I have a scar on my left breast, four inches long, that runs from the right side of my breast to just above the nipple. Nick, whom I no longer see, once said that if anyone asked, I should say I was attacked by a jealous woman. The true story, which I prefer, is that a surgeon made the cut, following a line I had drawn for him the night before. He had asked me where I wanted the scar, and I had put on a black strapless bra and my favorite party dress and drawn a line in ink just below the top of the bra, a good four inches below the tumor. The surgeon took it out using a local, and when he was done, I asked to see it. It was the size of a robin’s egg, with the gray brainlike matter that gives it its name: medullary cancer. It rested in the middle of a larger ball of pink-and-white breast tissue, sliced down the center like a hard-boiled egg, an onionlike layering of whitish-gray tissue about it, and I looked at it hard, trying to figure it out. We did not know it was cancer until twenty minutes later, when they had almost finished stitching me up and the pathology report came back, and then I was especially glad I had looked. Mano a mano, eyeball to eyeball. This is a modern story. Me and my cancer. I won.
Whom do I introduce first, me or my breasts? Formerly, I thought of my body as a unit, indivisible, with my breasts in some small way contributing to my notion of who I am. Now that they have shown the ability to destroy me, I regard them with new respect, thinking perhaps they deserve not only separate but higher billing. As this is a breast-cancer story, maybe they should have it.
They are, anyway, good-size breasts, and though they are fibrocystic, which means the milk-producing tissues thicken and form fluid-filled sacs, and though I have what some people claim may be other predisposing factors for cancer—menstruation at an early age, no children—I did not worry about the disease. There is no history of breast cancer in my family; I do not smoke; I go to the gym. My father, the year before my diagnosis, died of prostate cancer, but I viewed this as a separate thing. Also, because I knew it would be difficult for me to spot a malignant lump given the cystic condition of my breasts, my gynecologist always examined them, and I had regular mammograms. I had my first when I was 30. For the past five years, I had gone to the Guttman Breast Diagnostic Institute, which had been recommended to me by my gynecologist as being as good as a private service and a whole lot cheaper. In 1986, it was $45, as opposed to $125, and if a woman couldn’t afford to pay, it was free. The wait was long, but there was a cozy female camaraderie, sitting in your paper hospital shirt next to ladies of all ages and seeing how many shapes we come in. One morning, when the room was exceptionally crowded, I counted and figured out there were 140 breasts ahead of me: I had a mammogram once a year, and every year the letter I got afterward began the same:
“Dear Ms. Wadler,
“We are pleased to inform you that the results of your examination were satisfactory and within normal limits… .”
Who I am is a journalist, 44, Jewish, never married, which, as everybody in New York knows, thanks to our 1 million collective hours of analysis, is a whole other category than single. I was raised in the Catskills, in a boarding house, in a large, noisy, opinionated family headed by my father’s mother, who, rather than leaving the Russian shtetl of Molov Guburney, brought it to America with her. It enclosed her like a capsule, the Bubble in the Bubble; she never learned to read English and spoke to me in Yiddish, a language I did not entirely understand. I came to New York, to the Village, at seventeen and have lived here since, working for newspapers and magazines. My closest friend is Herb, a comedy writer. We hang out so much that when I am seeing somebody, we joke about how to explain about Herb. Herb’s idea is that I throw a sheet over him when he is lying on the couch reading the newspaper, and after each date I pull back the sheet a little bit, and by the time it gets serious, the guy’s got the picture.
By the time this story begins, last year, I had had a lot of serious dates and a lot of jobs and was working as a writer at People magazine. If, as research claims, tension contributes to disease, I was a good candidate: I had been working, for three years, on a book about a French espionage case, juggling six-month stays in Paris with a job in New York. Though the story, which inspired the play M. Butterfly, was wonderful, Paris, when I arrived, was hard: I had two friends in the city; I did not speak French; I sometimes went entire Sundays speaking only to waiters. Soon after I returned from my first stay in France, my father died an ugly death, hooked up to a life-support machine. I was a bad fit at People and always had been: I like 40 inches just to say hello; the style at People, which I had come to respect as one does a skill that does not come easily, was somewhere between sausage and haiku: Reduce War and Peace to a snappy two-pager, and then, if Photo can’t get a home take of Pierre and Natasha in the hot tub, they kill the story anyway. I was tired all the time: On weekends and evenings, I wrote my book; during the day I went to the magazine.
Also, I was in a difficult relationship. His name was Nick Di Stefano, he was a sportswriter I had known for years, and I had been seeing him, on and off, for eight months. He was Italian, which in my family is considered practically Jewish, except that (1) as children, Italians don’t talk back to their parents, and (2) as adults, the men Run Around. Naturally, being so trouble-some, we find them very appealing, and anyway, I had always liked Nick. He was smart; he knew all the lyrics to The Pajama Game; he dressed like a forties sharpie; he had the requisite newspaper Up-Yours Attitude toward authority. Also, there is something very nice about a relationship in which you have known each other a long time and are in the same business. We watched old movies from his collection, and he cooked and told me how much he loved his mother and took me dancing. Then he waltzed off to Miami for a weekend with an old girlfriend, and that was the end of Nick, Chapter One. She, it turned out, wanted to just be friends. Now when Nick is with me he is often petulant, seeing himself as the tragic hero of a doomed love affair, a role I have traditionally tried to reserve for myself.
“Why does it always have to be so serious with you?” he says. “Why can’t we just live in the moment?”
And also, “You don’t want me to work it out and decide what’s right for me. You just think if you give me enough time I’ll get her out of my system.”
“That’s what you want in a woman, to be that selfless, you should be dating Mother Teresa,” I say. “Why don’t you call her up in Calcutta and see if she’s available? From what you tell me, she’s the only single woman you haven’t nailed.”
Then we break up and I go to bed for the weekend and lose two days out of my book.
