The time that passes between a biopsy and diagnosis might as well be years. That's how it felt.
In reality? Everything happened about 1 week apart:
Week 1 - felt a lump
Week 2- saw my PCP
Week 3 - first mammogram and ultrasound
Week 4 - biopsy
Week 5 -
The day after my biopsy, I told only one person aside from my husband--my intern. I was holding a packet meeting for the literary magazine I run, and I needed my intern to help move the tables and chairs around since I was told not to lift things. Also, my skin was not happy with the steri strips they used on the biopsy site and the blisters were killing me. That same weekend I went to a bachelorette party for a friend who was a recent breast cancer survivor. Of all the people in the world, she would be the one to most understand the anxiety I was feeling while waiting for the results. But it was her bachelorette party, and I didn't want her to worry, so I slapped some extra bandages over the irritated skin and tried not to look too awkward holding my arm away from my armpit to prevent the rubbing.
I was at work when I got the phone call. Another normal day teaching college writing and trying not to think about the fact that I might have cancer. I was sitting in my office when the call came in, but since I share the office with another instructor, as soon as I answered and heard who it was, I stepped across the hall into the empty conference room to take it.
Hi Katherine, this is Dr. Englander from Penn Medicine. Is this a good time to talk?
Your test results came in and it is IDC breast cancer.
The exact conversation is a blur, but I remember confusing IDC with DCIS, which is a pre-cancer stage 0. I breathed a huge sigh of relief and said, "IDC, so it's pre-cancer, right?"
No, unfortunately it IS cancer. Invasive Ductal Carcinoma...
My heart was pounding and I tried not to cry knowing anyone could walk in or by the conference room at any moment--colleagues or a student of mine. I think I asked a few questions, he said the full details would be sent to me through my online portal, and that I should make an appointment with a breast surgeon. I asked who he would recommend, either at Penn or another nearby hospital I was considering, and I used a red dry erase marker to scrawl the names on the whiteboard next to me since I had nothing else to write on. As soon as I hung up, I took a photo of the info on the board, erased it, and went back to my desk to pretend nothing happened.
I was diagnosed on 10/24/18 with Invasive Ductal Carcinoma in the left breast. At clinical staging, the mass was between 2.5 and 3cm, grade 2, with ER+/PR+ HER2- hormone receptors, and 1 confirmed positive lymph node.
I held it together until I got home, including talking to my husband briefly on the phone that afternoon. I didn't want to tell him over the phone. Maybe I didn't want to believe it yet.
When I got home and walked in the door, he knew right away. He asked if I'd heard from the doctor yet and as I nodded, the tears came. And then the year-long journey began.
After finding a lump and getting a mammogram and ultrasound, I was referred for a core biopsy of both the lump in my left breast and a nearby lymph node that appeared abnormal on the ultrasound. To say I went into the appointment terrified would be an understatement.
I checked into the breast center, changed into my hospital gown, and was taken to a small private waiting area outside the exam room. Since a biopsy is technically a surgical procedure, I had what felt like an abundance of paperwork to sign. A tech sat and talked me through the documents and then asked that question I'd been trying to suppress the whole day:
How are you feeling?
Nervous. Scared. Terrified. How many other ways to put it?
My eyes filled with tears as I struggled to respond. I think I said "nervous." I took a few deep breaths and tried to stay calm. Still, it felt nice to admit to someone that I felt anything. My whole life people have seen me as emotionally strong, and I'd been trying to keep a positive attitude and avoid panic, so that little moment of release was probably necessary for me.
I wish I remembered the name of the nurse who assisted with my biopsies because I'd love to thank her. The procedure room was dim and I laid on a bed. She brought pillows to help me get comfortable since I'd be laying sort of on my side, sort of on my back for awhile. She draped a sheet over me to keep me warm and covered until the procedure. But the real gratitude lies in the fact that she talked to me. Non-stop. Instead of waiting in silence for the resident and the radiologist to come in for the biopsies, she just talked. Asked me questions, talked about herself, I don't even remember what and it didn't even matter. It helped me feel comfortable and kept me calm during what would have otherwise felt like an eternity of waiting.
Finally, the doctors came in and explained the procedure. The radiologist was laid-back and was clearly there out of formality--he let the resident, Dr. Kim, take the lead. She used the ultrasound wand to locate the areas of concern and gave me a numbing injection. The sting of the needle was truly the worst part. Then I couldn't feel a thing. She made two tiny incisions and used a core biopsy wand to take samples from the possible tumor and lymph node. The device sounded like a staple gun as she took the samples, but thankfully, no pain. I did feel the strange sensation of blood running from the biopsy site down my back--truly an out of body feeling when your breast and armpit are otherwise numb. I wondered--how much blood is back there? I would have guessed a puddle, but in the end, it was only a few drips. Perception is a tricky thing.
She only needed to take one sample from each site, much to my relief. "Dr. Kim, you are my new best friend." Even though it wasn't that bad, I was grateful to just be done with it. The nurse sent me home with an ice pack in my bra and instructions to rest and take Tylenol. The hard part is over, I thought. Or so I thought
At the end of September 2018, I felt a lump in my left breast and my world was turned upside down. I tried to ignore it for about a week - (1) to see if it would go away on its own, as the internet suggested it might, but (2) because I was uninsured and waiting for my new health coverage to kick in from my new full-time job. Throughout my adult life, I have been without insurance more than with, and this is the first time I was able to get coverage through my own, full-time employment (as opposed to through a spouse's insurance or through the ACA healthcare marketplace).
When the lump still felt like a brussel sprout under my skin in early October, I called my Primary Care Physician, who is also my gynecologist. She referred me for a mammogram but assured me that often in young women, these things are just a cyst, and not to get too concerned about it just yet. I called from my car to schedule the mammogram, and spent the next week trying to convince myself that it was, in fact, just a cyst even though deep in my gut I already knew.
At age 36, I had never had a mammogram before. I changed into the hospital gown and waited with the other women in the small waiting room, pink pens and brochures and other decor scattered throughout the breast center. When it was my turn, a tech brought me into the room and situated my breasts, one at a time, into the machine. She viewed the images on her screen, and readjusted me a few times to try to get clear pictures of the area where my lump was palpable, near my left armpit. She gave no indication of what she was seeing on the screen.
I returned to the waiting room to await the results. While most of the time, mammogram results come days or weeks later, this particular breast center has doctors reviewing the images electronically on the spot. Just a few minutes later, a woman pulled me into a separate waiting room, private, and asked some questions: Had I ever had a mammogram before? Why did I come in for one now? Did I have a family history of breast cancer?
After the fact, I realize that this was the moment I should have known I had cancer. It was clear on my mammogram that something was terribly wrong. But I was still in denial. No. No family history.
She led me to an exam room for an ultrasound. I laid on my side, lump facing up, and a resident globbed on the ultrasound gel and took several images with the ultrasound wand. After a few minutes, a radiologist came in to review the images and to take another look. She was not encouraging.
The radiologist ordered a core biopsy of the lump and a nearby lymph node that appeared abnormal on the ultrasound as well. Without saying "you have cancer" she was telling me "you have cancer." She asked if I had anyone with me. She encouraged me to schedule the biopsy at the front desk before leaving. She handed me a business card for a breast surgeon and said I should make an appointment now, don't wait for the biopsy results, and that whatever this was, I should have it removed.
Breast cancer survivor.