The year of goodbyes and.., p.1
The Year of Goodbyes and Hellos, page 1
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Dedication
In memoriam
To Rosenda, Mary Sue, Gloria,
and to all the cancer patients who didn’t get enough time.
Dedicated to Dr. Irene Kazhdan and all the doctors, nurses, and researchers who specialize in oncology, thus making more time for their patients.
Contents
Cover
Title Page
Dedication
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Sixteen
Seventeen
Eighteen
Nineteen
Twenty
Twenty-one
Twenty-two
Twenty-three
Twenty-four
Twenty-five
Twenty-six
Twenty-seven
Twenty-eight
Twenty-nine
Thirty
Thirty-one
Thirty-two
Thirty-three
Thirty-four
Thirty-five
Thirty-six
Thirty-seven
Thirty-eight
Thirty-nine
Forty
Forty-one
Forty-two
Forty-three
Forty-four
A Note from the Author
Discussion Questions
Acknowledgments
About the Author
Praise for Kelly Irvin
Also by Kelly Irvin
Copyright
One
Kristen
Delivering the news required a certain finesse combined with brutal honesty. My technique had been honed over the years. Lean into it. Do it fast. Make eye contact. Adopt a kindly, caring tone. Because I did care. Because it sucked. Then brace for what came after the words that would irrevocably change a patient’s life.
“You have uterine cancer, Mrs. Sedaris.”
Pausing to let the diagnosis sink in, I laid the PET scan report on my desk. My words rattled around in the tiny exam room. Angst sucked up all the air, making it hard to breathe.
My patient, a physical therapist, avid cyclist, and vegan, who glowed with health, stared at the framed North Dakota Badlands photo on the wall behind me. Red blotches blossomed on her throat. She tugged her jean jacket tighter and buttoned it. It provided poor protection against a cold draft. It was a mere sixty-six degrees in San Antonio on the springlike first day of February, so the arctic air temperatures maintained in the Texas Cancer Care Clinic couldn’t be excused.
Still, she said nothing. There were no words to be had.
Mrs. Sedaris’s husband, seated in the chair next to her, clasped her hand. His big fingers, covered with fine blond hair, entwined with her thin ones. “So what now, Dr. Tremaine?” Only a slight quiver in his deep bass voice gave him away. “Will she have to have a hysterectomy?”
She was twenty-six years old and the mother of an adorable toddler with the same silky blonde hair and indigo eyes. She’d shown me pictures of the little girl named Shiloh on her phone the first time we’d met after a referral from her gynecologist.
“Yes. Given that the cancer has metastasized, the surgeon will remove your uterus, ovaries, and fallopian tubes.” She would be thrown into early menopause. Sugarcoating the situation would not help. Most of the time it made things worse. “We have three gynecological oncology surgeons on staff here. An appointment with one of them is next. After you’ve met with him, we’ll map out a treatment that could include radiation and likely chemotherapy once you’ve recovered—”
“But we want another baby. We’re trying . . .” Mrs. Sedaris’s voice broke. “We were trying when the bleeding started.”
“I’m sorry.”
Sometimes those were the only words I could offer. Leaving the uterus and other female organs intact and hoping chemotherapy would eradicate her cancer wasn’t an option—not in my book. Mrs. Sedaris’s symptoms of breakthrough bleeding and abdominal pain didn’t necessarily point to cancer. Her menstrual periods had always been irregular and painful. By the time her ob-gyn sent her for a CT scan, the cancer had spread. Now my job was to utilize all means available to keep my patient alive.
But you’ll be alive, I wanted to say. You’ll be here for little Shiloh and your husband, and all those who love you and whom you love. But I didn’t. Because no oncologist could guarantee that. Not with a sneaky, insidious, smarmy disease that constantly reinvented itself, overcoming every medical tool devised to destroy it. Not when her cancer had spread. She would be in treatment for the rest of her life—however long that might be.
I held out a clipboard with a form that would allow us to send a tissue sample to a company for molecular profiling after her surgery. “With that information we can determine the best treatment options following surgery.”
Mrs. Sedaris didn’t take it. Mr. Sedaris, also blond and blue-eyed but tanned the way a coach who spent his afternoons on the football field would be, did it for her. His chair creaked under his brawny weight, the legs spindly behind his massive calves.
My phone dinged. I took a quick peek. Maddie. When was the last time I talked to my oldest daughter? Our weekly calls had turned into sporadic texts sometime last semester—or maybe it was the semester before. Guilt’s sharp arrow tips tried to pierce my thick physician’s hide and then fell, broken, to the ground. She needed help with her rent after her apartment roommate bailed out at the last second to live with her boyfriend. Which was why I’d been in favor of dorm living. My husband, Daniel, had sided with Maddie. Something he’d done a lot lately.
Think about it later. Later would come in the middle of the night. I added her request to my mental to-do list without responding.
“It’s highly treatable,” I offered as I handed Mr. Sedaris a pen. “We should get started as soon as possible, though. When we finish here, my medical assistant will take you to the surgeon’s scheduler. I’ve already talked to him. He’s expecting to do a preliminary evaluation early next week or as soon as he can squeeze you into his schedule.”
