The Mammogram Industrial Complex

The Mammogram Industrial Complex

The Mammogram Industrial Complex 1920 1280 Emily Sinclair

The patient sits on the exam table. The doctor says, Seatbelt? Sunscreen? Calcium? Good, good, good. Have you had a mammogram within the last year?

Well, I changed health insurance and we moved and so

Have a mammogram. 

 

The patient pushes open the door to the mammography center. She sees that it shares space with a doctor’s office that employs one of her ex-husband’s best friends, a man who luxuriates in his perceived charm. The patient re-considers her appointment, but goes in anyway. There is a Keurig in the waiting room, the scent of vanilla espresso faint but distinct.

The patient states her name.

The receptionist says, I love your hair. That big messy look. Sure wish I had it.

The patient has had a stressful day. She has not showered or even really eaten, except almonds. She hands over her insurance card and license.

I’m here for a cancer screening? 

The receptionist winks, her mascaraed lashes dropping like a crow’s wing. I’d make a terrible bartender. Can’t tell how old anyone is. I’d guess you’re about thirty?

The patient is fifty-one. Her hair is greying and there are lines around her eyes and mouth. She points these things out.

Receptionist: Well, you look GREAT.

The patient ignores her, out of politeness. Why do some women find the dishonesty of flattery comforting? She looks away, like a cat.

Love your bag, the receptionist says.

 

*

 

Breast as object: The boys of the patient’s youth, trying to cop a feel. What exactly did they want? To squeeze a breast? To simply touch one? What drives the desire for this ductal network? How odd it seemed that a boy would want to suckle at her breast, like a baby. How erotic. Sex is the most inexplicable and mysterious part of any person. She Googles the first boy who ever touched her breast and he’s on YouTube saying he’s “very intentional about building a great workplace culture and then she finds an obituary for his wife, who died of a rare cancer just weeks ago.

 

A tech says, I’ll take you back.

To when, the patient thinks, following the tech.

She is told to remove her shirt and bra and put on a warm pink robe.

Take off your robe. Stand here, next to the machine. Lean forward. Raise your arm. Turn your head to the side. I’m going to compress the breast now. I’m sorry. Are you okay? Take a breath and hold it. Now let it go. 

On the screen are white branching ducts leading from the milk-producing lobes to the nipple. The patient does not know how to read the image. Except that there is a small solid circle among the branches.

 

*

 

At a certain point, the body begins to betray you. And like most betrayals, it’s been happening for a while before you find out about it. Once, the patient developed a fascination with molar pregnancy, which is when an abnormally fertilized egg becomes a kind of tumor. Photos of molar pregnancies show meaty-looking clumps of cells with human attributes: teeth, hair, and bone. They are freakish things that must be removed. Her fascination was a way to pass the time in the hazy, scary weeks between the home pregnancy test and the official first doctor’s office visit. She wondered, What is us? What is not us? What do we do when things are not as they seem? Then she miscarried.

 

*

 

While she waits for the results of her mammogram, the patient imagines the mammogram center’s inevitable customer survey email.

Q: Were the facilities reminiscent of a boutique hotel?

  1. Did employees compliment you on your [check as many as apply]:
    1. relative youth
    2. overall style
    3. choice of accessories
    4. hair volume

2.)    Did someone say:

                                Are you okay are you okay are you okay? 

The patient wonders if when everything is a product, people are no longer able to talk to each other.

*

Breast as commodity: a woman with whom the patient used to be friends had breasts that were universally admired by all their mutual friends. One drunken night, the friend told the patient they were implants, which she’d long denied. She’d gotten them at a young age, and her body responded by creating scar tissue around one of them. She pulled up her shirt and bra and the patient saw that one of those perfect breasts had a squeezed, bulging quality to it, and the skin had torqued and shrunken, like a rotting cantaloupe. Capsular contraction, the friend said. Touch it and you’ll feel the scarring. 

That was the first and only time the patient ever touched a female breast not her own. It was exciting as well as disturbing, given that it was a manufactured breast. I’m getting it replaced, the friend said.

Then she grabbed her breast and rotated it in a circle and the patient heard a cracking sound.

I have to do that every so often to break up the scar tissue, she explained. The new ones I’m getting will be bigger. 

*

 

The patient receives a letter. It has been recommended that you return for a left breast diagnostic mammogram with tomosynthesis (3D imaging) and ultrasound. Your mammogram shows that your breast tissue is dense.

The patient has gotten a letter like this once before. She had the fancy ultrasound, which showed nothing, but she was younger then. She says to her husband, What if this is the before?

In three months and two weeks, she will be the youngest of her father’s children to outlive him. He died of lung cancer eleven days after his fifty-second birthday.

She returns to the mammogram/ex-husband’s friend’s office, smelling of sweat and livestock, because she’s just come from the barn where her horse lives. Crescents of dirt line the top of her fingernails. Mud has collected along the frayed threads of her jeans.

