by Charles Bock
When Alice’s face had still been pretty swollen, and her counts were still in the shitter, and she’d barely had the strength to hold up a glass of water, and couldn’t eat so much as a third of Dartmouth’s version of scrambled eggs, Oliver had realized: This is one way it could happen. The fear that had followed was visionary. Whether or not her hunger strike was intentional or drug induced was beside the point. No matter how much the doctors, nurses, Tilda, Oliver, or even Alice’s mom prompted her, no matter whether Alice understood their words, caught their implications, without eating, Oliver had realized, she’d keep fading: turning too weak to try and pick up a plastic fork, too weak to chew. At which point, her inability to put a piece of food into her mouth, the impossibility of her chewing, the momentum of her weariness and weakness and lack of appetite, they’d spur more weariness and weakness, furthering her lack of appetite. Liquid nutrition would not matter.
This was one way she could vanish.
“These eggs actually look pretty good,” he’d said. “Why not go for one more bite?”
•Mt. Zion Cancer Center, 1200 York Ave., Hematology/Oncology, Rm. 820
•Whitman Memorial, 1220 York Ave., Hematology/Oncology, Rm. 412 (critical)
Two separate bouts of induction chemo. Six consolidations. Plus enough radiation to create a mutant army. These along with two bone marrow transplants—the first allogenic, then, when the cancer returned, a nonallogenic transplant, using a chemo drug approved for use on children, still experimental in adults. In short, every weapon they could think of. Still her leukemia came back, its third and final stay. In the back of the exam room, the doctor, damp in the eyes, continued with his responsibilities, explaining that they’d continue the woman’s regular appointments, keep monitoring her, administering her routine of blood transfusions; she’d come into the urgent care center when necessary, and the hospital would of course admit her if and when needed. If she was strong enough and was willing, they could even try more chemo. But the most that could be expected was temporary easement.
The best thing to say about any day that followed was: she did not feel any worse; at the same time there were no days when she felt an improvement. No days when she felt stronger, or had sustained bursts of energy, when her counts rose of their own accord, when her most cherished foods seemed more appetizing than biting down on a cinder block. She regressed from walking to needing a walker, from needing a walker to taking a wheelchair. The woman could not take care of herself but was too proud to enter a home; she felt that was giving up. But her insurance would not cover a home living aide; so one of her grandchildren took a leave of absence from Columbia’s graduate program in nanophysics and moved into the old Queens brownstone; and since the old woman’s thighs were too weak and the toilet too low, five or six times a day she helped her grandmother—all wrinkles and skin and noodle appendages—squat onto and rise from the bowl. The granddaughter herself was spindly in the manner of a preteen boy, accustomed to huge science books and hours of reading, not even close to in shape to lift anybody, even a shriveled old woman. She certainly had no experience transporting invalid seniors back and forth to the hospital. But she purchased a heavy steel ramp, and convinced the super to let her store the thing in the ground-floor maintenance closet, so on the two days a week when it was time to get Granny out of the apartment for her transfusions (the only things the old woman left the apartment for anymore), the granddaughter could get her up and down the large front steps out in front of the stately prewar building. She ordered an expensive car service for each trip, paid the super to set up the heavy ramp over the front steps. Transferring the old woman out of the chair and into the car was one more slice of fresh hell; the super had been a Russian mob underling before coming to America and refused to get involved unless the granddaughter paid him more; usually the driver stood and watched.
In this joyless manner the two women moved from the beginning of the endgame to wherever this new place happened to be, and were summarily informed that the insurance company had determined that, in this new phase, they no longer needed care from an elite hospital. The granddaughter stayed up late reading policy manuals, she spent untold hours on the phone appealing the transfer of care, dealing with all the attendant paperwork that surrounded her appeals. The granddaughter conscripted very bright friends to do research, make calls, cast the proverbial wide net. She did not want her grandmother transferred to that city hospital. Her friends came up with a drug, not yet approved by the Food and Drug Administration, but undergoing testing at various hospitals in the Northeast. The tests were still in their early stages; some results were encouraging. The woman’s eyes were gummy each morning; her left lid was red and inflamed; she saw things in double and triple, and was weak in a manner that made her previous states of weakness look like workouts by steroid freaks on Venice Beach. The city hospital was a dark and gloomy hull, a broken-down graveyard, especially in comparison to the gleam of new money that sharpened Mt. Zion’s hallways. The city hospital’s waiting rooms were like outclassed cousins whose attempts to keep up made them appear much more quaint and sad.
