The Last Goodbye (23 page)

“Well, it’s hard to say just yet without a biopsy. Usually these things are benign cysts but I would like to get a second opinion. These machines aren’t the best. I’m going to refer you on to my colleague Gareth O’Keeffe for a more detailed examination. Now, I’m sure it’s nothing to worry about but it’s best to get these things checked.”

“But otherwise all looks good?” I said.

“Yes, the baby seems fine.”

I went back out again and made arrangements to see Gareth O’Keeffe.

Then I decided to treat myself to a cup of tea and a sticky bun in the hospital coffee shop. I smiled at the black-and-white scan photo that the doctor had given me. It still didn’t look like a baby yet, more like a jellybean, but I was excited. I tried to make out his scrawly handwriting in my chart but I couldn’t make head or tail of it. I was annoyed with myself for not asking more questions. But there was no point in tormenting myself, wondering what it all meant. The appointment he had set up for me was the following week so at least things would be clearer soon enough.

When I went home and told Noel he just asked more questions.

“But what do you reckon it is?”

“I told you I don’t know, Noel.”

“But is it serious?”

“For the last time, I don’t know – we’ll just have to wait until my appointment next week.”

“But the baby is fine?”

“Aren’t I just after telling you that?” I snapped.

Noel had decided to come with me for the appointment with Doctor O’Keeffe the following week. He drove this time so I was able to sit back as we set off for the hospital. I had been thinking about it all week but then I had to remind myself that the radiographer had said it was probably nothing to worry about.

Doctor O’Keeffe came and met us in the waiting room. We followed him into his rooms.

My heart was beating as I climbed up on the examination couch. Noel took a seat near my head. I watched him twisting his gold wedding band round and round his finger. He did this sometimes when he was anxious. We both stayed quiet while the doctor did the scan, waiting for him to tell us what was going on.

Finally he spoke.

“It would appear that you have a large ovarian cyst, Eva. I’m measuring it to be approximately eight centimetres in diameter.”

“Eight centimetres! Sure that’s nearly the size of a sliotar!” Noel said.

“Now these things are usually harmless but we need to keep an eye on it.”

“But you don’t think it’s anything serious, do you?” Noel asked.

“It’s hard to say – I would like to see you back here in a couple of weeks so we can monitor it.”

I was deflated when we went back outside. Doctor O’Brien had warned me about the possible complications of being pregnant at my age but never did I think it would be something like this that I would be dealing with. Whatever about my initial shock at discovering that I was pregnant, I had surprised myself by growing to like the idea of another chance of holding a little baby again. My mood had been lifted over the last few weeks as I went about my mundane jobs of doing the laundry, making dinners, cajoling the kids to do their homework. It had given me something to look forward to. And then this had happened.

Chapter 31

A couple of weeks later we were driving around the hospital car park looking for a space. We drove up and down the rows and then we would see someone pull out of one we just passed and another car would rush in and take the vacated space. The rain hit the windscreen hard and the wipers swished it away.
Eh-eeek, eh-eeek, eh-eeek.
One of them was squeaking like nails on a blackboard and every so often it would irritate Noel and he would turn them off but he would have to turn it on again a few seconds later to fend off the rain.

“I’ll drop you up to the door – no point in both of us getting wet,” he said.

I was going back to meet with Doctor O’Keeffe for the follow-up scan.

A short while later Doctor O’Keeffe was staring hard at the screen in concentration and we were staring at him.

“It looks complex and the borders are poorly delineated. Due to its size I would be very surprised if it resolved spontaneously. Now these things are usually benign but equally it may be malignant –”

“Malignant?” I said.

“Yes, as in cancerous. Now the rates of malignancy in ovarian masses during pregnancy are less than one per cent so it’s only a tiny chance – but we have to err on the side of caution. In a non-pregnant patient we would usually perform surgery to remove the cyst and take a tissue biopsy to rule out malignancy. However, as I’m sure you can guess, abdominal surgery during pregnancy is associated with its own complications such as spontaneous miscarriage, rupture of membranes, preterm birth, infection, thrombosis . . . There are also the effects of anaesthesia on the foetus and the mother to consider.”

“I see.” I was stunned. All I could focus on was the ink stain from the pen that was sitting upside down inside his pocket.

“There is a lot of debate about whether surgical intervention is warranted in all pregnant patients that present with large cysts – in some cases close monitoring throughout the pregnancy and subsequent postpartum surgery can achieve good outcomes for both mother and baby. But in your case, Eva, due to its size and complexity, I would recommend surgery sooner rather than later.”

“Are you saying that I have cancer?”

“No, not at all, but I would like to do a biopsy to know what we’re dealing with here.”

“But you just told me all the things that can go wrong after surgery.”

“We need to weigh up the risks, Eva. Ultimately it is a decision that you and your husband need to make – whether you choose to have surgery or if you wish to continue without surgery. But, obviously, if it is cancer that we’re dealing with here and we’re not treating it, then . . .” he paused to choose his words, “there are other risks to think about . . .”

He didn’t need to spell it out to me.

“And this surgery that you’re talking about – what would it involve?” Noel asked.

“Well, Eva would be put under general anaesthetic and then a laparotomy would be carried out whereby we would do an incision through the abdomen to surgically remove as much of the cyst as we can. As I said it might be nothing to worry about –”

“But what about the baby?”

