Year of Plagues

by Fred D’Aguiar

  Well, reality, supercharge me. Show me your bluest skies, make light cut into a room as if onto a stage in Vegas. The demonstration snaking past the quad below my office window ricochets off the surrounding buildings. The quad teems with so much life, its antagonism registered with me as vibrancy, necessity, a vital course charted by the pulse of the given. The bullhorn asks: What do we want? The marchers reply something indecipherable. The bullhorn asks: When do we want it? The marchers reply with a resounding Now. I want to find out more.

  Ordinarily, I would have headed outside for a better view. Not today. I feel tired and flat. I care but not enough to change the course of my lethargy. I remain in my seat—not even bothering to stand, as is my usual practice, at my computer mounted on a platform, mounted in turn on my desk. The ergonomics of longevity seemingly out of my reach now. I languish in disease mode. My head, chock-full of morbid detail, needs additional room in my body, already rented out to my disease, to accommodate everything. I am in the middle of my life. This cannot be the sum of it. I have to fight this thing.

  Flomax relaxes the sphincter muscles and eases the flow of urine. The weak trickle regains some of its backbone though in no measure anything resembling the fire hose of my ESPN days. I take one pill at night and go to sleep and it helps me make it through the night without having to fumble in the dark between the bed and bathroom. Flomax is my new best friend, an enabler in the truest sense of the term; that is, someone who helps a person to grow into a better human. The chemistry of it is of some interest to me. I am intrigued by the way the drug targets my contracted and depressed sphincter, surrounded and oppressed by my prostate, and induces the muscles to bow before the pressure of my urine.

  I wish that Flomax had a similar force against the cancer that self-proliferates and enlarges my prostate, and hampers my urinary tract. Could there be a Flomax of the depressed spirit, able to open the spigots of optimism and induce in me a positive viewpoint that might banish those cells and shrink my prostate? I want to believe in the power of the mind over the matter of its house, the body. My body is in full rebellion against me. My mind cannot run fast enough to catch and curtail the body’s wild sprint toward the cliff of oblivion.

  I wonder if art is up to the task of healing. If autosuggestion helps in any perceptible fashion, or if a positive outlook is tantamount to my mind fiddling while the Rome of my body burns. For I burn with cancer. Is my mind, with its penchant for recall in the middle of a crisis as a coping mechanism, simply whistling Monty Python’s “Always Look on the Bright Side of Life” while faced with the devastation of life? For my life is threatened with a summary end. I wonder if my speculation about the many things that could go wrong with me is a symptom of my propensity for camp exaggeration in the face of a fine-tuned assault on my being.

  Since my late teens, when I lived in London, I had rejected the idea of the medical model, thinking that doctors and hospitals would not work for me. Back then I supplemented it with something that was all to do with me—my natural leanings toward positive thought as an antidote to dark despair—with my childhood in Guyana surrounded by homeopathic remedies for illnesses and then in the UK taking my lucky good health as a sanctuary from scientific medicine.

  So that today, I believe intuitively in, well, yes, intuition; that is, in the capacity of the mind in coalition with the spirit to turn destiny or what purports to be inevitability topsy-turvy. There must be some help that I can muster on behalf of the medical model that I embraced in order to ride with this condition. I say ride after Parliament’s 1975 “Star Child” (A-side) and “Supergroovalisticprosifunkstication” (B-side) “let me ride,” injunction to the quarrelsome spirit to chill, to fall into harmony with an easier way of working with a bigger force, not by direct opposition to it but by flowing with it. There is not a shred in me of acceptance of my disease as somehow too far gone. I keep to the front of my mind that if I can maintain this positive thinking then I can slow down this thing and help the drugs and other medical methods perform their ministry. Together, my mind in partnership with medicine can overcome, chant down, Bob Marley fashion, the Babylon of my disease.

