I knew, of course, that I couldn't have breast cancer. Nobody in my family had ever had cancer. We were the hard-driving Type-A types felled by heart disease, not the reticent types prone to cancer. Moreover, I was scrupulous about using only underarm deodorants without aluminum, did not buy food containing chemicals, and ate copious quantities of orange vegetables, cabbage, and salmon, all of which, according to a Good Housekeeping article my friend's mother had clipped out and sent her, reduced the risk of breast cancer.
The only reason that I even bothered to go for a mammogram --my first in four and a half years -- was a series of classes Rabbi Kelemen gave on "doing your hishtadlus [effort]." The rabbi had taught that the only causal force in the universe is God. Everything happens only because God wills it from moment to moment. The Torah, however, obligates us humans to expend "normal effort." Thus, God sends us our livelihood, but we are obligated to get out of bed in the morning and go to work, because that is normal effort. And if we don't bother to expend the effort to work, God will likely teach us a lesson by not sending us a paycheck.
"Normal effort" for good health in 2003 mandates routine mammograms every two years for women over 50. I had gone for a mammogram shortly after my 50th birthday. I was appalled at how excruciatingly painful it was. Two years later, on schedule, I made an appointment for a second mammogram. It was the only time in my life that I totally forgot to keep a medical appointment. Was it my cocky certitude that I didn't have breast cancer or my primal fear of pain? Two and a half years after that, succumbing to Rabbi Kelemen's exhortations to "expend normal effort," I dutifully went for my second mammogram.
They found a lump.
I was unfazed. After all, everybody knows that most lumps are benign. And I knew that I couldn't possibly have breast cancer.
Dr. Cohen, looking grave, told me that they would have to take a biopsy. He never used the words "cancer," "tumor," or "malignancy."
After the biopsy, Dr. Cohen told me that, because they were working so close to the chest, I would have to go for an immediate chest X-ray. I started to wonder what all the urgency was about. Ruth, the somber-looking nurse (a melancholy personality, I surmised), told me to wait in the waiting room while they called the X-ray clinic. Instead, I walked just outside the entrance of the building to get better reception for my cellphone, so I could call my rabbi to ask him to pray for me. I was in the middle of getting his phone number when Ruth came running out of the building, waving the order for the chest X-ray.
"They close at three o'clock. It's 2:25 now!" Her voice was almost panicked. "Can you get across town in time? You'll have to drive fast!"
Speeding across Jerusalem, I felt like an unwitting passer-by who gets caught up in the chase scene of a movie. What was all the urgency about? I had just gone for a routine mammogram.
The chest X-ray came out clean. "Ruth needs to learn to relax," I muttered to myself.
Eight days later the Breast Clinic called and asked me to come in at five o'clock to receive the results of the biopsy. The previous week, despite my protestations, they had told me that they never give results on the telephone.
When my husband Moshe and I arrived, the waiting room, so busy and crowded the week before, was nearly empty. The only other people sitting there were an Israeli couple who looked to be in their early sixties. The woman, with henna-dyed reddish-brown hair, appeared distraught and worried. She kept leaning her forehead on her husband's upper arm.
I sat there reciting psalms and feeling sorry for the woman. Perhaps she really had breast cancer. Unlike me, of course. After about 15 minutes, I struck up a conversation with her, to divert her mind a bit. Her name, she told me, was Tzipporah. She wished she could recite psalms to stay calm. I offered her my book. She smiled and shook her head. Just then, a nurse called in Tzipporah and her husband.
Twenty minutes later they emerged, looking stricken. Tzipporah could barely walk. She leaned on her husband. Filled with sympathy, I jumped up and asked her, "Tzipporah, do you want me to pray for you? What's your mother's name?" Her eyes dazed, Tzipporah nodded, and barely croaked out the name, "Rachel."
