In Danger

by Josepha Dietrich

  A plummy English voice always made her wince. It was more than just prejudice against the upper classes: it was political. As if she felt the hand of the British class system and her fate as an adopted Londoner like a hand on her head holding her down, squashing her ambition.

  Among the academic slides there was a shot taken by my mother’s adopted father, with whom she’d had an affinity. She was glum-faced, sitting in a striped deck chair, leaning away from her adoptive mother. Mum’s black hair hid most of her beautiful face – she was all red lips, long legs and hidden eyes. Her family of three were on their only holiday in Italy together. Mum was 14 and would meet a boy who would write letters to her for a year.

  I flicked through every one of the 200 slides for a glimpse of my mother’s face, holding the miniature memory up to the light. I couldn’t throw away any picture of her. I had to keep any memory, even if not my own.

  In the waiting room, magazines dating from 2005 to near recent lay in wonky piles on coffee tables. There was always a disparity in the quality of reading materials at private and public hospitals. The TV was pumping out inane crud to a few watchers with dull eyes and their minds willingly turned off. I wanted the brighter places promised by Dr Seuss in Oh, the Places You’ll Go! Where were the Boom Bands playing?

  The powerful cancer-busting drugs bubbled and boiled a few metres from us. The chemist, who was shaped like a matryoshka doll, spoke to patients through her protective glass window. How can I help you, darling? She was efficient, with high energy.

  I arrived that Friday at 8.15 a.m. and at 11 a.m. I saw my oncologist for a review. My portacath was accessed, bloods taken, urine sample provided and weight recorded. My temperature and pulse were taken (fine), and details of the most recent side effects duly noted (not great) by a pregnant research nurse from England. She was sensitive, with pale blue, almost white eyes that washed out – hid – her perceptiveness.

  At that moment I was cancer free. I could say so without shuddering. I was freer than I’d been in months and calmed by the peekaboo dawn of good feeling. The gruelling chemo regimen was over. I wasn’t sick. My mouth didn’t provide a dash of metal with every meal like a sadistic saltshaker. I enjoyed food again. Hope had washed back in and surrounded my ankles. Cautious optimism stopped it from drowning me and blurring my vision. I was happier.

  The next stop on the breast cancer train was breasts off.

  It was 12 days into the new year and Kubrick’s space odyssey still hadn’t happened nine years after it should’ve. Humans were still grounded on Earth. Virgin could fly you through the stratosphere. If you could afford a sizeable house in Sydney’s inner city you could float gravity free for a few minutes. But no, Earth was still our main residence. We paid an extra two dollars per plane ticket to minimise our carbon footprints in the sky, there was political argy-bargy on minimising emissions and many countries were experiencing extreme weather conditions – from snow covering all of England to catastrophic fires in Victoria, Australia.

  I may have thought globally, but my world was still very much local. In a strange twist of fate, I visited the day oncology unit more often for my Zoladex injections now than I had for chemotherapy. I had Zoladex once a month, regular echocardiograms to check the drugs weren’t compromising my heart muscle and IV Herceptin every three weeks to suppress the HER2 protein that my particular brand of breast cancer liked for breakfast.

  Now that I was no longer undergoing chemotherapy and the intensive support had faded, I took Celso along for the ride. He attracted a lot of attention from the nurses. Fellow patients engaged with me in a way they wouldn’t have if the subject hadn’t been babies – mainly their own and their own’s own. Celso was a bit of babbling sunshine and normality in a place where people were going through really difficult stuff and feeling sick along the way.

  My new do in the new year was a faux Mohawk like David Beckham’s, though greyer and thicker. Less than two months after my ovaries had been turned off, hot flushes were the worst of the menopausal symptoms. When the hot flushes came on it was like molten lava oozing out of a volcano. The heat was red hot, and consuming. My heart went from thumpidy thump thump to boom boom in an effort to manage whatever was happening internally with the rushes. I told a young nurse about this and she informed me that her aunt named them ‘power surges’. They were powerful. Another nurse, an older one, provided some good advice:

  Honey, mine used to help me get out of bed in the morning. I’d be all warm and tucked in, then the heat surge came on and I’d jump out of bed straight away. I knew I had ten minutes to get dressed without feeling the cold one little bit.

