Kristopher Jansma - Why We Came to the City

Irene looked around too, as if she couldn’t remember, then shrugged. Why didn’t the doctor just get on with it? She felt sick. That couldn’t be a good sign.

“Usually people bring a friend, or a family member.”

Irene nodded as if taking this under advisement for next time. She searched the doctor’s large dark eyes for some clue as to what she knew that Irene did not.

Dr. Zarrani smiled and then laughed a little to herself. “This morning a woman brought her doorman — a little Hungarian gentleman with red epaulets and a hat.”

Irene smiled, feeling almost at ease, just as Dr. Zarrani cleared her throat and said, “Ms. Richmond, you have cancer.”

Irene looked down quietly. She reached across herself and adjusted the sleeve of her shirt. Her first complete thought was that she shouldn’t get a bird after all.

Eventually she said, “Well, shit.”

Dr. Zarrani continued in a calm and even tone. “The biopsy revealed that the lump under your eye is a malignant osteosarcoma, which is the most common form of primary bone cancer. Tumors in the arm are most likely, but they can also present in the legs and skull. We’ll have to do a more thorough scan to be sure that this is the only tumor, but it’s small, and we’re optimistic that this hasn’t metastasized yet. Of course we’ll need to do more testing to be sure. Very likely a CT and a bone scan, probably an MRI of your head and neck.”

Irene felt dizzy. “Where did it come from?” she asked. Then she rolled her eyes and said, “Wow, sorry. That’s a pretty stupid question, right?”

Dr. Zarrani shook her head, a little dark hair falling in front of her eyes before she quickly brushed it back. “Not at all. Some cancers do have known causes, although you’re correct that we don’t know for sure what causes this type. There have been a lot of studies. We don’t know if it has a genetic component. Environmental causes are possible. We’ve looked at fluoridation in the water, dietary factors, dyes, preservatives, too much red meat, exposure to radiation, pesticides, BPA in plastics, artificial sweeteners, certain types of viruses, high tension wires, using cell phones…”

“And nothing?”

“Nothing conclusive.”

Irene looked away at the blank wall. She wanted to just climb into it and disappear.

“The long-term survival rate for osteosarcoma is fairly high. Sixty-eight percent.”

“Sixty-eight percent doesn’t sound fairly high.”

“Sixty-eight percent isn’t bad. And you’re lucky in a sense. Because you’re so young.”

Irene took a deep breath and shifted her gaze to the floor now. It, too, offered nothing. “See, now to me that seems distinctly un lucky.”

Dr. Zarrani smiled a little. “Sixty-eight percent is taken across the board, over all cases. Including very young children whose immune systems aren’t anywhere near strong enough to handle the treatment. Osteosarcoma affects children quite often, actually. Again, we don’t know why. And then there are the elderly, who generally don’t have the strength to pull through either. What I’m saying is, because you’re young and otherwise healthy, if we take this thing head on and act quickly, your chances are going to be very good.”

A weight that Irene hadn’t quite noticed suddenly seemed to lift from her shoulders, even as the knotting in her stomach got worse. She leaned forward as if she were at a board meeting — arms bent at the elbows, fingers pressed together.

“So what do we do?”

“A team of specialists will review your case.”

“Oh, but I like you ,” Irene said, smiling crookedly. Was she really flirting with this woman who was telling her that she was maybe dying? Used to being confused, Irene was completely bewildered now.

Dr. Zarrani seemed about to say something but stopped herself before it came out. “I’ll be head of your team, but you’ll need a plastic surgeon, a chemotherapist, a radiologist—”

“Radiation?” Irene said, touching her eye.

“It helps to kill the tumor. Though this is delicate because radiation will likely permanently affect your vision in the eye, because the tumor is so close.”

Irene stared blankly down at the table, bracing herself for tears that were not coming. “No. That’s not going to work,” she said. “I’m a painter. Well, more sculpture lately. Doesn’t matter. Thing is, I’m really going to need both my eyes.”

“I see,” Dr. Zarrani said softly. “Well, as I said, we’ll have a specialist take a look.”

“That’s nonnegotiable,” Irene said, even as she intuited from Dr. Zarrani’s gaze that this wasn’t a negotiation. “Oh fuck,” she sighed finally, easing back and looking up at the blank ceiling. After a moment she peeked back again. “What are the odds?”

“Well, as I said earlier, around sixty-eight percent generally—”

“No, I’m sorry,” Irene said, shaking her head. “I mean what the odds are that I’d… I mean, why me? Is this, like, super rare? How many people get this?”

Dr. Zarrani nodded. “Extremely rare particularly for someone your age. As I’ve said, it’s most often seen in very young patients or the elderly. It — well, it isn’t the sort of thing you see often in healthy twentysomethings.”

Irene laughed. “So I’m just lucky then?”

“You could look at it that way.”

“I really couldn’t,” Irene said. “I guess my mother always said I was one in a million.”

Dr. Zarrani smiled. “Osteosarcoma affects about five people in a million, across the whole population.”

“You know that off the top of your head?”

“I’m very good at what I do. Which is why I’m confident that we can get through this together.”

Irene nodded, scanning the bare walls again. “You know, you should really put some art on the walls in here. Everywhere else in this hospital there are, like, banal Water Lilies prints and that sort of thing. You know? Stuff that can kind of fade into the background. But then if you really need some art to look at — like if you’ve just been told you have a thirty-two percent chance of dying — then there’d at least be a Monet print to distract you.”

“Perhaps you could paint — or sculpt — us something,” Dr. Zarrani said.

Irene smiled. “If you can cure me without ruining my eyes, I’ll paint this whole hospital.”

Dr. Zarrani stuck her hand out, over the open file, across the table, and Irene shook it.

“We’ll begin in a week. It may take a few hours. And do bring someone with you next time,” Dr. Zarrani suggested.

Irene shook her head. “I’m not close with my family,” she explained. “Actually, I left home when I was sixteen, and I haven’t spoken to them since. But don’t worry. I can handle this on my own.”

Dr. Zarrani shook her head slowly, and Irene couldn’t escape her sharp disapproval.

“I’m sorry, Ms. Richmond, but I’ve seen Navy SEALs who couldn’t handle this on their own. You’re going to have to have some help. You’ll need people to get you to treatments and take you back again. You’re going to feel sick all the time. Someone’s got to make you eat because you won’t want to. You’re going to need prescriptions filled and insurance claims filed and dressings changed. You see those Lifetime movies with cute little children and pretty ladies who are always stoic and brave and solemn. They might throw up once or twice, some hair falls out, they get a little thinner… but that’s nothing. That’s just for starters. Listen to me when I say this. You are about to go to war with your own body. That’s the best way to describe it.”

Irene felt every fiber of herself, sick and well, tight with fear. What the hell did she know about going to war? Metaphorically or otherwise.