Yet Carrie is remarkably calm about it all. “Right now they’re both still shy of a centimeter,” she says, “so in nine months, the growth has been very slow. That’s encouraging. Because of their size and location, I don’t think a surgical biopsy would even be possible just yet.” Yet. Surely one of the most portentous words in cancer. “You could just enjoy the rest of your summer and wait until your next scheduled scans in six months and see where you are then,” she continues, “but because of your cancer’s high recurrence rate, you might prefer to have a consult with Dr. Partridge.” Tiny specks in my lung. Could be nothing, but they’re growing. I’d say the idea of enjoying the rest of the summer is not an option anymore.
“Thanks for the information,” I say. “Can you transfer me over to Dr. Partridge’s office?”
I knew all along there would be good checkups and not-so-good checkups. Yet the achiever in me cannot help feeling like I’ve let down the team.
That night at dinner, I give Jeff and the kids the light version of the story—that my condition has changed a little, and that I’m going back to meet with Dr. Partridge. It’s easier to spring on them than “I could have cancer in my lungs, you guys.”
“There are all kinds of things it could be,” Jeff says to me later, as we climb into bed. “Benign tumors. Fatty deposits. We don’t really know.”
“Absolutely,” I reply with a halfhearted smile. Maybe there is a correct way to respond when you get the news that you might—or then again might not—have a potentially fatal recurrence of your cancer, but I don’t know what it is. It’s kind of like someone pointing a gun at you that might—or then again might not—be loaded. Do you shrug or do you panic? Shrugging seems like a better plan, especially when you know you can always switch to panic later. But had I known then what I know now—that my doctors will soon be calling me in their reports a patient with a “presumptive diagnosis of Stage 4 melanoma” who was getting checked “to establish metastatic disease”—I’d surely have panicked.
August 2, 2011
While Jeff and the girls are spending a long and I hope distracting day at Coney Island with friends, I am sitting in my seersucker gown again as Dr. Partridge makes perfunctory chitchat before getting around to the cancer talk. It’s almost exactly one year since the day of my diagnosis, just as bright and pleasant as it was 12 months ago. Where better to celebrate my cancerversary than Sloan Kettering?
“I’ve reviewed your scans,” Dr. Partridge says, “and they’re not encouraging. I don’t like to wait around with growths. I’m going to recommend you go over to our thoracic department for a consultation about a surgical biopsy. In the meantime we’ll do the mutation test on that melanoma we removed last year.”
Within this institution full of orchids and free saltines in the waiting area, this place is teeming with cancer. The people who work here are just trying to move it from the bald people sitting outside in the waiting room into dishes and slides and cabinets within. Somewhere in Sloan Kettering, the original tumor that tried to kill me is preserved, like Han Solo in carbonite. “If we need to treat you further,” she continues, “I want you to meet with the immunology team again and talk to them.”
“I thought the lung nodules were too small to biopsy,” I protest.
She gives a thoughtful squint and says, “One of them is pretty deep, in a delicate part of the lung. The other one is close to the surface. I think Dr. Risk can hit it. Once he sees what’s going on with that one, we’ll know what we’re dealing with. It’s fairly straightforward. You wouldn’t have to stay in the hospital too long.”
“His name is Dr. Risk? You think he can hit it?” I ask. This is all very confidence inspiring. Where’s Dr. Sure Thing? I’d like to schedule a meeting with him. And I thought biopsies were brief, in-office affairs. I suppose, come to think of it, that taking mystery nodules out of a person’s lung is a little more elaborate.
“You’re a good candidate for a successful procedure,” Dr. Partridge explains. “You’re doing well, right? You feel all right? You’re young, you’re in excellent shape.”
I’m 45 and my doctor clearly suspects I have cancer that has metastasized into my lung, but sure, I’ll play along. “I guess so,” I say. As she gropes purposefully around my lymph nodes, it sinks in that I really might have cancer again. And with that sobering thought, I learn that’s how you get through a lymph node check without giggling.
