It was two hours later when he came in, and she was still lying there. But he never came to see her. He said not a word to her. She lay there, awake, all night, and Sam slept on the couch in the study.





Chapter 12

The oncologist Dr. Herman had referred her to was located on Fifty-seventh Street, and was a woman. Alex had been told to expect to spend an hour and a half with her the first time, and forty-five minutes to an hour and a half thereafter. There would be two visits a month, unless of course there were any problems, in which case she would see her more often.

Alex had scheduled the appointment at noon, and was expecting to be back in the office at one-thirty.

Both Brock and Liz knew that she was starting chemotherapy on that day, and of course Sam did too. He had left for the office, after their massive argument the night before, without even bothering to have breakfast. And he never called her in the morning to tell her he was sorry, or wish her luck with the chemo, let alone offer to go with her. She had already figured out one thing, she was going to have to get through this without him.

The building was a modern one, off Third Avenue, and the waiting room was well decorated and had an open, airy feeling. It was warmly lit, and decorated in soft yellow, and everything about it was deceptively cheerful. If they had led Alex into a dark tomb, it would have seemed much more appropriate. And for some reason, she was relieved to see that the woman she'd been referred to was her own age. She seemed quiet and capable, her name was Jean Webber. And Alex was pleased to see, from her diploma on the wall, that she had gone to Harvard Med School.

They talked in her office for a while at first, and the doctor discussed the pathology reports with her, and what they meant. It was a relief to be treated like an intelligent human being. She explained that the cytotoxic drugs they would use were not “poisonous,” contrary to common belief, but that their purpose was to destroy bad cells and spare good ones. She explained also that Alex's tumor had been Stage II, which was not great news, but that other than the four lymph nodes involved, there had been no further infiltration. It had gone no further. The prognosis, as far as Dr. Webber was concerned, was good. And like the other doctors involved, she felt absolutely sure that chemotherapy was necessary to obtain a complete cure. They couldn't take the risk of leaving even a fraction of a cell to divide and spread. Only a hundred-percent cure was acceptable, and would assure Alex that she would remain free of cancer. Because of the mastectomy, radiation was not necessary. And because of the nature of her cancer, hormone therapy would not be necessary either. The final results of the tests had indicated that it would not be useful. A chromosomal test had been done too, to examine the DNA of the cells involved, to see if there was a normal or abnormal number of chromosomes, and they had found that Alex's cells were diploid, which meant that they had the normal two copies of each chromosome. She had had the optimum outcome. It was a relief hearing about it, except that even with the good news came bad news. The bad news was that she had had cancer at all, and she had six months of chemotherapy ahead of her now, which profoundly depressed her.

When they talked about it, Dr. Webber understood. She was a small woman with dark brown hair flecked with gray, which she wore pulled back neatly, and she wore no makeup. She had a sympathetic face, and small, neat-looking, immaculate hands, which moved to emphasize what she was saying.

She tried to explain to Alex that while the side effects of chemotherapy could be disagreeable, they were not as fearsome as people believed, and with proper treatment they could be managed. And she assured Alex that none of the side effects caused permanent damage. Dr. Webber said she wanted to hear from her if she was having any problems. And the side effects to be expected, and discussed, were loss of hair, nausea, body pain, fatigue, and weight gain. She might also experience sore throats, colds, and problems with elimination. She could expect to stop menstruating immediately, but she told her that it was not impossible that she would menstruate again after chemotherapy. The eventual sterility rate was fifty percent, but that gave her an even chance of still having a baby, if she still had a husband, Alex thought to herself, as she forced herself to listen to the doctor. And Dr. Webber went on to reassure her that there was no evidence of birth defects afterwards.

There were potential, but remote, problems with bone marrow, though, and her white count getting too low, but these were less than likely. And bladder irritations were not uncommon. Only the weight gain surprised Alex, it would have seemed that with the nausea and vomiting she would lose weight and not gain it, but the doctor explained it just seemed to be an unavoidable factor, like the hair loss. She suggested that Alex go out and select a wig she liked immediately, even several of them. Given the drugs she would be taking, it was almost certain she would lose all or most of her luxurious red hair. But it would grow back afterwards, the doctor reassured her.

