In the movie 50/50, there’s a scene where Joseph Gordon-Levitt’s character considers his 50 percent chance of dying from cancer and realizes there’s a lot he hasn’t done in his life, like visit Canada. Although the movie about my experience with cancer would be more optimistically titled 89/11 (or would that be 11/89?), I got to thinking about the things I still haven’t done, and what I should be doing with the time I have left.

It’s true that all of my doctors expect that I will live many years in good health. But getting cancer once, at such a young age, greatly increases my chances of getting cancer again — I’d be deceiving myself if I thought otherwise. We all have potential cancer cells growing in our bodies, and for most of us, they never coalesce into a tumor. But my potential cancer cells have already proven themselves to be highly motivated. Funny how the only overachieving cells in my body are the bad ones.

In the first few months after my diagnosis, it felt like every day I discovered some new way in which my life had permanently changed. I remember the day I learned that my hopes of becoming a mother would have to be deferred until my mid-thirties. I remember seeing my mastectomy scars for the first time and understanding that I couldn’t breast-feed my eventual children. Having my lymph nodes removed meant that hot yoga and jacuzzis were off-limits forever. In fact, it only just recently occurred to me that my cancer scars make me ineligible for any kind of occupation involving being naked — exotic dancer, porn star, Victoria’s Secret model, Lindsay Lohan. Not that I wanted to be any of those things to begin with, but now I definitely can’t.

But I also try to see my cancer diagnosis as a door opening. My worst nightmare came true and it was awful, but life went on. I’m fine, I’ll probably continue to be fine, and what in the world do I have to be afraid of now? In a way, getting cancer was the most liberating experience of my life.

Yes, I have nasty scars on areas of my body that are supposed to be beautiful. On the plus side, it feels pretty pointless to worry about how the rest of my body looks now. Moreover, I have a newfound appreciation for this body, because it is the thing that moves me through life. It’s my conduit to pleasure. It’s my vehicle for connecting with the world and the people around me. This body is the best thing that has ever happened to me, and it is pretty incredible.

Facing the prospect of my own untimely death also made me realize how futile it is to be afraid — of anything. Before I got cancer, I worried constantly. I worried that my food was undercooked and I’d get E. coli and die. I worried that an earthquake would hit in the middle of the night and I’d be crushed. I worried about car accidents, and terrorist attacks, and my slow-cooker catching fire. But then that day came, when some stranger told me over the phone that I might die, and soon, and suddenly worrying about slow-cooker fires seemed a bit silly.

We are all going to die. Some of us will die of cancer, and some of us will surely die in slow-cooker fires. There’s no point in worrying about all the different things that can kill us because Death will find a way around all of our carefully crafted defenses. So I decided to let go of my worries as much as possible. I’m still working on this, a year post-diagnosis, and it’s not easy. But I know I’d rather spend my very finite and limited time doing other things.

Which brings me back my original question — the only question, really, in life: knowing that I have a limited amount of time to live, and having decided not to spend that time critiquing my own body or worrying about how I’m going to die… what do I want to do instead?

I think this is the part of the essay where I’m supposed to rattle off all the things I intend to do with my life. Visit India, run a marathon, write a book, and yeah, those are a few things I want to do. But another thing I’ve learned is that the things I really want to do in my life are much simpler, and yet more difficult to articulate.

Today I walked home from work. It’s about a 2-mile walk, mostly uphill, but it was a gorgeous near-spring day in Seattle. The sun was going down over the sound and the mountains, making a dazzling pink sunset. It was cold but not too cold. The day was slipping away at a leisurely pace. Normally I’m in a rush to get home to my dinner, but today I took a different route, a longer route, and I didn’t hurry. I stopped to explore a fancy market I’d never been in before. I discovered a cute bar tucked away in a side street. I popped into a restaurant I’d heard of but never tried and ordered food I wouldn’t normally have eaten.

I know this sounds like a total cliché and before I got cancer I would have rolled my eyes at this, but by slowing down and taking a different route, I understood that every day of my life could be like this — a veritable buffet of new experiences.

Do I want to go to India? I don’t know. Sure. Run a marathon? Write a book? I suppose I do. I guess I just don’t feel it’s that important to make a list of all the things I want to accomplish, and then set about checking them off, one by one. I am certain that I want to say yes more. I don’t want to hide out in my apartment watching The Office all night, every night, even though I love that show. I want to be comfortable, but not too comfortable. I want to ask myself questions and live my way to the answers. I want to speak up for myself, and I want to be kind to myself.

I thought 50/50 felt dishonest in a lot of ways — in the movie, the guy unemotionally receives the news that he has cancer. His mom cries though he never does. He has some setbacks that aren’t really explored, and in the end, he has surgery and the whole thing ends on a hopeful note. Based on my own experience, it didn’t adequately portray the sheer terror of getting cancer at 27, the feeling of having the next 50 years languidly spread out before you one moment and cruelly snatched away the next. And I didn’t feel that it elaborated enough on the journey from terror to enlightenment that many cancer patients, including myself, go through. But I liked 50/50 because it’s not like Joseph Gordon-Levitt’s character got cancer, had an epiphany, and finally visited Canada like he always meant to. Life isn’t really like that. Life is beautiful and strange and over too soon, and life doesn’t lend itself to check boxes. Fuck your bucket list. Just get out of your house, and say “yes.”

Illustration by Rebecca Elves

A month after my unilateral mastectomy (in which one of my breasts was removed), I began the weird and painful process of reconstructing my breasts.

My cancer surgeon had given me a list of plastic surgeons in the area who specialized in breast reconstruction, though there was one in particular she recommended. He was, as she said, “an artist, with an artist’s ego.” His bedside manner left a bit to be desired, she warned, but he was the best plastic surgeon in the city and easily as talented as any plastic surgeon in Los Angeles, the Kingdom of Fake Tits, where I briefly considered going for my reconstruction surgery.

Once I had recovered from my mastectomy and solidified my treatment plan with my oncologist, I made my first visit to the plastic surgeon’s office, also known as the place where I discovered exactly how shallow I really am.

My plastic surgeon was tall, handsome, not too old, and blunt — but in a charmingly sardonic sort of way. He took me into his office and explained the reconstruction process. There are a few different ways to reconstruct a breast. One very common method is to give the patient a tummy tuck, then use the excess skin and fat from that procedure to create a new breast. This option was out of the question for me, mainly because I did not have enough skin and fat in my abdomen to accommodate a tummy tuck.

