Biopsy

As a birthday gift, my mom wanted to take me shopping. So we were in the Nordstrom shoe department and I had one leg deep in a black over-the-knee boot when my phone rang. My mom was still smiling from whatever we'd been talking about before. She took a fraction of a second longer than I did to realize: this could be the call we'd been waiting on for almost a week. The results of my biopsy.

*

Last year was a year of health scares. It was mammograms and ultrasounds, biopsies and removals, my body sprouting strange buds and poison from roots I didn't even know existed. Seven months ago, around the time a ping-pong ball-sized cyst grew on my thyroid overnight, I felt an unfamiliar lump in my breast. I was nervous and distrusting of my body, analyzing it unforgivingly for any changes, each one seeming more foreboding than the last. The cyst was removed, a silvery needle penetrating the darkness of my throat on an ultrasound screen, and it tested negative for cancer. The relief was tempered by the mammogram and ultrasounds results, which showed a cluster of microcalficiations and that my breasts are heterogeneously dense. The doctor explained that dense breasts can slightly increase cancer risk as well as make finding cancer more difficult: cancer appears as white on a mammogram. So does dense breast tissue. So if your entire breast glows white on a screen, it's easier to miss those few spots--like specks of salt, in the case of my microcalcifications--that could otherwise give you an early warning. Younger women are more likely to have dense breasts, as are premenopausal women and women taking hormones for menopause. As for the microcalcifications, they're fairly common in general, the doctor said, and most often benign, but considering my age and family history, they could be a red flag. In some cases, microcalcifications are the first and only warning sign of cancer--no lump, no pain, just these tiny grains doing their silent proliferation. It'll probably be fine, the doctor said, smiling, but just in case, come back in six months.

*

I've known the specter of cancer since I was five years old and my grandmother was diagnosed with leukemia. My dad's mom, whom we called Guela, was petite and fierce, with a laugh you could hear from one end of the house to another. She loved to travel, made "the best French fries in seven counties," and adored the few of us grandchildren who were already born. She'd come pick up my brother and me and take us to the lake, where we stood in the marshy shoreline picking up rocks and rubbing the wet dirt between our fingertips. She used to take me through drive-through carwashes because she knew I loved them--the sudden darkness, the windows becoming opaque with soap, the rising bubble-gum smell, the roar of the hoses. I always felt like we were in the belly of a whale.

At the lake where Guela used to take me.

She went to MD Anderson in Houston for treatment, with my dad and his three brothers taking turns to be by her side. True to her vivacious personality, she wrapped bright scarves--I remember red, in particular--around the smooth globe of her head, and when she was home on those Sundays we all went to my grandparents' house for lunch, nothing felt different. There was her laugh, the hugeness of her presence, her bright brown eyes and her fingers and wrists layered with jewelry that reminded her of a trip to Venezuela or Hawaii or Europe.

I used to call her long-distance when she was in the hospital. She was so proud of me, telling the nurses how her five-year-old granddaughter had memorized the ten-digit phone number and her room number. I have a memory of pulling a chair to reach the wall phone in the kitchen and calling her late at night. My mom must have talked to me already, a car ride I vaguely remember in which she told me that Guela would be going to heaven soon, to be with Jesus. I was angry then. I didn't want her to go, didn't want Jesus to have her. She was mine. But the night I called her, something must have shifted inside me, or perhaps I saw the pain in my parents' faces and wanted to make at least one thing easier, or perhaps I just wanted to talk to Guela one last time, even though she couldn't talk back anymore. I told her that I loved her, and that she could go to heaven to be with Jesus if she wanted.

And soon, she was gone.

Guela and me.

*

I thought the six months between mammograms would be unbearable, but they passed quickly amid work and travel, family and friends' birthdays and the birth of my niece, Charlie. Then it was September and I received a letter from Baptist Breast Center reminding me that I was due for my follow-up. I folded the letter and placed it on our bedroom dresser, where I saw it every day but didn't call the number that stood out in bold blue ink. I kept forgetting, I told myself. It seemed each time I remembered, it was six o'clock in the afternoon and they'd be closed. Once, I called but was kept on hold for nearly ten minutes. I hung up and didn't try again for another month.

