The Doctors In Bellevue

The Doctors in Bellevue

When I heard Dr. Te say I had breast cancer, I wasn’t really all that surprised. I knew something was going on after all the mammograms and the painful and humiliating drilling called a “biopsy” they did in my right breast which left it scarred. I also have a family history. My maternal grandmother died of it and my maternal aunt. But neither my mom, nor any of her other 5 sisters had it.

I also knew it had to be very small and very early. I had no symptoms, no lumps, no pain, nothing looked abnormal. Both of my breasts looked normal, beautiful and like each other. No difference.

“And you have to see a surgeon right away.”, she said. “Cant this wait? I’m leaving the state for good in 4 weeks. I’m getting on a plane and moving to Florida in 4 weeks.” “NO, YOU HAVE TO DO THIS NOW! IT CANNOT WAIT!” her voiced sounded so alarming.

So, I stepped on the conveyor belt and entered “the system”, the disassembly plant, the meat processing plant. I became cancerous breast number 99,999, a statistic, and a faceless, nameless, insignificant middle aged white woman like so many before me.

The first surgeon I saw was Dr. Kristi Harrington at Overlake Medical Clinics Breast Surgery. That is where they send you next. But before I saw the doctor, I quickly made a call to my dear friend, F. I knew she had breast cancer 7 years ago, and was treated for it. She was the closest person I knew who had it, I trust her. She was the first person I called.

F. explained that her breast cancer was in one place and was DCIS, not invasive. She opted for lumpectomy and as a result had a small indentation and a small scar. She also had a small scar under her arm where they had taken a sample lymph node, known as a “sentinel node”.

This was all new to me. F also steered me to a reliable website where I could read more. It was breastcancer.org. I was completely clueless. Its not that I never believed it could happen to me. It’s just that the thought of having it was so horrific to me I never thought about it. I couldn’t.

The site was very helpful and answered many questions. It seemed conservative and reasonable. I learned how common this is. 100,000 women a year are diagnosed before the age of 59. I in 8! I never felt more like a statistic, more insignificant.

 I made up my mind that I would have what F had, a lumpectomy. They would go in, use a melon baller, scoop out the cancer, I would have a small scar and go on my way. Radiology may or may not be needed to follow up but that was not a given. It is controversial, but it did not seem so bad. I knew what I had was small and it was early.

I saw Dr. Harrington on June 11. She is an older woman, slight of build, and probably one of the best in her business, since breast surgery is her specialty. She is a dispassionate, matter of fact, no nonsense, dry factual kind of person. She rarely looked me in the eye and concentrated on my reports. I really liked her no nonsense style, emotionless. I wanted the facts. I did not want anything held back. Dr. Harrington treated me like cancerous breast 99,999, faceless, nameless, which just happened to have a middle aged white woman attached to it. Like so many she had seen before. Nothing special. No different. A cipher. A blip.

She very patiently took her time to show me my images. She took out the teaching materials, the flip charts, worn out from so much use and explained what I had. She showed me the cross sections of the cancerous cells  and the artist’s drawings of the invasive ones (kinda squiggly). She drew diagrams. She seemed tolerant but bored.

I followed along. I am not stupid. It seemed very understandable the way she explained it in layman’s terms. I had come alone. I really did not think I needed anyone with me. I am a competent adult.

Then she showed me my images. There is cancer, it looks like grains of sand scattered all along the milk duct, in two places. They are very small, like grains of sand. It took a trained radiologist to read these images.

Then she took an electronic pen and drew a line on the images showing me the tissue she would have to take out. She drew a big circle around one spot and then continued the line to encircle the other. There, that is what we would be removing. I looked at the image of my beautiful little breast, all flattened out and the lower ¾ of it would be missing. They have to take healthy tissue, along with the cancerous tissue to obtain a “clean margin”.

Suddenly my throat went very dry and the air in the room became heavy and hard to breath. The blood in my ears began to pound and it became hard to hear. “That is most of my breast,” I said, “there would be almost nothing left. My breasts are small.” “Yes,” she said matter of factly, “and your nipple would be pointing at your toes”. My heart began to pound. I could feel the muscles in my neck stiffen. “What is left would have to be irradiated to prevent reoccurrence and no plastic surgeon would touch it to reconstruct it.”

