“I need a plan,” I say. “Tell me a plan.”
“We can certainly start to explore your options,” Judy-Ann says. “If you’re sure you’re ready—”
“I’m ready,” I say. “I’m ready, let’s go.”
I have two courses of action. The first is “surveillance.” Regular screenings, every three to six months. Mammograms, MRIs, ultrasounds. Not all of this is necessarily covered by my insurance. I get the impression the screenings are less about making sure I’m cancer-free than waiting for the fucker to show up. The second is . . . it. Mastectomy. I still can’t form the word without shuddering. In one fell swoop, this reduces my risk from very, very high to very, very low. Real peace of mind. I just have to lose my tits for it.
No. Fucking. Way. “I read online something about BRCA cancers forming earlier in younger generations,” I say. “Is that true?”
“Officially, there’s no evidence of that,” Judy-Ann says. “But I can say personally, yes, I have seen that happen. Often due to lifestyle and environment factors, but we don’t know for sure.”
“How can I reduce my risk?”
“I’m not a physician,” Judy-Ann is quick to say. “I can’t officially advise you on that.”
“Unofficially?”
“A physician would probably suggest a low-fat, high-fiber diet. Regular exercise.”
I’m not naturally thin. I perform the compulsory labor of femininity via spin class and the odd celebrity diet. “I’m pretty healthy.”
“Reduced alcohol intake.”
“Ouch. Really?”
“A physician might say alcohol increases the risk of breast cancer.”
I’m shocked. “Wow, someone should really tell . . . every single person about that.”
“How many drinks would you say you have a week?”
“I say I have very few, but that’s a terrible lie.” I laugh weakly. “Me, personally?” I point to myself, as if it might be possible she’s asking for, perhaps, the average of everyone in the waiting room. “I have a very social profession. Drinking is really a part of the culture.”
“Eight to ten?”
“A day?” I laugh, relieved. “No, no. I mean, sometimes. On weekends. Thursday to Sunday. Including Sunday.”
“I meant a week,” Judy-Ann says. “How easy would it be for you to eliminate drinking?”
“Very easy.” I’m shaking my head, and stop. “How much would that reduce my risk?”
Judy-Ann makes another sympathetic face. “Not very much.”
I’ve never wanted a gin and tonic more badly in all my life.
I’m on birth control for my acne, which Judy-Ann says is good. The pill is helpful for reducing ovarian cancer risk. “For a lot of women, it’s as essential as pills for cholesterol or heart disease,” Judy-Ann adds, which surprises me. I’m too young to worry seriously about ovarian, but we run through the signs anyway. Have I noticed bloating, increased abdominal girth, urinal urgency? No, no, no. This is good, good, good. I can keep monitoring myself as I get older. Or there’s . . . the other way.
“An oophorectomy.” I force myself to say the odd word in a calm, controlled tone.
Judy-Ann nods. “Most women wait until after they’ve completed their family before they have their ovaries removed. Do you want to have children?”
The huge question is asked in such a low-stakes perfunctory way, I almost laugh. “Kids. Wow. Offspring. Fruit of my loins.”
“We don’t have to go into it now.”
The way I see it, women tend to fall into two camps. There’s the always-wanted-kids clucky mom-in-training types, the ones who feel this innate calling; it’s like they can see their own future and it involves a family Christmas card and playdates with strangers they met in a park and they’re like, Yes. Score. Then there’s the women who are like, No freaking way. I’m not destroying my vagina and turning into a milk station for some gremlin to ruin my career, my sex life, and all my best clothes. Fuck you and your biological imperative propaganda, I’m pouring myself another vino and binge-watching Game of Thrones, again, because I can.
Me? I’m neither.
I pull at a stray thread on the love seat. “Jury’s out on kids.”
“Are you currently in a relationship?”
The question every single girl longs to hear! Have you heard that saying “There’s a lid for every pot?” These days, thanks to online dating, there are too many lids. New York City is a lid party 24-7 and it is exhausting. “No, I am not, Judy-Ann.”
