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Hard Choices - Mastectomy and Radiation

Diagnosis

I was diagnosed with breast cancer on a bright, sunny April day in 1990. On one level I was shocked to the bottom of my toes. On another level I think that deep inside my soul, I already knew.

Women react in different ways to their moment of truth. Some are totally numb. Some weep inconsolably. Still others say that their diagnosis made them so angry that they wanted to kick everyone across the room.

Obviously, that's not fair. But this is a society based on the good old American "can-do" spirit. In this age of technology, we have difficulty accepting that we have a body that may or may not be fixable. We have little tolerance for a disease that may or may not be curable.

We aren't much attuned to living with uncertainty or challenging complexities. Mortality is often an unacceptable concept.

One minute the world is a safe place. The next minute, we have involuntarily climbed on a merry-go-round of emotions, a chaos of testing and decisions, a whirl of public relations considerations.

Decisions

The seventeen days following my diagnosis were a blur. I phoned for information (now I would search the Net), visited doctors, had tests, and made preparations for my piano students and their upcoming spring recital.

Managing the logistics was complicated by the immediate discomfort of discontinuing hormone replacement therapy. I couldn't sleep. I had night sweats and terrible hot flashes. I felt drawn, unable to think clearly, just when I most needed clarity. I got over a half dozen opinions before I scheduled a modified radical mastectomy. It was a difficult decision to face.

More Decisions

After the surgery, I visited a radiation oncologist. He sat there, deep in thought. "There was a third primary tumor. It is within one low power field of the deep fascial margin of resection. It is too close...."

Part of my rationale for choosing mastectomy rather than a lumpectomy was to avoid radiation therapy. Was I now revisiting that decision?

I asked the global questions I had asked before: What would you suggest if I were your mother? What advice would you give to your wife or your daughter?


Radiation Therapy

And so it came to be that we canceled a long-planned trip to Europe and I began the 25 daily trips to the radiology department instead.

And so it came to be that I huddled in a corner of the waiting room, wanting to be treated, but afraid of the treatment. I felt embarrassed to lie bare in front of these people who had never seen my beautiful breast—who only saw the one-breasted wonder. It nauseated me to lie on the cold, hard table with my back aching and my shoulder throbbing.

Was I shaking from the cold or was it fear? It terrified me to be left in that room with the six-foot concrete walls.

Goodbye At Last

But I made the therapists laugh when I fashioned a cute polyester nipple on my “fluffy.” I tried to be their cheeriest patient. I wanted them to look forward to seeing me, since I could hardly look forward to visiting them.

When I finished the last treatment, I stood on my head and left a poem of good-bye:

I lie on the hard table.
Calculations are made, angles adjusted.

The tiny light above me blinks.

Lines of treatment
are carefully drawn
on my chest.

Then the therapists are gone—
gone with their friendly chatter,
gone with the cheery “Here we go.”

I am alone
in the round room
with the soft light—
alone with the huge machine,
surrounded by six-foot walls of concrete.

I wonder if the light is healing.
Is radiation my friend?
Can it be my foe?

One day I am finished.
The electrons have done what they can.
I go to resume my life.

It will be good again—
filled with busy days
children smiling at me
the sun rising and setting.

But that tiny fear lurks
in a dark corner of my soul,
ready to pounce
when I am tired
and the sun goes down....

(Excerpted from Fine Black Lines ©1993, 2003 Lois Tschetter Hjelmstad)


Good-bye, Beloved Breast
One night in February 1990, I found two lumps in my left breast. I did not think they were a problem. The doctor and a mammogram did not think so, either. We were all wrong.

I was so confident that the lumps were nothing that I did not rush to the doctor.
Fortunately, I contracted a severe cold several weeks later. When I visited my internist, he prescribed medication for my bronchitis. As I pulled on my shirt to leave, I casually asked if he would like to check the lumps. He would; he did; he ordered a mammogram, even though the one three months earlier was negative. Promising to call if it showed anything, he asked me to come back in three weeks. Fortunately, I heard him.

When I returned, he sent me to a surgeon. The surgeon thought the lumps were a problem. In a very quiet voice, he explained why I needed a biopsy. I remember a small chill fingering my spine, but I was Queen of Denial.

So on the way to the hospital on a bright April morning, I tossed out, "And what if the biopsy is positive? I do not want our children to know I have cancer before I do."

"Oh, don't be silly," said my husband, Les.

"But just suppose?"

"I'll think of something."

When the surgeon found Les in the waiting room to tell him that I indeed had cancer, that strong man wept, walked around the block to compose himself, picked up a phone and lied to our children for the first time. Much later that afternoon, I finally asked the question to which I already knew the answer. I called the children and told them the truth.

And at that point, my life changed forever....

It was without a doubt the most beautiful spring I'd ever seen. (We don't always get spring in Denver. One year it snowed on May 24.) Part of me was overjoyed with the beauty. Part of me was saying, "How dare you present me with so much perfection at a time like this!" That year, spring was breaking my heart.

A Poem in Response

The evening before my first mastectomy, I wept as I wrote:

Good-bye, beloved breast
I shall never forget you -
Shall I ever come to the end of grieving?

When first you developed in sweet innocence
I was dismayed -
I was afraid of emerging sexuality...

But you became beautiful
My lover treasured you
My children nuzzled you and were nourished
I cradled you in my hands to cherish your softness...

Now a dark menace has invaded you
And somehow I must bear our parting...

Good-bye, beloved breast
Good-bye, beloved part of me
Good-bye, symbol of my femininity...

(Excerpted from Fine Black Lines, ©1993, Mulberry Hill Press)

I needed comfort. I needed courage. I needed a sense of certainty about what I had to do. Five weeks of radiation therapy replaced the 38-Day Grand Tour of Europe we had planned. I think I would have liked Europe better.

Would you join me in my campaign?

Can we commit to helping ourselves and other women get past the fear and denial surrounding breast cancer to become gatekeepers of our health?

Be persistent about doing self-exams, getting an annual clinical exam and having mammograms as indicated. Encourage each woman in your life—grandmother, mother, daughter, niece, friend, and granddaughter—to do the same. (The youngest woman I knew with breast cancer was 14. Unfortunately, she didn't make it. I also know a woman who had a mastectomy at 98. She's 104 now, which proves that early detection does save lives.)

The life you save may be your own.

©2002 Lois Tschetter Hjelmstad


 
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