“I have to believe that, otherwise there’s no justification for the hell you’ve been through.”
“Well, I believe it’s working, Riley. Not because it’s the only choice I have, but because deep down I truly trust it. I suddenly believe I will survive after weeks of preparing for death. I can’t float in between like you do.”
“I never said anything about death. I said we need to see for sure, meaning without an ultrasound and blood work we know nothing.”
“The tumors were there and now they’re not, Riley. It’s the first tangible proof I have that tells me this was worth it. I know they might still be in there, but they shrunk or moved or something. It changed. I did something and changed cancer. I pushed back. It pushed me and I pushed back.”
She couldn’t explain it any other way. Maybe she wouldn’t win, but he’d told her in the very beginning to get in the ring and she did. She’d fought harder than she ever thought she was capable of fighting. It wasn’t over yet. Most days she felt beaten and outmatched, but today...today felt like she landed a punch and that was a game changer.
His head lowered. “I get it. I’m sorry I shit on your parade. I didn’t mean to. You’re right. We should’ve celebrated today.”
She smiled, believing his second apology to be more genuine than the first. Brushing a hand down his cheek, she grinned. “Day’s not over yet. We could still celebrate.”
His lashes slowly lifted as his gaze melded with hers. “What do you mean?”
She laughed. “What do you think I mean?”
“Sex? You mean sex?”
His shock was comical, but then she sort of shocked herself. Did she want to have sex? “I don’t know.”
He tried to hide his disappointment, but there was no disguising the way his smile left his eyes. “We don’t have to.”
“No,” she quickly reassured him. “I mean...we can.”
He frowned. “Do you want to?”
She wasn’t sure. She shrugged. The words just sort of fell out, lost little clouds floating through stormy skies, so reminiscent of the girl she used to be. Those familiar pieces were so comforting. She wanted nothing more than for them to be true, but as she considered her exhaustion and the effort it would take, disappointment crushed her.
Reading her, he settled on his back, compensating by holding her hand. “Let’s get some sleep,” he whispered.
She nodded as he reached for the lamp, setting the room to darkness. Turning away from him, she silently cried. What if they never had sex again? As much as the instinct felt right the motion felt wrong. What if this was what their relationship would always be, him worrying about her delicate state and her being too fragile to prove to anyone that she could be strong again.
She huffed and he turned. “It’s fine, Emma.”
“It’s not fine. Everything is not always fine.”
“I’m not going to sit here and fight with you.”
“We’re not fighting, Riley, but I’m allowed to get frustrated. The fact that you’re acting like this is okay is only frustrating me more.”
He sat up. “What do you want me to do, demand sex? You’re being irrational.”
“No. I just... I just want to be normal again.”
Sliding back under the covers he took her hand, lacing her fingers with his. “We’ll get there.”
As much as she envied his confidence, she didn’t always share the same beliefs. But in moments like this all she could do was hope he was right.
****
The following week, as they waited for Dr. Lindsay in his office, anxious curiosity made it impossible to stay calm. This was the big one, the moment they found out how the cancer responded to the chemotherapy.
She didn’t want to face another round of chemo, but if that was what she needed to do, she would. Hearing more chemo would be better than hearing the cancer progressed and the treatment failed. Every day she felt around and still couldn’t find the tumors, so she was hopeful.
When the door opened Riley noticeably tensed and she stopped breathing. Her body surged on the verge of passing out as Riley grabbed her hand, squeezing tightly.
Dr. Lindsay sat down at his desk. “Emma. Riley. How are you feeling today?”
“Nervous,” she answered honestly. God, she was so tense.
“Understandable. Well, I have some good news.”
Good!
Her mind latched on to the word good, but then panicked at the term some. “Okay.” She breathed and squeezed Riley’s hand a little harder.
“Your test results show a partial response to the chemotherapy.” Partial. “What that means is, while the cancer didn’t totally disappear,” It’s not gone... “There’s been a notable reduction in the size of the tumors. In other words, it’s working.”
She exhaled and panted for a few seconds, possibly smiling. Her face was totally numb. “It worked?”
“But the tumors are still there?” Riley asked.
“Yes, the tumors are still present, but the markers have fallen. You’re not out of the woods yet, but this is great progress and definitely a reason to be happy.”
She was happy, so happy there should be a bigger word for the emotion. Elated. Jubilant. Nothing was enough. “What happens now?”
“Well, you have a few options. The chemo can continue, but I’m going to advise against that based on your personal response to the therapy for the time being. The next option is to remove the remainder of the tumors in a partial mastectomy—a lumpectomy.”
She’d definitely been smiling, because she was very aware of her expression falling. “But...they’re shrinking.” She, of course wanted them gone, so a lumpectomy was always on her radar, but having that foreshadowed thought shoved into the present managed to shock her all the same.
“They are—a great sign. But, based on your recent tests, I think it’s best we pull back while your body’s at it’s strongest.”
Strongest? She was weaker than a baby calf. “You don’t think my body could handle more chemo?”
