Molly's Cancer -- ''Maybe, Deep Down, I Suspected Something Was Wrong''

Already it's been a difficult month. My father has moved into a nursing home after several years of failing health. My mother's still recovering from the strain of caring for him. The whole family is coping with visiting him there.

It's December 1990. Three days after Christmas, I come into work here at Pacific magazine. I'd asked for the previous day off "for some tests."

I run into a co-worker. She asks how the tests went.

"Not so well," I say. "It's cancer."

"Your father?"

"No, me."

I was 34. Playing in two basketball leagues, hitting a few tennis balls, running, doing some weights, feeling good.

And not surprised to learn I had cancer.

Maybe that's not so unusual. Maybe nowadays everyone figures they'll eventually get cancer.

Or maybe, deep down, I suspected something was wrong.

July 1990. It's a few months before the abnormal mammogram. We're working on the fall fashion issue of Pacific magazine. I know less about fashion than about neural networking. Friends tease me about the range of colors I wear, all the way from blue to gray.

But I have hair. Down to my knees. So, at my editors' request, I write about having long hair.

The headline (which I don't write): "Signature Hair."

The subhead (which I do): "The trick is to not get too attached to it."

The piece ends with a story about Barbara, a woman I've just met at a Buddhist retreat in Massachusetts. She has no hair. Assorted colorful hats. Large, dangling earrings. She almost flaunts her smooth head. Quite avant-garde, I think.

Until I hear why she has no hair.

Chemotherapy.

Then, back at the newspaper, there's the day my hair catches in the hinges of a bathroom stall door. It's not the first time. It's usually catching in something or other. Seat belt, door knob, belt buckle.

It's also not the first time that, after my initial irritation, I think:

Don't be impatient. You won't have this frustration anymore after it all falls out.

Attachment. It can be very tricky. I'd been working on it for several years, while looking into some Buddhist teachings and meditational practices. Attachment and aversion. Nonduality. Equanimity. Compassion. Emptiness.

Attachment to hair, to ego, to appearance. Aversion to illness, suffering, death.

Namkhai Norbu Rinpoche, the Tibetan lama leading that Massachusetts retreat, emphasized integrating the teachings into daily life. Around the clock, ideally. That was challenging enough, even when I was healthy.

But with cancer?

November 1990. I'm standing at the kitchen counter at home, chopping vegetables. Phone rings. I grab it, stretch the cord, and continue chopping.

It's Dr. Heilbrunn, the radiologist I haven't met. He's checked my mammograms. There are a few dots he thinks should be looked into. It could be just calcifications; could be something more. He'd classify them as Level 3, he says. Based on his track record, when something is Level 3, 16 percent of the time it is cancerous.

Gulp.

For an instant, I feel like I've been punched in the stomach. I put down the paring knife, pick up a pen and begin writing down what he had just said. As I scribble, Heilbrunn breaks the silence.

"Are you OK?"

"Yeah, I'm just taking notes."

It's called "the annual company mammogram." Sounds like "the annual company picnic." But much easier. I didn't even have to leave the building.

The idea is to encourage early detection, for employees and their families. Cancer that hasn't spread beyond the breast can mean lumpectomy, not mastectomy. Removing only the tumor, not the whole breast. And maybe only radiation, not chemotherapy.

I'd actually thought about getting my first mammogram the previous year, but never got around to it. I decided this time there really was no excuse. I was a little younger than the usual age - 35 or 40 - for first mammograms. But my risk, statistically, was greater: My mother had gotten breast cancer 30 years earlier.

A few days after the company mammogram came a call: Could I go in for a magnified mammogram? Sure. I didn't give it much thought.

But my eyes watered a bit after that call from Dr. Heilbrunn. Then came the referral to Dr. Rick Clarfeld, a surgeon who specializes in breast disease. An in-office needle biopsy produced "suspicious" results. He ordered the full-fledged biopsy.

Dec. 27, 1990. Biopsy day. Waiting with my friend Torben in the PolyClinic surgery center. I pick up that morning's USA Today. Headline: "Epidemic of breast cancer hitting women."

A couple hours later, I was one of the 175,000 women in the U.S. diagnosed in 1990 with breast cancer.

