Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
First Chapter of Pam of Babylon
Chapter 1
Dog days of late August, the perfect backdrop in which to hear a terminal diagnosis, Harley Jones thought as she walked to her car. The smell of tar and garbage mingled with the wind and the heat, like a big, stinking convection oven. It was the afternoon and the streets of Philadelphia were sweltering.
The first time she’d made the trip to the same medical center two years ago was also during August, but she wasn’t alone that time, accompanied by Devon, then four-years-old, who enjoyed spending the day in town with Mommy. The receptionist, a chubby, older woman named Fern, frowned when she saw the little girl.
“The doctor will want to examine you,” she said looking down at Devon.
“That’s fine,” Harley said. “My sitter had a problem at the last moment and I didn’t think I should cancel.”
“I’m glad you didn’t,” she replied. Scratching her cheek, she glanced around her cubical. “If you’d like, she can come back here with me and play secretary when it’s time for you to go in. It might be more comfortable for her than going in the exam room.”
“That’s very nice of you to offer,” Harley said, pleased, not the response she expected when showing up for an appointment with a child in tow. “Devon, you’d like playing secretary behind the window with Miss Fern, wouldn’t you?” The little girl smiled and nodded her head quickly.
“Yes, Mommy. I’d like it.”
“Have a seat, and fill this out,” Fern said, handing Harley a clipboard with a half-inch thick pile of papers. “And here’s some paperwork for you too, Devon.” Devon took the paper and pen and followed Harley to the seating area where they worked quietly for fifteen minutes.
A woman in a nursing uniform stuck her head out of a door to the side of the reception window.
“Mrs. Jones, follow me please.” Harley stood up, reaching for Devon’s hand. They walked through the door and paused at the reception cubical.
“Welcome to reception,” Fern said smiling, and Devon happily went inside to sit beside her, well taken care of for the next twenty minutes.
Harley felt sick, following the nurse through a maze of corridors until they reached a stuffy exam room. The nurse weighed her and stuck a thermometer under her tongue, took her blood pressure and put a pulse oximeter clip on her finger.
“Dr. Michaels will be right in,” she said, putting the equipment away. “Take your blouse and bra off and put this on, opening to the front, please.” Harley did as told, looking at her reflection in the shiny metal of the paper towel dispenser.
At that first visit, before she’d ever met Dr. Michaels, she didn’t know that someday they’d be friends. She was sorry that she wasn’t fully clothed at this first meeting, with him sitting behind a desk, a framed photo of his wife and son to the left and her file of reports to the right. Pulling the paper gown around her, a chill went through her body, just as he tapped on the door and walked through without waiting for her response.
“Jeremy Michaels,” he said, sticking out his hand.
“Harley Jones,” she replied.
“I know Dr. Forman well,” he said, referring to the surgeon who’d done her biopsy. “He called me especially to talk about your case. Can you repeat what you know? I just want to make sure we’re on the same page, that I understand what you understand.”
“Dr. Forman said I have Stage IV Inflammatory Breast Cancer. He said because of my age and the type of cancer, I had to act fast. He said I’d most likely have six weeks of chemo, surgery and then radiation.”
“The protocol for your type of cancer is changing all the time. We won’t wait six weeks for surgery.”
“I wasn’t expecting surgery so soon,” she said, feeling sick. Her cheeks were quivering and she was willing herself not to throw up, not to cry. He offered her his hand.
“I know this is upsetting. It’s understandable.” She took a deep breath and released his hand, searching for a tissue. He turned to the counter and grabbed a box, offering it to her. “The plus side of this is that you’ll be done with surgery and not have it looming.”
“What happens first?”
“I have the results of your PET scan here, and it shows a small lesion on your liver.”
Harley held on tightly to the exam table. The probability that the cancer had spread to her lymph nodes was huge, but to her liver already? That was unexpected.
“Because of it, we decided we want you to have two rounds of chemo before surgery.”
Harley’s head was spinning. It was late August. She had three children to get ready for school. Could she do it in three weeks? A lesion on her liver…already?
“School is starting soon. This couldn’t happen at a more inconvenient time.” He grinned at her, trying to downplay the trauma she was going to face.
“Something tells me you’ll do fine,” he said. “Easy for me to say. My wife does all the school preparation stuff.” Harley laughed, the human side of the doctor revealed.
Jason, her husband, would buy school supplies, shoes and backpacks and she’d do the clothes. Her mother-in-law was awesome, babysitting and helping with shopping.
“I have three in school, including teens. It won’t be easy getting it done in the next three weeks. I’ll have to hustle.” The possibility that she’d get sick from the chemo didn’t occur to her, eating up more of the time she had allotted for school shopping, and he purposely didn’t mention it.
They chatted about their families and then he asked if he could look at her biopsy site. He put gloves on and peeled back the gauze. She watched his face, expecting him to frown, knowing it was bad. “Yes, we need to move fast.” The punch biopsy site was not healing as it should have been. Her husband asked to look at it daily, sometimes more than once.
