16th December. It’s my birthday. I have missed my period. Okay, let me clarify – my tubes have been laser-singed, hacked and chopped after my son was born. No chance.
My breasts feel tender, maybe as a side-effect. Unrelated activity: Someone sends me a breast self-examination video. Some coincidences are willed high above.
I do a breast-self-examination. Just like that.
Tiny. Hard as a marble. Painless. Can’t see it from the surface. But can feel it.
7 days later.
Damn! Lump’s still there. Right breast. Definitely needs a check. I worry. For two minutes. Then, forget. Remember again on new-years-eve.
Happy New Year sounds trailing off. Photos of new-year’s eve parties making their way to facebook. Resolutions. Resolution-mocking memes. Time to get back to work.
Sharp business jacket. Yellow. My favourite colour. On the way to Majumdar Shaw Cancer Center. Getting a doc’s opinion. Hope it doesn’t take long.
10:00 am. The watch glints in the slant of the 9:00 a.m. sun through the car’s window.
How long will the check-up take? Office by 1:00? Impatient. Tap my fingers on the arm rest.
Radio plays. Chittiyan Kalayian Re. Meri white kalayian re. I make mental checklists. My hobby.
Need waxing. Need to lose weight. Need a new maroon lipstick.
Christmas tree needs to be packed. Mistletoe removed. RSVP to that brunch pending. Kids’ uniforms and bags checked. Daughter’s 13th birthday coming up in three weeks. Theme. Theme. Theme? Some teenage popstar theme? Damn! I am clueless.
Majumdar Shaw Cancer Center
6th floor. Spacious. Elegant décor. Posters about how small and insignificant cancer is and how indomitable human spirit it. Yaah..yaah…blah blah. I hate inspirational posters.
Not many people in the waiting lounge. We wait.
Could it be cancer? …….Naaah! No-one in the family has it. Some stupid fleshy lump, I guess. I need to lose weight. That’s it.
We are called in.
Dr Archana Sanjiva Shetty. Young and pretty. Fresh like a daisy. Examines me.
There is a lump. Yes, I can feel it. But, it could mean many things. Get an ultrasound. We will see then. She smiles.
I smile. Business-like.
Ultrasound wait. Lots of people. Stomach churns a little. Could it be c_ _ _ _ _ _ ? Hush! Bad word ! Bad word. Don’t even think.
My name is announced. I don that silly robe which could put the entire nudist colony to shame. Cold blobs of gel are squirted on the breast. The hard, rude probe follows. An indifferent sonographer. A staring nurse. About four minutes of snooping around mammary-land.
Okay – it looks like cancer only. Phlegmatic, indolent announcement. Loud. Care-a-damn loud.
What? WHAT? What did she say? My ears feel like a throat jammed with peanut butter.
I stare. I start shivering. I don’t know why. But I shiver.
I could have cried. Maybe, yelled. Or, shrieked. Held her by her shoulders and done a filmy, ‘nahin,nahin, nahin… keh do yeh jhoot hai?’ So many options.
But I choose to shiver. Violently. The voices in the background grind into an invisible mixie.
Now, don’t cry-vry here. Only biopsy can tell if it is cancer. Go get a mammogram and then see Dr Shetty again.
She dumps some paper towels on me.
Not sure how but I manage to get back into the yellow jacket. I walk out. My husband waits in the distance. He looks blurry.
I walk towards him. Still shivering. A shuddering washing machine on wheels.
He is looking at me.
I glide like Richie Rich’s robotic maid, Irona. A shivering Irona. I say, weakly,
She says it looks like _ _ (I just can’t say the C-word) uh…. she says it does not look good.
I clutch his arm with cold, Venky’s frozen-chicken fingers.
My legs are giving way now.
He holds me firmly. Does not say anything. He has been like that only for the 20 years that I have known him.
He walks me to the Mammogram center. My heart is silent. Very quiet. No pounding. No hammering. Just quiet. Sinking. Sinking very deep. My legs have grown new joints. They bend every which way. He holds me from under my arms and helps me walk. Must be tough: we both weigh approximately the same. We don’t talk.
Deep-breathe. Deep-breathe. He tells me.
I breathe noisily through the shivers.
We wait on those rows of chairs. Chairs stuck together on a single long rod. People sitting on them joined by fate. It’s a long wait. How long? Don’t remember.
