“Mrs. Redfield.” Out in the clinic hallway, Jacquelyn greeted the tall woman with a calm smile. “Welcome to your first day of chemo. Dr. Martin has asked me to go over some information with you. I know this is a lot to give you in one day, but we want you to understand every aspect of your treatment.”
“Oh, I don’t mind.” Daphne moved into the chemo room with the sure grace of a forest creature. She settled into the deep cushions of the chemo chair and automatically thrust out her arm.
An old pro, Jacquelyn thought, recalling that Daphne had undergone chemotherapy before. “Thanks,” she murmured, smiling stiffly. She swabbed the skin and then efficiently inserted the IV. Maybe I’ll be an old pro, too, before I’m done.
As the antinausea medication slowly dripped into Mrs. Redfield’s vein, Jacquelyn wheeled her rolling stool to the other side of her patient’s chair.
“These,” she said, placing a stack of pamphlets in Daphne’s lap, “will tell you more than you ever wanted to know about cancer and its treatment. I have given you brochures on radiation therapy, tumor markers, blood counts and infections, breast cancer, adjuvant therapy, eating hints for cancer patients, the importance of social support and taking time with your loved ones—”
“Save your breath, sweetie,” Daphne said, putting her free hand on Jacquelyn’s arm. “I’ve been through all those booklets with my other doctors. I’ve had the mastectomy, I’ve been through a round of chemotherapy. I can tell you all about tumor markers and CA 15-3, the breast cancer antigen.” Her eyes gentled. “I’ve been around the block a few times, Nurse Jackie. The big C and I are old friends.”
“Friends?” The horrified whisper slipped out before Jacquelyn could stop herself. In all her days as an oncology nurse she had never heard anyone describe the dread disease as a friend.
“Yes.” Daphne’s eyelids lowered as if the medication were making her drowsy. “God has used my cancer to bring me closer to Him. And though it hasn’t been an easy cross to bear, some people carry far heavier loads than I do. And I’m not alone. I have my husband, my sons and a caring church family. The pain is bearable, and the fear—well, I’ve given that over to God. He holds my life in His hand, so nothing can harm me without His permission.”
Denial, Jacquelyn thought. Religion as painkiller. She’d seen it a thousand times, though none of her other religious patients had managed to smile through their denials as easily as Daphne Redfield. From where did the woman find such peace? Jacquelyn considered herself a Christian, though not a live-it, breathe-it fanatic like Mrs. Redfield. Still, if such peace was real, maybe Daphne could help Jacquelyn find it.
The comfortable chemo chairs, coupled with the warmth of the sun from the wide windows, often put patients to sleep. Daphne’s eyes were about to close, so Jacquelyn gently prodded her. “Tell me about your sons,” she said, leaning forward to adjust the IV line. “How old are they?”
“The twins are almost eighteen.” Daphne’s eyes widened. “Tall, handsome boys, they are. Young men, really. They’ll be graduating from high school this June. I used to think I couldn’t wait until they could drive, now I can’t wait to see them graduate.”
Jacquelyn nodded as she monitored the flow of antinausea medication. “You’ll have to bring them up to meet us sometime.”
“I will,” Daphne answered. “They’d be thrilled to meet a pretty girl like you.” She swiveled her head and glanced pointedly at Jacquelyn’s hand. “No wedding ring, I see. A steady boyfriend, maybe?”
Jacquelyn leaned back and crossed her arms. “Not anymore,” she said, lowering her voice lest Stacy should overhear. She didn’t want to give the other nurses a long explanation of what had happened with Craig, the pain was still too fresh. “I guess you could say the going got rough, and Mr. Tough Guy bailed out. I’m afraid I’m going to be single for a while…a long while.”
“I’m sorry.” Daphne rested her chin on her free hand, a faint smile on her lips. “But what happened? If my memory serves me correctly—and the older I get, the less often it does—you were supposed to go see your doctor.” She gave Jacquelyn a compassionate, troubled look. “Did you go?”
“I did,” Jacquelyn said, feeling her throat begin to close up. She didn’t like talking about personal things in the office, but she pushed the words out. “And it was a malignant lump, not a cyst. So I’m meeting with Dr. Martin this afternoon. I imagine I’m facing a lumpectomy in the near future.”
Daphne’s eyes darkened with pain. “Oh, sweetheart, I’m so sorry.”
Jacquelyn looked away, unable to bear the sight of such compassion. Why had she said anything to this woman? She didn’t want pity or commiseration. She only wanted to get the thing cut out and get on with her life.
“I’ll be praying for you.” Daphne reached over and squeezed Jacquelyn’s hand.
