by Joyce Marcel
American Reporter Correspondent
February 23, 2006
THE STYLE OF CANCER
DUMMERSTON, Vt. -- Everyone has their own style, even when it comes to breast cancer. Or so says my cousin Joan.
I always call her "my cousin Joan." It's like that's her name - all three words, all the time.
Even though she was born three months ahead of me, Joan is really my mother's first cousin, not mine. Her father, Jack Goodman, was the baby in a family of seven children - his sister, my grandmother, was the third-born. So Jack was actually closer in age to my mother, and they became close friends. Joan and I have carried the tradition into the second generation.
Jack and his family lived in the Bronx. My family lived in Brooklyn. But we visited each other often, and there are pictures of Joan and me as babies, crawling around on the floor. Somehow, through proximity and the blessings of DNA, we became synched up, like sisters, like twins, even though we are nothing like each other.
When we were about 13, Joan and I started taking the subway into Manhattan on Saturdays. We'd meet in the theater district and use our allowances to see a matinee and eat at our favorite Japanese restaurant opposite the City Center. The restaurant owners were very kind to two innocents alone - they greeted us warmly, taught us how to use chopsticks, explained how to pronounce "sukiyaki" (skeeyaki), and watched over us tenderly. The restaurant is long gone, but it still lives in our hearts.
When Joan and I were teenagers, we explored the world of sex together. I was always the leader, taking ridiculous chances and getting us into dangerous situations. But Joan was always right behind me, and sometimes she sprinted ahead, if you know what I mean.
Now Joan is a wealthy industrialist. She owns and runs a small factory that produces electronic safety devices for airplanes - she took over the company after its founder, her husband, died. She lives in New Rochelle, N.Y. Every time, within minutes after I think, "I wonder what Joan's up to right now?" I get an email from her. It's just like that.
But I was as blindsided as she was when she went for a regular mammogram and learned that she had three types of early cancer growing in her left breast. Two were easily removed with lumpectomies, but the biopsies concluded that the third was "invasive." Joan needed either a mastectomy or serious chemotherapy and radiation. Joan, who started out in life as a nurse, chose surgery.
Joan is comfortable with surgery in a way that I will never understand. I seem to be saddled with a deep feeling that the body is sacred; even a paper cut upsets me. To me, elective surgery is an oxymoron. To her, it's just another face lift and thank God for it.
Once Joan got the diagnosis, she turned into a research demon. "Some people don't want to know anything, and they're fine," she told me. "Everyone has their own style. For me, the more I know, the better I am. To me, knowledge is power."
It turned out that she had three options: A mastectomy and a scar (and maybe, later, a tattoo); reconstructive surgery with either a silicone or saline implant; or an operation called a tranflap, in which, while the patient is still on the operating table after the mastectomy, one end of the abdominal wall is severed and the muscle is slipped up under the skin to the breast area and refashioned into a replacement breast. Over time, other muscles move in to replace the missing part of the abdominal wall.
Joan chose the tranflap, which involved an incision across the whole of her lower abdomen, the siphoning out of about 10 pounds of fat (she thought of it as a bonus, a tummy tuck), the construction of a replacement navel, some serious stitching on her breast, and a later nipple reconstruction. The entire surgery would last almost eight hours.
She explained her choice this way: "On a deep gut level, I want to end up with two real boobs."
Before the surgery, Joan set in place a remarkable support system. She created a family email network. Her close friend Lenore, a doctor, arranged to come down from Maine and be with her for the operation and for a week afterward. Then I would come for a week.
As she prepared for surgery, Joan was calm and collected. She asked everyone, on the day of the surgery, to "think positive thoughts of me wrapped in a violet/lavender comforter and send that healing loving energy to me." Me, I had nightmares about her lying on a metal table, being filleted like a flounder. She came out of the operation serenely. I had to be scraped off the wall.
I spent last week in Joan's lovely apartment overlooking Long Island Sound. She was pale, weak. cut up and determined. I took her to doctors' appointments. I shopped and cleaned. We had a medical emergency that required a second, in-office surgery. I cooked and froze meals. I scolded her to make her sit still. We watched endless Olympic ice skaters on television.
In cancer talk, Joan will never return to "stage zero." She will always be, at best, "stage one," open to risk, taking oral medication. But she caught it just in time.
A few years ago there was a flurry of news reports about the dangers of mammograms. We heard that the radiation itself is harmful and can cause cancer, and that even women over 50 don't need one every year.
But if Joan has anything to say about her experience - from which she's still weak, still sitting down a lot, still eating my frozen beef stew, and still watching ice skaters on television - it's that women - especially women over 50 - need a mammogram every year. The last one saved her life.
Joyce Marcel is a free-lance journalist who writes about culture, politics, economics and travel. She can be reached at firstname.lastname@example.org.