One day when I was nine and Suzy was twelve, we arrived at the barn just as they were preparing to geld a beautiful yearling. As they eased the tranquilized pony to the ground, Suzy and I hung back by the fence, but when the veterinarian drew his tools from a leather bag and got down to the business at hand, Suzy got horribly upset and ran away screaming. My initial reaction was “How silly!” but I realized later this wasn’t about Suzy being a wimp or wanting attention. My sister was excruciatingly tenderhearted, empathetic, and easily upset by any thought of violence or mutilation.
I, on the other hand, scrambled up a tree for a better view, fascinated by the entire procedure, and when it was over I peppered the vet with a thousand questions. Why do they do that? What’s that thing? Will he be able to run as fast? Can I look in the bucket? I tried to share what I learned with Suzy so she’d know it wasn’t just some random atrocity.
“It helps him, Suzy. He’ll be healthier and easier to ride and won’t hurt himself scrapping with other horses.”
Suzy wanted none of that. She covered her ears as if she could still hear the yearling’s frightened whinnies.
“Nan, don’t you know what that is? It means he can’t—you know.” She blushed pink, trying to think of a way to say it. “He can never have children. Don’t you think that’s sad?”
I was stumped. I’d been so fascinated with the basic mechanics of it that this aspect hadn’t even occurred to me. Daddy and the wranglers were eager to point out all the good reasons for doing it, but this had never been brought up in their explanation of the procedure. It was all efficacy, no emotion. (Balancing the two continues to be one of the greatest challenges in cancer care.)
While the event didn’t deter her from riding, Suzy was never quite as eager as I was to get to the barn. For me, riding was synonymous with joy, freedom, feeling alive. I learned everything I could about the history and science of horses, and knowing all that made it feel even more wonderful. It frustrated me that Suzy didn’t see it that way, and I worried a little that what it really meant was that Suzy was just plain sweeter than me.
“We have to go to horse camp,” I told Suzy when school ended the following summer. “It’ll be tons of fun. Please, Mom, can we?”
“We’ll see,” said Mom, “but Aunt Rose would like you girls to visit. I think it would be a wonderful adventure for you.”
“Just the two of us?” Suzy’s fork poised halfway between her plate and her astonished expression. “We’d go to New York City all by ourselves?”
“Dad and I would put you on the plane in Peoria, and Aunt Rose would be right there to meet you when you land at LaGuardia. She wants you to stay a whole week.”
Our father hushed Suzy’s and my joyful trilling at that, but not very sternly. Suzy was immediately buzzing with packing strategy and general enthusiasm, while I interrogated Mom about agenda and logistics. We couldn’t stop chattering about our plans as we cleared the table and did the dishes, imagining New York City as nothing less than the Emerald City, the only possible habitat for Aunt Rose, the most outrageously fabulous woman we’d ever encountered.
Suzy worshiped Aunt Rose because she was the epitome of fashion and femininity, stirring clouds of chiffon and perfume as she made her dramatic entrances and exits, filling the rooms between with flirtatious laughter and witty Hepburn banter. Men flocked and fell all over themselves in an effort to please and impress her, and she generally had her way when it came to everything from dinner reservations to travel destinations. I worshiped Aunt Rose because she was always in motion. Grand gestures illustrated her hilarious tales of passenger ships and love interests and African safaris. She was audacious, outspoken, and fiercely self-determined. She could do anything and feared nothing. Aunt Rose was barely middle aged and had already been married four times. (Daddy used to say, “Her husbands didn’t die, they escaped!”) She adored Suzy and me and brought us wonderful presents from wherever she happened to be. One summer she returned from Hawaii with hula gear and ukuleles for us, showed us a few island moves, and took pictures of us giggling in our grass skirts and coconut bras. Bottom line: Aunt Rose was fun.
At bedtime, Mom came to our room and said, “Before you go to New York, I need to remind you that Aunt Rose was very sick last year. She had breast cancer, and they did a mastectomy, which means …”
“We know what it means,” Suzy said brusquely. “We don’t need the details.”
