dr. nima grissom

i went to see the breast surgeon today. it’s great to have the first appointment of the day, when you don’t have to wait and you feel you’re the only one your doctor needs to deal with at all. for nima grissom, that is certainly not the case. she must be one of the busiest surgeons in the world; she must see tons of breasts every day. maybe literally! i understand she is a “diplomate”. i wonder what it’s like to be a breast diplomate.

leanne came with me; we were whisked almost immediately into the exam room by the receptionist who wore surgical gloves (i tried not to let that make me feel infected). for fashion, dr grissom’s office gives you little short halter-top smocks, open in the front of course. i looked like a cross between some bad britney wannabe and a football player. i asked leanne to take notes, and said immediately that i wanted the fashion commentary in the logs.

dr grissom arrived right away and was noticeably better dressed. there was no surgical gown or white smock. there was a comforting thick navy cardigan. it was cold. i was hot. she was direct and yet attentive. i had a quick lie-down on the table, quick breast exam, then i got to say goodbye to the halter top and get back into italian polyester as she addressed what to do about my left breast.

to the point: my calcifications are very small, and she recommended “stereotactic needle-localized biopsy”. here are some of leanne’s notes – in their fairly raw form – about what dr grissom said:

• calcifications are quite common: 20% of all women
• of those 20%, 10% are malignant but not necessarily invasive (DCIS)
• my calcifications are too faint to biopsy with the ‘computer version’ of biopsy
• stereotactic, open surgical biopsy:
  • do in xray
  • under sedation
  • pinpoint and remove in strips with needle
  • is most accurate
  • normal duct doesn’t have dead cells in center
  • take out piece of tissue to look at
  • littlest chance to miss
  • can’t see or feel – rely on needle placement from xray
  • an xray after will immediately check what was removed to make sure it has the calcifications in it
  • the majority are benign
  • a mammogram thereafter in 1 year might still have calcifications – not a big deal
  • just a little sedation, not general anaesthesia

it strikes me today that i felt like i received a lot of information, in a short time, while feeling listened-to at the same time. that’s an excellent quality: to pay attention while talking. dr grissom expained things in a very attentive way, looking directly at me, being clear and level but with a good sense of humor in spite of my interruptions with awkward jokes. obviously quite experienced yet accessible, happy to answer questions and to plow through my pile of research from the Internet, even writing notes for me on my papers. i hauled out my chart from imaginis.com – link quoted in below entry. she explained that this was the same as the “open surgical biopsy” last on the list at that link. that link definitely does not put this procedure in a good light, yet dr. grissom scoffed at the “golf ball” sized description and “two-inch” incisions. it takes me aback slightly that there will be two incisions (one for each area of calcification), and that there will be about a half-inch “permanent scar” for each, yet contrary to the imaginis document, it will not make future mammograms difficult to read, says she. dr grissom also assured me that there will not be any divets left in my breasts. in additon, she went over the reasons for making incisions as close to the sites as possible. it’s clear she’s done this kind of thing before…

the thing to rule out is this DCIS. ductal carcinoma ‘in situ’. it again makes me feel special to speak latin. i understand that the ‘in situ’ – if that is the case – is the important part about it. the upside is the highest rate of certainty in the results. the additional if ironic upside for me is the sedation. i think it’s better i do these sorts of things under sedation. i tend to faint at the sight of any needle, so i might as well be sleepy already and lying down. i’m only concerned what sorts of babbling i might do under sedation. i hear it can be quite embarassing…

dr. mulder says it’s not surprising dr grissom opted for the needle localization since she’s known for getting quite “to the point” as soon as possible about biopsy. she’s glad dr grissom opted for that course of action. the results will be the most conclusive and convincing.

the date is set for friday, february 21. in advance, dr grissom recommended, like nearly everybody else i’ve ever met to speak about breasts, dr. susan love’s breast book. she says i should read the part about calcifications and DCIS, and skip the others, and she doesn’t even know i’m a hypochondriac. i have lots to learn and understand in the next two weeks. perhaps most understandably, dr grissom’s day is nearly empty next friday, on february 14th — i suppose it’s not everybody’s idea of a good valentine’s date. i would have just as soon done it then, but this sort of biopsy is meant to be no rush, and i have myself booked in the “bw reporting and analysis” class all week next week anyway. i know, i’m the envy of my block with that one.

on the way out, a peculiar lite-rock version of “freebird” was playing on the office radio. as leanne left, she was weeping in advance for the scars in my breasts. i hadn’t really considered that yet. from what i understand, this is the best way to be 100% certain and early, which is the best way to preserve my breasts and me entirely, so i hope she loves them just the same! when i got home from work tonight, dr susan love’s breast book was waiting on the couch.