Chapter One

It’s Not About the Breast

In the hospital parking ramp, Lucy snuck a glance at a new mother placing her infant into an elaborate car seat. Her husband stood hovering at her shoulder, his hand gently touching her hip. The woman lingered, gazing at the tiny, beet-faced infant, love fairly oozing from her pores. Lucy waited until the new family drove away, watching the taillights recede all the way out of sight. That particular tableau of the American Dream could have been hers, should have been hers. It would have been hers, she knew, if she’d only stayed conscious and had the right supplies when needed.

Today she just had to get through the work day. “Get a grip, Peterman,” she said to herself. She shoved open her car door, and moved to get out. Instead she dropped her head to the steering wheel. She tried to pull the tough-girl mask over her sorrow and get on with her life. Instead she cried like adults learn to cry: silently and alone.

Grabbing the rearview mirror, after her allotted ten-minute-cry, she checked for tattle tale mascara under her eyes, wiped her nose with the fast food napkins she stashed in the glove compartment for this very reason, and got out of her car.

On the fifth floor of Med One Hospital and Clinics in downtown Elmwood, Lucy brushed a piece of lint from her shoulder and tried to anchor a springy curl behind her ear. With almost religious reverence, she placed her palms on the smooth counter and breathed in the disinfected, white, no-question-can’t-be-answered aroma. For Lucy, there were no gray areas here. Sorrow, maybe; loss, certainly. But always in black-and-white. The doctor is IN. She widened her eyes and said, “God, I love Mondays.”

Melissa, a brown-haired, plump, hyper-organized nurse who had worked with Lucy since the beginning of her tenure here, pulled her head back.

“I’ve warned you to keep that kind of thing to yourself around here, Dr. Peterman. Nobody likes Mondays. People like Fridays, Saturdays, but never Mondays.”

“I love ’em. I get to see you, talk to people in pain, drug them, and cut out their problems. It’s the next best thing to working in a candy store.”

Melissa frowned and said, “You don’t fool me, Dr. Peterman.” She squinted at her. “You look pale. Are you sleeping?”

Lucy didn’t answer her. “Where’s my other lab coat? I hate the pockets in this one.”

“I think you should talk to Menkin.” Stanley Menkin was a fellow surgeon, a friend, and the clinic director. He was not, however, the kind of guy who understood weakness. Stanley and she were the same in that respect, and Lucy was not about to request a leave of absence. This was a man’s world. Have a baby, take six weeks, and get back to work. Lose your family, go to the funeral, get back on track by heading to the office. Or, in her case, the hospital.

Melissa continued. “Take one day a week off. You came back too early.”

“Oh,” Lucy went on, “I brought some good coffee and put it in the break room. I cannot drink that crap the med students bring in.”

Melissa stared at her, and put her hand on Lucy’s closed fist. “Dr. Peterman.”

“If I’m working, I can pretend that nothing happened. This is what I do. I work.”

Melissa withdrew her hand and watched Lucy slip her lab coat, like armor, onto her shoulders effectively changing the subject. She nodded in the direction of the patient rooms. “Your student got a head start this morning.”

Lucy glanced over and saw Blake, her medical student standing at the foot of a bed with his hands in his pockets and the door wide open. The woman before him clutched the neck of her gown, her legs exposed, her bare white knees pressed together.

As Lucy approached, she heard the student say, “It looks like you only have a thin layer of skin and subcutaneous tissue available to work with. That’s unfortunate.” He shook his head disapprovingly. “This predisposes to the formation of a capsular contracture.” With a tone of voice that made it sound like he was translating for a child, he went on to explain, “This can produce an unnaturally round breast.” Then as if to lighten the moment he said, “Better than baggy boobs though, right?” Then he winked at his patient.

Lucy moved into the room fueled by three things: memories of her own failings in the sensitivity department, powerlessness in the face of bad news, and furious anger. She yanked the privacy curtain closed, and as the ball bearings hissed into place, closing out the world, Lucy lost her righteous indignation at the situation and replaced it with empathy for the woman on the bed. She was able only to muster a scowl at the med student. To the woman in the backless, undignified gown, she said, “Hello Mrs. Hallorman. How are you today?”

Mrs. Hallorman was a slim, brunette with pore-free skin and eyes like large chocolate discs. She dropped her head into her hands, and as her shoulders shook, silent tears soaked her palms. Lucy put her hand on the woman’s shoulder and handed her a tissue but neither shushed her nor muttered that “things” would be fine. In Lucy’s recent, and very bitter, experience, “things” were not always fine. Only eight months ago, she had lost her husband and her unborn baby in a single afternoon.

