2 Diagnosis

My husband and I had seen the surgeon in the morning and I was still trying to conserve my leave time for after delivery, so my husband dropped me off at the office so I could try to work during the afternoon.

I had intended to work pretty much right up until the point where I went into labor. I joked with people that I would be sitting at my desk when labor started and I would have to ask someone to take me to the hospital.

I was meeting with the human resources people, going over the details of company policy about maternity leave, when I heard in the conference room a general page that I had a phone call. It was my husband, letting me know that the hospital had called to find out why I hadn't checked in yet. Apparently I was supposed to go by and fill out paperwork and meet with the anesthesiologist during the afternoon but no one had told us about this obligation so we didn't know to go. This was a big deal to the hospital and it was a required activity before the surgery. They would reschedule the surgery if I didn't have this meeting first and I didn't want to wait out the weekend with the hole in my chest which hurt and had to be rebandaged every morning.

The afternoon was half over and we had to get to the hospital before the end of the business day, so I waited for my husband to pick me up and tried to focus on what I needed to know so we could finish up the meeting. I remember starting to lose my cool as I struggled not to cry. I put my head in my hands and confessed, "I don't want to go into surgery tomorrow." I wanted the lump in my breast removed because it hurt all the time with the incision still open. I wanted the lump removed because I wanted to get on with my life and the term of my pregnancy. I was afraid of the unknown, though, and the sudden urgency to report to the hospital the day before the surgery for any reason was unnerving.

We live in Austin, Texas. My mother lives about an hour and a half away. She drove to our house the night before so that she could accompany us to the hospital the morning of the surgery. My father and step-mom decided to drive in the morning of the surgery and meet my husband in the hospital waiting room.

We left the house before the sun came up and arrived on time at the hospital. As the nurse took my vital signs that morning and checked for the fetal heartbeat before surgery, we talked about what I was there for. I told that nurse that my surgeon suspected that I had a mass brought on by pregnancy hormones. The nurse told me she had had that when she was pregnant. It was no big deal to remove the mass and everything was fine. I felt silly, then, for having sounded the alarm and having my parents drive in for a simple procedure like this. I mentioned this to my mom and she reminded me that I gave the parents the information I had and it was their decision to come to the hospital that day. That comforted me.

They put me into a "twilight" sleep with anesthesia and the surgery began. A local anesthetic numbed the area where the surgery was performed on my breast and I slept through most everything. They couldn't put me all the way under with general anesthesia because I was in my third trimester and it wouldn't be safe for the baby.

They put a pillow under one hip because had I reminded the anesthesiologist in the prior afternoon's meeting that the weight of the baby interferes with blood flow to the heart of the mother when she's flat on her back for more than a few minutes. That's why pregnant women shouldn't do exercises while laying flat on their backs and why they shouldn't sleep on their backs. I thought it was interesting that I had to remind medical professionals of this simple fact of pregnancy that kicks in about the fifth month.

My obstetrician made an interesting statement at one point. She said that pregnancy terrifies most of the medical community. All the rules change, you see, and I got the impression that medical professionals who don't deal with babies and pregnant women every day forget what the changed rules are and they worry about making a mistake. I think that's a good thing to worry about.

My expectant condition is what changed the surgery location from the surgical center in the same building as the breast surgeon's office to the hospital I had selected to deliver my baby. My breast surgeon was consulting with my obstetrician and they wanted me to spend some time in the maternity ward after the breast surgery so the baby's heart rate could be monitored for a while.

So I went into surgery, having been warned to expect the baby to be affected by the anesthetic and to not kick as much for the rest of the day. When I woke up in the main recovery room two hours later I was delighted to feel the baby kicking per his usual routine. I rubbed my belly and talked to the baby. I was the only patient in the recovery room who was smiling, but I had a good reason to smile. The baby had sailed through the surgery and was doing fine. The lump was gone. I didn't feel any pain. Life was good. I was a little puzzled as to why my one hour surgery had taken two hours, but I kept drifting in and out of sleep so I didn't worry about it much.

