"Acceptance doesn't mean resignation; it means understanding that something is what it is and that there's got to be a way through it."
-Michael J. Fox, about having Parkinson's disease.
Sara sat rigid with tension, her eyes creased in a frown of worry. She and Grissom had been waiting for fifteen minutes, and she just couldn't get comfortable. They had been told that Dr Fournier was running late, and it had unnerved her no end. Why couldn't everything run smoothly? She just wanted the whole meeting to be over and done with so they could know and get on with the next phase of treatment. There was so much uncertainty; so much was at stake.
She stole a glance at her husband who despite his calm exterior shared her inner turmoil. His gaze was vacant, staring in the middle distance as he drummed his fingertips onto the side of his leg in a slow, steady beat. Every so often he would refocus, look around at her and smile, before his eyes would invariably flick over his shoulder at the slowly-ticking clock above their heads and he'd give out a sigh.
Shooting up from her seat, Sara smoothed down her skirt and for the third time walked over to a display board a little further down the corridor. She made a show of scanning her eyes over the leaflets pinned to it, again, but none held her attention for more than a few seconds and soon she found herself clasping her arms around herself and pacing. Hospital noises receded into the background as her mind wandered.
The night before had sadly seen no repeats of the previous evening's antics. Feeling tired after such an active day Betty had left for her hotel straight after dinner. She declined Sara's offer of walking her back but promised to send a text on safe arrival, which she did. As soon as Grissom had closed the door on his mother he'd retreated into himself, foregoing his nightly watching of the eight-o'clock news for an early night. Sara had opened her arms out to him, and he'd wearily fallen into her embrace, right there in the small entrance hall.
Physically, he was spent, weak in her arms. The day had visibly taken its toll on him, but she knew that he was also worried about what tomorrow would bring. He didn't say as much; he didn't need to. When Sara checked on him after finishing clearing up the kitchen he was sitting up in bed, snoring softly, with his glasses far down on his nose and a half-closed book on his lap.
He mumbled a sleepy "Thanks" when she'd removed the book from his slack hand and carefully slipped his glasses off. His smile was dreamy as she helped him down fully under the covers and tucked him in. He turned on his side then, facing her, and letting out a long breath through his nose burrowed his head deep into his pillow. Sara kissed his stubbly cheek and watched him for a moment before she turned out the bedside lamp.
She pottered around the apartment a little, put some quiet music on. The evening had turned cooler, and she closed all the shutters and windows before curling up on the couch and booting up Grissom's laptop, the iPad not being great at opening email attachments. And she knew there was one from Nick – an article from the Las Vegas Sun about Javier Santiago's trial. Once she'd cleared her inbox of all the junk mail, she read Nick's email and the article, did a little online banking, settling a few bills that needed paying, and then wrote Greg a lengthy and long overdue email.
She was thanking Nick for his detailed account of his testimony in Javier Santiago's trial – the man was definitely going down, Sara was pleased and relieved to learn – when a new message popped up in her inbox. She finished writing her email to Nick, sent it and then with a smile of anticipation on her face opened Greg's reply.
"I'm online!" Greg wrote. "You still there?" His excitement made her smile broaden and tears form in her eyes.
"Yes," she quickly typed back and pressed 'send'.
The banter went back and forth for a good half-hour. Greg told her about developments in Vegas while she recounted her day at the Louvre in more detail and how against all odds she was getting along with Grissom's mother. She never felt the tears trickle down her face as she told him how happy they were, how great a time they were having. He wanted to know when she was coming back, and again she cleverly avoided answering. Several times she paused, her fingers poised over the keys, desperate to share her burden and tell him about Grissom's cancer. But she just couldn't find the strength to do it. It was just easier to pretend that everything was honky-dory in the City of Looove, as Greg liked to put it.
She slept badly when she finally did fall asleep, tossing and turning, her mind filled with images of death and Vegas. She woke early, and when she couldn't take anymore of lying there in the dark listening to Grissom breathing she got up, hurriedly searching for her running gear and getting dressed. Grissom slept on unaware. A run to the river and back would hopefully raise her endorphin levels and boost her morale. She grabbed her keys and Hank's lead and whispered loudly for the dog to come. Five thirty was no time for an old dog to wake though, and he took his time about it.
Grissom was already up when they'd returned. He looked preoccupied, but otherwise rested. He'd made a start on breakfast, neither ate much of. Their hospital appointment wasn't until eleven. Betty had come at ten, and they'd left, opting to walk to the hospital despite the overcast weather. Betty would make lunch for them. Sara promised to text with news.