  The ghostly ministrations of intangible forces such as positive thinking are things in the world, invisible but felt presences that can be co-opted on my side, if I dedicate my mental powers to them. At the cellular level, Flomax (tamsulosin), an alpha blocker, stops the hormone norepinephrine from reaching alpha receptors at the uptake point of cells, thereby robbing them of the necessary chemical messaging that tells muscles to contract. Flomax operates on my behalf by latching onto muscles in the bladder, neck, and prostate gland and lulling them to sleep. At the level of the idea, I see a force, or feel it, I should say. I think that my frame of mind might rein in the diagnosis and turn it around in ways difficult to measure, yet part and parcel of the changes brought about by medicine.

  A second doctor conducts a biopsy of my prostate. It’s an outpatient procedure. Debbie accompanies me. She never leaves my side. We wait in a small room where I am told to undress and wear a hospital gown with the opening at the back. I ask if I can keep on my socks. The nurse looks at the green leaves on the pair, and by the way she nods and smiles I tell her the herb of those leaves does not figure recreationally or otherwise in my life these days. With my back to the nurse, I lie on my left side and face Debbie. The nurse shows me the probe, about a foot long and as fat as a truncheon, covered in a condom. She explains that the doctor will insert the probe into my anus and push it up my rectum and out of that probe needles will shoot through the walls of my rectum and into the afflicted areas of my prostate and extract cancer material for analysis. The perforations in the rectum wall, she tells me, are minuscule and they self-heal quickly, though I may see traces of blood in my stool for a day or so afterward.

  Debbie laughs at the ghastly rocket of the probe. I nod in astonishment at the size of the thing. I can feel my sphincter shrink as if I have waded into the North Sea off the coast of Aberdeen. (That one time was my last time and my then lover made me do it.) The doctor comes in with a colleague. He introduces himself and points at the monitor that he says will guide the biopsy. There is a camera on the steel probe. He warns me that the process of going through the wall of the rectum, though painless, feels weird, as if someone snaps a rubber band against my skin. Debbie takes my hand and the nurse uses most of a tube of lubricating jelly to cover the probe. (That has grown with my alarm to resemble, now, a baseball bat.) I stop seeing what happens next. That probe is huge. I feel stuffed beyond capacity. The doctor asks me to breathe deeply and to keep breathing no matter what I feel and that I should remember it will be over fast. He says he needs up to twelve samples from my prostate. He speaks with a slow baritone. Great, Barry White is my torturer. He says that he has an image of my prostate from the previous test so he knows exactly where he needs to go to obtain the samples. I want to snap at him to get on with it. His slow delivery adds to my ballooning alarm about what is about to happen to the interior of my posterior.

  Let the games begin. And they do. A silent movie runs. Moving images composed of touch. The probe fills up my rectum and the twang from a rubber band is more like a needle puncturing the roof of my mouth. One dozen of those pops. I count down. I raise my eyebrows. Guess my eyes must have looked as if they were about to pop out of their sockets. Debbie has turned pale with a look of being trapped at the uppermost point of a roller coaster on the verge of a precipitous descent. The doctor is accurate about the strange pain. Not of damage to the skin, more of an interior wreckage that is too deep to identity, that unfolds and most certainly stays central in my mind’s register of discomfort. Breathe. Try not to crush Debbie’s hand. Let cancer have its way with me—backward, forward, and upside down. I abandon my body and retreat mentally to my childhood memory of a game where I drive, in complete silence, two matchstick lovers to their drive-in movie date in their bottle top cars along the road of those wooden railings on the back stairs.

  A fe
w days later I see a third doctor and he tells me in the company of my wife that another test is necessary to be certain that my bones and other areas near the prostate are not affected by the cancer cells. He says the biopsy results confirm cancer spread all over the prostate and perhaps elsewhere too, going by the MRI. He assures me that my enlarged prostate gland and hugely elevated PSA reading, though causes of concern, were not in themselves sufficient diagnostic tools to form the basis of a treatment plan. The cancer is present in large amounts but more of a sense of its locations (plural, his word) is needed before attacking it (his word, attack). He said I needed to have a few tests. A computerized tomography (CT) scan, a bone scan, and more than likely a final scan aimed specifically at a search in the body for antigens generated by cancer cells on the surface of the prostate; that’s at least three more tests, which qualifies as a battery of them.

