Tuesday, January 6, 2009

Monday Night's Dream

I was in a doctor’s office that I’ve never seen before in real life. The reception desk was on my right and I was wearing a striped dress. Dr. Rocco came out from the back and told me I had cancer again, this time in my left breast. I asked her how she knew and she pointed to my dress. As she said the words “I can see it,” I could suddenly see it too. In two places the stripes of the dress parted around pearly, colorless circles. The space between the circles and the stripes was filled up with a milky-looking slickness that tapered at both ends. These cancer-spots on my dress reminded me of eyes on a peacock tail feather. They reminded me of egg yolks so pale they matched the whites surrounding them. They reminded me of river-stones and oysters and moons.

We took the dress off, the receptionist, Dr. Rocco and I. It slipped off my body and we held it up to the light streaming in from the window on my left. We held it up high enough that it reached the curtain rod at the top. We hung it on the rod and suddenly it wasn’t a dress anymore, it was a curtain. We stood there looking at it as the cancer-egg-oyster-tails grew and shifted between the fat colored stripes.

I was sad, gazing at this indisputable evidence my cancer had returned. Then, suddenly, I had a hopeful thought. “Dr. Rocco,” I asked, “How can this be my cancer? It’s not even on my body, it’s on the curtain!” She shrugged and told me, “Cancer is strange. We don’t understand everything about it. This is yours alright.”

This I believe

I think I have cancer in my left breast. I have no reason for thinking this. I don’t even know if “thinking” is the right word. It’s more like a feeling. I guess I "feel" I have cancer in my left breast. That’s a little more accurate, but still not right. The truth is, I believe I have cancer in my left breast. I just believe it’s there.

I don’t want this to be true. I think about calling Dr. Rocco and asking her if it’s possible. I’ve asked her already. I asked my oncologist, Dr. Kennedy, too. They’ve both told me I’m safe. I’ve had a mammogram and a MRI on that breast, they remind me. Even tiny little lump #2, which was invisible on the mammograms, showed up clearly on the MRI. So, I’m safer than most women. I should be completely assured that I do not have cancer in my left breast. Even a tiny tiny little cancerous cluster would have shown up on the MRI. Right?

Except that I also had cancer in my nipple. What did they call it? Crone’s disease? Rhone’s disease? I can’t even remember now. I remember it is also the name of a bone problem…I think. Geez. I really need to brush up on my research.

Whatever they called it…it was a special and rare kind of breast cancer that landed in my right nipple. The mammogram didn’t catch it. The MRI didn’t catch it. They only even found out I had it by poking around in my breast after it had been removed from my body.

These are the numbers I remember: only 3% of breast cancer patients have this kind of cancer and most of those are older than 65. What is it about me that put me in this statistically unlikely situation? What is it about me that will keep me from getting cancer in my other nipple? Nothing that I can think of. I feel convinced that I am going to start growing cancer in my remaining nipple any minute now. That is, if I haven’t already.

I think about calling the doctors and asking them again. “Are you SURE I don’t have breast cancer? What about my nipple!?”

Nipple. Nipple. Nipple. What a silly word. I used to play a game with friends where we imagined a business we could open and then had to come up with a name for it. What would we call the topless hair salon? Snipples.

If I called my doctors and asked them about my nipple, what would they do? What could they do? Offer to biopsy, probably. But, I don’t want bits of skin sliced off my nipple. Really. I don’t. Who can blame me for that? I’m sick of being poked and sampled and having pieces of me removed.

So, I don’t call them.

Maybe I’d worry less if I was taking Tamoxifen. But then, I’d be worrying that I had the side effect, uterine cancer. Dr. Kennedy said uterine cancer is easy to spot, because it makes you bleed at unusual times. Just this past month, my period came a week early, or at least it seemed like it to me. Whenever my period starts I always think it can’t possibly be time for that again already. So I can’t really be trusted. But I had unusually painful cramps, and it flowed dark and heavy. Strangely, it only lasted about a day and a half. I didn’t worry about it. I figure my body knows what it’s doing. But, if I was taking Tamoxifen, you bet I’d worry. I’d probably be convinced I had uterine cancer.

Instead, I’m convinced I have nipple cancer.



Some days I try not to think about it. Other days I let myself. It doesn't seem to matter. Like God and ghosts and aliens, it's always there because I believe in it, regardless of what I think, when I think or whether I think.



Nipple cancer does have a symptom. It acts like something called dermatitis. It looks and feels like dry skin. But nipples are weird any way. How can I be certain it's not dryer than it ought to be? It already looks and feels different than any other skin on my body. Does a nipple even count as "skin?" Do lips? I don't know. I feel unqualified to even have a body. I don't know enough about it.



Mom shared a list with me years ago. I don't know where she found it. It was a list instructions for living a human life. I think there were seven of them altogether, but all I can remember is the first one.



