The Cast

by Amy Blumenfeld

  I was relieved that she seemed to buy the story. “He is, but I give him credit. He always gets back on the horse. That guy is determined and disciplined as hell. I see him a lot now. We’ve actually become pretty good friends. It’s a side benefit of being a physical therapist, I guess—your klutzy friends are forced to spend time with you.” I chuckled nervously.

  “That’s great,” she said. “But wasn’t the accident a while ago? Didn’t he already have his shoulder repaired last fall?”

  I had forgotten about Lex’s stellar memory. When we were in junior high, rumor had it that she was partly to blame for the firing of our seventh-grade American history teacher because she corrected the content of his lectures so often.

  I cleared my throat and held a fist to my mouth as if I were suppressing a tremendous belch. “Yeah, well, Nolan might want to get another opinion on his collarbone. It’s still acting up a little.” It was a stretch, but I needed a cover.

  Again, Lex stared at me. I suspected she was deciding whether to drop it or inquire further. She was probably the kind of mom who didn’t have to utter a word to make a kid confess wrongdoing. She would have made an effective boss if she’d worked in management after she’d gotten her business degree, instead of getting pregnant on her honeymoon and becoming a stay-at-home mom.

  After an agonizing moment, the inquisitive look on her face softened. “Lunch?”

  “Yes.” I exhaled in relief.

  We walked over to the diner, and I held the door open for her to walk in ahead of me.

  “Uh, Lex?” I asked.

  “Yes?”

  “Just don’t mention the surgery stuff this weekend, okay? It would be totally unprofessional for me to talk about it with anyone, even you.”

  “No praaablem,” she said, in her exaggerated Midwestern twang, and then playfully snaked her arm around mine, resting her hand on my bicep. She leaned her head on my shoulder, and I caught a whiff of her hair as we walked to a table in the back of the restaurant. She smelled fresh and floral—intoxicating. I had to remind myself that this was the same girl who spread a rumor in first grade that I had cooties.

  “Hey, Lex?”

  “Yes?”

  “I’m really glad you came home.”

  Chapter 5: Becca

  I tapped open the Words with Friends app on my phone the moment I hit the chair. The waiting room was packed for a Thursday before a getaway weekend, and, given my determination to avoid small talk at all costs, I kept my head low and my eyes fixed on the game. Just as I was about to score seventy-five points on an optimally placed Q, Nolan walked in.

  “Hey,” he said quietly, taking a seat beside me on a beige couch. “I dropped Emma off at Jordana’s. Not surprisingly, Jordy’s got a whole day of activities planned for her, so we’re covered.”

  “Okay, good.” I pressed PLAY on Quilts and was pleased to see the word had given me a sizable lead against Emma’s former nursery school teacher, whose addiction to word games rivaled my own. I then clicked on my news apps to skim through the day’s headlines, and when that got stale, I put the phone away and scanned the room, despite the promise I had made to myself not to do so.

  Ever since I had gone into remission in high school and had begun returning regularly for checkups, waiting rooms had been places where I could be a symbol of hope to others in the thick of a crisis. Once a year, I would lift my sleeve to display the patient ID wristband subtly broadcasting that I—the teenager with the long hair; the college kid wearing the Columbia University sweatshirt; the twentysomething young woman in the black business suit; the lady with the beautiful engagement ring; the mom with a photo of her daughter on her custom cell phone case—was a patient, too. I had been where they were, weathered a similar storm, and moved on. But this time felt different. I was returning not as a long-term survivor to impart wisdom, but as a patient in the eye of a new hurricane. I couldn’t help but wonder if all this time I had just been a false advertisement.

  “Scardino?” the receptionist called.

  Nolan and I both looked up. “Yes?” we answered in unison.

  “You can go in now. Room two, please.”

  As we settled into our positions in front of a mahogany desk, I pulled out the grocery store receipt with the notes I’d taken while sitting on the sidewalk at Emma’s bus stop. I had been on autopilot as soon as I heard my doctor’s voice on the phone and so intent on catching her every word that I had actually jotted down you’d look amazing with implants!

