Avneil FF

Chapter 41

The doctor took a long pause after pronouncing her diagnosis.Both neela and avni absorbed her words silenty.After a pause the doctor spoke againNow I know that this word cancer evokes a lot of fear and worry in you...but let me assure you that we can treat this. And i would like to explain your disease and your treatment options in more detail if you will allow me to.Avni gripped neelas hand tightly under the table and exchanged a glance with her mother before sayingAvni- yes doctor, please continue.Doc- ok so as I said, we have confirmed a diagnosis of cancer. However every disease has a wide clinical spectrum and it's behaviour and ultimate treatment, outcome depends a lot on it's severity. In Ms.Pareikhs case we have managed to detect the disease at a fairly early stage.from the tests we have done thus far it appears as if her disease is localised to the single breast lump. She does not have any other lumps in the right or left breast and does not appear to have any lymph node involvement Additionally the disease has not spread to any other distant organs like the lungs or liver. She paused again allowing time for them to assimilate the informationDoc- now we doctors have treatment protocols developed depending on the stage of the disease. And I'd like to discuss your treatment options also.Neela- nodded at the doctorDoctor- in the given scenario the treatment option that is recommended would be surgery followed by most likely  chemotherapy plus or minus radiation therapy as well if the need arisesThe first step would be surgery- now since her tumor is a 2x3 cm lump we could offer her both a mastectomy i.e. complete removal of the affected breast or a wide local excision of the tumor only -which would be breast conserving. However we will also have to do a lymph node dissection to confirm that no disease has spread to the axilla. The breast conserving surgery while it is less radical would make radiation therapy a necessity. On the other hand if you decide to go with a mastectomy , you may not need radiation therapy if we confirm post operatively on the biopsy that the disease is indeed localised. Are you with me so far?Neela-, avni- yesDoctor- after surgery, once we have allowed a few days for it to hel and made sure that the surgical site is clean we will refer her to our oncologist who will be giving her what we call adjuvant chemotherapy. This chemotherapy is necessary to reduce the likelihood of a recurrence happening in future. We can discuss more about it once we have a full pathology report post ooeratively. I'm just preparing you for all possible modalities of treatment that you may  need to undergo. We have run some additional tissue tests on her biopsy to look for something called hormone receptor status and her2neu receptor status. These tests are also important to prognosticate. If they are positive we will be able to add some more targetted drugs which can reduce her rate of recurrence.Avni- so how soon can she have a surgery.Doc- I will give you sometime to absorb all this information, maybe you can read up about it too...once you have made up your mind about breast conserving surgery or mastectomy we can schedule it. In addition she will need some preoperative workup - few more tests and anaesthesia clearance and also you should meet the oncologist who will be treating you later so that they're in the loop too. So let me schedule these tests in the next few days and you can meet me on Wednesday so that we can plan further. Does that sound ok?Neela- nods.Doc- is there any other immediate concern that I can address?Avni and neela were silent....Doctor- I know this is a lot to take in all at once. But let me assure you that I'm here to help you. I am giving you these brochures we have designed for our patients which has some of the most frequently asked questions and also some links to useful resources. I hope you will go through them and of course you can contact me for any of your concerns and questions too. Avni- thank you doctor.And neela, avni picked up the pamphlets, booked appointments for the remaining tests etc..and finally headed home.The ride home was silent. Both avni and neela had multiple thoughts swimming through their heads.When they reached home, avni first insisted on having lunch. Throughout lunch the air was thick with tension. Neela- was scared. Not so much about the disease but avnis response. She knew that avni was definitely going to be very affected by this. She also knew that avni was really sensitive but over the years thanks to neelas parvarish in part avni had become battle hardened . She was now so stoic and it was difficult to read her emotions.Neela- baccha...she started to say. But was interrupted.Avni- ma, you trust me right?Neela- of course ye kaisa sawaal hai?Avni- ma, toh aap please rest kijiye. We have got a lot of information today. I need some time to do some research but I know one thing- main aapko kuch nahi Hone doongi. I will make sure that we are fully prepared to tackle this. We will go to the best medical team, and I know we will make sure you get the best treatment. She said with quiet resolve in her voice. Neela- I know baccha...Neela- was hoping avni would talk about her feelings but instead avni was only focused on what to do next. Neela was lost herself...she needed to spend some time coming to terms with the situation herself before trying to coax avni so she decided to let it be.Avni- maa, aap thodi der aaram Karo. Aaj subah aap jaldi uth Gaye...why don't you lie down for 1-2 hours.Neela- aur Tum?Avni- research. She said simply.She picked up her laptop, the pamphlets the doctor gave and headed to the study locking the door behind her.Neela also didn't stop her. She knew this was avnis coping mechanism and she too resigned to her room And sat by her window listening to the wind chimes. She turned on some soothing music to calm herself down.Despite their respective coping strategies, both avni and neela were undeniably getting caught up in the new storm brewing in their lives now. And they could only hope that they would weather this storm.