Holidays in Heck (27 page)

In theory I could get my radiation treatments elsewhere, within easy commuting distance. But it's worthwhile to find out what a doctor himself would do if he had your medical problem. And he probably thinks he does. Several doctor friends have told me you can't get through medical school without being convinced that you have every disease in the textbooks, including elephantiasis, beriberi, and guinea worm infestation. Dr. Pipas immediately said that, for anal cancer, he'd go to the radiologist Dr. Bassem Zaki at Norris Cotton Cancer Center.

Dr. Zaki is a Coptic Christian who immigrated from Egypt in his late teens. He and I talked about Middle Eastern politics, which, as far as I'm concerned, is the second most interesting blood sport after upland-game shooting.

Dartmouth-Hitchcock Medical Center is a sparkling edifice, full of light and air and surprisingly good art for a nonprofit institution. The architectural style is higgledy-piggledy 1980s modern—2 million square feet, every one of which is between you and where you have an appointment. Finding your way around is a trial run for Alzheimer's but a small price to pay for the pleasant surroundings. Even the food in the cafeteria is good. Various scientific studies have shown that patients recover better and faster in cheerful environments. Duh.

The staff at DHMC is also cheerful, but not
too
cheerful. The staff members don't make you feel like a small child at the receiving end of an overambitious preschool curriculum.
Perhaps they know better because DHMC is a teaching hospital. The Dartmouth Medical School is the fourth-oldest in the nation, founded in 1797. DHMC is venerable as well as modern. But not
too
venerable. It doesn't use leeches.

Being at a teaching hospital puts a patient in a comfortable equation with the institution. People are expecting to learn something from you, not just do something to you. But let's not push the idea of equality too far. There's a current notion that you should “take charge of your disease.” No thanks. I'm busy. I've got cancer. I'm willing to face having cancer. I'm not willing to face having cancer with homework. I promised Dr. Pipas and Dr. Zaki that I wouldn't show up with sheaves of printouts from the Internet containing everything on Wikipedia about malignancies. They each laughed with detectable notes of relief. (Although I suspect my wife has made her way into the health blog ether. Fish oil pills, raw kelp, and other untoward substances started showing up on the dinner plates after I was diagnosed.)

Dr. Pipas and Dr. Zaki combined had something like half a century of medical experience. God wants us to have faith in what we can't see. Therefore He certainly wants us to have faith in what we can. I could see the diplomas on the doctors' office walls.

“I've got cancer” is more than an excuse for rational ignorance about medicine. It's an excuse for everything. From niece's wedding to daughter's piano recital to IRS audit, you're off the hook. I even tried my excuse on the Pope. I couldn't go to Mass because of the effect that germ-swapping Vatican II “sign of peace” handshakes could have on my radiation-weakened immune system. And I continued to employ cancer as an excuse until an exasperated spouse finally shouted, “You're curable! You
can too
put your dirty dishes in the sink!”

The radiation treatments weren't bad—twenty minutes proped on a machine in a humiliating posture. Most of me was exposed and the nurses were embarrassingly pretty. But it's interesting, the connection that physical modesty has with physical vanity. Once past sixty you can reasonably abandon both. This was one of the life lessons with which having cancer abounds. I hate life lessons. Consider all the I-hope-you've-learned-your-lesson experiences: skinned knees, high school romances, wreckage of dad's car, flunked college courses, horrible hangovers, failed marriages. I tell my children, “Avoid life lessons. The more important the lesson, the more you should avoid it.”

The chemotherapy was worse than the radiation. The pump in the fanny pack of poisonous chemicals made a whining whirr every minute or so—not frequently enough to get used to and too frequently to let me sleep. A long plastic tube that attached the fanny pack to my mediport allowed me to bury the pump and its noise in a mound of pillows. But then I'd forget that I was connected. As with all attempts to forget one's troubles, I was courting disaster. I'd get up in the middle of the night to go to the bathroom and be yanked back to the mattress by the tubing. The fanny pack came with a bag of protective clothing and instructions for dealing with chemical spills. According to these instructions I was supposed to do, by myself, what the entire U.S. government had done during the 2002 national anthrax panic.

The cumulative effects of the treatments were unpleasant. The loss of my previously full, thick head of ungrayed hair met with no sympathy from my age cohort of males. I developed fatigue, mouth sores, and a rash around my loins as if I'd been dressed in nothing but hip boots and an Eisenhower jacket and turned on a spit in a tanning salon.
Suffering makes us question God. My question was: What evolutionary purpose does the itch serve? Indeed, an itch may be an argument for intelligent design. Maybe we itch not for biological purposes but to give us a moral lesson about surrendering to our strongest passions. I had the strongest passion to scratch certain parts of my body. If, however, I had scratched these parts of my body near a school or playground, I would be sent to jail.

Dr. Pipas, Dr. Zaki, and the Dartmouth-Hitchcock staff were attentive to my complaints and gave me generous doses of things to turn complaints into complaisance. But I was nagged by a concern about the quality of my medical care. Was it too good? I'm well insured and passably affluent. I asked Jason Aldous, Dartmouth-Hitchcock's media relations manager, “What if I weren't?”

“We're a charitable institution,” Aldous said. “No one will ever be refused care here. On the other hand, we have to keep the lights on. We do try to find any possible means of payment—government programs, private insurance, et cetera.”

The hospital has a whole department devoted to that. “In about sixty percent of cases,” Aldous said, “people who think they aren't eligible for any assistance actually are.” Then there are the people who have income but no savings, or assets but no income. Discounts are provided and payment plans worked out. Failing all else, treatment is simply given free—$63 million worth in 2007.

