Beneath It All (Beneath #1) Page 5

  We walked through Millennium Park and found our way to the Bean. The Bean is a large bean-shaped sculpture with a mirrored surface. Its curves twist and distort images, and I was brought to tears when I saw my reflection. Distorted. That was what would become of my body, or maybe it already had where the cancer was attacking me, only I couldn’t see it. That would change in a few weeks, when I would be left with nothing but scars to look at for the rest of my life.

  Our flight home was quiet; we were both lost in our own thoughts. We barely spoke to one another; however, our hands stayed intertwined the entire flight. It was the only comfort we could offer each other. We both collapsed from exhaustion when we finally arrived home. Noah slept soundly, while I woke up several times during the night with my mind racing.

  By morning, I wasn’t close to being rested, and it was a chore getting ready for the back-to-back appointments that Dr. Freeman had set for me. I just wanted to stay curled up in a ball and ignore the world.

  Sitting in the waiting room of Dr. Lauren’s office was nerve-racking, and I found myself bouncing my knee up and down, which was not something I ever did. Noah noticed my odd behavior and placed his hand on my leg and began to gently massage my tense muscles. It helped to ease my nerves.

  “Victoria Madison?”

  And there was my name again. I was going to have to get used to hearing it frequently now. Maybe I should change it or use a fake one at each office. That would be entertaining; however, I’m sure the physicians’ billing departments and insurance companies wouldn’t be too pleased. The thought did make me smile, though . . . just a little.

  We were led to an exam room, and I was provided with another lovely paper gown and . . . well . . . I knew the drill. Shortly after I got settled, Dr. Lauren tapped lightly on the door, and I noticed Noah shift uncomfortably in his chair. “Good morning, Victoria. I’m Dr. Lauren,” he stated as he shook my hand before turning to Noah. “And you are?”

  “I’m her husband, Noah. Thank you for seeing us on such short notice,” Noah said in his most proper and professional voice. He was in “attorney mode” and was going to listen to every little fact that came out of Dr. Lauren’s mouth. I could see the wheels turning in his head and knew he would be cross-examining the good doctor in no time. Poor guy didn’t know what was coming.

  I turned my attention to the tall blonde doctor whose hazel eyes were looking sympathetically at me. “Dr. Freeman called me late in the day yesterday and explained your situation. I was happy to make room for you on my schedule since she’s a dear friend.”

  He took a seat on the stool and flipped open my chart. “Now, let’s take a look at the findings from Dr. Frank’s report. I see you had quite the work up on Tuesday. Do you still have tenderness in the area?”

  “Yes, it’s still a bit tender, and the bruising is getting more colorful by the day. Maybe it’s just in my head, but I feel a constant burning feeling in that area now,” I confessed and was sure he thought I was crazy. To be honest, I did feel crazy, and since hearing those four damn words, I had felt a constant burning sensation in my breast.

  “Yes, I’ve heard several women say that. Though I can’t say I understand it, I’m told it’s a normal feeling.” He looked back down at the report. “It appears that the measurement of your tumor is estimated at just over two centimeters long, and it appears to be self-contained. We don’t see any ‘spidering’ or rough edges in the mammogram or ultrasound films. Dr. Frank also noted that he didn’t see any inflammation in your nodes, which is encouraging, but we will still do a sentinel node biopsy during surgery to be safe.”

  “What’s a sentinel node biopsy?” Noah inquired.

  “It’s a procedure in which we will inject a radioactive dye into the nodes under the arm of the affected breast prior to surgery. The dye travels to the sentinel node, which is the primary node, and will filter into others surrounding it, making them all a bright blue color, which allows me to locate it and the other primary nodes quickly during surgery. I’ll take between three and five nodes immediately at the beginning of surgery and send them to the lab for testing. If the results come back positive, we will take more nodes until we get the all clear. There is a higher likelihood that the cancer has spread to other areas of the body if the nodes come back positive. It will allow your medical team to be proactive in planning your course of treatment.”