  The hot flushes combined with the moist heat of the Brisbane summer made for many showers and changes of underwear.

  I knew with the turn of this year my mastectomy surgery was impending.

  But how do you prepare for a mastectomy?

  You can’t.

  Part of what killed my mother was her need to be feminine. She baulked at full removal when first diagnosed with cancer and only allowed the surgery after her third occurrence. It’ll affect my notion of myself as a woman, she’d said when we first discussed a mastectomy.

  I wrote an ode on my blog to my mammaries by way of saying goodbye:

  If there’s a mammary heaven mine will be with friends soon. The message I want them to take to mammary paradise is not to be good girls, but saucy minxes. May they flirt with anyone that flies by; may they bare all without shame; may they flop down in some angel’s lap and cause them to blush.

  Dear mammaries, how I’ll miss you.

  I’d loved my ‘ladies’, but I’d never had the sensual connection that some women talked of. I enjoyed them. I liked their shape. I was glad, though, that the intense bind of femininity to breast wasn’t present in me.

  The last day of my original body was 31 January 2010. On 1 February I would become a cyborg. Living was wilder than any story I could imagine. Emotional preparation aside, I clicked into doing mode: getting rid of cancer mode.

  My first female anaesthetist did a stellar job. She phoned me the Friday before mastectomy Monday and talked through my prior bad anaesthetic reactions and how she was going to handle things. I took two Phenergan (anti-histamine, anti-nausea) pills at 11 a.m., and by 1.30, when I was due to go into theatre, I could barely remain awake, slumped over the side of the well-padded chairs, drooling.

  When the time came to go in, my breast surgeon loomed over me to confirm I knew exactly what was about to happen. He had a blue tinge under each eye, as if he’d been working too hard or too late. Okay? he asked.

  I’m in the middle of one of the weirdest days of my life.

  He gripped my left shoulder in sympathy, and then I was wheeled into theatre.

  And.

  Action.

  In my case the procedure was this: my breast surgeon made a circular incision around my nipple, taking it away, and then through the opening removed all the breast tissue. In some women breast tissue can go up under the armpit, which mine did, so the surgeon travelled up there through the same incision site. This part of the operation took two hours. He had to scrape the underside of my skin to remove every bit of breast tissue attached there.

  Next Dr Theile entered the theatre and performed the last stage – the reconstruction. He inserted saline tissue expanders into both breasts through the same open site, and then sewed me up. I would have one long scar across each breast, with no nipple. It would resemble more of a boy’s chest than a woman’s until the expanders started to stretch my skin out. Dr Theile inserted drains through small cuts he made on the side of my torso into the breast mound area and sutured them in place. The drains usually stayed in for one week. This part of the operation took another two hours. All up, I was under a general anaesthetic for four-and-a-bit hours.

  When I first woke up after surgery I kept saying, I feel weird, I feel weird, to a newly
minted nurse from Queensland University of Technology. I didn’t need to ask what her role was; it was embroidered on her blue-collared QUT shirt. She was pumping up the blood pressure cuff. An IV line was delivering fluids on the same side as the blood pressure cuff and it hurt like hell.

  B was beside me. He sat next to me reading for several hours until I woke up. In times like these B was my knight, standing guard to make sure I was treated well and everything was okay medically. He translated my discomfort for the nurse. I was protected.

  Back into the sleep abyss. No dreaming.

  Awoken again.

  I need to go back. Sophie’s looking after Celso, he said. Sophie was B’s lovely cousin.

  Okay pea, you go. I slipped back into the dark.

