me that I have a tumor that is probably 3-4 cm in diameter, and in order for her to go in and get all the affected tissue as well as another centimeter or so of healthy tissue all around, a lumpectomy probably won't be feasible. She also tells me that because the cancer has already grown outside of the milk duct where it started (i.e., the "invasive ductal carcinoma" part of my diagnosis mentioned in my last post), a mastectomy is the best option. She explains that they will take the sentinel lymph node out during surgery, and a pathologist will cut and examine it three different ways. If this lymph node is clean, then they all are clean because they all sort of line up after that one; that's why it's called the sentinel node. She also explained that the first step of reconstructive surgery can occur after the mastectomy, but frankly after I heard the "M" word, I think I got some stuff confused. I do know that a plastic surgeon will be handling that part of the surgery, should I decide to get it done. She tells me that she can't yet say with any certainty what stage I'm at or whether I will have to have chemo; they will know this when they test the lymph node. The next real shocker is that she says I'll have to take three weeks off work to recuperate. I just started my job in February; I don't have three weeks of sick leave. More on this later.

I am again crying, trying to get control. She waits patiently. Kyle asks lots of questions, and she answers them all very thoroughly. I have to say, I'm impressed. I really like this woman, despite the fact that she's telling me the worst medical news that I have ever received regarding my own health, well, outside of the cancer diagnosis. She tells me that she will know more if I have a breast MRI, bone scan, and CT scan; she will get an indication of whether the cancer has already spread outside my breast tissue. I agree that this sounds like a good plan. She also wants me to see a plastic surgeon; again, cool with me.

Next she has her nurse, who seems more like a patient facilitator, come and talk to us. Her name is Kelly, and she tells us that she's a 10-year breast cancer survivor; she also had a mastectomy, so she knows where my head is. Because I, of course, am still crying off and on. I tell her that I have very limited amounts of sick/vacation time, so I'd like to consolidate all these scans if possible. She says that's totally doable, and she will get approval from my insurance and have the imaging center at Baylor Irving call me. And you know what?? She did exactly what she said she would. She also tells me that Dr. Brian only works with three plastic surgeons, and one doesn't take my insurance; the other two are really competent and again, highly recommended. So we go with the closer of the two; he's in Fort Worth. Kyle and I are seeing him next Thursday.

So now I have an appointment for a breast MRI, a head-to-toe bone scan, and a torso CT scan for Tuesday morning at 6:30. Gah! I AM SO SO SO NOT A MORNING PERSON! This is going to take about 6 or 7 hours, I'm told. Oh, and more good news: the breast MRI is again the thing with the holes in the table, but this time they will be doing both. LOL! I did ask the woman at the imaging center whether they would have to be under compression, and she said no. Thank whatever gods there may be for that. I will have an IV and they will give me lots of injections of radioactive agents and dyes through it. I wonder whether I'll glow in the dark :)??

They ask me if I'm claustrophobic, which of course I am, so I'm freaking out a bit about the MRI, as well as all the rest of this stuff, and talked to my friend (and supervisor) Suzanne about it. She's like, "Have you ever taken Xanax?" Me: "Nope, but my dog has a prescription for it because of his storm phobia." Suzanne: "Call Dr. Rice." And then all kinds of stories about how well it works to alleviate anxiety. So I call Dr. Rice and tell her that I'm really nervous about the MRI because of my claustrophobia, and she's like,"Have you ever taken Xanax?" Hehehehe. I pick up my prescription on the way home Friday night; I haven't tried it yet. Supposedly it will help me sleep as well, which would be AWESOME! I have horrible insomnia, especially when I'm worried. Actually, I take that back. I just have horrible insomnia all the time.

Kyle and I have been talking a lot about what we think about Dr. Brian. Kyle's much less willing to trust than I am, not nearly as quickly anyway. So I ask Suzanne if her OB friend can elaborate on why she would go to Dr. Brian if she got my diagnosis. Suzanne forwards me the response from her friend, who wrote (in part): "Mary Brian is a force of nature. She is an excellent surgeon and trained in an era where women didn't become surgeons. She has no problem kicking people's ass for the benefit of her patients. She was a general surgeon for years with the good old boys then started doing only breast surgery. Most other mastectomies are done by general surgeons doing gallbladders, appendixes etc. She probably does about 12-15 surgeries a week...which is a lot." She wrote a bunch of other stuff about the other two doctors (a radiation oncologist and an oncologist) in the practice and how fabulous they are and how well they communicate with each other. I cry yet again when I get this note because I'm so relieved to hear that my surgeon is so highly regarded by another physician, and I really like the thought that I have a surgeon who can kick ass! I have never even thought about placing my life in a stranger's hands. I wonder what it feels like to be her? And I wonder whether this force of nature will be strong enough and smart enough to defeat the negative force of nature inside of me?