|Circling the Drain
Say goodnight, Gracie...
My HMO physicians medical assistant, Jan, called me today, to tell me that it looks like I have lung cancer. Whenever I am inclined to feel sorry for myself, I think of people like Jan whose job it is to handle Dr. Carters doomsday calls.
October 21st tends to run in my family. It was my Grandmother Moores birthday, my fathers birthday, my godfathers birthday, my godsons birthday and my own birthday. My father died four years ago, on October 20th, 1998, the eve of his 86th birthday. So week before last, for my birthday, I treated myself to the October 21st CT scan that discovered my lung noduIe. I should have known better.
The probability curve has not closed on this bit of news, pending another chest scan. I might still live forever, and then again I might be out of here pretty quick. Until somebody knows something for sure, it could be anything. Whats a nodule? I asked immediately. Jan had been reading from the lab report, and was reluctant to ad lib. It could be a shadow, she said. It could be valley fever. It could be cancer. She placed a studied, equal emphasis on each of these items as she ticked them off, as though their disruptive potential to my life might be more or less the same. Cancer. A rapid, unappealable eviction notice from the bio-political zone. Im sorry, Mr. Moore. Mother Nature has stuck a rocket up your ass and pointed you out the door. The nice thing about lung cancer is that you dont have time for the five Kubler-Ross phases - denial, anger and whatever. You can go right ahead and burn your belongings and wrap up your affairs and choose from among the limited, by and large unpleasant exit scenarios available to you. Unless, of course, its the good kind of lung cancer.
A milestone of this kind doesnt distinguish one in any way from the run of mankind. All will enter this terrain. Many are already there, come to it well before myself, the new kid on death row. My friend Wilma has it too. It was ironically Wilma mothers ghost who cured me of smoking, from the moment I walked out of her memorial service 14 years ago. Elnas relentless nagging, however, only strengthened Wilmas resolve, and with an admirable assertion of the unbroken human spirit she went on to inhale another 200,000 cubic feet of straight-from-the-butt tobacco smoke until her lungs found a way to make it stop. Shes treating her small but inoperable node with herbal elixirs and has cut back somewhat on cigarettes at the recommendation of her naturopathic doctor. She says shes seen everything she wanted to see, as though life were a kind of steamship cruise to the orient with agenda items that you check off to make sure you got your moneys worth. My sister-in-law Margie has a more systemic version of cancer. She has been fighting it for several years - 3 or 4 rounds of chemotherapy, hair loss, devastating fatigue, little spells of normal life, new tumors, etc. Her CA count is back up again this month, and she has gone to Florida for more surgery. She has a complex and engaged life, with many loved ones. For Margie, cancer is like some horrible in-law who cozies into your home for long periods and occasionally goes back to hell for a little while and seems to leave you alone.
My demise is still like the uncounted votes in the Ryder truck in Tallahassee. Nobody has delivered a prognosis, so it could be this way or it could be that. Is it already one way or the other, lying in the empirical space beneath my ribs like the True President, waiting for the light of discovery? Hoell probably thinks so, but his thinking ignores quantum dynamics.
Jan finally called with the results of my second CT scan. She read the information about the location of the tubercle in a medical language I did not easily follow. I asked her to send me a copy of it. She said that the lab recommended I come in in another three months and get another chest scan. I asked her if the report mentioned whether or not I had lung cancer. She said no, it just says come back in three months. I said that that was not acceptable. If I have lung cancer I need to plan my life one way, and if I dont, I need to plan it the other way. Do I sign a Spring teaching contract? Do I sell my house? Do I send in a two year subscription to Harpers? Surely it is appropriate for me to be alarmed by this radical possibility. I dont think that just keeping an eye on the situation is a very good medical response to lung cancer. Im not prepared to sit with maybe having lung cancer while all that time goes by. I want a diagnosis. I want to know what is showing up and what it means. Jan didnt know what it meant, because she was just reading from the lab report. She said she would talk to Dr. Carter, and call me back. She did this, telling me that Dr. Carter suggested sending the film to a pulmonary group near him, and getting me an appointment to go over it with one of their doctors. So. I have made this appointment. Now well get a peek at the future.
Nancy at Catalina Chest has been trying since last Tuesday to reach me to confirm this date. It is noteworthy that for three days, while I fretted about nobody getting back to me, her message was on my phone machine, the led light blinking on and off trying to get my attention. The simple push of a button apprising me of the magical date and time at which I will become either thenceforth reprieved or capped on schedule. How important to have one more weekend to believe it could all be a big mistake, as though the possibility of a happy outcome could be kept alive simply by avoiding any kind of news. The cat in Schrodingers box is neither alive nor dead. Its not hopeless.
