The Art of Starting Over

Chapter 21 - White and Black

He has a round, youthful face with kind features and wears square, rimmed glasses. He looks like he must be in his late forties, tall and slim and has salt-and-pepper hair that looks rather unkempt.

"Emily Buġeja?" he asks as he takes his seat in front of us. His voice is deep and velvety and seems to contain all the tranquillity and thoughtfulness in the world. I suppose being around death so much does that to you.

"Yes," Millie confirms as she looks at him anxiously through her big bright eyes, hands wringing in her lap.

"I'm Dr Debattista," he says putting forward a hand for her to shake. "I believe you work with Dr Borġ?" Dr Borġ is the rehab doctor who ordered Millie's tests and referred her. Millie smiles and nods in answer to his question.

"It's a pleasure to meet you," he says in a friendly tone. Then, he heaves a long breath and starts. "I had a look at the blood results and ultrasound report. I am afraid I must confirm what you've already been told. The report states that there is a mass in the uterus which, at first glance, appears to be malignant or cancerous."

He draws in another slow breath and looks attentively at Millie. I automatically reach over and find her hand without taking my eyes off Dr Debattista's face.

"However, from the information that we have so far we cannot tell what type of cancer it is, how aggressive it is or how far it has spread, if at all. The ovaries and surrounding organs seem to be fine but as I said, the tests done so far are not enough to know for certain. Dr Borġ told me that you have been experiencing a pressure sensation in your abdomen and you've also had occasional vaginal spotting for the past six weeks. Is that right?"

Six weeks?

I look questioningly at my grandmother. She affirms this with a quiet nod.

Six weeks?

"Are those the only symptoms you are experiencing? Any unusual discharge, pain on urination, or severe pelvic pains, perhaps?" he asks clicking his pen.

Millie shakes her head. I want to ask him if this is a good sign but I purse my lips tightly, too scared to interrupt.

"Okay," he says scribbling something in his notes. "Now, I know Dr Borġ has already taken your medical history however, I will need to ask you some questions as well so that we can establish a way forward. Some, probably most, of these questions may be the same."

I notice how gentle his eyes are. I can see the pain and consideration in them. I wonder how many other patients he will see today and how many times he will be the bearer of bad news. I listen quietly as they go through the usual questions, my hand still firmly wrapped around Nanna's.

Age?

Sixty-two.

Past and current medical problems?

None.

Family history?

Mother and father both died of heart problems, sister died of pneumonia, brother committed suicide, daughter died of breast cancer.

Drug history?

The occasional paracetamol for headaches. That's it.

Does she smoke? Does she drink?

No. No, she doesn't. She is perfectly healthy.

The cause might be genetic, he says, because she's not obese, she doesn't have metabolic syndrome, whatever that is, her insulin levels are fine, menstruation and menopause were unremarkable... On and on it goes.

I try to stop my right foot from twitching nervously because it's making the chair squeak loudly.

He weighs her, checks her height, blood pressure, pulse and blood sugar levels. He listens to her heart and chest and then scribbles an endless note in his file. Finally, he sets down his pen and removes his glasses.

"Okay," he says. "Well, the first step is to determine what we're dealing with. Now, in order to do that, we would need to take a sample from the tumour itself and look at it under a microscope. We can do that through a hysteroscopy, which means that we have to insert a thin tube with a camera at the end of it through the cervix and into the uterus so that we can have a good look inside. Then, while we're there, we scrape some cells off the tumour and send them to the laboratory. We also need a CT scan of your chest, pelvis and abdomen so that if the cancer has spread we would know immediately."

He looks at both of us as he explains, turning his head from one to the other. I feel overwhelmed by all the information he is giving us and still, somehow, I have more questions than when we walked into the room.

How likely is it that the cancer has spread? How big is the tumour? What will we do after all these tests? What are the possible results? Will she need chemo or radiotherapy or both? Will she need surgery? What is the prognosis? Will she make it? Will my Millie live?

I look over at her and she looks just as bewildered as I feel. But unlike me, she finds the courage to speak.

"Okay," she starts slowly. "May I ask, Dr Debattista, will the hysteroscopy be painful? Will I need to be put to sleep?"

"In most cases, a sedative is enough," Dr Debattista answers slowly. "You will be given painkillers during and after the procedure so that we keep you as comfortable as possible. Once the effect of the sedative has worn off, you can go home."

Millie nods slowly, processing, then opens her mouth again. "And what will be the next step after these procedures? I know it must depend on the results but what should I be expecting at this stage?"

I stare at her. The pragmatic way she is approaching this, all of it, is baffling. She looks so calm, so determined. Unexpected tears blur my vision. I am not sure if they are tears of sadness or fear or pride but I squeeze her hand tighter and she squeezes it back.

"It does depend heavily on the results," Dr Debattista agrees, "but most probably you will need to have a hysterectomy. We have to get that tumour out of you and that means removing the uterus. Whether or not we remove any other organs, such as the ovaries, tubes, cervix or any other surrounding tissue will depend on the type and grade of the cancer. We can consider radiotherapy or chemotherapy afterwards as well but again, that decision will depend on the histology results. If the cancer is still contained, it will improve the prognosis drastically. Like I said, from the ultrasound report it seems that there is a good chance that this is the case. But we cannot be certain until we do these tests. Do you have a gynaecologist?"

"Yes, I have an appointment with Ms Marjorie Atkins next week," Millie replies.

Dr Debattista nods in approval, still looking at her carefully.

"When can she have the hysteroscopy and the scan?"

My voice comes out a bit gravelly, but at least I managed to keep it steady. Now that we seem to have a plan I just want to get this over and done with as quickly as possible.

I get the feeling that this is a race against time, a feeling I know all too well. It was the same when my mother started her treatment. A long sprint with the hope of returning to our usual routine once we cross the finish line.

"I can organise everything for next week if you agree," he adds in Millie's direction.

Millie swallows visibly. "Yes, of course. Thank you, doctor."