saline implant or reconstruction using tissue from another part of my own body. What . . .? I feel woefully ill-equipped to decide, but I dig in, refuse to panic, and make an appointment with Dr. Carolyn Kerrigan, a plastic surgeon.
When patients lose a breast, she can build a new one. "Here, look at these pictures," says Dr. Kerrigan, pulling out a looseleaf notebook. "This is what we can do for you. It's pretty amazing how far we've come with reconstruction."
I look at women with imperfect breasts, arms held wide in a crucifixion pose, the better to display their rebuilt bodies—obvious patch jobs after a catastrophe. This is a good job? I think. This is progress? I wonder what the first attempts looked like.
I contemplate my choice, as Dr. Kerrigan kindly busies herself with paperwork, avoiding my eyes. Hmmm: Lop off my breast and leave a flat spot—a deficiency everyone will see, a badge of dishonor, a testament to not living right, not having good genes, not eating what I should have? Or fill the hole with belly fat and stretch the skin around it—carefully stitching, shaping, coloring, so that in my clothes, if you don't look too closely, you won't notice that it's a little higher on my chest, that the nipple's different? What a Hobson's choice.
Building a new breast
I choose the imperfect over nothing at all. The procedure is called a TRAM-flap reconstruction—TRAM standing for transverse rectus abdominis musculocutaneous. It's one of the best decisions I make during the entire cancer experience.
Tuesday, July 17, is mastectomy day. The Same-Day waiting area is so crowded that Rick and I sit on the floor in the hall. While we're waiting, 13 different people touch base with us. Kim Grafton will take off my diseased breast; Carolyn Kerrigan will build me a new one. I feel safe, in good hands. Both women are warm, talented, gentle, empathetic. Breast cancer touches many of us as we enter our forties and fifties, and it can strike at random. Kim and Carolyn know they
My oncologist talks about hormone drugs, radiation, side effects. He rattles off statistics—this is a language cancer patients learn quickly. Chemo plus tamoxifen, a hormone drug, will reduce my chance of recurrence to about 16%. I say yes to chemo.
could end up on the table, under the knife, at any time.
Finally, after six hours, I'm called.
The operation lasts five hours, its projected duration shortened by excessive bruising. So Dr. Kerrigan closes everything up and retreats from the field of battle, telling me she'll add the finishing touch—a new nipple—later in the week.
I wake up in the recovery room at suppertime. It's bright, hot, nearly empty. I spend the night in great discomfort.
Carter Dodge, once again my anesthesiologist, had told me I'd feel as though I'd been run over by a truck; he's right.
I lie on a hard bed, attended to by a traveling nurse—someone hired temporarily to fill a staff vacancy—from Nova Scotia. She tells me she used to be a concert violinist, but after 14 concert tours she quit to pursue her true passion—nursing. Her husband of 31 years left her for a younger woman four months ago, and now she's on the road. Like soldiers in a foxhole, we bond completely over the course of that long night. In the morning, I leave the recovery room for a bed in an inpatient unit; I never see the traveling nurse again.
With trepidation, I force myself to look at my chest. I see bloody bandages swathing an open wound. But sure enough, despite the massive swelling, I can detect the solid feel of a breast. I picture myself in a sweater, or getting dressed in the locker room after a workout at the gym. Even—dare I think it?—in a bathing suit. Am I really prey to such vanity? No, I just want my old self back. But barring that, I want to look like my old self. And, in clothes, I will.
The next four days are a blur of IV tubes, morphine, and ultrasounds of my new breast every two hours around the clock, to ensure that the veins are connecting and working. On Saturday, Dr. Kerrigan instructs an intern, Dr. Loan, as they build me a new nipple, the two of them patiently stitching side by side.
Before that procedure, while I wait outside the operating room, I chat with a nurse who tells me that she'd had a mastectomy eight years before, that her cancer has been "a mess." Leaning tiredly on my gurney, she looks much older than the picture on her ID badge. Her skin is white and papery; her hair thin and dry; she radiates an air of defeat. Will my cancer be a mess, too? Am I seeing my future?
The next day is Sunday. They let me go home. Tell me I have six weeks till chemo begins. Monday I go back to work, unable to resist the siren song of friends,