At that moment, Dr. Cohen called in me and my husband. I had imagined the scene a dozen times during those eight days. He would usher us into his large, well-appointed office. We would sit down across the desk from him, and, with a relieved smile, he would announce, "The tumor is benign."
Instead, he ushered us into a tiny room dominated by a lit-up screen. Perched in front of it was my mammogram. The three of us squeezed into three chairs that were facing the screen.
"Now this is the lump," Dr. Cohen pointed to a bright spot of light that looked like the head of a comet, "and these are the irregular cells which extend from it, six centimeters along the milk duct." He pointed to specs of light that looked like the thin tail of a comet. He then launched into an explanation of the significance of calcification of cells.
Moshe and I were confused. What did it all mean? Finally Moshe piped up. "You mean the lump is not benign?"
Breast cancer. There are words that explode like bombs.
Slowly Dr. Cohen shook his head. "I'm afraid not. It's breast cancer."
Breast cancer. There are words that explode like bombs. Moshe clutched my right hand. Breast cancer. I sat there silent, the truncated limbs of my life strewn around me like the aftermath of a terrorist attack.
Finally I blurted out, "I can't have breast cancer. I have two books to write!"
Dr. Cohen fixed me with his eyes. "You're not going to die from this. We've caught it early. This is Stage One Cancer. The tumor is only five millimeters. But you will have to have a mastectomy."
"Why not a lumpectomy?" I protested. I don't know how I remembered the word. Or any words. In an emergency room after a terror attack, I had seen victims in shock. They had no visible signs on their bodies, no burns, no shrapnel, but they stared straight ahead and did not speak.
Dr. Cohen pointed again to the tail of the comet on the mammogram. All those cells would have to be removed. It would leave the breast so disfigured that there was no point in keeping it.
I don't remember what else he said. Finally, he recommended two surgeons to us, and handed my husband a note with their names and phone numbers. We left, as dazed and stricken as Tzipporah.
A diagnosis of cancer is like a black hole. It sucks you in at a dizzying speed and dumps you out in a different universe. We emerged from that tiny room denizens of a new, strange world. It had its own language: stages, levels, in situ, invasive… It was populated by people who had survived cancer or were in the process of not surviving it, all walking incognito among unafflicted foreigners, their brand, their scarlet letter "C," invisible beneath their flesh.
A doctor would later tell me: "One in nine women will get breast cancer. Among Ashkenazi Jewish women, it's one in eight. You have no idea how many women you know who have had breast cancer."
As we left the breast clinic, I thought of my four friends who had died of cancer -- two of breast cancer, two of ovarian cancer -- during the last eight years. How could Dr. Cohen be so sure I wouldn't join them?
As soon as we reached our car, I picked up our cellphone and called Rebbetzin Milakovsky, in order to get an appointment with my rabbi. "Rebecca, how are you?" she asked in her sweet, Polish-accented English.
"It's… it's…" The words "breast cancer" simply would not come out of my mouth. All I could do was cry into the phone.
On the way home, we had intended to stop at the butcher shop in town. My sense of efficiency (after all, we were already out in the car) would not let me renege on the errand. Since finding a parking space in downtown Jerusalem is nearly impossible, we decided that Moshe would circle around the block while I ran into the butcher shop.
As soon as I emerged from our car onto the crowded sidewalk, I felt like I had stumbled onto a firing range where the shooters were oblivious to my presence. Every look, every gesture -- a gruff word from the normally gruff butcher, a fellow customer jostling me to get to the frozen ground beef -- would be lethal in my condition. I was on the verge of tears. I felt like screaming: "Be gentle with me, or I'll shatter."
Of course, how could they know that I had just been diagnosed with cancer? Suddenly, with horror, it dawned on me: Just as my affliction is invisible to them, how many times had I spoken curtly or with exasperation to a stranger or to an acquaintance who also may have just been diagnosed with a dread disease? How would I know? How could they know?
