August 2005
The weeks were moving swiftly. It was becoming clear that I was not going to meet someone before the operation. This reality drew me deeper into depression. Somehow I’d believed that magic was going to occur over the summer, that my life and love would be settled before the surgery.
“I bet you’re going to fall in love with your surgeon,” Rebecca had said. “It’s going to be some crazy story like that.”
“Considering my breast surgeon is a man in his sixties and my plastic surgeon is a young Asian woman, that’s highly unlikely.”
As the summer waned, so did my optimism.
I was seeing a new therapist, David, on the urging of my friend Rosemary. Rosemary was the most extreme character among my friends. She was a fifty-year-old Jewish South African woman who’d been a cult, avant-garde film star in the seventies. Back then, she’d been happily entrenched in the experimental theater and film scene that featured hard drugs and orgies and from which some famous actors and musicians emerged. Rosemary herself was a wild and colossal spirit who was now sober. David was the therapist who had helped her get clean when she was using heroin and drinking vodka like water. “If David could wrangle me, he can handle you, Jessica.” I could not argue with this logic. Like Mark Epstein, David was a practicing Buddhist, but he was also a cancer survivor.
David listened to my forecasts of doom. I felt as if my life and opportunities for happiness would be over on September 12. I’d had chance after chance to find love and now my time was up. “You are casting yourself in the role of the old maid, Jessica,” David said. “This is not reality. This is a story you’re constructing.” I spent full days in bed. Dr. Smith started calling me at home every night to check on me. She wanted to know what my plans were for the next day and insisted that I not spend my time alone. I was touched by her phone calls, yet some nights I didn’t have the strength to face her and wouldn’t answer the phone.
One hot summer night, I dragged myself out to a party downtown with Jonathan and Alexandra and ran into an old friend, Ali Marsh. Ali told me she’d read my Op-Ed piece and had been thinking of me. Her best friend from high school, Anna LoBianco, also had the BRCA-1 mutation and had recently undergone double mastectomy and reconstruction. Unfortunately, she’d discovered she had breast cancer before she found out about the gene. She went through months of chemotherapy and was now having radiation. Ali told me Anna was in remission and doing well and would be happy to get together with me to talk about the operation and show me her new breasts.
Anna and I met at a coffee shop near her apartment on the Upper West Side. I don’t know what I’d been expecting—all I knew about Anna was that she’d gone to a fancy New York prep school with Ali and was a year younger than I.
Anna walked in the door—this formidable woman with a strong, sturdy, easy sense of self. She’d lost her hair from chemo and her scalp was just beginning to show new growth, but she exuded health. An onlooker would have more likely assumed she’d shaved her head as a fashion statement. Anna apologized for being late—she told me she’d just ridden her bike across the park from her radiation appointment. I was awestruck.
Anna’s spirit was so large that the moment I met her I felt my own energy recharge. Her eyes were remarkable. They were tawny-colored and through them you felt her power, humor, and warmth. This was not someone who’d be knocked down easily, by cancer or anything else. I had an image of her as Superman and the cancer as bullets bouncing off her chest. Anna told me she worked at the Bank Street College of Education uptown on 112th Street. I was not surprised to learn that she also sometimes taught a self-defense class for girls after school. Anna lived with her boyfriend, Chiq, and they had two kids—Ruby was almost five, and Dario was nineteen months.
Being around Anna for just five minutes shamed me. Here was a woman who had faced cancer, chemotherapy, radiation, and mastectomy all while working and raising two small kids. And she rode her bike across town to medical treatments! I was healthy, yet hiding under the covers because of an impending elective procedure. I felt embarrassed about making a fuss over breast surgery in light of all Anna had been through.
“The mastectomy was easy,” Anna said, her eyes smiling. “It’s cancer that was a bitch.”
There was cancer all over Anna’s family. Her maternal grandmother, Miriam, got breast cancer at forty-two and died of a recurrence at fifty-two. Miriam’s sister Estelle had breast and ovarian cancer but beat them both and lived to be ninety-four. Estelle tested positive for the BRCA-1 mutation in 2002, and her daughter, Anne, tested negative. However, a year later, in her early sixties, Anne got breast cancer anyway. Miriam’s brother, Lovey, did not get cancer, but his son, Martin, died of prostate cancer. Martin’s daughter Kate was diagnosed with breast cancer in her forties. Lovey’s daughter Laura was diagnosed with breast cancer and beat it. Laura’s daughter, Fran, died of breast cancer in her thirties.
In spite of all this, neither Anna nor her sisters felt particularly alarmed over their own health because their mother, Dora, was in her sixties and had never been diagnosed with cancer.
