The Cancer Chronicles by George Johnson Read Free Book Online

from out east brought news that Nancy’s father had suffered a hemorrhagic stroke—what a horrible year this was—and lay in intensive care at Stony Brook University Medical Center. The appointment with the surgeon was postponed and a flight to LaGuardia Airport was booked. Nancy called home that evening and told me about sitting at his bedside: his eyes, his smile, the grip of his hand, his obvious comprehension. He filled every cubic inch of her soul, except for a tiny space. The space got larger. In the days since her arrival, the lump had obstinately endured.
    She didn’t have to leave the Stony Brook campus for a medical consultation. The next time she called she was walking back to her car from an appointment at a clinic, past familiar buildings (she had taken a degree in biology there). Her voice was wavering just enough that I knew she was probably crying, or trying not to. The doctor had palpated the lump. It was not soft and round as it would be from an infection. It was not cat scratch fever. It had the hard, irregularly shaped feel of a malignancy. The look on his face told her that she almost surely had cancer. He recommended aneedlebiopsy—the sucking out of cells to see if they are malignant. She decided to come home for the procedure.
    There are those times we all come to know when you are sitting in a hospital waiting room surrounded by other people—the older ones flipping through magazines, the younger ones staring into the bottom of their cell phones. I had been through that with my mother after her torn rotator cuff and when the second of her knees was replaced. I had been through it with Nancy for a detached retina after a horseback ride. I knew what to expect. Just when you think you cannot endure another minute, the surgeon walks in, her mask hanging around her neck. She is smiling, pleased to be giving you good news. This time that didn’t happen. “We may be looking at acarcinoma,” she said.
    She had sent a sample of the lump downstairs to pathology for a quick look under a microscope. The misshapen cells resembledepithelial cells that form the lining of organs. But they had mutated enough to become less differentiated. They were losing their genetic identity. Reverting to this primitive state, cells bear a resemblance to those in an embryo—rapidly dividing, chameleon-like, and capable of doing almost anything.
    The diagnosis would have to be confirmed in the laboratory. But there was little doubt about what was happening. I walked with the surgeon to the recovery room whereNancy lay in an anesthetized blur. I remember her smiling as the surgeon spoke, and I only realized later that she was barely absorbing the information. For the rest of the week I tried to be optimistic, and maybe I unintentionally misled her. My understanding was that the diagnosis was, say, 90 percent certain, that the lab report was a technicality, a way to be absolutely sure. I thought that was Nancy’s understanding too.
    A few days later I was upstairs in my office when the doctor called her to break the news. “Extensivemetastatic adenocarcinoma, moderately differentiated.”Adenocarcinomas are carcinomas of epithelial tissues that contain microscopic glands. They can arise in the colon, lung, prostate, pancreas, almost anywhere. I don’t remember how I knew to walk downstairs. Or did she walk upstairs to me? I had never seen her so upset. She told me that she had hung up the phone and screamed. Somehow cancerous cells had gotten into herlymphatic system and lodged inside that node in her groin. But where in her body had the cells come from? It would be weeks before we knew. “Metastatic cancer with an unknown primary”—it seemed like the worst possible diagnosis. A tumor was single-mindedly growing, shedding more seeds, metastasizing. But no one knew where.
    There were hints from the pathology report describing the character of the cells:
    ESTROGEN RECEPTORS    
Approximately 90% positive