No News is Good News

Count All This — Chapter 24: Surgery

Just when Jo Kasten’s son encounters schizophrenia, she discovers she has breast cancer. Meanwhile, her marriage faces a test. Count All This is a story about love and loyalty, addiction and madness. This is the twenty-fourth chapter. Find the first chapter here.

The night before surgery we tried to behave as if nothing unusual was happening, but my nerves hummed. I felt like I was being tumbled by a big wave at Santa Cruz. “Don’t fight it,” my parents had told me as a child. “You can’t beat the ocean. Roll with it. Press your body flat against the sandy bottom and wait for the wave to pass over. Then swim up.”

Larry cooked dinner; I wasn’t hungry. Jane arrived and set up a sleeping bag on the couch. Eddy announced that he would come to the hospital with the rest of the family. I felt a moment of hesitation, but didn’t want him to see it. Would my newly-diagnosed son make a scene at the hospital? Run amok amid the scalpels and the antiseptic?

“Are you sure you want to?” I asked timidly. He didn’t answer. “Okay. That would be nice.”

After dinner, I wanted to watch Harold and Kumar go to Whitecastle. We didn’t have the usual debate. It was my party. I got to decide. I had a crush on the Indian actor who played Kumar, and even though I’d heard the silly jokes about farting, and smoking pot, half a dozen times already, they still made me laugh. We sat on plush seats in Larry’s makeshift theater, black silhouettes before the bright colors on the big screen. The scene in the operating room made me squeamish, but it was over quickly. Once the movie ended, we synchronized our alarm clocks, agreed on the lineup for the morning showers, and went to our rooms.

I huddled up to Larry in the darkness. I remembered the story of my father’s reaction to my mother’s mastectomy. How he’d taken one look at the wound and then run to the toilet to vomit. I thought how my soft breast, my welcoming cushion, my womanly embrace, would be exchanged for a lopsided bone cage in the morning. Lopsided because one side had been lopped off. Would I still find myself beautiful? Would Larry? My whole body felt exposed and raw, as if I’d been stripped of flesh.

I woke before the alarm rang in the morning and immediately took two Ativan to calm my nerves. The house was hushed and hurried as we rose and showered and dressed in separate rooms. We took two cars to the hospital, so people could come and go independently. The surgery was expected to take three or four hours, not counting the lead time for preparations, or anything unexpected.

We walked as a group through the dark, pre-dawn parking lot and down the maze of halls to the surgery center—Larry and I in front. I wore no jewelry. None was allowed. I’d taken off my gold wedding ring that morning, along with the antique silver ring of tiny diamonds Larry had given me unexpectedly on our tenth anniversary, and the tarot pendant Karen had made. I stored them all in the plush jewelry box my mother-in-law had given me one Christmas. I had to cut off the hemp bracelet Rose had woven for me at camp. It lay on the bathroom counter at home, part of a makeshift alter comprised of sand dollars and seashells, my mother’s pale yellow tea cup.

Rose said she’d make me another, and I asked her to do it during the surgery. I liked the image of her fingers moving back and forth, intertwining the rough brown threads, placing a smooth, colorful bead, and thinking about her mother while they opened me like a package with a sharp, steel knife. It seemed like she’d be casting a spell, weaving a magical net of protection.

Larry and I paused outside the swinging double doors while the family found seats in the waiting room. Eddy sat stiff-backed and silent, as if holding the boundaries of his body together was an effort that took all his concentration. Others looked more relaxed. Everyone was seated in the dark little room, when Larry and I passed through the doors, into the burning light.

“Hello,” I told the nurse behind the counter, as if I was checking into a hotel. “I’m here for a mastectomy.”

First we were led to a changing area where I took off my clothes and put them in a little locker. They gave Larry the key. I wore my hospital gown with the opening in front, as they had instructed, and little paper booties, as we walked to my designated bed. A nurse drew the curtain around us, and came inside. I lay on the bed. Larry sat in a chair beside me. The nurse asked a few questions about when I had last eaten, and what medications I had taken, before taking out a black felt pen and writing “yes” on my left breast and “no” on my right one.

“How do they know that ‘yes’ means remove this breast?” I asked. “What if they think it means to keep it?”

“This is the way we always do it. They know what it means.”

While she was writing another nurse came in with a pair of white tights she asked me to put on. “These will keep the blood flowing in your legs during surgery. We hook them up to a machine, and they massage you.”

