The dream and reality of a breast lump core biopsy

I woke up this morning in a state of great apprehension following a bad dream about the biopsy.

I remember fragments of the dream. In the consulting room, a nurse made me drink 4 kidney bowls of custard which contained the anaesthetic. I also had to eat as much as I could from many other bowls of different foods including spiced cabbage, rice and other things. She told me to be sure to eat as much as I possibly could to make sure I got enough anaesthetic. Because I wasn’t so hungry this made me anxious – I asked why I couldn’t just have an anaesthetic in the usual way. She fobbed me off. The hospital was huge, old and dirty – not unlike Whipps – started off daylight but then became night. I waited for whoever it was who was going to do the biopsy in a waiting room filled with other silent people on wheely beds or in chairs. They were old and poor.

Sonja was there and we decided to kill time by going for a walk. We bumped into Bijan and Babak, who had grown up a lot – Bijan was about 13. He wouldn’t let me cuddle him, but Sonja stole a kiss, which embarassed and pleased him. A reversal – Babak was happy to see me, but Bijan was reserved.

Back at the hospital, a brindled old surgeon eventually arrived and entered the waiting room. Considering the number of people in the waiting room when I first went in, I thought I’d have a long wait, but mine was the first name called. That’s all.

In reality I arrived at the hospital and reported to X-Ray as instructed on my letter. They’re very friendly there. I was sent straight to Ultrasound, which was odd because the breast nurse had said I’d have to choose (one of many choices I was supposed to make, but subsequently demurred on) about whether to have the biopsy with or without ultrasound. Anyway, out came an HCA, Romford’s finest at a guess, call her Sandra. She gave me a gown and a branded hospital carrier bag for my stuff and sent me off to change. I asked why I was having another US when I had counted on seeing the breast nurse, to which she replied that hadn’t I’d already seen the breast nurse? I had, for just about long enough for her to introduce herself and tell me she’d see me next time.

Then after about 2 minutes wait (sat opposite an ancient, frail and by all appearances dying man in a wheely-bed whose mouth was permanently open to breathe, whose eyes sometimes opened, sometimes fell closed, completely motionless apart from his heaving chest) I went into the US room and Sandra told me to lift up the gown and get on the bed thing. She asked me if the lubrication was too hot – it wasn’t. Then things got a bit strange. Sweet, kind woman, but indelicate. After introducing herself, she put a cuddly toy into one hand (which I dropped to the floor as soon as I decently could) and promised she would be holding my other one all the way through. Previously unworried, I became suspicious and made the mistake of asking her what was going to happen. I had to drag it out of her bit by bit. Here’s what I pieced together. I had 3 lumps so there would be 3 biopsies to do. Each biopsy would involve a sharp scratch at first and then pressure – if I felt pain I must tell the radiographer (my immediate thought was that it was probably going to hurt but they wouldn’t know in advance). Oh, and each biopsy had to be done 4 times because it sometimes doesn’t go right first time. So12 biopsies, each with a sharp scratch and pressure. Then she described a big “gun” with a “very long needle”, and that did it for me. My period was due, and what with the bad dream, tears began to roll down my cheeks. She patted and clucked and reassured me that they were the A-Team, so I told her about the circumstances of the bad dream and imminent period, so that she would understand that these were freak tears which should be ignored.

In came the radiographer, who I’ll call Dr Ajaykumar. He had done my last US, nice man of between 60 and 90. In came a nurse, African woman, not as young as she looked (I know because she said later she had 8 grandchildren). Meanwhile I was silently weeping on the bed. Sandra offered to take my glasses – “Sometimes it’s better not to see”. Then I definitely wasn’t about to part with my glasses. Dr Ajaykumar tried to rally me, I kept saying brightly “I’m fine”, which I was really – especially after he offered to inject me with a double dose of anaesthetic (hello, placebo?).

He found the first lump by ultrasound and then, as Sandra pressed my left hand to her own breast, Dr AK gave me an anaesthetic injection in the top of my right one which he asked Sandra to massage in for a minute or so. I had stopped crying by then and commented that the massaging was an interesting job – she replied hastily that she was married with children and not a lesbian :-). They asked me if I could feel sensation, I thought I maybe could – but IN went the big one (I averted my gaze to the wall, while the women cracked jokes – it was convivial and relaxed in there). Dr Ajaykumar warned that the first biopsy was harder because it had to make a track. I felt the skin resist, then give, and he had to press pretty hard to get to the lump – there was a grisley sensation. Taking a biopsy did indeed involve pressing a trigger to try to shoot a hollow needle through the lump, which made a loud click but nothing else. I was vastly relieved.

