Rural Routes, Blog Version

This was written several months ago. If you have not heard from me, this explains why. If you have heard too much from me, this also explains why. I have passed the one year mark now and the shadow recedes.

     My button-down top was inside out. I stood outside on a city sidewalk, and I was mortified. There was nowhere to hide.

     I had felt disoriented all morning. When the nurse told me to face a certain way during my regularly scheduled mammogram, I turned the other way. Left and right had lost their meaning. So apparently had inside and out.

     After the mammogram, I had simply thrust my head through the open neck and slipped my arms inside the sleeves, not noticing that the loose-fitting garment had turned inside out when I had taken it off earlier. I wondered if the nurse noticed when she showed me the way to the exit. When my husband drove up, I got in the car and slouched down in the seat to right my clothing.

     Less than a week later, I received the letter from Cancer Care Manitoba.

     “An area of concern was seen on your mammogram that requires further examination. Breast Health Centre will contact you directly.”

     “Directly” meant later that same day. I was scheduled for an ultrasound and possible biopsy the following Friday.

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     The waiting room at the Breast Health Centre reminded me of mothers and mother’s milk – nourishing, warm, with sculptured angels in attendance.

     My name was called. Once inside the patient room, I took off my top and bra and donned two hospital gowns, one with the opening at the back, the other serving as a robe.

     After the ultrasound was completed, the technician decided that, yes, a biopsy was in order. Local freezing was applied to my right breast and a tissue sample was taken. The technician also inserted a tiny piece of titanium into my breast, explaining that it would serve as a location marker in the event that surgery was necessary. It would be removed during the surgery. If there was no need for surgery, the titanium would stay inside my breast. He assured me that there was no danger involved and the metal would not set any bells ringing if I went through airport security.

     An appointment was already scheduled for a visit with the surgeon. If the biopsy came back negative, the appointment would be cancelled.

     The technician and nurse left the room so that I could get dressed again. The nurse had returned to the room when I got a look at myself in a mirror.

     My top was on back to front. This is not good, I said to myself.

     I asked the nurse to direct me to the nearest bathroom. Once inside, I slipped my arms out of the sleeves and rotated the fabric around my neck until the garment’s front was where it should be.

     That evening at a family meal, I revealed the presence of titanium in my breast.

     “Your mother is Superwoman now,” my husband said.

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     A week later, my family doctor phoned with the biopsy results. I had just logged into a Zoom session for a writers’ group that I lead, but I left the discussion to take the call.

     “I’m sorry to tell you this. It is not good news,” my doctor said. He has been my doctor for close to thirty years.

     I returned to Zoom and completed the session but was discombobulated throughout.

    My husband wondered why I hadn’t just begged off and let the meeting go ahead without me.

    “I don’t know,” I said. The older I get, the more I don’t know.

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     My husband accompanied me to the next appointment at the Breast Health Centre where I was introduced to my surgeon and presented with a copy of the pathology report from my biopsy.

     There were forms to fill out and a nurse reviewed the pathology report with us. Another document detailing the likely treatment schedule was shown, and the nurse highlighted in yellow the sentences and lines applicable to my particular scenario. Surgical removal of the tumor first of all. Some lymph nodes would also be taken. Whether or not cancer showed in the lymph nodes would determine the next steps – chemotherapy if cancer were present, radiation if not. Then anti-hormonal therapy.

     She described what would happen during and after surgery and outlined the recovery process. For several weeks, I should not attempt any activities that required back and forth arm movement. The examples given were vacuuming and ironing.

    I own an iron but am not exactly sure where it is stored in the condominium we purchased when we retired from farming. It has been a long time since I used it, and I donated my ironing board to a thrift store when we moved. Giving the task up for a few weeks would not be difficult. Leaving the vacuum cleaner in its storage spot for a while, however, would be a gift.

     “Are you Jewish or of Icelandic descent?” the nurse asked while going over the medical forms I had filled out.

     “Three of my grandparents were Icelandic, yes, but what does that have to do with breast cancer?” I asked in turn.

     It turns out that there is an Icelandic mutation in the BCRA2 gene which increases the risk of breast and other cancers. A similar mutation affects Ashkenazi Jewish women.

     Later, I would be told that if my medical appointment had been held in any Canadian city other than Winnipeg, the Icelandic connection would not likely have come up. In Winnipeg, though, Icelandic connections run deep. Hundreds of Icelanders emigrated to Manitoba in the late 1800s. The bloodlines are well diluted by now, but according to Statistics Canada, Manitoba is home to the largest Icelandic population outside of Iceland.

     A social worker told me she was available to talk at any time and asked me if there was anything I wanted to ask her.

     “There is one thing,” I said. “I have a younger sister with metastatic breast cancer which is incurable. She has been on chemo for three and a half years. I feel guilty even worrying about the little tumor found in my breast when her situation is so much worse.”

     No guilt, she told me. No making comparisons. Your sister’s story is not your story. You have a right to worry. This is the big C after all.

     She advised me to seek out credible sources of information, but to avoid personal blogs. “People want to document their journeys, but you are on your own journey and their experiences may not be helpful.”

      I did not tell her that I like to call myself a writer and have a blog of my own.

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     I arrived at the hospital early for my 8 a.m. pre-op appointment with an anesthesiologist. The meeting had previously been scheduled for 10:30, but I needed to be in Neepawa, MB at 1:00 and I moved the appointment forward so that my husband and I would be able to get there in time. We were going to my cousin’s funeral. She was five years younger than me and had died of cancer.

     “I want to talk to you about your heart test results,” the anesthesiologist said. “It will not affect your surgery but needs to be looked at.”

