By Rabbie Rachel Esserman

The discovery of the BRCA1 gene has greatly affected many women’s lives, particularly those with a family history of breast cancer. Now they can test to see if they have a genetic tendency toward the disease and make educated decisions. Gila Pfeffer, the author of “Nearly Departed: Adventures in Loss, Cancer, and Other Inconveniences” (The Experiment), tells of her mother’s early death from breast cancer and her attempt to prevent a similar occurrence in her own life. Her memoir would be extremely difficult to read were it not for her humor about parts of her health journey, which greatly lighten the experience.

Pfeffer writes about her mother’s heart-rending experiences while ill and the way she and her siblings managed to cope through the shiva. Some in their Orthodox community expected the author to drop out of college to take care of her father’s household and raise her siblings. She refused, although she did come home weekends to help. Her mother wished Pfeffer would marry before she died, but Pfeffer’s dating experiences did not go well, that is until years later when she found the right person: Phil, who became her husband. 

When Pfeffer gets tested, she finds out that she has the BRCA1 gene, which was not a big surprise since her mother, paternal and maternal grandmothers, and a great-aunt all had breast cancer. She begins having mammograms at age 30, although she had to fight with her health insurance to pay for them. Wanting to add a fourth child to her family in her 30s, she undergoes additional tests and is told all the scans are clear. 

Pfeffer didn’t want her children growing up without a mother so she opts for a voluntary double mastectomy after her fourth child – having a type of reconstructive surgery that uses her stomach fat to fill the tissue. (She jokes that, after having four children, the operation also gave her a much needed tummy tuck.) Unfortunately, the doctors find some very small cancerous tumors in her breasts and she now faces more surgery and chemotherapy, exactly what she was trying to avoid by having the mastectomy. 

Her major concern – besides staying alive for her young children – was to shield them from the fact that she is sick. She manages to keep her children from understanding what was happening, although she writes of how she later realized she needed to tell them – in age understandable ways – what occurred, if only because she decided to go public with her experience.

Reading about how her family and friends pitched in to help her shows the power and beauty of community. Parts of her memoir could be regarded as a love letter to her husband. Overshadowing her experience is the phantom of the Holocaust: both her parents’ families had lost members during the war and it feels as if part of her reason for having four children is to replenish the number of Jews, although it’s also clear that she loves big families – both her family of origin and the one she creates with Phil.

But “Nearly Departed” is also filled with humor, from her sarcastic answers to an intake form (or rather, the answers I’m sure she wished she’d written) to chemotherapy inspired lyrics to be sung to the tune of “Under the Sea,” to her vision of her organs dancing to a ragtime tune while leaving her body. Her snark will definitely endear her to readers.
It’s clear that Pfeffer hopes that her work will encourage others to get tested for the BRCA1 gene and take charge of their own destiny. As numerous doctors told her, getting the double mastectomy saved her life. The story is also an inspiring tale of courage and family, leavened by Pfeffer’s Jewish faith and her desire to not leave her children orphaned as she once was.