After my farewell to the radiation oncology department, I take the elevator up to the lobby and meander through the hospital complex to meet with Dr. Weary, my oncologist. (My heart feels heavy because Dr. Alpha is no longer my guardian angel and in my purse I have reams of computer print outs about the side effects of Arimidex, Dr. Weary’s drug of choice.)

Dr. Weary is late. I study my computer print outs for more than an hour, sitting alone in the small exam room. I feel clammy and light headed as I read other women, my cancer sisters, enumerate the side effects of Arimidex:  joint pain, bone pain, loss of concentration and memory, dizziness and insomia, hot flashes, nausea, hair loss, aging skin, vaginal dryness, trigger finger, loose joints,  anxiety,  leg cramping and  fuzzy brain. One woman writes: I hobble out of bed like a 90-year old, I will quit taking this pill. I’d rather die than live like this.

I  am about to fall off my stool and faint when Dr. Weary finally appears. He looks, well, weary. He apologizes profusely about letting me wait so long. But in the middle of his “I- am- so- sorries,”  his cell phone rings. He sighs. At first he looks like he plans to ignore it then glances and the number and answers. It is clear to me, it is another physician calling. And it is clear to me it is about a serious matter. “Go ahead, don’t worry,” I tell Dr. Weary has he excuses himself and leaves to continue the call out of my ear shot.

When he returns, I waste no time. I hand him the two-inch thick ream of Arimidex complaints. And just so he won’t have to read all the pages, I verbally high light the awful side-effects. Dr. Weary sighs again. He reaches out and takes the pages out of my hand, but instead of reading them, he dumps them in his waste basket with a thud, sits down and stares me straight into the eye: “You read too much,”  he says calmly.  “The only women who will go on  the internet are those who have complaints. For every woman you have read about, there are a thousand with no complaints.”

Dr. Weary scribbles my dreaded Arimidex prescription on his pads, rips it off, and hands it to me. “Here, the pharmacy is across the hall. If you don’t feel good, call me and I will put you on something else.” His cell phone buzzes again. Our session is over. Normally I would feel dismissed, not validated, and mad as a hornet. But somehow Dr. Weary makes me realize that his primary concern are those patients of his who are in immediate danger. Right now, I don’t need him all that much. As far as he is concerned I am making mountains out of mole hills,  and loosing sight of the real reason for the medication in the first place: To stop the spread of cancer. And if, or when, I do need Dr. Weary, he will be there for me.

I leave a bit befuddled, but calmer. I will be eating Arimidex pills for five years. The University Medical Center oncologist suggested Tamoxifen for 2 1/2 years and Arimidex for another 2 1/2 years. According to the National Cancer Institute the benefit of tamoxifen as a treatment for breast cancer is firmly established and far outweigh the potential risks of blood clots, uterine cancer, and many of the same side effects as Arimidex. Over thirty years, Tamoxifen has shown effective on pre-menopausal and post-menopausal alike.

Arimidex, on the other hand, is a fairly new drug without the same track record. So why am I on Arimidex only? Dr. Weary never explained why.  On the other hand, Tamoxifen works by binding up estrogen in a woman’s breast so it cannot feed the caner. But Arimidex prevents estrogen to develop in post menopausal women.  Somehow Arimidex makes more sense in my un-scientific mind. I buy my first jar. It costs $35 because I have health insurance. The cost is $378.70 for 30 pills  if I did not have insurance. Time will tell how I will feel and how much good they will do. By the way AstraZeneca’s profits for the first quarter of 2010 were on the order of  $3.73 billion.

When do you buy a car without inquiring about cost? Probably never. Chances are you carefully research different brands of cars, repair records, gas mileage, safety records, dealer cost (so you know how low you can negotiate)  or you read used car ads for a good deal until your eyes bleed.

