Chapter 2 Diagnosis
The waiting room was nearly empty when Stella walked in at 9:25 am. She checked in with the nurse and sat down to wait. "Hurry up! Please hurry up." She thought. Moments later she was sitting on an examination table wearing a paper vest instead of her bra and sweater. Stella felt for the lump again secretly hoping that somehow it was all a big mistake and she could go home and forget the whole thing. No luck, it was still there.
The door to the room slid open and Dr. Phillips entered the room. Sarah Phillips was a very straight forward person who wasted no time on chatter and Stella admired that. "Okay Stella, let's see what's going on with you. You said you felt something in your left breast?" She nodded. Stella laid back and as the examination got underway the questions continued. Do you do a monthly self-exam? Again Stella nodded. "Good." Her hands stopped. "Is this what you felt?" Tears sprung in her eyes as she nodded her head once more. Did you check the right side? Stella's eyes got huge. "She shook her head and said in a panicky voice, "Oh, God, no, I mean… I'm not sure… I stopped… "Calm down, it's okay I'll check you out completely, try to relax." Dr. Phillips said as she continued. Her voice was reassuring but every muscle in Stella's body was tense. A moment later it was over. "Okay, Stella, you can get up and get dressed. We'll meet in my office to talk." Before Stella could say anything the doctor was gone.
The wall of Sarah Phillip's office was covered with photos of smiling women and their families. Stella's picture wasn't there. She didn't have any children and up to this moment no serious health issues that weren't job related. She sat down at a small table in the corner where the doctor was seated. Dr. Phillips reached across the table and took Stella's hands in hers. "Stella, I know this has been a very difficult morning for you and you must be very frightened. You did the right thing by coming in. During the examination I did not detect anything abnormal in your right breast, but," she paused and squeezed Stella's hand as she continued, "there is a mass in your left breast." Those words felt like a punch to the stomach. This was now real. Stella nodded and looked down into her lap not wanting to show her fear. "Stella, look at me." No response. "Come on look at me." She said in slightly more forceful tone. Stella looked up and their eyes met. She continued. "I know those are the words every woman dreads hearing and I'm not going to tell you not to worry because that's impossible." She smiled trying to break the tension. What we have to do now is determine if it is a cyst or something more serious. Okay?" Stella nodded again, not yet sure of her voice. As she was about to continue she glanced down at the folder Stella had placed on the table. "I see you have been putting your research skills to use. May I see?" The doctor looked over the contents. "This is very thorough. You have data from some excellent sources." Have you read all of this? Her professional demeanor was kicking in and while still sniffling and shaky she responded, "Uh, yes, most of it." "I should have known you would come in prepared. That's good. You must know then that this could be many things. I need you to take a scientific approach. Evaluate the evidence as it comes in and don't jump to any conclusions. "Stella," she said in a very caring voice, "I know you and understand how difficult it must be for you to cope with something over which you have no control. The best way to deal with this is to focus on one step at a time. First we diagnose, and then we treat. Alright?
"Yes, I understand." She said, dabbing her eyes and trying her best to appear composed.
"Okay then. My nurse is trying to schedule you for a mammogram and ultrasound. The results of those scans will give us a better idea of what we are dealing with. You are free the rest of the day aren't you?
"Today? Stella seemed surprised, worried, and relieved at the same time. She wanted it done quickly but not sure she was ready for the results. You mean both tests could be done today?"
"It's possible. The imaging center we use often has openings on short notice. Now your records indicate you were here not quite 10 weeks ago for your annual check up and nothing was out of the ordinary at that time. Is that correct?"
"Yes, Stella replied, everything was fine."
"And nothing has changed in your physical condition until now?"
"That's right."
"When did you last perform your self exam?"
"I do it in the shower on the 16th of each month. The date is circled in pink on my calendar."
"That's a good plan; I wish more of my patients had a routine like that."
