Today’s theme song is brought to us by the one and only Nat King Cole: Smile. The other day, I cried for the first time since this breast cancer business started. It happened during an appointment with my surgeon. You may be thinking, geez, the communication thing must be getting even worse! Not so. She was the same wonderful person I met during the first appointment, so I am disregarding the second appointment as an off day. I had met the plastic surgeon, a lovely woman double-boarded in general surgery and plastic surgery, who made me laugh when she asked if it would be OK if she made #LeftBoob the same size as right boob. Ha! Would it be OK. She thought reconstruction was definitely possible and asked me to set up another appointment with her the week before surgery. She was going to follow up with my surgeon, and I thought we would be good to go.
Enter: The Tumor Board, a multidisciplinary group of 20-30 doctors before whom oncology cases are presented to gain the perspectives of their various specialties on the proposed treatment plan. The surgeon presented my case, fully on board with the immediate reconstruction concept, and the tumor board revolted. I envision them throwing rotten tomatoes and beer, and definitely with the theater critics from the Muppets, Statler and Waldorf, providing most of the feedback. In short, they almost unanimously thought immediate reconstruction was a horrible idea because of the infection risk of placing a foreign body in my chest while I’m still being treated for pneumonia.
I get it. I really do. But seriously? Come on. That was the one upside I was counting on in all of this. To be fair, they did not say it would never be advisable, just not now. Maybe 2-3 months after finishing chemotherapy. But that leaves who knows how long in the interim and means I would need to have a second surgery. And why am I the only one “being fair” here? Oh, but that wasn’t all. They also thought it strongly advisable that right boob come off at some point too (yet another surgery), given my history and the particular “feeders” of this cancer. I can’t even fathom that at the moment. There won’t be anything left of my body at this rate.
So I asked if delayed reconstruction would be covered by insurance at the same level as immediate reconstruction, and my surgeon quickly said oh yes, it’s federal law. At which point I sighed and mumbled, of course it is… but when I need a new prosthetic leg, which I would argue is much more important to my daily life than a fake boob, that’s a totally different story. The lack of prosthetic parity was news to her, and we had a brief but fruitful conversation about those who lobby on behalf of breast cancer and what we think of various organizations. Somewhat surprisingly, we were on the exact same page. It was refreshing and reassuring from someone who has made a career treating breast cancer. Suffice it to say, if you want to make a donation in support of breast cancer research, the American Cancer Society is your best bet. Other than the government, they fund the most research.
I have long resisted asking why, why to any of this. It always seemed like a question with either no answer or an unsatisfying answer, nor would any answer be likely to change underlying facts or circumstances. It’s not like anything in my lifestyle puts me at huge risk for what has happened thus far, so what could I change?
So when I got home, I pulled myself together and called my old oncologist at Walter. I told him I needed to know that something good had come of all of this, that someone had learned something that meant some other person wouldn’t have to go through what I have. He recalled the first time we met, both by phone and in person. I also distinctly remember the first time we met by phone. It was August 2006, and I had just moved into a fabulous apartment in the North End of Boston with a view of Old North Church (think one if by land, two if by sea). It was his second month as a hem-onc fellow and his first night with the on-call pager. I was his very first page! Lucky duck. I introduced myself, told him he had probably heard about me from the others, but in case he hadn’t, I went ahead and welcomed him to the hem-onc service. At which point he knew he was in trouble. I proceeded to ask him a question to which he did not know the answer, but he dutifully located the answer and called me back in short order. It wasn’t until a few months later that we met in person, but he very clearly remembers our first in person interaction as well. I apparently told him I was the very picture of health, aside from this whole cancer thing. That sounds exactly like something I would say. And we proceeded to build a wonderful doctor-patient relationship, as well as a friendship. It helped that we share a sense of humor (ie, very bad jokes).
He told me my new oncologist had reached out to him, and they had a nice conversation. I am heartened that she has connected with my old team for something of a changing of the guard. He also said I am my own textbook. I used to joke that I made a game of dodging all of the usual graphs and charts of standard oncological care. Apparently I wasn’t too far off! But it’s a textbook that no one has written, which concerns me. When one has essentially donated one’s living body to science, one likes to think others will somehow benefit from it. However, he assured me that my case has been quite informative, particularly in terms of how he treats and interacts with patients whose cases have become chronic, as well as how he teaches up-and-coming hem-onc doctors. And I must say, sometimes knowing how to communicate with your patients is even more important than the medical side of things.
An old friend always used to say, “Hey – do me a favor? Smile!” She actually wrote it on a sticky note and put it on the wall just inside my apartment door the last time she was there before she passed. So that’s what I’m going to try to do, even though like Nat King Cole sings, right now my heart is aching. But with an adoring puppy like this one, how can you help but smile?