WRITTEN BYMaria Maranga, DDS
It was a bright, humid midafternoon when I got the call - the call I had nearly forgotten that I was expecting. Almost in haste and annoyance, I heard the voice of the radiologist on the line.
Then I asked, “So is it atypical?”
She said no.
“Is it premature?”
She said no.
The last choice simply eluded me as she told me, “Well, actually you have breast cancer.”
In absolute disbelief my response was, “Oh.”
I suppose this wasn’t a usual response because she then said, “It sounds like you were expecting these results.”
Falling to the floor of my private office, I thought, What a stupid thing to say. Is any woman just waiting for this news? I continued to listen but couldn’t really hear her as my heart pounded away.
Next the radiologist described the cancer staging and what treatment options my surgeon would discuss with me.
I immediately thought, Is she kidding me? Why isn’t my surgeon requesting an in-office visit with my husband and me?
I quickly have a 1970s flashback of Marcus Welby, MD. The music is as dramatic as the words when he gives me the bad news. Just as the commercial interrupts Dr. Welby, so does my assistant, Tina, interrupt me. I shrug her away as she tells me patient Carol S. isn’t getting numb again. I suddenly leave the 1970s and zoom back to 2004.
2004. It was supposed to have been our big year. I worked extra hard that year as my husband and I built our family dream house.
“How much time is all of this going to take?” I asked the radiologist.
She directed me to speak with my surgeon.
Ah, my surgeon! I’d only used her to aspirate my breast cysts with a device that looks like a footlong turkey baster. As I cried in an unoccupied operatory, I finally hung up and made the traditional “I have breast cancer” calls to my husband, sister, etc. Tina told me that my 12-year-old son Philip heard me crying. I forgot he was in the office doing clerical work for us. Carol S. offered to reschedule after getting the news and immediately the flurry began. [I don’t know why or how, but soon after my diagnosis everyone called or stopped by. People I didn’t even know suddenly embraced me with something out of a scene from that Ya Ya Sisterhood movie.]
We cancelled the remaining patients and Tina drove Philip home because I couldn’t tell him right then. On my way home my breast surgeon called my cell phone and engaged me in an unemotional conversation similar to a hair stylist offering to redo a bad perm or color mishap. I agreed at Exit 62 of the expressway to schedule a lumpectomy in three weeks. The last 10 exits seemed impossible to get past. I cried, I stopped, I cried again. I got a phone call from my friend who already had “googled” my type of carcinoma. I didn’t believe that I had a good prognosis. I couldn’t believe anything right then.
At last I was home! My husband (a physician assistant/college professor) met me in the driveway. We had company that night and discussed treatment options with everyone.
The next morning was the Friday of Labor Day weekend. My sister and I decided not to tell our parents until they returned from their weekend trip. By profession I’m an endodontist. I practice four-and-a-half days a week and teach a half-day in the postgraduate division at Stony Brook Dental School on Long Island in New York. I left the big city glitz many years ago to take over a small practice in an obscure and semirural farming town. Still in the classic “denial stage,” I looked at my appointment book and thought, This is my busy season; I can’t take off any time right now. My immediate referral community is made up of “retiree snowbirds.” At that time of the year they race to have all of their dental work completed ASAP! Snowbirds ... they are a funny breed. I often say to them, “What’s the big rush to get to Florida? Does it really matter if you get to the $9.95 buffet on a Tuesday instead of a Friday?” I now understand their urgency. It’s all about beating mortality - a race for which I did not train.
I quickly put the cancer saga aside in order to deal with the day’s schedule. I tried to concentrate but became easily distracted. Many endodontists I know suffer from either carpal tunnel syndrome or visual problems associated with microscope usage. However, here I was being betrayed by my breasts. Those little size A cups of nothing were now spilling over in poison. I always thought that I was lucky to be a small-chested dentist. Many friends complain about chest and back pain related to oversized breasts or poorly designed bras. I got to wear stretchy “training bras” - the kind you first get on that magical day when your mom decides, “It is time.”
Finally the day ended, and Tina and I discussed what needed to be done. I decided to take a leave of absence from teaching. We’d use that extra time to complete as many patients as possible. We would also work additional Saturdays that month. I told Tina that I planned not to tell my patients or referrers. She disagreed but gave me her support and confidence. We both were almost in tears. It was similar to a Girl Scout pledge, but this badge of courage wouldn’t be easy to attain. I tried not to think about the potential of becoming disabled. I could never teach full-time - I’m too overpowering for that. I would train myself to access and instrument canals with my brain if necessary! I would give up surgical cases and bring them to the dental school. Besides, I often disliked suturing anyway.
