Quest Cycles Applying the Hero Quest to the crises in our lives Linda S. Griggs
BCQuestCycles@aol.com

Scenes from a Hero Quest - Part 2 - Adjustment Phase

Details how I learn to balance and center myself during the summer
after the end of my treatments.

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Adjustment Phase (June 1994 -- Sept. 1994)
Excerpts from Part 2


adjust

Adjustment -- by Mary Ellen McNaughton


Libra, balance, centering, equilibrium, balancing of opposites, justice.

A young woman (the feminine aspect of the Fool) holds the great magic sword between her legs and balances on her toes. . . . She is actually balancing only on the tip of the sword. Only absolute concentration and stillness, which come from finding one's inner center, will allow this condition of equilibrium. . . . The slightest distracting thought will cause her to waver and destroy the balance she has found, the balance that is the nature of the Universe.

Gerd Ziegler, Tarot: Mirror of the Soul


Inanna's descent

The original departure into the land of trials represents only the beginning of the long and really perilous path of initiatory conquests and moments of illumination. Dragons have yet to be slain and surprising barriers passed ­ again, again, and again.

Joseph Campbell, The Hero with a Thousand Faces



Inanna, Queen of the Great Above, set her heart on
Earth's deepest ground. . . .
Then down She went ­ through the mud that
tore the gold from her ears. Down through granite arms
that ripped the shirt from her breast. Down through fire
that singed the hair from her head. Down through iron
She thought was core that took her limbs. Farther and
farther down She hurled through emptiness that drank her
blood.

Janine Canan, "Inanna's Descent," in Her Magnificent Body


June 4, 1994

It's Sunday morning. We're reading the paper in bed. The sun is in my eyes. I ask my husband to close the blinds a bit so I can see. When he does, my eyes focus on the headline: "Behold a fighter." Below the headline is a picture of a sleeping woman, the folds of a sheet framing her slightly smiling face. Beneath the photo is the caption: "Dee rests in a hospital bed following her second mastectomy. She decided early in 1993 to give up her remaining, healthy breast rather than risk cancer there."

The large-type summary of the story says, "Dee lost her breasts to cancer, but not her spirit; so she thrust her story in the light, showing her scars and her struggles in a message of humanity."

I'm pumped up to read the story of this survivor, this woman who sounds like she's not taking her cancer lying down, this woman who sounds a lot like me.

To the left of the story summary is a picture of a woman displaying her perfectly sculpted bikini-clad body. I figure is it an "after" picture, to show how far Dee has come since her surgery. The caption reads, "In 1985, seven years before she got breast cancer, Dee was a competitive body builder at age 33."

It's a three-page spread. Inside there are more pictures of Dee: in the shower, after her first mastectomy, "struggling with the image of herself as one-breasted"; during a breast cancer march on the White House, pulling up her shirt to a television cameraman, "baring the scarred mound that used to be her breast"; in the recovery room after her second mastectomy, feeling where her healthy left breast used to be, grimacing; on the doctor's examination table, tubes sewn into her armpits, feeding saline solution into the "two early mounds" on her mutilated chest; and finally, head in hands above her two new beautifully reconstructed breasts, having found "another cancerous tumor in her right pectoral muscle."

I can barely read the words in the article. My eyes keep racing ahead, trying to find the happy ending. I skip to the last section: "Shortly after the new year, Dee's fear was realized that 'lurking somewhere is that one god-damned cell that could rear its ugly head one day.' . . . The months of chemotherapy, the sacrifice of her healthy breast, her defiance -- none of it prevented the cancer from coming back."

And then I read the very last paragraph, about her son's taking two bikes apart in his room and carefully polishing every nut and bolt. "'I think,' Dee says, 'what he is trying to do is put something back together again and make it beautiful and whole again because he can't do that with me.'"

There is a side bar on reconstructive surgery, with an artist's conception of the steps in a couple different methods, a graph showing the percentage of women choosing each different method, and a list of things to be sure to do after reconstructive surgery: "rest, eat small meals, avoid gaining weight, follow exercise schedule assigned after surgery, and maintain a positive outlook." It goes on to caution that "complete recovery may take 6 months to a year." There's another side bar detailing the local resources available to "answer women's questions and address their fears." A nurse is quoted as saying, "Our biggest battle is the fear of knowing."

I stare and stare at the two side bars, trying to figure out who in the world thought they went with this story of a woman who obviously swallowed all this crap the first time around, a woman who followed all the doctor's orders, got plenty of rest and exercise, maintained a positive attitude, confronted her fears, and still came out on the short end of the goddamn stick.

And I cannot figure out how the people who decided to run this article want anyone to feel, or what they expect anyone to do. Surely there are thousands of women, right here in my town, who are reading this article right now, and feeling their breasts for lumps, and debating whether or not they should go see a doctor about them because, after all, what's the use? Dee did everything right. And look where it's gotten her.

