Thursday, February 28, 2008

Clampdown, Part II

This time around, for my fourth mammogram in about five years, things started out well. I had remembered my slip! The technician seemed pleased. And for some reason, everything was breezy--in retrospect, maybe too breezy. I changed quickly, she positioned me about four different ways, I didn't move, the films, she exclaimed, "were good." The only difficulty for me was the horrible pinch I felt, given that I was pre-menstrual and my breasts were tender to touch, let alone to squeeze and flatten into pancakes--but even that passed quickly. In and out in ten minutes--I was amazed, and had one of those silly, delusional thoughts, that I had somehow conquered the clampdown, figured it out, put in my dues, breezed by all the troubles that had snagged my previous mammo experiences, and could now eat my cake. Cake! When I left that day, I felt light, even a little smug, laughing at my past foibles with the clampdown. As if!

Yeah, well, I should know better, shouldn't I?

A few days later I got a call from a nurse at the local women's health center that had ordered the mammogram. I could tell instantly from her voice that something was wrong. "Hi Liz, it's M. from the Health Center. We've just been reviewing your test results. Did Amanda tell you anything?" That's never good. And who the heck was Amanda? And what would she be telling me? "They found a nodule on your mammogram, left breast. You need to have retakes and an ultrasound..." The rest, gibberish. Somehow, I scribbled some notes on a piece of scrap paper. Shit. Shit. Shit. Call CRI for retakes and ultrasound.

The fear came on immediately, sinking into my belly like a lead weight and sending sharp bursts of panic all over. I hastily made a call to schedule mammogram retakes and an an ultrasound at the place where I've always had my mammograms; I'd have to wait until the end of the week, and would have to go to the hospital for the ultrasound. I placed a call to the hospital. They could see me directly after my mammograms, and I should bring my films with me so that the radiologist could read everything right away. My anxiety whirled into a paranoia-dust storm. I felt blinded. There seemed to be an urgency in everyone's voice that suggested that I was the last one to find out about the nodule, a mini conspiracy theory in the works.

Later, I spoke with L., a wonderful mid-wife who lives just up the hill from us and whom I see for my annual exams. She offered up a much-needed dose of perspective. Why worry about this? It could be fine. And she was right. I have spent far too much time in my life fretting about the what ifs and spinning out tales of chaos and catastrophe. I would just have to wait. Try to go about life as usual. And wait.

The Clampdown

Most days, I don’t worry about the size of my breasts. Oh sure, sometimes I get momentarily brainwashed by the abundance of self-improvement (i.e., breast-enhancement) television shows and print ads into thinking that I am too small, and inadequate and unattractive as a result, and should start saving up for implants, or better yet, for an extreme boob makeover (what the hell, make ‘em a D!), but it lasts only a few seconds, and my usual perspective is quickly restored ~ that small breasts are just fine, thank you. It’s just as india.arie sings in Video, “Don’t need your silicone, I prefer my own. What God gave me is just fine.”

God, perhaps, and more surely, what Mama gave me, anyway. Long before I understood the power and surety of genetics—that no matter how hard we try not to, we all become our mothers at some point—and before I reached the tender age when my own body was scheduled to go through the glorious changes that I was sure would land me in at least a C cup, I teased my mother relentlessly about her utterly flat chest. What the hell was I thinking? That I would somehow inherit the ample bosom that my great grandmothers and grandmothers sported and memorialized in sepia-tinged old family photos, taken when they were, of course, having scads of brats, nursing babies, drinking whole milk, and enjoying a more Rubenesque weight to begin with? “You and your sister sucked me dry when you were babies,” my mother would say in her defense. And I’d believed her, of course, just as I had when she had told me my shoulders were cold was because they were made of ice. It all made sense, right? Shoulders made of ice, breasts made of milk, and that touch of cellulite on her thighs? Why, cottage cheese, of course. It seemed that I, infant me, was to blame for her tiny breasts, after nursing so vehemently in the first three months of my life that I had left her with nothing but two nuclear-powered nipples that looked alarmingly large, knobby, and barely sewn on atop her flat chest—testimony to my nursing prowess, perhaps, their acute functionality, or, as I would realize later, my mother’s ability to spin a good tale.