  Though the news was jarring, the phone call I received on the street corner that day was not entirely shocking.

  Mammograms and MRIs had been a part of my life since my mid-twenties, because the radiation that helped to annihilate the Hodgkin’s put me at risk for breast cancer. It was sort of ironic to think that the medicine responsible for saving my life as a child could potentially kill me as an adult, but it was a price I happily paid. Over the years, I’d had a few suspicious mammograms followed by biopsies, but they had all turned out fine. I expected this to be the same.

  “I’m sorry,” I whispered, and reached for Nolan’s hand as we waited for the doctor to enter the room. He had been reading her framed diplomas on the wall and turned to look at me as if I were crazy.

  “For what?”

  Though I knew none of this was my fault, I felt a need to apologize. I thought about how much Nolan had put up with already. Yes, I gave full disclosure right from the start of our relationship that the treatment I’d had could pose some long-term issues. But I couldn’t help wondering if, had he known then what he knew now—all the hurdles we would face having a baby, or how, at age thirty-nine, his wife would be diagnosed with breast cancer—he would have reconsidered proposing to me. I was a risky stock. Yes, I looked pretty and polished, just like his friends’ wives, but if you scratched beneath the surface, I was different. I wondered if, deep down, he felt like he’d gotten a lemon. I knew that marriage for everyone—with or without a cancer history—was a gamble. It was sort of like buying an airline ticket. You book a flight knowing there are inherent risks: mechanical delay, weather delay, overbooking, bumpy ride, fiery crash to the ground. But purchasing a ticket for a flight that has an increased likelihood of malfunctioning isn’t something many people would willingly do. Nolan bought a ticket, got onboard, and buckled up, smiling the whole time. He chose to make my journey our journey. I was lucky he was mine.

  “Just promise me you won’t ever allow Emma to call anyone else Mom, okay?” I asked. I had fought long and hard for the title and was blessed a million times over to be the mother of this girl. The thought of another woman taking my place made my chest tighten. My face began to contort, and I knew I was on the precipice of an ugly cry.

  “Oh, Bec! Stop!” he insisted, and pulled a tissue out of the box on the doctor’s desk. When he dabbed it against my cheek, I broke.

  “I want to be the only one she calls Mom.” I sobbed like a child who didn’t want to share her toys.

  “Honey, stop. It’s all going to be fine. I’ve got your back. I promise.”

  I knew he did. In fact, just that morning, without my saying a word, he had offered to drop Emma off at Jordana’s and meet me at the surgeon’s office. He knew I couldn’t bear to watch my daughter walk away from me, grab the hand of another woman (albeit my best friend), and set off for a day of fun while I reprised the role of a patient. He also knew that I wanted to avoid Jordana. It wasn’t that I didn’t trust her. After all, I was in the delivery room when she birthed her twins; trust is hardly an issue once you’ve seen your friend’s placenta. But I needed to be in control and have a plan before I shared my news and she started in with what would undoubtedly be a barrage of questions. Not to mention I knew there would be fear in her eyes, in the tone of her voice, in the way she clasped her hands and nervously ran her fingers through her hair. Every gesture and utterance would come from a place of pure love, but being the focus of her angst would be exhausting and suffocating. I couldn’t c
ut her out entirely, but I could limit our communication to email and texts.

  Just as I was checking my compact mirror for mascara smudges, the doctor entered.

  “Becca, Nolan, it’s good to meet you both,” Dr. Baxter said warmly. A trio of gold bangle bracelets jiggled and chimed as she extended her arm for a handshake.

  “Well, Becca, I’ve reviewed your records, which”—she raised her eyebrows—“are quite voluminous, and I’m impressed by how well you’ve stayed on top of the game in terms of long-term follow-up. I see pulmonary function reports, chest X-rays, bloodwork, MRIs, the whole gamut going back over two decades. Good for you. Not all patients are this compliant after so many years.”

  I smiled at the compliment. “I sort of feel like it’s one of my jobs,” I said.

