by Rod Dreher
It was a risky move, Tim thought. West Feliciana isn’t a big place and there might not be enough business to go around. Tim quickly discovered that he enjoyed being a country doctor because he was able to get to know his patients personally before they became his patients. Treating people he knew as a baseball coach or a Sunday school teacher allowed him to practice medicine in a personal, emotional, and even spiritual way. For Tim healing was not only about fixing the body; it involved helping patients discover how they could bring their emotional and spiritual lives back into balance. He found that at times he anticipated that particular patients would be coming in to see him, simply because he had heard through the community grapevine what was going on in their lives.
Tim did not know Ruthie well. She was older than he, and had gone to a different school. Ruthie’s and Mike’s paths began crossing Tim’s and Laura’s when my youngest niece, Rebekah, and Mary Margaret Lindsey, their daughter, became best friends in first grade.
There were other connections. Tim and Laura were leaders in Young Life, the teenage parachurch Christian fellowship, whose meetings Hannah started attending when she was fifteen. But for the most part the Lemings and the Lindseys were little more than acquaintances until Abby succeeded in convincing Ruthie to walk into the Daniel Clinic.
Ruthie showed up there at the end of the workday. Her shortness of breath startled Tim. She could barely complete her sentences without gasping or succumbing to her raspy cough.
Her previous doctor had called it allergies. Then he said it was bronchitis, or maybe asthma. Nothing he prescribed had worked. Given Ruthie’s shocking degree of physical distress, Tim knew something critical had to be done for her.
He ordered a chest X-ray. The results came back on a Friday, and they were grim. Splatters covered her lungs. Fearing cancer, Tim ordered a CT scan for early the next week. He phoned Ruthie at home to tell her the news.
“I’m not going to lie to you, it’s not good,” Tim said. “We have to rule out cancer. I’m not saying it’s cancer, but I am saying we have to rule it out.”
Ruthie took the news calmly. But when Abby called to hear the results, she found Ruthie in tears.
“There are spots on my lungs, and they don’t know what it is,” she cried. Mike was overnighting at the fire station and she didn’t want to deliver the news by phone. She swore Abby to silence and said she wasn’t going to tell anybody else just then. She didn’t want to worry them.
“I’ve got to pull myself together,” Ruthie said. “I’ve got to go pick up the girls.”
“Do you want me to get them for you, Ruthie?”
“No, I can do it. I’ll be fine.”
“Ruthie, we’re going to figure this out,” Abby said. “We’re going to get through this. Okay?”
“Okay.”
Ruthie climbed into her SUV to head out to pick up her children, but the burden of this news paralyzed her. She realized that she couldn’t, after all, keep it from Mike until he finished his shift on Saturday. She sat in the Ford under their carport, and dialed his number on her mobile.
“I have some bad news, Michael,” she said, and began to cry. “Tim called and said they found spots all over my lungs. I’m so sorry. I know you didn’t need to hear this.”
Mike swallowed hard. This was worse than they had anticipated. A lot worse.
“Try not to worry too much,” he said to his wife. “It might be nothing serious. They still have to do more tests. I love you. I’ll see you tomorrow.” Ruthie kept the news from Mam and Paw.
Days later the radiologist called Tim to discuss the results. “It’s crazy, but I don’t know what this is,” he said. “It could be fungal, it could be an infection. She doesn’t have a defined mass, and her lymph nodes are fine. This one has me stumped.”
That’s when Ruthie disclosed her condition to me. I was driving home from work at dusk and called her as I motored home along the wooded road headed for a ridge along the Schuylkill River. As I sat in traffic waiting for the light to change, I heard my sister say: “There are spots on my lungs. But listen, don’t worry about it. If this were cancer, my lymph nodes would be messed up. They’re normal. This could be some sort of fungus from those peppers I inhaled. You can’t tell Mam and Paw, though. You know how they worry.”
This really is cancer, I thought. But I dropped that notion like a pie tin of hot coals. Ruthie’s tone was so matter-of-fact and reassuring that it was easy to trust her. Besides her lymph glands were fine, and we all knew that forty-year-old women who have never smoked don’t get lung cancer. Anyway there’s crazy stuff in the subtropical air in Louisiana; maybe a hurricane or a storm kicked up something last fall that got stuck in her lungs. It was probably a fungal thing.
