Something in Dr. R’s message does not add up. First I have an old pneumonia scar. Then it is radiation damage on the left lung lobe. But I had my right side radiated.  If anyone could solve this mystery, it would be my radiation oncologist, Dr. Alpha.

I call Dr. Alpha’s number, fully expecting to get his voice mail, but he picks up on the first ring.

No, he never took any x-rays of me, but I had a CAT scan before I started radiation. (How could I possibly have forgotten that?) He will look at it and call me back.

In less than an hour, Dr. Alpha is back on the phone. He has compared my  CAT scan from five months ago with the new one. The 8 mm granuloma on my lower left lobe does not worry him. It was there before I started radiation and has not changed at all.

“More worrisome,” Dr. Alpha tells me, “is the growth on the lymph node just below your heart.”

I try to steady my voice so it will not quiver. All my bluster and bravado from my days of radiation have  evaporated. I hear how meek and scared I sound. He must have heard it too.

“They never told me anything about a growth under my heart.”

“No, they wouldn’t. They try not to give you all the information. You want to come down and see?” offers Dr. Alpha. “I will show it to you and explain.”

I want to take him up on the offer and drive down and see for myself. But I also do not want to crash into his busy schedule. What do I know about x-ray images anyway? I did not even know you had lymph nodes under your heart. I will have to take Dr. Alpha on his word.

“You definitely need a PET scan,” Dr. Alpha says. “This needs to be fully investigated. I will schedule one for you.”

“But I have one scheduled for tomorrow at 1 PM. I guess I have to go ahead then?”

“Yes, you do. I will read it and get back to you as soon as it is done,” said Dr. Alpha.

I feel doomed. Dr. Alpha’s words – this definitely needs to be investigated – throb in my ears. “Investigated,” has a serious ring to it, like a grand jury inquiry or Senate investigation. And, yet, the idea that Dr. Alpha will get to read my PET scan calms me and reassures me. I know he will level with me no matter what the outcome.

Whatever it was that showed up on my friend Elise’s mammogram, it needed a biopsy. A different doctor might have said “Let’s wait and see. Come back in six months.” But not Dr. Guru, he claimed that a biopsy was “the medically prudent thing to do.” So Elise went ahead and had her biopsy “just in case.”

It was a lucky thing too. Elise’s voice was shaking a bit when she told me they found cancer.  This was the second time in twenty years she had received this dreaded diagnosis. You’d think one gets jaded, but that is not how it works. If anything you are far more scared the second time around. You cannot help but think: “What is wrong with me?”

Dr. Guru assured her “it ” was early and extremely unlikely to have spread. She was relieved thinking she could probably avoid the much feared chemo therapy. Elise had a mastectomy, what the heck, her other breast was already gone. Why not even out the front side and avoid radiation?

That evening in the hospital, Dr. Guru stopped by her bed to check on her, and to tell her that he found a cancer cell in her sentinel node. On top of that, it was a different kind of cancer than the one he found in the breast. Elise could tell how shocked the normally cool Dr. Guru was at this unexpected turn of events.

After a review of the pathology report on both cancers, Elise’s oncologist allowed her to skip chemo therapy and opt for hormone therapy only. She is doing fine – so far. That is the horrible thing with cancer: you look good, feel good, and whoops, a little cancer cell jumps up and rakes havoc with your life.

I am telling you this to let you know: always look into something that is “probably nothing.” Yes, a breast biopsy is not pleasant, but it is no worse than getting a crown at the dentist, and infinitely much less painful than a bee sting. Remember the words from Dr. Susan Love: breast cancer is not about statistics, it is about the individual.

When you hope for the best always plan for the worst. Medically, it is the prudent thing to do.

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. Weary piles on the good news about his chemo regimen:

“You will not suffer for five months straight. Only for six week-ends. You may have your treatments on Fridays so you can recover over the week-end and be at work by Monday. Maybe by Tuesday.”

“Great.”

“We give you medication to control nausea. You will not feel so hot, but it is bearable. You will be able to function. “

One thing he does not mention is this statistic: a large percentage of women who receive chemo loose their memory, and not insignificant: many can never again experience orgasm. It seems to me that this would be as important to mention as the hair loss, more important since hair grows back. But Dr. Weary does not bring these subjects up. Perhaps he thinks:. Death is the ultimate loss of both joy and memory.

While I am processing the thought of having chemo and  I try not to fall apart before his eyes,  Dr. Weary brings up a new National Study.

“Thousands of women are in it,”  he says as if there were safety in numbers. “Women with oncodx score lower than 11 get hormones only. Everyone with a score between 12 and 24 gets assigned by a computer at random to receive chemo or hormone blocking medication only. Everyone 25 or higher gets chemo. Of course, once you agree, you have to accept what the computer chooses. The decision is not yours,” he says.

