Promise Me (30 page)

I went home to Dallas. I had things to do. SGK was sponsoring a seminar on breast cancer detection the next day, and there were a million details to keep me occupied the rest of the afternoon. One of the display tables featured an array of lifelike prosthetic breasts with lumps in them, and the next morning, as I welcomed our guests, I watched the women stand there, brows knit, palpating the different types of tumors. I don’t know why I’d never felt those breast forms before, but that day I did. One of them felt chillingly familiar.

As I stood there, talking to our audience that day, the knot in my heart tightened.

“A biopsy entails the excision of a lump, from which thin samples are mounted on slides for microscopic examination. The ‘permanent
section’ takes several days to analyze. Results from the frozen section are available within minutes. If a tumor is malignant, a test—the hormone receptor assay—is done to determine if the cancer’s growth is influenced by hormones. There’s a lot of important research being done right now in the field of hormone therapy, and you’ll be helping to support that with your donations.”

The women gathered there looked up at me, trusting what I was telling them, making notes on little yellow pads as I explained the difference between a mastectomy and the new lumpectomy surgery that had now gained wide acceptance.

“If you refer to your handout, you’ll see the statistical differences in … in survival … with the various forms of adjuvant therapy. These decisions are deeply personal, and it’s imperative that we get all the information before …” I cleared my throat, thumbed through my notes. “It’s our responsibility to be vigilant about our own breast health. We can’t just take a physician’s word for it, even when it’s a physician we know and like—a physician we respect and trust. You are the CEO of your own body. Just as a business hires consultants, you look to your physicians to provide you with an expert opinion, but ultimately the decision is yours.”

By the time I left the podium, my face was burning with shame and fear, and I’d decided to practice what I preached. What kind of hypocrite could tell these women to do one thing, then go home and do another? I went home and called the surgeon who’d done my three previous biopsies in Dallas.

“Dr. Fogleman, it’s Nancy Goodman Brinker. I need a second opinion.”

Sitting on the edge of his exam table the next day, I felt considerably less calm.

“This doesn’t feel good to me, Nancy. It’s small, but …” He shook his head and thought for a moment. “If I were you, I’d get it out.”

I nodded. That was a logical response. Good medical reasoning. Get it out.

Okay, Suzy
. I pushed my palms together in my lap.
Now what do I do?

“Let’s head upstairs and do a transillumination,” said Dr. Fogleman.

“Maybe,” I said. “Let me think about it while I get dressed.”

He left the room, and I put my blouse on and combed my hair, calmly instructing myself not to overreact. Dr. Fogelman had said the same thing about the other three lumps. Everything I’d learned in the last three years was very much in keeping with Dr. Ames’s solid advice. I also knew from my research that this test, which illuminates the interior of the breast (it’s also called diaphanography), was probably not going to shed any light, as it were. I never considered those three biopsies that came back benign to be “unnecessary”; there was a question that needed to be answered. The only unnecessary test is one that tells you what you already know, and unfortunately, this particular test has a history of doing that, but it might reveal something about the size and shape of the tumor. I opted to do it.

Reading the results on an infrared-sensitive camera, the radiologist reported a solid round tumor with a clearly defined exterior. Like a little candy-coated gumball.

“There’s definitely something there,” said Fogelman.

No kidding. I bit my lip, tried to swallow my frustration.

“The radiologist thinks it’s benign.” He shrugged. “That well-defined border is a very good sign. Maybe watch and wait is the way to go.”

I forced myself to go about my business for the next ten days, pretending to the best of my ability that everything was fine. I didn’t want Norman to look at me with that somber tick at the side of his mouth. I couldn’t bear to drag Mom and Daddy through this whole thing again. I wanted Eric to feel happy and secure, knowing he was loved by an invincible mommy who’d always be there for him. I went riding with Norman on the weekend, wrote thank-you letters in the evening, fixed Eric’s lunch, attended board meetings and moderated discussions, and spoke pleasantly with Mommy on the phone, even though she kept asking, “Are you sure you’re all right? You sound tired.”

It took every ounce of self-control to keep my hands away from my breast. Every moment I was alone, I prodded and poked it, thinking,
No. It’s not growing. Or … is it my imagination or …

Something was off. It was changing.

