Next steps...

It has been an exhausting day at our house.  Papaw Robbins stayed with the kids (which was so fun for them to wake up to :) while Bryan, my mom, and I headed down early this morning to my appointment with Dr. Hernandez.  Everyone was unsure of how to prepare themselves.  Would we be getting any bad news today?  Would the information be clear?  Should we be worried?  We settled our hearts a bit by listening to a Tim Keller sermon on the way down.  He talked about God's covenant with His people, and his words were like balm to my restless soul.

My appointment began with a mammogram, and it was strikingly similar to my very first appointment back in February.  The same radiologist that had delivered the original devastating news was even there to read my report today (although, sadly, I didn't get to talk to her today).  My next stop was the meeting with Dr. Hernandez.

Again, none of us was sure of what to expect.  We knew that we would probably leave without all of our questions answered.  But we weren't even sure of the questions we would ask when given the opportunity.  We were trusting that God would be sovereign over the meeting and that we would leave with the information that we needed to take the next step.

As usual, Dr. Hernandez's bedside manner was wonderful, as was her knowledge.  I think it can be so difficult for doctors (surgeons, in particular) to convey and explain medical information at a level that makes sense to a lay person.  They see these things every day and have such an understanding and skill set in their field.  For me, when the cancer talk begins, I feel like time stands still.  I hear words, but I really have no idea of what to do with them or how to process any of them.  Dr. Hernandez explained everything, we all asked a few questions, and it was over.  I kept thinking that I needed to ask more questions, but I was unable to even formulate my thoughts into words.

We scheduled my surgery...July 14th...and we went home.  Most of the information we received seemed good; but for some reason, my heart ached.  I wanted solid, clear-cut answers, and that was just not something we were handed today.  My head was spinning as we were greeted by our kids asking us a million questions and wanting to tell us about their time with Papaw.  My parents left, Bryan got ready to leave for work, and I wept.

I couldn't exactly explain why I cried.  There have been so many times during the past few months that I have watched people cry tears for me, and my eyes have remained dry.  I've handled some of those big things with a sense of peace and confidence, but it's the little things that seem to knock me off my feet.  Things that would seem routine sneak up on me and bring with them a flood of emotions when I least expect it.

After some rest (as much as could be experienced with 4 kids, right ;) and some time to get perspective, I feel a little better equipped to understand much of our conversation with the surgeon.  I'll try to convey that here as much as possible...

The WONDERFUL news is that the mammogram and the exam revealed that the tumor has shrank significantly with the chemo!!  The tumor was originally 5.5 cm, and what now appears on the mammogram is 4 cm of calcifications.  Whether or not any of that is cancer, the doctor could not answer.  If it had been 5 cm, she would have recommended a mastectomy, but because it was 4 cm, she would like to try a lumpectomy.  This would mean that she would go in and remove the area of calcifications and try to get clear borders surrounding them.  She would also remove lymph nodes, using a radioactive dye during the process to determine how many seemed questionable/necessary to remove.  Everything would be sent to pathology, and hopefully all would come back clean.  The next step (a month later) would be about 4-6 weeks of radiation, which would require daily short appointments with significantly fewer side effects.  Regardless of what we do, I will continue to receive an infusion of Herceptin every 3 weeks for a year.

My other option is to go ahead with a mastectomy, which would be a more difficult surgery and recovery.  Because of my cancer type and tumor grade, they decided that I needed to do chemotherapy before surgery.  Had I done surgery first, I would have needed a mastectomy.  But because the chemo seems to have been effective in shrinking the tumor, it is now most likely not a necessity.

During the appointment, I kept thinking that a mastectomy seemed like the safer option in terms of removing all of the cancer.  I just want it to be gone, and I certainly don't want it to return!  In hindsight though, I think the doctor is trying to save me from going through a more difficult surgery and believes that radiation will be more effective at killing the remaining cancer (should there still be any after surgery).  With the lumpectomy, she is not sure she will be able to get all of the margins the first time and may have to go back in again.  But she would rather start with the least invasive method first and see if it will be effective.

The other thing I asked about was doing scans afterward to make sure there was no cancer anywhere else in my body.  Surprisingly, she said that we would not do more CT scans or a PET scan.  We would assume the best unless I develop any other symptoms.  This is where things get difficult for me, and I realize that the cancer road may be a long one.  From what I understand, you are not declared "cancer-free" for five years.  I haven't researched, nor have I talked about my prognosis with anyone really, not even my doctors.  I've never felt like it would be helpful to know those details.  Today, I realized that my trust in God's providence is not over when my chemo is done.  It's not over when they wheel me out of surgery.  And it's not finished with my last radiation appointment and a final scan declaring me "cancer-free."  That's the plan that I wanted to hear today.  Let's get it all and go home...end of story.  And it very well may go just like that !  But I have no idea what my future looks like, nor do I have any control over the cells in my body.  As a good friend pointed out today, no one does.  None of us knows the number of our days.  During the days and weeks before my cancer diagnosis, I had no idea of what was brewing beneath the surface.  I would have considered myself totally healthy!  What gives me rest tonight is that God holds each of my days in His mighty hands.  He knows each cell in my body and what it's doing.  He knows all of my breaths.  And He's known it all before the beginning of time.

So after the haze of this crazy exhausting day, I can take the next step.  I don't have to worry about what's ahead of that one.  Grace will meet me there.  Only this day is before me, and I can choose live it fully and joyfully.  There is such freedom in that.  While I was resting this afternoon, I read my devotional, which included the following verse.  In light of everything, there could not have been more perfect words for me to see...

"So we do not lose heart.  Though our outer self is wasting away, our inner self is being renewed day by day.  For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen.  For the things that are seen are transient, but the things that are unseen are eternal."  (2 Corinthians 4:16-18)