She is lying on the operating table, half naked, and half groggy from the anesthesia working its way up the vein on the topside of her left hand. Dr. Castile walks in. She is an attractive woman, with long brown hair now hidden under her surgeon's cap. She is young, not much older than Pam's 33 years it seems, and she is smiling; that same warm smile that greeted Pam the first time they met, in her office next door to the hospital, just one week ago.
She grasps Pam's free hand and holds it in hers. "Ready?" she asks. Yes. There is relief in finally being here; in not having to wait any longer, dwelling uncomfortably in that tentative space of uncertainty.
Dr. Castile explains the procedure she is about to perform. Pam has heard it before, but finds comfort in hearing the words again. The soft lilt of the doctor's voice washes over her, and she is swept up in the rhythm of its cadence.
"I will make an incision along the side of your breast, about a half inch away from the nipple. I'll remove the tumor and the surrounding tissue. We will do a biopsy right here and then send it on to the lab for final results. You'll be aware of everything, but you won't feel any pain. The whole procedure shouldn't take more than an hour. Okay?"
"Okay", Pam replies, as if she has a choice.
The anesthesiologist walks in and introduces himself from behind his mask.
"Hello. I'm Dr. Sykes."
Not quite sure what to say to a man she is meeting for the first time while lying on a steel table, nude from the waist up, she offers, "Hi. I'm Pam." Then, pointing, "...and this is my breast." He is stunned for a moment, but Pam smiles at him. He laughs. They begin.
She feels a slight pressure on her breast but not much else. A small white curtain hangs near her shoulders, shielding her from them and separating her from the rest of her body. For the moment, it seems, it is not hers anyway.
She hears them speaking in hushed tones and initially strains to listen. But the drugs are fully at work now and she soon loses interest. Her eyes wander, first to the anesthesiologist's face, and then, when tiring of his intent brown eyes, up to the stark white ceiling above her. She thinks about Paolo. He is outside in the waiting room where she left him earlier, sitting alone among a row of empty straight-backed plastic chairs worn by years of holding anxious loved ones. 'I'd rather be here', she muses.
Her mind drifts to some weeks before, when she and Paolo had gone to Italy to spend Christmas with his parents. Florence in winter. It was almost more magical then than in the summertime; the tourists were long gone and the city belonged to her. In the two and a half years of their marriage, they had come here often, and it had begun to feel like home.
For Pam, Christmas was a treat. She came from a small Jewish family and grew up with quiet holidays and no colored lights. This time of year had always been a little sad for her, with no one around to fill up the hollow silence of their apartment except for her sister and mom and dad. Her parents came from Europe, where most of each of their families had been wiped out during the war. Dad still had some family in Paris, but they were very far away, and although Pam wrote back and forth with her cousins, it wasn't the same.
Paolo's family was large and boisterous - siblings and spouses, numerous aunts and uncles, an endless parade of cousins and all ages of children. Christmas Eve was intoxicating, with generous courses of focaccia, marinated eggplant and fried vegetables followed by pasta with meat sauces made from wild boar and spiced tomatoes. Phone calls came from Sicily from relatives who couldn't make it, and fiercely competitive card games at the kitchen table lasted well into the night. Shot glasses appeared along with an array of grappa bottles, accompanied by plates of biscotti filled with figs. They finally stumbled to bed sometime near dawn.
For New Year's they were invited to a friend's farmhouse a hundred kilometers north of the city, in the heart of Tuscany. They cooked sausages and bruschetta over the open fireplace, and at midnight watched the neighbors' fireworks from the portico, huddling in the brisk, country night air. They went around the table then, sharing their resolutions for the coming year, a tradition that felt familiar to Pam. She turned to Paolo, knowingly; they had discussed it many times in recent months. They wanted to start a family. She hugged him tightly; they were madly in love. There was so much to look forward to.
"Pam. Pam, can you hear me?" She opens her eyes and sees that Dr. Castile is standing over her. She is in the recovery room, where two nurses help her sit up. She looks around; there are several other people nearby who have also just had minor surgery. Pam smirks at the thought - 'minor surgery' - as if cutting her open and poking around inside was an everyday occurrence, like buying the newspaper or walking the dog.
She is suddenly aware of Dr. Castile, who sits beside her, very still, as if waiting politely for Pam to finish her thoughts. Or for Pam's eyes to tell her she is ready to hear what comes next.
Pam lets out a long deep sigh, as if she had been holding her breath since they had flown home from Italy and she had discovered the lump. Maybe it is the residual effect of the anesthesia that keeps her calm, or simply the validation of her fears, but she is oddly relieved. For the first time in weeks, she breathes freely. "Have you told Paolo?"
The doctor nods. "How is he?" Pam inquires, knowing she doesn't need to ask.
When the doctor brings him in, he is pale, and for the first time since Pam has known him, speechless. She reaches for his hand and holds it firmly, reading his eyes that search her face for reassurance. The doctor leaves them with instructions for the next few days: Sponge baths with a washcloth. Rest. Painkillers if she needs them. They set up an appointment for the following week, to discuss next steps. And then, with one last comforting glance, Dr. Castile is gone.
They drive home in silence. Pam calls her parents; her father answers the phone. She tells him the news and he too is silent. "We'll get through this dad," Pam musters, suddenly aware of a vague sense of guilt. "I love you." They don't talk for long. He says he'll tell mom. She is grateful; she can't bear to stay on the phone.
That evening, and every evening for the next week is spent quietly at home, with Pam and Paolo huddled on the couch absentmindedly gazing at the television. Palermo, their cocker spaniel, paces back and forth across their feet, keenly aware that something is different. Wrong. He begs to be permitted on the couch, behavior not typical of his independent and somewhat aloof nature. He stops his pacing just long enough to scratch furiously at the fabric near the armrest, then stops again to look up at the two of them, pleading determination in his eyes. When he fails to get their attention, he begins to howl - a deep, painful wailing that is something Pam has never heard but that sounds remarkably like the cry of a baby. He is relentless, so Paolo finally reluctantly lets him up on the couch. Now he struggles to wedge himself tightly between the two of them and then, finally secure, he falls asleep.
Pam is touched by Palermo's behavior. She finds comfort in the warmth of his small body next to hers. And at that moment, she begins to understand just how much their lives have been disrupted. But it would be much longer until she would begin to comprehend its profound impact on her life, on theirs together, and on the future.
Pat Zadok is an executive producer for a large advertising agency in New York City. She is a 20-year survivor of breast cancer.