  I’m glad Noah was with me because I knew I would not be able to remember everything that was being said.

  “There are two surgical options I would like to discuss with you,” he said as he motioned to me to move up onto the exam table. I quickly stood and stepped up to take a seat, hearing the rustle of the paper underneath me.

  He held up a diagram as he spoke. “We can do a lumpectomy, in which I’ll make an incision and remove the tumor from your breast and a portion of the tissue around it. It will be sent to the lab, and they will determine if there are cancer cells in the surrounding tissue. If there is, then I’ll remove more tissue until we have clear margins. You will be stitched closed and will be able to go home later that day. If we don’t get clear margins or if the surrounding tissue is larger than anticipated, we will make the decision while you’re in surgery to do a single mastectomy to the left breast at that time.”

  He switched to another diagram. “The second option is a single or bilateral mastectomy. This is a more radical surgery and will require at least a two-night stay in the hospital. The surgery generally takes close to three hours, and if you start the process of reconstruction, it will add an additional two hours. All of the breast tissue is removed, including the nipple, ducts, and areola.”

  I quickly interjected in surprise. “The nipple and areola? Why?”

  “Because the type of cancer you have is ductal carcinoma and it’s located in or on your milk ducts. Those travel to your nipple for nursing and need to be removed as well. If you decide to proceed with reconstruction, they can rebuild a nipple and tattoo the areolas for aesthetic purposes, but you will not have any feeling in them. For some woman that’s an issue. Are you planning on having children?”

  “Eventually, yes, but isn’t that out of the question after chemo?” I questioned, feeling my emotions starting to overtake me. Hold it together.

  “It’s not impossible, but it’s definitely something you should discuss with your oncologist, because chemo can affect fertility.”

  Noah cleared his throat. “So the chances of having children are slim?”

  “I wouldn’t completely rule it out, but, as I said, that is a discussion best had with your oncologist and gynecologist. There are risks involved that they will be able to explain better than I can.”

  He stepped over toward the desk to set the diagrams down. “A mastectomy is a very radical surgery and the recovery time is long, especially with reconstruction,” he warned as he washed his hands and reached for a pair of medical gloves. “Do you mind if I take a look at your breasts?”

  I shook my head no and opened the gown. Modesty was officially out the door; I was pretty sure I would be flashing them to all kinds of strangers over the coming weeks. Sigh.

  Dr. Lauren examined my breasts, the whole grab, cup, poke, and feel routine that I had become accustomed to. He closed my gown, took off his gloves and was about to say something when Noah spoke up. “What would you recommend? In your professional opinion, what are the pros and cons?”

  “Professionally, I’ll say that this is a very personal decision. Every woman is different, and frankly, the decision is Victoria’s. With the preliminary reports from the mammogram, ultrasound, and biopsy, your insurance would cover either option. One thing to keep in mind if you choose to do a lumpectomy: there is a very strong chance that you will have to do radiation. If you go with a mastectomy, due to the estimated size of your tumor, you most likely would avoid it.”

  He took his glasses off and leaned back against the counter by the sink. “Personally, if it were my wife, I would trust her instincts and suppo
rt her decision. She has to live with it for the rest of her life.”

  “I’m having a bilateral mastectomy with reconstruction,” I stated to both of them and was met with a moment of silence as two sets of eyes searched my face for confirmation of my verbal decision.

  Dr. Lauren was the first to speak up. “I’m not surprised by your decision, Victoria. You’re young and the fear of it coming back is more common in younger patients. There is nothing wrong with being proactive, and since you don’t have any medical history, I think you’re making the right decision for you.”

  I looked over to Noah with imploring eyes, waiting for his response.

  He finally spoke up. “Thank you for your honesty, Dr. Lauren, I appreciate it. After hearing what you had to say regarding the results from Dr. Frank and watching the myriad of expressions cross my wife’s face, I agree that she’s making the right decision.”

  Noah stood up to walk toward me and placed his hand on top of mine, which were folded in my lap. “How soon can we get this scheduled?”

