Copyright (c) 1993 First Things 31 (March 1993):26-33.
I had spent most of Saturday, February 29, 1992, Leap Year Day, working through a stack of books and notes I was using for a major paper on Transcendentalism, due in draft at Cleveland State University in the Graduate English program. Sunday afternoon, too, was reserved for this endeavor. Sunday morning, my wife and I were planning to begin the first of a series of membership classes at a church in the greater Cleveland area we'd been attending since the fall. We had as well-I mention only to indicate priorities set for the weekend-declined coveted orchestra tickets at Severance Hall offered by a friend, and had asked to postpone dinner with another couple. There were other plans.
In my study, midnight Saturday approached. I suddenly woke up in my chair: I had fallen asleep. And, now the only one up, went through the half dreamlike routine of shutting down the house, brushing my teeth, dropping the sooner the better into islands of proper sleep. There was a no less exacting day arriving in the morning and, the several weeks ahead being the end of the quarter, an assuredly even more taxing half-month on the horizon. Sleep, as it almost always came to me, should be sweet, and nearly immediate.
Only the sleep didn't come. It didn't come by twelve-thirty. Nor by two. Nor by three. Instead, a glittering kind of pain was shooting across the lower stretches of my abdomen. It came in spasms; continued for periods of ten to fifteen seconds, then abated, only to return at intervals just short enough to prevent sleep. By four, my wife sensed something was amiss; we thought it might be the flu she had had two days before, or the Mexican meal we had eaten with such relish earlier in the evening. Whatever it was, it was no doubt sure to go away if several hours of sleep could be found.
That sleep finally came hours later. I awoke shortly after noon feeling wan but, on the whole, better. Twitches played less frequently across my lower abdomen. I split a grapefruit with my wife and drank a glass of cranberry juice. Perhaps that was all there was to it. Sleeping it-whatever it was-off, and then some fruit. I proceeded to my study. On to Transcendentalism.
Emerson, Thoreau, and Theodore Parker came along, surely enough, but then the spasms came too. Not continuously, but at twenty-to-thirty-minute intervals; everything was normal between them. But they too, those burning jags across the stomach, would no doubt pass, the feeling was, as the night ones had. Around four in the afternoon, my wife prepared a steaming cup of universal medicine, chicken noodle soup, and brought it to my room. I managed a quarter of it, but my taste was gone. And the spasms now came on with even greater intensity. Their duration barely varied: ten to fifteen seconds of back-arching lower abdominal pain-then nothing. As if all were normal.
This went on-reading in fifteen-minute to half-hour increments, then a ten-to-fifteen-second spasm-until nearly eight o'clock, when I finally stumbled into the next room to my wife. "Do you think it could be ulcers?" I asked. I had been toughing it out. She was much concerned; a nurse, she was afraid of obstruction somewhere in my abdomen. "I'm calling the doctor," she said.
Meanwhile the first nausea came, and vomiting. After, I felt much better. Perhaps that was all there was to it. The doctor then returned the call. My wife explained. Dr. Kent from our health plan wanted us to go immediately to the Green Road Urgent Care facility. They could decide from there whether to continue on to the University Hospitals' ER. My wife packed a small overnight bag, just in case.
At the Urgent Care, the appendix came under immediate suspicion; nothing suggested itself more clearly by way of diagnosis. There would have to be further tests made, the doctor there said, "And you are obviously ill." I was sent to University Hospitals to be admitted.
The spasms continued, if with less frequency. Though now, shortly after one A.M., I was a patient for only the second time in my life: the first, a two-night stay for naturally passing kidney stones in 1981. But now a fierce hiccuping began. Nausea and vomiting recurred; the hiccuping ended. I felt better. Perhaps I was cured. I fell asleep.
Monday morning dawned as test day. There was so very little Transcendental, i.e., the viewing of life as if from the stance of a god, about it. There seemed everything of the human, and reality-batteries of X-rays, EKGs, body fluids. The organism as laboratory. By the end of the day the attending surgeon, Dr. Joseph Crowe, reported that all the early diagnoses had been cleared. The day's X-rays did show some kind of blockage in the colon that only a more intrusive picture of the area could fully reveal. Those tests were scheduled for tomorrow, Tuesday.