Because the unexpected gesture brought tears to Jacquelyn’s eyes, she rose quickly from her stool and hurried toward the small room where the chemo medications were mixed. “I’ll be right back,” she called over her shoulder, grateful for work to keep her hands and mind occupied. “It’s time to mix up my magic medicines.”
Jonah fumbled in the file and pulled out two films, then snapped them into the groove at the top of the light box on the wall. He frowned at the X rays. Jacquelyn Wilkes’s mammograms showed a definite mass in the left breast, but nothing, thank God, in the right.
He stepped back and leaned against the edge of his desk, ice spreading through his stomach as he stared at the films. How—and what—did he tell her? She would demand the truth, plain and unvarnished, and he might have to recommend options far more severe than what she was expecting. Everything depended upon the size of the actual tumor inside the mass. If the nodule was one centimeter or less with no lymph nodes involved, she might be able to have a lumpectomy only. If the lump was one and a half centimeters, he’d probably prescribe tamoxifin or radiation after the lumpectomy. But if the tumor was closer to two centimeters, he’d have to consider so many other things—the lymph nodes, the type of tumor, her age and family history…
A headache began to pound at his temple. Should he treat her at all? Maybe Dr. Shaw was right; he should have sent her to Dr. Kastner. The voice of an old medical school professor echoed in his memory: You cross a dangerous line when you treat someone you love. Can you separate your emotions from your regard for good treatment?
He’d never come near that dangerous line before. But no one had ever affected his emotions quite like Jacquelyn Wilkes.
What if “good treatment” required a mastectomy? Would such a disfiguring operation traumatize her? Despite her professionalism and her knowledge about cancer and cancer patients, she was only twenty-eight and unmarried. No single woman wanted to think about facing the future with a vivid scar across her chest, but anything less might prove to be a death sentence.
And that, Jonah knew, he could never accept.
He stared at the shadow on the films a moment longer, then turned off the light box and watched as the films went black.
Something in Jacquelyn rebelled at the thought of climbing onto the exam table in Dr. Martin’s treatment room. She took a chair at the desk, knowing the doctor would have to stand when he entered. She didn’t care. She’d been on her feet all day. The work, combined with her mental exhaustion, left her so tired her nerves throbbed.
She felt momentary panic when the doctor politely rapped on the door—he’s here, it’s really happening—but forced her face into calm lines. Jonah—Dr. Martin, she reminded herself—did not remark on her odd maneuvering when he entered, but gave her a brief smile and perched on the end of the exam table himself, her chart in his hand.
She murmured some inconsequential greeting and he responded in kind while he studied her chart as if he had never seen it before. What was that expression on his face? He kept his eyes averted as he read a note from Dr. Shaw. She couldn’t tell if she’d be facing Dr. Jekyll or Mr. Hyde when he finally lifted his gaze.
“I won’t go through the usual drill, Jacquelyn, since you already know it,” he said, lowering her chart to his lap. He looked up and clasped his hands, his eyes searching her face. “But it’s good we caught this as soon as we did. The radiologist and Dr. Shaw believe the cancer is infiltrating ductal carcinoma. And because these cancer cells stimulate the growth of fibrous, noncancerous tissues in the vicinity of the tumor, it’s possible that the actual malignant cancer is smaller than your lump may suggest. The radiologist estimates your mass at just over two centimeters. If the tumor inside is significantly smaller, a T1, lumpectomy and radiation are definitely in order. We can save the breast, and with follow-up radiation treatments we can almost guarantee that there will be no reoccurrence.”
“I thought there were no guarantees with breast cancer,” she said, impaled by his steady gaze.
“Well,” he said, tilting his head, “you’re right. But the risk is minimal. Women with T1 tumors who undergo a lumpectomy and radiation face less than a two percent chance of reoccurrence within the same breast.”
She stared stonily at the floor. “What if the invasive component is a T2? That would make me a stage II cancer case, and the treatment is entirely different—”
“Jacquelyn,” he interrupted her with a raised hand, “I have every reason to hope it’s a T1. We’ll go in, do the lumpectomy and check the lymph nodes. After surgery, we’ll make arrangements for radiation treatment at the hospital.”
“And if I don’t have the radiation?”
Surprise blossomed on his face. “Why wouldn’t you? It’s a simple procedure, far less stressful than chemotherapy—”
“It is not simple.” She shook her head. “Radiation therapy requires five daily visits to the hospital for five weeks. For five weeks I’d be exhausted, burning and peeling while I’m trying to work.”
“You could take a medical leave—”
“I—I won’t,” she stammered, wondering if she could make him understand. If she stopped working, she’d be admitting that she was sick. She’d be alone in her house with only Bailey for company, alone for more than five weeks, once she included the time she’d need for surgical recovery. “Radiation would drop my white cell counts,” she continued. “I’d catch every cold between here and California.”