  In one test I react as if there is an awful texture and taste that I repeatedly swallow to try and rid my mouth of and it makes me feel that I am on the verge of throwing up. In one hour I consume the two pints of that emetic-like substance. In another test the doctor wants me to receive a nuclear injection that will glow around the areas of the bone trained to absorb the dye if those bones were damaged by disease. I brace myself for the unpleasant as a means to procure the resplendent: that medicine with a bad taste, this other medicine with a bad feel, both working in the only way they know how, by being medicine; that is, not nice in order to do some good.

  I always shave for these appointments and dress my best as if about to face a classroom or my doom. For the next test I am not allowed to eat or drink. This time I savor a small coffee—not my usual two giant cups—and eat a light meal, a banana and a slice of brown bread topped with goat’s cheese and avocado, a tasty power food. The nuclear medicine, methylene diphosphonate (MDP) renews this avocado taste in my mouth. The hospital makes it (the MDP, not the avocado) to order with a shelf life of mere hours to do its work before it breaks down. I lie on my back. The radiopharmaceutical fluid is injected through a drip set up in my arm. A small dose, no more than a couple of tablespoons of liquid (26.4 millicuries, or mCi, to be exact) feels cold running into my right arm, a weird kind of cold not on the skin but worming its way under the skin and into my flesh. The cold feeling disappears as my warm blood floods the meds.

  I tell myself to relax and breathe deeply and slowly. I summon two visual aids: the first is Blackheath Hill in South London at six a.m. with a light fog and a highlighted fox glancing back at me periodically as it trots across the hill, a stone’s throw from me on my paper route; the second, Marie Curie in her radioactive lab of perilous discovery. The radiation photography begins.

  About halfway into it I feel a wave of nausea. I don’t just mean that I feel what is akin to an urge to vomit wash over me. I really mean a wave that sweeps me off my feet and bowls me around in deep sand and pebbles. (This tumble-in-a-washing-machine experience happened to me when I tried to bodysurf with my kids. Reader, it was horribly embarrassing.) And the nauseated sensation grows rather than lessens. I call out to the technician, Hello, I feel . . . and as he rushes in and pushes a tall bin next to my gurney, I turn my head just in time to expel coffee, toast, and grime from my guts. The effort of throwing the operation of my body into reverse makes me break out in a cold sweat. I apologize as I retch (try speaking and heaving at the same time) and he says not to worry, it happens to a lot of people. He hands me tissues. I wipe away slime and grimace at the awful feeling that flares and subsides almost immediately after I retch up avocado and stuff. I soon feel better. He says the nuclear cocktail fed into my veins sometimes causes the body to think that it has ingested a poison by mistake and the only thing to do is expel it. That the act of retching fools the body into believing that it has succeeded in saving itself from an attack via its gut. Yes, well, you could have fooled me, dear technician. That vomiting was for real.

  By way of contrast the medicine lights up the lymphatic pathways around bone as though shining a light into a dark room to reveal the furnishings in it, monochromatic bone with a soft, fuzzy look, angular as bones are but almost porous in appearance and so, in my mind of associations, close to looking at a fine bone china teacup that is almost translucent, that is in the shape of a fragile body. On the monitor the dark patches swirl around. Apparently the medicine links to tissue that has traces of the prostate-specific antigen. The nuclear binding is chemically designed to seek out PSA exclusively. The medicine captured on the magnetic resonance imaging monitor resembles iron filings dancing to the push and pull of an invisible force. Somewhere in there, wrapped up with all that frenetic activity, is the disease, which is called out by the radiopharmaceutical to see if any of it has latched on to my bones. I cannot tell. The technician will not say. I ask him if when I get angry I’m going to burst out of my clothing and turn into a green, muscle-bound giant. He laughs and says there are no side effects except the nausea, which should clear up soon. He wishes me well and sends me on my not-so-mirthful way.

