FIRST, YOU GET PISSED: Chapters 1--30
FIRST, YOU GET PISSED
Mary-Ann Tirone Smith
Author of Girls of Tender Age: A Memoir
"How long would it have taken me to feel that I had a right to be outraged?"
Author's note: The story presented in this book is true. However, in some cases, names have been changed to protect the privacy of the individuals involved.
Copyright © 2018 by Mary-Ann Tirone Smith
Jacket design: Courtney Lopes Jacket photograph: Charles E. Bimmler
To Charles Edward, my king of kings, and Saltalamacchia, prince of the realm, with love.
Amanda, Joey, Emmie, and Chris Borst, Jene Maria Smith, Jere Paul Smith, Kim Gonzaga, Duane Trevail, Tadhg Hoey, Marnie Mueller, Karen E. Olsen, Betty Rollin, Joan Schmitz, Barbara Tirone, Marion Morra, Eve Potts, Laraine Olinatz, Heather Styckiewicz, the staff at Beach Library, Fort Myers Beach, Florida, and in memory of Mollie Donovan and Shirley Temple Black
ALSO BY MARY-ANN TIRONE SMITH:
The Honoured Guest
An American Killing
Masters of Illusion: A Novel of the Great Circus Fire
The Port of Missing Men
Lament for a Silver-Eyed Woman
The Book of Phoebe
THE POPPY RICE MYSTERIES
She Smiled Sweetly
She's Not There
Love Her Madly
IN COLLABORATION WITH JERE SMITH
Dirty Water: A Red Sox Mystery
Girls of Tender Age: A Memoir
FIRST YOU GET PISSED
"How long would it have taken me to feel that I had a right to be outraged?"
CHAPTERS 1 -- 30
EVERY YEAR, A POST CARD without the picture arrives in my mailbox. Maybe you get one, too. It comes a week after your mammogram, telling you that everything is right as rain. In my case, the card comes from my OB/GYN, who always scribbles a happy face on it. Sweet. But once, around three or four years ago, a detour: no card. Instead, I get a letter from a lab. The key message is: You have dense breasts.
I call my primary care guy and ask him what "dense breasts" means.
He says, "It doesn't mean anything. It's a way for them to cover their tracks in case they missed something."
I do admire Dr. Slattery, my no-holds-barred doc. In the movie, "Love Story," the female lead, Jenny Cavalleri, gets really sick and knows it's bad. She goes to her primary care guy, and after her examination, tells him not to bullshit her. He doesn't, and consequently, we all know how the movie will end, unless you already read the book. Then you know how it ends before it starts. My boyfriend at the time says, "Break out the Kleenex."
It isn't necessary that I tell Dr. Slattery not to bullshit me.
I find it a bit of a relief that the OB/GYN, whose name is Dr. Montessi, doesn't have to go around drawing unhappy faces when things aren't right as rain.
About breasts: You know how glad you are to leave the doctor's office after a mammogram? Delirious with joy because you don't have to live through that again for another 365 days, an entire year before your breasts will, once again, be compressed between two steel plates. I mean, your breasts! They've never done anything to deserve that kind of…uh…"discomfort." Discomfort is a hangnail for crissake, in case anyone in the medical field is reading this. A mammogram hurts.
My own breasts make me feel so good about being a woman; they please my partner while my partner is pleasing me; they allow me to experience a unique intimacy between two humans— me and my apparently starving newborn. We do what we have to do because, even though our breasts don't deserve pain, they surely don't deserve to succumb to cancer.
So now, this year, this summer, the first week of August, August 6th, I get a another detour, but not a letter, a phone call. Caller ID reads: Yale-New Haven Hospital. I figure it's my daughter, who probably has to use a company phone for some reason. She's a nurse at the Yale-New Haven Infectious Diseases Clinic. I tap green. A woman's voice, not my daughter's: "Hello, I'm Dr. Somebody." Her name doesn't sink in because I experience an immediate loss of breathing ability, thinking that something's happened to Jene. Then, the voice says, "I'm a radiologist at Yale."
"Fuck," I say aloud, though quietly, thinking Jene broke her arm. When upset, I ordinarily say to myself, Shit. But this is a far higher grade of upset. There are times when dropping an F-bomb is therapeutic.
Before I can ask, "What happened?" The radiologist says, "We've seen an anomaly in one of your images. It almost always means nothing, but we still want to do a second mammogram. My nurse will make an appointment for you. I'll connect you."
Maybe she said, goodbye. I wouldn't know because of the panic that takes hold of me. Jene doesn't have a broken arm; I have an anomalous breast. In my ear, I hear phone connecting noises, while the radiologist's words echo: It almost always means nothing. That is called bullshit re Jenny Cavalleri. The give-away is almost, a word meant to soften the blow, but of course, has the opposite effect. It's not nothing.
I'm switched over to the nurse. I don't remember the appointment conversation with her, but I put the date in my cell, August 22nd, even though I don't remember doing that either.
A flash of memory: Once, upon my release after a mammogram, while I'm getting dressed, the technician reappears. The johnny-coat, size C (colossal), is around my ankles. She gives me a big smile. "I'm so sorry, Mary-Ann, I need another picture. Something seems awry with your left breast. I'm sure it's because you moved."
I moved? Does one move when one's breast is in a vise?
I get another round of torture . The verdict: "My error. There was nothing there."
I say, "Thank you."
Shit. I already thanked her for torturing me the first time. (If you have my mother for a mother and you don't say please and thank you, you're a sociopath.)
Now, on this day, this beautiful summer day in August, it's a radiologist who's telling me something is awry, not a technician. It's something!
I have to talk to Charlie is all I know. Charlie is my husband. He's an ex-widower. His late wife died of breast cancer.
I will wait for the right moment to tell Charlie the crummy news, but along those lines, as any shrink will advise—say you have to inform the kids you're getting divorced—there is no right moment. Receiving news of a divorce will make them hate the parent giving them the news even if you segue directly into, "But I've got Southwest tickets to Disney World for April vacation!" That's because the first thing the kids will say is: "Dad's coming, right?" The little nincompoops. Did they not hear me say Dad and I are getting divorced? So we all know the answer to their question, which makes them hate you more, unless you're Jennifer Garner and Ben Affleck.
Come April, they'll be saying, "Dad would have never stood in this long a line and we'd have missed Space Mountain." We'd miss it because Dad would throw his arms up in the air, storm off, meaning we have to get out of the line to find him because there are no cell phones then.
For now, all I know is, I just have to spit it out. I realize that as I'm brushing my teeth that night, spitting out toothpaste. Charlie is in bed. I'm brushing away for a good, long time. Earlier, he welcomes me home from my mammogram with my mothers' favorite cocktail—a Sidecar. Google it. Know that it requires a beer chaser if you're my mother. I'm acting as if it's just any old day, and I need to take advantage of at least a little denial. The refusal of the unconscious to accept the truth is a gift from the gods, wouldn't you say? Charlie and I have a lovely dinner. The man cooks. The man is a good cook. Mussels in white wine and garlic, and bread he had to go ten miles from home to get. Nice sauvignon blanc. All lovely, but I don't taste a damn thing.
So, I'm brushing my teeth, while chanting silently to myself in rhythm with the brushing: There is no right moment, there is no right moment, there is no right moment. Can you brush your teeth all night? Denial only takes you so far. I have to stop. I press the button on my electric toothbrush, put it back into its stand, screw the top onto the toothpaste, and look at myself in the mirror. My usual flossing and a rinse of Listerine will have to wait. I tell my face in the mirror, "Get it over with."
As soon as I come into the bedroom, our dog, Salty, gets out of my spot and goes to the foot of the bed. He performs this ritual every night. Great in winter since his 58-pound self leaves me a big warm spot. Salty remains at the foot of the bed until he's sure we're asleep. Then, ever so cautiously, he makes his way back to where he was, plants his head on half my pillow, and is immediately and blissfully unconscious.
Every night, I sleep between man and beast.
Tonight, I stand there looking at Salty at the end of the bed. He doesn't know why. He raises his head. I pat it. I climb into bed and nestle into Charlie's chest, a magnificent chest, I have to say—broad, hard muscles, gently hairy, and especially sexy nipples. Yum. Neither of us has put on a pair of pajamas since we co-mingled. We are diehard cuddlers what with being naked. We very often entwine our naked selves together like two kittens and pretty much make love without even thinking twice. But tonight….
I say, "Sweetheart?"
"I have to have another mammogram. They saw what they call an anomaly but that it almost always means nothing. I'm sorry." I immediately think of Nancy Reagan, who told the President she was going to have a mastectomy and that she was sorry. At the time, I thought she was apologizing because he would have a wife with only one breast, but now I realize she was saying she was sorry because they had to face something unbearable, especially her.
Charlie's breathing stops just like mine did when I hear the almost always thing. He knows from almost always. I wait. When he can speak, he calmly asks, "Have you felt a lump?"
"Me, neither." Considering the way his first marriage ended, he's obviously on guard.
Then he says, "Is it Starlight or Starbright?"
Once, when looking at my breasts after bestowing them with his sweet caresses and warm kisses, Charlie says, "I love you, Starlight, and you too, Starbright. You're so gorgeous." Charlie gives my breasts names! Lol. (Lol is exactly what I do at the time. Note: When I first see lol in an email, I think it means little old lady, as in the Beach Boys hit, "The Little Old Lady from Pasadena.")
Tonight, laughter of any kind, lol or otherwise, isn't in the cards. I say, "The radiologist didn't tell me which breast. Maybe she did, but I must have blanked it out."
Since Charlie has passed through his initial terror mode and into a mode of being there for me, he props himself up on his elbow and says, "You're going to be all right even if there is something. It's very soon. I mean, we still can't feel anything."
He pulls me into his strong arms, and says, "I love you."
I don't think I told you what a fabulously deep voice Charlie has. It's like, when he says, I love you, the sound comes from the depths of his soul. When I first meet Charlie, I say to my friend the writer, Sarah Clayton, "He has this really deep voice," and she says, "A deep voice goes a long way."
Then we're nuzzling, then kissing, then touching each other all over, making love. It's our best way to communicate as Charlie has a fairly serious hearing loss from the time he's fourteen. He doesn't get medical attention for chronic ear infections until they become mastoid infections. (His widowed mother is "on the dole." That's what welfare is called back in the day.) So let me tell you this: I would rather have a man who can't hear me than one who won't listen to me.
Anyway, Charlie makes love to me in an especially soothing way. While he's loving me, I'm thinking of this one night when Charlie is finished making out with Starlight and Starbright and he says to me, "Your breasts give me peace, Mary-Ann. Serenity." Then he gets a little weepy. He's a very emotional guy, him and his deep voice.
I say at the time, "All I know is that that you are really making my toes tingle, cutie."
He stops being weepy and gets turned on instead.
Now, tonight, I interrupt him, "Charlie?"
"How come you named my breasts?"
Without even trying, I am changing the subject.
He says, "What?"
I forget to put my lips up to his good ear. Well, not good, but better than the other one. I repeat the question.
He says, "It was because of the story you told me about your aunt."
"The one with the jars."
Is changing the subject part of the denial phenomenon? Maybe. Anyway, with the subject changed, Charlie and I go about still enjoying that most wonderful stage in a relationship— autobiographical reverie. All new lovers enter this state until they either find out there's nothing all that interesting about each other (usually right away), or stay lovers forever continually exchanging missed-out pieces of their lives that render them more and more in love.
When I'm little, Auntie Mary says to my mother, "My stars are itchy."
My mother says, "So scratch them."
Auntie Mary reaches into her bodice and follows her sister's instructions. The thing is, I think Auntie Mary is saying jars, not stars. I never heard the word breasts before. It is several years before I learn that human jars are actually called breasts. I just figure breasts are a certain brand of jar, which makes perfect sense because they look somewhat like jars. I tell that to Charlie.
He says to me, "Rather than call your breasts Jar A, and Jar B, I think I'll go with Starlight and Starbright," and proceeds to make wishes on my breasts in keeping with the rest of the nursery rhyme. Among the wishes: I won't leave him, I'll love him forever, I'll marry him, and the Red Sox will win the World Series. All come true.
On this awry night, remaining wrapped up in one another, Charlie and I both pretend to fall asleep, until we finally and blessedly, somehow, do.
And only then does our Salty dog move up the bed.
AUGUST 22nd ARRIVES, and I am where I don't want to be—the imaging center at Yale. Charlie is ushered into a special waiting room for family or friends of women having advanced placement mammograms. Salty is enjoying the action at doggie day care. The breast-crushing machine is revved up, only this time the two steel plates are a quarter the size of the usual ones, appropriately, more the size of a sandwich. These are geared to descend upon the breast anomaly, specifically.
The technician arranges Starbright onto the bottom plate and has me hold the bar that is alongside the machinery. She dashes over to a console, presses a button, and the upper plate descends. When Starbright is flattened and hurting, she returns to my side and lowers the upper plate manually, twisting a short rod with a vinyl cover, sort of like a gearshift. I'm gripping the bar with all my might.
"Can you take another turn?"
Tears are springing to my eyes. She dashes around to her control panel, calling out to me, "I'll be really fast." I'm still hanging onto the bar for dear life, bearing the singular pain, when she calls out again:
"Three seconds, two seconds, one second, done!"
Starbright is released.
She rushes over to me. "You okay?"
"I'm really sorry."
I can tell she is. I say, "I appreciate your running."
She's not finished with Starbright naturally. I forget all about the dreaded side view, but it doesn't hurt worse than the usual side-view mammogram, don't ask me why. It doesn't take as long, either. I only know it's over. The technician tells me I can get dressed.
I do. As I'm grabbing my bag to leave, she says, "The doctor will be out shortly."
I say, "What doctor?"
"The radiologist. The one who called you. She's looking at the images."
I sit down on a little bench for one.
The jury is out, and my brain is churning. Maybe I'll have to wait a really long time, all day, I don't care, because when the jury goes out and is back before you have time to blow your nose, forget it, you're guilty. Five seconds later, the door next to the door that is the escape hatch opens. I am doomed. Again, because of who my mother is, I stand when a person enters a room.
In walks a tall, slim, very pretty girl in lab wear, who looks to be in the neighborhood of twelve years old. She smiles and puts her hand out. So do I. I'm trying to smile but don't know if I'm successful. We shake.
She says, "Please sit down, Mrs. Smith."
Mrs. Smith is my late mother-in-law's name.
She next says, "I'm Doctor…." She tells me her name, and it goes in one ear and out the other just like before, on the phone. My brain has made an executive decision: If you don't know her name you'll think you're dreaming this whole damned fucking thing.
I sit. This is no dream. This is the opposite.
She steps over to a chair and pulls it over to face my bench. She's Asian. But this is Yale. You might as well be in Beijing. She places the chair directly opposite me, sits down, and looks deep into my eyes and asks, "Do you mind if I call you Mary-Ann?"
I say, "I'd rather you do." I do not ask, Do you mind if I have no idea what your first name is, or last name either, and I don't want to know?
She says, "I'm the doctor who spoke to you on the phone."
We are not even a foot apart, face to face. I feel my saliva drying up so I try to brace myself. I don't want to faint and fall off the chair and have a concussion, although I'd surely rather have a concussion than whatever the thing is she's going to tell me I have, though I know what it is but can't take it in.
She leans in closer. I see she has what is called back in the day a "lazy eye." Maybe, like Charlie, her mother had no money for medical care. (My friend, the writer Katharine Weber, doesn't get appropriate medical care when she tells her parents she can't see out of one eye, even though her parents have a ton of money. They just won't believe her. They think she wants to wear a certain style of glasses popular at the time.)
I gaze into the radiologist's face. She must be one of those brilliant Asian kids whose tiger mother sees to it that she graduates from high school at nine.
She says in a chummy way, "Ya know, Mary-Ann…see…like, here's the thing." She sighs. "We have loads and loads and loads of ducts." Maybe she is twelve. Did she say, Ducks? Maybe she is nine and skipped elementary school altogether.
Leaning in ever closer, "I mean, like, we have…" then, her voice goes up a couple of decibels. "…a zillion ducts!"
Oh. Ducts. This is not good.
"We have bile ducts! We have lymph ducts! We have intrahepatic ducts.…" She gives me several more examples of ducts I've never heard of, finishing with one I have, "…and we have mammary ducts!"
This is getting more ominous by the minute. My brain is playing a comfort song. Julie Andrews is singing to me: The hills are alive with the sound of music, with—
The radiologist interrupts. "Now, Mary-Ann, let me tell you about the problem with ducts" Then she says forcefully, "They are full of…junk!"
Good God, I thought she was going to say they were full of shit.
I don't say, Get to the point, because I don't want to know the point. Instead, I say, "My mother never let a day go by without telling me to get rid of all my junk."
A couple more decibels: "OMG! My mother, too!"
What does one say to that, to that person, at this time, in this place I'm in? Nothing. Besides, she's on a roll, doesn't leave me a second to respond to what our mothers have in common.
"So, here's why our ducts are full of junk!" (Good. She's still not getting to the point.) "Because when our cells die, they're replaced with new cells. But the old cells leave deposits behind. Deposits!"
Turns out our ducts are full of shit.
"And one such deposit is called a…" (drum roll) "…calcification!" She takes a big breath, keeps going. "BUT! We have calcifications throughout our bodies, not just in our ducts." (She's still emphasizing ducts but has toned down the volume.) "You can have calcifications anywhere, like…like…in your larynx. Calcifications in hard tissue such as the larynx, however, are not worrisome. They just sit there."
Here it comes, because who doesn't know that breast tissue is soft? She's now speaking to the point, dropping the use of like as an adverb. I have no problem with the likes since it's the equivalent of um. I think um is worse.
"So…" (She still starts off sentences with the conjunction so, which I do all the time, even though language purists will rant)… "last year, Mary-Ann, I saw a few teeny-tiny calcifications in one of your mammary ducts in the left breast. Calcifications found in mammary ducts can sometimes be the deposits of mutated cells. Sometimes the deposits—the calcifications—will form a pattern. I saw no pattern last year and neither did my colleagues."
Is that good or bad? She starts her next sentence with, However... Bad.
"However, when the next year rolls around, when the patient—you— has another mammogram, most of the time the calcifications are gone, but sometimes they're not, and sometimes they have even increased in number."
She pauses, waiting to see if I can take what's coming. Oh, but I can't. Do I have a choice, though? No. I say, "My calcifications have increased, haven't they?"
"Yes." She reaches over and touches my wrist. "When you were here last week, I immediately took a look at that particular duct where I'd seen those few calcifications a year ago. Not only have their numbers increased, they've increased significantly, and the calcifications have formed a pattern."
I'm not surprised she's going to say something terrible like that, but at least her voice is growing significantly softer. She is calmer, and no longer in need of like. I ask, "A pattern. A pattern like a china pattern?"
"Uh…no. More like a cluster, actually. The calcifications have formed a cluster. A little independent galaxy of their own."
I tune her out, though not deliberately. My brain needs a rest. My brain is stuck at galaxy. My children and I so love galaxies, along with constellations and meteor showers, and human-made satellites, and everything else in the sky. Once, the three of us and their cousin Melanie lay on our backs in a field behind the neighborhood elementary school watching the Perseid meteors showering across the Milky Way. We try counting the number of meteors in each shower. We don't get far because Melanie throws up. Lying on your back and watching meteors zipping overhead can actually make you car sick if you are so prone. Besides the Melanie episode, another time it's four o'clock in the morning, when my son pats my shoulder. I wake up and he whispers in my ear, "Mom. The aurora borealis. Hurry."
I creep out of bed and follow him out to the deck. The Connecticut sky is bursting with Technicolor striations. My son, whose name is Jere, will grow up to ask his beloved girlfriend to marry him and how would she feel about having the ceremony during the upcoming Delta Aquarids? These are lesser known meteor showers, in case you don't know. His girlfriend thinks it's a capital idea. (I am so very glad he found his Kim, who becomes our Kim during last year's Delta Aquarids.)
The radiologist notices how I'm drifting to a better place and lets me have my moment of peace. Then she has to interrupt. I'm not her only patient after all.
I say, "Go ahead."
She tells me what I need to hear about the galaxy in Starbright's mammary duct, and I have to pay attention so I can tell Charlie the exact words. Right now, he is waiting and waiting, out in that higher-level waiting room, wishing for a shot of Macallan 12. I am wishing the same.
So, here is what I need to know. She races through it and uses the C-word for the first time. She has to do it at some point, doesn't she? "This anomaly can indicate a cancer but the good…really good…news is that the higher resolution, limited angle mammogram you just had showed that no cells have made their way through the duct wall. If they had, they would definitely be cancer cells. But I could see none."
I now feel my first emotion after a week of my nerves shot. A ping of anger suddenly fills up the very core of my being. I am picturing a bunch of scrawny-assed cancer cells joining forces to smash through the wall of my mammary duct with a battering ram so they can chow down on my dense breast. I am pissed.
I say to the radiologist, "The fucking little bastards."
The radiologist says, "Yeah."
Then, her elbow on her knee, her chin resting on her hand, she says, "A biopsy is kind of the final word as to whether or not what I'm seeing is a lesion."
"A lesion is cancer."
She really cannot stand saying the word cancer. I am thinking that when this poor woman must tell a patient that cancerous cells have burst through her mammary duct, that she sees lesions, it breaks her heart. All I know is, I can't stand saying the word cancer, either. And now I have to prepare for that word applying to me.
I take her hand. She squeezes it and then holds it very gently in both of hers. She says, "Let me describe the biopsy procedure for you."
Very Dear Reader, if you have never had a breast biopsy described to you, hang on to your hat. Smoke a joint. It's medicinal in this case because, like me, I'm sure you just figure that someone sticks a needle into your breast and sucks a couple of cells out of the duct junk to be examined by the boys in the lab. When I'm a kid, I love "Hawaii Five-O," who doesn't? In every episode, Jack Lord can be counted on to say two things to James MacArthur: "Book `em, Danno," and "Send this to the boys in the lab," the latter when he's holding up a possibly blood-stained screwdriver.
And so, if you don't have a joint immediately available, go pour yourself a shot of Macallan 12, or if you don't drink have a mug of coffee unless you're a tea-drinker, in which case, head for the cupboard and brew the superb Lapsang Souchong. If you don't have that variety—maybe never heard of it—go with Lipton's or whatever, and the next time you go out buy a box of Lapsang Souchong, once recommended to me by Kim, who knows her tea.
THE BREAST biopsy. Ready?
The radiologist starts with, "You'll be on your stomach on a table with a hole in it. Then—"
I interrupt. "I'm getting a massage, first? That'll help."
"Uh…no. The hole is where your breast will hang out so we can do a much more intense mammogram previous to—"
"Starbright will hang through a hole?"
I explain about Charlie's names for my breasts. She stares at me, sort of. The lazy eye is presently leveled toward the wall over my shoulder. Then I repeat my question: "You're saying my breast will hang through a hole?"
"And where are you? Underneath the table on one of those things your mechanic rolls around on when he's under your car?"
"Not exactly…" she gets a rather huffy expression on her face, but right away reverts to her previous kindly demeanor. She has trained herself not to take offense with her patients. She says, "It's a stool. But it won't be me who's rolling around. Another radiologist will be on the stool, and a nurse and technician will scoot under the table as need be."
"They'll each have their own stool?"
What did I think? They'd be down on their hands and knees?
I think for a moment. "Are you saying you won't be doing the biopsy?"
"What I do is analyze images."
I visualize three strangers crammed under a table with Starbright in the middle of them. I wonder how they get at the breast of a woman with cute little perky breasts. At Branford Harbor, where we have a boat, there is a captain who names her cruiser, Sea Cup, which is the size of her bra. I'm a Sea Cup, myself. (When I tell the captain that, she gives me a knuckle-bump.)
Alas, I must force myself to concentrate on the business at hand, but I want very badly to blink like I dream of Jeannie does and vaporize. I can't. I listen as the radiologist continues the narrative.
"First, the doctor will numb the breast... he'll numb Starbright, actually." She smiles at me. "Starbright won't feel anything at all."
We are very glad to hear that. I like this woman.
"And next, he'll make a quarter-inch incision—"
"Incision?" She pulls back from me. I must have shouted the word. I shout it again. "Incision?"
"A needle requires an incision? How the hell big is it?"
"It's not a needle."
"It's not? What is it?"
"It's a spring-loaded, large-core transducer. Essentially, a—"
She clears her throat so that she can talk fast, preventing me from interrupting her again. "A transducer is essentially a metal tube filled with very fine needles except they have barbed ends…" I am thinking, but do not say aloud, Jesus Christ Almighty "…and these barbs will hook several strands of tissue within the duct. Then the transducer will draw them out of the duct and into its tube. After that, the transducer is taken out. Then we send the specimens to the lab to see if the cells in the duct are cancer cells."
I really do hate the word cancer. If you change the second c to a k, you've got canker. I get canker sores when I'm a kid. Now I have cancer. (I say it. Cancer. If only to myself.) Maybe if you get canker sores as a kid, you're predisposed to cancer. I bet if the radiologist said, "…we send the specimens to the boys in the lab…" I wouldn't be doing that monkey-brain thinking. I'd laugh.
I work around the damn monkeys who have set up a trampoline in my cerebral cortex. I ask her, "How will the other doctor get it out?"
"He'll pull it out."
"How many what?"
"How many specimens will be in it?"
"Oh. Four or five."
Whew. I'm thinking she'll say eight hundred. I ask, "Will the incision require stitches?"
Naturally. I'm hoping for the same number of stitches as the specimens, or fewer. Imagine the number of stitches you need if you're breast is riddled with cancer. I cannot imagine. I ask again, "How many?"
"Two…maybe three. Then we'll leave a marker behind—a tiny wire—so that if you do need to have surgery to remove the duct, the breast surgeon will know exactly where to go."
I say, "The transducer guy won't be doing the surgery?"
"He's not a breast surgeon."
"There are surgeons who only do breasts?"
"Yes, but if you choose, you may have any surgeon you like, including one who does not specialize in breasts."
Ping of anger. "What do I look like, Doc, some kind of idiot?"
She says, "Hah! No, Mary-Ann. You don't. What I mean is, if you have had a surgeon in the past you can talk to him or her about all this. You might decide that surgeon will be more appropriate." She puts her hand on my knee. She smiles. "But if not, you will have the best breast surgeon in the country. We are so fortunate she is right here at Yale. Diane Quigley. I will see to it that your surgeon will be Diane Quigley."
I will never forget Diane Quigley's name.
But I am not ready yet for that particular discussion. I need to finish this one. "About the marker? The wire?"
"How big is it?"
"It's the size of an eyelash. It will serve to guide the surgeon."
I try not to picture a doctor with a scalpel in each hand rummaging around inside my breast looking for an eyelash. The radiologist knows what I am thinking. She says, "The end of the marker will stick out of your skin and there'll be a Band-Aid over it."
Can you believe this? I can't, but it's all true. Right at that moment, I do not want to know anything else about an eyelash sticking out of Starbright. I am finding myself overwhelmed with a need to backpedal. I have to ask an extremely specific question centered on statistics. Statistics is truth. I don't like surprises. So, here is my pressing question for the radiologist: "What are the odds that the calcifications are cancer?"
She doesn't skip a beat. "Twenty-five percent."
"Is that based on your own experience?"
"No. That's based on statistics." She gazes into my eyes with one of hers trying to look elsewhere.
I know exactly what she means by No combined with the unbalanced gaze. In her experience, the odds that the calcifications are cancer, based on what she is seeing in my mammographic images of Starbright, are one hundred percent. The gaze reflects the fact that she's not comfortable lying.
She thinks I will cry. Maybe I look like I will break down. She asks, "Would you like a Kleenex?"
Forty years ago, the New York Channel 4 newscaster Betty Rollin titles a book she writes, First, You Cry. (Back in the day, you had to put a comma after first. Now, not so much.) It starts with her learning she has breast cancer and how much the diagnosis screws up her life that is already screwed up because her husband is a philanderer, and it's about how no one wants to talk about such an embarrassing subject as breasts. In perfect timing with what is going on with me, the book is re-issued, a new edition. I read the first edition way back when because it gets such good reviews, not so much because breast cancer is the culprit, but because it's about life in general when you meet up with a monkey wrench. Life is full of monkey wrenches, isn't it? Betty Rollins's book is both moving and exhilarating. I remind myself to go to Madison on the way home, a nearby town that has the best bookstore in the country, "R.J. Julia." No one knows what R.J. stands for, or who Julia is. I will buy the new edition even though I still have the original. I want to support Betty and maybe she added new stuff.
Mainly, though, knowledge is power. My mother drills that into my head.
To my radiologist, I say, "No, thank you. I don't need a Kleenex. I need you to tell me what to expect."
She takes my hands in both of hers. "Please, please understand, Mary-Ann, that if there are cancerous cells in your mammary duct, we have caught the cancer early enough to cure it."
I am now apparently hallucinating. The doctor is telling me the cancer that is more than likely inside Starbright is curable.
She says, "Did you hear me?"
I say, "Yes. What do you mean by cure it? There is no cure for cancer. You die from cancer."
Here is how my mother describes her golf partner's stomach cancer surgery: They opened him up…loaded with cancer! Loaded! Sewed him right back up again. Left the damn cancer where it was. They'd've needed a shovel to get it out. Dead in a month.
Most ironically, my mother is diagnosed with stomach cancer shortly thereafter. They open her up—loaded with cancer. I picture a load of cancer looking like oatmeal. They take out ninety percent of my mother's stomach, treat her with a short course of chemotherapy, and she's back on the links in no time but dead in a year. That's all the time chemotherapy can give her, but right up until her last month, it's a good year of doing what she loves doing—playing golf, replacing golf with cut-throat card games when there's snow on the fairways, getting her hair done once a week, hanging out with her sister, my Auntie Margaret, doing crossword puzzles, knitting sweaters, and watching Pat Sajak and Vanna White every day, no matter what. The last month? There can be no dignity in death, same way it is with childbirth.
I tried my best, Ma.
The radiologist is speaking, still holding my hands, yet more warmly. I try hard to pay attention. She says, "If the cluster of cells is a lesion—something we won't know till we have a pathology report—then we have found a cancer before it can be felt or even seen by the human eye. If there are cancer cells in the duct, your surgeon will excise the duct, and the cancer will never come back. Never. It can't come back. The duct will be gone, and the cancer along with it. Again, I saw no invasive cells outside the duct."
I believe her the first time she tells me that, and I still believe her. I probably have a duct full of cancer but at least it's not a stomachful. I say what I'm next thinking. "But calcifications might show up in another duct next year, right?"
"No. First, the lesion will be disappeared by Dr. Quigley." She snaps her fingers. "Gone! And your post-operative treatment will prevent any new cancer cells from developing in…Starbright."
I find that impossible to believe. "Post-operative treatment is chemotherapy, right?"
"Not likely in your case since the lesion is minuscule. Dr. Quigley, and your oncologist, and your radiologist will discuss radiation with you. Also, any drug treatment to follow."
"You're my radiologist."
"I do not give radiation treatment. I–"
"Sorry, I forgot." I pause a moment to drum up some courage. "But what are the chances that what I have is a more advanced cancer than what you…" how should I say this? "…than what the images are telling you? What are the chances you missed something?"
Pause. Then, "I don't miss anything." Pause. Then, "But I have to tell you that sometimes, a protuberance—a tiny bit of a cell—will penetrate the duct wall. So tiny it will not be visible on the mammogram image. The pathologist will see it, though, once the duct is excised. Then you'll be scheduled for a second surgery—but through the same incision. Dr. Quigley will take out a margin that incorporates any tiny bits of a cancer cell that might have worked their way through the duct wall."
Is this a horror film, or what?
I ask her, "What are the chances of that?
Another twenty-five percent. I might believe the statistic if she said, Twenty-two and seven-eighths percent.
She officially has no more time for me; she leans back out of my face, and says, "Let's go ahead and make that appointment for a biopsy, shall we?"
She has other patients, after all. I am suddenly feeling exhausted. I can't ask her if there is anything else she should tell me because I'm shut down. But not to worry. There are other people I will be able to question: this Dr. Quigley person, an oncologist, and a radiologist—one who actually does the radiating.
But it turns out the image-reading radiologist has one last thing to tell me: "During the biopsy, in addition to the little marker, they'll leave a chip in your breast so that in future mammograms we'll be able to zero in on the exact area of the excised duct. The chances of that will be as close to zero as you can get."
Believe it or not, I say, "The vet put a chip in my dog's ear so they can find him if he ever gets lost or stolen."
She is so glad to smile again. Broad grin. "Same idea, sort of. What's your dog's name?"
I tell her his real name in case she's a baseball fan. "Saltalamacchia." (Jarrod Saltalamacchia starts his too few years catching for the Red Sox the summer Salty is born. They both have the exact same curly hair as well as extraordinary catching prowess.)
The radiologist, what with the expression she makes, is clearly not into baseball. So I say, "But we call him Salty."
She asks, "What is he?"
"Cool, he doesn't shed. I have a beagle. We had to buy a new, really powerful vacuum cleaner a week after we got him. He's two."
I say, "Salty is two! What's your beagle's name?"
"His name is Greensleeves. Guess what we call him?"
Now we both laugh, believe it or not. I know I can't believe I'm laughing, but I am. She says, "So, I'll have Dr. Quigley's assistant call you. Her name is Beth. She'll make the appointment for the biopsy, and another with Dr. Quigley once they have the pathology report. At that appointment, she'll discuss the pathology with you and take it from there.
I wish she'd left out the take it from there part. Laughing or otherwise, I'm in no condition to think about crossing a further bridge. She stands. So do I. She hugs me. I hug her back.
The hug softens the pain of what I am now thinking: I have to tell Charlie.
I GO INTO THE waiting room and Charlie is sitting there all alone, looking into a magazine he's not reading. He doesn't hear me come in because he basically can't hear anything as soft as sneakered footsteps even with the industrial-strength hearing aids he wears. Then he senses me. He's up and his arms are around me. After a moment or two, we sit down together.
I tell him everything except the one-hundred percent odds part I detected in the radiologist's expression. I start with, "The doctor says that the mammogram found these strange cells in a mammary duct." I skip the galaxy part too. "So, I have to have a biopsy to see if they're cancer cells. She told me they found them early enough that if they do turn out to be cancer cells, the duct will be removed and I will be cured."
(Did you note the euphemism, removed?)
Charlie responds the same way I do when I hear that. "Did you say cured?"
"Yes. A breast surgeon will take out the duct. The radiologist says she is not seeing any cells outside the duct. When the duct is gone, the cancer cells will be, too." Then I add, "If there even are cancer cells."
It is not the time to mention the possibility of cancer cell protuberances having successfully penetrated the duct wall, wiggling the rest of their sorry-ass selves out of there and onto a path of destruction, engulfing everything. (Did you see "The Blob?" The original movie, a 50s horror film, about a small, round, half-solid, half-liquid ball that just happens to be in a meteor, a meteor landing on earth, when scientists who note such things are out to lunch. It crashes in a wooded area of rural Pennsylvania and cracks open upon impact, and the little ball rolls out of the woods until it reaches a street, whereupon it catches up to and devours one hapless soul after another, none of whom can outrun it. Do I need to explain that the little ball gets bigger and bigger as it digests half the people in the town?
"The Blob" is one of my all-time favorite, super-camp flicks, so I seem to have memorized the theme song, which now comes cha-cha-ing through my head: It creeps and leaps, and glides and slides across the floor, right through the door, etc.… Beware of the blob!
I right now google to see if I got the song right. (Also, right now, I am hating the concept of metaphor, as in, the blob is some kind of tumor.) But you will never guess who composed "The Blob." BURT BACHARACH! I'm only glad he found his way to San José. And I can only hope that he doesn't own the rights to the song, but if so, that he won't charge me a lot to include one-and-a-half lines of his lyrics in this book.
And getting back to Charlie, why would I talk about the possibility of a second surgery now? I can put it off because I might not ever need to have that conversation. But the way Charlie holds my gaze to his, I know he needs more. I change my mind and give him the story of the possible second step with the caveat that the chances are slim. Then I describe the margin-thing and while I do, I am actually visualizing the scene in the "The Blob" as described in the above lyrics segment. It oozes through the space all around doors until its weight alone forces the doors off their hinges, and then the rest of the Blob, now enormous and blood-red after having eaten all the cancer cells—I mean the people out on the street—rolls on through.
If I may, in Phoenixville, Pennsylvania, where the movie was filmed, the townsfolk reenact the absolutely unforgettable Colonial Theatre scene once a year during "Blob Fest." I would tell you about that scene but I hate spoiler alerts. (Get the original Blob from NetFlix.) All tourists to "Blob Fest" are invited to take part, to go into the Colonial and have a seat. The participants pack the Colonial and on cue, come flying out, running and screaming while the Blob….
You really have to see the movie. All I know is, if I'm at a point where I should start thinking Bucket List, "Blob Fest" is in the #1 position, where I do believe it will stay, ahead of Graceland even.
Though I'm able to move my mind to other things, yet another form of denial, the big tear rolling down Charlie's cheek interrupts. He is crying in relief because, like me, he now has the radiologist's optimism going for him. We hold each other, and I know that even though I'm facing the possibility of bad news, he is also facing maybe losing another wife to breast cancer. I'm feeling such sympathy for Charlie because he is a good man. When you feel love and affection for someone, even if it is mixed in with devastation, the desire to spit nails can be temporarily nudged off to the side of your brain by a flashback to "The Blob."
I whisper into his hearing aid, "Kiss me."
He does. He sniffs to stop the tears. Then he says, "I'm sorry, baby."
I say, "I'll be getting a call from someone today. To make an appointment for a biopsy. So we better get going."
He repeats himself. "I'm sorry, baby." His eyes fill with tears again.
"I know, sweetie."
Driving home, I do what moms and dads do no matter what else is happening in their lives, even cancer. I think about our children.
Charlie's son Jay is getting married in three weeks. When Jay and I meet, when we make eye contact for the first time, we like each other instantly. Maybe since we're both artists and know the same struggles. He's a musician. His band is "The Pop Rocks." Did you like the 80s sound? Did you hate the 80s sound? Did you know there even was an 80s sound? Doesn't matter. It's a smashing band, a fun and terrific band, all the musicians good, even the girl singer who doesn't wield a tambourine you'll be happy to know. Google them to see when and where they're playing and go dance and sing with them: "…God bless the rains down in Africa…" and "…we built this city on rock and roll…" and "…another one bites the dust," and "...oh, Daddy dear, you're still number one, but girls just want to have fu-un..."
Naturally, I have been so excited about my approaching role—Stepmom-of-the-Groom (and determined to do Jay's real mother proud). But now this happens. I'm going to have to tell Jay and Melissa, his bride-to-be, about my mammogram.
The first written mention of the word melissa is in an ancient piece of Greek writing. Melissa, in Greek, means honeybee. This name so fits her: she is lighter than air, and she pollinates everyone who knows her with her kindly grace. From the minute Jay and Melissa are engaged, it's pretty clear a fairy tale wedding is on the horizon.
My son Jere's wedding takes place on an island a few months ago. Just he and his Kim. They hop on the Narraganset Bay ferry in Rhode Island where they live, and have their private and personal ceremony on the most beautiful spot on earth, or at least, surely, on the Atlantic, Block Island. I don't get to be Mother-of-the-Groom who walks down an aisle, but Jay, as it turns out, becomes back-up.
Jere and Kim's wedding is another version of a fairy tale. After the ceremony, they will have a wedding reception for two—them. Instead of people, their guests will be the millions of stars of the Delta Aquarids, falling all around them. But, totally unexpectedly, they do end up with a witness, who turns out to be a star in his own right. They are no sooner off the ferry when they see the comedian Steven Wright walking down the street. They are huge fans. (So am I.) Kim nudges Jere, who thinks, This is it, and without giving himself time to chicken out, goes right up to Steven, telling him how he and his girlfriend are so crazy about him, giving him significant details as to that craziness, and that they are getting married in a few hours, and will he be their witness. They have no witness. Steven Wright spots Kim kind of hanging back. He smiles at her. She smiles back. I don't know which is more dazzling about Kim—her so-genuine smile, her huge, green Bette Davis eyes, her one-day-burgundy, one-day-chartreuse hair, or the 2004 Red Sox World Series Championship logo tattooed at the base of her spine just above the bikini line. (Steven is wearing his 1980's-era Red Sox hat when they spot him. Jere's own Red Sox hat is of the same era.)
Melissa is golden like honey, Kim as Technicolor as the aurora borealis.
So, Steven Wright looks to Jere again and says, "Sometimes I have to think about things." All the same, he puts Jere's number into his cell, doesn't say, Don't call me, I'll call you, and Jere gives him the time and location of the wedding: eight o'clock that night on the sand at the foot of the Mohegan Bluffs.
Back at their hotel, right when they're watching him on YouTube, a text message from Steven appears on the screen: I'll be there.
A Block Island hotel is the kind of place where you can jump up and down screaming with joy, and no one bats an eyelash.
