by Ha Jin
“I accept your recommendation.”
A long pause ensued. The doctor seemed amazed by his prompt answer. Having met some of Dr. Rabb’s patients, Tian was positive he was in the best hands and saw no need to hesitate. Then Dr. Rabb asked, “Are you sure?”
“Yes, I am.”
“Then I’m going to ask Samantha to make an appointment with you, and I will see you soon so that we can discuss the details. In short, we must start the treatment without further delay.”
* * *
—
Finally he heard from Shuna. She emailed, saying it would have been too emotional for them to talk about his condition on the phone, so she was writing instead. She urged him to adopt the conservative treatment, so as to minimize his suffering. “I am so sorry to hear about your lung cancer, Tian,” she wrote. “I shouldn’t have let you go to America alone in the first place. I failed to be a good wife to you.” In spite of her consoling words, he resented her attitude—she was talking as though his life were about to end.
He wrote back to inform her that they—Tingting, Funi, Jawei, and he—had decided to put up a fight. “Miracles can happen,” he concluded. “Do pray for me if you can.”
He thought about defending his immigration but was unsure what he would even say. He might not be able to hold back his anger. Yet Shuna might be right from her perspective: Had he remained in China, his life might have differed greatly. But who could predict when and where cancer would strike?
He knew Tingting had quarreled with her mother. The girl was adamant that Shuna come to Boston and spend some time with him, to see him off on the last leg of his life journey. Her mother refused, saying she had classes to teach. Tingting blew up and shouted at her, “My dad was once your husband. Don’t you have any feelings left for him?”
Tingting told him that Shuna hadn’t answered her question and had instead hung up. “She’s heartless!” she said.
“Don’t talk about your mother like that,” he warned her.
From time to time Jawei would call Tian or come to see him in person. The young man was dead set against the conservative treatment and actively helped him combat cancer. He did research online to find alternative remedies. He knew a lot about lung cancer because his aunt and cousin had both died of this disease, mainly due to the air pollution, he believed. In spite of his support for the treatment recommended by Dr. Rabb, Jawei said it wouldn’t be easy to go through all the chemo sessions. His cousin hadn’t survived the therapy and died during the third session because of her low white blood cell count. Jawei suggested to Tian two herbal supplements, which he’d found after several nights of research. One was turmeric, a widely used remedy for cancer. He told Tian, “A top cancer hospital in Houston has been giving this supplement to its patients for years now. It has proved very effective.”
As for the other supplement, IP-6, Jawei said, “It’s made from rice bran and has no side effects at all. According to the clinical statistics, patients who took it during chemotherapy ended up with white blood cell counts even higher than before they had started the treatment. Uncle Yao, from now on, you must take IP-6 every day.”
“I will,” Tian said. “I’m going to order turmeric and IP-6 tonight.”
Jawei also told him that the drugs used in chemotherapy hadn’t changed for half a century, but the methods of administering them had improved, especially in America. In other words, Tian’s chemotherapy was conventional, but its effectiveness depended on the details. Tian was impressed by his knowledge of cancer. Jawei said he might study it eventually if he ended up doing graduate work in biochemistry. He’d taken two premed courses and enjoyed them a lot. He’d found medicine more interesting than economics. Tian told his daughter privately that he was very pleased with Jawei. He hoped that their relationship would develop steadily.
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Funi also had a suggestion about how to approach chemotherapy. One of her coworkers had received the same treatment for bladder cancer. She told Tian, “The man said he was shaking nonstop with chills because of the drugs they pumped into his bloodstream. You should take some ginger powder before going to chemo.”
That was what he’d do, he agreed. Funi went with him to Mass General for his next appointment. Somebody had to carry the oxygen can for him; otherwise he wouldn’t be able to move about.
