Choosing a Surgeon

Once I had been diagnosed with cancer, my next step was to meet with a breast surgeon. Regardless of my final chosen treatment path, one truth remained – the cancer had to be removed. It could not remain in my body. My doctor’s office sent a referral to a surgeon and told me if I didn’t hear from his office by the end of the week to call them myself.

They didn’t call. I ended up calling myself to schedule an appointment. When I called I was given an apology and told the surgeon would be out for two weeks on vacation starting the following Monday. Appointments were booking almost a month out. Again, more waiting. The waiting was becoming almost comical to me at this point and I kept praying for God to keep me from worry and fear.

My husband suggested I wait until I had more answers to tell friends, but I didn’t. I chose to tell close friends I knew who would faithfully pray for me. I needed their support and I know prayer is the most powerful tool we have. I told them the disappointment of the delayed news and the waiting for my next doctor’s visit.

In my first two weeks of waiting I read an entire book on surviving breast cancer and exhaustively searched credible internet sites. I continued to pray for peace as not to worry. I read in The Breast Cancer Survival Manual by John Link, M.D. book there is always a sense of urgency, but in most cases, you are fine to take time to thoroughly consider your treatment options (Link, 2).

This was not the first time I had had a breast cancer scare. I had another one six years earlier when my first daughter was six months old. God was so gracious to me, but it was not a shining example of me being having peace and not worrying. Once I learned I needed to get a biopsy and cancer was a concern I freaked out. I was a first-time brand-new mom steeped in hormones coupled with a breast cancer scare. Much to my regret I let fear get the better of me and I spent an entire night in my living room worrying and waiting for my doctor’s office to open so I could call.

My doctor graciously scheduled a fine needle biopsy to get me an immediate answer. The mass needed to be removed so I underwent a “surgical biopsy” to remove the mass a few weeks later (it’s only referred to as a “lumpectomy” if the mass is cancerous). The day I ended up going in for surgery I was a little less of a mess. I sat down to do read my Bible study early that morning. The focus for that day was peace despite life’s circumstances. I felt a great deal of comfort and peace knowing the message I read was exactly what I needed to hear for what lay ahead of me that day.

During my waiting to meet with the surgeon, I was reminded of my first breast cancer scare. Oddly, the surgeon who had performed my first surgery was not who I was being referred to this time. While researching treatment options I came across a website where breast cancer survivors could post before and after photos along with the details of their treatment: FORCE(Facing Our Risk of Cancer Empowered). Pouring through these images and treatment options introduced me to the idea of “hidden scars.” There is even a special hidden scar certification for surgeons.

As I looked through the list of surgeons in my area who were certified, I saw my first breast surgeon’s name. I was reminded of an interaction with my recovery nurse following my surgical biopsy. The nurse told me my first breast surgeon did the best job she had seen of locating scars in inconspicuous places. Scar placement wasn’t even a consideration when I had my first breast cancer scare, but it had been for my surgeon. She located the scar in such a way that I hardly notice it and it is naturally obscured. Very rarely do I see it and am reminded of that experience.

Pouring through before and after photos I quickly realized how obvious most breast surgery scars are. I even read that 87% of breast cancer survivors are self-conscious about their scars and 72% were unhappy with their scar placement.1 Regardless of my treatment path of choice, the idea of not having to live with obvious and visible reminders was appealing. On a Thursday I decided to call my first breast surgeon’s office. A second opinion couldn’t hurt. Calling her office as a returning patient expedited the process. After a brief hold I was asked if I could come in first thing the very next morning because they had just had a cancelation.

The next day was my birthday. With all that had been going on of late, my husband took that Friday off work to spend the day with me. Together, on my birthday, we met with a breast surgeon two weeks earlier than my initial referral. That was my favorite birthday present that year. The surgeon greeted me with a smile and a hug. This meeting produced a shocking revelation too –

I had not officially been diagnosed with breast cancer.

The breast surgeon looked at my pathology report and told me I had only been diagnosed with ADH – “Atypica Ductal Hyperplasia.” However, the report alluded to cancer, but the samples were not adequate to make this conclusion. I asked if I could have a copy of my pathology report for my own records and I was immediately supplied one. She said the next step would be genetic testing, which I did that day in her office.

