Cease and De-Cyst
It's been a rough few weeks. Few months, if I'm being honest. One of those periods of time when everything--work, relationships, health, money--seems to require more effort for a shittier result. (I don't often talk so negatively, and I already feel guilty for it, but it's the truth.) So when I started to feel run down last week, I thought it was about time everything caught up to me. I took a long nap on Thursday afternoon and felt slightly better on Friday, though my throat was sore when I yawned. At least it was the weekend, I thought. I could spend all Saturday in bed if I wanted to.
That evening, in Laredo, I begged my mom and Adrian to go with me to Pilates. The instructor had messaged me to let me know she'd had cancellations, and she couldn't hold the class with just one student. But I'd been looking forward to it all day, and with some mildly desperate pleading, both my mom and Adrian agreed. Afterwards, in the backseat of my mom's car, I laughed and my throat hurt again. I touched the spot where it was sore and felt my stomach drop slightly: there seemed to be a bulge where I hadn't known there to be one before. As my mom and Adrian chatted in front, my fingers explored my neck. The lump was tight and round, tender to touch. It felt about an inch tall and wide, and there was no matching fullness on the left side of my throat.
Maybe it's a lymph node, I told myself. After all, I'd felt as if I were coming down with something. But I wasn't sure that was the right spot for a lymph node, and I'd never had anything like it before. Or had I? Maybe this was always there and I was just noticing. I'm highly observant of some things, utterly oblivious of others. It could be that I'd just never paid attention and this was completely normal.
At home, I asked my mom if she felt anything weird on my neck. The moment she touched it, her eyes widened. She stepped back. "You can actually see it," she said, voice rising slightly with alarm. "It's a big bola on your neck. The whole right side looks swollen."
Adrian came downstairs as we were poring over horrifying Google images, and soon he joined the Party of Internet Despair by huddling over his phone in a corner chair.
"It might be your thyroid," he said, looking up. "I've always thought you have hyperthyroidism. With the way she eats," he explained to my mom. She nodded.
I rolled my eyes. "My thyroid is fine. Remember? They tested it with all the heart stuff last year."
He grunted and went back to his phone.
"I just wish your dad were home," my mom said. (He'd taken Cleo for a walk.) "He's always so good at diagnosing."
I laughed. "Why don't we skip a step and I'll just start taking the Mexican Amoxil that's in the cabinet?"
My mom shushed me, and everyone went back to their screens.
"Speaking of eating," I said to Adrian, "I'm starving. I'll take a shower while we wait for Dr. Dad, so we can go to dinner after."
Half an hour later, my dad was peering down my throat with a flashlight, as he had since I was a little girl feeling the first swell of a throat infection. He confirmed that the right side looked raw but didn't see any telltale white marks of infection. As he looked at my neck, I looked at his eyes. What is it that they say about flight attendants? That when they start to panic, you should start to panic? My dad is similar. His feathers are not easily ruffled by health ailments (which, granted, sometimes means he suffers long after he could have been on the mend). His eyes, though, were thoughtful and full of concern.
"Maybe you should go to one of those urgent care places," he said softly. "Doesn't have to be tonight. But maybe tomorrow morning."
He made it sound like a casual, offhand suggestion. But it was serious and I took it seriously.
That night, I woke up around three a.m. and couldn't go back to sleep. I kept running my fingers over the lump in the darkness. Had it really grown so suddenly? Or was this a product of time that only now, with some discomfort, had gotten my attention? Either possibility was disconcerting, as though my body and I--whatever the "I" is--had been cruising along parallel paths, not touching, when I'd thought they were connected.
The next morning, the soreness had increased, and my head felt foggy and painful from lack of sleep. We went to a new free-standing emergency room, whose walls were painted a soothing aqua, and whose waiting room was furnished not with uncomfortable dark faux-leather seats but with upholstered chairs and paisley settees in light, shimmering fabrics. The woman behind the front desk offered us snacks and recommended the gourmet coffee while we waited. I wanted to compliment her on the commitment it must take to apply false eyelashes at nine in the morning.
Before I'd finished more than a few sips of coffee (which was indeed delicious), Adrian and I were called back. We were seen first by a nurse and then a doctor, who palpated the lump and announced that it seemed to be a cyst on my thyroid, but he wanted to do an ultrasound to make sure.
"I told you," Adrian said when the doctor left. "I thought it was your thyroid."
"Yeah, but that doesn't mean I have hyperthyroidism," I quibbled in return.
We were there for a total of three hours, during which time our phones didn't get any service. It was that whole part of town, the doctor explained at length, when I wanted him to explain why I had a cyst on my thyroid, which had been confirmed by the ultrasound. Just as I was thinking that my mom was probably panicking at not hearing from us, the curtain to our little room parted and a nurse sang out, "I have a visitor for you!"
My mom entered the room, her face lit with relief and sheepishness.
"Mom!" I said, laughing. "What are you doing here?" But I have to admit I was happy to see her.
