Syracuse, NY 13210
Volume 5, 2005
Cancerland, a novel
An Excerpt from Chapter Six: B.C. and A.D.
Chloe maneuvered around the chairs and the IV pole and bent awkwardly over the side rail. She kissed Nina gently on the cheek.
“Sorry, I can’t move my neck,” Nina said, pointing to the bandage covering the biopsy incision on her neck. “Just call me Frankenstein.”
“You look like you’re in terrible pain,” Chloe said.
“It’s better now. Codeine is our friend. Shake me if I start sounding too loopy.”
“Don’t worry. I’m prepared to take copious notes. This should help.” She placed the cup of cappuccino in Nina’s free hand.
The pungent scent of espresso, warm milk, and cinnamon washed over Nina’s senses. She felt her mind clearing. Of all the comforts from the outside, this one she missed the most: the smell of strong Arabica beans. No matter how many times she’d tried to give it up on one health regimen or another, coffee found its way back into her cup and under her nose. On this significant morning, its aroma was especially invigorating. It had the smell of courage, and of hope.
“ Thanks, luvy. I’m in heaven.” Nina slurped the foam off the top of her drink.
“Hello, Nina. Miss O’Donnell.” Nina turned to see her doctor standing in the doorway with a large, orange folder. Her dark curls bounced as she nodded to both of them. It was the first time Nina had seen her maverick doctor in a lab coat, and even more uncharacteristically, she was wearing a skirt and heels. “Is this a good time?” she asked, holding the folder across her body.
“Yes, please come in,” Nina said. “We’re ready.” Nina placed her cup on the dresser and Chloe sat down, leaving the chair next to Nina open for the doctor.
Nina heard the rustle of Dr. Delfina’s clothing and her heels against the floor, measuring out what seemed an endless path to the open chair. Dr. Delfina’s expression was amicable, upbeat even, Nina told herself. And she was feeling so much better this morning. But as Dr. Delfina assumed her seat, Nina’s mood shifted. She felt her heart twice its size, pounding against the inside of her ribcage, vying for space in her chest. Dr. Delfina rested the folder in her lap.
“I heard you had a night sweat,” she said. “How are you feeling now?”
“Pretty good, actually. My lungs anyway.” Nina said, demonstrating with a deep inhalation that turned into a cough. “I’m nervous, of course…about the biopsy results.”
When Dr. Delfina looked down at the folder, Nina took the opportunity to study her doctor’s face. She noticed that her doctor was several years younger than herself and just as nervous. Nina was surprised by the feelings of compassion she had for the younger woman in the chair opposite her.
Then, she saw Dr. Delfina rotate her head ever so slightly to the left. Only a trained eye would have caught it. In Laban Movement Analysis, it would have been notated as a mere shadow movement—a suggestion of a movement before the actual action. Nina had studied the system in great detail. She was certified and had even taught specialized courses at the studio for dancers, anthropologists, and the occasional political consultant. Her doctor’s simple gesture was a turn and not a nod; a ‘no’ and not a ‘yes.’ Even before her doctor spoke, Nina sensed there was bad news ahead.
“Night sweats, swollen lymph glands, shortness of breath—these are all indications…” Dr. Delfina paused as if out of breath, “of non-Hodgkin’s lymphoma.”
Nina’s eyes widened. “I don’t really know…what lymp—” Her tongue tripped over the awkward word. “What does that mean?”
“It’s a blood disease,” Dr. Delfina said, proceeding slowly. “A cancer of the immune system. I’m afraid…your biopsy tested positive.”
Cancer? What is she saying? I’m the healthiest person I know. There’s no history of cancer in our family. None whatsoever. Nina saw her doctor’s lips moving but she couldn’t catch up to what she was saying. Nina felt dizzy. Out of breath. Chloe was standing up now. She was coming closer. She was putting her arm around her. Nina looked at Chloe, then at her doctor. Their eyes looked so sad, so full of compassion and it frightened her.
“Are you absolutely certain?” Nina asked, anxiously. She felt Chloe’s arm bolstering her back.
“Yes,” Dr. Delfina answered. “The CAT scan confirms the biopsy results. We are quite certain. You asked to see the scans?”