That’s where we’re at, broken up, the morning I discover the lump. It is the first week in March, Monday, a crazy day at People. I am feeling particularly tense because I’m taking another leave of absence and have one week in which to finish my stories. I am so frantic I have canceled my mammogram at the Guttman, figuring I’ll do it when my leave begins.
Then, as I’m showering, I feel it: a large, oval swelling on the upper inner part of my left breast. I have always wondered how women who discover lumps find them, but there is no missing this; it seems to be, as I move my hand around it, the size of an egg, slightly raised, sore to the touch. My breasts, since my mid-thirties, have been sore and swollen before my period, and as I’ve gotten older the soreness has increased—but I had my period two weeks ago. Another strange thing, this lump seems so big, and I don’t remember it being there yesterday. I decide I should get it checked out, but I am not very concerned. What I have heard about breast cancer is that except for a lump, it is asymptomatic; you don’t have pain. I figure it’s just another one of my fibrocystic lumps, which come and go. I’ll call the Guttman and make that appointment for next week.
I go to work and forget about it. Then, in the afternoon, my breast starts to ache. I remember People has a staff doctor and call him. I feel a little silly about this; I am sure it is nothing, but I figure a doctor is right there in the building, so why not? He doesn’t seem worried, either, until he examines me. Then his face tightens up. In the bright light of the examining room, where there is a small mirror, I see why: There is a pink flush on my breast over the lump, as if there is an inflammation, which I did not see at home. There is definitely something there, the doctor says. What it is he cannot say, but he thinks I should see a specialist. If I like, he’ll be glad “to expedite it.” I tell him I’m planning to go to Guttman next week. “I think it would be better if you saw somebody sooner than that,” he says.
I burst into tears.
Boy, I think, I really must be strung tight today, and to him, though he hasn’t mentioned the word that is now as much a presence in the room as another human being, I say, “Sorry. My father died last year of cancer.”
He makes a call. An hour later, I am outside the Time-Life Building, hailing a cab for the Upper East Side offices of a surgeon we’ll call Luke. I am scared. Before I leave his office, the doctor asks if I will have health coverage during my leave, and that has added to my feeling that this is serious. I am now flip-flopping between telling myself I am overreacting and a giddy hysteria. Standing on Sixth Avenue, I have turned into Zorba the Greek. I want to live. The things I haven’t done flash before me, a long list of “But wait, I wanna… .” But wait, I wanna finish my book; but wait, I wanna get married; but wait, I wanna make some money and take Nick to Paris to meet my friends; but wait, I’m just getting started… . I think about Nick and the time we’ve wasted fighting and make a deal with myself: If everything’s okay, I won’t worry about monogamy; I won’t hok him about moving in; I will make the most of every moment. As unwittingly as Newton discovered gravity, I have stumbled upon the key to making me the dream girl of every uncommitting man in Manhattan: breast cancer.
Formerly, I thought of my body as indivisible. Now that my breasts have shown the ability to destroy me, perhaps they deserve not only separate but higher billing.
In the doctor’s office, there are a dozen women. They seem older than I, and oddly, they all look alike. They look like a truck ran over their faces, I find myself thinking, which I know, as soon as it crosses my mind, is an ugly thought and not correct. Then I realize what I am looking at: fear. I have never seen so much of it sitting together. It’s a good thing there’s nothing wrong with me, I think. Then, as I have a wait, I go for a walk. I have already called Herb, but now I find I want to talk to Nick too. He tells me it is probably nothing and is very sweet.
“Just tell me what you want me to do, baby,” he says.
The doctor, when I get in to see him, is my age, a good listener, with the kind of Waspy calm I like to see in airline pilots and other people to whom I am entrusting my life. Speaking to him, I remember something: In the past few months, in addition to soreness before my period, my breasts have been sore afterward—so much that it was uncomfortable if Nick rested his head on my chest, and I wondered if I had had a false period and was pregnant. Though I had called my gynecologist’s office and asked a nurse if that was possible, it never occurred to me to make an appointment and have the doctor check my breasts—she had examined them four months before.
Now Luke examines me.
“I don’t think this is anything to worry about,” he says, and I feel relief rushing over me like a warm bath. “Malignancies tend to be hard, almost stony. You can’t manipulate them. This you can. I’m 98 percent sure this is not malignant.”
What he believes I have, Luke says, is an inflammation of some sort, perhaps a cyst. To find out, he would like to aspirate the lump: take out some liquid with a hypodermic, and send it to be analyzed. It’s a painless procedure; all I’ll feel is a needle prick. When a cyst is aspirated, a lot of liquid usually comes out, generally clear. It is painless, but it doesn’t go as planned.
“Huh, that’s odd,” Luke says, and he shows me: He has been able to draw out very little liquid. What there is is thick and puslike, though that could be consistent with infection.
I get dressed. Luke tells me he still sees no reason for concern; the signs point to an inflammation, and he’s prescribing Dicloxacillin, a form of penicillin. We’ll try that for a week or two and see if it reduces the swelling. If not, he will remove the lump. I am concerned: If it’s a cyst, I say, how come more liquid didn’t come out? And if it’s not a cyst, what is it?
“I don’t know,” says Luke. “That’s why we’re doing the tests.”
I go meet Nick at the Lion’s Head, downtown. He’s wearing his fedora low on his head and gives me that cocky Bronx grin that has always knocked me out.
“See, I knew it would be nothing,” he says, and within hours we are un—broken up.
I am not a hypochondriac, I lean toward the other extreme, associating sickness with weakness and therefore denying being sick. This, I believe, is the legacy of my mother, Milly, who ran off to Florida at seventeen to paint flamingos on glass, in my childhood stole trees from state preserves insisting they were hers because her tax dollars had paid for them, and at 65 is still one of the great forces of nature.
“I’ve never been sick a day in my life,” she says. “One hour after I had you, I was eating. The other women in the hospital were screaming their heads off. I made up my mind, ‘How it went in, it will go out,’ and that was that. This worrying you have about every little thing, that you got from your father. He was the worrier. Him and his mother. The Aspirin Addict.”