I made it through Thanksgiving with my strange little secret intact. (I have told Father Joe, nobody else.) Tom came out from Santa Barbara. We had a Friday-after-Thanksgiving turkey here with the usual derelicts. Myself, Tom, Wilma, Hille and Father Joe. To spend an evening with the priest and my nearest neighbors to either direction, all of whom have incurable illnesses, was something I probably should have consulted Miss Manners about. If consistency counts for anything it can be said that I made it through my whole life without ever throwing a decent dinner party.
A word about fear: Receiving the Black Spot from your doctor, if that is what has begun to happen, is about what you'd imagine. You hang up the phone and you think Son of a bitch. Im toast. Not that you didnt already know it. Like milk, youve received a rough expiration date. Drink by Fall 2004. Keep irradiated to prolong shelf life. How much time before life turns sour? Jan didnt say. Maybe Ill find out on Tuesday. In the cellar underneath the dream of life a small alarm, like a seat belt buzzer, starts to sound. How did Laurie Anderson say it? - like distant summer bees. Little by little the news reorders the constitutive priorities of life, as the future in which things might be put vanishes now here, now there. I dont mean to say that the alarm, or even the sudden radical readjustment of lifes immediate priorities, feels really bad. Ive been thinking about death all my life. Im not one of those people who pretends it is not up ahead someplace. I also dont believe I am a foxhole mystic. Contrary to most psychological points of view, I dont think my weltanschauung is driven by the dread of death, for I have kept the problem of mortality conscious and before my eyes since childhood. Certainly we shall see. The observation, just now, is simply that it is not a terrible feeling, a kind of scream or anything like that. Just an improbable hybrid of unease and calm. I function surprisingly well with its unremitting presence, and even tune it out altogether for short periods. The detachment is perhaps denial (something Ive alerted myself to look out for.) The inevitability that shortly I will be hurled into what our present vantage point can only picture as oblivion, not from a state of samadhi, but from a state of morphine delirium and extreme physical discomfort, is not yet terrifying, not yet interesting.
In 1950, the top floor of the Central School gymnasium in Helena, Montana featured a fire escape which I have always held in my brain as an image of the experience of death. It was a steel tube which spiraled to the ground like a water slide, designed to dump large quantities of grade school children into a ground level heap with only minor injuries. The ingress to this tube, up on the third floor, was a scary behold. A round orifice plunged downward in a sharp, steep curve, into convoluted gloom and complete uncertainty. Once committed to that journey, there was no way to scramble back. The outcome was to be accepted on faith, for the other end of the tube was many coils of darkness away from view. It was the kind of contraption into whose terrifying maw teachers had no doubt been directed to throw their students bodily if necessary.
A later image was my first (and nearly only) parachute jump. I related the experience to my father during the two weeks I sat at his death bed, not knowing then, any more than I had known during his life, whether he had spiritual needs of any kind. The escalation of madness leading to the point of jumping out of an airplane begins on the ground in a compelling exercise of posturing and bravado which locks one into an irreversible commitment to a foolish and death-defying stunt. We are in our twenties. Usually a woman is involved. We strap on the wad of nylon and canvas which is supposed to unfold perfectly and save our lives in the nick of time. We climb into a single engine plane with no doors and a pilot with a pony tail. The plane takes to the air in a clamor of vibration and propeller blast, until we are looking down from a sickening height at a patchwork of fields and tiny buildings - an unsurvivable void into which nobody in their right mind would throw himself. The plane having made its final run to the target area, the first parachutist climbs out the door into the slamming maelstrom behind the propeller, stands on an exterior foot peg of some sort, and holds onto the wing strut. He cant hear a thing. At a given moment the instructor slaps him on the shoulder and he pushes off. The poor devil plummets out of sight, into stomach wrenching oblivion. Then it is our turn. Out the door we go, staring downward into the unthinkable distance. A thousand banshees pound our eardrums. The plane is a tormented assemblage of screaming aluminum and loosening rivets. A demented gale whips our clothing. Only the thought of that rosy breasted chick back at the airstrip makes death preferable to returning to the ground with the airplane. So we are resolved to go, like cannon fodder at Gallipolli. All thought suppressed, the world boils down to the slap on the shoulder and that casting off into the hail of bullets, into the abyss in a leap of pure faith. The slap comes. We surrender our hold on the aircraft. At once, like an eclipsing star, the noise is replaced by silence, the motion by stillness. We are suspended in a steady upward wind, floating above the unmoving earth. One situation instantly yields place to another. Confusion snaps into stability, bedlam into peace, terror into exultation. In the blink of an eye, we are changed.