Dr. Delfina walked to the window, and pulled out one of the films from the folder. As she held the plastic sheet to the light, it made an ominous, warbling sound.
“It’s remarkable how detailed these images are,” she said as she fished in her shirt pocket with her other hand and pulled out a pen.
Nina saw three columns of boxes, all of them containing one repeated image that looked like an illuminated pretzel with a large knot at its center. She tried to focus, to feel some connection to the twelve solarized pretzels in front of her, but she couldn’t make sense of them. Out of the corner of her eye she saw that Chloe had returned to her chair and was scribbling onto a note pad.
“This is a cross section of your chest cavity,” Dr. Delfina explained. “As if we were looking from the top downward. You see this mass here at your mediastinum?” She pointed with her pen to a glowing knot at the center of one of the pretzels. “This is one lymph gland that has grown to six centimeters in diameter. Normally, they are the size of a lentil.” She tapped her pen lightly against the plastic, hitting the center of each of the pretzels.
“This is one tumor pictured at different angles. This is why you’re having trouble breathing. This tumor is crowding out all the organs in your chest.”
Nina gasped. She felt betrayed. Who is this uninvited guest, she wondered, and what does it want of me? “How long has it been there?” Nina asked.
“We’re not able to say exactly when a cancer first starts. Every person produces some cancerous cells. It’s when they progress uncontrollably that it becomes a disease,” Dr. Delfina explained. Distraught and bewildered, Nina looked to Chloe.
“How did I get…How does one get lymphoma?” Nina asked.
“We don’t yet know, exactly. But lymphoma is one of the most rapidly growing cancers. It strikes unconditionally, rich and poor alike. Jackie Onassis, Paul Tsongas—the Senator from your home state—the Shah of Iran, to name of few. All of them were diagnosed with lymphoma.”
“Excuse me, Doctor,” Chloe interrupted, “but all those people are… deceased.”
Nina felt the muscles in her body trembling. She’d read about these luminaries dying of “cancer,” but had never heard the word “lymphoma” mentioned. She slid her legs deep between the sheets and drew the covers around her waist.
“It can be deadly, I want to be straight with you,” Dr. Delfina continued. “But treatment has improved in the past twenty years. King Hussein of Jordan was diagnosed just last year. He responded well to treatment and now he’s in full remission. Each illness is entirely different.” Dr. Delfina slid the scan into the folder and pulled up a chair to Nina’s bedside. “You have a very aggressive type of lymphoma, Nina. It came up quickly, and will proceed quickly if we don’t begin treatment immediately. Immediately,” she emphasized, leaning forward. “While we have the advantage.”
Overwhelmed, Nina looked to Chloe for assistance. “What sort of treatment are you recommending?” Chloe asked.
“The good news is that the more aggressive the illness, the more likely it is to respond to treatment. I’ve asked Dr. Jeffrey Solomon to be your oncologist. He’s the head of hematology at Hudson River. There’s no one better. I like him a lot and I think you will too,” Dr. Delfina said. “He wants to start your first round of chemotherapy as soon as possible.”
Chemotherapy? Nina remembered a former student, a woman in her thirties, a lovely dancer—extremely gifted—named Rose. She’d walked into the Studio well over ten years ago wearing a silk headscarf, determined to continue dancing despite chemotherapy treatment. Over the months, Nina watched Rose become sicker and sicker. She had to leave class early before the center floor work, explaining that the treatment, and not her illness, was zapping all her energy. Rose started missing whole weeks of class, and eventually, she stopped coming altogether. After a couple of weeks, Nina called Rose at home. When her husband answered, he explained that Rose had just died.
Ever since then, Nina had sworn she’d rather die than undergo chemotherapy and suffer what Rose went through.
“What are my other options?” Nina snapped. “What if we don’t do chemotherapy? Are there any surgical options to consider?” Nina was astonished to find herself talking in this manner to her doctor.
“Not in your case. NHL is a systemic lymphoma,” Dr. Delfina answered, calmly, “which means it cannot be contained in one area. It cannot be removed effectively with surgery, like some other cancers. It can pop up anywhere within your entire lymphatic system.”
