My Dutch Oncologist

October 10, 2013

It is a cold, rainy day when Nicole, Maarten and I enter the hospital, typical Dutch weather.

I can’t keep myself from thinking back at the quick goodbye we had with the kids. We were lucky enough that we could leave them with a sweet friend of ours. She would take good care of the boys during the next few weeks until Maarten returns. She is an amazing person with a great heart and I am very grateful to have her in my life. Actually, I am grateful for everybody in my life. All our friends reacted very friendly and helpfully when we told them the news.

This past weekend went by so quickly. Actually, I would have loved to hold hands with the boys the entire weekend; I had the strong urge to feel and smell them every second of the weekend. I am going to miss them like crazy. For how long? I shouldn’t think about that. Funny enough, the boys had a different opinion about this weekend because the whole weekend was filled with parties and friends! Maybe better for all of us. A perfect way for them to forget about everything and enjoy life. If I would be in their place and if I could choose between staying home with my sad parents or going to a party, you would probably find me at every existing party! I have to keep in mind that my boys are bigger now, 12 and 13 years old. They have other things that keep them busy.

The waiting room of the oncology department is serene and very clean. It looks like a living room; everything breathes the sense of warmth. It smells like coffee and there are nice magazines everywhere. Not even after 5 minutes a nice young doctor meets us. He could have been the brother of our king Willem Alexander. He asks us who is Renate. For the first time in my life I don’t feel proud to say that I am Renate. In the room of the oncologist we actually have a nice chat. I am a bit septic; I know myself and see that this is a tactic diversion. Not much later he tells me how he planned the treatment for me. Actually, not funny at all; a treatment of six sessions of chemo therapy, with a break of 3 weeks between each session. The chemo therapy treatment consists of 3 different medications: TAC Docetaxel/ Taxotère (the biggest evil), Cyclosfosfamide and Doxorubicine/ Adriamycine and will take about 4 to 5 hours.

He tells me that he was hesitating between 9 or 6 treatments and I wonder on which base he took his decision. Thank God he choose the last option. Anyway, I feel safe and comfortable with him.

’18 weeks’, I immediately calculate after hearing the treatment. Íf I make it, because before every next treatment they need to check my blood. Depending on the values of my blood, they will decide if I am strong enough to deal with the next treatment. The doctor continued, telling me that these 6 chemo treatments will be followed by 23 or 25 daily radiations. I immediately put a stop on this. I resolutely explain to my oncologist why I don’t want to have radiations. I want a double mastectomy, amputation of both breasts. I noticed that he is surprised but he immediately replies that we need to discuss this matter once more after we have finished the chemo treatments. When that time is near, he will arrange meetings with the responsible doctors so they can properly inform me. First thing to focus on right now is the chemo therapy.

‘I am going to check a date regarding the PICC-line (*)’, I hear him telling me. ‘A PICC-line?’, I hear myself wondering out loud. He explains to us that this is a new method to enter the infusion of the chemo. PICC stands for Peripheral Entered Central Cathether. A PICC-line is a small, slim, long silicone tube that they will enter in your upper arm by a keyhole surgery. The tube is long enough to reach the big vein nearby your heart. The PICC-line is much more newer than the Port-a-cath (PAC), which is also often used with patients who have to go through a longer treatment or which have difficulties with being injected. Something he already noticed. He’s right, my veins are really hard to find. Without realizing it, I see my sweet Bitch in my imagination holding the big needle in her hand. From a far distance I hear my oncologist juggling with some times and dates. Thank God I pop out of my daydream when he asks me if I would be ready to have the PICC-line entered next week. One day after this operation I will start my first treatment. After my approval of the dates, he lets me meet my 24/7 nurse; a nurse that will be available 24 hours a day, 7 days a week. This nurse informs me about the medication I need to take before I start the treatment and the ones I need to take after my treatment, about the nurse that will visit me at home after the treatment for a boost-injection and the side effects of the chemotherapy. Complete loss of my hair, diarrhea or constipation, skin rash, decrease of your white and red blood cells, nerve damage, change in the structure and strength of your nails and sometimes even losing your nails, allergic reactions, infections, muscle and joint pains, a general feeling of weakness and being tired, nausea, vomiting, change in your sense of taste, infection of your oral mucosa, lack of menstruation, etc. (**) Next to that, I am not allowed to share a toilet the first week after my treatment and my clothes need to be washed separately so that others will not get in contact with the chemo that I have in my body.

