The knock of the knot – A Breast Cancer Blog with Lacanian Angles Curves
Needlework and Syringes
Keeping my routines as normal as possible helped me prepare mentally and physically for the lumpectomy, which some sources call a partial mastectomy, excisional biopsy or breast-conserving surgery BCS. Clinicians regard BCS as the gold standard for early stage breast cancer treatment. Surgeons skilfully accomplish “acceptable” cosmetic outcomes by removing just enough breast tissue to achieve adequate surgical margins. My life was as busy as normal. This fake normality was fuelled by a creeping inner denial. At work I kept schtum maintaining a professional secrecy – apart from my over arching boss, work colleagues were in the dark. The only giveaway sign was my attitude, more positive, stiffly smiley, unusually chipper. I was the smile without the cat.
Three days before surgery an NHS letter arrived advising me as a woman of a certain age to come for a routine mammogram for early cancer detection. Eye roll. Despite our state of the art technology this monumental failure of “joined up working” perpetually creates these painfully ironic events. Action-reaction: I gave them a call to cancel and mentioned that for their records my breast was already being treated for cancer. The following day I received a phone call asking if I was still up for the op. That took me by surprise, I was astounded to discover that clearly there must be women who do a runner, change their minds or simply say no thanks to surgery.
At 8:30am the day before my surgery I was summoned to the hospital’s Nuclear Medicine Department to have the necessary radioactive injection. Preparing myself for the same intravenous syringes (in the arm or hand) problematic hidden veins were not permissible. I drank a ton of water and tried to keep my veins visible by arriving briskly on foot, wearing gloves and keeping warm with lots of hand/finger agility moves. The big surprise was discovering that the needle enters around the areola. Ouch!
With my arms bent obediently behind my head, the needle injecting the radioisotope was expertly entered several times. The nurse warned me that it would hurt. Its path was numbed by doses of lidocaine, a local anaesthetic. The eye on the needle steady as if measuring across the face of a clock. The expression “sharp scratch” was replaced by a trill anecdotal comment about how patients acquaint this pain to a “bee sting” – a formulaic “sound-bite” indeed, but painwise none of this needlework caused undue discomfort.
Imagining the pain and playing through worst case scenarios were par for the course but in-the-act going with the flow wasn’t too horrendous. It felt barbaric yes, the nurses injecting around such an intimate part in full light of day and then massaging down to ensure the radioactive liquid was absorbed. It felt bizarre and a tad torturous. But the huge bruises (on the back of my hand) from the cannulas, (needed for the breast MRi and bone scan) were more sore and a greater nuisance to every day life. Nerve healing zings of pain, a week after the three core needle biopsies from the breast, took the biscuit. These sudden unannounced debilitating zings of excruciating but momentary agony went on 24-7 for several weeks. But perhaps this is individual. Instead of pain, the greater trauma was from not knowing the details of procedures. This made me feel cumbersome and “done to” a vulnerability shrouded by my own ignorance and heightened feelings of useless ineptitude.
As part of the lumpectomy procedure the surgical oncologist had explained that the radioisotope and blue dye injections were essential to locating the exact nodes for SNB (sentinel node biopsy). The injected nuclear fluid tracks around the lymph nodes which light up once the blue dye is absorbed. For a lumpectomy to be successful the clinical team must ensure that no tumour cells have infiltrated the lymphatic system. This is now the clinical standard of care replacing the more complex full axillary node dissection which more frequently exacerbated fluid build up and swelling in the arm called lymphodema. This condition is still a classed as a possible side effect. A set of simple thrice daily exercises are recommended to reduce the chances of accumulated fluids. http://www.lymphedivas.com/ is a phenomenal outlet for fashion compression sleeves. Their blog is informative too.
The detection and treatment of breast cancer is like a biological game of hide-and-seek. Deciding if cancer is present, how widely it has spread and how to remove it are all part of the algorithm. I could not feel my cancer, it was non-palpable. What I did feel was a normal cyst. The cancer did not show up on the mammogram. I have learned that mammograms have limitations. At present they provide two-dimensional images of the three-dimensional breast. Glandular tissue and tumours are similar in density and remain occult especially in women with dense breast tissue.
My cancer barely showed on the ultrasound as an area suspicious for malignancy tucked alongside the cyst. DCIS means the cancer is still contained within the ducts. The biopsy gave confirmation that my cancer has a name, it’s called IDC and tomorrow we’ll find out if it has spread to the lymph. Above is a diagram of the types of cells, assisting to verify the stage of cancer. I would love to see what these cells are really like. Daring to ask the surgeon to keep it for me, he asked if I’d like it in a jar. In earnest I nodded. He thought I was joking.
The knock of the knot – A Breast Cancer Blog with Lacanian Angles Curves
Cancer Tests…Patience! Warrior or Worrier?
Who knows the depths of this rabbit hole? When will the falling stop? We came away with the diagnosis of IDC Invasive Ductal Carcinoma. “Cancer Patient” what an earth does one do with that title? What a hot potato! The recent history of vitamin D deficiencies and femur pain alerted the specialists to arrange a full body CT scan and MRi, the results of which would be known before surgery. In the meantime celebrations were in order for remaining whole. It seemed appropriate to run the first of the month 10K. Who knew how the surgery and treatment would alter my running ability. My breasts, my lungs, my thorax and my general ability to be me.
