The Breast Day Ever

First, I have to credit one of my patients for coining this title in recounting her story to me recently. I can’t share her name due to HIPAA, but know she’s out there and she’s amazing. Thank you for making me smile with this.

I got the call none of my patients want to get. “We found something on your mammogram and we need to do more testing”. I didn’t need to google, I knew what my risks were and it wasn’t overly comforting. I have category D dense breasts which affects about 1:10 women. It makes it a bit harder to get accurate mammograms but also inherently increases risk of breast cancer. Stress also has a documented negative impact on the neuroendocrine and immune system and is a known risk factor for breast cancer. This past year has hands down been the most stressful of my life.

I also know we are all living through unprecedented stressful times right now. Everyone I know has anxiety brimming as pandemic fatigue melds with viral fears. The stress of every decision, every action, and the fear of judgement for said actions has us all on edge. My first thoughts, “I can’t tell anyone yet. It will probably be fine and no one needs extra worry right now.” I also felt that if I didn’t tell anyone, maybe I could try to complete a day where I still focused on my patients without worrying about what might be. Possibly delusional, but I went with it. I knew I wouldn’t be able to completely ignore the persistent rumination that would ensue, but if I could decrease the amount of loving and worried phone calls and texts I received I could at least try to move through my days without drowning myself in fear. So I chose 1 person, one of my very closest friends, colleagues and confidantes. Someone who has been down the breast cancer road herself and someone I could trust to “handle” me the way I felt I needed to be handled. In other words, keep my secret. I told her. And she “handled” me perfectly.

I danced with my worry for a couple days while I waited to go in for my second round of imaging. I knew my health was important and needed to take precedence, however, I did just open a comprehensive, collaborative medical practice on my own in the midst of a pandemic. I needed to make sure my patients were receiving the care they deserved. My mammogram was on a Wednesday, they called me with the news an hour after I left, and I scheduled further imaging for the following Monday. Not even a week, but it felt like a month.

Finally, on Sunday, I told my husband. If I’m honest, I may have been driven to tell him at this point because Life360 would have ratted me out. But we’ve been together since we were 15 and keeping things from him is not my forte, even when I feel it’s for the best. I downplayed as much as my soul could muster. “They just didn’t get a good enough view and want to make sure they didn’t miss anything”. He seemed somewhat calmed by that. I didn’t have details to share with him yet, so I wasn’t holding that back. My fear was the only thing waiting to be unleashed. I know, emotions are never wrong, but at this point I felt like this particular one wasn’t helpful to share.

The day for my 2nd round of imaging finally took a leisurely stroll in my direction. I performed more acrobatics to get the perfect view - the lesion they were looking at was close to my chest wall which creates a bit of Olympic style mammography. After the 1st round this day, I sat in the dressing room (alone and Covid-style) waiting to see if they needed more. They did. After the 2nd round I sat and waited again, working tirelessly to breathe (it’s nuts how oxygenating isn’t at the top of important things to do in these moments) and notice the feeling of tightness in my chest for what it was. Once again, they came back and needed more, this time an ultrasound. They looked so thoroughly with the ultrasound I walked away with bruised ribs (since the lesion they were evaluating was against my ribcage). Then it was back to my dressing room to work on not ruminating again.

Then the radiologist comes in to talk to me. A wash of relief rushed over me when I realized it was someone I knew. I knew she wouldn’t pull any punches with me. She recommended a biopsy, but did say it wouldn’t be wrong if I just wanted to wait and repeat imaging in 6 months. First: WHAT KIND OF SOLDIER CAN WAIT 6 MONTHS FOR THIS STUFF?! Not it! Biopsy please! Second: this option did seem like a glimmer of good news!

Again with the schedules. Biopsy was set for 3 days later. By now my staff and my husband know (since I can’t seem to sneak out on any of those people!). Here’s what I know - I have grouped micro-calcifications that put my BIRADS at a grade 4 (on a 1 -5 scale where 1 is benign). Still not loving my odds. And every minute still feels like a week.

Biopsy was done Thursday morning. And let me tell you, having a giant needle shoved into my boob to suction clumps of tissue out was not nearly as bad as I worked myself up for it to be. Win! Positioning for the biopsy, however, was no joke. There’s a very large (for this small chested human), slightly intimidating hole for my breast to fall through as I lay face down on a table. Mammogram paddles underneath to squash and pull the breast tissue so they can get to the biopsy site. But since my spot was so deep, I also had to put my arm and shoulder through the hole, which had no padding at the rim. Legit, but my shoulder endured the worst of the pain during that procedure! It’s still bruised from the pressure. The biopsy itself, surprisingly not so bad. After numbing they use a 9 gauge needle to collect the breast tissue. For reference, a 16 gauge needle is used for blood donation and generally a 21 gauge is used for blood draws (smaller number gauge equals larger diameter opening). So a 9 gauge is essentially a pipe. Anyway, pressure and ice packs and I’m off.

24 hours later, results are in. Benign! Halle-friggin-lujah! Then a sudden realization of how fast my head had been spinning for the past week and a half. I panicked. I held things in. I didn’t sleep. I didn’t eat. I snapped easier. I disconnected. My stomach hurt. I was having trouble concentrating and finishing tasks. I had left the biopsy appointment without registering the wound care instructions they gave me. When I read them later they glossed over my processing center and skipped right back out. I had to look for the paper 3 more times to be sure I was doing it right.

So here’s my lesson. My worry was as ever present as what I fear empathy in the medical community is absent. Many of my patients, friends and family members have gone through this ordeal and more with much more stressful outcomes. I remember telling my husband after my biopsy that I was at least grateful for the increased empathy I would gain. He was still feeling a bit salty about the whole deal and fired back “You don’t need more empathy!”. I knew his fear and understood his reaction, but it only took a couple seconds before we exchanged a glance knowing that could never be true. It can be easy to forget the emotional toll medical workups place on our patients. We push and poke and tell them it will “just hurt a little”, totally negating the mental and emotional pain of preparing for the procedure and waiting for the results. Being on the blunt side of the needle time after time can have a mirroring effect of blunting our empathy and our compassion as the actions can become mundane. I will be forever grateful for my results. But I will also be perpetually grateful for the reminder of why I started this medical practice. Today I’m grateful for my health. I’m grateful for my reminder. I’m grateful for my practice and for the people who care so much that I couldn’t bear the thought of increasing their worry. I’m grateful for the amazing team at Mercy Health Comprehensive Breast Center for reminding me how much compassion can calm the nerves of the patient (this group is NOT part of the problem). And I’m grateful for the opportunity to help them show the community that empathy and evidence based medical care can co-exist.

The photos below highlight the progression of my mood starting with delight in myself for practicing self care and scheduling my mammogram, to more testing, to biopsy, then 1 day post biopsy and 3 day post biopsy bruising.

Written by Nisha McKenzie humbled PA-C, Founder and Owner Women’s Health Collective