Monday, November 12, 2007

Caution, Knife


I first realized that my breasts are unusual when I was fourteen. It was summertime and I awakened each morning to go to summer enrichment camp (or whatever) at 7am. Each day I walked down the back steps into the kitchen to find my parents' eyes glued to my chest. "Hi" I would say. And they would both snap out of it and say hi and we'd eat toast and I would go to school. FInally, toward the end of the summer, my mother said, "It's unbelievable. You just get bigger every day."

I thought she was talking about my lengthening femurs. Silly me.

Since that summer, my breasts have been their tenacious and inconvenient selves without reference to the feelings or desires of their owner - or the feelings or desires of boob-addicts who try to have a relationship with me so as to get access to them. They do their own thing. If I lose ten pounds, they pertinaciously refused to shrink. If I gain half an ounce, it looks as though someone has stuffed a couple of honeydew melons under my sweater. They will not be denied.

Maintenance, general

If you wear my size, (thank you, but no, I will not be disclosing it) you know that the engineering considerations of my bras allow for a dizzying variety of lace and embroidery and itty bitty flowers and netting and straps. You people in an A cup? Those are cute. How nice for you. But your bras are more of an idea than they are garments. They don't have to do any heavy lifting, so to speak.

I routinely pay upwards of $100 for a bra if it fits and if it's pretty and the underwear matches. My current favorite brands are French but I sometimes go in for a certain American brand of slutwear that makes very pretty things, including matching garter belts and several varieties of each item in the same color scheme. They do not limit me to a thong (whose idea was that, and why did it catch on?) and if I want two slightly different versions of the same bra, I can have it, and the garter belt, too. Did I mention how much I hate thongs?

Maintenance, medical

I go twice a year to get mammograms, and usually other procedures too. I love going to the radiologist and flinging my breasts onto the plastic plate - and I love having them squashed - and I love studying the filmss - and I love the ensuing conversation with radiologist. I love also the follow up ultrasound resulting in yet another appointment with the breast surgeon, and if I really luck out, I get to have an MRI, and a biopsy, too. My breasts, as Drs. Caution and Knife will tell you, are uncooperative.


My mother died of breast cancer when she was 52. Because she never did breast exams and her doctor didn't bother with those either, she did not know she had cancer until it was in stage two, infiltrating her lymph nodes. Everything I know about stage two diagnosis can be summarized in two words: you're fucked. My mother would be alive today if she had been diagnosed just three lymph nodes sooner.

For me, the maintenance began early. In 2002, my Ob/Gyn flipped through my chart and said, "Let's start mammograms. Your mom was 42 at diagnosis, and she from (flip, flip) from what I can see here (flip, flip), she was in stage one by the time she was 35. We need a really good baseline."

So off I went to Dr. Caution. I brought my mother's medical records with me - the six inch file of the whole ugly show - and handed it to the radiologist to review while the racktation consultant did all manner of undignified and grotesque things to my rack. I wore the paper robe cheerfully. I did not even flinch when she squeezed breast B (the right one) so hard that I thought my head would explode.

When Dr. Caution called me back to her office, she stared at the films for a good while before saying anything. Then she looked at my mother's files again and said, "get back into the gown. I need more films"

Twenty more minutes of squashing ensued. Then I headed back into her office and she looked them over - and said, "Do you have to go back to work or anything? Because I'd like to do an ultrasound."

I called out for the rest of the day and got gelled up for an ultrasound. After multiple pictures of each breast, Dr. Caution finally spoke.

"Your breasts are so... interesting. Take a look at these." She gestured to several indistinguishable spots on the films. "I can't get good views of what these are, no matter what I do." She glanced back at the dogeared chart of my deceased mother and said, "Can you stay for a biopsy?"

Well, Jesus Christ already. Of course I can.

After said biopsy, which involved local anesthesia and a needle roughly the circumference of a cigarette being shoved into my beloved left breast, I finally called FB (YoYo, former boyfriend). He, being a physician, was able to discern what was going on without much difficulty.

"Ask her if you have fibrocystic breasts."

I asked. No.

"Ask her if you have cysts, period."

I asked. No.

Yoyo paused. "Ask her if you have dense breast tissue."

I asked. YES. (I knew that before I ever slung my rack onto to machine, so thanks).