  “Well, you’ve done a good job. And it’s because you’ve done such a good job that we’ve caught this. But, as you know, even with regular appointments and someone as responsible as you, these things can find a way to sneak in and rear their ugly head.”

  My stomach dropped. Oh my God. How bad is it?

  “Normally with someone your age, we would recommend a lumpectomy, and then, based on the results from the biopsy, we would determine your course of treatment. Right now, we know you have a tumor the size of a small grape in your right breast.” She reached for a notepad and sketched out two circles with a small, darkened oval on the inside corner of the right one. “What we don’t know is whether the cells have spread to the surrounding tissue.” She drew arrows shooting out in all directions from the darkened oval.

  “What stage is she?” Nolan interjected.

  “I can’t say for certain. We won’t know what we’re dealing with until we see whether those cells invaded the lymph nodes. But if I were to guess, I’d say she’s Stage Two.”

  “How do I get rid of this?” I asked.

  “Well, Becca”—she put the pen down on the notepad and looked at me with an expression that somehow conveyed fascination, admiration, and sympathy all at once—“you’re in a different category than most other patients your age. Your chest and all the lymph nodes in the upper portion of your body were already treated with high doses of radiation to cure the Hodgkin’s when you were a child. So radiation is not an option for you.”

  Oh my God. Don’t say chemo. Please do not say the word chemo.

  I suddenly had a vision of Emma and Nolan hovering over me in a hospital bed, the way my parents did when I was a child. I imagined Emma holding the basin at the ready in case I got sick. The image itself made me want to vomit. Years ago, my aversion to chemo had become so strong, I’d gotten nauseated at the mere sight of the nurse’s scrubs and the scent of the gauze before the medication was administered. One time, I puked in the hospital elevator before we even reached the pediatric ward.

  “Given your history,” she continued, “there’s a good chance this could recur in the same breast or the other one. So even though your left side is completely clear and, as far as we know, the right side has only a small affected area, I’ve consulted with some of my colleagues and I’d strongly recommend doing a bilateral mastectomy. This way, you won’t have to worry about any sort of recurrence down the line. Does that make sense?” She cocked her head and looked at me kindly.

  Where do I sign? I thought. How could I pass up an opportunity to rid myself of anything that could pose an obstacle to being healthy and watching my daughter grow up?

  Though I knew I wouldn’t totally be in the clear until after the surgery, when we would know whether the cells had spread, the thought that I could have this intrusion literally cut out of me and proactively shield myself from a potential threat down the line was enormously comforting. I actually exhaled.

  “It absolutely makes sense,” I said, and smiled. I felt the need to connect with her and differentiate myself from other young women, to show her I wasn’t in any way undone by this news—that to me, this was a no-brainer.

  “All right!” Nolan said enthusiastically, and rubbed his hands together. “Let’s do it! That’s one way to get a boob job, Bec!”

  Though the doctor seemed unsure how to respond to Nolan, I laughed. He has always had an unpredictable way of reacting to things. A small scratch on a wood table can trigger a full-on freak-out, and his proclivity for ordering late-night infomercial exercise equipment has caused me at times to question his sanity. But in truly serious matters, he has always used humor to make me feel as if everything will be okay.

  Sitting there in the doctor’s office, I felt strong and secure. I was proud of myself for being vigilant about my care, and for having the clarity in a moment of crisis to confidently make a life-altering choice. I was grateful to be in the hands of this reputable surgeon, and at a hospital with a proven track record for saving my life. I had the unwavering support of a husband who kept me laughing even in my darkest moments, and if there was one lesson I learned from my experience as a kid, it was that laughter was powerful medicine. Becca Night Live and the cast got me through the first time; Nolan would be my supporting cast this time around.

  “So, what’s the next step?” Nolan asked.

  “The next step would be for you to meet with our plastic surgeon. He’s excellent and has a great deal of experience with young women. We operate on Tuesdays and tag-team the surgery. I start by removing the breasts, and then he inserts the implants. The whole thing takes a few hours. Of course, you could choose to forgo reconstruction. It’s absolutely your choice. If that’s the case, we have a very nice boutique downstairs with a variety of prosthetic options.”

