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The first time I noticed was in yoga class. In my early thirties, I was as limber as I’d ever be – though I wouldn’t appreciate this until later – and could easily wrap my body into deep twisting poses. That morning, I twisted left, stretched my right arm over my left shin – and felt my whole body stop, as if hitting a speed bump. “Hmph,” I mumbled to myself, took a deep breath, exhaled, and shot my arm out with more force. But my torso remained immobile. It’s like there’s something in the way, I thought. I blamed that and other little things, like weight gain and bloating, on age and focused on what was going well in my life, which was a lot.
In the decade since I had graduated from Stanford University, I had charted out a textbook reporting career with the goal of being a foreign correspondent. In my late twenties, I had landed in a high-profile reporting beat on race and ethnicity at The Oregonian in 2000. Within three years of the September 11 attacks, I had travelled to Afghanistan to report on a story about a local family returning to their post-Taliban homeland.
My romantic relationships in Portland had been fleeting and tumultuous, a multi-chapter textbook on exciting but unavailable men. At the time, that was how I liked them. During my reporting trip to Afghanistan, I travelled and lived with a family in Kabul, and they assigned their youngest son, just a couple years younger than I was, to be my bodyguard. The first time I met Asad (I’ve changed his name here, for his safety – he and his family have been targeted in Afghanistan for cooperating with American journalists), I was told not to make eye contact with him in front of the family elders. Yet something grew in spite of, or more likely because of, the slow reveal: our long, risky road trips outside NATO-controlled territory; the conversations when we “bumped” into each other in the family house’s only gender-neutral space, the courtyard; and my growing appreciation of his gallant, self-effacing regard for me – as well as his long, straight eyelashes and easy smile.
Returning from Kabul, my studio apartment seemed barren and silent compared to the thrumming, multi-generational Afghan household. In my homesickness for a place far from home, I developed an unshakable feeling that Asad was somehow part of this grander trajectory of my changed, smaller world and personal-professional existence.
A year later the universe seemed to offer an answer. Asad miraculously secured a student visa to study in the United States – no small feat for a young, single Muslim male – and would settle near Washington, D.C. I had been interviewing with The Washington Post and hoped that within a year the newspaper’s editors would find an opening for me that would help launch me into a foreign bureau. It all felt uncanny. That he was charming and even sounded handsome on the phone provided a pleasant buzz that kept me out of my usual trouble with other men.
Then I felt that weird sensation in yoga, and little things seemed not right with my body. I kept busy, wrote a lot, and would feel giddy for days after getting an email or call from Asad. I went for a routine checkup and felt as if my gynaecologist, Dr Warshaw, were talking about someone else when he calmly said he had felt a mass, probably a harmless fibroid, on my uterus, and he’d be sending me to radiology. I wasn’t worried because it felt impossible that I should be.
The next few weeks are a blur of disjointed moments in my memory. A young, inexperienced ultrasound technician stops her chatty small talk in the middle of the scan, and grows quiet and grim.
The next day, I get the call at work. “Are you in a place where you can talk?” Dr Warshaw says.
The rest of the conversation comes back to me in sensations, not words. The phone feels sweaty against my ear, which is hot. The room feels too brightly lit. I can hear things being said, but I am surrounded by an impervious layer, through which the sentences – the kind reassurances about a likely benign cyst, laparoscopic surgery, small incisions, preserving the ovary if at all possible, the other one appears normal, four to six weeks’ medical leave – all run off. I latch on to the only one I can grasp. “I can’t afford to take four to six weeks off,” I plead. “I have too much work to do!”
I feel suddenly aware of the mass on my right ovary, which is large, so much larger than Dr Warshaw thought – he had felt something on my uterus, but it was because the ovarian cyst had grown to the size of a misshapen grapefruit and was lying on the uterus. By then I can feel it, distending my abdomen, pressing on my bladder at night, taking up space – and growing. I have a pre-op phone call with the Catholic hospital. The nurse gives friendly advice, that I should bring slippers for the cold floors and a light robe that will make walking around in a hospital gown more comfortable. She tells me that the rooms typically have a crucifix on the wall, but if I request, they will remove it before I occupy the room.
I am not religious. Yet this question, more than the ones that preceded it about the risks of general anaesthesia, about living wills and advanced directives, sends rivulets of ice water down my spine. If I ask the hospital to take it down, will I later regret it? My throat is suddenly tight. “Um…” I cough out. “Uh … no, that’s OK. You can leave it. It doesn’t hurt, right?” I laugh nervously. “I’ll take all the help I can get,” I add, feeling tears in my eyes for the first time since that surreal call from Dr Warshaw.
Well, check “stripper” off the list of possible future careers.
