My Yellow Envelope

I stood looking at the giant yellow envelope. It made me uneasy. It is so big that I can’t find anywhere to keep it permanently. I have to move it almost every day.

It is a constant reminder of my diagnosis. It contains copies of my imperfect mammogram, biopsies and MRI.

My hand shakes a little as I reach down and pick it up.

Today I see the surgeon.

I gather the yellow envelope and both my binders. I take a deep breath and try not to think too far ahead.

I have an early morning appointment and the waiting room is empty when we arrive. I work through the pile of paperwork that I have to fill out and try to hand off the offending yellow envelope to the receptionist but she tells me to hold it for the doctor.

All too quickly we are seated in the doctor’s office waiting for her. It is her personal office and not a treatment room. I feel comforted by the things I see, several binders from breast cancer conferences and recognition as a top doctor by Phoenix Magazine and America’s Top Physicians. All this on top of a friend’s glowing recommendation made me breathe a little easier.

I like her energy as soon as she comes into the room. She has a friendly face with compassionate eyes and is very patient with my questions. I forget about the envelope in my lap and listen intently to her describing DCIS and my treatment options. She regularly reminds me that this is very early stage and that I do not need to panic.

But she also makes sure I understand what grade 3 means and spells out the possibilities of this becoming more serious. She asks if I have any family history of breast cancer. I tell her no.

As she explains about mastectomy and lumpectomy I again feel like someone has punched me in the stomach. This is worse than reading the book.

The standard treatment for my situation would be lumpectomy and radiation.

My research had told me as much but hearing it from a real live doctor that would actually be doing the cutting….it was surreal.

We followed her into the treatment room. I remembered the oversized yellow envelope that I had been told so many times to bring and held it out to her. She told me that everything was in the reports she had already seen but let’s have a look.

As an anatomy geek I have always loved looking at films. I’ve seen my husband’s back in an MRI, my mother-in-law’s lung and brain films, countless broken bone x-rays, torn ligaments and even color pictures of my own ovaries and intestines from my appendix surgery. I used to keep those color pictures on a bulletin board in my room until my husband made me take them down.

I find the human body fascinating and love any chance I get to learn more about it.

But that day I didn’t feel the same excitement.

It seemed like there was no end to that yellow envelope. She just kept pulling out films, holding them up to the lightbox and pointing out little specs. I saw the clips that were left in from the biopsies. She reminded me that she would remove the one from my left breast.

I started to feel lightheaded and I think the color drained out of my face because she glanced at me, said we had seen enough and turned off the lightbox.

She pulled out a paper top for me to put on as she stepped out of the room. I looked at it with disdain….it was a dull pink.

Feeling vulnerable in a paper shirt I thought about what she had told me. The MRI showed a 5.5cm area of concern. I asked my husband about the math and he said it was a little over 2”.

I looked down at my breast. In my mind there doesn’t seem to be enough real estate there to be taking 2” out. And that 2” doesn’t include the extra tissue around the DCIS that needs to come out to get clear margins.

I feel my eyes well up. Will I be disfigured? Unattractive? Less of a woman?

Rationally I don’t think that will be the case but my mind seems to touch on every scenario. I tell myself to just breathe.

The doctor returns and does a quick exam. She tells me I am lucky that the surgery will be on my bigger breast.

I don’t feel lucky.

She finds nothing unusual and quickly I am dressed again in my own shirt.

With my file in her hand she asks, “When do you want to do surgery? I do procedures on Monday, Wednesday and Friday.”

Even before I had the first mammogram I had a premonition that I would be having surgery. Because a very close family member was already scheduled for surgery I blew it off, thinking my mind was just superimposing myself on that situation.

I really like this doctor and I know that if I have surgery she will be the one but I haven’t yet come to terms with having surgery.

And I don’t have all the facts yet.

“I want to meet with the oncologist and radiologist before I make a decision about surgery”, I replied.

She was surprised. Normally a patient doesn’t meet the radiologist until they have had surgery and then meets the oncologist after having been radiated.

That’s not how I’m going to do it. How can I make an informed decision about the first step in my treatment if I don’t know all the steps and all the players?

The medical assistant is very pleasant as she gives me the referrals. She also feels compelled to ask if I am ready to schedule a surgery date. I tell her that I will get back with her after meeting with the other doctors.

I gather my binders, my big yellow envelope and the little slip of paper that spells out the names for the next steps on my journey.

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