“That’s good.” He laid the clipboard in his wife’s lap and placed the pen in her hand. She scribbled her signature without reading the form. He patted her arm. “That’s good.”
In time they would realize that highly treatable didn’t equate to highly curable. Patients could only take so much in one sitting. “Give me your phone, and I’ll put my cell phone number in it. Call me if you need me.”
She met my gaze for the first time since I’d said the words uterine cancer. “You’d do that?”
The clinic where I practiced had a terrible habit of making it difficult for patients to reach their physicians. Messages disappeared into great voids. I needed to be accessible to my patients. It was my job. “Put yours in mine too. That way I’ll recognize it when you call.”
My phone dinged again. Not Maddie, surely. She knew better.
No, it was Daniel. My husband wanted to remind me we were attending his mother’s seventy-fifth birthday celebration that evening. He’d reminded me three times before I left the house at seven earlier in the day. And two times the previous night after I’d turned off the reading lamp, rolled over with my back to him, and tugged the sheet up around my shoulders.
I ignored his text. Ignored him. That’s what he’d say. But I wasn’t ignoring him, just leaving my response for a more appropriate time. I was with a patient. I’d respond later. Which would be about the time I arrived at the house and found him pacing, ready to go.
The door opened. My medical assistant, Shay, stuck her head in. “Sorry to interrupt. Methodist is calling about Mr. Chavez.”
My hospitalized patient with late-stage colon cancer. I took the phone. “Shay, please take Mr. and Mrs. Sedaris to see Dr. Rodriguez’s scheduler.” I turned back to the couple. “Once we have a date set for your surgery, we’ll schedule you back with me.”
Mr. Sedaris stood. He took his wife’s arm and helped her up, like she was an elderly woman in need of a cane or a walker. I held out my arms. “See you soon.”
She accepted my offering and walked into them. I hugged her tight. Her thin body shuddered. I heaved a breath, let go, and stepped back. “See Dr. Rodriguez and then we’ll make a plan, okay?”
“Okay.” She gave me a watery smile, the first since I’d come into the room. “See you soon.”
Trust and hope lived in those words. The seeds had been planted. By our next appointment she’d be over the shock and ready to participate as a member of the team responsible for keeping her alive.
At least I hoped she would. I wasn’t a big proponent of the so-called power of positive thinking, but a patient determined to fight for survival often fared better. I didn’t know why. I didn’t really care why. Only the results mattered. “See you soon.”
I stepped out into the hallway with Shay. She beckoned to the couple. “This way.” She glanced back at me. “You’re about a
The clinic insisted on scheduling my patients fifteen minutes apart. “How bad is it?”
“Mrs. Cochrane says she’s bringing her sleeping bag next time, and Mr. Johnson thinks we should provide a lunch buffet.”
“I’ll catch up.”
“Uh-huh.” Shay had been my medical assistant for five years. She knew better. “Take your call. I’ll bring Mrs. Cochrane back as soon as I finish with these folks.”
Shay knew I would do my best for the sake of my patients sitting in a crowded waiting room, watching the minutes tick by, some fuming, some numb, some resigned. It shouldn’t be like that, but I couldn’t fix it. This was the price I paid for practicing in a large corporate clinic.
As soon as I finished with the situation at the hospital, I double-timed to the next exam room where a patient with pancreatic cancer had been waiting for half an hour. I put my hand on the knob. My phone dinged. Not Daniel again. He knew better. I let go of the knob and checked.
My sister, Sherri. When was the last time I’d talked to her? She texted me on New Year’s Day from her son Cody’s house in Fayetteville, where she was spending the holidays. We used to talk more, but time seemed to get away from us—or me. I glanced at my smartwatch. Ten thirty. She should be sitting crisscross on the rug in her kindergarten classroom in Kerrville, reading Little Blue Truck to her students. Or trotting in a single-file line to recess. Her life as a teacher had always struck me as idyllic. Not fair, I knew, but so hopeful and full of tomorrows. She gave her students the key that opened the door to a lifelong love of reading. What a gift.
Know yr busy but need to talk. When u can
Tonight? No. She went to bed so early, and I worked. I stabbed a response with my rapid-fire index finger.
Will try to call u on lunch break. are u on cafeteria duty today?
Not at school. In car. Doctor’s office parking lot
The hair on my arms prickled. A cold breeze wafted over me that had nothing to do with the overactive AC. My older sister had always been the picture of health. She loved Zumba, Billy Blanks Tae Bo, and spin classes. Her weight was perfect for fifty-two, likely so were her cholesterol and blood pressure. Last year she finished fourth in the San Antonio Rock ’n’ Roll Marathon’s female fifty to fifty-five age division.
Why? what’s up? are u sick?
Suddenly light-headed, I waited, staring at the little twitching bubbles that meant she was typing a response.
