The No Good Very Bad Day

My mother passed away in September 2024. I didn’t post anything about her battle with pancreatic cancer as it was underway out of respect for her privacy. Recently, I came across a handful of writings I forgot. I had intended to keep notes for my own sanity and to reinforce certain conversations. I’m going to go through those I have – and share them as I can.

Fall 2023

It’s never going to be good news when you get a call from your mother and she says, “The doctor wants to see you and me both in her office at 3:30 Wednesday.”

My mother had just recently decided to start seeing my concierge doctor. At 85, she was feeling less than impressed with her longtime doctor who always seemed to substitute in his PA and often didn’t spend more than 15 minutes with her. Heck, I know from experience it takes more time than that to get her around to talking about what ails her and to weed through the side paths to start to see any sort of pattern. My doctor will sit with me for an hour as I hypothesize various diagnosis and never once indicate that I should hurry.

When I learned Mom had a chest x-ray, then a second chest x-ray, then a CT scan, I knew something was up. My doctor is nothing if not thorough.

Upon arrival I was surprised to be handed one copy of the CT report while we sat together in the waiting room. Each holding one side of the stapled pages, we began perusing. My stomach sank. There were lots of terms and measurements and way too much medical jargon, but I began to see one word, “metastatic.” Likely metastatic. Concerning for metastatic, Almost certainly metastatic. I think my eyes began to cross. We finished our review and I held onto the pages, silently fuming that they would hand us that report without someone to guide us through it immediately. For an office I typically trust, I was doing quite a bit of screaming at people in my head.

When we did get called back to see Dr. T, we sat in an exam room and she gestured to the document in my hands. “You’ve read it?” she asked.

“Yes,” we nodded, and I added, “It’s a lot.”

“It is a lot.” she agreed. The doctor went on to backtrack through how this all came about. My mother had come to her complaining about occasional hives, and telling her she would wake up sometimes with her tongue swollen on one side. Dr. T considered this troubling (as one will when your tongue is so swollen you feel like you can’t even talk until you’ve held an ice cube in your mouth for a while). Suspecting some sort of allergy, perhaps related to my mother’s apartment of two years, the doctor listened to my mother’s chest and detected wheezing. Thus the chest x-ray. But there was something odd in the x-ray and they hadn’t used markers so they went back and did it again. This time it picked up just the top of her pancreas – where another anomaly was spotted. So, the next move was an abdominal CT scan. Those results were the ones in my hand. The ones telling us the small 1.5 cm spot on my mother’s pancreas that the previous doctor had been watching for any signs of change over the past several years had, over the past 5 months, grown to 3.7 cm. And then there were all the other locations where scary things were visible. Liver, pancreas, kidneys, retroperitoneum.

Dr. T went on to tell us the main concern: Pancreatic cancer has spread throughout her abdomen. She walked us through the next steps of finding an oncologist and determining if a biopsy is needed or not. From there we would discuss treatment options, or not. She explained the situation of the pancreas, how difficult surgery is, and additionally, how chemo for this is a hard road. She was preparing us to consider all the how’s and what’s that were running through our minds. During that discussion and my mother’s questions and comments, I sat calmly, trying to make my mind stop squirreling around. I wanted to run out of the room and drive straight home to bed where I could cry. In fact, my need to cry kept distracting me from my need to listen. To pull myself away from the abyss, I would pinch myself and try harder to focus on what was being said. I didn’t want my mother to break down if she saw me breaking down so I nodded sagely and re-doubled my efforts to think of something intelligent to ask. After the doctor said, “We don’t know if this is something that is a matter of months or a matter of years,” my mother shrugged and declared, “Well, I’ve had a good life.”

Thinking I must have heard wrong, my head swiveled to see her expression. She looked perfectly serious. I could hear my brother’s voice in my head snort and say, “Since when does she think that?” But she meant it; I could tell. I just didn’t always think she knew what a nice life she’d had – especially after marrying my stepfather, when things like country club memberships, expensive dinners, a big house and yearly trips to Colorado to get away from the Texas heat for a month were a way of life. Not that “things” make life good or bad – but they certainly take the sting out of some of the other disappointments. And frankly, I don’t even know if those are the things she was picturing in her mind at the moment. Maybe she was thinking about her kids, and granddaughter.

We left the doctor with all sorts of plans to hear from her office regarding a contact and appointment at two hospitals. I thought she could get into Presbyterian faster – and it’s very close to both our homes. But she prefers UTSW and has more faith in their doctors so both plans were set in motion. We could always choose later, once she’d met the oncologists.

We have received confirmation that we are in at UTSW for Wednesday.

In the meantime, I understand she has talked to her sister and brother. Her sister believes there is no way they could tell any of that from a scan and says she won’t believe it until there is a biopsy. I am trying to walk a fine line myself. I want her to have hope and to feel like the worst is not a foregone conclusion, but I also have to keep the train on the rails a bit. This is not fake news.

