Selena kept a tight grip on her purse strap. She rarely carried more than a small clutch, but today needed something more substantial to cling to. She scanned the waiting room one more time, for lack of anything else to do, but the landscape hadn’t changed in the past five minutes. Women sat around the room in various postures and stages of pregnancy, along with women like her waiting to see the doctor for other reasons.
Like all doctors’ waiting rooms, the patients spoke in subdued tones, but there were laughter and smiles as well. How far along are you? Don’t you just hate it when your feet swell? All the discomfort and joy of pregnancy was bounced back and forth, though the women were often strangers. A young woman sat two seats down from them, her baby, tiny, carefully swaddled in a carrier/car seat. She was probably there for her two-week checkup.
Oliver sat beside her and, though he held a National Geographic, and his eyes rested on a page, but he hadn’t turned it. In fact, if his eyes had not been open, she’d have sworn he was taking one of his power naps. Men were always uncomfortable in a gynecologist’s office, but was he experiencing the same heart-sickening fear and pain she was?
An older woman, maybe in her early fifties, entered the office, checked in at the window and sat down near the door. A brightly colored scarf, pulled tight around her head, followed the round curve of her skull and ended in a long tail down her back.
Selena fought the urge to brush back a long strand of her thick, dark hair for fear the woman would notice.
Would she lose her hair, too? Of course she would.
Her heart raced, harsh and sickening. Nausea surged up to coat her mouth with saliva. Sweat pooled beneath her arms and between her breasts.
A nurse came to the door leading back into the examining rooms and Selena’s head jerked up along with everyone else’s. The nurse’s eyes came to rest on her, “Selena.”
Oliver reached for her arm. Her legs shook as she stood.
“Doctor Sanderlin will see you in her office now.” The nurse led the way past a number of examination rooms and turned two corners before they arrived at a door. The black plate fastened to it at eye level read Captain Alicia Sanderlin M.D. ObGyn. After a brief tap the nurse opened the door and motioned them in. “Please have a seat, Dr. Sanderlin will be with you in a moment.”
A large cherry wood desk and desk chair dominated the room, its surface cluttered with paperwork. A bud vase with three pink roses, some baby’s-breath, and greenery sat on one corner. Behind it a bookcase stretched, filled with medical texts and decorative knickknacks. Three well-stuffed armchairs upholstered in a rich burgundy fabric sat in front of the desk in a curve. Striped drapes matched their color and the gray carpet.
They’d barely sat down when Dr. Sanderlin rushed in. Oliver stood politely while Selena shoved to her feet.
“I’m sorry you had to wait, Ensign Shaker, Selena.” She paused to shake Oliver’s hand, then retrieved a file from her desk, and, instead of sitting behind it, she repositioned the third chair so she could face them both.
Her gaze moved from Oliver to Selena and stayed there. The woman had been her ObGyn since they’d moved to San Diego, and Selena trusted her to be both caring and a straight shooter. But God, she wanted to be anywhere else but sitting in front of her in this chair now.
“I have some good news and some not so good news,” she said, her pale green eyes steady. “Mixed in with all the other tests we ran last week, we did a pregnancy test, and it came back positive.”
Selena caught her breath and her hand instinctively curved around her lower abdomen. Oh, God, what would this mean if she was sick? “I’m a little late, but I thought it was probably because of…of…everything else.”
“Well, from your HCG levels, I’d say you’re between six and seven weeks pregnant. Before you leave today we’ll do a preliminary exam and try and pin it down.”
Selena reached out to Oliver, and he took her hand and squeezed it, but his open joy when he’d gotten the news about Lucia was absent, as it was for her. The worry overshadowed everything else. How were they supposed to feel about this?
Dr. Sanderlin drew a deep breath. “Now for the not so good news.” She opened the file. “The surgical oncologist we referred you to submitted this pathology report to me. I want to go over everything with you both in depth.”
Selena nodded, unable to speak.
“The tissue sample did show a malignancy.”
Oliver’s fingers squeezed hers almost to the point of pain, then eased off.
Selena curled the fingers of her other hand against her throat as bile rose again.
“From the position of the tumor, we believe it is Ductal Carcinoma. An HER2 test was done. This test detects the proteins in the cancer cells which tell the cells to grow and divide. It came back negative, which is a very good thing. We also tested the tissue to see if it was hormone-receptor negative or positive. It is positive for hormone receptors.”
Dr. Sanderlin slid closer to the edge of her seat. “With this type of cancer, the tumor feeds off the estrogen in your system. But, based on the numerous ultrasound images we did, it’s fairly small, so we’ll be able to tell if it’s spread beyond the boundaries of the initial tumor when it’s surgically removed and a dissection of your lymph nodes is performed. You’ll return to the surgical oncologist for the removal. I’ve already talked to him and set up an appointment for you. As soon as you meet with him, they’ll schedule your surgery.”
Selena’s face felt numb. “Won’t the anesthesia harm the baby?”
“I’ll be working closely with Dr. Brooks, Selena, so you and the baby will get the best care.” Dr. Sanderlin turned to lay the file on her desk. “The first step in finding out how we need to treat this malignancy is to remove it and see how far it’s spread. We don’t want to wait to remove the tumor and any affected tissue.”
Oliver’s expression was wooden with control. The only thing that moved was his throat as he swallowed.
“Once we get the results from your surgery, I’ll refer you to a medical oncologist. Dr. Dixon has a wonderful reputation and is a very caring doctor. I think you’ll like him.
