Dear Paul:

Let me tell you where I have been. For ten months or so my health had been deteriorating rapidly. New symptoms appeared and never went away: I presumed that I had begun to age too quickly and that I should prepare myself for death.

I hadn’t been to a doctor since 1966 and I thought perhaps I was paying the price for too many late nights: I was urinating every hour, an indication, I assumed, of a collapsing prostate; my eyes were getting weaker, an indication of advancing blindness. My knees and elbows ached and often I was unable to pick up my feet when walking: symptoms of advancing arthritis, surely; and the icy tingling in my fingers and toes I presumed to be “pinched nerves.” I began dropping things: coins, keys, pens flew from my hands. And I was becoming angrier all the time: this was the most disconcerting of symptoms, perhaps because it didn’t feel like a symptom at all: it was a state of mind and I couldn’t escape it. I was continuously in a near-rage, and began to frighten people who had known me for years: I couldn’t laugh at a joke, I couldn’t make a joke. At night I could feel anger washing over me in waves. And I got angry at the anger, because I knew somewhere in my mind that there was no reason for it, and that made me even angrier.

I was depressed and in a fog: I seemed to be continuously hung over. I couldn’t sleep more than two hours at a time. I became afraid of meeting people; I couldn’t bear to make an appointment: the world became heavy and there seemed to be too many things to do. I was losing weight as well, for no reason that I could see (I presumed that an unspecified “wasting disease” was overtaking me). One day in the supermarket, when I could hardly walk because my feet were hurting so badly and my ears were ringing, a friend I hadn’t seen for a year came me up to me and congratulated me on how well I looked (so lithe, so svelte!): I could barely form words in my mouth. A short time after that I woke up in the morning and heard a voice in my head say: “Osborne, you have diabetes.” A simple declarative sentence.

Diabetes was merely a word to me then; I knew nothing more about it. But the directive seemed clear enough and I went down the hill to the clinic where I learned that indeed I was suffering from a condition of the blood brought on by a defect in my pancreas, in the “islets of Langerhans,” to be precise, and that its name was diabetes, a condition described (as I would later read) by a Greek physician in 150 BC as “a melting of the flesh into urine.” So it must have been my pancreas (or perhaps the islets) talking to me early that morning and now I try to include my organs in my thoughts whenever I can (an interesting exercise: try acknowledging your spleen sometime, or your liver, or your pituitary gland).

The doctor prescribed pills and I stopped eating sugar (for months I had been drinking root beer in cans, thinking that caffeine and sugar might get my energy up), and within days I could feel the symptoms leaving my body: the fog in my head lifted, the pressure in my eyes disappeared: I could feel my body beginning to work as it had long ago when I was healthy; the tingling in my fingers went away, and suddenly I could go for half a day without emptying my bladder. I realized that I had never known what health was: certainly I had been unable to remember it during the time of my sickness, which, as health came to me, I understood to have been about four years. Soon I was awash in normality: my eyesight improved and I had to get out an old pair of glasses because the new ones no longer worked. I could lift things, and my keys no longer fell out of my hands. I began walking long distances. My bowel movements became pleasant (I hadn’t even noticed how wretched they had become) and my mind became clear again, which was perhaps the greatest gift of all: I could feel myself returning to intellectual life (my writing projects had gradually stalled out: now I was discovering them again, patiently waiting for me in file folders).

The diagnosis was a gift of knowledge as well as health. Now I knew something of healing, and how ill health makes the world invisible. For a while the doctor who gave me my diagnosis seemed to me to be touched with genius. But when I began to experience turns of breathlessness he measured my blood pressure, which was too high, and prescribed another drug; my legs were hurting again and he prescribed a drug for that too. Now I was dizzy with drugs and I began to remember why I had stayed away from doctors for thirty-four years. I turned to the “literature,” a great sinkhole of medical bafflegab and self-help nonsense (a book in the public library warns diabetics not to smoke marijuana because it is “an illegal substance”), and began monitoring my own blood sugar. Eventually I discovered that the pill I was taking was precipitating episodes of low blood sugar, and the breathlessness that I was feeling was the result of an accompanying adrenaline rush: this was the cause of my high blood pressure. The solution was to cut the dose and change my diet. I was in control again.

The pain in my legs began to diminish, and eventually I started wearing tights under my trousers, to soothe the nerve endings in my skin: now I am walking without pain. These complications made me angry only in a mild way, because I no longer experience rage: instead I make my way into the world a step at a time, patiently assembling a regime. I pull on my tights in the morning and feel like a secret Elizabethan courtier. I am learning to come back into the world, to pick up the many things undone over the last year, and to begin to do them now.

–Stephen

Dear Lauren,

Yesterday was a germ disaster. Truly incredible. Every time I left the house I was splattered with influenza microbes, as if my fellow humans were mist-machines and I was an orchid.

The day began happily enough. I slept quite late, moving in and out of dreams, until I finally got out of bed around noon. Then I ejected myself into the world, where I proceeded to have a lovely smoked-salmon sandwich at Cafe Melange on Atlantic Avenue. My phone-therapist had told me that a daily intake of salmon is good for depression. I found this to be excellent news. As you know, I have put up over the years a legendary resistance to his recommendations of anti-depressants, but I embraced this salmon-cure. “The perfect remedy for a Jew like myself,” I had said to him. “It makes me wonder whether pork is good for depressed Christians, and Muslims probably need lamb.” So of late I’ve been absorbing lox more than usual, since I’m having my annual winter suicidal-ideation fest, brought on by light deprivation and family gatherings.

I enjoyed the first half of my sandwich, lapping it up like some people gargle Paxil, but then I was full, and I asked the waiter to please wrap up the remaining half, thinking it would be wise to spread out my dosage across the day. So the waiter carried off my plate and I continued reading my newspaper and suddenly there was a volcanic sneeze. I feared for the worst, and it was indeed the worst that had occurred. I looked up to see my waiter in the after-throes of a nasal explosion, his head turned politely away from my plate – but had he turned in time? Most definitely not! I once saw a science show on PBS which captured, somehow, in slow-motion, the distance that the average sneeze travels. I clearly remember seeing on the television – a chilling image which has haunted me for years – thousands of particles flying out of a person’s nose and spreading a good fifteen feet in all directions. It turns out that the structure of the average human nostrils, while bearing a resemblance to a double-barreled shotgun or twin cannons, has the shooting ability of a gatling gun: its fire – microbes, not bullets – blankets and decimates everything within 180 degrees.

So it was clear that my salmon sandwich had been terrifically violated, and there was no way I could eat it now, and this was upsetting on a number of levels:

(1) I had wasted money – I should have cleared my plate. Also, I enjoy eating at Cafe Melange because the prices are reasonable. For $5.95 you get a smoked salmon sandwich, a nice heap of coleslaw, some mixed dark-green salad, and a pleasing complement of olives. But now my pleasure at a bargain was destroyed – for $5.95 I had only gotten to eat half a sandwich!

