Five Women (37 page)

How quickly they act when they finally know, Gara thought, relieved that she didn't have to make decisions. She knew of other women who had spent weeks researching every doctor and hospital they could before they chose someone, but she had no more time to waste, if not because of her physical condition then because of her mental state, and she felt comfortable just having been led to this specialist by a doctor she trusted. She liked that she was surrounded by women physicians. They were in the club, they lived with the same fear of breast cancer as she did; they would understand.

Dr. Beddowes sounded kind and pleasant on the phone. She gave Gara an appointment for two days later, when the full report would be in.

“Are you tired?” Jane asked. “Do you want to take a nap? Does it hurt?”

“No, I'm okay,” Gara said. “I took some pain killer, and I'll take it again tonight before I go to bed.”

“Let's go out tonight,” Jane said. “It's your night, we'll do anything you want to. Where do you want to go?”

“I don't know,” Gara said.

“It's so nice tonight we can go outdoors. We can have dinner at an outdoor café. Eliot will take us.”

So later the three of them sat in a sidewalk restaurant near Gramercy Park in the mild evening, watching the throngs of people walking by. Somewhere there was music playing. I have cancer, Gara kept thinking. She felt wrapped in a cocoon of her own, set apart, vulnerable, temporary. She looked around. Everywhere there was brightness. She had never seen colors so vivid, or details so alive and intense; the buildings, the people, the trees. She didn't know if her mind at this time of fear was distorting what she saw, or if things had always looked that way and she had never noticed before.

I don't want to leave a world that looks like this, she thought. I never knew it was so beautiful. If I have to die soon, then I'm going to try to see everything this clearly for the short time I have left. As she sat there looking and listening, mingled with the sorrow that all of this might end so suddenly, she felt an odd kind of peaceful happiness, as if a vision of what the universe was really like was finally hers.

Dr. Beddowes was in her forties, with short gray-streaked hair and a round, unlined, pretty face. “This is probably going to happen to me, too,” she said with a smile, “so I'm always nice to my patients so someday someone will be nice to me.”

Gara smiled back, liking her immediately.

“When Dr. Fink took out the lymph node,” Dr. Beddowes went on, “another one was stuck to it and came out too, and they both had cancer and lymphoma in them. It's a very mild form of lymphoma, one of the few that's almost benign. It's called well-differentiated lymphocytic lymphoma because you can feel the lymph nodes without surgery and it's easy to watch. You don't have to worry about the lymphoma. I wouldn't even treat it. When you get an infection of any kind, the lymph nodes near the site will jump up. That's what happened here.”

“So the lymph nodes were a kind of watchdog,” Gara said.

“Yes. We can't find the primary source, although we know it's breast cancer, so it's in the breast. Breast cancer can go elsewhere, but it always starts in the breast. In your case we don't know where in the breast. We have to discuss what you want to do.”

“A mastectomy,” Gara said calmly.

“That's what I would recommend. A mastectomy probably followed by chemotherapy. And then reconstruction.”

“So the whole process will take a year,” Gara said. A year lost in a life that was already indefinite, but it could not be helped.

“Yes,” Dr. Beddowes said sympathetically. “About a year. I'll send you for some tests at the hospital tomorrow to see if it has spread anywhere else in your body. You'll have to stop taking your estrogen replacements because breast cancer likes estrogen. Here's a book for you to read, and a list of some others you might want to buy.” She gave Gara a copy of
Dr. Susan Love's Breast Book
, a thick paperback. Gara had heard of it.

She stayed up all night reading it, looking for the chances of a postmenopausal woman on chemotherapy surviving cancer. I have cancer, she told herself over and over, not really comprehending it yet. Overnight her life had completely changed. I have cancer, she thought the first thing when she woke up. It was always everybody else. Now it's me. I have cancer. She still couldn't relate to it, even though she was going through all the right motions. She was aware that she had not shed a tear. It had not even occurred to her to cry. I just want to survive, Gara thought.

And then she was at the hospital again, in an area ominously called Nuclear Medicine, drinking radioactive liquid in the waiting room, then standing in front of a clicking machine, looking at a tiny television screen and seeing there her body segmented and photographed in a series of twinkling dots of molecules on a dark background, a starry sky of her mortality, of her disease.

