“And?”
“I went to see him at lunchtime.”
“What about? You can't have figured out already that you're pregnant?” It had only been two days, and he smiled at her. She was so anxious to have a baby.
She hesitated for a long time, torturing both of them, but she hated to say the words, to tell him and make it real. She hated to do it to all of them. But she knew she had to.
“There was a shadow on my mammogram.” She said it like a death knell, but Sam seemed a lot less impressed than she was.
“So?”
“It could mean that I have a tumor.”
“ ‘Could.' That means they don't know squat. And Martians could land on Park Avenue at midnight. But will they? Not likely. Probably just as likely as your ‘shadow' being a tumor.” She liked the way he thought about it. It restored her faith in her own body, which, in the past twelve hours, seemed to have betrayed her. But maybe it hadn't. Maybe Sam was right. Maybe she was just overreacting. “They don't know anything. It's probably just what it appears to be, and nothing more than that. A shadow.”
“Anderson wants me to see a surgeon and have a biopsy. He gave me three names to call, but I don't have any time before the trial. I thought I'd call one tomorrow, and see if he could see me at lunchtime. Otherwise, I'll have to wait till after the trial,” she said, looking worried.
“Did he think that would make a big difference?”
“Not really,” she admitted, feeling better than she had all day, “but he said I should get to it soon.”
“Obviously, but there's no need to panic. Half the time these guys are protecting themselves, they don't want to get sued, so they tell you the absolute worst, just in case, so you can't ever say they didn't warn you. And then if it's good news, everyone's happy. They never take into account the damage they cause by scaring you to death. For chrissake, Alex, you're a lawyer, you should know that. Don't let these bozos scare you!” She looked up at him with a grin, suddenly feeling both relieved and foolish, and he was smiling at her. He wasn't panicking. He didn't think she was going to die. He wasn't clinging to her, or being melodramatic. He had put the matter completely into perspective. And she suddenly realized that he was right. Even John Anderson wouldn't want to leave himself open to a lawsuit.
“What do you think I should do?”
“Get through your trial, have the biopsy in your own sweet time, but stay calm, and don't let these clowns scare the pants off you. And I'll bet you the profit on my next deal that your shadow is just that …and nothing more. Look at you, you're the healthiest woman I know. Or at least you would be if you ate occasionally and got some sleep.” But just talking to him now she felt better, and so relieved. He was intelligent, he kept a cool head, and he was probably right. It was probably just a scare, and not a tumor.
She felt immeasurably better when they turned off the lights that night, and only slightly worried again when she woke up the next morning. For an instant, she remembered that something terrible had happened the day before and she had that feeling of foreboding you get when you're in the midst of disaster. But as soon as she woke up, she reminded herself of everything Sam had said and she felt better again. And she made a point of waking Annabelle up and having her sit in the kitchen with her while she made breakfast. She even had a list of possible costumes for her. Liz had researched it the day before. They had a pumpkin, a princess, a ballerina, and a nurse, all in Annabelle's size, who opted instantly for the princess. It was exactly what she had dreamed of. “Oh Mommy, I love you!” she said, throwing her arms around her mother's waist.
“Me too,” Alex said, giving her a one-handed squeeze with a smile, as she flipped pancakes for her. She suddenly felt like celebrating. It was as though she had already been relieved of a terrible burden. Annabelle was happy, and Sam had convinced her that the shadow the doctors had seen was surely a false alarm. She wanted with her entire being to believe him. And this time, when Alex left for work, she swore and crossed her heart that she would call Annabelle at lunchtime.
She left her with Sam again, and kissed him fervently before she left, thanking him for his reassurances of the night before.
“You should have called me at the office. I'd have told you then.”
“I know. I guess I overreacted. It was stupid.” But anyone would have.
She kissed them both good-bye, and hurried out to the office. Brock was already waiting for her again, along with the rest of the team. She met with Matthew Billings, and it was eleven-fifteen before she remembered to call the surgeon Dr. Anderson had recommended.
A nurse asked why she was calling him, and Alex explained that it was about a biopsy, as Brock came back into her office for a file, and she prayed that he would take it quickly. He did and then disappeared again, as she wished she had locked the door. But maybe, if Sam was right, it really wouldn't matter.
Eventually, Dr. Peter Herman came on the line, and he sounded serious to her, and not terribly friendly. She explained about the shadow on the film, and that Dr. Anderson was concerned and felt that she should see him.
“I've already spoken to him.' Peter Herman explained. “He called me this morning. You're going to need a biopsy, Mrs. Parker. As soon as possible, I believe Dr. Anderson explained that.”
“Yes, he did.” She tried to maintain the calm that Sam had given her the night before, but it was more difficult with a stranger. She felt threatened by him, and everything he represented. “But I'm a trial attorney, and I start a trial tomorrow. I really can't do anything for the next week or ten days. I was hoping to come and see you after that.”
“That would be a very foolish decision,” he said bluntly, denying everything Sam had said to her, or perhaps confirming it. Maybe he was just protecting himself from malpractice, she told herself. This way, he had warned her. “Why don't you come and see me today, and then we'll know where we stand. And if we need to, we can set the biopsy up for a week from next Monday. Would that suit you?”