(2) The waiter would think I was nuts if I tried to confront him – very few people saw that PBS sneezing special – and so I felt a pathetic impotence when he brought me my half-sandwich neatly wrapped in a little bag. It’s like I’m a closet neurotic or something – I should have stood up for myself, for my sandwich. I even carried the thing all the way home and put it in my refrigerator, for some odd reason going through the motions as if I would eat the thing later in the day. Maybe I was trying to lessen the blow. “Act as if,” they call it, in New Age circles. But, still, it was very disturbing to think of that pretty sandwich – to all appearances a toothsome bit of nutrition – poisoned by the invisible seasoning of my waiter’s microbes.

(3) And, lastly, it was depressing to think that I had been deprived of a full dose of salmon; it’s not good to play around with one’s prescriptions.

After putting the sandwich in the fridge, I crawled into bed and took a nap, which, before I heard about salmon, was my old depression cure. In the late afternoon, I tried to rally and get some work done, but it was useless. The day was a complete waste, mostly because my sandwich had been killed. I then opted for socialization and distraction: in the early evening, I went to see “Cast Away” with a friend. It was playing at Union Square and the theater was very crowded and we sat in the balcony.

As soon as the movie started, the young waifish woman next to me, who was dressed like a college undergraduate – jeans, T-shirt, unwashed hair – convulsed three times in a row with sneezes. I scrunched myself into the far corner of my seat, hoping this was just a start-of-the-movie sneezing fit, and I felt slightly cursed, recalling of course the salmon incident just a few hours before. But I had no idea the extent of what I was about to go through. The young woman should have been on a croup ward in a hospital in a Dickens novel. Throughout the whole two-hour-and-twenty-minute movie, she coughed, sneezed, sniffled, choked, wheezed, and noisily re-inhaled whatever it was her nose was trying to expel. Like most people of her generation (and my generation, too) she had come unequipped with handkerchief or Kleenex. I kept trying to shame her into submission and good health by turning my neck violently at her, but she continued to infect me and everyone within miles, all the way down to the Angelika theater. It was maddening. She also had some kind of obsessive-compulsive disorder. She kept rearranging her hair nuttily and three times she took out a jar of moisturizer and rubbed down her face and hands. I looked around for two other seats, but there weren’t any, and again I was a bit of a closet neurotic – I didn’t want my friend to think I was insane.

I was outraged by this young co-ed, but I also felt somewhat guilty for all my neck-craning in her direction. Just a week ago, I went by myself to see “Crouching Tiger, Hidden Dragon,” and I found the movie’s opening action scenes so stimulating that these high-pitched joyful squeals came out of me, which caused this fellow in front of me to whip his head around twice to show me that my reactions were immature and uncalled for. But I didn’t agree – the whole audience was moaning with pleasure. It’s just that I, being a little more susceptible to the effects of cinema, happened to be making extra-loud yelps of rapture. When he did it a third time, trying to wither me with his dead eyes, I let him have it. After he’d returned his gaze to the screen, I spoke hotly into the back of his head: “Listen,” I said, leaning forward with virile intent, “let me enjoy this film. What’s the big deal if I make a little noise? Just cool it!”

The action element of the movie had me feeling manly and aggressive, which accounts for my verbal assault, and he didn’t turn around for the rest of the film. I had put him in his place. But I also became self-conscious and didn’t squeal quite as much, though I did give myself credit for a moral victory and tried to fake a few loud squeals to show that I was undaunted. After the film, I stood up and stared at his back, ready to give him more verbal karate chops – I wanted to accuse him of being a pencil-necked bourgeois – but he pointedly didn’t turn to face me. The coward!

So my numerous attempts to shame the flu-ridden pestilence seated next to me at “Cast Away” did give me some pause as I thought of that snobby fool I had encountered and destroyed, but she really did deserve my craning neck. She should have stayed home and overdosed on some cold remedy. When the movie ended, I was sorely tempted to cut her in half with this line: “You really shouldn’t have come out tonight!” But I held my tongue and raced out of the theater and into the bathroom to wash my face and hands of her damn splattering. I was as riddled with microbes as Bonnie and Clyde with bullet holes.

So there you have it. My whole depressing report. Now I’m a bit hungry, having worked hard to type this to you, and it occurs to me that I still have that smoked-salmon sandwich. It almost feels – covered as it is with germs – like a living thing there in the fridge, like that tell-tale heart of Edgar Allen Poe, and I have this sort of mad compulsion to go eat it. But that must be the suicidal ideation and depression rearing its head again, which, if I look at it, is the start of all this anyway: the depression led me to salmon which led to the Cafe Melange episode which sort of led me to feeling the need to go to the movies.

But I still believe in salmon, so I’ll go out now, return to Cafe Melange, and get a fresh sandwich to go. Then I’ll come back here and eat it. Alone. In safety.

feeling a cough developing in the chest, oh, no…but sending my love, and not microbes, though perhaps you should handle this letter with rubber gloves…though mentioning this at the end is not fair warning, so I’ll jot a note on the envelope, well, big kiss and lots of love,

Jonathan

Cheryl: How old were you when you were diagnosed with diabetes?

Matt: I went to the emergency room on New Year’s Eve, 1998. My birthday is January 5th, so I was still twenty-six.

Cheryl: How has having diabetes impacted your beer drinking?

Matt: It has devastated my almost Herculean intake of beers. Now I only sip pre-dinner beers occasionally. On the rare instances I find myself in bars, I only have one beer. Mostly I just don’t go to places where there is beer anymore.

Cheryl: When I first heard you got diabetes, I was sad. Then I laughed. I thought it was hilarious that you were going to have to start exercising or being healthy or whatever. I pictured you enjoying picking out some obnoxious velour sweatsuit with maybe a matching headband, then sitting back down to watch TV or play your guitar.

Matt: I did acquire some day-glo sweat tank tops after my diagnosis, but mostly for rock ‘n roll purposes. I find “exercise” difficult. It has never been in my nature to do some repetitive, painful thing (except get wasted and wake up with a hangover). However, I do like riding a bike around, shooting baskets, and now Meg and I play tennis every couple weeks. I still can’t get really competitive with myself about it though.

Cheryl: If you wanted to go get a half-gallon watermelon daiquiri could you? Or only occasionally?

Matt: No, I wouldn’t, or Chubby Hubby ice cream, pistachio cannoli, or a Butterfinger either. There are some European sugar-free chocolates that are top-notch, but I don’t really crave sweet stuff, or miss it really.

Cheryl: What food do you miss the most?

Matt: It’s situational, I guess. If Megan is eating a huge slice of banana cream pie at a diner I feel sad. But it’s more about the experience than any particular food.

Cheryl: I’ve noticed that you have a certain insulin injection style that I have not seen before. The hey-look!-then-stab-yourself-in-the-stomach style. I liked that a lot. Did you develop that yourself? It’s a real dinner-party shocker.

Matt: I don’t really know the proper etiquette. I usually go to the restroom if we’re at a restaurant. I didn’t even know you noticed me doing it, let alone that you thought I had a fully developed “style.” I’ve read that some people inject through their pants leg. That’s extreme!

Cheryl: Does having diabetes make you have to pee a lot?

