ANOTHER CHANCE AT LIFE:
A BREAST CANCER SURVIVOR’S JOURNEY
by
Leonore H. Dvorkin
Smashwords Edition
Copyright 2010 by Leonore H. Dvorkin
Smashwords Edition, License Notes
This e-book is licensed for your personal enjoyment only. This e-book may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
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Visit Leonore’s author page at Smashwords.
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For Pam and all the others —
so brave, and still so beautiful.
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TABLE OF CONTENTS
Chapter 5: What the Eye Will Never See Again
Chapter 6: Cutting It Off and Carrying It Away
Chapter 7: The Immediate Aftermath
Chapter 8: Pause and Reflect — Why Me?
Chapter 9: Going Forward from Here
Chapter 10: Setbacks and Solutions
Chapter 11: Self-Pity Personified — Putting All This Into Perspective
Chapter 12: Breasts, Beauty, Sex, and Femininity
Chapter 13: My Much-Appreciated Prosthesis
Chapter 15: Health News and New Health Horizons
Chapter 16: Going Forward into the Future
Chapter 17: Aging, Accepting, and Appreciating
Chapter 18: What Will the Future Bring?
About the Author / Links / Contact Information
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On August 11, 2008, I celebrated the tenth anniversary of my left-side mastectomy, an operation that marked a significant and joyous turning point in my life.
This book relates some of the facts surrounding my experience with breast cancer as a disease and some details of my particular type of mastectomy. I’ll tell you how I discovered the cancer, the steps that were taken to rid me of it, what kind of pain I had after the mastectomy, and what the aftereffects of the operation have been.
Then come additional musings, all with a highly personal slant, on the whole tangle of related subjects: fear of surgery and death, the inevitable “Why me?” question, femininity and body image, sex and breasts or the lack thereof, cancer as measured against other types of health problems, the tremendous value of emotional support from others in times of crisis, our wonderful 21st-century openness about illness, and more.
I want to state at the outset that I in no way intend to say to other breast cancer survivors or patients: “This is the way you should feel. This is the way you should react. This is the path of treatment you should select.” Absolutely not! Your emotions and reactions and medical choices are your own.
If my words can be of help and encouragement to other women who have gone through the same experience or who are going through it now, then that will be a rich reward. However, this book is primarily for the many women who have not yet developed breast cancer but who will in the future, as well as for all the others who fear they might develop it. I’ve written this book to tell them that breast cancer does not have to be counted among the greatest traumas of their lives. Instead, with luck, they can go on living and doing all they did before. They can come out on the other side of the experience better than they were before, both healthier and happier.
I know this is true, because it happened to me. What follows here is the story of how.
* * * * *
It all began sometime in early 1998. I was sitting in my kitchen one morning talking on the phone, still dressed in only my nightgown. I was suddenly aware that my left nipple was leaking slightly and that it felt peculiar, very slightly painful. When I pulled down the front of the loose gown to look, I could see that the nipple had put out a few drops of a thick, yellowish substance. It was unlike anything I had ever seen come out of my breasts before. I squeezed the breast gently, and a few more drops came out. Then they stopped.
How strange, I thought. Then I put it out of my mind, assuming it was some oddity connected with menopause. I was 51 years old.
My only child, Daniel, was born in 1969. I breastfed him for ten months, until he weaned himself. Back then, I was a member of La Leche League, one of only two women’s group to which I have ever belonged. This international organization promotes the practice of breastfeeding. (The name means “milk” in Spanish.) La Leche League educates women about the numerous physical and psychological benefits of breastfeeding for both babies and their mothers. In addition, it provides women with emotional support and social contact with other mothers who wish to practice this most basic of interactions with their babies.
In 1969, my husband and I were living near Houston, Texas. David’s first job out of college was as an aerospace engineer, working on the Apollo program at NASA. It was the wife of one of David’s co-workers, a woman with two small children of her own, who told me about La Leche League and the valuable support it offered. During one of the group’s cheerful, lively meetings, I was glad to learn that one of the benefits of breastfeeding for the nursing mother seems to be a reduction in the risk of developing breast cancer.
That’s the key phrase, though: reduction in risk, not prevention.
I had no trouble nursing Daniel. Right from the beginning, I found it a joyful, satisfying experience. However, when he was only three or four months old, Daniel decided that he was going to nurse exclusively on the left side. There was no persuading him otherwise. That left me comically lopsided, a swollen, leaky C cup on the left and a dried-up A cup on the right. There was no harm done, as far as I could tell. Daniel seemed to be quite healthy, apparently getting plenty of milk from the one breast. I was more amused by the situation than anything else.
We both adjusted well, and our peaceful and leisured nursing sessions continued as before. I didn’t work outside the home back then, so I never had to rush him. But whatever physical or emotional benefits I might have reaped from those happy times, they could not protect me from the disease which, almost three decades later, was to strike me and the breast that had nourished my son.