Fear should act as self-preservation, shouldn't it? But it often doesn't.

Finally, I made the appointment. October 25, three days before my thirty-second birthday.

*

One of my mom's sisters was diagnosed with breast cancer when she was in her late thirties. I remember my mom saying that my aunt had caught it herself, her fingers detecting a lump that the mammogram had somehow missed. I was still young, maybe around ten, and self-involved as all children are. My aunt and her family lived in Houston, so I remember, dimly, trips up there in the huge blue van we used to have. I remember sleeping on the back bench seat and spending periods of time in an unfamiliar apartment. My aunt went into remission--I can still feel the swell of joy, sweeping us all up into its glittering current, when we found out. She was meticulous with self-checks and returning for her follow-ups, my mom says, and made it to five years before the cancer returned. Again, she went through treatment, and again, she beat it.

Later, another aunt--my dad's brother's wife--was also diagnosed with breast cancer. When I think of the three women I've mentioned--my Guela and my two aunts--it strikes me that they were all fierce. They were (and are) women of strong personalities, of sure voices, ready and determined. This aunt, too, went into remission, but the cancer returned around the time I left for college. She passed away, leaving two children under the age of about fourteen. The loss was stunning, unbelievable. I couldn't imagine how my cousins would survive it.

*

The mammogram was quick, five or ten minutes in a small room, and concentrated on my left breast. A thirty-something woman helped me maneuver into tight and awkward positions, draping my arm over the machine, nudging me closer, shifting my hips. "Don't breathe," she would say when she retreated to take the picture, and inevitably those were the moments I had just exhaled, so I waited airless, trying my best not to take in a huge gasping breath, while each one was taken.

"Hmm," she said.

"What do you see?" I asked, striving for conversational--woman to woman, idle curiosity.

"This must be what they're looking at," she said, glancing over at me from the little booth where she took the photos. "These little white spots. Unusual in someone so young. It'll be interesting to see what the doctor wants to do."

"Right," I said, more stiffly. "Interesting."

The doctor was a blond-haired, blue-eyed woman in her mid- to late-fifties, wearing a skirt and wedge sandals. In the previous year, all the doctors I'd dealt with were men; one said, walking into the room, "Boy, you're a cute little thing, aren't you?" I didn't fully realize I wanted something different until I sat beside this woman.

Dr. McKay was friendly and matter-of-fact. "These are your breasts," she said, pointing to the mammogram photos backlit by a glowing white board. "This was back in April," she said, pointing to the one on the left. "And this is today. Notice a difference?"

In both photos, the microcalcifications were clustered together in one spot, as if a salt shaker had been upended and quickly righted, the granules neatly scooped together.

"There are more of them now," I said.

She nodded. "Yup." She changed the picture, showing me another angle. The spots were like paper dolls, multiples of the same shape hidden directly behind the original. So what were clearly more microcalcifications, but still seemingly only a few, from one angle, turned out to be quite a bit more from another.

"We're going to have to do a biopsy," she said.

"Oh," I said.

"I'm hoping it's fibrocystic changes, but we need to be sure."

I nodded. "Right. Yeah. Of course."

She explained that she would go in with a hollow needle about the width of the hole in a pen and collect as many of the microcalcifcations as possible. Local anesthetic, an hour or two, results in three to five business days. Any questions?

"Percentage-wise," I asked, "what are the chances of it being something bad?" I couldn't bring myself to say the word.

"One in four are cancerous at this stage," she said. "Your history adds another ten percent."

"Oh." The wind felt knocked out of me, both by her bluntness and the figure. I'd expected her to say something like, Oh, maybe five percent--we just want to be absolutely sure. But up to a thirty-five percent chance? One in three?

