“Well, it is a tumor, and it is malignant,” Luke begins briskly, as if he’s giving a lecture to a group of medical students. “It’s what’s called a medullary carcinoma; it’s. . . .”
I am having trouble following. Thoughts are going through my head faster than I was aware thoughts could travel: This can’t be real. Is he telling me I’m going to die? Should I ask for a rabbi? No, wait, I’m not a religious Jew, I’m more like an ethnic Jew—that would be hypocritical. But maybe rabbis in hospitals are more like therapists. Why is he telling me this stuff here, where I’m alone? Wasn’t that the point of bringing Herb?
I interrupt him.
“Do you think we could hold off on this until we get upstairs and you can talk to my friend too?” I say.
And, as we head to the third-floor waiting room, “I think I could use a drink.”
They offer me a wheelchair, but I don’t want it—it is very important for me to be on my feet. Herb is where I left him. I have been formulating the idea that it will be bad to be negative, that I’m under attack and it’s got to be all systems go, but as I see Herb, I give him a thumbs down and shake my head. Luke shows us into one of the little curtained-off cubicles.
“It’s, like, malignant,” I say.
Herb looks dazed. we find chairs. A nurse, hearing what is going on, brings me a cup of coffee, a small act of kindness that is enormously comforting. Luke starts his talk from the top. I had remembered from my father’s illness that it is important to take notes when you see the doctor, because in times of stress you do not remember all you hear. My notebook is in a locker with my clothes, but I see Herb, stunned as he is, pull his little notebook from his blazer and start writing, as if it’s the old days and he’s at a press conference. I feel a wave of love. He’s so solid. I focus in on Luke. He is saying that they’ve removed a medullary cancer, which is a relatively infrequent type, with “a better than average prognosis.” It was “a well-circumscribed mass,” 2.8 centimeters, with seemingly clean tissue around it—he’ll have more detailed results in a few days. It has been caught early; clinically, it’s a stage-two cancer. Provided there is no cancer in the lymph nodes under the arm, it is “quite curable.” I do not entirely believe him. I was in the room with my father when a New York specialist told him that prostate cancer was curable. Four years later, he was dead. On the other hand, this is all so weird, I don’t know what to believe. I don’t even know, when I say what I say next, if it is me or something I picked up from the movies. I just feel it’s important to get it straight.
“Look,” I say, “I have no plans of dying of this thing. That’s just not how I see my life. So what’s the next step?”
Luke runs through them: The next thing to do is remove some lymph nodes from under my left arm and see if the cancer has spread. That’s very important, the key diagnostic tool. We also have to decide how we want to treat the breast: with lumpectomy and radiation or with mastectomy and reconstruction. Lumpectomy is removing the tumor and leaving the breast, which is what he has just done, except that he would reopen the incision to take another look. The success rates for lumpectomy and mastectomy are the same. Whichever I choose, the lymph nodes have to come out.
I have another terror besides death—general anesthesia.
“Lymph-node surgery, can it be done under a local?” I ask.
“Impossible,” he says.
I remember lymph nodes. When they took a sampling from my father’s groin, there was cancer in eight out of eleven. I didn’t know what that meant, exactly, but I knew it was bad: The surgeon, calling Dad’s room after the operation, asked to speak to me, not my mother.
“What are the chances it’s in the lymph nodes?” I ask.
“Twenty to 30 percent,” he says.
I’m feeling dreamlike again. I don’t get it, I tell Luke. I had mammograms, I had checkups, this thing was enormous; how was it missed? He says medullary is not like other cancers—it may not calcify and can appear on a mammogram as a cyst.
“So how do we know there’s not another one of these things somewhere inside me?” I say.