Matt: Maybe.

Cheryl: Who’s more worried about your diabetes? You or your wife Megan?

Matt: We’re both fixated on death. She’s a hypochondriac, though, so I’m not sure. Probably her.

Cheryl: Do you think that your immune system was compromised by the time you got scabies from thrift-store clothes in the Ninth Ward, leaving you open to attack by other opportunistic diseases?

Matt: Who really can know these things? Yeah, I think it could be related. I’m not certain how though. I’ve heard about how schizophrenics can exhibit symptoms of diseases they don’t even have. I’m not saying I’m full-blown schizo (whatever that means) but I entertain the idea of a psychosomatic source for my diagnosis. I had asthma pretty severely as a kid and still have allergies. I’m scrawny, my vision is bad. I’m the kind of guy even the army would reject.

Cheryl: Are you still hot and tired all the time?

Matt: Yeah but for different reasons. No, I’m not, just kidding. I’m cold and peppy now.

Cheryl: If you had to pick a chronic disease to get, assuming you didn’t have one already, what would it be?

Matt: Probably the one Andre the Giant had, or an enlargement of the brain giving me super-computing abilities. I wouldn’t “pick” any if I had the choice though.

Cheryl: How often do you think about death?

Matt: Daily, though not always my own. I think our whole consumer culture in America is focused on death so it’s hard not to.

Cheryl: Would you ever go to a, like, Rockers With Diabetes support group if they had one?

Matt: I tried a support group at first and I came home more frightened than I was before I went. But I did make lots of phone calls to diabetics who had similar lifestyles to mine, people I didn’t know, friends of friends. It helped me, but I think I freaked a lot of strangers out. I haven’t talked to any of them since. I found the non-diabetic friends I had (i.e., everybody) very caring and supportive all on their own.

Cheryl: I just recently gave my first injection. It was to my dog. I enjoyed it. It made me feel all scared and then powerful afterwards, like, that was no big deal. Now I can deal with whatever life dishes out. It made me think of you stabbing yourself in the stomach with that hypodermic needle.

Matt: O.K.

Cheryl: What’s your current biggest fear in general?

Matt: I have a vague undefinable dread. More specifically that I will somehow “fail.” Also that George W. Bush will be the leader of the free world.

Cheryl: If diabetes was one of your paintings, what would it look like?

Matt: I don’t do paintings anymore. The idea of “Diabetes Art” came up after the diagnosis though, from different artist people. But that just sounds like a really poor idea.

Los Angeles
September 17, 2000

Paul:

I almost forgot – got the results back, finally, and everything seems to be clear. As far as my doctor is concerned, I am in remission. Everyone is thrilled and I know that I am too (somewhere inside), but I am also cautious. The reality is that I have to be monitored every month, take tests every three months for the next two years. It is kind of hard to grab relief. I don’t know how much I can take and I kind of feel cheated. Relief should be unmeasured. One should be able to grab a handful unabashedly, but alas, it does not seem to be the way right now.

Aliza

San Francisco
September 26, 2000

Aliza:

You know, I don’t think I ever wrote you back to say (cautiously, of course): congratulations. That’s great news. Because I’ve just been working on your letter from April, I think I’m sort of stuck in your situation back then – but I’m glad you’re not.

I had a few misgivings today about not explaining in the editor’s letter that you’re better. But I think it’s important not to give people any relief from the situation that you describe in that letter – part of what makes that letter so powerful is that you didn’t know how things were going to turn out.

Anyway, if you have any thoughts on all this, please let me know.

Paul

Los Angeles
October 10, 2000

Dear Paul –

First of all, thank you for your congratulations. I still don’t think in terms of remission because, well, because I don’t know how to think about remission. It isn’t that easy a concept to get my head around. It is sort of final, but sort of not, and that’s not reassuring. I’d rather just get on with my life, ignore the medical terminology, and integrate my various doctors’ appointments into my “regular” schedule (whatever the hell that is). Basically, get used to the fact that I, as my doc said, am now in the medical system. I am trying to think about that in a non-depressing way. On the other hand, I do love my doctor. Really. Love. In love. It is a totally idealized relationship. In the back of my mind, I think he has saved my life which, in a way, he has. He is fantastic and I am experiencing a very large, very robust crush on him and a monthly visit ain’t a bad thing. I’ve discussed it with my boyfriend and he is fully aware of my feelings. There are two men in my life. Lucky girl.

Now, then, I know what you are saying about the letters. It’s weird because we are in the present and the letters are so, so (believe me, so) in the past. As me, Aliza, I’d love to tell everybody what is up, and that I’m better now. It is hard to get some of the letters from readers who don’t know, who empathize, who have had a similar experience and wish me well. I kind of feel like I am leading them on – but then I have to tell myself that they are not reacting to me, they are reacting to the letters. And the letters are from another time.

We have been manipulating the time thing from the beginning and you’ve been explaining the situation so I don’t think we have to feel too bad about never being in the present. I wonder, really, if we are ever going to catch up. I am way ahead of the letters in terms of recovery.

Regards,

Aliza

Milford, Connecticut
November 3, 2000

Hi Aliza,

Sorry for the long delay in getting back to you; I hope you’re well. I’d like to run a third installment from you next week. I spent the afternoon reading through a bunch of your letters, and here’s what I’ve come up with: What I’d like to run next is a combination of two letters that you wrote to Miriam early on in the radiation process, one that was focused more on ending chemo (the relief letter) the other that was focused more on the radiation itself. I think they were written within a week or two of one another, and though the mood’s a little different, I think they’ll be most effective if we can combine them.

Let me know what you think. Hope all’s well.

Best,

Paul Tough

Los Angeles
November 6, 2000

Dear Paul –

I can’t get to it this week. I’m sorry. I’ve got this tingly feeling in my arm and I have to take some tests and I am mildly anxious and I just can’t concentrate. I’m sorry. I’ll keep you posted. Hopefully, by the end of this week, all will be well and I can get something to you.

In mild anxiety,

Aliza

Milford, Connecticut
November 7, 2000

Dear Aliza,

I’m sorry to hear about the tingle. I hope everything’s just fine. I’d say I’m sure everything’s just fine, but I’m in Connecticut, and it’s hard to be sure of anything out here, so I’ll just be hopeful instead. Please let me know how those tests turn out, and whenever things are better, we can turn to installment number three.

Best wishes,

Paul

Los Angeles
November 10, 2000

Hey –

The news is not so good. There is a recurrence of my tumor and I have to go back in for treatment. Different this time. Something called a stem cell transplant which necessitates me being in the hospital for four weeks. First, I have to do two more rounds of chemotherapy – most probably next week: three days in a row, then rest three weeks; another round, rest three weeks. Then I go into the hospital, they take out my stem cells, give me five days of chemo in the hospital and eventually, return my stem cells. The whole thing sucks and I am not in the mood at all, as you can imagine.

