Wednesday isn’t without its good moments, though.
After we get back to Oshawa from downtown, Kevin and I visit Dr. Daria. She sees us immediately once again. I almost feel guilty–I’ve called the number several times over the past few weeks, and they’re booking routine visits for the second week of December. But this is serious. If I had a cold, I could go to a walk-in clinic.
We tell her what Dr. Cho said. “I need to go one something more permanent than Ativan,” I tell her.
“Let’s put you on Zoloft. It takes a few weeks to work up to full strength, but it’s for both depression and anxiety.”
That sounds like a good plan. One week at 25mg and then up to 50mg.
When I was in college, I was depressed. I tried all sorts of different medications, including Wellbutrin, which I was allergic to. It gave me hives and led me to have to answer the embarrassing question of, “What are you allergic to?” with “Wellbutrin” every time I went to the hospital to have my pre-natal twin appointments. I even got a medical receptionist asking what it was once, so obviously it’s not well-known. I mean, who’s allergic to some random anti-depressant?
Anyway, I tried Zoloft in my early twenties, and it made me feel very disconnected to the world. Like, staring off into the distance with a zombie-like look on my face, to the point that a friend took me back to the clinic and they gave me something else. However, I figure that my body chemistry is different, the situation is different, and it’s 15 years later. I’m willing to give it a try.
Dr. Daria tells us that she’s been unable to get us into the breast clinic. They’ve been giving her the runaround. When she faxed over the results of my biopsy–which were, “YEP, CANCER”–they faxed back and told her to find a radiation surgeon.
My panic levels are rising.
“Don’t worry,” she says.
Yes, of course. Don’t worry. I’ll get right on that. “If they don’t get back to us, can you just refer me to Lakeridge?”
“Look,” she says, “I know it feels like we’re wasting time here, but we really aren’t. This is a difficult time, but we have to do this first, this staging where we hunt down the source. We actually don’t have the immunostaining back from the biopsy, which we need to have before we start treatments. It’s possible the results will be different than the first biopsy, and then the treatments will be different. It’s all tailored to what kind this is.”
The panic recedes, but only a little bit. I can’t feel the cancer cells rallying themselves to attack more vital organs right now, so they probably aren’t. Right? I mean, it’s been months since I had the pain in my abdomen, the pain I think has to be the liver tumor. But that means it can’t be that aggressive, can it?
What does “aggressive” even mean?
“Dr. Cho said he’s going to refer us over to the breast clinic and ask someone to see us right away,” Kevin reassures me. “He said that if we don’t hear anything by Friday morning that we’re supposed to call him.”
Friday morning feels precisely three hundred eighty-five years, five months, six days, and fourteen hours away.
We leave Dr. Daria’s clinic. I sit in the car while Kevin goes to fill my Zoloft prescription. The phone rings.
“Hello, this is [insert whatever her name was] from the Princess Margaret Breast Clinic. Is this Samantha?”
“Yes, it is.” The relief floods through my limbs and makes my arms rubbery. I almost drop the phone.
“We’d like to setup an appointment for you tomorrow. Does 1:30 or 2:15 work better for you?”
I decide against taking a sleeping pill Wednesday night. Thursday morning, we take the train instead of driving into the city; the whole ordeal takes almost two hours. This is one of the big reasons I don’t like working downtown. The time-consuming commute is so draining. At least it’s not rush hour, so the trains aren’t packed ass-to-elbows with grumpy, early morning businesspeople.
We’ve been here before from this direction before: when Phoenix received a positive newborn screening test for a possible diagnosis of cystic fibrosis or CF, we brought two five-week-old babies to Sick Kids to be tested across the street. Talk about an ordeal. There was a pall over the whole building, and when we finished the test and went to lunch, I almost cried several times. A little girl wheeled past us hooked up to an IV, and I lost it.
And I think I have it bad. How much worse to watch your child suffer through this?
Neither baby was positive, but Phoenix is a carrier of the CF gene. She’ll need to be told before she has kids, and her significant other will likely need to be tested as well. Two recessive genes, and they have a 25% chance of having a baby with CF.
So many diseases, barely staved off by modern medicine. How have we made it this far as a species without dying off to internal predators?
In the waiting room, Kevin says, “I bet Dr. Warr is an older guy with a big beard. You know. Beardface,” pronounced “Beard-fuh-say” from the TV show Scrubs. I manage what might be considered a laugh.
They have me fill out a questionnaire about how I’m coping. At least I’m still taking showers and brushing my teeth, although I score pretty low on some of the other areas of mental healthiness.
