The Tender Bud

A Physician's Journey Through Breast Cancer

Madeleine Meldin

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134888092
• Edition: 1
• Topic: Psychologie
• Subtopic: Relations interpersonnelles en psychologie

The Tender Bud is the moving story of one woman's journey through breast cancer. The woman in question happens to be a senior psychiatrist of broad learning and deep clinical insight. Madeleine Meldin weathered the crisis of breast cancer without the support of an immediate family and in the context of ongoing professional burdens. This book is the journal that she wrote for herself as an aid to coping with the personal upheaval of diagnosis, mastectomy, and the aftermath of treatment. It was written while these events unfolded. With arresting candor, Meldin chronicles her emotions at each stage of her odyssey - the recurrent cycles of denial, anxiety, and despair; the conflicting feelings engendered by her physicians, surgeons, and the treatment "establishment" in general; her struggle between resignation and emergent hopefulness.

Unique to Meldin's account is her ongoing juxtaposition of the different dimensions of "having cancer." Simply and gracefully, she chronicles the everyday dimension of cancer, with its obligation to proceed maturely and dispassionately with medical and surgical care, to meet one's professional responsibilities, to maintain the appearances that allow one to carry on with one's life. Meldin excels at showing how even the most mundane experiences of everyday life - conversations with friends and colleagues, the selection of clothes, a trip to the hairdresser - became saturated with her illness, with her sense of herself as a cancer patient.

1

Discovery

December 29

All was now ready: tickets, phone calls, office care. One more month and winter in the U.S.A. would become summer in the Caribbean. The alarm sounded at 6:00 A.M. as it had done for the last 40 years since I was a girl of 13. I got up and said my “Our Father” to join the sun and all creation, human and beast, angel and virus, in the entrance into this new day as inaugural as any other day since the beginning of time.

I pushed on the TV button to catch the news left behind as I slept while (unlike myself as a girl of 13 who got up at six) I made my bed, feeling virtuous and self-contented. There was no news today. There was only the usual: the bickering in Washington, the war between Iran and Iraq, and the oppression of blacks in South Africa. Enough. The atomic bombs had not left the silos. Men in government were crazy in their normal ways. I could begin the day and take care of my present without the interference of history-making history. I went down to the office, put on the heater and the humidifier, closed the door to the study, checked that everything was in place in the office and in the waiting room, and finally unlocked the door for the first patient to come in. Then I went to the kitchen. The sun was still below the horizon, but the clearing sky announced its coming. The kettle had enough water for a cup of tea. It would boil while I showered. Then the tea could brew in the hot cup while I did my aerobic exercises.

I started the shower to get it warm and pushed the button to hear more news from the public radio station. The news continued to be banal and warming. There were some stories about dinosaur bones in Colorado and a woman 105 years old in Alabama.

The hot water warmed me too. I thought about the joy and good luck of us Americans and citizens of Western civilization who get such a wonderful rain of hot water on ourselves just by turning a knob. All the while we take it so for granted. On the radio I heard the voice of a homeless person living in a cardboard home in Los Angeles: “The shade is better than the open air, but it has no facilities like a hotel—no bathroom, no showers.” I felt grateful and inhaled the warm vapor while delighting in the lilac scent of the soap.

Then, there under the soft lustrous skin, the finger felt something, something I did not want my finger to feel. But it did feel it—a small, slightly elongated hard mass in the right breast. A barrage of denying thoughts fired from my brain, like a well-trained team of artillery men firing in orderly succession. Boom! “That is not a node.” Boom! “It is only the progesterone you are taking.” Boom! “It is just the mammary tissue.” Boom! “It is not really hard.” Boom! “It can be a cyst.” Boom! “Don't exaggerate. That is nothing.” Boom! “Quit examining.” Boom! “There is no cancer in our family.” Boom! “Don't make it cancer.” Boom! “If you keep on touching it, you'll make it bigger.” Boom. . . .

