Chapter 11 ~ Excision

Photo by
Brendon Stuart

Two days before I was scheduled to meet my surgeon (“Oh, you have a surgeon now!” my friend Angela exclaimed, as if I had purchased an expensive hat), I woke up at 4 in the morning and wondered what she would want to do with my left breast. Would she want to “remove” it (take it somewhere else, perhaps)? Or could she make, merely, a “large area excision” as suggested by the doctor who called my cell phone to tell me I have “ductile carcinoma in situ.”

I was driving past Burlingame High School at the time, with its marble-columned porch and sweeping circular driveway circumscribing lush grass and stately redwood trees. A train was traveling in parallel to our right, behind a stand of eucalyptus. My eldest sister Claire sat in the back seat. My sister Jean—who had just arrived with her daughter that morning after driving 18 hours from Walla Walla, Washington for the family’s annual summer reunion in Santa Cruz—sat in the passenger seat up front. We were returning from visiting Eddy in the hospital, where he’d gone for a second stay three months after the first. It was a Sunday. I wasn’t expecting the doctor’s call. They had told me at the Women’s Center that the results from the biopsy wouldn’t be back until Monday or Tuesday. When the phone rang, I reached for my handbag with one hand, nestled it on my lap, and began digging around in it while keeping my other hand on the steering wheel and my eyes on the road. When I finally pulled it out of the bag, it was one ring short of going to voice mail.

“Hello?” I said triumphantly, proud of my ability to drive and manipulate my cell phone at the same time.

“May I speak to Josephine Kasten?”

“This is she.” I surprised myself with my immediate formality. My legs tensed. No one calls me Josephine.

“This is Dr. Brand from the Women’s Center. I’m calling to tell you that your biopsy report has come back, and you do have what I suspected, ductile carcinoma in situ.”

Everyone in the car could hear Dr. Brand’s sentence. Jean immediately started to loudly cry. Claire reached around from the back seat to comfort and hush her. I felt irritated by the disturbance and switched the phone to my right ear to block the sound, carefully keeping my left hand on the steering wheel, my right foot on the accelerator—carefully advancing the car down Carolan Avenue, past the lush grass and trees.

“What does that mean?” I asked in a businesslike tone that matched his.

“It’s a form of breast cancer. But the good news is, if you have to have breast cancer, this is the best kind to have. The ‘in situ’ part of the name means it hasn’t traveled anywhere. What we found in the biopsy was not invasive cancer. Nonetheless, it will have to be excised. The next thing you need to do is make an appointment with your primary care physician and ask her to refer you to a surgeon.”

Excised.

That’s a word you don’t hear in many venues.

“You’re going to want to call your primary up right away.”

Two days before I was scheduled to meet my surgeon I lay on my back, with my arms crossed over my chest, holding each of my breasts in my hands. Lawrence lay next to me, snoring softly. His left hand was under my shoulder and his thighs were curled up on my side of the bed, where I’d slung my knees over them. His right hand was resting on my right hip. We have a small bed, a double, and always sleep close together, but it had been closer, I noticed, since the biopsy came back bad.

Have I mentioned that Lawrence is a handsome man? A French and Arab mix, he’s long and thin, with wild, masculine eyebrows and thick, black hair gone silver at the temples. It used to be thick, anyway, thick and curly and radiating off his head like a white boy’s afro. But lately, I can see through his hair to bits of scalp when looking down at the top of his head while he’s sitting at the kitchen table. And one time, when I fished a great ball of hair from the drainpipe in the shower, I noticed that most of it was his blacksilvergray.

Lawrence thinks that I’m attractive, too. I know because of the time he showed a picture of me as a teenager in a pink ruffled bathing suit to Scott, one of our neighbors at our first house in Brisbane, a sleepy hamlet nestled in a crevice of San Bruno Mountain, just a few miles south of San Francisco. “See that!” he said, pushing the photograph under Scott’s nose. “That’s what I married!” At the time, his choice of pronoun seemed unfortunate, almost rude, but there was no mistaking the sentiment. He was proud.

Lawrence wasn’t supposed to lose his hair. My father always told me that male baldness is a sex-linked gene which is passed down through the mother—if the mother’s father keeps his hair, her sons will, too. And though I never met Lawrence’s maternal grandfather in person, I saw pictures of him with thick, steely-gray hair in advanced age.

