Amanda Kovattana

Middle-aged musings in interesting times

Friday, August 03, 2012

A Caretaker Notes: Grace

Our journey continues to engage the healing path in the run up to surgery.

The Fourth Chakra

Breast cancer is a disease associated with the fourth chakra, the heart chakra. Because of this association, I saw the disease through the lens of love as a missing ingredient somewhere along the way in Catherine's life, that now had to be replenished, particularly the consistent, unconditional love of a mother. (Her mother had died just over two years ago.)

And so I took particular care to imbue my role as caretaker with all the consistency and care of a mother's love. I made sure Catherine knew where I was at all times, so that she would never feel a sense of abandonment. I came home when I said I would or called. (As a partner I had not always been good about that. Stuff happened, I was in the moment somewhere else. I was independent that way.) Catherine, in turn, noticed my steadfast attention and thanked me often for this care and told me of her deep gratitude for my sticking by her. 

In my caretaker role, I organized myself around meals and driving Catherine to doctor's appointments. I upheld the culture of the patient by deferring to her preferences and served her requests without questioning them. It was a different kind of love than I had shared with her as a partner. It was not the give and take of compromise or the call and response exchange between lovers. It was about being a channel for healing.

This role also allowed me to receive love from others since it didn't threaten my independence. It transcended it because this, too, was a part of the love being channeled towards Catherine's healing. So when my colleagues and friends offered to help in any way I accepted with gratitude, mostly by letting them take me out and feed me, offer tea and sympathy. Others wrote asking how things were going. Many, at my request, sent pictures of otters and other cute animals to give moral support when we were at the infusion lab.

One colleague I hardly knew mentioned that she, too, had been seriously ill and extremely anxious. When I asked her to tell me how she had overcome her anxiety, she bolstered me with her story of slow, but gradual healing and gave me some useful tips on what she did to facilitate her progress. Then she followed up a week later with an offer to make a meal for me to take home to Catherine (whom she had never met). I was profoundly grateful and realized that she was paying forward the love that her community had offered to her and her husband during those months of debilitating illness.

This quality of rising above personal autonomy allowed me to feel intensely connected to the life force and to the gifts that people were offering. One morning on the dogs' walk, I told my spirits that I was worried about Catherine's lymph nodes and could they do something about that. I immediately felt guilty for asking and then forgot about it completely. 

Later that morning at the end of my session with my chiropractor, for tendonitis in my ankle, he said he had something he wanted to give me. He then asked me to think of something that was making me anxious while he did a muscle test on me. I held out my arm and he pushed down on it. (The muscle test is the chiropractor's tool to determine what the body needs.) Sure enough when I thought of Catherine's lymph nodes the arm went down like a knife through cheese. He then took out an electric hammer and hammered up and down my spine telling me to continue to think about the distressing thought. When he finished, I held out my arm and he pushed down on it to test again. The arm stayed strong, resisting the pressure. 

"Good," he said, "at least now the stress won't take it out on your body." I was dumbstruck then amused. The spirits had answered my request in a way that would help me directly, rather than try to convince me everything would be fine.

"Thanks," I said, "that's exactly what I needed".

The rest of the day continued to roll forward with equal measure of helpful attention. It made me feel downright high.

At gatherings, people who had not seen me in some time, showered me with attention and were intently interested in what I had to say even beyond news of Catherine. This had the affect of feeding my creative energies enormously and inspired me with thoughts of putting some of the stories I was telling into a book. 

On the way home from such a gathering, traffic was stopped and I saw, to my amazement a regal, multi-colored rooster crossing the street. This was a suburb as busy as a city, not the country; free range animals did not saunter out into the street. The sight of a chicken crossing the road struck me with cosmic belly laughs. I shouted out the window at it.

"Hey chicken, why did you cross the road?" The rooster turned briefly in my direction, then headed on its way down the sidewalk leaving me with one of life's existential questions. Why are we here, if not to cross the road?

My moments of awe were propelled by the seriousness of our situation. I was so grateful when nothing dire was happening that ordinary life was imbued with a bittersweet appreciation for its very rightness. 

I also had some ugly days (though few). Relatively small frustrations sent me into a rage I hadn't felt since I was young. One phone call with a clueless vendor frustrated me so much I was seething and then the car door opener wouldn't work, likely jammed by my electrical energy. (It only worked for the front door, but later it was back to normal.) The day unravelled from there when I left a $68 bag of Orgain (an organic liquid meal replacement) in the parking lot of Whole Foods and didn't notice it was missing until Catherine asked about it at bedtime. The store had called me to say they had it at customer service, but I didn't understand the message and it was too late to return the call. It took me an hour to write down everything that had annoyed me that day.

