By the time she was thirty, Gila Pfeffer was the oldest living member of her family, having lost her mother to breast cancer and her father to colon cancer. A simple blood test confirmed she carried the BRCA1 gene—which put her at high risk of developing cancer herself. Determined to break the cycle of early death in her family, Gila decides to undergo an elective double mastectomy.
This memoir follows her journey as she becomes a reluctant expert on how to sit shiva, grows up, falls in love, and enters motherhood, before her life is derailed yet again. Her double mastectomy reveals cancer already growing in one breast.
The following is an excerpt from Nearly Departed by Gila Pfeffer.
If you ever find yourself at the center of a crisis, the best piece of advice I can offer is this: You call the shots according to your own needs. If anyone gets offended by not being granted a better seat to your shit show, well that’s their problem.
I sauntered into Dr. Seagle’s office wearing my standard uniform: a black merino wool turtleneck, denim skirt, and black leather boots which I hoped would convey “peer” rather than “patient” to my pregnant oncologist. I was already envisioning a future where we’d meet up for coffee and talk about friend things; the doctor/patient era of our relationship would be but a blip on our radar screen. Before my infusion, she had to take my vitals and wrote the order for my chemotherapy mixture to be prepared. I had to follow that same protocol for the rest of my treatment, which would take place once every two weeks. In those final moments before starting what would be my first dose of eight, I felt protected sitting across from her desk while she conducted this last bit of admin. My body was still a chemo virgin. The last time I sat here, squeezing Phil’s hand while Dr. Seagle laid out my treatment plan, I’d wanted to bolt. Now, I wanted to avoid what was coming next by staying in her office forever.
Reluctantly, I followed a nurse to the chemo suite, where I kept my eyes straight ahead as we picked our way past a row of women in recliners, their drips already in progress. I didn’t want to see them. I didn’t want to identify with them. In my peripheral vision, I saw that every patient had someone with her, and I was proud of my choice—a little smug, even—to go it alone. I was also stupidly pleased with myself for looking so vibrant and well with my shiny hair and peachy complexion marching past the chemo chorus line to the very last seat against a wall.
It took fifteen minutes to set up fluid bags, clear tubes, and an IV pole. I was sitting upright in a pink pleather recliner, close to the edge so as to avoid unnecessary contact with hospital furniture. I knew that every surface there was wiped down with antiseptic and was probably cleaner than my own home, but as a germaphobe with an overactive imagination, the thought of having to make contact with a chair that surely held the sweat, tears, and hair of countless others nauseated me almost as much as the thought of having chemo. I made a mental note to bring a bedsheet from home next time.
“Would you like a blanket?” the nurse offered.
“No, thanks,” I smiled politely.
Blankets are for sick, shivering chemo people and no, I don’t want your magazines or fuzzy hospital socks or anything else to bring my awareness to my present surroundings. I didn’t even want an ice cap, a torturous and unreliable method of slowing hair loss by wearing a frozen helmet during infusions. From what I’d read, ice caps had a low success rate. I wanted to be left alone to sit for eight hours while organizing my purse and updating my contacts in a spiral-bound address book. No, I would not like to lean my (germtastic) chair back. Please go away.
“I’m all good, thanks,” I said when she finally ran out of things to offer me from the chemo suite menu.
As she left, another nurse approached and said, “Hello, I’m Rose.” She wore two surgical masks and a clear face shield. And gloves. And a plastic apron over a yellow disposable gown, two layers of cover over her scrubs. I wore no protective gear at all. I felt exposed. She tied a rubber tourniquet around my arm and tapped until she found a nice juicy vein into which she could thread an intravenous needle. “First, I’ll flush out your veins with saline solution and then I’ll attach your IV to the AC,” she said, pointing over my shoulder at a clear plastic bag filled with what looked like red fruit punch. A label on the bag was printed with “Adriamycin and Cytoxan” in sinister block letters. I felt sick and I wasn’t even hooked up to the drip yet. “Don’t be surprised when you go to the bathroom and your urine is red just like that liquid,” she warned without cushioning the blow. I already didn’t like her.
“OK,” I said, as she slowly got to work connecting the tube dangling from the pouch to the cannula sticking out of my left arm, the whole time muttering, “Yes, careful now, that’s it,” under her breath. It did not inspire confidence.
“Why are you wearing so many protective layers?” I asked, partially out of genuine concern, but just as much to drown out her anxiety-inducing pep talk. I could see the fruit punch moving through the tube toward my vein at a glacial pace. It was like a torture method from a movie where the antagonist dangles the hero over a tank full of angry sharks, lowering him bit by bit. Unlike in the movies, no one was going to swoop in from the paneled ceiling overhead to rescue me.
