* * *
VIVIAN: In this dramatic structure you will see the most interesting aspects of my tenure as an in-patient receiving experimental chemotherapy for advanced metastatic ovarian cancer.
But as I am a scholar before … an impresario, I feel obliged to document what it is like here most of the time, between the dramatic climaxes. Between the spectacles.
In truth, it is like this:
(She ceremoniously lies back and stares at the ceiling.)
You cannot imagine how time … can be … so still.
It hangs. It weighs. And yet there is so little of it.
It goes so slowly, and yet it is so scarce.
If I were writing this scene, it would last a full fifteen minutes. I would lie here, and you would sit there.
(She looks at the audience, daring them.)
Not to worry. Brevity is the soul of wit.
But if you think eight months of cancer treatment is tedious for the audience, consider how it feels to play my part.
All right. All right. It is Friday morning: Grand Rounds. (Loudly, giving a cue) Action.
(KELEKIAN enters, followed by JASON and four other FELLOWS.)
KELEKIAN: Dr. Bearing.
VIVIAN: Dr. Kelekian.
KELEKIAN: Jason.
(JASON moves to the front of the group.)
JASON: Professor Bearing. How are you feeling today?
VIVIAN: Fine.
JASON: That’s great. That’s just great. (He takes a sheet and carefully covers her legs and groin, then pulls up her gown to reveal her entire abdomen. He is barely audible, but his gestures are clear.)
VIVIAN: “Grand Rounds.” The term is theirs. Not “Grand” in the traditional sense of sweeping or magnificent. Not “Rounds” as in a musical canon, or a round of applause (though either would be refreshing at this point). Here, “Rounds” seems to signify darting around the main issue … which I suppose would be the struggle for life … my life … with heated discussions of side effects, other complaints, additional treatments.
JASON: Very late detection. Staged as a four upon admission. Hexamethophosphacil with Vinplatin to potentiate. Hex at 300 mg. per meter squared, Vin at 100. Today is cycle two, day three. Both cycles at the full dose. (The FELLOWS are impressed.)
The primary site is—here (He puts his finger on the spot on her abdomen), behind the left ovary. Metastases are suspected in the peritoneal cavity—here. And—here. (He touches those spots.)
Grand Rounds is not Grand Opera. But compared to lying here, it is positively dramatic.
Full of subservience, hierarchy, gratuitous displays, sublimated rivalries—I feel right at home. It is just like a graduate seminar.
With one important difference: in Grand Rounds, they read me like a book. Once I did the teaching, now I am taught.
Full lymphatic involvement. (He moves his hands over her entire body.)
At the time of first-look surgery, a significant part of the tumor was de-bulked, mostly in this area—here. (He points to each organ, poking her abdomen.) Left, right ovaries. Fallopian tubes. Uterus. All out.
This is much easier. I just hold still and look cancerous. It requires less acting every time.
Excellent command of details.
Evidence of primary-site shrinkage. Shrinking in metastatic tumors has not been documented. Primary mass frankly palpable in pelvic exam, frankly, all through here—here. (Some FELLOWS reach and press where he is pointing.)
KELEKIAN: Excellent command of details.
VIVIAN: (To herself) I taught him, you know—
KELEKIAN: Okay. Problem areas with Hex and Vin. (He addresses all the FELLOWS, but JASON answers first and they resent him.)
FELLOW 1: Myelosu—
JASON: (Interrupting) Well, first of course is myelosuppression, a lowering of blood-cell counts. It goes without saying. With this combination of agents, nephrotoxicity will be next.
KELEKIAN: Go on.
JASON: The kidneys are designed to filter out impurities in the bloodstream. In trying to filter the chemotherapeutic agent out of the bloodstream, the kidneys shut down.
KELEKIAN: Intervention.
JASON: Hydration.
KELEKIAN: Monitoring.
JASON: Full recording of fluid intake and output, as you see here on these graphs, to monitor hydration and kidney function. Totals monitored daily by the clinical fellow, as per the protocol.
KELEKIAN: Anybody else. Side effects.
FELLOW 1: Nausea and vomiting.
KELEKIAN: Jason.
JASON: Routine.
FELLOW 2: Pain while urinating.
JASON: Routine. (The FELLOWS are trying to catch JASON.)
