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by Mary-Ann Tirone Smith 




The memoir will be posted every Sunday, one chapter a week, on this page.


If you're getting a late start, you can READ CHAPTERS 1 - 14 by clicking "PREVIOUS CHAPTERS" on the red menu bar above.


This week:  CHAPTER 15.


SO, I'M BACK HOME after my biopsy, in case you forgot, and I get a call. I can tell by the ring it's from someone at Yale-New Haven Hospital. I have caller-ID. I'm right. I am grateful for the glass of pink wine from Provence presently in my hand, even though I'm supposed to be resting in bed, which I had been, but now I'm on my way back from the refrigerator. I click the green button.

     "Hello, Mary-Ann. This is Justine, Dr. Quigley's PA."

     I try, but I can't choke out a hello.

     She doesn't pause. "Congratulations! We've got the pathology report. You have DCIS!"

     Hot damn! I don't have cancer after all! I have some minor thing called by its initials. I assume minor since, after all, I have just been congratulated. I ask what the letters stand for. She says in an entirely different tone of voice upon realizing I don't know what DCIS is, "Ductal carcinoma in situ."

     I surely recognize the word carcinoma. A lesion is a tumor, carcinoma one step beyond: cancer. I lose the ability to breathe and my heart its ability to beat. I sit down on the floor so I won't fall down. I am known to faint. But I can hear Justine continuing along, so I know I'm managing to keep the phone in my hand against my ear.

     "The lesion you have is restricted to your mammary duct." She's reduced the horror to lesion.  "None of the cancer cells have invaded surrounding tissue. They're in situ…the cancer hasn't spread."

     I first hear in situ when I  make friends with these archeology students. I'm in Hawaii studying the literature of the Pacific, the dances of Polynesia, and photography, the last with five other students chosen by a famous photographer who picks us based on the photographs we submit. I took my pictures with my mother's really old Brownie. Apparently, a Brownie has a top quality lens because back in the day, we didn't really have poor quality anything. The archeology students dream of finding an artifact in situ, meaning they would find it in the original, natural, existing place and position. The cancer cells in my duct are in the original, natural, existing place and position where they were found. Too bad they fucking morphed from junk to cancer, not unlike when people found Etruscan miniature statues and would say, What's this pile of junk? and threw most of it away before the statues morphed into valuable artifacts.

     Somehow, my brain is processing what Justine is saying despite my drifting off to an Etruscan analogy. I may have cancer, but not only is it still in the mammary duct where it evolved, it hasn't moved! This is, of course, what the radiologist told me, but she never says anything about such a phenomenon having a name, damn it.

     I ask Justine, "It's not anywhere else?"

     "It's nowhere else!"

When I am twenty-one years, travelling around a sharp bend on a motorcycle, suddenly there is a man directly in my path. I have a choice of three things I can do: Hit him; take a right into a ditch; sail into a forest of ebony trees. (This happened when I was in the Peace Corp.) I go with the ditch, become airborne, and fly off and over the motorcycle, landing just on the other side of the ditch. (The motorcycle is in the ditch.) From my prone position, the first thing that registers is that I'm still alive. So, I bend my right leg, then my left, then my right arm, then my left. My limbs are intact and I assume my neck or back isn't broken, otherwise, how could my limbs work? I'm bleeding all over the place but I am okay. In case you want to know, a bunch of Cameroonians go get the Honda 125 out of the ditch, get me onto it, and I go to the nearby home of a volunteer with the German Peace Corps who pours liquid green soap into my scraped forearms and knees. That's all you need to know except the volunteer is from Berlin and is gorgeous.

     Now, on the phone with Justine, sitting on the floor, I am saying to myself: I have cancer, but it's not in my lungs, brain, colon, bones, pancreas, liver, ovaries or stomach. I have a cancer that is walled-off by my tough little mammary duct struggling with all the strength and power she can muster to maintain the ramparts. My duct must sacrifice her life for me so that I can be cured.

     Shooting out that panicked information is my brain's way of telling me I won't die within a year like my mother does after I receive the news that she has stomach cancer. An oncologist tells me, not my mother.

     "It's metastasized, Mary-Ann. Stage 4. Your mother gave me instructions not to tell her anything, to just do what I had to do. She didn't tell me not to tell you. Can you please speak with her and get back to me?"

     Poor guy. I tell him I will ask her primary care doctor to talk to her. She loves him. I am there when he tells her the news. She's watching TV. She turns off the sound when the doctor makes his presence felt. After he tells her, she doesn't say a word and right then, my Auntie Margaret comes to visit. She stands there in the doorway, gaping at the tableau in front of her.  

     My mother says to her, "They told me I have cancer. Look!" She waves her hand at the TV. "Right in the middle of Oprah."

     She releases the mute. Auntie Margaret sits down on the bed and they watch the rest of Oprah.

     I cannot help but note that she said they, not he.

