The cold January day I was diagnosed with cancer, I was told it would be a good idea to keep a journal.
I don’t keep journals, I thought, but I nodded because I’m polite, and because I didn’t have the mental energy to object. I wanted to tell my surgeon I’ve tried to keep a journal, but when my writing becomes personal, I imagine the embarrassment of someone finding and reading it, and I stop. But I don’t tell this to the surgeon or the nurses who have gathered. I just continue to nod and wonder why no one has noticed that I’m sliding to the floor.
Four days earlier, I had undergone surgery, a precautionary lumpectomy for what my doctor was sure would be a mammary duct infection. Two days later, my surgeon called and asked me to come in to see her:
“I’ve been trying to reach you all day. What have you been up to?”
A busy surgeon has been trying to call me all day? Not her nurse or her receptionist? I am both alarmed and comforted by the personal touch.
“You need to come in first thing tomorrow morning,” she says, “and bring a family member or friend.”
I tell her I can’t. I have to work. I’ve already missed too many days for doctor appointments, ultrasounds, mammograms, and surgery. Suddenly I’m devoted to a job I don’t like. I feel a fierce loyalty to a manager I refer to as “Squirrelly Boy.” I worry about my already overworked co-workers, whose sympathy has been wavering. I told them I’d be back in a few days.
The surgeon and I compromise and agree to meet the day after tomorrow. I don’t know why I feel I must win this argument. A struggle for control, perhaps.
I bring a dear friend, as a liaison between the world and my emotions. If I can’t speak, then Penny will speak for me. My surgeon is young and well dressed, in linen slacks and a blazer. For some reason her clothes make me feel better. I rarely pay attention to such things, but Penny and I comment to each other on her outfit more than once. I guess you don’t want to be handed potentially bad news about your health by someone in a hooded sweat shirt.
Despite my churning stomach, I feel calm and detached from the scene. I am offered coffee, water, juice. I don’t care for anything. I’m fine. Penny declines as well. I can tell she’s nervous. We sit at a table on which my doctor has placed a blue folder containing my pathology report, my patient information, and her handwritten notes about my diagnosis, which we haven’t yet discussed. I am impressed by her organizational skills and find myself feeling way too emotionally connected to this woman, who dresses so well but still hasn’t even given me the verdict I have come to hear. I worry that I will start to cry over what’s in the blue paper folder. Jesus, get ahold of yourself.
I am told that my right breast is “exhibiting ductal carcinoma in situ with a tumor whose exact dimensions cannot be determined with certainty.” Five of the nine tissue sections of the entire submitted specimen are “involved” by tumor, with the largest area of tumor measuring approximately 0.7 by 0.35 centimeters. “The nuclear grade is high,” says my well-dressed surgeon.
I find this fascinating and feel badly for the patient, whoever she is. We couldn’t be talking about me because I feel fine. I try to look as though I’m concentrating, but my thoughts drift. I start to worry about whether I have enough gas in my car. I have to force myself to come back to this little conference room.
I ask if I have cancer. Somehow this still isn’t clear to me. When the doctor confirms that I do, it is an odd relief. I don’t want to have to explain to people that the “architectural pattern of my breast lesion features an intraductal papillomatous tumor.” Saying I have cancer will be easier, except when I tell my mother.
My cancer is stage four — the last stage before metastasis — but there is every indication I will be fine, the surgeon says, if we act now. (Do people wait?) They are scheduling me for a partial mastectomy. My tumor is in the front, so the front of my breast will be removed. The nipple will be sliced off.
That’s when I start to lose my ability to see color. I’m reduced to yellows and grays. I feel myself slipping down in my chair, but no one notices. I could use some of that water now. I’m surprised no one has tried to catch me. Then I realize I haven’t moved. I’m still upright in my chair, drenched in sweat. Blues return first. My surgeon’s blazer is a deep marine blue. It matches her eyes. I feel cool air brush across my skin, evaporating my perspiration. I am told that the first of my surgeries will be next week.
I need a long walk. Maybe later today I will walk the dogs. Maybe I’ll write down what I see on my walk: not a journal, just a record. I’ll note the passing of a red fox by his powerful scent mark, and I’ll picture dormant earthworms curled in tangled balls below the frost line. I’ll count white-throated sparrows along ice-crusted stream banks and observe the horses’ breath as it billows like fog around their muzzles.
Yes, I’ll keep a record.
