Stage I never sounded so good

About 15 years ago, I had the best hamburger and watered down beer ever. It was from a local diner type of place in Brooklyn Heights that had different burgers. The occasion was me finishing off the NY and NJ bar exams after studying like a mad man for the previous two months. Though, it would be months until I would find out if I would be paying NY and NJ money every year just because I passed their exams, the burgers tasted so good, at least in my memory, because it came right after a stressful situation -- in other words it was my relief burger. I thought I would never repeat and have a burger taste so fine ever again, but I was wrong. Last night we had a burger that tasted just as sweet -- the post-lumpectomy hamburger.

The stress had been growing the last week. We went to a comedy club last week on spur of the moment (and also because my brother volunteered to babysit) and it was such a relief to go out and eat, laugh and chat with another couple we met there without someone asking my wife "how are you feeling?" Meanwhile life carried on as we approached the date of surgery. The day before my wife bussed into the city for her last round of pretests. Of course the hospital didn't call us to tell us her admittance time so, with her cell phone battery going red, she made one final call to me, from the hospital, to call the hospital to find out the time. She later discovered that was a good move as the outpatient department can be very bad about making those calls in a timely matter.

They told us her admittance time was 2 PM, so we immediately called our morning/get the kids on the school bus sitter and said they were relieved. This disappointed our daughter as one of the women was her Sunday school teacher, Upon hearing this, she decided to come later in the evening (once we realized we had a later surgery time, we knew we'd be home late) to relieve the after school sitter, which was very sweet. The nice thing about the late start was not only was my wife able to go to the Y for a final work out, but that I was able to work a few hours and was able to vacate my planned day off, saving it for a nicer occasion. 

The other advantage, and those in the NYC area will know what I mean, is that we managed to avoid both the morning and evening rush hours. Driving into and out of Manhattan is not that bad if done out of peak times. And once in the city, traffic moves at a slow but predictable pace. While I don't love driving in the city, I equate it to driving my wife's Civic over my larger car. In her car I feel the road while I generally float in my car. When driving in the city, all my defensive driving sensors are on full alert, a big difference from driving in our fairly quiet suburb. 

Since it was post-rush hour, I guesstimated that the trip would take 90 minutes which was right on the nose (despite Google maps telling me it would take 1:04 or 1:14 with traffic) -- 60 minutes to get to and drive through the Lincoln Tunnel, another 30 to get across town. We wanted to get in a  bit early so we could stretch and walk around a bit before going to the hospital, so we left home around 11:30 and had the car parked in the hospital's subsidized lot (rate I paid was the same as nearby commercial garages I had coupons for -- pro tip: if driving into Manhattan, print out coupons for garages near where you are going, you can save a ton of money -- but was actually connected to the hospital by tunnel) by 1PM. We wandered a bit on the east side, just talking, burning off some energy and then, at 1:45, entered the hospital.

The waiting room was crowded and my wife's surgery was delayed, so we sat. We found out later that it was due in part to complications with some earlier surgeries. So while my wife's actual surgery was scheduled for 3:40, she didn't actually go under the knife until 5:20. We found this out as we sat in a consultation room she had been called into at 2:30, and where she changed in, as she couldn't get a room in the outpatient ward right away due to overcrowding. At least, once we knew surgery was going to be late, we could inform our child care people we would be home late. We had some more waiting before finally being called into an outpatient room.

We met the anesthesiologist, who explained what he would be doing etc. And then, after mistaking the patient monitor for a flat screen TV (thought it looked funky) and getting a nurse to come in, my wife more or less kicked me out. So, while she waited and did  some sit ups, I took a walk. Now we used to live in downtown Brooklyn/Brooklyn Heights when younger and used to wander the city but foot often on weekends and I decided to repeat the experience. So from York and E.66th St, I wandered up to 92nd Street & Park Ave. I stopped for a slice of real NYC pizza on Second Ave somewhere in the 80s, seeing first hand what some merchants have been complaining about, that their stories are buried behind construction equipment for the Second Ave subway (no idea how those businesses can survive as pedestrian traffic is routed away from their doors)  before continuing on my mission. Our wedding anniversary is this weekend and I wanted to find a nice piece of jewelery for my wife and there is no better place than Madison Ave on the Upper East Side.