"Sara."
Sara startled, snapping herself back to the present, and looked over at Grissom.
He held out his hand to her. "Come and sit back down. There's no point getting yourself all worked up like this. It's not going to change anything."
She sighed and covered the distance back to him. "I know." Forcing a smile, she took his hand and resumed her seat by his side.
"The way I see it…acceptance is the key to happiness."
She acknowledged his words with a nod. "That's not stopping you from worrying though."
He gave a wry smile. "I'm not worried about me."
French voices could be heard, approaching down the corridor, and Grissom looked up and beyond her shoulder toward the sound. Sara turned, just as Dr Fournier and another doctor she hadn't met before turned a corner toward them. Both wore white lab coats over a shirt and tie. Picking up her purse off the floor Sara shot to her feet while Grissom followed suit more sedately.
"Monsieur et Madame Grissom," Docteur Fournier greeted on reaching them. "I'm sorry I am so late, but I had an emergency downstairs." He opened his hand toward his colleague and smiled. "Madame Grissom, I don't think you've met Docteur Vasseur, our specialist surgeon in upper gastric cancers here at l'Hôpital-Dieu."
Docteur Vasseur gave Sara a smile and nod as he extended his hand. He was a tall and sinewy man, balding on top - late forties or early fifties, if she were to hazard a guess. He oozed charisma and confidence. Deep lines on his tanned face told Sara he liked to spend his spare time outdoors, and as she returned his strong handshake she couldn't help wondering whether his presence today meant good or bad news. Dr Vasseur spoke flawless American English, and it was clear he'd spent time in the States. Later she would learn that his credentials were top-notch, that he had worked for ten years in the Kimmel Cancer Centre in Philadelphia.
Was he there to explain why resecting was impossible, or the opposite? Surely if the news was good, he wouldn't need to be there, would he? She looked over to her husband, wanting to glean some clues as to the answer to that question from him, but his face was expressionless. After exchanging a few meaningless pleasantries, Docteur Fournier opened his office door and indicated that the couple should go in. Sara stepped in first, followed by Grissom, both doctors bringing up the rear.
The office was small and windowless. Shelves of books lined both side walls. A light box had pride of place on the back wall behind the desk covered with stacks and stacks of files and envelopes. On one corner of it, a miniature human body model with brightly-coloured removable body parts stood with its back to them. Docteur Vasseur closed the door and remained standing there while Dr Fournier walked round his desk and sat down. He opened his hand, inviting them to do the same and Grissom and Sara silently moved forward to the two chairs, tensely doing as bid.
"No need to look so worried," Dr Fournier said, offering them a warm smile, "I'm pleased to say the news is good."
Sara's eyes closed at the rush of relief that filled her. "You can operate?" she gasped.
The doctor gave her a confident nod. "Yes, we believe we can." His eyes flicked over to his colleague standing at the door before refocusing on her. "The tumour looks to have diminished enough for us to attempt to resect."
Sara lifted her hand off her lap, reaching for Grissom's and squeezing it tightly. A shaky smile on her lips, she turned toward him. Tears prickled at the back of her eyes, and she blew out a breath. "Gil, that's wonderful."
Grissom met her eyes and nodded. He looked stunned and shell-shocked, as if he just couldn't quite bring himself to believe it. Dr Fournier picked up the top envelope from a stack on the right-hand-side of his desk and slipped out what Sara assumed were Grissom's scan results. Standing up, he turned to the light box behind him and slid two scans onto it before flicking the light switch to the 'on' position.
"Why don't you see for yourselves?" he said, turning around.
Sara sat forward on her seat. Her eyes were glued to the light box as she listened while Dr Fournier pointed his finger at the tumour on each scan. The tumour did look like it had shrunk, but what did she know? She looked over at Grissom who was slipping his glasses off. He was looking cautious; his reaction was guarded, almost understated.
"And the buts?" Grissom asked.
Sara's elation died down. Her gaze became anxious, and she turned back to Doctor Fournier, expectantly waiting for his reply.
"No surgery is risks free," he said, "As you well know. And your operation is particularly difficult. Accessing the pancreas takes skill and precision, but Dr Vasseur is the best." Grissom and Sara both turned toward the doctor who just smiled at them. "In the first instance we would like to try to operate laparoscopically," Dr Fournier went on, and they both refocused, "but of course we would need your…accord – agreement – in case of complications and we need to open you."
Frowning impatiently at his lack of fluency, Dr Fournier looked up at Dr Vasseur and smiled before explaining that his colleague's English was better than his as he had spent so much time working overseas. He went on to list the man's credentials, which Sara had to admit were impressive. "Dr Vasseur will explain the procedure better than I can. Alain?"
