The first visit to an oncologist’s office is a humbling experience, particularly, if, like mine, the reception room is large enough to accommodate three doctors as well as a number of nurses and technicians administering chemotherapy in the side rooms. The room is full, every seat is taken, as I look around with the sobering knowledge that the one thing we all have in common is cancer. But that, I almost immediately realize, is a false assumption, for a surprising number of patients come accompanied by spouses (one of whom offers me his seat, a gesture which would a short while before have offended me, but I now accept with gratitude) or more frequently a child supporting an aged parent, a disproportionate number of the latter Chinese. The temptation is to measure myself against all the others. I come off well, I think, particularly compared to what is obviously the worst case: an ancient shriveled Cantonese peasant woman who seems in the process of devouring herself, like one of those dragons on medieval manuscripts swallowing their own tail. She is little more than a wisp of desiccated, wrinkled flesh and brittle bones, but still clinging tenaciously to that paltry remnant of herself. More touching because of her youth is a woman in her thirties wearing a black knitted cap to hide her baldness, though nothing can altogether disguise her waxy, jaundiced complexion, which is far more revealing than any loss of hair. While no one, I am sure, outside that room, would have any cause to suspect I also suffer from cancer. I am already reacting, I realize, as if cancer were something shameful to be hidden from the world’s gaze.
When I meet my oncologist for the first time his youth fairly assaults me as he ushers me into his room. He looks like a college freshman who has just begun to shave a week before, yet he has to be in his mid-thirties. Part of this impression of extreme youth must be due to the enthusiasm he can scarcely contain as he studies my biopsy report. He is like a teenager with a new toy he wants to share with everyone he meets. He is so in love with his specialty there will apparently never be enough patients to satisfy his inexhaustible curiosity. Nor does the knowledge that the specialty he so dotes on is cancer in its multifarious forms in any way diminish his appeal. In fact, it reassures me.
He is perhaps five-foot ten, fine-boned and fine-featured, with a pink-cheeked, creamy complexion that any woman might envy. So neatly and compactly is he put together, every time I see him, and I will see him often, he looks as if he has just stepped out of a shower ten minutes before. I try to imagine those neat, immaculate hands working in some garden, coming in contact with mud and roots and worms, but I cannot; anymore than I can imagine his shirt spotted with some derelict leftover from his lunch, or his trouser crease sagging at the knee. He seems made of some finer material than the rest of us. Yet before I leave after this first meeting I know he is married, has a daughter and twin sons, the last two just beginning to walk. It seems impossible to explain how he has found the time to achieve all of this, beyond his education and internship, as well as considerable travel on the side, and still manages to look twenty, but an imminently competent twenty.
After shaking my hand he sits down behind his desk, measuring my face as if he is about to paint my portrait before he speaks.
“There’s good news and there’s bad news,” are his first words, spoken with the confident smile of a star student reading a paper to his class. “The good news is you have the slow-growing variety, which is fairly easy to treat. So forget Jacqueline Kennedy. Think Paul Tsongas instead. The bad news is that it tends to recur.”
I notice that he, too, now that the lady is dead, has dropped the superfluous Onassis. More to the point, I think how wise he is to know that she is just the person I have been thinking almost obsessively about for days. I also remember Paul Tsongas, while running for President, dismissing his cancer as unimportant. Not in any way an obstacle to his future performance of presidential duties. Nor do I bother to remind the doctor that Paul Tsongas is every bit as dead as Jacqueline Kennedy, though, granted, he took considerably longer to reach that inanimate state than the former First Lady; and that in the long run is what it is all about, cancer treatment–buying time. Though neither as rich nor as famous, Senator Tsongas bought considerably more time than the late Mrs. Kennedy. So I am quite happy to use him as my role model. If he lived fifteen years after the first diagnosis, that will get me to 88–an age I have never, anyway, expected to reach under the best of circumstances and one I’m not quite sure I want to reach, if the aging process continues to accelerate as fast as it has in the last year. I have two minimum requirements to make old age bearable: physical mobility and a certain degree of mental agility. I am quite willing to accept that words and names do not always come when they are needed, particularly under the stress of conversation, as long as you still remember the identity of the person you can’t name and that the forgotten word does exist and its meaning is well understood, for the name or the word will eventually come–hours later when least expected. And no longer needed. Once these two requirements fail me, I will look forward to the grave as a blessing. Nor am I averse to helping myself along the way with a slight nudge.