Pfff, this doesn’t make me happy at all. It would have been better to tell me the things that will NOT happen to me, than we could have already left an hour ago!

At last the nurse tells us that there will be a big event for everybody who is or has been affected (in) directly by cancer, organized by a foundation, knowing ‘Adamas Inloophuis’: A foot or hand massage will be offered, there will be classes of painting, yoga and mindfulness; a writer will explain her book where she writes about her cancer experience, etc. This event will take place in a building not far from the hospital. It’s called ‘seize the day’.

With a dizzy head and rosy cheeks we walk out of the hospital. Being outside again I realize that the only positive thing that have happened is that it stopped raining; the sun is shining.

 (*) A PICC-line is a central based drip that has been placed in the vein of the upper arm. The end of the line enters the big hollow vein in the chest, just above the heart.

Why a PICC-line? A PICC line is used when blood needs to be taken for research or medication needs to be administered. A drip causes damage to the veins. The PICC-line can be a good alternative when there needs to be an often administering of medication or blood needs to be taken, to prevent damage to the veins.

– Medication can be administrered in a safe and pain free way

– The body can hold the PICC-line up to 12 months

-The contrast liquid used with a CT-scan can also be administered through the PICC-line

Inserting and taking care

A radiologist will enter the PICC-line. The end of the line will be taped off with a special bandage to keep it clean. The nurse in the hospital will take care of the PICC-line

Source: www.olvg.nl

(**) A port-a-cath is a little hollow injection space, a little cap that is placed under the skin. On top of the cap there is a self-closing silicone membrane. Attached to the injection room there is a thin catheter attached. This catheter is entered into a vein. This will make it possible to enter the medication and liquids into the vein. A port-a-cath is used often for people that need to be injected often and/ or people who have a higher risk for vessel irritation (like with cytostatic). Also for people that have difficulties being injected a port-a-cath can be the right solution. By using a port-a-cath the inflows of medication will be less sensitive and painful.

Source: www.borstkanker.nl

The Bitch

September, 2013

I am in the turmoil and it is spinning on high speed.

First I had the lymph node removal. Not a very pleasant one, I must honestly say. Thank God this operation has been performed with a local anesthesia. At the end of the operation I started to feel an enormous shot of pain through my upper arm. This was probably a nerve, which is almost impossible to avoid cutting through during operations like this.

The wound under my armpit is healing very slowly. Its nice and small, but everything around it looks bruised. The surgeon placed a drain so the liquid can go out. During the operation you loose a lot of liquid and the drains helps to get it out. Maarten is very sweet and helps me every morning and evening with replacing the bandages. He himself says he has become almost a doctor. During a check up, the doctor told him not to use so many bandages (I couldn’t even move my arm anymore because of so many), Maarten answered, “I just said that I am only half a doctor!”

During the operation they removed 6 lymph nodes and luckily they were all clean. As to say: no metastasis! I am just so happy!

With my right arm half way up (because of all Martin’s bandages), I go through all the researches. These go quick, fast and good, all straight after each other. My friend was right: almost every result makes me really happy. No metastasis in my lungs, bones, liver, blather, uterus and ovaries. Everything looks clean!

The last research is an MRI scan. One of the worst checks of all. I know I have to lie still in a tunnel for at least 12 minutes. With this in mind, I postponed my visit to the restroom until the latest moment possible. I enter the room in my little paper dress and ask the doctor where the rest room is. The doctor (an enormous bitch) makes a deep sigh and says, “To the rest room?? Now?” Irritated, she sends me out to the only rest room, which is not located next to the changing room, but all the way in the back of the waiting room. I had to go through the waiting room full of people, all, in my paper outfit! After passing the waiting room twice, I finally lay down on the table of the famous MRI tunnel. I was a lot more nervous and ashamed, but at least with an empty bladder. The Bitch quickly explains to me in an irritated way what is going to happen, while standing next to me with an enormous needle for the infusion. My veins are really hard to find, I know from experience, but with this needle she is messing enormously with my hand. Needle in, needle out, not a pleasant feeling at all. I try to explain the bitch in a nice and sweet way that normally they use my other hand because there the veins are thicker and easier to find. Without looking at me she takes my other hand, but again, she can’t do it. I start to believe that it’s not because of my veins, but because of her. “I shouldn’t listen to other people”, I hear her mumbling to herself. I feel like a sad and poor object at the moment. She finally gives it another try at pocking in my other hand and again she starts to grumble. Finally the needle is in. Thank God! I let her know that it is hard for me to lift my other arm because of the recent removal of some lymph nodes. Again I hear her grumbling, “Couldn’t you have told me before?? Now I need to check if the whole MRI procedure can continue!” and she walks away. ‘Luckily’, she returns with the message that we can continue and that I am allowed to go in the tunnel. She explains me that she will fill up the liquid again, at half of the scan. This is good to know. At least I will know when I am on half time.

