It’s a large lymph node

November 30. My appointment with Dr. Ewing was at 9:00 a.m. I was told to arrive 15 minutes early for the usual doctor appointment reasons…insurance cards, sign off on the privacy policy, blah, blah, blah. June went with me this time since Steve had an appointment of his own. She was in charge of audio-recording our conversations, and she had a list of questions from Steve (of course).

Dr. Ewing had an unexpected something, and was running late. So for the first 45 minutes or so we met with members of Dr. Ewing’s team — Doctor Rothman (a fellow at UCSF) and a male medical student (sorry, I don’t recall his name). They asked me a lot of questions about my previous cancer and how I found the current cancer. They took turns feeling my tumors. 

Finally, Dr. Ewing arrived and we got down to business. She examined my tumors, and said that the main one might just be a large lymph node. Really? I didn’t know there were lymph nodes in that area. She wanted to know if I’d had an MRI. No, I said. Not an MRI. She said the MRI would give her an accurate map of what is going on. June gave her the list of questions and Ewing immediately said I did not qualify for any of the studies. She said it was obvious I would need some sort of chemotherapy to shrink the tumor before any surgery. No, I told her. I’m not doing chemotherapy. I’d had it 19 years ago and it damn near killed me. The look of disbelief on her face clearly expressed her reaction to my response. She said that if it was a triple-negative tumor, as she suspected, they do not respond to anything (did she mean anything except chemo?). She went onto describe a horrific outcome without chemo and surgery. I told her I’d rather die from cancer than from chemotherapy. The MRI, she said, will tell her if surgery is possible. It was about then that we were told my MRI was scheduled for 11:30 a.m. And that I would have a fine needle aspiration (FNA) of the node under my arm later that afternoon. We all agreed that was great news. Ewing is also going to have a conversation with Dr. Rugo and will try to get her to see me today, if only briefly. That would be great, even though I’m sure she would just try to talk me into chemo, but at least I could ask her about other options to shrink the tumor if it isn’t operable.

The MRI took about 45 minutes. Before the procedure, they sent me for a blood draw. Then June and I had time for a coffee (Chai latte for her and a green tea latte for me) before heading across the street to the MRI lab on Post. 

The lab was running a little behind, but they went ahead and had me change out of my clothes into hospital gowns (one open to the front and one open to the back), hospital pants (ginormous one size fits all with a drawstring tie that still didn’t keep them up) and hospital socks. I filled out forms assuring them I had no metal in any part of my anatomy except the metal marker from my first lumpectomy. They told me the marker was titanium so no problem. They also put an IV in my arm for the contrast media they were going to use. I’d only had one MRI before and that was on my foot (no contrast media) and it wasn’t that big of a deal. I was feeling a little apprehensive about my whole body being inside that ominous machine. Surprisingly they had me lay face down, so my tiny bit of anxiety about feeling claustrophobic disappeared. The technician did let me know that the contrast media might make me feel nauseous, but usually that feeling passes without incident. Suddenly I was wishing I had not had that green tea almond milk latte. Ewww. Good news. I never did feel anything other than a cold rush moving up my arm when it was injected. Sometimes it’s the little things that make us most grateful. Once the procedure was over, June and I went back to Dr. Ewing’s office. 

The results were good. The tumor is a large lymph node that is lying under the muscle. The cancer is not in the muscle tissue. Dr. Ewing said she would do surgery with or without chemotherapy (in my mind I’m doing a happy dance). She did say that surgery would be tricky either way because that is where  major vessels and nerves come into the arm. Of course they are, I say, and we all share a nervous laugh. She leaves the room to see if Dr. Rugo might have a few minutes to see me. She is still with another patient, so Dr. Ewing sends me over to get the FNA. It was completely painless and the doctor who did it was able to let me know right then that there were cancer cells in the aspiration. As expected. Any other outcome would have been an unbelievable surprise. 

We headed back to Dr. Ewing’s office and waited to see Dr. Rugo. After about an hour, Dr. Ewing poked her head in and said Dr. Rugo was still with another patient. So we kept waiting. And waiting. And waiting. Finally Dr. Ewing let us know that she had to leave, but Dr. Rugo was still hoping to see me. So we waited. After awhile Dr. Rugo’s assistant came in to let us know that she still had 3 other patients to see before she could see me. I start doing the math and realized it could be 8 o’clock before we ever see her. It’s 4:30 p.m. and we have not eaten since 7 that morning AND we still had a 3-hour drive ahead. June was willing to do whatever I wanted. I was exhausted and hungry and I knew June was, too. I decided that we needed to go have dinner and then go home. He said Dr. Rugo was gone all next week. I told him I would see Rugo on the 18th as scheduled, unless she could see me sooner. To just let me know if anything changed. He understood and said he would let her know.

The bottom line.  It was a good day at UCSF. I finally feel a bit of forward momentum. I’m relieved the cancer is not in my muscle. That it is likely encapsulated in the lymph nodes. I like Dr. Ewing. I trust her. I feel safe with her. We got off to a little bit of a rocky start, but I expect to move forward with surgery, hopefully before the end of the month. 

We all live in suspense, from day to day, from hour to hour; in other words, we are the hero of our own story. —Mary McCarthy