Release this afternoon was thus foreclosed, but I was not without hope, still, for getting out, perhaps, tomorrow. For the first time, however, we called my family: it was not going to be a one-day wonder we could best tell about some days later. We could as well reassure them there was only discomfort and tests involved at this hour. I called my editor at the newspaper where a story of mine was in production, still needing attendance; he told me it would surely appear but that my health was the highest priority. And I had called the university earlier in the day to let my professors know I wouldn't be in class this evening, and perhaps not Tuesday, depending on release and how I felt, but I was hopeful about the rest of the week.
These things happen, I reminded myself. It was odd, and disconcerting, but normality would return soon enough, we, or at least I, was confident.
At just past 4 P.M., Tuesday, March 3, 1992, Dr. Crowe and four residents came into the room. There was an added measure of seriousness in the air. The doctor had the findings of the past several days, and specifically this day's. He had a paper for me to sign. He explained. They had found a tumor. A large one. High up on the left side just below the rib cage the colon had become constricted by the growth to perhaps (he showed with his fingers separated) an eighth of an inch. Surgery was imperative. Tomorrow. If things worsened, sooner. The paper-the release form-included exploratory surgery, a possible splenectomy (the spleen was just above the site), a possible colostomy. There were other possibilities, too, some listed. The gravest, however, though not listed, seemed most in mind even as I, somewhat numbly, signed. It somehow didn't seem real.
I had cancer.
Several days, several hours, ago I had a future.
T. S. Eliot's lines seemed to fill the room in a kind of aural antiphony: "Pray for us now and at the hour of our death, pray for us now at the hour of our death . . . "
I heard the somehow spectral voices of family outside the hospital room even as they were being turned away from the door, asked to wait several minutes down the hall. I was being prepped for surgery, and I was now fully in the grip of an institution: not just of a massive urban hospital but of hundreds of years of medicine. I was relating to the world and to those closest to me from a most unexpected distance, I, among creation's most uninstitutional of creatures.
Throughout the evening members from the surgical team, nurses, doctors, anesthesiologists, stopped by my bedside to introduce themselves, asking if there were questions. (Was this now standard operating procedure, I wondered, those opening up the inside chatting up the one opened up?) They were, it seemed irrefutable, uniformly sympathetic and friendly. Before the procession ended, a half-dozen gowned and soft-spoken people-people I was not, however, to recognize in the shadowy operation room (only the medical student who held my hands in hers as I sat waiting on the table's edge registered)-passed by my bedside like emissaries of another world, a world I was even now in the vestibule of, pressing inwards.
A more familiar, almost ancient, world was still waiting down the hall to see me. They had begun their eighty-mile journey to Cleveland almost on hearing the news of the afternoon. I realized yet again that I was in the grip of an institution; my emotions were somehow annealed to its corporate matter-of-factness, the incremental, inevitable, necessary next thing; I was unprepared for the emotion-my wife and others had been talking to them-as my siblings finally approached bedside, restrained though they sought to hold themselves: a brother's tremulous voice, a sister's tear-streaked face.
For the first time (something broke loose in me), I wept. But my tears were, odd perhaps, tears of sympathy. My suffering seemed less than theirs, somehow. I wished to comfort them; I sorrowed with them. It was they, I somehow felt, who were most in need of consoling.
But there was barely time for anything. I was soon being sent downstairs once more for a last round of pre-op X-rays. A hapless kind of processional formed in the hallway as siblings and several friends whispered encouragement, waved, as the wheelchair entered the elevator then disappeared inside. Several promised to return again early in the morning. My wife, having barely left my side since entering the hospital, stayed to see them off.
Now alone and waiting in the hallway by the X-ray room in the bowels of the quiet nighttime hospital, I was joined by another. A second porter wheeled a chair near to me. Seeing the human being set beside me I was shamed, and, for the first time somehow, frightened. The middle-aged patient's taut nose and mouth were fully masked; his head was glistening almost iridescently bald, no doubt from untold radiation; his eyes were tightly shut to the world. Upwards to ten assorted bags and packs rode above him like a vast multi-sac bladder and fed into his body through tangled capillaries of tubes. He seemed almost an appendage of them. Regal, preternaturally still, he appeared like a barely breathing mummy. His porter, I observed then, was wearing latex gloves.
