Thursday, December 3, 2015

The Cancer Journal

I'm allergic to almost any cologne, skin cream, deodorant, and such and such. If I apply an antiperspirant—say one of those roll-ons—to my armpits for three days running, a rash will break out. Remedy: stop putting something on my skin that I know my skin doesn’t like, and the rash disappears.

On Thursday, July 23, I left work at 4:30 with plans to meet friends in Provincetown at six p.m. It had been a humid sweaty day; there is no air conditioning at work, but I didn't have time to take a shower. One of the friends we were going to meet was our beautiful god-daughter. She has just graduated from high school, and we have a gift for her. The gift needs wrapping, and a card for her needs a note written in it. I was living, just for a bit, in a rush-rush world, so, in lieu of a shower, I rolled on some Mennen's. It had been given to me by a sweet motel clerk in Ohio, part of a little toiletries kit, after I had become separated from my luggage on a day of flight distress on the way to my sister, Joan’s funeral seventeen months earlier.

The day after our lovely evening in Provincetown I noticed a soreness in my left armpit. It was about the size of a quarter. Not a big deal. I supposed it had something to do with the roll-on deodorant. It would go away.

Except that it didn't.

The next day it had doubled in area, and had come to seem like a slight sensation of burning. Still no visible rash. And the sensation spread more on Sunday and then more on Monday.

I phoned to make an appointment to see my doctor. She could see me on Wednesday, July 29. I supposed my soreness would be simple enough to diagnose and treat.

Not quite.

It was a puzzle to the Nurse Practitioner, Danielle, whom I see since my regular doctor's patient load became too heavy for him to handle (and he, anyhow, had long ago become tired of my whining). Danielle called the doctor in to look at me; it was a puzzle to him as well. They consulted, and then they ordered an EKG. It seemed to me that this was throwing something at the wall to see if it would stick, but what do I know? Does something awry in the heart show up as a bit of a burn in one armpit? Maybe.

After a while they came in to announce the results: the EKG was radically different from the one they’d done just a few months ago when I had been there for my annual physical.

"You could be having a heart attack,” the doctor said. “You have to go to the ER. We've called an ambulance."

"I can drive my truck to the hospital." I slid off the end of the examining table.

"No, you’re not driving anywhere,” the doctor stated firmly. “In fact, you need to sit down. Here's four baby aspirin. Chew them well. The ambulance is on the way."

I've been given to understand that if you don't do what the doctor says, the insurance company doesn't have to pay your bill. That's a good plenty of incentive to do what you're told.

A clerk appeared and offered to lock my truck for me. There's nothing in it worth stealing, I just didn't want it to be towed from what is a private parking lot – not that it being locked or unlocked would make any difference to the towing company.

"Your truck will be just fine," the doctor said.

I asked the clerk, "Would you grab the book that's on the seat for me?"

I don't normally bring a book to my doctor's office because I always ask for the first available morning appointment, so there’s never more than a couple minutes wait, and they always have a television on up in a corner, tuned to CNN, and the news this morning was constant coverage of Tom Brady’s four-game suspension. But, yes, for some reason – certainly not because I'd thought I'd be needing a book to read in a hospital – for whatever reason I’d put a book on the seat of my truck. The kind clerk handed me the big fat The Bit Between My Teeth – A Literary Chronicle of 1950-1965 by Edmund Wilson, one of my favorite writers, one of my favorite intellects.

I asked to borrow a cellphone. I called Mark. He was in Chatham at The Wayside Inn. It was his day off but he was about to take a Jamaican woman, a colleague who has worked at the Inn for a long time, and her 12-year-old son, to Provincetown, just because the boy had never been there. I told Mark that he didn't need to come but I just wanted him to know what was going on. He said he'd see me at the Emergency Room. I said I wanted him to go on with the fun day for him and Maureen and the boy, but, no, he'd see me at ER.

Jesus! I’m actually heading for an ambulance with three healthy-husky-looking guys in their thirties or forties. They help me up and onto the gurney. I lay back. I'm wheeled through the hall toward the back door, out into the sunshine.

When I'm on the highway heading north, say from my home to my job, and I meet an ambulance from Truro or Provincetown I always think: oh, please don't let it be my Abby, don't let it be my Rodney, don't let it be my Ruth. But now I think: Don't ask for whom the sirens will scream; they are going to scream for me. I’m one of those people, one of those in need of help … I just don't feel like one of those people.

I'm inserted into the ambulance. I've always had a sort of crush on ambulances – they look so glistening and sleek and clean, marvelously equipped and all, and, with their flashing lights and their sirens and their rights-of-way, so authoritative and butch on the roads – kings of the road – but in this, my first ambulance ride, I’m being inserted backwards; my view is through the rear windows; there’s not going to be much to look at except sky and trees and pole-wires falling away in our wake; all the beautiful high-tech equipment is behind me, out of view. I’m strapped to a gurney; I can’t even turn onto my side for a different view.

