Up front, let me say that I intend to "share" this horrific story with you. You will read of my care givers and treatment side effects. You may take into account that I am a Registered Nurse (RN), but first I am a breast cancer patient in this story. Incidentally, I am a Clinical Psychiatric Nurse Specialist, a role in which I have learned much about myself. I intend to speak in real terms, not medical jargon. My intent is to help you devise your own "plan of care". After all, you are the central star in your own unfolding story.

Unwittingly, this story will be a look at my tendency to procrastinate. In looking back at the discovery that I had a lump in my breast, I became aware that I only paid marginal attention to my own "breast health". After all, both breasts were there every morning when I woke up.

When I was twenty-five, and very thin, my first husband often suggested that I have a breast augmentation (enlargement) because I wore a 32A size bra, when I wore one at all. Those little breasts were just fine with me. I did, sometimes, wish that they would look bigger when I wore certain clothing. Once, I got a few padded bras. When I went to visit my family, my Father said, "What did you do to yourself"? I had to assure the whole family gathering that I had not had surgery to look sexier. He joked with me about it later, and I defended my little breasts after that embarrassment. By the time I was thirty five, I had gained some weight, and wore a 34B bra. I was very proud. I exercised frequently and took vitamins, and considered myself in touch with the most healthy modes of eating and drinking and other positive health practices.

At thirty five my bust size was 36B. I felt very proud, even though a portion of the adipose tissue below the belt had increased. I had just completed my college education and had been a practicing RN for one year.

By forty five, I was divorced. My son and daughter had embarked on their own careers and education, and I had just finished my Masters degree in Mental Health and Psychiatric Nursing. I was then wearing a 36C bra, and had two flawless mammograms under my belt during the previous ten years. During this era, women’s magazines and the medical community were in public conflict about when a woman should begin getting mammograms. Fifty, instead of forty, was often promoted as the time frame for beginning annual mammograms.

There was no history of pre-menopausal cancer in my immediate family. Two of my father’s sisters were diagnosed with breast cancer in their forties or fifties. There was no other family history of breast cancer, on my father’s or mother’s side of the family. My mother is an only child, still living and well. My grandmothers both lived into their nineties. One grandmother died of a stroke, and one of heart failure. I know of no other cancer in my whole family. Possibly, breast cancer lurks in the family tree in distant New England, where all of my mother’s relatives live. She says she is unaware of any such occurrences of cancer. I was raised primarily around and among my father’s extended family.

I married for a second time in April of ‘94. Richard and I were living happily ever after, and enjoying each day, and one another, immensely.

I had gone for a complete physical and breast exams twice in the year and a half since I had remarried. I had never had a history of cysts or irregular breast tissue. Prior to one of those physicals, I had thought I felt a pea size bump deep in my right breast. Neither Dr. Rose nor I could detect it again during a searching examination. We agreed that I would get a mammogram before I got my next hormone replacement check-up, scheduled in about six months. Taking hormones followed a hysterectomy, with tubes and ovaries removed, which I received five years earlier.

Why did I settle for waiting to have that breast mammogram? Let’s see, I had several excuses. I was no longer sure that I had ever felt a lump in the first place. Dr. Rose couldn’t find it. It probably was benign if it was there at all. Even if it was cancer, we know that cancer grows slowly. There was no reason that I would ever get breast cancer. Besides, God knows that I don’t deserve breast cancer.

It is now difficult for me to face all of the paltry reasons that played through my mind as I fought down the idea that I could have breast cancer for any reason.

Several months later I felt an unmistakable lump the size of a quarter deep in my breast on the right side. It felt exactly like the lumps we practiced finding in the breasts of teaching dummies in nursing school. A lump still didn’t mean breast cancer to me. Yes, I felt a little fear, and I was breathing fast. I soaped the area liberally and felt the area again. Something odd was there. It was so close to my underarm, it could have just been a swollen lymph node. I put my extended right arm down. I felt again. No, it is not there! Good. I extended my arm, and moved my fingers lightly over the area. No, no lump. I pressed harder. Yes, there it is. I felt rather numb. My mind was whirling with dread and conscious denial.

I completed my shower, took a long time shaving my legs. I looked in the mirror. I told myself out loud to stay calm. I got back in the bath and lathered every inch of my body, saving the right breast and underarm for last. It probably won’t be there when I feel again. I slowly extended my arm and froze as I easily located the worrisome lump.

