When I first started dating Ted, he told me about Gina, but not much. That was fine. Obviously he wasn’t interested in seeing her exclusively, so I figured anything could happen between us. Maybe even true love.

That was three years ago. Since then I’ve learned that Gina has been married twice and is childless. She owns a chic women’s jewelry shop, had a nose job when she was younger and made the striped curtains hanging in Ted’s kitchen.

Chances are, Gina has gleaned some information about me, too. She probably knows I have never been married but have one son, and that I gave Ted the Klimt print that hangs in his bedroom. I wonder if she knows that I write for a living and dye my graying hair. I wonder if she wonders about me as much as I do about her. I wonder if she, too, has resigned herself to the fact that Ted has no desire to be monogamous

As I shiver in the chill wind, my 11-year-old son does cartwheels in the tide. He wears a bathing suit; I’m in a jacket and wide-brimmed hat to protect myself from the sun. Wrinkles are even more frightening when you don’t know who has more of them, you or the other woman.

The apples and juice we brought with us now seem unappealingly wholesome. What I crave is a glass of brandy in front of a roaring fire with a lover who wants only me. But then I always yearn for what I don’t have — milky skin, a garbage disposal, Katharine Hepburn’s neck, rapier wit, a committed man.

Our dog cavorts alongside my son, who is running now, down the beach with a kite rising slowly behind him. It floats high above us, red and white and gold against the late afternoon sky. When my son comes back, he sits down beside me and begins to concentrate on attaching the kite handle to two sticks that he has placed upright in the sand.

“Look at my invention!” he says. I envy how he stays with the moment. The kite, like one of my unrealized dreams, has risen far beyond us, its string stretched taut. Then I remember the dreams that have come true, like motherhood, like having a lover who makes my heart race at the mere thought of our next night together.

Gina and I just happened to fall for the same guy — a man who was unhappily married for 20 years, finally got a divorce and now wants to answer only to himself.

Ted once told me he thought Gina and I would like each other, that we share many of the same values. We do seem to have at least one thing in common: an ability to make do with what we’ve got. We’re two pragmatic women in our 40s, no longer holding out for the “one and only.” Instead, we’re settling — possibly for less than either of us deserves, possibly for more than either of us would otherwise have.

Who knows? In another life, maybe she and I would become friends. She could teach me to wear jewelry with flair; I could invite her to share in the joys of motherhood.

But in this life, I often wish Gina would drop off the face of the Earth — like I did last week, when I saw a bottle of champagne in Ted’s refrigerator and knew, since Ted doesn’t drink, that it must be hers. (I reminded myself, of course, that if Gina ever reached behind the frozen waffles in his freezer, she’d find my vodka and feel the same pang of jealousy. The reminder didn’t help.) But how can I be jealous of a woman who recently had a lump removed from her breast and is now suffering through chemotherapy and radiation?

It would be unthinkable to begrudge her time with her man, even though he’s my man too — but, of course, I do. I try to put myself in her position, try to imagine her terror, try to see myself as her sister, not her foe — yet still I begrudge her that time. I want her to be gone. I have even stooped to wonder what might happen should Gina fail to beat the cancer. Would my relationship with Ted get better? Would I have more of what I want? I know the answer, but the answer doesn’t matter.

Last night, as Ted and I were on our way out the door to a movie, the phone rang. It was Gina, feeling panicky and depressed. Ted said he couldn’t talk right then but promised to call her back later in the evening.

When we returned, that’s what he did. I waited in the kitchen. They spoke for just five minutes, but I think he helped to calm her down. Meanwhile, I poured myself a double shot of vodka straight up, and thought, would I want to be with a man who didn’t call her back?

This wild, windy stretch of beach is surrounded by cliffs. Behind me, tall reeds of grass grow in a circle, forming a clearing. When I was a little girl I would have turned that empty space into a secret hideout, or a pretend house. I would have chosen to believe that these grassy walls were shielding me from the wind, keeping me safe.

My son has let go of the kite string, and it falls onto my skirt. He has run to the ocean’s edge and is daring the waves to come closer. The undertow is powerful, so I keep careful watch. His presence anchors me to the moment, won’t let me drift too far from what’s real. And like it or not, Gina is real. The baking pan I saw on Ted’s counter last week was probably hers; I suspect she made a cake for his birthday. The casserole dish beside the pan was mine; I made strudel.

I close my eyes and try to visualize the woman I’ve never met, but with whom I share so much. I stop wondering whether she would outshine me on the dance floor, upstage me at a party, outdo me in the kitchen or the bedroom. Instead I envision Gina standing in the middle of a tall ring of grass, protected from the wind.