The run was steady and just over the hour. My PB stands at 54 minutes but that was several years ago and before the Half Marathon Training. My times had become slower after learning to run over longer distances. My Barcelona Half Marathon Time (la Mitja Marató) was two hours and seven minutes. Considering all that had happened throughout August I was not going to beat myself up with some ‘self-flagellation’ for taking a few extra minutes on such an amazingly sunny day. Running in London in a crop top at 48, who wouldn’t scream “Carpe Diem” and take a few snaps. What’s wrong with being a self voyeuring narcissist! In fact why hadn’t pictures been taken more frequently! Notice the word “pictures” not “selfies”. Perhaps because a body is taken for granted on the day-to-day and no-one expects alterations to come out of the blue.Who ever expects a personal Frankenstein to step into their lives? In fact who wonders if they will become the next wretched monster. With the zing of post- biopsy nerve pain easing, to run was bliss.
My preferred sports’ bras are both Royce and Shock Absorber. I combine but tend always to wear two bras if I want to go under the radar. The visible jiggle, joggle, jug-gle is both discomforting for me and distracting for onlookers. Not to mention damaging for the jugs in the frame! Mine are still pretty pert – two sports bras, see! We don’t wish for casualties!
The knock had come as a warning to wise up, chivvy and prepare for an impending change. Atishoo, atisshoo, pass me a tissue as self indulgent tears are welling, not of pain but of fear and impotence. Dates are marked on the calendar as time slows whilst smiling like a super-trouper to keep up the formal normalcy of each working week. September 7th and it’s time for the bone scan. Why oh why do my veins vanish when shiny needles appear. Of course it was impossible to put the cannula in the crook of my arm. Deep veins, narrow veins, delicate veins, I’ve heard it all. So the tube was plugged into one of the bulbous veins in the transparent skin upon the back of my bony hand. Ouchy. Stripped into the hospital robe I lay upon the machine as the nurses fled for cover in their little bunker. Once switched on, a burning hot sensation seeped into my hand as the radioactive liquid rushed into my body. It was burny. I called out in case that was unusual. My voice was swallowed by emptiness as no-one replied. Silently, eyes closed the machine whirred. It’s drone-like shadow inches from my face. It’s metallic greyness leaving a cybernetic taste upon my lips. In a different life those mineral atoms and molecules may have become a mountain bike or a child’s scooter and these living cells of mine may have had a reprise: no hawk-eyed nurse, with hours of CPD training would have noticed tell tale signs of cells showing suspicion of malignancy. Who is this person being scanned for cancer?
Some days after the whole body bone scan came the breast MRi. Wearing two medical gowns the specialist eyed my veins which once again hid away, having to be coaxed into action from the dark bruises on the back of my hand. A cannula was attached and a cold dye injected in order to achieve clear images once the machine was activated. Despite waiting some time before my turn came, no-one had explained the postures required. A slight confusion and sense of humiliation and impotence flooded over me as I was asked to mount the machine on all fours. I felt incompetent like a child and emotion chugged hot behind my eyes. Clambering upon my hands and knees I lurched my stomach forward lizard-like, before lowering these pendulous dugs into the hollow depressions within the scanner. How ungraceful. The clinician adjusted my chin on a padded rest and fiddled with the side openings where my body dangled. If only I had seen a photo of the machine and ungraceful posturing then maybe the sting of salt would have been prevented. It was tolerable and over in a flash but those moments of confusion had left a heave of sadness and desolation. On September 11th the results came through to confirm that things were as before, no worse, no better, although the lumpectomy and sentinel node biopsy would bring the final judgement by determining if the lymph nodes were clear. All that was left was to wait for the date of surgery. Breathing into these events my hope was to maintain a modicum of normality.
The knock of the knot – A Breast Cancer Blog with Lacanian Angles Curves
There is no “if”
The recommended hospital check up on August 17th became a dizzy drama which had ended in the collection of three biopsy samples tagged with the verbal verdict “suspicious of malignancy”. We now fast forward a week to August 24th for the consultant’s truths and the clinical evaluations of the extracted tissue. Cancer is bad enough. But breast cancer is not just a question of removing the invasive tissue, the damage is more often than not on display for all to witness. Sweaters or shirts, yoga or work, small is beautiful, big is better, size doesn’t matter, asymmetry is the new me. Aesthetics are examined because the gaze is where it’s at and choices are weighed according to appearance. Seen, gazed upon, evaluated by well qualified clinicians and ones own inner critic. Yet only the survivor will know how or what they feel. Once the “C” word has been uttered the die is cast – the journey has begun. And how different it is to be the follower of the path rather than the one who watches the follower trip-trap, trembling into the face of the unknown.