And I know there must be hundreds of women, right here in town, who are reading this article, who (like me) are already missing a part of a breast, or even a whole breast or two, who have made it through radiation and chemo, and who were feeling pretty damn good about their chances for survival, until they read this fucking article.

Women who, like me, are putting down the paper, pulling their sheets up to their quivering chins, staring straight up at the blurring ceiling, trying to figure out how they can just shoot themselves now, and save a few steps.

Dance with death

At first we all think we can outrun the death aspect of the Life/Death/Life nature. The fact is, we cannot. It follows right along behind us, bumpety-bump, thumpety thump, right into our houses, right into consciousness. . . . Many see this nature as a dance with death; Death as a dancer, with Life as its dance partner.

Clarissa Pinkola Estés, Women Who Run with the Wolves

June 5, 1994

I'm sitting in a pile of articles I just printed off the Internet. I'm trying to compare the numbers on my original lab reports with the numbers in these articles, trying to figure out where I'm at statistically. I want to prove to myself that my prognosis differs from Dee's, that my prognosis points unequivocally to life. I'm trying to figure out if, given my unequivocally good prognosis, I should now risk doing what most patients do: go on hormonal therapy (Tamoxifen) for 5 years "just to be sure."

Although anatomic stage (size of primary tumor, axillary node status) remains an important prognostic factor, other histologic and biologic characteristics may have predictive value. Tumor nuclear grade and histologic grade are significant indicators of outcome following adjuvant therapy for breast cancer.

I pull out a blank sheet of paper and draw a line down the middle. I label one side "good prognosticators" and one side "not so good prognosticators."

I learn that infiltrating or invasive ductal cancer is the most common cell type, comprising 70 to 80% of all cases. It feels good to know I have such a common "garden variety" kind. I make one mark on the "good" side.

I learn that the reason I'm classified as a Stage I is because I am a T1, N0, M0 (tumor 2.0 cm or less, no regional lymph node metastasis ­ node negative, no distant metastasis). I make another mark on the "good" side.

Then I read the 5-year survival rate of women with Stage I breast cancer: 85%.

That means 15% are dead at the end of 5 years. That's 1 in about 6. I make one mark on the "not so good" side.

But I've had radiation and chemo. Surely that affects the numbers.

Two studies have shown significant improvement in disease-free survival after five years for patients treated with adjuvant chemotherapy.

I make one mark on the "good" side. I read on.

Because local recurrence in the breast occurs in as many as 20% of patients choosing chemotherapy plus radiation, patients should be monitored carefully for this occurrence. Subsequent mastectomy will control the disease in most of these patients.

I feel the heat rising up the back of my neck, the back of my head and ears prickling with sweat, my temples flushing. I make one mark on each side.

But I'm node negative. It hadn't spread to the lymph nodes.

Approximately one third of patients with clinically negative nodes will have histologic involvement and would be candidates for additional treatments as per Stage II with positive axillary nodes.

I start to make a mark on the "not so good" side, but turn instead to the discussion of additional treatments for Stage II node-positive patients, skimming it for counterbalancing good news:

A recent report on node-positive postmenopausal patients demonstrated disease-free survival benefit for chemotherapy in ER-negative patients, but overall survival was not prolonged.

My face is burning up. I'm trying to figure out, based on what's technically true for me and what's not, how much of this really applies to me. I am not Stage II. I am not node positive. I am ER (estrogen receptor) negative, which means my tumor was not particularly receptive to estrogen. When I was diagnosed, I was still having periods, but they stopped after my first chemo session and have not yet returned. Does that make me "postmenopausal," or just "menopausal," or none of the above? Has my chemo done nothing to prolong my overall survival?

I flip back to Stage I prognosis:

Some patients with Stage I tumors appear to be at low risk of relapse (e.g., those with tumor size less than 1.0 cm or with more favorable histologic tumor types -- for instance, medullary, mucinous, papillary, tubular) and may not require post operative adjuvant hormonal therapy. . . . High histologic grade of tumor and high rate of mitosis may identify a high-risk subset of patients with T1 lesions less than 1.0 cm.

I page through my lab reports, looking for my exact numbers and tumor classification -- to confirm I'm at low risk. My tumor was right at 2.0 cm, and the "morphology is consistent with infiltrating lobular carcinoma." I hear the buzzer going off in my head: "ghahhnnnnnnnnnn." No match.

My histogram shows a "DNA aneuploid pattern with a DNA index of 1.9 and 'S' phase of 10% and a G2+M of 4%." There's no scale, nothing to compare this with. No way to tell if this is high or low. No way to know how to interpret the summary statement: "borderline increase in S+G2M."

I put my right hand between my breasts. I feel my heart ricocheting against my fist. I cannot keep my left hand, which is holding the pages, steady. My eyes keep finding "poor-prognosis node-negative patients."

I look and look and look for the good news about ER status and Tamoxifen.

