Every day now the same routine: leave work for the hospital. Park curbside by the entrance and walk through the sliding glass doors into the main lobby. Take the elevator one floor down into the basement, turn a corner and – voila – radiation oncology. Change into the insane asylum robe, wait a few minutes before being called to lie down on the plastic foam bag and get zapped. You cannot feel a thing. You can only hear a hum from the equipment.

After a week of radiation, my right breast is red, feels warm, and a bit tender. Despite all careful instructions: don’t wash with harsh soaps, use aloe creams, don’t wear a bra. Don’t expose to sun light. Not now. Not for the next two years.

-Look at my breast. Is this radiation damage? I ask the two techs who attend me at each session. They are G., short and stout and severely menopausal. Fans her sweat attacks away with my folder. (At one session I cannot resist giving G. a card that reads: those who say “no sweat” have never been through menopause. ) The other tech is J., also short and fairly heavy set. She has a luminous black complexion, is cheerful, and has a great smile. She is making plans to take her 10-year old daughter to Paris on her next vacation.

They both glance at my red breast and laugh at my wild imagination.

-Honey, you will not be able to notice anything for at least three weeks, if that. It is way too early.

But my breast only seems to be getting redder, and feels hotter each day. I compare my left breast with my right by feeling them with the back of my hand and looking in the mirror. Yes, my radiated breast is much warmer than my left breast. I call Dr. Alpha, who I normally see only once a week.

-Your techs think I am a hypochondriac, but my radiated breast is red and hot although I am told it will not happen for weeks.

The next day, Dr. Alpha examines me, the same way I examined myself: By feeling the two breast with the back of his hand and comparing the color of each breast. He nods in approval.

-You are right. Again! says Dr. Alpha. Good thing you noticed too. You have an infection. It is not unusual after two surgeries. But it would have been difficult to detect later as your treatments proceed. I will give you an anti-biotic. He scribbles on his pad.

-Wow, Cipro, the athlete’s drug. Thanks. Do you have special instructions? Taken with meals? With a bottle of wine?

-Half of bottle of wine. Dr. Alpha chuckles.

Finally, I am scheduled for radiation therapy or rather: Preparation for radiation. I meet with a technician to get my measurements set in a foam contour.  Actually, it turns out to be  nothing fancier than a plastic bag that she fills with warm liquid. I  then lie  down and my contours are set as the liquid firms up.  When I come for my therapy I will  lie down in exactly the same position every time.

The radiation oncology department has two waiting areas: one  for family or friends who accompany a patient. In this area there is an aquarium and a small reception desk, a few arm chairs.   It is almost empty.

A door with the sign: “Radiology Patients Only”  leads to another small, crowded waiting area. The ceiling is low and covered with acoustic tiles.  The chairs are the same type as in the outside waiting area.The magazines in the basket are out-dated and dog eared. Staff members, mostly women in blue scrubs, mill about, going in and out of side rooms, opening and closing doors, appearing or disappearing from behind curtains,  seemingly without purpose. Back against one wall is a blue drapery and behind it some cupboards above a low bench. That is where I am supposed to change into a cotton gown, property of the hospital, one size fits all — or nobody.

I also have a CAT scan which takes but a few minutes. I lie down on a narrow bed that slides in and out through a dough nut hole. I have no idea that I am receiving 6000 rads of radiation through out my whole my body. It is a  hundred times more radiation than a regular X-ray. Nobody explained the high level of radiation I would receive. Nobody told me why they need to have my cat scan although I recently had an MRI or why the MRI images would not be good enough.

Every day, Monday through Friday, for the next eight weeks, I will receive a prescribed dose of radiation to kill any cancer cells that may have been left. The therapy will cover my whole breast with some extra shock treatments concentrated on the breast area  where the tumor was (the tumor bed.)

A linear accelerator produces the treatment x-rays and this special  therapy to kill cancer cells is known as EBRT – external beam radiation therapy. (Without radiation, 40 percent of lumpectomy patients have a local recurrence of their breast cancer.)

The exact level of radiation will be set by Dr. Alpha and his medical dosimetrist. The actual radiation therapy treatments will be handled by his radiology technicians. I am told that I will be checked by Dr. Alpha, the radiation oncologist, every Monday.

I get to pick my time slot. I choose  2.15 PM Monday through Friday.  (Should I not be able to come one day, I can come twice the next day, as long as it is six hours between the treatments.) Finally, I get a parking pass, a yellow 8 x 11″ piece of paper with the words radiation oncology written in magic marker. It  is valid for the next eight weeks. When put on my dashboard, it allows me to park for free right outside the hospital entrance doors and to  avoid the crowded parking garage.

I am all set for my personal Chernobyl.

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.”

I leave Dr. Weary to meander through the bowels of the hospital until I end up in its basement.  “Radiation” reads one arrow pointing down yet another hallway.  Around that corner another door:  “Environmental Services.”

Toxic waste? Then I realize it is only a euphemism for the janitor’s office. Around the next corner from the janitor’s closet a sign reads: “Radiation Oncology.”

The ceiling is low, the tiny waiting room has a few wooden arm chairs, all empty, and a floor to ceiling aquarium with what looks to be salt water fish. The receptionist is heavy set, slow, none too friendly. She waddles off to make a copy of my pathology report before she sends me next door.

Inside the door, a figure, slightly bent forward, comes steaming towards me in the dark hallway,  walking with a bit of a limp. Hip injury? Knee? Still, Dr. Alpha looks fit and tall, dressed in a short sleeved silk shirt, well fitting slacks and a cool belt. Hugo Boss?

At first glance, I expect him to be “a man’s man” and a bit full of himself, someone who talks “at” women, or above their heads.

Wrong.

Dr. Alpha pulls up a chair, right next to mine, by the large conference table. He  is informal and attentive,  seems sincere as he immediately engages me. He asks how I discovered my cancer. We chat about my oncodx test result? What about my visit with Dr. Weary? Like Dr. Guru and Dr. Weary, Dr. Alpha carefully probes my neck. I dare barely breath as his large hands searches for a swelling or a node perhaps missed by the others.  But without as much as a glance at me, he sits back down and again checks the “shared decision chart” that I just received from the oncologist.

“I don’t want chemo,” I tell Dr. Alpha.

“There is this study from your neck of the woods,” he says. “It shows chemo at your stage to be of very little benefit.”

“From the Karolinska Institute?”

He nods.

Like with Dr.Weary, I have no sense that Dr. Alpha’s “patient time management clock” is ticking, even though I have been dropped into his schedule without much warning.

“Do you happen to have your pathology report with you?” he asks.

Although his receptionist just copied it for him, I fish out my own copy from my purse which by now is an ambulatory file cabinet. Dr. Alpha adjusts his reading glasses. In one nano-second, he is hung up on the “less than 1 mm margin all other sides free of carcinoma” issue,  the one issue that bothered me for weeks, the one issue  I just had given up on.

A cancer research team in Lund, Sweden has found a new a gene profile that can help oncologist better determine when lumpectomy followed by radiation may not be appropriate.

The newly discovered gene reveals whether or not a tumor will respond to radiation. Women who have tumors with this particular gene will in the future most likely be advised to have a full mastectomy.

Currently all women who have breast conserving surgery will undergo some form of radiation since statistics show that up to 40 percent of those who don’t have radiation after  a breast sparing procedure will have a cancer recurrence.

The gene discovery study needs to be fully completed before any new standards regarding lumpectomy and radiation can be made common practice.

(The photo above shows a single breast cancer cell, not the newly discovered gene.)