How lucky we are, sometimes, that we cannot foresee the future.
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After those strange few minutes in the kitchen, there were no more yellow drops for a time, but there was some pain in the nipple. I found out later that it was due to a ductal papilloma, a tiny wart that was growing in a milk duct.
Still, I didn’t rush to the doctor. There was no lump that I could feel, and my most recent mammogram had shown nothing alarming. Several years before, I had had two suspicious lumps in my left breast surgically biopsied, but they had turned out to be pea-sized cysts.
I knew that my maternal great-aunt Leonore had had breast cancer in her seventies, but I knew of no such cancer in any closer relatives. My mother contracted breast cancer, too, but a year after I did. Thus, prior to my first symptoms, that particular illness was not high on my list of health worries. Given all the heart trouble on both sides of my family, my inherited tendency toward high cholesterol, and my long history of varicose veins, I was much more fearful of a heart attack, a stroke, or blood clots.
More droplets came out spontaneously over the next few months, and the liquid grew thicker. Sometimes there was a bit of blood mixed with it. I had heard that nipple discharge could be a sign of breast cancer, so at last I grew alarmed enough to call my primary care physician, Dr. Werner Baumgartner, for a breast examination. My yearly physical exam and mammogram were already scheduled for about two months from the date of my phone call, but I didn’t think I should wait that long. The earliest opening for another appointment, they told me, was about three weeks from the date of my call.
Since 1986, I’ve been associated with Metropolitan State College of Denver, an institution with some 22,000 students. Metro State shares a downtown campus, which bears the historical name of Auraria, with the University of Colorado Denver and the Community College of Denver. I obtained my second Bachelor’s degree from Metro State in 1991. Since 1988, I’ve had the privilege of working on the attractive campus as a self-employed tutor of foreign languages. I’ve also taught a few German courses there as a part-time instructor.
Over the years, I’ve had more than one occasion to visit the excellent campus health clinic. Several years ago, after I put my right hand through a window by accident, suffering a deep and spectacularly bloody cut as a result, a doctor at the clinic did an impressive job of sewing up my hand, quite possibly saving the mobility in my little finger. Everyone at the clinic with whom I have ever come in contact has been friendly and competent.
I called Dr. Baumgartner’s office on June 2. The same day, on an impulse born both of an instinct that something was very wrong with me and of confidence that I would receive good care, I stopped by the campus health clinic and asked if I could make an appointment for a breast exam. I could pay for it, I told them. I just needed some reassurance while I waited for the coming appointment with Dr. Baumgartner.
The next day, I was examined by a physician’s assistant, Linda Valente. She listened attentively and seriously to what I had to say about the pain and the discharge, and then gave me a thorough manual breast exam.
“I think we’ve got trouble here,” she said simply.
Then she called Dr. Baumgartner’s office and persuaded him to see me the day after that, on June 4. I’ll always be grateful to her for her care and her caring.
There followed all that had to follow before the final diagnosis could be made, that fearful period which cannot be hastened and must be endured. The wheels of the medical bureaucracy often turn slowly. Over the next several weeks, I had another manual breast exam, then a mammogram, then an ultrasound test. On July 17, Dr. Elizabeth Brew performed a surgical biopsy of the lump that was, by that time, quite palpable slightly to the outside of my left nipple.
On July 22, after all the weeks of worry and days of more than a little pain from the biopsy, the definitive diagnosis arrived via a brief message on my answering machine from one of Dr. Brew’s associates. It was cancer.
Did I scream? Did I cry? No, I didn’t. But my calmness was not due to any extraordinary bravery on my part. It came from the fact that the grim news was not really a surprise to me. It was what I had expected. Deep within me, in some dark recess of my being unconnected with my breasts, I had known since my visit to the campus health clinic that my body was harboring cancer.
Did I then delay further action out of fear? No. Because all I could feel, once I had the diagnosis, was a terrible urgency to be rid of this alien thing that was growing inside me.
I called my husband and son first, then Dr. Brew’s office. In a little over a week, she could see me for a consultation regarding the course of further treatment.
That evening, David and I started searching the Web for all we could find on the type of breast cancer I now knew I had: DCIS, or ductal carcinoma in situ. Together, we devoured roughly 75 pages of authoritative information from a variety of sites, primarily those of major U.S. medical schools and cancer organizations. I was reading the last few pages as David drove me to Dr. Brew’s office on July 31.
* * * * *
By the time Dr. Brew sat down with us, David and I had both been convinced by all we had read that the safest course of action would be for me to have a so-called simple mastectomy (the removal of the entire breast but no underlying muscle tissue), and not the more conservative treatment of lumpectomy (the removal of the cancerous lump and some surrounding tissue). Lumpectomy would have to be followed by several weeks of radiation treatments.
