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Valerie, July 2009

Even when cancer was over, it wasn't over. After the mastectomy was called off, there were still six weeks of radiation treatments to undergo to help prevent the cancer's return. There was a course of tamoxifen, an oral medication that could reduce recurrence by up to 50 percent, but that came with its own set of side effects. It gave Valerie insomnia and hot flashes, and left her unable to walk two blocks without resting.

Two years after she noticed the peau d'orange, 19 months after the cancer vanished, she was still visiting the radiologist's office every three months. The doctor would do a sonogram and mammogram and zero in on a few tiny areas that concerned him, pressing the biopsy needle into her breast to remove this or that bit of tissue for testing. But the tests always came back negative. Eventually, Valerie didn't bother to worry.

Just after the 4th of July weekend, she came in for her scheduled scans. This time there were five troubling areas, the fifth of which was deep inside her breast. Last one, last one, last one, Valerie thought. The needle hurt terribly.

The fifth area turned out to be a four-millimeter tumor. Valerie called Oratz. She let herself be indignant: Hadn't she taken a course of preventive drugs, been injected with gallons of toxic chemicals and zapped with hours of gamma rays? Hadn't she been that one-in-a-million case—managing to have nearly every side effect of every treatment she'd undergone, but also managing to disappear a cancer so prolific it might have killed her? She needed order. She needed things to make sense. She was lucky? She was unlucky? She was neither. It wasn't that simple. It was a story still unfolding—there was no way to know the end yet. And it was a story that was only hers. She remembers Oratz telling her, "Don't project anything you've heard about anyone else onto yourself. Your situation is different. Your story will be unique."

A double mastectomy was scheduled again. This time there would be no last-minute reprieve. At least, Valerie told herself, the surgery would negate the need for more chemo. She contacted a surgeon who said he would be able to spare her nipples, making reconstruction less complicated. Insurance wouldn't fully cover the surgery. She thought about what else she could do with the money she'd have to pay out of pocket—buy a car, perhaps—and then decided to move forward. "I was terrified of being disfigured," she says. In post-op, she woke in the midst of a violent reaction to her anesthesia. "A nurse was holding my chest as I retched so I wouldn't rip out my stitches."

Once she recovered, Ken came in to see her. He said, "You look so beautiful." She knew she looked terrible. She thought, What, did he read a book that says you're supposed to say that? She didn't understand that he was just so happy to see her, so happy she was alive, until he told her they hadn't been able to save her right nipple after all because the surgeon had found a tumor just beneath the areola and another elsewhere in the breast. All those tests, all those hollow, prodding needles, and still—still—there was no way to be sure they'd found it all.

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