How could I have a lump in my breast, that size, and not have realized it sooner? It just can’t be there because Richard surly would have discovered it sooner. A voice outside my own seemed to take over in my head. "I have been doing breast exams regularly for years. . . . I’m a newly wed with well loved breasts. . . . Neither my mother nor any of my sisters have had breast cancer. . . . This doesn’t have to be cancer. . . . It could be some kind of cyst. . . . It’s almost the holidays. . . I have an appointment in February for another routine check-up, anyway. . . . It is a cyst and will probably go away by itself by then."

While this voice vigorously convinced me that this was "no big deal", another voice in the back of my mind was screaming, "You have cancer!"... "You are going to die!" "Be reasonable," I said out loud. In my rising panic, I knew that I had to mediate between those two points of view racing around in my head. My usual approach to combating fear or high anxiety is to meditate on a familiar prayer. Automatically I launched into, "Our Father who art in Heaven, hallowed would be Thy name; Thy kingdom come; Thy will be done on earth as it is in heaven. Give us this day our daily bread; and forgive us our trespasses as we forgive those who trespass against us; and lead us not into temptation, but deliver us from evil. Amen."

I am pretty sure that I said it twice before my breathing slowed down. I took a couple of deep sighs, and had a flashing thought that when I would walk into the living room and approached to sit next to Richard on the couch that he would suddenly look up and say, "My God, you have a lump in your breast!" My mind switched into the "protect Richard from the truth mode." "After all", that voice in my head resumed, "It’s probably nothing."

Richard had already established himself as a strong emotional support, so I could not turn off my desire to share my fear. I needed to tell him. I needed his support and reassurance. On some level, I knew that I could be more objective and practical if I talked to Richard about my dreadful discovery. I was so afraid that I got up from the couch several times and went into the bathroom to again feel for the growth. I probably had a serious expression on my face, if not a furrowed forehead. Rich said, "Are you all right?" I said, "No, feel right here and tell me if you feel a lump." So much for being coy. He easily found it when I held my arm in just the right position. I told him how I had discovered it. We sat next to each other, with him holding my hands. I leaned against him. I was thinking how this could possible interfere with our future plans. I could be told that I needed a mastectomy, chemotherapy, hospitalizations. Nurses probably do make the worst patients. My mind was conjuring up every complication known to medicine. I was remembering the deaths of my own patients who had end stage illnesses. As Richard held me, fears of the unknown and images of death danced in my head. Somehow, his arms gave me the courage to push the dark thoughts away and speak logically. I remember telling Richard that I had a doctor’s appointment in a couple of weeks, but that I would call Dr. Rose in the morning and tell him of our discovery. Richard agreed and I remember going on to reassure him about the minimal odds that it was, indeed, cancer. "I have no family history, etc". I can still feel his arms holding me close. I remember feeling guilty that we had only been married a year and a half and I was causing him this great concern. At the same time, I was aware that I did not know how Richard himself might choose to cope with such spooky prospects. He seemed to sense that I was holding onto my own coping skills by a thread.

We continued our usual evening ritual of reading and television. Later, as I was lying in bed in Rich’s arms he said, "You are going to call the doctor tomorrow, and no matter what we have each other." It was very reassuring to have someone strong enough to share this grief and trouble. I slept well.

Richard had a flex schedule and by the time he left for work the next day, I had already made a new medical appointment for the following day. On one hand, that was reassuring. On the other hand, Dr. Rose wanting me to come in right away was startling. Dr. Rose too quickly responded to my need to be seen regarding ‘the lump’. What, no two weeks wait? My anxious mind screamed.

Fortunately, human beings have a powerful survival instinct. In times of extreme fear and stress the focus on the self and the immediate situation intensifies. I am usually focused toward others. Perhaps it’s the nurse in me. This psychological effect further added to my stress. I consciously wanted to reach out to my mother and father and sisters and brother. I could not. Thoughts of pain and death passed through my mind like scenes rotating inside a kaleidoscope. I felt guilty and hopelessly sad at even inflicting the "idea" of breast cancer on Richard. Was this going to create financial strain? What will happen to our closeness and affection? "Oh, my God, I can’t do this!" In my head, "Well, Old Girl," my mother’s sweet pet name for her eldest. The memory of those words was comforting. My Mother used to get me to set still and study or do my chores or prepare for a speech, by taking away my arguments with those words.

I admit, even the idea of canceling the appointment, and forgetting my discovery entered my mind. Could I pretend as if it had never happened? Oh, that tricky denial.

I was off to the doctor for my two pm appointment. My right outer breast was sore from so many frequent pressing checks.