     I sit down on the bed, too, and watch Oprah. The doctor slinks out the door. Auntie Margaret says to us, "I left home ten minutes ago. You didn't miss anything."

     The oncologist has positioned himself at the side of the doorway and is crooking his finger at me. I got out. He gives me a hug. He says, "I'll talk to her doctor right away. You go home to your family. Let your mom's sister have her visit."

     Now, with all those recovered memories fighting for attention in one instantaneous moment so I can somehow deal with what's going on, here is what I say to Justine, "Can you tell me everything you just said again? I think I blacked out there for a minute and I want to be sure I didn't miss anything."

     Here I am, not wanting to miss a thing, and I had a mother who didn't want to miss Oprah.

     Turns out, I missed quite a bit, including, "Even though the radiologist is sure the cancer cells are non-invasive, we want to be positive. Because, Mary-Ann, if they are invasive, when Dr. Quigley removes the duct she will also remove a margin of tissue all the way around in case microscopic protuberances of the cells are just starting to stick out through the duct wall."

     My duct will be sacrificed, after all.

     I don't say to Justine, My no-name radiologist already told me that part, because Justine's not finished.

     "The lay term for your surgery is lumpectomy."

     Lumpectomy isn't a medical term? Of course it isn't. I say, "But there is no lump, right?"


     "Then why are we calling the surgery a lumpectomy?"

     She takes a moment to answer. Then she says, "Due to the incredible speed of the development of technology, no one's had time to come up with a new lay term."

     "But I bet there's a new medical term, right?"

     "Uh…no. We use the original one."

     "Which is?"      

     "Partial mastectomy."

     I have no reaction since Justine's sledge hammer does its job. My head is instantly pounding and I almost never get headaches as I believe I have said.

     I just barely hear her ask, "You okay?" amidst the pounding.

     No automatic okay from me. I am not okay. In fact, anger is rising up from my stomach into my throat, which makes the pounding stop. When fury is justified you feel strong. You get pissed. Let nature take its course rather than biting your lip or sucking it up, which I feel will lead to a heart attack. (When you go to a shrink and he tells you that you have anger issues, leave. It's like when you have a partner who says things like, "Calm down," when he's the one who caused you to lose your calm in the first place.) You are absolutely entitled to fire an air-to-ground missile at the shrink. The partner you just get rid of.

     I say to Justine, "Listen, in the real world, a mastectomy is when you have your breast guillotined. I'm just having a little tiny piece of junk taken out of Starbright, and that piece is so small that no one—not me, not my husband, not my OB/GYN, not my radiologist, not my breast surgeon—no one can feel it. So, the surgery I'm having is…. It's an invisiblectomy."

     Initial silence. Then: "Yes! Yes, it is! That's exactly what it is. Why not?!?!?! I love it! That's what we're calling it. An invisiblectomy! But again, the main thing is if you have to have breast cancer, Mary-Ann, this is the one you want!"

     I need to ask her something. "Justine, if I hadn't been getting mammograms, I would eventually have felt a lump, right?"


     "How long before that would have happened?"

     "Hard to say."

     "Give me a ballpark."

     "Uh…three years. More or less."

     Holy shit! Do you hear that? No, you don't, but you just read it. I can't believe it either. I say, "I would have had breast cancer for three years before I felt a lump?"

     "Give or take."

     "Give or take what?" 

     "A few months."

Holy shit again. I ask as quietly as I can since speaking quietly can be soothing, "And at that point would the cancer cells have broken through the duct?"

     "Oh, yes."

     "What stage would that put me in?"

     "At least 2."

     "What happened to 1?"

     "If you can feel a tumor, it's always a 2. Stage 1 is when the mammogram shows the lesion has penetrated the duct wall."

Something occurs to me. "I have no stage?"

     "You do. You are staged at zero."

     Is she mad? Has anybody ever heard of Stage Zero cancer? She can see I'm shocked.

      "It cannot be palpated. Stage Zero."

      How about that? Then I ask, "About the lesion. May I verify that it's a tumor?"

      "It is, but as I just explained, it's too small to palpate. Mary-Ann, that's not the point. The point is, we can't know if the cancer cells in the tumor within your mammary duct are the invasive type."

     "There are two types?"

     "I don't know as we know how many types of cancer cells there are in any cancer."

     We can't? "Excuse me. Won't the pathologist do a test to find out if the cells are the invasive kind or not? Because if they're not, I won't have to have an invisiblectomy, right?"

     "There isn't such a test."

     "You're kidding."

     "A test hasn't been developed yet."

     "Why not?"

     "I don't know."

     Does the above show without me telling you that I'm no longer speaking quietly? So do you hear this, Susan Komen people? And what about you, Dr. Love? Time to move on from breast cancer awareness. We are so aware, for crissake. We couldn't be more aware if we tried. We're all getting yearly mammograms except for those of us who have some sort of psychopathy. Those women are aware, too, but they need a shrink not a Breast Cancer Awareness Parade down Fifth Avenue. Please put all the donations you get into a test for invasiveness instead of the pink ribbons! I mean, I have to watch Mookie Betts swing a pink bat when no one knows if cancer cells in a breast are invasive until it's too late?