My decision in favor of a mastectomy was based primarily on the information that DCIS is often scattered throughout the breast, and that it has a slightly higher rate of recurrence than some other types of breast cancer. Also, my basic nature almost always favors “better safe than sorry.” Better a little immediate overkill, I figured, than too conservative treatment followed by my death later on from missed and then metastasized cancer cells.
Also, as odd as this may seem to some readers, I found that I feared the prospect of multiple radiation treatments more than I feared the prospect of losing a breast. The treatments sounded most unpleasant, both painful and extremely disruptive to our lives, as they would entail going for treatment five days a week for six weeks. I figured I would rather have my breast cut off, get well, and get it over with.
Another factor in my decision was the realization that a lumpectomy would not leave me much of a breast. My previous surgical biopsy, during which the two cysts had been removed, had left a definite indentation on the outer side of my left breast. The newly discovered cancer was almost directly under my left nipple. In order to do a sufficiently large lumpectomy, Dr. Brew would have to take off my nipple and also remove a good-sized chunk of flesh from beneath it. Were I to get more cancer on that side in the future, even more chunks would have to come off. Given that my breast was so small to begin with, barely a full A cup size, all those separate procedures would amount to what David wryly called “mastectomy by degrees.” So there seemed to be no point in not having a mastectomy right away and being done with it.
Dr. Brew, happily surprised by our calm manner and the extent of our information, concurred with our judgment. Yes, she said, by electing a mastectomy versus a lumpectomy, I could avoid both radiation and chemotherapy. I would also reduce my chance of a recurrence of cancer (on the left side, at least) to almost zero. She seemed all but certain that there was no lymph node involvement, which was a big relief.
There was never any discussion of breast reconstruction apart from my telling Dr. Brew right away that I didn’t want it. I would never trust a plastic sack of liquid sewn into my chest. It would be another alien thing in there, leaving me worried that it would break someday. I had also read that it would make it harder for any future cancer to be detected.
So the whole consultation was quick, calm, and cheerful. At the end of it, my surgery was scheduled for less than two weeks later.
Did I fear the surgery itself? Not particularly. How could I, when I had already had seven major operations in my lifetime, starting at the age of 18?
Here’s a brief summary of my medical history.
I was born with a strange and strong tendency to develop varicose veins. Accompanied by some very unpleasant physical sensations, they first started surfacing when I was about 12. By the time I was 18, my legs were in worse shape than my mother’s after her six pregnancies. The bulging blue veins that covered my legs were a source of much embarrassment to me, as well as painful. I was relieved and happy to learn that there was a surgical remedy.
I had my first varicose vein stripping in the summer of 1964, right after I graduated from high school. I had my fifth such operation in December 2000. Thanks to a new surgical technique and the skill of an excellent vascular surgeon here in Denver, Dr. Dennis Olson, that last operation was extremely successful. But Dr. Olson was quick to warn me that there was no guarantee that I would never need another such operation sometime in the future. As he put it, I’m just a “vein former.”
For the comfort, health, and improved appearance of my legs, I wear support pantyhose all day every day except in very hot weather. No matter what the weather, I have to wear them whenever I exercise with weights or use the treadmill. Without them, my legs feel vulnerable and uncomfortable. In short, support hose are my friends: irritating at times, but needed and much appreciated.
In 1964, the surgeon who first operated on my legs told me I should probably avoid having children, predicting that pregnancy would be bad for my legs and dangerous to my health. How right he was! Four years later, Daniel was conceived in spite of the contraceptive foam that David and I were using at the time. The pregnancy was so hard on my legs that I had to wear not regular support hose, but tight elastic bandages during the last few months.
Not long after Daniel was born, I was told that a second pregnancy might well result in my death due to blood clots. That was a terrifying prospect, and I certainly had no wish to experience again the pain I had undergone while carrying Daniel. So, at the age of 23, I found it imperative to consider and then choose some method of permanent birth control.
There were not many options, especially if one added the stipulation that there had to be a 100% guarantee that I could never get pregnant again. I couldn’t take birth control pills, as they pose definite risks to women with circulatory problems. Contraceptive foam had already proven its limitations. Condoms are not always reliable.
David could have had a vasectomy, but even that has been known to fail. Besides, we wanted him to remain fertile. There was always the slight possibility that I could die before he was old. If he remarried, we reasoned, he might want to father a second child. Even though I knew that I could not safely have a second child, I didn’t want to cheat him of that chance.
Tubal ligation was one option, but back then, the neat, quick laparoscopic method had not yet been developed. Not relishing the prospect of major abdominal surgery just to have my tubes tied, and on my doctor’s wise advice, I chose a vaginal hysterectomy. It would leave my ovaries intact, my hormones normal, and no visible scar. Plus, the surgeon assured me, I would be well within six weeks. It all sounded fine to me.
