About the Author
DOUGLAS KENNEDY's previous novels include the critically acclaimed bestsellers The Big Picture, The Pursuit of Happiness, A Special Relationship and The Woman in the Fifth. He is also the author of three highly praised travel books. His work has been translated into twenty-two languages. In 2006 he was awarded the French decoration of Chevalier de l'Ordre des Arts et des Lettres. Born in Manhattan in 1955, he has two children and currently divides his time between London, Paris, Berlin and Maine.
Excerpt. © Reprinted by permission. All rights reserved.
Five Days ONE
I SAW THE CANCER immediately. It was right there in front of me. As always, I found myself taking a sharp intake of breath as the realization hit: I am looking at the beginning of the end.
The cancer was shaped like a dandelion. Sometimes this sort of tumor looks like a cheap Christmas decoration—a five-and-dime star with ragged edges. But this specific one was more like a minor-looking flower that had been denuded, stripped down to its seeds, but with an insidious, needle-like structure. What radiologists call a “spiculated structure.”
Spiculated. When I heard that word for the first time I had to look it up. Discovered its origins were actually zoological: a spicule being “a small needle-like structure, in particular any of those making up the skeleton of a sponge” (I’d never realized that sponges have skeletons). But there was an astronomical meaning as well: a short-lived jet of gas in the sun’s corona.
This last definition nagged at me for weeks. Because it struck me as so horribly apt. A spiculated cancer, like the one I was looking at right now, may have commenced its existence years, decades earlier. But only after it makes its presence known does it become something akin to the burst of flame that lights everything in its path, demanding total attention. If the flame hasn’t been spotted and extinguished early enough, it will then decide that it isn’t a mere fiery jet stream, but rather a mini supernova which, in its final show of pyrotechnic force, will destroy the universe that contains it.
Certainly the spiculated species I was now looking at was well on its way to explode—and, in doing so, end the life of the person within whose lung it was now so lethally embedded.
Another horror to add to the ongoing catalog of horrors that is, in so many ways, the primary decor of my nine-to-five life.
And this day was turning out to be a doozy. Because, an hour before the spiculated cancer appeared on the screen in front of me, I had run a CT scan on a nine-year-old girl named Jessica Ward. According to her chart she’d been having a series of paralyzing headaches. Her physician had sent her to us in order to rule out any “neurological concerns” . . . which was doctor shorthand for “brain tumor.” Jessica’s dad was named Chuck—a quiet, hangdog man in his midthirties, with sad eyes and the sort of yellowing teeth that hint at a serious cigarette habit. He said he was a welder at the Bath Iron Works.
“Jessie’s ma left us two years ago,” he told me as his daughter went into a dressing area we have off the CT scan room to change into a hospital gown.
“She died?” I asked.
“I wish. The bitch—’scuse my French—ran off with a guy she worked with at the Rite Aid Pharmacy in Brunswick. They’re livin’ in some trailer down in Destin. That’s on the Florida Panhandle. Know what a friend of mine told me they call that part of the world down there? The Redneck Riviera. Jessie’s headaches started after her ma vanished. And she’s never once been back to see Jessie. What kind of mother is that?”
“She’s obviously lucky to have a dad like you,” I said, trying to somewhat undercut the terrible distress this man was in—and the way he was working so hard to mask his panic.
“She’s all I got in the world, ma’am.”
“My name’s Laura,” I said.
“And if it turns out that what she has is, like, serious . . . and doctors don’t send young girls in for one of these scans if they think it’s nothing . . .”
“I’m sure your physician is just trying to rule things out,” I said, hearing my practiced neutral tone.
“You’re taught to say stuff like that, aren’t you?” he said, his tone displaying the sort of anger that I’ve so often seen arising to displace a great fear.
“Actually, you’re right. We are trained to try to reassure and not say much. Because I’m a technologist, not a diagnostic radiologist.”
“Now you’re using big words.”
“I’m the person who operates the machinery, takes the pictures. The diagnostic radiologist is the doctor who will then look at the scan and see if there is anything there.”
“So when can I talk to him?”
You can’t was the actual answer, because the diagnostic radiologist is always the behind-the-scenes man, analyzing the scans, the X-rays, the MRIs, the ultrasounds. He rarely ever meets the patient.
“Dr. Harrild will be talking directly to Jessica’s primary-care physician. I’m sure you’ll be informed very quickly if there is—”
“Do they also teach you to talk like a robot?”