“I …yes … it would …but …I'm very busy today. My trial starts tomorrow.” She had already told him that, but she was feeling desperate again, and very frightened.
“Two o'clock this afternoon?” He was relentless, and she found herself incapable of arguing with him. She nodded her head silently at first, and then agreed to come to his office at two p.m. Fortunately, his office wasn't far from hers. “Would you like to bring a friend?” The question surprised her.
“Why would I do that?” Was he planning to hurt her, or render her somehow unable to take care of herself? Why would she take a friend to meet a doctor?
“I find that women very often get confused when confronted with difficult situations and large amounts of information.”
“Are you serious?” If it weren't so shocking, she would have laughed. “I'm a trial lawyer. I deal with difficult situations every day, and probably more ‘information' than you deal with in a year.” She was not amused by his comment.
“The information you deal with normally is not about your own health. Even physicians find facing malignancies of their own difficult and upsetting.”
“We don't know that I have a malignancy yet, do we?”
“You're quite right, we don't. Will I see you at two o'clock?” She wanted to say no, but she knew that she shouldn't.
“I'll see you then,” she said, and hung up, furious with him. Part of her reaction was the hormones and part of it was that he was the potential bearer of bad news and she feared him deeply. And as soon as she hung up, she called one of her paralegals in, and gave her an unusual project. She gave her all three names Dr. Anderson had given her, and told her to find out about their reputations. “I want to know everything about them, any dirt, any good stuff, what do other doctors think. I'm not sure who you should call, but call everyone, Sloan-Kettering, Columbia Presbyterian, the medical schools where they teach. Call everyone you have to. And please don't tell anyone you're doing this for me. Is that clear?”
“Yes, Mrs. Parker,” the paralegal said meekly, but she was the most industrious worker assigned to Alex and she knew she would get her the information.
And two hours later, she already had the scoop on Peter Herman. Alex was about to leave when the girl came hurrying in and told Alex that he had a reputation of being cold to his patients, but he was the best there was surgically, and there was something to be said for that. One of the hospitals she'd called, and the most illustrious, said he was extremely conservative but one of the best breast surgeons in the country. And the early reports on the other two were that they were almost as good, but not quite, and even more unpleasant to their patients than Peter Herman. Both of them were supposedly prima donnas. And Herman supposedly liked dealing with doctors and not patients, which was probably why John Anderson liked him.
“At least he knows what he's doing, even if he's no Prince Charming,” Alex commented as she thanked her paralegal, and asked her to continue to follow up on the others. And as she took a cab to his office, she wondered what he would say to her about the gray mass on the mammogram. She had had a range of views now, Sam's optimistic one, and John Anderson's far more ominous one, which Sam said was probably nonsense. She liked Sam's view of it a lot better.
But unfortunately, Peter Herman did not share. Sam's assessment of the situation. He told her that the shadowy area they saw was clearly a tumor deep in her breast in an area, and of a shape that almost always indicated a malignancy. Naturally, they couldn't be sure until they did the biopsy, but in his experience what they were going to find would be a tumor, and not a good one. After that, it would depend on the stage it was in, the degree to which it had infiltrated, whether it was hormone receptor negative or positive, and if there was metastasis. He was cold and matter-of-fact, and he painted anything but a pretty picture.
“What will all of that mean?”
“I won't know till we get in there. At best, a lumpectomy. If not, you may want to follow a more extreme course, which would mean a modified radical mastectomy. It's the one sure way of being certain that you've eliminated the disease, depending on the stage of the tumor, of course, and the extent of the involvement.” He showed her a chart that meant absolutely nothing to her, which had letters and numbers on it and covered a variety of contingencies, all of them completely confusing.
“Is a mastectomy the only way to wipe out the disease?” she said in a strangled voice, realizing that he'd been right. She was completely confused, and felt utterly stupid. She was no longer the trial lawyer, she was merely the woman.
“Not necessarily,” he answered her, “we may want to add radiation or chemotherapy. Again, this will depend on other factors at the time, and the extent of the involvement.” Radiation or chemotherapy? And a modified radical mastectomy? Why didn't they just kill her? It wasn't that she was so enamored with her breasts, but the idea of being completely disfigured and desperately ill from chemo or radiation made her want to vomit just thinking about it. Where was Sam now with his cheerful prognosis, and warnings about surgeons fearing malpractice? She couldn't even remember it now. What Herman said was so much more real, and so utterly terrifying, she could hardly think straight.
“What exactly would the procedure be?”
“We'll schedule you for a biopsy. I would prefer to do it under general anesthesia since the mass is so deep in your breast. And after that, you'll have to make the decision.”
“I will?”
“Presumably. You're going to have to make some informed choices. There are a number of options in this area of medicine. You'll have to make some of the decisions, they don't all rest with me here.”
“Why not? You're the doctor.”
“Because there are choices to be made, involving more or less risk, and more or less discomfort. It's your body and your life, in the final analysis, and you must make the decisions too. But with early detections such as these, I almost always suggest a mastectomy. It's a great deal wiser and surer. You can always have reconstructive surgery within a few months to restore the appearance of the breast, if you wish to.”