“I think it’s getting bigger,” I told Fogelman.

He moved my paper gown aside and ran his fingertips across it. “I think so too.”

I immediately called Dr. Ames. “I don’t care what this is. I want it out. Now.”

“All right. No problem,” he said, trying to soothe me, but I was no longer in a mood to be soothed.

“If you don’t want to do it, that’s fine. I can go elsewhere, but I’ve made my decision.”

“Nancy, I’m as confident as I can be that this thing is benign, but if it’s troubling you this much, then sure, let’s take it out.”

“Immediately? Tomorrow?”

He sighed, good-natured, patient with the impatient patient.

“Sure. Come on down. I’ll give you a local and do it right here in the office.”

Norman was out of town on business, and I didn’t want to wait for him to come back.

“I’m not worried,” I lied to him that night on the phone. “I’d rather just go by myself and get it out of the way.”

I told Mommy the same thing, then called my friend Sandy and asked if she could go to the hospital with me. Doris Bechtold, the wonderful patient care coordinator who’d taken me and my family under her wing that first day we brought Suzy in to M. D. Anderson, greeted me at the door and took me to meet Dr. Ames, who walked with me to the day surgery room.

I lay back on the gurney, and a short curtain was placed under my chin so I wouldn’t be able to see the procedure. Awake and aware, I felt the sting of a needle, then nothing as the local anesthesia took effect. Focused on the faces of Dr. Ames and the assisting nurse, I looked for any sign of emotion. Horror at a breast filled with cancer. Or bemusement at this silly, hysterical woman. There was only concentration, a strange sort of artistry.

“All done,” said Dr. Ames. He smiled behind his surgical mask, and I saw the corresponding crinkle at the corner of his eyes. “I’ll see you in a little while with the good news.”

They wheeled me to the recovery room, where I stared at the ceiling, making occasional small talk with Sandy for what seemed like hours but was probably about seventy minutes. As luck would have it, Dr. Blumenschein
was gone on a ski vacation. I’d have given anything to hear his voice on the other side of the curtain surrounding my bed.

Where is he?
I kept thinking.
What’s taking so long?

Then the curtain slid aside with a metallic hiss, and there was Dr. Ames.

“Well, hello there,” I said unsteadily. “Another false alarm, right?”

“No,” he said. “It’s not a false alarm. I’m sorry, Nancy. It’s cancer. I sent it back twice. They confirmed that the tumor was malignant.”

He was good. Didn’t drop eye contact for a moment. I wish I could say I took it well. It’s not like Dr. Ames was telling me anything I didn’t already know in my heart of hearts, but the words broke over me like a swarm of red wasps, and I flailed to my feet, batting at them.

“
No!
Tell me that’s not right. Tell me it’s—it has to be a mistake.” I choked and started sobbing. “
Please, say you’re not telling me this. You can’t tell me this. It’s not true.
”

Rage and fear pushed everything else aside and consumed me. I think I’d actually convinced myself that it was going to go the other way, that somehow—by learning enough, doing enough, working hard enough, being good enough—I’d inoculated myself in some way. Or that Mommy had. The screaming unfairness of it forked through me, not for my sake, but for hers. Why should she have to face every mother’s worst nightmare twice in one lifetime? The thought of telling her, ripping her world apart again—I pushed my fist against my side, crying so hard my ribs hurt. Sandy stood there horrified, gripping my hand, knowing there was nothing to say. After a moment, Dr. Ames put his arms around me.

“All right, let’s be calm,” he said. “Nancy, you know the drill here. It was small. We got it early. You’ve got plenty of options.”

“Get them off me.” I gritted my teeth, forcing myself to breathe. “I want them both off. Today. Get them off me right now.”

“Nancy, calm down.” Ames folded his arms in front of him. “We’re not making any decisions like this.”

“It’s my decision, and I want them gone.”

“We’re going to sit down and talk about it. Rationally. After you get dressed and take a minute to call Norman and … you should call your mom.”

I suspect he knew I wouldn’t be moved. This day had been hanging over my head like the Sword of Damocles since the day my sister died. I was terrified of every step on the path she’d chosen, and I wasn’t going to go the same way. I wasn’t going to cling to my breasts or to false hope or misplaced trust.