When it comes to your health, shopping for the best deal usually does not enter into your equation. If you are told that six weeks of radiation is mandatory following a lumpectomy, you just say: When do I start and where? You don’t say: how much would that be? Usually you pick the facility closest to you and one that is covered by insurance. You do not call around and ask how much others may charge. (They probably won’t even tell you.) Also, you’d like to think that  you chose a radiation oncologist on his skills and a facility based on its equipment, not on price. Most people go to the radiologist recommended by  their oncologist.

The reality is that even with good insurance, you will end up paying between 10-20 percent of the bills yourself. And here is the reality check: My bill for one month of radiation comes to $44,681.00.

This amount does not include the whole six weeks. It does not include the bill for radiation set up, initial consultation with the radiation oncologist nor does it include the cost of a CAT scan.

Of course the total amount of $44,681 is what people pay who don’t have insurance. I will pay a percentage of the adjusted rate negotiated by my insurance company.  If I did not have insurance, could I have asked for “an adjusted rate?’ Probably not. I would have been stuck paying the whole thing.

When your life is in the balance, the price becomes irrelevant. Yet when I write the checks, a few thousand dollars at a time, for my part of the bills, I cannot help but think of people who simply do not have it. I think of people who have to put it on a credit card and pile up high interest rates. I think of people who don’t even have the ability to put it on a credit card because they don’t have them or their available credit would  not cover their medical  bills. Combine this reality with the fact that a woman with breast cancer usually sees her income go down by an average 26 percent. In my case it already looks like my income for the year will be down by close to 40 percent. For one reason I work a lot fewer hours, and when I am at work I am distracted. And I have not even had to have chemo therapy, a major stumbling block in anyone’s work schedule.

“Dr. Weary, my oncologist, called me yesterday,” I tell Dr. Alpha, on my last day of radiation. “Please note that yesterday was Sunday.”

Dr. Alpha nods, waits to hear what I have to say.

I tell him how sad and disturbed Dr. Weary seemed when I nixed chemo. I admitted to Dr. Alpha that the idea of chemo scared me more than death itself. Dr. Alpha listens attentively. I suppose it is this precise trait that connects him with his patients. He does not seem annoyed. He does not seem distracted or bored. His face is alert, with an empathetic expression which makes you think he agrees with you and makes you talk more. But actually, as you reflect on it, you have no idea what he is thinking. Had his profession not been radiation oncology, I suspect he might have been perfectly suited for diplomacy. (Doctors of Osteopathy are trained to listen and to talk to patients from all walks of life, I found out.)

His listening skills, his neutrality, are such that I , at one point, feel emboldened. I blurt out that I think some oncologists have to give chemo just to have a viable practice. How could they make any money writing prescriptions for hormone pills?

Dr. Alpha does not look shocked. He nods.

“Yes,” he admits, that might be true for some oncologists, but not for Dr. Weary. He has a practice with all the patients he can possibly handle.”

I know Dr. Alpha is telling me the truth. Dr Weary is legendary in our city. Stories circulate about how personal and caring he is. He keeps people alive beyond everyone’s expectations. He often sits with his patients while they get their infusion. He called me on a Sunday. Maybe he should get a life I had thought. But learned that he has a young wife and four small children. He has plenty of life to live on a Sunday. Yet he called me because he is conscientious. I feel ashamed.

I inform Dr. Alpha that I missed an earlier appointment with him because I was out of town.

“Did you go somewhere nice?”

“I was be in San Francisco.”

“Business or pleasure?”

“Pleasure. Visiting my youngest daughter. When you get cancer,” I added, ”you start taking your pleasures seriously, “

Again, I immediately feel embarrassed. How incredibly superficial this must sound to a doctor who has a whole waiting room filled with seriously ill patients: The young woman with cancer in her collar bone, the lady with the meat loaf neck, the two young men with colon and prostate cancer. The teenage boy who has a shaved head and who comes in with a different adult every day. Hospital staff? Ward of the State? It does not seem like friends or family accompanying him. Dr. Alpha has patients rolled down to him on their hospital beds. They are kept in a hallway adjacent to the small waiting room. But I can hear groans and moans under heaps of sheets and blankets. Are these patients needing radiation for pain relief? Yet Dr. Alpha is poker faced. If he was tempted to slap me, he did not let on.

