The "Power" in Empowerment

As I look ahead to surgery in the coming month or two there are two surgeons on my team.  Dr. Knaus, the Oncology surgeon who would perform the lumpectomy/mastectomy; and Dr. Pavone, the plastic surgeon who would perform reconstructive surgery.  Both men were referrals from The Block Center and both have proven to be wonderful.

Let me just say that when you're sitting in the exam room with a pink paper shirt on (a mini gown that opens in front and doesn't even cover your belly button) the last thing you want is for your doctor to come into the room and make you feel even more awkward.  And that is why I am so thankful for Dr. John Knaus.  The first time Pete and I met him, about 4 months ago, he was so very kind and thoughtful.  Pete and I sat and talked with him about my situation, of course, but then talked about our joys, families, activities and so on.  He shared about himself as well, his family and personal love of fishing.  At the end of our visit (it didn't feel like a "doctor appointment") he sent me off with his personal cell phone number and a kiss on the cheek.  Wednesday was no different.  Greeted with a firm handshake and a kiss on the cheek my heart swelled from the moment we said hello.  I had been nervous about this appointment but with that greeting all anxiety melted away.  

We caught up on life over the last 4 months, including the course of my chemotherapy treatments, his weight loss that I had remarked on, how my children were doing as well as to discuss specifics for my upcoming surgery.

As per my recollection, I had been directed by every oncology surgeon I'd spoken with, toward a bilateral mastectomy.  The reconstruction part was always up to me, however the mastectomy part seemed like a given as far as any health care practitioner I'd talked to was concerned.  Believing that I had no options in this matter left me feeling depressed and forced into something with which I wasn't completely comfortable.  

"What have you decided?" he asked me.

I confess I couldn't speak for a moment, I was so taken aback by the question.

As he waited for me to reply, I explained to him that I had been under the impression that I didn't have a choice or decision to make.  That I HAD to have a mastectomy.  He kindly and calmly explained that I do have options and he laid them out for me: 

1. Lumpectomy with close monitoring due to the risk of recurrence.

2. Unilateral mastectomy with or without reconstruction with close monitoring.

or 3. Bilateral mastectomy with or without reconstruction and moderate monitoring as this procedure would provide a 98% chance of "cure".  (Cure is in quotations because there is no defined cure for cancer.  A person who has survived a cancer diagnosis by 5 years is considered "cured", however, all treatment for cancer is experimental.  I feel it's very important to clarify this.)

Dr. Knaus assured me whatever I decide to do he will work with me.  If I choose to act conservatively  with #s 1 or 2, he explained I would be watched carefully.  He further explained that if I wish to distance myself from the medical community and to carry on with life, then the most aggressive approach, a bilateral mastectomy, would be best.

For the remainder of the appointment he took time to answer my questions as I sought more specific details regarding incisions and scarring, length of surgery and recovery and anything else I could think to ask him about.  He provided the facts and was honest in giving his opinion when it was solicited.  It was an open and honest conversation.  He made eye contact with me, called me by name and waited patiently for me to answer his questions.

Leaving the exam room I noticed how light I felt.  I definitely felt better leaving his office than I had coming in.  I made it a point to tell the office staff how much I appreciated their kindness, as well as that of their boss.  It makes all the difference in the world to have kind people to work with when in the midst of a health crisis.

I went into my doctor's appointment on Wednesday railing against the idea of having to have at least a unilateral mastectomy and knowing most would advise bilateral given my genetic risk factors.  I left the doctor's office almost certain that I will be choosing a bilateral mastectomy given my genetic risk factors and feeling confident and good about the decision.  Dr. Knaus had given me my power back.  He handed me the reigns and told me to decide.  He gave me clear options and answered all my questions so that I would have all of the information I would need in order to make a decision.  In doing so, I was led right back to the recommended course of action.

Given all that I have learned about cancer, wellness and my body over the last several months I remain torn with this decision on some level.  Torn because I know there are no guarantees that I won't get cancer again whether I act aggressively or not.  Torn because I know that genetics are not a road map to the future and there is so much happening in the medical world toward treatment and prevention that it is incredible.  

At the end of the day, however, I will make a decision based on the treatment of the day and the information provided me; I will make a decision for my husband and my children, the choice that is likely to afford me the most time possible with them.

As I look ahead toward surgery in the next couple of months I'm so thankful for my team.  I am thankful for the doctors, nurse,  therapists, family and friends.  I am so very grateful to God for the way I have been led and cared for on this healing journey.