I sometimes wonder what my patients think of me.

In recent weeks, the coin has been flipped and I find myself sitting more oft then not in a doctor’s exam room in a flimsy apron.  The biopsy that was scheduled became an ultrasound.

The ultra sound became a mammogram.

The mammogram found three lumps in my breasts.  That’s right, plural.  BreastS. The mammogram is becoming a biopsy.

And here I sit, in my office, on my lunch break, completely un-phased by the whole ordeal.  I recite to myself, my mantra of the month: “you are too young.  You are fine.”  But of course, squished way back in the mind is that little voice that is begging to be heard.

I don’t let that voice talk.  It will just talk and make me paranoid to the point where I can’t function at work.  I usually am able to control that voice but every once and awhile it escapes and runs through my head, scampering madly across, cackling and shrieking:

“Look at her!  27 with breast cancer!  She thought she was too young too!!”

Shut up voice.  I am not her.  She has a major family history of cancer.

“hey how about her?  How young is she?  And just married? Wow, that sucks.”

Shut up voice.

“How about her? 35 and a mom to three little girls all around SC’s age!  Hear how she describes them crying when she shaved her head!  They didn’t know who she was”

Shut up voice. I am not her.  I’ll take SC with me when I shave my head.  It will be a game.

“HAHAHA!  You admitted it!  You are going to have to shave your head!  Why? Because you have CANCER!! “

Fuck you voice.  Leave me alone.

“Yep, you are going to die soon.  What is going to happen to SC?  How will he grow up?  Will he even remember you?  Will he forget your voice?  Your smile? Your smell?  Your laugh?  How will he learn to treat women? Who will be his role model? Will he be alone forever? What if he falls into the wrong crowd? What if he calls someone else his mom?”

SHUT THE FUCK UP VOICE!  I AM WORKING HERE!

I wonder how many of my patients are like this in their own heads?

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Posted by: alainnneart | July 29, 2009

You bring me closer to god.

The overstressed 40 something daughter looked like she had been frazzled all night.  I don’t blame her.  I wouldn’t want my mother to have cancer either.  But she seemed almost over bearing.  She was priming over her mom, making sure her mom had a blanket, a pillow, the book, her iPod, a bag of medicine in her giant, over-sized bag.

Her daughter looked unkempt, blue men’s dress shirt wrinkles over jeans and a turtleneck. She had on sneakers that were worn down and filthy, like she had been running in the mud.  She smiled at her mom and said, “I’ll go get some coffee from the cafeteria and run some errands right around town.  I’ll be back in a few, ok?  Remember to take the herbal supplements I got you to help you with your nausea.”  The daughter fussed through the bag, searching for whatever miracle drug she thought she had.  Eventually she gave up and handed her the bag and turned to leave.  She was almost to the door when she turned and called, “and don’t forget I put Vivaldi on your iPod!  And you have acupuncture this afternoon”

After she left, I turned to her mom who was settling into her chair.  For a 60 year old, she looked good.  She still had a thick head of curly hair that had not thinned in the 6 cycles or the radiation.  Mind you, she is thin and looking frailer each time I see her.

I watched her light up as her grandson arrived.  John is in his 20s and a student at USF.  He has these intense, bright blue eyes that when he looks at you, it’s like he is looking right into your soul.  He and his grandmother are close, I can tell.  They look thick as thieves when they are together.

Today was a funnier day then usual.  When her daughter left, I noticed that Heather looked at her grandson and winked.  Thick as thieves, I saw Tony pull out his iPod from his pocket.  As soon as her daughter turned the corner, the ear buds came out of her ears.  Quickly, I watched as she and her grandson swapped iPods.  I walked over to them, curious to know what it was all about.

“Oh, yeah,” Heather said laughing, “I love my daughter.  I do.  But this bullshit is driving me insane.  Vivadli?  Really?  And acupuncture?” she laughed.

“Well, what are you listening to then?”

She smiled, popped the ear buds in.

“Nine inch nails of course.”

For the first time in a few days I have not thought about the biopsy.  Maybe the paranoia is fading a little.  Or maybe I am really busy.  However, I have been thinking a lot about Mary.

Her cancer started as breast cancer.  I don’t want to bother her with details of my own current problem with the lump, but I was some information from her about her struggles.  I guess it’s a “what if it is the big C?” sort of discussion I want to have.  I think I would be comfortable talking with her but I won’t call her to burden her with this.  After all, she is declining and currently planning her own funeral and memorial.  Bothering her with some that could really be nothing is not what I want to do right now.

I know enough about cancer to be able to tell you a few things.  Maybe that’s why I am only really worried about the lump late at night when my brain slows down and I can think about it.  Otherwise, I continue my day’s routine with SC and at work.  I try to pretend it’s all the same.