I'd prepared myself for the worst. Which I usually do, biopsy or Seahawks game. So it wasn't a shock. Not even when Dr. Clarfeld suggested the possibility of having a double mastectomy, to prevent the cancer from spreading to the other breast.

The hardest part of the day was telling my mother.

I was her "baby," the youngest of six. We'd grown even more close in the past few years, as my dad's health deteriorated. I dreaded breaking the news to her.

She wasn't there when Torben and I arrived at her house in the Ravenna neighborhood. I felt like chickening out: We could go home and call her later, I said. Torben was gentle but firm: We should wait and tell her in person.

I knew he was right. In the seven years we'd been together, he was usually right about such things. Which was fine with me.

Torben and I shared so many things, from ball playing to Buddhist teachings to Indian food. We also shared respect for each other's strengths: maybe my organizational skills and spicy cooking; certainly his kindness, patience and flexibility. Like telling me later that it was OK if the strain of the coming months would make me grumpy; and OK if I didn't do my usual chores around our apartment.

And I appreciated him thinking of my mother at a time like this.

My mom finally got home after almost two hours. We three sat down in the living room like any visit. She started telling us where she'd been, what she'd been doing. When she stopped, I said we'd come from the PolyClinic, where I'd had a breast biopsy, and it was positive.

Silence.

Then tears filled her eyes, which made tears fill my eyes. I got up, then she got up. We hugged, and cried.

After a little while, she turned the conversion upbeat. Which she usually does. "Well, Molly, I beat it," she said. I told her how I'd start doing some research, get second opinions, look into the lumpectomy vs. mastectomy issue. Take it from there.

We didn't stay much longer. Torben drove us to our Belltown apartment. I was a little down. Not because I had cancer - I figured I could handle that. I felt sorry because I'd made my mother sad.

Cover headline, Time magazine, Jan. 14, 1991:

One American woman in ten will get

BREAST CANCER

Why - and what can be done?

Everywhere I turned, there was more breast-cancer news. Was there this much before, and I just didn't notice?

At times all this information was overwhelming. But I needed enough to make decisions: Which surgeon? Lumpectomy or mastectomy? Which oncologist? What about reconstruction? Which plastic surgeon? TRAM flap or implant? Silicone or saline?

My boss said to take off whatever time I needed. Only later would I realize how important - and rare - that kind of support can be. I told her I might want to write about this whole experience one day. Betty Udesen, then the Pacific staff photographer, started tagging along. Her mother died of breast cancer.

I phoned the National Cancer Institute for free copies of research articles. Joined the UW Alumni Association so I could use the Health Sciences Library. Hit the downtown public library. Tried to get semi-conversant in flow cytometry, T-cells, estrogen receptors. Called the American Cancer Society for phone numbers of women who had reconstructions, and those who did not. Gathered more than 80 names and phone numbers from family, friends, the medical community. Called about half of 'em.

I wound up seeing three surgeons, three plastic surgeons and five oncologists.

The year is 1977. I'm getting second opinions on the knee I blew out playing basketball. One surgeon says that although he would operate for a male basketball player, he wouldn't for a female, because a career isn't at stake. The surgeon at Group Health calls the operation "experimental surgery" and writes in his notes that "she's just looking for someone to tell her what she wants to hear." I wind up choosing one who's a five-hour drive away. Not just because he's a well-known specialist, but because he's the only one who actually takes the time to address all my questions.

I was prepared for a similar battle. I was surprised. Appointments were granted within days, not weeks. Doctors were less defensive. Questions welcome. Counseling and support groups at every turn. Had the medical world changed that much since '77? Or just for this disease?

Still, it seems as if today's model patient asks a couple of questions and trusts the doctors and the system from there. I didn't. Maybe it was my journalistic training, or some notion that I could understand a few of the details, even if I hadn't gone to medical school.

Asking a lot of questions meant challenging authority. I cried while trying to argue my point with that Group Health knee doctor. He took it as a sign of emotional instability.

I'd worked on that, being less attached to my arguments, having less fear of being wrong or disliked. Yet, in doctors' offices, sometimes I still wouldn't think of what to ask until a few hours after I'd left. I went into every meeting with a written list of questions.

Like with my knee injury, I wanted to understand the disease and the treatments. That meant asking as many questions as it took. Having doctors who would answer them.

