January 17, 2007, or so: Something or Nothing

At the Mammogram Factory the radiologist was peach-colored/complected, with brown/red hair, and she had soft-looking skin. Why did it seem soft? I don't know. She seemed sorry. She seemed sad, rueful. She stood on my left as I lay there next to the ulstrasound machine. She didn't say cancer. She said, You need a core-needle ultrasound-guided breast biopsy. She said, It's abnormal. It's suspicious. But it might be nothing. As an afterthought. She said, We can do it at Noname Hospital. I said, I'd like to go to Fancy Hospital, and she told me I could wait for the films (mammograms and ultrasounds) to take to Fancy. Only later I realized that she could have done the surgery herself. I was rejecting her. Why did I go to her radiology center if I didn't want the radiologists there to work on me? I don't know Noname Hospital, I don't know where it is. I know Fancy Hospital, my hard-to-get-ahold-of gynecologist is there (harder to get ahold of him than it was to find someone in the State Department, back in my journalism days), my left ovary and salpingo (aka Fallopian tube, "discovered" and named by an Italian doctor) are there, or were there, were removed there and I imagine them in a jar there, I imagine them as an enlarged bean sprout. But they probably quickly became "medical waste." My friend J's ovary is there, preserved, she thinks. It had teeth in it.

I call my husband L on his cell phone on the phone in the waiting room and he said, Why didn't you call my land line? and I say, I may be freaking out here and you're worried about minutes, which you never go over, and he says, I'm sorry, I'm sorry.

Then the e-mails, then the talking, then the imagining. I make lists of women I know with breast cancer, more on the alive list than the dead one. P tells me that Y and Q had the same diagnosis and Y had a mastectomy and Q had a lumpectomy with radiation. I have disapproved of women with reconstructive surgery, except my best friend from high school, who had a double mastectomy.

The e-mails confuse me. K talks about four aspirations of cysts during which brown fluid shot out of her. People say, It may be nothing, it is nothing, it's probably nothing, which I told them, but I think: I know it isn't nothing and now, a few days after the radiologist's words, I don't remember what she said exactly. I start thinking I've been exaggerating, getting people upset for nothing. But the last two times I had breast surgery (removal of a fibroadenoma and a biopsy) I didn't react like this. Because the doctors said both were probably nothing, and they were.

I make an appointment at Fancy Hospital and drop off my films of my breasts. I'm going to sell them to Playboy, I tell my husband.

When I had the cyst removed in March it was pretty clear it was nothing, just CYA surgery on the part of the doctors, but still I looked up ovarian cancer. I saw it was more common in Ashkenazi women and in childless women. I told people I was going to convert to Buddhism and adopt a child. But that doesn't seem funny to me any more.

P calls the morning after my e-mail and asks if I'm crying but it's just my allergies. Overall, I am oddly cheerful. I'm afraid I'm happy that I have cancer, or may have it--relief that the other shoe has dropped? Or, worse, that it makes me feel important to be in the center of a mortal storm. Or if I have cancer, no one can expect anything of me. It makes me think about American Jews and Israel. As Philip Roth has written, for American Jews, Israel has been our Australia--a place you could always go if your life wasn't working. I always felt that if I lived in Israel, nothing would be expected of me, because living there was enough. (That was before the intifadas, before it seemed incumbent on everyone to work for peace.) I think: If I have cancer, no one will expect anything of me. Just getting through the day will be enough. As Marjorie Gross has written on the pros of having cancer, "People don't ask you to help them move." (She died of ovarian cancer.)

P sends me Barbara Ehrenreich's Welcome to Cancerland. Unlike everyone else I know, I hadn't been a fan of Ehrenreich. Till I read this piece. I tried to link it here but failed. You can find it by searching

The day I went for the mammogram I also had an appointment with a hematologist because I have a high platelet count--high enough to be monitored but not to require intervention. Before the doctor came in, a fourth-year medical student interviewed me to practice his skills. He was nervous and hadn't read my chart. I was telling him about my long menstrual periods, which supposedly aren't related to the low amount of iron in my blood, but really are. I said, in explanation, I have fibroids. Oh, he said, I'm one of three boys. Pause. He mumbles: What did you say? I pretended I didn't hear him, but for a moment imagined the spectre of five sons, imagined them around me in the patient room. I explained: Fibroids. Uterine fibroids.

January 23 & 24: The Unjolly Fellow

January 23 my husband L and I spent more than eight hours at Fancy Hospital. Luckily he brought his laptop so he could work. We saw many doctors. Many pictures of my breasts were taken. You could wallpaper rooms with the mammograms and ulstrasound images from that day. Fancy Hospital found three suspicous places, to the Mammogram Factory's one. Which is a good thing, a lucky thing. I was lucky too because Fancy could perform the core biopsies that day. Unluckily, the Unjolly Fellow did it. He was a handsome thing, a Fellow, meaning he was no longer a resident but not yet a radiologist who could be set loose upon the breasts of the world. I have found that apprentice medical workers are usually defensive. They are M.D.s, after all, they've taken all that Organic Chemistry (while we were off reading novels) and they've cut up bodies and probably delivered dozens of babies, and they know that we think of them as Not Real Doctors. The Fellow seemed nervous. How so? His face. It seemed to have an apprehensive look on it. Or was it defiant? He did the core biopsies, which consisted of poking holes in me. The ultrasound tech deftly moved my arm around so that it would be more comfortable during the procedure. The lab techs and nurses and anyone else who is not an M.D. are called by their first names. Doctors are called Doctor. I wished I'd gotten a Ph.D. after all so I could be Doctor too. I wish I could be awarded an honorary doctorate right now from anyplace, anywhere. The tech was probably twice the Fellow's age but still she was First Name and the Fellow was Dr. Last Name. Later the real radiologist came in, a warm and confident woman with a New York accent and forehead wrinkles. She guided the Fellow's hand somewhat. I don't know how good a job he did but I thought he was going to biopsy three places and he did only two. Four days later my breast would still look like it had a black eye. When I'd show it to friends they would gasp.


