A Small, Malignant Mass

by Leisa Bowman

“A small, malignant mass. Eleven o’clock. Six centimeters out. Right breast.” The radiologist’s precise words stated so matter-of-factly entered my ears. They materialized as a stark black and white imprint in my mind’s eye.  This was the reality they discovered, but it only sank into my resistant consciousness as if in slow motion. I had no choice; I couldn’t say “no” like I wanted to. It was there. It was a part of me. It was inside me.

In January 2012, at the age of 51, I was diagnosed with breast cancer. Though flooded with near indescribable emotion and thoughts, I also had to face the bitter irony that not only did I have breast cancer, but my own mother had died of breast cancer at age 51. The cancer diagnosis itself was frightening. I could feel no lumps.  It was frightening, too, because in October I had had a completely clear mammogram. The discovery of the cancer indeed seemed providential; I had been having occasional pain in my left breast so the doctor ordered an MRI of both breasts. A painful needle core biopsy was performed, confirming that I, indeed, had a small malignant tumor in not my left but my right breast.

I had no choice; I couldn’t say “no” like I wanted to. It was there. It was a part of me. It was inside me.

Very quickly I learned that cancer is not just a devastating, life-threatening disease; it is also a thief. It strives to rob you of your dignity and modesty. It is demoralizing and dehumanizing, ugly and insidious. I was soon to learn that every step of the way I would feel vulnerable and violated. It was not because of any person but because of what the life-saving treatment of this hideous disease demands.

Surgery was the first part of my treatment, and meeting my surgeon was an experience. Almost with an audible “whoosh” she breezed into the exam room, thrust out her hand, and introduced herself. Her sandy, pageboy-style hair and horn-rimmed glasses reminded me immediately of Diane Keaton. Dressed in a chocolate brown mock turtleneck and beige slacks, she quickly sat on a rolling stool and coasted to a stop facing me. Then, seemingly without any breath, my surgeon dispensed information, facts, and opinions in a fast-paced rush of words, explaining in detail what the MRI found. Barely able to keep up, my mind imagined her thoughts flowing even more rapidly than her speeding words. It all seemed a blur to me.

Next was the examination. First, she examined me in the conventional “lying down, arm raised” position, and then unexpectedly, she asked me to sit upright. Still exposed, the surgeon grasped my small breast like a fisherman might grab hold of a struggling fish and proceeded to flop it side to side and up and down, pulling and stretching it in every direction.  Even though she was a female physician, I still felt very vulnerable and violated, and I was glad when she finally told me I could “cover up.” Last, she spoke the words, “You have a very small cancerous tumor. I’ll remove it and take two to four gateway nodes. You will need radiation after that, but the prognosis is good.” I cannot even attempt to describe my gratitude for her words; not only was the prognosis good, but I did not need chemotherapy!

The date and time for my surgery was set for Tuesday, February 7, two days before my 52nd birthday. The idea of someone cutting into my breast—especially after the painful biopsy—gave me the chills, but surprisingly I had no immediate fear.

However, that all changed when I opened my eyes at 5:30 AM on February 7th; the fear slowly and stealthily crept in and grew.  Finally, I felt it—the gravity of it all. Before, I had known the weight of it in my mind, but not in my heart. Now, my heart could no longer escape the stark reality of what was about to happen and what it all meant.

Very quickly I learned that cancer is not just a devastating, life-threatening disease; it is also a thief. It strives to rob you of your dignity and modesty. It is demoralizing and dehumanizing, ugly and insidious.

We arrived at the hospital at 7 AM for the surgery preparations—vital signs, blood tests, examinations, and markings with surgical markers. Having someone drawing on your bare breast with a marker is humiliating, even with the knowledge that the person is a medical professional. In a surreal way, I couldn’t keep from thinking that to all the people surrounding me—poking and prodding me—it was just another day at work. Their lives went on as usual as they “prepped” me for the life-changing event that was soon to take place and for which I had no real grasp.

For the second time on the seventh, I again opened my eyes. My last memory had been of an I.V. in my arm and a face mask placed over my nose and mouth. I was alert upon waking, not groggy. I opened my eyes and knew immediately that the deed was done. I could move my right arm only enough for a brief and timid peek at my breast. I do not know what I expected to see, but what I did see was a shock. An almost three-inch semi-circle incision, ironically so like an upside-down horseshoe I thought. It framed my areola, tugging my nipple upward. The incision looked angry, bloody, and twisted, reminding me of some bad mending jobs I had done in my life. It was just so raw and brutal looking. I did not dare to find the incision under my arm, for fear of the maneuvering but more for fear of what I would see.

