Garrulous

One fringe benefit of this whole medical ordeal: I have a renewed respect for the power of words. Some of them now terrify me.

Despite what you might think, “cancer” itself isn’t among them. This is possibly because, like the disease itself, the word is so prevalent. There’s just no escaping it. In the last few days alone, I’ve heard radio reports on controversy over the new federal guidelines for breast cancer testing and on an odd and contagious strain of facial cancer decimating Australia’s Tasmanian devil population; I’ve watched television ads for local cancer treatment centers and the spot with Jennifer Aniston hugging the little bald girl with a brain tumor; and I’ve read stories on the new Lance Armstrong book and the benefits of acupuncture for cancer patients. I have bookmarked in my browser the website for Planet Cancer, an organization for young adults with cancer, and I’m now going to a local support group for the same where the word, of course, tends to come up. I listen to it drop from my own mouth several times a day: “When I had the cancer, blah, blah, blah…” When a doctor first uttered it in connection to me, it was like a mortar shell had blown up in my face, and in the following weeks, each mention reverberated like an aftershock – but the shock diminished after every occurrence. I’ve made a kind of peace with the word, which is just too monolithic to fight or ignore. If predicted rates of occurrence in the general population prove correct (1 in every 3 women, 1 in 2 men), I suppose everyone will come across “cancer” ever more frequently.

I no longer fear “cancer” but a few words associated with it – words that occasionally sneak up in online articles or leap out from the pages of reports sometimes handed to me by doctors or nurses – really get to me:

Carcinoma: a type of cancer perhaps most synonymous with the general definition of the disease, it is an invasive malignant tumor derived from epithelial tissue – the surface tissue lining the skin and most of the body’s glands, organs, and various passageways – that tends to spread to other areas of the body. The word is a derivation of the Greek karkinoma (“a cancer”), which is itself a mash-up of oma, a suffix meaning, simply, “tumor,” and a variation of karkinos, or “crab.” All this makes me think of a miniature crustacean skittering sideways over the surface of some soft bodily lining and then burrowing in, as if on a sandy beach, and making a second hard shell of the body part it has inhabited. Maybe this is how the Greeks thought of the disease? It’s not a pretty thought.

Squamous: as in squamous cell carcinoma, the type that had emerged from my tongue. Standing alone, squamous means to be covered with or formed of “squamae” (scales), to be scaly, or to resemble scales, which many simple surfaces and linings of the human body do, at least on the cellular level, although one might think first of fish or the cool, rugged hide of a snake. Probably because of its proximity to “squash” and its soft, squishy second syllable, the word makes me think of cooked root vegetables, carrots and beets and gourds that have been boiled and roasted and stewed. Things steaming and tender. Like a baked potato, which is what I sometimes think of when I hear the word “tumor,” probably because of that word’s nearness to “tuber.” Tumors, though, are more often like raw vegetables, fibrous and hard. When I reached in mouth and ran my finger my finger along it, my own felt cold and tough, unyielding and inhuman. Now that the tumor has been removed, my remaining tongue is again soft and pliant. During every follow-up appointment, my surgeon or his nurse practitioner pulls on gloves, reaches in my mouth and palpates it to make certain it is remaining that way. They warn me – the nurse practitioner especially – to stay vigilant against any hardening; a carcinoma (you’ll learn, should you look it up) “often recurs after excision.” There’s a phrase that chills me to the cold, hard bone.

But the word I fear and loathe above all others in the language, the one that makes me tense and my heart thump faster every time I see or hear it: metastasis.

Now, I rather like this word’s constituent parts. Meta just sounds nice, an Old World name you might find belonging to a pretty peasant girl in a headscarf. Although in modern English it is usually a self-referential term (“referring to itself or its characteristics, especially in a self-parodying manner” – the horror film Scream, for instance), in the original Greek it can indicate something more generally transcendent, meaning “after,” “higher,” or “beyond.” Stasis, again from the Greek, also sounds pretty and possesses a beautiful meaning: “a standing still.” More technically, it can be defined as “the state of equilibrium or inactivity caused by opposing equal forces,” more or less the same thing; while the meanings of the word are even more precise across different fields – in medicine, for instance, it refers to the stoppage of the normal flow of a bodily liquid, like blood – they all signal something frozen, unmoving. I tend to think of its use in science fiction and picture bodies in a state of suspended animation, a years-long slumber in coffin-like chambers on a spacecraft traveling across galaxies.

These two words, so simple, innocent, restful even, on their own, become something hideous and toxic when wed. Metastasis. Muh-tas-tuh-sis. It sounds ugly and threatening, all the vowels flattening out like a snake on the prowl and ending with an awful hiss. And the meaning is even worse. “Beyond” + “a standing still” = “change.” Change. That doesn’t seem terrible at all until you recognize the nature of the change. Metastasis has been almost entirely appropriated by Medicine, and now its primary definition, the first and sometimes only definition you will encounter in almost any dictionary, will go something like this: “The transference of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces.” As I understand it, metastasis is the way many (most?) cancers kill. There are a few varieties, like those born in the blood, that accomplish this without spreading, but many need to migrate from their birthplace to realize their fatal potential. They begin in one spot as tumors that may take months or years to build and emerge but can move like wildfire once they’ve leaked cells into a nearby system of blood vessels or lymph nodes, which they ride into other areas of the body, into the lungs or liver, bones or brain, where they take root and take over, possibly unto death. It’s scary to hear that you have a tumor, but it’s terrifying to know that it has metastasized.

I felt uneasy after my surgeon called me a week before my operation to let me know that a PET scan had, unexpectedly, revealed a bright spot on the right side of my neck indicating something cancerous there, in one or more of the lymph nodes. This was unexpected because no one could feel in my neck any little bumps or lumps, any inflammation whatsoever of the nodes. Nevertheless, some cancer had definitely broken off from my tumor and made its way into them. In the consult a week earlier, the surgeon had labeled my cancer “Stage 2,” meaning, I believe (though I refuse to look this up to confirm), that it had not spread to the nodes; I wanted to ask him if I now qualified for an upgrade, but I didn’t, not really wanting to know the answer. For his part, the surgeon carefully avoided verbs like “spread” or “metastasize,” approaching the problem from a considerate distance with a picture and vague pronouns. “Something” had lit up on the right side of my neck in the scan. A tiny fuzzy spot brighter than the surrounding area on the film. “But we’re going to remove the lymph nodes on that side anyway,” the surgeon added.

“So… I shouldn’t worry?”

“No, no,” he said.

I did, of course, though not to the extent I might have if I had allowed myself to consider the full possible import of the “something” that had lit up on the scan. I had spent a week believing that my cancer was self-contained. A portion of my tongue was to be carved out, sure, but after that occurred and a bit of my wrist was stitched into the opening, the matter would be done with. I suspected now that maybe this wasn’t true, but I clung to the surgeon’s “anyway,” that casual adverb that assured me that this surprising and worrying bit of light would be contained and corrected by a process already planned out.

I didn’t break until later. I didn’t imagine cancerous cells speeding station-to-station through my lymph nodes on their way down to my lungs or liver, maybe out to the bones or up to the brain, where they would take root and flower and weed-like strangle my organs and kill me until I read a few words on a sheet of paper. One morning a few days after my weeklong stay in the hospital, after the tumor and nodes had all been removed, I looked over the half dozen papers given to me by a nurse upon my discharge. On one was a section briefly detailing my diagnosis and course of treatment to that point. A phrase near the end caused to me collapse in a shock, followed by an eruption of tears urgent enough to make my mother drive a half-hour to console me after I called: “Pathology revealed invasive squamous cell carcinoma, well to moderately differentiated, with two of ten lymph nodes positive for metastatic squamous cell carcinoma.”

I basically knew all of that already, but seeing it laid out in those cold clinical terms, with those hated words, made it, well, real.

After my mother arrived and I calmed down enough, we called the surgeon to see exactly what those words meant.

Tonight, I’ll attend a meeting of “Survivor Portland,” a support group for “young adults between the ages of 21-40 who have been diagnosed with cancer” (I finally looked up the precise description), and though I never imagined I’d get excited about anything associated with the word “cancer,” I’m really looking forward to it.

For one thing, this meeting – or rather, a little meeting before the meeting – will be filmed. The Lance Armstrong Foundation wants a few minutes of non-audio footage of just such a group for a video it’s producing on young adults with cancer. Members who wish to participate have been invited to come to the meeting 20 minute early so they can be taped “sitting around the table talking & expressing emotion,” or at least silently pretending to do so. I’m still trying to decide if I should arrive early. I could be filmed feigning sorrow and empathy and encouragement, perhaps gesturing pensively to my mouth and throat when I mime telling my own tale. It could be cool to feature in a globally distributed film (the LAF has some serious reach) concerning an issue with obvious personal relevance. Then again, I’m not much of an actor and I’ve never like being photographed. Many a photo of me consists of nothing but my open palm reaching for the lens.

