Later the surgeon’s nurse will tell me they are “fluff n’ puffs.” Boob jobs. They get seen after the cancer patients.
When the surgeon enters the exam room he says, “You’ve sure thrown us a curveball here, young lady.” The new tumor is malignant, and surgeons love to blame the patient. “Now we’re going to have to do a mastectomy instead of the lumpectomy. Up to you if you want to do a twofer on the mastectomy.”
*
Montaigne summons Plato’s belief that doctors should ideally experience all the illnesses they seek to cure: “It is right for them to catch the pox if they want to know how to treat it.” He sounds a little cranky here, but he suffered through a number of kidney stones and I can imagine that might predispose you to crankiness.
I ask the surgeon if he would recommend a double mastectomy if it were his wife—the question you’re always supposed to ask. He hedges.
“We’re all different,” he says. He tells us the tumors are shaped like a dumbbell, with each tumor being one of the weights on either end. And between them—no one’s totally sure but—what looks to be a four-centimeter-long bar of cancerous material. He calls my new lump an occult tumor—hidden on earlier imaging.
It feels as though they might be really into drama over here at the Aesthetic Center.
“I definitely didn’t expect this twist,” he says gravely, but with a little excitement brimming in his voice.
I can’t help but think about a surgeon who one of the chemo nurses once told me about. It was back in the 1970s and early ’80s, when she worked in radiation oncology, and she used to see all the patient files. The doctor recommended a radical mastectomy—a disfiguring procedure where not only is all the breast tissue removed, but so is much of the underlying chest muscle—in 100 percent of his patients.
Although it had been standard practice for decades, the traumatic procedure fell out of favor in the mid-’70s due to improvements in our understanding of the spread of cancer cells. This surgeon, however, kept recommending radical mastectomies until the day his wife got breast cancer.
“Not for her,” said the chemo nurse. “That was when he performed his first simple mastectomy.”
*
As John and I leave the building, there are still no cars in the parking lot. And I can’t make out the name of a single other practice in the complex—too dappled is the shade. I feel John’s foot heavy on the pedal as we hurry from the driveway into the pristine cul-de-sac, not totally certain if we are escaping—or complicit in—some new, dark art.
3. Dispatch from the Dark
Speaking of the dark: It’s past midnight, and we’re lying in bed. “I just can’t wait for things to get back to normal,” says John from his side of the moon.
I’m not sure how to respond. I hadn’t realized how attached I have become to the idea that, even in all of this, we are moving ahead somehow, and that dealing with all this is something to value. I feel a sharpness in my throat, the slip of the sureness beneath me.
“I can’t handle you saying that,” I say after a silence, even though I know he isn’t trying to fight. “Thinking that way kind of invalidates my whole life right now. I have to love these days in the same way I love any other. There might not be a ‘normal’ from here on out.”
He’s not happy. I feel the cool bricks of an invisible wall settling into place between us. I turn away to face the window, a heavy orange haze filtering in through the trees. It’s not as dark out as it should be.
“I don’t believe you,” he says. “I don’t think you’re being honest.” It’s the tone I’ve heard him use when I’ve told him I think he’s being a shitty parent. Or that no matter what I’m probably never going to like watching hockey. Anger that morphs from hurt. “I really think you’re in some kind of whacked-out denial right now if you think these days are loveable.”
“These days are days,” I say, calm and furious. “We choose how we hold them. Good night.”
Around 4 a.m. I feel his hand on my back. “I’m so afraid I can’t breathe,” he whispers.
“I know,” I say, scootching a little toward him but still facing away. “So am I.”
*
Montaigne: “I learn to mistrust my steps everywhere, and I take care to control them.”
He also believes in lively shouting matches before meals and only “begetting children” before sleep. We are doing it all wrong.
4. Say Please
My kids think I’m obsessed with the word please.
Why is it so important, they whine, what’s the big deal? I make them a list one night. A list they won’t possibly understand for twenty to thirty years, but I am trying to write things down:
Because you will find that the fruit will drop, but rarely into your mouth.
Because the bathroom faucet sticks, and please makes the stronger hand less weary.
Because on summer nights the expectant sky cloaks the trees like a bed sheet, and storm cells spit tornados toward us from deeper south, and the willow oak in the backyard is a monster, and every night we lie down at its feet. Because we never taught you to pray.
Because at night you are thirsty.
Because someday your children, on the other side of your wall, will cackle into the darkness long past their bedtime.
Because right now through the open windows I can hear the newlyweds next door carving out a backyard patio by lamplight, deliberating as they kneel together in their yard, placing flagstones. The stones they hand each other are heavy and oddly shaped. And they must level each one in the dirt—tapping, cajoling, and swaddling the difficult rocks—and then make their way upstairs to bed.
Because the s in please is the sweetest sound, like steam rising after a summer shower, like a baby whispering in his bed.
Because you are human, and it is your nature to ask for more.
Because want, need—those unlit cul-de-sacs—are too perilous unadorned.
5. Mother and Daughter Tour Italy
I opt for a single mastectomy at Dr. Cavanaugh’s urging. Halves the chance of complications, she says. Halving, dividing, splitting, cutting—this is our new language: cells, statistics, surgeries, household duties, anxiety. But in trying to make less and less, we are always somehow making more.
I struggle the most with the asymmetry of a single mastectomy. It feels more conspicuous—and neither here nor there. I keep picturing a volcano—Vesuvius threatening on the horizon.
*