And answer them not begrudgingly. Unlike one doctor, who told me, "If it makes you feel better to do all that reading and ask all those questions, then go ahead." I also heard: "You're trying to get information to make decisions, not to be an oncologist."

I gave up trying to convince doctors of my point of view. I just took a deep breath and kept asking. Even the hard ones ("How many of these procedures have you done, Doctor?").

It came down to taking complete responsibility for my health.

I had as much support as I could have asked for: family, friends, employer, nurses, doctors, insurance company. But they could not make these decisions for me. I was truly on my own.

The moment I realized that, I never felt so alone.

I'm getting names and phone numbers from a friend who had breast cancer many years ago. They're for "the underground," people who believe in non-toxic therapies. Usually as an alternative to chemotherapy.

My friend moved from Seattle a few years back. She says she was diagnosed as terminal, started but couldn't handle the chemo, pursued a holistic approach to treatment, and is cancer-free some 20 years later. She warns me she hasn't been in touch with these references lately.

"Don't panic if some of them have died," she says. "That happens."

Doing the research and seeing the doctors helped me both understand and question our medical system. How conventional medicine - and much of our society - is based on research according to the scientific method. How strong the threat of malpractice suits is. What roles the drug companies play. How, for now, we mostly treat cancer, not prevent it.

All that made me more interested in alternative approaches. I wanted to know my options.

Most of the places I called were in Texas or California. They have offices in the U.S. but clinics south of the Mexican border. There, therapies aren't under the scrutiny of the AMA or the FDA. For better or worse.

The brochures, newsletters and tapes outlined their treatments. Everything from laetrile to chelation to detoxification to New Zealand sheep glandulars. Some family and friends who knew I was gathering this information were nervous, even if they didn't say so. Would I go off the deep end and move to Tijuana?

I felt that pressure. Which bothered me more than the thought of the treatments themselves. I found local doctors for advice on vitamin supplements and diet. I'd give the conventional route first crack. Most of the alternative treatment information went unread.

But I haven't thrown it out.

Torben tells our apartment manager I have cancer. She watches over our building and its tenants like a mother. The next time I see her, the first thing she does is reach out, touch my long braid, and say, caringly, "Oh, that beautiful hair."

My hair? What about my life?

Pretty quickly I realized I wasn't dealing only with cancer. I also had to cope with others' reactions to the disease. That wound up taking almost as much energy as the cancer itself.

Some, like our apartment manager, focused on chemotherapy and its potential effects.

Others looked for consolation: "Well, it's a good thing you caught it early." A statement, not a question. I was young; the cancer also must be young. I didn't want to disappoint them by telling the truth: We didn't know yet if it was caught early. Only the lymph-node lab tests, after surgery, would tell.

From a few, I never saw a reaction. I know of two old friends - living in Seattle - who were told by others that I had cancer. Almost two years later, I still haven't heard from them.

"I always thought I'd be the first to get it." - My oldest sister, when I told her I had breast cancer.

A week before surgery, we had the first of two family meetings about breast cancer. Myself, my mother, two sisters, a brother-in-law, a niece and, despite the subject, the usual family joking around (it's not uncommon for the Baltimore catechism to come up). My niece taped the meetings, and sent copies to those who couldn't come.

We sat around the coffee table in my oldest sister's living room. I went straight into my latest thoughts on reconstruction and lymph nodes and didn't come up for air till 20 minutes later. My brother-in-law asked me to back up a little. And the questions kept coming: What type of cancer was it? Is it on one side or both? What doctors had I seen? Why did I settle on particular ones? What's the hereditary factor?

I started again, at the beginning, and gave them a blow-by-blow of what had happened, whom I'd seen, what I'd done. Told about how one doctor said my support system was important, that I should be sure to get 12 hugs a day, and then he got up and gave me one. We laughed; our family was close, but we weren't big on hugging.

My mother talked about the radiation treatment after her mastectomy in the early '60s. How she had to take the bus, transferring two or three times, to get to Virginia Mason. She had to sit alone in a cold, scary room for the cobalt therapy. She was so tired when she got back, she could barely climb the few steps to our front door. One sister always had chicken soup ready for her. Another had given her a bright pink coat to wear, that she somehow drew strength from.