Blue looks so good on you, says the receptionist. Is that your favorite color?

 

The 3D mammogram is in the same room as the first one, with a new tech.

I’m just gonna torture you a bit today, haha, the tech says flirtatiously. I’m not really. I just like to say that. A little joke, you know. 

She loads the patient’s left breast onto the plates, murmuring like a pigeon. I’m so sorry. I know it’s so awful. Are you okay are you okay are you okay?

I’m fine, says the patient. Just tell me what you need me to do. 

Are you okay? 

 

*

 

The origin story of the patient’s breasts: fifth grade, the appearance of the puffy tips, aching and sore, the training bra in sixth grade, the frank, full breasts of high school, then, in college, a lump, many large lumps. The doctor laughed: If these were cancer, you’d be dead. These are cysts. Quit smoking and drinking so much coffee. 

Ten years later, she had children and put them on the breast and they grew quickly.

You could breastfeed an army, said the pediatrician, an image the patient pondered with some distress.

 

The 3D mammogram continues to indicate an area of concern, so now it’s time for an ultrasound. Another dark room, another pink robe. Lie on your right side, left arm over your head. The ultrasound tech moves the probe across the patient’s breast.

Oh my god, she says.

How big? The patient asks.

Two point seven centimeters. Can’t you feel that?

No. 

There’s another one, too, she says. I need to get the radiologist. 

 

Alone in the room, shirtless, the patient grabs her phone and takes pictures of the ultrasound images. On the black screen, there are small dark oval circles with red and yellow dots indicating blood flow. Wavy white fibrous tissue encloses the ovals. To see the inside of herself on a screen is oddly reassuring: there she is! The images recall visits to the planetarium, the stories and mysteries of the night sky. The stories of the stars told in mythologies: Queen Cassiopeia, Cancer the Crab. Perhaps part of her own mythology is in her breasts: girl, woman, mother, object, patient.

The radiologist says, You need a biopsy.

The patient says, There’s vascularity in the masses. And what do you think about the margins?

The radiologist turns and says, Are you a doctor? Do you work in the medical field?

It’s complicated, the patient says, because it is.

He relaxes. Honestly, it doesn’t totally look like cancer. But, it doesn’t not look like cancer either. 

The patient is sent back to the velvet-chaired waiting room. It wouldn’t surprise her if a sleek and pretty young person appeared with a drink menu. Now, in fact, would be a good time for a little snort of something cold and alcoholic in a nice glass. She is exhausted. She’s been here for nearly two hours. The scheduling person appears and asks the patient to follow her down a short hallway.

Thank you, the scheduler says, in low reverent tones, so much for walking all this way.

Oh, for Christ’s sake, the patient thinks. No problem, she says.

They discuss appointment times and details of the procedure. Afterwards, the scheduler walks the patient to the door.

Any exciting plans this weekend? The scheduler asks this in the cheery tone she’s no doubt been taught in some corporate training session on customer satisfaction.

Nothing as exciting as this, the patient says.

 

In the weeks before the biopsy, the patient researches obsessively. She compares the images from the ultrasound to images in medical databases and agrees with the radiologist: it does and does not look like cancer. She cancels all her plans for the month after the biopsy in case she’s having surgery or chemotherapy or something. She fumes, not for the first time, about the language of breast cancer: fighters, warriors, pink armies everywhere. She doesn’t even like #FuckCancer. When she is alone, she strips naked and touches her left breast. Ah, there they are. The lumps she missed. She could tell the story of her life more honestly if she focused on what she’d ignored or failed to see than if she focused on what she did see, which was mostly what she wanted to see.

What if the lumps were growing, their cells spreading? There’d be surgery and they’d be gone, these lumps. And if she is perfectly honest, she has tender feelings toward the lumps. They would of course need to go, but they are in her, of her. They’ve been along for the ride. She Googles how long it would take for a cancerous lump to grow to be the size of hers: seven years. She thinks, a lot of good things have happened in seven years, and they were always here. She doesn’t want cancer marketing to take away whatever small love she has for her body’s endurance.

 

On biopsy day the patient is driven to the hospital by her husband. Another pink robe, another set of cheery gals. (Your glasses are so sporty, so chic!). There is an explanation of the paperwork, the aftercare, all dutifully attested to by the patient’s signature. No lifting anything more than five pounds for five days. Steri-Strips and surgical glue must remain in place for fourteen days. The surgeon will leave titanium biopsy markers in the breasts so that the masses can be identified for surgical removal, if necessary. The patient is shown some of the marketing materials for the markers, the In Celebration of Her™ Program.  There are various styles of marker: the breast cancer ribbon, a Venus symbol, a heart and six other styles.