“Would you rather have a cold or increase your risk of recurring cancer?” His tone was light, but his meaning was not.
Her eyes caught and held his. “You said we caught it early.”
“But as you pointed out, we won’t know exactly what we’re dealing with until the pathologist looks at the tumor. We also have to dissect the axilla—”
“I know the drill.” She drew a deep breath. The axilla housed the lymph nodes, part of the system that removed wastes from body tissue as well as carrying cells that helped the body fight infection. If the malignancy had spread beyond the lump in her breast, the lymph nodes under her arm would contain cancer cells.
“If my lymph nodes are clean,” she said, speaking in as reasonable a voice as she could manage, “what are the chances the cancer will reoccur if I don’t have radiation therapy?”
Jonah frowned in exasperation. “Thirty percent. Too high a risk, if you ask me. The figure might be higher in your case, considering your family history.”
She looked away and ran her hand through her hair, thinking. He was looking at the negatives; she wanted to focus on the positives. Of one hundred women like her who had lumpectomy only, seventy survived with no return of the cancer. A large majority. They ate well, exercised, loved their families and firmly put cancer behind them. Why couldn’t she be one of those seventy?
“I’ll make you a deal, Doc,” she said, looking up at him. “If you find even one positive lymph node, I’ll undergo radiation. But if my lymph nodes are clean,” she said, holding up a restraining finger, “you’re going to leave me alone. I’ll do my monthly breast self-exams, I’ll eat right, exercise and have a yearly mammogram, but you’re not putting me through radiation. I don’t want five weeks of sickness. I don’t want to even think about cancer for that long.”
“You shouldn’t be thinking about cancer. You should be thinking about getting better. Fighting back. Doing all you can to stop it.”
“That’s exactly what I’m going to do.” She rose from her chair. “So refer me to a good surgeon, schedule me for the lumpectomy and let me know when to report to the OR. I’ll be a model patient, but if my lymph nodes are clean, you’ll excuse me from your class, Doc. I know all about cancer—I don’t need any more lessons.”
“Jacquelyn Wilkes,” Jonah answered, his eyes flashing with a maddening hint of arrogance, “you are a stubborn woman.”
“I know.” She lifted her chin as she moved toward the door. “Deal with it.”
Two weeks later it was all arranged. Standing at the nurse’s station near the end of a busy day, Jacquelyn reached for the large calendar on the desk and marked Thursday, October ninth, with the words “Jacquelyn out.” Of course, she’d be out longer than one day, but hopefully not more than two or three. Lumpectomies usually healed quickly.
At 6:00 a.m. tomorrow she would report to the admissions office at Chambers-Wyatt Hospital where surgeon Thomas Wilder would perform a lumpectomy and axillary dissection.
She had already met with Jonah Martin to discuss the final details, and as a matter of routine she signed consent papers allowing Dr. Wilder to immediately perform a modified radical mastectomy in case the tumor proved to be two centimeters or greater in size. “Everything in me says the tumor won’t be that large,” Jonah had told her, “but if it has grown to that size in so short a time, we don’t want to take a chance. And I don’t think you want to undergo two separate surgeries.”
“That makes sense,” Jacquelyn answered, scrawling her name across the bottom of what was certainly an unnecessary consent form. The hospital covered its bases like a New York Yankees infielder; the nurses weren’t allowed to dispense even an aspirin without the proper signed document.
Jacquelyn had slid the stack of consent forms back across the desk toward Dr. Martin, ready to be finished with the entire situation. She had kept herself busy in the past two weeks, purposely trying not to think about anything beyond a lumpectomy. Radiation was an extreme possibility she might have to face, but she’d cross that bridge if—and only if—it proved absolutely necessary.
Now she fidgeted at the nurses’ desk, making a series of last-minute reminders for Stacy, Lauren and the temp nurse who’d be covering for her while she recuperated.
“Jacquelyn, if you’ve got a moment—”
Jacquelyn looked up from her paperwork into Lauren’s questioning eyes. “Sure, I was just finishing up a few notes.”
Lauren leaned against the counter at the nurses’ station and spoke with a depth of concern Jacquelyn had never heard in her voice. “I know your surgery is tomorrow. And I just wanted you to know that I’ll hold a good thought for you.”
Hold a good thought? As if that would do any good! Jacquelyn swallowed her exasperation and flashed a smile of thanks. “Thanks, I appreciate it. Are you sure I’ve covered everything? I’ll only be out for a week, maybe even less—”
“Take all the time you need,” Lauren said, gathering a stack of reports from her basket on the counter. “Relax, enjoy your time off and luxuriate in the deep sleep of drugs.” She tilted her head and gave Jacquelyn a jaunty smile. “That’s the best thing about surgery. When I had my impacted wisdom teeth removed, I went home, went to bed and let my family fend for themselves for twenty-four hours. I haven’t had as good a rest since.”
