BOOK REVIEW / MEMOIRS : Ghostly Memories Feed Cancer Nightmare : YOU DON’T HAVE TO BE YOUR MOTHER, <i> by Gayle Feldman</i> (W.W. Norton & Co.; $23, 256 pages)

Gayle Feldman was most of the way through a long-awaited pregnancy when she learned that what she and her doctors prayed was merely a blocked milk duct was, in fact, a malignancy. That sentence contains in it sadness enough for any lifetime, but Feldman looked back over her shoulder, into the past, and saw the ghost of her mother, who had died of breast cancer at 47.

Every decision she faced in the present churned up memories of a lonely, frightened adolescence. The birth of her son--early, induced, so that she could get on with the grim business of fighting her cancer--became a challenge as much as a joy. Tiny Benjamin Reid demanded a happier life than his mother had had. It was up to her to make sure that she escaped her mother’s fate.

The title of this harrowing, uplifting memoir comes from an advertisement Feldman happened upon early in the story; it became something of a mantra for her, a chant to ward off the awful silent mystery and confusion that surrounded her mother’s illness. For Bossie Feldman was a casualty, not just of her disease, but of the way it was handled in the 1940s.

First an ill-informed doctor wasted precious time insisting that there was nothing wrong. Then she had a surgical biopsy, back in the days of the “one-step” procedure, and awoke from the anesthesia to find that she had lost a breast.

Shame and dismay made her a recluse, shut off even from her children, who inherited a legacy of fear and superstition. Feldman recalls one heartbreaking incident in which her mother called for help getting out of the bathtub--and Feldman, terrified at having to see her mother naked, stood paralyzed outside the bathroom door, unable to move.

Until her condition was diagnosed, Feldman had had her share of good luck: a loving, deeply affectionate 20-year relationship with David Reid; a job she loved at Publisher’s Weekly; a warm network of family and friends, and, after a harrowing round of surgeries and fertility drugs, a healthy pregnancy. She and her husband were preparing for the arrival of “C.C.”, or “Constant Companion,” as they had come to call their pending child, when she was suddenly catapulted back into her mother’s life.

She did what any self-respecting, well-educated professional woman with good health insurance would do: She went to her exquisitely resourceful ob-gyns, who sent her to competent doctors, who gave her attentive care. If anything, the occasional ogre she encounters seems all the more dreadful because her core support is so exemplary.

Which is not to say that some of the medical personnel she encounters shouldn’t be reincarnated as their own patients so that they can see what neglect feels like.

The chilly doctor who tried to turn her away when she arrived at the hospital to have her labor induced (“You’d better go home and call us back in the morning. Why does she need to be induced, anyway?”) retires forever the notion that women doctors are necessarily more compassionate than the men. There is the dolt of a nurse who chatters about Feldman’s “interesting” breast throughout her surgical biopsy, the orderly who can’t be bothered to wheel her out of recovery because it’s break time, the nurse who forgets to bring her baby.

But Feldman kept her wits about her. She and her husband seem possessed of exquisitely calibrated emotions. They allow themselves the release, and relief of tears, but they also know exactly when and how to lose their tempers.

I might have gone further and throttled the girl in the coffee shop who refused to put out her cigarette even though Feldman is asthmatic, but I would have been wrong. Feldman and D. Reid, as she calls him, know just how to muster their forces to best effect.

She is also a lovely, modulated writer, capable of the understatement that is perhaps crucial to writing about this subject. Had she been operatic, it would have been too much to bear--the events are quite sufficiently melodramatic.

The clean pen-and-ink word portraits she draws--of family members, of a clumsy night nanny who forgets that Ben has fallen asleep in her bed, of her no-nonsense woman surgeon--are memorable ones.

Her medical situation is presented with equal clarity, but here the simplicity can be a bit misleading. One wants desperately to believe Feldman’s claim that she is “cancer free”--it is a tribute to her writing skill that the reader develops a fierce emotional investment in Feldman’s continued good health--but life is never quite that certain.

There has been much interest in prophylactic mastectomies (which Feldman eventually had on her other breast) as a protection against breast cancer for high-risk women. Still, it is not a guarantee: Some of those women develop cancer anyhow, in the remaining tissue, and doctors disagree about whether the procedure has anything but psychological advantages.

There are plenty of almost “sure things” in breast cancer treatment. There are not yet any definitive answers. The reader prays that the numbers will favor Feldman and her family--but she and the 180,000 women who will be found to have breast cancer this year still need better odds.

Perhaps the only thing lacking here is a somewhat stronger sense of context. Not even the best care comes with a lifetime warranty--and not everyone is as well taken care of as was Gayle Feldman.