Her new doctor thought her vision problems might be from leukemia in the brain. He urged a kind of low-grade chemo, immediately, a syringe of it pushed in to linger in her brain fluid. Actually, he said, it’s a lot better than it sounds. She refused: nothing till the tests came back.
Wouldn’t you know, the numbers came back. Turned out she’d been drinking too much water, which had been clearing out her system, causing all kinds of imbalances, which may have played a role in her vision problems. It raised the possibility the woman’s vision problems weren’t caused by brain cancer. It also was eminently possible medicines had caused her muscle weakness and the problems with her gait, which was why she’d been so unsteady. The hospital corrected the problem by giving her different steroids. Instead of water, doctors had her drink Gatorade. She was released in four days.
And this, the woman being right about not getting the chemo injected into her brain, would indeed have been a nice little we-really-did-know-better-than-the-doctors type success story, high-fives all around—that is, if the cancer had indeed subsided after the woman had switched to Gatorade. But we all know, Gatorade does not cure cancer. When the woman got out of the hospital, she still needed her wheelchair and her ramp and her car service. She had to have someone bring her food and aid her up that little step into the bathroom and get her up from off the toilet. In a matter of weeks some other germ got to her and her lungs were filled with so much mucus she was back in the hospital, and in order to breathe, in order to save her life, she needed this thick tube jammed down her throat. Insurance wouldn’t spring for a private room, they put her in with another sickie, apparently everyone would just have to cross their fingers and hope that a thick vinyl curtain would stop any germs. In the side counter of her small basement dry cleaner’s, the woman used to have a boxy television set with shitty reception, lines of fuzz and white noise, the images going wavy whenever the 7 train passed nearby, and still, through the course of her days at work, she watched game shows. Press Your Luck. Wheel of Fortune. She used to rise every day at dawn and walk her two little Yorkies and do tai chi in the small cement park next to the expressway. She’d helped teach the granddaughter how to organize and alphabetize by using the numbers and names on laundry tickets, and that same granddaughter was now taking up very large chunks of her grad-school-insurance-paid-for fifty-minute therapy sessions complaining that she could not take any more of this, her own life shrinking, she was being forced into a cage, but she also had to take more of this, because the only way things looked like they were going to change was in the wrong direction, and she wasn’t prepared to handle that.
Still. Rumbling around in her head, that fledgling idea.
Her older brother flew in from the West Coast after she shared her idea. And once they’d struck out with the Indian woman who followed around their grandmother’s doctor as if she was his pet, they approached
the real man in charge, cornering the doctor in the hallway outside the room their grandmother was sharing, and bringing him up to speed about this drug that hadn’t been FDA approved for leukemia, but had been approved for other forms of cancer, and that even now was being tested in other hospitals. They gave the head doctor the experimental drug’s clinical trial prospectus. The granddaughter pleaded for him to take it home over the weekend. Give it a read.
The doctor told her he knew what they were trying to do. It was admirable. But they were talking about a controlled trial being conducted by another hospital. The doctor had never worked with this drug, and the granddaughter wanted him to prescribe it on an outpatient basis, for a disease it was neither intended nor approved for?
The granddaughter’s voice was steel as she reminded the doctor he sure didn’t have a problem recommending the injection of chemotherapy drugs into an old woman’s spinal fluid before tests had confirmed the cancer had spread there.
The doctor flinched and responded, with some ire, that he made a diagnosis; and the granddaughter did not flinch, and said she knew he did, and he should diagnose this. He should prescribe this for her.
