The Saving Graces (12 page)

   At first I thought I was the only one who couldn't stand Dr. Glass, but it turned out we all hated him. Except for Emma, though, we managed to be polite.
"I don't understand what you're talking about," she said, leaning forward with her head jutting, as if a leash around her neck was holding her down. "You're the only doctor in the room, notice, so would you mind speaking English?" I'd never heard her sound so shrill. It would have embarrassed me-in the majority of situations, I think we accomplish very little by being confrontational-but I was angry, too, and in her way Emma was speaking for all of us.
A lot of framed certificates hung on the wall behind Dr. Glass's desk. He had a tasteful office, a large staff, several prestigious hospital associations. What he lacked was a bedside manner, or even one that hinted he cared at all a-bout the people who came to him to hear the worst news. Maybe he did care, but you couldn't tell it from his dead eyes or his thin smile, and not from his virtually inaudible speaking voice. He moved his lips like a ventriloquist-hardly at all. We had to bend over to hear him, me with my notebook pressed to my chest-I was the official note-taker-and strain to catch his low, rapid-fire mumble.
"I'm saying there is no surgical cure for a cancer that's already spread beyond the site of origin. Still, the patient who presents with stage four metastatic breast disease has a number of treatment options, although some or none may be indicated in the individual case. In this case, we have-" "In Isabel's case. She's the 'patient presenting,' and her name is Isabel." "Emma." Isabel was chalk white but calm, calmer than we were. Even when Glass had enumerated the metastases-"mets" he called them-in her spine and pelvis, both femurs, and her rib cage, she'd sat with her hands folded in her lap and stared straight back at him, not flinching. I could hardly take notes, my fingers were shaking so. It wasn't only the doctor's delivery that made it hard to write down what he said. My mind kept switching on and off, the strangest sensation, as if my fear was shorting out the circuitry in my brain. - At least I wasn't crying. Rudy was crying. To hide it from Isabel, she got up and walked to the window, pretending to look down at the traffic on Reservoir Road. But I saw her sneak her handkerchief out of her pocket and hold it over her mouth and nose. I wanted to shout at her, Don't you dare break down! That's all we would need. Emma's rudeness made a distraction, at least-we could focus on it instead of the horrible, devastating things, one after another, Dr. Glass would not stop muttering.
"In Isabel's case," he said, narrowing his eyes behind his Ralph Lauren bifocals, "where we have carcinomatosis in a distant site, a patient presently in menopause, with a positive estrogen but negative progesterone receptor status, as well as a prior history of cytotoxin-chemotherapy-I'm saying the treatment modalities available to us have narrowed and are somewhat limited." "What about a bone marrow transplant?" Emma kept squeezing the arms of her chair with both hands, as if she'd fly out of it if she let go. "That could cure her, couldn't it?" He bounced his fingertips together and retracted his lips in a slow, annoying rhythm, like a guppy. "There are a number of factors to consider before I would endorse ABMT/BCT. Autologous bone marrow or blood cell transplantation," he said when Emma uncrossed her legs and stomped one boot heel on his carpeted floor. "A number of factors." He turned cold eyes on Isabel. "I wouldn't rule out antiestrogen therapy to begin with, although the fact that you've already tried tamoxifen, with obviously unsuccessful results, makes me less than hopeful on that score. DOwn the road, there's chemo. At this time there's no way to tell whether you'd respond better to HDC or SDC-" "High-dose or standard-dose chemotherapy," I interrupted. "I read about it on the Internet." He actually smiled. "Very good." But the surprise in his voice was insulting, and I sympathized with Emma when she sucked her tongue, tst. "Eventually-it's too soon to say yet-you may decide to undergo what we call induction chemotherapy, a prelude for patients considering I-IDC with ABMT/BCT. It's not a therapy in itself, but it's helpful sometimes in determining whether a cancer will respond to the drugs we use in high-dose chemo. On the other hand, responding to or 'passing' induction therapy doesn't mean HDC with ABMT/BCT will be any more effective than SDC, it simply means the cancer is sensitive to chemotherapy. Also, it doesn't mean you'll live longer or have an equivalent or better quality of life with HDC than SDC." "So really, it doesn't mean anything." "It means exactly what I said it means." We stared back and forth between Glass and Emma, whose eyes were locked. He seemed nettled, but she looked like a witch, a Fury; I could swear her hair was standing on end. Even Rudy turned around, caught by the hostility in the room, thick as a mist.