I admit that I have often wished she would simply disappear. In moments of jealousy turned to spite, I have even wished her ill. But I have never wished for Gina to endure cancer, its pain and fear; and I know I do not want her to go through it alone.

But it’s hard to be jealous of fictional pals.

Then I read a story in a magazine about five women who have been meeting for dinner once a month for 27 years, and I was, for a moment, truly envious. These were real women. I cannot imagine the stability of a group friendship like that, the sense of history — the marriages, divorces, births and deaths, toddlers and teenagers that must have come and gone — the ease, the comfort, the fullness of time. I will never have that.

But I have had something else, a kind of friendship that may be even more miraculous. It is a sudden, intense friendship born of adversity, a fierce, temporary connection that comes when you need it and fades when the moment has passed. When it is happening, it is the most important relationship in your life. When it is over, the hole it leaves closes quickly.

“There’s something suspicious on your mammogram,” the nurse had said. I knew there were many things it could be, but I also knew there was only one thing it was. The biopsy, a day later, confirmed it. Nancy was the only person I could think of to call when I got the news. She was the only woman I knew who had had breast cancer. She was not a close friend, but she was more than a nodding acquaintance.

“Shit,” she said over the phone when I told her, a reaction I came to appreciate later after two friends fell apart on me when I told them the news. What you don’t want when you tell people you’re facing something terrible is pity. You’ve got enough of that going on inside. What you do want is anger. There’s energy in anger.

Nancy came over that afternoon and sat with me at the kitchen table for hours. I don’t know what she did with her two children. I don’t know how, for the next two weeks, she rearranged her life so that she became a fixture in mine. I never asked, and she never burdened me with the details. During those weeks other friends called; other friends cared. But they didn’t know what to do. “Call me if you need anything,” they would say, meaning it. But of course I didn’t. I couldn’t articulate what I needed. I didn’t know what I needed. Nancy knew.

She is a large, solid woman who listens carefully and measures her words. She is not a hugger, but when she hugs, you stay hugged. That first afternoon she sat and listened as I railed on about death and dying and how I couldn’t believe this was happening to me and how I would never live to see my kids get out of middle school. Every once in a while she would pour more tea. When she got up to leave, she took hold of both my hands and looked me in the eye. “I’m still here,” she said. “You will be too.”

The next morning she dropped by to give me her cell phone so I wouldn’t be house-bound waiting for calls from doctors and labs. Later that day, she drove me to my first appointment and sat with me as the surgeon outlined the reasons he couldn’t do a lumpectomy and would have to remove my breast. When he left the room, and I allowed myself to cry, she sat next to me on the examining table, her shoulder touching mine. “Do you want to see what a mastectomy looks like?” she asked. I nodded, and she lifted up her shirt and unhooked her bra and showed me.

I found myself calling her several times a day. Sometimes I had news. “I have estrogen receptors!” I yelled once from a pay phone. That was good news because it made the cancer more treatable. But sometimes I had no news, nothing to say. I just wanted to hear her calm, soft voice.

She came with me to all my appointments that first week, tape recording the sessions in case I missed something, handing me paper cups of tea, keeping me fortified with cartons of yogurt. She insisted I go for a second opinion and arranged everything for me, making appointments with the doctors in Seattle who had treated her four years before. She took two days out of her life to come with me, to drive the five hours up and back the freeway and stay in a motel, to sit with me in waiting rooms and exam rooms and consulting rooms, and when it was all over, to celebrate my “excellent prognosis” with something big and gooey from the bakery.

Then, as quickly as she had come into my life, she left it. She was in charge of a two-week camping trip for her daughter’s school. She had to go. By the time she came back, I had weathered a few storms on my own. My surgery was over, and so was the initial shock. I was less needy. I was more myself. She sensed that immediately and slipped back into her life, her children, her husband, her work, her own set of friends.

I saw Nancy a few times after that, and for a while we spoke weekly on the phone. “Just checking in,” she would say. Then the phone calls, both hers and mine, grew less frequent and finally all but stopped, and she went back to being what she was before, a person I occasionally saw around town.

The thing about temporary friendships is that you don’t have the chance to repay the debt. I think of those five women who have met for dinner for the past 27 years and all the opportunities they have had to pay back each other’s kindnesses, to trade places, weak and strong, needy and needed, over the years. Nancy and I don’t have that history nor are we likely to have that future.

Once, in the thick of our friendship, I despaired aloud over never being able to adequately thank her. That’s when she told me about Janet, who came from nowhere to pull her through the three worst weeks of her life. “The way it works is this: You are how I’m repaying Janet,” she said.

