» Nonfiction

Russian Roulette

Anne Panning

“Angelina Jolie’s Disclosure of Preventive Mastectomy Highlights Dilemma”

                                                —The New York Times, May 14, 2013

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I. Catapult

Plastic Surgeon #1, sidetracked, is convinced I have scoliosis.  “No,” I repeat. “I do not have scoliosis.” Still, I stand in my underwear and hang my arms over my head like I’m diving. He fingers my spine silently. Humpity, humpity, hump.  “Hmm,” he says, unconvinced.  It turns out I have “severe chest wall asymmetry.” Basically, I’m uneven, a tippy table, which will make breast reconstruction complicated.

The plastic surgeon’s name is Stephen. He’s got a soft, dewy face, dark hair, black glasses, and when I ask questions, he suddenly whips back on his stool as if ready to catapult himself into space. Dr. Stephen crosses his hands over his white coat. He’s busy and rich and has many women to see. He doesn’t like my fifteen-point list of questions. “We’ll take good care of you,” he says. He signals we’re done by stuffing his pen into his lab coat pocket. I bet myself one million dollars he’s been trained to say that at the end of every consult.

It’s the nurse, Danielle, who lays out the facts in his wake: My BRCA (read: breast cancer) genetic mutation predisposes me to a 90% chance of the most vicious, untreatable breast cancer. Plus, holy hell: a 65% chance of ovarian cancer, the “silent” killer. The choices: 1) Have surgery to remove all at-risk body parts or 2) don’t. I want “don’t” but can’t choose “don’t.” How can I? I have two children. A beautiful husband. All the students I have yet to teach and love. There’s still Japan to visit. Indonesia. My children’s weddings. Their grandchildren! To do nothing is Russian Roulette. To do nothing is to wide-eye my way through every sleepless night waiting for my mutant DNA to blastoma the hell out of my breasts.

Danielle wears leather joggers and high heels. Her holiday manicure features tiny gold Christmas trees sparkling at the tips. I like her and imagine if I go with Dr. Stephen, I’ll really be going with Danielle—health care being what it is.

 II. Goldilocks

Plastic Surgeon #2 says I’m lucky. “You have the perfect ‘Goldilocks’ situation for direct-mastectomy-to-implant!” She dutifully lists the reason aloud:

1) my breasts have just the right droop (ptosis)

2) I “want” to go smaller, not larger

3) I’m not overweight

4) I don’t “want” to keep my nipples

5) I do not have and have not had cancer

Apparently, I meet all items on the Goldilocks checklist for a perfect and immediate reconstruction. But where is my perfect little bowl of porridge? The tiny chair that’s just right—until I break it? Because I’m broken. Am I broken? What does a broken little stick of DNA look like?

The doctor’s name is Elena, and she tries to bring me in closer by hushing her voice. “I understand why you’re doing this,” she says. “I have a two-year-old.” Which I translate to mean: she is young, still green, which makes me wonder, then worry: How many breast reconstructions does she even have under her belt? I ask; I have to. “One and a half,” she says, smirking at the half. My friends have always teased me about my horrible poker face. Dr. Elena must see it in my eyes: my fear, my “oh hell no!” She adjusts her white coat with a quick glance at the clock. “Why don’t you look at some of these photos,” she says. She is immensely professional and kind. She angles the monitor so I can see.

I stare at headless women’s photographs on the website. Dr. Elena clicks to show me “Before” and “After” breasts. I note the women’s whiteout swimsuit lines, their freckly constellations, the taut cords of their necks: chins up, eyes unseen. The “Before” breasts fascinate with their oddities and quirks: the gigantic bumpy nipples like big melted cookies; the soft, deep flop of boobs hanging heavy to the belly button; the tiny, hard nipples that really do look like pink pencil erasers. All the women wear the same white satin triangle underpants: the plastic surgery uniform of the brave. The “After” breasts remind me of Coraline’s crisscross button eyes. They look like blank, soft doll faces, nipples gone, pale skin hatched with red scars. “So which of these are your patients?” I ask. She scrolls and clicks back a few. “This one,” she says. I nod. It looks like every other horror show of loss.

I don’t ask about the other half of the one-and-a-half procedures she’s done.

III. Wink

Plastic Surgeon #3 is the overeager guy in high school, the three-sport athlete, the smart, generically handsome, deeply insecure charmer all grown up. He’s got a gray cowlick and an aggressive overbite some might find attractive. His name is Howard, and something about his beady eyes and frantic movements feels ferret-like. “You don’t mind if I have a resident in here with me, do you? This is Luke.” Hasn’t that ship already sailed? I mean, here he is. “That’s fine,” I say, even though it’s the only appointment my husband is unable to attend. Never mind: I’ve grown used to standing topless in front of blue walls for photographs while men take pictures and talk about my breasts.

Luke is a curly-haired surfer type. He’s the young scribe and the apprentice and is working hard to make me comfortable. “Oh, yeah, totally,” he says in answer to my questions. “Yeah, yeah. I hear ya, man. It’s all good.” They measure the distance from sternum notch to nipple; they lift each breast as if feeling for the perfect weight and density of a ripe grapefruit. Dr. Howard dictates, and Luke writes: “nipples everted, shoulder grooving mild, ptosis level two for each breast.”

“Hey, I know what ptosis means,” I say. “It means my breasts are really floppy and droopy.” I laugh, shrug my shoulders like, “Eh, what’re you gonna do?” This stops both of them in their tracks—literally. Something has shifted. Dr. Howard fumbles with his tie. “I didn’t say that,” he says. Luke offers bro backup. “Oh, no, man. That’s not what he was saying at all.” Now it makes sense how remarkably quick and easy it was to secure  an appointment with Dr. Howard, even though he’s Chief of Breast Reconstructive Surgery at Best Hospital in the World. He’s a hot commodity on the speaking circuit for his expertise on microvascular surgery, yet I got in to see him immediately. I think I might understand: He’s a bit of a letch. Or is condescending. Cruel. Perhaps he has not dealt with women appropriately in the past. Perhaps that’s why Luke is here at the get-go.

“Can you send me the link to the photo gallery of your past patients?” I ask. Luke gives me a thumbs-up. Dr. Howard swivels back to his computer. “Oh, we don’t really do photo galleries like that.”

“Really.” I dare him to dismiss my curt, angry tone. “And why’s that?”

“Photos aren’t really that helpful,” he says. He crosses his arms, and I catch him glancing at the clock. Luke’s cell goes off; honest to god, it’s Bruno Mars’s “Uptown Funk.” He doesn’t apologize but dashes out the door without a word. It’s now me against Dr. Howard.

“Trust me, your breasts will be stunning.”

“Define stunning,” I say.

“Ha,” he says. “You got me there.” He looks longingly at the door for his wingman. Anyone, anything, to get him out of this room with this terrible woman who takes things way too seriously.

“Are we done?” I ask.

He stands, smoothing his tie. “Just let me know what you decide.”

He winks at me on his way out.