“Will I have a lumpectomy?” Harley asked, hopeful. “I forgot to ask Andy.” Andy Forman, her surgeon.
The doctor looked into her eyes. “Lumpectomy isn’t indicated for inflammatory cancer,” he said, a hint of regret in his voice which he would curse himself for later.
Harley felt the blood drain from her face, pinpricks of fear. A mastectomy? Afraid to ask about reconstruction in case it too wasn’t warranted and needing that buffer, she didn’t respond to his answer.
“Fern will set up your first appointment for chemo. The pharmacy will mix a special agent for your type of cancer. Any questions?”
Harley shook her head, frowning. She’d live in a state of denial for the next twenty-four hours, not thinking about anything but what tasks she could get done right then while she was in town.
“If you think of anything, call me. My service will put you through.” Harley looked up at him, grateful for his interest, but at the same time it frightened her. Why was he being so nice?
“Are you this available to all your patients? Or am I dying?” he was honestly taken aback and she saw it in his face.
“No, you are not dying and yes, I do try to be available, especially to nurses who work at the same hospital I do.” She grabbed his hand and laughed, sorry immediately.
“I’m sorry. I’m a train wreck.” Putting his hand over hers, he smiled.
“You’ll do well,” he said, and she believed him. “Get
dressed. Fern will schedule your appointments for you.”
Harley thanked him and slipped off the table. She thought of the calls she needed to make, her hysterical mother who’d offered to take a day off work and drive up from Delaware, her sisters, her girlfriends. She’d wait until Jason got home from work to unload on him. What had started out to be a routine health scare in the middle of the night, no big deal, one in eight women, was turning into a nightmare with immediate chemo, surgery sooner than later, and the scary words hanging in front of her face, a liver lesion.
Later that afternoon, Devon riding in the grocery cart with a new toy, awarded for being so patient and well-behaved all day, Harley stopped at the meat counter to select as many dinner choices as she could for the next weeks to make life a little easier. Chicken in every form for baked chicken, potpie and noodle soup, stuff to make chili and spaghetti sauce, pork chops and steak, lots of burger, a roast.
As she was leaving the beef section, a slab of liver caught her eye, its glistening membrane stretched over the lobes, even a vessel orifice, the round interior of it beckoning exploration with a pinkie finger. It made her sick, tempting her to put all the meat she’d carefully chosen back, make a commitment to veganism. Where was the lesion in her liver?
Forgetting where she was, her hand unconsciously went to her breast. Her right breast.
“Well, look who’s here!” She looked up and her older sister, Melissa stood at the side of the basket, her big, eight-month pregnant belly getting in the way, one-year-old Greg on her hip. Harley was the baby of the family, but she found love early in life. For Melissa, it had come later, in the past two years.
“Wow, look at all that food.”
Almost slipping, asking what are you planning for? Melissa remembered Harley had an oncology appointment that morning.
“Did you go into the city today?”
Examining her sister’s pale face, Melissa knew before Harley said a word that it had not been good. What she was planning for was disaster.
Taking a deep breath, willing her emotions to stay numb, Harley nodded. “I did. This poor kid has been dragged through the hospital, mall, bank, the post office, you name it.” They made over Devon, patting her head.
“Do you want me to take her?” Melissa loved motherhood and adding another child, especially a beloved niece to her retinue was not a big deal.
“Yes,” Devon said, answering for Harley, struggling to get out of the seat. “I’ll go with Aunt Melissa.”
“Are you sure?” Harley asked Melissa, choking down a sob. “You have your hands full.”
“I’m fine,” Melissa said. “Come on kiddo, hop in. Just push the eggs aside.” With Devon in the basket, Greg agreed to sit in the seat. “See, I needed her to occupy Mister Greg,” Melissa said, buckling him in. The little boy smiled while Devon tickled him under the chin.
“Thank you, sis. I’m almost finished shopping. I’ll call you when I get home.” She’d pick Devon up later, before bedtime. They leaned in for a peck on the cheek.
“You’re welcome. Enjoy freedom for a few hours.”
Melissa quickly turned away, chattering to the children, swallowing back her own tears. She didn’t need to know what was happening with Harley’s health because she just didn’t think she’d be able to tolerate anything negative, but would invest every spare second she had into caring for her sister and her family.
Harley pushed the cart up and down the aisles, grabbing anything that looked remotely tasty, loading up heavily on convenience foods, just in case. She could always open a box of pasta and a can of sauce if she was too exhausted to cook. Jason tried to fill in, but she never cared for anything he prepared.
Jason was a nurse anesthetist; she was a staff nurse in the post-anesthesia recovery room. They’d worked together for years and by now their routine worked like a well-oiled machine. This glitch might be nothing, but it could also mess everything up.
Jason had discovered it. They were lying in bed talking, not having sex; he wasn’t consciously feeling her breasts, his hand armed draped across her chest. She was on her back looking up at the black ceiling, listening to him talking about his father’s anger because they weren’t driving to Sea Isle City that weekend.
“He can’t believe I’d rather spend a weekend cutting the grass than fighting shore traffic to stay in a summer cottage with my brother and his kids.” Harley laughed.