And I’d hate to be thought an opportunist. I’ve only attended the group once before, last July. “We haven’t seen him since the summer,” others might think, “but now that there are cameras rolling, De Niro here makes a return appearance. The nerve!” But I haven’t had the chance to return until now. (Well, I had one chance but the time I spent idling in traffic beforehand while giving a co-worker a ride home killed it.) The group meets the second and fourth Tuesdays of every month, and though my schedule varies – often wildly – from week to week, I always seem to work the second and fourth Tuesdays. Until now. Until this December.

I don’t actually think the group would judge me should I show up for the filming. From what I remember of the members present during the July meeting, they’re a fine bunch of people. Understanding. They understand that, hey, sometimes things come up and get in the way. Work. Life-threatening disease. And if this meeting begins at all like the last one, I won’t have to feign a thing.

I came to the meeting last July despite certain qualms I had about a such a support group, reservations about encountering people still sick and perhaps even confronting death – which you’ve got to assume is a distinct possibility with something involving people with cancer. Of course there were people still in treatment. There was a bald head and face with no eyebrows, belonging to someone who sat just to my left. And, as it turned out, someone had died. I gathered that much from the conversation among those already present when I entered the conference room.

Two women – one middle-aged, one around my age, both oncology social workers – led the meeting. Both welcomed me and took pains to assure me, as I fought the urge to bolt from my seat and sprint to the elevator, that deaths in the group were actually quite rare; they’d only experienced a handful in its several years of existence. Still, there was the fact of Shadyah, a longtime group member and young mother who’d passed away just a few days earlier after a lengthy fight with late-stages cervical cancer. The meeting began with people taking turns sharing their thoughts and memories of her. The older social worker, who’d known Shadyah the longest and best, lit a large candle and began a long reminiscence/eulogy that ended with her more or less sobbing. Then she automatically passed the candle to the person on her left: me.

This led to a slightly awkward second. “Oh!” the social worker said, realizing the instant the candle left her fingers the potential discomfort or embarrassment here for the newcomer. She began to reach out as if to take the candle back, then gestured instead to my left. “Sorry. You can just pass it along, if you like.”

But I held onto the flickering candle. Now, I loathe public speaking, even among small groups (there were about a dozen people there) and, despite any illusions or delusions I may sometimes harbor about my character, I can admit that I’m not usually a picture of grace under pressure. Maybe “Strain Under Pressure.” That would make a suitable caption for a normal image of me under duress. I can panic and snap and fold in on myself. I had started to when I heard about Shadyah: though I didn’t know her, such a death – and the thoughts it inspires about your own death – was the thing I feared most about coming to such a group, and here it was, the first thing I’d encountered. Looking around the group during the first social worker’s turn, though, I realized that of course this fear belonged to all of us. Some of them knew Shadyah, so the loss was personal and especially painful, and we all felt terrible for her little girl and husband, but we shared above all else, and I could see this, I swear, on everyone’s face, the feeling of there but for grace of God or good fortune or the miracles of modern medicine or what-have-you go I… and maybe still could, should something go wrong. Recognizing that we were all in this particular foxhole together calmed me. I was suddenly and strangely happy to be sitting in that particular seat. In what was for me a moment of uncommon poise, I held the candle and said “She sounds like she was a wonderful person, and I’m just sorry I won’t have the opportunity to meet her.”

After talking about Shadyah, we went around the table again and talked about ourselves. And if I may say so, we had some interesting stories. We’d experienced some unique things. We knew some things the public-at-large didn’t necessarily know. For instance, things such as: chemotherapy doesn’t necessarily make one’s hair fall out. Before my own experience with cancer, I assumed it did. I heard “chemotherapy,” I pictured a bald head. And profuse vomiting. But first, a bald head. This is what the elderly aunt of one member of the group must have imagined when she heard that her niece was diagnosed with colon cancer. She immediately mailed the young woman a wig. (I don’t remember the woman’s name. With a few exceptions, I don’t remember the names of the group’s members, though I clearly remember everyone’s cancer and the story behind each.) Why the aunt had a wig, the niece couldn’t say, and the color and style of the gift didn’t suit its recipient, who was in her mid-thirties and like Shadyah, a mother. Not even close. This was a wig, she guessed, from the 60s, a thing better suited now for a Halloween party, something you’d put on for a sight gag. Plus, she never needed a wig, of any sort: “I didn’t lose any hair from chemo. It seemed to grow a bit darker and coarser afterwards, but none of it fell out.”

Whether or not a person loses hair from chemotherapy depends on the type of drug administered, which itself depends on the type of cancer being treated – and there are a lot of different types. If you learned nothing else from the people in that room, you learned at least that cancer is stunning in its variety. This is one reason I think the group, if it looks anything like the members assembled that July meeting, makes a fine choice for the Armstrong video. We were a grab bag of cancers. A veritable United Nations of cancers, each representing a distinct form of the disease and area of the body it had colonized (brain, breast, tongue, testicles, and so forth). We had it covered, literally, from head to toe, and no two alike… well, except for the two women who shared colon cancer.

The first was the mother with the unused wig. She was 18 months past treatment and looked good, healthy and full-figured, cheerful and without complaint. She recounted what must’ve been a painful, grueling, and – with two small children – incredibly exhausting ordeal like she was discussing a movie she’d seen the week before. Still, there was a certain tightness at the edge of her smile, a slight shadow in the expression that I don’t believe could be detected or deciphered by someone who hasn’t been through a similar experience. It said, “I’m now this far past that piece of hell, and I’m not going back, knock on wood.” Everyone in that room who was out of treatment had it. I’m sure I did, and do every time someone asks about my health. “Well, I’m not officially in remission yet, I have a ways to go actually, but the scans are clean so, so far so good.” Fingers crossed. Knock on wood.

As for the other woman with colon cancer, her anguish was written clearly on her face for anyone to see, civilians included, since she was currently in the middle of treatment. Bony under wrinkly sweats I imagined she was probably living in those days, with limp, stringy hair, a sour squint behind her glasses, and gestures that appeared pained, arthritic even, she looked 35 going on 75. She’d probably be the first to agree: “I’m just sick of feeling like an old person. All I can do is lay around and watch television.” She was weary of the constant fatigue and neuropathy, another thing we in that room knew. (Actually, while nearly all the others dropped that word, “neuropathy,” and talked about the pain, numbness, and tingling in their fingers and toes, I never experienced it; it was a new word and idea to me.) Being in the thick of it, she couldn’t help letting a little bitterness and discontent seep out. “Well, at least they’ll let me have juice now,” she sighed, raising her Snapple bottle in an ironic, half-hearted toast. “That’s… something, anyway.” It was something but maybe not enough to compensate for weeks with no food but plenty of pain, diarrhea, and all the unpleasantness that comes with toxic drugs and irradiation of the bowels.

Another thing I loved about the group: we had one big thing in common within that commonality were plenty of differences. Some aspects of that woman’s suffering were painfully familiar to me, while others I had to imagine. Everyone’s story had something in it that surely made everyone else in the group think “Imagine that!” Or possibly “Holy Shit!” There was a collective gasp and “Ouch!” when my turn came and I arrived at the part where a portion of my tongue was carved out. Some of the others’ stories made me gasp and swear. There was the tall blonde ER nurse who was diagnosed years back with a Hodgkins lymphoma so advanced her doctors were certain she was a goner. Now she was a year into remission and had become a cancer volunteer, advocate, and speaker so prolific she’d won a few national awards and been nominated for a few more at the time of the meeting. There was the bald, brow-less fellow next to me, also in the middle of chemo for a rare form of cancer inhabiting his left foot. He was still waiting to learn if he’d lose the foot or not. Then there was the married couple. The husband, some sort of environmental engineer, had fought and lost a certain part of himself to testicular cancer. This isn’t the most common form of cancer out there but to hear him tell it, his was just like the flu, an inconvenience that had come and gone during the middle of the disease afflicting his wife. She had a form of brain cancer so rare its like had never before been seen, a strange occurrence where certain proteins in her brain were turning into malignant crystals or something. It took doctors and researchers at OHSU months just to devise a chemotherapy treatment for her, each round of which entails opening her up and sneaking a catheter up through her torso and into her brain to get the drugs past the blood-brain barrier. She’d had, at that point, 24 rounds of chemo – or 24 full surgeries. Prone to seizures, she wore a medical alert device around her neck and talked somewhat haltingly, but that she could talk at all I found amazing. Imagine.