Perhaps I should have specified that I wanted a piece that would be less than our mortgage payment. While we make a nice living, I forgot we don't make a Madison Ave living. Sheesh. Fortunately I finally stumbled upon one of those old NYC type of throwback stores -- an upscale, old fashioned pharmacy, with sales clerks and a vast fragrance selection. Reminded me of the little pharmacy that was in my old neighborhood that also offered that rare thing these days -- customer service. With just a few questions (after I told her I had no idea what perfume my wife wears, heck I don't even know what I wear as my wife buys all my cologne) she was able to pick out a $100 perfume that my wife later told me was perfect.

Unfortunately I wandered a little bit more than I realized and I got back to the hospital just as my wife was being taken into surgery for her procedure. While that did give me another chance for a last minute trip to Bloomindales for a last chance for the jewelery I was looking for -- I basically just sat down with my book for the wait. The nurse said the surgery should take about 50 minutes, so I could expect to speak with the surgeon in about an hour. One hour came. Nothing. 6:30 came. Nothing. My phone rang, it was mother-in-law. I told her my wife was still in surgery. She told me she would call the house and speak to our children.

And then I waited some more. 6:45. Still nothing. And that is when I began to get a little nervous. Fortunately, as I was about to bite some one's head off, the staff came for me and told me my wife was in recovery and the surgery went well. Whew. I called home, spoke to our son, and told him mom was doing OK. He was relieved. And of course he hung up before I could speak to our daughter or sitter. Kids.

The surgeon got held up so they eventually brought me to the recovery room. My wife was alert and talking, unlike my grogginess after I had wisdom teeth removed, she said she was wide awake alert as soon as the drugs keeping her sedated were removed. The nurse gave her some basic instructions and then the surgeon came in.

The surgery went very well, he said. The tumor, though over 1cm, was small and he got all of it plus clean margins. The tumor was in the skin and he only took one lymph node. Pending on the lab reports, he said the tumor was Stage I and he believed that this would be it. Whew. What a relief. If you told me 6 weeks ago I'd be happy to have my wife's breast cancer staged as a one I would have thought you were crazy. Funny how fast your world can change.

We left the hospital and walked up to First Avenue looking for a bite to eat as my wife was starving, having not eaten all day. We soon found a nice, Irish pub -- they type of place we used to frequent when we were in law school and didn't have the parenthood pressures and responsibilities that put those days to an end for us a long time ago. We looked at then menu, considered our usual healthy meals, then said to hell with it, we wanted hamburgers. Nice big, juicy, greasy hamburgers. I also had a beer (wife was still on Vicodin). I gave my wife her anniversary gift a little early, which made her extremely happy. The beer and food arrived and we devoured our burgers with glee. While we ate and drank, we felt a huge weight lift off our shoulders. Though we still don't what is next, we felt like we were free of what has been keeping us down for the last month. Best dammed hamburger I had in the last 15 years.

Now the waiting for the lumpectomy begins

For better or worse. That is what we said all those years ago and now, on the eve of our 15th wedding anniversary, we will experience the worse -- at least so far.

My wife met with the surgeon at Memorial Sloan-Kettering yesterday and is scheduled to have her lumpectomy in 2 weeks, at which time they will also check her lymph nodes, with her radioactive seed plantation the day before. Next week, however, she will go in for a bilateral MRI  which, as her initial radiologist predicted, they would resist doing as they feel it leads to over diagnosis but they quickly relented when she pushed the issue, noting her breasts are heterogeneously dense, which sounds like it could be kinky but isn't. The surgeon told her he believes the tumor to be stage 1, but that will be confirmed by the results of the sentinel lymph node biopsy (and she will also be tested for the BRCA gene).

