parallels and patterns

In 2017, I had a cancer scare that ended in a hysterectomy. This year, I’m experiencing a cancer scare but I don’t know yet what its ending will be. Several milestones in these two years have aligned almost to the day.

Which is all to say that I’ve been thinking a lot about parallels and patterns lately.

These things are aligning far too much for my liking

I celebrated(?) the start of 2024 with a routine mammogram a few days in. Go big or go home, I say.

A few days later, the clinic nurse called to tell me that there were anomalies on my scans for one side and that they needed to schedule a follow-up mammogram. A common thing, she reassured me. Sometimes the scans aren’t clear, or there’s something they need a closer look at, or maybe it’s something more that they need to have checked out. When she scheduled the follow-up for the end of that week, I tried not to think about how much more urgent it must be if they could fit me in that quickly. I’d had to wait 4 months for the initial appointment.

Sal went with me to the follow-up. When I was finished, the nurse took me to the back waiting room while the radiologist read the scans. About 20 minutes, she said. I’d barely finished dressing when she came to say the radiologist would give me the results. I knew that wasn’t a good sign.

She led me to a small room designed to soften hard news. Soft seating, soft pictures on the walls, soft music on the sound system. Brochures with titles like “Breast Cancer and You” and “Facts and Myths about Cancer Treatment”. The nurse brought Sal to join me. He knew that wasn’t a good sign, either.

The radiologist explained that I had something called microcalcifications, which are calcium deposits in breast tissue. They’re very common, especially in women over 50, and often benign. But if they have a certain pattern, they can be an early sign – sometimes the only sign – of breast cancer. I had not one, but two different sites with microcalcifications in the certain pattern. Sal squeezed my hand.

The next step was a core needle biopsy to remove tissue samples for testing. The nurse went over the process so I’d know what to expect. She scheduled it for the next week. Impossible not to think of the urgency this time. But a crippling winter storm meant it had to be rescheduled and to try not to worry about the delay. Two weeks after the follow-up mammogram, I had the needle biopsy. Sal went with me.

For being just an outpatient procedure in a doctor’s office, it’s intense. Needles and tools for extracting tissue – 12 samples at each site – and tools for implanting tiny markers the size of a grain of rice (I called them “my pieces of rice”) for future mammograms. Or to help the surgeon if they have to go back for a surgical biopsy, but I tried not to think about that. All of this while squished in the mammogram machine for an hour with three people working on and around you. They did a great job making it as easy and comfortable as possible, but there’s only so much that can be done to alleviate being stuck in a medieval torture device for a thousand years.

I came out feeling pretty battered. As we left, Sal squeezed my hand. I lived in a bra for four days straight and spent a lot of time with ice packs tucked in there.

While we waited for the outcome of tests, I tried not to think about the parallels to 2017. Appointments, procedures, even the winter storm…the dates of all of these landed on or near anniversaries of the same things seven years ago. But patterns aren’t fate.

Insurance, on the other hand…. The start of the year was also the start of a new plan year for my company’s insurance – and, as it happened, the company had also just switched insurance providers – so I was breaking that new insurance card in right away. By the follow-up mammogram, I hit my deductible limit. By the needle biopsy, I hit my annual out-of-pocket maximum. Neither of these amounts are small, even with decent insurance that I’m lucky to have through my job. I’ll be on a payment plan for at least a year and a half. Longer, if they agree to a smaller monthly payment like I hope they will.

I can’t help thinking what will happen if (when?) I reach some other limit I don’t know about that denies coverage, or if (when?) treatments stretch beyond this plan year. What if I reach a point where I can’t work anymore and don’t have this insurance? If things get bad, I don’t want to spend precious time working. What what choice will I have? I know that I’m lucky. I also know our system is Stoopid With Two Os. I should not have to be thinking about these things at a time like this. No one should.

So you might have breast cancer, now what?

Early the following week, the nurse called with the biopsy results. The good news: not cancer! The not-as-good news: not not cancer.

That’s how I explained it to people, anyway. Easier than explaining the nuances of atypical ductal hyperplasia, my actual result. Basically: there’s no clear sign of cancer, but it may be an unclear sign of something that could be or become cancer. The next step would likely be a surgical biopsy, but the nurse was scheduling me with the surgeon who would actually make that determination.

The surgeon explained that what I had isn’t the sign of potential breast cancer we typically think of. There’s no lump, and it doesn’t spread in the same way. That’s both good and not good. It’s more often benign (good!), somewhat less aggressive (also good!), and probably wouldn’t even require radiation or chemotherapy if they got it all (very good!). But it means a 2x-3x higher lifetime risk of breast cancer (not good), can spread in locations nowhere near the initial site (also not good), and can be trickier to remove (very not good).

That last part explained why I’d had to be scheduled with a surgeon specialist from the Advanced Surgery clinic.

Which is why the surgical biopsy wasn’t just a removal of tissue to test, it was a removal of (hopefully) all the tissue that potentially was or could be cancer. She would be thorough, she told me, but would remove only what she needed to keep it as cosmetically pleasing as possible.