Before this woman’s story but after a few other accounts of difficult treatment and suffering, another woman questioned whether or not she actually belonged in the group. Sure, she’d had a tumor in her brain the size of a walnut – discovered after her parents happened upon her in the middle of a grand mal seizure – but it had been removed almost immediately and her chemotherapy drug, just a pill taken daily, had no discernible side effects. In short, she hadn’t suffered, not really. But she was still in the middle of chemo and not to the far side yet, and I could see, I swear, some of that tightness in her smile. She was sure she was fine, but fingers crossed, just in case. And she wasn’t sure she belonged? The rest of us protested immediately. A walnut-sized brain tumor?! Holy shit! C’mon, of course you qualify. I was the newest member of the club, but I protested as loudly as the rest. I’ve only made it to one meeting so far, but I’m certain I belong.

To anyone still reading this: I’m sorry! I’m a terrible blogger. I think there’s an expectation with this medium, a promise even, of content provided and updated reasonably often, and here I’ve gone over a month and a half without a new post. There are reasons for that – reasons I could spend an entire blog post or ten explaining – but let me just say they mostly involve work: some serious injury and illness (not mine this time!), some ill-timed vacations, some walk-outs and firings, a little vomiting and blood (again, not mine!), and, on the whole, me spending more time at work than I cared to; and when at home, me giving more time and mental space to the consideration of new bedding, throw pillow options, and furniture arrangement than I should. I’ve always been a bit obsessive, partial to trivia, and given over to trivial obsessions, and I’ll be honest: when confronted with a choice to revisit the cancer experience or dwell on home décor, the home décor often wins out. Again, sorry, and as we say at work after mangling your order and spoiling your visit, we’ll try to do better by you next time.

My lapse and lengthy silence here reminded me of an email exchange I had with an oncology social worker who helps run a local support group for young adults with cancer. (Or who’ve had cancer. Or – and this may describe the majority of its members – who fall in the nebulous region between the past and present tense of the disease, people who are past treatment yet far from the point where a doctor might at last suggest that okay, perhaps they can now be called free and clear. I’m still uncertain how to precisely label or describe such a group, a sign of the complexity of the disease and the confusion and anxiety of life touched by it.) I had a chance last summer to attend a group meeting, and I thought I’d have a chance to attend the one after it but work, as it has ever since, got in the way. I’d told the social worker I’d be at the meeting, and a few days after I wasn’t, I thought I’d best explain myself. Her response: “I appreciate you letting me know why you were unable to make it. I worry when people indicate that they are coming and then are unable to make it, so thank you.”

In the time before all of this, I could sometimes be a thoughtless and inconsiderate son and go weeks and weeks without thinking to call my mother and check in. At a certain point, she would call me and invariably begin the conversation with “Just wanted to make sure you’re still alive.” There’s exaggeration, of course, in that statement; I’m pretty sure she never actually thought my body was lying undiscovered and decomposing in some corner of the house. There’s not a pinch of hyperbole, though, in the worry of the social worker. In her world, in which I suppose I now reside, something truly bad may have happened to someone who doesn’t check in, who hasn’t been heard from in a while (so again, to the social worker, my mother, my handful of readers, I apologize, I’m fine, still here).

This is one reason I resisted for some time the idea of such a group, towards which I’d been urged by various people at the center where I received treatment – that center’s own social worker, the psychological counselor, my speech pathologist, the nurses. They all suggested I might benefit from talking to others who’d experienced – or were currently experiencing – issues specific to young adults with cancer (or who’d once had cancer, or who’d had cancer and probably don’t anymore but maybe do – who can say for sure just yet but, God, let’s hope not – or whatever you want to call it.) I figured I didn’t need it. I have a solid support system of family and friends to whom I’ve blathered on at length about the ordeal, detailing for dozens of people every scary, painful twist and turn in the saga. I’m sure I’ve bored some of them. I’ve certainly bored myself on occasion. And so I thought a support group might prove redundant: “… and then they cut me here and stitched me there and fed me this and zapped me with that, blah, blah, blah.” But I also worried that such a group might prove depressing, terrifying even: perhaps there would be those fuzzy heads, bald heads, the head-wraps and scarves, gaunt faces, faces without eyebrows, shriveling arms, trembling fingers, bad skin and scars less polite than my own. Maybe there would be members who wouldn’t be walking away from their disease. Members who up and died and reminded you that perhaps you could too, should your disease rear its head again. Which it won’t, damnit!… but maybe could?

I figured out soon after surgery that the whole matter wasn’t resolved by surgery, and wouldn’t be completely decided by the subsequent radiation and chemotherapy. Not really. You’re cut and poisoned and irradiated and then wait and hope for the best. For years. Every so often extremely expensive pictures are taken of your insides and everything appears clean and fine. You’re pretty certain you are clean and get by just fine, for the most part, on this faith. Every so often, though, you catch sight of an idea swimming like a crocodile in the back of your mind: perhaps a few specks of the disease have survived and are swimming somewhere inside your body, just waiting for an opportune time to take hold and bloom again. You learn that even after cancer has been obliterated and wiped from your system – you know it has, damnit! – it persists as the idea of its return. You drift nonchalantly through most hours, unconcerned… except when any strange protuberance appears on the skin or any twinge or flutter occurs below it. Any unaccountable sensation in the body induces an instant flood of panic. Your throat is a little sore one day; you have some sudden irritation around your gums; a slight ache travels through your ear – surely the cancer has returned! You idly run your hand under your arm and feel a bump that you know, in a horrible moment, is a lymph node swollen with disease… but which turns out to be a pimple. You know the odd pains in your chest signal a tumor in the lung but after a few sleepless nights and a clean chest X-ray, the doctor suggests merely an inflammation of the cartilage around your ribs – possibly from one of your physical therapy exercises. Your surgeon explained the phenomenon when, during a follow-up appointment a few weeks after surgery, you gestured in terror to strange swellings on your tongue that bore a disconcerting similarity to the original tumor (just part of the healing process, it turned out): acute cancerphobia, possessed, he said, by every person who’s ever had the disease. He has patients 20, 30 years in remission who still call him in extreme alarm after every spasm and pang. The surgeon and your other doctors don’t want you to be eaten alive by anxiety, but they also want you to remain vigilant and alert to any symptoms signaling a recurrence of the cancer, just in case. It is a fine balance to maintain. It is a different, sometimes difficult, way to live. Sometimes you wish you’d just had a car crash or heart attack or been shot – you’d almost died but hadn’t, that simple, and could move forward without this doubt trailing you.

I have friends whom I believe can understand this. I have friends whose older cousin, a radiologist, is so haunted by his fight six or seven years ago with melanoma that he gives himself frequent scans (he owns his own machines), once interpreted a sore ankle (he’s an avid runner) as cancer spread to the bone, and has begged several physicians he knows to preemptively remove several clusters of lymph nodes (they’ve refused).  I have a friend whose mother a few years ago survived lymphoma. I have a friend who lost his mother a few years ago to colon cancer. I got in touch last spring with a good friend from college whom I haven’t seen or spoken to since then. Her father, it turns out, passed away in 2000 from lung cancer just a month after diagnosis, which had been preceded, as lung cancer usually is, by a strange and persistent cough. My friend now has her own mysterious cough, which has caused her, given history, no little anxiety, and she’s been referred to her own ear, nose, and throat specialist. I also spoke just last week to my former boss, a man whose father experienced prostate cancer and whose brother is currently in the final stages of a long battle with the disease. He had just had a regular check-up and blood work done; everything came back just fine except for the prostate test, the only thing which really concerned him but which had somehow been fouled by a technician. He had to redo the blood draw and was anxiously awaiting the results. It was, he said, his chance to peer into the “hole” in which I lived.

I have friends who, even if they haven’t lost loved ones to cancer or had cause to worry about their own health, worried about me. After my diagnosis and during treatment, my co-workers passed the hat and collected a thick wad of cash, stuffed in a card signed by all and inscribed with many wishes for my continued well-being. Many of them called, texted, emailed, and visited. They asked about the pain, the fear, about how I coped. Most, when I see them, still inquire about my health and wish me well.

This last winter, though, I lost a job and moved locations in the company (more on that later). The sympathetic audience I had at work was gone. My new co-workers, the people with whom I was now spending a good part of each week, hadn’t followed any of my medical ordeal and didn’t have the years of emotional investment in me, of course, that would make them care about the outcome one way or the other. They didn’t know about the cancer. For the most part, they weren’t too curious about my scars. Or were too polite to ask. I had to wait for opportunities, however thin, to introduce the subject. If asked if I liked Indian food, for instance, I might reply along the lines of, “Well, I used to, but after radiation, I can’t handle the spice too well.” Even when the subject came up, many still weren’t too curious: “Huh… bummer… but you’re fine now, right? It’s all gone?” And I’d start to explain that I sure hoped so, and so far so good, but there was still a lot of wait and see in my future… and their attention had already wandered off. Strangely, almost none of them had any experience with the disease. One man did – his elderly mother is being treated for gall bladder cancer – and he was easily the most empathetic, took the most interest in me, but he was fired a few months after my arrival. After that, I finally took an interest in the support group and took my chance to attend a meeting.