It’s a long time before the wheels of this ambulance even start rolling. The men issue, among themselves, commands and then back-up commands; everything is repeated, confirmed; they are simultaneously communicating with the ER. One of the guys (the only one I can see; he’s sitting on a pull-down jump seat to my left) says, “Open up!  I’m going to squirt some nitroglycerine under your tongue.  Raise your tongue... higher... can you raise it higher?”

A second one confirms for the record and for the ER: “Nitro under tongue.”

Someone inserts an oxygen diffuser to my nose.

On a scale of one to ten, ten being the most pain, what is your level of pain?”

I don’t have any pain. Zero, I guess.”

Finally we are moving. If there is a siren I do not notice. If there is excessive speed, I do not notice. We’re taking the back roads; I know the route well; I used to live nearby and I took this route to Hyannis three or four times a week, usually to sit in Border’s Bookstore and read books and drink lattes. I know just what each intersection for which we slow down looks like. But I’m seeing only the sky and the trees and the power-lines. Seeing them backwards. And I’m wondering just what the hell is going on. Finally we stop, the rear doors are opening, I am removed, and I am being gurneyed along two long rows of employees sitting at computers until I’m stopped inside a small private area, a little cubicle.

Cape Cod Hospital Emergency Room
Mark walks into my little cubicle momentarily. He's come 18.6 miles; I in the ambulance have come 5-1/2 miles, but Mark has been waiting for the ambulance to arrive. This is not criticism – the EMT people, as I've pointed out, do a lot of preparation before those wheels begin to roll.

The Yarmouth Fire Department submitted charges totaling $1099.37 for that ride of 5-1/2 miles. Blue Cross Blue Shield paid them $436.12, and I had a co-pay of $100.00. Had I been allowed to drive my truck the cost would have been, at most, half-a-buck’s worth of gas.

I’m not complaining. I was just worried that my truck was going to be towed. Plus, I'm dealing with irony.

It took a long time before I was seen by a doctor. Another EKG test indicated that there was nothing wrong with my heart, but, to be sure, I was trundled through what seemed like long halls and around many corners until I came to a place where a CAT scan could be performed.

Back then to my little ER cubicle where I am eventually introduced to Dr. Marcial Santos, a fine-featured delicate-looking beauty of a man with the most perfect color of skin a body can have. It is his job to gently tell me that the good news is that the CAT scan confirmed that there is nothing wrong with my heart, but that the bad news is that the scan depicts what Dr. Santos calls a ‘black mass’ above my left lung.

I am admitted. 

That is: I am captured. My wrist is banded. The system has grabbed me. I am Kafka's Citizen K. The thin white band might as well be a chain. 

A sweet attendant tells me she is taking me up to the fourth floor to one of the best rooms in the hospital.

It has a view of the harbor,” she says.

All this has taken up the entire day! My appointment with Danielle had been at 8:30 in the morning; by the time I am admitted and in my room I am told that I need to hurry and make a selection from the menu for my dinner because there is a cut-off time of six-thirty p.m.

Mark’s sister, Nina – there's no sweeter person in the world – works the evening shift at the hospital as a Unit Secretary. She comes into “one of the best rooms in the hospital” during her “lunch” and she and Mark go to the cafeteria where, with Nina’s discount, they have good pork dinners for something like three bucks. I am glad to be alone; I don’t want anyone having to watch me eating a sad hospital meal; and as soon as they return I urge Mark to go home; he’s dedicated enough of his day off to me. But I'd at least spared him having to watch me eat an appallingly bland stir-fry.

As I was still worried about my truck, Mark promised that he and his friend Sharon would fetch it the next afternoon.

Hyannis Harbor, reflected in my bathroom mirror.
I had something good to read, and the view. I’d be okay, and I did sleep pretty decently, waking up only once during the night because the tubes attached to me... I think there were five ... got disarranged and uncomfortable. And this isn’t counting the bi-hourly checks of one’s vitals.

Morning came. A decent breakfast also came; even the omelette was good. And eventually a technician pushed into the room a contraption with which she performed an Echocardiogram on me.  At the end she said, “Your heart is amazingly strong for a man of your age.”

