Two Sisters: A Novel

by Mary Hogan

  “Ready.”

  Pia inhaled hard. She wasn’t ready. Not at all. Nausea gripped her stomach. She wanted to push past the technician and run through the waiting room and exit the hospital and fling open the car door and race home, not caring one whit who saw her nakedness in the flapping blue gown.

  “Put your arm right here.”

  With the skill and speed of someone who had seen every size, shape, and condition of a woman’s breast, the technician chatted about her bum knee as she peeled back one corner of Pia’s gown and ladled her breast onto the cold glass plate of the X-ray machine. “It’s never been the same since I played soccer with my seven-year-old,” she said. “Hold still, please.” Retreating behind a glass partition, she pushed a button that lowered the top half of the glass plate down to flatten Pia’s breast. “Deep breath in. Hold.”

  “Owww,” groaned Pia.

  “Sorry. Hang in.”

  Silence, pain, intense tugging on the skin of her chest, buzzing, then release. The glass plate lifted up.

  “First time?” the technician asked sympathetically.

  “I’m thirty-one.”

  “Ah.” Taking the plate out, replacing it with another, the technician repositioned Pia’s breast and repeated the whole process. “I try to be gentle with the virgins.” She laughed. “Deep breath in. Hold.”

  The awkward, painful process was over in fifteen minutes and Pia was escorted into an examining room down the hall.

  “Dr. Rushkin will be right in,” the technician said before quietly shutting the door behind her. Pia nodded, mulling over the protocol. When a woman manhandles your breasts, should you at least ask her name? Bond as mothers? How does your seven-year-old like school?

  While waiting for the radiologist to come in, Pia stared at the blank light board and cradled her sore breasts as if they were two small children who’d had their first vaccinations. She wanted to place them safely back into her bra. Soon, there was another soft knock on the door.

  “Come in.”

  “Good morning, Mrs. Winston.” The doctor entered and tossed her breast X-rays onto the light box. “Let’s see what we have here.”

  Bearded and soft bodied, resembling a rabbi more than a radiologist, the doctor stroked his chin hair as he looked at the spidery blobs on the screen. Pia heard him breathe in, then out. Then in again.

  “See anything?” she asked, knowing, of course, that he had.

  “Could you please lie down and lift your left arm over your head?”

  Down she went onto the crinkly paper covering the exam table, watching the deliberately placid expression on the doctor’s face as he pressed his fingertips around her left breast in a circle, focusing on the one area she knew he would. She wondered why her whole chest hurt until she realized she wasn’t breathing.

  “I’d like to do a biopsy,” Dr. Rushkin said matter-of-factly. “There’s an area of concern.” Area of concern, Pia repeated in her head. Like Chernobyl or Fukushima. A poison zone. “Right now?” she asked.

  “Yes. You have time?”

  Without waiting for an answer the doctor picked up a plastic bottle of gel and squirted a quarter-size amount onto a sonogram wand. “It won’t take long. Lie still, please.” Pressing the wand to the side of Pia’s left breast, he watched the image on a monitor. Pia subtly twisted her neck to see. It was similar to Emma’s ultrasound. Then a darker thought intruded: Emma’s image was the beginning of life; this is the outline of death.

  “I’m numbing the area now. You’ll feel a small pinch.”

  With the spot marked on the sonogram screen, he injected her breast with an anesthetic. As he continued, he narrated his actions.

  “Tiny incision. Locating the tissue. Hold still. There.”

  Pia heard a snapping sound. She felt pressure, like a painless hole punch. When he said, “The bleeding will stop soon,” she wondered if she would have time for that manicure after all.

  “Keep the gauze and bandage on overnight.”

  Dr. Rushkin showed her the maggot-size piece of pink tissue he’d removed and inserted in a glass tube. She looked at it, then looked away. A piece of her body was outside herself, beyond her control. Soon, she would belong to medicine. No longer a person, but a patient. There could be no more denying. No further lying. Though the incision stung a little, it was no worse than a nick from cuticle scissors. Which reminded her: she should call Tara at the nail salon to see if she could take her first thing tomorrow morning, after she dropped Emma off at school.

