The Doctor's Unexpected Family

by Lilian Darcy

  ‘Want me to get it?’ she offered.

  ‘Yes, if you could.’

  She put the tea down on her desk, crossed to his office and grabbed the phone. ‘Declan McCulloch’s line.’

  ‘Caroline?’ She heard her friend Nell Cassidy’s voice.

  ‘Yes, hi, Nell. He’s on the multi-header. Can I take a message?’

  ‘Could I speak to him? He’ll want to hear this. You will, too, come to think of it. I’ve just assisted with the biopsy on Alison Scanlon’s breast and the removal of the ovary, and both Dr Di Luzio and Dr Forsythe agree with me that they’ll be very interested to see how this one turns out.’

  ‘Hang on a minute. Dr Forsythe?’ The name was familiar, and Nell’s casual use of it distracted her from Alison Scanlon’s details for the moment.

  ‘Yes,’ Nell answered crisply. ‘He’s…’ She hesitated for a tell-tale moment. ‘New in the department. Started today, in fact.’

  ‘Bren Forsythe, we’re talking about? Bren from years ago, Nell? Or someone else?’

  ‘Yes, Bren Forsythe.’ Nell’s tone was even more businesslike. ‘He’s back. Our new general surgeon.’

  Caroline wasn’t fooled by the tone for one instant, but she swallowed further questions for the moment. ‘Tell me about Alison Scanlon,’ she said, then added innocently, ‘But first, are you free for lunch?’

  Nell wasn’t so easily fooled. ‘How much is lunch going to cost me?’ she drawled, and Caroline knew she wasn’t talking money.

  ‘Nothing, unless you want it to,’ she said.

  ‘All right, and I probably won’t want to. There’s really…nothing to say, Caroline. Honestly. He’s back. That’s all. Twelve-thirty? Café? I’ve only got half an hour.’

  ‘See you there. Now, tell me the bottom line on the biopsy, and I’ll get Declan so he can hear the details.’

  ‘No bottom line yet, until he’s looked at what we took out, but it does look, cautiously, better than we feared. Three people are calling me, Caro, so—’

  Caroline got Declan to the phone in five seconds, with four words. ‘Nell. Alison Scanlon’s biopsy.’

  The two doctors had a short, technical conversation which Caroline couldn’t hear from her desk, then Declan came back. ‘What did Nell tell you, Caroline?’ he asked.

  ‘Not much, but I want to hear.’

  Natalia looked interested, too, as she’d heard about the tragic case.

  ‘The tumour has shrunk remarkably after the treatment. They’re sending up the sample, and I’ll do the lab work on it myself so we can see it under the microscope this afternoon. Meanwhile, guess what Gian Di Luzio found inside the lump on the ovary, once they’d removed it?’

  ‘Not a clue, Declan.’

  ‘A tooth, and some hair.’

  ‘Eww!’ Natalia made a face. ‘Don’t tell me things like that!’

  ‘All right, so it does sound weird,’ he agreed, ‘but it’s not all that uncommon, and it’s great news.’

  He spoke quickly, and his eyes were bright. Seeing him like this, Caroline realised he’d looked tired and preoccupied all morning. She had instinctively trodden carefully with him. She’d kept her distance, limited her conversation, and she hadn’t even known she’d been doing it until now, when she recognised the way his mood had changed.

  ‘It means the lump in the ovary isn’t a secondary tumour,’ he said, ‘but almost certainly a benign dermoid cyst, containing multi-potential tissue.’

  ‘Multi-potential,’ Natalia repeated, in her strong accent.

  ‘Tissue that can grow into anything—like teeth and hair—but isn’t malignant or dangerous in any way. When I first heard about the lump on the ovary, it seemed to confirm that everything we feared about the breast was true.’

  ‘But if the ovary is a benign, unrelated condition…’ Caroline came in.

  ‘Exactly. It’s possible the cancer hasn’t spread, and since the breast tumour has responded so well to treatment…’ He paced the office. ‘Lord, I never thought this woman had the palest ghost of a chance, but now just maybe…’ he closed his forefinger and thumb together, leaving the tiniest slit of space between them ‘…maybe she does.’