After two hours, one sister's final question: "What can we do for you, and what should we do for us?" For me, nothing, I said, I just need to come to terms with the decisions I have to make. For them, do breast self-exams, have regular mammograms, consider a low-fat diet.

We all started to leave. But first my mother walked up to me. And gave me 12 hugs.

"What's the problem?" - Dr. Clarfeld

Lab tests from the biopsy showed the cancer wasn't large, but it was spread out. I should have a mastectomy, not a lumpectomy. On one side, not both. My energy switched to whether to have reconstruction. It would become my most difficult decision.

I'd found a plastic surgeon I liked, Dr. Frank Thorne. I knew I wasn't interested in the TRAM flap, where stomach tissue was moved to form a new breast - too complicated. The debate was just under way about the safety of silicone implants. Dr. Thorne thought they were safe. Saline was another option.

Surgery approached. I wavered. Called women with implants, women without. Had lists of questions for Dr. Clarfeld, Dr. Thorne. Finally, during yet another phone call, Dr. Clarfeld's no-nonsense manner broke through, and he asked that simple question: What's the problem?

Too simple, too direct. I started crying.

During a long talk with Torben, I began to understand the problem. I couldn't quite reconcile having a reconstruction with the image I had of myself. Makeup, hairstyles, the latest fashions had never interested me. It seemed like plastic surgery belonged in there somehow.

Deep down, however, I wanted to have the reconstruction. That just wasn't consistent. And it bothered me.

Torben put his arm around my shoulders and said something I hadn't thought of:

"So don't be consistent."

I went for the saline implant.

Jan. 24, 1991. Two days before the mastectomy. I see Dr. Clarfeld to sign the surgery consent form.

We sit down in his office. I take out a T-shirt from my backpack and tell him Torben's son is in this hard-rock band, Metallica. I thought a shirt from their first album was appropriate to the occasion. The shirt says: KILL 'EM ALL.

I give it to Dr. Clarfeld. And think I detect a slight smile.

The next morning's newspaper: "Breast cancer risk increases" (from one in 10 to one in nine).

Jan. 26, Swedish Hospital. I know this routine, from the biopsy and knee operations. Strip, put on hospital clothes. It takes two shower caps to hold in my braided hair. I get to walk to another waiting area and get up on the bed they'll roll into the operating room.

The anesthesiologist asks, "Which side are we doing?"

I answer, "Left, I hope," as she starts the sedative.

I lie there, talking with Torben and Betty. Dr. Clarfeld comes in before washing up. Still in his street clothes. He pulls open his jacket, Superman style. Underneath, the KILL 'EM ALL shirt.

We all break into laughter.

Surgery went well. Mastectomies are known for being fairly low-pain procedures. My only major discomfort was from the drainage tubes, which stung like heck when I moved. The second night I was more uncomfortable, apparently because the substitute nurse (who twisted her hair around her finger like Gilda Radner) was squeamish about dealing with those tubes.

Daytimes were dominated by my roommate, T., who also had a mastectomy. She was in her early 70s. Usually the curtain was drawn between us. She turned her TV volume on loud. She had only one visitor, no flowers. I asked if it was OK to set some of mine over by her, by the window. She gave the doctors and nurses hell. Insisted she didn't have cancer, so why did they remove her breast?

Three days after surgery. I've finished my morning sponge bath. Feel refreshed, sitting in a chair, ready to get the OK to go home. Dr. Clarfeld comes into my room. A few pleasantries, but he seems a bit somber.

The lab report is back, he says.

The lab report. I've almost forgotten about it. My mind changes gears, fast.

The cancer has spread to the lymph nodes, Dr. Clarfeld says.

How many? I ask.

In six of the 15 nodes removed.

Six? I said. SIX? Zero is considered great, two is still not too bad, 10 is very bad. Six meant my chances were much greater that the cancer would spread, if it hadn't already.

Six meant I had to have chemotherapy.

I sat there after Clarfeld left. My hospital roommate, T., called out from behind her curtain. Molly, are you crying?

Yes.

A little later, Dr. Thorne comes in. How are you doing? OK, but did you hear my node news from Dr. Clarfeld? Six! Dr. Thorne says he's sorry.