A different nurse ushers us in. She takes my weight again and puts us into a room. “We have a fellow visiting from Saudi Arabia that will see you first, and then Dr. Warr will be in to see you. Is that all right?”
I can’t remember what a fellow is, so I stammer out a question. “Is that… like… he… is training here?”
“Yes, that’s right,” she says.
Dr. Fellow (because I can’t remember his name) comes in. He’s not a friendly-looking fellow. (Note to self: Take that pun out for the book version of my blog.) He’s very solemn, asks a lot of questions I already answered from Dr. Cho, and tells me he needs to do an exam.
Same as yesterday, he pokes around in my mouth. Then he pushes on my abdomen and asks if it hurts.
“Nope.” I consider telling him about the pregnancy, but he doesn’t seem very talkative, and I’m not sure it’s relevant.
He has me take my bra off and does a breast exam. It’s odd because doctors who aren’t from Saudi Arabia always step out to have me disrobe and put on the hospital gown that’s lying on the exam table. However, I really do not give a fuck right now, so I let him do whatever.
He stops and looks at the giant bruise on the right side of my left breast from the biopsy, which is looking much better than the horrible purple and black striations from a few days ago. “Does this hurt?” He finally pokes around.
“Yes, but it didn’t before the biopsy.” I can’t tell if any of my answers are good or bad. He mostly seems confused. Maybe I’m the first live patient he’s had since getting to Canada. I have no idea if I’m being racist or something, but the whole thing is increasing my anxiety notch over notch.
Back at the table with Kevin, he says, “We’re going to do chemotherapy. Do you have health insurance?”
He mentions something about immunotherapy that goes along with it. He writes some numbers with a dollar sign next to them on a paper, but it’s not a paper for us, it’s for him, facing him, and he takes it along. When he leaves the room to get Dr. Warr, I clutch Kevin’s hand. When the door opens again, I’m crying.
Dr. Beardface–I mean, Dr. Warr sweeps in. He is indeed exactly like Kevin described, and later I wonder if he looked him up on the website just to get a smile out of me. One thing is certain, though: My oncologist has arrived.
“Please don’t tell me anything more that’s bad,” I say through the tears. “I just need to know how we’re going to treat it. My mental health– I just can’t–”
And he does. Over the course of ten minutes, he melts away my fears like the chemo is going to do to every last cancer cell in my body.
“I’m not worried about the liver tumor,” he says, “although there is one on your spine we need to take a closer look at.” It’s close to my spinal cord, and the CT scan didn’t give enough information to say whether it needs radiation. “You’ll need to have a spinal MRI.”
“Dr. Cho wants me to have a brain scan.”
“Are you having headaches?”
“Um.” Am I? “No, only when my jaw hurts badly enough. Then it’s sort of a whole head throb.” And from all the crying. And when I stop drinking caffeine suddenly and for no particular reason.
“That’s normal. I’m not worried about it.” His name badge is hanging from a cord that says, Princess Margaret: One of the Top 5 Cancer Hospitals in the World. “I’m not putting an upper limit on this. I have a patient who went on this therapy fifteen years ago, and he’s still going strong. He runs his own business and travels all over the world.” He gives me a piece of paper with information about my treatment. “Another woman had more bone mets and a larger liver tumor than you, and when we started this, it just melted away.”
Melted. Away. That’s right, fuckers, all of you. Just you wait. I’m going to pee you out like alcohol the day after a bender.
Or however that works.
“Am I going to need surgery?”
“No,” he says.
“Because we can’t.”
I decide I don’t want to know more. I already told him not to deliver any more bad news, so I trust that I don’t need to know. Later, Kevin asks Dr. Daria why: it’s because excising the primary site causes more mets to pop up all over the body. Like disturbing it that way makes it mad. I might have been able to handle that information, but then again, maybe not. I guess you have to kill it in its sleep.
We talk about the practicality of treatment. I need to get a portocatether in my chest because of the frequency of IV treatments. He says I can transfer back to the local cancer center. “The first two lines of treatment are the same. If, for some reason, they don’t respond, you can always transfer back here for additional clinical trials.”
Yes. OK. But he seems so steady, so confident, that I believe I won’t need it.
This is doable. I can do this. Paclitaxel (Taxol(R)) + Pertuzumab (Perjeta(R)) + Trastuzumab (Herceptin(R)) targeted to Her2 breast cancer. All three the first day, Paclitaxel alone on day 8, and then all three every three weeks thereafter for six months.
It’s rush hour when we get to the train, and the grumpy, early evening businesspeople get to be treated to my chatter on the phone with my brother, enumerating all the ways that I’m going to beat cancer’s ass into the ground.