Uninterrupted I prattle on .

“And by the way, I hate AstraZeneca! They pat themselves on the back about their cancer drugs which nets them hundreds of millions in profits. At the same time they produce and sell numerous carcinogens. No wonder they don’t  explore pills for prevention or a cure.”

“I don’t like them much either,” Dr. Alpha says.

“During radiation I feel I am doing something about my cancer. Every day.  Now I just have to anxiously feel wait and see.”

He nods

“Yes, that is all normal,” he assures me. “This is how people feel.”

I wondered if this was normal for all radiation patients, or just his? Did life outside his aura of confidence and care seem cold and uncertain, scary? What about patients who had distracted, stress out radiation oncologists who were poor listeners? Was it Dr. Alpha that made radiation seem healing instead of destructive? Or was it, really, the idea that the machine killed cells in your body that you found comforting? Or both?

Aware of the ticking clock, his packed waiting room, of which he did not seem the least aware, I felt the need to get up and go. My six weeks of radiation therapy have come to an end. It has been remarkably easy. No pain. No nausea. No fatigue. But that is how it normally is with breast cancer. Radiation of other parts of your body is a totally different matter.

“Well, I guess I am ready to transfer my emotional dependence from you to Dr. Weary now,” I say.

I wanted to ask him to be my medical oncologist, the cushiest job he would ever have. How much effort would it be for him to call my local pharmacy to fill my hormone prescription and to do my blood work now and then? But I know it is time to bid Dr. Alpha adieu. Upstairs in the next building, I have my scheduled appointment with Dr. Weary and I am already running late.

Second time in OR, I feel like a pro, familiar with the routines of the ambulatory surgery unit.  The prep-nurse and I exchange recipes and talk adult children. While we chat,  Dr. Guru flies by the open drapery, grins,  and gives me a half baked wave. He looks a bit like the cat who ate the canary. Suddenly, I feel silly. I  been prepared for both of us to be haughty and stand-offish, still irritated with each other. Unlike me, he obviously has many more important things to stew about than our mini-battle.

Minutes later Dr Guru is back. He slumps in the visitor’s chair opposite my gurney, legs stretched out across the floor. He is in his comfort zone. I, on the other hand, am not, covered only by my thin, ill-fitting cotton gown.

“So tell me about this business with that radiologist,” he says.

Naturally, he wants  to talk about how the re-excision reared its ugly head.  All I want to talk about is my post-operative treatments.  I drone on about Tamoxifen versus Arimidex. I tell him I liked the professor who said no to chemo therapy.

“See,  if you shop for doctors long enough, you get exactly want you want,” Dr. Guru says. Before I can protest and reach the pillow behind me to throw at him, he is on his feet and gone. The curtain sways behind him.

Just as well. Why pick a fight with the guy who will wield the knife while you’re in twilight?

In OR, I jump up on the cot, stretch my arms on the cross. The OR is emptier and quieter than the first time. A re-excision obviously does not hold enough drama for the student body.

I wake up with a blue tent still over my head. I  hear people talk and laugh, instruments rattle, water is running. I scoot over to the gurney on my own. Actually, I could just have walked out of there, but they insist on wheeling me out.

That afternoon, my oldest daughter comes over with wild flowers from Gloria’s garden and a Get Well balloon. My son comes around around three with a nice bottle of red wine. My friend Cecilia shows up with a bunch of gossip magazines, a couple of Valrona cupcakes, and a bouquet of dark red roses.

In a letter, my youngest daughter writes:

“Difficult events don’t build character, they reveal character. This same thing can be said for you in this terrible scare – your spirit remains bright and strong.”