Also, before going off at 62 as a volunteer in the Israeli army, “I don’t fear death. Death to me is just another adventure. I can think of no greater honor than dying for the state of Israel, the Jewish homeland.”
“You’re an old dame, Ma,” I say. “You think they’re gonna put a machine gun in your hand and send you to the front? You’re gonna be cleaning toilets.”
“Don’t even bother to bring back the body,” she says.
I do fear death. Even more, I fear a bad death, strapped to machines in a hospital like my father. “Joyce,” he had taken to telling me from the mountains, when I called once a week from Paris. “Your father is a very sick man. Your father is dying.” I did not entirely believe him. I knew he was sick, very sick. I had been there for the early operations in the city and the last-minute flights to Florida. I knew the cancer was creeping up his spine and down his legs and was eventually going to kill him. But his blood counts were good, he was going to his business every day. It is a rotten thing to admit, but a voice in me, hearing him, was satirizing him: “Joyce, your father is dying”—Hebraic Dramatic Third Person, now replacing that previous family favorite, “You realize, of course, you are killing your father.” He was a worrier, and critical and angry. Worrying how he and his mother and his two younger brothers would survive on a small dairy farm when he was nineteen and his father died; worrying about making a business out of nothing when he was in his thirties; worrying once he was successful it would all disappear. Then, when I got home from Paris, I saw the worrying was real: My father was 67 and got up from his desk at the office like a man of 85, his weight down 30 pounds, shaking, and supporting himself on a cane. Seeing me, he started to cry. “I never thought I’d see you again,” he said, and I was filled with self-loathing. What the f— was I doing in Paris all that time? I didn’t even need all of that stuff. Why wasn’t I here with my father? Two weeks later, he fell and broke his hip, and after that operation, his heart started to fail and they put him on life support. “You’re not getting enough oxygen, Bernie,” the doctor said. “Your lungs are exhausting your heart. If we don’t put you on this machine, you’re going to die. Do you give your consent?” My father nodded yes. Nobody in the family had any idea what life support meant, but in an hour, when they let us in to see him, we found out. An oxygen tube had been stuffed down his nose, his hands were strapped to the side of the bed, and he was pulling against the straps like an animal at auction, trying to speak but unable to because of the tube down his throat.
“We had to tie his hands to the bed because he already pulled the tube out of his nose once,” one of the doctors said. “He’s a little out of it now because we sedated him.”
He was on the machine for two months. A few days into it, they gave him a tracheotomy so he would be more comfortable, but he could never again speak. I knew it was his life and going on the machines had been his decision, but I never changed my mind about it. I thought he would have been better off dead.
I do not, however, dwell on that memory the week of the scare. I trust Dr. Luke, and I know he’s good—a friend was a patient; his reputation is excellent. I do mention the lump to my mother, who is in Florida for the winter, but I tell her I don’t think it’s serious, and I believe it.
That changes a little on Thursday when I talk to Luke about the test results. He tells me, in a tone indicating there is nothing to be concerned about, the results are pretty much what he expected, though there are “a number of atypical cells which could be consistent with an inflammation.”
My old reporter’s bell goes off.
“What do you mean atypical?” I ask. “How many cells?”
He seems a bit irritated, as if I’m worrying for no reason.
“A number,” he says. “But that could happen with an infection. Keep taking the penicillin and come in in ten days, and we’ll see what to do then.”
The next week, I start my leave. Though People and I have our problems, they have been extraordinarily good to me. This is my third leave; it includes health benefits. I am perhaps 80 pages away from finishing the book, and it is a wonderful section. My 24-year-old assistant, Stefan, back in Paris, has cornered a particularly evasive source. The story is reaching its climax: My hero, Bernard, a member of the French Foreign Service, has been charged with espionage and made the terrible discovery that the woman for whom he became a spy is a man.
I do fear death. Even more, I fear a bad death, strapped to machines in a hospital like my father. ‘Joyce,’ he told me, ‘your father is a very sick man. Your father is dying.’
The only thing is, I am distracted by this thing in my chest. It’s so sore I cannot sleep on my stomach. The penicillin doesn’t seem to be doing much after ten days. There is a very bright light in my gym locker room, and I see how vivid and delineated the area around the lump still is.
“I’m starting to feel this thing has a life of its own,” I tell Herb one night, as he’s stretched out on the couch. “Like it’s gonna come flying out of my body any minute, like that thing in Alien, and run around the living room and put on a sports channel and tell me to get it a beer.”
I decide it’s time for independent research and pull out my medical reference books. My old standby, the AMA Family Medical Guide, is not very comforting: It defines “breast abscess” as a pus-filled infected area but says that it is uncommon and usually affects women who are breast-feeding. It says, starting to make me nervous, that a cancerous lump “may or may not be painful,” occurs most often in women in their forties and fifties, and is “slightly more common in women who have never breast-fed a baby.” The only good news is it is also “slightly more common” in women whose families have a history of the disease. The Professional Guide to Diseases is worse. It adds white middle- and upper-class women to the higher-risk list, as well as those “who are under constant stress or undergo unusual disturbances in their home or work lives.”
Eleven days after the discovery of the lump, I go back to see Dr. Luke. He examines my breast and in less than a minute makes a decision.
“This has to come out,” he says.
I am not scared now—I am relieved. I don’t think it’s cancer—I’m too healthy for cancer—I just want this thing out of my body, the sooner the better. I’d be happy if Luke could do it right now in the office. He says that’s out of the question. It will be done with a local anesthetic at a hospital and will take maybe half an hour. I ask if I can watch: I saw breast surgery when I did a story on a plastic surgeon in Beverly Hills, and I also hung out for a month at the New York City morgue, so I figure I won’t be squeamish. Luke says he’ll be glad to explain as he cuts but that most people do not want to watch when theirs is the body involved. I decide he’s right.
