Oncology

Hooter Hotline #15: Oncology

February 10, 2010

“Oncologist? Isn’t that some one who is an expert at being on-call?” My husband thinks he is being so clever to say this whenever he hears the term. I always roll my eyes and groan in response because he expects me to, but the truth is I am usually the one guilty of most bad puns. It’s my philosophy that one must risk many bad puns to eventually stumble upon a truly great one. The pun muscle must be kept in shape for brilliance to reveal itself when the perfect setup comes along. It’s very satisfying when the potential great pun is pitched and you smack that ball square on, zinging it into homerun territory. I’ve had a few moments like that in my time and it is so sweet.

While waiting for my first appointment with the oncologist back in November, I noticed that this waiting room was not like other doctor’s waiting rooms. This assembly of patients does not come for sports physicals, vaccinations or sinus infections. They come for a different set of shots and infusions. They come to see how their blood counts are holding. They come to be reassured that even though their counts are below normal, they can still get by. They come hoping to hear words like “remission,” “shrinking” and “We don’t need to see you again for a year.” These differences create a palpably different vibe in the air. There is a measured, restrained tension on many of the faces. It is surreal to think that this is MY waiting room now.

I scan the room to keep my mind occupied and I notice one face that doesn’t have “the tension.” She possesses such naturally merry features that she could be Mrs. Claus. Pink round cheeks, grandmotherly plumpness and her sweet, perpetual smile make me think that she might have freshly baked cookies in her purse. I would guess her age to be around seventy. She waits calmly with her wool coat buttoned her ankles crossed and a relaxed grip on her handbag. The most striking thing I notice is her bright red wig against her fair complexion. I think to myself, “If I ever have to lose my hair, I’m going to have some fun with wigs and hats too.”

My attention shifts to a frail woman wearing a turban who is being led to an exam room. She is very gaunt and moves delicately. Her frame is just a whisper. I imagine how much weight she must have lost. I wonder if it hurts when she walks. There’s no way to tell if she’s winning or losing the battle. My eyes wander again and they fall on my cheery lady. She still wears her peaceful closed-mouth smile. It seems like we’re waiting a long time for my appointment. I find myself checking on the cheery lady frequently. I’m sure that I gravitate towards her because of the expression on her face. I’d like to tell her how impressed I am that she is always smiling. I’d like to tell her that I want to pray for her and that I hope she does well. I have enough time to decide that I really will do this. Then her name is called. She rises and walks in front of me. I pop out of my chair and slide in beside her. “Pardon me, Ma’am,” I begin, “I just had to say that I noticed what a lovely smile you had and that it was encouraging to me.” “Oh, how nice!” she said. “Do you like my new red hair?” she asked. “Yes, yes I do. It’s gorgeous,” I replied. We were both moving fairly quickly to keep pace with the assistant leading her to her appointment. I touched her arm and said, “Can I give you a hug?” She smiled widely and we stopped momentarily for the connective embrace. “Thank you,” she said. “Keep smiling. I’ll pray for you. Get well,” I called softly after her, standing still while she continued ahead. Yes, this was a different sort of waiting room. Everyone in it likely needed hugs and extra prayers. If you ever run out of things to pray for, just spend 30 minutes in an oncology office, but don't forget to bring your smile.

It turns out that my first appointment with Dr. Olson was worth the wait. I strongly recommend that anyone facing breast cancer and the many options of treatment, schedule this appointment before making any surgical decisions. I believe surgeons and OB/GYNs should make this recommendation at the time a patient is informed of a positive cancer diagnosis. Several important things come from taking the time to do this. The patient gets the undivided attention of the oncologist for an extended amount of time at the initial consultation. Dr. Olson’s practice holds these consultations at the larger Rose Quarter office where they have a special room designed just for this purpose. It looks like a miniature living room with homey decor and soft lighting. Patients meet a nurse navigator who presents them with an extremely thorough resource notebook. Simply holding this notebook in my hands made me feel better. It has dividers already labeled for patients to organize test results, sections on decision-making processes, explanations of vocabulary and procedures etc. One of the most thoughtful touches was the business card holder page placed in the front. The oncologist and nurse navigator cards were already loaded as well as “Breast Friends” and there was room to add my own cards for the breast surgeon, plastic surgeon, radiation oncologist and more. I grab that notebook every time I need to make a call.

