Recently, I had my first mammogram in four years ago. There's a reason I allowed so much time to lapse.
The last time I had a mammogram, the technician located a suspicious area that was promptly examined via sonogram. The sonogram revealed a mass that seemed to be problematic. It was determined that I needed to consult with a surgeon about having a biopsy.
My memory of the sequence of events that followed is vague.
I remember thinking a lot about ex-husband guy - how I needed to make peace with him - how if I was to die, my children would be forced to live with him, a man with whom I could no longer converse without volcanic eruptions of the emotional variety. This was the predominate thought.
So I tried my best to make peace with He Who Had Been The Source Of Much Suffering in my life. I had two weeks - the amount of time leading up to the scheduled breast biopsy - in which to do this. After that point, I would of course be dead.
This is how I imagined it.
In those days, a biopsy was handled differently from the way it is performed today. It was a procedure performed under general anesthetic at the hospital. A sample of the tissue was taken and if it was determined cancerous, breast tissue would be removed on the spot: either just the lump or the entire breast or both breasts or both breasts with accompanying lymph nodes. The severity of the operation could not be known in advance.
On biopsy day, I arrived at the hospital around dawn. I waited in a room that felt like the holding tank for prisoners on death row awaiting execution. When my name was called, I was taken to a basement area where an IV was run. The chill of the fluid entering my veins reduced my body temperature which nicely complemented the frigidity of fear.
At this point I was placed in a wheel chair and was pushed to an elevator which took me to a pre-op room. Here, a guide wire was to be inserted in my breast that would lead the surgeon to the problem spot. In order to run a guide wire, a technician would use a sonogram to locate the mass. Then, a wire would be inserted at the exact spot where tissue needed to be removed.
Lying on the table, preparing for the unknown, understanding that if the mass appeared cancerous, I could awaken with a good portion of my breast gone, if not the whole thing. I could not even entertain the notion of both breasts being gone when I awoke. Nor could I conceive of the post-surgery treatment that would inevitably ensue. Panic soon overrode all thought and my mind became numb.
The technician glopped gel on my breast and slid her tumor-seeking device along my it. Occasionally she made sounds indicating perplexity. She called in another technician who echoed her sounds. They called in the surgeon who looked at the sonogram and pronounced that I had a series of cysts. There was no need to perform a biopsy.
I was wheeled back to the basement quarters where the IV was removed and I was discharged.
How did this happen? How did a suspicious-looking entity in one person's eyes become a series of harmless cysts in the eyes of another? And another? Did no one else examine the results of the initial sonogram? Did the nature of the mass morph into a less suspicious-looking entity during the two weeks I waited for a biopsy? Did my work to make peace with ex-husband guy generate this metamorphosis?
I was in shock and did not have the presence of mind to generate questions of this nature.
This episode prevented me from having regular mammograms after that. In retrospect, I cannot defend my decision to avoid this procedure. I am, however, fully aware of the fear factor in the equation.
Recently while performing a self exam, I noticed an area in my right breast that felt wrong - like it didn't belong there. I decided to set an appointment with my gynecologist, hoping to avoid another potential breast imaging fiasco.
I like my gynecologist. She's got the sort of integrity that makes me want to listen to her. So when she, too, felt the lump in my right breast was suspicious, she sent me to have a mammogram and sonogram at the same lab that does hers.
The mammogram is a fascinating process. For women too young to have experienced this procedure, and for men who never will, here's how it works:
Arrive at the lab. Do not wear deodorant or lotion. After sitting in a waiting room, a nurse will call you - and maybe a couple of others - and ask you to follow her. She leads you down a hallway to a row of changing rooms. Vinyl curtains, reminiscent of the coverings of beauty parlor chairs, hang in the doorway of each "room." You are instructed to remove your blouse and bra and put on a half gown with the ties in the front. Afterwards, you wait in another waiting room. And then, you go to the mammogram area.
The mammogram machine is an over-sized C-clamp. It has a nice little shelf on which you rest first one boob, then the next. Once your boob is on the shelf, the attending technician commences the clamping process. This entails bringing the upper section of the C-clamp down upon your boob until it is as flat as possible. Then, the technician excuses herself long enough to run across the room to take a picture of your flattened boob and its contents. She repeats this process on the other boob. Then, she gets a side view. The whole machine revolves around and your boob gets squeezed from its inner side to its outer side as opposed to upper side getting mashed to the lower side as in the previous steps.
When you have problem spots like me, an additional set of pictures is required with the x-ray equivalent of a telephoto lens. So the whole process described above is repeated with a special viewfinder added.
Now, it probably isn't politically correct or even good form to admit this, but the mammogram kind of excites me. I basically walk around half naked in front of another woman and allow her to manipulate my breasts. To me, the clamp is less painful, more stimulating. I recognize this is not the case for most women.
After visiting the mammogram room, I go to the sonogram room.
The sonogram is a fascinating technology. Gel is applied to the breast. Somehow, this serves as the conduit for the sound waves emitted from a device called a transducer. The transducer sends out pulses of sound which travel through the breast and basically send back echoes. Understanding how all this translates into imagery requires more knowledge of physics than I currently posses. But in the end, a different sort of image is created than that of the mammogram. And when used with the mammogram, the sonogram proves a useful diagnostic tool.
After examing the results of my mammogram and sonogram, the doctor said that she suspects I have a cluster of cysts. She tried to be reassuring. But she wanted me to return for a repeat sonogram five days after my next period. She told me that if it is indeed a cluster of cysts, its structure will change with the fluctuation of hormones.
I had to make an educated guess to schedule my next appointment. My period has become irregular, I assume because of my age and the phenomenon of perimenopause. My guess proved to be inaccurate, so I had to postpone the repeat sonogram for a week.
The day of the repeat sonogram, the doctor informed me that no noticeable change appeared in the structure of the mass. It was now time to embark upon another diagnostic test: the Breast-Specific Gamma Imaging or BSGI - a procedure involving the injection of radioactive dye and a specially developed camera: the Dillon 6800. This test indicates areas of increased metabolic activity in the breast. As cancer cells display uncontrolled growth, the BSGI is a fairly accurate diagnostic step to take prior to, but not instead of, having a biopsy.
As I contemplate the set of circumstances that confront me now and compare them with those which ocurred four years ago, I am reminded of the Native American teaching associated with the totem animal Rabbit. Rabbit teaches us about fear. He says that we call our fears to ourselves. In so doing, the very thing that we fear will get us in the end.
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