Three Weeks in Spring

Chapter 8

At one-ten he called Dr. Barry. Maybe he’ll be there early. If it’s bad I can be the one to tell her. If it’s good she won’t have to feel the tension of calling and waiting. He dialed and waited while the phone rang. “Dr. Barry’s office.”

There was an eerie normalcy to it all. Just as if he were calling to find out what was playing at the movies.

“This is Robert Parker. Is the Doctor in?”

“I’m sorry, the Doctor won’t be in until one-thirty. Is this an emergency?”

Oh, sweetheart, you don’t know what an emergency this is. “No, thank you. I’ll call back.”

He called again at one-twenty, caught between the pressure of Joan’s imminent arrival and the reluctance to call more than he had to. Barry was in.

“Hold the line, please,” the secretary said.

As he held, Joan came in the door. “I’ve got Barry coming to the phone,” he said. “Shall I talk or do you want to?”

“No,” she said. “I better do this.” Her palms were sweating and her stomach hurt as she took the receiver. He left the room and stood in the living room, where he could hear her but where she wouldn’t have to watch him watching her. The stillness was in him. Joan could hear the office music as she waited. The voice on the phone said, “Dr. Barry.”

“Hi, Dr. Barry, this is Joan Parker.”

“Hi, Joan. We’ve got the mammogram results and you have a very, very, very suspicious mass in the left breast.”

Three very’s, Joan thought. She said, “Uh-huh. Okay, what do we do now?”

“I want you to come in now,” Dr. Barry said. “Do you have time?”

“Yes.”

“It is time to talk with a surgeon about a biopsy.”

Joan said, “Is it malignant?”

“There is only one certain way, Joan. That is a biopsy.”

“I know, but would you guess? You probably don’t want to guess, or give your feelings on whether or not it’s malignant.”

“Joan, the only way to know for sure is a biopsy. Do you have a surgeon you prefer or would you like to talk with Dr. Eliopoulos?”

“Dr. Eliopoulos is fine.”

“Good. I saw him a half hour ago in the hospital dining room and we talked a little about you. He does not have office hours today, but he will come in to talk with you.”

“When?”

“You should call him and arrange that. Tell him when it’s best for you.” He gave her the number.

“Okay.” Joan didn’t want to hang up. She wanted Barry to tell her something that would make her feel better. She wanted to say, “Can’t you tell me something better?” But there was nothing to say. Nothing he could say. Joan said, “Okay, Okay. I’ll call Dr. Eliopoulos,” and she hung up.

She said to Ace, “It’s a very, very, very suspicious mass, he said. I have to see Dr. Eliopoulos this afternoon.”

“I’ll come with you,” he said.

“Yes.”

“You want me to call?”

“No, I will.”

“He couldn’t say if it is certainly malignant?”

“No,” she said. “He says a biopsy is the only certainty.”

“That’s what we’ll go with then,” he said. “So far we still don’t know. And that’s how we’ll act.”

The last vestige, she thought, the last vestige of hope. Maybe the biopsy will come out negative. Very, very, very suspicious. “Christ, that doesn’t sound good,” she said.

“What?”

“The very-very-very-suspicious. That doesn’t sound good at all.”

“No. It doesn’t. But it sounds better than you-have-breast-cancer. We have to deal with what we have and not with what we fear. We know this much and that is what we know. We stay with what we know. We have to do that.”

She nodded. “All the news is bad news,” she said. “Never all week do we get any hopeful news. The whole week has been getting a little worse, and a little worse. I want to find out what the bottom is like.” She dialed the number Barry had given her.

The secretary who answered knew Joan’s name. Joan’s voice was steady but it was very, very hard not to cry.

“The doctor will be here in a half an hour, and he’ll meet you here in his office.”

Joan said, “Yah. I’d like to bring my husband.”

And the secretary said, “Oh, my all means.” Very kind. Everyone is very kind. Oh God, this isn’t good. They are too kind. They’re really being too nice.

They were kind, too, in the doctor’s office. Joan and Ace were brought right in. Dr. Eliopoulos appeared at once. A tall man, with large strong-looking hands. Surgeony-looking Joan thought. Joan lay on the table and Eliopoulos examined her breasts. The nurse stood by, and so did Ace, feeling oddly out of place and almost explosively protective. Joan could see him obliquely, leaning against the wall in the corner of the office, his arms folded across his chest, his face blank. It was a characteristic pose. How often I’ve seen him like that.