     Is there a baseball statistician reading this? Please see if the batting averages, slugging percentages, RBIs, etc. are higher for players when they use pink bats as opposed to the usual natural color of wood. If higher, I'll revisit this particular peeve at another time. Meanwhile, I'm sending both the Komen and Love  organizations a check for a hundred bucks, asking them to put it toward developing a test to see if cancer cells in mammary ducts are invasive or not.

     Justine goes to her game plan. She says, "So let's make an appointment for you to see Dr. Quigley so she can tell you all the details concerning the surgery."

     I think, Fuck.






A BIOGRAPHICAL ESSAY (with pics and video to follow)


I was born and raised in Hartford, Connecticut and have lived in Connecticut until I served as a Peace Corps volunteer in Cameroon. There, I lived in Buea, a town situated on a series of ledges five thousand feet up the side of Mt. Cameroon, an active volcano, its peak nearly 14,000 feet above the equatorial sea. Having aspired to be a beach bum, I am happy to say I now live a half-block from the Gulf of Mexico in the town of Fort Myers Beach, a barrier island that takes the brunt of any hurricane leveled at the city of Fort Myers. Most fortunately, I have a water-loving family and a labradoodle named Saltalamacchia, also a water-lover. Salty is my first dog.


My grandparents on my father's side emigrated from the Italian Piedmont, and on my mother's, Quebec. My fondest childhood memories are of sweltering summers blue-crabbing with my French-speaking grandfather from 5 a.m. until 5 p.m., my grandfather wearing a worn three-piece suit and cap, and me, my underpants. When I told my Italian grandfather that I would be going to Cameroon as a Peace Corps volunteer he told me there were very good grapes grown in Africa.


My brother was autistic, a savant, who would not allow singing, laughing, sneezing, electronic sound (including television, radio and anything that produced music), and the flushing of the toilet except when he was asleep and he never seemed to be asleep. He had a library of over two thousand books all on WWII. As his adjutant, I attained a vast pool of knowledge on such things as identifying fighter bombers from their silhouettes and why we dropped the atomic bomb. "To win the war," Tyler told me. "But it didn't work so we dropped another one. Victory at last."


The relationship with my brother was one of three influences on my writing; the second, my father's bedtime poetry and prose following the Our Father and Hail Mary: "My name is Ozymandias, King of Kings. Look upon my works ye mighty and despair!" The third influence was the shelf of classic children's literature my mother kept stocked with such gems as The Swiss Family Robinson, Bambi, Tom the Water-Boy, Silver Pennies, King Arthur and the Round Table, The Child's Odyssey. Somehow, The Bedside Esquire (1936) found its way to the shelf and I read the extraordinary short fiction within, including Hemingway's "The Snows of Kilimanjaro," Gallico's Keeping "Cool in Conneaut," Salinger's "For "Esmé with Love and Squalor," Hecht's "Snowfall in Childhood," and my favorite, "Latins Make Lousy Lovers," by Anonymous who turned out to be Helen Lawrenson, the only woman with a piece in the collection. (Sheesh.) There was also an excerpt from the novel, Christ in Concrete, by Pietro Di Donato, that so bowled me over I decided I would be a writer, too, just like all the writers who wrote fiction for Esquire Magazine in 1936.


After Peace Corps service, I taught, worked as a librarian and got my first freelance writing job with Reader's Digest. The Digest editor assigned me sports and games for How to Do Just about Anything, a book which sold 50 million copies world-wide. Reader's Digest made a vast fortune on that book alone, while the writers earned $25 to $75 dollars per article. I learned economy of language writing such pieces as "How to Play Tennis" in fifty words.


In 2010, I was awarded the Diana Bennett Fellowship at the Black Mountain Institute at UNLV, where I wrote my most recent novel, The Honoured Guest: Anne Alger Craven, Witness to Sumter, in Her Words.


My work has been reprinted in several foreign languages. I have taught fiction and memoir writing at many venues including the Mark Twain House in Hartford, CT, and on the Aran Islands through the National University of Ireland, Galway, and online via this website.


Presently, I spend time in Fall River, MA, where I went on a tour of the Lizzie Borden house. By the time the tour had ended, I knew who killed Lizzie's parents and it surely wasn't Lizzie. The competition, however, is stiff. Since I started writing this novel, another novel with an entirely different take on the crime was published. And there is a film presently in the works, again, with another take altogether. I'll keep up my work on my own version, which, I'm convinced, is the real one.

Photo credit: Marion Ettlinger
Salty, my first dog--aka, Boy in a Dog Suit--who watches over me while I write.
Salty's Baby Picture. Charlie and me, along with Emmie, Joe and Chris