The Jewels of Tessa Kent (45 page)

“Your cramps are complicated. You need a doctor who knows more than I do,” Helen Lawrence replied, her voice firm.

“But a cancer doctor! That’s insane! Why can’t you handle my problem, Helen, why do you think I came to you? I don’t want to see anyone else. Why are you handing me over to every damn doctor in this damn city?”

“Tessa, I know how you feel, but like it or not, you really need to see someone who knows more than I do,” Helen Lawrence insisted. “I’ve made an appointment for you. Doctor Hill will see you this afternoon. Fortunately she had an opening in her schedule, she’s a very busy doctor.”

“But … but … look, Helen, what’s the big rush? I feel doctored up to the hilt right now. And my cramps are gone, as usual. Nothing’s different, I just have to learn to live with them.”

“Tessa, the sooner you see Susan Hill the better. There’s never going to be a perfect time and I want her to get into this, she’s the best I know. Is your gentleman friend still out of town?”

“Yes, but Helen, this afternoon? Really this afternoon? It usually takes an eternity to get a doctor’s appointment in New York. This sounds suspiciously like your typical Beverly Hills celebrity service to me. Why do I have to go now?” Tessa asked, her voice childish with reluctance.

“You’ll like her, Tessa.”

“Oh, no doubt about that. I’ll be crazy about her. I’ve always wanted to meet a medical oncologist.”

*   *   *

How could a cancer doctor be so wholesomely pretty, have such flaming red curls, and look no more than thirty-eight or -nine? Tessa wondered, trying to distract herself as she sat in front of Dr. Susan Hill’s desk. What kind of person could possibly choose to be an oncologist when there were so many other specialties in the world of medicine?

“Doctor Hill, how long have you been an oncologist?” Tessa asked, nervously, feeling as if she should be seeing a wise old man instead of this young woman, who could only be a few years older than she.

“I’ve been in practice for twelve years, Miss Kent,” she said, smiling.

“May I call you Susan?” Tessa asked impulsively. She’d feel more comfortable if she didn’t have to say “doctor” every five seconds.

“Of course, in fact I’d prefer it. And I’ll try to call you Tessa, even though that seems a bit like name-dropping.”

“Good. Is that your own hair color?” Tessa asked, nervous enough to ask any question she could think of that had nothing to do with her visit here. Susan Hill laughed.

“It used to be, until five years ago, but now I have to give it a little help. Still, I wouldn’t feel like me without it.”

“Where did you go to medical school?”

“Out in L.A., where I grew up. I graduated from UCLA Med School, and then I did my internship and residency at New York Hospital, when my husband and I moved here. I always wonder why doctors’ diplomas are hung on the wall too far away for anybody to read them, but where else could you put them?”

Tessa Kent would run out of questions soon, Susan Hill thought, but she was right to ask as many as she wanted to. If you’re going to an oncologist, you need to know something personal about him or her. It still didn’t level the playing field: In time she’d end up knowing
a great deal more about this strikingly vivid personality, this woman she’d seen on screen more than a dozen times, this actress who was so much more beautiful than she looked on film, than Tessa Kent could ever know about her.

“Why did you pick this particular specialty, Susan? How come you didn’t want to be in something more agreeable, dermatology, for instance, or plastic surgery?”

“Because there’s such immense progress being made in the field of cancer,” the doctor answered, a smile of genuine enthusiasm flashing across her face. “It’s the single most fascinating area of medicine today. This is where I can do the most interesting work and see real results.”

“So, tell me, what’s wrong with me?” Tessa asked abruptly, disgusted at her postponement of the questions she knew she should really be asking, instead of playing for time.

“I’ve studied the radiology and biopsy reports carefully.” The doctor’s smile faded. She’d rather have answered more questions. “They indicate a tumor of the pancreas.”

“A tumor—you mean a cancer?”

“Yes.”