She patted my hand, her voice softening. "Again, I'm really hoping it's just fibrocystic changes. There's a good shot of that."

"Okay," I said. "Thank you."

I scheduled the biopsy for two days later.

*

When my mom's dad, my Poppi, was diagnosed with esophageal cancer, we heard the news with the shock of watching a redwood fall. Poppi was a Marine, a cowboy, all lanky limbs and the most beautiful baritone voice I've ever heard. His nickname as a boy was "the Pepsodent Kid," after an old toothpaste commercial, for his strong even teeth and wide smile. He hugged us hard, made fun of my boyfriends, and played Santa every Christmas, passing out gifts one by one as the whole family crowded into the living room, forty of us strong, eating tamales and drinking hot chocolate (the kids) and wine (the adults).

Grandma, Poppi, and me.

His prognosis wasn't good. He only went through treatment for love of my grandmother, my mom says. Poppi's hair changed, became lighter and sparser, and he dragged around what my memory says was an oxygen tank. I remember visiting him in the hospital bed and realizing that I'd never seen him lying down before. He was always at the ranch, on a horse, or sitting tall and strong at the breakfast table at my grandparents' house when we visited. "Do the dance," he told my grandma, and she burst into a giggling rendition of some goofy Fiesta Texas commercial. I watched him watching her, his face shining with love, and when she was done, he asked us, "Isn't she beautiful?"

We still laugh at a story my grandma tells. They were driving, and he was quiet, contemplative. Then he said, in all earnestness, "You know, I just can't imagine life going on without me."

Neither could we. I truly thought he would beat it. So in June of my junior year of college, I left for Melbourne, Australia, where I would be studying abroad. He'd only been sick since February. But by August, I was on the phone with my dad. His voice was soft and sad as he told me that it didn't look like Poppi was going to make it. I felt electrified with panic. I'd take the first flight home, I said, but my dad said, No, no. It could be two days, two weeks, or two months. They don't know when. They just know . . . He trailed off. He promised to let me know as soon as there was any change.

I was in a creative writing class only days later when I got the call. Poppi had passed.

I sprinted the two miles back to my street, sobbing, my backpack thudding against me. There was a Flight Centre near our apartments, and I went straight in and booked a flight home that day. I was so angry. Angry at my father, angry at myself--why hadn't I just left when I knew I should have? I could have been there. I could have said goodbye.

*

By eight thirty last Thursday morning, Adrian and I were waiting for my name to be called. We sat quietly, he flipping through a magazine and I staring blankly ahead of me. Every so often he squeezed my hand or leaned in close, saying something that made me laugh despite myself. "Did you ever have bedazzled jeans?" he murmured, tilting his chin toward the woman checking in, whose back pockets bore huge sparkling crosses. Others came and went, routine mammograms. It was Breast Cancer Awareness Month, so there were pink and purple hydrangeas in vases and pink ribbons everywhere, and a sign on the door said, "Hope starts here." I thought, No, fear starts here. Then I told myself to stop being so grim.

I was called back and asked to change into a (pink) gown over my leggings. I'd worn socks and tennis shoes instead of my usual flip flops because I was sure, somehow, that the room would be freezing. It was. Goosebumps rose on my skin when the technician, Lori, asked me to slip one arm from the gown. To the left, my mammogram photos hung on a backlit wall. To the right, there was a step stool leading up to a metal table covered with white paper, and which had a hole in the middle. The doctor would be coming in from underneath the table.

"Go ahead and climb up there and slide your breast in the hole," Lori said. "This is going to be uncomfortable. I'm sorry."

"It's okay," I said, full of false bravado. "Do what you gotta do."

For the next fifteen or twenty minutes, she worked to get my breast at the right angle for the needle. I gritted my teeth while she pulled and twisted my breast, while it was squeezed between plates, while she murmured to herself and said things like, "Is this position bearable?" and "You're going to be more bruised from me yanking you than the needle!" and "I'm so sorry, hon, I know." Then Dr. McKay swept into the room, rubbing a firm hand across my back and asking how I was doing before explaining what would happen next.