I also realize I am concerned about a scar. I’ve never considered myself particularly vain; I have always thought of scars as a badge of honor, a sign of an enemy vanquished, but those, I now realize, were scars on other people. Luke says he can reach the lump from any number of spots—just show him where to make the cut. He books the surgery for five days later, at St. Luke’s-Roosevelt Hospital Center, one of the hospitals where he has privileges. I have one last problem.
“I’ve got this deadline on this book,” I say. “This isn’t going to hang me up time-wise, is it?”
“Listen,” Luke says, “this comes first. This is your life.”
A few friends by now know i have a lump in my breast and am a bit worried about it, but it is Herb I ask to come to the hospital. He is not simply my best friend but a free lance, while Nick is on staff. Also, after the initial enthusiasm that accompanies all our reconciliations, Nick is preoccupied with his own problems: an apartment he cannot sell; his unrequited romance. He also hates doctors. Who goes to doctors? asks Nick. Women. Something is wrong, the best thing you can do is leave it alone, and it will fix itself. In my case, we don’t even know that anything is wrong, so let’s just quit thinking about it. I think I know what the real story is: his first wife, the mother of his 22-year-old-son, who developed schizophrenia in her late twenties. She was a nurse, she had some idea what was going on, and when a doctor confirmed it, she killed herself. I give up trying to talk to Nick and take a stroll by myself to Barnes & Noble, to the section where they have the medical textbooks. The most comprehensive seems to be Breast Cancer, Conservative and Reconstructive Surgery, by Bohmert, Leis, and Jackson, a surgical atlas. It’s $129, too much to spend if I don’t even know I have a problem, but I skim it, looking at the pictures. There are a lot of women squooshing a breast like they are squeezing the Charmin. I figure it’s to show how lifelike reconstructions are, but it strikes me as a man’s notion of what is important to a woman. I have never squeezed my breast that hard, and if a man did it I would holler. I flip through the studies. Every one seems to include a five-year survival rate. I put the book back.
I spend the night before surgery alone. Nick calls three times, asking when I am leaving for the hospital so he can call and wish me good luck. I remember I have to make my decision about the scar. I put on a bandeau bra that is the skimpiest I own and a skinny little Nicole Miller dress, deep purple, with spaghetti straps, that I wore when Nick took me dancing at the Rainbow Room. I loved that night. I had a thirties evening bag that I had got for 40 francs at a flea market in Paris and a Deco rhinestone bracelet from an estate sale in New York, and as I get dressed I wonder about the women who had owned the bag and the bracelet, and where they had worn them, and if they had been as happy as I. Then I take off the dress and turn down the top of the bra a little bit and trace the edge with a ballpoint pen. As I do, I start to cry. I don’t have a perfect body by model standards, my breasts are different from what they were in my twenties, but they are my breasts, it is my body, and I like it very much. Now I am making a mark that says, “Cut me.”
Next morning, I talk to Nick. “Call me with the good news as soon as you get out of surgery,” he says. Then I go to the hospital with Herb. In the taxi, I remember all our strange trips: Kenya, where we eyed the lions from an open Land Rover and were scared they were seeing two New York Jews and getting an urge for delicatessen; Paris, where we went looking for Jim Morrison’s grave at Père-Lachaise Cemetery and had no idea where to find it until we spotted a girl with pink hair. I tell Herb what we should do is regard this as just another weird adventure.
“You sure you don’t want to ask to watch the surgery, because it could be kind of interesting,” I say.
“Pass,” says Herb.
Roosevelt is gloomy. a group of homeless people has set up housekeeping on the 58th Street side, a sofa and two armchairs arranged in a traditional living-room style. Inside, the hospital needs painting. On the third-floor short-term-stay center, Herb parks himself in a reception area, while I go to a large room, which is partitioned with curtains, and change into baggy hospital clothes. Taking off my bra, I see that the line I have drawn is very low, nearly halfway down my breast. Wonderful, I think. Now the doctor is going to think I’m fast. A few minutes later, the surgical resident who will be assisting Luke drops by.
“Whoa! You can’t miss that!” he says when he examines me.
Luke comes to get me. He looks very preppy, sockless in clogs, and is very sweet, putting an arm around me as we walk to the operating room. I have a feeling this is politically incorrect behavior and I am not supposed to like it, but I do. The operating team includes a male and a female nurse, as well as the resident and Luke. Seeing the line on my breast, Luke laughs.
“You’ve sure made this idiotproof,” he says.
The doctor picks up the tumor. I am astonished at how big it is. The excised flesh has been sliced down the middle to expose the cross section of the tumor.
They paint my breast with a red-brown ointment that smells like iodine and cover the rest of my chest with sterile cloth. I can’t see the surgery, because Luke has asked me to turn my face to the right, but he has promised to tell me what I will feel and what he is doing. The anesthetic is Xylocaine. He injects it around my breast, waiting for the area to numb, then makes a cut. I have a feeling of warmth and wetness. Then there are strong sensations of tugging as he pulls back tissue and starts tunneling up to the lump, in the inner upper quadrant of my breast. Sometimes I feel a bit of pain, almost a burning sensation, and he gives me more Xylocaine. The tunneling goes on for twenty minutes, and while it is not as unpleasant as a dentist’s drilling, the more tissue that is pulled apart and clamped, the more uncomfortable I become. I am having second thoughts about being so concerned about looking good in a low-cut dress. Luke tells me they’ve reached the lump, but they’re going to go beyond it and take a margin of healthy tissue. I’m getting worried again. I don’t know whether the room is cool or I’m feeling a nervous chill, but Luke seems to be cutting a lot of flesh—I know the lump is high, but I feel he is burrowing up toward my collarbone. Then I feel some final tugging and the thing is out, and I see out of the corner of my eye a metal tray and they are cauterizing blood vessels. Luke moves away from the operating table and a few minutes later comes back. It’s a tumor all right, he says, sounding serious, but what sort he cannot say. He’s sending it to the lab now. I tell him that before he does, I’d like to see it.
“You sure?” he says.