The speed of events leading to that place called “diagnosis” leaves a cut that strikes to the quick. The cancer journey traverses the path of the Lacanian Borromean Knot at a surreal pace. The criss-crossing shifts between the raw horror of the Real Order to the incomprehensible medical spiel in the Symbolic Order. Here one hears a series of numbers and ciphers that announce the severity and spread of the tumours. All of it takes a while to sink in. How does a mere mortal with no medical knowledge interpret, contemplate, face or side step these truths? How if not with flights of fancy, fear and fortitude? The Imaginary Order assists to re-play all possibilities no matter how far fetched.
For one who enjoys contemplating all case scenarios in order not to get nasty surprises a mastectomy or even wide spread malignancy were in that worst category. How does one deal with the receipt of such news? In the past week my knowledge and reading about breast cancer had increased exponentially. I had over forty windows open on my cell phone. The most difficult to assimilate was recent publicity regarding over-diagnosis. Particularly I was concerned about an apparently benign type of cell disorder namely DCIS, ductal carcinoma in-situ. Yet this bugger of a stage zero cancer pointed to all sorts of possible future complications and is often treated with double mastectomy. Okay if a huge tumour were present then a mastectomy had to be the course of action but if they’d discovered one of these supposedly benign dubiousities what would be the decision then? Throughout the week my imaginings ran riot and my non-medical brain clung to “watchful waiting” an expression that seemed to do very nicely. My semi-subconscious had affirmed that if it were all neat and small then it would be permissible to “just wait and see”. Maybe the bad cells would slip away unobserved if they weren’t given the centre stage. Mastectomy however was on another astral plane. Of course anyone in this situation goes through the list of “what ifs” and it is necessary to do so. It is necessary to prepare oneself for the decision making to come; to arm oneself with the knowledge and try to find the strength to take the next step. It is natural to consult and scan the evidence from: medical trials, hospital case studies and those who’ve had first hand experiences in blogs and forums.
If a mastectomy were needed then so be it. There is no choice remaining if that is the considered treatment. So easy to say and so quickly contemplated in that safe imaginary space. But then what? Then comes chemotherapy, being irradiated and the immediate discussions about remaining flat or facing reconstruction. Now that is a biggie because often it is the patient’s choice. Never have been good with choice – how can anyone know what is for the best? As a big breasted gal having part of my body replaced with a prosthesis goes against the grain. I like my breasts. I’m slim, I maintain that lollipop shape and I likemy breasts. But maybe that is the reaction of many. Would choosing flat be closer to remaining me? Remaining authentic? Would a unilateral operation then soon imply the need for a double mastectomy just for gravitational balance? What would the physical complications be if the healthy side remained a 30GG? Becoming so lopsided is probably asking for future structural and musculoskeletal complications! A one breasted quasimodo!
In the consultant’s room I had the letter in hand, the classification was U4. Falling into the biopsy procedure seemed almost an accident yet a lump had been noticed. It wasn’t just routine. I myself had flagged up the possibility that maybe there was an irregularity, an irregularity that was part of my body topography and that had been noticeable as a visible palpable knot for months. I heard myself explaining this as the consultant sat squeezed in front of us in quite a tiny room. About to embark on my “leave well alone” strategy I began to speak, “If it is a cancer….” Before I could say more the consultant had doubled in size. He rose up in his seat and rapidly stiffened, bracing himself to reply. His response to my bargaining plea almost knocked me into the back wall. In retrospect I don’t think he spoke loudly but his tone and gust of breath gave no room for nonsense. “IF…if… there is NO place here for if. It is cancer!”
That piece of straight talking brought us all into the here and now. No menacing real, no vague cloud of symbolism and no room for imaginative reprise. Yet all the Borromean elements were present. The real like a spectre in the corner. The symbolic of voice, body language, gaze and scientific convention opened a chasm between us. The rabbit hole was widening as I was falling further and further away from what I new as tierra firme.
They’d not discovered a benign lesion. It was a baddie. It was not DCIS or a cyst or fibrous tissue. It was IDC. Invasive Ductal Carcinoma that the biopsy had siphoned out. Leaving rogue cells (that had already broken out of their region) to possibly spread further around the body was out of the question. There were no ifs nor buts, it had to be excised: scalpel brandished and incisions made. The consultant wasn’t part of the team I had seen on the day my world was turned on its head. He gave little room for chat. He was very matter of fact and an operation was going to be planned. The lump was to be removed, clear margins sought and the sentinel lymph nodes biopsied. Only after the surgery would the specialists really know what they were dealing with. What imposter was I harbouring? BUPA was mentioned. Could BUPA be a saving grace? Everything was already moving way to fast and the surgeon most likely would be the same guy whether I were to choose private or not. Why fast track to BUPA? I’ll stick with the NHS. The word “lucky” began to infiltrate into conversations. Lucky to be in a part of the planet with a pretty amazing healthy care system. Lucky that the malignancy had been found early. Lucky to live not so far from the hospital. Lucky not to have to consider those worst case scenarios. Lucky to be relatively young, very fit and healthy. Healthy! Yes healthy – Bah humbug – Lucky Lucky Lucky.
The knock of the knot – A Breast Cancer Blog with Lacanian Angles Curves
Being whole is taken for granted – The Scare Begins
Despite assuming that we are whole, we all have holes, gaps, absences we’d like to fill. But those are part of who we are. Some holes we parade, others we hide. To our best ability we suture with pride, nobility, secrecy and these become part of our life-armour as we grow in experience. Our life scars, from old sutured wounds that have mapped our journey conceal the cuts and cavities within us. Being pre-advised of a future harm gives time to prepare. To throw on the chain-mail to choose our weapon.