I understood that in Holland, being in the tunnel of the MRI, you keep in touch with the doctor. And if I am correct, you get a little device in your hand that you can squeeze when something is wrong. Squeezing puts you in contact with the doctor in charge. You even get to listen to some music and you can bring along your own music, trying to minimalize the sounds of the MRI.

Unfortunately, nothing of all above mentioned in my current situation. I have to lay down on a stiff board table with two wholes in it. My breasts fit exactly in it. I lay my head down to the left side. My arms have to be stretched out next to my head. It hurts incredibly but I promise myself to continue and finish it. I have to. The Bitch says something to me that I can’t hear and in a natural reflex I turn my head around, but at that moment I bang my head very hard against the wall: BENG!!! Ouch! Stupid me, I am in the tunnel of course! I realize that there is no possibility to move. Pfff, I am already smothery. The Bitch still screams something at me while I feel that the table where I am laying at starts to move. Not much later I hear an enormous noise of the tunnel. Waves of very loud noises alternated by loud ticking. It keeps going on. I feel I don’t know if I can keep going on… I try to calm myself, but I feel like screaming real loud: “I want to get OUT!” My arm hurts immensely. ‘Renate, remind yourself of beautiful and nice moments’, I try to calm myself. ‘Come on girl keep going! It’s only 12 minutes of your whole life’. While I lay there very uncomfortable, I manage to think about something that makes me happy: happy moments with Maarten and the boys, friends and family. In my mind I also start reading the cozy magazine LINDA. It may sound funny but this Dutch magazine always makes me happy. In my mind I turn the pages; beautiful pictures, interesting interviews and funny stories, Dutch happiness.

And all of a sudden, the sounds stopped and the table moves back again. I survived! I am not claustrophobic or quickly panting at all, but this MRI… I decide I never ever want to experience this again, or I will choose to have an anesthesia…

On recommendation by others we decided to make an appointment for a second opinion at the Presbyterian in New York. We will leave right away after receiving the last results, the ones of the MRI. Just before our departure, we pick them up so I can add these to the papers of NY. While in the car I am quit anxious and I open the envelope to read the outcome of the MRI. All my faith and hope drop immediately. If I understand what I read, their advice is to remove the lump in my other breast. I kind of forget about this lump, but the Bitch of the MRI reminds me about it. Maarten immediately contacts the surgeon and he responds amazingly: he is able to operate me immediately the next day in order to remove this tumor. One extra ride in this crazy turmoil.

Removal number three.

The results show that the tumor is mitigated. ‘But’, the pathology department tells me, ‘the tumor has a weird shape so it is a good thing that it has been removed’. I am not really sure if this is something that I wanted to know…

Due to the unexpected extra operation we had to cancel the meeting in New York. As they are very busy they let us know that a new meeting can only take in 2 weeks. After talking to several people, Maarten and I have decided that it would be better to have my treatments back in Holland.

With the help of my mum and sister we get in touch with an oncologist in Holland. All my results that have been translated by a sweet friend have been scanned and sent to the oncologist and we made an appointment. I have a good feeling about this. My family in Holland feels very relieved: finally they can do something for me. For me it feels good to be able to speak my own language during this period of fighting this terrible disease. This knowledge calms me. But the fact that I have to leave Maarten and the children behind doesn’t feel right at all. My boys are very relaxed and positive. “Everything will be alright mum. Really, we will be OK!”, they try to comfort me. At the end I do believe this is the right decision: Maarten can continue his work and the boys can continue their school and meeting up with their friends. Without being confronted with a sick wife respectively mother who can’t stand for the person she wants to be for them.