“Not without significant damage. Keep in mind, we’re looking at your entire system, not just your breast tissue. The progress you’ve made is notable and enough that I’m confident we’ve reached the time to discuss surgery. This option will conserve a portion of the breast and hopefully some breast sensitivity.”
Riley leaned forward. “Is it possible for the cancer to return after that? Could she still need chemo? I mean, if you think she shouldn’t have anymore, what are the chances she won’t have to if she has the tumors removed?”
Dr. Lindsay offered a sympathetic smile. “Unfortunately, until we know more about the cause of breast cancer, there will always be a threat to women with Emma’s diagnosis. Breast cancer isn’t something contracted. It’s a mutation of cells and researchers are still trying to identify the trigger. By removing the tumors and a fair amount of healthy tissue surrounding the masses, we diminish the chances of the damage spreading. The surgery’s often followed by radiation and in some cases, additional surgeries.”
The end—she wanted to get to the end so her life could begin. “What’s the other option?”
“The other option is an MRM, Modified Radical Mastectomy.” The gravity of option B dramatically altered the energy of the room.
“Losing my breast?” The words were possibly the most painful words she’d ever spoken, heavy and clunky, jagged and crude against her tongue.
Dr. Lindsay nodded. “Yes, removing the affected breast.” He folded his hands and adjusted his posture. “I want you to understand the advances that have been made, Emma. This isn’t the same procedure practiced twenty years ago. This sort of surgery no longer removes the pectoral muscles, only the breast and the affected lymph nodes. Cosmetically, there are countless reconstructive options. You might be a good candidate for nipple sparing as well, meaning the incisions are fairly hidden and the nipple is conserved.”
“Is the MRM more effective than the partial mastectomy?” Riley asked, tak
ing the next question from her mind.
She was so grateful he was there. She’d never be able to handle all this on her own.
“The chance of reoccurrence is slightly higher with a lumpectomy, but still considerably low; that’s why radiation’s used, thereby making both procedures equally effective. The decision comes down to the patient and peace of mind.”
She supposed it was like weeding a garden. They could remove the weeds, bit by bit, but if they missed any seeds the weeds would return, and they’d treat the area with more poison. Or, they could remove the garden forever. But there would always be the chance one of those pesky seeds might get left behind and form in the surrounding areas where the beds once were.
“Does keeping the nipple raise the chance of reoccurrence?”
“Unfortunately, yes, but the risk is very low.”
Pressure. Ungodly pressure built in her shoulders and tugged at her belly as if his words physically pushed her down. Riley stood and dispensed a glass of water from the cooler in the corner and handed it to her. “Have some water.”
“Thank you.” She sipped and looked back at the doctor. Exhaling harshly, she shook off the fear and sat a little straighter. “Sorry. Go on.”
“I want you to understand, one operation does not guarantee survival anymore than the other, Emma.”
Bleak. Every time she leaned on the slightest reassurance someone shook her, reminding her there were no assurances. “I understand.”
“Neither does either surgery guarantee a future free of chemotherapy or radiation, and because this is an invasive kind of cancer, patients often need additional therapies.”
He steepled his fingers. “I want to be perfectly clear on that matter, because I don’t want you to make your decision and then get blindsided if things don’t turn out the way you expected. Every patient’s different. We can only go by what we know. You’re very young and the strand of breast cancer you’re dealing with is aggressive and requires equally aggressive treatment, but we’ve reached a point where you get to decide which angle of approach we take.”
Her hands trembled so she lowered them to her lap, wrapping her numb fingers around the empty cup. “What about my other breast?”
“If you opt for the MRM?” He nodded as though expecting the question. “There are prosthetics available, but each woman’s different. Some women opt for a prophylactic mastectomy—or double mastectomy—in this case for multiple reasons. It might be a desire for reconstructive symmetry or a method to put their mind at ease.”
She glanced at her chest, oddly recalling a time she’d wanted boobs so badly she stuffed an entire box of tissues in her bra. “What would you tell your wife if she was in my shoes?”
He slid her a pamphlet. “I’d tell her this isn’t an easy decision and there are always going to be benefits and risks. It’s natural for a woman to want to maintain her breasts, but we also live in a time when augmentation isn’t unheard of. I’d support her decision either way, because it’s a very personal decision. But at the end of the day, it would be hers.”
Doctors were experts of evasion. She was glad she wasn’t married to one. Blowing out a slow breath she sat back. An unexpected sense of empowerment washed over her. She just had to decide and then they’d move to round two. If she made the right decision, it could possibly be the last round of this tiring war.
It was her decision. She smiled, her expression a bit shaky. “I appreciate having a choice at all.”
She hadn’t decided anything in quite some time. The last choice she made was to fight and from then on she’d fought without rest. Now things had calmed and she was given a choice again. She blew out a breath. “It’s a lot to consider.”
“I advise my patients to write down the pros and cons, really take your time considering how each approach will put you at risk or be beneficial, and which is going to affect you most on a personal level. Every woman’s different as is each case of breast cancer. You don’t have to decide what’s right for womankind. You only need to choose what the best solution is for you.”
“Thank you.” Yes, she said thank you—as far as messengers went, he was a decent one and didn’t deserve to be shot.