Sandwiched between this early confidence, or rather, ignorance, and the adult-onset level of comfort that I would enjoy later on, was a period of supreme uncertainty and anxiety about the size of my breasts. True to form, I was a late bloomer, and when I was in junior high, when my friends started to “bud,” I was still in the nothing-growing-in-the-garden, super flat mode, wearing little bras just to feel "normal"--if that's at all possible at the age of 13. It’s amazing what thirteen year olds will do to not get noticed. Not only was I undeveloped in the chest area, but I felt shapeless everywhere else as well, with boyish, slim hips, big feet, and bony, stick out shoulders. To make matters worse, I was taller than most everyone else. When friends weren’t calling me “egghead,” they were calling me “bone” because I was so skinny. I just couldn’t fill anything out. Boy’s pants seemed to fit me better. I remember one particular day of reckoning: I had gone to the locker room after school to get ready for field hockey practice, and had started to change when I realized that I had forgotten to wear a bra that day. I was mortified. So I did what every other 13 year old would do: Rather than risk the humiliation, I said I wasn’t feeling well, bagged out of practice and ran home fast. Too smart, too tall, too skinny—it was all I could do to disguise the fact that I was also too small. Who says there isn’t a Girl Code? Save face at any cost. Eventually, I grew annoying little speed bumps, and that was about the extent of it until I went to college, drank a lot of beer, went on the pill, swelled, and started to actually fit into a B-cup bra (well, just barely). During my sophomore year, I roomed with three other women who all had enormous D-cup boobs, so big they suffered back pain, had to special order bras, and complained about them incessantly. Guys would sing that song from Sesame Street to joke about our suite: “One of these things is not like the other…”

When I got married, I wore my great grandmother’s wedding dress that her grandmother had sewn by hand. It had needed a few alterations, most notably the addition of about four inches of fabric in the back (I suppose I could have used a corset to whip my rib cage into proper shape), but fit pretty wonderfully, and it dawned on me that maybe my great grandmother, who had stood nearly as tall as I did in her youth, had passed on not just her height with me but her small chest as well. There was much comfort in feeling how well her dress, my dress, our dress, fit my body. I’ll never forget how I felt after the ceremony, the relief at having the walking-down-the-aisle-with-all-those-people-looking-at-me part was over, the anticipation of being able to relax and enjoy the company of friends and family at the reception, and the sudden annoyance, when a male friend from college commented at how “beautiful” I had looked in my dress, “except for not being able to fill out the chest.” Why did I invite him? And what the hell was he thinking, saying something like that to a bride on her wedding day? “Gee, you look lovely, but just to let you know, that dress makes your butt look really big!” Should I have worn a padded bra? Faked it? Not my style, thanks. I remember feeling slightly stung, but think I only hiccoughed, or laughed it off and turned away, when of course I wish I had issued a more appropriate response--I should have flat-out decked him, kneed him in the crotch, given him a right hook to his stubbly chin, sent him reeling, packing, out of town, Run away, Scar, run away and never come back, after, of course, and only after I had told him that he would look fabulous in those spiffy pants if not for his tiny, wee penis. Damn shame, it was. Missed opportunity. Oh well.

By the time I was married and pregnant with my first child, I thoroughly enjoyed my suddenly super-sized (for me anyway) breasts, filling out shirts for once in my life, and graduating to bigger and bigger cups. Once I started nursing my son, my breasts took on an entirely different role, of course, and I was relieved that they were more than up to the task. Unbelievably, I had to buy D-cup nursing bras, and though the occasional engorgement was painful, it was also a strangely satisfying experience to suddenly have, albeit rock hard, big bazookas. Of course they were suddenly in the way, and I didn’t want my husband touching them at all. Hands off! These don’t belong to you anymore! And my toddler would run over, lift my shirt, and lay claim, “MY num-nums!” And it was amazing to feel so unabashed about nursing in public and not worrying about whether a little skin was showing, or if a nipple got loose in a crowd. As far as breast feeding went, there was a certain amount of pride involved—after all, is there a more perfect, portable food? (ok, maybe bananas, but they turn brown and yucky after awhile) After three years of nursing, I was ready to stop, but admittedly, I was a bit depressed when my breasts started to shrink back to normal size. It was definitely time to get pregnant again. So I did. And after giving birth to my second son, a 10+ pounder who rocketed through in record time, the midwife said I had a “pelvis like a mach truck.” “Ah, thank you, I think?” At the age of 33, I wondered if I finally gotten my womanly curves.