“I’m probably healthier now than I was a year ago,” I say. “I’m taking care of myself. Things are good. It’s like that phrase I bet you hear all the time, right? I’ve had the gift of cancer.”
She pulls her hands away and shakes her head. “Gift? Oh no,” she says. “That’s the worst gift I could possibly think of.”
In a world in which people who’ve had cancer are routinely expected to be heroic and inspirational, it is very nice to have a doctor who understands that cancer is actually just a really unpleasant thing to have life hand you.
“Well, I had been hoping for a set of car keys under my seat,” I admit, “but I guess this was what I got instead.” Now I have to face the very strong possibility that my cancer is the gift that keeps on giving.
When I finish with Dr. Partridge, she sends me to Dr. Risk’s office for a brief preliminary surgical consult. Dr. Risk is confident, articulate, and personable. I’m not the sort of person who needs to do loads of investigative reporting on a person before I let him carve me up; instead, I just talk to him a few minutes and think, I’ll bet he can hit it.
Then when I finish with Dr. Risk, I go over to the immunology department. Dr. Esposito, who I met with back in the fall, moved on just a few weeks ago to a post in Boston. Now I have been transferred to a colleague named Dr. Jedd Wolchok.
Dr. Wolchok is roughly my age but strikes me as so capable and avuncular I immediately feel like a trusting child in his presence. He is thin and compact, with salt-and-pepper hair and steely blue eyes. In his white lab coat, he almost seems to disappear into the spare examining room. You can tell he’s a doctor because he instinctively opens doors with his elbows. Yet there is something about him that reminds me of Steinbeck’s description of Doc in Cannery Row—a “cool warm” man whose face, like Doc’s, tells the truth. “So you’re a patient of Dr. Partridge?” he asks as he shakes my hand. “Let’s see what we can do for you today. I’ve been going over your information, and I think if it turns out you need some therapy after the surgery you’d be a good candidate for systemic treatment.”
I am keenly aware of the starkness of the entire situation, but his manner is so genial, so pleasant, it’s almost old-fashioned. I find it hard to believe he grew up in New York, though he did, right on Staten Island. His mother was a public school teacher in Brooklyn. He went to school downtown at Stuyvesant before landing at Princeton. And though I may like to joke about Sloan Kettering being my second home, for him, it really is.
Back in 1984, while he was still just a college freshman, Wolchok found himself on a student project at Sloan Kettering, working with cancer immunologists Alan Houghton and Lloyd Old. His task involved observing the blood samples in melanoma patients who were being treated with a synthetic antibody that recognized a target on cancer cells. Antibodies—also known as immunoglobulins—are proteins that recognize and lock on to invaders. Our immune system naturally produces them, but they can also be created outside the body and introduced as a method of fighting disease. Wolchok observed it in action in those patients: Their tumors were going away. The regressions with that earlier form of therapy, unfortunately, didn’t last. But as Wolchok says later, “It was very clear to me that this could work.” He was hooked. That lab he started out in is now the same lab he oversees.
He has also studied music, and plays the tuba in a local ensemble, the Brooklyn Wind Symphony, in his spare time. I will someday ask him why he didn’t pursue a career in music, and he will reply in utter seriousness, “Do you know how hard it is to make it as a professional musician?” My musici
an friends will find this question—and the knowledge that it might just be easier to develop cures for cancer in long-dismissed fields of scientific study than make a go of it in their industry—remarkably validating.
“Dr. Partridge said chemo was a wash for melanoma,” I reply, “so I don’t understand how this is different.”
“The rationale is clear,” he explains patiently. “The immune system is there to protect you against dangerous illness. Defining cancer as a dangerous illness is not a big stretch. What this type of treatment does is take the brake off the system to let it go fight the cancer. It makes sense.”
“So you believe this works?” I ask him.
He smiles. “Yes. For a long time, there was a lot of skepticism. Then came ipilimumab. We’re seeing the evidence now. Immunotherapy,” he tells me, “is like religion. For years, we just had to go on faith.” He thinks a moment and then adds, “Well, faith and data.”