1. You will be given a body.



I guess I'm not ready for lessons 2-7 yet. I'm still struggling with this first one.



Is my nipple normal? Hard to tell. I don't have anything to compare it to, now that the other one is gone.



It seems like such a silly, trivial thing to be worried about. It's a tiny little part of my body, not even as large as my thumbprint. It's more like a pinky-print.



And yet, the standard treastment for nipple cancer, if I remember correctly, is prompt removal of the entire breast. They wouldn't do that if it wasn't serious, would they?


I was reading a book last month called Voices of Breast Cancer I didn't read much of it, but what I read was quite good. I would have read more, except I came across a story that was too much like mine. Some woman in her 30's had been diagnosed with ductal carcinoma insitu. She'd had a mastectomy and been pronounced cancer free. She didn't even need to undergo radiation or chemo. Hooray for her and her loved ones. Then, a few years later, she had cancer in her other breast. This time it had spread to her bones before they caught it. I guess she died or is dying now. I don't know. I didn't read any further.

Maybe I'm dying? I don't feel like it. But I could be. I guess anyone could be. I believe I might be. But, it doesn't seem worth the hassle, humiliation, pain, suspense and despair of having my nipple biopsied. That's why I don't use the word "think," when talking about my alleged nipple cancer. I am obviously not thinking clearly. Given the choice between my nipple or my life...surely I would choose life!

But I'm not being given a choice. It's not that clear! I'm just silently and constantly convinced that my body in busy turning herself against me.

It's sad. We used to be good friends, my body and me.

If some other friend was acting this bad, I would just stop associating with them. I'm not going to put up with this! But this relationship is more like one you'd have with a child. No matter how many poisonous, deadly habits she aquires, I just have to love her harder.

Monday, January 5, 2009

Clean Slate

It’s morning, my favorite time of day, on Monday, my favorite day of the week. January is too cold to be my favorite month, but New Year’s is for sure my favorite holiday. I love the new beginingness of it, the chance to start all over fresh. I love this chance to pause for a moment and look out at the clean stretch of life ahead…a time with no mistakes in it yet, and no regrets. So, on this…the first Monday morning of 2009, I’m looking forward to a really wonderful year.

I’m settling into a new home now, and a new routine. I plan to make writing an everyday part of my life again, like it was back in September, before I started traveling so much. Moving from place to place and not having much of a daily schedule has been the main thing that’s kept me from consistently posting blog entries. But, even if I write for 3 hours each morning and force myself to publish something every week, I still have a problem that is going to get in the way of keeping up the Double Whammy Diary. I have a problem with sex.

I’ve tried really hard to give an honest and complete account of my cancer experiences. I want to share the real details of all the procedures, appointments and options I’ve faced and am still facing. I want to be open about the feelings I struggle with, even when they are embarrassing and unattractive. I want to share all the big and little ways in which having cancer has changed my life. I want to be unflinchingly and daringly forthright. I want to give a real, true, honest, unvarnished account. When looking over my recent memories, and deciding what to share, I don’t want to avert my gaze away from unsavory, impolite or intimate events. I want to take a full frontal approach to sharing my story. This means I have to write about sex.

Perhaps if I’d had melanoma, or cancer of the spleen, I’d be able to write from a neuter perspective. But breast cancer is unavoidably a sexed and gendered issue. I really do want to keep writing about breast cancer. But, I really don’t want to write about sex. You can see where I have a problem.

There are lots of reasons not to write about sex. What if I run for office and my opposition uses my sex life to discredit my character? What if I attract a stalker? What if prospective employers google me and find this blog? These possibilities don’t really bother me.

Here’s what gets in my way:

1. My family reads this blog. I’m not going to say any more about that right now except, thank god my grandma doesn’t have a computer.

2. If I’m going to write about sex, I’m going to have to write about being a lesbian. I’m afraid this will marginalize my perspective and keep some people from being able to relate to it.

3. It’s just plain scary.

I wonder what professional authors do? A lot of them probably just do what I’m doing, and avoid writing about such topics. But some of them write really honestly about scary, marginalizing things I’m sure their families don’t want to read. I’d like to figure out how to be like that. It’s too late to start using a pseudonym, so I’ll have to find another way to do it. I’ll probably make lots of mistakes along the way. But, I haven’t made them yet!

Happy New Year!

Tuesday, December 23, 2008

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!






Saturday, December 6, 2008

Yes

On Sunday, we met for breakfast at Bob Evans. All my family that lives in Maryland was there. My mother, sister, grandmother, brother-in-law, and two nephews came. So did my Aunt who lives in Virginia. It was a perfect opportunity for K and I to reveal the secret we've been keeping for weeks.

