Lightning (11 page)

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.”

“Are you telling me he's lying to me? That he'd do a mastectomy even if I didn't have cancer?” Cancer. They were saying it now like “Kleenex,” or “microwave,” or “nosebleed.” It was a dreaded word that had become part of her daily vocabulary, and she hated hearing it, especially when she said it. “Do you think this guy is a complete charlatan?” She didn't know what to think now, and Sam's attitude was making her crazy.

“Probably not. He's probably basically responsible, or Anderson wouldn't be recommending him to you, but you can't trust anyone, not doctors anyway.”

“That's what they say about lawyers,” she said glumly.

“Baby, stop worrying. It's probably nothing. He'll make a little cut in your breast and find out there's whipped cream in there, sew it up, and tell you to forget it. Don't put yourself through this in the meantime.” He was so purposely blithe about it that in some ways it made her even more nervous.

“But what if he was right? He said that masses like this, this deep in the breast, are more often malignancies. What if it is?” She kept trying to make him see what was happening, but he just wouldn't.

“It won't be a malignancy,” Sam insisted doggedly. “Trust me.” He absolutely refused to hear what she was saying. He seemed to be shielding himself from the realities with optimism and good humor. His insistence that nothing would happen to her made her feel suddenly lonely, and although she desperately wanted to, she didn't entirely believe him. All he had done was shake her faith in both Dr. Anderson and Dr. Herman. So much so that on the second day of the trial, she used a brief recess to call one of the other doctors Anderson had recommended.

She was younger and had published fewer articles, but she was just as respected, and reputed to be just as conservative as Dr. Peter Herman. Her name was Frederica Wallerstrom, and she agreed to meet Alex before court the next day, at seven-thirty in the morning. And when Alex met with her, she wanted Dr. Wallerstrom to be the solution to all her problems. She wanted her to be nurturing and warm, tell her that her fears were in vain, and that more than likely the tumor would be benign, and none of the horrors she had heard would apply to her. But Wallerstrom looked extremely stern, said nothing at all as she examined first Alex, and then the films, and when she spoke, her eyes were cold and her face entirely without emotion.

“I'd say Dr. Herman was being quite accurate in his assessment. You can never tell of course, at this stage. But my guess would be that it's probably malignant.” She didn't mince her words, and she seemed unconcerned with Alex's reaction. As she listened to the woman with the cropped gray hair and powerful hands like a man's, Alex felt her own palms grow damp and her legs start to tremble. “We could be wrong of course, but you develop a sense of these things,” she said coolly.

“And what would you recommend if it is malignant, Dr. Wallerstrom?” Alex asked, trying to remind herself that she was the consumer here, that she was auditioning this woman, and she still had options and choices. But she felt like a child, helpless and without knowledge or control, as the other woman eyed her with dispassion.

“There are the advocates of lumpectomies, of course, in almost all circumstances, but personally, I think the risks they take too often prove them wrong, and a decision like that can be disastrous later on. A mastectomy is the surest way of assuring that you have eliminated the disease, coupled with chemotherapy in most instances, of course. I'm a conservative,” she said firmly, discarding the other school without hesitation, no matter how respected or valid their theories. “I'm a proponent of mastectomies. You can do other things. You can opt for a lumpectomy and radiation, but you're a busy woman, and how realistic is that? You won't have the time, and you may regret it later. Sparing the breast now could prove to be an enormous mistake later. You can risk it of course. It's your choice. But personally, I completely concur with Dr. Herman.” Not only did she agree with him, but she seemed to have nothing to add, no warmth, no kindness, no compassion for Alex as a woman. If anything, she was even colder than Dr. Herman. And although Alex had wanted to like her, because she was a woman, if nothing else, she liked her even less, and could hardly wait to rush out of her office and take a breath of air. She felt as though she were suffocating from everything Dr. Wallerstrom had told her.

Alex arrived at the courthouse at a quarter after eight, and she was shocked to realize how little time the doctor had actually spent with her on such a serious matter, or maybe it was only serious to Alex. To everyone else, it seemed like a very ordinary occurrence. An easy choice. Get rid of the breast, and the problem. It was all so simple, as long as they were the doctors, and not the patient. To them, it was a matter of theories and statistics. To Alex, it was her life, her breast, and her future. And none of the choices were easy.

She was disappointed to realize that having gotten a second opinion, she was no more certain of what would happen to her, no more reassured about the outcome or the options. She had somehow hoped that Dr. Wallerstrom would allay all her fears, and tell her that everyone else was overreacting and being foolish. Instead, she had only heightened Alex's fears, and made her feel even more frightened and lonely. The biopsy would still have to be done, the situation and the tumor analyzed, and the ultimate decision would have to be hers, and her surgeon's. There was still the chance, of course, that the tumor would be benign, but after everything they had said to her in the past few days, it seemed less and less likely.

Even Sam's cheerful refusal to believe the worst seemed patently absurd now. And with his adamant refusal to discuss the possibilities with her, the pressures of the trial, and the fertility medication she knew she was still reacting to, she felt as though she was barely clinging to sanity during the entire week. She felt as though she were walking underwater.

The only thing that kept her from losing her mind completely was incredibly solid support from Brock as they worked their way through the trial, and it seemed like a miracle when the jury absolved Jack Schultz of absolutely everything the plaintiff wanted. They denied the plaintiff everything, and Jack must have thanked her a thousand times. The trial only took six days, as it turned out, and they were finished at four o'clock on Wednesday. Winning had been the only good thing that had happened.

