Category Archives: Social Commentary

Biopsy: Rhetoric and Intimate Pain

Who ever thought up the word “mammogram”? Every time I hear it, I think I’m supposed to put my breast in an envelope and send it to someone. Jan King

The anomaly in my left breast was located and first imaged in 2008, with a mammogram and then an ultrasound. It was determined to be a benign adenopathy; in other words, nothing to worry about. This finding was confirmed in 2010 with a second mammogram.

This year, I made the mistake of changing imaging clinics, which means changing radiologists. The new clinic is housed in a hospital, so they’re used to seeing the worst, trained to look for the worst. After the mammogram, the technician said, “Oh, there’s something in your left breast. Nothing to worry about, but don’t be surprised if they call you back for an ultrasound.” I respond that I’m already aware of the anomaly in my left breast. I’m not worried.

The call came the next week. I booked the ultrasound. More imaging. More radiological inspection.

The follow-up call came the following week. “We’d like to do a biopsy.” Umm…wait a minute. The anomaly had already been examined and dismissed twice. I respond, “If I can get the images from the other clinic, can we nix the biopsy?” “Oh, that’d be great! Probably, yes.”

The day before I leave for Norway, in the midst of conference prep, travel prep, cat-sitting prep, absent-from-class prep, I’m flying through the city trying to relocate the other clinic, get copies of previous images, and drop them off at the hospital. I tell them I’ll be unavailable, out of the country, for the next several days. They nod and smile understanding.

I return home to a phone message. “We’d still like to do a biopsy.” Okay, now I’m getting a bit anxious. I’m still 96% certain that there’s nothing to worry about, but the medicos, those authorities on my health, are concerned enough to make this request, so it’s only natural that I begin to feel a little less certain that everything’s okay.

I’m really not looking forward to this. There are no opportunities to ask questions until I’m lying supine, half-naked, vulnerable on the examination table. Ultrasound guides the procedure. While the tech is relocating the anomaly, I ask the two questions I’ve been formulating. “What are the chances that this is nothing to worry about?” “Oh, well, the radiologist reported it as ‘undefined,’ so it’s nothing that we look at and say, oh, that’s a cancer.” Okay, so that’s good news. “How big is this thing we’re talking about? The size of a pea? A marble?” “Oh, not even the size of a pea. The size of a really small pea.”

So, umm, what are we doing here?

Somewhere in here it’s explained that the “mass” is close to the chest wall, so they’ll have to be careful not to catch a nerve or the muscle.

The doctor doing the biopsy arrives. Somewhere in here it’s revealed that they’re not doing a needle biopsy, but a core biopsy. And not a single core biopsy, but three samples—from something less than the size of a pea. This ensures an adequate diagnostic sample. Maybe it’s just my interpretation, but I get the feeling that both the tech and the doc are also wondering why we’re doing this.

The doctor explains that she will sterilize and freeze the area, then make a tiny incision through which to insert the core biopsy gun. “This is what it sounds like,” she says, pulling the trigger. I jump. She says, “It sounds like an automatic stapler. I’ll tell you before I take a sample.”

Core Biopsy Gun

She proceeds with her plan slowly, gently, carefully. This is the best one can hope for. When everything is correctly positioned, she says, “Okay, 1, 2, 3” and fires. The mechanism reverberates through my ribcage like a nail gun. I jump and tense automatically. Eyes wince shut, waiting for the recoil. My reaction surprises her and she waits for me to relax slightly before removing the gun that cradles a small piece of my flesh. I think that this is what a tree feels when a dendrologist removes a core sample, except my flesh has nerves and blood.

Satisfied with the first sample, she returns for the next, carefully reinserting the gun’s muzzle into the three-millimetre incision. I feel the tool move and tug inside my breast, against the freezing. Once everything’s lined up, she says, “Okay, 1, 2, 3” and fires again. A nail gun goes off inside my chest. Instant stabbing pain in my left pectoral muscle writhing on the table mouth open in surprise and shock and nausea and eyes squeezed shut and it’s not stopping it’s not stopping it’s not stopping it’s not

Carefully, she removes her precious sample. I say, “I have to put my arm down.” Not waiting for permission, I follow this announcement with this action. “Okay, just don’t touch anything.” I’m still writhing pain not stopping not stopping not

She’s checking, checking with the ultrasound wand. I’m imagining leaving. Getting up and walking out. Then I’m imagining returning if the sample is inadequate. Better stick with it. But it hurts it hurts

“I’d be really glad about now if you could tell me that you don’t need the third sample,” I say. “That’s what I’m checking for,” she says. With the tech’s help, they take one last picture as evidence that they have a through-and-through of the “mass,” like a lucky bullet wound. She says, “We’ve got everything we need. You can go now,” or words to that effect. My memory is hazed by pain. I apologize. Apologize for not being a compliant patient. For being betrayed by my sensitive body. She turns from the door, says, “I should be apologizing to you,” and leaves.

