*

Laura is thrilled to see that the nationally syndicated column “Ask Amy” has mentioned Laura’s website and brant after running a letter about breast cancer. Laura is already getting lots and lots of really positive comments about her “Breast Brants” and about her new book on Failure, and, oddly enough, about her “Just Jimmies” post (who knew there were so many rabid Brigham’s Ice Cream fans out there who still remember the days of yore?)

To all her new readers — Welcome! And please bookmark the brant! Or, if you’re just here for the day, thanks for passing through! For her regular readers, click here for the link to the “Ask Amy” column:

Laura just wants to be sure she’s been accurate and clear and fair in her self-reportage (a.k.a. branting) about her breast surgery. So here are a few very important points she wants to be sure she communicates to anyone reading her Breast Brants:

1) While Laura opted for breast reconstruction surgery (and has complained about the difficult and prolonged recovery ever since but not about the results which are terrific!), it’s important to note that not every woman diagnosed with breast cancer wants to have reconstructive surgery.

Also, not every woman is able to have the sort of reconstructive surgery Laura had. For instance, some women are too thin to have the “tummy tuck”-TRAM-flap surgery that she had (although Laura can’t imagine who these people are and why they are too fit and in shape to have “extra flab” for various just-in-case procedures such as this one, but that’s another brant) and opt instead to have breast implants used. And sometimes radiation to the breast makes it impossible for the breast to be reconstructed later. Laura just didn’t want everyone to think that you have to have reconstruction or that everyone can have reconstruction. As many of the websites Laura has linked to in her breast brants show, there are lots and lots of different options for women depending on their diagnoses and their feelings on the reconstruction vs. non-reconstruction issue. Laura feels lucky that she was able to choose whether or not to have reconstruction at all and also that she chose this type of reconstruction in particular.

2) Again, while Laura has complained about the difficult and lengthy physical recovery of the TRAM-flap breast reconstruction surgery, she wants very much to clarify the fact that she would recommend this procedure to anyone interested in having it and that she herself would do it again were she faced with the same decision. This is 100% completely true despite all of her complaining about the discomfort and difficulty of the recovery.

Laura also wants to be sure to say that despite all her complaining about the recovery, the cosmetic result — i.e., the newly reconstructed breasts — is pretty fantastic (or, will be when Laura is finished with a few more cosmetic changes to the breasts — more about that later). Laura wants to communicate the importance, however, of finding the best and most talented plastic surgeon possible for this sort of reconstruction (or any sort of reconstruction). Laura was incredibly lucky to have both a brilliant and expert breast surgeon (Dr. Duggan) performing her medically-related breast surgery, and also to have an incredibly talented plastic surgeon (Dr. Chun) performing the cosmetic-reconstruction.

3) Living in Boston, minutes away from the Bermuda Triangle of Harvard Medical School, The Dana Farber Cancer Institute, and The Sagoff Breast Centre, Laura knew she was getting the best diagnostic care and the best treatment plan available. And yet still she was advised to get a second opinion and so she did (she had a friend who had a friend who was a renowned oncologist at Johns Hopkins and this friend sent Laura’s information to him to see what he thought and he agreed completely with the treatment plan she’d been advised to follow). Laura recommends that everyone get a second opinion even though in the midst of all the turmoil one goes through at the beginning of a diagnosis, running around looking for a second opinion seems almost too much to bear. But it is one of the most important parts of the whole recovery/survival process. Especiallly for people who don’t live near some of the best treatment centers/cities in the country, it’s important to get the absolute best advice at the very beginning so that you can feel assured that the subsequent treatment protocol you follow at your local hospital will be the very best it can possibly be.

4) While Laura complained bitterly about being prodded and pushed into leaving the hospital before she felt ready, she should have mentioned the very important fact that she was very lucky to have excellent medical coverage (Tufts Plan) which entitled her to several visits from a visiting nurse. Linda Stern, Laura’s visiting nurse, showed up for the first time on Thanksgiving Day (yes, her turkey was in the oven waiting for her to come home to baste and serve it) and Laura truly doesn’t know what she would have done without her that day and on the other days Linda came. As Laura mentioned in Breast Brant II, these days most surgical patients leave the hospital before they feel ready with complicated instructions for “self care” at home, and only some of them are lucky enough to have the sort of medical coverage that entitles them to this incredibly helpful Visiting Nurse service. Laura recommends to anyone facing breast surgery or any other sort of surgery to find out whether or not their medical plan makes them eligible for this type of home care. If they do not have this available to them through their health plan, they should strongly consider obtaining information on a local Visiting Nurse service before their surgery just so they have the information should they really need it. (Believe me, you don’t want to be flipping through the Yellow Pages the day you return home from the hospital…). Ask your health plan provider for names of services in your area or ask your local hospital to recommend good visiting nurse services. Even though it might be an out-of-pocket expense, it might be an absolute necessity in your recovery.

