Listening half-heartedly, Charles examined Dr. Stephen Keitzman, who had assumed that typical condescending air of the physician in charge, doling out bits and pieces of information as if he were lecturing. Obviously Keitzman had experienced this scene many times before and his stock phrases like “I’m sorry to say” had an overused, insincere ring. Charles had the uncomfortable feeling that the man was enjoying himself, not in the same manner he’d enjoy a movie or a good meal, but in a more subtle, self-satisfied way: he was the center of attention in a crisis. This attitude abraded Charles’s already frayed emotions, especially since he was more than familiar with the general material Dr. Keitzman was covering. Charles forced himself to remain silent while his mind’s eye conjured up kaleidoscopic images of Michelle as she grew up.

“In order to allay the inevitable sense of guilt,” continued Keitzman as he bared his upper teeth in one of his nervous grimaces, “I want to emphasize that the cause and date of onset of leukemia like Michelle’s is unknown. Parents should not try to blame specific events for initiating the disease. The goal will be to treat the condition and bring about a remission. I’m pleased to be able to report that we have very favorable results with acute myeloblastic leukemia; something we didn’t have ten years ago. Now we are able to engineer a remission in about eighty percent of cases.”

“That’s wonderful,” said Charles, speaking for the first time. “But unlike the five-year cures you’ve been achieving with other forms of leukemia, can you tell us how long the remission lasts in Michelle’s form of the disease.” It was as if Charles had to goad Keitzman into revealing the worst news at once.

Keitzman pushed back his glasses and cleared his throat. “Dr. Martel, I am aware you know more about your daughter’s disease than other parents I deal with. But since your field is not specifically childhood leukemia, I don’t have any idea what you know and what you don’t know. Therefore, I felt it best to have this discussion as if you knew nothing. And even if you are already familiar with these facts, perhaps they are helpful to Mrs. Martel.”

“Why don’t you answer my question?” said Charles.

“I think it is a more fruitful approach if we concentrate on obtaining a remission,” said Dr. Keitzman. His nervous tic became more frequent. “My experience has shown that with the advances in chemotherapy, leukemia should be approached on a day-to-day basis. We have seen some spectacular remissions.”

“Except in Michelle’s type,” snarled Charles. “Come on, tell us what the probability is of a five-year survival with acute myeloblastic leukemia.”

Dr. Keitzman looked away from Charles’s challenging eyes to Cathryn’s frightened face. She had paused in her notetaking, gaping at Dr. Keitzman. He knew the meeting was going badly. He glanced at Dr. Wiley for support, but Dr. Wiley had his head down, watching his thumbnail play against his other fingers. Trying to avoid Charles’s stare, Keitzman said in a low voice, “The five-year survival is not impressive in acute myeloblastic leukemia, but it’s not impossible.”

“Now you’re getting closer to the truth,” said Charles, jumping to his feet and leaning over Dr. Keitzman’s desk. “But to be more exact, the median survival of acute myeloblastic leukemia if a remission is obtained is only one to two years. And, in Michelle’s case, with circulating leukemic cells, her chances of a remission are a lot less than eighty percent. Wouldn’t you agree, Dr. Keitzman?”

Taking his glasses off, Dr. Keitzman tried to think of how best to word his response. “There’s some truth in what you say, but it is not a constructive way to view the disease. There are lots of variables.”

Charles abruptly walked to the window, watching the dirty snow flutter past. “Why don’t you tell Mrs. Martel what the survival time of the nonresponder is… the patients who don’t have a remission.”

“I’m not sure what good this…” began Dr. Keitzman.

Charles whirled around. “What good? You dare to ask? I’ll tell you what good it is. The worst thing about disease is the uncertainty. Humans are capable of adapting to anything as long as they know. It’s the hopeless floundering that drives people crazy.”

Charles stormed back to Dr. Keitzman’s desk as he spoke. Eyeing Cathryn’s pad, he grabbed it and threw it into the wastebasket. “We don’t need notes on this gathering! It’s not a goddamn lecture. Besides, I know all too well about leukemia.” Turning back to Dr. Keitzman, Charles’s face was flushed. “Come on, Keitzman, tell us about the survival time of nonresponders.”

Keitzman moved back in his chair, his hands gripping the edge of the desk as if he were prepared for flight. “It’s not good,” he said finally.

“That’s not good enough,” snapped Charles. “Be more specific.”

“All right!” said Dr. Keitzman. “Weeks, months at the most.”

Charles didn’t answer. Having successfully backed Dr. Keitzman into a corner, he was suddenly adrift. Slowly he sank back down into his chair.

Keitzman’s face recovered from a series of sustained twitches as he exchanged sympathetic glances with Dr. Wiley. Turning to Cathryn, he resumed his recommendations. “Now, as I was saying. It is best to try to think of leukemia as a nonfatal disease and to take each day as it comes.”

“That’s like telling a man on death row not to think about death,” mumbled Charles.

“Dr. Martel,” said Dr. Keitzman sharply, “as a physician I would expect your response to the crisis to be significantly different.”

“It’s easy to respond differently,” said Charles, “when it’s not a member of your own family. Unfortunately I’ve been through this before.”

“I think we should discuss therapy,” offered Dr. Wiley, speaking for the first time.

“I agree,” said Dr. Keitzman. “We must start treatment as soon as possible. In fact, I’d like to start today, immediately after all the baseline studies are done. But of course, we are going to need consent to treat because of the nature of the drugs.”

“With the chance of a remission so slight, are you sure it’s worth subjecting Michelle to the side effects?” Charles was speaking more calmly now, but he had a terrible vision of Elizabeth during those last months, the violent nausea, the loss of hair… He closed his eyes.

“Yes, I do,” said Dr. Keitzman firmly. “I think it is well established that we have made significant advances in treating childhood leukemia.”

“That’s absolutely true,” confirmed Dr. Wiley.

“There have been advances,” agreed Charles, “but unfortunately in types of leukemia other than Michelle’s.”

Cathryn’s eyes darted from Charles, to Keitzman, to Wiley. She expected and wanted unanimity on which she could build her hope. Instead she could feel nothing but dissension and animosity.

“Well,” said Dr. Keitzman, “I believe in aggressively treating all cases, whatever the chances are for remission. Every patient deserves a chance at life, whatever the cost. Every day, every month, is precious.”

“Even if the patient would rather end her suffering,” said Charles, recalling Elizabeth’s last days. “When the chances of a remission—let alone a cure—are less than twenty percent, I don’t know if it’s worth subjecting a child to the additional pain.”

Dr. Keitzman stood up abruptly, pushing back his chair. “We obviously view the value of life very differently. I believe chemotherapy to be a truly remarkable weapon against cancer. But you are entitled to your opinion. However, it seems evident that you would prefer to find another oncologist or handle your daughter’s therapy yourself. Good luck!”

“No!” said Cathryn, leaping to her feet, terrified at the prospect of being abandoned by Dr. Keitzman, who Dr. Wiley had said was the best. “Dr. Keitzman, we need you. Michelle needs you.”

“I don’t think your husband shares your view, Mrs. Martel,” said Dr. Keitzman.