Dr. Delfina returned to the orange folder and rifled through the other films. “I want to show you one more film, the anterior view.” She carried one of the plastic sheets to the bed and set it upright on the mattress so that it rested against the inside of the rail.
“Here, take my pointer, if you like. Tell me what you see.” She put her pen in Nina’s hand.
Nina instantly recognized the image of the human torso. She knew the territory well from Dr. Netter’s meticulous etchings in Atlas of Human Anatomy. But here, now, was a picture of her own torso. With Dr. Delfina looking over her shoulder, Nina raised the pen and touched the image on the sheet.
“These lines here are my rib cage. And this here…this is my spine.” She studied the thick, black and white images of her vertebrae and felt a sense of gratitude. “Spine looks good. Even strong, I’d say,” Nina said. “I can make out my lungs here, and here,” Nina said, tracing over the two balloons on either side of her spine.
“Anything else? What about your heart?”
Nina searched for the outline of the familiar, fist-shaped organ but she couldn’t find it. She saw only the large luminous mass at the center of her chest.
“I know where it should be,” Nina said, “but, no, I can’t make it out.”
“If you look carefully… May I?” Dr. Delfina reclaimed her pointer and reached across the bed. With the edge of her pen, she followed a faint line on the film. “If you look closely, you can see the top of your heart, right here.” Then, she raised the pen a bit higher, to the uppermost edge of the luminous mass. “We knew you had a pleural effusion—the liquid surrounding your lungs that is impeding your breathing. What we didn’t know until now,” she said turning to address both women, “is that Nina also has a large pericardial effusion. There is fluid surrounding Nina’s heart as well.” Then Dr. Delfina turned squarely to face Nina. “The reason it’s hard for you to see your heart on this film…is because it’s literally underwater.”
Nina stared at the devastating picture and fought hard not to cry. No need to add to the damage done, she thought. All those nights since April, crying uncontrollably over the loss of Sam, falling asleep only after she’d run herself dry. She had told no one about the extent of her grieving, not even Chloe. She had lied to all of them, told them that she was over him. But she was certain, certain as the scan in front of her, that her grief had cost her dearly. That all those spent tears had somehow found their way to rain upon her heart.
“Nina,” Dr. Delfina said, as she leaned in slowly toward her, “the disease is impairing the function of your lungs and now your heart. That makes the classification of your illness Stage IV. ” Dr. Delfina exhaled loudly and shook her head. “We cannot delay.”
“What does that mean, Dr. Delfina? Stage IV?” Chloe asked.
“Stage IV is the most advanced level of cancer. And to answer your question, Nina,” she said, her face visibly strained, “without chemotherapy, I fear you will not survive the week.”
When Dr. Delfina pulled a business card from her pocket, Nina motioned for Chloe to take it. Nina had reached her limit. She was too numb to comprehend the full extent of her doctor’s words. “You’ll have to excuse me. I just hit the wall,” she explained, as she inched herself down to the bed. Through heavy eyelids, she saw the two women huddled together as they spoke in lowered voices. Nina tried to pay attention until she could no longer keep her eyes open.
“How do we get in touch with the Dr. Solomon?” she heard Chloe ask.
“He starts his rounds at 8:00 a.m., but he may not show up until…”
As Dr. Delfina continued, her accent seemed more pronounced to Nina in the darkness. She half-heard the discussion about Dr. Solomon’s training, his qualifications, his research grants, his myriad publications but there would be time for that later. She pulled the sheet over her eyes like a child wishing the world would go away.
She thought about the diagnosis. A line had been drawn between two worlds: the time Before Cancer, and the time After the Diagnosis. She knew that she would never be able to cross back over that line.
Nina exhaled and listened to her body’s inner machinations. With her hand over her heart, she wondered if she might sense the teeming activity beneath: the cancer cells dividing and multiplying exponentially, refusing to die off like normal cells, each one on an obsessive drive to survive at the expense of all other life, including her very own. She imagined the glowing mass she’d seen on the scan and wondered if she might be able to feel the tumor, feel its ominous edges inside her ribcage. But she felt nothing. Absolutely nothing.