Go Back Three Spaces

Remember the setbacks intrinsic to board games. Players are sent back three spaces, or maybe they forfeit a turn simply because they landed on the wrong square or drew the wrong card. In the overall rhythm of the game, these impediments are never really catastrophic, but they trigger a keen sense of frustration nonetheless.

I had a similar setback earlier this week. My radiation treatments, scheduled to begin during the last week of April, were taken off calendar, and I was sent back to the breast surgeon to discuss re-excision. Before I explain further, let me assure those who are quick to worry that my health status has not changed in the slightest. No new or bad facts have presented themselves. This week's shift in treatment reflects nothing more than a change in thinking about the next step.

If you've followed this blog for awhile, you may remember that, based on the pathology report following my surgery, the breast surgeon achieved a "clean" margin around my invasive cancer, but only a "close" margin around the pre-cancerous condition (known as DCIS). While achieving a "close" margin is not as bad as a "dirty" margin, the downside is that close margins leave lingering doubt -- maybe all of the DCIS was removed, but maybe it wasn't. Close margins call for additional medical intervention. Depending on each patient's circumstances, they are either rectified by the surgeon, who removes a little more tissue during a re-excision, or by the radiation oncologist, who increases the radiation dosage to kill off any unwanted cells that the surgeon missed.

In my case, the breast surgeon instructed me to discuss the margin problem with Dr. Rad, which is my nickname for the radiation oncologist I'm seeing. At the time, which was back in December, Dr. Rad was confident that by increasing the radiation levels, he could eliminate any remaining bits of DCIS. My reaction to this idea was tepid at best. From a holistic viewpoint, I was a little hesitant to let Dr. Rad dial up the dosage, but I was the only one who balked. The rest of my team -- the medical oncologist and the breast surgeon -- all concurred with Dr. Rad and green-lighted this plan. Since I lack an M.D. after my name, arguing with three medical experts seemed pointless. I acquiesced and agreed to return to Dr. Rad after I concluded chemotherapy in order to begin super-charged radiation treatments.

But this week, when I showed up for a pre-radiation planning session, Dr. Rad looked at my chart again and changed his mind, although not for medical reasons. He cited my age and said that he was reluctant to proceed because he didn't want me to be unhappy with the cosmetic results of extra radiation. To be honest, the picture he painted was not a pretty one. Given that I was never fully invested in the extra dose idea anyway, he didn't have to say much before I agreed to inquire further about re-excision. Two days later I was consulting with a breast surgeon, although not the same one who performed my original procedure since that doctor has since relocated, but everything still fell easily into place. The new surgeon believes that by re-excising, he can both rectify the margin problem and give me a better cosmetic outcome than radiation would impart.

Even though I think I'll be happier in the long run by following this course, the delay is still frustrating. I want to reach the finish line, and I don't relish being sent back 3 spaces. The re-excision is scheduled for next week, and radiation is set to begin at the end of May.

As a kid, I always enjoyed board games, and I good-naturedly weathered the inevitable lost turns or directives to retreat a few squares. At least that's how I remember the long summer days I spent playing Trouble or Parcheesi. This experience, however, is testing even my patience. I want to get to Candyland. Now.