My husband runs to the store and comes back to prepare deviled turkey and a cheese platter for the visitors. They have wine. I have water. Everyone relaxes in the living room reading, chatting, and now and then looking up to grab a snack. Like after my lumpectomy, it feels like Boxing Day. Around 7 PM, my sister-in-law and my niece come over with chicken and green beans to make dinner for us.  Afterward, as after lumpectomy, we all play cards, Spite & Malice. My niece wins.  A perfectly pleasant end to a procedure I had wondered about, fought and waited for so long.

As soon as I am heeled, I will be off to radiation.

This is the week Dr. Guru promised to do my re-excision.  But not a word from his office or from his assistant, Joy,  who  supposedly is “arranging the details.” No explanation. No apology. No  follow up.

Meanwhile I am obsessed with my research, trying to figure out the dangers of putting off radiation. Everything I have read says it should ideally be within four weeks of the lumpectomy,  no more than eight weeks.

I find a Breast Society Journal that confirms what I suspect:  2^nd incision not good for the breast, tunnel syndrome etc. Dr. Guru himself has written something in this journal.

And how will Dr. Guru know where to carve again, now that my breast, presumably, has heeled?

“Will remove lateral margin with aid of frozen section. My assistant arranging details. Thanks,” reads Dr. Guru’s email in response to mine. But he gives no hint of exact date for my re-excision although “next week”  is right now.

I call Dr. Alpha, my radiation oncologist,and ask him  if a two week wait is OK.  ” Not ideal, but OK,” he says.

Pissed, I call Dr. Guru’s office.

“I am supposed to have surgery this week, but I have no idea which day he means,” I tell his assistant.

She has no idea either.

“These small procedures are so hard to fit into his schedule,” she laments.

“I am already aware of how terribly insignificant my procedure is , but I cannot go on with my radiation and hormone  treatments without the re-excision.”

”Oh no,  that is not what I mean.”

“Can another surgeon do it?” I ask realizing I sound ridiculous.

“Oh no, then you are a new patient and have to start all over again. How about  the 15^th?”

“That is TWO weeks away. Two months since my first surgery.”

Briefly, I am put on hold. She comes back to tell me they have no openings this week. None.

“Maybe the 7th. I will call you back if we have a cancellation. Promise.”

“He usually does these small procedures on Fridays,” she says. “But this Friday he has a 10-hour procedure scheduled.”

I don’t give a rat’s tail anymore.

“How about my little one before the big one on Friday?”

We keep wrestling over the phone, both of us digging in our heels, but neither of us loosing our cool.

“I am going over to the hospital this afternoon,” she finally concedes. “I will ask him to call you if he can do something about it. Some times he sees thing I don’t.”

“Have him call me either way,” I tell her. “I want it straight from Dr. Guru’s mouth to my ear why he told me he was going to do it this week and suddenly he can’t. I want to hear him say it.”

Around 3 PM,  Dr. Guru’s assistant calls. She sounds relieved. “You have pre-op  on Thursday at 10.45 AM. Your  re-excision is on Friday, 1 PM.

I immediately feel guilty. What melanoma patient has been pushed off the table to make room for me? What woman with advanced breast cancer, a double mastectomy with reconstruction may have been pushed off the OR table? What person needing a 10-hour surgery is now in a complete funk because of me?

“Bullshit,” says my friend Cecilia.  “He just canceled his golf game, that was his 10-hour procedure. Don’t kid yourself.”

But I am not convinced, just relieved to know it will finally be done.

Twenty minutes after Professor Oncology nixes chemo therapy, five minutes after Dr. Alpha, the radiation oncologist, calls to tell me that I need a re-excision to get clear margins (you are supposed to have 2 mm) I am sitting in my friend’s garden sipping tea from her bone china cup. I am “in the moment” trying not to mull over all the “what ifs.”   The insufficient margin frustration is behind me. Well,  almost.  My new bosom buddy, the radiation oncologist, took charge of the incomprehensible pathology report. He even called a day earlier than promised to let me know that I , indeed, need a second surgery!