That operation was performed in March of 1970, shortly after Daniel’s first birthday. In spite of how young I was when I lost my ability to have more children, I have never once regretted my decision. It was a vast relief to be freed forever of the fear of another pregnancy. Into the bargain, I permanently escaped the mess and discomfort of menstruation. All in all, I have to call it one of the best medical decisions I ever made.
After that — and I can no longer remember in exactly what order they came — I had several more operations, as well as an assortment of other medical problems. Besides all the above-mentioned vein operations (another one every few years, it seemed, resulting in legs that are covered with more than a hundred scars from my groin to my ankles), there was foot surgery to correct the large and painful bunions I had on both feet and to straighten a crooked little toe. There was also an operation to remove a Baker’s cyst, which developed inside one knee after I did too much bicycling in too low a gear. That was a painful lesson in the wisdom of the caution that more exercise is not always better.
I had several other more minor surgical procedures over the years, most of them in connection with skin or dental problems. And in 1985, due to an extremely stupid act on my part while I was training a young woman for a bodybuilding competition, I sustained a back injury that almost ended my long career of teaching weight training. It caused me some of the worst and most prolonged pain I have ever endured.
It should also be noted that I survived being born three months premature, weighing only 2 lbs. 11 oz. I’ve been told over and over, by family members and doctors, how amazing it is that I lived, and that I suffered no serious permanent damage to my body or brain.
It’s obvious, then, that I’ve been pretty tough from the very beginning. Physical problems have been part of my life for almost as far back as I can remember. Having had to deal with so many challenges over so many years, I’ve developed a strong faith in myself. It’s a confidence that I can overcome any difficulty, that I can emerge from each new ordeal changed, perhaps, but better than before. So why should my reaction to the physical and emotional challenge of cancer have been any different?
I also have a lot of faith in doctors and hospitals — not blind faith, but trust born of long, varied, generally positive experience. I certainly had a lot of faith in Dr. Baumgartner and his choice of surgeons. As luck would have it, a friend of mine who was a surgical nurse had worked with Dr. Brew. Marilyn assured me that Dr. Brew was both highly competent and very compassionate, which jibed perfectly with my own impression of her.
Thus I was ready to be cut open and healed once again.
* * * * *
In late July, between my diagnosis and the scheduling of the mastectomy, the fear of death began to creep into my consciousness. This operation would be quite different from anything I had ever had done to me before. All my other surgeries had been to correct what I would call mechanical problems, not to treat life-threatening diseases. Also, I was younger and stronger when those other surgeries were performed.
By 1998, I was middle-aged, menopausal, and about 25 lbs. overweight in spite of regular weight training and walking. This time, I found, I had a distinct fear of dying of a heart attack or stroke while under the knife. So I made a list of certain of my possessions and the people who would receive them if I died, and I planned a quick trip to Kansas City, Missouri, where my mother, four of my five sisters, and several members of their families live.
Perhaps it was some manifestation of their own fear of breast cancer, but once I informed my mother and sisters that I would have a mastectomy, I found that they were not in agreement with my decision. They thought I should elect a lumpectomy plus radiation treatment, presumably because that is what they themselves would choose unless they had no other option.
In fact, a year later, my mother did choose lumpectomy and radiation as the treatment for her own breast cancer. Given her advanced age and heart problems, a mastectomy would have been too dangerous for her. I’m happy to report that she recovered well and is still alive today at the age of 89. So there’s a good illustration of why you have to base your own medical choices on your overall health, your age, your type of illness, and a host of other circumstances. Most certainly, one treatment does not fit all.
In contrast to my family members, virtually all my friends here in Denver applauded my decision to have a mastectomy and said they would do exactly the same. I found the discrepancy quite odd, as well as disturbing. I wanted and needed my family’s love and support. But it seemed that I could not make them understand why I was choosing to have a mastectomy, and they seemed puzzled and at times even annoyed by my relative calm and optimism. After the surgery, I encountered a few other people with the same attitude. It was almost as though some people were disappointed that the entire experience was not more traumatic for me.
I certainly didn’t want strife with my family just then. We had had far too much of that the year before, after they had all read manuscript copies of my one novel thus far, Apart from You. (The book was published by Wildside Press in June 2000. A revised edition was issued by both CreateSpace and Smashwords.com in 2010.)
Several members of my family objected violently to certain parts of the book. Our discord reached such an unpleasant pitch, and hurt me so deeply, that I wonder to this day whether or not my prolonged emotional pain had anything to do with my getting cancer. That is, I think my intense and protracted inner turmoil may possibly have lowered my resistance to what was lurking in my genes.
Was there indeed a connection between my hurt feelings and my getting cancer? That is most likely an unanswerable question. And in the years since my surgery, the simple passage of time, as well as many subsequent instances of warm contact and communication with my family, have blunted my painful memories of the unexpected strife regarding both my novel and my health choices.
It’s an unfortunate family indeed that can’t eventually get past upsetting details and disagreements — even though some of those disagreements may be, at the time they arise, true mountains rather than molehills.