5) One last thing Laura wants to mention about health-insurance options is that unbeknownst to her, whenever a Tufts Plan subscriber receives a cancer diagnosis, a Tufts Plan Case Manager is assigned to the subscriber in order to help figure out beforehand all the things that subscriber will need. Laura was called multiple times before her surgery by a terrific case manager, Christine Wells, who went through all the things Laura would need to think about before and after her surgery — including preparing food in advance and freezing it; getting a help-schedule in place with friends and family; understanding the nature of the surgery itself and what the recovery would entail and how long it would last; informing her that she was entitled to a Visiting Nurse service who would help her upon her return home from the hospital, etc. This was an invaluable service that Laura felt grateful to have, though she also felt grateful for the fact that she had all sorts of support already in place (husband, friends, neighbors) to help her. Some health plans offer this pre-surgical “case management” service and Laura would advise anyone facing surgery to check and see if their health plan offers it. If not, she’d advise them to ask their surgeon lots of questions about recovery issues and also to scour all the excellent breast cancer websites which provide a great deal of information on both the medical aspects of the surgery as well as the practical aspects as a result of the surgery (discussion groups are especially good for this, as are the general FAQ pages).

6. Last but not least, Laura hopes she has not come off sounding like a wanna-be expert and smarty-pants know-it-all about breast cancer. Certainly she knows absolutely nothing about the chemo and radiation aspects of the treatment process and recommends that people turn to all the excellent resources on the internet and at their local hospital for information on those all-important topics. Laura is simply sharing her anecdotal experience and some of the things she learned during the diagnostic and surgical processes of her treatment on the off-chance that some people might find her information useful.

As promised, Laura’s finally going to tell the story about what happened to her a few weeks ago while taking some pills, even though the story kind of makes her look like a total gweeb for screwing up something as easy as taking pills. But that’s neither here nor there.

Almost a month ago, when Laura was just 4 weeks post-surgery and minutes after her husband and son left for school, Laura started her usual routine: climbing the stairs back to bed after seeing her boys off for the day. Winded and hunched over, she went to her night-table and took the usual daily handful of painkillers and Antidepressants, only the glass of water she used to swallow the pills with had less water in it than she’d thought. So before she knew it, all the pills went down except for one teeny tiny one (one of her Antidepressants) which didn’t go down and which proceeded to burn the back of her throat like a circus torch.

Laura couldn’t believe how painful the burning in her throat was! She ran to the bathroom and stuck her face under the tap in the sink (thereby killing herself with abdominal-surgery recovery pain) and drank some water, but that didn’t help. Racing as quickly as she could back down the steps (one step at a time, pathetically, though with incredible determination), she even went to the freezer and took a spoonful of fuzzy frost-crystalled ice cream in the hopes that the cold creamy sensation would ease the pain. But again, nothing. In fact, the burning searing pain in the back of her throat wasn’t only not getting any better, it was actually getting worse!

Laura didn’t know what to do. And as she stood in the kitchen holding her throat (as if that would help, which of course it didn’t), she began to feel the back of her throat swelling due to the extreme iritation the pill had caused. She was certain the pill wasn’t even there anymore, but clearly the severity of her pain had something to do with the fact that the pill was generic and was thus not coated. Not that she could really even focus on that somewhat arcane point of pharmaceutical manufacturing because she was too busy focusing on the fact that her throat was starting to swell and she suddenly thought she was going to die.

Maybe it was because she’d watched too many medical dramas in her youth (Marcus Welby, MD; Chad Everett’s Medical Center; St. Elsewhere; ER) where every time you turned around someone was being rushed into the emergency room requiring a fake doctor to punch a whole through the neck and straight into the fake patient’s trachea to access a blocked windpipe. Or maybe it was because she was just naturally negative and pessimistic and a catastrophizer of the highest order who feared death not only from the usual every day things (car accidents, plane crashes, cancer, aneuryism) but also from slightly more esoteric things, like taking a handful of pills without enough water. For Laura The Writer, The Branter, The Recovering Surgical Patient, the irony of the situation was inescapable:

I can’t believe I’m going to drop dead right here because I fucked up swallowing some stupid pills that I was taking after breast cancer surgery!

Despite the fact that she was still able to breathe, she still had no idea whether or not the swelling in her throat was going to get so bad that the swelling would indeed make it impossible for her to breathe, so she did the only thing she could do:

She called 911.

After one ring, she hung up in embarrassment.

