The Tuesday after Thanksgiving, I entered the hospital for day surgery, and to have that lump removed! I had convinced myself, and Richard, that this was just a formality to confirm that I did not have cancer. I assured my doctors that I was an unlikely breast cancer candidate.

Fortunately, Richard insisted on taking me to the hospital. I had visited the hospital the previous day myself, and had preliminary chest x-rays and blood tests done. Most of the paper work prior to the surgery was completed, too. I browsed in the hospital gift shop that day and bought an ice cream sundae in the cafeteria. I made a brief visit to the hospital chapel and left fervent prayers that I would not be found to have cancer. I went thorough my litany of anxiety reducing prayers, ending with "thy will be done".

Fear of having to be "the patient" instead of "the nurse" enveloped me as I drove home that day. On the seat beside me was an envelope with my pre-operative instructions: No food or drink after 11pm...Surgery was set for 7:30am.

I prayed myself to sleep that night. I cried with Richard’s sympathetic arms around me. We had been married twenty months at that time. I let myself verbalize that it was not fair to either of us. Richard said, "One step at a time". I slept soundly. The alarm awoke us both at 5:30am.

The day surgery department had efficient, kind nurses. They had me in the hospital garb and with an I V going in my left arm almost before I had time to worry about those details. I had the nurse contact the anesthesiologist so that I could be sure to let him or her know that I didn’t want to be put into such deep sleep that I would have to be intubated. Intubation means having an anesthetic that requires having an oxygen pump machine breathe for you.

When the anesthesiologist arrived, I explained my fear of being put deeply to sleep. He obviously thought that I was real anxious about what he considered a minor procedure, but he agreed to my request without too much resistance. Looking back, I can say that I went to surgery with some sense of control over my situation. Richard brought my bag of personal items and purse and walked next to me to the surgical suite. It was well after dark before I awoke that day. I felt for my breast. It was tightly bandaged. Rich was sitting beside me. The nurse came in and tried to get me to sit up. I was pale and had to lie back down. I tried to sip water-oops, nausea. I dozed a while. I received a shot for nausea. One hour later, I was able to sit up and slowly get dressed with Rich’s help.

We went home later that night with a prescription for pain medication, acetaminophen with codeine. As stoic as I was attempting to be, I was grateful for that the next day and for several days later.

I sat out by our pool in the warm sun the following day. I told myself several times, that the worst was over. I even had my 35mm camera take an automatic picture of myself sitting there, to reinforce the "normalcy" of my minor surgery and biopsy.

My right arm was sore for a week. The incision area held a small rubber tube that drained quite a bit of clear fluid from the incision site. I felt sorry for myself. To cope, I worked a couple of night shifts at the psychiatric hospital. To my relief, I forgot all about the sore breast while I was working. I took only plain acetaminophen for any remaining soreness.

Richard and I did talk about "what if" it’s a diagnosis of breast cancer? I generally knew what choices I would be facing:

I talked to Richard in general terms. It was too painful, yet, to extrapolate those ideas directly onto myself. I would say something like, "Usually, the choices would be certain kinds of chemotherapy ...sometimes radiation is a choice". Richard is so good at keeping an impassive expression. How dearly I loved him for letting me go on and on when I needed to be examining my future choices.

My own psyche was dead set against a mastectomy at first. When I was seven years old I almost lost a leg to what was thought to be bone cancer. My parents refused to have my leg amputated, as doctors recommended. They sent me to Ann Arbor Childrens’ Hospital near Detroit for alternative treatment. It was discovered that I had a bone infection which was healed twice by newly discovered antibiotics. The process was arduous, and I was separated from by family for months. I was completely healed and have no resulting handicap.

When I was seventeen, I was a passenger in a car that crashed into an embankment. I suffered extensive left sided facial injuries, and lost partial sight in my left eye. Against serious odds my left eye was repaired. I endured much emotional pain and adjustment trauma. The grief at being disfigured as a teenager required long years of counseling and adaptation.

Looking back at those difficult times, I know that the support of my family and close friends did a great deal to help me recover.

When a child, my parents did not expect less from me because of my health. My brother and sisters certainly didn’t! I was the eldest.

My family often moved, and I learned from a young age to keep in touch with family and friends by writing letters and remembering special events. These practices evolved into periods when I would keep a journal, in which I could pour out my feelings about various things. I was confident, as I struggled with the uncertainty of my current situation, that if I did have cancer those cathartic methods of healing worked before, and they would work again.

