Diagnosis

This is a true story, at least in one out of nine cases. It starts as it always does, a year or two after the beginning when the lump is large enough to be detected by a mammogram.

‘They asked if I could come in again tomorrow for an ultrasound, which is not a good sign,’ Imma said.

‘You had a similar finding two years ago, and they said it was nothing,’ I answered. We had the option of a routine scare. The finding is suspicious; the odds are fifty-fifty. Your physician will have results in a few days.

Back home, Imma cooked and sat with us at the table – business as usual - so that the kids wouldn’t worry, but she did not touch the food ‘I ate earlier’ - twenty-four hours earlier. A few days are a long time to wait with fifty-fifty, plenty of time for me to Google Breast Cancer and take your first cancer SAT. Invasive: Yes, No. Size: Less than two centimeters, less than three centimeters, less than five centimeters, more than five centimeters. Given my ignorance, I marked non-invasive and less than two centimeters, came up with the equivalent of a then-you-have-nothing-to-worry-about prognosis, and waited to see what the new day would bring.

‘Please come to the office tomorrow.’ The message recording said.

‘That’s it then,’ Imma said. Would you believe that I have Cancer?’

‘They said it was small, an early stage; the prognosis is excellent in such cases. Besides, we still don’t know for sure.’ I wanted to sound credible, so I didn’t give away my Google sources.

‘I know, this time I know.’ Usually, I love to take her word for things, assuming the role of the emotional parasite, sucking confidence from her; this, however, was forming up to be an exception. I needed more time to transition from being an emotional dependent to a supporter.

‘I knew it since the vitamin D deficiency started two years ago.’ Imma continued to fortify the verdict she had cast. We had three more meals to skip.

In the waiting room, Imma concluded that the malignant findings were definite. ‘Did you notice how the family physician’s wife pretends that I’m not here?’ She paused. I had nothing to contribute, although I had yet to find a doctor’s assistant who acknowledged anyone’s existence. ‘She comes in three times a week to help with the paperwork. She is always nice to me; we chat about the kids.’ That was troubling evidence; middle-aged Jewish women are known to talk to each other when they share the same confined space. The fact that they rarely spoke to me did not surprise me. While I was middle-aged, my feminine credentials were lacking. My generally introverted presence is aggravated in medical establishments, putting me on the aggressive side of my passive-aggressive being.

‘Mrs. Porat’, this time, the surgeon’s assistant held the door leading into the inner corridor open for us. Her face was emotionless, but that did not trouble me – I knew this woman lacked emotions. ‘Please step up on the scale….’ Only years of conditioning in America kept me from asking if we could skip the crap – we were here to get a cancer diagnosis, not a dietary consultation.

‘Your blood pressure is high.’

I wished my gaze could do physical harm.

‘The doctor will be with you momentarily.’

One thing I was sure of: it had nothing to do with introversion; I was well within my rights to despise that woman and the system that bred her.

Dr. Cohen, the surgeon, stepped in, dressed in his battle gear, blue scrubs, a short, thick man in his sixties, the hair on his head and chest going any which way, with a human expression on his face. Had the scrubs been dark blue, I could have mistaken his large hands for a dairy farmer. He started talking before he sat down: ‘I have bad news.’ Imma leaned back on the examination bed. ‘It is malignant,’ assuming we all knew what ‘it’ was, ‘but it’s small,’ he blurted, desperate to get the whole message across. He was nervous in a compassionate way; I liked that for the little it was worth. ‘In cases like this, we remove it, we treat you, and that’s the end of it.’

‘What kind of treatment?’ Imma asked.

‘Why don’t we step into my office, and I’ll explain what happens next. On the way, we bumped into the family physician. ‘You’ll be fine,’ he told Imma; he signaled me aside and handed me a prescription like a grandparent sneaks candy into a grandchild's hands so the parents will not notice. ‘This is for anxiety; she can take one every six hours if she needs it.’

‘Ok if I use them?’ I asked.  

He caught a glimmer of a smile on my face and slapped my shoulder. ‘What are you doing walking around in a T-shirt like you’re on some kibbutz?’ Imma was right; everybody in the clinic knew about our tumor. Now we had to hope they knew everything there was to know about getting rid of it.

‘At the stage you are in, we take it out, treat locally, and that’s the end of it.’

‘Do you remove the breast?’ Imma asked, frightened, but not for her figure. Survival was her only concern. I felt a bit selfish, caring more for the breast than she did, but then men will be men. ‘Of course not. Why would we remove the breast?’ I liked him, not for saving my breast so much, but for how he said it – informal and sincere about minimizing the physical harm, giving a sense that this was routine, you do what needs to be done and fix the problem.

