It’s hard to describe. I no longer find myself inexplicably more angry and impatient for two weeks before my annual mammogram. The anxiety lasts for maybe a day before and it isn’t terrible; after all, my right breast has never showed any problems. I am not BRCA positive and I have no greater chance of getting breast cancer in my right breast than most “normal” women. Now that the breast that went wrong is gone, it’s statistically extremely unlikely…
Wait. What the hell am I doing? Am I explaining myself to you? And who are you, and why do you need an explanation? Why am I being defensive? Why do people with terrible illnesses have to explain themselves to people without them? The truth is that I know 3,000 times more about breast cancer than the average person and not by choice and yet here I am, explaining, justifying. I hate this, when I do this. And yet…
Can you blame me? After being profiled in the Huffington Post several years ago for having a lumpectomy, I read comments from readers who decided I was “vain” (even though that surgery was medically advantageous for me since it included radiation) and, even… that I “didn’t really love my children.” You read that right. I never wrote about that here, did I? But yes, a man—of course, a man—who knew nothing of medicine or cancer and less of me, said that I did not love my children because I didn’t have a mastectomy. Let that sink in for a moment. Another commenter implied that I deserved to die, since I cared more about my looks than my life. That person apparently believes you need breasts to survive—since no human being has ever died from breast cancer local to the breast, and metastatic breast cancer gives not one shit whether you had a lumpectomy or mastectomy in the first place. But every single one of those commenters believed that from reading a few lines on the internet, they knew more than people with breast cancer, and the people who have dedicated their lives to studying and fighting the disease, and that they were in a place to pass judgment. And we feel that judgment clearly, those of us who might die young through no fault of our own. And we attempt to educate, to explain. And it’s bullshit.
So cut me some slack. And let me try this again.
It’s hard to describe.
The nightmares are intense, movie-like, and seemingly unrelated. They only last a night. You can’t sleep in, because you can’t really sleep. You go about the morning, unloading the dishwasher, making breakfasts and lunch. You have taken the day off and your husband is coming with you for the mammogram. He always comes with you. This time you end up almost wishing he wouldn’t. You fight in the car, he is wholly unable to comfort or distract you and you resent him for not trying. He claims to be quiet because he’s tired and concentrating on driving and you find these petty complaints enraging. You think he is making this horribly anxious day be about him, and you aren’t entirely wrong, and it’s one of those taboo things people who have had cancer rarely discuss—when the people they love disappoint. It’s real though, and it’s hard.
Once you are finally in the mammography suite, you realize, as you always do, that he can’t come with you anyway. You go inside and are ushered through various people checking you in and then you are separated by multiple waiting rooms. So why does he come? You know the answer, which is that the very first time you ever walked in this room is the time your life changed. You never got to have a normal mammogram as a woman without breast cancer. You don’t know what that’s like, to have this be a routine test. So he comes with you, if for no other reason than someone has to drive home if you need to fall apart.
You are still in the diagnostic camp, though they scan you like it’s screening: just two pictures, nice and easy. You go back to the waiting room. And then, you are called back in, for another picture because “we just saw some tissue there and need another angle.” You ask for clarification and they don’t give it to you and you know they aren’t supposed to tell you anything. The mammography technicians are supposed to be gods of the poker face, all sympathy and no information. That aspect of the job must be much tougher than contorting breasts into metal machines.
You have one more picture taken and go back to wait. And then, a different woman comes for you. She says, “I will take you back to this area and then we will get your ultrasound going, ok?”
You stop right in the middle of the hall.
Oh my God, she says. They didn’t tell you? I am so sorry-- they are supposed to tell you. They saw some tissue on the mammogram and this is just to clear it up. Oh God, someone should have told you.
You cannot even speak. You know why women get ultrasounds. It is to confirm the breast cancer everyone knows is already there. You have had two of these before, and saw four tumors, three the first time, one the second, round and clear as day on those ultrasounds. But those times—you had at least felt the lumps yourself. You knew something was there. This is totally out of the blue.
OK, you say.
God help anyone who is in the room when all you can say is “OK.”
You follow her. She is nervous and talking too much. You feel sorry for her, and realize if you lived with her or loved her, you would hate her just a little bit right now. It is in her being a stranger that her awkwardness reads like empathy. It is because she doesn’t know you that she cannot say “well this is some bullshit” or “Jesus Christ I can’t believe they didn’t warn you” or just “what the fuck.” She is just doing her job and she sees thousands of women like you. Or so you think, until she doesn’t stop talking. And you wonder what the look in your eyes looks like to her. She seems afraid of you, and you aren’t even talking. Maybe that’s it. Maybe it’s your silence that throws her off.
She describes the procedure to you. You tell her: “I know. I’ve had two of these before, when I was diagnosed with breast cancer twice before.” She changes tactics and tells you about the gel and where to position your arm. You contort yourself so that even though the computer screen is above and behind you, you can see it. You watch her and she watches you watching. She stops talking. After a while the circle comes into view, perfect in its roundness. You see her type “4 cm.” You think that’s impossible, that is huge, all three of your tumors together weren’t that large.