Slowly I began to emerge from the shooting of the artillery. The medical fingers became professional. They examined, noticed, recognized, explored the neighboring areas. Then I said, “You have a small node in your right breast. The consistency is cystic. Wait a couple of days. Examine it carefully. If it is still there, then get an examination at once.”

My brain began a new type of firing. Now it functioned like a computer, accumulating one-line sentences against the until-now unthinkable thought: breast cancer.

“Your mammogram was normal.”

“Dr. Barron's office did not call you.”

“There is not one case of breast cancer in your family.”

“You have been taking estrogen and progesterone as prescribed for breast cancer prevention.”

“Your adipose tissue index is low.”

“You have never smoked.”

“You eat healthful food.”

“You exercise every day.”

I had the feeling that I was appealing my case in front of a tribunal that was about to pass a final judgment. I wanted to convince them that I should not have cancer, least of all breast cancer. I felt aware that 1 was being persuasive in making my case, bringing in factors that would make it impossible to conclude that I had cancer.

Working was a very hard task. My mind had no other interest but to argue my case. I decided to work in battle with myself, to listen to my patients, to feel their feelings, to understand what they also were afraid to understand. I earned my bread with the sweat of my brow.

Trying to distract myself proved arduous. When the work day was over, my mind perched successively on the shoulders of every one of my critics in the past and its furious firing began again.

Boom! “You are making a mountain out of a molehill.” Boom! “What are you complaining about? That is nothing” Boom! “You are always so certain. You get all excited and imagine things.” Boom! “Forget it, You are always bothering people with your little complaints. All that noise for a puffed rice size little lump.” Boom! “The doctor will laugh when you, a doctor, arrive in a panic with such a lousy little thing. Forget it!” Boom! “Stop thinking. Anyone would think you are dying of cancer. You exaggerate. You always exaggerate.”

I stopped myself after having fallen flat on my face, hit by so many critics. I got up slowly to recover my dignity. I told myself, “Cancer is nothing to play around with. It is a subtle and terrible enemy. I shall do what I promised. If tomorrow it is there, I shall call the doctor the day after and have it all carefully checked.”

I dreamed of a storm and floods in a valley with nearby mountains I had seen on a trip to Machu Pichu. I woke up and thought of some Peruvian hills called by the local people Nono. They have that name because they are shaped like two breasts, and Nono, the guide told us, is the Quechua name for breasts.

I repeated the routine of the previous day as though life were following its natural path, while I, for the first time was afraid of my body, of showering, of finding that small grain of puffed rice at the tip of my right breast. I needed willpower to bring my medical fingers to the right upper tip of my right breast. It was there. It was slightly bigger, hard, and firm to palpation. The surrounding tissues were normal. “Tomorrow I shall call the doctor,” I resolved. I could not do it today. All of me—mind, body, soul, I, my past, my future—did not want to hear today that I had breast cancer.

My mind took over again. This time I envisioned the grotesque parade of the dead. Elizabeth, my girlhood friend of 41 years, was the first one to appear, looking corpselike as she had the last time we talked together so tenderly, so sadly, so painfully. Her last wish was, “Please take me to see the lake. I want to smell the air, to see the mountains and the water.” We had to carry her there bodily. There were others in the parade, the ones I knew personally and the ones whose stories I had heard about. I felt fear, the cold fear of a prolonged death. Images of nursing homes in New York City returned like apocalyptic visions, showing in front of me white bones rising from beds of sorrow.

The morning weather was gray and gloomy; so was I. Integrity and will power brought me back to my work, and it was a blessing to work. I felt grateful to my patients. I wanted to thank them for telling me their thoughts and feelings. Listening to them was healing the premonition of death in me. They were alive, wrestling with life and with me. I felt particularly grateful to those who wanted to fight with me or who complained about me. It was an indicator—unknown to them—that they considered me a living and strong enemy for today's battle. In my heart I thanked them for making me participate in the fight of life. I was also grateful that they would continue to come, not abandoning me to this inner enemy installed in my breast. I had a wish to say something soft, compassionate, kind, to each of them. Perhaps I wanted to soothe myself in them. I did not. I supervised my every word, my every thought. I had to remain their doctor, regardless of what I felt. I had to attend to their pain, whether or not I had my own. A feeling of dignified pride sustained my self-monitoring task. At the end of the day I felt like a laborer who has faithfully carried her bricks to the point of construction. And I felt exhausted, lonely, and alone with this unshareable secret. I had to talk to my doctor. I could no longer be alone with this knowledge. Nobody else, not even my best friends, could say anything until a medical examination had been performed on my breast.

