The new girls

The inside of the waiting room was nothing like I had pictured. I mean, this was a plastic surgeon’s office, so shouldn’t it be crawling with Kardashians or something?

But no, as I settled into my seat, I noticed the only other people in the waiting room were a woman clearly undergoing chemotherapy, staring down at the carpet, and the woman with her, on the edge of her seat, staring at her. That woman in the kerchief could be me in a couple of months, I thought. Try as I might to avoid it, I kept seeing her in my peripheral vision.

And that’s when two things hit me: 1. This shit just got real. And 2. I should probably stop my daughter Nora from tearing up pamphlets and un-potting the potted office plants.
             Erasing the years off of one woman’s face or plumping up another’s lips—plastic surgeons do that, too, and it’s probably their bread and butter since they don’t have to deal with a-hole insurance companies. But then there are people like me and this woman in the waiting room. Not here by choice, but perhaps by chance or, in my case, a bad game of genetic roulette. Though I had certainly interviewed enough plastic surgeons and their patients over the course of my writing career, somehow the scope of the profession had slipped my mind. Probably because what’s focused on in the media are the hapless celebrities—male and female—who keep pushing the limits of plastic surgery till  they all look Blanche from “The Golden Girls.”

Decisions, decisions

I was called into the consultation room ahead of schedule and waited nervously while Nora destroyed the pamphlet displays in there. Right on time, a man in a really nice suit came in. I’ve done my fair share of time in hospitals and such, and I could always spot the surgeons. They were higher up in the doctor clothing hierarchy. 

I had actually met Dr. R. Michael Koch almost a decade before, in my previous life as a health reporter for the local paper. I had collaborated with him on a piece about leeches and their usage in modern-day trauma centers. I wondered if he’d remember me, Leech Girl. He did. Although, at no time during that leech interview did we discuss my breasts. What a difference 10 years makes!

Motherhood had really taken a toll on the old girls.

Dr. Koch is a native of Great Britain and he’s got a calming, soft accent—almost as if hippie painter Bob Ross mated into the royal family. Seriously, people with British accents can easily convince me that whatever they’re saying is the most academic thing ever uttered. Dr. Koch could have persuaded me to hollow out my chest and turn it into a Panera bread bowl, filled with delicious cream of broccoli soup, and I totally would have been like, “OK. That makes complete sense.”

We painstakingly went over my options for surgery; his ink renderings of my torso looked a hell of a lot better than the post-Nora reality. We talked about what procedure might be best for my situation, almost as casually as discussing options on a new car. Should I go with upholstery or leather? Did I need those all-weather mats?  Given my age, I wasn’t keen on implants. The shelf life for those was about 10 years. God-willing, I hope to have a long life ahead of me and I didn’t relish the thought of having to trade them out every decade. I settled on the DIEP flap. Though it had a lot more recovery time up front, the results would be more natural and I wouldn’t need as much following afterward. (Implants require more frequent follow-up visits to slowly plump them up with saline and typically require more revisions.)

Another great thing about the DIEP flap, and here comes that silver lining again: I had permission to bulk up the 'ol gut before surgery, and yet I’d still get a flatter stomach out of it. Essentially, DIEP procedures start out as tummy tucks, but instead of throwing away all that good meat, it’s transplanted to the chest and sculpted into mammary masterpieces. As for fattening up, I couldn’t go totally crazy, but a little extra padding would give Dr. Koch more to work with. I accept your challenge, doctor! And so does Five Guys Burgers.

Following the consult, “before” pictures were taken of my breasts. Good lord! Just when I thought I couldn’t feel any worse about myself, I saw the havoc Fio and Nora had wrought in all its digital glory. I wanted to yell, “Dr. Koch, I can't bear to look at these wonky bazongas one minute longer! Please give me a capital set of knockers!” You know, something to lighten the mood and in a language the good doctor could understand. But I can never totally read surgeons, especially a Brit, so I kept my mouth shut.

As I was sitting with the office care coordinator, describing all the various ways my insurance company would likely try to dick everyone over, Dr. Koch came in and handed me a printout on the Young Survival Coalition, urging me to get involved with the global group dedicated to women diagnosed with breast cancer before age 40. “It’s a great organization. They’re actually having a benefit concert with Katy Perry, but maybe you’re a little too old for her,” he said. I am an old fart, but I couldn’t think of a proper response. “You have to admit, from a plastic surgeon’s perspective, Katy Perry has some pretty spectacular boobies,” I blurted out. Annnnd the filter's off. Damn it! I waited for his response. He gave a little laugh and fled the scene.
             As I left the office that day, in my wake a trail of Hurricane Nora-related destruction, I was at peace with my decision. I wasn't delighted by the thought of a seven- to nine-hour surgery, a night in the ICU to monitor for blood clots, or the long recovery I likely faced. But I just wanted to get my life back. And this was one of the first steps to achieving that goal.

