Choices

By Gail Konop Baker

The nurse insists on wheeling me into Radiology for the pre-op needle localization. I detest this idea, not only because I don't need a wheelchair, don't feel sick or weak, still don't actually believe I'm here for surgery, am waiting for someone to announce over the loud speaker that this is all a big mistake. But also because my husband is a radiologist in this Radiology department. I've walked these halls numerous times over the past decade, carting babies and toddlers and resentment, barely registering the patients I flew past, the patients I sometimes envied because they commanded more of my husband's time and attention than the children and I did. And while I've spent years waiting for him to be more husband and father and less "doctor," now, I'm hoping I have everyone's undivided attention, that they haven't fought with their spouses, don't need to rush to some kid's recital, aren't making grocery lists in their head. I want to call a pre-surgical conference reminding them to think about me, concentrate on me, heal me, cure me, save me. When does the part when I become a bigger person kick in?

"A little cold," the technician says, hoisting my breast onto the Plexiglass tray. "You're lucky you have such large ones," she says. "It must have made nursing easier." She gestures to her nearly non-existent chest, unwraps and holds up a long skinny needle with a hook on the end. "This is what we use so the surgeon knows exactly where to cut."

I nod, watch her manipulate my flesh, swab and mark it, and think how my breast doesn't even seem like a breast, like when I was nursing and the idea of breasts as sexual objects seemed absurd. I loved nursing and I was good at it, always had plenty of milk, enough milk to feed the neighborhood, my husband and I always joked. I remember the contented look on each of my baby's faces, the nipple spilling from their lips -- still moving, still suckling in their sleep. I felt so useful then, powerful and competent, irreplaceable and absolutely amazed that I could nourish and comfort another human being with the milk my body produced, the warmth of my skin . . . Betrayer! I want to scream to at my breast. How could you? How could you? The words I would have used on my husband and his lover. The one he'll be afraid to take now that I am his sick wife.

The technician wrenches my flesh away from my chest wall and says to the nurse, "The best part about the Mediterranean were the topless beaches."

"You went topless?" the nurse asks.

"Hell yes," she says to the nurse. "There is no self-consciousness. And I figured when in Rome . . . Don't breathe," she says to me as the machine compresses my breast.

I think about my trip to Nice with my husband Mike this past fall. Our first extended time away from the children in seventeen years, my second trip out of North America ever and I couldn't relax, felt guilty the entire time, thinking it too extravagant, wrong to leave the children for such self-indulgent travel. As I sunbathed facedown my husband undid the top of my tankini, and when I sat up and my top fell away, I gasped and cupped my breasts with my hands. "I'm too old for this," I said.

"No you're not." He tugged at my hands, wiggled a playful finger toward my nipple.

"It's just not my kind of thing." I fumbled with my straps.

"Your choice," he said as if I were obviously making the wrong one.

With my breast smashed on a tray like a slab of meat, soon to be anesthetized and sliced open, excised and cauterized, sent to pathology to be analyzed, I wonder, why hadn't I seized the opportunity, why had I hesitated, cared what others thought, been so self-conscious, held back, not relaxed more, not celebrated every goddamned nanosecond of my life?

Brad Stevens, another radiology partner, whose wife was diagnosed with breast cancer the year before, walks in and over to the viewbox where he stares at my films. I see the tension pull his crisp white surgical jacket too taut against his shoulder blades as he says, "I see a couple more suspicious areas." Now my husband joins him and he's staring at the films too, raking his fingers through his hair as he says to his partner, "Are you thinking we should biopsy those areas?" Ann, my surgeon, (whose mother had breast cancer and worries about her own risk, something she revealed to me when I asked her preoperatively about prophylactic removal of my breasts and she said she'd contemplated it for herself), enters the room, nods at me and then stands next to Mike and studies my films.

They both look at my husband and he says, "I don't think I should be involved in this . . ."

"You're already involved," Brad says, his voice more clipped than I want it to be, making me all too aware of how much is being juggled in this pre-op room. All of their professional opinions, their egos, their personal brushes with breast cancer, their relationships with one another and me, the fact that they know that I know they're all human, all flawed, and that medicine is more primitive, less precise than most people realize. I picture the screen door Mike hung last spring, off by more than an inch in the door jam, rattling in the wind.

"You make all of us nervous," the technician says and pats my hand.

"Doctors' wives," the nurse concurs and rolls her eyes.

After everyone agrees that I, in fact, do harbor more suspicion, and as they bustle around me, handling my flesh in the way I imagine Mike handled the cadaver he dissected in medical school, clinically, anatomically, I think, what an odd thing; a breast, a glob of fat and tissue that hangs off the front of your body, that changes from sexual to nurturing and back again, that requires special equipment, pushed up for dress-up, bound for running, swabbed with betadine, tattooed with permanent marker, pierced with fishing hooks in four places before lumpectomy.

"You have the most pre-op needles I've ever seen," the technician says, all of us gazing at my hideous pin-cushioned flesh.

"Is there an award for that?" I say, before the implication of all those needles sinks in. "Do they want to take my -- " I whisper to my husband, my throat closing before breast, and it strikes me that I'll never go topless in Nice. Never be a stripper. Never pose for Playboy. And now I want those choices back.

"No," he says and chuckles nervously and pats my head. "This is just precautionary. So you don't have to wait for more cores after you heal from surgery. This way we'll know sooner . . . "

I look to the surgeon whose lips are pursed before she says, "If it's diffuse DCIS that is what we'll do."

I swallow hard, say, "It's okay. I nursed my babies. They've served their purpose . . . it doesn't matter . . . " Choke, sputter, heave and cry, in spite of my best efforts not to, as I realize it does matter, how much the idea of losing my breast, my choices, my life . . . horrifies me.

And that horror stays with me all the way down the long corridor, the four wiry antennas poking out of my chest, bobbing into one another. Now I understand why I'm in a wheelchair. I'm physically and emotionally spent, and I might not willingly cross the threshold into the surgical suite otherwise. At the door, Mike bends down to kiss me, and I smell fear in the parched space between our lips -- sour and brittle, laced with all the things we forgot to say, all the times we didn't love one another enough . . . and I feel his effort not to tremble against my moist face, not to look grim as he mouths, "BBBSS." Our private acronym: the one we carved into a wooden table at Chumleys in New York City our first year in love; the one each of us has traced on the other's back, over the years, when we couldn't sleep, after we fought, when there were no more words. Our code that means at turns: I'm sorry; please don't hold a grudge; I remember when; I love you. I mouth the letters back and our fingertips brush one last time before the nurse pushes me through the double doors toward the sterile bed prepared for me, and I have a vivid flash of me not waking up. But I worry more for him. Waiting is the harder gig.