Danielle Steel - Lightning

But, as with the lumpectomy versus the mastec-tomy i;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.

He said very honestly that he thought there was almost no chance at all that her mass would prove to be benign. He had just seen tumors like it too often. What he was hoping for her was that it would not have infiltrated, or metastasized, and that there would be minimal node involvement. And he also hoped, of course, that it would be nothing more than a Stage I tumor. She felt herself blanking out on him again, and forced herself to listen and understand what he was saying. She wished Sam were there with her but he was too busy denying that there was even going to be a problem, she hadn't even thought to ask him.

“What about the pregnancy?” Dr. Herman asked her before she left. “How real a possibility is that?” It could affect some of their decisions.

“I don't know,” she said sadly, “for the moment.” She wouldn't know for sure until that weekend.

“Would you like to have some counseling, before the biopsy?” he asked, showing his “human” side again, which was very small, and very seldom seen, but at least he was trying. “Particularly, if you might want to make this a one-time procedure in the event of a malignancy, you might like to speak to a therapist, or some other women who've been through it. Normally, we recommend peer groups, but that usually isn't until later. They're extraordinarily helpful.”

She looked at him ruefully and shook her head. “I don't have time. Particularly if I'm liable to be out of the office for several weeks.” She had to cover all possibilities, and she had already asked Matt Billings to cover for her, and she had given a lot of her work to Brock. She knew he would take good care of it. But she hadn't told either of them where she was going. She had intimated only that she had a medical problem that needed to be worked out, and it could take anywhere from two days to two weeks, but they were prepared to accept that and help her out as much as possible. Brock said he hoped it was nothing serious, and Matthew didn't even think of it, and wondered if she was going to have a nose job, or her eyes done. His wife had done it the year before and he didn't think Alex needed anything of the sort, but he also believed that all women were a little crazy about their looks, and Alex looked so healthy, it never dawned on him that she might have a serious problem.

“How soon do you really think I'll be able to go back to work?” she asked the doctor honestly.

“Possibly in two or three weeks, depending on how you do. And then of course it'll depend on how you do with the chemo. We'd be starting that approximately four weeks after surgery. Some women do very well, others have more problems.” To him it was already a foregone conclusion. She had cancer, the breast was coming off, and she was going to have chemo. Maybe Sam was right and it was just a factory that lopped off boobs to pay the rent, but it was hard to believe that. From what Peter Herman said, it was a lot easier to believe she had a serious problem.

He wanted her to go to the hospital that weekend for blood tests and a chest X ray, and they had discussed the impossibility of her giving her own blood on such short notice. But he had told her that even radical mastectomies rarely required transfusions, and if need be, after the surgery, he would call her office to organize donor-specific blood, and other than that, there was nothing left to say, until Monday. He told her that he wanted to hear from her over the weekend if she discovered she wasn't pregnant, and she agreed to call him. And eventually, she left his office feeling wooden.

She went back to her office for the rest of the afternoon, and home to Annabelle and Sam for dinner that night, and only Carmen noticed how quiet and withdrawn she was. Alex didn't say anything to Sam about her visit to Dr. Herman, until later that night, but when she did, he was already half asleep, and he didn't even answer her, as she explained what the doctor had said to her. And when she looked over at Sam again, he was snoring softly.

She cleared her desk on Friday morning before noon, and Brock came by to pick up some files, and wish her luck the following week.

“I hope whatever it is works out, the way you want it.” He suspected what it might be, he had heard the word “biopsy” in one of her conversations. It was a word that struck fear in his heart, but he hoped that hers wouldn't be serious, and that she'd be back in the office quickly. She said a hasty good-bye to him, and then gave Liz her final instructions. She said she'd be calling in for messages, and she could send work to the house in a few days, if Alex wasn't back yet.

“Take care of yourself,” Liz said quietly, and then hugged her as Alex fought back tears, and then turned away so Liz wouldn't see them.

“You take care too, Liz. I'll see you soon,” she said, exuding a confidence she didn't feel, and then she cried all the way uptown in a cab, to pick up Annabelle at school. It was Friday and they had ballet to go to.

She took Annabelle out to lunch at Serendipity, and then they went straight to Miss Tilly's. Annabelle had never been happier. She was pleased that Alex was around again, and not “busy with the judge” anymore. Annabelle told her in no uncertain terms, over a hot fudge sundae, that she really didn't like that.

“I'll try not to do it more often than I have to.” Alex hadn't said anything to her about her trip to the hospital on Monday, and on Saturday she tried to talk to Sam about what they should say to her about it. She thought a business trip was the best idea, explaining that she was going to the hospital would be much too threatening.

“Don't even think of it,” Sam said, looking annoyed at her, “you'll be back by that afternoon, for heaven's sake.” As he said it, he looked edgy and sounded angry.

“I might not be,” she said quietly, upset that he was continuing to refuse to face the problem. He was clinging to denial. “I could end up there for a week if they do a mastectomy,” she said, trying to force herself, as well as Sam, to accept it, but he refused to hear it.