Citizen of the Month

the writing and photography of Neil Kramer

Good News/Bad News

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The good news is that Sophia doesn’t have invasive breast cancer.

The bad news is she has DCIS (Ductal carcinoma in situ).

What is DCIS?

DCIS is not life-threatening. It is non-invasive, and is considered the earliest form of cancer—Stage 0. Stage 0 breast cancer (sometimes called pre-cancer) is an uncontrolled growth of breast cells that is stuck inside the milk duct where it started. It has not yet figured out how to spread outside the duct or to other areas of the body.

Although this cancer stays inside the milk ducts, it is associated with an increased risk of getting an invasive cancer, or cancer that has spread to surrounding tissues, in the future. The risk of the DCIS coming back is extremely variable and depends on the size and personality of the DCIS, as well as the type of treatment. Recurrence of cancer can be either non-invasive (not life-threatening) or invasive (potentially serious). The main goal of treating DCIS is to reduce the risk of an invasive cancer later on.

Another downer is that the doctors want Sophia to come back for another surgery in the same spot– in TWO AND A HALF WEEKS from now. This will be the third surgery she’s had at Cedars-Sinai in less than two months. It seems that the DCIS was found very close to one of the margins, so they have to do a bigger surgery.

Now, remember when we bad-mouthed Cedars-Sinai for their treatment of Sophia’s mother when she was in the hospital? Remember we changed our mind about Cedars-Sinai when everyone was so kind to Sophia during her surgery? Well, we’ve changed our mind AGAIN. It seems that when the surgeon at Cedars-Sinai took out the tissue, he forgot to mark the orientation (the North and South, so to speak) of it, so now the pathologists have no idea whatsoever near which margin the DCIS is located. Apparently, doing the orienting is a standard procedure. Because of this error, the surgeon will have to cut out more tissue all around. Sophia is incredibly pissed off at the doctor for that. She insisted that I write about this detail here, but I was nervous about mentioning the surgeon’s mistake.

“Do we really want to get on his bad side?” I asked. “After all, he’s probably going to be doing the surgery again.”

Sophia was adamant.

“Don’t write about it all if you’re NOT going to tell the truth about what happened to all the people who have been waiting to hear from us.”

Sophia is pretty sad and upset. I’ve been trying to be upbeat all night, telling her to look on the bright side. It is non-invasive. But maybe I’ll shut up for a while. Sometimes, it’s good to let someone be angry, although this is an area that I’m not very good at. I never know what to say, other than “Don’t be angry and sad.”

Thank you all for your wishes, prayers, and the good cheer you sent Sophia’s way. Keep ’em coming.

“You should go back to writing your regular stuff.” said Sophia. “We all could use something funny.”

70 Comments

  1. I understand Sophia’s frustration with the doctor. My grandmother is a two-time survivor of breast cancer. Both times it was found because of self-exams. The second time the doctor tried to pooh-pooh my grandmother’s concerns. (She worked as a nurse’s aid, by the way.) My grandmother was insistent and the cancer was discovered.

    Sophia is right. Screw getting on his/her bad side. Right now it’s all about getting it right.

    I’d try to add something funny but my life isn’t all that funny right now either.

    Although I have had good luck with doctors to date, I also recognize their fallibility. And in Sophia’s case? Inexcusable. If it is SOP to mark the directions, then the doctor needs to be flogged, at the very least.

  2. Neil, thank you very much for the update and the detailed explanation of DCIS. You’re right, it is a good news/bad news kind of thing. I would be livid if I was Sophia. I’m so sorry that she must be subjected to yet another surgery. I’m sending good thoughts your way.

  3. Oh, Neil, I’m so sorry to hear that Sophia is going to have to have surgery again and of course even more sad that it didn’t turn out to be 100% good news. Even though I know you guys are frustrated about the foul-up, the “stage 0-ness” certainly is encouraging. Keep us posted, thoughts & prayers will remain with y’all, and much love & hugs to you both.

  4. So glad it’s stage 0 and glad they did something about it – here they take a long time to even look at these things. Sorry about the messup – that’s so frustrating!

  5. Oh my dears. What a difficult time this is for both of you. I can’t even imagine what it feels like.

    Yeah, Neil, sometimes it is best to allow someone to feel angry and sad. It is hard to stand by helplessly and just listen.

    I can imagine some amazingly humorous post coming from you soon, because if you are anything like me, it’s the best way to express some of the most complex of feelings … through humor.