So it is that temporary friendships outlast us, repeating themselves serially, rhythmically, as each of us steps up when we are needed. We temporary friends are shamelessly intimate. Our connection is white hot, too hot to last. But it is also too essential not to pass on. I know how I will thank Nancy.

In the morning light, I think about Billie’s crying and guess that her pain is, as it is for me and every other human being, cumulative. There is the wound or operation or illness that hits our bodies. And there is heartache in its various forms woven in and out of our souls. Which does she cry for? Which pain is it? Or is it both?

I don’t cry, but I have pain, too. The most obvious, a lost and reconstructed breast, with a jagged scar running down my back that looks like a random, thoughtless slicing. Gauze and tape cover wounds and drain sites. Some sources of pain I can feel and others I cannot yet, still numbed by severed nerves and medications strong enough to take me up and out of this hospital room.

Then there is my divorce. So far, my children and I have kept moving on, but here I am immobile and I fear the hurt and abandonment that circle above my bed, waiting to settle their talons and weight on me.

In the morning, a nurse calls her and Billie answers. She sounds like one of my students, a seventh-grade boy who reminded me from the start of a bird: black, lustrous, delicate, skittish. I worked with him carefully, as if one wrong move or word and he’d take flight. Twice a week I’d put my finger out for him to land on and hold my breath to see if he’d stay. Week after week. Before this operation we were into our second year, and he’d found his perch. Billie’s voice is soft, uncertain, tentative, as if it might not hold in the air. But at night it fills the room.

I am silent. My crying sticks in me, just as if they’d put their dressings and gauze and tape to hold my tears in place. The tubes coming out of me do not drain despair and the tubes going in bring healing only for my body — nothing deeper. When I talk on the phone or to a nurse or visitor, I describe the beauty of the flowers sent to me: the pink begonia in its sandalwood basket, the dozen white roses arranged with eucalyptus and heather, the vase from the Brattle Square Florist holding a summer’s garden of lilies, iris, and sunflowers. I don’t talk about how the pain meditation makes me so sick that they have to alternate morphine with Compazine, or how much it hurts just to move in bed, my back cut and filled with tubes. My new breast pulls and aches where my own had been. I don’t think about the surgeries I’ve had in the past although my doctor told me that I held my body rigidly, as if I knew when each cut was coming. My body remembered.

On the second day Billie speaks to me. She says in her whispery voice that barely makes it through the curtain that she is sorry she had the television on all night; the nurse has told her that it kept me awake. The pain is so great, she says, that the only thing that helps is to watch the movies. She sounds matter-of-fact, as if she too has trouble talking about what hurts when the sun is up. I say that if it’s the only thing that helps her, keep the television on. I say that my daughter can bring me earplugs.

She seems grateful. I can hear it in her voice gathering itself up like a bird taking flight. She confesses that the pain squeezes at her until she is almost passing out. I hear how they started with cutting off her toes, a few at a time and then cut off her leg first right above the ankle. She describes how they keep coming back to do more and then this last time they took it right below the knee, and now they say that they don’t know if they have to be going back again. Her words dip down. “I haven’t been home in six months,” she says. I imagine her crumpled down in bed, her body fading with her voice.

I say that I am sorry. That I have lost things, too. I don’t know what home is anymore. My husband is gone. My children are grown and away at school. My body aches, too. Pain settles, perches, nests, reproduces, and I try not to let it go too deeply in.

I want to get up to see Billie now that we’ve talked, but I’m hooked to too many tubes and I don’t even know if my arms will lift me into a sitting position or if my legs still work. Morphine drips into me, making me think I can walk, but I can’t figure out how to rid myself of the catheter and lingering epidural lines.

That night she has the sound all the way off and I am grateful, but when they wake me to take my blood pressure I still hear her crying. I ask the night nurse when I’ll be loose from so much tubing and she says by tomorrow night I’ll be able to get up to use the bathroom and the antibiotic and pain medication drips can roll along with me on their metal stand.

And it is true. By the time Billie starts her crying the next night I have already been up twice and I know exactly how far my legs will carry me. I can get to her.

She starts her wall way down low, and I push the button to raise my bed. Its whirring sound is drowned out by her crying. In this upright position, I can see out the window. Mission Hill bathes in the light of a full moon so bright that the colors of the houses are visible. Sitting, I can smell the sweetness of the roses on my windowsill, and I breathe them in as if they’ll give me strength. I begin to hoist myself up on my right elbow. I, who have loved the strength in my arms from working out, find it hard now to make this simple move, but before I know it I am sitting up and pulling my legs over to dangle from the bed. The I.V.’s in my arm will move with me — in fact, their stand adds support as I edge myself down to the floor and shuffle around the drapes to her bed.