There was no thought of not seeing my mother and sisters before my operation. The last-minute plane ticket cost me a scandalous $830 for a trip that has the passengers in the air for all of 75 minutes, but I paid the money and went for a visit over the weekend of July 24.
I’ll never be sorry I did. We talked very little about my disease or the coming surgery, and I found myself grateful for that. Instead, we did a lot of talking about other (mainly family) matters, a lot of comforting eating, and some sightseeing.
Almost every visit I make to Kansas City includes a visit to the fabulous Nelson-Atkins Museum of Art and its interior garden restaurant, Rozzelle Court. That trip was no different. Surrounded by the glory of art and artifacts from the long ago past, it was easier to distract myself from my uncertain present and future.
Even with the constant pain I still had from the surgical biopsy, even with some still, solemn moments alone with myself and my thoughts when sitting in the bathtub every morning, contemplating the breast that would soon be gone, the visit as a whole was truly joyful.
Even the weather cooperated. I had expected the usual brutal, humid heat of late July in the Midwest. I grew up mainly in South Bend, Indiana, so I was well familiar with such heat. But during my visit, there was a prolonged, very cool wet spell. The nightly rain on the old farmhouse, the home of my older sister and her husband, was immeasurably soothing.
At Monatco, the metal fabrication job shop in Kansas City, Kansas that my brother-in-law Timm Ferguson ran, I chatted briefly with his parents, Glenn and Colleen. They had not yet been told the reason for my short, previously unannounced visit. Colleen was her usual bubbly, loving self, giving me a big hug and complimenting me on my new, very short haircut, telling me that it made me look “young and perky.” It was a lift I needed.
Sadly, that was the last time I saw either of Timm’s parents alive. Colleen died of heart failure in late January 2001, and her grief-stricken husband followed her to the grave just a few weeks later. And only eight years after that, their son Timm, my older sister Margot’s husband of 40 years, died of lung cancer.
Oh, readers! If you love them at all, hug your parents and your in-laws whenever you can. You never know which embrace will be the last.
On July 27, when I was about to board the plane to go home, I felt a much deeper fear of death than I had until then. It was difficult for Margot and me to say goodbye to each other.
She hugged me very hard as the tears spilled down my cheeks in spite of myself.
“It’ll be all right,” she said. “I know it will.” But she was crying, too.
“I’m not sure of that,” I replied.
Then I had to go.
* * * * *
A few days later, there was another social occasion, a thoroughly cheerful one.
I’ve taught coed weight training classes since 1976. Nowadays I teach in the basement of my home, rather than in a commercial studio. Until a few years ago, three of my students were a woman named Peggy Dinkel and two of her grown children, Laura Arundel and Vanessa Caniff. Another of Peggy’s daughters, Julia Dybdahl, used to attend my classes as well. On August 2, 1998, Peggy celebrated her 65th birthday. Vanessa had turned 30 the day before. On Peggy’s big day, they had a huge barbecue at Julia’s house, and David and I were invited.
For several hours, we all ate, laughed, and celebrated life and family love. Watching the many children at play, I was filled with a powerful sense that life goes on no matter what happens to any single individual. The whole of it is much greater than the parts.
The few people at the party whom I told about my cancer and the coming operation — then only nine days away — took it all very calmly and nodded their enthusiastic agreement regarding my decision in favor of a mastectomy with no reconstruction. “You’re right,” they said. “That’s just what I would do in your position.” It was needed reassurance.
David and I have wonderful photos from that day, a few of which I still keep on the refrigerator. I captured David playing with the Dybdahls’ little black dog, Princess. Two of Peggy’s young grandchildren, Emily and Ian, spontaneously plopped themselves into my lap for a photo. It was as though I were a favorite aunt, instead of a stranger to them. The happiness that radiates from all our faces in the resulting picture gives me another sort of reassurance every time I look at it.
Trust. Affection. Love. Celebration. These are universal constants, and they will endure past every misfortune.
* * * * *
What the Eye Will Never See Again
The evening before my mastectomy, David and I went out and bought a Polaroid camera. We did not yet own a digital camera, and we knew that no commercial lab would develop the photos I wanted him to take: pictures of my naked body, whole for the last time. I wanted not just memories of that body, but clear and lasting evidence of the old image of myself.
In the photos, there is no sign of the disease itself. Nor is there any sign of the fear and uncertainty I felt.
The simple, grainy little pictures that resulted from that evening’s photo shoot would never pass as art. We made no effort to glamorize or soften the images in any way, to make me look like anything other than the middle-aged, somewhat overweight woman I was and still am. I simply stood there unclothed, in the bathroom and then in the hallway, and let my beloved husband and the technological wonder in his hands capture my Before, the body he had known and loved for over thirty years.
That evening, neither one of us had any firm idea of what the After would look or feel like, or how either one of us would react to the changes. And so both of us wanted those pictures, evidence of how I was on that side of a great divide in my self-image and my life.