  The word prosthetic made me wince. I didn’t want a prosthetic. The fact that they had a set schedule of every Tuesday for doing the surgeries made the whole thing feel like a well-oiled machine, as if I were following an established path. Nolan and I looked at each other and seemed to communicate telepathically. We simultaneously turned back to Dr. Baxter. “We’d like to meet with the plastic surgeon,” I said assuredly.

  Ten minutes later, I was wearing a gown and sitting atop an exam table, reading the “Understanding Reconstructive Surgery” booklet the nurse handed to me when we walked in. As we waited for the doctor to arrive, Nolan checked his email and voice mail while I made notes, circled passages, and scribbled questions in the margins. In hindsight, that was my first red flag—I had a million questions, but Nolan seemed to have none.

  Eventually, the plastic surgeon walked in and Nolan turned off his phone.

  “Good morning. I’m Dr. Farrow, and this is my nurse practitioner, Anne. It’s nice to meet you. Will you please remove your gown?” He was all business.

  I glanced at Nolan, suddenly embarrassed. Where do I plant my eyeballs while standing topless in front of my husband as another man manipulates my breasts? I wondered.

  “So, are we looking to match your current C cup?” the doctor asked. “Go smaller? Larger? What did you have in mind?”

  “Definitely smaller,” I said. I had never thought my chest size suited my petite frame. In fact, a guy friend in college actually nicknamed me the Letter P because my figure matched the outline of a P.

  “Smaller? You sure?” Nolan asked.

  I shot him a look, and he recoiled.

  “Anne, would you hand me the B and C cup forms, please?” Dr. Farrow asked, holding out his hand toward the nurse but keeping his eyes focused on my chest. He held the forms up to my breasts for comparison. “This is not exact, but it should give you a rough idea of sizing.”

  I looked at my reflection in the wall mirror and tried to imagine the new look but couldn’t. It wasn’t that I lacked creative vision; it was that I had no interest.

  “Now feel these,” he said, placing another set of forms in my hands. “This one is silicone, and this is saline.”

  I had no idea what I was feeling for or how I was supposed to react. I passed them to Nolan so he could have a turn.

  “Ooh, that’s so weird,” he said. I thought he might start to giggle. He had a tendency to do
that in awkward situations.

  Not knowing what else was expected of me, I began to ask Dr. Farrow the questions I had written in the margins of the handout. I morphed into reporter mode: focused, curious, unbiased, emotions in check—exactly the way I’d interviewed sources for the Columbia Daily Spectator in college and then as a television producer for ABC News before Emma was born. I learned about the pros and cons of silicone versus saline implants. I was informed of the risks of infection, rejection, and potential leakage. I was told there would be not one but multiple procedures, and that my history of radiation could have created scar tissue that might cause some complications. Just like the mystery of whether the cancer spread to the nodes, they wouldn’t know how extensive the scar tissue was until they got in there.

  As the meeting wore on, the more difficult it was for me to remain detached. I suspected most of Farrow’s patients found shopping for a set of new boobs to be the more uplifting (no pun intended) appointment of the day—the one that looked ahead to the future and helped women believe they were regaining control of their lives. For me, though, it was the opposite. I could feel my shoulders rise, my upper back hunch. More surgeries, more recovery time, more appointments, more pain, more risk of infection, more time away from Emma . . . The words ran on a loop in my mind. And for what? Breasts? I had been strong and secure in Baxter’s office, but I could feel myself growing weak and uncertain in Farrow’s.

  “If you have no other questions,” he said, “we should probably get you on the schedule.”

  I felt as if I were on a speeding subway. Everything was moving so quickly.

  “I have one more question,” I finally said. “Is it possible to do the mastectomy now and then do the reconstruction at a later date? Or does it all have to be done at the same time?”

  “It’s not impossible,” Farrow said, “but the healing process is easier if you do it at the same time. I wouldn’t recommend doing it separately. Now is the time.”

  “Have you had patients who have opted out of reconstruction?” I asked.