"Sorry this part is taking so long," she said. "Your breasts are just so small it's hard to get them at the right angle."

Great, I thought. Thanks for that.

They worked together, continuing to pull and twist and squeeze, and I wondered why they couldn't have already shot me up with whatever numbing agent they were going to use because this sucked. My neck was twisted at a harsh angle ("Sorry we can't give you a pillow!"), as I stared at the plastic choking hazard tag on the window blinds. They took multiple mammograms ("Don't breathe!") to make sure they were in the right position. Finally, Dr. McKay injected me four or five different times to numb me. "Poke, poke, poke," she said, by way of warning.

After the numbing, everything became more bearable. I felt pressure and pulling and heard a strange hollow mechanical roar, but my neck hurt more than anything else. Lori left to make sure the sample they'd taken was what they needed--those small breasts! making everything so difficult!--and, unfortunately, it wasn't. Dr. McKay injected me with more anesthetic, and she went in with the needle again. Throughout the process, I felt one or both women's hands on me, squeezing my hand or rubbing my shoulder or forearm. They said things like, "I'm so sorry, I know this is tough" and "You're doing excellent, really great." At one point, I told them, "You know, I'm really glad you two are women." They laughed, and Dr. McKay said, "Well, we do have a couple of excellent male doctors here--I wouldn't have hired them otherwise!--but I know what you mean."

On the next check, they were satisfied. "We got almost everything!" Dr. McKay said. "That's good news! Now they're going to get you bandaged up, and I'll come back and talk to you in fifteen minutes."

Two new women came in, faceless because my head was still turned toward the window, and hands put pressure on my breast, working to stop the bleeding before they applied Steri-Strips and gauze. When I was finally allowed to sit up, I was trembling uncontrollably, with cold or adrenaline, I wasn't sure. I sat on my hands while I waited for the doctor to return.

When she came back, she told me again that she'd gotten almost everything, and that I could expect a "big ole bruise, no extra charge." I laughed, not because it was funny, but because it was over.

*

We grew up going to my dad's parents' house for lunch after Mass every Sunday. My grandpa was the family patriarch, soft-spoken, a mumbler of magnificent proportions, Army veteran, entrepreneur, my father's mentor and best friend. I remember him in white muscle shirts when I was a little girl, when he would let me hang off his arm while he bicep curled me. He misspelled my name on every birthday card ("Katy"), and he said, "Love you, mija" every time we left his house. My dad always kissed Grandpa on the cheek as we said goodbye, saying, "Love you, Pop," and Grandpa returned it. I loved seeing two strong men so unafraid of being affectionate with each other.

Grandpa.

It was his dentist who sounded the alarm. Grandpa had gone in because his dentures weren't fitting right, and the dentist saw something he didn't like. When my grandpa followed up, there it was again, that word we’d all come to dread, to feel deep in the most frightened, painful parts of us: cancer. It was in his jaw, likely from his days of drinking and smoking (same as Poppi). They would have to operate, remove as much as possible, and then he would need radiation. My grandpa responded with his typical matter-of-fact stoicism: “Oh, well,” he said. “You play, you pay.”

The surgery was brutal. They took most of his jaw but couldn’t get all of the cancer. His face was radically changed, and if he was a mumbler before, now he was nearly incomprehensible—except to my dad, who always seemed to know what my grandpa needed to say even before he tried to say it. The radiation burned his mouth and throat, making eating a torture. Thanksgiving came, and I remember him falling asleep in front of the football game at my uncle’s house. It was a grotesque parody of normalcy.

He was diagnosed in August, and in March, the call came. My mom, this time, in the hardest call, she says, she’d ever had to make. I was in my home office in Austin, alone, and I didn’t know what to do when I hung up. I felt baffled and disoriented, stumbling onto the upstairs deck and falling to my knees. I no longer prayed the way I used to when I was a kid, and even then, I never prayed the rosary outside of funerals, but now I said those Hail Marys and Glory Bes one after the other in a feverish dream. Grief surprises you, strips you down, takes you to places that are new and familiar at the same time, primordial and ancient. So I knelt and prayed and it sustained me until I could be with the rest of my family.

