#38: Doctor's Orders

Two months in healthcare limbo, hospital gown ranking, Final Destination, & The Pitt.

In my favorite horror franchise Final Destination, anything can kill you—outdoor grills, ladders, shaky rollercoasters, household appliances, power tools, tanning beds, escalators, elevators, pool drains, LASIK. At any point, anywhere, anything could fall in just the right way to send rocks or fences or metal poles careening toward you, turning you into bloody, pulpy mush.

This is more or less how I view the world, or perhaps I should say how anxiety preys on my brain—what if the scaffolding I walk under collapses? What if a Doordash biker knocks me into traffic? What if my carbon monoxide alarm malfunctions at the wrong moment? What if a subway tunnel floods? What if I missed a dent in a can of grocery store chickpeas and get botulism? Listeria? What if a cockroach crawls in my ear, or I get hantavirus? What if my appendix bursts on a long flight and nobody can get me to a doctor in time? Maybe I should never fly. Maybe I should never drive.

I work pretty hard to keep hypochondria in check mostly because I’ve seen enough doctor shows to know that doctors despise a Web MD hypochondriac, and if there was really something wrong with me and I came armed with internet diagnoses, they’d be more likely to dismiss me and as a result, I would die. I’d like to think I’ve landed elegantly in faultless “better safe than sorry” territory, which is how I ended up in the ER with bad but not screamingly bad abdominal and pelvic pain and thus kickstarted two months in healthcare limbo.

The ER Trip

As a woman with a typically Ashkenazi gastrointestinal system (the other half did not kick in here), I’m used to a certain degree of stomach aching and cramping, but in early April a persistent mild abdominal pain morphed suddenly. It felt like someone was wrapping a giant blood pressure monitor around my waist and squeezing hard and also like someone was stabbing me from the inside around where an appendix might be.

I was excited when I thought it was appendicitis. I thought it would be chic to have the same surgery as Madeline, convenient to not have an appendix anymore, and I was going to take myself out to Bemelman’s for a $40 cocktail to celebrate my recovery.

What I thought it would look like when all my friends came to visit me after my glamorous appendix surgery. credit: Viking Press

I ended up in the ER because it was a Sunday and on Sundays, urgent care and normal doctors aren’t open. I spent most of the day waiting in a little room, playing the chicken game on my phone. Between the waiting: a full blood panel (my second in a week since I’d had my annual physical a few days prior) via poorly inserted IV, a pelvic exam performed by two unconfident interns, an ultrasound, and a CT scan. 7 hours later, I was told they couldn’t find anything seriously wrong with me and I could go.

This was $100.

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6 Other Diseases Besides Appendicitis I Thought I Had Before, During, and After the ER Visit:

1. Hepatitis A, even though I’m fully vaccinated but the bloodwork came up funny and I had to get a Hep A booster because apparently vaccines can FADE and for two weeks I really thought I had a liver disease and I stopped drinking and I was in a panic about how if I had a liver transplant I’d never get to go anywhere again because you shouldn’t get Covid with a transplanted organ and—

2. UTI, and I did drink like 32oz of cranberry juice one night just in case it fixed things (it did not)

3. Ovarian cancer? Cyst?

4. Kidney stones/disease

5. Crohn’s

6. Crazy bad IBS

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The MRI

After a quick follow-up appointment ($25), the gist of which was “we really have no idea what’s wrong with you,” I was scheduled for an MRI.

When you get an MRI, they ask you about six different times if you’re claustrophobic. I’m scared of everything but I’m not claustrophobic about MRIs. They’ll let you out if you make a fuss! I’m still not that scared of MRIs even after “The MRI Scene” in Final Destination: Bloodlines. For an MRI, you’re inserted flat on your back into a loud, white tube for half an hour. Obviously you can’t have your phone with you, so for half an hour I was in an interim waiting room where the only magazine was an internal NYU Langone magazine. As I was staring blankly at the walls, I heard a nurse wheeling an older woman around ask what music she wanted to listen to this time. As an aux cord avoidant, this sent me into a mild panic. I thought I’d just ask for generic classical or jazz, but I was worried they’d stick me in there with elevator jazz or Vivaldi’s “The Four Seasons” (no offense…¹) so when it was finally my turn and they asked what I wanted to listen to I said, the score to 2001: A Space Odyssey. The tech said “weird choice.” Sorry my guy, MRI machines look exactly like this:

credit: MGM

This was the right choice because it did feel like I was in outer space. When you’re in there, an automated woman’s voice instructs you on when to hold your breath so the imaging can take place. I guess breathing is to an MRI what jumping around is to a normal camera? I didn’t ask. I drifted into a half-nap state despite how loud the beeps and whirs were, restful but not asleep because I had to heed the breathing instructions, and elated when Strauss’s “The Blue Danube” finally hit.

Four days later I received the results:

IMPRESSION:

No acute abdominal pathology.

Nodule in right breast, most likely benign lymph node or fibroadenoma. Correlation with dedicated breast ultrasound recommended.

The MRI was $0, surprisingly.

