Don’t Borrow Trouble

“Don’t borrow trouble.” It’s a phrase I remember my mom uttering 12 years ago, when I called her in a panic after discovering a lump in my right breast. It was the summer of 2002 in Boston. Kevin and I were newly engaged and living in a condo in a charming, quiet Brookline neighborhood. After he’d proposed in July, we’d rapidly transitioned our jobs, grabbed the first decent apartment we could find, and merged our belongings from our respective residences in Illinois and California. We’d set our wedding date for June 2003, and I was preparing to begin my MBA program in a couple of months.

I don’t know what possessed me to do a breast self-exam at that particular moment. Maybe I was bored, taking a break from unpacking as I puttered around the empty condo, while Kevin was already working regular hours at his accounting job in downtown Boston. Or maybe I was thinking about my mom, who was undergoing treatment back in California. My mom was diagnosed with breast cancer in 1998, when I was a sophomore in college, and she had already completed a mastectomy and chemotherapy. Everyone had breathed a sigh of relief and crossed their fingers after her chemo concluded in the spring of 2000.

After the whirlwind of my college graduation weekend, my mom went back to just being my mom, helping me pack up my tiny dorm room, telling me she understood my sadness when I had to say goodbye to Kevin, who was taking a job in Chicago while I returned to the Bay Area to work in public relations. I knew she felt as heartbroken as I did as we drove away from campus together that May afternoon, watching out the window as the dorms and trees and walkways seemed to slide away, the finality of it all, one last punctuation mark in my college career.

Once I adjusted to being in a long-distance relationship with Kevin, the next few months were a blissfully sweet and carefree time. I started my new job and made friends with my coworkers. Together, we explored the clubs in San Francisco where newly graduated 20-somethings spun and laughed wildly on the dance floor, conjuring up the not too distant campus parties of the past few years.

But one late afternoon in September 2001, as I worked from home on my company-issued laptop and contemplated another dinner of Brie and crackers with my roommate, my dad showed up unannounced at my apartment. He got right to it, no chit-chat. His words made my stomach drop. “Mom had an appointment, and there’s some bad stuff going on.” A scan had showed metastases: the cancer had invaded her bones and now required a powerful drug, Herceptin, to keep it from spreading further. Keeping the disease under control was now the best-case scenario; once cancer spreads to the bones, it’s rarely curable.

I stared at my dad, a jumble of frightening thoughts spinning in my head and hurtling down into a dark cave. I wanted to be numb, not let the weight of his words sink in. “But, what does this MEAN?” I asked him, again and again, even though I knew. My mom’s life had never been more precarious. This threat would never go away.

But we were fortunate. Herceptin worked amazingly well for my mom in the next few years, shrinking her tumors and halting the cancer’s progression. My mom responded so well to the drug that her oncologist was literally jumping up and down with excitement when she called us with the good news. We’d all received a gift: more time.

My mom was still healthy and stable when I called her one day in August 2002, my fingers shaking, tears burning in my eyes as I croaked, “I found a lump, what if it’s cancer?” She listened, as only a person with her recent experience could. She soothed me and promised we would get it checked out with her surgeon in California. And she gave me some advice I would remember always: “Don’t borrow trouble, honey.”

I soon returned to the Bay Area for my scheduled biopsy, which would be a relatively easy outpatient procedure. I remember how my mom took care of me that day, how cheerful and in control she was as we drove to the surgical center, as I sat shaking and terrified in the passenger seat. She stayed with me throughout the procedure, joking with my anesthesiologist, admonishing the prep nurse to bring me an extra blanket. She tsk-tsked about the lame quality of snacks (graham crackers and apple juice) offered in the recovery room. A couple days later, a phone call from the surgeon confirmed I’d had a fibroadenoma, a benign lump common in younger women. I healed quickly and flew back to Boston, where the demands of graduate school and wedding preparations soon crowded out any lingering anxiety in my mind. That was 12 years ago.

Last month, on the advice of my primary care physician, I finally went in for the baseline mammogram I’d been putting off for months. The exam was tolerable, and even with my mom’s history, I wasn’t expecting anything other than a normal result, the happy letter in the mail a week or so later.

On Wednesday, two days after the exam, I was cleaning up after lunch with my youngest daughter when my cell phone rang. It was a number I didn’t recognize, yet immediately I knew what it was about.

“Hello, is this Regina?” (Using my full name. A bad sign.)

“This is Teresa from the imaging center. We need you to come back for some additional views.”

NO, no, not this! I screamed internally. In that instant, I felt fear’s paralyzing grip, the acrid taste in my throat. A feeling so familiar, a reminder of every awful moment after my mom’s diagnosis and subsequent recurrences. I heard the words “nodule” and “an area of calcifications.” I remember the nurse telling me that she wanted me to breathe, that it was not uncommon to be called back after a baseline mammogram, and I grasped at that statement like a drowning person in a swirling black sea. I hated the fact that this nurse could speak so calmly to me while I dangled on the edge of a complete freak-out. I didn’t know enough to ask the right questions, to seek out the answers that might provide the sanity I needed in that moment.