In the middle of the tense silence, Isabel stood up.
"I'll call you. About hormone therapy, and to set up the test. Tests. What you said, the induction. She waved her hand gently-the real name wasn't important, she meant. All of us, even Glass, especially Emma, looked rueful and embarrassed. Because, for a few mmutes, it had been easier to behave as if the problem here were a personality conflict instead of someone's life. Isabel's life.
We rode down in the elevator in a strange, self-conscious silence until Rudy asked where we should go for lunch. Sergei's in Georgetown, we decided, because we could walk there. We couldn't seem to look in one another's faces, and yet we stayed bunched together in the elevator, arms and shoulders touching, like marchers in a demonstration. Isabel had asked inc to go with her to see Dr. Glass, not Rudy or Emma. Somehow they'd found out, though, and insisted on going with us. That had made me mad; how pushy, I thought, how insensitive. Now. . . oh, God. Now I didn't want to think what I'd have done without them.
We asked for a booth in a corner of the restaurant, and I went to call the office, tell my assistant I'd be a lot later than I'd thought. When I came back, Rudy was ordering drinks.
"Double scotch, rocks," she said-like a man, like my father. Isabel and I asked for iced tea. "Hey, you guys-" -Rudy started to protest, but Emma said, "I'll drink with you, Rude. Beer, please, whatever's on tap." When the drinks came, nobody toasted. That's something we always do, at least for the first one. But this time we just sipped, still not really looking at one another. Everything I thought to say sounded either too light or too dark, so I just sat there. Finally Emma said, "Is it me, or was that guy a flaming asshole?" and we all started talking at once.
Class had been awful, but I wouldn't have said so in case Isabel still liked him-he'd been her oncologist for the last two years, after all. But she told us, "I went to him because I'd heard he was good, and after that there wasn't any reason to switch-I thought I was cured. But I've always thought he was arrogant." "Arrogant. He's a cartoon," Emma said. "I hated him as soon as I looked at him. Did you see the way he held the door for us? Sarcastic bastard." He hadn't wanted all of us in his office. "Just one," he'd said with a fake smile. "Don't you think?" Implying it was silly of us, but cute, a girl thing, to want to stay together. But, no, we didn't think. Part of me could even see his point, and yet I'm the one who said, with particular force and composure, "We think it's important that we all hear what you have to say, Doctor. We're acting as Isabel's surrogate family." He chuckled and spread his hands, trying to suggest that that was absurd. We just looked back at him, not budging, and finally there wasn't anything else -he could do. Emma was right: he had held the door sarcastically.
We ordered lunch. We're eating, I thought. Just like always, just as if something horrible hadn't happened. Isabel got the seafood salad. We could talk about some things but not others. For example, nobody could say, "How do you feel right now? What was it like when he said those things about the cancer in-your body? Are you afraid?" All we could do, it seemed, was be together, ourselves, the same as always.
Emma asked the first really personal question. "Have- you told Terry or your mother yet?" "Not yet. I was waiting until I knew for sure." Isabel laid her fork down and sat back. She'd eaten almost nothing. "My mother won't understand-I probably won't tell her at all. There's no point." Her mother just went in a nursing home; she has Alzheimer's disease. "I'll have to tell my sister, though. And Terry. Oh, God," she whispered, and shut her eyes tight.
Rudy's face turned red; she put her hand over her mouth. Emma looked away.
I said, "I'll call Terry. If you want me to." Isabel reached out and rubbed my arm up and down, hard, smiling with her jaws clenched. "Thanks. I'll call him tonight. It's better." She squeezed my elbow. "Thanks," she mouthed. That was as close as she came to crying all day.
"I can start a Web search," I said, trying to sound brisk. "I've done it before at work. It's amazing how much information is out there, and it's easy to access." "As a matter of fact, Kirby's already doing that." "Kirby? Your neighbor?" Isabel nodded.
"Wait a second. Kirby knows?" I couldn't believe it. Kirby knew, and Isabel hadn't even told Terry yet?
A little color came into her cheeks. She turned her teaspoon over and over on the tablecloth. "I didn't tell you this yet. I didn't have a chance." "Tell us what?" "Kirby She looked up and laughed. "Kirby's in love with me. He says." "What?" "But he's gay." "You said he was gay." "Yes, well. Apparently I was mistaken." "Wow." Emma- sat back and started to laugh.
