Wednesday, June 15, 2011

Nipple Remarkable

A bit of a longer post, as I'm pasting below an essay I read at a faculty reading of the Kachemak Bay Writers' Conference the other night.  It's been a recovery day after five days of intense teaching, learning, listening, talking, absorbing, sharing -- a literary overload.  This was the tenth annual, and I've taught and helped organize every one, except last summer's.  Last summer, while my writing community gathered on the end of the Homer Spit, I roamed the halls of chemo-land.

I began writing this essay last fall, and then I put it aside.  Thinking about what to read, I looked at it again, then asked my friend Margaret, a poet, what she thought.  "I think this is something you can only truly say in poetry," she said.  Those words lit a little fire in me, and I spent every spare moment after that madly revising, cutting out the narrative, explanatory parts, trying to let something underneath story and explanation speak -- the poetry -- another voice, another music, and I hope a deeper truth.  Reading it aloud to a room full of writers and friends was otherworldly and cathartic.  But it seemed to only walk me to the edge it, and to remind me that catharsis is a long term, ongoing process.  A bigger process than I imagined a year ago.  


As I trudge around my sister’s Cape Cod yard in the dark, trying to walk off chemo’s nausea and reflux, trying to breath past the spike in my throat, I recite in my head a mantra of names from a loved place:  Lucky Bay, Iktua Bay, Squire Island, Point Helen, Green Island, Long Channel, Dangerous Passage, Danger Island.  But names alone can not displace the power of the new language, strange, dense syllables lapping their colorless syllables into my ear.  Nor the new sensations:  my body, sliced, stitched, bandaged, pierced, infused, irradiated, pricked, transfused, staged, anesthetized.  Chemo-brained, nerve-numbed, de-marrowed.  My body yellowed, smocked, defrocked, and though deflowered and defoliated, nonetheless, by some, pinked.  Pinned, beribboned.   On breast cancer chat rooms you find women at all hours asking advice about side-effects, answering, storying, worse-case scenario-ing, signing off with their new names.  When I moved alone into my first Alaskan cabin, uneasy in the woods with a door that wouldn’t lock and a guy on a snowmachine in the cabin next door, for the phone book listing, I renamed myself Inanna Ivins.  Thinking it it would keep me safe.  Who are you, IDC, 2. 5cm, nodes, ER/PR, positive, positive? 

Close your eyes, slow your breathing.  Imagine on a picnic table a sheet of paper held in place by a magnifying glass.  Walk to the table.  Sit down, pick up the paper, try to decipher a language brute and unfamiliar:  stitch short = superior, long = lateral.  A right breast mastectomy without an axillary tail measures 18.0 x 17.0 x 5.0 cm. It weighs 339 grams. The specimen is oriented with long and short sutures that designate the lateral and superior margins respectively. An ellipse of tan skin is present located centrally.  The skin is unremarkable. The areolar measures 3 x 3 cm and the nipple measures 1.5 x 1.3 cm and is grossly unremarkable.   Like seeds, spit the words out of your mouth.

I meditate upon it – No – I study it.  No.  I deconstruct.  I read it again and again, ciphering out clues, searching for what I might have missed.  Only after months do my eyes land on that world:  grossly.  Close your eyes.  Breath.  Count backwards from ten.  Imagine a text, a page torn from a tome, lying on a picnic table in Nickerson Park in the sun.  95 degrees in the shade.  A page.  Crumbs.  A blue jay.  Burn ring from a magnifying glass on the page.  A sudden, hot gust lifts it up, carries it away, into the woods.  Does someone chase after it?  Does it land face-down in Cliff Pond?  Whose face appears reflected beside it?  IDC 2.5 cm, nodes,ER/PR, positive, positive is that you?

Other phrases, like “early stage” I roll around in my mouth with like-minded others “curative,” “survival.”  Early maybe, but still she’s “invasive,” she’s grade 3, aggressive,  she’s only stage 2, but still, not zero, not one, like some of those luckies chatting on Breastcancer.doc whose first names are all DCIS.  The sisters in situ.  IDC, she trespasses, colonizes.  Invasive Ductal Carcinoma.  The most common, unremarkable form of the disease.  No.  That is not my name.