I also asked her about hidden scars. I shared with her how happy I have been with the placement of my scar from my first surgery she did. She thanked me for the compliment and laughed as she shared she has always hidden scars, but now she has a certification to prove it. I asked her how she would hide the scar with this procedure and she pointed along the outside of my areola. The same placement as most breast implant incisions.

She was eager to answer all my questions and explain next steps. She said moving forward, my treatment plan depended upon two things – determining if it was cancer and if it was genetic. If the genetic testing confirmed the breast cancer was genetic, even with just a diagnosis of ADH, a mastectomy was a viable option. If the genetic testing confirmed it was not genetic, the next step with just ADH would be a lumpectomy. The lumpectomy would determine if the growth was in fact ADH or cancer. If the lumpectomy confirmed the abnormality to be cancerous, then we would discuss further treatment options.

We left that appointment encouraged and relieved to have some answers, but also a little confused as to why my doctor misdiagnosed me. Since it was my birthday and my husband was off of work, we went out to breakfast. Over breakfast we discussed the recent revelation that I had not officially been diagnosed with breast cancer. We were both frustrated and confused by this misinformation. I even asked:

 Should I tell my friends? Just kidding I actually don’t have cancer.

My husband quickly discouraged me from sharing this new revelation. After all, I could still be “re-diagnosed” with breast cancer once a better sample was attained. What a rollercoaster ride!

At the end of breakfast my husband told me my birthday gift was a massage and he had scheduled an appointment for me that morning. He told me to take my time at the spa and relax. Whenever I was done I could text him and he would pick me up. I love massages.

Fairly shortly into my massage the masseuse commented that I was incredible tense. I felt the need to apologize and explain I had recently been diagnosed with breast cancer and that was probably the cause of the tension. As she continued to work she casually asked me:

 Have you considered praying about it?

Oh man, had I prayed about it! I told her I had been praying about it.  Apparently, my body was betraying me in that moment and revealing I was carrying a lot of stress despite my prayers.

After my massage I enjoyed a long steam shower and when I returned to the changing room to get dressed I discovered a missed call and a message on my phone. The other breast surgeon’s office had called. He had a cancelation the following Monday and they wondered if I would be available to take the appointment. My third favorite birthday present and answer to prayers (my second was the time at the spa).

The following Monday my husband went with me to meet with the other breast surgeon. When we walked into the office I checked in at the front desk. The receptionist asked my name and the reason for my visit. I decided to approach this visit as I had my first. I wanted this surgeon’s opinion, maybe this surgeon agreed with my doctor. So I reverted to what I had been originally told by my doctor – DCIS (breast cancer). Glancing at her computer she rudely retorted:

 You don’t have DCIS.

I responded simply with that is what my doctor told me and that is why I am here. Talk about a warm welcome! She handed me paperwork, took my payment and told me to sit down.

I sat next to my husband who had just observed my front desk interaction from afar. He glanced at me and commented how terrible and rude the receptionist was to me.

What a way to greet someone in this situation! I guarantee almost everyone who comes in here is scared and nervous. A little kindness and compassion would be nice!

I agreed. To say the least, we were both rather put-off.

I filled out my paperwork and we were called back by the doctor’s assistant. Ok I know it is bad to make judgements based upon outward appearance, but both my husband and I had the same reaction. The doctor’s assistant was probably in her 50’s or 60’s and she was wearing knee high black leather boots and a mini skirt. Not professional at all.

She took me into an exam room and also asked me why I was there. I told her my doctor had told me I have DCIS. In a belittling and demeaning tone she quickly corrected me too – “You don’t have DCIS.” She continued in that tone and addressed genetic testing. She said it’s recommended, but only for women who have been diagnosed with breast cancer. She reminded me again I had not been diagnosed with breast cancer, so I didn’t need genetic testing.

She looked at my paperwork and noted my mom had been diagnosed with breast cancer. She asked me if my mom had done genetic testing. I was not sure. She then proceeded to lecture me on how my mom should get genetic testing done. The results would take about 3 weeks. If they were positive I should then get tested and wait an additional 3 weeks for my results. Are you kidding me?! I told her that was not an option.

During our entire conversation she moved from standing to sitting. When she was done with her genetic testing lecture she instructed me to undress from the waist up and she would be back with the surgeon in a moment. When she left the room my husband immediately commented how unbelievably uncomfortable and unprofessional she was. He said he wanted to look at her while she was speaking to us, but she kept flashing him her underwear as she moved all around in her miniskirt, transitioning between standing and sitting without bothering to cross her legs or even attempt to keep her knees together. The whole ordeal was awkward and uncomfortable, conversation aside, which only added to the awkwardness.