Reading the writing on the wall or seeing “las orejas del lobo” is very different to suddenly facing the Lacanian real in the lion’s den. Where did the lion come in? Where fight, flight or freeze are inappropriate. Ready to be eaten alive, the cancer patient struggles as the very jaws of unspeakable change close around us. Hurled into a foreign future by one life changing incident. When do the wheels of fate turned irreversibly? How will this duel in the gladiator’s ring terminate?
August 17th 2015 – From Friend to Foe
My first appointment was casual. How crazy is that. I’m not a pill popper, I take no daily nor occasional medicines nor am I a believer in herbal snake oils. However a month earlier, in July, after mentioning pain in my legs. The pain emanated from the bones not the joints. Tests had shown quite a significant ‘vitamin D deficiency’ for which I was prescribed a 20,000 IU supplement to be taken twice weekly. Or in Spanish un suplementazo containing 20,000 IU of Vitamin D per capsule. Now a pill is a pill but this dose was huge when compared to a similar capsule from Vitabiotics. The Vitabiotics dose is a measly 25 microgram (1000 IU) and a typical Cod Liver Oil tablet with its heavy load of Vitamin A has 200 IU of vitamin D. An eye opener and certainly confirmation of deficiency. Fortunately the blood test results had indicated that everything else was fine.
Regarding the breast, I knew there was a nodule, a knot of tissue that had slowly risen to the surface over a year or so, to make itself known as an unknown. The GP had thought it fine, part of dense tissue but symmetrical and in harmony with my shape. Clearly being sent to the specialist clinic was the precautionary part of the government’s latest “routine” services. So I rocked up alone and confident. The appointment unravelled in three parts.
At each step I was getting closer to the finding myself lost in the forest of Hansel and Gretel with no way back. Or was I the trusting Little Red ready to be gullible, tricked and misled. But it wasn’t a crow that ate the bread it was me. Did I mark out the path? Did I even have bread or anything to use as a sign to bring me back to safety? At what point did the shadow of the trees enclose in? Part of me is still there in that forest waiting to find my way out. Back running, stumbling toward the sunny day I’d left behind. Back to normal. Before the knot. Before the knock.
Being called in promptly, the first part involved seeing a young nurse, much like my GP. My GP oftentimes sits with her legs underneath her on the swivel chair, casual and youthful. This nurse had me manoeuvre my arms above my head, to feel for symmetry. She happily stated that all appeared fine. The depth of precaution still as part of the routine check, led me to part two, the mammogram which showed nothing. This machine was already known to me. When I lived abroad it was normal to scan at around 35 years, thirteen years ago. The machine was maybe a bit more high tech and the human side was impressive with sincere apologies for any pain incurred by the pressure of the clamps. Being told that I had dense and firm tissue for my age gave more optimism. Apparently it is normal to get an unclear image, the experts understand that mammograms fail to pick up any shadows with larger or firmer breasted patients.
So is it surprising that I ate the bread? How was I to know that I would be trapped and would never get out the same way that I came in. I was unconcerned. In a sunny place, relaxed and calm. Behind me I could still make out the start of the path in the sunlight. I would soon be home and fine. It was all friendly, no sign of evil until the hissing began from the audience. Oh nurse, what a grand machine you have! All the better to examine you with my dear!
The third part is where things cloud quickly over. Skipping footloose and fancy free into the final room I prepared for the ultrasound. By coincidence I had to lie on my left side facing the wall and by facing the wall I couldn’t see the ultrasound screen to my right. I was pretty much out of the picture, blotted out, as a sideways silhouette stretched prone on the medical couch with my arms askew. There were two nurses and a lot of murmuring. I was listening but only aware that tones were not so chirpy. None of this was pleasant and time seemed to be speeding up. My mouth became dry.
The sunny glade was still bright but by now I think my confidence was getting a knocking. There was no longer a way forward, nor apparently a way out.
The fourth part made me blink. The question asked was not a question it was a statement. Here I realised I had certainly become part of a medical algorithm. If you can’t turn anywhere on the compass-rose then start downward digging. They were preparing to take a biopsy and wanted me to twist further to the wall. Whoa! Hold those horses, I came here for a regular check. I didn’t sign up for this. I wasn’t even warned that instruments and pain may be part of the outcome. Ha! I whisked out my phone and asked to make a call before the needle.
At least I’d used my chance to send a search party into the forest, however twisted out of shape with shock I may get. I could see myself sitting in the glade. No longer warm but chilly and shocked at my own original optimism. Ready to face the fact that I had no control. Yet somehow a narrator was reassuring me that this whole chapter was being re-written for my own good. This was how my story began taking a turn into greyscale.