Billie is sitting up. Everything is dark except for her sheets and the layers and layers of moon-white gauze wrapped around the stump of her leg. Her skin is a glossy brown, her hair tied back in a dark bandanna. She has on her own nightgown, a soft navy cotton one. She’s probably sixty; she looks like someone’s grandma. She rocks herself back and forth, holding onto her bandaged leg as if it were a baby she’s cradling. Her moans and tears mix together so that my heart almost breaks now that I can see her. I get myself up on the bed beside her with the help of my pole. She doesn’t seem surprised. I come to her bandaged too and without speaking she keeps rocking.

I rub her back in unison with her rocking so that we’re both moving together and she tells me that the pain doesn’t seem to stop. All these operations. I feel her pain and it opens me up as much as the surgeon’s knife and this time what comes out are my feelings. I can’t stand it either, all these surgeries. My chest begins to heave; we keep moving together as if we’re all one motion, her rocking leg, my rubbing arm, our sobbing throats. She says that she’s losing her home because she can’t work and I suddenly feel my house empty. It’s just another divorced couple’s house on the market, but I cry for all the fires in the fireplace and family dinners at the table that will be too big for anyplace I will ever live again.

She cries for the pain and I rock along with her. I tell her that I’ve never known such burning and pulling at my flesh. She’ll never be the same, she says, and I know what she means and then we don’t talk. My sobbing grows and overtakes hers. Billie rocks years of tears out of me just as surely as if she were cradling me in her arms instead of her leg. We do this for the next two nights, as illicit as lovers forbidden to meet. I give her touch that soothes her and she takes me to a place in the darkness, alongside her grief where I too can cry.

But in the morning, at the residents’ early rounds, I am brave and strong and take it all with courage. People like me to behave that way. I like it, too. I thought that’s the way it had to be until I found Billie and the nights and finally a way to let go of sorrow and rage and hurt that kept me raw and empty inside.

During the day the clusters of residents and doctors and nurses tend to our bodies, but at night Billie and I tend to our souls.

1997 — Cancer Says

I lie in bed once again at the time of the winter solstice. It is the darkest day of the year. I stare at the candles on my grandmother’s wicker table that became my altar when I first had cancer. I used to burn a fat blue candle with a drifting smell of lavender, a white taper in a silver candlestick, and a votive in a gilded, star-cut container with light flickering out, as if to a night sky. I have not lit them since my surgery. Over the altar hangs a Matisse sketch of a nude with full breasts, thick heavy nipples. Further up on the wall is a New Mexico cross, two sticks fastened at their center with garlic doves and dried red peppers.

In the darkness I hear “Silent Night” from the stereo downstairs. My son and a friend from college are stringing lights on the tree. We always used multicolored bulbs, but the boys went out a few hours ago and bought five strands of tiny, starlike white lights. When he was small I taught my son that stars were for wishing. He now says in his stage of questioning God that while others pray, he looks for a star. I know he is afraid. Tomorrow or the next day we’ll have the pathology report. His friend downstairs lost his mother to breast cancer; as he watches me, I wonder how much he thinks of his mother. How much does my son think of his friend’s mother, buried six years?

This is my second mastectomy, my seventh and eighth surgery. Seventh, the mastectomy itself, eighth the reconstruction, one following the other with a half-hour break to change “teams” as if my body were a playing field.

This is the first time I have really understood I have cancer. With the original surgery five years ago, denial’s seed pushed up and produced a sheltering tree so vast that when I looked to the sky I could see only bits of lacy blue. I felt little threat to my life. Instead I focused mostly on the plight of women with breast cancer. I saw us as sisters: bruised, cut, stitched, and marred. Then when the suspicious mammogram, the confirmed malignancy, the surgery and subsequent radiation occurred again a year later, I sat under the shade of the tree and looked around, talking about the other patients but saying little about myself. With the third surgery two years later, they took my breast altogether. That surgery knocked me down. It was winter and through the bare sinewy branches I saw a stormcloud sky. Gunmetal. Fast moving. A sky full of tears. Today, I’m laid out flat recovering from another surgery — another breast. The tree above me is still bare; the winter sky is dull, unmoving, a ceaseless gray with no puffs of clouds or streaks of sunlight. I am totally exposed to whatever it might do: snow, sleet, blow a northeaster hard for days.

A week ago, after I woke up from the surgery, I wondered if it was my breast they had taken. Had they removed my heart? Stitched my mouth shut? I had nothing to say. I knew the routine of recovery: the drain sites with their plastic tubes and suction cup containers, the lengthy knifing across my back marking the taking of the latissimus dorsi to make a breast. I knew how long before I’d be able to walk, that morphine made me sick but that I could tolerate doses of synthetic heroin. I remembered the casings they put on my legs to prevent clots, the plastic filling up with air every few minutes and then deflating like a slow breath taken in, held, and let out. I knew to order puddings and tea with extra milk. I knew what to do, but I no longer knew what to say.

