The creators of Sex and the City wrote and filmed three different endings for the series finale: In one, Carrie ends up with Barishnikov; in another, she ends up with Mr. Big; and in the third, she remains single—continuing her quest for love and identity. The reason they went to the trouble and expense of shooting three endings was to keep the real ending under wraps—it was a secret even from the actors and crew, so there was no chance of it leaking out. Rumor had it that the producers screened all three endings in front of test audiences to ascertain what the public wanted to see happen to their darling modern single woman Carrie Bradshaw.
Millions of women around the country watched with vicarious pleasure as Carrie got her fairytale ending—the unobtainable rogue prince Mr. Big gallops into Paris crying mea culpa and asks her to live with him happily ever after.
Others were disgruntled with the finale. Anyone who had invested years in following the travails of Carrie and Mr. Big knew that they’d never really just waltz off into the sunset. One of the reasons Sex and the City had struck such a chord with its audience was that it had managed to capture the complexities of modern dating life with an emotional veracity (even if glamorized by money and designer clothes). This Cinderella ending insulted a lot of loyal viewers. Mr. Big wouldn’t reform his ways for long; Carrie would have too much self-respect to stay with a man unworthy of her—if the creators had remained true to these characters, the relationship would not work out. But test audiences proved suckers for the fairy tale.
In my life—in real life—there was no test audience.
After a year together, Mark and I broke up.
We’d met just as we were each emerging from traumatic situations. We clung to each other and promised ourselves to each other before we’d gotten the lay of the land. Mark healed me and made me feel beautiful, scars and all. The questions that had plagued me: What is a woman? What constitutes femininity? Would I be sexual, desirable without my natural breasts? Mark answered those for me. He made me feel not less of a woman, but more of a woman for choosing life. I believe that our relationship also restored him after the painful dissolution of his marriage. But it grew apparent that this relationship was not going to have a fairytale ending. Our personalities were too intense, and ultimately too combative, for a peaceful union. With mutual love and respect, we parted ways.
I am now thirty-seven, with the perilous threat of breast cancer behind me and the threat of ovarian cancer still looming. I will have my ovaries prophylactically removed at forty. I am ready to have a baby.
The questions I’d asked myself in a frenzy when I first discovered I carried the breast cancer gene—Could I no longer afford to be true to my beliefs about love? Would I have to marry the next man who’d have me in order to bear children?—I’ve since answered. No, I do not have to compromise my ideals. I will not choose a partner out of fear or the pressure of a biological clock. I’ve made bold choices throughout my life so that my external circumstances would reflect my internal convictions. I was born with a name that I found diminishing; I realized I had the power to change it. I inherited a gene that statistically ensured I would get cancer; I took action to prevent it. Love hasn’t worked out according to my timetable? I will have a baby on my own and wait for love to unfold as it may. And so, dear reader, I’m heading to the sperm bank.
As I’ve already learned, the advances of biotechnology offer an array of choices, but they also come with ethical dilemmas. I’ve decided to purchase sperm and be artificially inseminated, but I can take it a step further. A technique called preimplantation genetic diagnosis, or PGD, would enable me to create embryos in Petri dishes and genetically test them for the BRCA mutation. I could then choose to implant only the embryos that do not carry the mutation.
I believe in utilizing biotechnology to promote health. Of course I don’t want my children to inherit the breast cancer gene, but there is no existing method to alter the genetics of an embryo. The only option is to select the embryos that do not carry the faulty gene. Had this technology been available in 1969, I would have ended up in the trash can. Can I, in good faith, choose embryos that don’t have the mutation and destroy the others? Is taking action to ensure my unborn child will not have to go through the terrors my mother, sister, and I have suffered the responsible choice? Or is it immoral to extinguish a life merely because it carries a gene that I myself live with?
I’m about to dive into these uncharted waters.