Before the needle, calling home was reassuring but nothing was going to change. Surely it was for the best to acquiesce to the professional care. Coming back on a different date was not a suggestion. The core needle dove in under the skin allowing the clipper that clipped, to snip and sample an area that defied a simple visual or manual appraisal. The procedure wasn’t that uncomfortable, just totally unexpected. Anaesthetic squirted in ahead of the gouge. They took three samples. They gauzed me up with instructions to leave the padding on for 24 hours and so I gathered myself together and was led back out to the waiting room. Once in the corridor somehow the day was not as bright as I first remembered. Though I now had a comforting hand to hold, my someone special to hug and their caring company, to walk with me outside and into the street. Shock is a funny thing. Shivering in the cold light of the truth, it was slowly dawning that a part of me had been taken to a laboratory for analysis. This could be the start of something quite unexpected. My place was now limbo. Lost on a spectrum between healthy and any degree of eyebrow raising antonym. With cold sweaty palms, my heart fluttered hard in my chest. I felt sick.
The knock of ill fate has arrived. How could someone so damn healthy receive a diagnosis of breast cancer. Clearly not as healthy as you thought huh? As I write in my whole pre-surgery state, I am still reeling in shock. Well let’s not go there just yet, to the place of self criticism, the world of what-ifs. A breast cancer diagnosis is a shock but especially for anyone young, when those check up warning adverts often show more elderly women. At 48 I’m middle aged, so not young as such, born in the 60’s but still if you’re as old as you feel I’m certainly the younger side of the spectrum. Cancer in someone who is slight of frame, medium height, has never dieted but maintained a trim weight by sheer devotion to sensible exercise and joie de vivre. Living in the mediterranean for almost two decades must also have contributed to being pretty fit. Isn’t eating enough to go to the loo every day essential? Kiwis are remarkable for the digestion. Two a day to be reduced once clockwork 😉 is the keyword. Of course in my early twenties I would skip breakfast in favour of being a chain coffee drinker with powdered cuppa-soups on the go. Now half a slice of toast gets my metabolism going in the morning to break the fast. Yes with lashings of peanut butter. That first bathroom trip before commuting to work is essential to feeling unbloated. In fact my exercise plan is hardly a set plan because I self-sabbotage. I cannot force myself to do something without the inner-me rebelling with a “why should I”. So I set up a flexi-plan whereby I would never leave three (or in my later years four/five) days between a run, a swim or a sporty spot of cardio activity. There are things I never eat, not a fan of pastry or sauces that have lost their source. Some “foods” aren’t foods. Forget that old maxim of eating everything and “getting it down you lassie to be fit and strong”. If it’s too snacky, too processed, has zero nutrition or empty calories why consume it. Not really a fan of big brands either. If ever eating out who wouldn’t prefer to give their hard earned cash to a little independent business than feed money to the corporates? Eat-well exercise-well, never starve, never diet, never deprive, has always worked. It’s all about life style, “a way of life” not ‘fits and starts’ by jousting with fitness! As previously mentioned, I do drink an awful lot of water too. So maybe my downfall has been drinking all that water stored in plastic bottles, or an on/off use of anti-perspirant. I rarely use perfumes or sprays or make up. I used to drink powdered soup. Isn’t all that a tad carcinogenic? Again it’s about moderation.
A daily arrow of eyeliner isn’t total abstention but better than creating excessively addictive beauty habits. The advertising makes it just dandy even for the youngest in society to slather on creams, gels and nail varnish. They say bras themselves can’t do any harm. There we have it! A few more “whys” and “what ifs” and plenty of research available. Not that it helps when you are already the 1 in 8.
In my younger years my heavier chest just made me look bigger than I was. At school the nick-names began. Now since my diagnosis I have that inner voice screaming out breast insults! Yes a life long neural network – a veritable collage – of breast insults that have brought this new ‘breast tourettes’ bubbling to the surface. I googled a few and was surprised at how politically correct bloggers are these days. Less gawping, gaping and certainly no touching without permission or a court order. So let’s let off some steam and type out some breast related insults or compliments. Afterall with a fuller figure (above the waist at least) and youth on your side, the traffic stops!
Not so these days, not for me as I’m pushing 50 and so it should be. Us oldies move over for the sprite youths. It is hard though when once the traffic stopped and now you have to skip to avoid being run down as the green man is flashing. Growing older comes to us all. No time to stop and contemplate! But today’s girls, what a lot of insults they’ve missed by growing up in the twenty-first century. At school, as my buttons popped open, the first metaphor was Melons!
I wonder if I can find images for every insult (or twisted compliment) that I grew up with! Not to take away the joy of a lively imagination. 🙂 And please do look at the Busty Girl Comics because really they hit the mark for the over-endowed.
Bazookers, tits, knockers, bad boys, the girls, ample bosom, jugs, dugs, orbs, gourds, sweater-stretchers, lung protectors, frost detectors, hooters2die4, honkers, zonkers, jogging partners, gazongas, fun bags, baps, ta-tas, boobies, boulders, busts, chest, cones, fried eggs, itty bitty titty, nice pair, bee stings, cup cakes, love apples, watermelons, big mammas, flans, mosquito bites, good rack, stacked, the double ds, storm in an E cup, cleavage, breasticles, brazons, lactation station, Cor what an eyeful, give us a handful, fancy a squeeze, get your tits out love, give us a grope!