From behind the curtain again, T. rats: She's been crying, T. tells Dr. Thorne.

I have to laugh.

I returned to research mode. For another four weeks. One doctor didn't like one of the strongest chemotherapy drugs, said it damaged the heart muscle. Another doctor disagreed, saying such damage occurred when the drug was given without limits. Now they'd come up with a maximum lifetime dose, and would not exceed it.

I realized I didn't have the knowledge or time to really understand the subtleties. I had to pick a doctor. And trust him.

I went with Dr. Henry Kaplan at Swedish, and the chemotherapy he recommended. It was stronger than the usual chemotherapy for breast cancer (because of those six lymph nodes). Dr. Kaplan had practically guaranteed my hair would fall out. But I didn't want fear of losing my hair to drive my decision.

The closer I got to the start of chemotherapy, the less I seemed to worry about it. I turned the corner when I found out it wasn't guaranteed that I'd be depressingly sick for the next four months. I talked to a women who was going through the same treatment. She said it wasn't that bad. She was tired, and had a funny metallic taste in her mouth, and the only things that she really could eat were milkshakes.

I could live with that.

Feb. 27, 1991: The war in the Persian Gulf ends. Chemotherapy begins.

These days it's not uncommon for cancer patients to be encouraged to use visualizations. Usually to help "fight" cancer: see the cancer cells as "the enemy," see the white blood cells as the good-guy attackers leading the charge in this battle inside the body.

Not for me. The T-shirt for Dr. Clarfeld notwithstanding, I wasn't a battlefield. Kuwait was a battlefield.

In the meditation and visualization practices I had already been doing, the approach wasn't so much that the cancer cells were enemies. Rather, one tried to see them as cells gone awry, needing purifying and compassion.

It also wasn't me vs. them. The idea was to see through that duality.

There is no "them." There is no "me," either, for that matter. But maybe that's another story.

The evening that chemotherapy begins, Torben and I go to a Chinese restaurant. I feel fine, eat normally. I pass up my usual glass of wine with dinner because I hear alcohol doesn't mix well with the drugs.

After dinner, I open my fortune cookie. It says:

THERE IS A PROSPECT OF A THRILLING TIME AHEAD FOR YOU.

Dry eyes, itching eyes, puffy eyes, watery eyes, blurry vision. Sore mouth, mouth sores, sensitive teeth. Weak fingernails. Heartburn, nausea. Sore skin, leg cramps, aching joints, fatigue.

Written down like that, it now looks worse than it was. Maybe I was lucky. For me, chemotherapy side effects were mostly a series of annoyances. And possibly a bit of a mind game.

(Also, I never did get stuck on milkshakes. But over one stretch I craved only spaghetti with tomato sauce. And in another three-week span, I ate more hamburgers than I think I had in the previous three years.)

In the final couple of weeks of chemotherapy, though, I understood why that treatment lasted only four months. The body started breaking down. The little annoyances wouldn't heal any more.

All those disagreeable side effects. And one bonus:

No acne. For the duration and several months beyond. It was probably the longest spell of clear skin I'd had since I was 12.

"Sorry for the delay in thanking you for the book you sent. It arrived at a time when I didn't want to read anything about `having' cancer. It was three months before I opened it."

I'd sent a copy of a book I found helpful, "Cancer and Consciousness," to Barbara, the woman I'd met at the retreat back East. She had gone on to have a bone-marrow transplant, and was home recovering. Months later she replied, with that explanation.

I could understand her point: With her letter she included some tapes of writer Steven Levine on the subject of death and dying. I was almost through chemotherapy and didn't feel like listening to someone talk about death and dying. I still haven't listened to them.

Things I did not want to do while getting chemotherapy:

- Talk to the support organization Y-Me. (Why not me?)

- Read more about which drugs cause which side effects.

- Keep a journal.

- Go to a support-group meeting.

- Cook.

- Wear a wig.

- Wear hats.

- See the film "Dying Young."

Funny how fatigue can help organize priorities. I couldn't control my energy level. I could control what I did with the energy I had.

I used our telephone answering machine freely, even when home. Accepted a sister's offer of dinner, delivered, once a week. Agreed to let a friend clean our two-room apartment. Kept working, but went home when my co-workers thought I was too tired. Tried not to pretend, to them or myself, that everything was normal.

