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READ ALL ABOUT ME: BIO, PICS, VIDEO.   Please see below, following the final chapter of First, You Get Pissed.    

FIRST, YOU GET PISSED

(a working memoir)

 

by Mary-Ann Tirone Smith

 

"How long would it have taken me to feel I had

a right to be outraged?" -- Sally Field 

 

If you're getting a late start, you can read CHAPTERS 1-32 by clicking "PREVIOUS CHAPTERS" on the red menu bar above.

 

With Chapter 33, the final chapter, I will leave this manuscript up on my website for one more week. Then I will see about getting it published. I'll keep you posted, readers. Thanks for all your kindly words thoughout this chapter-a-week process.

 

HOLD THE PHONE!

 

Due to multiple requests that I leave the memoir up "just a little longer" (preceded by, "But I won't be able to finish by the end of the week!"), I am leaving the memoir as is for another couple of weeks. (You can always copy and save it to a word document, and with that, you can even print the entire book. Fine with me. It's not finished, though, just so you know. Adding that final layer.)

 

CHAPTER 33

 

DURING MY NEXT-TO-LAST week of radiation, a second crisis—though not as awful as the first—occurs at the Yale Shoreline Clinic. For starters, the young woman with the cool hats isn't there. I feel my heart fall into my stomach.

     Lori comes in.

     I am shaking. She says, "Are you okay?" I say the girl's name; it's all I can get out: "Nora."

     Lori says, "Oh. Not to worry. We were able to reach her before she left home this morning. So here's the story: the accelerator keeps shutting down. We're getting someone here to figure out what's going on. We need you to come back this afternoon…" she looks down in a little book "…at 4:15 if possible."

     One second after my relief that my radiation mate is all right, I say to Lori, "I can't do that."

     "We hate to miss a day."

     "What if it doesn't really get fixed and falls on me?"

     "It isn't falling. It's shutting down because it knows something's not right."

     "It knows?"

     "It's programmed."

     "It could still fall down. Sign me up at Yale-New Haven with a newer machine that has never malfunctioned, though there's always a first time."

     I leave.

     Dr. Frye calls me on my cell. First, she asks, "Have you pulled over?"

     I say, "I'm starting to."

     "Call me right back."

     I do. She says, "Mary-Ann, listen to me. The accelerator has a fail-safe. Everything stops when there's a malfunction. The accelerator will always shut down because the sensors are programmed to detect a malfunction. After three tries at re-starting it, the accelerator shuts down for good till we get a crew here. They just left. The malfunction turned out to be in the motor that raises and lowers the table. The table wasn't going up and down to the height the nurses keyed in so it shut down. It's fixed now. Come at your regular time tomorrow. It's too late to radiate any more patients today."

     I say, "But what if the table malfunctions tomorrow and goes up and doesn't stop and smashes me into the accelerator? Or what if the sensors malfunction?"

     "Mary-Ann."

     "What?"

     "You can trust me. If there is any kind of malfunction, the machine stops in its tracks. I promise you that. And in addition to the sensors there are back-ups: It  works."

     She loves that line. It works, can you tell? So do I. When it does.

     She goes on, "This is the first time this has ever happened. Even if it happens again, we have that fail-safe. Please trust me."

     I say, "I'll try."

     Charlie tells me that the machines at Yale-New Haven are the same as the one in Guilford. I go online. The fail-safe always works. There are no fatalities or injuries that I can find. Or maybe the DOT covered it up.

     Next day, I tell myself I will roll off the table if I feel it's rising too near to the machine. I will yell, "Stop," though I won't wait for my nurses to run in. Too bad. So that means I have to keep my eyes open.

     And so, what with working my EMDR stones overtime, I watch the machine just pass by, and back again, a couple of times.

     I'm good. No IEDs exploding at the side of the room and the table doesn't smash me into the accelerator. I close my eyes for the last minute and have a little rest.

     The day after that, I change purses and inadvertently don't put the stones in the new purse. I realize it when I'm in the dressing room, changing into my johnny coat. I don't even look for them in my purse just in case. I know they're not there the second I go to get them.

     I have my radiation without my EMDR stones. My nurses notice. When we're finished, they all hug me.