Tessa felt death inhabit her body. Death, unmistakable. She closed her eyes and dropped her head, raking her hair back from her face with all the strength of her hands. She was going to faint, she thought dimly, through an icy mist.

“Put your head between your knees, yes, that’s it, way down. Stay like that and breath deeply, long, deep breaths. Take your time, don’t lift your head until you feel ready.”

Eventually Tessa fought through the mist and faintness. She fought the word “death.” Cancer
wasn’t
death, cancer was cancer and she could be cured of it. She felt the doctor’s hands on her shoulders, steadying her.

“Sorry,” she said, lifting her head. “I didn’t know people still almost fainted in this day and age.”

“That’s the least of it,” Susan Hill said, pouring her a glass of water.

“Where exactly is the pancreas?” Tessa asked. Chemotherapy, she thought, draining the glass of water. Ten to one that’s what she’d have to have, but her hair grew amazingly fast. If it all actually fell out, she could always wear wigs while her hair was growing back in. She was accustomed to wigs. No one need ever know.

“Look at this chart, Tessa. Here’s the pancreas, that transverse organ, that looks like a longish, horizontal piece of liver, thick at one end, thin at the other. It’s surrounded by the duodenum here, the liver here, the spleen, and the stomach. Your particular tumor is right here, at the thin end, where I’m pointing.”

“It’s a nasty-looking organ,” Tessa said with as much bravado as she could. “What’s the purpose of it?”

“It’s a gland that secretes pancreatic juice, a fluid made of different enzymes that help in digestion, and it also secretes insulin.”

“How important is it? Is it indispensable, Susan, like a heart or a liver?”

She was asking the right questions, Susan Hill thought, and going straight to the point. Tessa Kent was a smart, direct woman, making that serious effort certain patients were capable of to be thoroughly informed about something they’ve never before, under any circumstances, wanted to understand or even think about.

“No, it’s not actually indispensable. There are some patients in whom the pancreas can be removed surgically. Then they can be maintained on artificial pancreatic fluid and insulin injections for the rest of their lives.”

“ ‘Some patients’—do I need that operation, Susan?”

“No, Tessa, you don’t. The only time to operate, what we call the ‘resectable’ time, is when the tumor is confined to the pancreas. Yours is not. You see, one of the problems with this particular tumor is that it doesn’t
cause any symptoms, such as pain, in its early stages, so it’s rarely discovered at a time when an operation is possible. You wouldn’t have known you had it at this point if you hadn’t gone to a doctor for other reasons.”

“So if Helen Lawrence hadn’t sent me to Doctor Wing …”

“Exactly, you couldn’t have known yet.”

She only answered the questions a patient wanted to ask, Susan Hill thought. It was vital to let them set the pace of their tolerance for knowledge. No two patients were alike. They all had different points at which they turned off the spigot of understanding, a different comfort level at which they could accept or permit themselves to learn things. Tessa Kent looked, from the brilliant determination in her extraordinary green eyes, as if she were going to keep on going right to the end. If that was her choice, she had every right to know as much as it was possible to tell her.

“You said the tumor isn’t confined to the pancreas?”

“No.”

“Where did it spread to?” Tessa persisted.

“Certain lymph nodes close to the pancreas, the celiac nodes. Yours are enlarged, a sign that an operation isn’t possible.”

“Well, you can’t get rid of my pancreas. So that’s one option I don’t have,” Tessa said, squaring her shoulders. “What
will
you want to do next, what treatments are available? Is it going to be chemo or radiation or a combination of both?”

“You know a lot of medical terms.”

Tessa had said “chemo” and “radiation” with such fine, careless courage, as if they were just two words without resonance, Susan Hill thought, yet she hadn’t been able to hide the slight trembling of her lips. Her age, her age. Only thirty-eight. My God, but she was young. Much too young for this.

“I read a lot of magazines,” Tessa explained, “and you can’t get away from seeing articles about cancer, can you? And you can’t always make yourself skip
them, much as you’d like to. So what exactly are you planning to do to me?”

