serum
WHEN RICHARD WAKES up four days out of the surgery, his lungs have stopped filling with fluid. He had one round of chemotherapy in surgery, and now the ongoing treatment begins. One nurse supports his body while another changes the sheets under him. They roll him from side to side while he grimaces in silence. I’m scared one of the tubes coming from his body is going to be jerked out of him, that blood or urine or morphine is going to be unleashed on the room, though the clean, spare gestures of the nurses make their maneuvers look like Tai Chi. I unstrap the pressure wrap machine that forces a band of oxygen around his legs to prevent blood clots from forming. The hair on his legs is wet with sweat, and I lay my cool hands on them, wanting to offer some relief.
The nurses ask me to bring them clean cloths and spotless sheets and unmarked soap, and I’m thankful to be useful. They speak in measurements of what is being eliminated, and I write their words in a little notebook: 10 cc. urine; 12 right chest tube; 13 left chest tube. Nurse Jen leans in with a wide shoulder and lifts Richard’s upper body to bring him into a sitting position. This is their goal for the day—to get his legs over the edge of the bed, to help his body strengthen by allowing it to sit for a few minutes. They strip the gown from his seventy-six-inch frame and hand the clothing to me. I look down at the patches of dried blood over its even stripes. Near the door is a large bin where the soiled linens go, and I walk the gown there, placing it with the sheets that are still warm from his body. I can hear the shouts of the shift change on the other side of the door, and I peer through to the light, watch the interns laughing, listen to people talk about the weekend. My hand is on the door and there is part of me that wants to walk out and get a hotel room, order a pizza, and sit in front of the television watching movies—to pretend that none of this has happened.
I want to be a woman whose main problems are getting the kids through college, finding meaningful work, dropping the extra fifteen pounds. I want to stop asking the doctors why there’s something missing. I want to make things easier for the nurses, to ask the doctors the right questions, to be loving and kind and gentle with my beloved. I want to pretend I don’t know what I know: the man I have known for decades has gone somewhere else. Instead, I walk to the supply closet for new gowns, a comb, baby powder. When I walk back to the room, his naked back is to me, and I am dumbfounded by his frailty.
His shoulders hang low and his back is bowed. He is forty pounds lighter than he was a few days ago. His is a body without strength, without vigor, without lust, without intention, without memories. A body taken apart and reassembled, a body that has not settled into the space of gravity, a body that knows nothing about its own scars, crevices, grumbles.
“Would you like to bathe your husband in private?” Nurse Jen asks, and I walk across the hard linoleum. I come to his side and say, “Yes.” She brings me a pink bowl filled with warm water and in it soaks a bar of soap. She lays out towels and a washcloth. She walks across the room, pulls the curtain, and exits, closing the door fully behind her, not leaving it a few inches ajar as it has been before this moment.
My husband closes his eyes, and I take his hand in mine. The light of the new is in his thick fingers and large square palms. I squeeze the water from the cloth and rub it across the soap, beginning to make swirls in his palm, pressing into the flesh of the life line, stroking through each of his fingers. I lay the dry towel across his knees and place his hand to rest there while I glide the cloth up his arm, softly caressing against the grain of his wispy black hair, smoothing over his wide shoulder. I lift the arm onto my shoulder and rub under it, silky soap making a trail into the pit, its dark curls slick with lather. Once I could lick there, swirling his hair in my tongue, breathing in his scent as if to memorize its salty musk. Now there is no odor, except of chemotherapy, the smell of ice on steel. It is the fragrance of his first treatment, a burning liquid they poured inside him while his organs lay on the table near his open body. I imagine the synthetic medicine binding to his cells, the sick cells dying, the dead cells pouring out of him, onto my cloth.