Nobody says anything better than Annie Dillard, so here she is, in embarrassing contrast to my crude stagecraft:
Speaking of psychiatric pundits, six days after my CT scan and 3 days prior to my bad news phone call, I received an e-mail communication from my lifelong friend Noel Hoell (Christmas Hell; his middle name is a comma), a frothing-at-the-mouth atheist, in response to some mention of the deity on this web site. Noel is not only content to disbelieve in God, he doesnt think anybody should be allowed such pernicious fantasies or permitted access to churches or given license to infect others with spiritualism or other obfuscatory nonsense. He thinks religion is the root of all evil. (He is a very intolerant, very wicked human being, and I herewith issue a fatwa on his life.) God or no God that is spooky timing. Our dead mutual friend Phippy Barbour studied and relished synchronicities, seeing them as evidence that individual consciousness is directly wired into the quantum foam. Noel and I exchange maybe two e-mails a year. What an astonishing co-inky-dinky that the timing and the orchestration of his note should be just such as they are! How could I not share this with you?
A word about anger: Naturally I will want to blame my death on others. It is not appropriate to insert such complaints here. I just dont want to quietly pass away without warning all of you that it is in the best interests of your Health Maintenance Organizations to move you along as quickly and inexpensively as possible into your graves. We cant fault them for this. They are entitled to optimize their profits just like everybody else. Likewise our primary care physicians, who see several thousand patients a year. They dont remember who we are from one visit to the next, and they cant be expected to care about us except in a sort of general Hippocratic way. The files containing our medical histories, and the office girls who maintain them, are really our lifelines. That and the extent to which we are prepared to be responsible and proactive and nosy and assertive where our own health and survival are concerned. We are lucky enough to live in a compassionate society that does not make us into Soylent Green. Beyond that there are no automatic protections. Suffice it to say that I presented my (perhaps hypochondriacal) symptoms to my PCP on March 4th, 2002, and assuming anybody tells me anything on Tuesday, three doctors, three lab tests (one lost) and nine months later, I will have finally received a tentative diagnosis of deadly cancer (with no treatment to date) from what the Republicans have described as the best god-damned health care system on earth.
I dont normally have dreams worth remembering, but pieces of yesterday found one another in the neural projection room last night, and edited themselves into a short pre-dawn production.
One piece of footage came from a remark I made to brother Tom while finding him an alarm clock to use in the trailer. We were talking about internal alarm clocks, and I said that I had a sort of Rube Goldberg device for getting up at precisely 6:30 every morning, to wit: Barney, my giant, wood-eating macaw, gets down off his cage every morning at that time, and climbs up onto the dining room table (our deceased parents dining room set). I hear his toenails walking across the polished tabletop, and I am awaked by moms ghost.
Another piece came from a brief portion of a seven hour PBS marathon featuring Bill Moyers talking to Joseph Campbell. They have run this video for us so many times that it has become like one of those mood tapes of whale songs or bird estuaries. It is a soothing alternation of Bill asking naive and leading questions, and Joe coming back with wise and insightful responses, on and on like a sort of long, mellifluous canticle of mystical affirmation, providing a far better filler noise than a Nascar race or a Bob Ross painting lesson. Joseph was holding his fingers in a circular figure, and was explaining the significance of the holy syllable aum to Tibetan and other Buddhists. It is known, he explained, as the syllable of the four elements, and consists of three distinct sounds corresponding to the three stages of our lives, i.e. initiation and birth, the procession of life, and closure. Our lives are the three sounds, and the fourth element is the silence between intonations, which stands for the pure emptiness which contains time and space, life and death, from which all eventfulness emerges, and into which it all vanishes again. I think I was standing there with an armload of laundry, having snagged my mind briefly on a tantalizing hook of familiar meaning.