    So, I, for one, will be standing by helplessly listening – really listening – and continuing to hold you both in my thoughts.

  6. i do think it’s good to vent, maybe sophia should be a guest blogger to get her frustration out, you could be her editor?
    prayers continue for your beloved, my card is on route because i kept forgetting to mail it, but my thoughts about her (and you) have continued. get well lovely lady.

  7. The risk of the cancer depends on its “size and personality”?

    Oh my God–even tumors have personalities?

    Sheesh!

    OK, Sophia, we’re all envisioning a puny little pathetic no-good lazy whiner of a tumor that is being voted off the island/the blog/your boob/your life/ and Neil’s life by all the amazing, witty readers of Citizen of the Month.

    Is everyone with me? Leave your comment now to send this pathetic, weak, squirrely, sissyfied tumor into oblivion.

    It’s 15 minutes of fame is OVAH, baby.

    (Hope that made you smile, Sophia. And I recommend drawing a compass on your tit before the next surgery. Maybe a freakin GPS is an even BETTER idea.)

  8. I can certainly understand Sophia’s frustration, but I’m glad to hear that she seems ready to move forward! She’s absolutley right that being honest and open about the entire situation is what’s best, stay healthy, Sophia!

  9. “Sometimes, it’s good to let someone be angry” … this is true, Neil, especially when somebody is messing around with your body. I’m glad Sophia has you in her corner. Prayers to both of you & I’m so glad that it wasn’t the worst case scenario. Much peace and love, JP

  10. I’m very happy that the surgery went well and just as sad and angry that she has to go through it again and that the nurse made that mistake. Please tell Sophia she is in my prayers though and that she is going to beat this pathetic, loser of a cancer.

    And, Sophia, if you need to yell at someone feel free to yell at me and let Neil have a break – I am used to it 🙂

  11. Praying for Sophia…sending good thoughts to you and S-

  12. Who needs all this tsuris?! I am just glad it is a much milder diagnosis out a whole array of possibilities. I have something called Atypical Ductal Hyperplasia, which was discovered through a surgical biopsy. It’s not cancer, but it’s something to keep an eye on.

  13. Oh, geez. This is good and bad. Do let Sophia be frustrated and angry. Someone suggested letting her write here; that’s not a bad idea.

    And what Dagny said. Hugs for you both.

  14. Thoughts going through a surgeon’s mind:
    OMG! I’m going to be on a blog! Sponge. I wonder how many people read it? Clamp. Probably millions! Retractor. She’s so cute, taking pictures for it. Protractor. OK, it’s another day, another surgery; nothing unusual here. Suction. Does my hair look OK? East-West orientation: marked. Did my smile look a little forced when she photographed me? Scalpel. Is there something in my teeth? OMG, I think there WAS something in my teeth and I’ll look like an idiot on the blog. DCIS – stage 0. I should have worn my nicer scrubs. All done here; sew her up. The lighting in here is certainly harsh. Just another surgery in which I don’t divert from the SOP, never do. Gauze. Does this surgical mask make me look fat?

  15. I’m with the others….it’s ok to let Sophia be angry. And while it is not the news you wanted to hear, it is certainly better than the way bad news it could have been. You are both in our thoughts and prayers.

  16. Non-Highlighted Heather

    May 15, 2007 at 5:21 am

    As a woman, I can only imagine the fear and the sadness associated not only with facing cancer, but facing the alteration of a breast. I watched my mother go through it with a double mastectomy. And even though she had non invasive lobular carcinoma in situ, after seeing my grandmother die after doctor’s weren’t aggressive with her cancer, she opted for the mastectomies with reconstructive surgery. My mother in law also went through the sadness of having a breast permanently altered through a lumpectomy.

    I don’t know if that’s part of Sophia’s anger. I don’t know if they’ll be removing enough tissue to possibly alter the shape or form of her breast, but if they are, I have to imagine that’s one of the things causing her anxiety. As evolved as we women can be, our breasts are part of what define our femininity, our beauty. Losing a piece of that is traumatic. Again, I could be totally off base, but that’s just a thought that went through my mind. And if I am right, it’s just not something you can shrug off and not be a little (or a lot) angry about. Give her the space and the time that she needs to work through her emotions. Words are useless in this situation. Just be there. Let her vent, let her cry, let her find her way through this.
    And if she needs a woman to vent on, you both know where to find me. I can be there in a half an hour.

    xoxoxoxoxoxo. It’s gonna alright.

