Passing

by Michael Korda

  In that she resembled her father, Paul Mogford, who, when he had been moved into a “cottage hospital” (the English equivalent of assisted living) with emphysema and heart problems after a lifetime of chain smoking, simply turned his back on the treatment options and willed himself to die. Stubbornness was built into the Mogfords, along with a certain pitiless realism, and Margaret was in that way too her father’s daughter. When her marriage to Burt was breaking up, she wrote a short story about her own suicide as seen through the eyes of her friend Mayo, who would actually commit suicide herself a few years later. “Silhouetted now, hair spread out, so all I could see was this wonderful mane and slim body . . . she sighed and from the position of her arms I could see that she had stuck her thumbs in her belt. As long as I had known her she had done this, pulling the belt and waistband of her jeans away from her body . . . ‘You know,’ she said, ‘it’s not the people any more that I think about, not even my mother and father. I always worried about how it would affect them. Now I don’t. And I used to think, well there’s that new movie opening next week, or we are going to Bali, or somewhere, and I would forget about it all . . . Not now, not any more.’”

  I could talk to her about Dr. Kluger until I was blue in the face. Once Margaret decided she wasn’t going to travel down that path, her mind was made up. She was always like that, a Scorpio, she had the courage of her convictions; once she had decided to make a break with something or someone it was immediate, permanent, and without regrets. Once she had decided to do something, it was done, set in stone, that was the spirit that had carried her to victory so many times, and brought her to the life she wanted. She did not waste time on second thoughts. Her good friend and fellow competitor Carol Kozlowski emailed Margaret shortly after her successful MRI. “I hear that you’ve fought bravely and are gaining ground . . . I guess I wouldn’t expect any less from you. I’m hoping you’ll find joy sitting on a horse again, even if you never step onto the competition arena again. I still have an image of you on Nebraska, fairly unbeatable, in my memory. So many wonderful memories, you’ve always been beautiful on horseback.”

  Beautiful on horseback was exactly what Margaret wanted to remain. She wasn’t about to settle for a long, slow slide into the toxic side effects of immunotherapy and a life spent in ERs and hospitals. She was determined to re-create her life as it had been for as long as she could hold on to it. “Always good to sleep in your own bed,” she emailed Carol Kozlowski when Carol told her she was driving home by herself from the Millbrook Horse Trials after competing with her horses to Geneseo, New York, a distance of over three hundred miles, instead of spending the night—exactly what Margaret would have done, was doing.

  She was home, and determined to stay there.

  8.

  THE LIBRARY—or, as we called it more realistically, the “TV room”—of our house must have been built during a brief period of prosperity on the part of the owners back in the mid–nineteenth century, when there were still people around locally who knew how to do such things. It has nicely carved wooden shelves and cupboard doors, and a very pretty fireplace—nobody could call it “elegant,” but it was at once handsome and cozy, unlike the larger, chilly living room, which we seldom entered. Margaret and I tended to gravitate to the TV room for a drink before dinner and a look at the news, and we often ate dinner there on folding TV tables and watched a movie or a miniseries, sprawled out on the big sofa with one or two of the cats beside us. Normally we would have gone out to dinner to celebrate our thirty-eighth wedding anniversary on June 30, but Margaret was still sensitive about the droop in the right side of her lips, so we stayed home quietly and celebrated in the TV room. By coincidence we had both written the same message on the card attached to each other’s gift: “38! May we have many more!”

  Since Margaret could only drink through a straw, I had bought her an antique Tiffany sterling silver bamboo-pattern straw, which would save me from bringing a fistful of straws back from Dunkin’ Donuts every few days, and she had bought me a half bottle of champagne. We talked about taking a midwinter vacation, which we hadn’t done for years, but without conviction. We did not talk about the disease, or the MRIs, or the side effects of the medications, which was perhaps our best gift to each other over the past six months—cancer so easily becomes the only subject of conversation, the unwanted guest at every celebration.