RADIATION REVELATIONS

Radiation2

Inquiring minds want to know, so: The actual radiation therapy takes around 3 minutes. Not including getting undressed and dressed again. On Mondays, I visit with the doctor who asks how I’m doing and then tells me to keep applying aloe gel. Riveting, right? Those days the appointment lasts maybe 20 minutes tops, the most frightening part of it being when I step on the scale. The longest visits are the ones when we do simulation. We did that at the very beginning and again a little over a week ago.

During the last seven appointments, they focus on the actual tumor bed, so the simulation allows them to take measurements and X-rays to check they are targeting correctly.

In simulation, you lie down on a table with your “damn traitor” boob exposed so they can start turning you into a human connect-the-dots game again. This time there was a fun moment when the tech looked at my breast,then learned in for an even closer look and said, “Wow.”

Not certain if “wow” was good or bad, I squashed my immediate impulse to respond with a sarcastic, “Yes, they’re pretty spectacular, I KNOW.”

As it turns out, they were looking for the incision where the surgeon went in (twice) for the lumpectomies. Potential TMI coming up, so skip to next paragraph if you don’t want to get too personal, or if you are squeamish. The doc went in by making an incision just at the edge of the areola (wince). See, if you use professional language, it’s easier to deal with. Despite two procedures, it is nearly invisible. (As evidenced by the two tech faces bent extremely close to my um, scar area, exclaiming, “Wow. Who was your surgeon? Dr. Ganaraj? She’s amazing.”)

I couldn’t agree more.

Once THAT was established, measurements and X-rays began again. More lines being drawn on. This time with green instead of blue. Then to the CT scan to confirm the alignment. I left with three new clear tape circles covering green Xs and a renewed, unwelcome realization that this is some serious shit.

UPDATE: At this point I’ve had 4 treatments of the tumor bed. They have a special plate that is made just for me – to focus on the tumor bed specifically – as determined by the simulation session. They were telling me that some people end up with plates shaped like the US, or like Texas. (Not exactly the plate but the hole in the plate.) Apparently, in cases of mastectomy, often the hole in the plate is shaped like a penis. (How’s that for adding insult to injury?) We can’t decide what mine is shaped like. The tech said Woodstock’s head. (Snoopy’s buddy.) You decide. This is the view from lying on the table – so what I see.

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Since this awesome fun time is nearly over, I took some other photos too – here is the massive machinery behind the door I never noticed before.

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Here it is in motion.

Crazy, right?

This is the room where you get the treatment. Not like a sterile hospital room, right?  It’s like getting radiation therapy in someone’s sort of messy office.

Radiation1

Here’s another view of what I see from the table. See the purple light beams in this photo and the one of the plate? Those are what they line my green Xs up with.

Radiation4

The current phrase that pays is “GOOD-NESS I’m tired.” Seriously, some mornings I think if the bed was on fire I’d just lie there. (Probably thinking it was another hot flash.)

But we’re in the home stretch. Just three more treatments! Until then, zzzzzzzzzzzzzz.

THE SURGICAL STORY – OR BREAST CASE SCENARIO

I can’t help myself. Dad would have liked that title.

Update: Thursday, in preparation for the lumpectomy on Friday, I returned to the nuclear medicine lab where I’d had the MRI and all that jazz done. They needed to give me some sort of injection. Unfortunately, I Googled what sort of injection I needed before this procedure and as you may have experienced at one time or another, Google scared me silly. There were descriptions of injections (multiple) directly into the “bull’s eye” so to speak, and the declaration that it feels like someone is putting out a cigarette on you. For ten minutes.  By the time I arrived at the lab, I was surprised they couldn’t see my heart beating through my shirt. It was giving my recent cardio ablation a run for its money. I told the nice technician that people were saying terrible things about her on the Internet and she said it was totally untrue. I would get to judge for myself. 

In my case, it was one shot, not four, and while it DID sting quite a bit, it certainly wasn’t torture. Thank goodness. The purpose behind this was to inject another dye that would show the doctor which lymph nodes are the first in the transportation of cells. That way she could remove those for testing while she was doing the lumpectomy. 

The next day we drove through a deluge to the surgical center, where they ushered me into the room where I would receive a wire. This wire would be inserted into the lump with guidance from an ultrasound, then I would be given a mammogram to make certain it was in place. The wire would guide the surgeon to the lump. For some crazy reason I thought the wire would be a tiny, skinny-type wire. Imagine my surprise when I sat up after this procedure and had a TV antennae sticking out of my chest by about 6 inches. It was crazy! They quickly taped it down so I could put on a shirt and make my way to the mammogram machine.  At some point as I stood there with the antenna sticking out again, getting smashed in the mammo contraption I realized it had happened. That moment had come when you are either so sick or so overwhelmed and out of your element that you don’t care if you are shirtless in front of a stranger and have a metal thing sticking out of your chest.  I was a walking dowsing rod. Only instead of water, I would lead you to Chardonnay. 

