My sister pulls one plus-sized monstrosity over her chest after another and we try to laugh about it all -- we do laugh long and hard when we realized one is actually a nursing bra. She calls my mother in as she unsnaps the cups and let them fall. My mother manages a tired smile and heads back out to the racks to find more for Kari to try, although she has already been through at least a dozen and none of them are holding her in the way they should.
How did she find the lump? This seems to be something everyone wants to know. Was she a responsible young woman, doing her monthly self-exam and there it was? Or did her boyfriend feel it first? I want to comfort them when they ask, assure them that my sister is indeed responsible and yes, yes, it was one of those monthly exams we are all supposed to be doing that caught it and probably saved her life. This is not the truth, however. What happened instead was she felt it in the shower one morning. By that time it hurt and was already too big to ignore. She waited, though, to have it checked, having read in the natural health books her boyfriend favored that it was best to wait through a few cycles before going to a professional. Examine the mass before and after your period. Note any changes. Last month, it was the size of a peach pit, now it has the girth of a ripe plum…should I be alarmed?
With this kind of growth rate, she only lasted through one cycle before going to see her primary care physician, Dr. Cathy Jones, at Bastyr, a naturopathic teaching center in Seattle. After examining her, Dr. Jones said that although it was probably a cyst, she would need an ultrasound. Then, through some misunderstandings of my sister's financial situation (given that my sister was living without water or electricity and only had catastrophic insurance coverage, this was somewhat understandable) Dr. Jones gave her some information about low-income clinics to look into. Going this route delayed the tests, as my sister found herself immersed in government health care red tape, with one place telling her they only offered their services to women at-risk, those over 40. Finally, finally, now, some six weeks later, she scheduled an ultrasound at a regular clinic and has an appointment in a few days.
"C'mon," she says. "I know you want to touch it." I shake my head but she grabs my hand and puts it on her, on that thing. It is hard and gelatinous at the same time, and when she pressed my fingers into it, she winces and so do I. Touching it, I feel it's possible that all my teeth might come loose or that my skin might start to slough off my body, starting from the center of my forehead on down.
"It hurts just when you touch it or all the time?"
She lets my hand go and sighs. "All the time."
"But that's good," I say. "Cancer isn't painful, cysts are. Cancer doesn't hurt." I have been on the Internet, and this is what the Internet has told me. That, and the fact that 80% of the lumps found in women's breasts are benign.
"Eighty percent of lumps are benign." I say, my voice rising slightly. "Eighty percent."
"Really?" my mother says from the other side of the curtain. Her hand reaches through with a few more bras.
I take them from her and hold them out to my sister. She shakes her head.
"I need a minute," she says, quietly. She stands there bare-breasted, staring at herself in the mirror. I look at the floor, studying the scuffs and dirt on the linoleum, then up at the dressing room wall, at the outlines in the paint where three hooks have been pulled off the plasterboard. I wish we were at Nordstrom in a carpeted dressing room with soft lights for her to do this in.
"Eighty percent, that's good," my mother says through the curtain. She has confessed to staying off the Internet for her own sanity. She already knows more than she needs to as a medical social worker, having done an internship in radiation oncology in graduate school. She has also watched plenty of people die from the disease during her years of hospice work and in the nursing homes where she's worked for nearly 20 years. "Besides, cancer is an illness of age. It is supposed to be a disease of the old, not the young."
"How many clasps are there on those?" my sister says to me.
"Four on this one. Five on the two others."
"Five fucking clasps," she says, trying not to cry. "Why these boobs? Hasn't it been enough that I've had to carry them around for 15 years? Now they have to give me cancer?"
"It's not cancer," I say. "We don't know what it is, but it's not cancer." She wants to believe me and I want to believe me too, so we both nod slowly, as if considering the possibility and deciding, yes, that is the truth.
"Let's just get these and get the hell out of here," she says, grabbing two bras and pulling back the curtain to reveal my mother, who looks pale and seems somewhat unsteady on her feet. As the three of us walk in silence to the checkout counter, I will us days into the future, trying to see invisible sound waves moving through Kari's breast and producing ultrasound photos of nothing more than a fluid-filled cyst. I try to imagine the shape of the relief we are all going to feel when that happens, something like a sharp pin that will pop the bubble we've all been encased in since she told us this thing was growing so fast she could see the difference from one week to the next.
