by Jim Cangany
"I don't know. There's a hospital here in Santa Rosa, Sutter something or other. I assume she'll get her treatment there."
"Who are her doctors?"
"Christ, Miranda, I don't know. We're supposed to meet someone on Tuesday, a surgeon I think."
"So you don't know where she's going to get her treatment or who's going to be treating her."
I rubbed my temples. I thought the world of Miranda, but this conversation wasn't helping.
"Obviously not. Been kind of busy trying to come to grips with this. Are you going to keep asking me questions—"
"You need to come home."
"To Indy? What the hell are you talking about? I can't come home."
Miranda sighed. "I'm sorry. I wasn't very clear. You both need to come to Indianapolis. I think Annie should have her treatment here."
"There? Why?"
"Who are you talking to?"
I whirled to find Annie standing at the foot of the stairs. Her hair was still wet, and her eyes, though not bloodshot, still had a defeated look to them. When I told her it was Miranda, she actually smiled and practically ran to my side.
She grabbed the phone and put it on speaker. "Hi Randi, miss you."
"Hey Annie, I miss you too. How are you holding up? And don't give me any song and dance."
Annie leaned against the counter. "Honestly, not so good. I go from denial to anger to tears at the drop of a hat. I'm scared out of my skull."
"I know you are honey. And I have an idea that'll help, if you hear me out."
I turned my attention to dinner while my fiancé and her best friend discussed Miranda's proposal. I knew it was a done deal when Annie turned the speaker off, sat down at the dining room table and asked me for a pen and paper. By the time their conversation was over, Annie had three full pages of notes. She handed the phone back to me.
"Listen up, E.J. Try to relax tonight. Tomorrow, your job is to book a flight to Indy and pack some things. Annie's going to be busy contacting her doctors to get her records sent here. I'm going to have you meet with a doc my mom works with. I'll call you tomorrow when I have the appointment confirmed. Any questions?"
I shook my head. "No. Well yes. Why are we doing this?"
"You're a good man, and Annie's a strong woman. But you have no support system out there. No parents, no friends. Nobody. You've got people that can and will help you here. I gotta run. Give Annie a hug for me."
As soon as I cut the connection, Annie looked up from her notes. "Got your marching orders? I know I've got mine."
I chuckled. "Guess so. You okay with this?"
She gave me her decision-is-made nod. "Yes. That phone call's exactly what I needed."
"Good. But what's up with this Randi business? I've never heard anyone call her anything but Miranda."
"Yes, well, we girls must have our secrets. There's more to Randi than you know. And no, you're not allowed to call her that." Annie raised her eyebrows and for the first in days, she gave me a genuine, ear-to-ear smile that made me think that maybe we might have a chance against this thing.
Three
The minute Annie saw Miranda at the airport, she dropped her bag and ran into Miranda's waiting arms. Annie's back starting heaving as Miranda stroked her hair and spoke to her in a tone too low for me to hear. I kept my distance. This was a moment between friends.
When I drew near, Miranda handed me her car keys. "You drive. I need to bring Annie up to speed on our plan."
"What do you mean, our plan?" Annie said.
"I'll tell you on the way."
While we double-timed it to the car, Miranda explained she was going to serve as Annie's Patient Advocate, her go-to person for any questions Annie might have.
"All too often, people in your situation are totally overwhelmed. Between the doctors, the medical terminology and the insurance issues, just to name a few, the learning curve is impossibly steep. It's not uncommon that a recently diagnosed cancer survivor doesn't even ask any questions because he or she simply doesn't know what to ask. Or if they have a question, they don't know who to approach.
"The hospital will assign a Patient Navigator to help you through the process. She'll answer your questions and get you information. If you want, she'll sit in on your meetings with doctors.
"But I know you, Annie. And I know you may not be comfortable confiding in someone you've just met. That's where I'll come in. If you have a question you're not comfortable asking the Navigator, ask me. If you have a concern, bring it up. I'm sure you both are dealing with a ton of uncertainty right now. I can help relieve some of that."