They met with Samantha and discussed the plan for the chemotherapy, which Dr. Rabb believed should begin within a week. The schedule for the infusions was frightening. Tian looked through the dates of the treatment, spread over a period of more than three months. There were four sessions, each consisting of three daily infusions of the drugs. After each session was a three-week hiatus for his white blood cell count to recover. Once it resurged above 1,500, the chemo would resume. Samantha blinked her large hazel eyes and said in a soothing voice, “Bear in mind that between the second and the third sessions we’ll start your chest radiation. That may be the toughest period of your treatment. We’ll work on the schedule for that when we come to it.”
She also prescribed two kinds of laxatives that he could get over the counter, since one immediate side effect of the chemo was constipation. There’d be hair loss too, but he mustn’t be scared by it, because his hair would come back. “As a matter of fact, your hair might grow back better than before,” Samantha said. A smile, a touch studied, emerged on her pale face, sprinkled with a smattering of freckles. Oddly enough, he felt rather peaceful in her presence, as he came to be aware that there was still kindness and even beauty in the world. Without her freckles, he’d say Samantha, willowy and sturdy, could have been a beautiful Irish blonde. He reminded himself that no matter how hard and daunting, he’d have to make it through the chemo sessions—life was good and worth struggling for.
At the end of the meeting, Samantha gave him a tip. “Don’t eat any of your favorite foods when you come for the infusion, because afterward you’ll hate that food. Chemotherapy can ruin your appetite and your taste buds.”
On the train back to Quincy, Funi said that the medical personnel at Mass General’s Cancer Center, especially the nurses, were so kind that it must be hard for them to keep their composure up for their entire shift. With his head resting against her shoulder, he echoed, “They’re very different from doctors and nurses in China, aren’t they?”
“Forget about China. Some doctors there are like robbers. A coworker of mine in Dongguan once hurt her foot and went to the hospital to get treated. They sewed up her toe but charged her more than three thousand yuan. She didn’t have that kind of cash in her bank account and couldn’t pay. She said this was blackmail and argued with them. They wouldn’t let her go without settling the bill. Then the doctor, who had just treated her, came and cut the stitches and left her wound open. Later she had to sew up the gash with cotton thread by herself. She was limping for months afterward because of it.”
He sighed. “Common people there are just treated like insects.”
“I wish I will become a doctor if I’m born again,” she said earnestly.
In spite of Funi’s rustic looks, she was perceptive and literate, mostly self-taught by reading newspapers and magazines in both Chinese and English. She could even converse with Americans in English now.
She and Tingting had been getting along well since he had become ill. They shared the duty of accompanying him to the chemo infusions, filling in for each other whenever one of them was not available. He was glad that his daughter stopped grouching about Funi, without whose help he could hardly function now.
Meanwhile, he was living with the constant, ferocious pain of cancer, a hundred times more intense than regular pain. Yet he tried not to take too many of the oxycodone pills that Dr. Rabb had prescribed, afraid of becoming addicted. In his case they weren’t very effective anyway. He longed to get through the treatment as soon as possible, thinking he would either survive it or get killed by it. He often we
nt online to read the literature about lung cancer. An article on lung cancer victims’ mortality stated that one-third of patients died of fright, another third of the severe treatments, and only the final third were actually killed by the disease itself. He reminded himself that he mustn’t be frightened. He did some soul-searching too. He was not afraid of death even though he was not yet forty-five. He was sure his music would survive him by a long time. What’s more, he had managed to live for six and a half years as a free man, independent of an oppressive political system. Yet there was an acute feeling of an unfulfilled artistic life. At his age he ought to have had a long career ahead—he had aspired to develop his style into full maturity, unique and even majestic.
The next Tuesday, before setting out for his first chemotherapy session, he drank a mug of ginger powder in boiled water. With his daughter he rode the subway to the hospital. The infusion room was on the eighth floor, lovely and sunny, its windows overlooking the Charles and offering a view of the city, dappled with red and orange leaves. As the drugs, cisplatin mixed with etoposide, flowed through the IV into his forearm, he felt less agitated than he’d anticipated. The Zofran tablets he had taken seemed to be helping. He was cold, shaking with chills from time to time, but there were small heat packs available that could keep individual parts of his body warm. The disposable plastic packs resembled tiny rubber hot-water bottles, and they were activated by shaking. When they get cold, they could be reshaken to heat them up again. Tingting put them under his arms and on his chest and stomach, all under a thick preheated blanket.