  THE PHONE WOKE her. Will’s side of the bed was empty. He was already downstairs. The aroma of morning—coffee, buttered toast—eased her abrupt awakening. When Will didn’t answer on the third ring, she picked up.

  “Hello,” she said, heavily, sleep still trapped in her throat.

  “Mrs. Winston.”

  Those two words knocked the wind out of her. Dr. Rushkin’s distinctive voice, a throaty monotone, sounded whisperish even when he spoke normally . She could picture his thumb and index finger stroking the beard on his chin. In her mind she could see his sad eyes.

  “Good morning,” she said, steeling herself. A radiologist, she knew, wouldn’t call first thing in the morning with good news. Doctors sent good news through the mail in a form letter with their signature scribbled at the bottom. With a difficult notification they divested their desks of it early in the day, before patients arrived and bedside manners were required. Even so, when Dr. Rushkin’s low voice announced, “The biopsy came back positive,” Pia paused, not sure if positive meant good or bad.

  “Are you saying I have cancer?” she asked.

  “Yes,” he said. “You have cancer. The lab just faxed me the results.”

  Suddenly, Will appeared at his wife’s side holding two mugs of steaming coffee. “What did you say?”

  Cupping the phone, Pia whispered, “Thanks for the coffee, sweetie,” in a dismissive way. Will sat on the bed and set the mugs on her bedside table.

  “Coasters,” she mouthed. Into the phone Pia said, “Can I call you back?”

  There was a pause before Dr. Rushkin said, “This can’t wait, Mrs. Winston. Do you have a pen?”

  “Yes. Yes, I do. One moment.” She reached past Will into the bedside drawer for a pen and a Post-it note. Then she said, “Go ahead,” and wrote down the name and phone number Dr. Rushkin gave her. He said, “I’ll tell him to expect your call this morning.”

  “Will do!” Pia chirped before hanging up.

  “Who was that?”

  “The coffee smells divine, my love.” Pia reached for the warm mug and encircled it with both hands, trying to still the shaking.

  “Pia.”

  Pasting a fearless expression on her face she said, “It appears as though God is testing us today.”

  Chapter 19

  “EVERYTHING OFF FROM the waist up.”

  Those six words replaced the only other words Pia had regularly heard in a doctor’s office: “Don’t forget sunscreen.” Dr. Rushkin had been referred by her gynecologist, the best in Connecticut. Rushkin, in turn, referred her to the best oncologist in the state, Marc Payton. Joked Pia, “If our doctors were the worst this could all be a mistake.”

  Will hadn’t laughed. He hadn’t said much of anything since he heard the awful news. Not once did he say, “I felt that lump more than a year ago. You assured me it was nothing.” He didn’t glare at his wife with a set jaw. Never did he angrily turn to her and scream, “How could you be so goddamned careless with your life?”

  His feelings of fury, he told himself, were probably fear. Losing Pia, the linchpin of the Winstons’ life, was unthinkable. Why, she made his very life possible. Without her . . . there was no without her. Period. And there was no use flinging accusations or demanding an explanation. As much as he wanted to know, needed to know how she could do this to him—how she could be so goddamned careless with his life—what good would it do? It was too late. They could never turn the clock back to that night at the Gree
nbriar when Pia could have caught her cancer early. Christ, they were at a health spa! Doctors were on staff. They could have X-rayed her chest the very next morning and seen that the hard pebble was self-contained—a misshapen wart that could be scooped out with a surgical melon baller. Instead of a fucking facial, why didn’t she go to the clinic? It was right there at the resort! At the very least, they would have told her to see an oncologist the moment she got home. Pia let him play golf while her cancer was morphing into a jellyfish, its tentacles spreading and eating away her life? How could she be so goddamned selfish?

  Will said nothing. He felt his chest burn as he held her hand and bit his tongue and sat next to his wife in Dr. Marc Payton’s office—the best oncologist in the state of Connecticut—while his entire world exploded in front of his face.

  “There’s no way to sugarcoat this,” Dr. Payton said. Head of oncology at Connecticut General, he had the ideal sprinkling of gray in his inky black hair. Enough to trust him, but not so much that you mistrusted his ability to keep up with the cutting edge. His office was distinctly Swedish in decor. Finely grained light wood, clean lines, no frills. On his wall was the obligatory framed diploma, on his desk photos of his athletic son, lovely daughter, and fit blond wife.