The only real reconstruction option available to me, other than no reconstruction at all, was a three-step process, in which a tissue expander is first placed under the skin of the breast that was removed, and gradually injected with saline solution to stretch the skin to the desired size. Then a standard saline or silicone breast implant is placed in the healthy breast to match the side with the expander. (I did not have to have the other breast enlarged, but it is easier to enlarge both breasts to a new size than to reconstruct a breast to match an existing size.) Finally, four months after the expander has been filled to its desired size, the expander is replaced with a breast implant to match the healthy side.

I’ve read about women — celebrities, mainly — who have compressed the mastectomy and reconstruction into one marathon surgery. None of my doctors advocated this approach because the risk of complications like infection and bleeding is much higher.

My plastic surgeon explained all of this in that first visit, aided by photographs of past patients. The photographs, which might best be described as “torture porn lite,” showed women in the various stages of reconstruction. Although my tolerance for medical terminology and icky situations had risen considerably in the previous three months, I wrestled with nausea while looking at these pictures of women’s mutilated bodies. My heart broke for this awful club of women whose bodies were beat up by grueling cancer surgeries and radiation. Thankfully, my plastic surgeon wound his way around to the “after” pictures — photographs of beautifully reconstructed breasts that were almost impossible to distinguish from healthy breasts, other than the scars.

Then we went into an examination room, and I took off my shirt so the plastic surgeon could assess my breasts. He used a permanent marker to draw a series of bisecting lines and arcs across my torso, measuring the width of my rib cage and my remaining breast, all as a means of determining the proper size and placement of my expander.

Standing there with graphs and charts drawn on my chest, my plastic surgeon finally asked the million-dollar question: how big did I want to my new breasts to be? I had looked forward to this moment for months, and I’d mentally debated the answer a hundred times in the weeks leading up to this appointment. I’d spent a fair amount of time on the internet “researching” the size of Gisele’s breasts. (For those interested, the online consensus is split between whether they are Bs or Cs.) As someone with naturally tiny breasts, I was excited about the prospect of coming out of this nightmare with gargantuan jugs, like a sick sort of consolation prize. I didn’t buy into society’s idea that bigger breasts are more beautiful, but finding bras and dresses that fit me was really tough at times, and, hey, why the hell not? But on the other hand, losing a breast had made me realize that I actually loved my tiny tits. They worked on my body, they actually looked pretty great under tight t-shirts, and they were, well, mine. How sad and ironic that losing one of my breasts was the thing that helped me come to terms with my 32AAs.

So here is what I told my plastic surgeon: I wanted my breasts to be as big as they could be, without looking like a porn star or a cartoon. He chuckled and said that was the best answer I could have given, and one he didn’t hear very often. In my case, he guessed, I’d be able to go up to a B cup at most, and that was all right with me.

A month later, I went in for my first reconstruction procedure, to have the expander put in. I was surprised to discover that many plastic surgeries take place in the plastic surgeon’s office rather than a hospital. It felt like I was going in to get my teeth cleaned or something, though of course I was considerably more nervous. The surgery took about an hour, and I remember coming out of my anesthetic fog sometime during the car ride home. I had worn a zip-up hoodie to the plastic surgeon’s office, and on the way home I’m told I tried unzipping it several times, to the point where my husband had to hold my arms at my sides to stop me from exposing myself to all of Seattle. I guess I was pretty excited to have something resembling normal breasts again, after two months of a lopsided, freakishly flat chest.

But it would be a few days before I had a chance to appreciate my new look. The night after having my expander put in was hands down the most painful and unpleasant night of my life. It turns out that the chest muscles underneath the breast that had been removed had gotten pretty used to their solitude in there, and putting in the expander caused them to seize up and spasm uncontrollably. I’d been given Vicodin and Valium for the pain and the muscle spasms, but aside from making me sleepy and dull, they didn’t help much. I remember waking up that night at 3 a.m. in total agony, my entire body wracked with uncontrollable tremors. It felt like someone had bashed my ribcage with a sledgehammer. I called out for my husband, who rushed to get the painkillers and Valium down my throat. I lay there for 20 minutes, waiting for the chemicals to hit my bloodstream, trying not to make things worse by panicking. My head started buzzing from the Valium, and then I was asleep.

A couple of weeks later, I went in for my first “fill,” in which saline is injected into the expander to enlarge it. It was a very weird experience, to watch someone stick a big syringe into my boob — which I couldn’t feel, because my breast no longer had any nerve endings in it — and slowly inflate it. I had a total of two fills, and by the time I was done, my new boob was approximately a B cup, just as my plastic surgeon had predicted.

The final two surgeries in the reconstruction process were a breeze. I’d gotten used to the heavenly leaden feeling that washed over me as I sunk down into anesthesia, and I’d gotten used to my post-surgical routine of playing video games and watching The Office while taking half a Vicodin every two hours. Aside from that first night after getting my expander put in, I found plastic surgery to be shockingly easy and relatively painless. I wondered if I would have gotten implants, if I hadn’t gotten cancer and if I’d known just how mild the unpleasantness of plastic surgery really is. Moreover, the implants do feel pretty realistic — that urban legend likening augmented breasts to a ripe grapefruit is, in my experience, false. Other than the scars, I don’t think anyone would be able to tell my breasts are fake.

One thing I still struggle with, and may for a long time to come, is the scarring. My left breast has a 5-inch long scar from the mastectomy, from my armpit to my nipple; my right breast (“the healthy one”) has a 3-inch scar on the underside from where the implant went in. I’ve heard people say that scars are interesting, that scars tell a story, that my scars make me a survivor, blah blah blah…but I hate them. I hope that over time I’ll be able to view my scars as an inextricable part of myself, but for now I just avoid looking at them.

Six weeks after my final reconstruction surgery, I did something I hadn’t done for more than eight months: I walked into a Victoria’s Secret and I bought some new bras. In the end, my breasts didn’t turn out as big as I’d hoped they’d be, and I mentally scolded myself every time I caught myself wishing they were bigger. The fact was, I was lucky to be alive.

