MAY 29, 2021
THIRD AVENUE, NEW YORK CITY
THE FICUS is thirsty. Its brown leaves are so dry they’re curling up; some branches are already dead. Standing there in its plastic pot, it’s the very incarnation of hopelessness, if indeed the word “incarnation” can be applied to a green plant. If someone doesn’t water it soon, David thinks, it’s going to die. In all logic, it must be possible to find a point of no return on the continuous thread of time, an irretrievable tipping point after which nothing and no one could save the ficus. At 5:35 on Thursday afternoon someone waters it and it survives; at 5:36 on Thursday afternoon anyone in the world could show up with a bottle of water and it would be No, babe, sweet of you, thirty seconds ago, I can’t be sure, maybe, but now, what are you thinking, the only cell that could have set the whole thing going again, the final viable eukaryote that could have rallied its neighbors—Come on, guys, let’s see some motivation, let’s have a reaction, fill yourselves up with water, don’t let yourselves go—well, the last of the last has just left us, so you’re here too late, with your pathetic little bottle, ciao ciao. Yes, somewhere on the thread of time.
“David?”
A gentle man’s voice stirs David from his existential, vegetal musings. He gets up and hugs a tall man of about fifty, only just older than he is but one whose hair is already white, a man who looks like him, as is only right for someone with whom he has a good deal of DNA in common.
“Hi, Paul.”
“You okay, David? Is Jody not with you?”
“She’ll join us as soon as she can. She’s teaching her class at the Goethe-Institut, I didn’t want her to postpone it.”
“Okay.”
David follows his brother into his office. A French Empire desk, oak bookcases, Art Nouveau crystal wall lights, carmine-colored drapes in thick velvet, and through the window a fine view over Lexington Avenue and, further over, on the corner of Third Avenue, the entrance to their Friday squash club. The room rather successfully disguises what it is—this office belongs to an oncologist, one of the best.
“Do you want coffee, David? Tea?”
“Coffee.”
Paul slips a capsule into the coffee machine, puts a chic Italian cup under the funnel, and finds a way of avoiding eye contact with his brother for a few more seconds. He guesses that David, having heard him say his name too many times, already knows. In war films, when a soldier’s spurting blood and the sergeant says, You’ll be fine, Jim, you’ll pull through this, Jim, it’s never a good sign. The kindly rhetoric, the Italian espresso with its unctuous crema, this device of constantly delaying their conversation—it all indicates the worst.
“Here.”
David nods, automatically takes the cup, and immediately puts it down on the desk.
“Go on. I’m ready.”
“Right. You remember we did a biopsy during your scan yesterday…I have the results.”
Paul pushes aside the cup, takes some photos from an envelope, and spreads them on the desk, facing his brother.
“It’s what I was afraid of. The tumor in the tail of your pancreas, opposite the small intestine, here, is malignant. Cancerous. And it hasn’t just spread into nearby blood vessels and lymph nodes, it’s metastasized in your liver and your small intestine. Clinically, you’re a stage 4.”
“Stage 4. In other words?”
“It’s too advanced for us to consider a distal pancreatectomy and splenectomy, that means removing the pancreas and the spleen.”
David visibly reacts to the blow. His breathing is labored. Paul has a glass of water ready and hands it to him. His brother looks up into his eyes. It was because Paul noticed the characteristic unhealthy yellow in the whites of David’s eyes that he insisted on running tests. David takes a deep breath.
“Prognosis?” he asks.
“It’s too late to operate so we’ll do radio and chemo to shrink the tumor.”
“Prognosis, Paul,” David says again.
“How can I put this? It’s a bastard.”
“Which means…? What’re my chances?”
“A twenty percent chance of surviving five years, that’s it, that’s what the statistics say. But probabilities don’t mean a thing. We’re going to try to do way better than that. I’ve set up an appointment for you with Saul to get a second opinion. He’s the best. He’s taking you on as an urgent case, he can see you tomorrow, and I already sent him your biopsy results and your MRI images.” “It’s not worth it, Paul. I believe you. Let’s do what you said. When can we start?”
“As soon as you can. As of now, you’re off work for a good three months, at least. Let your people know right away. Do you have good medical insurance?”
“I think so. I never needed to check. But I guess so, yes.”
David stands and takes a few steps. He’s shaking with anger, but is it anger? His whole body refuses to be impervious to this. Oh Lord, why do we always go back over the last few weeks, why is it that we can’t help wanting to gauge just how blind we’ve been? And all those days lived without a care, in the last bliss of ignorance, eating out, telling jokes, taking the kids to the movies, making love with Jody, playing squash with Paul, when maybe if he’d just had a scan, what, three months ago, the diagnosis would have been made and he could, perhaps, have been saved. David wonders whether some part of him had guessed, and whether that part of him didn’t want to know.
“When did it start?”
“I don’t know, David. There’s no way of telling. The tumor could have been there for a year, or two months. No one can know. Every pancreatic cancer is different.”
“Would it have been too late to do anything two months ago? After that hellish flight from Paris when hail trashed my plane, I was already kind of tired, remember? My pee was very dark too. And I didn’t have time to get tests.”
“I don’t know. What I do know for sure is that we need to concentrate on what we can do now, and there’s a lot we can still do.”
