Pink Christmas

"If you're the worrying kind," the doctor said, "we can do a biopsy now, but I think we can wait a few months and see if anything happens."
"If I were the worrying kind, I'd probably have had this done before now, instead of waiting four years since the last one."
"Good point."

About an hour before, I'd been sitting in the waiting room, surprisingly (to me) busy for 8:30 in the morning. The other women sat on the tastefully upholstered cushions of the low-slung sofas and chairs, flipping through issues of various women's magazines or Cancer Today. The cover models on the latter looked frankly healthier.

You know what's weird? Sitting in the waiting room--or, later, in a consultation room--of a breast imaging center, reading about the cancer industrial complex and pink culture, overdiagnosis and overtreatment, the cultural and commercial branding of breast cancer that has resulted in questionable progress except for increasing profits and fundraising for certain sectors of the economy. This isn't to discount the reality of breast cancer, and the importance of detection and treatment. It's just interesting, and disturbing, to realize how complicated it all is, and how consumer-driven.

I was sitting in the waiting room because a couple of weeks ago, after repeated nudging by various doctors and my insurance company, I'd finally gone in for a mammogram. This was my second, the first and heretofore only one having been semi-forced on me before I left Philadelphia, by a cheerfully insistent doctor. On that occasion, they'd found a few calcifications, done an ultrasound that confirmed nothing particularly worrisome, and sent me off with a large envelope of X-ray films and the suggestion I have another in six months, just to be on the safe side.

That was four and a half years ago. I'm not the worrying kind.

This time, everything was digital. Miraculously, I still had and could locate those old films, so I dutifully brought them with me and left them with the staff for scanning. Last week, I got a call that I should come back in for a follow-up, and "maybe a biopsy."

Every once in a while, a nurse would open a door to the waiting room, and quietly call out women's names. "Marjorie? Evelyn? You can come back now." When my turn came, they referred to me as Ms. Lastname. I idly wondered why.

While I was waiting, I wondered what I would do if something turned up that seemed to require further intervention. From the statistics I'd been reading, apparently only a small percentage of follow-up mammograms lead to biopsies, and only a small percentage of biopsies actually reveal anything. The argument is that the various false positives and extra tests are a worthwhile price to pay for those few cases that actually are detected. Which is true at the population level, maybe, but it does raise questions about women who are un- or underinsured, subjected to unnecessarily aggressive testing and treatment, and whether the benefits really do outweigh the risks and expense.

"Your breast tissue is more dense and even than I'd expect in a woman your age," the doctor said as he glided the ultrasound wand across the layer of gel covering half my torso. Both of us were watching the screen intently. He was very professional and detached, but it's hard to know how to respond to a statement like that in these particular circumstances. I've had weird medical compliments before--I've been told I have beautiful corneas, for example, and a lovely cervix. The latter was the closest, I guess, to this situation, but the cervix isn't usually a sexualized part of the body. I'd kinda just been told "nice tits!" in the most clinical way possible.
I didn't say anything.

The follow-up mammogram was done by a sunny, athletic woman about my age named Sherry. We chatted about photography and technology while she nudged my fleshy bits into position on the machine. "Okay, hold onto that bar, lean forward, arch your back. Now look over this way, chin up. Breathe... and hold it." I pretended I was having some kind of high-fashion concept photo shoot, one that required me to contort myself into awkward poses and allow strangers to push and pull at various parts of my body. It was all in the name of Art. Afterwards, she helped me adjust my capelet and led me into a second waiting room, where another nurse came to call me into the examination room. I perched on the edge of the patient chair while I waited, cooling coffee in one hand, iPad in the other, reading about fraud cases brought in relation to hormone replacement therapy and high-powered branding consultants brought in to develop just the right emotional message to persuade women to ask their doctors about certain cancer drugs.

I was relieved at the lack of interesting findings, not just for the obvious reasons, but because I still hadn't decided what I would do if there was a decision to be made. It's so hard to make informed choices, even when you have access to information and options. Everything's just too complex. I'm lucky on all those counts, but I'm surrounded by parallel universes in which just one small part of my life is different, and everything else changes dramatically as a result. Mostly for the worse. How much power do any of us have, individually, when it really comes down to it? I'm so used to looking at things systemically that it's not hard for me to see how lots of people making (for the most part) decisions based on genuinely good intentions can create structures that on the whole do more harm than good, or at least serve purposes very different from those most participants think they do.

I'm supposed to go back in another four months. Or maybe four years and four months. I'm not the worrying kind.

Of course, this is all much easier for me to ponder as a (mostly confirmed, for now) outside observer. If I suddenly found myself in a terrifying medical state, I might be profoundly relieved at the option to embrace a ready-made role rather than flail around wondering what I was supposed to do. I could pull on a pink T-shirt and run races and be part of a sisterhood. I'm sure it would be tempting, even though I'm not really the pink type, in any sense.



Not a very Christmassy entry, yet again. Maybe I should call this "Holidailies: Medical Edition." It's that kind of year, I guess.