Catherine, on the other hand, no longer sweat the small stuff. She had too much to think about, trying to solve the problems of her illness, to be bothered by trivial things. Nor did she have time to ask questions of chickens, but her compassion for the suffering of others ballooned. She was moved by stories of lives brought down by tragedy. Once her anxiety subsided (with enough drugs on board), she was able to benefit from her meditation practice, even meet with her spiritual group, in the city, the week before surgery. By the day of surgery, she was relatively calm. We had both had surgery before so had an idea what to expect.

To Reconstruct or Not to Reconstruct

The biggest decision for breast cancer patients is about reconstruction surgery, replacing the missing breast with an implant. Is it worth it? What complications does it engender? How is it done? The surgeon assumed that anyone still young enough to have an active life, would want reconstruction surgery. Very few of her patients even the gay ones, she said, did not. Both she and the plastic surgeon felt that being able to restore a normal form would erase the psychological scars of the illness. I had my doubts. No fake boob would erase this trauma. It had no integrity, no right. It was an impostor. Though it did have a convenience factor to it. It would negate the daily placement of a prosthesis into a pocket of a specialized bra. 

Catherine worried what I would think of her not having a normal body. I thought the whole idea intriguing. And I had always liked scars.

A writer in my writing group, Ann Davidson, had published some beautiful poems in 1990, about her cancer journey which included meeting her prosthesis after her mastectomy. I telephoned her to ask if she had any regrets. She was warmly supportive and filled me with reassurance that, though it took a period of adjustment, it had never caused her any regret; it had, after all, saved her life and she did not want the complications of reconstruction surgery. Nor did her asymmetrical body cause any public consternation when she went naked into a hot tub. But she cautioned that it was a process and would take time. She wished us well and mailed us a copy of her chapbook "Modified Radical and Other Cancer Poems". Catherine read it in one sitting looking a little sober afterwards. 

"That was intense," she said.

We went to the plastic surgeon for a consultation. I happened to know him from my days working at the Palo Alto Medical Center (as a graphic artist in public relations). I was already acquainted with implants, the strange familiarity of them, because this very surgeon had given one to my photographer friend Warren. He had it on his desk in his closet size office. He showed it to me once because we were buddies and given to sharing about women. Together we admired the life like consistency of the silicone gel under the clear plastic dome. It felt just like a real one in a futuristic robotic way, streamline without a nipple.

The plastic surgeon recognized me, but couldn't place me. I told him and then we sat down to business with three of the implants on the examination table. Catherine asked about the procedure. He explained that he would work in tandem with her surgeon the same day as the mastectomy and insert the empty implant under the extra skin she would leave for him. Then, over the course of weeks Catherine would come to his office and the implant would be filled a little bit at a time, gradually stretching the skin over the dome of the implant until it was the same size as the remaining breast. He might also have to do some adjunct surgery to get it to match. Finally a nipple would be tattooed in place. This was already too much procedure for Catherine who knew she would also be facing chemotherapy. Plus friends who had had reconstruction complained of infection and additional complications.

Catherine asked about the durability of the implant and the likelihood of it needing to be replaced. To prove its durability, the doctor picked up one of the implants and bounced it hard on the carpeted floor. We watched the translucent orb sail up to the ceiling and down again until he caught it. We were duly impressed. And no, it likely would never need to be replaced.

There was just one more question. Did the implant harden over time? Catherine had felt a friends and they were rock hard she told me. The doctor explained how the body treated a foreign object by enveloping it with scar tissue. Over time the scar tissue contracted around the implant and made it into a ball shape, he explained, showing us with his large hands. That did it. The body itself recognized the impostor for what it was. I was glad he told us that phenomena so graphically. I also appreciated that he wanted us to know all the details and was not attached to what decision we might make.

(The method Suzanne Sommer's made famous, of using the body's own fat as an implant, was not ready for prime time said her primary surgeon.)

It would still be possible to have reconstruction surgery later, the plastic surgeon assured us. It would just be harder because the extra skin wouldn't be left there by her first surgeon, so would have to be stretched even more. 

There are pictures on the web of women post mastectomy. Catherine saw one of a young woman at a Breast Cancer march, wearing a bikini top over her one breast. Something about the woman smiling, carrying on with her life, assured Catherine that she could do this. She was not alone. There was a whole tribe of one breasted women out there.

