This Side of Sad

by Karen Smythe

  ***

  Ted wasn’t a doctor, or even in medical school, when I had that first cyst removed from my right breast. That scar faded to pink but didn’t disappear completely; after Ted studied surgery in his third-year rotation, he touched it one night and said the doctor who’d operated on me was obviously old-school, his technique primitive. I was young enough then to think that my body’s scar would be unique, that I’d have it always, and that the scare of cancer taking me would be as close as we’d ever come to the possibility of being apart.

  For the double mastectomy, my doctor insisted that I book six weeks off work to convalesce, but I knew I wouldn’t need that much time. James knew that, too, or should have known: I’d recovered quickly when, a few years after we married, I had an operation on a Thursday to remove an ovarian tumour, and was back to work by Monday. It had been a large dermoid, the kind that wraps itself around a core of hair and teeth and bits of bone that grow in the wrong place at the wrong time. Benign, so it could have been left, but to avoid the potential agony of a future torsion, my gynecologist took the whole organ out.

  She assured me that I could conceive with one ovary; she didn’t know that James and I didn’t want the life we’d made disrupted.

  ***

  Ted wanted a little girl first, he said, and I wanted a little boy. He asked me what age limit I’d set for having kids. “About thirty-two,” I said off the top of my head, and that seemed to satisfy him. I wasn’t worried about it; women were having babies well into their thirties in those days.

  I was twenty-four when I met Ted, and he was twenty-six. I was almost thirty when he left.

  ***

  While I was still on extended bereavement leave from work, Gina’s kids, Anna and David, both sent me requests to be their “Friend” on a website called Facebook. Gina said she’d tried to learn how to use it, but she’s as hopeless with computers as James was. Neither he nor Tony joined, because teachers had to protect their reputations, they said. Being online Friends with students was not exactly kosher.

  Going public with my life didn’t feel right to me at first, either. How could I create a consistent online persona, when I am someone different with every person I know? Slightly different, anyway. An extrovert might think I am shy, while someone less outgoing than I am would see me as warm and easy to talk to. Then again, maybe a smattering of selves in cyberspace is a fair approximation of a person.

  In the months after I quit my job I was feeling more and more isolated, so in the spring, on a particularly bad day when I thought Facebook might at least be a source of entertainment, I made a scant profile, and searched for a few friends from university. I found Tanis right away. She became a dermatologist, and she lives in Windsor with her lawyer husband; they have the two children she always said she wanted. Drifting from people who had children was natural, and most of my close friends from university had followed that predictable path. I didn’t need to reconnect with them to feel that I knew them. The problem was me, with the difference between who I’d been then and who I’d become.

  I’m still not comfortable with Facebook. I feel exposed, found out, guilty of not being the person I am publicly claiming to be. Of constructing a person who does not exist. Ted once complained that I wasn’t socially stable, that my personality was too fluid. He wanted me to present myself a certain way to his friends, to be the same strong person I was with him, in the beginning.

  ***

  From day one, Ted and I both felt as if we had known each other for years. I didn’t have that instant closeness with James, though. I never pretended that I did, or probed for details about his past, or other relationships. And James didn’t wonder about whom I’d been with or who I’d been before I met him, either. Who we were now, with each other, was what mattered to us. Just not for the same reasons.

  If I were to bump into Ted somewhere now — at a walk-in clinic, say, or an emergency room — I’d probably revert, instantly, to my former, needy self, an anxious version of me that James never met. James never wanted me to be sensitive, clingy, or needy; my independent nature was one of the things he said he loved about me. Why did he want me to be bowled over by my diagnosis? The tumour was caught early, I reminded him. I was taking care of it; I’d be fine. I thought James would be fine, too, once the malignancy was cut from my body, but the wait was hard on him. He called in sick so many times in May and June that his colleagues must have thought he was acting the cancer patient.

  James’s anxiety hasn’t gone away. Or maybe it’s come back, and I’ve picked it up, like a virus. It’s certainly not dead, his distress; it is nudging me, making itself known again, inside of me this time.

  ***

  The radio-oncologist I was referred to said if I followed his recommendation — three months of daily radiation — the chance of recurrence and death was statistically insignificant. “Attitude makes a big impact on outcomes for cancer patients, Maslen. Your chances are very good without a mastectomy,” he chided when I told him I was taking the surgical route. I wasn’t going to become one of those radiated women who worry for the rest of their lives that they’ll personify that so-called insignificant statistic labelled PMR, for “Percentage with Metastasized Recurrence.” I didn’t care that this doctor saw me as an alarmist. All I wanted was to be alive in five years’ time.

  After the surgery I discovered I’d also been referred to a plastic surgeon; reconstruction could be done as a separate procedure, so the surgeon who visited me post-op in the hospital was taking another crack at convincing me. He said it was selfish not to reconstruct, that I should think of my husband. He’d caught me off guard, so I didn’t know what to say. I accepted his printout with diagrams of silicone implants lined up in a row, from small to large. I was to decide on the bust size I wanted, then call his office when I was ready to proceed.