But still ahead: a stress test, and a biopsy on the tumor to determine whether or not it is malignant. I learned that the biopsy could not, for scheduling reasons, be performed until the next day. It was now about 1030AM; nothing would happen today except, if I was lucky, the stress test.  And then tomorrow, Friday, that biopsy. It occurred to me that the biopsy might not happen until late in the next day; I suddenly felt the horror that I might not be getting out of the hospital until Monday. It is rare to be dismissed on a weekend. “All the doctors are on the golf course,” is, somewhat jokingly, given as the reason. At this moment I turn my head away from the door and a few tears fall. I could not imagine lying here, for no good reason, for all that time.

No sooner had my couple of tears dropped and been dried away than I heard someone say, “What the hell’s going on in here?”

Surprise! Big surprise! I’m tickled. In has walked my boss, Janet, who is, I always like to point out, not just my boss but my friend, and, with her, Leslie, the Chief Law Enforcement Ranger at the park. What a morale boost it is to see their faces and hear their voices! And while they sit and visit – they hadn’t come to Hyannis particularly to visit me, but rather to attend the AmeriCorps Graduation ceremony – a Dr. Kelly Swanson comes in. She has a warm smile and a lovely face. “Do you mind if we talk about your condition in front of your visitors?” she asks. I don’t mind.

Essentially: It has been decided that I really do not need to do a stress test; the second EKG and the CAT scan and the Echocardiograph have convinced them that I probably have nothing wrong with my heart; further, since an array of other tests will be done in the near future, which will confirm the same things that the biopsy might confirm, they are going to let that go unscheduled until sometime in the near future.

Dr. Swanson explains that I have what is called a Pancoast tumor above my left lung. She speculates that, depending on many upcoming tests, it could probably be removed, even laparoscopically, and I’d be cancer-free – but that there is one little problem: the tumor was resting on a nerve which, if in the process of slicing the tumor away, gets damaged, could result in the loss of the use of my left arm. 

So, yes, it was that nerve being irritated that was causing the slight burning sensation in my left arm pit. And so, meaning to take no unnecessary risk, they would probably, Dr. Swanson said, attempt to shrink the tumor away from that nerve with radiation and chemotherapy.

None of this sounds all that bad to me. I love the laparoscopic idea. I imagine a tiny incision. Simple. But what I hear mainly is that I am going to be dismissed from the hospital! I am beside myself with thrill! I tell Dr. Swanson that I’ve run into a dozen or so doctors in the last 24 hours but she is by far the best.

My visitors leave. Dr. Swanson leaves.

I order lunch. Meatloaf. It is absolutely delicious – even the mashed potatoes and gravy are delicious.

Although it was about eleven a.m. when Dr. Swanson came in and told me the news, the fact is that I am not dismissed until about 530PM. She had a wad of paperwork to do, not just on my case, but on other cases. It was only after she'd set up about ten appointments for me, and had consulted with ten or fifteen other care-givers, that she finally returns to my room for the official dismissal.

Mark has been there waiting for much of the afternoon, coming as soon as he’d gotten off work at 2 p.m. He drives me to Yarmouth. My truck was where I’d left it. I drive home.

The next morning I walk into work at 8AM.

What the hell are you doing here?” my boss asks.

The first of the several appointments arranged by Dr. Swanson is for an MRI scan late in the afternoon on Monday, August 3rd. For convenience’s sake it is to be done at a Medical Center in Brewster, much closer to my home than Hyannis.

The venue to which I am led in the medical facility, once I've undressed and donned an open-backed smock (but am allowed to keep my shorts on!), looks like a set for a low-grade science-fiction movie: I face a steel platform about five feet above the level at which the technician and I are standing. She unlatches the gate to what is an open elevator; it is, for safety, surrounded by steel rails and the gate. We step onto the elevator; she latches shut the gate behind us. We slowly ascend the five feet. I notice off to the right a set of stairs by which we might have ascended. “Why didn’t we just walk up the stairs?” I wonder. “We think this is safer,” she says. Once arrived at the higher level, we enter an area that looks more like the typical rooms of a medical facility.  

I can only suppose that this raised area, and its being at a far end of the large facility, has something to do with keeping the dangers of radiation exposure as far away as possible from people in the facility.

I'd been asked if I am claustrophobic. I'm not. It is, for me, not an uncomfortable procedure. At its end, I am dismissed. I drive to a joint in Orleans and have a cheeseburger and a milk shake.

I know things like this are not amazing anymore, but still it amazes me that the pictures from my MRI are electronically transmitted so that, along with my medical history, they are presented the very next morning to a group of perhaps 20-25 people who make up what may be called a 'cancer board'. The 'cancer board' is made up of oncologists, social workers, other doctors, other caregivers. New cancer cases are presented at its weekly meetings. The patient attached to the records is anonymous. Each particular case is considered and discussed by the members, and a consensus reached as to what is thought to be the best method of treatment.