During the three-hour infusion, the nurse came several times to check on him and the other patients. There were eight chemo recipients in the room that day, each in an easy chair, and some, like himself, wearing oxygen cannulas. The black man next to him, named David, had prostate cancer; he was accompanied by his son, a bespectacled graduate student studying foreign affairs at Tufts. All the patients were quiet in the infusion room except for David. He had a short, graying beard, was quite extroverted, and chatted with others whenever he could. He called the nurses “sweetie” and asked for a soft drink whenever the service cart came. Tian was amazed by his buoyancy and asked him why he didn’t seem stressed. David said, “If you’re a good man, you shouldn’t fear death.” Tian pressed him, “Why? Can you elaborate?” David went on to explain, “I’m a Christian. If God wants me back, I’ll return to him. If he wants me to stay here, I will continue to live. Everything is in God’s hands.”
Tian wanted to ask why he was so sure he was a good man, but he checked himself. Nonetheless, David’s words made Tian pensive, and he wished he too were a Christian who believed he was going to a better place when he left this world. Between chatting with David and with Tingting, the time passed quickly. Down the hallway there was a small lounge where free coffee, tea, fruit, and snacks were provided for the patients and their companions. There was a sign in the coffee area that thanked the donors who’d funded the space, a couple who had both died of cancer a decade before.
Around lunchtime, a woman wearing a burgundy apron came with a cart loaded with drinks, chips, fruits, and a variety of sandwiches: cheese, beef, chicken, turkey, tuna. Tian couldn’t take any cold soft drinks, feeling a little nauseated, so he got a hot tea from the woman. He found out she was a volunteer. She said she had been treated here for breast cancer, and that after she had recovered and after her daughter had gone off to boarding school, she decided to donate her time at the hospital helping other patients. She also said that most of the foods and drinks and fruits were bought with the funds donated by former cancer patients. Tian was deeply impressed by how good deeds could perpetuate themselves. For lunch he could eat only a chicken sandwich since he didn’t like cheese, or tuna, or even turkey. Tingting was hungry and had a vegetable soup and a beef sandwich from the food cart.
The infusion went smoothly overall. He was grateful that his daughter had kept him company.
The following two infusions also proceeded without a hitch. So the first session of chemotherapy concluded successfully—he now had a three-week break before the next one. A few days later his hair began falling out. When he woke up in the morning, he was horrified to find his pillow littered with wads of hair and his sheets with tiny flakes of skin. Even his pubic hair and some of his eyebrow hair were falling out too. Within two days he could see his scalp in the mirror. It was scattered with large pimples and sores, some of which were ruptured and dripping with pus. The ulcerous spots seemed to be exit sites of sorts for the cancerous stuff to leave his body. In Chinese medicine, this process is called “poison excretion,” a positive sign despite the nasty appearance. So he wasn’t terribly bothered by the dripping sores on his head.
Miraculously, soon after his first chemo session he began to breathe with less difficulty. He could move around without wearing the cannula and could sleep somewhat peacefully at night. Funi stopped camping out on the sofa. Tian no longer coughed as much as he had before and was able to drop the foam cup too. Everybody was impressed by the rapid improvement—a new scan showed the tumors had shrunk by more than eighty percent. Even Mrs. Kuo at the herbal pharmacy, where he’d still go to pick up some herbs, said she must give credit to Western medicine. “There’s no way Chinese medicine could treat cancer with such quick results,” she said.
Though also pleased about the outcome, he had read enough about small-cell lung cancer to be wary of optimism. In general, chemotherapy works more effectively on small-cell lung cancer, but in the long run the disease can resurge and even become drug-resistant. He knew his cancer was among the most vicious and he couldn’t afford to be too confident.
