My mom had surgery yesterday. I didn’t want to say anything about it until she was all done and okay, which she is. I spoke to her this morning. The best news is that from what the surgeon saw at the time of surgery the mass that she had removed is likely to be benign. And let me tell you, folks, this is a real relief since Mom fought off breast cancer over ten years ago. I can’t tell you the relief I feel, and I’m sure the rest of the family feels the same way.

Pathology will have to be done, of course. But I think it’s encouraging that the doctor was willing to make a limited commitment to the tumor being benign right after surgery. After all, they look at this stuff every day, and cancerous tumors often look very different from ones that are “innocent”.....

Anyway, in the meantime I went to a “women’s doctor” for the first time in seven years. I’m aware that skipping it for so long is not among the smartest things I’ve ever done, but, as the doctor said, “Well, you’re here now.”

But I’m sure there were patients he would have rather seen. People to whom he could have given happy news, for instance “You’re pregnant!” or at least someone who didn’t have to write their “family history including any cancer” into the margins.

“Genetic counseling is available for people in situations such as yours where it may be very helpful to know if you are carrying the BRCA1 or BRCA2 gene mutations.” He said. I knew he was going to say this. The guy is not a moron, it would almost be negligent of him not to bring it up.

I sighed. “When you get down to individual cases, the rule of large numbers ceases to apply.”

Mostly, I said this just to see what he would say next. In a world full of people who B.S. just for the sake of BS-ing, I’ve found it helpful to use a three step manure detection process. First I take an adversarial approach – as if I’m of the opposite opinion, even if I’m not. This lets me know how strongly the person himself believes what he’s saying. Most people who are just BS-ing will shut up the minute they get the slightest push back. Then I ask a ton of questions – anything at all that comes into my mind, regardless of how stupid it sounds. You’d be surprised what, in general, you can learn that way. That lets me know if the person has any actual idea of what they’re talking about. Lastly, I make some fairly long inconsequential comments while looking away, digging around as if for a pen or a tissue in my handbag or flipping pages of magazine, but during this time, I’ll look up very quickly to catch the fleeting expression on the person’s face when they think that I’ve stopped paying attention. That’s when you catch how the person feels about what they’re saying.

In this case, he was not at all dissuaded by substantial push back – and, to his credit, he wasn’t nearly as surprised as most doctors are to get it. He had a very compelling argument. And when I looked up at the end his expression was enlightening. It was sad compassion. You very rarely see that. I sighed again.
Let me say that I really don’t think that I’m carrying the gene (I say gene for convenience. All women have the genes. The testing would tell if I was carrying the mutation that allowed reproductive system cancers to start and grow unchecked) I think that the situation in which my family now finds ourselves has to do with environmental, not genetic factors. I think the well water wasn’t good over in The Land That Time Forgot. My grandmother who died of ovarian cancer – God rest her soul – lived all her life over on Curtis Bay, which is practically a toxic waste dump. There are a lot of places like that in Maryland, which is why we have such a high cancer rate in this state. 3rd highest in the nation, if I remember right. My mom moved out of there as a young woman, only to get involved with that well water. My father, who has had colon cancer ate a terrible diet as a young man – at least from the standpoint of risk for that particular disease – red meat and potatoes, and he smoked. He gave up cigarettes when I was a little tiny child because he heard that the smoke might not be good for young children, but, like many men, he smoked a pipe for years after, til I was in about the 3rd or 4th grade.

Don’t misunderstand me, I’m not saying anything as cruel as “he brought it on himself”- at the time the American Dream was meat at every meal, and a man prided himself on being able to provide such good things for his children. This state is such a swamp of pollution of every kind. Some people say that cigarettes are more addictive than heroin – I admire him very much for giving them up, because he was more than a casual smoker. This was in the days before anti-depressants were given out to soothe cravings and the only gum available was Wrigley’s Spearmint.

I’d bet money that I don’t have the genetic pre-disposition. But would I bet my life? I’m always saying “Knowledge is power” but a little knowledge is also a dangerous thing. Actually, it’s usually not the little knowledge, but the remaining ignorance which causes problems. And what difference would it make if I knew? Sure I could get better screening, I could even have my ovaries removed. Ovarian cancer is a scary, scary disease, because it’s not often caught early enough to save the woman, and with the very stuff of life to feed on, it grows like wildfire, creating almost no symptoms until the end. But even if I had my ovaries removed, I could still get ovarian cancer – how’s that for a twist of fate? I could have the mutated gene and never get cancer of any kind. I could not have the gene and get cancer any way….see what I mean about the remaining ignorance?

In the end, I took the slip of paper with the geneticists name written on it. I thanked the doctor for his time,firmly shook his hand, and walked out into the twilight, no better informed than I had been in all these past seven years.