The nurse comes in. Dr. Ramdoolal is ready for Mrs. Sinclair.
“Anna should go with Beatrice,” Neil Lee Pak says to Anna’s father. “Woman business.” He says this as if John Sinclair has not known his wife’s woman business for years. But John Sinclair yields to him. If he has noticed the tiny red tributaries crisscrossing his wife’s eyes when she returned from the bathroom, he has decided to say nothing. Privacy is their code of honor, proof of their loyalty to each other. Proof of their love. He will stay with Neil Lee Pak in the waiting room, he says.
Anna is relieved when she sees Dr. Ramdoolal. He is not a young man, but she did not expect to see a young man. A middle-aged man perhaps, and perhaps he is. His face is unlined, his skin color vibrant; it has not lost that rich brown hue of many young Indians on the island. But his black hair has turned white, shocking white indeed, and there is not even the slightest hint of levity in his dark brown eyes. This is a doctor who has witnessed human suffering, she thinks. He will understand her mother’s fears.
Dr. Ramdoolal takes barely a minute to examine Mrs. Sinclair. He asks her to unbutton her blouse. He sees the tumor, the size of a lemon, pushing out over her bra. He grimaces.
He does not need her to take off her bra, he says. He has seen all he needs to see. He asks if there is also a lump under her arm. Beatrice nods.
“Let’s take a look.” Dr. Ramdoolal stretches out his arm to help her remove her blouse. She recoils. Anna mumbles an apology and slides the blouse off her mother’s arm.
“It’s only on one side,” her mother says. She lifts up her left arm.
The tumor is the size of a plum.
Dr. Ramdoolal grits his teeth. “You can button up,” he says.
Her mother’s trembling has subsided; her secret is out. “How long, doctor?” she asks. She rebuttons her blouse with steady fingers.
“It’s cancer,” Dr. Ramdoolal says, matching her directness. “But I suppose you know that.”
“My mother died of breast cancer. How much time do you think I’ll have?”
“It depends,” he says.
“Depends?” Anna’s mouth drops open.
“There are treatments, but your mother has let this go too long. You know that as well as I do, don’t you, Mrs. Sinclair?”
“Two years,” her mother says. “I’ve felt it for two years.”
Anna feels faint.
“That would be my calculation,” Dr. Ramdoolal says. “Maybe more.”
“So what happens next?” her mother asks.
“I will discuss that with you in my office. It will be good if your husband is there with you.”
“And my daughter?”
Dr. Ramdoolal nods his assent.
Anna needs to sit down. There is a chair in the room, but she cannot leave her mother’s side now, not when her mother has managed to summon up her strength to look Dr. Ramdoolal fully in his face as he gives her that inconclusive answer. It depends, he said. It depends on what?
“Depends on how she reacts to the treatment,” Dr. Ramdoolal says to John Sinclair when they are all sitting in front of him, in his office, Anna in the middle between her mother and father.
He is encouraging at first. Mrs. Sinclair is lucky. She has what is called a neglected primary. It is a slow-growing cancer. “I see many cases like this in postmenopausal women,” he explains. “The ovaries have shut down. The baby-making hormones have dried up. There’s nothing there to feed the tumor. It will grow, though, but it won’t spread as fast as if it were aggressive. Some women last into old age with lumps bigger than your wife’s still in their breasts. Something else kills them, not the cancer. The fact that the tumor has not killed Mrs. Sinclair in all those years she has felt it means it is not aggressive.”
“Two
years,” Anna corrects him. Two years are already too many. She will not let him blame her mother for more. She will not let him get away with
all those years
.
Dr. Ramdoolal, who has managed to avoid eye contact with any of them as he speaks, looks directly at Anna, surprise, tinged with annoyance, registering on his face. “Pardon me?” He lifts his eyebrows. It is obvious he is not accustomed to being interrupted.
Anna turns to her father, pointedly addressing him: “Mummy says she has felt the lump on her breast for two years now.”
John Sinclair lowers his eyes to his hands. He has not missed his daughter’s unspoken accusation. How long has it been since he saw the protrusion on his wife’s breast?
The size of a lemon!
The size of a lemon is too large for him to have avoided noticing the tumor on his wife’s breast.
“Your wife is not exceptional,” Dr. Ramdoolal says, sensing John Sinclair’s discomfort. “Some women wait more than two years after a lump is visible before they come to see me. They pray.”
John Sinclair frowns at his wife. Anna pats her shoulder.