Five minutes before the ceremony is to start, Jere and Kim watch their witness climb down the treacherous wood stairway, zig-zagging the face of the bluffs to the beach 206 feet below, where they are standing with an acquaintance who has a certificate to marry people in the state of Rhode Island. Steven Wright is juggling his wedding gift. It's a kite. He tells Jere and Kim, "It's not meant to be flown. It's a symbol of your love taking off," and then he witnesses them take their vows and signs their marriage certificate.
Are you verklempt, or what?
So with all this wonderful dual wedding stuff, I really have a lot to be happy about, even though I know my fury will rise again. For now, wanting to believe I'll be cured if I have cancer, though doubting it, I am still a thrilled mom/stepmom. In case you've ever wondered if a thrill can be experienced even when a person is devastated and in terror besides, the answer is yes.
Circling back, this night of the second mammogram, Charlie holds a conversation with Starlight. While he gives Starbright's soon-not-to-be identical-twin a massage, he tells Starlight that we will work together to get Starbright through this. To have someone in a conversation with your right breast is very funny. So then, we all make love and when we are melting into sleep, Salty sneaks into his usual position. On this night, though, he tucks his head into my left armpit and snuggles up to Starbright. All those stories about how a dog can sense a lot of stuff with his baseball-size brain are true. I do what I normally do—turn from Salty and snuggle closer to Charlie's back away from dog-breathing, but tonight, I first have to extricate my arm from under Salty's head. I whisper to him, "You're a good boy. I love you." And he is content to sleep up against my own back.
Then I cry just a little bit. Finally, this is what makes me cry. Dog-love.
Not long afterward, Charlie stirs with the assurance that I am asleep. I am, but I wake up when he creeps out from under the blanket because even with a king size TempurPedic you can feel the other person get out of bed. He circles our giant bed that we are still paying for and gets in on the other side of our dog, who is doing his best to protect me from whatever it is he senses. Or maybe Salty knows exactly what's going on. Just because a dog doesn't speak your language doesn't mean he doesn't understand it.
Like me, Charlie realizes we now have a fourth partner, in addition to Starlight, who will help Starbright survive—our Salty dog. Charlie gets into bed on the other side of Salty, puts his arm around both of us, and we fall asleep on a three-foot-wide edge of a thousand-square-foot TempurPedic.
THAT NIGHT, BEFORE I go to bed, I'm a little perturbed that I didn't get the biopsy appointment call. I take a Benadryl and sleep like a rock. I awake to the smell of potatoes frying in onions and paprika. Smoked paprika. Have you ever tried it? Try it.
I open my eyes. Charlie is not in bed. Neither is Salty. Charlie is in the kitchen and Salty has no doubt woken to the sweet sound of a package of bacon being unwrapped. I can smell the bacon frying, too.
A couple of times a week, Charlie will wake up and say, "I need eggs." That's after he has one of those climaxes where he makes the noise of a herd of wild boar. I keep telling him we're going to get a knock on the door from the East Haven animal protection lady asking if we're harboring wildlife.
Now, on this morning, he figures both of us need eggs, nothing to do with replenishing his sperm supply, but rather to replenish our spirits that are so crappily diminished. So here he comes into the bedroom with two Greyhounds. I sit up. In case you don't know, a Greyhound is grapefruit juice and vodka, preferably fresh grapefruit juice and preferably Grey Goose. We had our first Greyhound at Pepe's, the oldest restaurant in Key West, where the grill guy—a descendent of Pepe—makes a highly noted breakfast. I have to say, though, after a Pepe's Greyhound, you don't know what the hell you're eating. Or care. You only know it's really good. Charlie once tells me that one morning at breakfast at Pepe's I'm blathering on to everyone within earshot that Pepe's oatmeal is better than even the oatmeal you get at the Dorchester Hotel across the street from Hyde Park. Charlie whispers to me, "It's Cream of Wheat. They must have run out of oatmeal."
After a Greyhound—oatmeal, Cream of Wheat…whatever—you'll love it.
Now, Charlie sits down on the bed, hands me my glass, and we clink. No toast, just the clink. What are we supposed to say? Here's to Starbright having a long life? We have a sip, and I realize that Charlie managed to run out to Stop & Shop and buy actual grapefruits, a whole bag, I'm sure, since he doesn't know how to buy fewer than six of anything.
I say, "Mahalo, Charlie." We learned to say mahalo instead of thank you in Hawaii. I always say mahalo after those aforementioned orgasms, which also means, I love you, also appropriate.
Charlie says, "Aloha," which in addition to the above, also means you're welcome. We clink again.
At our second sip of our Greyhounds, Salty appears in the doorway with a look on his face that says, "Where the hell's my bacon?" Then he trots back to the kitchen where he will return to his post, guarding the bacon until Charlie attends to it again instead of me.
Charlie gives me a smooch. "Five minutes, Okay?"
I roll over for my five minutes. I'm depressed. So I try to think about the beautiful dress in the shop in Branford waiting for me to model for Melissa. But I am unable to concentrate on a happy thought.
I sit up when I hear Charlie dishing everything out and telling Salty, "Go get the Mommy." (We refer to ourselves as The Mommy and The Daddy when speaking to Salty.) Salty gallops into the bedroom, jumps on the bed, and barks at me—Get up, get up! The bacon's done!
I throw off the covers, and he runs back to the kitchen in case the bacon is escaping. That cheers me a tiny bit. He's a handsome dog, our doodle. He's apricot. That's his color according to his breeder. She also says, "This puppy is happy in his own skin." We don't know what that means. It's my first dog and Charlie's second. He only had his first dog for a few weeks before it fell off the third floor porch in the tenement in Bridgeport, CT, where Charlie lived. Charlie is convinced the landlord threw the dog down the stairs. This is the kind of thought that takes over when you're depressed.
I put on Charlie's white terrycloth bathrobe instead of mine. I need a great big, soft and cozy one. It doesn't warm me up. I drag myself out to the kitchen.
We sit down to our breakfast. I have no appetite. I am overtaken by the grief I feel for myself. Suddenly, I might as well be a banana peel tossed out a car window onto the side of the road. How will I eat Charlie's bountiful breakfast spread out before me? I'm getting more depressed with each second. Then I notice the little bowl of blueberries to the side of the butter, even though we aren't having cereal. The blueberries hit a nerve made really sensitive by my depression. I don't feel a ping of anger. Oh, no. Instead, this blast of fury fills me to the brim.
Charlie feels it. "What's the matter, honey?"
I'm staring at the bowl of blueberries. I look up at him. I bang my fist on the table. Dishes rattle and glasses wobble. Salty jumps.
I shout: "HOW THE FUCK CAN I HAVE FUCKING BREAST CANCER? ME? ME! I DON'T SMOKE. I EAT RIGHT. I EXERCISE. MY MOTHER DIDN'T HAVE BREAST CANCER, SHE HAD STOMACH CANCER! I BREAST-FED TWO BABIES FOR TWENTY YEARS EACH, AND EVERY GODDAMN FUCKING MORNING I COVER MY GODDAMN FUCKING CEREAL WITH GODDAMN FUCKING BLUEBERRIES! THEY DIDN'T FUCKING WORK!"
I am crying hysterically just the way Betty Rollin does when she learns she has breast cancer.
Charlie is stricken, frozen in place, coffee mug mid-air, knowing what a terrible mistake he made putting out the blueberries.
When I am a child, my mother never complains. Instead, she says, "I blame the government!"
This is long before it is de rigueur to blame the government. I need Charlie to know right this minute that I'm just pissed at the calcifications in Starbright's duct, and absolutely in no way am I angry with him for the blueberries. So I raise my head from my arms folded on the table in front of me, sit back up, take his hand, look into his eyes, and say, "I blame the government."
His eyes close for a moment. I brush his cheek with my other hand. Then he opens his eyes again. Damp eyes. He breaks into a smile. Did I mention he has dimples? He knows I forgive him for trying to cure the cancer we both know I have with blueberries. We don't need a biopsy to tell us.
He puts his mug down. It's a souvenir from the duck boat tour we took in Boston. Our goofy picture is on the goofy mug. We are standing in front of the goofy duck boat. We are different people then than we are now. I am instantly depressed again because I know I am going to categorize every event as "before cancer" and "after cancer" from here on in: Duck boat tour, before; Jay and Melissa's wedding, after.
Salty barks. When he's distressed, he has this loud, sharp bark that sends piercing notes into poor Charlie's hearing aids. He's distressed about my shouting, but he's also distressed since neither The Mommy nor The Daddy is passing him pieces of bacon. He's been waiting at least ten minutes or ten years; he doesn't know the difference.
Charlie gives him an entire strip of bacon. Salty is so happy he runs off to eat it in his favorite spot—in the middle of our Turkish rug that cost a shitload of money.
Charlie says to me, "I love you, Wonder Woman." He calls me that sometimes.
I tell him I love him, too, and more tears spill over and down my cheeks. I say, "I blame the luck of the draw."
He says he's sorry again.
"It's a crap shoot, isn't it?"
BEFORE I MEET CHARLIE, before I meet anyone, my daughter encourages me to get out there. There are very few single men wandering about the condominium complex where I live. There are three, and none appeal, though I do like a fellow named John quite a lot, who is half my age. He is cute and polite and kindly, and an Olympian, besides. That would be the Special Olympics. He wears his several medals proudly, but he can't really say which competitions he won. John is afflicted with Down syndrome. He is also a baseball fan and we talk baseball when I walk Salty, who spots John waiting for his bus to take him to his special school. Salty drags me over to him. John works hard at remaining calm and gingerly pats Salty's head.
Our conversations are usually along the following lines.
John: "I don't like the Red Sox."
Me: "Yankees Suck."
John: "I'm afraid of dogs."
Me: "Salty is named after the Red Sox catcher. He won't hurt you even if you are a Yankees fan."
John utterly believes me, and comes to look forward to petting Salty.
One day, I ask John for his autograph, but he can't write. So I gave him a stick and we walk down to the edge of the Sound and he writes something with the stick, while Salty sees to his ongoing condo duty of chasing the Canada geese off the grass. I take a picture of what John writes, which are not words of any known origin.
My relationship with John is not really going anywhere.
When it's a few years since Charlie loses his wife, his own daughter tells him he has to get out there and meet people. He prefers being with his camping friends, Bruce, Gary and Jim, so she fills out an eHarmony application for him, right at the same time I fill one out with the help of Jene.
The first four men I meet are about the biggest assholes I've ever come across. One of them is an economist, who brags that he is responsible for pharmaceutical ads now allowed to air on TV. I say, "Wow. Because of you I get to see two people sitting in separate clawfoot bath tubs with no plumbing, out in a field, drinking wine and about to have ravenous sex after the man takes a Viagra."
The economist is not amused. Also, he's positioned himself at a table where he can stare at any woman who comes through the door, which he does. I am not amused, either. I tell Jene I'm closing my eHarmony account. She sympathizes. But then a picture pops up in my eHarmony email of a guy on a boat. Clever Kristin has seen to a second picture—her father holding baby Gianna, his first grandchild. They are nuzzling each other. So, okay, I'll try one more of these jerks. At least I'll get a boat ride out of this.
During our first month of knowing each other, Charlie and I go out three times. The first time, we meet for coffee, something eHarmony strongly suggests. After the coffee, we decide we might as well have breakfast, and we eat and chat for a good hour. The second suggestion is lunch or dinner. We decide on dinner, but before dinner we will spend the day eagle-spotting on the Connecticut River in an Audubon Society boat, the first of many boat rides. It's February and we freeze. We don't care. We see lots of eagles and an egg in a nest, something that makes the Audubon people delirious with joy. The third get-together is of our own design. Whe pass a billboard on a highway on the way home from eagle-watching. It's advertising "Riverdance."
In unison, we say, "I've always wanted to go to 'Riverdance.'"
Then Charlie drops me off at the MacDonald's on I-95, where my car is parked. We say good night, and exchange a peck on the cheek.
By the next morning, Charlie has two tickets for "Riverdance," and within the week, we go. Instead of the sort of thing you wear to go out to breakfast when the point is to be noticed in a crowd of strangers waiting for tables, or the jeans and heavy winter jackets you need for standing on the deck of an eagle-spotting vessel in the dead of winter, I get to dress up.
I meet Charlie for dinner near the Oakdale Theatre. I take off my new black coat with that cute nipped-in-at-the-waist cut. The hem skims my knees. (Earlier in the day, I'd run out to Macy's to find a dressy-ish winter coat, and as soon as I go into the coat area, there is the perfect coat on a mannequin standing right in front of me. I'm so happy, knowing this is not the occasion to look for something on the sale rack which is what I normally do.)
I'm also wearing a soft black cashmere sweater that envelops my Sea Cups fairly snugly. Also a gray flannel miniskirt. I wear miniskirts in the 60s and never look back. And tights and way high heels. At the theatre lobby, we first go to the restrooms. I come out first, my cute little coat over my arm, and pose. Charlie comes out, his eyes do a tenth of a second scan from the top of my head to my boots, and he says, "You look great, Wonder Woman."
I say, "I know it."
He is taken aback and then smiles at me. He has dimples, be still my beating heart. Then I say, "Thanks, Charlie. You look great, too." He does, what with his big wide shoulders. He looks great in everything he wears.
We love "Riverdance."
Then, throwing eHarmony to the wind, he invites me to dinner at the German Club in Bridgeport, where his father got a job after emigrating from Germany in 1935. Charlie says to me, "The club is great—they celebrate every holiday there is. It's a St. Patrick's Day dinner dance. Time for us to do some dancing on our own, no? They always have a great band."
I say, "Yeah. It's time."
"We'll have fun."
I know we will. I like to dance. I say, "And it's always nice to have corned beef and cabbage once a year."
He looks into my eyes. "Is it all right if I pick you up?"
He is alluding to the eHarmony warning: The woman is not to let the man pick her up at her home for at least six dates. By the sixth meeting, it is apparently safe to assume you can tell the fellow is probably not an axe-murderer.
I consent to the pick-up.
Then, very carefully, he says, "A couple of my friends will be there. At the dinner dance. Is that okay?"
I tell him I look forward to meeting his friends. That's true, I do. He gives me a major smile, accompanied by major dimples.
In preparation for going out dancing with Charlie, I root around my closet for a certain blouse I never wore. I bought it at Bonwit Teller in New York at Christmastime, the first Christmas after I get divorced. I cannot bear to stay home that Christmas. I cannot bear to put up a tree. So, I go to New York for Christmas week. I end up walking all over Manhattan and go to all the places I always wanted to see just like I used to do with my father.
My father takes me to New York every year on my birthday, along with one of my all-time favorite people, my cousin Paul. Having an autistic brother, who can't tolerate the loud noise with which a birthday party is rife, precludes the typical celebration. Over the course of ten years, Paul, me, and my father go to every tourist attraction you can think of: Statue of Liberty, Empire State Building, Haydn Planetarium, Grant's Tomb, Bronx Zoo, Coney Island, Museum of Natural History, and one birthday where we spend an entire afternoon in Times Square, watching old black and white comedies starring Laurel and Hardy, the Three Stooges, and Abbott and Costello. My father and Paul and I laugh our asses off, and having memorized, Who's on First? we say Bud and Lou's lines right along with them. The rest of the audience does, too.
Newly divorced in New York, but alone this time, I wil go to MOMA, the Guggenheim, The Niue Museum, the Metropolitan Museum of Art, the symphony, the Met, and the reading room at the New York Public Library, where I fill out little pieces of paper, and the librarian brings me the first six of my books that were thus far published. I am glad to say, my father at least got to buy copies of the first four before he dies. There is a scene in my first novel that takes place in the viewing rotunda atop Grant's Tomb. It isn't open to the public. It's open to Paul and me on my tenth birthday because my father gives the guard a Monte Christo, a cigar from a box someone brought him from Cuba.
I love all that I do in New York as an at-a-loss divorcée, even if I am alone. On my last night, I see Carrie Fisher's one-woman Broadway show, "Wishful Drinking." It's absolutely rip-roaringly hilarious, with terrific visuals, for example, a screen drops down behind her and there she is in a photograph with the rest of the cast of the original "Star Wars," only just their heads, each head atop a Pez dispenser! Honestly, if I were an actor, I'd rather be honored with the head of a character I'd played atop a Pez dispenser rather than an Oscar any day. (If you're ever tooling along I-95 across Connecticut, keep your eyes peeled for the Pez museum sign if you want to be an hour late for wherever you're going and experience a flood of childhood memories, while you eat Pez's.)
The big bonus for the "Wishful Drinking" audience is that the seats are three-quarters empty because a predicted blizzard is already seeing to three inches of snow on the ground an hour before the curtain rises. When the curtain does go up, Carrie is sitting in an upholstered, overstuffed, comfy chair, stage center, gazing at us. Instead of saying her lines, she first thanks us for braving the storm, then invites us to come on down and fill up the orchestra seats. How cool is that? We all grab our coats and stumble down the steps and Carrie yells, "House lights!" which come on, and none of us kill ourselves.
Once she proceeds, I'd say half her lines are ad-libbed, each funnier than the last. She is a riot without, seemingly, trying. And, holy hell, am I ever needing a riot at this point in my life.
Need I tell you that the show ends with a standing-O? All of us are doing our best to make more noise than a full house would have. Carrie makes a zillion curtain calls. I feel connected with her—based on her autobiographical show, she has nowhere to go after the show, either.
Thank you, Carrie. I so mourn the loss of Carrie Fisher.
I join the audience in a walk out into whirls of fat snowflakes blowing horizontally, the streets and avenues empty of traffic and covered with a six-inch deep, shimmering, blue-white, down comforter. And oh, the lights! Dazzling with the absence of headlights. The circles of light from the street lamps, and the walls of neon give the snow that other-worldly sheen of blue.
I meet up with some German tourists walking my route through the deepening snow, while everyone else is waiting for taxis that will never come. One German asks me, "May you please direct us to Rockefeller Center?"
Since I'm not concerned about finding a taxi and feeling a need for company, I may.
"Follow me." I wish I could say it in German, but I took French in high school. I can't speak French either. The Germans understand English just like all Europeans, since they take English starting in infant-care school and every school forever after.
I lead the way, and we stop to buy big boots from a boot-vendor standing on a corner alongside a couple of garbage bags full of boots. The Germans first confer, and one asks the boot-vendor, "Please excuse, but…. They are not leaking?"
The vendor waves his arm over his head and says, "This be snow, man."
All the way to Rockefeller Center in our new green boots, the Germans keep saying, "This be snow, man." They laugh and laugh just like Carrie Fisher's audience.
We stare at the big tree and the half-dozen New Yorkers, who are skating around after climbing the wall long the rink's perimeter, which is closed because of the storm. No one stops them because there are no cops or guards around. Nobody is around. Then I take the Germans to see the big star hanging over 5th Avenue, and then the crèche at Saint Patrick's. When we walk past the windows of what is no longer Bonwit Teller, I see a beautiful blouse. It's black, kind of a sheer gauze with a bit of subdued ruching in the front and a pattern of teeny, tiny, barely visible white rings reminiscent of the cigar smoke rings my dad used to blow into the air for me to put my finger through. The blouse also has a sparse scattering of clear sequins for just the right amount of subtle holiday sparkle. Maybe I'll come back next day and look at it, but I doubt I'll be trying it on because a store on 5th Avenue is beyond expensive.
The Germans then insist on buying me a German beer at the Plaza, which the bartender sees to pouring into steins. He says, "On the house." Do I love New York? Yes. When I decide to head back to my hotel while I can still walk a straight line, the Germans don't notice me leaving because they're singing. The bartender does, though, and calls out for me to be careful and not fall into a snowbank. The Germans turn and wave their arms, shouting in German, to come back, come back. They are holding two steins each, and a great deal of beer is splashing forth. They can see I mean to go, and I hear a chorus of donke shons behind me.
The snow is almost over my boots. When I get to my hotel at around three in the morning, the doorman holds the door for me, and says, "We were so worried about you." Nice. This is a time in my life when I appreciate someone worrying about me, as well as having a bunch of merry Germans to share a blizzard with, and Carrie Fisher inviting me to take an orchestra seat at her show and making me laugh. Poor Carrie Fisher.
I wake up the next day feeling calm for the first time in a long time. I go back to the store that is no longer Bonwit Teller's and buy the blouse. This is a serious splurge, but it's the first item of clothing I buy since the divorce. I don't look at the price tag. I try it on, gaze into the mirror, and it really looks good. I look awful. My mother would have said, "You look like the wreck of the Hesperus." (As an English major in college, I learn that "The Wreck of the Hesperus" is a narrative poem by Henry Wadsworth Longfellow. Digging further, I come up with my favorite piece of trivia ever: The poem first appeared in a magazine called "Weirdos and Creeps."
So, maybe I can wear the pretty blouse next week on New Year's Eve. Yeah, right. Once home, I stash it in the back of my closet. That New Year's Eve, I'm watching the ball come down on TV. I am not totally depressed, though, because my son is somewhere in Times Square amidst a zillion people. Jere will report back next day that a Navy ship was in the harbor and there were sailors all over the place including "girl-sailors." Jere and his friends form pee-circles for the girl sailors. Do you know what a pee-circle is, Dear Reader? Since the Porta-Potties are disgusting, the fellows form a circle, turn their backs, and the girls pull off their jeans—or, in this case, the bottom half of their Navy uniforms—and pee in the circle.
I forget all about the New York blouse until Charlie comes along and invites me to the German Club for a Saint Patrick's Day dinner. Sequins are meant for dancing. I buy it because of German tourists, and I'll wear it to Charlie's German Club. Meant to be, wouldn't you say?
I find it still neatly folded in tissue. I try it on. It looks better than I remember, and I look a hell of a lot better than the day I bought it. I'm happy instead of melancholy. I buy black velvet skinny jeans and a pair of smashing boots to wear with it. So listen, Dear Reader, have you read Love, Loss, and What I Wore, by Ilene Beckerman? The very book that the late, and sorely-missed Nora Ephron turned into an off-Broadway play, in collaboration with her sister Delia. The play is as heartbreaking and exhilarating as the book . If you haven't read it, do it—paperback, seven bucks—because, maybe you'll remember the new blouse you didn't wear when you were going through loss. Maybe it's still in the back of your closet.
I'm looking forward to St. Patrick's Day, need I say?
ON ST. PATRICK'S DAY, it's pouring-down rain. Charlie squeezes through my door, his arms loaded with four bottles of olive oil, yummy-looking objects suspended in each. Also, a bottle of pinot grigio and an especially long loaf of French bread. Once we set it all down on the kitchen table, I help him get his jacket off, dripping water all over the floor. Stuffed inside the jacket is a large plastic bag holding three of the books I wrote.
"You'll sign them for me, right?"
I told you he was a good man, didn't I? Also, a shrewd one.
We put the jacket and his shoes in front of my roaring fire, and I can't help but notice that in the firelight the sequins on my New York blouse are sparkling. Charlie is struggling to keep his eyes away from my hint of cleavage, so I don't know that he even notices the sequins. Then we set up a dipping-oil tasting on the coffee table.
Settled into the sofa. Bottles of oil, French bread on a board, plates, wine and wine glasses are arrayed in front of us. Is this fun, or what? Charlie uncorks the wine, pours, and we clink glasses. Then I dash back to the kitchen for a bread knife and a lot of napkins. I drip neither oil nor wine on my blouse while savoring the four flavors of infused olive oil. Also, the French bread turns out to have a seriously crunchy crust and ultra-chewy insides. It came from a bakery, not Stop & Shop. Nice.
Conclusion, a unanimous vote giving the lemon-garlic-rosemary oil top honors. We vote against another glass of wine because St. Patrick awaits and get into our rain gear. We step out the door and under his big golf umbrella, I take his arm. He says, "I don't know what makes a man happier than when a woman takes his arm." Nice, again.
So these Germans know how to make a great corned beef and cabbage feast, including vegetable seasoned with something wonderful, I can't discern what, and then, oh, the encore: apple strudel and black forest cake, of course, with sides of creampuffs called Windbeutel, hazelnut macaroons, and rum balls. There are rum balls, and there are German rum balls.
Our table of Charlie's friends exhibit the same hearty appetites we do. We hit it off. Then Charlie and I groove a few hours away, getting down, or slow-dancing, me with my arms around his neck, what with the Guinness Stout on tap, and my utter enjoyment of his company. The dance will go till midnight, but there we are, saying our goodbyes to his friends an hour earlier. They hug me goodbye, clearly as happy as can be that Charlie is with someone.
He drives me home, thunder booming and lightning bolts hitting the Sound. When he pulls into my driveway, he stops the car, turns off the ignition, and says, "You forgot to sign my books."
He has such an innocent look on his face. I smirk. His face returns to its usual devilish quality, and he's out of the car, dashing around to open my door.
Inside, we sit on my sofa once again, the tall narrow bottles of olive oil stoppered and still lined up on in front of us. They're beautiful. I start signing books. Charlie says, "I think I'll get your fire going again, okay?"
I look up. "Okay."
He stirs up the burning embers and starts another fire. I get the bottle of wine, two glasses, and an afghan. My Auntie Mary made the afghan, the aunt with the jars.
We sip wine and cuddle till our lips seem to meet up, and things become…uh…intense. I pull away a little.
"Listen, Charlie, I don't know you well enough to have sex with you."
He kind of sits back, puts his hands in his lap, and casts his eyes downward. I think, Shit, did I misjudge this guy or what? He's sulking!
I haven't misjudged him. In a very quiet little voice, instead of his big, sexy, deep one, he says, "Dear eHarmony, How do you get to know someone really fast?"
I laugh. I can't stop laughing, and I'm falling in love with him because he's laughing, too, good sport that he is. I unbutton the top button of the New York blouse, which by the way, he tells me he loves when we're dancing. I can't do the second button; they're about an eighth of an inch in diameter and I'm looped. Charlie does the rest. He is kissing me while getting my bra off, and then I take his hand, pull him up from the sofa, and head to my bedroom.
Here is what I'm thinking while that last is going on: Recently, my daughter's good friend is on her second date with a match.com guy, who she's beginning to like a lot. She's enjoying their conversation and their dinner together, and then he gets all serious and confides in her that oral sex is not his cup of tea.
Her response: "Deal-breaker."
That would certainly be a deal-breaker for me. Hmmmm….
I sit on the edge of the bed, figuring now he'll take off his clothes, but instead he rests his hands on my shoulders and most gently pushes my naked upper half down onto the bed. Then he pulls off my boots, my black velvet jeans, whispers that my knee sox really rock, which means I'm giggling while he slides down my underpants that I hope aren't too frayed at the edges, since I didn't expect they'd be removed after the corned beef and cabbage. So…guess what he does first?
I am impressed on many levels. And he is impressed because I am coming in about seven seconds. That's because when you're lying on a bed topless, and a man you really like a lot, even if you don't know him as well as you wish you did, unzips one of your boots and pulls it off, and then unzips the other one and pulls that one off, too, all of this very slowly and very deliberately, you are already nine-tenths of the way to an orgasm. If there really is a heaven and you get there, you'll be having oral sex 90% of the time, at least.
Here is what happens on earth: My sequined black blouse and bra are in the sofa cushions; I've just experienced some serious pleasure; Charlie's clothes are now off; we're both in bed; and my hand is fondling his penis. I move my hand a little, and he stops me. He takes my wrist, pulls my hand away, and says, "I have to tell you about my one and only."
I feel an instant nausea. My hand goes into cardiac arrest. I draw back. Here I am, crazy about this guy, and I no sooner fall in love with him, when suddenly he's going to tell me he really likes me a lot but…See, I have this girlfriend….
Nope. Charlie puts my hand back where it was headed. He says, "I had testicular cancer. I was forty-two. Fortunately, I only lost one."
I don't know what to say, of course, but I think: You didn't put this in your eHarmony bio, Buster.
Then we make love all night long.
I'M NOW MARRIED to a man with one testicle, and I soon might have one breast. Life is a crap shoot. And remember the blueberries? I dumped them into the sink, turned on the water, flipped the garbage disposal switch, and sent those blueberries into oblivion.
So, have you bought Love, Loss, and What I Wore yet? Yes? You didn't buy it? Call Roxanne Coady at the R.J. Julia Bookstore in Madison, CT, and buy it over the phone at 203-245-3959. She'll mail it to you tout suite.
The assistant to Dr. Quigley, Beth, calls the day following the blueberry melt-down and asks me how I'm doing.
I say, "It hasn't quite sunk in that I might have breast cancer rather than calcifications that have formed a constellation."
She says, "There's a good chance that you don't." (Of course, she never saw the radiologist's expression.) "So how are these dates? Can you see Dr. Quigley on September 8th for an examination? Then your biopsy will be on the 11th."
"The 11th of September?"
I don't say, Nine-eleven? Neither does she.
Of all the scary days in the year, that one is, of course, the worst. I put it out of my head, go to my cell and look at the calendar.
I say to her, "That's two weeks!"
"Can't something happen in two weeks?" Meaning: Won't that give the cancer cells in the duct time to break out?
She knows what I mean. She says, "No."
Her voice is strong and confident, and besides, her words are what I want to hear.
I have absolutely no memory of how Charlie and I get through those two weeks. I imagine we do what we do if everything were normal, what else? I check my email, I write the zillionth draft of a short story I've been working on for many years. Charlie does his thing, and then we take advantage of summer. We no doubt walk down the street along the water to the Sandpiper and have ice cream cones or Italian ice. We swim in our condo's pool or in Long Island Sound. We kayak. We cook out with our families. We go to Nellie Green's in Branford, our favorite restaurant and have the cold shellfish platter for two—chunks of lobster, clams, mussels, shrimp, scallops and great stuff to dip everything in. Mostly, though, we go riding around in Charlie's boat with Salty. We fish and we catch fish as Charlie knows how to fish. For specific species even.
He is also a great coach and since he adores me, meaning when the species we choose requires the use of live bait rather than a lure, he hands me a rod and he hooks the bait, not because I prefer not to do it, but because I have so much less strength than normal in my right hand since I broke my thumb not too long ago. I tend to drop things, particularly live bait. It is not helpful to have live bait flipping, crawling or scurrying around your boat's cockpit when a certain dog is either chasing it or hiding behind a bucket while barking loudly. Even though I always feel sorry for the bait, let alone the fish, I have managed to rationalize that we're all part of the food chain and if the invasive crab isn't used for bait, there's a good chance he'll get scooped up by a gull, who will fly up to a height of twenty-five feet, drop him onto rocks to smash his shell, and then eat him alive. As for eating the fish, it's either us or the newly expanded osprey population, who catches fish in their talons and bring them to the nest for the baby birds to eat. Alive.
My friend, the science writer—Suzie Allport—tells me that 90 % of mammals die by being eaten alive, not that a crab is a mammal. Actually, my dad and I are at the South Street Seaport once, and I order sushi. He stresses out that I am eating uncooked seafood and will end up with ptomaine poisoning. Meanwhile, he's eating oysters on the half shell, animals that are still alive. (If you don't believe me, squirt lemon juice onto your oyster on the half shell and it recoils. Aargh.)
Here is how you catch a blackfish, also called a tautaug. Charlie baits my line with an Asian crab, the aforementioned invasive species that's killing half of Long Island Sound, and he has me just drop the line over the side of the boat with the wriggling crab and a light sinker. Then you slowly drag the crab and sinker across the ocean floor. If you feel it drop a foot, your bait is now at the base of a ledge. This is where blackfish hang out. I swear there must be a blackfish at the base of every ledge in the Sound because, within seconds, I get a bite. Here is the secret to actually catching the blackfish. You feel it nibble at the crab. Charlie says a blackfish first nibbles off the crab's legs first, an appetizer as it were, eating them one by one. You stay perfectly still during the nibbling. Then the fish will glom down on the crab's body, a distinctly different feel than the nibbling, and that's exactly when you yank, and the hook will go through the blackfish's upper or lower lip, making it easy to release him, which we do after he flops around on the deck as Salty goes ape-shit.
We catch and release lots of fish and keep one to grill for dinner on Charlie's little grilling contraption right on the boat. Charlie is a man of infinite accoutrements plus a back-up for each.
But there is one thing I do during those summer days that I remember really well. Since I'm the sort of person who makes lists for her lists, I go to my things-to-do list, and add to it: Make an appointment with an oncologist. Then I put an asterisk at the end of the line, which means: If you can't do it this second, do it as soon as possible.
Then I draw a spiral next to that line which references a new list specific to that item and write: First calls—Joan Schmitz and Marnie Mueller, two friends who live in New York and who just might know of a great oncologist at Sloan Kettering, an hour and twenty-minute train ride from where I live. Joan and Marnie are two of my all-time favorite people I have ever known. Joan is in advertising but retires at, like, age thirty, when she produces the first television ad for a new company called FedEx. After seeing her ad, everyone in the entire universe starts calling FedEx to come get a package for delivery the next day. (There would be no FedEx if the U.S. Post Office in its infinite brilliance hadn't determined that no one in his or her right mind would pay an exorbitant amount of money for a one-day mailing service.)
The FedEx ad, in case you don't remember it, stars a comedian famous for fast-talking. He sits behind a desk throwing papers from one pile to another as fast as he's talking. Get it? That's how fast FedEx will deliver your package. Joan wins a Clio, the Oscar of adverstising. According to Wikipedia, a Clio is a statuette, not unlike Oscar, but is a representation of the Greek goddess Clio, the mythological muse known as the proclaimer, glorifier and celebrator of history, great deeds and accomplishements. Oscar is representative of someone's uncle.
First, Joan sympathizes mightily and then gives me the name of someone she says is a top-flight oncologist at another hospital in New York, Weir Cornell, which "everyone knows is better than Sloan Kettering."
Marnie is a writer whose novels win well-deserved book awards, and was also a Peace Corps volunteer at the same time I was, she in South America, me in Africa. Here's how Marnie and I meet: Whenever there's a Peace Corps event where the media needs to interview one or more former Peace Corps volunteers who are now writers, Marnie and I often get invited, and when we both can go, we always have a good time. I just alluded to the fact that I'm an actual writer. I usually don't tell people that because it's such a conversation stopper. But I won't say a lot about it because writing is a really boring topic. One possible detail you might not find boring are the questions I get at book talks/readings, whether at Gateway Community College in New Haven, or down the street at Yale, starting with, "How wide are your margins?" Or worse, "How do you get an agent?" This particular question rings terror in a writer's heart because it means the smiling questioner is about to ask you to read his single-spaced 1200 page manuscript called, The History of the Tribal Indians of America, and if you like it, you could send it to your agent. Me, having been in the aspiring writer's shoes, means I will sympathetically read the first fifty pages and get back to him, though when scanning through the front matter, I pretty much convulse at his Table of Contents: CHAPTER 496. THE MONGOLIANS CROSS THE ALASKA LAND BRIDGE AND BECOME ESKIMOS.
Anyway, I call Marnie. First, she sympathizes—sympathy helps a lot, by the way, as opposed to, I'm sure you'll be fine--you have such a good attitude, and then gives me the name of her friend's doctor at Sloan-Kettering, telling me she often goes with the friend to her appointments. He's been her friend's oncologist for thirty years! I respect Joan's opinion but will start with the guy who's kept Marnie's friend cancer-free for thirty years, Larry Norton. I google him to find he is head of the Sloan Kettering Evelyn H. Lauder Breast Center. (Evelyn was the daughter-in-law of Estée.)
I dial his office and tell whoever answers that I am a good friend of Marnie Mueller, who often accompanies a friend for appointments with Dr. Norton. I give the name of Marnie's friend. I am routed to Dr. Norton's PA. (I'm sure you know a PA is a physician assistant, who likely used to be a nurse, not to be confused with an NP, a nurse practitioner, or an MA, a medical assistant. My father was in manufacturing as were 90% of men in the 50s after they got rid of all the Rosie the Riverters when the war ended. When he was way on in years, a health care provider introduced himself to my father as an MA, and he thought the guy said ME and was totally happy to have a mechanical engineer take care of him.)
I have no idea what training PAs, NPs and MAs have, but that's who you get when you think you're seeing actual doctors and nurses, especially true in emergency rooms, one of the innumerable reasons you risk your life when you go to one, a death toll significantly reduced, fortunately, because of Obamacare. People against the Affordable Care Act don't have a daughter-in-law who is a soap-maker, and a son who takes care of the home-bound elderly. Unlike, doctors, lawyers, teachers, IBMers, members of Unions, the butcher, the baker, the mailman, the fireman, the neighborhood cop, etc. they don't have free health care benefits, but at least they now have health insurance that's…uh…affordable, thank God.
So, I tell this person, Dr. Norton's associate, about the appointment I want to make and she asks me my diagnosis. I say, "I haven't had my biopsy yet so I don't know. There was something in my mammogram."
Dead silence. Then she says snootily, "You don't see an on oncologist until after the pathology report is available, and that, of course, is after you've had your biopsy. Then your surgeon will discuss your options with you, and then you see an oncologist."
I say, "I thought the oncologist was in charge of your treatment."
She sighs, finds her way to becoming at least somewhat compassionate, and explains the role of the oncologist, which I learn is basically the same as Captain Kirk's job on the USS Enterprise: "An oncologist will advise you and your team."
An advisor. Okay. But presumably I have a team.
I say, "My team is at the Smilow Cancer Hospital at Yale-New Haven."
She says, "If you can't move temporarily to New York for your treatment, you will do very well to choose an oncologist at Yale. Cancer patients sometimes cannot handle the commute since it includes getting from Grand Central Terminal to our offices. In addition, I have to tell you that Dr. Norton is not taking on new patients, but I'll be glad to give you a recommendation so you can see another of our oncologists."
I have three words for her: "No thank you."
Bottom line, if you don't live in New York, but you want to be treated at the most famous cancer hospital in the world—not necessarily the best, mind—you have to be rich so you can move there. There is no sense in calling my friend Joan's guy even though Joan will say, "You can stay in my apartment with me!" I need to stay with Charlie, who tells me he's willing to sell his boat if I have to live in New York.
My daughter, Jene, gets me the name of the person everyone says is the best oncologist at Yale. But he is heavily involved in a research program and is not taking on new patients just like Dr. Norton, even if a patient has a daughter in community health at Yale-New Haven.
So next, Jene suggests I have Dr. Quigley recommend someone. I speak to Beth, Dr. Quigley's secretary. I mean assistant, or PA, or MA, or nurse, or intern, or whatever she is. After she further explains to me why I don't see an oncologist until there's a pathology report, I say, "Okay, but I'm going to have to google him once I know who it is and I might not want him. Or her."
She says, "Let me see what we can do."
She calls me back. "Mary-Ann. Great news! You can see Dr. Ionescu, he's—"
"Excuse me? The playwright? He's dead."
She says, "What's the playwright's first name?"
"I forgot. Why?"
"Our doctor is Dumitru."
I stop that conversation. I am losing my mind, which you are entitled to do when you suddenly have cancer.
She says, "You can make an appointment once we have your pathology report."
I don't respond. She tries harder. "Dr. Ionescu is the new head of oncology here."
I still don't seem to have anything to say. I have lost my mind. She has one more piece of information up her sleeve: "We stole him from MD Anderson!"
Wow. I'm back. It is not necessary for her to say another thing. I know all about MD Anderson. It's a cancer hospital in Houston, Texas. While I'm teaching a writing class, one of my students hands in an essay describing how his son was diagnosed with some kind of deadly leukemia "...on Tuesday." (The class is every Friday.) He then hands in pages of details about researching treatment for this cancer, finding that the greatest success rate in terms of the number of surviving patients, as well as the most experienced doctors who treat it, are in Houston at MD Anderson.
He calls me Monday and asks if I've read his essay. I tell him I have and how sorry I am to read of his sad news. He says, "I know it's a fiction class, but I found myself writing what was happening."
I say, "All writing is good for your fiction. Don't worry."
He says, "Thanks." Then he says, "I'm taking my son to MD Anderson for a second opinion. Can I mail you another essay next week? I won't be back for class."
I tell him he can. I ask him, "Can I read your work to the class? They'll want to know."
Eight students. We are a tight bunch.
First, a pause, then he says, "Okay. I'm feeling burdened with not telling anyone."
The next week he notifies us and his supervisor at IBM that he's moving his entire family to Houston. IBM sees to a new job for him in their partnership with NASA.
The class decides to send him their assignments and ask for his critiques, if possible. He is glad to have something to do other than what he's doing. He is unable to come back to us, though. When the class ends, the participants form an aspiring writers' group. I tell them they aren't aspiring, they're actual writers. They laugh at that even though it's true. They maintain contact with their classmate in Texas. Ten years later they will all fly to Houston for his son's graduation from Rice. Soon after that, my student and his family move back to Connecticut, except for his son, who will remain in Texas for the regular monitoring he'll require all his life. He will stick with MD Anderson. He's hired at NASA. He continues to do well.
The group gets together once a year for three days of intentions to write, but they talk instead and have fun. I get Christmas cards from all of them. Then one of them gets a short story published in "Golf Digest," a magazine that doesn't publish fiction. They think his story is an essay. It isn't; he made the whole thing up.