I wasn’t supposed to lose my hair, either. Female baldness is rare, except in cancer patients. But those are other women—the bald ones. I have always been a lucky person. The good news is that if you have to have breast cancer, ductile carcinoma in situ is the kind to have. DCIS is not a traveling cancer. It’s stationary. It doesn’t like to intrude. They won’t need to render me bald while chasing rogue cells through my bloodstream with toxic chemicals. They’ll just perform an excision—just cast the devil out, just cut him off from the body that feeds him—just render the cancer ex situ: off site.

I had hoped, when I married Lawrence 22 years ago, that one of our children would inherit his magnificent hair, so voluptuous and appealing that just putting your fingers in it communicated a sense of abundance, of ease. But none did. Rose has medium-thick hair to which she periodically applies a henna paste in order to color it red. It isn’t curly, but when she came home from studying biology in Costa Rica this summer, it had metamorphosed into chin-length dreadlocks that emanated off of her head like a white girl’s afro. In one or two places, she had fastened a shell. Eddy’s hair is dusty brown and lank, like its owner. Henry, unbelievably, is a blonde Arab. Not one of our children inherited Lawrence’s voluminous hair.

But, the other child—the one I aborted two months after beginning a sexual relationship with Lawrence—she might have had his hair. During the two weeks that I considered a potential future together, I envisioned her looking Arabic, like her father, with big, liquid brown eyes, tan skin, and luxuriant black hair. I saw a thin frame, like Lawrence, and lean, artistic fingers. I saw her standing before me in a white dress.

Paradoxically, the abortion was the initial incident that convinced me it would be okay to fall in love with Lawrence. He already had many of the elements I desired in a partner. He was smart, funny, and I liked his dark, boyish looks. But he was extraordinarily shy. He drove me home from the newsroom of San Francisco State University’s Golden Gater for two months before he kissed me, and even then, I had to engineer the event. “You can kiss me now,” I told him one night outside my flat on 19th Street and Guerrero in San Francisco, sitting on my side of the bench seat in the phlegm-green Valiant he had inherited from thick-haired Grandpa Dabu. He moved across the seat with alacrity and took my head in his hands. His smooth, purple lips tasted of summer. His moustache tickled my nose. It was a more than satisfactory kiss.

But Lawrence also had deficits: he suffered from a perennial lack of enthusiasm; he wasn’t joyful or enamored of life; with his cynical humor, he seemed prone to depression; and he was four years younger than I was. Besides, at 25, I wasn’t yet in the market for a serious boyfriend. I preferred grieving with large quantities of gin over two dead parents and another less handsome but more joyful boyfriend who had recently “gotten away.” But when I accidentally got pregnant, despite the enormous, thick plastic diaphragm that I filled with spermicide and maneuvered up my vagina with difficulty every time I had sex, Lawrence’s reaction couldn’t be ignored.

“I’ve got a problem I need to talk to you about,” I told him one evening after school. We were sitting at the round table in my small kitchen, drinking cranberry juice. The room was cramped and cluttered, but cheerful. Light poured in from a skylight overhead and a small window overlooking the fire escape. Photographs and magnets covered the refrigerator. A few random dishes waited rinsing in the sink. Various roommates could be heard in other parts of the flat—one in one bedroom, two more in another. We heard both a television and a radio blaring. It seemed likely that we’d be interrupted any time.

“Oh yeah? What’s that?” He looked at me guardedly, wondering what I might be planning to spring on him. My behavior was still almost completely unpredictable to him. We’d only been sleeping together for a month.

“Well, I guess I’m pregnant.” I watched his face closely, to see how this news would affect him. “I took a pee test.” Unbelievably, undeniably, he registered relief.

“Really?” He looked happy. It was inexplicable.

“Yes, really,” I nodded, looking down at my glass, embarrassed, barely able to suppress a smile in spite of my heavy news. “What are you looking so happy about?” I couldn’t resist teasing him. “This is a serious situation.”

Lawrence nodded, adopting a sober posture right away. He reached across the table and put his hand over mine. His effort to behave with maturity seemed comical. “Well, what do you want to do about it?” he intoned.