Nothing much left to say.
Am shocked off my ass.
Aliza

Milford, Connecticut
November 10, 2000

Dear Aliza,

I’m very sorry to hear that. That must be really disappointing, not to mention frightening, and it does indeed suck. I was used to the idea of a healthy Aliza, and I’m sure you were, too. Please keep me posted as much as you can, though I’ll of course understand if you have more important things to do. And I’ll remain hopeful, out here in Connecticut, and be thinking of you.

Best wishes,

Paul

Los Angeles
November 26, 2000

Dear Paul –

Thank you so much for your thoughts. I’m okay. That about covers it. Up, down, all around. At the same time.

At first, I was pissed, pissed, pissed, thinking, “What? You have got to be kidding. I’ve only had two months of being clear and I still appreciate it, surely that must count for something.” But oncologists, while I’ve noticed they are really personable – mine has a great sense of humor – do not kid about these things. So I started the inevitable questioning: Did they not get it the first time? Whose fault is this? Did I do this? Did I bring this on? Karma? What? What? What? Then there is the questioning of faith and the questioning of the way in which I believe – is this God’s doing? Because so many people were trying to comfort me by saying something like, “God gives to each of us what we can take – and this will only make you stronger.” And I’m thinking: (a) I don’t believe in that kind of God, and (b) I’ve already been through six months of chemotherapy and radiation. I’m feeling good. I’m feeling strong. The rest of the strength that I need, I can pick up in my daily life, through normal travails, as I get old and make mistakes, like other people do. So that God approach fizzled.

Then I had to move on to my personal belief system of “randomness in the world” and “shit happens” and the worst, worst, worst, most incomprehensible fact of all, which is that life is not fair. It takes so much out of me to accept that some people get bad things and other people don’t and that’s just the way it is. A part of me feels (or hopes) that life is more balanced than that, but I just don’t think it’s true. Why do kids get sick? Why do they die? Why do nice people get sick and mean people don’t? I know of a lot of people who are positively floating through life in some sort of dark cloud: bad relationships, bad communication with others, intense misplaced anger, nervous, frenetic energy, frustrated dreams, lies, Satan’s package, the whole deal – and they are just the picture of health. No colds, not even a swollen gland. Floating.

My every instinct wants to say, It evens out. Don’t worry. There is more joy coming for you. But the reality is that being a patient sucks. You can try to call your clients and sound happy, look for an apartment and think about moving, write your novel, but the foremost thing on my mind is that I am twenty-nine, on the cusp of what I want to do, and I have cancer again. I have to lose my hair again (I mean, is there ever a good time for a girl to lose her hair?), I have to go through chemotherapy again (once was more than enough), I have to be absolutely anal about the people that I see and come in contact with because of the germs that they may bring near me, I have to look at my family as they take care of me (sad, sad, sad), I have to have this between me and my boyfriend (sad, sad, sad), I have to have copious needles and doctors and nurses and blood and syringes in my life (not my favorites), I have to kiss goodbye a certain kind of freedom and three precious months (or more) of my life as I go through the chemotherapy, recover from it, get my transfusions, go into the hospital, get more chemotherapy and spend four weeks there resting and hoping to something or someone that this works, that this is it, that I can move on, that I can stop being the damn patient and start being me.

That is how I feel. That said, I want to keep working on those letters, okay? I am going to look at the one you sent me and send it back to you this week. While I need rest and silence and all that, I also need projects and vague deadlines not imposed by me.

Take care then –
I will too. Oh I will.
Aliza

Dear M –

I just got back from Montreal and New York, where I was visiting everyone for the holidays, and it was weird. It was my first time out – of L.A., of the cancer zone, of the bubble that is my apartment and my life, of whatever is vaguely within my control – since all this cancer business began. I walked through the airport like a complete idiot: “Oh wow! Food court. That must be the smell of over-boiled hot dogs. Cool.” So this is what remission looks like.

I had to reconfigure my plans in New York around sixteen thousand times. At first I told myself, Only three plays, one gallery, one museum, a few friends, family, and the rest is naptime. A day into it, I said, Okay, two plays, one gallery, no museum, two friends, and family. Then I went out for too long one day (five hours – can you believe?), got a cold, stayed in on Saturday and Sunday and reconfigured again: no plays, no museums, no galleries. One friend in person, one friend on the phone, immediate family only, perhaps a walk down the street and many a nap in my sister’s very large, very comfortable and very welcoming bed. Was this productive? Did I really use my time in New York City? Well, the old me would think, not particularly, but the me that is, that must deal with certain physical limitations, must say, good enough.

Yet again, what else is new? I am at another stage in this whole cancer situation. Post-results, post-treatment, the shock has worn off. The shock that allowed me to be in it and to do what I had to do – it’s worn right off. It was like a coat of strength, and now I am naked. Lord, am I naked. I think of chemotherapy now, I cringe. I absolutely cannot stomach it. I don’t feel the chemo nausea, but I feel something leap to the top of my throat and settle there. It is very hard for me to think about it, talk about it. I don’t recognize myself as having gone through it, and if I let myself think about it, I wonder: If I were to have to do it again, how would I?

While I was in it, I talked about it because it was there, it was what was happening. The appointed day would come, a family member would arrive to pick me up, I would get in the car and we would drive to the doctor. Needles were inserted, vomit was expected, and saltines were eaten. While it felt horrifyingly real, technicolor real at the time, it never felt as real as it did when I landed in New York and Montreal, when people I knew, people who had, from a distance, asked after me, thought about me, wrote to me, cried for me and prayed for me all hugged me tightly and wished me good health. Oh boy. The weight of it all. I couldn’t really believe they were talking to me. What did they mean, health? That’s something that you say this time of year, right? Rosh Hashanah rhetoric. Happy New Year. A good year. A healthy, happy year, but what does it mean?

It means. It means.

When I walked into synagogue in Montreal that first day of Rosh Hashanah, and people smiled at me (the so-great-to-see-you smile – though they really meant it), and my mum put her warm, perfumed arm around me and the cantor sang and the shofar was blown, I was pretty much overwhelmed by the meaning of it all. When I was young, the high holidays were time off from school, endless synagogue-sitting, and much, much, much too much brisket. But in the last few years, as I have chosen, on my own, to make the effort to mark the days, I have really thought about its meaning, thought about the significance of closing one year and getting ready to start a new one. I love the symbolism. I love that it forces me to treat that day as different, as something more, bigger than just another Wednesday or Sunday. I like being forced to stop and look at things differently, take a breath, reflect on what has been.

This time, though, as the congregation stopped chatting and we were allowed to sit in silence, I didn’t have to think about what the day meant, how significant it was to me. It just happened. It just was. I knew. For the first time in a really, really long time, I felt a relief so intense I could not control it (and I have become quite adept at controlling it). It wasn’t a relief like letting go, though that component was certainly there. It was more incredulous. It was more like amazement-relief, if there is such a thing. I am here, I am here. I was blown away by the fact that I had made it, that I was there. For the first time, I really understood what I had been through, what it was about. It’s wild that it took a little soulful Hebrew tune (not even the words) to allow me to cry finally, and close this year.

I hope you and Peter are well. I can’t wait to see you. Happy new year to you both – much goodness and no crap this year. Well, realistically, and I am, always, a realist, if there must be crap, let it be manageable. In the spirit of Yom Kippur, if I have wronged you in any way this year, I apologize.

