by David Wind
Dr. Michael Blumberg held John’s gaze. “That’s what we have to determine. The metastasis makes me think it’s either late stage three or stage four, but last week’s MRI wasn’t definitive, which is why we’ve scheduled the combined PET/CT scan for this afternoon. This dual scan test lets the doctor compare areas of higher radioactivity on the PET scan with the detailed appearances on the CT scan. This will give us a better picture of both. It will tell us the stage the cancer is at, and tell us if and where it has spread. It also gives us a more informed way to determine possible treatments.” He paused for a moment, his eyes jumping between John and Claire. “Until we have the results, guessing is pointless.”
“So, all we get to do is wait around?”
“I wish there was more, John; for now, that’s the only thing any of us can do.”
Claire’s hand tightened around his. “I understand.”
“Your oncologist appointment is with Sam Parks, who I believe to be one of Long Island’s best. You’ll meet with him at South Shore; he’ll go over everything prior to the tests. Once we know the full story, he’ll set up the procedure for treatment.”
“What about second opinions?”
“John, we’ve known each other now, for...eight, nine years? Before we look for a second opinion—and you have every right to a second and a third or more—let’s get the first real opinion in. But, do understand, for this type of cancer, Sam is the best there is, bar none.”
John gave a single nod.
“Your appointment is for two p.m. No food until after the scan.”
<><><>
Wednesday 6:45 p.m.
“Having gone through this myself, with my sister’s cancer, and knowing you both as well as I do, I understand exactly where you both are right now, psychologically, so I’m not going to pull any punches.”
“Thank you,” John half whispered, taking Claire’s hand into both of his and meeting her eyes with his.
They both turned to Dr. Blumberg, whose face appeared as strained as John knew their faces were.
Turning the monitor toward them, the doctor adjusted the screen. The images, like a strip of film, appeared one frame at a time. He ran the cursor over one, and the image filled the screen. Black, grey, blue, and red wavered across the screen and Blumberg pointed to one area. “This is where the tumor is located.” He outlined the area using two fingers.
“If this was all we had to contend with, we could attempt surgery using a Whipple procedure; however, in this instance it won’t do any good. The Whipple is a pancreaticoduoden-ectomy, where part of the pancreas is removed, along with duodenum and sometimes a portion of the common bile duct and gallbladder.”
He moved the cursor, the screen flicked, and another image took over, this one mostly red and blue. “The issue is that the cancer’s spread beyond the bile ducts and has invaded several other areas of your body.”
Blumberg’s words faded, and John’s mind did its best to shut down. A weakness spread through him and his hands tightened further on Claire’s hand; he closed his eyes to stop the tears. He forced his eyes open and looked at Claire. Her face was white, bloodless. It took a dozen breaths for him to find the words, “We can fight this.”
The doctor’s eyes were on Claire, not John. “I’m sorry, Claire...”
John watched his wife moisten her lips with the tip of her tongue, and then straighten her shoulders. Her hand tightened on his. She glanced at him, favoring him with the barest of smiles before saying, “What are my...options.”
“There are only a few choices. With surgery out of the picture, you’re limited to chemotherapy alone, or chemo with radiation. It may slow the spread, but it won’t stop it. I...I’m sorry, we’re past that point.”
John leaned forward, his hands still gripping Claire’s hand. “There must be something.”
Blumberg turned to John. “I wish there was.”
Claire asked the inevitable question, “How long?”
“There’s no real way of pinpointing it. Everything depends on you. It could be months, possibly a year.” Blumberg took a breath. “Take whatever time you need to decide on what you want to do. Talk it out, think it over and let me know. I’ll do whatever you decide.”
He picked up a large manila envelope. “I put the full radiologist’s report, along with the oncologist’s recommendations and a copy of the PET/CT scan disc in here, should you seek other opinions. I’ve added several pamphlets about...about what will come next.”
John stared at Blumberg, took in the crisscrossing lines around his eyes, the sadness shadowing the man’s features. “How can you be so certain?”
Blumberg closed his eyes, leaned back, and said, “The evidence is indisputable.” Opening his eyes, the doctor pointed to the monitor. “This is the head of the pancreas. It is...”
<><><>
John stopped pacing the living room, drained the gin and tonic, and turned back to Claire, who sat on the couch watching him. The fog that engulfed his mind at the doctor’s office still clouded his thoughts. “We are not going to give up.”
Claire held his gaze. “This isn’t about giving up.” She pointed to the pamphlets Blumberg had given them. “This is about what comes next.”
“We’re going to see another doctor, we will get another opinion. They didn’t even do a damned biopsy!”
She reached out, clasped his hands in hers, and pulled herself to her feet. She did not release his hands. “You heard what he said before we left. There’s no reason for a biopsy. John, I don’t want to go through that.”
He pulled free from her hands and shook his head. “I won’t accept this. I will not lose you.” He glared at her, his anger so palpable his hands shook. Dear God, why her? It should be me!
<><><>
Claire’s eyes were shadowed from a sleepless night. He had been surprised when he’d woken alone. He’d found her on the deck, facing east and staring at the sunrise. Silent, he sat next to her and took her hand in his.