Right away, ice was placed on my breast and vitals taken for the next couple of hours. Then, that was that, and I was sent home. Just another day, another patient—only this patient was me.

Recovery at home went without glitches. A few days of ice packs and gentle movement followed by weeks of range of motion exercises. In two weeks I returned to work, knowing that I still could not put the breast cancer behind me. Radiation therapy loomed ahead, scheduled only four weeks after surgery.

The week of March 12th was to begin my radiation, but prior to that, I had two appointments: one to meet with the radiologist and another to get “marked.” Meeting my radiologist was a very different experience from meeting with the surgeon. Unlike the exuberant entrance of my surgeon, the radiologist simply walked into the exam room, introduced himself, and shook my hand. He was a tall, middle-aged Asian Indian man with dark, gentle eyes and a bright smile. His lavender shirt and coordinated tie set off his dark coloring, and he proved to be as relaxed and laid back as my surgeon was intense and hyper.

With pictures and hand-drawn diagrams, my radiologist explained the two types of radiation I could undergo: mammocite or whole breast. He spoke slowly and easily and sprinkled our appointment time with a light, but sensitive, sense of humor. I knew right away my choice was whole breast radiation.   Even though it meant 33 days (Monday through Friday) as opposed to one and a half weeks with mammocite, whole breast was not invasive, as mammocite was, and produced the same statistical results.

Finally, I felt it—the gravity of it all. Before, I had known the weight of it in my mind, but not in my heart. Now, my heart could no longer escape the stark reality of what was about to happen and what it all meant.

After our conversation, I again had to be examined. Sitting upright, I opened my gown exposing my bare breast to yet another stranger, this one a man. Yes, I knew he was a doctor, but it was still an embarrassment to me. A man whom I had met only moments ago, touching, groping, pressing on my breast. And I just had to sit there and endure it like it was nothing when, indeed, it was something—to me.

My next appointment, for the “markings,” included a CAT scan, a body mold, marker markings, and tattoos. First, two female technicians performed the CAT scan as I lay naked from the waist up in the machine. Next, they laid me on a type of bag filled with some crumbly substance. My body was positioned according to the CAT scan readings and the air was sucked out of the bag, creating a stiff mold with the correct positioning of my body. I would lie in this mold, exposed, arms up over my head, to receive my radiation treatments. Next, the technicians drew a rectangle and X’s on my bare chest with a permanent marker. Not completely sure they were on target, they called in another medical professional to check. It was a man, a strange man again to see my nakedness. He had me make slight shifts in position so the radiation would be delivered accurately. I hated it, but again, endured it like it was nothing for a stranger, a man, to be touching my exposed breast. It was a huge relief when he finished, and I was left alone with the females.

For the last part of the appointment, I received my “tattoos.” I had no idea what to expect, but I ended up with four “dots” that simply looked like black pen tip marks. The tattoos were permanent, and at least one could be seen above my shirt’s neckline.  It seemed to commiserate with the marker already seen well above my collar. All of my tops are cut similarly, so I was anticipating questions from students about the markings when I returned to school. Curiously, no one said a word, and I was relieved because, for no valid reason, I was embarrassed of the markings. The markings set me apart. They were yet another aspect of this dehumanizing disease that made me different; they were visible symbols of the disease in addition to my permanent scars.

Toward the end of my “marking” appointment, something surprised me. I heard what sounded like a bell being rung three times. I wondered what it was, and the confused look on my face prompted the technician to explain, “That means someone has finished radiation!” They informed me that when a patient completes the course of radiation, he or she gets to ring the bell in the radiation waiting area three times in celebration.

I initially thought it was a silly practice and could not imagine myself ever ringing a bell at the end of my radiation (I am way too reserved), but at the same time, it made me feel good. I felt good for the person who had rung the bell and tried to picture what that person might look like and how elated he or she might be feeling at that very moment. As odd and simple as the tradition seemed, the notion of it all encouraged me. I would begin my own treatments in just a few days.

On the first day of treatment, I learned what the other 32 would be like. I was shown to a changing room, told to undress completely from the waist up, and instructed to don a hospital gown with the opening in the front. Then, I was to sit in a waiting room until my name was called. Of course, I did as I was told, but the waiting room had other, similarly attired patients, some of them men, sitting patiently in the square arrangement of chairs. Uncomfortably, we had no choice but to face each other.  I was acutely aware of my nakedness covered only by the thin cloth of the unattractive gown. I wondered if the others felt the same.