At the car, Miranda guided Annie into the back seat, grabbed an accordion folder, and joined her back there. They spent the drive to my condo deep in conversation. I caught snippets of things that sounded familiar, like chemotherapy and radiation. Other things, like port and genetic markers, were over my head.
When we got to the condo, Miranda followed us in. The aroma drifting toward us from the kitchen immediately got my mouth watering. I inhaled deeply to make sure before looking at Miranda.
"Irish Stew and soda bread?"
She smiled. "Yep. I figured you two could use some good, old-fashioned, comfort food, so there you go."
Miranda hung out while we got settled in and wouldn't leave until we assured her we were okay. Before she took off, Annie gave her what looked like a bone-crushing hug.
"Thank you so much Randi. I don't know how I can ever repay you."
"Oh that's easy, honey. Get better so we can all dance at your wedding reception. One more thing. When I called you a cancer survivor a while ago, I meant it. You'll have good days and you'll have bad days, but you have not been sentenced to death. You will survive this. Don't ever forget that each day that you wake up is one day closer to beating this thing." She squeezed Annie's hand and headed for the door. "I'll check in after your appointment. Call me if you need anything."
We ate a quiet dinner in a travel-induced stupor. While I cleaned up, Annie flipped through the materials Miranda had given her, jotting down a note here and there. With a sigh, she got up from the table and plopped onto the couch. She kicked her shoes off and propped her feet on the coffee table.
She sat there, with her eyes closed and her head leaned back, taking slow, deep breaths. It was a relaxation technique I'd seen her employ when she'd gotten majorly stressed out on tour. Whether it would help her tonight, I had no idea.
I had a moment of inspiration and brewed one of her favorite drinks. After a couple of deep sniffs of the French Vanilla hot chocolate aroma, she opened her eyes.
"I don't know if it'll cure the cancer, but it'll sure make me feel better tonight. Thanks." She took the steaming, ceramic Kermit the Frog mug in both hands and held it to her nose. Her lips curved upward and then she took a sip.
"So what can you tell me about this doctor I'm seeing tomorrow?" she said.
"We're seeing tomorrow. Nothing much other than we'll see her after we meet with the Navigator. She's affiliated with St. Vincent Hospital. It's about fifteen minutes from here. It's the hospital where Mom worked. I think Miranda's mom works up there now."
I turned on the television. "Enough of this serious business. Time for a few laughs." I slid in a DVD and joined Annie on the couch.
We spent the rest of the evening laughing like we hadn't a care in the world while we watched Young Frankenstein. When it was over, I took Annie in my arms, looked into her eyes, and stroked her hair.
"Can I be totally honest with you about something?"
"Uh huh."
"That—" I pointed toward the TV, but never took my eyes off her. "—is beyond a shadow of a doubt, the greatest piece of cinema ever made."
Her eyes grew wide for a few seconds. Then her eyebrows furrowed and she pushed me down with both hands.
"That? The greatest piece of cinema ever made? How dare you say such a thing?" She climbed on top of me and started poking me in the chest. "There is no way that's the greatest
movie ever."
The pokes were more ticklish than anything. I laughed. "Why not?"
"Because." Annie tried to maintain a frown, but couldn't do it and started giggling. "Because, you dummy, I'm not in it and I know for a fact the best movie of all time in your opinion would have to be one your fiancé is in. Right?"
I grabbed one of her wrists to stop the poking. "Maybe."
"Maybe? Why you little snot." She hit me over the head with a pillow. When I said it didn't hurt, she hit me again and again until we rolled off the couch, Annie squealing in surprise.
It was a well-fought battle, but after a few minutes, I managed to wrestle the pillow from her. Once the pillow was out of her reach, I struggled to my feet and scooped her up in my arms.
"I love you North Star," I said as I carried her to the bedroom. I lay her on the bed, snuggled in beside her and pulled the covers over us.