‘What about Chemotherapy?’ Imma asked.

‘I don’t think that’s necessary.’

‘Radiation?’

‘Perhaps just a Mammosite – it’s a new procedure of five targeted radiations to the cavity where the tumor was.’ He called it for what it was; he was settling down; I felt better for him. The surgeon continued: ‘There is no evidence of lesser recurrence in women who have had their breast removed…’ which sounded on the verge of statistical impossibility – how could there be recurrence if there was no breast? ‘I can have you in for the procedure in a week.

‘How do you know where the boundaries are?’ I asked, regretting that the question would annoy Imma. She didn’t need details; she wanted results. ‘We use a special radioactive marker...’ he began, raising his seat, Lincoln in front of the nation, ‘…and you use a mono Geiger?’ I slipped in, showing off Google-supported general knowledge. ‘…and I cut around it.’ He finished in a crushed voice, having his thunder stolen. This was similar to the half-worm-in-the-apple problem, which I understood very well. Imma began validating his credentials. ‘Is my condition rare?’ she asked. He fell for it. ‘Oh,’ he began puffing his cheeks and blowing the air out. ‘It’s a growing epidemic; sometimes, I operate five times a week, at least ten times a month.’ Rumor had it that he was considered one of the best breast surgeons in Silicon Valley, even if he didn’t have the acting skills to match. I envisioned him moving through dimly lit milk ducts, sloshing in his galoshes, fumbling and tripping through puddles of milk, staring at the needle on his little machine, carving through the tissue around him with broad sweeps of his machete, bringing the instrument closer to the fresh fissure in the tissue, listening to it crackle, as he poked deeper. He needed to cut within three millimeters of the tumor without cutting into it. Could he do it?

He was checking his calendar. ‘I can operate on September 11th, ‘He said, ‘but I will not be available for a follow-up for two weeks after that. My wife is taking me on a cruise….’

‘Sure, sure, blame the wife.’ I could tell that part of him was talking to his mother. At the core, he was a nice Jewish boy raised in a towering shadow of guilt cast by a thundering petite Jewish mother years before Phillip Roth mortally wounded the myth. ‘How could you possibly go on vacation knowing I had a ten percent chance of getting breast cancer? You couldn’t wait for me to get my cancer after everything I had done for you?’ ‘… but I will arrange for my colleague to see you,’ he concluded uneasily. Dr. Cohen made a few calls to arrange an operating room and schedule all the procedures. While on hold, he tried to keep life support active in the room.  ‘My wife paints,’ he said.

‘Did she draw the pictures in the room? Imma asked. She knew she did, but she played along with the small talk.

‘Yes, she did. She also runs a painting studio for women who have had breast cancer. If you like… hold on’, he gestured towards the phone. ‘Tuesday, no, it can’t be Wednesday. I’m gone on Wednesday… yes, sentinel node biopsy and partial mastectomy, yes… Cohen with a ‘C’… thank you.’ He turned to me – the errand boy - ‘Check with Sherry; she’ll set it all up and explain everything.’ He turned to Imma, ‘About the paintings….’

‘I’ll call her,’ Imma lied.

Sherry gave me a list of dates and places, and I wrote things down, making sure I understood, hating the feeling of having no better option than to do exactly as I was told. On the way out, we stopped by the front desk. The family physician’s wife choked on a you’ll-be-fine smile, which she knew she failed to produce, but we were glad she tried – she knew all along and was happy to get the elephant out of the room. I searched for the surgeon’s assistant to try another lightning bolt from my eyes, but she had gone to weigh another innocent victim. We had a week to stew in whatever reality we perceived.

‘We have to decide who we notify.’ Imma said as we drove home. ‘We’ll tell Yeela and the boys, ’ she continued, ‘I don’t think we should tell Tal. Yeela can tell her when she returns to Israel’. It will be three weeks after the operation; the fact that she’s there will make it easier for Tal.’

I agreed.

‘Irit, Michal,…’ she thought for a moment, ‘Should we tell your parents?’

‘We should tell them because Michal will not keep it from them, and we want Hikko in the picture.’ I said. ‘No one else in Israel should know for now.’

‘What do we tell them?’

‘Exactly what we think we know – they found a lump, its malignant, small, early stage, operation, and some treatment, prognosis complete recovery.’

‘I’ll talk to the kids, my sister, and yours.’