While she already has the time set for the plantation, they will not give us the time for her lumpectomy until the day before, which is hard when you have small children. We can't just go "bye, remember to lock the door when you leave for school" if the surgery is early or have no one home if the surgery is late. While we have people from our temple standing by, a little pre-notice would be nice. For now, there is nothing to do but wait, and hope my wife doesn't make any other detours on her pre-surgical trips to the city by stopping at places like Saks when she is walking between where the NJ Transit bus drops her off at the Port Authority Bus Terminal on the west side of Manhattan and Sloan on the east side (I'm driving her in on the day of surgery but, as former long time NYC residents now exiled in the suburbs, we are vary comfortable taking mass transit -- the bus to the city, which takes a little over an hour depending on time of day, is a short walk from our house).

Of course, when you are waiting, you start doing some research, which can be good and bad. My wife has had a couple of good discussions with a woman from our congregation and one of my mother's cousins, both of whom had lumpectomies in the past and both of whom went to Sloan. I also spoke with another cousin whose mother was diagnosed at 49, did not get the best treatment by her doctors (she went elsewhere and they didn't get all the cancer), and ultimately paid the price. At least I now know why her father was really, really pissed afterwards for a long time. We also have been viewing videos on the Sloan YouTube breast cancer page, a serious of taped lectures by senior department doctors which do a pretty good job of explaining breast cancer procedures for laypeople.

One thing we have discovered, how much more pleasurable it is reading ebooks for this over traditional print media. My wife had found a really good breast cancer book at the library and decided to purchase an electronic version as it is a thick, heavy book. Not only is it easier to carry around and read, but we realized we could download the book to multiple readers (smart phones, tablet computer) as long as we had the right app and signed in to the same account, meaning we can both read the book together or quickly reference it if we are somewhere without the reader or tablet. Nice that we can both easily reference the same material on our own devices in lieu of one reading a passage and then passing the book to the other to read and then comment on.

Other research we did revolved around the pathology report, which we saw for the first time yesterday. Doing medical research before bed can be a dangerous thing. Some doctors say a high Ki-67 marker is bad (my wife is at 30%) others call it a poor man's test or just a prognostic indicator they wouldn't necessarily base a treatment decision on. Her Her-2 ratio was 1.08 and not amplified, some said that was good, others not so much and that again it was just another prognostic indicator. The estimated SBR Grade is 2/3, which seems to imply that her cancer cells are poorly or moderately differentiated and growing faster than we would like it to be, but we don't really know what that means. We ended up finding a lot of medical research papers that were a bit outside our field of expertise but did provide the occasional explanation of a term that we could understand. We've been through the message boards with mixed results. It would really be nice if some of the sites that try to define something would explain why X is bad instead of just stating it. We'd ask questions but, at this point, we just don't know enough about what is going on in my wife's body to ask the right questions without scaring ourselves.

Our children, 11 and 7, still seem to be doing ok, although we've noticed they are a bit more clingy and both do not really like it if one of us is not in the bedroom end of the house (we have a "L" shaped ranch) when they go to sleep. I noticed our 11 year old took significant interest when my wife was reading a mommy is sick type of book to our daughter before bed the other night. We are trying to keep things as close to normal as possible, letting our 7 year old have a sleep over Friday (that reminds me, need to buy booze for myself) a family fun day with our congregation on Sunday. We were to go away the week of the 17th (school ends the 15th, camp begins the 25th) but that is cancelled, though we may slip away for a night or two down the Shore instead if my wife is up to it. It really hit home when my wife got her FMLA paper work filled out (fortunately I have a flexible work schedule and can work remotely, or even go into my company's main office which is a short cab ride from the hospital, so at least my paycheck will still be coming in if my wife is forced to take unpaid leave for an extended period).

It will take 10 days post-surgery for the lymph node results to come in, at which point we find out if my wife gets chemo or radiation (tamoxifen is a given). Also, we find out if the margins are clear or she has to go back. Then finally there is the chance she will still need a mastectomy. Left unsaid, for now, are our fears that the cancer has spread, there will be a recurrence and that she may be a part of the small percentage who don't even make it 5 years. I suspect we will be living with that white elephant in the room for a long, long time.

Hopefully, we will get the good news that the tumor can be taken out with the lumpectomy, radiation will eliminate the cancer cells and we can go about our lives and continue to raise our family with just a checkup for my wife every 6 months. Funny what is considered good news these days.