Drill, Baby, Drill

It has been a week and a day. Last Wednesday I got an MRI-guided biopsy. I have waited to write until my emotions calmed down somewhat. This entry is to help me process my complex emotions on the topic, and also to throw out some larger questions the experience has raised for me.

Radiologists saw nothing when they did a mammogram, but they could not see well, so I got an ultrasound. They saw nothing with the ultrasound, but they ordered a session with a breast specialist and an MRI. The breast specialist (who I admire) felt nothing unusual, but agreed. I got the MRI and they saw no mass, but an undefined shadow--so she recommended an MRI-guided biopsy. She did not feel I needed a biopsy. Really she wanted to order another MRI in three to six months, but insurance would not allow that, she said. Insurance only allows you to act with urgency, or not at all. So she was going to opt for urgency. Once she made up her mind, that was that. I like her. I do not find her alarmist. She assured me the process would be quick, easy and non-invasive. It would take 45 minutes, and then an hour in the recovery room to stop the bleeding. It was not an emergency, she told me. I could have it done any time in the next month. But sooner would be better.

She answered a few of my hysterical questions by email, and then I was on my own, the time was booked. Wednesday, 9:30 a.m..

I turned up and was whisked through the bank of insurance specialists. They liked me because my insurance is good--you do not even need pre-approval the woman told me with a smile. You are lucky.

I was sent downstairs to a subterranean maze of rooms where you could hide if a nuclear weapon ever goes off in L.A.. I changed into a gown and then was sent to have an IV put in. That would be used to send the colored fluid through my body so they could see the contrast on the MRI.

I was led into the MRI room by a cheerful nurse. Soon, I was told, I would be informed about what would happen that day. Finally a young male doctor radiologist came in. I had never met him in my life, and he had never met my doctor. He told me that I might have DCIS. He told me they would slide me into the machine, find the spot, put some lytocaine (sp?) on my breast then they would drill into my breast with a needle slightly smaller in diameter than a number two pencil, slide me back into the MRI machine to make sure they had the right place, pull me back out of the MRI, then take eight to nine samples in the shape of a rotary phone all the way around the shadow--hard because they could barely see it--and then I would be done.

I could not drive myself home. Oh yeah, he remembered, we will be shooting a piece of metal into your breast to show us where we went because after this procedure there will be abnormal cell growth all around where we drilled into you and we need to know for the future that this was caused by us, and not you. And you can't drive yourself home. This is a serious operation.

I was alarmed. No one had told me about metal, or about anything at all. It seemed like a lot of samples. I didn't want metal. He told me he would show me the metal and the needle they would be drilling into me. He did not. I resisted. I was naked. I had no phone. I had no way to contact my doctor. I was trapped in an underground room with a doctor I had never met in my life who was really defensive and made everything sound much worse than my doctor had. I was getting emotional, which he did not like. He told me yes, there could be a lot of swelling. Yes, there would be considerable bleeding, and yes, there would be contusions. None of this matched what my doc had said, which, I suddenly reflected, was not much at all.

I sat shivering in my gown on the edge of this giant futuristic machine that looked like it could take me apart, send me through space and time, and reassemble me cell by cell in Afghanistan. I crumbled and gave in. I said they could do whatever they wanted. I signed and said I would not blame them if I got infected, if I bled profusely, if they hurt me any way at all, if they shot metal into me.

I lay down. They couldn't get my position right. They slid me in and out a bunch of times. I asked the doctor how many times he had done this procedure. He did not answer.

For some reason they wanted the machine tighter than normal. I am not claustrophobic, but I was starting to feel that way. They could not find the shadow spot. Finally after going in and out two to three times they found the spot. They put the lytocaine on me. The doc drilled into me. They slid me back into the MRI machine. They slid me back out. He started his motor. He took his eight to nine samples, whirring away into my breast like I was a two by four. I lay there. He ran in and out into his control room. Lots of voices. Another doc who sounded like she knew what she was doing came in and put her hand on my back and told me it would all be over soon. I couldn't move. My head was down. I was awake. The doc came back. They had missed. They got mostly fat. They had to do it again. They put me back into the machine. They tried to find the right spot. They slid me out, they drilled in again. They slid me in to make sure it was right. They pulled me out.

They drilled again--nine more samples. They tested. This time they were happy. At this point I had been in and out of the MRI machine about eight times. They had taken 18 core samples. I hurt. Finally they let me up. I was crying. There was blood everywhere. The doctor said nothing to me. He just took his bloody tools and walked away. The nurse wiped clean my breast that was already swollen and full of contusions. They covered me and bandaged me to try to stop the bleeding. My blood was still all over the MRI machine. The whole process took two hours.

I cried and cried. Just silent sobs. They told me I had to ride in a wheelchair. I said no. They said yes. I said no. I felt like it was the only thing I could do to try to restore my dignity. I walked to get my clothes. They called a supervisor who told me I had to ride in the wheelchair. I said no. She rolled her eyes and said she was going to have to talk to her supervisor. Sigh. I could fall. I could sue.

They walked me upstairs and put me in a recovery room. I had to stay for two hours because I did not have a driver. The recovery nurse was nice. The most informative person I had met at the hospital. He said most biopsies come back negative (unlike the doc downstairs who said it was very possible I had DCIS--the most common form of cancer). He told me MRI guided biopsies are good because they take out so much of you it is effectively like a lumpectomy. He told me that my doc was a fellow.

A day later, before I had my results back, a nurse called from Cedars. She wanted to know how my experience was. And she wanted to know if I would recommend Cedars and its Imaging Center to my friends (Kind of like, Did you enjoy your stay at Canyon Ranch? Would you recommend us to your friends? Thank you, I will give this to my marketing department.) She spoke to me longer than anyone the whole day at the hospital, with the exception of my sweet recovery nurse, Ricky.

Is there some division of labor that hospitals abide by? Are nurses assigned the duties of compassion and listening? Doctors the role of distant, hard-line, non-emotional robot?

A week has passed. My breast is still swollen. It is black blue and yellow all down the left side. There are contusions. Inside there is a huge lump of scar tissue. Where I had no lump before, now I have one. I am sure it will go down over time. But it will be there.

I hate my breasts right now, and I hate my body. I feel modest, vulnerable, violated and traumatized.

Though I have no record of breast cancer in my family, and no obvious risk-factors, the fact that I have been checked carefully now means I am on the official watch list. I am being told to be checked more regularly, even though two MRIs and an MRI guided biopsy have shown that I have no cancer, even though fibrous and dense breasts are not a risk factor for breast cancer. The mere fact that I have had tests, means that now, forever after, they want to keep more of an eye on me.

My medical records, written so as to get the insurance needed to get the tests I need, read in a way that is far more dire that my actual situation. When I read what the doctor said (which she explained she had to do to get insurance coverage for me--which I am grateful for) I get heart palpitations.

But I know the words she wrote to get the tests will live as the truth, not the words she told me about my breasts. So again, my risks will be elevated in my medical record.