When Johnny Met Rosie--Women in EMS Part 11: The Little Mass That Could

Life is about two things: choices and changes, entwined like the double helix of our DNA. Some choices bring change; some changes require choices–a cycle of fortune and circumstance leading on into implacable infinity. There are days in everyone's life where they are confronted by something so remarkable that they know deep down that every day after it will be impacted in some fashion.

Today is one of those days.  

I'm writing this in real time. It's September 21, 2013 and it's a gorgeous fall day. Point of fact: many of the MAJOR events in my life have occurred on beautiful fall days, and I am beginning to suspect and/or hate the entire month of September. (Forget just the month; the entire year of 2013 has been awful.  Let me put it this way… it has a kill count.)

Just this morning my children and I went to the local track for a run. I use that term loosely of course. I jogged and walked as the boy rode his bike and the girl kicked a bright yellow ball over the infield turf. The track sits up on a ridge above my son's elementary school and has a pretty view of the surrounding area. The foliage is just starting to turn; it’s still mostly green but it’s like a child dipped his hand in bright finger paints and just skimmed across the horizon with splashes of red and yellow here and there, a promise of the autumn spectacle that is not far off. 

Propellers hum in the background as planes depart from our small local airport. We tend to come to the track right around the same time that the skydivers go up, and once again we were not disappointed. I made sure to take a minute to just enjoy the panorama, listen to my children laugh and enjoy the crunch of gravel under my feet, the woodsy green smells and bright parachutes floating to the earth in lazy, graceful circles.

Today is a "normal" day of errands and time with my children. The bank, the dry cleaners… mundane tasks made enjoyable by leisurely drives down winding roads on this gorgeous day.  Finally home with bags in hand and mail tucked under my chin, my only thoughts now are of dinner and what else I can get done today. I sit down to flip through the mail and open an innocuous envelope. It’s from the Women's Center. I just had a yearly mammogram done last week, so I’m expecting the usual "Negative, don't forget to schedule next year's appointment."

Instead my eyes are immediately drawn to a passage that is hand-marked in vicious yellow highlighter. It’s the section that explains that my test showed "a finding" that requires additional study. Just in case that wasn't terrifying enough, they made sure to put the sentence starting with "YOU NEED TO CONTACT YOUR PHYSICIAN" in all caps.

Frantically, I scan the pages. What are they talking about? I feel fine, nothing is amiss–absolutely nothing has changed since last year. Yes, I know I'm 44, yes, I know I'm overweight, %*&# you very much, but what's wrong with my breasts?! There it is:

Diagnosis: 2 cm right breast mass to be excluded.

The text blurs on the page. "Most such findings are benign (not cancer)." Yes, there's that, but it's still a mass that was NOT there two years ago. What does the rest of this mean? "No suspicious calcifications." Is there such a thing as well-behaved calcifications? And why would there be any bone in my boobs to begin with? "Scattered areas of fibroglandular density." That's new too, what is that? I'm a fairly well-educated, experienced paramedic, so why does this frighten me so much?

It frightens me because I know. The saying goes, "a little knowledge is a dangerous thing." If there's any profession that qualifies for an incomplete education, it's ours. We are the absolute experts on the last ten minutes of life; everything else we know just enough about in order to intervene. We are the speed daters of medicine—two or three minutes, make your decision, ring the bell, move on to the next. We are the experts at A B C, and now I must operate somewhere further down the alphabet.   

It frightens me because it threatens to move me from front-row spectator to center-stage. I’ve been witness to the desolation of the cancer spectrum time and time again… from friends, to family, to every cachectic husk I've tried vainly to intervene on, knowing all along that I was seeing their inevitable death in their flat gaze and hearing their exhausted tenacity in every rasping breath.

It frightens me because I know the strain in a husband's voice, the tears on a child's face, the stoic grunting of a patient whose life has become a never-ending sequence of infection, vascular access, vomiting, exhaustion and isolation. I am the caregiver, not the receiver. I say when, I say what, and this is not in my plan. It’s fall and it’s PHTLS season; I do not have time for this. I have two classes next week alone. There are the re-certifications due, annual training to set up and all the stuff to do with the kids: dance class, riding lessons, track and field… not to mention still riding the truck.  

Endless chains of events play out in my head, fed by my imagination and based on my experiences.  I run my hand through my trademark mane of hair and my breath catches in my throat. I see my entire identity suddenly at risk, with a 2 cm mass threatening to strip me of who I am. Sequences of possible outcomes race past my mind’s eye, colorful vignettes that show everything from business as usual to having to say a final goodbye to my children. A shriek of laughter draws me back from this ridiculous spiral and I see my kids jumping on the trampoline out back, the dog running stupid circles around it. The clock has barely moved; it’s maybe two or three minutes since I opened the envelope.  A tiny rational portion of my brain watches all this in bored amusement. “It’s early, it’s small and in all likelihood it’s absolutely nothing but age-related.”  (See, even my brain can’t guarantee me 100%.)

Nothing, and everything, has changed.  

I tell a few people—my husband and those closest to me. I need reassurance that this is nothing.  They are practical, they are "sure" it will be fine and that even if it is not, it is early and we will get through it. I tell them via text because I need that insulating layer. My children are still playing, blissfully unaware of all the potential this speck on a film could have in store for them. Their day is still "normal." If I talk about this out loud yet, I will not be able to maintain my smile for them and it's too early for tears.

Time to shake it off, put on the big-girl panties and deal with it. After all, that’s what we do, isn’t it?  We take slivers of information and weave them into a comprehensive whole, a foe we can see and fight. Time to find out what the next step will be—to see if I really have something I need to put up a fight against.

My best friend says, without hesitation, "I will get you through this. I have power. After all, look what I did to your brother with just the power of my mind.”  (Another story.)  Not "You will get through this,” but "I will get you through this."  Just like that, a promise that I won't be alone. 

I still feel alone.

Betrayed by my boobs.

She also says, "You have, however, inspired me to get a mammogram."

My response?  "Please do."

That goes for the rest of you out there, too. October is Breast Cancer Awareness Month. All I can say is that right now, I’m pretty painfully aware. Are you?

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact her at taloscar@gmail.com. She is also a member of the EMS World editorial advisory board.