I have a man-made breast. It was created fourteen years ago from a saline implant and a piece of my latissimus dorsi. The doctors sliced a length of my back muscle and twisted it through a tunnel under my arm to the front of my body. They were quite proud of their work. Even before I came out of the morphine haze of the operation, they paraded the medical students past for a look. “Wow” they said, after removing the white bandages and pointing. “Beautiful wound.”

Fourteen years later it’s a baseball on my body, red stitching round the top and bottom. Fourteen years later it’s an upright, tight breast, while the sag of midlife lowers the left one, soft and tired.  I should be happy I’m still here, fourteen years later. I should be grateful that I look pretty normal with my clothes on. But there are moments when the right side of my body tightens up and fights with the left, moments when I can’t believe what happened and wonder what to do with my self-pity. Fourteen years and do I breathe easier? Fourteen years and still I descend into a nasty little girl, pouting and pissy, when I sit in the chair waiting for the mammogram.

My breast doctor has never known who I really am. I don’t think I ever smiled in her presence. She kept me waiting three hours the first time I went to see her, six months after the surgery. I lit into her, told her I didn’t think we should bother with the examination, I didn’t want a doctor who wasn’t available. Today I’m shocked at my behavior. She was a petite dark-haired woman, named Hoolihan. We stood in the corridor braced in our own stiff bodies, staring each other down.

“I was busy,” she said.

“The receptionist said you were eating lunch,” I said.

“I had other patients to deal with,” she said.

“Let’s not waste each other’s time,” I said

“Come in the office, let’s start over,” she said.

And so we did. I called her Hooligan behind her back. God knows what she called me.

The last time I saw her she smiled at me and said, “Nine years out.” I didn’t know what she meant. Out where? She looked pleased. She may not have seen that many people who make it nine years out. She’s inside with the tough cases. I stayed with her because she’s supposed to be good and because I’ll never let a male doctor cut my breast again. And because she knew the nasty side of me and still opened the office door.

My right breast is my hard place. I don’t like to hug people for fear they’ll bounce off this breast, there’s no ‘give’ there. Men always gave me the strongest hugs after the surgery, those who knew about it, testing the new equipment I suppose. One even asked which one—pointing and touching.

When I lie down I go lopsided, a mountain on the right, a soft hillock on the left. When I lie on my belly the right breast stays upright keeping me listing to the side. I cannot understand why women buy breasts like this. They may stay perky, but they are not comfortable.  So, that’s my hard place. It sits on the right, connected to my back. It sits like a stone beside my heart and I have to work each day to keep my heart from hardening beside it.

Today I got a phone message from Teresa, the panic high up in her voice, the barely contained scream I recognized immediately: Two masses in her breast. Cancer cells. Can we talk? She asks. Finally we connect and I hear that even now all these years later, some doctors don’t get it. She had to wait ten days, until she called the doctor herself and was given the diagnosis over the phone. “Get a new doctor,” I say and give her two names. “Call the social worker at Beth Israel.” I say, and I hear the change in her voice. Sometimes it’s good to be bossy—don’t worry I say, you’re going to be okay, it’s early. Get a second opinion, from a female doctor who can look you in the eye. I’ll call her again tomorrow. I won’t be bossy then, I’ll just listen. I cannot believe another one is diagnosed. Teresa, who is healthy and beautiful and runs culinary tours of Spain. No junk food, no toxins in her body, why Teresa? When they diagnosed me, it was 1 in 9. Now it’s 1 in 7. It’s not getting better, it’s getting worse.

“Learn to say no,” the oncologist said when I asked how to stay healthy. But I can’t say no to good food, and I can’t say no to the cancer phone calls. I believe I’m fine, fourteen years out. My role model is Julia Child, who went in with two breasts and a question and came out with one breast and an answer. Those were the barbaric days when they didn’t bother with the biopsy, just cut open the melon and if it didn’t look right, removed it. Julia went on to do her work, drink wine, consume copious amounts of butter and salt and live to ninety. My kinda gal.

Everyone has cancer. That was the most comforting thing someone said to me. A science writer friend. “Everything in life has cancer cells,” she said and I suppose it’s true. Cancer is a cell gone bad. We all stray now and then. Go bad. Waffle. So do cells. Some just fall off, others start proselytizing and converting others. Those are the ones you have to look out for.

Another phone call from Teresa who has gotten more bad news on the breast cancer front. The terror in her voice is creeping through the phone. “Can Ed listen in?” she asks, and I say, “Of course.” and off we go with the question and answer session.

“Did you get a fake nipple on your reconstructed breast?” The question comes fifteen minutes into the conversation and although Ed has been silent, I know he’s there and I think well, he’s going to have a wife with a fake breast, there are so many of us out there now, no point in being shy. So we discuss the options. Tattoo or labial surgery and I tell her I have a blind breast. We laugh. Her voice is not as ragged. Ed is still silent. I talk about what is down the road. I tell her go out, have a glass of wine, a good meal, relax, every minute that you don’t think about it all is a precious minute. She thanks me, says they’re going on a date, and we say goodbye.

Only after we have hung up do I remember Ed’s sister died of breast cancer two weeks ago, the same week Teresa had her initial diagnosis. The doctor wants her to make a decision about the mastectomy this weekend, the weekend they will be attending her sister-in-law’s memorial. And I wonder how Ed is managing to look at his beautiful sexy wife with the image of his dead sister superimposed.