In August 2004, a year earlier, Anna felt a small lump in her left breast while breast-feeding Dario. She assumed it was a swollen milk duct and paid no attention to it. A few weeks later, her milk wasn’t producing properly, so she decided to stop breast-feeding. The lump did not go away.
Anna went for a checkup with her gynecologist in November 2004. Her doctor felt the lump and said it was probably nothing, but did a needle biopsy to be sure. The results were inconclusive. Anna scheduled an appointment with a breast surgeon.
In the next two weeks, Anna’s tumor grew very big, very fast. It had corners and edges—irregular contours—and they were visible through her skin. She went to see the breast surgeon in mid-November. Another core biopsy was inconclusive, yet the doctor believed it was papillary breast cancer, a very treatable form. Since Thanksgiving was coming up, a lumpectomy was put off until the beginning of December. In the meantime, Anna took the BRCA test.
By the time Anna went in for her lumpectomy, she had learned she was BRCA-1 positive. The surgeon removed the tumor, but the BRCA results meant her chances of recurrence of cancer in the second breast were very high, so Anna would also need to undergo a double mastectomy. Since Christmas was approaching, the surgeon suggested they wait until after the holidays and scheduled Anna’s mastectomy for mid-January. Strangely, he did not remove or check any of Anna’s lymph nodes during the lumpectomy; apparently he intended to check them during the more extensive procedure. The tumor was removed and the doctor staged Anna’s cancer at IIB. Anna and her family were relieved.
Almost immediately after the tumor was removed, another lump appeared under Anna’s left arm. She called the surgeon’s office. A nurse told her this was normal—it was drainage from the lumpectomy, not to worry. Christmas rolled around and the lump grew dramatically bigger. Anna called the office, was told that the surgeon was out of town until after the holidays, but not to worry. “Never get sick during Christmas,” Anna advised.
At her January surgery, Anna’s surgeon expressed alarm at the new, large lump. It was, in fact, a malignant tumor. During the mastectomy, the surgeon removed all of the lymph nodes from Anna’s left arm and the sentinel node from her right arm. The cancer had spread to one lymph node. It was not good to have any node involvement, but one didn’t sound terrible. After all, it could easily have spread to four, five, or six. However, Anna’s cancer was “triple negative” for estrogen receptor, progesterone receptor, and HER-2/neu, which meant the cancer was aggressive.
Anna had the same reconstruction process I had chosen—expanders and silicone implants. She’d had the expanders put in during the initial mastectomy operation but had undergone chemotherapy before having her second exchange surgery. She was all put back together except for her nipples. She told me she wasn’t that happy with the reconstruction because she’d wanted to have smaller breasts and her male plastic surgeon had bullied her into going bigger. It was hard to imagine someone bullying Anna, though I told her I’d had a similar experience with a male plastic surgeon in Los Angeles.
Despite her ordeal, Anna was amazingly calm and upbeat. She said the chemo had made her sick, but she’d never missed a day of work. When she started losing her hair, she just decided to shave it all off. She didn’t bother to wear a wig or scarves. Anna said the idea of having cancer made her worry a bit about her kids, but mainly she was tough and in full remission—she’d just had a clear PET scan—and wasn’t terribly concerned about it.
She mentioned in passing that a month after starting chemo, the doctor had discovered “some lymph node involvement in her chest”—an enlarged node beneath her sternum. She’d had some back pain, so they did a bone scan and something lit up on one of her ribs, which the doctor dismissed as a false positive. However, they found the sternal node on the bone scan. She said the node couldn’t be removed, though they were treating it with radiation. She didn’t make much of this, but it sounded frightening to me. From my experience with my mother, I knew too well that any stray cancer cells were bad.
Anna wanted to talk about my decision to have a prophylactic mastectomy. Her mother and her sister Yummy had just taken the BRCA test, and both of them were found positive. (Her mom was one of the lucky few whose mutation had never caused cancer.) Her second sister, Nina, had not yet taken the test. Anna was adamant that Yummy have a preventative mastectomy, and Nina, too, if she tested positive. Yummy refused to discuss it. Anna had forwarded my article to both her sisters and wanted to enlist my help in persuading them. I told her I would of course speak to either of them, anytime.
I walked with Anna to her apartment so that I could have a proper viewing of her newly reconstructed breasts. She lived in a one-bedroom with Chiq and their two kids, which made for cramped quarters, but the apartment had a wonderful, homey vibe. Ruby and Dario’s artwork hung all over the walls, and everywhere were lots of photos of the kids, friends, and loved ones.