“Here it comes,” I thought, “the rationale for an abortion. He was probably just happy for one fleeting moment when he realized I wasn’t dumping him. Or maybe he’s thrilled to have his potency confirmed—some kind of macho pride in his healthy sperm.”
“I don’t know,” I said aloud. “I really don’t see how I can keep it.” In spite of my almost-giddy feelings, I had started to cry. “I haven’t got a job,” I defended. “I haven’t got a college degree. I haven’t got a good place to live.” I spread my hands to indicate the inadequate party flat, noisy and dirty and full of people. The smell of marijuana wafted from a back bedroom. The refrigerator was full of beer. “But I really don’t want to have an abortion, either,” I continued. My voice sounded distant, wet. “I always told myself that I believed in a woman’s right to have an abortion, but that I would never have one myself.” I stopped to look at him for affirmation, but he said nothing. “It’s not fair! I used a diaphragm every time! I don’t see how this could have happened!”

Lawrence scooted his chair closer so he could put his arm around me. He tried to move smoothly, but was all angles and bones. His knees and mine collided. Our huddled bulk was blocking both the doorway into the kitchen and the door to the refrigerator. He leaned his head over, put his cheek next to mine, making a sort of private space with his halo of hair. “You can keep it if you want to,” he murmured. “I’ll help you. Do you want to get married?”

“Married?!” I pulled back to look him in the eyes once again. Was he serious? Was he insane? This was only the second time someone had offered to marry me, and I couldn’t help feeling exhilarated, despite my confusion. “How could we get married now?” I asked him. “We hardly know each other.”

He seemed dejected by this rebuttal. “We still could. If you wanted to…”

“Look Lawrence,” I decided I had to be the grown up in this situation, the one to take charge. His easy proposal of marriage was so unexpected it almost threatened me. What if he was a radical Christian who would insist that I carry the baby to term? He’d never mentioned God to me before, and it didn’t seem likely, but then neither had his proposal. I suddenly realized that my condition gave him power over me, power I didn’t want him to have. “There’s something else I need to tell you.”

“What’s that?” His eyes were beautiful behind his wire-rimmed glasses. Deep brown and sweet, like root beer. Tender. Welcoming. I felt an overwhelming desire to take him immediately into my bedroom and make love to him.

“Well…” I didn’t want to tell him what I planned to say next. I didn’t want him to withdraw his proposal. I didn’t want him to fall out of love with me. I didn’t want him to stop driving me home from school; to stop following me around the journalism room with his big, hungry eyes; to stop meeting me secretly in the darkroom where we fumbled together in the acrid smell and the sexy red light. I didn’t want him to decide that I was a slut, to reject and discard me like a used condom. I felt suddenly tired of the passionate and poetic fervor with which I’d been grieving past hurts with promiscuity and alcohol. I felt suddenly ready to stop all that, to turn over a new leaf. But there was no getting around the confession before me—no turning back. It had to be done. Besides, what I was about to say would protect me from any Christian crusading he might be considering. It would shift the power back into my hands. And it would be a kind of test of his loyalty—an initiation rite.

“I’m not entirely sure it’s your baby,” I blurted quickly before I lost courage, with the same bravado I used when jumping into a cold, rushing river from a high bridge.

His face was blank, unreadable.

“You’re not?” he finally said.

What was going on behind those John Lennon glasses? Had he already crossed me off his list of potential life partners? I waited fearfully. When he said nothing more, I stumbled ahead.
“I’m pretty sure it is,” I offered hopefully. “I mean, we’ve made love like a hundred times this month, right? But two times I made love to other people.”

“Two?” He was still unreadable.

“Yes. Right at the beginning. When we were first getting together. When we weren’t really a couple yet.”

“Who were they?”

I began to feel irritated. Was he going to expect an apology now? I didn’t figure I owed him one. We weren’t engaged. We weren’t married. Still, I didn’t want to prolong the discomfort by equivocating. Straight through with the truth was bound to be best. If he decided to dump me, so be it. He was too skinny, anyway. Too untried. Too young. Nothing of significance had ever happened to him, while I’d already lost two parents and become both a slut and a lush. I wrote poetry. He had pimples—a whole array of pimples splashed across his back.

“One was Mike Rivers,” I said, naming a professor at school who was also a reporter for the San Francisco Chronicle. “I practically forced myself on him. He wasn’t really interested. I don’t know what I was thinking, why I seduced him. I guess I wanted to hang around the Chroniclenewsroom.”