She sat in the courtroom, feeling drained, but looking pleased, and she thanked Brock for all his help. It had been the hardest ten days of her life, harder than anyone knew, and they had done some extraordinary teamwork.

“I couldn't have done it without you,” she said graciously, and really meant it. The last few days had worn her down more than even he suspected.

“You were the one who did it.” He looked at her admiringly. “You're a pleasure to watch in the courtroom. It's like great ballet, or fine surgery. You don't miss a stitch, or a step, or an incision, or a suture.”

“Thank you,” she was packing up their files, with his help, and his words had reminded her that she had to call Peter Herman. She dreaded seeing him again, and the biopsy was only five days away now. She knew nothing more than she had before, except that her visit to Dr. Wallerstrom had confirmed Peter Herman's assessment. And Sam had literally refused to discuss any of it with her again. He said it was a big fuss about something that would never happen. She hoped he was right, but for the moment, he seemed to be the only one who thought so.

She tried to feel victorious about the trial, and Jack Schultz sent her a magnum of champagne, which she took home with her, but she wasn't in the mood to celebrate. She was nervous and depressed, and very frightened about Monday.

The day after the trial ended, she went back to see Peter Herman, and this time he didn't pull any punches. He told her in no uncertain terms that if a tumor that big and that deep turned out to be malignant, she would have to have a modified radical mastectomy, and extensive chemotherapy, and it was best to face it. He explained that she had two choices. She could have the biopsy, under general of course, and then discuss the options with him again afterwards. Or she could sign a permission slip before the biopsy, which would allow him to do whatever he felt was necessary, after he'd done the biopsy. It would mean being put under general anesthesia once instead of twice, and trusting him completely. It was unusual, he explained, to do the procedures in one step rather than two, but he also correctly sensed that Alex wanted to get it over with in a single operation. The only complication would be if she was pregnant. And he said that, whether she was or not, he'd understand perfectly if she preferred doing the procedures in two stages.

But, as with the lumpectomy versus the mastec-tomy
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she had to be the one to make the decision. She had to choose if she wanted to do the biopsy by itself, or in tandem with the actual operation. To Alex, as she discussed it with him, it seemed simpler to deal with it all at once, rather than prolong the agony, and go back to the hospital again for a mastectomy, if the tumor was malignant. She trusted Dr. Herman to make the right decision once he biopsied the tumor. And she had already made the most difficult choice of all since seeing Dr. Wallerstrom. Although the prospect of doing only a lumpectomy was very tempting to save her breast, even the vaguest hint of greater safety by eliminating the entire breast won her over. Both views were heatedly debated by equally respected surgeons, and yet it was clear to her which Peter Herman preferred, and much as she ached at the prospect, she decided to follow his thinking. She had already agreed to the modified radical mastectomy he had described to her, if the tumor proved to be malignant. And to chemotherapy, if he felt it was needed. But they would make that decision later.

But the real agony for her was what she would do if she was pregnant. She knew what she owed Sam and Annabelle, but she also knew how difficult, if not impossible, it would be to give up an unborn baby. Dr. Herman explained very clearly as she stared at him that in the first trimester of pregnancy, mastectomies were always performed rather than lumpectomies, because of the inadvisability of doing radiation. Having a lumpectomy automatically meant the necessity for radiation. But in the case of a mastectomy, if chemotherapy was advised, it would almost certainly cause a spontaneous abortion. It would do the same in the second trimester as well, so if chemotherapy was necessary, it would more than likely kill her baby. It was only in the third trimester that they felt they could afford to wait, and treat the cancer after the baby was delivered.

He said very honestly that he thought there was almost no chance at all that her mass would prove to be benign. He had just seen tumors like it too often. What he was hoping for her was that it would not have infiltrated, or metastasized, and that there would be minimal node involvement. And he also hoped, of course, that it would be nothing more than a Stage I tumor. She felt herself blanking out on him again, and forced herself to listen and understand what he was saying. She wished Sam were there with her but he was too busy denying that there was even going to be a problem, she hadn't even thought to ask him.

“What about the pregnancy?” Dr. Herman asked her before she left. “How real a possibility is that?” It could affect some of their decisions.

“I don't know,” she said sadly, “for the moment.” She wouldn't know for sure until that weekend.

“Would you like to have some counseling, before the biopsy?” he asked, showing his “human” side again, which was very small, and very seldom seen, but at least he was trying. “Particularly, if you might want to make this a one-time procedure in the event of a malignancy, you might like to speak to a therapist, or some other women who've been through it. Normally, we recommend peer groups, but that usually isn't until later. They're extraordinarily helpful.”

She looked at him ruefully and shook her head. “I don't have time. Particularly if I'm liable to be out of the office for several weeks.” She had to cover all possibilities, and she had already asked Matt Billings to cover for her, and she had given a lot of her work to Brock. She knew he would take good care of it. But she hadn't told either of them where she was going. She had intimated only that she had a medical problem that needed to be worked out, and it could take anywhere from two days to two weeks, but they were prepared to accept that and help her out as much as possible. Brock said he hoped it was nothing serious, and Matthew didn't even think of it, and wondered if she was going to have a nose job, or her eyes done. His wife had done it the year before and he didn't think Alex needed anything of the sort, but he also believed that all women were a little crazy about their looks, and Alex looked so healthy, it never dawned on him that she might have a serious problem.