Knowing more: Friday's appointment

Friday morning finally came after what felt like a very, very, long week of waiting. My anxiety had ramped up over the later part of the week and, despite my better judgement, my mind had been wandering to some pretty dark and scary places.

Andy stayed home from work so that we could tackle the appointment and wrangle the boys together, and we drove uneventfully to the hospital in the city for what we thought would be a quick second opinion.

Roscoe was too full of curiosity, energy, and emotion to sit in one place for long so we split up shortly after we arrived. Roscoe and Andy left for the waiting room, while Merritt (hungry, as always) and I stayed to wait for the doctor. She arrived lovely and poised, her tone was warm and she spoke slowly and deliberately. I liked her right away. I felt relieved to be at Georgetown and confident that I was in the right place. She reviewed my family's cancer history (there's really not much to document), and other risk and protective factors. Then we moved on to discuss my lump.

She showed me an image from one of the ultrasound films, and pointed to a clearly delineated oval. She explained that the borders of the mass are smooth (a good sign), and that it grows in the plane of the breast tissue (also a good sign). She noted that one area of the mass has more shadows than the rest, and that the biopsy had probably been ordered based on that area alone. She did an exam one-handed, clutching Merritt in the crook of one arm since I needed both of mine to strike the familiar breast exam poses.

Then she asked if I wouldn't mind another ultrasound. Of course I didn't. We spent some time discussing the information that I had received about the potential risks involved with a biopsy during lactation. I learned more about milk fistula, and met with the other doctors to further discuss ways to minimize the risks while still moving forward with the procedure.

Three months of "watchful waiting" was identified as an alternate option, and when I shared that a catastrophic thinker like myself would have a hard time surviving that long, she mused that we wonder why the cost of health care is out of control, only exacerbated by unnecessary tests. "It's because people can't bear to live with the uncertainty." I shook my head, knowingly.

I asked if they would advise a biopsy given a different circumstance--say the same diagnosis but a woman not currently nursing her child. They said yes, they would, and right then I knew that it was what I wanted too. I wanted the same standard of care.

She left the room to order the ultrasound and to see if a biopsy could be performed later that afternoon.

What might have been one hour, turned into almost six as I was ushered into and out of the maze of hallways, doors, and patient rooms that make up the Breast Center. Andy and the kids had been given a consult room to camp out in so in between meetings I sought shelter there too, filling Andy in on the latest, nursing Merritt, and chatting with Roscoe who has had a lot to say lately.

In the end, the doctors decided it was best to take a conservative approach and instead of using the smallest gauge needles as necessary for a true core biopsy, they started with the largest gauge needle used for a fine needle aspiration and worked their way down until they had enough tissue to comprise an adequate sample. For me, that meant two different sized needles and five separate attempts.

I watched the whole thing on the ultrasound and felt some of it, too, since the doctor opted not to give me a full dose of lidocaine.

I nursed Merritt right before the procedure to empty as much milk as I could, and I nursed him on the affected side just a few hours later once back at home. The site has been a little tender but I can hardly complain.

I'm grateful for physicians who listen, and who care about families. Physicians who are unafraid and willing to find creative solutions in order to meet their patients where they are and who provide the best quality health care to ensure the highest quality of life.

The results will be in later this week.