After the bone scan she lay on a narrow slab under a thick plastic tunnel, unmoving, holding her breath while other pictures segmented her body even more, into tiny slices, a biopsy without a knife, each a photograph of the fiber of her being.

“It hasn't shown up anywhere else,” Dr. Beddowes told her happily. “When Dr. Fink does the mastectomy we'll do a lymph node sampling to see if it's spread to any other nodes. I want you to have a plastic surgeon there at the operation so you can have an expander put in at the same time to start the reconstruction.”

“Why do you want to do a reconstruction?” Gara asked, only out of curiosity, since she would never have opted otherwise.

“You're so thin that if you don't do it you won't be just flat, you'll have a hole.”

She obviously thinks I'm going to live for a while, Gara thought, if she wants me to look good. She felt rather encouraged.

Dr. Beddowes handed Gara a piece of paper. “Here are the names of two very good doctors. One is kind of Hollywood and the other is very down to earth. See which one you like, and of course, see which one is free for the date of surgery. I'd like to have the surgery done as soon as possible because we waited so long. Next week?”

“Give me two weeks,” Gara said. “I need to tell my patients I'm going away.” She would tell them she had to attend to personal matters and give them a referral doctor. It would be hard enough to deal with her own fears without having to deal with theirs. “How long will I be too sick to work?”

“You'll be in the hospital two days, and then you'll be recovering for about five, and after that it's up to you. You'll have a drain in for two weeks.”

Of the two recommended reconstructive surgeons Gara picked the Hollywood type, Dr. Lister, who wasn't her idea of Hollywood at all except that she looked like a warmer Grace Kelly and was just as young as Gara's other doctors. She had no idea what the down-to-earth doctor would have been like, but she didn't have to make a choice because Dr. Lister was the only one available. She was happy with her decision. She felt as if she was in a sisterhood of bright young women. She didn't want to be parented, she wanted to be a partner in her fight to live.

“You'll stay with us after you get out of the hospital,” Jane told her. “We'll take care of you. You can stay as long as you want. You have the guest room.”

“Thank you.”

The surgery was set for a Monday, and she was to go to the hospital early that morning. She told Jane there was no point in coming with her; she would take a cab. She was nervous, and the few friends she had told were all calling her to wish her luck or to cry. Gara was glad they were concerned and cared about her, but she could hardly bear to speak to them. She just wanted to find her inner strength and be left alone. They were outside somewhere, and she had left their world. She would need them later.

The night before her surgery, in her own apartment, in bed, Gara said goodbye to her breast. She looked for the last time at the sagging little thing she was so fond of and spoke to it silently. “You've served me well,” she said to it affectionately. “Remember all those nights in parked cars with college boys who just wanted to get their hands on you? We've been through a lot together, you and I, all these years.” She touched it gently. “Goodbye, and thank you.”

Early the next morning at the hospital Gara found herself lying on a gurney outside her operating room, in a section where a man was lying on the gurney next to her, surrounded by his family—wife, son, daughter—waiting for his own surgery. The family kept kissing and comforting him and telling him they loved him. She wondered if they thought he would die. For the first time it occurred to Gara how alone she was. Carl was not there. They had no children. Her parents were no longer alive and she had no sisters or brothers to hold her hand. It felt odd, and she knew she had to put it out of her mind or she would feel sorry for herself, and afraid. After all, she had told Jane not to come. She could even have asked someone else. She had chosen to be this way. Was it bravado or not wanting to bother other people with her problems, bravery or her feeling of lack of entitlement?

The wife looked at her. She seemed to feel Gara's loneliness. “Are you here by yourself?” she asked.

“Yes,” Gara said.

“Well, I'm sure it will be all right. I wish you luck with your operation.”

“Thank you.” They smiled at each other. Then Gara was wheeled into surgery.