  As the summer wore on, Margaret’s strength returned. She was still too thin, the facial muscles on the right side of her face were still stiff, simple things like brushing her teeth were lengthy, infuriating tasks, but she was driving by herself now for short trips without me riding shotgun. Perhaps more important she graduated from riding Monty, the reliable old paint I had inherited from her once his competition days were over, to riding Logan go Bragh, her big black event horse—Logan was strong, “forward moving,” as horsemen like to say, with a mind of his own, and plenty of power under the hood. He was too much horse for me—I wouldn’t have ridden him on a bet—but it was interesting to see that when Margaret was mounted on him, she looked as if she had never been ill at all. She still needed a cane to walk, and needed help to eat or brush her teeth, but once she handed the cane to Miguel and mounted Logan she and the horse came together as one, it was a fine thing to see. It gave her more confidence too, and made the ordeal of waiting for her next MRI on September 22 a little easier to bear.

  She described the two weeks leading up to the MRI as “tense and worrisome,” but that is putting it mildly. It was not just that each MRI had the potential of being a death sentence, pronounced by a radiologist instead of a judge—each one put at risk all the effort Margaret had made to recover, the hours in the gym balancing on a narrow beam, or trudging up and down improvised steps and around obstacles, further hours of speech therapy and occupational therapy, and all the walking back and forth over our fields, despite the heat, the humidity, and the bugs. It was a huge investment of time and hope, all of which could be swept away in a second by the appearance of new tumors or the return of the old one. You could see the small signs of tension, the constant, nervous shredding of a piece of Kleenex into tiny pieces—was Margaret even aware she was doing it?—the time she spent out in the barn with her horses, listening to their quiet snorts, which are a sign of pleasure in a horse, stroking each silken nose, communing with them, the way she would stop while we were out walking and stare at the fields and fences as if she were trying to imprint all of it on her mind. It did not seem to her fair that all of this could be torn away from her, and of course it wasn’t, disease never is. She had never believed in a God who punishes, she preferred not to believe in Him at all rather than that. She didn’t believe either in the kind of moral equivalency that people express when they say consolingly, “Well, think of all the good years you’ve had . . .” as if the good years had to be paid for by so many bad ones, or that a formula existed by which so much joy and pleasure had to be paid for by an equal amount of pain. Sometimes Margaret asked why this had happened to her, but it was a rhetorical question. She didn’t expect an answer, or even suppose there was one.

  By now the secretary behind the desk in the Radiology Department welcomed us back as if we were familiar clients at a good restaurant. I held on to Margaret’s hand until her name was called and waited patiently for her return. It was not a long process, there was never any significant waiting time, and when it was done we walked around the corner to the Cancer Treatment and Wellness Center next door to see Alain. Within a few minutes he appeared, smiling, to take us into his office and tell us that the MRI was clean. We were back out to the car in fifteen minutes, Margaret looking years younger. “Dr. Alain very pleased with brain scan, huge sigh of relief,” I emailed a friend.

  The next MRI would be just before Thanksgiving.

  It was a turning point. Starting the next day, Margaret began riding two horses a day again, just as she had for years before her illness. Her appetite improved. She still tired quickly, but at times she seemed li
ke her own self again, although that was an illusion of course: cancer and brain surgery change the person in so many ways, nobody is or can be “the same” afterward. Whatever else she was, Margaret was no longer invulnerable. She had survived what seemed like the worst that could happen, but she had not emerged unscathed—nobody does. Her hair was growing back to hide the scar on her head completely, but she had a sense of the impermanency and fragility of things. She began to write cryptic random quotes in huge, uneven capitals in the small notebook she kept on her bedtable beside a photograph of her father and a red leather case containing the Royal Mint gold coin commemorating the coronation of King George VI in 1937, the year she was born: “Walking debris,” surely an ironic self-description; “Yesterday’s gone,” perhaps remembering Brenda Lee’s song, but perhaps also a wistful reference to her own life; “I have a rendezvous with Death,” the first line of Alan Seeger’s famous First World War poem; “Would you cross the Rubicon for me?” perhaps a question aimed at me? More mysteriously, “Remember the Ark was built by amateurs, the Titanic by professionals,” and just below it, “Uncork time!” Of course she would want to go back to the time before the diagnosis of a brain tumor was made, which is perhaps why she added “Age of Innocence,” a reference to the time when she could still ask, “What’s the worst thing that can happen to me?” instead of living with the fact that it already had.