The questions continued for a few minutes and as they were wrapping up the nurse came in with an appointment card. "Ms. Bonasera, would you be able to make a 12:30 pm appointment today?" "Yes, I can make that, what is the address?"
The next few minutes were spent going over possibilities and options. While they wouldn't have the results until the end of the day, Stella realized she would likely have to have a biopsy. Dr. Phillips gave her more handouts on what to expect and prepared a list of surgeons for Stella to review. Biopsy, surgeons, cancer, her mind was spinning. This is getting to be too much.
"Stella, Stella are you all right?" Dr. Phillips said and hearing her name seemed to bring her back. "Oh, uh, yes, I'm fine; this is just so much to take in."
"I understand, believe me. This is a tremendous shock to your system. You got up this morning and everything was fine, and in an instant your whole world came to a stop. It is going to take a while to sink in but we can't wait for you to accept this. We need to move quickly. Now I've arranged to have the results of your tests sent to me immediately. Can you come back around 4:00 pm? By then we'll know what to do next. She could see the fear in her patient's face. "Try to think positive Stella," she said smiling.
The last thing Stella was feeling was positive. "I'll see you at 4:00" she said nervously. "Thanks' Doc." With those words Stella shook Sarah's hand and headed out the door.
"Stella Bonsera?" the nurse called out to a waiting room full of people. It was 12:35 pm. Stella had arrived early to fill out the paperwork and was so immersed in the handouts Dr. Phillips had given her she almost didn't hear her name being called. She closed the folder and followed the nurse into a small room that seemed more like it belonged in a home than in a clinic. It was painted in soft hues with pretty watercolor prints on the walls and fresh flowers on the table. A blond, middle aged woman who'd been sitting at a desk rose to greet her. "Good afternoon Ms. Bonasera, my name is Martha. I'll be conducting your mammogram and ultrasound today. If you have any questions or I can do anything to make this easier for you please let me know. I just need to confirm a few things in your file and then we can get started." Once the questions were answered Martha continued.
"May I call you Stella?"
"Of course."
"Okay, Stella, We'll do the mammogram first. Remove your sweater, bra and any jewelry you have on and place everything in this" she said handing her a plastic bag. "Then put on one of the robes over there." she pointed to a pile of folded terry cloth robes in the corner. "When you're ready gather your things and meet me in the next room.
Stella undressed quickly and reached for one of the robes. It was warm. "They keep them heated, nice touch," she thought as she turned and entered the examination room. It had the same décor as the outer office and Stella realized it was meant to put the patients at ease, as if anything could make this experience easy. "Smash and flash", that's what Stella had jokingly called mammograms. They were always painful and nerve-wracking but up until today they had just been something to endure every couple of years. She blinked back tears as Martha positioned the machine. "Grab the handle, hold your breath … okay let go." The ritual is repeated several more times and then, thankfully it's over.
"Alright Stella, we're all done here. You did very well. You okay?" Stella nodded. Martha smiled. "Good, well one down, one to go. You can put your robe on and when you're ready meet me in the next room for your ultrasound." With that, Martha disappeared behind yet another door and Stella followed quickly.
Martha tried to engage Stella in small talk to ease the tension as she turned on the equipment and smoothed the warm gel over Stella's breast.
As the transducer moved over her skin images began showing up on the screen. Stella wanted to look but was terrified of what she might see. Martha made the decision for her.
"Stella, I know you want to look but I need you to be very still so that I can get the best images possible. Why don't you close your eyes, and try to relax."
Fifteen minutes later it was over. "Okay Stella, we're all done." Stella opened her eyes and sat up. Martha smiled and put her hand on Stella's shoulder.
"You can get dressed and leave through that door when you're ready," she said pointing to a door to the left. "I'll get the images to the radiologist immediately so that he can forward them to your doctor with his findings. We understand how important it is to our patients that the results are read immediately." She smiled and put her hand on Stella's shoulder. Stella managed a weak smile as she reached for the bag with her clothing. She wanted desperately for Martha to tell her what she had seen during the scan but she knew as a technician Martha would not be allowed to speculate. Stella would have to wait a while longer.