I’ve been at Memorial since eight in the morning, and it’s a lot to get my head around, but I have a team and my team’s plan sounds promising, and that’s good enough for now.
After my epic marathon of meetings, I walk directly from Sloan Kettering to Grand Central Station and then head out to Westchester, to spend the rest of the day helping Jeff’s mom set up her new computer. It’s a useful distraction from the fear of an agonizing death thing, and it feels good to be doing something for someone else. It isn’t until hours later, when I’m standing languidly on the train platform like a character out of Cheever, waiting for the Metro-North to take me back into the city, that I finally look at my phone.
There’s a new voice mail from Deb. “Hey,” she begins, and there’s an unnerving mechanical hissing in the background. “I’m just calling to see how it went on your big day, and to let you know I’m in the hospital because part of my bowels fell out. So call me, okay?” Just then, as I listen to her voice in the warm light of early evening, the train pulls in, and for a beat I consider the compelling efficiency of leaping in front of it, just to beat cancer at its game.
I don’t want to have a conversation about dislodged bowels on the 7:10 to Grand Central, so I endure the ride, my heart racing all the way, until we pull in at 125th Street. As I begin to walk the long stretch toward the A train, I take out my phone and call her back. “Jesus, Deborah Ann, you just had to top me,” I say.
“I’m fine,” she says, while machines drone behind her. “What’s up with you? I thought you had these lung spots for a while. What’s the big deal now?”
“They’re growing,” I tell her. “I’m having surgery to see if it’s lung mets.”
All she says is a grim “Oh.”
“Enough about my day,” I reply. “Why is your junk falling out?”
“The Avastin they have me on has been working great,” she says. “My numbers are down low again. I feel good. Apparently this is a pretty common side effect.”
“Really? Losing your organs? That’s a bitch of a side effect,” I reply, as a shirtless man tries to sell me a single cigarette.
“There’s nothing keeping my insides in,” she explains. “I was in the shower this morning and I felt something sliding out of me. I looked at it and it was pink and shiny, and I shoved it back in and called the doctor.”
Okay, wow.
“I called my doctor and spoke to the nurse, and she said she thought it might be one of those things that happens when your bladder drops. I guess that occurs a lot. Anyway, I went in to the doctor and told them that something had popped out, and after that they didn’t let me stand up again. They drove me around the corner to the hospital in an ambulance.
“Tomorrow they’re going to operate,” she continues. “They’ll take my lower intestines out, and the reconstructive surgeon will rebuild my vagina with a piece of my abdomen. It’s risky because I’m not supposed to have surgery right now. The meds interfere with clotting and wound healing. It’s considered ‘emergency’ work, but what am I supposed to do? Who knew what could fall out of you in the shower?” In a lifetime of daily hygiene, I have only ever dropped soap and an occasional bottle of Head & Shoulders, and neither of those slid out of my body, so yeah, this is pretty revelatory.
I cannot believe how calm she sounds. In contrast, I have now had to stop in the doorway of the Taco Bell to take some cleansing, trying-not-to-faint breaths. “Well, good luck,” I say, “because I am cringe-walking my way through Harlem right now with a look of horror on my face.”
“No, it’s cool,” she says. “I’m going to have a supervagina. It’s a lot of responsibility.”
“You’d better be careful,” I tell her. “I’ve seen Battlestar Galactica, and those things always turn on their masters.” Then I add, “I’ll be thinking of you tomorrow. Happy new vagina.”
I walk by street merchants with card tables heavy with hats and incense, until I spot a tiny storefront church with a table laid out in front. There’s an open book on it with the words “Prayer List” emblazoned at the top. Below are two columns—a list of names and next to them, intentions. So many people. So many prayers. Beneath the last one, I write the word “Debbie.” Next to it, I write another word. “Grace.”
I call myself a Christian and I pray every day. I am grateful when people say they’re praying for me. So why is it, then, that I want to punch a wall when someone suggests that the outcome of my health or anyone else’s is dependent upon the whim of God?
