Dignity - Mar, 2007

After making the decision to have a bilateral mastectomy, but before my cancer surgery, I had a consult with the plastic surgeon to discuss the possibility of immediate reconstruction. I had done some research, so I basically knew what my options were. They could cut my belly, creating a breast mound with fat and muscle from there. Not appealing, since I would never again be able to do a sit-up. They could cut my back, tunneling latissimus dorsi muscle, skin and fat from my back under the skin of my underarm, creating a pocket in front to fill with an implant. Not appealing, since my back already would ache when I played the piano for too long, or did dishes. The third option was to place tissue expanders under my chest muscle at the time of my cancer surgery. These would be like balloons that would be gradually filled with saline until they were the appropriate size, then a second surgery would be done to replace them with silicone or saline implants. This seemed like the best option to me, because it was the least invasive, it involved the least amount of cutting and pain, and just seemed to be the least horrible alternative, realizing, of course, that none of the alternatives could actually be classified as good.

So I naively went to this appointment, thinking I would tell the doctor what I had decided, he would tell me what to expect, and I would go to breakfast with my husband who had thankfully come to the office with me. I had no premonition that this was going to be one of the worst days of my life, worse even than the day I received my diagnosis, worse than talking to my general surgeon about the cancer surgery itself. I didn't know what to expect, so as the meeting with this doctor began to play out unexpectedly, I struggled to maintain my composure and hide the fact that I was thrown completely off balance. Although I eventually developed a rapport with my first plastic surgeon, and ended up liking him immensely, at this moment, on this day...well, not so much.

First of all, they have me strip and put on a gown - they allow me to keep on my socks. It's very difficult to feel strong and in control when the person you're dealing with is dressed, and you're not, so I'm already feeling vulnerable. The doctor comes in, shakes my hand, and lays me back on the table so he can examine the affected breast. Then I stand on a stool so his face is chest level, he opens my gown, takes out his tape measure and pen, and starts to make and record very precise measurements of everything. He is very matter-of-factly discussing my breast shape, size and position, the amount of belly fat I have (to determine whether I am even a candidate for the belly-cutting surgery), and my options. Add to this the fact that his nurse and my husband are in the room, and for everything the doc says and does, he turns to my husband to make sure he's following, and now it's starting to feel a bit like a science lecture, with me playing the role of specimen. I find I can no longer look at him while he's talking to me, and so I find a spot on the wall where I can focus. My husband asks if the doctor has any pictures of results that we can see, and he hands us a medical textbook to look at, warning us to avoid the pictures of actual surgeries. And there we are, looking at headless pictures of topless women, each with one real breast and one reconstructed breast, trying to decide which we like best. I have an otherworldly feeling, like I'm glimpsing myself doing this in some parallel universe, but it's not happening in my real life.

And then, before the meeting is over, they have me drop my gown and stand completely naked in front of a blue sheet, so the nurse can take photographs. I never did get an adequate explanation of why it had to be this way, why I couldn't put on my jeans, or even my undies, for this part. She assures me the pictures will be from the neck down, will never find their way onto the Internet, and are for their securely kept records. My throat starts to ache with the strain of unshed tears. I find I am violently gritting my teeth, and very deliberately blinking to keep the tears at bay. They let me wrap the gown back around myself as the doctor finishes up what he needs to say, but I no longer comprehend the words. I know if I speak, I will lose it, so I'm mutely nodding when it seems appropriate, but mentally I'm yelling at him, "Go, go, go, go, go..." I desperately want him gone - in that moment I despise him, I despise the room I'm in, and it's taking everything I've got to hold it together. But I am bound and determined - I will not cry in front of this man. He has measured me, marked me, photographed me, and I know if I cry, it will be the thing that finally shatters around me any remaining dignity I have.

Finally, it is over. I'm alone in the room with my husband and I raise my hand, signaling to him, "Don't talk to me - don't touch me." I put on my clothes, controlling the urge to bolt. I try to walk out of the room at a normal pace, when my brain is still screaming, "Go, go, go, go, go..." It's at this point, the moment I start to move, that the turmoil within me reaches a saturation point and I feel the tears prick in my eyes. No amount of blinking can hold them back now, and my husband pulls me toward him, protecting me with his body and arms from all the people who have to step around us, as I let the ugly sobbing run its course. And then I say the only sensible thing I can think of. "Let's go to breakfast." And so we do, gradually steering ourselves back to a sense of normal.

During this time, in an attempt to keep my perspective, I would joke that at least I wasn't losing something vital, like my nose or my right hand. But I was losing something, despite the joking. I will never be thankful for my cancer. I will never count my cancer as a blessing. But I do recognize that this ugly and difficult path, although full of loss, has brought me somewhere, and that somewhere is a good place, a place where I recognize that what I've lost wasn't necessary for me to live a life full of joy and purpose. And that, is a blessing.