Alain Vasseur pushed up from the wall and crossed over to the desk, perching on the edge of it. He didn't waste any time, and Sara liked his no-nonsense approach and honest demeanour. "At the start of the operation, we will make five small incisions – holes – in the abdomen instead of making one large cut as you'd have with open surgery, and a tiny fibre optic camera will be passed through the laparoscope inside the body. We'll take a good look, check the surrounding lymph nodes and only then will we be able to tell categorically whether the cancer has spread to other nearby parts or not."
"Don't the scans show that?" Sara asked.
"Not if the cancer has only just metastised, no. The tumour or tumours would be too small to show up. When surgery fails it is because of microscopical tumour cells left behind, so it's important we get it all out."
"But surely as well as shrinking the existing tumour the preoperative radiochemotherapy stopped cancer cells from spreading," Sara argued, glancing at Grissom for confirmation.
Dr Vasseur smiled, shared a look with Dr Fournier.
"In theory, yes," Grissom replied, and she looked over at him. "Honey, what they're trying to say is that there are no guarantees. That they can't know until they open up." Sara sighed, nodded. Grissom refocused on the doctor. "And if the cancer has spread?"
"We'll have to abort, I'm afraid."
Grissom lowered his eyes and nodded.
"If it hasn't though," Dr Vasseur went on, a little more enthusiastically, "and from your latest scans and blood test results it would appear that it hasn't, we'll proceed with the distal pancreatectomy and splenectomy as we've talked about before – albeit briefly." Grissom nodded, and Dr Vasseur turned to Sara, explaining for her benefit, "That's when we remove only part of the pancreas as well as the spleen. In your husband's case, it's way too compromised already and trying to preserve it would only cause more complications."
"How long will Gil have to be in hospital for?" Sara asked when the words had sunk in.
"If it all goes according to plan," he glanced at Dr Fournier for confirmation, "one week in hospital followed by one month's complete rest at home."
"One week?" Sara repeated with surprise.
The doctor nodded. "Keyhole surgery minimises the risks and discomfort associated with standard open surgery. It also limits post-operative complications and dramatically reduces recovery time. We'll control the surrounding blood vessels and veins and remove an entire section of the gland – the tail most definitely and a portion of the body. How much will depend on what we find on going in. And don't forget we're also taking the spleen out. Then we'll reconnect the intestine and what's left of the pancreas afterwards. It's tricky but I've performed the surgery before."
Sara felt dizzy at the amount of detail they had to take in. And the risks? "How many times?" she asked. "How many times have you done the surgery?"
"A few," Dr Vasseur replied and held her gaze.
Sara was about to ask about success rates when Grissom spoke. "What kind of complications are we talking about here?" he asked.
Dr Vasseur refocused on him. "Even if we take the cancer out of the equation, the deep and central location of the pancreas in the abdomen, coupled with its "wet sponge" texture, make it a unique organ for surgeons to conquer." His eyes kept moving back and forth from Grissom to Sara as he spoke. "It lacks a capsule, or covering, and is thus prone to bleed or leak juices with even a small degree of rough handling. Add to that, more routine post-op complications like internal infection and blood clots."
Grissom sighed, nodded. Sara took his hand again, squeezed it. They'd beaten the odds before; they would do it again.
Dr Vasseur went on speaking, and even as she felt overwhelmed Sara appreciated his openness and candour. "As we plan to only remove a segment of the pancreas, the cut edge will need to be sutured to prevent leakage of pancreatic juices from that area. That is the most common complication which we want to avoid at all costs. Performing a safe and proper anastomosis between the small bowel and the soft pancreas and all the connective blood vessels is hard, and the risk of leakages is great."
"Anastomosis?" Sara queried with puzzlement.
"It's…a type of suture, a connection made between the vessels and part of the intestines."
Sara gave a nod, then blew a breath and ran a hand over her eyes. Overwhelmed didn't even come close to describing how she was feeling.
"It's a lot to take in," Dr Fournier offered, "but the scans show Monsieur Grissom has a very good chance."
"Or I wouldn't even be thinking of attempting the surgery," Dr Vasseur piped up.
Sara opened her mouth to ask how soon they would operate, but Grissom beat her to it. "And do you have a date in mind?" he asked, eyes flicking between the two doctors.
"Yes," Dr Fournier replied. "We've scheduled you in for the tenth of August."
"The day of the storming of the Tuileries Palace," Grissom mused quietly, and Dr Fournier chuckled.