So we prepared to say goodbye. Our dharma teacher suggested we do a ceremony for the departing breast. Catherine's therapist asked if we would make love one last time with it. That sounded good. It was more familiar territory than the former, so we did that first. 

Ceremony was more my thing and over the weekend ideas came to me. We should have a lei for the breast, I said, and we picked out a pretty necklace of pink and aqua stones. I put on one of my magical shirts of swirling blue and white with black pants and placed the lei over her left breast. I invoked the four directions and the four elements as witness. We spoke to the breast and thanked it for it's many attributes, its beauty and symmetry—the pleasure it had given. Catherine apologized to it for whatever she might have done to cause this cancer. We thanked it for making this sacrifice to save Catherine's life. 

Thus consecrated for its final task, we assured it that it would not be forgotten and that Catherine's spirit would continue to be whole without it. I was satisfied that we had properly marked this passage and released our helping elements. 

Operation Day

The day of the operation we checked ourselves into the light filled penthouse of the Cancer Center. The waiting room had nicer furnishings than most people's houses and was divided, by curved paneling, into conversational groupings. An electronic board listed the progress of each operation; some forty in all. 

Catherine was whisked off to be prepped and then I was invited in to wish her well just before they wheeled her in. Surrounded by the busyness of procedure it was in stark contrast to the calm, timeless, tension of the waiting room.

My origami animal for the day was a red Chinese dragon for good luck, which I was studiously folding on a side table, when friends Carol and then JoAnn arrived to keep me company. The rest of my network sent us their best wishes and healing light on Facebook including three women intuitives we met on our Stonehenge tour last summer. On Catherine's side, her friends were also supporting her on the spiritual plane. Christians prayed, Buddhist sent metta and a group of Shamans performed a healing ceremony for her. 

Wi Fi at the center allowed me to check in on this cadre of healers, via my iPod, and I felt how intensely we were being supported. The four hours passed quickly with lively conversation about Silicon Valley being a cancer cluster because of the chip manufacturing. Said manufacturing now imported to Asia. 

"Because we like to share," said JoAnn wryly. 

At lunchtime the surgeon came out to tell me Catherine had done very well; all had gone fine. I passed on the news, texting, e-mailing, posting, and then calling her dad before making the long trek to the hospital building where I stayed with Catherine until her brother spelled me so I could have dinner. My friend Dave and his mother Marilyn lived across the street so I had arranged to go there. My mother came by too. It was a festive day on my end.

Catherine looked better than I expected and was able to come home the next day. I went to fetch her. As I drove her home I had a momentary vision of bringing home a newborn. It was a new life she was entering with her asymmetrical body and the challenges still ahead to keep ahead of the cancer;  it could also be a new beginning.

The Next Step

The surgeon called a few days later to say the pathology report showed her lymph nodes to be clear and the margins at the site of surgery were all clear too. At the office visit, the following week, her status was officially declared Stage One, the most optimum we could have hoped for. We celebrated by going to Watercourse Way, a zen like spa nearby, and buying her surgeon and her husband a couple's massage. Catherine had been moved by her advocacy and care. She told me how the surgeon had knelt by her bed in the operating room, held her hand and looked into her eyes, holding her with her gaze until she went under the anesthesia. Women physicians bringing in a whole new healing dimension of love to medicine, despite the war like basis of modern medical intervention—the battle engaged against disease using similarly toxic weapons, knives and derivatives of mustard gas. 

Given the month since the difficult chemo treatment had been stopped, plus the two weeks of recuperation post surgery, Catherine had gradually returned to her usual self. We actually talked about subjects other than cancer, watched movies and our shows and ate regular meals.

Two weeks later we were back in the oncologist's office, his white mustache twitching like a magician ready to present a rabbit. There was the slim hope that, because the pathology had been so good, he would tell us she didn't need to do chemo, but that was not to be. This doctor was thorough; he wanted to be certain. He had a strategy derived from the latest study targeted at the triple negative cancer. He wanted to give her Taxol for three months, then the off-the-shelf standard chemo for two more months. Taxol did not make people sick, but it did cause them pain in varying degrees. It sounded better to have that option first. Later, after reading too much on the net, it sounded awful. But Catherine was game to cross this road too. In a week we would be back at the infusion lab.

In the interim, I was off to Angel Island for a much needed weekend camping holiday with a dozen women friends.

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