  The days grew shorter as autumn began, the mornings began to be crisp, the leaves started to turn, it was sometimes even chilly—perfect riding weather, probably the best time of year in the Hudson Valley, “good sleeping weather” as they used to call it up here from the days before air-conditioning, when people put on a sweater and started to think about pumpkin pie and turkey. Margaret put on a little weight, not much, but she was moving in the right direction. Her hairdresser Tom had somehow managed to perform a small series of miracles to make her hair look good. I emailed a friend that things were beginning to look better.

  I should have knocked on wood when I wrote that, or whispered, Inshallah, God willing.

  Never tempt fate.

  We celebrated my eighty-third birthday on October 8 quietly at home, it wasn’t a “significant” one like seventy or eighty, we used it to celebrate the rate at which Margaret was recovering, clinking our glasses together on the sofa in the TV room. It seemed like old times.

  But it wasn’t. A week later her symptoms began to return with a vengeance, the trembling right hand, the facial paralysis, the problems with speech and finding the right word. They were minor at first, one could pass them off as fatigue, or perhaps the result of trying to do too much too soon, but a few days later it was apparent that we were back in full crisis mode. After a call to Alain her MRI was moved forward urgently, and with it the anxiety returned.

  This time there was a lengthy wait between the MRI and Alain’s appearance to show us into his office. We sat glumly next to the tropical fish tank in the slightly surreal surroundings of the Cancer Treatment and Wellness Center waiting room. The tropical fish did not cheer her up—she disliked the whole idea of confining any living creature in a cage or a tank, even fish, and for that reason she always avoided zoos. She was not a vegetarian—quite the contrary, she was happy to eat a Dover sole properly cooked and served—but she hated the idea of keeping anything trapped behind wires, bars, or glass.

  “I know it’s going to be bad news,” Margaret said. “He’s never kept us waiting before.” The same thought had occurred to me, but I tried to reassure her: there might be a snag or a problem with the MRI, or Alain might have a patient with an emergency. From where we were sitting we could see the door to his office, and after some time we observed Dr. Julie Choi, the radiologist, go in and shut the door behind her.

  “That’s a bad sign too,” Margaret said. “He never needed her help to look at my MRI before.” Margaret had not, as they say, “bonded” with Dr. Choi during the Gamma Knife radiation, although I myself had found her perfectly pleasant, but for whatever reason the two did not seem to have hit it off, and the long time that Dr. Choi spent with Alain increased Margaret’s anxiety sharply.

  After a time Dr. Choi left his office, and Alain came out to greet us, with rather less ebullience than usual. The results of the MRI were ambiguous, he explained once we were seated. There were signs of swelling, perhaps a delayed reaction to the Gamma Knife radiation. His notes describe what he observed from his physical examination of Margaret, and from the MRI. There was, he wrote, “a slight increase in the right-sided facial droop . . . [and] decreased coordination affecting the right hand,” as well as the fact that she “was taking smaller steps,” which I had not noticed at all. I ought to be paying closer attention, I told myself. On the MRI he saw “a significant increase in the edema surrounding the resected lesion as well as a slight, but noticeable, increase in the size of the lesion,” and “a slight increase in size of the much smaller right parietal lesion that was treated at the same time [that is, the time of the Gamma Knife radiation].” It was possible that “the increased size of the lesions could be due to the delayed effect from the radiation treatment”; however, it could also be a recurrence of the tumors, or worse still a combination of the two.