Anna took off her shirt in the bedroom and showed me her breasts. They were large—a C-or D-cup, but Anna was tall and big-boned and I thought they really suited her. There was a long, horizontal mastectomy scar across the middle of each breast, and no nipples. Anna said she hadn’t yet gotten around to the nipple reconstruction, and didn’t know if she would bother. Chiq didn’t care and she felt fine as they were. What annoyed her was that they were so far apart. She tried to push them together to form cleavage and showed me how they wouldn’t move. We both laughed about the new fake-breasts travails. This was the first time I’d seen her act girlish and it was very sweet. I told her I’d read about this cleavage issue online—the implants fit under the chest muscles and if your anatomy was such that the muscles were spread apart, there was no way to squish them closer together. But I thought her breasts looked great. I thanked her for meeting me, sharing her story, and flashing for me. We said we’d keep in touch on all matters.
I was inspired by Anna. She pulled me out of victim mode.
DANIELLE AND BRUCE were worried about me. They still believed that my decision was rash. Danielle felt that I was wildly underestimating how traumatized I would be when I woke up without my breasts. As he’d consistently done for my mother, Bruce wanted to do something special for me before my surgery. He came up with the most staggering gift—sending me and Danielle on an extravagant vacation to St. Barths at the end of August.
I could not believe my eyes when we got to the villa. It was all dark wood and billowing white curtains with rooms that opened onto a lush pool area and the turquoise sea beyond. This villa was fit for the honeymoon of a European princess, but it was mine and Danielle’s for ten days. It would be the most indulgent vacation of my life—nothing to do but swim, do yoga, and, in my case, emotionally prepare for the loss of my breasts. This was the most peaceful oasis I could ever have conjured—an extraordinary present, impeccably timed—as my surgery was in two weeks and panic was beginning to set in.
St. Barths is a French Island and French women often go topless on the beach. For the first and only time in my life, I walked and swam and spent all day with nothing covering my breasts—in the privacy of our villa and in public by the sea. It was liberating, incredible, and—I felt—appropriate, all things considered.
It was rare for me and Danielle to spend so much time together. We shopped at the grocery store and cooked all our meals; we talked a lot about our mom. Danielle told me that she and Bruce were thinking about having a baby—nothing would have made our mother happier. I spent hours writing in my journal. I told myself that the choice I had made was claiming life, health, and future. It was an investment for my unborn children that I would be well, that I would be alive to care for them. I gave myself pep talks to act on my convictions without fear. And if panic set in when I woke up without my breasts, I would have antidotes to remind me why I’d chosen this path. I wrote: Having surgery is taking care of my self. My true self. My spirit, my character, stuff on the inside. Whatever the cosmetic result of my body, my breasts, is not all that consequential.
I built up my strength and courage during the day, but at night my subconscious took over. I dreamed that my teeth were falling out. I dreamed I was speeding in a car and there were no brakes. I dreamed that I was in New York City in a postapocalyptic world, running through the bombed-out streets, seeking shelter. But during my waking hours, I didn’t feel anxious. I was identifying with the powerful reasons I had chosen my course of action.
While we were in the fairy world of St. Barths, Hurricane Katrina hit New Orleans. Danielle and I watched the devastation on television from so far away—horrible and surreal. Suddenly it occurred to me that I had considered scheduling my mastectomy at NOLA in New Orleans this week! It was an eerie near miss.
The last morning of our vacation, I sat on the floor of my bedroom in front of a large mirror and gazed at my naked breasts for an hour. It sounds ridiculous, but I felt sad for them. They needed to be sacrificed in exchange for my health. It seemed so strange that my own body could be a danger. That my own body could kill me. It was unfathomable. I stared at my boobs and assessed them critically. They were two large, sagging appendages. Then I considered them from another point of view. They were feminine, womanly, sexy. Natural, earthy, and beautiful. I felt remorse that I’d taken them for granted and complained about them all these years. Sitting there in the mirror was my own weird, private ritual of honoring them and saying good-bye. I thought about my mother. I thought about her breasts, which had been very similar to mine. I thought about how she’d always dressed to enhance them, how proud she’d been of “keeping her figure” through the years. Then I pictured her suffering and dying. I remembered her piercing eyes in those last weeks. Never forget me, Jessica.
I had no doubt that I was doing the right thing.
By the time I returned to New York, I was ready. In those final days before the surgery I was in a feverish, almost elated state. I knew I would have lots of visitors after the operation and I was preparing the apartment like a salon. I ran around the city searching for a rug—bought one and lugged it uptown on the subway; unrolled it, hated it, lugged it back down on the subway. Tried another one and did the same exact thing. This time my friend Rosemary had to accompany me because I was in such a tizzy. We got on an express train that took us deep into Brooklyn by accident—we ran up and down the stairs on the platform to switch trains, lugging the stupid rug like madwomen. As a present, my father went to the flower district and, with Danielle’s help, bought seven large trees for Harriette’s apartment—three for indoors and four to be lined up on the terrace. It was a tremendous gift, and symbolic—the trees breathed new, flourishing life into the place.
