“I want you to know that your situation is not entirely hopeless,” Dr. Raefsky repeated to me.
“I don’t understand,” I began, trying to get a handle on what he was saying. He looked away from me to Suzie. I was suddenly a bystander.
“There are new therapies we are working on but there’s no hurry. You can go home if you want to.”
“What?” I repeated, moving from bystander to troublemaker in one word. He never acknowledged me.
“You’ve been through two major surgeries,” he persisted. “If you’d like to take some time to just be with your family, it would be understandable.”
Suzie looked confused and my head was about to explode. Dr. Burn’s warning that a single cell was all it took to spread cancer rattled through my brain. What possible good could come from waiting?
“Why would we want to do that?” I exclaimed, getting obviously upset. I looked to Suzie who had no clue either. Dr. Raefsky looked at me and sighed. He started again.
“I’m just saying she’s been through two major surgeries and . . .”
“I heard what you said.” I was really starting to get ticked at this guy. “What I want to know is why would we ever want to wait?” He looked taken aback. “Every day we wait means cancer cells have a chance to spread, right?”
“Well, yes but . . .”
“Then what’s the point of waiting. We want to fight this thing, right Suzie?”
“Yes,” she paused. I finally got a handle on my mouth and waited. “Absolutely, I want to fight,” she repeated.
I bit my tongue. I wasn’t there to cause problems but I wasn’t about to let Suzie get overlooked or dismissed again. They had already sent her home with a major cancer undetected. I’d already had to fight to get her back into the hospital. I’d fight for her again if I had to. The pause hung in the air until Dr. Raefsky spoke.
“Well, I guess we could schedule some tests in the morning to see if it has spread anywhere else.”
I looked at Suzie and waited. “That sounds good to me,” she said.
“Good,” I echoed.
“Alright,” he nodded without enthusiasm. “I’ll go and set it up.” He walked across the room, shook Suzie’s hand and patted her on the arm. “We will walk with you through this,” he said and held her gaze for a solemn moment. She smiled. He smiled.
“Thank you,” I said by way of apology as he walked out. He nodded and closed the door behind him. We sat quietly for a moment to try to take it in.
“That was intense. What was that about?” I finally said.
“I don’t exactly know.”
“Hello, I’m your oncologist, Dr. Doom,” I snarked.
She laughed. “I don’t know. I kind of liked him.”
But then, she always was better at reading people than me.
What we didn’t understand was that Dr. Raefsky was one of the most optimistic physicians we would ever meet. He was trying to bolster Suzie’s hope in spite of an absolutely hopeless diagnosis. My overreaction was based on one glaring gap. We had no idea. None.
Here were the facts. In 1994, multiple breast cancer tumors that had metastasized to the brain was a death sentence. Life expectancy was measured in weeks, not months.
The skull is inaccessible for a reason. The brain is the most critical, delicate and energy-hungry organ in the body. It is even protected from our own blood by a highly selective wall called the blood-brain barrier. While alcohol, caffeine, and nicotine can get through, penicillin can’t. Or chemotherapy.
Cancer, however, is drawn to the brain.
Radiation technology at the time was unfocused and unsuccessful. The only treatments left were highly experimental. Given the size of the brain tumor, they knew Suzie probably had two weeks to live.
But no one ever told us.
One of our most surprising discoveries has been that doctors are people, too. Despite the god-like hype, they hate giving bad news as much as the rest of us. So they lie by omission. For some reason, this imperfection makes me like them more.
Burns and Rosenthal had left it entirely in the hands of the oncologist. However, our meeting with the oncologist was delayed by the brain surgery. By the time we met with Dr. Raefsky, he assumed we’d already been told.
The unspoken truth was that Dr. Raefsky wasn’t suggesting that Suzie go home to rest. He was sending her home to die. He was giving her the chance to choose how it would happen. She could be surrounded by her family and children while she still felt well or she could spend her last few good weeks in misery at the hospital.
Instead, my uncharacteristic and uninformed rant caused him to wait. He would do the tests as soon as possible. They would say what they would say. And we would have time to process the truth. In a specialty so filled with bad news, it was not in his nature to kill our last hope.
For that, we are eternally grateful.