Season of Blessing (8 page)

“I can tell you that the tumor looks to be about three centimeters. That's larger than I would have liked. It has poorly defined margins, which is also not a very good sign. I'll know a lot more when we get a pathology report on the tumor itself after it's removed, and Sam will probably want to take some lymph nodes.” He paused. “Sylvia, are you all right?”

She ran her fingers through her hair, trying again to focus. “Yes,” she said, “I'm fine. Thank you for calling, Al.”

“No problem. Sylvia, I'll call Harry if you want me to. I can explain things to him.”

“No, that's all right. I'll do it. I just don't want him to rush home. His work there is so important.”

“Sylvia, he needs to come home. How much surgery you have is up to you and the doctor, but I wouldn't go through this alone. Harry wouldn't want you to. Tell him everything, Sylvia. Don't hold it back.”

Her eyes stung with tears by the time she got off the phone, and she sat there staring into the air. Moments ticked by, and she didn't move.

The phone rang again, startling her.

“Hello?” It didn't even sound like her voice.

“Sylvia, it's Al again. I just wanted to let you know that Dr. Jefferson's office had a cancellation this afternoon. You can go at three o'clock if you'd like.”

She nodded, as though he could see. “Yes, I might as well get this over with.”

“I'm sure you'll have a lot of questions,” he said. “I'd recommend that you take a tape recorder with you so you can remember everything later. You might take a friend, too, just to be there with you.”

Her hand trembled as she brought it to her forehead. “I'm not ready to tell anybody yet. I'm going alone.”

“Whatever you think is best. And, Sylvia, call me if you have any questions. Harry, too.”

“I will.”

She hung up the phone and decided that she didn't have time to stare into space. Her problem was in her breast, not her brain. She had a tumor, and it could be removed. She might not even need a mastectomy. Lumpectomies were just as successful these days. Maybe they could quickly pull it out on an outpatient basis, and she wouldn't have to have radiation or chemo or anything. The sooner she took care of it, the sooner she could return to Nicaragua and pick up with her work as if nothing had ever happened.

But as she prepared for her appointment she realized that that probably wasn't the case.
Poorly defined margins
. She knew what that meant from dealing with her mother's cancer. It meant that the cancer wasn't contained in a bubblelike wall. It had seeped out, into the tissue. It wouldn't be as easy to remove as it would if the margins were well-defined.

The phone sat on the desk before her, like a live being challenging her. She needed to pick it up and call Harry, but she knew he would panic and drop everything to come home. No, she needed more information before she called him. She would wait until after the appointment with Sam Jefferson. She looked in the mirror, struggling with the surprising anger that her body had betrayed her in such a way. Her intuition had failed her.

Pulling herself together, she drove her rental car to Radio Shack and bought a little handheld recorder to take with her.

The doctor's office felt like Montreal in January. Though it was August, and the thermometer outside read eighty-five degrees, Sylvia wished she'd worn her coat.

Sam Jefferson seemed pleased to see her. “How have you and Harry been?” he asked as he ushered her into his office.

“We've been fine.” She took a chair while he settled behind his desk. She tried to keep her voice level, polite. “Working hard, though.”

“Yeah? Harry practicing cardiology down there, or has he branched out?”

“He's more of a general practitioner now. He has a medical clinic that takes care of everything from sore throats to gangrene. He puts in about twelve hours a day. We've really come to love the people.”

The doctor smiled and looked down at her chart. “Well, you guys really have guts doing what you're doing. I've thought of doing a medical mission trip. It sounds really rewarding.”

“I'm sure Harry would love to have you come to León for a couple of weeks if you ever want to.”

She was stalling. She knew that, but she wasn't sure she was ready to jump into this discussion. What if she couldn't handle the truth?

But they couldn't go on making small talk forever.

Finally he got around to the subject at hand. “Sylvia, I've looked over your X rays and your biopsy report, and as I see it, we have several options.”

She got out her recorder, switched it on, and set it on the chair next to her.

“With many of my patients I offer the option of a lumpectomy or a partial mastectomy to preserve as much as we can of the breast. That's certainly an option for you, but because of the irregularity of your tumor's margins and the type of cancer cell it is, I can't recommend that. I would recommend a mastectomy.”

Her stomach sank like lead. “My mother had a mastectomy over thirty years ago,” she said.

“Well, the good news is that it doesn't have to be as bad as hers was. Back then, we did radical mastectomies, where we took the breast, lymph nodes from the armpit, and the muscles in the chest. Today we can do a modified radical mastectomy, where we leave the muscles alone. That makes the surgery less disfiguring and easier to recover from.” He handed her a couple of books and pamphlets about mastectomy surgery. “These will explain the procedure in more detail and answer your questions.”

“If I have a mastectomy, will that take care of all of it, or will I have to have chemo?”

“I'd recommend that you follow up with chemotherapy, especially if it's spread to your lymph nodes.”

She thought of her mother with her bald head and paperthin skin, suffering through intense nausea and weakness.

“You said options. What are the others?”

“Another option I'd recommend you consider is a bilateral mastectomy.”

“Both breasts?” Her ribs seemed too small for her lungs, and she tried to catch her breath. “Why?”

“The fact that your mother died of breast cancer causes me some worry,” he said. “A bilateral mastectomy would virtually ensure that you don't get future tumors in the contralateral breast.”

Tears sprang to her eyes, but she fought them back.

“It's not absolutely necessary,” he said. “As I said, it's just an option. Some women choose to do that to be safe, to prevent recurrence, or to prevent a new cancer from growing. But it's your call.”

“Do you think the cancer has spread?”

