Part 3: “This breast has gone to WAR!"

So I had to have two biopsies on my left breast, one for the spiculated mass and one for the architectural distortion. On the Monday afternoon two weeks after my suspicious mammogram, thanks again to repeated phone calls and pleas, I had an ultrasound-guided right side biopsy. I lay on a table with my left arm over my head as a plastic wand glided over my gel-moistened left breast. A very public encounter with a very private part, but at least that part of the procedure was painless.

The radiologist, Dr. Linden, told me they would choose an area, numb it with lidocaine, make a small incision in my skin, insert the biopsy needle, and then collect a sample from the tumor with a device that sounds like a staplegun. I imagined it with sharp, tiny pincers at its end, like a specially trained crayfish, clamping onto a bit of flesh, slicing it free of the surrounding tissue, then gripping it triumphantly during the withdrawal. They snapped it a few times so I wouldn’t be startled by the noise.

The biopsy needle bore is about as wide as a pastry tube nozzle, leaving you with a perfectly round entry scar. That’s why they need to create an incision. You can’t just jab it in. Dr. Linden incised and drove the needle in, then reconsidered.

“I think I want to try that from a different angle,” he said. To me or to the tech? Unclear. They swabbed the wand over me again.

I think I want you to get it over with, I thought. Actually, I think I wanted you to get it right the first time.

Dr. Linden made a new incision and slid the needle again. “Taking a sample,” he said, and the device snapped. “And another.” Snap snap. They also used the biopsy needle to deposit a few titanium “butterfly” markers near the spiculated mass. That’s what the nurse called them. I assume they’re shaped like butterflies; I didn’t get to see them before they were inserted.

After the biopsy, you need to have a mammogram to see if the markers are in the right place. I was allowed to sit up and shrug the gown onto both shoulders. I stood up to walk to the mammogram room, and I saw the sample container. It wasn’t a long, narrow test tube. It was rectangular, about an inch and a half long, maybe ¾ inch wide. Clear plastic, with something like an absorbent dish sponge at the end. Wisps of what looked like raw beef or tuna floated above the sponge in a viscous liquid. That’s what the inside of my breast looks like, I thought. Lean meat. I thought it was just a sack of fat. Or maybe that’s what the tumor looks like. A squiggle of meat, lapped in fat like a lamb chop.

Thanks to the multiple needle entry followed by a mammogram, my breast was bruised and tender before the mammogram-guided procedure that Friday.

For anyone who has never had a mammogram, I describe it like this:

Imagine the tenderest part of your inner thigh is placed between two large flat panes of glass. The panes are pushed together much closer than you would think physically possible. Next, you’re told to inhale and hold your breath until your eardrums rupture. Remarkably, when the panes finally separate, your flesh is not macerated into a bloody jelly like a victim of the medieval torture boot. There’s no permanent damage.

Sometimes I think about the novel Dune and the gom jabbar. Seeing my breast emerge intact and angrily pink from the mammogram machine seems just as miraculous as Paul Atreides withdrawing his hand and realizing it wasn’t burned to a crisp.

I dread my annual mammograms, but they’re not as bad as mammogram-guided biopsies. You’re not clamped quite as tightly for a biopsy, but they do stick your squeezed flesh with many needles. First several tiny lidocaine injections, which burn, ironically, as they squirt into you. The hipster anesthetic agent. Then a small incision and in slides the enormous biopsy needle, which you’re not supposed to feel; if you do, your breast is large and they haven’t numbed it sufficiently.

I’m not sure why they don’t numb you before they position you between the crushing panes of glass and slowly push them together much closer than you would think physically possible. Radiologists, take note: you could make mammograms easier on us and our breasts.

The procedure took place on a Friday afternoon. “Let me know if you feel anything,” said Dr. Dobbs, who, like Dr. Linden and many of the other radiologists I encountered in Manhattan (where the medical system’s cancer care flagship is located), was both youthful and male. I wondered if they were all breast men.

(Each biopsy is staffed by one doctor and several nurses, so I don’t remember the nurses’ names as well as the doctors’. I never met the Brooklyn radiologist who found my tumor on the mammogram, so I don’t know if he’s young, but he must have studied my mammogram really carefully and diligently to spot my tumor, so I think it’s safe to say he’s a breast man too.)