“No second opinion. No nonsense; but, I’ll do whatever treatments may help.”
“Claire—”
“—No arguments, John, please. I spent the night here, thinking, reading...” She nodded toward the pile of pamphlets and brochures.
“I love you, Claire, and I need you.”
“I know.”
CHAPTER FIVE
July
“You have to eat.”
“I can’t, not now. Maybe later.”
John nodded. The chemo sessions left Claire weak and nauseous: they left him feeling helpless. He’d found a way to get grass, which helped to ease her nausea, but she’d been reluctant to use it too often.
He lit the joint and handed it to her. “Smoke.”
She took the slim marijuana cigarette and pulled on it. When she tried to hand it back, he shook his head. “One more.”
After her second toke, he took the joint and put it out. “Lay back, close your eyes. Concentrate on chasing the nausea away.”
John had set up his recliner for her, and as she laid her head back, he spread the light quilt over her. He knew that in another few minutes, the chills would hit her hard. It always happened after the twice-weekly chemo sessions. It was a little worse after the radiation, which followed the second treatment of the week.
“I’m sorry.”
John stiffened. “For what?”
“For this.”
His eyes misted. He swallowed, and knelt next to the chair. Stroking her cheek, he smiled at her. “Never say that again, ever.”
“This isn’t Love Story, this isn’t a book or a movie. And love does sometimes mean you have to say you are sorry.”
“This isn’t a book or movie, this is our lives. Apologies are for things you do, not for what happens to you. Don’t insult me with an apology for being sick.”
“It’s been almost two months. I’m screwing up everything. You miss work twice a week. You’ve lost clients. You spend the nights working at the dining room ta
ble. And you tell me not to say how I feel?”
He looked into her eyes, took her face in his hand and whispered, “If I could give my life for you to be better, I wouldn’t hesitate.”
A tear escaped her right eye and traveled slowly along her cheek, slipping downward between her ear and the curve of her jawline. He reached for it, wiping it away with a gentle stroke of his index finger.
“I know I’m losing you. I know you will be gone and I will spend as much time with you as I can. I don’t give a damn about work, or about anything. You’re all I care abo—” His voice choked off with emotion.
She stroked his face, smiled. “I know.”
“Good. I’ll hear no more about it. I’ll take whatever time I take to spend with you.”
Claire’s face tightened suddenly, she gasped as the chills hit her so hard it took everything he had to hold her on the chair until the first heavy battery of shaking passed. When it did, he went into the kitchen and ladled out some of the soup warming on the stove.
Claire managed to take in half the mug of chicken soup before the chills came back, this time not as bad. When he tried to get her to drink more, she shook her head. “Okay, baby, you’ll finish later.” But, he knew she wouldn’t eat anything else until tomorrow.
An hour later, with the effects of the grass and one of her pain pills, she fell asleep. He scooped her from the chair, carried her to the bedroom, and put her into bed. Only when she was covered, and he was certain she was in a deep sleep, did he leave the bedroom, making sure the monitor was on.
Returning to the living room, he went to the couch and sat heavily. He looked toward the dining room, to where his laptop sat, knowing he had work to do, but unable to push himself off the couch.
A moment later, his breath exploded outward as a wave of sadness swept through him. He tried to catch his breath, but couldn’t. Tears came, an outpouring of sadness so deep he couldn’t control himself, couldn’t stop, and as he sobbed for breath, his mind went blank.
<><><>
He had no idea how long he had blanked out for, but when he was able to think again, he glanced at the clock. Twenty minutes had passed, and he had no memory of it. He shook his head. “Be strong!” he ordered himself aloud. “You have to be strong for her.”
Standing, he wiped the wetness from his face and went to the dining room table. Leaning over the table, he moved the mouse and a few seconds later, the screen came alive. He sat, opened the first file, and went to work.
Three hours later, exactly as he knew it would happen, Claire woke with a groan. He flew out of the chair, and raced to the bedroom. Kneeling beside Claire, he handed her another pill. When she took it, and drank half the water, he went around to the other side of the bed, slipped onto it, and drew her into his arms.
“Go back to sleep, my baby.” Holding her close, he stroked her back as another set of chills battered her. He knew she would fall asleep within five minutes. She always did. With the additional meds, she would sleep for at least four more hours before the pain hit again, and if everything went as it should, the chills would be over until her next treatment.
He held her close while she fell asleep, but instead of returning to work, he closed his eyes. Just for a moment, he told himself.
He woke when she did; the clock read four forty-five. He bit back a curse, shifted, and turned on a bed lamp. Her eyes reflected her pain. He started to rise, but she stopped him. “I don’t need anything. Just you. Hold me.”
He slid his arm under her neck and pulled her against his side. Her arm went across his chest, her hand cupped over his ribs. “I don’t want all those pain killers, not until I can’t handle it any longer. Please, I don’t want to spend what time I—that remains drugged out. I’ll smoke the grass after the treatments, I promise. But no more pills until I can’t manage it.”
His only answer was to hold her tighter.