The Breast Ultrasound

I scheduled the quickest ultrasound I could—an hour on the subway away in Bay Ridge the following Thursday. I liked that it felt a little like a spa—there was a little dressing room where I put on a gown and a little locker to put my belongings in. The procedure itself was easy peasy, and the results unsatisfying—yes, there was a suspicious mass on my breast. I was given a BIRADS (Breast Imaging Reporting and Data System) score of 4 for suspicious (the highest score is 6) and I would have to get a core needle biopsy to find out what was really going on.

This is where the trouble started. I had a hell of a time trying to get the biopsy scheduled because my primary care doctor was on vacation (????) all week and there was no out of office contingency in place to get literally anybody else to put the biopsy order in for me. Then there was an additional week of calling my doctor’s office because the ultrasound results in my portal declared that the mass was on my left breast and a piece of paper they’d handed me at the office told me to get a biopsy on my right breast.

This cost $250.

Waiting, Lifting, The Pitt

Everyone on the r/doihavebreastcancer subreddit agrees that the waiting is the worst. The sub assured me that a tumor wouldn’t grow enough in a month to make a material difference. It wasn’t unusual to have to wait a month or two, it just sucked.

In the 3 1/2 weeks between my ultrasound and MRI, I began to kind of lose it in good and bad ways. I was on Reddit a lot, learning about cancer stages and how 80% of masses are benign but also about horrible, exceptional cases. I learned the first 3 stages of breast cancer are relatively curable, but also began to picture a life of endless follow-ups and cancer coming back again, and again, and again. I quit tap. I didn’t write. I made too many jokes about getting a masectomy and how it would be nice to trade in what I’ve got for a fresh set of A cups. I spent so much time calling my doctor, who was avoiding my messages (?) and making me feel insane. Isn’t it important to confirm which breast has the lump on it? Did I have two lumps? Could I trust anybody?

After the MRI confirmed there wasn’t anything wrong with me abdominally, I started drinking again, but not too much—I was (still am) in a craze for fruit and arugula and always having something fresh on the side and ordering seltzers at the bar if I didn’t need a drink. The dormant Angeleno in me had awakened to the fact that everything was a carcinogen and it was time to eat lots of farro and leafy greens whenever possible and should I be worried that rice has arsenic in it?

I’d like to give Dr. Robby a kiss, but I want Dr. Mohan to actually look after me, but NOT in her post-shooting adrenaline hour. credit: HBO Max (we’re back)

I started “lifting.”

I wasn’t doing anything impressive—just a routine I’d cobbled together from a Tik Tok and a Youtube workout with 5lb weights, but I did it every day for 2.5 weeks straight by combining weights time with The Pitt time.

The Pitt is solid, entertaining, normal television. Its hook is that the season takes place over the course of a single 15 hour shift in an ER. Each episode follows 1 hour of the shift and the show is very, very medically realistic. The Pitt doesn’t try too hard to shock you with wacky ways you could get sick and die. On House, people were always getting rare parasites and developing mold based mania but save one girl with Korean skincare based mercury poisoning, people on The Pitt mostly have normal problems—fentanyl overdoses, shooting injuries, car crashes.² This is good because it’s generally a mistake to introduce me to new ways I can die. The comfort of The Pitt is that so many awful things that happen to our vulnerable bodies can be fixed by professionals. The pitfall (pitt-fall…) was the same as all hospital shows—doctors and nurses are talented, tireless heroes, but they are also human. They might be tired. They have their own biases. They might call you back after two weeks of relentless calling and say “no it’s fine, the mass is on the left side” and be totally wrong.

The Gastroenterologist

The abdominal pain that started it all had mostly subsided by the time I saw a gastroenterologist, the final frontier. He told me he had no idea what was going on, but it wasn’t IBS. “We’re really good at finding the bad stuff, and still not that good at the rest of it,” he said. “Come back if it gets consistently worse.”

This was $40.

The Breast Biopsy

When I walked into the neat waiting room of the women’s imaging center, I was assaulted by the sound of construction. I just played this video back and it sounds like an alien invasion. The receptionist yelled “WHAT IS YOUR NAME?” and then “SORRY.”

Luckily I didn’t have to wait too long before being brought deeper into the office to change and wait. The jackhammering was fainter there, and you could hear the pleasant classical music that normally soundtracks the space. There were flowers and complimentary water bottles on the little table. A woman asked me which breast the biopsy was for, and I launched into an explanation of the whole left/right confusion. She said, oh it’s the left. 10 minutes later she walked past the waiting room and said, “no it was actually your right!”

Ultimately none of this really mattered because in an ultrasound guided core needle biopsy, they simply… do another ultrasound before they go sticking a needle in you. I don’t really regret being annoying about my own health, especially because for a while I wondered if I had two masses, and eventually I was told my ultrasound results had been recorded wrong after all. The mass was confirmed on the right breast. The 3-woman team who performed my biopsy was kind and sympathetic, and for the first time in weeks I felt heard, and vindicated, and not like a nuisance.