In fact, I didn’t know and was intensely interested in the details, but Suzy obviously didn’t want the conversation to go that way. This meant one of three things: Either Suzy had heard something earlier and hadn’t had a chance to clue me in, or Suzy had heard something and didn’t think I should be told, or Suzy had heard nothing and didn’t want to hear it now.
“Do you have any questions, Nancy?” asked Mom.
I shook my head. I had only a vague idea of what mastectomy entailed, but judging from Suzy’s response, I suspected it was something irredeemably brutal.
As our plane cruised over the water into LaGuardia, I nervously wondered if Aunt Rose would have the strength to make it to the gate to meet us. If she did manage that, would we still recognize her? I breathed a deep sigh of relief when we saw her standing at the end of the Jetway, slender and stylish and still very much Aunt Rose. She was as glamorous and animated as ever, madly in love with the man who’d recently become her fourth husband, and her husband clearly was crazy about her. We rushed to throw our arms around her, and she felt whole and warm. I felt sheepish and silly for thinking she’d ever be otherwise. If anything, she felt sturdier than ever, built up and tightly buttressed by the staunch whalebone corset that provided a functional prosthetic structure to her torso. At the time, I had no inkling of how unforgiving and painful that corset must have been; all I knew or cared about was Aunt Rose, standing tall, laughing out loud, and extending a strong hand to each of her nieces.
The first few days of our adventure were filled with shopping and lunching, striding down busy streets, strolling through quiet art galleries, the quintessential New York experiences. We were starstruck when we learned that Aunt Rose lived next door to Greer Garson in a co-op at Hampshire House on Central Park South. My Fair Lady had just opened on Broadway, and Suzy and I were very much the flower girls transformed into a couple of grand ladies. Every hour was thrilling in some oh-so-metropolitan way, but by the third night of our Big Apple adventure, Suzy and I were plain tuckered, and even Aunt Rose was showing signs of fatigue. She retired to her room that evening, after tucking Suzy and me into the guest room, where we fell into one of those typical sister-on-sister did not, did so squabbles. I don’t remember what it was about any more than I remember other bones of contention we used to clash over, but eventually, Suzy decided to bust out the big guns and tattle to Aunt Rose. She stalked down the hall, and I sat seething on the bed, waiting for the sound of Aunt Rose’s high-heeled pumps in the hallway. Instead there was the scuttle of Suzy’s bare feet on the wooden floor, like the beating of a hummingbird’s wings, as she dashed back to the guest room.
“Oh, Nanny … oh, Nanny,” she breathed with her back to the doorframe.
“What is it? What’s wrong?” The squabble forgotten, I was instantly up with my arms around her.
“She was … her … it’s awful,” Suzy whispered, blinking back tears. “I don’t know how anyone could live through a thing like that.”
Peering down the hall toward Aunt Rose’s room, I could hear her singing. Her husband said something and they laughed languid, romantic laughter together. I tiptoed toward the light that slanted from her open doorway and held my breath as I peeked around the edge of the jamb.
Propped on pillows in a sea of ruffled bedclothes, Aunt Rose had one elegant hand in her lap, the other on an open book at her side. Her silk robe had fallen open a little, exposing the startling remnant of her chest. Concave and burned bluish-purple by high-voltage cobalt treatments, her bosom looked hollowed out and fragile. I would have sworn I co
uld see the chambers of her heart pumping through skin as thin and discolored as onion paper.
She glanced up and smiled inquisitively. “Why, hello there.”
I swallowed hard and said, “Goodnight, Aunt Rose.”
The Storyteller’s Mastectomy
FANNY BURNEY was ten when she addressed her first journal entry: “To Miss Nobody.” But Fanny was somebody now. A contemporary of Jane Austen and Mary Wollstonecraft, Fanny wrote wildly popular novels that helped launch a wave of literary women that included Mary Shelley and the Brontë sisters. Fanny married General Alexandre d’Arblay, a hero of the French Revolution. In 1811, they were living happily in Paris with their sixteen-year-old son, Alexander. One of Napoleon’s own physicians, Dr. Larrey, gave Fanny the news.
