Sunday, February 20, 2011

The Unvarnished Truth

A woman I know was shocked to learn I’d had a bilateral mastectomy.

"I’d die before I’d let anybody cut off my boobs!" she sputtered without thinking.

Instantly, she was embarrassed. I told her I understood. I remember when I felt the same way. But that was five biopsies and two affected sisters ago.

The Omaha World Herald interviewed my sisters and me last Friday afternoon in a quiet studio high above downtown Omaha. Unseasonably spring like, the day was warm and hopeful. Our interviewer, Live Well Nebraska editor Stacie Hamel, was wonderfully kind and sensitive. But none of us bargained for the raw emotions that would erupt in that quiet room.

"How did your mother’s death impact you when you were young?" Stacie asked my sister Terri who sat resolutely in front of the video cameras.

To our horror, Terri’s eyes filled. Barely able to speak, she struggled valiantly to pull herself together. "It was very hard," she said at last, her voice barely above a whisper. She recalled Mom’s terrible suffering and spoke of her constant fear that her own breast cancer would return and of the agony she endured imagining her children growing up without her.

Terri’s grief, so instantly unveiled, shook all of us. After her tearful interview, we clustered around to comfort her. Her stoic demeanor these last five months had fooled all of us. It took an interview at the Omaha World Herald with a kind journalist to help us realize Terri was still reeling from her breast cancer diagnosis.

Even more surprising was my youngest sister Caroline’s reaction. Stacie Hamel particularly wanted to talk to Caroline about her reasons for being the only sister who chose not to have a prophylactic mastectomy. Like Terri, Caroline immediately became emotional.

"I’m scared to death," she sobbed. "I’m a single mother who wants to date and have a life again." Even more heartbreaking was the admission that she would possibly have considered the surgery had she been able to afford it. "I know insurance would pay for it," she burst out. "But I can’t take six weeks off from work."

After that, Caroline refused to have her picture taken with us. Terribly upset, she would have no part of a photo in a large city newspaper that would circulate her image as a woman "marked" for breast cancer.

Soaking up kind attention from our families and friends, I’ve conveniently closed my eyes to the very real dark side of prophylactic surgery.

"If you’re going to write responsibly," my good husband reminds me, "you have to tell the truth."

So here’s the unvarnished truth about an elective bilateral mastectomy: It’s a difficult operation, and it’s not over in a day. The entire process is long and uncomfortable. One morning, you will rise to inspect your scarred chest in the bathroom mirror, and you will wonder why you ever persuaded yourself to do such a terrible thing to your body.

A young woman wrote to me recently that her husband was not able to understand her decision to undergo an elective mastectomy, especially since she didn’t have cancer. "He’s scared to look at me," she said. "I’m not sure if he’ll ever see me the same way again. I wish I’d never had this awful surgery."

Some of us don’t have supportive families to buck us up. Some of us, in spite of health insurance, can’t afford the surgery. And the grim reality of prophylactic surgery is that it’s not 100% effective.

"It’s impossible to remove all the breast tissue," Dr. Grange warned us. "But it can reduce your risk by about 90%."

While I feel liberated by those odds and feel certain that I will never confront this disease, Terri agonizes over the single cell in her breast cancer that may have escaped. "I’ll always worry about breast cancer," she admitted to Stacie Hamel.

After a long and difficult day, we thanked Stacie and said goodbye to Caroline. Deb, Mary, Terri and I fell into my little car and headed back to Lincoln feeling subdued and worried about Caroline.

"Look at that beautiful sky!" Terri exclaimed once we had driven out of town and were tooling down the interstate. Over the Nebraska prairie, the sun was disappearing behind a glowing red horizon, and we felt peace and perspective returning.

"Let’s go to the Macaroni Grill!" I suggested. It was our favorite restaurant, and it had been ages since we’d had dinner out together.

Over margueritas, Coronas and steaming pasta, we relaxed and celebrated our milestones thus far. Mary was two weeks past her surgery and feeling good. On March 3rd, just days after her 45th birthday, Terri would undergo one last operation to get her brand new boobs. In spite of the worries of the last five months, we had much to be thankful for.

"The four of us just had double mastectomies!" Mary informed our lovely red-haired waitress. The waitress looked at all of us, astonished.

"That calls for cake," she smiled. She returned with a huge piece of chocolate cake for Terri’s upcoming birthday and also brought the restaurant’s strolling opera singer with her. He sang "Happy Birthday" in Italian to Terri. During his serenade, we could see that the eyes of our waitress were misting over.

"My sister died of breast cancer," she told us.

 I gripped her wrist.

"Have you had your mammogram?" Mary asked in her very direct fashion.

"No," the waitress shook her head.

"Make an appointment tomorrow!" Mary commanded her sternly.

"Don’t be afraid!" Deb said.

Terri reassured her gently. "It’ll be okay."

The red-haired waitress promised us she’d make an appointment for a mammogram the following week.

After she departed, we stared silently at each other. The four of us had made the difficult decision to undergo a prophylactic surgery that comes with no guarantees. But it’s required no less courage for my sister Caroline to keep her breasts. Staying on top of annual mammograms and waiting desperately by the phone to hear the results, good or bad, is an act of bravery in itself.

You choose. Then you live with it.

And you remind yourself, in the meantime, to take time to savor the sunset.

And to enjoy a marguerita with your sisters.