I have always been uncomfortable around the concept of a deity who grants rewards to those he deems worthy or punishes those who displease him. That doesn’t work for me. I don’t believe in a God who sides with one particular football team on any given Sunday any more than I believe in a God who heals some people from cancer because they prayed correctly—but manages to let children and moms and plenty of nice people die of it all the time. I don’t want a God who plays favorites. Prayer to me doesn’t mean asking for what I want, even if what I want is something perfectly reasonable like not having cancer again or Debbie not dying on the operating table tomorrow. It means being open to connection. I have felt, in a visceral way, the power of prayer and intention and whatever you want to call it. I’ve felt it as a gesture of love, a love that is both human and divine. It gives me comfort and strength. But when it comes to the literal work of fighting cancer, I’ll take doctors and medicine. I have faith in things that science cannot prove. I believe in things it can. I also reserve the right to blow on dandelions and throw pennies into the fountain at Lincoln Center.
When I come in at night, the kids have already been fed and are in their pajamas and reading on the couch, worn out from their day with Daddy. I wave wanly at them and go into the bedroom, where I assume my regular end-of-day position under the ceiling fan. Jeff slides down in the bed next to me.
“How did it go?” he asks. It’s the first chance we’ve had to talk. This hasn’t been the kind of day to relay information over a text, or even a hurried phone call while the kids are screaming in the background.
“I have lots of cancer news coming in, and it’s taking a lot out of me,” I tell him. “I’m having a surgical lung biopsy. Dr. Partridge all but told me that she thinks the cancer’s back and it’s metastasized. Then Debbie called to tell me her insides are falling out. She needs surgery. Like the kind that could go seriously wrong. You know the first thing she said when I talked to her? She wanted to know how I was. Christ.”
Jeff sighs like some outside force is squeezing all the air out of him. It’s a heavy, defeated sound.
“I can’t keep trying to figure out how it’ll all turn out okay,” I say in reply. “I’m so tired of being hopeful. Pessimists don’t struggle or ask for miracles. They get knocked down, they stay down. This whole past year, we just keep getting up, and then we get beaten down again and again.”
“I guess so,” Jeff shrugs, “but at least we get a few more turns being up.”
We don’t say much else. We just lie there in the cool darkness and listen to the low hum of
the fan, steady as a heartbeat.
Late the next afternoon, I am drinking iced tea and tapping on my laptop at the Indian Road Café and feeling somewhat catatonic with distraction when Debbie’s husband, Mike, calls me. “The surgery went great,” he says. “Everything is going to be fine. Oh, except she has to stand on her head from now on.” I let out a loud chuckle of relief. She’s going to spend the next few weeks recovering, and then she’s starting on the chemo drug Abraxane.
“I cannot believe how gangster your wife is,” I say, “pushing her internal body parts around and whatnot. I’m pretty sure now that she killed Tupac. Tell her that I love her and I’m thinking of her, and that even though we can’t do all our sex stuff, she can still pleasure me.” When I talk to her the next day, she sounds groggy but profoundly relieved.
The next weekend we drive down to Washington, D.C., to visit Jeff’s high school friends and my cousin Maggie and her daughter, and to show the girls the city for the first time. It’s only mid-August, but each moment of the weekend has a deeply wistful, end-of-summer feel. In two weeks, we’ll be on Cape Cod. I’ll be recovering from my own surgery, and will know for certain if the cancer is back. Maybe it’s not. I have to cling to that hope. They’re tiny spots. This could all just be something else, something totally minor. That’s how we’d explained it to the kids: that the doctors just need to see what’s going on. We must have done a good job, because they don’t seem terribly concerned at all. They’re having fun. That’s how I want it. We have long, lazy dinners catching up with family and old pals. We see the Wright brothers’ airplane and tour the Capitol. I take the kids to where I stood on the Mall for Obama’s Inauguration.
A Series of Catastrophes and Miracles Page 13
