So Much for That. Lionel Shriver

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СКАЧАТЬ 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 to shake hands and find himself in the car and have the omission, the elision, the craven evasion, steeping the inside of the vehicle like toxic emission fumes. But he also did not understand why he had to be the one to ask. Glynis might have raised this obvious matter before, but if so she hadn’t shared with him the upshot of such a discussion, and that seemed impossible.

      When trying to get up to speed about a disease he’d never heard of before last Friday, through the following weekend Shep had spent hours at the computer. Know thy enemy, he figured. Yet on one medical Web page, well into its patient, hand-holding explanations of every test and treatment that mesothelioma patients might expect, he had finally arrived at a section headed “Survival Rates.” He had nearly memorized the first paragraph, having stared it down for so long:

      Following on this page is quite detailed information about the survival rates of different stages of mesothelioma. We have included it because many people have asked us for this. But not everyone who is diagnosed with a cancer wishes to read this type of information. If you are not sure whether you want to know at the moment or not, then perhaps you might like to skip this page for now. You can always come back to it.

      It was his initial impression that the authors of the text were being patronizing. His first impulse was to scroll down. He had always faced difficulty squarely. But this was different, if only because it was not his difficulty. It was bound, at points, to seem like his difficulty, but he would have to be mindful about that. Still, there was no question that as that paragraph burned on the screen, what bloomed in his gut was terror. He reached for the mouse. He withdrew his hand from the mouse. He did not scroll down. Taking the page’s advice, skip this page, he had returned to the same point on the same website three other times. He had never scrolled down. He wasn’t ready. In this office, with a fellow human being СКАЧАТЬ