“Are there new treatments? Drugs?”
“Yes, we’ll try everything there is, plus, if you want, chemicals that are still experimental, revolutionary stuff that’s not on the market yet, I swear it.”
Paul’s lying, because it’s better than Well, no, David, there’s nothing new, it’s a bastard, like I said, we don’t know how to deal with it, not a clue, we haven’t found a miracle cure, we don’t even know why patients say a particular protocol works better than another.
“It’s a painful cancer, right?” David asks, sitting back down.
“I promise we’ll do everything to minimize the pain throughout your treatment. Of course, there are undesirable side effects. Obviously. You get nothing for nothing.” Undesirable. Like hell. That’s right, bro, yes, you’ll puke up your guts, spewing from every orifice, you’ll lose your hair, and your eyebrows, and forty-five pounds, and then what? All that to claw back what, maybe two, three extra months, a twenty percent chance of surviving five years, twenty percent, yes, but not from where you’re starting, little brother, in your case it’s a one in ten chance, not even that, shit, it’s so unfair, it stinks…Paul draws up his chair and sits next to David, who’s stopped moving, paralyzed, all his spark gone. Paul puts a hand on his already absent brother’s arm, hoping this gesture will calm the icy panic sweeping over him, and he also hopes that just the touch of his hand can draw out and destroy the darkness, because it’s insane but that’s how it is, years of practice and hundreds of patients lost still haven’t stopped magical thinking from surfacing every time, even in the depths of the most rational mind, and also right now—why now?—he suddenly remembers the bowling nights in Peoria when David bowled like an idiot and still got strikes, the fucking lucky jerk of an asshole, and the smell of pink marshmallows torched in the gas flames at Aunt Luna’s place, and the sweet berry perfume that that blonde chick Deborah Spencer used to wear, the one they were both nuts about and who ended up sleeping with that meathead Tony the Dinosaur, wait, why did people call him that again? and David’s speech at his first wedding, with Fiona, a totally half-assed marriage, by the way, it sure was half-assed, and that speech was so dumb and so funny and so wonderful because it was funny and dumb, and the birth of his, Paul’s, son, also called David, and Baby David asleep in Uncle David’s arms as he sobbed with emotion on the maternity ward, and everything that’ll be lost, sayonara, and everything that cancer will drag down into its dark whirlpool, and then, out of nowhere, tears prick his eyes, it’s brutally sudden, shit, an oncologist who goes and cries, what the hell is that? Paul turns aside, takes a Kleenex, and blows his nose loudly.
A ray of sunlight comes into the office. It’s not great timing, but the fact that it comes in, the fact that it lends David its golden light, makes it a beam of life, a fleeting miracle as the fickle sun heads west between the two skyscrapers on Third, at 5:21, a marvel that lasts exactly twelve minutes, spring, summer, and fall. At 5:33 it’ll be over.
“Okay, David. I don’t have another patient. Let’s wait for Jody, I’ll talk you through the protocol.”
Paul explains, at length, and David listens without interrupting. But Paul will need to explain again the next day because he won’t remember any of it. David will have been thinking of Jody, of the look of indescribable distress on her face, of the kids’ eyes when he has to tell them that Daddy’s very sick, Grace, Benjamin, my darlings, you both need to be very brave, you also need to help Mommy a lot and be very good, is that okay? He will have thought about his medical insurance, which is excellent, sure, but they’ll make some inquiries and criticize him for hushing up his ten years as a smoker from the age of fifteen to twenty-five, he will have thought about the inescapable pain, the degradation of the final days, the cremation, even the music his friends will be made to listen to, something nice, don’t you think, Paul, some rock, a bit of blues, but not God-knows-whose seriously depressing requiem, he will have thought, not for the first time, about the kids’ school fees, about the mortgage on the apartment that he paid off early, what a moron, when—if you die—the life insurance pays off all the outstanding money owed, he will have thought about everything yet to happen and everything that will still happen, after. He will even have thought about strange things.
“By the way, Paul…in your waiting room…”
“Yes?”
“The ficus. You need to water it.”
It’s 5:33 and the sun slips away.
THURSDAY, JUNE 24, 2021, 10:28 PM
MOUNT SINAI HOSPITAL, NEW YORK CITY
THE FICUS in Paul’s waiting room isn’t dead. But David hasn’t been back, and he won’t see the sun glide between the two skyscrapers, or even the sun. Room 344 at Mount Sinai Hospital faces due north, and he will most likely vacate it in a few days. Death has taken up residence in his now-gaunt features.
In the battle against pain, they’re complementing morphine with trials of a nanomedication being developed by the French, which means they don’t have to keep raising the dosage. In the battle against cancer, the medical team have given up. Too aggressive, too invasive, too advanced.
Someone knocks at the door, but no one replies: next to an unconscious David, Jody is asleep in a chair, exhausted from so many nights spent by his side. The children have been at Paul’s place for the last three days. The door opens, softly, lets in two men in black suits, wearing gold badges. The first man leans silently toward David, collects a sample of saliva from the corner of his mouth, stows the tiny spatula into a tube, and immediately leaves the room. The second man takes out a cellphone, photographs the intubated, dying patient, sends off the image, and sits down on a chair, unable to tear his eyes away from that emaciated face.