The bad news is mentioned only at our first meeting; never again does he so much as hints at its possibility, until eight years on, I remind him of it, and his only reply is a Mona Lisa smile that says everything I need to know.
During our first meeting we are interrupted by a telephone call, a doctor colleague returning a call of his, and for a few minutes I am forced to listen as he relates the symptoms of another patient, and possible approaches to her treatment. Although the language is so arcane, without understanding much of what is said, I am nevertheless reassured. Here is a doctor who does not believe he knows it all and is willing to consult others with more experience than himself. It’s the omniscient doctor I fear most.
Once the call is terminated, he outlines a series of tests I will have to undergo before he can decide upon the form treatment will take. I am to have a Kat scan, an MRI, and another form of scan from the ominously named department of nuclear medicine, along with countless blood tests and give a sample of my bone marrow for analysis. The technology is a bit overwhelming, but also reassuring. Even the frequent blood tests, unlike any I have previously had, intrigue me. I insert my index finger into a little black machine that looks like those portable credit card machines European waiters bring to the table. In place of a card I put in my finger, and after a few moments a tape comes clicking up, analyzing twelve different factors of my blood with three columns: the ideal number or range of numbers of each factor, my number, and the difference between the two, if any, plus or minus. Though the readings are meaningless to me, I am dazzled. My particular technician is only interested in four of the twelve factors, but that any machine can accomplish such a feat and in so short a time seems miraculous to me. The bone marrow sample I am to donate has made me apprehensive, but once a diagnosis of cancer has been made, most patients, I have come to find, including me, acquiesce with a kind of blind faith and numb fatalism to anything asked of them; and in this particular case my fears are groundless. The doctor himself, minus his suit jacket, but without the usual white smock, draws the sample from my right hip bone as dressed in the customary green gown, I lay on my left side on the customary hospital table. The entire process is not quite
as painful as a dentist’s injection of Novocain into the gum and over before I am sure it has begun.
When all the tests are completed and analyzed, I am spared what I have been most dreading, chemotherapy. I am to have radiation instead. Arrangements are made with radiology, which cannot fit me in before the second week of June. It is now the first week of May and since I have been warned, because of the location of the tumor on my neck, I will soon lose all sense of taste for some time, perhaps even permanently, I decide to use the intervening weeks indulging myself. I will return to London for my beautiful English goddaughter’s third birthday on May 19th and eat my way through my favorite menus at my favorite restaurants, of which there are surprisingly many in London. No country in my long lifetime has so radically changed its eating habits as England, from everything over-boiled in a single pot in the fifties, to haute cuisine in the nineties as diverse as that of any country in the world.
The trip is important here solely because of what occurs on my penultimate day: I slip getting out of the bathtub and crack two ribs. There is no effective treatment for cracked ribs but time. Six Weeks. Which means my twenty sessions of radiation are to be painfully and immeasurably complicated by my inability to lower or lift my torso on my own without some ballast to absorb most of the strain.
The radiologist in charge of my case, is a short, graying man of indeterminate age whose head seems permanently tilted on his short neck in a kind of quizzical look. He has a soft, Midwestern accent as flat as the plains that spawned it Perhaps to put me at my ease, we spend much of our first session talking about France, of which he seems inordinately fond, comparing notes on Parisian hotels and restaurants. The sole purpose of the meeting seems to be–beside sizing me up–to arrange two appointments for the following Thursday and Friday that will not entail any radiation, but simply set up the perimeters to be used by the technicians who will actually administer the daily dose.
