Escape Points (11 page)

This time I would bring cookies. That would be nice. Be the patient who brought food. When I saw her later she commented on how nice I looked and complimented me on my shoes or my skirt or my jacket. And everyone on the safe side of cancer smiled at me and was pleasant. And why not? They didn’t have cancer. The rest of us did.

“No need to come back with me, I’m good,” I told Paul.

“Sure, OK,” he said.

But I knew he would show up, if not tomorrow then Friday. And he did show up, twice more that week; I walked in and there he was in the waiting room. My sister Maureen came once as well.

When Paul came to the hospital, we talked and he told me jokes. Paul and I were close mostly because we were just a year and a half apart. I fixed him up on dates in high school, college, and after college. He fixed me up for high school and college formals, and all of them I forgave him for and he forgave me. He was my closest friend. When I was first divorced, he and his wife, Bernie, invited the boys and me over for dinner a lot. We went out to eat often, even vacationed with Bernie and their three. He included me in dinners, parties, and all-couples events and never once made me feel awkward that I was alone. He had a book signing party for my first book, selling copies in his backyard. He had been a champion for the boys and went to their wrestling meets and football games and was always there for us. Since his wife died—“passed” Paul said
because I don’t think he could say “died”—we talked almost every day, sometimes more than once. “U.P.” my boys called him, for Uncle Paul. When I got home after the second round of radiation, I told the boys U.P. was there.

“That’s good, Mom. It’s good you have U.P.,” Brendan said.

When I started radiation, Paul lent us his Nissan Altima so Weldon could drive himself and Brendan to weights at 5:30
AM
and I could sleep another hour before getting up to get Colin ready and get to work myself. Weldon also needed the car to drive to wrestling camp at 5
PM
. With one car, that was impossible. I did it one day, raced home from work in an hour, picked up Weldon, drove the hour back, did work in the car while he was at practice, then came back home. That was exhausting, plus a total of five hours in the car for the day. Paul’s generosity was enormously helpful. After a few months, he surprised me with the title to the car; I had thought it was a temporary loan until I had my strength back.

“It makes me feel good to help you,” Paul said. “I promised Mom I would.”

T
he young woman at the reception desk with the gold bangle bracelets was chirpy. The chairs against the wall were filled with patients. It was my first appointment with the oncologist on the eighth-floor Radiation Oncology Center.

“Do you have a copy of your last will and testament?” she asked.

“What did you say?”

“If you don’t have it, that’s fine. Do you have your insurance card with you?”

Still numbed from the first question, I fumbled through my purse to find my white insurance card and handed it to her. She continued to process my information, printed out a wristband, attached it to my left wrist, and then handed me my paperwork.

I was positive she just asked me for a copy of my will. A nurse, doctor, or administrative assistant has never asked me for a copy of my will; not for my emergency appendectomy, the births of my three children, the wisdom teeth extraction when I was twenty-one, even the lumpectomy I just had. Old, sick people need copies of their
will when they go to the doctor. I was only forty-eight. And I had cancer.
Had
. Past tense. I did not have cancer anymore.

“I’m not planning on dying today, so why do you need to have my last will and testament before I meet the doctor?”

“We just want it on file.”

Got cancer? Everyone got right to the point. I was grateful she didn’t ask me if I want to be cremated. If anyone did ask, the answer was no. I would prefer the traditional route, the elaborate casket, the wake from 3 to 9 on two days, not just one, where hopefully the boys would be on time, have neatly pressed shirts, and not chew gum. The funeral could be first thing in the morning, a traditional mass with pretty music, my niece Alyssa could sing, then a printed program done on InDesign, not just thrown together, with hopefully a good picture of me, one where I am laughing maybe and my hair looks good. I hoped Madeleine would help the boys with their eulogies. God knows what they would say. Oh, and no elaborate headstone. I found those obnoxious—the huge statues of angels, the gilded and marble tributes, what was the point. I didn’t visit my mother and father’s graves, though all my brothers and sisters did. Not out of disrespect, of course; I really didn’t want to. It didn’t make me feel better; it made me feel worse. I didn’t need to go to their graves to talk to my parents. I would tell the boys they didn’t have to visit my grave, but I would not bring that up now. That wouldn’t be for a very long time. They probably wouldn’t visit anyway, so it would be better if eventually I told them I didn’t want them to, then they wouldn’t feel any pressure. But I would be old when that happened. I would be ninety, maybe one hundred. I would get very old.
Why did she need the will today? I was not going to die today.

Mike offered to drive me and waited there if I needed him to talk to the doctor; sometimes the doctors spoke in codes. I considered myself an educated person, and I took four years of Latin in high school, but some of the words the doctors said I had never heard before. Like
brachytherapy
and the drug names. I knew the basics: penicillin, the sulfa drugs the boys have taken for infections, and the drugs my mother took in the last years of her life—Fosamax,
Halcion, and a half dozen more. They could just as easily have been the names of cars.