It took three weeks for Ruthie to get an appointment with a pulmonologist. The doctor examined the first CT scan, found it puzzling, then ordered a second scan. This one was dramatically worse, and her lymph glands were enlarged. It looked for all the world like an extremely aggressive form of cancer.
“The truth is, it was a terminal illness from the moment I saw her.” Tim sighs. “I know that. But in my mind, as a doctor who wants to fix things, I thought about that three weeks, and wondered if we could have found this earlier.”
The pulmonologist ordered a bronchoscopy, a procedure in which surgeons snake a tubelike instrument through the mouth or nose into the lungs to examine the condition of pulmonary tissue and retrieve tissue samples for biopsy. It did not go well. Ruthie’s lungs were in terrible condition, and hemorrhaged badly.
“I’ve never seen one like this,” the pulmonologist told Tim. “The only thing we can do is figure out what kind of cancer this is so we can treat it.”
Ruthie’s doctors scheduled surgery for February 16—Mardi Gras, 2010. Fat Tuesday, the high holy day of south Louisiana revelry. They would go into her lungs to excise and biopsy the growth near her heart. In the days leading up to the operation, Tim tried to comfort Ruthie and Mike, but he was discouraged by how rapidly her health was declining. Meanwhile Ruthie was quietly researching medical possibilities.
Was she frightened? Yes. But she stayed calm. She knew that Mike and the girls were watching her closely, and taking emotional cues from her behavior. If she kept her head and stayed upbeat, maybe they would too. She had to be strong, she figured. She couldn’t let Mike and the children be afraid.
The annual Spanish Town Mardi Gras parade rolled on the Saturday before her surgery. Though Carnival celebrations are more common in New Orleans and Louisiana’s Cajun country, Baton Rouge’s funky Spanish Town neighborhood held its own popular parade, which had become a Capital City tradition. Ruthie and Mike joined their friends in a krewe—a Mardi Gras parading club—called the Krewe of Updog (“What’s ‘Updog’?”—get it?) in the parade. Ruthie rode an Updog float, tossing beads and doubloons into the crowds below. She told friends who asked about her health that she was going to have a little outpatient procedure done on Tuesday, but it was no big deal.
Ruthie and Mike awoke at five on that morning, dressed, and drove to Baton Rouge for the surgery. All the girls knew was that Mama was going to the hospital to have some kind of operation done to determine what was causing the cough. Ruthie had kept all knowledge about the severity of her condition and the seriousness of the surgery from the three children. Because it was a school holiday in Louisiana—Ruthie, for whom the universe was south Louisiana, had been surprised to learn that schools elsewhere didn’t have Mardi Gras off—Mam took the girls to Laura and Tim’s house for the day.
Mam stopped off in Starhill to pick Paw up, then drove on to Our Lady of the Lake, the big Catholic hospital in south Baton Rouge. As the waiting room at the Lake filled with friends and family, the lead surgeon made an incision above Ruthie’s breastbone and began to burrow into her chest cavity.
CHAPTER SEVEN
The Bright Sadness
What the surgeons found that February morning was so frightening that one of them telephoned Dr. Geral
d Miletello, a veteran Baton Rouge oncologist, directly from the operating room. The surgeon’s voice was shaky and scared as he described what he had seen in the patient’s lung. It was a large, angry tumor that gripped the superior vena cava, the vein that carries deoxygenated blood from the upper half of the body to the heart. They had tried to cut the tumor out, but found it impossible.
The surgeons were upset. Ruthie should not have had this tumor. She was young. She had never been a smoker. She had no family history of lung cancer. Nothing about this diagnosis made sense.
Still in scrubs, one surgeon gathered Mike, Mam, Paw, and Abby into a small room adjacent to the waiting room. He began to tell them what he had seen inside Ruthie. Everyone was tense and afraid.
“It’s cancerous,” the surgeon said. “It’s a malignant carcinoma.”
