Katie grinned. Pepper thumbed the blue stitching on his white lab coat. “Seriously. Peter Pepper, M.D. Doctor Pepper—just like the soft drink they named after me.”
Josh smiled. The guy was good with kids.
Pepper continued, “Katie, we’re going to do some tests today to find out what’s going on with that leg. Your dad and I are going to talk for a few minutes then I’ll be right back. Okay?”
Katie nodded.
“Fingers crossed,” Josh whispered and instantly regretted it. How many times had he whispered the same thing to Sharon? Always whispered, for to voice such things aloud was to invite the notice of arbitrary and capricious forces. It was a fact that hospitals, beacons of scientific and technological progress, resurrected faith in the most primal fears and superstitions. ‘Fingers crossed’ had shown itself to be powerless. “Good luck,” he amended.
Pepper led Josh to a brown-carpeted room where they sat at a small conference table. Josh noticed a book open face-down on a side table. It’s Time To Go: Preparing for the Death of Your Child. Josh scooted his chair closer to the doctor.
“Mr. Gibbs,” Pepper said, “I’m sorry for the circumstances that have brought Katie here but I want you to know that I am optimistic.”
“Good,” Josh answered cautiously. He felt himself relax.
Pepper slipped on a pair of glasses and aged ten years. “When did Katie first start complaining of leg pain?”
“Six week ago. I figured it was just something from soccer.”
Pepper withdrew an x-ray film from a folder and snapped it onto a light box on the wall. “Yes, there it is.” Josh looked but had no idea what he was supposed to see and Pepper didn’t bother to explain. Pepper shoved the x-ray back in the file, fished out another film and slid it on to the box. “See that?” Pepper pointed to just below the knee.
Josh couldn’t control his irritation. “Dr. Pepper, I didn’t see anything when I looked at these in Winston and I don’t see anything now. I am not here for an anatomy lesson. I am here to get some facts about what is wrong with my daughter.”
Pepper raised his hand. “I’m sorry.” His face softened. “I’m not sure what Dr. Wright told you, but that isn’t at issue. My specialty is pediatric oncology. The orthopedic surgeons and I have looked at the x-rays and we agree. Your daughter has osteogenic sarcoma. It’s one of the most common bone cancers among children . . .”
The words fell on Josh like body blows and for a moment everything—the doctor, the room, time—stopped. Presently, he became aware of his thudding heart, his quickened breathing and the boy doctor saying, “ . . . it usually occurs in the long bones, just as it has in Katie’s leg.”
Josh released his death grip on his chair arms. “I’m sorry . . . can you repeat that?”
“I said osteogenic sarcoma in children generally presents in the long bones. Katie’s case is classic.”
“How can you be so sure that’s what she has? Dr. Wright wasn’t sure.”
“Dr. Wright was correct not to speculate before Katie was seen by a specialist. And there is always the chance that a biopsy will tell us our suspicions are in error. Believe me, no one wants to be wrong more than me.”
“I think you most certainly are wrong.” Josh interrupted. He wasn’t going to sit idly by and accept what he was told. He was going to fight, starting with the diagnosis.
“I have looked at a lot of x-rays and CT scans of this disease and I must tell you, I do not expect that outcome.”
“If you’re sure, then why are we doing a biopsy?”
“The primary purpose of the biopsy is to stage the disease—to see how much of the bone is affected and to determine if the cancer has spread to the other tissues.” Pepper spoke slowly and evenly. “The process is called metastasis.”
Josh felt old wounds reopening, the sickness and poison oozing forth. “I’m all too familiar with the term, doctor. Now, tell me—”
“The biopsy results dictate the details of treatment—what kind of chemotherapy and the nature of the surgery.”
“It has to be chemo? Radiation won’t take care of it?”
“We’ll know after we run some tests but typically I’d expect thirteen weeks of chemotherapy, followed by surgery to remove the affected bone and tissue, followed by thirteen more weeks of chemotherapy.”
“That’s half a year.”
“Could be less. Could be more. But that’s a good number to keep in your head. After that, there’ll be rehab, of course.”
“Why ‘of course’?” Josh challenged.
Pepper looked at him like it was something he already ought to know. “For a long time the standard treatment for this disease has been chemotherapy and amputation. Removing the entire extremity offers the best chance of excising all the cancerous tissue. More recently, we’ve developed techniques using bone grafts or artificial implants that allow us to save the leg in those cases where we can safely do so. In either case, Katie will require significant rehabilitation.”
“But she’s a soccer player,” Josh protested, as if that would change things.
“I wouldn’t think of that as a realistic expectation going forward.”
Josh chafed that Pepper said it with such finality, offering no hope, as though this was an everyday setback, not the end of a way of life. “Doctor, you brought me in here and told me you were optimistic about Katie. Now you’re telling me she definitely has cancer, that you may have to cut off her leg, that we’re looking at a half year of chemotherapy—”
“That’s just—”
“A helluva lot of time in the goddam hospital, not to mention rehabilitation.” Josh felt the heat wash through him. “So what in almighty hell are you optimistic about?”
Pepper set his jaw. “Mr. Gibbs, this is a first-class hospital. I have confidence in my training and ability. What I am optimistic about is that the orthopedic surgeons and I can save the life of your daughter. That is the priority here. My plan is to admit Katie this afternoon, have one of the orthopedic guys perform a needle biopsy to confirm the cancer and do a couple of scans. If it has spread, we start treatment right away. Those cancer cells are bad actors and once they start to metastasize, they’re a ticking time bomb. If the rest of the body is clear, within a week or so the surgeon will perform an open biopsy so we’ll know if we have a chance to save the leg. If there’s no chance, he amputates. If there is, she’ll get her first round of chemotherapy. Then, we’ll be fighting this thing.”
Thoughts tumbled into Josh’s brain in no helpful order and spiraled away before he could get hold of them. To think forty-eight hours ago his chief worry had been that Katie might miss camp!
These doctors—so unshakably confident of their diagnoses and their hospital and their training and their abilities—made his blood boil. In the end, all their promises and protocols, their degrees and high-tech gadgetry amounted to nothing more than voodoo witchcraft. Sharon had died. And now this pint-size Dr. Pepper was taking him down the same old path, pushing him. And they weren’t even sure Katie had cancer. Nothing had been proven. “You won’t be doing that,” he said.
Pepper’s expression froze somewhere between agog and