2000

Leah awoke the next morning feeling anxious and scared. She stayed in bed, under the covers wanting the world to go away and leave her alone. Finally, her bladder demanded that she get up. After a long shower where she could cry and not be heard, she headed down to the kitchen.

James was sitting at the table looking like he hadn't slept all night. He, in fact, had been up a good part of the night researching breast cancer information on the internet.

"You look like shit, James. Are you okay?"

"I'm fine. How are you this morning?" James saw the look in Leah's eyes. She was scared. He didn't wait for her answer. "What time is your appointment?"

"Two."

"Shit." The day loomed ahead of them.

"I know. I'll go crazy before then."

James stood up, "Let's get out of here."

"What? Where to?"

"I don't know, we can start with breakfast somewhere and decide from there. All I know is we can't just sit here wondering. We're only making things worse. We don't even know anything for sure yet."

James did the best he could to distract her all morning. They ate breakfast at her favorite coffee shop and then they went shopping at the Mall of America. It was easy to kill a few hours there, Hell it was easy to get flat out lost there. Finally they ended up having a late lunch at a café not far from her doctor's office. It was there that it hit her.

"Leah? Are you okay?" James was watching his sister as her skin grew pale and her breathing became faster.

Leah couldn't speak; she could only shake her head 'no'.

"Take a sip of your water." She was starting to hyperventilate. "Leah, slow down. Come on, take deep breaths." He got up and moved to the chair closer to her. Putting his arms around her, he pulled her closer to him and started talking to her softly, "Shhh Leah, it's okay."

Finally her breathing started to slow down.

"Come on, let's get you out of here," James stood after placing a few bills on the table to cover their meal and a tip. Leah simply sat there looking at him, she couldn't move.

He took her arm and helped her to her feet, then with his arm around her waist he lead her out of the restaurant, and to her car. He put her in on the passenger seat and went around getting in the driver's side. "Leah? Look at me. Are you okay now?"

She took a deep breath and said, "Yeah, I think. I'm sorry James. I don't know what happened."

"You, my dear sister, just had a panic attack. That's what happened."

"Shit."

James started up the car and drove the few blocks over to the doctor's office. He parked the car and turned off the ignition. "Come on, let's do this."

"Hello, Leah," Dr. Moore said as he came in the room and extended his hand to Leah. (she's been his patient for quite awhile right? He should know to call her Leah)

"Hello, Doctor. This is my brother, James. I brought him with me since my husband is out of town."

"James," Dr. Moore shook James' hand. "Glad you are here."

Everyone sat back down and Dr. Moore got right to the point.

"Leah, there is what appears to be a mass on your last mammogram. It looks suspicious. I would like to do a diagnostic mammogram to see what that shows."

"How is that different from the mammogram I already had?"

"It uses the same machine but we will focus on the area in question. I would like to have this done today if that would be alright with you."

"Okay, when?"

"I have you scheduled over in radiology at two-thirty. After they perform the mammogram, come back here to the clinic. I will have the results in about a half hour and then I can go over my findings with you."

"Do you think it is cancer Doctor?" Leah couldn't help but ask.

"I won't know anything for sure until I see your films, but my guess is invasive lobular breast cancer."

James spoke up, "What exactly is that?"

"It is fairly rare and usually hits women a little older than Leah. It starts in the cells that make up the lobules at the end of the ducts where the breast milk is made."

"But I haven't noticed any lumps, so is it still small?"

"This type of cancer is less likely to form firm lumps, so it is not easy to find during a self exam. The area I am seeing on your mammogram is about the size of a half dollar. One of my concerns is that if it is cancer it could have already metastasized."

"What does that mean?" Leah asked.

"That it has spread," James said quietly.

After Leah took the mammogram, she and James walked back to the clinic.

"I'm scared, James."

"It's going to be okay, Sis," James only wished he could believe it.

They were taken back into another office to wait for Dr. Moore. He came in after a forty-five minute wait that seemed like years to both of them.

"Leah, James," the doctor was all business now. "What we are seeing here on your films looks to be an invasive carcinoma. It appears to be located on the far left side of your left breast. I would recommend we perform an excisional biopsy. This would remove the entire lump and some surrounding normal tissue. Depending on what we find, I may need to do a partial mastectomy. I don't believe that I will need to take the whole breast, but I will need to remove some of the lymph nodes to test so as to determine what follow up treatment you will need."

Leah didn't move. She felt as if she was underwater. She was aware of James asking questions.

"So you believe it has spread? Is that why you're taking the lymph nodes?" James asked.

"I am taking the lymph nodes so that we will know if it has spread," Dr. Moore said.