Compared to this woeful seemingly skinless man I was, I felt, even in my extremity, in the pink of health. Here was not The Boy Inside the Bubble, but The Man Outside. He seemed to be sleeping, or rather, in a trance. I searched for something to say: a word of comfort, camaraderie. I was somehow there too, now, I thought. I should acknowledge him. I searched for words, but no words came. I failed. His silence silenced me. I felt a peasant near majesty in the court of suffering. His fierce, clenched eyes followed me into the X-ray room, down the hall when leaving and then to my last night's sleep before the knife.
Early next morning, my eldest sister and sister-in-law followed my wife and the transport lady on the long ride from University Hospitals' Hanna House to the portals of the operating room. Their whispered, aching, fierce endearments as the doors opened to me and closed on them again brought tears to my eyes. Their fear, their helplessness, cut me with grief. I alone, I told myself at the time though now know it to be less than true, am made of sterner stuff.
I am, however, most certainly made of a human body that all too easily can be opened up with a cut extending vertically from below the belly button to the very peak of the sternum-all without knowing: sitting on the operating table's edge I breathed deeply into a small black muzzle fitting just over the nose and mouth: five, ten, fifteen inhalations: then nothing; nowhere (that is, the dictionary definition: utopia), which, you later discover, lasts for fully four and one half hours. Until the voices-far-off, somehow unearthly, insistent voices-and the tattoo of pin pricks along the thigh and sides: "Can you feel this? Can you feel this?"
Your own surreal voice echoes from some ether in the present: "Ygeke. Ygeke. [Yes. Yes.]"
This is now present tense, things are happening now: when you wake up, sliver of consciousness by sliver, in your now private room (recovery room entirely lost to you), your first lucid if muffled question to the voice you recognize, your wife's: "A colostomy?"
"Ohthankgoodness! Oh . . . ! I'm living?"
"Very much so."
"Able to go home?"
"Of course. Of course. Soon enough."
The more compelling question, however, is: Will I be able to handle the larger findings of the surgery I've just passed through? What-in the doctor's jargon: Adenocarcinoma, Colon Resection with direct Anastamosis has changed my life forever, if not prematurely ended it?
Soon enough, soon enough.
By late afternoon of March 4, 1992, I essentially know in outline what has since been fully revealed: that upwards to 50 percent of the total cancer still remains even with the softball-size tumor removed, that it has broken through the abdominal walls, that some lymph nodes are enveloped, and the liver has been encroached upon.
It is all rather serious business, the furthest removed from illusion, as the Transcendentalists would have it; sickness, death, or their prospects.
Life is no joke.
If my inauspicious birthday to this mortal coil was Christmas Eve of 1951, my worst day then was the evening of Leap Year Day 1992, onset of a second endlessly problematic round of life. Life quite unlike any I would ever have imagined for myself, though all too, even brutally, real.
Life, in a sense-my life-is starting all over again.
Even as it's threatening to end.
To coin a phrase, and even to praise: life-but another one-goes on.
I would be healed.
Or at least, barring that, heal as quickly as my condition allows. On Wednesday evening, hours after surgery, I stand upright beside the bed, supported by my wife and her sister. The day after, I take some steps within the room. The following day, I venture some feet up and down the hall. By Saturday, I circumambulate on my own among the chairs set at the end of each long hallway on the tripartite floor. I have become quite the traveler.
Sunday afternoon we have invited the nearly twenty-five nieces and nephews in my family up to the hospital. In a family with eight children, where I am the youngest of five boys and have three younger sisters, nothing quite like this has ever happened. We are a family where, until my now aged father's ailment of several years' standing, no serious illness or accident to speak of has visited. This had been true even in my childhood and youth, and now that run of almost uninterrupted health and a shielding from adversity has extended into yet another generation. My siblings tell my wife and me that their children seem quite bewildered, stunned even, by this turn of events and barely know what to make of things. An uncle gravely ill is almost fully outside their register of life.
So, we'll have a meeting.
As we are a singing family, the dining arboretum known as the Atrium at University Hospitals in Cleveland on Sunday afternoon March 8, 1992 is filled with the lifted voices of children eight to eighteen and their parents. They surround their uncle who, still with naso-gastric tube inserted and a morphine pump in place for pain at the push of a button, listens: they sing like cherubs. Forty minutes later, I ask to speak. The children gather as if circling a camp fire, their parents scattered behind them like sentries. They are very quiet.
