by Howard Fast
There were no other patients waiting. Evidently Joe had cleared his calendar for her. She picked up a copy of Time magazine, but her usual interest in the current lunacies and injustices of mankind had vanished. She was frightened and depressed. Why hadn’t she asked Philip to come with her? She wanted his arm around her, the good cheer and unquestioned hope that he always radiated. Philip would have told her not to worry, that whatever it was, they would meet it and overcome it.
Time passed, an eternity of time, and then she finally heard Joe’s heavy footsteps. She waited for him to appear. If he was smiling, all would be well; but he was not smiling, and her heart sank.
“Come into my office, Barbara,” he said.
She went into Joe’s office and sat again in the chair facing his desk. The X rays were on his desk.
“We have a problem,” Joe said. “I don’t know how much of a problem, but you have a fairly large tumor on your intestines, and another that is smaller. Now, don’t think cancer immediately. I know you well enough to know that you want the truth, as well as I can spell out the truth. I’m not an oncologist, so I can’t tell you how serious this is, but there’s no reason to jump to conclusions. This may or may not be a malignancy. I’ve already called Bill Calahan, and he and Sam will be waiting for us at Mercy Hospital in two hours. I told Hilda to switch everything to Dr. Clement here in Napa. He covers for me.”
Barbara was silent.
“My dear, take a deep breath. Please don’t be frightened.”
She was frightened, terribly frightened. She took several deep breaths and then, in a whisper, said, “Why must I go to the hospital?”
“Because they will know what to do. I called Philip at the church. He’ll meet us at the hospital.”
“Joe,” she asked, “am I going to die? Tell me the truth.”
“I can’t because I don’t know. At this moment you’re alive, and your heart is good and your color is good.”
“I don’t want to go to the hospital. I want to go home,” she said, like a child pleading.
“Barbara dear,” he said gently, “you’re my sister and my patient. You must go with me to the hospital. Then we’ll know. You do want to know, don’t you? There’s no alternative.”
She was silent for a few moments, her eyes wet; then she nodded. “I’ll drive there myself.”
“No, I can’t let you do that. You’ve just had a terrible blow. I’ve canceled everything for today. I’ll take you.”
“All right, Joe. We’ll go in my car,” she said softly. “I’m better now that I heard the worst. I’ll ask you only one more thing—do I have a chance?”
“Of course you do. I don’t even know what these tumors are.”
“My mother died of cancer.”
“That means nothing.”
“If I’m in the hospital, Eloise and Sally will want to come. One of them can drive you back. Or you can drive back in my car. I can do without it for a while.”
“Don’t worry about the car.”
Driving back to San Francisco, Barbara confronted what might well mean her death. She had faced death before, both in Nazi Germany and in El Salvador, but those were moments of high excitement, not unlike Philip’s plunge into the burning bus. This was different. She recalled Philip telling her once that part of his opposition to the death penalty was the injunction in Deuteronomy where Moses is told that he must die and never cross over to the Promised Land. Why, she wondered, should anyone be cursed with a knowledge of approaching death? But I am being foolish, she told herself. Millions of people die and know that they are dying, and I certainly don’t know that I am dying.
She said to Joe, “Don’t ever lie to me, Joe. If I am going to die, tell me so. I don’t want that monstrous chemotherapy. I’ve watched too many people suffer through it. And I don’t want to die in a hospital. Can you promise me that?”
“You’re not dying.”
“All right. I don’t really feel that I’m dying. I feel quite well now that I’m over that dumb scene I made. What shall I tell Philip? He loves me so. Do you know, Joe, I was never entirely sure that I loved him—oh, I did love him, but not the way he loved me. Then—oh, just about Christmastime, I fell madly in love with him, absolutely madly, which is very strange to happen with a man you’re already married to.”
“Not so strange,” Joe said.
“And then this.”
She was mostly silent for the rest of the drive. At the hospital Philip was waiting for her in the parking lot, and he threw his arms around her and kissed her. Joe went ahead to register her, and Philip and Barbara followed more slowly.
