Violation (28 page)

“For a person who might have a 30 to 50 percent chance of being cured, people who are young and fit, you treat,” he says. “But for older people with a 10 or 20 percent chance, many say, ‘The hell with it, I know I'm going to die.' And some people say, ‘If I'm going to die anyway, I'm going to go down fighting.' Unfortunately, the regimen hasn't really changed much in many years. The current treatment is to poison the whole bone marrow and hope the normal cells will recover faster than the leukemia cells.”

The first cycle is called induction and will hopefully put the patient in remission. Induction hits like a truck—strong drugs, high doses, long cycles, repeated cycles. Leukemia won't stay in remission long for many people, so they return for what is called consolidation chemotherapy. If they don't go into remission, they return for what is neatly termed salvage.

A few years ago, we tried to salvage a young soldier with leukemia. One night I started yet another cycle of three drugs. By then he was emaciated, too weak to stand. He couldn't bear to have his burning feet touched; his throat hurt all the time, and his hair was nothing but pale patches. He had just turned twenty-one. Almost all of his problems were caused by the drugs, but without the drugs he would have been dead already. When I came in one evening, carrying my gown, gloves, goggles, and the bags of medicine, I saw that he was watching
Team America: World Police
on the unit's DVD player. He barely glanced at me as I went about the familiar task, his gray eyes large in his wasted face, watching the movie with a small, spacey smile. He had been in Iraq a few months earlier. “America! Fuck, yeah!”

SOMETIMES I THINK
the doctors don't cry in front of the patients because the nurses do it for them. I hold a weeping woman in the utility room, because she has just confessed to me that her husband won't make love to her anymore. A longtime patient is told he doesn't have enough stem cells for a transplant, there is nothing more to do, and is sent home, and the head nurse cries as he goes. A handsome young man bleeds to death in the arms of a young nurse, and we all cry. We cry quietly, in private, not always in front of one another. There are times when tears seem the correct response.

The mother with lung cancer took the experimental drug and her thick blonde hair fell out. She was too tired to read, too scared to talk, and her pain was hard to control. I still think about her face, other faces, the gradually dawning realization. I remember her pretty, ravaged face as she slowly realized she was probably going to die, and soon, and hard. In lonely silence in a strange room—a face bared, flinching in tiny tics of resistance, ducking this last punch, until it is irresistibly clear: I am not going to get better. I half-expect the earth to move in response, and perhaps it does.

“There are bad and difficult days, trying days,” says Brendan Curti. “But you have to be optimistic to do this work. There
is something spiritual and uplifting in it.” There is in fact joy of a kind—this common struggle of people, undefended and bare. This is one of the flavors I taste in my tears.

So many of them have died. The Sweetheart of Sigma Chi died. The pizza-loving lawyer died, the marijuana-smoking artist died, the mentally ill woman died, the poor man with all the tattoos died, and of course the young soldier died. We all knew he would. But not the pianist. I ran into her sister in a public bathroom, where we stood outside the toilet stalls as she told me my former patient was doing fine. And not the Bible student, who went home after more than six weeks of harrowing struggle. Not the hiker, whose bones healed after the transplant, who can hike for miles now.

And Lee is well, though she still struggles with fatigue sometimes. She looks the way she did a few years ago—her hair is thick, her face dear and soft. She no longer looks like a cancer patient.

“I like the word
remission
,” she says. “It means live every day as best you can. I have a 70 percent chance of long-term survival, which means a lot. But a 30 percent chance of relapse seems like a lot, too. I'm just now beginning to think about what's next. And how do you live without treatment? During treatment, at least you're doing something about your cancer. But I felt so good that Wednesday when I woke up and I didn't have to go to chemo.

“You walk in with cancer,” she tells me. “He says, ‘You're in remission.' And you walk out free.”

I don't like to hear cancer patients described as brave. Their virtue is going on, without much choice. How can we speak of degrees of courage here? To be sick this way is to have a kind of existential wound. One's life is taken apart like a motor, screws and facings laid along the table until it is just parts and nothing is left whole. I know I'm not brave, not the way that word is meant—stiff upper lip and all. When it is my turn, if it is my turn—I shake to think of it. I am surprised sometimes to hear the small murmur in the back of my mind, coming without warning. I am helping a trembling man my own age onto a commode, smelling his stale
breath, and I think,
I'm glad it's not me
. The thought shames me, but there it is. Being brave is simply a matter of going on, because what else is there to do but this difficult thing—wait for me to come down the hall in my blue gown and gloves, and hang up a bottle of poison.

