Calculations

To say I wasn't nervous walking into Johns Hopkins today would just be a lie. Today was the day I would receive my pathology report - the day I would learn how far the cancer had spread.

I tried to push the thought aside - the one that makes me cry. The one where I imagine how old my children are when the disease comes back in my brain, my liver, my bones or my lungs, and the doctors tell me it can't be cured. What if that is my story? How old will they be? Will they be 3, 6 and 8? Will they be 7, 10 and 12. Will they be 10, 13 and 15. My mind hurts at the thought. All those ages are too young for my kids to not have their mother. Then the tears well in my eyes.

We drive to the top of the parking garage. We take the elevator down, and I repeat in my head, "I'm not a statistic. Whatever the surgeon tells me does not determine my story." But I'm nervous.

I shouldn't have looked the calculator up. Once I found it, I should have ignored it. But I didn't. A calculator that would let me enter the details of my breast cancer and then tell me my life expectancy. You entered in the size of the tumor, how many lymph nodes were infected, what types of things made the cancer grow. I wouldn't know all the details till we saw the surgeon today. But I knew enough to play around.

I knew the tumor was likely under 2 cm, a good thing. I knew it fed off of estrogen and progesterone, a good thing, in a way with some new drugs available. I knew the cancer was in at least one lymph node. Not good. Worse. The surgeon said three of the lymph nodes he removed looked enlarged. If the cancer had visibly spread to three nodes, how many more had invisible amounts of the disease? Each lymph node with the disease meant it was more likely the cancer was somewhere else too, lurking, hiding, waiting for its time in a little corner of my body to escape chemo, escape radiation, escape hormone therapy and return to grow.

Beep. Beep. Bop. The calculations didn't look dire. But they didn't look good either. I gasped when I saw how much my long term survival chances dropped with each additional node found with cancer.

We entered the Outpatient Center and got our orange security bracelets. There were less people than usual waiting on the first floor for the elevators. We waited for one instead of taking the stairs. We arrived four minutes early for our appointment at the Avon Breast Center. As usual, there was a long line of people waiting to be called back into the second waiting room. As usual, all of them looked far older than us. We waited for nearly an hour. I took out some paper and a pen. I started writing questions.

When would my port stop hurting? When would I know the numbness on the side of my body was permanent? What should I do so I can lift my arm above my shoulder again? My arm swelled up again some. Was that bad?

Would I ask the one I really wanted to know? What are my chances?

Yes.

I looked at my list. What would I do when he told me the results? Would I cry? Would my mind keep seeing the same sentence over and over? Would I hear anything else he would say?

That's why I had my list. I would force myself to think.

Steve wrote work emails on his phone. "It doesn't matter what they tell us," he told me repeatedly. "The drugs are going to do their job." Steve was wearing the calm, confident face. I knew he didn't always feel that way. But he was doing a good job of making me believe it today.

The lady at the front desk called my name. Do you have any pain today? Yes. How much? Moderate. Do you want to discuss pain with the doctor today? Yes.

We're called immediately into the examination room. Steve helps me pull my loose t-shirt off. I can only lift my arms so far without pain, and I still have a long plastic tube shooting out of my body to collect the drainage from the surgery. I put on the hospital gown, sit on the examination table and wait. Several minutes pass so we start looking at the cancer staging flip chart. We've looked at this chart many times. It's in nearly every examination room we've sat in during the last two months. We start a familiar debate. Steve argues we're likely a stage III. He's preparing me for the worst news. I argue that there was a small chance, with just three lymph nodes infected, we could still be stage II.

More time passes. My back aches. So I lay down on the table and nearly fall asleep. Steve starts answering work emails again.

Then there is a knock. The doctor walks in. He's wearing a navy sweater that zips down halfway. His hair is cut close to his head. He wears glasses and has a goatee. He has a little extra weight on him. Each time I see him he reminds me more of a jolly family uncle then an oncology surgeon. We talk about the chart Steve's been compiling of how much fluid he empties from my drain. I almost forget the real questions for the visit. Then the doctor seems to remember too. "Let me go get your pathology report."

"Can I have a copy?" I ask.

"No," he smiles. Then says, "Of course."

He returns with the nurse that is a breast cancer survivor herself. They hold a stack of papers. The nurse seems to be smiling. I don't remember what they say next. I don't remember who asked what. I just remember one sentence. "The cancer was only in one lymph node."

The lymph node that had the cancer was bigger than the tumor itself. But no other nodes had the cancer. Not even a cell. And they had a lot of nodes to sample. They removed 17.

I could hardly think. I didn't even hope the news would be that good. I was just so happy. I felt like someone had given me a license to believe what I believed on most days. That it would be a hard year. But my baby would be fine. And I would beat the disease.

Steve was smiling. He offered to bring the doctor homemade humus, Lebanese style, with each chickpea shelled. He joked that it was far better than the Iranian hummus, where the doctor's roots were. The doctor started talking about high horsepower blenders and sneaking cabbage into his son's smoothies. The nurse continued smiling. The doctor hugged me. A first in my life.

I got out my list. I made sure I asked all my questions. But the answers hardly mattered compared to the phrase I kept seeing in my head. "One lymph node."

What are my chances? I'm not telling you. I'm not a statistic. But they're looking much better after today.