We have to get through this together. We all do. I promise my boys that I will come back strong and healthy. Stronger and healthier than never. I get my act together. I can do this, together with my three men, family and friends. Holland, here I come!!!

The Diagnosis

September 13, 2013 (Friday)

Finally Maarten and I enter the doctor’s room. Of course, we had been waiting a couple of hours. The surgeon came in running and complaining. “Everything is working against me”, I hear him whispering and he’s complaining in an apologizing way. “Well, hopefully that will stop now.” I joke, while Maarten and I sit down in the chairs opposite of him. I look at the doctor waiting for the answer. I see it right away.  Our surgeon, the nutty professor, had the same face as he did last week when I visited him with my friend. I feel an enormously strong and hot presence going up from my feet through my whole body. No! This is impossible! I can’t have breast cancer? I don’t want to be sick! I don’t want to have cancer! I am still young, aren’t I? I don’t feel sick at all! No, this is impossible! I don’t want to die yet! I am not done living yet! I still have a whole lot to do in life, together with Maarten and the boys, my family and friends! I want to see the boys grow old! I want to know to which fantastic woman they will get married! I want to enjoy my grand children when the time is there! I still have so many travelling plans! I made the agreement with Maarten that we would still enjoy a cup of coffee and a croissant together in 30 years on a cozy terrace that is surrounded with colorful Bougainville, under the sun in the South of France! I can’t die right now, right? Hopelessly I look at my sweet Maarten and I feel the first tears dropping down my face. Far away, I hear Maarten talking to the doctor and making an appointment for the next operation scheduled on Monday. My lymph nodes need to be checked; he will need to take some of them out to see if there are any metastases (the lymph node procedure). He also gives Maarten an extended instruction on a bone scan, long scan, an echo of the pelvis, uterus and ovaries, MRI and more blood work.

He explains that this is not the normal hormonal breast cancer, but a very aggressive type, triple negative. A very fast growing type of cancer, which is not sensitive for hormones. “You will be alright”, I hear him say, “but we can’t wait too long anymore, so we need to perform the test as quick as possible”.

We leave his room numbed. Déjà vu. Crying again. Only now I am the one crying in the arms of Maarten. In the hallway my friend is waiting and she cries along with us. The doctor is looking at us from the door of his room, waiting for my friend to enter. She has already done all the tests and needs to discuss the results. She has entered the crazy turmoil of the hospital. From of today, I will join her; in the turmoil of the hospital, in the turmoil of life; for the rest of our lives.

Back at home I immediately call my parents. My mum hears my voice, doesn’t hear me correctly and thinks that I am laughing. I hear her “laughing along” and ask her why she is laughing. “Mom…”, it’s hard to express the words with my dry and thick throat, “I have breast cancer.” I express to her. She is silent for a long time and suddenly starts asking questions. She doesn’t understand it. “How is that possible? Why you? My daughter! If somebody should get it, it would be me with my 73 years. Not you!” She touches me and I understand her. It must hurt immensely; being a parent, you want to have all the terrible diseases, as long as they do not affect your child.

After my mom, I need to let my sweet sister know. She’s shocked, but I feel that she’s keeping strong, that’s the way she is. It makes it easier for me to express myself. I explain everything to her and I tell her that after my lymph node operation I will have more information. Most certainly I’ll get chemotherapy because of the size of the tumor and the type of cancer, being very aggressive. “And I just finally had my hair long!” I hear myself making a joke. When I am done talking to my sister, I try to find some energy to call some friends. After that I put the phone away. I am done. I am tired and can’t remember the last time I cried so much. I hear Maarten coming home. He picked the boys up from school. On the way home, he explained to the boys what is going on. When I see them coming home, the only thing I can do is cry. My sweet boys. Here I am, your mom… sick … a wreck. That is impossible? I have to be strong for you guys. I hug them, I love to feel and smell them. Maarten and I have always been very open and talk a lot. We think that is very important. I know that there will be people who will choose to hide their illness, I respect that, but that’s not me. I wouldn’t be able to do that. This is life and life ain’t all sunshine and roses. I don’t want my boys to be overloaded with fear and sorrow, but I do think they need to know what is going on and that these things are part of life. I explain to them that I will have to take a lot of tests from now but that I still have no clue about everything that is going to happen. “I am not going to die, do you hear me?!” I tell them. And again I feel the tears dripping down my face. The last thing I want them to think is that their mom won’t be there for them anymore.