Harper's
, June 2007

Cancer treatment is always changing and there are many surprises—but one of the surprises is how much stays the same.

     
Twitchy

WHEN I GO TO THE DENTIST, I TAKE MY IPOD AND CRANK
it up. The right music is important: big music, strong-flavored and complex, but not too sweet. Piano concertos don't work, and folk songs are all wrong. I listen to the Doors and Art of Noise and Talking Heads. Depending on how the visit goes, whatever music I choose will be tainted for months afterward—a bit dentisty, with the faint scent of nitrous.

I pull off the headphones when the assistant appears. Sharon is my favorite, a sassy, skinny blonde of a certain age who makes cracks under her breath. She shares the same bleak humor I bring to the chair. We chat a little, and then she puts the dark rubber nose mask on me, and the smell is the smell of emptiness, the smell of no smell at all. She wraps a bib around my chin and then gives me big black safety glasses, and finally I put the headphones back on. They prop my mouth open and stretch the rubber saliva dam across my tongue and hang the slurping suction tube on my lip, and then I have a hot flash and start panting like a dog. I know I look like a drunk on Halloween, but it's a passing concern. Fashion's not my worry here.

“We're turning the nitrous on now,” she says. I sink back, eyes half-closed, and turn the volume up a little more on “Light My Fire.” The empty smell is gone, replaced by a light breeze, and I take it in deeply.

This is one of those modern dental offices, the kind you find near suburban shopping malls. All the dentists are women, and the
walls are pink and pale blue and light green, soothing pastel walls with big murals of tropical islands and country roads. There are skylights above the chairs and everyone wears colorful scrubs. The waiting room has a children's play area and lots of good magazines.

I watch a cloud cross the skylight.

Dr. Johnston appears at my side and speaks to me. I mumble, “We've got to stop meeting like this,” and then her looming face drifts back and I'm humming to myself again.

She murmurs to Sharon, picks up a silver tool, prods a bit here and there.

I hear Sharon say, from a distance, “She's pretty twitchy today.”

“Yeah—why don't you turn her up a little?”

I smile to myself.
Yes, turn me up a little
, I think. I watch a cloud cross the skylight. On nitrous, there is a vague numbness like a line drawn around the edges of my body. Sometimes I feel as though I am gently bobbing in the small eddy of a stream—moving, but going nowhere. I know what's happening, what happens next; I hear snippets of their chatting, something about weekend plans, and I resent it. I want them attending to
me
right now, but my resentment is distant, too, and fades away. I watch the sky, a cloud inflating in an interesting way, expanding into a yellow sheet and then darkening, and R. L. Burnside growls, “Baby done a baad, baaaad thing” and the yellow cloud is gone and all I see is blue.

I HAVE WEAK
teeth, and of course I blame my mother, who gave birth to me in 1957 when everyone smoked and drank martinis during pregnancy. My mother's pleasures were few enough—coffee, cigarettes, romance novels, and a bowl of ice cream every evening—but she enjoyed them deeply. A few months before she died of breast cancer, she said out of nowhere, “You know, there are two things I'd do differently in my life if I could do it over.” And I'm looking at my father sacked out on the couch, and thinking, only two?

“I wouldn't start smoking”—and that hangs in the air a moment—“and I wouldn't let you kids eat so much sugar.”

I'm not sure why the last mattered much to her then. Considering. My brother and sister and I spent a lot of hours at the dentist, and more hours drinking Dr. Pepper and eating popsicles. We used to get sugar sandwiches as a treat—white sugar, margarine, and white bread—Wonder Bread, which builds strong bodies all kinds of ways. Perhaps the Flintstones Vitamins weren't the miracle cure the commercials led her to believe. The inadequate brushing from a childhood lived without much supervision took its toll. But I suspect this is something more buried and intractable—genetics or karma or destiny—something embedded in the whole of me. Either way, this is the result: countless fillings, several crowns, many teeth more false than not, and long afternoons in the chair beneath the skylight.