I had 4 biopsies in that one, all throught the same hole I think. After about the third one I started to look at the monitor, completely restored. I observed that trying to do a biopsy without the scan (a choice I’d been offered last time) must be like searching for a needle in a haystack, and how on earth did people do it? Uncomfortable silence, Sandra and Dr AK met eyes, followed by slow but heartfelt nods of agreement. Then more scanning in my other jubbly, another anaesthetic injection and 4 more biopsies, with reassurance that they were far enough from the nipple for me not to experience discomfort (god save me from nipple lumps – they sound dreadful).

Then came the next choice. I see about this choice business – they only give you choices where there’s an opportunity to save themselves money with your blessing. I was supposed to tell him whether to take a biopsy from my 3rd lump. I told him I wasn’t in a position to do that. They discussed it amongst themselves – lots of dithering, lots of trying out ideas and looking at my response while I remained noncommittal. First they said hopefully I’d probably had enough of the experience by now. Then they said that the third lump was the same character as the other two and didn’t need to be tested. Then they said they really should go ahead or the surgeon would want to know the reason. So they decided to go ahead and I had another anaesthetic injection, but when he locked the (now horribly gorey) scanner onto it Dr AK decided it was too small to bother with. So I was dismissed.

In total I was in there for about an hour. Each biopsy took about 2-4 minutes, and in between they referred to the scanner. Then, after politely refusing their kind offer of tea or coffee, I sat for 15 minutes at the nurses station on an automatic BP monitor (thought I might flake out after all – yawn after yawn after yawn). Then walked back to the tube (very slowly, I realised, as I kept being passed by amblers) and went home.

It’s been about 5 hours now – some bleeding through the dressings but almost no pain.

I have stuff to do, so why…? AjaxWrite

It’s 9.53. This morning I have already written an abortive email demanding that my line manager change the long-time-no-see time in our VLE. I asked my Italian colleague what happened after the Lutherans beseiged the pope in 1527, as described at the end of ‘Leo the African’ by Amin Maalouf (he had no idea). Then I reported some spam. Then I looked at my jobs.ac.uk email. Then I looked at Slashdot. Looking at Slashdot involved going looking up Blackberry and Treo on Wikipedia, and trying out AjaxWrite, beta version of new web-based word processing. Very promising but has a way to go to cater for those of us who do habitually put MS Word through its paces. I can’t seem to use styles, for example, and I miss my toolbars. Anyway, promising and definitely the way things will be in The Future (with everything we write stored on the web and searched by robots, probably).
Now it’s 10:10. Back to the chapter Wiki.

Online meetings

Skyped my friends in Tasmania today for a bit. They showed me their house on their online photo album and I showed them mine on my Flickr. My house changes all the time because of all the work we’re doing on it. It was really good to see things like the view from their front window, and the chimney to their woodburner, even.

Just joined an online conference which starts next Monday – JISC’s Innovating e-Learning 2006. John came in, checked if we wanted to ‘attend’ (I still say ‘go’), paid and within a couple of minutes I was in. SO much time saved compared to registering and booking flights and accom, sorting out maps, saving receipts, claiming reimbursement etc etc. I’m not sure that my online presence is any better than my f2f one, but I’ll try anything once (well, twice – I presented at the previous one). Been previewing the presentations. The diversity of formats is exciting – html chunks, Flash presentations and of course PowerPoint. Looking forward to this – though disappointed that there doesn’t seem to be any realtime stuff. I think realtime ‘events’ are really important if you’re trying to cement an online group. I want breakout sessions with a video presence. Obviously JISC isn’t quite there yet.
Anyways… back to this effing chapter.

Google again; do equinoxes make you hungry?

It’s only 10:16 and I have already eaten my breakfast, lunch and remaining chocolate.

Google has just avoided surrendering details of search requests to the US gov:

“We will always be subject to government subpoenas, but the fact that the judge sent a clear message about privacy is reassuring,” Google lawyer Nicole Wong wrote on the company’s Web site Friday night.

“What his ruling means is that neither the government nor anyone else has carte blanche when demanding data from Internet companies.”