     But then, just shy of one week to go, shit happens. I will be radiated for the last time the day after Christmas, a Monday. (It would have been the Friday before Christmas but for the radiation table crapping out.) Starbright's skin across the entire left half of my chest, my armpit, my left side around to my back is a color best described as prune whip. The radiation treatments slowly, but most surely, first turn my skin pink ("like a sunburn") as warned, and then to pink with white spots, and then, as I am warned early on, "tan." The pink phase does not look anything like a sunburn.

     My skin looks scalded. Also, as we know, there isn't any such thing as a sunburn with white spots. As for the tan, my skin is not tan; it is the color of prune whip, something I just told you. An alien force, not the sun, is destroying my skin. And what is especially disappointing is seeing Dr. Quigley's perfect, nearly invisible, beautifully curved incision scar become inflamed. It is now a curved purple-green smudge.

Pam says, "It will likely return to the way it was."

     Likely. Remember almost always? In the medical profession, likely, discomfort, and almost always are euphemisms. 

     The pink stage is my discomfort stage, discomfort according to me, not any medical person. The spotted stage the discomfort turns to hurting, especially along the lines of the creases just at the edge of my armpit. But wait a minute—do I have two really long creases before the treatment started? I look down again. The answer, I have to say, is No. What were faint lines are now deep creases, the result of swelling.

     I tell Pam. She says it is normal to swell up a bit and feel discomfort. I say, "I'm not talking about discomfort, I'm talking about pain."

     "Are you using the Lubriderm?"

     "Out of desperation, I am. But it doesn't do anything."

     "It keeps your skin from getting dry."

     "But what about the pain I'm feeling 24/7? My skin, dry or damp--it hurts!"

     "Let me get Dana."

     Dana is the ultrasound nurse who I don't see ever since the ultrasound. Pam goes out. I wonder if Dana is her superior. I have to wait till a patient is finishing up and then Dana comes in and sits down in Pam's chair.

     "Hey, Mary-Ann, I'm sorry you're hurting. You are allowed to dab cortisone cream along the creases for relieving the itch. Now I know what you feel is beyond itchy—"

     "Way, way beyond."

     "Yes, I understand. All the same, try it. Then you can talk to Dr. Frye Thursday if you're still having...pain."

     She forgets to give me a prescription. I ask for it. She says, "You're to have over-the-counter Cortisone."

     "Why can't you just give me a Percocet?"

     "I'm sorry, no. You can't be groggy during the treatments. We need you to be alert."

     My friendly pharmacist gives me the most powerful over-the-counter cortisone he's got. He says, "Can I warn you of something?"

     "Yes."

     "This won't do a damn thing for the pain you're feeling."

     I say, "Yeah, I didn't think so. Why is there not a prescription medication for skin going through radiation?"

     "There is. Insurance requires doctors to recommend over-the-counter drugs first. If the patient is clearly going to 2nd degree burns, they give the okay for the prescription cortisone which will help. You might be starting to enter that phase."

     I call Dr. Kumar. I ask her what I should do. She says, "We can't interfere with your treatment."

     "There is no treatment unless you really want to think of Lubriderm as a treatment. I'm really hurting."

"I'm sorry."

     At the end of the day I'm crying. From pain and from frustration. Charlie makes me a perfect martini. He uses Bombay Sapphire gin instead of Grey Goose. Higher proof. I am able to stand the pain with just that one martini.

     Two days later, Dr. Frye is telling me that the white spots are from the absence of melanin disappeared by the radiation. "They'll probably go away."

     I say, "I don't give a shit about the white spots. When will this pain go away? I'm not talking about white spots. My chest near my armpit is burning."

     "I'm sorry."

     I tell her what the pharmacist said. She says, "You haven't entered the level required for prescription cortisone."

     "What if I enter it tonight at 2 am? How will you know that?"

     "I will when you come in. This is the protocol, Mary-Ann."

     "Yours?"

     "The hospital's."

     I raise my eyes to hers. My look says it all. So does hers. Dr. Frye's gaze is directed at the floor.

     The spots go away in a couple of days. The pain doesn't.

     And two days after that, I wake up to rather a shocking sight—Starbright has a dark ring around her nipple. A really dark ring!

     I go show Charlie. He says, "Omigod, Starbright has a black eye."