“Yeah,” I say. He picks it up. I am astonished at how big it is. The excised flesh is the size of a tangerine and has been sliced down the middle to expose the cross-section of the tumor—that must be what Luke did when he left the table. The tumor, which is the size of a robin’s egg, is grayish white, with a layer of whitish-pink tissue. Around that is what appears to be normal breast tissue, pink and white, like very fatty, coarsely ground chopped meat. Luke points out the layering around the tumor, saying it appears to be encapsulated, and that is good. I don’t think any of this is good. I can’t believe this big gray glob came out of me. I have a bad feeling, a sense of unreality, as if I am in a dream or a place I had no intention to be.
“How soon will we know the results?” I say, as they start stitching me up.
“About twenty minutes,” Luke says.
And then, more to myself than to anyone else.
“How am I going to tell my mother?”
“Don’t get yourself worked up,” the male nurse says. “We don’t even know that it’s anything, yet,” and I try to hold on to that thought. But another part of me thinks he’s patronizing me; maybe they don’t want to deal with a flipped-out woman on the table if they’ve got to stitch up her chest. I feel lonely, unable to say what I’m thinking, and scared. I concentrate on being calm. In fifteen minutes, just as they’ve finished bandaging me, somebody comes into the room.
“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.
“We don’t,” he says. “Your breasts are a breast surgeon’s nightmare. They’re large and dense and full of lumps.”
I remember the pictures in the medical book. The real ones are gonna be this dangerous, let them make me a fake.
“Take it off,” I say.
He explains a bit about breast reconstruction. I had assumed it was like the breast-enlargement surgery I had seen in Los Angeles, an operation in which the doctor put a silicone implant under the muscles or tissue or the breast and the patient woke up with a new breast—except that in the case of cancer, you would remove the breast tissue first. Luke says it is not that simple: You don’t wake up with a new breast; they put an expander in your chest; it takes a few months. If I go with lumpectomy, in which radiation is required, it takes six weeks. Lymphnode removal involves three or four days in the hospital. There are no shortcuts—this is cancer. I do not have to decide about mastectomy or lumpectomy in a few days, but I should have surgery within four weeks. Whichever procedure I choose, lymph-node removal will be done at the same time. After that, there’s a good chance I’ll need chemotherapy for six months. Meanwhile, they’ll be doing more tests on the tumor: DNA analysis, hormone receptors. I can take the cotton dressing off my breast tomorrow and come to his office Friday; he’ll have those results and take out the stitches. I’m having trouble assimilating all this; so is Herb. We’re two liberal-arts guys suddenly thrown into Columbia Medical School. I’m still back with the idea that reconstruction is a long-term process and I may be walking around lopsided for five months. Luke recommends Dr. Susan Love’s Breast Book.
I have one more question. I am afraid to ask it, but I have to, anyway.
“What am I looking at here?” I ask. “Statistically?”
He isn’t any happier answering than I am asking. He doesn’t care much for statistics, he says. You can still have a cancer that has a high cure rate, and if you’re in the percentage that is not cured, it doesn’t matter. In my case, I have a cancer that has a favorable prognosis and is “more curable than average.”
I need something harder.
“When my father was diagnosed with prostate cancer, it was something like a 60 percent survival rate at four years, a 40 percent survival rate at seven years,” I say.
“I would say the statistics, in your case, are considerably better than that,” he says.
“How much better?” I ask.
“For breast cancer, the overall cure rate is 70 percent. For medullary, it’s above that. I would say 80 percent, 90 percent.”
I feel better. I like these odds. I don’t entirely believe them, but I like them. This leaves me with one immediate problem: how to tell my mother. Herb has the solution: “Lead with the positive.” I find my notebook, and we work out the lead and phone it in. The last time I did this, I remember, I was filing a breaking story for the Washington Post on a Concerto for Piano and Dog at Carnegie Hall. The dog had stage fright, which was good for me, as it gave me a new top. There is a reason people hate reporters. The phone rings, and I begin the performance.
“Well, Ma, I’m out of surgery, and I’m here at the hospital and everything went great,” I say.
“Oh, thank God, I’m so relieved, I don’t know what to say, I was so nervous I couldn’t sit still, my friends called, I told everybody, ‘Get off, get off, I can’t talk, my daughter is right now this minute having surgery in New York… .’”
I break through the wall of words, power-talking, a skill I developed from 43 years of training with champions.
“The lump turned out to be malignant, but it’s the best kind you can have,” I say. “It’s called medullary, it tends not to spread, they seem to have got it all. It was in one lump, I saw it, it looks like it was encapsulated, that’s a good sign.”
Silence. She believes me like I believe the doctors.
“I’m coming north,” she says.
I tell her she is staying put, I probably won’t be having surgery for at least a month, and hit her with all the other positive stuff I can think of. This cancer is very rare, hardly anybody gets it, and it has a very, very good prognosis. Yeah, it was big, but this kind grows very fast, and the doctor says we caught it early. The longer I talk, the harder it is. I am hearing my mother and my dead grandmothers and all the aunts in the family. “The worst thing in the world that can happen, the very worst thing, is for a parent to survive a child,” they are saying.
“Talk to Herb, Ma,” I say and walk down the hall.
Then I call Nick. Most of our relationship, I’ve wanted him to be more expressive. Often, when we are together, he withdraws and watches two or three old movies in a row—if he doesn’t, he says, he’ll think about his life, which he can’t bear. In the morning, he moves the television so that he can watch Lucy reruns from the shower. Right now, however, I have this feeling that if he falls apart I will fall apart, and I need him to be strong.
“I’m going to tell you something, and I don’t want you to get emotional, because it’s going to sound worse than it probably is,” I say.
I have the feeling, at the other end of the line, of a man who has been slugged in the stomach.
“You just got to give me a minute. I wasn’t expecting this,” he says.
