Cutting Blind
Whilst my physicians by their love are grown
Cosmographers, and I their map, who lie
Flat on this bed
- John Donne, excerpt, ‘Hymn to God, My God, in My Sickness’
In a few days, my surgeon will remove something from my body that she can’t feel or see. That’s the interesting thing about this particular brand of cancer: it’s invisible not only from the outside, but from the inside too. Under a microscope, I imagine the scene looks veritably apocalyptic, with aberrant cells filling the ducts they line with necrotic and calcified remains. But to the naked eye, it all looks like regular breast tissue.
That’s what the flurry of imaging tests in the past few weeks have really been about: giving the surgeon a road map for where to go. But because breast tissue is mobile, none of the maps are perfect. The calcium in the tumor lights up on a mammogram, but the compression used to get that level of detail distorts its relative size and location. The MRI was taken while I was belly-down, with gravity elongating the breast tissue as dye tracked through the tumor, but that’s hardly a position I can assume during surgery. Metal tags were left in the center of each lesion at the time of its biopsy, but they offer no clues as to how to arrive at the places they mark.
Enter: the guide wire. Just before I’m wheeled into the operating room, a radiologist will insert thin wires into the lesions under direct (likely ultrasonographic) visualization. The wires have barbed ends which hold them in place so the surgeon has a steady path to follow. She will then, in what seems to me an act of sheer ingenuity and skill, visualize the dimensions of the tumor from the imaging tests to resect not only the cancer, but with it a wide margin of healthy tissue—enough to ensure all the cancer is gone by an acceptable margin, but not so much that excess tissue is unnecessarily lost.
It's the inversion of every surgery I’ve ever done. Cataract surgery is all about taking what you can see. I used to tell residents, take time to optimize positioning, tape lashes, focus the scope, wet the cornea, maximize iris dilation, use staining dye if you need to—because if you can’t see it, you can’t do it. If can’t see it, it’s all over.
This is something else. This is a kind of surgery where it’s not all laid out in plain view. And because breast tissue cannot be frozen for immediate sectioning like skin can, there’s no way to know if margins have been achieved until a good week after. In the moment, you can’t know. You go on skill and faith, on the images you’ve been given and a wire that leads the way.
Last Saturday, I was sitting on our couch, listening to our daughter’s chamber music group rehearsing in the next room—wrenchingly beautiful strains of Mendelssohn’s Quartet in E-flat Major punctuated by the giggles of teenage girls—when the doorbell rang. It was one of our son’s swim friends, part of a group of kids who had come over so often over the years they were like family. We asked if she was here to see if our son was free to play, but she didn’t say anything, just stood there at the doorstep in her helmet, looking lost. She had heard about my diagnosis and found herself biking over. I gave her a hug. I hope it hasn’t spread, she kept saying. Probably not, I told her, but we don’t know for sure. They’re doing a surgery to find out. She stayed to pet the dog and we talked things over.
Over the past week, folks have appeared, unbidden, like the girl at the door. Instead of the doorbell, it’s a ping on my phone, a package in the mailbox, a jar of soup, warm gloves for the hospital, or a simple note. I feel it all coalescing around me—and it’s hard to take in, in a way, because I like to think I’m fine. I have all the images, all the dimensions. I’ve settled into the diagnosis; I’m ready for the surgery. But really, I’m just someone trying to wrap my hands around the invisible. I’m feeling out each step as I go, and it turns out all the messages and mail and soups and songs coalesce into something like a wire I can touch as I go. Yes, here we go: and I’m alone, but not alone after all.
