Walking To Gibraltar, Chapter 5: In Which Lymph Nodes Are Involved

Astrid did not smoke. Astrid did not drink. Astrid was not overweight. Astrid did not live a sedentary lifestyle; her whole life, aside from shopping, was working out. Astrid had no history of breast cancer or other female cancers in her family. Astrid did not have dense breast tissue. Astrid did not take the Pill. Astrid did not eat a high-fat diet. Astrid did not live or work in a high-risk environment.

Astrid was 39 years old. Astrid had breast cancer. For no good reason anyone could explain.

"We simply don't know," said Dr. Dresser. "There are certain risk factors that increase the likelihood, but there's no one-to-one causal relationship with any of them. You might smoke and drink your whole life and bathe in asbestos every night and not get cancer."

"It just doesn't make any sense," said Astrid.

The office was dim. Yellow light pooled from the lamp on Dr. Dresser's desk. Blinds turned closed to hide the dying sunlight. Frank and Astrid sat on the sofa, half a cushion-width apart. Doctor Dresser cleaned his glasses.

"No, it doesn't," he said. "I know it's a shock."

 "How can you be sure it's cancer?"

"I've been doing this for a long time, Mrs. Carey. There's no mistake."

"It's not possible?"

"No."

"But it was so small."

"Small and aggressive. Thank goodness you found it."

"What if I hadn't found it? You couldn't even find it on the mammogram."

"No."

"Then how can you be sure it's cancer?"

Dr. Dresser sighed. "Mrs. Carey, I'm sure this is terribly difficult for you to understand."

"Don't patronize me, Doctor. I'm not stupid."

"Of course, not. You're under a lot of stress."

Frank could vouch for that. When Astrid was afraid, she turned cold. She had barely spoken to him since he'd gotten Dr. Dresser's call. Before the phone call, she'd been rude, superior—mocking, almost. Gloating. He was a pathetic creature, and she was putting him out of his misery. Since the phone call—stone. As if to tell him he had no right to any feelings about any of it. He was Chauffeur, Relayer of Messages. Still pathetic, but required. He understood nothing. No one was telling him he had cancer.

"Look," said Dr. Dresser. "You need to have surgery. The tumor was aggressive enough that a mastectomy is not out of the question. But I think it makes good sense to consider a partial mastectomy—what's sometimes called a lumpectomy."

"Why?"

"It's more conservative. You wouldn't lose your breast. Only a—notch."

"But maybe you should just remove the whole thing. You said it was aggressive."

"Yes, but we really won't know whether it's spread until we see if the lymph nodes are involved."

"What does that mean?"

"When we do the surgery, we'll also make an incision under your arm to remove twelve or fifteen lymph nodes. We'll biopsy them and go from there."

Hospital stay. Plastic drain. Compromised immunity. Ongoing danger of infection. Permanent numbness. Lymphedema. Bizarre. The tumor was a grain of sand. Smaller.

"Doctor," said Frank, "We've read about sentinel node biopsy." Lymph nodes in the breast have to drain somewhere first. The idea was to inject a dye at the tumor site and see where it goes. Then remove and test just that lymph node.

Dr. Dresser shook his head. "Not proven. It's still experimental."

"You won't even consider it?" Astrid asked.

"I want to tell you a story," said Dr. Dresser. "A few months ago, an old friend of mine came to see me. I've known her forever. She's one of the most beautiful women I've even known—homecoming queen in my high school class. A master gardener.

"I told her what I'm telling you. You'll have numbness. You'll have a notch out of your breast. I'd advise you not to get your hands in the dirt for fear of infection. I'm quite sure it broke her heart.

"But she's alive. It was the right thing for her, and it's the right thing for you. I would tell my daughter the same thing."

"Was there cancer in her lymph nodes?" asked Astrid. "Your homecoming queen—did you find more cancer?"

"No. Fortunately."

"So you really didn't need to remove them all."

"We had to test them. To be sure."

"So now she's permanently numb and disfigured, and her arm is going to be swollen and flabby."

"There's a risk of lymphedema. Somewhere between five and ten percent."

It was just crazy. Astrid was somewhere between perfectly healthy and dying of cancer. Somewhere between "cut off both my breasts just to be sure" and "go fuck yourself—it wasn't even cancer."

"I want another opinion," she said.