There’s a deep dimple in my left breast. It makes plunging Vs or pushup bras a challenge. I’ve switched to bandeau topped swimsuits to cover it. There’s having your breast stared at, and there’s this.
I know how petty that sounds. The dimple is getting deeper, somehow, even though the flesh around it is shrinking. Its surface is thickening.
Recently, I noticed a mirrored pull at the bottom of my breast when I raised my arm to dry beneath after a shower. I wiped the steamy mirror and looked closer, lifting my arm at a more acute angle. I wondered at what point in the extension was this new dimple most pronounced – how long it had been there before I noticed, tucked, as it was underneath, in the fleshy weight of my shrinking breast.
At first, I blamed the fine-needle biopsy for the dimple. It’s just where the doctor inserted the giant ultrasound-guided needle to take a core sample of my flesh. Like I am a tree. A living, giving, tree.
I thought it was just scar tissue, formed by the body’s stubborn healing after the assault of the needle. I felt like a wimp. That needle is the least invasive way to take a sample for a biopsy. Some people have to have surgery. I only had to have my breast punched. They gave me local anesthetic. It still hurt like hell, but I felt like it should be nothing.
The bruise was pendulous and its pain was all-consuming. I pressed bags of frozen peas against it and winced. Then acute pain gave way to blossoming bruises across my skin, a kaleidoscope of colour.
When this dimple started to emerge, I only blamed the biopsy.
The dimple formed when the tumour in my breast, the mass of errant cells where my cancer began, receded with treatment. It pulled back, hungry, when we cut off its estrogen supply, first with Tamoxifen and Zoladex. Then an oophorectomy replaced the Zoladex. When Tamoxifen failed and my cancer spread to my liver, I started taking Letrozole and a clinical trial drug. As the tumour and my breast have shrunk concurrently, internal scar tissue has formed, dimpling the remaining flesh.
You’d never know. Not unless I told you, or I stopped being careful of how I dress. I do it to make both of us more comfortable. If you don’t see the scar, you won’t ask me why I have it. We’ll both be spared awkward talk of death and dying, of cancer. You won’t have to encourage me with talk of how I’ll make it. I won’t have to flinch and bite my tongue. Who was it said, “Ain’t none of us getting out of here alive.” Oh yeah, everybody.
Yet I find myself wondering what horror I’ve been spared.
There’s this thing about being a patient today. We’re living on a continuum. It used to be much worse. People didn’t survive surgeries. Yet they still went – desperate as they were – under the knife. My disease is incurable, but my treatment is much gentler than it used to be.
Once, I would have begun with a radical mastectomy, carving my breasts and chest off in wholesale butchery. This would have been followed by chemo and radiation at levels rarely seen today, so toxic that my organs would struggle to press on. And I’d still only have a slim chance of living a few more years.
Or, like my aunt, I'd weight the pros and cons and choose to just let go.
Today, I have many treatments available. Some are fairly easy to tolerate. Palliative care doctors and nurses are getting very good at helping us to manage pain and mitigate the side effects of our drugs. Sometimes they do so with other drugs that also have unpleasant side effects, but it’s much better than it used to be for terminal patients like me.
In the future, immunotherapy or nano-particles or something yet undiscovered will render this disease neutered. Women like me will get on with their lives, cancer barely a blip. I know I shouldn’t be, but yes, I am holding my breath for this future.
I’d give anything to leave this behind.
Science moves in fits and starts. Clinical trials are happening now, around the world, testing countless approaches. My cure could be sparkling in a test tube, or coursing through a mouse’s veins. I am in a phase one trial. The drug that seems to be extending my life could take years to come market...or it could never, if it doesn’t improve against the status quo in a blind phase three trial. Sometimes a drug does work for a few people, but not enough to justify the cost of production and it disappears. Other times, a breakthrough drug changes the market.
It’s impossible to see where we are on the continuum without the lens of history.
So. I can only live in the now.
I hold on to this moment. I have been away a lot, spending time with the people I love while I can, soak up the beauty of the world. It’s been a real gift, but I have pushed myself to my limits and I’ve had very little time this summer to sit in my garden, watching the birds flit from my feeder and the bees and butterflies dancing across flowering herbs while listening to snippets of conversation and laughter drifting from neighbouring houses.
I’m sitting in the shade. It’s hot in Toronto. I’m wearing little and soaking it all in.
This delicious moment.
I am living in its glory, but I am also living in a shadow. This is the duality of my life.
For each moment of joy, each push to be present, there is a pull back down to the ground. I find that I am unable to lose myself in any given moment. Underneath my hopeful smile, there is pain, fatigue and always fear. These feelings are co-mingled. My nerves are jittery. My grief unresolved.
How do we keep living when we’re dying? I wrestle with this question daily.
I lost seven friends this summer. Women who, not long ago, seemed as strong, even stronger than I feel. My days are haunted by their shadows even as they are more full for the friendship we shared.
And every day, in the shower and as I choose my clothes, I see the dimple in my breast where my primary tumour still is. I feel the stretch where my arm is still stiff from radiation to a tumour in my armpit this summer. I feel the ache in the tumours in my bones. Every two days I replace my Fentanyl patch, muting the pain, but never silencing it entirely. I take extra opioids every day when the pain breaks through this baseline maintenance.
See how my moods ricochet? See how I fly between extremes? The dizzying speed of fluctuating moods. The cascading dominos of thoughts.
So I breathe. I watch a bird. I smell a flower. I pour my hope scattershot into the air. I honour sisters in mets, both living and dead. I try to honour myself, and the good this body has done for me, the joy and love I have felt in its forty years.
And I hope for more with all I have.