Suddenly, my cell phone buzzes. A Magnolia Cancer Center number.

The way Dr. Guru, my surgeon, puts it to me, one might think that he himself had called  my radiation oncologist, to tell him to hold off radiation,  not the other way around.

“I am still not convinced you really need this,” Dr. Guru says. “But maybe it is not such a bad idea, after all.” Then in what seems like a vague apology he adds:  “I know you are very busy and all and this will be a bit of an inconvenience for you, but we might as well go ahead and put it behind us. “

“Might as well. But when?”

“Next week.” Dr. Guru does not hesitate. “We will schedule this for next week. Joy will call you to arrange the details.”

I feel stupid for being so happy. How much happier could I not have been  had  I been wrong about the re-excision, and able to start radiation right away? Is it not childish to be happy about being vindicated? After all, I am the one who will be the most inconvenienced, just like Dr. Guru admitted. Also, I feel mildly irritated that Dr. Alpha has to tell me not to hurt Dr. Guru’s feelings by “not rubbing his nose in it.” What other profession is filled with egos so fragile that they need to be perpetually wrapped in velvet and praise? A master surgeon is never to be reminded of a mistake, however slight or insignificant.

The sign “Magnolia Cancer Center” does not look as surreal as it has during my previous visits. After all, I do have breast cancer and this center is for me. Although I do not yet have the hollow eyes, the waxy complexion, the bloated body, or the shuffling gate of so many of the other cancer patients I see here. I suppose it is because I have yet to start my treatments.

A large black woman with a gap between her teeth greets me. Her look is that of kindness and concern, but not pity. I must have “new patient” written all over me. Eventually, I ,too, will be ground down by all the chemicals and look like the others: a shadow of former self.

The oncology department’s reception is as spacious as a hotel lobby, and lit by large windows. Someone has obviously dumped a serious amount of capital into this interior. (Although not enough money to allow the purchase of scanners to allow the doctors to email reports to patients.) Yet, the setting is remarkably different from Dr. Weary’s crowded, and a bit shabby, office.

The first person to check me is not Professor Oncology. It is a short, slightly round faced man in a white coat. I assume he is a student at first. Then I notice his  name tag.  He is already a doctor,  a  fellow in oncology, he explains. He seems kind, serious, and gentle. He weighs me in fully dressed and I wish I had kicked off my shoes to reduce my chart by a pound.

Professor Oncology looks Indian and seems too young to be a full Professor and Cancer specialist . Had I met her in a hospital corridor I would have taken her, too,  for a  medical student. Her black straight hair hangs down below her shoulders as does her drab navy skirt which goes inches below her knees and her white coat.  Her face is completely devoid of makeup. Her hands have a pianist’s sinewy, long fingers. Carefully, she feels about my neck, looking for signs of swollen nodes. She feels my breasts, and my armpits. She asks for permission for Dr. Fellow to examine me also.

Dr. Fellow stops with both hands around my neck and looks over at the Professor. He must think that he found something. I tense up, but she shakes her head. I immediately relax as does he.

The professor does not print out an adjuvant online graph like both Dr. Guru and Dr. Weary did. Instead, she  scribbles a few things on the back of a piece of paper. She tells me what I already know: stage 1, node negative, ER/PR + strongly so, HER/2 neg. grade 1 tumor. Like Dr. Weary, she is a bit baffled by my relatively high oncodx score.  It is 23. But she is still convinced that chemo would only improve my odds by 2%.  The professor, more than any of the others, stress the toxicity of chemo therapy: Leukemia, heart problems, bone marrow loss, risk for other infections.

Unlike, Dr. Weary, she does not agonize even a bit about skipping chemo. To my immense relief, she seems to have no doubts. She does not wring her hands, does not stand up only to abruptly sit down.