More on the Mercury News site.

I retrieved naivety

At 32, I’m proud to say that I have on several occasions been called naive. The first was about 7 years ago on being “let go” by Robbie, a highly urbane and worldly character and my boyfriend of the time. He was a copywriter and I think I’d failed to show enough enthusiasm for the profession, and maybe even pontificated about the sinfulness of pouring his creative energies into inserts for computer magazines. I’d never outgrown my teenage anti-commercial leanings, though admittedly back then they were fuelled by conscience rather than hard fact.

Anyway, because I was excessively tender and soft-centered at the time (unlike now) my self esteem suffered severely, and from that day forth I began to preface every opinion I dared to venture with “This is probably naive, but…”.

But one night a couple of months ago I had the eye-opening revelation that the kind of people who make a habit of calling other people naive must be deeply cynical, a trait I’ve never liked because of its inertia and negativity. But somehow cynicism has become so desirable, and so impressive that cynics are out of the closet and tolerated in public? “Ah, he’s such a cynic”, confided one colleague’s little brother, fondly. “I’m a real cynic”, said a notable academic in my subject area, unapologetically. Maybe it’s because cynicism is associated with discernment, independence, rebelliousness, it has become a quality that people (actually only men in my experience) are often quick to attribute to themselves.

Since I realised that cynics are short on the kind of idealism and optimism I value, I’ve stopped being impressed and no longer indulge them. Sometimes I deliberately misunderstand them and vehemently reject their claim to cynicism, as if they were committing a misplaced act of self-abasement. Sometimes I show sorrow for them, as if they were afflicted. Most often, I just ignore it with ostentatious displays of boredom.

Thank the lord, I retrieved naivety and my own character to boot. All my dessicated cynical readers, you know who you are – green up and put those stars back in your eyes.

The humanity of inhumanity

Last night, against my better judgement I watched Downfall (2004, Oliver Hirschbiegel), a remorseless, comfortless bloodbath, on Channel 4. It’s great triumph was the depiction of leading Nazis’ progressive psychological dereliction as the figure who had claimed their total submission spat and hissed to his ignominious end holed up like a rat in a besieged Berlin bunker.

What becomes of a people who were prepared to surrender their autonomy so completely when their gift is thrown back in their faces as useless? For some opportunists, Nazi commitment fell away with breathtaking ease and they surrendered to the Russians. But there were others with psyches too far fused with National Socialism to survive its rupture, whose only means of defiance was death. Frau Goebbels poisoned her Aryan children rather than surrender them to a world without it. A terrifying Nazi rump made its way through Berlin culling non-combatant Germans – the frail, escaping civilians – stringing them up as scarecrows to ‘restore order’ and rally troops. There were many breakdowns, suicides and euthanasia. The single chink of hope resided in a small boy with bright hair, the last of his Hitler youth brigade, as he picked his way through the bomb-wracked streets of Berlin, back to the house of his (dead) parents – resourceful, courageous, misled.

Here’s where I always lose it. If I lived back then and wasn’t Jewish, might I have been a National Socialist? I’m almost positive that I’d never have gone with its tenets but I can’t say conclusively that I wouldn’t have been a coward. London doesn’t offer so many opportunities to test yourself against a malevolent state. The world is chock full of megalomaniacs like Hitler – is it victim-blame to point my finger at the cowards who upheld him in power? What about those who upheld him through conviction? Certainly, the presence of a conscience changes the nature of a crime.

By the end I was crying so much I could hardly climb the stairs to bed, wept all through my shower, and silently into the small hours (today my period came, which I hope is the reason for the sheer extent of my sorrow). Just before I fell asleep I realised with a sense of desperation that it’s very stunting to feel guilty for events perpertrated before your time, and that the only way to exorcise this kind of haunting conscience is vigilance in the here and now. Sudan. Iran. Zimbabwe. My own back yard.

Freedom of speech ends with “leverage”

I dispute that ‘leverage’ is a verb. ‘Lever’, on the other hand, is. So we can “lever change” but not “leverage change”.

The word ‘leverage’ incenses me. Yeah yeah yeah – language is dynamic, language can change… But ‘leverage’ perfectly exemplifies a type of pedantic ignorance, particularly widespread in the U.S.A, which uses syllable count to impress and contaminates our existing lexicon with meaningless, self-aggrandising improvisations.