In the interests of space and time and at last getting something new up, I’ll recount that meeting in my next post. So, to be continued…

When the surgeon called me at home for the second time, I was trying to string 50 feet of cable from the living room in Gen’s house to our bedroom – well, her bedroom – and the new television I had just purchased to kill time during recuperation from my forthcoming surgery. I was also recovering from a nasty Vicodin-induced rash.

At the end of our appointment a few weeks earlier, the specialist had scribbled down a prescription for the drug and pressed it into my hand: “For the pain.” I told him there wasn’t any, at least not the sort that warranted anything stronger than the ibuprofen I sometimes popped before meals. He insisted. I took it.

I filled the prescription after he called two days later with the results of the biopsy.

I’d never taken Vicodin, or anything like that, never having sustained an injury or affliction that would make a doctor offer it, and I’d never take any of the pills offered illicitly by friends or acquaintances. This was new territory for me. After taking some, I discovered it wasn’t a particularly exciting territory. I didn’t notice a difference in pain, and I didn’t feel loopy, stoned or in any way high. As near as I could tell, a Vicodin was just an over-sized Tylenol – but one dusted with some serious “Don’t Worry.” Now this I liked.

My year had been nothing but worry. Just a few weeks into it, Gen asked me to move out and for us to seek counseling. Perhaps I should have listened but I didn’t move out then; I moved instead across the hall into the little bedroom that I had just finished converting into an office (we had moved Lilli into the finished room in the basement). I did everything else I could, though, to salvage the relationship: coordinated with co-workers and moved around my work schedule to make more time off together with Gen and Lilli, spent more time on homework with Lilli, took them both to the beach for a weekend, took Gen to a counselor. And when she didn’t like the first counselor, took her to a second. I talked about everything, tried to address every concern and complaint. But it was all too little too late… and all of it exhausting. For much of February, and again for much of March, I seemed to be in the grip of some lingering flu or durable cold, continually tired and achy. Somewhere in the middle of this, Gen relented and let me move from the narrow futon mattress I’d been sleeping on in the office and back into our bedroom – her bedroom. But the flu persisted. And then came the sore throat, and the sores.

And then Gen ended it all. I was asked to move out of the house for good. I moved first back into the office and onto the futon.

I worried about finding a new place to live and what shape my life would take afterwards.

And then I worried about something that immediately shrunk and shamed all the previous worries.

Vicodin, I discovered, provided a nice reprieve from my cares, even the anxiety created by carrying around a malignant tumor. I don’t think I had much pain, but if I did, I didn’t care. Everything elicited a shrug.

I have cancer. Oh well, shit happens, you know?

I remember popping a few pills behind the bar on the Saturday night following my surgical consult and, while waiting for the great wave of evening business to crash down on us, holding court before a circle of concerned co-workers.

“ – and, yeah, they’re gonna have to slice half of my tongue out, here on the right side.”

“Good God!”

“Eh.” I shrugged. “And they might saw my jaw open, right here, and pull it apart to get in there to do the operation.”

“Jesus Christ, Brent!”

“I know, right? Oh well, what’re you gonna do? You do what you gotta do.”

They all guessed so. I believe it was Davis who thought about the hair. Told about the reconstruction of my tongue and noting all the hair on my forearm, he asked, “So are you going to have a hairy tongue?”

“Huh… that’s an interesting question. I don’t know. I’ll have to ask. Maybe? Oh well.”

Everyone agreed I was taking everything pretty well, considering. “How are you so calm?” someone asked, maybe Liz. “I think I’d be curled up in a ball on my bed in tears.”

“Eh, what’re you gonna do? I really like this Vicodin, though. I never knew. I think I’m gonna take a few more before it gets busy.”

“Jesus, Brent!”

“No no no, I’m fine. I’m not high or anything. I’m just…” And my hand described a wave gliding down into a perfect, level plane.

We all agreed the week I would spend in the hospital after surgery might not be so bad, provided there wasn’t too much pain. If there was pain, there would be drugs for that, and drugs that were far more potent than Vicodin. “If I were you,” someone said, “I’d just stay doped up all week watching television.”

So I developed a plan: until the surgery, Vicodin, which left me unconcerned about the operation, the possibility of damaged speech or a hairy tongue, and even the cancer itself, especially since it was confined to my mouth; during the week in the hospital, whatever wonderful drugs the doctors and nurses would pump into me; and for my continued recovery at home, a new television. Gen owned the only set in the house and since at some point I would have to pick up one of my own, I decided this was the perfect time to buy the large hi-definition flat screen of which I’d long been dreaming. I had just endured the difficult, exhausting disintegration of a long-term relationship; I had cancer; I deserved this. After my diagnosis, Gen returned me back to the bedroom and took for herself the futon on the office floor. I would set up the TV at the foot of the bed. I decided I would buy it on the following Tuesday, after the PET scan the surgeon had scheduled for me. “Normally, I wouldn’t do this,” he told me and my mother near the end of the consult, “but I’m sensing a lot of anxiety here, so we’ll go ahead and do one.”

Like many great plans, mine began to unravel. A few days before the scan and after a week of taking the drug, a week of relative ease and unconcern and peaceful surrender to whatever was to come, the Vicodin turned on me. A small but persistent itch began on my chest. Soon after it forked, spread to my shoulders and blossomed into a full-torso rash, a mantle of prickling, burning red that lasted, ultimately, for three days. On the first afternoon I called my friend’s mother, a nurse, who confirmed that it probably was the Vicodin, which she said made many people itch, herself included. She suggested Benadryl. I left a message with the surgeon. I called the specialist, who phoned a prescription for Darvocet to my pharmacy. The Benadryl helped. I could tell the Darvocet wouldn’t, at least not like the Vicodin did.

As I sat waiting a few days later in the lobby of the radiology department of the university hospital, I could tell the Vicodin was working its way out of my system. My itching lessened and my worry grew. I nearly cried as I surveyed the other people in the lobby, representatives of a group I was encountering for the first time and would come to consider, in a way, as my people. There was a pair I would see many times later in the hospital, a little girl, six or so, thin and bald and the woman with her who had obviously shaved her own head in solidarity. I had read about such acts and seen them on television but here it was, in the shorn flesh. All the nurses seemed to know the pair well. There were other bald adults. There was an old man wheeled in on a gurney, a catheter sneaking out from under the sheet covering him to a bag full of urine hanging on the end of the bed. There was the woman I helped into a seat who had the first chemo port I’d ever witnessed. This was now my club, but only, I hoped, for another week or so. The specialist had mentioned radiation, but the surgeon had described surgery and radiation as two separate options, so I assumed he and his partner would do their cutting and sewing and that would be the end of it. In the lobby, I started to question that assumption. I damned the Vicodin for abandoning me.

I regained my calm during the scan, a relaxing procedure, almost the sort of thing you’d find in a spa. In a small room, a nurse sat me in a chair and injected me with a sugar solution containing a radioactive substance. As she explained, the solution would gravitate towards cancerous areas in the body, which would then – thanks to the radioactive material – shine brightly when photographed. We had to give the solution time to move through my body first, so she reclined my chair, draped a warm blanket over me, and turned off the lights. After an hour, when I’d nearly fallen asleep, the nurse pulled me from the room and put me in another and into a massive white cylinder. Something whirred around my head, chest, and the rest of my body, snapping photos I guessed.

Afterwards, I bought a new television.

At home, I assembled the stand I had also purchased. I wrestled the set – a 42-inch LCD flat screen – out of the back seat of my car by myself. I unboxed it, set it on the stand, and unfurled all the accompanying cords. When I screwed in the cable that emerged from the floor in the corner of the bedroom – a cable we’d never tried before – nothing happened, no picture materialized. In the basement, I discovered the cable connected to nothing and had no part of the system of cords currently delivering cable television and internet to the house. Its end was cut and frayed.

I returned home from the work the next day with a 50-foot length of new cable, which I connected with a splitter to the cable coming into the old television in the living room. I tacked the cable to the baseboards and up and along the trim of the doorway of the hall leading to Gen’s bedroom. It wasn’t pretty, but it was serviceable, and as I explained to Gen later, it wouldn’t be there forever. I had gotten almost to the bedroom with the cable when my phone rang.

It was my surgeon. “So you and the Vicodin aren’t getting along, huh?”

I explained about the itching and the new prescription I already had.

“Well, if you’ve got any other issues, just talk to me, I’m your doctor now for all of this,” he said. “I also called because I’ve got some news about your PET scan. Number one, nothing showed up below your neck in the rest of your body, so that’s good.”