A second later, they called back. Apparently, Laura thinks she remembers hearing once, by law, they have to call back anyone who calls 911 and then immediately hangs up because they’re not sure if they actually have an emergency or not.

What followed was the usual sort of tragi-comic scenario Laura always seems to get herself into. There she was with her intensely burning throat feeling like a total idiot for having called 911, then trying to explain with her extremely raspy voice and limited supply of oxygen exactly what had transpired before she thought she might expire from an inability to respire.

“Is there an emergency?” the dispatcher said.

“Sort of. I think so. I’m not sure.”

“OK Ma’am. Just tell me what your emergency is.”

“Well, I swallowed some pills,” she began slowly, gearing up for the rest of the explanation.

“Is this an overdose?” the dispatcher asked.

“No,” Laura said in as loud a whisper as she could manage, “but one of the pills got stuck because I didn’t have enough water.”

“So you have a breathing obstruction,” the dispatcher said. “Can you reach the object and dislodge it?”

“No…” Laura rasped with exasperation, about to clarify but not getting the chance to.

“So you have a blocked airway,” the dispatcher said.

“NO!” Laura again rasped exasperatedly. “The pill got stuck at the back of my throat and burned the back of my throat and the reason I’m having trouble breathing,” she said, pausing momentarily because she was having trouble breathing, “is because the pill burned the back of my throat before I had a chance to swallow it.”

“So…” the dispatcher said, clearly trying to understand what the hell Laura was angrily whispering about, “you’re having an allergic reaction to a medication you took.”

Completely exhausted, Laura wanted to give up and hang up, but she knew she couldn’t: Brendan and Benji would be home in six hours and she couldn’t bear the idea of them finding her collapsed in the front hallway with her stupid elastic waistband-black-”yoga-pants” (that she never actually wore to yoga because she was too lazy to go to yoga) on and the cordless phone in her hand having tried and failed to explain herself to a 911 dispatcher!

(Besides, if she did hang up, they’d only call back and then she’d have to start all over from the beginning….)

And so despite herself, when the dispatcher offered to send “a unit” to her house, Laura agreed. As she waited for the unit to arrive, she opened her front door to get some fresh air even though she couldn’t actually breathe in much of it and when she did, oddly enough, none of her many neighbors was out.

Laura lives on a cul-de-sac, a dead-end that abuts a golf course, and their house is the last house on the dead end. It’s a beautiful spot for a house, a 1933 Colonial tucked in under some trees with all that sloping green (or, in winter, white) beyond, but the houses are really close together which makes for some rather “tight” situations with the neighbors. Usually, at that time of day, mid-morning, there would be any one of several neighbors out — Karl across the street who has a contracting business he runs from home; Carole his wife who is a nurse and part-time student; John, the stay-at-home dad two houses up; and Barry, the new neighbor directly next door who works from home, too — not to mention Al across the street who, though several decades older than all of them, is always outside doing yardwork — but today of all days — a day when Laura was fighting for her life, sort of! – the street was quiet. Empty. As the fire engine heaved down the street and came to a stop across the street from her house, Laura was grateful that no one was around to witness her latest grand mal seisure of idiocy.

She was also glad they weren’t around to witness the fact that not only did a fire truck arrive with three firemen, but a police car arrived with one policeman, and then an ambulance arrived with two EMTs.

In seconds they — all six of them — were in her house in her livingroom; the firemen offering her oxygen which she accepted; the policeman checking out her amazing-for-a-fake Christmas tree (”It’s from Target,” she stage-whispered, moving the oxygen mask aside just long enough to get the words out as if her telling him and him hearing her were a matter of life and death); and the two EMTs — two slightly-odd short-haired navy-windbreaker-wearing middle-aged women, TweedleDum and TweedleDee — trying to figure out if they should take her to the hospital.

At the mention of going to the hospital, it was as if Laura suddenly came to her senses. What a ridiculous thought! she thought. Sure! Fine! A house full of emergency personnel! But I’m not going to over-react and actually go to the hospital!!

In the end, of course, she did go, since the EMTs convinced her that since they were there, they might as well just take her in — especially since Laura informed them (in a desperate attempt to gain sympathy and prove that she wasn’t crazy) that she was recovering from a bilateral mastectomy and reconstruction. Both EMTs nodded in agreement.

“Better safe then sorry,” they said in unison. And with that, they escorted Laura out of the house and over to the ambulance.

Laura was still surprised that no one on her close tight never-any-fucking-privacy street was around — where were these people when you actually needed them?! she thought wryly — and she started to get nervous because she realized that she hadn’t called Brendan, or left him a note, and now that her voice was completely gone, he’d have no idea why she’d left the house, since the last time he saw her she was shuffling around the kitchen, still unable to drive. She also realized that having no voice was preventing her from correcting how the two EMTs were describing her situation as they called it into the ER — why couldn’t anyone seem to understand that there was no actual obstruction in her throat, just a burned out larynx from a misguided uncoated generic pharmaceutical!

