Yesterday, as it turns out, was Spa Day at Duke Cancer Center.
When John and I arrived yesterday morning, it looked like they were setting up for a wedding reception—white folding chairs, flowers, cocktail tables with white tablecloths. Someone was playing the grand piano in the lobby.
(FYI, April and Leo—in the throes of their illnesses!—have decided to get married in the hospital, so maybe that was just on our minds.)
As the makeup ladies and their unguents and the masseuses and their chairs emerged, it quickly became clear there was not to be a bride and groom. Just lots of free samples and wellness brochures.
What there was—and I don’t think anyone really saw this coming—was a Poetry Fox. More accurately, there was a man—in a giant furry fox suit—with a typewriter—composing poetry. You give him a word, and he furiously types up a poem based on it, right on the spot. Then he reads it to you aloud.
But we had a date with the Queen, so we had no time for Poetry Fox.
It was great to see Dr. Cavanaugh. We hadn’t seen her in the flesh since I first started treatment. When she walks into the exam room, it’s the kind of thing where suddenly everything is going to be okay. She’s got it all under control. She is not afraid to say things like “hopefully cured” and “probably no more chemo.” She told me my cancer seems to be “kind of wimpy and not too clever.” I mean, I felt a little sting that she wasn’t more impressed, but fine.
Here’s the situation: the chemo does not seem to have shrunk the two tumors in any dramatic way. While in some ways this seems like a bummer, there is a silver lining. Apparently, chemo works best on more aggressive tumors—the more quickly the cancer cells are multiplying, the more the chemo can kill them off. So, a tumor that doesn’t really respond to chemo is likely a tumor that is pretty lazy. This doesn’t quite line up with the prognostic indicators from the pathology report (a high rate of proliferation, the fact that the tumors are triple negative, which generally means aggressive), but the Queen feels pretty convinced. And the thing with smart, aggressive tumors is that even though they respond well to chemo, they can also find insidious, clever ways of coming back. Less true for the wimpy ones.
According to the Queen, my tumors are shaped like a dumbbell, with each tumor being one of the weights on either end. And between them—no one’s totally sure but–what looks to be a 4cm pipe of vaguely cancerous material.
On the mammogram images, to me it looks like you’re in an airplane at night. The tumors are two lit-up cities—say Greensboro and Winston-Salem. And the 4cm stretch is I-40, lit up by headlights. What we don’t really know is how trafficky 40 is until the surgeon gets in there. That will determine a lot of what happens next.
According to the Queen, this is a stupid way for cancer to behave. Smart cancer explodes itself like an atom bomb—mushrooming out wherever possible and jumping on the lymph node train to ride to the far reaches of the body and set up diabolic satellite campuses there. Stupid lazy cancer makes a tumor, gets bored, sidles around, builds a nearby tumor, hangs out there munching on donuts.
But in order to confirm the geography of the tumor, she sent me for yet another scan and also set up an appointment for me to talk to the surgeon again, just to make 100% sure that everyone was totally resolved that a mastectomy was the best option. It is the best option—I actually do feel totally resolved on this—but I’m all about process, so we obediently went through the motions.
There was a VERY LONG WAIT to get the scan. All around us, spa day continued. Lots of patients, a little flushed and their chemo caps slightly askew, wandering around dazed after having a massage. Lots of lavender wafting in the air. For 2½ hours I sat in a packed room of anxious women—ranging in age from about 25-90, all in our grey dressing gowns—half of us texting, the other half knitting. No one with enough focus to read.
There was a line. The woman in front of John got a mediocre rambling prose poem about a childhood memory of Poetry Fox’s. But John gave the Fox the word “nonplussed” (a much-debated word in our household that I have apparently misused my whole life) and got in return a surprisingly delightful poem that—while indicating that Poetry Fox also does not understand the accurate meaning of nonplussed—is definitely a worthy souvenir of our cancer days at Duke.
In short, we were downright nonplussed (I think?) by the whole experience. A FOX WROTE US A POEM! ON A TYPEWRITER! BETWEEN ONCOLOGY APPOINTMENTS!
Many hours and lifetimes later, we eventually were seen by the surgeon, Dr. Georgiade, who confirmed that given the latest scan and information, a single mastectomy is still the way to go. That is officially scheduled for June 18th—so the countdown is on.
[And for those who might wonder about the single v. double mastectomy, the thinking is that in the immediate moment, what is most important is taking out the active cancer. This is what Dr. Cavanaugh calls a “Fighter Issue.” There is another category of things—what she calls “Survivor Issues” that involve making sure this thing doesn’t come back some day. That involves considering removing my other breast and possibly ovaries, etc.
But there is a 20% chance of infection when removing a breast, and what she doesn’t want is for that chance of infection to occur in the non-cancerous-at-the-moment breast and delay/prevent me getting treatment in the cancerous breast.
I will very likely have the other breast removed someday down the line when I am cancer-free and we are thinking about prevention and reconstruction and having another surgery anyway, but right now we’re firmly in the “Fighter” camp.]
“Make them work / to crack / you,” Poetry Fox once famously wrote.
While I don’t really subscribe to this philosophy in my emotional life, I’m good with that as a mantra for the medical journey. I hate the all the warfare jargon around cancer—the battling, the fighting/surviving, the winning/losing, the “beating this”-ing, but I think I’m good with not letting it crack me. I
will be the densest little nut—a squirrel’s effing nightmare—green and unyielding. Not even Poetry Fox’s sharp, clever teeth will pry me apart.
(Of course, the real question is, how many joints did Poetry Fox smoke when he got home from Spa Day?