“Okay.”

“Number two, nothing showed up on the right side of your neck. But, number three, something did light up on the right side of your neck. That was, um… unexpected. But we’re going to remove all of the nodes on the right side of your neck during surgery anyway.”

“Oh… so I shouldn’t worry about this?”

“No, no, don’t lose any sleep. I’ll see you next week.”

I reached for the Vicodin but came up with only Darvocet, itchless, ineffectual Darvocet.

Do you know how to make yourself feel like a real asshole? Make your mother cry.

Here was mine, silently weeping in the exam room before the surgeon and his nurse practitioner. In glasses and hooded sweatshirt, with pen and notebook, she looked ready for a morning of grocery shopping or lesson preparation – she would tutor children later in the day – but instead found herself here, comforted by the kind nurse practitioner, forced to listen and watch and imagine some unpleasant things happening to her oldest child.

She was there because you’re supposed to bring someone with you to such appointments. As I learned a week earlier in the specialist’s room, it’s entirely possible at these meetings to be told things such as: I think it’s cancer. And: we’ll have to cut out part of your tongue. You want someone with you who can listen, ask questions, and take notes on your behalf since you might find that once you hear things like that, you won’t be able to keep up with the conversation. Not really. If this had taken place just a month earlier, it might have been Gen with me in that exam room. To be fair, she had taken the morning off work some days before to accompany me to the C/T scan ordered by the specialist – the results of which would be read and revealed by the surgeon – and she would spend many days, she later told me, in anxious tears at her desk. But things had changed. As she was to remind me later, if she had been my wife, such responsibilities would have fallen naturally to her. Instead, they came crashing down onto my mother.

And here was my mother, crying. She’d been worrying about me for a week.

I knew what it was to worry about a child, but I didn’t know it well. By the time I met Lilli, her mother had a nearly three-year head start on the worrying game. With much experience in suffering and loss behind her, Gen taught Lilli to stay close and always – and several times – look both ways before crossing the street. Lilli cleaved so tightly to her mother that there didn’t seem to be any need – or room – for any concern from me. For years, she’d grow panicky in parking lots and shriek at any car moving toward her. She insisted on holding hands to cross the street long after a point even Gen thought reasonable. Bright, dour, and suspicious, Lilli didn’t make us worry that she would do something reckless and get herself hurt. Gen grew instead to fear that maybe she’d gone too far, created someone too timid and afraid of the world. Or possibly predisposed to mental illness? She’ll be fine, I insisted. Still, I left my girlfriend to bear the brunt of her daughter’s worst behavior. Working mostly nights, I’d pull a pillow tightly over my head the mornings Lilli threw volcanic tantrums across the hall while Gen tried to dress her for school. She would scream that her socks were too loose or too tight or none of her leggings the proper color. We sometimes feared the neighbors would think we were beating the child, and I sometimes fretted that she might have a difficult time with friends at school, but I never imagined her doing poorly in class, collapsing in an actual nervous breakdown, or lying broken or diseased in a hospital bed. I left the real worrying to her mother.

Growing up, I don’t believe I gave my mother much reason to trouble or cry over me. An oldest child, I sometimes bullied my younger brother and sisters and once pulled my Swiss Army knife on a neighbor girl (I don’t remember the beef), but I got into few fights. At eleven, despairing of life as a tubby fifth grader, I threatened suicide with a butter knife, but never even touched the dull serrated edge to my skin, and that was the last time I flirted with the subject. I didn’t maim or kill small animals and signal a future as a violent sociopath. My criminal career pretty much began and ended with a pack of gum lifted from a grocery store when I was five. As with the neighbor girl, I was scolded by my mother and dragged before the victim to make an apology, and the shame greatly deterred any future misdeeds. I was a good student, a favorite of teachers, but not of girls, overweight through all of high school and never in danger of giving my parents an early grandchild. I didn’t stumble into any vices until college.

My mother always maintained that raising my brother and me was easy and that my sisters caused her the real grief. Neither of them lived an After School Special, exactly, but the two of them butted heads with her and sometimes lied, crept out of the house or smuggled boys in, and caused our mother on occasion to wonder about their whereabouts and imagine one or the other lying bleeding and broken in the road. The younger one was once caught drinking vodka from a Pepsi bottle with friends on school grounds during her freshman year of high school. It wasn’t long after that she decided the whole education thing wasn’t worth her effort and later, that she’d rather finish out her teenage years someplace other than in our parents’ home.

I was away at college for much of this drama, so most of what I knew about my mother and weeping I had learned from sentimental films and television shows and even commercials – they could pull tears from her effortlessly. Just show an estranged father and daughter reconciling, a pair of reuniting lovers, or a stricken child in a hospital bed and my mother’s eyes would instantly moisten. Whenever she caught me grinning as she wiped them after a particularly affecting coffee ad or scene of Touched by an Angel, she would tell me to “Just shut up!”

In the exam room, the surgeon gave her a different set of pictures to consider.

The first weren’t so terrible, maybe even a little comic. The surgeon peering intently into my mouth, help open as wide I could. Me sticking out my cancerous tongue. The scope. Like the specialist, the surgeon produced one, but it was not, he noted, a neat little battery-powered number like the one belonging to the other doctor. Apparently the specialist was known – and possibly envied – for his scope. The surgeon let his nurse practitioner do the honors with this instrument. I had already described this process to my mother, but I don’t think she cared for it; she made a small cry, and I saw her cringe and close her eyes just before I shut my own as the tube began to creep up my nose. For me, the second time around wasn’t so bad. I thought of people flossing their nasal passages with limp spaghetti noodles, and imagined this spectacle of the scope might be sort of funny for people who could bear to watch, with me exhaling in a girlish pitch the various “eeeeees” and “oooooohs” necessary to open my nose and throat to the tube. And the nurse practitioner had little to report other than a small clot of mucus. “The clinical term for that, I believe, is ‘booger,’” said the surgeon. He was that kind of doctor. Before we met in the consult, he called me at home to introduce himself and began by asking about my tumor: “Hey, so just how big is this thing?”

Then next image was less slapstick, more medieval. The surgeon was going to cut out part of my tongue. He, and the specialist before him, might have said “remove” or “excise” or “resect,” but I always heard “cut out.” We had to picture a sharp blade slicing into muscle, in this instance the one lying in my mouth. It seemed a punishment straight from the dark ages. I imagined some poor, trembling peasant hauled before the village court, accused of slandering his neighbor or speaking ill of royalty or conversing with a goat, a sure sign of satanic collusion, and the king loudly proclaiming: “Cut out his tongue! The knave shall be dumb the rest of his days!”

I’m not sure what my mother imagined.

Then came the mad scientist bit: after the cancerous piece was carved out, another surgeon would harvest tissue from my left forearm and sew it to the remaining tongue. (The forearm because it is rich in blood vessels, like the tongue, and the left one because, well, I’m right-handed.) The surgeon assured us this reconstruction would offer me continued speech: “You won’t sound exactly the same as before, and you won’t be entering any tongue twister contests, but you’ll still be able to talk.”

My tongue’s fate was certain, but there were other contingencies to consider.

A transfusion, should something happen during surgery and I lose a lot of blood.

A tracheostomy. Should it appear, after surgery, that the trauma of the operation caused serious swelling in the throat, the surgeon could decide to open a hole there so I didn’t suffocate overnight.

My jawbone being sawn apart at the chin and opened up like the mouth of a crab or the creature in Predator. The surgeon told us this was a real possibility should he decide, come the start of the operation, that my mouth wasn’t wide enough to accommodate the maneuverings of his fingers and scalpels and everything that would be needed to remove the offending portion of tongue and reconstruct it. For the three weeks between consult and surgery, I had cause to picture a bone saw coming at my face and blood spraying and bone dust flying and my jaw pried apart like a peanut shell.

For those three weeks, my mother must also have envisioned and replayed these horror film scenarios.

For the week before the consult, she must have considered, at least for a moment, that she – nearly a grandmother, indifferent to exercise, diabetic – might outlive her oldest child.

We had to consider that I had done this to myself.

Unlike so many children, I didn’t give my mother cause to worry about me during high school, my teen years: I gave it to her after. I never tried cigarettes and alcohol until college, well away from three younger siblings who could follow my lead, a father for whom such things weren’t merely advised against but divinely prohibited, and a mother who had the regular earthly maternal concerns about these behaviors. She always thought I was too self-possessed, too in need of control, to be tempted by drinking. I wasn’t, until my freshman year, when I tried some wine in a friend’s dorm room and understood almost immediately the wonderful release it provided someone who could deliberate and agonize long and hard over the proper order of arguments in a thesis paper or the correct kind of deodorant to buy. Around the same time, someone had me try a cigarette as a means of masking the smell of marijuana (a drug that never quite took like the other two). Smoking, I learned, offered a quick, convenient, and regular reprieve from the stresses of any given hour. At home during breaks and for the year or so I lived there after college, I walked around the block to sneak cigarettes and tried to time my return home after nights of drinking with friends so I could steal into my room unnoticed by my parents. Of course my mother knew about these habits. She was disappointed, concerned about the smoking and furious that I had driven drunk. I sometimes agreed to stop, and meant it, but then I persisted, furtively.