Treatment:  a cookbook recipe: surgery, chemo, radiation, hormone therapy.  On the ultrasound image, the tumor gray, barely distinguishable from the surrounding normal, fibrous tissue, a nodule sprouting tendrils.  In the pathology report, it’s described as a 2 cm spiculated mass.  My mind reaches past the pathological lingo to a place I love Imagine a place where you feel safe, Prince William Sound, for metaphor, the familiar made strange, the strange, familiar, safe.  In Prince William Sound, in late summer, rain falls nearly every day.  Storms are waterfall makers.  The saturated, mossy earth can’t hold all the moisture and it plunges down the granite cliff sides and rills, white with oxygen, into the sea.  Tiny coves where we anchor turn viscous and green, and from a kayak, I can dip my cup into the freshwater lens and drink ions of alpine tundra, avalanche slope, muskeg.  Lion’s mane jellyfish, as if called by the sound of rushing water to a death fugue, aggregate near stream outfalls and die en masse.  Their red-orange bodies whiten.  Ghost-like, they drift and disintegrate, their tentacles dragging along the rocky bottom, tangling in eelgrass. 

The tumor’s tendrils twine, creep toward the lymph node under my arm.  After surgery, some pathologist typed out the words I read again and again:  “nipple grossly unremarkable.” The ghost-jellies of the Sound eventually dissolve in the sea, are reabsorbed.  The ghost-jelly in my breast, and the breast itself, and that grossly unremarkable nipple, are who-knows-where and so I

imagine a safe, loved place.  Drag your kayak up the beach and tie it to a log.  Slog through the muskeg behind the pond where wild irises grow and your boots sink into sphagnum and mud.  Enter the forest and climb the steep bank to the big hemlock.  Over  twenty years you’ve cried into its lichen-encrusted bark, nails dug into moss, gales hissing through the branches.   Sit with your back against the trunk.  Listen to the hermit thrushes and fish crows and waves slapping the beach below.  Sense someone there.  Look around to see arriving a black bear, a deer, a river otter, an eagle, an owl.  Put your hand to the flank of the bear.  Breath in the musty stench of skunk cabbage, den, and fawn.  Imagine her fierceness as cure, how it passes into you through your palm and travels up your right arm to the scar. 

Walking on a deserted beach called Crow’s Pasture with Lauren, who’s nine years post (I don’t know her other name, I’ve never asked), we find a knife in the sand.  Knife with a red plastic handle and a retractable blade, a fisherman’s knife.  And a few steps away, three square plastic dice.  Instead of odds, these dice spell out “sly.”  Knife, the surgeon took away my breast, so what to do with you? 

Imagine a place you love.  A stream bed littered with bleached, eyeless salmon bodies, you kneel over the carcass of a coho, fresh, a red-handled knife in your hand.  Beside you a black bear teaches you how to eat, how to replace your body, cell for cell.  Start with the head, he says.  Start with the brain.
Chemo leaves me bald and yellow-nailed, like a punk rocker, a chronic smoker.  Is that because Cytoxan is derived from mustard gas?  A thin layer of my face, Dijon brown, rubs off in the shower.  Skin so dry, I go through a bottle of Vitamin E oil in a week.  Months later, I stand in front of a mirror, my fingers tracing my skin’s new leaves, my head’s white, infantile fluff.

On a meditation CD, a woman named Bellaruth Naparstak with a soothsayer’s voice, instructs me to visualize in my body an army of fierce and hungry white cells and I, its commander.  I close my eyes and hear, like a hive of bees, beneath the sluice of blood pulsing in my ears, the thrumming horde in my bone marrow.  I command.  When the fierceness dies within me, I imagine killer whales swimming all through my body, echolocating down the channels of lymph and blood, cornering cancer cells, searching them out, cancer's traces, not syllables now, but a broken alphabet, killer whales ushering them out.

Despite the pink language of hope, the green language of survival, the white language of statistics and stages, one red word overshadows every other.  On the mudflats in the Sound, a crab, a sidewise scuttling creature, is comical, tentative, quick to retreat under a rock or frond.  Cancer is no such animal.  Cancer is sly.  A red-handled knife.  Three dice tossed in the sand, spelling out my name.  Not Innana, not IDC.  In the gray language of fear.

Imagine a stream.  Amid rocks and blue-black piles of bear scat, salmon carcasses litter the grass, their faces chewed off by river otters and bears, their eyes gouged out by gulls.  Get on your knees and sip the water from the stream like a deer.  Drink until your jaws ache, until chemo's heat in your body cools.  Then lie face down.  Place your face on a swath of sea paper stretched between grass blades, studded with tiny snails and woven with eel grass.  Breathe in the smell of salt and decay and damp stones.  Clutch grass in your fists.  Know you could die right here, right now, today, and it would be okay.