Yes, the unbelievable lump was still there. Dr. Rose had no trouble finding it this time. My experienced touch guided him. I talked a lot to convince him that the odds were on my side and it wasn’t cancer. He said it was located in the area of the right outer breast where cancer is most often seen. Next, he said, "biopsy". Somehow, I knew that I wanted that entire lump removed as soon as possible. Suddenly, I felt strongly that this growth might turn in to cancer. I remembered Dr. Styles, an oncologist, saying that cancerous type growths and tumors were found in every autopsy that he had ever done. More about that later.

Dr. Rose gave me my biopsy choices. A needle could be used to extract a portion of the growth and examine it. A part of the growth could be cut out surgically. "I want it all removed so it doesn’t turn into cancer, if it isn’t cancer now". I sounded pretty confident. I felt as limp as a dish rag. I was numb. Dr. Rose sat down and was actually looking directly at me. He was aware that I am an RN, and I had told him that I had worked for an oncologist in the past. His attentiveness was scaring the heck out of me! He picked up on my urgency to "get this out as soon as possible". Dr. Rose said, "I’m going to refer you to Dr. Sea". I said, "Is he an oncologist"? Dr. Rose said, "No, he is a breast specialist. He will do the biopsy. Then we’ll see if anything else is necessary."

I liked Dr. Rose, but I was prepared not to like "the breast man". Dr. Rose said, "Dr. Sea’s office is right upstairs, you can make an appointment with him today". I felt like Dr. Rose’s voice was far away. I was sitting on the exam table facing him and staring without blinking. He said, "Are you okay?" He has a neatly trimmed beard. His eyes are blue. I had tears in my eyes. I could not hide from his gaze. I wiped away the tear that slowly slid down my cheek. I slowly nodded my head. I stood up and he put his hand on my shoulder. We walked up the corridor together, toward his receptionist. He told her that I would be coming back to see him after I saw Dr. Sea, who would be doing a breast biopsy. I was not able to speak. Uncontrollable tears pushed at my eye lids. Jennifer’s sympathetic expression, brought on by Dr. Rose’s personal concern wasn’t helping, but I was so very grateful for the caring support.

I took the elevator up to the second floor. Dr. Sea’s receptionist set up the appointment for the following Monday. This was to give me time to have a bilateral mammogram, at yet another, office and bring the report back to both physicians. Such is the world of HMO’s. I can’t say that this was an unfortunate circumstance. Looking back, it forced me to take part in my own health care. I had to make plans, organize these activities and act on them. At the time I felt a little angry. I wanted to be helpless and mentally shut down, so that those ugly flashes of impending death would not interfere with my vision.

On my way home, I stopped at a Mexican restaurant and ate hot salsa and drank a margarita. I wanted to drown my self pity in food. "Oh, my God, this just can’t be happening to me," kept going around and around in my head.

My next stop was the public library. I went to the references and sought information, any and all that had to do with breast cancer. Dr. Love’s Breast Cancer Guide was the number one recommendation, by the sympathetic librarian. She led me right to the row of books on breast cancer. There were about ten on the shelf. I was disappointed. I had imagined an entire row with hundreds to choose from. I wanted to read the personal stories of real people who had dealt with the fear and dread that I was experiencing. I took an arm load of books and sat at a table to look them over. The majority were pretty impersonal and technical. I was looking for the experiences and thoughts and feelings of real people at that time. I had read a few articles in nursing publications, written by nurses with breast cancer in the past. I could not find such a book among those available. I needed some guidance. How does one deal with this uncertainty and fear? What does one do with these surreal feelings? I did not even know if I had breast cancer, but I was acutely aware of the ways that my life could and would change if I did. I felt desperate about how to make logical, practical decisions to insure my most favorable outcome.

I had quite a bit of first hand knowledge about the disease of breast cancer, but when I factored myself into that equation, I felt panic. I felt extreme anxiety. I also felt a tremendous aversion to surgery of any kind, let alone breast removal. More on that later.

I left the library that day with no books. I went home and read my own clinical, impersonal reference text books on breast cancer. I also reviewed three years of RN Magazines and American Journal of Nursing publications, reading the most current articles and information regarding breast cancer. I read late into the night.

I went for my bilateral mammogram. Prior to the appointment, I spoke with my daughter, who remembered my last mammogram had been when she was a senior in high school. Had that been ten years before? She was sure. So, I did not have any recent mammogram to compare with those I would be getting done. I‘d had regular physicals, at least. This realization evoked guilt, and jolted me to reflect on why I may have not discovered this growth sooner.

A few years earlier I had participated on an ethics committee, discussing the relative importance of frequent mammograms. Recent healthcare reports give conflicting advice about whether annual mammograms were needed prior to age fifty. Research indicates that the statistical survival rate is the same for breast cancer victims whether they have frequent mammograms or not. No clear path was evident.