- – - – - – - – - – - – - – - – — – — – — – — – —

The news comes that I have slipped through cancer’s narrowing noose once again. I do not have invasive cancer, and for days I am lifted out of my mourning. I come downstairs and sit by the tree; the lights burn through my melancholy. Each ornament is full of meaning — the ones my children made long ago from pine cones, yearly cross-stitched Christmas sentiments from an aunt, the hand-blown glass balls friends have given me each year. I ask my son to turn “The Messiah” to full volume to fill the house. When I was growing up, my father used to sing it every year with a chorus. I close my eyes and hear his bass part, the one he rehearsed in the bathroom each morning while he shaved. The smell of molasses and sugar drifts through the house. My daughter is home now, and she bakes gingerbread men the way I used to and frosts them with white pants, green shoes, yellow hair. They have cinnamon drops for eyes, so that they look like clowns. We laugh. We all rejoice.

A few days after Christmas, though, I don’t get out of bed. I don’t raise the shades. I lie there until the visiting nurse comes to change my dressing. Once she’s gone, I’m back under the covers. I’m so still inside I wonder if I’m alive. My spirit, I realize, is as scarred as my body. Have I gone through all of this finally to give up?

At the end of the week, the silence that has wrapped itself around me is pushed away by loud voices. They’re my own. Screams I’d stuffed back not with a fist but with a smile; not with a gag but with my own refusal to pay attention. Pain drones right through the center of the wails. It shapes itself from the hours waiting for pathology reports. The first time, when I hadn’t heard for eight days, I dressed to go to work. I called the doctor’s office when I had my Coat on. The nurse said the results had just come through and the doctor needed to talk to me. “Don’t go to work,” she said, and I sat by the phone for the next hour. When I think of waiting and bad news now, I see myself in that navy wool coat sitting alone by the phone waiting to be told I had cancer. Pain shapes itself from the repeated slicing of my palest flesh; from the mammograms in those rooms where other women glided in and out, exchanging the “johnny” for their own clothes as I sat, pulling the cotton gown close around my body, and they called me in again, first for another view and then a magnification and the cheerful technician who eventually couldn’t even look at me and became grimly silent herself except to say, “Move in closer … Lift your right arm … Hold your breath.”

I think now it’s as if I’ve been holding my breath for five years. I gasp in mouthfuls.

My scream carries through the house. My keening climbs the attic stairs, settles into the depths of the basement, sweeps through the rooms. This pain penetrates the walls so that when I’ve moved, this house will remember not only my beautiful children as they grew from toddlers to young adults, but it will have recorded what I finally felt.

An explosion has occurred in me, and fury snakes into the air. I want to rip out all the I.V.s I’ve had since 1993; I want to snatch the scalpels from the surgeons’ hands and plunge them into the earth where they’ll cut no more. I would return my muscles to my back and take a club to the radiation machines maneuvering into place to kill my cells. If I could, I’d try to find my lovely pink nipples in the midst of my discarded flesh and then drug all the doctors with an anesthesia as strong as mine — let them be gone from this earth for eight-hour stretches.

But the doctors were as kind as anyone could have hoped, I’m not mad at them. It’s not God either, for I do not believe God punishes. It’s loss I throw my rage at. It rolls along, gathering new parts of my life. It circles me, waiting for the kill, for I am now so vulnerable. My breasts cut from me. My husband’s desertion and divorce, my children grown, my house to be sold. I scream to scatter loss. I swing my arms out in the air, throw back my head and yell to stop, please, please to stop.

As the days pass, I feel calmer, and oddly, I return to where I began five years before — feeling the pain of millions of women with breast cancer. I think of my friend Susan, whose spine crumbled after cancer spread to her bones and the woman who had her first child aborted at three months when they discovered her breast full of tumors. I ask for healing. For me. For them.

Cancer takes your life and changes it, transforms it forever, and sometimes, as it does for me today, gives it back. Cancer then says to take up your broken self once again and, if you are able, fashion something even better than what you had before — “before my visits began,” cancer says.

Compilation and introduction copyright © 1999 by Hilda Raz

I will not perceive the connections among these memories until all the cancer treatments are done. But I am dreaming with vague knowledge of being ashamed, and the shame is always for needing something I cannot have, or something that is not what I thought it to be. Somehow, I am humiliated, not merely disappointed; exposed, not merely wrong. A little beggar girl I saw long ago in a poverty-stricken street in Naples is in my kitchen. She looks at me with the pathetic eyes of a hungry cat and scratches on my refrigerator door with dirty, bitten nails. A river fills with blood, and long-missing bodies float to the surface while I sit in a boat aloof, even dissociated, wondering at the strangeness of what is happening right before my eyes. A distanced critic, I watch the dramas and keep track of all of the themes.