The phone cut into their conversation. Lauren moved to take the call while Jacquelyn tried to ignore the mocking inner voice that wondered how an oncology nurse could compare breast cancer surgery to impacted wisdom teeth.
Stacy came around the corner and brushed a tendril of brown hair out of her eyes. “Five o’clock, thank goodness! Sometimes I think quitting time will never get here.”
Jacquelyn glanced at the charts still on the desk. “Is the last patient gone?”
“Yes, thank goodness.” Stacy blew at the stubborn lock of hair, then tossed Jacquelyn a grin. “Want to go grab some Chinese food? Sort of a last fling before you’re laid up?”
“No Chinese food, no anything.” Jacquelyn shook her head. “The liquid surgical diet, remember? Twenty-four hours before surgery, only liquids and gelatin allowed. And nothing after midnight.” She lightened her voice. “For lunch I feasted on a cup of chicken consommé. I think for dinner I’ll go with lime Jell-O.”
“You must think I’m an awful ditz.” Stacy’s expression clouded for an instant, then she reached out and patted Jacquelyn’s arm. “I’m so sorry. I didn’t mean to be insensitive. It’s just that you look so good, I can’t believe you’re going under the knife tomorrow. If it were me, I’d be home in bed with my feet propped up, milking sympathy from everyone I know.”
Lucky girl, to have people in her life. Jacqueline only had Bailey.
“I guess we’re different then.” Jacquelyn smiled and set aside her cynicism, trying to find the nerve to ask the question she’d avoided all day. “Stacy, I do need some help. I might be in the hospital for two or three days and I don’t have anyone to look after Bailey. If you can’t do it, I’ll understand, but I hate to take him to a kennel when he could stay home where he feels secure.”
“You want me to take care of that monster?” Stacy took a hasty half step backward. “Jacquelyn, he’d bite my head off. Dogs know if you’re afraid of them, and that big brute just terrifies me.”
“That big brute—” Dr. Martin’s voice came around the corner, joined an instant later by his imposing, self-confident presence “—is as gentle as a kitten.” He paused by the desk where his eyes met Jacquelyn’s. “You don’t have anyone to take care of the dog?”
“It’s okay, I can take him to the kennel,” she said, heat stealing into her face. She’d simply die if he thought she was hinting that he ought to step in. He’d done enough by saving Bailey’s life; he didn’t have to dog-sit, too. “It’s not a big deal.”
“Jacquelyn—” his voice was crisp “—I’d like to see you in my office, please. Now.”
The commanding tone in his voice caused Jacquelyn’s pulse to beat erratically.
“Uh-oh,” Stacy whispered as Jacquelyn slipped away. “I don’t know what you did to set him off, but maybe he’ll go easy on you, seeing as how you’re having major surgery tomorrow.”
When Jacquelyn reached his office, Jonah was leaning against his desk, his arms folded tightly across his chest, one hand pressed to his chin.
“Doctor?” Jacquelyn steeled herself for whatever rebuke might come. Had she been too distracted by her own upcoming surgery that she overlooked something on a patient’s chart? Had she unintentionally snapped at someone? She had been a little curt with Daphne Redfield yesterday; she simply hadn’t felt like listening to the woman’s saccharine assurances that God had everything under control….
Jonah’s eyes were as flat and unreadable as slate. “Jacquelyn,” he said, lines of concentration deepening along his brows and under his eyes, “if you don’t have anyone to take care of the dog, who is going to take care of you?”
Her dread and embarrassment shifted quickly to annoyance. What right had he to pry into her personal affairs? She hadn’t intended to involve anyone from the office in her illness. She would have to consult with Dr. Martin after the surgery, of course, but he didn’t need to know her plans. She would hire a day nurse from a temp agency for the first day or two of her recovery; she’d already placed one call and received an excellent reference. After that, she’d take care of herself, warm her own soup, change her own sheets. She was strong and she knew what had to be done.
She swallowed hard, trying not to reveal her irritation. “I’ve made arrangements. I’ll be fine.”
His expression clouded in anger. “I don’t know why you insist upon being so independent. Let us know if we can help. You can’t take care of yourself right after surgery—”
“I’ll be fine,” she insisted, her voice sharp. Why was he doing this? She didn’t need his personal attention; she didn’t want it. Most of all, she didn’t want him to know how utterly and completely alone she was.
She whirled and moved toward the doorway, but paused just before leaving his office. “If you think of it tomorrow, say a prayer for me. And if you don’t pray—” she shrugged, not looking at him “—then hold a good thought.”
On the verge of tears, she turned and fled through the office hallway.