The Anger Returns

After He Said Cancer | A Memoir

Mid-sentence I stopped reading and caught my breath.

“Assuming Stage 2…survival ~70-80%,” the note read.

I had jotted this note during the first appointment with his cancer doctor in a small gold notebook. I thought that the shiny color of the notebook would help keep my spirits up — and bring us luck.

It hadn’t.

Since that appointment, the notebook had been gathering dust on a shelf. I hadn’t picked it up or re-read my scribbles. Somehow, I couldn’t bear to look at it and be reminded of that time. The grief was paralyzing and he went to most of the long list of appointments alone.

Three years had gone by, and now I read these notes for the first time.

Stage 2? This made no sense. His armpit was full of cancerous lymph nodes that felt like a handful of small rocks.

An ultrasound had been done before this first visit with the oncologist; the matted lymph nodes had been found, biopsied, and determined to contain cancer. By the time he was diagnosed, there was no way that his cancer was Stage 2. After the lymph nodes were removed, the pathologist counted 14 cancerous lymph nodes. It made me sick.

Why did she say that he might be Stage 2 and get our hopes up?

I sat down at my computer to confirm what I already knew. Stage 2 breast cancer could have at most three cancerous lymph nodes in the armpit. If the cancer has spread to more than 3 lymph nodes, then the cancer would be upgraded to Stage 3. Ultimately, he had nearly five times more cancer-filled lymph nodes than someone with a Stage 2 cancer.

It was a s-t-r-e-t-c-h to say that he might be Stage 2, especially after they examined him and felt the rocks in his armpit.

Warmth began to spread up my neck and face. My eyes burned and chest tightened. I rubbed my face and my eyes with both hands and covered my eyes.

The anger was returning. It felt like I had been lied to.

Here was evidence that the oncologist had presented his disease and long-term survival as a possible Stage 2 cancer when that seemed very, very unlikely. Why on Earth would she have done this?

My first thought was that this was part of her subconscious tendency to “sugar-coat” his cancer and present the best possible case scenario, rather than the most realistic one. It was a pattern that we had noticed. Visits with her were always uplifting, which was good. But any potential negatives were mentioned in a tiny breath and quickly de-emphasized. When the extent of his cancer was finally known, she could hardly bring herself to say the survival statistics that we repeatedly asked for.

Part of me hadn’t completely forgiven the oncologist for missing the massive blood clot that nearly led to my husband’s death or for her lame attempt at an apology. I thought I had forgiven her and gotten over this.

Stay focused, I told myself. Figure out what happened at this first visit and then it will become clear.

Closing my eyes, I tried to recall the visit as clearly as possible. Parts were coming back to me, in pieces.

The oncology team was running behind schedule, I remembered. A medical assistant had come in to let us know that their care conference had run late in which they were discussing my husband’s case – along with the other patients that they would see today. In the care conference, the results from his biopsy, mammogram and ultrasound would have been presented so that the oncologist, breast surgeon and radiation oncologist could discuss his case before meeting him on his first visit.

I recall that the oncologist and breast surgeon came into the room together, along with a trainee of some kind. They spoke to my husband briefly and asked whether we had any questions. Here is where the discussion of his survival must have occurred where I jotted down the “assuming Stage 2” comment.

Next, they performed the breast exam, which means that they pushed on the tissues in his breast and armpit to find any irregularities. One-by-one, they examined him in silence.

When their hands passed over his armpit, I studied their faces for a change in demeanor. Would they register surprise or dismay when their hands passed over the rocky lymph nodes in his armpit? I wondered. They kept their poker faces during the exam, just as I had kept mine with many of my patients in the past.

“We want to discuss his case for a few minutes and then we will return,” the oncologist said. They stepped out of the room, and we were alone.

In that moment, they must have suspected that he had Stage 3 or metastatic disease. The small lymph node rocks in his armpit would have told them in a flash that his cancer was more advanced than they had realized at first.

I knew how to keep a poker face with patients. Many times, I had performed an ultrasound on a pregnant woman and unexpectedly found a fetus without a heartbeat. Before telling the patient, it was our practice to have a second physician come into the room, repeat the ultrasound, and confirm the finding. I would keep my poker face while the second physician completed their ultrasound exam, looked at me, and nodded in affirmation that they could also not see a fetal heartbeat. Only then would I let down my poker face and tell the patient that her fetus died with all the compassion and kindness that I could possibly muster.

What happened next, I prodded myself. Did the oncologist return and tell us that she was concerned that the cancer might be Stage 3 or worse? No, she didn’t. If she did, I would have written it down. I looked down at my notes again and found a few more sentences to decode.

“If three or fewer lymph nodes are positive and genomic testing is favorable….maybe avoid chemotherapy….but if chemotherapy is recommended, it would occur over 3-6 months and be given entirely as an outpatient,” the notes read.

This made no sense. Why had the oncologist thought that he might have three or fewer cancerous lymph nodes in the first place? Fourteen were found during his surgery. I got up from the computer and took a step into the hallway.

“Darling…do you mind checking your electronic medical record?” I yelled. “I want to know how many lymph nodes were noted on that first ultrasound report when they did the biopsy.”

“Why?” he retorted from the living room. “What does it matter?”

He was probably reading a book and didn’t want to be bothered to log into the computer. This information was meaningless to him and he wanted to keep reading his book. From his perspective, overthinking the whole thing was pointless, and a waste of his energy.

My perspective was different. It was a Venus-Mars issue, and I needed to know.

“I want to know,” I said. “It’s part of my healing to figure out what happened at that appointment.”

His exhale was audible from down the hall. Ten seconds passed and I heard him get up and go down the stairs to the basement, where he had set up a home office. The exercise was pointless to him, but I appreciated his effort. For me.

I followed him down the stairs until I stood behind him. The screen was visible over his right shoulder. It took him a few minutes to get into his medical chart and open the ultrasound report. The text was too small for me to read from where I was standing.

“What does it say in the ‘Impression’ section at the bottom?” I asked. “How many suspicious lymph nodes did they see?”

If the answer was more than three, the words “Stage 2” should never have been mentioned in his initial consultation. He was quiet for a moment as his eyes scanned the page.

“Three,” he said. “The ultrasound found three suspicious lymph nodes.”

My anger evaporated, leaving me stunned and silent.

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If you would like to read other posts, here are a few:

1. How It Began. This story is the origins of my Substack and tells the story of the first moment when we learned of my husband’s breast cancer diagnosis. https://www.afterhesaidcancer.com/p/how-it-began

2. A Beach Surprise. A nice day at the beach turns into something else thanks to our mischievous animal. https://www.afterhesaidcancer.com/p/a-beach-surprise

3. A Queen. The story of a dear friend that lost her husband to breast cancer.

   https://www.afterhesaidcancer.com/p/a-queen

4. The Phone Call. He waited to tell his family about his cancer until the last moment. https://www.afterhesaidcancer.com/p/the-phone-call

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