I asked Aldous about who gets what treatment from which doctor. Do your means affect the hospital's ways?

“The doctors,” he said, “don't know how—or if—you're paying.”

What Jason Aldous told me seemed true from what I could see of the hospital's patients, a cross section of Yankees,
flinty and otherwise. The Norris Cotton Cancer Center alone treats more than 5,000 people a year. And we were all amiable in the waiting rooms. Anytime someone new came in and sat down he or she was tacitly invited to spend about three minutes telling everyone what was wrong. Then the conversation was expected to return to general topics. The general topic of choice during the summer of 2008 was how the Democrats would destroy the private health care system that was saving our lives. When medicine was socialized we'd have to sit in waiting rooms forever, if we lived. (The exception to the three-minute rule was for a child patient. Then there was unlimited interest and upbeat chat.)

In my case at least, the amiability had something to do with painkilling drugs, of which I was on plenty. Opiates are a blessing—and a revelation. Now when I see people on skid row nodding in doorways I am forced to question myself. Have they, maybe, chosen a reasonable response to their condition in life? Being addicted to drugs is doubtless a bad plan for the future, but having cancer also lets you off the hook about taking long-term views.

I'm sure that various holy martyrs and pious ascetics will disagree, but I saw no point to adding suffering to my suffering. And I can't say I had a sign from God that I should, at least not if God was speaking through my old friend Greg Grip.

Greg was baching it in a cottage on Lake Mascoma, fifteen minutes from Dartmouth-Hitchcock. He's divorced and his college-age daughter was away at a summer job. “I'm not saying you can stay at the cottage while you get treated,” Greg said. “I'm saying I will be deeply offended if you don't.”

Dr. Zaki arranged my radiation treatments, late on Monday afternoons and early on Friday mornings. My wife and children were spared self-pitiful weekday grousings. And I missed them, so I was on good behavior over weekends.

Greg is a splendid Weber grill cook. Charcoal fires produce carcinogens, but the chemotherapy had that covered. Dr. Pipas said I could have one measured Scotch each evening. But he failed to specify the measure. I think the pint is a fine old measure, although the liter is more up-to-date.

I couldn't tolerate the sun, but Greg's cottage is on the southwest shore of Mascoma. The patio was in shade all afternoon. I read a lot, mostly histories of World War II concerning the Russian front. Everyone on the Russian front in World War II was having it worse than I was.

Tony Snow, the former Bush administration press secretary, wrote an essay about dying from colon cancer. Tony said that the sense of mortality promoted “the ability to sit back and appreciate the wonder of every created thing.” Every created thing put on a wonderful show for me at Lake Mascoma. A family of mergansers with six ducklings was living under the dock. A pair of mallards had taken up residence in the shrubbery. Beavers swam up and down the lake; I don't know why—Mascoma has a concrete dam. There were bird sightings—hawks, turkey vultures, kingfishers, a bald eagle, even an extremely wayward pelican. A hummingbird visited the patio every evening. Skinny-dipping sightings were also made at a nature reserve across the lake. Water skiers and Jet Ski riders took amusing falls. Not to engage in the pathetic fallacy, but the weather itself was kind and cool. Greg's pointer Weezy slept on my bed each night, though this may have had less to do with doggy compassion than
the fact that Greg won't let her sleep on his. Weezy's dulcet snoring drowned out the chemo fanny pack pump.

I'm doing fine now. Anal cancer can be invasive, but mine seems to have had a wimpy EU-style foreign policy. The cancer is gone, as far as can be told. I still have a colonoscopy to worry about and a CAT scan to dread and six-month checkups to fret over. I'll be OK. Or I won't. Or I'll go through it all again.

This summer was not the worst summer of my life—loving family, kind friends, skilled and considerate care, a big warm dog in the bed. The worst summer of my life was forty years ago when I was young and healthy and didn't have a care in the world. But there was this girl, and a novel that refused to write itself, and anomie, and angst, and weltschmerz. . . . Nothing brings us closer to God than age and illness. I only hope the Almighty doesn't mind having nothing but sick old people around.

Kabul, July 2010

I
f you spend seventy-two hours in a place you've never been, talking to people whose language you don't speak about social, political, and economic complexities you don't understand, and you come back as the world's biggest know-it-all, you're a reporter. What do you want to know about Afghanistan, past, present, or future? Ask me anything.

As all good reporters do, I prepared for my assignment with extensive research. I went to an Afghan restaurant in Prague. Getting a foretaste—as it were—of my subject, I asked the restaurant's owner (an actual Afghan), “So what's up with Afghanistan?”

He said, “Americans must understand that Afghanistan is a country of honor. The honor of an Afghan is in his gun, his land, and his women. You take a man's honor if you take his gun, his land, or his women.”

And the same goes for where I live in New Hampshire. I inquired whether exceptions could be made, on the third point of honor, for ex-wives.

“Oh yes,” he said.

Afghanistan—so foreign and yet so familiar and, like home, with such wonderful lamb chops. I asked the restaurateur about other similarities between New Hampshire and Afghanistan.

“I don't know,” he said. “Most of my family lives in LA.”

In Kabul I was met at the airport by M. Amin Mudaqiq, bureau chief for Radio Free Europe/Radio Liberty's Afghan branch, Radio Azadi. “Our office is just down the main road,” he said, “but since it's early in the morning we'll take the back way, because of the Suicides.” That last word, I noticed, was pronounced as a proper noun, the way we would say “Beatles” slightly differently than “beetles.” And, in a sense, suicide bombers do aspire to be the rock stars of the Afghan insurgency (average career span being about the same in both professions).