“You have a cancer in the breast,” he told her. “There’s nothing for it but the knife.”
By the eighteenth century, researchers had agreed: Breast cancer was not a systemic or spiritual problem, but a localized disease, with surgery the only logical response. From its inception, however, the mastectomy set at odds two guiding principles of the practice of medicine:
Primum succurrere, “First, hasten to help.”
And Primum non nocere, “First, do no harm.”
Before the time of anesthesia, before any concept of antiseptics or any reliable method for determining the difference between benign and malignant tumors, most women who underwent mastectomies died, either from the surgery itself or from rapidly raging infection. But some survived, lending credibility to the idea that mastectomy offered a potential “perfect cure.”
Surgical procedures became more and more aggressive. Even when only a small portion of the breast was diseased, surgeons zealously went after the axillary lymph nodes by opening up the armpit. Soon surgeons in Paris were performing “en bloc” mastectomies, removing the entire breast, chest wall, and lymph nodes. The director of the cancer institute at England’s Middlesex Hospital urged removal of the surrounding skin as well, rather than risk a return of the cancer owing to any “mistaken kindness to the patient.”
“Madame, it’s a small thing,” Dr. Larrey assured Fanny Burney. “You sit in a chair. I excise the tumor. All over in a few minutes. I must caution you, Madame: The consequences of procrastination are dire.”
Fanny later wrote to her sister Esther that she rose at eight on the appointed day and dressed with the help of her maid; the advancing cancer had left her right arm almost useless. Young Dr. Aumont arrived with a letter from Larrey, advising her that he and his colleagues would come at ten. Larrey reassured her of his dexterity and expertise, and admonished that, for sensibility and prudence, she should “secure the absence” of her husband and son.
Fanny made a pretense of lingering over the note, struggling to hide her growing apprehension. She had to protect her son from “the unavailing wretchedness of witnessing” what was about to happen. She dashed off a note to the chef du division du Bureau where her husband was at work, informing him of her situation and entreating him to trump up some urgent business to detain d’Arblay until it was over. She sent her maid down to Dr. Aumont—“the terrible Herald”—to inform him in no uncertain terms, she would not receive Larrey until one.
“I have an apartment to prepare for my banished Mate,” she fussed. “Two engaged nurses are on the way. I have a bed, curtains, and Heaven knows what to prepare.”
Dr. Aumont remained in the salon, stolidly folding stacks of linen. Word came that the surgeons couldn’t come until three. Dr. Aumont left, promising to return at that time, leaving Fanny for two lonely hours with nothing to do but contemplate her fate. She tried to write letters to her family, but the debilitating ache in her arm prevented her. She wandered the apartment, finally forcing herself to open the door to the salon, where she discovered Dr. Aumont’s immense supply of bandages, compresses, sponges. Clearly, significant blood loss was anticipated.
Fanny recoiled. In a state of torpid shock, she paced until the clock struck three. Gritting her teeth at the agony in her arm, she forced a few words onto paper, short notes for d’Arblay and Alex “in case of a fatal result.” She rang for her maid and hired nurses, but before she could speak to them, seven men in black—Dr. Larrey, Monsieur Dubois, Dr. Moreau, Dr. Aumont, Dr. Ribe, a pupil of Dr. Larrey, and another of Monsieur Dubois—entered without announcement. Fanny was indignant, but she found herself unable to assemble a single syllable to object.
Why so many? she wondered. And how dare they enter without leave?
“Dubois acted as Commander in Chief,” she wrote to Esther. “He ordered a bedstead into the middle of the room. Astonished, I turned to Larrey, who had promised that an arm chair would suffice, but he hung his head, and would not look at me.”
“Two old mattresses and an old sheet,” Dubois told the apprentices. Those arranged to his liking, he turned to Fanny. “If Madame would mount the bed, s’il vous plaît.”
She stood trembling, suspended in terror, eyes darting toward the door, windows, any avenue of escape. Her maid sobbed quietly by the door; the nurses stood frozen nearby.