     That's exactly the thought I have. I'm a god damn Dalmatian with one spot surrounding his eye.

     I put ice against my breast. Charlie massages my shoulders.

     An hour later, Pam is returning my call after I leave her a message while I'm really crying. She says, "The ring will fade away. I promise it will. It fades away as quickly as it appears."

     It does--in a couple of days. The next Thursday, I'm in the office. I am at the height of the prune whip stage, and I will demand pain relief for the pain I'm in, or I will go to the emergency room.

     Pam still isn't in so I see Dana again. 

     She listens to me vent, and when I finish, she asks, "In addition to the pain, does it itch?"

     "No."

     "Because if it itches, you can't scratch it. The Lubriderm diminishes the need to scratch."

     An enormous segment of the medical profession refuses to acknowledge pain. A while back, I have chicken pox. I'm, like, in my forties. I catch it from my children, whereupon my mother tells me I never had chicken pox as a kid, even when my entire second grade class has it. Here is what I find out about chicken pox through personal experience that little kids can't make their parents understand: The pox don't itch, they hurt. They hurt like hell. The reason children want to scratch at the pox is not because they're itchy, it's because they hurt so much they want to rip the pox out with their fingernails.

     I say to Dana, "If I'm still hurting with the cortisone, what do I try instead?"

     I think she says something like baking soda. Whatever she says is not what I want to hear. I whip out a list of products radiation patients report online they've tried in addition to Lubriderm: A&D Ointment, Eucerin, Aquaphor, Biafine, Radicare, calendula, Vaniderm, Miaderm, Mepilex, and—get ready—"Kiss My Itch Goodbye." The only product that all the comments suggest as having worked: aloe vera.

     Anna says, "You can't use any of those."

     "Including aloe vera?"

     "That's right."

     I don't say, Why? I don't tell her about my Peace Corps friend, Peggy, who becomes Maggie. What would be the point? Instead, I say, "The creases near my underarm and now my armpit really, really hurt. I'm getting more and more swollen. I'm using ice packs."

     "You can't do that. You only have today, tomorrow, and then one week left."

     I already have used ice, as you, Dear Reader, know. I ask, "Will this get worse?"

     "It might. It could blister."

     "I'm going to wait for blisters to happen?"

     "Blistering often happens right at the end, when you're getting boosts. It'll only last a few days."

     Perfect. Boosts? What boosts? But before I ask what boosts are, I ask, "Which stage of blistering lasts a few days? At their initial appearance? When the blisters start to hurt? When they break? When they start oozing shit?"

     Is it obvious I'm getting really, really pissed?

     She ignores me and goes right into a programmed explanation of boosts. "Radiation directly to the place where the duct was removed, rather than the whole breast, is a boost. Near to the scar. We've already boosted your nipple, which caused the brown ring, and we did your underarm in case all of the breast tissue didn't make it into the mammogram images."

     Jesus God. I want to tell her to stuff her boosts unless she gives me a pain medication. And where the hell is Dr. Frye? She usually appears by now.

     That's when Dana says, as she's escaping out the door, "You won't be seeing Dr. Frye today. She has an emergency in New Haven. You will have Dr. Barth. He's filling in. You can discuss the radiation boosts with him. He's very good."

     An emergency? How can that be? Does someone appear in the emergency room with an ear ache only to be told he needs immediate radiation? I'll have to wait a week to tell Dr. Frye that if the boost treatments give me more pain than I've got now then I'm not doing it. Or I'll tell the fill-in to tell her. Or I'll have four martinis a day and hope I don't get hooked.

     (Note: The day after I write the above paragraph, tomorrow, my neighbor, who is crying, tells me her daughter went to the doctor yesterday, two years after she first felt a lump in her breast. Saying that part makes her cry harder. She say the doctor got her rushed over to Yale-New Haven where and they brought her right to surgery. Dr. Quigley was waiting and did an emergency mastectomy. Perhaps there's something that can happen requiring emergency radiation, too. I can only hug my neighbor for a long time.)

     I sit in the examining room in my johnny coat and wait for my substitute doctor. It is no time for me to be all by myserf. I am. There's a tiny tap at the door. I say, "Come in." It's Nora with yet another cute hat.