Here with the surgeon, it was all in the open. As with the specialist, he began the appointment by asking questions, and here, in front of my mother, I had to admit to admit how much I smoked (half a pack a day, pretty consistently) and drank (about once a week, usually, and almost always to excess).  The surgeon duly noted my answers and, as with doctors before and after, didn’t comment or assign blame. Even though I felt I deserved it: “Just say it!” I thought, “C’mon, just say it! Tell me. I did this.” The closest I ever came to satisfaction on this point was when my radiation oncologist, after explaining that researchers had linked HPV and other viruses to oral cancer, concluded, chuckling, “So this may not have been all your fault.” I figured that over a decade of drinking and smoking and six years working in a busy, smoky bar made it mine, but I understood that there were probably a host of other factors to take into account – genetics, personality, environment – and that no one could hope to diagram what had been responsible for what, exactly. The case against me would be circumstantial, and there was no utility in pointing fingers, so they didn’t. My mother never did either. Still, if I were to die, I thought, it would be on me.

Dying didn’t seem to be on the table, though. After reading the C/T scan and checking me out in person, the surgeon said he believed my cancer to be stage 2. The tumor appeared to be self-contained, not yet leaking out and threatening to colonize other organs.

My mother started crying. I could only nod dumbly at the surgeon and left it to the nurse practitioner to move over and comfort her, offer further assurances. Both of them clarified and expanded on the message of the specialist: “This is fixable. Don’t worry, we will fix you.” Then they told us what was still to come, none of which, despite its graphic, possibly painful nature, seemed beyond our ability to handle, now that we learned I was to live.

In the car ride home after the appointment, I had to ask my mother to recount some of what had just been said: “Wait, so I’ll be in the hospital for a week after the operation? Is that a week exactly, or like six days? Eight?”

“I don’t know. They just said a week.”

“And the feeding tube – how long do I have that for?”

“Well, the whole week you’re in the hospital, and maybe a week after.”

“And, um, how does that work again, the tube?”

“Through your nose, down your throat, and into your stomach.”

“Oh.” But I remembered one detail clearly. “And they might saw my jaw open!”

She shuddered. “They won’t have to do that,” she insisted.  “He has to tell you everything that could possibly happen, just in case, but I’m sure they won’t have to do that.”

“Yeah, but imagine the scar,” I said, running a finger from the middle of my lower lip down my chin. “It would be badass. I’ve never seen one like that.”

I offered to take her out to breakfast, which seemed the least I could after what I had put her through, would put her through. It also seemed like a good thing to do while my jaw was still in one piece.

Someone recognized the Hand of God on me in a Taco Bell.

I know, I know: a Taco Bell. I should be more careful about what goes into my body, after everything that’s happened. And I think I am, most of the time, but this one evening, a few weeks ago – Taco Bell. After a long day of errands and housecleaning, I finally took notice of the hollow gurgling in my gut, and to quiet it, took the path of least resistance: out my door and around the tall hedge separating my garden apartment from the fast food restaurant on the other side.

Two middle-aged black women got out of an old sedan and stepped into the restaurant ahead of me. They didn’t appear dressed for church – one in a plain white t-shirt and jeans and the other in a purple tracksuit, neither with a frilly hat to cover their beaded cornrows – but apparently they had just come from a religious service of some sort, where, I learned, the reverend was in fine form, Deborah (scandalously!) did not show up, but fortunately Levon, one fine specimen of manhood, did. I didn’t mean to eavesdrop, but I couldn’t avoid it either. Every word of the conversation rang out across the parking lot, and then bounced against the walls of the restaurant once the women were inside, where they made no volume adjustments whatsoever.

We were the only customers in the place. The real action took place just outside, a long line of cars in the drive-through lane, and all the employees, the few of them on duty that night, hung back by the window, taking and relaying orders, or in the kitchen, furiously scooping and squirting and wrapping. No one stood at the front counter.

“Hey!” the woman in the tracksuit hollered. “Anybody working in here? Huh?”

All the workers’ heads swiveled towards her, and behind the pair of women, I bristled. “Oh boy,” I thought, “here we go.” I’ve endured plenty of impatience and exaggeration over the years from certain sorts of customers, the kind who claim their order has taken an hour when only five minutes have passed, who thump on the bar when they want a drink, who snap fingers and shout. People who can’t see past their own desires and give no thought to how they make others feel. I imagined tapping the woman on the shoulder: “Hey, excuse me. You’ve only been up here a second, and, contrary to what you might think, you’re not the only person here. They’re working hard. Can’t you see that?” But I didn’t tap. I considered her broad stomach and hips and how I have shrunk in the last year. I recalled the blast radius of her words, and how I tend to keep my own quiet, unobtrusive, politely away from other people’s conversations and hearing. Clearly I would be overmatched in an argument. I also added in my tongue, tallied up the consonants and letter combinations I might trip over in my reproach, and calculated all the potential awkwardness and embarrassment. I let it go.

A man at the drive-through window covered the mouthpiece of his headset. “I’ll be right with you ma’am.”

Best of luck, buddy, I thought, but the woman let it go with a loud “Hmmph!” and returned talking to her friend.

I was deliberating over my order – burrito? chalupa? both? – when the woman turned toward me. In a flash of panic, I wondered what I had done to earn her attention. Had I accidentally stepped forward and kicked her ankle? Did she need to return to her car for something and I stood in her way? Did she somehow know about the confrontation I had briefly envisioned? Could she look into head, see into my heart? Was this about to get loud and uncomfortable?

She stared right at me, smiling. “How you tonight, child?”

“Oh… um, okay, I’m just getting around to getting some dinner and – “

She was suddenly fluttering her fingers near my face. “You got a glow about you, yes you do! I see that, mm hmm, a glow.”

A glow? The radiation should have run its course months ago. I wondered if I’d gotten any sun that day. Had I drunk any coffee? Anything that might have reddened my face?

“A glow? Really? I, uh – “

“Oh, and you’ve had some surgery, child, I see that too, mm hmm.” Her finger traced a path from below the corner of her jaw to the center of her throat, mirroring the scar on my neck.

My heart flooded with delight in that instant. She had gawked and pointed. Most people are too damned polite to acknowledge the scars. After I’ve told my tale and pointed out the one on my neck, many people claim it had escaped their notice and try to assure me “Oh, you can barely see it!” As if I’d want it obscured. I know my surgeon did an exceptional job with the incision around my throat, tucking it into one of the creases of the neck, and the scar can fall under the shadow of my jaw, but I believe it’s still pronounced, perfectly visible. This woman noted it after just a few seconds. The scar on my left forearm, which the surgeon promised would resemble a shark bite, is undeniable. I sometimes make a point of using my left hand to set down a beer or a check at a table, twisting my palm up afterwards so the thing is on full display to customers. Even so, I never get a reaction or questions. People are polite. I understand. They’re just being sensitive since many people, I understand, are sensitive about their scars, try to hide them, would draw back and put a hand on them or pull a sleeve over them if noticed. These people may be the majority. I’ve seen the ads on television for creams and lotions promising to remove or minimize the appearance of scar tissue and help you return to your untouched, unblemished self. I even have a few of these solutions, given to me by friends, but I’ve never used them. Never would. My vanity runs in the opposite direction.

“Yeah, I had cancer!” I said. “Cancer!” I almost hollered. Like a child demonstrating a new toy or recounting the plot of a movie, I rambled on in great excitement and detail, pointing to my mouth and flipping over my arm, revealing the large oval of rippled tissue on the inside of my wrist and the thick pink ribbon running nearly to the elbow, and explaining in a mad rush of words everything the doctors had done. And then this happened, and this, and that!

Her eyes popped wide at my recitation. “Oooohh, cancer, that’s something! Oh child. Well, you got a glow about you. You blessed. The Lord’s watching out for you, yes He is. You blessed. He’s touched you.” And she grabbed me and hugged me tight to her expansive chest.

And then it was time for she and her friend to place their order.

I don’t know about a glow or God or His Hand upon me. I won’t admit to any divine imprint or deny the woman what she claims to have seen. My own beliefs don’t run in that direction – though after everything that’s happened, I have wondered on occasion if I’ve been cursed (and certainly I’ve been blessed, as much as anyone whose family has had his back at every turn). But I have been marked and set apart. Not to sound melodramatic, but I’ve suffered and endured some relatively unique things and the experience is written plainly on my body. Carved into it in a few places. I would never try to hide or erase it. I would rather people, on occasion, stop and gawk and ask, “What the hell happened there?” But, in our collective civility, they almost never do. And sometimes I feel like shouting and snapping my fingers at them: “Look at this! Now recognize!”