We began reviewing charts of patients who never returned after their emergency visit. I began to feel like the female character in Shirley Jackson’s “The Lottery.” In this short story the woman wanted to clean up her home before meeting her unsuspecting fate. She cleaned her dishes ... and Tina and I cleaned out the records. I now became obsessed with new-patient emergencies. They must come over today ... right now! I tried to calculate which cases I could and couldn’t do surgically without causing a raised eyebrow. Those that I do now take longer to suture. I over-examined each flap design. I secretly hoped my suture lines would heal as well. I also began questioning in depth every single new patient’s medical history. If they circled cancer, I told them a friend was just diagnosed. I still refused to give up my cover. This small town embraced their only female doctor with much excitement; I couldn’t disappoint them with this illness.
I decided to see my gynecologist. If I needed breast surgery, I wanted to be sure that the rest of my female organs didn’t betray me too. My doctor insisted that I go for a second opinion at Memorial Sloan Kettering in Manhattan. At first I resisted, but then I remembered forcing my father to go for a second opinion for an ocular tumor. My husband and I went, and there was no turning back. Equipped with an overload of information about my type of carcinoma, I decided this was where I needed to be.
With the help of my new breast surgeon, I decided on a full mastectomy. My inner Catholic school conscience woke up and screamed, You can’t take off that much time! My family has always had a hard time convincing me to take a vacation. But I didn’t care for these reasons: #1 I have young children and #2 I have young children. I suddenly was not afraid of missing days of work. I needed to make a full recovery for them. I couldn’t pretend to put a small bandage on this problem and only hope for the best. I needed to control as many variables as possible. It became clear to me that I had to tell people. In fact, I must tell them. I started out slowly until Carol M. came in (not to be confused with the Carol S. who couldn’t get numb). I don’t usually review the medical histories of six-month follow-up patients in great detail. But this time I did. Carol, a woman in her 60s, had a “pink ribbon” tattoo on her ankle. Sheepishly I asked, “Is it for you or a relative?” She said, “I’m a six-year survivor.” I took a deep breath and blurted out, “I’m a future survivor.” She stared at me and in one orchestrated move she swooped me up to her missing bosom and we cried.
It was the longest cry I had had up to that point. The release of frustration forced me to confront my fears of losing referrers. I decided to call my older lady/patient Joan M., a local business owner. She knew most of my referrers from the Rotary Club. I confided my illness to her. She practically laughed at me for worrying about “something so dumb” as losing business. I explained to her that the nature of my practice is emergency-based. No one wakes up one morning and decides, Yes, I’m going to have a root canal today. You can put off getting a crown for a few weeks but not this. Joan agreed but added that my reputation was already solid.
She said, “So what if they refer elsewhere? Some may come back, but if not, who needs them anyway?”
I love her!
Geared with confidence, I confronted my next hurdle. I had three benign tumors in my left breast, which I was told would have a 33 percent chance of turning malignant in five years. It had to go! I’m a left-handed endodontist, and I couldn’t take this risk. Reasons? #1 I have young children and #2 I have young children. Even if I survived a reoccurrence, I would still need to work. I convinced myself of a double mastectomy. Upon discussing it with my gynecologist, he disagreed with my decision and told my husband and me that he would protect me for the next five years. “I’ll make sure of it,” he said. He planned to biopsy those three benign tumors every six months for five years. I thought he was crazy. With my personality, I would never stop worrying at the beginning of the sixth month. I could never tolerate such incompleteness. The idea of being poked every six months was disturbing to me. The doctor also mentioned that he would biopsy my gyn area as well every six months in his office. I began to feel light-headed. A poke here, a poke there, here a poke, there a poke, everywhere a poke poke! I needed this insanity to end.
I began to call my referrers. To my surprise, all were very positive and were themselves comforted by my attitude. I revisited my breast surgeon and handpicked my reconstructive/plastic surgeon. I did numerous strength-training exercises presurgery. I did so many chest curls that I felt as if I were burning off those dreadful breasts. Psychologists have cute names for this type of presurgery behavior.