"Thank you for everything, Martha, you made this as easy as it could be." "You're welcome Stella, take care."
Stella dressed quickly and exited the clinic. It was 1:30 pm and her appointment with Dr. Phillips wasn't for another 2 1/2 hours. Her stomach growled and she realized that she'd had almost nothing to eat all day. After walking for a bit she stopped at a small café for a salad and sandwich and then walked to a Barnes & Noble Booksellers to kill time. Stella entered the store and stopped almost immediately as her eyes fell upon a large display near the main counter. It was a collection of books about breast cancer in honor of National Breast Cancer Awareness month. "Oh God", she whispered to herself. "Is this an omen? I'm not going to look, not yet because it might be nothing." Trying to keep positive and needing a distraction she moved toward the magazine area. As hard as she tried, her eyes kept wandering back to the front display so she moved to the back of the store where the music and movies were located. Finally she gave up her internal struggle and returned to the display. The time passed quickly as she leafed through titles like; Just get me Through This, Bosom buddies: lessons and laughter on breast health and cancer, Uplift: Secrets from the Sisterhood of Breast Cancer Survivors, and First You Cry. She was surprised to see titles for husbands and friends. Most of them talked about the importance of offering love and support. Who would I lean on? One name came to mind, Mac. He'd want to know. He'd be there for me. In fact he'd be upset if I didn't tell him. Well I guess we'll cross that bridge soon enough, she thought. Looking at here watch it was time to go. She left without purchasing anything and walked back to Dr. Phillips office.
Stella did not have to wait once she checked in. The nurse escorted her to Dr. Phillip's office. "Come on in Stella, I have your scans. Let's go over them." She pushed the power button of the screen on the table and the image appeared. Stella didn't need any help in seeing the source of her anxiety. There was a bright spot that clearly didn't belong. "As you can see this is what we are concerned about." Dr. Phillips said as she moved her pen to the area of the screen. She clicked the mouse and the next image appeared. "It appears to be very dense so it's not likely to be a cyst." The sound of another click and the ultrasound images popped up. "Here we see it again. It appears to be about 2 centimeters. It's low in the breast which is good but it looks close to the chest wall so we need to act quickly." Dr. Phillips looked over to Stella. "Stella, are you alright? Do you understand?" Stella was speechless. Her eyes were fixed on the screen. She reached up with her left hand to touch it as if to make it real. At the same time she moved her right hand over to touch her left breast. It didn't seem possible that the lump displayed on the screen could really be inside her. But it was. Tears were forming in the corners of her eyes and she began to shake. "Stella, look at me." Dr. Phillips pushed the screen's power button off to force her to look away from the screen. "We still don't know this is cancerous." She reached for Stella's right hand and held it firmly. "We need to schedule you for a biopsy. Do you want me to make the arrangements?" Forced back to reality Stella transitioned into detective mode. She took a deep breath and brushed away the tears. "Biopsy right, okay, when and where?" "I'll send your scans to Dr. Jobe today. He'll suggest which type of biopsy procedure would be best. You have information in your file on the various types. Do you need me to explain them to you? She shook her head. "I think he'll probably lean towards either the core needle or the vacuum assisted procedure. It all depends on how he feels about the location. Either way it will be done in his office under local anesthesia. It takes about an hour and you can go back to work right after."
"Stella, I know this isn't what you had hoped to hear. Please try to remain positive. It still may be nothing. If on the other hand it is cancer, you've got a lot of things in your favor. We caught this early, you're young and in excellent health. Survival rates for early stages are above 90%." Stella sighed heavily and nodded. "Okay, I'll just have to take this one day at a time. What do I do now?" Well, I assume you want the first available appointment?" "Yes." Okay then I'll call you tomorrow morning as soon as I know. Stella stood up to leave. Dr. Phillips handed her he research folder with some additional information and gently placed her hand on Stella's arm. "Stay strong Stella." "I'm trying." She replied. After thanking her Stella stepped out of the office and headed home.