Meanwhile, before that MRI, I'd been called by my PCP's office and told that any time one has been in the hospital, one's Blue Cross Blue Shield plan requires that a visit be made to the PCP. So I was back in South Yarmouth chatting with Danielle at 830AM, perhaps at about the time my case was being discussed by the 'cancer board'.

I sensed from Danielle's questions that the aim of this visit – what with all the shockingly sensational news I'd lately received – the aim was to assess my mental health. I told Danielle that I have determined to keep at the forefront of my thoughts that mine has, on the whole, been a most blessed life, that good fortune has been of a much greater measure than that of ill-fortune, and that I have been rich in many important ways, such as rich with friends, and rich with good times, and rich with a family in which I have found great amounts of love and laughter. I said that I intended to face whatever in the way of ordeal that lay in my future with as much courage and grace as I could muster. I mentioned that I had seen four or five close friends die from cancer or from AIDS when only in their forties, to say nothing of the many more who died who were good friends if not exactly close friends. How can I see myself as anything but lucky to have been blessed with the fair number of years I have been spared? Frankly, if this malady is to kill me, I shall not feel cheated; while, if I had come down with something in my forties that I could be sure was going to take my life, I would have felt terribly cheated.

If, in my forties, I felt cheated and still feel cheated because I lost a dear friend, and then another and another, and so forth, how must they have felt? I shudder with memories of those who wasted away, and of the many memorial services, and of hearing the drop of one shoe of bad news and knowing that another shoe would be dropping in a week or a month or three or six months.

I've been going through a lot of papers lately; it seems like I never threw any sort of document away. I just happen to pick up a letter I received in 1994 that includes:

I'd written Herbie, telling him I'd be down this week end to see him;
when I called Friday evening to confirm, his mother said that they'd
had to take him to the hospital on Thursday; he couldn't eat or
swallow, and the doctor didn't expect him to last much longer. I told
her that I'd come to the hospital, so drove down yesterday, was there
with him and his mother for 2-1/2 hours (his first NYC room-mate,
Billy, and his lover Dick came in for a few minutes, and later two
wonderful aunts, sisters of his father, were there). He was in pitiful
shape, weighing 70 pounds, emaciated beyond belief; he opened his
eyes and seemed to recognize me, but couldn't talk. They were
giving him morphine orally every two hours, in addition to a
morphine patch; his mother fed him apple juice with a syringe.
She and his sister had made the funeral arrangements, and she
asked me to be a pall bearer. I left at around 4:00 pm, mass at the
cathedral, then a hurried supper in a French cafe before driving
back. His mother called me at about noon today to tell me that he
had died very easily at about 5:45 yesterday afternoon. Services will
be Tuesday afternoon at 2:00, at a funeral home; I'm so glad that
she's not having the funeral at her Baptist church, which he hated
…. It's impossible to be sad at his death, as he was in such a horrid
state, but it is sad to think of all the suffering in the lives of his, Harold's, Jay's, Kenny's, and the countless others.

Yes, but for good fortune, I might have been among the countless.

Surely some of what I said to Danielle would have sounded insincere to a cynic, but I was being forthright and honest. Certainly no-one can face his or her death with equanimity, but I, whether it comes soon or later, am going to make an attempt to come as close to that as any human can.

I do feel blessed.

I won't feel cheated.

How could I?

At the end of our conversation, when I rise to depart, Danielle rises too. She approaches me with arms spread for a hug. A lovely gesture such as this – she is quite new in my life – can bring a tear to a man's eye.

Danielle Leighton
Danielle happens to be drop-dead gorgeous. As in: Italian movie-star gorgeous. At work I dig up a picture of her on Google Images. She's way more gorgeous than the picture shows. I make it my screen-saver. A number of my male colleagues now want Danielle to be their PCP.

I take Wednesday off. A lovely friend from Ireland, who happens to be spending some time near Boston, along with her four beautiful children, comes to visit. Mark and I and they have lunch at a seafood place! We feel like tourists! I have Lobster Bisque! Then we play miniature golf! Then we go to the beach for three hours! It is one of those perfect days such as Lou Reed wrote a song about.

I'm serious: I am blessed.

August 10. Monday. 845AM. Mark has offered to accompany me for all consultations. He will help me keep things straight. He will remember things that I won't remember. I sometimes introduce him as my iCloud; some people get it; some don't.

Today is my first consultation with the doctor who has been designated as my Radiation Oncologist. But first I have a lengthy consultation about radiation with her nurse, Christine (whom I will come to love for her extremely good nature and her wonderful sweetness and her tender caregiving). She talks about possible side effects, some remedies for such, and so forth. I am handed a schedule of radiation treatments. It looks daunting.

Most people,” Christine says, “say that it goes by much quicker than they expected it would.”