NITROUS OXIDE IS
a mysterious drug, though in part it is anti-nociceptive; that means it blocks some of the sensory perception of pain, just like Advil. But the lidocaine takes care of that. In fact, I don't mind the shot, the part most people dread the most. I don't need the nitrous to prevent pain. I need it for the fear of pain, for the fear of the drill, for the smell, the grinding noise, the vibration, the gestalt of a world I find vaguely terrifying far out of proportion to my experience. I discovered nitrous many years ago, thanks to a dentist who knew I wouldn't get my teeth fixed otherwise. Unlike my other fears—plane crashes, apologizing—this one has not lessened in time. Everything changed with nitrous; I still hated to go, but I could go.

Why nitrous works this way, no one really knows. Nitrous reduces anxiety and makes people feel happy, and the medical literature invariably describes the effect as “pleasant.” People report sensations of tingling, vibration, throbbing or droning sounds, warmth, a sense of being heavy or floating. Patients on nitrous are suggestible, accommodating, with “an indifference to surroundings.” Indifference is, above all, what I lack in the chair.

I am a connoisseur of dosing. Dentists typically use a 20-percent mixture; I need about 30 percent to get through a procedure, a dose that causes some people to lose consciousness. For me, it's just right. Over the course of an hour, I feel myself fading slightly in and out of the room, separate from the complicated maneuvers going on in my mouth. I am a little removed, but not gone; the tension remains. Now and then I am reminded to unclench my jaw, relax the hands, which have somehow become tightly wrapped around the arms of the chair. We have signals. Up, I raise my thumb. Thumbs up, for more gas.

People still call nitrous oxide the laughing gas. I don't get the giggles like some people do, but I make some very funny jokes—profound, meaningful jokes with a subtle poignancy and the hint of tragedy that brings classic humor to life. I never forget that I've taken a drug, but somehow the idea that my funny jokes, the funniest jokes I've ever made, are not really very funny and are entirely the product of chemistry, makes them funnier still. There is some vast and deeper humor here, a whistling past the graveyard that lightens the burden of my fear.

Dr. Johnston has been my dentist for a long time. We've gotten to know each other over the years and have a friendly relationship. One day, as I am fading in and out of the room, she suggests that we take care of a filling at the same time she works on the crown. “Get it over with,” she says.

“Yeah,” I smile. Long pause. “Why don't you do a pelvic while you're at it and cover all the bases?” I think this is very funny and start chuckling.

She just thinks
I'm
funny right now, and rolls with it. “I'm afraid I'd get arrested for that,” she says.

“Oh, we should just get married, we love each other so much,” I say, apropos of who knows what.

“That's illegal, too,” she answers, and after a few more laughs, I go back to the clouds, and she goes back to work.

I
'
M SITTING IN
the park on a sunny day, reading my book and eating a bagel. And crack. A
bagel
. A bit of my tooth falls into my hand. And here I go again; I know what's next. I know the whole story, each chapter, and the long arcs of tension and release to come.

I come in to have the impression made for another crown. Dr. Johnston is gone, and this is my first appointment with Dr. Bennett. Dr. Johnston is brisk and practical. Dr. B is padded and cheerful, and seems willing to wait as long as necessary for me to get comfortable. I'm nervous today—I'm always nervous, but she's a stranger to me, and so I tell Dr. B about Grandpa Doc.

Large sections of my childhood reel off in my head like a film noir starring Gloria Grahame—all sharp shadows and lurching camera moves. Grandpa Doc wasn't really my grandfather. My grandfather, the rumor goes, killed himself, but no one ever talked about it. To this day I'm not sure what really happened; there's no one left to ask. Doc was my grandmother's third husband—a tall, thin, bald dentist who loved to fish and hunt. I saw him in my parents' living room, holding a highball and laughing, and I saw him in his office. He didn't like children much, but as a favor he did our dental work for free on the weekends, when his office was closed.

Childhood trips to the dentist are one of the dream sequences in my dark B movie, full of quick cuts and freeze frames: cold, dim office; echoing voices; white walls; bright metal trays. I'm alone in a high, high chair. The images are vague but immediate, lingering the way dreams do. I am six years old, under fluorescent light, and looming over me is a tall, thin, bald man in a high-collared white coat. He is not smiling.

I asked my brother recently what he remembered of these visits, and he answered with the same bleak smile I bring to the chair today. “I had the pleasure of that office many times,” he said. “My youthful oral hygiene was more like lowgiene.”