She draws up a five-year plan for hormone therapy: five years on Tamoxifen.  Or, she suggest,  we can do 21/2 years  and then switch to Arimidex, an aromatase inhibitor. I look aghast. “Oh well, Tamoxifen then,”  she shrugs. She does not ask what I have against Arimidex. She gives me an appointment for two months later when radiation will, supposedly, be over. She does not explain why I can not be on hormone blockers while on radiation. She does not bring up insufficient margins. I do not tell her about Dr. Alpha other than to mention that I will have radiation at a hospital closer to home.

Dr. Alpha, my new radiation oncologist, flips back and forth  in my pathology report. He seems annoyed. Not with me, but with the report. He pushes the reading glasses back on top of his head. “I don’t understand this,” he says. His tone bristles, but he looks kindly at me as he stabs his finger at at the bone of contention, my pathology report and the words “all other margins free of carcinoma.”

I am a bit embarrassed because in the margin I have scribbled: WTF.

“Oh no!” I hurry to explain everything, not  to defend Dr. Guru but  to sooth Dr. Alpha. I don’t want him to get more agitated and annoyed with Dr. Guru. I fish the Vanderbilt report out of my purse and show him  exhibit number one: Vanderbilt confirmed the first pathology report from my lumpectomy.

“Dr. Guru explained everything in his emails.” I tell Dr. Alpha. “I can send you copies. ”

Dr. Alpha does not seem convinced.

“Well, something is wrong.”

He starts to explain why my pathology report  is wrong, then abruptly stops himself.  He realizes that I can not process the meaning of his words so he draws a picture. “Here is the lateral margin,” he begins and goes on to explained how there has to be one. Then he goes back to the report, flips back and forth before he, frustrated, tosses the pages back on the table. Obviously, the answer he wants is not there.

“Either your pathology report is wrong or your surgeon is wrong,” he says firmly. Although he seems irritated with the report, a bit angry even, Dr. Alpha manages not to be the least bit unpleasant. “This is not right and I can not treat you like this. I read these reports all day long.  All day long. That is what I do for a living and I have seen everything.”

I am tempted to ask him about “everything,” but I guess that it would take an eternity and be way over my head anyway. Darn I wish I had paid more attention to science and not blown it off as “nerdy.”

“Forget Vanderbilt! They just confirm tissue cells. They don’t confirm margins,” he says and hands back the Vanderbilt result.

“Either the pathologist marked the slides wrong or the surgeon is wrong and has to redo it and give you a re-excision.” says Dr. Alpha.

“But that will take for ever? He is busy.”

“Not at all. He owes you. He will just have to get up a bit earlier in the morning. I am here till seven or eight at night. My colleague, Dr. E’s car never leaves here before 7.30 PM either.”

I mildly defend Dr. Guru. “I am sure he works that late too. In fact, some of his emails are sent late at night.”

“I will put in a call to him right now.”

“Good luck!”

“Let’s start with your pathologist then. Do you have her number?”

I scroll through my Blackberry while Dr. Alpha in a typical Type A fashion watches over my shoulder. “No, not that number, that’s not it. Oh, so you don’t have it,” he says while I am still scrolling. “Well, I will take care of it and I will call you by Friday. This will be cleared up by then, one way or the other. Either you have to have another surgery next week or we can start your radiation.”

“As part of a regular ongoing effort to provide quality patient care,” reads the letter from the Breast “Care” Center. “We encourage annual follow up care.” It then goes on to say that they would greatly appreciate receiving information concerning my health status since last treated there.

Really?

This is the Breast Care Center where I had  mammograms for ten years without ever receiving a bi-rad score, and where they could no detect a hazel nut sized, slow growing, tumor from one year to the next. I was the one who discovered my tumor when it  was T1C-almost Stage 2.

This is the Breast Care Center where the radiologist, as she measured my ominous lump on the computer screen during my biopsy, said: Oh, we saw that last year. But we did not know what it was.  How about finding out? Is that not what radiologists are supposed to do? Are they not supposed to investigate a lump seen on a mammogram? Is that not why women have them?

