“Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.”
Ken Murray, How Doctors Die, The Best American Essays, 2012
Originally published in Zocalo Public Square
By Oliver Sacks, 1933 – 2015
“When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate—the genetic and neural fate—of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.”
New York Times essay.
(Click image to enlarge.)
My annual mammogram keeps migrating. It used to fall in August, then in September, and now this year it was in October, national Breast Cancer Awareness month. The exam migrates because I receive my referral from my primary care physician at my annual check-up, and if that appointment gets delayed then the mammogram appointment gets delayed as well. Admittedly, however, I’m usually not in any rush to have my boobs pancaked between two metal plates. A week’s procrastination here or there and eventually I find my scans scheduled smack in the middle of pink ribbon season. I’m usually apprehensive enough about the exam without being deluged by reminders that one in eight women will be diagnosed with breast cancer in her lifetime. Frankly, an entire month of heightened awareness seems like overkill to a person in my demographic: postmenopausal, childless, with a maternal grandmother who died of breast cancer. I already eye a glass of alcohol with suspicion, mentally calculating the increased risk at which it puts me and hoping that the effect might be counteracted by my otherwise healthy habits. I opt out of full body scans at the airport and beg off dental x-rays when possible, out of an abundance of caution. That the mammogram itself exposes breast tissue to potentially carcinogenic radiation is an egregious contradiction to which I’ve resigned myself.
Mammograms and I have a long history, beginning in my fourth decade, since only recently has the value of scans for younger women been called into question. Both of my mammaries have met metal every twelve months since I was thirty; furthermore, there was a period of about three years where my left breast got special attention, being squeezed and pinched and photographed twice as often as its twin. The fact is, when I was forty, I got the dreaded call-back: “Something” had shown up in the images of my left breast. A sonogram shed no greater light on what that Something might be—small calcifications, perhaps, but my breast tissue, as little as there was of it, was too dense to tell for sure. We decided to take a wait-and-see approach, following up with more frequent mammograms that would reveal whether the Something had changed or grown. I’m not sure why this specter of an actual anomaly taking up residence in my chest did not send me into a panic: perhaps it was because no one mentioned any consequence more dire than having my left side mashed flat at double the rate of the right. When, however, after numerous follow-ups a radiologist finally asked, “Why don’t you just go ahead and get a biopsy and have it over with?,” I became alarmed. The prospect of a giant hole-punch (as I imagined it) plunging into the most delicate and sensitive skin on my body suddenly made every possible outcome more concrete. I inveigled a meeting with Lillie Shockney, a breast specialist at Johns Hopkins and, at the designated hour carried my x-rays, like an undetonated IED, into Shockney’s office. The expert took one look at the films and said, “This is nothing to worry about. Nothing.” I floated out of there on a wave of relief. I had dodged the one-in-eight bullet, at least for the time being.
I now have more mammograms under my belt than I care to count, but that doesn’t make me any more blasé about them, especially when October obliges women to recall that breast cancer increases with age and that the average age at diagnosis is sixty-one. Oh, by the way, I just turned sixty-two. Sitting in the waiting room of Advanced Radiology a couple of weeks ago, I ran through the worst-case scenario in my mind, as a way both of steeling myself should it come to pass and of warding it off, because, as everyone knows, if you envision a catastrophe vividly enough, it can’t really happen. The office was busy that morning and I had fifteen or twenty minutes to contemplate this bleak future before the clinician with her clipboard opened the swinging door and called out, “Barbara.” I was on my feet before she got to “Newman,” because Barbara is my first name, which I answer to when it is used by medical personnel. Another woman stood up almost simultaneously, just before the clinician called “Barbara” again, this time with a different surname. The other Barbara and I followed the clinician back into a maze of halls and exam rooms to the changing area, where she entered one of two curtained stalls and I the next. By the time I’d taken off everything above my waist, deposited those items and my purse in the locker, donned a blue cotton gown with the opening in front, and locked the locker, taking the key (attached to a shiny round CD, so that no one would accidentally leave the building with it), Barbara was already sitting in one of a pair of chairs that flanked a coffee table covered with magazines.
I picked up a Redbook and leafed through it, meanwhile surreptitiously sizing up my companion. She was about my height (that is, petite) and (I guessed) about my age. We ventured a bit of small talk about the hospital gowns, which feature three short ties attached in such a way that no configuration of connecting them will secure the garment around one’s body. Suddenly Barbara burst out with (apparently) faux chagrin, “I hate it, I hate it, I hate it. I put it off as long as possible.” I told her about my own migrating mammograms. “It’s been two years,” Barbara responded. Two years! I suppose I should have tut-tutted at her negligence (this was a couple of days before the American Cancer Society’s announcement of its new guidelines recommending mammograms every other year for women fifty-five and up), but instead I admired her audacity. She’d done the equivalent of spitting in Hitler’s eye while walking a wire suspended over Niagara Falls. We went on to rail against all sorts of overscreening and overtreatment by the medical profession. It turned out that Barbara was a nurse, so her aversion to scans, tests, and prescription meds seemed to vindicate my belief that no good could come from them. I was just about to declare that I intended to forgo treatment if I was diagnosed with ductal carcinoma in situ, otherwise known as “not-really-breast-cancer-(yet),” when another gowned woman with a sullen expression entered the changing area and headed for my stall. “Hey,” I protested, “That’s my. . .” “My clothes are in there,” the woman snapped back and disappeared behind the curtain. Advanced Radiology was definitely doing a booming business during October: I couldn’t remember ever having to share my stall with anyone before.
