Dog Lived (and So Will I) (20 page)

I’d like to tell you Seamus is the kind of dog who senses when his master is sick or tired or just not having a good day and cuddles, stays by my side, brings me my slippers, and licks my tears (if there were any) away. But you’ve read this far, so you know better. He isn’t that dog.

He’s Seamus. He is the master.

As I recovered from surgery, he spent time on the couch with me but usually stole the cashmere-blend throw blanket for himself and left me with the cotton one. He wanted cuddles only when he wanted them, whether I needed them or not or was awake or not. He continued to force the breakfast issue by bounding up into our bed at seven in the morning and shoving himself between Chris and me. Luckily, my surgery was on the right side and I sleep on the right side of the bed, which meant my left side generally bore the brunt of Seamus’s morning demands. He kept me in good spirits and laughing, though, and he kept my mind off me. I liked being home with just Chris and Seamus and the occasional visitor. I liked the peace and quiet, and Chris seemed more than able to handle taking care of me. I couldn’t lift my right arm, I needed regular medication, and I was tired, but other than that, I was functioning.

My mother had come out to California when she and my stepfather were on their vacation, before my surgery, and even then (when I looked and felt healthy) it was clear my diagnosis had caused her a great deal of stress. She was calling regularly and initially wanted to come out to help as I recovered. I told her to wait. It seemed more likely that if I needed more help than Chris could provide, it would be during chemotherapy. This turned out to be a wise decision. My mother broke out in stress-related shingles before I even recovered from the surgery.

Dr. Karam called, emailed, and texted to check on me the day after my surgery and again the next day. By the time he called on the third day with the pathology report, I had forgotten I was waiting for it. I’d finally been able to shower and vaguely blow-dry and style my hair with limited success since I couldn’t raise my right arm above my shoulder, which happens to be where my head and hair are located. I felt good enough that my neighbors and friends Jane and Francis had come by to visit, bearing food. Between our conversation and Seamus’s howling for the food, I almost didn’t hear the phone ring.

“
Hola
, T. This is Amer. Your margins are all clear. I’m so happy. This is all good news.”

“Oh. Hi, Dr. Karam. Right. Clear margins. Wait, I thought we knew that already?”

“This is from the pathology report, so it’s all good. Now we know for certain. And your tumor was 1.7 centimeters so the mammogram was actually more accurate than the MRI.”

“And that means?”

“Stage 1c, but smaller than we thought. Not as close to two centimeters. And you’re all done with surgery.”

“So you’re breaking up with me?”

“Ha! No. I’m still your doctor and primary contact. You still need to see me.”

“Am I still having chemo?”

“Likely, yes. We’ll get you to Dr. Glaspy for that. Chemo is really going to be good for you—necessary for this. It’s an aggressive cancer, and chemo is best. But today this is good news. Clean margins are very good news.”

“Yes, I remember that. Clean margins. That was a big deal for Seamus, too.”

“How is Seamus?”

“He’s good. He’s right here with me.”

“Yes! I hear him.”

One should always have an enthusiastic doctor. And one who listens. My surgeon not only could remember my name, my condition, and my medical history, but also could remember my dog’s name. And he cared about all of the above.

I shared the news with Chris and Jane and Francis, who happen to be three of the smartest, most articulate people I know. But what vocabulary suffices as a response to “I’m now cancer free”? We were all reduced to simple exclamations of relief that weren’t much more than a teenager’s “ohmygawd!” Luckily, in addition to being charming, intellectual, and Irish in all the best ways, Francis Carney made a mean martini. I celebrated my clean margins with a dirty martini. The green olive played the role of the green dog biscuit perfectly.

• • •

After my follow-up appointment with Dr. Karam, he walked with Chris and me over to the oncology department in another building to meet Dr. Glaspy, the oncologist.

“You’re going to like him. He’s the best there is. He will tell you exactly what you need to do,” Dr. Karam said.

“He’s going to tell me I need chemotherapy. Chances are, based on that alone, I’m not going to like him.” I was still hoping that somehow, some way, I’d be spared chemotherapy. Although Dr. Karam had been very good at leading me gently to the near certainty of it, I was too frightened of chemotherapy to have yet accepted the message.

“That may be, but what is that expression? Don’t shoot the messenger.”

After introductions, Dr. Karam left us with a parting, “You’re in good hands.” He gave me a hug and shook Chris’s hand.

Dr. Glaspy was nothing like Dr. Karam. He was a large man and his demeanor was serious and somewhat reserved. I thought perhaps I’d been spoiled by having a funny, gregarious surgeon who was so kind and empathetic, so perhaps my judgment was skewed.

Dr. Glaspy began to explain his role in my care.

“My job is a little like a guy on a riverboat with the gamblers. You know those riverboats with tables of guys playing poker?”

My mind flashed to Mel Gibson and Jodi Foster in
Maverick
. Was that a riverboat? And how does it end? The only other riverboat I could think of was the Mark Twain Riverboat at Disneyland, and surely there was no gambling going on there. Mickey would not have it. Wait. What does this have to do with my cancer?

“Um, sure. Right. Riverboat gambling,” I answered Dr. Glaspy, but I was looking at Chris. Chris smiled and raised his eyebrows.

“My job is to walk up and down the boat looking at the cards each player is holding. I can tell you your odds based on the cards you’re holding, but I could be wrong. You could be dealt a different hand completely. All I can do is look at your hand and tell you your odds and the best way to play that particular hand.”

My worries increased. I started arbitrarily calculating my odds of survival. Fifty percent? “Okay. So, what are my odds? What have I been dealt?”

“Well, it’s not a good hand.”