Then Herb and I head downtown. Normally, a glass of wine puts me to sleep. Now we go to the back room of the Lion’s Head, where we are known as The Ones Who Only Eat, and I order a margarita. I get a second one. Then I talk tactics. The position I am taking, I say, is not that I have cancer, but that I had a cancer and they cut it out. I am not doing an avoidance number, we will research the hell out of this and get the best people in the business, but until it is established otherwise, I consider myself healthy. I go tottering off to my place. I am not sure whether the sense of unreality is coming from the news I have received or the drinks. The Xylocaine is wearing off, and with every step, even in a bra and bandages, my breast bounces and hurts. Luke had offered me a prescription of Tylenol 3, but I’m a little afraid of drugs, and I didn’t think I needed it. Now I see I do. I call up the pharmacy to have the drug sent over. Even with the Tylenol my breast feels as if someone has stabbed me. I know I should talk to my brothers, who by this time have probably had thirteen conversations with Ma, but I am too tired. I go to bed, exhausted, wanting to be taken care of. I think of my grandmother Wadler, round, warm, and cushiony, the one member of the family who thought I was perfect just as I was, and wish she were still around. I think about Nick, who has said he will get out of work as soon as he can and pick up supper, and wonder what is keeping him. He calls, eventually, from the street near his bar. The bank must have messed up, he says, he can’t get any money from the machine, he’s got maybe three dollars. I go to meet him at Balducci’s, bumping into Sigmund Freud on the way. “You understand the message he is sending you,” Freud says. “You vill not depend on him for nossing.” I banish him from my consciousness by taking him to the deli department and giving him a number and telling him to pick up some derma. There is no derma in Balducci’s. By the time Freud figures it out. I’ll have lost him.
When Nick and I get back to my place, just on a point of pride, I set the record straight.
“I’m still the same person I was yesterday,” I tell him. “If we break up every three weeks, we break up every three weeks. I don’t want you to treat me any differently.”
Which, as it turns out, is the stupidest thing I will say in the course of this whole illness.
And also, as far as Nick is concerned, the least necessary.
They have an interesting way of dealing with illness in my family. They form little whispering cabals, deciding who can ‘take it.’ This is to protect the people you love.
If this were ancient Egypt, and people were buried with the things they used most often, the executors of my estate would have no problem making a decision: They would plant me with a phone in one hand and a Diet Pepsi in the other, and if it turned out there was life after death, I would be on the phone, talking to one of my girlfriends or having an emergency session with my shrink. It being late when I am prone to anxiety attacks, I would probably reach a machine:
“It’s Joyce. It isn’t a question of life and death—well, actually, it is, but I mean I can handle it—um, anyway, this death thing has turned out to be a little more stressful than I thought, and if you have some time, can you give me a call? If it’s not inconvenient. Otherwise, I’ll see you the regular time Thursday. One good thing about this, you won’t have any trouble getting me to lie down.”
But when I get a diagnosis of cancer, it changes. It isn’t just that I am numb from the news and the surgery. It isn’t even that I need to be alone to sort this stuff out. I have spent a lifetime sorting things out with my friends. But now, I feel, I am under serious attack, and when the Scud missiles are raining on your head, you don’t have time to get on the phone with your girlfriends and say you are terribly depressed. Also, there is something else—I am afraid of negativity. Cancer is a scary word; people hear it and think “death,” and I don’t want that sort of energy around me. I also don’t want to hear, however well-meaning, other people’s stories. Until now, I thought breast cancer was breast cancer. I had no idea there were different kinds, some more dangerous than others. I also realize that everyone’s body is different. I love my friends, I want their support, but hearing a story about a friend of a friend who “had it” and is now doing fine will be a waste of my time—what I need is hard facts about medullary and information about the options. I’ll tell some close friends the diagnosis, but they have to keep it to themselves. Just on a professional level, I don’t want this around. Journalists are the biggest gossips in the world and the least reliable—one lunch at Orso, and three hours later word will be all over town that Wadler is dying, and I’ll never get another book. I’m also making a rule: Information goes out, but unless I ask, it doesn’t come in. Herb and I also ask friends to let me call them. If they want to know the details of what’s happening medically, they can call Herb for briefings. Herb calls them Breast Conferences.
Wednesday, the day after the surgery, I get organized. I have an advantage: I am a reporter, and so are a lot of my friends. I call up two or three and give them a task: Herb looks for Dr. Love’s book and checks on Luke’s credentials (they’re excellent); Heidi, a magazine editor I have known for twenty years, will call the American Cancer Society and the National Institutes of Health; Max, who is the bureau chief for an out-of-town paper, will call his contacts; we’ll all get names for second opinions. There is no way, with a life-threatening disease, I am not getting a second opinion. The reference I trust most comes from an old friend who is a doctor and researcher. “You’ll go to Jeanne Petrek at Sloan-Kettering for the surgery, Norton as the oncologist. He’s the head of the breast-cancer department at Sloan, very sharp. He’s a friend, our wives are friends. Make the call and tell him I sent you. No, wait, I’ll make the call myself.”
I’ve got other problems, too: my job and my book. My publisher has paid a bundle for this story—“Let’s face it, now they own you,” Ma had said when I signed the contract, and I have no idea how long this breast business is going to hang me up. I have the same concern about People. Neither is a problem. The publisher tells me to concentrate on my health. People editor Lanny Jones changes my unpaid literary leave to a medical leave—on full pay—and says the resources of the company are behind me. Within days, I’ve got four people from Medical calling me with the names of cancer support groups and specialists. It’s a relief. But I wonder, What happens to poor women in New York who don’t have medical insurance, and don’t have families that can help them, and don’t have friends to get them to the head of the department at Sloan-Kettering?
But I have another ongoing problem closer to home: Ma. They have an interesting way of dealing with illness in my family. They form little whispering cabals, deciding who can “take it.” Or, if they must deliver bad news, they hit you in a roundabout way. “You know your uncle Murray, in the hospital in Kingston, he’s not doing very well,” my aunt Shirley had told me, in a phone conversation years ago. Then she asked to speak to my boyfriend. A few minutes later, he passed back the phone. “Actually,” said Shirley, “he’s dead.”