Now, I turn back the pages of my journal to the day I found the lump, a surprisingly undifferentiated hardness I wasn’t even sure was a lump at first. I read my brief entry the day I went for a needle biopsy and received the diagnosis. “You are the fifth person I have diagnosed with breast cancer this morning,” the radiologist said to me, and it was only noon. “It’s an epidemic.”

But eight months before that, when I was experiencing increasingly intense panic attacks, I had written: I feel as if an actual illness inhabits me. Something at once foreign and part of me devouring myself.

I appreciate the danger of ascribing facile metaphor to illness, especially to cancer. I can become angry at the many books and acquaintances who advise one to move to northern Maine, where a hypnotic serenity presumably neutralizes the effect of sorrow and loss, to subsist on brown rice and seaweed, or “eliminate stress” from one’s life (an injunction that only increases stress in me, as I become stressed by the thought of how much stress there is in my life). I am suspicious of alternative healing methods that overemphasize the “spiritual” core of physical illness and even counsel an avoidance of Western medical knowledge. My life has been saved by Western medicine, an early, relatively small cancerous tumor removed from my breast, followed by harsh chemical treatments that have hopefully destroyed any cancer cells that might have been left behind.

But there is a sense one gains irrevocably after a life-threatening illness, that the mind, or spirit, and body are indeed one, or at least in intimate communion. I believe in the reality of the spirit and that it can be hurt as well as healed. For me, that healing always involves various forms of storytelling — the kind you recount to a therapist in that space out of ordinary space and time out of ordinary time called a “session”; the kind you write and rewrite in various formulations, experimenting with various designs; the kind you dream. It is in the perception of design that I experience healing, and if that word has been rolled around too often by shallow minds seeking instant and painless transformation so that it has lost its original power to suggest the relief of remedy, the joy of cure, I find that I still remain attached to its old-fashioned, simple promise that what is broken can, at least sometimes, be repaired.

Between chemotherapy treatments are three weeks during which I try to make myself as strong as possible in body and mind, not only to prepare myself for what is a terrifying encounter each time but to build up my immune system in the face of attack. Close friends offer love and gifts, and one of the most treasured is the gift of several weeks’ stay in Bellport, Long Island, at the home of my friends, Sally and Bill, who are traveling in China. Reading or sleeping in these large, quiet rooms where all day and into twilight the sun alters the pale off-white colors of the walls, reflecting rosy pink, pale green, a slightly bluish lavender; swimming in the backyard pool, which is surrounded by hedges, maple, pine, and at one end, an old grape arbor; walking the hilly roads to the bay, or biking to the tiny, quiet town, I am at the same time veiled and wide opened, thinking I am perfectly composed, like an elegantly constructed story, then suddenly overwrought, bursting into unfocused tears. I am extremely frightened of cars that, in New York City and here in these quiet streets, seem always about to crash into me, and I leap out of their way as they pass, causing drivers to look at me as if I am slightly mad. My need for love and reassurance is gigantic. I try to keep it on a short leash, afraid I will lose any hope of forbearance. Fear of death races through me like a brush fire, indistinguishable from the hot flashes that have greatly intensified since I stopped taking estrogen the day of the diagnosis, so that one sets off the other by association and it all comes back, weeks of being trapped in my body, its pain, its disease, the certainty of its inevitable disintegration. The only escape is into the details of management.

Chemotherapy changes the body in many small and obvious, as well as large and mysterious, ways, and for the first time in my life I have a skin rash due to the chemicals in sunscreen lotion or to the sun itself. I use #15 to protect myself but spend large amounts of time wondering if I should escalate to #45 or return to #8. I plan my meals of spinach, broccoli, brown rice, count off a small pile of vitamins each morning. Despite my undiminished craving for hamburgers, vodka on ice, cigarettes, bread and cheese, I research and create a dozen vegetable dishes and I eat them. I eat them every day and I follow them with glasses of clear, purified water. Despite my desire to sit and stare, read or think or write, I walk, and I walk fast. And despite a lifelong ambivalent love affair with death, I have never been so certain that I want to live as long as I possibly can. During the months of treatment, the clearest reason for living is to see Adam and Khary develop their lives, their children born, their ambitions fulfilled, not to have to leave them. Only much later will the desire to live include the wish to see my own life develop. Now, hope is only sought after, not yet reclaimed.