     I did not remember having an EKG, but what did I know? I couldn’t put my clothes on properly.

     She showed me the abnormal sections on the graph report.

     “I am going to refer you to a specialist,” she said, adding that I did not seem to have a family history of heart issues.

     “Actually, I do, “I said. “My mom died of a heart attack, and her dad did, too. And my mother’s two brothers also had heart attacks.”

      “Oh?” she said and looked at the file in front of her. “This is the wrong one,” she said and slid the brown folder onto a shelf above her.

     She led me into the reception area and instructed the staff person there to contact the heart specialist.

     “His office will call you with an appointment date and time,” she told me.

     I walked down the corridor, made a left and then a right and pushed the button for the elevator. The dim light made it impossible for me to read the report she had given me.

     Once on the ground floor, I dug my reading glasses out of my purse and took a clear look at the reports. The patient name at the top of the report was not mine.

     Back up the elevator I went, back down the hallways and into the anesthesiologist’s office. I handed the papers over to the receptionist.

     “I was given this, but that is not my name,” I said.

     “Oh, that’s not good.”

     “It is very good for me,” I thought, but did not say it aloud.

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     The first drive of the day when my surgery was scheduled was to a hospital where a thin wire was inserted into my breast leading to the titanium marker.

     After removing the gowns and once again dressing in my street clothes, I was relieved to see in the mirror that everything was as it should be: outside-out and front-to-front. A good sign, I thought.

     The second drive of the day was to another hospital where the surgery would be performed. Not every hospital has the equipment and/or qualified staff to perform the wiring procedure, which is why I needed to visit two hospitals that day. I was sent to Surgical Day Care and once again I donned the requisite two gowns. The term ‘day care’ amused me because I had always thought of it in relation to the young, and none of the visitors that day were children. We were all perhaps vulnerable in one way or another.

     A young male wheeled me down to Nuclear Medicine. There my breast was injected with a radioactive dye that would turn my pee blue for two days.

     “This may sting a bit,” the young man warned.

     ‘Sting’ was a misnomer. Bees sting. This was a double-edged blade of fire that sliced into my breast, widening as it travelled inwards.

     Just when I thought I was going to scream, the needle was withdrawn.

     “All done,” the young man said.

     “Thank God,” I said.

     He laughed, but I hadn’t really meant it as a joke.

     Back in Surgical Day Care, a woman approached my bed and began to prepare me for an EKG.

     “Why are you doing an EKG?” my nurse asked.

     “There’s some confusion about a previous result. They asked for it, so I am doing it.”

     “Ah, the EKG mystery continues,” I thought.

     I was given a small pill to help me relax and taken to the surgical area. Because surgical staff were running ahead of schedule that day, anesthesiology students were given the task of asking me questions in a kind of role play, rehearsing the script they would follow in a future time when they were fully qualified. Luckily, I knew all the answers, but was disconcerted by their repetition.

     When eventually a middle-aged woman took over the questioning, I was not sure whether she was the real thing or another student. A mature student, but still.

     My confusion lessened when she began to talk about my EKG results, explaining to the students that there had been some confusion about the state of my heart. She revealed that the most recent test showed some anomalies consistent with aging, but definitely not the issues earlier identified.

     As the time for surgery neared, my surgeon appeared at my side, gowned, capped, and masked so that I did not recognize her until she introduced herself.

     “Would you like me to phone your husband when the surgery is over?” she asked.

     “Yes, please. That would be nice of you.”

     She touched my shoulder before she left my bedside.

     The third drive of the day was the one that brought me home, where I talked to my adult children and then went immediately to bed.

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     In the following weeks, I would come to know the Cancer Care Manitoba location well.

     I met with a radiation oncologist to discuss what was coming next. I had a CT scan and was given tiny tattoos in preparation for my radiation treatments. I went for a mock-up session during which measurements were taken.

     On my first day of radiation therapy, I saw a poster for an information session on anti-hormone therapy in the elevator coming up from the basement where treatments are given. I made a mental note to look into that. I also saw a poster promoting a creative writing session for those who wished to put their experience into words and do it well.

      Leaving the building, I searched for my phone to let my husband know I was finished. He answered almost immediately.

     “You look radiant. You’re glowing. I don’t think I’ve ever seen you looking better,” he said.

     He and our dog were less than a block away walking towards me.

     Cancer humour is an oxymoron. But what can you do? I laughed.

     He must have thought that he had crossed a line, because the next day he brought me roses.

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     I did read one, and only one, blog written by a cancer survivor. My sister sent it to me, saying that “it covered all the bases.”

     I do not know the blog’s author and cannot attribute her words correctly; therefore, I will not retell her story in detail. I can say that, in her blog, a mountain lion became a metaphor for cancer. Where we live, we call these animals cougars. Whatever you call them, they are sleek and cunning loners that kill efficiently. Yet I prefer the mountain lion analogy because the world ‘mountain’ adds an extra layer of danger and fear.

     I tell people that I am lucky. My cancer was caught early, discovered by a routine screening. The tumor was not yet palpable. I still have most of my right breast. There was no cancer detected in the lymph nodes. The radiation treatments went well and for the next five years, I will take daily anti-hormone pills, assuming there are no adverse side effects. My story is flash non-fiction in comparison to others I know.

     “None of us get out of this world alive,” my dad used to say. He died of cancer at the age of sixty-two. He often followed it up with, “Death can’t be so bad; no one has ever come back to complain about it.” Other than the jokes, my dad never wanted to talk about the end of his life. I don’t either, but I’m still living in the mountain lion’s shadow, and I need to give voice to the thoughts inside my head.

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