It started about a month ago. I was sitting at my desk at work and felt the vibration of my cell phone go off, only I was picking up the vibration in the left side of my chest instead of my hip. I didn’t think much of it – my phone usually sits in my blazer’s pocket and leans against the chair arm, so when it buzzes half the time I pick up the vibration through the chair on my feet or my arm or something and not through the phone itself.
But when I checked the phone, there was no call. Odd, but I let it go.
It happened again a few hours later, and a few hours after that. Definitely a vibration, but no calls on the phone. When I came home that night, I was leaning against the arm of the sofa when it happened, and the phone wasn’t even in the livingroom, so I knew something odd was going on. And it had chosen to go on in my left breast. This was not cool.
Like most procrastinators I gave it a day or so, but when I found myself checking my phone twice an hour I decided I’d had enough. Various Google searches were inconclusive, so I called my gynecologist’s office. “Oh,” the nurse on duty says, “We should get that checked out. Can you come in today?”
Now, for those of you who’ve never gone to the OB-GYN, especially in a specialist-poor state like Malpractice-Land Pennsylvania, let me tell you: you can’t see you gynecologist today. You can see her (or him) in three weeks, or a month, or if it’s your yearly physical and you’re a new patient they can get you in sometime in October if you call now. So when I hear “come in today” my brain registers “oh shit”.
But, as always, there’s a catch. My employer changed insurance back in January and I never checked the list for the OB-GYN, just for my general practitioner and Nighthawk’s specialists. When I try to book an appointment with the receptionist, she says, “We don’t take Aetna.”
“So now what?” I ask, panic rising.
“Well, you can pay out-of-pocket and be reimbursed by your insurance.”
Hell, no. But at the same time, with the mental panic-meter on “growing concern” I decide I’d better get an appointment booked somewhere else. The problem, of course, is finding someone who’s accepting new patients and takes my insurance and answers the damn phone. An hour and a half later, I finally take the advice of a kind receptionist working for an office an hour from here who couldn’t get me an appointment for three weeks and book an appointment with my general practitioner.
Flash forward to that Monday, when I see the doctor. By now the vibrating isn’t occurring as often, but everything’s kind of achy. She does an exam, can’t find anything, and thinks I might’ve just whacked it with something. “It’s most likely a deep bruise and a pins-and-needles kind of effect. Try not to lean on them too much.” We’re both big girls, and she knows that’s easier said than done. But she doesn’t want to take chances. “Is there cancer in your family?” she asks.
“All over the freaking place.” I reply. My dad’s side is pretty clean, but I’m relatively sure my mom’s side has has pretty much cancer of the everything, and it tends to strike young. My mom specifically? Not that I’m sure of, but I know she had problems of some sort right around my age. My sister? She’s 17.
Now this is where the politics of medicine come in. See, when you’re under 30, your chances of being diagnosed with breast cancer are one in over 2000, and between ages 30 and 40 it jumps to 1 in 235. I’ll be 30 in June, so I’m on that line. But I’m a decade away from 40, when it jumps to 1 in 53, and everyone “should get a mammogram once every year or two”. And mammograms don’t image younger tissue as well as older tissue, because the younger stuff is too solid. So a lot of insurance companies won’t approve a mammogram in women under 35 unless there’s a history of cancer in your immediate family, but they will approve a yearly mammogram in someone who’s 51 with no history at all.
And that’s where I’ve always balked. If I knew my mom had breast cancer, I’d get access to better treatment – more tests, etc. – than if I knew she doesn’t. If she was the one at the appointment, she’d say her sisters have had it and she’d get access to all these tests. But just because she’s at higher risk doesn’t mean her daughters are? Bullshit.
I’m 90% sure my insurance will cover it either way, because I have good insurance, but I’m not going to take any chances. So I don’t ask my mom whether she’s had cancer. When doctors ask me, I answer, “I don’t know.” And my doctor has no problem with that me. “I don’t want to take any risks,” she replies. She writes me a prescription for a mammogram, and an ultrasound in case my breasts are too firm to get an accurate mammogram. I check with my insurance company to see if I need a precertification – they don’t need one, and the woman I speak to doesn’t see any age restrictions on my insurance. I book the appointment, but they can’t get me in until almost two weeks later.
Time passes. By now, the buzzing sensation only occurs rarely, and yes, it seems to be related to leaning on the sofa arm or accidentally smacking my left side with a computer or something when working. Still, if I didn’t go, and there was something in there, I’d kick myself down the road, so I didn’t cancel the appointment.