Photos of my post-surgery body would come later. Somehow, we wanted and needed to document the entire process.
There are the pictures taken the night before the surgery. There’s one of the thick bandages and the drain tube and its attached bulb that I had in me and on me for three days after the surgery. There are pictures of my body freed from the bandages, unflinching pictures of my naked chest and its big red scar.
Then, two years later, came photos of my chest all healed, my body about ten pounds heavier but quite strong again — and my broad smile, reflecting my new joy and inner peace.
* * * * *
Cutting It Off and Carrying It Away
The day of the operation came at last. We had to rise very early, as we needed to be at the hospital, St. Anthony Central, by 6:00 a.m. I was sleepy, but less nervous than David. There was no one to accompany us. I hadn’t expected either of my parents or any of my sisters to come to Denver to be with me during the procedure, and our son and his wife (now his ex-wife) were out of town.
Due to all my previous surgeries, the lengthy pre-op procedures were familiar and unthreatening to me. The insertion of the various needles and tubes was not pleasant, of course, but there was nothing done to me that hurt more than a little. The entire hospital staff with whom I came into contact that morning — the admissions personnel, the surgical prep nurses, the anesthesiologist, the nurses on the surgical team, and Dr. Brew herself — radiated confidence and cheerfulness, which I found far more soothing than the seriousness I had expected.
After I said a loving and emotional goodbye to David, the fiftyish nurse who wheeled me into the operating room told me matter-of-factly that she had had a mastectomy, too. Yet there she was, evidently none the worse for the experience — working, smiling, and helping others like her.
My last words to Dr. Brew, just before I slipped into unconsciousness, were, “Do a good job!” Somehow I knew by then that she would.
Having surgery is a strange experience, at least when one is given general anesthesia. In my experience, the actual hours of surgery pass for the patient much as a night of deep sleep does: very rapidly and dreamlessly, as though the time had simply vanished. It’s the waking up that can be unpleasant.
Thanks to modern painkilling drugs, there isn’t usually much pain at the operation site. But there can be nausea, a severe headache (often due to nothing more complicated than caffeine withdrawal, they now know), and a frightening chilliness that can cause the entire body to shake even under the warming blankets. It’s not for nothing that they have an entire room and special staff to take care of the groggy post-op patients, those poor souls who wake up relieved to have survived the surgery but often very uncomfortable, cold, trembling, and disoriented.
How long I was in recovery, I don’t know. I woke up again in my private hospital room with a worried-looking David at my side. There followed a long evening of repeated bouts of nausea due to the morphine I was being administered intravenously. It was later changed to Demerol, which solved the problem. There were periods of semi wakefulness followed by periods of extreme grogginess, as well as the frustrating realization that the few words coming out of my mouth probably weren’t making a lot of sense to anyone.
But I also felt enormous gratitude that one of my Spanish students — Al Miller, a pediatric nurse — had come to keep David company and help look after me that first evening. His arrival was a very welcome surprise.
It was Al who recognized at one point that I wasn’t sufficiently hydrated and got them to adjust my drip bottle. I have an almost dream-like memory of him standing for what seemed like hours on one side of my bed while David stood on the other, both of them watching me, two pillars of caring.
Once my nausea had lessened somewhat and I no longer required constant observation, David and Al began talking to each other about computers, information technology work, and science fiction, favorite topics of discussion for the two of them. Their calm, low voices were a soothing background hum to me. At one point I heard Al tell David that he had turned 45 the day before. He talked about his career dreams, his hopes for a bright new future. David offered his encouragement. There it was again, that necessary looking forward.
Dr. Brew came in briefly, looking concerned and a little frazzled. My prolonged and violent nausea had thrown a monkey wrench into the anticipated procedure — which, she told us to our amazement, would have been my almost immediate release. That’s right, folks. Your average HMO here in America now expects simple mastectomies to be same day surgical procedures. The woman is expected to get her breast (or breasts) lopped off, be monitored for a few hours for any complications, and then be sent home.
Only my nausea was keeping me there for the night. They could not release me if I was still throwing up, Dr. Brew told me succinctly. That finally quit, and I was able to keep down a bit of Jell-O. By then it was late enough that I was allowed to stay the night and was assured that the insurance company would pay the extra cost. Oh, thank you, kind and generous HMO functionaries, for allowing me to stay in the hospital for all of 28 hours!
After Al left, even after David left later (he desperately needed some sleep), I had yet another visitor. This time it was one of my German students, Laszlo Kovacs. As pleased as I was to see him, I don’t think I was very good company. It was late, and I was extremely tired by then. Laszlo saw the situation immediately. He wasn’t there to bother me; he was there to show he cared. He gave me a get-well card, then sat near my head for a while, talking mainly about the pleasant visit he had had with the nurses at their station outside my room. He gently touched my hand, smiled at me, wished me a speedy recovery, and then left.