All of that annoyance, paled, however, to the fact that they were having a hard time getting her strapped on to the stretcher. This would have been annoying and uncomfortable enough given her sore throat and feelings of idiocy, but since she was still in a great deal of pain from her breast cancer surgery, it was extremely annoying. It was also scary, since they couldn’t seem to figure out how to get the stretcher up and into the back of the ambulance without tipping her over. Had she been able to scream, she would have; instead, she just mouthed the words:

DON’T TIP ME OVER!!!!

To make a long story short, when they arrived at the hospital, less than a mile away, the ER people seemed both completely unaware of her arrival and completely uninterested and unconcerned about her condition. Laura thinks this bizarre combination of unfortunate events — the perfect storm of potential malpractice! — had to do with the fact that 1) the EMTs had a lot of friends in the ER to say hello to and 2) the EMTs had told the ER nurses and doctor that there had been an airway obstruction but whatever had obstructed the airway wasn’t there anymore. Laura assumes this is the case because both the nurses and the one doctor kept looking at her as if she was crazy, and they only looked in her mouth once to make sure there was no giant object stuck in the back of her throat. Whenever Laura, out of frustration at the fact that no one was treating her intense throat pain, tried to speak, no one heard her, which would then force her to wave her arms and pantomime various messages:

GIVE ME A PEN AND PAD! she mimed desperately first. And then:
CALL MY HUSBAND ON MY CELL PHONE AND TELL HIM WHERE I AM!

In time and with great disinterest they deciphered her flapping arms and waving hands game-of-charades and called her husband, and shortly thereafter he arrived, shocked to see her on a stretcher looking crazed with only an IV in her hand administering only a mild pain killer and nothing else — no anesthetic spray to the back of her throat; no Ears-Nose-and-Throat doctor checking to make sure her voice box and vocal chords were still there and assuring her that she would indeed, someday, speak again.

Eventually, Laura was released, and Brendan drove her home, and it was only after scouring the Internet looking for a similar freak medical condition to show up on Google, that she found one: a bulemic woman who was also an aspiring opera singer. Her question about whether frequent vomiting could be the cause of her recent voice loss was answered by a voice teacher who said that yes it was because the vocal chords had been burned, but that they would heal themselves in about a month.

It’s been three weeks for Laura’s vocal chords, and while she is talking up a storm, her voice is two octaves lower than normal. She sounds like Brenda Vaccaro now and she hopes she always will.

Sarah Dealy (flowers).

Cory (nee Halaby) (food).

Laura is completely panicked that she forgot to thank someone in that long list in her last entry.  She’s going to go over the list with a fine-toothed comb tomorrow and hopes that you’ll forgive her if she has, unwittingly and inadvertently and unintentionally, forgotten to thank you.

Laura is anxious to bring this three-part brant topic to a close, and yet she can’t yet. She absolutely must thank a whole bunch of people whose help completely saved the day:

Her good friend Hilary Monihan for setting up a helping website on lotsahelpinghands.com so that all of Laura’s friends could sign up for times to bring meals and take Benji for playdates. Her wonderful friend and neighbor Tracy Aber co-managed the details of the site, and then all of Laura’s friends and all of Benji’s friends from school and all his teachers from school started helping out in the most amazing ways.

Meals would be left at the door (thank you Elisa D’Andrea and Liz Steinberg and Carole Nathanson and Sheila Doyle and Mike Lorant and Wendy Hurwitz and Pinar Kilicci-Kret and Lisa Goodman and Deb Klein and Micki Avery and Patrice Thornberg and Denise Joseph and Carole Aghassi and Andrea Miller from the Rochester JCC and my book group [Kathleen Olesky, Nancy Leslie, Elizabeth Smith, Liza Schaeffer, Andrea Hauser!);

Benji would be picked up at school and taken for playdates and movies and museum-visits and library-visits (thank you John and Tracy Aber and Hilary Monihan and Paula Fazli and Charlie Mixer and Wendy Hurwitz and Audrey Marks and Kate Haworth and Pinar Kilicci-Kret and Sheila and Mike Doyle/Lorant!) and hosted for four fabulous days in Rhinebeck New York with his cousins and their dogs and their horses (thank you Pat and Colleen Dealy!);

Wonderful gifts of flannel pajamas (thank you Williams School teachers [Brett Aronne and Michelle Gillis and Carolyn Kaufman and Jan Lewis and Julie Gold and Chris Moynihan] and my sister [Linda]!) and unbelievably delicious smoked fish and bagels Fed-Exed from Barney Greengrass in New York (thank you, Goober and family!) and a “bouquet” of fresh fruit (thank you Sally and Len!) and robes and soaps and lotions (thank you Theresa Park and Elise Supovitz!);