The breast surgeon explains the details of where the cancer is and what type it is. The patient will get a cancer primer from the breast surgeon complete with nifty, personalized diagrams. Dr. Wheeler made some memorable analogies during her teaching session with us that were entertaining as well. For example, Ductal Cancer In-Situ is when you leave the teenage girls alone at home for the evening. Infiltrative Ductal Cancer is when those same teenagers decide to have a party, invite boys and break open the liquor cabinet. The breast surgeon will also explain choices of treatment and share a lot of statistics. Meeting with oncology several days later allows questions to spawn from absorbing the first round of data. It was reassuring to hear the oncologist use the same basic statistics in describing the situation. It helps to know that everybody is singing the same song. This meeting is a great time to ask the questions you didn’t know you had when you met with the breast surgeon. Having my husband with me for the consultation relieved me of having to regurgitate tremendous amounts of information as well as explain it to him later. He was also free to ask any questions or seek clarification if he needed to.

That being said, today’s appointment would be my third visit with Dr. Olson. No longer a “Poster Child” for lumpectomy, we came to hear if Chemo would be required. I have learned that every doctor has his or her own style of conducting an appointment. Dr. Olson’s is to launch into an explanatory set-up of the data he is about to divulge. He doesn’t start with, “Your Oncotype-DX is ____ and this is what that means.” Instead he takes us down a familiar path with a set of bar graphs he’s used previously to describe risk of recurrence. This time however, he’s updated it with new information from the recent pathology reports. At the end of his spiel, he tells me my statistical risk that breast cancer will reoccur in some distant region like the liver, brain or bone. All the while the Oncotype-DX printout is on top of the pile of papers he walked in with. These papers are setting in front of the computer that he is using to show us the updated graph. I have to resist the urge to speak through clenched teeth, begging him to QUICKLY get to the point. Eventually he does and in classic Stafford fashion, the $3,000.000 test yields my risk as “intermediate” which is the same result as his bar graph. Well, there’s a chunk of change wasted. When all is said and done, Chemo is the prudent choice. It’s what he would recommend for his wife if she were in my position. I didn’t even have to ask the question. He just offered it up assuming it was coming. “How do you feel about that? Are you okay with this?” he asks. Emotionally weak from my drain issues, arm pain and new loss of hope to avoid chemo, I answered in a quaky voice, eyes brimming with tears,
“I just have to be okay with it. To live is good and I want to do everything I can to perpetuate that. The chains are on the bus and we’re headed up the mountain.”

After we concluded our appointment, we were ushered to the scheduler’s area. It’s no coincidence that she has a box of tissues next to the lame dish of hard candy. I knew I was in trouble when the first thing she did was offer me a pocket calendar the size of my own day-planner. Within a few minutes I was scheduled out to April for chemo sessions every other Friday, Neulasta injections every other Monday, lab draws, a cardiac echocardiogram and the essential Porta-Cath placement. While I was scribbling these life-saving dates down in my new book, my vision diminished to the equivalent of looking through a fish bowl. I couldn’t believe what I was writing down. I used to work 12 hours shifts every other weekend and those weren’t always fun, but they looked good now compared to my new weekend plans. I dabbed away the colossal silent tears and pressed on. The scheduler, Janice had such a gentle way about her. I knew she understood what she was laying out for me. I knew from her tone of voice that she wished she didn’t have to do it.

Chemo is slated to start February 26, 2010. Chemo Class was slated for the very next morning at 9:00 AM.