  I finally came round at midnight saying the same thing: I feel weird. This time there had been a shift change and the night staff were older sisters, stern but capable. I longed for their hand or ear. They came and went.

  The first time I stood my jaw quivered; my whole body quaked.

  This is normal, just post-op shock and the anaesthetic wearing off, said the formidable nurse. The back of her head was flat, but her face was strong.

  I didn’t sleep the first night without my breasts. I had come to dread being awake in a hospital, tied to the bed with tubes and catheters. This night alone with my thoughts was no different, like my time post–Celso’s birth, but I had no nausea so I was okay. I loved my anaesthetist. Without her preparatory phone call I wouldn’t have coped so well.

  If my mother had undergone a double mastectomy in 1996 she likely would have lived. Fourteen years later, I sat upright in bed with two drains taking the excess blood away from my wounds. A TV was high up on the other side of the wall. On my left a large sliding glass door framed a city view with glimpses of the Brisbane River. The decision was mine, all mine. But if it wasn’t for my mother’s decisions and breast cancer experience I wouldn’t have been in that hospital bed. My mother’s death, I realised, saved my life.

  Have you opened your bowels? asked the same nurse from the day before, who’d hurt my arm taking my blood pressure.

  No, not yet.

  Are you getting wind or rumbling in your stomach? she added.

  Yes.

  Okay, well, walk around again today and drink plenty of water.

  Done deal.

  Four hours under anaesthetic slows down the body. It’s like putting a frog in a fridge. My lymphatic system – which transports excess protein and waste product from blood and tissues – was sluggish. I had puffy hands. The physiotherapist came around on day one to put me through my paces.

  When I was able to walk without aid I took myself off to get a magazine on the ground floor as the physio suggested. I wore B’s pyjama top (blue with red polo players), pink monkey pyjama bottoms, my leg-constricting leggings, ankle socks, Bonds sticky slippers, and no chest. I wondered if people thought I was a ‘he’. At the elevator a woman mistook me for a visitor, asking, Who are you here to see? She was one democratic thinker.

  Despite everything I still felt the same sense of relief I’d first woken with, without my breasts. I was literally and figuratively lighter. This feeling never wavered. There is nothing like death staring into your eyes for mental toughness. But my nightlife took on other emotions. It was as if a large whiteboard recorded my nightmarish dreams and in the morning I’d reach for the duster and quickly wipe the words and images away. Some were drawn with black marker and were hard to remove; faint traces remained until the following night, when another hallucinatory dream wrote over and changed the previous day’s faded nightmares.

  In one of them I was empathising with another young woman whose mother had died and I said, I remember the second time my mother died. We were in some hospital ward with old medical machinery around. Then I was inside a hospice – one without dignity – and watched my mother wake up from being dead. She’d come back to life. It was real and made sense in my dream and also when I woke. My experience of going through cancer treatment after caring for my mother as she went through hers made me relive her death and everything that had led up to it. My mother had died twice. The first time hadn’t counted. I understood her death more now, as I had come close to mine.

  It was as if I had a door marked breast cancer. Once I opened it, it drew in others who had also experienced the disease. A big, kind woman who served the hospital meals had had breast cancer two years prior to my diagnosis, but she’d been clear ever since. She told me this after she’d enquired about my chest bandaging. She said she took her hormonal medication every other day because it played havoc with her. I would be too frightened to do this, equating this decision to taking the contraceptive pill every other day: you’d risk getting something you didn’t want.

  On day three the nurse came to sponge bath me. It was my first look at my body, albeit with dressings on, in the mirror. The constricting bandages gave me a cliff of a chest.

  Part of protecting your lymphatic system against lymphedema is to maintain well-moisturised skin. After enlivening mine I did the does my bum look big in this side to side, glancing in the bathroom mirror. I was 163 centimetres tall and weighed 52 kilograms, and my hair was short and thick-wavy like Mia Farrow’s in her Sinatra days. I might’ve been 35, but the image before me was of a tall 11-year-old boy. I was pre-adolescent again. Flat on the back and front. My shoulders were broad; when I was a girl, T-shirts used to hang down before breasts interrupted the curtain look and made a woman out of me. The renewed flat-chestedness was familiar. I’d lived through the emergence of womanly bits before. I was a changeling. Though this time my form would be female but my fertility would not.

