While we're waiting for my surgery, Boris and I begin to meet with oncologists and I get tested for the BRCA1 gene. I also start reading every study I can find on breast cancer and pregnancy.
Our first meeting is with a well known breast cancer expert at St. John's. I ask her if I can just have a mastectomy and move on with pregnancy and life. Unfortunately, the answer is no. She says that my tumor is too aggressive and that regardless of whether the cancer has spread to my lymph nodes, I'll need chemotherapy. Throughout our meeting she calls me "young lady," and reminds me many times that breast cancer is curable and that I need to do what's best for me so that the cancer doesn't spread. I ask her about the baby and tears fill my eyes when she says that in her opinion, keeping the baby is too risky for both of us. In her opinion there aren't enough long term studies regarding the affects of chemotherapy on fetuses. She also tells me that I have a very high likelihood of being infertile after treatment. I tell her that I desperately want more children. Two more to be exact. She's not cold or uncaring, but very frank and just reiterates that my life is the priority and that she wants me to be around for Miles and that needs to be my focus. She basically has told me that I need to get over wanting more children. Jokingly, I ask her if I'm going to be bald. She looks at me seriously and says, "yes." That's it. Conversation over. I start sobbing to Boris. How the fuck can this be happening? I'm so heavy with sadness I don't know how I'm going to survive.
That same week, I speak to three oncologists via phone and email (including Dr. Susan Love) about the opinion I was given. People are unbelievably nice to you when you tell them you're pregnant with cancer. I have cell phones, home numbers, email addresses and have been told by several doctors to call them at any time. They all disagree with the initial opinion I received. I meet with a fourth oncologist at Cedars who had just met with the hospital's tumor board (comprised of 30 doctors including 7 oncologists). They also disagree. He says that there is no reason to terminate my pregnancy (no one says the word abortion in any of my discussions. Too unsavory to call it what it is I suppose). He says there is plenty of long-term data about chemotherapy during pregnancy (I've already read a zillion of the studies) and that the treatment he would give me doesn't negatively impact my recurrence or survival rate in a significant way. I tell him that I mean no disrespect by my next question, but I ask him about the religious make-up of the tumor board. I explain that Boris and I believe in quality of life, not just life and that we want a healthy, happy baby, not just one who is breathing. He assures me they are a sacrilegious bunch. I love this man. I feel much more positive.
In the midst of choosing an oncologist, I go to see my perinatologist, Dr. Silverman, to have my 12 week ultra sound. Junior Jr. (another boy) is perfect with a "beautifully thin neck." Dr. Silverman also agreed that the risks of a major defect or malformation of the fetus after the first trimester is very small (about 1%). It's still impossible to fathom how I can't take Advil or have a glass of wine, but chemo is safe during pregnancy. Our biggest risk is having a small baby. Apparently the placenta absorbs the brunt of the chemo and protects the baby, but then isn't always the best at delivering food and nutrition. Dr. Silverman said my chances of a small baby in utero are 30-50% and if the baby's growth is too small, I will deliver early so he can gain weight after he's born. He was also the first doctor to tell Boris and I that as we weigh our options, we need to have a frank discussion about whether Boris wants to possibly raise 1 or 2 children alone, as death is an unfortunate reality. He reminds us that we have no idea if or how my body will respond to chemo and unfortunately, I have the worst tumor type for recurrence and survival. Boris refuses to have that conversation because he says death is simply not an option.
Later the same day, I meet with my fifth oncologist, Philomena McAndrew, who was recommended by almost everyone we've spoken to. Her practice is insanely busy but she is considered one of the best and I love her from the start (I initially was told I couldn't meet with her until October even when I told the receptionist I was pregnant with cancer and think I got the appointment after several doctors my family knows called on my behalf). She meets me in her office and immediately hugs me. She agrees that continuing with my pregnancy is safe, if I think I can handle it. We spend over an hour discussing various scenarios, courses of treatment and my pregnancy. I ask her if I'm going to lose my hair (I'm taking a poll in the hopes that someone says no). She says yes. Shit. It's then that I notice that she has thick, straight hair that falls just below her back. Rude. She introduces me to her staff, the nurses and they all look at me with such sincere sadness I think I'm dying for sure. These are medical professionals who deal with cancer patients all day long. But pregnant cancer patients...not so much. We're special. And sad.
Boris and I have all of the information that we can possibly have at this time. For now, we wait for my lumpectomy and the results. Boris and I really want this baby and are relieved that all of the doctors believe I caught my cancer early. If my lymph nodes are negative, my cancer is stage 1 and there's a very small chance the cancer has spread. If that's the case, we have decided we're going to keep the baby. If my nodes are positive, then it's stage 2 or worse and we're going to "terminate the pregnancy" so the doctors can immediately determine if the cancer has spread to my bones, brain, liver etc. and can determine my treatment accordingly.
I am trying to be positive and remember that breast cancer is curable and that my mom is the best proof of that but it's incredibly hard. I went from worrying about whether Miles naps well to worrying whether I'll be around for his 5th birthday. I am more thankful for Miles now than ever because I have to be strong for him and am having a tough time being strong for myself. I just break down all the time, but then he smiles at me or takes a few wobbly steps before tumbling down, and he shrieks with laughter and makes me smile and laugh and forget what's going on, even for a few minutes.
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