My score of 23 is uncomfortably close to those who MUST have chemo. I feel faint. I try to divert his attention from chemo to hormone therapy. Which one would it be? Tamoxifen?

Dr. Weary waves his hand dismissively. No, his hormone blocker of choice is Arimidex. “Much better stuff,”he says

We talk about the study at length. He seems to have all the time in the world, no concern with the “patient time management schedule.” But I am anxiously aware of the clock on the wall behind him.

I hear myself tell Dr. Weary that I feel I ought to participate in the study for the sake of my two daughters. But I am really uncomfortable with the randomness. The Russian roulette aspect of the computer choice. I am terrified of chemo. After a long silence I ask Dr. Weary point blank:

“Would you let your wife take part in the study?”

He stares at his desk for what seems to be an eternity. Finally, he looks up.

“I’d like to think that I would be brave enough to let her do that,” he says softly.

I decide to make it easier for him:

“What about your daughter.”

“Chemo,” he says without the slightest hesitation. He shuffles the papers in my file, reads my score over and over. “I am puzzled by the high oncodx score given the profile of the tumor characteristics in the pathology report,” he tells me.

Eighty percent of my cells are well differentiated, strongly ER and PR positive, not HER/2 positive (25% of women are.) I am stage 1, excellent general health. But something in my tumor put me at intermediate risk for distant recurrence.

Distant recurrence is doctor speak for Stage IV, about which Dr. Susan Love in her breast book writes: “Take care of your affairs in the time you have left.”

“I will support you in whatever you decide,” Dr. Weary says with a sigh. He wrings his hands, stands up, only to abruptly sit down again.

“I don’t know,” he says, almost as if talking to himself more than to me. “This breast cancer thing, you just never know. It has a way of sneaking up on you, of surprising you. I suppose I have over prescribed, but it is so hard to see someone come back. It is so hard.”

Dr. Weary looks tremendously sad as he speaks. And his sadness fills not only the room, but me as well. People have told me about him, how he will come and sit and talk to patients while they are getting their chemo. I think about M. who asked him to keep her alive at stage IV as long as possible so her daughters would be older when they lost her, more able to care for themselves. I can not even begin to imagine the emotional difficulties of Dr. Weary’s job. I also imagine that without chemo, he would not have much of a practice.

“I used to give everyone chemo,” he says. “It was probably overkill, but I did not know it then. My colleague over there,” he points at the wall, towards the office next door. “He has been in this game for 30 years and he gives chemo to everyone.”

I laugh nervously and manage to make some comment about how “I will be sure to avoid him.” We agree that I will also consult the oncologist at the University Medical Clinic.  He does not seem the least offended that I like to have a second opinion. “She is the chemo lady,” he tells me, then, noticing my startled expression, he corrects himself: “No, she is the hormone lady. Well, I don’t know. You will find out.”

“Get a second opinion, then, decide. Some of my patients have gone to her.”  Dr. Weary  seems quite insouciant.

Just as I am about to leave, he asks if I wanted to meet with a radiation oncologist. “Might as well,” he says. “Either you will start radiation right away or in January when chemo is over, so you consult with him now. I will check if he is free.” Dr. Weary picks up his phone and tells the person on the other line that he will be sending over this “very nice lady.”

The Breast Consultants at Vanderbilt University confirm the previous findings in my pathology report. And Dr. Guru assures me that “he would not do a re-excision on his own wife.”  That does it for me. I cancel the appointment  with the second surgeon, the one set by my sister-in-law.

After all, the second surgeon has not been inside my boob. Dr Guru has.  And I find Dr. Guru’s statement that he would “not redo the surgery on his own wife”  more compelling than anything he could have told me. His wife was my anesthesiologist: attractive, funny, smart, a bit sassy. I believe that Dr. Guru has every reason to want her around.

For the first time in weeks, months really, I begin to relax. I don’t have to delay further treatments. I will have radiation for sure, but I can deal with that. No worries.

I still feel tremendously weary and anxious at the mere thought of chemo therapy though.  But Dr. Guru rolls that stone off  my heart with a few words: “Not much benefit for someone like you,”  he says, and shares with me a chart that shows only a one percent benefit of chemo therapy in my case.

-Why did you not say so right away? I ask him. You know I have been petrified.

-Well, I wanted it to be your decision, he says. Some women will opt for chemo even for a one percent benefit.

In a jiffy, life looks simple and uncomplicated.  No speed bumps ahead.  No re-excision. No chemo therapy. Now that I have dodged that scary chemo bullet, I promise myself to be a good person. I will be more patient, kinder, less judgmental. From this day on forward, I will be a new me to show the whole world my gratitude. Always.

