“I have a lot on my mind. Things aren’t going well with the business, and I’m feeling the pressure.”
“Maybe it’s a good thing that I’m working.”
He stopped eating. “That may help you, but it won’t do a damn thing for me. Don’t you understand? We have major financial problems with Horizon Drugs. A teacher’s salary won’t fix that.”
Ruth looked at him with disbelief. “You know very well what I meant. Why do you try so hard to misunderstand what I’m saying? I’m your wife. I want to help.”
“If you want to help, write me a check for $650,000.”
“$650,000! What’s going on?”
Henry rattled off a litany of problems with the recent expansion of the business and the reductions in reimbursement. He used simple language, defining each term as if he were explaining something complex to a moron. He wanted to offend her, and he did.
“Why do you talk to me in this way, Henry? I’m intelligent and over the years, when you talked with me, I developed more than a passing knowledge of the pharmacy business.”
“A passing knowledge won’t do me much good now.”
“I can talk to Daddy. Maybe he would lend you the money until your cash flow problem straightens itself out.”
Henry laughed with obvious disdain. “Bert Carlin lending me money. What a joke. That prick would love to see me crawling to him for help. It would make his day…no, it would make his decade.”
“Don’t trash my father. He’s been nothing but kind and generous to the kids and to us. What do you have against him?”
“That’s easy. Nobody was ever good enough for Bertram Carlin’s daughter. I’ll never give him the satisfaction of watching me fail. If I go down, his precious daughter will go down with me.”
Chapter Ten
Matt Wallace took one look at Debbie as she put down the phone. She stared at him and paled. “What’s wrong?”
“I’ve never been so frightened in my life.” She grabbed Matt’s hands, and told him the mammogram’s results. “I need a breast biopsy” She paused. “It could be cancer,” she said in a whisper, as if not saying it aloud would change the reality.
Matt’s reaction to the words, the image of breast cancer was like the near miss in his car, or turning around and finding his child gone in the supermarket. The hollow feeling in his stomach was his visceral concession to terror.
Needle biopsy by the radiologist revealed cancer.
Debbie and Matt met with me the next day.
They sat before my desk waiting expectantly and I pulled my chair around to join them.
“I’ve had too many conversations like this one. It’s never easy for me or the people I care about. Breast cancer eventually affects one in nine American women, and it arrives with twin attributes, a reality, and a mythology. The reality is the tumor, its size, its location, its pathology, its hormonal sensitivity, and of course its spread. This, more than anything, determines how we’re going to treat it. Then we have what I like to call the mythology of breast cancer.”
“Mythology?” Debbie asked.
“I don’t like the word, but it’s the best one I can find. It describes our obsession with breast cancer and it’s all over TV, especially on shows like Oprah. Then we have the books and articles in women’s magazines with gritty stories of struggle and survival against all odds, and the tragedy of death too soon.
“The universal fear of the disease is real and rational. Women inhale it, absorb it, and assimilate it, like the air they breathe. Overall, it’s beneficial and has increased awareness of the disease, raised huge amounts of money, and reversed the image of the disease from pessimistic to hopeful.
“The one disadvantage is the overwhelming amount of information available about treatment. Much is useful, but it makes life more difficult for patients by being confusing and sometimes irresponsible.”
I ran them through the alternatives and, as much as I tried, I was unable to eliminate my bias for breast conserving surgery—maybe I shouldn’t try to be objective.
“I’ll leave you alone for a moment. Take as much time as you need. Talk it over. If you need more time to consult with others, that’s okay too.”
Debbie and Matt sat side-by-side. Matt grasped her hand. “What’s going to happen?”
“You heard Dr. Roth. I’m going to have a lumpectomy. It makes the most sense to me. They’ll remove the tumor and its surrounding tissue. Then they’ll operate on my right armpit to examine and remove any affected lymph nodes. What do you think?”
“I trust Arnie, and I trust your judgment. Who’s going to do the surgery?”