January 24: When Positive is Negative

The Unjolly said he would call me January 24 at 3. I had a small meeting at school that afternoon but kept my cell phone on the table in front of me. A little after 3 it rang. It was my husband L. At 4:30 I called Fancy Hospital and left a voice mail message with the radiology department. A few minutes later the Fellow called. It's positive, he said. I guess they learn in the cancer segment of med school never to utter the word "cancer"--it'll scare the patients. Look on the bright side, it's positive. Accentuate the positive/eliminate the negative/and leave Mr. Well-Enough alone. Isn't that how the song goes? I said, rather haltingly, Are you calling because you said you'd call or did you get my message on the answering machine? only I'm sure it came out more scrambled and inarticulate. He said: Are you OK? Of course I said yes.

I learned years ago not to ask someone if she's OK. Instead you ask: How are you? Or, if you don't know what the situation is, you ask: What's the matter? It's too easy for the other person to respond, I'm OK, and then everyone's off the hook.
Of course I don't know if the Fellow poked me in exactly the perfect ways. in the exact perfect spots. My friends who gasped at my breasts weren't experts.

Jan. 24: How NOT to Tell Your Class About Your Breast Cancer

1. Be grateful that during class you don't think about your cancer, except during free-writing, when they're making lists that begin with Because, with Susan Donnelly's poem Why I Can't as the model. The title of your list is: Why I Don't Trust Doctors Who are Very Good-looking.
2. Tell them as soon as you know, on the day you get your diagnosis from the Cold (and good-looking) Blonde at Fancy Hospital. Don't wait until you have concrete information that your students will need, such as dates of classes you will miss.
3. Wait until five minutes before class ends. While they are standing with their coats on, say that you have something to tell them. That you have breast cancer. Expect your voice to be calm. It will not be. It will break. You will be in danger of crying. Tell them you will find substitutes for any classes you'll miss. Tell them you're going to talk to a surgeon the next day, but be unable to continue, leaving them stunned. Then exit.
4. On the way home, think about how irresponsible you were.
5. At home, send an e-mail to all of them, telling them you're sorry if you freaked them out. Become paranoid when only one of them replies.

6. Have your friend K tell you that it's all about what you need, so whatever you needed to do was OK. Know that she's wrong. Your job, in a way, is to protect your students from your own mishugas.

7. Post this on the class's website and see what happens.
January 25: Surgeon
The surgeon is warm but business-like, a nice combination. The cancer is in three places, so she can't do a lumpectomy. She has to do a mastectomy. She says it's probably Stage Two, because the mass is probably more than 5cm. But I thought it was 2cm. She explains that now they're thinking of the three places as one big place. Surgery would be in two-three weeks. Without reconstruction, the hospital stay would be one-two days. With, four to five. I tell her I don't want reconstruction but she encourages me to talk to the plastic surgeon anyway, just to see what my options are. And then suddenly, I, who'd imagined myself a one-breasted, defiant Amazon, find myself thinking: I would love to have reconstruction.
January 25: Valium Quest
I have an MRI planned for Tuesday, so the doctors can check out the calcifications on the right breast. I am scared most of all of the confinement. The Real Radiologist had asked me if I was claustrophobic, and I said yes, and she said I should take Atavan or Valium before the MRI then. One of my doctors (via voice mail) informs me that Atavan should be enough and that she'll send in a prescription. But I know what Ativan does (reduces the anxious lump in my throat) and I know that that's not enough when I feel claustrophobic. Listen, I want to say to her, I have had asthma since I was three *days* old. I don't mean three years. I mean days.
I am afraid of running out of breath. I am afraid of the lack of air and the perceived lack of air. Years ago I paid good money to spend an hour floating in a dark tank for relaxation. I was afraid the whole time that I would fall asleep and drown. I consider it a wonder that I can do yoga; the thought of paying attention to my breath is alarming.
P will take me to the MRI and will read The New Yorker to me while I'm in there.

January 27: Black Camisole

W. greets me in black lacy top with black bra straps showing. She's tucked her top into black pants. She has graciously offered to talk to me about reconstruction after her mastectomy. Indicating her camisole, she says, I'm not wearing this just for you. Her treatments have zapped her into instant menopause and she's suffering from hot flashes. But why shouldn't she wear her camisole? She looks fine in it. And later, when she shows me both breasts, I see that they're almost identical, except for the long scar on top, across one of them. She lets me push a little on the new breast so I can tell that it's soft. She has saline implants and praises her plastic surgeon to the skies: He loves women's breasts, she says. She also recommends her surgeon. All was done at Pretty Good Hospital, though she tells me you can pick and choose your surgeons and oncologists and pathologists, they can be at different institutions. She sent her slides to a certain pathologist in Tennessee who she says is world-famous. The idea of doing that seems daunting, but why not? She says that Fancy Hospital misread her pathology report. I have a friend who does research at Pretty Good. That night he says he'll check to see which surgeons are good, which ones are drunk, which are in a down period. I had never before touched another woman's breasts. My idea of teen-age-hood and life was much influenced by Anne Frank: The Diary of a Young Girl, read at a very early age. I remember she talked about asking a friend if she could touch her breasts. Her friend said no. I thought it must be a normal thing to ask another girl. But I never did.

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