The waiting room was filled with close to one hundred people waiting for several doctors in the center. Many were older people, some younger, some more were bald. People in wheelchairs, people with walkers, men, women, white, black, Asian, Hispanic—reading the paper, the magazines, drinking coffee, watching TV, staring straight ahead. It was like a gate in the airport terminal, but with oxygen tanks. Like every other element of synchronicity, you got a diagnosis of cancer and suddenly the whole world had cancer. Molly Ivins had cancer. An outspoken newspaper columnist and author, I saw her speak at a conference a few months ago; she was thin and looked weak, but her words could still knock over a charging bull. We both worked at the
Dallas Times Herald
in the 1980s, and when she was in the newsroom, boy, everyone knew it. She died. Lots of people with cancer died.

“I like your skirt,” a woman in a turban said as she smiled to me.

You could gather a lot of compliments in the radiation and oncology waiting rooms, I have found; polite consideration, everyday niceties, warm greetings, kind encounters are the norm. It was as if you arrived in this place after your diagnosis and we all figured life was too short, so why the hell not, might as well be as pleasant as possible; we were all in the same boat.

“Thank you,” I said. “I like your blouse.”

Mike and I moved from the reception hall to sit in another crowded area; a few minutes later, a nurse called my name. She was also smiling and bubbly, like a human fruit smoothie.

“I can’t wait to get away this weekend,” she told me in a familiar tone, like this was not the first time she weighed me or met me, but we were old school friends. For a second I forgot where I was; it felt like she and I could talk about shoes. Or the weather, or what we each had for dinner the night before. She weighed me, took my blood pressure, and walked me back to a treatment room where I would meet Dr. Ruta Rao. In oncology centers, losing weight is a bad thing. They want your weight to stay the same. I
could have started to hyperventilate. But I kept breathing slowly, through my nose.

Like most every doctor on my support team but my surgeon, Dr. Rao was younger than I was. She was beautiful and petite, polite and soft-spoken. After some small talk, she handed me a printout from Adjuvant! Online. I was not sure why it had an exclamation point in the title; I guess they really mean it.

Don’t use exclamation points in your writing, I told my students. Save that punctuation to follow the words
fire
and
help.

On the left-hand side of the single white sheet were boxes the doctor had typed in under the heading P
ATIENT
I
NFORMATION
. For age, 48; for comorbidity, average for age. My ER status—for estrogen receptor—was positive, that was good. Tumor grade was 2. On a 1 to 10 scale, I guessed. That’s good, low side. Tumor size, 0.1 to 1.0 cm. Zero positive nodes. That was also good. My ten-year risk of relapse was 18 percent. Wait, that’s almost a fifth. Four out of five people are alive without a recurrence of cancer in ten years. But one is not so lucky. Was I the one?

Ten years; that used to seem like a long time. At my ten-year college reunion everyone looked exactly the same except for the former homecoming queen, who had gained about a hundred pounds. Many of us were pleased with that detail, though I knew in my heart it was mean. The twenty-year college reunion was different. The women looked outstanding and the men not so good; they were bald and had bellies that hung out over their belts, and they still couldn’t dance, though they acted as if in all that time no one had told them that simple truth. The men acted like they still were cute, you know, as Colin would say, “like they owned the place.”

Oh, the women all looked great, because only the women who look outstanding go, Dana said. Not feeling quite Christie Brinkley? Stay home and send your regrets. Working out, doing yoga, had a recent touch-up of highlights? Then you could go.

At my twenty-five–year college reunion, I knew only a few people there. “Weren’t you in marching band?” a woman asked me at the check-in table, who did not look at all familiar, not even if I squinted.

No, I was not. I was not in marching band. Nothing against marching band, but no.

Ten years. In ten years Colin grew from a toddler to a seventh grader; Weldon from a preschooler to a teenage driver; Brendan from being half my size to towering over me. I had spent ten years teaching at Northwestern; in that time having hundreds and hundreds of students in my classes. I wrote three books in ten years. It was ten years since I was divorced. I was alone for almost ten years and then I was in love. And then I was not.

You could do a lot in ten years. You could do a little. I would have to keep doing a lot.

On the right side was a graph in horizontal gray and black stripes. My chances of being alive in ten years? That was listed as 78.6 percent, with surgery only. That was a grade of C, not so good. With hormonal therapy, 88 percent chance. Better. With combined radiation and hormonal therapy, there was a 92 percent chance I would live to see Colin turn twenty-two. The paper said so. Nowhere on the paper did it say 100 percent. Nowhere.

My life was down to a printout, a thin sheet of paper I held in my hand, though the weight of it was a hundred million tons on my heart.

I knew it was possible that anyone could die at any time. I mean intellectually I knew this; we were not immortal. But most mornings before this all happened, when I made my bed, put the wet towels in the dryer, stirred the fruit in the yogurt, or pulled the car out of the driveway, it did not cross my mind all that much. I wanted to tell Dr. Rao about my Meg Ryan hair. Since the brachytherapy, my hair was thick and extracurly. It had this luscious messiness that was not its usual temperament. I woke up and it always looked fine.