The materials say, “With each purchase of the Bard Heart, Bard Venus and Bard Ring breast tissue marker shapes, C. R. Bard, Inc. will contribute $1 to the American Cancer Society® in honor of breast biopsy patients. This limited time offer enables our customers to celebrate and support their patients with every marker placement.*)”

Limited time! The patient thinks.

 

A nurse says, You probably know this already, but your breast is a clock and we locate tumors on the face of the clock. Your tumors are at 2:30 and 3:30 and five and six centimeters from the nipple. 

The patient did not know her breast was a clock.

In the procedure room, the tech says, Raise your left arm over your head. We’re going to make a sterile field on your left breast. An injection of local anesthetic into the breast, followed by an incision. The surgeon slips the probe inside the left breast and it makes a whirring noise as it slices up the growth into tiny, study-sized pieces.

The surgeon says, I don’t think this is cancer.

The patient asks, What about the indistinct margins?

That’s why we’re here, he replies.

The nurse asks, Are you in medicine?

The patient says, It’s complicated. What the patient does not say is that she is:

  1. a) a hypochondriac who
  2. b) has had several serious illnesses misdiagnosed so
  3. c) she has learned to read her own pathology reports and relevant medical studies, as well as those that pertain to her children, and her dogs, and
  4. d) she often questions whether she is in fact a hypochondriac or simply a realist.

 

On the ultrasound screen, the probe blurs the image of the mass as it slices it up. The pathology report will say that 900 milligrams (.03oz) of tissue was removed.

When the biopsy is over, the surgeon presses hard on the breast (“hemostasis was achieved with manual compression,”) for about five minutes to stop the bleeding. The patient winces. The breast has always been tender to the touch.

Sorry for the pain, the surgeon says. But the pain is part of what makes it look not like cancer. 

The patient considers the conundrum: There will also be pain if there is cancer, and a loss of sensation if she has breast reconstruction. She will have breasts, she will look like other women—she might even, with new fancy breasts, look better than she does now—but she will feel nothing.

The surgeon’s name is Brett. The patient thinks he is a nice guy, but today is the day that Christine Blasey Ford will testify that she was assaulted as a young woman by a nominee to the Supreme Court, also named Brett. So, for Dr. Ford’s sake, the patient glares at her surgeon.

 

The patient is led down the hall for a post-operative mammogram to check placement of her titanium markers (the patient did not give a shit about choosing her markers and asked the nurse to choose for her: one is V-shaped; the other a breast cancer ribbon, that ubiquitous symbol of disease and marketing). Then, a nurse binds her breasts close to her body to reduce the chance of hematoma and hands her an ice pack. The patient dresses in standard-issue Colorado woman clothes: gray t-shirt, jeans, Dansko clogs, and a puffy vest. The nurse says, I just love what you are wearing. What great style!

 

As instructed, the patient returns home and lies prone on the couch, an ice pack on the aching breast. Dr. Ford testifies before the Senate Judiciary Committee: “I am here today not because I want to be. I am terrified.”

At night, the pain is excruciating. She drinks two capfuls (5 mg) of black cherry flavored liquid marijuana bought two days ago just for the possibility.

Just going to chill out on the sofa after work, huh, the female budtender said, with a knowing expression.

The patient replied, Something like that.

 

The patient receives the results by phone the next day. Someone from the mammogram center calls to say, I’m calling with good news. Your pathology report says that both masses are fibroadenomas, which are completely benign growths.

Fibroadenomas were a distant possibility; they are a condition of women ages fifteen to thirty-five. The patient makes a note to brag to her husband: Your wife has the fibrocystic breasts of a much younger woman.

The woman from the mammogram center says, In your history, it looks like there are other people in your family with cancer. Have you ever considered genetic testing? 

The patient thinks, everyone in her family who has died, on both sides, for several generations, had cancer. In fact, there is nothing but cancer. But, she says to the woman on the phone, she is not going to have more children so why would she do testing?

Well, the woman says, I just wanted you to know if you’re ever interested, that we have genetic counseling here. We offer that service. It runs about two thousand dollars. 

The upsell. It’s what Nordstrom does, when you ask to try one pair of shoes and they bring out four. The patient says, You’re using a phone call about cancer test results to sell me a new service, one not requested or suggested by my doctor? 

No, says the woman. That’s not it at all. I’m just informing you. 

The patient sits at her desk, gazing at her image reflected in the glowing screen of her computer. She remembers that the breast is a clock, how the margins matter, how the lens stares deep inside her, peels her back, reveals her on the screen. Isn’t anything private anymore? In a gentle tone, the patient says, I’m not buying what you’re selling. 

Header photograph © Mane Hovhannisian.

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  • “The Mammogram Industrial Complex,” by Emily Sinclair (Fiction ’14) | Friends of Writers 12/08/2020 at 12:54 pm

    […] alum Emily Sinclair was recently featured in Barren Magazine. Read an excerpt of “The Mammogram Industrial Complex” […]

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