Different Levels of Bad News
Yesterday, we spent the day at the hospital running from appointment to appointment and squeezing in a couple of unscheduled stops too. We had thought it would be a straightforward day with no significant news (which means we expected no stress and no problems). Not only did we receive some new news but we found that there is such a thing as different levels of bad news.
We started at Genetics. Here we discussed new genetic tests that help determine whether there are any known genetic components to Sheila's cancer. If we find that there are any known genetic components, then Sheila's children and grandchildren will be on a completely different and more aggressive preventive medicine schedule than that recommended for the general public.
The purpose of this genetic testing is to rate the risk of cancer being carried genetically through statistics and common cancer genes in order to avoid potential cancer getting out of hand in any children or grandchildren before the regular testing schedule even begins for them. The logical theory is that if cancer is caught early, then there is a better chance of a quick recovery.
Genetics, as expected, was a piece of cake.
After Genetics, we had to beeline over to Radiation Oncology for Sheila's first consult with her Radiation Oncologist. Sheila's team of doctors is the same as for her first incidence of cancer 11 years ago so this was like revisiting old friends. Again, we were expecting a pretty straightforward, simple day at this point.
As we were briefly waiting in the examining room, Sheila noticed that she missed a call from the hospital. The only call we were expecting was one to let us know about the pathology report from her surgery last week. She quickly listened to her voice messages and, sure enough, it was the surgeon calling with the pathology results. Unfortunately, we knew we didn't have time at this point to play a bit of telephone tag so we decided that we would simply stop at her office after this appointment with the Radiation Oncologist.
A minute or two later, the Radiation Oncologist came into the room.
Since this was Sheila's Radiation Oncologist the first time she had breast cancer, we caught up with the doctor about our lives over the past ten years and then someone knocked on the door... the oncologist quietly answered the door... she then quietly turned back toward us with some papers in her hand. I've seen papers like this before... this looked like a pathology report to me...
Sure enough, she was handed the pathology report we had been waiting on since Sheila's surgery last Wednesday. The doctor then quietly read a small part of the report to herself then softly conveyed to us the findings of the part she had just read to herself.
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| Although a great facility and a great team of doctors, this entrance hallway does appear a bit ominous. |
First, having the same exact type of cancer pop up again is far better than having a new type of cancer pop up. If a different type of cancer had popped up this time, this would mean that there is no predicting the behavior of the cancer in Sheila's body and that her body is now unpredictable and sort of wild. So, developing the same type of cancer, in this case, means good news. It is predictable so we can lean heavily on statistics to guide us for treatment options and prognosis.
Secondly, although Sheila has breast cancer again... and although this is the same type of cancer again... this is not a "recurrence". A recurrence means the same first tumor has grown back again. This did not happen. Sheila now has a new occurrence of breast cancer. Admittedly, I had previously and erroneously referred to this new cancer as a recurrence simply because she has breast cancer again... I made this error both in this blog and when discussing things with the doctors. I was wrong and the doctors politely explained the differences... technically, this is a new occurrence and not a recurrence. This is good news too.
More good news is that the surgeon did remove all of the tumor. This means the surgeon will not need to operate on Sheila again to remove what may have been missed last week. There were clear margins all around this tumor. So, this is good news too.
Now, for some more good news that is also a good news/bad news sort of thing... The Radiation Oncologist sat in silence for a few seconds clearly thinking about what this pathology report means for treatment and how to best convey this to us... she then explained that Sheila would require 33 radiation sessions... Monday to Friday for two days short of seven weeks. We were expecting radiation therapy to be a part of her treatment but we were originally thinking it would be only four to six weeks. So this is slightly worse news than anticipated but really, in the big scheme of things, hardly worth mentioning.
What is worth mentioning, however, is that the pathology report also showed that although two of the three lymph nodes were normal and healthy, one of the three lymph nodes removed in Sheila's surgery is showing isolated tumor cells. This, we were not expecting and this was not good news.