“Though pregnancy makes it more difficult to treat cancer,” the doctor continued, “we can treat it. But we won’t be able to start you on hormone therapy or radiation until the baby is born. And we can’t start chemotherapy until you’re at least four months along. We can’t treat your cancer as aggressively as we would if you weren’t pregnant, but we can fight it and keep it in check until the birth, and then get more aggressive afterward if we need to.”
Her throat ached from the effort not to cry. “What about the chemotherapy?”
“Dr. Dixon will go over the protocols with you, but there are drugs we can use which won’t impact the baby. He’ll give you medications to control your pain and nausea, but your body will be going through a lot.”
“And if she weren’t pregnant?” Oliver spoke for the first time.
Selena jerked around to look at him while her heart sank. He couldn’t be serious.
“If she weren’t pregnant, you could attack this thing full-on, right? Wipe it out.” There was an edge to Oliver’s voice she had never heard before, a blend of rage and pain that gripped her by the throat and brought tears to her eyes.
Dr. Sanderlin paused a moment to study him. “In years past, termination of the pregnancy was suggested as part of the protocol for treatment. But we no longer encourage that first thing. I recommend you wait for the results of Selena’s surgery and make a decision then. There will still be time if that’s the course the two of you settle on.” There was no judgment in her tone, only compassion. “Breast cancer is survivable, Ensign Shaker. Selena will have three doctors in her corner, making sure she gets everything she needs to overcome this.”
Dr. Sanderlin stood. “I’m going to take Selena down the hall and do a brief exam. You can stay here while we accomplish that, and I’ll send her back here when we’re done.”
As soon as the door closed behind the two women, Oliver leaned forward in his chair, dropped his face onto his hands, closed his eyes, and took deep, gulping gasps of air to keep from vomiting. He finally succeeded in quelling the nausea somewhat.
Dear God, she had cancer. Selena had cancer. He had prayed, hoped it wasn’t cancer. He’d prayed for anything but that. And gotten a pregnancy in return.
He paced the office, feeling caged, smothered by his rampaging fears and the rage accompanying them.
Had the changes in her hormones triggered the cancer? Would the baby they’d been trying to conceive kill her? And how would he live with that?
His military training said if something was a threat to life, you took it out. End of discussion.
But the baby would delay her treatment, curtail it. He knew Selena would never agree to ending the pregnancy. He’d seen her reaction. That fierce, protective, instinctive response the news had sparked.
How could he fight her maternal instinct? How could he fight his own conscience long enough to argue for termination?
But if it came down to a choice between her or the baby, Selena had to take priority. She had to agree with that. She was everything—to him, to Lucia.
An exam supposed to take a few minutes stretched on to half an hour. Worry set in and Oliver breathed a sigh and rose when Dr. Sanderlin came into the office.
“I thought I’d take a moment to give you an update, Ensign Shaker. May I call you Oliver?”
“Yes, ma’am.”
“Have a seat,” she pointed at the chair he’d just vacated.
She settled into the chair closest to him. “From the physical exam and the information Selena shared with me, we’ve determined she’s seven weeks pregnant. She’s understandably excited and frightened at the same time.”
“Could the pregnancy have triggered the cancer?” he asked.
“I don’t believe so. From the size and position of the tumor, I’d say it already had a start before she became pregnant.”
“She does self-exams every month.”
“And that probably helped her detect the tumor before it spread any further but a woman can have a malignancy before it’s ever detected, even with a mammogram. When Selena has her surgery, we’ll know more about whether it has spread to the lymph nodes. Please try to stay calm, for your benefit as well as hers. Once the tumor has been removed, we’ll know where we need to go from there.”
He nodded. Her calm settled his roiling gut, but not the fear. He had to get a grip on that himself. “Thanks, Doc.”
“Her appointment is on Friday for a preop workup and more tests. We’re not dragging our feet on this, Oliver.
He nodded, unable to speak around the knot in his throat.
“I’ll be talking to you soon,” she said as she stood.
“Okay.”
They had never had a quiet marriage. Whether they were making love, fighting, even cooking together, they made plenty of noise. But for the last three days silence had been their language.
And now in the car it resonated between them as loud as a scream.
It took twenty-five minutes to reach home, every second taut with unspoken recriminations. It was almost a relief when she finally asked, “Did you mean it?”
He didn’t need her to clarify what she was asking about. “Yeah. I meant it. If it comes down to a choice, I choose you, Selena.”
“They’re going to take the cancer out and that will be the end of it.”
God, he hoped so, prayed it would be so.
“We made this baby just like we did Lucia. It was made with love, Oliver.”
He gritted his teeth against a flood of painful emotions. He could turn the tables on her and lay on some guilt, but he wasn’t there yet. He’d save that for when it counted. “You said you’d wait and see what they discover during surgery. If it’s aggressive, cara—” he couldn’t say the words.
“This is my body, Oliver. I don’t say anything to you when you put yours at risk every time you deploy.”
“This is different, Selena.”
“No it’s not. You put yourself in harm’s way to protect those who can’t protect themselves. Where is the difference?”
The difference was she was the one who was in danger now. It was only supposed to be him. “I’m a trained soldier. I do everything I can to make sure I come home to you, Selena.”
“But there’s never any guarantee. I’ve watched you go to war twice, waited for you to return. I knew there’d be a chance I’d lose you each time. Even when you go somewhere to train, with all the dangerous stuff you do, I know there’s always a possibility you could be injured or killed in an accident. That’s my reality.” She laid her hand on his thigh and his muscles tightened. “This is our family, Oliver. I need you to be as supportive of me as I am of you.”
He’d never heard her talk like this before. And whatever he’d planned to say couldn’t stand up to everything she’d just dumped on him. So he said nothing at all.