I soak the cloth in water again and rinse him in its warmth. Droplets slide down his forearms, where I want them to wake something that wants to live, where I want them to rouse some fire under the pallor. I dry the length of his arm, almost as big as half of me and so weak it flops to his side without support. I rub down his broad back, pat his left arm and hand, touch the skin tenderly. I walk around the pole that holds his IV lines, avoiding the tape and tubes near his wrist. I wash the dried blood near his chest tubes, keeping the water away from the tape down his middle, a wide bandage over two feet long where his skin is quietly restitching itself. My hand travels down to clean his penis, and I gently swab around the catheter, my hand finding his testicles, holding their weight in the way I would if I wanted to make love. I wipe him with sweet strokes; I look up to his face. He opens his eyes. Tender, surrendered eyes. Tears fall down my chin at the dignity in his submission.
I wrap him in his clean gown and lean him back into a fresh pillow, strapping on the leg bands that will pulse his blood through the day and night, making the sound of wind as it is carried, a measured music in our unsteady life.
Later that afternoon, the nurse fills Richard’s peritoneal cavity with a chemotherapy called 5FU, or fluorouracil, a toxic agent that acts to interrupt an enzyme required for DNA replication, killing cancer cells permanently. Once his belly is full, he moves from lying on his right side to his left side every thirty minutes, for a total of six hours. This is so the chemo can reach all of his organs. It is incredibly hard work for him, as hard as any workout he has ever done, and once he moves onto one side, we prop him up with pillows and foam pads so he can stay fixed in one place. After the moving is complete, the fluid stays in him until it’s drained out eighteen hours later. Then he is refilled, and the moving begins again. The fluid presses against his ribs and wounds, and the intense pressure is the source of his pain. During the time the chemo fluid enters him I sing a song, no words, just sounds. The melody seems to calm Richard.
I take off my amber beads and press them to his back for their coolness, and because I imagine that the gems he’s seen me wear might be comforting on his skin. I run a damp cloth over his forehead, and his languorous eyes open. He is an inchoate being, newly drawn but fully aware.
I don’t speak much because I know he’s trying to stay alive. I understand that he craves the quiet. He isn’t worried about who he used to be. That desire for a solid identity is mine.
The man who survived on smarts, charm, and looks has vanished. Who he was, isn’t.
I hold his face in my hands, his black whiskers under my palms, my fingers pressed to his temples. I hear: Everything that you take to be your story is gone. All that there is: touching, telling, making things. If no thoughts arise, there’s no experience of anything.
“Quiet, right baby? No thoughts. No thing. Nothing,” I think I whisper. But then I wonder if I’m speaking, or if my mind is transmitting those thoughts to his mind.
His eyes close. He nods.
Dad comes to stay for five days. He sleeps at a hotel near the hospital each evening, while I’m in Richard’s room. When my father comes back in the morning, he gives me his key and urges me to leave and get some rest.
“We have to keep the room calm for him, Dad,” I say. I show my father how to assist Richard as he turns his long, reclining body from right to left so the scalding solution travels through his innards. I show my father how to refill the aromatherapy diffuser I have placed on the counter, so the fragrance of rose attar and rosemary fills the room. I ask him to speak softly, so Richard can get some sleep. My father comes to Richard’s side and punches him three times in the shoulder.
“He’s going to be fine!” he says.
“Dad.”
My father, who is always reliable in a crisis, who is generous with all his resources, who, during my childhood, hit first and talked later, repeats his gesture of love, the one he learned from a family whose way of expressing affection was roughhousing: he punches Richard on the shoulder.
“If you do that again, I’m going to have to ask you to leave,” I say over my husband’s body, staring my father down so he knows I’m serious.
When I return to the room an hour later, NASCAR blasts from the television and my father claps his hands loud enough to shake the nurses from their perch. I fume.
Richard opens his eyes and looks up at me and whispers, “It’s okay.”
Four days later, in a letter to friends, written from the hospital, I say:
Today is Richard’s last day of chemo. The doctors have opted for four rather than five days. His second day was excruciating, but they changed his pain medication yesterday and he was able to rest rather than fight his way through it. . . . He is almost always watching from far away. The medical term for this is lack of lucidity, but it sometimes seems by his language and questions that he is seeing in two worlds now, the one in ordinary life and the one heading toward death.