I have an appointment, arranged by my sister-in-law, with Dr. Weary a much respected oncologist whose specialty, it seems, is to keep cancer patients alive long after others would have tossed in the towel. The day after, I have an appointment with another oncologist, at the Medical School, arranged by Dr. Guru’s office. I might as well hear two opinions, have two physicians confirm in unison that all is A-OK.

I am on cloud nine.

My husband and I are both stuck in the glue of our gloom, unable to reach out to each other.

I am restless, crabby, scarred, impatient, and distracted both at home and at work. I cannot concentrate on anything. All I do is obsess about a second surgery. It is not the surgery that scares me, but delaying the treatments has me excessively worried. And the type of treatment.

My husband is down for many reasons: his job, my situation, life in general. This time I do not have the emotional resources or stamina to try to help him break out of his zone. I am too preoccupied and self-obsessed. Also, I am, irritated with him.

He has not even glanced at any of the many brochures, articles, and books on breast cancer lying around the house. It would be good to have his perspective on matters. My husband has a scientific mind. He is the type who will read the instructions for a new Panini grill cover to cover. But the pamphlet “What to Expect from Chemotherapy” sits untouched on his bed stand while he gorges himself on a big fat business book. I am pretty sure he has not spent two minutes Googling breast cancer to learn more. It is as if he thinks: That is her problem. But if he had prostate cancer, I would be all over it. So to speak. I would want to try to figure out what he would be facing. What we would be facing.

Late one afternoon, I finally receive an email from Dr. Guru in response to my question about my lack of clear margin.

“I appreciate your concern. The primary excision was not oriented so I don’t know where they came up with lateral. The additional margins, inferior and medial, were removed after the primary excision was performed. They were the closest margins deemed from intra-operative inspection and no residual tumor was in those specimens. You do not need additional surgery. Sorry for the confusion.” Guru

I  read the mail several times without a clear understanding. Did he take out the tumor then went back in and scraped out some more? Is that what he means by “intra-operative perspective?” But what does “the primary incision not oriented” mean? He’d have to cut the first line somewhere.

I believe Dr. Guru when he says I do not need a second surgery (although I am still annoyed with him.) Had he only sat down with me to explain my pathology report, all this hysteria and worry and anxiety would not have come to pass. He would not have had to endure my blistering emails.

Yet, I am  relieved. Now I can move on to the next treatment. Will it be radiation or do I need chemo first? The mere thought of chemo therapy petrifies me.  Millions have endured it. So why am I such a complete whimp? And when will I find out if I need it? Where is my oncodx test result?

Three weeks after after my lumpectomy, and after some prodding and probing,  my pathology report arrives in the mail. I polish my bifocals. — the better to see you my dear –  and sink down in my favorite reading chair.

On page one, I immediately zero in on these worrisome phrases:

“All other surgical resection edges free of carcinoma”, “cribriform pattern with associated comedo type necrosis”, and “perineural invasion is identified” (slide 3H.)

Cells with cribriform pattern are considered less aggressive. Comedo type cells, on the other hand, are nasty little fellows. They are associated with the most aggressive form of cancers. Comedo-type necrosis, along with  tumor size, nuclear grade, and margin width are all important predictors of the probability of  recurrence.

Necrosis is Greek for death. Comedo type necrosis happens when the cells proliferate so fast they kind of choke on themselves and die. But other type of cells like cribriform, papillary and solid may  also suffer necrosis to a varying degree.

I realize I need to ask Dr. Guru what “my necrosis” means. Guessing is both a scary and an inaccurate activity.  I am a bit annoyed that he did not ask me to make an appointment and offer to explain everything.

Perineural invasion means that cancer cells and nerves are entangled. Do nerves provide the path of least resistance when cancer cells escape the breast, like veins and lymph nodes? I need to defer to Dr. Guru on this one as well.

Before I can compose an e-mail with questions for him, my mind is set on fire by the following:

-tumor less than 1 .0 mm from lateral resection edge

-all other surgical resection edges are free of carcinoma.

Now I am not an English major. English is, in fact, my second language. But “all other edges free of carcinoma” sounds to me as if ONE edge is NOT free of cancer.  Or do I need to take my TOEFL test again?

What happened to my “wide” margins?

“Yesterday was horrific, “ says  Dr. Guru’s assistant when I call to complain that he never called with the pathology results, as promised. “I had to snatch him to even get one second.” She lets out a deep sigh, the kind that seems to come from  the bone marrow, not from the lungs.

I feel guilty for nagging her about my pathology results. I have no problem understanding the plethora of emergencies Dr. Guru must face each and every day.

“And he is going on vacation, you know,” his assistant tells me.

I imagine the scene: Phones ringing. Faxes rattling. Lights flashing. Intercoms blaring: Dr. Guru, Dr. Guru. Line 2. Dr. Guru, Dr. Guru, OR 5. Patients, like me, but a lot sicker, clamoring for his attention. Patients with melanoma cell spreading like wild fires, begging him to intervene.

