Confusion sets in

We went to Plainer Hospital today, formerly known in this blog as Pretty Good. Plainer just seems more apt. We waited more than two hours in the modest (white and gray cherry blossom wallpaper, two real and one artifical plant, dun-colored industrial carpet, easy-going reception staff) office of the Much-Recommended Surgeon. Part of the reason for the delay was his caseload and part was my lack of all the proper reports from Fancy Hospital. It took phone calls and faxes to get them. Finally we saw him and he said virtually the same thing that the Fancy surgeon had said: Need a mastectomy on the left, up to me what to do with the right. He would support me if I wanted a prophylactic mastectomy or if I wanted to leave it alone (which I want to do). One thing he said that was different from Dr. Fancy was that he would remove a whole level of lymph nodes under my arm. He said he doesn't do sentineal node biopsy, which is a way of isolating the node most likely to have cancer, removing it and sending it to pathology to see if it's malignant. This preliminary check happens while you're still on the table. The node gets a more thorough analysis later, one that takes three to four days. The problem with this, he said, is if the node is found to be negative at first, but then, after more analysis, it's shown to be positive, the surgeon will have to go in *again* and take out more nodes. He'd rather take out the first level of nodes and feel around to the second level while he's in there, and can see if the second level looks suspicious. The problem with taking out those nodes is you can get swelling in your arm. I was confused and when we got home I called W, who was one of the people who had recommended him. She said he and another surgeon did a sentinel node biopsy on her, but reminded me that she had Stage Zero cancer and I probably have Stage 2. L is sure that the surgeon said he doesn't do sentinel node biopsies, not just that he wouldn't recommend one for me. I consulted The Bible aka Dr. Susan Love's Breast Book, and it seems that a sentinel node biopsy is the thing to do, unless a surgeon isn't skilled in it. She also warns: "If you have two lumps that are in different places in the breast, the sentinel nodes may be in two parts of your armpit and the procedure won't work."

But Dr. Fancy didn't say anything about my lumps precluding a sentinel node biopsy. I will have to ask her.

I don't want to ask her. I don't want to do more research. I don't want to do any of this work. I don't want to try to understand about different kinds of receptors and look at cut-away drawings of ducts and lobules and vessels. I don't want to read about steroid antiestrogens and aromatase inhibitors and GNRH agents. I don't but there's no choice. I also don't want to curl up and ignore all this while the cancer grows and spins through my bloodstream and lymphatic system. I told L tonight that I was upset and he said, Finally!


When Y came over last night he talked about how he was asked for ideas on how to commemorate the famous 1937 Memorial Day Massacre in Chicago. He suggested a
re-enactment. That it would be much more interesting that three or four hours of speeches, he said. The idea made sense to me. If there are Civil War and Revolutionary War re-enactments, why not one of a labor struggle? I started thinking about re-enactments in general, how psychology is based on showing us how we re-enact our childhood ways of being, with all their frustrations and reward systems. Cognitive therapy is supposed to show us how we repeat and how we can stop repeating that which harms us. Anna O., the famous patient of Freud's friend Josef Breuer, reportedly repeated all her symptoms a year after she'd had those symptoms. A re-enactment. How would I re-enact my breast cancer? Would I want to? Jews have an unveiling of the headstone a year after a person is buried. At my father's unveiling the rabbi re-read his eulogy from the year before. (It hadn't improved with age.) What is the difference between re-enacting and going through the motions, being in a rut? There is conscious re-enactment and unconscious. Lady Macbeth: Out, out, damned spot.... What, will these hands ne'er be clean?