I no longer ‘did’ exercise as a by-product of my passion for rock climbing, where getting rip-roaring fit went with the challenge of solving a difficult crux (the tricky part of a climb). Instead I tripped through the local door of a gymnasium before the sun rose to attend get-fit classes and later became a road cyclist to remain fit. I wasn’t developing a skill to aid a lifestyle choice, but I was fit again.
Pink bits: can a doctor–patient relationship help heal you?
In a novel by Joy Williams called State of Grace, a character says, ‘There must be something beyond love. I want to get there.’ The sick man has got there: He’s at a point where what he wants most from people is not love but an appreciative critical grasp of his situation, what is known now in the literature of illness as ‘empathetic witnessing.’ The patient is always on the brink of revelation, and he needs an amanuensis.
Anatole Broyard, ‘The Patient Examines the Doctor’
One year on from my mastectomy and reconstruction I entered Dr Theile’s office to cross one last t. I was getting my areolas tattooed. It was the finale to a year-long process to reconstruct my breasts.
What’s the dye made out of? I asked.
Dr Theile was leaning over me on the surgical table, penning where he’d place the areolas on my breast mounds. I don’t know, he answered. His nurse was beside him, handing him instruments.
Great!
The nurse smiled down at me. I’d come across a little harsher than I meant.
He continued, But the cosmetic tattooing done on women’s faces is a vegetable dye, so it wears off eventually in case they don’t like it.
That’s a good idea. The white lights of the room and overhead lamp meant I could talk more easily with my eyes shut. Eyes open I was distracted by the room.
Dr Theile had me sit up, lean slightly back and then lie down again. He squinted and leant back to see the best place to tattoo my areolas. He was an artist working on a composition. He went over to a long bench and mixed up colours. Do you want browner tones or pinker?
You know, this may sound silly, but I haven’t even thought about what colour I’d get them, not once.
He turned and assessed my skin tone. You’re more pink.
I nodded. Yes, I agree, pink it is.
The pink ink Dr Theile had worked up was very bright.
I don’t want fluorescent areolas.
He chuckled. It’s okay – they start out brighter than the end result. After six weeks they fade considerably to flesh tones.
Good … where did you learn to tattoo? It had interested me ever since I found out that Dr Theile was doing it and not a cosmetic tattooist. I envisioned a white room with surgical students wearing pink aprons and mouth-to-mouth dolls with pierceable skin laid out on tables.
I used to get a medical tattooist to do it, but she became too busy and my patients had to wait too long to complete their reconstructions … Dr Theile frowned, genuinely distressed at the memory of women’s final results getting drawn out. So I started doing it again. Originally I learnt to do it in America. I went over there for further surgical training and they taught me how.
I mumbled, impressed that he had training from highly qualified Americans au fait with cosmetic surgery. All good as far as I was concerned.
Have you read Direct Red? I teased.
Dr Theile’s back was to me as he put down an instrument. No, I’m very slack.
I had lent the book to him the previous year, hoping he’d find that his early experiences of surgery resonated with the author’s – that he could enjoy his highly specific knowledge explored from another’s perspective. I figured there were few good surgeon-writers.
His nurse reassured him, That’s a bit rough on yourself, isn’t it?
You are busy with work, plus you have a family, so it’s okay. I softened the tease.
I read Direct Red: A Surgeon’s Story several months after my mastectomy because my friend Sara had told me there was a mastectomy scene involving a very young woman. I psyched up for it. However, when I read the book’s opening line – I am about to faint. Methylene Blue. Acridine Orange. I have been holding someone’s neck open for seven hours – I was hooked.
The author, Gabriel Weston, gave up a training position in ear, nose and throat surgery in London for a fixed surgical job with less status after meeting Thomas, another woman’s baby on a hospital ward. Thomas had inspired her to give herself more time with her own baby. Up until then she hadn’t felt an overwhelming need to include more home time. Scenes from the book have stayed in my mind, conjured by her eloquent, haunting words. For example, she assisted on an emergency procedure with a man who’d struggled furiously with the anaesthetist trying to sedate him for an operation on his aortic aneurysm: a swelling or at worst rupture at the aortic wall. The aorta runs out of the left ventricle of the heart and is the largest artery in the body. It goes down into the abdomen, where it heads off into smaller ventricles, common iliacs:
Looking down, I peered into the trough of Mr Cooke’s emptied abdomen, and could see it filling with blood so fast that the outline of the gushing source was visible beneath the red meniscus. Like when you fill a paddling pool with a hose and it’s half full and you can see a knuckle shape on the surface just above where the hose is.
The man’s situation resonated with the experience of my post-partum haemorrhage, where my internal iliac arteries were tied with dissolving stitches to stop massive blood loss and mortality. Before they’d wheeled me in at 2 a.m. to undergo an emergency operation to save my life and uterus, I had catching pain in my right shoulder, a sign
