In which I learn I am not a superhero.

Estrogen necklace from Molecularmuse

I own this necklace. It is is the estrogen molecule. My postdoc advisor got it for me when I fledged, and it remains my favorite necklace. So I wore it today to my first official appointment today as a cancer patient. Anna suggested it is part of my superhero outfit. 

It started off swimmingly when first there was a train parked on the tracks so I had to go the long way around. Once we arrived, we navigated to seats in the lobby and I sat down facing the only person in the whole giant room who was obviously ill, crying, and telling her partner that she was in pain. Thankfully, they quickly called us back and put us in the little room that was to be ours for the next 3.5 hours. 

The good: I was pulled in by the nurse navigator, who is AMAZING. On the advice of friend Beck, I'd frontloaded questions that I emailed in. She had read them and cracked up and shared with the docs. The docs showed varying levels of likelihood of having read them. My care team [Edit: Anna also popped in to suggest that I should call them my Careola Team and damn I am going with that. Team Careola? Hmmm.] is a multi-disciplinary team, including a surgeon, oncologist, radiation oncologist, & genetic counselor. More can be added if/as needed. The hospital has a whole breast center (there's got to be a nipple joke there but for the life of me I can't find it). The whole team was smart, sharp, evidence based. No one seemed rushed. They answered all my questions, enthusiastically even. Most of them had a good sense of humor (though one didn't seem to understand my question about using the radiation to ensure that at the end of this I could shoot lasers out of my boobs, so that seems like less and less of a possibility). I still have a lot of questions about the pharmacological aspects, but those won't be answered until we are a lot further into this process.

The bad isn't actually bad. Well, there's the previously mentioned lack of laser boobs. But beyond that, I had hoped I'd walk out of today with a semblance of a plan but instead it's more hurry up and wait...and honestly is more good. As my MD brother likes to remind me, I'm not a (real) doctor, and my PhD only gives me enough information to read and understand the literature, but not treat. It's awe inspiring to ask these women questions and hear them talk about data and how it's used to inform my individual treatment. But the downside of that is that it will be a while before I know my full plan of attack.

So where do we go from here? MRI is first. The insurance company has to authorize that but somehow the nurse navigator managed to get that done before I walked out the door today, so I'm already scheduled for that. Once that imaging is done, I'll meet with the surgeon again and the tumor itself (and some tracing they do the day of surgery with a sentinel lymph node) will inform my post-surgical treatment. Whether I need chemo and/or radiation remains in the air. Order of operations will be: surgery (or, ahem, operation) --> chemo (if needed) --> radiation (if needed). You may have questions about the if neededs, and if so, hold yer horses because those will not be answered until probably after surgery. 

I'm also waiting on a genetic panel they did today -- a screen for 8 genes related to breast cancer which should be back within a week or two, and then a bigger screen for 90 genes in general which is pretty wild. 

So yeah. In a nutshell, I confirmed that I need surgery, the nurse navigator is bad ass, Team Careola is bad ass, I have a lot more appointments before anything is sure, and sometime in May is probably when surgery will happen.