For women who are Stage I or Stage II and ER positive, taking Tamoxifen for 2 years or longer can prevent recurrent disease and increase survival. There is a decreased incidence of carcinoma in the contralateral breast and decreased cardiovascular mortality in women treated with Tamoxifen.

But my estrogen receptors are negative.

Some evidence indicates that ER-negative women could receive similar benefits with Tamoxifen treatment.

They cite no evidence to support this statement. I turn back to the evidence for those ER-negative Stage II node-positive postmenopausal patients:

Chemotherapy and Tamoxifen, given for one year, failed to improve either disease-free or overall survival.

There are these wet places on the pages. By the time I find the section on the side effects of Tamoxifen, I can barely read the words any more.

The use of adjuvant Tamoxifen has been associated with certain toxicities: uterine cancer 2 to 4 times the predicted incidence for untreated women.

They say uterine cancer is impossible to detect until it's too late.

I feel myself sinking down, the papers closing over the top of my head. I reach a hand up trying to steady myself, but can't find anything there to grab onto.

Trials and revelations

If you realize what the real problem is -- losing yourself, giving yourself to some higher end, or to another -- you realize that this itself is the ultimate trial. When we quit thinking primarily about ourselves and our own self-preservation, we undergo a truly heroic transformation of consciousness. And what all the myths have to deal with is transformations of consciousness. . . . You have been thinking one way, you now have to think a different way . . . either by the trials themselves or by illuminating revelations. Trials and revelations are what it's all about.

Joseph Campbell, The Power of Myth

June 6, 1994

They've been talking about it on the radio all week. They say it's too late to spray or otherwise launch a full-scale chemical attack. They say it's not just the damage this batch of caterpillars is doing that matters.

True, each of these caterpillars will grow plump munching on our trees' new leaves, they say, but the real damage comes later, when each of these caterpillars stops munching long enough to make a cocoon that morphs it into a gypsy moth that doesn't eat anything, but lays a thousand eggs somewhere safe in our backyards to start the cycle all over again next spring.

They say the trees can recover from one infestation. They say it's the repeated cycles of infestations that will eventually take their toll. They say we've got to be diligent, each one of us, and that we need to do it ourselves: pick the caterpillars off one by one, and drown them in buckets of soapy water.

It only takes one, they remind us, to get it all started again.

I think I understand what they are saying.

So I dutifully fill a bucket with soapy water, put on my sun screen, sun glasses, sun hat, and walk outside at high noon to check our trees.

They say they like oak trees. I'm looking, looking up at the branches of our backyard oak but can see nothing. I'm bracing myself against the trunk, standing on tip toe, stretching up to look, look, fingers gripping the ribbed bark.

Something is tickling my finger.

It is making its slow way steadily up a gully of the gray oak bark, this red-dotted gray caterpillar with spiky black hairs. I bend down to lift up the lethal bucket of water. When I look back at where my hand was, I can't see the caterpillar.

But I see three others, then five, then ten, then twenty. You can't see them straight on, only from the side, when you aren't really looking. It's a matter of focus: losing focus.

I pull them, one by one, off the tree. I have to be gentle, pressing just enough to jostle them off the bark but not so much as to squish them in my fingers. I don't want their goo on my hands. Sometimes they let go easily, and sometimes they grab hold with all their little suction feet and I have to poke a twig between sets of feet to dislodge them. Sometimes they fall on the ground and I lose them in the grass. Sometimes I step on them -- the bottoms of my shoes sliming with their squooshy little deaths.

They are tough little cookies.

When I drop them in the bucket, they struggle to the top, to breathe I guess, then turn themselves inside out, outside in, trying to roll out of the poison. After a minute or so, they sink to the bottom, dead, making room at the top for new ones to try the same twisting trick and fail. After awhile, the soap is gone, and they take longer to drown.

I dump one bucket full of soggy corpses in the gutter, fill another, and move on to the next tree.

We have six oak trees. And the neighbors all around us have oaks. I am standing on a ladder reaching up as high as I can. But I know I am barely reaching the bottom branches. I know there are herds of caterpillars grazing 30 feet above my head. The deck is littered with their droppings.

Even with my hat and glasses the sun is too bright. My arms are tired, my legs are achy, my back is hurting.

My neighbor walks by and stops to watch. "You think you're doing any good?"

"I was just starting to ask myself that."

"How many you got so far?"

"Maybe a hundred."

"Hmmmm. That's a hundred thousand that won't be around next spring. That's gotta make some difference, don't you think? I better get home to do mine."

So I start counting by thousands, and by the time I finish the last tree I'm feeling really good about the more than half a million caterpillars that won't be here next spring. I've done what I could. I can't do any more.

I dump the last bucket, rinse it out and hang it up, put away the ladder, and go inside. I take off my sunglasses and sun hat, take off my shoes, gather up the Tamoxifen articles, and put them all away.

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