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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 - 13 by clicking "PREVIOUS CHAPTERS" on the red menu bar above.


This week:  CHAPTER 14.


MY BIOPSY. Besides the doctor and nurse Jackie, I will also have a technician—the third woman in the room. She smiles too, and shakes my hand, doesn't tell me her name. She will be running the Star Wars apparatus, a stereotactic guidance machine allowing the surgeon to see through my breast in order to level her derringer into the galaxy, fire the barbs, and bag some strands of cells that I hope are all tucked inside the duct and not on their way out. Or already out.

     The trio of women helps me climb onto the table and I sit there trying not to look at the hole, which is fairly small, while they help me out of my seersucker robe and into the top half of a surgical gown. 

     The doctor says to me, "Is it the left breast or right breast that we will be biopsying today?"

     Am I surprised at this question? Do I say, What, you don't know? Are you some kind of moron? I would, but her question is in the same category as the one Charlie gets from his surgeon regarding which knee he'll be replacing. Charlie says to him, "Left," and his doctor doesn't say, "Right," so as not to confuse the issue. He says, "That's correct," and draws a happy face on Charlie's left knee. His name is Dr. Komninakas (first "n" is silent, otherwise people who can only read English can't say his name, not knowing that as with the word solemn, that "n" is silent, not the other one). Dr. Komninakas is a man of few words, but every word he does say is pertinent, and he is incredibly kindly.

     So I say to my surgeon, "Left."

     She says, "Correct," and doesn't draw anything on Starbright.

     Because of such seemingly insignificant exchanges between surgeons and their patients, we don't get headlines in the tabloids about doctors amputating the wrong…whatever…. Thank God.

     I also say, "It's actually Starbright who is having the biopsy." Then I tell them about Charlie naming my breasts. I guess I must really like that Charlie did that because whenever I think of my breasts, I'm happy they have names.

     My three attendants share a chuckle.

     The technician asks, "What's the other one's name?"

     The doctor and the nurse chime in together, "Starlight."

     Based on the look on the technician's face, no one ever recited the wish-upon-a-star nursery rhyme to her when she was a child. So I do. When I finish, she is very quiet and then says…uh…reverentially, "That is so beautiful."

     I am reminded of Joe Namath back in the 60s when he tells Dick Schaap in an interview that he liked the movie Romeo and Juliet but hated the ending, and Dick Schaap says, "Joe, you didn't know they would die, did you?"

     Joe says, "No, did you?"

     Back in the day, you couldn't not like Joe Namath, now not so much. Big J-E-T-S, JETS-JETS-JETS cheer for #metoo.

     But what with thoughts to Juliet, I am now thinking of my attendants as heroic.             They get me onto my stomach, shift me around a bit, and then guide Starbright through the hole, apologizing to me for their cold hands.

     Then the doctor disappears under the table. The table rises, I guess to the height she likes. I can hear her creeping around on her stool. The thing your mechanic rolls around on when he's under your car is called a creeper. Charlie tells me this after I explain to him about the biopsy procedure. He's a mechanical engineer. When I meet him, he works for Sikorsky. He helps refurbish Marine One, the President's helicopter. He tells me the things he does specifically to all sorts of helicopters including the Black Hawk that ferried the Seals sent by Obama to take out Bin Laden. I ask Charlie if he rolls around on those carts on wheels under the helicopter like car mechanics do, same thing I wondered about the biopsy radiologist. He says to me, "We don't need creepers, Mary-Ann. We do the designing on computers."

     He also laughs at me for being so cute. But I laugh at me, too. Do you remember Mallory-isms? Does your grandmother remember Gracie Allen? Alas, I'm in that category, and my daughter, too, who also laughs at herself, a champion. Actually, my son somewhat. Me: "Honey, I know you can't stand earth science, but this next section is really enlightening: The Dust Bowl." Jere: "Who played?"

     The biopsy technician leaves me to study a couple of computers. Three screens suddenly light up at once. I can hear her tapping away. Jackie asks me, "You okay?"

     I say, "Why, has something happened?"

     She says, "No. I meant, are you comfortable?"