My follow-up appointment was set for an agonizing two weeks away, and would include another mammogram as well as an ultrasound, with results read immediately by the radiologist. The entire call lasted seven minutes. After we hung up, I texted my husband a somber update that included some expletives, then convinced my daughter to watch a show upstairs so that I could cry in bed. I also contemplated downing a bottle of vodka, but decided that a drunken mom picking her kindergartener up at the bus stop would likely be frowned upon. Instead, I called an awesome friend who had been through something similar, and we talked for a while. I was still curled under the covers when Kevin returned home early from work, promising me all would be okay.

The next few days were a fog. I lurked on breast cancer chat boards, feeling comforted one moment and devastated the next as I read about different women’s experiences. It didn’t help that just a few days before my call back, I had read this insightful but heartbreaking post which now brought me to tears. Think of yourself at age three or even five, and try to recall the people who were in your life then but aren’t anymore. Can you remember them, see them in your mind’s eye for more than a brief glimpse, a flash of a smile or a laugh or the scent of perfume? If tomorrow I was gone from this Earth forever, how would my daughters remember me?  

But worrying eventually becomes too exhausting, so I crawled out of my pit. My daughters needed me to be functional, not weeping into my oatmeal like I’d been handed a death sentence. I reached out to a few people who I knew I could count on for support. I started to write this post. And I called the imaging center back and spoke with a different nurse who was able to provide a straightforward, reassuring interpretation of my initial exam. I felt relieved, but angry at the same time that these details weren’t shared with me previously. I wondered how many women have experienced similar anxiety that could easily have been alleviated by a prompt, thorough discussion of their test results.

On the morning of my follow up appointment, I lay in bed for hours before my alarm would go off. Finally, 2:15 PM arrived and I was able to check in at the hospital. I sat in the lounge adjacent to the ER, waiting for my pager to buzz and indicate they were ready for me, as if I’d reserved my own private table in some bizarre restaurant. The radiology technician greeted me first and took me back to the mammogram room. She was kind and considerate throughout the test, telling me, “Let me know if you’re doing okay. I don’t want this to be painful.” I felt shaky and on the verge of tears, muttering a feeble joke about how the X-ray machine looked like a modern torture device.

With the X-rays completed, the technician gave me a plush white robe and asked me to sit in a smaller nearby waiting area so that the attending radiologist could decide if more views or an ultrasound were needed. Another staff member, an older woman with short blond hair, brought me some apple juice in a little plastic cup. I felt, momentarily, like a small child whose every need was being considered. This was both comforting and disorienting. My fingers would not stop trembling, tapping their staccato as I texted a quick update to my sister and friend. I read the Scary Mommy post again.

The first tech returned to say the doctor wanted to do an ultrasound, and I soon followed another employee back to a new room. This one was dark, cool and quiet, and I felt more relaxed; at least this exam wouldn’t be physically painful. The ultrasound technician had an easy, casual bedside manner, and we chatted a bit about Halloween and the seemingly boundless energy of young children. After the ultrasound was complete, the technician explained that the attending radiologist would be in to see me soon and would conduct her own ultrasound to double-check everything, but that it would be quick. Then, the doctor would review her findings with me.

Moments later, a triangle of light spilled into the room as the technician returned, this time with the radiologist, a slender middle-aged woman with soft blond hair and an unhurried manner. The doctor guided the ultrasound wand in slow circles, not speaking, except to ask me when I’d had the previous benign biopsy. After a blissfully short exam, she put away the wand and said, “Ok, good.”

I turned on my side to face her, propping myself on an elbow as she explained, “So there were a couple of things we were looking at with these additional views. First were calcifications, but yours seem to be the benign kind, and they are on both sides, which suggests these are just natural fibrocystic changes occurring.”

I felt some of the air return to my body. She continued, “You also have a nodule on this side, very small, but it has coarse calcification which helps us feel confident it is a fibroadenoma. So, I don’t feel we need to do any biopsies at this time.”

No biopsy. No immediate danger. I felt like a fish thrown back into the water, at least for now.

I thanked the doctor and we discussed next steps: follow up for another exam in six months to confirm that things still look okay. Though I’m still awaiting the official report, as I researched later online, my exam would likely be classified as a “probably benign” finding: there is a 2% or less chance of malignancy, but the radiologist would prefer to confirm its stability, so a short follow-up interval is typical.

While “probably benign” certainly isn’t as comforting as 100% benign, I’m grateful for this good news. And while I was initially tempted to pursue a biopsy just for my own peace of mind, I did some more reading and learned about how many women undergo invasive procedures for which there is no medical justification, purely because we are all (understandably) terrified. Breast cancer awareness in our country is outstanding, but there’s a delicate balance between a healthy awareness and a fear that prompts us to make extreme decisions.

I hope that in six months, I’ll have an uneventful follow-up exam and can effectively close this chapter of my own mini medical crisis. Until then, as my mom so wisely said, there’s no point in worrying about what might (but probably won’t) happen. Fall is in full swing, and there are still a few good running weather days left. There are holidays to celebrate, friends and family to visit, and painted hand turkeys to create and hang around the house. The business of simply living life, while trying (albeit sometimes failing) to be a decent parent, spouse, and human being, deserves my full effort and attention. So I won’t borrow trouble, but instead think about what I can give.

~ ~ ~