  17. I don’t come out of my shell to comment much, but now’s a good time to say how glad I am to hear the Good News. The Bad News is bad, aggravating, angering, expensive, painful, wow, so many things, but the good news is good news. I wish both you and Sophia the patience to deal with the bad. And, of course, good health and a rapid recovery.

  18. I am so sorry she has to endure yet another surgery a well as this diagnosis. My thoughts and prayers are with you both.

  19. Man, I’d be pissed off to no end at a screw-up like that. Sorry to hear about that, but I’m really glad the diagnosis was non-invasive.

    Thanks for the update, Neil. Been saying prayers for Sophia.

  20. Ok, that just SUCKS!!!! Praying for you down here in Alabama.

  21. I’m not sure all the right words even exist for these situations. I can’t imagine how upset Sophia must be with an oversight like that.
    You’re both still in my thoughts and prayers, even if the words are not right. Take care.

  22. Fuck the surgeon. And fuck cancer.

    Tie a knot and hang in there guys. It’s not the best possible news, but it’s not the worst either. xoxo

  23. i’m sure sophia’s DCIS has a good personality, probably a sense of humor too

  24. I’m not if your insurance covers it or not but perhaps it’s time for a trip to Sloan- Kettering? Or I can give you a great name for a surgeon in NYC, (one of my best pals used her.) Email me if you want.

    Wishing you both all the best…

  25. I don’t have a clever or insightful comment, but you guys are in my thoughts.

  26. That really sucks that he didn’t know which way is up! Did he at least offer to give you 25% off the bill? Ya, didn’t think so.

    Hang in there Sophia and be pissed off all you want, hit, kick or throw something (watch out Neil) and let that anger out!

    Then take a deep breath and keep positive. I’ll be thinking positive thoughts too.

  27. Neil, I’m happy to send Sophia some homeopathics to help with the physical stress of surgery. Email me if you are interested. Love to you both.

  28. while it isn’t the best news, it much better than what could have been the outcome. for that, i am grateful! and it is hard to let people feel anger but sometimes you just have to let people process through their emotions in their own way and time. besides, sophia’s fiery side is part of her charm!

    love to you both.

  29. I can’t add too much more to the wise and insightful comments about the good/bad. It is indeed both of those things and a lot more, probably.

    What I can say is Neil, do everything you possibly can to keep the words “Don’t feel [whatever emotion]” from coming out of your mouth. Sophia and you NEED to feel this. NEED to be angry and sad. NEED to grieve the stupid error. NEED to feel frightened about what’s going to happen next. NEED to be pissed off that more time and energy is going to be spent on this than you wanted. NEED to be fucking insanely outraged that they are going to have to cut Sophia’s body again. (BTW, if cutting away more breast tissue isn’t ‘invasive’ what is?) I’d feel pretty damned INVADED if I were Sophia.

    And she has to feel it. And you have to feel it too. It’s going to be uncomfortable. So what. You don’t want her to hurt because you love her and want to protect her. I understand that. But don’t don’t don’t tell her not to feel it.

  30. I agree with Not Faint Hearted. I’m more like you and I want everyone to be happy, but being happy can mean being in denial. Sophia seems to be healthy and justified in her anger.

    I hope everything goes well with this next surgery.

  31. I’m definitely glad to hear that this is non-threatening.

    Maybe you could go for a second opinion to someone who may be able to see the margins more clearly/not cut out so much tissue?

    In any case, my thougts are with you and I hope the next surgery will go well!

  32. May you both continue to be strong for the next surgery, and we in the peanut gallery will continue to support you, too!
    B’hatzlacha rabah, Sophia.

  33. Neil, I am very relieved to hear that Sophia’s mass is not cancerous. I am sure that the doctors will be all the more careful this time around, knowing what happened before. No one wants to look like an ass twice in a row with the same patient.

    That said, there really isn’t anything anyone can say to make Sophia (or you, I reckon) feel better. Sometimes just knowing there’s someone (or many someones) out there who WANTS to make you feel better is enough to get you through the hard times. I always recommend ice cream in times of difficulty. I’ve yet to find the soft serve ice cream cone that didn’t make ME feel better.

    Sending lots of love to you both. Sounds like love is what you need the most. Know that you’ve got it from me.

  34. yeah, I see the good and the bad. yea/damn.

    As for the doc, rant away Sohia! That is just sloppiness on his part and inexcusable! He’ll really be the surgeon to return to?