The weekend is a weekend of surviving. The only thing Maarten and I do, is cry. Honestly: yes, I do think I will die. Thank God we contact some friends: their son was diagnosed with leukemia and has now fully recovered. They fought with the complete family and they won! They motivate and encourage us. They encourage me to never forget some things: “Patience.” “Anything can happen”(todo pasa). “Never pity yourself and there are worse things.” My friend and her husband visited us. She finally received her positive results, after a week, of her tests and she let’s me know that these will give me hope as well. I hold on to her words.

I decide to be strong. Yes, I have breast cancer but I will fight like crazy. Be prepared, you silent killer. Here I come! You won’t get any chance with me; I WILL SURVIVE!

‘Our’ surgeon

August, 2013

Sick people, kids crying and screaming, exhausted nurses and doctors that come in and out. Once again we are waiting for a doctor. Thanking my friend for her faithful companion so the wait could be pleasant and while we recall things that happened in the summer. She is a lovely, beautiful, super intelligent and strong woman, but without any doubt at this moment she is very nervous. Today she’ll get her results of pathology. We are sweating because this time there’s neither air conditioning nor a VIP waiting area! No, this time we are, just like everybody else, waiting in a plastic chair in the hospital hallway.

After 2 hours we are going in to the see the surgeon. My friend introduced me to the surgeon and explained briefly why I accompanied her. He is exactly how I expected him to be, an Einstein type! He comes toward me and I start telling him my version to make sure that he sees the importance of taking out the cist the faster the better, and without general anesthetic, of course!

He accompanies me behind a curtain and there I show him my lump and I noticed that it has been to many people that have seen my breast these last few days, oh God! As I go back to his desk where my friend is waiting, the surgeon says that indeed he is able to remove the cist (my little lump) with local anesthetic and that’s exactly what I wanted to hear! I get really excited! He looks at his schedule and he asked me when do I want the operation. “Yesterday!” I answered, he looked confused thinking that I didn’t understand his question and I noticed that my Dutch humor hasn’t been appreciated… We agree that next Monday is the first option that I have after my enthusiastic response of “yesterday”.

Now it’s my friend turn the surgeon takes her behind the curtain to check her wounds. Meanwhile I sent a message to my husband Martin, letting him know that the operation can be done on Monday. Thank God my husband can accompany me because he’s going a trip next week. Without noticing my friend comes back and I feel I have to let go my chatting with Martin. When I look up I see my friend crying like Magdalena. Suddenly I got goose bumps all over my body… What happened?! Don’t tell me that…?

Yes… the doctor just finished telling her that she has breast cancer.

Monday came and I can’t stop thinking about my friend. What a nightmare it must be to go through all this. I imagined the horrible weekend that she went through… I really try not thinking about it but I can’t! I left her a good luck charm in her house, a steel angel with a little candle, hand made by me. Love, hope, faith and warmth is what she needs. But what can I do?

Now concentrating on me, more nervous every minute waiting for the surgeon. It has been an hour since they called me to take off my clothes and change into a paper dress. They took me through the general recovery room to a very small bathroom of one by one. It was disgustingly dirty, inclusive there was a large garbage can to deposit medical stuff that was full. They gave me a garbage bag from a local supermarket to put my belongings and after I put my stuff in there the nurse gave the bag to my husband Martin. He is very anxious because he can’t be there to wait with me. In the hallway there are a lot Dominican families, big complete families. Families occupying all hallways, being very nervous and loud. I understood this is very typical of this country for the whole family to be there when one relative is sick.

Once in a while Martin tries to go in but they don’t let him. Neither can he call me because he has my cellphone in the plastic bag from the supermarket.

Bit by bit my paper dress starts to break. I try to close my legs in an elegant way to hide what is underneath, fighting to put ends of the dress under my and between my legs; not easy! What a disaster. I try to calm down thinking that the doctor is going to come in at any moment; I make up some sort of game believing that he will come in when the arm of the clock is on certain number. But so fair I never win; the doctor doesn’t show up at any moment.

Finally, I don’t know after how long, the doctor comes in and we are going to start. It is really going to happen: he’s going to take out my little lump!

The intervention is a kind of weird, I can hear everything they’re saying. The sensation of being “present” and perceiving everything feels awkward.

