By Allison McCarthy
I.
Exactly something I would do: convince myself that nothing was something. I find out that someone I know tangentially has died of breast cancer, and it gives me a chill, so I do a half-hearted self-exam while sitting at my desk at work. I think I feel a little something, and I convince my PCP to order a mammogram. I make my friends touch the BB-sized pellet near my armpit. Each one pokes it around and comments casually and confidently that it’s probably nothing, a calcification of some kind, and each time I agree.
Two weeks later, I am lying on the exam table with my arm over my head.
“On a scale of one to ten, how concerned are you that this is cancer?” I ask.
The doctor, having read my mammogram, is moving the ultrasound wand up and down as she prepares to do a biopsy. “Ten out of ten concerned,” she says.
It takes a few days to confirm that it’s cancer and set a date for the double mastectomy a few weeks later. I am thirty-four.
II.
My husband, Ben, plans a trip to Miami just before the surgery. The goal is to take a break from it all—relax, have fun, and spend time on the topless beach. We fly first class, drink rosé nonstop, and I keep my top off nearly the whole time. Miami is full of fake boobs (and butts), and all weekend we talk about which boobs are closest to the ones I hope to have at the end of all this. I keep a photograph from this trip on a bookshelf, hidden behind pictures of family gatherings and knickknacks. I am lying on my side, wearing hot-pink bikini bottoms and smiling big, with my small but objectively nice boobs in full sun.
On the day of the surgery, Ben and I get up after a night of non-sleep. We are both anxious and resigned, understanding that the race we just ran—getting a diagnosis, finding the right doctors, and learning everything we possibly can—is over, and we are at a totally new starting line. By Ben’s design, the song we danced to at our wedding plays as we begin to drive. He gives me a small smile and keeps his hand on my knee. Before they take me into surgery, I go into the bathroom and pen a little love letter to him, not having to say that this is the “in case I die” note.
III.
I don’t die. When I wake up, I am groggy and drugged and feel an intense but blurry pain. I don’t fully register the nurses who shuttle in and out of the room. I am asleep and awake at the same time. I know sometime soon I will have to look at my chest, but I’m not ready.
While Ben is grabbing coffee from the cafeteria, the intern who assisted in the operating room comes to check on me. This is his first time assisting on any surgery and he is eager to follow up, to stay in the mix. He says hello and carefully opens the light pink front-clasp bra I somehow woke up wearing. I look down at my chest and see total flatness—almost an inversion—and two huge scars, the edges connecting in a sort of pucker. My stomach and chest are just one continuous line. The view makes my head roll around on my neck, and I am suddenly nauseous.
During surgery they put in drains: long, clear plastic tubes sticking out both sides of my body, attached to my skin by two dinky stitches that constantly pull. The drains are filled with a pink ooze flecked with white: my body’s fluid. Everyone can see my insides slowly flowing out. It all ends up in a little holder at the bottom of the tube, and I have to log the volume of its contents an endless number of times per day. Then I flush the ooze down the toilet and begin the whole process all over again. Of all the different post-surgery things, this is the most painful, banal, and disgusting, and it is a task I am unable to do myself. In the three weeks I have the drains, I start to perseverate on them becoming permanent appendages, envisioning Ben dutifully stripping, measuring, and flushing my insides down the toilet every day, forever.
Along with the drains, they put “expanders” under my skin, which are just empty plastic bags. There is a corner of one of the expanders that I can poke and move around and hear the plastic crunching. Each week, I go into the plastic surgeon’s office to get a “fill,” which entails someone jabbing a needle with fluid into the expander, the goal being to stretch the skin before swapping them for actual implants. Afterward, they put a small circular Band-Aid where the needle went in, exactly where my nipples used to be. Even though the idea of stretching my skin this way makes me want to vomit, it’s like I am going through puberty again as the flatness of my chest slowly starts to give way to tiny mounds. Each week, I take a picture, tracking the progress.
IV.
There is a leather-bound notebook I use to write down questions and take notes during the mind-numbing number and breadth of doctor visits. The journal starts with information about my specific type of cancer, notes from appointments, information about the surgery, and what to expect during the recovery period and breast reconstruction process, conversations with women who are further along in the process, and then abruptly it shifts to notes about follicles, egg retrievals, frozen embryos, names of medicines I have never heard of, questions about genetic testing, daily hormone injections, something about a “trigger” shot, and frequency of blood draws. The cost of everything associated with IVF has at least one comma, and nothing is guaranteed or refundable, regardless of the price or outcome. The chances of any fertility treatment working are “it depends.” We start thinking about fertility medicine as a bunch of crossed fingers and specialty juices.
We have one week after the mastectomy to decide whether we want to make embryos before we start chemotherapy, radiation, and then years of hormone therapy that will put me into “chemical” menopause, evoking a picture of toxic sludge slushing about in my body. We go for it.
As we start the process, our conversations take wild turns. We talk about what Ben needs to do to have the best “sample.” He can’t drink or smoke weed. He should wear boxers, not briefs. Absolutely no hot tubs. When he must masturbate to have the best sperm: it must be fewer than three days before he gives his sample, but at least 24 hours since. I learn this while he is at work, and I call and tell him he MUST go into the bathroom and jerk off RIGHT NOW or the whole thing will be ruined. We are forbidden from having sex with each other.
There are two weeks after surgery when I still have the goddammed drains, get the expanders filled, have my blood drawn every other day, and give myself countless IVF shots. Each time I am poked by a needle, that familiar Lil Jon party song plays in my head: shots, shots, shots, shots, shots, shots.