*

I was supposed to ice my breast and wear a tight sports bra for the rest of the day, but the pressure hurt, so I took the bra off before I climbed into bed for a nap. I woke up to a deep, foreign pain, a throbbing soreness that made me lift my shirt to look at the gauze: the white had turned a bright, startling red, and as soon as I sat up, blood trickled down my ribcage. “Shit,” I said, texting Adrian a photo and telling him I was going to call the doctor. She told me to come back in right away, and Adrian immediately left work to drive me.

In a different room than I’d been in before, Dr. McKay and Lori helped me remove the sports bra and put on the pink gown. They peeled off the gauze and Steri-Strips and told me they’d have to extract as much blood as possible to avoid my forming a golf ball-sized hematoma beneath my skin. The incision had opened, Dr. McKay said, and I glimpsed an inch-long slice of skin that their fingers worked around, and while Dr. McKay pressed and Lori dried the blood off my skin, Dr. McKay told me of her children, one of whom is still at A&M, and I told her that my siblings and parents had gone there as well, that I was the outlier going to Southwestern, and she said her husband had gotten a teaching job there, but she couldn’t find a job in Georgetown so they’d stayed in San Antonio. When my blood spurted, she joked, “This is why I don’t wear glasses anymore.” (At least, I hoped it was a joke.) It hurt like hell, but again, I was glad for them. They understood this intensely vulnerable space in a way no man, whatever his talent or experience, ever could.

They rewrapped me and gave me more Steri-Strips and gauze to take home, just in case. Dr. McKay wrote her cell number on a business card and handed it to me, telling me to call her any time, day or night, if I had questions or concerns.

The next day was my birthday, and the last thing I felt like doing was celebrating. But I’ve always subscribed to the practice of trying to look my best when I feel my worst. (A new birthday dress and the stunning Jimmy Choos Adrian gave me offered a nice head start.) We went out with some of my best friends that night, drank prosecco, laughed, and I was so glad I hadn’t canceled.

The next day, we went to Austin for Halloween weekend. It’s become a tradition—dressing up, drinking too much, dancing, making the kind of absurd and hilarious memories that come up any time a funny story is warranted. I dressed as Wonder Woman. Just beneath the left strap of my ridiculous shiny dress, the gauze bulged slightly and a bruise was spreading a web of color across my skin. I couldn't help feeling like the costume was a private joke with myself, an unmissable irony at the same time as an obvious truth: isn't that most of us, showing the world what we perceive to be our strongest, brightest selves while the source of that power actually lies in our hidden wounds?

Back home on Monday, gauze off.

*

My parents grew up across the street from each other. They met at fourteen, became best friends, fell in love--they only ever dated each other. My mom's older sister met her future husband around the same time. He was all motorcycles and cigarettes, handsome as a movie star, my mom says; a rebellious teenage girl's dream. I knew him, of course, as my uncle. Still handsome, gruff, with bright hazel-green eyes. He was a smoker as long as I knew him, and yet, it was still a shock when he was diagnosed with lung cancer. He fought it hard, undergoing treatment and quitting a lifetime habit cold turkey, as I understand it; my aunt and another uncle also quit smoking.

I was in Australia again, this time with Adrian, when I got the call from my mom: he hadn't made it. My mom's voice was thick with grief and a sort of awe: he was her age. He had so much life left.

