CANCER, DIAGNOSIS, LIFE EXPECTANCY, METASTATIC BREAST CANCER, PROGNOSIS

LIFE EXPECTANCY

After the Biopsy

After the biopsy of the tumor in my shoulder—after the biopsy, the biopsy surgeon’s brusque disappearance, the cheery nurse’s averted eyes–I am sitting on the edge of a hospital bed. The bed is in my hometown hospital, in the central-coast-of-California town where I grew up and still live. I have been sitting on the edge of this hospital bed all afternoon. I have been trying to distract and entertain my husband and grown daughter with idle conversation. While I wait for my oncologist, in her official capacity, to deliver the bad news. 

It’s after five o’clock when she steps into the hospital room like she’s walking into a funeral—almost on tiptoes, her greetings hushed and tentative. She rolls a chair in front of me, sits down and says, “The biopsy confirmed the tumor in your shoulder is a metastasis of your breast cancer.”

Picture my oncologist, with her just-beginning-to-gray hair in an about-to-fall-apart bun and her blue eyes as wide open as her sympathetic disposition. I have known and depended upon her for five years now. For the purposes of this story, I’ll call her Dr. Dear. 

Funny how the news you’re expecting can be almost as welcome as the news you wish you were getting instead. After months of shuffling from one test to another, from steroids to muscle relaxants, from physical therapist to acupuncturist, I am relieved to have a diagnosis—even, unbelievably, this diagnosis. I smile and nod. “It’s baaaack,” I say stupidly. Then, “I understand.”

“You’re taking this diagnosis very calmly,” says Dr. Dear. Behind and to the left of her, on the orange-Naugahyde window seat, my husband and daughter sit side-by-side. 

For the purposes of this story, I’ll call my husband Dreamboat–because he’s like the man-of-my-dreams, only married to me. (And every marriage is a boat on the sea, right? Sailing before a beneficial breeze one day, lurching over stormy swells the next?) Dreamboat is tall and slender–a runner of marathons. He sports a frizzy gray ponytail and a goatee, which make him look exactly like what he is: a boyish, aging hippie.

I’ll call my twenty-eight-year-old daughter Progeny, because the best thing I ever did was to create her. I know, I know: everybody’s in love with their kids, or ought to be–but this is my story, so I get to dwell. Progeny is a lawyer who works from home. She has come to the hospital dressed in her usual work outfit: shiny, expensive-looking leggings (gift from her husband? —Married last month. New son-in-law: adorable!); a couple of thin t-shirts (plucked from the barrel of a five-dollar sale?); and the fake-denim puffy vest that called Progeny’s name to me as I passed it in a Christmas shopping frenzy (at Tar-jay) a dozen years ago. Plus, a couple of fragile-looking silver-chained necklaces, light-blue fingernail polish, and the pixie haircut that frames her big brown eyes and delicate chin so they look like what they are to me: ba bump, ba bump, ba bump—my heart.

I will my eyes to tell Dr. Dear what I can’t say aloud: This is me with my daughter and husband in the room. I am mothering right now. I am life-partnering.

Dr. Dear talks about the reports: yesterday’s MRI, today’s biopsy—she’ll release the reports to me over the hospital’s website, blah-blah-blah… Am I signed up? Yes. Do I know how to view…? Yes.

A longer glance at Dreamboat and Progeny confirms that they are not as anxious as I am. Stepfather and stepdaughter, they’re perched on the window seat like a pair of well-trained puppies.  Sit. Stay. Watch me. 

Here to keep me company. 

Here to protect me–though, like puppies, they’re probably not sure how. 

They will understand what Dr. Dear said when they have to: when I explain it. When I explain it better.

Dr. Dear tells me we’ll discuss the next steps soon. She stands, shakes hands, and makes eye contact all around. She is a good person—and an awkward one. I can tell she brought her grief-tending skills—learned in some oncologist’s seminar that only she took seriously—and she’s surprised she hasn’t had to use them. As Dr. Dear  leaves, the discharge nurse comes in. The discharge nurse discharges me. 

Progeny walks us to our car, hugs me tenderly, then goes home to her job and her husband. 

An hour later, Dreamboat and I are in our kitchen. We are nuking leftovers for dinner. We lean against the counter, hip-to-hip, and watch a plate of yesterday’s chicken turn under the microwave’s dull amber light. 

I tell Dreamboat, “I have metastatic breast cancer now. It’s terminal. I’m going to die.” 

Dreamboat is wearing running shoes, like always. Still leaning against the counter, he crosses his right foot over the left, uncrosses, then crosses the left foot over. He sighs and drapes his arm around my shoulder. “We’re all going to die, Baby,” he offers. 

“I’m going to die sooner.”

Step Two

I phone my sister that evening. My sister understands immediately. “If you need me,” she says, “I can be there.” 

I do and, a few days later, she is.

I’ll call my sister Angela because she’s the kindest actually helpful person I have ever met— my-sister-the-angel-on-earth. (Though I don’t believe in angels and other crap like that.) She’s four years older than me, which makes her sixty-three; but Angela is sixty-three-going-on-forty, with her long, naturally-still-light-brown hair and her petite/muscular figure. Since Angela retired, she’s been bouncing from coast to coast, pulling grandma duty for her daughter on the east coast one month, for her son in Southern California the next. 

I have a tumor in my left shoulder. I can’t use my left arm; can’t drive one-handed, especially on all these pain meds. Dreamboat has been driving me everywhere. But Angela bounces to us in time to drive me, in my little Fiat 500, to what Dr. Dear has called a “next-step” appointment. 

