Inside My Head

That was the physical.

The emotional is harder to pin down.

I am predisposed to fear, because of the death of Natalie. That is a fact.

But this process has made me think a lot about medicine, about technology, and about not knowing.

I do know now that I do not have breast cancer. That is nice. And I know for people whose breast cancer was not caught--they would envy the care and diligence with which my doctors paid attention to me. Indeed, I know that I was afforded the luxury of these tests precisely because I have the best of insurance and my insurance would pay for them. If my insurance had not paid, I do not know that the doctors would have made the same decisions. My great insurance entitled me to more expensive and invasive tests.

But here was the side-effect. For six weeks I was in hell--either at appointments, waiting for appointments, being tested, or waiting for results. Even with the best insurance there is to offer I will pay a lot of money, and the bills will keep filtering in for the next year and a half.

I was told the procedure would be non-invasive. I now question what that means.

For three days afterwards I could not close my eyes without imagining I was back in that room with the machine drilling into me and the blood everywhere. I could not sleep. I read terrifying mysteries to soothe myself. My doctors said this would all be nothing. In fact, so many doctors handled this process I feel like a piece of meat floating down a conveyor belt. I do not even know who I would talk to if I wanted to say, "Hey. That was really unpleasant. You should alert people that this could be emotional--even beyond the fear of having cancer."

I have recovered well. I am not infected. I am not ill. But my breast is huge and swollen and emotionally I am a wreck. Even knowing I am OK, I feel violated, and angry. My body is strong. But my mind is feeble and fragile. One friend estimated it will take me three weeks to feel normal.

I feel that because machines have trouble with dense breasts like mine, I must undergo more extensive testing. Is that right?

MRIs are notorious for way over-enhancing--in other words many things that enhance are not cancer. They are also good because in the process of over-identifying enhanced spots, they catch tiny cancers that no other technology can catch. If I had cancer I know I would be grateful.

I now have a scarred and swollen breast that will have a permanent lump. The experience was so unpleasant I think I may opt for the European model and wait until I am 50 for my next mammogram. I feel betrayed by a medical system that grossly underplayed the physical and emotional trauma that having a foreign body--however small--drill into you, has on the psyche.

I wonder if our medical system relies too much on its technology. I wonder if it teaches people to put too much faith in technology that is still often wrong. I wonder if we love our technology so much that we order people who have only a minute chance of having a disease to undergo tests to take the possibility of disease down to zero. I wonder if I should be part of that decision. I wonder if we underestimate the trauma of tests and overestimate the peace of mind and accuracy that tests bring.

An I wonder how the tests themselves will alter how I am treated in the future--even though the best doctors and technology have never found any cancer in my body.

Facing the Wave-breasts-first!

I have read a lot more Buddhism since my friend, Natalia, died of breast cancer. She had me read to her in her final hours from the Tibetan Book of Living and Dying, and things that happen at times like that stick with you, forever. One thing that struck me is that Buddhism, or at least the way Westerners talk about it, use a lot of surf and water metaphors. That resonated for me -- since I love to surf.

I read a fair amount since her death--because I felt scared when she died. I was not ready. My spiritual house is not in order. I need to figure out what it is I believe and how I want to live and how (emotionally) I want to die. The rest I cannot control. But that I can.

One thing Buddhism demands is that you live awake. That you are totally in the moment--not thinking about the past or the future. It is about turning and facing the wave. When something scary and terrifying and horrible and maybe even exciting is racing toward you, do NOT turn your back, do not run. Turn around, look at it, size it up, take it on. That is the only way you will survive. That is the way to get through it.

I am a procrastinator. I face real waves. I know how to do that. I know how to go over the top and dive through. I know how to go under and escape the rough water. But the psychic waves are harder. I run. I close my eyes. I look away and try to pretend they are not happening. And like real waves, they knock me off my feet and pound me in the surf.

So I am trying to be better. From the big things to the small.

Today I went to get my annual mammogram. For me the issue is now so loaded I am practically quaking by the time I walk through the door of the imaging center. It does not help that the place I go-- the Beverly Tower Women's Center -- is cold, institutional and matter-of-fact. On top of that, a woman my age went there with a lump she was worried about, they told her she was fine, and a year later she was diagnosed with stage 3 breast cancer--in the exact spot she had asked them to look at. Young women are hard. Our breasts are dense.

Still. You go in, they squeeze your breasts this way and that. Not tenderly like a lover, matter of factly and coldly. Like a meat cut. (Although the technicians tend to be the most human and kind.) You get all these photos taken, and a few weeks later you get a letter in the mail--formulaic and impersonal--telling you you are fine, or that you are not.

Last year they found something strange in me. Not a lump, but fibrousness. They told me to come back in 6 months (all in an impersonal letter, in difficult to understand medical language and no way to talk to the doctor or ask questions). My OB was aggressive--she is awesome--and sent me to a breast specialist at Cedars. I was so upset at that point that I started crying hysterically in the hallway and a white-coated woman ushered me into a small, windowless (soundproof?) room full of boxes of kleenex where I could cry freely. They were afraid I would send other semi-hysterical women over the edge, too, I am sure.

In the end I got an MRI--terrifying--and everything was OK. Needless to say I was not excited about going again.

Today I went. I faced the wave. I got the mammogram. I got the ultrasound. And today the Doc who signs off on the impersonal letters actually came out and talked to me. What a difference it makes. They gave me an ultrasound just to be sure. All clear. They told me so on the spot. I was so grateful I cried. I felt my whole body go limp. I was even more scared than I had thought.

But I faced the wave. I looked for the truth. And now I can move forward, put the worries behind me, and use my energy for good things. It's a tiny step on my Buddhist path.

Do you get nervous when you get mammograms? Do you go weak in the knees? What do you wish your doc did to make it easier?