Illustration by Rebecca Elves

A week or two after my mastectomy, I had my first meeting with my oncologist. My mom, dad, and husband all accompanied me to the appointment. After sitting in the waiting room for more than an hour past my appointment time, we were finally led back into a small but comfortable exam room, decorated with dozens of gorgeous landscape photographs and coffee table books about baseball and coral reefs. (We would later learn that my oncologist is also an accomplished photographer.)

Ten minutes later, a tall, white-haired, bespectacled man with bushy eyebrows and a tweed jacket breezed in. I liked him instantly — he seemed warm and professorial, like Dumbledore or Gandalf.

He shook hands with everyone in the room, then looked at me over the top of his glasses — he does this quite often — and said, “You’re too young to be here.” We all laughed nervously, and he smiled. 


Then it was time to deliver the news we’d all been waiting anxiously to hear: the pathology report. After my mastectomy, my surgeon had sent all of the tissue she’d removed to a lab. The lab analyzed the tumor and my lymph nodes, and also looked at six other suspected tumors to determine whether the cancer had already begun to spread.

The first piece of good news was that my tumor was smaller than the MRI had suggested. Tumor size is one factor affecting what stage my cancer was — the larger it is, the more advanced the stage of cancer. Mine was on the larger side of small, if that makes any sense — it was 3 centimeters across, which is right on the border of stage 1 and stage 2.

The next piece of good news was that the two lymph nodes my surgeon had removed were completely clear of cancer cells, meaning it was unlikely that the cancer had already started spreading to other areas of my body.

But perhaps the biggest relief of the day was finding out that the other six suspected tumors were, in fact, nothing at all. All of this good news painted a more complete picture of the road ahead of me: I was, as my oncologist announced, “a clear-cut stage 1.” As such, I had an extremely good chance of surviving and an extremely low possibility of recurrence later in life. I beamed around the room at my parents and husband with happy tears in my eyes.

After giving us a few moments to compose ourselves, my oncologist began to outline my options for treatment. Despite my overwhelmingly encouraging prognosis, I would still need to undergo standard cancer treatment to ensure that the cancer didn’t spread or recur. It’s not enough to remove the tumor: all traces of any malignant cell must be obliterated, by chemotherapy, radiation, hormone therapy, or a combination of all three.

Most of us are familiar with chemotherapy. We’ve seen the bald, pasty people walking around with scarves on their heads; we’ve seen the movies with chemo patients vomiting violently; we’ve seen that episode of Sex and the City where the girls toast Samantha with popsicles while she’s getting a treatment. Reduced to its most basic idea, chemotherapy is poisoning all the fast-growing cells in the body. Chemo casts a broad net: cancer cells grow quickly, but so do the cells that give us hair, fingernails, and immunity from germs. So while chemo kills the cancer, it also kills all those other types of cells too, and increases the risk of becoming seriously ill with the flu, pneumonia, and other common ailments that, for a healthy person, would mean a few mildly unpleasant days off from work.

Radiation is also a very common cancer treatment, and has been for decades. It’s commonly administered on a daily schedule for about six weeks. Nowadays, a radiation oncologist creates a computer model of the tumor site, and during the treatment a very precise beam of radiation is aimed at that area, killing all the cancer cells that may remain. In many ways, radiation is not as unpleasant as chemotherapy, but in some patients, it causes severe burns and permanently damages the skin.

Since I’d had a mastectomy instead of a lumpectomy, radiation was deemed unnecessary. With a lumpectomy, there’s a chance that a few stray cancer cells were left behind in the body, and radiation is one way to ensure that those cells are killed before they can spread. With a mastectomy, the chance of leftover cancer cells is smaller. So: no radiation for me, which also meant that my reconstruction options were still wide open.

A third, lesser -known type of treatment for breast cancer is hormone therapy. Some tumors, like mine was, are strongly hormone-receptor positive, meaning that the tumor feeds on hormones in the body. As such, one very effective method of treating these tumors is to shut down hormone production for a period of time. As recently as the ‘70s, the only option for shutting down hormone production was to remove the ovaries — a very effective treatment, yes, but a permanent one.

Thankfully, there are now drugs that effectively shut down a woman’s hormone production in fully reversible ways, and studies have shown that halting hormone production for a period of five to ten years is all that’s needed to prevent the cancer from coming back. One powerful and very common drug is called Tamoxifen, which, in a sense, prevents cells in the body from taking up hormones in the bloodstream. Cells that feed on hormones, such as hormone-receptor positive cancer cells, are essentially starved to death, then flushed out of the body via normal waste processes.

My surgeon had already warned me about the probability that I’d have to undergo hormone therapy, so I’d had some time to fit my head around the idea that I would soon be in chemically-induced menopause and unable to have children for the next half-decade. My oncologist confirmed in that first appointment that I would definitely have to undergo hormone therapy. Because I was so young and at the peak of my hormone production, he wanted to try a combination of Lupron and Tamoxifen — the Lupron to halt the production of hormones in my body, the Tamoxifen to stop my cells from taking up hormones already floating around in my bloodstream. It sounds like overkill, and in a sense it is. Many, many patients are treated with Tamoxifen alone, with positive results. But my oncologist worried that my body would try to counteract the Tamoxifen by increasing hormone production. So: monthly shots of Lupron on top of the daily Tamoxifen pill, for at least five years.

I’d always hoped to have my first child before I turned 30. In fact, the only lasting goal I’d ever set for myself was to become a mother, hopefully to a little girl. Even in my teens I loved to imagine a tiny, delicate version of me, an impish fairy princess in a pink tutu, a blank slate I’d teach all about feminism and Shakespeare and love. To have that dream postponed by cancer was devastating. Moreover, around the same time I was learning that I would be unable to have children until well into my 30s, my best friend learned that she was pregnant with her first child, a daughter. I tried my best to be happy for her and take part in her joy, but it was heartbreaking at times, watching her rub her growing belly and exclaim how big her breasts had become. My rational brain understood that her pregnancy was not an insult to my own deferred plans of motherhood, but it hurt my heart nonetheless. It took some time, but I came to view the five years to come as time I could use to travel, eat out at fancy restaurants, live selfishly, and save money for a big house I could fill up with a hundred children once the hormone therapy was finally over.