And so finally to bed, and a night of fairly busy dream activity, almost all of it forgotten the instant one skit was replaced by another, until, following some unpleasant riff involving a petty quarrel with my brother Jim, I found myself in my old room in the basement of the Flowerree Street house where I spent the last eight years or so of my childhood. We all lived in the basement circa 1950, until we could afford to put a top on the house. In my dream I was going through piles of paper from work (Byron Medical) so the time was current, and I was my normally stressed 63 year old self, sorting through boxes of memos and lists and forms and notes, looking for things I needed to copy or keep for my own records. I had it spread out in stacks on the bed and on the floor. While hauling another box of this stuff down the stairs, past the laundry room (which had previously been the kitchen before the upstairs was built) I noticed my mother standing there, in that windowless, cement-walled grotto where she had spend much of her life. She was a younger version of herself, in her mid-thirties, very pretty and pleasant looking. When I got to my room with the unsorted documents it occurred to me that mom was dead, so she was perhaps a ghost. However it was very important to locate certain papers while I had the opportunity, so I continued sorting. Pretty soon Todd and Scott from our front offices arrived. They were getting ready for some kind of audit, and needed to go through the same piles of records, which put an end to my sorting order. So I went back to the laundry room to talk to mom.
We were standing there next to the sink, with maybe a box of family photographs on the counter. She said You know, you guys (the living) think about me a lot more than I ever think about you. All this stuff (papers, photos) has no importance to the dead. The dead dont care very much about the living. Thats why we never come back to visit you.
But youre here right now, arent you? I said.
Not really, she said, smiling.
You were the worst about squirreling away recipes and hoarding mason jars, I tell her.
She laughs. The worst.
An interesting day. First thing in the morning Don, my insurance broker, calls to tell me that since I am outside the Oracle Fire District, nobody will give me homeowners coverage unless I clear all the vegetation from my property, put a metal roof on my house, and pay a hugely inflated premium. Last summers brush fires have spooked them. The protecting hands are shaking me off like an unwanted bugger. Their television jingles run through my mind as I watch their backsides disappear down the road. Whoa, good neighbor! Where you going?
Normally such news would have constituted an emergency, but in the current context it seemed like something which could only slightly diminish the good fortune of the heirs to whom I will shortly bequeath my property. "Well Don, I said. I dont see the problem. If your people can offer me an affordable rate Ill buy the insurance, and if they cant, I wont. No hard decisions there.
Fire insurance is one of a number of disappearing problems. The need for a low mileage car. The dilemma of whether to go for crowns and implants or a set of hand carved Mexican dentures. Will my retirement stash be enough to provide an income in my golden years? When will I finish my house? How will I get my cholesterol down? Do I know enough? Should I quit drinking? Should Bush invade Iraq? It is almost as though there is a upside to this. Everywhere I look, worries are falling away like autumn leaves. Money problems invert to inheritance issues. The whole logistical snarl of my life boils down to finding homes for four parrots, designating the disposition of my assets, finding time to read the rest of Annie Dillard and walking out onto the ice. The part of me that frets about crisis management has begun to relax.
I have an appointment with Dr. Cobb at Catalina Chest at 11:00, to look at my CT film. If he says Im ok Ill be very happy. If he pronounces my death sentence, I will quit both my jobs and take the rest of my life off. Wait a minute. This is not so bad.
Dr. Cobb seems to know all about chests. He put up sheet after sheet of the hundreds of cross sectional salami photos into which I had been sliced by the scanner. Sure enough, there about 1/4 of the way down my right lung was this tiny white speck. Somebody had drawn a circle around it with a sharpie pen.
Its very small, he said. It wouldnt show up in an X-ray. Its too small to biopsy. Its probably just a little piece of junk thats been in there for a long time. At this stage, the only way to know if its malignant is to see if it gets any bigger. We scan it again in three months, and as long as theres no change we increase the intervals.
And if its malignant?
Then well get it out of there, he said.
Thanks, Doc, I said. Thats a load off my mind.
The happy option. The cat lives. Gore is President. The dream of immortality had already begun to wrap around me as I walked into the parking lot to the gas guzzling Ford pickup that I have got to replace before it drives me to the poorhouse. As I turned onto La Cholla I remembered that my homeowners insurance was due to expire in a week, and that getting the Oracle Fire District enlarged to include my place was going to involve enlisting everybody on Cody Loop to sign the request along with me. If I didnt get a coat of sealer on those banisters this month I might as well set fire to the place myself. Charlie Goffs cows were trashing my yard, and I secretly suspected that Id spend half of my annual vacation up in the catclaw rebuilding a half mile of barbed wire fence. I remembered that I had resolved to quit teaching, no matter how things turned out. I reconsidered it, then reconsidered it again, then decided to decide later. Im weeks behind with my e-mail. I need socks.