by Cullin Mitch
So we will survive this, Hollis had told himself. In order to have a future together, he had needed to survive the Korean conflict, and, in turn, she was obligated to draw out that future together by overcoming her cancer. You have no choice, he thought. If I could survive getting shot to find you, you must survive this to keep us from being apart. Defeat isn't an option, even should the battle lines remain.
Although now the harsh August of his military past risked being rivaled by the heartbreaking August of his sedate present — this last August, almost two years since Debra was diagnosed — when the medical options had dwindled down to the possibility of a single clinical trial, after a fourth and final round of chemo had proven less effective than the first round. But the end of chemo didn't crush Debra's spirit; rather, an expression of acceptance passed across her face, some small relief taken from the understanding that she would no longer have to endure the harrowing side effects of treatment — the chemicals burning through her veins, the low white cell blood counts and the numbness and the fatigue, the secondary ailments inherent to fighting off the disease. And there was, too, that final thread of hope, a phase-II clinical trial aimed at inhibiting the growth of blood vessels which supply tumors with blood.
“It's what is known as an antiangiogenesis drug,” Dr. Langford had told Debra and Hollis.
“What does that mean?” Hollis asked.
Seated behind her desk, Dr. Langford moved her center of gravity forward as she calmly spoke, bringing her elbows to rest upon papers and folders, clasping her hands together: “Well, basically, antiangiogenesis agents get in the way of the cancer, interrupting its growth. Of course, we won't know how well it'll work until we've given it a shot — the tumors might not shrink at all, or, best case, the growths could be stopped from spreading. Who knows. The good news is you won't experience the debilitating side effects that characterize chemotherapy. However, a few risks are still involved — ”
“I don't care about risks,” Debra said. “Believe me, there isn't a risk I wouldn't take right now.”
Hollis's hands clutched the chair arms. “What sort of risks?” he asked, sounding unusually sharp.
Blood clots leading to a stroke — Dr. Langford stated matter-of-factly, eyes fixing on Debra — or fatal bleeding in the lungs. “The fact is, there's about a twenty percent chance of this drug resulting in your death. Should clotting occur, though — and should a lethal break or rupture transpire — it'll happen quickly. You won't have much warning, and you'll feel little if any pain.”
“Fair enough.” Debra gave a slow but confident nod. “I can live with that,” these last words producing a lingering, incongruous smirk on her face.
Then came a promise from Dr. Langford, a straightforward agreement made to the sickest of her patients: at the point the disease became unstoppable and nothing more could be done to prolong the patient's life in a meaningful manner, she would say so without hesitation. “Except we're not quite there yet,” she said, lifting her chin slightly and running a hand up over her throat. “Not yet.” Even so, Dr. Langford wanted Debra to begin considering end-of-life decisions, to ask herself what she wanted to do with whatever time she had left. “In other words, do you want to spend your time receiving therapies with a low rate of response but documented rates of toxicity? Or, instead, would you like to take a trip, go visit somewhere you've always wanted to see, or perhaps accomplish something special? One doesn't necessarily exclude the other, mind you. But it's important thinking along those lines — while you can.”
“I understand,” Debra said. “I understand,” she repeated.
As for Hollis, Dr. Langford suggested he look into attending a class on caregiving at Gilda's Club, as it would likely come in handy. “It's not an easy role to play,” she told him. “Also, you must take care of yourself, continue doing the activities you like — don't let yourself feel guilty for allowing yourself to enjoy life during this difficult period. It's okay, and I'm telling you it's okay. You've got absolutely every right to do some things just for yourself, and that'll give you the capacity of taking better care of Debra when and if it should come to that.”
Hollis averted his eyes and sat stiffly and awkwardly. Why are you saying these things? he thought. Why are you telling us this now?
“He worries too much,” he heard Debra say, her voice suddenly breaking, and felt the warmth of her hand briefly squeeze against his wrist before retracting.
“I know he does,” Dr. Langford said, pushing a box of Kleenex across her desk.