I tell Angela that’s “next step” as in Step One: discover you’re dying. Step Two… uhm…?

It has been decades since my sister drove a car in our hometown. On our way to Dr. Dear’s office, I remind Angela to make a left turn at the next light and she does this thing she often does while turning—she speeds up, moves into the turn lane, suddenly finds herself more than halfway through the intersection, does not apply the brakes, makes a hairpin turn, then slows to her usual speed, which is a crawl. 

As I said, Angela is the kindest actually helpful person I have ever met. And she’s one of the worst drivers. 

There’s nothing Angela has to do but stay in her lane for the next mile. She can do that. I gaze out of the car window. Weedy, dried-golden grasses along the roadside. Oak trees. A woman in a lab coat, walking and talking into her cell phone.

I have already Googled every term I didn’t understand in the latest MRI and biopsy reports: infiltrating, enhancing, mass… But the terms that come to me in the middle of the night: prognosis, prediction, estimate—so far, I haven’t pressed Search on those. 

In the Fiat, on the way to Dr. Dear’s office, while the demands of driving are not too severe, I ask my sister the question that has been plaguing me all week: does she think Dr. Dear will offer me a prognosis? “Years or… maybe months… to live?” 

Angela is leaning over the steering wheel as she often does when she drives uphill. (Helping the car with its gravity problem?) She doesn’t say what almost anyone else would say: Why? Are you worried? You shouldn’t… 

“I read an article,” Angela says, “about how doctors are trying not to give those old-fashioned prognoses anymore. Studies show doctors aren’t that good at predicting how much time their patients have left.” 

At the next intersection–controlled by stop signs–Angela waits so long the car behind her honks. She glances in the rearview mirror, then takes off. Crossing the intersection, she says, “I guess that was for me.” 

“I guess it was,” I say and we both laugh. When other drivers honk at Angela, which happens regularly, she always says, “I guess that was for me.” She’s no fool, my sister.

“Anyway,” Angela says, “I have a friend who was given six months to live–eight years ago.” She pauses and coughs this light double-cough: her habitual introduction to bad news. “This guy is dying now—my friend,” she says. “But he did well for a long, long time.” 

We’re coming to the final turn before we enter the medical office complex. I remind Angela to take another left where the big red sign advertises empty office space to lease. She makes a more or less conventional turn but ends up on the left side of the street she has just turned onto–she seems to think we’re on a one-way street–and I’m just about to say something when another car appears: our partner in a head-on-collision-to-be if we were on anything other than this quiet side street. 

Angela says, “Oh,” and pulls to the right. I thank goodness for my tiny Fiat—easy to move out of the way.

The other driver, a woman in a hair-sprayed hairdo and a Mercedes, passes us without looking, or honking, or flashing the finger. Has she just come from Dr. Dear’s office? I wonder.  From the heart surgeon next door? Is she driving home with her own load of worry? With her own bad news?

With a prognosis?

Maybe you pictured it like I did: The Giving of the Prognosis. Like a scene in the kind of television show I watched when I was a kid–where the doctor, a fatherly figure, sits at his glossy walnut desk. His crisp white lab coat buttoned over a crisp white shirt. He wears a tie. On the desktop in front of him, the doctor’s hands are crossed, one over the other, over your case file. Your name typed on the big white label (seen in close-up): SO-AND-SO (comma) MRS. 

You and a loved one sit at the other side of the walnut desk, awaiting news. The doctor speaks. “Well, my dear–Mrs. So-and-So–I suspected this from the moment I first saw you and now, I’m sorry to say, your tests have proven my suspicions correct: you have the rare and incurable Such-and-Such disease.” 

The doctor pauses while you and your loved one gasp, shake your heads, raise handkerchiefs to the corners of your eyes. The doctor frowns sympathetically. Bright stage lighting catches the glint of an almost-tear in the corner of your doctor’s eye. “Furthermore,” he says, “you have only years,”–or… maybe months—”to live.” 

X, in this case, is a one-digit number. Three or five or something. He’s a good guy, this Dr. T.V. Show, but he can’t help being stingy with your life expectancy. It’s only a sixty-minute program.

In my purse, in the Fiat–back here in reality–my phone makes a sound like a small bird burping: the Dr. Dear Appointment alert on my calendar app. I realize Angela is parking. We’re right on time. With a few extra back-ups and forwards, Angela maneuvers the little car into a space made for an SUV.

We don’t get out.

“The doctors who weren’t good at predicting how much time their patients had left,” I ask, “were they over or under?”

Angela does the double-cough thing. “They overestimated how long their patients would live.”

“Shit,” I say, and we laugh. Angela reaches over and I think she’s going to hand me the car key. Instead, she squeezes my hand. I needed that. We get out of the car.

Crossing the parking lot, I tell my sister, “I don’t want a prognosis right now. Help me remember, in case Dr. Dear offers it.”

“What will you say to her?”

“I’ll tell her the truth: I’m not ready for the countdown yet.”

13 thoughts on “LIFE EXPECTANCY

    1. I think it’s great that you know where you are and you aren’t reaching for that step. That step that defines you instead of YOU defining you.

      What a hidden gem, your writing is so visible. It feels like we are there with you in your descriptions. Thank you for sharing your words.

    1. Oh, this is so powerful and compelling, breathtaking in it’s sweetness, heartbreak, humor and exquisite detail. Thank you!

  1. Another courageous, frank, piece–exclusively yours as always. Your crystal clear prose, your humor, the brutal, stark reality you somehow soften with your vast embrace of humanity… all leap off the page.
    As I tackle my own grim subject, I realize how much I can learn from you.
    Count me in as a regular here.

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