     She stops in her tracks. "Are you all right?"

     "No."

     She comes to me and takes my hand. "I'm sorry. It's my last day. I wanted to say goodbye. It's almost over for you, too. Hang in. Just hang in, okay?"

     I will be brave for her. She can't be more than twenty-five years old. I say, "Okay. You hang in, too."

     We kiss each other's cheeks and she leaves. Every time I see Nora at our radiation appointments, she is all by herself. She wants it that way, I can tell. When my daughter goes to court when she gets divorced, she chooses to go all by herself. My mother would have said about her granddaughter, and about Nora too: Tough cookie.

     There's a knock on the door. I can't call out, Come in, because I'm crying. The door opens a crack, then a little more. A gentleman who is a replica of Mr. Rogers peeks in and takes in the scene. He comes right over to me and puts his arm around my shoulder. He says nothing. He knows not to. He will wait for me until I can tell him what's wrong.

     I cry for a long time, while he just pats my back. Finally, I say, "I'm all swollen in my underarm. I feel like the skin there is ripped. It's probably going to blister because I got a boost there. No one warned me. I don't want any more boosts. I don't want any more radiation. "

     He speaks. He sounds like Mr. Rogers. He says, "I am here to help you. Please let me introduce myself. I'm Dr. Barth." He puts out his hand. I reach up to shake it. I don't tell him my name. I don't care if he knows my name or not. This is how you act when you're really, really depressed.

     Then he says, "I'm a retired radiologist. I live a mile down the road. When Dr. Frye has an emergency, I head over." He smiles. Then he says, "You're really hurting."

     "Yes."

     "And every day it hurts more."

     "Yes."

     "May I examine you?"

     How lovely of him to ask, but then we're talking Mr. Rogers here. I slip the Johnny coat off my left shoulder. First, he just looks at Starbright. Then he asks, "Did the nurses suggest cortisone?"

     "Yes, but only if it itches. It doesn't itch. It skipped any itching stage. It went right to pain. Especially here, where I told you." I touch the creases alongside my swollen armpit. "Besides, my druggist told me over-the-counter cortisone won't do anything."

     He says, "That's true. Listen, I'm not going to touch your radiated skin. This is not the time to examine your breast."

     He helps me put my arm back into my johnny coat sleeve. Then he says, "It's Mary-Ann, isn't it?"

     "Yes."

     "There are studies showing that smearing cortisone on radiated skin several times a day helps considerably. It is being considered. This would not be an over-the-counter medication. Have you got a dermatologist?"

     "Yes."

     "Ask him if he'll suggest a cortisone with the greatest effect. Ask for a prescription."

     "He's a she. She won't do it. I've asked her to help me and she can't. Actually, more like she won't."

     He says, "I'll give you a prescription.  Listen…."

     "Believe me, doc, I'm listening."

     "Don't rat me out."

     Then I am so grateful I start to cry again. He hugs me again ever-so-gently. Then he starts writing. When we say goodbye, I ask, "Do you live on the beach?"

     "Yes."

     "Cool."

     He smiles a Mr. Rogers smile at me.

     I drop the prescription at the drugstore and get home only to learn a friend of mine is just back from Cancun and comes over from the airport on that very day with a giant tube of cortisone. It has a higher amount of the main ingredient—cortisone—than anything you can get off the shelf in an American drugstore. As it turns out, my friend says her friend, who she travelled to Mexico with, is staying an extra week, and she's bringing some more back in case I need it. (I now consider my friend and her friend my actual support group.) 

     The Mexican drug doesn't work entirely. You know how Advil takes the edge off a muscle ache? The Mexican drug takes the edge off the pain of my burned skin. A wide edge, happy to  say. Then my skin doesn't blister; and then over the course of three days the swelling goes down, and on the fourth day there is no swelling at.all My pain level goes from pain-10 to pain-7, to pain 3. I go online and rat out Mr. Rogers, not that I tell all of social media his real name, only that he was without a doubt separated from the real Mr. Rogers at birth, and how his cortisone advice made a huge difference on a couple of levels, not just pain, and the news that you can get some serious cortisone online without a prescription from Mexico. About a zillion people comment that you can get whatever drug you want from pharmacies all over the world, not only Mexico but also our other neighbor Canada. The links start pouring in.