After another three years of nursing, days filled with amazement at watching my toddler's sheer joy in laying claim to his "nah nah's" (love all the different names toddlers give their mother's breasts--food, comfort, and warmth all rolled into one--almost like a first pet!), nursing for a split second here, an hour there, nursing while listening to stories, one eye on the pictures, off and on again, ah! what the nipple endures!, I watched my breasts gradually shrink once again, but this time to smaller than normal size. Whoa, is this what my mother had meant? I burned my nursing bras, done with that, thank you, and tried on my old bras, which felt scratchy and uncomfortable. So I went back to wearing tank tops, camisoles with the nifty (nifty!) built-in bras, and some days, nothing at all. And most days I really don’t think about it at all.

Today was different. Today I had to think about it, and wish for just a little more. Today I had a mammogram.

It was routine, my second one in three years, but I suppose enough time had elapsed in between that I had conveniently forgotten just how painful it is to have what little breast tissue you have crammed and squeezed and poked and flattened and pushed into positions more awkward than trying to nurse a baby in the backseat of a speeding car ~ much, much worse than having a nursing toddler chew on your nipple for sport, or help himself to grabbing and squeezing some milk out (“Look, Mommy! It squirts!”). My entire chest and breast region is sore and achy, and while I am grateful for the technology that we hope is saving thousands of woman’s lives every year, I must also spit on it! Pfst! I spit on you! And curse it! Damn mammogram!

Ok, I feel a little better now.

Granted, it started off badly ~ I had forgotten to bring my referral slip from my doctor’s office, and the technician announced that she could “easily refuse me,” but lucky for me, oh lucky me, she agreed to do the mammogram, and eked out a subtle punishment in her short temper and sharp tongue, while her hatchet man—the rectangular box known as the “mammography unit”—roughed me up. “I’m going to need to ask you a lot of questions, since you DON’T HAVE YOUR SLIP.” “Was there any information that I need to know on your slip? Since you FORGOT YOUR SLIP, you’ll need to try to remember what she wrote down, if anything.” Obviously, she was under the impression that my brain was addled, or had stopped working, and she may be right. “I suppose we all have a lot on our minds ~ that’s probably why YOU FORGOT YOUR SLIP.” As I changed into the lovely johnnie gown in the little changing closet, I was tempted to keep the curtain pulled, sit down, and hide out on with the stack of People magazines for awhile until she cooled off. Nope, not an option. “Since you DON’T HAVE YOUR SLIP, I need you to COME OUT HERE and answer some more questions about your history.” Ok, so much for finding out if Brad and Jen are ever going to get back together.

After getting through the questions (“Any chance you could be pregnant? No? Sign here. Date of last period? Did you at least remember NOT to wear deodorant or powder today? Your grandmother had breast cancer, right? Mastectomy at the age of 51, died at 83 of breast cancer.” “No, she didn’t die from breast cancer.” “Then WHAT exactly did she die from?” As if…), she strapped on a heavy apron around my waist to “protect my belly.” “Ah, you might be TOO TALL for this machine. I’m going to have you sit down.” Oh crap. Too tall, too small. Leaning in while sitting on the chair simply didn’t work (“there’s no way we can get both breasts up there”), and the difficulty was clearly aggravating her. So she asked me to stand, and raised the little boob platform as high as it would go. I was then instructed to lean into it with my right side, at which point she grabbed my breast, lifted it up onto the platform, and told me to “lean into it, relax my shoulder, bend my knee, keep my feet and hips facing straight ahead, hold onto the handle with my hand, and let the corner of the platform rest in the middle of my armpit.” Rest? More like dig into and pinch. And so many instructions! I was already feeling like a bad dog for forgetting my slip—I wasn’t sure I could follow so many commands. And where were my treats?!