But you see, it’s not all the same.  I sit and talk with these incredible women in the chemo room and I see it from two points of reality.  The first is that these women are absolutely amazing to me.  They glow, and it’s not from the radiation they get, and they ooze confidence, hope and down right sexiness.  Most have now lost their hair, something I myself am very vain about, and they have these amazing scarves around their heads.  They are wrapped so artfully that it’s truly a wonder and a testament to the grace and fluidity of beauty they possess.

But I look at it also from the medical point of view.  For example, despite B’s beautiful outlook and wild eyes hope, I know that she is not going to make it.  I know that it’s spread too far and is in too many organs now.  I know that she will soon be referred to Hospice.  I know that in six months I will be, once again, heading to a funeral.

What scares me is this could be me.  We’ll all know more on Friday, but it could be me.  I never thought I could survive a lot of the things that I have.  I have had crash courses in heartbreak, violence, and death and in life.  I don’t think I am ready for another crash course now.

I went to the beach today to talk to my best friend.  Renee died about 7 years ago in a car crash.  I told her spirit all my fears.  My questions where answered with the sound of crashing waves.

Posted by: alainnneart | July 26, 2009

by the time you’re 35

Like most teenagers, I had a few problems that I thought were the end of the world.  DO you remember the times where the littlest things just rocked your world?  And only you went through them?

I admit, that as a teenager, I was depressed.  I wore a lot of black.  The truth is, I didn’t fit in with my classmates.  I am sure that every one really feels this way at times but really, I didn’t fit in with my classmates.  I had skipped some grades.  I got picked on, a lot, thanks to my siblings, and being smart if not socially awkward.

I have been reading through my old diaries.   As it turns out, I was obsessed with death and ending my life when I was a teenager.  Obviously, I got through the teen years, with only a few physical scars to prove I was there.  More emotional scars then anything else.  But I digress…

I seem to have the underlying theme that death has always been chasing me.  I have been injured in several accidents in my life, and yet here I am.  My heart has stopped before, and yet here I am.  It always has seemed to me that what ever the world could throw at me, I could throw back and survive.

I work in a hospital where people constantly surround me in various stages of death.  I don’t say living anymore, because we are all dying, metaphorically speaking, and I see the stages with many patients.  Remission for the 4th time, newly diagnosed, end stage…. I think I work with people like this to remind me how fragile life actually is.

But now comes the lump.  When I got my second opinion, the doc asked if it hurt at all.  “Nahhh…” I answered, “it’s just there and surprising, that’s all”

But you see that is not exactly true.

I have had pain on that breast for a while.  I pushed it to the back of my head, thinking I needed better bras or I was infused with PMS.  Hell, I even thought maybe I was pregnant, but that would be divine intervention.  It would have been smarter to actually look at the pain earlier, or even admit to it.  But to admit to it is admitting to defeat?

While I am not looking forward to being jabbed in the breast with a giant needle next week, I do want this obsessive feeling to go away.  Perhaps it’s just the ghosts of my past self, all teen and angst laden, whispering in my ears while I slip into dreamless sleeps and restless nights, “this is it.  You have dodged all the bullets you can.  It’s your time now.”

But what would become of SC?

I am distracted at work.

I am sitting in my office staring at a blank patient profile that I am supposed to be completing. I can see the women outside in the chemo chairs talking about scar tissues and other things. I am young. Much too young to half a lump the size of a marble in my breast. The one thing that this job does make you is paranoid.

However, having a bit of paranoia in your life is needed to remain vigilant to possible problems. I mean, what other 30 something year old would have instantly called for a second opinion? Here’s the thing, plain and simple: It’s probably nothing. This is literally a blip on the radar and it will pass. I will go off back into my happy little sheltered world and smile knowing that I am fine.

Then comes the little “what if” voice.

What if it isn’t nothing? What if you are really going to be on the other side of the table for a while? What if it’s minor? What if it’s more aggressive? What if it’s in more then one spot? What if you are really sick and need help with SC? Who will be there to help you? What is going to happen? Why is this happening? What if I don’t make it? What if I don’t beat it? Will SC remember me? Will he forget everything? Who will he live with?

The questions go on and on until it’s madness in my head. You see, all these years here, as much as I have tried to place myself in my patient’s position and said that I have been looking at it from their point of view, the truth is…. I haven’t. I haven’t ever been really able to see things from their point of view.

This is my little wake up call.

Posted by: alainnneart | July 23, 2009

On the other side of Ok… ok at all in anyway….

There are roses on the ceiling.  NO really, there are roses on the ceiling.  This is what I am thinking as I am laying on an exam table.  I wonder to myself, is this what it’s like on the other side of the coin?  This is what my patients are thinking?

I am waiting for my “second opinion” from my doctor.  After all, I assume that I only had a slip of the mind.  There is no real lump in my breast.  It’s all part of my imagination.  Look what I do for Christ’s sake!  A little bit of paranoia is necessary to survive.

My doc comes in and smiles. She is an old friend from school  Her hands are warm as she pokes my boob.  It’s helped that I marked the area with a little blue X.  But all I notice, as we make small talk, is the roses on the ceiling.  Someone placed a postcard at the top in order to make these lovely “female” visits more beautiful.