“Julie Kramer. Arnie says she’s the best.”
She squeezed Matt’s hand. “I’m trying so hard not to think the worst, but you of all people know how difficult that is for me.”
“You’re the best and I love you. I’ll always love you. This will work out. I know it.”
Debbie lay on a gurney in outpatient surgery waiting for the orderly to roll her into the operating suite. Matt stood on one side, Julie Kramer, the general surgeon, on the other.
Julie took Debbie’s hand. “The surgery won’t be difficult or too uncomfortable. I can’t guarantee it, but I think that this is going to be Stage I or II disease, and you should be fine. We’ll know more when we see what the tumor looks like under the microscope and we examine the lymph glands in your armpit. Nevertheless, you’ll need radiation afterward.”
Matt turned to Julie. “What about chemotherapy?”
“That will depend on what the pathologist finds.”
For two days, Debbie stared at the phone each time she walked by. She’d picked it up several times to call Julie and nearly broke her neck racing into the house to answer a telemarketer. Imagining the worst, she slept four hours the first night and two the next.
Finally, Julie called. “Good news, it’s Stage II. I’m not going to recommend chemotherapy.”
By the fourth week of a seven-week course of radiation therapy, Debbie was sleeping better and had caught up on her soaps.
The radiation oncology department was deep within the bowels of Brier Hospital. It loomed dark and forbidding. Patients of all ages filled the large reception area awaiting—no dreading—their turns as if they were cued up for root canals. Nobody smiled. Nobody laughed. Nobody made eye contact.
After her first treatment, Debbie met Matt in the waiting room. “The procedure didn’t scare me…much. I barely felt anything. What made me feel special,” she smirked, “was the staff scurrying from the room to get to the safety of the lead wall before they turn on the machine.
“The place gives me the creeps. I don’t know if a good interior decorator could help, but the radiation oncology department’s message is oppressively solemn, as if you’re entering a church or a mausoleum. Huge whirring and buzzing machines loomed over me, aimed at me, and made me feel as if I was a bug under a dissecting microscope.”
When Debbie stood before the mirror each morning, it wasn’t the small lumpectomy incision that disturbed her. Instead, it was the hideous purple indelible ink markings on her skin, the target zone for those radiation beams.
I’m ground zero, she thought.
After four weeks, the side effects, though mild, were predictable. The skin over her breast and upper arm had first taken on a rosy hue, like sunburn but lately the skin had darkened. She felt mild nausea, fatigue, and a scratchy soreness in her throat.
More troubling than anything, was the realization that she was no longer in control of her life; that she was somehow less than she was before. Hugs and kisses from Matt were satisfying but an inadvertent touch anywhere near her breast made her pull away painfully. The message was clear to anyone as perceptive as Matt, and he did not approach her sexually.
“Don’t think for a moment that I’m not interested. I know you’re not ready, and that’s okay.”
“That not okay. I love you. I want to make you happy. I want to make love to you, but… this is all
my fault.”
“You’re remarkable. Don’t be so hard on yourself. Only you could find a way to blame yourself for something out of your control. I’m focused on getting beyond this and to our future together.”
Debbie caressed his cheek. “Three more weeks to go…piece-of-cake.”
Disease is ingenious for its creative ways of torturing humans. I’d cared for patients with every variety of illness. On top of the list were the illnesses I feared the most, the ones that made it difficult to breathe like emphysema, chronic bronchitis, asthma, and heart failure, and those neurological diseases that paralyzed or destroyed control over one’s body. The worst and the most pernicious of all was cancer. In decades past, the diagnosis carried a finality; you had cancer and eventually, you died.
“Today, with progress and the promise of treatment, we talked of cure, we began to expect, to anticipate cure. Although we couched our prognostications with disclaimers, the statistics, the maybe’s and the perhaps’s, cancer patients rapidly embraced the idea of cure, and make it their own, setting themselves up for disappointment and chaos.