FELLOW 3: Psychological depression.
JASON: No way.
(The FELLOWS are silent.)
KELEKIAN: (Standing by VIVIAN at the head of the bed) Anything else. Other complaints with Hexamethophosphacil and Vinplatin. Come on. (Silence. KELEKIAN and VIVIAN wait together for the correct answer.)
FELLOW 4: Mouth sores.
JASON: Not yet.
FELLOW 2: (Timidly) Skin rash?
JASON: Nope.
KELEKIAN: (Sharing this with VIVIAN) Why do we waste our time, Dr. Bearing?
VIVIAN: (Delighted) I do not know, Dr. Kelekian.
KELEKIAN: (To the FELLOWS) Use your eyes. (All FELLOWS look closely at VIVIAN.) Jesus God. Hair loss.
FELLOWS: (All protesting. VIVIAN and KELEKIAN are amused.)
—Come on.
—You can see it.
—It doesn’t count.
—No fair.
KELEKIAN: Jason.
JASON: (Begrudgingly) Hair loss after first cycle of treatment.
KELEKIAN: That’s better. (To VIVIAN) Dr. Bearing. Full dose. Excellent. Keep pushing the fluids.
(The FELLOWS leave. KELEKIAN stops JASON.)
KELEKIAN: Jason.
JASON: Huh?
KELEKIAN: Clinical.
JASON: Oh, right. (To VIVIAN) Thank you, Professor Bearing. You’ve been very cooperative. (They leave her with her stomach uncovered.)
VIVIAN: Wasn’t that … Grand? (She gets up without the IV pole.) At times, this obsessively detailed examination, this scrutiny seems to me to be a nefarious business. On the other hand, what is the alternative? Ignorance? Ignorance may be … bliss; but it is not a very noble goal.
So I play my part.
(Pause)
I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home. Eight cycles. Eight neat little strophes. Oh, there have been the usual variations, subplots, red herrings: hepatotoxicity (liver poison), neuropathy (nerve death).
(Righteously) They are medical terms. I look them up.
It has always been my custom to treat words with respect.
I can recall the time—the very hour of the very day—when I knew words would be my life’s work.
* * *
(A pile of six little white books appears, with MR. BEARING, VIVIAN’s father, seated behind an open newspaper.)
It was my fifth birthday.
(VIVIAN, now a child, flops down to the books.)
I liked that one best.
MR. BEARING: (Disinterested but tolerant, never distracted from his newspaper) Read another.
VIVIAN: I think I’ll read … (She takes a book from the stack and reads its spine intently) The Tale of the Flopsy Bunnies. (Reading the front cover) The Tale of the Flopsy Bunnies. It has little bunnies on the front.
(Opening to the title page) The Tale of the Flopsy Bunnies by Beatrix Potter. (She turns the page and begins to read.)
It is said that the effect of eating too much lettuce is sopor—sop—or— what is that word?
MR. BEARING: Sound it out.
VIVIAN: Sop—or—fic. Sop—or—i—fic. Soporific. What does that mean?
MR. BEARING: Soporific. Causing sleep.
VIVIAN: Causing sleep.
MR. BEARING: Makes you sleepy.
VIVIAN: “Soporific” means “makes you sleepy”?
MR. BEARING: Correct.
VIVIAN: “Soporific” means “makes you sleepy.” Soporific.
MR. BEARING: Now use it in a sentence. What has a soporific effect on you?
VIVIAN: A soporific effect on me.
MR. BEARING: What makes you sleepy?
VIVIAN: Aahh—nothing.
MR. BEARING: Correct.
VIVIAN: What about you?
MR. BEARING: What has a soporific effect on me? Let me think: boring conversation, I suppose, after dinner.
VIVIAN: Me too, boring conversation.
MR. BEARING: Carry on.
VIVIAN:
It is said that the effect of eating too much lettuce is soporific.
The little bunnies in the picture are asleep! They’re sleeping! Like you said, because of soporific!
(She stands up, and MR. BEARING exits.)
The illustration bore out the meaning of the word, just as he had explained it. At the time, it seemed like magic.
So imagine the effect that the words of John Donne first had on me: ratiocination, concatenation, coruscation, tergiversation.