The Radiation Oncologist softly explained this finding to us as she closely watched each of our faces. Unlike most of Sheila's appointments, this time Sheila and I were sitting on opposite sides of the room (that is the way the chairs were placed in this examining room) so it was obvious that the doctor was trying to carefully read our faces because she would deliberately watch one of us closely and then turn around to watch the other closely. I could clearly see that Sheila was holding back a flood of tears... the doctor must have seen this as well because she continued explaining things very softly and with great care.
We did not expect lymph involvement at all (if I were to guess... I'd say were were about 99.9% sure she would not have lymph involvement because she was not showing any symptoms) but something else we definitely did not expect is that there are different levels of bad.
They have sent the samples obtained from Sheila's surgery for further testing, different testing. This will determine the "level" of badness found in her tumor as well as in this one lymph node. This level of badness will be classified as either a low risk, an intermediate risk or a high risk. We definitely did not expect bad news today nevermind levels of badness. I do believe that if we could watch ourselves in a video at this appointment, we would clearly see that we were both taken aback and a bit shocked at this point.
So, there are three levels of bad and, for now, which level we are dealing with is an unknown. This further testing will determine the level of badness and the aggressiveness of treatment.
The Radiation Oncologist discussed a few of the key findings in the pathology report and we discussed treatment options as well as what each of the findings actually means in the big picture of things. This discussion was a bit difficult and I could clearly see and hear that Sheila was holding back a tidal wave of emotions. We were definitely not expecting lymph involvement so we were both anxiously awaiting more information before jumping to conclusions.
After exhausting the discussion about the pathology report, we also discussed Sheila's next Radiation appointment. She'll be fitted with a custom molded body cast (for lack of a better term at this moment) for her 33 radiation appointments to keep her perfectly still while she is receiving radiation. They will also mark her body with tiny tattoos for lining up the focused radiation. This will be a long, grueling appointment for Sheila.
After Sheila dressed in her clothes again, the doctor met us at the front desk... helped with scheduling us for Sheila's next Radiation Oncology appointment... and then we said our goodbyes as she gave Sheila a concerned and empathetic hug.
We then made our way to The Breast Care Center to discuss the pathology report with the surgeon. We felt this would be easier and more effective than trying to discuss this over the telephone as was originally planned. After all, we were right down the hall from them anyway.
After discussing much of the same stuff as we had already discussed with the Radiation Oncologist, we thanked them for taking the time to squeeze us into their schedule and made our way to Hemotology and the lab.
Sheila still had to give some blood for the genetic testing. While waiting our turn in the waiting room, we discussed all this new information as we again reviewed the pathology report line-by-line. I don't think any of the people sitting next to us cared to hear about this stuff but it helped us to sort out all this new information.
At this point, I remembered that my own health had already crashed on our drive to the hospital and I was now in need of more medications. During our drive to the hospital, my body was fighting off anaphylaxis (thankfully Sheila had decided to drive) as my vision narrowed and blurred, breathing labored, nausea increased, and lower GI problems started screaming their arrival. Later at night, while taking my nighttime dose of medications, I would realize that my health crashed because I actually missed my morning dose of medications before we headed to the hospital. Now, many hours after my health crashed and after a handful of emergency medications, as I was attempting to retrieve some medications out of my camera bag I noticed my Kindle sitting in my bag. We were so busy and the day was so hectic that I didn't even have time to read anything at all on my Kindle. HA! Apparently, I really did think it would be a rather boring day at the hospital of reading magazines on my Kindle. This day was anything but boring!
As I was taking more medications to stabilize my own health, Sheila and I tried to find something a little funnier and lighter to talk about rather than dwelling on lymph involvement. I managed to get Sheila to laugh at this point but I suspect there was a bit of nervous laughter in there.
We received quite a bit of relative good news this day but the bad news was foremost in our thoughts and it seemed to darken the prospects of all the good.
But, we did not expect different levels of bad...
such strength and love. sending both of you positive energy, healing light, and love.
ReplyDeleteThanks... it is much appreciated by both of us!
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