I had made a preset appointment to return to Dr. Sea and have my incision checked, the drain removed, and review the outcome of the surgical report. Dr. Sea was not smiling. I knew before he opened his mouth. He stood looking at the preliminary written lab report, "It is breast cancer." The breath went out of me.

"What kind of breast cancer?" I asked

Then he looked at me, sitting on the exam table with tears in my eyes.

He said, "Just the standard kind. We need to talk about what to do next".

I said, "What do you normally do?"

He said, "A mastectomy, and we need the axillary dissection to determine if it might have spread."

I said, "You do a lumpectomy. I don’t want a mastectomy. Just take out the lymph nodes."

He sat down and said, "Well, I didn’t expect it to be cancer. I need to go back in and remove a little more tissue around the boarders of the cancerous area."

I shook my head in agreement.

He said, "Some people fear the cancer so much that they will have both breasts removed if they are even at high risk for breast cancer."

I said, "I want to keep my body parts." Now, I am wondering if that is also from my Roman Catholic background.

I am not suggesting that others would make their decisions based on my life history. Do look back at your life, and your roots, and appreciate the positive influences that they may provide to you now. Trust your instincts. Lean on your loved ones. Those extended family and friends are a part of who you are.

One of my friends has two lovely breast implants. She accepted the offer of a double mastectomy when a breast cancer lump was found in one breast. She loves those new breasts and never has to fear breast cancer lumps in them. Somehow, I am not as afraid of breast cancer as I am of losing a body part. Perhaps, I should not be? That reasoning is not based entirely on my own experience. Way back in the early 80’s, the oncologist for whom I was a nurse, believed that a wedge resection or lumpectomy offered the same cure rates as a mastectomy. This has held up until today, and the more radical surgical approaches for breast cancer have been replaced by less disfiguring approaches.

The fearful methods of "slash" (surgery), "poison" (chemotherapy), and "burn" (radiation), have all been made less awesome by science. The real key to survival is early detection. It is much easier to remove, even an aggressive breast cancer from a localized area, than it is to discover its insidious growth deep inside the body. That is why, it is important to tell your physician to remove the alien growth as soon as possible. If your physician will not remove the growth immediately, go to a surgeon who will. Tell your doctor that removal is necessary for you. After the lump is out it cannot turn into cancer. The physician can happily report a negative test result. If it is cancer you would be talking about what next? "What next" is most fearful, if you must be deciding whether or not to then receive chemotherapy and/or radiation.

When I had completely healed from the biopsy, I went to day surgery again. This surgery was to remove a limited amount of lymph nodes in the area of the breast cancer to attempt to determine if the growth may have spread. Richard took me to the hospital. Leaning on him was so comforting. I insisted that he go to work though. I could not have him sit all day and wait for me.

Dr. Sea agreed to remove the least amount of lymph nodes needed to achieve a clearer picture of whether or not the cancer had spread through the nodes, and possibly to other areas. A final diagnosis is determined by a study of the microscopic cells of the cancer, how it is growing, and how far it may have spread. The first place that is evident is in the biopsy of adjacent lymph nodes. The number of lymph nodes involved corresponds to a particular stage for the breast cancer. These stages then correspond roughly and clinically to the risk for the breast cancer to have spread to other organs or areas. These stages correspond, as determined by your physician, to the choices of treatment that you will decide upon.

Looking back, I would say that if you have personal contact with anyone else who has encountered cancer treatments, talk to them. Chemotherapy for cancer treatments can be heavily countered by drugs that almost eliminate nausea and vomiting. That does a lot to enhance the quality of life while you receive chemotherapy. You are also much less likely today to have to spend time in the hospital. The drugs can usually be given a your oncologist’s office or at a comfortable outpatient clinic. You will have an expert Registered Nurse administering the drugs, with the physician only a few steps away. This is a desirable circumstance for receiving chemotherapy. The atmosphere is pleasant and the skill of staff exceptional. If you have any reservations about the services or staff available to you, ask. Do not be intimidated because this is the medical field. You doctor is not a god. Your nurses are not saints. They are all as good as their training and experiences. If they are going to provide you with the care and treatments that you are entitled to, they must also be willing to communicate with you. I realize that throughout all of this medical maze of choices you will have uncertainties. Fear sure does make you forget those questions that you had thought of while lying in bed or over the weekend, etc. Write the questions down. Bring them when you go to the doctor’s office, or call on the telephone and ask to speak to the doctor, with your questions in hand. Doctors who deal with cancer patients realize your anxieties. They are usually willing, indeed want, to satisfy your questions. Hand your list of questions to the doctor. Plan to bring two or three questions, written down, to each office appointment. If you have any questions that can’t wait, call the office between appointments.

