I met my oncologist as a cartoon in the graphic memoir, Cancer Vixen.  In the cartoon version, Dr. Paula Klein is blonde and glamorous and wears Manolo Blahnik heels with her white lab coat.  In person, Paula is dirty blonde and wears flats.  Every three months, I visit Paula and go through the rituals required of breast cancer.  

(See letter M)

“Hi how are you?”  I always say.

“How do you think I am? I work in a Cancer Center.”  She always answers.

I like her brusqueness because it is easy to see the softness inside, a half open oyster.  The forced cheeriness some employees have at the center feels oddly out of synch in the serious world of Cancer.  Dr. Klein is always in a rush and records her notes in a device mounted on the wall speaking so fast she sounds like a disclaimer for medication:

“I’m with Marian Fontana who had a 1.5 millimeter, intraductal carcinoma and estrogen positive cancer in the left breast that was treated with a lumpectomy, a re-incision.  When was your re-incision?”

“August.”

“August of 2009 which was followed by a course of six weeks of radiation therapy starting in. …when did you start?

“October.”

When she is done recording, she gives a breast exam, her fingers disappearing into the flesh of my breasts.

“How’s your dating going? You still with the life coach?”

“No. He was a loner. ”

“What do you know about life being alone all the time?”

“Exactly.  I have a date tonight though.”

“Good. He nice?”

“He seems nice on the phone.”

“Good. You’re good. Everything’s good”

After my visit, I meet my date at Odeon in Tribeca where a balding, muscular man named Sam sits smiling.  After he greets me with a wet kiss on the cheek, he tells me he has an eleven-year-old daughter, that he just lost his job a week before and that he hadn’t been to Tribeca since 9-11.

“I was running uptown with my daughter in my arms” he says.   It is a bit early for the 9-11 story, but I listen quietly reaching for a slice of bread.  “You were at the doctors today?”  he asks and I look up startled by his psychic abilities until I realize, I had exposed the cotton and Band-Aid from having my blood drawn when I reached for the bread.

“Yeah. A check up,” I say, pulling my shirt down.

“Who’s your doctor?”  he asks.

“Paula Klein.”

“You have cancer?

“How do you know that?”

“I went to Jewish day Camp with Paula.”

“Small world,” I say, trying not to look mortified.

“Lets call her and tell her we’re on a date.

“No that’s o-“

He is already on his cell phone scrolling through his numbers.

“This is so crazy!” he says, finding the number.   “Hey Paula! It’s me, Sam. You’re never going to guess who I’m sitting having dinner with.  Nope….  Nope. .. Nope…Marian Fontana.”

Since Paula is world renowned, there is often long waits at see her. To me, this is like being stuck in traffic. If you only have a short time left on the planet, you don’t want to spend it in a waiting room. To distract myself, I bring a book and by my third visit, I have befriended another avid reader named Anita with auburn hair in a bob.  We talk animatedly about books and start to make our appointments on the same day so we can exchange paperbacks we have finished and loved.

On my next visit, Anita looks puffy and is wearing a blonde wig. “Did Paula ask you to join her study?”  she asks.

“No. What is it?”

“Something about why women gain weight when they are diagnosed.”

“They don’t need a study for that.  You eat it all because who wants to die on a diet?”

“True. Maybe it’s for stage 3 patients or something. ”

“Yeah, maybe,” I say feeling guilty for my joke, but Anita doesn’t seem to notice and hands me The Short History of Women, by Kate Walbert.   “A bit meandering, but I finally finished it,” she says.

I give her Lit by Mary Karr.

A few months later, I visit the cancer center only to discover it has been taken over by Beth Israel Hospital.  Originally run by St. Vincent’s, the security guard tells me he is lucky they kept the Cancer Center open at all.  Dozens of his friends at Saint Vincent Hospital lost their jobs.

I feel like a child of divorce. Everything looks and feels different and yet is the same.

In the waiting room, I am thrilled to see Anita, her hair growing back, thick and auburn.  She strokes her hair when she sees me.

“You look beautiful!” I say.

She gives me a new book, Let the Great World Spin by Colum McCann, but I have forgotten her book and in truth, never read it.  I have been unable to pay attention to books lately.

Paula’s office looks the same except for a resident who sits at her desk, taking notes.

“Where’s Paula?” I ask.

“She’ll be in soon,” the resident says explaining that Beth Israel is a teaching hospital now.  She flips open my chart.