Abashed, I remembered Rashi's commentary on the Torah's injunction not to verbally afflict with words a widow or an orphan. The 11th century sage Rashi wrote that the proscription extends to not verbally afflicting anyone, because, although the widow and orphan are the most obvious examples, everyone suffers.
I managed to make my purchases and leave the store without breaking down in tears. My two bags of frozen poultry, salmon, and vegetables were heavy. By the time I turned the corner to the street where I hoped my husband would find me, I could carry them no further. I plunked the bags down beside me and waited for our car to pass.
A young man in his mid-twenties, wearing a knitted kipa, was walking along the sidewalk, which, due to construction, narrowed at the point where I was standing. When he reached me, he jumped over my bags and continued walking. Two meters further, he turned around, smiled, and asked, "Can I help you?"
It was a simple act of noticing that a stranger might be in need. In my fragile state, however, I felt like I was the beneficiary of a world-shaking magnanimity. I was so moved by his kindness, that I could not speak. I shook my head mutely. And I wished that I would be the type of person whose random love could rescue strangers from the depths.
Two days after my surgery, a volunteer from the Israeli Cancer Society -- a woman who had undergone a mastectomy five years ago -- visited me in the hospital. In the course of our conversation, I said to her: "Well, the surgery is over. Now the worst is behind me."
She replied acerbically: "Once you've lived through the diagnosis, the worst is behind you."
I nodded my head knowingly.
OPENING THE LETTER
The next morning, I splurged on a taxi to the Kotel. (In the weeks leading up to my mastectomy, I would treat my body to many indulgences, trying to console it for the ordeal visited upon it -- hand-made jasmine soap, two suits, a massage, and two hats. Although our budget could ill afford these luxuries, and I felt like a clliché buying a hat to ward off depression, the truth is they made me feel feminine and attractive, a dire necessity, not a luxury at all, for a woman with breast cancer.)
Our sages say that when afflicted with suffering, a Jew should not ask, "Why?" (for who can fathom God's infinite mind?), but rather, "What?" "What do You want me to learn from this?" "What is the lesson hidden behind this suffering?" "What do I need to change in myself?"
The Kotel, or Western Wall, is the second holiest Jewish site after the Temple Mount. According to the Talmud, the Divine Presence never leaves the Western Wall.
I went to the Kotel the morning after my diagnosis to ask God what He wanted me to learn from this sudden and traumatic hairpin turn in my life. Fourteen years ago, my husband and I had become Torah-observant Jews. Moshe had left a lucrative psychology practice and I a budding writing career to raise our children in the holy atmosphere of Jerusalem. I idealized growth and was willing to pay a steep price for self-change. But breast cancer? Rather than the next segment of road on my spiritual journey, breast cancer seemed like a gigantic obstacle blocking the road.
God was sending me a message in a sealed envelope. I prayed to open the envelope and read His letter.
I sat in the shade of the ancient wall and meditated. Everything, everything, everything comes from the One Source. The same God who gave me my husband, my four wonderful children, my apartment in Jerusalem, and every single breath, that same God was now giving me a malignant tumor in my left breast. God was sending me a message in a sealed envelope. I prayed to open the envelope and read His letter.
I had learned to meditate by "putting my mind in neutral." Then, if I was fortunate, my mind would slip into "intuitive gear," where ideas would spring not from my intellect, but from a higher faculty, connected to the Divine. "Poor man's prophecy," my husband called it.
What do the breasts represent? I asked. The answer came clearly: They are the organs of nurture. What is this tumor growing in the milk duct? It is a blockage. What is blocked about my nurturing, and why in the left breast?
The answer almost knocked me off my chair. In Kabbalah, the right side stands for chesed, a free pouring-forth; the left side stands for gevurah, restrained giving, holding back, din, judgment. Known among my friends as a generous and loving person, always the first to volunteer to help a needy neighbor, I was okay on my right side. But there was a blockage in one of the 36 milk ducts on my left side. There was something wrong with my gevurah.