“Okay,” Eliopoulos said. “When you get dressed, come in the office and we’ll talk.”

As Joan put her bra and blouse back on, alone with Ace in the examining room, both of them were thinking about being railroaded. They’re not railroading me, Joan thought. They’re not pushing me, Joan thought. They’re not pushing me into mutilating surgery because I’m a woman and it’s easier for them than long-term management.

She’ll have what she wants, Ace thought. It’s her body and her life. I will see that she gets what she wants. But, Christ, I hope she goes for the surgery. I hope she doesn’t fuck around with this and lose her life for a goddamned abstraction. I want this settled. But she’d get what she wanted. He perceived his life in simple and somewhat dramatic terms. That’s what I’m for, he often thought. If they want something I see that they get it. They didn’t always get it, and he didn’t always see to it that they did. He knew that too. But it was a guiding principle, and it helped him decide what to do.

In the office they sat across from Dr. Eliopoulos and he said, “Well, we’d better go ahead with the biopsy.”

“And if it proves malignant?” Joan said.

“Then I feel we should go ahead and do a modified radical mastectomy.”

“While she’s still under?” Ace said.

“That’s the best way. If it’s malignant there’s no point to two surgical procedures.”

“Why a modified radical?”

“I don’t do radicals,” Eliopoulos said. “The survival rate, we’ve found is the same for modified radicals as it is for radicals.”

“What’s the difference?” Ace said. He didn’t want to dominate a discussion that was hers more than it was his. but he knew how sick and numb she must feel and he plowed ahead. She’d interrupt as she wished.

“The so-called Halsted Radical,” Eliopoulos said, “takes pectoral muscle as well as the breast. In the modified radical we don’t take muscle.”

“Why not just do the lump?”

Eliopoulos shook his head. He was never in doubt and the certainty with which he spoke and the fluency of his explanation had a part in their decision. He was very clear about what he thought. “A lumpectomy is not good medicine. I won’t do it. There may be someone who will, but I can’t. I think it’s immoral. If you just excise the lump itself, you have absolutely no way to know if the malignancy has spread and if it has how far it has. This is an amorphous lump. It’s outlines are not distinct.”

“And chemotherapy,” Joan said. Her voice was steady.

“Chemotherapy is a fallback position. If you start with chemotherapy and it doesn’t work, then it’s too late for the mastectomy and you have nowhere to go. Again. I won’t do it. I think it’s bad medical practice. There is one doctor in Boston who will do it, I think, and I can give you his name. But I can’t do it.”

“Why is it too late?” Ace said. There’s that harsh edge, Joan thought. When he argued, or when he was after something, as he was here, he made her very uncomfortable. He had no skill to do it gracefully. When there was something at stake, a harsh rather ugly tone developed. He was capable of asking someone why six or eight times in a row, backing them down to the essence of their position. Usually she hated it. Here she did not. We have to know, she thought. Go ahead, we have to know.

Eliopoulos said, “As with the lumpectomy, you don’t know what you’re dealing with. You don’t know how far it has spread and thus you are working blind. You need to biopsy the lymph nodes.”

And it went on. Often over the same ground twice. Eliopoulos careful, thorough, unhurried, unoffended. After a half hour of very grueling discussion, Joan said, “We’re taking too much of your time.”

“No,” Eliopoulos said. “No, that’s perfectly all right. Take as much time as you need. It’s an important decision.”

“I don’t mean to push you to the wall, Doctor,” Ace said, “but I don’t know how else to ask.”

“I understand that,” Eliopoulos said. “You have every right to get all the facts.”

After an hour of question and cross-question Joan and Ace felt half disembodied, floating among the questions, in the clean medical room with the textbooks on the wall and the framed diplomas and certificates.

“I know what I think,” Ace said. “But I won’t tell you my decision till you’ve told me yours. It must be yours and I don’t want to influence it.”

Joan said, “Yes. I know what we’ll do. On the operating table, if this lump has been removed and found malignant, a modified radical mastectomy is called for.” She said it formally, carefully, as if saying it just right would help make the decision just right.

“I agree,” Ace said. “That’s what should be done. Do you wish to be awakened before they do the mastectomy?” He spoke to her as if Eliopoulos were not there.

“No, I see no point to that. Once it’s started I’d like it done.”