She first mentioned the lump to my mother and me two months before, at a Red Robin near a terrible suburban wasteland called the Silverdale Mall. I had been living at home for less than a month by then and we were all up in Poulsbo, near where Kari lives, staying at a little cabin that my mother and stepfather rent for a week every year. It is nestled in the woods and sits on the Puget Sound and is rustic but functional, complete with a deck and saltwater pool that overlooks the water. It was the end of August and we had all been looking forward to the vacation and the pool, but it was unseasonably wet that year, and poured rain for six days straight. Therefore, come the middle of the week, everyone except my sister had fallen victim to various advanced forms of cabin fever. My stepfather had become devoted to computer solitaire and was opting not to interact much; I had experienced an existential crisis a few days previous regarding my ex, deciding that since he could easily be labeled mentally ill and because I had loved him, really loved him, I was fated to either date crazies for the rest of my life or die alone; my mother had broken down just that morning because we were trying to revamp her wardrobe, gently forcing her to shed the too-large, shapeless hippie dresses she coveted and buy some updated outfits in the right size. The makeover had started with a new haircut and her impending 40th high school reunion and she had been enthusiastic about the whole thing initially, cleaning out her closets aggressively and making way for the new. What we didn't think about was the time between old and new, however, and now she was left with little to wear while we rebuilt her look and the outfit-less vacuum was beginning to wreak havoc on her identity.
"Don't you understand?" she said. She was sitting on the floor of the living room and knitting while she talked, not making eye contact with any of us. "My entire childhood was about external appearances. My father used to call me 'bubble butt' and 'four eyes.' Just before he died, the very last time I spoke to him, he asked me how much I weighed." She put down her knitting and glanced up at us. "I liked my clothes, I miss my clothes. They were comforting, they were me."
When she started to cry, Kari and I looked at each other and then over to my stepfather, who was playing solitaire with headphones on and was moving his head in time to the music. He continued to click one card after another into place on his laptop as my mother cried, apparently oblivious to the drama unfolding in front of him. This was unusual, but none of us were really ourselves that week. My sister and I looked back at each other and knew we had to get my mother out of the house. Kari suggested the mall, a place we'd already been three or four times that week because of the rain and the wardrobe crisis. This is more times than my mother usually goes shopping in a year, as she abhors malls almost as much as she does bars and the drunk people inside of them.
"We'll find you something great today," my sister said, and held up the book we'd found about women over forty revamping their look. In addition to its many tips, it helped women determine their style type via a series of pointed questions, in order to rebuild their wardrobes around a few central principles. Aside from liking her clothes comfortable and functional, the quiz had determined that my mother valued the feel of the fabric more than anything. "Something cashmere or silk?" My sister's voice was high and tight.
My mother agreed, but despite our best efforts, the outing didn't go well -- she hated most of what she tried on, and vowed simultaneously that she would never step foot in a Gap again and that she was so hungry she might faint. The only place to eat beyond the food court was a Red Robin across the parking lot from Macy's and the only place to sit was in the bar at the counter, but my mother was too tired to object. I considered ordering a Pina Colada to take the edge off, but I knew watching me order a drink in the middle of the day would have pushed my mother over into the abyss. We were looking at our food -- greasy, garlic cheese bread and spinach dip surrounded by stale tortilla chips, when Kari choked it out.
"I have a lump," she said, and she was already crying.
My mother looked at me as if I knew what was going on, but I didn't. It took my sister a minute to speak and when she told us how she'd felt it a few weeks ago, that it hurt and was big enough there was no way she could have missed it, neither of us were all that alarmed.
"It's a cyst, honey, I'm sure," my mother said. "It's probably fibrocystic breast disease. I have it and I've had plenty of lumps checked out that I never told you girls about because they turned out to be nothing. We have no family history either and you're so young."
