PEOPLE ALWAYS WANT TO KNOW how you found it. There is no story without an origin: the moment of discovery, the anomaly that might be innocuous, but isn’t. The suspicious symptom submitted for inspection. They will carve it out of your body, label it with an identification number, send it to a laboratory for expert interpretation. One week later, they will tell you how sorry they are.
I will say I found it in the shower, because this is a story I have heard before. It seems indecent to admit that my asshole boyfriend discovered it while groping my breast during sex, that he asked what’s that? before coming inside me.
And anyway, I can’t imagine why it matters.
To be sick is to be consistently solicited for the story. To be sick is to be asked to explain oneself, to make meaning of oneself for the benefit of others. “People ask, How did you get in there?” Susanna Kaysen opens Girl, Interrupted, her best-selling memoir of psychiatric institutionalization. “What they really want to know,” she continues, “is if they are likely to end up in there as well.”
People typically do not ask how you got cancer, or even when; after all, such things are impossible to say with certainty. So they ask how you found it : it, the inauspicious sign from which the inevitable trajectory proceeded.
But what they really want to know is whether you caught it early. Even though cancer is classified in four stages, in the popular imagination it has only two. One is early. The other is too late.
What they really want to know is if you went looking for it, whether you were circumspect or careless with this commodity, your body.
What they really want to know is whether you are to blame.
THE SURGEON WHO WILL eventually cut off my breast is the one to break the news. Of course, on some level I already know, because when I’m invited into the exam room of that West London clinic, an hour and a half after my scheduled appointment time, the doctor is brimming with a terrible forced cheerfulness and poorly suppressed pity. And because the first thing she asks me is whether I am alone. And because there are too many people there for this to be ordinary. The doctor called the surgeon. The surgeon called the nurse. The nurse called the social worker with the alligator purse.
I once heard that the expression break the news originated with medieval messengers who would need to break the seals on parchment scrolls to deliver information. I have no idea if this is true, but it seems appropriate. When you break bad news, you need an intermediary: to open a pathology report, point to an x-ray. This isn’t personal, they seem to say. It’s science.
More often than not, this is where the story of sickness begins: in the clinic, at the moment of diagnosis. Illness narratives—or “pathographies,” the term literary critics have coined for this genre—“begin not with the emergence of disease but with the emergence of the narrator-author as a diseased person,” writes medical humanities scholar Catherine Belling. After all, there is no way to narrate the origin of cancer—“oncogenesis”—from a biomedical perspective, to trace our way through our opaque interiors to the first moment of errant cell-division or genetic mutation; this story can only be speculative. Unsurprisingly, then, one’s awareness of oneself as “diseased” often coincides with the occasion of diagnosis. I did not think of myself as sick until I was told I was. Since then, I have never been anything else.
Seven days earlier, this same doctor had ordered an ultrasound of the it that I—that is, my boyfriend—had discovered some six weeks before that. If the ultrasound technicians couldn’t confirm that it was a benign fibroadenoma based on the imaging, she said, I would be passed along for a core needle biopsy. Poked with a little needle: this is how she had euphemized it. She might have more accurately likened it to being shot with a staple gun. The needle in question was as thick as a ballpoint pen and had a loud clacking air release like a pea shooter as it plunged into the flesh of my breast. The two doctors performing the procedure squabbled above me as they shot the needle in again and again, unable to get a satisfactory sample until the third or fourth attempt. Out of pain and horror or the sheer shock of it all, I started to cry.
I thought about how nothing this violent had ever happened to my body.
I supposed that made me lucky.
Before they left with my tumor sample in a neatly labeled specimen jar, they waved a consent form and asked if I’d be willing to donate the tissue to research. I was a subject, an experiment, a curiosity. Dumbstruck, I signed. They thanked me and left without looking at me, leaving the task of cleaning and bandaging my bleeding, already-purpling breast to the young Irish nurse who had been witness to this.
You’re a brave lady, the nurse said as she swabbed at the rivulets of blood. I brushed this off. Surely bravery implies some measure of choice—and what choice had I had as I lay half-naked on that table, not having understood what it was I was consenting to? It would have been just as brave, I thought, to have been blindsided in an alley.
Still, I was taken aback by her kindness, by the seeming sincerity of her empathy. This woman seems genuinely distressed for me, I thought, puzzling at how this involvement with patients must present an occupational hazard.
Now I realize why: she knew.
I didn’t. As I took the Tube home from the clinic, holding my hands in front of me, trying to keep the swell of rush-hour strangers from bumping up against my bandaged chest, biting my tongue to keep from crying out when they did, I assumed I would find out soon enough that everything was fine, that I would feel abashed for having used the resources of the National Health Service, resources that would have been better spent on people who were actually sick.
“What we’ve found,” the surgeon says now, “is a breast cancer.”
She pauses before “cancer,” pronouncing the word slowly and roundly, as if to ensure that I will not ask her to repeat it. The oddness of this pause—it is as if she wants to offer me one last luxury of lush ambiguity, one last moment of unknowingness, one last opportunity to make my own meanings.
There is a box of tissues on the table. This detail irrationally irritates me: the stage has been set. But I don’t want to give them the satisfaction of conforming to the expectations of this role. I am determined to respond without histrionics, to behave in a way that will convey that I am a person to be taken seriously.
“So,” I say, after allowing for an inordinately long pause of my own, “what do I do about that?”
There is a chuckle of relief. I am taking it well! They won’t need to waste their time or their tissues on me.
“Given your age, your lack of family history, I did not expect this,” the surgeon continues. “I was very surprised.”
At this, everyone else in the room murmurs and nods, as if this ameliorates the situation somehow, acknowledging just how surprised they all are, how unlikely, how very unlucky it all is.
As she starts detailing treatment options, my vision begins to tunnel in; I feel myself disappearing into space. I chastise my body for its painfully clichéd response, which strikes me as indecorously feminine. I am experiencing a goddamn swoon. In any case, my cover is blown. I am not taking it well at all.
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EMILY WAPLES is an assistant professor of biomedical humanities and director of the Center for Literature and Medicine at Hiram College. Her work has appeared or is forthcoming in venues including Creative Nonfiction, Fourth Genre, Gordon Square Review, Ploughshares, and River Teeth.