"But it's not what you were talking about before? The invasive lobular?" James asked.

"Yes, it is the invasive lobular, invasive carcinoma is a more specific name for it."

"What is her prognosis?"

"Good, as long as it has not spread. Leah, I think we have caught it early. I would expect you to need to go through some radiotherapy and possibly some chemotherapy. We will also check the cancer cells for hormone receptors, more than likely you will be treated with Tamoxifen, a drug that blocks the estrogen that promotes growth of the cancer. But the survival rate for this type of cancer is good. I'd say eighty-five percent or better."

"And if you find more in her lymph nodes?"

"Then we will need to be more aggressive in her treatment, but at this point in time there is no reason to think she will not survive.'

"When would you want to do the surgery?"

"We don't want to wait too long. Leah, you can take a few days to get ready and get a second opinion if that would make you feel more comfortable. I wouldn't wait more than a week or two."

"Would all the treatment be done here in Minneapolis?" James asked. God, she was so glad James was with her. She could only sit and listen to them talk, she couldn't form a reasonable question, it was like she was outside her body just watching it happen.

"Yes, we have a great oncology department here. Leah, you will be assigned to a breast unit team, which would include myself as your surgeon, a cancer specialist, a radiologist, a breast care nurse, a chemotherapy nurse, and several other consultants."

"So where do we go from here?"

"Go home, adjust to the information I have just given you. Here are some pamphlets to read. You may want to get on the internet and do some research of your own. There are some web sites listed in the brochures. Give me a call, no later than the end of next week and we can schedule the biopsy. Of course if you have any questions in the mean time I would be available to discuss them with either of you, or with Will, of course."

Dr. Moore stood up and shook James' hand. He then turned to Leah, who still had not moved. "Leah, I know this is a lot of information to take in all at once. Go home get some rest, you don't need to make any decisions today," he gave her shoulder a gentle squeeze and walked out the door.

James began gathering up all the pamphlets and brochures they had been given. He stood up and looked down a Leah, "Leah?" She still didn't move, didn't even look up at him.

"Leah? Come on, let's go home." He took her arm just like he had earlier in the restaurant. He led her out of the doctor's office, to the car, and drove her home. She never said a word.

When James got Leah home, he took her in to the den and led her over to the sofa. He then went into the kitchen and fixed her a cup of tea.

"Here Leah, drink this," she took the tea and looked down at it in her hands. "Leah?" She finally took a sip of the tea.

"What am I going to do, James?" it was almost a whisper.

"You are going to have the surgery. Then you will have whatever treatment they say you need after that. You are going to fight this and survive it," James said. He was sitting next to her on the sofa. He took her chin in his hand as he said this and turned her face to him, looking straight into her eyes. "You are going to survive this, Leah," he repeated.

"I'll be disfigured."

"So fucking what."

"But, Will, he'll…"

"Will nothing. He will love you the same as he always has. Can't you see that? This will not change that. When are you going to believe he loves you?"

Leah started sobbing, "I can't do this, James. I can't do this."

James hugged her, "Shhhh. Yes you can. You can do this, Leah. You are the strongest person I know."

Later that evening Leah had finally fallen asleep on the sofa. James wasn't about to wake her up so he just covered her with a blanket and turned the TV volume down low. He then headed to the airport to pick up Will. He wasn't sure how he was going to explain why he was there instead of Leah. Should he tell Will the truth? Would Leah want to be the one to tell him? No, she would be too afraid to tell Will. James would be the one to break the news to him, but not in the airport. He would have to make some excuse until he and Will got home.

"James? What are you doing here? Where's Leah?" Will looked beat. It had been a long two days.

"Um, she fell asleep on the couch so I decided I would just come pick you up myself," Will looked at him. There was more to it, something was going on. "How was your trip?" James tried to change the subject.

"Long. James, what's going on?"

"Let's go home first, okay?"

Will nodded and they headed off to get his luggage.

Neither said much on the drive home. Once at the house James sat down at the kitchen table. Will followed him and set his luggage on the floor.

"Where's Leah?"

"She's asleep in the den. Will, sit down for a minute okay?" Will sat down across from James and waited for him to continue.

"Leah, um, it appears, um, there's a, um…" James stammered not sure how to say it.

"James, what is going on? Just say it." Wild thoughts were running through Will's mind. Whatever it was, it couldn't be worse than what he was imagining.

"They found a mass on Leah's breast. The doctor thinks it is cancer. He wants to schedule a biopsy and may take at least part of her breast."

Will blinked a couple of times. Okay maybe it could be worse than he was imagining, "When?"

"When do they want to schedule the biopsy?" James was confused.

