Passing

by Michael Korda

  About three weeks after coming home, Margaret took what was for her the biggest step of all. She came out as she did every morning to have a cup of coffee in the tack room and give Tiz Whiz, the barn cat, her morning brush, looked at my horse Montage, who had just been ridden and was still tacked up, and said, “I think I’ll get on him.”

  Miguel and I exchanged glances. I nodded. Monty, a western paint, was far and away the most reliable and good-natured of our horses. Margaret had taken him from being a humble packhorse on a Montana dude ranch with brand on his shoulder to a combined training champion, and in all that time he had never given her a moment’s trouble. No horse is ever completely safe, but Monty was as safe as they come.

  Margaret made her way out through the barn and down the short ramp to the mounting block, Miguel helped her up the steps while I took her cane, she put her leg over Monty and sat down in the saddle with a sigh of pleasure. With Miguel holding Monty’s bridle, she walked him twice around the big oval paddock without incident, then came back to the mounting block and dismounted.

  She was smiling for the first time in more than five weeks.

  7.

  MARGARET STARTED TO take her life back bit by bit. Although her fingers were still clumsy, she was soon able to communicate with friends by email from her cell phone, short messages with many mistakes, but at least she no longer felt quite so cut off. She walked every day with her cane, increasing the distance day by day. I drove her to shop for fruit and vegetables at Adams Farm Market and to the supermarket, to MidHudson Hospital for her therapy and to Styling Sunsations to have her hair washed. She was tired, still reluctant to speak on the telephone, the right side of her face was still partly paralyzed, so eating was difficult enough to prevent her from going to a restaurant, but at least she was making progress.

  On June 6, six weeks after Margaret’s brain surgery, she emailed her friend Liz Benney: “I have only been able to email very recently, having lost the capability of doing so completely a few weeks prior to surgery. And even now I make so many mistakes, so keep them short. I don’t have to tell you that I have been through a terrifying journey . . . A four and a half hr. brain surgery, a week in the ICU, followed by twelve days at Burke for rehab . . . I started in a wheelchair, then a walker and now a cane, which I often do not use . . . Everybody tells me that I have made terrific progress since getting home, I even got on the mounting block and sat on one of the horses last week! But will I ever ride out like I used to, I wonder . . .”

  The next day she took an even more ambitious step, about which she emailed Megan: “I took a walk whilst Michael was riding, got on Monty when he got back and walked [him] once around the Oval, then drove my car to get my hair washed—with Michael with me, of course.” Doctors and physical therapists had all been uncertain about when or even if Margaret could drive again, and were reluctant to be pinned down to a date for it, but in the end she decided for herself that she was ready and simply said, “Why don’t I drive?” when we went to the car. She drove more carefully than she had in the weeks before her surgery, when she had seemed to me to be driving too fast and passing slower drivers a little too close for comfort. She was not nervous or overcautious now, she simply took it slow, for a change.

  None of this is to say that progress was easy, or linear. Every step forward exhausted Margaret. She who had always had enough energy for two people now found herself lying down for much of the afternoon. Everything, even the simplest task, took forever to do. She stabbed away at her cell phone to compose emails to old friends, spending what seemed like hours to send a message of only a few lines, or, worse, erasing it by mistake. “Tend to get a bit tired,” she wrote to her goddaughter Tamzin Blinkhorn in the UK with typically English understatement, but then added: “This is a medical journey I would not wish on anybody.” To Andrea Addison, the sister of her friend Robin, whose ashes we had sprinkled next to the stone wall in Margaret’s “Field of Dreams,” the eight-acre, perfectly cared-for field that contained her favorite jumps and which was kept as green and flat as a cricket pitch, “This morning I made it up The Field Of Dreams, and sat on the jump next to Robin, oh, how I wish he were here.” That was her reward for the long uphill walk to reach the field—to sit for a few minutes on the stone wall she had jumped so many times and “chat with Robin,” who had been dead for five years.