The doctor was as informative and as reassuring as she could be, and Alex tried to pretend to herself that she was listening to a new client, and had to hear all the evidence before reacting. It was a good system for her and it worked for a while, but as she continued to listen, what she began to hear couldn't help but overwhelm her. The nausea, the vomiting, the loss of hair, the relentlessness of it made her feel breathless.

The doctor explained that she would have a physical exam each time she came, a blood test, and regular scans and X rays, all of which could be performed in her office. They had the latest state-of-the-art equipment. She told her that she would be taking an oral drug, Cytoxan, for the first fourteen days of every four-week month, and then she would be coming in for methotrexate and fluorouracil intravenously on the first and eighth days of that same four-week month. After the intravenous drugs were administered, she could go back to her office. She wanted Alex to be careful to rest more than usual on the day before they were given to make sure that she minimized the problems and didn't lower her white count.

“I know it all sounds very confusing at first, but you'll get used to it,” she smiled. Alex was startled to realize they had been talking for almost an hour when the doctor led her into the next room for the examination.

Alex undressed carefully, folding her clothes on a chair, as though each moment, each gesture mattered, and she found she couldn't control her shaking. Her hands were shaking like leaves, while the doctor looked at the surgical site and nodded approval.

“Have you picked out your plastic surgeon yet?” she asked, but Alex only shook her head. She hadn't made that decision. She didn't know if she even wanted reconstructive surgery. The way things were going she wasn't sure she cared. And thinking about that brought tears to her eyes, as the doctor pricked her finger for her blood count. Suddenly, there was a catch in her throat for everything, and as the doctor set up the IV, Alex suddenly found herself sobbing and apologizing for it.

“It's all right,” the doctor said quietly, “go ahead and cry. I know how frightening this is. It won't ever be as scary as the first time. We are very, very careful with these drugs.” Alex knew that that was why it was so important to have selected an excellent and board-certified oncologist. She had heard horror stories of people who had been killed by improperly administered chemo. And she couldn't help thinking about that now. What if she had a reaction? What if she died? What if she never saw Annabelle again? Or Sam? …even after the awful fight they'd had the night before. It didn't bear thinking.

Dr. Webber began an IV infusion of dextrose and water first, and then she added the drug to it, but the IV kept backing up, and her vein collapsed just after they started. It was painful, and Dr. Webber immediately took the IV out, and looked at Alex's other arm, and then her hands, which were still shaking.

“I generally prefer the dextrose and water first but your veins aren't looking so great today. I'm going to do a ‘direct push,' and then we'll try this way again next time. I'm going to inject the undiluted medication right into your vein. It stings a little bit, but it's faster, and I think for today you'll be happier if we get this over with quickly.” Alex couldn't disagree with her, but the “direct push” sounded very scary.

Her neat small hands took Alex's hand, and she carefully examined the vein at the top of it, and then injected the medication into it, while Alex tried not to pass out from the sheer emotions. And as soon as she was finished she asked Alex to press hard on the vein for a fall five minutes, during which time she wrote out a prescription for the Cytoxan, and went to get out a single pill and a glass of water. She handed it to Alex, and watched her take it.

“Fine,” she said, satisfied. “You've now had your first dose of chemotherapy. I'd like to see you back here exactly a week from today, and I want to hear from you if you think you're having any problems. Don't be shy, don't hesitate, don't tell yourself you're being a nuisance. If anything seems unusual to you at all, or you just feel rotten, call me. We can see what we can do to help you.” She handed Alex a printed sheet of side effects that were normal, and those that weren't. “I'm on call twenty-four hours a day, and I don't mind hearing from my patients.” She smiled warmly and stood up. She was a lot smaller than Alex and she seemed very dynamic. She was lucky, Alex thought, as she looked at her, she was doing her job. It was just like the people who came to her, with terrible legal problems, and frightening lawsuits. She could take care of them, she could do her best for them. But the problem and the anguish were theirs, not hers. Suddenly, she envied the doctor.