  At the hospital café two hours later, Caroline found Nell already seated by the window, unwrapping a sensible chicken salad sandwich from its plastic covering. She had a cup of tea and a banana, too, the rotten woman! Under such circumstances, Caroline couldn’t possibly get a big, triangular piece of the chocolate walnut cake she coveted.

  Joining Nell, with her own toasted cheese and tomato sandwich, strawberry yoghurt and hot chocolate, Caroline tried without success to read her friend’s face.

  Nell was an expert in the art of masking her feelings behind a terrifyingly cool façade. Her nickname in her own department was IQ, which stood for Ice Queen as well as being a pointer to her bright mind. Most of her staff bought the façade without question, and Nell was apparently very satisfied with her own professional image.

  Old friends such as Emma Croft and Caroline herself weren’t fooled, but they didn’t challenge Nell on the issue very often, all the same. Caroline suspected that Nell had something to protect, or something to hide, and she’d always wondered if that something had anything to do with Bren Forsythe.

  During Nell and Caroline’s final year of high school, Bren had been the top student at Ranleigh, the local private boys’ school where Caroline wanted to send Josh next year. Nell had occupied the same top position at Ranleigh’s sister school, Glenfallon Ladies’ College. She and Bren had gone out together for a few months during that unique, tumultuous window of time around final exams and Christmas and the wait for results in January, when everyone’s life had been up in the air and everything had seemed terribly, wonderfully important.

  Even then, Nell had been fairly private about it. Caroline hadn’t known, at the time, if this had been because the relationship had been desperately serious or because it hadn’t been serious at all. Bren had had some health problems, she remembered, but she hadn’t ever known what they were or whether they’d been significant.

  Then, even though Nell, Caroline and Bren had all been studying medicine, they’d each gone their separate ways for a time. Caroline had been accepted into Sydney University, where she’d met Robert, Nell had chosen Newcastle, and Bren had moved to Melbourne, where he’d deferred his studies for a year.

  Nell had always planned to return to Glenfallon. ‘To protect Dad from Mum,’ she’d said, in that cryptic way she had. Joking? Or not?

  As she’d outlined to Declan weeks ago, Caroline had limped back here with a failed marriage and a failed medical career. It had seemed like a backward step at the time. Not any more. She loved it here now.

  Bren hadn’t come back at all, not even for holidays, as his family had moved to Melbourne, too, at the same time. Seventeen years on, Caroline would have assumed him to be totally set up in his career, with a wife and children, and probably a golf club membership and various other professional accoutrements as well. If his return to Glenfallon was going to haunt her best friend, she wasn’t happy about it.

  ‘So…’ she said, then mentally scored herself zero points for this brilliant conversational opener.

  ‘You didn’t get cake?’ Nell looked disappointed at the items on Caroline’s tray. ‘I was planning to con you into giving me half.’

  ‘By mentioning my diet, right? I saw your banana and felt too guilty.’

  ‘Then the banana backfired completely.’

  ‘We were supposed to share the banana as an antidote to cake poison?’

  ‘I won’t try to be so clever next time.’

  Caroline decided not to try to be clever either. ‘Tell me about Bren,’ she said simply.

  ‘There’s nothing to tell. He was ready for a change. He knew we were likely to need someone. We always need someone, if they’re good, and of course he is.’

  ‘So you must have known for a while?’

  ‘A few weeks, yes.’ Nell looked u
p, tried to meet Caroline’s eyes and failed. This was unusual.

  ‘Why didn’t you say anything?’

  ‘Say what? That the hospital board had hired him? It might have fallen through. And, Caroline, please don’t start—’ She broke off, and began again. ‘Seventeen years is a long time.’ She laughed. The sound cut and twisted in the air. Nell’s laugh had always been a complicated thing. ‘If I’d been in any doubt about that, one look at him proved the point.’

  ‘Why? Has he aged?’

  ‘No! I have!’

  ‘Not badly, Nell. Most people wouldn’t think you were thirty-five.’

  ‘Hmm. From a few of the looks he given me, he’s not most people. Anyhow, tell me if your car’s running properly now after you had to mortgage your first-born to pay for the repairs, tell me the latest news on your sister-in-law, and tell me what Declan said about Alison Scanlon.’