Judy-Ann asks, “Do you have any relationship goals?”
“I wouldn’t mind being in one,” I say. “If only because you’re basically a second-class citizen as an unwed woman.” Here’s something you never hear: It was a real single-friendly day. There were so many singles there! All different kinds of singles, enjoying some good single fun. I was there myself, as a single.
“How about a timeline?”
“For . . . ?”
“Marriage, children.”
My cheeks and throat tingle with heat. My instinct is to perform indifference, even disgust: Gross! How bourgeois! But it’s not the truth.
“I don’t have a timeline,” I mutter.
Judy-Ann makes another note. “For a young woman looking to form a primary relationship, there can be a physical consideration—”
“Let’s not beat around the bush, Judy-Ann. You’re saying if I get my tits cut off, guys will be less into beating around my bush.”
The counselor gives me an almost amused smile. “No, I’m not saying that. It’s just something to consider.”
A scratch of anger under my collar. “Do you have the mutation?”
“I don’t.”
“Right. So you and your husband”—probably high school boyfriend, probably married for a billion years—“have never had to deal with something like this.”
“That’s true. My wife and I have not.”
Holy smokes, Judy-Ann’s a lesbian? Steph’s right, my gaydar is the pits. What else have I gotten wrong about this goddamn shit show? I mumble sorry, feeling about ten inches tall. We’re silent a moment. My fingers find my left breast again. “When does this feeling go away?”
“What feeling?”
“This . . . worry.” This ever-present, bubbling dread.
Judy-Ann closes her notebook. “It’s different for everyone.” Which sounds very much like It never goes away. “Let’s move on to insurance.”
* * * *
I’m introduced to Dr. Laura Williams, a breast surgeon. She is six feet and almost disconcertingly beautiful; a tall Kerry Washington, in a white coat. She radiates the calm, efficient kindness that must be in everyone’s job description here. A brief breast exam confirms my lump’s existence, which leads to a diagnostic mammogram. This takes place on another floor of the rabbit warren treatment center. I change into a white terry cloth robe with an NY3C logo embroidered on the pocket in teal green. It’s as soft and nice as a hotel robe, which is a surprise. The hazy memories I have of hospitals from early childhood are full of lurid colors, bright lights, and hard smells. The female technician who helps me with the mammogram is polite and polished. The equipment is as shiny as a spaceship.
Did my mother get a mammogram? An ultrasound? How did she find her first lump? It’s hard to picture the half-smiling dark-haired woman in the six faded photographs I have getting freaked out and losing control like I did this morning. I can count on one hand the memories I have of my mother, which I know are supposed to be rose-tinted and fuzzy-edged. They’re not.
When it comes to my past, there’s so much I don’t want to remember.
The results of the mammogram are inconclusive, as is the ultrasound that follows. My breast tissue is dense, Dr. Williams tells me. Which is the case with many young women. A biopsy is required to work out if my lump is cancerous. I assume this will be weeks away. No. It’ll be now. I am “lucky”: yesterday’s snowstorm caused a few people to reschedule. I can’t help but
feel I am already being treated like a cancer patient.
“That’s because you are,” Dr. Williams says. “We want to give at-risk women the same level of care as women with cancer.”
“Suppose it’s something.” I draw my robe around myself. “What happens then?”
“It’s hard to say,” the doc replies. “I’d rather not speculate.”
Jesus, no one is willing to commit to anything. I just need a goddamn answer. “I’d really rather you did.”
“I don’t want to panic you—”
“I’m already panicked! Just tell me what happens if this is something . . . cancerish.”
“If we caught it early, maybe a lumpectomy. Maybe radiation. Maybe . . . something more radical.”
Chemo. The word is such a vicious, nasty slash that neither one of us wants to say it out loud.
“And after all that,” I say, “you’d still recommend a mastectomy, right?”
“Theoretically, yes. Probably. But let’s see how we go with the biopsy.”
Catch-22: all signs point to mastectomy.
