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.

Downward

Winter turns to spring. I’m trying to accept my lot and move forward.

My husband and I decide to try for our second child, the little one who will complete our family. 

I do still have days where I’m lost in contemplation over self diagnosis, and I decide I better have everything I can think of checked out. I make an appointment to see an OB-GYN to have a hard, painful mass in my left breast looked at, get an annual exam, and while I'm there, pick up a prescription for prenatal vitamins. 

 There is a six week wait before I can get in.

When I do finally see the doctor, I leave with an ultrasound referral to look into the lump "just to be sure" and a prenatal vitamin prescription that will never be filled.

Life, Derailed

The weeks are passing and I am getting no better.

The pain with every movement is excruciating. I am using a walker or a wheelchair to get around. I am banging against the walls of a broken body, trapped in immobility.

My parents start watching my son more frequently. My husband starts falling behind in his work. I am growing increasingly frustrated.

I am harboring adamant hope that the right doctor will figure out what’s wrong with me, give me the correct prescription or adjustment, and then everything will be normal again. But why is it taking so long? 

In the meantime, I’m missing out on my life with regularity. 

 



After months of misdiagnosis and severe immobility - months of terrible - I am diagnosed with Ankylosing Spondylitis, or "something resembling it."

Spondylitis is an autoimmune disease that causes chronic inflammation of joints. What I hear is: there is no end. There is no cure.

Confused and in disbelief, I am reduced to retching sobs many, many times over the coming weeks. I don't believe the real ailment has been found but am also losing hope that I will ever be set back onto the tracks of a normal life again.
I see my everything as hindered with no end... Missed walks, hikes or exercise of any kind, attractiveness hindered by an awkward gait, the potential inability to have and take care of a second child...

* * *

I learn to give myself weekly injections of the drug Enbrel and do gain immediate relief from them. I do my best to move ahead and accept my lot, but the disbelief never goes away. I still think I haven’t seen the doctor yet who will get this right - who will return me to the normal I had always known.

Life, Derailing

It hurts when I sit up in bed.

There is un-ignorable aching springing from my ribcage and from the right side of my lower back. I feel strange; the pain is unrecognizable to me and I can only attribute it to an accident or a fight that did not actually occur. Could something (or some things) have happened to my body yesterday without my knowing? Did I get jabbed in the rib cage? Did I pull or strain something in my lower back?

It hurts every time I move my legs; I can’t take a step without limping to compensate. What is happening?  

The Fall

Fall 2009

The leaves are changing colors and blanketing the ground. The cooling air has us unpacking our sweaters, piling wood next to the fireplace, and thinking ahead to the coming holidays. The promise of apple cider, baked goods, and joyful visits with family cheers each day with anticipation.

The exquisiteness of fall is never lost on me. I am a 28 year old woman with a husband in his seventh and last year of graduate school, a two year old son, and a rather uninteresting job. I live fairly modestly, taking joy in simple life changes, such as the season. 

I have been planning my son’s Halloween costume for weeks and am absurdly excited to take him to a carnival with his cousins. I love the festivities that Halloween is the start of. I love that I now have a young child to teach holiday traditions to and relish each small joy with. I am filled with happiness and enthusiasm.

The anticipated carnival is held outside a large church in a town nearby and is swarming with costumed people.  Hay and pumpkins are everywhere.  Food stalls, farm animals, rides, and game booths form rows and rows through the previously empty field.  I’m running around after my little Yoda, with his cape and painted green face. 

 

We’re laughing a lot, and I keep trying to take pictures in spite of the bad lighting and little subjects who won’t stand still.

I don’t realize it at the time, but pictures or none, I will remember everything about this night... the bad Chinese food we ate for dinner, the light blue shirt I was wearing, the chalky parking space we pulled into just as the street lights were coming on, how it felt to lift my little guy over the inflatable obstacle course barriers he couldn’t climb, to duck and weave through them with his twenty-five pounds attached to my hip.  The details have etched themselves into my memory as significant.

 

This was to be the last day of my normal life. Tomorrow, on November 1st, I will wake up sick. Very sick.

 

Preface

A young and frightened woman stands in the parking lot of a nondescript medical building, hugging her fiancée. The life she hasn’t yet lived suddenly looms in jeopardy... the wedding she is just beginning to plan, marriage, a career, travel, pregnancy, motherhood… the future that is so big in her 19-year-old eyes.

She has a small lump in her left breast and is about to go inside for an ultrasound. Her paternal grandmother had breast cancer late in life, which is enough to make the possibility frighteningly plausible. She has a tearful prayer in the arms of the young man she can’t wait to marry and then makes her way inside alone to discover what will become of her.  

The ultrasound technician squeezes the cold gel onto her chest and slides the wand over the small lump. After a few minutes, the technician leaves the room to get the radiologist for a second opinion, which of course further incites the fears of the young woman. But the doctor who comes in, rather quickly determines the lump to be nothing but a cyst that will heal in time. The oh-so-young woman, awash in relief, leaves to return comfortably into her life that is unfolding with normalcy and good-fortune.

She is innocent and happy; she is perfectly healthy - or so she will think for another nine years.

The Beginnings of a Blog

Just after my son was born, my husband told me he wanted to start a blog to share photos and info with our many distant relatives. I was completely opposed.

"Isn't that a little self-absorbed?" I countered. After all, who (besides the grandmas) really wants that much information about our child and our lives?

Nearly 5 years and some 20,000 hits to our humble family blog later, I am branching out to create a new venue - one in which Grandma is not my (only) target audience.

My first several posts are copied from either our "family" blog or my own personal writings. I will re-live the last couple years of unbelievable pain and suffering - of miraculous beauty and joy with you.

Come along.