FIRST, YOU GET PISSED: A Memoir
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 - 17 by clicking "PREVIOUS CHAPTERS" on the red menu bar above.
SO, NOW IT'S BACK to Dr. Quigley at Yale-New Haven, enjoying nothing but valet parking. What's this? I'm feeling happy about going back to the Breast Center? It's all relative, baby.—Albert Einstein
Once again, Charlie and I leave time for the Q Bridge as we head for Yale. Jene will meet us there, per usual. But we will be late because the moving of cement mixers from one side of the Q Bridge to the other seems to be the order of the day. Our exit into New Haven is walled off. I didn't tell you about the ongoing construction on the Q Bridge along with the news of the feral cat colony because you'd have stopped reading. I will only say it takes fourteen years to replace the bridge. Time-consuming to get those cement mixers into correct position.
Without our exit, Charlie and I are forced to stay on I-95 until we're on the other side of New Haven. Then we backtrack through an unfamiliar neighborhood, but Charlie is brilliant at threading his way through alien territory to find secondary routes. He can sense exactly which one-way streets you can drive on in the opposite direction and survive, without killing anyone else either. I don't believe such a thing possible, but that is before I meet Charlie.
We are greeted at the hospital by a troop of valets all trying to outdo one another on helpfulness scale. They all but lift us out of the car, and Charlie is replaced behind the wheel by the leader, who drives the car out into a wall of traffic. Within seven seconds, we're in the door and directed to a corridor, bypassing the fountain and food court and into the Breast Center. Jene isn't there yet. The receptionist remembers me, the one who takes the same shuttle bus to Yale-New Haven my daughter does. If you live east of the hospital you don't drive to work unless you're a masochist and love having your passage blocked by cement mixers.
Jene's shuttle buddy sees to Charlie and me escorted immediately into Dr. Quigley's office. Marina is at the computer, ready to rumble. She gives a little wave. Dr. Quigley walks in on cue and welcomes us with her mighty handshake, a sign of a serious surgeon. The seriousness of her grip makes clear she doesn't give a rat's ass if you're late because all her patients are late re the Q Bridge. And after all, you have breast cancer.
She has us sit down, and right then, Jene, in her Yale blue scrubs comes flying in, having run the mad dash one more time from community health. She's out of breath and Dr. Quigley steers her into a chair next to me. She asks her, "Which clinic are you with?"
Jene says, "Infectious disease."
Dr. Quigley says, "Good for you," and then places herself squarely in a chair in front of me, her knees all but bumped up against mine. Rather than having a nurse give me a big binder as with Nurse Dorothy at Danbury, Dr. Quigley grabs a similar one off her desk and places it in her lap. It is facing me, upside down to her.
She says, while waving two pieces of paper stapled together, "This is your pathology report. We are now going to talk about what it has shown me." Then she opens the binder and sticks the report into a clear page holder and flips past it. While she tells me proceeds to tell me what the pathology report says, she simultaneously customizes the contents of the binder with a large Sharpie.
"We'll start here, Mary-Ann." She flips a few more pages out of her way. We jump to a page with the letters DCIS at the top. With the Sharpie poised, she says, "Forget all the pages before this one. You don't have time for them. They're a bunch of psycho-babble intended to make you feel secure. According to my patients, they don't."
She looks up. I give her a glance that says, Thank you, please carry on.
Looking deep into my eyes, she underlines the heading, DCIS, with a swift black slash.
Next she underlines the words, Stage Zero, at the top of a list of stages while saying, "To confirm what Justine told you, this is where you are." (She has retained the conversation with Justine who passed it along to her. Impressive.)
"Your cancer cannot be seen with the naked eye and it can't be felt. That stages you at Zero. You can read about the rest of the stages if you're inclined, but they don't pertain to you."
She flips more pages to get to the one she wants. I am now looking at diagrams—cross sections of breasts. She circles the first one and says, "Here is the normal breast. I am so glad to tell you that you have three major things going for you in your own breast…" She begins writing in the margin the following. "One: The cancer cells are contained in a single mammary duct as opposed to several mammary ducts. With the latter, a mastectomy would be appropriate."
There is no chance to ask why that is; better to dig out six ducts than chop off the entire breast I would think, no? But she's still talking.
"The cells that your mammogram found look like what you see here as opposed to the normal cells that line a duct." She points the Sharpie at the normal diagram, then goes to the cross section next to it, mine.
In the cross section of the normal breast, the duct is a little, slightly elongated, oval thing with identical cells lined up along its interior wall, row upon row, filling up the breast. All neat and regular Army. They remind me, actually, of the Rockettes.
Dr. Quigley says, "So yours is Stage Zero cancer." The cross section representing my own breast shows most of the Rockettes lining the duct are identical little soldiers, too, but Dr. Quigley draws at little arrow pointing to a line being pushed aside by several heftier Rockettes. Consequently, these Rockettes are anorexic just like the real Rockettes, but also deformed since it's clear the bigger ones have been hogging the breast tissue and cannibalizing their fellows besides. This duct is partly empty.
