Laura Bosse
IN RECENT YEARS WEARING A MASK HAS BECOME COMMONPLACE THROUGHOUT OUR SOCIETY. MANY OF US, HOWEVER, HAVE BEEN WEARING MASKS FOR YEARS.
We wear the figurative mask of a smile that, if you look closely enough, you will see does not quite reach our eyes. We wear these masks to conceal the realities of addiction, failing relationships, illness. We wear this mask to cover our pain, our fear, our disappointment, our anger. We wear these masks to protect ourselves from perceived judgment, to protect our children from the turmoil surrounding their environment. We wear these masks from the moment we wake up until the moment we settle our children into bed, if we are lucky. Sometimes these masks slip down ever so slightly, but we are well-practiced at pulling them right back up. Sometimes our eyes deceive our mask and let loose tears that we fight all day to withhold.
I have personally worn a mask for several years, concealing many circumstances of pain, frustration, and fear. I have become very successful at masking the turmoil in my life. Over the last several months, I used that practice to deal with a very unexpected health crisis. I turned 40 as the world entered a global pandemic and, as a result, did not get around to scheduling my first post-40 mammogram until March 2021, a few months into my 41st year. I have been told for years that my breast tissue is dense so, when at the mammogram, the technician told me I was sure to get called back due to dense breast tissue, it was neither alarming nor surprising. And the call came, as expected, telling me a second look was required. The fact that I was being sent to the Dana-Farber Cancer Center in Weymouth didn’t even raise much alarm. With so many things happening outside of my own health and outside of my control at the same time, this was truly the least of my concerns. I was grateful for the literal mask I wore to the appointment for the second mammogram because it concealed the fact that I was not able to muster my figurative smile mask at that time, due to concerns for a loved one, my former husband specifically. And still I was not worried about cancer. Not even when I was told at that same appointment that I needed to have three areas biopsied did I start to worry. Let’s get it on the schedule; let’s get it over with so I can check the box. I have no family history of breast cancer, I had no suspicious lump. This was all just routine.
As I lay on my side, feeling the tugging pressure and hearing the whirring sound of the little drill vacuum pulling cells from my body, I could feel the mask falling away. I found myself reciting the serenity prayer over and over and over again: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. I forced myself to take deep breaths, to just get through it. I wanted nothing more than to be off of that table and out of that room. It had finally all become too much. The nurses were so kind, assuring me that only 15% of these turned out to be anything to worry about. And so, when I received a call on May 19th from the nurse practitioner with the results of my biopsy, I was somehow caught completely off guard.
“I was pulling in to pick up my son when I was told, over the phone, that I had breast cancer. I was again grateful for the literal mask because there was no way that I could conceal the shock and horror and uncertainty that fell over me at that moment. My first thought was of my daughter, who would now have a history of breast cancer. My second, as a single mother, was who would take my children if the worst were to happen?”
As I started to catch my breath, the process began to unfold. The next step was an MRI to confirm that everything had been found. I went into the MRI on the Thursday before Memorial Day weekend. As I was pulled out of the tunnel, a third nurse had joined the two who had put me in and was complaining profusely about her allergies. I felt like screaming, “But do you have cancer?”
The results of the MRI posted in MyChart on Friday, but with the holiday weekend, I heard from no one. I googled, texted friends familiar with MRI results, but my mind began to spiral. Then, over the span of the holiday weekend, a family in our town suffered an unimaginable loss. A young mother passed away unexpectedly after giving birth to her third child. I was heartbroken for her family, for her children, for her community. And in that moment I realized how incredibly lucky I was. I was so grateful to be alive to have the opportunity to have breast cancer. And to have the opportunity to be alive to fight it
I called the doctor Tuesday. I learned from my point of contact’s voicemail that she doesn’t work Tuesdays. I couldn’t wait any longer so I called the general line and left a rambling message about cancer images, next steps, a plea for information. The woman who called me back turned out to be my oncology surgeon’s nurse practitioner and she told me all the right things. She scheduled me to see the oncology surgeon later that week and apologized profusely for the delay in response. When I assured her that it was OK, because that’s what we do when we wear a figurative mask for years, she restated that no, it was not OK. She said, “We want everyone to feel tucked in.” I realized, in that moment, that that was exactly what I needed to feel, tucked in, like a child wrapped tightly in a familiar blanket being sung a lullaby; I needed to feel protected.
