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Prognosis: Hope despite the unknown

Need for information intensifies before surgery

By Regina Brett

This column was first published Tuesday, March 10, 1998

Journalists make the worst patients.

We have a need constantly to seek information we aren't supposed to have. We turn doctor appointments into interviews.

My poor surgeon sets up an appointment and I show up with two pages of typed questions, a tape recorder and two notebooks.

If knowledge is power, I've got it. I've read 20 books on breast cancer in 48 hours to prepare for a 45-minute biopsy.

The surgeon will cut out the lump in my breast and send it to a lab to find out if it is cancerous. More than 80 percent of biopsied lumps aren't, so I'm hopeful.

The hardest part is telling my daughter I need surgery. The sound of her sobbing on the phone from her dorm room still breaks my heart.

As the surgical team prepares the IV, I ask my surgeon when I'll know the results. He cautions that the frozen cut -- in which the tumor is frozen, sliced thin and examined under a microscope -- isn't always accurate.

I want to know anyway. I don't want to wait five days for a pathology report. "I can't promise you anything," he stammers.

I look up at the men and women cloaked in green around the gurney at University Hospital in Cleveland and ask, "Would you guys want to wait five days for your results?" No one says a word.

During surgery, voices fade in and out. I vaguely remember discussing the Olympic Games and trying to explain the sport of curling. They think I'm too drugged to make sense.

My husband joins me in the recovery room. The surgeon removed a lump the size of a grape. He leaves my bedside to check on the frozen sample to give me my verdict. As the surgeon passes the foot of my bed, he squeezes my toes.

He will never know what that simple gesture meant to me then and now.

He comes back and apologizes. It's cancer.

The tears start to fall. They haven't stopped.

The surgeon calls the next day to confirm the pathology. It's Stage II, a 2-centimeter tumor, a Grade III pathology, the fastest-growing.

My husband holds me as I break the news to my daughter. All three of us weep.

The next day the surgeon puts before me what he calls choices. A: More surgery. B: Radiation to kill any cancer left in the breast. C: Chemotherapy, to kill any cancer that spread.

Unfortunately, I'm stuck with D: All of the above.

The treatment plan is chemo for four to six months, then radiation five days a week for five weeks. The best-case scenario is I lose part of my breast, all of my hair and get to live. Guess I should be more positive: I get to live, lose my hair temporarily and keep part of my breast.

"You are young and healthy, so we can be aggressive. You can withstand a lot," he insists.

Can I?

He offers compassion but no pity. He tells me about other patients whose vital organs he has removed.

Yes, it could be worse. I can live without a breast. It's not like losing my arm or my eyesight or my ability to walk, think or remember.

I try to stay focused on the true choice in front of me: I must choose life. I am losing part of my breast to choose life. I will let my hair fall out to choose life.

People have asked, "What's the prognosis?" That's one question I won't ask. It's not because I don't want to hear the answer; it's because I don't believe anyone knows.

Prognosis is based on so many factors, it makes for a twisted math equation involving your family history, your age, your percentage of cancerous lymph nodes, the size and grade of your tumor, and it somehow ends up with a percentage of how likely a recurrence is.

The only cancer math I can handle is this: I will live each 24 hours with as much hope, faith and love as humanly possible.

This column was first published Tuesday, March 10, 1998

Journalists make the worst patients.

We have a need constantly to seek information we aren't supposed to have. We turn doctor appointments into interviews.

My poor surgeon sets up an appointment and I show up with two pages of typed questions, a tape recorder and two notebooks.

If knowledge is power, I've got it. I've read 20 books on breast cancer in 48 hours to prepare for a 45-minute biopsy.

The surgeon will cut out the lump in my breast and send it to a lab to find out if it is cancerous. More than 80 percent of biopsied lumps aren't, so I'm hopeful.

The hardest part is telling my daughter I need surgery. The sound of her sobbing on the phone from her dorm room still breaks my heart.

As the surgical team prepares the IV, I ask my surgeon when I'll know the results. He cautions that the frozen cut -- in which the tumor is frozen, sliced thin and examined under a microscope -- isn't always accurate.

I want to know anyway. I don't want to wait five days for a pathology report. "I can't promise you anything," he stammers.

I look up at the men and women cloaked in green around the gurney at University Hospital in Cleveland and ask, "Would you guys want to wait five days for your results?" No one says a word.

During surgery, voices fade in and out. I vaguely remember discussing the Olympic Games and trying to explain the sport of curling. They think I'm too drugged to make sense.

My husband joins me in the recovery room. The surgeon removed a lump the size of a grape. He leaves my bedside to check on the frozen sample to give me my verdict. As the surgeon passes the foot of my bed, he squeezes my toes.

He will never know what that simple gesture meant to me then and now.

He comes back and apologizes. It's cancer.

The tears start to fall. They haven't stopped.

The surgeon calls the next day to confirm the pathology. It's Stage II, a 2-centimeter tumor, a Grade III pathology, the fastest-growing.

My husband holds me as I break the news to my daughter. All three of us weep.

The next day the surgeon puts before me what he calls choices. A: More surgery. B: Radiation to kill any cancer left in the breast. C: Chemotherapy, to kill any cancer that spread.

Unfortunately, I'm stuck with D: All of the above.

The treatment plan is chemo for four to six months, then radiation five days a week for five weeks. The best-case scenario is I lose part of my breast, all of my hair and get to live. Guess I should be more positive: I get to live, lose my hair temporarily and keep part of my breast.

"You are young and healthy, so we can be aggressive. You can withstand a lot," he insists.

Can I?

He offers compassion but no pity. He tells me about other patients whose vital organs he has removed.

Yes, it could be worse. I can live without a breast. It's not like losing my arm or my eyesight or my ability to walk, think or remember.

I try to stay focused on the true choice in front of me: I must choose life. I am losing part of my breast to choose life. I will let my hair fall out to choose life.

People have asked, "What's the prognosis?" That's one question I won't ask. It's not because I don't want to hear the answer; it's because I don't believe anyone knows.

Prognosis is based on so many factors, it makes for a twisted math equation involving your family history, your age, your percentage of cancerous lymph nodes, the size and grade of your tumor, and it somehow ends up with a percentage of how likely a recurrence is.

The only cancer math I can handle is this: I will live each 24 hours with as much hope, faith and love as humanly possible.



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