Lawrence offered no opinion.

“I’m pretty sure he already has a girlfriend on the paper—the librarian. Besides, he’s about a hundred years old. There’s no way I’m going to tell him about this. He wouldn’t be the slightest bit interested.”

Lawrence nodded slightly and waited.

“The other was Jim Cage,” I named an old friend from Stockton. “We’ve been flirting with each other for years, and before I started going out with you, we tried being boyfriend and girlfriend for about two weeks, but it didn’t work out. He got angry and threw me out of his apartment one night when I was pretty sick with strep throat or something, and I realized he wasn’t someone I could depend on. Besides, he’s a hardcore alcoholic. He wouldn’t make a good father. I don’t think I want to tell him about this either.”

I stopped talking and awaited his condemnation. I had no idea what he might say next. We had both drawn back by this time, sat separate in our independent chairs.

“Look Jo,” he began matter of factly, “if you don’t want to get married, but you still want to keep the baby, and you don’t want to bring it up with either of these other guys, I’d be glad to be the father.”

My mouth dropped open. Where was the recrimination? The jealousy? The angry outburst? Were we just going to skip over all that? This man might be young, but he is certainly strong minded. It began to dawn on me that despite his drawbacks, Lawrence was at least as interesting and unpredictable as I was. It began to dawn on me that he was a damn good human being.

“You’re kidding.” I finally mumbled.

Lawrence shook his head. “I think it would be fun.”

“Well, it’s tempting,” I scrambled to regain my dignity, still stunned. “Because my father died this year, you know, and this baby could be his reincarnation.” I put my hand on my still-flat belly. It seemed unbelievable that my regret and alcohol-suffused body was capable of forming a new life. Still, I thought I felt something inside me. Some lightening. Some inspiration. Some grace.

Lawrence sat quietly, waiting, apparently undisturbed by the revelation of my uncertain beliefs about life and death. I began to feel calmer, safer, less pursued by the Furies, more capable of directing my course. But there was one more land mine I needed to negotiate. “But what if I decide I want to have an abortion?” I rushed forward. “How would you feel about that?”

Michael appeared outside the door to the kitchen and barked playfully at us to move out of the way. We scooted back in our chairs, staring at each other, as he pulled a beer out of the refrigerator. “What’s going on in here?” he wondered, leaning back against the counter as he twisted off the top. “What are you two up to tonight?”

“We don’t know yet,” I answered, giving Michael a brief glance before returning my gaze to Lawrence. “Right now we’re just having a kind of…private conversation.”

“Oh, I see how it is,” Michael looked first at me, then at Lawrence. “God forbid you should have your private conversation in the privacy of your room. But hey, that’s okay. I know when I’m not wanted. Fine then. Be that way.” He tossed a laugh over his shoulder as he left the room.

Lawrence still didn’t answer.

“What would you think?” I pressed him, waiting nervously for his pronouncement.

“If that’s what you want to do, then I’ll support you,” he said. “But I don’t want you to think it’s your only option.”

I was stunned again.

When my brain started working, I realized that he had pretty much covered the gamut. He would marry me. He would be the father of my child if I didn’t want to get married. He would drive me to the abortion clinic, if I chose that. After all the power was placed in my hands, it took two more weeks for me to decide on an abortion. It was partly because I had begun to fall in love with Lawrence that I finally made that choice. That afternoon in the kitchen made me think it was possible that we might make it—might make a successful marriage—under different circumstances. Perhaps if we were graduated, employed, monogamous, and had known each other for more than three months... Then there was the ill-fated phone call to his parents, whom I’d never met. He was still so naïve that even as he reported it to me, he wasn’t entirely aware that he had done something wrong. It went something like this:

“Guess what Mom and Dad. I have a girlfriend.”

“That’s nice son.”

“And guess what else. She’s pregnant.”

“What?! ?! (this would be his father speaking). You’ve only just met her. How do you know it’s yours?”

“She’s 90% sure it’s mine!”

When he related that phone call to me, my first thought was that the child, if I carried her to term, would have no grandparents. My parents were dead, and his parents would never consider this baby truly theirs—not to mention the animosity they would justifiably feel for the older woman who was apparently trapping their son into early marriage with the oldest trick in the book.