  I would have liked to talk to a doctor I knew personally, someone who would understand my perspective, when I was thrust into the world of ultrasounds, biopsies, mammograms, and treatment plans. I needed to talk to someone who would support my refusal of the three Rs: removal of the lump and surrounding tissue; radiation; reconstruction. Not Tanis, who was a doctor by then; we’d not been in touch since I left London.

  Ted was practising somewhere, I knew. What would Ted think? Allowing myself to envision him standing before me in a white coat, reviewing my medical record through glasses perched on his nose, produced a familiar desperation in me. It was panic, the same kind I’d felt when Ted told me there’d been an “administrative glitch” regarding his upcoming internship, which of course wasn’t true. My body was signalling danger, whether I admitted it to myself or not.

  I didn’t make any effort to find Ted, then; but I did start to think about him once in a while. And as James and I drifted, in the months after my surgery and into his retirement, I thought about him a little more often.

  eight

  When I got the call at the office, I listened, thanked my family doctor for letting me know, and hung up the phone. On my way to talk to Nancy, who’d become my closest friend as well as my boss, I stepped into the stationery room. I didn’t think about what I was doing as I grabbed a Hilroy exercise book, which looked exactly the same as it did in primary school; I stuck a white mailing label on its cover, found a Sharpie, and wrote “The Boob Diaries” in permanent, black ink.

  The Boob Diaries

  May 3rd

  Gina, James, even Nancy will be extremely upset when I talk about this, so I’m going to minimize those conversations. I’ll use this book to record what is happening to me, to document considerations and conversations with doctors, and to record my decisions, in case I need reminding later on. It will have to substitute for talking with someone who understands me.

  So here we go…

  Dr. R. called me at work today, to say the pathology has come back. Not good — a second opinion was sought and the diagnosis confirmed. High-grade malignant cells, though seemingly contained. He has referred m
e to Dr. A., a general surgeon. I asked him if a mastectomy will be an option but he didn’t want to presume. Dr. A. will explain all the options, he said.

  Okay, then.

  I went home at lunch to talk to J. He was on his laptop in the living room, and he looked up when I opened the door. I never come home midday, so he was frowning at my appearance.

  “I have something to tell you,” I say. He smiles, expecting good news, because I’m smiling. Then I tell him what Dr. R. said.

  I watch confusion scuttle across his face before pain reaches his brain, as if he’s reacting in slow motion to a stab in his back from the blade of some phantom enemy. He stands up, staggers the few steps to where I am, and embraces me.

  “It’s okay, hon,” I say, patting him on the back. “I’ll be fine. It’s early, very early. It could be much worse.”

  I don’t feel anything. I know I should be scared, or sorrowful, or something — and that I should be moved by James’s reaction, by his fear of my mortality, if nothing else. But I’m not.

  May 4th

  This is so ironic. I wasn’t worried about the cyst, which had grown larger since the previous ultrasound, but my family doctor was. In April he insisted I see a surgeon, who would order a biopsy to rule out cancer. That’s when the fun began. The radiologist who did the procedure missed the lump entirely, but when I questioned him about it he said it just felt that way to me — the needle goes in on an angle, etc. etc. Dr. A. wouldn’t say her colleague had missed the lump, only that the results were inconclusive, but she ordered a repeat biopsy, this time under a needle-guided procedure using the mammogram machine.

  The second biopsy was done by the same radiologist who did the first one, but he acted as if he’d never met me before. While my breast was pressed between the mammogram plates, he looked at the projected image and inserted needles to locate the lesion precisely. I knew the samples he cut out hit the mark by how it felt compared to the first time. He wished me luck when he left the room, and I wondered if that was an appropriate remark to make, considering.

  May 5th

  It was 3 a.m. and we were both awake. J. held me. We said nothing.

  May 21st

  I make jokes in my head that I can’t tell J., but they make me laugh anyway:

  – That’s it, no more wet T-shirt competitions for me!

  – At least I won’t have to line up for the ladies’ room at the theatre anymore.

  – Paint my toenails, doll, and take me to the Mardi Gras!

  May 24th

  I imagine telling Gina funny titles for a movie about what I’m going through. Boobless in Boston. Titless in Toronto. Jugless in Jerusalem.

  May 30th

  Consultation with Dr. A. this morning. When we walked in, the secretary said hello in a subdued tone, probably thinking I didn’t know the results of the biopsy yet and that I would be getting a shock shortly.

  Dr. A. suggested a lumpectomy and radiation, with mammograms every six months for a couple of years, and wanted to refer me to another specialist. I told her I want a mastectomy, to be done with it. No reconstruction, either, no fiddling around with the tissue. I’d heard of people who went through the process of expansion with the pain and the infections that typically complicate things, and then the cancer came back — so no, thank you. She asked James what he thought, which annoyed me. They’re my breasts! He said he just wants me alive, which is what I knew he would say.

  James insisted she order a mammogram of the other side, too, because he thinks he can feel another small lump there, though I am not convinced.

  June 12th

  I picked up the mammogram results at the Records Department this afternoon. James was right. The left breast also has “suspicious calcifications.” I booked another appointment to discuss with Dr. A. for June 27th.

  I haven’t told J. about my appointment next week with the radio-oncologist, partly because he is still so upset, and partly because I don’t want to have to argue with another doctor and try to keep James’s mood up at the same time.