Well, it wasn't totally a secret. I told my mom right away. But, for everyone else, we wanted to wait and tell them in person. After our breakfast announcement, I told Aunt C. on the phone. I guess my cousins and Uncle G. might find out by talking to her, or by reading this blog...if I don't call them soon. Sorry! Maybe I'll call you today, because I'd rather you hear it from me than read it on this blog.

But even if you read it on this blog, it'll be better than the way my best friend from high school found out. She heard it at work, from a woman she didn't recognize, who turned out to be the grown-up little sister of another friend we'd had in school. This woman knew about it because she'd seen it on my sister's facebook.

I'm getting married.

This is startling to a lot of people. I mean, I wasn't even dating anyone!

But, 12 years ago I was. We were pretty serious. We were pretty happy. I was pretty young. And so, my answer to that first proposal was, "Sweetheart, I'm not the marrying kind. But if I was, you're the kind I'd marry."

At least, that's what I've been told. I don't remember saying that at all. What I do remember saying is, "The very idea of getting married makes me want to take a cold shower."

So, things got kind of weird between us and we stopped dating. But we stayed friends, and always loved each other. I'm sure we would have gotten together again at some point, except that we never managed to both be single at the same time.

For over a decade now, I've been asking myself, "What would have happened if I had said yes to K?" I never know the answer, but I'm always sure that it would have been something good. I'm always sure that we would have been happy and that we would still be together.

I feel so incredibly lucky that I got a second chance to answer the same question from the same person. And I feel absolutely certain that this time, I got it right.

Thursday, December 4, 2008

Choose Your Favorite Entry

Finally, I've got my technical problems fixed and am able to post on this blog again. Now I'm just wondering...what happened to November!?

If you haven't totally given up on this blog by now...if you still check it once in a while...if you ever read it, I could use your advice!

My cousin E...who is a published author herself and knows about such things, thinks I should write a book proposal for my Double Whammy Diary. She thinks I've got a third of a book written already, and that my story is timely and that my perspective is valuable. She doesn't think I need to do much extra work to get a book deal. Her suggestion is, send a brief proposal and a few of my favorite blog entries to publishers who might be interested.

My problem is...I don't know which ones to print!

Do you have suggestions? Which were your favorites? Which ones made you laugh out loud. Which ones did you keep thinking about after you read them? Which ones seemed totally original? Which ones made you wish there was more to read? Which ones would make you decide to take a chance on an unknown author, if you were a publisher?

I'd love to know!

Thank you, thank you, thank you, for believing in me.

P.S. If you haven't heard alread, I'm getting married! More on that later.

Pockets and Bubbles

I love my little pink prosthesis, Phyllis. I love knowing she’s there and I love the pressure of her weight against my damaged skin and I love the way she saves my figure in in a tight T-shirt. I love to hold her in my hand and to squeeze her and play with the shy and retiring little nipple. Unlike a real nipple, the more I touch it, the more it sinks into the fleshy hill behind it. It practically disappears if I press right on it, but it always comes back after a few minutes.

But lately, despite her charms, Phyllis is giving me trouble. I don’t lose her anymore, thank goodness. Years ago, Mom sent me a set of black and red zippered bags for my birthday. They were pretty, but they weren’t anything super-special. They were just the kind of thing you would use to organize your suitcase or your top dresser drawer. She apologized at the time for not coming up with a better gift idea, but I still cherish these bags years after I've forgotten or used up other, showier presents. They are pretty, and useful, and fit my strict color scheme. Best of all, there always seems to be one in the perfect size and shape whenever I suddenly have a need for such a thing. I've used them for more purposes than I can count and the medium sized one is now the perfect home for Phyllis to share with my compression sleeve and the pink music festival style bracelet that annouces " ALERT:LYMPHEDEMA No Blood Tests, Blood Pressure, No I.V. or Injections Into this Arm!”

Now that I have a place to put her, I do a good job of remembering to put her away every night. My problems start when I am getting dressed the next morning.The two bras I bought the day I got her each have a little pocket sewn into the cup. She rides in there and it keeps her from moving around on her own. Also, it’s just more attractive. She’s hidden from view. If I’m wearing something low cut, and bend over to pick something up, and someone happens to see down my blouse far enough to notice that something is off*, they might notice that my chest looks unbalanced. They might notice that the silky black fabric is doing something a little different on the right side than it is on the left, but the details of the situation are not entirely obvious. They won’t see what looks like a shiny chicken cutlet peeking out between my body and my lingerie.

More importantly, I don’t see it if I happen to glance down my own blouse. I hate the way that looks. There is my smooth, clean, healthy skin. There is my cute, stylish undergarment. And there, nestled between them like an over-zealous chaperon, sits this fatty cold-cut. It cleaves to my skin in the center, but peels away at the edges. The look is sloppy and unsettling, like I left the body factory before I was fully assembled. It makes me sad to think of myself like that.