He made it sound like having a fender put back on a car, and not a breast on her body. And she didn't know it, but his preference for mastectomies as the surer cure was what had earned him his conservative reputation.
“Would you do the biopsy and the mastectomy on the same day?”
“Normally not. But if you prefer it that way, we can. You seem to be a very busy woman, and it would save you time, if you're prepared to entrust me with that decision. We can work that out beforehand, in the event of certain findings. We would have to plan that carefully.” Of course, she thought of Sam, to avoid a lawsuit. And then she thought of something else.
“What if I turn out to be pregnant in the next few weeks?”
“Is that possible?” He seemed surprised, and she felt faintly insulted. Did he think she was too old to have babies, just tumors?
“I've been taking Serophene and trying to get pregnant.”
“Then I would think you'd want to abort, if you were, and proceed with treatment. You can't afford to let something like this go for eight or nine months. Your husband and family need you, Mrs. Parker, more than they need another baby.” It was all so coldblooded and so simple, like the razor-sharp edge of a scalpel. She still couldn't believe what she was hearing. “I'd like to suggest that we schedule your biopsy for a week from next Monday and you come in to see me before that to discuss the options.”
“There don't seem to be very many of those, or am I missing something?”
“I'm afraid not, at this point anyway. First we have to see what you've got there. And then we can decide what to do about it. But you should know that my preference is almost always mastectomy in the case of early cancers. I want to save your life, Mrs. Parker, more than your breast. It's a question of priorities. And if you have a malignancy that deep in your breast, you may be a lot safer, and better off, without the breast now. Later, it may be too late. It's a conservative stance, but it's one that has proven to be reliable over the years. Some of the newer, riskier views can be disastrous. Doing a mastectomy early on could well be a great deal safer. And if indicated after the surgery, I'd want to start an aggressive course of chemotherapy four weeks after the surgery. This may sound frightening to you now, but six or seven months from now, you'll be free of the disease, hopefully forever. Of course, I can't recommend that to you now. We'll have to see what the biopsy tells us.”
“Would I still be able to …” She could hardly bring herself to say it, but she knew she had to. She wanted to know, since he had been so free about suggesting an abortion if she were pregnant, “…would I be able to conceive afterwards?”
He hesitated, but not for long. He had been asked this question before, though usually by younger women. At forty-two, most women were more interested in saving their own lives than in having babies. “It's possible. There's about a fifty percent sterility rate after chemotherapy. But it's a risk we'd have to take, of course. It could do you grave harm not to have it.” Grave harm? What did that mean? That it would kill her not to have chemo? It was a nightmare. “You'll have time to think about all this, during your trial. And I'd like you to make an appointment whenever possible. I'll try to accommodate your schedule as best I can. I understand from John Anderson that you're a very busy attorney.” He almost cracked a smile, but not quite, and Alex wondered if this was the “human” side John Anderson had referred to. If so, it was very small in comparison to the cold-blooded technician and scientist he was the rest of the time, when he was not being “human.”
He scared her to death with his icy factual explanations, but she also knew of his excellent reputation. What she needed was an excellent surgeon, if it turned out that she had a tumor and it was malignant. And she could have Sam to boost her spirits.
“Is there anything else I should explain to you?” he asked, and surprised her with the question. But all she could do was shake her head. It was worse than wh
at she'd heard the day before, and he had completely overwhelmed her. She could already imagine herself without her left breast, and undergoing chemotherapy. Did that mean she would also lose her hair? She couldn't bring herself to ask him. But she had known women who had been through it, and worn wigs, or had the shortest of short haircuts. She knew what everyone did, that if you had chemotherapy, you lost your hair. It was just one more affront to a rapidly growing list of terrors.
She left his office in a daze, and when she got back to her own office, she wasn't even sure what the doctor looked like. She knew she had spent an hour with him, but suddenly his face was blank, along with almost everything he had said except the words tumor and malignancy, mastectomy and chemotherapy. The rest was an indistinguishable blur of sounds and noises.
“Are you okay?” Brock walked into her office almost as soon as she got back, and he was shocked at how she looked again, and very worried. “You're not getting sick, are you?” She already was sick, probably, according to her doctors. It seemed incredible. She felt perfect, nothing hurt, she wasn't ill, and they were telling her she probably had cancer. Cancer. She still couldn't bring herself to believe it. Nor could Sam.
She told him that night, when she got home, everything Dr. Herman had said, and Sam just brushed all of it off again, with the same calm, easy insistence.
“I'm telling you, Alex, these guys are protecting themselves against malpractice.”
“But what if they're not? What if they're right? This guy is the biggest breast surgeon in his field, why would he lie to me just to cover his own ass?”
“Maybe he has a big mortgage on his house, maybe he needs to take so many boobs off every year to cover it. What do I know? You've gone to a surgeon, he's not going to tell you to go home and take an aspirin. Hell, no, he's going to tell you that you need to take your boob off. And if nothing else, he's going to scare the hell out of you, to cover himself, just in case you do have something there, which I don't believe for a minute.”
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