Three Generations of Elizabeths, Breast Cancer, and Self-Preservation

When your maternal grandmother dies from breast cancer, there’s this strange intersection between her health and your mother’s health and yours.

The house I live in is half a mile from my childhood home. How I wanted to leave this place when I was young, this podunk town with one gas station. I grew up climbing trees and wandering dirt roads with my brother, a towheaded adventurer calling “come on, Elizabeth,” over his shoulder as I struggled to keep up. I’m named after my mother, who was named after hers. They lived in this town, too. Night is darker here—a perpetual new moon, twice the stars against the ink, cocooned in song of whippoorwills. In this quietude was charm, a Charlotte’s Web-esque upbringing complete with farm animal pets: a rooster, a rabbit, a chicken, a duck, two pygmy goats with bells on their necks. But dirt roads made me restless.

It almost looked like I had made it, riding the subway in the big city, getting my heel stuck in the sidewalk on my way to work in a shiny skyscraper on the Hudson. When I returned—two kids, a divorce, and a remarriage later—I wondered if there were empty spaces left by my uprooting. I sunk my hands knuckle-deep into the soil, wanting to put my roots right where they had been. My mother is still here, but her mother died years ago. Cancer came first for her breasts and then for the rest of her.

The deer here are so plentiful we need road signs to warn us of their crossing. They feature a silhouette of a buck mid-air, frozen in a perpetual, majestic leap. Still, you don’t see them until you’re white-knuckling, slamming the brakes and saying a prayer to who knows what god—the god of deer maybe—a simple, “please please please.” Otherwise you often see them dead, bodies tended to by turkey vultures.

A group of vultures is called a committee. I like the sound of that. Picture one stout vulture with a gavel calling order, designating who gets which part of the deer: an organized dissection. They are dedicated opportunists, circling the air in small bands of three or four by the roadside. Their relationship to the deer hit by cars is an example of commensalism. One species benefits while the other does not. And yet, something about the way the deer fall by the roadside seems almost graceful—their necks arched like crescent moons, eyes looking onward still.

My grandmother died when I was nine years old, on Christmas Eve. I had known she was sick, in the vague way that children know things, by registering the subtle downturn of my mother’s mouth when I asked how Mommoms was doing. That night, I woke with a start, not from excitement for coming presents, but something else, a cold chill in my chest. It felt like I’d been having a nightmare but couldn’t remember what it was, and when I looked out into the hallway I was relieved to see my mother walking by. I ran out to meet her but found the passage empty. I kept looking—in the bathroom, in her bedroom, downstairs. On the couch in front of the Christmas tree was our neighbor. My mother was at the hospital, he said. In the morning, I found out Mommoms had died during the night. I’m not a big believer in ghosts, but I think it was her I saw walking through the hallway. I think she came to say goodbye.

A group of feeding vultures is called a wake. Picture vultures in mourning garb, eulogizing the victim. Then they eat it. The cavity is exposed, cavernous, ripped raw down to its hollowed center.

*

“Scooch down,” Dr. Liu says. It’s the time of year when I must have my own internal cavity inspected. Dr. Liu pat-pats his fingers around my breast and aims for small talk. How is my husband? What are the kids up to? Have there been any changes in my mother’s health? When your maternal grandmother dies from breast cancer, there’s this strange intersection between her health and your mother’s health and yours. It’s another thread that links us. Each year Dr. Liu asks me about my mother, meaning without saying, Has she been diagnosed with cancer yet? Each year I smile and raise crossed fingers like a scout, so far so good.

There are other threads I wonder about but can never ask. My grandmother’s suicide attempt. My mother’s difficult marriage. All of us sensitive, submissive, shy. But only our shared vulnerability to cancer is open for discussion.

My grandmother’s life is shrouded in mystery, but I know she kept a jar of Marshmallow fluff and a spoon next to her bed for late-night cravings. I know she was a nurse until she had children; there were black-and-white photos of her in her uniform and hat, kept neatly in albums in my mother’s closet. I know she tried to kill herself when my mother was a child and was wheeled out on a gurney in the middle of the night. No one ever talked about it or told my mother why. Mommoms had two older sisters who never married. They called her homely. Homely is not what I would have called her. There was another picture of her resting back on her palms in the sand in a bathing suit, smiling up with hair coiffed like Marilyn Monroe’s. It took my grandfather’s breath away, even decades after her death. He’d gone AWOL to marry her during WWII when she found out she was pregnant. He served a prison sentence for loving her so much, and she raised their son alone for the first two years.