I start by telling them that I think I understand. They are in the position I was in at their age-all of their ages. Apart from an Amish grandmother who died when I was six and a grandfather who died when I was twenty-eight, there was no death or serious illness or accident in the family I know. (We are now a clan of over forty.) The full range of suffering, reversals, calamity, and death common to the lot of all families was somehow through God's mercies temporarily suspended for us. I have no better reason why, I say, apart from mercy.
So if I couldn't fully answer their-or my-questions as to why the run of good fortune, then I could assure them that I too, through my own years, had felt that dearth of experience with close-up sorrow and loss I knew intellectually was as fundamental to life itself as-life. I knew, as we all knew, if we thought about it, and sometimes we did, the time was coming when the run would be over. Only I hadn't, I confessed, exactly pictured myself as the one to end it.
No matter; here it was, the run was definitely over, and what I could assure and reassure them of with no reservations was that what they saw before them in myself was not somehow abnormal or out of this world, or unreal, but very real, natural and normal in the affairs of men and families.
Women and men are born, they live, they enjoy, they suffer slings and arrows of both banal and outrageous fortune, they, at last, die. This is the natural rhythm of life, I tell them. Realizing the boundaries of the mortal coil is important even in understanding ourselves, knowing who we truly are. We are not little gods. We are humans-and since The Fall, subject, indeed captive, to sickness and death, every last mother's daughter and son. Thus they truly shouldn't be worried overmuch about my ailing body. Like theirs, like every other's, I tell them, it has obsolescence built into it. It's made to wear down, and out. And, early or late, it does.
It's another matter for the soul, however, I continue. It's more than mortal clay. It's made not merely for time but for eternity. That, I tell them, is the sum of things. And how we mortal humans born with immortal souls respond to Who breathed life into us-and, later, died to restore us, alienated, back to Himself-makes all the difference.
The indisputable cancer I have, I tell them, bears only on my body. My soul, my spirit, has no out-of-control cells to speak of. On that they can rest assured. I am truly in good hands, medically and every other way. Every human effort, they can be sure, is being made to fight the disease (I tell them I plan on making presidential contender Paul Tsongas who fought off lymphoma look like a malingerer), but the disease-disease itself-shouldn't be thought of as anything out of this world.
It has everything to do with this world. It is so very important for them to understand and remember that. Life, one way or other, goes on-including mine. Including theirs. Let's-I end my peroration-keep looking upward, shall we?
Whereas earlier, before the singing began, the children had been warily edging around me, unsure how to approach or what to say and catching themselves staring, the ice appears to have broken between us. I seem to have lost my dread, totemic aspect; here again is someone they know. Five of them walk with my wife and me on the long trek back from the Atrium to Hanna House to see the way the room has been decorated and the many flowers. Before they leave to join their parents, I conduct a mock interview with each of them concerning strategies for eats on the ride back, and then their goals for the rest of the evening when they get home, playing it all back to them from a microcassette player. We record much laughter.
By now I am quite tired. My wife is walking the children downstairs. I hadn't even known I was going to be giving, and certainly hadn't prepared before, a speech today. . . . My thoughts are racing even as I'm dozing off . . . when suddenly an imposing figure sweeps into the room, followed by someone unfamiliar. It's my editor. He introduces the second man as a doctor friend brought along "to make sure they're treating you right." They are, mostly. An hour later the publisher of the newspaper stops by, and we end up walking together, he, my wife, and I, down to the Atrium again and back, discussing news of the day, and business.
It's almost as if there has been no illness.
It's almost possible to imagine a time when there won't be any.
It's also true that I am about to fall into a twelve-hour sleep and, when I awaken, be fully four days from even leaving the hospital still, no question, a cancer patient.
It makes no difference. The reality remains the same.
Even as W. B. Yeats resonates of everything having changed, changed utterly.
We must wait to see if a terrible beauty has been born.
We are pilgrims and strangers in a new land. Cancer does that to you. When I am released from University Hospitals in Cleveland on March 12, 1992, a week after surgery, the world no longer looks the same. There has been a transformation: nothing will ever be as it was either within the world of men and nature or within myself. Still leafless, skeletal trees stand as sentinels along the street; bee-like traffic has taken on a different rhythm; the atmosphere itself somehow seems as if of a different substance. The diaphragm consciously takes in air and breathes out. The earth is drenched with mortality.