  Margaret was sleeping badly despite the sleeping pills and all the exercise—getting up at night to go to the bathroom meant waking me so I could turn on the lights, come around to her side of the bed to help her out of it, give her her cane, then hold her arm as she made her way to the bathroom and back again. She seldom went back to sleep again afterward and was somewhat envious that I did. All the exercise in the world isn’t enough to erase the anxiety that keeps you awake. The pursuit of physical fitness as defense against cancer is a delusion; of course exercise is good, regaining physical strength is important, but it’s not necessarily going to stop the cancer from spreading. The enemy within doesn’t care how many miles you’ve walked, or ridden, or biked, it has its own remorseless agenda. As my friend Julie Houston, a cancer victim, now dead, put it, “There is so little control . . . over cancer that one reaches out to anything—exercise, nutrition, what have you—as something to hold the illness at bay. These placebo activities provide something to do, rather than just sit back passively, at the mercy of the medical world.”

  Margaret was the person least likely to “sit back passively, at the mercy of the medical world,” she pushed herself hard even as the temperature climbed, as if she were in training for something. Before her cancer diagnosis she had the gift of fitness without working for it, her horses kept her slim and fit—luckily for Margaret, what she loved doing most was also good for her—but now she had to work hard at it every day, and hated every moment of slogging on in the heat and the humidity, cane in one hand, fly whisk in the other. There is more to “walking the course” than you might suppose in combined training. The walking part of the course may be two or three miles long, before the cross-country phase, in which there must be careful decisions on the best approach to each fence, wall, or ditch, and counting off how many strides the horse has to make before taking a fence. Margaret was a good, brisk walker, but walking for its own sake had hitherto not been part of her life. She took to it doggedly, but without enthusiasm.

  I had kept Margaret’s friends up to date from the onset of her symptoms until her return home, but now she was in touch with them again herself. To her hairdresser, friend, and fellow cat lover Tom Della Corte in the city she emailed: “I have started walking on the trails every morning, a little bit more each day . . . I would like to come and see you [in New York City] pretty soon, I look like such a wreck. Months since I had high lights and a haircut. My surgeon says I can have color, but you would know best. I have hair growing in where shaved off for surgery—the scar is at least five and a half inches [long]. But my hair is breaking off badly, and thin. And oddly enough, straighter than I have ever known it.”

  Margaret hesitated to go down and see Tom, worried that her appearance might put off others in the salon. I emailed her concern to him: “She wonders whether people . . . would be shocked at the sight of the scar. I think most people would simply think there is a beautiful woman who has had a bad time of it, don’t you, sympathy rather than shock?” Tom told her not to be silly, promised to give her as much privacy as possible, and managed to perform a small, welcome miracle with her hair. Even so, as Margaret emailed a friend, “I have slipped backwards somewhat . . . Too much time indoors, I have always been an outside person, very active, bottom line is I feel depressed.”

  It was not a coincidence that Margaret’s next MRI was scheduled for July 21, three months after surgery—as we would soon discover, her spirits plummeted toward the end of every sixty-day period as she approached the next MRI. She longed for the day when the interval between MRIs could be raised to ninety days. In the trip down to Northern Westchester Hospital in Mo
unt Kisco for the MRI she sat stiff, dry-eyed, and silent in the car, looking very much like Jacques-Louis David’s sketch of Marie Antoinette in the tumbril on her way to be guillotined in the Place de la Révolution. At any rate, things went smoothly this time, “MRI was good, no sign of new cells,” Margaret emailed Megan, the next MRI would be in September. “I had gone downhill during the weeks beforehand from depression as to what the outcome would be,” she wrote to a friend. “My surgeon told us that had I not had the surgery when I did, I would have been dead within two weeks the tumor was so large.”

  The first neurosurgeon we saw in Poughkeepsie had warned us that she might be dead in a matter of weeks if we didn’t let him do a biopsy. Alain, who called often to see how Margaret was doing, and whom we both regarded as a good friend, now put her survival at two weeks if she had not had the surgery, and that did make Margaret feel that she had dodged the bullet, but it did not cheer her up much. Her life was now clearly divided into two parts, before and after brain surgery, and she wondered if she would ever be “the person I was before.” It was a question she asked a lot, of herself, of me, and I had no clear or honest answer to it.