It is only then that the tech gives me the after-care instruction sheet, and I realize the extent to which I have been intentionally injured. Apply ice to reduce swelling. Take Tylenol (not Advil or Aspirin which might induce further bleeding). Keep site clean and dry for at least 24 hours. Keep dressing in place for at least three days. Be on guard for signs of infection. Expect bruising for up to three weeks. Avoid heavy lifting for at least 24 hours. This is the number for emergency follow-up. Ensure that you have an appointment for regular follow-up in 10 days.

I leave in a mild state of shock. My left pec is screaming. For days, my left arm and hand are weak, with reduced sensation and movement. Bruising is still apparent on my breast during the follow-up appointment.

The follow-up doctor is someone I’ve never met. To her credit, she begins with, “You’re fine. Everything’s okay.” She later acknowledges, “You weren’t worried, were you, but we made you anxious, didn’t we?” That’s right. I say, “I wonder if I had to go through this simply to indulge a radiologist’s curiosity.” She responds, “Probably, yeah.” The ultimate determination? It’s a benign adenopathy.

Now, don’t get me wrong. I understand that statistically there are some advantages to mammograms and early cancer detection. But that’s not what this was about. Some people have since suggested to me that this was to improve biopsy numbers, which in turn ensure continued funding. While I can’t attest to that, I do know that this wasn’t optimal patient care.

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The Floral Leg

The first thing I noticed when she got onto the streetcar was her leg. It looked to be tattooed with an ornate flowering vine climbing from the top of her sneaker to somewhere beyond the bottom of her shorts. It was truly beautiful and unlike any tattoo I’d seen. As she came closer, walking the length of the streetcar, I noticed the knee. It was a mechanical joint. For a fraction of a second I thought it was a steampunk fashion statement. Then I realized that her whole leg had an un-flesh-like sheen and was whiter than her other leg. It was a prosthetic.

When I was a kid, losing a limb was not a topic for conversation. A man in my hometown had an artificial hand; he always wore a grey glove, whether due to shame or social stigma, it’s hard to say. I remember when I was maybe three, curiously pointing out a blind man on the street to my mother; she told me not to be rude. Disability—different ability—naturally evokes children’s curiosity. The other is more othered than we are used to, maybe more than we are comfortable with, and that evokes curiosity. What’s wrong with asking, with being curious about another body’s circumstance and how it functions in the world we co-inhabit?

Ambroise Paré’s 16th-century artificial leg design (Wellcome Collection)

London’s Wellcome Collection displays the design for Ambroise Paré’s 16^th-century artificial leg. More recent additions to the collection include a pair of girl’s artificial legs from 1966, complete with little red shoes, and the i-limb, a high-tech artificial hand. People have been dreaming of ways to replace lost body parts for centuries, but these often clumsy replacements were hidden and as close to the originals as possible. Most contemporary artificial limbs seem to sink into the “uncanny valley”; they try, and fail, to look normal.

But it would seem that a new generation, adept at high-tech and with an encouraging creative flair, has new ideas about designing prosthetics. I found the young woman’s Floral Leg on the Alternative Limb Project website. This British company creates limbs that “stand out as a unique piece of art, reflecting the wearer’s imagination, personality and interests.” The owner, Sophie de Oliveira Barata, started her career in television and film special effects prosthetics, and has transferred her skills into the real world. While she continues to make realistic-looking artificial limbs, she has also designed a variety of “alternative” limbs, including legs fitted with stereos or crystals, a gadget arm (that looks very steampunk), and arms with snakes or feathers or carved wood. These are artificial limbs that, while optimally functional, very consciously do not look like the limbs they’ve replaced, but rather make a creative statement. These are replacement limbs meant to be noticed, meant to evoke conversation.

Sophie de Oliveira Barata’s Floral Leg design (Alternative Limb Project )

I don’t know what happened to the young woman on the streetcar, but I do know that it takes a lot of violent force to rend a limb from a body, or to damage it to a degree requiring amputation. Bike accident? IED? July has been a cruel month, with wars in the Ukraine, the Gaza Strip, Syria, Nigeria… Hundreds, or thousands, of innocent people have been killed or maimed, either as “collateral damage” or with quiet intent. Planes have been shot down. Houses and schools attacked. Unprecedented numbers of people are on the move with nowhere safe to go. A lot of violence. In my mind, these events are somehow solidified into this one image of a young woman wearing an artificial limb designed to attract attention and evoke conversation. When we got off at Bathurst Station, I wanted to shout after her, “I love your leg! It’s beautiful!” but I couldn’t find my voice and she disappeared onto a waiting bus, with dozens of people looking after her.