     Is she kidding? Starbright is hanging out of a hole and I need a pillow. "No, I'm not. Can I have a pillow?"

     "Sorry, sweetie. You have to be flat."

     The right side of my face is placed flat to the table. I do not need to say that besides a breast hole, there needs be a massage hole, too. The doctor says something I can't understand, and the nurse says to the technician, "All set?"


     Then to me, "Excuse us for a minute."

     She and the technician together duck under the table for a whispered consultation with the doctor and then come back up again. This is really too bizarre. I shut my eyes and stop looking at the computer screens.

     The doctor calls up to me, "We're set to go here, Mary-Ann. First, I'm going to numb your breast with lidocaine. You'll feel a burn."

     I already know it will burn. A few years ago, I got a cortisone shot into my frozen shoulder, which was first numbed with lidocaine. It burned and it didn't numb anything. I didn't ask for another one. Times have changed. Today, not only will I ask for another one if I need it, I'll demand one. Or a double dose. Whatever. I'm in charge. The doctor underneath the table first wipes something across Starbright to make the burn more tolerable. It is more tolerable.

     Then she says, "I'm making the incision." I grit my teeth, but I don't feel a thing.

     Twice I answer the nurse's call-out, "Everything okay up there?" with "Yes."

     I hear the technician tapping at keys. I wonder if the doctor has a screen under the table or whether she pops up and looks out at the technician's screens every once in a while. Happily, the tech isn't saying things like, "Holy shit, Doc, you're way, way off."  

     I feel movement under the table. Jackie emerges and stands very close to me. She places her hand gently on my shoulder.

     I say, "I'm okay," before she can ask me again.

     The doctor calls up to me, "I'm now drawing the first tissue sample out from your breast."

     She didn't even tell me she'd stuck in the transducer. And I never figured she'd take them out one at a time. Would you?

     While she continues her fishing trip, Jackie is rubbing my shoulders and back. Then she asks, "How's Starbright doing?"

     I say, "There are places Starbright would rather be than here."

     "I'll bet. Is she feeling any pain?"

     "She's not feeling anything and neither am I."


     I think Jackie is basically trying to keep me from falling asleep so she can continue her pain checks rather than dealing with me waking up, shouting in pain.  She is also able to tell I am appreciating, if not enjoying, the mini-massage she's giving me.

     Then the doctor says, "I am putting in the marker." Then: "All done."

     I now have an eyelash in my breast.

     I think of my friend Sarah Clayton, who might well have corrected her with: "All finished." Or maybe Sarah wouldn't have done that if she were in my situation, knowing she was trapped in a really vulnerable position and the doctor might turn out to be someone who can't tolerate being corrected.

     The technician next gets under the table again with the doctor. I can sense their moving about when, all of a sudden, my breast hurts like hell. I make the mistake of waiting a few seconds to see if it will stop hurting. It doesn't. It gets worse.

     I shout, "That hurts!"

     Jackie grips my shoulders, and the technician calls up, "Oops, sorry. I'm just pushing your breast back through the hole. I'll be more careful."

     It stops hurting. I am beginning to think Starbright is in some kind of vise they don't tell me about, and by mistake, the technician tightens the vise instead of loosening it a là my worst-ever mammogram experience. 

     Jene would later say, "Squeezing your breast through a tight hole hurts because the breast had just been…uh…."


     "Yes. And the anesthetic wasn't broad enough to handle that manipulation. So sorry, Mom." She thinks further and says, "Or more likely, they were pulling the transducer out. They didn't tell you because they didn't want you to jump."

     I say, "They should have warned me and prepared themselves for the jump. Why didn't they give me more lidocaine?"

     "I wasn't making excuses for them."

     "I know. Thanks, honey."

     She says in sort of a mumble, "Protocol."

     I think, sarcastically, but don't say, The Yale Way.

     When Jackie tells me nurses do their best to see to patients' comfort, "best" obviously doesn't mean going out on strike till patients having breast biopsies either get enough lidocaine or something that will work when they pull out the derringer. Meanwhile, the technician's head now rises out from under the table to face me. 

    "There's a Band-Aid over the incision." 

