Beginnings: Biopsy

On a Friday morning in early June I kissed my husband of nine months Steve good-bye and headed to my scheduled doctor’s appointment. I was having a couple of cysts aspirated—a routine procedure for me, as I’d had benign, fluid-filled cysts making regular appearances in my breasts since I was thirty. My annual mammogram, which I’d had the week before, had been clear. I typically had a follow-up ultrasound because of my dense, and busy, breast tissue, but I’d opted out of it this time. The radiologist didn’t think it necessary, and I knew I was heading back for the aspirations, anyway. I figured it would take about an hour to drain the one or two cysts in each breast that were bothering me, and then I planned to head to the office to finish the one last report standing between me and summer break.

The large cyst in my right breast had, as they sometimes did, already calmed down on its own; I wondered whether it was even worth bothering with it. My left breast still felt swollen and tender, though, so I kept the early morning appointment.

The attending nurse and the ultrasound technician arranged me on the table, placing a pillow under my left shoulder and asking me to curve my arm over my head, lifting my chest. The surgeon joined us and asked for the location of the cyst to be drained. I pointed him to the lower outer quadrant of my left breast.

“Oh, yes, I can almost see it there,” he said. With my body contorted, the lump under the skin was nearly prominent enough to spot with the naked eye.

The doctor located the cysts, per usual, with ultrasound. I always watched the images as they appeared on the monitor next to my bed. Each breast typically featured a multitude. They looked a bit like photos I’d seen of black holes, or solar eclipses: a black center, with a clear light-ring around the edges. As the surgeon rolled the wand over my left breast, I noticed something odd on the monitor. There was a dark mass, but unlike the manifold cysts I’d seen on the screen over the years, its border was irregular, furred.

“That doesn’t have the defined outline that a cyst usually does,” I said.

The doctor kept rolling the wand back and forth, back and forth. “No, that doesn’t look like a cyst,” he said quietly. “I think we’re going to need to turn this into a biopsy.”

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Just a few nights before, my husband Steve and I had been lying in bed, talking about what a crazy, busy year it had been. We’d bought a new house together, moved and combined our two households, moved each of his two sons into their first apartments, planned our wedding and gotten married,  and graduated the youngest son from college. We’d both worked the full academic year as professors, and there’d been some work-related stresses for both of us. Steve had, in fact, just started a new job with a research non-profit, while I was wrapping up teaching a three-week intensive learning course that included camping and rafting in West Virginia. Our new life together was good, but we were exhausted. “I bet we’d score off the charts in one of those life-stress tests,” I joked, and Steve agreed.

When I awoke the next morning, our conversation still on my mind, I searched online and found the Holmes-Rahe Stress Inventory, which assigns point values to significant changes (positive or negative) in a person’s life. Curious, I completed it—and scored a whopping 412 points. According to the inventory, any score over 300 increased by 80% my chances of having a “major health breakdown” within the next two years. I understood the score as proof positive that our past year had, indeed, been stressful and eventful. At the time I didn’t think much about whether it might actually predict my future.

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I went straight home after my appointment and called Steve. The doctor had completed a core needle biopsy of my left breast, taking three separate samples of the mass they’d found. In some discomfort, I decided to skip the office and work from home. I threw myself into finishing the report, then began packing. Steve and I had planned a weekend at the Peaks of Otter, a rustic lodge and restaurant off the Blue Ridge Parkway, overlooking a small lake in the valley below Sharp Top and Flat Top mountains. We wouldn’t have any answers until Monday or Tuesday, so we went ahead with our getaway.

Having the fact of your mortality plunked down in your path recalibrates perspective, turns up your awareness. We stopped on the way to the Peaks to browse art and antiques in nearby Bedford. A light breeze lifted and chuffed my hair as I rounded a corner onto Main Street. I thought: pay attention to this pleasure; you won’t have it long if you lose your hair to chemotherapy. Later, walking along a forest trail, I noticed tiny details: unremarkable mushrooms, striking patterns of bark on trees.

We tried to stay positive. I researched “benign breast tumors” on my phone, looking for descriptions of all the possible permutations that matched my symptoms. In a lighter moment, Steve looked at me with a tender smile and twinkly eye and said, “I thought of this earlier, but I wasn’t sure I should say it—I don’t mind if you have one Sharp Top and one Flat Top.” He reassured me that even if we’d known for certain we’d face this moment before we’d walked down the aisle, he still would have chosen to marry me. We’d had so little time together, and we wanted so much more.

The next morning, as we strolled the path around the lodge’s lake, we met Ranger Neas, who pulled fossils from his backpack that showed the Roanoke Valley was once an ocean, and asked us if we were familiar with Einstein’s theory of relativity and the time-space continuum. We’d asked him about trees, and ended up talking about time. Instead of understanding time as relative, he asserted, we’ve become slaves to our human construct of time and the belief that time-is-money. “But nature doesn’t do that, the mountains don’t do that,” the Ranger said. I was reminded of Aldo Leopold’s “Thinking Like a Mountain”—the mountain takes the long view, even as it understands the value of the smallest interaction. We could choose to change our relationship to time, the ranger urged. Instead of the clock being life’s measure, we could choose beauty, joy, love—the richness of the life we live. We could learn to understand, value, spend time in ways that are more meaningful.

My own relationship to fate and faith is ever-changing, but our conversation with the ranger felt something more than coincidental.

Each evening during our stay, Steve and I held hands as we sat outside on our room’s balcony, tracking the stars as they appeared to move across the firmament. We tried to describe the different shades of dark that were the sky, the water, the mountains, pondering whether reflected moonlight was silver or some other color. When I saw a single falling star, I wished, and hard.

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The call came, as promised, on Monday afternoon. The radiologist’s phrasing stuck with me: “I’m sorry to tell you, it is a cancer.” A cancer: singular, specific. It felt somehow less all-encompassing, stated that way—a thing that was, a thing that existed, not a blanket pronouncement of my fate. I was grateful for that, and for the kindness in his voice. “We’re going to fix this,” he said. “I hate it, since you’re so young. But we’re going to fix it. It’s a garden-variety—if there can be such a thing—intermediate-grade breast cancer. And we’re going to fix it.”

I hung up, cursed, cried. Steve and I walked a few fast laps around the park across from our house, amped up on adrenaline. After we’d burned off some of the shock, we decided to have dinner at the local restaurant where we’d shared our first date.

There, as the sun set, it created star-shaped shadows from the lamps hanging behind the window shades. There was still much we didn’t know. The waiting had begun.