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The Year of Goodbyes and Hellos

By Kelly S. Irvin

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Chapter 1
Kristen
Delivering the news required a certain finesse combined with brutal honesty. My technique had been honed over the years. Lean into it. Do it fast. Make eye contact. Adopt a kindly, caring tone. Because I did care. Because it sucked. Then brace for what came after the words that would irrevocably change a patient’s life.
“You have uterine cancer, Mrs. Sedaris.”
Pausing to let the diagnosis sink in, I laid the PET scan report on my desk. My words rattled around in the tiny exam room. Angst sucked up all the air, making it hard to breathe.
My patient, a physical therapist, avid cyclist, vegan, who glowed with health, stared at the framed North Dakota Badlands photo on the wall behind me. Red blotches blossomed on her throat. She tugged her jean jacket tighter and buttoned it. It provided poor protection against a cold draft. It was a mere sixty-six degrees in San Antonio on the springlike first day of February, so the arctic air temperatures maintained in the Texas Cancer Care Clinic couldn’t be excused.
Still, she said nothing. There were no words to be had.
Mrs. Sedaris’s husband, seated in the chair next to her, clasped her hand. His big fingers, covered with fine blond hair, entwined with her thin ones. “So what now, Dr. Tremaine?” Only a slight quiver in his deep bass gave him away. “Will she have to have a hysterectomy?”
She was twenty-six years old and the mother of an adorable toddler with the same silky blonde hair and indigo eyes. She’d shown me pictures of the little girl named Shiloh on her phone the first time we’d met after a referral from her gynecologist.
“Yes. Given that the cancer has metastasized, the surgeon will remove your uterus, ovaries, and fallopian tubes.” Which would throw her into early menopause. Sugarcoating didn’t help. Most of the time it made it worse. “We have three gynecological oncology surgeons on staff here. An appointment with one of them is next. After you’ve met with him, we’ll map out a treatment that could include radiation and likely chemotherapy once you’ve recovered—”
“But we want another baby. We’re trying . . .” Mrs. Sedaris’s voice broke. “We were trying when the bleeding started.”
“I’m sorry.”
Sometimes those were the only words I could offer. Leaving the uterus and other female organs intact and hoping chemotherapy would eradicate her cancer wasn’t an option—not in my book. Mrs. Sedaris’s symptoms of breakthrough bleeding and abdominal pain didn’t necessarily point to cancer. Her menstrual periods had always been irregular and painful. By the time her ob-gyn sent her for a CT scan, the cancer had spread. Now my job was to utilize all means available to keep my patient alive.
But you’ll be alive, I wanted to say, you’ll be here for little Shiloh and your husband, and all the other people who love you and whom you love. But I didn’t. Because no oncologist could guarantee that. Not with a sneaky, insidious, smarmy disease that constantly reinvented itself, overcoming every medical tool devised to destroy it. Not when her cancer had spread. She would be in treatment for the rest of her life—however long that might be.
I held out a clipboard with a form that would allow us to send a tissue sample to a company for molecular profiling after her surgery. “With that information we can determine the best treatment options following surgery.”
Mrs. Sedaris didn’t take it. Mr. Sedaris, also blond and blue eyed but tanned the way a coach who spent his afternoons on the football field would be, did it for her. His chair creaked under his brawny weight, the legs spindly behind his massive calves.
My phone dinged. I took a quick peek. Maddie. When was the last time I talked to my oldest daughter? Our weekly calls had turned into sporadic texts sometime last semester—or maybe it was the semester before. Guilt’s sharp arrow tips tried to pierce my thick physician’s hide and fell, broken, to the ground. She needed help with her rent after her apartment roommate bailed out at the last second to live with her boyfriend. Which was why I’d been in favor of dorm living. My husband, Daniel, had sided with Maddie. Something he’d done a lot lately.
Think about it later. Later would come in the middle of the night. I added her request to my mental to-do list without responding.
“It’s highly treatable.” I offered as I handed Mr. Sedaris a pen. “We should get started as soon as possible, though. When we finish here, my medical assistant will take you to the surgeon’s scheduler. I’ve already talked to him. He’s expecting to do a preliminary evaluation early next week or as soon as he can squeeze you into his schedule.”
“That’s good.” He laid the clipboard in his wife’s lap and placed the pen in her hand. She scribbled her signature without reading the form. He patted her arm. “That’s good.”