She took my hand and held it tight against her chest. "I love you too, Lucky Star."
I lay awake until her breathing leveled out and I knew she was asleep. Only then did I allow myself to relax.
"Sweet dreams pretty girl. We start getting you better tomorrow."
* * * *
"Annette Wilson?"
I looked up from the two-month-old Sports Illustrated I was thumbing through. A woman was standing at a door that I assumed led from the waiting room to the exam rooms. She had short, spiky blonde hair and wore a pink ribbon necklace. After a deep breath, I tossed the magazine on the wooden end-table and followed Annie toward the woman.
"I'm Julia Lyons, and I'll be your Navigator. I'd like to visit with you and talk about how I can help you before you see Doctor Furman. Would that be okay?"
Annie gave me a quick look. Her mouth was in a straight line. As intensely private as she was, opening herself up to Julia wasn't going to be easy. She'd accepted the fact that she was going to be dealing with a handful of doctors and nurses. Getting comfortable with additional people was going to take some time.
Anxiety radiated from her as she inspected her finger nails. Out of the corner of my eye, I saw Julia waiting there, a picture of reassuring calmness.
Annie cleared her throat. "That would be fine."
Julia gave us a quick smile and led us down a brightly lit hallway. Paintings of flowers hung every ten feet or so. The third door on the left opened into a sterile exam room. It had the usual sink in a corner, a vinyl covered exam table along one wall, a backless stool for the doctor and three metal-framed chairs.
The flower motif had been carried on in the exam room. A painting of a field of sunflowers hung on one wall. It conjured images of the Tour de France. Given my and Annie's mutual interest in cycling and her half-French heritage, I chose to take it as a good sign.
Once we were seated, I expected Julia to start the conversation. Instead, Annie spoke first.
"I appreciate the patience you showed in the waiting room. Thank you."
Julia leaned toward Annie just a touch. "I'm a nurse by trade. Five years ago, I was in the position you're in right now. Even with my medical background, I felt lost, confused, scared. When an opportunity came up to work as a Navigator for people dealing with breast cancer, I jumped at it. I understand how you may be feeling right now and I'm here to help in any I can."
Annie's nod told me all I need to know. I got out my pen and took notes as Julia gave us an overview of the role she could play for us. She had just promised to research a question about insurance when a nurse came in.
After a brief interview and the routine temperature and blood pressure check, the nurse left. A few minutes later, there was a knock on the door. In the blink of an eye, a razor-wire knot formed in my gut. Here we go.
The door opened and a woman about Annie's size stepped in. She had shoulder length, brown hair that was streaked with gray. Her hazel eyes glittered when she smiled.
"Ms. Wilson, I'm Dr. Ann Furman. It's a pleasure to meet you." They shook hands and Annie introduced me. Something about the doctor's demeanor put me at ease, and I got the sense it was the same for Annie. Maybe it was her warm smile, or the fact that her sweater had little yellow ducks woven into it.
Annie had designated me as her official note taker, so I focused on writing things down while the doctor went through Annie's medical history. When that was completed, the doctor pulled out two x-rays and hung them from a backlit exam fixture.
She flipped a switch and the x-rays lit up to reveal images of Annie's breasts. With a pen she pointed out two masses, one very small, the other larger, in her right breast. Each mass was identified with a tiny, bright square.
"These are images from the MRI you had taken. As you can see, there are two tumors. The bright spots are markers that were put in place when the masses were biopsied. The markers can help us identify the locations of the tumors as your treatment progresses."
She pointed to the other image. "In your left breast, there's a single tumor here. This is where I need to be honest with you. The fact that there are multiple tumors is indicative of a malignant form of breast cancer."
"Form of breast cancer?" Annie's voice came out uneven.
Dr. Furman nodded. "Yes, there are many forms or types of breast cancer. The name of this type is Invasive Ductile Carcinoma."
Annie steepled her fingers in front of her while I flipped to a new page. "All right, what does that mean?"