The decision was made and she never doubted it. For the sake of her life she was convinced it was right. And she had another turn down the spiral. Now she was no longer thinking about saving the breast. Now she was thinking about living or dying. She was where he had begun. He had never cared about the breast, except that she had. He had always worried about life or death.

“Okay,” Eliopoulos said. “I’d like to have you come in Sunday, Sunday afternoon. Check-in time at Union Hospital is three o’clock, I believe.”

“Can I have a private room?”

“We’ll try for that.”

“Oh, Doctor,” Joan said, “I beg of you that I have a private room.”

“We’ll try. I’ll tell them it’s important. Even if you don’t get it the first day, I’m sure we can get one soon.”

“Price is irrelevent,” Ace said, and felt like a fool saying it. So corny, so typical, so middle-class, middle-aged, overweight paterfamilias. The best money can buy. Spare no expense, my good man.

“Monday and Tuesday we’ll do some tests,” Eliopoulos said. “Bone scans, body scans, that sort of thing. Nothing unpleasant, and Wednesday morning we’ll do the biopsy.”

They both nodded. They didn’t ask about the scans. They knew he meant x-ray scans and they knew it was to see if the cancer had spread. They were a long way down the spiral now. Now they were willing to settle for a breast. A simple boob, for crissake. Now they were hoping it was only breast cancer and that it was not infesting her body. Now they were praying for only mastectomy. Each step along the process caused more anxiety. Each diagnosis presented worse possibilities. It was a week now since she’d found the lump. A week of excruciating anxiety. The anxiety and the uncertainty were exhausting. And the jagged descent of her hopes, and the effort to control them left her almost disoriented. Last Friday night, she’d found the lump and gone to sleep, and Saturday, it had not disappeared. Monday, she’d gone to Barry’s office and he had not said, “Oh, it’s just a benign cyst.” Thursday, the postponed mammogram had not dispelled her fears. Today, her talk with Eliopoulos had confronted her with the possibility of metastasis.

For Ace, the descent had lasted only three days, but he had begun farther down the spiral and his mind had never been preoccupied with worries about losing a breast. He felt a little lightheaded as they walked out of the office and into the bright spring day. The fear was a palpable weight in his chest, dragging downward on his shoulders, causing him to slump. He caught himself, and straightened. Two more days and she goes in the hospital. I want this over, he thought. I want somewhere along the line to know something.

They didn’t speak of it, as during that spring they spoke of very little, but they both at one level of consciousness speculated on how much the need to end the uncertainty influenced their decision. To have gone to another doctor and gotten a second opinion, or to have agreed only to a lumpectomy and then found a doctor to do chemotherapy, would have postponed certainty, perhaps for months. We had to know, she thought. We couldn’t have stood that, he thought. Am I giving up a breast just because I can’t stand the uncertainty? she thought. Did I let her go this route too easily because I don’t have the strength to hold out and exhaust all other avenues? he thought.

Their fear was of what they didn’t know. It was a fear of what they might have to undergo, a fear that she might suffer, a fear that she’d be disfigured, a fear that the mastectomy wouldn’t work and the cancer would spread and there would be other operations and other uncertainties. There was fear that she would linger in pain and there was fear that she would die. The fear was very large and varied. Like a conglomerate rock, and binding the conglomerate was the other fear. The fear that they couldn’t handle it. That one would let the other down, that they would both let the children down. The fear that when they met the beast in the jungle, they would fail.

What will I say to her? he thought.

“Ace, I can’t stand this,” she said. Her face was red and tight.

“Yes, you can,” he said. “We’ll do this. We’ll take it a step at a time.” What can I say to her? How can I get us through this? What if she can’t do it? It was very hard to be tough. So much harder to be tough when you really needed to be. When there was something to be tough about. It was much harder to be tough than a lot of people who spoke of it ever had a chance to know.

The feminists. She thought. When you read about this kind of thing and hear people talk about how the sexist pig doctors want to snip off your boob... All that sounds so good. The sexist bastards will never get me. But then when you have a malignant breast and you might die if they don’t remove it and there’s just you and Ace to decide and you feel like you might die from the awfulness of it before the cancer can even get you, and you’re terrified, then it doesn’t sound as simple as they made it.

“Did we do the right thing?” she said.

“Yes,” he did.

“Eliopoulos is right, isn’t he? He’s not just railroading us. You’re convinced, aren’t you?”

“Absolutely,” he said.

“The feminists...” she said.

“Fuck them,” he said.