The fanfare leading to the surgical procedure was somewhat ridiculous. We were invited to the hospital three days prior for a set of meetings, an elaborate charade for validating our medical coverage. After the institution was content that someone would pick up the tab, we were herded into an office shared by two nurses for a medical consultation. Only the nurse facing us was present, which was a pity because maybe the other could have explained the medical procedures correctly. At first, Nurse went through registration procedures while a massive man with a badge that said Boris drew some blood. Boris skipped the which-arm-do-you-prefer vein selection dialog. Instead, he picked up whatever arm was close to him, picked a spot, flicked the needle in, and switched four small test tubes as Nurse droned on. I tried to follow Nurse’s thought process. Did she honestly believe that Imma would be listening while she was dripping blood in the hands of a stranger?

Boris finished, slipped out of the protective gloves, and quickly collected the tools of his trade. Imma always made it a point to make friends with people who have a right to stick her with needles. ‘You were the best I ever had,’ she said. Fortunately, Boris was new in the US and interpreted the words only in their immediate context. Nurse continued, and Imma dozed off. ‘When you leave the operating room, you’ll have a small plastic bottle attached, which will collect the fluids from the wound through a plastic tube the surgeon will insert and leave there.’ I didn’t like tubes coming out of wounds. Imma leaned against me, pretending to listen, silently screaming to leave. Nurse went on. ‘When you see the bottle is full, you should detach it from the tube and empty it.’ I imagined the bottle, warm to the touch and sticky from what was sure to be oozing around it. ‘The body tends to secrete fluid for a few days after major trauma,’ Nurse continued with the sensitivity of a corpse. I recalled Hila was attached to such plumbing when she was operated on five years earlier. Nurse folded her arms in front of her as she came to her concluding remarks. ‘It’s important that she be fasting….’

‘Which is what she’s been doing for the past week.’

‘…You should be here at six o’clock in the morning to start the guided needle procedure.’ Nurse spoke with an authoritative but hushed voice so as not to wake Imma. When she concluded, I declined Nurse’s offer to answer questions and walked with Imma to take a chest X-ray. Google mentioned that breast cancer could metastasize to the lungs, and we didn’t want that.

‘Can you take care of the logistics and just make sure I get wherever I have to be on time?’ Imma asked in a weary voice. I nodded, knowing it was the least and the most I could do.

 My cancer research continued throughout the week. I became well-informed in the T-N-M breast cancer classification system. T is for tumor size, which in our mind’s eye was ten millimeters long – a baby cancer – the lowest grade save for ductal carcinoma, which only aggravated pessimists classify as cancer. N stood for lymph node involvement because it would be too easy to use an L. The lymphatic system is the cancer’s estuary through which it conducts its maritime expeditions to the rest of the body, so it was preferable to keep cancer cells away from the lymph nodes. M is for metastasis – a fancy name for cancer colonies elsewhere in the body. The order made sense – as T grew in value, it increased the probability of a more significant value of N, which also increased the risk of higher values of M. Values of each letter ranged from 0 to 4, which meant you could get a theoretical maximum score of 12. High scores spell disaster. With what we had now, I marked T1-N0-M0 on the cancer SAT mental sheet I was keeping – an early stage one, is what it was called. Imma summarized her preferences more plainly ‘I don’t want my children to be orphans, and I want to see my grandchildren.’ My silence offered little comfort. Denial told me it was best to let the wave of fear flow over me and wait for more information.

Dr. Cohen met us in the pre-operation room. Imma lay on the bed, ready to be wheeled away. The guiding needle had been placed; the radioactive marker was injected – all he had to do was go after the thing and get it out. He stood at the side of the bed smiling, leaning his hands on the side rails, making small talk, playful almost. ‘You’ll probably be able to return home this afternoon,’ he said.

‘Dr. Do you have the test results?’ I was referring to the chest X-ray and the blood tests. ‘Oh, they were fine…’ his tone reversing responsibility to me as if I was spoiling a Kodak moment or something. ‘Aren’t you going to kiss her?’ the nurse asked me as I detached myself from the side of the bed. I did as I was told. ‘When do I get her back?’

 ‘Two hours.’

I called Yeela. ‘How’s Imma?’ she asked.

‘They’re just getting started. Did the boys go to school?’

‘Yes.’ 

‘What about the visitors?’

‘I took them to the train station.’ Tal had arranged for two of her friends to use our hostel home as they passed through the valley on their tour of the world after their discharge from the military in Israel. In a way, it was better to have them; the more to do, the better. ‘When should I come over?’

‘Take your time, not before 11:00; we will not be able to see her before one o’clock.’

‘You said it’s a two-hour operation...’

