“And what would you recommend if it is malignant, Dr. Wallerstrom?” Alex asked, trying to remind herself that she was the consumer here, that she was auditioning this woman, and she still had options and choices. But she felt like a child, helpless and without knowledge or control, as the other woman eyed her with dispassion.
“There are the advocates of lumpectomies, of course, in almost all circumstances, but personally, I think the risks they take too often prove them wrong, and a decision like that can be disastrous later on. A mastectomy is the surest way of assuring that you have eliminated the disease, coupled with chemotherapy in most instances, of course. I'm a conservative,” she said firmly, discarding the other school without hesitation, no matter how respected or valid their theories. “I'm a proponent of mastectomies. You can do other things. You can opt for a lumpectomy and radiation, but you're a busy woman, and how realistic is that? You won't have the time, and you may regret it later. Sparing the breast now could prove to be an enormous mistake later. You can risk it of course. It's your choice. But personally, I completely concur with Dr. Herman.” Not only did she agree with him, but she seemed to have nothing to add, no warmth, no kindness, no compassion for Alex as a woman. If anything, she was even colder than Dr. Herman. And although Alex had wanted to like her, because she was a woman, if nothing else, she liked her even less, and could hardly wait to rush out of her office and take a breath of air. She felt as though she were suffocating from everything Dr. Wallerstrom had told her.
Alex arrived at the courthouse at a quarter after eight, and she was shocked to realize how little time the doctor had actually spent with her on such a serious matter, or maybe it was only serious to Alex. To everyone else, it seemed like a very ordinary occurrence. An easy choice. Get rid of the breast, and the problem. It was all so simple, as long as they were the doctors, and not the patient. To them, it was a matter of theories and statistics. To Alex, it was her life, her breast, and her future. And none of the choices were easy.
She was disappointed to realize that having gotten a second opinion, she was no more certain of what would happen to her, no more reassured about the outcome or the options. She had somehow hoped that Dr. Wallerstrom would allay all her fears, and tell her that everyone else was overreacting and being foolish. Instead, she had only heightened Alex's fears, and made her feel even more frightened and lonely. The biopsy would still have to be done, the situation and the tumor analyzed, and the ultimate decision would have to be hers, and her surgeon's. There was still the chance, of course, that the tumor would be benign, but after everything they had said to her in the past few days, it seemed less and less likely.
Even Sam's cheerful refusal to believe the worst seemed patently absurd now. And with his adamant refusal to discuss the possibilities with her, the pressures of the trial, and the fertility medication she knew she was still reacting to, she felt as though she was barely clinging to sanity during the entire week. She felt as though she were walking underwater.
The only thing that kept her from losing her mind completely was incredibly solid support from Brock as they worked their way through the trial, and it seemed like a miracle when the jury absolved Jack Schultz of absolutely everything the plaintiff wanted. They denied the plaintiff everything, and Jack must have thanked her a thousand times. The trial only took six days, as it turned out, and they were finished at four o'clock on Wednesday. Winning had been the only good thing that had happened.
She sat in the courtroom, feeling drained, but looking pleased, and she thanked Brock for all his help. It had been the hardest ten days of her life, harder than anyone knew, and they had done some extraordinary teamwork.
“I couldn't have done it without you,” she said graciously, and really meant it. The last few days had worn her down more than even he suspected.
“You were the one who did it.” He looked at her admiringly. “You're a pleasure to watch in the courtroom. It's like great ballet, or fine surgery. You don't miss a stitch, or a step, or an incision, or a suture.”
“Thank you,” she was packing up their files, with his help, and his words had reminded her that she had to call Peter Herman. She dreaded seeing him again, and the biopsy was only five days away now. She knew nothing more than she had before, except that her visit to Dr. Wallerstrom had confirmed Peter Herman's assessment. And Sam had literally refused to discuss any of it with her again. He said it was a big fuss about something that would never happen. She hoped he was right, but for the moment, he seemed to be the only one who thought so.
She tried to feel victorious about the trial, and Jack Schultz sent her a magnum of champagne, which she took home with her, but she wasn't in the mood to celebrate. She was nervous and depressed, and very frightened about Monday.
The day after the trial ended, she went back to see Peter Herman, and this time he didn't pull any punches. He told her in no uncertain terms that if a tumor that big and that deep turned out to be malignant, she would have to have a modified radical mastectomy, and extensive chemotherapy, and it was best to face it. He explained that she had two choices. She could have the biopsy, under general of course, and then discuss the options with him again afterwards. Or she could sign a permission slip before the biopsy, which would allow him to do whatever he felt was necessary, after he'd done the biopsy. It would mean being put under general anesthesia once instead of twice, and trusting him completely. It was unusual, he explained, to do the procedures in one step rather than two, but he also correctly sensed that Alex wanted to get it over with in a single operation. The only complication would be if she was pregnant. And he said that, whether she was or not, he'd understand perfectly if she preferred doing the procedures in two stages.
But, as with the lumpectomy versus the mastec-tomyi; she had to be the one to make the decision. She had to choose if she wanted to do the biopsy by itself, or in tandem with the actual operation. To Alex, as she discussed it with him, it seemed simpler to deal with it all at once, rather than prolong the agony, and go back to the hospital again for a mastectomy, if the tumor was malignant. She trusted Dr. Herman to make the right decision once he biopsied the tumor. And she had already made the most difficult choice of all since seeing Dr. Wallerstrom. Although the prospect of doing only a lumpectomy was very tempting to save her breast, even the vaguest hint of greater safety by eliminating the entire breast won her over. Both views were heatedly debated by equally respected surgeons, and yet it was clear to her which Peter Herman preferred, and much as she ached at the prospect, she decided to follow his thinking. She had already agreed to the modified radical mastectomy he had described to her, if the tumor proved to be malignant. And to chemotherapy, if he felt it was needed. But they would make that decision later.
But the real agony for her was what she would do if she was pregnant. She knew what she owed Sam and Annabelle, but she also knew how difficult, if not impossible, it would be to give up an unborn baby. Dr. Herman explained very clearly as she stared at him that in the first trimester of pregnancy, mastectomies were always performed rather than lumpectomies, because of the inadvisability of doing radiation. Having a lumpectomy automatically meant the necessity for radiation. But in the case of a mastectomy, if chemotherapy was advised, it would almost certainly cause a spontaneous abortion. It would do the same in the second trimester as well, so if chemotherapy was necessary, it would more than likely kill her baby. It was only in the third trimester that they felt they could afford to wait, and treat the cancer after the baby was delivered.