One day I went for a little walk from our downtown apartment. I had in mind to get something from Woolworth, three blocks away. Got about half a block. Could see the store. It looked as if it was three miles away. A fleeting voice said to suck it up. But this kind of fatigue gave a certain calm. Naaah. I chuckled, turned around, and went back home.

March 1991. Torben says he's never seen me like this.

It's almost silly, after all I've been through. I can almost not sit still. The itching is driving me crazy. The itching from my hair falling out.

I'm driving to the hairdresser's. Haven't been to a hairdresser for probably 20 years.

I absent-mindedly push in the cassette that's been sitting in the tape deck for who knows how long.

"Look at yourself," Billie Holiday sings, "if you had a sense of humor, you would laugh to beat the band ..."

I laughed.

I never considered having long hair to be a big deal. To me, not cutting it all those years meant spending less time, money and energy on curlers, permanents and hairstyles. I thought losing my hair also would be no big deal.

Wrong. It might not have been important to me, but it certainly was to other people. For some, hair becomes a symbol. Of illness. Recovery. Life. With apologies to Susan Sontag, hair as metaphor.

Even if I didn't want it to be.

"My glasses are steaming up." - Betty, while taking photos of my haircut.

I was so happy to get rid of that hair. Besides the itching, the strands falling out had become completely matted above the braid.

I think the whole episode bothered Lori, the hairdresser, and Betty more than me. When Lori finally started to shave my head, she turned the chair so I couldn't see myself in the mirror. I'll admit to a bit of a shock - and a fleeting thought of Auschwitz prisoners - when I first caught a glimpse of the newly shaved head.

Jim, one of Lori's co-workers, saw the lopped-off braid on the counter and thought it was cool. Everyone had been asking me if I was going to save the braid. Ugh, I thought, especially after it started to mat. I told Jim he could have it. He said he'd attach it to the back of a hat and wear it to parties. I figured the hair would see many more parties that way than it had with me.

Dinner at Cactus in Madison Park. Torben and I are meeting a group of friends. When we get there, one friend at another table is talking with a woman he knows.

I sit down at our table and wave to the friend. He does a double-take - it's the first time he's seen me without long hair.

"That's one of the friends I'm meeting here," he says to the woman.

"Oh, I noticed her when she walked in," she says. "She must be Buddhist."

"Uh, well," my friend stammers, "in fact, she is, but that's not why she has such short hair. She's just been through chemotherapy."

"Oh," the woman says, "how convenient!"

In a way, she was right. Friends in the Buddhist community were comfortable with shaved heads, even on a woman. "I'm used to people at the Zen Center," said one, the first time she saw my new haircut.

But with many others I still had to deal with more traditional Western views of illness.

And death. My father died not quite two months after the end of my chemotherapy.

My attempts at equanimity were seen by some as denying my feelings, hiding from emotions, not facing up to fears.

"You felt worse than you thought" during chemotherapy, some co-workers tell me now.

It wasn't like that. I would feel the emotions. I just would try to not get too caught up in them. I wasn't always successful. I did think, "Why me?" once, months after the end of chemotherapy. I got a nasty virus. I'd been through the mastectomy, chemotherapy, then my dad's death. Why did I have to get this cold, too?

One meditational practice involves considering thoughts to be like clouds: insubstantial, just floating through the mind. I didn't have to cling to them, or ride them. If I felt nauseous, I tried to realize it was an understandable offshoot from the chemotherapy, and not dwell on it. If I feared death, I tried to acknowledge that fear, and then let go of it.

I did discover a new connection with one particular meditational figure. Ekajati, she's called. The embodiment of nonduality. She has one eye. One fang. And one breast.

Happy birthday to you ... happy birthday to you ... happy birthday dear Libra ... with a Cancer rising ... happy birthday to you!!!!

Like this message, little things could take on new meanings. Often ironic, sometimes awkward.

That note was sent to me through The Times' computer system, the day before my birthday last year. From a co-worker interested in astrology. She'd asked a few days earlier what time I was born. She researched my rising sign, and innocently enough included it in the electronic song. Did she realize the dual meaning?