I buy new sneakers for my daily walks, thick-soled, high-tops. I list the treatment dates, crossing off numbers 1 and 2, beginning the process I will continue for the next four months and beyond, of writing everything down to keep myself from succumbing to panic. But I am frequently in a state of fear. If Douglas is more than fifteen minutes late, I begin to cry with the grief of a child abandoned, incapacitated and alone, and when he returns from a run, a trip to the store, a little late from work, I sometimes have to turn my back on him, close a door behind me, hide my shame.

I try to love my body, take care of it, look at it in the mirror despite its ordinary signs of aging and the not so ordinary long indentation on the side of my right breast. But often, it doesn’t feel like mine. It has been cut into, entered, poisoned by strangers. These assaults, I am warned in printed releases I have to sign, may have unpredictable consequences to my heart, my liver, although I am assured that “probably” everything will be fine. But I am suddenly aware of my body parts as if they are delicate infants needing my protection, part of myself and apart from myself at the same time: my liver, my heart.

One night Douglas and I make love, the first time since the surgery, and just as I knew would happen the moment he is inside me I begin to cry. Not so much cry as keen. I sound like a woman in mourning, a low wail to the heavens as she watches a coffin descend. I hear my own voice as if from far away, as I did when I was in the hardest part of labor, giving birth to my sons. In the past months of this lonely journey, I have seen how I cherish beyond measure the old love between Douglas and me. But ordinary vocabulary does not suffice. Old implies worn, or even worn out, but I mean it in the sense of an heirloom, precious, reliable, rich with history. People say I am strong, but he has seen the fear, knows how many nights we have slept with the light on, held me when my sobs seemed bottomless, listened quietly, at times holding his head in his hands while he looks at me sadly, to my shouts of rage at the American medical system, at rude nurses and doctors who are afraid of pain and suffering, at tumors that are over one centimeter and so require chemotherapy as a treatment that perhaps but not definitely, might stop the spread of what, I am informed repeatedly, is a systemic disease. Otherwise, I would have told them to cut the breast off, take it, I would have said, and leave me be. When he gently lays his fingers against my wounded breast or touches the still partly numb right arm, I think of blood, of vomit, of the terror of losing my hair, which I’ve been assured will not happen with the particular combination of chemicals being injected into me. When he moves inside me I lay my hand on my own hair as if by pressing down I might keep it rooted there, and I am lost somewhere inside my body which is vast, foreign, yet some poor fragile thing. Then in the next moment I fill it again and know the difference between his touching and entering me and all of them touching me, entering me, actually entering the flesh of my breast and cutting away tissue for testing, for saving my life, yes, but cutting parts away, parts I have never seen myself but picture as throbbing, raw, and I am unable to say how hard it has been and how dearly I love him because my need is bottomless, it will swallow us both. And so I surround myself with layers of his silence until I am inside it and can feel the words he might have been able to say at some other time, in some other life. Nor does he cry with me, but tonight I am reconciled to this habitual absence of words and in the darkness of the room, against the comforting, damp sheets, after awhile I am able to say it, it has been so hard, and to repeat it and repeat it as if this simple phrase is a baptism, or a burial song.

The next morning, Ruthie, oldest intimate of my soul, arrives with her dog, Puto. We walk the narrow streets leading toward and away from the bay, talking of our lives, pressing constantly for some deeper knowledge framed in words that will enable us to escape the demons of depression and fear we have so often faced and fled together. I consider her very brave, and often dream of her exploring remote islands I am frightened to visit because of dangers lurking in ocean storms, or in the broad deserts she and her daughter are willing to cross in order to swim in some perfect lagoon. She dreams of me and the places I have lived as havens she comes upon when she is lost. Accompanied by her dog, an exceptionally intelligent animal whose only fault is that he barks incessantly when he’s excited, which he always is on long walks, we wander around roads leading to mansions surrounded by gardens, expansive lawns and high hedges that make Sally’s spacious and comfortable home seem like a functional cottage. As we walk we talk of love and need, and then she says, after a characteristic silence in which I know she is pondering some thought until she finds the precise words, “You have a great need for love, to receive it and to give it,” and the trapdoor snaps open. I have to stop and catch my breath. I am standing at the edge of the darkness. The way down is steep. I am flushed with hot shame. I am the beggar girl with catlike paws. “No I don’t,” I say to her, a child’s voice, as if I’ve been insulted and have no sensible response. “What’s wrong with it?” she says. We are stopped on the road. Puto is barking at us as if he is a sheepdog and we are his wandering sheep. “What’s wrong with it?” she repeats. But all I am able to say is, “I don’t know. Something is wrong with it. I know that much.” I am filled with images shooting through my brain like some video rewinding, spinning its pictures backward in time.