This is the Breast Care Center where I was sent me home after a biopsy with detailed instructions on how to apply an ice pack on my breast every fifteen minutes. They told me not to have vigorous activity for 24 hours. Told me, that if I had a large area of redness or fever, I were to call them  immediately. But there was not one word what I should do in the unfortunate event the biopsy was not what they had hoped. No instructions at all how I should proceed if my biopsy was positive for cancer.

This is a letter from the Breast Care Center where its own radiologists calls me at work and tells me: You have cancer. Any questions? And hangs up on me when I, too stunned to even understand what she just told me, answers: No, no questions.

Click.

This is a Breast Care Center where a major overhaul of both procedures and training of staff is needed – an overhaul of everything from how to communicate with a patient, how to read an x-ray, what to do when a radiologist sees something “she does not know what it means.” How about consulting with another doctor? How about calling the patient back for additional x-rays? How about a biopsy?

And as part of the general over haul, this Breast Care Center should consider some new magazine subscriptions.

Most women no longer crochet doilies or make many casseroles. At least no one I know.

I will write them back and let them know my status: I will never set foot there, ever, again. The letter came with a stamped return enevelope.

“Sometimes when I consider the tremendous consequences that come from little things, I am tempted to think there are no little things.” – Bruce Barton

-When will you have your re-excision? my sister-in-law wants to know.

I tell her that I believe Dr. Guru when he says my margins are clear. He says that I don’t need a second surgery despite a pathology report  which seems to indicate a margin of less than 2 mm.

I tell my sister in law that my real worry is the prospects of chemo therapy. Of course, no oncology appointment has been scheduled yet. Somehow I am under the impression that Dr. Guru’s office will set it up.

-You need a second opinion,  my sister-in-law says firmly. I will call Doctor Weary to schedule an appointment. Now.

My sister-in-law’s friend died from breast cancer. Her margins were never clear despite several surgeries. But her situation was different from mine. She was much younger than me, by a decade or so. Her cancer was, sadly,  more aggressive. Her prognosis was more “unfavorable” from the outset.

I tell my sister-in-law that a new surgeon can not possibly figure out margins from an old surgery, now healed. But she will have none of it.  She calls me back with two appointments, less than a week out: one with Dr. A, her friend’s surgeon, one with Dr. Weary , a well known oncologist at the hospital that was feuding with my insurance company at the time of my diagnosis. But the feud is over. They will accept my insurance.

Although I cannot for the life of me understand how a second surgeon could possibly tell my margins, I feel relieved.  Someone, other than me, is doing the heavy lifting. A mill stone rolls off my shoulders.  Appointments have been set for me, whether they make sense or not. I realize how wonderful it feels to have been removed from the decision making process and able to just follow someone’s command

Energized, I decide to also ask the University Medical Center to send my pathology report along with a sample to Vanderbilt University for a second opinion.

Maybe it is not a bad idea to find out more about my cancer cells, given that both the Breast “Care” Center and the University Hospital says my cells are moderately to well differentiated and slow growing. Yet the OncoDX test indicates that they may not be quite as benevolent.

You, too, can send your pathology results to Vanderbilt for a second opinion. Check information below or go to www.breastconsults.com. In most cases, insurance will pay. If not, their fee is quite reasonable.

Q: How do I arrange for my slides to get to Vanderbilt (VUMC) for consultation?

A: Patients wishing to have their slides shipped to Vanderbilt should contact the originating pathology department and tell them you are requesting a second opinion from the Breast Consultation Service at Vanderbilt University (aka. David Page, MD and Associates). Request that they send the pathology slides and all reports corresponding to those slides. Also, ask them to include a face sheet of your demographics and billing information for billing purposes. The address to send the consults to is as follows:

David Page, MD
Vanderbilt University Medical Center
Department of Pathology
C3321 Medical Center North
1161 21st Ave. South
Nashville, TN 37232-2561
615-343-0072 (Phone)
615-343-5137 (Fax)