“Um, are you going to be alright?” Dr. Pedersen asked. He was standing bent over me, one hand on my shoulder and the other holding a long, thin tube that blew a stream of cool air over my face – something to keep me alert and prevent me from passing out there in his exam room. That was a real possibility after what he had just told me.

And that was a difficult question to answer – was I going to be alright? – any way you took the scalpel to it.

To begin with, my lips didn’t work so well. Pedersen had sprayed an anesthetic up my nose to prepare for the scope he would then snake up my right nostril, though the nasal cavity, and down into my throat. He gave me a few extra squirts of the stuff when I told him I wasn’t sure I felt it taking effect; I didn’t want to take any chances, not after he told me where the business end of the scope would be heading. He had given me a Kleenex to catch any runoff (I still clutched it; he didn’t offer to take it or proffer a wastebasket), but some of the liquid had still managed to dribble down onto my lips and numb them too. Even if I tried, I couldn’t form a coherent answer.

And there was the vast new alien landscape to behold behind that question. Was I going to be alright? You tell me doc, this is brand new territory for me, I’ve never been here. I don’t know these trees, these mountains. I don’t know how to traverse this terrain. This is your land, not mine.

And I wasn’t even really there to provide an answer. Pedersen had finished squinting behind the eyepiece of his instrument, slid the hose out, said what he said, and suddenly I was gone, slipped into a secret compartment, curled up and hiding from the audience. I was alone with a passel of thoughts popping off like firecrackers, first among them, I think: No no no no no, wait wait wait wait wait, the other doctor said – and the one before him – no, this isn’t right. This isn’t how it’s supposed to go down. Wait a moment here. Let’s back up.

Let’s back up.

Two weeks before, I had shone a light into my mouth and seen for the first time the sores that had plagued me, at that point, for over three weeks and made talking an uncomfortable chore, eating painful and something I did less and less, sometimes only with the aid of pain relievers. The light illuminated a little nest of angry and alien-looking blotches at the right base of my tongue, red and purple and grey, ribboned with yellow. And the tongue itself strangely flared on the right side. I went online, added in the other symptoms – sore throat, earaches – and arrived at certain websites.

The next morning, after a terrible, sleepless night, sitting in an exam room at the walk-in clinic, I gestured anxiously to my mouth: “Cancer?”

“No, I don’t think so,” the clinic doctor said. “You’re pretty young. You don’t smoke that much. You don’t really fit the profile.” Like the other doctor I’d seen at the same clinic nearly two weeks before, before I’d thought anything but “well, this is annoying, guess I should get it looked at,” this one also thought it was just cankers, obstinate canker sores. Sometimes those suckers were stubborn. “Yeah, and that tongue does look pretty beat up. You might be chewing on it at night. You might need to get a retainer or bite-guard to sleep with.” That was all. At worst, the possible dorky indignity of a mouthpiece. So, maybe something bigger than a common cold sore but surely not the massive horror that had sprung up in my fretful brain. A huge relief.  I had overreacted.  I explained to the doctor, “Yeah, and my girlfriend just broke up with me. Just yesterday, actually. So, with everything, I probably just overreacted.” Still, the doctor asked, it had been nearly a month since things started? That was a little a strange. He didn’t think it was anything, really, but here was a referral to another physician, an ear, nose and throat guy, a specialist, a good one. Just in case.

Nearly two weeks later, I stood before the admitting counter of the specialist’s office, late and apologetic. I thought I’d given myself plenty of time for the trip, but the early morning traffic had been terrible, dense and crawling. Another visitor, an old lady, agreed, but the woman behind the counter regarded me unsympathetically. “You should have checked in over 20 minutes ago. Your appointment was ten minutes back. We’re busy here, there are other patients. I’m not sure we can fit you in now.” Fine, I thought. While sitting in traffic, I’d considered turning off and heading back. It wasn’t anything, really. Didn’t these things, even the most persistent, eventually heal on their own, anyway? Just give it some time and warm saltwater. I’ll go home and back to bed. Why not?

But I didn’t. I was squeezed in. I was checked in quickly, shown to the exam room, and waited just a moment or two before Pedersen walked in. (Some past and future appointments had me waiting a quarter hour or more for whichever doctor to arrive; 15, 18, 20 minutes alone to consider the paper sheet on the examination table, the mysterious mechanics of an exam chair, the tubes and gauges of various wall-mounted instruments, the number and variety of small jars and boxes on the counters and in the cabinets, the medical hieroglyphics on certain charts and containers, the advice and admonitions and warnings of certain posters, and yes, that is a good idea there, I should do that! I wouldn’t want to catch that! And what does that mean? And how does that work? And what does that do? And, oh God, will he actually find something? Is there something to find? What is he going to find?!) Pedersen left me no time to question and consider the possibilities.

In my moment alone, I did register that the examination room, in a suite on the fifth floor, was the first I’d been in with windows, large west-facing windows that filled the space with morning light. And that here the posters were more specific than those in the walk-in clinic, which spoke of the flu and the cold, general malaises moving through the population. Here were cut-away profiles of the human head, its intricate pockets and passageways demarcated in different reds, pinks, and peaches. And here was Pedersen in white coat, tie, and dark dress slacks, different from the clinic doctors, who bounced hurriedly from room to room in cottony, pajama-like scrubs, attending to this and that, runny noses and upset stomachs, a little bit of everything. He was a specialist, an initiate in the particular mysteries of the ear, nose, and throat. Someone who would put his finger on my little problem and let me move on, all I wanted to do after everything that had happened with Gen, just move on. Enter the next part of my life. I had even found an apartment already, would sign and move in the following week.

Pedersen carried a clipboard that certainly held the reason for my visit, but still he asked: “So what are we here for today?”

He didn’t seem particularly interested in the question, perhaps a little rushed – at 8:15, perhaps already behind schedule thanks to me, this annoyance to ripple through the rest of his day – and I was no longer particularly worried when I explained, gesturing dismissively to my mouth, “Well, it’s just these stubborn sores.”

“Well, let’s take a look.” He pulled on a pair of latex gloves and had me open wide. He directed the beam from a small, slender light into my mouth and looked in. He reached in and felt my tongue and its base with one hand, and then with both pressed fingers behind my ears, along my jaw, and down my neck, landing and tapping out a final exploratory rhythm in the hollows above my clavicle.

“Um, I’d like to take a look down your throat,” he said and explained the scope. Oh, well… anything, I guessed, to find the problem and a remedy. To move on.

A moment or two after he set aside the instrument and as I was trying to shake off the novel and unpleasant sensation produced by the tiny black hose twisting and slithering its way through my airway, he said, “Well, I think it’s cancer. It looks like cancer, it feels like cancer, it smells like cancer. I could be wrong, but I don’t think I am.”

Smells like – what? Wait a minute, what?

A curtain of fluttering, blinding white fell across my vision, and Pedersen would soon produce, like a magician, seemingly out of nowhere, that second hose, a wand of hissing air to wave across my face and conjure me back into the moment for, like a prop rabbit or dove, I had disappeared. Or it must have appeared that way to him. I was still there, beholding a string of thoughts igniting and exploding:

Cancer… cancer… CANCER?! But the other doctor said – and the one before him? Wait a minute here. This isn’t right.

And:

HA! I knew it! I was right. HA!

And:

Smells like cancer. Huh. I guess that explains why the floss didn’t help.

And:

I’m not ready to die. Please, I’m not ready.

And:

Good job, Gen! I guess you got out just in time, huh?

And:

HA! So right!

And:

Pedersen, poor guy, having to start out his day like this. I wonder how many times each week he has to break news like this to somebody?

And:

This can’t be right. The other doctor said – and the one before him? Whoa, let’s back up here.

But we didn’t. We were still in the present, part of my face numb, Pedersen blowing air into it, keeping me from pitching onto the floor. He wasn’t done with me. “Are you with me? Okay, I’ll need to biopsy the tumor, to make sure. Are you with me?” I guess I nodded, but I was only partly there. Though I’d felt all kinds of squeamish over the scope, I barely registered the next procedure and its escalating violence. He sprayed my tongue with one anesthetic; pricked it in several places with a lancet to administer another; and finally, produced a much larger needle that he proceeded to stab into my tongue, four times I think. I felt nothing.

Pedersen performed a final trick, a prediction of my future. “Okay, are you still with me? We can fix this. I didn’t see anything in the throat or feel anything in the nodes, so I think it’s just the tongue. That’s good. We’ll do some scans to make sure. If the tumor was smaller, I could remove it here, but I’ll have to send you someplace else. Maybe OHSU. A surgeon will cut out part of your tongue, about half I’d say, and replace it with tissue taken from elsewhere on your body, probably your arm. And then you’ll have some radiation. This is fixable, Okay?”