Mike buried his head in his hands and heaved with sobs as Abby threw her arms around him, as if to keep him from flying to pieces. Mam and Paw collapsed into tears. Trembling, Paw looked with desperation around the room, as if looking for cover. Mam thought, My God, I’ve got to call Rod.
Julie and I knew Ruthie was having exploratory surgery that morning and had been up for hours, praying and worrying. At half past nine my iPhone rang. The screen told me it was Mam. Julie and I hustled into the bathroom, where our children couldn’t see our reaction, in case the news was bad. I answered the call.
“Baby, it’s cancer!” Mam shrieked. “It’s cancer! It’s malignant. Sister has lung cancer.”
My stomach tightened. This is really happening, I thought.
To us.
To our family.
Julie, who could hear Mam’s frantic voice through the phone, gasped and threw her arms around me. I steadied myself against the sink, swallowed hard, and told my mother I would be on the next flight I could book.
“Mama, don’t worry,” I said. “God will take care of us.”
I ended the call, held my wife, and with my head buried in the crook of her neck, felt hot tears pour down my cheeks.
“We have to tell the kids,” she said.
Our children—Matthew, Lucas, and Nora—knew that Aunt Ruthie was going in for an operation to figure out why she had been coughing so much. They did not know what this meant. They had never dealt with serious illness in a close family member. We dreaded breaking this news to them.
At eleven, Matthew was the one we were least worried about. Wry and unusually mature, Matthew was already adept at using ironic humor to distance himself from strong emotion. Four-year-old Nora—named for the high school teacher who helped me leave St. Francisville—was too young to appreciate the gravity of this news.
But Lucas? The news would tear him to bits. Blond, athletic, and buoyant, Lucas, age six, was easily the most spirited of our children—and by far the most emotional. He was especially close to Aunt Ruthie, who saw a lot of herself in him. She adored Lucas’s sweet nature, his eagerness to be outdoors, and, despite his physical toughness, the way he would tear up over sentimental things. From the time he was four Lucas cherished waking up early on visits to Mam and Paw’s, putting on his shoes, and running over to the Leming house. Sometimes he would crawl into the bed and snuggle with his aunt, who doted on him and gave that sweet baby Pop-Tarts even though his daddy said he couldn’t have them.
And now we had to tell him that Aunt Ruthie was very sick and might die.
Julie and I gathered the children around the Jesus icon on the mantel. It was where we said our bedtime prayers. The night before we had prayed as a family for Aunt Ruthie’s peace, and for God to guide the hands of the surgeons the next morning. Now we would pray for her again.
We sat together on the edge of the coffee table, with the children standing in front of us. They were visibly nervous, eyes wide and mouths tight.
“Kids, we have some bad news,” I said. “Aunt Ruthie has cancer. It’s a bad disease. She’s really sick.”
They stood stock-still.
Lucas was the first to speak, saying in a tiny voice, as if he were peeking out from under a blanket, “Is she going to die?”
“She might, baby,” I said. “The doctors are going to do all they can, and we’re going to pray for her. But she might.”
His fists shot up to his eyes, pressing them hard and rubbing vigorously. The harder he dug and twisted, the more wild tears soaked his cheeks and hands. It looked like he was juicing a lemon.
Nora and Matthew, their faces blotchy and distressed, stepped by instinct toward me. Julie swept them and Lucas into my embrace. We collapsed into each other and cried for Ruthie, for Mike, for the girls, and for ourselves. After a minute of this, I stood and asked everyone to face the icon. We crossed ourselves and prayed for Ruthie.
I told the children I would have to go later that day down to Louisiana to be with Aunt Ruthie. Lucas ran to his room and threw himself facedown on his bed. He pulled his pillow down tight over his head and tried to hide from the worst day of his life.
I phoned my manager at the John Templeton Foundation, told him the news, and said I needed to go. I had been an employee there for exactly six weeks.
“Take as much time as you need,” he said. “Don’t worry about it. We’re thinking of you and praying for you all.”