His hands began shaking, his eyes started welling. Debra sniffled beside him, but he wouldn't glance up. He refused to acknowledge her tears, because she wasn't supposed to weep; she didn't do that: she was the stronger of them, he had always told himself. Nor would he recognize those other tears forming around Dr. Langford's eyes, brushed away by the doctor's fingertips as Debra both chuckled and wept, saying, “Damnit, doctors aren't supposed to cry. That's not right.”
Dr. Langford chuckled too, even as the tears continued. “Oh, lord,” she said, breathing deeply and then exhaling. “The day I quit crying is the day I really should stop being called a doctor.”
Both women laughed, each one reaching for a Kleenex. It isn't funny, Hollis wanted to say; instead, he forced a smile, his hands shaking uncontrollably but imperceptibly, and gazed at the woven gray patterns infused throughout the industrial carpeting around his shoes — a perfectly flat, cold expanse of fabric, befitting an office where the illusion of hope was kept in check by a less ideal reality. But the faint trembling of his hands wouldn't cease — not while he wrung them together, or hugged Dr. Langford goodbye, or drove off into the desert toward Nine Springs with Debra staring out the passenger window, lost in thought as her palms slid on her jeans. His hands shook in the driveway, when opening the passenger-side door, helping Debra rise to her feet, unlocking the house; they shook inside the entry-way — in the living room, in the bedroom, in the bathroom — while holding the unused vial of pain pills left over from Debra's surgery, the safety cap slipping his grasp and falling into the sink, his unsteady fingers pinching two pills and bringing them to his mouth.
As Debra watched television in the living room, Hollis stretched out for a nap, resting on their bed, staring at the yellow ceiling. He awaited the forgotten sensation to wash over him — that escape from unimaginable pain, that medicated reprieve he had relied upon so long ago — and soon his nerves settled, the trembling soothed by the medication as he began to drift. Shutting his eyes, he reached down, touching his left leg through his pants, pushing at the area where he had once been shot; but he felt nothing there which summoned his old injury, just hard bone and skin belonging to a badly scarred leg which had carried him into retirement and, for almost as far back as he could remember, had pressed against his wife every night — such an unassuming yet intimate mingling of their bodies, so comforting and, until now, so easily taken for granted.
15
Debra would not get better. “They've done all they can do for me, dear.” A final clinical trial, a few more drugs, with each subsequent exam or test confirming results which her withering appearance had already telegraphed: no signs of improvement, if anything a continued decline. But, her tired voice assured Hollis, she would be fine regardless of the likely outcome, and, as well, she insisted he must be fine, too. Yet following restless, anxiety-filled nights in which even medication couldn't induce slumber, her mood was erratic and depressed, the nails on her fingers chewed down to the flesh. And that once oval face was ravaged not just by sickness but also from a lack of sleep — the hollow cheeks, the deep-set eyes, the drawn lips devoid of color. Now alone in his garden, Hollis wonders if he hadn't done enough to save her, to find different solutions or investigate radical alternatives, making an effort to suggest other treatment options. Maybe he should've spoken up in Dr. Langford's office, pressing the doctor harder — rather than sitting passively by, unsure of what to do next, senseless from the continual bad news
while Debra did most of the talking; yes, he should have pounded his fists on the doctor's table, confronting the woman: “This bullshit isn't good enough for us, and it isn't working! We need to cure my wife!” Except that kind of behavior would have only added to the stress and futility of the situation. No, he is convinced, there was reason for temperate, rational, straightforward talk: it kept them from immediately panicking when, in truth, they should have been hurling chairs at walls and cursing God at the top of their lungs.
Then last Wednesday Debra raised her head at the kitchen table and spoke almost as a whisper, so that Hollis paused and looked at her, his fork stopping midair between his open mouth and a large serving of barbecue-grilled portobello mushrooms. “Tell me about us,” she'd said; but her quiet voice had reached him with the clarity of a scream, and he had, in that moment, grasped both the direct and indirect meaning of what she uttered — her hushed request underlined by an expression which, as it appeared on her face, conveyed two different states: a pensive, half-formed grin; sad, gently blinking, smiling eyes. “Will you, please, tell me about us.”