My turn comes. I can’t bear to go inside alone. Did not have a great experience the last time I went for an examination alone few minutes ago, did I?
I beg – let him come in with me. Please. Please.
Huh? She looks puzzled. She does not allow.
The test is short. She does not convey any verdict, thankfully. She hands the report. Jelly legs. School-bag –heavy heart. Back to 6th floor. Dr Shetty studies the reports. Kind face, I scan.
We need to do a biopsy. Can you come back at 2:00 pm?
Kind voice. Gentle. So soft. Like she might hurt me with the harsh ‘c’s and ‘d’s in her chosen sentence.
I finally cry. Fat tears. Spheri-fying from dazed eyes in rapid plops.
She holds my hand.
Even if it is cancer, it is totally treatable, Rachna. You will be fine.
Cancer? Totally treatable? That did not go together.
More plops. Husband holds my shoulders. Always been a shy guy. Can’t expect hugs. Awkward chiropractor is the best he can do.
We come home. To start back at 1:30 for the biopsy. Home looks different. Splintered frames. Why is it so quiet? Why so quiet? I splash water. I call a friend. I cry. I howl. She is too shocked to say anything sensible. I lie in my bed. I am shivering.
Shoulder-holder is beside me. He is quiet. He is holding my hand.
2:05 p.m. We are back at MSCC. Dr Shetty explains the procedure. Local anaesthetic shots. Gun-shot collection of samples. Am led to the Minor Procedure Room. A kind nurse is there. They handle me like China. The breakable one. Pokes and jabs. Not too unpleasant. I have a high threshold for pain. I don’t panic. That’s me.
Your report will be ready in three-four days.
The next few days stick together like badly-made sabudaana khichdi. Indistinguishable from each other. The world is looks faded as if washed in cheap detergent. I am in a daze. We pack in movies. Where has all the colour gone? Dinners. Distractions. Malls – the trusted panacea. We take our children along (12 and 8 years old). They don’t know anything. We don’t tell my parents. What to tell?
I make some phone calls now and then. To my sister. In-laws. My rakhi-brother. Friends. I cry. I howl. I laugh bitterly. Assurances pour in. Prayers. Some blame the doctors. The medical system. You are fine. They are doing all these tests-vests only to make money. Thieves. Should be jailed.
Then we discover Bi RADS on my report. My rating is 4 C. That means, chances that malignancy will be established in the biopsy are 80%. I cry again. Snot, tears, sweat. Loud wails. In the office conference room. With two friends. They cry too. We pray.
I await the imminent. It comes in four days. Dr Shetty holds my hand and assures me again:
It is totally treatable.
I don’t want waxing.
I don’t want to lose weight.
I don’t want a new maroon lipstick.
I just want to live.
Our last carefree photo before the diagnosis – December 30th, 2014, Ooty
The BIRADS acronym stands for Breast Imaging-Reporting and Data System which is a widely accepted risk assessment and quality assurance tool in mammography, ultrasound or MRI. Part of the initial implementation was to make the reporting of mammograms more standardised and comprehensible to the non-radiologist reading the report.
Category 1: Negative
There’s no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.
Category 2: Benign (non-cancerous) finding
This is also a negative mammogram result (there’s no sign of cancer), but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret the benign finding as suspicious. This finding is recorded in the mammogram report to help when comparing to future mammograms.
Category 3: Probably benign finding – Follow-up in a short time frame is suggested
The findings in this category have a very high chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it’s not proven benign, it’s helpful to see if the area in question does change over time.
Follow-up with repeat imaging is usually done in 6 months and regularly after that until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it still allows for early diagnosis.
Category 4: Suspicious abnormality – Biopsy should be considered
Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some doctors divide this category further:
- 4A: finding with a low suspicion of being cancer
- 4B: finding with an intermediate suspicion of being cancer
- 4C: finding of moderate concern of being cancer, but not as high as Category 5
Not all doctors use these subcategories.
Category 5: Highly suggestive of malignancy – Appropriate action should be taken
The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.
Category 6: Known biopsy-proven malignancy – Appropriate action should be taken
This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy. Mammograms may be used in this way to see how well the cancer is responding to treatment.
Next Week : # 2: My Surgery