Who's telling who?

A friend sent me this link today. It's a good article, about how women aren't getting all the information they need to make informed decisions about their reconstruction. It talks about the reasons why some surgeons only mention the implant option, and not the more extensive, but more frequently successful TRAM flap options. The writer has done her research and describes the situation and the procedures very cleary.


http://www.nytimes.com/2008/12/23/health/23beauty.html?pagewanted=1&_r=1&hp

But, I have two problems with the article.

One. The title of the article is "The Price of Beauty: Some Hidden Choices in Breast Reconstruction." I find this so irritating. I'm still struggling to articulate exactly what all the issues related to losing a breast are, so it's hard for me to write exactly why this is so galling. It feels misleading, dismissive, and minimizing. It seems to reduce the issues around post-mastectomy breast recontruction down to vanity.

Women do not have their breasts rebuilt because they are vain.

I didn't forgo reconstruction because I am not vain. (Heaven help me, I can't pass a mirror, or a storefront window without looking at my own reflection.)

It's a completely inappropriate title.

This article doesn't really discuss beauty at all. It discusses different ways to stretch, slice, re-assemble and introduce artificial elements to women's bodies.

This article does, however, discuss price. It talks about how the profit margin of various surgeries affects which information a woman is given.

This headline reminds me of one I saw years ago on the cover of the Rocky Mountain News. The article covered a court case in which the local government had been found guilty of discriminating against people on the basis of their sexual orientation. I don't know how such a case could have come to court, much less been successful. As far as I know, the Colorado State Constitution offers no protection to people who are being discriminated against on the basis of their ascribed alphabet letter, be it G, L, B, T, Q or S.

But I do remember that the wronged party won. And I do remember the conservative spin that this publication put on it.

All across the state, front pages trumpeted, "Gay Rights Tab: 40 million!"
What a joke. It should have read, "Unlawful Discrimination costs taxpayers 40 million!"

And if I was reading the New York Times on paper right now, instead of on-line, I would take the biggest fattest sharpie I could find and cross out, "The Price of Beauty." In it's place I would write a more truthful, more accurate and more controversial title.

"The Price of Capitalist Health Care: Hidden Choices In Breast Reconstruction."

With a title like this, the author surely would have been compelled to addressed my other complaint. If Ms. Singer is trying to reveal the hidden choices, why does she not mention the really obvious one, not having reconstruction at all.

Maybe she and everyone else who writes about and talks about and performs these surgeries without mentioning it thinks this option doesn't need to be discussed because it's obvious. But that's just silly.

Doctors are in an extrememly powerful position. They exert their influence over patients not just throught the options they discuss, but also throught the ones they don't discuss. Imagine you are unhappily pregnant and your doctor discusses the possible termination options without mentioning the "obvious" choice of letting the pregnancy run it's course. Wouldn't you feel that he was steering you in a direction. Of course!

Imagine now, that you don't live in today's liberal culture. Instead, imagine that you live in a culture where the site of a pregnant women is as unsettling and questionable as say, the sight of a woman with only one breast.

How will you even have the courage to consider the option that your own trusted doctor doesn't even deem valid enough to mention?

The choice to forgo reconstruction is not obvious. And yet, it's a valid, safe, inexpensive, option that involves considerably less time, effort and pain than the alternatives. Every doctor discussing mastectomies should be offering this to his/her patient.

Especially considering that, unlike all the other options, this option allows you to easily change your mind later on.

How many mastectomy patients would wait a few months, or a year, or a decade, if they knew that they could have their reconstruction completed after the surgery?

If my own experience is any indication, women are led to believe that they need to have the reconstruction initiated on the same day they have their breast removed. We are led to believe that choosing to live without a breast would be unspeakably bizarre.

It's just not true. But who's telling us, unless we ask? And how do we ask intelligent questions about things we don't understand? And how do take the time to read and research and understand these complex issues when we feel like our lives are at stake if we don't hurry up and do something!