As soon as this comment was out of his mouth, the man was all contrite.
“Hey, that was kind of wrong of me, wasn’t it?”
“Don’t worry about it,” I said, maintaining a neutral tone.
“Now you’re all hurt.”
“Not at all. Because I know how stressful and worrying this must be for you.”
“And now you’re reading the script again that they taught you to read.”
At that moment Jessica appeared out of the changing room, looking shy, tense, bewildered.
“This gonna hurt?” she asked me.
“You have to get an injection. It sends an ink into your veins so we’ll be able to see what’s going on inside of you. But the ink is harmless.”
“And the injection?” she asked, looking alarmed.
“Just a little prick in your arm and then it’s behind you.”
“You promise?” she asked, trying too hard to be brave, yet still so much the child who didn’t fully understand why she was here and what these medical procedures were all about.
“You be a real soldier now, Jess,” her father said, “and we’ll get you that Barbie you want on the way home.”
“Now that sounds like a good deal to me,” I said, wondering if I was coming across as too cheerful and also knowing that, even after sixteen years as an RT, I still dreaded all procedures involving children. Because I always feared what I might see before anyone else. And because I so often saw terrible news.
“This is just going to take ten, fifteen minutes, no more,” I told Jessica’s father. “There’s a waiting area just down the walkway with coffee, magazines—”
“I’m goin’ outside for a bit,” he said.
“That’s ’cause you want a cigarette,” Jessica said.
Her father suppressed a sheepish smile.
“My daughter knows me too well.”
“I don’t want my daddy dead of cancer.”
At that moment her father’s face fell, and I could see him desperately trying to control his emotions.
“Let’s let your dad get a little air,” I said, steering Jessica into the scan room, then turning back to her father who had started to cry.
“I know how hard this is,” I said. “But until there is something to be generally concerned about . . .”
He just shook his head and headed for the door, fumbling in his shirt pocket for his cigarettes.
As I turned back inside I saw Jessica looking wide-eyed and afraid in the face of the CT scanner. I could understand her concern. It was a formidable piece of medical machinery, stark, ominous. There was a large hoop, attached to two science fiction–style containers of inky fluid. In front of the hoop was a narrow bed that was a bit like a bier (albeit with a pillow). I’d seen adults panic at the sight of the thing. So I wasn’t surprised that Jessica was daunted by it all.
“I have to go into that?” Jessica said, eyeing the door as if she wanted to make a run for it.
“It’s nothing, really. You lie on the bed there. The machine lifts you up into the hoop. The hoop takes pictures of the things the doctor needs pictures of . . . and that’s it. We’ll be done in a jiffy.”
“And it won’t hurt?”
“Let’s get you lying down first,” I said, leading her to the bed.
“I really want my daddy,” she said.
“You’ll be with your daddy in just a few minutes.”
She got herself onto the bed.
I came over holding a tube attached to the capsule containing all that inky liquid, covering with my hand the intravenous needle still encased in its sterilized packaging. Never show a patient an IV needle. Never.
“All right, Jessica. I’m not going to tell you a big fib and say that getting a needle put into your arm is going to be painless. But it will just last a moment and then it will be behind you. After that, no pain at all.”
“I promise—though you might feel a little hot for a few minutes.”
“But not like I’m burning up.”
“I can assure you you’ll not feel that.”
“I want my daddy . . .”
“The sooner we do this, the sooner you’ll be with him. Now here’s what I want you to do . . . I want you to close your eyes and think of something really wonderful. You have a pet you love, Jessica?”
“I have a dog.”
“Eyes closed now, please.”
She did as instructed.
“What kind of dog is he?”
“A cocker spaniel. Daddy got it for my birthday.”
I swabbed the crook of her arm with a liquid anesthetic.
“The needle going in yet?” she asked.
“Not yet, but you didn’t tell me your dog’s name.”
“And what’s the silliest thing Tuffy ever did?”
“Ate a bowlful of marshmallows.”
“How did he manage to do that?”
“Daddy had left them out on the kitchen table, ’cause he loves roasting them in the fireplace during Christmas. And then, out of nowhere, Tuffy showed up and . . .”
Jessica started to giggle. That’s when I slipped the needle in her arm. She let out a little cry, but I kept her talking about her dog as I used tape to hold it in place. Then, telling her I was going to step out of the room for a few minutes, I asked:
“Now is the needle still hurting?”
