Clinical Case of Post Traumatic Breast Disorder Following a Biopsy
Carnes et al. March, 2008
Let’s face it, girls, mammograms hurt, yet most of us forty something ladies keep going back for more hoping to hear the good news, “Your mammogram was fine. See you again next year in the Vice Department.” I’m sure you all know what “the vice” is.
And so it was with grave concern I heard my doctor speak the words, “Your mammogram shows an abnormality. We would like you to come in for an ultrasound at the hospital next week. It could be a benign cyst, but of course we need to find out.” My brain froze as I frantically tried to remember what “benign” meant. How big did cysts get before they took them out?
I remembered people who just didn’t go back because they hated medical procedures. Come back next week? That only gave me seven days to envision all the horrifying possibilities and to become an internet expert on every single one of those horrifying possibilities. I was not a quitter. I would survive the week, or at least I would survive the tests.
A week to the day cold jelly was being generously applied to my left breast. I was uncomfortably aware of something more chilling than the cold jelly. My left breast was already the smaller of the two girls, thus if they had to remove a lump that would mean an even smaller left breast. My husband assured me he would not notice even though he had already noted the size differential on our honeymoon several years ago. I asked the doctor what he thought. The doctor assured me no one would notice. Everyone had different sized breasts.
Back to the cold jelly. You can only dissociate for so long during a medical procedure before they jerk you back to reality. Today the good news was that I didn’t have to have that left breast clamped in a vice. The technician stroked a wand across my breast while we watched a TV screen. It was not in color. I don’t know if color ultrasounds have been invented yet. Maybe color doesn’t matter. With the first stroke of the wand a black jelly bean sized oval showed up on the TV screen. The technician stopped moving the wand and stared at the screen.
“There it is,” she said. Heck, I could see it myself. Then she pressed three fingers against it. Splat! It squished down and formed into a flat black line like a dash in a sentence.
“Ma’am,” she said since we were in South Carolina, “it looks like a fluid cyst, and it is small, probably not cancer, but we will need a biopsy.”
What’s this ‘we’ will need a biopsy? You mean I will need a biopsy unless you want to be a boob donor. Hey, we could start a new charitable organization, Boobs by Proxy. Being a polite southern lady I said nothing of what I was thinking, of course.
I actually said, “Oh good. That means just a needle biopsy. I read a lot about that on the internet.”
“Ma’am, you will need to see Dr. Sandoff, the surgeon. He handles all these biopsies unless you want to travel fifty miles to Charlotte. That generally means a six week wait, and I know you don’t want to sit around worrying about this.”
Of course I didn’t. I wanted to know if it was cancer or not. This was some scary stuff, not just a wart on your finger. What I did not know was that surgeons can be “scary stuff” too. After all, they stood to make more money cutting out lumps, not just punching needles into fluid cysts and pulling back the plunger.
Thus it came to pass when I saw Dr. Sandoff the next week I was scheduled for surgery with general anesthesia – the works. I asked Dr. Sandoff if he couldn’t just withdraw some fluid and test the fluid for cancer cells. I was informed that the needle might miss the cyst and thus miss the cancerous cells. I suggested that the internet said needle biopsy was standard procedure for a cyst this size, especially since it flattened to a dash in the ultrasound exam. This suggestion did not go over too well with Dr. Sandoff.
End of discussion. “Here is a legal document I would like you to sign,” said Dr. Sandoff as he leaned toward me handing me a paper to sign.
“What am I signing?” I nervously asked. This wasn’t looking good. Oh well, I guess I could die on the table, and I have to sign that I agree to that.
“This document gives me permission to do a radical mastectomy if I find the lump is cancerous.”
“Whoa, the cyst is only a centimeter and it flattens to a black line, well, whatever color cysts are. No one would do a radical mastectomy for a cyst that small.” I could see my already smaller breast shrinking to nonexistence.