  When my plastic surgeon took my dressing off, I glimpsed my chest, but I wasn’t prepared for a full-frontal investigation. I remembered too well my mother’s left breastplate after her mastectomy: concave with an angry red-purple dash across it like the Joker’s smile. I didn’t want to see mine. On the other hand the pain was less than I imagined and I only required Panadol for a week to control the discomfort.

  I had my breasts removed around the time of Mum’s birthday. It was a strange day. I sat up in my hospital bed knowing that what killed her was hopefully behind me. I’d written to the surgeon who’d performed her mastectomy, asking for the details of her treatment as he knew it. I received the answer on what would’ve been her 61st birthday. It told me of the decisions I knew about, like no to chemotherapy, no to radiation, yes … eventually, to mastectomy and close monitoring. The dates were the important part for me. Like some kind of medical bookkeeper I wanted to match up my recall of events with dates and my mother’s progression towards the grim reaper.

  The terms and medical reality of breast cancer were part of my language now. But at 22, when I’d held my mother’s hand, reassuring her that the lumpectomy scar wasn’t that bad, I was sure her fate wasn’t my own. Wrong.

  I found myself leaping back and forth between her experience and my own. For breakfast in hospital I’d ritually open the lid of my morning prunes and dump them in my rolled oats. Of course this meal assisted the ‘opening of my bowels’, something that became quite dire for Mum.

  A thought shot over the bow of time to what I saw of her life during breast cancer. A ray of guilt zapped me when one day in the last fortnight of my mother’s life I walked into her hospital room and found her asleep with her meal untouched in front of her. No nurse had attempted to assist her to eat. Even in my mother’s awake, semi-conscious state, she couldn’t pick the spoon up and bring it to her mouth. I did this for her.

  Tess (my aunt-in-kind) raised her camera to take a photograph in the last week when Mum would only take food if I fed it to her. I stopped her, knowing Mum wouldn’t have liked an eternal recording of the indignity of the situation.

  I left hospital after four days. Two weeks after the procedure I saw my plastic surgeon. My chest area was hypersens
itive; it was a strange, disembodied feeling. I explained the sensation to Dr Theile:

  Imagine wearing a fat suit over your body after a severe car accident left you bruised and lacerated.

  He was above me, staring down with clasped hands and a focussed but bemused expression. I was topless on his examination table. I lifted my head to peer at my chest. I was a flat plain. No breast mounds obscured my view of my stomach. I was more adolescent male than female with defined stomach muscles and broad shoulders, apart from the red, healing cuts. Like this, I could get away with wearing swimming trunks only on the beach. If I touched near the incision points my un-inflated saline implants crinkled like cellophane.

  I continued my disembodied story to Dr Theile. An old friend comes to wish you luck and pats you on your fat suit – because you look funny – right over the area where your ribs connected with the steering wheel.

  Dr Theile grimaced and swayed. The fluorescent light behind him made me squint.

  You see him touch the fat suit, but can’t feel the contact. What you feel is the pressure of his finger directly over the wounded area. The disconnect between sensations is deeply disturbing.

  Dr Theile then touched my chest and I almost jumped off the examination table.

  I’ll start inflating you in one week, he said, snapping off his gloves.

  Three weeks after my mastectomy I was back in the examination room, topless again. Dr Theile had a nurse who was also his secretary perform the saline injections into the tissue expander if he was busy. On my expander was a valve shaped like a pincushion, the size of a 50-cent piece. Inside it was a magnet. She put a divining gadget the size of a mobile phone over my breast mounds to align magnet to magnet. I saw worry in her widened eyes. I haven’t done this before, she said.