She returned with the surgeon as promised and he too lectured ne on genetic testing. I finally spoke up and told him it was a mute issue, I had already met with another surgeon and done the genetic testing at her office. The results would be coming, let’s not belabor the point. He completely ignored my comment and would not let up on the topic. He kept circling back to the topic every chance he got.

He did an exam and told also me I did not have DCIS, I only had ADH. I asked him why my doctor would look at the pathology report and tell me something contradictory to the report. He simply said he had no idea why. I then took out my phone with my list of questions to ask him. As he responded, I recorded his answers in my phone, so I could refer to them again later. As I did this he paused from answering a question and commented in a really rude and put-off voice:

 Is there something you need to be doing right now?!

In my nervousness I completely missed the implications of his comment. My husband however did not. He immediately interjected with “Her questions for you are on her phone and she’s recording your answers.”

I asked this breast surgeon about scar placement too. He indicated on my breast that he would make a straight incision across the exterior side of my breast about 2 inches long beginning at my areola and ending near my arm pit. Talk about an obvious scar without any attempt to conceal it! He did not even attempt to hide or obscure scars. He just made incisions where ever it made it easiest for him to work.

He answered my questions, but I will be honest I left his office really angry. The overall attitude of everyone, including the surgeon made me never want to set foot in there again. If he was trying to win my business, he and his office staff failed miserably. I was also upset about my doctor’s misdiagnosis of breast cancer. In leaving my husband suggested we sit in the car together and call my doctor. We wanted answers.

I called my doctor’s office and had to leave a message with the receptionist. I explained that I had been misdiagnosed with breast cancer two weeks earlier. I had just met with two different breast surgeons, both of whom told me I did not have breast cancer. I wanted answers as to why I had been misdiagnosed and led to believe I had cancer for two weeks when I did not. Even though I was the one on the phone, my husband couldn’t hold himself back from sharing his thoughts too. His comments were all heard by my doctor’s receptionist too. She told me my doctor didn’t normally call patients himself, a medical assistant would call me. I stood firm and told her I wanted to speak to him directly, not his medical assistant. I wanted answers from him directly. She said she would see what she could do.

My doctor called me the following evening and explained to me why he concluded I had cancer from the pathology report. The pathology report stated the findings:

 are suspicious for low-grade ductal carcinoma in situ (DCIS), but the limited extent of these changes warrants a diagnosis of atypica ductal hyperplasia (ADH).

He then explained the pathologist wouldn’t just put that on the report. To him that meant, in his gut, the pathologist thought it was DCIS, but he couldn’t say it conclusively from the samples provided. He told me he always treats patients for the worst-case scenario listed on pathology reports. His explanation put some of my concerns at ease, but I still felt I would have preferred to know the whole situation from the beginning instead of just being told I had cancer, living for two weeks with the diagnosis and then being blindsided by the revelation I didn’t officially have cancer…yet.

I also discussed the two different surgeons and shared very candidly my distaste for the surgeon he recommended. My experiences with the two surgeons could not have been more different. He told me to consider the doctor himself, not his office staff (honestly – not helping much). He said he would refer his daughter to the surgeon he originally referred me too, but he refers patients to the breast surgeon who did my first surgery too. He said either surgeon was great, it was just whomever I felt most confident and comfortable with.

In retrospect I will say, what an answer to prayers to have appointments with two breast surgeons! I was given the miracle of two canceled appointments I could fill to eliminate my waiting. Those two weeks of waiting allowed me to research and gain an understanding of my original diagnosis of DCIS and treatment options. This research led me to meet with my first breast surgeon. Had I been immediately seen by the surgeon to whom I was originally referred, that may not have happened.

I ended up choosing my first surgeon and I could not be happier with the outcome. Even in meeting with another survivor who was treated by the surgeon I was originally referred to, she told me I made the right choice. Despite the fact she credited him with saving her life. She said everything she had heard from survivors about the surgeon I chose made for a much better experience overall. I was not in the clear from worry or fear, but I was trusting God daily, hourly and minute by minutes that he is good. I may never know why I walked through this, but I know with God nothing is wasted. I don’t believe he is the author or source of bad things, but I believe nothing is beyond his ability to redeem and bring about good in some way.