Lucy allowed a moment of silence for the woman’s loss and another for her own. She pursed her lips and breathed through the memory of her husband’s face on their wedding day and then, horribly, right after the car accident that killed him. Lucy caught her student’s eyes over the distraught woman’s head. He looked away and glanced at his watch.

After forty-five minutes of reassurance and education in that small, curtained cubicle, Lucy and the student stepped into the hall. “You are not to get started without supervision. Do you understand me?”

“I’m a fourth-year student,” he said. “I’ve done surgery. I came from orthopedics.”

He and Lucy looked at each other. She saw in his expression an unconcealed overestimation of his experience and an underestimation of hers. When he scratched his forehead, the shine of a manicured fingernail glittered in the fluorescent light. She motioned for him to follow her as she pushed her way into a small vacant office near the main desk. The door shushed shut.

“Here’s a news flash, pal: Reconstructing a woman’s breast after surgery for cancer takes a little sensitivity. We’re not doing celebrity makeovers here. It’s not about swimsuit fittings or new breasts as high school graduation gifts. These women have cancer. Cancer in a very intimate place. A place that helped them to feel beautiful for the proms, sexy on their honeymoons, and more than a little ready for infants. A woman would rather die of heart disease than get breast cancer, because getting breast cancer is like being stabbed in the heart. The very least we can do is use language they comprehend.”

“I understand,” he said as he glanced over Lucy’s shoulder into the mirror on the opposite wall and fixed a lock of his hair.

She eyed his lavender shirt and fancy shoes. “Tomorrow,” she said, “you can quit with the fashion show. Women in this clinic just want good medicine, not medicine doled out by someone so concerned with his appearance that he can’t even walk onto a cancer unit without using an entire tube of hair gel.”

He stood at attention as if realizing, like most men, that he’d miscategorized the tall, red-haired woman standing before him.

Lucy wasn’t finished. “If you’re going on this ride-along with me, listen up. When we meet with the patient, I’ll make the introductions; you put away your smug-ass smile and listen. Afterward, I’ll ask you what you heard.”

She straightened the collar of her lab coat. The med student tried to look interested.

“Here are a few things to remember. If I let you speak, never label a woman’s breasts as anything, let alone pendulous, baggy, sloppy, saggy, or slouchy. These are terms for old furniture, not biologic tissue.”

The medical student stared and shook his head as if saying, Of course not, never again.

Lucy waved him off. “Medical students think terminology has no emotional meaning. I don’t care who you are, nobody wants a baggy anything, let alone baggy boobs.” The student began to look alert.

Lucy exhaled, “Listen, patients will use slang. Boobs, knockers, hooters, cans, whatever. Usually not tits though. Tits are crude and smack of strippers.” He swallowed and looked around the room. There was a poster on manual breast examination on his right. He glanced away.

Lucy squinted at him. “Orthopedics, huh? I’ve told Stanley to rotate you people through proctology first. After you do sphincter work, a few knockers are nothing.” Lucy moved to the door and touched the handle.

He frowned and said, “Excuse me, but don’t we do a psychology consult for some of that stuff?”

“Oh my God, seriously?” Lucy dropped her hand  and turned, blocking the med student’s way. “That woman in there knows that she no longer needs to accommodate her breasts when hugging friends, carrying groceries, or feeding a child. Her scars and the sympathetic look in her husband’s eyes will only cement those facts. Some of us know what it’s like to lose their entire world in an afternoon. In this rotation, I decide your future. Do you need a lesson in loss?”

For probably the first time in his life, the medical student standing there was without experience or answers. Lucy took a deep breath and softened her voice. “Here’s the thing, Blake. Breast reconstruction is all about remembering three things. Number one, nobody wants a belly that sticks out farther than their breasts. Two, women don’t entirely equate breasts with sex but they know men do. And three, given the choice between having a man or having breasts, in most cases the man might not make out so well in that competition. Women reconstruct for themselves.

She stared at the medical student until he dropped his eyes. “Wow,” he said.

Lucy closed her eyes and said, “Yeah, Dr. Phil. Wow. Now, go do your write-up.”

Back at the nurse’s station, Melissa pulled her head up from her notes.

“Did you set him straight?”

Lucy shook her head, “For one glorious minute maybe, but not for life.”

“He’ll get better. Most of them do after this rotation.”

“I guess. It’s exhausting work, training a person to be human.”