Bottom line, here, I'm good with Dr. Ionescu. When I google him, I find out that Dr. Dumitru Ionescu is Romanian. I'm very admiring of immigrants. I am regularly boggled by stories of my immigrant grandparents, as you may have noticed. A cousin of mine draws our family tree headed by our Canadian grandmother who has a baby every other year for twenty-four years, but the tree shows a four year gap between babies six and seven. I ask my mother if a baby died. She says, "No. Pippi was serving in the Boer War when my sister Coranna was born. A year later he came home and a year after that, my brother Romeo was born." (Pippi is as close to papere as we grandkids can manage, papere being the French Canadian diminutive for grandpa.)
My response is, "WHAT?"
She asks me, "What, what?"
"Ma! Pippi served in the Boer War?"
She deigns to explain the Boer War connection. "Pippi is still a Canadian."
First, I ask, "He never became an American citizen?"
"He didn't have time. He worked three jobs."
"Did he pay social security?"
"What are you? A Republican now?"
"That was a joke." I don't tell her I realize that social security didn't come into play till FDR. But I drop it and go back to the crux. "So what if he's a Canadian. What's that got to do with the Boer War?"
She rolls her eyes in a gesture of, How could a daughter of mine be such an idiot? She says, "The land that had the Boer Was was owned by England. Just like Canada is owned by England. So when World War I broke out, he was drafted."
"He was drafted?"
"What are you, a parrot?"
"Holy shit, Ma! How come I don't know that?"
She rolls her eyes in a gesture of, My patience with you has run out. She says, "What does it matter?"
My mother's generation only talks about the weather, how cute Pat and Vanna are, and who she should sue when the 8th fairway is under water so the course is closed.
Anyway, I tell Beth I'm fine with Ionescu, but that I prefer to make the appointment myself.
She says, "Sure," and gives me the number. Beth, I come to find out, is trained to give a breast cancer patient anything she wants. She says to me, "Don't forget to mention Dr. Quigley's name."
I call and, without telling the Dr. Quigley-recommended oncologist I haven't had my biopsy yet, she assumes I did and makes the appointment. Nice. I don't have to lie to her.
A HUGE PLOT TURN occurs in this memoir the day after my phone chat with Beth.
Backstory: When my second or third novel is published, I have a reading at the Westport Library. Westport is a wealthy town in Fairfield County, a wealthy county in Connecticut, the wealthiest state in the Union. It's where Martha Stewart lives before she ends up in the Big House. I still can't believe how Martha gets sent up, while the head honchos at GM, who commit mass murder with their lethal ignition switches they know will kill people, are out on the street—Easy Street—free as birds but hopefully, living lives of debilitating guilt. Why do I doubt that last?
It hasn't always been that way. In 1944, the Ringling Brothers Barnum & Bailey circus tent catches fire during a performance in Hartford, CT, the fire attributed to official malfeasance. Said officials had seen to the six-city-blocks-long big top being water-proofed with equal parts paraffin and gasoline. One spark from a cigarette, and one-hundred and sixty-nine people are dead, thousands seriously injured, almost all women and children because the war is on, meaning all the husband/dads are in Europe or the Pacific, dying and getting injured themselves, but in far fewer numbers percentage-wise than the people who went to the circus.
The corporate head honchos at Ringling, knowing the horrific risk of dousing the tent in the equivalent of napalm, turn themselves in, plead guilty, and are incarcerated. So maybe if the radiologist is wrong, and I have a diagnosis of Stage 4 cancer with seven months left to live, I will feel driven to make a citizen's arrest of every goddamn one of those crumbs at GM. Maybe, even if the radiologist is right, I will do it anyway, if I actually get through all this cancer shit and am…uh… cured.
So, anyway, the readings at the Westport Library are bag lunches. People bring food and eat while the author reads. If you surmise this is disconcerting to the writer, you are correct. The lunches are usually take-out from all the too-wonderful Westport restaurants, so the library smells like Japanese-French fusion. No alcohol allowed in the library, which is too bad for the poor writer promoting her work, because if the librarian would come through with a drinks wagon, they'd get a hundred people at their author readings instead of the usual dozen or so and sell some books! Mary Higgins Clark had far more than a hundred people when she came to the Westport library. They caused such a traffic jam out on Main Street that no one could get to the library including Mary.
My own reading is notable for two reasons having to do with my having a half-dozen more people in the audience than the usual dozen: Reason #1: An EMS team of three is there in full regalia. Their ambulance is parked in a handicapped spot outside the library door. The leader of the team comes up to me before I start reading.
She says, "My book discussion group is reading your book, so I dragged my first responder guys to the library so I can hear what you have to say about it."
I thank her. She should be thanking me because she's figuring she won't have to read the book now. I also ask her to thank her book group for choosing mine.
Another member of the team is standing next to her with a heads-up for me: "Our alarms might go off during your reading and we'll have to get up and run out the door."
I say, "I hope you at least get to finish your lunch."
He looks at his watch. He doesn't say, Then why don't you get cracking? Instead: "Me, too, ma'am."
I have people leave my readings all the time who are not first responders though they don't run, they sneak out when my head is down. This does not say I write crummy books, but rather that there are a number of people who are easily offended. I had an American Airlines pilot raise his hand and ask me why I swear so much. I say, "Whoops. Did I say a bad word?"
He says, "No, but you swear in your book all the time."
I tell him it's my characters who swear so much, not me.
He says, "Then why don't you write about characters who don't swear?"
I refrain from saying, "What are you, nuts?" since he obviously is. I just point to another person whose hand is up.
So, now, in Westport, I get a lovely, thought fairly long intro from the librarian, and she's lucky the EMS alarms don't go off during her kindly words. They do go off in the middle of my reading, but at least the fleeing first responders are finished glomming down their bag lunches, not purchased, by the way, at the Westport restaurants, considering the smell of Skippy's that goes out the door with them.
Reason #2 as to my having a half-dozen attendees beyond the usual dozen: There are three women sitting together off in one corner, who are especially enthusiastic—they clap louder and longer than anyone else when I'm introduced, and they keep giving me a thumbs up, on and off, during my entire book talk. When I finish, the three stand up. I figure they have to dash out just like the EMS team. But no, they are giving me a standing ovation. This encourages everyone else to stand and join in. Like a fool, I stand up, too
Then the entire audience, including the librarian, forms a line to have me sign their books. It really is quite wonderful to talk to people willing to fork over $20+ bucks for a book with my name on it instead of John Grisham's. The librarian stands in line, too, as she is buying a copy for the library.
The three quite lovely women, who are of a certain age, meaning older than me, and who lead the standing-O, are now in front of me with such dazzling happiness in their faces they remind me of the Supremes about to break into Ain't No Mountain High Enough….
The Diana Ross of the group says, "We're your cousins!"
I say, "You are? Have we met?"
"We haven't, but we're the Morra girls! I'm Marion, this is Mollie, and here's Eve."
All three stick their hands out, and we shake.
Mollie says, "Our mother was your grandfather's first cousin. She was a Tirone! Our father was a Morra but two of us are married, so Eve is a Potts, and I'm a Donovan."
Marion says, "I'm the one who's still a Morra."
It is Marion who most resembles my father's sisters, my Auntie Palma and Auntie Alice. The other two do, too, but just a little bit.
Eve says, "We called your grandfather Viscu."
I figure that's the nickname for Francisco, my grandfather's actual name. When he comes to this country, Americans call him Frank, but his family and Italian friends called him Chick. My father's nickname is Yutchie. There was once a comic strip in the Daily News called Yutchie, so presumably that's a common nickname in the first generation Italian-American community. Italian nicknames are often quite far removed from the actual names, as anyone who has read the four Neapolitan novels by Elena Ferrante will attest. Every single character in the Neapolitan quartet has several nicknames, and not only can you not stand these obnoxious people, you don't know who the hell is who, even though there's a guide in the front of the book listing the characters along with all their nicknames and their relationship with other characters, whose names are also listed, along with their nicknames.
Elena Ferrante's narrator/protagonist's name is also Elena but is called Lenuccia, or Lenừ, or by her last name, Greco. Her co-protagonist is Raffaela, who is never called Raffaela, but instead Lina, or Lila. (Tip: the nickname guide is several pages long but skip it because it won't help.)
The most wonderful irony here is that the name, Elena Ferrante, is a pseudonym! So we don't know who the hell the author is either. By the time I turn the last page of the fourth and final book, I didn't give a shit who's who because, as I said, they're all so obnoxious. I immediately have to follow up by reading The Martian to calm myself down. Matt Damon is really good as the Martian in the movie.
Mollie goes on to say, "Viscu means Viscount in Italian."
She next launches into a story of how my grandfather got the nickname Viscu. This holds up the book-signing line considerably, but no one cares because these are all people who love stories. Besides, it's Westport where no one really works except ambulance staff.
"Your grandfather," Mollie says, "our beloved Viscu, was a houseboy for the Archbishop of Turin who was also a Viscount. Only he preferred to be called Viscu rather than Your Eminence."
A woman just behind the Morra girls asks, "What exactly is a Viscount?"
Eve says, "It's nothing. An honorary member of the nobility. The King just names someone he likes a Viscount."
Mollie continues. "So when your grandfather would go to Saturday night dances, he'd help himself to the Viscount's closet. Everyone knew it, so that's how he got the nickname. Then he got caught, then fired."
There is more but it would take another ten pages what with my grandfather being an anti-fascista and getting secreted into the U.S. like Michael Corleone only in reverse, but I'm already trying your patience.
The Morra girls invite me to lunch once I finish signing. They don't do bag lunches: "We tend to refrain from eating out of bags," Eve says. I accept since my publicist neglected to tell me about the bag lunch part of the reading and I'm starving. We go to a Japanese-French fusion restaurant.
I am certainly stymied as to why I never heard of my Morra cousins, so jumping ahead, I call my dad, and he fills me in. "This was Westport?" he asks.
"They're the rich branch of the Tirones. They won't have anything to do with us because we're the poor Hartford relatives."
I call my Auntie Palma (born on Palm Sunday or did you guess?) after hanging up with my father. She tells me that what my father said isn't true. "I bet one of that branch of the family slighted your father," she says. "The Morra girls are lovely just like their mother. She was very good to me." She pronounces their name, Moodah, which is the kind of pronunciation you get in the Piedmontese dialect spoken in the Piedmont region of Italy where you find the city of Milan, where my rich Italian Tirone relatives have a townhouse; and in Turin, where they mainly live; and in Asti, where the family farm is. There are no poor Tirones in Italy.
Auntie Palma also says that she never met the Morra girls until they were all adults because when she and my father are children in Elmwood, Connecticut—the Italian neighborhood of West Hartford—Westport may well have been Timbuktu. "We couldn't visit them, Mickey." (I told you that being Italian we all have nicknames like the Ferrante characters, right? In addition to Mickey, when my father is feeling a pronounced affection for me—something he can't express for cultural reasons—he calls me Pinky. My favorite nickname of all time is my brother Tyler's—Totsie.)
So then, Auntie Palma goes on to say, "Who could afford cars? Well…the Westport Tirones had cars but they weren't so rich that they could afford gas. This was the Depression!"
My lunch with the Morra girls is terrific. Since they travel back and forth to Italy all the time, they tell me things like uncovering a painting of our family tree under many other coats of paint on the side of one of the family's barns in Asti. They hand me a copy of a picture of the barn with the tree, and sitting in front, my great-grandparents holding their new baby, Francisco. I can have the picture. I am so overjoyed to have this priceless gift.
I google the Morra girls. Marion and Eve are medical writers. They are famous medical writers. I buy their most famous book, Choices, meant for everyone out there who is diagnosed with cancer and who want to find out the choices available to them besides the ones their doctors tell them, or most often, don't tell them. I buy it. It is fascinating and written in such a fine narrative style that it is as entertaining as it is informative. It's over a thousand pages. That gives you an idea of how many choices there are, but fortunately there's a comprehensive index. By the time I'm diagnosed with cancer, I've forgotten about that book.
Meanwhile—if you haven't forgotten the way I forgot about Choices—here is THE PROMISED HUGE PLOT TURN: The Morra girls and I see each other a few more times, and then we don't keep in touch with each other beyond a couple of exchanges of Christmas cards. But one day, a few years ago, my daughter is working at Yale-New Haven on weekends in the med/surg unit. A woman is admitted on a Saturday morning. The woman's name is Mollie Donovan. My daughter looks for the VIP listing on her chart because only VIPs get to check into the hospital for the weekend. A VIP's doctor will come see the patient on a weekend, while the rest of us can wait till Monday, thank you.
Jene is a hands-on nurse. She sits on the edge of her new patients' beds, holds their hands, and introduces herself. She will also bring them coffee—or whatever they are needing—and gets the information she requires to put into their charts while chit-chatting the whole time. Jene and this particular patient end up having quite the chit-chat.
Mollie tells Jene she looks familiar and asks where she lives. Jene says, "Branford." Branford is the town next to mine, East Haven.
Mollie says, "I have a cousin who lives in East Haven. Do you know people in East Haven?"
Jene says, "My mom and dad live in East Haven."
"Do they know any writers there?"
"My mom's the only writer in East Haven."
Mollie just stares at her. Then she says, "Omigod! No wonder you look familiar. You could be Maura's twin! Maura is my daughter! You and I are cousins! Your great-grandfather was my mother's first cousin!"
Jene and Mollie so hit it off, how could they not?
That night, when Jene calls me, I tell her that Mollie Morra Donovan is one of the rich Westport Tirones. Jene says, "What's a Rich-Westport-Tirone?" I tell her. Then she says, "All I know is, I'm related to a VIP!"
And so, you ask, how is any of that a HUGE PLOT TURN?
It's not. I still haven't gotten to the plot turn yet, I see. It needs a new chapter of its own. Ergo, Chapter 10 will be the only chapter in this memoir with a title.
Note: The last edition of Choices came out a few years ago because, according to the publisher, you can now see what your choices are online at "WebMD," so what is the point of another edition?
I'm not going there.
CHAPTER 10. THE HUGE PLOT TURN
THE PLOT TURN is set into motion by an article I read in The New York Times. I learn that Marion Morra is president of the American Cancer Society. Obviously, there's a lot I don't know about the Rich-Westport-Tirones. I remember Choices so well and can't believe there will be no new editions. You might as well stop publishing the Encyclopædia Britannica because you can find out everything you need to know at "Wikipedia" (æ is called an "ash" and it is acceptable not to use it any longer, but I like using ashes.) Meanwhile, I'm thinking, I have a cousin who is president of the American Cancer Society. Holy shit! Who needs an oncologist to answer your questions when your cousin is the freaking president of the American Cancer Society?!?!
I go get Choices out of my book shelves. Alas, there is no such cancer as DCIS when the book is published. I'll have to get the latest edition. My copy is the third. I have Eve's phone number and I decide to call her. It's been a long time and as soon as the how-are-yous are finished, Eve tells me that Mollie passed away. I feel so terrible and I tell her how Mollie was Jene's VIP and she says, "Mollie told me all about it."
She says, too, that she and Marion miss their sister so much.
We go on to chat for a while, catching up on happier moments, and then I tell her that it looks like I have breast cancer.
First, a silence, then Eve says, or rather commands, "Mary-Ann! Listen to me."
"You will meet Marion and me for lunch. You will tell us everything. Then we'll tell you what you have to do. When's the biopsy?"
I say very casually, "Next Thursday," rather than September 11th.
"Okay, listen to me…" she says again "…in case I forget this: During the biopsy, the minute you feel anything, give the doctor a shout-out so he'll stop what he's doing and give you more lidocaine."
I say, "Rest assured."
"Can you meet us before then?"
I say, "I can meet you in ten minutes."
"How's tomorrow? That will give me time to get in touch with Marion. We'll have lunch."
I say, "Breakfast will be more convenient for me, if that's okay." (I write seven days a week, including Christmas, from six a.m. till my brain freezes over, except during Christmas mornings of yore, when my kids tumble down the stairs before sunrise and head for the tree. I can hear them now: "SANTA CAME!" They shout that long after they stop believing in him.)
"Breakfast is perfect," Eve says. "We'll meet at some diner midway between the three of us. I'll get back to you."
There is a perfect diner geographically on I-95 halfway between Eve's house in Essex and Marion's house in Milford, and right near me as I'm smack between the two. We all three love road food at diners hard by interstates, as it turns out.
When I get there, they are already in a booth and get up while I walk in. We hug. We are so glad to see each other again even though it is not the same without Mollie.
We sit down and Eve signals the waiter. The three of us get two fried eggs over easy, home fries, white toast, and coffee.
We answer in a chorus: "No thank you."
We laugh about wanting identical breakfasts, and then I'm prompted to tell them exactly what's going on. I sail right into the name of the oncologist at Sloan Kettering that Marnie Mueller recommends to me, Larry Norton.
Marion sails right back at me. "If you had to choose the top ten oncologists world-wide, Larry Norton would head the list. He's—"
But I have to interrupt. "Alas, Marion, I can't see him because he's not taking on new patients."
She says, "I'll talk to him."
Eve says to her sister, "He's up to his ears in research."
I say, "I have another recommendation at Yale-New Haven, Dr. Devlin, but—"
Eve again. "He would have been our recommendation if you'd decided to be treated at Yale. He's great. He—"
This is a conversation rife with interruptions. "His dance card is full, too." Anything having to do with getting cancer has a million unforeseen pieces of unexpected news, usually all bad.
But my cousins say they can talk to him, too, and Larry Norton, no matter how busy he is.
I say, "Well, here's the thing. Dr. Devlin's secretary called me back and told me he arranged it so that I can see the head of oncology at Yale. His name is Dr. Ionescu, but not the playwright. He's Romanian. He's from MD Anderson."
Eve puts her fork down. "I don't know him but that says a lot. A lot! Leading the oncology department at Yale? From MD Anderson? A lot!"
"But here's another thing. I was told by Dr. Norton's secretary, or whatever she was, that I don't see an oncologist until after the biopsy so he can see the pathology report first. Does this make any sense to you?"
Marion says, "No. However, that is the protocol."
"But isn't the oncologist the big cancer expert?"
"So what about my ten million questions?"
"Your surgeon and radiologist will answer those."
"But I have questions now. And will the surgeon or radiologist talk to me about whether or not I really need radiation?"
"They will push for what they think is best."
"Won't they be biased?"
"How can I be sure my oncologist is a member of royalty rather than just a Viscount?"
Eve smiles, Marion does, too, and shrugs at the same time. Eve says, "When you're the chief, you're royalty."
I say, "So, guess what?"
"I made an appointment with him anyway."
"The head of oncology at Yale. The Ionescu guy. Unless he checks my file out, he won't know I haven't had the biopsy till I get there. You think he'll check out my file?"
Marion says, "Yes, but not till thirty seconds before the appointment. Too late."
Eve says, "Good for you. Take charge!"
Marion says, "He will not be happy."
I say, "That'll make two of us."
Then we get into a fifteen-minute discussion about the politics of cancer treatment, none of it making sense just like all things political.
Eve says, "Meanwhile, and most important thing, Mary-Ann, is that the best breast surgeon you could ever hope to find is at Yale. Diane Quigley."
Boy, does that make me happy. "The radiologist who diagnosed me told me she would get me Diane Quigley! The best is what she said, too. I figure that's because I'd mentioned Sloan Kettering and she wants to keep me at Yale. I have an appointment with Dr. Quigley!"
This thrills them and, of course, makes me feel really optimistic until Marion says, "What's the oncologist's name again? Ibsen?"
"No, Marion. Ionescu."
Marion says, "I'm going to check him out, but just know, Mary-Ann, that Diane is brilliant and experienced. And she will care about you."
This should be true of every doctor, but we've all met the ones who don't give a flying fuck about us. Experience is the most important thing according to my friend, the writer Jessica Auerbach, whose father and daughter are doctors. Our first novels are published the same year when we don't know each other, even though we live three blocks apart. (Thank you Jere's best friend's mother, Maureen Gorman, for introducing us.) So Jessica's father feels that if you need a surgeon, make sure you find out how many surgeries he's done. If he says anything fewer than five hundred, pack your tack and get out.
I ask my cousins, "How many breast surgeries do you think Dr. Quigley has done."
Marion says, "A zillion."
The main cancer topic we discuss after that are my qualms about whether I'll have to have a lumpectomy or a mastectomy or chemotherapy or radiation or what.
Eve says, "Listen…Diane and the guy from MD Anderson will give you statistics. They will take into consideration how they feel about you in particular. They will not treat you like a breast cancer; they will treat you as a specific individual who has a breast cancer that must be destroyed. Diane's goal will be to save your life and save it with the least amount of disfigurement. So, you—"
I put my hand up. "I'll have disfigurement options?'
They both smile. Eve says, "Yes."
And Marion, "But as far as Diane is concerned, the options don't depend on statistics, they depend on you specifically—what shape you're in, your medical history, if you have some other illness, if you smoke, … You don't, right?"
"I don't. But I did."
"In my late twenties. But just for a few years. I didn't inhale. Like Bill Clinton. If I inhaled, I'd faint."
Eve said, "Good." Good means it doesn't really matter if you're lying or not. "So, all that stuff is important. At the same time, it's your breast. Yours. Get as much information as possible because even with what we've said, no one cares more about you and your breast than you."
I say, "Charlie does."
Then we spend a long time talking about who Charlie is and all our personal stuff. Marion and Eve have retired and are spending their time traveling all over the place. I agree with them that travel is the most perfect of distractions from deciding what you should do with yourself when you don't know. Also, they've put their houses on the market, buried statues of Saint Joseph upside down in their back yards, and intend to rent and be footloose and fancy-free from here on in.
Our breakfast ends with them making me promise that I will call them with any and all questions, something I most certainly come to do.
So, thank you, Marion and Eve, and I'm sorry you lost your VIP sister, Mollie. I don't ask what she died of because I cannot handle hearing if it was breast cancer.
SOMETIMES I ENJOY a misadventure, but not when it comes to an appointment with the woman who will be treating me for cancer, if I have cancer. There is no need to tell you how miserable it is to have to wait for so much time to elapse to find out the news that, perhaps, you're about to die.
Date of misadventure: August 24th, sixteen days since the constellation is noted to me by the radiologist with no name. Charlie and I drive into the "Air Rights Garage" at Yale-New Haven Hospital and head upward toward the 4th floor, as instructed, where the Smilow Cancer Hospital is situated. If you ever have to go to the Smilow Cancer Hospital, and I hope you don't, I promise you that you will experience the exact same misadventure I do. At least you'll be prepared. But isn't it funny that the garage is named for the fact that the hospital has to buy air rights over their own parking lot from the city of New Haven to build a five-floor parking facility? Clearly they become so pissed they name it the "Air Rights Garage." They could have named it after the Mayor. They could have named it after the first famous Yalie: "The Nathan Hale Garage." Or maybe just, "The Spite Garage." At least the guy who foot that bill wasn't the owner of Chef Boyardee, as with baseball stadiums.
We follow the Smilow signs, driving round and round, whereupon we see a pair of huge glass doors emblazoned with the word: SMILOW. What's with these people who want to have buildings named after them with signage the size of the Hollywood one? Do they say things like, "You want my money to build a mini-hospital inside a famous one to treat people with cancer? Fine. I'll send you a check. But I want my name on the front door, and the letters had better be at least six feet high." Do they think that makes them presidential material? Lol.
Charlie takes a parking ticket from a machine that has SMILOW splashed across its front. The machine then speaks: "Welcome to Smilow." Good God. We park, get out, and walk to the glass doors which spread open before we reach the threshold so that the letters SMI are on your left, LOW on your right. We enter, though I am wishing I were anywhere else on the planet.
Inside, we are immediately confronted with a vast bright space. We are enclosed in glass walls, sun streaming in from all sides and above—glass ceiling, too. Perhaps the design is meant to cheer people up who have cancer, or who might have cancer.
Also, there is an open stairway in the middle, the widest indoor stairway I've ever seen, plus elevator doors in the one small piece of wall not made of glass. The only object in this entire…uh…foyer? Lobby? Lanai?...whatever… is a giant desk with a smartly uniformed security guard sitting in the chair behind it.
We approach him. He seems nervous. He asks, "May I help you?"
I actually have to say these words: "Can you tell me how to get to the Breast Center?"
I have no idea that it is the guard's first day on the job and, as we all know, when a man hears the word breast, he cannot think straight. The fellow looks at me, and I do believe he wants to say, "I wish I knew, baby," but his training leader is rushing toward us from out of somewhere, not unlike when the people who return to Earth in "Close Encounters of the Third Kind" come out of a flying saucer bathed in so much light, you can't see them at first.
He says to me, "Sorry, ma'am, Beaumont is new. May I help you?"
I take a deep breath because I'm feeling faint. "I have to go to the Breast Center."
He gives me directions: "Go behind you to the elevator bank. Press 1. When the doors open–"
He is interrupted by the appearance of a woman with a tag hanging around her neck that reads, GUIDE. She very gently places the palm of her hand between my shoulder blades, smiles, and asks me, "You haven't been here before?"
"You're seeing a doctor then?"
My stomach is turning over in addition to my feeling faint. "Yes. Dr. Quigley."
The guide smiles some more. "I'll take you right to her office. You won't have to sit and wait at the Breast Center waiting room."
The guides know from experience that if they don't head patients off at the pass, those patients—already in major stress-out—will have to listen to Beaumont's boss go through a 25-step list of directions and halfway through they'll start crying, or in my case, ask, "Have you got a fucking print-out?"
Charlie hears just bits and pieces of the above because we are in a place where sound dissipates into the endless vastness of space instead of heading straight into his hearing aids. He is more grateful for the guide than I am.
She leads us into one of the elevators, and we head down four floors in reverse of the direction our car took. We come out and walk—I'd say, a mile—past a large fountain with granite bench seating all around where no one is sitting since whose ass wants to sit on granite? The fountain is surrounded by a food court, and there are two gift shops. The tables and chairs and the gift shops are full of people. Since I'm pathologically curious, I wonder why there are two gift shops. Alas, I will find out but not now.
Then we arrive at another bank of elevators hiding in an alcove. We go back up again, this time to some other floor, not the 4th, the floor where we started.The guide leans in to us and says conspiratorially, "I'm going to suggest they put lights in the floor like on an airplane, pink obviously, for the breast center."
I say, "I've yet to see a hospital designed with a patient in mind."
She says, "This one wasn't."
We take some twists and turns past a large crowd gathered up at a cell hot spot and arrive at Dr. Quigley's office, where the guide immediately leaves me, calling out, "Good luck, dear," as she races back to her designated position. Who knows what Beaumont might be up to?
Dr. Quigley's PA, Justine, greets Charlie and me with a quite wonderful smile and sweet handshake. She puts us in a tiny cubicle stuffed with three hard chairs, a small table, a stand with a computer on it, plus a rolling chair in front of the computer. She tells us to sit down on two of the three hard chairs. Then the doc comes in. We stand up again. Diane Quigley.
Yet another kindly smile but a very strong handshake. I introduce Charlie, she shakes his hand, too, and I tell her my daughter is a nurse in community health and will be running over here any minute.
She says, "Good."
Diane Quigley has shiny, black, curly hair and wears, big, black glasses, and dangling earrings that are maps of the African continent in bronze. She has style, the kind of style that is not only cool but also says: This is my style and if you don't like it, tough.
She gestures for us to sit down again.
A young woman in a white lab coat comes in. We are introduced: Marina. She smiles, shakes our hands, and then takes the chair in front of the computer. Her back is to us. She will not turn around until we get up to leave. I will learn that whenever and wherever I have any sort of appointment at Smilow—doesn't matter with who—Marina will be there. All Smilow Breast Center doctors do not look at computer screens and take notes on the keyboard while talking to me or asking me questions. Doctors today, excluding Dr. Slattery and Dr. Montessi, never so much as look into your eyes. They stare into a computer screen instead. They have no idea, as have doctors of yore, that if your eyes are bloodshot, yellowed, crossed, rolled back into your head, etc. that it just might tell them something about the patient's condition. They are no longer steered toward obvious diagnoses by the sight of you because they're trying to figure out how to navigate the computer to order blood work.
The doctors at Smilow each have a Marina who taps away at the keyboard getting down all the stuff the doctor and patient say, all the stuff the doctor needs in order to remember who the hell the you are and what your problem is.
Dr. Quigley sits down and opens a folder while Marina places her hand on the mouse, ready to rumble.
"Let's look at your medical records here," she says. She flips through the pages within, stops, and looks up at me. Marina, scrolling through my medical records online, also stops, but doesn't look at me. She says to Dr. Quigley, "Number 17."
Dr. Quigley says, "Thanks." Then she says to me, "Tell me about this…you had a fibrous tumor removed from your underarm…uh…ten years ago?"
I say, "That long?" Wow.
She waits. Here is what I say only in a nutshell: When I got pregnant, I got swellings in my armpits. My obstetrician told me it was errant breast tissue. In a pregnant woman, that tissue will swell along with her breasts in preparation for producing milk. (Can you stand it?)
My obstetrician also tells me not to worry; the swellings will most likely go away. What he doesn't say is that I have only a fifty-fifty chance of that happening. So, in my left armpit, the swelling goes away, but not in my right. I have to have surgery to disappear a lemon-sized benign mass of hardened breast tissue.
Now, Dr. Quigley peruses the file for maybe thirty seconds more, finds nothing else interesting, and says, "I'll meet you in the examining room and I'll include a good look at both armpits. Justine will take you."
I say, "Don't you just look at mammograms?"
She raises an eyebrow. Silly me.
Justine appears on cue, and right with her, here comes my daughter, out of breath, having arrived in her blue scrubs on a run from Yale-New Haven's community health clinics quite a ways away, requiring that she dodge heavy traffic, mostly trucks and ambulances. It's her lunch break, not that nurses have lunch, or any breaks at all. While she hugs me and then Charlie, Dr. Quigley looks her up and down. I introduce them to each other. I cannot help but note that Dr. Quigley and my daughter are two beautiful women. Dr. Quigley says to Jene, "I'm so pleased to meet you. You do good work. Have a seat. I am about to examine your mom, and we'll be back shortly. Dad will be able to fill you in on anything you need to know, but you didn't miss much."
Jene collapses into a chair. She doesn't say, Charlie's my stepdad; she's too tired. Dr. Quigley turns to the door, and Justine and I follow her. I don't want to follow her. I want to go have coffee somewhere with Charlie and Jene. When Salty doesn't want to go where he's being led, he stops. He won't move despite pleas, threats, treats, and me pulling impotently on his leash. Oh, to have that luxury.
In the examining room, Justine gives me the usual directions. I take off my T-shirt and bra, and put on a johnny coat. Justine puts some stuff into her computer while she asks me questions, never looking up once. Nurses don't get other nurses like Marina to help them. Then Dr. Quigley comes in with Marina trailing behind, her arms full of the folders with my medical records and I don't know what else. Justine leaves. Marina sits down at the computer, while I learn what "a good look at both armpits" means.
Dr. Quigley pokes her fingers so far into my right armpit in order to feel around that I actually shout out a yelp.
She says, "Sorry," and continues without letting up while I try not to make noise and just bear the pain. She does the other armpit and then says, "There are no lumps in the breast tissue under your arms. Good."
Yeah. Way good. I don't ask what a mastectomy of the armpit requires. I try not to imagine it.
She has me lie down on the examining table and basically treats my breasts like bread dough. She kneads them for some time.
She says, "Not feeling a thing. Good."
Yeah. Way good again.
"I'll see you in my office."
She's gone, so is Marina, and I get dressed. Justine returns to lead me back to the office, where another chair has been squished in. Dr. Quigley is already there, Marina at the computer. She says to Charlie, Jene, and me, "If the suspicious cells in your duct do turn out to be cancerous, they likely have not infiltrated the surrounding tissue, but we won't know for sure until we have the pathology report after your biopsy."
I ask, "What are the odds that they've infiltrated?"
"Twenty percent. If, in fact, they are cancer cells."
"What are the odds that they are?"
"Based on my experience, the odds are very high."
Dr. Quigley's demeanor does not say to me in any way that she is lying. So her saying very high instead of 100% gives me hope. And so does her saying if they are cancer cells.
So I say, "Thanks, Doc."
She says to me, "You're welcome. Beth made your appointment for the biopsy, correct?"
She says to Marina's back, "What's the date?"
The reason she asks Marina instead of me is because she knows that a newly diagnosed cancer patient—even a possible cancer patient—can't be trusted to remember anything. But if there's one date everyone remembers it's 9/11. I'm glad I don't have to say it. Marina gets around having to say it. She says what I said to the Morra girls, "Wednesday."
Dr. Quigley flashes me her lovely smile again. There is compassion all over her face. She says, "Marina will give you your pre-op instructions—they are simple and straightforward."
She stands up. She takes Jene, Charlie, and me into her gaze, all of us together. (The ability to do this is the sign of a good teacher. I hope she's also a professor at Yale. I later learn she is. Good.) "I'll see you again when we have a pathology report. Hang in there."
Handshakes all around and she is gone. Marina hands me a sheet of paper and is kind enough to watch where I put it. Then she says, "Remember, the paper is in that little side pocket right there." She points to the side of my tote bag.
I wonder how many millions of phone calls she's taken with requests for another copy of pre-op instructions because the patient can't find the original.
Jene, of course, has to go. She hugs Charlie and me and says, "Call ya tonight, Mom."
To her back, I say, "Okay, sweetie." She's on the run.
I read the pre-op instructions aloud to Charlie on the way home after he clicks the setting on his hearing aids that reduces road noise. The only instruction of note, besides that I should get to my appointment fifteen minutes early, is not to take aspirin, Advil, or anything else but Tylenol from here on in. That won't be too difficult. I take aspirin if I have a headache (rare), Advil if I have an achy muscle (rarer), but I never take Tylenol because it doesn't do anything for the above.
Naturally, Charlie says, "Good thing vodka isn't on the list." He's talking about our Sunday morning greyhounds.
THERE WILL BE a new man in my life, Dumitru Ionescu. My appointment with him doesn't go well but I've been warned—thank you, Cousin Marion. He comes into the examining room, where I'm sitting on the end of a table in the johnny coat. He is pissed, though not as pissed as I am since, presumably, he hasn't been diagnosed with the likelihood that he has breast cancer. He walks in, followed by Marina, who offers a quick nod to me.
Just he is about to slip behind the computer, while I'm wondering if Dr. Quigley has assigned her to me, or if she has to share her with him, Dr. Ionescu says to her, "Thank you, Marina. I won't be needing your assistance today."
He says that with a Romanian accent. He sounds like Johnny Depp in I forget which movie.
Marina, meanwhile is taken aback, but looking at me shrugs, and is not quite out the door, when Dr. Ionescu, still not taking a seat, says, "I am unable to answer any questions you might have—or even examine you—until I have a pathology report."
I realize he neglected to tell his nurse about not examining me, so I'm sitting there in a position of whatever the opposite of power is when one is forced to wear a johnny coat. Actually, it would be a dilemma more gruesome than powerless, since what chance has a johnny coat got against Dr. Ionescu's blazing white lab coat that happens to be starched to the point of military-grade steel?
And since he had no intention of examining me, the least he could have done was to sit down. He made a decision to be rude. I'm really pissed now. I say to him, "I understand that's the protocol you follow, but I should think you'd want to meet a patient before you might have to tell her she has Stage 4 cancer and will be dead by Christmas."
He starts to speak, but I don't let him. "There's a clinical trial study that was just concluded. I've put the synopsis on your desk." I point. "It says women over a certain age, an age that happens to be my age last year, should not be radiated after breast surgery. That they will have the same life expectancy with or without it. I need to know if your conclusion is the same after consideration to the study. I need it before I speak with my surgeon and radiologist."
The very edges of his lips turn up a tiny bit. He says, "If I have the pathology report on your biopsy, I will only need to see you once."
He folds his arms across his chest. We stare each other down. I figure, let him fill in his immoral silence. He does. "Do you believe you have cancer?"
"Why is that, if I might ask?"
"I saw it in the radiologist's eyes."
He raises an eyebrow in a manner of Count Dracula. But then he gives me a smile that isn't wise-ass. A small smile, though. He says, "I appreciate that."
He looks down at the chart in his hand. Then he says, "Ms. Tirone Smith, the consulting appointment you would like to have before news of pathology is the way it should be. I agree with you utterly in that determination. The hospital's insurance policies, however, do not."
Then he takes a step to his desk, puts down the chart, and picks up the study. He sits down in his leather office chair, not hospital issue. He looks up. "I don't know this study."
"Maybe you do. That's a Google-generated synopsis."
"I can see that. May I keep it so I can look at the actual trial documents?"
I smile because I'm impressed with that and am not the sort of person who holds a grudge if the grudgee shows some iota of repentance. I say, "Sure, Doc."
He's no longer pissed. He is instead, I'd say, curious.
"I will look into this study beyond the synopsis. I will need to know how many women were studied, how long the study lasted, the medical condition of the women in the study, their ages, and many more such details. However, it is my opinion that your radiologist is the best person to advise you once he has examined you, once he sees mammogram images, and…when he has the pathology report."
He has to look up from his chair to me on the table. Oh, such a sweet, crooked Count Dracula smile, the one Dracula himself reveals just before he sinks his canines into your jugular.
He says, "I will think of something to write in my notes so your insurance company will pay for this visit."
I relax. I'm no longer pissed. Dr. Ionescu is the kind of guy, I decide, who you meet at some party, and instead of asking you either, Would you like to go have a cup of coffee? or Wanna fuck? He says, Would you like to go over to the Omni tonight at midnight and sneak up on the roof and have a swim in their pool? The kind of guy who wants to know what makes you tick.
I thank him for his intention to manage a reimbursement for my non-protocol appointment. Then I say to him, "I don't have a radiologist yet. Have you got a recommendation?"
"I don't. I'm not here long enough. But your surgeon will recommend a radiologist when he examines you. Have you a surgeon?"
I decide not to tell him I've been examined already. I can't expect him to know everything. "Her. Diane Quigley."
"Oh. Very good. And so, once you have considered the opinions of Dr. Quigley and your radiologist, we will meet again, and I will tell you what I have learned, and you can make the decision yourself."
He has just elicited another question in ever-curious me. "Have you found that your patients will generally just do what you say to do?"
The eyebrow. Then, "Yes."
"You don't like that, do you?"
"I do not judge. But there is the exception. Those women who hear the words breast cancer and decide to immediately have their breast, or both breasts, removed before I can advise them."
I feel sympathy for him on that front. Not as much as I feel for the women who make such a decision. All the same, I say, "I'm sorry." I am.
He gazes at me. He believes me that I feel badly for him because the situation he describes is part of what he has to accept, like it or not. I smile at him. A smile of, maybe, camaraderie.
I change the subject. "Listen, Doc, I'm really into statistics."
Just like Dr. Quigley, he says, "Good." Then: "If your pathology report shows the cluster in your breast is made up of cancer cells, I will give you the statistics as to survival rate based on the likely development of those cells, and the size of the cluster. If the cells have infiltrated tissue outside the mammary duct, I will give you the pertinent statistics as to that. Have you considered the ramifications of hearing those statistics? In terms of how it will affect you psychologically?"
"Uh…knowledge is power. Even if the knowledge itself sucks. I care how I will be affected psychologically. If I have psychological problems, it's why God made shrinks. Like, if I'm going to die, I'll want to know if it's next week, next month, or if I've got a few years. I will need to know in order to adjust my life so that I don't waste any time that's left."
He just looks at me. I see a lot in his gaze. He is in a Catch-22. Maybe he should have his nurse ask his patients if they want to know the statistics behind the choices available to them. Then he won't have to see the patients who don't want to know anything it all. It's a waste of their time and his. Then he can just see people like me, who the need the head honcho to tell them the facts — to tell them the truth. I sigh to myself.
He's still gazing at me rather than speaking.
I say, "What about drugs? If I have cancer, I don't know yet if I'll need radiation or even chemotherapy. But according to Google, I'll need to take drugs, right? Will that be your job? To determine what drugs I'll need and how long I should take them?"
"Yes, but you won't know what drugs to recommend until after the pathology report."
His accent becomes more pronounced, "That is not actually correct. There are only two options: one drug is meant for patients who have not attained menopause and an entire family of drugs if she has. But yet, there are exceptions. For example, if a woman has attained menopause but has the constitution of a much younger woman, I recommend the drugs normally given to a woman who has not attained menopause."
I pull the johnny coat back up over my shoulder and it falls off the other side as it is programmed to do. I don't care. The Count and I understand each other.
I say, "Thank you, for all the information you've given me."
He stands and puts his hand out to me. I take it and he helps me off the table. His hand is as smooth as the living dead.
I will later note the charge for my twelve minutes with Count Dracula: $8372. I think about that. As Yale's Chief of Oncology, the Count is of course entitled to get paid a lot more than the minions; though over seven hundred smackers a minute seems a tad high. I would guess that, unquestionably, Captain Kirk, commander of the Enterprise, is paid a lot more than Scotty, Bones, Sulu, Lieutenant Uhura, Spock, and of course the nameless blond who is clearly Kirk's mistress. Never mind that all Kirk does is stand there and order everyone around as if they can't figure out what to do without his telling them. They tend to look at him blankly when he does that to them.
