Two Sisters: A Novel (18 page)

Pia put on her dark glasses and backed out of the parking spot. On her way to the radiologist’s office, she swung by the dry cleaners to pick up Will’s favorite suit and drop off several tomato-stained ties. Obviously, he’d been eating a lot of pizza lately. She emitted an exasperated puff of air. If not for her, Will would live the same way he had in college.

“Glorious day, isn’t it?” Pia said, flashing her easy grin at a Westport woman who looked exactly like her. Same honey blond hair color. Same pressed white shirt tucked into skinny jeans. Both drove hybrid SUVs. Cypress pearl paint, the most exquisite greenish-gray. The car needed gas, but she’d fill up after. More than anything, Pia hated to be late.

Dr. Rushkin’s waiting room was nicer than most. Upholstered sofas lined the walls, classical music softened the air.
Architectural Digest
and
People
magazines were the current issues. A tall clear vase held real flowers and fresh water. Pia filled out the clipboarded form the receptionist handed her.

6. Date of last breast exam?
Never
.

7. Lumps? Tenderness? Nipple discharge?
Possible.

8. Family history of breast cancer?
No. No one. Not anyone.

“Mrs. Winston?”

Pia looked up.

“I’m ready for you.” A technician in blue scrubs stood smiling at the doorway, her hands gently clasped in front of her. Pia handed over the clipboard and followed her into a small room with a huge machine that resembled a telescope on steroids.

“You’re right on time,” Pia said, making polite conversation.

“Dr. Rushkin doesn’t like to make his patients wait.”

The technician’s life revealed itself in her no-nonsense movements, her wash-and-wear haircut and dimpled hands. She was a mother, no doubt. One who stopped off at Wendy’s drive-through on her way home, too tired to make dinner. Her husband had a favorite chair. Remote in hand, he melted into it while his wife unpacked the white bags and smoothed the burger wrappings into plates. When asked how their school day went, her kids glumly said, “Fine,” and ate their meals in six bites.

“Everything off from the waist up, Mrs. Winston,” the cheerful technician said. “Open at the front.” She handed Pia a blue fabric gown wrapped in cellophane and said, “I’ll be right back.”

After neatly hanging up her bra and shirt on the door hook, Pia pulled open the cellophane and shook the gown open. She put her arms through the gown sleeves and tied a bow at the top. The room was standard-issue medical: scuffed eggshell walls, gray linoleum floor, a rolling stool, and a monstrous beige machine of unyielding metal. Softly knocking, the technician said, “Ready?”

“Ready.”

Pia inhaled hard. She wasn’t ready. Not at all. Nausea gripped her stomach. She wanted to push past the technician and run through the waiting room and exit the hospital and fling open the car door and race home, not caring one whit who saw her nakedness in the flapping blue gown.

“Put your arm right here.”

With the skill and speed of someone who had seen every size, shape, and condition of a woman’s breast, the technician chatted about her bum knee as she peeled back one corner of Pia’s gown and ladled her breast onto the cold glass plate of the X-ray machine. “It’s never been the same since I played soccer with my seven-year-old,” she said. “Hold still, please.” Retreating behind a glass partition, she pushed a button that lowered the top half of the glass plate down to flatten Pia’s breast. “Deep breath in. Hold.”

“Owww,” groaned Pia.

“Sorry. Hang in.”

Silence, pain, intense tugging on the skin of her chest, buzzing, then release. The glass plate lifted up.

“First time?” the technician asked sympathetically.

“I’m thirty-one.”

“Ah.” Taking the plate out, replacing it with another, the technician repositioned Pia’s breast and repeated the whole process. “I try to be gentle with the virgins.” She laughed. “Deep breath in. Hold.”

The awkward, painful process was over in fifteen minutes and Pia was escorted into an examining room down the hall.

“Dr. Rushkin will be right in,” the technician said before quietly shutting the door behind her. Pia nodded, mulling over the protocol. When a woman manhandles your breasts, should you at least ask her name? Bond as mothers?
How does your seven-year-old like school?

