This morning, I sat in the very clean office of the surgery wing of the university health system. Unlike the kelly green of its other spaces, the green here is more, subdued spruce with amber accents and frosted glass dividers. Once ushered into an exam room, I sat, watching briefly, long, vinyl blinds sway against the bright light of early June and wondered, why, would you ever close them on a day such as this, after a winter this long. I imagined it as an office or bedroom, the view from it, over the old farm fields, now the research sites of agricultural study. The sky today is big, warm, filled with billowing white clouds. Something about the sky here, just feels Northern, on the edge of great woods or great water, just out of sight. I’m not sure how the clouds tell this story, but they do.
After the nurse left, I disrobed, glad I have been exercising this week, regretting not plucking a few stray hairs that in a few moments, a stranger would see. I’ve been getting breast exams for almost a decade now, in part because I am a worrier, a hypochondriac, but in larger part because my mother died of breast cancer, before she was 60, and her mother, nearly a decade earlier in her own life. But the disease is one that is not easily mapped for me. My grandmother was never someone I knew, she gave my mother up for adoption, and so, we only know that she died and when, and of what. She died before age 50 and left 6 children behind. As a child, I focused on why she left my mother, now, as a grown woman myself, I think more about what it was like for her to leave the others, the ones she held, cared for, and had to leave too soon.
My own mother, eschewed altogether, the Western Medicine model of treatment for breast cancer. After all, she only found out about it on a fluke, not having ever considered the need to get a mammogram. When diagnosed with a tumor nearly an inch big and growing, she did no surgery, no radiation, no biopsy, no chemotherapy. Instead, she did her own version of healing, a reliable path she had walked so many times before for fibroid tumors or chronic fatigue, nursing her own loss and abandonment by making tinctures of wild-crafted herbs she’d collected in the desert, diving into the mystery of Chinese medicine, homeopathic remedies, acupuncture, hypnosis, and also, her first love, Buddhism, the one place she could quiet her busy, Gemini mind.
I have a noisy mind too. Lately it’s been consumed with thoughts of the future, the next steps, big life choices like career, family, marriage, which all seem equally distracting and yet, somehow completely uncertain and passing me by. By my age, my mother had three children, was getting ready to leave one man, and find another, to get back in school. Around 40, she moved us to town, started perming her hair, taking speed-walking classes, singing in the university choir, making a whole new set of friends, inventing herself anew, losing 30 pounds. By my age, perhaps, my grandmother too, had many children and was married. I know she also was a woman who reinvented herself many times: professor, woman umpire, government intelligence agent, starter of her own political party.
Today, the kind woman PA explained two risk models: models of my chances of having breast cancer, both in the short term and longitudinally. She told me what to eat, how much to exercise, to stop drinking, she told me how often I’ll be checked now, and how, she told me my options, we made a plan: mammogram, MRI, mammogram, repeat. She felt each breast, all the while, we laughed about the weather, the long winter, about Michigan, and how there was so much snow this year in the UP that she couldn’t go ice fishing with her nephew as usual. We remarked how far away the UP is, and how beautiful. My breasts, tender under her fingers, made the fear rise up in me.
She also told me today that by the time you can feel a lump, it is 1 cm large, and that a mammogram is far more sensitive than our own abilities, likening it to detecting a grain of salt on a blackboard. An image that will stick in my brain, surely. She told me that by the time a lump is 1 cm big, you’ve had it for 8 years. 8 years. 8 years.
My mother wasn’t afraid, like I am, she just didn’t believe in the Western paradigm. She was suspicious, didn’t like how prescribed their methods are. She felt she’d rather go her own way, than go through chemo, radiation and surgery only to feel like shit and have a compromised immune system for the rest of her life, she said. I respect that. I respected her choice, though many would not. It was her path. But I couldn’t help but think today, her lump was an inch big. How long had she been carrying that destructive fruit? How much more time would there have been to heal, if she had known sooner? Could I, would I, still have her here? In turn, I imagine her there in the room with me, all the questions she would ask, all the ways her perspective, her unending curiosity would actually shift the physician’s perspective. Her bright eyes and sharp mind filled strangers with natural sweetness, made them open up. She’d know their life story by the end of it, because that is who she was. But, would she support my path, of discovering my own health through this regimented, structured, but perhaps institutionalized way?
