My breasts will be removed in 10 hours.
I stand naked in my bathroom, staring at my reflection in the mirror. There are three small, red puncture marks on my right breast, souvenirs of the biopsy that confirmed my cancer.
My husband comes into the bathroom and stands next to me. “Do you want me to take pictures?” he asks tenderly.
I shake my head, but don’t look away. I know that I’ll never want to look at pictures of what I once had: breast tissue, nipples, a softness and pliability that not even the very good implants I’ve chosen could replicate.
My husband and I had sex last week, and I’d assumed we would have it again before my surgery. We still could; I could kiss him and lead him into the bedroom, lower myself onto him and ask him to squeeze my breasts hard and then harder still because after tomorrow I won’t feel anything.
But if I do, all I’ll be able to think about is that it really would be the last time I’ll have sex in this body, and that seems unbearably sad. Instead, I hug my husband tightly, feeling my breasts flatten against his torso, and cry.
I spent much of my adolescence thinking about breasts: specifically, my lack thereof. In eighth grade, one of the popular boys said to me, smirking, “Hey, Sarah, all of the other girls’ shirts stick out in front. Why doesn’t yours?” I stared at him, my face burning with shame as his friends snickered.
It took five more years but eventually, to my surprise and awed gratitude, I filled out a 34C bra. I reveled in wearing scoop-neck tanks and fitted sweaters and spent far too much money at Victoria’s Secret, buying bras and slips in shiny fabrics that made a series of boyfriends groan appreciatively. And I liked that, while my hair could be unruly and my skin was prone to breakouts, my breasts always looked good.
My breasts were also one of the few parts of my body that I could count on not to cause me pain. I have no memory of not being in pain; from my earliest childhood, my head and eyes hurt, a constant discomfort that was misdiagnosed as headaches and eye strain for decades. Shortly before my 30th birthday, a neurologist figured out that the problem was related to specific nerves, and I had two surgeries to decompress those nerves in my head and face. The operation on my head was a success, but one on my face failed to help, and the pain around my eyes persists.
When I was in college, my right wrist suddenly began to hurt. I endured years of misdiagnoses and failed treatments before an MRI revealed damage to the tendons and cartilage in my wrist. I’ve had eight operations to fix the damage, but my wrist aches constantly and will never function normally again.
In my early 30s, muscle spasms began to wreak havoc on my shoulders and neck. As with my other chronic pain, the muscle spasms began spontaneously and have proven difficult to successfully treat. One file cabinet in my office is full of paperwork related to my health: consult notes, surgical reports, invoices for experimental treatments, lists of medications, and films from an alphabet soup of exams: MRIs, CTs, X-rays. Forty-three years of damage takes up a lot of space.
In contrast, everything associated with my breast cancer is confined to the slim folder that my breast surgeon gave me at our first meeting, the name of the hospital emblazoned on the front.
My breast cancer was discovered during a routine mammogram. It was caught early; I was diagnosed as stage 0. I didn’t even know it was possible to be a stage 0 cancer patient until my breast surgeon explained that it meant that precancerous cells had been found in the ducts of my breast. The cells were so widespread that she recommended a mastectomy.
The surgeon also said that although I could keep my left breast, I might want to consider removing it, too. It wasn’t just about lowering the odds of a recurrence, she explained; there was also my chronic pain to consider. If I kept the healthy breast, my oncologist would want me to take Tamoxifen, an anti-estrogen medication used to help prevent a recurrence, for five years. But my muscle spasms were affected by hormones; they became much worse when I had my period. Because of that, neither the surgeon nor the oncologist thought that I’d be able tolerate Tamoxifen well.
A lifetime of living with chronic pain had made me comfortable with making big medical decisions quickly and having no fear of aggressive treatment. While having a bilateral mastectomy after being diagnosed with stage 0 breast cancer felt a little bit like using a hammer to kill a fly, it also made complete sense to me. I returned to that feeling of certainty often in the days leading up to my surgery, the knowledge that I was doing the right thing in the face of so many unknowns.