Dr. Molly Sullivan
Following this enjoyable time, in comes Dr. Molly Sullivan. Frankly, it seems like the nurse has imparted the important information; still, it is a pleasure to meet Dr. Sullivan, the one who's in charge of my radiation!

Three days later, on the 13th, I consult with Dr. Jeffrey Spillane. He will perform the surgery. Mark and I sit in chairs. He sits on the side of the examining table, casual, his legs dangling, his hands propped on the edge of the table, and matter-of-factly talks about the upcoming surgery. I'm writing this almost two months later; frankly, I can't remember much about this visit, except that at the end I just had to ask if he is related to the writer Mickey Spillane. He said no, but that one time his mother checked into a swank hotel in Hawaii where Mickey would sometimes stay. Shortly after entering her room, a delivery of lavish bouquets and fruits and candies was made. She had no idea of the why of this largesse until an employee told her they thought she was Mrs. Mickey Spillane.

The next day, the 14th, a Friday now – things seem to be moving right along – I have three appointments. At 130PM I have a Computerized Axial Tomography (CAT) scan. The technician is smiling and friendly. The purpose of achieving this three-dimensional image of my tumor is for her to tattoo tiny dots on my left chest; these dots indicate where the beams of radiation are to be directed.

Dr. David Lovett
At 320PM I meet my Chemotherapy Oncologist, Dr. David Lovett. He has a face that bespeaks good nature, a really nice manner, and well-tailored attire; and he's one of those lucky people whose face seems, permanently, to register a smidgen of a smile that is ready always to break into a full smile. (I love this because for much of my life people have told me I look like I'm sad; I don't feel sad. One early morning in a convenience store a stranger actually said to me, “Come on, it can't be that bad!” I wanted to say that my mother had just died an hour ago, and that also I'd be taking my dog to be put asleep in a couple hours, and that I'd just been laid off at my job, and that I'd just totaled my new pick-up truck, and that he should tend to his own business. But I just grinned and, as I always do, bore it. Sometimes when someone wonders why I look “sad” I just say that I take life very seriously.)

Dr. Lovett informs me that I will have chemo (Cisplatin and Paclitaxel) once weekly, on Thursdays, for the duration of my radiation treatments. Again, this does not sound that bad to me. And the Thursday chemos are scheduled to begin right after that day's radiation treatment (each of which, as I will see, lasts maybe five minutes, while the chemo lasts up to four hours). They're very nice about accommodating the fact that I live 26 miles east, scheduling things close together.

I have a break – four days without appointments. Then on Tuesday, the 18th, there is a biopsy at 130PM. I am on my stomach; there is local anesthetic. No pain, just a few sharp pinches when the needles go into my back twice or thrice to remove bits of tissue from the tumor. This is accomplished by a Dr. Dombroski, whom I don't think I meet until he's standing next to me at the procedure. A lovely nurse, who has been with me throughout, takes me for two walks during a half hour of recovery, and then walks me to the front exit of the hospital; she has sent Mark ahead to be waiting in the car for me there. The whole procedure takes about an hour.

All goes well according to the pleasant doctor, though I learn this only on the phone as he couldn't, I guess, wait around for me to wake up.

The next day I am at the hospital for a Mediastinoscopy; that is, the removal of three lymph nodes that are closest to my tumor, which three are, if my cancer were to metastasize, its most likely targets. This is preventative; it is believed that my tumor is growing, but not spreading to other tissue (such, at least, is my understanding).

Mediastinoscopy is quite a procedure. There is the pre-op stage; a technician shaves my upper-chest; he tells me there is nothing to worry about; that the procedure is common; a successful outcome is expected. Then a young Korean-born man who, as a youth, emigrated to Los Angeles with his parents, approaches me. He is a student at Ross University School of Medicine on the island of Dominica, and is on an 8-week study program at Cape Cod Hospital. He asks my permission to observe my operation. Of course. I enjoy chatting with him – I am always fascinated to learn new things about the world from a person rather than from something I'm reading – and I can hardly wait to get home and read about Dominica on Wikipedia. Even the way it is pronounced charms me … it is Dome-in-EEK-a, the accent on the third syllable.

