Tamoxifen Tonight
- Flashes and Flashbacks

Jeanne Holtzman

It's 11:00 P.M. and I wash down a Tamoxifen tablet and begin the determined preparations for sleep. Before breast cancer, before I found the lump, before the surgery, and before these pills meant to starve the tumor, sleep was not an undertaking but an effortless pleasure. Closing my eyes at night, I would deeply and blissfully slumber until my snooze alarm persistently nudged me back to myself. Now, Tamoxifen sabotages my body's thermostat with repeated false alarms, an exaggerated mockery of menopause.

My husband retires to his bedroom down the hall, our resolute attempts at sleep having become solitary endeavors. I strip down to my underwear, being sure to remember to remove my potentially suffocating socks, and try to recall the weather forecast. Thankfully, tonight will be cold and breezy, but not below freezing. Perfect conditions to invite the chill air in through the window next to my bed. I gratefully open the window wide and wriggle under the cool covers almost naked. The thin outside air smells exciting, like nights camped in a sleeping bag by the side of the road, like an adventure. . . . I fall asleep.

At 12:45 A.M. sweat begins to prickle up between my breasts and collect under my chin, and the nape of my neck becomes muggy. I fling the covers wide, but not out of reach, and lie spread eagled, all the better to radiate. The heat churns out of me in pulses, in surges of swelter. I am a furnace, an oven, a kiln. I can almost see the heat rays rising off me, like a cartoon of the Sahara desert. I move to the cool side of the bed. Cold air puffs through the window soothing my breasts and belly like fat raindrops on parched earth. Unmercifully, the draft stops and I pull the cold pillow against me. Slowly my body cools to lukewarm, and finding the covers again, I turn over with hopes of slipping back into oblivion.

But I have been flushed into alertness, my brain heat-activated. My left hand drops to my right breast, and I re-live finding the lump. An ordinary moment, about to watch "The Wonder Boys" with my husband on our new TV, our 10-year-old daughter sleeping with her girlfriend downstairs. Then without warning my life shifts. Lying back for viewing pleasure, with one arm behind my head, I cross the other over my chest, and my fingers graze the unmistakable lump on the edge of my breast. It is hard, not benevolently soft like a cyst, and clearly defined. Mobile. That is good, I guess. But I know that it has not been there for too long. Not 10 months earlier when my childhood best friend called to tell me she had breast cancer, and I did my self exam for three days in a row. Not even a few months earlier, when I searched my breasts again after curiously dreaming that I had breast cancer. This was a new, hard, painless lump in a 52-year-old woman. Not a reassuring picture. Sure, it could be benign, it could be a fibroadenoma. But it could just as easily be cancer. I feel it a few more times to be sure I haven't imagined it. I say nothing to my husband. We watch the movie.

My world becomes a torment of suspense. Waiting for appointments, waiting for tests, waiting for results. I am brittle, on high alert. I imitate everyday life while my mind is a din of shrieking smoke alarms, screeching air raid sirens. The taste of turmoil gags me and I lose 6 pounds. All the preliminary results are reassuring, but I am not reassured. I am expecting malignancy. More appointments, mammograms, biopsies, apprehensive anticipation, inching my way to a diagnosis. Until it is removed, I reach for the lump repeatedly, feeling it, willing it to get smaller, softer, go away.

I go alone to see the surgeon to finally find out if it is breast cancer. Of course, my husband would come with me if I want him. But I surprise myself by preferring to be alone. I want to react by myself, to deal with it by myself, to be one-on-one with the doctor. I don't want to be distracted by anyone else's feelings. I don't want to cope with accepting sympathy or support. I wonder if this is perverse. Wouldn't most people want someone with them, someone who loved them? Am I a freak to want solitude more than solace? Is my husband cold and uninvolved not to insist on coming, or is he simply respecting my needs? I go alone and wait alone, cold in a tiny paper johnny, in a room as small and sparse as a jail cell.