At eight in the evening, Richard receives the final round of chemotherapy. It’s been a week since the surgery, and Richard has had nothing more than ice cubes to taste. My father sends me to the cafeteria. The food is terrible; even the salad is a sodden, brown mess. I walk past the greasy sandwiches, the fried foods, the hot table where entrées sit in soupy goop. I eye a Krispy Kreme doughnut. Looks like dinner. I eat it in three bites. I am proud to be able to live on even this ridiculous repast. I am alive. And strong. I think I can will Richard’s body and my own into continued existence.
When my father leaves and Richard is sleeping, I walk the halls. I’m alone now with my thoughts. I cannot sleep when he is resting in the day, and I cannot sleep at night when he is restless. I want to take my shoes off and run in the grass. Since the night of the emergency surgery, I have not left—and I will not leave—the hospital, not even for a walk outside. I take to the halls, listen to screams of pain, and I cry. One of the nurses insists on taking me for a drive. I’m agitated as she steers through roads lined with gritty tenement buildings. I ask her why she is doing this. She says she thinks I could use a break.
I walk the stairs six times a day for exercise. I cry a lot. I decide the staff will have to get used to the woman who cries as she moves through the building. I peer into the rooms with the doors left open. A wife grabs my arm to ask if my husband is here for PMP too. Her burly, brusque police officer of a man is in constant agony.
“Has anyone told you how long the chemo pain lasts?” she asks.
“I don’t know,” I tell her.
“He won’t let me go out of the room! I told him to stop crying and keep focused on what he needs to do to fight the cancer!” she says.
I nod my head. My husband is angelic, sweet. I do not tell her that he didn’t used to be so peaceful. I do not say there is no one here anymore to fight. I do not tell her that Richard’s memories are not returning, even in our second week after the surgery.
I slide into bed after checking Richard’s urine output, making sure he’s warm and dry, since he tends to sweat through his sheets. Soon after I settle in, he bolts upright straight out of sleep and says: “Sera-sanguineous. I like that word. It reminds me of the grassy steppes of the African plains.” He will barely speak for another month, but there he is, uttering complex metaphors. He’s never been to Africa, though I recall the steppes were the habitat of the mammoth and the first humans, about ten thousand generations ago. My husband hasn’t uttered either sera or sanguineous in the twenty-five years I’ve known him. I have no idea what he’s talking about. When we return home, I go running for the dictionary. The phrase means “the serum involving bloodshed.”
Truth is also sera-sanguineous. Truth is the serum involving bloodshed. Truth can save us, I think.
When we read it in the preparatory notes, we knew it was going to happen. Still, it’s a shock to see it, or rather not to see it: the belly button, the navel, disappeared. The eighth day after surgery, Richard’s left lung having finally been drained of its excess fluid, the left chest tube is removed. (The right tube will be removed days later when its draining is complete.) Dr. M peels back the dressing running from just under Richard’s xiphoid bone on his chest to the top of his pelvis. Lying there, like a snake, a pouched pink zipper, are fifty stitches, scarred skin with no sign of ever having been connected to an umbilical cord.
I try to hide my shock, cover my tracks, imitate the face of calm in the way that partners do: we communicate without ever opening our mouths. I’m quiet until the doctor leaves.
“Maybe you can get a tattoo on the scar,” I joke.
His empty body frightens me. I wonder if he can read me, if he remembers what I used to be like, if he knows if I am fearful or brave.
“Does it hurt?” I ask.
Richard moves his hands down the sides of his abdomen and lifts his head to look, as if the navel might have fallen, slipped to the side while he was sleeping.
We cry for the missing navel, this remnant of having been nourished by his mother. I wonder where they sent his spleen, the big bucket of cancerous mucin, the foot and a half of his lower colon—all likely sent packing to the incinerator, along with the other outworn organs. I imagine us walking through the halls, searching for Richard’s navel among the bins of the surgical unit, a dimple of an “innie” lying among abandoned parts.