What if, what if. What if she was here. What if I get this thing. What if I’m worrying over nothing and the legacy of this, skips me somehow? My mind, rolls over the question again and again, and I think of my sister, I call her, I tell her to start getting the tests, the mammograms, the check-ups. She’s in her 30s now and it’s time. If our grandmother died at 47, does that mean this cancer was growing in her, at our now ages?
My partner texts to ask how it went. I can’t respond. I don’t respond. I just sit in my car in the parking lot and cry.
When I get home, I read the package the woman gave to me. I pour over each slide in the adapted power point, I check to see if I understand the omega recommendations, I calculate how much I exercise per week, I ponder changes to my diet. It seems scary, how the environment is poisoned and that’s why we all have cancer, even if the packet doesn’t say so directly, they mention it several times and tell you how to avoid pesticides in your food. They make sure to tell you that the most important thing you can do is maintain your “ideal body weight” which, I realize as I read it, is completely insane. It is based on the logic that fats contain estrogens, that they make you prone to cancer. I calculate the body weight index they offer anyway, and take a deep breath, and feel angry, at the surety with which they imply that being fat will give you cancer. This is wrong and I know it. I open the second packet, it is branded by Susan G. Kommen, slick, graphically designed. I suddenly realize I am already inside the business of breast cancer and feel sick. I go back to the first packet, I look at the citations, see if they are current, are coming from scholarly publications. They aren’t. I wonder if I can trust none of it. I wonder if the science is different now. I wonder if diet and exercise are just good general recommendations for us all and they need something to tell people about how to avoid cancer.
I go to sit outside on my porch and look out over my neighbor Dara’s yard. It is resplendent with four kinds of peonies—white, fuchsia, pale pink and one that is two-toned, almost daisy like. There are delphiniums bursting with color and the last of some tiger-stiped iris. Dara is in her 60s and lives alone, mowing her own yard, working full-time, tending to her flowers. The air smells sweet. I think about my mom. I think about what I always think about lately, about how I am getting older, how it is changing everything—how I feel about myself, how I feel about the world, about others. My neck hurts, my wrist hurts, my eyes do not see as well, I am slower, and more patient. I imagine somewhere in my mind, my younger self, and my now self, moving toward older age, passing each other in a dark indiscernible field, an underworld, dimly lit, one of us the maiden, and the other older, headed toward the crone time. What would it be like to look into my own eyes? What would I give her, tell her? What would she give me? The secrets to her fearlessness, to her certainty that more was coming, and most of it good?
I begin to think then about inevitability and culture. The packets in my hands say that I can do lots of things to prevent an untimely death. Those things are staying thin, eating more fresh food, moving my body more. This is what all capitalist culture tells me to do, now cancer is heaped on top of it. They moralize my well-being and tell me the answer is in exercise, in diet and in the luck of the draw. So, I think to myself, if I get cancer and I’ve done all the right things, they will say it is bad luck and not my fault. If I do not, and get it, they will tell me how I could have prevented this. Somehow, I will be a failure. If I get it and have it removed, will my mother, gone all these years, think I have failed, will I? Will it make any difference at all? Will I instead, dance through this precious and perfect life, into another kind of ending altogether? Will I be like my beloved Elaine, who wandered mountains and swam rivers, free of shame, nearly fearless, until the cancer took her as well?
I wonder a lot lately, about what is fate, what is free will, what is really in our control. And if we are all going to die, what is this preservation instinct in us? Buddhism tells us it is natural to fear death. Islam ponders total surrender to God, and a melting into the divine, beyond our bodies. But for most of us, there is something in us, something about ourselves that makes us run from old age, sickness and dying. I would, after all, I’ll admit, love for the peonies to last, they are so fragrant, so delightful. But they too, are fleeting.