People were openly gawking. Orderlies and nurse-practitioners had stopped in place to watch. The doctor’s voice was searing now as he said the grandmother would take the drug and the odds were she would be dead in a week. Even today her condition was serious. He might need to perform a procedure to clear her lungs that was traumatic to say the least, and was going to require that the granddaughter and her dad finally make a decision on the do not resuscitate form.
The doctor then reminded the granddaughter that hospital policy was to do the most humane treatments for their patients. In reply he was told it was awfully big of him to consider this option so seriously and decide what was so humane.
The granddaughter could not make him prescribe that drug, said the doctor.
They locked eyes and the doctor maintained his gaze and purposefully slowed his words and said the hospital would do their best to get the grandmother stabilized and home to the granddaughter. He told the granddaughter that if the grandmother felt sick again, they could bring her in, or could choose not to. He said he was sorry, he could imagine how the granddaughter must feel.
“You can?” she answered. “You can understand, but still say no?”
Welcome to my body
THE BLUE OF cloudless skies. A woven mesh, lightweight metal, materials designed to ward away, to shield. Everyone who entered wore one. And of course the usual gloves. The masks.
Alice asked if she at least got a smock. Carmen gave a small laugh, made eye contact with the second nurse. Working as a pair, they made sure that the patient number on Alice’s plastic bracelet corresponded to the numbers on each round glass bottle or plastic bag, asking Alice when her birthday was, then checking that item off their list. Carmen showed Alice each bottle, explaining: This is an antibiotic drip of penicillin. This is Sapeptamonizene.
In the two big windows the sky had darkened, the snowfall thickening even further, and between this and the colored crepe paper over the lights, the near side of the room was enveloped in gloom. Carmen asked if it was okay to take down the mood paper, they needed to be able to see everything. Alice looked disappointed but nodded, then mouthed out her recognition of the second nurse, the name emerging as a question. Requita winked back, kept on hooking up the glass bottles of cloudy drips, the transparent bags bloated with mucus-looking liquid. Above the battery pack, an almost ghostly tree formed, branches thick and limbs spreading, tubes running down toward Alice’s port like so many vines. Carmen was using a red Magic Marker to write on Alice’s skin the current military time and date, so the next nurses would know when to change dressings, replace catheters; Requita was casting evil eyes toward the battery pack’s infernal beeping. Now she rolled back the sleeves of Alice’s robe, began wrapping gauze around Alice’s forearms; she wanted to ensure Alice’s arms stayed warm. This would help the medicine circulate.
“We’re putting you on a steroid,” she said. “It’ll run through the course of the consolidation. It makes you feel energetic, even a little high.”
“With any luck,” Carmen added, “you’ll start that appetite.”
Near the entrance, Dr. Eisenstatt began fitting his arms into his blue smock, leaving the strings that were supposed to go around his neck untied, giving the smock a looseness, a droopy scoop around his upper chest. When he stepped forward the nurses ceased jawing. The doctor’s forehead was flushed; his eyes darted, wide, a bit wild, but disciplined. He acknowledged Oliver, checked that the nurses were properly subdued.
“Where have you been, Howie?” Alice called. “I thought you’d abandoned me.”
It was evident Dr. Eisenstatt was not accustomed to being teased, especially not by patients. His already flushed face turned a deeper shade. The doctor seemed to stare through his chart. He did that thing where he pinched the bridge of his nose. Rubbing his eyelids with his thumbs, he murmured something unheard, took a few breaths. In the scoop of his undone smock, Alice recognized his starched and narrow pin collar, replete with gold bar running behind the raised tie knot—a flourish that defined custom-made, high-end dress shirts. Alice also noticed that his shirt was a bit too large, couldn’t have been custom made. The thought flashed through her mind that the doctor’s mother bought it for him at a Barneys Warehouse sale. Alice chided herself but also felt nourished—not merely by the doctor’s brain freeze, his vulnerability, or even his confusion, but rather, by the vehemence of her own cattiness.
