• leaflet

    . . .a thin triangular flap of a heart valve. . . a small book usually having a paper cover . . . a medical lit-art e-journal from The Permanente Press
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Elegy to Taos Quartz

Vol 6: Iss 2, Prose

Sometimes I still wonder where her tumor went, its craggy edges, the ridge that halted my fingers on a cold March evening as we huddled together against the velvety blood-red cushions of my living room couch. “Can you check something in my breast?” my sister asked, somewhat flippantly but in an unfamiliar hushed whisper as if the words were breezes trapped in a canyon, escaping the dark cavern where they’d swirled, hidden for weeks.

So used to the “Could you check ...” questions from family and friends over the years of being a physician, I felt no shudder of fear or hesitation as my fingertips headed towards her chest. Yet this time, reassuring platitudes disappeared, ghostlike, fleeing to the corners of the room. Her right breast, just above the areola, held a depression surrounded by an ominous swelling, the nipple distorted as if drawn inward. My mouth drained of its saliva, my stomach sank to below my knees, a wisp of vertigo passed through my head.

My gently probing fingers, accustomed to the smooth spongy texture of the female breast, slipped into the crevice of the depression; their journey interrupted by the nubbly surface of her tumor. We are taught in medical school the defining characteristics of masses in the breast—smooth, mobile, discrete, adherent, gritty, hard, irregular, skin dimpling, nipple retraction—to prognosticate about the likelihood of malignancy. A ridge of chiseled quartz rose to meet my fingertips-edges sharp, face gritty, like a mountain’s surface carved from a glacier’s passage, distinct from the comforting fullness of healthy breast tissue yet woven in place with poisonous tendrils. Gritty. Hard. Adherent. Irregular. Discrete. Matted. These were the words in my fingertips. These were the words to describe the mass, not in a model of a breast, not in one of my patient’s breasts, but in the breast of my own sister, in my best friend. I opened my eyes, already grieving, and held her terrified beseeching blue-eyed gaze to my own.

When the tumor was removed, weeks later, in a Boston teaching hospital, the surgeons took with it my sister’s right breast and a group of pebbly lymph nodes from her armpit. Pebbles that became palpable along her chest wall during the weeks of waiting for surgery. Pebbles that harbored satellites of cancer, malignant outposts in the frontier of my sister’s body. Pebbles that defined her in the medical world as Stage 2b. Pebbles whose existence I had tried to deny, unable to accept that her cancer could be that aggressive, unable to hold the weight of guilt for failing to press the surgeon for an earlier surgery date, unable to believe that I couldn’t protect her, cure her, save her; that my power went only so far. Not far enough.

Six weeks after the evening my fingertips met my sister’s tumor, she underwent a simple mastectomy—so named because the underlying muscle is not removed from the chest wall, just the whole breast “like a package.” I suppose “simple” should have felt reassuring, not quite as good as “partial” but not quite as bad as “radical.” Yet that one word, “simple,” has always struck me as discordant when talking about breast removal. How can it be simple to remove a woman’s breast? The breast whose purpose is sustenance. The breast, which through a complex interaction between the placenta, the pituitary gland, the ovary, the thyroid, a series of cascading hormones, and the suckling of a newborn, creates milk to feed another human being, to sustain another life. To simply take the breast seems impossible.

I still imagine the operating room theater that day. Dr H, her graying hair tucked in a blue paper cap, her delicate fingers and hands shielded with gloves, standing next to my sister’s sterilely prepped and draped body, only her right breast visible, purple skin marker lines drawn on its surface, a map of deconstruction. I wonder if the nurses and anesthesiologist felt a slight wave of nausea or a sinking feeling, as I had, when they viewed that depression, the retraction of the nipple, the puffy swelling. I wonder if they chatted about her tumor, her prognosis, her cancer. Or if they joined me in silently grieving for my sister, for what I, and they, knew in our hearts was ahead for her. Or if she was just another patient, an anonymous woman, a name on a schedule, the breast in room 4.

In my mind’s eye I can see the surgical scalpel poised in Dr H’s hand, held gently yet precisely like a writing pen readying to spill beautiful words onto an empty page. The point of the scalpel pierces the surface of Eva’s skin, sparkling beads of bright red blood emerging like tiny red currants or rubies, marking the path of the instrument. I imagine her movements as graceful, familiar, perhaps rote, as she extends her incision deeper. Metzenbaum scissors replace her scalpel as she “undermines” or loosens and dissects the fat and subcutaneous tissues away from the skin’s edge. I imagine her gloved hand reaching into my sister’s wounded chest, (gently) shelling out of the entire mammary gland, holding it in the palm of her hand as you would a bird’s nest, marveling at this nest’s rotten egg- the tumor encased within billows of soft, yellow breast tissue. She passes it to the waiting hands of the pathologist, his own scalpel prepared for slicing.

