Freedom from myths | My ‘monkey darling’

MINT

Freedom from myths | My ‘monkey darling’

The stitches have healed just fine but don’t press it,” said the oncologist to a 36-year-old female after a breast surgery to remove a malignant breast tumour. Her next thought was “if it can’t be pressed, how will I have sex?” She never asked that question though because according to her, it was a bit “shameless”. Her sex life, which had been dragging since the diagnosis, soon became non-existent. Her right breast looked scooped out with a turned-in and misshaped nipple. The awkwardness around it and her fear of loathing by the man who she had loved since college caused the relationship to sag interminably. When she asked her elder sister, the response was angry. “Here we are worried about your survival and you want to know how you will have sex with half a breast?” retorted the know-it-all big sister.

Then there is the case of a 42-year-old lady, a university lecturer. Due to a spreading cancer, she had a bilateral mastectomy three months back as well as breast reconstructive surgery—often done now as part of the same operation that removes a cancerous tumour. Now, instead of what her husband called “Fat Girls”, it is an area of botched-up tissue and skin dotted with deep red scars and blue-black bruises covering gel-filled mounds. She has no nipples. Nipple reconstruction is done later, usually a few months after creating the breast mounds.

It is a truism that breast cancer awareness is spreading, at least in urban areas. It is also correct that cancer excisions, partial, single or bilateral mastectomies and reconstructions, done in top hospitals with modern surgical tools and expertise do not necessarily leave the patient “maimed”. This volatile word is used by plastic surgeon Shahin Nooreyezdan of Indraprastha Apollo Hospitals, Delhi, when he says “we no longer maim patients the way we did in the past—these are very sophisticated surgeries now”. At the same time he admits that scarring is indeed permanent and no reconstruction can restore a breast to normalcy. There are many before and after surgery pictures and videos on the Net but watch this one set against Adele’s lyrics Sometimes it lasts in love but sometimes it hurts instead, to imagine the scarring a breast cancer patient could face—https://www.youtube.com/watch?v=FFEq0tviKYE&feature=endscreen .

Graphic: Ahmed Raza Khan/Mint

Doctors say few patients, almost none, bring up how disfigurement, even when life-saving, becomes the third person in an intimate relationship. Those who do ask even indirectly suffer from the guilt of being “morally indiscreet”. Sex and self-esteem are big casualties in every cancer patient’s life. It is not just one surgery after all. Chemotherapy brings a tide of other cosmetic defeats and radiation can cause blisters in the breast area.

“Boobs, boobs, boobs, a girl must have boobs,” sang a blithe music group at a Las Vegas night show while girls with real and fake boobs danced in exaggerated joy. The audience, women included, had a glint in their eyes. Most women anywhere in the world have a secret breast story. Besides biologically shaping feminine identity, breasts form the core of our self-image. Naming them once a boyfriend or husband comes along adds to the erotically charged heartbeats they create in our private lives. In India however, most such stories are not shared. So when a breast dies, mourning it is a lonely ritual for the patient. Besides, cancer doesn’t just affect those who have husbands. It demolishes every type of woman without discrimination—single or married, sex workers or housewives, with or without a sex life—thus needing personalized counselling.

According to the last three-year report (2006-2008) by the Population Based Cancer Registry (PBCR) set up by the Indian Council of Medical Research, breast cancer in cities in India accounts for 25-32% of female cancers. According to Breast Cancer India, a Mumbai-based organization, this implies that one-fourth (fast turning into one-third) of all female cancers are of the breast. While an update of this study is still to come, leaving us with figures already four years old, surgical oncologist Sumeet Shah who heads Breast Cancer India, suggests further analysis to understand what’s actually going on. “Around 48% of women with breast cancer are in the 25 to 50 years age group. The younger the patient—with many more years before menopause—usually, the more aggressive the cancer,” adds Dr Shah. According to the PBCR data, 50% breast cancer patients in India present themselves at stages 3 and 4, effecting survival rates.

Among the frequently asked questions at forums (much like an Alcoholics Anonymous group) like those organized by Breast Cancer India, sexuality questions never come out starkly. “Among the first things I offer and impress upon my patients is a breast conserving surgery (where feasible); however, many patients insist on removal of breast and a majority of them do not want reconstructive surgery,” says Dr Shah, adding that a number of women even in their 30s just write off their sex lives. Dr Shah, who worked at Mumbai’s Tata Memorial Hospital till three years ago, admits that body image issues left hanging in the air urgently need to be addressed.

Deepali Kapoor, psycho-oncologist and part of the Breast Cancer Foundation at Delhi’s Indraprastha Apollo Hospitals, counsels both husband and wife after cancer surgeries. She points out that a majority of Indian oncologists being male, women shy away from asking body-related questions. “Most sidestep these issues even before female surgeons, so it is only over a period of counselling a patient that we can help with sexuality issues,” she adds. Dr Kapoor begins by exploring the nature of relationship between a man and his wife and if there is indeed a sex life that needs to be saved. She compares the worry around scarred breasts with questions of death, equally avoided by patients.

Women in smaller towns or rural areas have no recourse at all. Most live with sexual rejection, if they live at all. Earlier this year designer duo Shivan & Narresh in collaboration with the Women’s Cancer Initiative of Mumbai’s Tata Memorial Hospital launched the Mastectomy Blouse For All for breast cancer survivors. “It has an in-built prosthetic breast and is proposed for Indian women—many of whom living in villages aren’t even exposed to the idea of bras—to be able to wear the Indian sari without loss of self-esteem,” says the design note. The blouse is available at their flagship stores in Mumbai and Delhi and comes in UK sizes 8-16.

These are a relevant step but as Dr Shah says, “Support needs to go beyond padded bras and mastectomy aids.” Nobody has quick solution though small armies of volunteers holding the flag of awareness at urban as well as grassroots levels are doing their bit. What women need, says a senior psychoanalyst, is a romantic or poetic acceptance of the harsh reality and some wry humour.

Here is an instance. It is a part of short story on the breast after cancer titled Monkey Darling in author Shinie Antony‘s book Séance On a Sunday Afternoon. “L throws back her shoulders. Out comes the phantom breast to play. The one that doesn’t rhyme with anything, can’t be heard or seen, doesn’t pat her heartbeat like it used to… Damn she must name it.

Monkey darling. It comes to her late at night, between a toss and a turn, when one side of her body heavy with flesh rolls down the empty other side. To cart around and get used to a 34-D for years and years only to lose it!

L sits up slowly in the bed and peers down. What can you say about mammary made of moonlight and mist and memory and mangled skin? Monkey darling, she sings tenderly. My own monkey darling.”

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