  June 16th

  Consultation today with radio-onc., who wants me to come every day for 12 weeks to have beams shot through the tumour. I repeated what I’d said to Dr. A. — that I don’t want a lumpectomy followed by radiation, I want the full surgery. Bilateral. I told him the mammogram showed suspicious calcifications in the other breast, too, and I may as well have them both off.

  His nurse says that what I want is overkill. “It’s like putting on huge galoshes for a little spring shower!”

  The cancer clinic has had a cancellation, apparently, and I can begin treatments next week. “I’ll put your name down while you think about it some more,” said the nurse. She booked me in for a measurement and fitting of the body cast, which will hold me in place so the beam hits the exact spot, every time. “There’s a limit on what the tissue can take, and we don’t want any misfires.”

  June 17th

  I cancelled the measurement booking by leaving a phone message on the nurse’s answering service last night.

  June 27th

  Dr. A. is nervous. Removing healthy tissue is against the standard of care. One breast, the diagnosed one, will be removed, but she isn’t comfortable taking off the other one, since it might be fine. Only a biopsy or lumpectomy — which I refuse to waste time with — will be determinative. James spoke up and said that it is prophylactic and also cosmetic, to make me balanced — surely she can understand that? She went away to call a surgical colleague who has more experience. She’ll call when she hears back.

  July 13th

  Dr. A. agreed to do the full surgery. She realized that a lumpectomy, her preference, would have to be so large to capture the suspicious tissue that she’d take half the breast off anyway. It is booked for August 24th. I worked it out with Nancy: I’ll take my vacation days to avoid going on short-term disability, which HR has suggested I do. Don’t see why a lack of breasts would be considered a disability. I mean, really.

  It dawned on me today that after I have this surgery, I’ll be down two breasts and one ovary. Uterus aside, that leaves me with just twenty-five percent of the defining essentials of womanhood. I’d be well on my way if what I wanted was to become a man. I wouldn’t mind having a boy’s hips again, but that’s another matter.

  August 20th

  The “pre-op” appointment was a waste of time. Blood work, weight — okay, that makes sense. But the nurse wanted me to talk about it with her. She’d have hugged me if I’d let her, but I didn’t want her sympathy. I’m not behaving according to the norm, apparently. I’m supposed to be feeling sorry for myself, in mourning for my soon-to-be-gone body parts. I think what people really want me to do is help them feel better about their awkwardness over what to say to me. They’re projecting, expecting me to react as they would. It’s not about me at all; it’s about their fear that something could happen to them.

  August 25th (noon)

  I’m writing this entry on the back of the paper tray liner from last night’s uneaten dinner. I’ll tape it into my book when I get home this afternoon.

  I’m on Tylenol 3 to help with the agitation, mostly in my legs — it was difficult to fall asleep last night, they were so restless. Otherwise, as long as I didn’t think about food, I did well for having been under an anaesthetic for so long; unexpected blood loss complicated matters in the surgical suite, I’m told, and a transfusion was required.

  August 25th (4:00 p.m.)

  Home. Here is what I remember from yesterday (August 24th):

  I awaken in the recovery room, nauseated. I hear a woman speaking quietly in the distance. “Hello, Maslen, you’re doing great. Can you take a deep breath for me?” It is a friendly voice but belongs to no one I know. “Can you open your eyes?”

  I blink a few times and can make out a fuzzy face hovering above me. “Try to lift your head up a little, so you can swallow a sip of water.” But a tidal wave in my gut knocks me back. Retching. Dry heaves. A cold metal tray
shoved too late underneath my chin. A scratchy paper towel wipes coughed-up mucus and acid from my lips.

  The nurse injects an anti-emetic into my IV. Soon the nausea begins to ease. I smell tarnished silver every time I inhale. It reminds me of my grandmother’s necklace after it blackened against my skin. “Would you like to see your husband now?” I shake my head, then drift off, imagining it’s Ted who is coming to be by my side.

  James was at the foot of the bed when I woke up in my hospital room this morning. I was so happy the nausea was gone that I felt euphoric. My lips were dry and tasted like metal when I ran my tongue around them. James found a straw for the Styrofoam cup of water on the table next to my bed and held it to my mouth while I sipped.

  The day nurse who came into my room with discharge paperwork was jolly and loud. “Let’s take another look at your chest — or at what’s left of it!” she said. I laughed, but also thought it would have been cruel if she’d said it to the kind of woman who’d be traumatized by the procedure, and I was glad James had already left to bring the car around front.

  The nurse helped me to sit on the side of the bed, my feet dangling far from the floor, and began to peel away layers of gauze. When I looked down at the concavity at the top of my ribcage while she worked, I had the bizarre thought of Gloucester with his eyes gouged out. When the nurse finally reached the wide strips of surgical tape that held the flaps of my flesh together, I saw there were stitches, too — I wouldn’t stop bleeding, apparently. “Nice, clean job,” said the nurse. Dr. A. came by to check on me, too, before I was escorted to the elevator. Pleased with her artistry, the stitched-up symmetry of my chest, she sent me on my way.