Pathology Report

JV Genova

Wondering: when do you become a mother? Is it when your child’s eyes search for you when she’s afraid or uncertain? Or is it when the surge of protectiveness unexpectedly swells inside, a sleeping beast with spitting ferocity? No, maybe it’s when the baby wails from another room, wanting to be fed, but you cannot help her, though you are the only one with the food.

What no one tells you are all the important things, the hardest things. Mostly, they just say, “Sleep when the baby sleeps.” They don’t tell you how to sleep when the world is on fire, or how to rest when you realize your daughter probably won’t have the same rights—hard-fought rights that you’ve had, such as reproductive rights. In 1967, Joan Didion wrote that “the center was not holding.” Her words are perhaps more resonant now than ever before. The center is not holding—or perhaps long ago it stopped—and as my child grows, so does this quagmire and this awareness of the shifting sands of our world. The realization that I was a mother came in waves, but my acute awareness that I might not live to see my child grow penetrated my very core, not unlike a biopsy needle.

It makes for a good story, really. Once, a creative writing teacher—admittedly, fiction—urged our class to “torture the protagonist! You’ve got to torture your protagonist!” This is good advice. He’s an excellent writer. The story—the one in which the protagonist might be said to suffer—goes like this: While nursing one day in 2012, I felt a lump. Miserable with the flu, I was lying in bed, trying to keep my baby healthy (by nursing, even with the flu) and happy (though I could hardly get out of bed). I assumed it was mastitis—a clogged milk duct—but called the doctor just to be sure. Immediately after examining it, she sent me to the Breast Diagnostic Center. It sounded almost like a place you’d take the car for diagnostics—to determine what was wrong. The very implication was that something was wrong. It’s one thing to offer a diagnosis, whether for the body or a country. Healing is a different matter.

Lactating female, as in successfully breastfeeding for six months—something I never saw myself doing. Then again, I never saw any of this coming. Marriage, a child, a four-door sedan, a house. The return of blatant white nationalism and far-right neofascism. A cold civil war, growing hotter. I didn’t see myself having a child, because I was so afraid of falling short, of somehow damaging her. But it’s no longer me I’m afraid of. I want to locate this invasion, root it out, and stop the feeding of what is an apparent disregard of history.

No one ever sees the cancer coming. Except now I think maybe I actually did; maybe it was visible to me on some strange psychic level. Before that day in February of 2012—when my daughter was barely six months old—when the nice doctor lady punctured my lactating left breast with a needle and I watched its entrance to my body on an ultrasound screen, I had already had dreams. The same dream. Several times. Enough times to create insomnia until the sun came up. In the dream, a shadowy presence I could not see hunted me. It could see me; it knew right where to find me. And the thing was dark, and it felt like the feeling in your gut right at the moment you learn someone you love has died. It felt like watching the towers fall. It felt like hearing a dog be beaten. It felt like death. I did not see it coming, but I was not surprised by its presence—much like the wildfires that consumed portions of the state in which I live, or the grackles that arrive each season, black wings above casting shadows below, electric cackles echoing.

Could anyone have seen this collective moment coming? Could anyone foresee the political division that has become apparent and only grown? What was our prophetic dream? Or illusion? Maybe it was on social media, but somehow we missed it as we scrolled past racist memes and misinformation. Siddhartha Mukherjee writes in The Emperor of All Maladies: “Nothing is invented; nothing is extraneous. Cancer’s life is a recapitulation of the body’s life, its existence a pathological mirror of our own. Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.” Much like I hoped my daughter might be. Maybe not so much a copy of myself, but perhaps a better, updated version. She is better than I ever might have imagined; still, I eye my dreams with suspicion. I wonder what I cannot see.

The nine people on the Supreme Court have argued for and against our right to healthcare, including our access to insurance coverage despite any preexisting conditions. Capitalism trumps compassion. There came a time when the hospital bills sat unpaid on the kitchen table, shoved aside for my child’s dinner, a stain on the envelope where there should be a stamp. Perhaps this is the definition of motherhood: resource allocation. How much worry and fear to be set aside for later?

It may be a phrase that’s been tossed around casually, but the personal is political became my personal refrain for all of 2012. Barack Obama signed the Affordable Care Act into law in 2010, and just under two years later, I was diagnosed with breast cancer at a young age. To be diagnosed with cancer at a young age automatically places you in the category of high risk. My husband and I had not yet finished paying the bills from our daughter’s 2011 birth when a new cascade of envelopes with bills inside began to arrive. I often wondered who “approved the billing” my pathology report so mechanically indicated.

During the biopsy, my baby cried in the waiting room while my body—which literally held her food—lay exposed under bright clinical light. Months later, I would compare bill amount totals to checking account totals and wonder how much to put toward bills and how much to baby food. The realization that I was a mother felt as stark as my bald head.

