I hadn’t given enough thought to this. I presumed I’d come here, terrorize June about her idiot scam, scare her a little with the threat of her stupid baby sister spoiling everything, but this is horrible. I’m struck with self-disgust that I didn’t consider the terminal illness part of this whole equation. There’s got to be something wrong with me. June was right. I can’t actually handle any of this.
Dr. Ramirez turns to me. “Are there any questions you’d like to ask me? Or Jayne…” She smiles warmly. It’s a jolt to hear her refer to June as me. “It’s a lot of information to process at once,” she finishes.
I’m dumbfounded by how resigned June seems, how passive. I pull out my phone and hit the voice memo record button. My heart is pounding as I type Jayne as the file name. “I didn’t bring a notebook and I want to make sure I remember…”
I set it on her desk, with the screen up. Dr. Ramirez smiles. “If it’s all right with Jayne.”
June shifts beside me. “It’s fine.”
“Dr. Ramirez, what’s going to happen?” My voice is shaking. I have to sit on my hands to stop pulling on my bottom lip.
“The recommended treatment for uterine cancer is surgery. We’ve recommended a total hysterectomy and bilateral salpingo-oophorectomy.”
“Salpingo’s a weird word, isn’t it?” It’s the first thing June’s said unprompted since we arrived. “Sounds like a Filipino dessert.”
Dr. Ramirez removes her glasses and cleans them with the sleeve of her white coat. Without them her features suddenly recede. She puts them back on and becomes our doctor again.“Totally,” I tell her. I don’t know what else to say. “With ube or durian or something.”
“Totally,” echoes June.
I swallow hard.
“What’s a bilateral salpingo-oophorectomy?”
“It means they’re taking my ovaries,” interjects June. “And my uterus. If you didn’t know what a hysterectomy was.”
“Okay…” My knee’s shaking so bad, I uncross my legs. The surgery plays like a gory movie in my mind. I imagine the wetness of my sister’s organs sliding over each other for a brief second before my focus swings in a wide arc, out of the windows, hurtling away from this room and into outer space.
The black mirror of my phone screen flashes. I’m shocked that it’s been recording for seventeen minutes. I understand what June was talking about. How you can comprehend all the words but that the sentences themselves are inconceivable.
“Jayne,” says Dr. Ramirez, and I look up sharply, glancing away when I remember who Jayne is in this room. “It’s laparoscopic, so it’s minimally invasive.” Her small hands steady a laminated diagram. Pink. Peach. Red. It occurs to me that the female reproductive system looks like the flux capacitor from Back to the Future. There’s no way this drawing has anything to do with either of us. I breathe and count what I see.
One: my sister watching the doctor intently.
Two: my sister’s chest rising and falling.
Three: my sister in her overalls with her size-six sneaker jogging in place.
It is the foot of a child. For sale: baby shoes, never worn.
Dr. Ramirez slices an area on the diagram with her capped pen. “Detaching the uterus…”
I’m pulling my lip so hard my eyes water. There’s a gummy buildup on the corners of my mouth that I scrape with my thumbnail. It’s harrowing. June will be giving birth to her own womb.
Poor June. Poor, poor June.
I wish there were adults present. A mom and dad other than ours.
My older sister is too young for this, but I see the wisdom in her decision not to tell. The only thing that would make this worse is for her to translate to our parents and watch the terror unfold on their faces.
“Wait,” I interrupt. June looks up at me dazed, as if she’d forgotten I was there. “Are you saying that the only treatment is to take everything out? Isn’t that… I don’t know, a little drastic? How bad is it? Do you have to do it now?”
“Uterine cancer in your early twenties is rare. There are options to preserve fertility with hormones, which is what we talked about, but that’s a deferment of surgery, not an alternative. Eventually Jayne will need the hysterectomy and oophorectomy.” Dr. Ramirez keeps referring to her patient by name. It’s jarring each time. Maybe it’s a med school thing. Maybe it’s a bedside manner thing, but it lends a surreal, automated quality to our talk. As if it’s prerecorded.
The thought flits into my mind that my sister is just another appointment among ten or fifteen Dr. Ramirez sees in a day.
“But with specialized care with her multidisciplinary team, Jayne could absolutely deliver a healthy baby before surgery.”
June laughs, a dry mirthless snort. “Thank you, but I’m not about to get knocked up in the immediate future,” says my sister. “I wouldn’t even know what to put on my dating profile to requisition sperm like that.”
“Jayne,” says Dr. Ramirez, this time looking right at me. My blood runs cold. It’s as if she knows. Then she turns to her patient.
“Thank you,” says June. I know this tone. Her mind’s made up. “But you said so yourself. I’m the one making the decisions. It took me forever and a mountain of literal faxes to even get a referral to see you. I’ll pass on risking my life for the next few years on the off chance I’ll get knocked up.” June shakes her head. “I’ve thought about it. Do the surgery. Just take everything.” June’s open palm brushes against her middle as if to scoop it out.
“Also.” June sighs. “Dr. Ramirez, I’m not trying to be difficult, but don’t you think egg freezing is kind of a scam? The actual percentage of live births is, like, maybe eight percent. For thirty grand of drugs and drama?”
“It’s about knowing that you have the choice if you want it,” says Dr. Ramirez.
“They throw your eggs out like on Storage Wars if you accidentally miss a bill.”
To her credit, Dr. Ramirez remains completely composed. She nods. “I see.”
June flips her neon folder open. It’s full of paperwork. Her narrow handwriting is scrawled all over the various bills. “I just want to set a date.”
“We can do that.”
“Terrific.” June riffles through some papers. “And another thing, don’t you think it’s, I don’t know, distasteful to demand the surgery deductible before you’ll cut me open?”
Dr. Ramirez places both hands on her desk. She’s instantly mouselike again. I imagine her tiny feet dangling in her chair behind her desk.
“You’ll have to speak with your insurance carrier and…”
“Well.” June flips through the reams of printouts until she pulls out what she’s looking for. Meanwhile I was convinced my sister wasn’t doing anything all day but watching garbage TV. The morass of logistics spread out in her lap is exactly June’s wheelhouse. Turns out being sick is a full-time job. “They told me to take it up with you. It’s based on hospital policy. I just talked to them”—June confirms it with her notes—“yesterday.”