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The Human “Management” of Non-Human Animals

I was as strong in biology in high school as I was in the arts. When, after some trial and error and debate, I finally chose a path, I pursued the arts. When I see the direction biology has gone in the ensuing decades, I’m grateful for the wisdom of my younger self.

When I was in school, the notion was that animals existed as part of a food chain—with humans at the apex (of course). The human ego likes to place us at the top. This is the rhetoric of “Man, the Custodian of Creation,” based on the religious idea that men (and women and everyone between—humans), were placed on Earth as caretakers of what God (or Gods or Goddesses or Mother Nature or Gaia) had created. Given our record, we are clearly at risk of being smote. Whether considering wild or domesticated species, the way we “manage” non-human animals is appalling.

In practice, humans remain at the apex, so that if a human animal is threatened by a non-human animal, even if the human animal is encroaching on the non-human animal’s turf, the non-human animal usually winds up dead. But as we begin to understand how species actually inhabit their territories, we’re realizing that the correlations between animals are much more complex than we’d previously imagined. While we’ve shifted our thinking away from a food chain and towards a food web, these webs are much more complex than we fully comprehend or appreciate. And yet we have the audacity to continue thinking that wild species are somehow ours to “manage.” Through a combination of recklessness and ego, we’re doing a lousy job.

Image by Mansur Gidfar from http://www.bewareofimages.com/

For instance, tigers have lost over 90% of their habitat to human encroachment. Wild tiger populations are down to about 3,200 individuals, and yet they continue to be killed by poachers and because of conflict with human interests. Three tiger subspecies have been hunted to extinction.

In the oceans, estimates for the number of sharks killed annually from overfishing, finning and bycatch range from 100-200 million. While humans generally fear sharks, this slaughter compares with only 72 attacks by sharks on humans in 2013, only ten of which resulted in death. The Pacific coast off California has seen a marked increase in the Humboldt squid population—an animal in whose waters it would be much more dangerous to intrude. While reasons for this population explosion are up for debate, some scientists think it may be due to shark overfishing, as sharks enjoy raw calamari. Sharks, like tigers, are apex predators; remove the sharks, and the natural balance and environment are shaken, sometimes in surprising ways.

But this isn’t just a pissing match between human and non-human predators. Elephants and rhinos are strict vegetarians, and yet they too are being poached at an alarming rate for their tusks and horns. In spite of sanctions and political pressure, demand continues to grow, along with the estimates of the numbers of animals killed. A shocking 30,000 elephants are killed each year for their tusks. In South Africa alone, over 1,000 rhinos were poached in 2013. Consider too that these animals are slow to reach sexual maturity, have long gestation periods, and usually produce only one calf that requires maternal care for at least two or three years.

And these are just a few of the species being decimated by human greed and ignorance. In Canada, we’re acutely aware of the plight of polar bears due to loss of habitat from global warming. Right whale populations are now estimated at about 300-400 individuals worldwide, due to competition with industry and fishing, as well as climate change.

While some organizations, like the World Wildlife Fund and Wild Aid raise awareness through education, support ecotourism as more financially viable than poaching, and work to protect species at risk, other organizations created to caretake wildlife use culling to control populations, rather than supporting natural ecosystems to do this work. I wrote about some disturbing culls a few years ago.

This is the kind of “management” practise that recently led the Copenhagen Zoo to kill a giraffe named Marius, publically dissect him, then feed him to the lions. The zoo refused all alternative offers, and the zoo’s biologist, Stenbaek Bro, argued that Marius was cluttering up the gene pool and that the public dissection was educational. While he’s correct that in the medieval era public dissections were performed for this reason, there is no possible justification now. Anyone who wants to see a giraffe’s anatomy can simply go online or read a book to find the information, without killing another giraffe or traumatizing curious humans.

But it’s not just zoos killing animals. American Wildlife Services are reported to have “accidentally” killed in excess of 50,000 animals since 2000, including protected and rare species. Some organizations are bizarre hybrids that support conservation so their members have plenty of “game” for “sport.” For instance, the British Association for Shooting and Conservation aims, “to promote and protect sporting shooting and the well-being of the natural environment.” This is the kind of statement that assumes that we have a right to “manage” other species and that we actually understand all the complexities of interspecies interrelations.