Everything looked correct on the mammogram, so I was taped down again and walked across the hall to where the actual procedure would take place. I got to change into one of those gorgeous hospital gowns/tarps and prepare to meet the anesthesiologist, surgeon, etc. in the meantime, while Robert sat beside me behaving quite properly, I decided I needed to start a texting group and let my besties know what was happening moment by moment. I will plug that text message in on another post. It’s probably not as enjoyable to you as it was for me, but I want it on the record anyway. 

To cut to the chase, the surgery went great. Lymph nodes look totally normal but she’s sending them in anyway for testing. I should hear about that this week. I was wrapped in yet another fashion forward item – a tube top – and told to wear it for 2 days, if possible. Which I did. Then I gladly removed it.  I slept most of the evening after surgery and then was strangely awake all day Saturday and Sunday. No naps. Monday, I couldn’t get enough sleep. Go figure. 

Okay, ending it here for this report. More to come.

A NEW DIAGNOSIS

“Hi, I was recently diagnosed with breast cancer.”

A slow growing, less than 2 cm infiltrating ductal carcinoma. It’s grade 1, so basically as good as it can get for bad news. At this point it looks like the next steps are a lumpectomy and 6 weeks of radiation. So, we’re really almost done with the whole thing. (At least that’s what I’m telling myself.)

This happened really quickly. I was at work about a month and a half ago and suddenly felt a sharp pain in my left upper breast/chest area. I held a hand over it, which is really not a good look for the office, and just muddled through until it stopped hurting. Then it was totally out of site out of mind.  Probably 2 weeks later I was reading in bed and felt another sharp pain in the same location.  Inspecting it more closely, I found…a lump. 

The next day I called my doctor, who got me in for a mammogram the NEXT day. A few days later I was back in, getting a biopsy. (Ouch.) Two days later my doctor’s office called and asked me to come in for the results. Full on panic started then. Never a good sign. It was around this time that shock set in. And a little parking lot car crying may have taken place.

Luckily, I have a great doctor. Surgeons were recommended. Appointments made. It became basically waiting from day to day to find out what was happening next. What was the news? Results? It was so surreal. I could not stop thinking about my friend Leah being diagnosed with stage 4 breast cancer and dying two years later. Although my initial results looked good, I couldn’t help but think at three in the morning, “What if this is a secondary location? What if I’m riddled with cancer? Is that why my hip hurts? Does that explain my migraines lately? As fast as my doctors were moving, and it was FAST, there was still waiting time, and it felt endless. I started writing the night before the last round of tests. It was 1:30 AM and I’d been trying to sleep for hours. I had an MRI, bone scan and CT scan awaiting me the next day. This was my stream of thought: 

– Tonight I am a little nervous about the MRI and scans tomorrow, but I know in my head that chances are really small that anything will have spread. I SHOULD be worried about my sudden break up with estrogen therapy. My little tumor (to be named later) is estrogen receptive. That means estrogen is no friend of mine, and has to go. Which is funny (not), because without it I am a mess. Within hours of removing the patch, I was unaccountably annoyed. With everything.  Maybe now is the time I should learn to laugh at the small stuff. Small stuff I suck at. Big stuff? I’m a freakin’ rock. Mostly. 

It’s 2 AM now. The hot flashes and monkeys in my head are still at it. I’m waiting. Waiting for the test, biopsy, results, appointment, phone call. Good news. Bad news. Whatever. After the tests tomorrow, I could hear from Dr. G in the afternoon. Or, it might be Friday. It definitely won’t be later than that. And this will tell me if there are any other places they see anything suspicious. So I feel like once I know that, we can move forward. In the meantime, I guess I’ll go with this nervous breakdown/insomnia thing.

So, as I said earlier, the tests were good. Compared to what many women go through, this is a cake walk. I’m almost embarrassed to even call it cancer. I feel there’s an in between something it could be called. But then again, I have the option of lumpectomy or full mastectomy, so that’s just scary. That’s for real, right? Not pleasant  to consider. Life changing. I just keep going back and forth between feeling really lucky and feeling terrible. I haven’t settled on an emotion yet. And maybe I just won’t. 

That ought to be fun for everyone around me. Woohoo! Which way is the wind blowing today?

Side note: when you’re diagnosed with cancer, they give you a 3-ring binder. With tabs. It’s like they realize your mind was just blown and someone has to organize you or you’ll fall apart. Which is probably very true.  For the past 2 weeks, all my test results and doctor stuff was in my purse. Wadded up. Now it’s hole punched. Cancer will motivate you to get your s#!& together.

Well, some of it.  Don’t expect miracles, people. I’m still a hot mess. And I can promise you, no matter what, that will not change. 

Okay, so that’s that.  More to come.