"So," Rudy said, grinning, pleased. "Do you like him?" Isabel shrugged. "Oh," she said, and nothing else.
"Well, are you, you know..." "Lovers? No." Emma stopped laughing to ask, "Are you going to be?" Isabel's face had been lively for a minute, but now the animation faded. "I might have. I hadn't decided. Then.. .She shook her head. "He's a friend, a good friend." A good friend. It was the first I'd heard. And she'd told him about her illness even before she told her own son. But she'd told me first, and that was...
Maybe she hadn't. Maybe she'd told Kirby first. Even before me. - I hate jealousy. At least it's its own punishment; it makes me feel like hell.
After a while, we started talking about other things, normal things. I wondered if anyone else was as surprised by that as I was. This is how it's going to be, I realized. Whatever happened, Isabel was going to try to make it as easy for us as she could.
Over our coffee, she asked about Henry. "What happened with the sperm test, Lee? Did you get the results yet?" "Yes," I said, "the nurse called yesterday. They've figured it out." "They have?" "What's the story?" I had been feeling guilty for being happy, for having twinges of gladness in the midst of my closest friend's crisis. But now the Graces' expectant faces and excitement, Isabel's excitement, erased all that. "You won't believe it. Henry has too many sperm." Their mouths dropped, then they whooped - with laughter-I knew they would.
"He's so relieved. Normal is between twenty million and two hundred million per millimeter, and Henry's got over a billion." "Get out." "A billion?" "It's a rare condition." "Oh, what a manly man," Emma said breathily. "Tell him I'm awed." "So what happens now?" "Well, we probably can't get pregnant in the normal way. It's a motility problem-he's got so many sperm, they clump together and can't move. So we'll have to do Al. Artificial insemination." "With donor sperm?" "No, they can use Henry's." "Oh, Lee, that's wonderful!" "I am so happy for you." "The nurse said I could be pregnant in six months." Isabel leaned over and kissed me. This was the news that had kept me going. How could I lose hope for her when this blessing was happening to me?
"This is so great. But you know," Emma said, "fifty years ago you'd've been out of luck, Thank God for the miracle of modern medicine." I saw her start to reach for her glass, then stop. A sheepish silence fell. Emma had been going to toast the miracle of modern medicine. Then she'd remembered: the one most in need of a miracle here was Isabel.
"All right," I said, pushing my plate away, "what's the plan? How are we going to work this? I'll get on the 'Net again. Kirby, too-that's great, two heads are better than one." I really meant it. "It sounds like you probably need to decide about hormone therapy first, so that's where I'll start. We still have plenty of time to figure out the HDC and SDC or the BMT, if you decide to go that route. My father knows one of the head oncologists at Sloan-Kettering, they used to be golfing buddies, so I can call him and try to get some referrals, preferably local. You'll need at least two second opinions, don't you think? A different one from Glass's, whatever his turns out to be, and a tiebreaker, that would be ideal, but we'll see how it goes. How is your health insurance? Have you checked to see what it considers standard practice versus experimental?" Emma started to laugh. "What?" Isabel joined her-even Rudy looked amused. "What's so funny?" "Nothing." Isabel put her arm around me.
"Am I being bossy?" "No, you're being great," Emma said. "You are," Rudy said.
"Well, somebody's got to get this thing organized.

   And I'm assuming time is of the essence, right? Am I right?" They stopped smiling.
"You're right," Isabel said quietly, when no one else answered.
"She has to be all right, Emma. She looks great, God, she looks beautiful." "1 know. She's never looked better." "How could this have happened? How can she be so sick?" "I don't know." Emma shook her head, miserable. It was just us now; Isabel and Lee had left Sergei's together at about three, but Emma and I never even got up. It was understood that we were staying. Like old times.
The waitress came over. "Can I get you ladies some more coffee?" "No, but I'll have another scotch," I said. "Just a single this time." Emma lifted her eyebrows at me. "Well, shoot. Guess that means I'll have to have another beer." So we started drinking. Sometimes alcohol really works for me, really is the answer. Not always. But sometimes, something about the way it goes down, easy and clear and-bright or something-well, I can't explain it. But every once in a while, I just know it's going to be perfect.