That brought me back fully into the present. Okay, okay. This is possible. This is real. This is what will be done to me. Okay. I’ll let you do whatever you need to do. Scan. Radiate. Cut away. The question then arose that inspired a sudden need to speak, quite difficult with tongue and lips nearly frozen: what should I do? I strained to move the stopped parts of my mouth and form and emit words.

I think he sensed the inquiry behind my facial contortions. “Oh, you’ll need to quit smoking, of course. And keep up your weight.”

What else? Give me the rules for this place, damnit! I wanted to demand. You looked in your eyepiece and waved your wand and moved me to this strange land, specialist, now help me out! Do what you do, but I’m in this, right in the middle, I need to do something, give me something to do, what do I do? How do I proceed from here? What do I do to keep from sinking, to pull myself out, to live?

I strained. “Waa elf thwoob I do?”

“Excuse me? Oh, just keep up your weight. Eat milkshakes if you have to. And don’t go poking around the internet, you’ll just scare yourself.”

Milkshakes? Surely there was more to it, but Pedersen had me up and out of the chair, patting my shoulder, on the way to the door, tissue still in my hand. I had been late to the appointment, after all, and they were busy. There were other patients.

We were only 20 minutes or so into our second counseling session with Charlotte when Genevieve jumped onto the subject and train of thought that would speed inexorably towards our end. We sat in a triangle, Gen and I in chairs a few feet apart and both facing Charlotte, carefully considering us from the other end of her small office. I’d been all for the counseling – anything to save the relationship – but speaking was a little painful; a cluster of canker sores had been troubling me for a few weeks, enough that I had gone seven days without a cigarette, my longest smoke-free stretch in years. I left most of the talking to Gen. Possibly a mistake. She looked from me to Charlotte, from Charlotte back to me.

“… and I asked Lilli a few days ago who she would like to live with if something happened to me and she said Granny, and then Linda, and then Eddie’s sister in California.”

“Come on,” I protested, “she’s only 10, and she doesn’t have to follow any rules at your grandmother’s or Linda’s, it’s all ice cream and Disney channel and…”

“No, it’s not that – ” And Gen was off, springing from that damning bit of information and sprinting again through the litany of charges against me, the issues that had brought us to this place, this counselor: over seven years we’d been together and her daughter and I still hadn’t formed a real father-daughter type of bond, weren’t truly close, not close enough that Lilli would want to live with me if something happened to her mother; seven years, and I still hadn’t been brave enough to flee bar and restaurant work, despite Gen’s complaints about our differing schedules (“We’re always two ships passing in the night!”) and mine about squandered potential; seven years, and we still weren’t married! Sure, I had put a roof on her house, but not a ring on her finger. I hadn’t made any sign to the world of how I felt about her. I hadn’t made any commitment. I was still hedging my bets. Seven years, and Gen still had to refer to me as her “boyfriend.” Think of her! And think of Lilli, at school talking to her friends and referring to her mom’s “boyfriend” back at home. God, it was trashy! And think about Lilli if anything happened to her, to Gen!

I remember her eyes narrowing as she wound up and sped furiously through her argument, and Charlotte’s eyes widening. I think that Charlotte – who reminded me of a younger Lili Tomlin – sensed what was coming, and I suppose I did too, but it still felt a surprise when the blow landed.

“No, you know what? I’m done! No more. I’m sorry, Brent, but I’m through. We’re through.”

Charlotte winced, as if struck too, and tried to reel her back, as if Gen hadn’t already leapt over the precipice: “Now wait, wait a moment here, can we talk about this some more? I don’t want something to happen here that can’t be taken back.” She tried, but it was like trying to hold back a bull, a truck, a speeding train. Good luck lady, I remember thinking: this was the girl who once expressed a desire for a window in the rear of the kitchen, a spot where there was only wall, and I woke one morning some days later to the sound of her attacking the back of the house with a crowbar and power saw. This wasn’t someone who devoted a lot of time to careful and considered planning, the weighing of options. There was no turning back.

Gen sat suddenly tight-lipped, shaking her head. There was no turning back.

Charlotte sighed and eventually conceded. The session apparently continued for the next half hour, and I believe there was talk of how to break the news to Lilli, how to respect each other, and separate gracefully, and honor the years we’d spent together and… I don’t know, I was in a daze, working to keep my stare fixed on the counselor and my head from bobbling drunkenly the way my vision was. At the end, Charlotte took my hand, fixed me with a regretful, pitying look, and offered her continued services – to me alone, should I want to talk about any of this.

After we stepped out of the sprawling old home that housed Charlotte’s office and into the dull spring afternoon, Gen asked if I wanted to talk about any of this.

I declined. I wanted to go home. And cry. This was the worst thing that had ever happened to me.

This was not even close to the worst thing that had ever happened to Gen.

And there it was, one of the towering differences between us, a thing she had long fretted over and I was prone to shrugging off: the wide gulf between our experiences. I was a little older, but she was years more worldly. She was my first girlfriend, really, but she entered the relationship with a three year-old daughter and one failed marriage already behind her. The loving and supportive parents who’d given me a functional, pretty un-dramatic upbringing were still married. Gen’s father was on his fifth wife, her mother was once imprisoned for shooting her stepfather, and both were responsible for neglect and leaving their daughter vulnerable to unspeakable abuse as a child. She’d fled home as a teenager. She once almost died in a horrible automobile accident. She’d lost brothers, cousins, an aunt, friends… No one close to me had ever died. I’d broken a few fingers and toes and once developed an irritating little cyst over my tailbone but had otherwise always been in good health. My story? A gentle situation comedy. Gen could write epic poetry or an Oprah-approved novel about the pageant of adversity and affliction she and her family had endured. It’s the stuff of Faulkner or Morrison, a multi-generational saga filled with fortunes won and lost, divorce and adultery, abuse and addiction, death and disease, and so on and so forth.

She could lose sleep worrying about where Lilli would end up should something happen to her (anywhere but with Eddie, her degenerate ex!) because in Gen’s world, things, terrible things, did happen to people. I approached the question indifferently: “What? Oh geez, c’mon, you’ll be fine.” Nothing really bad had ever happened to me. I was soft and secure. I had an unspoken faith in the safety net and always believed deep inside that no matter what horrible traumas befell other people, things would always turn out at the very least OK for me and mine.

This isn’t to say I didn’t worry. Oh, far from it. I could agonize over small decisions and overreact to trivial inconveniences. For example:

Sometimes while driving, I’d make a certain noise (let’s call it an “alarming squawk”) that made Gen start in the passenger seat and look for the oncoming car, the tree, the pedestrian about to roll up the hood of my Civic and into the windshield. Failing to spot any imminent crushed metal, shattered glass, or torn flesh, she would look at me, hand over her suddenly racing heart, and demand: “What? What is it?” And then I’d have to admit, sheepishly, that I’d only missed a turn, entered the wrong lane, remembered the wallet left on the desk at home. She’d growl in frustration and get a look that said if crumpling car parts weren’t about to cave in my skull, she’d gladly do the job. And then I’d get an injunction –

“Stop doing that! Just… stop it!”

– and a lecture on proportion. Which I lacked. Obviously. You didn’t make these noises of animal panic over a forgotten wallet – you saved them for when the wolves were actually at your heels, about to devour you. You saved them for the real thing.

And so, every so often in the car, my girlfriend had opportunity to give my self-image a swift kick in the groin. I liked to think of myself as a cool customer, the kind of man who could stare down crisis with an Eastwood squint and maybe even a bit of a Bruce Willis smirk, but I knew she was right. I could disintegrate into a sweating, sighing, hand-wringing mess of nerves and indecision when shopping for t-shirts or a new toothbrush. And faced with something bigger, like a camera purchase? I lay awake several nights in a row anxiously weighing the pros and cons of a few select models.

Gen was right. I’d been living in her house for years paying half the mortgage (sometimes more), putting money into repairs and remodeling, parenting her daughter, playing at married life, but I’d never gone all in. I’d just sat there forever fidgeting my chips, hedging, worrying, weighing.

And for that, I lost a fortune. The worst thing that ever happened to me.

I went home from the counselor’s office. I lay on the couch and cried. I got up and, for the first time in a week, smoked a cigarette.

It hurt, the cigarette. I found a flashlight, went into the bathroom, and, for the first time since the sores began, I looked into my mouth, really looked to see what was happening in there.

I went online. I called Gen at work, crying, to tell her my fears. She told me later she thought I was just being a melodramatic asshole. Crying wolf.

Two weeks later I was diagnosed with cancer.