“Of course,” Hollis answered, setting his fork aside. It didn't matter that only a few bites of his dinner had been swallowed, or that he had bothered to prepare the meal for them, or that he was, in fact, quite hungry; none of that mattered at all, especially when Debra — sitting directly across from him, her plate untouched and the food still steaming — could no longer share with him the illusion of having an abundance of time. Instead, her mind had gone searching backward of late, retreating into the past more frequently: perhaps, Hollis worried, because her present and her future had begun to merge, narrowing in so as to become nonexistent. With whatever future remaining for her close at hand, she had nowhere else to go but back to where those left-behind years felt tangible yet distant, and, to some degree, infinite. And while Hollis wished to think otherwise, there possibly could be no next year for Debra, no welcoming of the new century, no slow amble into old age for her; this was likely her future, the last of their future together, and the past now held more hope and promise than what might soon lie ahead.
Such an eminent feeling stemmed from yet another turn in Debra's failing health which, after so many months of trying to keep despair away, cast something of a portentous shade upon the optimism they had sought to maintain; it certainly marred Hollis's faith in her chances of, eventually, overcoming the disease. For even with the antiangiogenesis clinical trial under way, she became conscious of her midsection thickening, swollen and distended and hard, a severe bloating in her abdomen which, she knew, was an indicator of tumors blocking the lymphatic system from draining fluid. “At least I know how I'd look pregnant,” she half joked, staring at herself naked in the full-length bedroom mirror, her normally rapid-fire tone labored by a shortness of breath. “Better late than never, I suppose.”
“I don't think that's very funny,” Hollis said, moving next to her, studying her reflection as if that other version of herself was glimpsed in a fun-house mirror — the scarred stomach jutting bizarrely outward, supported in her palms where it curved downward from the navel, conjuring up the bloated, malnourished third-world children he had sometimes seen on late-night television commercials.
“I don't really think it's funny either,” she snapped.
“Ascites” was what Dr. Langford called the condition, although Debra was already positive of the name before the doctor confirmed its onset (derived from the Greek word askos — Dr. Langford had gone on to explain — meaning bag or sac): a further sign of advanced ovarian cancer, that point when the disease had infiltrated the lymphatic system and had grown well beyond the ovary — often leading to bowel obstructions, pain and pressure, nausea and vomiting, difficulty eating, sometimes requiring a nasogastric tube or gastrostomy tube to be surgically placed through the abdomen and into the stomach. But until the clinical trial was finished, any kind of surgery was to be avoided, and, instead, the excess fluid was removed like gasoline siphoned out of a car, temporarily alleviating the pressure while also robbing her body of much-needed protein and nutrients.
Within five weeks, Debra's stomach had been drained three times at an outpatient clinic, a thin cannula tube depositing between two to three liters of fluid inside a plastic drainage bag. Each of the paracentesis sessions brought on an increased loss of muscle mass — a visible physical depletion, sagging skin and pronounced bone structure — which caused her to look more haggard than ever before, more wasted away and enfeebled; the quick transformation bowed her body, making her stooped, somehow smaller, seemingly fragile and years older than Hollis. Her walk had become a hunched shuffle, her movements sluggish and wavering. She required assistance when going from the house to the Suburban, the Suburban to the clinics, the clinics to Dr. Langford's office. She couldn't grocery shop anymore, or run errands on her own — the frustration of which was sometimes expressed with tears, the occasional throwing of a drinking cup or a pen or a paperback. And as Halloween approached, she lamented the lack of children in Nine Springs, what would be the complete absence of trick-or-treaters on their street, because — as she noted — her appearance wasn't too far from the Wicked Witch of the West. “I bet I'd scare the living daylights out of them,” she'd commented. “Wouldn't even need a costume or any makeup. I'm just plain spooky.”