My wife's sister drives the car that takes us home. The two have spent some portion of the past several days making, to their satisfaction, "the house ready." It does indeed look like a new home. Yet everything, though burnished, remains much as it's always been. The new hue seems to rise both from human hands and from sources beyond. Had a house ever felt so much like a home and yet like a transit station?
In the evening, while I am resting, my wife calls to Connecticut to let her aunt and uncle know. He, a much-honored Ivy League historian, has been abroad, guest of Aberdeen University in Scotland through much of February and March as lecturer in a long-standing series. His wife, it turns out, is flying to join him in the morning; she will bear the news.
Daily, the mail brings a cache of letters and cards; flowers are dropped off. I do not, as yet, have the wherewithal to do any writing, or giving out. It is others who give; I receive. I am not just a patient, but a debtor.
The thoughts and words received are humbling, restorative, and even disconcerting. I hear from expected, and unexpected, quarters. A two-year-younger fellow alum who "always looked up to you as a role model in my high school years" writes from Illinois "shocked to hear the news of your cancer," and with "sadness knowing I will probably never see you again in this life." A colleague who begins, "During the years we worked together I have come to love and respect you as a brother" assures me that "He told us, when we go through the waters He would be with us." A Liberian émigré also from the same institution writes, "I ask myself, why did this happen to good people like you, when all these wicked people are walking around town?"
These are metaphysical questions, and one discovers soon enough that with a grave illness or accident the depths are plumbed by nearly everyone; we ask ourselves, and others, the most fundamental questions. If it is indeed true that there are no atheists in foxholes (a somewhat doubtful proposition), perhaps even more true is the certainty of the metaphysician by every sick bed.
Why do we suffer? And to what ends?
Friends of ours from Cleveland make a cottage they own in the county of my birth available to us for the last ten days of March-vacation days, as it happens, for my wife, and we plan for going there. We want to think. We want to separate ourselves from everyone. We want to spend time with people. We want to be alone. We want to be with family. We are, at times, unsure of what we want.
We do know that the cottage is lovely, set back in a craggy woods all to itself. Here the skeletal trees mass like an endless thicket. Deer venture up to the wooden patio where corn has been laid to entice them. (My eldest brother arrives one morning straight from the feed mill with bulging sacks.) A menagerie of birds live their bird lives just outside the wall of glass the lodge is enclosed by. Snow limns land and tree in a gauzy hush early in the week; warm spring breaks out several days later.
When we arrive home, somehow having managed to live with all our contradictory hopes for the vacation, an air mail letter, among others, awaits us. It reads like the sum of humanity and yet is suffused with the divine. It breaks my heart.
"Dear James and Lynne, Sylvia arrived from the USA over the weekend, but our delight at being back together after too long a separation was marred by the news she brought about the cross that has been laid upon you. I cannot even attempt to explain such things, and one of the reasons I did such an unsatisfactory job when I used to try to do pastoral work is my inability to get much past the boundaries of 'past finding out' and 'incomprehensible' that the New Testament has placed against our scrutinizing what is inscrutable.
"But of this I am sure: that the same mystery from which such trials come shows itself to be as well a source of strength and patience, even of joy, far beyond anything we ever dreamed of. And that is, I suppose, the ultimate meaning of the suffering, death, and resurrection of Christ.
"It is, I'm sure, no secret to anyone that the two of you hold a special place in our hearts, as though you were our own children. With that bond between us comes the privilege also of suffering with you and weeping with you, but of sharing consolation and peace with you as you face the future.
"As a professional, Lynne, you know far better than I what can be done to battle against this disease and why it is so important not to surrender hope.
"You will both be in our thoughts and prayers. We leave for Czechoslovakia on Friday, and I'll be back in the States on the evening of the 31st. With our abiding love. . . ."
And so we begin the second life, not surrendering hope.
Dr. James K. V. Willson and his Fellow, Dr. James Sabiers, direct the treatment program I begin at University Hospitals' Ireland Cancer Center. CAT scans taken March 31, a time distant enough from the surgery for healing to allow the computer camera to reveal what cancer yet remains, reveal two tumors perched like lethal leeches on the liver. They do allow importantly, however, for monitoring: what treatment can be seen affecting visible forms can be assumed for numerous smaller tumors "seeding" the area.
