cairn
THE LIGHTS ARE off in the vestibule outside surgery where we wait for the doctor to emerge. A janitor sweeps the floor. My sister holds her arms around me as we sit on the chairs outside the door to the operating theater. A hospital employee asks if we need anything.
“Can you get us a blanket?” Christie asks.
But there isn’t any blanket that can erase this chill. My teeth chatter so intensely that I lock them to keep from biting my tongue.
All I can think of are the calls I made to my children after they took Richard back to surgery. The buried sorrow in Joshua’s throaty question when I’d called him at college, “Is he going to be okay, Mum?”
“He’s with the best surgeon in the world, honey,” I answered.
The friend I asked to watch over seventeen-year-old Dylan said she would relay the news to our daughter when she woke up, but that “it wasn’t the time” to upset her with this information. I sit in the waiting room, knowing that I’ve made the wrong choice to allow things to be kept from our girl—we don’t keep secrets—but I’m unable to do anything now to change it. Our cell phones don’t work in the waiting room. The only pay phone is down a long hall. I won’t get up and walk those hundred steps to call Dylan; I think that if my body is close to Richard’s I can save him. I can’t speak of my regret to my sister. She holds me and keeps saying reassuring words: “It’s going to be okay, he’s strong, they got him back to surgery in time, hang on.”
We sit on cold chairs in the cold room next to the room with his cold body. No one comes out. Hours pass. I imagine Richard’s body in shock. Ever since I placed my hands on him in the elevator, I’ve been concentrating on sending him my vitality. If I can force some of my indomitable will into him, then maybe he can endure.
I remember the day we said our new vows in the sunshine, nineteen years married, Mount Rainier shining onto Mystic Lake like a stony buffalo, Richard sitting across an old log in his bandana, leaning in to give me a kiss, me holding the swell of his strong calf. I cannot imagine losing this man. I can’t see into a future where he doesn’t exist. I imagine whispering into his ear while he lies on the operating table: Later, I’ll tell you the story of today as if I am a cairn and you have forgotten a fork in the trail. I will him to live, live, live.
Suddenly, I stand up and push Christie’s arms aside. I can’t keep the news of what’s happening from our daughter. I run down the hallway to make the call, and then I hear my sister yell, “Sonya! Come back!”
I pivot on the grey linoleum marked with such serious scuffs. I run back to the waiting room and see Dr. M looking straight at me. His eyes are tired and regretful. “He’s recovering. He had four liters of fluid in his abdomen, and copious amounts in his left chest region. This shouldn’t have happened. They should have called me right away.”
“When can I see him?” I ask. I can’t take the doctor’s word for it. I want to know that my husband has returned.
An hour later, when I arrive at the ICU to wait for Richard’s arrival, there’s a man dying across the hall. The family wants to light a candle to honor the man’s passing in the way of their religion. They’re distressed that the hospital environment will not allow for such a fire. I stand in Richard’s empty room and try not to look. Dr. M arrives and says that after a few minutes I have to leave, that the nurses can’t do their work if I’m there—it’s policy, no discussion. I relent. In a few hours, I’ll come back to check Richard’s status, see if I can sneak in early, I think.
The steel gurney is rolled in from the narrow hallway. From the doorway of the intensive care unit, I watch three nurses hover over my husband’s body, now covered in a thick blanket. Richard won’t wake up for hours. I hold his hand, which is huge, hefty, cold. I wonder how we will speak of his near death from the cancer surgery when he awakes, how this story will enter the family lore. My mind searches for something witty I can say to him when his eyes open: Dramatic enough for ya? or Let’s try for boring for the next, oh, thirty years. Instead, I lean over and kiss his eyelids just to feel their tender skin.
The nurses send me away to rest. On the telephone I tell Joshua that his father is going to survive. We cry. Dylan wants to know what happened while she slept. She’s shocked by the sudden news; her voice is reflective and sad. I ask them to be sweet to themselves, tell them that I’ll call again after a sleep. We listen to each other breathe. The near loss feels close, like we could disrupt his safety if we say too much.
When I return, Richard is sitting up in the ICU, the tube in his mouth and nose preventing him from speaking. His midnight eyes stare at me blankly.
“Sweetheart,” I say, and he cries, silent tears. He’s not self-conscious about crying. He’d usually be throwing out medical questions, engaging the nurses, trying to make people laugh at his jokes. Instead, he’s all heart. “Why are his hands so swollen?” I ask the nurse.
“Two surgeries. Poor circulation,” she answers. “We have a list of things that have to happen to get him released from the ICU and onto the hospital’s digestive cancers ward.”
“So he can start chemo,” I say.
