Cancerland

I had no choice. When I was diagnosed with stage III breast cancer, my course of action was already in place. Chemotherapy, surgery, radiation. I chose my doctors and I chose my wig, but other than that I did exactly what traditional medicine prescribed.

Jessica Queller had too many choices. In her compelling memoir, “Pretty Is What Changes,” she does not have cancer. She is young and healthy, with a fabulous career and a full life. All she’s missing is the man of her dreams, the one with whom she’d eventually have children. But she is smart, pretty and she has a beautiful body; the man will surely come. Then her mother dies of ovarian cancer after surviving breast cancer. Doctors tell Queller that her mother most likely had the “breast cancer gene,” the BRCA genetic mutation, and that she has a 50% chance of also having it. As the book begins, Queller has made her first choice: to have the test. It comes back positive.

Having the BRCA1 gene meant Queller had an 87% chance of developing breast cancer and faced three new choices: ignore it -- surprisingly, women do; practice extreme vigilance, with frequent checkups, mammograms and other tests, and the constant worry that every twinge is cancer; have a prophylactic double mastectomy. Surgery reduces the odds of getting breast cancer to 10% but at a very large price for a disease that may never appear.

I read this book in one sitting. The descriptions of her mother’s treatments and their side effects were particularly hard -- I found myself back in Cancerland, a place I thought I had left. And Queller got them exactly right. She is an accomplished TV writer and producer, including for “The Gilmore Girls.” I expected more jokes, more snappy patter and witty repartee a la Lorelai and Rory Gilmore, but for most people, cancer is not a humorous topic. On the other hand, I was tempted to skim the long passages about her parents’ histories, their meeting and first apartment, as well as Queller’s personal anecdotes about her dates, her writers’ meetings, and her friends -- even when those friends were Calista Flockhart and Cokie Roberts’ daughter-in-law.

Queller spends most of the book giving us the back story leading to her decision. We see a lot of her day-to-day life, but frankly her life -- privileged and busy as it is -- is not that interesting. The conversations with her sister, her friends, even the various cancer patients she finds, begin to be redundant. I was growing impatient. I was 99% sure she would have the surgery -- why else write the book? -- but I wanted to see the moment that decision became clear and, even more, what happened afterward.

Queller is good at explaining the medical information for the layman, but she retreats from the emotional. She states her feelings in the driest, almost nonchalant terms. “In the shower, in the writers’ room, in the car, in yoga class, in bed in the dark at three a.m. -- I obsessed over the potential repercussions of removing my breasts. It did not take long to conclude that my personal life would be in the most peril.” She knows that mastectomy means you can never breast-feed but says only, “My mother didn’t breast-feed, which was precisely why I’d always wanted to. . . . Not being able to . . . would be a great loss.” After finally having the surgery, she never admits a moment of regret or wonders whether she has done the right thing. Perhaps this is the confidence that helped her attain success in the television business, but I knew more about her mother’s agony over losing her hair to chemo than Queller’s feelings about losing both breasts.

After surgery, Queller’s friends immediately go back into matchmaking mode. Interestingly, the eligible men in this story are objectified in a way that would insult most women. They are quantified simply as mate material, by looks, job, intelligence and their ability to deal with her genetic predisposition. A friend sets her up long distance with Mark, a sportswriter, and they fall in love by phone. She travels to Los Angeles from New York to meet him, but their first night together is never shared. We miss the moment when she reveals her postoperative breasts for the first time. It is hard to imagine a scene more fraught, more defining of the choice she has made, but that is all the reader is allowed -- to imagine it. “[Mark] was incredibly handsome, over six feet tall, with an athlete’s body to match his tough-guy persona. . . . We had as much chemistry in person as we did over the phone. From that moment on, every night that Mark did not have his daughter, we spent together.” Then Mark mostly disappears from the narrative until Queller, describing their breakup in past tense, says, “With mutual love and respect, we parted ways.”

In 2005, Queller wrote a New York Times op-ed piece about testing positive and her subsequent dilemma. It was a controversial piece, as is this book, about knowledge, chance and whether to take our possible future health into our own hands. I read her article when it appeared, long before cancer was in my life, and was moved. In “Pretty Is What Changes,” I expected more. More fear, yes, but also more depth, and ultimately more triumph. She is an Amazon, like one of those women who, legend has it, removed a breast to be better warriors. I only wish I felt more viscerally connected to her battle. *