All my love,

Ali

Dear M -

It’s clear to me now that I felt very little relief while I was going through chemotherapy. There was happiness and there were certainly moments of joy – it was not all dire – but there was clearly no relief. But after the sixth and final chemo, I felt relief, and it was new, and delicious. When I got over the major nausea and grogginess (around Wednesday), I could hardly recognize the person who went through those months of chemotherapy. It felt like me, but a much more serious, heavier me. And for the first time, I could actually look back at the whole experience and feel like something had been accomplished here. I did something. Prior to that, each chemo was its own island. I never really thought, “I’ve gone through four, isn’t that great?” I kept on thinking, “Damn, the fifth is going to be unpleasant too.” But after the sixth, I felt like the whole five months was like a handkerchief blowing in the wind. Gone.

It took me a very long time to unpack my chemo bag. I took out the magazines that I hadn’t read and prepped myself to get through them, but I couldn’t even look at them. They just screamed “chemotherapy.” I had to throw them out. I also threw out the bag. I threw the whole package into the clean, white, plastic garbage can in the kitchen and then had to take the whole bit to the bin outside. I didn’t want any of it in my house. When the garbage trucks came on Tuesday, I finally felt some closure or escape or something. Distance. I didn’t throw out the CD player or the CD’s, but I’m not touching them for a while. The worst thing would be to play something and be taken right back to those pale pink recliners at the doctor’s office and that nasty red fluid dripping into my arm.

I am now nine days into radiation, and it is draining me. I’m running out of energy to play this game called cancer. It’s a marathon, and I’m a sprinter by nature. I like going from event to event, using the momentum of each as a springboard to keep me interested. I’m not good with long things. After a while, I don’t know what to do with myself. While chemotherapy was horrible and I am not interested (ever) in repeating the experience, at least I understood the schedule. I would be down, then up, then down again. I understood how it worked, how it would make me feel, and what I would be capable of. I was able to plan. I could count on throwing up at least once, craving a grilled cheese sandwich after four days, not sleeping through the night while on the steroids, driving on my own by Tuesday (the fifth day after treatment). By the end of the first week, I’d be able to read a sentence without it jumping all over the page. It was important to me that I could count on this schedule. There was something wonderfully comforting in the predictability of it all.

Radiation, though, is an entirely different ballgame. Every day I spend twenty or thirty minutes at the doctor’s office, depending on how backed up the radiation technician is. The actual radiation only takes thirty seconds (fifteen seconds for my front chest, fifteen seconds for my back chest), but there seems to be a pile-up of humans in the morning – which is when I have my appointment – and sometimes it feels a bit too much like waiting for your car to be serviced, only I’m the car. While I’m in the waiting room, trying to read whatever I’ve brought in or the unbelievably outdated and frayed MODE and Good Housekeeping magazines stuffed into the magazine racks, everything seems normal. I feel normal. Way more normal than chemotherapy. There are no needles, no drugs, no nausea. Each day is the same. I drive myself to the doc after sleeping the whole night; I’m showered and wearing real clothes, not sweatpants; sometimes lipstick has been applied; I talk back to idiotic morning radio hosts and sing ‘N Sync songs out loud in the privacy of my car; I exchange hellos and little small talk-y jokes with the parking lot attendants and the guy who runs the coffee cart. They recognize me. It feels like I’m going to my office. It is the most regular gig I’ve had in months.

It all feels really normal until something, and it only has to be a little thing, reveals that it is not. It could be the person in the elevator who smiles a bit differently, a bit nervously, when she notices the little round sticker with an X right in the middle of my chest, then looks at my close-fitting hat to confirm her suspicion, her fear. I can almost hear her thinking, how can it be? That girl’s so young. I feel like I’m introducing a brutal jolt of reality into her life. Once the elevator door opens, she scrambles out, hugging her child close to her chest.

It could be the other people waiting in the doctor’s office. The octogenarians. All of them, as usual, looking at me with a mix of curiosity and sympathy – again, it’s the “she’s so young” line. How can I possibly respond to that? Yes, I am only twenty-nine. Yes, I do have cancer. Yes, it sucks. There are moments when youth is a trophy – your first novel/film/business/whatever at a young age. It inspires a certain kind of awe. In this case though, youth is depressing. When I look at the other people in the office, I feel unlucky. They’ve had years of freedom. I’ve got years ahead of me, knowing that I have this in my history. I have to think about recurrence, the consequences of the treatments, fertility implications.

Or perhaps it’s when I’m alone in the radiation room, silent, lying like a slab of meat atop the metal table, being raised toward the ceiling. Maybe it’s when I’m staring at the radiation machine – a square box, suspended above me – and the specially made metal block in the shape of my tumor that the rays must go through. While I know I don’t want to see it and don’t need to see it, I can’t help but look at it. It’s so big, I think. Is that the original size of my tumor, before chemotherapy, or the current size, after chemotherapy? I’m too afraid to ask. I don’t want to know. I’d rather come to my own conclusions than be told the worst.

Or when I’m trying to clear my head and think pleasant thoughts during the thirty seconds that I’m being zapped. Hard as I try to reach some transcendent, meditative state, I’m always counting the seconds in my head. I get past fifteen, to forty-five, and I wonder if the technician is having a coffee. Has she gone to the bathroom mid-session? Is there a timer or does she use her watch? Does she know that she’s gone over? Then I think of the consequences of too much radiation.

Honestly, I try to turn my brain off. I try to move through the world as if everything is fine, but I am always reminded, in some way, that this is what is going on with me and it is unusual. I can’t completely dismiss this anxiety over my health, my life, the way other people who do not have cancer can. I can feel it. In the back of my mind. Floating. I wish I lived in a comic book or a cartoon. No meaningful context to life, no great consequences to actions, just moving from incident to incident without thought. Road runner-esque. Pummeled in one panel and ready for more in the next.

Aliza

Dear Paul:

Since I wrote you last I’ve come to Saipan, in the Northern Mariana Islands in the Western Pacific. This part of the world seems to draw me. When I was in Halifax, I found myself counting the months until I could get back into my boat and get to sea again. I accomplished a version of that, I guess, by coming here. I still have my residency to finish – but part of that includes this elective I’ve set up, a three-month stint of community internal medicine here on Saipan. Working here reminds me a little of working as a G.P. in the Canadian Arctic – with the TB and parasitic diseases – but then I hear the surf exploding against the reef and the resemblance seems not so great, after all.

I’ve been spending some time at the leprosy clinic. The patients come in – the sweatshop workers from the Philippines, the indigenous Chamoros, and, very occasionally, a North American – and they show us their pale numb spot(s) and we nod and try to decide if it is getting better or not. We encourage them to keep taking their pills. They say they will. They make their appointment to come back in a month. The encounters are quick and uneventful. The whole time, I’m just staring.

Leprosy is a fascinating disease, and when I’m with these people I have to consciously restrain myself. Being very interested can look a lot like delight. You wouldn’t want anyone thinking you were delighted that they have leprosy. You wouldn’t want to be delighted to see someone with leprosy. Even if you were.