My gynecologist, a very good man, had retired six months earlier. He had referred his patients to two doctors, and I had selected Dr. Marcus, a woman, and had my records sent to her. Now was the time to make her acquaintance. I called the office. The secretary, said with a condescending tone, that Dr. Marcus did not have time for at least five weeks. I said, “I am 53 years old, and I have a lump in my breast. I must see her immediately.” She argued that it was impossible. She could send me to another doctor. I retorted that Dr. Marcus had all my records and previous mammograms. I had to be seen by her at once. The secretary claimed that it was impossible. I requested that she inform the doctor immediately about my demand to be seen at once because of my age and the nature of my node. Then, miraculously, she found an hour four days later. I had won a battle of wills, a life-saving battle of wills that I should not have had to fight. I imagined the shy and frightened clerks and housewives, incapable of fighting a dictatorial secretary who governs the doctor's schedule like an old fashioned courtier closing off access to the queen. I imagined their cancers growing, invading the lymph nodes and bones, and the secretary polishing her fingernails while answering their anguished phone calls. I am not in favor of lawsuits, but there is something terribly irresponsible and uncaring about a secretary who deals with matters of life and death as though she were dispensing favors by virtue of her power to control access to the doctor.

The doctor, a woman in her late 30s, was pleasant, well mannered, and obviously knowledgeable. She had read my record and knew my medical history. She established the rules of our relationship in a polite manner. She proceeded to examine me. Her fingers explored my breast with precise tactile questioning, knowingly stopping where the underlying surface indicated pathology. She found the node and informed me that it seemed like a cyst. Hopefully, I agreed. Under the pressure of my own fingers, the node had the tense, elastic consistency of a tightly contained liquid mass. She informed me that she was going to aspirate the liquid or whatever else she would find. Her surgical technique left nothing to be desired; it was gentle, unhesitant, efficient. She sighed joyously, “I have good news for you. It is a cyst. The liquid is milky, a bit cloudy, with some fat particles. It seems like a typical cyst. However, to cover every possibility I am sending it to the pathologist. I'll be surprised if it's worse than a cyst.”

I asked to see the liquid. It looked a little like diluted milk, with small whitish particles and slightly larger fat grains, a perfectly innocent and esthetically pleasant liquid. I felt a certain warm feeling of gratitude toward it. Its benign appearance seemed to cleanse me of my images of dreadful cancerous cells invading my breast.

I dressed while chatting with the doctor about these kinds of milk-duct cysts and their benign prognosis. I informed her that 1 had a trip abroad scheduled a month hence. She said the report should be in in a week.

I wanted to believe what I had seen: a cystic liquid, mischievously frightening me with the unthinkable word “cancer.” But I did notice something. I was afraid to fully inform myself about what I had noticed: the node did not disappear after the aspiration. I knew what that meant: either there was more liquid there in another cystic compartment (an unlikely hope), or there was a solid mass of tissue, of cancerous tissue. I chose to believe it was a cyst. My option was incomplete. I called Joe, an experienced gynecologist and very close friend. He asked me to describe it all carefully. I did. “Don't you worry,” he said. “Everything you say points in the direction of a cyst.”

My wish to believe that it was only a cyst gained the upper hand, and I declared myself free of cancer. I had a good reason. This was an important moment in my life. In six days I was to deliver a very important lecture, the culmination of some research I had been carrying out for years. I was proud to be asked to present my work to a group of reputable scholars. I had polished my presentation to its finest details. Gregory and Carmen, a couple of academicians and very close friends, helped with editing and my style of delivery. A moment of intellectual glory was coming, and I was determined to enjoy it fully.

