Season of Sisters (32 page)

"Probabilities are better than nothing, aren't they? Especially if, like Justin said, she's already overestimating hers."

"The implications of those probabilities are so complicated, so controversial, and so potentially life-changing that in this case, information might well do Holly more harm than good." Grace sighed and toyed with her fork, not eating. "For someone who claims to know nothing about the subject, Maggie, you are doing a fine job of presenting a pro-testing argument."

She turned to Holly. "What is it you would hope to get out of testing? What will you do with the results? You won't be able to trust a negative result."

"Are you certain about that?"

"Yes, honey. I am. My family researched this question within the last year. The only way to get a negative result you can feel certain about is to belong to a family in which the mutation has been identified in others who have tested positive for it. That's not possible in Holly's case, since her mother and aunts have already passed on."

"Oh. Well, there goes my hope of marrying Justin without bringing a guilty conscience to the altar with me."

"A guilty conscience? Why would you have a guilty conscience?"

"I know what it's like to watch somebody writhe in pain for weeks on end and to be helpless to do anything to stop it. I won't do that to those I love. I refuse to."

Nodding, Grace put down the scrolled silver fork. "Okay, with that in mind, let's address the matter at hand. Why would you get tested at all? If you can't trust a negative result, why would you want to know you tested positive? How do you think you would react? Would you do anything different? Would you change how you manage your health?"

"Manage my health?" Holly winced. "I can't say I actually do that. I've always felt why bother to do breast self-exams when I'm a walking time bomb."

For a moment, her confession left her two friends speechless, until Maggie declared, "That's nonsense. I can't believe you'd be that foolhardy with your health."

"You should be ashamed of yourself," Grace added.

Holly didn't know what to say. Hers was a response based upon emotion, not rationale, and she didn't know how to explain it. Instead, she tried to defend. "There's not a lot of health management involved for someone my age. I do see my gynecologist once a year."

Maggie snorted. "Just to get your birth control prescription refilled, I'll bet."

Rather than admit that Maggie was right, Holly addressed Grace's other questions. "As far as how I'd feel if I tested positive... well... I don't know. I don't think I'd be any more afraid than I am now. In fact, it might be a relief to have it confirmed."

"Would you take better care of yourself?" Maggie demanded. "Do those self-exams? Follow a low-fat diet? Exercise? Have mammograms?" She glanced at Grace. "Is she old enough to have mammograms?"

"At twenty-five? Ordinarily, no. However, I think with someone with her family history they do start them young."

"Great," Holly said. "So even if I don't carry a genetic time bomb, the doctors can do me in with radiation."

"Oh, you and your attitude make me so mad. Say you're right. Say you're bound to get it. That doesn't mean you have to die from it, you know. Breast cancer is beatable, especially if you catch it early."

"This is what your Life List is all about, isn't it, Holly?" Grace asked with insight. "They're not so much goals to achieve as things to do before you die. It really is a bucket list. My stars, I never realized what a negative outlook you have."

Testy now, Holly snapped, "It's not negative. It's realistic."

"It's bull ca-ca," Maggie said. "Have you talked to a counselor about any of this? Not a shrink. A breast person. Somebody who specializes in situations like yours. There must be someone like that out there."

"A genetics counselor," Grace said. "Genetics counseling isn't counseling about stress or anxiety, or therapy in a traditional sense. Instead, it explores the issues we've talked about here tonight. Things like making sure you understand your genuine risks of inheriting a genetic mutation and what you can do to minimize those risks. It helps you to thoroughly think through what you would do or feel if you have a mutation and what you would feel if you don't. A genetic counselor also touches on areas like social and job discrimination, privacy issues, and family relationship issues."

"That sounds exactly like what you need, Holly." Maggie stood still for the first time since they arrived. "You've never spoken with a genetics counselor before?"

"I didn't know such a person existed."

Maggie looked at Grace. "Where do we go to get her one?"

"Actually," Holly said, "now that you mention it, I think I read something about counseling in the paperwork Justin gave me about the testing program he recommends. Seems like you go through counseling before they do the blood work."

Grace nodded. "That's good. I'm very relieved to hear that. I know when Sally and I looked into it, some commercial labs didn't require counseling as part of the process. I think that's awful. Just because the technology exists doesn't mean we should use it indiscriminately. People cannot make good decisions without good information."

"I thought you said there weren't good or bad decisions."

"I said right or wrong. That's different from good and bad. Although, maybe 'decision' is not the right word in this case. Maybe what Holly faces is more of a process. She has information to gather, options available to her to learn about that hopefully will empower her."

"Empowerment. Now there's a word I like."

"Oh, me too." Standing at the buffet, Maggie sank her fork into a slice of triple chocolate cake. "I need some of that myself. Although, I did make a stab at it on Sunday. Mike came over and we had sex, then I threw him out of the house."

"What?" Grace and Holly shouted simultaneously.

"It'll keep. Let's finish talking about Holly first."

"I'm done," Holly hastened to say. "I've decided. I have an appointment next week and I'm going to keep it. I'll talk to the counselor and then decide yea or nay on testing. So, Maggie. Tell us what happened."

"I should have known it wasn't UPS. They don't deliver on Sunday."

Chapter 14

Justin and Holly didn't speak as they exited Simmons Cancer Center in Dallas. Justin handed the parking ticket to the valet and while they waited for their car, he clasped Holly's hand. She returned his grip, hard. He was her anchor, her source of strength. She'd have been lost had he not come with her today.

Her thoughts swirled like cotton candy around a paper cone. So much information to process. So many decisions to be made.

