Second Surgical Follow Up: Buzz Kill?

This week I had my second follow up surgical appointment in Indianapolis with one of my medical heroes: Dr. Bob Goulet. He knocked on the exam door, opened it carefully and stepped in the room with a hearty: “Yo, Ang!” played up with a strong New York punch and an equally gregarious smile. He caught me a bit off guard but I got off a “Yo, back atcha,” with a less practiced accent. It was that fifteen second exchange that managed to put me at ease, make me feel safe. I was back where I belonged. Faith. Trust. They came rushing back into my spirit and I took a big, deep breath.

He extended his hand to Don first, then to me. Then he sat in a chair right next to Don and across from me. “So. How are you?” His question took me by surprise. How was I? Healing up nicely as far as I was concerned. I was done with radiation. No, I wasn’t experiencing any shortness of breath. No, I wasn’t experiencing any chest pains. No, I wasn’t experiencing any sudden weight loss. I explained that I was thrilled that I weighed the same that I did two weeks prior to Christmas. Success for me! Managed cookies, cooking, and café lattes with skill and grace over the holiday season. It was a first for me in probably 20 years.

“I had started to lose weight before ‘this’,” I said, using my right hand to dramatically introduce my left breast hidden under the warm exam gown. “So I’m hoping I can finally get back to losing weight and keep heading down that path.” I wanted to gleefully shout that I wanted the rest of my body to look as firm and youthful as my surgically altered “treated” breast. I’d been given a second chance to reclaim parts of my life that I’d lost along the way. Why wouldn’t I be happy?
“Dieting and weight loss can be emotionally stressful. I don’t think you need to do anything right now. You’re in a vulnerable place.” His words didn’t make sense to me. Dieting. Emotionally stressful? Well. Maybe if you do it successfully, I thought. It’d been about a decade since I’d experienced that success. But since finding out I had breast cancer I found it very easy to cut out alcohol and substantially ease up on sugar and sweets. I had cut out 2% milk in favor of skim. More nuts and dried fruit, veggies and grains. Less snacks and breads. No stress. I was taking a “think before you kill yourself” approach to my consumption of food. I get that I won’t be able to weigh 150 pounds again. And I’m not sure I’d want to. I recalled my favorite employer 20 years earlier chastising me for losing too much weight in his opinion, “There’s not going to be anything left to hold onto…” he said as he extended his hands out toward my hips, then realized what he’d said and done. Ya. Probably a harassment charge in there somewhere. But Pete was a strong, passionate man who often just said what was on his mind. His face turned bright red and he stammered an, “Oh, God. I’m…I’m…uh…” a few of his partners who stood by helpless to stop his slip razzed him in front of me. His wife scolded him. I just shook my head and muttered, “I get it. Never mind.” That office was like a supportive family though, so I wasn’t offended and I took his opinion under advisement. I was most comfortable at 160, so I “stopped the insanity”.
But a vulnerable place? Now? I felt incredible. No more radiation. No more burned skin. No more electric charges of pain racing from my arm pit to my forearm. My mornings were back to being my own. I had established a new division in our company. I was selling again. I wanted to sing out: “I can see clearly now…the rain is gone!: Vulnerable? Are you kidding? I’ve never felt better!
“How’s your memory? How’s your concentration?” he asked cordially as he still sat across from me, hands folded in his lap. He was looking at me not some papers in a manila folder. In fact there was no folder or chart anywhere in the room. We were having an actual conversation, not a clinical examination of systems as I’d been used to with doctors prior to my breast cancer.
“What?” I teased. He readied to repeat the question, but I stopped him. “Nah. I really don’t have a memory anymore. I was told that my lack of recall was due to my managing multiple tasks, stress, and lack of sleep long before this. I was used to closing my eyes and focusing on an image or a person for a while to bring it to mind. Now? Friends, family, employees, clients, those who are close to us accept that it takes me longer to pull things into focus. And when it comes to someone new? Well, I just smile and shake my head.” I waived my hand in a mock salute to illustrate my point. Dr. Bob smiled broadly and broke into a genuine laugh.
“That’s the radiation. That’s caused by the radiation. That’s temporary. That will go away. One day you’re going to wake up and you’ll realize you’ve got your brain back. It’s back. It won’t even be a gradual thing. You’ll wake up and it’ll be back.” His words were confident and deliberate.
“What about your energy? Are you tired?” Don and I both started laughing. “Oh, there was a while remember, Ang?” Don asked. “Oh, ya. There was a period like two weeks or so. I would be sitting and talking or listening and then my eyes would shut. The next thing I knew I was asleep. Crashed. I stopped picking up from swim team ‘cause I couldn’t keep my eyes open to drive! And it started all at once. It was like one day I was fine. The next I was sacked. It took a while to push through. But I go to the gym and work out so I try and work through the tiredness. I think that part is over.”
Dr. Bob wasn’t joking anymore. He had a more concerned look on his face. “That feeling may come back. Don’t be alarmed if it does. It’s totally normal. “ Ah, I thought. So I’ll have no brain but it won’t matter because I won’t have any means of staying awake to engage it anyway? Great! I thought all this was behind me.