I never understood this, but now I do: You don’t tell the people you love, because you want to protect them. But in doing that, you cut yourself off. I talk to Nick about it. He says mothers are stronger than you think, and anyway, I owe my family the full story. The day after the biopsy, I call her.
“I figured you might be worrying, and I was just wondering if you had any questions,” I say.
“Yeah,” she says. “What aren’t you telling me?”
Trick question. Damn, these mothers are smart. I tell her there is a small possibility “it” may be in the lymph nodes, but if it is, it’s not the end of the road. I say because I am concerned another lump might one day be missed, I am leaning toward mastectomy and reconstruction, but that might not be so bad—it would be fun to be able to wear cute little camisoles, and maybe, at 43, I could use a perkier pair.
She’s scared. I can tell because she hits me with Second-Generation Wadler Cure-All One:
“You know, money is not an issue.”
“I know that, Ma,” I tell her. “It’s okay. I got insurance.”
“New underwear, anything cosmetic, that’s on me,” she says.
“Well, I don’t know, Ma,” I say. “My bras are very expensive. I don’t know if a poor old widow like you can afford them.”
“Thirty-four B is a good size,” she says. “I’ll bring cash. I’ll put a thousand in your account.” She starts upping the amount, bargaining with some unseen force. “Three. No, five. Six. For the things that aren’t covered by insurance. Taxis for back and forth to the hospital. New underwear. A wig.” I’m suddenly peeved.
“What makes you think I’m gonna need a wig?” I ask her. “I didn’t say anything about chemotherapy. I’m healthy. I had cancer. I’m just giving you some remote possibilities, because you asked. Anyway, that stuff about chemotherapy has changed—not everybody loses their hair.”
“A blonde one,” she says. “On me.”
‘You know how we’re always saying we miss things,’ I say to Herb. ‘Paris in the twenties. I had tickets to Woodstock, but too much mud. But for this trend, I’m right on time.’
This is another strange thing about breast cancer: Though I have just been told I have a life-threatening disease, it’s not like a cold or the flu, where you feel sick. Physically, the day after the biopsy, I feel as strong as I’ve ever been. My breast aches, but only mildly, and I can take care of it with the Tylenol. I can’t see the cut on my breast when I take off the cotton pads, because it’s covered with a row of fancy bandages, but my left breast, despite the amount of tissue that’s been removed, looks the same size as the right, and somehow I knew it would. Medically, however, we’re all still very confused. Herb is having trouble finding Dr. Love’s book; NIH doesn’t know of any medullary experts. Also, we don’t understand why you would do a mastectomy at the same time as the lymph-node surgery. If the lymph-node surgery is to see if the cancer has spread, wouldn’t you do that first? If it has spread, why take off a breast?
I go back to Barnes & Noble. They don’t have Dr. Love’s book, either, but they do have my old pal, Breast Cancer, Conservative and Reconstructive Surgery. I plunk down the $129 and get it. I also pick up The Pill Book: The Illustrated Guide to the Most Prescribed Drugs in the United States, one or two paperbacks on breast cancer, and a book by Norman Cousins, the former editor of Saturday Review magazine: Head First: The Biology of Hope and the Healing Power of the Human Spirit. I remember hearing about Cousins’s work a few years ago; he had a serious illness and cured himself by laughing. Thursday evening, before going to Luke’s. I start reading the medical books. What they say is a lot stronger than what Luke has said:
Cancers are classified in stages, depending on size, whether they are in the nodes, and whether they have spread to other parts of the body. There are four stages and stage two is not that great: According to one study, the five-year survival rate is 65 percent. Medullary is rare, accounting for perhaps 7 percent of breast cancers, but it can spread, and if it does, it can kill you. The worst kind of breast cancer, accounting for perhaps 2 percent, is inflammatory. The skin is flushed and has a peau d’orange texture—exactly what I saw the day my lump was discovered. Very few people live beyond five years with inflammatory cancer. I am petrified. I don’t care that the lab reports have classified my cancer as medullary. What if they made a mistake? And even if it’s only medullary, these statistics are hell. I call up Nick, convinced I am doomed. “You’re driving yourself crazy,” he says. “What do you care what some book says? Maybe it’s out of date. Your doctor says you have the best kind.” I am not interested in anything Nick has to say. I just want to be next to him in bed and hold on to him.
At nine the next morning, I meet Herb at Dr. Luke’s. My breast, when Luke pulls out the sutures, has a thick pink scar, but I think I heal great. The problem is, I’m so frightened by what I’ve read in the medical books, I’m almost stuttering. When I tell Luke about my research, he is not happy. He knows some patients do this—lawyers, usually—but it’s not a great thing to do if you’re not a doctor because you can easily misinterpret things. I do not have inflammatory cancer. On the basis of size I have a stage-two cancer, but medullary is not the average breast cancer. I have, he repeats, a very favorable case.
We move on to the big decision: mastectomy or lumpectomy. I still don’t understand why one would decide about mastectomy before knowing if cancer is in the nodes. Luke says one has nothing to do with the other. Lymph-node dissection is diagnostic; it indicates whether the cancer has spread. Mastectomy or lumpectomy has to do with treating the breast and killing any remaining cancer. If the cancer had been found in a few places on the breast, a doctor would likely recommend mastectomy. If one is worried about recurrence, one might also.
Herb wants to know the statistics on recurrence. Luke says with lumpectomy, it’s 15 or 20 percent; with mastectomy, it’s down to 4 percent. My chances of getting cancer in the other breast is higher than other people’s, 7 percent for the next ten years, but Luke does not recommend a prophylactic mastectomy. He’s sending me for a mammogram, but he sees no indication of trouble in my right breast.
I want to know about reconstruction. Luke says at the time of the lymph-node surgery, he’d remove the breast tissue, leave most of the skin, but remove the nipple—it’s safer, because in one out of four times, the cancer is in the nipple. Then a plastic surgeon puts in an implant and constructs a new breast. It will look good, he says, but it won’t feel like a breast. It’s an artificial implant. I try to imagine what it will feel like. A contact lens which at first you are always aware of, then never feel? A football?
