RECALL TO BREASTSCREEN

After a mammogram, only one woman in twenty is called back for further testing. I am perfectly well, and as far as my GP or I can tell, I have no suspicious lumps. So there is no reason why I should be anxious as I wait for the letter from BreastScreen to give me the all clear.

I’ve been told there could be a two week wait for the results, but something –perhaps the pause (the long pause) as the radiographer hid her head and studied my pictures before deciding we were all finished – makes me oddly unsurprised when a letter arrives just one week later. It’s a recall for more mammograms, but also possibly for an ultrasound, a clinical examination and a biopsy.

The next available clinic day is just two days later, and there are times available at 8.10 am and 8.20 am. With our current relaxed schedule of no particular deadlines or reasons to get up early, 8.10 sounds almost like dawn. I would really frighten myself if I felt I had to be there as urgently as that! Meekly, I agree to the slightly less alarming 8.20 slot.

On Thursday, September 26^th, the day of my recall, I hear the birds begin their morning at 5 am. There must be so many of them, hidden away in the eucalypts and angophoras around our house, and in the dense barrier of trees along the ridge towards Coal Point. Before it’s truly light they begin a frenzy of chipping and chirping, with occasional warbling from a magpie or cackles from a kookaburra. They’re barely in evidence when I get up just before 6 – a crow caws in the distance, a king parrot persistently does its piping, pure squeak – but otherwise their morning chorus is over, and I presume they’ve already breakfasted as well.

Because we’re so anxious about all the traffic as Novocastrians head off to work, we allow an hour for our trip from home to the clinic. This means we are actually ahead of the peak hour, and the roads are so astonishingly clear that we arrive before 8 am.

The clinic is already open, though. I hand in my paperwork, have just enough time to sit with Martin in front of a low table stacked with magazines about homes and gardens, or yachting and other outdoor activities (rather more of this latter type, I notice, appropriately, because men are more likely to spend a lot of waiting time here than women), and before I can begin checking my watch, we’re called into a consulting room by the Nurse Counsellor.

She explains what’s about to happen. There’s uncertainty about my results. They’ll need to do more checks. It could take two to four hours, I’ve already been told. As if I’m taking part in a play and need a costume, she gives me a pink BreastScreen carry bag with a kimono-style gown in it. I can put my clothes in the bag, she says, and keep them there throughout the day.

After this little interlude, Martin is parked back in reception while the nurse counsellor and I head to the examination area. Now I know why all those women last week were sitting soberly on chairs in this bleaker waiting area. They were in a category requiring more serious attention, not just whizzing in and out with a simple mammogram.

There is filtered water and tea and coffee and biscuits and cheese – and of course, good stacks of magazines – but there is also a held-breath feeling here. I’m one of the first for the day. I move into the centre of the room, settle in the comforting sofa, try to be calm.

“Bring a good book,” the receptionist advised me when I rang for my appointment. So I have brought something utterly distracting: Shooting Stars and Flying Fish, Nancy Knudsen’s story of a sailing trip around the world, a three year escape from ordinary (in her case, corporate) life.

This book is like a hallucination to me. I could never imagine doing anything like this, so I read it with wonder and bewilderment. As a way of escaping from my present situation, it should be perfect … but before I can read more than a couple of pages, my radiographer from the previous week is calling my name.

This time, she’s gentler. Even a little apologetic for having to repeat the procedure, because she remembers it was painful for me. In fact, this time, it is more bearable. There is still a yellow bruise line across the top of my right breast, but it’s the left one that matters today, and the squashing is over soon enough.

Then it’s back to the holding area. I’m still clothed, instructed to wait. The sofa beckons, but perhaps because I don’t expect to be sitting here long, I take one of the chairs along the wall.

This gives me a straight view across to the young woman who must have just come out of another room. I’ve already noticed her in the outer waiting area because with her wavy blonde hair and open face, she reminds me of Botticelli’s Venus.

She’s already in a gown, and as she subsides into a chair on the opposite wall, she appears to be crying. Not audibly, or in a visibly disturbed way – it’s more like a melting she’s trying not to let anyone see.

I think of going across and asking her if she’s alright, but before I can, I realize she has her phone to her ear. “What do I do?” I hear her say. Very quietly. Then she is silent for a long time before she repeats herself. “What do I do?”