This time, it gave me the courage to say, "I'm so frightened. It's all I can feel. Oh, Emma, what if she dies?" I could only whisper it. "What if Isabel dies?" She slid out of her side of the booth and sat down on mine, making me shove over. "I'm scared, too. It's all I can think about." "I just can't believe it. Still. Last week she was fine, and this week she might be dying. How can that be?" "She's not dying. People beat it, people have remissions for years, decades. People are cured, you read about it all the time." "That's true." Emma drew vertical lines through the condensation on her beer glass. "My father died of cancer." "You were little, though, weren't you? You didn't see it." "I was eight, and they were already divorced. I don't know anything about it, just that he died of cancer. Of the liver." "I hate cancer." "Because it's slow, so you know. God, I'd rather be hit by a bus. Anything." I stopped tearing my napkin into shreds to stare at my hands. What if I were dying? My skin . . . the shapes of my fingers, the gray-blue veins in my wrists. How could I lose myself? To be something, and then to be nothing. To cease. "She won't die," I said. "She's too young." But I meant, I'm too young.
Emma said, "Can I have a cigarette?" "I quit." "Oh. Okay, that's cool, we'll both-" "Let's buy some." "Okay." She got up and bought us a pack of Winstons.
"Can you believe I've got a date tonight?" she said, blowing a smoke ring at the ceiling. She was back on her side of the booth, and she was changing the subject, changing the mood. For me. She takes care of me.
"Who with?" "Brad. Same guy." "I thought you broke up." "We did, then we sort of reunited. Out of inertia. But tonight I'm telling him it's really over." "What's wrong with him?" "Nothing." We smiled, recognizing that we've had this conversation, about different men, a thousand times. "What's wrong with him?" "Nothing." Emma could write a book and call it that.
She squinted, using her thumbnail to peel the label off the Sam Adams bottle. She was wearing her hair up, to show off the enamel earrings I made her for her birthday. Emma thinks her skin is too pale, she thinks her hips are too big, she thinks her hair is too red or too brassy or something-I've never gotten that one. None of this is true. It used to worry me, how out of touch she is with her own looks, but now I just accept it. It's Emma. Anyway, I have a theory that feelings of inadequacy make people kinder and more tolerant of one another. They help keep us civil. *** "Are you in love?" "Am I in love?" She smirked, pretending she thought I was still talking about Brad. She rolled bits of label into balls and dropped them in the ashtray. Finally she quit playing and said, "How could I be? I hardly ever see him." "Why do you see him at all?" "Well, for one thing, he's helping me with an article I might do about the D.C. art world." "Another article?" "This is different, freelance. It wasn't even my idea," she said defensively. "The editor at Capital liked the piece I did for the paper and suggested I do something like it for them. The state of art in Washington." "Do you know anything about the state of art in Washington?" "No." She laughed. "So Mick said he'd help me." "But doesn't it hurt, Em? Wouldn't it be better if-" "We're friends, Rudy." "I know, but-secret friends." I wished I hadn't said that. It made her blanch. She lit a cigarette without looking at me and stopped talking.
I thought of the night we finally patched up our quarrel over Curtis. She called me at two in the morning, and I came. I found her sitting on the sofa in the living room of her old Foggy Bottom apartment, crying bitter tears and cursing Peter Dickenson, whom she had just thrown out. She'd gone with him longer, been more serious about him than any man since I've known her. They were even talking about marriage.
She'd really scared me that night, but in some ways this was worse. It wasn't that violent grief, that brokenhearted anger that I'll never forget-this was quiet and invisible. It was stealing parts of her, eating her up.
We ordered more drinks. Emma cheered up, and that cheered me up. I love the slow, warming sensation of my body going numb when I drink. It starts in strange places, my cheeks, my triceps, my thighs, and eventually it seeps into everything. It's no wonder people sleep with anybody when they're drunk. I feel such loving calm, such understanding, as if I'm everybody and everybody is me. I can control it now, but when I was younger I would screw anybody. I mean anybody. After a few drinks. - Just then, sure enough, a couple of guys came over from the bar and hit on us. One was cute. Sergei's is good for lunch, but later in the day it turns into a singles bar. Emma scowled at the two guys, who looked like lawyers, both younger than us. She reached for my hand across the table. "Hey, do you mind? We're trying to break up here. Jeez, the insensitivity of some penoAmericans." They said, "Heh, heh," and went back to the bar.
We ordered another round. Emma said, "How did it get to be happy hour?" "Oh, no. Oh, no." "What?"
"Curtis is coming home. I'm supposed to pick him up! Oh, my God." "What time? Take it easy, he can get home by himself. He does it every-"
"The airport. I'm supposed to pick him up at the airport."