Rose jerked her head up and glared.
“This is very dangerous medicine I’m working with here, ma’am!” she spoke in a breathy, reverent tone. “It can be deadly! I can’t risk getting even a single drop on my skin, it could burn right down to my bone!” I made a mental note to request that she never administer my drugs again.
With my line firmly in place, she left me to marinate in my own terror. I stared out the window at the Hudson River, trying to get my heart rate back to normal before reaching for my address book and getting to work updating names, phone numbers, and birthdays. I did my best to keep the IV pole and its tubing out of my line of vision as the scarlet river snaked down the tube toward my arm. I had no appetite and no use for the buffet in my tote bag.
About two hours in, I really needed to pee, but was loath to leave my corner office. I didn’t want to walk past the other women or be exposed to the sights of my new world. Behind my eyelids, I summoned the palm trees of Miami, the choppy ocean waves, but my bladder was relentless. I grabbed hold of my tethered IV pole and dragged it to the bathroom, taking care to not dislodge the clear tubing lest it spray my red poison at everyone in its path (preferably nurse Rose) like an out-of-control fire hose.
In the bathroom, I calculated how much longer it would be until I was done, and Hayley could come take me home. I got lost in my thoughts about what my kids might be doing at that moment when I went to flush the toilet and gasped. Staring back at me was a bowl full of red fruit punch. I was halfway to fainting before realizing it was the Adriamycin. Shaking uncontrollably, I tried to calm myself with long deep breaths and sharp exhalations. It didn’t work. Half-dizzy, my pole and I made our wobbly way back to the end of the chemo suite, but this time I forgot to not look at the other patients. Finally, I glimpsed my future. Wool beanies with no hair peeking out, silk scarves tied tightly to bald skulls, green/gray complexions with sunken, eyebrow-less eyes and, worst of all, blankets up to their chins.
The combined effect of my bathroom scare and seeing the bald-faced (sorry) truth of what was coming for me was my undoing. My tears came hot and fast, and I scurried back to my seat where I finally lost it, sobbing loudly into my coat draped over the arm of the chair. Coming here alone was a bad idea.
A nurse (not Rose), middle aged and wearing a colorful headband in her short, black hair, appeared out of nowhere and took my hand—the one without a cannula in it—and massaged it in an effort to calm me.
“My dear,” she began in a strong Trinidadian accent, “Shhhhhhhh, it is OK, sshhhhhhh.” I kept on wailing, cursing myself for telling Hayley not to come until my infusion was finished. What a fool I was to think I was above needing support. The nurse must have assumed that my tears were due to a poor prognosis, that like countless other patients who’d been in her care, my life was on the line because the next thing she said was, “Make plaaaans for da future,” waving her free hand in a dramatic arc, which made me think of Sebastian the crab from Disney’s The Little Mermaid. I was powerless to stop my brain from picturing the nurse standing before an oceanic backdrop in a crab costume, singing a song about my plight.
“Chemotherapy” (to the tune of “Under the Sea”)
So, you got a gene mutation
I think it called “BRCA1”
Well now start your celebration
You in for eight rounds of fun
You should make plans for the future
Could have had a worser fate
If you caught your cancer later
You’d be at the pearly gates
Whoa-ooh
Chemotherapy . . .
Chemotherapeeeeeeee
Darling it sucks here
Soon you’ll have no hair
Take it from meeeeeeee
Now wait for nausea to set in
And mouth sores make it hard to grin
Hide in your lair now
You with no hair now
Chemotherapeeeeeeeee
I grabbed my phone from the tray table and dialed Hayley’s number. She picked up on the first ring.
“How fast can you get here?” I gurgled, my voice thick and nasal.
“I’ve been sitting in my parked car around the corner for the past two hours. I’ll be there in five.”
I swear I could hear angels singing hallelujah as she ran toward my chair.
“So damn stubborn, you are, Bwian,” she tutted, using the Monty Python nickname we’d called each other since we were eighteen. We cackled like hyenas, fully aware of the stares from my fellow suite mates. I now understood why none of them was there alone.
Excerpt from Nearly Departed: Adventures in Loss, Cancer, and Other Inconveniences © Gila Pfeffer, 2024. Reprinted by permission of the publisher, The Experiment. Available everywhere books are sold. theexperimentpublishing.com
Gila Pfeffer is an essayist, humorist, and author. Her work has appeared in The New York Times, The New Yorker, McSweeney’s, Today.com, and Oprah Daily. Gila’s monthly “Feel It on the First” campaign uses humor to remind women to prioritize their breast health. She is the author of Nearly Departed: Adventures in Loss, Cancer, and Other Inconveniences. She splits her time between New York City, London and Instagram (@gilapfeffer).