“So you had a 1.5 centimeter intraductal carcinoma,” she says.

“That’s right.”

“Any history of breast cancer in the family?”

“No.”

Her face twists and she is silent for an uncomfortable length of time, flipping back and forth between two pages.

“Why didn’t you have chemo?” she asks.

I feel my heart race.  Why is she asking this? During the course of my treatment the idea of chemo frightened me more than dying itself.  I was scared of my body running down, my hair falling out and the world staring in pity at my bald, swollen head.

“I would prefer to talk to Dr. Klein about this,” I tell the resident.  In a few moments, Paula appears looking harried and tired.

“How are you?” I ask.

“How do you think I am? I work in a Cancer Center.”

She turns the recording device on looking back and forth from me to the resident, speaking faster than ever.

“I’m with Marian Fontana who had a 1.5 millimeter, intraductal carcinoma and estrogen positive cancer in the left breast that was treated with a lumpectomy, a re-incision in…”

“August, 2009” The resident says.

“She has some side effects to her Tamoxifen including leg cramps. Are you still having leg cramps?”

“Yes.”

“Write that down,” she tells the resident.

“In October…” she continues. “What a minute….” Her face shifts as she pushes the glasses up her nose.  “Why didn’t we do chemo on you?”

“We didn’t need to. My oncotype number was low.”

My sister and I were waiting in the small examining room.  There was a quilt on the wall in a frame, made by a family member of someone who had died.  The nurse came in, her crocs squeaking on the tile floor.  “No chemo” she announced casually.   My hand clamped over my mouth to hold in the scream, but the tears fell fast and quick, relief itself rolling down.

“You’re oncotype number is high. We should have done chemo,” Paula says shaking her head.  I have never seen Paula worried.  Serious but never worried.   The oncotype test is performed on early stage breast cancer patients to determine their chance of reoccurrence.   The lower the number, the better your chances of survival.  0-17 means low risk, 18-30 means medium, 30 to higher…

My number is 6 and in the cancer world that is as good as winning the lottery.

“It says on your chart 26.”

“I have that too. “ the resident says.

“We have to take your ovaries out right away,” Paula says looking panicked.

“It’s a six, Paula.  Can you call the genetic company please?”

“We have it on both charts,” she says shaking her head wondering I imagine, how she could have missed it. “I’ll be right back,” she says, the resident practically running out behind her.

I take out my appointment book and look at my sloppy handwriting scratching in my life in small boxes.  I could have my ovaries out on Wednesday, but then I wouldn’t make Aidan’s Parent-Teacher conference the next day…”

Dr. Klein returns in a few minutes exhaling hard.

“Oh thank God it was a six.”

Within minutes she examines my breasts, rolling her fingers across and under.  “So, are you still seeing Sam?” she asks.

“I broke up with him last week.”

“Why?”

“He collected sneakers you know. Ugly ones.”

“That’s why you broke up with him?”

“No. He never told me his daughter lived upstairs.”

“He was always weird,” she says.

Six months later, I am back at Paula’s.  This time there are three residents in the room. They are all Indian with smooth skin and bright lipstick.

“Make sure you go back far enough. Hers was very far back,” she instructs them as they take turns examining my breasts..

“This is like a lesbian porno.” I joke.  The residents giggle but Paula is distracted.

She lifts my arm and frowns.   “Looks like we have secondary lymphedema based on the coloring of the skin.”

“What?” I ask peeking at my underarm glistening with sweat and as black as country sky.

I laugh hard.

“What?” Paul asks trying not to smirk.   I shake my head, laughing too hard to answer.  “It’s a new shirt, right?”

I nod and now the residents are giggling too.  One of them hands me a tissue.  “I just bought it at TJ Maxx.”

“That’s funny,” Paula says without laughing.

“How are you?” I ask, forgetting our usual banter.

“How do you think I am? I work in a Cancer center,” she lifts my other arm.

“I didn’t see Anita today,” I say.

“I can’t share patient information.”  Paula says, her voice cracking.   The Indian girls are frozen, staring off like sculptures and after a long silence, Paula finally says,    “They found her dead over the weekend in her apartment,” adding  “I’m not supposed to tell you.”

I bite my lip and nod, pulling my bag to my chest. A Short History of Women was weighing it down. I had finally remembered to return it. I never read it and don’t think I ever will.