The surgeon comes by for rounds every morning. Our hours are ordered by the schedule of the doctors. Every morning I ask Dr. M about Richard’s absence of memory, and after ten days, the doctor offers to provide a consult with neurology.
The neurologist saunters into the room, blocks me with his back, and leans into Richard on the bed: “Is this your concern or your wife’s?” Richard raises his shoulders, lifts his palms, a favorite gesture since his time in the ICU, the comme ci, comme ça of opinion giving, the big Whatever sign, showing his postsurgical lack of defensiveness.
“I am just living through this,” Richard answers.
The bow-tied neurologist answers, “Hmnn. Now count backward by sevens, starting at one hundred.”
When the neurologist quizzes him, Richard remembers the president, the year, and my name. He tells the neurologist that he does not remember how he got here, what his life was like in the months leading up to the surgery, or much of his past.
“He’s already ahead of ninety-five percent of the population!” the neurologist declares after twelve motor skills tests in five minutes, as if that ought to satisfy our cravings to have Richard remember his life, then and now.
Perhaps he’ll remember his life if his family comes for a visit, I reason. Two weeks into our time at the hospital, Dylan arrives for the weekend. She’s harried trying to find her way into the hospital. I go down the stairs to bring her to the room, to ease her transition to the strange and unsettling cancer floor. She comes up the elevator. We miss each other. She arrives in the room to see her father naked. She’s not scared by his nudity; she’s unsettled by his lack of modesty. He’s a youngster in a man’s body, uninhibited, unaware, an innocent. She has come face-to-face with a man who is no longer her father. She has no way to speak about the sudden change. She massages her father’s Flintstone feet and takes me to get food. In a few months she will write her college-entry essay and hand it to me to read. That’s when I will realize what happened for her on that day.
Joshua doesn’t come to the hospital.
Days, I’m completely focused on getting Richard well. He’s working like a bear that’s come out of the springtime cave, lumbering toward survival. But at night, when he’s sleeping for a few hours between tests, I run the events over and over in my mind. Everything that didn’t happen that day of his surgery angers me—not protecting our privacy, the incorrect blood tests, the lab refusing to release blood, the staff not calling our surgeon, that I didn’t argue more loudly on Richard’s behalf. Being confined makes me irritated. I’m cross about the terrible food, the unclean room, the lack of information from the doctors, my inability to resolve the mystery of Richard’s missing memories. To cope with my anger, I write lists in my journal. I came to the hospital hoping to record our dreams, conversations, and healing journey. But I find myself writing lists.
THINGS THE NURSES AND DOCTORS TELL ME
THAT I BOTH APPRECIATE AND RESENT:
1. Get some sleep.
2. This is within the range of normal.
3. You’re not used to seeing him this vulnerable.
4. You really ought to get more sleep.
5. How much sleep have you had?
6. His short-term memory loss is normal.
7. It’s not useful to remind him of his memory loss by saying, “Do you remember . . . ?”
8. Why don’t you take a nap?
9. How is he today?
10. How is he this morning? This evening?
11. It’s lucky your sister is here to help you understand the doctors.
12. You have enough time for a rest.
13. How many times have you walked today?
14. Your husband is so peaceful. The engineers, they’re the worst. They want everything fixed right away.
15. Well, of course he’s confused! Is your husband on narcotics at home?
16. He needs to get out of here without any further complications.
17. Memory lapses can be caused by thyroid problems and vitamin B deficiencies and narcotic drugs. And oh yeah, syphilis. Says the attending physician.
18. The trauma of the second surgery and the loss of blood and the potential decreased blood flow to the brain could have contributed to brain changes. Says the surgeon.