It shocked me to see the look on Deborah Wallace’s face when she returned to my office eighteen months later in despair.
“It’s back,” she said without emotion, although her eyes were red from crying.
She was right, of course. When I examined her right breast, I found a small, hard nodule at the lateral margin of her lumpectomy incision. Biopsy confirmed the diagnosis.
To make Wellcare happy, I did the blood tests, the CT scans, the bone scans, and the x-rays locally, but I decided to send Debbie for a consultation at UC Medical Center in San Francisco.
“I’m sending you to UC, Debbie. Stanley Becker is a world-class breast cancer physician. He’ll evaluate your case and then present it to Tumor Board where we’ll benefit from the best minds available. They even have access to experimental protocols for treatment, although I know your treatment will be a standard approach. At the end, we’ll get their specific recommendations for treatment. Either I’ll carry them out or I’ll have one of our own cancer specialists work with us.”
I remembered the first time I went to Tumor Board as a medical student. My patient was a young man with pancreatic cancer. The entire situation was tragic: his age, the devastating disease, his young family, and their hopelessness. The meeting shocked me for its cold-blooded approach to cancer, the brusque recommendations presented in a casual manner when everybody knew what it meant for the patient.
I recall my chief resident’s words after the meeting. “They’ve got to guard themselves from becoming involved in the emotionality of cancer, and to protect their objectivity…to do their job.” I didn’t buy it, and still don’t. Maybe it takes a certain kind of person to work with cancer patients every day.
Debbie sat with her arms crossed. “When I felt it, I knew what it was immediately and I died. Matt was worse. We thought we were through with this…what a joke.” She laughed bitterly.
I held Debbie’s hand. “For selfish and practical reasons, I’ve never lied to you, and I never will. First, I’m a bad liar, and second, you’ll know that what I tell you will be the absolute truth.”
“You told us what we needed to know. You warned us about the first five years, and that we shouldn’t do exactly what we did. We convinced ourselves it was gone. You can’t tell us anything today that we don’t already understand.”
Oh, yes, I can, I thought. Maybe I’m overly paternal, but I’m trying to save them from the burden of knowing too much. That, too is part of my job.
Chapter Eleven
When the cruel buzzing alarm clock jolted me awake, I knew I was sick. My stuffed head, scratchy throat, and headache told me all I needed to know. Disease had no respect for physicians. It’s your turn, Dr. Roth.
I pulled the covers over my head. “You go in for me this morning, sweetie.”
Lois sat up in bed and rubbed her eyes. “If I could, Arnie, I would. Maybe Beverly can lighten your afternoon schedule so you can finish early?”
I pulled the blanket back exposing my face. “I hate that. Patients have waited weeks for an appointment. I don’t want to disappoint them.”
I lingered in the shower soaking up the intense heat. I dressed and came to the kitchen table where Lois had hot coffee ready.
She placed her lips on my forehead. “I think you have a fever. What’s your schedule like today?”
“The usual, except, this morning we terminate life support for Samantha Goldstein. That’s a hell of a way to start a day.”
“How long has it been?”
“She’s been in a coma for three weeks. Yesterday’s EEG showed minimal brain wave activity. Clinically, she’s brain dead. All hope is gone, and I think the family understands.”
“I couldn’t do it.”
“That’s one hell of a comment. Do you think I enjoy this?” I lowered the coffee cup too quickly and spilling some on the table.
She touched my arm. “I’m sorry, Arnie. I know how tough this is for you.”
“In spite of all we know, all modern medicine has to offer, we failed Samantha and her parents.”
“This isn’t your fault.”
“I know that, but the way they look at me every morning breaks my heart. They trusted me with their daughter’s life and I failed them. I shouldn’t feel guilty, but I do.”
“What else could you have done?”
“Nothing.”