While waiting for the radiologist to come in, Pia stared at the blank light board and cradled her sore breasts as if they were two small children who’d had their first vaccinations. She wanted to place them safely back into her bra. Soon, there was another soft knock on the door.

“Come in.”

“Good morning, Mrs. Winston.” The doctor entered and tossed her breast X-rays onto the light box. “Let’s see what we have here.”

Bearded and soft bodied, resembling a rabbi more than a radiologist, the doctor stroked his chin hair as he looked at the spidery blobs on the screen. Pia heard him breathe in, then out. Then in again.

“See anything?” she asked, knowing, of course, that he had.

“Could you please lie down and lift your left arm over your head?”

Down she went onto the crinkly paper covering the exam table, watching the deliberately placid expression on the doctor’s face as he pressed his fingertips around her left breast in a circle, focusing on the one area she knew he would. She wondered why her whole chest hurt until she realized she wasn’t breathing.

“I’d like to do a biopsy,” Dr. Rushkin said matter-of-factly. “There’s an area of concern.”
Area of concern
, Pia repeated in her head. Like Chernobyl or Fukushima. A poison zone. “Right now?” she asked.

“Yes. You have time?”

Without waiting for an answer the doctor picked up a plastic bottle of gel and squirted a quarter-size amount onto a sonogram wand. “It won’t take long. Lie still, please.” Pressing the wand to the side of Pia’s left breast, he watched the image on a monitor. Pia subtly twisted her neck to see. It was similar to Emma’s ultrasound. Then a darker thought intruded:
Emma’s image was the beginning of life; this is the outline of death.

“I’m numbing the area now. You’ll feel a small pinch.”

With the spot marked on the sonogram screen, he injected her breast with an anesthetic. As he continued, he narrated his actions.

“Tiny incision. Locating the tissue. Hold still. There.”

Pia heard a snapping sound. She felt pressure, like a painless hole punch. When he said, “The bleeding will stop soon,” she wondered if she would have time for that manicure after all.

“Keep the gauze and bandage on overnight.”

Dr. Rushkin showed her the maggot-size piece of pink tissue he’d removed and inserted in a glass tube. She looked at it, then looked away. A piece of her body was outside herself, beyond her control. Soon, she would belong to medicine. No longer a person, but a patient. There could be no more denying. No further lying. Though the incision stung a little, it was no worse than a nick from cuticle scissors. Which reminded her: she should call Tara at the nail salon to see if she could take her first thing tomorrow morning, after she dropped Emma off at school.

T
HE PHONE WOKE
her. Will’s side of the bed was empty. He was already downstairs. The aroma of morning—coffee, buttered toast—eased her abrupt awakening. When Will didn’t answer on the third ring, she picked up.

“Hello,” she said, heavily, sleep still trapped in her throat.

“Mrs. Winston.”

Those two words knocked the wind out of her. Dr. Rushkin’s distinctive voice, a throaty monotone, sounded whisperish even when he spoke normally . She could picture his thumb and index finger stroking the beard on his chin. In her mind she could see his sad eyes.

“Good morning,” she said, steeling herself. A radiologist, she knew, wouldn’t call first thing in the morning with good news. Doctors sent good news through the mail in a form letter with their signature scribbled at the bottom. With a difficult notification they divested their desks of it early in the day, before patients arrived and bedside manners were required. Even so, when Dr. Rushkin’s low voice announced, “The biopsy came back positive,” Pia paused, not sure if
positive
meant good or bad.

“Are you saying I have cancer?” she asked.

“Yes,” he said. “You have cancer. The lab just faxed me the results.”

Suddenly, Will appeared at his wife’s side holding two mugs of steaming coffee. “What did you say?”

Cupping the phone, Pia whispered, “Thanks for the coffee, sweetie,” in a dismissive way. Will sat on the bed and set the mugs on her bedside table.

“Coasters,” she mouthed. Into the phone Pia said, “Can I call you back?”