These are exactly the scrawny-assed bastards of my imagination who will follow their leaders until they all breach the duct wall to get at the...uh…fresh meat beyond. I'm sorry to be so disgusting. That's the mood I'm in.
The drawing is so simple, so primitive, I cannot help but notice the diagram next to mine labeled Stage 1. That duct has a lot more of the seriously deformed cells and three of them, along with the leaders, have squirmed through the duct wall, and a fourth is halfway out.
Then the Stage 2 diagram has words in bold print: THE TUMOR CAN BE FELT. In the drawing, the duct is swollen with nothing but deformed cells and a slew of them—more than are left inside the duct—are barreling out in all directions.
I refrain from looking further down the page. Dr. Quigley is already flipping that page anyway. "Let's move on to the second thing that is a plus for you: The mass of cancerous cells in the duct is less than two centimeters."
She circles a circle that is two centimeters in diameter. Whoever put the binder together is aware that we patients don't know or can't remember what a centimeter is. Without the picture, I, for one, would be thinking, Let's see…one centimeter is one one-hundredth of a meter…a meter is slightly bigger than a yard…that means one centimeter is three or four feet across…therefore, how long will it take a train to travel a million centimeters if the engine's top speed is a hundred miles an hour, but it's average speed is…etc. An ordinary #2 pencil is one centimeter wide. Two centimeters is about three-quarters of an inch square.
I ask, "How come I can see it with the naked eye, but not the cancer in my duct?"
"Once you are in the breast, you can see the lesion of a Stage Zero cancer with the naked eye. The duct will be bulging."
There's an image I never wanted to experience. Fortunately, Dr. Quigley is already moving along to the third thing going for me. "Three: Your cells are estrogen-receptive. This is huge."
Before she can explain the significance of these three things I have going for me, plus whatever it means that my cells are estrogen-receptive, I say to Charlie, Jene and Marina, "Will you look at what this woman is doing? She's writing upside down!"
My interrupting to announce that feat is as if Dr. Quigley is reading a book to kindergarteners sitting around her in a circle and one of them pees his pants. Jene and Charlie are jarred out of contemplation by what is a metaphor of the peeing kid. Dr. Quigley says, "I've been writing upside-down for 33 years."
Note: Dear Reader, this is a memoir not a documentary. I remember her saying thirty-three years. Jene and Charlie each swear she said some other number of years. Rest assured whatever the number, it's high enough to meet my friend Jessica's father's standard: At least 500 surgeries or bail.
Just to be sure, though, I say, "How many times have you performed breast surgery?"
"Thirty-three years…. Hey, you lose count."
No prob-limo. I never get to ask Starliper that question because of the very little time available to me, but now that's moot.
"So to get back to the final configuration you have going for you, since the cancer cells are estrogen-receptive, after surgery you will take tamoxifen or another drug, depending on what Dr. Ionescu determines is best for you. But I know he will agree that it should be tamoxifen even though the other family of drugs—aromatase inhibitors—are more appropriate to women who are close to, or into menopause . But with your physical make-up and good health, tamoxifen is the wisest choice."
Again, why do we need the oncologist? Never mind.
I ask, "What makes the two options different from each other?"
"The aromatase inhibitors prevent your body from producing estrogen."
Wow. That's scary.
"Tamoxifen takes on the characteristics of estrogen. Therefore it attracts estrogen-receptive cancer cells. When those cancer cells attach to the tamoxifen, the tamoxifen kills them."
Holy shit! There certainly is an animated movie here. I want to say, Sign me up for the estrogen annihilators, baby. But instead, I ask, "How long will I take it?"
She says, "Five years."
"Yes. But if after five years, maybe another five years if you've tolerated the drug well. Otherwise, you'll move on to five years of the aromatase inhibiters. That regimen is the present thinking. Dr. Ionescu will discuss the treatment in more detail."
"Will he talk about the drugs' side effects?"
She raises her chin, better to level her gaze directly into my brain. "Listen. There are side effects with every drug. Just don't read what the side effects of tamoxifen are and then you won't have them."
Uh-oh. I do not want to get into how insulting that is. There is no arguing with self-appointed gods. Instead, I will grouse about it to all my friends. All sympathize with me except my friend, the writer Becky Rice, who says, "For someone like me, it's exactly what I would need to hear. If I read the side effects to some medication, I have them all within minutes."
So maybe Dr. Quigley has found that most of her patients are a bit on the neurotic side, like Becky. I will stick to talking drugs with the Count. My respect for Dr. Quigley, though, has dropped a couple of notches even with the upside-down writing ability.
Now Charlie has something to ask, something he desperately wants to be assured of. "Will Mary-Ann need chemotherapy?"
