“THANK YOU FOR COMING,” DR. HOUSEMAN SAID. HE WALKED around his desk to greet her and folded Erin’s hand into his own. “This has been a difficult week for you. You must be exhausted.”
“I’m just getting used to it,” she said. “I feel like I’ve been playing catch-up since I got here.”
“Yes,” he said, “I can imagine.” He motioned for her to take a seat and closed the door to his office. Instead of returning to the chair behind his desk, he grabbed the one next to her, turned it around so he could sit facing her, and lowered himself into it.
“The biopsy,” she said, “it’s bad. That’s why you asked me to come here.”
He shook his head noncommittally. “I asked you to come here so we could discuss the results. In these situations, it’s best to keep an open mind and to remember that this is just information—neither bad nor good. I like to think of it as a starting point that will guide us toward the best possible course of action.”
She took a deep breath and let it out. “Tell me what you found.”
Mark nodded. He was quiet for a moment, organizing his thoughts.
“The procedure itself went well,” he said. “Dr. Kowalski was able to complete the bronchoscopy and obtained tissue samples of the mass in question. He was also able to perform some needle aspirations of several local lymph nodes. There was minimal bleeding. Your father tolerated the procedure without difficulty.”
“That’s good,” she said. She’d been worried about the bronchoscopy. It wasn’t commonly performed in veterinary medicine, and she hadn’t done one herself since vet school. Still, she knew about the risks. If things went wrong during the procedure, the complications could be serious.
Mark shifted in his chair. “Yes,” he said. “I was pleased that it went so smoothly.”
They sat across from each other, so close that their knees were almost touching.
“Dr. Kowalski took the samples back with him,” he said. “He had them evaluated by a pathologist in Billings—a specialist in cytopathology. He’s the best they’ve got.”
“Thank you.”
Mark put his hands together in his lap. “Unfortunately,” he said, “this does appear to be lung cancer—squamous cell carcinoma to be exact.”
Erin stared at him. After a few seconds she realized she was holding her breath.
“It’s a non-small-cell lung cancer that accounts for about a third of all pulmonary malignancies. There is a strong association with smoking, but it can also be caused by other factors, such as age, genetics, and exposure to certain minerals and metals. Asbestos and radon are common contributors.”
“Okay,” Erin said. She could feel her heart walloping in her chest.
“Staging was the next step,” Mark continued. “In your father’s case, Dr. Kowalski was able to obtain cell samples from lymph nodes on both sides of the mediastinum. Unfortunately, several of them were positive, which gives us a diagnosis of stage 3B squamous cell carcinoma.”
“Stage 3B,” she said, trying to make sense of the information.
“This is”—he sighed—“an aggressive form of cancer. Because of the involvement of lymph nodes on both sides of the chest, surgery is generally not recommended. Radiation and chemotherapy are both reasonable options. In addition, recent studies have also shown that treatment with certain tumor-targeting antibodies or medications to enhance the immune system have both been effective in shrinking the tumor and improving life expectancy in some patients.”
“What are the . . . I mean . . . why would he . . . ?”
“I don’t know why this happened to him,” Mark said. “We look for answers, but most of the time we just have to . . . deal with what’s in front of us.”
Erin’s vision blurred as her eyes welled with tears. She tried to draw a breath, the cartilage of her throat lifting and falling, but it was like pulling air from a vacuum. A tear rolled down her cheek and spilled onto the back of her wrist, and when she looked down, she saw that her hands were balled into fists in her lap, the nails biting into the flesh.
Erin put her face in her hands and cried. It was the only sound in the small confines of the office, and the sobs ripped through her like jagged chunks of metal. Of all the shitty things to happen to her father . . . of all the horrible things he had been through already . . .
Mark reached over and put a hand on her shoulder. “I’m sorry,” he said. “I really wish I had better news.”
Now that the tears had started, it was hard for Erin to get control of them. She let them come. A storm had been building up inside of her since she’d gotten Mark’s initial phone call, the one telling her that her father was ill and she needed to come home to Wolf Point. Everything had gone wrong since then. Had she really expected this to be any different?
“What’s the prognosis?” she asked, and she looked up at Mark as if there was a chance for something hopeful and unexpected.
He shook his head. “It’s impossible to say. Estimating these things is always tricky.”
She grabbed a tissue from a box on Mark’s desk. “How much time does he have, statistically speaking?”
“Statistics tell us how the average person will do,” he said. “Nobody’s average. Your father’s certainly not average.”
Erin nodded. This is what she told the families of her own patients when the diagnosis was a bad one. Renal failure. Feline leukemia. Cardiomyopathy. They were just words until you knew how to interpret them. “How much time does he have?” a client would ask her, and Erin would look down at the animal and envy the fact that it would never comprehend the details of this part of the conversation.
She looked back at Mark. “You’ve got to tell me,” she said. “If I don’t have much time left with him, I need to know.”
“Erin . . .”
“Please.” She took him by the hand. “I’m going to find out anyway. I’d rather hear it from you.”
He swallowed. “These days people can look it up on the internet. It’s not good for them. It doesn’t paint the complete picture.”
“I understand all of that,” she said. “How long?”
“The median survival for all stage 3 non-small-cell lung cancer is fifteen months from the time of diagnosis,” he said. “Stage 3B is worse, about twelve months.”
“Twelve months,” she said.
“Half of stage 3B patients live longer than that.”
“And half of them die sooner,” she said.
“Yes.” He’d been leaning forward, and he slid back in his chair a bit. “As I said, it’s difficult to predict.”
Erin sat back herself. She looked down at her hands. “Goddamn it,” she said.
They were quiet for a moment, neither of them talking.
“He helped me deliver a calf once,” she said. “He walked me through the process one step at a time.”
“That’s how we do this,” Mark told her, “one step at a time.”
“What’s the next step?” she asked. “Where do we go from here?”
“We could transfer him to Billings,” he said. “We don’t have an oncologist here in Wolf Point. You should talk to your father. We both should. We don’t have to decide right away.”
“I can’t talk to him. He’s on a respirator, remember?”
“Not anymore,” he said. “We removed the breathing tube an hour ago. Your father’s breathing on his own now. He’s weak—deconditioned from lying in bed so long—and he’s pretty groggy. We were giving him a sedative while he was on the ventilator. It takes time for it to clear the body. It’ll be another few days until he’s ready for a lengthy conversation. But you can talk to him. He’ll understand what you have to say.”
“He’s awake?”
“He’s conscious, yes. He might be sleeping now, but he’ll wake up if you talk to him. We’ll get him up and moving around soon. His muscles have atrophied. He’ll need some time to recover. This is the tough part,” he said, “helping David to climb out of the hole we dug for him.” Mark winced, realizing too late that he couldn’t have picked a worse analogy.
“I’m worried,” Erin said, ignoring his comment. “He’s stubborn, my father. What if he decides that he doesn’t want the treatment?”
“You’ll talk him into it,” Mark said. “Or you won’t. There’s no perfect solution here. It’s a decision that the two of you have to make together.”