February 2012. I laid supine, noting the cheery flowers painted on one tile of the white ceiling above my head. These presented both a repulsion and pleasure, though I hardly registered either the emotion or the flowers. Now I recognize that they repulsed me in their cheeriness, in their assumption that I wanted something pretty to look at while a hollow needle punctured my very sensitive lactating breast without telling me that I should probably be scared shitless (shitless!) right now. But the flowers on the ceiling and the way I felt about them were all peripheral. In my actual periphery, the doctor prepared me for the “stick” I was about to feel, as she watched the monitor to her left, allowing it to guide her needle. I turned my head so that I, too, could see, and tried to decipher the black and white blobs and blurs on the screen. At around the time the physician was placing the radiopaque marker—about the size of a sesame seed—into the area of palpable concern, I could hear my baby wailing in the waiting room. Bright sounds in a beige room. The needle entered and the doctor watched. When she finished taking a sample of the interior of my breast with the hollow needle, a tiny marker waited inside me so another doctor could see precisely where the site of palpable concern sat. My other palpable concern screamed in hunger outside the dark and cold room as a friend gently bounced and shh-shhed her around the waiting room. A drop of milk dripped. The body responds.

And yet, fear distorts: the one without suspicious mass or architectural distortion was excised. I opted for a bilateral mastectomy. This is a matter of risk mitigation, of the surgical removal of the likelihood of my dying before my daughter is grown. The architecture inherent in building a life sometimes means unexpected paths and difficult decisions. When my daughter is old enough to understand, I want to be able to tell her I did everything in my power to stay. And when even the healthy tissue was taken away, I knew they would dissect those parts they removed from my body. I understood that I would become a study, for my sake and for the sake of others. When surgeons remove a tumor, they don’t just throw it away—they examine it, catalog it, take tiny slices of the tissue for later study. They don’t just get rid of it and move on. It’s necessary for healing to make a full assessment of that which has created malaise.

I tried to lessen the risk of my dying soon by removing all the tissue, but I do not know how to lessen the risks my daughter will face. Her risk of cancer is higher, thanks to my diagnosis, but perhaps I ought to worry more about the neighborhood school and the likelihood of someone entering with a gun someday.

It’s 2012. Both breasts gone. Sent to the lab that almost certainly sits in the bowels of the hospital. There, under bright, clinical lights, a technician would pull them from formalin, slice them, examine them, and catalog them, perhaps while thinking about a lover, or maybe about lunch, or possibly about the state of the American political system. They couldn’t see what was coming, either. 

A few months later, I would find myself supine yet again, paper covering the exam bed crinkling beneath me. Once breasts are removed in a mastectomy, if a patient plans to have reconstruction, temporary expanders are placed where the breast tissue used to be. The purpose of the expanders is to stretch the skin in preparation for permanent implants. The process looked like this: removal of all breast tissue and insertion of expanders (an inflatable balloon-type thing with a valve), which are placed in the chest wall—though they have nothing in them, yet. Following healing from surgery, the patient returns to the doctor, where each week or so, saline is injected into the expander to slowly stretch the skin. In my case, this took several appointments which could only happen during the weeks I was not doing chemo. Once chemo is finished, reconstruction can take place, at which point the expanders are removed and replaced with more permanent implants.

As I laid on the table, the nurse practitioner used a tool that reminded me of the planchette used in Ouija board games. She would hold it over my chest, where the tool would then indicate where the expander was. Then, a stick. The area where the breasts used to be is generally numb—much like your cheek feels following a dental procedure—but I could always feel the needle. As she slowly pressed the depressor, allowing the saline to fill the expanders, the sensation was one of pushing. It felt a little like the air being pressed gently out of my lungs, yet I was still able to breathe.

“Um . . .,” I remember worrying on the second appointment. I was, of course, on a first-name basis with several of the medical professionals I saw each week. “Miriam, I swear I can feel that. On my heart. It feels like it is pushing on my heart.” I tried to remain stoic, but the feeling was too strange, too foreign.

Miriam smiled as she continued pressing. “You probably are feeling it on your heart,” she said. “I mean, the expander is probably pushing a little bit around where your ribs are, and it might be touching your heart.”

That sensation continued each time I had an expander fill on my left side. It’s amazing what we can get used to, just as a lab technician becomes accustomed to pulling nipples from formalin and examining slices of them under a microscope. I found I am able to sit with fear in ways I never could have anticipated. I realize precisely where my heart sits in my chest. I did not see this realization coming.