A moment later, Barbara was summoned to the exam room. The image of a mammogram assembly line flashed across my mind, with Lucy and Ethel struggling to keep up with the mounds of. . . er, mounds. . . pouring down the conveyer belt. As if to provide a laugh track for my fantasy, sounds of giggling and friendly banter drifted down the hall. Barbara must have hit it off with the radiology technician. Maybe the staff went easier on patients they liked–for instance, skipping that little extra tightening of the vise at the end of each pose. By the time Barbara got back, the sullen lady had dressed and left, and yet another woman, younger, perhaps in her late thirties, had donned her blue gown and was sitting in the chair Barbara had occupied earlier. Barbara stepped into her stall, but as she pulled shut the curtain, she popped out her head and grinned: “I warmed them up for you.” Then it was my turn.
“Hello, I’m Jill. I’ll be performing your mammogram today.” Apart from that greeting, Jill and I exchanged no superfluous words, only her instructions and my murmurs of assent: arm out, turn here, grasp there, don’t move. The process was routine and swift, so swift that when Jill paused between shots, ensconced in the lead-lined booth where she could view the image she’d just taken, I had only half a minute or so to wonder what she was seeing and whether the pause was prolonged enough to indicate that she had noticed Something Worrisome. Before I knew it, Jill was leading me, CD key-chain in hand, back down the hall. “You’ll receive your results by mail in about a week.” How I appreciated that week-long reprieve! In the bad old days, a radiologist would be on call to read questionable scans and order additional tests immediately. Inside the changing room, the younger woman—glossy brown hair cut shoulder length, full lips and cheeks, gown held closed with an arm across the rib cage—was still sitting patiently. “She was right,” I said, “The plates weren’t cold at all.” The woman smiled wanly. “It’s my first time.” I thought of all of the many things I might say about what lay ahead for her, then limited myself to “It’s uncomfortable, but it doesn’t last long.” “That’s pretty much what my sister told me,” she answered. I ducked into the stall, retrieved my clothes from the locker, put them on (noticing that the top of my chest looked like it had been badly sunburned), and emerged again. By then, the young woman was gone. I dropped my blue gown on top of the others in the overflowing hamper and headed home.
Copyright © 2015, Florence Newman
Florence Newman is professor emerita at Towson University, where she taught in the English Department for 27 years. A specialist in Middle English literature, she has published and delivered conference papers on Chaucer, the Gawain-Poet, and medieval women writers. She grew up in Blacksburg, Va., reading books in her parents’ library and eating strawberries from her grandfather’s garden. She currently lives with her husband in Towson, Md., escapes occasionally to their farm on Virginia’s Eastern Shore, and travels farther afield when time, energy, and finances permit.
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When my bother, Vernon Leroy (Lee) Sizemore, retired from the military, he earned his living as a sign painter, a skill he had picked up in vocational high school and sharpened by—among other things—painting pin-up girls and fancy lettering on the noses of airplanes. In the years before his death, he was doing broadsheet window signs for grocery stores and night clubs. Some of his expert brush lettering signs were finished with glued-on glitter, especially those promoting bands and singers. Near the end of his life, he fell off a ladder while hanging an exterior sign and wound up with a severe right-side head injury. He was in a coma for months. Once he woke up, I visited him several times in Denver. He always had something interesting to say, riffs that would start O.K., then wander off into fantasy, not making much sense—but to my ears they were weird poetry. And when he drew Picasso-like portraits of people, me included, he always left the right side of the head blank. When I asked why, he said because that was the way they were.
Lee was a wonderful older brother. Because of all the good things he taught me during trips to museums and theaters, letting me tag along when he shined shoes in South Baltimore bars, and schooling me in basic sign layout theory, I’ve dedicated this post to him.
A collection of photographs like the ones above, on a wide range of subjects, are in the archives of FSA/OWI (Farm Security Administration/Office of War Information). These rich color images, taken within three years of the invention of Kodachrome, serve to inspire as much as to document. To see more of them on this site, type “WPA color” into the small search window in the sidebar on the right of this page. For the complete collection, visit the WPA site by tapping the link in the sidebar box marked “Photography.”