Medical terms are less evocative. Still, I want to know what the doctors mean when they … anatomize me. And I will grant that in this particular field of endeavor they possess a more potent arsenal of terminology than I. My only defense is the acquisition of vocabulary.
* * *
(SUSIE enters and puts her arm around VIVIAN’s shoulders to hold her up. VIVIAN is shaking, feverish, and weak.)
VIVIAN: (All at once) Fever and neutropenia.
SUSIE: When did it start?
VIVIAN: (Having difficulty speaking) I—I was at home—reading—and I—felt so bad. I called. Fever and neutropenia. They said to come in.
SUSIE: You did the right thing to come. Did somebody drive you?
VIVIAN: Cab. I took a taxi.
SUSIE: (She grabs a wheelchair and helps VIVIAN sit. As SUSIE speaks, she takes VIVIAN’s temperature, pulse, and respiration rate.) Here, why don’t you sit? Just sit there a minute. I’ll get Jason. He’s on call tonight. We’ll get him to give you some meds. I’m glad I was here on nights. I’ll make sure you get to bed soon, okay? It’ll just be a minute. I’ll get you some juice, some nice juice with lots of ice.
(SUSIE leaves quickly. VIVIAN sits there, agitated, confused, and very sick. SUSIE returns with the juice.)
VIVIAN: Lights. I left all the lights on at my house.
SUSIE: Don’t you worry. It’ll be all right.
(JASON enters, roused from his sleep and not fully awake. He wears surgical scrubs and puts on a lab coat as he enters.)
JASON: (Without looking at VIVIAN) How are you feeling, Professor Bearing?
VIVIAN: My teeth—are chattering.
JASON: Vitals.
SUSIE: (Giving VIVIAN juice and a straw, without looking at JASON) Temp 39.4. Pulse 120. Respiration 36. Chills and sweating.
JASON: Fever and neutropenia. It’s a “shake and bake.” Blood cultures and urine, stat. Admit her. Prepare for reverse isolation. Start with acetaminophen. Vitals every four hours. (He starts to leave.)
SUSIE: (Following him) Jason—I think you need to talk to Kelekian about lowering the dose for the next cycle. It’s too much for her like this.
JASON: Lower the dose? No way. Full dose. She’s tough. She can take it. Wake me up when the counts come from the lab.
(He pads off. SUSIE wheels VIVIAN to her room, and VIVIAN collapses on the bed. SUSIE connects VIVIAN’S IV, then wets a washcloth and rubs her face and neck. VIVIAN remains delirious. SUSIE checks the IV and leaves with the wheelchair.
After a while, KELEKIAN appears in the doorway holding a surgical mask near his face. JASON is with him, now dressed and clean-shaven.)
KELEKIAN: Good morning, Dr. Bearing. Fifth cycle. Full dose. Definite progress. Everything okay.
VIVIAN: (Weakly) Yes.
KELEKIAN: You’re doing swell. Isolation is no problem. Couple of days. Think of it as a vacation.
VIVIAN: Oh.
(JASON starts to enter, holding a mask near his face, just like KELEKIAN.)
KELEKIAN: Jason.
JASON: Oh, Jesus. Okay, okay.
(He returns to the doorway, where he puts on a paper gown, mask, and gloves. KELEKIAN leaves.)
VIVIAN: (To audience) In isolation, I am isolated. For once I can use a term literally. The chemotherapeutic agents eradicating my cancer have also eradicated my immune system. In my present condition, every living thing is a health hazard to me …
(JASON comes in to check the intake-and-output.)
JASON: (Complaining to himself) I really have not got time for this …
VIVIAN: … particularly health-care professionals.
JASON: (Going right to the graph on the wall) Just to look at the I&O sheets for one minute, and it takes me half an hour to do precautions. Four, seven, eleven. Two-fifty twice. Okay. (Remembering) Oh, Jeez. Clinical. Professor Bearing. How are you feeling today?
VIVIAN: (Very sick) Fine. Just shaking sometimes from the chills.
JASON: IV will kick in anytime now. No problem. Listen, gotta go. Keep pushing the fluids.
(As he exits, he takes off the gown, mask, and gloves.)
VIVIAN: (Getting up from bed with her IV pole and resuming her explanation) I am not in isolation because I have cancer, because I have a tumor the size of a grapefruit. No. I am in isolation because I am being treated for cancer. My treatment imperils my health.
