Tom Petty dies of a heart attack on the day of my breast biopsy. I picture him, this rock star I loved, looking down at his chest, clutching it with his hand, and then collapsing, lying down for the last time. If I live as long as Tom Petty, I only have ten more years.
When I tell my husband, Chris, the man who’s loved me for 32 years, that I have invasive carcinoma in my left breast, he goes into pragmatic doctor mode. He carries a digital copy of my 3-D mammogram and ultrasound to another radiologist to hear her opinion, just to be sure.
I don’t go into pragmatic doctor mode, myself. Instead, I go quiet. I don’t want to review my 3-D mammogram with Chris, or anyone else. I saw the exploding star on the radiologist’s screen and I don’t want to see it again.
As the shock of my diagnosis fades away, I feel sad, unfocused. Wine doesn’t taste the same. I’ve lost weight. I feel insubstantial, like my body is taking up less space and I can imagine the house without me. The kitchen quiet. Junk mail on my desk. A pile of New York Times still in their blue plastic bags.
Chris is careful around me, cautious, enveloping me in reason and routine. We discuss medical results in low tones—my estrogen receptor status, my genetic testing. Maybe it’s not really true if we remain calm.
I register voters in a school gymnasium. I watch Part II of Angels in America. I pay my life insurance premium.
In the general surgery exam room, Dr. Hoagland touches my left breast, his fingers up and down in little circles, looking for the mass at 8 o’clock—the one I never noticed, the one I should have found myself. Tells me he’s having trouble feeling it, identifying the boundaries, even though he knows it’s there. So, he’s not surprised I didn’t feel it. I want to hug him.
If I had eaten meat and not tofu, I wouldn’t have breast cancer. If I’d liked camping instead of staying in hotels, I wouldn’t have breast cancer. If I’d worked out more, I wouldn’t have breast cancer. If I’d meditated, I wouldn’t have breast cancer. If I hadn’t used so much hand sanitizer, I wouldn’t have breast cancer. If I’d had more sex, I wouldn’t have breast cancer. If I’d had a dog or a cat, I wouldn’t have breast cancer.
But so many women have breast cancer. So, so many women.
Even some women who have pets.
My MRI shows radiating spicules flaring out around the mass, which measures 3.1 cm by 2.2 cm by 2.3 cm. There would be an increased risk of positive margins were I to choose a lumpectomy, the Tumor Board says, and I’d need radiation.
I choose a mastectomy.
We tell our kids, Sarah and Ben, over Skype on a Sunday night. Ben, listening from his room at college, looks bereft; he sobs and steps away from the camera. Now, I know what Ben will look like when he hears I’m gone.
Sarah, listening from her apartment in NYC, cries quietly and declares she’ll stay with me after the surgery, after Thanksgiving. To take care of me.
My sister offers to come here from North Carolina.
A girlfriend offers to come down from Chicago.
I don’t really want anyone else to come. Sarah will be with me.
My plastic surgeon doesn’t feel for the mass. Dr. Noel looks at my chest and describes the procedure to place an expander during the same anesthesia, after Dr. Hoagland removes my left breast. He shows me photographs of other women’s chests with breasts made by him, computerized images post reconstruction. Not what God gave you, he says. But not bad, I think. My new breast will be smaller than the size of my natural breast, he tells me, and he’ll modify my right breast to match.
I hadn’t realized my own breasts weren’t the right size.
One week before my mastectomy, lymph node biopsy, and expander placement, the young pre-op hospital nurse sets before me a transparent bag holding a pink blanket. “We give them to everyone diagnosed with breast cancer.” I imagine walking around the hospital trailed by a pink spotlight. I long to slide it back across the floor and reply, “I don’t want it.”
During each of the next seven days, I feel like I’m planning for an extended trip to somewhere unpleasant and dangerous.
I worry I might die.
I change the water in the fish bowl. I winterize the outdoor faucet. I water the ficus.
Nothing to eat after midnight on Thanksgiving Day, so I cut up an apple and everyone watches me eat it.
I’m not hungry. Just terrified.
Before bed, I take a shower and wipe my left chest with antiseptic wipes, as directed. With careful strokes, over my entire breast, across the nipple, lifting to wipe underneath. Watching in the mirror.
Enough with the waiting.
I don’t want to be left alone in the hospital, so Chris spends the night beside me on the plastic couch.
Dr. Noel tells me that, when I first awoke in the recovery room, I lifted the sheets and looked down at my chest. He says women don’t usually do that, don’t usually want to look.
Eight-inch, almost-horizontal scar with sutures. Three transparent plastic tubes coming out of small round holes in my chest wall.
No nipple. No areola. No breast.
At first the ache of my chest wall and left arm are so enormous that I wonder how I would recognize a heart attack, were I to have one. It hurts to lift my arm to my face to brush my teeth, hurts even more to lift my arm to the top of my head to wash my hair. I cannot reach back to put my hair in a rubber band or get off the sofa without help.
Here I am, a woman who avoids wearing bathing suits, being stripped of clothes by my twenty-six-year-old daughter, who kneels down to pull off my pajamas and guides my legs into elastic-waisted pants for my doctor visit. Who stands in front of my mirror with bare-chested me, stripping my drain tubes and emptying the bulbs of the milky orange slosh, watching me look at myself in the glass.