On Thursday I am introduced to the full Department of Radiology, which will become home territory for the next month, excluding Saturdays, Sundays, and the Fourth of July. I am ushered into a small dressing room, told to strip the upper portion of my body and put on the standard green hospital gown that ties at the back of the neck. I can leave my trousers on, but am given a pair of paper slippers for my feet. Once I am dressed, the room is locked and I am given the key as I am led to a waiting room where five other patients, similarly garbed, are already waiting, some, unlike me, without their trousers, most noticeably a handsome young man in his early twenties, touchingly thin, with abundant black hair and meltingly beautiful black eyes, leaving me to conjecture what kind of cancer he can be suffering from. No one acknowledges anyone else’s presence by more than a glance. No one speaks. Most browse magazines, of which there are many on a large central coffee table. Surprisingly, there is no sense of camaraderie: we’re all in this together so let’s try to make the intolerable bearable by a little shared sympathy, or at least some acknowledgement of our shared humanity. Without anyone telling me I understand on that first day, and it remains true until the last day, with one exception, no one addresses anyone else or even so much as looks at anyone else except when he or she enters or leaves the room. The single exception is a young man on the following day who, filled with an irrepressible relief, announces joyfully, “This is my last fucking session.” A few of us smile, a few look startled, but no one speaks.
When a lab assistant in a white gown calls my name, I follow him into a huge room that immediately strikes me as a possible set for a new staging of Frankenstein. Spotlighted in the center is what looks like a large catafalque upon which I presume I am soon to be laid out in state. A tall, athletic-looking young man in his early thirties, pleasantly but not spectacularly handsome, with clean-cut, symmetrical features and an enviously robust body well over six feet tall, approaches me with a smile I have already begun to recognize as sweetly solicitous but at the same time somehow distantly impersonal. It seems to be a part of a lab technician’s training: your job is to make the experience as comfortable and unintimidating as possible for the patients without in any way getting involved in any other aspect of their case histories or personal lives.
He asks me to lie down on the catafalque. I explain the unfortunate matter of my cracked ribs and we soon devise a method that will make the ordeal as painless as possible. He grasps me by the upper part of my right arm, while I hold firmly onto to his arm so that all the strain that he cannot assume is left to my arm to bear rather than my back as I am eased down slowly onto the platform. I am asked to lie very still, keeping my eyes and mouth shut as someone presses a warm sheet of plastic netting onto my face, molding it to fit my features. Then a horseshoe-shaped plastic arch is slipped over my head, to which the bottom of the molded bust is fixed so tightly, my head is completely immobilized. Curiosity is all that has kept panic at bay, for I suffer from a mild case of claustrophobia and cannot bear to be confined. As soon as the plastic has cooled the whole thing is lifted off my head and I am shown what looks like an idealized bust of myself, with all my features–forehead, cheeks, nose and chin–well marked, but with none of the ravishes of age visible, the wrinkles and the sagging flesh. It is identified on the plastic horseshoe with my name and the date: SILVA 6 . 13 . 2000.
Once it has been securely and permanently attached to its plastic frame, it is again placed over my head and clamped to the catafalque so that any movement is once again impossible. In such situations, I play number games of increasing complexity to quell the rising panic: counting, slowly, one to a hundred forward and backwards, then by twos, by threes, and onward, depending on how long the ordeal continues. At the same time I am distracted by people marking my neck with a purple felt pen, aiming the nozzle of the x-ray machine and then retreating behind a large glass window to read the position, more or less like sailors trying to establish with their sextants the exact location of their ship. For this procedure the doctor in charge of my treatment coaches the athletic young man as to precise markings and readings before they actually begin to zap me, a very slow process that goes on for two days, after which I am released and told to report the following Monday at ten o’clock to start the actual treatment.