“You’re out about the time you’ll hit a wall, Angie. It happens to everyone. It just does. You may feel weepy, vulnerable. You start to think of your own mortality. That normal. There will be feelings of loss. If it gets overwhelming we can help you. Just be aware of it. It’s a normal stage.” I heard his words. I couldn’t imagine anything changing. Hadn’t I been through all that already?
“I’ve got some coping things I’ve been doing to help keep me focused, “ I argued. “I have some tricks. And I started a blog so I can write about what’s going on. It’s my way of coping and making sense of everything. I may have crashed a while ago. I had a really bad time that day that Edwards gal died. That was a hard day. But I know there’s nothing I can do any more than anyone else can do. I don’t smoke. I quit alcohol. I don’t eat read meats. I don’t work around asbestos. I exercise. I try and do the things I can to eliminate the causative things. I understand I can help not get lung cancer, colon cancer, stomach cancer, skin cancer. You know? I’m not at any greater risk of getting breast cancer than anyone else.” I pleaded.

“That’s not correct.” He said. “You have an elevated risk of breast cancer occurring in your right breast because you had it in your left.”
“But that doesn’t mean it will happen,” I parried back. “And there’s nothing I can do to make it not happen.” I was frustrated that he wouldn’t let this go. I got that I had cancer. I preferred to think on it in the past. I HAD cancer. They removed it. I had radiation as a preventive measure. I was taking Tamoxifen as a preventive measure. I wasn’t planning on getting cancer again. I know there’s no guarantee, but dammit there was no guarantee that any other woman alive wouldn’t get breast cancer the first time. There is no way to protect yourself or ensure that you won’t get it. As far as I was concerned I was again just like every other woman in the world.

“I don’t think you’ve really taken in everything you’ve gone through yet.” He said. His face was kind and tender. Tears sprang to my eyes. You really gunna make me cry now? Huh? I thought. Is that what you want? I was confused.
“I get that I had cancer. But I’ve been through some really difficult life experiences,” I stopped as I looked back to Don for reassurance and support. I hoped he’d jump in and join the conversation. Back me up. But he sat silent looking at me. “I’ve learned ways to cope with things as they come up. Not that it is always easy, but I’m aware of what to look for and what I feel and what I have to do to get through things.” I was talking faster and trying not to cry. I didn’t want to share my life story right then and there. It wasn’t my job to make him understand my belief system. But I continued my course. “I. Have. Had. To deal. With. Some. Experiences. That I would rank as a 10.” The words were hard to get out. “This is more like a six or seven in comparison.” I stopped. The three of us were quiet. I wasn’t in denial. But I couldn’t talk about the other things. The expression on Dr. Bob’s face was doubt and concern, but I continued. “I get that I am really, really lucky. I get that. I understand that I need to be on the lookout for uterine cancer and endometrial cancers now because of the Tamoxifen. But I feel protected because I’ve got a whole team of people who’ll help me keep watch for signs of cancer. I didn’t have that before.” My voice cracked. My tears welled. I would not blink and let them fall though.
Dr. Bob continued his argument softly and tenderly: “I don’t think you’ve fully realized yet just how significant this is. You are going to experience feelings of loss. You’re going to reflect on your own mortality. That’s natural. You are still very vulnerable right now. I want you to know that you haven’t fully realized what you’ve gone through. When that happens I believe you’ll understand that this was the ten and the others were closer to sevens. You’ve been through a lot.”
You don’t know the half of it, I thought. Or maybe he did. I wouldn’t know how he could have learned of my challenges. Maybe he just knows what makes people behave certain ways. I was amazed that he’d remembered who I was. “Do you really even remember me?” I asked when we first started talking.

“Yes! Why would you think I wouldn’t ?” His question was earnest and his voice reflected a little hurt.

“Because you perform so many surgeries. How would you even be able to remember me?” I was truly curious and flattered that he really seemed to remember me and my situation. His command of the appointment left me feeling at peace. I knew from the first meeting Don and I had with him in August that he was direct, honest, and open. He listened. He just knew things. I trusted and believed him now, too. I would be on the lookout for a pending crash, a stunning wall. I would allow myself to be a cancer survivor.
But what if I hit a wall because I’m looking for it? What if reflecting on our conversation caused me to begin to be weepy, worried, sad. Have I cried more since my appointment? A little. Have I thought more about other losses in my life since that appointment? A little. But although I see my diagnosis, surgery, and treatment as serious, difficult, scary, shitty stuff, I believe it could have been far worse had it not been found so early. I’ve seen cancer’s viciousness up close and personal. I am beyond grateful that I am not in a fight of the magnitude I’ve witnessed in my family.

I believe God was nudging me to seek answers for several months leading up to my diagnosis. That’s how I see God act in my life. I felt Him move me to action. So I listen harder now. I’ve seen His power in numerous ways through my life. I may hit a wall in the next few weeks. Dr. Bob is the expert in this area. I do know that if I hit that wall God will be with me to help absorb the impact. And He’ll be waiting on the other side of the wall to help me focus on all I’ve been given. Family. Friends. Health. Faith. Hope. Love.
I will remember each day that I have been given this day to LIVE! And given a choice. I choose HOPE!