Through the closed door I hear the voices and casual laughter of ordinary people having an ordinary day at work. I hear my doctor speak loudly and decisively, "Stop taking the calcium. DO NOT take the calcium. Don't take that yellow pill. Tell me what I just said." I hear muffled footsteps passing back and forth beyond the closed door, while I silently sit and wait. Finally, the door swings open and the surgeon steps briskly into the room. "Bad news, Jeanne, it's cancer," and the waiting, the stomach churning waiting for the diagnosis is over. I have breast cancer. Surrounding the sinking dread is relief. I finally know. In a way, I am vindicated. I wasn't wrong to worry. I speak one word in response. "Shit".

Now, 6 months later, it's one in the morning and I am doing a self breast exam, wishing for sleep, worrying about the cancer coming back. Will it recur? How long will I live to mother my daughter? Can I hope for 5, 10, 15 years, get her to her mid twenties, maybe even married? I don't want to abandon her as a child, a teenager. Who will help her learn about boys, makeup, life? And what is this pain in my hip, my neck, what about this change in my bowels? I try to rein my thoughts in, relax, slip back . . . . I fall asleep.

I open my eyes again at 2:56, and know that this is going to be a bad one. I am not hot yet, but feel the heebie-jeebies coming on. I kick the covers off in anticipation. My skin is getting tighter and tighter, shrinking so it can't possibly cover my body. I am close to bursting, jumping out of my skin. Soon my flesh will exude through my skin like garlic through a press. Electricity is surging, pulsing through the surface of my legs and feet, crackling on and off like a flashing neon sign. My skin is on speed. Now, when the heat finally begins, it is almost a relief to feel soggy. To pump out the heat, sweat it out, and cool down. But again, my thoughts are ignited. And after pausing briefly on the mundane - what should I wear to work tomorrow? Did my daughter study for her spelling test- the cancer rumination resumes: I was diagnosed with cancer, but the surgeon, direct and uncompromisingly professional, assured me that this was an uncommon and very favorable type of cancer. Low grade, well differentiated. She told me it would not kill me. My oncologist told me I would not need chemo, the most savored words ever said to me in my life. My radiation oncologist did not encourage radiation for this favorable tumor. There was only a 5% risk this would come back and kill me, she said. She told me I was lucky.

Lucky! I am having a hard time feeling lucky. Wasn't I pretty unlucky to get cancer in the first place? I am not feeling sufficiently appreciative and thankful and I am afraid this means that I am a bad person, and that I will be punished for this lack of humility, probably with a recurrence. Of course, I was lucky to get a favorable tumor. So, I am a failure at feeling lucky. How else should I feel? I have been waiting to feel deeply changed, to feel what I have read and reread from cancer victims, or must I say "survivors"? To have each moment become precious, realize what's important in life, discover life's true meaning and beauty. I keep waiting to not feel impatient, frustrated or irritated, but grateful and blissful for just achieving life. I wait for exaltation, but it doesn't come. Why don't I feel transformed? Was my brush with death too glancing? Just enough to leave me in a state of perpetual agitation and uncertainty, but not enough to achieve grace? Perhaps the contrast wasn't big enough. I wasn't sufficiently shocked and disbelieving when I was told I had cancer, but grimly expectant of it, like the return of a bad nickel. Or is it possible that I already had my priorities somewhat in order, so the shaking of my mortality didn't cause any serious realignments? In any case, I have failed to reach this higher level. Again, I agonize over whether I am too proud and defiant in the face of cancer and death . . . . I fall back asleep.

At 6:45 A.M., the familiar and soothing voices of NPR newscasters, briefly silenced by the snooze button, coax me back into the world. I sit up, close the window, and trudge off to the bathroom to shower away the night. Reaching for my toothbrush, I see and swallow another 10 mg of Tamoxifen. I am ready for another day. Another unlucky/lucky, uncertain, unenlightened, hot flashing, but irreplaceable, day in my life.

© Jeanne Holtzman

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