I consider the importance of marking this time—of looking closely at what sections of this collective moment might warrant recording—of marking the margins of safety, of inheritance. Just as I hoped to mark my own past before surgery: sitting topless on the toilet lid, my husband plastered my chest. We purchased a pregnancy casting kit—meant to commemorate a pregnant woman’s belly during her final months—not for my own pregnant belly, but for the breasts I was about to have surgically removed. This moment marked a margin, a line of time I was about to cross. It felt important to chronicle it. Breasts heavy with milk while our daughter slept, I sat still while the plaster dried that my husband so carefully placed on my breasts. I sipped wine while it hardened—an outer shell of myself. We removed the plaster “bust,” set it out to dry, made dinner. The cast sat in the closet, safely tucked away, as I had surgery and recovered.

Given the distance of time, I look at it now as it hangs on my bedroom wall. I note how one breast is larger than the other because my baby nursed on one side before her nap. The other breast, full of milk, she would nurse from when she woke up. Without the cast, I would have forgotten what my natural breasts looked like. It’s a strange thing to look at a part of yourself that no longer exists. Maybe it’s a little like advance planning your own funeral and seeing the headstone. It’s all so far away, and yet so near. Distance is perhaps a relative concept.

The thing about an invasive cancer is that one is always left to wonder if, or when, it will invade again. How do I prepare my daughter for all the ways in which it can all go wrong, or the ways in which a cancer spreads outside the body, into the body politic? I celebrate the currently uninvaded margins in my own cells but know little about how to rid the larger whole of this malignancy, or how to protect my daughter from it. It is impossible to forget my own history, though many seem to have forgotten or distorted our collective history. How do we tell the ones we are trying to protect that sometimes the aberrations we thought we’d eliminated stage a recurrence?

In March of 2012, the tumor’s size is roughly the size my daughter had been when I was about two months pregnant. At four months pregnant, I planted bulbs in the garden and considered growth and life. I began to prepare for change, though I did not quite know how. We can’t always see what’s growing. This is true for all things, including deep within the recesses of the place you call home—whether your body or your country.

One could argue that having biological children is nothing more than a reaction to a fear of death or a response to the reality of one’s own mortality. Perhaps it’s simply the evolutionary pull. Whatever the reason, half of your genetic material is left to walk the earth once you no longer do. It’s arguably the closest thing to tangible, physical immortality we will find. This is true for non-biological children, too—raising children is a way of perpetuating the self. I was not seeking immortality, but I never feared my own death until my child was born. I also did not worry to this extent about the future—the future of the planet, the future of this country, or the future of next generations. I wonder now how facing my own mortality prepared me for this moment and all the ways in which I’ve learned to deal with fear every day. But when she looks up at me with her gray eyes, my fear for my daughter could bring me to my knees.

Even when you don’t take them for granted, the days pile into months, which accumulate into years. The dream might return, and what’s left to excise? To survive is to continue to live, despite an ordeal, illness, or contrary circumstances. We are in state of metastasis now; fascism is creeping in from darker corners. A man in my tiny town flies a Confederate flag on a pole in his front yard until teenagers steal both the flag and the pole. The man moves away, but a woman works to ban books in our little library.

The summer of our wildfires has ended, the flames finally suffocated by the relentless work of firefighters and inevitable cold of autumn in the Rockies. The grackles have returned—a sea of black movement in the green grass as they hunt for insects. They fill up the ash tree, impressive in its size, leaves a giant bloom of yellow. By the hundreds, they fly overhead, black bodies briefly blotting out the sun—flashes of shadow. I stand captivated by their movements, their electric cackles.

Our current understanding of epigenetics tells us that we can change the expression of genetic sequences. According to the National Institutes of Health, the term epigenetics has evolved to “include any process that alters gene activity without changing the DNA sequence and leads to modifications that can be transmitted to daughter cells.” Put another way: we can influence the expression of our genes—we can modify their behavior with our own. Put in the most simplistic way: it might be possible to avoid the proliferation of cells that become cancer through various “lifestyle” choices, such as diet, exercise, and stress reduction. And so, I try. I eat ridiculous amounts of kale, I use the elliptical machine, I write. I do these things in the hopes of changing the trajectory, in the hopes of finding understanding. The outcome of an election or political maneuvers alone will not be our collective epigenesis, but perhaps we can change an inevitable diagnosis of our failure. There is no final diagnosis to offer, only uncertainty.

The plaster cast now hangs on our bedroom wall. We painted it black. When the sun filters through the south-facing windows, the color changes to gray.

JV Genova holds an MFA in nonfiction from Colorado State University and is a former associate editor for Colorado Review. When she isn't writing, she dabbles in photography and grows potatoes. She cannot believe she is someone's mother. She can be found on Twitter @jv_genova and on Instagram @jv_genova.