There are other threads I wonder about but can never ask.

My mother’s life, too, is mysterious, though not as removed from me as my grandmother’s was. My mother raised me on Little House on the Prairie and good intentions. She married my father the day after high school graduation and endured more than her fair share of hard knocks and bruises. When her mother was dying of cancer, she took the time to make pumpkin pancakes for my third-grade class. All of us performed, in different ways, the miracle of making the bed and lying in it, or knowing when to pull off all the sheets and start again.

*

In the spring, a new cycle begins. When you live adjacent to 1.1 million acres of pine forest, the smell of cinder-singed air on a chilly morning is an almost comforting signal that long, hot summers are on their way. The National Parks Service describes prescribed burning as a means to “reduce fuels and thereby prevent destructive fires.” It is an intentionally set, carefully controlled burn. Nearly all the forest along the roadside looks the same: scorched earth, tree trunks burned up to their middle. In this case, fire is the problem and fire is also the solution. I am grateful for these rituals, these efforts at protection, when climate crises and volatile fires threaten communities around the world.

Two years after my grandmother died, a wildfire tore through 15,000 acres of forest close enough that we prepared for an evacuation. Black clouds clotted the sky, but excitement whirred in my chest. A resident told The New York Times that “nothing exciting ever happens out here except fires.” She was right. It was an event as much as it was a threat. I was eleven and not sure what to pack. None of my dolls or toys seemed significant. I met my mother at the bottom of the steps, holding a framed photograph of my grandmother. “I’m just taking this,” I said. My mother looked at me and pulled a brooch out of her pocket: a tiny silver frame surrounding the same picture of my grandmother’s face. In the morning, the fire was nearly contained. Soft flecks of ash fell through the air like snow.

In the spring, a new cycle begins. 

*

“They saw something on my mammogram,” my mother says, two weeks after my own visit with Dr. Liu.

“Oh? What does that mean?” I’m elbow deep in dishwater, phone tucked between shoulder and ear.

“It’s nothing. I just have to go for a biopsy.”

Somewhere around this time I started a new habit of crying at the kitchen sink. Maybe it was because people ignored me there, stopped seeing me the way you stop seeing a broom when it’s propped against a wall too long. I cried then, open-mouthed, wondering what would happen to my mother, to me, my children. Dr. Liu had said at my appointment that I should consider BRCA testing if anything changed with my mother’s health.

I tried not to worry as the date of her biopsy approached. I failed, for good reason. The biopsy went badly. Her breast was a labyrinth of blood vessels and they’d been struck during the procedure, which she was awake for. Blood spurted from her body and they told her not to look. When it was over and she got into the car to go home, she realized there was still blood on her cheek.

Not long after, I had surgery to remove a benign mass from my left shoulder. It required twenty-six stitches, the silver thread trailing across my shoulder blade like a centipede. I thought about all the time I’d spent in the gym, lifting weights from my hips to my shoulders to make the muscle look the way I wanted. Now it’s sliced down the middle with a permanent red line. These bodies aren’t really ours, are they? We have so little control over what happens in and around and to them.

I have a recurring nightmare that my mother dies. In it, I fall to my knees in the front lawn, fists grasping clumps of wet earth, throat bared to the sky in a wild howl.

*

There’s a sign by our development about defensible space. It’s a term for keeping a buffer around your home to prevent the spread of wildfire. Its suggestion is one hundred feet. At the bottom of the sign, in a flame-bedecked font, it challenges: Do you have what it takes? Fear is an excellent motivator. It inspires us to protect ourselves and those we love. It brings children and mothers and creatures of all kinds to their knees.

When the day came for my mother to get her test results, she didn’t call. That’s how I knew.

These bodies aren’t really ours, are they?

“It’s the good kind,” she was saying as soon as she picked up, but my legs had already buckled and I was on the floor making a noise best described as a bellow. How diabolical, how sacrilegious, even, that her body—the one that had broken itself open to give me life—should now have to fight this thing, and there was nothing I could do. I couldn’t even say the word “cancer” out loud for a week.

