already made the most difficult choice of all since seeing Dr. Wallerstrom. Although the prospect of doing only a lumpectomy was very tempting to save her breast, even the vaguest hint of greater safety by eliminating the entire breast won her over. Both views were heatedly debated by equally respected surgeons, and yet it was clear to her which Peter Herman preferred, and much as she ached at the prospect, she decided to follow his thinking. She had already agreed to the modified radical mastectomy he had described to her, if the tumor proved to be malignant. And to chemotherapy, if he felt it was needed. But they would make that decision later.
But the real agony for her was what she would do if she was pregnant. She knew what she owed Sam and Annabelle, but she also knew how difficult, if not impossible, it would be to give up an unborn baby. Dr. Herman explained very clearly as she stared at him that in the first trimester of pregnancy, mastectomies were always performed rather than lumpectomies, because of the inadvisability of doing radiation. Having a lumpectomy automatically meant the necessity for radiation. But in the case of a mastectomy, if chemotherapy was advised, it would almost certainly cause a spontaneous abortion. It would do the same in the second trimester as well, so if chemotherapy was necessary, it would more than likely kill her baby. It was only in the third trimester that they felt they could afford to wait, and treat the cancer after the baby was delivered.
He said very honestly that he thought there was almost no chance at all that her mass would prove to be benign. He had just seen tumors like it too often. What he was hoping for her was that it would not have infiltrated, or metastasized, and that there would be minimal node involvement. And he also hoped, of course, that it would be nothing more than a Stage I tumor. She felt herself blanking out on him again, and forced herself to listen and understand what he was saying. She wished Sam were there with her but he was too busy denying that there was even going to be a problem, she hadn't even thought to ask him.
“What about the pregnancy?” Dr. Herman asked her before she left. “How real a possibility is that?” It could affect some of their decisions.
“I don't know,” she said sadly, “for the moment.” She wouldn't know for sure until that weekend.
“Would you like to have some counseling, before the biopsy?” he asked, showing his “human” side again, which was very small, and very seldom seen, but at least he was trying. “Particularly, if you might want to make this a one-time procedure in the event of a malignancy, you might like to speak to a therapist, or some other women who've been through it. Normally, we recommend peer groups, but that usually isn't until later. They're extraordinarily helpful.”
She looked at him ruefully and shook her head. “I don't have time. Particularly if I'm liable to be out of the office for several weeks.” She had to cover all possibilities, and she had already asked Matt Billings to cover for her, and she had given a lot of her work to Brock. She knew he would take good care of it. But she hadn't told either of them where she was going. She had intimated only that she had a medical problem that needed to be worked out, and it could take anywhere from two days to two weeks, but they were prepared to accept that and help her out as much as possible. Brock said he hoped it was nothing serious, and Matthew didn't even think of it, and wondered if she was going to have a nose job, or her eyes done. His wife had done it the year before and he didn't think Alex needed anything of the sort, but he also believed that all women were a little crazy about their looks, and Alex looked so healthy, it never dawned on him that she might have a serious problem.
“How soon do you really think I'll be able to go back to work?” she asked the doctor honestly.
“Possibly in two or three weeks, depending on how you do. And then of course it'll depend on how you do with the chemo. We'd be starting that approximately four weeks after surgery. Some women do very well, others have more problems.” To him it