No time at all seems to pass before I am lying on a padded hospital bed. Someone in scrubs thinks it’s a good idea to show me the needle that’ll penetrate my breast to numb the tissue. It is the size of a spear. “Why are you showing me this?” I ask, light-headed and trying not to panic. “I don’t understand why you’re showing me this.” A stranger holds my hand as it skewers my skin. I am a piece of meat. After I’m numb, I feel an awful, unnatural pressure as another long silver needle pierces my flesh on a brutal fact-finding mission. On the ultrasound machine next to my bed is the inside of my breast, looking like a black-and-white moonscape. Everyone searches the screen for the thing that could kill me.
Tears leak down the side of my face. Not because I’m afraid (which I am) or it’s uncomfortable (which it is). It’s because no one outside this room of polite and friendly medical professionals knows I am on this table.
I am completely and utterly alone.
6.
* * *
Vivian calls, again and again and again, until finally, I pick up. She wants to run a postmortem on our pitch, by which she means a debrief of my monumental fuckup.
“I’ll start with what I could have done better,” she says, her tone bristling with efficiency. “I shouldn’t have thrown you in the deep end. It was our first time pitching to an investor for our first round of funding, and I should’ve been more cognizant of the pressure that put on you. It was a mistake to go for it so quickly, and I’m sorry. Okay, your turn.”
I press myself into the far corner of a conference room. Beyond the glass walls, Hoffman House employees sip takeout lattes and send lightning texts. “Something’s happened.” I tell her everything. She’s silent throughout, to the point I’m unsure if she’s still on the line. “Hello?”
“I’m here,” she says. “Just processing.” Another pause. For a wild second, I think she’s going to fire me: flush the last eight months down the drain. “I’m sorry this happened to you, Lacey.”
Is happening, I want to correct her. “I’m sorry about the party,” I say. “I know Tom was a big deal.”
I expect her to scoff this off, reiterate that my health is the most important thing, that Tom doesn’t matter at all.
“He was,” she says. “But there’ll be others.”
“Sorry,” I say again. “I’ll catch up on everything by the weekend.”
“Okay, good.” There’s a pause before she adds, a tad hastily, “No rush. Take all the time you need.”
Knowing how high her standards are for everyone, from the guy who works at her local bodega to her own parents, I’m sure she doesn’t really mean it. And I don’t want more time. The ticking clock is already deafening. I find a handful of organizations for women at risk for hereditary cancer. They have strong, sassy names: Bright Pink and FORCE: Facing Our Risk of Cancer Empowered. I become addicted to their website forums, staying up night after night to lurk on the graphic, emotionally raw discussions of our collective fate: Ovaries out, or just fallopian tubes? and Best post-op bra for silicon implant? and 23 y o BRCA2 + scared. I feel like a stalker, reading confidential medical files. Threads discuss fertility issues, the pros and cons of “nipple saving surgery,” feelings of fear, of isolation. The frankness and the normalizing nature of the discussions are overwhelming. Confronting. They even have a name for women who choose prophylactic (preventative) surgery.
Previvors.
The thread I can relate to most right now: Anyone else here sick of waiting?? They don’t call it being a patient for nothing. If you have a mutated gene, you better get ready to wait: for appointments; follow-up appointments; tests; test results; first, second, third opinions. Guess what I’m not? Patient. I am so hysterical with the stress of waiting for my biopsy result that I accidentally spend $200 on shoes, which I definitely cannot afford, as I keep pushing back all my clients. I try to meditate for the first time since . . . for the first time. I breathe in and out. In and out. I try to find inner calm, but all I can think is: I’m dying. I’m dying. I’m dying. Burying my mother’s death—something I was barely even conscious of—wasn’t enough to escape it. I’ve always wanted life to move faster: to get to the next thing, and the next, and the next. Now I want time to slow down. To stop from delivering me to the future written under my skin.