“What do you mean?” Lisa asked.

“It’s like my hair was blown dry from the inside out,” I said.

Lisa wasn’t buying my reasoning. No one had documented Meg Ryan hair as a side effect. “Are you using a different shampoo or conditioner?”

Dr. Rao gave me a prescription for tamoxifen and talked about how I would be taking it every day for the next five to ten years.
Tamoxifen
. The name sounded like poison to me. It rhymed with
toxin
. And in a game of Scrabble,
toxin
would likely be the first derivative word that came to mind—every day for five years or more. I didn’t know why I was so afraid of that small pill; perhaps it was because it held such power, because my survival depended on my taking it every day without fail.

I knew it blocked estrogen and that estrogen fed tumors. I understood it had been used for thirty years to treat breast cancer and that all the printed materials said the benefits outweighed the risks. But the side effects listed were not inconsequential: blood clots, stroke, uterine cancer, and cataracts. Oh, yes, and hot flashes, fatigue, headaches, nausea, vomiting, skin rash. Sounded like a pretty scary bucket list to me. Every day for five years. Then Dr. Rao said as an afterthought, yes, sometimes weight gain.

Wonderful. But I guess measure the weight gain against the recurrence, followed by dying and leaving your kids without a parent at home, and a little belly fat is fine. I could always wear jackets, to cover up the fat, I mean. Thank God tunics were in style.

I had a dream a few months later that I dropped the prescription plastic bottle of tamoxifen on the ground and a small white Maltese so tail-wagging sweet scooped down and licked up all the small pills. I was trying to grab the pills out of his mouth but couldn’t get them before he swallowed all of them. Seconds later in my dream the dog collapsed and died. I woke up sweating and panicked.

“I recommend you have genetic testing on the tumor removed from your breast,” Dr. Rao explained.

I nodded.

The test was the Oncotype DX breast cancer assessment, and it looked at twenty-one genes in the tumor tissue that could accurately determine the odds of recurrence by looking for specific biomarkers showing predisposition to other kinds of cancers. The test offered more information about the type of tumor it was and if I should have chemotherapy in addition to the radiation to significantly lower my chance of recurrence. They said recurrence, but what they meant is the chance you won’t die by a certain time. A ten-year deadline. Or
the chance that you will. The test, not covered by most insurance, came up with a recurrence score from 1 to 100, taking into account the biomarkers. I would wait two weeks for the results. I would later pay almost $4,000 for it. I had a list of questions for Dr. Rao, and she answered them, but it was as if she was speaking in slow motion; her words muffled and distorted through a screen of petroleum jelly. I just wanted to get out of her office, out of the building. I thanked her. I pretended that on the inside I was not hollowed out.

In the waiting room Mike was in the same chair. I handed him the piece of paper.

“Do you want me to talk to her?”

“No, let’s go.”

In the elevator I had to grip the handrails because I could not feel my legs and I started to cry. Mike held me up, his arm around my shoulder, gripping me. I thought I would faint; it felt like the closing moments of the Looney Tunes cartoons, when the circle of black tightens around Porky Pig and he stutters, “That’s all, folks.”

“She told me my chances of being alive in ten years,” I said between sobs.

“But they are good,” Mike said.

Mike was like my father, someone who was not prone to moods or ill temper; someone who would be the same kind soul on Tuesday as he was on the previous Thursday, and a thousand Thursdays to come. Like Johnny Carson was every night at 10:30, always in a good mood, always a smile on his face.

And here was Mike, taking a half day from the hospital for his sister-in-law. He was that same kind of man, to my sister of course, but really to all of us. He had always been good to my mother, like another son. He changed her light bulbs when she called, always available with medical advice and interventions. Talked to all her doctors, listened to her, invited her to dinner every Sunday night at their house; he cooked, mostly grilled fish like tilapia or salmon and vegetables. He was good to me and he was good to my boys. He came over to talk to the boys or go for a walk with their dog Haleigh, then Sammie. I was glad Mike was there.

When the elevator arrived at the main floor, we walked the crisscrossed hallways to the main lobby. My throat was parched; it felt as if all moisture in my body evaporated. I felt like my head was not connected to my body and I could fold to the floor like I was a paper doll.

“Let’s sit,” Mike said.

There by the deli counter with a clear case showing stacks of plastic containers of chef’s salad, premade sandwiches, biscotti, coffee, and juice, I cried. Nurses and doctors and visitors were buying lunch and snacks and going about their day because no one had just told them their chances of being alive in ten years. I couldn’t hold it in. I cried. The wet bursts were hiccupping hard because my boys weren’t there and I knew I couldn’t cry like this at home. I cried in front of twenty people eating a late lunch because I had to be a vision of strength and a comfort to the boys at home later. My surgery and radiation scared them. I learned that teenage boys who have been abandoned by a parent don’t take well to the illness of the only parent they have left to care for them. They became aggressive, irritable, caustic to me and to each other.