    Hugs for the next go round.

  35. Sounds like the good news far outweighs the bad. Hooray! And best wishes for Sophia’s next surgery. Hopefully it will be the last.

  36. The good and the bad, blam! all at once. Yikes. I’m sorry to hear about the errors, but exceedingly glad to hear it wasn’t invasive.

  37. Geez. I can see why Sophia is so angry. This is her life, her breast and the doctor f***ed up. The good news that she will be alive and well and able to be pissed off about it. I’m so glad about the good news part.

    My best to both of you.

  38. Long time reader

    May 15, 2007 at 11:24 am

    Not to worry you any further but just a thought..

    I had surgery many years ago. The surgeon made a huge mistake. He swore he would fix it in the next surgery. He only made it much worse. This was a well known and “highly respected” doctor.

    I ultimately had to go to a different surgeon to not only fix his mistakes but to still solve the problem.

    I strongly suggest that Sophia finds a new surgeon – one she has complete faith in.

  39. Sophia: I’m sorry your results weren’t better, but I’m glad they weren’t worse.

    Take good care. You’re both in my thoughts.

  40. I’m very relieved to hear that the cancer isn’t in a further stage. But Sophia definitely has a right to be angry. Hope this ordeal will be over for you soon and no more hospitals for a while!

  41. Oh! Well wishes to SOPHIA! She will be alright and this will be all over soon! Hugs from da East Coast.

  42. Neil, I’m sorry to hear that Sophia has to have surgery yet again and that she has cancer. I’m relieved that her cancer is Stage 0. My thoughts continue to be with the two of you as this continues.
    Regards to anger…its not personal. Let her be with her anger and you practice just being with her.

  43. I agree, let her rant all she wants. It’s her boob, after all! When someone is cutting into your body you get to complain. But I am so so glad it’s not the invasive stuff, now that part is good news. 🙂

  44. Right on, Sophia.

  45. Probably the comment that struck the biggest nerve is Not Faint Hearted’s one:

    “What I can say is Neil, do everything you possibly can to keep the words “Don’t feel [whatever emotion]” from coming out of your mouth. Sophia and you NEED to feel this. NEED to be angry and sad. NEED to grieve the stupid error. NEED to feel frightened about what’s going to happen next. NEED to be pissed off that more time and energy is going to be spent on this than you wanted. NEED to be fucking insanely outraged that they are going to have to cut Sophia’s body again. (BTW, if cutting away more breast tissue isn’t ‘invasive’ what is?) I’d feel pretty damned INVADED if I were Sophia.”

    I know most of my commenters are women and this is a stupid and typical thing we guys do.

  46. This blows. I hate when people tell me to see the silver lining just as the cloud blows over and starts pissing rain. For purely selfish reasons I’m glad the news is overall good. I’ve grown attached to all of you as my imaginary friends.

  47. Okay, Neil. So here’s where I out myself. My day job when I’m not a struggling writer is as a surgical administrator. First of all, surgeons do make mistakes. Okay, not that has made you even more pissed, I’m just telling you the truth. But I’m wondering… has Sophia chosen the surgeon she likes best? Will your insurance policy allow this (in other words, do you have HMO or PPO?).
    The reason I ask is that you live way the heck out there where the seals come in and frolic in your yard. If you want a second opinion with a surgeon who scored in the top 1% of his national boards, is well recognized as a surgeon’s surgeon, and is generally loved, just gimme a holler. I’ll get you in pronto. You just need to show up with all her reports… oh.. and with Sophia.
    Look it up: http://drdavidanderson.blogspot.com
    And everyone loves PIH.

  48. I’m in agreement with long time reader – find a different surgeon. I would be angry beyond anything you could print. And Not Fainted Heart had it right about invasion – it’s tough being brave once it gets tougher each time there is an invasion!

  49. Up until now, Sophia has loved her surgeon. He is the head of the department at Cedars Sinai. Who knows why he made this error? Maybe he was overconfident? Maybe he had too many patients in one day? I never got to talk to the doctor after the surgery, which would have been nice since I was in the waiting room nervously sitting there, because he had to rush to another surgery. From what I understand, it is normal operating procedure to note the orientation. This just shows that a doctor who is at the top of his field isn’t perfect. Despite it all, Sophia will probably use him again just because they already have a relationship and it is too complicated to change. I’m curious to hear the doctor’s explanation when he comes back from vacation.