Herein lies the paradox. John Donne would revel in it. I would revel in it, if he wrote a poem about it. My students would flounder in it, because paradox is too difficult to understand. Think of it as a puzzle, I would tell them, an intellectual game.
(She is trapped.) Or, I would have told them. Were it a game. Which it is not.
(Escaping) If they were here, if I were lecturing: How I would perplex them! I could work my students into a frenzy. Every ambiguity, every shifting awareness. I could draw so much from the poems.
I could be so powerful.
* * *
(VIVIAN stands still, as if conjuring a scene. Now at the height of her powers, she grandly disconnects herself from the IV. TECHNICIANS remove the bed and hand her a pointer.)
VIVIAN: The poetry of the early seventeenth century, what has been called the metaphysical school, considers an intractable mental puzzle by exercising the outstanding human faculty of the era, namely wit.
The greatest wit—the greatest English poet, some would say—was John Donne. In the Holy Sonnets, Donne applied his capacious, agile wit to the larger aspects of the human experience: life, death, and God.
In his poems, metaphysical quandaries are addressed, but never resolved. Ingenuity, virtuosity, and a vigorous intellect that jousts with the most exalted concepts: these are the tools of wit.
(The lights dim. A screen lowers, and the sonnet “If poysonous mineralls,” from the Gardner edition, appears on it. VIVIAN recites.)
If poysonous mineralls, and if that tree,
Whose fruit threw death on else immortall us,
If lecherous goats, if serpents envious
Cannot be damn’d; Alas; why should I bee?
Why should intent or reason, borne in mee,
Make sinnes, else equall, in mee, more heinous?
And mercy being easie, ’and glorious
To God, in his sterne wrath, why threatens hee?
But who am I, that dare dispute with thee?
O God, Oh! of thine onely worthy blood,
And my teares, make a heavenly Lethean flood,
And drowne in it my sinnes blacke memorie.
That thou remember them, some claime as debt,
I thinke it mercy, if thou wilt forget.
(VIVIAN occasionally whacks the screen with a pointer for emphasis. She moves around as she lectures.)
Aggressive intellect. Pious melodrama. And a final, fearful point. Donne’s Holy So
nnet Five, 1609. From the Ashford edition, based on Gardner.
The speaker of the sonnet has a brilliant mind, and he plays the part convincingly; but in the end he finds God’s forgiveness hard to believe, so he crawls under a rock to hide.
If arsenic and serpents are not damned, then why is he? In asking the question, the speaker turns eternal damnation into an intellectual game. Why would God choose to do what is hard, to condemn, rather than what is easy, and also glorious—to show mercy?
(Several scholars have disputed Ashford’s third comma in line six, but none convincingly.)
But. Exception. Limitation. Contrast. The argument shifts from cleverness to melodrama, an unconvincing eruption of piety: “O” “God” “Oh!”
A typical prayer would plead “Remember me, O Lord.” (This point is nicely explicated in an article by Richard Strier—a former student of mine who once sat where you do now, although I dare say he was awake—in the May 1989 issue of Modern Philology.) True believers ask to be remembered by God. The speaker of this sonnet asks God to forget. (VIVIAN moves in front of the screen, and the projection of the poem is cast directly upon her.) Where is the hyperactive intellect of the first section? Where is the histrionic outpouring of the second? When the speaker considers his own sins, and the inevitability of God’s judgment, he can conceive of but one resolution: to disappear. (VIVIAN moves away from the screen.) Doctrine assures us that no sinner is denied forgiveness, not even one whose sins are overweening intellect or overwrought dramatics. The speaker does not need to hide from God’s judgment, only to accept God’s forgiveness. It is very simple. Suspiciously simple.
We want to correct the speaker, to remind him of the assurance of salvation. But it is too late. The poetic encounter is over. We are left to our own consciences. Have we outwitted Donne? Or have we been outwitted?
(SUSIE comes on.)
SUSIE: Ms. Bearing?
VIVIAN: (Continuing) Will the po—
SUSIE: Ms. Bearing?
VIVIAN: (Crossly) What is it?
SUSIE: You have to go down for a test. Jason just called. They want another ultrasound. They’re concerned about a bowel obstruction— Is it okay if I come in?
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