Cancer, So Far
2018 BLR Nonfiction Prize Winner
Last summer, the moths clung to the shingles of our house. They fluttered right past us, mottled wings snapping, through our open door. They settled on our ceilings and lampshades. They lay in wait in the flour like snipers in the snowy European fields during the Great War. They nestled in the timothy that we fed to the guinea pig. When we opened the bag, the moths flew out, thick and yearning as a V of geese on a blue fall sky.
I had cancer then, but I did not know that yet. I was more obsessed with the moths than with the faint, pink bleeding I assumed was menopause or a last, sputtering period. When the moths flew by, I caught them with my palm. They were sticky and dusty at once. I had to wash off the wings from my fingers.
The gynecologist waves the pathology report in the air and says that it is what we hoped it would not be, a syntactical twist I have to unwind slowly. Yet, he adds, if he were going to have a kind of cancer, this low-stage endometrial cancer would be the one he would choose. I am not yet used to the weird things people say to you when you have cancer.
A second pathology is done after the hysterectomy and it turns out that I do not have endometrial cancer. I have mesonephric adenocarcinoma, a cervical cancer so rare that there are fewer than one hundred documented cases. It is often misdiagnosed initially because of its rarity and its similarity in appearance to endometrial cancer. I look up images of both, like I would know the difference and not make the same mistake.
The doctors discuss with me and my wife what to do next with this incredibly rare cancer. Some margins of the tumor are poor, the word poor in this case meaning impoverished, too thin and therefore permeable. The tumor was spongy and sloppy as it grew from my cervix, up my uterus and through my fallopian tube into my ovary, like some omnivorous being. Everyone is encouraged, though, by the twenty-seven pelvic lymph nodes, all of which are negative. It feels like a middle-school report card. The fact of the clean lymph nodes is excellent. The tumor is careless, sometimes. The margins are poor. The fact it has not spread is good. My health besides having cancer is excellent. It is expected that the treatments will go very well.
The oncology fellow reviews the consents for radiation and chemotherapy. The dose of chemo will be very small—I won’t even lose my hair! The fellow is kind and thorough, listing all the horrific side effects, but assuring me that most of them are rare. There are two boxes at the bottom: “curative” and “palliative.” With great ceremony, he checks “curative,” like he is signing The Declaration of We’re Going to Beat This.
In a windowless room with a CT scanner, I lie still on the cold table as my radiation oncologist plots my first tattoos. I’ve never understood why people riddle their skin with butterflies or skulls or friends that R.I.P. I always look at them and think, “They probably regret that tattoo now.” I am not a woman with pinwheel flowers tattooed to her shoulders or yin- yang signs on the curve of her ankle. I now have four tattoos, small dots, which the therapists will use as guides for radiation therapy. My wife tells our two school-aged kids that they are tattoos of the earth from very far away.
The one thing that I feel absolutely sure about is the power of words. I have devoted my life to that idea and I know that words won’t fail me now. But still, when a friend doesn’t at first acknowledge that she already knows I have cancer and then reveals she has received misinformation that my situation is imminently dire, I am wordless, imagining what she imagines, me gone from the world.
“I’m going to be fine,” I say, though I know I sound too confident. As I walk across the muddy field to pick up my children after school, I imagine my erasure from the scene. It is confounding—the idea of not being there for my children, of not walking through the world, not having words. It’s astonishing.
The PET scan is supposed to be the last formality before treatment begins. I love the very idea of a PET scan, that the places that light up are the places where there is the most metabolic activity, the most life—the head and the heart, with their surges and failures. But the glow on my PET scan is not a surge of life. The faint flare along my stomach tissue is only about a centimeter, but it makes all the difference. Even before I hang up the phone with the doctor, I understand that everything has changed. The cancer has metastasized.
I will never use my tattoos now. Instead, I will need chemotherapy for months, plus additional surgery. Another doctor gets out new consents for the chemotherapy treatments. The two boxes glare out at me again: “curative” and “palliative.” I remember the sweeping celebratory hand checking “curative.” Now it’s a solemn hand that checks “palliative.”