Both chesed and gevurah are modes of giving. Chesed pours forth without restraint. Sometimes that's not the best way to give. Sometimes the one receiving requires more measured giving. For example, Albert Einstein teaching math to an eight-year-old would not help her by pouring forth everything he knows. The pure exercise of gevurah, however, must be dictated by the needs of the receiver, not the limitations -- the stinginess or meanness -- of the giver.
A blockage in the left breast. In front of my mind's eye I suddenly saw all the people whom I refuse to nurture: my political opponents on the Israeli left; people I don't approve of; unmarried men over forty who suffer from commitment phobia and don't deign to marry my single friends; pro-Arab academics; vociferous feminists (of whom I used to be one); American Jews who spend their tourist dollars in Europe instead of Israel; and a host of other people guilty, in my mind, of moral failures.
With this revelation came another that overwhelmed me: God has sent me this message, this cancerous tumor, because He believes in my ability to grow, to change, to become more loving, tolerant, and empathetic than I presently am. I think I am, by anyone's standard, already a good person and a good Jew. But I have the potential to become even better, not to rest on my laurels, not to continue strolling down my spiritual path at a comfortable pace, but to race forward. The cancerous tumor is a ball that God is throwing me, confident in my ability to catch the ball and run with it. With my diagnosis of breast cancer, I have been upgraded to the fast lane.
I had the sensation of a hand on my back pushing me to run faster than I ever thought I could. I either had to double my speed or fall flat on my face. But with His other hand, He was holding me up. I wouldn't fall. Spiritually, I could really become someone great. I sat there by the Kotel, the tears streaming down my face, and thanked God for the gift of the tumor.
Then I took the bus home. (I no longer felt the need for petty indulgences.) I walked into my apartment feeling exalted, privileged, closer to God than I had in years.
It was Lag B'Omer, a minor holiday in the Jewish calendar. All my children were home from school. The night before, my husband had explained to them that Ima is sick with something serious but not life-threatening, and she will need an operation. They shouldn't worry, but they should pray -- hard.
Now, as soon as I entered the living room, they all besieged me. They were fighting about a piece of a board game which Sheina, my 15-year-old, had lent Mordechai and Shimon (12 and 10 respectively), and they had somehow lost. Even little Shoshana (7) joined the fray.
I stared at my clamoring children and thought: "How did these aliens invade my new world, my world of cancer? Here I am about to lose a part of my body, and they are crying about losing a plastic game piece?"
I lifted my hands to heaven in a gesture which 17 hours before would have seemed to me melodramatic, and in a choked voice croaked: "Your mother has cancer! It's a serious illness. I can't take all your bickering and fighting. Do you want me to move out of the house until my operation?"
As the children stood there, their mouths agape, I ran to my room, flung myself on my bed, and cried.
And that's how it was for the next few weeks: I was a pendulum swinging between spiritual exhilaration and sudden depression.
Bernie Siegel's Love, Medicine, and Miracles convinced me that depression is a breeding ground for cancer. I went to Rabbi Kelemen and asked him for a method to make myself happy.
He pointed to a blessing that every observant Jew says every morning: "Blessed are You Hashem, our God, King of the Universe, who fulfills all my needs." He explained that this blessing signifies that everything I need, I have. Contemplate this truth, he advised me, and I'd be happy.
"Everything I need, I have." I started to repeat this over and over to myself. Of course, to believe in God means to know that He runs the world and dispenses to every single soul exactly what that soul needs to accomplish its purpose in this world.
Then, I realized, the converse must also be true: Whatever I don't have, I don't need. If, after my mastectomy, I don't have a left breast, then I don't need a left breast.
If I have a malignant tumor, I need that tumor for the lesson it has come to teach me.