I drifted off to sleep under a soft emotional blanket of love from my husband and affectionate caring from two of my favorite and most faithful students. It was a portent of much more such warmth to come.
I awoke a new woman, feeling surprisingly normal and ready to go home. With David’s help, I was even able to wash my hair in the bathroom sink and then put on a bit of makeup. A new blue-and-white striped caftan covered my thick bandages, the drain bulb and its tube, and my legs. With my all but disabled left arm, it was impossible to put my support stockings on, but I figured my legs would be fine until I could exert that much pull again.
I was discharged at 10:00 a.m. I bought a cappuccino in the lobby of the hospital, said goodbye to the friendly nurse who waited with me while David retrieved the car, and was on my way home.
That afternoon, I received several long-distance phone calls from family members. Bouquet after bouquet of flowers arrived from far and near, from relatives and students and friends. The house soon looked like a flower shop. The dining room table was dominated by a huge, gorgeous display of blooms from Peggy Dinkel and her daughters. I was overwhelmed by the beauty, as well as by all the presents, fruit baskets, cards, phone calls, and e-mails I received. There were even some e-mails from strangers, from people whom David knew only online — other science fiction writers and readers, mainly, whom he had told about my surgery.
The cards were so numerous that I had to suspend them overlapping one another on a long string stretched across the living room hearth. They stayed there for several weeks afterward. Never in my wildest dreams could I have anticipated such an outpouring of love and concern. More than anything else, I think, that helped me to heal.
So that was the first benefit of my cancer: finding out how much other people cared about me. It was an amazing revelation.
* * * * *
Sleep heals, too, but I wasn’t getting a whole lot of it. There was no way for me to recognize this right away, but the Darvocet that Dr. Brew had prescribed for my pain was acting as a powerful stimulant on my peculiar system. After a few restless nights during which I slept three or four hours at most, I was utterly exhausted.
On August 14, I went to see Dr. Brew for the removal of the surgical dressing plus the drain tube and bulb. She apologized profusely for the unexpected effect of the Darvocet and told me to discontinue taking it. She guessed that I could probably get along with nothing more powerful than Aleve, my favorite over the counter pain remedy. As amazing as it might seem, given the extent of the surgery I had just had, she was right.
She also had some important information for me, information based on the report from the hospital pathology lab. It was that my cancer had indeed been multi focal.
Several tiny additional bits of cancer, undetected prior to the mastectomy by the manual exams, the mammogram, the ultrasound test, or the surgical biopsy, had been found scattered throughout the dissected breast. (In the lab, the breast was cut into seven slices, each of which was then examined under a microscope.) If I had elected more conservative treatment, any one of those specks could have grown into a larger spot of cancer sometime in the future.
That was proof that my decision in favor of a mastectomy had been the right one. There was no sign of cancer in the lymph nodes, however, meaning that there was no need for me to undergo radiation or chemotherapy. It all added up to welcome, reassuring news.
I wish I could have been in the pathology lab to watch the dissection of my breast. David found this detail horrible, but I found it fascinating. If I could have gotten through all the required science and math courses, I’m all but sure that I would have become a biologist. It’s a great joy to me that our son is pursuing a doctorate degree in the exciting new field of Bioinformatics, also known as Computational Biology. That’s biology, computer science, and mathematics all rolled into one. I’ve always admired and envied David’s and Daniel’s scientific and mathematical abilities.
The removal of the drain tube and its attached bulb — icky but helpful contraptions — hurt hardly at all. During the brief procedure, I was fascinated to find that I had phantom nipple pain. I could have sworn that my missing breast was still there, feeling much as it had before the surgery. But of course it was gone. In its place was a neat horizontal scar, five inches long. There were no visible stitches, as those were all internal, and would gradually dissolve. At each end of the scar, the skin was a little puffy, a bit bunched up. I have no idea why, but to this day, those small bulges have never gone away.
Above the scar was the large bulge of my tucked up pectoral muscle. Dr. Brew told me I had the best-developed pectoral muscles of any woman she had ever worked on — due to my 30 years of weight training, obviously — and that the muscle there had been rather challenging to deal with. But I believe she must have done a very good job. Although I think I will never again be able to bench press more than about 50 pounds or do dumbbell flys with more than about 15 pounds per dumbbell, the important thing is that I can still work out and can still teach my beloved weight training.
Of course there was no thought of weight training that day. I was mainly relieved to have the drain tube out and the bulky surgical dressing gone, as my chest felt much freer and more comfortable thereafter.
Looking at my new chest was more interesting than anything else. Dr. Brew told me that most women cry at that point, weeping for the loss of the breast. But I could only smile with relief, relief that my cancer was gone and that the surgery had not been particularly painful or debilitating. It was also good to see that the surgical site and the scar were not really all that ugly.