"No, when did they find the mass?"

"I took her for a consultation today. That's when she knew for sure. I guess the doctor called her Tuesday saying there was a problem with her last mammogram."

"When did she tell you?" Will asked.

"Last night."

"Why didn't she tell me?"

"I don't know, Will. In her twisted head she is afraid you won't love her anymore."

Will sighed, then sat and stared blankly at nothing. Finally, he stood, gathered up his luggage, and went upstairs. A few minutes later, he came down the stairs and went into the den. James was already there, sitting at the desk surfing on the internet. His way of coping was to get as informed on the subject as he could. Will stopped in the doorway, staring at his sleeping wife. After all this time and she still couldn't trust him to be there for her, that broke his heart. More than his wife having cancer, knowing that she still did not believe that he really loved her was made him start to cry.

James looked up from the computer screen at Will and said, "She loves you, you know?"

"I know." Will came in and sat down in one of the recliners. "When we were first dating," he started talking quietly, "and it was starting to get serious, I remember I was worried that my having already had a vasectomy would be an issue. I asked her if she was sure she wouldn't be sorry some day that she hadn't had more children. She looked me in the eye and said, "I don't ever want to have to tell someone I love that I am pregnant again." I thought that was so sad. That she could feel that afraid to trust someone to love her. I guess she's still afraid."

"She's afraid of a lot of things right now," James said.

"Yes, I'm sure she is. What did the doctor say?"

"That she has pretty good odds, eighty-five percent or better. That she needs to have surgery, followed by radiation and maybe chemotherapy."

"When is the surgery?"

"It's not scheduled yet. He told her to go home and take some time, to call him by the end of next week to schedule it."

"What did she say?"

"Not a word."

"Not a word? Nothing?"

"No. She hasn't said much since we've been home either."

Will sighed deeply, rubbing his hands over his face. He suddenly felt so very tired. "She would be more comfortable in our bed."

"I know, but I didn't have the heart to wake her."

"Neither do I. What are you finding on the net? I assume you're looking up breast cancer."

"Yeah, I'm finding a lot. Survival rates are good if it is detected early. It says here that the prognosis is the same for a partial mastectomy followed by radiotherapy as they are for a full mastectomy. It looks like our biggest concern is if it has spread to the lymph nodes. Her doctor mentioned that he would need to take some of the nodes when he does the surgery to see if the cancer has spread."

"The radiation will have side effects, right?"

"Yeah, they're down playing that here. They mention a few: nausea, fatigue, skin rashes, and possibly difficulty swallowing. Chemotherapy doesn't look like a walk in the park either, but it only lasts for a few weeks, looks like about four to six weeks each. The doctor also mentioned a drug to help stop the growth of the mass. Looks like it will cause her to have menopause like symptoms, hot flashes, mood swings, stuff like that. A partial mastectomy would be easier on Leah, she's afraid of being disfigured."

"She needs to have whatever procedure gives her the greatest chance of survival. If that means she loses her breast then she loses it," said Will

"I agree, but Leah won't see it that way," said James.

"Then we have to convince her."

They were both silent as James continued his research and Will watched Leah sleep. A few minutes later when James looked up, Will was asleep in the chair.

James got up and went outside onto the deck. He pulled a joint out of his pocket, lit it, and inhaled deeply. Tears began to run down his cheeks as he smoked the sweet smelling weed. In his head, he knew that Leah would more than likely be okay. She had a very good chance of surviving this. In his heart, he was scared to death. Somewhere inside him was a little boy that still felt like she was all he had left in the world.

Leah awoke with a start remembering that she was supposed to pick up Will at the airport. She sat up, then saw Will asleep in the chair, James must have gone to get him.

Leah sat there watching Will sleep wondering, if James had told him. Then her thoughts turned to Ryan. She hated to think of how it would affect her son.

Despair washed over her in waves. She wanted just to crawl into bed and sleep. Maybe when she woke up it would all be a dream.

She got up and started to wake Will. Then she realized she was afraid to face him, afraid for him to see her. She turned instead and went up the stairs to their bedroom, stripped off her clothes, and crawled under the blankets. She lay there for a long time listening to the clock tick. Finally she fell asleep.

James came back into the house. Will was still sleeping in the den, but Leah was no longer on the sofa.

"Will. Will. Where's Leah?"

Will opened his eyes, looking around. "I don't know."

"She probably went to bed. It's late, you should go too."

"What time is it?"

"Almost midnight."

Will nodded and got up from his chair. James followed him up the stairs heading to his own bedroom. Neither man could remember ever feeling quite so tired, and this thing had only begun.

© Melina Catts 2004

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