Not to mention all the gorgeous glorious flowers (thank you Blog Moms and John and Tracy Aber and Beth Teitell and Warner Books and Marianne Szegedy-Maszak and Paula and Jonathan Fazli and Hilary Macht-Felgran. and Karl and Carole and Hannah and Sophia Aghassi and Jane Dealy!) and books (thank you Marian Brown!) and chocolates (thank you Mary Granfield and Tom Perotta!) and magazines (thank you Barbara Lietzke!) and the back-preserving husband-pillow (thank you Wendy Hurwitz!) and the box of cool toys for Benji (thanks Jenny Loviglio and Nico and Tavi Hartman!) all the emails and cards and good wishes.

In fact, her friends were so unbelievably helpful and caring that she wishes there was a way she could extend this lotsa-helping-hands thing — I mean, what could be better than having great meals brought to your door and your child entertained to the point that he’s having the time of his life?

Having the meals and playdates last another six months, say, till May or June….

Laura knows that she said she was going to finish up the brant she started on December 22 on December 23, and here it is December 29 and she’s only now just getting to it. But Laura suspects it’s less laziness and more ambivalence about her brant-topic that kept her from keeping her word.

(Laura has inserted a pink ribbon — the universal symbol for fighting breast cancer — here in an attempt to lighten and brighten things up! She wishes she could figure out how to put smiley faces — particularly those adorable winking blinking smiley faces — on the pink ribbon but she’s just not that technologically savvy. She did manage to find this pink smiley face-emoticon which she thinks is a pretty good second choice — pink smiley face = symbolic pink color associated with fighting breast cancer–so she happily inserts it here:) <--oops! unintentional smiley!

Despite the fact that Laura is no privacy freak — in fact, she’s often been guilty of the Way Too Much Information thing — she’s still feeling a little funny about writing such a depressing buzz-killer-of-a-brant-entry right in the middle of the holiday season. And yet she just couldn’t figure out how to leave out the event that bracketed the publication of Piece of Work — after all, she found out about her condition a month before the book came out, and she had the surgery about two days after her final book event. And so, in a strange way, it felt like all of her bragging and ranting and self-promotion needed to be tempered by reality: that is, Laura didn’t want her fans (both of them) thinking that she had this amazingly fabulous ‘I write, therefore I’m happy’ kind of life. One of the purposes of her brant — from the very beginning, if you check back to the introductory entry — was to humanize herself for her fans; to show them that she, too, has problems like everyone else. Life isn’t perfect, that’s for sure, but Laura still feels lucky that after a fuckload of major surgery and six whole weeks of shuffling gingerly from her bedroom to the bathroom and back to her bedroom, she has a new set of fake boobs and a flat stomach to show for it.

And so, just to finish the story and move on: Laura had her surgery on Friday, November 17 and it took 12 hours. Yes, that’s right — 12 hours. It was so long that the nurses gave her a pass on getting out of bed the next day and let her “relax” with her patient-controlled morphine drip until Sunday. Which is when she suspended her disbelief and let two nurses talk her into the idea that they were going to pull her out of bed and help her walk to the bathroom four feet away.

The only thing worse than getting out of the hospital bed for the first time was the fact that the minute she’d gotten out of bed the doctors started trying to tell her it was time to go home. They’d tell her on their rounds in the morning; they’d tell her on their rounds in the afternoon; interns, residents, surgeons — doctors she’d never seen before and would never see again — all of them crawling out of the woodwork and stopping in to stare at and cop a feel of her new reconstructed boobs and then tell her that she really should think about going home already.

“So, how are you feeling today?”

“Well, you know, pretty bad.”

“Sure. You were on the table for a long time.”

“Twelve hours, they told me.”

“So, how do you feel now?”

“Now? You mean compared to a minute ago when you asked me? Pretty much the same. Like I got hit by a truck and then the truck sat on me.”

“That’s normal.”

“That’s reassuring.”

“You had pretty major surgery and it takes time to recover. But you really should start thinking about going home already.”

“Already? But it’s only been two days.”

“Right, but tomorrow will be three days. And the sooner you get up and walk around the easier your recovery is going to be.”

But Laura refused to budge. She couldn’t understand how she was supposed to get up and walk around so she could go home when she could barely make it to her handicapped-accessible bathroom! Were they crazy? What was this madness about going home two days after major surgery? Did someone mix up the charts and think she’d come in with a hangnail?

