Just What the Doctor Ordered

She was a delightful girl, and Cathy, much to her relief, liked her on sight. So, more importantly, did Stephen, and as he was also settling in well at his new school it was with a light heart and in a thoroughly optimistic frame of mind that Cathy set off for work the following Monday morning.

Considering that they were living on top of each other, Max had maintained a remarkably low profile during the previous week; apart from a visit from Stan the gardener, to tell her that she and Stephen could feel free to use the area of garden beyond the stables, and Agnes the housekeeper popping in to ask if there was anything she could do, they had had no contact with their landlord, and Cathy was beginning to think that renting his flat wouldn’t be so bad as she had first feared.

Working with him, however, would be a totally different kettle of fish, she was certain. Still, she was on firm ground there, and not even he could shake her confidence in her ability as a doctor.

Her first patient, however, was less enthusiastic.

A well-dressed, athletic-looking man in his early thirties, he walked into the room, took one look at her and stopped in his tracks.

‘Oh.’

She glanced down at the notes. ‘Mr Carver? Do come in. I’m Dr Harris. Take a seat.’

He hesitated, and then with a resigned sigh he lowered himself into the chair she had positioned beside the desk, and gave her a wary smile.

‘I wasn’t expecting a woman,’ he offered.

She grinned. That’s equality for you. For years women have expected their doctors to be men. For some reason men find it uncomfortable when the boot’s on the other foot, but don’t worry, the most important thing is that I’m a doctor. Now, what can I do for you?’

He paused for a second, then took a deep breath and met her eyes. He was quite clearly worried. He had been fitted in as an emergency, and her list being the lightest on her first morning, he had been sent to her.

‘What’s wrong, Mr Carver?’ she prompted gently.

He dropped his eyes to his hands. ‘I think I might have testicular cancer.’

So that was it. She set down her pen and leant back in her chair. ‘What makes you think that?’

He let his breath out on a sigh. ‘I saw the nurse a few months ago—she runs a well-person clinic. She gave me a leaflet on self-examination, and I’ve been doing it regularly ever since. My brother thought I was crazy, but it’s so simple—I just do it in the shower while I’m washing. Anyway yesterday I noticed a slight tenderness, and I think I can feel a sort of bump—nothing much, but I thought it would be a good idea to have it checked.’ He twisted his wedding-ring distractedly. ‘I haven’t told my wife. We haven’t got any children yet although just recently we’ve been leaving it to chance, but if I have got—I mean, the treatment—there won’t be any children, will there?’

She smiled. ‘I think you’re jumping the gun here, but let’s assume I find a lump that looks suspicious. The first step then is to refer you to a specialist at the hospital. They’ll examine you and do an ultrasound to make sure that it’s not just a cyst or a hydrocele, and if they’re satisfied that it’s a tumour they’ll remove only the affected testicle. Now, if you’ve been checking yourself regularly as you say, then this will have been caught in the very early stages, and the likelihood of it having spread is very small, but speed is the important thing.’

He didn’t look reassured. ‘And the prognosis?’

The success rate for this type of cancer now is between ninety and ninety-eight per cent, depending on the speed with which it’s picked up and the type of cancer. And it still has to be proved to be cancer. It could be orchitis, or an inflammation of the membrane around the testicle—almost anything. The lump may not even exist except in your fears.’

‘Oh, it exists,’ he said hollowly. ‘I checked yesterday because it started hurting on Friday. I played squash, and I thought I’d strained it or something, but it got worse over the weekend.’

‘I think I should have a look before we go any further. Just slip your things off and lie down on the couch. I’ll be with you in a minute.’

She drew the screens round him and wrote down his symptoms in the notes, then, pulling on a pair of gloves, she went behind the screen and examined him.

Her examination finished, she stripped off her gloves and left him to dress.

He emerged while she was writing up his notes and perched stiffly on the edge of the chair, his hands fisted on his knees, clearly tense.

‘Well?’ he asked after a moment.

She set down the pen. ‘You’ve got a lump, I’ll give you that. It’s very small, but it’s there.’

He looked searchingly at her. ‘And?’ he prompted.

‘I’m going to refer you to a specialist. I’ll phone him, and you should get an appointment within a matter of days. If you don’t, ring me. And don’t worry. If it is cancer, you’ve detected it very early. The operation should be very straightforward.’

‘And afterwards?’

‘After the operation, depending on the type of tumour and the existence of any secondaries, you’ll either be given chemotherapy, which has made great strides, or radiotherapy, or a combination of both. As far as fertility is concerned it will affect the other testicle temporarily. After about two years, however, it will probably have recovered enough for you to father children. However, for insurance against the unlikely event of permanent sterility in the other testicle, you will probably be advised to store semen in a sperm bank.’

‘Before the operation?’

She nodded.

‘But won’t it be affected? I mean, isn’t there a danger it will give the baby cancer?’

She shook her head firmly. ‘No, absolutely not. Hundreds of men have been treated in this way now, and many of them have successfully fathered perfectly normal children both before and after the operation.’

He was still silent, watchful. An intelligent man, he wanted the answers to all the questions. He met her eyes candidly.

‘What if they have to remove both testicles?’ he asked quietly. ‘I mean, it’s castration, isn’t it?’

‘It’s highly unlikely that they’d need to remove both,’ she assured him. ‘Removal of one makes absolutely no difference to your potency, so you needn’t fear that you would lose any of your masculine characteristics. Your voice, body hair and so on will remain completely unaffected. Once you’ve healed after the operation, you life will proceed exactly as before. That’s on the medical side. On the cosmetic side, if you wish they can give you a silicon implant to replace the missing testicle. No one would ever know the difference.’

He nodded and stood up, framing a polite social smile. ‘Thank you, Dr Harris,’ he said calmly. As he turned away, she saw the fear still lurking behind his eyes. Cathy took the bull by the horns.

‘Mr Carver, you still don’t know if you have cancer. If you have, it’s in the very early stages. Your chances are excellent.’

He paused at the door. ‘Will I be treated any quicker if I go privately?’

‘I very much doubt it. I think you’ll find you see someone in a day or two. Why? Have you got private health insurance?’

He shook his head. ‘We haven’t got round to it. I’ve got life insurance, though, although I must say I never thought I’d need it.’

She gave him a wry smile. ‘I think it’s extremely unlikely that you will need it, at least for a good many years.’

He answered with a grim smile of his own. ‘Let’s hope you’re right. And thank you for your help.’

‘You’re welcome.’

He left her, and for the next couple of hours she was swept along by the tide of patients that followed.

It took her longer than usual to deal with them because she had to get used to a new computer system, but finally she reached the bottom of the heap of notes, and with a sigh she went out into the kitchen at the back, from where a delicious smell of coffee was drifting.

Max was sprawled at the table, one foot across the other knee, a cup of coffee propped on his belt buckle.

‘Well, well—you’ve finally finished your surgery.’

She flushed under the implied criticism. ‘I’m sorry I took so long, but the computer doesn’t seem to like me.’

John Glover came in behind her and chuckled. ‘Join the club. It has me for breakfast every day. The only person it seems to like is Max, and he can get it to turn circles on the ceiling. Oh, and Andrea, of course—the practice manager. But then she could charm the birds out of the trees.’