Reality Check

Sometimes the best news just isn't good enough. My oncologist does her usual trick of dimming my hopes, but travel and work come to the rescue.

Hanging on with one hand, still trying to dance

I did not feel too afraid as I headed into my scan on Monday. My tumor markers were down to normal, which augured well. I was a little concerned that the whole alimentary canal was still requiring a lot of assistance to work at all, but I figured that was possibly the results of chemo.

Still, I could feel my body prepare for a meeting with my oncologist by speeding up my heart and breath, tensing my abdomen. I can’t blame my body; our conversations have never been uplifting.

Good news first: she said my scan showed no visible signs of disease and that the liquid that had previously filled my abdominal cavity was gone. She was pleased with the tumor markers, as well as with how well my blood has been rebounding from chemo, for the first time.

I wondered if I could consider myself in remission. I knew that I needed nine more weeks of taxol, but figured that was mostly insurance, to sweep up whatever invisible cells remained.

“Oh no, the cancer is still there,” she said.

“It is? How can you tell? If the scan and the tumor markers are okay?”

“Because I’ve been doing this for more than thirty years.”

I hate when doctors respond to a sincere question with proof of their competence. I am not questioning their competence, I am trying to figure out how we know the cancer is still there.

“Your bowels are still not working. That means the cancer is there.”

“But couldn’t that just be the result of the treatment?”

“No.” Her answer was unequivocal. “Look, if we were to stop the taxol now, the cancer would come immediately back.”

I absorbed this.

“But after the next nine treatments it is possible that I would be in remission? Aren’t some people in remission longer term after taxol?”

“No.”

“No one? Surely one person? Someone? Sometimes?” I could hear the desperation creeping into my voice. But she did not reply.

“The speed at which the cancer recurred before… it indicates…. It’s not a good sign.”

Once again I wanted to beg for hope, knowing that she would never offer it falsely.

“I don’t think you realize how far you have come since the last time I saw you,” she said. “He knows. He will tell you.” This last with a gesture towards Tim. I tried not to be offended that she thought Tim would know more about my body than I do. I tried to focus on how far I had come, how much better I was doing. The last time my oncologist saw me, I was in the hospital for six nights.

“Does that mean she thought I almost died then?” I asked Tim later. “That she thought I could have had an occlusion and died? So I’m doing better because I am not on the verge of death?”

The risk of occlusion remains, my oncologist made clear. When I had suggested that I try going off the osmotic laxatives that keep things moving, she said, “No! Do not stop the Movicol. I think that would be dangerous.”

Before all this, she asked me how the treatments were going. I said I had been tolerating them very well, at least until the last chemotherapy, which knocked me into bed for two days. “Also, I have had increasing nausea,” I said.

She frowned. “You’re not supposed to have nausea with just taxol.”

That is what the chemo doctor also said when I told her. “You’re not supposed to have nausea with this treatment.” They always say it as if I am doing something wrong. You are having the wrong side effects! I can hear them thinking. You must be making this up!

“But I am. And it gets worse each time.”

“Well, your whole alimentary canal is upset, and problems with the bowels can mean problems further up.”

I accepted this, although the nausea seems directly related to the amount of taxol in my system. But who am I to know anything?

“Oh, one more thing,” I said before we left. “I am going to be teaching writing to a group of MFA students from the US from January 1 until the 12^th. In Paris and Arles.” I didn’t have to tell her, but I thought that she should know my plans. “But I will still do chemo on the 8^th, Tim will come get me and take me to the hospital and back.”

My oncologist sighed. She clearly thought this was a ridiculous plan. “Why?”

“Because I love to work. Because what else am I supposed to be doing? And because we need the money.”

“You are supposed to be resting.”

“I’ll only be teaching two hours a day at most. I will have time to rest.”

I did not convince her of the wisdom of this decision. But both Tim and I know that I am happiest when I am working, that my work—whether writing or teaching—fills me with energy and purpose. Also, my oncologist does not know how much I love my friend and fellow author Carla Spataro, director of the Rosemont College MFA program in creative writing, and how much I am looking forward to seeing her as well as the students I already know from the last international program I taught in Morocco.

I am compelled to put in a plug for the MFA program here. Carla is the most brilliant director imaginable. She offers her students a wider variety of classes than I ever had in my own MFA program, a roster of inspiring teachers, the opportunity to meet and listen to industry professionals, and support with their careers. Carla is a wondrous mixture of fierceness and humor, toughness and tenderness. I cannot recommend her program enough, with all my heart. Also, she has a new book out, More Strange than True, a Shakespeare-inspired magical tale of love and transformation. You should read it.

https://www.amazon.com/More-Strange-Than-True-Spataro/dp/1952386950

When I told Theo I was going to Paris to teach, she insisted on coming with me, at least for the first four nights. I am delighted to have her company on the trip! Especially because I was sad about missing any part of her school holidays.

Yesterday, the final day of 2024, was a day of tears and misery. While I had returned from the hospital with the best news that was possible, the best news possible was not as good as I wanted. I did ballet, I took a long walk. And I remained tetchy and tormented. We received two generous invitations to New Year’s Eve fêtes, but I could not inflict myself on others in my irascible condition. We stayed in, Theo made us eat grapes under the kitchen table for luck, and Tim read me to sleep.

Fortunately, I have a train to catch. Travel and work, do your magic.