That left the question of chemotherapy. My oncologist had sent my pathology report to a fancy actuarial firm, which looked at all of the data surrounding my case and all the data currently available about cancer in general, to determine the exact odds of survival, spread, and recurrence I faced. The actuarial firm sent back a report detailing my exact percent chance of survival under a number of conditions. The main purpose of this report was to help quantify the benefits I might expect from chemotherapy, which is itself a difficult ordeal with its own risks.

Before we got the report back, we knew that my particular kind of cancer had an extremely low chance of recurrence — less than 15%. These are already very good odds, as far as cancer goes. While we waited to hear the results of the actuarial report, I told myself that if the benefit of chemo was determined to be a 5% improvement in my odds, I’d go ahead with the chemo as soon as possible.

As it turned out, the number crunchers determined that chemotherapy would improve my odds by 1-2% at most, and that wasn’t accounting for the risks associated with chemo. With this in mind, my oncologist gave me the option of choosing for myself whether to go through with chemotherapy.

My oncologist gave me one week to think it over, but before he sent me home, he gave me some framework for thinking about my decision. Because I was so young, he said, many oncologists would push me to do chemo just so we could say we’d done everything we could to get rid of my cancer. Then he put his hand on my shoulder and told me that if I was his own daughter, he’d tell me not to go through with it. In his mind, the benefit wasn’t worth the cost. But, he added, at the end of the day, I had to be able to look at myself in the mirror and feel like I’d made the right choice. If the cancer came back in five or ten years, would I regret not doing chemo the first time around? On the other hand, he told me to also keep in mind that chemo was by no means an insurance policy — even with chemotherapy, the cancer could still come back. To use one of his favorite phrases: sometimes it’s just the mystery of life.

This was the first true life-or-death decision I ever had to make. On one hand, I wanted to do everything in my power to get rid of the cancer once and for all. On the other hand, I really, really dreaded the well-known side effects of chemotherapy: losing my hair, the soul-crushing fatigue, the chance of serious complications like pneumonia, heart problems, and infertility. I went back and forth like this for a week, discussing it constantly with my husband, my family, and my friends. In truth, I could hardly think of anything else. Almost everyone encouraged me to skip it, considering my prognosis was already so encouraging. But I still waffled. After a few days, my oncologist called me to see how I was getting on, and I told him I was still struggling to decide. He offered to take an informal poll of the other oncologists in his practice and call me the next day with their opinions. I gratefully accepted his offer, and when I hung up, I decided that I’d accept the consensus.

The next day, as expected, he called back to say that of his six colleagues, only one voted that I should undergo chemotherapy.

That decided me. No chemo. I could hear the smile in his voice when I told him my decision. I felt like I was taking a path from which there could be no return, but I vowed not to look back.

Illustration by Rebecca Elves

Cancer at any age is isolating. Cancer at the age of 27 feels doubly so. Even though my husband, my family, and my friends know about what I’m going through, they still have the luxury of objectivity. They understand the fear and uncertainty I face on a daily basis and they see the pain of my treatments, but they don’t live it themselves. It’s not something that I blame them for; it’s simply that I don’t know anyone my age who has gone through what I’m going through.

I’ve had a lot of time to process what’s happening to me. I write about it, I think about it when I lie awake at night, I talk about it with my husband and my family and my friends and my doctors. Often I worry that I’m being narcissistic, which with me is never that far from the truth. I’ve watched friends pull away from me since my diagnosis, and I can’t help but feel that it’s due to “cancer fatigue.” Cancer has taken over such a huge proportion of my headspace, so it’s hard not to talk about it constantly, but I understand that the drama can be a lot to take sometimes. I get bored with it, too, believe me. In any event, I can imagine it’s difficult to know how to react when someone says, “I have cancer.”

When I first tell people I have cancer, usually one of two things happens: the other person goes all rah-rah Live Strong Race for the Cure cheerleader (“you’re gonna beat this!”), or the other person valiantly struggles to mask their horror and the urge to blurt out “you’re gonna die!” Both reactions are perfectly natural and understandable; in the first days after my diagnosis I swung back and forth between the two extremes myself. But obviously, neither of these two reactions is particularly realistic, and neither is ideal. In a perversely paradoxical way, I’d hear the Live Strong cheerleader and think, “fuck you, I could die;” I’d hear the Debbie Downer and think, “fuck you, I might not die.” (Clearly, in the beginning of this ordeal, I would feel angry toward healthy people. To be completely honest, I still do, sometimes.)

Once I started my treatments, one thing I heard a lot was, “You’re an inspiration.” This is an incredibly kind thing to say, and something I never expected another person to say about me, the solid-C student, the lax dog-owner, the indifferent housekeeper, the screw-up who somehow managed to get a life-threatening disease at 27 years old. It is humbling to hear that others are inspired by my illness, and I invite more people to be inspired by me: I make an awesome breakfast sandwich, and I’m not kidding, my dog’s capacity for misbehavior is truly impressive.

But in all seriousness, being called “inspiring” is also a bit discomfiting. It’s a lot to live up to, and on my best days, I feel pretty much the same as before, minus one boob and about 20 years of life expectancy. On my worst days, well, there’s nothing inspiring going on. Just lots of crying.

It’s also hard to know what to say when people ask, “How are you?” It’s an innocuous question, one we all ask each other on a daily basis with the best of intentions, but once I found out I had cancer, it was tough to tell whether people were asking me how my day was going, or if they were asking euphemistically about the cancer. I’d usually just say I was doing fine, and if the other person wanted to hear more, I figured they’d ask. Some people would ask how my treatments were going or how I was feeling, and I appreciated the specificity. I know that no one wants to hear a litany of my medical complaints in response to a simple, “How are you?”

Another thing I get a lot is, “My mother/grandmother/sister/wife died of breast cancer.” This is something I had to learn to inure myself to early on. As a society, we tend to hear a lot about people who die of cancer, and not much about the millions of people who are diagnosed with cancer, give up a year or more of their lives slogging through the grueling treatments, and come out on the other side. As a newly diagnosed cancer patient, it’s hard enough to be optimistic. Though I’m genuinely saddened to hear about others who have fought cancer and lost—my own grandmother died of breast cancer, so I really do know how it feels—I don’t want or need any further prompting to consider my own odds. That’s an uncertainty I live with every day.

