The author and young friend – August 2009
Thus begins my summer ritual. I leave the house at 9:30, walk the five blocks up Clay Street to Webster, cross the lobby of the Webster Street medical building, take the elevator to the fifth floor, then follow the long winding trail to the Buchanan Street hospital, where I take another elevator down two floors to Radiology. There a young, invariably smiling, Chinese woman escorts me, like a spa hostess leading me to the warm mud baths, to one of the dressing rooms for me to don my green smock. When I am ready she then weighs me on an old-fashioned scale with moving brass weights, after which I move on to the waiting room. That first day it is filled with people I’ve never seen before, but will soon begin to recognize, if not acknowledge. Some will disappear after a few days never to be seen again and new ones will arrive. They too will come to understand almost immediately that conversation is forbidden, everyone guarding his or her own cancer as if it is some precious treasure that may be damaged or disparaged if exposed. There I sit until a familiar face appears at the open door and beckons me to follow.
The team that works with me consists of six people (beside the athletic technician who is responsible for the actual radiation and is thus the one constant), two women and four men, two of the latter are Asian, a very short Japanese (or possibly Korean) and a much taller Cantonese. They are all, with one exception, ordinary looking, kindly and intelligent. But most of all dedicated. The one exception is a short, stocky woman with platinum-bleached hair arranged in a helmet of jelled spikes, an elaborate tattoo on one upper arm, and facial piercings, a chrome knob through her left nostril and another through her right eyebrow. In my youth I would have described her as one of the Angry Ladies. No one seems to pay the least attention to her provocative makeup, and I too, very soon, cease to notice it. Within a few days they all six seem equally beautiful–if nameless–angels dedicated to making my ordeal as comfortable as possible. Except for the first day, I see them only two or three at a time in various combinations. The strongest will ease me down onto the table and at the end of the session, help me back up.
Each session takes from fifteen to twenty minutes, only two of those minutes are devoted to the actual radiation. I am first lowered onto the table and the mask is instantly clamped over my head, invariably followed by a moment of panic, until I can focus on some distraction, usually mathematical. I try at first recalling poems or passages of Shakespeare I once had to memorize, but that soon proves not a good idea, since a word or a phrase that fails to come when I need it, so frustrates me, it simply adds to my anxiety and makes me even more conscious of my bondage. So I stick to mathematical matters, which is a little like listening to Bach partitas, everything has to fit beautifully and neatly into place. The x-ray technician focuses the x-ray nozzle, checks the reading behind the glass panels, makes further adjustments, often marking my neck with purple felt dots, until he is satisfied. There are always two zaps, the first considerably briefer than the second. Their length of duration is flashed in blue on the wall in front of me (or perhaps the ceiling, since I have no difficulty reading them) so that I always know how close I am to the end. During the actual zapping, though I have been given no instructions, I stop whatever mathematical exercises I am employing to concentrate solely on the blue numbers before me. Like a countdown, they proceed from the highest number to zero. I don’t even breathe until the last second is reached. There is no sensation whatsoever, except my own (irrational?) fear that something may go wrong if I so much as blink and I will be left a paraplegic for the remainder of my days.
This routine continues uninterrupted without variation for the first fifteen sessions, after which I am asked to return to Dr Frankenstein’s laboratory for some further refinements, to achieve a more precise calibration of the areas to be attacked, since, as the doctor explains, adding to my anxiety, the last five doses will be considerably more powerful, and because the area affected is so close to the spinal cord they want to be absolutely sure no permanent damage can be done. After this one-day hiatus, the old routine is resumed for the final five days without any mishap.
The last session, which is like a graduation ceremony, leaves me with mixed emotions. I receive congratulations from all around, as if I have truly accomplished something on my own rather than merely acted as the passive receptor of their remarkable accomplishments. My sole accomplishment has been to endure. I have come to depend so completely on my ministering angels and will, I know, miss them all. Even the spike-haired angry lady. I will also miss the secure comfort of the daily routine: knowing precisely how I will begin each morning. I ask the doctor if I can keep the plastic mask that has been my greatest tormentor. He smiles, surprised by my request, since no one before seems ever to have made it, but agrees they have no further use for it. So it is mine to do with as I wish and I carry it home as a kind of trophy.
As for the physical effects of the treatment itself: after the first week, I begin to notice a drying up of my saliva; by the end of the third week, I have no taste whatsoever and have to force myself to eat. What I eat is a matter of complete indifference to me, but since I always share my dinner with my friend, a superb cook, I do at first make some effort to pretend I am actually enjoying what he has prepared, but that effort is wasted. The fancier the dish, the more I am repelled by what is set before me. It is, I decide, trying desperately to make a virtue out of necessity, a great opportunity to regain the long lost waistline of my youth.