  “I would like to get surgery scheduled as soon as possible. I see here you’re scheduled to see Dr. Blake Forrester this afternoon to discuss your reconstruction, is that correct?” I nodded my head in agreement.

  “Good. I think you’ll like him. Once you come to an agreement on reconstruction, his office will contact mine to schedule surgery. There’s no need for you to schedule another appointment with me. Have you made an appointment with an oncologist yet?”

  “Umm, no, not yet. I guess I didn’t even think about that,” I confessed, feeling like an idiot. “I guess I need to find one.”

  “No worries. I’ve a few recommendations I can give you. I’ll get their cards while you’re getting dressed and will meet you in the hallway.” He reached over to shake my hand and then Noah’s before he left the room.

  I dressed in silence and could feel Noah watching me. I could see the anguish on his face in his reflection in the mirror on the wall. He was starting to digest what was happening . . . really and truly happening.

  When I was fully dressed, I turned toward him and our eyes met. I saw fear in his eyes, something I had never seen there before.

  “Noah, it’s going to be okay. We have to know that. I’ve chosen the most radical surgery so that it’s all removed. I’m choosing to fight.” I tried my best to sound confident in my words and gave him my best reassuring smile before I turned toward the door. I’m sure it wasn’t very convincing, but I tried.

  “Stop.”

  I turned back around. He placed his hands on either side of my face with his forehead against mine. “You’re amazing. Simply amazing. I’m in awe of your strength because right now I’m so afraid, and I don’t know how you’re doing this.” He leaned down and gave me a chaste kiss before placing his hand in mine to exit the room together.

  Dr. Lauren was waiting for us in the hallway like he had said. “Here are two oncologists in the area that I would recommend. I suggest you call today and make an appointment for early next week with each of them. It’s important to bring a list of the same questions to both doctors, as you want to be comfortable with your choice of doctor for treatment. You will be seeing him or her frequently.”

  “Thank you again. We both appreciate your honesty and will be in touch.” I smiled, trying to keep my “I’m kicking ass and taking names” attitude going. “I guess I’ll see you again on the day of surgery.”

  “Yes, you will. Take care of yourself, and please call if you have any more questions.”

  “We will. Thank you, Dr. Lauren,” Noah added as he accompanied me toward the lobby.

  Our hands didn’t part as we left the building. It was like we were two warriors going into battle . . . only this battle was raging in my body.

  *

  “Victoria Madison?”

  I cringed. How do they do that? It’s just another normal, happy day for them, but all I wanted to do was curl up in the corner and cry.

  I stood, and Noah grabbed my hand as we were escorted into another exam room with a table, two chairs, and a desk in the corner with a round spinning chair. As a kid I used to spin on them, but I’m sure if I tried today, I would end up nauseated. It was a nice thought though.

  “Are you nervous?” Noah asked me as he sat in one of the chairs.

  “No, I don’t think so.” Who am I kidding?! “Honestly, I really don’t know. I feel like I’m on a thrill ride at a theme park and I’ve no control over what happens next. I just have to trust that the ride isn’t going to get stuck at the top, or worse—derail.” I fought back the tears that were again threatening to spill out from my eyes.

  I never thought I’d have a plastic surgeon. I’m not a vain person, and I planned to age gracefully. Yet, here I was, sitting in his office and suddenly feeling very awkward.

  “It’s okay, Victoria. Everything will be okay,” Noah reassured me. “We are just talking with him to weigh our options. Nothing is set in stone, and if you don’t want to do reconstruction, it’s okay. I’ll support your choices.”

  That did it. A few tears started gliding down my cheek just as there was a tap on the door. I quickly swiped them away and looked up as a gorgeous man walked into the room. My heart fluttered.

  He was tall and lean, with thick dark hair that was every hairstylist’s dream. His eyes were a warm chocolate brown, and his skin was perfectly tanned. His suit was custom tailored, his tie was a striking cobalt blue, and his shoes . . . well . . . nice shoes were my weakness. Gulp.