Does Dr. Diane Quigley, presently in charge of my breasts until the pathology report becomes available, need any oncologist telling her what's what? I would think not. But anyway, I will not entirely judge whether the Count is worth all that money until he weighs in on both my pathology report and the clinical study I told him about.
CHARLIE AND I return to Smilow on the anniversary of the terrorist attack on the World Trade Center and the Pentagon, and the deliberate crashing of a commercial flight into the Pennsylvania countryside. It is 9/11, and I'm about to have my biopsy.
As I approach the lobby desk at Smilow, Beaumont is now looking fairly confident. He looks up, smiles. "Breast Center, right?"
He says, "You were my first customer. I'm sorry I was no help."
I smile back at him. I think it's my first genuine smile, and hopefully, not the last at the Smilow Cancer Hospital at Yale-New Haven. I say, "The first day on a job is in the top ten of everyone's worst nightmare."
And he, "Yeah, it sure is."
He signals to a guide just stepping out of the elevator, a different guide from last time. This one heads over, and Beaumont says to her, "These people would like to go to the Breast Center."
She gives us an especially big smile and says quite merrily, "Well then…. Just follow me."
Up, down, in and out we go until, feeling a bit subdued what with the journey, the guide confides, "We're almost there, dear. Just around the corner."
I whisper to Charlie, "This is nuts."
He puts his arm around my shoulders. "What did you say, honey?"
I speak in my just-above-normal usual voice with him and repeat, "This is nuts."
What do I care if the guide hears me?
She says, "It certainly is. It's why I volunteered."
I say, "Thank you."
She leads us around the corner and here we go past that giant fountain and food court. Then she takes us down a new corridor past the two gift shops. I think I told you the first one is the normal one, but in the other a woman standing at a display counter is bursting into tears.
The guide, really subdued now, says, "That's the shop for breast cancer patients who have had mastectomies."
A shop girl is still holding up the bathing suit she was showing the woman before she started crying her eyes out. It has two imitation breasts sewn into the cups.
May I say that nothing prepares a woman for such horrors even with all this awareness shit going on.
The Breast Center turns out to be a big room packed with living room furniture—ugly upholstered sofas and chairs, and a myriad of coffee tables strewn with magazines like WebMD and Women's Health. Cruel choices.
Dear Smilow, Get fifty subscriptions to People so all the women with breast cancer can read about William and Kate and their latest baby and other such stuff that keeps people at a safe distance from reality.
In the moment before one of the receptionists sitting behind a long counter can ask me what she can do to help me, I end my quick scan of the room. There are so many people packed into one place, all of them wanting to blow their brains out, including the patients' husbands, fathers, mothers, sisters, brothers, boyfriends, and kids.
The receptionist says, "Can I help you?"
I ask her, "Are you Denise?"
"My daughter Jene rides the van with you from the commuter lot. She said to say hello."
Denise smiles. "It's nice to meet you."
She is all business. She doesn't say something like, Jene is such a sweet girl. Or maybe she doesn't like Jene. She just puts my name band on my wrist, and asks me my birthday, and if I've been to West Africa in the last week. Though I really want to say, Yeah, my friend and I went to Ouagadougou for lunch, but not to worry—no one threw up on us, but I don't. I used to be verbally caustic like my mother but have come to try to keep such comments to myself. I write them though, as you, Dear Reader, now know. Denise, after all, is the messenger, not the creator of Yale-New Haven Hospital nonsense protocol.
My birthday matches the numbers on my bracelet. Denise tells us to have a seat till someone comes to get us.
Charlie and I sit together on the only sofa that has two empty spaces. We nod to the man in the third space. He's weeping. I pull a Kleenex out of my little packet, something I carry around these days. I hand it to him. He takes it, but he doesn't look at me or say thank you. If he did that, the weeping would turn to all-out crying, for sure.
One wall of the room is glass and our immediate view—directly on the other side of the glass wall—is the main entrance to Yale-New Haven Hospital, where there are uniformed valets parking people's cars. At that moment, I officially begin to learn the ropes at Smilow. This first rope is: You don't park in the parking garage for four bucks. That amount happens to be five dollars less than valet parking, that is, only if you don't lose your parking ticket, which patients tend to do since we're in altered states. Forget about the wherewithal to read the fine print on the little ticket that states: To take advantage of the discounted parking fee, you have to have your voucher validated. But even if you do read the fine print, the prospect of asking Beaumont tell you where to have your parking ticket validated is so depressing, you just think, Fuck it, I'll pay the full Monty.
I now know not to go to the parking garage. Just drive up to the main entrance, get out, watch the valet zip off in your car, and then, in my case, take the seven-second walk to the Smilow Cancer Hospital, first and only stop, Breast Center.
My feeling on the parking fee, of course, is that patients shouldn't have to pay a goddamn penny. Now that I think about it, neither should visitors. How to discourage people from visiting friends and family in the hospital: charge them to park.
I hear my name called out. It's Justine to take Charlie and me to a mini-waiting room, where I can change in an adjacent room full of lockers. Justine smiles the whole time. I am learning more ropes: at Smilow, absolutely everyone smiles at you the same as when you fly Southwest. No jokes, though. Last time I fly southwest we have an extremely hard and bumpy landing. There are at least five banging bounces of the wheels. When the plane slows down, the attendant announces, deadpan: "You may have noticed that we've landed."
I change into something that isn't a johnny coat. The only difference is it's long and it ties in the front, meaning you don't walk around with your ass hanging out. It's almost to my ankles. I would imagine really short people must trip over the hem all the time. Then I have this robe. It's seersucker. Seersucker, as you may recall, is crinkly white cotton with very thin blue stripes. For a while, men went around in suits made of that stuff from Memorial Day to Labor Day—just those three months, thank God. At least the men were cooler even if it meant they were wearing dishtowel material.
Then Justine returns. With her is a young, handsome, African-American guy pushing a wheel chair.
He smiles and says to me, "The train is leaving the depot, ma'am. I'm Hank."
I say, "Nice to meet you." I look at his name tag. Hank A. Copes. I can't help myself. "Is the A for Aaron?"
First, he stares at me, and then the Yale-New Haven smile turns into the kind of grin that makes the world truly a bright place, something I'm needing right now.
He says, "I can't wait to tell my Mama you said that to me. She's been hoping someday a lady would say that. Took twenty-six years. Mama loved Hank Aaron."
"Everyone loved Hank Aaron. I'm glad I got to be the first but I hope you get a second lady before too long. I'm Mary-Ann."
I reach out to shake his hand. We shake. Since I'm in an altered state, I say, "My mother named me after Jesus's mother and grandmother." I do not explain that there is no "e" at the end of Ann—something Catholics do to differentiate themselves from Protestants.
Hank Aaron says, "My Mama will like that, too. Jesus had a grandmother?"
"Yes, two, just like the rest of us. St. Anne was Mary's mother. I don't think anyone knows anything about Joseph's mother."
He says, "Can I help you into the chair?"
I could have carried on the preposterous conversation forever, what with Charlie next to me, enabling my not wanting to go anywhere in a wheel chair. Now, he helps Hank, who is seeing to my hems that are trying to get caught in the wheels.
Hank says to Charlie, "Come along with us. The family waiting room is on the way."
It isn't. Hank is supposed to have someone else take care of Charlie. This Hank Aaron guy just happens to be a compassionate person. Nice. So, he takes us on a detour that we don't know is a detour, and we drop Charlie off. I get another smooch and then a little wave goodbye as Hank turns me away from him. I can't help but look back at him. Charlie's shoulders are very broad, so much so I can't get my arms all the way around them. There's a tremor in his shoulders right now, so he's glad I look back to him. He calls out, "I love you, Wonder Woman."
Hank passes me a Kleenex; my own little pack is in the locker. He rolls me through a zillion corridors and into an elevator. We go up, get off, go down, get off, and then travel along a few more corridors, but I don't care. I ask him, "Do you ever get lost?"
He says, "No, ma'am. But everyone asks me that. Used to it. I got it down now."
I say, "I'd been hoping we were lost."
"I bet you were, ma'am. But all this will be behind you before you know it, and you'll be out there boogying in no time." He pats my shoulder.
After another quarter mile, we stop at a door where a nurse (or a PA, or an MA, whatever) is waiting. She says, "Hi, Hank," and thanks him, and to me: "Hi, Mary-Ann, I'm Jackie, your nurse."
Oh, good, a real nurse. We shake hands. "I'll be with you during your biopsy."
I will remember Jackie's name.
She and Hank Aaron get me out of the wheelchair. He waves goodbye to us—"Good luck, ma'am," he says—and pushes the chair back to where his next passenger awaits. He turns, though, just like I did with Charlie, and calls out, "Maybe I'll see you for the return," and then Jackie has me through the door.
I tell her, "Back in the day, wheelchair attendants would bang the wheelchairs into the walls, particularly if your arm was broken."
She says, "I hope you never had that experience."
"No, but I broke my collarbone when I was seven, and the nurse in the emergency room yanked my T-shirt off over my head."
"Oh, God. I'm so sorry. We really do our best to see to your comfort."
I say, "But there's always a bad apple."
"Yes, that true. I report bad apples, believe me."
"I'm so glad to hear that."
"We've come a long way."
Right in front of us is an open door. She shows me in. It's a dim and creepy room with a table with a hole in it, as described. Also, we are crammed in amongst many pieces of shiny steel equipment. Two other women, who, needless to say, are smiling at me, stand there. One says, "I'm Dr. So-and-So, and I'll perform the biopsy."
She holds out her hand. I shake it. A lot of people don't do that anymore because of germs. But when you're talking cancer, skin-to-skin contact with others is very important. That would be my theory.
Dr. So-and-So will be wielding the transducer. Yesterday, I checked online the various styles of transducers and decide I'll call mine a derringer even if it does shoot barbs rather than bullets. I recover a memory of Nancy Reagan. She once announced during an interview, in defense of gun-lovers' loony-tune interpretations of the Second Amendment, "I own a gun." Then she smirks and says, "But it's just a little gun. A derringer."
A little gun? What does a derringer do, kill people a little bit? Now I know why I think of my transducer as a derringer. That Nancy Reagan story is in the back of my head and it comes to the front of my brain just before I'm biopsied. Nancy Reagan—no surprise here—becomes a supporter of background checks on gun buyers. When your husband takes a bullet to the chest and his friend and press secretary takes another to the brain, and the shooter is clearly insane, you see things from a new perspective. Charlie says if an unbalanced person is denied access to a gun, every member of the household should be denied access, too. Like Adam Lanza's mother, for example.
I order the monkeys doing their polka thing across my brain to please stop and try to focus on what's happening to me right now at Yale-New Haven Hospital.
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 smiles. "Yeah."
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."
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.)
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 the term, 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. Incredibly, I remain smitten. I think back. The German volunteer looks like Mark Ruffalo even though no one ever heard of Mark Ruffalo at the time as he probably wasn't born yet. That's all you need to know of the inident.
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 while 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 now positioned himself at the side of the doorway and signals me with a crooking finger to come out. I slink out, too. He says to me, "I'll talk to her doctor right away. You go home to your family. Let your mom's sister have her visit."
So, 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 have a mother who doesn'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. Silently, I thank her.
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."
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?"
"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, "And as to 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 even 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."
"A test hasn't been developed yet."
"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 fucking 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. I remain pissed.
WHEN I GET HOME, I take Salty out for a surprise walk. I bring him to a no-leash trail at the Branford Supply Ponds. At least one of us is happy. He chases a million squirrels. I don't have to worry about Salty running off and getting lost. My vet says he's a forty-foot dog rather than a bloodhound, who will track a scent till he drops, or until he makes it the few miles to I-95, etc. Salty will never allow himself to be more than forty feet from me. I'm always getting such praise for training my dog to come back after the squirrel has run up a tree. I just tell people, "He came that way."
On our walk I get to think, all the while gazing upon the fluffy, dancing tree tops of the Connecticut woods. I listen to the gurgling sounds of the brooks and streams leading to the ponds, and to the birds chirping their brains out. I am thinking of Justine; what horror does she experience when she picks up the phone and doesn't get to say, Congratulations? When she knows the woman she is speaking to will die from a cancer staged at 4 and will need a mastectomy, chemotherapy, and radiation to get maybe another year? A year of being grateful to be alive even while being tortured in hope that someone will find a magic bullet?
That sort of thinking vanquishes fury. I sit down on soft moss and cry.
Second, you cry.
Salty comes trotting back and looks at me with his concerned eyes, which are the most magnificent topaz. When he is worried, not only do his eyes have a piercing quality, his doodle ears rise to half-mast like angel wings sticking out the sides of his head. I pet him a few times, and then get up, but he still walks alongside me, loyal and protective, at least till the next squirrel crosses our path. I mean, he's a dog. All I know is I'm no longer crying. Thanks, Salty.
Justine calls me the next day. Dr. Quigley can't fit me in for two weeks. I instantly picture the scrawny-assed, bastard cancer cells, already more than two weeks further advanced than when I saw them with the radiologist. They have, without a doubt, depleted whatever junk they'd been feeding on in my valiant duct, but having failed at a battering ram-style sortie, are now preparing to rip it the poor duct open with their pointy little microscopic teeth. The Navajos would thank the spirit of the buffalo they just killed before eating it. I thank the little duct for trying to save me. I thank the duct silently, and I say to Justine, "What if the cancer cells are becoming invasive and they invade during the next two weeks?"
"How do you know that?"
"I told you, it takes years to go from less than a centimeter to a size you can feel."
"In other words, it could happen, but the chances are infinitesimal."
She sighs. "Exactly right. And if a protuberance does breach the duct wall, Dr. Quigley will take care of it because it'll be within the surrounding margin she's also going to remove."
So I'm thinking sorties and Justine is talking breaching a wall.
I say,"Breach the duct wall? What were you? In the Army?"
She laughs. "My father."
I don't get into how much I love military terms. They remind me of my brother, who I miss so much. He is autistic when no one ever heard of autism, obsessed with World War II. He often calls me Lieutenant, pronounced Leftenant, when he is, say, in the role of Montgomery, as opposed to Patton, whereupon I get the American pronunciation. Consequently, it's either, "Mind the antiquities, Leftenant," or "Knock off your belly-aching, Lieutenant, or I'll smack you in the face." Tyler dies from complications of diabetes. I don't get to tell him, while I'm doing research for a Civil War novel, that Major Robert Anderson, as with all the upper echelon graduating from the Military Academy at West Point, studied Napoleonic strategy and engineering in Paris. His French is so good, he's asked to translate the French book of army regulations into English and it's still in effect to this day. A few updates but that's all. Some words he let be, like sortie, no English word available to do it justice.
Justine makes the new appointment with Dr. Quigley. Then, in addition to goodbye, she says once more, "Congratulations!"
Because I like Justine and am calmer because of my thoughts of Tyler, I say, "Thank you." After all, she means well.
Charlie is home after my walk. I tell him all about the Stage Zero cancer I have, taking care to verify what Stage Zero means. If it is actually possible, I think maybe he is even more relieved than I am, both of us putting out of our heads the part about the microscopic protuberances possibly sticking out of my duct wall, or any actual cancer cells that just might have made it out to the margin but are, in fact, through the margin and out into the density. (I don't know if Charlie thinks that last thing, but I do.)
Consequently, it is turning out that, unlike the rest of us, this is Salty's lucky day. We decide to immediately have an outing in our boat, a 32-foot Hydra Sport that morphs easily between fishing boat and cruiser. I love the boat. I love wandering aimlessly in and out of the wonderful nooks and crannies that make up the Connecticut shoreline, and I also like tear-assing across the Sound when Charlie morphs into a cowboy.
We head out to the marina. When we get there, we follow Salty down the dock. He jumps in and out of everyone's boat to say hello. All our dock mates are jovial and more often than not, half-smashed. We accept an invitation from Tony and Diane aboard The Little Annie Fannie to have a drink. Their boat is named after the family dog who is afraid to jump from dock to boat. She has to stay home. So, imagine having a perfectly normal conversation, laughing perfectly normally, when you've just found out you have cancer, though a mild case. While I drink my beer, I have a fleeting moment of thinking I will google DCIS and ask if "mild" might not always be the case. But I won't. Not yet, anyway.
Salty enjoys a few Triscuits and we head to our own boat where we get him into his doggie life jacket and start our engines. The sky is an especially brilliant blue, the water deep purple, and the temperature warm enough where you really look forward to leaping in. We drop anchor at Kelsey's Island and climb down a step to the swim platform and jump. Salty barks for us to get the hell back in the boat, and when he's sure we won't, he sails up and over the rail doing a magnificent belly flop and will save us. He herds us toward the island. On the beach, he will have another leash-free romp.
While we stroll along the shore, me looking for sea glass, Charlie debating whether to go back for his surf rod, Salty trotting ahead, I am feeling happy—so perfect a day, both weather-wise and company-wise. We take our towels out of their waterproof bag, spread them out and plop down side by side. And what do Charlie and I end up talking about? Getting a second opinion. The loveliness of Kelsey's Island doesn't make cancer go away. Rational thinking, presently required, butts in. On our backs, I tell Charlie my plan wherein I will call my OB/GYN and ask her who's a good second opinion doctor re breast cancer. Then we hold hands and fail at falling into our usual semi-snooze. We don't talk anymore, either. We just listen to the sounds of Salty running up and down the beach, nose to the ground, hoping to hustle back to us with a treasure, usually a dead gull.
Anyway, I get antsy. I want to start making a second opinion happen. I say to Charlie, "Sweetheart?"
"There is stuff to do. I'm sorry."
He rolls onto his side and says, "Let's go."
And here comes Salty, something hanging out of his mouth that looks like a gull but turns out to be a discarded Pamper. We thank Salty and leave Kelsey's Island.
I call Dr. Montessi. First, I must listen to the recording which beings with, "If you are in labor, press 1." Every time I hear that line, I get a contraction. Instead of listening to the rest of my number choices I go directly to 4 since you get a person right away as with: "If this is a billing question, press 4."
As always, I admit my ruse to the billing person, apologize and she says, "No problem, I'm transferring you to Dr. Montessi's nurse." She probably uses the same ruse when she calls her doctor.
The nurse says, "Hey, Mary-Ann! We got the news. I have to tell you…if you're going to get breast cancer, you can only pray it's DCIS. Congratulations!"
I think, Jesus, Mary, and Joseph. Saying the Holy Family's name to myself—sometimes aloud, as a matter of fact—is as close as I get to praying, even though it's basically a form of rolling your eyes. "Thanks," I say. Then, "I have a breast surgeon at Yale, but I need Dr. Montessi to recommend another one for a second opinion."
"No problem." (When I'm complaining to my son about the overuse of no problem, he recommends I listen to Plesiosaur, a singer-comedian, who has a song which is essentially a parody—an ad for a limousine service called, "No Prob-Limo." Check it out on YouTube. It's a riot.) The nurse goes right on to say, "I'll have Dr. Montessi call you as soon as she's between the patient she's with now and the next."
While I wait for the call, I flash back to a surgery I had a while back and realize that the doctor who operated on me might well be a breast surgeon. She was great. I don't remember her name, but Dr. Montessi will since she's the one who recommended her. It was when my errant breast tissue rose to the fore. Remember when I mentioned that? What happened was, when I had the baby my breasts were so engorged—can you stand that word?—I thought they'd explode, along with my armpits which kept getting rounder. The La Leché leader's advice: "Just keep feeding that baby till your body adjusts to what she needs. The engorgement will go away." Pediatrician's advice: "Oh, forget about breast-feeding and buy a crate of Enfamil. I'll give you some coupons." To me, that's like saying to someone who's hungry, "Forget eating. Just stick a tube into your stomach and pour the food in through a funnel. I'll give you some coupons for liquid pepperoni pizza." Idiot. The guy's my pediatrician for one visit and then I get another one.
I turn to Benjamin Spock, who knew more about babies than anyone in history and consequently discusses the phenomenon I'm experiencing in my Bible of the moment, Baby and Child Care. In his advice to pregnant women with engorged armpits, he says what LaLeche says but adds what to do in the meantime: Get in a hot shower and massage the swelling downward back toward the breasts where any milk being produced belongs. This works. Of course it works. It's Dr. Spock! (Denial allows me to disregard the phenomenon that there must be a tunnel from your breast to your armpit where milk might end up.)
But jump ahead ten years. The mass in my armpit comes back—swells up and starts getting hard. And noticeable, too. But…. (Chorus: "Denial.") So, I'm only in denial until that summer when I'm sitting on the beach with my mother and she asks, "What's that thing hanging down from your armpit."
I call Dr. Montessi, who checks it out and she says, "The mass has become fibrous-"
"Mass doesn't always mean a tumor.
"Well that's good."
"And unsightly." My mother's opinion confirmed.
She asks if I'd like a surgeon who treats breast issues to remove it, or a plastic surgeon as there will be a scar under my arm. I go with the former. Who cares if there's a scar in your armpit? The only one who will notice it is your mother.
The scar turns out to be a fine three-inch line and my swollen armpit becomes flat again. FYI: So, here is what I found out about the Errant Breast Tissue anomaly at my local library (Google doesn't exist at the time). Some people, not only women, but sometimes men (!) have superfluous breast tissue in areas near to where it's supposed to be. And get this—they might have vestigial nipples, too! Francisco Scaramanga in Ian Fleming's The Man with the Golden Gun has just such an extra nipple. According to Ian, a vestigial nipple is a sign of virility, a detail that comes from Ian's imagination. You can always tell good fiction writers—they don't do research; they make everything up. That's their job. Job Description: Professional Liar. The trick is to make stuff up so that it sounds believable. Say, you're reading a science fiction novel about a flock of storks on the moon. If it's good, that's because the writer's explanation of how the storks get there feels utterly acceptable. Some readers, bless their hearts, finish the book and tell everyone they know about the experiment with a pair of storks placed aboard Apollo II, who, just before lift-off, escape and hide out in the Eagle, so when Neil Armstrong lands, they run out and find a cave with oxygen…etc. etc. etc. (Not as outrageous as Matt Damon running around Mars, no?)
Anyway, the virility part would be in a man, not in a woman, naturally. Also, Scaramonga's vestigial nipple didn't make it into the movie. Hollywood won't put in a detail like that, particularly in a James Bond movie, needless to say. Where was I? Oh. A vestigial nipple in a woman is usually so tiny she assumes it's a freckle. But at the end of pregnancy, when the women's breasts become engorged (God, that word again) all the breast tissue becomes engorged no matter where the hell it is. And then when milk comes out of the real nipples, it also comes out any vestigial nipples. How shocking is that? I don't even want to think about it. Neither did Ian Fleming. I mean, how virile would Francisco Scaramanga be if he's having sex with some actress and she says, "Eee-u! What's this stuff all over me?" And he says, "Milk, baby." (I have to say, though, if it were up to Quentin Tarantino, in the scene where James Bond and Scaramanga have their duel wearing those early 70s casual shirts, where the first button starts eight inches below the collar, Quentin would have seen to Scaramanga getting shot in nipple #3 rather than the general chest area, and instead of blood, milk spurts out.)
But getting back to the business at hand, I try to remember the name of that surgeon who disappears the fibrous mass in my armpit. I think as hard as I can. I remember she has the same name as a comedian from the 50s. I have his autograph. My father goes on a business trip when I'm nine and gets taken to a nightclub by the guy who runs the Mexican heat treating shop owned by Wade Abbot who also owns the Abbott Ball Company in West Hartford. They make ball bearings, a bounty of them created starting the day after the Japanese bomb Pearl Harbor. A tank won't move without ball bearings. Wade Abbot's father outsources the factory's work when the city of West Hartford won't let him expand his shop. (No one calls it outsourcing then.) When people ask my mother why my father is going to Mexico, she says, "The Mexicans are having trouble with their balls."
Anyway, my father's Mexican contemporary, who runs the plant in Mexico City like my father runs the one in West Hartford, begs off the nightclub my father would like to go to. Steve Lawrence and Eydie Gormé are playing the night club. The Mexican guy never heard of them. He warns my father he will be missing the best strip club in Mexico. He tells the guy he'd rather miss the strippers than Steve Lawrence and Eydie Gormé. The lead-in to their act is my father's favorite comic, not that he doesn't like Steve and Eydie. The comic is…let me think…Ernie Kovacs.
The surgeon I'm talking about here was Dr. Kovacs!
In additions to Ernie Kovak's autograph, my father gets me Steve and Eydie's, too.
I have my first ever surgery via Dr. Kovacs. After she removes what she refers to as the golf ball from my armpit, she says to me, "There are lymph nodes in our armpits. They have lines that transport the lymphatic fluid. The lines are as fine as hairs. When I'm in my patient's underarm, I use a magnifying glass to look for them to make sure I don't cut them. If one is cut, the fluid in it will leak out, fill the area, and the patient has to have it drained."
I'm thinking, how interesting, wondering what her point is.
"I'm sorry, Mary-Ann. I accidentally cut one. If your underarm becomes swollen again—which will most likely happen—it's not the breast tissue it's lymph fluid. You will have to come to my office and have the fluid drained out, or if it's a weekend, you'll have to go to the emergency room and they'll do it there. It'll just take a few minutes, though it might refill and you'll have to have it drained again."
I have to have it drained three times, actually. It isn't so bad a deal. And besides, I live fifteen minutes from her office, and one block more from Danbury Hospital at the time.
But it's why I like Dr. Kovacs. She tells me what she did and apologizes! She acts on a moral imperative, not only to apologize, but to tell me exactly what to expect, and what I'll have to do further, risking me suing her.
Now I get my call-back from Dr. Montessi, and she gives me the sorry news that Dr. Kovacs has retired. Actually, she gives me that news after she says, "Congratulations! If you have to have cancer, DCIS is the one you want."
I picture God saying to one of his bored angels, "What the hell…. This Mary-Ann person? Let's not give her stomach cancer. We'll give her DCIS instead. I like that she's a successful published writer after she practically flunks out of high school because she can't add or subtract."
The angel erases the check mark next to Stomach Cancer, and checks off DCIS instead.
And I like to think the angel says to God, "I've read all her books and I liked them a lot."
But if she does, God says, like all narcissists, "I wish I had time to read."
What he actually says is, "Were you the one who neglected to tell me that when I rolled the dice and came up with stomach cancer for her mother, the woman had named her daughter after my mom and Grandma? I mean, What the fuck?"
The angel is demoted and has to play her harp twelve hours a day for 750,000 years. (You're willing to suspend your disbelief that all the above is true, right?)
Then Dr. Montessi says to me, "We all miss Dr. Kovacs, Mary-Ann, but there is an incredibly intelligent and competent young breast surgeon here at Danbury, who I would go to if I had DCIS. Her name is Jane Starliper."
"Jane who?" (Is there to be yet another Star in the company of Starlight and Starbright? Yes.)
"Starliper. I'll call her right now and her nurse will get back to you to make an appointment for a second opinion, okay?"
I agree and ten minutes later the nurse calls me on my cell. "She can see you day after tomorrow."
"But that means my second opinion will come before my first opinion."
"Insurance companies haven't red-flagged that one. Not yet. Don't worry about it."
I say, "Damn insurance companies."
She says, "I'll drink to that."
The last two things the nurse says are, one, "It is really crucial to be on time for Dr. Starliper. She's squeezing you in because it was Dr. Montessi who asked for the appointment." And two, "Congratulations!"
I NOW LIVE an hour and fifteen minutes from Danbury as opposed to ten minutes from Yale-New Haven Hospital. I'm thinking this is all a little silly, but second opinions allow you to think more logically about choices that you wish you didn't have to consider, but you have to. I will leave at seven in the morning to get to our 9 o'clock appointment in Danbury because of rush hour traffic—19 million vehicles, most of them tandem-trailer trucks racing over the Q Bridge into New Haven from East Haven. If you look into your rear-view mirror while traversing the bridge, you will see an every-expanding chrome bulldog staring at you from the hood of a Mack truck climbing up your ass.
The Q Bridge is the longest in Connecticut, basically a parking lot on Interstate-95. When I-95 was built along the entire shoreline of CT on Long Island Sound, it cut the residents of Connecticut off from the Sound. This came about in the 50s when natural bodies of water were considered to be Mother Nature's litter box. I also think the placement of the interstate was intended to keep poor people, re black, from getting to the beach since they don't have cars and can't possibly walk across an interstate, especially I-95. (Are you interested in this particular shit-stain on Connecticut's history? Get Free the Beaches, by Andrew W Kahrl. He'll tell you all about it. I'm in two of the footnotes.)
Another interstate, I-91, leads from all points north including Hartford, meeting up with I-95 right in the middle of the bridge. The Q Bridge is a nickname; the Q is for Quinnipiac, though for a while people were calling it the spaghetti bowl but that name didn't take. Connecticut has a huge population of Italian-Americans and some felt offense at anyone making fun of spaghetti.
So no one ever uses the actual name of the bridge since it's too long but who cares? Here's who: Some nitwit bureaucrat comes up with a great idea to dumb it down. He decides the Pearl Harbor Memorial Bridge will replace the Quinnipiac Bridge, and there's a big article about the change in the New Haven daily paper. The trouble is no one knows what bridge the article is talking about because the nickname is now part of the culture, the intended name lost in the Great Hurricane of 1938. So Bureaucrat #2 has a mammoth flag raised over the bridge and then there's another article with a picture explaining how the name was changed to honor the fallen at Pearl Harbor and to hell with Native American Quinnipiacs who lived on what is now Long Island Sound for 8000 years. They were forced to "sell" their land and moved inland and joined up with a tribe fifty miles away until all but a handful of the combined tribes perished. Or as Jimmy Breslin once wrote: Here's how you discover a new land. Arrive on the land, stick a flag in the ground, and then kill all the people there.
If the Quinnipiacs had worn headdresses and lived in tipis and attacked the settlers, you might have heard of them, but they were unaggressive farmers and fishermen.
Anyway, so imagine you're on this bridge, and you want to call your husband to tell him you're sandwiched between two unmoving tandem trailer trucks, and that a shiny chrome MACK dog is looming ever-larger in the rear view mirror, you surely don't say to him, "I'll be fucking late. I'm stuck on the fucking Pearl Harbor Memorial Bridge."
A side note on the Q Bridge. It is situated above an arm of Long Island Sound that is New Haven Harbor. Above, and on either side of the arm, are miles of intertwined exit and entrance ramps, protecting a colony of feral cats estimated to be the largest in the country. So a local philanthropic group traps as many cats as possible once a year and brings them to volunteer veterinarians, who spay and neuter them. Then the philanthropists bring them back to exactly the spot where they trapped them, as they feel the cats have a constitutional right not to be evicted from the place where they have lived for generations. Oh, but the irony!
The philanthropic groups, however, don't feel the cats have the right to procreate. I am once asked by this group to be a model at their annual fashion show to raise funds for the feral cat neutering and spaying project. I say, "I'm five-two. What am I going to model? Gloves?"
But no. The fashion coordinator says to me. "Even though you're a shrimp, you are beautifully long-waisted, so I'm having you model three very snazzy Italian leather jackets paired with your own jeans so we won't have to cut two feet off the bottoms of ours." She flicks a glance to my feet shod in Red Sox flip-flops, and says, "You will love that we have a volunteer who I've talked into supplying us with her dozens of pairs of longitudinally infamous Mahalo Blahniks."
Can you stand it? Those were her exact words.
Where was I? Never mind. I only know I find it especially wonderful that a bunch of veterinarians volunteer every year to spay or neuter a million hissing, biting, clawing, vomiting, pissing and shitting feral cats.
The fashion show generates over $5000 for the feral cats, and I fall in love with two of the Italian jackets I model. (And again, Oh but the irony!)The third is strips of leather woven together as if the jacket is some kind of basket. The price of each jacket is, coincidentally, $5000. They are snapped right up, not by me.
Here's where I was, I think, before I got off on the Q Bridge. The Danbury appointment is on a Wednesday, Jene's day off. She will take Salty the night before and then drop him off at doggie day care in the morning on her way to our house. She wants to get a handle on Starliper, and I want to hear what her handle will be. Actually, it is recommended you bring a second set of ears to all important doctors' appointments to make sure nothing gets missed. Charlie's ears, our third set, are not terribly reliable. But he will get an incredible handle of his own on Starliper, what with his ability to make up for what he can't hear with extra-sensory perception, i.e. This person is not a friend, Mary-Ann, or Here is what makes this doctor tick, Mary-Ann, or when he knows I feel bad for doing something especially unforgiveable, We all forget the tickets sometimes, etc.)
Though Charlie, Jene, and I give so much extra rush-hour related time to get to Danbury, we don't give any extra time for trying to find where I'm supposed to go once I get there. So, it hardly matters that we are stopped on the Q Bridge for twenty minutes because a crane fell over the side and into New Haven Harbor, I kid you not, for we will learn that getting lost at Danbury Hospital is not like getting lost at Yale because Danbury, for starters, has no breast center.
We arrive outside a parking garage whereupon I call the phone number I have and tell the person who answers that I am just arriving at the garage. I'm only five minutes late.
The person is totally laid back because I have breast cancer.
"Okey-doke," she says.
Once parked, we cannot find our way out of the parking garage. So, we follow the exit signs walking down ramps, trying not to get swiped by exiting cars. There is no pedestrian egress. I know this is true because neither Charlie and Jene, nor I is an imbecile.
A sympathetic guy whizzing by, stops and yells to us to get in, and once outside, drops us at the emergency entrance, the only entrance in sight. Everyone in the emergency waiting room of Danbury Hospital hasn't any idea where we should go from there. In addition, no one has ever heard of a Dr. Starliper, including the guy with the directory of doctors forced to deal with the word breast since I ask for the breast center not knowing they don't have one. But he pulls himself together enough to direct me to a desk with a harried woman behind it.
"I don't have time to look up the doctors' names," she says. "What does he do?"
I say, "He's a she. She's going to give me a second opinion on my breast cancer diagnosis."
"Oh. Then she's probably at the Arts Center."
Jene says, "Excuse me?"
"Just walk down the street past the big parking garage, curve toward the left, go down the hill, and that's the Arts Center."
I call the number I have again and say I'll be at least another five minutes because I couldn't get out of the parking garage. I explain where I am and ask her to verify my directions.
She says, "Exactly right. Just come right to the desk at the Arts Center. We'll be waiting for you."
The street is long and downhill, all right. Steeply downhill. Charlie says, "I'm going to get the car. My new knee will not make it back up this fucking hill." Then he makes eye contact with me. He says, "I'm sorry, baby."
I assure him that it's no problem because it's a really hot day. He appreciates my effort to be concerned with him even though I'm the one with breast cancer.
As Jene and I head down the hill, she keeps expressing my own disbelief that we are going to an Arts Center. She says, "This is not the Yale way," in the same tone of voice that Charlie uses when he says he won't make it up the fucking hill.
At the bottom of the fucking hill, the road indeed curves left, and we see a big sign much like a movie marquee that reads, The Danbury Hospital Medical Arts Center.
I say to Jene, "I always thought medicine was a science."
She says, "It is," and gives me a look that says, This is not the Yale way.
I say, "Maybe there's great art on the walls to distract you."
"Yale has great art on the walls but we don't call ourselves an arts center."
This Starliper doc better be good, I think.
We go in and vent to the people at the desk about getting lost. They sympathize while one of them puts a hospital bracelet around my wrist and then rushes us to the elevator. Doesn't ask if I'm just back from West Africa. Jene is directed to a waiting room very close to the examining room while the nurse rushes me off with Jene calling out, "I'll find Charlie, Mom."
In the examining room, the nurse hands me a johnny coat to be left open in the front, hold it closed in front of me, get up onto the end of the examining table, and sit and wait while the johnny coat slips off one shoulder, then the other.
Dr. Starliper comes in. She's smiling a pained smile since I am so late for my appointment. We introduce ourselves and then she says, "I'm sorry. I can only give you twenty minutes. You're really so late." She doesn't look sorry; she's still looking pained.
I say, "When I made the appointment, I should have asked for directions to get from the parking garage to here." I put a pained expression on my face, too.
She says, "Yeah."
While she does a quickie massage/exam of Starbright, I'm thinking, Yale 15-Danbury love. Then she tells me to get dressed again, that a nurse will be right in and leaves.
The nurse leads me to Dr. Starliper's office, stopping at the waiting room to grab Jene and Charlie—he has completed the parking space shift successfully.
Dr. Starliper is behind a desk. She is staring at a computer screen. There is no Marina to do it for her. She brings up my mammogram. It's no Sea Cup. Quadruple-D would be my guess. Dr. Starliper immediately realizes this, so I don't have to tell her that it's not my mammogram image. She looks down at a list. She says, "There are no dates of birth here." I feel Jene sit up straighter next to me.
Yale 30—Danbury, Love.
Charlie adjusts his hearing aids because he cannot believe he is hearing right.
Dr. Starliper says, "Never mind. I've seen the right one." She means the correct one, not Starlight. She clicks off the computer and swings her chair around in our direction. "But meanwhile…" she smiles "…congratulations. You have the one breast cancer you'd want to have if you're diagnosed with breast cancer, DCIS. But in that regard, I have to tell you, we do things a little differently than at Yale."
"We don't use a wire marker in the breast. Our marker is a radioactive seed and we essentially use a metal detector to find it."
(I'm sure, Dear Reader, they must have pocket-size metal detectors rather than the kind treasure-hunters use on the beach, wouldn't you think?)
"Our method is far more dependable than the piece of wire Yale uses. Yours, in fact, has moved."
Yale 30—Danbury 15.
"A seed is more efficient and reliable. So, I will put one in during the surgery so that if we have to go back in, we'll know exactly where to go."
I say, "Why would you have to go back in?"
"I'm about to get to that."
This is so much to take in that none of us interrupts her with questions like, Where the hell did the wire move to? Or, Will your method make me radioactive? I won't deal with the moved wire, called a marker at Yale, till another time. It goes right out of my head, all our heads. Probably, because we don't want to hear such a thing what with The Yale Way having failed in this particular case.
But she's moving right along because I'm really so late for my appointment.
"I will take out the duct and a rectangular amount of tissue surrounding the duct about this thick." She holds up thumb and forefinger an inch apart. "Sort of like a book-shaped piece of tissue."
I'm a writer and I now learn I'm having a book taken out of my breast. Sometimes irony is not all that scintillating. I ask, "Would that be a paperback rather than a hardcover?"
She laughs. "A paperback. A really small paperback. With just enough margin to see if any bits and pieces of a cancer cell are in that tissue. In which case, we'll have to go back and take out a little more. But through the same incision."
Two surgeries through the same incision? I wonder what that scar will look like. I put that question on hold and ask the more pressing one, "What are the odds I'll have to have more tissue removed?"
"Twenty-five percent. But what I want you to know before I forget to tell you is that we will put the seed in the day before the surgery so you'll have to make the drive to Danbury two days in a row, or stay at a hotel. However, when it's time for radiation, you can have the radiation treatment closer to home—up to you. Radiation doesn't vary from one place to the other."
Jene's eyebrow shoots up. My guess, she knows a few radiologists who might disagree.
Charlie sneaks his phone out, taps it a couple of times, meaning he's changed the setting on his hearing aid. (Did I say his hearing aids bring him sound via Bluetooth?) He is not liking what he is hearing.
Up until this point, I am determined that convenience will not be a concern. Sloan Kettering remains in the back of my head before I commit to anything in Connecticut, Yale or Danbury.
So I say, "How long will the radiation treatment take?" (I don't add, If I choose to have it at all? since she's pressed for time.)
She says, "Three to six weeks."
"Once a week?"
First, she kind of gapes at me. Then she says, "Five days a week."
As much as I would adore spending that much time going to plays and museums and galleries and concerts and restaurants in New York, I know right then that there will be no Sloan Kettering for me. Not even considering the cost of the train commute, we'd have to find a hotel that will take dogs, and if we do that, we'll have to listen to other dogs barking all night, particularly at 5 a.m. if their owners want to get an early start. In your basic no-tell motel, everyone wants to get an early start as opposed to being a guest at the Four Seasons, where you loll around all night having sex and eating the fruit out of the fruit basket, and then sleep past noon, and stay another night, what the hell?
Dr. Starliper says, "I'm sorry, but I have patients waiting. Dorothy can give you more information and she'll be happy to answer your questions. It was nice to meet you, good luck, and again, congratulations."
On cue, in walks a nurse, Dorothy, while Dr. Starliper dashes out.
Dorothy looks like a sitcom mom who loves making and eating macaroni and cheese, vacuuming at least once a day, and whose only conversation with her children is telling them to do their homework or go clean their rooms. She takes us to a little lounge and we sit opposite her on three chairs, which she has arranged in a straight line. The whole time she is talking to us about breast cancer surgical procedures, she touches various places on her breasts. Example: "Judging from the mammogram pictures, the seed will go here," and she pats a spot that on me would be two inches due north of Starbright's nipple. Charlie is fidgeting.