The pathologist lays Eva’s disembodied breast onto his stainless steel bench. He unearths the gritty, hard, irregular, ridged stone of a malignant tumor from within the breast’s softness. The scalpel cuts into the tumor, haltingly catching within layers of gristle, chiseling into clusters of mutated cells. Its inner surfaces glisten with the iridescence of a fragment of quartz, the irregularities somehow strangely beautiful like veins of elements coursing through layers of earth.

Being both sister and doctor in the face of my sister’s illness creates sometimes unbearable turmoil for me. My doctor-self searches her pathology report for prognostic indicators, the tumor’s exact measurements. My eyes scan for phrases like “perivascular or lymphatic invasion,” “poorly differentiated,” “high grade,” while my sister-self searches for words that represent the person I know, her strength, her compassion, her humanity, her beauty. I read the description of my sister’s breast, of the tumor whose imprint remains on my fingertips, broken down into the “gross,” what the pathologist saw with his naked eye, and the “microscopic”—the hidden parts—his descriptions are generic, clinical, disembodied—so different from what I imagine as my sister, but so familiar to me as a scientist. This piece of tissue, this specimen, once a living part of her body, is sectioned, stained, fixed, frozen, placed in blocks, examined, analyzed, graded, and in the end, discarded. Our grief over the loss of her breast was obscured by relief that the mother of her cancer had been removed, that its progeny, the pebbles, no longer dotted her chest wall, that the compulsive urge to check for nodes had been put to rest. After enduring the agonizing weeks between diagnosis and surgery, my sister didn’t question where her breast with its gritty tumor would end up.  Neither did I. 

The truth is not all residual human tissues are simply discarded. Throughout the world, the human placenta, while no longer needed by a newborn, is considered sacred and vital to the ongoing life force of the child; it is thought to serve as the cord that binds the child to their community and their ancestors. Some cultures use placentas as medicine, or treat the placenta as a “twin” of the child, swaddling and burying it as they would a lost love one. For many cultures the placenta serves as fertilizer to a newly planted tree, an ongoing remembrance of the child’s life force, something to be thankful for.

But it isn’t easy to be thankful for cancer. What is easy is to feel anger—anger at cancer’s brutality, its randomness, its invasion, its theft of health, time and happiness. Yet cancer develops within our own tissues, not from a foreign invader, but from our own cells gone awry. The vessel of my sister’s cancer was her breast, a powerful symbol of femaleness, a source of power as the giver and sustainer of new life.

It wasn’t until weeks later, long after the bandages and drains were removed, as the purple serpiginous scar wound its way across her now flat chest, that Eva faced a wellspring of regret and grief for her breast itself. She dreamt of carrying her disembodied breast with her to her soul-home, Prince William Sound, and burying it among the wild blueberries and salmonberries, at the base of a sacred tree. She longed to give the breast a final purpose, to return it lovingly to its source, to nature, somehow to bestow her breast with gratitude and forgiveness. And me, I have remained haunted by the imprint of my sister’s cancer on my fingertips.

This week, 5 years and 3 months after my sister’s surgery, at a writing retreat for medical professionals in Taos, NM, I was asked to choose a writing prompt from a tray of natural objects. There were sprigs of plants, flower stems, a long thin twig, dried grasses, rocks, driftwood and seed pods. My eye immediately alighted on a lump of quartzlike stone. When my fingertips brushed its surface, it was hard and gritty with sharp edges. Its face had a smooth surface as if carved by a glacier. It was 2 and a half centimeters in width. It was my sister’s tumor.

I’ve held this stone in my hand, traced its nubbly gritty surfaces, felt my fingertips slip off its ledges, and slept with it in the palm of my hand. Tomorrow, before I begin my return trip home, I will walk the labyrinth here at the Mabel Dodge Luhan House with this quartz tumor in my hand. I will leave this totem in the center of the winding pathway, where it will join a collection of other stones, charms, pieces of sea glass, dried flowers and folded pieces of paper—each carrying a previous walker’s wishes, dreams, regrets, and ghosts. Perhaps I’ll say a little prayer, maybe even slip in a wisp of gratitude and a hint of forgiveness as I create a final resting place for the tumor that changed so much. And perhaps I will leave with a tiny sliver of peace.