And then came the CLAMPER (officially known as the “paddle”—and not to be confused with the Clapper, which inspired the beguiling litttle tv ditty “clap on, clap off”—I call it the clamper, for the sake of descriptive clarity), a clear plexiglass thing (looks a bit like a clear plastic tray, or a box) that gradually and menacingly got closer and closer (Jaws music here, please) as it was lowered to where my breast sat, waiting, quivering, treading water, on the platform. Ahhhh! Seconds later, the clamper had reached its destination, and was squeezing and compressing the be-Jesus out of my breast tissue, now utterly unrecognizable, since having been successfully flattened into a pancake so that, ahem, any small abnormalities could more easily read by the x-ray film. Of course, I don’t have a whole lot of breast tissue, so it felt as if chunks of my chest—skin and ribs included—were being compressed as well. And just when I thought it couldn’t get any worse, she tightened the vice. “Feeling a pull?” “Yep.” “Does it feel tight yet?” “Oh yeah.” “Doing okay?” “Splendid.” (Crap! I’m going to cry!) And then—here’s the part I loved the best: “Ok—now just RELAX and hold your breath.” Yeah, right.

By the time we were arranging my breast for the fourth film, she had started to forgive me, I could tell, because she was telling me I was doing an “excellent job” and had started to dish out her instructions with a little more patience. And just when I thought I was in the clear, this: “I’m just going to run these films through, because I’m worried we may have to do the right side over again. Your nipple wants to flip under, and I didn’t like the positioning on that one.” Yeah, well that was the favored side for nursing ~ and after six combined years, I’d say the nipple has been permanently realigned, reshaped, and traumatized, and has gone into hiding. No more sucking! No more flattening! Leave me alone! I can relate to that. Can you relate to that? I can relate to that.

She seemed very pleased with her second attempt at getting a good read on the right side, and I was beginning to feel like a naughty puppy who has just been forgiven for chewing up a shoe. “Well, you may have forgotten your slip, but you did a good job at holding your breath and keeping still and letting me squeeze your breasts into pancakes, so GOOD GIRL!” As I got dressed, her chatter was warm and friendly, and tail wagging, I was lulled into asking her about something I thought I had just read about: if MRI’s were considered just as good of a screening method as mammograms. I could see her jaw clench a little. “No, mammography is THE BEST way to detect breast cancer, but MRIs are sometimes better if you have implants.” Implants? “Just be glad YOU don’t have implants,” she told me, ”because if you did, we’d be doing twice the number of films, the first two with the implants in place, and a second series with the implants pushed back and the breast tissue squeezed around it in front. It’s really quite painful ~ and it’s double the exposure.” Do you think any of those male plastic surgeons tell their implant victims about that? Of course, having to get mammograms when they’re looking at the big 4-0 isn’t exactly on the minds of those 16 year olds anyway, but what is? Mama, don’t let your girls grow up to get implants. Remember, what God—or your Mama—gave you is just fine.

As I drove home to retrieve the forgotten paperwork, I mused over the relative discomfort of my visit, and an idea came to me: If men had to get testigrams to screen for testicular cancer every now and then, maybe more money would be spent on developing more comfortable and reliable screening methods for breast cancer. Bet that would go over big, eh?

Until that happens, I wish you all good breast health, and the courage to get those screenings done, when the time arises. Okay—gotta run and get my slip over to the mammogram place before they hunt me down like the dog that I am. Woof! I send you love ~ XO, Liz

Epilogue: That afternoon, I returned the slip to the front desk at mammograms-are-us. And no kidding, the receptionist said to me, “Aren’t you a good girl!” Wag, wag.