“He’s already completed the first step. He’s sitting up and interacting with us. Then, when we know his lungs are safe, the breathing tube can be removed. The NG or feeding tube remains until he can safely digest food.”
I lift the blanket and count the tubes running from his chest, abdomen, nose, arms, penis: thirteen. I’m not as shocked by his body’s appearance as I am by the childlike way he watches me. His eyes are wide, unblinking, soft. Everything about him—his muscles, his manner, his rhythm—has softened.
The nurse gives Richard a piece of paper and a Sharpie. He writes the same questions over and over, in black marker on a white page: Who is here? Who has been here? Who is coming?
He will write these questions again and again for days, and I will answer them again and again: “My sister is with us. Your boss was here. My father is coming.”
Within a day, the breathing tube is removed, and he leaves the ICU. He looks like he’s improving. His eyes track me in the room. His cheeks are pink. But when he can speak, there are more questions: What happened before now? Where do I work? Where are the children? When am I going home? Where is home?
“He doesn’t know who he is,” I tell the nurses.
“It’s just the morphine,” the nurses say.
In three days he’s moved to a private room. Across from his bed is a counter with a steel sink and a fluorescent light. Near the window is a bathroom with an industrial toilet that has a chain and lever, and a loud flush. Bottles marked URINE and containers marked WARNING: CHEMO sit on the floor. There is a small shower with cracked tiles and an emergency cord. I sleep on a rollaway bed tucked under the window ledge. The view from the window is of a gravel roof. One foot away, close enough so I can reach out and find his skin, Richard sleeps on a high bed surrounded by monitors that beep alarms and pump breaths. At night, when the room is dark and the equipment casts its unnatural light, I lie on the cold sheets and watch the helicopters arrive each hour like steely birds, their blades piercing the sky. The helicopters bring trauma patients. This first night, they bring a boy whose legs are severed. I hear the stories when I sit in the cafeteria and I eat the food that tastes like it’s never been alive. I push myself away from the table and walk to the tiny wood-paneled chapel where there is no talk, only weeping and prayer.
Before we came to the hospital, we left our home on Tiger Mountain near Seattle, a place with ravens and owls and peaceful winged ones, but that was before we said good-bye to our friends, before we placed our worldly goods in storage, before we flew across the country to meet a surgeon who, it had been said, could save my husband’s life. His body has been saved, though I no longer know if the husband I married is located inside that body.
When Dr. M comes to examine Richard, there’s fluid on his lungs. Until he’s stable, the five-day protocol of heated chemotherapy cannot begin. The protocol also cannot begin too late in the week, or he’s at risk of organ failure. If the chemotherapy isn’t possible, they can’t kill the microscopic cancer cells, and the disease returns.
“What happens if we don’t get the full five days?” I ask, but I already know the answer. We have to wait for the pathology results.
PMP happens to one in a million; fewer than one thousand cases are diagnosed annually in the United States. The dominant prognostic factor for survival is the pathology—is this a low-grade cancer, or the more malignant high-grade tumor that’s likely to respond as poorly to treatment as colorectal cancer? Complete surgical removal of PMP is extremely hard to accomplish, and the best chance for survival lies in early detection, choosing a PMP specialist for a surgeon, and completing HIPEC, the heated chemotherapy. Residual disease is common, and treatment involves more surgery to a body already wounded. Outcomes aren’t pretty for very many; I know the disease recurs in nearly three-quarters of the survivors. Still, for those with a complete cytoreduction and chemo, there is a slender chance of never requiring treatment again.
Richard is moved to the floor we will live on for weeks, for those with digestive cancers, gastrointestinal malignancies. We live now in a place that serves disease. The halls form a square, with wings for patients with stomach cancer, appendix cancer, colorectal cancer, and cancers of the abdomen and pelvis. The bulletin board outside his room looks as if a primary school teacher designed it: in bold letters are GASTRIC CANCER, PERITONEAL CARCINOMATOSIS, HEPATOBILIARY OR LIVER CANCER, PANCREATIC CANCER, PERITONEAL MESOTHELIOMA, and ABDOMINOPELVIC SARCOMA, as well as my husband’s disease: PSEUDOMYXOMA PERITONEI, the cancer that once grew like inflamed jam through his abdomen.
We lie in the room where the monitors beep and the equipment casts its cyaneous glow. When Richard is resting, I think of our former, cancerless life: the house in the woods, the liberal-minded city, the artistic friends, my career in marketing for museums, a good income I gave up to pursue writing and teaching. I think of the generations of family violence that we left to become the kind of couple we’d always wanted to be: kind, adventuresome, passionate. I think of our children, thriving teenagers who sometimes enjoy our company, who have said they find our family “amazing.”