"Well, we hadn't heard from you!" she said, as if she'd already prepared her defense. "Your dad's in the waiting room. They only allow two visitors at a time," she said as she hugged me.
Adrian stood. "I'll go get him."
I shook my head as my dad stepped into the room moments later. "Why are you guys freaking out?" I asked affectionately.
"We're not!" he said. "We just thought you'd be finishing up and would be ready for lunch soon."
"Uh huh," I said.
When the doctor returned, he explained that the cyst was five centimeters, or nearly the size of a golf ball. It was mostly fluid, he said, though the ultrasound did show some "debris" as well. There was an extremely low chance of malignancy--5%--but the thyroid wasn't his area, and I should get seen by a specialist sooner rather than later to get the cyst aspirated.
"What does that mean?" I asked. "Aspirated."
"They'll use a very fine needle to drain it and test the tissue. It's a quick procedure, but yeah," he shuddered a little. "Needle, neck, not fun." He laughed.
"Great," I said, forcing a smile.
This was a Saturday. We were due to celebrate my dad's birthday the next day and head back up to San Antonio on Monday to leave for Australia on Wednesday. The window of time to get a needle in my neck was small but doable, I thought naively.
In the end, we decided to drive up after lunch on Sunday so that I could try to make an appointment with my GP first thing Monday morning. Of course, he wasn't available, but I could see his PA. I hesitated over the phone, but thanks to insurance changes, I had no choice but to visit this particular practice, and thanks to time constraints, I had no choice but to do it immediately. I took the appointment, and Adrian and I drove straight there.
The visit was predictably short. The PA's eyes widened the moment she looked at my neck. "Oh, wow!" she said. "I saw the report, but--it's really big!"
"Yeah," I said. Then I told her the other thing--the night before, I'd been stretching when I felt a pain under my breast. There seemed to be something there, a raised lump that felt bruised to touch.
She had me lie down and gently felt around the area. "There!" she said, when her fingers found it.
"Okay," she said. "Yes, there's definitely a mass. I want you to get a mammogram and an ultrasound. I'll give you the orders, and also a referral to an ENT for the cyst." She gave me a strange sideways glance. "Then you'll come back here?"
I looked at Adrian, taken aback. "Uh, I guess so?"
"Yes, I want you to come back and let us know what happens--like how you're doing."
"Okay . . ." I said.
Adrian was shaking his head. His moods are powerful and deeply contagious--when he's happy, the room is happy. When he's upset in any way, voices lower, laughter is hushed; he's always had this effect. And right then, frustration was emanating from him in waves. He was furious with her for alarming me, for her reaction at the size of the cyst and her use of the word "mass." He thought she was incompetent, that the whole US healthcare system is unaccountably backwards. The minute she was out of earshot, I knew he'd be uttering a stream of expletives. His tension only exacerbated mine so that by the time we were back in the waiting room and I held a sheaf of papers with the words "breast mass" and "thyroid cyst," I could feel tears at the back of my throat.
Cancer runs in my family. Three of my grandparents have passed away from it, and two aunts have survived breast cancer and Hodgkin's lymphoma. I felt as though I'd crossed a threshold from concern to fear.
The rest of the day--an entire day--was spent calling ENT specialists one by one to see if they accepted my insurance. My widely accepted Blue Cross Blue Shield PPO had changed, across the state of Texas, to HMO, and those physicians accepting Obamacare, it seemed, were few and far between. Anytime I made progress--someone accepted it!--I was told there was no availability until July, or that the doctor didn't perform that specific procedure. I must have called upwards of fifteen doctors that day. Finally, one of them called me back. They would accept my insurance, but they needed my GP to fax over my reports, and once the doctor reviewed them, their office would call me back to schedule.
"But I'm supposed to leave the country in two days," I said. "Do you think--is there any way--?"
"He needs to review the reports."
I sighed. "Okay."
It was Adrian who said the obvious--we'd need to postpone our trip. So while I called the GP, he called Qantas to see about pushing our flight forward a week.
First thing the next morning, I was scheduled for the mammogram and ultrasound. Adrian got out of bed when I did and started to get dressed.
"You know," I said, "you don't have to come today."
He stepped toward me and wrapped his arms around me. "I want to be there with you."
"Let me reframe this," I said. I'd been giving this some thought since the day before. "If you're going to come to this appointment or any other that may follow, I really need you to make an effort to be a comforting presence. It doesn't help me when you get frustrated and upset; it makes things worse. Okay?"
He nodded. "Deal."
I worked on a book a couple of years ago telling the story of our client's approach to his cancer treatment. One of the things that stuck with me is the idea of asking for the kind of support we need--not just in illness, but in life. So many times, we feel we're being supportive of those we love, but our idea of support may actually be counterintuitive to their idea of support. Someone may find healing in solitude, for example, while well-intentioned friends and family insist on keeping them company. Imposing our own idea of comfort upon others can actually rob them of the dignity of choice.
