Tuesday, August 25, 2009

Narrow Escape Artist

Last summer, about three weeks after my wedding, I got offered a new job. (I say this as if it fell from the sky, but in reality, I applied, I interviewed, and then I got the offer; in other words, I chased this.) It was an amazing opportunity: a respected position at a prestigious university at a generous salary that would keep me in designer shoes for a long time to come. The only problem was the job was approximately 988 miles east of everything I knew and loved. Taking this job would mean leaving my beloved Chicago for a city where I knew only a few people and that I had only visited a handful of times. To complicate matters, they wanted me to start right away, and since G had just begun teaching, he wouldn't have been able to join me until the end of the semester. So I was staring down three months, alone, in a strange city, three weeks into my marriage.

But it was such an enticing opportunity, I agonized for weeks over whether to accept. I negotiated, I bargained, I wrangled more money from the offerer (more shoes!) and funds for relocation, I put a deposit on a furnished short-term rental. And then just when we thought we were ready to make the commitment -- put in notice at work, book a moving van, plan the going away party -- G and I balked. We started to crunch the numbers. It turned out that the big salary would not go as far on the I-95 corridor as it would in the simple ol' Midwest. And even though I'd be pulling in big(ger) bucks, G would have to look for a new gig of his own come January and there was no guarantee he would find something right away. After ten sleepless nights and purgatorial foggy days, we decided to stay put. I parlayed the offer into a sizable raise at my current job. And then I turned those other guys, with their ivy-covered walls, down and nearly collapsed of relief.

Right after this happened, the stock market tanked and took the economy with it. It turns out I got the last of any raises that would be offered at my company for a good long while. And then, in January, G scored an incredible new job with a salary that put that east-coast offer I had gotten to shame. So, moral of the story? I think we made the right choice.

This suspicion was recently confirmed--a thousand times over--when I learned that earlier this summer, the university, whose endowment had been ravaged by the tumbling market, had begun lay-offs across its campus. I knew that personnel cuts affected the department I had been invited to join particularly harshly, but I didn't know until last week -- when I was traveling for work and gossiping about the state of the industry with some media folks -- how pervasive the lay-offs had been: of the half-dozen folks who would have been my colleagues, only one remains employed. So guess who would have been a victim of that ax? Me. The job I was offered was eliminated. Not even the head of the department, who pursued me so doggedly, survived. When I heard the news, I marveled at how narrowly escaped disaster.

What does this have to do with boobs, you might ask. (To which I might answer, haven't I convinced you yet of my singular ability to connect seemingly unrelated events to my bosoms?) Well, I'll tell ya. The slim margin by which I averted potential unemployment (to say nothing of lost health insurance... I shudder to even think) reminds me a lot of the escape route I've been offered to cheat my genetic fate. If I had taken that job I would have lost it; if I hadn't taken that BRCA test, I could have been blindsided by breast cancer. When I turned down that job, I struggled for a long time to come to terms with my decision; I didn't have the benefit of hindsight to assure me I made the right choice. Because the thing is, I didn't know when I turned down the job it would go bad so quick. And this December, I don't know whether, when they cut into my flesh, they'll find perfectly healthy breast tissue or lumps and bumps that have already started to turn ugly. Chances are the pathology will come back clear and I'll never know what would have happened to my breasts if I had kept them.

But just as I did when it came to turning down that job last summer, when it comes to choosing a PBM I've weighed my options, made of lists of pros and cons, consulted with my husband and family, and reached a decision. And I'm trusting my gut here. On the job front, things worked out well for us: I make more money, G has a great new gig, and, most importantly, we are both gainfully employed in positions we like in a city we love even more. I can say almost for certain that almost none of that would be the case if we had made the move out east. I won't know what life would be like if I kept my breasts, but if this story represents anything larger -- or suggests I have a gift for getting out right before things go bad -- I want to turn down the offer of breast cancer just like I did that job. Because I don't want to be the victim of a lay off any more than I want to be stricken by disease. And I'm so glad I have a choice. Here's to hoping it's the right one.

Thursday, August 20, 2009

Thoughts on Body Modification, Aging, and BRCA

I was at a rock concert in college when the girl standing next to me, who was on acid, turned to me and, with a kind of panicked acceptance that usually accompanies great truths revealed by mind-altering substances, said “My arm is not my arm. Gotta go. Bye.” She abruptly left, apparently to search for her missing arm and return the one now attached to her torso to its rightful owner.