(This is perhaps a good opening for a favorite rant of mine: the pervasiveness of a terminal cancer diagnosis as the salient plot point for movies and TV shows. Breaking Bad, The Big C, Biutiful, Love and Other Drugs, Funny People, Battlestar Galactica, and so on. It’s a great way to frame the story in a definitive period of time, it adds urgency, but it’s also a little cheap, too, right? At a Race for the Cure event this summer, I heard about a woman who had advanced breast cancer back in the 50s. She underwent treatment more than 50 years ago, which must have been fairly primitive by today’s standards, but she’s still alive and has never had a recurrence. I want to see a movie about her.)

Luckily for me, I have some extraordinary coworkers who had the absolute perfect response to my diagnosis: they started a blog and took turns posting funny pictures and YouTube videos they thought might cheer me up. I was grateful for the gesture, and also a little sheepish to discover that a) the nuances of my personality fell into a few main categories, and b) those categories are: fancy shoes, pictures of baby animals, and movie quotes. And that this was so clear to others.

In fact, there are many people in my life who have been totally awesome in their reactions to my diagnosis. I have so much appreciation for the people who have been able to simply say, “That sucks!” and then let me talk about the cancer situation as much or as little as I want at that moment. Some days, having cancer is the only thing I can think and talk about. Other days, I’d like to forget I have cancer entirely.

Which brings me to the next best response I’ve encountered: treating me like everything is more or less normal, with the tacit acknowledgement that there is nonetheless one big exception to my normalcy. This probably sounds like a fine line to walk, and it is. My sister is one person who is great at this, and perhaps that’s because she is a nurse. She and I never really talk about my cancer, but when we do, she is accepting and matter-of-fact and imperturbable, and I really appreciate that. My manager at work is also really cool about this, and it makes performance reviews much less stressful.

It’s also comforting to be around people who can joke about the cancer. I realize that this is another fine line that is entirely dependent on my lead, and for that reason I try to be conscious of how I talk about the cancer myself. Hopefully I put others at ease about it. I have one friend who likes to joke about my cancer “acting up” as an excuse to get a day off from work or bow out of some onerous engagement. Maybe you have to be there, but it’s really funny. A lot of my friends also like to joke about my new, larger, boobs. Before my first reconstruction surgery, one of my friends asked, “so…is this going to be like a haircut, where we’re supposed to comment on it?” My husband will sometimes joke that once I have my fantastic new rack, I’ll leave him for someone with more money or better looks. (At least, I think he is joking.)

What I’d really love, though, is for someone to come over to my house a couple days after I have a surgery or a hormone shot and watch TV with me. Actually, I would like that most days, regardless of the cancer.

As fate would have it, a few weeks after my mastectomy, a coworker of mine was also diagnosed with breast cancer. Suddenly I had a kind of “cancer buddy.” It was weirdly nice to have someone around who could relate to what I was going through. At the same time, it turned out that her cancer was at a much more advanced stage than mine, and I found myself straddling the line between “concerned objective onlooker” and “comrade in arms.” I struggled with what I should say to her, what tips I should give, and how I could cheer her up without being the Live Strong cheerleader. The experience of having cancer is not the same for everyone, or anyone, really. What little advice or cheer I can give is tempered by the fact that I have been incredibly lucky; as cancer goes, the unpleasantness I’ve had to face has been minimal. Moreover, the truth is that cancer, at any stage, at any age, sucks. Nothing anyone says is going to mitigate that in a significant way, though it’s also true that having funny, understanding, patient friends and family is a comfort and a blessing when times are tough.

Though I guess that goes without saying, whether cancer is involved or not.

Illustration by Rebecca Elves

About those six little spots on my MRI.

There was one spot in particular that worried my surgeon. Think of a woman’s breast like a clock. Then divide it into quadrants — from 12 o’clock to 3 o’clock, 3 o’clock to 6 o’clock, and so forth. My initial tumor was in the 5 o’clock position, way down at the outer edge of my breast and seemingly very close to the skin. This in itself was worrisome enough, but there was another spot on my MRI around the 10 o’clock position. It was lit up like a Christmas tree on the scans, meaning it had soaked up a lot of the radioactive chemicals that attach to cancer cells. The quadrants are important because two tumors in two different quadrants most often necessitate a mastectomy, in which the entire breast is removed, as opposed to a lumpectomy, in which just the tumor is removed.

My surgeon ordered another biopsy, to determine whether the other spot was cancerous, too: back to the breast center, back to the young radiologist and the heavily-accented, motherly nurse, more needles, another ice pack in my bra, and several more mammograms.

Around this time, I was meeting with my surgeon almost every day. Now that we knew the cancer hadn’t spread to my other organs, we spent a lot of time discussing whether I’d undergo a lumpectomy or a mastectomy. My surgeon was not too keen on the idea of giving me a lumpectomy. Because my breasts are so small, she thought removing the lump might also leave an unattractive tumor-sized divot in my breast. Obviously, in the event that the second spot was cancerous, I’d have to do a mastectomy. But she generously offered me the option of having a lumpectomy if the biopsy came back negative for cancer.

A couple of days later, the answer came. Sort of. Unfortunately, this time, the radiologist missed the suspected tumor when taking the biopsy. It happens.

The Friday before I was scheduled for surgery, I got a call from the magnetic imaging lab, confirming my appointment for an MRI-guided biopsy of the tumor we missed last time, and the other worrisome spots.
I panicked. A biopsy entails poking the tumor with a hollow needle and taking a sample. An MRI entails laying absolutely still in an uncomfortable position, in a tiny, loud tube, for half an hour or more. Put these two together, multiplied by six for the other possible tumors, and you understand why I was not looking forward to this procedure. I pictured my breast like Pinhead from Hellraiser, with needles sticking out in all directions. No thanks.

I called my surgeon to ask her if I really, truly had to do this. I chose that moment to tell her that I had decided to go with the mastectomy. By my way of thinking, the mastectomy rendered the MRI-guided biopsy unnecessary — they were going to take it all out anyway, those six little spots included, and they could biopsy to their hearts’ content once the whole mess was removed from my body. I actually tried to persuade her to give me a bilateral mastectomy, in the misguided hope that removing both of my breasts would protect me from a recurrence of cancer in the future. She gently explained that a bilateral mastectomy was not necessarily an insurance policy, and suggested that we first deal with the known problem — the cancer in my left breast — before giving me an unneccessary. Later, I would be extremely grateful for this advice.