For a breast biopsy, they do the ultrasound, mark the spot on your breast with an X, apply local anesthetic and then stick a needle in and out of your breast 5 times. Each time they collect a sample, a loud sound like a giant stapler goes off. They demo’d this noise to me before they started so I wouldn’t be too startled. I could see the needle on the ultrasound screen because it was faced in my immediate direction. I thought maybe I should look away, but I was too morbidly curious. When they’re done, they stick a sesame seed sized piece of titanium in the breast to mark the spot for any future mammograms.

I am titanium. Adam kept saying I should use a photo of David Guetta but I’m sorry, who SINGS the damn song.

Afterwards, you can take Tylenol but not Ibuprofen, use ice, and you can’t lift anything heavy for a few days. You can’t shower for 24 hours, or submerge the area in water for a week. I went home, narrowly avoiding rain, ordered a kingly amount of Thai takeout, nursed my newly bruised metal boob and watched Inside Man.

The biopsy was $250.

The Mammogram

Before I could go home, there was one last step: a mammogram. Usually the first step in a breast cancer scare, this mammogram was just to confirm the piece of titanium was in the right place.

I had no clue what a mammogram was before this, and apparently what it is is a standing x-ray machine, like the ones at fancy dentists, where your breast is placed between a board and a pane of clear plastic and gets pressed like a panini while the tech takes the images. This was strange and short and cost $0 additional dollars.

Medical Procedures, Ranked

1. Ultrasounds - warm, gooey, a bit comforting but there’s something kind of sexually humiliating about wiping the ultrasound goo off when the tech is done

2. MRI - outer space vibes

3. CT scan - TV show vibes

4. Mammogram - boob panini

5. Blood work - I just find IV insertion very hit or miss ??

6. Breast biopsy - Novelty of watching the needle-in-boob on screen is fun and I liked these doctors best but ultimately recovery time/pain level is tough

7. Pelvic exam - Buy a girl a drink first! These are always cold and horrible and not interesting.

Hospital Gowns, Ranked

1. Biopsy/Ultrasound - At both the ultrasound & biopsy, they gave me the same green striped cloth robe with big pockets and both offices had a cute little changing room. LOVED! The biopsy place only had 2XL sizes left, but I found it kinda cozy.

   

   Left: Biopsy robe, Right: Ultrasound robe

2. MRI - I loved that these came with a little pair of shorts, but the color and paper material were blah.

   

3. ER - Basic, boring, exposed butt, no pockets. Two thumbs down. Pattern is kinda fun?

   

The Results

I was told to expect results in 2-5 days, but the very next day, just as the exterminator was interrupting my sick day (ice pack to the tit, Trader Joe’s coconut shrimp, plans to go see Final Destination: Bloodlines if the pain wasn’t too bad later), I received the “A new test result is available in your portal” text message.

Final pathology yielded BENIGN results, as below:

A. Breast, right, 7:00 4 cm FN, core biopsy:

- Hyalinized fibroadenoma

Total: $665 (not bad?)

Final Destination: Bloodlines

RIP Tony Todd. credit: New Line Cinemas

After blasting Carol Douglas’s “Doctor’s Orders” and letting Adam and my parents know that my results had returned benign, I went to see a midday show of Final Destination: Bloodlines and it was awesome. It’s about a family of Wasians!!!! The kills are tense, inventive, funny, gruesome— the MRI scene, a death trap BBQ, an ill-placed grand piano and a perfect opening disaster in a 1960s Space Needle type restaurant.

In Final Destination films, as in life, nobody escapes death. I’m usually too terrified of horror where the villain is “inescapable”—I feel safer watching stuff like The Descent because I’m never going to be stupid enough to go in a cave. A lot of smart people like to talk about how cathartic Final Destination can be for anxious people because it’s validating to see your fears amped up to 11 and made ridiculous on screen. I’m not entirely sure I feel that way. Mostly, the kills in Final Destination tend to be silly, nasty and Looney Tunes-ian enough to not freak me out too bad, but I’ll never go to a tanning salon or get LASIK or drive behind a log truck. I guess it’s been a strange relief to return to the land of hypothetical anxieties rather than the very real mystery mass in my body. When I told Adam about my new fear that a bat will bite me without me noticing and some time later I’ll die of rabies, he said he liked how exotic this was. I wish I could claim some kind of Zen new lease on life, but I’m still scared of everything.

In Bloodlines, a concept is introduced that you can’t defeat Death but you can stave it off for decades… by becoming a crazy shut-in. Bloodlines, more than any previous entries and in large part due to an emotional improvised speech by the late Tony Todd who was terminally ill with stomach cancer during filming, is about the importance of living life to your fullest and enjoying the time you’ve got. I like walking around the city and seeing my friends too much to retreat from the world and I hope that stays true forever. “You can die at any moment” is not particularly comforting, but it’s true and also not. Terrible things can happen, and you might be okay. Statistics are in your favor. I was in the 80%. I’m okay and all I can do is keep going, hoping for the best.

1. The Four Seasons piece from All That Jazz is my morning alarm and the rest of it is lovely but… basic….

2. Okay fine, The Pitt is also where I developed a fear of a cockroach climbing into my ear, exacerbated by the new appearance of the occasional American cockroach in our apartment as the weather’s shifted. We’re still dealing with this… :(