My sister nodded and tried to catch her breath and said she hadn't wanted to tell us on vacation, especially since she hated to worry my mother. It was an old perception she had carried around since childhood, that my mother couldn't handle things like this, that her response was always stress and panic, followed by massive freaking out and generalized overreaction. She was right to some extent, but I had never viewed my mother quite this way and had always gone in the opposite direction with her, confiding nearly everything, sometimes telling her far too much.
"It's hard for me to tell you these kinds of things," my sister said.
"Where do you think that comes from?" my mother said. She stuck a tortilla chip into the dip, pushed on its end a few times, lifting a scoop of mainly mayonnaise up and down. She left it there, folded her hands together on the bar.
"I don't know," Kari said. "It just is." My mother aside, this is something about my sister that has always been a part of her personality. Since she was a very small child, she has always been afraid of making waves, of making people uncomfortable or causing anyone around her any kind of pain.
She is alone during the ultrasound, she doesn't want anyone with her. The room is pitch dark, the gel they spread on her cold. A nurse presses the device to her breast once, then again. She looks down at my sister, back at the screen.
"What?" Kari says.
"I need to get the doctor," the nurse says, and leaves. The doctor comes in and does exactly what the nurse had. He presses. He looks. He doesn't speak.
"What?" she says again. "What is it?
"It's not a cyst," he says, and then he runs out of the room. Runs? We ask. Yes, she says. He runs out without saying another word to her, apparently to call Dr. Jones. He never comes back. Twenty minutes later, the nurse returns and tells my sister to put her clothes back on; she tells her she is free to go.
Kari calls our mother that night and talks to her for a long time about life and death and the life she's already lived. "I've had a pretty great 28 years and if this is it, well than this is it. I can't say that to anyone else, Mom. No one else will understand it, but I know that you do." She pauses. "I know too, that I am a teacher, and maybe this is what I have to teach." What they both believe supports this line of thinking: that all things happen exactly the way they are supposed to, including how and when we die.
I am in the room with my mother at the time and watch her face, which is concerned, but also, somehow, calm. She tells my sister that she does understand and then she is quiet, listening. She starts to tear up and laugh, and tells me Ted is in the background saying, "Jesus Christ, no one even has cancer yet."
"That's right," I say. "And no one is fucking dying. Can you tell her that? Can we just stop talking about anyone dying?" My mother does and says Ted appreciates the solidarity. This will be the first and last thing he and I will agree on for the next eight months.
A few days after the ultrasound, my mother and I drive up to Poulsbo and wait with Ted for the results of my sister's biopsy. After Kari's experience with the ultrasound, my mother has firmly stated that she is not allowed to go any more appointments by herself, and she won't, and will usually be accompanied by two or three of us every time. It is October now and my mother sips tea and we flip through SELF and Ladies Home Journal and Glamour and read about Breast Cancer Awareness Month, which, lucky for us, is October. We sit on hardback chairs in a pastel room that is somewhat pleasant; the large plate glass window in front of us frames what remains of a forest nestled between the hospital, a Costco and a Best Buy. We read statistics about the numbers of women diagnosed in a year (212,920) the number who die (40,970) the number who survive when diagnosed at Stage I (nearly 100%) which is encouraging, since we all believe that if it is cancer, my sister caught it early enough that she must be a Stage I. We read stories of survival and vignettes of brave tragedy as we wait, one hour turning into two, two into nearly three. The nurse comes out to tell us they are taking mammogram films as well, a procedure Kari isn't scheduled for.
While I sit and flip and read, I bargain too, with gods I am not entirely sure of, willing them to make it benign. I bargain even though I know it is pointless, an eerily familiar psychological stage of grief, as the longer the appointment takes, the more we all know at some level it is malignant. My sister will tell us later that they would take films from one angle, develop them, show them to the doctor and then he would order yet another set. All of this gave them the opportunity to find two other suspicious places in her breast to biopsy and a smattering of irregularly shaped white dots near her chest wall. This is called calcification and irregular patterns of it usually means nothing good, and it turns out that's what mammograms screen for, not the tumors themselves. We will see it soon enough on Kari's films, a tiny constellation of sharp-edged disease looking as harmless as lint gathered on a camera lens.