But last Wednesday morning was when Hollis realized their continually reduced optimism had already evaporated into thin air, coming shortly after Debra had finished the third paracentesis session and was informed by a young outpatient-clinic physician — not by Dr. Langford, not by anyone she had dealt with much during her cancer — that the ascites couldn't be managed any longer without causing serious problems. She would, naturally, collect fluid again in her abdomen yet receive no relief (to treat it further would only make her sicker faster, not to treat it would only make her sicker). Moreover, the clinical trial hadn't produced a single encouraging result, although it was an ongoing effort. All things being normal, they might have experienced a feeling of profound grief, of unfathomable fear, as if a kind of sword of Damocles had been hung above her head. Except they were accustomed to repeated setbacks, having forgotten what it was like to expect a breakthrough. “Oh well,” she had said at the clinic, shrugging indifferently. “It is what it is. That's life — at least what's left of mine anyway.”
“Stop that,” Hollis reproached her. “You're still here.”
“True enough,” she said.
Even so, the moment of Debra's defeat was now unquestionable, expressed symbolically that afternoon in front of their house when Hollis helped her step gradually down from the Suburban to the driveway. But rather than slip her arm through his arm, allowing herself to be guided forward like an invalid, she shook free of him, a look of simmering anger upon her face — eyebrows bunched, lips contracted — and mustering a brief rebound of vigor, she ambled quickly behind the Suburban, as Hollis followed, saying, “What is it? What's wrong?”
And there beneath such a blue, cloudless sky — the sun blazing across rock gardens, tile rooftop shingles, glinting off parked vehicles — Debra peeled a ribbon-shaped, teal-colored Ovarian Cancer Awareness sticker from the Suburban's tailgate. Muttering furiously under her breath, inhaling and exhaling in punctuated gasps, she pushed around Hollis, shuffling up the driveway, as he watched bewildered: lifting her hand, she slapped the sticker hard against the garage door, affixing it crookedly, before taking herself on into the house. Still, Hollis remained by the Suburban, his eyes flitting from the garage door to the ground to the house, and, unable yet to move, he felt himself grow cold in the sunshine. Afterward, he found her seated at the kitchen table, holding a paperback mystery, reading with the same furious look on her face. Nothing, then, would be spoken, nothing said for over an hour — nothing mentioned at all until, raising her head a while later at the table, she spoke to him almost in a whisper, so that he paused and looked at her, his fork stopping midair between his open mouth and a large serving of barbecue-
grilled portobello mushrooms.
Tell me about us.
“Well, now, let's see, what can I tell you about us.” Without fully standing upright, Hollis changed chairs at the table, seating himself beside Debra — near enough to stroke her shoulder, to gaze at her gaunt, hawklike profile while she slid her plate away, then folded her hands upon the table-top, then glanced at him intently and nodded once, letting him know she was ready for him to proceed. “Where should I start?” he asked, searching his memory, sifting through their life together, glimpsing random scenes which sprang out of nowhere — lighting fireworks on his sister-in-law's lawn, skinny-dipping among cattle at a West Texas watering hole, buying snow cones somewhere in Nebraska or Kansas when hauling their few possessions to California — as if he were flipping the pages of an old photo album. “It's odd thinking about it, but I'd sort of seen you before we actually met,” he told her with a calm, steady voice. “I'd caught sight of you from another side of the globe, during Korea, over in a country you hadn't even been to — and I didn't know we were destined for each other, didn't have a notion we'd meet one day like we did.” He wiped sweat from his forehead while speaking. Two flies buzzed against the kitchen window; the ceiling fan whirred high above a platter of veggie kabobs which had been brought to the table from the outside grill; the yellow Hawaiian shirt and tan Bermuda shorts he wore were stained and damp in places with perspiration. In four days there would be snow on the ground. “But I guess you were like a ghost to me until we became acquainted.” He hesitated, frowning at his choice of words. Debra, however, was grinning, appearing duly interested, somewhat pleased. “I mean, I'd first seen you, except I hadn't really seen you, if that makes any sense.” Everything was suddenly dim around him, the kitchen engulfed by shadows which covered the floor like black, stagnant water, and, just then, he realized it was getting dark a little too early. “So, what can I tell you about us?” he said, rubbing and patting her shoulder as dusk set in, aware more than ever of how good it had always been to simply touch her.