"Invasive Ductile Carcinoma is a very common type of cancer that grows rapidly, but is very treatable."
"In what way?"
"The standard course of treatment at this stage would involve chemotherapy, mastectomy, reconstruction, and potentially radiation."
A chill came over me as my pen dug into the paper. This sounded bad.
Really bad.
"What do you mean by at this stage?" I said.
"When we are looking at the growth of cancer cells, we identify the growth by stage, and grade. Stage refers to how far along the cancer is, from one to four. Grade refers to how rapidly the cancer is growing, again from one to four."
"And mine is?"
"Stage two, grade three; which means the cancer cells have metastasized and spread to the lymph nodes at a rapid rate." The doctor took a breath. When she resumed, she spoke in a measured tone. "The issue you face Ms. Wilson, is the cancer has possibly reached the lymph nodes. If it has the opportunity to progress, it could spread throughout your body."
"So what are my options?" Annie took my hand as she asked the question. I gave it a tight squeeze.
"There are two courses you can take. One is bi-lateral mastectomy to remove the tumors, followed by chemotherapy to eradicate any other cancerous cells. When the tumors are removed we'll also remove some of the lymph nodes to check them for cancer. If the lymph nodes are positive for the cancer, then I'd recommend a course of radiation to help prevent recurrence of the cancer. The second course flip-flops the chemotherapy and surgery. The advantage to the first course is that you get the tumors removed immediately. However, there is typically a six-week recovery period before chemotherapy can begin, and in that time—"
"Any cancer the surgery didn't get has a chance to grow."
The doctor smiled. "Exactly. I can tell you've done your homework. With the second course, we're able to go after the cancer cells immediately, and if you respond to treatment, we will be able to monitor your progress by feeling the tumors shrink."
I looked up from my notes. "Is there a downside to that option?"
The doctor switched her focus from Annie to me. For some reason, that tiny gesture was more reassuring than I would have thought possible. "Yes. First, your fiancé's options with regard to reconstructive surgery will be somewhat limited. Given her level of fitness, right now I would recommend reconstructive surgery be conducted during the same surgical procedure as mastectomy. And second..." She glanced at Annie's chart. "You're in your early thirties. Have you thought about children?"
Annie and I looked at each other. Children had come up in conversat
ion a few times, but not recently.
"I have," she said.
"As you may know from your homework, chemotherapy can cause infertility. There are procedures available that can allow you to freeze eggs before you start treatment."
"That will cause treatment to be delayed though, yes? And I'd have to take estrogen, which can increase the cancer rate."
Dr. Furman chuckled. I got the impression she was impressed with Annie's level of preparedness. The sound also conveyed a deep empathy she clearly had for her patients. I couldn't speak for Annie, but it made me feel safe.
"You've been thorough in your homework. The answer is yes to both."
"Or I can roll the dice and hope for the best after this is all over."
I felt like I was a step behind in the conversation. Annie and I had discussed many things since her diagnosis, but kids and fertility treatments hadn't been among them.
The doctor let us absorb the information in silence. She wasn't being pushy or bossy, which was reassuring, even though I still felt like a five year old alone in a forest at night. I hoped Annie felt as encouraged as I did. After a moment or two, she gave her decision-is-made nod.
"I want option two."
Dr. Furman made a note in the chart. "Good. Given the current state of your cancer, that's the option I would have recommended. There are no guarantees with fertility procedures and I don't want to postpone your treatment. There are a number of wonderful hematology oncologists with whom I work. Julia will give you a couple of names for your consideration. Before you can start chemotherapy, there are a few procedures you'll need to complete. I recommend a heart scan, a full body MRI and you'll need to decide if you want a port for the chemotherapy infusions."
I wrote as fast as I could while Annie and the doctor discussed these additional procedures. All the while, a question festered inside me, like an abscess that had been left untreated for far too long. When Annie said she was satisfied, the doctor looked at me.
"I know you've been busy taking notes, Mr. McCarty, and that's great. So I'd like to ask if you have any questions."