Then a Dr. Fortunato, an anesthesiologist, appears at the foot of my bed. He looks over my medical history. At some point he looks up from the papers and says, alarmingly, “No one told me you had had a heart attack!” I say that I don't think I have ever had a heart attack, that it was an EKG machine that had had a heart attack. “But you might not have known you had a heart attack! There's such a thing as a silent heart attack.” I have no response to this, though I want to say that I might also have had a silent this-or-that. He turns and walks away. I think: oh shit, a screwed up EKG is going to follow me around for the rest of my life. I see the anesthesiologist across the room consulting. He returns. Momentarily I am wheeled away. I think I saw Dr. Spillane. The next thing I am aware of is my coming awake, not groggily, but fully. Mark is fetched. I am taken home. I look in the mirror;
there is an ugly bandage at the base of my throat.  It'll feel
like a too-tight tie,”' Dr. Spillane had said. The instructions are that it is a “steristrip” bandage. I cannot shower for 48 hours. I should leave the bandage alone; it will come off on its own in due time. I am to be gentle on my esophagus: no spicy food, no alcoholic beverages, no acidic foods such as citrus fruits and juices, no carbonated beverages, no dry or hard foods such as crackers, nuts, potato chips, pretzels, and raw fruits and vegetables.

On August 20 I have an MRI (Magnetic Resonance Imaging) of my brain. Dr. Spillane had explained why this is necessary, but I've forgotten … I think they have to be positive that there is no sign of cancer in the brain. The technician asked me what music I liked. “Adele,” I said, that being the first name that popped into my mind. “I don't have her.” “Seventies rock would be okay.” She said something about having just bought the soundtrack to some movie; without my hearing-aid I did not catch the name. But the music was bloody awful; I was glad when the clang of the machine drowned it out; sometimes, too, the way-off-kilter rhythm of the machine was more attractive than the beat of the music.

When my little ordeal of sound was done, I saw, as I left the room, that the next victim was a tiny shrunken bent-backed woman who looked to be ninety or more. I took pity. I thought of Emily Dickinson:

I wonder if it hurts to live,
and if they have to try,
and whether – could they choose between --
they would not rather die.

There's a woman named Liz whom I love very much. I met her in the late eighties when she was a waitress in our restaurant in Vermont; she was a student working her way to a double major: literature and economics. Her father had died when she was young. She was estranged from her mother. I asked if I could adopt her. She politely declined. Now, with her lawyer husband, she's the parent of three handsome boys, 12, 14, and 16, who sometimes call me Grandpa George. Liz and her family are a major part of my extended family.

They come to Cape Cod for a few days, staying with friends in Wellfleet. This is another big morale boost. We meet them for breakfast on Sunday morning. On Monday night we all – there are ten of us – go to a drag show in Provincetown and have a fabulous time. The sixteen-year-old, however mortified, lives through a very unsolicited lap dance! On Tuesday we have breakfast on a picnic table outside Sam's Deli; and then I'm off to Hyannis because ….

Finally! Treatment begins! August 25th! I drive to Hyannis, 56 miles round-trip, every week day to have a few moments of radiation. I have a special ID card which I scan upon arrival, not needing to report to anyone; my name pops up on a computer somewhere to let them know I've arrived. Then I go directly to a changing room, take off my shirt and don a smock, leaving my trousers and wallet etc. on my person; then I sit in a waiting room until I hear my name called by a technician, who fetches me to the radiation room. Everyone, again, is lovely and caring.

On Thursdays I go right from radiation, up an elevator, to the chemo ward. Everyone there is also kind. I have to wonder if they don't pick especially caring staff for the cancer patients. In the chemo room – besides the busy nurses – are two volunteers. After you are seated in a comfortable reclining chair, one of the volunteers comes and tantalizes you by holding up a Hershey's kiss for your taking. You have to smile.

I usually have a good nap during chemo, and then am served a good sandwich and Lorna Doone cookies and milk and an apple for lunch. A comfortably elegant elderly lady named Sandy, who has a heart-warming smile, always delivers the lunch.

Once a week, on Tuesdays, I meet with Radiation Nurse Christine and then with Dr. Sullivan; also with the Chemo doctor and his nurse, Amy. (I haven't mentioned meeting her; she is a great wit, wry, long blonde hair, tall, perfect posture, another nice person.)

Dr. Lovett, however, after just one visit, dismisses me “for six weeks.” I am to have blood lab work done the day before chemo, and apparently some certain color of cells are counted; this count is noted by a chemo nurse. My count is apparently – week in, week out – good enough that further consultation with Dr. Lovett isn't thought to be necessary.

The chemo and radiation go fine. I had been told that these treatments would “wipe me out.” This, as it would turn out, was not the case; there were a couple Saturdays when I took long, deep, naps. But generally there were no bad effects; I prided myself on going straight to work from my treatments. The surgeon, Dr. Spillane, on my initial visit with him, commended me for this: “It's good to keep your mind busy.”

It did happen that on the 26th roundtrip to Hyannis I suddenly felt I couldn't do it again. I was sick of the trip. But I did it once more; I had to do it once more. And then I did it once more again. And then I was done.

While waiting for those last rays of radiation, the radiation nurse, the heart-meltingly sweet Christine, tells me that I have done “phenomenally” – I don't know exactly what that means; presumably that my tolerance has been good.