     There are some who would suggest behind my back that the cortisone working is a placebo effect. Don't you hate people like that? My mother would say, referring to such nincompoops, "Those are the same people you have to deal with at the lanes. You make a 7-10 split, and they say, 'I'll bet you'll never be able to do that again.' Damn crêpe-hangers." Crêpe-hanger is her second favorite insult after, shitheel. Google it if you don't know what a crêpe-hanger is because it's a top-of-the-line metaphor that would require an entire paragraph for me to define for you.

     So instead of telling Team Frye the reason my skin seems to be healing overnight, I instead pass the word through social media as to the efficacy and source for giant tubes of cortisone. I am too tired to fight City Hall.

     I finish my radiation treatments. It is my last day. There is a bell hanging alongside the door of the waiting room that makes a horrible, loud bong. I never notice the bell; I just wonder what the hell that awful noise is when someone's out there pulling it.  Apparently, when you have your last radiation treatment, Pam merrily swings the rope hanging from the bell. There is a bell just like it by the exit door at Big Y supermarket. You're supposed to ring it to show the cashiers that you are pleased with their service, never mind that it drives them crazy. I ask Pam if she will please not ring the bell. Pam says, "I won't." I can tell I'm not the first to make that request. I don't wear pink bows either. What am I? A miniature schnauzer?

     I send my radiation team a note thanking them for the various kindnesses they showed me. 

     I receive in return a "Certificate of Merit" from my team a week later. It reads:

 

CERTIFICATE OF MERIT

 

Mary Anne has completed the prescribed course of radiation therapy with a high order of proficiency in the science and art of being cheerful, outstanding in high courage, tolerant and determined in all orders given.

 

     The certificate is accompanied by a note from Lori: We couldn't write anything nearly as good as what you said in your note to us because we're not writers but still we tried our best. I don't mind that they don't get my name quite right because they are far too intensely busy to proof-read stuff. How I wish I wasn't leaving these women on such a sour note, but I am. They can sense the shift in my attitude, but no one addresses it. Good.

      Jere copy-edits the final drafts of all my manuscripts. When he comes to edit this memoir, he will circle my name on the "Certificate of Merit" and write in the margin: They fucking spelled your name wrong. He minds. He points out the dysfunction of phrasing in the certificate, too. When he proof-reads, he takes no enemies, but what's so important is that he knows never to tamper with narrative style (now known as voice), even, in my case, with all the idiosyncrasies, meaning tangents.

     My veterinarian sends my dog a "Certificate of Bravery" when he's a puppy after he's neutered and has an undescended testicle removed, involving liposuction because the testicle is encased in a large wad of fat. It reads:

 

CERTIFICATE OF BRAVERY

 

This certificate is to recognize Saltalamacchia's courage and strength for his neuter and liposuction procedure. This certificate is presented to you by the staff at East Shore Veterinary Hospital who would like to recognize how proud they are of his bravery.

 

    (The vet gets no red marks from Jere.)

     Do I need to tell you how many of my friends ask if Salty's vet could do a little liposuction on them?

     Oh, yeah. I send Mr. Rogers a bar of Kim's soap for men called, Dude, Where's My Soap? (First, I call my radiation team and ask his name just as I'm about to write Dear Mr. Rogers on my note to him. It's Dr. Barth.)

     And so, Dear Reader, my story has ended, hasn't it? Here is the moment when I am instantly aware that my memoir is complete, not counting a Tamoxifen adventure to follow, but how much can you take? The moment: When my Mexican cortisone has taken effect, on the night I'm at Pain-3, meaning less pain that a hangnail, not even discomfort, Charlie and I turn off the Christmas lights and go to bed. We don't close the bedroom blinds because the moonlight coming through the window has a lovely glow as does it's reflection on Long Island Sound.

     Charlie reaches across me, pats Salty's head one last time, tells me good night, and that he loves me. Then he props himself up on one elbow, places the palm of his free hand against my cheek, and says,"You had a brush with cancer, baby. That's all."

     That's all. A brush.

     I say, "Thank you, Charlie," and then I cry. Last, you cry.

     Get your yearly mammogram, girlfriends. It works.

 

END

 

 

 

 

 

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