"August?" Sara exclaimed with disbelief. She moved to the edge of her seat and turned toward Grissom. Why wasn't he surprised? Why wasn't he outraged at the delay? "But that's a whole five weeks away! Why wait this long?" She turned back toward the desk. "I mean, Gil's health is good; his weight has stabilised. He's the healthiest he's been since I've got here." Dr Fournier straightened up in his chair and held up a hand, trying but failing to curb her flow of words. "Surely now is the best time to operate, to cut this damn cancer out once and for all and―"
Grissom reached out a hand to her arm. "Sara," he said, sharply enough to stop her rant. "They can't operate sooner."
Sara's face registered a look of deep bewilderment.
"They have to wait," he added his tone softer now.
Looking full of compassion, Dr Fournier nodded his head. "That's right. There is a…how do you say…obligatory―"
"Mandatory," Grissom and Dr Vasseur provided at the same time.
Dr Fournier nodded. "There is a mandatory waiting time before we can perform surgery after irradiation. It is valuable to allow the normal tissues to recover from radiation before we cause more traumas with the surgery."
Sara tried to overcome her disappointment at this unexpected delay – well, for her anyway. She glanced at Grissom who was watching her. His gaze was tender, and he smiled at her. She was too upset to return the smile. "But what if the tumour grows back in that time?" she insisted, turning back to the surgeon.
"We're confident it won't happen," Dr Vasseur stated with assurance, once again holding her gaze unwaveringly.
"So what happens now?" Grissom cut in just as Sara was about to ask the doctor how he could be so sure.
Dr Vasseur turned his attention to Grissom. "You get plenty of rest and keep taking your medication as prescribed, and we'll see you again in three weeks' time for a pre-op check-up and more blood work."
"And stay away from infection," Dr Fournier piped up in good humour.
"That too," Dr Vasseur echoed with a smile.
But Sara wasn't paying attention to the banter. Five weeks, she couldn't help thinking. Five weeks of more uncertainty, doubt and worry. They had five weeks without treatments or visits to the hospital. Five weeks, enough time to pack up and go home, she thought suddenly, schedule an appointment with the best cancer centre in the States and organise the op there.
Both doctors pushed to their feet, bringing the discussion to an end, and nodding Grissom followed their lead. "Sara?" he called quietly.
She looked up and shook her head to clear the fog.
"You okay?"
She gave a wan smile and nodded her head, then forced a brighter smile. They'd been given tremendous news, and whatever issues she had with where he was receiving treatment could wait. "I'm sorry. It's a lot to take in, that's all." Grissom held out his hand and helped her to her feet.
"It is," Dr Fournier said with a smile, "and if you have questions or any worries about anything you have my number. Just call."
"Thank you, Docteur. We will," Grissom said, nodding his head, then his hand moving to the small of her back steered Sara toward the door. He couldn't wait to be out of there. When he shut the office door behind them, Grissom blew out a long breath, almost as though he'd been keeping it in all throughout the meeting. Then he laughed and shook his head, giddy with excitement. He looked past relieved. He looked elated, as if the news had totally exceeded his expectations and given him a new lease of life. "Oh, God, Sara," he enthused. "I can't believe it. I really didn't think—the odds, well, they weren't in our favour."
Sara reached up to him and brushed her hand to the side of his face. She felt so much love for him then, saw so much love staring back at her in that moment, that she had no words. Instead she gave him a wide smile and kissed him on the lips. Voices moving to the door inside Dr Fournier's office made them pull apart.
"Let's go home and tell my mother," Grissom said excitedly, "And I'm taking you both out to lunch to celebrate. I'm starving." He laughed, and taking her hand set off at a brisk pace toward the elevators. "Maybe afterwards, we can take in a boat trip on the Seine," he went on happily. "Better still, why don't we combine the two and have lunch on a bâteau-mouche?"
Sara laughed, said that she was sure Betty would love the idea. Feeling his eyes on her as they waited for the elevator to come she looked over at him. "You got that look, Gil."
He feigned innocence, or ignorance, or both. "What look?"
Sara didn't buy into the pretence, but his childish giddiness made her smile. "What is it?"
His shoulder lifted. "Do you think my mother would mind if we didn't go straight home?"
"Not if we texted her the good news and explained. Why?"
"There's something I want to do first. Something you said the other day, I—it made me think, and…"
Frowning, Sara racked her brain and came up blank. "What is it? What did I say?" she asked, unable to contain her anticipation.
Grissom's only reply was to give her his best impression of a mysterious smile while tapping the side of his nose. "You'll see."