It’s hard to describe what you think about. First, you begin to think about not seeing your kids grow up, but it’s too hard, so you stop. You think about how you will tell your boss, since you just started your job. You wonder if you will have to quit. In the next breath you think “I will have to delete facebook.” You honestly cannot imagine sharing with anyone if this is the third time. Your instinct is to never speak to anyone again. You think about how skinny and fit you used to be and how you are all right now but not in your best shape and yet well, I guess none of that matters now and it never did. You think about the fact that if you have cancer again someone will say it’s because you didn’t have a scientifically unwarranted mastectomy. Someone will say it’s because you gained 10 pounds. Someone will say it’s because you couldn’t not drink whisky sometimes in this political environment. Or, more likely, no one will say this to you, but they will think it. Others will think how unbearable it is for someone to have cancer again and again and they will leave. You are not being cynical. It’s the truth. The cynicism comes in with not wanting to talk to anyone. You think about how you will get through the day because thinking beyond that is impossible.
You think about circles and clocks. She measures your breast and writes down the “time” of the circle. She gives you a towel to wipe off the gel and nervously asks you if you need another. You know that she knows you don’t need one, and you vascillate between feelings of annoyance and tenderness towards her nervousness. You begin to put your clothes back on and you know that your silence, or maybe just the look of silence in your eyes, is killing this young woman just a little bit. She says that she will get the doctor, the radiologist, and it will be just a minute. You nod at her, silent. She reaches for the doorknob and says, quickly and nervously, “it doesn’t always mean anything. They just have to make sure, I wouldn’t assume it’s anything.”
You look at her, curiously. You think, huh. Well, actually, the only times I’ve done this, it’s meant…something. And we all knew what. You smile, and it’s the worst thing you could have done, you can see it in her eyes.
The door closes. You think about crying. And by that I mean you think about it, intellectually. You remember crying. All the time after your first diagnosis, making you feel like someone else. In the changing room after you found out the second time—you cried then fast and furious. You haven’t cried for more than a moment in years and years. You wonder if your husband is crying, because you told him about the ultrasound.
In the time it takes you to contemplate the nature of tears, the door opens. A radiologist you haven’t seen before is standing there: a tall, handsome white guy with perfect hair and one of those big, charming, toothy smiles. “Hello!” he booms, looking straight into your eyes. “You have a cyst, there’s absolutely nothing to worry about, everything is fine! My name is Dr. X.” And he takes your hand to shake it and then holds it with both of his. You can’t help but wonder if he learned all of this in medical school or charm school or what. You get mad at yourself for wondering. You say “I’ve had breast cancer twice and the only times I’ve had ultrasounds was to confirm my cancer. So when you called me back here, I assumed the worst. And I saw what she was looking at—it was a circle.” You realize you have momentarily broken the strength of his poker face and you feel somewhat guilty as he is genuine and caring and that is why he told you right away. “I like to tell people the good news before I even tell them my name,” he had said. You wonder again how he learned that, and half hope it was from some woman screaming in his face when he did things the other way around. You reiterate: “I saw it on the screen.” He recovers well, and just pulls up the images on the computer without even trying to convince you otherwise. He shows you the mass. “You see, it is completely black inside. Breast cancer is gray, or shadowy, or white. This has absolutely nothing but fluid inside of it—NOTHING. We aren’t even worried about this at all. See, here, you are coming back in a year for a screening mammogram!” He sounds excited and shows you the piece of paper releasing you as if it’s an award. He is so earnest, and attentive. You feel a little sorry for him too.
And then, as you are leaving, the technician pauses at the door: “it’s just that we can’t say anything. We have to wait for the doctor.” She looks at you imploringly, and leaves.
You understand her now. She knew you were fine, and could not tell you. She knew how scared you were and that she had the information to give to you to alleviate that fear and she could not give it to you. And you realize: This is what she does for a living, every day. Every day she stands inside people’s fear and suffering and bears witness to it. She sticks to her part, and it is hard for her. It is hard for the doctor too. But, most of all, this is hard for you. It’s ok to admit that, and to claim it: This is hard for you, most of all.
You head over to the oncologist and he agrees to see you 90 minutes early which is unheard of, but you realize he has the results of what just happened. Your blood pressure is high, through the roof for you, and the nurse just laughs and doesn’t seem concerned at all. Your doctor comes in, this man you have been dancing with for seven years, and does the same cursory exam and asks the same questions and tells you the same things: “you look great. Come see me in six months. Enjoy your summer.” When you ask him about the cyst, he tells you it’s common, you are just starting your period this month, it’s nothing to worry about. You look at him and he at you and he says something to you that you know he doesn’t say to everyone: “They are very conservative. You wouldn’t be in my office if it was anything.” You know these are the same words another technician told you years ago: “If they were worried, you’d be on the (biopsy) table right now.” They have never messed around in this place. Unfortunately, they have never been wrong. You ask him if there’s anything else you should do, knowing he will say no, and he says “Medically…you’re fine. You look great,” and he walks out the door.
Medically, you’re fine.
That’s it, you realize. That’s his way of empathizing. His stone face and monosyllabic voice and total unconcern with any of your problems save CANCER, all of that masks the fact that he, too, does this every day. He watches women fear and suffer and die. He has to tell people they are dying. He can tell the difference between suffering you will live through and suffering you won’t. He knows the toll it takes on the people who go through it. He knows it and the technician knows it and the radiologist knows it. They just handle it in very different ways, in very imperfect human ways.
And you are reminded again that they are all very good at this and also no better at this than you.
As I said before, it’s hard to describe.