As she walked down the street she thought about what a difference 24 hours makes. This time yesterday her biggest concern was the large pile of paperwork on her desk. Mac had been bugging her about getting it cleared up. Now she faced cancer, cancer! No, don't do this she thought. Not yet. We don't know that yet. Think positive, in fact try not to think about it at all, at least until we know. God what am I going to do? This is going to drive me crazy, she thought.
Stella entered her apartment, dropped the folder on the table in the hall and went straight back to her bedroom. She changed into sweats and curled up on the bed. All she wanted to do was forget. Forget the shower, the research, Dr. Phillips, Martha, everything. Sleep and maybe she would wake up and it would all be just a bad dream. She closed her eyes and after a long while and a fresh round of tears fell into a fitful sleep.
The clock read 7:00 pm. Mac's day had been insanely busy. His team had processed two new crime scenes with multiple victims and he'd testified in court. There were half a dozen messages he hadn't answered and a pile of paperwork on his desk but none of that mattered. He had only person on his mind - Stella. He'd almost called three different times during the day but stopped knowing what she needed most was rest. Still, he couldn't shake the feeling that something wasn't right. Deciding he was not going to get anything done until he was sure she was okay he closed the folder on his desk and stood up to leave.
Mac stood just outside Stella's apartment with a container of chicken soup from the deli down the street in one hand and her apartment key in the other. They had long ago given each other keys in case of emergency. He thought about knocking but if she was in bed he didn't want her getting up. He called her cell but it went straight to voice mail. As he opened the door he called her name softly so as not to startle her. Stella? No answer. The apartment was dark, no lights on anywhere. "Stell?" He called a little louder. Silence. He turned on the hall light and went into the kitchen. It was clean, no dirty dishes, nothing out of place. He put the soup down and headed toward the back of the apartment. The door to her bedroom was ajar. He peeked in and saw her on curled up on the bed. Mac breathed a sigh of relief. She was here. She was safe. He could see her chest rise and fall with each breath. He sat down next to her and studied her face as placed his hand on her forehead. It was cool but there were tear tracks on her cheeks and the pillow was damp. She'd been crying.
"Stella" he said while gently touching her shoulder. Stella, it's Mac. She opened her eyes and tried to get her bearings. This can't be right, my bedroom and Mac's voice. "Mac, what are you doing here?" She started to get up. He put his hands on her shoulders to stop her. "No stay where you are, I was worried about you and wanted to make sure you were alright. How are you feeling?" In a millisecond it all came back to her, the entire day's events. She put her hand up to her forehead and closed her eyes for a minute before responding. "Um, I'm okay, just a headache now. It was true she did have a headache. "You didn't have to come over." "Remember what you once told me Stell? It's what we do; we take care of each other. You're my partner." She smiled and put out her hand. "Help me up will you?" "Are you sure you want to get up?" Yeah I'm not sleepy anymore." "We'll I brought some soup if you think you could eat something." "Chicken noodle?" He nodded. "Actually that sounds pretty good. Why don't you get it ready while I freshen up." "Sounds like a plan." He said as he helped her to her feet. He could see something was troubling her and his nagging worry for her returned. Whatever it was he hoped she'd let him help her. As she moved toward the bathroom all she could think of was when she should tell him and how?
Mac left the bedroom and headed back towards the kitchen. His eyes spied a loose paper on the floor near the table. He picked it up and opened the folder to put it back when he noticed the title. He felt his heart sink as his mind processed the words. "What to do to prepare for your breast biopsy." Oh God, not Stella, please. Now he understood. His nagging worry just turned into full fledged fear. He would be there for her. He'd see her through it. Mac went to the kitchen and began preparing the meal wondering who would speak of it first? Will she tell me or do I tell her I know?