“Joan, the only way to know for sure is a biopsy. Do you have a surgeon you prefer or would you like to talk with Dr. Eliopoulos?”
“Dr. Eliopoulos is fine.”
“Good. I saw him a half hour ago in the hospital dining room and we talked a little about you. He does not have office hours today, but he will come in to talk with you.”
“When?”
“You should call him and arrange that. Tell him when it’s best for you.” He gave her the number.
“Okay.” Joan didn’t want to hang up. She wanted Barry to tell her something that would make her feel better. She wanted to say, “Can’t you tell me something better?” But there was nothing to say. Nothing he could say. Joan said, “Okay, Okay. I’ll call Dr. Eliopoulos,” and she hung up.
She said to Ace, “It’s a very, very, very suspicious mass, he said. I have to see Dr. Eliopoulos this afternoon.”
“I’ll come with you,” he said.
“Yes.”
“You want me to call?”
“No, I will.”
“He couldn’t say if it is certainly malignant?”
“No,” she said. “He says a biopsy is the only certainty.”
“That’s what we’ll go with then,” he said. “So far we still don’t know. And that’s how we’ll act.”
The last vestige, she thought, the last vestige of hope. Maybe the biopsy will come out negative. Very, very, very suspicious. “Christ, that doesn’t sound good,” she said.
“What?”
“The very-very-very-suspicious. That doesn’t sound good at all.”
“No. It doesn’t. But it sounds better than you-have-breast-cancer. We have to deal with what we have and not with what we fear. We know this much and that is what we know. We stay with what we know. We have to do that.”
She nodded. “All the news is bad news,” she said. “Never all week do we get any hopeful news. The whole week has been getting a little worse, and a little worse. I want to find out what the bottom is like.” She dialed the number Barry had given her.
The secretary who answered knew Joan’s name. Joan’s voice was steady but it was very, very hard not to cry.
“The doctor will be here in a half an hour, and he’ll meet you here in his office.”
Joan said, “Yah. I’d like to bring my husband.”
And the secretary said, “Oh, my all means.” Very kind. Everyone is very kind. Oh God, this isn’t good. They are too kind. They’re really being too nice.
They were kind, too, in the doctor’s office. Joan and Ace were brought right in. Dr. Eliopoulos appeared at once. A tall man, with large strong-looking hands. Surgeony-looking Joan thought. Joan lay on the table and Eliopoulos examined her breasts. The nurse stood by, and so did Ace, feeling oddly out of place and almost explosively protective. Joan could see him obliquely, leaning against the wall in the corner of the office, his arms folded across his chest, his face blank. It was a characteristic pose. How often I’ve seen him like that.
“Okay,” Eliopoulos said. “When you get dressed, come in the office and we’ll talk.”
As Joan put her bra and blouse back on, alone with Ace in the examining room, both of them were thinking about being railroaded. They’re not railroading me, Joan thought. They’re not pushing me, Joan thought. They’re not pushing me into mutilating surgery because I’m a woman and it’s easier for them than long-term management.
She’ll have what she wants, Ace thought. It’s her body and her life. I will see that she gets what she wants. But, Christ, I hope she goes for the surgery. I hope she doesn’t fuck around with this and lose her life for a goddamned abstraction. I want this settled. But she’d get what she wanted. He perceived his life in simple and somewhat dramatic terms. That’s what I’m for, he often thought. If they want something I see that they get it. They didn’t always get it, and he didn’t always see to it that they did. He knew that too. But it was a guiding principle, and it helped him decide what to do.
In the office they sat across from Dr. Eliopoulos and he said, “Well, we’d better go ahead with the biopsy.”
“And if it proves malignant?” Joan said.
“Then I feel we should go ahead and do a modified radical mastectomy.”
“While she’s still under?” Ace said.
“That’s the best way. If it’s malignant there’s no point to two surgical procedures.”
“Why a modified radical?”
“I don’t do radicals,” Eliopoulos said. “The survival rate, we’ve found is the same for modified radicals as it is for radicals.”
“What’s the difference?” Ace said. He didn’t want to dominate a discussion that was hers more than it was his. but he knew how sick and numb she must feel and he plowed ahead. She’d interrupt as she wished.
“The so-called Halsted Radical,” Eliopoulos said, “takes pectoral muscle as well as the breast. In the modified radical we don’t take muscle.”
“Why not just do the lump?”
Eliopoulos shook his head. He was never in doubt and the certainty with which he spoke and the fluency of his explanation had a part in their decision. He was very clear about what he thought. “A lumpectomy is not good medicine. I won’t do it. There may be someone who will, but I can’t. I think it’s immoral. If you just excise the lump itself, you have absolutely no way to know if the malignancy has spread and if it has how far it has. This is an amorphous lump. It’s outlines are not distinct.”
“And chemotherapy,” Joan said. Her voice was steady.
“Chemotherapy is a fallback position. If you start with chemotherapy and it doesn’t work, then it’s too late for the mastectomy and you have nowhere to go. Again. I won’t do it. I think it’s bad medical practice. There is one doctor in Boston who will do it, I think, and I can give you his name. But I can’t do it.”
“Why is it too late?” Ace said. There’s that harsh edge, Joan thought. When he argued, or when he was after something, as he was here, he made her very uncomfortable. He had no skill to do it gracefully. When there was something at stake, a harsh rather ugly tone developed. He was capable of asking someone why six or eight times in a row, backing them down to the essence of their position. Usually she hated it. Here she did not. We have to know, she thought. Go ahead, we have to know.
Eliopoulos said, “As with the lumpectomy, you don’t know what you’re dealing with. You don’t know how far it has spread and thus you are working blind. You need to biopsy the lymph nodes.”
And it went on. Often over the same ground twice. Eliopoulos careful, thorough, unhurried, unoffended. After a half hour of very grueling discussion, Joan said, “We’re taking too much of your time.”
“No,” Eliopoulos said. “No, that’s perfectly all right. Take as much time as you need. It’s an important decision.”
“I don’t mean to push you to the wall, Doctor,” Ace said, “but I don’t know how else to ask.”
“I understand that,” Eliopoulos said. “You have every right to get all the facts.”
After an hour of question and cross-question Joan and Ace felt half disembodied, floating among the questions, in the clean medical room with the textbooks on the wall and the framed diplomas and certificates.
“I know what I think,” Ace said. “But I won’t tell you my decision till you’ve told me yours. It must be yours and I don’t want to influence it.”
Joan said, “Yes. I know what we’ll do. On the operating table, if this lump has been removed and found malignant, a modified radical mastectomy is called for.” She said it formally, carefully, as if saying it just right would help make the decision just right.