And here am I, on the opposite end of the spectrum: BC stage 1 . I am  the patient who is never an emergency. Of course, he didn’t call. With only 24 hours in each day, Dr. Guru is forced to set priorities.

And now he is going on a much needed vacation.  How long will  he be gone? Two weeks? Three?   I picture some luxury junket paid for by the scalpel manufacturer.  No, not at all. It turns out he will be gone one week, working in a summer camp for kids with disabilities.

I am ashamed, feel selfish and petty, but I must find out what was in the tumor and what will happen next.

“When will I start treatments? When he comes back?”

“You need the oncogene test first,” Joy tells me.

My blood drains: he wants my oncogene tested?  Is it not the oncogene result I was supposed to get yesterday, the day before, really? Is that not the test result I have been chasing?

Did Dr. Guru not tell me: I am just waiting for the oncogene report? But how could he be waiting for that report if I did not even have the test?

Good grief, why don’t I understand anything?

No Pathology report .  It seems that I am off Dr. Guru’s radar screen.

Who cares? Not me! I am upbeat and sure of myself, thanks to the book “What Your Doctor Didn’t Tell You About Breast Cancer.”  I have been devouring it the past couple of days while waiting for the pathology results.

Tamoxifen — pouf — out the window  for sure.  I, for one, do not plan to  poison my body just to enrich Astra Zeneca’s corporate pockets. Now I question even the wisdom of radiation. Is that really going to be necessary?

I feel better than ever. Better even than before the  Breast “Care” Center called to tell me that they “regretted that the biopsy results were not what they had hoped.”

I grouse, around family and friends, that the service level at the University Medical Clinic is worse than  at a two star hotel. My insouciance is totally based on the assumption that no news is good news.

Instead of margins and oncogenes, I focus  on  a trip that my husband and I will take to visit old friends. The question is when? I am on the phone with our friends to figure this out.

“But what about your radiation schedule,” asks my friend M. “When can you get away?”

“Radiation,” I scoff. “Not even scheduled yet. Terrible service. No communication what so ever.” I am all bravado on the phone, but my friend M, a cancer researcher and biologist, is not amused.

“You have to take your care into your own hands,” he says. “Nobody else will do it for you.”

His words stick.

Of course. Who could care more about me than me?

Right then and there, I decide to step up my level of “care.” But how? Not only don’t I have the pathology report from my July 14^th lumpectomy.  ( I do  not  even have the first pathology report from the Breast “Care” Center .)

It is as if my pathology report has nothing to do with me. Everyone can read it, but me.

I have no idea if I have the oncogene. I have no idea what my margins are. I have no idea if I need chemo, after all. Or when it would start. I do not even have an oncologist!  How  can I take charge of my care when I don’t even know what my breast cancer care is supposed to be?

Friday. No news on the oncogene.  No news from Dr. Guru’s office all day Monday. Finally, I call his assistant just before closing time.

“We are waiting for your pathology report,”  she says. “Have you been to post op yet?”

“Yes, I had my ten second post-op  a week ago.”

It seems like his office should know that. Don’t they have a computer? Don’t they track their current patients? No Outlook Calendar?

“Ten seconds? Sounds normal,” she laughs. She sounds tired. Reluctantly, she puts me on hold to check for my pathology report and finds it in the in-basket.

I want Joy to read the report to me, at least the most pertinent parts, the ones about which I am on pins and needles: The oncogene and the nuclear grade parts.

“No, you will not understand it.”

Then, perhaps sensing that I am about to scream, she quickly changes her response to: “I don’t understand it.”

Of course. Does she think I was born yesterday? Is my age not on the chart? I force her to give me the high lights. She stumbles ahead: ER+, PR + (meaning that my tumor is sensitive to estrogen and progesterone. This is good news. They will respond to hormone treatments.) Lymph nodes negative. This is significant, but I already know that detail.

Dr. Guru’s assistant is clearly struggling. It is as if she is trying to interpret someone’s bad handwriting, not a computer printout.  I have “deja vu all over again.” But Joy is nicer than Dr. Morte. And she is not a doctor. Just an overworked, and probably underpaid, assistant. Out of mercy I free her from her misery.

“Please just email it to me.”

“We don’t have a scanner.”

One of the finest research institutions in the country, well in the Southeast, has no scanner?

“I can fax it to you. What’s is your fax number?”

I don’t want my pathology report to sit around our office mega fax machine for everyone to read. What if someone sees the word breast cancer and decides to swiftly transfer my job to someone with more potential?

“I will put your pathology report on his desk,” promises Dr. Guru’s assistant. “I will put it right on top so he notices it right away when he walks in tomorrow morning.”

“He will call you,”  she says. “He will call you tomorrow and explain everything.”