  I had been putting off having my pacemaker-defibrillator replaced until Margaret had her first MRI, and since this turned out to be a slightly bigger deal than anticipated, our positions were briefly reversed as Margaret worried about me, but I shortly resumed my role, the most difficult part of which was trying to find things that Margaret could eat, since chewing was still difficult, and—a bigger challenge—also wanted to eat. Breakfast was simple, a banana mashed up so it could be eaten with a spoon; lunch was easy at this time of year, a slice of mozzarella and a tomato, chopped up finely and drenched with olive oil; dinner was more of a challenge, since everything had to be chopped or mashed: crab cakes, macaroni and cheese, Japanese takeout—improbably, Pleasant Valley, a hamlet with nothing much in the way of food except a thriving McDonald’s, a diner, and Pam’s Bun ’N’ Run, has a good Japanese restaurant—and when I could drive over to Millbrook (I didn’t like to leave her alone too long), I’d return with an order of excellent sole meunière with gratin dauphinois potatoes and green beans from Margaret’s favorite local restaurant, Les Baux. All these dinners had in common that they were easily puréed or chopped, but Margaret never ate much even when it was something she liked. Struggling to feed herself with the special spoon we had taken from WMC was dispiriting, and when I fed her it seemed like a defeat to her. Given all the medications she was taking, the doctors at Burke had warned her against alcohol, but, with the civilized common sense of a fellow Roséen Alain overruled them and said he saw no harm in her having a drink every night. Margaret was never a big drinker, but her nightly vodka tonic with half a lemon squeezed into it had been an almost sacred part of her routine for as long as I had known her. Even when she was away competing she always took along a miniature airline bottle of vodka, a bottle of Schweppes tonic water, and a lemon, in case she had to have dinner at a place without a bar. Now she sipped her drink through a straw gratefully, although she seldom finished it.

  I had never given much thought to the notion of being a caregiver, nor imagined I would ever be one. I totally understood Margaret’s reluctance to have someone living in the house to look after her—she had a strong sense of privacy, as do I—but I had underrated the challenges it involved. Margaret and I shared most household tasks, we even stripped and remade the bed together like a team every Sunday morning. Of course, there were things we did separately. Margaret knew better than to ask me to join her to look for new kitchen mats at Kmart—my boredom level for that kind of shopping was low—and I did not expect her to accompany me when I took one of the cars to be serviced. After all, we were not Siamese twins, but we were together more often than many couples, especially after I retired. Now she needed help to do even the simplest and most basic things like tying her shoelaces, dealing with buttons, or pulling up the zipper of her jeans, and caregiving became a full-time job. I had vaguely assumed I could fit it in with other things, editing a manuscript, working on a book, but I soon realized that everything took twice as long when there was only one person to do it, and that there were a lot of things I didn’t know how to do and would have to learn. Getting Margaret’s hair put up and pinned so it wouldn’t get wet when she had her bath was one of them. I seemed to have no gift for using Magic-Grip hairpins or hair clips, and my clumsiness irritated Margaret almost as much as her inability to do it herself. Getting her in and out of the bath every afternoon continued to be the most difficult part of my day, and the one that left us both feeling helpless. She could no longer hold a razor, so I shaved her legs when they needed it, which turned out to be harder than shaving my face in the morning because it was a new task for me. Keeping tabs of Margaret’s medications was by comparison an easier, although time-consuming task. There were so many that they filled a dinner plate in the middle of the kitchen table, and since they needed to be taken at different intervals, my assistant Dawn and I drew up a chart in many different colors so I had a guide to what she had to take and when. It took a while for it to sink in for both of us that our life together was going to be radically different from now on, that so many ordinary things in life that Margaret had always done alone she now needed help with.