The symptom occurs where the real, imaginary, and symbolic overlap. When the symbolic is shifted in the direction of the real, we get the symptom. When the real is shifted in the direction of the imaginary, we get anxiety. When the imaginary is shifted in the direction of the symbolic, we get inhibition.
Lacan posited this was in relation to psychoanalysis but over time it has become a way to examine society as well.
Preamble and ID – Who am I?
To understand my title a back-story is necessary to reveal the front story. This will help to place the reader in my shoes, or indeed, in my under-things and even closer to my heart. Whilst running shoes and bras support (the) girls on their journey they also help to set the tone and pave the way to where this tome is going!
Me? I’m pushing a half century in work, wisdom and lexicon. If sliced like a tree you may see my rings and count them at leisure, if you had the time! Yet with thirty years of dedication to healthy living and life long learning the results are better than my teenage self would ever have envisaged. Seriously those teen years can be so shackling, imprisoning. After years of feeling the dreary drudgery of sub-par fitness it turned around. From my mid twenties to mid thirties I became a swimmer, devoutly lapping through the local pool or those beloved icy white waters of Aragon or the balmy waves of the seas in northern Catalunya. Once settled in the Iberian Peninsula, I’d left the sloth-life of university long behind, gnawed through the chrysalis and spread my wings. It took four years and a lot of failure to give up chocolate and a few other bad habits picked up as an independent twenty-something. By contrast living a Mediterranean lifestyle a natural diet was simple to adopt, a no-brainer, a non-negotiable. Not forgetting that for more than half the year flesh is not tucked under jumpers but on full view. Picture this: in those days before the fall of the Berlin Wall, before common currency, our wages were paid in pesetas. The wave of consummerist choice had not begun its ebb and flow. Unsurprisingly neither flavoured crisps, nor Cadbury’s, nor fast food chains had arrived. Expats filled their UK bags with Baked Beans and antiperspirant and picked peaches from the trees without a care.
With total will power (alongside a growing realisation that action comes before motivation) my stamina increased and I gradually whittled and honed to produce a svelte silhouette that led me to embrace the benefits of running. As a ‘lollipop’ shape, a term coined by Trinny and Suzanna, it is a total myth that one sports bra suffices.
To ensure zero movement two sports bras are essential. But at least we can thank technology for a decent though expensive selection to hold the girls in, up or down, depending on the occasion. Perhaps, the artificial creation of a 30GG bust is a scopic jouissance rather than a tactile pleasure? With no hips to balance things out, joking school friends expected me to sway with such forward weight. Running, alongside its benefits, brings its own ailments. Osteopathy and sports stretching became part of a body maintenance regime. In my early forties I discovered yoga, which has its own anatomical hurdles to navigate. Not too many forward bends and sun salutations please! Nor whilst I ponder, are the upside-down poses easy to breathe into! Yoga has been amazing for toning lateral abs and arms. Side plank is heaven.
So you get the picture, the body in this story is 100% natural. This has not been achieved without a routine nor plenty of fuel. Enjoying foods especially nuts and cake, without guilt, without greed and with heaps of healthy organic greens! If I have a toxic sin it’s the controversial abuse of bottled water.
A habit of imbibing phylates for the last twenty years as opposed to becoming dehydrated and suffering tremendous headaches. Yes the daily litre and a half of water has cured most of my migraines. Whatsmore I can’t drink it cold from the fridge. Yep a self confessed luke warm water guzzler.
These writings have been a long time coming. Strange that facing a diagnosis of breast cancer has become the catalyst as I divulge the ups and downs of my journey. Perhaps as my view of the world is revealed it will be clear that I am a Lacanian, albeit still in the larval stage. Devouring his work in an attempt to find reason. The bends of my twisting mind work with metaphor, metonymy, onomatopoeia and lateral thinking. I craft links that traverse a world of personal signifiers that may resound with others, whilst allowing me to both enjoy and despise my symptom.
The Symptom – What is your symptom?
Clearly my present medical symptoms are transcendent, who could have predicted this recent transition from being a lively carefree mare to a suddenly aging patient. A patient now sporting a monthly calendar speckled with future appointments, treatments and emotions. Beyond that my Lacanian symptom is a lifetime of understanding that one foot always remains in the gap. Whatever good karma is summoned the human condition forever drags the world behind it like a shadow. Every gaze is a moment lost.
Since forever, I’ve looked into the eyes of mortality and wondered what the hell it is all about and I can’t let that question go. Daily I look into the mouth of time and shiver at what it means. Fear, excitement and unfairness, the ephemerality of life has always been present to me. Emotion beauty and bewilderment are everywhere. Leaving the now behind and moving forward into the future causes a hankering and nostalgia that is palpable. It always has. Even as a twelve year old regressing across my own short life-time to a familiar building with dusty red Victorian bricks, damp walls and an abundance of old hardbacked books crammed in vertical piles. Or cycling though parkland with the comforting sameness of welcoming ever greens and grassy hillocks. Breathing in seasonal changes whilst the world fundamentally remains the same year after year, whilst also expecting the next thing on the plate of life. A wait which creates an unfightable anxiety of anticipation. Fear as the anticipation of change can only be kept at bay by being busy. What can one Desire next? Routine or surprise? Certainly going to work fills the void. Does that sound familiar? Well that is the symptom for me. Chasing life and simultaneously running away from the changes it leaves. Fear of the unknown, of being uprooted, of losing everything familiar. Whilst holding tightly to the now and the past it’s anchored by.