A week after my surgery, I received the pathology report. Several small invasive tumors had been found, and there was a chance that cancerous cells were still in the scant amount of breast tissue that remained. My diagnosis was changed to stage 1 breast cancer, and I had to have 33 radiation treatments.
For six and a half weeks, I woke up early and drove to the hospital for treatment before work. Radiation laid waste to my skin, which became discolored, peeling, and blistered. I coated my skin in burn cream, swaddled it in gauze, learned how to breathe through the exquisite pain of nerves regenerating and skin patching itself back together.
The first time my husband hugged me during my radiation treatment, I flinched. His touch was gentle but it didn’t matter; pain still radiated through my chest, my skin too raw for comfort. I saw the guilt and shock in his eyes as I jerked away. After that, we avoided anything more intense than holding hands. I missed our physical contact, especially spontaneous embraces, but my body was instinctively, perpetually hunched slightly forward, guarding against unexpected touch. It wasn’t just the pain that I feared, though; I didn’t know how to share my new form with my husband until I knew how I felt about it myself. So many people looked at my naked torso every week during my treatments, but I had never felt more removed from my physical self.
It was during this time that I began to think about niddah, a Jewish practice that forbids sexual relations for women following menstruation, until they have immersed in a mikvah. I was raised Reform and now belonged to a Reconstructionist synagogue, so I didn’t have any firsthand experience with the ritual, but I knew a little about it. And what I knew, I didn’t like; it struck me as deeply misogynistic to consider a woman “impure” when she had her period, which was such a natural biological process.
I read more about niddah when I was undergoing radiation. Most of what I learned reinforced my initial distaste for the practice, but the physical separation that niddah caused resonated with me in an unexpected way. Indeed, I felt a kind of kinship with the women who observed niddah and wondered if they, like me, found the enforced distance a time to reconnect with their own bodies. I wouldn’t have chosen any of this—the cancer, the radiation, the fact that my husband and I were experiencing the longest physical separation of our 17-year relationship. As much as I mourned my old body and missed the ease I’d had in my body and with my husband, I also knew intuitively that this was a time that I needed to create a space for myself, a bubble in which I could heal and adjust alone. It felt like I had stumbled into a different kind of niddah, if such a thing could exist: a cessation of physical contact due to a biological process gone awry, but one without a definitive end point.
One of the pieces I read about niddah was Merissa Nathan Gerson’s “Lessons From Jewish Sexual Law (in a Sexless Pandemic),” which introduced me to the concept of kavannah—intention. In that, too, I found a resonance that was not what the rabbis and mystics had perhaps intended, but felt right all the same: that until I could have sex with the pure intention and focus kavannah demanded, I wasn’t ready to have sex. Kavannah gave me a spiritual end point, a framework in which to think about my healing as something that would happen not just physically but emotionally, too.
Before undergoing radiation, the most I’d thought about Orthodox traditions had been when I watched Unorthodox, so it initially felt odd to find clarity and comfort in these notions. But my cancer treatment caused other beliefs I’d held to be turned upside-down: that my breasts would never cause me pain, that distorting and burning my body was the best way to save it, that I’d embrace those changes because they’d increase my chances of a good outcome. The more I thought about niddah and kavannah, the more it made a perverse kind of sense that these rituals, which were so different from the kind of Judaism I knew, would provide a blueprint to lead me out of this jagged time.
The night I decide to have sex again is at the end of an unremarkable day a month after radiation ends. My husband and I are in our bedroom, the yellow glow of the streetlights leaking around the edges of our closed curtains. Our lower bodies press close together, my husband careful to keep his chest from touching mine. My pectoral muscles are still tight and the implants feel like smooth stones resting on top of my torso.
I close my eyes as my husband moves on top of me, intent only on what I can physically feel: the cool sheet under my back, the minty scent of my husband’s breath, the familiar rhythm that I missed for so long. And then I am overcome with relief, the emotion so strong it brings tears to my eyes: relief that I am returning to the person that I used to be; that our physical isolation, necessary as it was, is over; and that I am still here, in this altered body, with this life yet to live.
Sarah Erdreich, the author of Generation Roe: Inside the Future of the Pro-Choice Movement, is working on a memoir about parenting with chronic pain.