“We would, of course, take every care to protect the baby but, as I mentioned, there are risks that you need to be aware of. I’m sorry, Eva – situations like this are awful for everyone involved. I see so few cases like this but when I do it presents an awful dilemma for the parents. I want you and your husband to go home and talk about it – we can put you in touch with a counsellor if you wish to talk it through with someone. I’ll give you a call in a couple of days to see how you’re doing.”

Noel and I drove home in silence, lost in our own thoughts. We didn’t even turn on the radio. I tried to remain positive. When I thought of the stats they were in my favour. “Less than one per cent of adnexal masses during pregnancy are malignant,” was what Doctor O’Keeffe had said and hadn’t he also said that some of them resolve themselves spontaneously? I kept on telling myself this, so why then did I not feel reassured? It was like I was waiting, tempting fate, for something bad to happen. Just as I was starting to get excited about this little miracle growing away inside me, I knew something bad was going to happen. I could feel it in my bones. You know that feeling when everything in your life is going too well and it starts to make you uneasy and you just know something lies in wait around the corner for you? It’s like someone is saying: ‘Look at her getting all smug – let’s just throw this at her and we’ll see how smug she is then!’ Well, that’s how I felt.

We went into the house and Noel put the kettle on. It was an automatic reaction – we always did it when we came in from somewhere.

I sat down at the table. When he put the cup of tea down in front of me I didn’t reach for it.

“Are you okay?”

I said nothing.

“Look, doctors these days are very advanced – they’re much more skilful – he’ll whip it out and you’ll be as right as rain again in no time. You’ll see.” Noel was trying hard to be positive.

“But I can’t.”

“Can’t what?”

“I can’t have surgery, Noel.”

“Why not? You heard what Doctor O’Keeffe said?”

“It’s too risky, Noel – I couldn’t live with myself if anything . . . were to . . . go wrong.”

“But what about the other risks?”

“What of them?”

“Well, what if it is cancer? What if something were to happen . . . to you?”

“Sure, I’ll be grand – tough as old boots, me! It would take a lot more than that to get rid of me!”

“Can you please just be serious for once?”

“I am being serious!”

“He advised you to have the surgery.”

“He also said it might be nothing and I’m not prepared to take a chance. You heard what he said – less than one per cent of masses are malignant. I don’t know about you but that to me seems like the odds are in my favour.”

“Well, maybe . . .”

“Look, he’s just being a typical doctor and covering his own arse – they have do that – but I’ll be grand.”

“Maybe you’re right,” he said uncertainly. “Well, we’ll see what he says at your next appointment.”

But I didn’t feel as confident as my words.

Chapter 32

Noel and I didn’t speak about it at all after that. I knew that I was probably doing a bit of sticking my head in the sand but I just couldn’t face up to it. We never even mentioned it to the children.

Kate was still acting like the devil’s child. I would catch her staring stonily across the kitchen at me, her eyes narrowed into piercing slits. Where had my blonde-haired angel gone? She was spending more and more time out with Aidan and her friends. Ordinarily I would have been pretty strict about her hanging around the town but under the circumstances I let it go. What is it they say: pick your battles? She was still on at me about going to Bergin’s and I had finally caved – I didn’t have the energy to fight her any more on it. The condition was that Noel would drop her down and pick her up – I knew she wasn’t happy with that end of the bargain but she knew better than to push me on that one in case I changed my mind altogether.

At my next appointment, when Doctor O’Keeffe said that the mass had grown again in size and that he wasn’t happy with the shape or complexity of it at all, I wasn’t surprised. Noel reached out for my hand and squeezed it and I could feel the nervousness in his. I felt numb and removed from it all whereas poor Noel seemed to be very upset. I somehow found myself comforting him.

“What are our options?” Noel asked.

“I would strongly advise you to proceed with surgery, both to attempt to remove as much of the mass as possible and also to do a biopsy so we know exactly what we’re dealing with here. Then we can decide on the best course of treatment.”

“I don’t want to do anything that may harm this baby.” I put my hands protectively across my growing abdomen.

“You are out of the first trimester now. I think there is a good chance for a successful pregnancy, Eva.”

“But you said there are risks too.”

“Yes, of course, there are – with any kind of surgery during pregnancy – especially with the location of the surgery in this situation.”

“Well, then, I can’t do it.”

“Eva – the risks to you may far outweigh the risk to the baby if we don’t proceed with surgery.”

“But you don’t know that – you said yourself that less than one per cent of masses during pregnancy are malignant – you don’t even know if it is cancerous. I’m sorry but it’s just too big of a risk to take for a less than one-per-cent chance when it might actually be nothing at all.”

“Will you stop being so stubborn?” Noel was looking at me, his eyes burning with upset. “Listen to the man – he is recommending that you have the surgery – why won’t you be reasonable?”

“I am listening – that’s why I am going to take my chances.”

“Are there any other options?” Noel turned back to Doctor O’Keeffe.

“Well, without knowing if it is indeed malignant, then I’m afraid not. We can sometimes do a blood test to measure tumour markers but it isn’t accurate for pregnant women as the levels of the antigen are usually elevated in pregnancy anyway. Look, ultimately it is your decision, I can only advise and then I have to respect whatever you decide on. I empathise with you both because it is a truly awful decision for any expectant mother to have to make.”

I nodded. The whole thing felt like an out-of-the-body experience.

“We’ll be keeping a close eye on you to see how it’s growing. If you do change your mind, please ring me anytime and I can schedule surgery immediately.”