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Closing in on a Killer : WOMEN TALK ABOUT BREAST SURGERY; From Diagnosis to Recovery: How to Go Through It in the Smartest, Calmest Way, By Amy Gross and Dee Ito (Clarkson Potter, 1990: $22.95; 333 pp.) : DR. SUSAN LOVE'S BREAST BOOK, By Susan M. Love, MD , with Karen Lindsey (Addison-Wesley, 1991: $13.95, paper; 455 pp.) : MY BREAST: One Woman's Cancer Story, By Joyce Wadler (Addison-Wesley: $16.95; 206 pp.)

October 25, 1992|Margo Kaufman | Kaufman is the author of "1-800-AM-I-NUTS?" (due this winter from Random House) and a contributing editor on The Times Magazine

As it stands now, one out of every nine women will find a lump in her breast, go to her doctor's office, and hear two of the most terrifying words in the English language: "It's malignant." Speaking (alas) from personal experience, learning that you have breast cancer is like being trapped on Mr. Toad's Wild Ride. Ordinary life is in abeyance, days are spent lurching from specialist to specialist, careening between Fellini-esque medical procedures--bone scan, liver scan, biopsy--trying to make major life decisions, while struggling to remain in control.

It isn't easy. But if there is a bright side to being part of a modern epidemic, it's the abundance of literature available on this subject. Gathering information gave me a way to get a grip. While Betty Rollins wisely titled her moving 1986 account of her bout with breast cancer "First You Cry," after the second or third box of Kleenex is depleted, the next step is obvious. Second, you read.

A warning: Coping with breast cancer tends to make you feel vulnerable. And some books are inherently more reassuring than others. A rule of thumb: Read what makes you feel better, not worse. With that in mind, here is a sampling from my medical bookshelf. In "Women Talk About Breast Surgery," Amy Gross and Dee Ito have assembled a support group in book form to show women how to be "the smartest possible patient and how to get the best possible care for yourself." This collection of conversations with women who have survived lumpectomy, mastectomy, radiation, chemotherapy, and/or reconstruction is compelling , comforting, alarming, infuriating, informative, and ultimately empowering. While the survivors' stories are buttressed by useful interviews with experts on anesthesiology, plastic surgery, oncology nursing, radiation, chemotherapy and even insurance, the authors operate on the assumption that the patient is an expert too.

"The women we interviewed are models of the New Patient: well-informed, skeptical, opinionated, insistent on getting involved in treatment decisions," they note. "These voices have all been to the front and returned to tell what happened." To read the war stories is to gain valuable insights into what it's really like to go through different cancer treatments (information that your doctor may be too busy or unable to supply), how it feels to live with one breast, the difficulties of juggling chemotherapy with a career, and the effect of cancer on a marriage.

These women offer helpful hints on decisions large and small. For instance; if you're having a mastectomy "you have to take a button-up nightgown because you can't lift your arm." If you're considering reconstruction, "study your plastic surgeons and don't do it unless you've seen their work. You ask them not only for pictures, but you say, 'I want to see a couple of patients you've done.' And if they won't show them to you, then don't use them. You wouldn't buy a car without driving it." Perhaps the most helpful information was inadvertently provided by the woman who lamented that she didn't bring a script filled with questions to ask her doctor. The authors jumped on the idea and have provided sample scripts for each procedure.

Still, this book is not for the easily spooked. Many of these women describe medical nightmares that I for one would not want to read the night before I entered the hospital. For example, one mastectomy patient recalls that "a doctor came into my room to get my medical history. . . . He said, 'Describe why you're here.' So I said, 'I found a lump in my right breast.' He said, 'Wait a minute, your right breast? Are you sure it's your right breast?' I said, 'Of course, I'm sure.' But her chart said the opposite."

While the fact that so many women survived their ordeals is a testament to the skills of the medical profession, the disconcerting message of this book is Patient, Heal Thyself. "Sometimes, you have to tell your doctor what to do," a woman declares. "That's a horrible way to think about it, but you have to take the offensive many times." If you prefer not to view breast cancer as sort of a guerrilla exercise in assertiveness training, than this may not be the book for you.

Dr. Susan Love is, or at least seems to be, the Marcus Welby of breast cancer, the doctor every patient who has ever spent three hours waiting for a doctor who spends 10 minutes without ever meeting her eyes wishes she had. A staunch feminist and advocate of patient rights, she co-founded and directed the Faulkner Breast Center in Boston. Recently, she moved to Los Angeles to develop and direct a comprehensive breast-cancer center at the UCLA School of Medicine. In a straightforward, clearly written, illustrated textbook, Love gives women the print equivalent of an expert second opinion, a user-friendly reference that explains everything you ever wanted to know about your breasts but were afraid (or didn't know who) to ask.

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