The second phone call comes three days after my partial mastectomy. There are still “carcinogenic microcalcifications” present, the surgeon says, “focally fine and coarse.” (It’s still there?) My elongated, dye-stained remnant of breast tissue requires radiation to try to kill these remaining cells. The surgeon prescribes an oral-chemotherapy regimen as a preventative against further cell growth. She suggests this instead of moving forward now with a complete mastectomy.
I’m not so sure. I know someone who opted for a radical double mastectomy, even though the cancer was present in only one breast. At the time I thought she was a martyr, but I’m beginning to see her side of it. I want this over with now!
I decide to follow my surgeon’s advice, however. For the many people who tolerate it, radiation can be scheduled during their lunch hour. (To be honest, returning to work isn’t all that appealing to me anymore.) There will be fatigue. (I always feel fatigued.) I may feel sunburned. (I don’t burn, I tan.) The treatment will cause rib pain and permanent damage to my lungs.
A brochure in the blue folder tells me, “The linear accelerator machine will accumulate charged particles and shoot them at a target that generates photons.” The photons will then be aimed directly at my unfortunate right breast. I wonder if my left breast will feel slighted by the lack of attention. Because of the angle at which the radiation will burn into my body, there won’t be any damage to my heart. I am relieved. My friend with the double mastectomy is now on a heart-transplant list because her own heart is so diminished by radiation.
The chemotherapy pamphlets are spread out on the table in front of me: many colorful brochures with pictures of smiling models who’ve probably never been in my position. I will be on an oral regimen, a pill. When I’m told I shouldn’t lose any hair, I try not to appear relieved. I don’t want to seem vain. After all, hair loss is a small price to pay in exchange for one’s life — unless, of course, it is my hair.
I will take this oral chemotherapy every day for five years. Five years: my new future.
Tamoxifen is a wonder drug, I am told, but there are risks, side effects. It can cause blood clots, cataracts, uterine cancer, bone cancer, hot flashes, and weight gain — sometimes ten pounds in the first two weeks. My well-dressed and extremely petite surgeon is starting to wear on my nerves. She reminds me how lucky I am that they found the tumor and treated it so early. Lucky? Give me a break. I have cancer, and now I’m going to be fat.
My surgeon explains how I will be measured and marked for radiation. Lines, arrows, and numbers will be drawn across my chest in bold marker that I must not wash off. (How do I keep the water off my chest when I’m in the shower?) I cannot shave my right underarm or wear deodorant throughout the entire eight-week treatment. My head starts to throb.
Then my surgeon cheerfully announces they’ll tattoo me prior to the radiation, to help the machines burn into me with greater precision. A hot flush rises from my chest to my face. I’m just old enough to associate tattoos with crusty old men and disillusioned war vets. My surgeon is younger than I am, young enough to think tattoos are fun. (Could it be that under that white silk blouse and finely woven blazer lies a rose or a heart with wings?) The tattooing is hardly a big deal, but with each phase of this discussion I’m becoming more and more belligerent. I hate tattoos and don’t want one. This becomes my only moment of clarity in this entire muddy morning: I have decided that I will not get a tattoo. This is how I will control an out-of-control situation. A portion of my body may be amputated, but I draw the line at a tattoo. I say nothing to the doctor, however. It’s just one of the many conversations raging inside my head.
When I get home, I stop at the top of my driveway and pull onto the grass to gaze down into the valley where I live. I remember standing on this hillside two years ago when I had taken a sabbatical from my career as a naturalist and biologist to help grow organic produce for local families. I was making a mental list of the tasks that had to be done that day — tasks that couldn’t have been completed had the day been seventy-two hours long. The workload and a drought were wearing down even my more experienced co-workers. Our neighbors had trustingly paid us in advance for the privilege of knowing where, how, and by whom their food was grown. I felt pretty sure they would notice if there wasn’t any produce for them to pick up. As I looked at the beds — the dry, cracked soil, the weeds everywhere, the lacy skeletons of leaves decimated by pests — my body just froze. I recalled seeing this same frozen stance in frightened deer, just before they turned to run, their white tails a warning flag to others in the herd. My own urge to flee down the hillside waving a white flag was overpowering. It is the same this morning.
At work, my supervisors and co-workers are frantically trying to divvy up my duties and figure out what part I can still play in their huge pharmaceutical machine. I just want to clean horse stalls and raise sheep. In here, I am a “quality-control virology biologist” helping to produce the flu vaccine. I am an exemplary employee who always follows standard operating procedures, rules of conduct, and safety regulations. I never pipette fluids out of flasks by mouth, but I am dying to see the remains of the employees who did. I suspect they are preserved in big jars somewhere in the dark corridors of this enormous facility.
