Page 85 of The Song We Lost

“Stage IV pancreatic adenocarcinoma,” he says.

The words have a finality here that they didn’t have in the kitchen.

“Advanced and aggressive.”

Aggressive.

“As we discussed previously,” he continues, looking at Sadie and Cole, “this type is often asymptomatic until later stages.”

My hands clench in my lap.

“What are her treatment options?” I ask before he can continue.

He looks at me now. Evaluating.

“You’re her sister.”

“Yes.”

He nods.

“With a pregnancy, our options are limited. Aggressive chemotherapy at this stage poses risk to the fetus.”

“What if she wasn’t pregnant?” I ask.

Sadie closes her eyes, but the doctor doesn’t react.

“Even without pregnancy, the prognosis at this stage is poor. Treatment could potentially extend life by a few months. It would not be curative.”

I swallow hard.

“Define a few,” I pressed.

Cole exhales slowly.

“Two to four,” the doctor says evenly. “Possibly six to eight, with a favorable response to treatment.”

I feel like the room tilts again.

“But if she waits until after delivery?” I ask.

The doctor’s expression softens.

“As I discussed with your sister, if she waits until after the baby is born treatment options become even more limited. The current plan is to treat her pain and make her comfortable.”

The words are measured, but no less devastating.

“So there’s nothing?” I ask.

“There is palliative care,” he says. “We need to focus on quality of life. She wants this time to be meaningful.”

Quality of life.

I look at Sadie, expecting tears. But she is not crying. She is rubbing her stomach.

“I want to enjoy my pregnancy,” she says quietly. “I want to meet my daughter. I want her to know my voice.”

Cole’s hands tremble.