I tried not to feel more guilt as our family started the morning with our familiar preparations for the day ahead. Ours was loving family life at its best. It was a life we took for granted. Now, as I thought about the Goldstein family, it was hard to feel secure about anything.
A gloomy sky and the thick ground fog matched my mood as I drove to work. My headache resisted the three aspirins I took at breakfast.
Samantha’s relatives crowded the ICU waiting room taking turns at her bedside, each saying goodbye.
I walked to the nursing station and stared at Beth Byrnes. “Are you ready?”
Beth nodded and accompanied me into the room. She hugged Samantha’s parents.
After my final perfunctory examination, I turned to Richard and Marion. “It’s time.”
“Please, a minute more.” Marion sobbed, holding her daughter’s hands and placing her head on Samantha’s chest. Richard stood behind his wife and caressed her neck and shoulders.
“It would be better if you waited outside,” I said, knowing that even in the severely brain damaged, the primitive part of the brain would struggle to keep her alive…not the picture I wanted for this family’s final memory of their daughter.
Richard took Marion’s hand. “We want to be here to say goodbye.”
I placed my hand on his shoulder. “Please. Say your goodbyes now and leave the rest to us.”
Marion’s mouth tightened. “I don’t see why we can’t be here,”
I kneeled before her looking into her eyes. “I’ve been through this more times than I care to remember. In all ways, it’s awful. Trust me; it’s better to carry your memories of Samantha as you see her now, in peace, at rest.”
Marion grasped the bed rail with both hands. “I’m staying.”
Richard placed his arm around his wife, pulled her close, and led her from the room.
Marion turned for a final look as they passed through the doorway. Beth followed, walking them back to the waiting room.
When she returned a minute later, she nodded. “Do you want me to…?”
“No, I’ll do it.”
I listened to the ventilator’s rhythmic clicks. Air whirred through its bellows and into Samantha’s lungs. I watched her chest rise and fall with each cycle, and then, with a moment’s hesitation, my hand hovering over the glowing red switch, I clicked the ventilator off, leaving the room in deathly silence.
Samantha’s chest remained still, but within a long moment, her mouth opened in its final gasp. Her back arched and her neck extended as he
r brain fought for survival. Two minutes later, the cardiac monitor alarmed as her heartbeats flickered chaotically across the screen and finally nothing remained but death’s infinite straight line.
My eyes filled and my head ached as I left Samantha, dreading the short walk to the waiting room.
Depression followed me through the day, worsened by my blossoming cold. My headache, at first a background discomfort, moved to the forefront making it difficult to concentrate. I must have missed several patients’ comments as more than one asked, “Are you okay, Dr. Roth?”
At 4:30, I entered the brightly lit examining room for my third from last patient. My head was killing me. I felt slight nausea, and when the lights themselves were painful, I knew at once that I had encephalitis.
I excused myself and started to enter an empty examining room when I saw Beverly. “I’m sick, Bev. Call Lois and call Jack Byrnes. I need to get over to the hospital. I think it’s encephalitis.”
The nausea returned suddenly, and I rushed to the sink, retching. My head felt like it was about to explode, my neck ached, and the room spun. I reached for the instrument stand and knocked it over. It hit the floor with a loud metallic crash. Somehow, I managed to get myself to the examining table before everything went black.
Chapter Twelve
The wailing siren had Lois’s heart racing. Her stomach cramped with fear as she turned the corner and pulled into the office driveway. She reached the door just as the siren blare died and the ambulance screeched to a halt at the curb.
Beverly waved at Lois. “He’s in here. Jack Byrnes is waiting at Brier ER. He said that we’re to get him over there STAT.”
When Lois entered the examining room, Arnie lay stretched out on the table.
“Arnie, Arnie! It’s Lois.”
He moaned and turned, nearly falling off the narrow table.
Lois grabbed his head between her hands and yelled, “Arnie…Arnie. Wake up.”
The Sixth Sense (Brier Hospital Series Book 3) Page 5