Some of you may choose to receive chemotherapy at home. These days qualified Registered Nurses, specially trained, may be available to provide home health services including administration of chemotherapy products. Discuss the nurse’s qualifications to administer cancer chemotherapy drugs with the agency sending the nurse, and then again with the RN in person. Cancer medications are toxic and caustic by nature. Side effects can further complicate your treatments, so you want to know that your nurse is well versed in dealing with such medications and aware of potential problems. Always request written information about the drugs you will be given. This will alert you if you happen to experience any side effects. Keep your physician’s, nurse’s and emergency numbers within easy reach.

There are several excellent books, available in book stores and libraries that go into depth about breast cancer staging and treatments. You should also obtain information from the American Cancer Society and other support groups.

The period of time between my actual diagnosis and having the lymph nodes removed was quite traumatic. I recently read in a "Science News Magazine", that an experimental method of using a radioactive dye to adhere to lymph nodes can determine, without surgery, if a cancer has spread. Oh, how I would have loved to have that available to me! I was a basket case. I was so sad. I had shared my diagnosis with very few people. A few neighbors, and my children and my siblings, parents, and in- laws knew. My sister in law, Jean, had a best friend who was in the process of receiving treatment for breast cancer. She told me stories about how they would stop by her doctor’s office on the way to lunch or shopping. It was so reassuring to hear those stories. Jean called me often. It was such a weight off my shoulders to be able to compare my own experiences with another person’s. Jean asked me questions about how Richard and I were handling various aspects of my care and treatments. She knew from her friend what kind of situations might arise. It also gave me a chance to ask questions.

Jean is a school teacher. She is intelligent and sensitive and brave. She and I had only been closely acquainted since I married her husband’s brother. I will always be grateful to her.

I had shared my diagnosis with my own brother, sisters and parents by then. It was done with a defensive air of optimistic over confidence. It took very little sympathy to tap into that reservoir of tears just below my logical front.

My real fear was death. Disability ran a close second. Dr. Sea was made well aware of my fears. I also commented to him several times that I did not want any more lymph nodes removed than absolutely necessary. I wanted to minimize my anxiety about possible future lymphadema. I said to Dr. Sea and anyone else that I talked to that my impending surgery, "Is not fair! I am a nurse. I should be taking care of patients-not being one"! Right up until I was put to sleep in the surgical holding area, that was my cry. A surgery suite nurse was crying with me when Dr. Sea came in to talk with me before the surgery. He stepped near me quickly and said, "Are you all right"? I could only shake my head and said, "No, this is just so unfair. I should not be the patient"! He shook his head in agreement and I saw tears as he looked straight into my eyes, and then moved about thirty feet away and began writing on his clip board.

Again, I insisted not to be put deeply asleep during the surgery. I had to explain my reasons to a new anesthesiologist. Anesthesiologists have their own ideas about what is best for the patient. My request was respected.

Richard had stayed with me right up to the surgical suite doors. I wanted to scream and cry but his strength passed to me, as I gripped his hand and tears streamed down my face. I felt guilty for causing him "trouble". The few times (I hope) that I said that to him, he hugged me and reassured me that wasn’t true because I had not deliberately acquired cancer! Now, is that man rational, or what? Even when you know these basic truths, it is invaluable to have a supportive person who can verbalize them. More is the bonus if it can be a spouse. Richard’s overall attitude toward my breast cancer has been to verbalize reality when my great "dread silences" replaced my usual verbal approach to the world.

Richard was at my side when I awoke from the lymph node removal. I could move the fingers and my right arm without pain. Richard and the kind nurse helped me dress and put my shoes on. Richard stopped on the way home and dropped off my acetaminophen with codeine prescription with the pharmacist.

Thanksgiving, Christmas and New years had come and gone as I struggled with efforts to diagnose that sly lump. By mid January the verdict was in: intraductal, invasive carcinoma.

Ten lymph nodes were removed. Two and a half nodes were "grossly" involved with cancer. These nodes were immediately adjacent to the cancerous growth. That was good. I clung to that belief. I also took refuge in the thought that what ever cancer I had was now removed. Was it? In the awareness that cancerous growths can be elusive enemies, the next round of serious considerations faced me.