‘Yes, but recovery takes about two hours as well.’

‘Bye, Dad.’

‘Bye.’

I crossed the hall into the waiting room to take stock of where we were. No metastasis; this was the first bit of good news in ten days. There was still a tumor to remove with clear boundaries, and we needed or thought we needed to know whether the cancer had reached the lymph nodes. At least the lungs were clear.

‘And who might you be?’ The elderly volunteer who watched over the waiting room asked, bending over to meet my eyes as she held on to her walking stick. ‘Gallia Porat,’ I answered in my naturally uncooperative voice, angry with myself for trying to find faults in a person whose intentions were to do her job and provide whatever support she could to herself and others. She looked the name up in the note and marked it with a yellow marker as though I had filled a restaurant seat reservation. ‘She’s in for the partial mastectomy?’ I liked ‘lumpectomy’ better because it sounded more confined. Nobody knows how big a lump is, but everyone agrees it’s relatively small. Partial mastectomy was an open contract to remove a breast. ‘I had that done fifteen years ago,’ she explained, displaying herself as support for statistical research indicating high early detection survival rates. My smile pushed its way past me to the front of my face. ‘She should be done in an hour and a half. The surgeon will come out when he is done to talk to you.’ She was using very plain English.

‘Thank you.’ I said, still convinced that her top priority was to rule out the possibility that I was a homeless man settling in her territory for a free cup of coffee. She moved on to check for the rest of the reservations.

Humi showed up to pass the time with me. I debriefed him. ‘Looks good for now.’ I said.

‘So the X-Rays were fine?’

‘Yes.’

The surgeon came in and walked towards us. I got up as protocol required but did not move far from my seat so that Humi could overhear what he said. ‘Everything is fine; the sentinel nodes are fine; she’ll be upstairs on the fifth floor in an hour.’

‘What about the drainage bottle….’

‘What drainage bottle? She doesn’t need that; it’s only for mastectomies.’ I decided that a full investigation was not in order.

‘Thank you, doctor, have a nice trip.’ I said. He shook my hand, waved goodbye, and returned to the operating rooms.

‘That sounded like good news,’ Humi said.

‘Did you hear lymph nodes clear?’ I asked him.

‘That’s what he said.’

Somewhere I had a gnawing feeling that something wasn’t right, something related to the time it takes to ensure that there are no cancer cells in the lymph nodes. I decided not to dwell on it. We had nothing to lose by letting a piece of good news carry us for as long as it lasted. For all we knew, it would stay that way. I didn’t ask how big it was or whether he got the whole worm. I had to trust that, being one of the best in the business, he got the job done. Humi called Rivka, who promised to call Iris to spread the good news. I called Yeela. and told her that the operation was over.

‘How’s Imma?’

‘I can’t see her yet, but the doctor said everything was fine.’

‘I’m coming over, and I made you some sandwiches.’

Yeela arrived and relieved Humi. I munched on the sandwiches and thought about how well she was taking things. I was glad she was with us, having come from Israel for a two-month visit right after the mammogram. It was hard to tell how she felt. Was she playing her role as the eldest, knowing how she felt would reflect on Tal and the boys? As if she read my mind, she turned to me, ‘Dad, are you telling me everything?’ She asked softly, ‘It’s not that I don’t trust your judgment, but there is no need to shield me from the truth.’

‘I’m telling you everything the doctor told me, which is all I know. So far, things look like they caught it in time.’

‘Let’s get Imma some food; she’ll be hungry after she wakes up.’

We walked out the main entrance, crossed through the front parking lot, and turned left on Grant Road towards the plaza where a new Whole Foods hanger had recently opened.

‘Don’t you want something to drink?’ Yeela asked, Imma’s nourishing responsibilities having been passed to her gene-for-gene. We stopped at the coffee stand. The beverage menu on the wall in the back was incomprehensible. Yeela understood I was lost and offered to get me something I might like. We both sipped our brews and dropped them into the first garbage bin we passed. ‘Let’s fix Imma a plate at the buffet,’ I suggested. ‘We need greens for the fiber, olives for the natural oil, baby corn for the less sugary starch, chicken breast strips for protein, tomatoes for vitamins, carrots to work the jaw muscles, orange peppers for Zinc,….’ It was depressing how low we had to stoop from the top of the food chain to stay healthy. We paid and returned to the hospital; by the time we got back, we could go up to see Imma.  

Imma was awake. ‘Ye-e-lush’ she beamed as Yeela gently leaned over to hug with her cheeks, wary of putting any pressure on the body.  I looked at the pain scale on the wall, five faces with changing expressions from what seemed to be joy to mortifying agony, with underlying explanations of how to interpret the facial expressions. ‘How do you feel?’ I asked.