After forty-eight agonizing hours, Dr. Williams calls while I’m in line at Starbucks. The biopsy is clear. The lump is a benign growth—something common and harmless. To say I am relieved is like calling Charlie Sheen “a bit of a drinker.” But all I say to the doc is, “Well, that’s good news.” I switch the phone to my other ear, conscious of idle eavesdroppers. “And what about my . . . other option? The more permanent one. What are the main benefits?”
“Reducing risk,” she says. “Almost to nothing.”
The line shuffles forward. “What about the downsides?”
“It’s a major surgery,” Dr. Williams says. “Anything from two to twelve hours on the operating table. Possibly multiple surgeries . . .”
She continues with a laundry list of nightmare details. I try to keep my face even, as if we’re discussing a no-stakes work presentation. “How do you think I should proceed?”
“You are young,” she says. “But I have seen breast cancer form in BRCA1 women younger than you. You don’t need to rush into a decision, Lacey. But my feeling is, it’s always better to be safe than sorry.”
Because being sorry might mean being dead. I order a black coffee, then instantly change it to a white chocolate mocha Frappuccino. As I wait for my order, anxiety builds in hot, uncontrolled waves.
What if a tumor starts forming now, right now? Judy-Ann said tumors form like that: aggressive ones, triple-negative. That’s really, really, really bad. I’d need tons of chemo to kill that. Tons. But what’s the alternative: mastectomy? Breast reconstruction, what, with implants? Fake boobs and scars? That’s horrific! Barbaric! That would be torture—
“Shut up!” I gasp, inadvertently bolting back a step.
No one in Starbucks even flinches, except one old man who gives me a knowing look and says, “I hear it too, sweetheart.” Hashtag New York.
* * * *
I have always been good at making a plan and sticking to it. My college nickname was “Lil’ Robot.” I know what I’m doing when I wake up because I’ve thought it through the night before. Which means I’m generally good with decisions. I don’t second-guess my lunch order or my life plan. But right now, and quite possibly for the first time, I am ripped down the center. After gorging myself on research and forum threads and what my insurance actually covers, I have information but no direction. Each possible path is frightening and badly lit. I can’t make a choice.
Finally, I accept the inevitable.
I need help.
Which is why, come Friday night, I call an emergency meeting of the minds at the loft.
* * * *
Steph hug
s me hello as if I just returned from the frontline. Vivian permits a scaled-back version of Steph’s signature embrace. (Viv is not a hugger, but this has never deterred Steph from trying.) I don’t think they’ve ever spent time together without me, which suits me just fine. They sit on opposite ends of the loft’s old sofa, wineglasses in hand. I’ve brought all the vino I had at home to stop it from tempting me with its cab sauv and sauv blanc siren song. Steph is comfortably cross-legged in a Blondie T-shirt, purple leggings, and socks patterned with peace symbols. Vivian is trying to find a spot on the sofa that doesn’t sag. Her expensive black slacks and a crisp white button-down indicate she came straight from our “office,” an overpriced shoe box in a coworking space in Tribeca that has free beer and Ping-Pong.
I am standing in front of a whiteboard. I am ready to begin. “As you know, I have a very important decision to make about my”—I indicate my boobs—“Golden Globes.”
Steph raises her hand. “Can we order pizza? Sorry, I know this is important, I just think I’ll have a clearer head if we had pizza.”
“I’ll order it.” Vivian is on her phone.
“I can do it.” Steph looks around. “Where’s my phone? Lace, have you seen my phone?” She runs her fingers between the couch cushions. “I just had it—”
“Done.” Vivian slips her phone back in her pocket. “Thirty minutes.”
“Shit, that was quick.” Steph gives Vivian an uneasy smile. “What’d you use, magic?”
“Yelp.” Vivian looks back at me. “You were saying?”
On the whiteboard, I write PRO and CON, and draw a vertical line between them. “Scores out of ten for each pro or con. Six for each column. Got it?”
My friends nod. It’s go time.
It takes us over an hour to finish the board. An hour of discussion and debate and wine and more wine. In the end, our pro column looks like this:
The Bucket List Page 4