Thirty percent chance of survival? Chris told me later he was thinking 20 percent. We both had our greatest moment of fear right there on the
Delta
Queen
.

“How not good?”

“Without chemotherapy you have a 30 percent chance of recurrence. And if it recurs we’re not talking about cure then, we’re talking about treatment to extend your life.”

So, wait, that’s a 70 percent chance it won’t be back? That’s not bad. Not bad at all. I expressed my relief, much to Dr. Glaspy’s horror.

“No,” he said, “that’s not good at all. Those are not acceptable odds. You are the poster child for chemotherapy. With chemotherapy we can cut those odds in half. With chemotherapy you will reduce your odds of recurrence to 15 percent—that’s still higher than we like, but it’s better than 30 percent.”

“Oh, right. No, I get that. It’s just that the way you were talking, I was expecting a lot worse. I thought I had no face cards and not even a pair of twos.” I spent many a day playing poker with my grandfather and our next-door neighbor Art when I was a kid. I was an excellent poker player at seven years old. I knew a bad hand when I was dealt one.

“It is a bad hand. Triple-negative is a very aggressive form of cancer. When I say you’re the poster child for chemotherapy, I mean that you could go to any oncologist anywhere and they would all recommend chemotherapy. It’s all we’ve got for this. Oncologists love to debate and argue the most effective treatments for various cancers, but not with yours. Every oncologist would tell you the same thing. You need chemotherapy.”

I realized then that my response had concerned him that I wouldn’t agree to chemotherapy. But the good and great Dr. Karam had done a fine job of slowly but surely turning up the chemo heat, and Dr. Glaspy was now bringing things to the inevitable boil. It was clear what I needed to do, and I would do it. Right then, though, I was thinking about Seamus and the hand he’d been dealt—the terrible odds that he’d beaten anyway.

Dr. Glaspy continued his explanation. “If we took one hundred women with your cancer exactly and put them in a room together, we know that with no post-surgery treatment thirty of them will have a recurrence of the cancer and seventy of them won’t. We just don’t know which thirty.”

I wasn’t picturing women in a room. I pictured one hundred beagles. Thirty of them immediately ran howling to one side of the room. In Seamus’s case, it was probably thirty that would not have a recurrence. The seventy beagles on the other side of the room would have a recurrence. I figured if the doctor could be on a riverboat, I could be in a beagle rescue. Now, if those beagles were at a card table, playing poker…Stop! Listen to the oncologist! He’s talking about your cancer!

“So we give them all chemotherapy. The chemotherapy will cut that number to fifteen. That means fifteen of those women will still have a recurrence, but another fifteen will not. Again though, we don’t know which fifteen.”

Fifteen beagles ran across my mental room and joined the other thirty safe beagles. Which side of the room had Seamus been standing on after his surgery? Either way, there was, as I knew, as I had insisted to that sorority-bitch of a doctor, always the chance he would survive. There’s always a chance. Seamus had shown everyone that much.

Later when I explained to a friend why I was undergoing chemotherapy even though there were no signs of cancer in my body after surgery, when I explained what these statistics meant, what the science could and couldn’t tell us, and most particularly when I told her about the beagles racing across the room in my mind, she clearly thought I had lost my marbles in that beagle stampede.

“Teresa, the doctor is talking to you about your life, your diagnosis, and all you can think about was your dog? You’re not taking this seriously,” she said.

Not taking cancer seriously. As though that can be done. She was not the first nor the last to make this comment to me. I was taking cancer seriously. I was also taking those odds very seriously. Seamus’s experience helped me understand my odds in a very positive way, whether my friend understood that or not.

I addressed Dr. Glaspy. “So, I could have the chemo but never have needed it—I could have been one of the original seventy?” Dr. Glaspy did not strike me as the kind of doctor one discussed her beagle’s cancer diagnosis with, at least not then, so I stuck to questions geared toward understanding my own chances.

“Yes, but you could also be one of those fifteen women whose life was saved by chemotherapy.”

Like Seamus. I understood now, far better than I had then, why Seamus had to undergo chemotherapy even though the surgeon had achieved the coveted “clean margins” around his excised tumor. Chemo gave him the best chance to be the beagle that crossed the room over to the safe side and walked out the doggie door to health. And he did it. Would I be that lucky?

There was only one way to know.

Once I agreed to the chemotherapy, Dr. Glaspy and his physician’s assistant explained the protocol to me. I’d have Taxotere and Cytoxan four times each, spaced three weeks apart. I recognized Cytoxan—Seamus had been given Cytoxan. They really do give the same chemotherapy to dogs and humans. I made a mental note to check to see if Cytoxan was what caused Seamus’s white blood cell crash.

Dr. Glaspy reviewed the possible side effects with me. “You may be fatigued, and you may be nauseous. We have ways of controlling that, and it’s certainly better than it used to be, but some patients do get nauseous during or immediately after treatment. Your long drive may be an issue. Do you have someone who can drive you?”

“I’ll be with her for each appointment. Do you think we’ll be able to head home by 2:00 p.m. and miss the traffic?” Chris said.

“Hard to know. And probably not for the first treatment. You might want to consider staying in a hotel if that’s an option for you. Or I can refer you to an oncologist closer to where you live.”

I considered that option. I’d had such good care at UCLA and trusted Dr. Karam’s opinion of Dr. Glaspy so much that I did not want to go anywhere else. On the other hand, I knew I couldn’t afford a hotel room each night of chemo, not with missing work on those days as well. The thought of being nauseous in a car for sixty miles and possibly as long as three hours was also not appealing. Things would be easier for Chris, too, if I had treatment closer to home. I decided to at least get the referral and meet the other oncologist.

• • •