“Aside from your concerns with my tardiness,” Eisenstatt said, “which I certainly understand and can sympathize with, and apologize for.” Eisenstatt refocused and paused, gracious. “Now that I’ve finally managed to get here, from all indications, things appear to be going quite well, which is heartening.” He stepped toward the bed. “It also came to my attention that you and the nurse had a meeting of the minds.”
Breezing past the nurse to whom he’d just referred, and whose name apparently did not matter to him, Eisenstatt stopped at the side of the bed. “Mrs. Culvert, let me assure you. You are exactly where you need to be. If the cancer was present, you’d be back in reinduction, understand?” His intelligence added weight to each sentence, and his focus impacted this weight, landing smack between Alice’s eyes. “We want to keep your cancer in remission. This is the treatment.”
Alice’s silence conveyed acquiescence. Readying the late pages of a tattered notebook, she followed the doctor as best she could, scribbling along while Eisenstatt explained that her consolidation chemo cycle was scheduled to run over the course of six days. Alice would get her dose at 7:00 P.M. and 7:00 A.M. Would have a day of rest afterward, on-off, this the pattern through her six-day cycle.
“So before and after seven, Doe can come.” She wrung out her writing hand.
“She misses you,” Oliver said. “I’ll have her here.”
On her side, Requita was wrapping a blood pressure sleeve around the arm nearest her port.
“I don’t think that’s a good idea,” Alice told her. “I’m not meaning to be difficult.”
Eisenstatt watched the nurse undo the sleeve. “A lot of our patients take for granted that consolidation is routine,” he said, a hint of the scolding father coming through. “Assuming things go according to plan, you’ll feel fine for most of your stay. When you go home and your numbers start to drop, that’s when you’ll get weak and tired. Probably half my patients end up coming back to the hospital—not from the chemo but from infections. Consolidation chemo is actually more potent than the induction.”
“Already you are bringing clouds of doom, O Jewish granny. Does this officially make you a yenta? Is that the term?” Motioning to the pictures on the bedside table, she spoke to Oliver. “Little kumquat.”
“You’ve been through this already, I understand. But we don’t want expectations working against you. It is not uncommon. After patients have been through che
motherapy once, they think they know what’s coming.”
“Doctor, is it possible for me to hold the drugs?”
Howard Eisenstatt, MD, looked at her as if she were from another planet.
“The chemotherapy drugs. Before we start?”
The ripple of confusion swelled, extending into uncertain looks. But he had no reason to refuse. The bottle itself was thick as a jelly jar, without a single contour: it came off the tree. Alice let it rest in her lap, then she pressed her palms until they were flat against each side. She shut her eyes, kept pressing her palms until the atoms of her flesh merged into the smoothness, until flesh and glass and medicine were one being, one thing. Inside the eye of her mind, Alice envisioned a smooth whiteness—flowing through her, pushing out stray thoughts, flattening worry. She inhaled up through her diaphragm, felt her chest rise, felt air swell through her, made her inner self as massive, as empty as possible. She took a long exhalation, pushing all of this gathered swelling energy out through her nose, feeling those flat stray worries push out of her body. Alice lingered on her child. Her friends. Her mother. Her passed father. Her husband. Her child. Love palpitated through her, and she channeled this love, harnessed it. “You have an important job,” Alice told the clear contents of the jar between her palms. “Welcome to my body.”
Exhaling again through her nose, Alice felt her skin alive and vibrating; and she was not scared. Handing back the bottle to Carmen, she gave thanks. Oliver was lowering himself with care onto the opposite side of the bed, making sure he did not land on her; he was lying sideways, at once next to her and on her, his chest warm on her arm and shoulder without being too heavy, his groin rubbing into her hip, the sensations wonderful, his leg now wrapping itself over hers, his touch tantalizing. Alice grabbed her husband’s hand. He kissed her on the neck, nibbled her hanging lobe. The nurses could have used popcorn, gawking the way they were.