Biotechnology is not just changing the lives of those of us who happen to carry a rare cancer mutation. Genetic tests are being woven into the fabric of modern life. The field of genetics is advancing at a remarkable pace, and these discoveries will soon affect every one of us.
Testing for birth defects has already become a routine part of prenatal care. The test that measures the level of alpha-fetoprotein (AFP) in the mother’s blood during pregnancy may signal abnormalities such as Down syndrome, spina bifida, or other neural tube defects. AFP screening may be included as one part of a two-, three-, or four-part screening. Multiple marker screening is not diagnostic, which means it’s not 100 percent accurate, but it determines who should be offered additional testing such as amniocentesis. These tests raise excruciating ethical questions of their own: Under what circumstance would a prospective parent choose to abort? Which diseases would be acceptable and which unacceptable? And what percentage of risk is the cutoff point? Do you abort if your unborn child has a 60 percent chance of a genetic disease? What about a 25 percent chance?
How far will we go in engineering embryos? I read about a case in London in which a couple has created embryos at a clinic that will screen them to make certain their baby will not be born with a squint. The father-and grandfather-to-be have severe squints that cause their eyes to look only downward or sideways. Embryos with the genetic mutation that causes this squinting condition will be discarded.
There are currently about twenty genetic tests available for different forms of hereditary cancer. On May 4, 2007, a front-page article in the New York Times announced a gene identified as a risk factor for heart disease. The genetic variant increases the risk of heart ills up to 60 percent and is so common that 50 percent of people in Europe are believed to carry one copy of it. On March 18, 2007, the New York Times presented a cover article about a twenty-three-year-old woman who opted to take a genetic test for Huntington’s disease—an incurable, fatal brain disorder that renders its victims unable to walk, talk, think, or swallow. She tested positive. As of now, there is no treatment for Huntington’s disease. People like this young woman seek the information so that they can be prepared for what lies ahead of them and make the most of the healthy years they have left. Many people are also seeking out the genetic test for Alzheimer’s disease with the same rationale: Though there is no treatment or cure, they want the knowledge so that they can plan their futures accordingly.
In 2001, CNN covered a story about a couple in Atlanta, the Nashes, whose daughter, Molly, was born with multiple birth defects due to Fanconi anemia, a genetic disease that often leads to leukemia. Her best chance for survival was a perfectly matched stem cell transplant. The parents decided to create embryos and select one that did not carry the genetic variant for Fanconi anemia. This embryo became their son, Adam. Technology enabled the Nashes to give birth to a healthy child and to use Adam’s umbilical cord blood for a transplant for his sister, Molly. It was the first time the PGD procedure had been used both to create a healthy life and to save an existing life.
These tests and technologies are not without their perils. They present complex, intensely personal dilemmas. But their value is incalculable.
ANNA LOBIANCO’S SISTERS, Nina and Yummy, decided to undergo prophylactic mastectomies a few months after Anna’s death. Nina chose not to get reconstructed. She decided she didn’t want any surgeries other than what was medically necessary. “And living without breasts is a way for me never to forget Anna,” Nina said, “to have her in my life, to be reminded of her every single day.”
Anna asked that her ashes be scattered at a river in Portland, Oregon, that she loved. Nina, Chiq, and several of Anna’s friends made the trip to fulfill Anna’s wishes in March 2007, nine months after her death.
“We went to the river on a rainy, gray day,” Nina said. “The ashes were in a plastic bag. There was so much of it. As we scattered Anna’s ashes into the river, I thought: she’s a part of everything, she’s in the ecosystem, she’s helping things to grow. This river meets the Pacific Ocean. Anna’s everywhere.”
It made me think about how, at the moment of my mother’s death, I was staring out at the Atlantic Ocean. I was awed by the vastness of the sea. Through my grief, I felt the interconnectedness of all life.
My mother and Anna lived fervently until their lives were cut short. Their illnesses served as warning signs to us, their families. We are living in an age in which scientific advances give us new opportunities to live. Seize them.