After an initial five-day hospital stay, I maintain a regimen that continues to this day: a weekly round of chemotherapy (of 5-Fluorouracil, or 5-FU) as an out-patient together with thrice-weekly shots of Alpha-Interferon, a biological agent, at home. And so it will be through late June. A second CAT scan will then reveal if the leech-like forms sitting on the liver have grown, remained the same, reduced, or, mirabile dictu, disappeared.
The forms needn't have decreased, only remain as they were, for the treatment to be considered a success. I would then continue it.
Should the forms have grown, other therapies even more experimental will be contemplated.
If the latter, the time of my end will be that much nearer, even if hope, the blessed hope, is never surrendered.
You never get over the needles.
The probing, the pinching, the sense of violation.
But then, cancer is a violation. And life is a matter of scale: we tolerate things we would otherwise repulse did we not know much worse, in this case mortal illness, awaits us.
Still, you never get over the needles. Each week at the chemotherapy sessions at University Hospitals, what is called a butterfly needle is inserted into a vein at the crook of an arm. No doubt I am a timid soul, but it has yet to become easy; I blanch at each entry. I try, however, to put up a brave front. Each insertion, I know only too well, is a sluice both for drawing out the body's most vital data and for sending in its most vital treatment.
Once a vial of blood is drawn through this means, it's quickly sent to the lab. The needle remains in place, as does a large syringe. Usually within five minutes the report comes back on what are this week's counts of platelets, red blood cells, and, most importantly, white blood cells (the disease fighters). The combination of treatment being given me of chemotherapy and the biological agent Alpha Interferon is an equal opportunity destroyer of fast (and far-too-fast) growing cells. That includes blood cells, with a ten-day life cycle-and cancerous cells. The latter, by definition, out of control.
Each week becomes a kind of medical minuet between the compromising effects of the cancer treatment on the blood counts-consistently lowering them, and hence increasing vulnerability to a wide range of infections-and the favorable effects on the fastest growing cells of all, the cancerous ones: killing them.
The protocols are elaborate. If the blood counts are below a specified number, I am sent home without that week's treatment (this has happened several times). The risks are too great, my defenses too low.
Otherwise, the giant syringe still attached to the butterfly needle becomes the modem through which this week's portion of liquid chemotherapy is slowly pushed into my veins. (Nurses wear gloves-a sobering thought-in defense against what I'm ingesting.) The killer chemo goes in search of the killer cells that have given me the diagnosis of Dukes D (the most advanced of four stages of) colon cancer. Not curable, my doctors tell me, but perhaps, just perhaps, controllable.
Think of it, they tell me, like a chronic disease. Asthma, diabetes, arthritis, high blood pressure, for example. These and other maladies are never really cured, only, with patience and medication, controlled, managed. There is the potential for this even for my illness, advanced though it may be. If the tumors yet remaining after surgery can at least be kept from growing-their natural life-their lethality can be arrested, for however long. Life, my life, with treatment, can go on.
The first evidence of success-and hope-for this modest ambition came in late June and late August. A CAT scan each time showed that two inch-length tumors perched on the liver, the furthest advance of the mass, had grown not at all since this treatment began. Gloria Deo. To be sure, the tumors had neither shrunk nor disappeared, but even to check their growth placed me in a minority of patients with my diagnosis; this was success, they told me. Treatment should continue.
And so it shall. Life will go on. Even if knowing there is no real end to treatment in sight, both of the chemotherapy given at the hospital and the Interferon shots-needles again!-I administer to myself at home. Even if knowing, as I've been told by my doctors, that checked tumors can, over time, build up an immunity to ongoing treatment and resume growing.
Perhaps they will. Perhaps they won't.
Meanwhile, I can resume living. Not just as before-that will never be; my cancer will always exist-but much like before, only, with the added measure of mortality weighing, much more so.
My ambitions have been few, even singular: I have felt impelled since youth to write; scribble, scribble. Little else has motivated me.
That urge continues. These pages reflect, and have reflected, one part of my interest.
And I too have that no doubt less than Great American Novel every self-respecting journalist is said to have in a desk drawer that I'd like, between assignments, to return to. I fancy it the best thing I've done, perhaps will do.