There was a pause before Dr. Rushkin said, “This can’t wait, Mrs. Winston. Do you have a pen?”

“Yes. Yes, I do. One moment.” She reached past Will into the bedside drawer for a pen and a Post-it note. Then she said, “Go ahead,” and wrote down the name and phone number Dr. Rushkin gave her. He said, “I’ll tell him to expect your call this morning.”

“Will do!” Pia chirped before hanging up.

“Who was that?”

“The coffee smells divine, my love.” Pia reached for the warm mug and encircled it with both hands, trying to still the shaking.

“Pia.”

Pasting a fearless expression on her face she said, “It appears as though God is testing us today.”

Chapter 19

“E
VERYTHING OFF FROM
the waist up.”

Those six words replaced the only other words Pia had regularly heard in a doctor’s office: “Don’t forget sunscreen.” Dr. Rushkin had been referred by her gynecologist, the best in Connecticut. Rushkin, in turn, referred her to the best oncologist in the state, Marc Payton. Joked Pia, “If our doctors were the
worst
this could all be a mistake.”

Will hadn’t laughed. He hadn’t said much of anything since he heard the awful news. Not once did he say, “I felt that lump more than a
year
ago. You assured me it was nothing.” He didn’t glare at his wife with a set jaw. Never did he angrily turn to her and scream, “How could you be so goddamned careless with your life?”

His feelings of fury, he told himself, were probably fear. Losing Pia, the linchpin of the Winstons’ life, was unthinkable. Why, she made his very life possible. Without her . . . there
was
no without her. Period. And there was no use flinging accusations or demanding an explanation. As much as he wanted to know,
needed
to know how she could do this to him—how she could be so goddamned careless with
his
life—what good would it do? It was too late. They could never turn the clock back to that night at the Greenbriar when Pia could have caught her cancer early. Christ, they were at a health spa! Doctors were on
staff
. They could have X-rayed her chest the very next morning and seen that the hard pebble was self-contained—a misshapen wart that could be scooped out with a surgical melon baller. Instead of a fucking facial, why didn’t she go to the clinic? It was right there at the resort! At the very least, they would have told her to see an oncologist the moment she got home. Pia let him play golf while her cancer was morphing into a jellyfish, its tentacles spreading and eating away her life? How could she be so goddamned selfish?

Will said nothing. He felt his chest burn as he held her hand and bit his tongue and sat next to his wife in Dr. Marc Payton’s office—the best oncologist in the state of Connecticut—while his entire world exploded in front of his face.

“There’s no way to sugarcoat this,” Dr. Payton said. Head of oncology at Connecticut General, he had the ideal sprinkling of gray in his inky black hair. Enough to trust him, but not so much that you mistrusted his ability to keep up with the cutting edge. His office was distinctly Swedish in decor. Finely grained light wood, clean lines, no frills. On his wall was the obligatory framed diploma, on his desk photos of his athletic son, lovely daughter, and fit blond wife.

“Spell it out.” Will gripped Pia’s fingers so hard she could no longer feel her hand.

Dr. Payton looked down at the manila folder on his desk. “The PET scan has revealed some distressing news. The cancer in your left breast has metastasized, Mrs. Winston. Meaning, it’s spread.”

“We know what the word means, Doctor,” Will said. “How far?”

“Far, I’m afraid. The scan shows evidence of cancer in your lungs, rib cage, and liver. I’m sorry.”

Dr. Payton spoke directly to Pia even as Will asked the questions. Pia extricated her hand from Will’s painful grip as Dr. Payton said to her, “Had we caught it earlier, we would have more treatment options.”

“How could I possibly discover breast cancer?” Pia asked, indignant. “I’m thirty-one. Isn’t a baseline mammogram at forty?”

Will shot her a sharp look as Dr. Payton quickly said, “I didn’t mean to imply in any way that this is your fault. An aggressive tumor like this is rare at your age. And not at all fair, Mrs. Winst—”

“Call me Pia.”

“Of course. Pia.”

“There must be a mistake. I feel absolutely fine.”