  He approached me with his hand outstretched to take mine. “Good afternoon, Victoria. I’m Dr. Blake Forrester.” His firm but gentle grip caught me off guard, causing me to gasp quietly; he smiled before releasing my hand to turn toward Noah. “You must be Mr. Madison?”

  “Yes, I am. Please, call me Noah.” Noah shook his hand with confidence. It felt awkward, like a testosterone surge was present in the room, even though it wasn’t.

  Dr. Forrester sat down on the spinning chair and flipped opened my chart. He studied it for a few moments before turning back to look at me. “I received your report from Dr. Lauren’s office about fifteen minutes ago and understand that you would like to move forward with a bilateral mastectomy followed by reconstruction. Is that correct?”

  “Yes, that’s correct. I’m not really sure what it all entails, but I know that I don’t want to wake up every day wondering if today will be the day I find a lump in my other breast.” The expression on his face told me that he understood my reasoning and he agreed.

  “Dr. Lauren explained the mastectomy portion of the surgery to you. Did he get into the reconstruction portion of the surgery at all?”

  I hesitated. Did he? I didn’t remember. “Honestly, I’m not sure.” How was I supposed to remember everything?

  Thankfully, Noah spoke up. “He briefly mentioned that it would be started immediately after the mastectomy, but didn’t elaborate much past that. I think he assumed you would explain that portion, since it’s your specialty.”

  “Very well, when the mastectomy is completed, I’ll scrub in and start the reconstruction process by placing tissue expanders under your pectoral muscles. This part of the surgery goes fairly quickly. I’ll also place at least one drain on each side to alleviate the fluid build-up from the trauma.”

  I looked a bit perplexed, and he picked up on it right away.

  “With the removal of all of your breast tissue, we will need to place the implants under your muscle to hold them in place. In order to do this comfortably, we will need to stretch the muscle out gradually to make room for the permanent implant. The mastectomy along with reconstruction causes a lot of trauma to the area, and the body naturally produces fluid to protect itself. This will cause discomfort and can lead to complications or infection, so we place a tube, just under your skin, that is attached to a bulb that will extract the fluid from your body.”

  A shivered passed through my body. “That’s just gross.”

  That earned me ful
l smile from Dr. Forrester, which made my heart skip a beat. He was too good looking for his own good. The man was charming and smart, and there was something about him that made me feel comfortable, but I couldn’t put my finger on it.

  “Yes, the drains are a nuisance, but they are necessary. They’re generally in for one to two weeks and will be removed in the office once the fluid levels have decreased. It’s a very easy procedure,” he assured me.

  “Understood,” I replied with a note of acknowledgment and disbelief. “Now, what exactly is an expander? This is all new to me.”

  He reached into a drawer a pulled out what appeared to be an industrial water balloon with a metal disk on the bottom. “This is a tissue expander.” He held it flat in the palm of his hand. “It will be placed under your pectoral muscle with two hundred cc’s of saline in it to start the expanding process. Once you have healed, we’ll start filling the expander with saline until we get it to the size we want.”

  What? Wait a minute. Fill the expander? How the hell was he going to do that? The look of sheer horror was more than evident on my face.

  “By the look on your face, I’m sure you are wondering how it will be filled,” Dr. Forrester said, a hint of humor in his voice.

  There was nothing funny about this. It sounded more like some sixteenth-century form of torture.

  “Well, yes, please enlighten me, because I have a feeling that long needles are involved, and that just isn’t going to fly with me!”

  “You’re correct; it does involve a needle.” He smiled as he held up the expander and pointed to a metal disk at the top of it. “This is a port. We locate it with a magnet so that we know where to insert a needle that will fill the expander with saline and not damage the expander. The actual fill process takes about fifteen to twenty minutes in the office and can be done every week or every other week, depending on your comfort level,” he explained. “You call the shots on when you want it done and how much saline you want injected. Your comfort is what’s most important.”