“Not really, but I can feel it there.”
“That’s normal. Now I want you to lie very still and take some very deep breaths. And keep your eyes closed and keep thinking about something funny, like Tuffy eating those marshmallows. Will you do that for me, Jessica?”
She nodded, her eyes firmly closed. I left the scan room as quietly and as quickly as I could, moving into what we call the technical room. It’s a booth with a bank of computers and a swivel chair and an extended control panel. Having prepped the patient I was now about to engage in what is always the trickiest aspect of any scan: getting the timing absolutely right. As I programmed in the data necessary to start the scan, I felt the usual moment of tension that, after all these years, accompanies each of these procedures I conduct; a tension that is built around the fact that, from this moment on, timing is everything. In a moment I will hit a button. It will trigger the high-speed injection system that will shoot 80 milligrams of high-contrast iodine into Jessica’s veins. After that I have less than fifty seconds—more like forty-two seconds, given her small size—to start the scan. The timing here is critical. The iodine creates a contrast that allows the scan to present a full, almost circular image of all bone and soft tissue and internal organs. But the iodine first goes to the heart, then enters the pulmonary arteries and the aorta before being disseminated into the rest of the body. Once it is everywhere you have reached the Venus phase of the procedure, when all veins are freshly enhanced with the contrast. Begin the scan a few critical seconds before the Venus phase and you will be scanning ahead of the contrast, which means you will not get the images that the radiologist needs to make a thorough and accurate diagnosis. Scan too late and the contrast might be too great. That’s why this small block of time still fills me with dread, even after the thousands of scans I have conducted. If I fail to get the timing right the patient will have to go through the entire procedure again twelve hours later (at the very minimum), and the radiologist will not be pleased. Which is why there is always a moment of tension and doubt that consumes me in these crucial seconds before every scan. Have I prepped everything correctly? Have I judged the relationship between the diffusion of the iodine and the patient’s physique? Have I left anything to chance?
I fear mistakes in my work. Because they count. Because they hurt people who are already frightened and dealing with the great unknown that is potential illness.
But children . . . children with cancers . . . it still pierces me. Being a mom makes it ten times worse. Because I am always thinking: what if it was Ben or Sally? Even though they are now both in their teens, both beginning to find their way in the world, they will always remain my kids, and, as such, the permanent open wound. That’s the curious thing about my work. Though I present to my patients, my colleagues, my family, an image of professional detachment—Sally once telling a friend who’d come over after school, “My mom looks at tumors all day and somehow always seems cheerful . . . how weird is that?”—recently it has all begun to unsettle me. Whereas in the past I could look at all forms of internal calamity on my screens and push aside the terribleness that was about to befall the person on the table, over the past few months I’ve found it has all started to clog up my head. Just last week I ran a mammogram on a local schoolteacher who works at the same middle school that Sally and Ben attended, and who, I know, finally got married a year earlier and told me with great excitement how she’d gotten pregnant at the age of forty-one. When I saw that nodule embedded in her left breast and could tell immediately it was Stage II (something Dr. Harrild confirmed later), I found myself driving after work down to Pemaquid Point, and heading out to the empty beach, and being oblivious to the autumn cold, and crying uncontrollably for a good ten minutes, wondering all the time why it was only now getting to me.
That night, over dinner with Dan, I mentioned that I had run a mammogram on someone my own age that day (this being a small town, I am always absolutely scrupulous about never revealing the names of the patients I’ve seen). “And when I saw the lump on the screen and realized it was cancerous, I had to take myself off somewhere because I kind of lost it.”
“What stage?” he asked.
I told him.
“Stage Two isn’t Stage Four, right?” Dan said.
“It still might mean a mastectomy, especially the way the tumor is abutting the lymph nodes.”
“You’re quite the diagnostician,” he said, his tone somewhere between complimentary and ironic.
“The thing is, this is not the first time I’ve lost it recently. Last week there was this sad little woman who works as a waitress up at some diner on Route One who had this malignancy on her liver. And again I just fell apart.”
“You’re being very confessional tonight.”
“What do you mean by that?”
“Nothing, nothing,” he said, but again with a tone that, like so much to do with Dan right now, was so hard to read.
Dan is Dan Warren. My husband of twenty-three years. A man who has been out of work for the past eighteen very long months. And s...
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