Soon I was called to the radiation room and was told to remove my gown and lie back in my custom-made mold. Although it was disconcerting to lie there with my entire bare chest exposed, sporting one disfigured breast, I was thankful and relieved that both technicians were female.

Almost daily the technicians changed and each was very kind, but I was always extra thankful when Mary Beth was one of them. She took great care in keeping me “covered up” as much as possible and fully covered my left, untreated breast for the actual administration of the radiation.

The markings set me apart. They were yet another aspect of this dehumanizing disease that made me different; they were visible symbols of the disease in addition to my permanent scars.

I immediately learned that it actually took longer to set me up for the treatment than for the actual 90 second treatment itself. Lying exposed, so the technicians could easily see my tattoos, they used some kind of remote control to make calibrations to accurately shift me into the correct position. Then, they covered my left breast with a sheet and exited the room saying, “This will be your treatment.” With my arms extended over my head, a huge machine clanked on by my lower left side, and soon I heard a buzzing hum. The 45-second buzzing signified the radiation being delivered upward through my right chest at a 45-degree angle. The buzzing stopped, and slowly the machine moved, circling over top of me and coming to rest on my right at about the 11:00 position. As it passed over me, I could not help but think that its creaking, clanging, and groaning sounded much like the trip up the first hill of the aged Comet Rollercoaster at Hersheypark. It was unsettling and made me wonder why, in this age of technology and engineering, they couldn’t literally work out the “creaks.”

After my musings, the machine once again buzzed, delivering the 45 seconds of radiation to my right breast from my upper left. That completed, I waited in that vulnerable position until the technicians returned and programmed the machine to move away from me.  I was told to sit up and put on my gown, and that was the end of my treatment.

The first several days continued in the same manner, but one day I was called into the treatment room by a male technician. Immediately, I felt apprehension and more discomfort than usual knowing I would soon be naked in front of a strange man. He and a female technician took the same readings and went through the same process as usual, but this was not “usual” for me. Once again, I felt very self-conscious with a man seeing not only my bare chest but my breast with its scarring and disfigurement. It would not be the last time this man would administer my treatment, and he was indeed kind and sensitive, but I dreaded whenever I heard not one of the females, but him, call my name.

Radiation treatment creates a burn on the skin. By the second week of radiation my skin had turned pink. By the third and fourth week a bad burn had developed which was quite itchy and uncomfortable. Getting home from work and radiation each day, I quickly stripped off my bra to allow my tender, smothered skin to breathe. By the end of my six weeks of treatment, the skin on my breast and surrounding area had turned brown and leathery. Now I felt not only disfigured but discolored as well. I was fortunate though; with small breasts there was none of the rubbing that larger-breasted women get, and so I had no blistering.

Every Monday, after my treatment, I was checked by the radiologist. He would check the health of the skin on my breast—a regular examination by a man. He would comment on the changing color, and he always said my skin was doing well. He was consistently kind and sensitive. Still, I dreaded these checks, these demeaning intrusions into my personal physical transformation.

I took my turn proudly. I clanged that brass bell three times, hard.

The week before my last three days of treatment, I had to be marked again, and a new body mold needed to be created for me. This had to be done because the final three days would use closely targeted radiation, focused on a smaller area—the exact area where the tumor had been removed. The mold was made in the same way the other one had been; what was new were the four new tattoos I received and the marker drawings. These marker drawings again showed above my neckline; the technicians even covered some of them with clear surgical tape so they would not wash off before the treatment.

My final three days of treatment came and went much like the prior 30. On the very last day, the technicians were extra encouraging and supportive, expressing their good wishes for me as I finally completed my 33-day ordeal. On that last day, I laid on the table, elated that I would be leaving it all behind me. I heard the technician’s words, “This will be your final treatment!” The huge machine clanked and creaked, buzzed and hummed, and soon I was slipping my arms back through the hospital gown. I was so excited to sit up and, for the last time, walk out of the treatment room. Overcome with joy, I abandoned my usual reserve. The bell hung right outside the treatment room, and I read the inscription to myself…

Ring this bell three times well,

Its toll to clearly say,

My treatment’s done,

This course is done,

And I am on my way.

 

I took my turn proudly. I clanged that brass bell three times, hard. I prayed that those hearing the ringing would feel the encouragement I had felt when I first heard the bell’s chime. And I prayed for their strength and courage in fighting—and beating—this insidious, dehumanizing disease once and for all.

 


Leisa A. Bowman is a graduate student in the post-baccalaureate gifted education certification program.