That did not sound like a good option to me, destroying my breast. What was left would not even fill a bra cup. What else could I do? She is not suggesting removing my breast is she? I asked her what she would do. She said if she wanted reconstruction, the most successful approach would be a complete mastectomy. Now I really couldn’t breath. I felt light headed and faint. I could not speak but only nodded. My worst fear, my worst nightmare had just come true.

I looked at her and I said,” if you had told me that this thing was so far advanced there was nothing you could do, that it was going to kill me, I would be grateful. I would be glad.” She looked at me for the first time in shock, leaned back and said. “In all my years of practice, I have never heard anyone say that!” I guess I was just the first one to admit it out loud.

Then she said something you almost never hear a doctor say. She said that with the stage I am at, by lopping off my breast entirely, no radiation required, it would be virtually 100% curable. What a choice! And I don’t even look or feel sick.

Dr. Harrington was done with me now and hustled off to speak to cancerous breast number 100,000. Before she left she arranged for me to have an MRI the following day. I made the appointment with her surly staff. Finally she said admonished not wait. Most women have their breasts lopped off right away. “I can do you next Monday.” She said. That would be 2 weeks before I boarded the plane for Orlando.

I left the office alone, armed with notes. Nobody was in the waiting room for me. Nobody drove me home. Nobody was home when I got there.

The next day I reported to the MRI station on the disassembly line, like a dutiful lamb. I went alone. I did not think I would need anyone with me. The waiting room was full and the staff were busy. The lady who signed me in told me she was a breast cancer “survivor”, too. I told her I was a breast cancer victim. She thought I had a bad attitude.

I was told by a young technician to undress and put on a gown. She was petite and perky and completely lacking in sincerity. She did not look me in the eye, or smile. I was just another cancerous breast with a middle aged, white woman who happened to be attached to it to be processed. Ho-hum, I wonder when is lunch? And she called me Amy.

I was made to lay face down on a hard slab with two holes in it for my breasts to fall through. The plates pressed in on either of of each breast making them flat. I was humiliated, scared, uncomfortable, sad, and mad all at the same time. It was like a nightmare, or torture. Then I was rolled into a huge machine which made loud noises over my head, like explosions. It went on for 20 minutes. The perky little technician came on the speaker, “Are you OK, Amy?”, completely without sincerity. Of course, I’m not ok . I’m hanging upside down with my breasts hanging out while you are shooting guns over my head. I’m scared and humiliated. What do you think? Should I be Ok with this?

She did not smile when I left. She thought I had a bad attitude. Cancer victims are supposed to be brave. Besides, it was time for lunch.

Dr. Harrington called me the next day with the results. The left breast was free and clear. No signs of anything. The right breast, in addition to the two known spots was found to have a third spot at 8 o’clock which looked suspicious. (There we go again making my body part into an inanimate object, a clock).

I did further research to find out about reconstruction after mastectomy. This was truly my worst nightmare come true. I always pitied women who had mastectomies. It seemed like a cruel, drastic, barbaric thing to do to a women. The thought was unbearable. And now it was happening to me.

I learned that reconstruction could be done at the same time as the breast removal. But it was not recommended. Higher risk of complications and infection. I looked at before and after pictures of women who had reconstruction. None of them looked symmetrical, or natural, And they all had massively huge scars going horizontally across their breast. Then I learned the worst. A reconstructed breast is a lifeless object attached to a woman’s chest. All of the nerves are severed in the process of removal and the fake will NEVER have any sensation! That is the most horrific thought of all.

The next day I went to see Dr. Minami, a soft spoken gentleman, a general surgeon. He reviewed my reports and confirmed everything I had heard from Dr. Harrington. There was no choice. I had no choice. I asked him about reconstruction and he confirmed that too, with one addition.  The remaining breast will grow old and age naturally, the reconstructed one never will. They will look more asymmetrical as the years go by. Wow, more good news!

When I called Dr. Harrington and asked her about doing a double mastectomy,she practically yelled at me, “         YOU JUST TOLD ME YOU WERE CONCERNED ABOUT LOSING SENSATION! WHY WOULD YOU WANT TO DO THAT?” “I don’t know, “I said meekly, “for prophylactic reasons.” “Your left breast is completely free and clear. There is no more chance of it developing cancer than any other breast in the world.” Well, she had a point.  

Before I left Dr. Minami, I had one other question. What about the “do nothing” option? What if we leave it alone, let it run it’s natural course and let me die a natural death. He stroked his chin thoughtfully and said, “Well, maybe if you were 80 years old you could consider that.” (There we go with statistics again, forget about the individual).