I realize he never heard Nurse Dorothy in Danbury give me the answer to that question. Charlie has had many extra days of worry. I feel terrible for him.
Dr. Quigley flips ahead many pages to one, CHEMOTHERAPY. She draws a giant slash diagonally across the page, a straight, true line corner to corner, like she's using a ruler, which she's not. My feeling is that you want this particular skill in your surgeon in addition to a serious handshake. Maybe she's not playing God. Maybe she is God. Who knows?
She says to Charlie, speaking as clearly and succinctly as possible, "No, she will not need chemotherapy. Mary-Ann just needs the duct to be taken out of her breast. If the tumor in the duct were more than five centimeters, we would first use chemotherapy to shrink it so that Mary-Ann's breast wouldn't be deformed by the extent of tissue loss to remove a tumor of that size. So, chemotherapy is not necessary for her because, one, the tumor is so small, and two, there will be no cancer left in her breast after I have removed the duct."
Charlie reaches over, grips her forearm and say , "Thank you."
She says, "You're welcome," and when he doesn't release her arm, she doesn't pull it away.
I look up at her. I've now got tears in my eyes, but I carry on. "You'll disappear my entire duct," which isn't a question since I know the answer. More like I'm thinking out loud.
She says, "Exactly."
And back to Charlie, looking into his desperate eyes, she says, "There will be nothing left in Mary-Ann's breast to poison with chemotherapy. Put it right out of your head."
Dr. Quigley recognizes Charlie's terror and takes the time to give him the reassurance he needs so badly. And so, he finally lets go of her arm, but he starts to shake. So, I reach my own arm around his gorgeous shoulders and I tell him, "Starbright won't get poisoned, Charlie."
He controls himself. He says, "I love you, Mary-Ann." Jene says, "I love you, Mom." I tell them both I love them too.
Then I say to Dr. Quigley, "What I hate is the word tumor. Thanks for not using it."
She says, "I hate that word, too."
I'm not done. "I can't believe just a few shitty cancer cells that are only now just forming a freaking battering ram is still called a tumor. Like a lumpectomy is still a mastectomy even if it's only a partial one."
Inspired by Charlie's and Jene's love, I do not get further pissed than that. Besides, what can Dr. Quigley say? She's just nodding at me. So, I ask one of those questions that thus far I have not been able to force out of my mouth. That's because I really need the answer to this particular question to come from this particular woman.
"Can it come back?"
She flips back to the Stage Zero page. "Understand that these cells have not penetrated the walls of the duct. After your surgery, there is no duct. No cancer cells to speak of anywhere. Gone. Disappeared, as you put it. There will be nothing there to come back. That said, down the road, you will soon be discussing radiation with your radiologist, and drugs with your oncologist. We want to make sure that if some microscopic bit of a cancer cell did escape the surgery, it will be rendered impotent through radiation and drugs.
"However, your risk of another breast cancer in the other breast is increased now that you've had the DCIS," and in that authoritarian tone she just used with Charlie, "But cross further bridges when you get to them. You will have little chance of encountering the bridge you're talking about. Actually, no chance as has been my experience. Do not go there."
I say, "Okay."
Now she makes a perfect oval with her Sharpie around the line she'd written about my cancer size, and with a flourish, she adds an exclamation point. "The cells receptivity to estrogen is good news, but it does show us that your having taken birth control pills, and then Premarin, and then using estrogen suppositories it's likely, but not definitely, that all three have contributed to the creation of the cancer cells in your mammary duct. But the great, good news as I've said is that we now have a drug to destroy any cells that might mutate via the estrogen produced by your body."
She gives me no chance to say, All of the above estrogen products were prescribed to me by doctors of the OB/GYN persuasion. She knows that.
"And, oh yes. Did I tell you, Mary-Ann, the incision will be around two inches long?"
First I answer her question, "No." But I'm thinking, What the fuck? This is one weenie little duct. I figure the incision will be in the half-inch range. I ask her, "Will it be on top of the little incision where the marker is?" Because if not, I am going to suggest she do that so that the scar will stay as close to the two inches as possible.
She says, "Yes. And I will keep the incision as far to the outside of your breast as possible so the scar will not be near your cleavage. You'll be able to wear low-cut tops and bikinis without the scar showing. Don't forget the sunblock."
Truth to tell, I'm now depressed about the size of the scar even if I don't need chemotherapy and even if Dr. Quigley prevent keep it from showing above a bikini top. There are times when relativity is pushed aside. When Jene is maybe three, she is crying inconsolably for no apparent reason. I ask her, "Why are you crying, honey?" And she says, "Because I yant to cry!" (She can't pronounce W yet.)
Well, I yant to be depressed.
I take some slow, deep breaths.
Dr. Quigley asks, "You're not going to faint, are you?"
NEXT SUNDAY, AUGUST 19, CHAPTER 19.
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.