“That sounds good. But why would the blood in my legs stop flowing?”

“Because the anesthetic slows down your heart. Because you lie so still for so long.”

After I pulled on the tights, she asked if I wanted a tranquilizer to make me fall asleep before they wheeled me to the operating room. “Yes,” I told her. Yes. Yes. Yes.

I drank the orange liquid from a small white plastic cup. The nurse left, pulling the curtains shut. Larry climbed up onto the bed, squeezing tight against me, putting his arm across my soft belly, directing his ragged breathing into my neck.

I saw our bodies from above, as if in a movie, the camera mounted high on the ceiling, looking down on us. My dyed-red hair splayed out on the white pillow, my bright blue eyes looked straight up, into the camera. Larry’s black shape and my blue-speckled one intertwined together on the hospital bed.

There was a moment in recovery when a large, distorted face leaned over me, shouting, as if from a distance. Can you hear me? Wake up!

Is something wrong? Am I dying?

Then two people were rolling me into an elevator, one at the head of my bed and one at the foot. We took up all the space. They brought me to a big room with bright windows and a little sitting area with a table and chairs, a long couch. It looked to be the nicest patient room in the hospital. I figured my boss Mandy in the Planning and Marketing Department must have arranged it.

My sisters and children came and kissed me, and smiled, and set themselves up in the sitting room. Jane unpacked the family’s favorite board game, Settlers of Catan. Eddy and Rose and Claire pulled up chairs around the table, unpacking the little colored pieces, stacking up the different cards, giving the room a homey feel. Larry sat near me, by the head of the bed. My entire chest was wrapped tightly in bandages. I wanted to lift the gauze to peer under it, but I couldn’t. I could see the left side was flat, the right slightly swelling. So at least they had taken the correct breast.

Then Dr. Tarsa was sitting beside the bed, reporting. “The surgery went well,” she said. “We got all the breast tissue, with a good, clean margin around the DCIS. But we did find some cancer in the lymph nodes.” She was brusque.

“You did?” I stared. She’d told us before the surgery that if she did not find any cancer in the lymph nodes, my chance of recovery was 90-something percent. She hadn’t talked about percentages if she did.

“The good news is it wasn’t much,” she went on brightly. “We did the sentinel node biopsy during the surgery, as I told you we would, and found cancer there.” She lapsed into reverie. “You almost didn’t even have to do the biopsy. You could feel it — the node was hard.”

Then she looked at me expectantly, as if this detail would impress me, as if the relative hardness of lymph nodes was something I could appreciate. But all I understood that the unusual condition of my lymph node was interesting data to her. I felt like a lab rat.

“So then we took out about 18 more, and though the lab results aren’t back yet — so it’s not official — it looks like there was cancer in only two of the 19.”

I looked at Larry and noticed that the rims around his eyelids were red. He held the bed’s remote control in one hand and slid the other up and down the cord. I knew the news wasn’t good, it wasn’t what we had hoped for, but Dr. Tarsa’s tone sounded positive, which confused me.

“What does that mean?” I asked.

“What it means is that your treatment isn’t over. I’ll refer you to a medical oncologist, who will manage your care from now on. There will be chemotherapy and radiation, probably. But the surgery definitely was a success. We got all the cancer that we could see, with a good margin. Now you’ll be going after any rogue cells that might have escaped through the lymphatic system and be lurking somewhere else in your body.”

“But I thought DCIS didn’t travel.”

“It doesn’t, normally, if you catch it soon enough. But if you don’t, it changes into invasive cancer.”

“So that’s what was in my lymph nodes — invasive cancer?”

“Yes.”

“Okay,” I mumbled. “When will I start chemotherapy?”

“That will be up to your oncologist. You’re going to have to recover from surgery first, which will probably take a couple of weeks. But I’ll get the referral in the meantime, so you can meet with your new doctor and plan out the next steps.”

Then Dr. Tarsa left. Then Larry climbed up onto the bed beside me and buried his face into my neck. My sisters and children continued playing Settlers in the sitting room, pretending not to notice his crying.

I held onto Larry and looked down at my bandage, trying to envision what was underneath. I could see almost nothing, just a flat plane on the left, a slight swell on the right, and a glimpse of black marker peeking out from under the bandage — just the tips of the letters that spell the word “No.”

That was the twenty-fourth chapter of my novel, Count All This. To continue, follow the free chapter links below or buy a digital copy of the whole book on Amazon, where leaving a rating or review will help others find my story.

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