I left Dr. Brew’s office that afternoon walking much straighter than when I had entered it.
The next day, after a good night’s sleep at last, I watered the flowers in front of the house and chatted with my neighbor, Judy Chandler. She was amazed to see me outside doing a chore only four days after my surgery. But why not? I felt fine, and watering the flowers was yet another affirmation of life. I contemplated the sparkling spray and the colorful blossoms with a whole new appreciation and joy. I was home. I felt good. I was alive.
That same afternoon, a friend took me to see a movie and then visited with me for over an hour back at the house. Later on, while some welcome rain fell, I napped for a bit. That evening, David and I went to our favorite Vietnamese restaurant, the Saigon Bowl, where I enjoyed a delicious dinner of spring rolls and seafood with black mushrooms. It was wonderfully heartening to be housebound no longer.
* * * * *
Why Me?
Since I’d been told that lifting more than 15 pounds total would be forbidden for several weeks following surgery, doing my usual tutoring work was out of the question. That’s because I take over 40 pounds of language books with me when I go down to campus two or three days a week. It’s not uncommon for a new bus driver or a fellow passenger to ask me if I’m on my way to the airport, loaded down as I am with a full wheeled suitcase, a bulging canvas bag, and my large purse. Believe me, it’s quite a trick to get on and off a city bus with all that.
The campus restaurant where I used to tutor, the Mercantile, has a 20-step flight of stairs up to the seating area, and there’s no elevator in the building. Immediately following my surgery, it was hard to imagine how I would ever get my books up those stairs again. (For a variety of reasons, most of them unconnected with the architecture of the Mercantile, I no longer work there. Now I tutor in my home and in the campus library.)
When I’m in my normal state of good health, I don’t see hauling all those books as a hardship; it’s merely part of my job. Years of doing that and working out with weights several hours a week have made me very strong. I should note here that above-average physical strength is a large and important part of my self-image. The idea of losing that strength is far scarier to me than the loss of a breast — or even two — could ever be.
However, I also believe in doing what the doctors tell me to do to aid my healing. In addition, my body was telling me that their advice was sound. I had no desire to go back to work before I was ready to do so.
My husband and I were fortunate that there was no pressing financial need for me to return to work right away. Thus I was free to relax and rest at home, sleep whenever I felt the need (which was rather more often than I had anticipated), go out when I felt like it, and do as much or as little work at home as I wanted to, biding my time until I felt I could return to campus. About three weeks after my operation, I was able to start doing limited tutoring at home and merely supervising my weight training classes, but I was always careful not to overdo.
Light housework proved to be no problem at all. I was doing lawn watering, dishwashing, cooking, and even laundry and bathroom cleaning almost right away. David always does the grocery shopping, vacuuming, ironing, bed changing, and bill paying, so he took care of all that as before, and of course did whatever I felt unable to do. His sympathetic supervisor allowed him to work from home for a few weeks.
Thus we managed fine. Our fortunate circumstances gave me the leisure to rest a great deal and to think about this large event in my life, about what it really meant to me.
There was much to think about. An important question for me, one which is still largely unanswered, was “Why me?” Surely that’s one of the first questions that any woman diagnosed with breast cancer asks.
Why did I get breast cancer? Was there an emotional component, the sorrow and anger connected with the previously mentioned conflict with my family over my novel? Was my genetic inheritance to blame? Could I blame it on the fact that we’ve lived since 1971 in Colorado, a state with high rates of both breast and prostate cancer? Or were other things to blame, certain actions or inactions on my part?
As a child in Mississippi, had I been exposed to too much DDT, which was commonly used to spray for mosquitoes? I used to run down the street after the truck, purposely breathing in the fragrant clouds. Had I breathed in too many gasoline fumes at service stations? I’ve always liked that smell as well. Had I stood too close to the microwave oven too many times? Had I eaten too much fat? Had I taken the wrong dietary supplements, or too many or too few of some of them?
It was all a big puzzle to me. Even as I was determined to make the best of the situation, there was some residual anger that I had gotten cancer at all. I knew I had to look that anger squarely in the face and then deal with it.
A great many people besides me were surprised that I had contracted cancer. That’s because anyone who knows me knows that I’ve worked hard, at least for most of my life, to get and stay fit and healthy.
I was a slender and active child, regularly running, swimming, climbing trees, roller skating, and ice skating. As a teenager, I loved our high school gym classes and the many calisthenics we had to do, such as sit-ups, push-ups, and jumping-jacks. During my mid- to late twenties and all through my thirties, I took modern dance classes, swam, bicycled, played racquetball, hiked, and taught up to 24 weight training classes per week. Then I worked out even more on my own. Until I was past 40, I weighed just 130 lbs. at 5’ 9”, and had less than 15% body fat. At my strongest, I could bench press and squat with close to 100 pounds, could do barbell curls with 50 pounds, and could do dumbbell flys with 35 lbs. in each hand.