A second converse also occurred to me: "Everything I have, I need." This means that if I have a malignant tumor, I need that tumor. I need it for the lesson it has come to teach me. If I have a nasty downstairs neighbor, then I must need that nasty neighbor. I need him for the spiritual growth that ensues from dealing with a difficult neighbor according to all the lofty interpersonal commandments the Torah enjoins upon me. If I have an unpleasant encounter with a friend, then I need that encounter. It, too, has a lesson to teach me.
Wherever I went during the following weeks, as I ran around to doctors and tests, a liver ultrasound, a bone scan, blood tests, pre-operative screening, genetic testing to determine whether I had the gene for cancer, etc., I repeated my new mantra: "Everything I need, I have. Everything I have, I need."
Sometimes, after a particularly trying experience, I would have to repeat my mantra a dozen times until I calmed down and regained my perspective. The mantra did make me happy, or at least content that God is in control and that whatever He sends me is for my spiritual benefit.
Two days after the diagnosis, my husband and I went to see one of the surgeons recommended to us, Dr. Oded Olsha, a middle-aged man born in Australia, educated in Israel and England. After examining me and my mammogram, he asked me how long it had been since my previous mammogram.
"Four and a half years," I admitted guiltily, adding, "I know I should have gone every two years."
"With a tumor this small," Dr. Olsha remarked, "even if you had gone two years ago, it's doubtful they would have found anything."
"You mean I don't have to feel guilty about neglecting mammograms?"
Dr. Olsha raised his bushy eyebrows, appalled. "Is someone trying to make you feel guilty? How dare they!"
How does one choose a surgeon? My best friend was insisting that I search out the most expert surgeon in Jerusalem, that I not settle for a mere good bedside manner, and that I check, double check, and crosscheck Dr. Olsha's credentials. As far as I was concerned, however, the moment Dr. Olsha took my side against all my own inner voices of guilt and reprehension, I knew I had found my surgeon.
Dr. Olsha corroborated what Dr. Cohen had said. I would need a mastectomy, but, pending the results of all my tests, most likely I would not need radiation nor chemotherapy.
He explained that the surgery would include a "sentinel node biopsy." Until recently, he said, a mastectomy included removing all the lymph nodes under the adjacent arm, because the tumor may have drained into them, spreading the cancer. This kind of operation, called a "radical mastectomy," usually left life-long pain and swelling in that arm. Many women who have undergone a radical mastectomy had to wear an elastic sleeve over their arm to control the swelling.
The relatively new procedure of the sentinel node biopsy involved injecting the area of the tumor with both radioactive matter and blue dye before the surgery. Then the surgeon could identify which specific lymph node or nodes drained from that particular area. While the patient was still on the operating table, a fast frozen biopsy was made of just the blue lymph nodes. If they were clean of cancer, no additional lymph nodes would be removed.
"Everything I need, I have." I thanked God that I had breast cancer in 2003 and not five years earlier.
After explaining several other points, Dr. Olsha asked me, "Do you have any questions?"
I surely did. "Dr. Cohen said I wouldn't die from this. But I have friends who died of breast cancer."
I was thinking of Ella, whose death five years before had left a permanent sore in my heart. Ella was the mother of eight children, the youngest of whom was 18 months old when Ella died in the very hospital where Dr. Olsha would operate on me.
At Ella's funeral, when it was time to say kaddish, I noticed all the men on the men's side of the funeral parlor standing in a bowed position. This was strange, for kaddish is not one of the prayers we say bowing. Only a couple minutes later did I realize that the men were bending over in order to hear six-year-old Yankl, Ella's oldest son, recite the kaddish for his mother. On Ella's 41st birthday, several of us had surprised her with a small, impromptu party. We drank toast after toast of orange soda, raising our paper cups to "L'Chaim," to life! Six weeks later she was dead.
"How does Dr. Cohen know I won't die?" I demanded. "Breast cancer is a fatal disease."
