'sneak attack' biopsy

No one enjoys surprises, that includes me; but with everything that's been going on during my 31st year of life (e.g., being an long-distance marriage while in grad school, my 'hot tub mishap' sending me to the ER, both parents being hospitalized, Dad getting cancer), I should be use to surprises, especially the un-welcomed sort.

Source: WebMd, http://women.webmd.com/picture-of-the-thyroid

In August 2010, I had a disturbing letter and cat-scan (CT) results sent to me concerning by the ER I visited during a bad accident in a hot tub that made me pass-out and hit my head and neck on a marble wall and floor.  After a nasty bump on the back of my head and concussive issues, I thought everything was okay...until I received those documents.  After seeing my primary doctor, Dr. N, he recommended I see one of the better endocrinologists in the area, who did his own ultrasounds of the thyroid, Dr. S, who is pretty awesome:  Dr. S took his time explaining to me what the ER's cat-scan of my neck meant (it read 'lesion on right lobe of thyroid') and does his own ultrasounds on his patients inside his office, instead of a random ultrasound technician somewhere else in the hospital.  In a world where the doctor's time with his/her patient is on a ticking-clock, Dr. S provided a thorough examination of my neck, explained to me physician jargon that persists in most CT readings and did the ultrasound.  After seeing several 'abnormalities' on the right lobe of my thyroid, Dr. S recommended I get scheduled for a thyroid biopsy.  With everything that was going on with Dad being sick, I was pretty freaked-out.  I know I shouldn't be, but 'ignorance is bliss':  being a fellow clinician, I knew that all sorts of stuff could be wrong with my stupid thyroid.  The thyroid is a pretty important gland for women, especially those wanting to get pregnant (see WebMd's down-low on the thyroid and women).  So knowing what I knew, I was scared.
The 1st scheduled biopsy took place in mid-October.  M took some time off of work and flew in from DC to be with me.  I remember crying the night before the morning of the appointment.  Dad was just diagnosed with cancer the month before and was just told earlier that week that it had spread or metastasized.  When I arrived to the biopsy lab to meet with Dr. S and his residents and nurse, I was beside myself; but I kept thinking, 'God is definitely in control of all this.  He wouldn't let me go through this alone.'  I soon calmed down and laid back on the examining table while Dr. S did one final ultrasound to verify that the lesions were still there.  After 45 minutes of looking (and the ultrasound jelly being spread allover my neck), Dr. S and his residents couldn't find it!  That meant they wouldn't have to do a biopsy!  I was beyond thrilled and very relieved!  I knew that God wouldn't give me more that I could handle on my plate...and my proverbial 'plate' was pretty full.
Yesterday was my 2nd scheduled ultrasound/possible biopsy.  And because the last ultrasound showed nothing, I wasn't too worried.  I didn't tell my family in CA that it was happening and I didn't ask M to fly out for this one.  I even drove myself to the appointment because I was so sure that they wouldn't be doing anything more than an ultrasound.  I remember thinking while I waited at the cancer center (where the biopsy lab is located), 'This is nothing.  I know they won't find anything and I'll be out of here in less than an hour when they see nothing on the ultrasound.  Sweet.'  Man, could I have been more wrong.  Dr. S conducted a physical exam of my neck and didn't feel much of anything that meant 'nodule' or bump; but he wanted to make sure that there was nothing underlying under the skin tissue.  During the extensive pre-biopsy ultrasound (the one the doctors do before they poke you with the biopsy needles), Dr. S found the 'colloids' and 'calcifications' with 'comet tails' on the right lobe of my thyroid.  Whatever the hell that meant, it was completely clear as to what they needed to do:  biopsy.  I was crestfallen.  Firstly, I hate needles (any kind) heading for my direction.  I know this is an empty fear since the doctors give you local anesthetics before the biopsy needles go in, but I hate them nonetheless.  Quite ironic, since I've been an ICU/ER nurse for a decade.  Secondly, this was just a biopsy.  I shouldn't be so freaked-out, since it's a routine procedure, right?  Right?
As the resident was prepping the procedure equipment and Dr. S was writing up his notes after my ultrasound, I briefly called M to let him know what that they were going to do the biopsy.  I could tell in his voice that he was upset that he wasn't with me for this appointment, but I didn't want him to be worried.  (It's amazing how much we try to be brave and not sound like we're worried ourselves.)  I had a bit more time before I needed to get a gown on and get on the table, so I texted Mom to let her know what was going on and turned my phone off:  I didn't want to hear the constant vibration of my cellphone going off during the procedure because potential and continuous texts/missed calls.
I laid down and prepared myself by pinching my own fingers for the burning injections of lidocaine, the local anesthetic they would be putting around the areas they would be getting the biopsy.  First, Dr. S made marking on my neck with the guidance of the ultrasound, to where he would be getting the biopsies from.  Because my 'lesions' were not superficial but within the gland itself, the biopsy would have to be performed under the guidance of the ultrasound rather than the doctor feeling them with his hands.  After sterilizing the area carefully (I'm allergic to shellfish and iodine, so they used alcohol), the local anesthesia shots were next.  I felt like I was at the dentist but worst:  instead of the quick lidocaine shots that go into your gum line, you've different places where several milliliters (mL) of anesthesia going into the soft tissue of your neck, down to your thyroid gland.  The first injection burns like fire, but then the subsequent ones are unnoticeable.  I closed my eyes while they gave me the shots, because it freaks me seeing needles so close to my face.
The biopsy needle (long and skinny) with its huge syringe chamber enclosed in a metal contraption came next.  I had to close my eyes and pretend I was somewhere else:  Looking at the doctor's hand holding an ultrasound probe on your neck while the other hand is manipulating the biopsy needle and syringe is not a fun sight.  The whole time this was going on, the doctor's arm is over your visual field.  No one's fault, but I would have started hyperventilating because it felt so claustrophobic with all this stuff going on around your face.  Thinking about what they were doing was also making me nauseous and you have to stay still throughout the whole thing.  Before every time the biopsy needle was inserted into my neck, I had to take one more swallow and not talk.  Keep breathing and don't swallow.  I kept reminding myself of this over and over again because it gave me a specific task to focus on while Dr. S manipulated the biopsy needle and ultrasound probe.  Not swallowing for a period of time is a tough job (you try it), even more so when there is a chance that something could be nicked if you did swallow.
During the breaks between local anesthesia injections, biopsy needle aspirations, delivering slides to the lab room, Dr. S had put on the computer a slideshow of pictures of his recent vacation to British Colombia with his wife and another couple.  I could easily turn my head to the side while laying on the table to look at the slideshow, while trying to remember to place pressure of the gauze dressing on my neck.  I saw pictures of wild orca whales, blossoming flowers at a botanical garden and mountain panoramic views.  The pictures were calming and it helped me focus on something beautiful and happy, instead of having to be on a table with needles getting tiny bits of your body tissue.  I wanted to escape to anywhere else but where I was and those pictures were a lifesaver, because when I would close my eyes during the biopsy itself, I envisioned beaching whales and majestic views of Whistler.

