I scheduled an appointment with a genetic counselor in the cancer-treatment clinic attached by tunnels to the “Mountain”—a building that shot up into the sky like the Tetons. Surely a geneticist would have answers to whether my genes were predisposed to health or illness. Surely a geneticist could predict my cancer risks from my family’s history.
When the day came, I parked in the familiar ramp on the top floor of the cement garage and walked the six gritty flights down and across the windy street; then pushed through the revolving doors of the Mountain; and descended the escalator to the underground tunnels winding to the cancer treatment clinic. Inside, the waiting room bustled with patients sporting bald heads and scarves, canes and walkers, IV poles and oxygen tanks. The mean age looked to be well beyond my forty-nine years. More like my mother’s age of seventy-five. I felt out of place—too young, too fit. Surely my genes were too normal to belong here.
Still, I recognized this place as though I were a regular. The same upright chairs upholstered in utility strength fabric lined against the wall. The same coffee machine gurgling and steaming and puffing the aroma of dark roasted beans. The same strategically hung artwork–paintings of poppies hopefully reaching for the sun.
I recognized the people too—adults clutching Styrofoam cups in one hand and cell phones in the other. Smiling nurse in blue scrubs who periodically emerged through swinging doors. Nurses calling out names for patients who stood in pressed business attire, and others who rose slowly with sweaty brows and untucked shirts and hair jutting at angles from the back of their heads.
I had accompanied my mother through similar twisting halls to exam rooms where she’d undress and wrap herself in an oversized robe tied with ribbons. I had seen her sit on crinkly white paper, transformed by the ties and paper and cold air up her slumping back into a patient. I’d seen the brisk strides of doctors breezing in and out in long white coats with stethoscopes draped around their necks. I’d heard their declarative voices and the uncertain murmurings of my mother. Everywhere, keyboards clicked and shoes shuffled across linoleum.
I recognized this place, so familiar since my mother’s cancer diagnosis.
But now, I was the patient inside the Mountain. Not my mother, but me. Waiting for answers. Looking for certainty.
*
I don’t remember much about my meeting with the genetic counselor. I don’t remember leaving through the revolving doors of the Mountain. I don’t remember the gritty parking garage or bouncing in my insubstantial car through the pot holes along the Mississippi River road. But when I finally pulled into a parking lot at the bank of the river, the fog cleared. The maples that lined the shore came into focus. All I could think about was a sliver of conversation. I couldn’t shake her voice. I couldn’t shake my own.
Has your mother had cancer? the doctor asks.
Yes, breast and ovarian, I say.
And your father?
Umm, yes. Kidney.
And your grandparents?
Yes, my mother’s mother had breast and ovarian cancer.
So both your mother, and maternal grandmother, had breast and ovarian cancers?
That’s right.
Has anyone in your family been tested for the BRCA gene?
My mother tested negative.
In my memory, I see the doctor’s head pop up and eyebrows rise; I hear her voice quicken as if breathless. I feel her energy animate with the excitement of a researcher finding an unusual subject–an outlier in the tails of the normal distribution. A person with a repeating family cancer history but without the BRCA gene. An anomaly.
So what’s my risk? I hear myself ask.
You must have a gene we haven’t yet discovered. Your risk is higher. But we don’t know how much.
You don’t know?
We don’t know.
The fluttering of the maple leaves came back into focus with the words “we don’t know” ringing in my ears. The Mississippi River raged behind the line of trees with the faster-than-usual current from heavy rains. I closed my eyes and bowed my head onto the car steering wheel and thought the strangest thought:
I wish I had that gene. At least then I’d know my risk.
*
In the coming weeks, I routinely sat in my car under the maples by the Mississippi River—ignition off and my son Ryan sleeping in his booster seat. My mind had become a squirrel running up and down trees; jumping sideways to an adjacent fence; eating the small bites of food left by strangers. I re-played the voices of doctors as they had talked to my mother, then me, then the two of us together. In my mind’s eye, I studied their voices and body language for clues. Patterns. Inconsistencies. Certainty. Uncertainty. My thoughts jumped from tree to tree with visions of conflicting words and body language.
Jump. You’re healing well from surgery, a nurse tells my mother. But she looks sicker than I’ve ever seen her before. Jump. The blood in your urine may be caused by cancer, a doctor says to me. But he sits tall and relaxed as he scrolls through the test results on his computer screen. Jump. This is a routine CT scan, a technician says to me. But he insists on pumping dye into my body that will light up tumors as I lie on a tray in a whirling CT machine. Jump. We have other medications we can try, a doctors says to my mother. But she looks to be having trouble sitting upright in her chair. Jump. I see no reason for concern, a doctor says to me. But I want to see you again in one month.
From though to thought, concerned eyes look at my mother. Concerned eyes look at me. Words and body language bump against each other in conflict.
A flash of lightening streaked across the sky, bringing the maples outside my car back into focus. I held my breath and counted—one, two, three—before the clap of thunder roared. A deep vibration rose up from the earth through the car’s floor. Then the clap of a terrifying thought: What would happen to Ryan if I had cancer?
Ryan startled—crying and panicked.
“Everything is okay,” I said. I had gotten good at lying.
I switched on the ignition and pulled out onto the winding river road towards my Berkeley Avenue home.
I would come back to this park by the Mississippi the next day, and then the next day, and then the next.
I knew that for certain.
***
Writing prompt: Create a list of moments when you felt uncertain. Then create a list of actions you took to gain certainty. For example, was there a place that you went to think? Were there conversations that you sought out to learn more about a situation? Free write (without censoring yourself) a description of one of those actions or places.
Author: Pamm Smith
Image Source: National Cancer Institute on UpSplash
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