Whatever the reason, this ridiculous farcical dance continued — the doctors telling her to start thinking about going home, and Laura trying to explain that there really was no possible way for her to go home quite yet, which then led to the doctors’ concern that there was some sort of pathalogical reason for her resistance to leaving the hospital. Laura realized that the standoff had devolved to this particular point when a social worker was sent in to ask her why she didn’t want to go home.

“Are you afraid?” the social worker asked. “Do you not feel safe at home?”

Laura was going to say Yes! Yes of course I’m afraid to go home with all these surgical drains and gauze dressings and yes of course I don’t feel safe at home caring for myself three days after surgery since I’m not a fucking registered nurse and neither is my husband! — but before she said anything she realized that the social worker’s question was probing for something else. Was she afraid to go home because she didn’t feel safe because there was domestic abuse? That was the real question. And while Laura doesn’t make light of domestic/spousal abuse at all, for a split second she was tempted to lie and say yes so she could get a few more guilt-free days of hospital time without being shamed every two hours by the doctors on patrol.

And so, on Wednesday, after managing to extract five days of in-patient care, at about 7 p.m. (they will, Laura found out, discharge you at any time of day just to get you the hell out of there), she left the hospital with her husband (who was taking two weeks off to be her full-time caretaker) and went home. After he hoisted her out of the car and practically carried her from the car to the door, she looked up at the flight of stairs that separated her from her bedroom — where she was told she’d be spending the better part of 6-8 weeks — and felt like she was facing Everest. How the fuck was she supposed to get up the stairs and into bed when she had barely made it in from the car without a team of trained medical professionals??

Very slowly, she quickly figured out. Which is how the recovery has gone. Very very slowly. Lots of painkillers for the first two weeks, and lots of sleeping and napping and resting and taking it easy for the next four weeks. And yet now, at the six week point after surgery, Laura suddenly feels she’s made a quantum leap from what she felt like a week ago, and a week before that. (One of the most frustrating parts of the recuperation she felt was the fact that progress wasn’t made day to day, but rather week to week — which meant that everyday she woke up she felt like it was like the movie “Groundhog Day.” She would feel no better until an entire week had passed and even then the difference would hardly seem significant.) For the past few days she’s been walking on her treadmill very very slowly (one mile = 45 minutes) and she even started driving again. Going to CVS and getting to walk through all the aisles touching everything and taking a full hour the way she always does and which drives her husband crazy trying to decide what body lotion and body oil and wrinkle-fixing face cream and toothpaste and hair dye to buy was one of the best moments in recent memory. And she hopes she never forgets just how remarkably joyful the smallest most everyday things in life like going shopping for toiletteries can be.

Well, it’s the end of December — 3 days before Christmas, in fact — and finally Laura has decided to sit up and update her brant. If you’ll notice she said “sit up and update her brant” as opposed to “sit down and update her brant” and there’s a reason for this, which is the same reason she took a 6 or 7 week sabbatical from branting: Laura’s been recovering from some major surgery that she had exactly 5 weeks ago and she’s been laying in bed ever since.

Back in November, when Laura was still branting fairly regularly (although not as regularly as she’d like — she still aspires to everyday-branting) — Laura was wondering what she would do about her brant during her post-op convalescence. Would she alert readers to her involuntary health-related sabbatical? Would she give them all the details about what sort of surgery she was having and why? Would she include them in her recuperation by writing a daily log of her physical healing progress? OR, would she simply disappear until the whole ordeal was over and resume her brant as if nothing had ever happened?

Laura really mulled this one over. While she’s certainly not a privacy freak — How could she be when she has her own website and brant?!?! – Laura still wasn’t sure if she wanted to be one of those people who blogs about every single thing that happens to them, even the incredibly personal ones. And because she was undecided about what to do she just ended up doing nothing: that is, she stopped writing her brant with no explanation as to why she’d stopped and when she might begin again.

If not for one of Laura’s good friends who for some reason is obsessed with her brant and checks it daily on the off-chance it’s been updated, Laura probably wouldn’t be branting right now. But this friend, Wendy, has not let up with her questions as to when Laura was going to start writing again, and because Wendy has been so helpful during Laura’s post-operative convalescent time, Laura felt it was only fair to do her a favor, too: branting as payback.

The other reason Laura decided to brant about her medical experience is because there are certain things she learned during the course of her diagnosis and surgery that she hadn’t known before it and that she figured most women didn’t know either but which she felt they should know. So here she goes.

In late August Laura was diagnosed with breast cancer. She was shocked but not really shocked since she’d always believed, deep down, due to her strong family history, that she would someday get it. In fact, Laura had always been so convinced of the inevitability of it, that she’d started having annual mammograms at 31 and continued to do so right up until she turned 44. But as time went on Laura heard more and more that women were being diagnosed with breast cancer even after they’d been “cleared” with a clean mammogram.

