Until my mastectomy, the only doctors I’d interacted with were my surgeon and radiologists, but after the surgery, I met the rest of my team: my physical therapist, my meditation specialist, my plastic surgeon, and of course, my oncologist. For a period of a month or two after my surgery, I met with one or another of these doctors on a daily basis, and, ironically, it was one of the most positive time periods in my life.
My first appointment was with my physical therapist, Bev. She was a petite woman with a salt-and-pepper pixie haircut, a great sense of style and a brisk, chipper attitude. It would be her job to help me regain the range of motion I’d lost in my arm as a result of the sentinel node biopsy. The first time I saw Bev, I had only about 5% of my normal flexibility in my left arm. I saw her twice a week for about six weeks, and my appointments with her quickly became a favorite part of my new routine. After I undressed and put on a hospital gown, Bev would give me a brief massage focusing on my left arm and the area of my chest where my breast used to be. It might sound weird, massaging a mastectomied boob, and it was, but it was also very soothing, not to mention beneficial. After the massage, Bev would spot me while I did simple stretching exercises to loosen up the muscles across my chest and underarm. Often the stretches were moderately painful, and sometimes I’d get frustrated with my slow progress. I saw myself as someone who’d gone from whole and perfect to deformed and disabled. But only some days—for the most part, seeing Bev was encouraging and relaxing.
I also saw a meditation specialist once a week, Carolyn. Carolyn was also a breast cancer survivor, and it turned out that she and I had the same oncologist. She specialized in biofeedback and Buddhist meditation techniques for dealing with anxiety and trauma. Her office was pleasantly dim and warm, and for the first 10 minutes of our hourlong appointments, we’d talk about how things were going, how I was feeling physically and mentally. Then she’d stick some electrodes to my neck and lead me through some relaxation techniques. My meetings with Carolyn were some of the most meaningful experiences of my life in general, and she had a profoundly positive effect on the way I view the world.
Carolyn told me about an experience she had shortly after she received her diagnosis of stage 3 breast cancer, and I hope she won’t mind me retelling it here. She had a dream one night. In her dream, she was in her house, walking into her bathroom, and as she pulled the shower curtain aside, she was horrified to find the bathtub was crawling with snakes and lizards and other dark, slimy things. She ran back out of the bathroom and gave herself a talking-to: in her dream, she told herself to turn toward her fears and not away from them, which was a Buddhist concept she was learning about in her waking life at the time. She walked back into the bathroom, pulled aside the shower curtain once again, and the reptiles had been replaced with gorgeous cuddly puppies. The next day, she related the story of her dream to a Buddhist friend of hers and asked her what she made of the dream. Her friend thought it was quite obvious: the reptiles in the bathtub represented her cancer—a dark, slimy, scary thing in her bathtub—but when she looked squarely at her fear, the cancer stopped being something scary and horrible, but a chance for new life and unconditional love—represented by the puppies. She taught me to look at my own cancer not as a setback or a death sentence, but an opportunity to live my life the way I always wanted: with more health, with more love, with more living. This was just one lesson Carolyn shared with me, and I will be forever grateful to her for showing me a more positive way to approach my fears.
During the same time I was meeting with Bev and Carolyn, I also had my first meetings with the two men who would do the most toward “fixing” me: my plastic surgeon and my oncologist.
In my life before my diagnosis, I always toyed with the idea of getting breast implants, because my natural breasts were so disappointingly small, though I never would have gone through with it. In spite of the whole cancer thing, I was pretty excited to meet my plastic surgeon and talk about the amazing rack he’d give me. Instead, in my first appointment, he mainly showed me pictures of his previous reconstruction patients, so I would get an idea of what I could expect with my own reconstruction. I hate to sound so anti-feminist here, and I don’t wish to be hurtful to my fellow mastectomy ladies, but a mastectomy is just…not awesome-looking, and in the plastic surgeon’s office, the reality of reconstruction came crashing into my brain. My new rack would maybe be bigger than before, and it would be a vast improvement over the mastectomy, but I’d still have significant scarring, and my new fake tits would pale in comparison to my tiny natural breasts.
Breast reconstruction is a process that can take six months or more, and can be very painful at times. The first step would be to implant an “expander” under the skin where my breast used to be. This would help stretch out the skin and muscles of my chest to accommodate an implant later. Every two or three weeks, I’d go to the plastic surgeon’s office for a “fill,” in which he’d inject saline into the expander to enlarge it. It sounds painful, but since the mastectomy left me with little feeling in my breast, it was actually comically un-painful, though the initial surgery left me feeling like someone had taken a sledgehammer to my ribs. Once the expander was filled to the size I wanted, I’d have another surgery to put an implant in the healthy side. This would bring my breasts to a roughly equal size, and the surgery would be as straightforward as if I’d come in like a healthy woman wanting breast implants. Finally, 3-4 months after my expander was filled to its final size, I’d have one last surgery to remove the expander and put in a permanent implant, matched to the implant on the healthy side. Voila. New tits.
The last, but most important member of my team was my oncologist. My oncologist came highly recommended, and, as I would learn later, is one of the foremost oncologists in the country. He’s such a big cancer kahuna that he doesn’t take on many patients at all, but a friend’s husband, who is a radiation oncologist, pulled some strings for me and got me an appointment. My oncologist was a warm, bespectacled, professor-like man prone to tweedy jackets, and I liked him instantly. He had some good news and some bad news to deliver.
The good news was that those six other possible tumors turned out not to be tumors at all, and I only had two cancerous lymph nodes. I was, as he said, “a clear-cut stage 1,” the lowest stage of cancer development. Also, my tumor had clear margins, which means it was more or less neatly encapsulated in its little sac of malevolence and hadn’t encroached on surrounding tissues like my pectoral muscles or my lungs. Yippee! As such, he didn’t feel that I’d need radiation treatment.
However, I would definitely need hormone treatment, which was an entirely new concept to me. My tumor was strongly hormone-receptor positive, meaning that the tumor fed off the hormones in my body: estrogen, progesterone, and so forth. In diagnoses like mine, research had shown that shutting off the body’s hormones for five years was a very effective treatment. (In the olden days, they’d shut off the hormones for up to ten years, or entirely remove the ovaries, which produce hormones in the female body.)
Upon first hearing about this treatment, I thought: fantastic! Sounds easy! But I quickly realized that shutting off my hormones for five years meant I could not have children for five years. I’d always hoped to become a mother before I turned 30. I come from a very large family and I adore children. I was crestfallen, and it took me a few weeks to make peace with the new plan for starting a family—33 isn’t too old to have kids, after all. One of the biggest struggles about having cancer is learning to accept the fact that the plan you had for your life just got tossed out the window along with your boob. Hormone treatment would mean I’d start “medical menopause,” with all the fun that implies: hot flashes, frizzy hair, aching joints, mood swings. My mom helpfully pointed out that I’d get to go through menopause two times in my life. But still, I thought, it could be worse. I could go through menopause no times in my life. Because I could be dead instead.
The big question I discussed with my oncologist was, of course, whether I’d have to do chemo. He had sent my tumor off to a fancy-pants lab for an actuarial analysis of its genetic makeup, in order to determine with scientific accuracy the possibility of its response to treatment and the likelihood it would return later in life. The results would take 2 weeks, and then I’d face the first and hopefully only life-or-death decision of my entire life.