Until this point, I had been thinking of it as basically the needle biopsy but with general anesthesia. I knew they’d remove more tissue, but this sounded more like…

Is this a lumpectomy? I asked. She paused. Well, we don’t call it that, she said, because there’s no lump to remove. But yes, the procedure is the same.

Slow exhale. Ok then. Sal squeezed my hand.

They scheduled my surgery for the afternoon of February 28th. Seven years ago, on February 27th, I had the first of what would be three surgeries. This time seven years ago turned out okay, I was better for it, my brain knew that. But the body keeps the score. And it could only remember what happened at this time seven years ago, not how it turned out. Patterns aren’t fate, but the body doesn’t know that.

The body keeps the score

In preparation for surgery, they needed to do a separate procedure to insert little radar reflector tags to help the surgeon identify (hopefully) all of the tissue that needed to be removed. More pieces of rice. It would be similar to the needle biopsy that I was still tender from. Was I available on the morning of the 12th for that procedure? That’s my birthday. Could I do it a different day?

Which is how I ended up spending Valentine’s Day in a medieval torture device for another thousand years. More time with ice packs. The two week countdown to surgery started. I stayed busy with the usual life demands and the extra work of getting ready to be out of commission for a little bit. I did and didn’t spend every moment thinking about what was happening and what it all meant and what if and what if and also what if.

A week before the surgery, sort of out of nowhere and also probably unsurprisingly, I hit a wall and absolutely plummeted. Down, down, down. It only lasted a few days, thankfully, but it was a vicious few days of brittleness and fragility and despair. I realized at some point that it was layers and layers of grief, new churning up old and older and oldest. Not that the realization snapped me out of it – if only it were so easy! – but recognizing Grief made it easier to put my arms around her.

That interlude of despondency did pass, though, and by the day before surgery, I felt more like I recognized myself. Which is good, because I wanted to go into that surgery feeling ready.

The issue wasn’t fear or second-guessing the decision – I wasn’t afraid and never questioned whether I was going to have it – and as surgeries go, it’s relatively low-key compared to a lot of routine surgeries. Same for the recovery. The magnitude is really all about the reason for this particular surgery…and all its implications.

And for that, I wanted to go in mentally and emotionally strong, determined to be my own biggest advantage. I couldn’t control whether the surgeon could capture all the tissue or how the tests will come out or if there’s going to be more steps after this one and what they’ll look like. What I could do for the person actually going through all of this was give her everything I’ve got.

She’s come a long way…she deserved my best.

The outcome

The surgery, the biopsy, the not-lumpectomy, whatever you want to call it – went well. I woke up minus all my pieces of rice and a chunk of flesh, plus a new incision and internal sutures covered by gauze and a waterproof sterile bandage. And a pink surgical bra, which I’ve been living in for a week and a half, with a week to go. Sal was there to squeeze my hand as I continued waking up in the short stay room.

It was a long day for both of us – we left the house at 11 AM and got home at 6:30 that night, just in time to give Waylon his chemo medication and both kitties the treats they’ve become so accustomed to that they can tell time without a clock. A bit of hot soup, pajamas, bed in the studio-turned-temporary-recovery-room. Falling asleep to walls covered in art, under quilts made by my mother. These things are medicine.

The next five days was a lot of resting broken up by soft foods, purring kitties, and slow binging of TV shows. I’d planned to at least read – I was gifted a lovely book I’d been saving to start during this time – but there’s a special kind of exhaustion during recuperation that limits your capacity for anything that requires exertion, including mental exertion.

I’m still waiting for test results. I still haven’t seen the actual incision. The pain and discomfort and fatigue will take a while to pass. I didn’t care as much about “cosmetically pleasing” when the surgeon discussed the tissue removal, my focus was on getting everything removed. I’m confident in her work, but I can see how my shape has already changed. The difference isn’t noticeable to anyone but me, but it affected me more than I expected.

Patterns aren’t fate

I’ve been doing a lot of pondering lately. Life, the universe, and everything. As one does. These are things I ponder all the time. But, you know. Potential life-threatening circumstances have a way of turning that pondering to a full-time job. It’s one of the reasons I haven’t been posting very often, or doing art, or writing, or pretty much anything. It’s another special kind of exhaustion.

I thought a lot about patterns while I laid awake, trying to sleep, mostly just resting with my eyes closed. Parallels to seven years ago. Patterns I ended then. New ones I started then. Patterns I still haven’t been able to shake, but want to. Need to, even?

Parallels in our world right now to a world a century ago, and less than a century ago. Patterns repeating themselves, to the horror of many and detriment of all. Patterns ended, patterns started, patterns never shaken but need to be. Do we want to, even?

I have no answers to the world parallels, of course. And not a lot of answers to my own parallels.

But I do have some. I can see the patterns I want to keep and the ones I want to keep changing. I can see the way seven years ago was a big transformation, a reset. I didn’t need this latest parallel to be reminded of 2017’s lesson because I never forgot it. But the lesson came anyway, and reminded me anyway, and this parallel is its own pattern. The difference isn’t noticeable to anyone but me, but it affected me more than I expected.

So I’ll give it everything I’ve got. Because I’ve come a long way, and I deserve my best.