<><><>
John walked into work at nine on Friday morning, said hello to Anna, the receptionist, and went directly to his private office. There was a Post-It on his monitor, with a note for him to come to Mark Halpern’s office as soon as he could. He stared at the note for several seconds, wondering if, at last, the partnership the firm had been dangling before him, like the proverbial carrot on a stick, would happen today.
Popping the top from his coffee, he took several sips of the now lukewarm black brew, and opened his attaché case. He took out the five files he’d worked on last night and this morning, set them on the far side of the desk, and went to Mark Halpern’s office.
Halpern, the managing partner of the accounting firm, was a tall, pencil-thin man who represented the perfect archetype of the successful accountant. His short hair was immaculately cut, and framed a long thin face. Gold-tone wire-rimmed Versace glasses rode low on a long thin nose while watery blue eyes looked outward above the rims. He wore a gray suit, white shirt, and blue tie.
“Morning, Mark,” John said upon entering the office.
“John.” Halpern nodded and pointed to a chair. “How is Claire doing?”
After settling in the chair, John shrugged. “She’s holding her own.”
“Good.” He paused to steeple his fingers under his chin.
Something about the way Halpern was looking at him sent a warning ripple through his mind. Intuitively, he knew whatever was about to happen would have nothing to do with the promised partnership. “Is there a problem?”
Halpern lowered his hands from beneath his chin and favored John with a protracted nod. “Yes.”
The silence following the managing partner’s words grew uncomfortable while John held himself in check. Finally, as the seconds stretched into a minute, Halpern elaborated, “There have been complaints from clients, of...delays, inattention to details...non-responses... John, one major client went to another firm, two others are threatening to do the same. I—we think you should take a month off, take a leave of absence to deal with your family’s...ah, situation.”
John stiffened. He stared at Halpern but did not see him. He shook his head. “Family situation? My wife is dying! That’s not a family situation.”
Halpern leaned forward, his face turning sympathetic. “I can’t pretend to understand what you are going through, but truth be told, its affected your work, which effects the firm. We have to think about the firm and you...you have to think about Claire.”
John’s mind clouded over, his muscles tensed to the point of cramping. He took several breaths as he fought for control.
Before John could speak, Halpern went on, “Take today, go over your accounts with Lester and Sam, and walk them through each one. Then, John, use the next month to concentrate on Claire without any distractions from here. Come back when you’re ready.”
Rage boiled in the pit of his stomach, growing harsher, deeper as the man’s words twisted through his head. He translated Halpern’s words from ‘come back when you are ready’, to ‘come back when Claire is dead’.
He started to snap an angry reply, but clamped down before it got out. He couldn’t afford to lose his job and their health insurance, which was much better coverage than the private school where Claire worked; instead, he swallowed his anger and disappointment. “Of course. Thank you for your consideration of my situation.”
But as he spoke the words aloud, something inside himself, something that had always been a part of him, crumbled. In that moment of surrealistic time, he knew something deep within him had been irrevocably changed.
“Good. I’ll have them come to your office so you can go over everything.”
Standing, John nodded once to Halpern and left the office in a semi-daze. When he reached his own office, he closed the door, sat at his desk, and stared at the blank monitor, knowing everything would be different from this moment on.
He picked up the phone and called home. When the aide answered, he asked about Claire, then told her he might be a little late, and asked if she would be able to stay for another hour or two. She
told him there would be no problem, he thanked her, and hung up.
John turned on the computer and when it booted, he opened his files. He studied each client name, deciding which client would go to which accountant while he was gone. All the while, the feeling of change that had begun in Halpern’s office grew heavier in his mind.
CHAPTER SIX
August
“She’s a fighter, John. She’s holding on, working hard not to succumb,” Doctor Allan Fein commented, looking up from Claire’s chart. Fein had called John into the office when Claire began today’s chemo treatment, telling John he needed to speak with him.
“She is,” John agreed.
Fein leaned back in his chair. “Still, she’s lost another two pounds. She has to eat.”
“She has trouble keeping food down.”
“Which is normal, but she needs the calories. Without them, she’ll weaken too fast. Maybe it’s time to put in a feeding tube.”
“She’ll never agree. We both know that.”
“It’s been almost three months since we started the treatments. They have slowed the cancer, but not stopped it...nothing can stop it. How is she handling things after the treatments?”
John closed his eyes. “The after-effects are lasting longer each time.”
“Perhaps it’s time we back off. There has been no improvement for a month.”
John’s eyes snapped open. “No. As long as she wants to fight, we fight.”
The doctor leaned forward. “Is she fighting because she wants to or because you want her to?”
His question kicked up the darkness always so delicately balanced on the edge of his mind—the always-present cloud of despair shrouding his thoughts and actions since her diagnosis did its best to make him ignore the oncologist’s words, yet the analytical accountant’s part of his mind heard and digested each one. “I don’t know.”
“Perhaps it’s time to find out.”
“What happens if she stops her treatments?”
“She’ll fade quickly; she’ll have perhaps two months.”
The darkness pressed harder on him. He knew exactly what had to be done now. He stood. “I’ll discuss it with her.”