And it’s not just wild animals at stake. Domesticated animals are non-human animals that human animals have tamed over many generations. We have altered their DNA and behaviour. Recent evidence shows that cats have been domesticated for over 9500 years and dogs have been our pets for 18,800 to 32,100 years. To my mind, a non-human animal that we have domesticated, tamed, is now our responsibility. And yet we don’t act very responsibly. Toronto has an estimate feral cat population of 100,000-200,000. Some of these cats started as someone’s pet, but the someone who adopted them, for whatever reason, didn’t have them spayed or neutered, or abandoned them when they moved. Cats reproduce at an alarming rate (even in the wild, given adequate habitat and hunting grounds), causing the feral population to spike. Organizations like Toronto Street Cat, a coalition of rescue organizations, work hard to neuter these animals, provide them with food and shelter, and find homes for adoptable kittens.

What happens when such volunteer measures aren’t taken? Prior to the 2008 Bejing Summer Olympics, thousands of stray cats were killed. Before the Euro 2012 Soccer Championship in the Ukraine, thousands of stray dogs were killed. And before and during this year’s Winter Olympics in Sochi, thousands of stray dogs, deemed “biological trash,” were killed. In many cases, these domesticated animals were dispatched in horrifying and inhumane ways. But with millions of stray cats and dogs euthanized in shelters each year, we can hardly boast of a superior record.

And this doesn’t even touch the millions of non-human animals killed each year in the name of “sport,” or “fashion,” or “science,” when better alternatives are often available. This doesn’t even touch the contentious issue of the billions of non-human animals raised and slaughtered for food for human animals each year.

Although human animals have enormous egos and a strong sense of entitlement, it is abundantly clear that we do not have the necessary knowledge to “manage” non-human animals successfully. And yet we like to pretend that we do. Part of the oil/tar sands rhetoric is that this destructive industry will put nature back just the way it was when they’re done. Unfortunately, we don’t know how to do that. A recent short film, How Wolves Change Rivers, underscores how much we don’t understand about natural systems and ecological balances, how much we don’t understand or appreciate the complexity of the natural web of life. When we do such a lousy job of managing our own population, how are we possibly qualified to manage the populations and habitats of other animals?

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Of Chance and Choice and Christmas

December 22 at 2:40 a.m. my power went out due to the worst ice storm Southern Ontario has seen in years. Tree limbs that lacked resiliency snapped off under the weight of ice, taking power lines with them and landing on a few cars and roofs. Hydro’s initial estimate was that power would be restored within 72 hours. That’s a long time in a society so addicted to gadgets that require electricity to function, but it’s a really long time when temperatures are below freezing and when fridges are packed with perishable holiday fare. It’s a really long time for people trying to travel home for the holidays. Flights in and out of Pearson International are delayed or cancelled.

The ice storm was beautiful–but inconvenient.

This Christmas won’t be the Christmas a lot of people had planned. A lot of folks won’t be able to get home. Travel plans will be changed at the last minute. A lot of food will spoil or will have to be consumed before it spoils. Barbeques will be fired up out of season. A winter’s worth of wood will be burned in a few days trying to keep pipes from freezing. Kids will spend the holidays camped out on living room floors in sleeping bags trying to stay warm. Strangers will share feasts of homemade cookies in airport lounges. Some will be disappointed. Some will think it’s the worst Christmas ever. Others will be creative and resilient and find ways to improvise. Arriving safely for Christmas is more important than arriving on time for Christmas. Even without power, tomorrow will come.

A low-light Christmas tree decorated in low light.

I’m lucky that my building has a back-up generator, so there is some heat, running water, and enough power for lights in the common areas and to run the elevators. This is a long way from a UN refugee camp, with multi-generational families crammed into unheated tents without adequate food or water. We are so spoiled to have been born into such privilege that we feel entitled to get angry when we don’t have everything we think we need. Yes, there will be hardships, but even if it takes a full week to get everyone’s electricity restored, we will recover very quickly.

I’m enjoying a warm cup of tea made from water heated on my fondue set. The building seems quiet without the hum of industrial systems and almost no traffic outside. It’s a little like being in the university library after exams, after the students have left, on the last day before campus closes for the two-week winter break. An eerie silence. A bit post-apocalyptic.

Monday morning 8:45 a.m. the power is still out. I’ve moved everything from the fridge into a cooler on the balcony. The building across the street from me, and everything southward, has electricity. I wonder if this is a little of what it feels like to live in places that don’t have our advantages, to look across borders and see the wasted resources. Makes me think even more about what we have and how we use it.