Five years ago a genetic counselor told me I was at “elevated risk”
for breast cancer. My mother died of it at 45; her mother had been struck
by the disease in her 40s but survived. Since both women developed breast cancer at a relatively young age, they likely had a
genetic problem that allowed a later “trigger” — such as diet, hormones, chemicals — to bring on the disease earlier
than in a woman without a genetic predisposition.

My own lifetime risk of breast cancer, based on epidemiological
studies, was estimated at one in four, compared to the “average” woman’s
risk of one in nine. I was left with a choice: preventive mastectomy,
extreme vigilance or denial.

I briefly opted for denial. The confusion over what to do was
paralyzing. Preventive mastectomy seemed barbaric. I like my breasts and I
didn’t want to lose them to a disease I may never get. Besides, surgery
can’t remove everything, and sometimes cancer shows up in the tiny bit of
breast tissue that’s left behind. That seemed just my luck — I’d lose my
breasts but wind up with cancer of the tissue around my collarbone.

The “extreme vigilance” option wasn’t terribly reassuring, either.
The news of my elevated risk coincided with a sudden surge in breast cancer
activism, as advocates began to protest the lack of progress on prevention,
detection and treatment of the disease. Suddenly, activists like Dr. Susan
Love were questioning the utility of mammograms for women under 50, whose
dense breast tissue makes it harder to spot a small tumor. Experts began
to debate whether annual mammograms saved lives or created a false sense
of security in younger women, causing them to neglect to examine their own
breasts.

Not that breast self-exam was a much better option, the advocates
noted: By the time a breast tumor is large enough to feel with your
fingers, it has often already spread. And with treatment options still
limited to “slash, burn and poison” — surgery, radiation and chemotherapy
– death rates were remaining high, despite earlier detection. I admired
the new activism, which was intended to goad the medical establishment into
action. But it also, for a time, intimidated women like me into not acting.

That’s when I met my breast surgeon. On our first visit, she
quizzed me about my family history of breast cancer — and about my
daughter, my writing and mixing motherhood with a career. Roughly my age,
she wanted to start a family, but worried about how it would mix with her
practice. Our conversation tacked back and forth between cancer research,
motherhood and men, and I walked away with a plan of action: She’d examine
me manually every four to six months, and I’d get a mammogram once a year.
Mammograms work for me: My breasts happen to be less dense than those of most women
my age, or as my radiology technician put it, “You have the breasts of a
55-year-old woman.” I wouldn’t have imagined thrilling to those words 10
years ago, but in this context they were the nicest thing anyone could say
about my breasts.

That was almost five years ago. In those years my surgeon has had
two babies; I’ve gotten divorced, changed jobs as well as boyfriends. We have a relationship. When we visit, she asks me for advice about
childbirth, child care and preschool. I ask her if I should think again
about preventive mastectomy (she says no), or worry about a tiny pimple on
my chest (she pronounced it “a big nothing”), or continue dating someone
who travels more than I do (she left that one up to me).

Her office calls when it’s time for my appointment. They call
again if I don’t call back. I feel too guilty to let much time pass
between visits, and I actually look forward to seeing her. She maintains
my sanity, and indulges my periodic paranoia. Once when I became convinced
that a small cyst below my left breast was more than “a big nothing,” she
squeezed me in at the end of her long day, removed it and sent it to
pathology just to reassure me. Of course, it was a big nothing. But I
didn’t have to wait weeks to get that confirmed.

Yet I still got tongue-tied when I tried to explain why I have a
breast surgeon. Sometimes I feel like it’s morbid to have a doctor ready
to treat a disease I may never have. On the other hand, breast cancer
already is my disease. Its assault on my mother, who had her mastectomy
when I was 12, shaped me profoundly. So did her culturally bred sense that
she had a shameful illness — both cancer and breasts were something you
whispered about — which kept us both from getting the emotional help we
needed. This society draws a cruel line between the well and the sick, and
the stigma of serious illness is part of its pain. I feel I know a little
of the terrain on the other side of the line now, and that helps me,
practically and psychologically.

My fear has become manageable. I’ve limited my worrying about
getting breast cancer to five minutes before my appointments. Then my
surgeon walks in, and we chat excitedly, maybe a little maniacally, the
whole time she examines my breasts. I keep up my end of the conversation
– my daughter, my writing, my boyfriend — while searching her face for
clues: Did she find anything? Am I all right? She helps me up off the
table and tells me I’m perfect. We finish up our conversation and make
plans for our next visit, like busy girlfriends penciling in their next
lunch date.