CHAPTER 42
Meanwhile at Johns Hopkins, the surgeon sharpened his knife, nurses got on the phone and rearranged their schedules, and interns scrubbed their grubby little hands. We were caught in the machinery. A theory had been proffered and rationalized. It was business as usual. If we didn’t do anything to stop the gears from turning, my father would be castrated in the morning.
Brenda helped him through the admissions process, while I hurried off to sound the alarm, explaining the situation to Dr. Jelinek, expecting him to slam on the brakes. The surgery was absurd, it made no sense. Right away, Jelinek reached into his pocket for a pen and drew two big circles on the tissue paper covering his examining table. He labeled the circles “testicles” and sketched three arrows coming out of each ball. Over the arrows he wrote the letters DES. Then he underlined the letters. “Your father is taking the drug DES to inhibit testosterone production,” he said, clicking his pen. “Testosterone is produced by the testicles. So you see, removing his testicles altogether would more effectively stop the production of testosterone.” He clicked his pen again, released the point, and underlined the balls.
I went back upstairs. The surgeon was just coming into my father’s room leading a crowd of five interns, the requisite visit before an early morning procedure. I followed behind the last intern. Brenda looked up from the roast chicken she was picking at on my father’s dinner tray. The surgeon introduced himself as Ved Ramanujam, chief of urology. He looked like a movie star from the 1930s—black pompadour, a lab coat draped over his suit like a cape. He stood back with one hand in his jacket pocket and let the lead intern speak.
“Say, Mr. Aronson, how’re doing? Gee, your eye doesn’t look so good. Has that been bothering you much?”
“Are you some kind of a wise guy?” my father said. “What’s your name?”
“Macomber.”
“Macomber,” he said. “‘The Short Happy Life of Francis Macomber.’”
The intern gave him a blank stare. He hadn’t expected words to come out of the skeleton with the bushy mustache and bulging eye.
“Hemingway. Don’t they teach you boys anything?”
No one laughed.
“My father was an English professor,” I said. His brothers always called him professor. And then when he left City to teach community college he officially earned the title.
“Ah,” Ramanujam said. “Professor Aronson.” His accent was lilting and dignified. “So, I understand, Professor, you are here at the Johns Hopkins Hospital prepared to have surgery tomorrow morning. Macomber, perhaps you can give Professor Aronson an idea of how the procedure will go.”
“Wait a second,” I said.
“What is it, ma’am?”
“Go ahead, Joanna,” my father said.
“This operation doesn’t make any sense. We don’t even know if he has prostate cancer.”
“Is that right, Mr. Aronson?” Ramanujam said.
“That’s right, doctor. Listen to my daughter. Joanna, go on. Tell them my story.”
I hesitated, not sure what story my father wanted told. He was pointing at me like I was being called on in class and I had better come up with the right answer. I took a moment and then I began to describe the morning three months ago when my father woke up with the mother of all headaches and I explained how that headache had never gone away and life was never the same again. I told them about the sack of potatoes and how he could hardly swallow tea. I told them about the terrible pain, and how no one believed him and Dr. Cromwell suggested he hold my father’s hand and how Heidenheimer said he might have cluster headaches, and then his right eye stopped moving. I told them about the nasopharyngeal carcinoma diagnosis and the adenocarcinoma cells and that yes, it was true, he’d had prostate cancer, but he’d been cured four years ago, in 1983, with radiation, and the cancer had never shown up again on any bone scan or blood test. Finally, I told them that the surgery they were planning for tomorrow morning had been scheduled without my father being examined by a single urologist, and so going forward with this “procedure” would be a terrible mistake. I glanced over at Brenda. Her face was stony. Finally, I said how desperately we had wanted my father admitted to the hospital, but only because he was starving to death.
Dr. Ramanujam came closer to the bed and peered down at his patient. Then he backed away again. He took his hand out of his jacket pocket and with one long crooked finger scratched around the roots beneath his pompadour. He turned to face the interns. “Macomber, cancel the surgery,” he said.
“Cancel it?” said Macomber. He sounded disappointed.
“You heard the man’s daughter, didn’t you? You heard the story. Nobody’s even examined Mr. Aronson. It’s possible this man doesn’t even have prostate cancer.” The doctor spoke angrily, with compassion. “So no, we are not going to cut off his testicles. If that’s all right with you, Macomber?”
“You’re my Emile Zola,” my father said to me. I had defended his honor. He threw off his blankets and swung his legs over the edge of the bed. “If you don’t mind, gentlemen,” he said, “I’m going to dance a little jig.” His slippers were waiting and he slid his feet into them and did a quick shuffle, then slipped them off and got back under the covers. Even Brenda laughed. She took her heart out of the freezer and left the frozen glob melting on the counter for a few seconds.
“By the way,” said Macomber, “why can’t he eat?”
“We don’t know,” I said. “And so far, nobody’s been all that interested in finding out.”
A full body scan was ordered and carried out. I’d never heard of a body scan. I didn’t know you could look at all the body parts at once. But surely Cromwell knew such a diagnostic tool existed, even in 1986. Surely Heidenheimer knew about body scans, and Jelinek knew, and all the other experts who’d examined my father and drew pictures and shook their heads all knew there was such a test. But no one thought to order it. He’d had so many doctors I kept a list, and now there was a new one to add, a gastroenterologist named Nick Morales, who had dimples and a cowlick, and was probably as young as I was. He bantered pleasantly with us at bedside. My father was in a chatty mood, eager to talk about his hobbies—gardening and cooking, and the painting class he was taking. “Well, not now,” he clarified. “I’m not doing so well now.”