Here I am, a woman who would never undress for a masseuse, now opening the door to friends bearing dinner, tamping down the urge to lift my baggy t-shirt and bare my chest, to show them my wound. “Look, it’s gone. He even took my nipple.”
I can’t stop telling people. When I schedule a future pedicure, I tell Annie. When I decline an invitation to a fundraiser, I tell Melissa. When an editor asks me for a few revisions on my essay, I tell her.
“I have breast cancer. I have breast cancer. I have breast cancer.”
I can’t stop saying it.
Dr. Noel tells me that, when I first awoke in the recovery room, I lifted the sheets and looked down at my chest. He says women don’t usually do that, don’t usually want to look.
I’ve chosen female doctors—my generalist, my gynecologist, my cardiologist, my dermatologist, my dentist, and, most recently, the radiologist who stuck a needle in my breast– all women. Now, two men, the only male doctors I have: one took off my breast, one is building me a new one.
Matter-of-fact and reassuring, Dr. Noel touches my left chest every five days, or so—feeling the tissue, assessing the wound healing, looking for fluid collections, showing me the edges of the expander. I lean back thirty degrees. He injects normal saline into my expander port. The only part I feel is the pressure as the needle pops through. He holds my arm and helps me off the table.
The final pathology of my lymph nodes shows 1.7 mm of metastatic carcinoma. Really small. Micro-metastasis.
Oh, please, let it mean nothing.
Dr. Hoagland’s office makes me an appointment with an oncologist.
I’ve become mesmerized by all the naked breasts on the computer and TV screens. All the women have two of them. A pair. They hang over men who are supine beneath them, oscillating back and forth. They fall, like ornaments, or sit up tight to the chest wall, rounded balls with shelves, like my new one will be. They flash by quickly beneath unbuttoned blouses or behind shower curtains. But, always, there are two of them.
As much of the post-operative pain recedes, I’m left with a steady clutching by my pectoralis muscle, like an alien hand. Disturbed by having been lifted away from my left chest wall for the surgical insertion of an expander and AlloDerm, the muscle tenses and catches. The nerve endings in my skin are gone, torn away with the removal of my breast tissue, so I cannot feel anything touching the skin covering my left chest. But I can feel the tight clenching of the pectoralis muscle, an unwelcome groping, sometimes leaving me breathless when I shut the car door or pick up laundry, seizing aggressively and holding on, warning me to set down the basket. I insert my right hand under my blouse and trace the outline of the mound, now taut and shaped like a rounded rectangle. I hold my hand there, waiting for my own muscle to let me go.
When Sarah leaves town, when I’m feeling better, I start noticing the masculine details of strange men. In a café, I watch two young twenty-somethings, talking loudly, in open jackets and those big outdoor boots, caramel brown leather, smooth, unlaced at the top. The guys are beautiful, chestnut hair, longish and mussed, like they’ve just run their fingers through. I feel like I’m radiating heat, marveling that an alarm doesn’t go off.
A shoe salesman stands close to show me a size chart and his gravelly voice makes me stop breathing. His silver hair is cropped close to his head, like my husband’s. He looks at me with pale blue eyes to see if I have a question. If I lean a couple of inches more toward him, my lips will touch his cheek.
I return a glass milk bottle for $1.50, clean, to the grocery clerk and the young man thanks me for washing it out. His arms are bare, with dark brown hair down to his wrist, like fur. I want to touch.
But I do not.
I wonder what’s going on with me.
Two weeks now since the last visit, since my last saline injection. Dr. Noel picks up the bra I’ve brought and fingers its softness, reads the brand, approves of its use. He answers the questions I’ve written on a scrap of paper. Tells me, again, that my original left breast weighed 1100 grams. That my new left breast will be three-quarters of that size. That he’ll modify my right breast to match my left and the scar will look like an anchor.
But he can stop filling me up anytime. If I want to be smaller.
In my medical chart in Dr. Noel’s office, there’s a horizontal picture of my chest, a “before” shot, the only existing photograph of my left breast. After my right breast is reduced to match my new doctor-created one and my expander has been replaced by an implant, I’ll acquire a new nipple and areola and a second image will be taken of the new pair. My chest in landscape, disassociated from my face, a diptych.
Today, I find out I don’t need chemotherapy or radiation because my tumor genetic testing is favorable, predicting a low likelihood of future metastases. I only need to be examined every six months by an oncologist and take an estrogen-blocking drug for at least five years.
I’m relieved and grateful for what I know is only luck.
I imagine myself facing the open barrel of a gun and a bullet whizzing toward me. In slow motion, like a badass from Crouching Tiger, Hidden Dragon, I lean back and to the right, in a backbend arc, like I used to do as a cheerleader. My hair sprays out in a halo and my arms reach back and out, balancing my upper body. The bullet tears into my left breast, ripping it clean off, blood in all directions. I right myself and look down at my chest. There was only one bullet and it missed my heart, leaving me with one pendulous breast, on the right, and one wound, cleanly sheared and flat, on the left.
After completing her pediatric residency, Laura Johnsrude worked as a general pediatrician before settling in the Louisville area. Once in Kentucky, Laura began writing picture book manuscripts, short stories, and creative nonfiction. She was published in the March 2017 issue of Hippocampus Magazine and in the spring 2018 issue of Bellevue Literary Review, receiving Honorable Mention in the Felice Buckvar Prize for Nonfiction for her piece, “Drawing Blood.”