I think about this from time to time because I sometimes worry that, post-mastectomy and reconstruction, I will look down at my new bosom and think, “My boobs are not my boobs. Gotta go. Bye.” And then *poof* like a cartoon, I’ll disappear in a cloud of smoke, leaving behind a skin suit shaped like me—-eye holes empty-—to collapse, deflated, unoccupied, on the ground.

What will it feel like to no longer recognize your own body? Will I feel panic? Alienation? Regret? Will I learn to accept the changes I made to it? Or will I always feel like something is just off?

I have a recurring dream in which I get a large, poorly drawn, and frequently thematically unfortunate tattoo. The design and placement are different every time—-sometimes it’s a childish rendering of sea monster across my torso, sometimes it’s misspelled words and doodles on my upper back-—but the feeling is always the same: enormous and immediate regret, so acute I can feel it in my sleep, followed by unspeakable relief upon waking. I pull up my sweat soaked t-shirt and check my stomach: no tattoo. And I collapse onto the pillows and remind myself it was only a dream.

It's not like I have a problem with tattoos, even. I mean, I have a tattoo. It’s a small, tasteful line drawing at the base of my spine. I got it a week before I graduated college with my best friend, who also got a similar design in a similar spot. In the decade or so since I’ve been inked, this spot on a woman’s body has become a popular location for tattoos (and to think I thought I came up with it all by myself lo those many years ago), and what goes there is often called pejoratively a “tramp stamp.” Despite all this, I don't regret my choice and have fond memories of the experience and warm feelings about the bond it represents with my friend, who now lives hundreds of miles away and in a different world-—filled with babies and diapers and such-—entirely.

But clearly, I have anxiety about body modification, no matter how enthusiastically I engaged in it in my metallic youth (I could have set off an airport metal detector a few years back when my face was littered with piercings). And I have ambivalent feelings about plastic surgery. So having to deal with both now is a bit of a mindfuck.

I keep asking myself why I would voluntarily—-electively, as the insurance companies might consider it—-alter my body-—remove parts and substitute synthetic facsimiles-—leaving scars both physical and psychological. The short answer is that I’d rather have scars from a mastectomy than a chemo port. But the longer answer involves considerations of body image, self esteem, and confidence. And to tease out those implications, it helps to think about how my body has changed in both ways I’ve chosen and ways I’ve had no control over.

The tattoo is permanent, of course, as are the scars left behind by the piercings, but these are physical reminders of willing choices I made. There are marks on my body left behind by afflictions and mistakes I’d rather forget: these are the artifacts of choices I didn’t make. I’m thinking chiefly of the acne scars on my cheeks: the bearded legacy of a pimply youth, my skin no longer breaks out, but it announces to all who sees it its history of dermatological disaster. Lest I spend my life walking around with a paper bag over my head, I’ve had to find the confidence to literally face the world despite my imperfect complexion, and for the most part I don’t let it get me down (but if I could swap my ragged flesh for porcelain perfection, I would in a heartbeat). There are other marks, too, mostly shaving related: the pigmentless strip of skin on my left shin when the razor slipped in the bath in middle school, the isthmus of scar tissue on my thigh from a particularly nasty cut in high school. And of course there are the stretch marks, which, having not yet been pregnant, I can only imagine are the dress rehearsal for the angry, tentacled cracks in the foundation yet to come.

Then there are the ways women’s bodies change as we age, a process of unfortunate dropoping and uneven bulging which now, as I enter my thirties, is a fact of my life: the crow’s feet that gather at the corners of my eyes, the horizontal ass migration, the disastrous effects of gravity on the hangy things. Like all women, I have this idea in my head that my body was always much better off [insert the date of some time in the past], when in truth, at that time, I was actually pretty unhappy about the state of my ass or thighs or hair. The thing is, our bodies are changing all the time: sometimes we help them (when we get tattoos or nips or tucks) and sometimes we’re victims of acne or aging.

So where does a double prophylactic mastectomy fall on this spectrum? I hope it falls more on the end of “things I do to myself”--and the attendant pride that comes from making a choice--than “things that happen to my body”--and the helpless anger that follows from things you can't control. Because I have agency over it: it’s my choice, it’s my scars, it’s my peace of mind. I don’t think I’ll ever be as fond of my mastectomy scars as I am of my tattoo, but perhaps I’ll have less ashamed of them than, say, the pock marks on my cheeks. After all, like the holes left behind by my facial piercing spree of the late-twentieth century, the scars on my reconstructed breasts will tell a story. One, I’m hoping, will have a happy ending.