Not sick. Have cancer
Two
Sherri
I didn’t mean to blurt it out like that. Bitter bile rose in my throat. I leaned into the heat blasting from my Equinox’s vents. February in South Texas was mild compared to the rest of the country, but I still shivered. The numbness receded, leaving room for a wave of nausea. The sense of unreality that had set in when the oncologist told me I needed to have a biopsy two weeks ago had painted the world in drab grays and bruised blues. It never really abated, even though I’d been sure the masses revealed in the pleural lining of my lungs by the CT scan would be benign. CT scan results could be wrong or simply confusing. WebMD said so.
Biopsies apparently were less so. Adenocarcinoma. I had to google that word. But the chest CT scan didn’t reveal the whole story. We still needed to know where the cancer originated. Thus the PET scan. I’d had so many medical appointments and missed so much work, my munchkins were starting to ask me questions. Questions I didn’t want to answer. Did kindergartners really need to know their teacher had a life-threatening disease? Did their parents want them to learn about death and disease at the tender age of five?
Not likely.
I leaned forward. My seat belt fought me. I fumbled with it. Finally, it complied and disengaged. I laid my forehead on the wheel and closed my eyes. Another wave of nausea ripped through me. I jerked upright, frantic, shoved open the door, and heaved onto the asphalt. Heaved until nothing more came up.
I glanced around to make sure no one had witnessed my ignominious display of weakness, then closed the door gently. The parking lot hummed with activity. Business was good at Kerrville’s medical arts building. Fortunately, none of the patients trotting through the lot were close enough to see my impromptu performance.
The smell. The taste in my mouth. The memory was so vivid, I gagged again and again. I grabbed a tissue and held it to my mouth.
My stomach lurched at the sound of retching. The grilled cheese sandwich and strawberry milkshake I’d eaten for lunch threatened to come back up. Mom didn’t have much in her belly. A few swallows of the milkshake and toast I’d made and insisted she try to eat. They both came up.
Her face gaunt and her skin an ugly green, she leaned back against her pillow and handed me the red plastic beach bucket. Breathing through my mouth, I gave her a tissue. I would never drink a strawberry milkshake again.
She dabbed at her mouth. The tissue still clutched in one hand, she pushed the scarf that covered her bald head back into place with her other hand. “Sorry, baby. I know this is not how you planned to spend spring break.”
It wasn’t like I planned to go to Corpus with my friends. A bunch of seniors on their last spring break before graduation. I had a job at Dairy Queen. We needed the money. A guy I hardly knew had agreed to cover my shift. “It’s okay, Mom.” I offered her a sleeve of saltine crackers. “Try to eat a few crackers. They’ll settle your stomach.” Now I sounded like a nurse.
Her mouth worked. She closed her eyes. She was so skinny that her high cheekbones looked sharp enough to cut wood. Her long-sleeve Henley shirt, big enough for two of her, hung on her body. “Maybe in a while.”
“Drink some Sprite then.”
She managed a few swallows. Two minutes later it came back up.
“Let me call the doctor, Mom.”
“He’ll just want to write another prescription we can’t afford to fill. Let me sleep. I’ll feel better after I sleep.”
She closed her eyes. I climbed onto the bed and snuggled close, my arm around her shrunken body as if I could somehow infuse some of my healthy cells into hers. Please, God, let it be true. Let her feel better after she sleeps.
Bong, bong, bong.
The grandfather clock’s chimes in my head struck again and again. The sound reverberated. I clasped my hands to my ears. It didn’t help. It first started doing that when Mom was diagnosed with cancer. I’d learned at fourteen that time was finite.
Bong, bong, bong. Not the pretty tunes one would expect. More the “Don’t Ask for Whom the bells Toll, they Toll for Thee” vibe.
They woke me in the middle of the night. While watching my children play on the beach or walking across the stage to get their high school diplomas. Time simply ran out while we were busy doing something else—usually something mundane like flossing our teeth or trimming a brisket.
Bong, bong, bong.
Seriously, God? Dad left us when I was ten. Mom died when I was eighteen. I took over as mother and father to Kris. Wasn’t that enough? I squinted against the afternoon sun beating through the windshield. Are You listening?
Of course He was listening. And biding His time. He had a plan. Do You mind sharing it, Mr. Yahweh?
I knew what He was thinking. Getting mighty big for your britches, blondie.
Kris’s ringtone blared Bruce Springsteen’s “Born to Run.” I jumped. The memories sank into a bottomless chest filled with everything from a first lost tooth to fender benders to a single DUI (son number two) to weddings and the births of my grandchildren.
I sucked in air and let it out slowly. Get it together, blondie. You can do this. I stabbed the green circle on my phone. “Hey.”
“Don’t ‘hey’ me. What do you mean, you have cancer?”
“You’re an oncologist. I’m sure you’re familiar with the disease.”
“Sherri Anne.”
Kris filled those three syllables with forty-plus years of good times, bad times, and everything in between. The two of us against the world. When Dad left. When Mom got sick. When Mom died. Kris and I had each other when we had no one else. I was the big sister. I took the lead. “Sorry. Yes. Ovarian cancer.” I resorted to my big-sister voice. My everything-will-be-all-right voice. “I just came from reviewing the PET scan results with my oncologist.”