    Am I being too ass-kissy here, trying to take the doctor’s side? I guess I am still

  50. Sophia just told me that she saw the pathology report and that her surgeon cut a huge “piece” out, a lot, a lot more than we expected, based on the size of what was seen on the MRI and related to us. Her family doctor thinks that he made this mistake because he thought that by excising so much he covered all the bases, and nothing will be found.  Still…

  51. Of course Sophia is in our thoughts and prayers.

  52. Oh dear… obviously, saying things like “look for the positives and how they can be improved rather than focus on the negatives” is terribly trite and cliche, and probably unhelpful. Still, blah. Neil, maybe you should have a chat with your penis and see what kind of opinion it has to offer on the matter…

  53. So glad for the part of the news that is good. Yes…some funny. Despite the glimmer of good news we still need some funny up in here. And Sophia? My best thoughts to you.

  54. I put Sophia’s name on some of the guerilla art heart magnets and will distribute them around town when I go for my morning walk. Perfect strangers will be sending loving thoughts your way.

  55. What a story. It’s one good reason to trust the Old Mighty, as my zaideh O’H used to say. We have this expression about not putting faith in man. Woman, yes, but not man. Refuah shlaimah, Sophia, Sarah Rivka bat Fanya, right? (a complete recovery)

  56. I’m so sorry, Neil. How incredibly frustrating. sigh.

  57. I think this merits an interview between the penis and the tumor.

    We’ve been through this a lot with my Mother-In-Law and it’s not an easy decision when a doctor you thought was great makes a big mistake. We have really personal relationships with these people. With Mother-In-Law I think it’s helpful to get her to step away from the situation because some doctors see her age before they see her as a person, but this doctor’s mistake wasn’t like that.

    It doesn’t hurt anything to be angry and maybe knowing that you’ll report to the world will keep him on his toes in the future.

  58. Wow, no wonder Sophia is pissed at the doctor. Don’t you think when doctors make heinous errors like that they should attempt to compensate by taking a chunk off your bill? They’d never think of doing that, though. Send Sophia my love.

  59. prayers and good thoughts sent to both of you. Yes, feel our emotions, so that we can deal and move on. Repressing doesnt help, but, focus on the light. (on the good).
    Lets celebrate! It wasn’t cancer!!! and it sucks, but hey, a little more take away means less area for the little bugger to decide to come back later!

    Heres to a successful surgery and God bless you both 🙂

  60. oh and also, i dont think you’re being ass-kissy..you need to have faith in the surgeon operating on the love of your life! and the surgery is going to go just fine!

  61. Dang, sorry to hear the bad news, but Sophia is right on all counts — especially on writing something funny.

    As to best way to handle these situations: Give Sophia lots of hugs and keep your mouth shut. If only I could learn the second part of that advice, I’d be much better off.

  62. Holy crap that completely sucks. Get her a punching bag (or maybe a little one for her thumbs) and just let her rip into it with all her fury. She’s right to be pissed! I understand your feelings too though– it’s hard to watch someone be angry and hurt and not know how to help them. Maybe you could be the punching bag, then? 😉

  63. Sophia,

    Get your bitch on and raise some serious hell. At the very least you are owed profuse apologies. If it were me, I’d walk in there and tell that doctor the subsequent surgery is on him because it was deviation from standard procedure that is causing it. Medical care is stupidly expensive and now he’s spending your money because of his carelessness. That does not work.

  64. If you need/want a second opinion, and don’t mind coming down to San Diego.. . Dr. Mary K Wilde at Scripps Ximed Center is awesome.

  65. As always, fingers and toes crossed for the lovely Sophia.

  66. I’m truly sorry I haven’t been here more lately. But allow me to say, as late as it is, that I’m really pulling for you, Sophia. From all accounts you are one heckuva tough cookie and, if anyone can beat this, you can!

  67. Paris Parfait

    May 17, 2007 at 2:32 pm

    Dear Sophia,
    Wishing you all the best and that you recover quickly enough to make your displeasure known to those jerks for making you go through that procedure again.

    Dear Neil,
    Do everything Sophia says.

    Love to you both. xo

  68. Thanks, Sandra, Kapgar, etc.

    Thank you, Tara. Your friendship means a lot. I’m just afraid of going to your site today and seeing what you wrote about Israel.

  69. I am frustrated and angry on Sophia’s behalf as well. Hopefully this means the doctor will feel a potential malpractice suit looming for this huge mistake and be two or three times more careful and thorough this time.

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