“I can’t be ‘exactly’ sure, until we talk it over. We have treatments for pancreatic cancer that will prolong life,” Susan Hill said carefully.

“
 ‘Prolong’?
”

“Yes.”

“
Prolong
 … what the hell kind of word is that? It could mean anything! Look, Susan,” Tessa demanded, suddenly ferocious, “say I take every single treatment you can throw at me, how long can I expect to be okay, after that?”

“That—that differs in each case.”

“
Damn it, give me an average!
”

“Even if the treatments are successful, the tumor will eventually return—”

“How soon?” Tessa interrupted savagely.

“In a year and a half, perhaps two, perhaps a little bit longer.”

This was where they’d been heading, but most people would never come this far, most people would not ask such precise questions. Susan Hill felt sick. Nothing, no amount of experience, had ever hardened her to this moment.

“
So soon? So soon?
” Tessa whispered. Her features were stone, her eyes almost black with shock.

“Tessa, in medicine there aren’t any hundred-percent guarantees, I can only give you my best opinion, but I could be wrong, nothing is an absolute …”

“Susan,” Tessa said desperately, “wait a minute, Susan, you said, perhaps longer than two years. Tell me what’s the longest I can expect to be okay if everything goes well, the treatments work out perfectly and I get very lucky.”

“It’s an inexact projection. A little longer, a few months, perhaps even a little more …”

“And then? What then?”

“Tessa, there isn’t a permanent cure for pancreatic cancer.”

“You mean that I have an
incurable
cancer? You’re telling me that even all the treatment in the world won’t make it go away?”

She’d understood this sooner, Susan Hill thought, she’d heard in several different ways that the tumor would inevitably return, she’d grasped that perfectly, but she still insisted on making it crystal clear, in boiling it down to “incurable,” a word she would not have used herself with a patient. Why, oh why was Tessa Kent so strong, so stubborn, a flagellant, determined to do herself the greatest damage she could? She was adamantly pronouncing the ultimate sentence on herself. Yet who had a greater right?

“Yes. Yes. Tessa, I wish I could say you were wrong but you’re not. There are no miracles in this kind of cancer. I’m as sorry as it’s possible to be. The most important thing I can offer you, Tessa, is a minimum of pain. The tail of the pancreas is where a tumor gives the least possible pain and most of that can be handled with narcotics. I believe in the most aggressive pain management possible.”

Tessa was silent, trying to think through the iron casque of shock that enveloped her and invaded her brain with utter numbness. Wasn’t there something else she could ask, something else that would give her some hope?

“Does everybody have treatment?” she asked, finally, barely able to offer the question.

“No, they don’t. They decide that they don’t want treatment, they don’t want the side effects, since, well, since it’s not going to fix the problem permanently.”

“I see. If there’s no ‘fix,’ Susan, the people who do choose to have treatment—why do they pick it?”

“Usually to try as hard as possible to be around for some special event, a child’s graduation from college, for instance, or a grandchild’s wedding or a golden wedding anniversary.”

“So … so. That means I must be … very young … for this.”

“You are. Exceptionally young.”

“Is there anything I don’t know? I don’t want to go home and remember some question I forgot to ask.”

“Tessa, I’ve almost never had a patient walk out of this office who asked every possible major question, but you have. You know all the options.”

“You mean the lack of options, don’t you?”

“This isn’t one of the days I’m glad I went into oncology. I’m here for you, Tessa, for everything. Any other questions no matter how small, any fears, any medication, anything at all, at any time of day or night. That’s my job. That’s what I do. Will you let me know as soon as you’ve decided how you intend to handle matters?”

“Besides die, you mean.”

“I mean I’m here for you …”

“Thank you for being so honest with me.” Tessa got up carefully, so that she wouldn’t stagger. She pulled herself up as tall as she could and forced a small smile.

“See you around, Susan.”

“Yes, Tessa. Whenever you want, remember that.”