She and Justin had just spent an hour and a half with a risk assessment counselor, this after having spent a considerable amount of time prior to the meeting developing a medical family tree and recording lifestyle information. Her brain was full of percentages and statistics, but one undeniable, unsurprising fact came through loud and clear.

She was considered high-risk.

Uh, duh. You've known that since you were twelve years old.

Yeah, but now it was official. The computer models said so. That nice, compassionate genetic counselor had spoken the words aloud. Most telling of all, her risk assessment level was high enough so that her health insurance company would pay for the testing.

The valet pulled up in front of them with Justin's truck and they climbed inside, still not speaking. Holly wondered what was going on in his mind. She wondered if anything he'd heard in the conference room had changed
his mind. No, she wouldn't torment herself with negative thinking.

She cleared her throat. "There's a park bench across the street near the pond with the fountain. It's a pretty day. Would you want to sit there with me for a while?"

His quick glance and a smile reassured her. "I'd love to."

He drove to the city park, leaving the truck in the parking lot nearest the pond. They walked hand in hand toward the graceful wrought iron and wood park bench on the grassy verge and sat down. A small flock of sparrows scattered at their approach and Holly shaded her eyes to watch them swoop and sail off into the pale blue sky. "Flying away does tend to appeal at times."

"You think so?" Justin tucked her closer against his side. "Where would you like to go?"

She closed her eyes and sighed. "Tahiti. Banff. Hearne."

"Hearne?"

"Hearne, Texas. South of Waco on Highway Six. The Dixie Cafe serves the best chicken fried steak with cream gravy in Texas."

"Ah. Health food."

"Did you catch that one graphic the counselor showed us? About diet and exercise?"

He spoke in his Dr. Stuffy voice. "A low-fat diet and regular exercise can significantly lower your risk of developing many diseases, not just breast cancer."

"Still, if four hours of exercise a week can lower a woman's risk of developing breast cancer by forty percent, I'd be a fool not to get up and move. It's something I can do. A way to be proactive."

He nodded. "A way to take some control."

Holly closed her eyes and listened to the soothing sound of the fountain. "What do you think I should do?"

Without hesitation, he said, "Exercise. And marry me."

Something inside Holly eased as she grinned. Not that she'd honestly expected Justin to abandon her, but reassurance was nice. "You know what I mean."

"Ah, honey." He brought her hand up to his mouth and kissed her knuckles. "As much as I love you... as much as I'd love to take this burden off your shoulders... I can't make this decision for you. It wouldn't be right. It's your life, your health."

"You're afraid I'll blame you in the future."

"Sure. Once we're married, I imagine I'll provide you plenty of opportunities to lay blame at my feet. Why start early?"

"Jus-tin," she chastised.

"Hol-ly," he mocked.

She smiled. "The counselor was nice, wasn't she?"

"I was impressed. Good presentation of the data. The visual aids helped simplify complex subject matter."

"Even I understood it, and I went into this entire business knowing nothing."

"I won't mention how crazy that makes me every time I think about it," Justin said. "Or how irresponsible it is for you to have ignored screening of any kind up until this point."

Holly rolled her eyes. "I appreciate your reticence."

"I'm the epitome of reserve."

"Or something."

He grinned, leaned over, and planted a quick, hard kiss against her mouth. Holly sighed.

She reached into her bag and pulled out the stack of papers and pamphlets the counselor had given her. She flipped through the pages until she found the personalized flow charts of steps to take should she test positive or negative.

"I really don't see why I need to test. Look, the procedure they recommend in either case is almost identical."

"True."

"And despite their assurances, can I truly count on my results remaining private? I could face discrimination for insurance or employment. No matter what laws are passed, you know it happens."

"Yes."

"What if the results did come back positive and instead of helping me cope, it made matters worse. I couldn't unlearn the facts."

"No, you couldn't." He paused for a moment, then said, "When will you schedule the test?"

Holly's heart swelled. Justin knew her so well. "I'm tempted to do it as soon as they'll let me, but I'm going to be deliberate about this. Give myself time to be certain of my decision. I may even wait until next fall so I'll be working during the three week wait. I think the waiting for results might be the hardest part of the process."

"It often is."

Holly sighed. "This might be a mistake, but I honestly don't think so. What I've learned in the past few weeks since I started researching has helped. Maybe I'm slowly coming to realize—in my heart, not just in my head—that if I get breast cancer, my experience need not be like my mother's or my aunt's. I don't have to die."

Justin shoved to his feet, threw out his arms, lifted his face toward the sky, and shouted. "Hallelujah!"

"Oh, sit down." Glancing around, she tugged on his khakis. Maybe he didn't have a stuffy side, after all.

He had a tender smile on his face as he looped his arm over her shoulders and pulled her tight against him. "You don't know how good it is to hear you say that, sweetheart. What finally got through to you? The statistics? The visual aids?"

"Grace."

Justin pulled back to look at her, the question in his gaze.

"Before I got to know Grace, my perception of disease came from my experience with my mom and with my aunts. Anytime I heard so much as a whisper about cancer, I buried my head in the sand. Grace didn't give me a chance to hide. She's a special woman, Justin. She's strong and she's vital and she's so courageous—and she's Stage IV. Look how well she's living. That gives me so much hope."

"It should. Things change so fast. Every week a new paper says the opposite of what was said six months ago. Treatment is very different now than it was when your mom and her sisters were diagnosed. Grace's medical management is much different. Honey, you're already much better off than your mother was. Like the counselor pointed out, now that you've been named high-risk, you qualify for all the high-tech screening. You could join a research study and contribute toward finding new treatment methods or cures. Would that count for anything on your Life List?"