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.

My friend Elise, who had breast cancer more than 30 years ago, sends me an email. Back when she had her first breast cancer bout, she was a law student with two young children. She had a mastectomy. No implants. No chemo therapy. No radiation. Now she has discovered something in the breast she has left.

Right away I pick up the phone to call her.

“ I went over to the Magnolia Cancer Center to get a diagnostic mammogram and to see Dr. Guru,” she says.  “He is not overly concerned but wants me to have a biopsy. Told me it would be the medically prudent thing to do.”

She pauses. I am looking for the right words because I can tell she is more worried than she lets on.

“I must admit I am a bit rattled,” says Elise. “Although Guru seems to think it is highly unlikely this is cancer.”

“So did he look you straight in the eye when he told you it is nothing,” I ask Elise. “Or did he avoid eye contact, shuffle the papers or glance at the cell phone as he spoke? Did he say it was “nothing ” or “probably nothing?”

Elise and I speculate over the phone, like two high school girl friends speculating about some boy. Did he really say he likes me? Do you think he will call? Except Elise and I are now two middle-aged women, not two loved-crazed teenagers. And our speculations are not about a boy one of us fancies. It is about the surgeon oncologist we both share. And we are not trying to read tea leaves about love, but about biopsy results before they are in.

We analyze Dr. Guru’s every gesture as he talked to Elise. Every nuance of his demeanor, of his tone of voice, of the words and how he weighed them. Finally, I conclude: Well, Elise, if that is what guru said and if that is the way he said it, then it is from God’s mouth to your ear. Of course you will be OK. He would never say it that way if he wasn’t sure, I tell her.

Elise sounds relieved. I am relived too. I believe what I just told her. But then again – even if I didn’t – I would have told her that  she would be all right. Just as I would have assured her if she had asked: Do you think he will call? Like any   real friend, I would have said: Of course, he will call you. And then if the call never came: “He didn’t call you? How strange. Maybe he lost your number? Maybe he dialed the wrong number, could he have read your 4 as a 9? You write your fours like nines some time. Maybe he is too shy?”

What is even more typical in my friend Elise’s situation, she would speculate with a friend rather than turn to an expert. Her husband is a doctor, he works with guru, and they are practically neighbors. The most logical step, perhaps, would have been to ask her husband to ask Guru if he really thought it was “nothing” or if he was more concerned than he let on. But no, Elise mulls all these scary details over with someone, me, who is probably the least qualified in the world, medically speaking, to give advice. But I will say what she wants to hear.

Dr. Guru calls me at work with the pathology report.  “I just got it,” he stresses.

(So he did read my  blistering email after my first surgery. Then I complained about him not sharing the pathology results until two weeks after he himself received them.)

“Everything completely clear, just as we knew it would be. Margin a bit larger than 2 mm.”

“Good job then, “I say.

Dr. Guru asks if I have decided to fore go chemo and when I say yes, he tells me it would have been of  little or no benefit in my case.

“Why add all those toxins to your body?” .

“Why did you not say so right away? I ask. “You knew I was terrified.”

“I wanted you to make up your own mind,” he says. “Some people will agree to chemo for a one percent better chance of survival.”

This is nonsense. How can a patient, a lay person,  “make up her own mind?” Even someone like me, someone who has cruised the interned “ad nauseam” cannot really decide. A lay person will often misread statistics and project wishful thinking into her readings. This is natural. This is why a doctor will see another doctor when she is sick. A lawyer will not represent himself. You need a professional, someone with experience and perspective.  Preferably a professional with no skin in the game.

But I say nothing

Dr. Guru tells me I may start radiation “any time.” “Your choice of hospital is fine,” he assures me. “Alpha is excellent. Many of my patients go to him.”

(Suddenly, he no longer refers to Dr. Alpha as “that radiation oncologist.”

Dr. Guru sounds upbeat. And I am amused. Now that the icy patches between us have been salted and sanded, everything is on the up and up.

That night, I go to bed relaxed and content.  For the first time since I received my breast cancer diagnosis,  I do not wake up in the middle of the night. Not even briefly.

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.

Three distinguished physicians, all cancer specialists,  seem lukewarm – or indifferent – to the merits of chemo therapy, in my case. I feel as light as a swallow, and just as fast, as I leave the Magnolia Cancer Center. I tip the valet $10, but before I can drive away, my cell phone buzzes.

“Charlie Alpha. You need a second surgery. Guru will call you himself. Just wanted to give you heads up. Please don’t rub his nose in it. This will be a very hard call for him to make.”

Dr. Alpha, the radiation oncologist, sounds kind of excited. Perhaps he, like me, thrives when he is on the barricades slaying dragons. “I hauled your pathologist back to work on her day off,” he brags. “Made her stay with me on the phone till we had gone through the whole path report, slide by slide. But her report is right. He is wrong.”

“But it will take for ever, weeks, even months to get time for a second surgery.”

I was mindful of Guru’s incredibly busy schedule and what, I assumed to be, low interest in stage one node negative patients who needed unnecessary re-excisions. He would just drag his heels.

“No, he won’t. He owes you.” Says Dr. Alpha. “It has to be done. See you in about a month.”

I almost make a re-excision unnecessary by turning onto West Wesley right in front of an oncoming car.

I call my friend Marie to let her know that I am on my way earlier than expected.  The Professor’s appointment lasted a scant 20 minutes v. the  hour long visits with Dr. Weary and Dr. Alpha.  Also, I  call my husband, my oldest daughter, and my sister-in-law to tell them about the re-excision but everyone is tied up at work . I get voice mail for all of them.

At Marie’s, the table is set for tea in the garden with her best bone china cups with the oriental motif,  and plates filled with cream puffs and cookies. Cecilia has baked her fabulous Valrona chocolate and orange muffins. Just what the doctor did not order.  I have come full circle from our tea the afternoon when I arrived   anxious  after my biopsy, suspecting that the irregular image on the screen was a cancerous tumor, not an errant hazelnut or benign cyst.

This time I am not anxious.  Well, a little bit perhaps. I have had a pain in my side for a couple of days. Could it be ovarian cancer? The Magnolia Cancer Center had a whole table covered with ovarian cancer brochures. Why did I not take one?

I make a mental note: schedule an appointment with a gynecologist . But first I need to find a new one now that I have fired the wooden and unhelpful Dr. Morte.  I also need a colonoscopy. I am overdue by a decade, according to the colonoscopy brochures.  Who performs those procedures? Colonoscopists? Is there such a thing? Maybe a gastro-internist-something? I tell myself I need to research who would be the best person to stick a tube with a light up my rear end.

At the same time I wonder: How did my parents make it into their 80s and 90s without any of these procedures? The most invasive procedure either one of them had was probably an x-ray and a blood pressure check.

But here I am with all these doctor’s appointments to schedule.  Apparently, many more dangers  lurk  inside the human body these days.

If true, is it the result of added hormones, pesticides, genetic alterations, microwaves,  chemicals and additives in practically every household item, noxious industrial fumes, car exhausts, and the exhausts nobody talks about: exhaust from cargo ships where dirty fuels and inefficient engines can make one single cargo ship contribute as much to pollution as 50 (FIFTY) million cars.

And when will Dr. Guru call back about the new surgery?