"She was only 26 when she was diagnosed," I say, pointing to photo a thin, dark haired girl in a magazine. "She died after it recurred, a year after her initial diagnosis." I offer up everything to the gods as I look at that dead girl, mainly in the form of please, fucking please don't let her die, anything else you want take it, whatever I have is yours.
"So hard to believe," my mother says, running a finger down the dead girl's glossy face.
Ted is quiet, looking at his shoes most of the time, which is what he usually does most of the time. My mother and I continue to flip pages, perusing the pink teddy bears and pink tennis balls and pink chocolate hearts available to purchase for the cause. We briefly consider ordering pink teddy bears, maybe some chocolates. This is something my grandmother would have done had she still been alive, made up gift bags for all those involved in this process -- relatives, parking attendants, doctors, Kari -- and in these anxious hours, it seems almost appropriate.
The nurse comes out again to tell us that tissue from three different places in her breast is needed, then once more an hour later and to say it won't be much longer. Ted stares out the bay window, looks back at his shoes. When my sister finally emerges, she is holding an ice pack to her chest with one hand, clutching a pen and pad of paper in the other.
"What the fuck is this?" she says, waving around the pen and paper. The pen is pink with a white ribbon on it and pad is white with a series of slanted pink ribbons cascading down its pages.
"I don't fucking want this. Someone take it." My mother does. Kari starts to cry as we walked to the car. Ted follows behind her, his hands shoved deep into his jean pockets.
"It's cancer," she says. "The doctor said -" her voice broke. "Can we get into the car?" We nod, we get into the car.
My sister sobs, she yells Fuck. She yells it loudly for what feels like a very long time.
"We don't know any of this for sure," her boyfriend says.
"Right," I say.
"Yes, we do," she says. "Yes, we fucking do." We sit in the car. We don't want to turn the ignition, as starting the car will make it all real and then we will have to pull out of the parking space, drive back to the cabin and call people; we will have to say it. "He doesn't think I'm going to die, though. He said it's really, really bad, but that I'm not going to die. Can we go home now?"
And I believe him, this doctor who hasn't seen her biopsy results or read the pathology. He is the best thing I have to believe in and for a split second, he is some kind of God to me.
Dr. Jones calls my sister late that night and says she is trying to get the biopsy results back as fast as she can, but it will probably be at least a day or two. My mother tells my stepfather to wait until we have the results to come up and in the meantime, Kari and Ted stay with us in Poulsbo, as the commute out to the land and back is nothing either of them has the strength to do. The four of us trip over each other in the tiny cabin while we wait and pretend not to be. My sister cries some, talks in low whispers to Ted at night. He has, up until now, said little about what he thinks she should do if it is cancer, but we all know what is coming.
Ted is a follower of an East Coast alternative medicine fanatic who recommends certain regimens for health and the prevention of all diseases including cancer; part of his program is the juicing of fresh produce and the purchasing of various powders to combine with said juices (you can also buy everything from chocolate bars to shampoo from him) along with purging alcohol, nicotine, sugar, wheat, meat products and dairy from one's diet. Ted and my sister had been on the fanatic's regimen for nearly a year a few years back, but had more recently gone back to American Spirit cigarettes, microbrews and the occasional Egg McMuffin.
All of this wasn't as disturbing as the fact that the alternative medicine fanatic eschews all modern forms of cancer treatments, and to that end, publishes volumes on why chemotherapy and radiation don't work, why mammograms are actually giving women cancer through radiation exposure, not to mention numerous conspiracy theories regarding pharmaceutical companies and the government.
What the fanatic believes is the cure for cancer - that is if you haven't prevented it by following his doctrine - consists of massive doses of Vitamin C administered intravenously, which one can receive in the privacy of his offices in New York City. The catch is, you have to literally be dying to get into his offices, as he only treats people who have tried all the other methods and failed. He only takes those with no hope left. So when I hear their soft whispers late at night, I pray my sister is telling Ted that it is not his decision or his body and that the fanatic's theories are too out there, unfounded, crazy, even. I pray she will then do exactly whatever it is the real doctors are tell her.