The week I went into the hospital for my surgery a Boston Globe reporter with breast cancer died at Dana Farber of a botched chemo order. That sat on the periphery of my world at the time, a rumble to the side. I cannot imagine what it’s like to face surgery days after you have buried a loved one who died of the same disease. I cannot stop thinking of Teresa and her jet-black hair and her beautiful hands and her silent husband who phoned me because I am still here. Another survivor.

That night I read Julia Child’s autobiography. “I’m at the age,” Julia writes, “when friends are falling off the raft.” I like the metaphor, if not the reality. Our raft is hitting rough water. We’re all hanging on, tying ourselves to the planks, paddling as best we can.

Teresa is having her surgery today. Ten hours of removing one body part—the right breast—and fashioning a replacement from another body part—her abdomen. It wasn’t easy figuring out which surgery to have. She called me a number of times.

“I need to be talked down,” she said, her voice in the highest register. “You’re still here, you survived the surgery. Tell me I’ll survive.”

I tell her she will survive. I don’t tell her I almost didn’t. I don’t tell her the breathing tube was removed too soon. I don’t tell her they chipped my tooth trying to re-intubate me. I don’t tell her I woke up to lack of breath and had to call the nurse with my eyeballs.  I tell her she’ll be fine and her voice comes down one octave and she begins telling me that she went to a class to decide which surgery to have.

“A class?” I say. “Yes,” she says, “and it was full.” Of young women in their 30s. I don’t tell her what I’m thinking. That we’re going to have a society of breast-less women, that things are getting out of control if they are holding classes to help you decide what style breast to choose. Is this the future? Lamaze classes? Mastectomy classes?  I suppose the classes are pass/fail. All the focus is on keeping the nipped bud of the female somehow connected to the plant.

So many phone calls—first the diagnosis—then the specialists with the percentages and the details and the decisions for her to make. Two surgeries for the price of one—a biopsy, a partial mastectomy, now a complete one. Extra credit if you take both off. Prophylactically. I don’t tell her about reconstruction, how the male plastic surgeon built a breast to look good from the viewer, how disturbing it is to the patient, who wants a breast that looks good when she looks down at herself. Two different perspectives.

I’m appalled at how much we now know, but still can’t explain. Everything at a cellular level, who knows what it means in life expectancy, in life skills, in living. She’s gone through the rabbit hole now. Life is lived in the midst of death, but we only believe it when we have to. She wants me to visit in a couple of weeks. She will be glad to be alive and unaware she’s still not quite there. Ten hours of anesthesia. You don’t know how far into the fog you are until it lifts. Until the day things come into sharper focus and you stare out at the world and wonder where you’ve been.

I don’t tell her it will never leave her. “You’re so vibrant,” she says. “You laugh, you’re out in life.” And I laugh and I hear her voice come down another octave and I remind myself to get up early the morning of her surgery and meditate and pray and think of her in the midst of my day. And I wait.

I was never given to prayer. I’m more of beggar. “Please, please, please,” I’d intone. I could never figure out how, when, where, or most importantly, who to pray to. The Lord’s Prayer came easily, having been recited weekly at church and daily at school until Madeline what’s-her-name complained to the Supreme Court. But somehow the Lord’s Prayer never seemed like something to turn to in dire need. It was a brush-your-teeth kind of prayer, a preventative prayer, something to say just before bed.

When the radiologist’s office called to say there was a problem one week after my first post-mastectomy mammogram, even begging was beyond me. There was nothing to ask for that hadn’t been asked for. There were no more bargains to be made. There was only silence. Prayer did not occur to me. I sat in the mercifully vacant waiting room, my mind and body empty. Fifteen minutes later the technician came in and said, “You can get dressed now, she says she doesn’t need another view.”

The doctor slid large X rays of my remaining breast into a wall light and said, “Everything looks fine—see—this year’s picture is the same as last year.”

“Thank you,” I said, breathing freely for the first time in days. I didn’t ask why I had been called in, then never examined. “Thank you,” I said, “thank you, thank you.”

As I left the building I could not stop. “Thank you, thank you,” I kept saying. All the way down the street, around the corner to the car, “Thank you, Thank you, Thank you.” A couple of weeks later I was reminded that for some Native Americans prayer is not a petition for something, but a giving of thanks for what is, that the Native American begins each day with thanks for the sun and the moon and another day on earth.

Teresa is on the other side now. She survived the surgery and has a new body. Tomorrow I will drive to New York City to visit. She says, “The new boob likes to get out for a walk now and then.’ For a minute I think she’s baring her breast in Washington Square. Who knows. Maybe I will too. Maybe we all should.

I went to my new doctor yesterday and showed her my fourteen-year-old breast. When she asked what kind of breast cancer I had, I had to open my records. “I can’t keep that in my head,” I said. She read the report, and said “Congratulations!” real glee in her voice. “Your kind of cancer, fourteen years.” She stopped short of saying, ‘You’re cured,’ but I liked her smile.

“Thank you, thank you,” I said. All the way down the street, around the corner to the car, “Thank you, Thank you, Thank you for the sun and the moon and another day on earth.”

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