‘When can I get out of here?’ She answered.

‘The doctor said three o’clock.’

‘What time is it now?’

‘It’s one fifteen.’

‘Did you see the doctor after the operation?’

‘Yes, he said it's out, and the lymph nodes are fine.’

Messiah (my cell phone’s nickname because it never calls) rang; it was Taly. ‘Nu?’

‘We were barely accepted to the cancer society; our credentials were marginal,’ I replied, annoyed somewhat with my cockiness, but what the hell? We all deserved a little break.

‘Can I speak to her?’

I caught Imma’s eyes and motioned ‘TALY’ with my lips; Imma nodded. ‘Sure, here she is.’

‘Talyinka?’ Imma always greeted Taly like a Polish baroness, a queue for a commoner like me to zone out. ‘If I can get away with a Mammosite, I could be done in a week.’  I overheard her despite myself.

We were ready for the wheelchair ritual to lead us out of the hospital. A nurse escorted us down the elevator, where we were picked up by another elderly volunteer who could have made better use of the chair. Of course, none of this was about care – it was all about liabilities. Imma signaled me to get the car while she pretended to listen to the volunteer’s instructions. Back home, Imma greeted the boys who were just back from school. Tal’s friends returned from a day in San Francisco – they had no clue. Imma prepared dinner. We all ate together: lumpectomy for breakfast, recovery for lunch, complete meal for dinner, a typical ending to a busy day.

        The surgeon took his time with the notes. He sat down, his scrubs over his T-shirt, his starched white gown over the scrubs, every hair on his head knowing its place, not one crossing over the aisle. I snarled at him silently. ‘At least he’s not a dentist,’ I tried to calm myself. ‘The tumor was larger than we thought,’ he began, only his mouth moving. Imma seemed to cave into herself. ‘This is quite common,’ he continued, ‘when the tumor's texture is too much like the body tissue surrounding it, so we cannot see it all in an Ultra Sound.’

‘What about the radiation?’ Imma asked.

‘After chemotherapy,’ he paused and continued to drive the nails in. ‘When the tumor is this size, you need chemotherapy and standard radiation treatments.’

‘What about the rest of the tests, hormone?...’ I asked.

‘Unfortunately, I don’t have the full report with me.’

‘We’ve been waiting for six days, and the report is not ready?’

Imma changed the subject. ‘I want to continue my treatments at Stanford.’

‘With which doctor?’ he asked, getting defensive, not because of us, but because he felt the stink could find its way out of the room.

‘Siegfried.’

‘Dr. Siegfried is known for his great bedside manner…’ he explained, shaking his head to indicate how sorry he was as he spoke. ‘He is semi-retired and no longer accepting new patients.’ Not only was he unprepared, but he also involved medical-center politics with the best patient care. I was disgusted with the man. He most likely felt that he had misplayed his cards and concluded by saying, ‘You’ll go through the treatment, and in all likelihood, it will be the last time you ever have to deal with breast cancer for as long as you live.’ But, Imma was already in the pits of chemotherapy while I was busy being angry. Our roller coaster slid back down to a low point.

        Messiah buzzed when we got back in the car; it was Iris. By this time, the close community was tracking Imma’s whereabouts. ‘How did it go?’

‘Well, unfortunately, it was worse than we expected; the tumor was bigger… ‘Silence on the other side. ‘… but he didn’t have the full report, so we still don’t know about lymph node involvement….’

‘Let me speak to her.’ 

I gave the phone to Imma, and she told Iris about the chemotherapy. The reality was that all we discovered was this was just another common cancer, not the beginners’ package we thought was there six days earlier.

Not having all the facts was getting harder to bear. Morning routines were the same; Imma sat with us at dinner pretending to eat. Iris and Rivka showed up when they could to sit with us to plod the evenings along; Humi came along when he could to help Imma nibble at some weeds. Rivka was dealing with a cancer scare of her own. ‘They called me up to come for a retake,’ Rivka said. She sounded almost happy about it. ‘I don’t care if they find something, they’ll chop it out, and we’ll move on. Let them cut the whole breast off for all I care.’ Rivka said.

‘The breast? Who cares about the breast? I just want to get rid of it.’ Imma thought for a moment and continued. ‘You know what, I don’t care if one is bigger and the other is smaller.’

‘All breasts are asymmetrical,’ Rivka said, which was news to me. I looked at Humi, who gave me an innocent don’t-look-at-me look. I could see something cooking in his mind.