Fuck cancer. Fuck genetics.

When I look at my daughter now, I get the overwhelming urge to apologize to her.

Repeatedly.

I’m sorry Mommy may have given you a very bad gene that will mean you, like her, are dogged by an enemy you can’t see. There's a 50/50 shot that you inherited a very insidious gene from me, baby girl, one that makes your lifetime risk of breast cancer 45 percent or higher, and your ovarian cancer risk almost 20 percent. That’s way higher than the average person. You could have increased odds of developing cancers such as pancreatic cancer and melanoma, too.

I feel like I owe my son an apology as well, because my mutated BRCA2 gene is harder on males than its counterpart, BRCA1. If I passed it along to him, he faces an increased risk of developing breast cancer himself, though it’s still much lower than the risk faced by females. And just like my daughter, he faces an increased risk of a host of other cancers and could pass the gene on to his children.

The creation of life is such a beautiful thing that the mutated BRCA gene seems almost sinful. How dare this thing called genetics mar beauty, such innocence, right from the very beginning!

Fuck cancer. And fuck genetics.

I worry what the future holds for Nora and Fiorello.
©Tamme Stitt Photography

Mystery solved

On October 25, I finally got the call I was expecting all along: that I was BRCA positive. Still, it takes your breath away. At long last, the family cancer curse could be explained. The disease that had killed my grandmother, her twin sister and my aunt had finally come to light. It wasn’t shitty luck or by chance that these women’s bodies turned against them. We had caught the culprit. Only we couldn’t close the case. This criminal would keep committing crimes.

My thoughts turned not only to my children, but also to that complex cyst on my right ovary that was supposedly benign. In light of the genetic test results, the breast surgeon recommended removing the ovaries, but the question was if it would be done at the same time as my already laborious DIEP flap breast reconstruction, which borrows tissue and fat from the abdomen. She asked me if I wanted to set up an appointment with my ob-gyn. “I think we need to bring a gynecological oncologist on board,” I blurted out. Though the pelvic MRI said otherwise, I was never entirely convinced the cyst was nothing. It was so…symptomatic. I was feeling pregnant (though not looking so) for a majority of each month.

 For the umpteenth time since this whole ordeal started, I was happy to have my health writing and research background. I knew the scientific literature had found that when removing a questionable cyst or performing removal of the reproductive organs, it was better to have a specialist like a gynecological oncologist do it. If the cyst was actually malignant, you need someone on your team who does this kind of surgery enough to avoid rupture. Rupture of a cancerous cyst would spread cancerous cells into the abdomen, possibly taking an early stage ovarian cancer into a much more advanced stage. Ovarian cancer survival rates are already so abysmal because of the tendency to be caught in later stages. I wasn’t taking any chances.

Me and my boobs: No love lost
©Tamme Stitt Photography

Rage against the breasts

I took a shower after that phone call from my breast surgeon. I do my best thinking there.

I was relieved that no one else was home, because, alone in that steamy shower, I unleashed years of pent-up rage. I yelled at my breasts.

Quite literally. And it went something like this:

“It wasn’t fucking enough that you decided to go all gangbusters on me and grow a little too big for my frame?” I hissed down at them. “Do you know how uncomfortable it was to be wearing a bra by the time I was in 5^th grade? Do you know the hell I went through in high school, because big boobs on a scrawny chick attract negative attention? And now you’re trying to kill me? Are you FUCKING serious?”

I was being completely irrational. Maybe this was a form of slut-shaming, “boob-shaming.” It wasn’t my boobs fault that I got harassed. That would be the fault of shitheads who didn’t know the definition of or care about the emotional effects of sexual harassment. My breasts had served me well in feeding my two children as they grew from newborns to toddlers. Still, a part of me was completely pissed off at them for everything I was going through.

And the cancer! The cancer! I was literally face to face with it! Knowing that I was a health writer, the radiologist performing my biopsies satiated my desire to see all things strange and disgusting by showing me the tissue samples after he removed them from the breasts. They had looked all stringy and innocuous, but now I know. Had I known then what I was looking at, I would have punched those tissue samples right in their cancerous faces—if they had faces.