“What did Joe tell you?” Barbara asked.
“Not much. He said there shouldn’t be any delay. You’ll stay here overnight, and they may operate in the morning.”
“He didn’t tell me that. Why don’t doctors tell me the truth?”
“I suppose he told me all he knew. Joe said he just doesn’t know enough to make any sort of diagnosis. Sam and a doctor, Bill Calahan, a specialist in oncology, will meet with you a little later. We’ll do this together, darling, and we’ll fight it through.”
The hospital room was pleasant enough, with a bright shaft of afternoon sunlight cutting through the windows. Philip helped her to undress and she put on the white hospital gown that a nurse brought her.
“Is it all right if I just sit in a chair?” she asked the nurse.
“Of course. If the doctor wants you in bed, he’ll tell you.”
“I thought Sam would be here,” Barbara said to Philip.
“Probably he’s with Joe and the oncologist. He’ll be here.”
“Why have I always been at odds with Sam, Philip?”
“You don’t want to discuss that now, do you? I’m sure he’s thinking about nothing but you at this moment.”
“Dear, dear Philip, who cannot think ill of anyone. Will you stay with me?”
“All night, if they let me.”
“I love you very much, and I need you.”
“I’ll be here.”
AT THAT SAME TIME, in Sam’s office, four physicians were discussing Barbara’s case. They were Sam and Joe; Dr. Calahan, the oncologist; and Dr. David Friedman, whom Sam considered to be the best abdominal surgeon in the hospital. It was possible that Sam considered himself the best, but the thought of operating on his mother himself was inconceivable to him. The four X rays that Joe had taken in Napa were posted on a large viewing light and were being examined by the physicians. Sam felt that Barbara should be X rayed again here in the hospital, and he pointed to two dubious areas.
Calahan did not agree with him. “I know what I see and I know what to expect. You’re right, Sam, those two areas are suspect, but these are good pictures. Joe tells me that she was very troubled with the information, and she’s been sedated, and she’s probably relaxed and more comfortable now. Why upset her more?”
“I’ll want X rays in the morning,” Friedman said.
“You must operate immediately?” Joe asked.
“No question. No other way to see how far it has metastasized.”
“What do you expect?” Sam asked Calahan.
“The worst, I’m sorry to say.”
“Why?”
“Well, those spots Sam pointed to. They would indicate the liver, and if it’s most of the liver, there’s nothing to be done.”
“No hope for chemotherapy?”
Calahan shrugged. “It would probably ease your conscience, Sam.”
“Don’t give me that shit about my conscience,” Sam said angrily. “This is my mother.”
“Take it easy, Sam.”
“What about chemo?”
“If there’s no hope for the liver and if it has metastasized to other parts,” Calahan said gently, “then chemotherapy would at best only delay the end a few weeks more—with a good deal of suffering in the interim.”
“The point is,” Friedman said, “do you want to remove the tumors on the intestines? That would
be a severe shock to her system, and it would only bring the end on more rapidly. From what you say, Dr. Calahan, nothing can be done about the liver.”
“I’m not saying that. I’m only saying what I suspect.”
“Then I want both of you in the operating room with me. I’ve done a good many of these, but still I’m not an oncologist.”
“What are you thinking?” Calahan asked.
“We’ll have the biopsies, and if you’re right, Dr. Calahan, I’ll close her up, send her home in a few days, and let her die in peace.”
“Damn it!” Sam said. “She’s my mother. You want me to pronounce a death sentence.”
“Sam, Sam,” Joe said. “She’s your mother and she’s my sister, but she’s also Barbara Lavette. I gave her my word that I would tell her the truth. She’ll make the decision. Her mother died of cancer, and she’s watched friends die after months of chemo. It’s one of the cruelest punishments we can bestow, and perhaps it’s worth it for those we save. But if it’s hopeless, you must tell her that, and she’ll make the decision. Barbara is a strong woman, a great woman. She’s lived her life fully and with nobility. She should have the right to die well.”
