Part 16: Diagnostic mammogram, dating, and a complicated cyst

Almost a year after the fateful and startlingly competent Brooklyn mammogram, it was time for my annual. This time around it was a diagnostic mammogram, along with a bilateral ultrasound, which I’ll have to do every six months for the next five years. I tried to return to the Brooklyn office that saved my life and most of my breast, but apparently their mammograms don’t diagnose—they’re just remarkably good at spotting tiny invasive lobular carcinomas.

I’d paid what I hoped were the last of the exorbitant bills, and almost had enough energy to spend some money on something fun. Then another set of exorbitant bills struck, so I wasn’t out spending fun money. But my energy was more or less restored, and I started thinking about going on a date.

I was afraid. I didn’t know how men would react to my tale of inconvenient and painful but not very terrifying cancer treatment. The word “cancer” is radioactive, a conversational grenade. How do you discuss it with someone you just met, who’s evaluating whether they want to spend time with you—hours, weeks, years? How do you know it won’t torpedo every attempted intimacy? How hideous are my scars, the lingering and unflattering one-sided tan, the spaghetti-and-meat-sauce weight I gained while suffering through the four weeks of radiation?

Not too hideous, as it seemed. I went on two dates with a rather emotionally withholding math professor I met on Bumble. There was no third, unfortunately, since during the second he disclosed ambivalence about the concept of long-term monogamy.

“Once the relationship has lasted a few years, all the magic is gone,” he said. “Isn’t it better to find another person and rekindle the spark?”

Sometimes you know why a man in his 50s has never gotten married. I find dating more exhausting than stimulating; I’m hoping to free myself entirely from the romantic rat race. And I’m a Gemini. I’m creative enough to keep the relationship spark alive, or at least keep the sex frequent and enthusiastic. Either way, I’m still Team Monogamy. So there was no third date.

The main takeaway, though, was that I disclosed my cancer treatment over cocktails on the first date and still got a second. Granted, I’d been hoping to get to second base on that second date. I wanted to know if my slightly mismatched breasts are still as beautiful as my surgeon and radiation NP think they are. I’ll have to wait for the next man who sticks around for a second or third date.

Almost a year after the fateful and startlingly competent Brooklyn mammogram, it was time for my annual. This time around it was a diagnostic mammogram, along with a bilateral ultrasound, which I’ll have to do every six months for the next five years. I tried to return to the Brooklyn office that saved my life and most of my breast, but apparently their mammograms don’t diagnose—they’re just remarkably good at spotting tiny invasive lobular carcinomas.

Instead, I went to yet another outpost of the medical center, this one blessedly close to the subway, where I donned the ugliest gown of any medical visit in this tale: a flat beige even less appealing than Arizona Tan. I was able to tie the strings around my waist, so I’m calling it a medium.

As with all mammograms, it was uncomfortable, but it seemed to go much more easily and quickly than I remembered from previous years. Perhaps because nobody stuck any needles into me while I was clamped between the unforgiving panes of lucite.

The ultrasound, however, felt a lot more aggressive than previous ultrasounds, which usually skim the surface of your skin with about as much pressure as basting a turkey. The tech kept apologizing as she pressed and jabbed with the slippery wand.

“I’m sorry I have to push so hard,” the tech said, frowning and poking and squirting more warm gel on me. I closed my eyes. The ultrasound tool isn’t painful, so the apology almost seemed unnecessary, but it seemed to be taking an excessively long time. “Your breast is just so dense,” she explained, leaning in and jabbing as she tried to echolocate something elusive in the right breast. I started to worry.

“I can almost see it…” the tech murmured. This was not reassuring. She might be one of those people who talk themselves out loud through difficult tasks. It was unsettling to think that a year after my worst mammogram—a year of torment, of surgery, radiation and about a million needle sticks—another potentially lethal growth was playing hide and seek in my body.

Ultimately the tech gave up and called in the radiologist, Dr. Smrz, a woman almost as slender as Dr. Flores but with a less adventurous fashion sense. She wore a white coat, dark slacks, and entirely unremarkable shoes.

I think Dr. Smrz placed the guide wires before my surgery, but if Dr. Linden hadn’t recognized me after the three weeks between a biopsy and an ultrasound explanation, I didn’t think Dr. Smrz would know me eight months later. How could she recognize me if I wasn’t trapped in a mammogram machine? Fortunately, this time she wielded neither wires nor needles. She took the wand from the tech and confidently pressed it into me. “There it is,” she crooned, victorious. “It looks like a little cyst.”

After sounding my right breast and reviewing my mammogram, Dr. Smrz reassured me that nothing looked too dangerous. The left breast looked more or less like you’d think it would after it had been dissected, extracted, and systematically broiled for a month. In the report this was summarized as:

Expected posttreatment changes in the left breast. Six-month follow-up left mammogram recommended, per postlumpectomy protocol.

But true to form, my body wouldn’t let me rest easy.

0.6 cm probable complicated cyst in the right 2:00 axis 8 cm from the nipple. Six-month follow-up right breast ultrasound is recommended.

“We don’t think it’s cancer,” said Dr. Smrz. “It just looks like a little fluid-filled oval cyst. We could biopsy it now. But since you’re due for a follow-up mammogram and ultrasound in six months anyway, we could just re-assess it then.”

That sounded good. I had enjoyed many weeks and months unpierced by needles, and I wasn’t eager to get stuck again. At home, I opened MyChart and peered at the mammogram and ultrasound images, but I couldn’t find a small oval like the glowing, opalescent paraovarian cyst in my pelvis. Maybe that one is uncomplicated. Instead, I saw multiple dark oval shapes and couldn’t tell any differences between them. I assume this is why radiologists actually go to medical school.

I did check out the “lumpectomy cavity” in the left breast, a knobbly, elongated lemon. It’s probably silly to worry that it will collapse and leave me with an enormous dent. If the mammogram machine didn’t squish it, I can probably relax.

According to cancer.org, a complicated cyst has “what looks like ‘debris’ floating in the fluid” it contains. Nobody wants to think they contain ‘debris,’ but I presume it’s just scraps of my own flesh. The great minds at appliedradiology.com reassured me that fewer than 2% of complicated cysts turn out to be malignant. Dr. Smrz didn’t seem at all eager to stick needles in me, and in my experience most radiologists are very keen to stick people with needles, so I believed her assessment of the risk as low. Still, it’s going to linger in the back of my mind for the next six months, and I hope the next ultrasound tech doesn’t have to talk him or herself through the procedure.

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