I am lost. I ask, since the cure rate is the same with mastectomy and lumpectomy, what the doctor recommends.
“I think mastectomy is the better treatment for you,” Luke says. “You’ve got difficult breasts, large, lumpy, and you’re worried about recurrence. Lumpectomy is for people who say, ‘I don’t want to lose the breast no matter what.’ That wasn’t your response. The only advantage of lumpectomy is that it preserves the breast. But it’s your decision.”
It is true, I think, that my first reaction was “Take off the breast”—but that was before I knew what reconstruction involved. Now I’m not certain. I ask Luke if, aside from statistics and my case, he has a personal bias. He says that he has had three medullary patients, and since one had a recurrence, he leans toward reconstruction. He also says that since he took so much tissue out of the breast, reconstruction will probably give me the better cosmetic result. I tell him I don’t think that will be a problem; my breasts are still the same size.
“That’s swelling from the surgery, and some pockets of air,” he says. “When it goes down, it may be much smaller.”
He suggests I talk to a plastic surgeon—there is one he thinks would be temperamentally suited for me, because he’s an artist and a doctor. I take this to mean that Luke is classifying me as a patient who is not so stable and is likely to cut off an ear or that he has been influenced by Herb’s beard, but I’m happy to be seeing the artist-doctor. Maybe when we get to his office, he’ll offer us an espresso. I haven’t had any breakfast. I could use it.
My mammogram, which we have taken across the street, is normal, except for what the report calls “a large radiolucency, in the left breast, consistent with residual air.” Apparently, Luke is right: My nice plump breast is pumped up like a Macy’s balloon and may deflate at any moment.
Then, in what’s turning into a cancer triathlon, Herb and I rush to the office of the plastic surgeon, Dr. Frank Veteran, in the Eighties, off Fifth. I’m a little worried about Herb. He’s the sort of man who feels uncomfortable in the lingerie department at Saks; I’m remembering photos of mastectomy from my medical books and wondering how graphic this consultation is going to get. But at the same time I’m excited. In the taxi, I have come up with a wonderful idea: Rather than mastectomy, why not, after treating my breast with radiation, do a reduction? If I get rid of, say, 30 percent of breast, I remove 30 percent of potentially dangerous, cancer-bearing tissue. I won’t have to run around nippleless or with a football in my chest. I could also end up with a very pretty pair of breasts. I do like my body, basically; there are times I look at myself naked and think I’m gorgeous, but as I’ve gotten older, or have seen skinny women with high little breasts at the gym, I have sometimes felt bad, looking at my sag, and wondered what it would be like to have a lift. I like Dr. Veteran, too. He’s not slick; there’s an air about him that suggests he has had personal experience with serious illness. Now, after Dr. Veteran examines me, I hit him with my idea. It’s original, all right—Veteran doesn’t know of anyone who’s done it—but he also says it’s not a good idea. Radiated tissue is difficult to work with: Some of the smaller blood vessels are destroyed; it doesn’t heal as well as normal skin. If one must operate on radiated tissue, one does, but he would prefer not to. Doing the reduction before the radiation is not a good idea, either. Reduction is major surgery; it takes time to heal, and that could delay radiation treatment. This is cancer; the medical considerations have to come first. My skin is good; I’m young; I can get “a very good cosmetic result” with reconstruction. The words “very good cosmetic result” disturb me. Is it a suggestion that I really could use a new pair? Is he saying, in a roundabout way, that what he has seen is awful? I have a sudden image of Joan Rivers, in an off-camera booth, feeding the surgeon lines. “She takes off her bra,” she says, “she could nurse SoHo.”
He explains reconstruction: At the time of the mastectomy, he would put an expander, made of silicone, under the muscles of my chest. You couldn’t put it directly under the skin, as you would with breast augmentation, because all the breast tissue is gone, and there would be nothing to serve as a cushion between the implant and the skin. Over a four-to-six-week period, a saline solution would be injected into the implant, enlarging it. The muscles on top of the implant would stretch, as in pregnancy, but, as in pregnancy, you couldn’t stretch them all at once. After two or three months, after the tissue around the implant had “settled down,” there would be a second operation and a permanent prosthesis would replace the expander. If you’re having chemotherapy, you have to wait longer because chemotherapy usually brings down the white-blood-cell count, increasing the risk of infection. Finally, in the case of large-breasted women like myself, there would be a third operation, a reduction of the healthy breast, to make it match the first and to build a nipple for the reconstructed breast.
To somebody who is terrified of general anesthesia, this is awful—I’m looking at three extra operations, not one. Then the doctor shows us the pictures and it’s worse: a color Polaroid of a woman whose breast looks like a halved grapefruit. The shape is perfectly round; a thick red scar runs from one side to the other; the woman has no nipple and no areola.
“I can’t walk around for six months looking like that,” I say. “It’s like a nuclear catastrophe.”
Then I feel terrible.
“What I mean is, it just sort of throws me, the idea of walking around like that with no nipple. I’m sure when it’s all finished it looks really nice,” I say.
The doctor shows us more Polaroids, including women with their finished breasts, who look much better. He says there are implants he can use for a more natural look, but while they have the same texture, all breast tissue is different, so my breasts may not feel the same. His patients say, however, that after a while they are not aware of the implant—it just becomes their breast. He’s a lovely guy. It’s running on two-thirty; we were booked at the last minute, and I’m sure he hasn’t had any lunch, but he acts like he has all the time in the world.
We leave. I know now, I tell Herb, I don’t want reconstruction. There is no way I am going to do those things to my body.
I also realize something else.
“You know how we’re always saying we miss things,” I say. “We weren’t around for Paris in the twenties; we weren’t reporters in New York in the forties; I had tickets to Woodstock, too much mud, I didn’t go. It just hit me: All these stories about breast cancer—for this trend I’m right on time.”
(This is the first of two installments.)
Some of the names in this story have been changed to protect the privacy of those involved.