After some discussion, my surgeon decided it would be ok to cancel the MRI-guided biopsy and move forward with my mastectomy as scheduled.

Everything was set for my surgery. The day before the operation, I left work early and went to Nordstrom to treat myself to some new pajamas. I figured if I was going to lose my boob, I might as well have some sweet jammies to wear while I wallowed on my couch. I also had to pick up a special “mastectomy camisole,” which had the distinction of being my first piece of clothing with “features”: a zipper down the front and down the side, snaps at the shoulder (all so it’d be easy to put on and take off), removable pockets for the drain (more on this later), and aloe-infused fabric for sensitive skin. The camisole was $60, but luckily it was covered by my insurance. I got two.

The morning of my surgery, my mom drove my husband and me to the hospital. I cried the entire way there. I wasn’t nervous about the mastectomy itself — in fact, looking back I’m not sure I had really even considered what it would mean to have my breast removed — but I was extremely nervous about the anesthesia. I was worried that once they put me to sleep, I wouldn’t wake up again. My mom and my husband had to literally pull me into the surgical waiting area.

I should explain a little about what happens during a mastectomy from a medical standpoint. Underneath the skin, a breast consists mainly of fat and nerves and milk ducts. During a mastectomy, the surgeon removes all of the tissue between the chest muscles and the skin. Aesthetically, the end result of a mastectomy is a flat chest on one or both sides, like a young boy’s. Many times, the surgeon will also have to remove the nipple, though not always. I got to keep mine (yay!), though after the surgery, it would have no feeling, and I would not be able to breast-feed. There was also a slight chance of “nipple death.” Don’t ask; it’s just as unpleasant as it sounds. Many women who undergo a mastectomy opt to have the breast reconstructed at a later date, as I did.

During the operation, my surgeon would also be performing a sentinel node biopsy. Breast cancer spreads first to the lymph nodes in your armpit. A few hours before my operation, a radiologist injected radioactive chemicals into my breast, and while I waited for surgery, those chemicals attached themselves to cancer cells in my body and followed the same pathways as the cancer cells. During the surgery, the surgeon used an instrument not unlike a Geiger counter to look for those radioactive chemicals in my armpit. Almost always, the cancer has reached at least a few lymph nodes, which have to be removed — one or two affected nodes is nothing to get overly worried about, but if the cancer had spread into many, or all of my lymph nodes, well… that would be bad news.

Just before the surgery started, my surgeon and her nurse came by with a Sharpie to draw a big black X over the breast they intended to operate on. It sounds primitive, but accidents happen. The anesthesiologist came by to start my IV, I said goodbye to my mom and my husband, and I walked into the operating room.

Some general anesthetics erase your short-term memory. I remember climbing up onto the operating table and making small talk with my doctor as they all bustled about making last-minute preparations. I remember bragging to my doctor about a book I’d read that was “even better than The Hunger Games.” I promised the entire operating room staff that I’d get them copies of it. To this day I have no idea what book I was talking about. Then everything faded to black.

My surgery started at around 3 p.m., and lasted until almost 6 p.m. My mom, husband, mother-in-law, and sister-in-law waited at the hospital the entire time I was in the operating room, and my mom and my husband were there when I finally started to wake up around 10 p.m. I didn’t fully wake up until 2 a.m. During the four hours in-between, I’m told I was a giant pain in the ass for my nurses: I kept trying to pull out my breathing tubes, I hit my nurse call button every 20 minutes or so to complain that my “blood pressure was low” (how would I have known?), and I repeatedly refused painkillers that weren’t offered, because I couldn’t possibly be feeling pain yet, because I was still technically sedated.

When I did finally wake up around 2 a.m., my husband was curled up under an uncomfortably thin blanket on a cot near my bed, trying to sleep. My mom had gone home for the night and would return in the morning. I was propped up with pillows and there was a faint burning sensation in my chest where my breast used to be.

I can’t easily describe how I felt — maybe it was an aftereffect of all the drugs in my system — but I think I felt fine, for the most part. Peaceful, almost. For the first time in weeks, I’d had a good, long sleep, and for the first time in weeks I woke up feeling confident that my body was cancer-free. I wiggled my toes under the hospital blanket. I’d survived.
Before he went to sleep, my husband had thoughtfully placed my iPhone on the table by my bed, and of course I couldn’t resist the urge to post a Facebook update about my surgery. I’m nothing if not loyal to my generation.
Throughout the night, my nurses came to check on me every hour or so, and soon it was morning. My surgeon came in around dawn to check on the incision and give me instructions for when I went home later that day. She asked if I wanted to look at the incision myself, and my heart flipped over: I’d so far managed to avoid thinking about my once-perfect, now-deformed chest. I knew I couldn’t put it off forever, but nonetheless, I declined. Around 7 or 8 a.m., my mom returned, and around the same time, my surgeon’s nurse came in to teach us all how to care for the drain.

I’ve talked about lymph nodes before, and how they relate to breast cancer — they’re the first place that breast cancer spreads to, and breast cancer surgeries usually include a sentinel node biopsy, in which cancerous lymph nodes are removed from the armpit. Under normal circumstances, lymph nodes create lymphatic fluid, which circulates through the body performing some essential purpose, though I honestly can’t say what that purpose is.

A mastectomy and lymph node biopsy disrupts the natural circulation of the lymphatic fluid, and if the fluid has nowhere to go, it pools in the void where the breast tissue used to be. This is not good. And so: the drain.

Don’t say I didn’t warn you: here it gets really gross.

The drain consists of a clear flexible plastic tube that goes under the skin and snakes around the surgical site. By my estimation, it’s less than a quarter of an inch wide, and the portion inside your body is maybe 12-18 inches long. Any excess lymphatic fluid goes into the tube, and the tube exits your body through a tiny opening in your side. A foot or two later, the tube terminates in a bulb resembling a grenade which collects the lymphatic fluid. Over the course of a couple of weeks, your body adapts and stops generating so much fluid, but in the interim, the drain has to be measured (to check the progress of your body’s adaptation) and emptied in the sink (!!!). This process is referred to as “milking the drain,” and I cannot think of anything in my life that was less pleasant than this.

Since I had to tote the drain around for a couple of weeks, the special pockets on the mastectomy camisole came in handy.