In those days I wrote a blog for the faith and culture site Beliefnet.com. Because of the intimate rapport I had developed with my readers, I felt that I could tell them what was happening with my sister, and to allude to a sadness I felt about a piece of unfinished business that lingered between us.
Since that “good country cook” remark over the uneaten bouillabaisse over a decade earlier, Ruthie had found more than a few occasions to sink a similar claw into me on visits back home. By then it was undeniable that Ruthie harbored anger at me, even though most of the time we got along well. It would usually come out in arguments over food, or the different ways we raised our children. Ruthie plainly loved me, but she just as plainly thought that I was a snob and a fraud.
I knew this was how she felt, but I also did not know how to address it. Like our father Ruthie was not one to let facts or contradictory opinions get in the way of emotional truths she had settled on. That was her nature. And it was my nature to investigate, to dissect, to analyze. Ruthie did not want to talk about it. Had I been living in Louisiana, we would have had to talk about it, because the tension was hard to bear. But I wasn’t living in Louisiana; I only visited for a few days each year. Why stir up trouble? We could work it out someday.
On our last Christmas visit home to Louisiana before we moved to Philly, Ruthie made an offhand remark about me at the dinner table that cut me deeply. As we gathered at the table to pray before Sunday dinner, Ruthie said, “Rod, why don’t you say the blessing, since you’re so holier-than-thou.”
I held my tongue, but was furious. Still seething after the meal I told Paw privately I was fed up with Ruthie’s behavior toward me.
“What is her problem with me anyway?” I asked him.
He looked hurt. “I don’t know, son. There’s something there, but I don’t know what it is.” She later told him that she had mistaken the spiteful phrase “holier-than-thou,” which means “religiously self-righteous,” for the benign term “prayerful.” I wasn’t convinced.
This episode was on my mind as I waited for the car to arrive to take me to the airport. I just had time to post this message on my blog:
Folks, my presence on this blog will be light in the days to come. I’ve just received terrible news of a critical family medical emergency, and will be getting on a plane for Louisiana this afternoon. I’m not at liberty to share details right now, out of privacy concerns, but I do beg your prayers for us. I will share more information as I am able.
To be sure, I’m not at odds with my stricken family member, but let me beg something else of you: right now, on this very day, ask forgiveness of those you’ve offended, and offer it to those who have offended you. Be reconciled, if you can. Don’t live as if you have all the time in
the world, because you don’t. None of us do.
Change your life. Repent. Love. It’s urgent. You have no idea how urgent until you get a phone call like I received this morning.
Within two hours my plane lifted off from Philadelphia, headed south.
Back at the hospital Abby snapped into crisis manager mode.
“Do you want me to call Tim?” she asked Mike. He said yes. She left the room to use her mobile phone. Mike stepped into the bathroom, knelt down next to the toilet, and, overcome by anxiety and horror, vomited. Abby punched Tim’s number into her phone, and told him everything.
“Do you know people?” she said to him. “What do we need to do?” Tim told her he would take care of everything.
As the day wore on the waiting room filled and emptied with more friends and family. News of the diagnosis devastated each new arrival. By late morning everyone was shattered, scared, sobbing, holding each other. Fear paralyzed Mike. Paw stumbled to a private alcove down the hall to be alone. Mam joined him and prayed silently: Why, God? She has always done the right thing. She has always been such a good girl. She has those three babies. Why her?
When Ruthie awoke from anesthesia one of her surgeons was sitting at her bedside.
“I have cancer, don’t I?” she said.
“Yes,” the doctor said. “You do.”
Then she met Dr. Miletello, a wiry, middle-aged physician with short salt-and-pepper hair and a generous smile. He would be her cancer specialist. His soft voice and tender demeanor made his manner more pastoral than clinical. For twenty-five years he had been having these bedside conversations with new cancer patients. It never was easy.
Yet Ruthie’s response to the news shocked the veteran oncologist. “She was almost like ‘thank you.’ No hostility. She was just very accepting,” he remembers.
A short time later Mike and Abby found Ruthie in the recovery room. She was alone and slightly groggy. A nurse let them know Ruthie had been told she had cancer, but Ruthie wasn’t aware that Mike and Abby knew.