Dr. Olsha answered in a gentle tone. "The breast cancer that younger women get is a much more aggressive kind. Post-menopausal women get a slow-growing cancer. We could wait a month, even three months, to remove your tumor, and no harm would be done. With the size of your tumor, the recovery rate is 95%."
I felt that the diagnosis was a death sentence, and Dr. Olsha's words were a reprieve. It never felt so good to be middle-aged!
We set the date for the surgery five weeks hence. That would give me time to do all the tests and to do "my research" on breast cancer and the pros and cons of reconstructive surgery, as well as to check out references on Dr. Olsha, just to please my friend.
HOW GOD FEELS
The evening before my surgery, I packed a small valise with a robe, slippers, toothbrush, toothpaste, two books, and bottled water, and set off to the hospital with my husband. All the way there, I was haunted by a sense of déjà vu. We had followed the same procedure each time I had gone to the hospital to give birth to one of our children. Those times, however, what had come out of my body was life: precious babies who filled me with delight. This time, what would come out of my body was death. And I would leave the hospital with less than I had arrived with.
Yet, I told myself, this surgery was also a birth. Out of this experience, I hoped to birth a new understanding, a gentler, more compassionate self. It was up to me if I left the hospital diminished or augmented.
Early the next morning, Dr. Olsha appeared at my bedside. He held two syringes, one of them grotesquely large. "I have to inject your breast with the radioactive matter now," he explained apologetically. "The blue dye you'll get in the operating room, but this stuff needs time to work. I'm really sorry. This first injection is going to hurt." He paused. "And the second one will hurt even more. I'm really sorry to have to do this to you."
He administered the first injection into my breast. It burned and stung. The second injection felt like the fires of hell liquefied into a syringe. I looked away and repeated my mantra, "Everything I have, I need."
"Now you know how God feels. People are always blaming God for all the pain there is in the world. But He's only doing it for our ultimate good."
When it was over, Dr. Olsha said, "I feel terrible to have to do this to my patients."
I tried to console him. "You're doing this for my benefit, so I won't need to have all my lymph nodes taken out." Looking at my kind, secular surgeon, I added: "Now you know how God feels. People are always blaming God for all the pain there is in the world. But He's only doing it for our good, for our ultimate good. And He feels even worse about having to inflict pain than you do."
THE FIRST SHOWER
The day after my surgery, many guests came to visit. I was busy all day, with barely a chance to read the book I had brought. Late at night, when all my visitors were gone, Dr. Olsha came to check my incisions. "Have you taken a shower yet?" he asked.
"No, I've been too busy."
"Well, it's a good idea to take a shower," he suggested. "You'll feel better."
After he left, I thought hard about his gentle suggestion. Years before, my friend Etty had told me that her young sister-in-law had had a mastectomy. When I inquired how she was doing, Etty replied, "She was doing okay… until she took her first shower. It was traumatic for her to see herself."
I took a good look at my own mind. Was I really too busy -- and now too tired -- to take a shower, or was I avoiding my own image in the mirror?
It was 11:00 at night. My three roommates were asleep. I lay there thinking about my now disfigured body. It would look strange, even freakish. "You're deformed now," I told myself, then edited the sentence: "Your body is deformed now."
Suddenly I thought of my mother, may she rest in peace. A beautiful woman, she cared little about fashion, jewelry, or makeup. While my friend Babette's mother used to say to her, "The most important thing in the world is to be pretty and thin," my mother's values were: Be good and be smart. It occurred to me that if I had had Babette's mother, this mastectomy would have decimated my sense of self. Thank God, I had my mother, who from my earliest years had inculcated in me a sense of self not defined by my body or my appearance.
"Everything I need, I have" did not refer, I realized, only to the things and people in my life. It also referred to my inner resources, my strengths, talents, and capabilities. God had prepared me to cope with my mastectomy 55 years ago, when He assigned my soul to the womb of this particular mother, who would raise her daughter with a sense of self that would remain intact even when her body wasn't.
With that I got up from my hospital bed and went to take a shower.