Tits Up

Probably Part One

I found out I had breast cancer in early May.

I’ve been told for many years that I have tricky breast tissue; dense, hard to read, littered with spotty spots. So I’ve been on a carousel of vigilance — getting checked every six months — an MRI in the spring, an ultrasound in the fall.

As I feel every time these appointments approach, I wanted to postpone-or-maybe cancel my April appointment. Hadn’t I just been checked?? And what if I got bad news? Bad news would be very bad for my spring schedule. My older son was graduating, the last of his high school baseball career packed into the coming weeks; my older daughter was coming home for three weeks to visit before living in Boston for the summer; my younger daughter was studying for finals and hatching a new summer plan daily; my youngest had Cape Cod and cousins on the brain, telling me hourly he could not wait to see them, confirming and reconfirming with me that I also could not wait to see them.

So I considered pushing the appointment. Just a little. Past the summer, a season not meant for serious things. Yes, yes: I’d wait til early fall — except then I’d have college drop-offs and parents weekends and football games. Ok — til late fall. But it’d be a shame to ruin Thanksgiving. I love that cozy holiday. And obviously December is too merry for grinchy news. So maybe mid January, which is a terrible time of year all on its own? That might be a good time for a bad thing.

But sitting with my airpods in, ready to dial the Imaging Center to reschedule, I ticked off all those months of delay on my fingers and saw my hands were full.

So I went for the MRI as scheduled, entubed and panicky, wondering what all the loud sounds were bumping into in my body. Days later, I got called back for things the radiologist didn’t like on both sides. The left side spot appeared less friendly and was also easier to access, so I went for an ultrasound-guided biopsy on that one first.

If AI takes over any one thing, I hope it’s ultrasounds. It’s not that I’ve always had bad techs doing these. It’s just that I don’t think this is a job for humans. I don’t want someone to keep sliding a wand over an area, re-gelling and bearing down harder, huhhing and humphing about my tissue as if it’s a funny prankster due a detention. I don’t like sighs that sound like a diagnosis. I think robots could and would act a lot less loaded about it all.

The teensy bad thing this human tech was hunting looked the same as seventeen other things on the screen, and not nearly as menacing as some of the stuff she just glossed right over. I remembered an abdominal ultrasound I had years ago to find out if I had a hernia. I had tried to look away from the screen because I couldn’t make liver nor gallbladder of it all. But on one glance, I spotted a two-headed mass and felt certain I was looking at my end. I was looking at my kidneys.

I thought of all my prenatal ultrasounds, peeking at floating aliens I’d love forever, grateful for organized organs and proper measurements, leaving with printouts of gorgeous profiles to stare at, silhouettes of expectations.

I imagined being sent home from this ultrasound with thermal pictures of an unlikeable spot to hang on my fridge. Look at what I wasn’t expecting!

The radiologist pushed in the plug to vacuum out what she needed. This did not hurt which was its own brand of distressing. Afterwards, I saw, wishing I hadn’t, the extracted globs in little plastic containers on the metal tray. Off they’d go to tell some story about me I’d have to wait an inhumane number of days to hear.

But the radiologist was reassuring.

“Oh good. This isn’t cancer,” she told me as she peeled off her latex gloves and tossed them in the trash. I wondered how many pairs she’d gone through in just this one day and felt a surge of doom for the earth and so many people on it. “I can tell by the way it acts. It’s soft, not rubbery. I’ll call you when we hear back from the lab, but this one will be fine.”

This is why, a long week later, I picked up her call in the grocery store. So she could tell me that this was fine. My tricky tissue had tricked her though.

“But you said it wasn’t…” I whispered, staring at bins of avocados, looking up at the BAKERY sign hung too high to be useful, my thoughts pin-balling, scrambling, desperate to get a cancer diagnosis reversed on a technicality.

“That’s right — I did, didn’t I? I know. I’m just as surprised as you are,” she answered, not in a disingenuous way, but as if this wacky plot twist might affect us equally.

I started asking her what would happen next. She did her best to give a rough outline, but her job here was done. She’d run her leg in this relay and now the baton was going to….whom??

Me? But I didn’t want to be in this crap race. Could I — I don’t know — scratch?

Or wait — no. Wasn’t that what cancer was trying to do? Scratch me? Fine, fine. I’d run. Give me the baton.

