Anxiety–Those Yearly Mammograms

A recent article in the New York Times (http://nyti.ms/1q4E05U) reported on a new mammogram technology that may be more effective in showing invasive breast cancers. Breast cancer specialists are searching for more precise tools.  Now radiologists, uncertain about what the mammogram shows, call women back for what proves to be an unnecessary second scan, which leads to anxiety.

I felt gratified that the article acknowledged the goal of reducing anxiety from what may prove to be an unnecessary follow-up. My own relationship with mammograms was full of anxiety. My first stun occurred when some calcifications showed up and I was told to return the same afternoon for a second scan. I was in my late 30’s. This was the first time I hadn’t sailed through with an “All clear, see you next year!” It was hard to breathe; I sat in my car in the parking lot of a CVS, unable to imagine anything else to do, waiting until my appointment time. The radiologist who examined the second scan gave me a qualified “wait and see.” Uncomfortable with the uncertainty, I sought out a breast cancer specialist I knew, Frank Gump, MD, to get a second opinion. “Not a problem,” he said. “These calcifications are in the periphery of the breast. You’re fine.” Much relieved, I vowed to get every mammogram examined by Dr. Gump to minimize the possibility of error.

Several years passed. Each year, I checked out the films from the radiologist’s files and took them to Dr. Gump to seek his opinion. The next stunner occurred when he looked at the films, which the initial radiologist had read as negative, and said with concern, that he saw a tumor. “How can that be?” The anxiety became unbearable until he looked at the envelope and saw that I had been given someone’s else’s films. Lucky me, poor other person. The last time I brought the films to him, again they had been read as negative, but this time, he saw a calcification in the center of the breast, behind the nipple. That day he did a biopsy, and a week later, he called to tell me that the biopsy showed very early stage cancer.

Now I am a breast cancer survivor with an additional history of what proved to be needless mammogram anxiety, much alleviated by Dr. Gump, for whom I will always be grateful. Perhaps the generation of women behind me may have less uncertainty, although uncertainty is our lot until there is a cure.

Time Marches On

The proud grandparents watch as their blue-robed grandson, tanned, tall, quietly confident, delivers his valedictory remarks.  Images float up.  Stunned toddler sharing his tired mother’s lap with his newborn brother, brothers playing basketball in the driveway, driving the family car home from dinner out for the first time, size 13 shoes piled in the mudroom.

A friend’s son also graduated. I’m sad, she says. He’ll be 10 hours away next year. I have to keep myself busy. Another friend’s grandmother died.  The funeral was in my home town. Seeing all the people I haven’t seen for so long, she tells me with tears in her eyes, I realized my life is half over.

My grandson is not yet one.  He is developing before my eyes. Now he can clap. He can do the raspberry. His father swears he can sing. The next time I see him, he may be walking. A friend says to me, when my little boy leaves the room and comes back, he is already different. Stop, I want to say, don’t change!

I am reminded of a poem by Gerard Manley Hopkins that addresses a young girl, Margaret, who is crying because the beautiful yellow leaves of autumn are falling.  It ends with the lines:

Now no matter, child, the name:
Sórrow’s spríngs áre the same.
Nor mouth had, no nor mind, expressed
What heart heard of, ghost guessed:
It ís the blight man was born for,
It is Margaret you mourn for.

 

It does not matter what you are talking about–leaves, grandchildren, graduation, life half over, the sorrow evoked is from the same source: as “time marches on,” our hearts know that all life, but more to the point, our life is finite.  As we experience these landmarks, we rejoice but sometimes we cry because we are mourning that the milestone marks life moving toward its and our inevitable end.

Witnessing–A Cousin Lost to Breast Cancer

“When I was driving to work, I suddenly felt this terrible sharp pain in my breast.” Thus my cousin Cathy told me how she knew something was wrong.  The pain in her breast was diagnosed as inflamatory breast cancer.