This concerned Laura. Clearly mammograms were not the be-all and end all of diagnostic testing and gave many women a false sense of security. In fact, later she would learn that mammograms are only 69% effective in picking up breast cancer, and believe me, if she’d known this statistic she would have stopped with the mammograms long ago. And due to Laura’s pessimistic nature, she began catastrophizing various horrible scenarios about finding a lump that was so far gone the remainder of her short wonderful life would play like Debra Winger’s in Terms of Endearment. Anyway, at some point last spring, after she’d had her usual annual mammogram, the radiologist reading her film suggested that at some point Laura might want to get a more definitive imaging test — such as an MRI.

Laura thought that was a good idea, but she promptly forgot about it — so busy was she in the early stages of her “Piece of Work” pre-publication self-promotion! — and several months went by before she remembered to ask her primary care physician about it. Oddly enough, her primary care physician, despite knowing her family history of breast cancer tried to talk her out of having the test (it’s expensive for the insurance company), but Laura persisted, remembering all the stories she’d heard about falsely-clean mammograms. Finally the doctor relented and ordered a breast MRI for her and, after scheduling it and rescheduling it twice, Laura finally kept her appointment in mid-August and had the test at the Sagoff Breast Centre in Boston.

Two days later, Laura was called and asked to come by for an ultrasound. Laura didn’t think much of this since when she asked if coming back for a follow-up ultrasound was normal the person on the phone said that lots of people get called back for an ultrasound. So you can imagine her surprise when she showed up for her seemingly “routine” ultrasound and was met by a radiologist pointing at something on her films. Confused, Laura nodded, until she finally understood what the radiologist was saying: she’d seem something in the left breast and though she didn’t think it looked like cancer, she wanted to be certain.

“I’m obsessive,” the radiologist said, a trait Laura figured was a huge asset in her particular line of work.

Before she knew it, right then and there, Laura had a needle biopsy (that was almost completely painless which surprised Laura no end since she thought it was going to be incredibly painful), and the next day, a Friday, she was told that the pathology lab would need the weekend to complete their analysis since the cells were apparently “atypical.” (Not all atypical cells are cancer cells, the radiologist reassured her, but Laura still didn’t like the sound of that).

Finally, that Monday at 5 o’clock, the radiologist called and said that the results were in: Laura had what’s called Ductal Carcinoma in Situ, also known as DCIS, an early type of cancer that starts in the milk ducts. It was Stage 0, she said, which meant that though the cancer was there, it hadn’t gone anywhere.

Yet.

Strangely, though, at some point during her explanation of the diagnosis, the radiologist said to Laura: “Don’t let the word carcinoma fool you. It’s a type of pre-cancer condition routinely treated by lumpectomy and radiation.” Which was a huge relief: pre-cancer isn’t cancer! Laura thought happily, which made calling everyone she knew who was waiting to hear about her test results a whole lot easier.

Unfortunately, though, the pre-cancer/cancer business ended up being a complete misunderstanding, Laura learned when she finally met with the head surgeon at the Sagoff Breast Center at the Faulkner Hospital in Boston.

Dr. Margaret Duggan — a tall, fiercely intelligent, completely approachable, extremely accomplished surgeon who seemed to be around Laura’s age (who is she kidding? Dr. Duggan is probably half Laura’s age!) and who wore scrubs and a white coat and adorably hip but not annoyingly hip black-rimmed squarish glasses, took Laura into her office and spoke to her for over an hour. She gave Laura an incredibly detailed and easy-to-understand mini-course that covered oncology and biology and genetics and surgery and plastic surgery and statistics and probabilities (Dr. Duggan, besides heading up the Sagoff Centre’s Surgery Department, also teaches at Harvard Medical School in her “spare” time) and which included hand-drawn diagrams on a pad of paper which Laura actually understood (if only Dr. Duggan had been her high school biology or chemistry or physics or calculus teacher, Laura is convinced she would have scored higher on the math portion of her SATs and would now, as a grown-up, be able to remember how to say the word “Sudoku,” let alone do Sudoku puzzles and help her son with his first-grade math homework). But despite her wish-fantasy sequence of mathematical and scientific competence, Laura quickly noticed how often Dr. Duggan was using the word “cancer” as opposed to “pre-cancer.”

“So, it’s cancer,” Laura said.

“Well, yes. It’s cancer,” Dr. Duggan said.

“Because, you see, the person who explained it to me said it wasn’t actually cancer, it was pre-cancer.” Laura didn’t want to go into the fact that she’d already told everyone including her husband that it wasn’t actually cancer. And she also didn’t want to appear stupid enough for Dr. Duggan to say: Duh.