Leprosy is fascinating because it is a scourge in the old-fashioned sense. It blinds, disfigures, and maims, and it is infectious and inspires strong responses in everyone. The organism that causes it, Mycobacterium leprae, prefers to grow in relatively cool areas of the body: in the skin and the peripheral nerves, especially in places like the tip of the nose, the eyes, the arms and legs. Much of the damage it causes is indirect, a result of deadened nerves: numb fingers are forever being scalded, pinched and burned without being noticed by their owner. Infections and recurrent trauma erode the affected tissue and where the infection is in the skin itself it looks a lot like eczema, except it never waxes and wanes, it just slowly expands and worsens.

M. leprae is a lot like the tuberculosis bacterium, and both critters have similarly storied pasts. The Pacific Islands once had a great many leper colonies, and it has only been in the last forty years that effective antibiotics have been available to treat leprosy, also known as “Hansen’s Disease,” after Hansen, the fellow who found the bug that causes it. I prefer “leprosy.” That’s what the Bible and the Koran call it. That’s what they called it in Papillon. “Hansen’s Disease” is misleadingly aseptic sounding. Leprosy is a septic situation.

The thing is that there is no shortage of diseases that blind and maim – diabetes leaps to mind immediately, especially among Pacific Islanders, where relative inactivity and North American diets are killing a generation of young people. The traditional elderly, who still eat taro root and rice mostly, are fine, growing old and appalled as their Spam-eating children and grandchildren develop kidney failure and lose limbs. The hospital here is full of wheelchairs creaking along, laden with legless Micronesians. It is the same situation, for comparable genetic reasons, in the Canadian sub-Arctic, among the Cree and Chipewyan, and in New Mexico with the Pima Indians, who have the world’s highest prevalence of diabetes. All these peoples are genetically adapted to recurrent famine and when they eat too rich a diet, they develop a peculiarly aggressive type of diabetes: their kidneys fail decades earlier than one would normally anticipate, gangrene develops in the feet and twenty-eight-year-olds have heart attacks. “Adult onset diabetes” is diagnosed in nine-year-olds.

Diabetes is as dull as dishwater. The only definitive treatment for the obesity-related version is weight loss, exercise and dietary modification, but here, as in North America, no one seems to succeed in doing any of that for a sustained period. And so treating it feels like swimming in Jello. It is tragic and important, but there isn’t an internist on this island – or many, anywhere else – who doesn’t groan about the problem. The other day one said to me, shrugging, “they all say they only eat salad, and every month they’re five kilos heavier and their glycosylated hemoglobin is two percent higher. You just have to make sure there’s room in the dialysis clinic, because you know that’s where things are headed.” That’s what I mean: it feels like you’re trying to forestall winter.

Diabetes is a disease of affluence – sort of. Here in the Pacific, the western diet is comparatively new and accompanied the increased standard of living that followed the post-war development. In the more traditional and much poorer islands of Yap and Truk just to the south, there is less obesity and far less diabetes. On the other hand the infant mortality rate is higher. In North America, although the obesity rate among adults is historically unprecedented, and is still climbing rapidly, obesity and diabetes both affect the poor disproportionately. So it’s a complicated thing, a consequence of being rich enough to have way more than enough to eat but not rich enough to be so consumed by bourgeois vanity to the point that you buy yourself an Abdo-Cizer.

Leprosy, on the other hand, is one cool disease; it contains no such connotations of self-made difficulty. It is unpredictable and when it occurs it is dreadful, but there is nothing inevitable and expected about it.

Even saying this aloud feels like a sort of betrayal to the diabetics and to everyone else with lifestyle-associated sickness. It isn’t that losing a leg is ever anything but a moving and dreadful event. It’s just that it’s also predictable and familiar. I suppose tertiary syphilis was like this fifty years ago, and tuberculosis too, for that matter. What do you suppose the dying consumptive George Orwell would have had to say if he knew how dull his doctor found all that coughing?

The whole profession celebrates illnesses that are unusual and therefore interesting. Weekly rounds in North American hospitals are typically devoted to rare departures from the steady stream of degenerative and lifestyle-related diseases. Every doctor’s ears perk up at the news of a lung mass that turned out to be fungus rather than the expected cancer, or of someone with chest pain that seemed like a routine heart attack but whose aorta, in fact, was ripping apart. These are called zebras, as in, “when you hear hoof beats, think horses, not zebras,” a reminder that “common things occur commonly.” And boy, do they ever. If you took away heart attacks, strokes, and the top four cancers – lung, breast, colon and prostate – Christ, no one in the developed world would ever die of anything. There are a million ways people can get seriously sick and there are basically six ways that North Americans ever do. It’s as plain in medicine as it is in art: wealth makes us boring.

On Saipan right now there is an outbreak of leptospirosis, a disease I have never even seen in Canada. It’s caused by a family of bacteria that live in various animals, but the most dangerous one, Leptospira icterohemorrhagia, is most commonly associated with rats. The disease is generally contracted from exposure to rat urine. When the infection is severe it causes kidney failure and severe inflammation in the lungs. There has been a death already, of a young man whose stoic mother wept disconsolately as she snipped hair from his head and put it into a little bag, breaking the heart of everyone here. But with treatment – simple penicillin, usually – it generally gets better. And when it does, people get up and go home and that scene with the scissors is what has been prevented, with a drug that costs pennies.

Two days ago I saw a Filipina contract worker who has Pott’s Disease, tuberculosis of the spine. She works as a janitor during the day and drives a cab at night. When her vertebra collapsed from the eroding infection in her bone she was in so much pain she bought a back brace that cost her a month’s salary so that she could continue to work both jobs. She’s forty and supports her family without assistance. Her infection is clearing quickly now and she no longer needs the brace. She wanted to know if there was anyone we could give it to.

Kevin

Dear Miriam –

Oh God, the treatment was really difficult this time. It coincided with the oddest of occurrences – me realizing I had cancer. Not just saying it, but finally, finally, despite my best efforts and my stubbornness at not admitting how frightening this all is, succumbing to it; having it hammered into my head: this is serious. Prior to that, I had been above the cancer. I had believed what my friend John, who had Hodgkin’s years ago, told me: it’s a really bad flu. That made it all manageable. With CANCER comes all the horrible, frightening cancer associations. With the flu comes slight discomfort – but you can still function, you know what I mean? You can still get things done, and I am very much a get-things-done person. I am quite incapable of thinking of myself as unproductive. But these days, productive means not waking up nauseous. I am trying hard to accept that, but implicit in that realization is the admission that I am sick.

A couple of weeks ago, a friend put me in touch with a therapist. I was thinking, I don’t need to talk about cancer. I’ve got it under control. These are a couple of months out of my life, treatable, better than what other people have, think of kids who have cancer, blah, blah, blah. Anyway, I went, reluctantly, and she has been my grace. For some reason, it is the one place where I can be as scared as I really am. And the reality is that I am. Regardless of the positive prognosis, I am fucking scared. This is a scary thing and it reads scarily to other people. I don’t want to tell clients that I have cancer because I don’t think they will call back. I save it for certain people only and even then, I watch what I say so they don’t get freaked out. I don’t necessarily care if they are freaked out by it (well, slightly), but I care if they show me that they are freaked because that will freak me out. So I don’t express the full extent of my fear. I just figured this out today.

