The Beginning of the End

The week before Miracle Warrior (who I've begun calling MWFS for Miracle Warrior Fiedler Shimanovsky) arrives I have a slew of doctors' appointments. Everyone wants to see or at least speak to me before I deliver. First, I have a consultation with my new surgeon, Ed Phillips. I haven't been to the Breast Center in at least a month and the receptionist compliments my hair as I sign the necessary paperwork. I'm led to one of the examination rooms and am introduced to Dr. Phillips' assistant. She needs to update the system and asks me a zillion questions, most of which I've answered before. I'm annoyed and hate having to answer them, especially because I know I'm going to have to answer them all again once I meet with the doctor. Plus, some of the rote questions are so fucking dumb that quite honestly I don't know how to answer. Like "do you have any pain." Um, what kind of pain? MWFS is ripping my pelvis apart. Does she want to know about my vagina pain? Emotional pain? I'm afraid I'm going to die. That's painful. I have to ask her to clarify. She means cancer pain. I'm not sure what that means but I say no. After at least 30 minutes, I've answered everything and she leaves.

Dr. Phillips enters the room and gives me a hearty handshake. He's a stout man with a ring of white hair on his mostly bald head. He is not surgeon-like at all. He's warm and asks me several times how I'm feeling and doing and holding up. It makes me uncomfortable to have to say "I'm hanging in there" so many times. The more I say it the more I wonder if it's true. We go through my "case" and he examines me. We discuss radiation and he suggests that I speak to Dr. Botnick again about how necessary the radiation is and says that in his opinion, radiation will make any slight lymphedema I have worse. Ugh. He asks about my plan for reconstruction and says that he totally agrees with my decision to have expanders/implants instead of a more complicated flap surgery that entails a lengthier and more difficult recovery. I had been warned that I might need a blood transfusion during the mastectomies. Blood transfusions scare the shit out of me so I ask him if I'll need one. "Definitely," he says. "It's not 100%, but close. With the removal of two large breasts, it's almost a certainty." I'm so upset. I ask if I can donate my own blood. He doubts it since it's too early to donate now for a June surgery, plus I'm pregnant and MWFS needs all of my blood and I'll need it for my c-section. Then I'll be on chemo and my counts will be all fucked up. He suggests finding family and friends who will donate blood for me. I know I could have 98730023 pints of blood donated in a second, but I'm still really upset and really scared. If there's a .0001% of anything going wrong with the donated blood, it will happen to me.

The meeting with Dr. Phillips takes about 45 minutes and then we're done. It seems strange that we meet for such a brief period of time for such a long surgery, but I guess there's not too many variables for him. He tells me that he books up far in advance, so I need to set a surgery date with his assistant. I ask him how we pick a date when I don't know exactly when I'll be done with chemo. Plus, what if I need longer than the standard 2 weeks to recover before surgery? Will I have to wait months before my operation?? He promises that he would move heaven and earth for me and would never make me wait for any prolonged period of time to get this over with. "You've been through enough," he says. Damn straight.

I have a short period of time to spare before my next appointment of the day with Dr. McAndrew. I call Dr. Botnick to discuss my radiation therapy. He's not in the office but calls back within minutes. I ask him the details of my therapy. What exactly will he be radiating? Exactly how many rounds? Is he sure I need it? How are my odds of living improved with radiation? What about lymphedema and other side effects? Dr. Phillips had mentioned that in his opinion, if the lymph node near the clavicle is radiated the risk of lymphedema is high. After I spit out my 20 questions, Dr. Botnick begins by saying "let me remind you that you absolutely need radiation." I know. I know. I tell him that Boris has already told me that he will kill me if I don't get it. "And I'm second in line," Dr. Botnick says. He goes on. "I'm being conservative with numbers but your chances of survival are increased by 2-4% with radiation. But more importantly, your chances of a localized recurrence are decreased by 20%. If the cancer recurs in a local lymph node, which is more likely without radiation, your chances of survival are much lower. You have to do everything you can to prevent the cancer from coming back. That's why you're having radiation. Forget about everything else." He tells me that if my arm isn't significantly swollen when I start radiation (it's not - in fact during my most recent lymphedema treatment, the therapist measured my arms and they are the exact same size except for a .05 cm. difference in my wrist!) then radiation shouldn't change that (but many breast cancer patients I am friends with disagree). I guess we shall see. Dr. Botnick also tells me that he wants to meet with me before I have surgery. He still doesn't think I need a double mastectomy. "Just promise you'll call me before you do anything." Although there is nothing on earth he can say or do to change my mind, I promise.

Then I go to Tower to meet with Dr. McAndrew. Amazingly I only wait 5 minutes before seeing her. We discuss MWFS and then it's down to business about my second cycle of chemo. I will be receiving 2 chemo agents: taxol and carboplatin. She tells me that most of the research shows that weekly taxol is not only more effective but easier to tolerate. Done. However, most of the research on carboplatin is based on doses every 3 weeks. She has many patients who have received weekly doses and she believes that it's very effective, but there's not much data yet to verify this. Fuck. If there's no data, why think it's okay? She also tells me that although 12 rounds is optimal, I may only have 9 depending on how I tolerate the agents. The neuropathy can get so bad that it could cause permanent damage. And the risk of infection is incredibly high. So if I get a fever or infection that turns septic, the schedule and rounds will change. Fuck. Fuck. Fuck.

Before I leave I have a blood draw and set up my scans. The nurse taking my blood compliments my hair and how much has grown back. Then she says, "you know it's going to fall out again, right?" Ugh. Yes, I know. She tells me that when I'm setting up my chemo schedule, to set up the first treatment as early in the morning as possible. "The first infusion can take all day." I don't understand. She explains that many women have an allergic reaction to the drugs (including shortness of breath, skin reactions, burning and a host of other really pleasant things). "If you have a reaction, we stop the infusion, watch you, then start the infusion again when the reaction subsides." Jesus Christ. I still can't believe this shit.

I set up my scans and as the nurse is telling me what I can and can't eat before each and how long they will take (one of them takes 6 hours!) I just stare at her blankly. "It's so surreal setting these all up," I tell her. "I just can't believe these scans are for me." But they are.

The rest of my week is an emotional roller coaster. I am getting more nervous and excited for MWFS' arrival and more depressed and nervous and sad that I start chemo again on March 2. Just 2 weeks after I give birth. I didn't realize how horrible I felt on chemo until I wasn't on it. I've been feeling so good and happy these past few weeks. And now I'm just so sad to know that I'm going to feel like death again so soon. Maybe worse than death. Who knows? I hate the unknown. I hate chemo. I hate cancer.

But setting up my scans and second round of chemo means that I am approaching the beginning of the worst part of my treatment. The sooner it starts, the sooner it ends.