Breast cancer survivor

A mammogram leads to a cult of pink kitsch

I was thinking of it as one of those drive-by mammograms, one stop in a series of mundane missions including post office, supermarket, and gym, but I began to lose my nerve in the changing room, and not only because of the kinky necessity of baring my breasts and affixing tiny X-ray opaque stars to the tip of each nipple. I had been in this place only four months earlier, but that visit was just part of the routine cancer surveillance all good citizens of HMOs or health plans are expected to submit to once they reach the age of fifty, and I hadn't really been paying attention then. The results of that earlier session had aroused some "concern" on the part of the radiologist and her confederate, the gynecologist, so I am back now in the role of a suspect, eager to clear my name, alert to medical missteps and unfair allegations. But the changing room, really just a closet off the stark windowless space that houses the mammogram machine, contains something far worse, I notice for the first time now--an assumption about who I am, where I am going, and what I will need when I get there. Almost all of the eye-level space has been filled with photocopied bits of cuteness and sentimentality: pink ribbons, a cartoon about a woman with iatrogenically flattened breasts, an "Ode to a Mammogram," a list of the "Top Ten Things Only Women Understand" ("Fat Clothes" and "Eyelash Curlers" among them), and, inescapably, right next to the door, the poem "I Said a Prayer for You Today," illustrated with pink roses.

It goes on and on, this mother of all mammograms, cutting into gym time, dinnertime, and lifetime generally. Sometimes the machine doesn't work, and I get squished into position to no purpose at all. More often, the X ray is successful but apparently alarming to the invisible radiologist, off in some remote office, who calls the shots and never has the courtesy to show her face with an apology or an explanation. I try pleading with the technician: I have no known risk factors, no breast cancer in the family, had my babies relatively young and nursed them both. I eat right, drink sparingly, work out, and doesn't that count for something? But she just gets this tight little professional smile on her face, either out of guilt for the torture she's inflicting or because she already knows something that I am going to be sorry to find out for myself. For an hour and a half the procedure is repeated: the squishing, the snapshot, the technician bustling off to consult the radiologist and returning with a demand for new angles and more definitive images. In the intervals while she's off with the doctor I read the New York Times right down to the personally irrelevant sections like theater and real estate, eschewing the stack of women's magazines provided for me, much as I ordinarily enjoy a quick read about sweat-proof eyeliners and "fabulous sex tonight," because I have picked up this warning vibe in the changing room, which, in my increasingly anxious state, translates into: femininity is death. Finally there is nothing left to read but one of the free local weekly newspapers, where I find, buried deep in the classifieds, something even more unsettling than the growing prospect of major disease--a classified ad for a "breast cancer teddy bear" with a pink ribbon stitched to its chest.

Yes, atheists pray in their foxholes--in this case, with a yearning new to me and sharp as lust, for a clean and honorable death by shark bite, lightning strike, sniper fire, car crash. Let me be hacked to death by a madman, is my silent supplication--anything but suffocation by the pink sticky sentiment embodied in that bear and oozing from the walls of the changing room.

My official induction into breast cancer comes about ten days later with the biopsy, which, for reasons I cannot ferret out of the surgeon, has to be a surgical one, performed on an outpatient basis but under general anesthesia, from which I awake to find him standing perpendicular to me, at the far end of the gurney, down near my feet, stating gravely, "Unfortunately, there is a cancer." It takes me all the rest of that drug-addled day to decide that the most heinous thing about that sentence is not the presence of cancer but the absence of me--for I, Barbara, do not enter into it even as a location, a geographical reference point. Where I once was--not a commanding presence perhaps but nonetheless a standard assemblage of flesh and words and gesture--"there is a cancer." I have been replaced by it, is the surgeon's implication. This is what I am now, medically speaking.

In my last act of dignified self-assertion, I request to see the pathology slides myself. This is not difficult to arrange in our small-town hospital, where the pathologist turns out to be a friend of a friend, and my rusty Ph.D. in cell biology (Rockefeller University, 1968) probably helps. He's a jolly fellow, the pathologist, who calls me "hon" and sits me down at one end of the dual-head microscope while he mans the other and moves a pointer through the field. These are the cancer cells, he says, showing up blue because of their overactive DNA. Most of them are arranged in staid semicircular arrays, like suburban houses squeezed into a cul-de-sac, but I also see what I know enough to know I do not want to see: the characteristic "Indian files" of cells on the march. The "enemy," I am supposed to think--an image to save up for future exercises in "visualization" of their violent deaths at the hands of the body's killer cells, the lymphocytes and macrophages. But I am impressed, against all rational self-interest, by the energy of these cellular conga lines, their determination to move on out from the backwater of the breast to colonize lymph nodes, bone marrow, lungs, and brain. These are, after all, the fanatics of Barbaraness, the rebel cells that have realized that the genome they carry, the genetic essence of me, has no further chance of normal reproduction in the postmenopausal body we share, so why not just start multiplying like bunnies and hope for a chance to break out?

It has happened, after all; some genomes have achieved immortality through cancer. When I was a graduate student, I once asked about the strain of tissue-culture cells labeled "HeLa" in the heavy-doored room maintained at body temperature. "HeLa," it turns out, refers to one Henrietta Lacks, whose tumor was the progenitor of all HeLa cells. She died; they live, and will go on living until someone gets tired of them or forgets to change their tissue-culture medium and leaves them to starve. Maybe this is what my rebel cells have in mind, and I try beaming them a solemn warning: The chances of your surviving me in tissue culture are nil. Keep up this selfish rampage and you go down, every last one of you, along with the entire Barbara enterprise. But what kind of a role model am I, or are multicellular human organisms generally, for putting the common good above mad anarchistic individual ambition? There is a reason, it occurs to me, why cancer is our metaphor for so many runaway social processes, like corruption and "moral decay": we are no less out of control ourselves.

After the visit to the pathologist, my biological curiosity drops to a lifetime nadir. I know women who followed up their diagnoses with weeks or months of self-study, mastering their options, interviewing doctor after doctor, assessing the damage to be expected from the available treatments. But I can tell from a few hours of investigation that the career of a breast-cancer patient has been pretty well mapped out in advance for me: You may get to negotiate the choice between lumpectomy and mastectomy, but lumpectomy is commonly followed by weeks of radiation, and in either case if the lymph nodes turn out, upon dissection, to be invaded--or "involved," as it's less threateningly put--you're doomed to chemotherapy, meaning baldness, nausea, mouth sores, immunosuppression, and possible anemia. These interventions do not constitute a "cure" or anything close, which is why the death rate from breast cancer has changed very little since the 1930s, when mastectomy was the only treatment available. Chemotherapy, which became a routine part of breast-cancer treatment in the eighties, does not confer anywhere near as decisive an advantage as patients are often led to believe, especially in postmenopausal women like myself--a two or three percentage point difference in ten-year survival rates,(1) according to America's best known breast-cancer surgeon, Dr. Susan Love.