We get zero embryos in the first round of IVF, which, given the amount of work + time + money it takes, is more like a negative number of embryos. The two embryos we make the second time around are frozen in this fraught moment and look like tiny bubbles that could pop at any moment. They are a problem to be solved another day—the doctors are clear that getting pregnant could cause a recurrence. We start to talk about finding a “gestational carrier.” After working so hard to stay unpregnant for so long, it’s hard to believe the lengths we go to have my daughter: three years later, through surrogacy, we have our daughter, Julia. We continue to be baffled that we created an embryo in a lab and implanted it in another person, and it all resulted in an actual, living, breathing baby. Even so, we still think fertility science is voodoo.
V.
We all wonder and ask what caused my breast cancer. It does not run in my family, and I don’t have the BRACA gene. “There are so many factors; it’s impossible to know exactly,” the doctors say. “But, what we do know is that a family history of cancer matters, and that things like smoking, drinking, and hormonal birth control can significantly elevate your risk.” It becomes clear to me that past, reckless me caused this cancer.
I smoked cigarettes consistently—not casually but really, truly addicted—for more than ten years, starting when I was about fifteen. For most of those years, the first thing I did when I got up in the morning, the last thing I did at night, and countless times in between, was smoke a cigarette. I stopped when I taught high school, and the students could see the teachers in the smoking area. I quit quit, not one cigarette since kicking the habit. I cleaned out and fumigated my car, threw away anything that reminded me of smoking, changed up routines that I associated with cigarettes, took up coffee drinking, and chewed nicotine gum.
The computer on the wheely cart the doctors and nurses look at during appointments contains your entire history. They are literally looking at the answers you have already given, but they still ask the exact same questions every time:
“Have you ever been a smoker?” they ask. I always say no.
To the question “how many drinks per week do you consume?” I always answer, “Maybe two or three? I’m not much of a drinker.” But I am thinking about how it’s actually closer to ten to fifteen or fifteen to twenty. Drinking is an old friend: I could not even begin to estimate the number of times I have been drunk in my life, often very, very drunk. What is the total length of time in my life I have spent in a state of hangover? How many nights have totally blank moments, minutes, or hours?
A key life priority from my mid-teens to my mid-thirties was not to get pregnant, and I was successful, thank God At no point in time did pregnancy not = very, very bad. The birth control I started taking in high school probably prevented me from getting pregnant hundreds of times. I did the pill, the patch (which my sister and I jokingly called the “slut badge”), the ring, then the pill again. Then another type of pill. At one point, when I was about thirty, I talked to Ben about taking a break from birth control because I had been on it for so long and it didn’t seem healthy. Ben said he didn’t know why we would change something that was working and take on any additional risk of getting pregnant just for me to “see how my body feels.” We got into three fights about it before I let it go and stayed on the pill. I do not believe those two or three years specifically caused my cancer—it was probably the previous fifteen when getting pregnant would have been catastrophic—but we have never, ever talked about those conversations.
VI.
Chemotherapy feels like a terrible, terrible eight-month-long hangover, much like the many past hangovers I have had. I keep asking myself if I actually feel bad or if I just think I feel bad, internalizing what I’ve seen in movies. Am I being extra? Is at least some of it in my head? The doctor gives me a week off from chemo so we can travel during the holidays, and I can hardly believe how incredible I feel for those few days. It’s unreal. Feeling like I have a perpetual hangover is fitting, cruel, and hilarious.
Then suddenly, it’s time for my “swap” surgery: the expanders have been filled enough times that my skin is adequately stretched (again, vomit), and I am ready for actual implants. I get my “new boobs,” and they are an incredible disappointment. My old boobs and all the fake Miami boobs we saw and these new boobs are not even the same body part. They are lopsided, different sizes, and oddly shaped, though I keep being told they will “settle.” (They don’t). The implants sit underneath my pectoral muscles, so every time my muscles move, the boobs go up and down. I can flex and my whole chest pulses. I don’t have nipples. Because there is no breast tissue – it’s just skin right on top of the implant – you can see the ripple of the implant right down the center of my cleavage. They are a mess. After the surgery, every single one of my (very well-meaning) girlfriends say, “Let me see your new boobs!” and I want to die when I see their reaction. At the same time, my doctors comment on how great they look. They are not gaslighting me—this is, comparatively, a very good outcome. I have almost no sensation whatsoever on my chest, but I constantly feel the intense pressure from inside—it’s like a permanent super-snug bear hug or someone sitting on my chest. Some people accurately describe it as feeling like an iron bra. I am never, ever not fully conscious of it, even now.
VII.
My daughter, now almost three, has just learned the word boob, I have no idea where. When she was a baby, she would bounce on my implants like a trampoline, giggling. Now she pulls down my shirt and pokes them. She thinks this is hilarious. I do too.
It’s been five years, and I am still here, and the cancer is still gone I take countless pills each day to reduce my risk of recurrence, and the ever-present side effects give me comfort that the drugs are working. I have a lot of fear and live in a state of constant vigilance that makes me (and probably Ben) feel a little insane. I never miss an appointment, and I still bring that leather notebook with me. I still get hangovers sometimes, but I never touch cigarettes. This is the best I can do.
We are in a completely different phase of life now, which is thrilling, scary, and sometimes boring. My life feels like it’s all cake, but with a thin layer of cancer-flavored frosting on top. The spotlight of the nothing that was something continues to dim as time goes on, but it’s always there. I feel and see it physically every day, and every now and again, on Ben’s face and my own, I see flashes of the toll taken on us by that time I had cancer.