In time they would realize that highly treatable didn’t equate to highly curable. Patients could only take so much in one sitting. “Give me your phone and I’ll put my cell phone number in it. Call me if you need me.”
She met my gaze for the first time since I said the words uterine cancer. “You’d do that?”
The clinic where I practiced had a terrible habit of making it difficult for patients to reach their physicians. Messages disappeared into great voids. I needed to be accessible to my patients. It was my job. “Put yours in mine too. That way I’ll recognize it when you call.”
My phone dinged again. Not Maddie, surely. She knew better.
No. it was Daniel. My husband wanted to remind me we were attending his mother’s seventy-fifth birthday celebration that evening. He’d reminded me three times before I left the house at seven earlier in the day. And two times the previous night after I’d turned off the reading lamp, rolled over with my back to him, and tugged the sheet up around my shoulders.
I ignored his text. Ignored him. That’s what he’d say. I wasn’t ignoring him, just leaving my response for a more appropriate time. I was with a patient. I’d respond later. Which would be about the time I arrived at the house and found him pacing, ready to go.
The door opened. My medical assistant Shay stuck her head in. “Sorry to interrupt. Methodist is calling about Mr. Chavez.”
My hospitalized patient with late-stage colon cancer. I took the phone. “Shay, please take Mr. and Mrs. Sedaris to see Dr. Rodriguez’s scheduler.” I turned back to the couple. “Once we have a date set for your surgery, we’ll schedule you back with me.”
Mr. Sedaris stood. He took his wife’s arm and helped her up, like she was an elderly woman in need of a cane or a walker. I held out my arms. “See you soon.”
She accepted my offering and walked into them. I hugged her tight. Her thin body shuddered. I heaved a breath, let go, and stepped back. “See Dr. Rodriguez and then we’ll make a plan, okay?”
“Okay.” She gave me a watery smile, the first since I’d come into the room. “See you soon.”
Trust and hope lived in those words. The seeds had been planted. By our next appointment she’d be over the shock and ready to participate as a member of the team responsible for keeping her alive.
At least I hoped she would. I’m not a big proponent of the so-called power of positive thinking, but a patient determined to fight for survival often fared better. I don’t know why. I don’t really care why. Only the results matter. “See you soon.”
I stepped out into the hallway with Shay. She beckoned to the couple. “This way.” She glanced back at me. “You’re about an hour behind now.”
The clinic insisted on scheduling my patients fifteen minutes apart. “How bad is it?”
“Mrs. Cochrane says she’s bringing her sleeping bag next time, and Mr. Johnson thinks we should provide a lunch buffet.”
“I’ll catch up.”
“Uh-huh.” Shay had been my medical assistant for five years. She knew better. “Take your call. I’ll bring Mrs. Cochrane back as soon as I finish with these folks.”
Shay knew I would do my best for the sake of my patients sitting in a crowded waiting room, watching the minutes tick by, some fuming, some numb, some resigned. It shouldn’t be like that, but I couldn’t fix it. This was the price I paid for practicing in a large corporate clinic.
As soon as I finished with the situation at the hospital, I double-timed to the next exam room where a patient with pancreatic cancer had been waiting for half an hour. I put my hand on the knob. My phone dinged. Not Daniel again. He knew better. I let go of the knob and checked.
My sister Sherri. When was the last time I’d talked to her? She texted me on New Year’s Day from her son Cody’s house in Fayetteville, where she was spending the holidays. We used to talk more, but time seemed to get away from us—or me. I glanced at my smartwatch. Ten thirty. She should be sitting crisscross on the rug in her kindergarten classroom in Kerrville, reading the Little Blue Truck to her students. Or trotting in a single-file line to recess. Her life as a teacher had always struck me as idyllic. Not fair, I knew, but so hopeful and full of tomorrows. She gave her students the key that opened the door to a lifelong love of reading. What a gift.
KNOW YR BUSY BUT NEED TO TALK. WHEN U CAN
Tonight? No. She went to bed so early and I worked. I stabbed a response with my rapid-fire index finger.
WILL TRY TO CALL U ON LUNCH BREAK. ARE U ON CAFETERIA DUTY TODAY?
NOT AT SCHOOL. IN CAR. DOCTOR’S OFFICE PARKING LOT
The hair on my arms prickled. A cold breeze wafted over me that had nothing to do with the overactive AC. My older sister had always been the picture of health. She loved Zumba, Billy Blanks’ Tae Bo, and spin classes. Her weight was perfect for fifty-two, likely so were her cholesterol and blood pressure. Last year she finished fourth in the San Antonio Rock ’n’ Roll Marathon’s female 50-55 division.
WHY? WHAT’S UP? ARE U SICK?
Suddenly light-headed, I waited, staring at the little twitching bubbles that meant she was typing a response.
NOT SICK. HAVE CANCER
 

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