To an extent fighting cultural growth in a push-me pull-you of wanting to stay still. Some of these waves are expressed vividly in A Monster Calls by Patrick Ness. The monster being all the unknowns we face with change and loss. Even the loss of today to face tomorrow. The instant loss of now and the nostalgia of then.
(Not for the ‘feint’ hearted – despite being a children’s book).
Chapter & Verse – A Breast Cancer Blog with Lacanian Angles Curves
The Borromean Knot is formed of three rings which are linked so that if one of them is severed, all three become separated. Thus no two rings are linked directly but all three are collectively intertwined. This is also termed a Brunnian link.
Lacan uses the Borromean Knot as a topology to illustrate human subjectivity and the interdependence (within the subject) of the three orders of the real, the symbolic, and the imaginary (RSI). Lacan’s Borromean Knot is a tool to examine the interconnectedness between language and the body. Language is essential in nuancing experience, adding that rebel flare of uniqueness where an invented word or Freudian slip might reveal the marrow of meaning. Language is how we share our stories. Meaning can sometimes be read in other ways: the gaze, movement, tears. Meaning is down to interpretation of the symbols given. Read my story and see what it means to you. Every story has a right to be told. Every story touches every reader with a new uniqueness.
Βreast Cancer Stories begin with a diary of chronological events. Time has an effect of order and disorder as a cancer treatment progresses with a sequential and consequential rhythm. These autobiographical events are interlaced with Lacanian concepts, sometimes narrative, prosaic, poetic, oftentimes opaquely viewed through the author’s Lacanian lens. I am no expert but hope to frame parts of my journey with a psychoanalytical slant that provides a fly on the wall perspective into the marvels, the mysteries and the (in)sufficiencies of science whilst drawing a ring around philosophy and creativity. Lacanian terms will be used such as: the gaze, the gap, the sutre, the borromean knot, the fourth ring, suppléance, objet a, jouissance.
Borromeanknocker shows a lived experience of the union of Lacan’s three orders. Surely, anyone stepping into a breast cancer arena for the first time and hearing that they have cancer will be faced with the Real. A place where the mind sinks into an unfathomable world, where nothing connects, a place beyond the expressable. Next comes the Symbolic Order where on the cancer path a new schema of neural networks are laid down to comprehend an entire medical universe, a new orbit of language, a “medscape” that grows from nonsense to become a cancer patient’s thesaurus facilitating communication from novice to pro. Alongside these is the Imaginary order, which contains our fears, nightmares, wishes and our own best self-image, our “ideal ego” which is the way we strive for others to see us: survivor, thriver, victim, statistic.
Borromeanknocker is written in a language to suit at least three audiences. First for myself as I indulge in a cathartic leap of creativity in my role as writer and patient. Second for those interested in one woman’s breast cancer journey, albeit a qualitative linguistic-ethnographic account. Third to the possible chagrin of contemporary scholars of language this account has a psychoanalytical Lacanian flavour centred around the signifier and how our relationships with “the other” are bound as gendered subjects through language. Our bodies, our desires and our human communication define our social identities. These dimensions can take a knock-back when cancer calls. Cancer can be lived as a tsunami that strikes and resonates upon our identities, upon our language, upon communication. It leaves behind a day to day heap of physical and emotional debris. How we choose (with the choices left to us) to reinvent ourselves and continue forward, is as individual as any recipe for life.
The rest of this entry addresses the topological borromean rings more thoroughly.
The Real Order– In the beginning, the order of the Real marks the earliest time when the infant is bound with nature and where early primal needs are satisfied. There is no sense of separation between the self and the world beyond. In this state the Real is a place of completeness for “his majesty the baby”. “His Majesty the Baby” as coined by Freud in ‘On Narcissism’ is rewarded with total devotion: point and receive, scream and be satisfied. This is where parents feed an innocent megalomania in their nurturer-child symbiosis. This completeness is fragmented by the introduction of meaning through language (the beginning of the symbolic order). Once the individual enters into the symbolic, commonalities are forged which create pathways of meaning through neural networks. Thrust into the realm of semiotics infants become forever barred from the comfort of that first safe place.
As an adult, the Real is stepped into where no symbolism reaches. The Real is found without being sought. It is captured by looking awry and through that glass darkly. It appears as an enigma. The Real is glimpsed in a gasp of a “now” that has already passed. It cannot be symbolised. Any contemplated interpretation or understanding of the Real is achieved after the fact, through the symbolic. The real may manifest in that sudden wordless sensation of realizing the existence of something abhorrent in one’s current situation.
The Real is held by an internal failure, a stoppage or a juncture that defies symbolization. It is an encounter with dislocation, trauma, aversion, where the symbolic cannot function as an interpreter. Žižek attests to the Real being viewed three ways. The real Real, which faces us directly with the horrifying “thing”. The symbolic Real which is viewed as ciphers and codes pertaining to meaningless formulas, and the imaginary Real which brings us in touch with inner most fears, anxieties and morbid obsessions. In the Real we see ourselves in an unrecognizable Otherness that provokes disgust. The Real itself is “nothing but a grimace of reality” (Žižek, 2002: xvii, cited by Glyn Daly).