The sentence lodged itself in my brain as Dr Warshaw explained at my pre-op appointment that he was changing his plan from a laparoscopic procedure to an abdominal incision. It seemed the cyst had grown so much since that first ultrasound that he now needed to cut me open. I pushed the ridiculous stripper thought away.
“See, the laparoscopic surgery would mean going in through your belly button,” Dr Warshaw said in a placid tone. He was young, a sandy-haired father of two whose paternal manner made me trust him. “But the cyst has grown and is now lying over where your belly button is. We think it’s benign, but just in case, I don’t want to risk puncturing it while it’s inside your abdomen. We’re going to have to do a Pfannenstiel incision. It’s a horizontal…”
“A C-section incision,” I said. I had done my research. Yet no accumulation of factual knowledge made me feel ready for the idea that he was talking about a scalpel slicing me open.
My friends who had given birth by caesarean section were quick to chime in. “Don’t worry,” more than one said. “You can still wear a bikini. Want to see mine?”
I was suddenly keenly aware of being single, of not yet having had children. Would a scar make me less desirable? Would the possible end of my fertility make me less than marriage material? Would cancer? I occurred to me that I hadn’t been in touch with Asad since I had gotten the news. Even he had faded to the background, his emails and calls unanswered. How could I explain this to him? Yet I felt embarrassed, angry at myself, that I couldn’t help thinking about the impending surgery through the lens of marriage and how men saw me.
At that pre-op appointment, Dr Warshaw had an important question. If he began the surgery as planned – to remove the cyst and, most likely, my right ovary – but then discovered the mass was cancerous, or had spread, how much additional surgery was I comfortable consenting to ahead of time? He was trying to ask as calmly as possible. I felt strangely tranquil. The answer came to me quickly and fiercely: “Unless my life would be in danger by waiting those few weeks for a second procedure, I don’t want any additional surgery that would permanently change my ability to have children,” I said. “Not the other ovary. Or the uterus, until we have a chance to consult.”
It was like hearing someone else’s voice speak from deep inside my body. This voice was sure, insistent, steady. Dr Warshaw nodded and wrote on his legal pad.
I liked being in the hospital. Before I had gotten there, my daily existence had been a morass: the surgery, possible cancer, fertility and what it meant to me, being single while facing a life-threatening health crisis, and taking a month and a half off work when I felt I should be at the peak of my professional game. The immediacy of pain and healing gave me clarity and focus.
Emerging from general anaesthesia felt like being washed up on a beach, mouth full of sand and salt. My first fuzzy thought was euphoria that I was alive. The nurse was telling me that the cyst was out, the surgery was a success.
From that point on, anaesthesiologists, surgeons, day nurses, night nurses, IV nurses, residents, kept me occupied with reporting to them my level of pain, my reaction to intravenous morphine, and my digestion. One morning I felt so ill I didn’t make it to the bathroom in time and projectile-vomited on the feet of the Jesus on the crucifix I had consented to have in the room. “Sorry,” I said to the small brass figurine.
One day, I woke up feeling particularly clear-headed, having been taken off morphine and switched to oxycodone pills. I decided to make a phone call I had been putting off.
“Wow,” Asad said, in his softly accented English, “I haven’t heard from you in a long time.”
Before I lost my resolve, I blurted a pre-rehearsed account of my surgery. I expected a long silence, or some uncomfortable platitudes in response.
“You don’t have to tell me everything,” he said, “but just tell me if you’re OK. Do you feel OK? Are you going to be out of the hospital soon? Can I help you with anything?”
I was the one who was silent. I felt tears, and a softly foreign sensation. I was starting to feel cared for.
Later that day, Dr Warshaw came to my hospital room. The pathology had come back for my tumour. Of more than thirty frozen sections, one was malignant. He paused to let me absorb that news.
The strangest sensation welled up in me – maybe fear, maybe sadness. Then, like my twist in yoga six months prior, it hit a roadblock. I was left with an unsettling confusion, a congestion of sorts. Later, I would come to recognize it as a side effect of oxycodone.
“What does that mean?” I asked weakly.
Dr Warshaw’s explanation was long, which was not reassuring. It only takes four words to say, “You don’t have cancer.” Those were not the words he spoke. He said that the mass was best described a borderline tumour. They sent samples out for more testing. I would be technically classified as having ovarian cancer and I would be staged. He wanted me to meet with a medical oncologist and the oncological surgeon who assisted in my surgery to discuss further testing and possible further treatment, if any. I knew “treatment” was a euphemism for chemo or radiation.
“My goal is to fight to keep your other ovary, the left, because I know you said future fertility is important to you,” he said.
I nodded. I knew then, despite the complex explanation, that he had just told me I had ovarian cancer, and though it may have been Ovarian Cancer Light, it was serious enough to send me to two oncologists.
“Remember,” he said, “it’s one out of thirty frozen sections. Different doctors will interpret that differently, but to me the important thing is that it’s borderline.”
