So Much for That. Lionel ShriverЧитать онлайн книгу.
of therapies at our disposal. New treatments, new approaches, and new drugs are being developed all the time. The survival rate has done nothing but improve.”
Shep knew all of this from the Internet, but felt it would appear impertinent for him to say so. Besides, it seemed important to allow the oncologist this formal introduction. Shep had already read enough to have registered that most of the nostrums in Knox’s grab bag of tricks were poisons. In the face of being able to do so little, it must have been comforting to the doctor to seem to be useful in this discursive way. His manner methodical but warm – he smiled encouragingly and looked Shep in the eye – Edward Knox had struck Shep from the start as very kind.
But even when doctors acted kind, the extent of their capacity to be kind was often out of their hands. However gently put, many a message that physicians were forced to deliver was cruel, and if it did not feel cruel it was a lie and thus was even crueler. Personally Shep didn’t understand why anyone would want to be one. Oh, certainly the tasks of stenting an artery and clearing a bathtub drain were technically akin. Yet a doctor was like a handyman who, some appreciable percentage of the time, had to knock on your door and say, I’m sorry, but I cannot clear your drain. That’s all the acting kind was good for: the I’m sorry part. And then he walks away and maybe he waves, leaving you with scummy standing water in your bath. Why would anyone want a job like that.
“And I do have some good news,” Knox continued. “First, as I assured you last week, Mrs Knacker, the MRI did not reveal any anomalies in the pleural – in the lungs. Even more critically, I now have the lab report from the laparoscopy. Mesothelioma comes in two flavors, if you will – two types of malignant cells. The epithelioid are less aggressive, the sarcomatoid much more so. In the samples we extracted, only epithelioid cells were detected. That makes the prognosis considerably more optimistic.”
Glynis gave a schoolgirl nod, as if she had done something right. Shep was about to ask, so what prognosis is that? He opened his mouth and it was dry. He closed it, and swallowed. Instead he said, wanting to be grateful, to play his part, to enter into the spirit of gung ho that was clearly expected here, “Yes. That sounds like very good news.”
At once, he could not help but reflect that only a week ago “good news” comprised the value of his Merrill Lynch portfolio increasing by $23,400 without his lifting a finger. Their son finally passing second-year algebra. Randy Pogatchnik playing hooky at some golf resort, so that for three days working at Knack would be, if not quite the same as the olden days, at least collegial. Glynis being in a playful, indolent mood he could barely remember now, and up for watching an old episode of The Sopranos. Now on a dime he was expected to enter a world in which “good news” comprised his wife’s abdomen coursing with vicious “epithelioid” cells rather than the even more vicious “sarcomatoid” kind and this information was meant to cheer him.
“As for where we go from here,” said the doctor, “you may want to commission a second opinion. It’s always possible that other specialists will recommend an alternative approach, but I thought I’d prepare you for the standard course of treatment for epithelioid mesothelioma. Assuming the diagnosis is confirmed, Mrs Knacker, you’ll probably be scheduled for debulking surgery as soon as possible. This is to remove as much of the cancer as can be reached. We’ve located three patches of diseased tissue in the peritoneum. I’m afraid that the surgeons I have consulted concur that one of those patches is inaccessible. Both to shrink the little bit we can’t reach and to discourage further malignant cell growth, chemotherapy will almost certainly have to follow once you’ve recovered from the operation. To that purpose, a thoracic surgeon will install two ports in your abdomen. This way we can deliver intraperitoneal infusions of heated cisplatin that will wash over your organs, rather than administering chemotherapy through your bloodstream. Unpleasant side effects with this direct application should be markedly less pronounced.”
“Does that mean I won’t lose my hair?” asked Glynis, reflexively touching her crown, as if to make sure her hair was still there.
A shadow crossed the oncologist’s face, a sadness, a pitying, into which Shep could read that such a small damage to his patient’s vanity was bound to be the least of Glynis’s problems. “Patients react differently to treatments,” he said gently. “There’s no way to predict.”
“Besides, it grows back, doesn’t it?” said Shep. This was the role. He was supposed to be upbeat.
A second shadow, and this time one that Shep could not decode. “Yes, once treatments are completed, it certainly does,” said Dr Knox, seeming to rouse himself. “Some patients find it grows back in even more thickly than before.”
Shep had the sudden impression that this visit, if not the whole song and dance from the X rays and the CAT scan to all the scalpels and “abdominal ports” and vile medications to come, was a farce, a macabre charade. As helpful and soothing as this doctor was trying to be, Shep felt distinctly humored. In turn, he also felt co-opted into a collusion with the doctor, whereby together they were humoring his wife. The joke was on Glynis. It was a wicked joke, a despicable joke, for which she would pay with every fiber of her being. He did not want to be a part of it. He would be a part of it.
“But before we go any further?” the oncologist continued. “Because this is such an unusual cancer, I have limited experience with the disease. Phelps Memorial has seen only two cases in the last twenty years. However, there’s a specialist in internal medicine at Columbia-Presbyterian, who works in tandem with a skillful surgeon. They both have extensive clinical experience with mesothelioma, and have a terrific reputation.”
“Are you trying to get rid of us?” said Shep with a strained smile.
Dr Knox smiled back. “You could say that. Mesothelioma patients come to Philip Goldman from all over the world. You’re lucky, because for you two he’s effectively right next door. Now, he doesn’t come cheap. It’s likely as well that he’ll be out-of-network for your insurance. You’d need to get permission from your insurer if you want them to fully cover an out-of-network physician, and you’d certainly have a good case. But even if your provider declined, I’d urge you to consider Dr Goldman. Your insurer would still pick up most of the bill; I don’t know the specifics of your health plan, but you might just be levied a higher percentage of co-insurance. And given the stakes … Well, I assume that money is no object.”
“Of course it isn’t,” Shep found himself saying. “We’ll pay whatever it takes to get Glynis well again.” Given his wife’s milk-money income from a chocolatier, the we was more farce. That the well again might also qualify as farce Shep was not yet prepared to contemplate.
Nevertheless, as Knox wrote out the contact details of this famously expensive shaman of the black arts, Shep considered this quantity now officially of “no object.” Of course it had no value by itself. Money was a means. But to ends not readily dismissed as “no object.” Food, shelter, clothing. Safety, insofar as there was such a thing, and thus also the capacity for rescue. Efficacy, power, sway. Ease, freedom, choice. Generosity, charity; if not love, for his children, wife, sister, and father, the palpable evidence of love. Education; if not wisdom, its prerequisite of accurate information. If not happiness, comfort, which could stand in for happiness in a pinch. Airplane tickets – experience, beauty, and escape. From the description of their apparent savior in Columbia-Presbyterian, raw, animal survival. For in the face of a virulent cancer, they would not simply follow directions, and marshal their forces of will; they would buy life. They would buy Glynis’s life, day by costly day, and in the end you would be able to affix a price tag to every one.
“So far, do either of you have any questions?” asked Dr Knox.
“The side effects …” said Glynis. Of course, there was nothing “side” about them. They were effects – big, brutal, and anything but ancillary.
“Each drug and each patient is different. You’ll be alerted what to be prepared for, I promise. Let’s get through the surgery first. Not get ahead of ourselves.”
In the proceeding silence, Shep looked to his wife, then to the oncologist, beginning to panic. He did not want