  There is a new kind of intimacy between couples when one of them takes on the role of caregiver. In a curious way it brought us closer together than we had been in many years, which is not to say that it was without its occasional flashes of stress, impatience, and even anger when a zipper got stuck or I dropped a hairpin for the umpteenth time. We all like to think that we will be up to the challenge when worse comes to worst, and that it will all happen naturally, but none of this is necessarily true. Margaret was sometimes incapacitated by her fear of becoming helpless and by her anger at the fact that her whole life had been turned upside down at the age of seventy-nine, and I was sometimes overwhelmed by my new responsibilities and the decisions that had to be made. Of course, so long as Margaret’s MRIs remained clean, these decisions could be put off for a time, but waiting passively for bad news did not seem to me the sensible thing to do.

  Margaret had been resistant to the idea of seeing an oncologist when Alain first brought up the subject. Given her feelings about doctors, it was remarkable that she had developed such faith in him—she saw him as her doctor, the one in charge of her case, she was willing to do anything he wanted her to do, she had accepted surgery, rehabilitation at Burke, Gamma Knife radiation, all without a protest—or at least without digging her heels in—but she emphatically did not want to consult at his suggestion with Dr. Kluger, the distinguished oncologist at Yale Cancer Center in New Haven who runs immunotherapy clinical trials on advanced melanoma patients. So far as Margaret was concerned, Alain was in charge of her case, the equivalent of her chef d’équipe in combined training. She did not want another doctor, besides which she was reluctant to commit to a long series of treatments with no end in sight. As Alain wrote to Dr. Adam, her internist, “Margaret has indicated very clearly to me that she does not wish to pursue systemic therapy for her stage IV melanoma and expresses great anxiety with regard to any additional therapy.”

  This was putting it mildly. Alain had called Dr. Kluger, and his office made several appointments with her, all of which I was obliged to cancel with considerable embarrassment at the last moment, since Margaret did not want to be driven all the way to New Haven to be placed in a program of testing experimental drugs with potentially alarming side effects. She had a horror of becoming a patient, still more of being a guinea pig in and out of emergency rooms, her life an endless succession of hospital visits, tests, and consultations as she pictured it, not without reason. What good was giving her more life if it wasn’t a life she wanted? she asked.

  I am not sure either of us realized the extent to which stage IV metastatic melanoma would remain life-threatening even if the removal of the brain tumor was successful. The cancer was there in her body
, it had been quiescent for over four and a half years since the melanoma surgery on her face, during which time she had remained completely asymptomatic, but now it was on the move, the brain tumor merely the first and most immediately threatening sign of what was going on. We do not hear what we don’t want to hear, and Margaret was determined not to hear this.

  I thought she should go to New Haven and hear Dr. Kluger out; she could always say no, after all. In the meantime I read up on advanced treatment for metastatic melanoma until it was a blur. Almost everybody I called in the medical world, and many outside it, had a list of medications Margaret should be on—had she tried Yervoy, had she heard about Opdivo, had her doctor mentioned BRAF inhibitors?—and stories about people who had been saved when they were at death’s door, but Margaret was particularly resistant to hearing about any of this. As for me, I soon realized that you can read about checkpoint inhibitors, ipilimumab, or targeted therapy all you like on the internet, but that’s not going to turn you into an oncologist, and for each medication the thing that first catches the layman’s eye is the list of dire side effects. Picking one at random, it would have been hard to persuade Margaret to take something that might cause among other things “lung inflammation (causing difficulty breathing), rash or inflammation of the skin, hepatitis, inflammation of the kidneys causing decreased kidney function, colitis (causing diarrhea or bleeding), and inflammation of the endocrine organs (pituitary, thyroid or adrenal) . . .” any more than she would have wanted to have “salvage surgery” explained to her (it is pretty much what it sounds like). She dismissed the horror stories, of which there were many. What she wanted was to get back to something that resembled her life as soon as possible, for as long as that might be. She had painstakingly created that life for herself, the house, the barn, the horses, and she would cling to it for as long as she could rather than spending it in a hospital gown undergoing treatment in New Haven or elsewhere.