So I made the decision and my other child—the fourth one, the lost desert nomad with the luxuriant black hair—was excised.

I don’t remember undergoing the procedure, only the crowded waiting room on Van Ness Avenue, where Lawrence sat beside me and held my hand. Afterwards, he took me back to his flat on Larkin Street and spread a sleeping bag on the floor in front of the television. I had told him I wanted to watch soap operas all afternoon and eat gourmet food. As I lay swathed in blankets and pillows, he brought me duck liver pate, water crackers, caviar, cream cheese, slender slices of sourdough bread, green apples, Vermont cheddar, Lindt chocolates, Planter’s fancy mixed nuts and a bottle of Silver Oak, the most prized red wine at Le Sorelle, the restaurant where he’d been working for the past year and would continue to work for the next 20. Erica on All My Children was tied to a chair in a leaky basement, struggling to escape her psycho kidnapper, who loved her so much he felt compelled to kill her when she threatened to marry another man (his twin brother—both albinos).

Although I don’t remember my own abortion, I have a pretty good idea of what must have happened from the one I attended when my friend Marcy asked me to come and support her through hers. She lay on a narrow bed in a dark room under a blue plastic and white paper blanket. The doctor had a white paper mask over his face, like a roadside robber who wanted to keep his identity secret. He told me to stand behind him, back by the machine; he wouldn’t let me stand next to her and hold her hand. The machine was cylindrical, with a long, crenellated hose, like a vacuum cleaner. A receptacle on top was made of clear plastic. When he flipped a switch a voracious noise filled the room and bits of bloody tissue began splattering against the sides of the machine. My throat filled with vomit.

You’d think I would be able to remember that apocalyptic noise, anyway, or whether my own doctor was a man or a woman. But I’m very good at forgetting—forgetting my abortion, forgetting the night my mother died, forgetting my father’s funeral (did he have an open casket?). Forgetting to get an annual mammogram for the past five years.

Four years after my abortion, when Rose became my firstborn child, she didn’t look Arab, but Irish, like me. I remember a few weeks after she was born, I was sitting on the beach at Santa Cruz with one of my sister Jean’s friends, looking at my plump, pink child sleeping peacefully under an umbrella in her plastic baby seat, so healthy and sweet smelling she was practically edible.

“A few years ago, I had an abortion,” I confessed ruefully to the stranger. “It doesn’t seem fair.”

The ocean made loud, sibilant noises that pressed against the back of my neck. The air was crisp and wet. Beneath my towel, the brown grains of sand cupped my buttocks, emitting vague warmth. Off to the right, beyond a bluff, we could see the tips of the tallest rides at the Boardwalk—the ferris wheel, the Hammer, the Rock-O-Plane—and every two minutes we could hear the rhythmic screams of exhilerants on the Giant Dipper, one of the country’s oldest roller coasters.

“Why not?” Jean’s friend—what was her name?—asked.

“I don’t understand,” I continued. “Why does this baby get to live, when the other one didn’t?”

The stranger turned her broad face toward me. She had chin-length silver hair which she tucked behind one ear as she wondered, “What makes you think it’s not the same one?”

The idea startled me.

Scientifically, of course, Rose couldn’t have the same body as my little Arab girl. The fertilized egg was destroyed by the abortion machine. But spiritually, Rose could easily be the same soul inhabiting a different body. After the abortion, she might have gone back to an ethereal waiting room until I was ready to be a mother. And then, when I was graduated and employed and monogamous and married and sober and living in my own little house in Brisbane, just to punish me, she might have made me wait and work a whole year at getting pregnant before consenting to re-inhabit my womb.

So that’s how I’ve looked at it ever since. That’s how I’ve expunged the guilt of my abortion.

Nineteen years after that afternoon on the beach, I lay awake at 4 a.m. in a warm bed in Sunnybrae. There was no baby in my womb, but something was growing inside me, something dangerous that the doctors wanted to excise. “In two more days,” I thought, “I’ll hear my surgeon’s recommendation.” My 46-year-old balding husband snorted and rolled over on his right side, away from me. I scrunched up next to him like a penciled-in shadow, wrapping my arms around his waist, pasting my thighs and knees behind his thighs and knees, pressing both of my rounded breasts into the flat of his back.

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