Without my having to ask, she next answers the first question I would have asked Dr. Starliper but couldn't because I'm really so late. "Now then, Mary-Ann, after you're out of the OR with your seed, you will not be radioactive."
I say, "That's good."
"But just to be on the safe side, you should not hold children or babies or pets to your breast."
She pats herself all over her entire left breast.
Game, set, match—Yale.
I'm doing everything the Yale Way even if they can't get an eye-lashed size piece of wire to stay where it's supposed to stay.
Then Dorothy asks if there is breast cancer in my family.
She breaks out a pen and notebook. Here we go. I say, "There are all kinds of cancers running rampant in my mother's family. Eleven brothers and sisters. All of them died of cancer except three." I relate the history in a nutshell: The first of the three was my Uncle Oscar, who died of natural causes in Florida in the loving arms of the two sisters who adopted him when he was in his eighties to avoid a tax or a fee, or something you have to pay when you get married; the second, Eddie, gets hit by a train when he crosses the tracks after leaving his favorite bar where he goes every night and gets drunk. Actually, I don't tell her that last part, or about Uncle Oscar's adoption. I go to the third: "My Uncle Norbert had cancer when he was in his twenties, but he's still alive. He's ninety-six. We don't know what the cancer was but best guess is that it was melanoma because he had commando surgery that removed the left front quarter of his entire neck. His doctor saved his tongue and larynx. We think that's why he never stops eating or talking."
She is now scribbling furiously, "What surgery did you say?" right when Jene asks at the same time, "Mom, Uncle Norbert had what surgery?"
Apparently, commando surgery is a term no longer in use in the medical field. After all, my Uncle Norbert had the surgery over seventy years ago. Charlie may or may not have heard any of that—he isn't hearing anything at all since the battery in his better ear dies and starts beeping. He is now fiddling with his shrink-wrapped little cardboard wheel of batteries, glad to be distracted, I can tell.
Dorothy says, "Let's focus on breast cancer. Did your mother die from breast cancer?"
"No. My mother and three aunts and one uncle had gastric cancer. But two aunts, one at a very young age, died with breast cancer."
That would be my Auntie Verna who has her sisters jump up and down on her because the pain distracts her from the horrific pain of her breast cancer once it metastasizes to her bones. We really need a Metastasize Awareness Week so more women will get mammograms.
I try not to think about that. I say, "I have a lot of cousins…" (Forty-one at last count. When my father was still with us he used to brag to people—I've got over forty nieces and nephews and not a one of them is doing time.) "…but none were diagnosed with breast cancer before she turned forty except one, two years after she felt a lump, which her doctor insisted was a bump on her rib. Did I say that one of my two aunts with breast cancer actually died of lung cancer?"
Dorothy says, "No, you didn't. This is all on your mother's side?"
"And your father's side?"
"Three brothers and two sisters. Only one had cancer. My youngest aunt. She had cancer of the larynx. Has. She's alive and well. She's ninety-two. She didn't smoke."
When she finishes jotting away, she asks, "And your grandmothers?"
"My two grandmothers died before I was born. All I ever heard was that their cause of death was identical—hemorrhage. They hemorrhaged and got taken to the hospital and never came back. They were in their fifties. I believe the hemorrhaging was related to the result of giving birth way too many times. My grandmother on my mother's side had a baby every other year for twenty-four years." I don't get into the two-year skip when my grandfather served in the Boer War.
Dorothy says, "I want you to see a genetic counselor. I'll have their secretary call you to set up an appointment."
Then she pats her left breast one last time and says kind of out of the blue, "I want you to know the scar won't be bad."
I'm not yet ready to hear about what Starbright's scar will be like. Neither are Charlie and Jene.
Then, Dorothy hands me a giant binder the size of a telephone book if you can remember what those were like. She says, "Read this. It tells you everything about your cancer and what you should expect as to treatment and recovery. You can skip stuff that doesn't pertain to you, like chemotherapy."
Wow. I am afraid to even ask about chemotherapy. I say, "I won't need chemotherapy?"
"You won't if your margins are clear. They likely will be clear since your cancer is so small. But if the tumor in your mammary duct turns out to be more than five centimeters, then we'll go and ahead reduce the size of it with chemotherapy so you can have a simpler surgery."
I have just gotten some non-congratulatory news. I feel my stomach turn over.
Dorothy stands up, tells me to call her any time, and she'll check in with me when I come for my genetic counseling. And so, we say goodbye to her and to Danbury Hospital with a plan never to return. Ah, the best laid plans….
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 at Christmas.
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 the 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."
I ask, "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 for just a moment, 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 got tears in my eyes, but I carry on. "You'll disappear my entire lesion."
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 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."
Now, in that authoritarian tone she 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.
DR. QUIGLEY'S VOICE penetrates my depression. "You okay, Mary-Ann?"
I look to her. I'd been gazing past her. "I guess."
"Then let me tell you the rest. You'll feel better. About the surgery. I will take out a rectangle of tissue from your breast which will contain the cancerous duct, as well as a half-inch-wide margin of extra tissue from all around it."
The only thing I can think of to say is what Dr. Starliper in Danbury says: "Like the shape of a book?"
"Uh…yes…except a book is a lot bigger than a mammary duct. Think postage stamp. Anyway, if we do find any cancerous tissue in the margin, I will go back through the same incision and take out another margin of breast tissue."
I say, "My other opinion surgeon said that my chances of that are twenty-five percent."
I am surely liking her better than Dr. Starliper. Then she says, "And I am happy to tell you my incision will follow the curvature of your breast. The scar will be far less prominent that way."
The curvature of my breast. I am now un-depressed, overwhelmed with the happiness I feel that my doctor is speaking about the curvature of my breast despite having to hear the word scar.
"Also," she says, "the scar will be a very fine line. There may be an indentation but one of my goals in terms of cosmetics is to try to keep that from happening."
"How will you do that?"
"Well, one of the ways is that I won't put a drain in."
"I won't," she says sternly, "There will be no drain. Instead, we'll let nature take its course. The place where the tissue has been removed will fill with lymphatic fluid. Instead of being drained out, the fluid will slowly be absorbed by the surrounding tissue, where it will stay and then become firm."
I ask, "Did you discover that to be the case yourself?"
I get a smile and a modest, "Yes."
Then I ask something else. "Are we sure I won't need a mastectomy?"
"I am one-hundred percent sure."
"Because if I do, I want an Angelina Jolie. I want a plastic surgeon right there to give me another breast."
"You won't need to be Angelina Jolie. DCIS does not require a mastectomy. But I will tell you…many women choose to have a mastectomy anyway. Some will insist on having both breasts amputated they're so in terror of another tumor returning to the other breast. But if the duct is removed, the cancer is gone. There is nothing to return. However, I must leave that decision to my patients. Angelina Jolie's decision was based on her genetic makeup and the likelihood that she would develop breast cancer. A courageous woman." She sighs. "But she was absolutely correct to have her ovaries removed. There is no way to detect ovarian cancer until, usually, it's too late for the patient to respond to treatment."
She changes the subject by flipping a page. I am soon to meet up with a woman like the hypothetical one that Dr. Quigley describes—my manicure-pedicure lady who I will be seeing the next day. When I tell her about having DCIS, before I can say—Don't forget your yearly mammograms--she says she had DCIS, too, and as it turns out, Dr. Quigley is her breast surgeon. She says, "I never let Dr. Quigley flip the pages. I just told her to cut them off. It's something I don't regret doing and I'd rather talk about something else."
I ask her if she's seen any good movies lately.
When I come to tell Dr. Quigley about the manicure-pedicure lady she says, really so sadly, "Even if I attempt to explain that some breast tissue is left behind after a mastectomy…that if that tissue is radiated, the chance is far less that you could get another breast cancer in the remaining tissue than if you have a mastectomy…. Amazing how minds get made up based on terror rather than reason."
I tell my friend the writer Christine Lehner this and she says, "No passion so effectually robs the mind of all its power of acting and reasoning as fear." She is quick to point out that Edmund Burke said that, not her. Rather than ask who the hell Edmund Burke is, I google him when I get home. He was a writer, orator, political theorist, philosopher, and a member of parliament who died in 1797. I am familiar with another of his many assertions: The only thing necessary for the triumph of evil is for good men to do nothing. (I also find out there are many people over the last 300 or so years, who have supposedly said the same thing though with a variation on the turn of phrase. The determination is that no one gets credit. Imagine that.)
Dr. Quigley is now flipping over several more pages in the binder and arrives at RADIATION. The fat Sharpie swirls around the word.
She says, "Once you have breast cancer, your odds will be higher that you will get a second breast cancer, higher than the odds of the rest of the population getting a first cancer. So, we want to reduce those odds while leaving the breast in place."
I send a communication to Starbright: Do you hear that? Dr. Quigley does not want to lose you. I don't want to lose you. You're staying. I am so happy for us both.
Dr. Quigley says, "That is why you will consider radiation, particularly since we already know you have breast tissue under your arms."
I say, "Shouldn't we radiate Starlight, too, then?"
Again, I have to explain Charlie naming my breasts. Then she says, "I have to say no to your question." She ignores the breast-naming part.
I ask, "Why shouldn't we?"
She says, "Sometimes, very, very rarely, radiation can create a new cancer. It appears years down the road. Statistically, though, better to have the radiation. But prophylactically? No? This is the sort of thing you'll want to discuss with your radiologist and your oncologist."
Is there nothing simple about cancer? No. I must move on.
I say, "There is some question as to whether women of a certain age benefit from radiation. I'm a year above that age."
She tells me what the Count told me with a little additional information. "We will not treat you according to your chronological age. We are treating you according to your specific body as it compares with the typical woman's body as she ages. You have the body of a woman twenty, twenty-five years younger. You are in terrific physical shape. Good for you. If you had the body and the typical physical conditions of the average woman of your chronological age, which I'm sorry to say means excessive weight among other things…. Or if you had some debilitating illness…we likely would not radiate.
"So yes, there are risks, Mary-Ann, as with everything, but risks that I feel you and your body can tolerate. You will handle the radiation well, and it will serve to keep your breast free of a future cancer."
"How long will the radiation last?"
"My second opinion doctor said four."
"I have an idea."
"How about we wait to see if I develop another cancer in my breast, take care of that one, and then have radiation?"
"But wouldn't you think that—"
"No. Your radiologist will be the one to discuss that further if you feel the need."
Dr. Quigley is an especially authoritarian breast surgeon.
"Finally," she says, "you will have a drug regimen."
She closes the binder. She hands it to me. In her authoritarian way, she says, "Read what I've circled. Do not read anything else." Then Dr. Quigley says to Marina, "We ready?"
Marina answers, "All set." And to me, "On the screen is one of the mammogram images of your…of Starbright." Marina produces a great grin. Nice.
Dr. Quigley ignores this and points her Sharpie at the computer screen. Good God, I'm thinking, is she going to write on it? No. She gestures to the calcifications that she will soon disappear. I can't make out anything where she's pointing that looks any different from the rest of the image. I see faint galaxies all over the place. I tell Dr. Quigley this.
She says, "Galaxies?" Then she explains that what I am talking about are not the calcifications of the duct. She doesn't say what those galaxies are that I'm seeing. Instead, she points at the duct that she will annihilate. "Can you see the density there that isn't anywhere else?"
"Well, consider that a good thing. We are getting rid of your cancer at the earliest possible time before the untrained eye can see the calcifications."
Then she smiles at me but doesn't say again, "Congratulations." Instead, she stands up. So do I. I hug her. I can't help it. She hugs me back.
I look into her eyes. I get the same feeling as the first time I look into Charlie's eyes, a feeling of trust. I am right about Charlie and I'm hoping I'm right about Diane Quigley.
Then she tells Marina to schedule an appointment for my surgery in two weeks.
I say, "Uh-oh."
Dr. Quigley: "What?"
"Charlie's son is getting married in two weeks. October 6th." Then I can't help myself, the words just come out. "My stepson is as sweet as his dad."
Dr. Quigley smiles. "Stepmom-of-the-Groom. Cool." She knows Charlie is a widower. She kind of cocks her head a little and takes a wide-angle look at me. She says, "You will do a great job of it."
I tell her, "Thanks."
"You're welcome." She looks toward the computer. "Marina, what's the next available date after Mary-Ann's wedding?"
Marina is on the ball. "You can do October 8th."
My surgeon turns to me and says, "I will see you the morning of October 8th. You'll get all the instructions you need beforehand. Have you got your dress?"
"No, but I saw one I love."
"You're waiting for the bride to approve, right?"
"Yes. She and I are—"
"Get it anyway." Ah, to be as authoritarian as Dr. Quigley. She says, "Have a wonderful wedding."
I thank her. Then I say, "Charlie and I are having a honeymoon, too, even though we already had one when we got married. We're going to the Dominican Republic in November."
TMI because she says, "No, you're not."
"With the radiation, you cannot go anywhere where your skin will burn further."
"I can cover up."
"No. Put the honeymoon trip off for a year."
Then she smiles again, stands up, and Charlie thanks her since he doesn't hear her nix the Dominican Republic.
I smile at her, too, and she gives me a look. I wonder if she can tell I'm going to the Dominican Republic. Will I need a vacation, or what? I mean, really, don't women in the Caribbean get radiation? Don't women in Connecticut get radiation in August? I'm going.
Dr. Quigley is off and Marina prints out my instructions.
BUT DR. QUIGLEY returns just when we're organized to leave, Marina reminding me where I put the instructions. The doc thought of something she wants to tell me. It's detailed and she says it all in one breath:
"Mary-Ann, one more thing. I want to recommend a radiologist, the most wonderful Joan Frye. She has an office here but another one at the Yale satellite hospital in Guilford, where there is a large radiation department. You won't have to cross the Q Bridge every day. It's on your side. Parking in Guilford is easy and it's free. Far more important, not only is Joan a first-rate radiologist, her team is first-rate, too. She's a born leader. I'll have Beth make an appointment for you before your surgery so you can meet her. She can examine you and answer your questions. She'll have seen the mammogram images and will have read the pathology report."
"Great!" I say and mean it. Once you know you won't have to drive back and forth across the Q Bridge every day for a month and pay $180, all told, to park, Dr. Quigley could have said Joan Frye and her team are werewolves, and I'd still say, "Great!" Of course, if Joan Frye rubs me the wrong way, I'll find another radiologist.
Have you noted that I have not allowed myself to absorb the fact that the surgery is scheduled for two days after the wedding? Denial is in order.
When I'm home I go online. I google, The most dangerous side effect of radiation for breast cancer. Denial is not in order for this particular piece of knowledge. Here is what I find out: I will have this very minuscule chance of the radiation treatment causing a horrific other cancer, something that Dr. Quigley mentioned but told me to ignore so I won't think I have it. This cancer rear its head many years down the line. If that happens, itwill either kill me, or if it doesn't, I'll wish it had. The cancer leaves your heart badly injured.
Google does not tell me the exact statistical risk of radiation killing me or injuring my heart via a bizarre-o cancer, only that the risks are miniscule. I will have to ask Dr. Frye about it, but first, I will have a discussion with my three favorite people: Charlie, who was radiated after his own cancer surgery; my daughter, who is a nurse, after all; and my son who has the ability to put an innovative yet logical spin on every topic under the sun.
I start with Jere whose brand of advice will be centered in comfort, which I need more than anything else at the moment. I call and tell him about what I found out on Google re radiation treatment. Does he even pause? No. He says, "Mom, it's not like they're going to send you to Hiroshima and drop another atomic bomb on your head." Does he pause before coming up with another analogy? No. "And they're not going to make you sit under a gigantic transformer all night long."
I feel better immediately because Jere is basically telling me everything is relative in his own inimitable way, which I always find to be fairly hilarious. I do wonder why he uses the image of me sitting under a gigantic transformer all night rather than all day. I'm guessing because no one will see me there at night and I won't get arrested on a possible trespassing charge. I'll ask him when we both have a minute.
Next I call his sister who says, "Learn everything you can, Mom. Just like you're doing. Go to WebMD and the Mayo Clinic in your spare time. And yeah, ask the radiologist about the statistical information available. I'll ask around here, too." Then…. "Wait! Mom! Ask our cousins! Call the Morra girls!"
Why didn't I think of that? I will first break out Choices; then maybe I won't have to bother them. I will do that as soon as I talk to Charlie.
Here is what Charlie says: "Having radiation was no fucking fun, I'll tell ya, but thirty-five years later, here I am. And lookin' good if I say so myself, considering."
Considering. The long-lasting effect the radiation has on Charlie is that the hair on the left side of his belly fell out, as well as some on the left side of his groin. Do not let anyone know this because all those idiot men who are having their hair ripped out of their entire bodies because they think they look good hairless, ergo younger, will head to the nearest radiologist and insist on full-body radiation. My friend, Debbie Jones Yetter, who doesn't write but reads a good five books a week, has a close friend who's an esthetician. Her most provocative job is taping men's bodies and then ripping the tape off along with their hair. They especially scream when she does their balls. What are we coming to? Or have we already come to it?
Charlie also has this to say: "After thirty-five years they must know a lot more than they did then. And hopefully, radiation won't turn you into a sleep-walker. I was always so tired. So tired that sometimes I just couldn't wake up. My body forgot how to wake up. That part was the worst. I mean, I had two little kids."
"I'm sorry, honey."
He nods. Sometimes Charlie just breaks my heart. He adds, "It gave me a hernia. I still have it. It doesn't bother me." Heartbreak continues.
As things turn out, I will also speak to my dermatologist, Dr. Kumar, who I happen to have a long-scheduled appointment with next day. Man, am I sick of going to doctors' appointments. But I like Dr. Kumar a lot. She is assured, beautiful, and maybe five feet tall, at most. What with the latter, she wears fabulous shoes with heels higher than all the shoes in "Sex and the City" put together. When she walks into the examining room, the first thing you do is check out her shoes and go ga-ga.
Next day, at this appointment, the shoes are a metallic dark gray, and the six-inch heels are the shape of pipes with some sort of silver faux embroidery along each side.
I say, as I point, "They're Italian, right?"
Speaking of ga-ga, that is a shoe Lady Gaga wears. I read that in People. The shoes cost more than my car. I say, "Holy crap."
She laughs. "I got them in Milan on sale."
We shake hands. I don't get into how my grandfather is from Milan. Instead, I tell her I have DCIS.
She says, "Oh, Mary-Ann. I'm so sorry to hear that. How're you doing?"
"I'm having surgery October 8th."
"But you already know that you're in a good position, right?"
"Yes." My second medical person who doesn't congratulate me, hallelujah.
"And speaking of Milan," she says, "in Europe, they don't even treat DCIS."
"No. They wait till the cancer cells break through the duct. Only then do they reason that there is a cancer because—according to them—if cells are in situ, how can the lesion be considered cancerous? Meanwhile, when bad stuff happens and the cells invade the surrounding tissue and the tumor is palpable, the patients will be biopsied and diagnosed again in terms of the extent of the metastasis. Then the patient is treated based on that."
I can't believe it. "Are they crazy?"
"Apparently. Want to hear something crazier?"
"I'll tell you anyway. Some breast surgeons in this country are starting to lean in that direction. There's a report on a clinical trial coming out that's turning heads based on the thinking that cancer isn't cancer unless it proves to be invasive. But the trial is flawed. All of the women in the study were treated for breast cancer. There wasn't anyone in the study playing Russian roulette, sitting with the DCIS, waiting to see if the cancer cells in their breast would become invasive."
"I guess you can't really find many women who do nothing about it."
"Right. In fact, you can't even know about them until they show up in a doctor's office, dying. That's if they show up. And even if someone volunteers for a study who's determined she doesn't want to be treated for her breast cancer, it would be unethical not to move mountains trying to convince her otherwise. And if nothing changes her mind, the doctors would then be unfairly forced to stand by as her breast becomes necrotic. I'm not even going to talk about the odor of rotting flesh."
She sighs. Then she says, "So, Mary-Ann. How about we look at the outside of you?"
She does her full-body check and gives me a clean bill of dermatological health.
I'll see her in six months. My insurance pays for a bi-yearly check-up because I once had a squamous cell cancer on my calf, where I now have a purple scar. But it's fading. Now, get ready for this. I go home, sit down with a mug of coffee, and read The New York Times. I am stopped by the following article: "A BREAST CANCER SURGEON WHO KEEPS CHALLENGING THE STATUS QUO."
Dr. Kumar just got through telling me the gist of the article. The breast surgeon of the headline, a certain Dr. Esserman, is quoted in the article saying stuff that defies all that is rational: "Ductal carcinoma in situ should not be treated but rather watched."
This opinion is based entirely on common sense, which is the most unreliable, untrustworthy, narcissistic, non-scientific reason for concluding anything about anything. And presumably, by "watching," does she mean having an extra mammogram here and there? And during the watch, when she spots the cancer cells throwing a victory party after breaking through the duct, does she arrange for an emergency mastectomy? She doesn't say.
Instead, she says, "For over a decade, I have seen the incidence of invasive breast cancer increase—in spite of the removal of some 60,000 DCIS lesions each year." She has seen this phenomenon? Who is she, God? So, guess what euphemism Dr. Esserman comes up with for a DCIS tumor? Quoting from the Times: "Indolent lesions of epithelial origin, or IDLES."
What will doctors say to their patients? "Congratulations! You have IDLES. Your cancer has only just started!"
So listen, Esserman, the incidence of invasive breast cancers might increase another 60,000 cases—give or take—if they aren't removed before an invasion. And, Dear Reader, guess which expert in the field is quoted by the Times' reporter responding to the IDLES-doctor? Remember Larry Norton, my friend Marnie Mueller's friend's oncologist who the Morra girls told me is one of the top ten oncologists in the world? He weighs in with an analogy as to whether or not an IDLE should be removed: "If someone shouts, 'Heads up!' do you duck or not?"
Here's mine: "What do you do if you hear the crack of a bat, and you're sitting in a loge box seat, and a hundred-mile-an-hour line drive is coming right at you—duck or not?"
Here would be my mother's analogy: "What do you do if you and your friends are playing golf, and there's a totally shit-faced, all-male foursome behind you, climbing up your asses, and one of them yells, 'Fore!'—duck or not?"
(Re the second example: Jere would try to catch the ball. One day he bare-hands a ball heading at directly at him. Not only does he catch the ball, he gets to show all the fans around him the stitch-marks embossed into his palm, matching almost exactly the color of the stitches in the ball—red.)
THE SATELLITE YALE hospital in Guilford is generally referred to by its previous title, the Shoreline Clinic. It's half an hour from East Haven where I live. If I'm going every day for a month, that's twenty hours commuting time plus treatment time lost to me. Can anything be done about that? Maybe. I am still not utterly sold on radiation treatment.
As you can tell, I remain in an altered state. I'm thinking of radiation as time lost rather than saving my life.
My appointment with Dr. Frye is in place, and I head for Guilford, an especially pretty eastern CT shoreline piece of New England. The town green is bordered not only by stately old houses and beautiful churches but also by little boutique shops—clothes, chocolate, books, etc. Alas, I'm not going into town to have a nice walk along the green. I'm going to a medical facility a hundred yards from the Interstate.
I easily park, and in the lobby of the Shoreline Clinic I learn that the radiation department is downstairs. The security guard waves me toward the wide stairway steps away. Stands to reason a radiation department is in a basement. I go down the stairs and come out into a place with no windows. The Shoreline Clinic does its best to guard against random radiation beams escaping the premises and zapping people parking their cars.
At the desk, I meet Alyssa. She gives patients their wrist bands, asks their birthdays, and every Monday enquires as to whether they've been to West Africa in the last week. Pertaining to my earlier remark as to that question, it is pretty much impossible to travel to 90% of West Africa and back within a week. I mean, you can do it but since travel to Yaoundé with Air France, for example, requires a Paris layover, who want to would fly direct?
I meet Pam, my personal nurse. She greets me cordially. Soon, I can't help but think that she would make a great first-grade teacher. She is patient and kind, and she takes me calmly through nine million questions up until the moment her computer crashes, losing my answers, naturally, as they are not yet saved. Charlie is with me. He steps right up to the plate, as always, "Can I get anyone a cup of coffee?" He's looking more closely at Pam than me.
I say yes, and Pam says, "Thank you. I just had one." Then she bashes at a few keys and looks up at him again. "Maybe I'll have another. Black, please."
Now Pam has to ask me the questions again, recording my answers on paper with a pen. But I am sitting in a leather La-Z-Boy sort of chair utilized for the comfort of cancer patients. It is all I can do to keep from falling asleep it's so embracing.
Pam is supposed to be finished with me before the doctor arrives, but she isn't. She will have to finish another time. Therefore, Dr. Frye will not know quite a lot about me yet. My radiologist is a sprite right out of Shakespeare except she's tall. She would make a perfect Puck even though Puck is a male and short. If she can't get that role, she's got Peter Pan sewn up. As my late mother-in-law might have said, she is a slip of a thing—tall, willowy, ethereal. Rather than walk, she appears to float. With all of that, based on her handshake, she is strong as an ox, something else my mother-in-law might have said. In our initial seconds of meeting, I'm thinking, if she plays volleyball she's the one who will leap up and spike the ball, giving herself a tenth of a second to be sure it will slam into your face.
Her hair is blond and short in a gelled, somewhat spikey style, yet soft. She is wearing a skinny, pinstriped shirt and skinny pants. If something from another planet were to see Dr. Quigley and Dr. Frye having coffee, it would assume they were two different species.
She says to me, in light of the crashed computer, "I'll ask questions as I go." She says that happily as that gets her out of having to read the nine million answers Pam and I will have to come up with at another time.
I actually feel instantly bonded with this woman, though she has crushed all the fingers on my right hand. Ensconced in the La-Z-Boy, unable to get to my feet and be polite, I make an excuse to her, "I'd stand up but I'm trapped in this wonderful chair."
"That's okay. I'll sit here, right next to you." She pulls up a chair.
I introduce her to Charlie who is just returned returning. She can't shake his hand because he's juggling three cups of coffee, which he passes around.
Someone walks in. Dr. Frye says to me, "This is Chelsea, my PA."
Speaking of separate species, Dr. Frye wears no makeup and Chelsea's eyelashes are coated with three pounds of mascara. She wears blush that must have taken an hour to perfect because her face is lit up seemingly from the inside. She has a perfect tiny beauty mark on her left cheek not of her design. She is quite stunning. Chelsea, alas, will shortly become my lightning rod and then will never forgive me for my…uh…over-reaction to something she says. More on that in a minute.
Dr. Frye: "Any questions before I tell you what we'll do here? And before my examination?"
I say, "Yes. I don't really know if I should even have radiation."
Her expression doesn't change. She says, "Tell me about that," like she's Carl Jung.
I say to her what I said to Dr. Quigley.
She says, "Here's what we know about very early breast cancer. Before mammograms, a woman, or her doctor…" she looks at Charlie "…or her partner, might feel a lump at its tiniest stage, Stage One. Partners are often the first to feel it even before the woman does. Then, after a lumpectomy the patient would be radiated. It's what we did when we learned that the chances of the cancer returning—whether after a mastectomy or a lumpectomy—are the same. But we needed something other than the immediate jump to surgery—chemotherapy and radiation. We've been following that procedure for forty years. And you know what?"
"It works. And now—hallelujah— we no longer need chemotherapy if the lesion is under five centimeters, and even then, at most just a few sessions to shrink it enough so as not to deform the breast with the surgery."
Exactly what Dr. Quigley told Charlie. But think: Forty years ago. When Betty Rollin's book was published, she must have just missed this treatment. I'm sorry, Betty.
I return to listening to Dr. Frye.
"Recently, there has been one addition to the mix, recognizing a cancer still in situ. DCIS. Consequently, more lives—many, many more lives—have been saved. Statistics show us that. But there are some who question the need to do the surgery for DCIS since the mammogram hasn't shown any cancer cells that have broken through the duct. But, of course, the mammogram won't pick up the infinitesimal pieces of a cancer cell that might have managed that. There are no long term studies or statistics yet of women who wait, who do not have a DCIS removed followed by breast radiation.
"So the reason I recommend radiation for you and others in your situation is because it works."
Clearly, she knows about Esserman, who doesn't mention statistics in the Times article. Who needs statistics when you've got common sense? Ye gads.
My question: "What about a fatal cancer I could get down the road caused by radiation?"
Her eyes widen. She says, "Chance in a million. But there is a far, far greater chance of your having another cancer in the same breast if we don't radiate it."
I will ask the Count for the actual statistic rather than question her "chance in a million" since I need to get on with Part II of my question.
"I heard an ad on CBS radio where you can have your breast radiated at the same time as the surgery. The radiation goes right into the incision. You only need the radiation that one time. What's your opinion on that option?"
She says, "It does sound good, doesn't? That's called intraoperative radiation. It's done in conjunction with clinical trials. We had just such a clinical trial at Yale. The treatment so often caused serious deformity of the breast that most women were sorry they made that choice. Also, when we began to make succinctly clear what they should expect—showed them photos—they almost always declined. Even photos after plastic surgery. We canceled the trial. So again, there are no long-term studies comparing the tried-and-true and the intraoperative. Actually, I don't know of any trials taking place in the United States. I think you have to go to Milan to have intraoperative radiation. I know they're still doing trials in Italy.
"But if you would like more information, or if that is the route you'd like to take, I will let you know where you can get information to that ongoing study or any others."
Milan again. Tempting. Especially after getting a load of Dr. Kumar's shoes.
Then Dr. Frye changes the subject. "I have to tell you—when I looked at your mammography images, I couldn't see a damn thing."
"That's because we aren't trained to read mammograms with authority. And what that means is that the cancer in your mammary duct is so small, you 'll only need three weeks of radiation."
"Dr. Quigley told me four. My second opinion doctor told me five."
She says, "Three," with a tone encompassing how she feels—Screw them. I'm the radiologist, even if she doesn't know how to read mammograms with authority.
Then she says, "One more thing. If you need a drain after breast surgery, we might have to postpone the radiation."
I say, "Dr. Quigley told me she doesn't do drains."
The no-drain decision must have been a recent one for Dr. Quigley. "Nope. She told me lymphatic fluid left in the breast will firm up, meaning less…uh…disfigurement, and so we should let nature take its course."
"Then that's brilliant, isn't it? After all, a drain can introduce infection into the breast."
"Dr. Quigley didn't even bother to tell me that part. She's rather authoritarian. As in, NO DRAIN," me raising my voice with the last two words.
First, Dr. Frye laughs. Then, right to business: "So, Mary-Ann, your first appointment will be for an ultrasound. We will see where your heart and lungs are in relation to your chest wall."
The word "heart" rings a bell. When I google side effects of breast radiation, I get, Possible injury to the heart. Now, maybe lungs, too. I don't ask about that at this time because I'm suddenly entering panic mode what with the problems I have with heavy things looming above my head. "Will I have to be in a tube for the ultrasound?"
"No. It's an open scanner. You claustrophobic?"
"I never was, but I had a recent incident that left me pretty much unable to be under any piece of machinery, including within it. Long story."
"Can you give me the drift?"
"Yes. Last year, I was waiting for the traffic light to change in that intersection in Branford on Route 1 where they're widening the road under the Amtrak bridge. They were also moving the poles there the traffic signal lights are attached by the wires. So, I'm waiting for the light to turn green and all of a sudden the traffic light signals all fell down and one of them missed my windshield by about an inch. It landed in the road next to my driver's side door. I was trapped in my car." I don't say, Then things got worse. She only asked for the drift.
She says what everyone says, "Oh, no! But I never heard about that."
"DOT covered it up. The Branford police helped them. They wouldn't have been able to do that if it had been a school bus full of kindergartners. I told you it was a long story."
She can only stare at me—to repeat myself—just like everyone else who hears about it. I say, "But I had EMDR therapy and I'm getting over it. I still panic when there's a heavy piece of equipment over my head, like a crane. I do my EMDR mental exercises on the spot to get past it."
"I'm so sorry. I'd panic, too." Pause. She's dying to ask me what the hell EMDR therapy is but she hasn't the time. (For now, in a nutshell, the therapist's goal is to inhibit conditioned fear responses when memory of a trauma is triggered. It works.) She says, "We'll do our best by you, Mary-Ann, I promise." She smiles. "You'll get past the crane."
I say, "Thanks." I like her. I will try to believe her.
Then she asks, "May I examine your breasts now?"
She helps me out of the chair. Actually, she pulls me out of the chair like I'm a feather. When I'm on the examining table, she asks if I'd like to Charlie to remain, I say, "Yes," and she checks out Starbright. She says, "Can't feel anything. This is so, so fortunate for you."
She pulls me up; I get a handshake. "I'll leave you here with Chelsea, who will give you further information, instructions and an opportunity for more questions. Then Pam will continue…uh…transcribing the answers to her questions."
Pam says, "My computer's up again."
Dr. Frye says, "Good," and she's off to her next patient.
So first, I get out of the johnny coat and put my bra and T-shirt back on. Also, I get back in the phenomenally comfortable chair, though honestly, I think it's a little excessive. Everyone's been climbing and stumbling around it because the examining room is never intended to have a super-sized La-Z-Boy in it.
Chelsea's accent is Southern belle; ergo, her voice is warm and hospitable. We have a nice chat. She has survived breast cancer. She is filled with sympathy, empathy and compassion. Then she says, "In regard to whether or not to have radiation, it's really just a matter of common sense."
Uh-oh. Sirens go off, bells ring, and for the first time since the morning of the blueberries, I freak. I should have known right then to ask Charlie to get me more coffee or even have a couple of sips of water, but I don't. Now is precisely when Chelsea becomes the lightning rod.
Without even getting into Esserman, I say, "There is no such thing as common sense. There is only data, statistics, and proof."
She stares at me.
So I keep going. "What makes sense to you might not make sense to me and vice versa. Common sense is simply a comfort like macaroni and cheese. I need professional care here. I need to make all my decisions rationally despite the stuff being thrown at me left and right, and I need to make them based on science."
She is stricken.
So am I. So now I say, "I'm sorry." But do I stop there? Alas, no. "Platitudes insult my intelligence." Holy shit. I am my mother.
She manages to speak. "I was just trying to…." She stops. She knows that anything she says will probably annoy me even more. What she doesn't know is something I figure out at a later date—that part of my attack on her innocent comment was in part due to the images still floating in my brain left over from my conversation with Dr. Frye of that fucking traffic light sliding off its cable and coming right at my face.
Chelsea was obviously a great nurse before she was a PA and composes herself rather magnificently. She says, "I respect how you feel."
I say, "Thanks." Then: "Anyway, I think Dr. Frye has covered everything."
She stands up. I manage to push myself out of the chair. I am now really sick of this place. Before Chelsea escapes, she makes sure to hug me without any part of her body except her arms touching mine. The protocol with cancer patients includes hugging, sometimes insincere, whether you want it or not.
I will apologize more genuinely to her at a future visit, tell her that it was not me being rude but rather the cancer I have. I won't add, Plus my traffic incident. Don't want to grovel that extensively. She will come to tell me she has no memory of what I'm talking about, even though I use the term common sense in my apology. She bolsters this by saying she's an Army brat and was exposed to so many hundreds of people in her life that her memory for who's who just isn't there. This is bullshit, right, all you Army brats? It's just that she will not accept an apology.
And then there's a scenario that will come in a couple of weeks that is nowhere near as bad as a traffic signal falling on you, but it's bad, and Chelsea becomes my lightning rod again.
ps. I decide to go along with the radiation plan.
FAR MORE CONSEQUENTIALfor me than Chelsea not accepting my apology, and my son's Hiroshima/All Night Under a Transformer analogies, and the Dominican Republic boogie-woogie, is that I have yet to tell Jay and Melissa what is going on. But I have it all planned. Although I cannot keep the breast cancer diagnosis from them since the burden of secrecy will be too demanding of me, I will couch the news by including the fact that being stepmom-of-the-groom at a wedding with 180 guests will distract me from thinking about this miserable, unexpected disruption to my life, to say nothing of the even greater distraction of seeing to a happy and successful post-rehearsal dinner, dear Lord preserve me. (Actually, I won't bring up that last with them.)
I have to call Melissa anyway. She and I are meeting at a bridal shop in Branford at the end of the week, the shop where my stepmom-of-the-groom dress quest ended. After looking at around 4,000,000 of them in big stores and small shops from New York to Boston and trying on 4,000 of those, I hate them all. Desperate, I ask my friend Debbie-who-read-five-books-a-week if I can borrow the dress she wore at her recent wedding, which will be perfect since it's beautiful and we're the same size. Debbie is all for it. But when she texts me pictures so I'll be sure, I realize her dress is the same color as Melissa's mom's dress, therefore, a no-go. Debbie is really disappointed and so am I.
So, how is it I do not go to the Branford shop first before going anywhere else, or calling Debbie? Well it's just like the people who live in New York their entire lives but have never been to the Statue of Liberty. Why? Because it's there. Another reason I don't go to the Branford shop that makes no sense whatsoever is that I buy my own dress there when I'm about to marry Charlie. Hello? At the time, since Charlie and I are getting married in Bermuda, just us, no guests, I figure to get a fun, red, floozy-like dress. I'll surprise him. So why are we getting married in Bermuda? Because Charlie and I have been through the who-sits-where debacle, and the guest-who-asks-if-she-can-bring-this-great-guy-she-just-met fiasco. One big wedding apiece was plenty. Then, one day, Charlie says in passing, "Mary-Ann, you're going to be my bride." Then the tears well up in his eyes, then mine.
I can see in his glistening-with-love eyes he's not seeing red floozy, he's seeing white virgin. I get a little bummed, what with him not thinking once was enough in that department, but next thing I know, he's buying a designer tuxedo and he's all excited about getting tailored. (I think all that comes from getting married young in the 60s when he wears a white dinner jacket with a cummerbund matching the color of the bridesmaids' dresses. Egad. I'm not going there except to say that when I bring the shower gift from my mother—wedding china—to the local consignment shop, the woman says. "Wasn't amazing how none of us had any taste in the 60s?")
So Jene and I are having breakfast at Branford Lunch, and I'm whining that I don't know what to wear when Charlie and I get married, how I haven't even started looking, either, because I'm having a hard time letting go of the red floozy idea. So, she suggests we go across the street after we finish breakfast to the local bridal shop and check out what they've got. I look across the street the Branford Lunch window. Not in ten million years do I ever dream I'd ever go into that particular store.
I say, "Jene, they won't have what I want."
She says, "You don't know what you want, remember? Maybe you'll get an idea."
"I don't think so."
She says, "Mom," the closest Jene will ever get to bullying me.
I say, "Okay."
After we turn down yet another cup of coffee and pay up, we jay-walk to the other side of the street and walk into the store amidst the billows of tulle, lace, chiffon, silk, taffeta, all floating above gentle white carpeting and hanging against the white walls decorated with tree branches sprayed white, covered with diamond dust which is a fine clear glitter. (Don't ask me how I know that last except to say I do have a little Martha Stewart in me, you can ask my friend Debbie. We made Christmas wreaths once. We denuded the town of Ridgefield, Connecticut, of pine cones. Do you know that when you melt the glue required to stick your pine cones together you use empty cat food cans? Why? Because Martha Stewart is an authoritarian. I do not write her a letter that the wreaths smell of that portion of tuna not meant for human consumption though fine for cats. Does anyone know how something a human shouldn't consume is fine for a cat? Email me if you do.)
Anyway, I explain to the shop girl that I need a second-wedding dress. Jene rolls her eyes.
"What specifically might you have in mind?" she asks.
"I guess I'm hoping there's a rack of second-wedding dresses tucked in the back."
The shop girl says, "Afraid not. But you'll easily find something in the bridesmaid dresses."
On that note, extraordinarily and fortuitously, my mind harkens back to William and Kate's wedding extravaganza, and without any further hesitation I say, "I'd like a dress along the lines of the one Pippa Middleton wore."
The shop girl says, also without hesitation, and with gusto, "I have it!"
She disappears into the torrent of white and immediately returns with Pippa's dress on a silver hanger.
It's a fairly good copy of the original. We head for the dressing rooms, I put it on, and Jene and I swoon it looks so good on me.
The shop girl says, "When is the wedding?"
"Hey, no problem. It's the sample, but we've got two more since everyone wants to try it on. I'll give you this one, half price."
She sizes me up as she makes the offer, worrying that I won't buy it since samples are a size 12, and I'll have to spend a ton to get it reformatted. I don't care. Time is money. I buy the dress and Jene and I go back across the street to Lucy, the tailor, just down from Branford Lunch. I put it on and Lucy says in heavily accented Italian, "'E look better on you than 'e look on Pippa." She manages to say this with a dozen pins wedged between her lips. Then she says: "You gotta the boobies. She gotta nuthin'." (Rule for writers: Never write a dialect phonetically. It will sound offensive. But this is a memoir, and I heard the dialect all my life, and I'm not offended. I fire these lines by several people and nobody's offended. I'm going with it.)