Red again.  The rash begins along the rib bone below the scar.  It spreads up to my neck, ruby regalia, wild fire.  Every morning, I drape a washcloth soaked in ice water across the burn before stepping into the shower.  Every afternoon I walk through the three-inch thick door with its radiation hazard sign.  I lie on my back on a cold slab, a warmed blanket over my body.  I'm held in place by a plastic form, my arms overhead, hands gripping a metal bar, feet gently bound with a strap while the technicians measure me with a little plastic ruler and call out numbers.  Now I am "99” and “1.5-2.2 deep with MLC”.  As the table rises and shifts, and laser lights draw red lines across my chest and on the walls.  Then the technicians say, “We’ll be right back,” flick on the overhead fluorescent lights, and leave me alone.  Me and my shadow, the depthless eye over my left shoulder. I counted breaths as the machine clicks and buzzes.  Shouldn't this sting?  Burn?  I keep my eyes closed.  Remember, I tell myself, Bellaruth, how she said remember    

to breathe.  Imagine looking into a deer’s eyes.  Imagine the cool light of the moon.

Half-way through radiation, my husband and I take our bikes on the ferry to Nantucket for a weekend.  Biking around the island one morning, I find a dead deer beside the path.  She lies on her side, her black liquid eye looking past my shoulder at the pale blue sky of autumn, at a translucent wedge of moon.  I kneel by her side and touch her forehead and her cheek.   Craig, ahead of me, doesn't notice, bikes on.  Surreptitiously, I slip my hand in my pocket and feel for my cell phone.  I photograph her, I don’t know why, and feel strangely ashamed.  Why are you so damn morbid?

The machine rotates again.  Its rows of metal teeth shift expressions.  After the last zap, the teeth make a strange fluttery sound, like frozen butterfly wings falling on crusty snow.  It clicks off, the eye closes.  I lower my arms.

Imagine first snow falling on the body of the deer, melting in the pool of its skyward-facing eye.  Imagine yourself held inside that water, blessedly cool, a secret inside your own pocket.

Waiting for surgery, I felt tender toward my breast.  At night, I placed my left hand on the lump and my right hand on my heart and imagined compassion flowing from right to left, from heart to breast.  I wept for it.  By day, I ate kale, tumeric, garlic, flax oil.  During Bikram yoga, my hands slid across my yoga matt; my sweat smelled toxic.  Imagine a dolphin guiding the cancer out of your body, back to source, Bellaruth Naparstak said through my Ipod earbud every morning.  Be gone, be gone, chanted the energy healers.  I felt empowered.  But as the weeks wore on, the terror of the spiculated mass grew beyond the tenderness and effort.  I’m done, I thought, every time I looked in the mirror after a shower.  Bring on the surgeon.  Bring on the red-handled knife.  Take this pound of flesh away from me.  When I awoke from anesthesia and looked into my surgeon’s eyes, I didn’t ask, “Was it in the lymph nodes?”  I said, “Thank God it’s out of my body.”  I didn’t ask, “Where is it now, my breast?”  In the hospital room, I stared down at the gown, where it lay flat across the bandage.  Where my breast had been was an absence.  No pain.  No sensation at all.  The bliss of disappearance.

Only later, when I read the pathology report, when I read those words, “nipple grossly unremarkable,” I wondered who had dissected it.  I wondered where he’d taken the remains.  I mourned the breast then, its fate.  I heard later about a woman who asked for her breast, and got it, and in a ceremony, placed it at the bottom of a deep hole into which her friends planted an apple tree.  That summer, when I stood in the outdoor shower and stared at myself in the mirror and ran my fingers along the scar, I thought about that breast, that nipple.  What place did they take it to, that mound of caressed,  abused, longed for and rejected flesh?  The hospital incinerator?  A freezer?  A dumpster?  That breast with all its stories and longing.  Marked.  Remarked upon.  Unremarkable.  Unable to remark.   Who-knows-where is as good as nowhere.  I would like to have taken it to Prince William Sound, that loved, safe place.

And then I realized that I could take it there, and I did.  And do.

Imagine a place, a place so powerful you refuse to utter its name.  You call it by another name, the center of the labyrinth, the place where the essence of the Sound rises up as mist, spills from the waterfall as clots of foam, mingles with sea grass to form paper, enters your body as breath.  A place that knows your true name.  The place where, once, you died, and it was okay.  Kayak to the waterfall, where the jellyfish and salmon steady themselves in the current.  From your pocket, pull out the breast.  Put your lips to the nipple.  Hold it in your palm as you submerge your hand in the water.  Let it go.  Watch it turn green as it drops to the bottom and disappears beneath the jellyfish and salmon.    


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