I don’t know if there is anyone on the other end talking to her – she just continues holding the phone to her ear, saying nothing, looking so terribly sad and shaken … I wonder if she holds it there long after the other person has gone to protect herself from anyone in this room coming across to talk to her and ask her what’s wrong. In any case, there is a wall around her so I don’t feel I should intrude.

My next examination is an ultrasound, which seems to take a very long time, although it is painless and the only stress is in my head, as I begin to worry why it does take so long. The woman who’s gliding and pressing the viewing knob over my jelled skin is calm and patient, just going over and over the slightly pushed-down tissue methodically.

By the time this is finished, Botticelli’s Venus has vanished. Other women have gathered in the internal area when I’m sent back there to wait for my next call, which will be to see the doctor. I notice that some women have come with a female friend or relative for support. It’s a very good idea, as this means they have a companion in this more anxious room.

So far, all the staff, medical and administrative, have been women. There has been a gentle cheerfulness soothing me through the whole process.

The doctor, however, is a man. That doesn’t particularly worry me.  This man’s manner does, though. He is brusque and detached.

Another man comes with him. I am told why the other man is there – but it is so quickly muttered that I don’t catch the words. I presume that the extra man is a trainee from the way he stays slightly in the background, observing, and also from the way the doctor speaks more directly to him than to me.

After all the sympathetic women, it is a shock to suddenly find I’m in a place where brutal news is about to be delivered, with no attempts to soften it.

While I’ve been waiting in the doctor’s room, I’ve noticed an illustration on the desk of a breast, arrayed with lines and labels. There is a staggered set of cells along the bottom of the sheet, and I can see that they represent stages of something called Ductal Carcinoma In-Situ – from a simple circle with clustered small shapes like little seeds around its innermost radius to the last circle which is darkened and spilling out ‘invasive’ cancer.

What can this have to do with me? I think, when the doctor, without any preliminaries, points to that progression of cells and announces: “You have abnormal mammogram.” He is gesturing along the line, well away from the healthy, simple circle – but I can’t understand what he’s trying to tell me. “You need biopsy,” is what I do hear and understand. “OK?” What can I do but nod? “After lunch, today. After 12.30. Any questions?”

He points again at the illustration and I don’t know if I really see him point at the central drawing, which is showing more seeds around its radius, but which is still classified as not cancerous, or whether I just want to believe this is what he’s saying I have …

But I can’t really think of questions. He has said there are specks of calcium. So I say I have osteoporosis, I have to take calcium for that, could this be connected somehow …

“No,” he says emphatically. “Biopsy. After lunch. You can talk to counsellor now. She will explain …”

For the time being, my isolation in the held-breath waiting area is over. I go back out to the light-filled reception room where Martin is still sitting, no doubt expecting to go home now that I’ve reappeared. It is still quite early – 10? 10.30? If all had been fine, though, the appointment might well have been over.

He looks at me expectantly. “It’s going to be a long day,” I say. “I need to have a biopsy.” I’m surprised to hear how easily I say it, although it feels utterly unreal.

The nurse counsellor ushers us away to another room then. Martin is able to come – and he remembers the room and how we reached it (by going down a corridor), whereas I don’t. There are bras in the room, he says, and I do have a memory, days later, of having seen all sorts of support bras as big as papooses somewhere, but I cannot recall them during this session at all.

The nurse counsellor has the same DCIS illustration on her desk. She explains what the doctor presumably thought he had already told me: there are spots of microcalcification in the left breast that are abnormal. I’ll need to have a core biopsy so that samples can be taken and tested.

She explains the procedure and jokes that the little piece of metal that will be put in as a marker of the site is the same shape as the Breast Cancer ribbon – a piece of metal, going into me??

This is starting to sound ominous …

Already there are consent forms, and another appointment to return for the full procedure at 2.30 pm. But first they have to do a trial run of preparing me, face down on a table with a hole in it for a the breast to go through, to see if it’s possible.

The nurse counsellor gives me brochures. Asks if I have any questions. The most obvious one I can think of is: Are you sure all this is right? Is it really me this is supposed to be happening to?

When I arrived here this morning, I was the statistical one woman in twenty being recalled after a mammogram. Ninety percent of those recalled are then given a clear report after these extra tests. Isn’t that what the letter from the clinic said? It was upbeat. I’ve read the reassuring stats. I have to be positive too and believe them.

After the core biopsy, surely I’ll be one of those lucky ones. I just have to get through that, I think, and this little nightmare will be over …