“The undefined margins mean that it's spread into the tissue around it, but it could be confined only to the breast. The lymph nodes will tell us a lot.”

Sylvia cleared her throat. “If I have a lumpectomy, it might get it all. Right?”

“Possibly. But you're not a good candidate for that, Sylvia. You'd be taking a chance.”

“But if we found out it didn't get it all, we could always go back and do a mastectomy, couldn't we?”

“That's possible. Again, I don't recommend it.”

Sylvia felt herself shrinking back into her chair. She suddenly wished she had waited until Harry could be with her. She tried to prop herself back up and sat straighter.

The room seemed to be moving, and Sam's face blurred.

“I don't know what I want to do yet,” she said. “I have to think.”

“Of course you do,” he said, “and you can take a week or two to decide.”

Sylvia got up and walked to the window, looked out. In the hospital courtyard, she saw children playing while their mothers sat and smoked cigarettes, the smoke rising on the breeze and disappearing.

“This is not a decision you need to make quickly. It's your body and your life. But my main concern right now would be trying to get as much of the cancer out of your body as possible so that any additional adjuvant therapy is easier and most successful. You need to talk it over with Harry and decide what you want to do. And if you'd like to get a second and third opinion, my secretary will help set those up for you.”

She glanced back at the doctor, trying to remember what it was she'd wanted to ask. The questions just whirled through her mind and she couldn't settle on one.

“If you choose the mastectomy, we need to decide whether you'd like to have reconstruction surgery at the time of the mastectomy. Or you may want to wait until later when you're finished with your treatment, and then go back and do the reconstruction. You may even decide you don't want the reconstruction at all. Some women prefer to have their battle scars to remind them how hard they fought and how much they've overcome.”

Sylvia had once believed that if anything like this ever came up in her life she would know quickly what to do. But everything seemed muddy and unclear.

He leaned forward on his desk, crossed his hands in front of his face. “I have to tell you, Sylvia, that the biopsy report shows that these are aggressive cancer cells.”

“Aggressive?” She turned back from the window. “Really?”

“Yes.”

Her hand came up to her breast. “But you said I had time. Two weeks, you said.”

“You do. But we shouldn't wait longer than that.”

She rubbed her face. “Well, I'd like it out now. Right this minute. Can you do it now?”

He smiled. “Take a little time, Sylvia. Get Harry home.”

She wondered how she would sleep that night knowing that this monster called cancer moved aggressively through her body, conquering new territory, staking its claim.

The doctor gave her some books on breast cancer and instructed her to read them thoroughly before she made up her mind. She walked in a haze back to the secretary, her arms overloaded with the books and her purse and the legal pad she hadn't used and the tape recorder clutched in her hand. The woman started talking about second and third opinions, plastic surgeons, possible operation dates.

But Sylvia couldn't make her mind focus. She wished she had followed Al's advice and brought a friend with her today. Someone who could think clearly while her thoughts rollercoastered out of control.

Failing to make any appointments at all, she left the building and went to her car.

C
HAPTER

Twelve

Sylvia didn't
go straight home to call Harry or share her news with her friends. She had errands to run. She had to go to the post office, the bank, the cleaners. She had to get things done.

The post office wasn't busy, so she went right up to the counter and bought her stamps. As she walked back to the car, she breathed in the sweet mountain air. The breeze felt like freedom on her face, but she was anything but free. She got into her car and drove to the cleaners.
Malignancy, mastectomy, aggressive cancer cells…

She shoved those words out of her mind and told herself that she wouldn't fall apart until she got home. She would finish her errand list.

She went to the counter at the cleaners, and the college girl behind it asked, “Name, please?”

“Sylvia Bryan,” she said.

The girl checked her slips for Sylvia's name one by one under the B's, then turned the spinning rack and checked some more.

“Bryan?” she asked. “B-r-y-a-n?”

“Yes,” Sylvia said. “Sylvia Bryan.”

“I'm sorry. I don't find a Sylvia Bryan.”

“I brought them in Monday.”
After I found out I might have cancer
, she wanted to add. “You told me they'd be ready today.”

“Just a minute. Let me check.” The girl went to the back, then reemerged and punched on the computer. “What's your phone number?”

Sylvia gave her the number and waited, tapping her fingernails on the Formica surface. The girl disappeared for five minutes while Sylvia waited.
Malignant…mastectomy…aggressive cancer…

The girl finally came back. “I'm sorry, Mrs. Bryan, but we seem to have misplaced your clothes. Could you tell me what they were?”

“A green dress, a black skirt, a pair of white slacks.” Her voice broke off and she desperately tried to remember what else she had brought, but she couldn't concentrate on her wardrobe. Her mind kept lunging back to reconstructive surgery, chemotherapy, death. Her mouth started to tremble and her eyes filled with tears.

Horrified, the girl caught her breath. “I'm so sorry, ma'am. I'll go look again.”

But Sylvia couldn't wait. She turned and ran from the building, got out to her car, closed and locked the door, and humped over her steering wheel.

She screamed out her rage and fury, then wept loudly for several moments. Finally, she pulled herself together enough to start the car.

She couldn't stop railing as she drove. “Lord, what are you doing? This wasn't part of the plan. I didn't even
want
to go to the mission field but you changed my heart, you made me want to go, and now that I'm there, now that it's my life, why would you take it from me? Why would you stop us in our tracks and bring our work to an end like this? I don't understand.”

She wept as she drove home, praying all the way, and when she pulled into the cul-de-sac, she prayed that none of her neighbors were waiting outside. But that prayer wasn't answered either.

Cathy stood in her driveway. Sylvia drove past her, gave her a quick wave, then pulled into her garage and closed the door behind her.