My mother and me at my graduation from Oxford University in 2009

I am sitting here in the surgical waiting room at Northwest Community Hospital, just outside of Chicago. Florescent lights hum overhead while visitors flip casually through month-old magazines. At one point, a group of tittering young women breeze by clutching congratulatory balloons on their way to the maternity ward. The clock ticks in the background, persistent and unrelenting.

It is 2:48 pm, and at this very moment, my mother is undergoing a double mastectomy for breast cancer.

Cancer.

Until recently, the word was merely an abstraction. Cancer arose in conversation as a nameless statistic; an anecdotal story about a friend of a friend of a friend; a scribble in a surgeon’s notebook from the past.

Cancer was someone else’s nightmare, someone else’s pain.

Now, quite unexpectedly and intrusively, it has become a part of my own life’s story.

As a medical historian, I am comforted by the knowledge that none of us are alone in our struggles against disease. And so that got me thinking about breast cancer, and the countless women from earlier periods who underwent mastectomies without anaesthetic. Who were these brave women, and where did they gather their strength from?

It may come as a surprise to readers that physicians and surgeons have been diagnosing women with breast cancer for thousands of years, and performing mastectomies for nearly as many. In the 1st century A.D., the surgeon, Leonidas from Alexandria,  described his technique for removing the breast which involved alternately cutting and cauterising the tissue with hot irons. During the Middle Ages, many surgeons began using a caustic paste which contained corrosive ingredients such as zinc chloride and stibnite. When applied directly to the breast, it would cause the tissue to undergo a rapid necrosis, making it easier to remove.

This, too, had its risks, and for the most part, surgeons continued to remove the breast without the aid of caustics in the following centuries. Each surgeon had his own technique for doing this, ranging from ‘impalement of the breast with needles and ropes for traction followed by swift amputation through the base’, to incising the skin and removing the tumour by hand. [1] The surgery was typically carried out in the patient’s home, and could take hours. After the procedure, the wound was often left open to reduce the risk of infection.

All this was done without anaesthetic.

Asa and Lucy Thurston, c.1848

But what of the women themselves? Those poor creatures who lived and died at the mercy of the surgeon’s knife? Unfortunately, it is difficult to know how they felt as women are often voiceless in the surgical casebooks which I study.

Occasionally, however, I come across a letter or diary belonging to a survivor. One particular letter stands out in my memory as I sit here waiting for my own mother to come out of surgery.

In September, 1855, Lucy Thurston—a 60-year-old missionary living in Hawaii—underwent a mastectomy after being diagnosed with breast cancer. A month later, she wrote to her daughter, Mary, about the terrifying ordeal. She describes feeling ‘depraved, diseased [and] helpless’ before the operation. When the surgeon finally arrived, he ‘looked me full in the face, and with great firmness asked: “Have you made up your mind to have it cut out?”’ The letter continues:

[The surgeon] opened his hand that I might see [the knife], saying, “I am going to begin now.” Then came a gash long and deep, first on one side of my breast, then on the other. Deep sickness seized me, and deprived me of my breakfast. This was followed by extreme faintness. My sufferings were no longer local. There was a general feeling of agony throughout the whole system. I felt, every inch of me, as though flesh was failing….I myself fully intended to have seen the thing done. But on recollection, every glimpse I happened to have, was the doctor’s right hand completely covered with blood, up to the very wrist. He afterwards told me, that at one time the blood from an artery flew into his eyes, so that he could not see. It was nearly an hour and a half that I was beneath his hand, in cutting out the entire breast, in cutting out the glands beneath the arm, in tying the arteries, in absorbing the blood, in sewing up the wound, in putting on the adhesive plasters, and in applying the bandage. [2]

As hard as it is to imagine, Lucy Thurston survived the horrific event and lived for another 21 years after her mastectomy.

And so history is full of such stories…some lost to time but no less real. It is this lineage which my mother is about to enter. A sisterhood of sufferers. A sisterhood of survivors.

It is now 3:58 pm, and I have 1 more hour before my mother is out of surgery.

Then, a new life begins: one shaped by cancer but not ruled by it.

1. William L. Donegan, Breast Cancer, 2nd edn. (2006), p. 6.
2. Anon., Life and Times, of Mrs. Lucy G. Thurston: Wife of Rev. Asa Thurston, Pioneer Missionary to the Sandwich Islands, Gathered from Letters and Journals of Extending Over a Period of More Than Fifty Years (1923; repr. 2010).