I texted my primary care physician who, after captaining us through our multi-year medical odyssey with my youngest, is utterly primary to our family and really cares. People think it’s cool to have all kinds of connections, to know people who can get you box seats at the Warriors or nosebleeds at Taylor Swift. But I’m telling you, be best friends with your doctors. These are the slam dunk connections, the only ways to stay Fearless.

Even though someone had filled the whole grocery store with water, and I was now sitting at the bottom of the ocean, my text went through. Her three dots flashed immediately. She was ready for me as always.

I tiraded a bit, telling her that I didn’t think this was all that fair. That I’d had my medical drama. That raising a kid with severe epilepsy should’ve earned me some sort of exemption in this category, dues fully paid.

I typed it knowing life doesn’t operate like this. I typed it knowing she knew this too — doctors, of all people, understand that life can be an indiscriminate asshole. But she didn’t try to talk me out of any of it. She just texted: I don’t even know how to begin to make it make sense in my brain either.

And this — on top of quick ins with the confusing number of doctors you need for a breast cancer diagnosis and granular instructions for my water-addled brain like call this one first — was just what I needed in that moment on the floor of the sea.

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I would’ve guessed that a cancer diagnosis would thrust you into some Chamber of Seriousness, where all you did was think about it and meet doctors and get opinions.

But in the weeks between biopsy and surgery, that wasn’t true for me. I mean yes — I had Appointments, a full schedule bringing me in and out of the city as if I had a new profession, all to buildings I could not believe I was entering.

Jesus Christ, what am I doing walking into a Cancer Center??

Everyone’s rightfully petrified of cancer, but until it shows up on your scan, it seems meant for other people you’d pray for and bring a casserole. It feels — I don’t know — off for you personally to have.

But of course, there isn’t a person walking under that Cancer Center awning and through those ominous doors thinking Ah, this makes sense — cancer feels right for me.

So your job becomes squaring this out of body experience with what is going on inside your body.

And in the meantime, as you work through all of the Appointments, you just…carry on. Yes, bombs are falling all over your city, but you must keep calm. So you drink tea in your kitchen, butter a bagel, pick up a kid in the city, make small talk, buy grad gifts, answer stupid emails from stupid people, decline some invitations because you’re suddenly in no mood for distractions, accept others because suddenly only a distraction will do.

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A week after nearly drowning at the grocery store, I went for the right side biopsy. I felt more worried given that the left had already revealed its disagreeability. People tried to comfort me: but I’ve never heard of breast cancer in both sides at once. I have no idea if this is medically sound, and I’m sorry but I cannot Google to fact check because I haven’t Googled a single scary thing throughout this experience. I learned this life hack when we were newly dealing with my youngest’s seizure disorder, quickly understanding online research could be its own kind of cancer: confusing, bottomless, horrifying.

But my son’s diagnosis hacked my life in another way too: when someone says rare, I hear likely. So I started to assume that I’d be some crazy anomaly with cancer in both breasts, and probably not even the same kind.

An MRI-guided biopsy combines all of the smushing discomfort of a mammogram with the added pain of needles. And since I wasn’t finding out if I had cancer, just if I had more of it, the procedure felt extra scary because more of it would mean a much more radical treatment plan.

Okay, here’s where I scrap that AI idea. The two techs working this giant, room-filling apparatus were critically human, making sure the technology didn’t swallow me. One gave me a warm blanket. And the other explained every step slowly. One warned of the painful parts. And the other apologized for the discomfort. One told me I was doing great, that it wouldn’t be much longer. And the other rubbed my back the entire time, each stroke like a string tied to a finger, reminding me I was, above all else, a living person.

After additional unreasonable days of waiting, my Gentle Oncology Surgeon called me on a Friday evening, well past the working day. She apologized for the hour, but didn’t want to wait. She wanted me to have a good weekend: the right was benign.

So now, knowing this, and that I didn’t have a particular propensity for the 782 kinds of other cancers they’d genetically screened me for, I would just need a quick lumpectomy, lift and reconstruction. In contrast to the other treatment possibilities that had loomed, this was just about the simplest path possible.

And so I conflated simplest with simple, and, you know: any time you’re conflating, you’re either dumb or screwed or both.

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The morning of the surgery my husband drove me to the hospital at one of those nauseous hours where you are surprised so many other people are already on their ways to places. Where? What is everyone doing?