*

A few years ago, I helped a client write a book about his radical approach to treating his stage four cancer: rather than embracing the war terminology around cancer ("courageous battle," "fight it," "kick its ass"), he was going to love his cancer. Not the fact that he had cancer, of course, but the cells themselves, because they were, after all, his cells--only sick. I learned an immense amount from him. One of the things he talked about was how people reacted to his cancer. There were those who said they'd pray for him, and those who said God never gives us more than we can handle. There were those who told stories about friends or family members who'd survived their cancer, as if somehow their survival and his were correlated. There were those who recalled people they'd lost with such grief that my client ended up comforting them. My client found himself simply wishing for acknowledgment. No one could fix this for him. There was no right thing to say (and plenty of wrong things). All he wanted was for people to say, I know this is hard--how can I be of support to you?

In the six days between my biopsy and the results, I found myself thinking a lot about this client, understanding more than I ever wanted to what he meant by acknowledgment. My best friends and family, too, had varying responses, and my reactions to some of them surprised me. When my mom went to the chapel to pray for me, and when one of my best friends said she would pray, too, I appreciated it because I knew they would. They would extend their spirit and their love for me into the unknown, and I loved them for it. Then I had a friend who immediately did some research and said, "The good thing is that even if it's bad, it should be really early." I appreciated that, too. Honesty is comforting to me. Facts are things I can work with; it was why I'd asked the doctor for percentages. I sent my friend photos of mammograms I'd found online that looked like mine and thanked her for not telling me everything would be okay. Adrian, of course, told me everything would be okay. I knew what he meant--No matter what happens, we will figure it out together--but the words frustrated me just the same. Quietly one night, I told him that him saying everything would be okay felt dismissive of my fears and of the very real possibility--one in three, right?--that the results would not be normal. He held me and let me cry, and that was what I needed--for someone else to to be strong so I didn't have to pretend.

*

I've always believed that the most important, life-changing moments, the ones you can't plan, happen when you are not looking for them. I'd been calling both my primary care physician's office and the breast center all week, asking after the results. My phone had been glued to my hand, the ringer on loud. I kept clicking on the home button, just to make sure I hadn't missed a call. But when it came, there I was, trying on shoes with my mom, and it took me a second to remember the significance of a ringing phone.

When I saw the local area code, though, I knew. I wished I had privacy, but there was nowhere to go. I stood up, one foot encased in that black boot and the other in a low athletic sock, claiming at least that one spot, that tiny patch of carpet, as my own for whatever came next.

"I'm calling about your biopsy results," said a woman, after introducing herself.

"Yes," was all I could say, and it was as if I'd gone blind, everything around me swirling white.

"It came back normal," she said.

"It did?" I gasped and immediately burst into tears, laughing and nodding at my mom, and I think I hung up on the woman as my mom jumped from her chair to hug me. I could feel her heart pounding against mine, we were both shaking and crying, and, to the sales clerk who'd politely stepped away and was pretending not to eavesdrop, my mom called, "Don't worry, it's good news! It's very good news."

*

My dad and Adrian met us a few hours later for celebratory wine. We kept repeating some variation of, "It's a good day." I was still in shock, exhaling big shaky breaths. In some ways, I was more emotionally prepared for the other kind of call than I was for this one. Normal. I couldn't believe I got to be normal.

On the drive home, I lowered my windows and turned the radio volume way up. The wind poured in, heavy and humid and tasting of rain. I remembered being seventeen years old, driving fast in my Ford Explorer, singing over the wind, feeling absolutely invincible with youth. It's been a long time since I felt that way. This last year has kept reminding me just how fragile life is, how quickly it can all change. But last night, driving home, I remembered that feeling. I grabbed it from the air, from my memory, and I held it hard.

*

I'm writing this because, well, I'm a writer, and this is how I process the world. But I'm posting it in the hope that it will do someone some good. That it will remind someone to go back for that follow-up, or for that first mammogram, or maybe to check for the BRCA gene. Or that it will encourage someone to rethink how they're supporting someone they love who has cancer. Or just that it will make someone think of those they've lost, and spend a little time in those memories. Most of the time, writers never know if or how their words affect people. We just hope they do, and that somehow, it's for the good.

#biopsy #cancer #breastcancer #breastcancerawarenessmonth #family #health