I don’t feel very amazing at the cancer hospital. I resent cancer for its intrusion into our lives. I thought myself in my prime, midforties powerful, and my husband a handsome, magnetic leader devoted to our family. Instead, here in the hospital, there is death everywhere. Instead, there is no past, even one into which we might be borne back ceaselessly. Instead, we are lost.
While I’m trying to sort out why Richard appears so confused, his lungs continue to fill with fluid. The tumor removed from his diaphragm has caused flooding in his pleural cavity (the space between the lungs and the thoracic cage). During the surgery, Dr. M placed tubes as a preventive measure to drain any fluid that collected after the operation. They aren’t draining fast enough. Dr. M shows me how to clear clotted blood from Richard’s chest tubes, and I carefully watch for black globules inside the plastic tubing that falls from the holes in his mid-right and mid-left ribs to the linoleum floor. I learn to press my fingers against the hard plastic to draw the knotty clots toward the bulbs that hold them like thrombus petals. Once I would have been disgusted by such a task, but now I consider myself essential, beyond taking offense. Richard’s body requires my care. I’m not just his advocate. It’s a relief that the doctors and nurses have included me in their work.
On the second day after we arrive in his private room, his heart appears to be weak and compromised. There’s a window of a few days to get Richard healthy enough to begin the chemo. Every day when I call the children, I sound encouraging, but I’m scared that their father will fall again, that the bare consciousness he reveals will slide toward blackness, toward death.
Every night Richard falls asleep asking, “What is happening?” The helicopter blades slice-slice-slice. The compression machines on his legs pft-pft-pft. I stare into the sky wishing that I knew what to do.
On the third day on the hospital ward I lean over, find his dark-blue eyes, make them fix upon my mostly steady gaze. “Richard,” I say, “the doctor is coming soon and we’re going to get you ready to talk to him, okay?”
And he closes his eyes and nods, not able to speak much for the tube that is running into his nose and down the back of his throat, not able to take in a deep breath for the liquid that is filling his lungs.
The nurse changes one of the bags that drips constantly, and I look at her with hope for reassurance. As if she is reading my thoughts, she says, “It may take a while to get his strength back after a surgery like this. But he’ll be up and walking the halls in a few days, won’t you?”
And then Richard grunts, lifts his eyebrow, using the least energy, never arguing with them, never wanting to make it more difficult for anyone who is watching over him.
The daily round is staffed with residents, specialists, and researchers, a dozen white coats grouped against pale walls, the floors edged with lint. I tell the medical team that my husband cannot remember his life.
“Let’s start the chemotherapy and see if his cognition returns,” Dr. M says.
Before she leaves for home, Christie and I pull Dr. M aside. “What about the blood loss during surgery?” we ask.
“The internal bleeding he suffered could have caused an anoxic incident,” the surgeon says.
It’s the first time I’ve heard this term. “Anoxic?” I ask.
“Lack of oxygen to the brain,” my sister whispers.
“We want to get as many days of chemo as we can.”
“We’re doing five days of chemo, right?” I ask.
“The chemo can’t happen too far out, so with the complications he’s experiencing, we’re likely to get four. We have to make sure that his lungs are more clear,” says Dr. M.
I understand that we’re on to the next thing, that saving his life is more important than figuring out the mystery of his mind. But I can’t believe that this man is the husband I kissed good-bye a few days ago, when he left for surgery.
This husband is now a shell. He has gone to surgery one person and come back another. I don’t have any way to tell someone that I have lost him. I know Richard no longer remembers where he lives, or the life we share with our children, or the work he does. I know he has fifty stitches running from his heart to his pelvis, where they have opened him up, taken out his organs, unraveled his bowels, and scraped the cancer that clung to his entrails. I know he has thirteen tubes running from his body, each of which puts something into him or takes something out. I know we have twenty-four hours to clear the fluid from his lungs and ensure his heart is durable enough so we can teem his gut with chemo emptied into his belly where it will scorch his organs, killing every last cancer cell. I know this will be painful, and he will have to endure 345,600 seconds of this pain before it will be over. I know when his eyes rest upon me they are calm, but when they look about the room they are wild, as if he can’t quite sort out how this happened to him.
I walk the halls of the cancer hospital and I observe men sitting up in bed reading the Wall Street Journal, coordinating their calendars with their spouses and colleagues, laughing with their children when they come to visit, remembering what they just did five minutes ago, for God’s sake. Compared to them, Richard is living in the fog of a distant land, an underworld that he can’t even report from, since he has little language. I gaze at the white paper on which he wrote notes in the ICU, and I see the same question over and over in a slanted, strange scrawl: Who is here?
I have the same question for my husband.