  We sat in silence for a few moments contemplating all this. As was usually the case when confronting bad news, Margaret was stony-faced. Alain explained that a course of steroids might bring down the swelling, and prescribed dexamethasone, accompanied by Pepcid in case the steroids gave her stomach problems. I was to keep in touch with him about her neurological symptoms, and we should return for the pre-Thanksgiving MRI that had already been scheduled. Hardly any doctor could have been more sympathetic in giving a patient bad news than Alain; on the other hand, he did not hide the fact that Margaret’s recovery was no longer a sure thing, if it ever had been. She had been making progress. Now she had hit a setback.

  In the car on the way home she sat in front next to Rob Tyson, with whom she usually enjoyed chatting, silent and staring at the road ahead. Rob knew the signs of bad news and was silent too.

  When we were home, Margaret put the kettle on and we sat down in the kitchen waiting for it to boil. “If I die will you look after my horses and cats?” she asked.

  I told her I would, of course, but said it hadn’t come to that. She should wait to see how she did on the steroids.

  The kettle whistled, Margaret got up to make tea. She had never looked healthier or better since her diagnosis in April, she always made an effort in any case to look her best for Alain. She put a biscuit on the saucer of my cup for me. She shook her head.

  “I can tell,” she said, “I’m entering a new phase.”

  9.

  THE “NEW PHASE” began at once, with a dizzying change of pace. It was as if the disease had been moving slowly until then, and now, after this latest MRI, everything was suddenly speeded up like fast-forwarding a movie; there was scarcely time to take a breath between one crisis and the next. It had been just over four weeks since the last MRI, which revealed the swelling in her brain, and the next one, weeks in which we waited to see if the steroids were working (they did not help), during which Margaret slipped back into anxiety and depression, and among other things ceased to be able to answer emails or grasp a knife, fork, or spoon—the fingers of her right hand were almost useless again. She wrote her last email, to Megan on October 20, as the leaves were turning and the nights were growing cold. (“I am hoping that the medications I am on start kicking in! To get the swelling down.”) After that she had to dictate her replies to me to send from her iPhone, there was no way her fingers could do it. All her emails after that date began with my writing, “I’m replying for Margaret.” Her speech regressed rapidly too, and not surprisingly her anxiety soared. Alarmed, I emailed Alain, “I think Margaret is going downhill very rapidly . . . loss of feeling in right arm below the elbow, and in right hand and right fingers, complete loss of appetite, huge apprehension (understandably).”

  In the meantime, I rea
d up on swelling in the brain—the correct medical term is “brain radiation necrosis”—on the internet, and soon discovered the Cancer Survivors Network of the American Cancer Society, which was chockablock with anguished and detailed entries from people who had experienced Margaret’s symptoms or worse. These were not easy or comforting reading, one writer described herself as being not only sad but angry, other entries sounding more like rants, one ending that he did not like “this necrosis BS” and did not want to go through brain surgery again, echoing pretty much Margaret’s feelings on the subject. Almost all the writers knew much more about treatment for brain cancer than I did. One wrote that her husband went through WBR [whole-brain radiation] and chemotherapy, then treatments of Taxol and carboplatin, followed up with Tarceva and one treatment of targeted radiation. I looked up the side effects of each medication and sighed. She added that she thought he would have been happier with a shorter life and being able to ride his Harley for a while longer. Obviously, I had a lot to learn about brain cancer, although as a motorcycle enthusiast from the age of seventeen I understood about the Harley. The general opinion was that brain radiation necrosis was almost as daunting as the brain tumors themselves, and could have a devastating effect. Another remarked simply, “Cancer stinks!” Amen to that, I thought.

  The American Cancer Society’s website is pretty much confined to the facts, and tends to put about as positive a gloss on things as you can on the subject of cancer and cancer treatment, but most of those who had experienced brain radiation necrosis, or their loved ones, were vocal naysayers who had apparently slipped through the review process and whose opinion was best summed up by that of Howard Beale, the crazed TV news anchor in Network: “I’m mad as hell and I’m not going to take it anymore.”