She woke up in a dim, pleasant hospital room with an I.V. attached to her right arm and the button for a morphine pump in her fingers. A searing pain on her left side near her ribs made her touch the button, and almost immediately she felt a little nauseated and completely out of pain. What a great invention, she thought. I don't have to wait and beg. She slept. The next morning the nurse helped her wheel the I.V. to the bathroom, where she brushed her teeth and combed her hair. She was back in bed when Dr. Beddowes came to see her, her round face glowing with happiness.

“They took out eighteen more lymph nodes,” Dr. Beddowes said. “There was nothing in any of them. You and I are going to grow old together.”

Gara smiled back at her. How nice, she thought, we're going to grow old together and she's younger than I am. Then she realized that what her doctor was also saying to her was that she would be under care for cancer, even if it meant just checkups, for the rest of her life.

“Can I have the I.V. taken off?” Gara asked Dr. Beddowes the next day when she came by. “It's too hard for me to drag it around by myself. I could go on oral painkillers and antibiotics now.”

“If you want. Your arm is going to be stiff, you know. You're left-handed, so you won't be able to brush your teeth or comb your hair for a while.”

“I already did.”

The next day she was walking up and down the hall with the nurse, counting laps. “If you keep doing this we're going to throw you out,” the nurse said cheerfully.

The day after that Jane took her home with her. “I thought you were going to be in a wheelchair,” Jane said, surprised, when she caught Gara emptying the dishwasher with her good arm. “Why are you doing things? We're supposed to take care of you. Why are you on Tylenol? Why aren't you on codeine? I never heard of anybody like you.”

Gara knew why: she needed the independence, she needed the focus. Being mobilized and directed toward recovery would keep her from feeling too helpless and frightened.

It hurt too much to sit up in bed from a prone position, so she used her bent leg to hold on to as if it were another person and hauled herself up. They had put a Johnson catheter inside her wound so it could drain, a plastic bag that somehow reminded her of a turkey baster attached to a long plastic tube, and she had to empty it several times a day and measure the fluid and write it down. Gara thought the worst part of the surgery was the drain. It hurt almost all the time. She pinned the tube to the top of her jeans and put the bag into her pocket, with a loose shirt over it. When she saw her patients she would pin it to her skirt. They would never know.

The
Breast Book
became her Bible. After the first few nights, lying on her back, she tried reaching the headboard of her bed with her fingers, to keep her arm from stiffening. She couldn't get anywhere near it, but she tried every day, and she could see the progress. She saw drawings of lymphedema, where the arm on the side where they had removed the breast and lymph nodes was swollen as a tree trunk, perhaps forever. That could happen at any time. Lymphedema itself could lead to cancer. You had to guard against infections, cuts, pricks; you couldn't lift anything heavy or trim your cuticles. One more thing to be afraid of.

What Gara was not afraid of was looking at the scar. She had already seen drawings of what it would look like, and she had never been squeamish about her own body, only her mother's. When the bandages came off to be changed she was surprised to see a small breast-shaped hill on the side where she'd had the surgery. It was the expander under the muscle, to stretch the muscle and skin, and saline would be pumped periodically into a tiny invisible port in it to make it bigger. Her own breast was fifty-one years old, but the fake one looked only thirteen. Dr. Lister had already told her that eventually she would take care of that. If Gara wanted them to they could both look twenty.

“When you're healed we'll start you on chemotherapy,” Dr. Beddowes said. “That will get rid of whatever tiny cancer cells might be floating around which we couldn't see, if there are any. Because your case is rather unusual we took it to the cancer board. Two doctors wanted you on adriamycin, but I said that was overkill. I'm going to give you CMF, which is the standard in cases like yours. That's Cytoxan, methotrexate, and 5–fluorouracil. You'll get two injections a week apart, and then two weeks off, for six months.”

She gave Gara three sheets of paper, listing the side effects of each chemical. The side effects all seemed awful and they all seemed much the same: hair loss, nausea, cracked fingertips, dark nails, mouth sores, fatigue, diarrhea or constipation, weight loss or weight gain, anemia. “You're lucky that they've recently come up with an antinausea drug called Zofran,” Dr. Beddowes said. “It's about a year old. The nurses will give you that in the I.V. before you get the chemo. Afterwards you might need a little Compazine, but I'll give you a prescription. This new drug is a miracle.”