Dubois issued a sharp command en militaire. “Let those women all go.”
“No!” Fanny recovered her voice. “No, qu’elles restent—let them remain!”
But the maid and one of the nurses were already running down the stairs. A brief squabble broke out when the second nurse ignored Dubois and stood beside Fanny, who “resisted all that were resistible” as she was compelled to take off her long robe de chambre, which she’d meant to retain for the sake of modesty.
“Ah, then, how did I think of my sisters!” she wrote. “I regretted that I had refused my friends—anyone upon whom I could rely. My sister Susanna—dear departed Angel!—how did I think of her! How did I long—long for my Esther—my Charlotte!”
Seeing her distress, Dubois softened and tried to soothe her.
“Oui—c’est peu de chose … it is a little thing.…”
He took up a scrap of paper, nervously tearing it into small bits. No one else spoke. Larrey was aloof, pale as ash. Seeing his twisting discomfort, Fanny fully comprehended the mortal gravity of this thing within her breast. Fear of it filled the room. What must the weight of its dangerous nature be, she thought, if this horrific exorcism is my only hope to escape it? Fanny climbed onto the bed and lay back, her naked bosom fully exposed. Dubois spread a cambric handkerchief over her face, but it was opaque enough for Fanny to see the seven figures in black and one in white as they surrounded her. Through the lace edging, she glimpsed polished steel, then she closed her eyes.
Larrey’s voice. “Who will hold the center?” Fanny’s eyes flew open. She saw Dubois describe with his index finger a line from top to bottom, then across, then a wide circle. They intended to take the entire breast. Fanny sat up and cupped her breast with her hand. She had no intention of letting it go.
“Who will hold the center? I will, Monsieur! C’est moil”
She tried to explain that the pain in her breast radiated from one small area; Dubois gently but firmly pressed her back into position and replaced the cambric hanky. Despairing, Fanny closed her eyes, “relinquishing all watching, all resistance, sadly resolute, wholly resigned.”
My dearest Esther—and all my dears to whom she communicates this doleful ditty—you will rejoice to hear that this resolution once taken, was firmly adhered to in defiance of a terror that surpasses all description—and the most torturing pain. Yet when the dreadful steel was plunged into the breast, cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision, and I marvel that it rings not in my ears still, so excruciating was the agony.
When the wound was made and the instrument withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, tearing the edges of the wound. When again I felt the instru
ment—now describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—and then, indeed, I thought I must have expired.
I attempted no more to open my eyes. They felt hermetically shut, so firmly closed the eyelids seemed indented into the cheeks. The instrument this second time withdrawn, I concluded the operation over—oh, no! Presently the terrible cutting was renewed, and worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered. Again all description would be baffled—yet again, all was not over. Larrey rested but his own hand. Oh, Heaven! I felt the knife tackling against the breastbone—scraping it.
This performed, while I yet remained in utterly speechless torture, I heard Larrey (all others guarded a dead silence) in a tone nearly tragic, desire everyone present to pronounce if anything more remained to be done. The general voice was “yes.” The finger of Dubois—which I literally felt elevated over the wound, though I saw nothing, and though he touched nothing, so indescribably sensitive was the spot—pointed to some further requisition. Again began the scraping. And after this, Moreau thought he discerned a peccant atom—and still and still and still, Dubois demanded atom after atom.
My dearest Esther, not for days, not for weeks, but for months I could not speak of this terrible business without nearly again going through it. I could not think of it with impunity! I was sick, I was disordered by a single question—even now, nine months after it is over, I have a headache from going on with the account—and this miserable account, which I began three months ago, I dare not revise, nor read, the recollection is still so painful.
The procedure took about twenty minutes, followed by the torturous dressing of the wound, during which Fanny briefly lost consciousness once or twice. In the rare moments she was able to speak, she didn’t beg them to stop. Instead, she pleaded, “Avertissez moi, Messieurs! Avertissez moi!” Tell me! More than anything, she needed to know.
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