11.26.2012

Apple Core Biopsy

A Core Needle Biopsy is a misleading name for the type of breast biopsy I underwent, misleading because it has the word needle in it. Core is the much more accurate describer in the name. It’s not unlike an apple-corer, which gets shoved in small increments through an extremely dense apple, until the core, or lump, is reached and a sample can be collected.
 
My biopsy unfolded with the smoothness of sandpaper.

The ultrasound the week prior brought me here, "just in case," since there was a bit of tissue that looked different from the rest. “It's most likely nothing to worry about… especially at your age,” assured the technician. 

The biopsy, like most unpleasant things, took place very early in the morning, and in the middle of a visit from out-of-state friends. I left home before my house guests, husband, or son had awoken for the day and am tucked into the corner of an empty waiting room. It’s too early to read a magazine, so instead I’m staring at the TV screen, a good 30 minutes into enjoying a display of deluxe steak knifes that I too could own with only six payments of $14.99. I hate that I’m here. Why is it so cold in here? And really, who picked this channel? 

Finally, a nurse opens the door and calls me back. We walk together down a long hospital hallway, during which I can not think of a single topic of small-talk. Apparently she can't either.
 
We enter a cubby of a room and she breaks the silence to direct me to a gown and small operating table and then leaves me to more waiting.

As I'm passing the time in a state of growing agitation, in walks a man in a white lab coat. A man? You’ve got to be kidding me? (Understand, I’m a young, inexperienced patient who has been spoiled with a lifetime of previously stellar health. Biannual trips to the dentist and annual Pap Smears (with my female primary care physician or my female OB-GYN) were previously my greatest causes for anxiety. I think I’m a generation past having to see male doctors for issues concerning distinctly female parts, and I haven’t yet crossed the threshold into the disenfranchisement and lost modesty of experienced patienthood.) I don’t want a man – a young, moderately attractive man with poor bedside manner and an unsettling lack of confidence - poking and prodding my sad little exposed breast.

I also really don’t want to be here and that hasn’t done much for me, so I’m trying to move on in my head. Let’s just get this over with.

A core needle biopsy unfolds with the area being numbed for a small incision, through which a very long and thick “needle” with a clipper-tip is inserted. Guided by ultrasound, the so-called-needle is placed appropriately to collect small tissue samples. The procedure takes about 15 minutes - purportedly.


Yeah, kind of like that.
I’m exposed, sanitized and readied. Man-Doctor raises the anesthetic syringe and plunges it into my breast, but it hits wrong, or is bent, or snaps… I don’t know what happened, but in an instant I’m shocked with a spray of cool liquid across my chest and face; it’s on my lips, it’s in my wide, startled eyes. 

That was the twig that broke the dam; I start to cry right there on the table.
 
The pain and immobility of the last 6 months, the tests, the doctor's offices, it's all playing before me with a parade of dark emotions. The tears spill over into my ears and down my neck. I want to wipe them away quickly, but I also don’t want to draw attention to them. Which is more discreet, I quickly debate with myself, flowing tears or hands wiping them away? The answer is neither.

I’m only at the start of a path that will produce so many more tears from medical tables, beds, and chairs. I’ll never overcome feeling pride at hiding emotion in front of my doctors or shame at showing it.

Today though, crying publicly is painfully new.

My face and chest is mopped up while profuse apologies are offered. The nurse, either in a failed attempt at consolation or simply startled herself, is repeating how she has never seen that happen in all her years of nursing. Lucky me.

Like a spooked mare, tense and angry on the table, I watch the successful reattempt at anesthetic administration. A small incision is made just above my nipple. I don’t feel anything, save the unpleasant sensation of droplets of blood running down the side of my ribcage. The “needle” I’m going to more fairly call a probe is brought forth and inserted into the incision.

Then the shoving starts. 

I was formerly quite certain that “firm” was not an adjective that would ever again be applied to my post-breast-feeding boobs. But apparently, the tissue in there is still dense and firm, as it is for most women in their 20’s, (in spite of what their outward shape would imply.)
 
Man-Doctor is struggling with the probe, trying to get it to travel through the couple of centimeters of tissue over to the tumor location. I can’t feel the prodding, but uncomfortably am witnessing the jamming process. There is a lot of grinding, like a new driver with an old transmission.

Finally in position, the probe turns into a grab, wherein the actual tissue cutting and collection occurs. It has the force and sound of a staple gun. 
 
1 sample… 2 samples… 3 samples obtained… The collections aren’t going well; a second type of apple-corer probe is brought in and given a go. 1 sample… 2 samples… 3 samples… I’m watching the clock across the room and cursing the fools who quoted the procedure at 15 minutes; we’ve already tripled that estimate. I’m staring at the ceiling. I’m staring at the bottle of sanitizer in the corner. Anything to keep me from looking down, because I prefer to not actually watch myself get cored.

Then it’s done. They are finally satisfied with the samples they’re able to procure. I’m wiped up, taped up, and sent out. 

I sit in my car in the parking lot and let myself cry (again) over the unpleasantness of it all. Resting my head on the steering wheel, I close my eyes and imagine that my run with bad health has just concluded. “I have survived this all and I’m okay. Everything will be okay.” I tell myself.

Then I start the car, drive home, and continue down the path of unravel.

~   -  ~
 
I spend the remainder of the day enjoying our company while I ice my bandaged breast intermittently in front of them. A holiday weekend will pass before the results are processed and I get the phone call.

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