The doctor looked stern. “Ma’am, I assure you, if it is cancerous your best bet for a cure is to remove the entire breast and the lymph nodes, not a lumpectomy. This is what I would recommend for my own mother.” Now why would he think I was old enough to be his mother? We probably had nothing in common except two intact breasts.
I was tempted to ask if he would want his balls removed if he had a fluid cyst in his scrotum. (Maybe that is not a fair comparison. I need to look that up on the internet.) Instead I blinked slowly like an old owl and said in a calm voice, “How about waking me up after the biopsy, and then you can biopsy the lymph nodes, and then we can discuss this paper again.” I had reached a standoff with Dr. Sandoff.
While we are on the subject of men examining their balls, I have often wondered when I see a TV ad encouraging women to examine their breasts with the woman naked except for a large towel wrapped discreetly around her body like a Greek goddess, why not show men looking like Greek gods reaching between their legs to examine their scrotums? But I digress.
Our local hospital had a wonderful new program designed to calm a patient’s anxiety. The day before my surgery a nurse went over everything I could expect during the next day’s procedure. It turns out there were a few events she did not anticipate. I explained to her that I was already angry because the doctor had not agreed to just aspirate the fluid cyst, but I resigned myself to my fate at the hands of the doctor who had said he would “care for me like he would his own mother.”
Next morning I arrived early for the surgery. I was taken to another mammogram vice, only this one had a chair I could sit on. A technician explained, “We have to do this to locate the cyst for the surgeon.” Sure enough, right there where we had left it, was the fluid, black jelly bean shape. “The doctor will be here in a minute, ma’am. He will place a needle in your breast to mark the cyst for the surgeon.”
What? Wait a minute. If this doc can put a needle in it, why couldn’t they just draw the fluid out and test it for cancer cells? I was getting more and more worked up. But my breast was already in the vice, and I couldn’t figure any way out of this. My problem was that I knew too much to be a good patient. The doctor came in just then. He was kind-of short, maybe five foot two in elevator shoes – the perfect height to examine breasts. I could see how he had developed an interest in his field.
He stepped on the lift lever to get up above my left breast there in the clamp. Trouble was he hit the wrong lift lever with his left foot. The mammogram vice started slowly rising in a jerky motion toward the ceiling with every pump of his foot on that pedal. Unfortunately my chair was not raised with the same pedal. It dawned on me after about two pumps that I might end up with a radical mastectomy even if the cyst was benign. My left breast was already about shoulder level, and I was standing up!
Suddenly the doctor exclaimed, “Oops, wrong pedal.” I was unceremoniously lowered back down to chair level. The long thin needle was inserted with an end sticking out the neck of my hospital gown. Could I have qualified for a bit part in a horror movie?
On to surgery. Shaved? I don’t recall. Events became a blur after the sedating shot was given. Ah, calm, peace, even, perhaps, light sleep while I was placed in a room full of gurneys and patients awaiting surgery. An old white-haired man lay on the gurney next to me. Misery loves company.
It was then I heard muttered whispers between the two attendants standing at the foot of our gurneys. “Which one is the leg amputation?”
My eyes shot open, and I distinctly spoke, “IT IS NOT ME! See this needle? Dr. Sandoff is removing a fluid cyst. Period.” If they had their way I would be leaving the hospital with a wooden peg leg and a parrot on my shoulder.
Some time later I awoke to the good news. “Your cyst is benign, just a fluid cyst. We will be sending you home in a few hours. Your husband is here.”
As I left later with my husband I was told, “Don’t get the bandage wet. Leave it in place for three days.”
Three days later I resurrected my left breast. The resurrection involved carefully unwrapping the sticky white tape which hurt. I was happy to note that the breast was only slightly smaller than it had been three days prior. The small incision was already healing and all but invisible.
On the other hand the top side of my left breast revealed a large red, oozing hole – an allergic reaction to the adhesive in the bandage. Not to worry, it completely healed in about six months. I am still getting therapy for post traumatic breast disorder. It has been several years, but I remain hopeful that the writing of this tale, all of it true, will be a healing experience.
Names have been changed to protect the not-so-innocent.