19. It’s good it’s nothing serious, then?
20. Patience.
There’s not a lot of patience in me. It’s forced on me, by the rules. Richard cannot eat or drink anything until his belly begins to make grumble sounds. His digestion must mobilize (he has to pass gas) before he can ingest. The only way to make this happen is to walk. He walks the hallways leaning on the pole holding his IV, the blue cords draped over the frame. We run into other recovering patients making this same circumambulation. When we meet people in the hallways, Richard cannot speak. He nods his head, a few words at a time. It’s like he’s a newborn—gentle demeanor, wide-eyed gaze, stunned silence. When other patients stop to tell us their stories of being out on the golf course a couple of months after their previous surgeries, or of returning to work robust and renewed, I can no longer imagine such a fate for my husband. I don’t know how he will return. I only know I can help him start to eat again.
Every time a new person comes in the room, he pleads for food. My sister Shelley sends me a basket of fruit, and I hide it behind the curtains so he cannot see the tempting contours.
“Juice,” he says, like a broken record.
After Dylan leaves to go back to high school, Richard’s body gets stronger—he can walk once an hour—but his digestion remains as silent as his speech. We spend most of the days ambling along the hallways. He’s unspeaking. I talk to nurses, doctors, other caregivers. I keep up a near constant chirp of encouragement for Richard. It’s as if he’s slowly waking up from a dream, and he isn’t sure what’s real.
On the seventeenth day, he farts and we rejoice. I take pictures of him famished for his first meal of weak broth. He eats everything that’s brought to him, including foods he detested before the surgery. He smiles wide, like a child content with his nursery meal.
Around the time we went to live in the cancer hospital we purchased a digital camera, our family’s first. Following the HIPEC surgery, I begin taking pictures of my husband, so I can document his state, so I can make sense of what is happening. I shoot him frail, in his first shower after he can stand again. There are close-ups of stitches and sunken eyes, long shots of being weighed and walking with IV lines, and pictures of him with Nurse Tim. My husband can’t remember the day before today, sometimes even the moment before this one, and I want these images to help him find his way back to his memories, if he chooses. I am still his scout, searching for some way to be of use.
But the faith I came into the hospital with is eroding. I know that I should be thankful that my husband is alive, and that dozens of people prayed for him during his ordeal—and I am grateful for the support. My time in the cancer center among the screams of pain, and the surgeons who, for all their earnestness, cannot control deadly cancer, has diminished my God. Maybe my God was the childlike belief that nothing terrible would happen to us if we did everything right. Maybe my God was the love I’d found again after years of avoiding our problems. Maybe my God will be revealed in the body of the man whom, I am starting to see, I do not know.
When he begins to eat, Richard improves rapidly. In three weeks, he’s ready to be discharged. Dr. M checks off a list of requirements. I read the discharge sheet: Keep contact with your hometown doctor. Send a Christmas card to your surgeon to tell him your cancer status. Do a CT scan of your chest, abdomen, and pelvis every six months. Complete recommended treatments. Stay strong, just in case you need surgery again. Do not drive for eight weeks. Do not lift more than fifteen pounds. Eat a nutritious diet. Keep your insurance statements. On our form, the surgeon has written NO in block letters beside the recommendation to watch the tumor markers. Another NO next to the requirement to exercise to get ready for the next surgery. There won’t be another surgery, in this doctor’s opinion. And then the number: 85%.
“What’s that mean?” I ask.
“Richard’s probability of living ten years is eighty-five percent,” Dr. M says.
“What about after ten years?” I ask.
“There are no statistics for that,” he answers.
And when I look perplexed the doctor repeats: “We don’t have statistics of people living after ten years. This is a new treatment.”
I had forgotten that we are the first generation of PMP cancer survivors enduring the Mother of All Surgeries.
Just as Richard has been a model student, a model employee, a model athlete, he now is a model patient. We have done everything asked of us. So why isn’t he back to his former self? It’s the question that no one has the answer to. I’m determined to understand what has happened to my husband, and to see if I can return him to the man he used to be.