Diagnosis day. A kind man with white hair who resembled a doctor in a children’s book—the platonic ideal of Doctor—came into the room with a folder and sat down with us.
The scans, he said, showed many tumors, in both lungs and all through the body. The kind of cancer was “squamous cell lung cancer.” The doctor said, “We can’t cure this cancer, but we have treatments we can think about.” He described the therapies. He said up until a couple of years ago the go-to would have been chemotherapy, which would have been exhausting and probably extended his life by just a few months, if at all. More recently, they’d begun to do immunotherapy instead of or in addition to chemo, with good effects.
The doctor said we only had to make one decision that day, “the first decision of a hundred more,” and that was what treatment plan to start with. He said the options were chemotherapy, immunotherapy, both, or neither. We all sat there, stunned.
“What’s your reaction when I mention chemotherapy?” the doctor asked.
“I’m a writer,” my father said. “I’m still employed. I want to do whatever will help me keep writing as long as possible. I think chemo might make me too tired. Writing is the most important thing.”
The room was quiet. Across from me, my mother’s eyes were filled with tears. She looked scared.
“You’re saying writing is what gets you out of bed in the morning,” said the doctor, clarifying.
“The idea of not being able to write fills me with dread.”
I couldn’t believe what I was hearing.
“You aren’t just a writer!” I said. “You’re also a husband and a father and a grandfather and a friend.”
Sounding exasperated, he said, “What am I supposed to do? Just sit around like a potted plant? I don’t make any sense to myself if I’m not writing.”
Another pause. My mother hadn’t said a word.
“If I do nothing, how long have I got?” my father asked the doctor.
“Well, we speak in terms of median survival,” the doctor said. “And with your kind of cancer and how far it’s progressed, we say the median length of time after diagnosis would be six months. That means half live longer than that.”
And, he did not say, that means half live shorter.
Six months. Once those words were spoken it felt like the weather in the room changed.
“I don’t want to do chemo,” my father said at last. He opted for immunotherapy. Probably no side effects. A 35 percent chance of improving his quality of life and possibly extending it. It would just mean an infusion every three weeks starting on Tuesday.
“I can’t Tuesday,” he said. “I have a deadline.”
“That’s okay,” the doctor said. “If you’re not done and can’t make Tuesday, just call the office and move the appointment to Friday.” I wondered what this kind, patient doctor thought of him, thought of us—this odd bohemian family, this workaholic patient.
The doctor broached the subject of quitting smoking.
“I don’t want to quit,” my father said. “I associate it with writing. When I try to quit, I don’t understand what writers do anymore. I don’t write.”
I asked the doctor if changes like quitting smoking might prolong his life, which is what the bronchoscopy doctor had told me in that room with the chaplain pamphlets.
But this doctor didn’t seem to want to push it. “This is a journey,” he said. “It’s hard to predict the various paths.”
I wanted to grab him by the collar and say, “I know you have to say that, but stop being so philosophical! Make him quit smoking and then tell me exactly how long he’ll live!” I wanted a death date I could circle in my calendar and plan around the same way when I was pregnant I wanted my due date to be the precise date I would give birth. (That didn’t work either. Oliver was born eight days later, and not naturally at NYU but via emergency C-section and with every last monitor and drug at St. Vincent’s.)
After the diagnosis appointment, I bought my parents food at a restaurant where in simpler times I’d eaten salads with a magazine editor. As we half-heartedly ate, I asked my father if he wanted to go on a trip to Europe or anything. He said, “Maybe a ballgame.” I made a note to buy the best tickets I could afford.
A half hour later, we left the restaurant and found that it was raining. I was the only one who’d brought an umbrella. There were no cabs. My father said he wanted to walk to Chelsea to go look at art. I gave my father my umbrella and called a car for my mother to take her back to St. Marks. As I stood there alone in the rain in my least favorite neighborhood, I watched my father walk away. Before he rounded the corner, he lit a cigarette under the umbrella.
Aside from a few days or weeks or months here or there over the years, he’s never been without a cigarette. For most of the past sixty years he’s smoked three or four packs a day. He and George Montgomery talked about cigarettes in 1977.
George Montgomery—SoHo, New York City (791 Broadway)—3/28/77
Peter Schjeldahl: Can I steal … ?
George Montgomery: Sure.
PS: I want to get the full effect.
GM: Take a pack with you!
PS: No, I think I better stick to my filters. I might get a taste for them. Since I smoke three packs a day, I better.
GM: I smoke two packs a day. You can get them there on St. Marks Place, at the Gem Spa or something, at that corner place there.
PS: There’s of course that great reference in “The Day Lady Died” about buying a carton of Picayunes at the Ziegfeld.
GM: I’d forgotten that Frank smoked them. We both learned to smoke them from someone else, a guy named Tommy Jackson, who’d been to Black Mountain, and they were the biggest-selling cigarette at Black Mountain.
PS: The literary cigarette.
GM: Oh yeah?
PS: Well, no, I’m saying …
GM: Oh. I don’t know why. They’re just a good cigarette, you know. I think Home Runs are made near North Carolina and they’re made of the same tobacco as these. One either smoked one or the other.
PS: It is a very tasty cigarette.
GM: Isn’t it? They don’t cost any more than the others, so you don’t have to worry about that.
PS: Well, I don’t know. The lungs, the lungs …