 Oddball, that's me

On Tuesday, the Hudson Valley Hospital Center's Tumor Board—essentially a meeting of oncological minds to discuss patient treatments—will present my case. I don’t think they have the time to discuss every patient, so what a dubious honor, to be considered weird enough to warrant individual scrutiny. But that’s Heather. I was always the one in the office with the computer that acted so bizarrely that even the most seasoned IT guys were left baffled. “I’ve NEVER seen that before,” was a familiar refrain. So excuse me if I don’t act surprised if it does indeed turn out that I have bilateral breast cancer AND ovarian cancer simultaneously. But the jury is still out, so I will try to remain positive till then.

   I’m hoping my gifted team of surgeons—we’re up to four so far—are able to do the DIEP procedure and the oophorectomy at the same time. I can’t fathom two separate recoveries from two separate abdominal procedures. But I’ll leave it up to the experts. Of course, I’ll still ask a million questions and probably drive them batshit crazy. But hey, that’s my right—until a restraining order says otherwise.

Hey! Stop staring at my boobs!: 7 unfortunate lessons of breast cancer

1. Everyone who knows about your breast cancer can’t help but look at your boobs. Yeah, they’re still there. And no, they don’t glow or otherwise call attention to themselves. At least, I don’t think they glow. In much the same way you’d avoid the gaze of a sworn enemy, I can’t even look at my boobs anymore.

2. Statistics don’t mean shit. My doctors thought the odds were stacked in my favor when it came to breast cancer. Well, guess who showed them! Yeah, doc, having bilateral breast cancer—especially at my age—is rare, but so is having a patient leap across the desk and jam a fork in your eye socket because you quoted her yet another God damn statistic. Or is it?

3. Insurance companies are asshats. I spend way too much time on the phone with these fuckers. They delay every procedure approval, adding undue stress and time onto every step in this already arduous process. Mitt Romney said corporations are people. If that’s the case, can I murder my insurance company?

4. It seems like everyone has had it. Congratulations! You’ve been granted access to a secret club. Suddenly, everyone starts telling you about their own or a loved one’s cancer experience. This is most disturbing when it comes from your peers. I mean, I know I’m a genetic mishap, but what the hell is going on with all the young folks with cancer?

5. Answers can be as worrisome as unknowns. To be honest, I’m not too concerned about the nine-hour surgery itself. That will be the most uninterrupted “sleep” I’ve gotten since having children. What does worry me is I’ll finally have answers. Many cancer patients crave them. I dread them. Right now, I can still pretend that it’s DEFINITELY been caught early, that it doesn’t involve the lymph nodes and it hasn’t spread. But that may not be the case, and I’ll find that out after surgery.

6. They give you clues. By “they” I mean the folks who do the tests, the radiologists and technicians. I know they’re all trained to act a certain way and say certain things, but I’m starting to get pretty good at deciphering their body language and whether or not they’re disturbed by what they see on the screen.

For example, there’s the formerly talkative mammogram technician reduced to monosyllables after your exam. The quick dodge out of the room to ask the radiologist “if he’d like additional images” or “if these images are clear enough.” The “Uh, I think I left the oven on at home. Be right back!” Actually, that last one was just about the only one I hadn’t heard. But, yeah, I know you’re in the radiologist’s office, Ms. Mammogram Technician, probably saying something like, “Holy shit! Did you see the growth on that one?!!” In a related aside, if your imaging/biopsy reports come back waaaay earlier than they said they would, you have a decent shot of being completely fucked.

7. You can’t get the cancer out of you fast enough. It what will almost seem like a total contradiction to my previous statement, the wait for surgery has been grueling. From that first abnormal mammogram to my mastectomy, it will have been almost two months of thinking about breast cancer day in and day out. Throw in worries about an ovarian cyst (and whether it was simply a cyst) and you’ve got a cocktail for heartburn, lingering headaches and constant consumption of chocolate.

I remember sitting in the breast surgeon’s office, discussing treatment options, and letting my glance fall to the couch over by the window. I could see surgical scrubs peeking out from her bag. It took all of my reserve not to scream, “Slap ‘em on and let’s rock and roll! Right here! Clear off your desk!” Every day that went by and this crap was still in my body seemed to bring me that much closer to a more advanced stage of cancer.  At least, in my mind it did. I know, logically, this had been growing for some time, and that a few weeks weren’t going to make that much of a difference. But it’s still enough to drive you bonkers. And trust me, by now, it’s a short drive.