This, more than anything he had said, made sense. I felt a bit strange about fighting for my future children, when none of the life choices I had made thus far had pointed me toward motherhood, or even marriage.
After I left the hospital, Asad was amazed to learn I had five weeks’ paid leave from work. There was no such thing in Afghanistan. He worried I would get bored. I assured him I had plenty of books, writing projects, and walking trails to keep me occupied. I relished being completely away from work. During my leave, it sank in that I no longer loved my job. With this newfound sense of the fragility of life, I wanted to experience people and places more intimately, without the goal-oriented detachment my role as a journalist had cultivated in me.
Early during my medical leave, Asad announced he was going to call me every day to help me practice Pashto, which he knew I had studied prior to reporting in Afghanistan. “So you won’t be bored,” he said. I accepted his offer with a bit of giddy disbelief.
We did speak on the phone nearly every day, and sometimes on Skype, which felt particularly thrilling since I had rarely stared at him directly in the eye in Afghanistan, not wanting to break gender protocol. We spoke in Pashto, me limping along the best I could as he noted vocabulary words I could study, and then we’d speak more in English. The conversations were mundane, about our days or what I was reading or what he was studying. But they felt like the beginning of intimacy, this simple accounting for a life, day by day, small action by small action.
The five weeks ended, and two rude awakenings awaited me. I returned to work, feigning enthusiasm for my job. The second was the battery of tests and scans my now-healed body had to undergo, in preparation for the appointments with the oncologists. Multiple CT scans with their wet-cement radioactive milkshakes; a PET scan, which required an injection stored in a thick lead protective case; a colonoscopy because my tumour had resembled a type that was more likely intestinal than ovarian in origin; BCRA gene testing, because my maternal aunt had been diagnosed with breast cancer at about the same age I was; more blood tests than I could count. Everything came back negative, which seemed to validate Dr Warshaw’s reassuring emphasis on the “borderline” in borderline cancer. That is, until I was sitting in the medical oncologist’s office.
Dr Lehman (not his real name) looked exactly like the husband in the American Gothic painting, balding, bespectacled and long-faced. He sat on a giant green exercise ball surrounded by framed medical degrees and citations in his office.
“If you ask me,” he said, “you didn’t have enough surgery. I would have recommended removing the other ovary, and probably the uterus as well.”
My mind felt like numb mush, and I had been off painkillers for weeks. I tried to argue with him about the staging of my cancer, which he called a 1c because the tumour had “ruptured”. He kept saying, “It’s standard for 1c ovarian tumours…” to preface increasingly awful treatment plans. I felt as if I were speaking against the force field generated by all the framed certificates on his wall when I argued that, because Dr Warshaw had intentionally punctured the tumour outside of my body during the surgery to drain the large mass and get it through the incision, it couldn’t be perceived the same way as a spontaneous rupture inside the body. Dr Lehman bounced lightly on the exercise ball as he made his recommendation: more surgery and chemotherapy.
The more I pushed, the more insistent Dr Lehman became as he walked me through a long handout on Carboplatin-Taxol chemotherapy, noting that if I chose not to have more surgery at this time, he would recommend three cycles. The side effects list was, of course, long and terrifying, and included possible infertility.
Dr Lehman sat astride his green ball, stock-still now, and stared at me. He told me among his most dreaded cases were younger women who return to him with recurrent ovarian cancers. “My aim,” he said, “is to not have you return here a year, three years later, with metastatic ovarian cancer and ask me why I didn’t tell you that could happen.”
I don’t remember the rest of the appointment, only that shortly after I paced the lobby downstairs with muffled rage. I knew what Dr Lehman had been trying to do: jolt me with a wake-up call about my mortality. I hadn’t been able to wrap my head around dying of ovarian cancer, not because I was fearful, but because in my gut it just didn’t feel possible. This must have infuriated Dr Lehman, whose professional existence was predicated on the calculation of mortality. For him, premature death was a perpetually lurking, hidden threat – much like the buried landmines that dotted the Afghan countryside through which Asad had guided me. To go anywhere there, one had to accept the idea that some, through no fault of their own, would be unlucky and meet untimely deaths. Others would drive or walk a few inches to the right or left, and proceed with the rest of their lives.
Dr Warshaw must have gotten his notes from the medical oncologist, because a couple days after, he called. “I didn’t expect him to come to these conclusions,” Dr Warshaw said, flustered and apologetic. He explained the staging of my tumour, how Dr Lehman didn’t agree with him over the question of rupture. Dr Warshaw’s surgical choice to partially remove the large tumour, drain some fluid while it was outside my body, and then remove it through a relatively small incision, was different than that of a doctor who was willing to make a larger incision – and leave me with a bigger scar, more pain, and longer recovery. “Rupture is rupture,” Dr Lehman had said. “It only takes one cell in the wrong place…” I repeated this to Dr Warshaw, and a long pause followed, during which I imagined he was attempting to say something other than, “Wow, he’s a real dick, isn’t he?” That made me smile for the first time in a while.