‘Shouldn’t you girls ask us what we prefer?’ he asked, holding two cupped hands in front of his chest. Humi, known for his caring and selflessness, was one of the only men alive who could ask such a question in a situation like this and get away with it. I was desperate to contribute to the conversation, and he gave me just what I needed. ‘Did Rivka ever give you a hard time because your testicles are lopsided?’ I asked, frowning.

‘How do you know his testicles are lopsided?’ Rivka asked.

‘Extrapolation...’ It was settled then; Imma could have a smaller breast. God as my witness, I couldn’t care less; in fact, variety seemed like a good idea.

Solitaire has become a social game these days. You play it on your laptop during meetings, as you sit in airport lounges, not to mention iPhones at Starbucks. So there are always people around you when you play solitaire on your computer, except when you have breast cancer – when you play alone in the kitchen at three o’clock in the morning.

‘Why don’t you bring the computer to bed?’ I asked, my hand on her shoulder, feeling how skinnier it had gotten over the past three weeks. ‘I don’t want to disturb you.’ The only help I could offer was that she wouldn’t ask for it because she was concerned for me. ‘That’s ok; I’ll hold your hand; maybe you’ll fall asleep.’

We still had three days until we met Dr. Siegfried, and Imma was bracing for the worst because there was no conclusive evidence to the contrary. T has gone from 1 to 2, which we knew, but N and M were unknown. She was finding imaginary metastasis all over her body, a bump on her wrist, tightness in the back of her neck, and a strange pulling in her stomach, all working harmoniously to convince her that the situation was dire.

‘Hila called; she said she wants to talk to me.’ Imma said. I wondered where Hila had disappeared. Hila had a double mastectomy five years earlier. Her attitude at the time was of squashing the cancer daemons like software bugs; if there was anyone whom Imma should talk to, it was Hila, who had just returned from a business trip. Imma did sound a little encouraged when she came back. ‘She said that I was healthy,’ Imma said. ‘The way she put it, cancer has three stages. First, you feel nothing; that’s when you’re really sick. You’d better hope you feel nothing because, by the time you feel cancer, it’s probably too late.’ Imma felt nothing in her breast. ‘Did she say anything about feeling weird bumps and lumps all over?’ I asked. ‘She said that you will feel funny things all over your body, that it was your mind playing tricks on you. But let me finish….’ She continued to quote Hila. ‘After they remove the tumor or cut it off – in your case, they’ll take it out; you’ll be healthy. Then they’ll treat you for a disease you no longer have, but statistically, some cells might be floating around your body; that’s when you feel sick.

‘What about Dr. Siegfried?’ I asked.

‘Getting to know him almost makes you grateful you had it,’ is what she said, Imma answered. It cheered Imma for a day or two, but all the daemons returned on the day we were finally scheduled to meet the legendary Dr. Siegfried.

We were in the waiting for the fourth time in three weeks, with all the ups and downs, hopes and disappointments that followed. ‘I don’t think I can take any more bad news,’ Imma whispered. She was leaning against me, her head against my shoulder, looking down at her feet. I pressed my cheek harder against her head; it was all I could say. We waited for an hour.

A young Asian woman in her early thirties came in first. Her badge said Mary Nathan, but this was not the time to contemplate whether there was a lost tribe in China. ‘I will check you first, and then Dr. Siegfried will come in, and we’ll go over everything, Ok?’ I liked the idiot-proof dialect she used.  As Mary examined her breast, Imma reviewed all her metastasis. Mary felt them one by one, following a ritual she had been trained to do, not expecting to find anything.

‘Hello, I’m Dr. Siegfried,’ he said as he walked in, his hand held out in front of him. He shook Imma’s hand gently, not removing his smile for one instant. He shook my hand, took a seat, looked Imma straight in the eyes, glanced at his notes, and said everything would be okay. ‘So I will live?’ Imma was back in business. The velocity of the question knocked the good doctor a little off balance. ‘Oh, yes, yes, of course, you will live.’ He was not supposed to speak in definite terms about cancer – a statistical disease. He quickly regained his composure. ‘Your situation is very manageable.’ Imma stepped behind the curtain of relief. I stayed on stage for the manageability of it, as this was not an adjective I was used to hearing associated with a disease. I listened carefully. The good doctor took the trouble to review the blood tests, the chest X-rays, and the pathology reports. He had reliable evidence and a plan of attack. ‘You see, modern medicine cannot…’ as though ancient medicine could, ‘… detect cancer growths before they are a billion cells strong, too strong for chemotherapy; radiation can kill such colonies, but we cannot radiate the entire body, the damage to internal organs would be unrecoverable’ which was a nicer way to say ‘the only way to kill cancer with absolute certainty is to kill the person as well.’ ‘In other words,’ I thought to myself, ‘they have given up on nuclear warfare in favor of carpet bombing with tactical weapons, ’ which felt very reassuring.