“Yes, that’s what they do instead of going to the doctor. They pray,” he says drily. He is speaking to John Sinclair as if he already knows of Beatrice’s nighttime vigil at her makeshift altar in her bathroom. “We live in a country that believes in miracles. I might as well not have gone to medical school.” He shuffles through the papers on his desk. “Not a week passes before I see someone in my examining room who claims he has seen God. What’s that thing, Mr. Sinclair?” He pauses and places his palm flat on the papers. “The name they have for the bleeding on the hands and feet? Yes, the stigmata. I had a man who came to see me. Big holes in his hands and feet. He had driven a nail through them, but he swore to me he had done nothing. He said he woke up one morning and he was bleeding. Like Jesus Christ on the cross, he said. Now people give him money to pray to Jesus Christ for them. But they won’t come to me. They prefer to give their money to that charlatan. Then, when it’s too late, they want
me
to work a miracle for them.”
Dr. Ramdoolal is not a Christian. He does not believe in the Christian God. If he allows himself to believe at all in the supernatural, it is in the gods of the Hindu temple where he sometimes prays.
“And that statue in Arima that started crying? Did you hear about that, Mr. Sinclair? La Divina Pastora.” Dr. Ramdoolal plucks out a sheet of paper from the pile on his desk and puts it aside. “Not that I have anything against prayers. I pray myself, but …”
“Miracles happen every day,” Beatrice says quietly.
“Yes,” Dr. Ramdoolal replies. “Yes, miracles happen. But that tumor has been growing for years in your breast, Mrs. Sinclair.”
“Two years without medical treatment.” Anna does not back down. “And yet she is here. Alive.”
“Your mother is fortunate.”
“The power of prayer,” Beatrice Sinclair says.
Dr. Ramdoolal shakes his head. “I wish you’d come to see me earlier, Mrs. Sinclair.”
John Sinclair is sitting at the edge of his chair. His spine is ramrod straight. The muscles in his neck are strained. He has left his wife and his daughter to do battle against Dr. Ramdoolal’s implied accusations. But Dr. Ramdoolal was looking at him when he said he wished Beatrice had come to see him earlier. He was accusing him, not Beatrice.
“Can you help my wife now?” he asks, his only defense.
“There are some things we can do,” Dr. Ramdoolal says. “First, she’ll need chemo.”
“Chemo?” John Sinclair’s back gets stiffer.
“Chemotherapy. We give her the drugs intravenously. The chemo will kill the cancerous cells.”
“And that is it?” Beatrice looks at him hopefully.
“Oh no, Mrs. Sinclair. That’s just the beginning. This disease is systemic. The tumor presents in your breasts, but tiny cancerous cells may be flowing through your body looking to attach themselves to an organ and form a new lump. The cancer is in your lymph nodes. I saw that when you lifted your arm.”
He cautions her that he can offer no guarantees. The chemo will reduce the size of the tumor. It will kill the bad cells but it will also kill the good cells, he tells her. It will attack her bone marrow, the factory, so to speak, where the red and white blood cells and platelets are manufactured. She will feel weak. He may have to harvest cells from her bone marrow and inject them back into her if she gets too anemic. The chemo will make her sick. She will vomit every time she gets the treatment. She will lose all her hair.
“My hair?” Beatrice has been listening attentively. She has been sitting still with her hands folded on her lap. Nothing in her expression has betrayed the slightest reaction she might have had to what Dr. Ramdoolal is saying, but when he mentions her hair, she brings her hand to her mouth and gasps. “All of it?”
“We don’t have any other choice. The tumor is too large. You’ve let it grow too long, Mrs. Sinclair.”
Anna tells Dr. Ramdoolal that she objects to his implication that her mother is to blame. “You’ve made that point already. I think you need to understand my mother was very frightened. Doctors made her afraid. They couldn’t help her mother and what they did—”
Beatrice Sinclair squeezes her daughter’s hand and stops her. “Let the doctor finish what he has to tell us, Anna.”
“It’s just that I want to be as honest with you as I can,” Dr. Ramdoolal explains.
“Go on,” Beatrice says.
“You need chemo first because it’s dangerous for a surgeon to remove a tumor that is as large as the one you have. Bleeding, you know. It could be fatal.” Dr. Ram-doolal does not sugarcoat his words. “When the tumor gets smaller, a surgeon will be able to do a mastectomy.”
“And after the mastectomy?” her mother asks.
“Some more chemo for insurance. And then radiation. But I must repeat, Mr. and Mrs. Sinclair, there are no guarantees. This disease is insidious. Some cells cling to the chest wall. You can’t be sure you have got them all.”