Once the nurse taught us how to care for the drain, an orderly delivered my breakfast and my first dose of Vicodin. After I’d finished my breakfast, I started getting antsy for home. With my mom’s help, I brushed my hair and put on my new jammies, and soon I was comfortably situated on my sofa in my living room.

After my mastectomy, I took two weeks off from work, mainly because I was not about to deal with THE DRAIN (in my mind, when I think about the drain, it’s always in bold, dreadful capital letters) in the bathroom at work: gross for me, gross for my coworkers, unhygienic for all. You guys can thank me later.

The first few days after my surgery were the darkest days of my life, and they passed in a murky haze of heavy painkillers and ginger ale. My left arm was in a fair amount of pain, I couldn’t bathe because of all the bandages, and, worst of all, the unavoidable fact that I had just had my breast removed hit me like a steamroller. I realized too late that I had not prepared myself mentally for losing my breast — I’d been so focused on removing the tumors, I had forgotten to think about how it might feel to go from being young, whole, and perfect to having only one breast.

It took me more than a week to finally work up the courage to look at myself. Intellectually, I knew what to expect, but emotionally, it took me a while to accept it. During my post-op checkup with my doctor 8 eight days after my surgery, I still insisted that I didn’t want to look at myself. My surgeon was very understanding on this point, but once I got home, my husband took me into the bathroom, stood me in front of the mirror and gently but firmly said, “You should just look at it, and then it’ll be over with, and you can stop being afraid of it and move on with your life. Okay?” I nodded, unzipped my hoodie, and bared my chest. Once I saw myself, I had to hold on to the bathroom counter for support. I felt hideous. Deformed. Mutilated.

But he’d been was right: once I got over my fear of seeing myself, I was able to start moving on with my life.

Illustration by Rebecca Elves

I was diagnosed with colloid carcinoma, sometimes referred to as mucinous carcinoma. Colloid carcinoma is like a little bag of mucus with cancer cells floating in it. Yum, right? I know.

Colloid carcinoma is a very rare type of invasive breast cancer, affecting less than 3% of all breast cancer patients. It usually appears in women who are older than 50. My mom, who is a nurse, dug up a bunch of studies on colloid carcinoma, and didn’t find any with patients younger than 48. I wondered, with morbid triumph, whether I was the youngest colloid carcinoma patient in history. I still don’t know.

The good news is that colloid carcinoma is a very slow-growing type of cancer, and it has only a 15% chance of spreading or coming back once it’s been treated. (As far as cancer goes, a 15% chance of recurrence is almost miraculously low.)

My cancer was also strongly hormone-receptor positive, meaning that the tumor was very receptive to (one could say fueled by) hormones like estrogen. This is also a very good thing, because treatments for these types of tumors are usually more effective than treatments for hormone-receptor negative tumors.

Breast cancer in women younger than 50 is often of genetic origin, and if it spreads, it tends to spread to the bones, brain, liver, or lungs first. (All very important parts of your body!) Over the course of three weeks after my diagnosis, I underwent testing to determine what had caused the tumor and if it had already started spreading.

One of my first appointments after my diagnosis was with a geneticist. He wanted to test my blood for the BRCA1 and BRCA2 gene mutations. These are inherited genetic mutations, passed down through families, which signify a stronger-than-normal potential for breast cancer. As I understand it, everyone has the BRCA1 and BRCA2 genes, and in normal circumstances, they work to suppress tumors in the body. But if a woman tests positive for harmful BRCA mutations, it means that these genes actually help tumors to grow, and her breast cancer is more likely to come back after treatment or spread to her ovaries or other organs. I was told this test is still fairly cutting-edge, and many insurance companies will not cover it because it comes with a hefty price tag in the thousands of dollars. Luckily, my insurance did cover it. The lab took two vials of my blood and sent them off to California to be analyzed. I would get the results back in two weeks.

In the meantime, to determine whether the cancer had already started colonizing other areas of my body, I had an MRI, a bone scan, and a PET-CT scan. The MRI consisted of lying in a tiny tube, boobs-down and with my arms over my head, for 30 minutes while it made very loud noises. I had to lie perfectly still the entire time; my arms and hands fell asleep after five minutes. The next 25 minutes were pure torture.

The bone scan was much easier — the machine made quiet, gentle swishing noises as I slowly passed through another tiny tube. The machinery is not sensitive to metal, so another person was allowed to sit in the room with me while I was getting my bones scanned. My husband came along and read a book. It took about half an hour, and compared to the MRI, the bone scan was downright relaxing. I almost fell asleep.

Then came the PET-CT scan, which was as tough as the MRI but torturous in another way: because cancer cells love sugar, I couldn’t eat any carbohydrates for two whole days beforehand. When someone tells you to stay away from flour, sugar, and starchy vegetables, let me tell you, the only thing you can think of is a nice, greasy bag of potato chips. For two. Whole. Days. I must have dropped five pounds just in potato-chip-related losses.

When I came in for the PET-CT scan, they gave me a nasty “smoothie” full of glucose and radioactive chemicals. Calling it a smoothie doesn’t make it go down any easier. And I had to drink two of them. At some point during my smoothie breakfast, they brought in a lead box, with a syringe inside (which is itself encased in a lead tube). This syringe contained more radioactive chemicals.

At this point, my husband had to leave the room, because I literally became radioactive myself. Despite what childhood cartoons might tell you, being radioactive does not activate superpowers or anything else awesome. Mainly I just felt tired, and a little nauseated. They injected me with the lead syringe and checked on my smoothie-drinking progress, and before I knew it, I was in — you guessed it — another tiny tube. The PET-CT scan checks soft tissues for cancer cells. Since I hadn’t eaten any form of sugar for the previous 48 hours, the famished, sluggish cancer cells would, supposedly, gobble up the glucose in the smoothies, and the radioactive chemicals would pick up on the cancer cells’ activity and cause them to light up on the monitors. It takes about half an hour, but I was allowed to take breaks and move around a little. On the way out, the nurses helpfully directed me to a basket with free bags of chips and candy. I grabbed two bags of Cheez-Its and ate them both in the car on the way home. They were the most delicious Cheez-Its I have ever tasted.