“I’m sitting,” I told Ames a few minutes later, facing him across the desk in his office. “I’m dressed. I’m rational. I want them off.”

“Nancy, I don’t think that’s necessary.”

“It’s not your call.”

“No, but I’m responsible for helping you make an informed decision.”

“Fred.” I almost laughed. “Do you know anyone who’s as over-informed about breast cancer as I am? You know I think the lumpectomy is a great option for a lot of women. I’ve fought for that procedure to be accepted. I’ve given seminars on the advantages and disadvantages. I’ve memorized the statistical differences. Mastectomy versus lumpectomy, with radiation or without radiation, chemo or no chemo. I also know it’s guesswork. Can you honestly look me in the face and tell me for a fact that this cancer hasn’t already hit my lymphatic system?”

“You know I can’t promise anything. But I can assure you …” He rethought the words he was about to say, knowing I’d heard it before. “Let’s run some tests to make sure it hasn’t spread. We’ll do a full body x-ray, bone survey, blood work. Take that time to really think this through.”

“Oh, I’ve thought it through. A thousand times. I thought it through every day while I watched my sister dying. I thought it through every time I felt anything bigger than a mosquito bite on my breast.” I took a breath, trying to ease the angry edge in my voice. “The tumor is close to the nipple. The cosmetic advantage of a lumpectomy doesn’t even apply here. Why should I risk my life—to
any
statistical degree—in order to hang on to a breast that’s going to be disfigured and misshapen anyway? For whose benefit would I be doing that?”

“I can agree with that, but what about the right breast? Removing it would be purely prophylactic.”

“That’s correct,” I said without flinching.

“You know as well as I do, the jury’s still out on the efficacy of that.”

“Well, it’s not the jury’s call either.”

I looked at my hands in my lap, cold but steady. I felt as poised as anyone prepared to jump off a cliff, hoping for deep water instead of rocks.

“Can you take the left breast off tomorrow?” I asked. “We can discuss the rest after we get the test results.”

Dr. Ames nodded. “Sounds like a plan.”

He and Doris Bechtold walked me through the battery of tests. Everything but my lymph nodes appeared clear. We wouldn’t know about those until the mastectomy was done. I was admitted to the hospital, and Mom and Norman arrived that evening. I tried hard to be strong because I could see the weariness and fear in their faces, but the sedative I’d been offered (and gratefully swallowed) left me feeling weepy and philosophical. Every time I closed my eyes I could see Suzy, skinny, scarred, and shivering in the hotel bathtub, her translucent skin no longer able to contain the cancer that ravaged her.

“Mommy?” I didn’t realize I was dozing until I jolted awake. “Where’s Eric?”

“He’s at home. Norman went home to be with him.”

“Oh, God, he must be so scared. And Norman. And
you
must be so scared, Mommy. Are you okay?”

“I’m just fine. Does it hurt?”

“Not really. I just keep touching it because … I’ll never feel it again.”

“I know,” she said, stroking my forehead. “But that’s tomorrow.”

“Tomorrow.” I nodded. “Tomorrow, Mom, we declare war.”

“Yes.” She didn’t look at me like I was dying. “Tomorrow, it’s war.”

“Tonight I just want to feel it.” I cupped my hand over my breast, moving my thumb over the nipple the way Norman did sometimes in his sleep. “It isn’t a bad-looking breast.”

“It’s beautiful,” Mommy smiled. “You wear it well.”

“What should I do about the other one?”

“You’ll know when the time comes.”

I rolled onto my side, and Mommy lay down on the bed with me, spoon-style. I closed my eyes again, allowing myself to be lulled. She talked quietly about being out on the water with Daddy, about the newly remodeled kitchen at Camp Tapawingo, and the matching butterfly blouses Suzy and I had when we were little. There was no pity or fear in
her voice. Her hand on my back was relaxed and warm. She had a cot brought to the room so she could stay with me, and her confident, steady tone got me through the night. Every time I jolted awake, she was there beside me in the dark.

“Mom?”

“Right here, sweetheart.”

“It’s going to be just like Suzy.”

“No. Don’t even start down that road.”

But I was already down the road and around the bend. No one could convince me otherwise. For the first time I think I truly understood how desolate Suzy must have felt.