     I say, "I hope it's latex-free."

     "We have a note that you have a reaction to Band-Aid adhesive. It's latex-free, but it's also got a gentle adhesive. That's usually the problem, not the latex."

     "Oh." You learn something new every day, right?

     The technician and Jackie ease me into a sitting position and get me back into the top half of the surgical gown and put on my seersucker robe. Did I say the robe is not meant to make you warm? It isn't.

     Jackie gives me a very careful hug, taking care to only hug my Starlight side. She says, "Good job!" (Now I know how children feel, when they hear they've done a good job, knowing they haven't done a goddamn thing, good or otherwise.)

     But Jackie is a good nurse; she knows I'm freezing. She goes over to a cupboard, brings me a warmed blanket, wrap it around me, and I am profoundly grateful. This is why I remember her name. She treats me in a loving and kindly way, except for the part where she knows I will have a moment of really awful pain and does not prepare me. She betrays me instead. I don't know how people in the medical profession can stand themselves knowing they are about to give a patient pain that can be prevented. 

I give one of Charlie's nurses a name when his knee is replaced: Rachet. In the middle of the night, twelve hours after his surgery, he begins feeling pain. We will follow the instructions he gets from Dr. Komninakas in the pre-op room after he draws the happy face on his knee: "Stay ahead of the pain," he says. "I have prescribed on-demand pain relief. The minute you feel anything, call your nurse."

     So, I pull the cord over Charlie's head, unreachable for him, by the way, and call the nurse to bring him a painkiller. The nurse doesn't come dashing in as I imagine she will. She simply says over the loudspeaker, "He's not due for his painkiller for another hour."

     I say, "What?"

     She repeats herself.

     I tell her, "He's in pain. According to his doctor, he's supposed to stay ahead of the pain. Bring his pain medication now."

     She says, "Do you have any Tylenol? Give him a couple until it's time for his Percocet. Eighty minutes, actually."

     Did this woman not see "Terms of Endearment?" Charlie makes a terrible noise. I shout in the direction of the speaker, "If you don't bring my husband something for his pain right now, I'm calling the police."

     There is a guy in the round area outside the door. He is at a desk. I don't know who he is or what he's doing there. He calls out, "She just took her cell phone out, Marilyn."

     Charlie gets an early dose of his pain medication. His eyes close. From then on, Marilyn is all over us. I don't think it's guilt; she's afraid we'll rat her out to Dr. Komninakas. I don't get around to it—but I give her a bad review online at a hospital review site.

     So, once I'm sitting up on the biopsy table with the hole in it, wrapped and ready to be handed back over to Hank Aaron, the doctor finally rolls out from under the table, stands up, and says to me, "Good job." Can you stand it?  

     There is a knock on the door and Jackie opens it to a guy with a wheelchair, a new guy, not Hank Aaron. My hand-maidens say goodbye and wish me well, telling me not to remove the Band-Aid. "It'll fall off by itself after a few showers." Also, "Do not wash Starbright, just let water run over her."

     I will remember that. If they give me more instructions, I will forget them.

     I do not say, Thank you, to them. I'm pissed that they let me be hurt. Too bad, Ma.

     The new wheelchair guy goes a little faster than Hank Aaron but doesn't bang me into a wall.

     Charlie is there in the waiting room, actually standing in the doorway. He leans down and kisses me. He steps over to my wheelchair, and asks me, what else, "You okay?"

     "I am. Starbright's got a Band-Aid."

     He basically picks me up out of the wheelchair with his strong arms and hugs me to his so beautifully muscled pecs just as gently as you hold your newborn baby to your breast when the obstetrician passes him or her to you from between your legs and on past your belly.

     Charlie helps me get dressed. The Band-Aid brings happy tears to his eyes because it's only a Band-Aid, not a dressing covering a flat place where Starbright used to be. Do you know that until Betty Rollin writes First, You Cry, the protocol is to send the biopsied tissue directly to the lab while keeping the patient anaesthetized during the wait for the results, and if there are cancerous cells, do a mastectomy without the patient knowing it? Back in the day the medical profession doesn't want anyone to know a damn thing. Not in any condition to fight City Hall, here is what Betty does about that instead: Before she has breast surgery, she asks her doctor how long the operation will take.