Then there was the Pacific planning meeting. For some time there had been an idea to do a story about a certain local woman in the arts field, I think. She was dying of breast cancer. Only after it was said did everyone realize how close to home that hit. Stiff silence. On to another subject.

Sitting at a computer terminal at work one day, several months after the end of chemotherapy. Thinking, chin in hand.

Uh oh. Right lymph node feels enlarged.

I feel like a deflating balloon.

I'd been warned about these false alarms, but they still caught me off guard. At first, every pain, every sniffle, every previously undetected bump anywhere in the body sets off an alarm.

Had the cancer spread?

Over time, those reactions subsided.

But I do think about a bone-marrow transplant. Not often, but I do. It may be the next step for me if the cancer spreads.

I saw a show on Channel 9 about breast cancer. This was when I still was staying tuned for every report about cancer that TV offered. Toward the end of the program, they showed doctors using big syringes to remove bone marrow from the woman featured. I surprised myself - I turned away.

We're seven people in all as the Pacific editor gets her first look at some of the photographs Betty has taken of me over the past year. The inevitable question: Which photo can we use on the magazine's cover? Betty and I propose one where Dr. Thorne is marking the breast the day before surgery. A little risky, a little risque, but no single image better gets to the point. The air is quiet, solemn. "What would the cover headline say?" someone asks. "How about BYE-BYE BOOBIE?" someone else says, and the tension cracks. "Or THANKS FOR THE MAMMARY?" says another. Later, Torben adds his two cents: "AND THEN THERE WAS ONE ..."

Seeing the humor in cancer might not be for everyone. It came easily for me, because it already was a part of my life. Maybe it became even more important once I got cancer. Laughter was ice-breaking, relaxing, rejuvenating. Some people took it up more easily than others.

Like Dr. Thorne. I had an appointment with him just a couple of days before minor surgery with Dr. Clarfeld, to insert a portable catheter in my chest for receiving chemotherapy. As Dr. Thorne was checking out my implant, he joked that the catheter had better go on the other side, to not mess up his fine work. Betty, there taking photos, told about a woman who before knee surgery had written along her good leg NOT THIS ONE, DUMMY! to prevent a mistake.

We all looked at each other. Let's do it, Dr. Thorne. He drew a little sign on my skin where the implant was. A scalpel in a circle with a line through it. NOT THIS SIDE!

March 1992. Coming up on a routine post-chemotherapy checkup. I go back every three months for two years, every four months for another two years, every six months for another year.

This one is scheduled for just before a family trip to Ireland. I begin to feel a little uneasy, even though I'd already had two normal checkups under my belt.

What if they find something wrong?

I reschedule the checkup for after the trip. It's not the first time I'll do that.

Yes, I've changed. I travel more. Save less. I've considered quitting my job, changing careers, moving. I follow a low-fat diet, take more vitamins. I've hung one of those waterproof guides to self breast exam from my bathroom showerhead. I read the obituaries. Have a note to myself to make a will. I take time to garden. Linger more at the sight of Mount Rainier. I hold Torben's hand a little longer.

September, 1992. Finally, I get to have my portable catheter removed. It is, presumably, my last cancer-related operation.

A friend asks me if I feel that it is really over.

Hmmmm. No.

That bothers her. She needs a sense of closure. Maybe more than I do. A few hours later, she asks again. Not even just a little bit over?

Not really. Sorry.

I could have used tamoxifen as an excuse. That's the hormone therapy I'm about to start that may reduce my chances of a recurrence. Sometimes the idea of taking the pills bothers me more than the mastectomy or the chemotherapy. They remind me of cancer. Twice a day. Indefinitely. Or maybe until "it" is over.

When?

That whole uncertainty is still very much alive. Along with the certainty of death. Perhaps somewhere in between those two "it" can be found, constantly moving, unresolved.

Thinking that, I have both a sense of urgency and a sense of calm.

And I think of my mother.

For going on two years now, whenever I visit, she gives me a bunch of hugs. We always laugh, and she counts them aloud, starting as if I'm already well past my quota for the day.

"Seventy-six, seventy-seven, seventy-eight ..."

Molly Martin is assistant editor of Pacific. Betty Udesen is a Seattle Times photographer.