“We need to go in... pretty deep,” Dr. Dobbs said with a straight face, “so we might need to give you more lidocaine,” he warned me as they were pricking me with the painful anesthetic.

You’re enjoying this, you sadistic, horny little breast radiologist, I thought as he slid in the needle. Sliding so deep into my breast. But unlike Dr. Linden, Dr. Dobbs knew exactly where he wanted to go. When I felt something poking inside me, I feebly bleated, “I feel the needle,” knowing what would transpire. I closed my eyes.

Dr. Dobbs instructed a nurse to shoot me with a few more burning squirts. I winced. After that, he pushed the needle in further and snapped a few samples. I was wearing a surgical gown over my casual Friday black jeans. It was draped to cover my right side and expose my left. I felt liquid trickling down my left arm, dripping onto my stomach.

“She’s bleeding, you better get that,” said one of the nurses; a hand mopped at my arm and belly. A few drops dribbled onto my leg. “Oh no,” another nurse observed. “It got all over the machine!”

I kept my eyes closed. For some reason, splattered blood on “Dexter” or “Law & Order” doesn’t bother me a whit, but when it’s my own blood, I’m a little squeamish. I could smell it, coppery and salty.

“It’s on the floor,” said another nurse. I could hear paper scuffing along the floor tiles. A nurse said “More towels,” and I heard stiff paper crackle, passing from hand to hand, scraping the front of the mammogram machine. I wouldn’t have been surprised if my blood had spurted up to splash the ceiling, given how tightly my breast was compressed and how many times they poked it.

They released me from the crushing panes of glass, and I opened my eyes. One of the nurses gently and impersonally wiped the blood trickling from the incision. She applied pressure, checked several times to see that it was still bleeding, then—apparently I was taking too long to coagulate—asked me to apply pressure with my right hand. I noticed smears of dried blood clotting my arm hairs. I felt it drying and tightening on the skin of my midriff.

“Sorry we got blood on your jeans,” another nurse apologized.

“It’s okay,” I sighed; “they’re black.” The nurses giggled.

“How’s that doing?” asked one of the nurses, nodding in the direction of my breast.

I lifted the pad and saw the bleeding had slowed significantly, while vivid bruising covered the entire surface of my breast. “Here, I’ll put a dressing on that,” said a nurse. She folded gauze and taped it down with what looked like clear packing tape, very wide and sticky. Smoothing it gently over the bruises and dried blood, she joked, “This breast has been to war!”

“This breast did a few rounds with Mike Tyson!” said another nurse.

“Have you been taking fish oil?” another nurse asked.

“I stopped more than a week ago,” I said, “but yeah, I’ve been taking it every day for years.” Fish oil supplements have been shown to improve people’s mood; they also thin your blood. You’re supposed to stop taking them at least a week before any surgery or procedure. Even though I had, I wasn’t surprised by my little biopsy bloodbath.

I’ve always been a “bleeder.” A week after sinus surgery at age 26, I got a nosebleed that lasted six hours and landed me in the emergency room. Dr. Stratton told me that I bled a lot during fibroid surgery, although not enough to require a transfusion. I have type O- blood and I try to donate as much as I can (proud member of the Gallon Club), but my inner elbows are always spectacularly bruised after a donation. Even routine blood draws take an unusually long time to stop oozing, although they frequently require two or three pokes before striking one of my notoriously bad veins. Once I got home I took some pictures of the purple and yellow breast from every angle. It took several weeks for the bruises to fade.

Bad news travels fast. In less than a week, the verdict was in. I didn’t want to call and talk, one by one, to everybody who would care about what was happening to me. I didn’t want to cry, and I didn’t want to repeat myself. So I sent out a mass email with everyone’s address in the BCC: line.

BCC: everyone who cares about Abigail

Subject: Bad news

I have breast cancer. Invasive lobular carcinoma, the rare kind. Of course it is. The universe says "fuck you" one more time. Second biopsy came back as a "radial scar." One of those probably benign but still not good things. I guess the surgeon will have a lot to cut out of me.

After the indignity of being pierced with a needle while squished in a mammogram X-ray machine, my cancerous breast has developed a big hard lump. According to the internet, this is normal and not a sign that the cancer has expanded after being squished and pierced.

I'm literally all bruise on this side. When do I get a nice gentle MRI?