The greatest change, however, is psychological. For the first time I think of myself as, incontrovertibly, an old man. Previously, brimming with abundant good health, I could go whole afternoons or evenings without once thinking of age until an unexpected mirror would flash back a disconcerting image, vaguely familiar, my dead father, perhaps, jolting me suddenly into the knowledge that the old man staring back at me is myself. Now I no longer require a mirror to tell me what I already know in my bones.
In about six months I have my first joyful sensation of taste restored. Someone has given me a pint of gelato classico and the combination of chill and sweetness is almost like a teenager discovering sex. It is sheer delight and I can’t get enough of it. There is an outlet on Clement Street and Ninth Avenue across the street from what used to be the Coliseum movie house. Every week I stock my freezer with three pints–black cheery, caramel, and straciatella–and indulge myself shamelessly at the cost of my hard-earned new waistline. I go from thirty-two inches back to the long-ago-resigned-to thirty-six and every fraction of an inch gained along the way is pure ecstasy. It is almost a year before I can fully enjoy anything so sophisticated as a fresh porcini mushroom lightly sautéd in extra-virgin olive oil, and I then reluctantly, but heroically, give up my addiction to gelato in any form, as I once long ago gave up cigarettes. Suddenly everything tastes good again and this most enduring of lusts is restored and with it a new lust for life.
For the next five years I see the radiologist every six months and the oncologist every six months, but the dates are straddled so that I see someone every three months. With the radiologist France and any recent travels are the main topic of discussion; with the oncologist it is Italy, though he also discusses his own travel plans with his family. My health seems almost incidental, though the latter does inspect my arm pi
ts, my groin and any recent suspicious moles, listens to my breathing, and orders a blood test.
For the second five years the radiologist’s visits have been reduced to one a year and our discussions are now more perfunctory. The only measure he seems interested in is my weight, which, once my appetite returns, remains depressingly the same, around one hundred eighty pounds, though my height, I discover with a shock, has shrunk from five foot eleven and three quarters to five foot eight and three quarters, which explains why certain young nieces seem suddenly so much taller than I remembered them being. My oncologist continues to monitor me every six months. Invariably he greets me by telling me how great I look, and I do make an effort when visiting him to dress in my best informal wear, linen jackets and trousers in May and cashmere turtlenecks with gray flannels in November. His mother, he tells me, is celebrating her seventieth birthday the same month and in the same city I am celebrating my eightieth–Venice–though her party is to be at the five-star Gritti Palace and mine at the four-star Monaco, which I let him know, with a superior smile, has the better kitchen. I still like him immensely. For some reason we both seem to want each other’s approval and our twice-yearly meetings seem far more social than medical. But knowing full well that I am ever waiting for that never discussed “bad news” to become a reality, he does let me know that the decade marked by 2010 is a purely arbitrary marking. It measures nothing but itself, he insists. Thus the assumption that my days are without number persists, which we both know, if taken seriously, is delusional. So I smile and continue to wait.
One of medicine’s great ironies is that virtually all effective treatments for cancer are themselves carcinogenic. In my imagination all of the radiation my body has absorbed over more than eighty years flits about within me like so many shoals of miniscule anchovies in search of some organ to feed upon–my pancreas, my liver, my kidneys–and until then it too becomes a major player in the waiting game. If my original cancer fails to recur in time, the radiation may produce another even more exotic form. I am rich in possibilities. I can, of course, avoid both eventualities by beating them at their own game and dying earlier of heart failure, a stroke, or a terrorist’s bomb, so why should my case be any different from that of any other octogenarian? The simplest answer is: it isn’t. We have already beaten the odds and are, by the incontrovertible and inexorable laws of nature, de facto team members of the same waiting game; but society has, for some reason, crowned cancer King of all Earthly Terrors, transformed every child’s boogeyman into a Godzilla-sized monster, THE BIG C, an honor it doesn’t altogether deserve. There are far worse ways to die yet we persist in giving cancer patients a kind of panache other victims–diabetics for one–are denied.
Wise old Prospero ends his valedictory scene in The Tempest by abandoning his enchanted island and promising to retire to Milan, where “Every third thought shall be my grave,” he says, acknowledging with his final words, the destiny of all geriatrics swept up in the implacable current carrying us to extinction. And he has gotten the proportions just about right. If every third thought is devoted to our coming death, that still leaves twice as many to revel in the vast storehouse of beauty still left to us–a Schubert song, a white hydrangea, a ballerina’s perfect arabesque, screaming children leaping into pools on hot summer days–to wonders as grand as a Bellini altarpiece or as simple as a child’s embrace–you can make your own list–but as long as one or all of these are still available for delectation–and the other two essentials, physical mobility and mental agility, hold fast–I am prepared to stand joyfully in that crowded waiting room for as long as my legs will hold me.