The problem is, if I use the little pocket, I can’t get her out again without practically undressing. This makes an awkward follow up to my frequent invitation, “Hey, wanna see my fake breast?” When I can’t plunge into my neckline and whip her out at a moments notice, I feel like I shouldn't even mention her existence. Being forced to err on the side of modesty and tact might seem like another plus side to using the pocket, but it’s not. Shameless exploitation of show and tell opportunities is one of the entitlements that comes along with breast cancer survivorship, and I like to make full use of it.

The other problem is, I’m pretty sick of having just these two servicable, but dull brazierres to choose from. I long for the black and cream colored lace I bought at Soma during a shopping spree with Iona last Thanksgiving. I sorely miss the cute pink racer-back that snaps in front and works great under tank tops. I sigh and shrug at department story manikins in their tempting underwire fashions with the pretty matching panties. I don’t even think about trying things on anymore because the voice in my head says, "Not for me. Not for me."

But it's not as pitiful as it sounds. I'm probably just being lazy. I think it's time to sit down with a needle and thread and figure out how to do some custom alterations to my undergarments. I'm developing a plan for fast application of easy-exit pockets. If it works out, I can buy and wear any bra I choose.I’ll still be able to bring Phyllis out at parties, but I won’t have to worry about random peek-a-boos. I won’t have to worry about her drifting over to the center of my chest, and I won’t have to worry about her sticking to my skin. She soaks up my body heat nicely after a few minutes, but when I first tuck her in, she’s always bitingly cold.

And there are hygienic concerns. I mean, really. What if I get sweaty? How often should I wash her? What should I use? Dish soap? Woollite? What about my lotion, my underarm deodorant, my perfume? These things might have a degrading effect over the long term. I don’t remember if she came with care instructions. If she did, I’ve discarded them by now. Or, they’re tucked in a storage shed twelve thousand miles from here.

I don’t even know what she’s made of.

The inside substance reminds me of silly putty, but softer. It reminds me of jello, but firmer. It reminds me of memory foam, but it’s not as firm as that. Overall, Phyllis seems very fragile and delicate. The outer surface, which appears to be responsible for holding the whole thing together and creating it’s pleasing shape, is nothing more that a clear plastic sheet several times thinner than a Ziplock bag. It’s more like the free bags you peel off the staticky roll in the produce aisle. I try to re-use those bags, but they just don’t seem up to the task of constant occupation. I use Phyllis almost every day!

What is going to become of her?She’s already starting to change. When I first got her, all her surfaces were smooth. Now, on her back side (which is my problem area too,) she’s developed some unsavory bumps. Multiple air pockets have formed between her pinkish bulk and the transparent sheet of her skin. At first these bubbles were small and pretty evenly distributed, but they’ve started to merge. Now there’s one big blister the size of a quarter, where the casing has completely separated itself from the filling. It’s driving me nuts. I want to prick it with a pin and force the extra air out. Everyone I talk to says this is a bad idea. But when I show it to them, they can understand the temptation.

I wonder what would happen if I popped it? Could I make a little round hole in the plastic without damaging the integrity of the whole thing. Would the surface start to rip? Would the inside start to squeeze out like toothpaste? Would a little dot of superglue save it? Would it need a Band-aid?Thank goodness the bubble has formed on the back side. If it somehow moved to the front, and settled into the center, the results would be devastating. My adorable little nipple would end up looking like the empty reservoir at the tip of a french letter. Forgive me for the U.K. euphemism. I cannot bring my self to write the C-word. (If you don’t know the phrase, or for a fascinating historical account, go to http://en.wikipedia.org/wiki/French_letter) I cannot bring myself to write the word, because the very idea of such an allusion turns my stomach.

What would I do if this happened? Disgust at one's own prosthesis is not quite close enough to home to be called self-loathing, but it's in the neighborhood. I’ve got enough body-image issues to deal with since my surgery. If that air pocket bubbles up under my nipple, I’ll settle for a gym sock stuffed C-cup. Phyllis would be in the trash faster than you can blink.

Like I said at the beginning, I love Phyllis. But, sometimes love just isn’t enough.





*I first typed the word “off” in the third paragraph as a way to say “not quite right.” I laughed at the double meaning when I re-read it. Something certainly is "off" when it comes to my chest, and we know exactly what it is! Looking the word up in the Thinkmap Visual Thesaurus (http://www.visualthesaurus.com/) that my sweetheart recently bought us a subscription for, I found that almost all the definitions for the word “off” seem strangely accurate in this context.
a. Not in operation or operational
b. Below a satisfactory level
c. In an unpalatable state
d. Not performing or scheduled for duties

And my favorite:

e. Not plugged in or connected to a power source.