Cathy's Robin

Robin–One of Cathy’s Series of Bird Pictures

Ten years younger than I, Cathy was only in her mid thirties.  A full-faced, smiling young woman, she was an artist and had developed a career designing needlework. She was not only developing a following, she had several patents and had won awards for her designs.

I had called Cathy because her mother, knowing I had also recently been treated for breast cancer, asked me if I would talk to her. Thus I became engaged long-distance (she lived far from me) with her in her struggle.  I was the far luckier person.  Cathy’s kind of cancer is aggressive and very hard to treat successfully. More than 20 years later, I’m still going strong.

Her treatment was harsh, including a bone marrow transplant, but she died within two years of her diagnosis.  She went, when she had to, from her home in the town where she worked to her family home, but she would go back to resume her life when she felt strong enough. She was always creating a cross-stitch project for someone during this time.

A tiny needlepoint picture of mushrooms by Cathy

A tiny needlepoint picture of mushrooms by Cathy

I think of Cathy often because we have displayed some of her paintings in our house. She was talented; we are both sad and enriched when we look at her work. I am also reminded of her mother, my Aunt Gloria. The youngest of three, Cathy’s mother lost her own mother at the age of 4.  Her father quickly remarried to a smiling, warm woman whom we called Mama Clo. My aunt and she got along fine; my aunt grew into a sturdy, matter-of-fact woman with a hearty laugh and a wry sense of humor.  She married and had two children, Cathy and a younger brother.  When they were about the age of Aunt Glora when her own mother died, her husband died of lung cancer. She married again to the local postmaster, outliving him after a long marriage. They were together with her when Cathy died, and together they cleared out her apartment and folded down her life.

The last time I saw Aunt Gloria, she was living alone in the house she had lived in with her late husband.  Her son had built a house next door. She welcomed us with pleasure and we spent lunch together reminiscing, catching up, remembering the family members we had lost.  When we asked if she had any of Cathy’s work, she gave us some of Cathy’s paintings.

Cathy Livingston photo

Cathy about a year before she died

Associations

One of the ways people get to know themselves better is to follow their associations. One thought leads to another, and if a person is alert to where the mind wanders and is curious about why this thought followed the one before, self-understanding may deepen. Visiting with my 10 month old grandchild reminds me of my own son when he was new, which reminds me of how upsetting it was to hear his cries of distress. This then reminds me of how my father, when visiting our new family, noticed my anxious race to my wailing baby, who had just woken from his nap.  He looked surprised.  He asked me why I was in such a hurry. “Slow down,” he said.  “You don’t need to rush; he’s ok.” Then my mind goes to a photograph I keep of my father, smiling at me as he stood with my then much older son, and I realize how much I miss my father, gone for nearly 15 years. Three generations were with my grandson this weekend.

As a lifelong reader of fiction and poetry, many of my associations are to what I have read. I love these parallel rich lives. Often when I listen to patients, I will be reminded of something I have read. For example, a young woman complained to me about her new husband’s annoying habits, and how she had never anticipated having to deal with such thoughtlessness. Her distress reminded me of a well-known marriage, that of David Copperfield and Dora. After their much opposed engagement and marriage,  he mused, “Sometimes of an evening, when I looked up from my writing, and saw her seated opposite, I would lean back in my chair, and think how queer it was that there we were, alone together as a matter of course – nobody’s business any more – all the romance of our engagement put away upon a shelf, to rust – no one to please but one another – one another to please, for life.” (Dickens, Charles.  David Copperfield, Chapter 42.)

Alone together, they have to get to know each other. Ultimately, neither David nor Dora could truly please the other. David had fallen headlong into love with a young woman who reminded him, probably unconsciously, of his doting yet hopelessly dependent mother.  I shift my attention, now reminded of this other marriage, back to my patient’s distress. Are the marriages similar? No. Are my patient’s hopes and disappointments similar? Perhaps.