The BRCA test was now about more than just me; it was about my children. I could roll the dice, wait and see, but could they? While getting tested was stressful, it was also a luxury. In a country with famously bad healthcare, a burden even more serious for marginalized and high-risk groups, the prick of the needle was a reminder of privilege. I had my blood drawn and waited for the results, waited for my mother’s surgery date, smelled the cinder on the cold spring mornings, waited. While I waited I cried.

My grandmother had a single mastectomy, though I didn’t know until after she had died. One of my most vivid memories is of hugging her, just after crossing the threshold to her little house, miles down the road from where I grew up. I remember the soft jostle of her body as I crashed into it with mine, all bones. Looking back, it strikes me that I didn’t know one of her breasts was real and one was fake. I shared a name with her and yet there was so much about her that I didn’t know.

I often wonder what she came to tell me the night she died, if it was more than just goodbye. Maybe she knew how I would struggle, like she had, to be happy. Maybe she knew one day I, too, would contend with suicidal ideation, how hard it would be to rectify being sensitive and vulnerable in a world so indifferent to pain. There are days when our shared name feels like a curse. I wonder if instead it can be a lifeline.

One night, the phone rang, and I answered it to hear the voice of Dr. Liu. Dr. Liu, who had wiped shit from my ass while I pushed and pushed in labor, lamenting between contractions that he could not have endured all those years of medical school for this; who carefully tucked my son’s fist back inside me when he tried to come out, arm first, like a tiny superhero; who had reassured me I was doing great, I was almost there, just one more push, and he was right.

“I have your BRCA results here,” he said.

I wondered if there would be a group rate for my mother and I to have our breasts removed, saw vultures waiting by my door, sharpening knives.

“You tested negative for both gene mutations, so that’s great news.”

Picture the vulture committee, disgruntled, taking flight (called a kettle, if you must know). There will be no breasts for you to feast on tonight, my friends! None from me. For the first time in a long time, I felt the sweet wash of relief. But where did that leave us, this committee of Elizabeths? There was still my mother’s surgery to think of, her six weeks of radiation treatment. There is no guarantee I won’t someday develop breast cancer despite testing negative for the genes.

*

I pull into the memorial park for the first time in too long. A heap of brown earth among the headstones indicates that a burial will happen soon, the ground opened up and waiting. A sheet of plywood covers the hole but not what the hole represents. In the trees, bits of silk flowers and leaves cling to their real counterparts, stuck to the bark of pine trees, bleached and faded, entangled with creeping vine.

But where did that leave us, this committee of Elizabeths?

When I get out of my truck, I’m not sure how I’ll find her. I pray that she’ll give me a sign. Within less than a minute, I can see my mother’s handprints on the headstone: the flowers arranged just so, the small ceramic figure of a mother holding a child. For a minute I crouch in front of my grandmother, a cluster of carnations in my fist, then I sit down in the grass, pretend I’m spending time with her again. The tears are sudden and ugly, a flash flood, sputtering out the words, “I miss you.” What I mean is, I miss what she could have told me. I have an urge to curl up between the weeds and sleep, or pretend to, the way I did once in her queen-size bed.

Seven minutes from her gravesite is the house she lived in when she died, where I once snooped in her bedroom and found a Ziploc bag of hair she’d lost in chemo—silky, blonde, and ribbon-tied like a doll’s. On the way, in the bright light of midday, I slam my brakes. A doe and two fawns, still speckled, move gentle mouths over crisp grass beside the road. For a beat that lasts longer than I could have hoped and not as long as I wanted, we see each other. One by one the fawns scatter deeper into the brush, and the mother follows. She is poised, wary but self-assured. She does not run. I wonder if she has a name, if the offspring waiting for her in the bushes answer to the same one.

I pass the sign by my development: Do you have what it takes? I’ve lived here almost my entire life and still don’t know if I can answer yes. Our bodies are the home itself and the open space willing to be burned protecting it. There is no whimsy when it comes to self-preservation, no spider weaving words of affirmation in its web. We dissect ourselves, removing some parts to save others. I think of the altered shape of my mother’s body, the unalterable fate of my grandmother’s. The earth we scorch to protect the earth we need.