“No, it’s definitely cancer.”

Laura nodded, taking a minute to recalibrate her delicately balanced sense of catastrophe-thinking. But as soon as she had done that, another piece of news surprised her: because there were two areas of this DCIS in the left breast, the surgical treatment would be a full mastectomy as opposed to a lumpectomy.

“Wow,” Laura said, nodding like a bobble-head toy.

“The good news is,” Dr. Duggan continued, “is that once you have the surgery you don’t have to have radiation or chemo.”

“Wow,” Laura said again.

“But,” Dr. Duggan continued, “once you have had cancer in one breast, you’re much more likely to get it in the second breast, and so we recommend that you consider having the other breast removed as well as a preventative measure.”

Laura stopped with the nodding. Here she’d come in thinking she had a small pre-cancerous condition and was going to have a lumpectomy — and suddenly she’s definitely having one mastectomy, and possibly two! Her head was spinning. And while Laura was definitely leaning in that bilateral mastectomy direction — better safe than sorry and have both done at once with immediate reconstructive surgery than sit around waiting for it to show up in the second breast — Dr. Duggan suggested she have the genetic blood test for the BRCA 1 and BRCA 2 genes to determine whether or not she had either of them. That way, if she tested positive, she might feel more convinced of her decision.

And so on a beautiful sunny afternoon a week later, Laura drove into Boston (getting lost twice, which doesn’t include getting lost trying to find her way into the parking garage) to the Dana Farber Cancer Institute to meet with a genetic counselor and have her BRCA blood test. The genetic counselor was very nice and extremely smart and to be quite frank most of what she said went right over Laura’s head. But the few things she got was that Ashkenazi Jewish women have a higher rate of breast cancer and that if you tested negatively for the genes it didn’t necessarily mean you weren’t going to get breast cancer, and if you tested positively for the genes it didn’t necessarily mean that you would get cancer, even though your chances were higher with the gene than without it.”But,” the genetic counselor explained, “if you do test positive for the gene then we recommend that you have your ovaries removed also since there’s an increased risk that you will develop ovarian cancer as well.”

Now Laura’s head was really spinning! In for a penny, in for a pound! Suddenly she was getting a double mastectomy and possibly also having her ovaries removed, too! Luckily, though, when the test results came back several weeks later, she found out that she had neither BRCA gene which again was a huge relief. At least she wouldn’t have to worry about being plunged into full-blown menopause at the tender young age of 44.

Laura processed all the news and information as quickly and as best as she could. Soon she was sent by Dr. Duggan to see Dr. Yoon Chun, a highly-regarded plastic surgeon who couldn’t be nicer or more lovely or more intensely intelligent (and who clearly was definitely younger than Laura) and who spent almost two hours with Laura in her office explaining the various reconstruction surgery options available to her. (Dr. Chun also drew pictures, most of which Laura completely understood, and had she not been so absorbed in the decision-making process regarding the creation and construction of her new boobs — saline implants? silicone implants? TRAM flap? DIEP flap? — she probably also would have started thinking about how different her future might have been had Dr. Chun been one of her high school science or math teachers).

And so while she freely admitted to herself and others that having to have such major surgery (the type of reconstructive surgery she was opting for — TRAM flap, short for transverse rectus abdominis myocutaneous flap was essentially a ‘tummy-tuck’ — that’s where the “reconstuctive material” would come from) sucked (recovery time was estimated at 6-8 weeks and Laura figured it might even be more), she couldn’t help but feel incredibly lucky that the news hadn’t been worse. Stage 0 was practically a gift, and the idea that she wouldn’t have to go through the agony of chemo and radiation practically made her giddy with relief. Compared to all the late-night catastropized visions she’d imagined over the years of getting cancer, this was nothing.

Not to mention the fact that she was kind of excited about the ‘Extreme Makeover’ idea of getting a free tummy tuck and having a flat stomach!

All of this, however, was happening barely a month before the publication of Piece of Work, something she’d waited four long years for, and just as Laura was thinking that all her pre-publication self-promotion had been a complete waste of time now that she’d have to cancel her book tour (not that it was that big of a tour or anything), Dr. Duggan assured Laura that the surgery could absolutely wait until her book tour was over. So Laura scheduled the event — which she now referred to almost always as simply “The Tummy Tuck” — for mid-November, after all her bookstore and Jewish Book Fair* appearances that she’d auditioned so strongly for were over (*unfortunately Laura had to cancel three of her five Jewish Book Fair appearances at the last minute since she had to have several mandatory pre-op appointments within a week of her surgery that had already been scheduled and that she couldn’t change).

TO BE CONTINUED tomorrow…