At the meeting with the oncology surgeon, I met that angel nurse, Meg, and felt the same sense of peace that I had received from her over the phone. The surgeon walked me through my diagnosis. What I had was called ductal carcinoma in situ or DCIS, stage zero cancer. The relief of hearing that we had caught it so early was soon shattered as I was given my treatment plan options. Despite the early stage, I was given two options: I could opt for a lumpectomy, which would be followed with daily radiation for four weeks, yearly mammograms and MRIs for the rest of my life, and estrogen blockers until I entered menopause. Or, bilateral mastectomy which would mean the entire ordeal was concluded. My initial reaction was that a bilateral mastectomy was incredibly aggressive and extreme for a stage zero diagnosis. I joked with the surgeon about going bigger because I was quite sure that I wasn’t going to go that route. The MRI had determined that there was another area of concern in my left breast, so we scheduled another biopsy to help me with my final decision. The surgeon took us into a radiology room to view the MRI of my breasts pointing out the three areas that were known to be cancer. She talked about how hard it is for patients to think about why they had cancer. She started to reassure me that I hadn’t done anything wrong to cause the cancer, but my past experiences have taught me that asking why does nothing but bring more pain. I have learned from past experiences not to ask, “Why me?” Or even, “Why has this happened? I have learned the beautiful gift of acceptance. Acceptingthings that I cannot control and looking, instead, at things that I can. I knew I couldn’t change my diagnosis, all I could control was my choice of what came next. Genetic counseling was also suggested to determine if I had a predisposition for breast cancer.
“As the days crawled toward the second biopsy appointment, I thought about what my life would look like for the next 10 to 15 years with either choice. I didn’t want to have the fear every six months that the cancer had come back; I didn’t want to spend the next 15 years in forced menopause with the hormone blockers; I didn’t want to spend the next four weeks in radiation. I decided to move forward with the bilateral mastectomy with reconstruction. And be done.”
Once a decision had been made, the next step was to meet with the plastic surgeon. Initially, I went into it expecting a hard sell for large breasts, my own preconceived notions about plastic surgeons, but what I encountered was the complete opposite. Dr. Helm was incredibly supportive and encouraging. He urged me to consider the trauma of a bilateral mastectomy, reassuring me that I didn’t have to go that route if I didn’t want to. He wanted me to understand that it wasn’t a breast augmentation. He said, “You will always have scars because you will have survived breast cancer.” These words were incredibly empowering, I would be a survivor.
I dealt with the choice lightheartedly, again putting that figurative mask on and joking about the free boob job and perky breasts at 80. But as the surgery date approached, I started to mourn the loss of part of my body, the part of my body that bonded me with, and nurtured and nourished my children for the first year of their lives. I wondered what I would look like when I woke up in the recovery room. I wondered how I would feel physically and emotionally.
I was lucky to have contact with several women who had undergone the procedure before me, so I had an idea of what the recovery would entail. I prepared for the worst and hoped for the best. I knew from their experiences that the drains would be the worst. I was lucky to have the support of my parents who came and whisked my children off to their home in Maine while I spent the first week recovering at home with my partner. I was so lucky to have a partner who didn’t let me lift a finger so that my body could focus on recovery. He washed my hair in the sink and installed a removable shower head when I couldn’t stand not showering for another second so that I could take a shower without compromising my wounds. I was lucky to have an army of friends who organized to surround me and make sure that I would have what I needed in my recovery.
I’ve spent the last 4 months with tissue expanders implanted, preparing my body to accept and hold the implants that will be placed during my final step in this cancer journey, reconstruction. 5 months to the day after my life-saving bilateral mastectomy, I will once again enter the operating room, putting all of my trust in Dr. Helm to complete this journey. My fears about how I would look and feel have subsided. My scars are minimal and only below the breast. Because of the stage and positioning of my cancer, I was able to have a nipple-sparing procedure. I am lucky. So many women are not so lucky. Many have to go through the trauma of major surgery in addition to radiation and chemotherapy, along with all of the torturous side affects that accompany them.
I am grateful. I am grateful for early detection, for skilled surgeons, for the legions of people who have circled around me and held me up with their support. I am grateful to be alive to have this experience. To fight this cancer. To have the perspective and experience to know it can always be worse. This is not a pessimistic stance, I assure you. I have learned that, unfortunately, there are no limits to the hardships and tragedies we may each have to endure, but I allow that knowledge to carry me through each new challenge with gratitude that I am here to face the challenge. And I allow that attitude, slowly, to replace my figurative mask with the confidence that it will be ok, and I will survive.
