Free So Much for That by Lionel Shriver

surplus pounds and sneaked cigarettes in the staff parking lot. The hypocrisy was reassuring. From doctors, Shep had always sought less authority than forgiveness.
    “I apologize that it’s taken us so long to arrive at a positive diagnosis,” Dr. Knox began, addressing himself to Shep. “Mesothelioma is notoriously difficult to identify, and we had to rule out a host of other more commonplace explanations for your wife’s fever, tenderness, abdominal swelling, and gastric dysmotility.” Shep didn’t know what dysmotility meant, but he didn’t ask, because then the doctor would know that this was one more of his wife’s symptoms that he hadn’t known about, or cared about, or noticed.
    “After all, as I’m sure your wife has told you, peritoneal mesothelioma is very rare,” Dr. Knox continued. “And I won’t mislead you. It’s also very serious. Because the peritoneum is a very fine membrane surrounding the abdominal organs, almost like Saran Wrap, diseased tissue can be tucked into corners that are difficult or impossible to get at surgically.” Shep admired the doctor’s locution, which at least pretended that of course Shep knew what the peritoneum was; Knox was loathto imply that his patient’s husband paid so little heed to his own wife’s grave medical distress that he wouldn’t bother to look up her diagnosis in a dictionary. “And I’m sorry to say that symptoms of mesothelioma don’t generally make themselves felt until the cancer is fairly advanced. Nevertheless, we have a range of therapies at our disposal. New treatments, new approaches, and new drugs are being developed all the time. The survival rate has done nothing but improve.”
    Shep knew all of this from the Internet, but felt it would appear impertinent for him to say so. Besides, it seemed important to allow the oncologist this formal introduction. Shep had already read enough to have registered that most of the nostrums in Knox’s grab bag of tricks were poisons. In the face of being able to do so little, it must have been comforting to the doctor to seem to be useful in this discursive way. His manner methodical but warm—he smiled encouragingly and looked Shep in the eye—Edward Knox had struck Shep from the start as very kind.
    But even when doctors acted kind, the extent of their capacity to be kind was often out of their hands. However gently put, many a message that physicians were forced to deliver was cruel, and if it did not feel cruel it was a lie and thus was even crueler. Personally Shep didn’t understand why anyone would want to be one. Oh, certainly the tasks of stenting an artery and clearing a bathtub drain were technically akin. Yet a doctor was like a handyman who, some appreciable percentage of the time, had to knock on your door and say, I’m sorry, but I cannot clear your drain. That’s all the acting kind was good for: the I’m sorry part. And then he walks away and maybe he waves, leaving you with scummy standing water in your bath. Why would anyone want a job like that.
    “And I do have some good news,” Knox continued. “First, as I assured you last week, Mrs. Knacker, the MRI did not reveal any anomalies in the pleural—in the lungs. Even more critically, I now have the lab report from the laparoscopy. Mesothelioma comes in two flavors, if you will—two types of malignant cells. The epithelioid are less aggressive, the sarcomatoid much more so. In the samples we extracted, only epithelioid cells were detected. That makes the prognosis considerably more optimistic.”
    Glynis gave a schoolgirl nod, as if she had done something right. Shep was about to ask, so what prognosis is that? He opened his mouth and it was dry. He closed it, and swallowed. Instead he said, wanting to be grateful, to play his part, to enter into the spirit of gung ho that was clearly expected here, “Yes. That sounds like very good news.”
    At once, he could not help but reflect that only a week ago “good news”