Here is the conclusion of my second-wedding dress story: On the day of the wedding, tropical storm Raphael becomes a hurricane twenty minutes before the hotel's shuttle van is scheduled to bring us to the Marriage Registry in Hamilton for the ceremony. The storm's eye forty miles is south of Bermuda. It's a Category 1, so the driver will take us even though driving is now only allowed if it's an emergency. (There is no Category Zero for hurricanes like there is for DCIS.)
When Charlie meets me in the hotel spa's lounge, I walk out of the dressing room in my Pippa dress, accompanied, bridesmaid-like, by the two beaming spa employees—one of them holding my bouquet—who insists on layering my really nice hair style with a couple of layers of hurricane-proof spray. Charlie gets up from his chair and just stares at me. I spin around what with Pippa's dress having that little flare at the bottom. Then he basically swoons—his shoulders start to shake and I have to hurry up over to him and hug him. I get lots of teardrops on my Pippa dress as well as my half-exposed boobies as Lucy the Tailor calls a cleavage. He tries to speak, no doubt to pay me a compliment, then the spa attendants start sniffling, but I can't hug all of them.
It is a perfect wedding even though there is no such thing as a hurricane-proof hair spray. The Marriage Registrar General, General Aubrey Pennyman, on Her Majesty's Service, officiates. The General could play James Bond, he's so gorgeous. My wedding ring was once Charlie's mother's ring. It's a cameo in a gold oval. It is all he has of her. She died when he was fifteen. I do not have to describe the emotion when he slides it on my finger, do I?
Our witness, Kim Majors, General Pennyman's secretary, catches my bouquet. Then we make a run for the van, Aubrey and Kim for their cars before the hurricane gets any worse. We have a reservation for cream tea at a hotel more England-oriented than the rest. When I suggest that, Charlie says, "Sure, baby," though his expression says, What the hell? Did she say tea? He's never known of cream tea. I'm happy to say he's blown away by ours. So am I. No pun intended what with Raphael, the hurricane, now creating one-foot waves in the koi pond outside the hotel's windowed wall.
When we get back at the hotel, the manager takes us in a golf cart to a moon gate on a cliff above the sea and takes our picture, something you do if you get married in Bermuda. Charlie manages to keep the golf umbrella from turning inside out. We still get drenched.
We go to our room and make love under the ceiling fan, where Pippa's dress hangs from blade, drying as it goes round and road. (I'm planning to wear it to dinner.) A few hours later, the stranded cruise passengers in the hotel's very lovely restaurant give us a standing O when we join them, my wedding finery dry and Charlie's only a little damp.
More in love than ever, our wedding day ends, with us standing on our balcony just like William and Kate in London, more in love than ever, but instead of waving at the hordes, we hang onto each other for dear life while we watch the crashing, smashing waves and the tops of the whitecaps blowing away.
I say to Charlie, "I guess we'll name our first-born either Raphael of Raphaella." We toast such a baby who will never be.
And with that, here I am, back to that same wedding shop in Branford, waiting for Melissa, even though I'm sure I will have to dig something out of the back of my closet to wear for her wedding. But miraculously, the store has so many bridesmaid dresses that look like normal dresses, I am utterly relieved. Also, there's my shop girl who sold me my Pippa dress and she remembers me. She asks, "Was your Bermuda wedding wonderful?"
I tell her all about it. Then, so very astute, she knows exactly what dresses I will like based on my selection of the Pippa dress. I immediately fall in love with the first dress she shows me because it's got a low V-neck and a low v-back and I look six inches taller than I am. Plus there are two more dresses she insists I try on—to be sure—and I like them a lot too, and then one that I sort of like because the color looks so great on me—a deep rich…uh…claret, I have to say. I can only hope that when I meet up with Melissa, we will be on the same wavelength, Dr. Quigley's advice notwithstanding.
Getting back to Melissa, I am saved by circumstances from having to tell her my sorry-ass breast cancer news. That is because Charlie asks me if he can tell Kristin, his daughter, about the biopsy. When she's a college student, Kristin learns her mom has breast cancer. Anna Quindlen's mother dies of breast cancer when Anna is in college—she writes a book about it. Many years later when Anna's sister-in-law dies leaving two teenage daughters behind, Anna tries to imagine the answer she and her brother will have to give the girls if they ever ask, "When does it stop hurting?"
The girls do come to ask that question. The answer: "If it ever does, we will let you know." The four weep together. It never does.
I tell Charlie, yes, of course he can talk to Kristin. But he doesn't think not to inform her that I'm not telling anyone else but my kids, so Kristin ends up telling Melissa. But it's okay. I don't want that job, anyway.
And doesn't Melissa call me just when I am about to call her about meeting in Branford? She says, "Omigod, what is happening with you? This is so awful. Are you all right? Omigod!"
I tell her everything, emphasizing that the cancer was detected so early that I will be cured. I say, "That's what everyone at Yale told me, Melissa, and I believe them."
She says, "I believe them too," but she remains upset. So, I distract her by reminding her that we are going to meet up at the bridal shop in Branford on Friday.
She says exactly what I know she will say, "We are? Omigod! I forgot. I'm sorry. What time did we say?"
"Two. But I'm flexible." I am, even though I'm a basket case, something she doesn't need to know at this particular time.
"Uh…hold on," she says. I wait while she checks her cell for whatever it is she needs to know. "I'll see you at two. I might be a little late."
She has to cross the Q-Bridge to get to Branford. "No problem, sweetie. If you're late, I'll be in the coffee shop across the street. I'm really okay, Melissa."
The next day, she is not late, and on the sidewalk we hug a more special hug than any of the previous ones. Then, arms around each other, we head inside. My shop girl suggests I model all four of the dresses. She says, "We'll see if the bride picks the dress you did." She gives Melissa a friendly smile. "It will be fun!"
Melissa gives me a look. It will not be fun. We're talking a wedding here. Who has time to have fun? But what a clever shop girl. The onus is now on Melissa to okay a stepmom-of-the-groom dress on this very day, meaning right now.
Naturally, I say without thinking, "What if she doesn't like any of them?" which is exactly what Melissa is thinking.
The clever shop girl says, "She's got enough to worry about without worrying about your dress."
The handwriting is on the wall, like it or not. Poor Melissa. But she rises to the occasion and says to the shop girl, "You got that right," and white-lies to me, "If you like it, I'll like it."
In the dressing room, one-by-one the dresses are ready for me, hung across the wall, while Melissa sits out in the showroom in a white lounge chair, not daring to look up at the millions of wedding dresses in case she spots one she likes better than the one she bought.
The shop girl says to me, "Now, we'll put on your second-favorite dress first. Then the third-favorite. Then the one you want, and then the one in plum." (This last is the one I think of as claret rather than plum.) And again, she says, "It will be fun!"
Here's what might be fun: I could sneak out and grab the ugliest dress in the shop, and parade out in that. I would do that to my friend Debbie and we would laugh all over ourselves but I won't do it to Melissa because she doesn't know me well enough.
First dress: I actually like this dress almost as much as I like the claret/plum because it's a great and flattering style, but it is a vivid emerald green and I realize it's too bright and I'll stand out too much. There is no time to order it in another color, naturally. But I sashay out past the chair where Melissa sits like one of the judges at "America's Got Talent," while I do my best to look like a model on the runway. The shop girl takes my hand to guide me up the step to a pedestal. I turn around.
Melissa says, "That is so beautiful. And the color is great for you."
The one thing I'm sure I can count on despite the little white lie is that Melissa will not say, "I was thinking more in the beige department." She wouldn't do that to me.
I look good in any color except gray, which drains the color out of me and my face becomes the color of a sink. (Stainless steel.) But I am so glad Melissa says the emerald dress is beautiful, the color great for me, even though she might actually feel the same way I do about the color. But at least I know have a possible fallback, thank God.
I come out in #2. It's a kind of gold. Melissa says, "I like that, but the style is too similar to my bridesmaids' dresses."
I haven't seen the bridesmaids' dresses; I only know they're black. I'm so happy to hear her say that about the gold dress because I like this dress quite a bit less than when I first see it. I mean, it's gold! What am I thinking? Oh, but the times I come home from a shop with a new dress only to find there are two things wrong with it: It's ugly and it doesn't fit.
Okay. I put on #3, THE dress. I look in the mirror and I love it even more. It is midnight blue drape-y chiffon, the lines so slim and long, which make me look even taller than the V-neck and V-back do. I take a deep breath, turn and look over my shoulder. Hallelujah! It doesn't make my ass look too big! (My daughter-in-law, Kim, has a bumper sticker that says, Does my ass make my ass look too big?)
I turn around again, 360 degrees. The dress also has a certain elegance, something you need when you're Stepmom-of-the-Groom, I think.
I come out. Melissa comes to attention. I am guided onto the little pedestal once again. She looks up at me at me for several moments. Her eyes become moist. She says, "It's… gorgeous. Oh, Mary-Ann, you look beautiful! I love it."
Before I can mist up, too, the shop girl is at the ready with a fabulous necklace which she fastens around my neck. I glimpse the price tag. It costs more than the dress. Another white lie, my turn. I say to her, "I'll think about it."
Now, the shop girl says, "We'll forget about the fourth dress, then?"
"Yes!" Melissa and I say together.
The minute we're out the door, Melissa says, "Tell me the price of the necklace."
"You don't want to know." I tell her.
She smiles with empathy, "Too bad."
We laugh, we hug, and she's happily on her way because she's now checked off another detail on her list of ten zillion details. I'm on my way across the street to Lucy.
First, Lucy says, "Ma-don! You got another sample?"
I confess I do because the wedding is around the corner and I just couldn't find anything. She pats me on the shoulder, empathetic I would have to say, just like Melissa.
Lucy pins and re-shapes. When I go for my final fitting, she wishes me well and sends me to a store with inexpensive jewelry that "…look like a million bucks. Say Lucy send you. They knock off ten percent."
I round up Jene's two daughters, and they help me pick fake diamond and sapphire earrings, and match them up with a necklace and then scurry around the store and come up with three slim fake diamond bracelets, and they all complement each other perfectly.
I buy the girls a few pieces of jewelry for a job well done. We're all so happy. I don't have to say they love Charlie, do I? Here is the oldest's letter to Charlie on his birthday, two years after we met. (He frames it and arranges it between a picture of his mother, and him and me in Hawaii on the beach):
To Charlie. I just wanted to thank you so much for making my Mooey happy. She is the best grandmother in the whole wide world and deserves the BEST. I know you make her feel like a queen, and it makes all of us so happy to have somebody like you in our lives. Plus, you have the world's best model train sets. You mean so much to me and my family and I am so grateful that you care about my Mooey. We all love you! Thank you, Charlie. I love you. Sincerely, Amanda. ps. This letter was written a year ago when we found out you got engaged.
Another verklempt moment, right? And isn't it provocative that Amanda thingks to hold off for a year before giving him the letter in case the engagement doesn't work out?
Melissa calls me a few days later. "I have so got to tell you this, you will love it! Charlie just called me. He said he doesn't want to see your dress till the wedding—no surprise there, right? But he wanted to know if your dress had a low back. I told him, yeah, it does. He was so happy. He says to me, 'Mary-Ann has such a beautiful back.' Isn't that awesome?"
I take my silver-sparkle wedding sandals from out of the back of my closet; they still have a little Bermuda sand on the bottoms.
I am ready to boogie.
IN A BLUR OF HAPPINESS and music and dancing and the sun just before it settles into Long Island Sound, on cue, Jay and Melissa's wedding is perfect except for Charlie's two little granddaughters. Our flower girls extraordinaire have to pee just as the procession is about to launch. Melissa's daughter, the junior bridesmaid, looks at me, and I say, "Go." She steers the little girls out of the line, and is gone and back in less than two minutes. How?—no idea. She's a trooper like her mother. Then we all proceed carefully down a hill on a wood stairway, the Sound shimmering, and across the grass to our seats. We watch Jay watch Melissa until the two meet in front of the Justice of the Peace. They touch hands for the last time as two single people.
My most verklempt moment of so many is when, around midnight, the couple sets off into the night and Melissa looks over her shoulder to me and says, "Bye, Mom."
When they are on Day Two of their honeymoon at the Punta Cana resort where I'm going with Charlie by hook or crook when Starbright is being radiated, Melissa texts us: I didn't know there were places like this. Thank you. (The honeymoon trip is our wedding gift.)
Also on Day Two, Charlie and I are back to Smilow. From now on, Smilow is how we refer to the cancer hospital at Yale. You can only take saying cancer over and over for so long.
Charlie makes the perfect hand-off when he passes the car keys to the Yale-New Haven valet. We now know those valets are under a lot of pressure. Inside the hospital doors, "Admitting," is the first turn to the right. It is 7 a.m.; we are exactly on time because we are sure to give ourselves an extra hour.
"Admitting" is a large dark room that looks like a bus depot only worse. Or maybe the lobby of a non-descript motel along the interstate with its row of free Raisin Bran, Corn Flakes and Fruit Loops, Econo Lodge coming to mind. We sit in the third row of the sad rows of folding chairs. They are mostly full as are the extra chairs lining the wall. I take in the miserable creatures all jammed together on these uncomfortable chairs and I am back to thinking bus depot—a Depression-era bus depot like you see in old black and white movies.
Charlie and I get Alfred Hitchcock's "Rear Window" from Netflix recently, a 50s color film when most are black and white. Turns out the reel someone manages to find in a box of empty tin cans is in terrible shape, so it's...uh...restored.
"Rear Window" actually looks like it's re-colorized! The grim backs of the apartment buildings facing James Stewart and Grace Kelly spying on the neighbor who—spoiler alert—murdered his wife are now glowing red like newly-sandblasted brick, and the decrepit garden where the dog digs up the flowers has Technicolor flowers rather than the dried-up weeds they used to look like, which was far more effective to the spirit of the film. Wouldn't you rather have some things not be restored? The movie would be so much better if the reel of film still had jagged tears, and holes, and coffee stains the way whoever found it found it. But that's me.
Yale-New Haven could take a lesson from the city of New Haven, I realize, once we sit down. When you serve on jury duty, you get to wait in a lovely, soothing room right after you walk across fabulous terrazzo floors, admiring the pillars and high marble ceilings that inspire you to stop bitching to yourself and feel glad about performing your civic duty. Yale, on the other hand, takes its cue from the DMV, where you sit for hours like a stupefied idiot waiting for your number to be called so you can go to the back of the first of 10,000 lines.
At the front of "Admitting" three people sit at a long table, a computer in front of each. One by one, patients are called up to the desk. At 8 a.m., an hour after I'm told to report, and two hours after my alarm goes off this morning, I'm still not called, so I approach one of the three people and ask if someone might have accidentally skipped my name.
I get a tight smile unlike the nurse smiles. The person says, "We don't call you until we hear the OR is ready for you."
"The surgery is scheduled for nine. Will they have me ready in time?"
She doesn't believe me, I can tell. "Let's give it a few more minutes," and calls out a name that's not mine.
I insist Charlie go and get some coffee so at least one of us isn't going through caffeine withdrawal. I'm not supposed to have anything after seven last night— thirteen hours ago—and I'm now starting to obsess; visions of Uncle Sam cereal, which I love and have every morning pass before me. I mix no-fat Fage (pronounced Fi-Yeh! as is helpfully stated on the packaging) Greek yogurt with no-fat milk until it's of a consistency where it will sink into the Uncle Sam but remain yogurt-like. Then I sprinkle on top Planters Nuts and Seeds trail mix I combine in a large jar with almonds and crushed walnuts. Scattered over all, as you know, a handful of the traitorous blueberries. I'm over my fury with blueberries even though I eat the world's healthiest breakfast and still get breast cancer, giving me the right to remain furious forever. But lately, forever takes on new meaning—it's not as long as it used to be.
Charlie doesn't go for coffee. At 9 a.m., he takes a turn asking one of the computer people, again, what's happening with me because the cavernous, depressed room is now empty except for us and them. Turns out, there is an error. I never get a late-night voice mail: Dr. Quigley has to take care of an emergency situation and my surgery is rescheduled for 11. I stay calm because shit happens. I stay calm for one more hour and then, stomach wildly growling, I approach the long table and ask a computer person if Dr. Quigley is out of her emergency surgery yet, and if so, could I be removed to whatever pre-op place I'm supposed to go to so I can get my mind off food, and so Charlie can go get a bagel at the food court. He is refusing to leave me until we both know what's what.
I say, "If my husband faints from hunger, he will hit his head on the floor and you will have to get a neurosurgeon down here, but they're all in surgery, which means you will have to take care of him."
The woman takes pity. She should. I'm willing to eat Fruit Loops if I have to. She makes a phone call. Then: "You can go to pre-op now. Someone will come for you in a few minutes."
Right. But someone does. I have no recollection of the walk through the web of corridors, and doors, and elevators, or the wheelchair driver except that it isn't Hank Aaron. But I do remember the feel of Charlie's hand in mine the whole time. He has warm strong hands, lucky me. (Oh, his massages!) He will not let me go until forced.
I do remember where we end up, I remember precisely. We're in a hallway lined on both sides with cubicles, bright and white like a hospital is supposed to be. I don't know how many cubicles because I can't see the end of the hallway. Suffice it to say, a lot of them. In each cubicle is a patient along with one to six hangers-on, plus a hospital bed. Imagine, if you're a Catholic, six people in the confessional along with a bed. You can tell which of the people are patients because they are into their surgical gowns and flimsy robes and are nervous wrecks, which is what I am.
I experience a camaraderie because we are a collective that we didn't join of our own free will. A collective of misery trapped in a nightmare, mine not so bad, I'm told, again, as you know. Forgive me, dear reader, for repeating myself.
The nurse has me out of the wheelchair, tells Charlie and me to have a seat, smiles, wishes me well, and then another nurse arrives with a clipboard. She smiles, pulls my cubicle's curtain closed, introduces herself, and I introduce her to Charlie as she already knows my name from the chart.
She says to me, "Everything off and put these on—gown, robe, and slippers." She holds out a cellophane package. I take it. "The doctor will be in to examine you shortly."
"No. A resident who will be with you during surgery."
Then she says to me while looking at Charlie, "Would you like your husband to remain with you while you change?"
I say to Charlie, "Do you mind staying, honey?"
He says, "Does a bear shit in the woods?"
He's getting a little punchy but who isn't?
The nurse leaves. When Charlie has his knee replacement surgery a year earlier, after he takes a flyer over a line (that would be a rope to you land-lubbers), the pre-op room at the hospital is more like what you see on Grey's Anatomy—big room, a lot of commotion, patients separated by curtains, several of them blood-stained, the curtains and the patients. Charlie, looking at the splash stain on his curtain, says, "Maybe someone dropped a chocolate milkshake."
He grins at me. I love him.
We are left alone, him prone on a narrow bed. He is so brave, so sure to grin at me so I won't worry, lol. I get on the bed with him and we wrap our arms around each other and make out a little. A nurse pops her head in, and says, "Whoops!" She pulls the curtain closed, making sure it covers the entire opening. She says to us from the other side of the curtain, "I promise next time I'll announce myself. You doin' okay, Mr. Bimmler?"
He still has his hearing aids in and says, "Yes," instead of my having to say it.
"Dr. Komninakus will be here in a few minutes."
Then we laugh just the way we do when we are in the quiet car on Amtrak from Boston after a ballgame and don't know it's a quiet car. A conductor interrupts us making out, giggling, etc. and tells us the quiet car should have noise no higher than the noise level of a library. He says, "That means none." We apologize. I say, "We usually drive," as if he cares. We wanted to experience the Acela. (The Acela travels at its greatest velocity on the eastern seaboard starting at the Connecticut/Rhode Island border and until it arrives just a few miles north at Kingston, where the University of Rhode Island is. If you take the Acela to Boston, make sure to never be in the bathroom during this leg of the trip or you will fly into the wall, etc. when the train decelerates in Kingston.)
Charlie and I snuggle up again and I'm almost asleep when we hear his nurse say, "Knock, knock."
Charlie says, "Yes?" as we disentangle.
"I'm back. With Dr. Komninakas."
Charlie says, "C'mon in, Doc."
The nurse…uh…gingerly, I'd have to say, parts the curtain. Both of them sport expressions on their faces I would interpret as: Please don't let these two be screwing their brains out.
Then, Dr. Komninakas takes over, eventually chain-sawing Charlie's kneecap out, and somehow, some way, fits a stainless steel one into the blank space. It works!
Today, here at Yale, in another pre-op room, Charlie helps me get into the "gown" and "robe," and then up onto the end of the examining table. He hangs the slippers on my feet. These slippers would be a perfect if I had fallen arches and wore a size 12, triple E. Then Charlie tells Starbright she will be fine. But he is looking into my eyes.
He takes a chair. I ask him to open the curtain because I am feeling a little close in addition to starving and freezing. He hops up and swirls the curtain to one side, reminding me of a matador. I am in the direct line of vision of the patient across the way and her six guests, but they are not seeing me. They are seeing what is in their heads and wishing they were seeing something else—anything else.
And then, zoom, here's Jene in her blue scrubs. She puts her arms around me, then lets me go, turns to Charlie and says, "Hi, Charlie," and hugs him, too. While he's off to find another chair, I suddenly think about Jene in a new light. She is now one of those women who goes to the doctor and has to answer the question, Is there breast cancer in your family? with, Yes, my mother. I scrunch back my tears. There's a lot of things now that make me cry rather than getting pissed.
She says, "Are you crying, Mom?"
She knows I'm lying and will cheer me up. "Salty is now playing with Ninjie, Mom."
Ninjie is one of Salty's two girlfriends at doggie day care. Ninjie is a rescued greyhound. She wears faux leopard jackets and jeweled collars when she makes her entrances. Salty, that little rapscallion, has a second girlfriend, Tia, a black lab who is so old she can't keep up with him and Ninjie, but is content to sit under a shady tree and watch their Greco-Roman wrestling.
How I wish I could be there right now—with a gang of dogs expecting humans to throw balls across the lawn for them to retrieve, and do this over and over till they drop. I'm often tempted to ask Dr. Cieplik and Dr. Beers, our vets at East Shore Veterinary Hospital in Branford, if they might consider allowing people who need assisted living to go to their doggie day care instead and play with all the happy dogs or sit with Tia and just enjoy the shenanigans.
Charlie's back with an extra chair, and Jene sits down. We three chat, trying to act like we are at Twin Pines Diner having coffee and bagels, even though an MA arrives to take my vitals. (MA is not someone with a master's, it is a Medical Assistant, someone who now does the stuff nurses used to do. Scary, isn't it? PAs and MAs instead of doctors and nurses.)
Jene then says, "We're really short-staffed today, Mom. My supervisor took over for me. She said to tell you that the clinic staff wishes you well. So does the patient I need to get back to. He told the supervisor he didn't want her, he wanted me. I told him about you. He said to tell you to give the doctors hell."
She smiles, but she's got tears in her eyes. She will fight crying, too, because she says next, "Then he told me to get my bad ass back as fast as I could." She quotes him, "'I don't trust nobody but you, sugar.'"
Now, we can laugh. She's a good daughter and she's a good nurse, too. She knows I've got Charlie, and her patient in community health is probably homeless, or drug-addicted, or an alcoholic with hepatitis. Who knows? And what advocate does he have? She says to Charlie, "Call me the minute my mom is back from surgery."
He says, "I will," and then they hug each other for a long time. When she hugs me, she is trembling. I say, "I'll be fine…sugar."
Big Jene smile. "I know you will, Mom."
"And I'll give the doctors hell."
Charlie says, "She'll do that even if your guy didn't say to."
The original nurse is back. She's overhearing this conversation. She says to Charlie, "Time for you to be off too, sir. You can go to the family waiting room. There's coffee and muffins—stuff like that."
Then she says to Jene, "Go there with your dad if you like. Grab something while you've got the chance."
Nurses watch out for their own. They'd better. But Jene is disconcerted for a second. Charlie recognizes her feelings and says to the nurse, "Jene's my stepdaughter."
Jene says, "It's okay," and to her stepfather, "C'mon, Charlie, I'll walk you to the food court instead. You can have serious food. Lunch."
She knows the family waiting room will not be a party scene.
Then I am buried in Charlie's arms, and a moment later he and my daughter are waving to me over their shoulders, stiff upper lips all around.
I say to the nurse, "I don't want to be alone."
My nurse, as it turns out, can be authoritative when need be. She says to me, "You're not alone. I'm here and I'll take care of you." She kind of looks past me. "And here comes one of your doctors, I think. It's hard to tell—these residents all look twelve years old."
IT IS INDEED one of my doctors. She greets the nurse and then says to me, "We so apologize for the long wait. Sometimes communication isn't what it should be. I'm Doctor Kim. I'm a resident." She puts out her hand. We shake.
I say, "When you're through with your residency, I know you will fix things like that."
She produces two great dimples. She says, "I'll certainly try, I can promise you that…" she glimpses down at the chart the nurse has handed her, "…Mrs. Smith."
If my late mother-in-law, Mrs. Smith, were alive, she'd be with me even though her son and I are divorced. I adored her. My own mother, if she were alive, wouldn't be with me, she'd be out on the links. I adored her, too, but I was raised with a low priority rating.
The resident examines me, and tells me my vitals are great. Then she looks me up and down, a more typical examination of non-doctors, and says, "Keep doing what you're doing. You're lookin' good." Then, "See you in surgery, Mrs.—"
"You can call me Mary-Ann."
I ask before she can get away, "You'll be there along with Dr. Quigley?"
She closes the curtain when she leaves.
The nurse who says she'll be with me isn't. It is time to take refuge into my second largest activity after writing—reading. I get off the table, get my book out of my bag, sit down in Charlie's chair, and put my feet up on Jene's. The book is the latest from the guy who wrote Corelli's Mandolin and a dozen more books that come before. I love them all, but nothing will ever top Corelli, which is why I put off reading Birds Without Wings, this newest book. I feel like it would be disloyal to Corelli and his mandolin to read Birds. But the writer has yet another book coming out soon, so I can't get behind. However, let me google here before I continue on this subject so I can tell you the author's name.
It is: Louis de Bernières. Like, who the hell can remember that?
Anyway, one of the ten million reasons I love Corelli is the rich and colorful names Louis gives his many, many chapters. In this new book there are 67 of them, twice as many as in Corelli! Clearly, I'm not the only one who loves his chapter names or he wouldn't have doubled the number. Inspired by Louis, I was going to give names to the chapters of this memoir. I wrote, Chapter One: "Dense Breasts." But I can't think of any more near to the quality of Louis', so I scotch that plan.
I start Birds Without Wings by first reading the names of Corelli's chapters, a few times, actually, and they totally live up to rich and colorful. I pick my three favorites and will ask the writers' group I belong to that they do the same, and we can compare. My picks: "Ibrahim Gives Philotheix a Goldfinch"; "The Telltale Shoes"; "The Humiliation of Levon the Armenian." My backup: "A Cure for Toothache."
A half-hour goes by. I'm loving this book, ergo am transported. But then a disheveled fellow with a major beer belly throws the curtain aside. He's got both old and fresh food stains down his shirt, a shirt that gapes open where a couple of buttons once functioned. I figure the guy got past Beaumont because all the security guards are probably having lunch by the fountain at the food court like I hope Charlie is doing.
I am about to reach for the emergency cord when slob-ola speaks to me. He says, "Dr. Crenshaw. I'm your anesthesiologist."
God, give me strength. I am going to have an anesthesiologist who sleeps in his clothes—clothes that he spills food on—and who probably lives on Bud Light to lose the beer belly when, as everyone knows, Bud Light will give you a beer belly bigger than the one you get with straight Budweiser.
My wheels are immediately spinning, trying to figure out how I can get another anesthesiologist at the last minute. But my stomach growls and interrupts my train of thought.
"It's nice to meet you," I say to Dr. Bud Light, "Have you got any food on you?"
He just stares at me so I say, "I'm starving."
Then he becomes all doctorly since he doesn't have a sense of humor and also might well think I'm making fun of him, and says, "Even if I did, I wouldn't let you have it."
No kidding, you slob, I don't say. He is supposed to keep things light so that I can remain calm, I should think. He should be saying something like: For a hundred bucks, I'll give you a piece of gum.
He doesn't say good luck or goodbye or anything else, just leaves, swinging the curtain shut again. I'm start chapter one of my book, just as the nurse returns carrying a tray with a syringe and a little glass bottle on it.
I say to her, "Listen, I have to get another anesthesiologist ASAP."
"Yeah? How long does he last in an operating room before he has to send out for a pizza?"
She laughs, she puts the tray down. "Don't worry, he fills his tank first. Really, he knows what he's doing. People request him all the time, and besides, your surgeon is Dr. Quigley who will be in complete charge," meaning that he probably doesn't dare send out for a pizza or Quigley will feed him to the guy in that Hannibal Lecter mask, only leather, in "Pulp Fiction," whose job it is to keep an eye on Bruce Willis while Uma Thurman's boyfriend is getting raped. "Pulp Fiction" is my all-time favorite movie since "Casablanca." (I'm sure Quentin Tarantino created the rape scene to give the audience a realistic taste of the horror a woman suffers, and her awful vulnerability, when she is raped. Who can know that Quentin's real-life girlfriend will nearly get raped by Harvey Weinstein, but Quentin is unable to take the threat to her seriously. Now, he does. So when are you going to take a metal bat to Weinstein, Quentin? Maybe Mira's dad, Sorvino Sr. will hold him down.)
The above is what my brain does when I'm feeling depressed and depleted. I have to trust the nurse is right, that Dr. Bud Light may be a slob with zero personality, but knows his anesthetics.
The nurse bends down to me and brushes my hair off my forehead. She says, "If it's any consolation, it's time for your pre-op tranquilizer."
Previous to this moment, I take a tranquilizer once in my life. I am in my 30s and I go to get out of bed one morning and can't because my neck is in some kind of spasm. I can't turn my head in either direction. I somehow reach my phone, the reach making my neck really hurt, and soon, Kay Yomazzo, my neighbor, is calling for an ambulance, and the last thing she says to me before I'm speeding off to Danbury Hospital is, sarcastically, "Thanks a lot." That's because she now has two toddlers to chase after instead of just hers.
At the Danbury ER, I see a doctor who determines my neck probably isn't broken but orders an X-ray and a couple of Valium to see that I lay still during the X-ray since I can't stop wiggling trying to get into some sort of pain-free position. After I take the pills I feel my muscles turning to mush, and the room begins to tilt.
I am wheeled off for the X-ray and brought back.
The doctor comes back again and speaks directly into my face, his own six inches from mine so I'll pay attention: "Well, Mrs. Smith, you have a tiny spur on a vertebra in your neck and my guess is that it somehow made the slightest contact with your spinal cord when you went to get out of bed, causing a muscle spasm. This is the body's way of protecting itself. It's a fluke. It'll probably never happen again. When you get home, take a hot shower—hot as you can stand it, just aim the nozzle right at your neck where it hurts—then take two aspirins and go to bed. Meanwhile, we'll put you in a neck brace. Wear as needed."
Then he says, "Are you in pain right now?"
I say, "Yes, but I don't give a shit."
He says, "Perfect," and is gone.
I really can't say enough for Valium if you're ever in such a predicament, and aspirin and a really hot shower if you suddenly have a muscle spasm. Works for me. I don't believe the ER's doctor about the vertebrae spur but he felt he had to say something in case I was the kind of patient who would ask why the spasm happened. I'm more of an I-don't-care-why-it-happened-just-fix-it person.
The room at Yale is actually tilting right now too, same as the Danbury emergency room where I take the Valium when Jene is two.
Next, the nurse takes the book from my lap, and someone is helping me into a wheelchair. I hope it's Hank Aaron, but I'm not conscious enough to check. I am vaguely aware of wheeling past the patients still in their cubicles waiting their turn, and the empty cubicles where other patients have already boarded and departed. None of those are back yet, but I think I must have waved at the gang across the way since they are slightly smiling and waving at me. The central figure, a really caring person, I'd have to say, calls out to me, "Good luck, sweetie." I give her a garbled, "You, too." The gentleman next to her starts crying.
I am unconsciousness. I don't slip into it. One minute, there's a gentleman starting to cry, and the next I'm aware of some small discomfort, like I'm lying on my back on a hard floor, plus I've gone blind. I realize opening my eyes will help. I try hard to do that but nothing happens. Maybe I fell out of the wheelchair since the driver wasn't Hank Aaron. I try again to open my eyes and they do. I'm immediately blinded by white light that is even brighter than Times Square where they now use LED bulbs. Am I going down a tunnel and God is at the end? I sure as hell hope not.
The discomfort I feel I pinpoint to my left arm. I have a moment of lucidity. I look away from the light and I can make something out. A tube from the vicinity of my inner left elbow is leading I don't know where. I try to follow it and can't help but notice that I seem to be encircled by a ring of people. Since they are all shrouded in white, it must be the Ku Klux Klan. I am in hell. But then I note that instead of the Neanderthal hoods, they are wearing shower caps. Also, masks that doctors wear over their mouths when they operate on you.
I am on an operating table and…I am fucking CONSCIOUS!
I hear a voice. Male. "Nu-Gu Chin, intern."
Another voice: "Shelley Halloran, surgical nurse."
"Marina Gonzales, RN." It's the kindly voice of Dr. Quigley's shadow.
"Franklin Crenshaw, anesthesiologist." With that, I realize I must speak! The ring of doctors includes the Budweiser Light-swilling slob, who has not given me enough juice. I try to yell, Help! But nothing comes out.
Next voice, not mine: "Monica Kim, resident," she who will make things more efficient when she's an actual doctor.
Next: In the voice of an adolescent whose voice box hasn't yet matured, "Charles Newton-Finch, the 4th, Yale medical student."
And then, "Diane Quigley, surgeon."
OMG. I will manage words so Dr. Quigley can save me. I say a mish-mosh of syllables, none of them real words.
The circle of people in white suddenly goes from statue-like to all looking around, eyes wide above the masks. They don't know where the voice is coming from. And so, with all the effort I can muster, I manage words! "Mary-Ann Tirone Smith, patient."
A circular row of eyes shifts to my face. Dr. Quigley—I can tell it's her by her awesome black glasses—leans over me and says, "Go to sleep, sweetie."
So I do, vaguely hoping she smacks Dr. Bud Light.
I wake up. Time can stand still. I'm in the very cubicle I'm in before surgery. The curtain is closed. Charlie and my nurse are on either side of me, each holding a hand. Charlie takes note of my eyes opening. He is waiting for that moment, I can tell. I smile at him. To keep from collapsing with relief, he bends over and buries his face into my stomach. He says something muffled. He lifts his head and takes out his cell phone. What was muffled was probably him reminding himself that he promised to call Jene when I wake up. He presses the numbers. Staring into my eyes, he says into the phone the sort of gobbledy-gook we all say, when we're crying while we try to talk.
I'm sure Jene understands him since she's an experienced nurse and hears crying language all the time.
But the nurse takes the cell from him. After she asks who she's speaking with, she says, "Your mom is out of surgery, and she's doing very, very well." She'll be going home in a few hours at most. Your dad is doing well, too." Pause. "Your stepdad, I mean." Another pause. She smiles into the phone and says, "You're welcome," and hands it back to Charlie. She calls Jene sweetie just like Dr. Quigley calls me when I announce my presence in the operating room. Once, a waitress calls my father sweetie. He becomes a regular at that restaurant.
Then Charlie says to me, now more sniffling than crying, "I love you, Wonder Woman."
I say, "I love you, too, Eagle Man."
Those nicknames refer to our second get-together when I suggest we go on the eagle-spotting trip with the Audubon Society on the Connecticut River even though it'll be freezing since it's February.
When I suggest the excursion, he says to me, "Who are you? Wonder Woman?"
I say, "Yes."
He says, "I love eagles."
Hence, our nicknames.
In the post-op cubicle, formerly the pre-op cubicle, I begin to drift in and out of the anesthetic. Then I find myself sort of sitting up with Charlie trying to pull my socks on. How he got the jeans on, I'll never know. The only other thing I have on is bandages covering Starbright. Starlight is uncovered and all perked up, she's so proud of her twin.
I think I will try to speak. I say, "Hi, Eagle Man."
He looks up. He has a really tear-stained face. The nurse probably figured he needed something challenging to do and so she left him to the job of trying to pull clothes onto a half-conscious woman.
I put my arms out. I say, "I think I'm falling."
With that, the sock seems to slide up by itself, and he comes around to the side of the table and gets his arms around me and holds me against him. He does this with such an effort at being gentle and not leaning onto poor Starbright that I'm really relieved at his success in that department; Charlie is pretty much a bull in a china shop kind of guy who trips over boat lines.
He says into my ear, "Tell me when you can sit up so I can get your shirt on."
I am so comfortable in his strong arms. But I don't say, I can't sit up, even though I can. I need a few more minutes, then I do, and Charlie picks up the jersey cami he has thought to put on the side of the bed while I'm unconscious. My instructions are to not wear a bra for a week, but rather something snug like a stretch cami. He brings the cami down, oh so tenderly, over my head and stops. Then he very carefully gets my left arm through the arm hole, and then not quite as gently, my right, figuring Starlight doesn't need that much attention. Then he covers Starbright and her bandages, and Starlight, too.
Then he picks up the plaid flannel shirt, also on the side of the bed, that I grabbed from his cache of thousands. A too-large shirt is recommended but I know I'll need something warm since we're talking hospital here where doctors don't want you to see them sweat.
Charlie gets his shirt on me, rolling up a foot of sleeve on each of my arms.
I say, "Thank you, Charlie. I love you."
The nurse gets back in time to see Charlie crying again.
"Let me do her sneakers," she says, so she can get us the hell out of there. Following that, she holds up papers while telling me what they say—instructions on how to take care of myself. I don't hear a word she says. But it's okay since it's all in the paperwork.
On cue, she says, "Look. I'm putting these papers in the bag with your shirt, bra, and underpants. You have your pain meds?"
What a cool nurse.
"I don't know."
Charlie takes a prescription bottle of ten hydrocodone tablets—brand name, Vicodin—out of his shirt pocket and waves them at her. "Don't worry, I got 'em."
I say, "I'm so damn hungry."
The nurse says, "You must be. We're almost all set to go here. Ten minutes most." She leaves and is back in five with a wheelchair. "Go get something to eat and take one of your pills with the food."
Exactly what I plan to do.
I say to the wheelchair guy, "How's Hank?"
"He's good, man."
The nurse says, "All best to you, honey."
Charlie says to me, "We'll start with soup."
I say, "Okay." He is telling me what I should eat before I can have a chance to say, I'm having a hot fudge sundae, but I agree.
Yale-New Haven has Scotch broth. Charlie has never heard of Scotch broth, something I was raised on—one of the thousand varieties of Campbell's soup. When it's home-made, it isn't half salt the way Campbell's makes it. The hospital Scotch broth is definitely home-made. So delicious. I offer Charlie a taste.
He says, "Boy, is that good. What're the white things?"
He gets a bowl for himself.
Once I finish my scotch broth, I take my pill and find I don't want to spend the time it takes to eat a sundae, but I need sugar, I can tell. Maybe a Milky Way. The Scotch broth clearly makes me a kid again. I make the request of Charlie. He comes back with one and also his favorite candy bar from childhood that is often hard to come by: a Payday. He waves it at me, sticks it in his pocket and unwraps the Milky Way. I first gnaw all the chocolate off, then eat the layer of caramel off the top. I stop.
He's previously seen my Milky Way performance. He says, "What's the matter?" I look up at him; I haven't got the energy to eat the nougat. Charlie eats it. Then he dunks his napkin in his glass of water and cleans my chin.
When I come to tell Dr. Quigley that after I take that day's prescribed hydrocodone (Percocet) I don't need any more. Four Advil at a time does the trick. She says, "Show-off."
Not quite the affirmation I expect. That's okay—the important thing is that having a mammary duct and its surrounding tissue surgically excised is nothing like having two ends of a broken bone screwed back together again—for that you need all the hydrocodone you can get your hands on. However, be prepared for when your doctor tells you there are new rules and he can't refill the prescription because you'll be addicted to opiates. Before that happens to you, here is my advice:
First, after taking your last Percocet, see to making fresh ice unless your fridge has an ice-maker. Then line up on your kitchen counter what you need to make a perfect martini. (A hint of freezer burn does not make for a perfect martini that's why you'll need fresh ice.)
THE PERECT MARTINI
Place a martini glass in the freezer where it won't fall over. Also a metal shaker and a strainer, preferable a really clean one. Since there is no such thing as a really clean strainer, you need to buy a brand new one. (Are you beginning to see why Julia Child insists you always read a recipe long before you turn the oven on, before you find out you have only two eggs left and the Nora Ephron key lime pie you're about to make requires five.)
Two drops of Vermouth (Keep Vermouth in fridge after opening—it's perishable, according to my dad, advice he gives me when I'm seven while he's teaching me how to make the perfect martini.) Note: if you use only one drop of Vermouth, you have an extra dry martini. I don't know why anyone would want that, seeing how the usual, normally dry martini is heaven on earth, but who am I?
Three ounces of your favorite gin (My favorite is Grey Goose, but I think I once told you that.)
Half dozen large ice cubes, FRESH.