It was a strange speech for Joe to make. Sam had always taken his uncle for a stolid, unemotional man; now Joe put his arm around Sam and said, “I’ll be in the operating room with you.”
They had never been close, and the difference between them was enormous. Joe, at sixty-eight, was a small-town internist and pediatrician; Sam, just thirty-nine, was a brilliant surgeon, chief of surgery at a prestigious hospital, with an income of over two hundred thousand a year. He was a member of a golf club and of the Redwood Club; he bore his father’s name, Cohen, proudly, refusing to be known as Samuel Lavette; and he wore three-piece suits. Even when Joe put on a suit for the first time, he looked rumpled and messy, and he had never learned to knot a tie properly.
Dr. Friedman said to Joe, very respectfully, “Doctor, make her comfortable for tonight. No food, but plenty of water. I have an operation scheduled, but I’ll drop in later.”
IN HER HOSPITAL ROOM WITH PHILIP, Barbara said to him, “I’m not afraid anymore, darling—well, nervous, yes, and I’m still upset, rushed here out of Joe’s office and put into this silly gown. I don’t like hospitals. I never did. But I’m not afraid. Everyone dies. We pretend that each of us is an exception—but there are no exceptions. But I’m disappointed. I learned to love you, and I do love you very much—I think more than I ever loved anyone else, even Marcel, who was my first love.”
“I know that, baby.”
“And the truth is, I can hardly remember him. I’ve never lived in the past. Did it ever occur to you, Philip dear, that this present moment is all that any of us have, and this is a good moment— even here in this wretched hospital. Oh, I love you so much, and we didn’t have enough time.”
“You’re not going to die.”
“Don’t deny it, Philip. That won’t help. Do you know why Joe and Sam aren’t here? Because they’re somewhere arguing about what to do with me and how to cut me up and what to take out of me. Joe is a good doctor, as good as any of them, only he’s no good at deception. When he examined the X rays, I knew the verdict immediately. I know my body better than any of them do, and the truth is that I’ve been dying for weeks, only I denied it. I didn’t want to leave you, and I don’t want to leave you now. That’s the worst of it. I’m sure they’ve decided to take out those tumors and sew me up again and then subject me to that horrible chemotherapy—”
“Darling,” Philip said gently, “we don’t know what they’ve decided. I’m sure they’ll be here in a few minutes.”
“I don’t want to be cut up, Philip. I never had an operation. I think that frightens me more than the cancer. You won’t let them do anything I don’t want, will you?”
“Of course not. You know that. But we’re not physicians.”
A few minutes later Joe and Sam entered the room, along with Dr. Calahan. Barbara was still in the armchair, and Sam went to her and kissed her on the lips, something he rarely did. He introduced Dr. Calahan.
Barbara smiled and took his hand.
“I’ve heard a great deal about you, Mrs. Carter,” Calahan said. “For years now. It’s an honor to meet you.”
“Thank you. I’m sure Dr. Lavette told you that I must have the truth about my condition. I don’t want anything else, only the full truth. I do have cancer, don’t I?”
“I’m afraid so.”
“Hold on,” Sam said. “We haven’t even had a biopsy. We don’t know.”
“Sam,” Barbara said, “don’t do that. You must allow Dr. Calahan to answer my questions as well as he can. Joe says he’s the best oncologist in the City. I must ask questions and he must give me honest answers.”
“But, Mother—”
“No!” Barbara said firmly. “I think we should talk alone, Dr. Calahan.”
“For God’s sake, Mother, be reasonable.”
“I am being reasonable.”
Sam nodded. “All right. Ask your questions. I don’t know what you hope—”
Joe put his arm around Sam. “Easy, Sam. You don’t win an argument with Barbara. You know that, and I wouldn’t upset her.”
Calahan, uneasy at what was happening, said that after all, he was not part of the family.
Barbara apologized for Sam. “He is my son,” she said, smiling, “and he loves me and I love him. But I must get some answers.”
Calahan nodded. “I understand.”
“Are these growths malignant?”
“Knowing your family history, I would say that they are—out of my experience. As a physician, I cannot say they are, because there has been no biopsy.”