About a week passed with no word from my doctors. Then in the space of three days, I got the results from all of the tests:

The MRI showed six other possible tumors in the side with the confirmed tumor, as well as one other questionable spot in the other breast and a spot on my liver. My doctors were already moving pretty quickly because of my age, but after this test result came back, people got worried. Liver cancer is very serious business.

But, miraculously, the PET-CT scan came back completely clear, meaning they didn’t see any troublesome areas in my soft tissues. This is why they did the MRI and the PET-CT scan — it provided a way of double-checking test results against each other. False positives are very common with MRI’s, and the PET-CT scan showed that the spot on my liver was probably just “artifact,” meaning I had moved during the scan or the machine had picked up a spot of radioactive static.

The bone scan: also completely clean. My cancer had not spread to any other part of my body, as far as the doctors could tell. All of this positive news was a huge relief. I was able to sleep again, free from the crippling anxiety of the past three weeks.

Then my genetic test came back negative. My cancer was not caused by faulty genetics. (Thanks, Mom and Dad!) The outcome of the genetic testing was also a huge relief, of course, but in another way, it brought up one gigantic question: if my cancer was not caused by genetics, as we’d all assumed, then what did cause it?

Over the next few days, I ran through a never-ending mental catalog of all the risky behaviors I’d accumulated over the course of 27 years: smoking cigarettes on vacation in Spain, daily tanning sessions throughout high school, not getting enough vitamin D, getting possibly too much vitamin D, eating factory-farmed meats, or refined sugar, or canned tomatoes, or soy products. No longer terrified of an immediate and untimely death, I was now terrified that my cancer was caused by something I’d done, something that I was maybe still doing.

The next time I saw my surgeon, I asked her about possible causes of my cancer and rattled off the list of what I considered to be the prime suspects. She smiled kindly and put her hand on my knee. “The sad fact is,” she said, “we might never know what caused it, and you could drive yourself crazy looking for an answer.” I looked at my mom and my husband, who so far had been to every appointment with me, and I asked them, not for the first time, why this was happening to me. They had no answer, of course. And now I knew: no one did.

I turned back to my surgeon and she held up her hand, ticking fingers up as she tried to reassure me:

“We know it’s not genetics.” (She held up one finger.)

“You’re not over 50.” (A second finger.)

“You’re not a smoker or a heavy drinker — other than the cancer, you’re as healthy as you possibly can be.” (A third finger.)

“So that leaves us with one last possibility: it’s simply the mystery of life. But I’m here to fix you, and that is what I intend to do.”

Illustration by Rebecca Elves

My name is Juliet. I am 27 years old. I have breast cancer.

One of the first things people ask me after I’ve told them I have cancer is: how did you find it?

For me, it was straightforward and unremarkable: around Thanksgiving, I felt a pea-sized lump in my breast. I worried over it for a month or two, but not enough to pick up the phone and call my doctor. Instead, I hoped the lump would just go away on its own. It didn’t. Then one Saturday night at the beginning of January, I discovered a second lump in my armpit. I knew enough about breast cancer to know that it spreads first to the lymph nodes in your underarms, and, being a bit of a hypochondriac, I panicked.

On Monday morning, I finally called my doctor’s office. In a hushed, almost embarrassed voice, I explained to the receptionist, “I have a lump in my breast.”

She told me to come in that day.

My doctor took a look, touched that tiny bump, and declared it a pimple. Or maybe a cyst.

Huge. Sigh. Of. Relief.

But just to be safe, she was sending me to the breast center, so they could confirm it.

No problem! I felt a sort of feminist pride to be making my first trip to the breast center. Only I waited nearly another month to call them for an appointment.

On February 1, I finally went in. A soft-spoken young ultrasound tech and a motherly nurse with a heavy Filipino accent ushered me onto a bed, squirted some gel onto my breast, and rolled over it a couple dozen times with an ultrasound transducer. As I squinted at the screen, trying to make sense of the black-and-white fuzz, I silently joked with myself that this was not how I pictured my first ultrasound; I’d rather hoped that it would be for a happy thing growing inside me instead of an evil pimple-cyst. The motherly nurse held my hand.

After ten minutes or so, the ultrasound tech looked up and declared it a cyst. Or maybe a pimple.

Huge. Sigh. Of. Relief.

But just to be safe, he wanted to biopsy the lump with a hollow-core needle. I suddenly felt very cold.

After I dressed, they led me to a scheduler, a brisk Indian woman with pictures of two teenage daughters on her desk. She booked an appointment for the next week and ushered me out the door.

The next week, my mom and my husband met me at work, and we walked the six blocks to the breast center together. I went into the same exam room, and was comforted by the same motherly nurse. While the same ultrasound tech prepped his equipment, I cried silently. I didn’t know why — maybe because I had no idea what to expect, or maybe I hadn’t taken any of it seriously until that moment. I can honestly say, though, that it still hadn’t truly occurred to me that I could have cancer.

The biopsy was unpleasant — as any new, slightly painful medical experience is bound to be — but the tech and his nurse were fast and efficient, and soon I was on my way home, ice pack stuffed in my bra and a humorously numb feeling in my breast. After a few hours, the lidocaine wore off, and I promptly forgot the whole thing ever happened. 

At work the next day, around noon, I got a call from a radiologist at the breast center. He had a deep, cartoonish voice and a Midwestern accent. He talked for a few minutes, using lots of incomprehensible science-y words, until I interrupted him.

“I’m sorry, but wait one second: you’re saying it’s benign.” More of a statement than a question.

A long pause.

“No. I’m sorry. It’s malignant.” Another pause. “It’s cancer. We’ve already made an appointment for you to see a surgeon right away.” 

I felt like my legs were going to give out underneath me. I was standing in an empty hallway in my office. The word echoed in my head.

Cancer.

Cancer.

Cancer.

Cancer.

I barely heard another word the radiologist said, and after another minute or so I thanked him politely and hung up. I looked all around the empty hallway, not knowing what to do next. I was shaking uncontrollably. I walked to a coworker’s office: I needed to share the news, to test the reality of the moment, to bump against it a little to see if it had any give. She wasn’t at her desk, but her officemate was. I didn’t care. I closed the door behind me and whispered those impossible words:

“It’s cancer.”

By the look on her face, I knew it was real: horrified, then shocked, then sympathetic. She rushed to give me a hug and rub my arm while I rolled the words around in my mouth a little:

“It’s cancer.”

Illustration by Rebecca Elves