Edward Munch’s painting The Scream is a good depiction of the deafening silence and anguished wordless reality when faced with the Lacanian Real. To use one of Lacan’s examples, “a knock on the door that interrupts a dream.” My life as a dream with its normal ups and downs – until the not discovered knott came knocking. The real is never directly present to our experience, but rather makes itself felt in its contingent effects. There is perhaps a suggestion here that our day to day world is akin to a dream or a mask that conceals the real. When the Real hits, its unanticipated, unpreventable interruption threatens the coherence and integrity of the life we know. Illness, death, or explosive life changes force us to face the Lacanian Real.
The Symbolic Order – The symbolic order is reliant on a joint agreement of meanings which ideally give clarity by circumventing confusion. From birth, babies are faced with an immersion into the symbolic, “As soon as the symbol arrives, there is a universe of symbols” and these symbols demand obedience to laws and contracts for effective social cohesion. Some of us find these easy to follow, others blunder into faux pas.
These laws are designed to restrict and control human desire and communication. The symbolic creates our known ‘reality,’ our day-to-day world which is described and classified by mutually understood codes that enable thought and comprehensible talk. Whilst the symbolic order is anchored to the linguistic dimension, it actually carries the human transition from nature to the domain of culture, of which language and its exchange of signifiers are the greater part. In creating meaning we depend on the field of the Other, whose presence stretches back into our distant ancestry. From the first human communication, from pre-verbal to the modern lexicon, the multiple effects of signifiers have been built over time. These structures form us as reactionary subjects within the symbolic order today. Words have importance within the symbolic order but the meanings of words are not always meant at face value. Signifiers are built communally and with each individual’s history. The realm of the “personal symbolic” has a depth of meaning held by the unconscious. A psychoanalytic interpretation of signifiers in wakefulness or dreams may reveal deeper meanings by delving into the root of a subject.
The Imaginary Order – Lacan’s Imaginary Order is not exactly a realm of images and imagination but of appearances, semblance (an inner disposition toward oneself) a memory of a presence and the affect of bodily sensory perception. It is a pre-language development state where the Ego develops. It is something that exists in the mind regardless of its existence in real life. Through imagining, one can identify with other people and images and view oneself as the other, or assume the other as oneself. For the infant and throughout life, the process of self-construction entails borrowing and appropriating images that become a constitution and reconstitution of the self or ego. It begins with the Lacanian “mirror stage” which is formed by silent interactions, experienced through visual images rather than words. A state of fantasy between our inner Innenwelt and outer Umwelt; these worlds form an inner sense of what we see and hear and how we internalise what is happening to and around us.
Self-representation is underpinned by how signification becomes arrested by fundamental images of ourselves that provide us with a sense of coherence regarding our place in the world. We “narrate” ourselves around core images with which we identify and/or wish to project.
The visual act has two parts, the eye and the gaze. Via a reciprocal gaze the infant is introduced into the world. The eye of the subject (the infant) looks out at the object (its mother), whilst the gaze “le regard” is received by the object being looked upon. The child’s first sense of wholeness is as being inseparable from its mother. The infant’s illusionary control over its environment is slowly fragmented by the universe of “otherness” whereby entities are hidden by words and engulfed by symbolic protocols not least absence and separation. Once the infant recognizes that its body is separate from the world and its mother, anxiety and loss result.
The infant has a simultaneous self-recognition and mis-recognition of its reflection. The mis-recognition comes about in that what the infant is seeing is not itself but a reflection of itself. A reflection that it owns and carries as its idealised image “Ideal-I” into the larger social order and which becomes a product of identification and absorption into discourse with others. Thus, this fantasy image “Ideal- I” is filled in by others who we emulate, assimilate or repress in our adult lives. Adults seek identification with ideas (as well as images) in order to compensate for their sense of frustration and the aggression and narcissism that arises from a desire to be coherent. But coherence is thwarted by competitive relations, rivalry and an envy that creates a polarity between alienation and recognition. The disconnect (dissonance) , between a coherent image and fragmented sensation, continues according to Lacan to be a part of the person’s life for as long as he or she lives. It leads Lacan to conclude that “the object of human interest is the object of the other’s desire” (1955-1956b p39).
Writing belongs to the imaginary order. Of course the interpretation of what is written crosses into the symbolic to make sense of what is read and to unpick the depths of meaning. Once uttered, words traverse from the silent ponderings and possibilities of the imaginary to the spoken symbolic order where meaning is situated in relation to otherness and the big Other. ‘The big Other’ regulates meaning and cultural expectation. It is the unwritten “rules” that bind us by etiquette and the conventions that make us part of our social group: going for a beer, taking tea, shaking hands, attending our 9 to 5, and of course following the doctor’s advice. But sometimes words are not enough, neither those spoken as reassurances nor those written as prescriptions for health and happiness. Sometimes words just don’t cut it.