I hated that my mind was going to cancer lessons, thinking of laying the foundation early, but I couldn't help it. Breast mass, I kept seeing. Thyroid cyst. Overindulging in Internet Despair the night before hadn't helped--the link between thyroid cysts and breast cancer now seemed obvious to me, almost inevitable.
Thankfully, the only abnormality the tests showed that day was a small cluster of calcifications. The doctor wants me to return in six months for a follow-up to make sure they haven't changed--not quite the all clear I was hoping for, but also not the "I have bad news" I was half prepared for. When we left the hospital on Tuesday morning, I felt buoyant with relief.
"I told you," Adrian said in the car. "That stupid PA, or whatever she was."
"Yeah, but it could have been something," I said. "People say 'why me?' when something bad happens, but really, why not me?" I looked at him. "Why not me? Why not you? It can happen to us as easily as anybody else."
There was still, of course, the matter of the cyst. It hadn't grown, I didn't think, and the soreness had remained at a constant level after its initial sharp increase, but still. My fingers kept absently returning to it, measuring its unfamiliar dimensions.
The specialist's office had called while I was waiting for the mammogram. With our trip coming up, the soonest the doctor could see me and go over the results from the as-yet-unscheduled aspiration would be May 10. More than a month away.
"Okay . . ." I said, "but will I actually be able to get the procedure done this week? Early next, at the latest?"
"The medical assistant will call you today to schedule."
I turned up my ringer and kept the phone by my side all day. Nothing. At 4:50, I called back to report that I still hadn't heard from the MA.
"He's been in clinic all day. You should get a call by tomorrow. If you don't hear by the end of the day, give us a call back."
The next day passed in a productive blur of writing and interviewing. By 4:00, the elusive MA still hadn't called, so I phoned the specialist's office again. I explained, for the hundredth time, that I would be leaving the country next week and would love to get this done before then.
"Let me transfer you to the radiologist," she said.
To a new receptionist, I explained again.
"Hmm," she said. "I do see here that we have orders for an ultrasound . . ."
"No, I've already gotten an ultrasound," I said. "I'm supposed to get scheduled for a fine needle aspiration biopsy."
"Oh." She sounded pleasantly unsettled. "Well, let me transfer you back to the medical office so you can get this sorted out."
So back to the specialist I went. After I explained the situation and was put on hold several times, the receptionist informed me that I would be receiving a call not from the MA after all but from the South Texas Radiology and Imaging Center, or STRIC, to schedule an appointment.
"They're usually pretty quick," she said, though it was unclear whether she meant quick to call or quick to schedule.
It was nearing 5:00, and my patience was running low. I decided to call STRIC myself to try to schedule. When I did, I heard the words I thought I'd gotten past: "Oh, I'm sorry, ma'am. We don't accept your insurance."
I actually laughed. Then I got the out-of-pocket cost and laughed again, before sighing and saying, "What's the soonest we can get this done?"
"Tomorrow at 11:30?"
So yesterday morning, Adrian drove us to STRIC, where a very nice ultrasound technician guided a very nice doctor in inserting six needles into my neck. (Fortunately, the first was to numb it.) On the ultrasound screen to my right, I saw the silver of the needle slide into the black of the cyst, wiggling around to collect tissue and break up the solid components. Each time a new needle went in, the blackness on screen was reduced, until finally it was almost gone.
"That's it!" the doctor said. "Hope it wasn't too bad."
"Not too bad at all," I said, smiling. I actually meant it.
Once the doctor left the room, the ultrasound technician explained that they would send the tissue and fluid samples to the hospital across the street for testing. "I'm not supposed to say this," she said confidentially, "but if I had to put money on it, I'd say it's going to be fine."
I thanked her and collected my things, meeting Adrian in the waiting room with a large Band-Aid on my neck. I gave him the recap of the procedure and then requested Five Guys for lunch.
Over burgers and two orders of regular fries (which we really have to stop doing), he asked, "Do you feel better?"
I thought about the past week and the intense range of emotions I'd experienced--from mild concern to studied nonchalance to creeping midnight fear to undeniable terror to twisting frustration to tearful relief to that little voice whispering, "You don't know for sure."
"I'm glad it's out," I said.
Today, I feel a mix of gratitude and guilt. It's hard to explain. I suppose I keep thinking about what I said to Adrian in the car--why not me?--and feel spared, at least temporarily, for no good reason when so many others aren't. Is that self-indulgent, or is the recognition of one's random good fortune at the heart of true gratitude? I don't know. I guess I don't need an answer today. Today, I can just breathe.
**UPDATE** This week, I finally went to the specialist for the results on my cyst. The PA entered the room first, and his initial words were, "Boy, you're a cute little thing, aren't you?" (I could write a whole other post about this comment, but I won't, at least not yet.) After this cringe-worthy comment, he went on to tell me that the cyst was, thankfully, benign. There's a 60-70% chance it will return, but if it does, the chances of it being malignant are just as low as the first time. We may need to talk about surgery if it keeps insisting on a presence, and I'll be back in another six months for a ultrasound, just to be sure, but as of this moment, I am a healthy, grateful girl.