“It’s not that bad, and the lack of space doesn’t bother me,” she said. “The kids and I love it there. If you change your mind, I’d be happy to go. We haven’t been in a while. The kids ask about it every week.”
“What’s this?” Jason sat up and leaned over her to switch the bedside light on. Shielding her eyes, Harley sat up, too.
“Hey buddy, I’ve got to be up by four-thirty.”
“Take this off,” he said, pulling her t-shirt over her head.
“Jason, get real,” she whined. “We can do it tomorrow.”
“No, not that,” he said softly, going for her breast again. “I felt something. Here, give me your hand.” She put out her hand and he took it and pressed it over her right breast.
“Ew, that’s new. I exam my breasts after my period and it’s coming up. Maybe it’s a swollen milk duct or a gland.”
“It feels like a swelling,” he said, pressing his fingertips over her breast. “Let me see it.” She stuck her breast out closer to the light. Whatever was in there had pulled the skin in, its texture like that of orange peel. Bile rose in his throat.
“I’ll talk to Andy Forman in the morning,” he said, his best friend who was a surgeon, breast surgery his specialty.
“Jason, I’ll talk to him myself. You’re outta control.”
He laughed, turning to switch the light off again, not like his heart wasn’t racing, his mouth so dry it was hard to answer.
“I like to be in charge of my women,” he said when he could speak. “When was your last mammogram?”
“I’m only thirty-six,” she said. “You don’t get them till you’re forty.”
“I guess I should know that,” he replied.
“Why should you? Don’t worry about it. I’ll talk to Andy myself tomorrow morning,” she repeated. “Let’s get some sleep.”
“I love you, Harley,” he said.
“Love you too, Jay.”
She kissed him on the cheek and rolled over with her back to him, wide-awake. Very slowly so he wouldn’t know, she inched her hand up under her t-shirt and started feeling around where the thickened area was…it was swollen and hot. The skin felt leathery there. Reaching to her armpit, she felt around and there it was; a painful swelling in her body that wasn’t there before, the heat spreading through her as fast as the dread. What the hell was this? She was as regular as clockwork with her monthly breast exams. Did she miss a month? But then she remembered, it was June, her period came at the end of May. Right after Memorial Day she did it and there were no discernible lumps or changes, unless she missed something.
Within minutes she could finally hear his breathing switch to the rhythmic breath of sleep. Very carefully, she slipped out of bed and tiptoed out to the hallway, going quietly down the hall to the den where she kept her lap top, spending the rest of the night reading everything she could about breast cancer.
Chapter 2
Exhausted after their night of little sleep, the couple got up before dawn. Jason’s mother, Granny Fran arrived to babysit at six.
“Don’t say anything to her,” Harley said. “The last thing we need is for the parents to start hovering. It’s probably nothing.”
But she had a sick feeling after what she’d read online and looking at her breast in the mirror that it wasn’t a nothing.
“Okay, whatever you want,” Jason said. “Are you going to speak to Forman or can I?”
“Let me, please. It’ll be awkward enough as it is. He’s there today.”
It was a Friday; the day breast surgeon, Andy Forman did biopsies. Jaso
n and Harley took separate cars on Friday; it was always busy, neither knew if they’d be getting off work on time. Walking out to the garage together, Jason bent down to kiss her goodbye.
“Let me know when you talk to him,” he said. She nodded and got into her car. Focusing on getting to work and doing a good job was how she liked to spend the ride. They lived in the suburbs but worked in the city at a big teaching hospital. If she had to get sick, it was the best place to be.
Jason was giving anesthesia in Andy’s room that day as usual, and although he knew his wife would probably get angry with him, he said something as soon as he was able. Jason and Andy were friends who played tennis and went on trips to watch baseball games for their favorite teams. Jason was setting up his anesthesia machine when Andy walked in with a pro-tennis catalog. He didn’t even say hello; it was the kind of friendship they had.
“Look at this racket,” he said. “It only weighs nine ounces.” He stood next to Jason, oblivious to the activity going on around him with the nurses preparing the room for his patients.
“Did Harley talk to you yet?”
“I didn’t see her. Why would she need to talk to me?” Andy put the catalog on Jason’s machine. “I’m getting that racket.”
“You already have a good racket. She has a change in her breast. It’s hot to the touch and is swollen and red, the skin over it is all puckered. It doesn’t look good to me.”
Andy headed out the door. “Is she in recovery?” Jason nodded his head.
❋
The post-anesthesia recovery room would get busy after the first case of the day finished and the patient was brought in to recover. It was just seven o’clock; anesthesia personnel visited patients in the holding area as they waited for their surgery to begin, the nursing staff for the OR got their rooms set up for the first cases, and the surgeons met for coffee in the lounge, getting old dictation out of the way, calling in orders for patients.
Harley was the first nurse to arrive in the recovery room; she’d leave by three unless they got slammed or someone called out sick. Alone in the unit with the anesthesia technician Carol, they went to each station together, preparing to receive patients. Andy Forman came in looking for her.
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