The amazing thing in dealing with cancer is that (for me, at least) fear, like hair loss, is infinite. There is always more fear to excavate and always more hair to lose. I shaved my head and thought that was it: I’ve conquered the hair-loss obstacle, this is what I look like bald, this is what I was scared of. But I still have my eyebrows, and they make a difference. Oh how they make a difference. I wash my face ever so delicately every day to make sure that the brows remain intact, that the last strands hang on as long as they can.

The actual chemo was really hard this time. For the last two treatments, I went in with energy and a bright, optimistic attitude, fully prepared to engage with the doctors and nurses and anyone else who cared to look my way. This time, I just didn’t have the resources, and that was damn scary. I left my sense of humor at the door. Actually, I think I left all my language skills there, too. It was scary going in virtually naked, without armor, and just letting those friggin’ drugs go into my body, worrying about what every sting and burning feeling was. I hated it. I felt like I was free-falling.

You know what else? It looked like everyone else at the doctor’s office was dealing with their chemo so well. I can’t help but compare myself and try to rise to their standard. No one is crying, everyone puts on his or her brave face. Across from me this woman came in, alone, with a full-course lunch. A lunch! I’m happy when I can swallow a cracker or the insides of a plain bagel, and she was having a croissant. She looked so happy-go-lucky, like she was going to drive herself home. Me, I’m lucky to get my bra off by myself.

And to top it all off, I was groggy and nauseous afterwards for much longer than before, which made me feel like something was wrong. I’m off schedule. How perverse is it to be sick because of the treatment, not the illness itself?

I am trying to get myself to go to one of the visualization/meditation classes at the Wellness Center, which is the holistic cancer center here. I know the schedules, but I have yet to get myself there. I think I have huge expectations for these alternative treatments, so I tend to cancel at the last minute because I worry that the yoga class or the meditation class can’t possibly deliver on my expectations. But also: everyone there has cancer. We will all have cancer. They will know I have cancer. That is the key – the only key – to entrance.

Regarding your friend: I don’t know if I want to speak to him yet. I don’t know what I want from other cancer people. I’m not yet settled in the club. First of all, I don’t want them to tell me the bad stuff. I really don’t want to go forward knowing any more than I absolutely need to. For me, ignorance isn’t just bliss, it is sustenance. I talked to this one guy who had lymphoma a few years ago and he started saying things like, “When it’s really bad and you don’t know how you can go on…” Whoa, bud! Red flag! Red flag! What the hell was he talking about? I had only been through my first chemo. I had thrown up a bit. A bit. I ate an ahi tuna sandwich afterwards. I was walking the next day, craving a chocolate milkshake. I still had my hair. Why the hell was he talking about “survival”? I didn’t need to hear that.

I don’t quite know if I want to talk and share with other cancer people. I feel the pressure of having to find conversation, to be a part of the group. I don’t know if I like the fact that we are supposed to like each other, confide in each other just because we all have cancer. It doesn’t feel natural. I rather prefer talking about it to people who don’t have cancer. It distances me somewhat from the reality of my situation. It feels like I am telling a story, talking in the third person. I like the distance. It is comforting.

I am afraid of the next chemo. I associate it now with discomfort, sickness, wooziness and complete and utter inactivity – can’t write, can’t read, can’t talk, can’t really watch TV or listen to the radio, can only focus on the spot on the wall that doesn’t spin.

What I want to try to do before the next chemo is find a way to think differently about my red drug. The nasty, cold one. It’s cold going into the vein. There is absolutely no denying that it is there, that it is in me. Dr. H. calls it poison in my system, and THAT vision just does NOT work for me. So I’m trying to visualize the red as pink. Maybe it’s candy, flowers, anything.

I am getting used to being stuck with needles – I wonder why I ever complained. The key to successful toleration of needles? Breathing in deeply as the needle goes in, engaging in conversation, if that is your thing, and thinking good thoughts.

Much love,

Aliza

Dear Paul:

These days I’m working on the neurology service, as a part of my internal medicine residency. (One year to go, almost exactly. Sometimes it goes as slowly as a summer afternoon in the heat: Breathe in. Breathe out. Good God, how could it still only be August?)

Neurology is two things: strokes, first, and then everything else – miscellaneous dysfunctions of nerve, brain and muscle, whose defects exist at diverse and molecular levels, rather than as a clot sitting in a vessel like a crude clog in a bit of plumbing.

The received wisdom is that strokes are dull and familiar and usually not treatable, and manifested by a depressingly monotonous array of facial drooping, dead limbs and inarticulate speech, and that the interesting part of neurology lies in the oddities of Azorean myoclonus and Familial Periodic Paralysis – strange and obscure disease entities whose near-infinite variety testifies to the literally incomprehensible (to me, anyway) complexity of the mammalian nervous system.

But recently I’m finding myself altogether more interested in strokes. It is true that they are dully oppressive events, not much treatable, at least in the curing sort of way, and so treating them is bereft of the easy sense of gratification that treating a large heart attack can carry, for instance. There, you get the drugs into someone fast enough and you can watch the effects of the clot melt away on the ECG. The blood pressure climbs and the water in the lungs dissipates – it is really the most privileged situation to find oneself in. The irony is that we use the same drug to try to dissolve clots in the brain, too – it simply works far better on the heart. This is because you can injure the heart and it can still cope; it isn’t that complicated and it has a certain amount of built-in redundancy. You shoot a bullet into a car and it might keep on going – try the same thing with your Palm Pilot and it’s another story. This is exactly what I find so compelling and so awful about strokes. Because they take out just one discrete bit of the brain at a time they reveal in demonstrable, obvious ways the importance of milligram-sized pieces of brain, and thus the extraordinary complexity of our wiring. Of the way we think. Of us.

Not long ago I cared for a man who had had a stroke; he could see reasonably well, and could write complicated and lucid sentences, yet he could no longer read. “Alexia without agraphia,” said the neurologist. When I looked puzzled, he said, “a common thing with left occipital infarcts.” The man’s visual-association cortex could not work, or at least that portion of it that is responsible for recognizing words.

The idea that writing and reading could be fundamentally distinct capabilities at the level of our hardware astonishes me maybe even more than it should. As the neurologist put it, shrugging, “you can write with your eyes closed, after all.”

I’ve been thinking about that ever since.

It feels otherwise. It feels like the only way to write is to read as you do so and to taste the words and recall and reflect upon them. Reading is the back swing and writing the fore: each step inextricably dependent on the other. This is true in several frames of reference – in the most immediate, how do you know if what you’ve written is even legible, let alone coherent, if you cannot read it? And in the longer view, everything we ever write is a recapitulation of something else that we’ve read. We form our ideas about how to write a letter from the letters we’ve read, and it is the same with novels and reports and pitches. Hand someone a harmonica who’s never heard music and they will sound even worse than harmonica players usually do, I imagine. But then, I’d have imagined you’d have to be able to read to be able to write.

