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first person

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Illustration by Rachel Wada

Could it get any weirder than this? Me, alone in a padded cell in the basement of a medical imaging centre, typing up my own mammogram report? I stopped the tape in the Dictaphone machine and rewound it to make sure I hadn’t misheard. Nope, there it was again, as clear as the first time. My own name, spoken by the radiologist.

I hadn’t wanted this job in the first place. I was only here because the mammogram tech suggested it. She had asked what I did for a living, making small talk while applying the vice grips. I grimaced and grunted out that I ran my own business doing medicolegal transcription.

I could just as easily have told her the truth – that I sold my life for $10 an hour by typing. Money was so tight in 2001, when our family was young and our expenses high. My mother always said anyone who could type would never starve, but I’d never wanted to test that.

When the technician said, “You should apply here. We need someone for evening work,” I just fell into it. A little extra cash would sure come in handy.

On my way out, I applied at the front desk. I didn’t tell them about my university education or my years interpreting medical reports for a large insurance company. I was afraid I wouldn’t get the job.

So there I was a few days later, taking a typing test in a soundproof room next to the X-ray machine. I popped the tape in the slot and sighed. You do what you must, and at least this job would let me be available in the daytime for my children.

When I heard my name on the tape through the headphones, I laughed – not for long, as it was a timed test – and clacked away as the radiologist droned on for another two pages. I was not familiar with the terminology – my expertise was in traumatic injury, not disease processes. At the end of the report came the BI-RADS code (Breast Imaging and Reporting Data System, I learned later) which rates how serious the results are. A score of 1 indicates a completely negative mammogram, 3 means there is a tumour, but most likely benign, and 5 is “highly suggestive” of malignancy. My score was 0. I didn’t know what that meant. The recommendation was to have the test redone in a year, so I wasn’t worried.

Half an hour later, I handed in the typing test, saying nothing about my report and got the job. A few days after that, my doctor called to discuss the results of my mammogram.

“Well, let me tell you what it says,” I said, laughing. She had ordered the mammogram because I had dense breast tissue and wanted a baseline before I entered menopause. I was 48, at least a decade away from when most cases of breast cancer are diagnosed.

“Repeat in a year is fine by me,” I said.

For the next few weeks, I spent evenings in the clinic. I soon noticed a pattern: normal mammogram reports were short and sweet, only a paragraph long: BI-RADS 1. Abnormal mammograms were long and talked about microcalcifications, architectural structures, cysts, and masses: BI-RADS 2, 3, 4, or 5. BI-RADS 0 meant they couldn’t tell what was going on: retest in a year.

Sometimes an idea enters your brain unannounced but feels so right it’s as if you’ve always known it: My mammogram report had not been normal.

I wasn’t worried but phoned the doctor’s office to tell her I wanted that second opinion after all. A few weeks later I was having “coned-down” views at the Women’s Breast Health Centre in Ottawa. After that, it was a needle biopsy. I was still not worried, although if I’d had a lick of sense, it would have occurred to me that all these diagnostic tests plus a room full of technicians and a radiologist standing in front of a screen in the next room to guide them was probably not a good omen.

I was lying down on my side with my arm over my head and one of the nurses apologized for making me uncomfortable. “Oh, that’s fine,” I joked. “It’s not like Survivor last night when the guy had to stand on a pole in the ocean with his arms over his head for hours.”

“That’s the attitude we like to hear,” she answered absently, her attention on her job. That was when the first frisson of fear leapt along my spine. “What did she say?” I thought. “Attitude? Attitude! Shoot, do I need to have a flipping attitude?!”

As ridiculous as it sounds, by the time I met with a surgeon a week later, it still hadn’t occurred to me that surgeons don’t fill their days seeing patients who have nothing to treat, so I appreciated all the time he was taking to educate me about ducts and lymph nodes and the difference between cancer in situ and invasive carcinoma. All of a sudden, there it was: “He’s telling me I have cancer.” This scrolled across my brain like a subtitle.

My next thought was, “That’s funny. My mouth is so dry. I’ve always heard people’s mouths go dry when they’re afraid. Am I afraid?” Yes, I was afraid. I was afraid I was going to die. I was even more afraid to ask if I was going to die.

It was stage two breast cancer, meaning it had already spread to the lymph nodes. If I had waited another year, well…

Every cancer patient will tell you that people are curious to know whether cancer is actually a gift in disguise. Did it make me more grateful? Was I finding new purpose and meaning in life? Did it strengthen my faith?

No, I never considered cancer a gift. If God was there at all, God was there right at the beginning, in the series of coincidences that led to my diagnosis and treatment. As if God was thinking, “This thing is coming down the pipes for Irene. Now how are we going to get her attention?”

And the answer was, “We’ll make sure she has a doctor who pays attention to details, a job that educates her to understand the implications of her mammogram results, and a medical system that treats her with the best they have.”

Because that’s what saved my life: the unlikely combination of very good medicine, allied with the doctor who ordered a mammogram at age 48.

And the job I hated.

Irene Templeman Walker lives in Ottawa.

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