I rode like a device in low-battery mode, only capable of basic functions.

My husband tried to charge me. “I think we have to remember that we’re lucky. That we caught this early and that we’re just going to do everything we have to for you to be okay.”

So sweet, so supportive, so not compatible with my mindset at that moment.

“I want you to know something — that is not how I’m thinking about today. This is not a We. This is a Me. And right now I’m thinking the really lucky thing would’ve been to never have had anything there to find in the first place.”

He put his blinker on and merged onto the highway, waiting for the cabin air to de-electrify just a little. And then: “Well, I think that’s understandable too.” The man is a professional.

We arrived to the vicinity of the hospital, but not the hospital itself because all surrounding blocks had been cordoned off after a massive water main break the day before. My husband had to drop me off a few blocks away so I walked in alone past cones and caution tape to this place I needed to think was infallible, not vulnerable to public works catastrophes.

I went through admissions and was assigned to what seemed to become my operating receiving room.

First my Gentle Oncology Surgeon came in, radiating warmth like a little personal space heater. The kind of doctor who makes you think Thank God this is what she decided to do with her life.

At our first appointment, Gentle Oncology Surgeon had told me she had an 8th grader and I liked thinking she was just here at work, just doing her job, which today included, but was not limited to, slicing into me. And then much later, she’d peel off her day’s last pair of latex gloves, and probably hop in a car to go pick up that kid from camp or something. And they’d have dinner and when that kid disappeared into their phone and bedroom because 8th grade, Gentle Oncology Surgeon would probably call other patients with excellent or terrible pathology news because she didn’t like to make people wait.

Panicked, I told her I no longer meant any of what I’d said at our first meeting. I wasn’t fine with change. I didn’t feel casual about my breasts. I didn’t want to go as small as possible because I’m a runner. I wanted to leave everything as status quo as possible.

She took my anxious, eleventh-hour switch in stride. Just another wrinkle in the work day, like a double-booked meeting or an error in one cell of a spreadsheet. Fixable, easy. She calmly told me to just be sure to mention this to the plastic surgeon when he stopped by.

I’d met with the plastic surgeon only once before the day of my surgery. A very nice man who was from Cape Cod and had a phone number with a Boston area code, which felt comforting to me, as if my breasts were better off in hometown hands.

Breast cancer treatment sits at this weird and disorienting intersection of survival, identity and aesthetics. And oncology surgeons and plastic surgeons make for strange bed operating-table fellows. One is there to get everything dangerous out — take as many pieces as necessary in order to keep as you as whole as possible, remove the spot and get the margins and harvest your lymph nodes for biopsy. The other is there on clean up, the architect in charge of the reconstruction after the house is dismantled, all of the asbestos hacked out of the insulation.

I found Pre-surgery Petrified a funny state for talking about appearances. This wouldn’t be a shoot-I-shouldn’t-have-got-bangs kind of thing. We were talking permanent changes here. To the house we had to live in.

As I stood in front of the Kind Surgeon, he took his mini tape measure out, snapping with quick precision as he marked distances from my nipples out in various trajectories. He narrated as he went, telling me and my husband his exciting plans for this remodel, drawing lines in purple sharpie. Plans for me all over me.

He took a step back and stared.

“The right side is bigger anyway. So we’ll take a little more over here,” he wrote a 10 on that breast — a 10 that would stain me for weeks — for the extra he estimated should come out of that side. I worried he’d forget whether this note meant it was 10 more or 10 less when the time came, the way I can’t make sense of my own notes to myself anymore.

Maybe I was destined to be off balance.

Everything was measured in grams, as if we were assessing the sugar content of a snack. Later I would Google how many grams of sugar were in a teaspoon and this would demoralize me; but then I would Google how many grams of sugar were in a pound and this large number would make me feel better.

The Kind Surgeon pinched under my breast to show how a lift would work. They call this a Lollipop Lift, he told us, and I would’ve bet the life I was concerned I was about to lose that this procedure was not named by a woman.

Next the anesthesiologist came in and introduced himself by his first name, which only underscored that he looked like he might’ve just crossed the stage for a diploma at my son’s high school graduation, just one of the many classmates I hadn’t known.