Yoyo said: "Basically, they want to be able to see in there and they can't. Because your breasts won't cooperate."

I said, "Because they are... dense."

Yoyo said, "Yes. Dense."

I wished they would wise up, already.

Later that week I took another day off and presented my story, my chart, and my very dense breasts to Dr. Knife, breast surgeon. I waited in my paper gown and listened, through the very thin walls of Dr. Knife's office, as he explained to Some Other Woman the procedure he would follow to cut off her breasts a few days hence.

Then Dr. Knife entered the exam room, introduced himself and then said he'd just be a minute. He sat at the sink turned his attention to pile of medical records there. Dr. Knife, a dignified middle aged man with salt and pepper hair and wire rimmed glasses, flipped through my chart and then my mother's. Then he took up a clip board and started asking questions. Dr. Knife asked me - and I timed it so never say I exaggerated - 31 minutes worth of questions about my breasts and all the other breasts in my family. Then he put my films up on the screen and paged through them, one at a time, pointing out to me along the way, the fifteen ways in which my breasts uncooperative. Then he turned the backlight off and for the first time, looked directly at my breasts, hiding there behind the paper gown.

I will never, ever forget what happened next.

Dr. Knife approached the exam table and then stopped just short of reaching for the paper gown. His hands dropped to his side, and he just stood there for moment, breathing, Then he closed his eyes for several seconds. Just about the time it was getting awkward (because you know it was not awkward at all before that) he opened his eyes.

"Let's take a look. Put both hands behind your head and sit up straight."

I did. Then he closed his eyes again, as if listening to some faint and beautiful music. He pushed the gown aside and did the most crazy thorough job of examining breast A - I can't even describe to you what this was like. He repeated the process with breast B - without ever opening his eyes. Finally, he reached for my hands and held my arms out to my sides, and opened his eyes. He looked at breast A and then breast B and then stood back and looked both together. He let go of my hands and the music stopped. He looked me in the eye, and said, "Perfect."

"Perfect?" said I.

"Yes," he said. Dr. Knife explained that he has, in 25 years of practice, caught many a tumor the size of a grain of rice. He also said he was certain there was nothing wrong with my rack - but that since my rack is so uncooperative and my mother's story so terrible, I should see both him and the radiologist every 6 months for the rest of my life.

Current disposition

Last week, I visited Drs. Caution and Knife and disclosed that my dad is dying of leukemia. Their response was pretty much what I expected: both were sorry and could hardly conceal their disappointment that I had made such bad decisions when selecting my parents. Both were eager to exert the full power of their medical facilities against the cancer that is now sure to arrive in one or both breasts - any minute now. Both Caution and Knife are poised and ready to cut my breasts off and irradiate and poison me until my hair falls out just as soon as the first cell divides. They are waiting for it, wanting it, panting at the door of the OR.

You might think I am not over-fond of Caution and Knife. I admit there was a time, when I was a breast maintenance rookie, that I did not much care for them. But I have made peace. Why? To put it plainly, the glass if half full here. Sure I have a squad of people who are just dying for me to get cancer so they can do their jobs, but the alternative - which is missing early diagnosis - would be far worse. These people drive me crazy, but their determination to wait by my side with their knives sharpened might save my life. Or not. Because odds are actually pretty good that I will never get cancer anyway.

Today's epic and unsexy post is dedicated to dmbmeg, who is learning what it's like to have your mom ripped out of your life when you are in your twenties, when neither of you is within a hundred miles of being ready to say goodbye. Also, you might think another comment that says, "I'm sorry, that sucks" doesn't help, but it sure as hell doesn't hurt. Go see her.


utenzi said...

That's a wonderful description of your dilemma with your breasts, Nina.

No doubt many women would envy your chest being rated "perfect" by a medical doctor but the downside of possible cancer makes that seem a lot less important. Most likely you'll escape breast cancer but taking the precautions you are is just plain smart. Good going.

bred said...

wow... WOW. what a story. i so often hear about women who experience some womanly problem--a suspiscious pap, a strange lump... and sudddenly get a delirious case of denial. it doesn't sound enjoyable, but how wise of you to follow through with these bi-annual invasions. what a great example for other humans and women of someone who is truly keeping track of their health. thank you for sharing this.