  ‘You’re changing the subject, Nell.’

  ‘That’s right. I am. Live with it.’

  Caroline considered pushing further, but decided not to. ‘The car seems fine. They fixed the oil leak, said I’d been very lucky. No visible damage to the engine, but I’m to keep my eye on it. Sandie’s having her second cycle of treatment in Canberra this week, and she felt wretched after it last time, so she’s not looking forward to it. As for Alison Scanlon’s biopsy, Declan is going to do the lab preparation work himself,’ she said. ‘He’s in such a hurry to see it.’

  ‘Tell him to phone me, or phone me yourself, as soon as he has a diagnosis, because I’m in a hurry, too. After seeing her breast that day six and a half weeks ago, if she’s going to live, I want to be one of the first to know. I liked her. I was absolutely furious with her, but I liked her.’ Nell’s face went still and thoughtful. ‘We had a couple of things in common, I think.’

  As soon as Alison’s pathology arrived in the department, Declan put the rest of his workload on hold and went along to the lab.

  ‘I’m going to section this one myself,’ he told lab technician, Mary Bennett. ‘Will you get it ready for me?’

  ‘You won’t get to it today,’ she warned.

  ‘I know. First thing tomorrow, I hope.’

  The tissue sample required several steps in processing before he could even begin to cut and stain it. It would be cut to a specific size, dehydrated and embedded in paraffin, so that the knife blade could make clean cuts and produce thin enough cross-sections.

  Tomorrow, it would probably take him an hour to complete the preparation of the tissue for analysis. He felt a need to hurry the process, but knew that such impatience could seriously compromise an accurate result.

  ‘This is the Scanlon case?’ Mary asked.

  For some reason, the entire department wanted the result on this one. It wasn’t by any means the only life-or-death case they’d worked on recently, but they’d all come to care about the outcome. With her husband a science teacher at the local high school, and primary school-aged children of her own, Mary must be around Alison’s age.

  ‘Yes, it is,’ Declan confirmed. ‘Do you know her?’

  ‘Not personally, but my sister-in-law works with her sister.’

  ‘The kind of connection you get in this town, I’m finding.’

  ‘Makes it hard sometimes.’

  ‘Makes it rewarding, too.’

  Declan got into work early the next morning, when only one of the lab technicians, Julianne, had begun work. ‘It’s ready,’ she told him, and pointed. ‘Over on the bench.’

  ‘Thanks. It looks good so far.’

  He sectioned the entire sample, having to force himself to use the big blade carefully as he carved each wafer-thin slice. His back began to ache and his eyes already felt tired and gritty, but he forced his concentration to stay sharp and focused.

  He hadn’t had anywhere near enough sleep this weekend, with Suzy down. She’d deprived him of sleep many times in the past, but on this occasion he couldn’t say that he’d found much in compensation, either before their talk or after it.

  He had a lot to think about now that she’d gone back to Sydney.

  Not now, though. Now he had to think about the work in front of him.

  With every cut of the wax-encased block of tissue, he looked for evidence of the tumour in the tissue’s architecture, and with every cut he couldn’t find it. That didn’t mean very much. His diagnosis would be made on the basis of what he saw beneath the microscope, not with the naked eye.

  He ended up with fifty blocks of tissue set on fifty slides, each sample transparently thin, measuring approximately one and a half centimetres square and stained the familiar pinkish-purple. With the tissue’s architecture still in place, these slides would look very different to the pap smears and sputum samples he so often saw. They’d have the appearance of maps, or photographs of landscapes, taken from space.

  With his office door closed, he set the slide trays beside his computer, switched on his microscope and brought the case details up on screen. In the background, he heard the department slowly come to life. Steph would be at the reception desk by now, her eyes bright and ready to appreciate a joke behind the tiny frames of her glasses. Tom would be checking his e-mails. The lab technicians might already have received a case or two from today’s surgery.

  It was a quarter to nine. Caroline wouldn’t get here for another twenty minutes, after delivering her son and her nephews to child-care and school.

  OK, so, Scanlon, Alison.