I’m enjoying the adventure of using my fondue set for cooking. I was getting tired of cold food, so managed to cook some noodles, as well as a cup of tea. Tried knitting by candle light this evening; it’s difficult to tell the knits from the purls. I rigged up a four-candle powered heater I saw online a couple of weeks ago (I am the child of an engineer; how could I not give it a go?). The air from the chimney was about 34°C / 94°F but I would need several to heat a space this size. The temperature in the apartment had dropped to about 17°C / 64°F and the outside temperature is going down to -10°C. I hauled out extra blankets and one of the cats cuddled up with me. Without the interference of artificial light, my diurnal clock is even louder; by about 4 p.m. it feels like bedtime and I have to struggle to stay awake until 8. It’s cold and bed is the warmest place to be. I settle in for a long night.

I’m the child of an engineer. How could I not try this out?

By Tuesday, Christmas Eve, 6:17 p.m. word is that power may not be restored until the weekend, a full week after the outage. I confess to finding a certain pleasure in the absence of the demands of electronic devices. I was seriously considering giving up my land line, but I’m glad I haven’t; it’s the only way I can contact the outside world. And I broke into the Harvey’s Bristol Cream Sherry. The cause for celebration? We were informed that we could access more heat! It’s been about 15°C / 60°F all day. That doesn’t sound so bad, but when you’re sitting in it, you start to feel it. With another cold night ahead, someone from the building came in and diddled with the radiator override, so now heat is pouring forth! Much relieved and so is my cat. Water and heat—the only convenience missing is electricity for lights and cooking.

Fortunately, a friend invited me to his place for Christmas Day, where I had good company, a hot meal, and was able to cook some perishable food before it spoiled. When I got home later on Christmas Day, the power had been restored, thanks to the efforts of numerous local and visiting Hydro crews. It was out for a couple more hours on the 27^th, but generally things seem to be returning to normal.

I hope that this holiday, without reliable power or transportation, causes people to reflect on their good fortune, testing their resiliency in the face of unpredictability, finding faith in themselves and humanity, to make the holidays bright and moving, even if they are not quite as planned.

A good time for quiet reflection.

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‘Tis the Season for…Conspicuous Consumption

Black Friday, the American phenomenon of greatly slashed prices just after the holiday celebrating the Giving of Thanks, has come to Canada. Fortunately, we do seem to be somewhat more civilized than some of our neighbours to the south. News coverage of the Eaton Centre, which opened its doors at six in the morning for the big event, showed a few dozen empty-handed people sauntering through nearly empty mall space. Meanwhile, in the great US of A, thousands of people breached store entrances before they were fully opened, grabbing stock from shelves, pummelling each other, being forcibly subdued by security, and scrambling for goods as if it was world’s end. But we’re not talking food here; we’re not talking about the necessities of life. We’re talking electronics, TVs and games; that fifth pair of boots or twelfth pair of shoes; that fiftieth towel or toy. Marking the beginning of holiday buying, ‘tis indeed the season for conspicuous consumption, and a day I prefer to avoid stores.

In some jurisdictions, the day also marks Buy Nothing Day (BND), conceived by Vancouver comic artist Ted Dave “To return the purchasing power of the marketplace to the consumer.” The notion was subsequently promoted by Ad Busters magazine, with events like a Zombie Walk, in which “The cheerful dead wander around malls, marveling at the blank, comatose expressions on the faces of shoppers” and Whirl Mart, in which “You and nine of your closest friends silently drive your shopping carts around in a long, inexplicable conga line without ever actually buying anything.” In 2011, Adbusters Media Foundation’s production manager, Lauren Bercovitch, started the Occupy Christmas movement, encouraging people to rethink their consumer habits to consider “Being ecologically aware, socially aware, culturally aware, environmentally aware…”

Choosing to participate in BND or to Occupy Christmas doesn’t mean becoming a Scrooge or the Grinch; this is, after all, and regardless of religious affiliation, a season of giving and celebration. Occupying Christmas means thinking about choice, rather than engaging blindly in consumerism, and that might still mean going to the mall for the latest Xbox release, but it doesn’t have to. For me, it means making gifts. Sometimes I’ve made food items, like baked goods or homemade soups and sauces. This year, I’m trying my hand at hand soaps and bath bombs. Although I don’t have a lot of free time right now, I’ve started working on a sweater for my little nephew; knitting is quietly meditative on these long evenings and something it’s easy to pick up and put down as time allows. I may also buy some locally crafted items (I have a lot of crafty friends). The one place I do spend money this season is on charitable donations made in family members’ names. This is my way of recognizing that, although it’s fun to give and get presents, most of us lead pretty privileged lives and don’t really need very much. For me, this is a season of quiet reflection and celebrating with friends—things money can’t buy.

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