My friend Gillian, a photographer, insisted I would always regret it if I didn’t document my breasts before the operation. I went over to her apartment one night and she spent thirty minutes setting up soft light to create beauty shots. Gillian and I had been friends since the ninth grade. I remember at fourteen writing the initials of the boys we’d kissed in the back of our math books (a grand tally of four between us). The night she lost her virginity she’d left her boyfriend’s apartment in haste to come over and tell me every last detail of the most important event in our young lives. We’d laughed and cried and gorged on brownies on the living room floor. This night, with her two-year-old daughter asleep in the next room, we downed vodka tonics and laughed and cried together once again. The photo shoot with Gillian was intimate and emotional—the focus was on letting my guard down, allowing her to memorialize the beauty of my body in its natural state.
Several days later I had a photo shoot with Rosemary and Kay of an entirely different nature. We had a cheap digital camera that none of us knew how to use and a six-dollar bottle of wine. This experience was about freedom and defiance. Taped to my wall was a quote from The Tibetan Book of Living and Dying: “What is our life but a dance of transient forms?” I would revel that night in my present state of being—celebrating it in preparation for letting it go. Rosemary and Kay took their shirts off in solidarity (though Kay declined to be photographed). We ran around my apartment with abandon, put on Russian hats with earflaps, lay down on the table with roses strewn around us, struck poses like a topless Thelma and Louise using rose stems instead of guns.
My friends rallied around me—spoiling and celebrating me as if it were my wedding. It turned out to be one of the most joyful times of my life. I had a “farewell breasts” night out with a group of my closest girlfriends. Liza (Cokie Roberts’s daughter-in-law) was eight months pregnant, but she ordered her husband to take charge of their two small children so she could spend the final weekend before the surgery with me. Calista and my agent, Jeff, flew in from California to be there for the operation. Jolie (who had taken care of our mother when she was ill) had worked as a nanny for Gillian all summer and was moving in to help Danielle take care of me for two weeks before returning to Poland. The day before the surgery, I popped into Limitone Salon to get my hair blown dry by Amir and startled everyone by cheerily telling them I would be removing my breasts the next morning. They gaped at me like I’d lost my mind, and were flabbergasted when I agreed to flash for Amir and Alon, two gay Israeli hairdressers. This is something I would never have done before, but now I had detached from my breasts. I didn’t see them as mine anymore; they were about to be gone, so showing them felt impersonal. “Oh my God!” Alon exclaimed. “I had no idea your tits were so big!”
Later that afternoon I went to Dr. Choi’s office to have my breasts photographed using new 3-D imaging technology. This digital scanner would enable Dr. Choi to determine the volume and contour of the breasts. She had explained to me that these measurements were most useful in the case of single mastectomy, when they were trying to re-create a second breast to match the first. However, she was now taking 3-D scans of all of her patients to have detailed before-and-after records.
I took my shirt off and a young woman drew Magic Marker markings on my breasts. I didn’t know if she was a doctor or a nurse or a medical student, but she was definitely younger than I. She told me she was going to take photographs from all different angles. Blue masking tape on the floor indicated where I would stand. As she drew on me, I asked, “Don’t you think this is odd?”
“What’s odd?”
“That my breasts are here. We’re drawing on them, photographing them. And tomorrow they’ll be gone.”
She looked up at me as a young woman, a peer, rather than as a medical practitioner.
“It is odd. I can’t imagine.” Her eyes flickered with compassion. “I’m sorry.”
The 3-D scan was a big box on a tripod, like an old-fashioned camera. I aligned my toes with the strips of blue tape, standing at a 90-degree angle, then at 45 degrees, then 0, as she snapped away. Then we did it all again on the other side. It was a somber experience, like last rites.
Suddenly, it was the night before the surgery. For “the last supper” I went to a restaurant with Jonathan, Alexandra, Calista and her son, Liam, and Danielle. Liam was about to turn five. Calista had told him they were coming to visit me in New York because I had to go into the hospital for a few days. He had drawn me a very detailed and colorful picture of a turtle on the plane to make me feel better. I’d always loved turtles (which Liam did not know) because I identified with the tortoise in the fable about the tortoise and the hare. I’d always been the last of my friends to hit significant milestones: In high school I’d been the last to have a boyfriend. In college I’d been the last of my group to lose my virginity. I’d been the last to find my footing in a career. Now I was the last to get married, and on my way to being the last to have a child. To me, the end of the race was arriving at a rich and fulfilled life. I always agonized over being so far behind, while I kept crawling along in my own slowpoke way, at my steady pace. Finally, finally, long after everyone had ceased keeping track of my progress, I would sneak up on them and cross the finish line with aplomb. I hung Liam’s turtle on my hospital room wall. It remains one of my prized possessions.