  He slid in the first slide and focused the microscope to begin his painstaking study of all fifty cross-sections. At first, he couldn’t find any evidence of a tumour at all. Was it possible that Alison’s chemotherapy had shrunk it away completely? Then, as the cross-sections he studied grew closer to the centre of the excised tissue, he began to understand what he was seeing.

  This wasn’t the carcinoma that he’d been so sure he’d find, but a sarcoma.

  Yes, it was cancer, but it hadn’t metastasised, and it probably wouldn’t. It wasn’t the type of cancer that did. Nell Cassidy and Bren Forsythe had completely excised the shrunken tumour during surgery. There was no evidence of abnormality at any of the margins. He’d never expected to find himself looking at something this good.

  He stood up, looked at his watch. Almost ten. Only now did he feel a knob of his spine burning near the top of his back. He’d been so focused on this. He stretched, rolled his neck and shoulders and opened his door.

  Across the corridor, Caroline and Natalia were both at work. He paused for a moment before he spoke, and watched Caroline’s concentration as she made a dab of blue on the slide she was studying.

  She had her hair up in a clip and he could see her neck and the delicate shading of the downy tendrils that had escaped. The sight reminded him of the day he’d brought Pete Croft home with a sprained ankle several weeks ago, to find the massage session in progress. He’d felt like a voyeur, watching Caroline’s naked, oiled back. It was crazy to feel the same way here at work.

  And yet he really needed to keep his distance from her now, even more than he had needed to that day six and a half weeks ago. She’d pick up on it, he knew, and she would be hurt, but that couldn’t be helped. The last thing he wanted was to get any closer to her right now. He needed to wait, and he needed to think.

  ‘Natalia?’ he said, deliberately using her name first. ‘Or Caroline?’

  Both women looked up.

  ‘If I want to send something to a different lab for a second opinion, what’s the procedure? Is there a particular lab we’d choose?’

  ‘Westmead,’ Natalia said.

  ‘What is it?’ Caroline asked.

  ‘Alison Scanlon.’

  She made a pained face, and nodded. ‘Then, yes, we’d usually send it to Westmead. So you’ve found the tumour and identified it?’

  ‘Yes.

  ‘What’s in doubt?’

  ‘Nothing, really.’

  ‘Oh.’ Caroline’s face fell.

  Natalia ha
d turned back to her microscope, but she gave a little nod, and Declan knew she was still listening.

  ‘I just don’t like the idea,’ he said, ‘of telling a patient that she’s got her life back without a second opinion to back me up. I’m not sure that she could stand another reversal of fortune, and I want to be absolutely sure.’

  ‘You mean…?’

  ‘It’s sarcoma, not carcinoma, and Nell and the new surgeon have got all of it out. The cells around the entire perimeter of the excision are normal to a measurement of ten millimetres. She has a really good prognosis and she should be fine.’

  ‘That’s wonderful!’ Caroline said, blinking back tears. ‘That’s not what anyone expected a few weeks ago.’

  ‘No, it isn’t. It’s great. I can’t even imagine how she’ll react to this.’

  ‘Could we look at it?’ Natalia asked.

  ‘Yes, the trays are on my desk. Do you want to bring them in here? Put slide three into the multi-header, and I’ll get Tom.’

  Declan disappeared again, and Caroline heard him at Tom’s open office door a few seconds later. Carefully, she put the blue-tipped toothpick back in her little bottle of artist’s colour, not knowing quite why her hand felt so unsteady.

  The news about Alison was great, almost miraculous. She couldn’t treat it as any kind of omen for Sandie, but it felt like one all the same. Alison’s case had seemed so hopeless, the worst possible punishment for her initial, long-lasting denial. Sandie’s illness had been diagnosed far earlier, and the overall survival rate for Hodgkin’s lymphoma was statistically much better than the survival rate for breast cancer. If Alison could ‘get her life back’, as Declan had phrased it, then surely Sandie could, too?

  But Caroline knew that cancer didn’t always work that way.

  She wondered if Declan would guess how hard she had to fight to keep the two cases unconnected in her mind. He’d hardly spoken to her for the past couple of days, and she knew she hadn’t just imagined the way he was keeping his distance.