The radiation has burned my chest slightly but also, later, – and this would puzzle me – burn my back much more – to the point of blisters. I want to remember to ask how this happens.

Christine also points out that it is protocol that when one has finished one's last treatment, he/she rings a bell that hangs in the waiting room, and everyone applauds. In fact when I walked out of the last treatment there was no-one in the waiting room, and even the little hallway of nurse stations was empty of nurses, and I had to get to my last chemo treatment, so I just walked on out without a goodbye to anyone, feeling kind of sad that I was missing saying goodbye to Christine especially. She was definitely one of my crushes.

No sooner was I ensconced in my recliner in the chemo ward than Christine shows up! She's stalked me! I get a kiss! I give a kiss! I am happy now. I don't have to feel cheated.

The worst experience throughout took place on Sept. 22nd, during my second meeting with Dr. Spillane. I don't remember which doctor had first put the word 'laparoscopic' in my mind, but I had all along been thinking the tumor's removal would be a simple matter. Not at all. It will be a five hour operation, Dr. Spillane says. A sizable piece of one rib will need to be removed. Muscles in my back will be cut; I am going to be horribly sore; I am going to need rehab to become able to use those muscles effectively; meanwhile, since they control my left arm, it may be useless until my muscles are healed enough that they can make the arm do the things it's supposed to do.

This depressed me. For a day and a half I was suicidal, forlorn. Perhaps I was just tired, for eventually I came to my usual self; I realized that there is nothing I can do and that I should not worry. All I have to do is take life one day at a time. So I am going to be really really sore. So I am going to have to go to rehab. I will deal with soreness and rehab when they happen.

And then I wondered if I could bring home the rib that Dr. Spillane might remove, and create from it a woman. I mentioned this possibility to Todd, my good buddy at work.

Todd laughed and said, “I think you're confusing yourself with another guy.”

The mother of one of Mark's colleagues sends me lots of good food. It's another blessing. She tests recipes for that non-glossy “Cooking” magazine out of Vermont. She loves to cook, and she is good! And I love to eat.

We're moving closer to surgery. I have to pass a pulmonary function test at the hospital. The technician, patting me on the shoulder, says, “I'm not allowed to tell you the results, but I can tell you that you have nothing to worry about.” Having smoked from the age of thirteen to the age of sixty-three I don't understand how I pass all these various pulmonary tests I've had over the years with flying colors.

Dr. Jeffrey Spillane

On the big day Dr. Spillane shows up in pre-op looking cool, wearing faded jeans and a casual shirt. I am stripped of everything: my shorts, my modesty, and my dignity. My chest, side, and back are shaved. Mark sits at my side; I tell him that fifteen years ago this very month my brother John, also fighting a lung cancer, died on an operating table; I say that if I should meet a similar fate today, I want Mark to know how to arrange the best deal on having me cremated. “Be frugal with my money,” I implore.

I can't believe how cold it is in the operating room. I am shivering. A burly sweet surgical tech – a “bear” in gay parlance – covers me with a heated blanket. I wasn't worried, but pats my hand and tells me not to worry. “I will be with you and I will take good care of you,” he says. I want to say that I am old enough that if I should not wake from the anesthesia it will be okay; I will be the last to know, and what a perfect way to go --- go to sleep and not wake up.

The anesthesiologist, Dr. Fortunato again, shows up. “Okay, here we go,” he says.

I wake. I'm woozy. Dr. Spillane is telling me that everything went better than expected. The tumor had been so expertly shrunken by the Radiation Oncology people that he had not had to remove one rib, let alone two.

I'm gurneyed to a private room overlooking Hyannis Harbor. Mark, who'd gone home for the five hour surgery, returns to the hospital. His sister comes in. They stay until suppertime. I'm coddled by nurses. I am so spiritually high and alert that I stay awake all night, enjoying my thoughts, being amazed at the phrase cancer-free, thrilled to have all my ribs, living what seems like the life, the life of someone hooked up to five-or-so tubes, someone catheterized, someone who's having pain medication inserted drip-by-drip directly into a vein, someone who has a half-inch clear plastic tube draining fluids from his chest. I am simply amazed at this latest version of myself. I hallucinate: I am lying flat on my back and it is three o'clock in the morning; when I open my eyes I should see the ceiling but instead I see the wall that would be in front of me if I were sitting up straight! I double-check. Yes, I'm on my back. Yes, the clock and the signs on the wall are above me. Cool! Wow! Groovy! I try to figure out if it is an optical illusion; I can't figure things out. I fall asleep for what seems at most ten seconds and in a quick dream I write a twelve-line poem; it is all layed out on a sheet of paper.  When I wake I can remember only the last line: Your future is in arrears.

