about the approach of menopause, he hadn’t passed comment. Now he realized: that was not her period. He also realized that she had started to wear a nightgown to bed not, as she had claimed, because she was cold; it was to hide the laparoscopy scar on her belly, which he had now seen. Though only an inch long, it alarmed him: a first violation, and not the last. The nightgown had injured him, too. They had slept for twenty-six years skin to skin.
Since that signal Friday evening a week ago, she had shared only bits and pieces about the tests. So her mention that weekend of one small technicality had stood out. Before the MRI, for which all jewelry must be removed, they had to do an extra X ray before sliding his wife into the tube. “Because they learned I was a metalsmith,” she’d said. “The imaging is magnetic. Metal screws it up. You can’t have any fragments or filings stuck to your body.”
He should have recognized why she had told him this: because she was proud. He shouldn’t have asked her, “So did they find any?” An effective but infuriating gambit increasing in frequency, she hadn’t responded to his question at all, which in this case meant no. They found no fragments or filings. She had worked so little in her studio for months that she could have taken the MRI just like anyone else. Even at such a juncture, he’d had to rub it in.
Your own little world. Her subterfuge would never have succeeded without his corresponding neglect. If he had noticed that despite the recent fullness around her stomach she’d grown thinner, he had made little of the observation, which was as good as not having noticed. He thought, I’d no idea that our marriage was in such disrepair, and then he remembered that until last Friday evening he was planning to leave her.
“That night,” he said. “You didn’t have to let me go on like that, about Pemba. You could have stopped me.”
“I was interested.”
“It wasn’t nice.”
“I haven’t been feeling,” she said, “nice.”
“How do you feel?” Shep was ashamed. In the last week he’d been solicitous, perhaps annoyingly so. Yet in the months beforehand he could not remember the last time he had asked her how she felt.
She took a moment. “Frightened. For some reason it was easier when you didn’t know.”
“That’s because you can give yourself permission, now, to be frightened.” He pressed her hand, just. “I will take care of you.” It was a big promise, one he would fail. But he would fail valiantly, and that was the promise he made to himself.
Dr Edward Knox extended a hand to Shep, his clasp firm and generous. The oncologist gave off the astringent tang of antiseptic, as if he were one of those rare physicians who really did wash his hands. It was a smell Shep associated with anxiety. “Mr Knacker, I’m so pleased that you could finally arrange to join us.”
In this phrasing Shep detected reproof, and his wife’s outrageous misrepresentations. In other circumstances, he would have taken her to task for them. Since now he would not, he sensed that taking her to task for anything was now pretty much a thing of the past.
The familiar air with which Glynis took a chair indicated that she had been in this office before. These two had a history together, and though Shep was “finally” here he felt excluded. He got the peculiar impression that for Glynis this office was a seat of power.
As the doctor assumed his swivel chair, Shep adjudged that the oncologist may have been in his latter thirties, although he’d grown ever less certain about ages. While he could still tell the difference between sixty and sixty-five, lately his juniors all entered an undifferentiated category of Younger Than Me, which was odd, since he had been that age before, knew what it felt like and how it appeared in the mirror. But from the perspective of a greater age it always turned out that you hadn’t, at the time, understood being thirty-seven at all, what it was, what it looked like. Unfortunately for current circumstances, younger people always seemed callow to Shep now, their confidence, which Dr Knox radiated in pulses, hollow and unjustified – that is, enviably self-deceiving. Still Shep wanted to believe in this man, and rather hoped that with friends he went by “Edward” and not by the flip, less reliable-sounding “Ed.” Fit and trim, Knox probably chose fruit for dessert in the cafeteria and made time for the treadmill in the hospital gym; he practiced what he preached. Personally Shep always had a soft spot for medical practitioners who carried twenty surplus pounds and sneaked cigarettes in the staff parking lot. The hypocrisy was reassuring. From doctors, Shep had always sought less authority than forgiveness.
“I apologize that it’s taken us so long to arrive at a positive diagnosis,” Dr Knox began, addressing himself to Shep. “Mesothelioma is notoriously difficult to identify, and we had to rule out a host of other more commonplace explanations for your wife’s fever, tenderness, abdominal swelling, and gastric dysmotility.” Shep didn’t know what dysmotility meant, but he didn’t ask, because then the doctor would know that this was one more of his wife’s symptoms that he hadn’t known about, or cared about, or noticed.
“After all, as I’m sure your wife has told you, peritoneal mesothelioma is very rare,” Dr Knox continued. “And I won’t mislead you. It’s also very serious. Because the peritoneum is a very fine membrane surrounding the abdominal organs, almost like Saran Wrap, diseased tissue can be tucked into corners that are difficult or impossible to get at surgically.” Shep admired the doctor’s locution, which at least pretended that of course Shep knew what the peritoneum was; Knox was loath to imply that his patient’s husband paid so little heed to his own wife’s grave medical distress that he wouldn’t bother to look up her diagnosis in a dictionary. “And I’m sorry to say that symptoms of mesothelioma don’t generally make themselves felt until the cancer is fairly advanced. Nevertheless, we have a range of therapies at our disposal. New treatments, new approaches, and new drugs are being developed all the time. The survival rate has done nothing but improve.”
Shep knew all of this from the Internet, but felt it would appear impertinent for him to say so. Besides, it seemed important to allow the oncologist this formal introduction. Shep had already read enough to have registered that most of the nostrums in Knox’s grab bag of tricks were poisons. In the face of being able to do so little, it must have been comforting to the doctor to seem to be useful in this discursive way. His manner methodical but warm – he smiled encouragingly and looked Shep in the eye – Edward Knox had struck Shep from the start as very kind.
But even when doctors acted kind, the extent of their capacity to be kind was often out of their hands. However gently put, many a message that physicians were forced to deliver was cruel, and if it did not feel cruel it was a lie and thus was even crueler. Personally Shep didn’t understand why anyone would want to be one. Oh, certainly the tasks of stenting an artery and clearing a bathtub drain were technically akin. Yet a doctor was like a handyman who, some appreciable percentage of the time, had to knock on your door and say, I’m sorry, but I cannot clear your drain. That’s all the acting kind was good for: the I’m sorry part. And then he walks away and maybe he waves, leaving you with scummy standing water in your bath. Why would anyone want a job like that.
“And I do have some good news,” Knox continued. “First, as I assured you last week, Mrs Knacker, the MRI did not reveal any anomalies in the pleural – in the lungs. Even more critically, I now have the lab report from the laparoscopy. Mesothelioma comes in two flavors, if you will – two types of malignant cells. The epithelioid are less aggressive, the sarcomatoid much more so. In the samples we extracted, only epithelioid cells were detected. That makes the prognosis considerably more optimistic.”
Glynis gave a schoolgirl nod, as if she had done something right. Shep was about to ask, so what prognosis is that? He opened his mouth and it was dry. He closed