The lecture went very well. The room was packed and the audience attentive. The question-and-answer period was an enjoyable exercise in intellectual agility. I savored the moment and the dinner that followed. The following day I consulted some colleagues, and we agreed on the journal to which to submit my presentation for publication. I decided to call the editor, who most graciously agreed to review it. “Now,” I said to myself, “is the time to start getting ready to teach a course next semester at the university, and I should keep writing about this subject that has brought me a pinch of academic glory.”

Life was rolling along full of satisfactions crowned with a serene feeling of accomplishment. The following morning's mail brought the usual mixture of junk mail, personal messages, and a letter from the gynecologist. It was brief: “Dear Doctor Meldin: Please contact me immediately for further care of your condition.” Signed, Dr. Marcus. The severity of the language foretold ominous news, or, to say it simply, the only news that it could be—cancer.

I called at once. Her account of the pathologist's report contained the euphemism a doctor uses to modulate the patient's fear of the worst. “The pathologist does not like the alignment of some cells in the sample I sent him. He suggests a biopsy to clarify the diagnosis. He cannot write a report with the information at hand.” Fear did not cloud my judgment. “I want to have a biopsy immediately,” I said.

“You know that time is of the essence,” the doctor said. She promised to get an appointment with a surgeon as soon as possible. I was free that afternoon. Two hours later I was talking with the surgeon. The biopsy was arranged for six days later. I knew that my chances of having cancer were now very, very high. Fear, horror, and disbelief intermingled as I beheld the procession of cancerous women I have known—the living and the dead—those crippled by the experience of the treatment, those capable of standing tall in the face of tragedy even to the end. It did not matter much if they were crippled or standing tall. I was always moved to great pity by their suffering, their ruined bodies, their concentration camp looks during the period of chemotherapy. Now, they, from whom I distanced myself by the powerful subtlety of the pronoun “they,” were getting very close to me, stretching out their bald heads and maimed chests to show me that I too could be one of them, one of those cancerous people who incarnate in their signs and wounds the faded tuberculous and lepromatous faces of the past. These are the forbidden faces of human doom.

Waiting, like waiting for Godot, is a long, despairing, lonely act, nervously filled with ceaseless looking in all directions, expecting it, it, just it, just it to come, to come forth.

The days of waiting ended on that Tuesday, exactly six days from the moment I had heard the medical euphemism about “cells aligned in a way the pathologist does not like.” That morning, as if all were normal, I saw three patients, from 7:00 to 9:40, as though my questions and carefully worded utterances to my patients could, in fact, undo the pathogenic power of a harmful “alignment of thoughts and feelings” in their minds and lives. The parallel construction of hopeful wishing made my work an act of displaced magic on my own behalf.

At 10:30 I was on the other side of the patient-doctor relationship. A bracelet was put on me to identify my body. I was given a unisex gown with a print of little blue flowers on a white background. We all—men and women—looked alike in the Day Surgery Waiting Room. Our feet were dressed in foam rubber green and blue gnome like slippers, and our bodies were covered with some piece of clothing called, with charitable exaggeration, a robe.

Each of us put on a faint smile and withdrew into a private universe of fear, encircled by the armrests of our chairs. Surgeons and nurses looked like inmates of a gigantically funny nut house, with their enormous, blue-clothed shoes and their pointed hats at the two extremes of bodies, covered by blue or green operating room gowns or pants.

Every so often a nurse came to fetch one of us. The arrow was unidirectional—a one-way street—from the chair, to the stretcher, to the operating table. Soft-voiced and kind, the nurses picked us up delicately, as you pick wild flowers knowing that they are going to wither in a minute. Like a small flower left in the climber's path, I was the last one, to be picked up in my inexorable journey to the withering process. Gentle hands of maternal women helped me from table to table. In loud voices they checked my name and the nature of the procedure: right breast biopsy. Then surgeon and nurses spoke to me with the m...