FOR THE GARNISH:
An olive without a pimento sticking out, or worse, an almond, or more worse, a chip of garlic. If you use one of those, instead of a perfect martini you'll have a shitty one. (Since you haven't read the recipe before you started, you may think you can dig the pimentos out of the olives you already have in the back of your fridge—likely moldy or smelling like Play-Doh if you have small children since they put their works of art in the fridge to harden and then forget them—but the flavor of the pimentos, etc. will still be in the martini. Yuck. Can you tell I can't abide a dirty martini? I would rather drink a martini with Play-Doh in it rather than olive brine.)
A toothpick. One made of wood, by the way.
Note: a vodka martini can never be a perfect martini. That's because it's not a martini. It's something Ian Fleming made up.
Take the metal shaker out of the freezer and put in the ice.
Drop in those two drops of vermouth.
Take the gin out of the freezer. (Oops, I forgot to tell you to keep your gin in the freezer too. Sorry.) Put your three ounces into the shaker. (If you haven't followed Julia's advice and don't have anything that measures ounces, guess. Note that if you guess you will have an imperfect martini, but at this point, fuck it.)
Swirl the shaker rather than shake or stir it—a half-dozen swirls. If you're curious as to why, google why you must swirl rather than the other two options and learn all about the chain reaction required to end up with a perfect martini.
Take your martini glass and strainer out of the freezer and pour the martini from the shaker which you don't shake, through the strainer and into the glass.
Skewer your olive with the toothpick and put it in.
Sit down in the most comfortable place where you live. In my case, it's Charlie's lap. If your most comfortable place is someone's lap, double the recipe because by now you are following Julia's advice and have already doubled the recipe, meaning you won't have to share your martini.
Have a second martini at bedtime. Don't listen to anyone who says alcohol will keep you awake. Listen to me. We're talking a perfect martini here, not a six-pack of Bud Lite.
Next day, two more; day after that, one plus four Advils. Then, as needed.
And so, since Starbright's surgery does not lead to anything beyond discomfort for the next few days I have just the one martini to celebrate the surgery being over since I feel a martini is a celebretory drink unless it's a pain-killer. (Unlike a doctor's interpretation, I see "discomfort" as equal to a hangnail. You don't feel discomfort when you have a mammogram, you experience pain. Notice they don't ask you your pain level when you have a mammogram. My average is an 8. And when you have an ultra-mammogram before a possible biopsy, it's a 10, though somewhat mercifully, lasts three seconds. Ergo, do all the martini stuff above before every mammogram.)
I sleep on and off for hours and hours during the days after my surgery. Hunger can always be counted upon though, to wake me up. For our next three dinners, Charlie and I eat our version of comfort food: The first night, lobster rolls from the Sandpiper down the street; second night, rigatoni with meatballs following my Auntie Palma's recipe. (Per two pounds of ground chuck, beat one egg in a large bowl, mix in a quarter cup of homemade bread crumbs—grate two slices of stale bread—and a little salt and pepper. "That's all," warns Auntie Palma, waving her wooden spoon in the air, "you're not making meat loaf!" Form into balls and fry them till brown in rendered salt pork, and chopped garlic on medium so as not to burn the garlic, and then put them in your pot of sauce to simmer for fifteen minutes, give or take, along with all the stuff you scrape out of the frying pan); third night, three-inch-high lamb chops from Costco in Charlie's marinade (olive oil, red wine vinegar, salt, pepper and a ton each of garlic and fresh rosemary needles) grilled rare. Julia Child once noted to her American viewers that the longer you cook lamb, the gamier it becomes. She, in fact, shouts an exhortation into the camera, a là Auntie Palma: "Lamb is not pork! Lamb has never given anyone trichinosis! You might as well eat an old shoe if the lamb chop is not a lovely rich, deep, just-shy-of-red inside." Julia child frees us to try rare lamb and swoon with culinary joy.
The morning after the lamb chop dinner, I get into the shower by myself, turn it on, and stand there for five minutes until the bandages are saturated. Since Charlie saw to a hand-held shower nozzle meant mostly for Salty since bathing a dog in a bathtub while trying to get him to stand under the showerhead is a debacle, I use the hand-held to saturate the bandages further. Then, staring into the wall, I peel them off with my free hand, per my instructions. I let the water run all over Starbright for a while until, finally, I muster the courage to look down.
In the pouring water, about an inch above my nipple, there is a very thin line, the same pinky-beige as the nipple itself, though I don't think Dr. Quigley has anything to do with matching up the color of her scars to her patients' nipples. The scar is not two inches, it's an inch-and-a-half. As promised, it has a slight curve to it not unlike the delicacy of the Mona Lisa smile. Starbright is the same size and shape she was before surgery what with the lymphatic fluid left behind by my doctor who has everything to do with that. Diane Quigley is the best, isn't she? Even if she doesn't commend you for not needing Vicodin. Even if she orders you not to go to the Dominican Republic.
I call Charlie, who is just outside the bathroom door in case I need him. He comes in, Salty trotting along right behind. They both get into the shower. Charlie is naked and wearing flip-flops. He's always prepared. He says, "You have such beautiful breasts." He runs his finger across the scar.
I start to say, Thank you, but instead, I say, "All breasts are beautiful."
This makes him laugh. He says, "That is so true. But yours are perfect." I laugh, too. Perfect? Perfection is in the eye of the beholder. Salty plops down onto the tiles, all four paws and belly up. We both squat down with him under the shower and scratch his fat tummy. (Later, Charlie, not me, will have to blow-dry him.) We kiss each other above our stretched-out dog who's wondering when the hell we're going to squeeze the Johnson's Baby Shampoo all over him. I get out of the shower and Charlie shampoos Salty.
I am now officially past one high hurdle, aren't I? Too bad there are more and too bad they get higher.
MY SECOND APPOINTMENT with the Count is soon upon me. I go myself. Charlie will be with his three friends who he meets when all are young men with small children. They're required to attend a meeting after volunteering to camp out with their seven-year-old Boy Scout sons. They hit it off. Jay tells me his dad is the best dad for getting stuck sleeping bag zippers unstuck. After the sons outgrow scouting, the dads continue the tradition of a yearly, week-long camp-out—fishing most of the day, then grilling their fish in the fire after having released all but what they'll eat. Do you know there's a release fishing hook with no barb so that the fish can just release him or herself without help? The foursome bring a lot of food and vodka from home so they eat and drink long into the night, one of the dads breaking out his guitar, another his harmonica, and another weed. They continue to honor that tradition.
So I'm off to the Count appointment. There is something I really need to ask him. Something I just found out this morning while perusing google. I sit at the end of the examining table editing a short story. I'm no good at writing short stories, but I keep trying. They take off, me unable to control them, while they try to become novels. I have two short stories in collections but neither of them are actually short stories, they're essays. If the editors of the collections see them as short stories, fine, as long as they still write the checks.
When the Count comes in, he has someone with him besides Marina. He introduces his resident, Khalid. I notice that all doctors refer to the residents, who by the way are also MDs, by their first names. I will take any odds that Khalid doesn't call Dr. Ionescu, Dumitru. I am noticing that Khalid's face is a mask of mortification. Rather than saying, "Lovely to meet you," or "Enchanté," Khalid just stares past my left ear avoiding eye contact.
I put out my hand, he takes it and drops it as fast as he can. Have you ever shaken hands with a moth? He also emits a little mumble. I hear a sigh, not from him, but from Marina, already in position at the computer. I assume Khalid is a Muslim who, even though he's been through medical school, is still not comfortable touching a woman who isn't his wife. I will try to be respectful, but the question is, how? I am perched at the end of an examining table naked but for my new, though modest, underpants beneath my falling-off johnny coat.
The Count asks me, "How are you feeling?"
I tell him I'm good.
"Your pathology report is all we could hope for."
"So I've been told."
Then, rather than, Congratulations! he says, "The regimen I would suggest for you is radiation and Tamoxifen. I think of this combination as a mastectomy/ chemotherapy preventer."
I say something inane like, "That's good." Whenever someone says something that has an epiphany-like ring to it, I am too flabbergasted to respond appropriately. Then I say to him, with a smile to Khalid, hopefully to show him how sympathetic I am to his religious and cultural idiosyncrasies, "Here's the thing. Doctor Quigley has told me the same thing. I have read the side effects of Tamoxifen. I agree that I should take Tamoxifen, but I have a very happy sex life. A side effect of Tamoxifen is my vagina atrophying. What are the chances of that happening?"
He doesn't bat an eyelash so it must be true. He says, "I don't know the statistic, but the chances are low. It is one of the least common side effects. However, if you do have indications of such, we will switch to an aromatase inhibitor. There are three." (This last, Dear Reader, has nothing to do with aroma therapy you get for an extra twenty bucks when you have a massage.) "However, the not unusual side effect of the aromatase inhibitors is a decrease in bone density. You would be monitored, though, with regular bone scans. You are very small-boned."
I get a Dracula sweet smile. I note an ever-so-slightly change of expression in Khalid, who looks as though he's hoping that the Count will have me take some aromatase inhibitors right now so that all my bones will break, and I will fall off the table and die of a fractured skull. I am not exaggerating. Khalid is between a rock and a hard place. Not all of us, as we know, are medical school material. Maybe he could study to be a criminal medical examiner and only cut up possibly murdered dead people.
I ask the Count, "If I have radiation, what are my odds of getting a serious radiation-created cancer down the road?"
"Point-zero-two percent." No chance-in-a-million prognostications for the Count.
Naturally, I cannot compute what point- zero-two percent means off the top of my head. I will ask Jere.
My johnny coat slips off my left shoulder, and perhaps coincidentally, Dr. Ionescu asks, "May I examine your breasts?"
I say, "Yes," what else?
He examines Starbright. Khalid's eyes are fixed on the toes of his Air Jordan's.
I have a thought. I ask the Count as he's doing his thing, "Will tamoxifen affect my libido, the one I just mentioned?"
Khalid makes a quiet sound inside his throat.
"Your libido with remain what it is," says the Count.
"It won't if my vagina atrophies."
He stops examining Starbright. "Again, if there is a problem with your vagina, you will stop taking Tamoxifen and we will likely switch you to another drug, altogether, Femara—"
"Who thinks up these names?"
"Marketing people. But according to trials, Femara is the most effective of the aromatase inhibitors when it comes to the threat of vaginal dryness. There aren't enough studies to show Femara's effect on bone density, though."
"We'd roll the dice then?"
"Let us wait till we get to that point."
The Count looks down at his watch, finishes up with Starbright and then does Starlight. With that out of the way, he says, "Now…I want you to know about the option available to you regarding your oncological care."
Oh. Just when I was going to ask him what happens when men have a cancer drug recommended to them that prevents the production of testosterone, but his left sleeve is up, his watch is staring at me and I know the answer. Fuck that, Doc. So instead I ask, "What option would that be?"
"Once you finish your radiation treatment, you may choose to become a client of the Survivorship Clinic."
"I may? What's that," I ask, swearing to myself right then that I will never think of myself as a survivor. I'll think of myself as a rescue, like ninety percent of dogs these days.
"A team consisting of an oncologist, clinical social worker, nutritionist, and physical therapist. You will begin by seeing all four, and then revisit the clinic each year afterward. You can see all four again, or whichever of the four you like, singly, whenever you like. By appointment. At each yearly visit, you will be examined, receive advice, and have the opportunity to ask any questions you might have of the team."
I start to say something like, Wow! but he's still talking.
"If you choose the Survivorship Clinic, you will be seeing Dr. Hale, who is an oncologist much admired by all of us. You will see her rather than me."
He is so sick of me, I can tell. I cannot help but consider that so many of his patients are dying and I'm not. Purportedly, at least. I say, "When do I have to let you know?"
"When you know."
"And until then I continue to see you."
"Why can't I see you and the team?"
"I believe I would agree with the insurance companies that you don't need two oncologists." The smile. "What will aid in your decision is when you actually meet with the Survivorship team for a consultation, which I strongly encourage. You may decide after that visit.
"Finally, I have looked into the clinical trials with women who do not have radiation after breast cancer surgery. None of the trials yet meet the criteria for serious consideration as they have not gone on long enough. But if I hear of anything else, another trial perhaps, I will let you know what I find."
He puts out his hand. I put out mine, while I hold up the johnny coat with the other. He says, "I wish you well."
Dr. Ionescu has never uses my name once. I say, "Thank you," as you already know I will. He's turning on his heel. Khalid is just about to make his escape, but I say to him, "Good luck to you, Doctor…" I read his last name on his lab coat "…Sharif." Maybe he's related to Omar.
He pauses. Maybe I'm the first one to address him as Dr. Sharif. He says what sounds like, "Thank you," really just a guess on my part what with the accompanying choking sounds. The Count is out the door, Khalid on his heels.
Marina stands up from her chair. She smiles at me and shrugs. I shrug back.
That night, I call Jere. "What are your chances of having something when the risk is point-zero-two percent?"
"One in 5,000, why?"
I tell him. He says, "Pretty low odds, Mom. Probably better than the odds of dying if you don't have radiation. Hold on." He's now tapping away at his laptop. Then he says, "Way better."
Why doesn't that make me feel better? I still thank him though.
I go to my own laptop and google: What events have a 1 in 5,000 chance of happening?
Answer: From the time your dad is 18 until he's 43, he will meet 10,000 women. The odds that your mom will be in this group is one in 20,000. So, what is the probability that dad asks mom out, they fall in love, they get married and have you? One in 5,000.
Well, that's a relief. It doesn't compute as far as I can tell, but then my brain is programmed to prefer to do things other than compute. So based on that little case study, it ain't gonna happen and I decide that one in 5,000 suddenly sounds just as far out of the realm of possibility as Dr. Frye's one in a million.
Before I'm even dressed, I know I'm going with the survivorship team rather than Dracula since a team of four, including an oncologist, has to be better than him and Khalid.
A FEW DAYS LATER, I insist Charlie stay home again while I head to Guilford for the ultrasound. I tell him an ultra-sound is an everyday thing and I will go to the Clinton Mall afterwards. I need a little something to throw over my shoulders for the wedding, if necessary. It's going to be outside on Long Island Sound and I'll have nothing covering my back, arms, shoulders, and a yet, unscarred cleavage. I confer with Kristin. She says to me, "I'm not getting anything. There won't be a Mass. It'll probably last three minutes."
She's right. I'm going to the Clinton Mall anyway. I'll browse aimlessly for fifteen minutes. My idea of a coffee break.
I say to Charlie, "Go to the boat, honey. Catch a great fish and grill it for dinner. Okay?"
I have to promise him I'll tell him every detail of my entire ultra-sound appointment. He will not argue further once I promise him what he wants to hear. Also, the prospect of finding a couple of fishermen at the marina to go out with is his favorite thing to do. I kiss him goodbye, but when he hugs me he holds my head against his chest for a few moments. When I'm heading through the door, I hear him call to Salty, "Let's go fishing, doggie." Nice.
First thing in Guilford, after I get my wristband and respond to the West Africa imperative, I sit with Pam, my personal nurse, just like last time. Pam's title is not "Personal Nurse," by the way.
She jumps right into the business end of the pool, talking about the side effects of radiation. "The most worrisome thing right now is how it will affect your skin."
More worrisome things to come, apparently.
An image of my late cousin, Marietta Kelley, comes to me. She dies from breast cancer two years after her diagnosis at 38. I say to Pam, "I had a cousin who had breast cancer. She had to have a mastectomy, chemotherapy, and radiation. Her coloring was almost the same as mine—dark hair, dark brown eyes, and fair skin. Her skin was actually porcelain. Mine's just fair. When it was time for her radiation, she told the radiologist that even though she had dark hair and eyes, she needed him and the radiology nurses to know that if she's in the sun for just five minutes, she gets a bad sunburn. She didn't tan either." I make sure Pam is looking at me and not the computer. She is. I tell her, "They didn't make an accommodation."
Pam's face falls. "I'm sorry."
"Two weeks after radiation started, she had second degree burns on her chest."
"So, can you put that in bold print that my skin is fair?"
She says, "Yes," and she does.
Marietta was way more than a cousin. Neither of us have sisters. We are each other's maids of honor.
I start to cry.
Pam gets me tissues and a cup of coffee. Then she has no choice but to continue. "Please understand, Mary-Ann, that sometimes even people with very dark skin become blistered, and we don't know why. It's painful and takes a long time to treat and heal. Your three radiation nurses will check you very carefully every day before they treat you, and Dr. Frye will examine you every Thursday. If you have any problem at all, call us. Or tell us about it when you get here if you feel it can wait.
"Although we will do everything possible to protect your skin, the skin will turn pink and then tan, a tan that might be permanent. And in certain places where your skin has a wrinkle—near your underarms, for example—your skin will burn more. You might swell up in those areas."
Before I can say, "Excuse me?" she hurries on.
"Then again, like some women, you might not be affected at all. The women who have the greatest difficulty, of course, are women with large breasts—more area affected obviously.
"I also have to tell you that with the breast tissue in your underarm, your underarm will be radiated and you'll receive a boost or two there. That would be a more powerful dose of radiation than you're getting. The hair follicles under your arm will probably not produce hair anymore after that."
I say, "Just like the left side of my husband's belly."
I tell her about Charlie's testicular cancer, how he was radiated from belly button to mid-thigh.
Pam says, "Yes, just like that. We will give you a lotion that will help your skin. Put it on every time you shower, but don't use it before you come here for treatment. Put it on after treatments, though, right in the dressing room."
"What's the lotion?"
I am expecting a prescription drug, but Pam says, "Lubriderm."
I say, "Lubriderm is over-the-counter."
"Yes." She reaches into her pocket and takes out some little samples and hands them to me. "We have a ton of these." I read the ingredients. I say, "This stuff is useless."
"You have just described pain to me—sunburn, blisters, swelling. So, I have to wait for those things to happen before I can get anything serious? What about staying ahead of the pain?"
"If you have some itching, you can use a little cortisone."
"Do you have a dermatologist here involved with radiation treatment since the skin on my breast is about to corrode?"
That's it. I'm getting angrier by the minute. "Why the hell not?"
"I don't know. I'm sorry."
"I'm going to call my dermatologist. I hope she knows something you guys don't."
"I hope she does, too."
When I get home, I will google what I should be putting on my skin. Also, I'll call my old Peace Corps buddy, Peggy Pennington, who moves to Canada and changes her name to Maggie. She passes the five-year mark since she has a lumpectomy a while back.
A nurse named Dana then comes to get me for my ultrasound. Pam and Dana walk me by the nurses' station, where Pam gets settled back in while she introduces me to another nurse at the station, Dana. She says, "If I'm not here, Dana will take care of you."
Dana has such a cute and heart-warming face. She smiles. She has a gap between her two front teeth. I find that gap, which one doesn't see much anymore, absolutely precious. She says, "It's nice to meet you."
I say, "And you," though I'm really getting sick of meeting people.
Dana leads me to a room where a shiny steel piece of equipment is hovering above a long table. At the foot of the table.
I say, "So that will go over my body and stop at my chest?"
"It will go higher than that."
"Will it cover my face?"
"Yes, but just for an instant before it comes back down."
Speaking of my face, she notes that it has lost all color. "You're claustrophobic? Not to worry. We have lots of patients who are claustrophobic. We'll give you a soft, fuzzy eye mask, and we'll be talking to you the whole time. Or we'll play music if you—"
"How close to my face will it get?"
"Close, but again, maybe two seconds."
Then I say, "I'm not claustrophobic. I've had two ultrasounds before. I was fine. But last year I had a really bad experience." Then I tell her what I told Dr. Frye about my "traffic incident" with a couple of extra details. "My entire car was hit with falling cables and live wires. They scraped half the paint off the car. They ended up draped all over the car like spaghetti. The workers who somehow caused the cables to separate were all screaming at me not to move."
First, she stares at me. Then she says, "Omigod. How horrible. Where did it happen?" I tell her. She says, "I never heard about that!"
So I go back to what I said to Dr. Frye, but instead of the school bus scenario, I say, "If I'd have been killed, you'd have heard about it."
Dana refines her earlier comment. "It wasn't on the news?"
"One way to cover up something like that is to call it an incident. News doesn't cover incidents. I'm suing everyone."
She starts to say something, but doesn't. She has to get back to business. So do I. She asks me to just sit on the middle of the table with my legs hanging over the side. She helps me up, and next opens a drawer in the cupboard behind her and dangles the warm, fuzzy mask on her finger. It's black so your brain will think it's night and you'll cork right off. If you believe that, you believe in the Tooth Fairy. Actually, when I'm a kid, I go on and on about the Tooth Fairy even though I know it's my father who sees to the quarters that appear under my pillow. I count my teeth. I believe in the Tooth Fairy until all 28 fall out, keeping all those quarters coming. My dad is onto me since I'm twelve when I lose my last molar.
So Dana says, "We're going to take care of you, Mary-Ann. That's why we're here." She looks toward a large window where three nurses are waving at me. Dana says, "Meet Lori, Sue, and Pat. They're your radiation nurses."
One of them gives me a thumbs-up.
"Can they hear us?"
"They sure can."
So I wave to them, and say, "Hi."
They do the same. Dana puts her hand on my shoulder, "We don't do much talking in there. But the very second you want us to stop the scan, we'll stop it. That very second, I promise. But don't move—just say, Stop! and it will stop." She smiles down at me. "I'm in charge of the stop button."
I say, "Okay."
She passes me the mask. I ask, "Is it cashmere?"
"I don't know, but I think it must be."
"So do I."
"Go ahead. Try it."
I do. All is dark and my eyes are swathed in tenderness. She says, "Let's lie down," and she guides me downward into position. "If you manage the scan, Mary-Ann, then Dr. Frye looks at the images. Once she's done that, she'll come in for a chat."
If I manage it. How wonderful that this Dana doesn't say something like, Don't worry, you'll be fine. She's a good nurse. She knows what honesty means to people.
She says, "While Dr. Frye looks at the images, so will we, and then I'll be back out. I'll mark a few spots on the left side of your upper torso, including around to your side. That's where we'll aim the beams when you have your treatment."
I say, "Okay." I'm committed.
I say okay about a zillion times since that first post-mammogram phone call.
"You know the machine will make a lot of noise, right? Since you've had two?"
"Yes." Who cares about noise if you're worried about the entire contraption falling onto your face, or breasts, crushing your nose, heart, and lungs and killing you?
"Maybe it will help if you know exactly what happens and when."
It won't, but I say, "Okay," for the one zillionth and first time.
I pull up the mask and try to pay attention to Dana as she describes the movement of the machine and the amount of time into the treatment when it will begin moving up and down. Two minutes.
"I am being honest when I say that with the mask, you will not know where the scanner is, you will just hear the motor that's moving it. I hope that helps."
It won't. "I'll try my best."
"We'll be rooting for you, okay?"
"I have to join the other nurses."
"Breathe slowly in through your nose and out through your mouth. It will relax you."
"I'm already doing that."
"Good." I will do my Lamaze/EMDR breathing even though the only thing that could relax me is if Charlie walks in with a Grey Goose martini.
I ask, "How long will the whole thing last?"
"Ten minutes. The actual radiation treatment will last ninety seconds."
Dana smiles at me, and this smile is meant to show me how happy she is to give me that last bit of good news. I immediately think positively: If a labor contraction lasts two minutes, I can do this.
She helps me get the mask back on and snugly into place.
She leaves—quiet footsteps and the soft opening and closing of a door. The pounding of my heart, on the other hand, is loud. I feel sweat leap out of every pore there is including in my scalp. I am distracted, realizing I will need to take another shower and shampoo my hair again. This distraction allows me to note that I have stopped breathing, a common occurrence when you panic, leading you to faint, or vomit besides, like that pervert George Bush, the father, did at the Japanese state dinner. This was before the #MeToo movement came along and he gets outed for grabbing women's asses including teenagers. He seemed such a nice fellow, the bastard.
I know from EMDR, and I especially know from Lamaze, that it's all about breathing. My Lamaze lady explains that the crazy breathing cycles she teaches our class are meant to keep your diaphragm up and away from your uterus during a contraction. Otherwise, during the contraction, when it rises while you're doing the more usual, uninformed, freaked-out gasping, it will bang into your diaphragm.
"That is what hurts," she says, "the collision not the contraction."
I can actually visualize what she's described, so I believe her. It works. I know that for a fact, because I experiment and just let one contraction happen without the Lamaze breathing. I can feel my uterus as it rises upward, but I just breathe normally. When it collides with my diaphragm, the pain is so shocking I make this horrible half-scream, then start breathing my brains out just in case the next contraction comes right away.
The ultrasound starts. I'm doing my Lamaze/EMDR in-through-the-nose-out-through-the-mouth, slow and steady breathing. I get through it.
Dana comes running into the room applauding. "Done!!! Good work!"
I get the mask off. The scanning machine is way down by my feet. Through the window I see the radiation nurses all busy looking at screens.
Dana says, "You just rest now."
When she's back, she's got a Sharpie in her hand. I feel its tip touch me in six places: middle of my chest; then Starbright gets two; two more under my arm; and finally, around to my side.
She says, "When you shower, don't wash off the marks."
Then she helps me sit up.
I say to her, "Is the radiation machine like this one?"
"Somewhat. It will be below your face and go back and forth, side to side, twice. It will be very close to your face, though. Focus on the amount of time…. Ninety seconds. That's all it will last. Back and forth, back and forth."
I ask, "How close to my face?"
She smiles. "We'll have your mask ready for you."
"Can I see the machine?"
"I'm sorry. There is either a patient being radiated, or it's being prepared for the next patient. You can see it online, though. I'm sure the treatment is on YouTube. You can probably watch dozens of people get radiated on YouTube."
Actually, thousands. And the radiation machine has a name—a linear accelerator. I'm going to keep calling it the radiation machine, which is less aggressive, I think, since accelerator connotes speed. I'm thinking of the speed of a linear accelerator as it falls on your head.
Dr. Frye walks in. She looks anxious. My cancer must have spread to my lungs. But no, that's not what she has to say. Instead, "Mary-Ann, the cancer we will radiate, as you know, is in your left breast."
Some people rely on an introductory comment before they can give you bad news. When a nurse called me from St. Mary's home where my brother was in order to tell me he'd just died, she starts with, Tyler wanted to go to the library tonight….
Dr. Frye goes on to the meat of the matter. "When I looked at the ultrasound images, I could see the close proximity of the larger chamber of your heart to your rib cage, and the small amount of fatty tissue in-between. Therefore, you should have a lower dose of radiation than I'd originally thought. But it means you will need five weeks of treatment instead of three."
Am I upset? Only slightly. A lower dose trumps five weeks over three, I would think. And she's talking about the damage to my heart a là Google.
I say, "So, that means the risk of the dangerous cancer that will damage my heart will be significantly reduced, right?"
First, she gapes at me, and then she says, "It will all but eliminate any chance of damage to your heart." Then she says, before I can comment on all but, "If you have the need to get it finished within three weeks, then you can be treated at Yale where you'll first go to breathing classes to learn how to keep your lungs from expanding, something that brings your heart even closer to your chest wall."
I do not get into the similarity of your uterus banging into your diaphragm with your lungs side-swiping your heart. I just say, "Ain't doin' that, Doc."
"Good," she says with relief.
I have a problem, but I don't talk about it at that point. My trip to the Dominican that Dr. Quigley said I can't take will now happen in the middle of my radiation treatment, not at the end of it as I'd figured. I will consider that at a later date.
Dr. Frye says, "Anything wrong?"
I smile. I lie. "Nope."
"Then I'll see you next Thursday."
Firm handshake, and off she goes.
I say goodbye to Pam at the nurse's station—Anna is off being someone else's personal nurse—and she dips into a vast tub of Lubriderm samples, scoops out about a hundred of them, puts them in a quart-size baggie and hands it to me. If Pfizer is giving hospitals a million kilos of Lubriderm, I guess the hospitals will be sure to recommend it over, say, a medication that might do some good.
In the lobby, the security guard asks, "Will you be heading east, ma'am? On 95?"
East is to the Clinton Mall. "Yeah."
"Accident. You're going to have to take Route 1, just so you know."
That is the same as saying, You're going to have to take a slow boat to China.
But it's a nice day. I will drive to the Guilford shoreline and sit on a bench and read instead of going to the mall. October on the Connecticut shore is fabulous because Long Island Sound is still warm, and ergo, the air is ten degrees higher than what it is inland. If you want to get married on the Connecticut shoreline in October, book your wedding on your fifth birthday. Melissa, determined to be married in October, is asked by the owner of the venue she is crazy about if she would consider a Sunday wedding since Saturdays are booked into infinity. Melissa immediately whips out her checkbook. If the venue-owner asked her if she'd be willing to get married on a Wednesday at 4 a.m., Melissa, a young woman who understands priorities, would have whipped out the checkbook just as swiftly.
But Melissa is getting married just before sundown, and as I mentioned it can get damned chilly. This is a possible glitch that October brides having an evening outdoor wedding don't think about. I hope they all have a Kristin in their lives to tell them their wedding ceremony will be over in three minutes and not to worry about it.
At a beach in Guilford, a private beach but it's not summer so no one cares, I put sunblock on, and then I go sit on a bench. I put my face to the sun. I'm alive and I intend to stay alive till I'm a hundred. I text Charlie on his boat that the ultrasound went fine.
I look at my phone. Maggie. She has texted me back: I never had a problem with my skin. I had radiation for a month. And every day—before and after they zapped me—I slathered on aloe vera."
I text a thanks.
I decide to call Dr. Kumar's office. She calls me back five minutes later.
She says, "We only use Vaseline here for burns less than first degree. You have to follow the radiology treatment protocol."
I say, "But we're talking Lubriderm, Doc. It's Vaseline in disguise. What kind of protocol is that?"
"I'm afraid there is nothing I can suggest."
"I promise not to sue you if you do."
"Mary-Ann, I know nothing of the effect of various creams or lotions on skin that is being radiated or has been radiated."
"Do you know a pill?"
"I'm really so sorry."
She is so sorry because she'd love to recommend something, knows exactly what to recommend, but can't. There's a reason, and that reason is, no doubt, unethical.
To all dermatologists everywhere: FORGET THE FUCKING BOTOX. DO SOMETHING ABOUT THE JOKE OF A PROTOCOL FOR CANCER PATIENTS GETTING RADIATED AND HAVING THEIR SKIN BLISTER AND BURN.
This is such a perfect time to call Laura, my EMDR therapist before I have a nervous breakdown. She once offered booster sessions if I fall back into the inability to drive under a traffic signal. I leave a message. She me calls me back immediately. She says, "I'm waiting for a patient. Can you be here in an hour? I'll have some time."
It's eleven o'clock. She will skip lunch for me. She is a woman dedicated to seeing that people can live normal lives instead of apoplectic ones. I'll bring her a bagel.
I say, "Thanks, Laura. I'll be there."
She is two towns beyond Guilford. Clinton. Then, once I see her, I can go to the mall after all, assuming the accident on 95 is cleared.
I open my book. It is the most recent mystery by my friend Karen Olson. Hidden. It's published by a UK publisher, meaning it will be called a crime novel instead of a mystery, a euphemism. She also has a previous series on hold with a sleuth who is a tattoo artist in Las Vegas. (Always set a mystery in a fun place to visit. Karen goes to Vegas several times—"research." Her books get Vegas down perfectly. I know this because I was the fiction Fellow at the Black Mountain Institute at UNLV for a year. If you're a writer, stop what you're doing and apply for that fellowship. Anyway, Karen becomes so totally familiar with being a tattoo artist, in addition to the geography and vibe of Vegas, she could be one. Which is the main reason I'm calling her.)
I ask her, "What do you put on tattoos to soothe the person's skin while it's healing?"
"What about Lubriderm?"
"Nope. It stings. Well, maybe it doesn't sting anymore. It's been watered down."
Is it any wonder Pfizer is stocking hospitals with all those Lubriderm samples? They need people to buy the big tubes before social media starts warning the world about the watering-down.
Karen says, "But if the tattoo ends up hurting a lot, I have the client call a doctor friend of mine and get a prescription for cortisone. Tell me you're not getting a tattoo."
I have to tell Karen what I am getting instead.
She sets out to comforting me. She succeeds. It is easy to be as fond of Karen as I have been since the day I met her.
Then she says, "Newly tattooed skin and burned skin are not the same. Go right to the cortisone."
Burned skin and radiated skin are not the same either. Karen can support you in the most subtle ways.
Shit. But, believe me, I thank her. Remember, quote-unquote, my mother: "Knowledge is power."
HERE IS WHAT I learn from Laura when we meet for our very first session: When the troops come home from first, Iraq, and then, Afghanistan, a large number of those soldiers survived the explosions of roadside bombs, also known as IEDs, without physical injury. However, they still can't drive their cars waiting for them in garages and driveways without having panic attacks. Untreated panic attacks, naturally, leads to misery, depression, worse.
Laura tells me how this is relevant to me: "At first, the soldiers who witnessed the IED explosions, often just a few feet away, were just glad they were alive. This was your experience, wasn't it? After the traffic light fell."
"Even when you were sitting in a car covered with cables and live wires, even knowing you couldn't open your door to escape."
"Yes. I saw the traffic signal lying on its side up against the door and I was so relieved that…."
"Close your eyes. Think back. Do what you have to do to put yourself back in the car."
I don't want to do this. Too bad. I trust Laura. I close my eyes and Laura starts talking to me about I don't know what. Then she stops. I open my eyes.
"Tell me what you're thinking right now."
I double over and burst into tears.
Very gently, she says, again, "What?"
It takes me a while to sit up again. "I should be dead."
"Mary-Ann. That is exactly what the soldiers say. You weren't relieved at all, were you?"
I close my eyes. She talks. She stops. "What are you thinking?"
I open my eyes. "The construction guys came running to my window. They yelled at me to put the window down. The live wires weren't crackling anymore. I pressed the button and the window came down. I remember what one of them said to me. I just heard him say it. I'd forgotten till now."
"Tell me what he said."
I can't speak. I am doubled over again.
Laura waits, and when I stop this new miserable round of crying she asks, "What?"
I gulp down some air. "The first guy to get to the window, the one who yelled at me to put it down, says…. He said, 'I thought you would be incinerated.'" I look up to Laura. "They thought I should be dead, too."
Laura says, "The troops that were nearly killed by IEDs came home, and they cannot get behind the wheel of their cars because their brains expect a bomb to go off right there on the shoulder of the road and when it does, this time they will be killed. They become recluses. I'm not saying it will happen to you, but I bet you can benefit from the process of the treatment they eventually had available to them."
EMDR therapy: Let me say it involves two physical things. Headphones that beep first in your right ear and then your left, over and over. Also, buzzers that you grasp in your hands that buzz in rhythm with the beeps, right to left, pause, right to left. Google it for more details. So while you're closing your eyes, listening to your therapist, and then coming back to her on demand, you're moving the trauma over to the far left side of your brain until it stays there. Took me six weeks and it stayed. The memory doesn't go away, but it's pushed out of your way so you can function. All I know is that it gives me back my sense of safety and I am able to stop driving in circles to avoid going under traffic signals, turning five-minute trips into half an hour.
At the end of each session, Laura has me breathe slowly in through my nose and out through my mouth for about five minutes. It's a good thing or I would fall off the first curb I come to. I must say though that my poor diaphragm keeps preparing for a contracting uterus to slam into it.
Now, at our last-minute session, just the sight of Laura is soothing. I review what's going on in a nutshell. She asks, "What do you think you need to do to get through the radiation?"
Because Laura teaches me that I don't know is not a helpful answer. I think for several minutes because she knows and I know that this isn't time to blurt out an answer like you do during the actual therapy. Finally, I have half an answer. "At least I'll need something in my hands."
"Well, that's a good idea."
"Can you give me a spare pair of buzzers?"
"I could but I don't think you'll have a place to plug them in."
"What else could you put in your hands that would give you the feeling of calm that you experienced with the buzzers?"
I think some more but just for a moment. I say, "Stones."
"What kind of stones?"
"Round ones. Smooth stones. Pretty ones."
"Perfect. Where will you get them?"
"At the beach."
"When will you do that?"
She laughs. "Isn't EMDR a miracle?"
I say, "Yes, and so are you."
She leans forward a little, her eyes sparkling a bit. She says, "After my last appointment today, I'm going down to the beach and I'm going to find some round, smooth, pretty stones too, and I'll hold them when I need to calm myself. If we meet again, we'll compare stones."
If we meet again. She is saying we probably won't, but if I need her, we will. I don't need five minutes of EMDR/LAMAZE breathing because I don't come apart at the seams. We hug, say goodbye, and I go to the beach. I do that aimless-looking walking beachcombers do. I find one stone right away. It's a little round cobble, charcoal gray granite, coated with multi-colored speckles. I nestle it into my palm and close my eyes. The stone fits perfectly into my right hand. It's cool and then it warms.
The hunt for a stone for my left hand takes much longer. Is it any wonder? We're talking my Starbright side here—that's the side that needs the most attention. My left hand, as it turns out, seems to require an oval. I swear I look at more oval stones than I did Stepmom-of-the-Bride dresses. Then I see a yellow one (my favorite color), a translucent quartz. As soon as I pick it up, I know it's the one.
This stone is a little bigger than the cobble, but then Starbright is a little bigger than Starlight. Both stones are made perfectly smooth over many years by the movement of the Long Island Sound tides washing them across the sand. In and out rather than right to left like my buzzers and beepers. I love the stones. I put them in the compartment of my bag meant for my phone charger. I throw the charger into the main part and hope I don't lose it.
Late that afternoon, Charlie comes home from fishing with Salty and shows me the fish we're going to eat for dinner. He puts it in the fridge and then pours me a glass of afternoon pink wine. I tell him how happy I am that I made it through the ultrasound, and then about my session with Laura. I show him my two stones. "I'm going to hold on to these during my radiation treatment."
A little pause before he says, "Good." Then he says, in as melancholy a voice as I've ever heard from him, "I remember when I had two testicles."
I say, "Power Puff is great at doing the work of two, Charlie." (I'm sorry, Dear Reader, but I told you we have nicknames for all intimate body parts, right? If you're rolling your eyes, I understand.)
He says, "Sometimes the one that's gone still hurts."
I make him one of his favorite appetizers while he grills his fish out on the deck—mussels in garlic and white wine broth and whatever herbs I feel like throwing in. I get a loaf of the high-end French bread out of the freezer that Charlie bought from the same bakery where he once got a loaf for me—the night he took me to the German club in Bridgeport, the first night we made love. The bread that bears the ultimate combination of the three C's: crunchy crust on the outside, decadent chewiness on the inside, and creamy butter spread out across each chunk you yank off. My father teaches me that you don't cut a great loaf of bread, you tear off a chunk. Why? Because it tastes better. It's true. The exception is when you make a sandwich with it. In a story he used to tell me, "Nanette Visits the Chateau," Nanette's mother makes her daughter special sandwiches when the radishes tops pop up in her garden in early spring. (This is France, after all.) Sliced radishes rest snuggly into the butter on the bread. When my father makes the sandwiches for me, he says, "Along with the crunchy, and the creamy, and the chewy, you get a nice little zing from the radishes."
Anyway, it's been a damnably long day, and it's taking me a damnably long time to get to what I'm needing to tell you, isn't it? Sorry. Here goes:
At the very end of this long day, we watch a movie. Then I'm about to take the shower where I have to wash around the dabs of the Sharpie. I go in the bathroom and stand in front of the mirror. I go get the stones out of my bag and come back. But I can't take off my clothes and hold the stones at the same time. I put them next to the sink. What I'm thinking I'll see will be barely noticeable little dots across my upper torso. I see something else that makes me gasp. There, staring at me from my chest are big, black, hideous, X's. I see swastikas. It is as if someone wrote obscene graffiti over Starbright and all around her with the biggest, blackest Sharpie that ever was. Each of those terrible X's has a broad, black circle around it.
I have a meltdown of such massive proportions I can't stand up. I have to sit down on the tiles. I am crying in unmitigated despair. Salty gets to me first. I'm shaking so hard I just lean against him and he bears up to my weight. I don't remember Charlie getting there but he's there, yet again, and I'm folded up in those muscular arms. He just waits till I stop shaking to loosen his grip, and then looks down and sees the X's.
He says very calmly, so like the same calm of Laura's voice, "When I got radiation, I had little blue dots. I'm sorry, baby. I wish I could have known."
I pretty much weep until I can speak again. When I am able to, I say, "Charlie, this is a warning."
He says nothing, just waits.
"I am not having fucking radiation."
Still, he doesn't say anything. He just keeps holding me. When he feels my muscles lose their tension, he says. "C'mon. We'll take a shower. I'll wash you around the marks so you won't have to do it."
I say, "They're not marks, they're swastikas."
He says, "Yes, they are." And then I know another reason why I so love him. Does he say, No, they only look that way? He does not.
I say, "I'm washing them off."
He helps me stand. He takes off his clothes, too. We get in the shower, and he picks up my lavender-scented Stella Marie soap, tinted by Kim the exact color of lavender in bloom, and he's soon got a washcloth full of lather.
While he's washing me, first my arms, he says, "Radiation saved my life."
