An Intimate Life (36 page)

I had a small lump on my right areola that my radiologist initially speculated was a blocked milk duct. A mammogram picked up a number of tiny, suspicious-looking spots, but no one used the c-word yet. I was told to have another mammogram in six months. “We’ll keep an eye on it,” the radiologist said. I trusted her judgment and left the hospital relieved. Six months later when I dutifully returned for the follow-up screening, I was advised that nothing had changed and that the best course would be to remain vigilant and continue with semi-annual mammograms. Once again, I went about my life confident that I was in no imminent danger. Coincidentally, a few days after my second test, my old pal Barbara, a fellow surrogate, called to tell me that our mutual friend, another Barbara, had undergone a lumpectomy after being diagnosed with breast cancer. As soon as we hung up I called the other Barbara to see how she was recovering. We chatted for a bit and I asked what her symptoms were. “Well, at first they told me I had a blocked milk duct,” she said.

The next call I made was to Evelyn, another surrogate, who had had a mastectomy several years earlier. I explained my situation, and she gave me what in retrospect was the best advice I could have received. “Tell them you want a stereotactic biopsy.” Within a week I had an appointment for one, and for a biopsy of the lump on my areola.

When Dr. Whitney walked into the exam room she had a serious look on her narrow face.

“I have breast cancer, don’t I?” I said.

“Yes, you do.”

I had infiltrating ductal carcinoma. She sat down and spread out the results from the stereotactic biopsy across her lap.

I felt like I was hovering above my body as I watched the scene play out.

“I’m going to take the biopsy of the lump. I’ll have the lab analyze it and we’ll get the results in about twenty minutes. Lie down and relax and I’ll be back soon.”

“I’m fine,” I said in disbelief.

“Cheryl, you’re in shock. Lie down and when I have the results we’ll take all the time we need to go over them and decide what to do,” Dr. Whitney said.

I lay down, but as soon as the door closed I jumped up and pulled my phone out of my purse.

I dialed my friend Joanne’s number. “I have cancer. I have cancer—again,” I told her, trembling.

“Come over here as soon as you can,” she said.

Then I phoned the nutritionist I had worked with when I had lymphoma.

“Have them send me all of your lab work. I’ll put together a plan for you. We’ll work together like we did before,” she told me, concerned but firm.

I was instinctively, immediately reaching out to my support system. Once again, I resolved to do everything I could to survive. I put away my phone and eased back on the exam table, crinkling the paper that lay over it. I took slow, deep breaths until Dr. Whitney returned.

She did a needle biopsy on the lump and soon we were discussing how we would treat the now undeniable cancer in my breast. The cancer in the lump was the same as that in my breast, which is not always the case. I learned that there are over forty different kinds of breast cancer and women can have more than one type simultaneously. Infiltrating ductal carcinoma is one of the most treatable, especially when caught in stage one, as was the case for me.

“I would recommend a mastectomy, given the number of small tumors,” Dr. Whitney said.

The mysterious spots that the mammograms had picked up were actually tiny, one-millimeter tumors clustered together in one quadrant of my breast. They were so small that at first Dr. Whitney could barely make them out.

“Fine. Should I let you take the other breast too?”

I wanted the cancer gone and I wanted any chance of cancer in my other breast to go along with it. I didn’t like the prospect of losing both breasts, but I liked the possibility of having to undergo treatment again even less, and in that moment my suggestion seemed logical.

Dr. Whitney assured me that I had a relatively low chance of developing cancer in my left breast and that only the right needed to be removed. When they performed the mastectomy, they would take out a few of my lymph nodes to be sure the cancer had not spread to them.

I asked her if this cancer was related to the lymphoma I had survived years earlier and she answered with an emphatic no.

One of the first things I did when I got home was find a breast cancer support group. I had joined a group after my lymphoma diagnosis and had found it to be a powerful adjunct to my treatment.

I had my mastectomy in February 2006. Luckily, the cancer had not spread to my lymph nodes and I wouldn’t need chemotherapy or radiation. I was sent home with two drainage bulbs dangling from my right side, below my armpit. I had to measure the amount of fluid in them every day so they could see that it was diminishing. I also had a fluid-filled flexible plastic expander in my chest to prepare my skin for reconstructive surgery, which would take place in April. Once a week I visited the reconstructive surgeon to have fluid added to the expander so that my skin wouldn’t contract. Most of the time I was uncomfortable, but I was rarely in pain. Apart from the first day or two after the surgery, I didn’t even take the Percocet that had been prescribed for me.