  I think the nights are longer and the days shorter for me. I sleep and the last thought is of my body; specifically, my crotch. A weight registers around the area, a heavy feeling of trouble brewing. I beam a positive electron stream at the location below my bladder and in the space behind my penis and in front of my rectum. That beam contains an outdoor concert at Blackbushe in the Hampshire English countryside, in 1978, the summer before the tragedy at Jonestown, Guyana. I attended the concert with my friend Geoff Hardy. He turned me into a Dylan fan and Dylan was performing with Joan Armatrading (and, I want to add, Van Morrison—of Astral Weeks—Bob Marley, and, I believe, Tom Robinson, among others). I should ask Geoff, whose memory retains an encyclopedia of these things, but I will not ask him, because, in this instance, I do not want confirmation that might contradict my ideal.

  I approached the portable toilets in the dark, and some way off from the actual portable cabins men formed a loose line as they urinated in the general direction of those toilets. As the night wore on, the line of men emptying bladders widened even farther away from those portable toilets until people just took a few steps toward the location of the bathrooms and unburdened themselves by aiming at the general vicinity of the portable potties. The women, more evolved, queued respectably for an age. The bolder ones wanted to use the men’s loos but found them too disgusting.

  What a map to stave off my insomnia! In this case olfactory but no less real as maps go, a psychogeography as far as the attention that it commands in me is concerned. Just one of Calvino’s numerous invisible cities (cities constructed out of one sense or another and tacked on to experiences of the actual places that I lived in, Georgetown, London, Miami, Los Angeles) that accounts for my life up to now. Places I return to periodically and know intimately as if I have never left them. Their sensory map now made visible in the service of my malady. Cancer is a city with a rampant population that seeks to expand its parameters into a sprawling body. I hope my return to a past moment of unencumbered joy, conjured and brought to bear on a troublesome present, might reduce the present-tense toll on me.

  I am in an odd place moodwise. Not good company and feeling drained after socializing (with my awful secret). I’ve cut back on social life in order to gather my thoughts and feelings and face up to the shock of my diagnosis. Would you believe this is my first hospital/doctor drama? Haven’t even broken a bone up to now. I view the medical establishment with some skepticism after my stint in it as a psychiatric nurse in South London in the early eighties. The way it captures the body and infantilizes the spirit. Its insistence on knowing what is good for the patient, who must submit to the regime or miss out on the benefits from the encounter.

  * * *

  The surgeon says he needs eyes and this next MRI, a prostate-specific membrane antigen (PSMA) test provides that sight, lights up the pathways of the spread of the disease, so that when he goes in he knows exactly where he has to head. Only problem is the test is not approved by the
Food and Drug Administration (FDA), so my insurance will not cover it and it costs three grand. I agree to pay.

  My frame of mind (I am the one, not Debbie, who is strapped in a car at the zenith of a roller coaster) never enters my thinking until I find myself lying awake in the dark listening to the cat snore and measuring the breaths of my wife by touch as our spoon-sleep posture allows.

  I have to Ngũgĩ wa Thiong’o my mind; that is, decolonize the mental frame of my cancer, which has colonized my body. Ngũgĩ models his analysis on the mental chains that survive the physical dismantling of colonization. The postcolony is really the colony by other means, the same situation with different faces operating the old structures of oppression. The Marley invocation to “emancipate yourself from mental slavery” is a spiritual rendition of Ngũgĩ’s philosophic and political mission conducted on this psychological front (with material ramifications).

  I modify Ngũgĩ by working within the structure he admonishes as the thing that compromises the thinker. For Ngũgĩ it is not possible to operate freely with the tools responsible for oppression in the first place. Lucky for Ngũgĩ that he can think in Gikuyu; that is, outside the frame of English, before moving into English to break it down. My cancer thinks (if I may personify the disease) inside me, and I have to think within the frame of the disease. I grapple with cancer as if the disease itself carries the emblems of my cure as much as my demise. My fight is not a binary of one thing against another but of two things conjoined.

  In one sense I need more Marley than Ngũgĩ. I must chant down the disease, smooth those spikes of its register in me. To sleep at night I need to be at peace with my disease, not peace as in surrender. The kind of peace, uneasy for sure, where opposing armies live cheek by jowl and know that both parties have to share the same space even if their views about the use of that space may vary.