‘Do I have to do the chemotherapy?’ Imma asked. 

‘It’s your choice,’ he answered, knowing it was all about how he said it, ‘but it does reduce the chances of recurrence by fifteen percent. You see, in cases like yours, where the cancer has…’ and he went on to explain that hormonal treatment was the new pink in cancer treatment ‘and your cancer is very receptive to hormonal treatment, which is good.’ Google and Michal told me that HER-2 was the indicator to watch.

‘That’s negative, which is also a good sign. Your Ki-67 marker is borderline,’ he continued, ‘less than 11% is what we prefer, over 20% is not so good, yours is 15%...’ his tone indicated that he could work with that. From what I could piece together, things were coming up roses.

‘What about the lymph nodes?’ I asked.

‘There was a microscopic finding in one sentinel node… but they were removed during your surgery, and there is nothing more to do beyond what was done already.’

‘How do we know it hasn’t spread?’

‘Chances are that it hasn’t, but we will do a bone scan to be sure…They usually do the bone scan as part of the initial tests; I am not sure why they didn’t do it in your case.’

‘I think we got lost in the transitions between doctors and medical centers,’ I explained. In my mind’s eye, I could see Dr. Cohen agonizing over the bone scan somewhere on board a cruise ship in the Caribbean. ‘What’s wrong, David? Why haven’t you touched your fish?’ ‘I didn’t do a bone scan…’ ‘There are no bones in this fish; why do you think they’re charging us a thousand dollars a day on this ship? I don’t know why we needed a ship….’

So this wasn’t over just yet. T had doubled in value – what a difference half an inch makes. N was still considered 0 even though it had a little (+i) in the parenthesis next to the 0. The lungs were clear, and the lump on the wrist was a ganglion - whatever that was, but with two ‘g’s and no ‘c’s, it was fine. Discovering that breast cancer does not metastasize below the elbow was also reassuring. M, which is what mattered, was still unknown; only a bone scan could tell us what we needed to know.

‘I wouldn’t be too concerned about it,’ Dr. Siegfried continued. ‘Let’s start your treatment and adjust if we have to. I am quite confident that the bone scan will be normal; we’ll start chemotherapy on October 5th.’  He typed a few comments into his palm-held computer. ‘Your regimen…’ - regimen is a word they use to emphasize that they know what they are doing – ‘…will be a mix of Cytoxan and Taxotere.’ I tried to write down the names to pass them to Hikko, but I needed help. ‘Could we have a copy of the treatment plan?’ I asked.

‘Of course, you’ll get that as well as sheets explaining what each drug is for and what side effects to expect.’

‘What side effects should I expect?’ Imma asked.

‘Most side effects can be minimized with other drugs,’ he said, ‘but you will lose your hair; that is the one side effect over which we have no control, but it will grow back after the treatments.’

‘Will my hair grow back after the treatments?’ I asked. He turned to me. I could tell he weighed the odds of my being a complete idiot or an aspiring comedian. ‘No,’ he said, allowing himself a brief smile that an idiot would ignore.

‘We’ll see you in three weeks then.’ He shook my hand again, maintaining eye contact, put a reassuring hand on Imma’s shoulder, shook her hand, and left the room. It was September 20th, as good a time as any for an upswing on the roller coaster.

‘Let’s go have lunch at the Bistro on California Avenue,’ I suggested. Imma accepted happily, ‘it would be a shame to die of hunger,’ she smiled. Neta, her long-time friend, called; it was midnight in Israel; she was waiting to hear – bad news, good news, any news. I answered. ‘I think we saw a light at the end of the tunnel, but I’ll let you speak with Gallia.’

‘Netuush, you’re not sleeping,’ Imma was upbeat.

‘Galyope, I was worried about you.’ Imma was on speaker – she never liked cell phone radiation. ‘It looks ok, I’ll need chemo and the rest of the crap, but I’ll be ok.’

‘I’ll believe it when I see her chewing and swallowing,’ I thought to myself,  balancing myself on the sidewalk's edge. Imma ordered real food. A bee buzzed around us; the sun was bright and warm; it was a happy cancer moment.