The mastectomy impacted my body image significantly. I’d grown to accept and love my breasts, even though they weren’t the perky mounds I had always wanted. I loved having my nipples sucked and played with during sex. The reconstruction would bring my shape back into balance, but I knew that the sensitivity in my right side would be much less than what I was accustomed to feeling.

I had to remind myself that I was more than my breasts. When I finally said it out loud to a friend it seemed so obvious that I hardly had to repeat it to myself or anyone else. In a way I had to relearn what I had discovered in my modeling days: An imperfect body could still be a sexy body. True, I would have to accept a loss of sensation, but I still had plenty of ways to receive pleasure.

Fortunately, Bob, once again, proved to be a supportive and devoted partner. When he learned that the cancer hadn’t spread into my lymph nodes his relief was on par with mine. He nursed me throughout my recovery, and our intimate life stayed strong. He often told me that all he wanted was for me to regain my health and that the worst thing he could imagine was that I would feel that I was somehow less appealing to him.

As I looked forward to the reconstruction, I began to think more about how the change in my body would affect my work. My greatest concern was that it would shift the focus of my interaction with a client to me, when it should be on him. I believed that clients needed to know about the mastectomy because my right breast would look and feel different from my left, and I didn’t want them to be distracted by that. One day I brought up my fear in my support group. Dr. Renaldi, one of two psychotherapists who led the group, asked me how I thought I should address the issue with clients. Having the opportunity to talk out a plan was exactly what I needed at this time. I decided that I wouldn’t mention it in the earliest part of the work when I was interviewing the client about his history, issues, and goals. I would reveal it only when we moved to the bedroom, and I would discuss it matter-of-factly. No great announcements, just another item on the checklist of need-to-know information. If I didn’t want a client to overly focus on my mastectomy, I had to be sure I kept it in perspective too.

I had another question that wouldn’t be answered so easily. I struggled with how I would talk about my breasts in the mirror exercise. Cancer would become part of the story of my body. Lymphoma may have been a more frightening diagnosis and a more grueling recovery, but my body had remained externally intact after it. Now, when I stood before a full-length mirror with a client following along, I would have to address the differences in my breasts. The new vocabulary I would need for this was nowhere in sight, but I had a feeling it would come in time, as I healed.

The reconstructive surgery didn’t even keep me in the hospital overnight. To help me look more even, the surgeon lifted my left breast and moved the nipple slightly upward. A silicone implant went into my right side.

It didn’t take long to realize that the surgery was a success. Under a bra and blouse my breasts looked even and unremarkable. When I undressed the difference between the two was evident, but not startling. What was more complicated was coming to terms with the loss of sensation. My new right breast had some faint sensitivity, but that was it. Once it healed I had to decide if I wanted, for aesthetic reasons, to have a nipple constructed from surrounding tissue. The appearance of my new breast sans nipple was fine with me, so I opted to pass on it.

One of the many lessons I have learned from working with disabled people is the importance of focusing on what you can feel and experience, as opposed to dwelling on limitations. Doing away with preconceived notions about how and where you should feel pleasure and training your attention on where you do feel it can sometimes make you forget that you have nonreactive areas. I’d seen disabled clients awaken to sexual feelings and often be surprised and delighted by it. It was time for me to apply this bit of wisdom to myself. So, I no longer had two sensitive breasts. I still had one, and a partner who never shied away from reimagining our life in the bedroom. And that was plenty.

Scott was the first client I saw after returning to work, five months after my diagnosis. He was coping with an overriding fear that his penis was too small, and he had gone to drastic measures to enlarge it. A doctor had given him injections, which, instead of growing his penis, slightly misshaped it. The last thing he needed was my body image issues spilling over into our work together.

I held to my plan not to mention my mastectomy right away. From the outset, it had to be clear that he came first in our work together. When we undressed, I told him about my surgery, and invited him to feel my breasts. Scott cupped my right breast in his hand and lightly squeezed it. He did the same to the left. “The right one feels harder,” he said. “Yup, they still haven’t perfected reconstruction.” Then we set about tackling his issues and the topic of my mastectomy didn’t return.

Once again, I had learned the value of simple, straightforward communication and of appreciating the full breadth of sexuality. When a client finally comes to see a surrogate he is ready to work on himself, and a slightly lopsided bust has yet to prove a problem in my work.

In the third session with Scott, when it came time to do the mirror exercise, the new narrative of my breasts, which I had only begun to formulate, unveiled itself to me. As I looked at my reflection I said, simply, “I have had breast cancer, but was lucky that it was caught early. I had to have my right breast removed and reconstructed. Now it’s not nearly as sensitive as my left. Even so, I like it to get equal attention.”