“And after that? After the radiation?”
“We wait.”
“For a miracle?”
Anna winces. The hope that floods her mother’s eyes is the wishful faith of a child believing in fairy tales.
“For a miracle,” Dr. Ramdoolal concedes. “For a miracle, Mrs. Sinclair.”
Silence falls between them, no longer than a few seconds, but an eternity it seems to Anna. Finally, her father speaks. “Will you do the surgery, Dr. Ramdoolal?”
The doctor shifts his body in his chair. “I can do the surgery, Mr. Sinclair,” he says. “I was trained at Cambridge. I have kept up with the latest techniques, but we don’t have the equipment. None of the hospitals here have the equipment I will need.”
“Then what?”
“I recommend the U.S. There are excellent hospitals in New Jersey. I can refer you to a surgeon, a friend of mine. He grew up here, went to the University of the West Indies. Paul Bishop. Do you know the Bishops, Mr. Sinclair? His father was a union man. Worked in the oil fields.”
“Henry Bishop,” John Sinclair says.
“The very man. His son Paul did well. He’s the head of surgery at his hospital in New Jersey.”
“Henry Bishop’s son?” Beatrice asks.
“She’s heard me talk about his father,” John Sinclair explains.
“I recommend him. You’ll be in good hands with Paul Bishop. Doctors hate to admit anyone is better than them, but I’ll tell you quite frankly: Paul Bishop is a better skilled surgeon than I could ever be, even if I had the equipment. After the chemo has reduced the tumor, have him do the surgery.”
Beatrice shakes her head. “No,” she says.
“Mrs. Sinclair?” Dr. Ramdoolal wrinkles his brow.
“I want to have the surgery here,” she says quietly.
“Go to the U.S., Mrs. Sinclair,” Dr. Ramdoolal says with exaggerated patience.
“I want to stay here.”
“I strongly recommend—”
“I will stay here, Dr. Ramdoolal.”
“If you want to die, Mrs. Sinclair,” he says, “stay here.”
Beatrice draws in her breath. The sound is audible.
Anna does not believe the doctor means to be cruel. He is frustrated, and this makes him sound cruel. Yet he has scared her mother. “Look what you’ve done! You’ve frightened her,” she snaps. She leans toward her mother and whispers, “You won’t die, Mummy. You won’t.”
Blood drains from John Sinclair’s face. “Die? What do you mean
die
, Dr. Ramdoolal?”
The doctor places his hands on either side of his head. He shuts his eyes and shakes his head. “Please, Mrs. Sinclair, Mr. Sinclair, I didn’t mean to say—”
“Is it that bad?” John Sinclair asks.
Dr. Ramdoolal slides his hands down his neck and clasps them together under his chin. “Your wife has as good a chance as any. It’s hard for me, you understand. I came back here after medical school—the government invited me to come back … they made promises, but they do nothing. They won’t buy the equipment. This is no place to have surgery, Mrs. Sinclair. I tell you that as your doctor. As someone who has your best interest at heart.”
“How can you speak this way about my country?” Beatrice says softly.
“It’s my county too, Mrs. Sinclair.”
John Sinclair reaches for his wife’s elbow. “Not now, Beatrice.” He turns to Dr. Ramdoolal. “We’ll take what you say under consideration, doctor.”
“I’m going to stay in my country,” Beatrice says.
Dr. Ramdoolal picks up the sheet of paper he has put aside on his desk. “You’ll have to decide about surgery soon, but for now you should start chemo. It’s the best thing for you to do, Mrs. Sinclair.” He looks at the paper. “I can make room for you. I’ll tell my nurse to fit you in. Tomorrow, then?”
“Yes, tomorrow,” John Sinclair answers for his wife.
At home Beatrice is quarrelsome, contradicting her husband at every turn. John Sinclair believes her nerves make her so. He thinks Dr. Ramdoolal has scared her. He is patient with her. He tells her that she will not be alone. He will sit next to her through each of her chemotherapy sessions. He will not leave her side. Anna will come too, he says.
“Oh, don’t make such a fuss, John. I won’t need two people,” Beatrice responds, dismissing him.
“Then it’ll be me alone.”
“If that’s what you want to do,” she says.
“Beatrice,
till death do us part,
remember?”
“So now
you
also think I’m going to die?”
He has put his foot in his mouth. Anna bails him out. “Daddy just wants you to know he meant his vows.”