“So,” I say, looking at my doc as she finds the place where I marked.  Her face is a poker face with a faint smile, “I am being paranoid right?  Fatty tissue, right?”

“hmmmm.”

Ok then, I will be quiet now and look at the flowers.

Eventually, I am over my exam and getting dressed.  I am not worried.  I have seen worse and this was nothing.  My doc comes in. “so nothing, right?” I ask, smiling.  She half heartily smiles. “Al, I need you to go and have a biopsy completed It’s the size of a marble and there is a history of breast cancer in your family….”

Of course the rest drones out.  I look at her.  I am shocked.  Certainly not me!  I am too young!  I am around cancer all the time!  NOT ME!!

So now we have to have a biopsy next week.

It’s the things that you never expect that usually blindside you at 3 o’clock on a Monday morning.  After all, you never expect to be fallible.  Or mortal.  Don’t we all think that we are going to live forever?

Reality is cold and crushing.  It comes in many forms.  It’s the reality of the doctor saying, “I’m sorry, there is nothing else we can do.”  It’s the reality of being hit by a car while driving to work.  Or even the reality of war, where people are killed for some reason that got lost a long time ago under mounds of bureaucratic bullshit.

For me?  It was simply making coffee.  This morning is cold and I was making coffee in my office at home.  I had planned to look over some paperwork, drive SC to school and head into the office.  However, all that changed, just because I was cold.

I stood leaning against the counter next to my coffee pot, waiting to hear the familiar and comforting gurgling as my little four-cup pot (which we all know is really about 2 cups) percolated and brewed.  A brief wind wafted through my window, which was open of my skinny cat to run in and out of.  Instinctively, like most women would do, I wrapped my arms around my breasts, because being braless and in a t-shirt was just plain cold.

That’s when I felt it.  The lump.  The lump protruding from side of my right breast. I gasped in shock and raised my right arm over my head, left arm diving under my black shirt.  I searched.  It was gone.  I shifted my fingers.  It was back.  Small and hard, the size of a frozen pea… the lump.

I suppose I am also a bit paranoid.  Could be a cyst brought on my hormones or even caffeine intake (I do drink a lot of coffee, don’t I?)  But knowing what I see every day made me worry enough to call my personal OBG and have an appointment made.  Because in this case, a second opinion is needed.

Posted by: alainnneart | July 15, 2009

All my words are bound to fail

Received notice toady that Mary has become a little more down trodden.  I flash to remembering when it was announced at our Monday morning meeting about the Cancer.  Heather tried to form the words and her mouth just gaped, open and closed and open and closed, trying to make sense of her announcements.

the tears that she was spilling was enough to warn us that something indeed was VERY wrong.  Finally, she turned to Elaine on her right ans said, choked up, “I can’t.”  Elaine, a woman from Brooklyn, and a very tough woman at that, simply turned to us at the table and said, “Mary’s cancer is back.  it’s in her liver and stomach.”

Tonight, I wonder to myself, when did we get so cold and clinical?  Our friend Mary, and this is how the proverbial “bomb is dropped”.  This is what I am thinking of tonight.

Posted by: alainnneart | July 14, 2009

Hit me baby one more time

A few nights ago. a few of the guys that I work with asked me if I wanted to go to a concert with them.  I figured that I needed a little “adult time” so I found a sitter and took the spare ticket to the Tori Amos concert.  I am a fan of hers, but not nearly to the degree that my colleagues are.

After kissing SC goodbye and thanking my sitter for showing up on short notice, we ventured across the bridge to Oakland. (I should say under the bay by way of BART) She was playing at the historic Paramont Theater.  The theater it’s self is a sight to see, refurbished and renovated back to the 1930s art style.  And the seats were amazing.

The show it’s self was also exquisite.  My favorite part, however, was when she started doing a cover.  She made the audience guess what she was doing, who she was talking about.  I had no idea.  When she began to play the piano it was a slow but fierce pounding of the keys.  She was singing Brittany Spears “one more time”.

I will publicly admit I find Brittnay Spears to be annoying.  I am not one for bubble gum pop.  But then came her kids and her very public breakdown and I saw her in a new light: Pity.  She has pressures that I cannot imagine.  She has severe post partumn depression, amplified by a failing marriage and is under the microscope of fame.  I pity her.

The song was very poient when it was sung at the concert for me in other ways as well.  For when Tori got to the last line in her slow ballad version of the song, she changed the lyrics to “Hit me baby, you always do, hit me baby one more time”.  Instantly, I was back to when SC was born, that one night in a sweltering June, where I realized it was time to leave him. SC was just beginning to walk, at 9 months.  I was so proud that he and I walked together.

It was a good decision, a hard one, but the best one I have ever made.  And now Stephan and I will never be hurt again.

Posted by: alainnneart | July 13, 2009

Truth

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