“Do you remember how we did the serial dilutions last month?” someone asks me.
No, I don’t remember. I’m just trying to remember where I parked my car this morning. I would swear it was by a tree, but there are no trees in this lot.
It’s hard for me to explain to everyone who stares at me in this ice-cold laboratory what I am going through. I stare blankly back at my co-workers. Should I tell them that I feel surrounded by death, that I have never been so aware of the brevity of life? I know they are waiting for something from me, but I have nothing to offer.
I lie awake all night. I have to go to work in the morning, but I cannot sleep. Three A.M. is usually when I grapple with fears about cancer. So many people have come to visit me since my diagnosis — to take me to appointments, to stay with me after surgery, to monitor any side effects — that I need a new bed for my guest room. A futon is no longer sufficient. I buy a reasonably priced twin bed on sale, but the following night, awake again at 3 A.M., I look into the guest room, and in the moonlight the twin bed looks too much like the hospital beds I’ve seen friends roll into their houses to prepare for the death of a parent or a spouse. I don’t go back to sleep. By 6:30 the low February sunrise has altered the guest room’s interior once again. The cream walls are softer, and the shadows have lost their edge. I guess the twin bed is OK.
Two months after my diagnosis, I’m walking in the garden on the farm where I rent a small house. I find garter snakes in the leaf litter and am surprised to see a black rat snake. Though it’s warm for March, it’s still early for the snakes to be out of hibernation. The black snake flicks her tongue along the wooden handle of a tool, stained with the oil and sweat of many hands. I imagine the odors lifting off the wood and swirling around her tongue, then disappearing into her mouth. She slowly lugs herself past the tools and climbs onto a raised bed, where the sun can bake the scales on her back. I open the garden gate. Though I know the snake can’t hear the high-pitched squeak of the rusty hinges, she lifts her head to follow the motion of the swinging gate.
The prescription bottle of tamoxifen has been sitting on either my kitchen counter or my table (I move it on occasion) for several weeks. I still haven’t taken a single pill. I am not ready to deal with the side effects. I have held the pills in my hands, stared at them, spilled them onto a plate and counted them. Once, I even touched a tablet with my tongue. But I have not swallowed one. I will start taking them the day I start radiation. I don’t feel at all as if I am tempting fate.
This hot, dry March doesn’t bode well for the coming summer. Someone has watered the garden beds, allowing water to pool. I watch the big black snake lower her head into a dark puddle. She laps up the water for a long time. Her jaws expand sideways with each drink, flattening her large head. Her thirst quenched, chin caked with mud, she slides her dark body along the garden’s border, through dust and dried tufts of grass. I watch as she disappears into a cluster of sumac trees, then reappears to scale a low-hanging branch and bask in the soothing sun once more.
My radiation treatments begin on a warm, surprisingly humid afternoon in late March. No one really talks to one another aside from polite initial greetings, but there is a feeling of community in Room 4 of the York Cancer Center. I quickly note that I am the only woman here with lots of thick, wavy hair. The relief I felt upon learning that I won’t lose my hair is replaced by a twinge of guilt, though I have no intention of shaving my head in solidarity.
Lorie (whose last name I don’t know) is pale, with thin, dark hair sticking out from under a bandanna. She is starting radiation today too, and we are scheduled to complete our treatments on the same day. That is our bond.
That night, two hours after I start my tamoxifen, I experience severe hot flashes. It is unlikely the side effects would begin in earnest so soon after I swallowed my first pill, but there it is: an internal flame that sears my chest and licks the veins in my arms. Maybe I’m having a heart attack. I change the bedclothes four times over the course of the night.
A mockingbird guards ripe black raspberries growing along the old wooden fence. The plants’ waxy canes arch down and root in the ground beside an herb bed where the black snake’s large body rests. When the snake finally crawls out from under the bent branches, her weight crushes pale green pennyroyal herbs. Their tender leaves bruise, and I smell the fragrant scent released into the air. The snake flicks her tongue to taste the air and crawls across the wet ground to a blanket of Bronze Arrowhead lettuce. Her eyesight is clouded by fluid, and her once shiny black scales are dull and gray. She needs to shed her skin. Before I go back inside, I heavily water the lettuce beds. Steam rises up from the hot ground. The warm, damp soil will help loosen the snake’s old skin.
