Page 25 of While You're There
“That is my area of expertise, and yes, I would be happy to take you on as a patient. There’s standard paperwork and hoops we need to jump through to make it happen,but most insurance companies now cover preventative surgery when it comes to BRCA1 and other mutations. Tell me about your ideal timeline. Is this something you’re hoping to do soon? Or in the next few years?”
He risked glancing over at Tori when he felt her gaze on him. He locked eyes with her, immediately recognizing the utter relief welling up behind unshed tears. This was it. They were finally here. A mix of excitement and relief coursed through his own body. A small pang of fear was present, too, but he knew these procedures were inevitable. More than inevitable, they were necessary. They were what she needed to feel whole.
“Well, we’re getting married next weekend,” Tori explained. “And then we’re going on a honeymoon.” She glanced over at him with a sly smile. Rhett winked in response, too elated to hide the excitement they were both feeling because of this appointment.
“Ideally I would like to have surgery at the end of July. I have a commitment during the first two weeks of that month, then I’d like to be able to return to school in August.”
Dr. Silko winced. It was the first less-than-enthusiastic indicator she’d given them up until that point. Rhett shifted forward in his seat, anxious to know what wasn’t going to work with Tori’s proposed timeline.
“The end of July isn’t unrealistic for surgery. But thinking you’ll be able to drive and return to life as normal within a month might be overly optimistic. Everyone heals differently, so it’s not impossible. If you have a lot of help and support throughout your recovery, that helps, too.”
“I’ll make sure she has all the help and support she could ever possibly need,” he asserted, nodding solemnly at the doctor.
“Good. I don’t see any reason why we can’t move forward with scheduling a July date then. Although I will put this idea out there for consideration: Usually, women opt for the risk-reducing mastectomy first if that’s part of their plan. I’m sure you know that from your research, so I won’t try toconvince you to go that route. Knowing that the greater risk is currently ovarian cancer, I think you’re smart to do it this way. But if you’re going to consider a mastectomy sooner rather than later, it may be wise to have the first surgery in July, give your body a chance to recover and heal and get used to the replacement hormone therapy, and then have the mastectomy at the end of the year.”
Tori glanced over at him with an uncertain look on her face. He wasn’t sure what to make of the suggestion either. He knew she would be tempted by the prospect of having both preventative surgeries by the end of this year. But was it tempting enough to fall behind in school? Would her determination trump her pride and independence?
She finally turned back to Dr. Silko with the same look of uncertainty. “Can I think about it for a few days? I want to check in with my advisor at school and talk it over with Rhett and our families.”
“You can take some time to think about it if you promise not to think about it too long. My colleague Dr. Brennan is a dual-trained plastic and breast cancer surgeon. She’s based out of Cleveland, and she’s the best. The work she’s doing with sensation and nerve preservation is phenomenal. She’s who you want, and I know she’s almost fully booked for the rest of the year.”
Everyone fell silent for a few beats. It was all good information, but it was a lot to take in. Rhett suddenly felt like maybe he should have been taking notes. He bit down on the inside of his cheek to stop from smirking. Tori would have teased him mercilessly if he had showed up to these appointments with a notepad.
“What are you thinking, beautiful?” he prompted.
“I’m thinking this is everything I was hoping to hear today.” She smiled at him before turning back to the doctor. “This is what I want to do. And I want you to be my surgeon. What do we have to do next?”
Dr. Silko offered them a tight smile and a confident nod. “You’ll need to come into my practice for a new patient intake appointment before we schedule the surgery. I can have my office call you on Monday to set that up. I’ll also get in touch with Dr. Brennan if you’d like, to put you on her radar now. She and I work together on a lot of cases like yours.”
“Yes, please contact her,” Tori replied almost instantly.
“Let’s talk logistics. What considerations have you given to fertility preservation?”
Tori sat up straighter. “I know the options. That’s not in the cards for me,” she stated with finality.
“What are you doing now to prevent pregnancy?”
“I’ve had a copper IUD since I was sixteen.”
“And when was the start date of your last period?”
“Last Saturday, May 11.”
“Okay, so you’ll need to schedule a time to come in and have the IUD removed before surgery. I can do it during your new patient intake appointment if you’d like, but then you would need to use alternative contraception until we do the full procedure.”
Tori grimaced at that idea. “What’s the latest it can possibly be removed?”
“I can take it out just a few days before your surgery if you’d like to keep it in place as long as possible. It can even stay in if you change your mind and decide to pursue fertility preservation.”
There was another long stretch of silence. Enough time passed that Rhett shifted in his seat, assuming they were done and it was time to go. But then Tori spoke up again.
“Just—just to make sure we’re all on the same page, what do you mean by fertility preservation?” Her question came out meeker than all her previous statements and responses. Rhett stilled as he picked up on the hesitancy in her voice.
He knew where she stood on having kids. He was certain she wasn’t interested in exploring any fertility preservation options. More likely, she was asking this question for his sake. He hated that she thought that was necessary.
“Assuming we’re moving forward with the prophylactic hysterectomy with BSO, I’ll be removing your uterus, ovaries, and fallopian tubes. Fertility preservation means we would harvest and store your eggs in case you want to have biological children in the future.”
“So that would mean doing an egg retrieval now, then having to use a surrogate for IVF later?”