     He says, quote unquote, Betty's book: "You're scheduled for nine. If it's benign, you'll be in your room by eleven. Otherwise," he says, lingering on the comma, "it will take longer, probably till sometime in the afternoon."

     Great line of writing, Betty. I really mean it, everyone; this is a terrific book.

     When Betty is brought to her room after surgery, she asks the nurse what time it is.


     And so, she knows her breast is gone.

     That astoundingly cruel protocol is done away with thanks to people like Betty, who goes on to demonstrate perfectly in her book what a horrible way it is to find out your breast has been amputated, and next, Shirley Temple Black. She enters the fray after her breast cancer diagnosis, when she learns the protocol. She stands up to her surgeon, tells him that even if she has cancer, she will need time to prepare herself for a mastectomy. She will keep her breast till that time, thank you very much. Her doctor respects that demand because, after all, she was the most popular child movie actor of all time and her friend Ronald Reagan appointed her Ambassador to Ghana and in his second term, to Czechoslovakia.

     Maybe there wouldn't be a thousand-page book called Choices, if my cousins hadn't been inspired by people like these two women. Now, who can we get to keep certain doctors from playing god? Example: Me to the doctor I had before Dr. Slattery: I volunteered for a research program at NYU. I need to take some cognition tests regularly to see if I might be getting Alzheimer's like my father. Doctor to me (disdainfully): Why would you want to do that? If the findings show you've got signs of Alzheimer's, you'll have to live with that knowledge. I don't say, but I think: If I want to see the pyramids before I die, better I pack my suitcase before the time comes when I'm peeing in closets instead of the bathroom, you jerk. I do say,"Knowledge is power," but I'm talking to the top of his head because he's trying to type notes into his computer, hunting impotently, and pecking with just his right hand.

     Charlie helps me get dressed. First, he takes the robe off and says, "Starbright is beautiful even with a Band-Aid."

     After he finds a cami in my bag—the list of pre-op instructions tells me not to wear a bra after the biopsy, but rather a snuggish cami, he drifts it down over my head (none of  my camis are actually "snuggish"), and then he says, "Let's go get some soup."

     I say, "I think I need the shirt."


     He digs out the plaid flannel shirt, his, and gets my arms in and buttons it. Then he rolls up the sleeves. It takes about five rolls. I choose this shirt because it's especially soft and will also hide the fact that I don't have a bra on.

     A candy-striper escorts us to the food court by the fountain right after she smiles and tells us, "I'm your patient ambassador." Is that adorable or what? When she leaves us, I say, "Bye, Madame Ambassador."

     She beams.

     The soup is delicious but I can't eat much of it because I start to feel really, really tired.

     So we go home and I go to bed wrapped up in Charlie's arms, which are not only strong, but covered with soft hair. I am known to fall asleep with my face against one of his forearms because the hair is pillowy and such a beautiful golden color.

     Salty is at doggie day care so he won't jump on me like he does Charlie when he get his new knee, even though I build a barricade around the bed. Charlie's in bed, Jene—knowing about the barricade— brings Salty in and Salty jumps over the barricade, knocking chairs and pillows hither and yon and does a four-point landing directly on Charlie's new knee.

     I become immediately hysterical, crying and trying to keep Salty from doing further damage, while Charlie is shouting, "Shit!" over and over and over. Jene, no Nurse Rachet, grabs him an extra Percocet and get Salty out of the bedroom. I tell Charlie I'm sorry about ten thousand times, and of course, he ends up comforting me what with the comfort of the Percocet.

     Later, Dr. Komninakus says to Charlie when he hears about Salty, "It's okay. Dog broke the new scar tissue forming. Save you some physical therapy pain."

     Next time I talk to my son, I tell him about my wheelchair guy whose mother named him after Hank Aaron.

     Jere says, "Hammerin' Hank. The best. He's the real home run king. No steroids. Not like Bobby Bonds."

     Forgive us, Dear Reader, if you have no interest in games requiring you to play with a ball. (Or if you have no interest in justice.)




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