This morning, I checked in at the local radiology center and waited my turn – everyone there was very friendly. Then I meet the tech. She’s tall, skinny, blonde, and frowning. “Here’s a gown. Take off everything from the waist up and put it on so it opens in the front. Wipe off your deodorant in the bathroom.”
The gown was cotton and designed by blind aliens who’ve never seen a human. The left panel is twice the width of the right, which means it opens at the center of my right breast. That might’ve been convenient if it was the right that was having the problem. There are two ties at the neck (which I tied) and one on the left edge at almost crotch-height, and another at the side seam on the right at just above waist height. If I wanted to show off everything, I could have tied it, but then, what’s the point of a gown? I only saw two other women while I was there, and all three of us were clutching the gowns closed like flashers who’d just escaped the mental hospital and hadn’t bought new trenchcoats yet.
Into the mammography room I go with the frowning tech. “You’re very young to have a mammogram.” I nod. She asks about what brought me there. I explain it. I stress that my doctor said the ultrasound would be fine if the mammogram wasn’t possible because of my age. I have to sign off that I’m not pregnant. “You’re very young to have a mammogram,” she repeats. “Do you have cancer in the family?”
“My mom’s had lumps and her sisters have had cancer.”
“But did your mom have cancer?” she asks.
“I don’t know,” I replied.
“Well, is she alive?” the tech asks, still frowning.
“Do you know how hard it is to talk about sex and breasts with your mother?” I ask in return.
“You’re very young to have a mammogram. I have to go talk to the radiologist about whether we can even give you one.”
While she’s gone, I pick up the only magazine in the mammography room, a copy of Health from a few months ago. It’s got four articles in it about breast cancer detection. Ah! Research material! I start reading.
The frowning tech returns. “We’re going to do the mammogram,” she explains, tells me how to adjust my gown, then velcros a lead shield around my waist. “Stand here, set your breast up here, now we’re just going to bring this plastic shield down…. are you okay? Hold your breath.” My breast is now squashed between the frame and the clear plastic shield. The machine whirrs then pulls away automatically. She changes the film, changes the angle of the machine, and has me step forward again. “Hold this handle and lean in a bit. This is going to be tighter than the last. Hold your breath.” It wasn’t painful when the breast-mushing was taking place, but after the mushing it ached. “One more. Stand here, face this way, put your arm up here, grab this handle,” smash, smoosh, squish, ” Are you okay? Hold your breath,” clickity clickity, “Okay, you can cover up now. I’ll go get these developed and we’ll find out what the radiologist wants to do next.”
Back to the magazine I go, until the tech returns.
“One more image. We want to retake the last angle” We reenact the last smooshing and I sit back down with the magazine.
A few moments later, she returns. “Everything looks fine. The radiologist didn’t see anything wrong. We don’t need to do an untrasound. Your doctor will have the report by next Wednesday.”
By this point I’m fried mentally. I knew the symptoms were probably nothing to be alarmed about when I went in, but my doctor and I agreed it’d be a good idea to have the mammogram “just in case”. The technician and her magazine seem to disagree – I was too young, the chances are low, and mammograms just aren’t very effective on breast tissue in my age group. On the other hand, the magazine (and a few websites I’ve hit since I got home) backed up my impression that I am higher-risk thanks to my aunts. But the magazine articles also cited various statistics and explanations that indicate that mammography in general isn’t as reliable as it should be, and that having a mammogram is vastly oversold. I have to wonder about the office putting a magazine that seems to actively discourage mammograms in the mammography room. What’s the lesson there? Is the tall frowning blonde tired of all these patients coming in and cluttering up her mammography lab? And why the constant harping on how young I was if they were going to go with the mammogram anyway? And if everyone – the doctor, the tech, the magazines, and the Internet – are pretty sure that a mammogram is less effective in younger women and an ultrasound’s the better deal, why did the radiologist decide the mammogram was fine? Are my breasts older than I am?
I’m considering the whole thing over and done with. Unless my doctor and the radiologist see something this week that the tech didn’t believe was there (nothing would shock me, mind) I expect to hear that there’s nothing wrong when I call for the results next week. I expect to find out that the buzzing is caused by tissue trauma, and that I just have to be nicer to my chest.
I’m sure of this because, despite the mixed messages and the doubt and the confusion, I received firm evidence today that my doctor was right. And it’s also why some day there’s a good chance this whole incident will be documented in a comic. See, ever since the smashing and the squooshing and the pancaking have finished, my left breast has been buzzing like a switchboard at AT&T. And in that sense, the mammogram was 100% effective.