I access the Internet on my Kindle. I make a couple comments on Facebook. In the morning, a FB friend from work comments: “George, were you really on FB at 0230 after surgery? Hope all is well.”

Yes, Sue, I was.

In the morning I am helped to the bathroom. I've washed my face. Now I'm shaving. Dr Spillane appears behind me in the mirror. “How ya' doin', Tiger?” And then, “Keep on shavin'. I'm just gonna take a quick look at your incisions.”

That “Tiger” will nourish my spirit for days and days and days.

After the next morning's check-up, Dr. Spillane gives me a “low five.” He's like a buddy.

There is on my table a jar of coins. Someone has labeled it: "Richard English's Coins." It's a long story. Richard was my buddy in the Army in Germany in 1961. He died last December. The cops took his cash, including these coins. In April when I was walking during my lunch break a Provincetown detective called and said that I, as the person who had handled much of Richard's affairs, both in life and death, could come and pick up the cash. The detective's hours were 7AM to 3PM Monday through Friday. I said that was inconvenient for me; could I have a friend who lives in Provincetown pick them up for me? Yes, that will be okay. So Jim Rann picked them up. I never got up to Provincetown when it was a good time to look Jim up, so when Jim and Rodney came to visit me in the hospital, Jim brought the bills and the jar of coins.

On Friday morning Dr. Spillane notices the jar. “What's that?” he asks.

It's a long story,” I say. “Kind of too complicated to go into.”

We chat for another five minutes and then the doctor says, “I'm really curious. I want to know the story behind “Richard English's Coins”.

I tell the long story of a long friendship. It reminds Dr. Spillane of a friend he has, a fellow surfer; someone whom he sort of looks after the way I tried to look after Richard, someone who, “if he goes off his meds” can get into a lot of trouble (not that my Richard had a “meds” problem, unless alcohol were considered a "med"). We talk about friendship, and about loyalty. Dr. Spillane, seeming very contemplative, helps himself to a coin from the jar; it's going to go towards helping his surfing buddy who has to appear in court tomorrow in Rhode Island. Dr. Spillane is going to use a credit card to book this buddy a hotel room convenient to the courthouse, hoping that the buddy doesn't run up a huge bar tab, and that he actually shows up for court.

I have lots of company. Rodney and Jim and Abby make me laugh even though it hurts to laugh. Tom, the IT guy at work, brings me a gift bag containing two good books, and tells me that nowadays his first date with any certain woman is for appetizers and a cocktail … that way, if you decide quickly that you don't like her, “you're not stuck with her all through dinner.”

Dear friend Madeline comes in one afternoon but I am napping and when I awake I go into a panic attack because my breathing has been shallow and now I'm gasping for oxygen; she's gone before I get settled down enough to chat

And I love so many of the nurses – they are so sweet – that I consider them my personal friends too.

The Radiation Oncology Nurse Christine stops in to see me every day. On the day that the pathology report of my tumor is available, both Christine and Dr. Sullivan come in together, beaming, it seems, at how perfectly their schemes had reduced the size of my tumor. They are on what strikes me as a victory lap! I'm glad that Jim and Rod are visiting so I can introduce them to these stellar care-givers.

On the Sunday after the Monday operation I am dismissed. So much for doctors being on the golf course so that no-one gets dismissed on a weekend. Dr. Spillane says I've been ahead of my predicted recovery every step of the way.

When he's ready to leave I say, “Thank you very much, Doctor. I'm so glad I ended up in your hands. You're my hero.”

You're my hero,” he replies as he walks out of the room.

I could cry. But I don't.

The operation was just over a month ago. No, no, no, I didn't want to go to rehab, and I didn't have to go to rehab. I've been home, and, unaccustomed to having so much free time, hardly know how to fill it. I read a lot, and I actually watched a couple hours of really stupid daytime TV. Slowly I am recovering, asking only that I am at least a little better than I was the day before. My instructions from the doctor are simple: I am to walk twice a day, and I'm to walk a little further each day. This will help build up my diminished oxygen capacity. I'm not supposed to lift anything that is more than five pounds. 

I've had no pain, just discomfort, a numbness in my chest and left arm; and that seems to be getting a bit better. I can even sleep on my left side again. Last week I returned to work very part-time: 3 hours on Monday, 3 hours on Wednesday, and 3 hours on Friday. This week I bumped that three up to four. Next week maybe I'll bump it up to five.

I miss all the attention. I can hardly wait for my next follow-up with Dr. Spillane; he's been surfing in Hawaii, so I won't see him until December 8th. I can hardly wait to see Dr. Molly and Nurse Christine again; that will happen in January.

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