“Maybe he should try being a human for Halloween. It’d be a stretch. Nobody would be able to guess his costume.”

Melissa offered Lucy a piece of candy from a plastic jack-o’-lantern sitting on the desk and said, “You’re coming, right?”

Lucy looked away. “Yes. Well, maybe. But I have another party I have to make an appearance at.”

“Dr. Peterman. You’re lying and you know it.”

Lucy pursed her lips and tried a feeble, “I’m not. My brother . . .”

“Your brother called and said all was clear for you to go. Look, I know it’s hard, with Richard gone.”

Lucy raised her head at the mention of her husband’s name. Her Richard. He’d been the kind of guy that woman overlooked—not because he was unattractive, but because he was just a brown-haired guy with a kind face. When Lucy described him to people, she’d say, “He’s one part Matt Damon and three parts that plain guy you don’t mind sitting next to on an airplane because you know he’ll help you with your luggage and otherwise leave you alone. The Matt Damon part was on the inside but was the only part Lucy could see. Richard was everything to her. He was the social one. He carried her through parties, dinners, and balls like a Ford pickup hauls a pop-up camper on Memorial Day. He made sure she had no lipstick on her teeth, whispered reminders of spouse’s names in her ear, and carried on a breezy running commentary at any party they attended together. It was the small talk that wore her down. She just couldn’t do it. Didn’t have it in her. Like any good surgeon, she either went right to the center of a person or deflected him with humor. There was no in between. That’s just who she was. “I can get to work,” she said to Melissa. “That’s what I can do. I don’t want to go to a Halloween party. I don’t want to smile like I’m happy, make conversation about the weather, or meet new people.”

Melissa put her hand on Lucy’s shoulder but Lucy pulled away gently.

“Look,” she said, “it’s not your job to take care of me. And my brother’s job is to just shut up.”

Melissa rolled her eyes, “It most certainly is my job to take care of you. We don’t have to be friends. God forbid,” she added dramatically. “But this place pays me to watch over you.”

“Only during office hours.”

Melissa stared unblinking across the nurse’s station.

“All right already. I’ll try to come to the party.”

Triumphant, Melissa saluted Lucy and said, “It’ll be fun. You’ll see. Now, carry on, Doctor. Your minions need a tune-up. I’ll see you tonight.”

The amber light of the fall day morphed to the purple black of late evening as Lucy shrugged on her wool coat. She glanced in the mirror on the back of her office door and touched her hair, trying to smooth the frizz that had escaped her careful blowout. Even with piles of product, her naturally curly hair regained its shrubbery appearance the second a drop of moisture met even one follicle. Opening her carefully folded, empty lunch bag, she filled it with the contents of her lab coat pockets: a handful of packaged needles, several gauze pads, three rolls of tape, two suture kits, and a small 250 cc IV bag.

In the hall, Lucy moved through the less-traveled avenues to the front entrance, avoiding the cafeteria, where workers had hung a banner—The Night of the Seven Deadly Sins—printed in bleeding-red paint. Black and orange balloons and streamers decorated its edges.

Spotting a colleague click-clacking down the hall toward her, Lucy veered into the restroom. As the door closed, the handle caught the lab coat she’d gathered in her arms and yanked it and her lunch bag to the floor.

Rushing to gather the dropped supplies, with footsteps echoing in her ears, she watched a roll of tape bounce behind the toilet bowl. Scrambling to retrieve it, she bumped her head on the ceramic sink just as the sound of the footsteps retreated.

Pressing her hand to her head, her eyes filled with tears. She allowed one fat tear to escape, feeling it slowly traverse from her lower lash to her cheekbone to her chin. Sniffling, she wiped her face with the crumpled white coat still in her arms and stuffed the hospital supplies back into the wrinkled brown paper bag. Then she yanked open the door and headed straight for the exit, counting in her head. Five, four, three, two. Just before the electronic doors opened, she pitched the filled bag into the garbage next to the entrance.

The security guard tipped his hat to her, “Two points, Dr. Peterman.”

Lucy was startled to see law enforcement so close to her, “And the crowd goes wild,” she deadpanned.

Finally, safely ensconced in her car, exhausted after a day of playing a saint, she drove home to turn herself into an original sin.

 

Chapter Two

If You’re Happy and You Know It

A spray of leaves—yellow, brown, and red—swirled on the sidewalk of Med One Hospital and Clinics like a litter of dogs chasing their tails. Lucy pulled her coat closer to her neck and looked at her brother, Charles.

“Don’t make me go in there.”…

 

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