Wednesday, May 15, 2013

Something in Common with Angelina

Angelina Jolie is not one of my favorite Hollywood figures but these last couple of days I have to hand it to her, she's certainly been up front about a very serious health risk and the steps she took to ensure she'll be around not just for her own sake but for that of her partner and more importantly her kids.  Given that a lot of women (and a number of men as well) see breasts as a major part of their identity, the idea of deliberately deciding to have them removed, even with reconstruction, is the stuff of nightmares. To have a major Hollywood star admit to scar-producing surgery and reconstruction with implants for more than enhancing their pulchritude (and their cup size) is almost a refreshing change. Yes, she may have done it to save her life -- but going so public about it is, I think, an act of heroism. Sooner or later it would probably have come out, Hollywood secrets usually do, so Ms. Jolie gets kudos in my book for having the courage to spill the secret before someone could do it for her and probably with a lot more negative publicity.

I talked to my friendly neighborhood (ok, internet neighborhood) pathologist about this just as I have asked for her very sagacious advice in my own encounter with breast cancer. She tells me that just because the gene is there doesn't mean cancer is a certain thing. It depends on a lot of factors and, I am sure, Ms. Jolie's doctors went over all the options and possibilities with her before she made her decision. Having the surgery doesn't completely remove the risk because those little cancer cells can still show up, to quote the doctor's email, in "...breast tissue [that extends] damn near to the back of the shoulder."* So Ms. Jolie isn't completely off the hook, and neither am I.  In that way, we have something in common, probably one of the few things other than the fact that her mother and my adoptive mother both died of breast cancer or a related cancer far too soon.

One thing, though, is that with Ms. Jolie going public about the prophylactic mastectomy and reconstruction, she's sort of emphasizing that she has (a) money to pay for the procedures and/or (b) really good insurance who accept her history and familial relationships with their outcomes as proof that it was a medical necessity rather than a whim. There's nothing wrong with that, really; I'm glad she does. I have to think, though, of the countless women who aren't as fortunate; they don't have the money for testing, surgery and reconstruction and often don't have insurance that will cover even most of the cost. I had Medicare and thank God I did, although the 20% I still am paying for the mastectomies is not exactly chicken feed. Ms. Jolie says she has some tiny little scars. I have some noticeable ones that, along with some lymphedema,
cause me some cosmetic angst, but I'll live with them. Mama did, and hers were worse than mine, so I can't really kick too much.  I have the option -- at a price -- for cosmetic surgery and/or reconstruction, but there's always a price, isn't there, no matter what kind of situation we find ourselves in? Ultimately it's what works for the individual that has to be the guide.

I read too where Brad Pitt has been strongly supportive of Ms. Jolie's decisions about her heath care and the process under which she went. It's good that she has such a strong support network. That's something I wish every cancer patient/survivor had.  It really makes all the difference, having someone or some people standing with you as you go through something like this, family and friends who allow you to rail at fate (or God), curse your body for its weakness, feel the depression and angst of a mutilation (and it is a mutilation, I don't care what they say) that will leave you feeling like less a woman in this world where there's a lot of emphasis on looks, including boobs. Bless those friends who stick by and not just help you work through all the "stuff", not by offering advice but by just being there, letting you do what you need to do without trying to minimize it or tell you, "It's over now, so now you can just get on with your life."

Mastectomies, even with reconstruction, can be a grief-producing event, just like a death, that has to be gone through at each person's own pace, in their own time and way without a cookie-cutter response that encourages them to stop thinking about it and focus on other things. Boobs are a more or less visible part that says "female" to the world. Losing part of your identity is not an easy thing, so dealing with it is complicated. There are some who can get lumpectomies rather than the mastectomies and who may not have to deal with quite as much grief or angst, but there's still some pain and some cosmetic issues to be dealt with. Reconstruction helps ease some of the feeling of being less feminine, perhaps, but not everyone opts for or even has the option for it. Sometimes prosthetics are the only answer -- but they are an answer, of sorts.

I wish the "just get on with things" folks had to look in the mirror and see what we see. Maybe they'd see past it -- or not see it at all but I do, and I don't think I'm the only one in the world who does. I'm grateful to those in my life who allowed me to do what I needed to do and handle it as I needed to handle it. They gave me a great gift and enabled me to heal emotionally as well as physically. I am glad Ms. Jolie had people to do the same for her.  We're both luckier than a lot of women.

I wish Ms. Jolie well.  I'm glad she spoke out, even if it points out the chasm between rich and poor when it comes to health care.  I'm glad she has family support and the opportunity to live with a bit less worry about the threat of possible breast cancer hanging over her head. I may never be a real fan, but I do respect her for making her choice and sticking with it. I hope others can read her story and take some hope and a bit of comfort in it. I think I do, regardless of how different we are and our lives are, because under the skin, we're both women, both looking at a disease and both looking to beat it, one way or another.

 *Personal email from Maria L. Evans, 5/15/13, used with permission.

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