Morales said that made perfect sense considering the body scan showed a fifteen-centimeter tumor on my father’s esophagus. While we tried to absorb this news, the doctor took out a fountain pen and doodled on the top sheet of paper fastened to his clipboard. He drew a long tube with a pendulous blob attached to one side. He colored in the blob and held it up. My father blinked. Finally, the artwork matched the truth of his experience.
“I recommend you eat only slippery foods—Jello, soup, that sort of thing,” the doctor said.
“Thanks for the advice,” my father said.
Morales noted the sarcasm and said he was surprised the tumor wasn’t discovered sooner. Had my father mentioned his trouble swallowing to anyone? I wondered then if my father’s shtick was the problem. The “help me doctor” stuff. The hat, the mustache, the Hemingway, the cigarettes, the tap dancing. Everything for comic effect. The play-acting about how he couldn’t speak for himself, ask my daughter, she’ll tell you. Everything was ironic, meant to show he was no sucker, no patsy, no victim. He thought he’d gain respect that way, calling attention to himself in the bargain, and ultimately get better care. But the result was denying his real need.
It was a lot to take in, what Morales said. I tried to feel some satisfaction at being right. My father did not have prostate cancer. He had a primary esophageal tumor that metastasized to his sinus. Morales scheduled an endoscopy. He’d look through the endoscope to see what was there and cut off a small piece of the tumor to biopsy. At the same time, through the scope he would insert a gastronomy tube—a feeding tube—so my father could get nourishment directly into his stomach. No need to swallow.
“We’ll figure out how to treat the cancer and give you a prognosis once we get the biopsy results,” said Morales. “But it’ll be a squamous cell cancer.”
“No,” I said. “It’ll be an adenocarcinoma.”
“No,” said Morales. “It’s in the middle of the esophagus, not the lower portion. It’ll be squamous cell, probably from smoking.”
When the doctor left, my father said, “Sleep here tonight, Joanna.”
“I’ll stay late if you want.”
“Not good enough. Tell them to put another bed in here. They’ll do it. Ask them.”
I hesitated.
“Please.”
I went looking for a cot. “Don’t do it,” the nurse said. “I can get you a cot, I guess. But honey, really. Look how tired you are. You need a break. Just because your father asked doesn’t mean you have to do it.”
“I guess you’re right,” I said, and I turned and went back to his room.
Shep Levine was waiting outside my father’s door. “You know the poem ‘Thanatopsis’?” he asked.
“No.”
“No?” Shep said. “C’mon. You should have learned it in high school. William Cullen Bryant. ‘. . .The gay will laugh/When thou art gone,the solemn brood of care/Plod on . . . ‘“
“My father wants me to sleep in the room with him but the nurse told me not to.”
“Why not?”
“She says I need a break.”
“What does she know about what you need?” Shep said.
I had a cot put in the room.
All night my father moaned. The sinus tumor had started pressing on the ninth cranial nerve. “Ah, ah. My gums. Shooting pains. Stop the world, I want to get off.” We held hands from bed to cot. In the morning, Morales ordered morphine and over the next two days the tenor of my father’s existence changed. He was groggy but pain free. He rarely moved from the bed to the chair. He woke with a loopy grin. His voice weakened until it was barely audible. Orderlies came and rolled him away for the endoscopy and he came out of recovery with a hole in his stomach like a bullet hole in a cartoon man. Miraculously, the hole didn’t bleed and the contents of his stomach didn’t tumble out. The G-tube protruding from the hole was attached to more tubing that was attached to a pump and a bag of chocolate Enrich hanging on an IV pole, and that was eating.
Now that I was sleeping over, I never left the hospital. There was no reason for it. To my diet of coffee and ice cream, I added little pop-top cans of Beefaroni that came out of the vending machines already hot. The doctors arrived on their morning rounds waking us at dawn, smelling of aftershave and coffee while I still lay on my cot like a child on a sleepover, snowbound with Betsy.
I remembered one Winter Solstice there was an ice storm that ended with a sleepover. “A veritable winter wonderland!” we all shouted at the crystal world from the carport. The other guests had gone home, only Johnny was left. The roads were treacherous and he had to stay the night. I waited in my bed in the dark until I could hear everyone’s sleeping breath, the three of theirs, anyway, and tiptoed down the hall to Johnny lying awake on the sofa.
“I can’t believe you came out here for me,” he whispered. “It’s so risky.”
I straddled his stomach. He propped himself up on an elbow and we parted the curtains and looked out at the moonlit snow encased in a shell of ice. “I wanna go out there and smash up that crust,” I said. “And eat it like the burnt sugar on créme brûlée.”
“You have a good imagination,” Johnny said.
“No, I don’t.”
“Imagine that you can make yourself tiny, and then tell me what you would do if you were inside my body.”
I believed every question adults asked was a test and most of their questions were probably trick questions as well, so I was thoughtful about my answer. “I would slide down your dick like it was a sliding board.”
Johnny laughed and put his finger to his lips to quiet us. “That’s great,” he whispered. “I love that. What a perfect answer.” Then he told me to go back to bed.
I parted the curtain to see the snow piled on the lintels of the Johns Hopkins Public Health building across the street, but it was dark already and our windows were mirrors. I asked my reflection why? Why did I love these flawed men, these hurt men who chose to hurt me? Johnny was right. I had a good imagination. I imagined they were my protectors.
The doctors appeared for evening rounds, their street clothes bristling beneath their white coats, impatient to leave for the restaurants where they would choose wines and clink glasses, cut into veal chops and duck breasts, leaving us behind to face the night. Sometimes I felt as if I were high on morphine, too, everything was surreal, riding my cot like a magic carpet alongside my father and past the Milky Way. I was glad I didn’t take the nurse’s advice, and listened to Shep Levine instead. My father would die. He would not come out of this thing well as I had promised those long weeks ago. But I would take the journey with him. For as long as possible, he wouldn’t be alone.