But there are luthiers I’ve read of who only play a few notes themselves, and vintners who abstain. I’ve met men who have sold pot for a living for years who themselves never smoke. There are, I expect, legless shoemakers, apartment-dwelling gardeners, vegetarian butchers, colour-blind painters; and I think that sex-trade workers who are numb to the pleasures of the flesh may be the rule, rather than the exception.

The obviousness of the statement strikes me even as I write it: there is nothing about creating a thing that mandates understanding it.

I wonder what the future holds for this man. I wonder if his interest and ability in writing will fade with its utility. Grocery lists, phone numbers, To Do lists – none of these will work for him anymore. He will live instead in the world of spoken words and insist on calls rather than letters. It will not be that much poorer an existence, I suspect.

In his hospital room his children and grandchildren crowded to the walls and struggled not to mouth the answers to him when I asked him to read simple words. I asked them not to, and they looked ashamed, like eighth graders caught passing notes in a quiz. In a few minutes I moved on and went to learn about a man whose stroke had left him blind but entirely unaware of having suffered any ill effects of any sort. Notwithstanding the bruises on his nose and the scrapes on his shins.

We are strange and complicated creatures. Even leaving our souls entirely aside.

Kevin

Dear Miriam,

Yup. Interesting has been the key word lately. Under the circumstances, I’m okay. This has been a whirlwind week in which I have gone from prospective bronchitis sufferer to cancer patient. I got the final diagnosis last Tuesday: non-Hodgkin’s lymphoma. I am most certainly numb. This is the result of the four-month-old “muscle spasm” in my chest and the sporadic numbness throughout my left arm. Despite all the many tests and acupuncture appointments, it took me coughing up some blood for the doctors to get their acts together.

On the one hand, I’m relieved that I finally know what is going on with me. I’m tired of lugging myself to countless doctors and having to “prove” that, indeed, something is not right with my body. I had started to write my symptoms down so I wouldn’t forget a thing when I was at an appointment, in order to maximize the opportunity. But, Christ. I ruled out cancer four months ago when one of the lame-ass doctors told me that my “discomfort” could be eradicated by physical therapy. I had envisioned playing with big, red plastic balls and hanging from uneven bars. Fast forward to the present as I contemplate chemotherapy (six treatments, one every twenty-one days, for around four or five months), which has one crappy rap. I don’t know many people who have said: “I loved it! I give it a thumbs-up.”

My doctor gave me the option of starting Wednesday (the day after the final diagnosis) or Monday. I chose Monday. I couldn’t face it that early – that would have been only a week since the blood-coughing incident, and I hadn’t really integrated the news. I kind of wanted to hold it off for as long as possible in the hopes that it might just go away. But I coughed up some more blood on Friday and experienced a different quality of pain in the chest and my doctor said come on in for your first treatment. All I remember was trying to hold in the tears while talking to the scheduler at the doctor’s office. I didn’t do such a hot job. I couldn’t make the appointment. My mum had to make it for me. It was almost farcical when she asked me when was a good time for me to come in. As if I had any sense of time. As if there is ever a “good time” for chemotherapy.

The chemo (note the insider’s slang – not chemotherapy but “chemo”) took place in the doctor’s office, where there is a whole annex of recliners, TV’s, magazines, and people. I was struck by how different we all were. I shared a space of four recliners with a forty-five-year-old blue-collar-looking black man, who left halfway through my treatment and was replaced by a fifty-ish Latina woman, flanked by her nervous and protective English-speaking kids; a forty-year-old white woman who had “fuck you” written all over her but applied her lipstick nonchalantly throughout, as if she was expecting company; and a jubilant though possibly senile seventy-year-old woman, white-haired, soft-cheeked, upper-middle-class, sipping a chocolate Ensure held for her by her Filipina caretaker.

It was all pretty amazing and inspiring, because for the past ten days I have been the only person in my “community” with cancer, which has been a bit of a pressure in an odd way. I don’t know how to act, they don’t know how to act (yet), and here were all sorts of people with it. They were walking in and out, going to the bathroom, having conversations. Smiling, even. The mean, lipsticked woman would try to sleep, turning from side to side as her IV dripped. The black man was reading the L.A. Times, which, in my opinion, is no great distraction. (A little insight into my mental state – I packed a bag for a mini-beach vacation: one thick magazine, two books, four CD’s, and one empty diary. I was going in for two hours.) Overall, it felt like a typical party situation, where no one knows each other but we all have something in common: the host. In our case, cancer, the greatest host of all. No one talked, but there were lots of empathetic looks floating around. We were sharing something so personal and intimate, so exclusive. We were at our most vulnerable, and no one on the street would even know. They didn’t know about this room in some innocuous building in L.A. I knew there were stories in that room. I just didn’t know how to start the conversations.

Interestingly, chemotherapy was actually okay. It was. In any case, it could not have been worse than the anxiety I had been harboring over it. Strangely, it provided me with some moments of peace. For the first time in many intense days, I actually had time to myself, a little control over my life. I was alone in my recliner, facing the sun, with an expansive view of the hills. I turned on my music to drown out any medical-speak, closed my eyes and tried to remove myself from the reality of that place.

Not that it was all a bed of roses, mind you. I had three drugs administered intravenously, over the course of two hours. My first drug was an anti-nausea drug which, if administered too quickly (which it was) makes you super-dizzy (which it did). It was a little nerve-wracking trying to focus on my magazine when the words were jumping all over the page. Next time, they say, they will give it to me slower.

That, however, was a cakewalk compared to the second drug, which was, by far, the most un-ignorable part of the whole chemo process. First of all, it has to be administered by a nurse; if it doesn’t keep flowing through the veins properly, it can do some serious damage. Then there is the drug itself: it is a cheap and ugly shade of red, a bit like cherry Kool-aid. Very synthetic-looking. And it is cold. As in, brrrr. I mean, really. If this shit has to be coursing through my veins, I want it at room temperature, at the very least. I want subtlety, and room for escape. But instead my eyes are open, and I can feel it traveling – first, its trail feels cold, then itchy, under my skin. Like I said, thoroughly un-ignorable.

I was so freaked out by the second drug that I can’t even remember the third. I do remember the nurse leaving and finally lying back down in my recliner. I remember looking at the bag of saline (a cleansing solution) that was dripping into my arm and praying that it would clean me up, just freshen up my veins and clean me up.

When I was finally finished, I was pretty elated and energetic: I actually went out to eat. Over the weekend I had very little nausea and for that, I took some drugs (whatever the hell they want to ply me with).

Twenty hours after the treatment, my left chest, where the tumor was, felt significantly better. It no longer felt like I had a corset pulling my chest in. I could breathe deeply. My arm was free of any pain, tingling or numbness. It was crazy. Like magic. While it was reassuring to discover that the treatment was working, it was also totally frightening. I had to admit that they were right. I have cancer.

Much love,

Aliza