The doctors remove the omentum, the apron of tissue where the cancer has spread. It is the third surgery I have undergone in as many months. These feel almost like trials in a mythic tale, as if I am trying to beat some god down or prove my worth. I plan what I want to say to the surgeon. “While you’re in there, take a scalpel and drive it right through my heart if I’m just going to have cancer from now on. Kill me now,” I will say. When he comes into the pre-op room, still in his street clothes with a smile on his face, I am absurdly glad to see him. I forget to tell him to kill me.
My wife and I meet with the fellow and the oncologist every Monday, after the lab work and before the chemo. These are uneventful meetings about which I should feel more grateful than I do. The doctors remain ecstatic about my blood counts, which have been fine, despite chemotherapy and a germy winter. There have been no complications, and we are all glad of this. Still, these conversations seem veiled and tentatively sketched, like early drafts of drawings. The original sketch will fade to pentimento, covered over by some furious, windowless impasto or some painterly, final line, like horizon. I know that it is likely—almost certain—that my metastasized cancer will return, that these conversations will darken over time.
Terrible things keep happening in the world. People haven’t stopped killing each other because I am sick with stage IV cancer. Terrorists continue attacking. Refugees keep streaming across borders. Wars soldier on. Planes fly too close to each other over international waters. Politicians obstruct justice and interfere with liberties. I need to get up, but I am tired. My son climbs in bed with me to watch TV. He rubs my bald head, the way I did to him when he was a baby. “Soft,” he says.
At chemotherapy most of us sit in recliner chairs. But there are beds for the truly sick. I wonder when and if I will ever be one of them. I wish them well and hope they are not suffering too much. During my treatment I watch The Americans, a show about Russian spies who live in the DC suburbs in the 1980s. I watch the spies kill people and steal vials for germ warfare and plans for nuclear weapons in order get ahead of their enemy country. I realize I don’t sympathize with the people in the beds as much as I should. I feel like am competing with them. I am so glad I am doing better than they are.
My wife and I spend more time alone together than we have in years. I tell her I am sorry about this, for what we had imagined about raising our children and growing old together. She says none of this is my fault. We have some version of this conversation every day, though each of us knows it makes no sense. We recognize that these words are just cover for the wordless scream searing through each of us as we consider what it means to lose a life—or lose a love; about what it means to have an absence—or be an absence.
I am trying to make the time pass during treatment, but even the idea of making time pass seems careless, ironic. I do not want any time to pass without purpose, if there is less time for me. I am spinning in my sorrow and my wife is keeping it together for both of us. We hope that someday it will be different, but then again, the difference might be that I am dead.
Hope is a thing with feathers, said Emily Dickinson. You don’t have to deny reality to have hope, say the experts. I struggle with this. What I am hoping for is an ordinary day twenty years from now. My wife and I will wake up in the morning, start the coffee, walk the dog. The kids will be grown and off into their lives. Hope beats in me in a terrifying way, like the ringing of a hammer. I am afraid it will crush me with its intangible sense of better or lucky.
Six rounds of chemo and I am finally done. The PET scan is clean. The oncologist is happy. For a moment, I can think I am saying good-bye to my cancer. But now, the doctors tell me, I am under surveillance. I thought it was called remission, a word that seems to push everything—even the doctors themselves—into the distance. But surveillance? Every cell in my body is now a subject of suspicion, a potential killer.
It is summer now. We are at the pool with the kids. Someone tells me about her friend who had cancer. When I ask how she did, the response is, “She passed.” Then, she tells me how she spoke to her friend a day or two before, and she just knew. She could hear it in her voice. Part of me just wants to say, Are you kidding me? Why do you find it appropriate to tell me a cancer death story? The other part of me wants to ask, What was the ‘it’ you heard. How did it sound?
There are new electronic road signs in the Boston area. Amber lights tell you exactly how many long it will take to arrive at your destination. Exit 93 Somerville: 7 miles, 9 minutes. Exit 128 Burlington: 4 miles, 8 minutes. Apps on our phones tell us exactly where the potholes and the cops will be. I wonder where the mystery went, the not knowing. It was not so long ago that we just got in our cars and headed out. We arrived whenever the traffic and the weather and the road construction allowed us to arrive. We somehow managed to get there without endless data and predictions coming at us. We arrived when we arrived.
I hate these signs, these apps. I hate the cruel precision of the specified arrival times. Why can’t we just go? Why can’t I just head out?
The last thing I want to know right now is how long it will take.