As they left the office she reconsidered this new information, simplifying the facts as much as possible. Somehow that made the news more manageable.
Was her cancer gone? Not at all.
Did her tumors disappear from chemo? Nope.
Would she keep her breasts? Maybe. Maybe one, maybe half of one, maybe none. It was mind boggling that this still felt like good news.
This disease might very well be the fastest overhaul a person could experience in terms of the way they viewed the world. Had she gotten this news two months ago, she would’ve been in an inconsolable puddle on the floor. Having gone through hell and back, things looked different. In her opinion, she was handling everything quite well.
Riley was silent as he started the car. She’d been so lost in her own thoughts she’d barely noticed he hadn’t spoken a word since leaving the office. Once they were driving she turned to him. “Are you going to say anything?”
He kept his eyes on the road. “I don’t want to influence you either way.”
“So you have an opinion.”
“I have lots of opinions, but I don’t know if any of them are right.”
She chuckled. “Human.”
She had opinions too. First, chemotherapy sucked, hardcore—a thousand times worse than anything she’d ever expected. Yet, she’d do it again if she had to. Strange that fact never changed. Her instinct to survive always outweighed the temptation to give up. But if there were ways to reduce her chances of suffering chemo again, she’d do them first.
Being diagnosed with cancer was the tip of the iceberg. Cancer was quiet. It silently crept into an unsuspecting life and secretly destroyed one cell at a time. Fighting cancer on the other hand was war. It was brutal and volatile. Cells—friends and foes—were massacred. It was a struggle that pushed a person as close to death as possible and then fought to bring them back, leaving all the bad behind.
She didn’t want to spend her life fighting that war. There was no quality of life when submerged in such an endless battle. She wanted to live. It was that simple.
Somewhere in the midst of ignoring the pain that stole her breath, the agony radiating in her bones, the absolute conviction that she would die before morning, somewhere in the middle of all that, the superficial worries were stripped away.
She never expected to think of herself as too skinny. And her hair, which she’d fussed over, singed, flattened, and tried to cook the curl right out of...she didn’t care about that anymore either. She was so busy competing to survive, her instinct to compete with others disappeared.
There was no room for distractions like envy or hate, no time for strife or vanity. These months had taught her no one really had control. They only had an unpredictable amount of time, so she better make every second count.
It was a peaceful epiphany and, as she accepted this lesson into her heart, she found it ironic such accord could be borne of despair. Above all, she wanted to be whole again, spiritually and emotionally. The physical didn’t so much matter anymore.
For the first time in a long time, she was confident enough to truly—truly—hope, and all the anger she’d lugged this far was swiftly put down and left behind. Her courage was borrowed, bullied out of her—by her—for those that longed to see her recover. She certainly wasn’t going to let one boob get in the way of all that, not after everything they’d done to help her this far. If there was a way to end this, she wanted it over.
“Tell me your opinions,” she said, concerned he might oppose her.
“I think this conversation deserves more attention and respect than us chatting it out on a car ride home from the oncologist’s office, Emma.”
“Then pull over and look at me, Riley. I want to know what you think. It matters to me. You’re one of the few people in this world wh
ose opinions mean something to me.”
He bit his lip and maneuvered through traffic. Yanking the wheel, he pulled into an open spot on the shoulder and faced her. He was angry and she didn’t understand why.
“Fine. If you died—” His words were harsh, dousing her with more reality. “—do I get to keep your boob?” He huffed out a breath, his knuckles white as his fingers gripped the wheel. “Do you hear how ridiculous that sounds? It’s a tit, Emma. I don’t care about it. I care about you. I care about having a life with you, by my side. I think letting something as meaningless as a boob get in the way of that happiness is insane.”
Who knew how a normal girl would react to such a statement from her boyfriend? She stopped trying for normal a long time ago. What she did know was that she loved him. She loved him for getting angry, for caring enough that he could barely speak of her demise without crying. She loved him because he never lied to her and when he said her breasts didn’t matter, she knew without a doubt, he was telling the truth. Honesty. Trust.
Her hand touched his. “I want the mastectomy.”
As he exhaled a harsh breath, his shoulders drooped forward and his head rested on the steering wheel. “Are you sure?”
His face tightened and she silently counted the worry lines around his eyes that weren’t there two months ago. He’d walk away from this scarred as well.
She rubbed her palm over his cheek until he faced her. Then she nodded. “It’s just a tit.”
His seatbelt unlatched and his arms wrapped around her, his face burrowing deep inside her scarf until his warm lips found her neck and he sighed. “I love you.”
“I love you too,” she said, holding him tight. He really was the most incredible man she’d ever known.
****
She was supposed to be shockproof by now, but she wasn’t. Once they’d told Dr. Lindsay her decision to have the mastectomy everything moved at jet speed and before she knew it, it was the eve of her surgery.
After endless research and exhausting deliberation, she opted for the bilateral mastectomy, removing the unhealthy breast as well as the unaffected one. It really was a personal decision; one she struggled to justify. The more she explained her choice the more frustrated and certain she became. Thankfully, Riley was open minded and shared many of her views.