We arrived at the reception for the bone scan test and waited for twenty minutes until the receptionist figured out that Siegfried was spelled with a ‘g’ and not with a ‘k.’ It made me wonder if it was possible that hospitals made mistakes. Pablo, a beaming young man in his five foot six and twenties, walked us through the well-lit corridors of the nuclear medicine bunker. After validating that Imma was who she was, he explained that the doctor – as if we knew who that was – would soon come in to explain the procedure and skipped out of the room to grab a doughnut - just like the one everyone passing in the hallway was munching. Next, a less beaming but taller pressed-and-dressed doctor wearing a starched, stainless white gown came in. He neglected to introduce himself by name, perhaps shielding himself from the pain of separation; he explained that Pablo would be administering an injection of the low-dosage radioactive agent and disappeared to grab his doughnut. A better-fed Pablo was back to administer the mild toxin precisely as the doctor had predicted. I couldn’t help but admire how well-synchronized their teamwork was. I watched Pablo insert a small, friendly needle under Imma’s skin. He seemed surprisingly composed for the sugar rush he must have been experiencing as he fixed the needle with a strip of sticky band-aid and moved his free hand back along the thin plastic tube to release a small valve. ‘…and we’re getting a good flow of blood.’ For sure, this was a crucial bit of information for Imma, who was looking away. After administering the toxin, Pablo freed Imma from the tubes and instructed us to report to the bone scan lab in three hours. Our departure was relatively emotionless.

The bone scan test took an hour. While waiting, I completed a word puzzle game, finding words like siege, possesses, and larynx spelled diagonally and backward across rows and columns of gobbledygook squares of letters. When I was done, I handed in my work to the receptionist for no extra credit.

        Imma had already worked up significant anxiety by the time we returned for the first chemotherapy treatment. ‘They called from the bone scan lab reminding me that I have an appointment with my doctor on October 5th; why would they need to remind me?’

‘Because that’s what they always do?’

‘They never called me before.’

‘You never had a bone scan.’

Dr. Siegfried proved himself a true knight of the cancer dialect: ‘I think your bone scan is normal…’ he began, being as reassuring as he possibly could. I could see Imma turning back from the gates of hell and throwing the invitation to the fires behind her. ‘…the only finding in your lower back is most likely the result of a compression fracture and not a metastasis….’

Imma didn’t let him finish. ‘Oh, that’s nothing! It is a compression fracture, I am sure of it! I was working in security at the London airport. After the pains started, I walked crooked for over a year.’ Imma’s swerve into the optimistic lane was so sudden that the doctor drove right past her. ‘Just to rule out all possibilities, I would still recommend a CT Scan of the lower back,’ he said.

Imma came to a screeching halt in the middle of the highway. ‘Maybe we can check my neck as well,’ she said. ‘I can ask for that if you really feel strongly about it, but I don’t think it’s necessary.’

Imma started driving again, ‘Ok, let’s validate the lower back.’

We let the community and families know that the bone scan was normal, not bothering to mention the CT; we decided they had had enough.

Danna called to invite us to see a movie on Saturday night. ‘We’re going to see a movie at the CT theatre,’ I said.

‘Why, what now?’ She asked.

‘We’re just validating the bone scan findings in the lower back.’ 

‘What does the doctor think?’

‘He thinks it's protocol.’

CT is a noisy one-person theater. Imma was the actress on the stage. A bored technician who had seen the show many times before was the only person in the audience. I did not have a ticket, so I waited outside, reading a tour guide that ranked dangerous places to visit worldwide. Imma did well on her show. On October 25th, we knew for sure that Imma was right about her back injury. By now, she had no hair and wore a hat without a wig, looking ‘Jewish’ as the boys put it. It was just a normal stage two breast cancer: T 2 N 0 (+I whatever that meant) M 0. It was fifty-five days and twenty pounds after the mammogram. I looked at the copy of the bone scan report. At the top, it mentioned Imma’s name, saying she had a prior history of cancer surgically removed from the right breast. I was certain that the surgeon had operated on the left breast. I was grateful that there was only one spine for that board CT scan technician to choose from, so I accepted the report as irrevocable truth. Our final score was 2 out of 12; we knew what we were up against and had a prognosis.

I crept into bed and fell asleep, listening to Imma’s steady breathing. Imma would be okay. All she had to do was weather the treatment.

I wish I could tell this story in the ninth person, far removed from the people and the events. Part of me wants to be far in the future, twenty-five years from now, writing a memoir looking back and remembering how primitive the detection methods were in those days, how they could make half-inch errors, how they had no way of knowing if they killed it all. As for now, this is a story in two first-persons who’ll get to see their grandchildren on one pill of Arimidex a day.