“Were you scared of Grandpa Doc?” I asked. My brother is a little older than I; we were partners as children, friends to each other along the way. He is the only person I can ask about things like this.

“I don't remember being afraid of
him
,” he said. “Just of the upcoming procedures. The needle, the awful taste of the novocaine that trickled out, the sound, and of course the swell stench of ground enamel.”

When I think about Grandpa Doc, I don't remember the drill. I don't remember shots. I don't even remember pain. Everything is much more fragmented than that. The tile floor, a long way down—the big cold vinyl arms of the chair—the bald man bending way down, face close to mine—that's what I remember. What I remember is dread.

Dr. B says, “Did your mother really send you there
alone
?” She did—she was sitting out in the waiting room with my brother and sister, waiting their turns.

“He was my
grandpa
!” I say. “You're supposed to like your grandpa.” I want to defend my mother, who did the best she could. “Besides,” I add, “I don't think I ever told her I was scared.”

There were a lot of things I never told my mother.

Those first visits to Grandpa Doc became visits to a nice young dentist in a sunny office up the street from our house, and in time led to my steadfast refusal to see a dentist at all. Do I have a post-traumatic stress disorder, as one helpful friend suggested? No, as long as I'm not actually at the dentist, there's no problem. Am I phobic? Phobias are usually a bit more occult, and this isn't as hard to explain as a fear of ants or peanut butter. I think this is as simple as it sounds: a lonesome and somewhat secretive child made to do something hard and never telling how hard it was and holding on until she was old enough to say, no more. Telling it to Dr. B in all the pink light, I feel a little silly. But when I get the stupid nose mask on and take a deep breath, all I feel is relief.

I GO FOR
a new kind of porcelain crown, because this time the tooth I've broken is in the front. It costs about the same, and this new kind of crown is supposed to be easier; it requires only one appointment instead of two. Dr. Johnston doesn't do this procedure, so that means seeing another new dentist, Dr. Fischl, a slim
young blond who looks about twenty-one years old. Like all of the dentists, at first she doesn't understand why I need nitrous for such a benign procedure.

“There's hardly any drilling at all!” she exclaims.

I reach for the mask.

I watch the light above me, the bright color in the sky. I know where I am, and what's happening. “I'm going to numb you now,” she says, and I feel the weird push of the shot into my gum, the slowly spreading fog that blanks out cheek, lip, tongue, my lower eyelid. But she goes for the 20 percent, and except for a few brief moments, I never have enough nitrous. I strain for it, as though in chains. Then I find out that this easy new kind of crown involves a slow, vibrating drill that rattles the inside of my skull like a hammer and makes me shiver from scalp to toes, and that the one appointment is a very long one.

When everything is done but the last fitting on my new porcelain crown, I can finally relax a little bit, knowing we're almost finished. But Dr. Fischl doesn't know me. She turns off the nitrous and switches to oxygen, without telling me—before the crown is polished. After all, this is when they typically turn off the nitrous for everyone else. It hasn't been enough, but a lot more than nothing. I don't know what's going on; I only know that I'm coming back while the work goes on—polishing and grinding, tugging and pushing, the buzzing and the
smells
, and I've shrunk into a shell and the minutes stretch very slowly out and on and on as I twist and flinch inside like a cat stuffed into a small box.

When I'm finally able to make a sensible complaint, the assistant tells me, “But the work is just on the crown, not the tooth!”

“Look,” I say. “Look. You can't turn it down. You can't, not until we're done, not for any kind of drilling or polishing or
anything
.”

“But it's not on your tooth, it's on the crown,” she says again.

“
No
,” I answer. “No—no vibration, the sound, the smell, I don't know, I
can't
.”

She looks at me for a moment, and I guess she sees something
in my face, because she just nods. “Okay,” she says. “Okay. I'll make a note.”

ONE DAY, ONE
of the dentists told me not to exhale through my mouth. I had thought I should do just that, in order not to inhale my own carbon dioxide. (My sneaky hope being, of course, that I could get a bigger dose of nitrous that way; I thought I might be getting away with something.) “The nitrous off-gases when you breathe,” she said. “Breathe through your nose, so we don't get any of the nitrous ourselves.” Then she paused. “Not that it isn't fun.”