How long would it take to kill me? We don’t know. We don’t know how fast it is growing. It could take 5 years, 10 years, 15 years, 20 years. Most likely I would die of something else. The only thing we know for sure is that one day I will die, by whatever means. We all will. Now I had another choice to consider. I left his office by myself, his grumpy staff did not look up or say goodbye.

Dr. Harrington said she could “do me” on Monday, the 18^th, 2 weeks before I was due to board an airline, to leave my home of 20 years, go to a place where I did not know a soul, never to return again. Somehow I could not picture myself doing that, flying cross country, stitches and a huge gash in my chest where my breast once was, drains coming out of my body, on pain medication, no one to help me, and a rolled up sock in the empty cup of my bra carrying a small, neurotic dog in a crate.

Once I got to my destination, there would be no follow up with my surgeon. I knew of no doctors in Florida. Who would take care of me post op? What if there were complications? What about plastic surgery? Would there be time to interview and find a plastic surgeon to put me back together again in two weeks time? I still had to put my furniture in storage, pack the kitchen, etc. I called around trying to book an appointment with a plastic surgeon to find out about immediate reconstruction, if that would be an option. I spoke with Dr. Stephens in Bellevue and he only took the call because he knows me. He did not do reconstructive surgery, but did not highly recommend doing it immediately. I could not get appointments with the other doctors I called. There was no time to research and interview them.

I was encouraged to scrape my plans indefinitely, to stay in Seattle and have my breast removed. But I did not like the doctors in Seattle. They were cold, impersonal, and did not offer me any hope or help. I did not have a rapport with any one of them. They worked in silos, they were very segmented. I wanted a team approach. I wanted everyone working together for me. I decided to wait until I got to Orlando. I would start over and find a team. They had to have good plastic surgeons in Florida, right?

I had come too far. Everything was in place. The lease on the apartment was up, my employer had been informed, I had an offer in on a house, and I had my airline ticket. I did not want to stay in Seattle in that toxic situation.

I remembered something my friend, F told me about and I read about on BreastCancer.org. It was Tamoxifen, a drug which has been effective in slowing down cancer which is hormone receptive, like mine. It is an estrogen blocker which deprives the cancer of the hormone which makes it grow. The side effects are hot flashes and mimics menopause. Taking it would plunge me over the cliff of menopause, into the abyss of no libido and being the dried up old crone I was always  destined to be.

I took the initiative, picked up the phone and made an appointment with the oncologist, Dr. Katherine Crossland the next stop on the disassembly line. I saw her on June 20^th, 13 days before my departure.

There is a term I learned by reading BreastCancer.org. The term is “newly diagnosed.” The advantage of using this term is that when you say it you are immediately labeled. The label, “newly diagnosed” is slapped across your forehead. This is a great time saver because everyone knows about the newly diagnosed. They are all the same. No need to ask questions. You can assume you know everything about them at the outset. Forget about whether she has a personality, has an opinion, and thoughts or feelings. They are all alike.

I met Dr. Crossland and I told her I was newly diagnosed. She nodded knowingly. She patiently explained my pathology report, showed me the teaching materials, and explained what I had. Then I launched into my story. In a high, tight voice I told her everything, from the story of my mom, to the move to Florida in 2 weeks, buying the house, to the breakup. I told her I was going to wait until I got to Florida to find a doctor. “But don’t you think I should be on Tamoxifen?” I asked her. “Yes!”, she immediately whipped out her pad and wrote me a prescription.

She was kind and sympathetic, not like the surgeon. I told her how I have been through surgery before in my long life. I do not handle it well and the recovery is long and slow. I was shocked when she said, “It is just like removing a lump of fat.” I looked at her in horror and shook my head, “Oh no, it is so much more than that.” Before I left, I confided in her that if I could find a doctor who would care for me throughout, and keep me comfortable, it would be my choice to let this thing run its course and die a natural death.

“It is not a pretty way to die, Amy,” she said. I wonder what is, I thought. Growing old and forgotten in some nursing home, dying of pneumonia? Being killed in a car accident? Heart attack? At least this way I get to choose.

As I was leaving she said, “You seem like you are under a lot of turmoil.” Duh! I looked at her with a wild look in my eyes and laughed in a high pitched, hysterical, insane sounding giggle. That was the end of my experience with “the cancer system” in Bellevue.