After an hour in recovery I was taken upstairs to a labor and delivery room. I remember rolling by my parents in the hall and briefly telling them hello from the gurney. I was so relieved and happy to have the surgery over with. I wondered why I saw tears in my step-mother's eyes. "The baby's fine," I thought. "She must be really worried about him."

The nurses helped me move to the bed and hooked up the fetal monitors to my belly. Then the nurses left and only my husband came into the room.

What I didn't know yet was that the breast surgeon had spoken with my husband while I was in the first recovery room. The mass was breast cancer, malignant and ugly and she could tell what it was by the color when she removed it. While I was still under sedation, she had sent the lump to the hospital pathology lab for a frozen cross section to confirm the diagnosis. Then my simple surgery turned into a lumpectomy as additional breast tissue and skin were removed.

On Friday, March 3, 2006 I was 34 years old, 36 weeks pregnant, and newly diagnosed with breast cancer thanks to a tumor measuring “at least 3.5 cm.”

My husband told my parents, still in the waiting room while I was in the recovery room. He informed the surgeon as well as my family that it was his job to tell me – nobody else’s.

So my husband came into my hospital room on the second floor, alone, while the fetal monitor showed a perfect heartbeat for our son. Guy held my hand while wondering how to tell me this horrible news. I smiled at him, thrilled that our baby was doing so well. He told me later that my happiness made this task even harder.

I wondered at his somber mood and assumed he was worried about the baby. "Kelric’s doing fine," I told him.

"That's the good news," my husband responded.

That's when I noticed the tears in his eyes. "What's the bad news?" I asked having no idea what could possibly be wrong.

It was the perfect opening to gently tell me the truth. "You're going to need chemotherapy, and radiation," he said.

I immediately leapt to the obvious conclusion. "Cancer? I have cancer?" I was shocked and beginning to feel numb.

Nobody had thought it was cancer! It was a stubborn infection. It was an abscess. It was a mass brought on by pregnancy hormones. This couldn't be cancer!

Then we both cried.

We pulled ourselves together and let my parents come into the room. Now it made sense why they had looked so gloomy as I had been wheeled past on the gurney.

During the next two hours I was visited by my obstetrician and breast surgeon.

I had heard that they wanted the baby to come early so that my treatment wouldn't be delayed. I hoped that this was a false rumor, but my obstetrician regretfully confirmed it was true. It wasn't advised to wait the three weeks or so for my baby to come to full term on his own. He needed to arrive early. One other thing – I would not be able to breastfeed since the chemicals used by chemotherapy are toxic and they would poison the baby through my milk.

The breast surgeon wanted to schedule the delivery for a C-section. She proposed back-to-back procedures where the baby would be delivered and then she would perform the sentinel node biopsy. She was leaving for spring break in a little over a week so we should consider scheduling things for the time before she left town. At least, that was the version of events filtered down to me by my husband.

When the breast surgeon visited with us in my room and she said something that rocked us on our heels. She was convinced that my condition must have a genetic component since I was so young. She wanted me to get genetic testing at once and if the results were positive she recommended a double mastectomy and removal of both ovaries as a preventative step for recurrence.

Here I was pregnant with my first child and my surgeon was telling me that she wanted to remove my ability to have any future children. I couldn’t believe it!

No. This was the first time my husband and I looked at each other and decided to go against medical advice and seek a second opinion before making that decision. You don't tell someone on the day of a breast cancer diagnosis that she needs to have reproductive organs removed to prevent future cancer. Let the initial shock sink in first.

I had been looking forward to a vaginal birth and a period of breastfeeding. In one day both goals were threatened. And for what? Not anything that compromised the health or safety of my baby such as pre-eclampsia or hypertension. It was my health and safety that took priority and that didn’t jive with my instincts as an about-to-be parent.

I was released from the hospital after my two hours of fetal monitoring showed no trouble for the baby. My parents, husband, and I went to a nearby restaurant and ate lunch. If I started to tear up they comforted me and reassured me that we caught this early and I would be fine. The mothers worked out a schedule of who would come look after me and the baby for the first few weeks after he was born. It touched my heart to see how much they cared and wanted to do all that they could to help.

My husband and I spent the weekend grieving my diagnosis.

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