An appointment had to be made at the mammography center. A prescription was required, which Dr. Rose had given to me. I filled out many forms. I sat in the lobby of that radiology center with a sad looking group of patients requiring or scheduling various x-rays or other internal imagining. No one made eye contact. Physical scars and signs of infirmity were obvious on most of them. I felt lucky that I still had my fifty-fifty chance of being disease free.

The mammography technician had a friendly and reassuring approach. After two pictures of the right breast showed no abnormality, and I had assured her that the growth was to the far right outside of the right breast. She consulted with the radiologist, who came into the mammography imagining room and examined the lump spot externally. I was then placed in a position where my body was at a right angle to the mammography x-ray plates. X-rays were never taken in a more awkward a position. I waited in the outer office as the last set of x-rays were developed and examined. "That was a good picture", my technician said. Depends on how you look at it. I was told that I could pick up my written report and x-ray images prior to my visit to the breast specialist, Dr. Sea, the following Monday.

All three medical offices were within two blocks of each other, about five miles from my home. I had to obtain referrals from Dr. Rose, my primary medical doctor, to see the other doctors and have the mammogram testing. Dr. Rose’s insurance representative had to obtain approval before each office visit with specific approval for each service.

The day arrived for my visit to Dr. Sea. He, also, is about my age, with the beginning of salt and pepper hair. He had his job cut out for him in dealing with me. I did weigh various approaches to diagnosis prior to my visit with him. Day and night.

Dr. Sea was pleasant. I told him that I had worked with an oncologist. He explained that his specialty was not oncology but "breasts". "Good", I said. He began talking about my choices of biopsy, which included some extremes. I perceived them to be excessive or inadequate. He said, "We can do a type of needle removal of cells for testing or take a portion of the lump for testing". I blurted, "I want the lump removed even if it isn’t cancer, now, so that it won’t turn into cancer later." I said other things about possibly missing actual cancer growth by taking a small area. "If I must have any surgery, I want the maximum benefit, and I don’t want general anesthesia." This time he looked directly at me and seemed surprised and nodded and said, "Okay. May I ask why you don’t want anesthetic?"

I blurted, "Once, I was the nurse who prepared a patient for a breast biopsy and something happened with the anesthetics during surgery, and she is in a coma today."

He said, "Oh". Then he explained that I would be talking to the anesthesiologist before surgery and I could tell him what I wanted for anesthetic.

Dr. Sea said that I could have the whole lump out even though he didn’t see that I had a high risk for breast cancer. The WHY flashed through my mind again. Not the "Why me, Lord?", but why would I have cancer?

Thanksgiving was fast approaching. Dr. Sea and I scheduled the biopsy for the following week. I drove home in a daze. I knew that Richard wasn’t fond of hospitals. I strongly considered driving myself to the hospital early in the morning, and driving myself back home by the time Richard had returned from work. It’s a good thing that I didn’t. I was soon compelled, by conscience, to tell Richard all. I needed his strength. When he came home, I met him at the inside garage door and just fell into his arms crying, and complaining, "I don’t want a biopsy, I don’t want surgery, I don’t want anesthetic. If I have cancer the doctor will want to do a possible mastectomy and remove my lymph nodes, and then I could have trouble with lymphadema!" All of my worries and fears flooded out between sobs as he held and patted me. "If I have cancer, I might die!" The darkest fears surfaced, and then I felt such relief, that I could apologize for the outburst. I looked up at Richard to see how he was responding to my grief. You know, in real life things seldom go the way we imagine. I was trying to protect his feelings, imagining that I was in total control, so mature, and confident that I only had some benign insignificant lump. Richard led me to the couch and we just sat there wrapped in each others arms for a long while. It may have looked peaceful, but I was sucking every drop of strength out of him that I could absorb. Eventually, I felt weary but calmer and I sat up. He said, "You will find out exactly what you have or do not have, and what the options are, and then make the best choices to insure recovery." Now, how could he make sense of all the information and anxiety whirling around us with that one statement? I only had to say, "Okay".

We spent Thanksgiving with Rich’s family. I did not want to cast any shadow on the festivities, so I did not mention the impending biopsy. I was amazed how sad I felt. I was sure that I was not going to be very good at the patient role. It was as if on some unconscious level, I knew that I had breast cancer.

After caring for breast cancer patients for years, breast cancer has always been my particular dread. I attributed my sadness to be related to my work history and the fact I did not want to be the source of unhappiness or worry for my friends and family.