  “Spell it out.” Will gripped Pia’s fingers so hard she could no longer feel her hand.

  Dr. Payton looked down at the manila folder on his desk. “The PET scan has revealed some distressing news. The cancer in your left breast has metastasized, Mrs. Winston. Meaning, it’s spread.”

  “We know what the word means, Doctor,” Will said. “How far?”

  “Far, I’m afraid. The scan shows evidence of cancer in your lungs, rib cage, and liver. I’m sorry.”

  Dr. Payton spoke directly to Pia even as Will asked the questions. Pia extricated her hand from Will’s painful grip as Dr. Payton said to her, “Had we caught it earlier, we would have more treatment options.”

  “How could I possibly discover breast cancer?” Pia asked, indignant. “I’m thirty-one. Isn’t a baseline mammogram at forty?”

  Will shot her a sharp look as Dr. Payton quickly said, “I didn’t mean to imply in any way that this is your fault. An aggressive tumor like this is rare at your age. And not at all fair, Mrs. Winst—”

  “Call me Pia.”

  “Of course. Pia.”

  “There must be a mistake. I feel absolutely fine.”

  That was a lie. For the past several months, Pia felt almost crippled by exhaustion. Her body ran out of gas by noon. She’d never been like other women who dragged their asses through life. Always, Pia had energy to spare. Will had married a domestic CEO, she often told him, who ran Winston Corp. with ease and confidence. Until lately, she had been great at her job. Never once needing an afternoon nap or a fortifying cappuccino. Balls were never dropped. For the past few months, however, she’d felt energy drain right out of her body the moment she pulled herself out of bed. And she never told a soul that she’d once parked in a far corner of the lot behind Ann Taylor to sleep in her car one afternoon because she feared driving home. The mere energy it took to concentrate on the road seemed beyond her. Is that what cancer felt like? A punctured fuel tank? A deflated balloon?

  “There’s no mistake,” Dr. Payton said. “Cancer affects everyone differently. Clearly, you have a high tolerance for discomfort.”

  Pia straightened herself in the soft chair.

  “What’s the plan?” Will said, leaning forward.

  As she watched Dr. Payton’s lips move, Pia heard only buzzing in her ears. How many times, she wondered, had he delivered this same bad news? Surely, it was the worst part of his job. Patients probably slumped over in their chairs, sobbing. Did they scream, “No, no, no!” Did black mascara run down their faces in two long tread marks? She noticed a teak tissue box on the patient side of Dr. Payton’s tidy desk. In her mind she pictured the scene: An interior designer dressed in a Chanel suit sat in this very chair and reached her hand forward. “The box should go here,” she said. “Within reach.” Fumbling for a tissue would never do, not at a moment like this. And she would advise against leather upholstery. (“Too impersonal.”) Though she would urge regular cleaning of the wool fabric. Smelling a previous patient’s desperation would be insensitive, at best.

  “. . . aggressive round of chemotherapy. Commencing immediately.”

  Pia glanced about the room noting the soothing wood tones, taupe carpeting, filtered overhead lighting. Had it all been on the designer’s blueprint? Decor to soften death’s blow?

  “Mrs. Winston?”

  She turned her head. “Pia, please.”

  “There is no easy way to deal with news like this, Pia. Breast cancer research is well funded and moving forward daily. There have been remissions at your advanced stage. All we can hope is—”

  Remission, she thought. The very word itself hinted at impending doom. As if cancer were merely on the run and would eventually turn itself in.

  “What about surgery?” Will asked.

  “Surgery is not a viable option.”

  “We want a second opinion.”

  “Will.” Pia looked apologetically at Dr. Payton. Death was no excuse for bad manners.

  “It’s okay,” Dr. Payton said, to which Will replied, “Nothing is okay about this.” There was no time to be polite. That morning, as they sat in Marc Payton’s waiting room, Will had been shocked to see so many sick patients. Eyebrowless ladies in turbans, sallow-skinned men with portable oxygen tanks, caregivers wearing surgical face masks, lamppost-thin women hugging themselves into layers of thick cabled sweaters. If Payton was the best, why did his waiting room look like death’s foyer?

