“So, you really think I’m off base here?” he said.
“Yes, I do,” Laurie said. “We will be having him evaluated to see if a professionally trained person thinks he has an issue that can be addressed in any one of a number of ways. We are not agreeing to drugs. Not by a long shot. I don’t think we have much choice. I’m afraid if we refuse, which I don’t want to do, JJ might be asked to leave the school, and unless you want to find another school for him on your own, we have to respect their concerns.”
“Okay,” Jack said, throwing his hands into the air in surrender. “You win. But I have one stipulation. I want the psychiatrist or psychologist who does the evaluating to be a male.”
“That’s rather sexist,” she said.
“Maybe yes, maybe no,” he said. “It will just make me feel a bit better that the analyst can understand my point of view. Humor me!”
“All right, fine,” Laurie said. She was certain that there were plenty of equally qualified men and women in the field, but if a male therapist made Jack feel better, she was for it.
“Okay, now let’s hear about this resident. What’s her name? Nichols?”
“Yes, that’s her family name,” Laurie said. “Her whole name is Dr. Aria Nichols. But first there’s something else we have to discuss. You never asked me about my breast screening today.”
“You’re right,” Jack said. His face fell, and he guiltily put down his fork, giving his full attention to Laurie. “I’m sorry. The visit to the Brooks School this morning got me all out of whack right out of the gate. I’ve been struggling to get back to some kind of equilibrium all day. Lou’s case of the scalded child added to my general muddle. So, what happened at your screening? Or shouldn’t I ask?”
“The news wasn’t good,” Laurie said. She could feel her anxiety ratchet up as the denial she’d been nurturing all day began to crumble. She was able to appreciate Jack’s feeling out of sorts, since she’d been struggling to maintain her own equilibrium since she’d had the MRI. Even now, it took her a moment to pull herself together. “Initially the mammogram was fine, but then something was found on the MRI. When they repeated the mammogram and did a diagnostic study in contrast to a screening test, they could see the questionable mass on the X-ray as well. It’s a little more than a centimeter, but it is a definite abnormality that has to be evaluated. It’s especially important to be looked into because of my status with the BRCA1 gene and since both my mother and grandmother have had breast cancer.”
“I’m so sorry,” Jack said with obvious alarm. “Oh my gosh! That’s awful and frightening news for you to have to bear. And I sincerely apologize again for forgetting you were having your screening today. There is no excuse, although maybe I’m guilty of a bit of denial.”
“It’s okay,” Laurie said. “I had to process the news myself, so I probably wouldn’t have wanted to talk about it much. At least we’re home now and can think about it relatively rationally. At least I hope so. One of the problems is that it seems so very inconvenient with everything else that is going on with Emma and now this issue with JJ.”
“This is super-important no matter what else is happening,” he said. “Are there any plans in place for the next step?”
“It’s the benefit of being a medical VIP,” she said. “The studies have already been looked at by a coterie of radiological higher-ups who all concur the lump is suspicious even though the fact that I have dense breast tissue makes the interpretation more difficult.”
“So, it will need to be biopsied,” Jack said. “Have you spoken to anyone about it?”
“Absolutely,” Laurie said. “They wouldn’t let me leave until I had spoken with both a surgeon and an oncologist, both of whom specialize in breast cancer.”
“Oh, good Lord,” Jack said. For a moment he stared off with unseeing eyes. Ever since his first family had died in a small plane crash after visiting him in Chicago when he was retraining in forensic pathology, he worried that he was somehow a jinx for anyone he loved. The horrid notion had been underscored by JJ’s being diagnosed with neuroblastoma as an infant. Then the superstitious fear had come roaring back when Emma started to retrogress and was diagnosed to have autism. Now, it was again returning big-time with the threat of Laurie’s having breast cancer.
“Jack, did you hear what I said?” Laurie had reached out to grasp his forearm and give it a squeeze.
“No, sorry,” he replied. He refocused his eyes on her, realizing he hadn’t heard what she had just added.
“I said that both the surgeon and the oncologist want to schedule a biopsy.”
“Yes, of course,” Jack said. He shook his head and breathed out through puffed cheeks, sounding like a tire deflating.
“I didn’t want to schedule anything until I spoke with you,” Laurie continued. “What has to be decided in advance is what should be done if surgical pathology determines it is cancer. At that point it can’t be a discussion because I’ll be under anesthesia. Of course, if it is cancer, the cell type has to be considered to some degree, as does whether there is any spread to the lymph nodes. But complicating all that is that I have the mutation in my BRCA1 gene. Should I just schedule a mastectomy rather than a biopsy?”
“God,” Jack murmured while he cradled his head in his hands for a moment, massaging his temples. When he looked up at Laurie, he added: “I’m sorry, but I’m having trouble processing all this.”
“The oncologist and the surgeon both suggested I just have the mastectomy,” Laurie went on, ignoring Jack’s admission. “But I just don’t know how I feel. I know what Angelina Jolie would say: Go for it. But it seems so drastic to me. And then there’s the issue about my ovaries. Should I have them removed at the same time because of the danger of ovarian cancer from the same mutation?”
“Honestly, these are questions that only you can answer,” he said as he began to get hold of himself. “We had all these discussions back when we first learned you carried the mutation. You were pretty adamant then about avoiding disfiguring surgery.”
“That was then, and this is now,” she said. “I’m a bit older and we have two children, which we didn’t have then. I’m certainly more amenable to the idea now, not that I like it. But do you have a feeling one way or the other?”
“You are a lot more important to me and to our children than your God-given breasts and ovaries,” Jack said. “Obviously I’ll be ruminating about all this, but if you asked for my opinion right this minute, I’d say go for it. Have the mastectomy and the oophorectomy, and if surgical pathology says there’s no cancer in your breast lump then the reconstruction is easier. If it is positive, then the reconstruction is a little more difficult.”
“You think I should go ahead and have both breasts removed?” The idea was still an anathema to Laurie.
“I do,” Jack said. “That’s if you forced me to give my opinion right now. Maybe tomorrow I’ll feel differently, but I don’t think so.”
“As the person in the center of all this, I can tell you one thing that I am absolutely sure of...” she said, fighting back tears, “and that is that I don’t want to put this off. If I have a cancer smoldering in my breast, I want it out today, not tomorrow.”
“I can appreciate that,” he said. “I’m sure I would feel the same. I think everybody would feel the same. It’s like walking around thinking you have a time bomb ticking away inside your body, ready to explode at any moment.”