After the operation, I asked the surgeon if he could see me on Friday for the results because my husband is going on a trip on the weekend. Thinking about my friend and what happened, I keep thinking of her results and it worries me. I want Martin to be with me when I go for the results.

Finally we can go home. I am tired but relieved: I got rid of my little lump!

Cysts all over!

August, 2013

 

Honestly, I’ve had a lot of luck getting all my tests done, referring to the famous system of “first come, first serve”. One of my friends is married to a well know person and for that reason they received us in the VIP waiting room in one of the clinics. One waiting room that left me amazed! With leather sofas, air conditioning, flat screen TV’S with the most popular show of the country; the only thing missing was a glass of wine!

Not even ten minutes have passed when the nurses were already taking us out of this beautiful and comfortable waiting area to proceed to start with the tests. I even felt bad to have to get up from that comfortable sofa.

When they were going to withdraw my blood I tried to convince my friend to go with me so she could have her blood test done but, sadly enough she had a small party the night before and she still had trace from the six bottles of champagne running through her blood. There was no purpose to analyze her blood in this condition. She did do the mammography with me, knowing the importance of frequently getting it done.

Dragging my nervous friend through the white and long hallway of the hospital, I seemed to be the brave one of the two of us, but I felt insecure and vulnerable since I suspected that the results of my tests were not good.

Once I received all of my results I compared them to my friend’s results, mine were indeed not that positive. Beside the cyst on my right breast I had another one on my left one, although smaller. Surprisingly the results showed me two more ciyts in my ovaries…

A biopsy was recommended of the cyst on my right breast and therefore my gynecologist sent me to a mastologist.

Finally in the consultation with the mastologist, I remember how carefully he touched my breast and studied them with much attention. He examined the ganglions under the armpit and thank God there was no inflammation. After answering a list of questions about cancer traits in my family, where thank God there is no history in my immediate family (as far as I know); the mastologist gave me two options: Take the cyst out or leave it where it is. Of course I want it out, not even giving a thought to the second option, I want him to take everything that doesn’t belong in my body out. Unfortunately the mastologist insisted in doing it with general anesthetic because according to him he need time to do the operation so he could leave my breast in the best way possible since it’s the most beautiful and important part of a women. For this reason he considered doing more tests even though I don’t like them. I didn’t feel like doing more tests or visiting more doctors and cold clinics but let them do it already because the little ball has me desperate! Let them take it out, every day the little bump gave me more a sense of disgust.

“What a horror! I have cysts all over my body!”, I am letting some steam out with my friends, they are so nice, they tried to calm me down. One of them incidentally had a little bump removed last week and she convinced me to go with her to her doctor, she has an appointment to get the results of the pathology test and I could sneak in, I thought with naughty kids face. She said that her doctor is a prestigious surgeon here in Santiago. A doctor with a lot of experience.

The fact that her operation has been done with local anesthesia convinced me to go with the same.

When I say goodbye to my friends one of them gave me a cup with a mixture of raw onions and beets. It looked like a witch position but according to her it eliminates all the cysts in a blink…

Could it really be that one day that I will get rid of my little bumps?

My gynecologist

Finally I am laying on the examination-table at the gynecologist’s.

I think of the three hours I have been waiting! Apparently the doctor had an ‘emergency’ so he took forever to arrive. Well, what can I say. Maybe it’s unfair of me, but sometimes I think that they are simply enjoying a nice party lunch or taking a relaxing nap.

After the lunch yesterday, I called one of my best friends right away, explaining vaguely my situation and asking if she could make an appointment for me with her gynecologist. I realized I don’t even have a gynecologist here in the DR. Only once, I visited a gynecologist and it must have been like 4 years ago. I cannot even remember his name. My friend didn’t take more then a couple of minutes to call me back to confirm today’s appointment. She is really frantic for doctors and hospitals. Unfortunately, she has a valid reason; her mother died of breast cancer at an early age. That’s why she took the opportunity to go together with me and have her annual checkup and to be honest, undergoing these kind of visits is much more fun together! Or better said, less uncomfortable. While waiting for the doctor, we were happily talking with each other; about what we have done during our vacations, how the kids are changing into teenagers, us getting old, etc. After an hour we started giggling. The sterile, silent room, full of desperate women made us giggle even more. But after an hour or two, unnoticed, we were tired of waiting we realized we were not waiting to enter a relaxing Spa.

