2. The Diagnosis
My baby,
This blog is meant for you to read when you are in your teens, so you can understand what your mother went through. I know some of this will be very painful, but I want you to know that you were my strength and the reason that kept me sane in my battle.
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We decided to visit my doctor that evening. It was a Saturday but she agreed to meet us. “Swati, you are very strong. You have a high threshold for tolerating pain. You must have received this report only a few hours ago; and here you are, calm and composed.” I was going to hear this repeated often, for the next few months. I don’t know if I was strong, I don’t know if I had realized the full import of the words in my report or if I had any idea of what was to come. Staying strong was not a choice. It was the only choice. After all, I could not afford to be upset in your presence, my baby, and I struggled to maintain some semblance of normalcy in your life, digging deep into my inner reserves of strength.
She spoke to her Oncologist colleague who asked that I meet him on the following Monday. The next 36 hours were hell. We went through the entire episode that had started in December, several times over. How the lump had suddenly appeared and the ultrasound report had called it benign, meeting the General Surgeon who examined and asked for a lumpectomy, followed by a biopsy. I had been reassured at every step that it was ‘nothing to worry about’.
But ‘worry’ I did. I had a bad feeling about this right from the outset, just like I would have a bad feeling a few times when you had a cough and I would know instinctively it was full-blown congestion. But every apprehension I had, was negated by the false euphoria created by the benign ultrasound report. There were red flags all the way, at every step, which I failed to notice. My doctor did not ask for a mammogram before the lumpectomy, which could have helped point to a potentially cancerous lump. I remember my brother had spoken to an oncologist-researcher friend of his who had strongly recommended a mammogram. Again, I went with what my local doctor advised. To be fair, even she hadn’t expected someone at my age to have cancer, and in India, a mammogram isn’t advised unless a woman is 40 years old and I was only 34. Having the luxury of hindsight now, though I hate to admit this, my father and my brother were right in recommending that I see an Oncologist. Just as they had been right in advising that I move to Bangalore many years ago or that I pursue writing as a full-time career.
Monday came and we did see the Oncologist but with a biopsy report that confirmed Cancer. I said a prayer under my breath as we were ushered in, hoping that we weren’t too late. After reading my reports, The Surgeon-Oncologist examined the affected area, asked me several questions and outlined the treatment. There were a few more tests to be done which would determine the finer details of the treatment plan. However, broadly, he said, there would be one more surgery to remove the remaining cancer cells, followed by chemotherapy, radiation, and if I tested positive for it, then hormone therapy too. I watched in silence as the doctor gave instructions over the phone to the laboratory for precise measurements of the tumor, cancer marker tests and hormone receptor tests. I asked with a shaky voice, recalling to myself with acidic humor that this sounded straight out of a 70’s movie, “What stage do you think it is”? To be honest, it sounded more like, “Am I going to die?”, though I didn’t want to sound too dramatic.
He replied, “It looks like a Stage 2a, assuming that the tumor hadn’t spread to your lymph nodes. We will update it to a 2b if we find out during the surgery, that your lymph nodes are, in fact, affected. There are chances that you will have a considerable loss of movement in your arm and lymphedema too if we remove several of your affected lymph nodes.”
It turned out that ‘grade’ and ‘stage’ weren’t the same things. The stage of cancer, as my doctor informed me, depended on the size of the tumor and whether it had metastasized or not. The ‘grade’ in my report as an indicator of severity. He noticed I had been clutching on to an almost crumpled sheet of paper and asked me what it was. It had all our questions, which your dad had painstakingly jotted down. “Ah, so you two are well prepared. Looks like you have been spending a lot of time with Mr. Google! I wouldn’t recommend Googling your questions as a lot of material online is unsubstantiated claims, bad research and people out there just to create panic. As your Oncologist, I am here to answer all your questions. Let’s go through your epic list now.”
It was very sound advice as I would recall later, as it kept me from excessively thinking over or analyzing my situation. The doctor was renowned and gave me confidence that the disease was curable and I was fortunate to have been diagnosed at an early stage. The treatment was going to be long and painful and if I adhered to the planned schedule, I would make a full recovery. He did something else too that was rare: he shared with contact details of a few of his former patients who were of the same age as me, with their consent. I spoke to a few of them and that really helped me, knowing there were others who had recovered and were leading fuller and happier lives now. That was the only good news I would receive for a long time. There was more news, but scarier than I could ever imagine.
The Oncologist had asked me several questions regarding family history vis-a-vis cancer. Cancer is a disease of genetic mutation. Breast cancer is the most common type of cancer associated with inherited genetic mutations which develop from BRCA1 and BRCA2 genes; along with ovarian, pancreatic and prostate cancers. He asked me to undergo a test to establish heredity within my family. My samples would be sent to a well-known lab in Germany to test for a hereditary genetic mutation. This test would be performed with high precision and results would be available in 30–40 days. If it was found that the test was positive, I would have to undergo further surgeries to have my ovaries, fallopian tubes and uterus removed. But that was the least of my worries. It would also mean that my sister, her daughters, my maternal aunts and above all, you, my darling daughter were all at risk.
I don’t recall ever having prayed so fervently for anything in my life. There was nothing that I wanted more than the report to turn out negative. When the report finally arrived, it proved without any iota of doubt that my cancer wasn’t hereditary. The entire family heaved a collective sigh of relief.