“If they are malignant, what are my chances to survive?”
“I can’t answer that now.”
“Why?”
“Because as a physician, I am not permitted to.”
Dr. Friedman came into the room, and Calahan introduced him to Barbara.
“I feel terribly important,” Barbara said, smiling. “I have never been a patient in a hospital before, and here I am with my husband and four physicians in my room, and I don’t even have enough chairs to ask you to sit down.”
“Mother,” Sam said, “Dr. Friedman will operate. He’s a very fine surgeon, and I have full confidence in him.”
Friedman smiled uneasily. He was a small, shy man with glasses, and evidently uncomfortable with praise. “I’ll do my best. It’s not a difficult operation.”
“You intend to remove both growths?”
“Yes.”
“I’ve been asking Dr. Calahan some questions—no, it’s all right, Dr. Friedman. By the way, did the blood tests show anything?”
Friedman glanced at Calahan and Sam. Then he said, “They’re not totally dependable, Mrs. Garter.”
“Oh?”
“There are a number of factors.”
What a strange lot of men, Barbara thought, as hard to get straight answers from as blood from a stone.
A call came for Sam and he said to Barbara, “I’ll be back, Mother.” And then he left.
Dr. Friedman said, “I’d like to examine Mrs. Carter. Would you step outside?” The three men stood in the corridor, and Dr. Calahan said to Philip, “I wish I could give you more hope, -Mr. Carter, but the liver is heavily involved. From what Dr. Friedman said, I would suspect that the cancer has metastasized widely. I’ll want to look at the blood tests, as uncertain as they are.”
Philip looked at Joe, and Joe nodded. “I love Barbara. I’d do anything in the world to save her, but if what Dr. Calahan suspects is so, then there’s little hope.”
“Is there any hope?”
“We always hope for a miracle,” Dr. Calahan said.
“Then what on earth is the procedure?”
“Dr. Friedman will open her up. While she’s on the operating table, we’ll do the biopsies and we’ll know the extent of the damage.”
“Will he remove the tumors?” Philip asked.
“Not if the cancer has metastasized to the extent we suspect, although the decision will be Dr. Friedman’s. We’ll simply close her.”
“And then—how long?”
“A few weeks—perhaps a month. Chemotherapy might delay it for an extra few weeks.”
“Will there be much pain?”
“We can control the pain, but we can’t control the effects of the chemotherapy. It’s not a pleasant experience.”
“Which means it’s thoroughly devastating, is that what you’re saying?”
“More or less.”
“If it were your wife in this condition, Dr. Calahan—what would you do?”
“Mr. Carter,” he said almost pleadingly, “how can you ask me that question? These are two different women.”
“Forgive me,” Philip said. “My wife will refuse the operation. She will prefer to die quietly. She knows there is no hope.”
“Did she tell you that?” Joe demanded.
“Yes.”
“My God,” Joe exclaimed, “can’t you change her mind?”
“I know her. I can’t. But why should I? Why should her last days be a perfect hell? My wife is a splendid woman. Why shouldn’t her last days be as painless and rewarding as the rest of her life was?”
At that point Dr. Friedman came out of Barbara’s room. The three men waiting for him were silent, and he joined their silence in a long moment. Then he said, “I have to tell you this, Mr. Carter. I found two very small lumps in her left breast. There’s no doubt that the cancer has metastasized. She refuses the operation. Do you want to examine her, Dr. Calahan?”
“To what end?” Dr. Calahan wondered. “Do you want me to, Mr. Carter?”
“What would the operation entail?” Philip asked Dr. Friedman.
Friedman shook his head. “Removal of both breasts as well as the abdominal opening. No, I agree with her. There’s no point in operating. And you’re right about the liver, Dr. Calahan—at least, so it seems to me.”
Calahan nodded, and Joe said, “Take her home, Philip. I’ll give you some prescriptions for the pain. If she’s hungry, let her eat—something simple—eggs, toast, and coffee. I’ll go with you if you wish.”