I’m not really afraid of doctors, nor have I had a bad experience, but I just don’t like to visit them. Somehow, I always find an excuse not to go. ‘Being too busy’ is one of them. Nonsense of course. I just have to free up some time! Not easy. Even more difficult here in the Dominican Republic, because of the system most doctors use, which is ‘first come, first served’. Who in God’s name invented this system? The silence was interrupted by a thrilling sound of my cellphone. A message of my dearest sister: If she could come and visit us this November? Yes, she made my day! She made up for all the waiting!

«I think it’s a fibro-adenoma as it feels very round and solid.» Without even understanding such difficult word, I at once woke up from my thoughts. Suddenly I became aware of some fingers touching and trying to move around my little lump. I realize I am still laying on the examination table.

«I really don’t think you’ll have to worry,» my gynecologist added, the owner of the fingers. «But for your own peace of mind it might be better if you have an echo and a mammography and some blood tests,» he concluded.

After these last words I can put on my cloths again. Quickly I sit in front of the doctor, who hands out a bunch of papers referring to all the studies and analyses I had to do. He also gave me a little jar, containing the Pap smear. I need to take that to the laboratory. I can’t help laughing while remembering the first visit to a gynecologist 4 years ago… He also handed me out a similar little jar. I couldn’t understand the words he said, as he spoke too fast Dominican Spanish for me. Unnoticed, I tried to make something out of it myself. Something logical. I assumed this was some medicine, so I asked him innocently: «How many times a day do I have to take this?» Without even a little smile on his face he explained to me that this was the Pap smear and that I should take it to the laboratory downstairs. Not often I have felt so ashamed!

“So, when you have all the results, you let me know”, the doctor again wakes me up from my thoughts.

Finally, we got to leave the hospital. Tired but satisfied, we are one step further!

A lump

August, 2013

Renate/survivor: It is a Monday on August 2013, after being away from summer vacation in Holland, I am trying to begin with all the daily routine habits. I feel good, I just came back from the gym, after some classes of Zumba and Kick Boxing. I love to feel that my body has been working! (I think that going to the gym two hours, three times a week is necessary for my body.) I feel I really need it, and now even more after all I ate and drank during vacation. I enter the shower quickly, because I don’t want to arrive late for lunch with some friends. While moving quickly in the shower, I drop my soap. As I bent over to pick it up, I feel that my right arm goes against my right breast. Almost without realizing I start to feel my breast and begin to check. All of the sudden I am on fire! I feel a little lump!!! Yes, really, I feel a lump, I feel again, and again…, it’s there. I can move it between my two fingers. It is solid and it doesn’t hurt… I am in shock…

I don’t hear anything from what my friends are telling me during the lunch. It seems that they have had a very nice vacation, but actually, I don’t get A-N-Y- T-H-I-N-G. I am still in shock…

Comment Patricia/Psychologist: Renate, your story prior to the diagnosis was probably similar to other women. If they could tell us the story of the little lump, they would come to realize the shock and before this, submerge into series of human fears related to the possibility of having a diagnosis of this kind.

I would like to share with you the 6 D’s, written by Holland (1979), like the most important fears that invade the person who faces the diagnosis of cancer, which are:

1D: Fear of Death: Of the consequences of the illness

2D: Fear of Dependency: Of the family and medical personnel

3D: Fear of Disfigurement: Of physical and functional changes

4D: Fear of Disability: To achieve objectives

5D: Fear of Disruption: Mainly of social relations

6D: Fear of Discomfort: Resulting from the disease and treatment

Personally and because of the work experience everyday with people who have cancer, ‘Fear of Pain’ and ‘Fear of Suffering’ may be added as one of the main fears; not less important than those set by Holland.

The moment you are confronted with the lump, you don’t start with all the fears; just with some of them. Because you do not know what really happens and you’re in shock. The only thing you have clear is that something is wrong with you. Something that does not hurt. But, despite of being scared and that your life may be in danger, the world around you goes on with ‘normal life’, without imagining what you’re facing. And, so far, ALONE.

But Renate, if you dare to tell us what happened as from this fact, as significant and radical, we can identify together all these warning signs that emerged as the days passed. And how mentioned fears often accompany the patient during the individual process.