Everything at work was in place. Tina and I completed as many patients as possible. Every patient and every doctor was instructed in the “what to do” scenario if needed. Other endodontists and oral surgeons were ready to step in if necessary. I convinced my surgeons and myself that I would only need two weeks to recover instead of the traditional five to six weeks. In my mind, this was the only acceptable time frame my referrers could handle. I knew this because I know their species.
Like an athlete preparing for a meet, I too prepared. I overate on protein and did my final workout. This time I cried. Would I be able to do these moves in a few weeks? A few months? What restrictions had the doctors forgotten to mention? The night before, I had some doubt about my double mastectomy. I calmly talked to my husband as if I were conferring on a wallpaper selection.
He admitted, “I don’t know if this is the right decision.”
I prayed to my deceased grandmother to give me a sign, but I remained alone. In the morning, the waiting area for surgery was filled with an eeriness. Family members crowded the patients as the surgical nurse called out each name. The drama was too intense for me, so I simply rose and walked quickly toward the surgical suite. Psychologists have cute names for this behavior too.
Once it was over, I tried to move my arms. I thought to myself that two weeks was going to be hard. Several hours later, Tina called. The office survived and so would I. My lymph nodes were all clean, so I wouldn’t need any chemotherapy.
After four days I went home to my adoring children, Philip, 12, and Gabriella, 8. I felt relieved and safe in my home, yet more hurdles awaited me.
After seven days, my breast surgeon called and said, “Are you sitting down?”
Of course I am! There were four deeply positioned chest tubes sutured into my underarms. The surgeon told me that because of my decision to take the left breast, I had saved my own life. Apparently the left breast had cancer growth in it that lay too close to the chest wall for the MRI to pick up. Even mammography scans would miss it for another three years. Maybe my grandmother did give me a sign! I looked up at the banner that my husband and children had hung across from my bed: We Love You, Mommy. I love you guys too, I whispered to myself. After all, they were the #1 and #2 reasons for my treatment decisions. I thought of my gynecologist. I couldn’t wait to tell him a thing or two or three. He would have biopsied the wrong site for the next five years. [By the way, I had a totally different type of carcinoma in the left breast.]
I tried hard to forget this and forged ahead to my last hurdle. Gabriella had a hard time this year as well. The doctors warned us that little girls between 7 and 12 sometimes don’t react favorably. Not my Gabriella! I thought. Guess again. The scars of other female-oriented cancers remain inside of the body. The scars of breast cancer are front and center. Gabriella was typically curious about why they needed to come off and where the nipples were being kept. I needed to lie about this one. I told her that they were in a special freezer at the hospital with my name on them. She was very upset that it was sometimes painful if she hugged me too tight.
Normally the reconstruction/plastic surgery portion of treatment is a pleasure for patients. Gabriella hated the hardness of the tissue expanders and checked them weekly when I returned home from the doctor’s office. She became frightened beyond reason and cried for me to get my old “boobies” back. We actually took her with us at 4 a.m. the morning of my implant surgery. She was unable to sleep over at my parents’ house and wouldn’t travel far from home in a car. Bellyaches appeared. Psychologists also have names for this problem, all of which I won’t forget. Our pediatrician thought her new diet was a cause. [I had switched her to organic milk and healthier foods to lower her own future risk of getting breast cancer.] When the diet wasn’t the answer, we eventually took her to a child therapist.
With two surgeries down and one to go at that point, we were being very careful with Gabriella. The night before my nipple reconstruction consultation was again hard for her. She wanted to share her own nipples with me. If only it were that simple. However, we are recently encouraged by her present progress. If I had to make the decisions again knowing how all this would affect Gabriella, I wouldn’t change anything. Her doctor assures us that “kids bounce back.” I may not have been that fortunate three to five years from now. Again, the reasons for the treatment plan were #1 I have young children and #2 I have young children. Hopefully with proper follow-up I, too, can retire as a snowbird. I’ll then ask Gabriella to accompany me to my own root canal appointment - a whole week ahead of the $9.95 buffet on Tuesdays. After all, it is all about beating mortality. ■
This article is dedicated to three patients/friends: Carol, a six-year survivor; Mary Jane, a future survivor; and Joan, now deceased.
Maria Maranga, DDS
Dr. Maranga maintains a solo endodontic practice in Aquebogue, N.Y. She is currently an assistant clinical professor in the postgraduate endodontic division at the School of Dental Medicine at S.U.N.Y. at Stony Brook. You may contact Dr. Maranga at [email protected].