I cried on my drive home from work today. I was listening to National Public Radio, and a reporter was describing famine conditions in some faraway place. Sierra Leone? The Sudan? Some arid place where the children have flies glued to their weepy eyes and runny noses, and the tall, elegant, black-skinned adults look like the expressionless marionettes that float down the streets at Mardi Gras. It’s a story I’ve heard dozens of times, always a different country, a different crisis, but today it made me cry — not for the victims, but for the unfair lopsidedness of life, which allows me to live in relative comfort while some small soul wails for milk that will never come.
I am astounded at the money and attention bestowed upon me and my disease. Each morning I am met by oncologists, receptionists, radiation technicians, and nurse “navigators” assigned to guide me through my treatment. The machines I lie on and under while being irradiated each day undoubtedly cost millions. The expense of operating that one clinic must be staggering. I would not be exaggerating to say that, while I’m there, I am immersed in luxury. And while I am more than thankful for the goodwill of that place, on the ride home in my car, I just weep.
In the northeast corner of the herb garden, the mockingbird’s white wing patches flash around a shed snakeskin. The black snake herself is nowhere to be found. When the castoff skin offers no resistance, the mockingbird returns with it to his post among the bramble patch, the empty, transparent trophy caught in the branches.
Lorie has gotten gradually weaker. Today she has trouble walking in for radiation treatment. When she comes back to the waiting room, the technicians have to stand on either side of her, holding her elbows to keep her upright. She is ashen gray, with that jaundiced yellow tinge of the gravely ill, while I am tan from walking on the farm. They have her swaddled in a plain white sheet not unlike a shroud, and I think, This is not a good image to present to a roomful of women facing cancer. I make a mental note to tell my family and friends to wrap me in greens and blues.
I don’t go to work today. I just don’t want to. Instead I take another walk. Blue butterflies float on a breeze — spring azures, the color of the sky. A phoebe settles on a branch and rearranges his gray-brown feathers. The branch sways, and he bobs his tail and sings his name while his fledglings sleep.
Lorie isn’t in today for her treatment. I know she went to the shore last weekend with college friends for a reunion, and probably a goodbye. I sometimes talk to the woman who brings her in each morning: not a friend of Lorie’s, just a volunteer driver. She tells me Lorie’s pain is worse. The cancer has spread from her lungs to her brain. I suddenly feel blessed with my breast cancer. I ask how long she’s had it. One year, the driver tells me, then adds, almost as an afterthought, “She was fine after her breast cancer, but a year later she started having chest pain. . . .”
The black rat snake slowly inches her way through the loose yellow straw lining the garden paths. She stops with her head tilted up, her new scales glistening blue-black in the sun. Silent, robust, strong.
Lorie doesn’t come back. I am told the oncologists decided to end her treatment early. She will not celebrate on the early-June day when both of us are scheduled to receive our last treatment.
By the time my friends and I commemorate the end of my radiation with an elaborate garden party, Lorie is gone. As we eat scones with clotted cream and toast my good fortune with iced raspberry tea, Lorie’s obituary is being printed. The next day I read about her in the newspaper. Her last name is Black. She leaves behind a husband and three teenage daughters. Everyone around me says, “Try not to think about her.” But I think she deserves to be thought about. I make a silent promise to think about her.
Shortly after my party, I develop chest pains, deep down in the bones of my rib cage. Lying down doesn’t help, and I can’t sleep. I have been warned against panicking at every ache and pain, but for the first time since I was diagnosed, I am having trouble functioning. I cannot find a comfortable position. I have to concentrate to breathe and am seriously wondering if it was a mistake not to have had a radical mastectomy. Was I too conservative? I was just following my doctor’s advice.
I schedule an appointment, and my surgeon, now dressed in beautiful summer linens, gives me a serious examination. “When I press here, does it hurt?” she asks, pushing on the spot where my ribs and breastbone connect. The pressure causes an involuntary moan. “Is it difficult to take a deep breath?” I am winded when I talk. “Has the Tylenol helped?” Hasn’t even touched it.
She already knows what is wrong with me. I have costochondritis, a form of arthritis. My case is probably caused by radiation damage. She prescribes painkillers. Apparently, I will live.
As I go out the door, I recognize some patients coming in. Some walk on their own, but others are wheeled in by chair or gurney. A few use canes or walkers. I see people limping and a few wearing far too many clothes for the summer heat. I glance at a woman about my age. We have never talked, but we have passed each other numerous times during our treatments, on our way in or out. We share a spring to our step and the sunbaked glow of a season spent outdoors. We nod to each other. We recognize luck when it strides past.