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Tian’s white blood cell count was a little low, but it was still high enough for the infusion to continue, so the second session of chemo began. It went well on the whole, though by the end of it he was bald altogether, having lost even his eyebrows, and became so frail that he wobbled a little when he walked. When he shuffled around indoors, instinctively he’d reach out for something to support himself. In spite of the positive effect of the chemotherapy, he had more pain now in his chest and in his back. Sometimes his waist felt like it was broken, probably due to the burden on his kidneys, forced to excrete the poisonous drugs pumped into his bloodstream. The drugs were designed to kill the cancerous cells, but they also destroyed a lot of good cells. The damage to his organs must have been systemic.
Because of his low white blood cell count, his third session of chemo was postponed for another week. Near the end of the break, the radiotherapy began. He was to receive twenty chest radiations, twice every weekday. This was the toughest part of his treatment, in which the infusion and the radiation overlapped. To prepare for the latter, he was given several drugs to mitigate the pain in his esophagus so that he could swallow food afterward. Five target spots for the rays were tattooed onto his chest. The radiations were grueling, one at seven a.m. and the other at three p.m. Everybody was afraid he might not be able to take the infusion, scheduled for nine-thirty in the morning. There would be a period of three hours between the chemo and the second radiation, but it would be impossible for him to return home and then come back. The hospital offered free lodging, but only to the patients coming from more than thirty-five miles away, so he lived too close to qualify. A hotel room wouldn’t be worth the expense, since he’d be able to use it for only a few hours, during the breaks between treatments. Fortunately a nurse allowed him to lie down in a curtained area where patients on gurneys waited for examinations or treatment. The nurses were like angels, wearing white coats in place of scrubs, and they were always kind and cheerful. One of them, Beverly, petite and with a son already in college, told Tian that she worked long shifts, twelve hours at a time, but she came only three days a week so that she could keep her focus. He could tell how exacting and fatiguing their job was, but they were attentive and composed at all times. They called every patient by the first name. More heartening, Beve
rly encouraged Tian to be upbeat despite his condition. She said to him, “Unlike most patients and in spite of your small-cell lung cancer, you’re basically a healthy man. All your vitals were normal, some perfect. You should be able to recover fully.”
He thanked her for those timely words, which meant the world to him and gave him more confidence.
Yet after the second infusion of the third session, he had to declare a self-imposed break. He was scheduled to have the infusion and two radiations on Friday, but he was sure that his life would be at risk if he proceeded according to plan. So he arrived at the hospital and told his doctors he was refusing to go through with the procedures that day. He would come back for them on Monday—the Cancer Center was closed on the weekend, and he would need to take those two days to recover. Dr. Rabb and Samantha and Dr. Kesuma, the woman in charge of the radiology department, pressed him to continue as planned, but he was adamant. He told them, “Look, I have been a good patient and have never complained about the pain and the fatigue. I feel it in my bones that if I have the infusion and radiations today, it might kill me. My body tells me that. Just give me two days’ rest. I promise to come back on Monday and will be cooperative again.”
No one could dissuade him. His daughter was mad at his stubbornness, saying he might ruin the treatment if he disrupted the schedule, yet she had no option but to yield to his resolve. Dr. Kesuma said to him, “You’re like my dad. He’s so strong-willed that once he decides to do something, nobody can make him change his mind.” Her bony face crinkled as she grimaced. She was a second-generation Malaysian immigrant and had grown up on the West Coast.
But, as it turned out, the weekend wasn’t restful for him at all, because he came across the news of his lung cancer online. The Global Post reported that Yao Tian was suffering stage-four lung cancer, struggling between life and death. The article implied that his days were numbered, and even expressed pity because his singing career had “ended so prematurely.” Tian was outraged by the article, which was using his condition as an illustration of the heavy price that people had to pay if they set themselves against the powers that be, if they deserted their motherland, if they chased the phantom of freedom in total earnest. It summed up his case this way: “Yao Tian lost his stage, then his audience and prestige, and now is about to lose his life. His career is over and he has reduced himself to nothing. We can’t help but feel sad for Yao Tian, the wonderful singer, who once enjoyed an illustrious career but is now falling into total silence.”