black markings (longitudinal and transectional) for biopsy sites

After several more injections of lidocaine (they had to go further inside the gland than they anticipated) and biopsy needles going inside my thyroid 5 times, they were finally done.  By the time the 2.5-hour visit was done, my endocrinologist attending physician was accompanied by his resident, a pathologist, the medical technician (who did the biopsy slides), another medical resident and a medical student in the tiny room where I laid on the examining table trying not to cry because I was scared.
Then it was finished.  The resident, Dr. U, wiped all the ultrasound jelly off and place a small bandage.  Dr. S said that he would hear results in about 2-3 business days and would be contacting me as soon as he knew anything.  I got dressed, thanked everyone, and walked out to my car in a daze.  At this time, it's rush hour traffic and I'm driving home in the hot mess of it.  I started tearing-up (the first time I had the private opportunity to do so since they first told me they would be doing the biopsy).  I couldn't believe this just happened.  My neck felt swollen and tender as I knew the lidocaine was quickly fading.
After a quick reprimand from Mom for not telling her sooner so she could fly out from CA to be with me for the procedure, followed by her apologies for not physically being there for me, I called M and told him what had happened.  M expressed his guilty feeling for not being there for all of this, but what is someone suppose to do when you're 800 miles apart except pray?  I wept on the phone with M, because I missed him so much and felt like I was alone.  I knew--deep down inside--that my family was always with me; but at this time of vulnerability, I was tired and by myself in St. Louis, without my husband and my family.  After talking with M for a few more minutes I could muster (my neck was starting to get painful even after the bag of frozen peas applied to control the bruising and swelling), I bid goodbye.
Thank God for good friends in the area.  Their kind messages and visits have made this time a bit more bearable, even without my immediate family and husband here with me.  KK came by last night with dinner and took both dogs out for their evening walk.  She kept me company until I was done eating and vowed to return this weekend if I needed anything else.  Other friends have offered to help out with anything and come over to the flat, if I should need anything.  I'm grateful for that and always thankful for the comfort of these close friends who have continuously backed-up their devotion to our friendship, even when I'm not at my best.

I woke up today (it's Sabbath) and my neck is quite sore and uncomfortable to turn my head to the left.  Being on the previous medications for controlling my asthma attacks the week before, I am wiped-out.  Completely fatigued.  This morning's meal consisted of a bowl of oatmeal, a cup of medications and supplements, followed by a glass of water and OJ.  I was hoping to be well enough to attend church service today, but this morning wasn't so easy to get out of bed and I still have the black marker residue from the biopsy that won't wash off immediately.  So I'm staying home, reading my Bible lesson for the week and listening to the online recording of a past sermon.  Today, I truly rest and petition God for the peace I already know of but need to be reminded of:  the peace of God and trusting Him with everything.  Sometimes in times like these (after a sneak attack biopsy), I need to be chastised for not remembering that 'God's got this.'
These are the facts:  My husband is not here full-time in sT. Louis.  Neither is the rest of my family.  I have great close friends who have been quite supportive and prayerful for my situation.  And most importantly, that God isn't going to let go of my hand through this uncertainty and this pounding 'alone' feeling I sometimes let myself feel when I'm out here in sT. Louis.
For now, I just need to get through my last semester of graduate school so I can join my husband.  I'll also have to deal with whatever the biopsy results are next week.  Right now, all I can do is 'just breathe.'