“Look,” he said, “I want you to meet with Dr Reddoch and talk this over. She’s the gynaecological oncologist who finished your surgery. She’s usually booked up months in advance, but I called her and she’s going to make time for you this week.”
Dr Reddoch was everything Dr Lehman was not. She was a stylish, warm woman in her forties. We met leaning across her desk, sitting in padded chairs and flanked by a large bulletin board overflowing with photos of her patients, and her patients’ children, born after cancer. She explained that oncologists like Dr Lehman and tumour board members were motivated to take aggressive stances because patients rarely sued for getting too much treatment. She took a different approach.
“In a case like yours, where all signs point to the fact that your tumour is probably borderline and every follow-up test was negative, there’s still a lot that we don’t know,” she said. “What you decide – or we decide – to do is really about the level of risk you’re personally comfortable with.”
She encouraged me to play out scenarios, even scary worst-case ones, so I could gauge my gut feelings and decide what I could and couldn’t live with. For some in my situation, the peace of mind that would come with doing everything possible was worth the sacrifices – the risks and physical suffering of chemo, the potential for lost fertility. For others, the regret that would come with those sacrifices was far greater than living with careful monitoring and a slim chance of recurrence or death.
“Ultimately, you’re deciding between two difficult choices,” she said, “and determining which one allows you to live with yourself, even if the outcome is not what you hope it will be.”
I knew as soon as she said those words that I would choose not to have chemo or any more surgery. Allowing the unthinkable to become thinkable brought with it a refreshing clarity. When I spoke the words “not the other ovary” to Dr Warshaw, that phrase willed itself into being from somewhere deep within me. I had plunged headlong into this unlikely relationship with Asad. I knew with a certainty that felt novel that my tumour and surgery had brought us to the precipice of something life-changing. The methodical, rational career-woman in me told me it was foolhardy to grow attached to the first man to come into my life after a fertility and mortality scare, and to turn away from all I had invested in reporting.
That was exactly how I felt about keeping my other ovary, not doing chemo, moving forward with my life with the possibility of having children – someday. I can live with this choice, that voice from within said. My surgery had been in July 2006. By the time leaves were starting to fall in Portland, I had been released from the follow-up appointments and the tumour-board recommendations. Dr Reddoch took me on as a regular patient, and we agreed to a rigorous schedule of follow-up screening. I was free to continue with my life. Asad and I were talking daily again, which felt at once completely natural and very significant. At times, it felt like nothing had changed. More often, it felt like everything had.
I spent New Year’s Eve in Alexandria, Virginia, with Asad. We held each other and kissed like teenagers – fervently, unselfconsciously – as fireworks bloomed over us at midnight. A little more than a month before that, we had been on one of our frequent Skype calls when he blurted out a confession of his feelings. As I shared the details of my surgery and treatment decisions, I told him I wanted him to know everything so he could change his mind if he wanted to. He didn’t. “You want children someday, don’t you?” I asked. “What if that isn’t possible for me?”
“There are women who are twenty-five, have never had a tumour, and can’t have children,” he said matter-of-factly. “There are things that we can’t know.”
That latter statement pervaded my consciousness as a mantra. My friends and family were surprised by the suddenness and intensity of my new relationship. But I had made my choice. I aimed a steady stream of certainty, as unswerving as Asad’s devotion to me, at them with the same determination that I had stared down Dr Lehman’s ego wall.
A month later, I was invited to Washington, D.C., to interview for a journalism teaching job at American University. A couple months earlier, when editors at The Washington Post had informed me they had to postpone hiring me because they “had a bad quarter”, I had decided not to wait for them.
American University offered me the job right before the July 4 weekend, and my friends in Portland, who knew how eager I was to leave the newspaper, threw an “Independence Day” party for me. At the end of the evening, we gathered on the patio of their hillside home and set off illegal fireworks. It felt right, somehow, to be blowing things up. My body, and my own sense of health and mortality, had been forever changed – but I had survived thus far, and had taken on ovarian cancer without giving up my sense of agency over my own life. I was leaving thirteen years in one career to do something with which I had little experience, teach at a university. I wanted to get on with the life I felt I was meant to have, and that life was in Washington, D.C.
There are things that we can’t know, I whispered Asad’s words to myself as I touched a lit match to the wick of a formidable-looking rocket. The wick burned down with a hiss, and I felt the firework’s explosive launch deep in my chest. An iridescent starburst in green and orange lit up the clear night sky. My friends whooped in approval. I stared up at the smoke trail, and the milky puff where the explosion had occurred.