I say, "Okay. Don't wash them off."
Then there's Salty getting into the shower, too, nudging us to make room so he can get beneath the showerhead. I say to Charlie, "I will not look at my naked body in a mirror again till I have my treatment, and even if I have to use Brillo, I'm going to get it all off."
He says, "Yes, you will. You won't need Brillo."
Charlie's knee-replacing doctor didn't draw a big X with a circle around it on his kneecap. He drew a happy face. Charlie got little blue dots when he was treated for testicular cancer, and then a happy face from Dr. Komninakas.
I take a Benadryl and sleep for ten hours.
NOT LONG AFTER I start treatment at the Smilow Breast Center at Yale-New Haven, and every day I go there afterwards, an apparition appears—not an angel, but close—Seraphina, the clinical social worker. I am one of her many clients as testified to by the stack of folders ever-present in her arms. Seraphina's goal as clinical social worker is to see to my mental condition. Never does she act as though I am damn lucky to have DCIS and not stage four gastric cancer. She doesn't congratulate me.
A physical therapist I see after a dog-leash injury (Salty took off after a squirrel and just about pulled my fingers out of their sockets) says to me at our final session, "Ya know, after I'd taken care of a motorcycle accident guy, I had difficulty showing a lot of concern for someone with, say, a dog-leash injury. I mean, this guy broke every bone in his body. Then you came along and said to me, My biggest problem is getting the bottle top off a Perrier. Then, after I became so fond of you, Mary-Ann, I learned that you had far worse problems than the inability to unscrew Perrier caps. That was your sense of humor talking. Even if that was your only problem I have the same job to do. To have compassion for all my patients, no matter the injury. I have to do a good job with whatever injuries I'm responsible for fixing."
I tell her she'd done exactly that. Nice to be part of someone's epiphany. I wonder what Seraphina's epiphany was. I know she treats me with the same compassion, and gives me the same great help, she offers to everyone.
Seraphina has a voice like a rippling stream just slightly accented. It's a clear brook of soul-cleansing water, her demeanor equally soothing. Yes, the caregiver smile, but with it comes the kindly wrinkles at her eyes. Her entire face smiles. She encourages me to tell her how I really feel. You, Dear Reader, know how I really feel, especially after the swastika marks. But I don't want to get into it with her yet; I'd rather just listen to her tell me how wonderful I am, as in:
"You are handling breast cancer in a sound way. You advocate for yourself; you are not afraid to ask questions; you expect to be assured that you are getting the treatment that is right for you. You understand that knowledge is power."
Maybe we were separated at birth and had the same mother. If I have questions that I don't think to ask a doctor, I ask Seraphina and she does the asking for me, though at least she doesn't have to call and press 4, etc. She just walks right into the offices and pretty much confronts doctors with her patients' questions.
Seraphina's job also includes keeping me informed to any and all services available at Smilow. Never mind that I can see a breast surgeon, a zillion radiologists, a shrink, a nutritionist, a physical therapist—I can even have free regular massages. I can have a Reiki massage! I had Reiki once, maybe fifteen years ago. I'm taking a yoga class with Swami Janet, and she offers all of us a complimentary Reiki massage—she just got her certificate. If we like it, we can continue to have them, only bring your checkbook. Reiki is a massage where the therapist doesn't touch you, but rather runs her hands inches above your body and feels the colors you are emitting, colors that pinpoint for her what it is about you that needs to be relaxed. Huh? you say. That's what I say too. I shy away from things with a fairy tale quality though I love fairy tales. But I give Reiki a whirl so I don't hurt my Swami's feelings.
So I'm on my back on Swami Janet's massage table. With her eyes closed, she first holds her hands over my face, palms down. She stops. Her eyes spring open. "This is amazing! I'm getting a light show here. We must work on resting your brain!"
I tell her my brain is always chock full of stuff and if ever I try to relax or meditate, all that is going on in my head does not desist.
"Here is what we will do about that," she says. "Without expressing anger, or even annoyance, I want you to gently tell the voices all speaking at once inside your head that they are preventing you from experiencing calm. Ask them politely to leave. Perhaps they will. If not, ask them again. If they quiet down, know that they'll come back and you will have to pause your meditation to remind them. You are in charge of them, Mary-Ann. You may keep reminding them of what you are asking of them. Explain to them you are not asking a lot—you just need time to be by yourself."
When you're raised a Catholic, stuff like that sounds like placing false gods before me.
I don't tell this to Swami Janet, but the voices in my head are laughing their asses off just hearing this stuff. What I get from all that is that I don't tell the voices to fuck off. They'll just laugh the harder. But I will do what Swami Janet says, thereby fooling them with my calm but authoritative manner to show I won't listen to them. Alas, I do not get around to prostrating myself and negotiating with the voices in my head. I put the whole damn plan in my pending file. A year after I start that file way back when, I never once check it to review what's pending. Instead, I throw it out. Then I start a new pending folder, and on the one-year anniversary, again, without ever opening it, I toss the whole thing. And guess what? The earth is still spinning on its axis!
Now, meeting with Seraphina before one of my many appointments, she tells me I can take an art class with highly considered artists who volunteer their time. An art class. Sheesh. Here I am a writer who can no longer concentrate after a traffic signal sliding down its broken support cable comes within inches of killing me. Instead, it kills my power to create characters and plots and dialogues out of thin air. Over a span of twenty-five years, I write nine novels, collaborate on another with my son, short stories—all that, even with a million voices in my head vying for my attention. Getting breast cancer doesn't help. The process of creativity not only requires concentration, but also imaginative thought.
And I can't read either! I pick up a book and read the first sentence 37 times, but the sentence won't register. I always read The New York Times every morning to clear out the cobwebs before I start the job of fiction. I can keep hundreds of pages—all in order—in my head, and then I can't even absorbThe New York Times banner headline. The only column I just barely manage is "The Hunt" in the Sunday real estate section. It is fun to root for all the people trying to find a place to live within their budget, whether the budget is two million or two hundred a month, ha-ha. My friend, the writer Suzanne Potter's daughter Anna, a Harvard grad, finds one place she can afford when she gets a job as an associate editor at Random House: a shelf. She shares an apartment with four others who help her put up a shelf in the hallway with a cot mattress on it. She keeps all her stuff on a shelf above that one. Then they cut out a whole between the two shelves into the next room so she can breathe. I kid you not. Anna, also a writer once she quits her job meant for the children of rich people, now lives in a house, I'm relieved to tell you.
So what do I do about this catastrophe of no longer able to write a single line of narrative? Same thing I do when I am going through a divorce ten years ago ten years earlier. I write a memoir, not about the divorce as I have no interest in doing that, but instead, about an event in my childhood that turns my rather outré family—outré rather than dysfunctional—as well as my entire neighborhood upside down. A crime so horrific, I'm unable to give you a précis right now because I don't want to upset myself further than I already am. You'll have to google it if interested: Girls of Tender Age.
Anyway, I don't have to tackle making people up, making up what they say, with a memoir. It's already there ready to be transcribed. So, diagnosed with breast cancer I come to write yet again—a second memoir, but this time I'm transcribing the events as they are happening rather than recalling what happened when I was nine. I can only hope that when I finish, I'm capable of fiction again. I am so chomping at the bit to write a novel about who killed Lizzie Borden's parents. It sure wasn't Lizzie. One tour of the Borden house, a present from son and daughter-in-law, I know exactly who did it. And why! Definitely not Lizzie and it wasn't the heat. Google the weather for the date of the murders and you'll see that. Great reading besides: I started with The Reliable Poultry Journal: Devoted to Better Poultry and More of It.
Anyway, I love my chat sessions with Seraphina. If not for her I don't know how I could go about the process of taking a step forward. Eventually, once fifty pages into my new memoir, I get to say to her, "Guess what? I just read the entire New York Times on my laptop!" Hug, hug, hug. She totally understands what to me seems a miracle. I say, "I didn't have the strength to turn the pages! But tapping the keys is a cinch."
She says, "And you would know!"
Seraphina reminds me of Charlie. Once, early on in our relationship, I run out into his office and I say, "I just got the TV from the DVR setting to real TV one!" I couldn't make that happen before. He looks up, he puts his arms out, and he says, "Good girl, Mary-Ann!"
I may be a feminist, but as I never hear those words as a child. I love hearing them now, from him, but no one else, so don't go getting any ideas. Quote Seraphina instead.
Seraphina also says, "You haven't been able to see to yourself because you've had to come back from the traffic signal and now you have to come back from cancer. You've coming back, Mary-Ann, you've coming back."
So, not only is Seraphina astute, knowledgeable, and articulate with the demeanor of a handmaiden attending to goddesses, she even pronounces Dr. Ionescu's name the way, presumably, Romanians do. She turns the s into a sh, and the last syllable coo, not like a pool cue. The trace of accent I initially felt I heard is maybe Romanian. I love my grandfathers' accents. My French Canadian grandfather pronounced dollar, doe-larʹ. My Italian grandfather, when somebody asks him how to say refrigerator in Italian, says, "Ice-a-box." As if they have refrigerators when he's a boy in Italy.
Re Seraphina and my coming back: That was before the swastikas.
The day after the swastikas, I have an appointment with Justine, Dr. Quigley's PA, to check on the healing of my incision. Seraphina dashes into the examining room while I'm sitting at the end of the table waiting for the PA.
She wants to tell me about a new support group for DCIS patients that starts tomorrow. "It's at noon. You can bring your lunch and there'll be cookies."
I have shown no interest in the other cancer support groups she has mentioned, but maybe the timing is right for me to try out this out. I will go. Seraphina is so glad.
According to Justine, the scar looks "good." No, it doesn't. Who ever heard of a good-looking scar?
I ALMOST MANAGE to get to a support group meeting in my life before Seraphina's DCIS one tomorrow. I accompany a friend to an AA meeting. She thinks she has a drinking problem and wants to nip it in the bud. We hang outside the door for a while because neither of us appreciates the vibe we're getting from the people heading in, that vibe controlled by the…uh…odor. Our feeling is that you shouldn't go to an AA meeting drunk, and so, we high-tail it back to her car.
My friend ends up making an appointment with a psychologist to find out if she has a drinking problem since she's not sure if she does or not. He tells her, "If you make rules about drinking, meaning, if you say things like, I only have two drinks and then I stop; or I only drink on Mondays, Wednesdays and Fridays; or I don't drink till after seven; or, I only drink Bud Lite, then you have a drinking problem. But if you break those rules, you don't have a drinking problem –you're an alcoholic."
My friend is not only in the rules stage as described, her go-to favorite: I only drink red wine because it's good for you, she finds that one glass leads to another until the bottle is empty by the time she goes to bed. So she stops drinking red wine and all the other alcoholic beverages come to replace the wine. Instead, she buys one of those seltzer machines and makes herself flavored seltzer. Green tea flavored seltzer, for example. It works. She is now addicted to seltzer. She nips her alcoholism in the bud. My feeling is she needed a romantic glass in her hand, liked cradling the globe of a red wine glass. She could make such great dramatic points with that wave of her glass. At first, she drinks the seltezer in wine glasses, but that causes a fall off the wagon. So I buy her six 1930s pilsner glass on ebay with short stems, the points at the bottom of the pilsers just before the stems are each a different, most beautiful color like sea glass. The pilsners more delicate and thin than your great-grandmother's tea cups. My friend makes even greater dramatic points when she waves those pilsners.
I have yet to make a rule about drinking, but I absolutely know that the minute I find myself making one, I'm getting a Soda Stream. But I do believe the reason I never have more than two drinks is I know that with the first drink, I'm adorable, and with drink number two, I find myself becoming a bit short with people. I never have a drink number three because I'll end up calling someone one a…. Never mind. Just know it's a word I won't even write, sparing you, Dear Reader, from having to read any more than an F-bomb. I always stop mid-second drink. Who wants to be short with people, let along disgusting?
Hmmm…. Is that a rule? I will rethink the 1½ drink thing when I finish breast cancer treatment. Hey, is that not a rule, too? The hell with it. No one has better advice than my father. When I'm fifteen, he says, "Okay, so if you go to Judy Morris's party tonight and you drink, you'll feel good. You'll have a really great time because booze takes away your inhibitions. Then you'll throw up on Mrs. Morris's sofa. Do you want to do that?"
"No, Dad." Then I do it.
I love when my dad speaks in parables. Who wants to go around throwing up on your friends' mothers' sofas? (Mrs. Morris doesn't allow smoking cigarettes, even though she figures we're all right with beer, so once she goes to bed when we all pretend to be sleeping, we smoke plastic straws. Inhaling the smoke that is sucked up a straw is a large part of the reason I throw up, never mind the beer.) I sneak out of the house without ever telling Mrs. Morris that I'm the one who threw up on her sofa and set the lamp shade on fire. Judy doesn't have any more parties.
With all that, I decide I need to go to Seraphina's support group accepting the inevitability of it being depressing; how can it not be? But I want to be with people who are in my same boat so I'll have empathy for my swastika marks and maybe I can give them empathy for something that affects them in an exceptionally bad way.
My decision is a big—way big—mistake, just so you know. Far be it from me to get your hopes up. I'm writing a memoir here, not a novel.
After I make my way through the Q Bridge cranes and steamrollers and bumper-to-bumper traffic, doing my EMDR breathing the whole time, and then maneuver corridors, elevators and the cubby holes of Smilow, I have to get past a large group of what appear to be medical students crowding themselves into a room next to the one I'm headed for. The students are very boisterous, loud and happy. They have not been diagnosed with breast cancer, nor are they about to take part in a support group. My guess is they're going to have a party.
In the support group room there is a long table. Two facilitators, Seraphina, and a nurse, will be hosting an estimated fifteen people. I am the tenth to arrive. Imagine the opposite mood to a loud, happy party. Grim. Seraphina waves to me and I wave back.
There is one sorry-ass plate of cookies in the center of the table. After a few more women trickle in and sit down, Seraphina says we will start by going around the room, each of us taking two minutes or so to introduce ourselves and say whatever we'd like—where we are in our treatment, our emotional state, etc.—I do the math, an especially simple calculation even for me. If we each speak for two minutes, that's half an hour. It's a one-hour meeting. That would leave two minutes apiece for more serious support. But maybe most people who come only want to listen, or feel safe, or whatever, and will say, "I don't feel like talking."
We end up with fifteen women. I feel compassion for our drop-out.
The woman to my right is the only one who looks like she has cancer. The minute I walk in, my eyes are riveted to her half-inch long, grey stubble covering her scalp. I know everyone must be feeling badly for her because she's had chemotherapy, but at least now she can be supported.
When I sit down, I smile at the chemo-hair woman, but she looks right through me. If I'm her, I guess I wouldn't be able to focus either.
Alas, we cannot start our support group meeting because it is clear the medical students in the next room are most emphatically having a party. Seraphina asks the nurse if she can find out if there's another room available for us. The nurse seems bent out of shape that she's been asked to run this errand. She comes right back. A matter of making a phone call.
"The scheduler told me to forget it." She says to Seraphina, "All the rooms are reserved."
She thinks to shut the door behind her and the noise level is reduced considerably.
Seraphina says, "Are you all okay with the chatter next door? It's much better with the door closed, isn't it?"
And I'm thinking, How come Seraphina doesn't go next door and ask the revelers to tone it down or head out for one of the ten million bars in New Haven?
But we're all right with the noise. What's a bunch of loud grad students having a party compared with having breast cancer?
Not a single one of has brought a bag lunch. I figure if the support group is something I'll be interested in, I will volunteer to head up a search committee for a restaurant with a little private room so we can have all our meetings some place more conducive to our forgetting our misery.
It is not to be. It is so not to be.
Seraphina nods to the woman to the left of the nurse. The woman remains mute. Seraphina says, "Just introduce yourself and describe how you are doing."
Personally, I think we should start with the reason we choose to attend a support group meeting, but I am not the facilitator and just because it's what I'd like to do, it doesn't mean everyone feels the same.
The first woman to the left of the nurse does not introduce herself but says instead, "I was diagnosed a week ago. I'm in shock. I don't know how long it'll be before I'm not in shock anymore. And I have so much to do!"
Seraphina and the nurse do not respond. Neither does anyone else because no one knows how to go about supporting her. As with all silences, this one does not appear to me to be helpful. But again, that's me. Still, I concentrate on willing Seraphina to act supportive: Please, Seraphina, give us something here. She doesn't. She just nods to the woman next to the woman in shock, who doesn't introduce herself either. Our second co-cancer diagnosee says, "Ditto," without looking up from the table. The first woman was at least able to do that. This one is probably relieved that she can give a one-word answer without having to look at anything besides a table top.
We will all follow suit in that none of us will introduce ourselves, and Seraphina will not ask, "Can you tell us your name?"
But before the third woman in the line can speak, chemo-hair says, "Can someone pass the cookies?" (I'm sorry about the name I think of her as.)
No one moves. I look around. Are we a pack of zombies, or what? Chemo-hair stands up out of her chair, leans across the table, and reaches for the plate. She pulls it over to her, takes a half-dozen cookies, and makes a neat pile right on the table. Then she passes the plate to the person to her left. That would be me. I say, "Thank you," and pass it on. So does everyone else. The cookies aren't touched by anyone but chemo-hair. While she eats the first cookie on her pile, she says, "So what's with this shocked business? I was never in shock. I just dealt."
Seraphina finally says something. "We're all different."
Is that it? We're all different? But what do I want instead? For Seraphina to smack chemo-hair and tell her to try to be a little more sympathetic? I don't. But I want something. Instead, Seraphina just nods to the woman to the right of the two women in shock. This woman is very together-looking—great hair, great clothes, great jewelry and great makeup. (The two women in shock look like they've slept in their clothes for a week and don't have the energy to lift a bottle of shampoo.) Together-woman says her name, Myla, and then turns to shocked-women, and says, "I was in shock for the whole first month." She smiles at them and touches the wrist of the woman still staring at the table.
Oh, but hallelujah! Support!
Then together-woman says she's having chemotherapy at Sloan Kettering to shrink her DCIS, which is over five centimeters. "It's six. When I had my biopsy and the pathology report showed that the tumor was one centimeter over the line, that's when I went into shock. I needed chemotherapy because of one crummy centimeter. So first I have to wait out my tumor shrinking enough to take it out."
She sighs but after getting no support, she continues, "So, my surgeon told me that with a short course of chemotherapy, the tumor would shrink enough in maybe just two weeks. Then I can have a lumpectomy and my breast won't be disfigured. Of course, I have an option to have a mastectomy, but I won't have a body part amputated except as a last resort, not a first, though I know everyone is entitled to their opinion.
"So, I'm going to have my lumpectomy here since the reputation of my breast surgeon is sterling, and besides, I like him. I'm not positive yet where I'll have radiation."
Wow. Who knew you could be treated for cancer à la carte?
Then she says, "The specific reason I'm here is because even though I have accepted that my hair will fall out, my problem now is that after three chemotherapy sessions, my scalp itches. I mean, it really itches. I just can't go around scratching my head all day. The chemotherapy people recommended Head & Shoulders. Believe me, Head & Shoulders might work for dandruff—I don't have dandruff so I wouldn't know—but no shampoo will work for this particular side effect of chemotherapy." She sighs again. Then: "Does anyone know what I can do?"
In response to her question, Seraphina says nothing, what's new? So, we all look to the nurse except the table-staring, shocked-women. Nothing from the nurse, either. In fact, the nurse looks entirely put out, like, How did I get roped into this?
Chemo-hair will oblige together-woman. Chewing the last of her stack of cookies, she says, "Who cares if your scalp itches? At least you have hair." She gestures to her nearly bald head.
We look to Seraphina. Finally, she will speak. She says to together-woman, "Have you asked your doctor about what you can do?"
"Yes." Like Seraphina, this woman also ignores chemo-hair. "I have no chemotherapy doctor at Sloan-Kettering. I have an oncologist and I asked him and he told me he didn't know but to ask my chemotherapy nurses. They're the ones who recommended Head & Shoulders."
We look to the nurse. Maybe she knows what to do about an itchy scalp. The nurse has nuthin'.
I do because I can no longer tolerate sitting there like a zombie, and since I'm just starting to feel some fury, I'd better say something so I can keep the fury in check. I want to be supportive. I say to together-woman, "Maybe you should ask your hairdresser. Hairdressers know everything."
She looks over at me. She smiles. Terrific smile with her plum lipstick. She says with quite a bit of enthusiasm, "Why didn't I think of that? Of course my hairdresser will know what to do. I'm calling her the minute I'm out of here."
My need to be supportive is on a roll. "You probably didn't think of it because maybe you're still in shock."
Now she grins. She laughs. She says, "Thank you for that. But I've graduated from shock, haven't?" She turns to shocked-women. "And so will you!"
They raise their chins a little. Progress.
I say, in keeping with my need to be supportive, "Where would we be without denial?"
One, "Yeah!" from together-woman.
Seraphina gestures to the next woman who makes several attempts to get any words out of her mouth at all. She is worse than in shock. She is stricken. She is the deer in the headlights. But finally, with extraordinary dignity, she whispers, "I thought I had DCIS. Just DCIS. But my pathology report came back yesterday. It shows that I'm triple negative."
All I can do is stare into this woman's still stricken eyes. I don't know what triple negative means. It must be the opposite of the three things Dr. Quigley told me I had going for me. I wait for Seraphina to say something, for anyone to say something. I look around. The faces of my group are either blank like mine or crestfallen because they know what triple negative means. But the die has been cast. We are statues, just like Seraphina and the nurse.
Then the woman pleads, "Is anyone else triple negative?"
Most of the women shake their head, no. I say, "I'm sorry, I don't know what that means."
She breathes in very deeply. We wait. She says, "That's when the cancer cells have no estrogen, no progesterone, and no HER2 receptors. So, the tumor will not respond to drugs—not to tamoxifen or all the other ones that will work for the rest of you. It's aggressive and it's…swift. It could be that it's too late for chemotherapy to do anything at all. I have to have it anyway. If that's so, my doctor is going to enroll me in a clinical trial."
Then she proceeds to give all of us, including Seraphina and the nurse, a pass. "It's okay if there is nothing you're able to say. I just want to ask you to pray for me. Then maybe the chemotherapy or the treatment I receive in the trial will work."
This woman is such a kindly, sweet-looking person, and she has just found out that her own DCIS cancer is surely not worthy of a congratulation. Finally, support arises. Someone says, "I'll pray for you."
She says, "Thank you." Then everyone promises to pray for her, even me, whose version of praying is to find a really pretty wildflower, and toss it into the creek next to my condo, and ask the flower to find a way to reach the heart of whoever it is I'm "praying" for.
I must ask something I really don't want to ask. "When did you find out your DCIS was triple negative?"
"When my surgeon removed an extra margin."
Jesus. What if Dr. Quigley has to remove an extra margin and I'm triple negative too? Why don't I know about this?
Then there's the sound of crying. Next to the triple negative woman, directly across from me, is a young African-American woman. She is especially beautiful. She struggles to stop crying but can't.
No one says a word. Finally, she wails, "I can't do this." She tries to control herself. She can't, but at least she can now make herself understood through the waterfall of tears. "I have to have chemotherapy because my tumor is more than five centimeters. But I don't have the negative cancer." She glances to the woman next to her with triple-negative DCIS. She says, "I should be grateful. I'm ashamed of myself that I'm not. But I…I can't have chemotherapy! I've got two little children. I work! I don't know how I can even keep my doctor's appointments. I don't know how I'm here! My boss is covering for me. I don't know what to do. What will I do? I can't do this…I have to work. I have two babies!" She is waving her arms around and then she just sobs and sobs, and I speak just before the silence starts or before chemo-hair says anything.
I say, "I'm sorry."
She sniffles, she mumbles something, and then she is sobbing too hard to speak again.
Silence anew. Then I get serious. I say to her, "You're not on a roller coaster. You can get off. You can take a break from dealing with cancer while you figure out how you will take care of yourself and your family during chemotherapy. I know you will figure it out."
She looks up at me. She takes out a Kleenex and blows her nose. I try to find something else to say. "Seraphina will help you with resources. I wish you well. I'll be thinking of you."
Cue, Seraphina. Nothing. The beautiful, young, African-American woman nods at me and blows her nose again.
I find myself staring at the plate of cookies. I don't want my turn to come. Maybe we'll run out of time.
But it's another patient's turn, another woman who is clearly in shock because she says, "I don't know, I don't know, I don't know."
She puts her head down in her arms.
The woman between her and chemo-hair pats her shoulders. Then this woman sits up straight and pulls in her chair a little closer to the table. She is of a certain type, maintaining the hippie look of the 70s—long hair in a braid down her back to her waist and tendrils at the edges of her strong face. She has high cheekbones that I would guess have never sported brushed-on blush. Makeup would look out of place on her face. Her hand-made wire earrings dangle down along her neck in geometric shapes, each shape with a little bear hanging within.
She says, "I have to have chemotherapy, too. At first, we didn't think so. But my tumor is five centimeters. I'm on the line. My doctor recommends I do it." She takes up her braid and runs her hand down its entire length to the very end. "I want to have my braid forever. But I feel selfish now. I'm not triple-negative. I no longer have babies to take care of. But still…I'm sorry. I just want to keep my braid."
And chemo-hair chimes in. She says, "Listen, I thought I'd have my hair forever, too. Nope. It all fell out. But now it's starting to grow back. So what's the problem? Yours will grow back. For now, you can cut off the braid and save it, and then when you've got some hair back you can wind it around your head and pin it on, or something like that."
The hippie woman is now staring straight ahead like she's in a trance. The braid has to be twenty-five years old. But I have to give chemo-hair some credit. What she's trying to say makes some sense even if the words are couched in phrasing and tone that make you want to tell her to just shut up.
Leaving the hippie to stare into space, Seraphina says to chemo-hair, "Why don't you go ahead now?"
She goes ahead all right. For maybe five minutes—but it feels longer. She's talking about missing her favorite daytime TV show for this meeting, and then we get a four-minute plot description of one of her shows. Seraphina and the nurse do not try to…uh…re-direct her. This so-called support group has no direction. Then the woman shifts gears. She says, "Listen, my breasts have always given me problems. My whole life. I've always had cysts and all kinds of stuff like that. I'm used to this."
She goes on with a history of her breasts until it all becomes blah-blah-blah.
She finishes and has another cookie. Our time has not run out, unfortunately. It's my turn.
I say the sort of thing I thought everyone would be saying. I say what I planned to say, which is: "I've been doing pretty well until my I had my ultrasound. I'm supposed to start radiation tomorrow. After I got home from the ultrasound, I had a meltdown."
Half of the women are looking at me, the other half at the table. "I came home and was going to take a shower and work around the little Sharpie dabs that mark the spot for the radiation beams since I'm not supposed to wash them off." I take a deep breath. Now, everyone is looking at me. "But they weren't little dabs. They're swastikas."
Chemo-hair jumps in. She leans toward me and says into my face, "Look at this!" and pulls up her shirt. "Look! I have black X's all over the place. So what. You can wash them off eventually. What's the big deal?"
No one says a word. Not anyone. Now the silence is horrific. I will surely not say to her that my X's are bigger and blacker than hers. I won't say anything. I'm going with the silence.
Seraphina proceeds to turn to the woman sitting between her and me, the last cancer patient of those who will consent to speak. The woman twists around in her chair to face me. She says, "I told my doctor to just tell me what to do and I'll do it. I don't want to think about it."
I decide she wants a response to what she's just said. She doesn't want it from chemo-hair, and she knows she won't get it from anyone else so she's looking at me. I say, "You're doing what you need to do. So am I. That's all anyone can do. Nobody's right or wrong."
I must have managed to smile at her because she's smiling back.
Now I look at my watch in a dramatic fashion. It's 12:55. I can't take even the five minutes left. I stand up and say, "I have to be somewhere at one. Gotta go."
At least no one is calling out, "I love you, Mary-Ann," thank God, like what I'm told happens in the AA meeting my friend and I skipped.
Out in the hall, I can hear the grad students again, more raucous than an hour earlier. Party on, guys, I think. I manage not to fall apart. I escape.
So maybe this is what a support group is. Everybody either talks, or mostly doesn't, and it's supposed to make you feel like it's okay to be having a nervous breakdown. If someone is obnoxious, insensitive, even downright cruel, then suck it up like you have to suck up breast cancer. Whatever the purpose of the method, I feel betrayed by Seraphina.
Later, I call her. I leave a message on her voice mail: I want the phone number of the African-American woman so that I can offer to do her grocery shopping, or her laundry, or babysit for her. Or she can call me.
Seraphina leaves a message with me telling me that HIPAA prevents her from giving out any information about her patients. HIPAA is pronounced hippa, and stands for the Health Insurance Portability and Accountability Act, whatever that's supposed to mean. It is one of the many papers you sign without reading when you see a doctor. But I want to know what it means, so I google it. Here is what it actually means: When you're sitting in a doctor's waiting room, the nurse no longer calls out to you from behind the glass, "Do you have any other symptoms besides the diarrhea and gas?"
I call Seraphina back and leave her a message to please give the woman my phone number. Seraphina leaves me a message that she will find some help for her.
Next time I have an appointment at Smilow and Seraphina appears she apologizes that the support group was so large, and assures me that they will break into smaller groups next time. But I have taken a lesson from the support group meeting I attend. Stick with people you know. Stick with your friends and your family even if they can't empathize. And contact me and I'll give you Laura the EMDR's phone number. At least she won't tell you to suck it up. Maybe a support group's message is meant to be, You can't fight city hall, so give up.
I fully understand that Seraphina can't be a jack-of-all trades even though she's surely a jack-of-most, one shy of all.
Next day, Dr. Quigley calls me. The margin is clear.
I ask her, "Are you sure my DCIS isn't triple negative."
There's a fairly long silence for her. Then, "Yes. I couldn't be surer."
"I just read on google that there was a clinical study in England with 438 women who were diagnosed with DCIS. Twenty-seven of them had lesions that were triple negative. All twenty-seven had a recurrence of breast cancer. Why don't I know that?"
She says, "Larger studies will provide more reliable information about whether and how the recurrence risk varies by DCIS subtype. The study is flawed in other ways as well."
"Which subtype am I?"
"I already told you. There were three parts, remember?"
"Good. You were paying attention."
In a week I start radiation. I so want this all to end. I really, really do. Silly me.
CUE GUILFORD. I'm in the waiting room and one of the radiation nurses comes in to get me. Charlie walks along beside us until the nurse tells him we'll see him later. He says his goodbyes to us. When he's half-way down the corridor, he turns and waves to me, as I know he will. I wave back, but I never take my eyes off him because when he gets to the door I know he'll turn and wave once more. He does.
The nurse says to me, "He's cute." Yes, he is. We're going to breakfast at Twin Pines Diner as soon as I'm finished. The nurse is not Dana, who is in charge of the ultrasound, but one of the nurses who is about to perform radiation on me, Pat. She's tall and thin and has a long braid just like the woman in the non-support group. First, she escorts me into another waiting room down the hall past the nurses' station, where Pam and Anna ask how I'm doing. I say something polite; "Fine, thanks," rather than, Great, how are you guys?"
In the new waiting room, she introduces me to a young woman with a book in her hand. She's pretty with a twinkle in her eye and no hair on her head, but along with the johnny coat she is wearing a very cool, floppy, beret-like cap. I introduce myself and then: "I love your hat." I do, but of course am instantly and eternally grateful that I won't be going hat shopping, or worse, bathing suit shopping at the second Smilow gift shop. I'm not triple negative. I'm apparently triple positive.
She says, "Thanks. I have a dozen new hats. I'm Nora. Nice to meet you."
"Nice to meet you, too."
"Good luck, then."
I ditto her a thanks and a good luck back.
She returns to her book. I take out mine and try to read. No matter how many times I read the first sentence on the page I'm on, I don't know what it says. Pat comes in. "Let me show you the dressing rooms, Mary-Ann."
Since she doesn't include Nora, I realize we're not both first-timers, just me.
There are three little curtained-off dressing rooms and a cupboard where Pat takes out my johnny coat. "Opening to the front, Mary-Ann. Just take off your shirt and bra."
She leaves. I change. There is no mirror to reflect the swastikas. When I come back out, the young woman named Nora is gone, but every day, she will be having her treatment just ahead of me. Now, however, there's a man coming out of the dressing room next to mine. The pre-radiation waiting room is unisex. He is wearing the equivalent of a johnny coat only johnny shorts. My top matches his bottoms. Every day, his treatment will follow mine. I don't know what to say to him and he doesn't know what to say to me. Then we both put our hands out at the same time and we shake. Awkward moment. Do we sit next to each other or as far away from each other as possible? No need to decide. Pat is back.
To me, "Ready?" I will never be ready.
She leads me to the…uh…radiation room. It isn't a room; it's the inside of a space station, the surfaces smooth, hard, shiny steel and lit by blue lights. The linear accelerator looks like the space module that was supposed to carry Matt Damon from the mother ship to Mars. All three radiation nurses are gathered—Pat, Carol, and Lori, who I am introduced to again, and they chat with me, drawing my attention to them rather than the space station itself. They all know about my traffic incident. Dana the ultrasound nurse, and maybe Dr. Frye, too, must have warned them. Did I mention, Dear Reader, that I have learned that a traffic incident, as opposed to a traffic accident, means that no investigation is required. All I get is a brief report from the Branford Police Department along with a diagram of a traffic light laying in the middle of Rte. 1, up against the driver's side door of my car—a primitive birds-eye drawing. I, personally, am not included in the drawing. It appears driverless. The live wires and fat cables lying all over the car, trapping me inside, do not make the drawing either. That missing detail, I decide, is part of the cover-up.
I hear a voice. "Did you bring a CD?"
Pat is the one who asks that. I say, "No," and all three huddle with me, full of assurances me that I'll be fine, that at least one of them will be talking to me at all times, that I can call for them to stop the treatment whenever I feel the need, etc. Heard it all before, didn't I?
Then they look at me, waiting. I say, "No. I brought these." I open my hands to reveal the hot sweaty stones I happen to be gripping for dear life that I get from my bag after I shake hands with the man in the johnny shorts. "My EMDR therapist and I came up with a plan. I'm going to hold these stones during treatment. They'll remind me of the comfort and relief I felt when I had my therapy after the falling traffic signal just missed me. I had to hold round metal buzzers during the therapy—these will have to do." I don't get into the headset with the beeping.
They act as though they hear that kind of thing every day of the week, and that my stones are the most wonderful idea anyone's ever had. They examine the stones. Lori, the third nurse, who is the most serious of the three with a very intense gaze, suddenly becomes soft. She says to me, "Gotta love Zen."
Even though they tell me the stones are really very pretty, I do detect a smidgen of skepticism in their eyes. I know if I were in their position, I'd be damn skeptical—worried, too—about a patient clinging to a couple of rocks. And what is Zen, by the way? I've never been too sure, what with having been a yoga dropout.
"Where did you get them?" Karen asks me.
"Down the road at the beach."
"I've never seen stones like that."
"I rubbed a little oil into them. On the beach, once they're dry, they lose their color so you don't notice them." I'm so nervous, which means I keep talking. "I have a writer friend, Barbara Mayer. She wrote an article once; it was called, 'Decorating with Water.' You get out a beautiful crystal bowl, fill it with water, and put it in the light." The nurses are staring at me, wondering when they can comfortably interrupt. "You put stones in the bowl, and sea glass, and whatever you think will look good under water. I tried it once—I got all the stones and glass together and set the bowl on a little table in a corner of the living room. I put a track light over. Stunning. Later that day, I noticed that my daughter had put in her mermaid-Barbie doll, creating an aquarium-like scene, and my son several Hot Wheels cars in case Barbie wanted to go somewhere, though how a mermaid can drive, who knows? He wanted to give Barbie a choice of vehicles. A little later, I heard a strange sound in the living room. The cat had jumped up on the table and there he was lapping up the last of the water."
I finally take a breath, and they all three laugh just as Barbara and I had at my one and only attempt at decorating with water.
Then Lori says, "Okay, then…let's go."
Then their hands are on me as they help me onto the table, guide me into a prone position on my back, and expose my upper body. Presumably, they check out the swastikas. I don't know, as I'm working so hard not to look up at the linear accelerator. Then Pat excuses herself. "I'm going into the control area." She points to where they will all be doing their thing once the accelerator has been set to aim. I channel Tom Hanks and beg him to see that there won't be a problem to tell Houston.
Beams appear from the machine overhead, but I still don't look at the machine itself. I look at my two remaining nurses standing to either side of me. Lori says, "We're lining up the light to the X's. That's all the beams are—lights. The actual rays will enter your body at all the marks, one at a time. I feel a second of being glad. The machine will be firing away at the wretched X's.
While lining up my beams' routes, Lori and Carol begin a nonstop, positive and enthusiastic narrative:
"I have got this."
"Mine is perfect."
"I am so beautifully lined up!"
"I love where I am here."
"I'm right on the money."
"Ready to go!"
They back away from me. Carol says, "We'll all be right there. Look."
I look to where she is pointing at Houston. Pat is waving at me.
They tell me yet again, "We will see you and we will hear you. If you need us to stop, just say stop and we will, but don't sit up or you'll hit your head on the accelerator." Aren't I glad I already know what the radiation machine is called?
Lori smiles down at me. "Don't move. Just hold onto those Zen stones."
I say thank you and get tears in my eyes because I am so hugely grateful to her for reminding me of the stones. I hold them tighter. I take a deep, cleansing, Lamaze breath like a contraction is about to start. I say to her, "Okay."
The last thing that happens before they leave me is Lori lifting the top edge of my johnny coat to cover Starlight. Then she gives Starlight a soft, gentle pat. It is as if she is telling Starlight to help me out. Starlight will, I know. She is happy to be able to do something for her non-identical twin.
Lori will give me that same little pat every day, five days a week, for five weeks. The one exception to her routine is on my second day of treatment when she asks me, "Have we got our Zen stones?" I show her. Then she doesn't ask anymore. She can tell by my face that I don't intend to have any heavy machinery traveling back and forth over me, even for only 90 seconds, without my EMDR stones at the ready.
The accelerator is set into motion. The sound it makes like any other really loud engine. As in helicopter. I breathe. I am now sure I know exactly how astronauts feel when the equivalent of nurses puts their helmets on them before squeezing them into their capsule, seeing them off with good cheer just before they get shot into space.
The image I place in my brain is Charlie and me on our Bermuda honeymoon sitting in two beach chairs. I am seeing us from behind. We are tapping two beers together, all around us pink sand and turquoise water. Between us is a beer bucket that says Corona. We're actually drinking Negra Modelo, which is pretty good, as opposed to Corona, which is no damn good at all. The noise of the accelerator stops.
It will take me a week to count off the pattern of movement, noise, movement, noise, to the point I where I can say to myself, You are one-quarter through; you are half-way through; you are three-quarters through, until the second it goes quiet: Done. Just like a labor contraction except, thank God, you don't feel a thing.
That first day, I think it's okay to move once the accelerator and its noise stop. Wrong. All three nurses are racing in at the instant I am starting to sit up.
"You can't move a muscle till we're back!"
(Sotto voice, Lori, but I still hear her, "Shit.")
I say, "I'm sorry. I thought it was over. "
"It is over, but we can't have you falling off the table."
My daughter being a nurse, I know that nurses really hate it when a patient falls on the floor. They are not allowed to help a fallen, possibly injured, possibly concussed, definitely in pain patient. Instead, one nurse must run for a doctor while a couple others sit on the floor trying to verbally comfort the patient without having to restrain her, as she might be hurt and then be hurt further as restraining is not a gentle concept, all while waiting and waiting for a damn doctor. There are no such terms as, ASAP or move your ass, when you're in a hospital and you need a doctor. (Next for the nurses after their patient is back in bed? Hours of work on a computer! Remember paperwork? At least you didn't have to do it three times because your computer screen keeps going blank for no known reason.)
All my three nurses, once they've finished scolding me, help me to sit up the rest of the way, telling me I did beautifully. I swing my legs over the side of the table. Lori says, "Good work with the stones!"
I don't mention that I have been holding the stones so tightly that I'm unable to unclench my fists.
On my way into the dressing room again, I cross paths with johnny-shorts. I shift one stone so they are both in my left hand and he and I shake hands again. He is a most pleasant-looking gentleman, around sixty, reserved, the opposite of the disposition of men in their sixties based on my observations. I think of Charlie and wonder if this man has testicular cancer. I feel a surge of sympathy for him. Empathy, rather, I have to say.
I don't see him, though, during my last two weeks. He's already finished. On his last day, he asks, "Is this your last day?"
"Two more weeks."
"It's my last day." He hugs me before he goes off for his final dose. I don't like knowing I'll be having treatment without him there to check in with me each day, selfish though that may be. He's a soulmate, even if in the far periphery of my life. Now, I hope he is cured and living happily ever after.
Charlie and I head out for Twin Pines. I have oatmeal with raisins and seven grains of brown sugar. Charlie has two fried eggs up, bacon, rye toast, home fries, half my oatmeal, which I couldn't finish, with the rest of the brown sugar dumped on top.