Sunday, August 16, 2009

I Know I Said I Wouldn't Blog on Vacation, But... *

* ... this doesn't count because I'm posting it now that I'm home. So there.

We’re due to land in Chicago in about an hour, so that means I have roughly 60 minutes left of vacation. “Vacation,” as I use the term, is more a state of mind than it is a place; you could argue that my vacation ended when I passed through the security checkpoint at the San Jose airport early this morning—-crossing a threshold that separated me from leisure and funneling me through the banality of modern air travel, or even last night, when G and I checked into a Holiday Inn Express and ate dinner at the Denny’s across the street (what could be less exotic than that?). But the reason I flipped open my laptop, even though it’s gotten a little bumpy up here and I’m resisting the urge to grab G’s hand for safety, is that I want to write this now while I’m still in the mental mindset of vacation. And what I want to say is this: I feel really, really great. For the last ten days or so, I was once more the person I was before all this boob stuff came cascading over my life like a violent wave. I was able to relax, to sleep well (and wake early—-a true accomplishment), and to worry about nothing more strenuous than whether or not it was time to take a dip in the ocean or wait until I finished reading a chapter in my book before I cooled off in the pool.

I have to say this now because in an hour from now, I won’t feel as grateful for this, as aware of the restorative power of our sojourn, as I am right now. Because in an hour, I’m going to be waiting for my bags in the bowels of O’Hare International Airport and then I’ll be getting in a cab and telling the driver my address and then I’ll be putting my keys into the lock and entering my apartment and thumbing through a stack of mail on the dining room table and then I will be back to reality. I will no longer be on vacation. And along with the rigmarole of my daily life, I’ll go back to thinking about certain stresses and all that I’ve gained in these ten days will be lost. So that’s why I need to declare this now. For another sixty minutes, (well, 45 now) I’m more than my mutated genes or my decision to have surgery—-I’m free from those encumbrances.

(I call this phenomenon—-the sudden vanishing of that vacation high-—“the camp effect.” I first noticed it the summer before seventh grade, when I returned home from two weeks on the shores of the Chesapeake Bay. I was away at camp for fourteen days and all of this astonishing stuff had happened to me-—I wore a bra for the first time (and had my bra strap snapped for the first time by a guy I had a crush on), the guy I had a crush on who I thought was so beautiful and unattainable actually turned out to like me back, I got good at swearing, I dealt with my fear of spiders. And then, I found myself back to where I’d been before all of that, staring at the same floral pattern on the bathroom wallpaper, hearing the familiar creaks of our house as it settled at night, wondering who I was and who were these strange beings called my parents, and being annoyed all over again at the very existence of my little brother—-and just like that, all that camp stuff, all that growing and experiencing and maturing was gone. I was me, all over again. That’s why I need to record this now, before the camp effect takes hold.)

This is not to say that during my vacation I did not think about boobs and all the unpleasant diseases they can fall victim to; in fact, I found myself sabotaged by them unexpectedly: a minor character in a novel I read over two gloriously days on the beach developed premenopausal breast cancer and later died of ovarian cancer, which, naturally, led me to diagnose her as being BRCA positive (she mentioned losing a mother to the disease, as well). I watched the way my breasts floated in the ocean, aware that they may behave differently (perhaps they will buoy me?) the next time I have the privilege of swimming in salt water. And my husband, especially, not in a gross or grabby way, or in a way I would feel uncomfortable describing in a public forum I know is visited by members of my family, seemed especially attentive to my bosom this trip, as if he were recording for posterity mental images of his wife in a bathing suit before.

But for the most part, my mind was quiet and I came to a kind of philosophical equilibrium: being BRCA positive is only as big a deal as I want it to be. My approach heretofore is to treat it like a very big deal (I’m reminded of my near compulsive need to tell people about my mutation when I first learned of it because the burden of knowledge was so great I needed to offload it on others, even those who didn’t want or need the baggage). And after this plane lands, it will still be a very big deal. But I hope I can take a bit of my vacation-induced calm back with me to real life and learn how to handle my very big deal in a less consuming manner. I’m not saying I’m canceling surgery or putting my BRCA status out of my mind; I’m hoping to stop treating this as a massively inconvenient intrusion into my life--one that brings with it unpleasant considerations of mortality and vitality--and just deal with it as life. A life that takes me to beautiful places, is filled with loving people, and will-—hopefully-—be filled with many more healthful years of both. And I can think of no more compelling reason to take the drastic measures I’m taking than to view it as a down payment on more vacations during which I get to watch my body—-strange and different though it will likely be—-float in the ocean and just be happy.