Finally, perhaps at this late hour a straightforward statement will be permitted me: I love my wife. She has been the hero.
God has been merciful.
I'll-to appropriate Beckett in Waiting For Godot-I'll go on.
There is a state, twilit but real, somewhere between life and death.
Those with terminal disease inhabit it. They are, for want of a better term, emigrants of the spirit. What citizenship they possess subtly shifts; the air about them somehow changes. They become alien in their own residency.
Terminal by illness places one on a febrile Ellis Island of a new and undiscovered country from whose bourn, as doleful Hamlet observes, no traveler returns.
But sail has been set, unquestionably, from the Old World; the New World awaits.
Yet this gradual, ongoing estrangement holds a profound paradox, one it might be hard to imagine short of being drawn in oneself. It comes as a point of wonder, and surprise. It makes one marvel anew at the quality of mystery in life. For even as the threads weaving one to native country of health unravel, the ties that bind to all we know and love, family, friends, coworkers, even strangers, tighten.
Or if not tighten, transform: they take on a fresh, heightened character; a nuanced dynamic quality enters every relation, from the most intimate to the marginal; complacency is effectively banished; carpe diem, seize the day, does not so much become an anthem of hedonism as a reminder that only the day, not the year, or the decade, or the life, is vouchsafed.
Never have tears been so near to laughter. Never the profusion of both. And never has loss and gain, longevity for depth, seemed so much of a piece, so exquisitely inextricable the one from the other.
This paradoxical, perhaps transcendent, émigré status was borne home anew by a recent CAT scan, the third set of computer pictures since March, monitoring my hereto checked tumors. Giving me the report, my doctor's voice faltered slightly on the word "unfortunately": Unfortunately, the treatment I have been on has now failed.
For five glorious months and two scans the treatment held; growth was checked. The odds, medically, had never been very long for even this.
But hope builds on hope-and success. Why shouldn't the so-far effective treatment continue to hold the pestilent, uncontrolled growths at bay? Why shouldn't a third view of the two inch-length malignant eels on a vital organ show the same arrestment as earlier views? Why? Why not?
The treatment, now, beginning in early October, has been altered. The concern all along about the chemotherapy (5-FU) has been the unavoidable effects it has had on the blood counts, seriously depressing them. These lowered counts over time forced a correspondingly reduced volume of the chemotherapy itself; these past several months, less and less has been taken.
The new, if still 5-FU-based, regimen, begun this week after a two-week hiatus allowing the counts to rise, has a new biological agent enhancer thought to be less punishing on the bone marrow than the one to date. Much higher doses of the chemotherapy are now within hope-the first full treatment has already begun.
Time will tell, certainly enough, as will the bi-monthly computer pictures monitoring.
Yet all of this, including (perhaps especially) the medical minutiae, is occurring on a somewhat surreal terrain.
The New World does take getting used to.
There is, for example, no illusion of old age. No thought of decades between now and whatever terminus might give me, and life itself, meaning. Either the meaning is now or it no doubt never will be.
There is no, or certainly fading, illusion of ever fully holding on to things. Things: not to denigrate their due place in living, but not a single item, not a book from my library, not a Mozart CD, not my gift of a lap-top computer or the vintage fountain pen made mine one Christmas morning, can accompany. It all, every single blessed thing, stays behind, like me to founder eventually in the dust.
There is no illusion of hanging on to any person, even the closest. We all, in the end, become separated: we had best cherish those who are near us (a gift, after all) before we do.
The night comes soon enough, in the words of One who rose from the dead, when no man can work, or love.
As I believe in the One who conquered death, who promised the like to all believing in him, the prospect of my own departure from this mortal coil does not fill me with terror.
I have hope. To be sure, I hope for more days. I love life-I've positively thrilled in it throughout this year, never cherishing it more deeply.
But it is, our human life, a being trapped in time. And time, for every single one of us, ends: sooner for some, later for others.
But ends. For all of us. Eternity extends: where, and how, we board is everything.
We are all of us, then, to that extent somewhere on an unfolding continuum between life and death.
Terminal. Between countries. Émigrés.
I'm simply, perhaps mercifully, reminded.
JAMES ANDREW MILLER is a correspondent with City Reports, a Cleveland, Ohio newspaper, where portions of this journal first appeared.