  “A second opinion is entirely understandable.” Dr. Payton lightly pressed his fingertips together. “I would advise you to schedule a consult immediately, however. These cancers spread at an alarming rate. I’ll messenger the scan results to whomever you choose. But, please, Mrs. Winston—Pia—get treatment as soon as you can. If this were me, or my wife”—for the first time he spoke directly to Will—“I’d start today.”

  Pia lifted her perfectly pointed chin. “That’s not possible. Emma has a soccer game.”

  THE SECOND OPINION was worse than the first.

  “Quality of life is a consideration here,” they were told. “Some of my patients choose palliative care at this point.”

  “Palliative?” Will tensed up, as though he was about to punch the doctor in the face. Pia rolled the word around and around in her head like sheets in a dryer, until her thoughts were a giant knotted ball.

  “Thank you,” she said politely, holding her purse with both hands to steady the shaking. She then stood up and walked out of the room without looking at a soul. After finishing the consult on his own, Will found his wife sitting in the car, staring blindly out the windshield.

  “Sweetheart—”

  “Take me home.”

  “We’ll go to Sloan-Kettering in New York.”

  “Please, Will. I want to go home.”

  In silence, Will drove his wife to their beautiful Connecticut house, its four dormer windows embedded in the pitched slate roof. A fieldstone facade extended all the way to the three-car garage. Glossy white shutters trimmed each French window, and, of course, a gently sloping emerald-colored lawn rolled down to the street. Anyone driving by that home would think the inhabitants had it made. Not a care in the world. How stupid people are, Pia thought. Utterly clueless.

  Inside, Blanca was drying her hands on a kitchen towel, her thick eyebrows pressed together. “Okay, Miss Pia?”

  “Fine,” said Pia with a sad smile. “Would you please put the water on for tea?”

  Alone, Will climbed the staircase to their master suite. Blanca had already made the bed, opened the drapes covering the gleaming glass doors leading to the sundeck. He peeled back the comforter on Pia’s side of the bed, arranged it in a neat triangle, fluffed her down pillows, and smoothed the soft linen sheets with both hands. Then h
e walked into the huge closet on his side of the dressing room, shut the door behind him, and wept.

  Chapter 20

  IMMEDIATELY, PIA WAS sucked into the cancer vortex. Her body ceased to belong to her; it was now the property of Connecticut General’s shiny new cancer wing. What Pia needed to do, the white coats told her, was fight. The very cells that gave her life had become enemy invaders crouching in dark corners, reloading ammo. Battling them on their own turf was her only means of self-defense. But they were wrong. For the first time in her life, Pia Winston understood that surrender was her only option. If she stood a chance at all, it would be because she released herself to the ugly machinery of cancer—hard plastic scanners with doughnut-hole entrances; robotic arms shooting burning, disfiguring radiation; thick IV needles attached to cloudy tubing; saggy bags of hideous pink fluid.

  “Everything off from the waist up.”

  Without question or comment, Pia had to do what she was told. Surrender to a team of strangers. Giving in was the only way not to give up.

  But surrender had never been her style.

  “This way, honey.” Will gently cupped Pia’s elbow as he guided her to the hospital’s elevator. He spoke in a reverent whisper. She wanted to elbow him in the sternum.

  “I’m not an invalid,” she said icily.

  Looking like a lost child, Will shifted his hand to his wife’s back. Pia felt the warmth of his flat palm. It took all her strength not to whip around and glare at that hand until Will returned it to his own damn body.

  “We’ll need to sit down with Emma,” she said. As soon as the elevator doors opened, she stepped inside and nestled in the far corner. Will stood woodenly beside her.

  “Level C, please,” he said to the woman in scrubs nearest the buttons. She nodded and darted a sympathetic glance in Pia’s direction.

  In that slowly descending elevator, Pia’s heart beat so hard it hurt. She wanted to jam the red emergency button, kick open the doors. What good was all that Pilates if she didn’t have the strength to pull herself out of an elevator stuck midfloor? If she kicked off her shoes she could probably outrun Will, what with all that pizza he ate at the office. Outside she would hide, then call a taxi. She’d have the driver drop her off at the Sound. Will would never think to look for her by the water.