Lastly, a confidence-inspiring nurse came in and took charge of the scene. This Best Nurse reminded me exactly of a nurse we’d had at Boston Children’s over a decade ago in the ICU. My youngest, very sick with RSV and pneumonia, had barely survived extubation the night before. He was only nine months old at the time — we didn’t know him well yet. We didn’t know the tricks his body would get up to, or that he’d pull off this kind of miracle over and over again.

We thought we’d just come through the One Big Scare. The frightening hospital night had faded into a routine hospital day, glossy winter sun outside the window, my son breathing steadily on his own, like he’d always planned to, small in a bed in the middle of the bright room.

This newly-on-shift nurse arrived, untainted by the horrors of the night before. He read the chart, checked my son and then looked me up and down.

“He is fine. You are not. First, you are going to eat something. And then I’m making this bed up for you wayyyyyy over here in the corner. You are going to go to sleep and you are going to know I’m watching everything. And I don’t want to hear from you FOR HOURS. Got it?”

It felt liberating to be bossed around. Released from my mortal fear and exhausting advocacy, I slept for the first time in nine days.

Here now Best Nurse was giving me the same permission — to just sleep and let everyone else do the work. He strapped my legs into compression sleeves. I didn’t like thinking my legs needed anything related to this procedure; it reminded me that this was happening to my body globally. But Best Nurse did it with such surety — it was just perfunctory, not threatening.

I didn’t even count down. I just listened to the OR banter amongst coworkers, as if I’d mistakenly dozed off in their break room, pretty sure Best Nurse was flirting a little with ———

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I’ve never been under before, and though I do consider Michael Jackson a freak, I now understand this one thing about him. That is one lovely and drifty sleep, and if your life has otherwise sucked because you got famous too young, had a mean dad and had…proclivities, I could see craving that state.

For hours (or days?), I could hear Best Nurse telling people I had been out for hours (or days?).

“She is just not waking up. She is OUT,” I heard them as if I was in a dinghy on the water and they were on shore on a pleasant summer day. Maybe I was on Cape Cod. Maybe my plastic surgeon was around here somewhere under a big beach umbrella with his family. I should ask him how it all went back there in the OR. Had the plans all panned out?

I understood, hearing everyone, that I could try to wake up. But honestly, why? This was the most relaxed I’d been in at least a month and as many as 21 years. And once I woke up, I’d have to start having formed thoughts about what had happened during my drugged nap.

So I kept sleeping. And then I remembered I should try to get home to see my family, and I asked for some juice and fell back asleep while drinking it, my husband catching the cup as my arms flopped back to Neverland.

Somehow, in ways I cannot recall, I was dressed and wheeled out to the car in a wheelchair by Another Nice Nurse. I told this man he was SO good at his job, over and over again. What a lovely person you are to wake up to after something like this. How good you are at steering this wheel chair. I can tell you make a real difference for people.

Listen: hospitals run on nurses just like society runs on teachers. You can never praise either enough, no matter how high you are.

We arrived home to my whole team, my kids, our nanny, and my parents who’d flown in from the east coast the day before because if there’s a single thing they wouldn’t do for our family, we haven’t found it yet.

Everyone guided me up the stairs like they each had a string and I was some daffy parade float veering for onlookers on the sidewalk. Whoa. Let’s straighten her out.

Once properly deflated, I was parked on my bed. And the people I love went in all different directions to get me tea and Tylenol, pillows and front-buttoning pajamas.

How lovely: I was back on the Cape, my bed a raft in the water, people taking turns swimming out to me, hefting themselves aboard to float with me and have lazy conversations in the friendly late afternoon light, feet hung over the edge to feel the water lapping.

At a point, my people all dove off, swimming to shore, leaving me to rest. I fell asleep, my hands pretending to hold a drink again, this time a giant hot tea perched on my abdomen.

But I didn’t spill it. I woke up from my moonwalk just as I’d dozed off, cup upright and intact and full.

Because I am lucky.

Jen.

IMPORTANT NOTE:

This is my written guarantee that someone in your life is delaying a mammogram right this minute. It could even be you. And I understand: mammograms can be uncomfortable and inconvenient and scary. You could find out something bad, and you could find it out at a bad time. But the sooner you get the mammogram, the more likely you won’t find out the worst. So go on your text strings with your many beloved women and ask: is everyone up to date on mammograms? Bug your wife or mom or sisters or daughters or aunts or cousins or friends. And bug yourself too.