I am in a high-risk category for breast cancer. My mother has had it twice. I am 59 and have been having mammograms since I was 40. I examine myself (none too thoroughly) and have manual breast exams every three months.  I took Tamoxifen for five years, prophylactically, after research and discussions with my doctors about a study suggesting that it might prevent an initial occurrence in a healthy woman as well as reduce the chances of recurrence. I feel confident that I am doing what I can to prevent this disease.

The new mammogram guidelines must be confusing to many women. I fall into an unambiguous category, so will continue to have one every year. I am not in a position to evaluate the new guidelines, but I hope what I have written will resonate for many of us.

In the mammogram waiting room this bright November morning, it reeks of tension and fear, despite the warmth of the slanting, thin sunlight making its way through thermal panes. I am cold in a waist-length teal blue cotton hospital gown and jeans, my nipples rising against the slight material of the wrapper. I am both shivering and dripping sweat from my armpits. I have brought with me the hardest New York Times crossword puzzle I could find. Mad focus helps to pass the time and dull the anxiety. I am deep into my puzzle and don’t talk to or look at anyone else. I need to be in a cocoon, a zone of invisibility until it’s all over. Still, I can’t help but hear the three other women in the room.

It only helps a little if the waiting room is nice, like this one in Edinburgh.

One is in her 50s, a State Department humanitarian aid worker, curly auburn hair, fit, attractive. She calls this test her “mammy,” to me a surprisingly affectionate term. She has had a lumpectomy and radiation. She thinks she got breast cancer in Iraq, from all the stress. There is an elderly Israeli – her back-of-the-throat Rs tip me off after the first few syllables. Right away, I see she has all the cynicism, anger and fatality of her compatriots. She has been here since 8:15 and it is 9:40 and no one has seen her. It is sadistic, she tells the others. She used to teach Hebrew but quit after having cancer. It turned her hair white. The third is an obese, chatty, pink-faced, high-voiced, people-pleasing woman. She is breathing heavily and perspiring. When she goes into the dressing room to put on her clothes, she asks me to pass the deodorant.

Who knows what private apprehensions lurk in this comfortable, clean, color-coordinated room with nine armchairs, five dressing rooms, 10 lockers and a filtered water cooler? There are tissues, brochures and very old magazines. At least two of us have gotten bad news once before.

I have just returned to the waiting room after what is, curiously, the least stressful part of the ordeal: the actual test. Other than the momentary vise-like compression of my breasts and the bored, efficient manipulation at the hands of the technician as she places them just right, I am strangely distanced from the experience. I tell myself the pain is nothing if it means I will be all right.

At this moment I am not thinking what my rational mind knows: that breast cancer is not a death sentence. I am not thinking of the millions of survivors with their pink ribbons and brave optimism. I go right to catastrophe.

My mother had breast cancer at 36 and then again at 43. She is alive and flourishing at 85, but her illness, particularly the first time, when I was 11, marked my childhood and my view of the world more than any other event in my life at that time. That may even still be true. Even though she lived, it feels like death to me.

In our family, things moved ahead only “if all was well.” If everything was fine, at least what passed for fine in my family, life could go on unimpeded. It was either all good, or it was all bad. In good times, there were holiday gatherings, work, shopping trips, school activities and family dinners. If, on the other hand, “all was not well,” the cogs of my family’s machine shut down and all activity, all joy, all plans were held in suspension until there was a resolution. Some crises were medical, and there were many over the years: my mother’s illnesses, heart disease, a serious car accident, cardiac surgery. There were others, too: my parents’ complicated marriage, several separations, always a sense of not enough money, troubles in my aunt and uncle’s family, and the adults’ ongoing burden of having to help out in my grandparents’ liquor store.

The adults around me did not cope well with ambiguity. Things could never be both good and bad or even a little bit of both. Good was okay, nothing to get particularly excited about, hardly noticeable in its banality, and never appreciated for its simple delights. Bad, in contrast, was misery. It was operatic. It was stomach-churning, hide-under-the-covers, end-of-the-world scary. There was no such thing as just a little bad; crises of any kind turned into stop-all-happiness-until-it’s-over bad.

I spent hours in hospital waiting rooms in which I was drawn reflexively to sit with my family because if I didn’t, I feared something worse was going to happen to the hospitalized person. The attitude going in was that enjoyment of daily life would somehow have a negative effect on the situation. Thinking grim was the way to stave off disaster.

So it might be imagined that as an adult I have had to develop coping mechanisms to deal with calamities – real or fantasized – and to get me through times when my guts are screaming “This will not end well!” but my heart is yearning for good news. Today I am in the middle of such a time, waiting for the result of a mammogram. If there is bad news, I hope I can dig deep enough to tell myself the world won’t end.

Every year I prepare for the test with my own brand of magical thinking. I schedule it for the beginning or middle of the week, Wednesday at the latest. I figure if I get bad news on a Thursday or Friday, I cannot live through a weekend of waiting to have a biopsy or to see my breast doctor, with whom I schedule an appointment a few days afterward anyway, just in case. A couple of years ago I asked my doctor to allow me to have a diagnostic, as opposed to screening, mammogram, to make sure I could get the results right away. Not knowing is out of the question. And for a little extra assistance, I take an Ativan.

I play elaborate mind games. This year I considered re-scheduling it until after a weekend writing retreat on the theory that if I got bad news, I would not have the peace of mind to spend four days in a hotel room writing. My interior monologue goes like this: If I don’t have the test this week, I won’t know anything. If I don’t have the test but do have breast cancer, I ought to be acting quickly and not sitting in a hotel room. If I don’t to go the retreat, I am robbing myself of an experience I deeply desire, notwithstanding other anxieties about it. The voices are calling to me: Bad news is around the corner. You can’t escape this. If you go for the light instead of the darkness, something very, very bad will happen.

It is a formidable adversary. Still, I go. Hurray for the forces of light.

Here in the waiting room the week after a writing retreat, I wonder if my life is about to change – or end. I want to get out of here. The longer I sit, the more I worry. My arms and legs are crossed to contortion. Is this going to be a Before and After moment? Why is it taking so long? What have they found? Will I suffer? Will I ever wear a pretty new lipstick or sing out loud in the car or feel safe in the world again? What of mutilation, chopping off a breast or two?

And then I’m called in to see the radiologist. Twenty paces have never been longer. I walk into a low-lit room with digital screens on three sides and a friendly woman who extends her hand to introduce herself. “You’re fine. Everything looks great.” I don’t even remember her name.

I am back in the world, back in the game my heart and brain left behind in order to get through this. I love everything. I go into the dressing room and say a little prayer of gratitude to the universe. Then I leave. I go out to Old Navy and to celebrate my relief, I buy myself a pair of cozy flannel pajamas.

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