Year of Plagues

by Fred D’Aguiar

  The science of how a cell locks on to cancer cells and blocks them from feeding and turns them against themselves resembles a Lego assembly or a puzzle without a perimeter. One end fits another and sends a signal to show the fit. That fit means the cancer cell is compromised. One med is cut and tailored to latch on to the end of a cancer cell and prevent that cell from sinking its teeth into a healthy cell. Again a signal is sent out to show that the block is a success. The cancer is blinded by the shine (a trick) of the med and it turns against itself, and kills itself. Which protein, and which proton, and which enzyme are a matter for science. The result is a body starved of testosterone.

  Science warfare tricks my cancer cells to turn their arsenal on themselves; science blocks all the food cancer needs to multiply. I bow my head to science and step aside. At the chemical-molecular level my meds send out waves of attack against the cancer, all for my benefit. Medicine is in the crease for me as my primary bat, the one destined to send cancer sailing out of the cricket stadium and beyond the boundary of my body. With this in mind Debbie and I dress and drive to the hospital, for my pre-op appointment. There is a song in my heart as I drive into the belly of the COVID-19 beast, invisible creature that shifts into many manifestations, present in all the sick palaces of hospitals where sick people congregate.

  I offer a prayer, made aware by the news of the statistics of the disease weighted heavily against poor, and black and brown people. Help them. Make them breathe easily and unaided again. If I join their ranks, help me. The lanes shine on the I-5 (locals insist on the definite article every time they mention this motorway), magically free of congestion. Overnight rain has washed the city spectrally clean, and I imagine, fresh.

  At the hospital in Westwood, we find a parking space in no time. The parking lot is more empty than full. Usually, I would have to set aside time to cruise around the basement floors and wait for someone to show up, and follow them very slowly in my car as they walk to their car and grab their spot. Not today. We park near the hospital doors and stroll in with our masks on, two painter’s masks that I dug up in the shed, and sprayed with disinfectant, and left out in the sun. We’re greeted by two masked figures in hospital scrubs. They wear gloves as well. The man holds his thermometer to my forehead and the woman does the same to Debbie. They ask us if we’ve had a temperature or any flu-like symptoms in the last week. We say no. They wave us into an empty hallway. A few souls wander in masks. And nurses at stations, kitted out in masks, gloves, all looking dazed in their slow movements, which we adjust to with a similar shuffle. We search, wide eyed, the many department signs for the right one that would dissipate, so we hope, this scene of wandering, aimless souls, and replace it with the mayhem of a recovered routine.

  We take the elevator by pressing the call button with the retracted nib of a ballpoint pen. The lift opens to a floor that is vacant of human traffic. The sign for internal medicine, where I am to be assessed, is arrowed to my left, and we march on in that hospital post-op shuffle, as if afraid that imaginary stitches might burst and our bodies splash onto the floor. Our extreme caution at being in a diseased space, one hijacked by COVID-19 and barricaded against invasion, leaves us slow in our thinking, unable to speak and more than a little afraid. The corridor is blocked by a hospital clerk, masked and gloved; she asks me my name and appointment time. I begin to fill in a form, we stand rather than sit, and I use my own pen. I take out one of my antiseptic wipes from the clear ziplock plastic bag, and I wipe the A4 clipboard all around its frame as if casting a spell on the thing rather than cleansing it with any real effect.

  The questions are all ones I have answered many times in the last four months. Do I smoke? No. (Though I always want to write, Never tobacco.) Drink? Yes. How often, and how much? Not a lot and not at all since toasting in the New Year. And then the ailments, all of which I am pleased to answer in the negative: heart, kidney, diabetes, shortness of breath, headaches, all negative. Today I know that the operation is just two appointments away and in a little over a week. I repeat my answers in a spell that I cast to protect my body after the anesthesiologist switches off my mind. A second nurse asks me to follow her and I say that my wife is with me and she asks if Debbie is symptom-free as well. Yes. I am weighed. 164 soaking wet, as they say, that is, fully clothed with boots and raincoat. Take off five pounds, give or take a pound of clothing. I feel heavy.

  The nurse directs us into a room and she takes my temperature in my ear and my blood pressure, one hundred over seventy-three, pulse sixty. All good, she says. How do I feel, she asks. I say tip-top except for the scourge of my cancer. She says she needs an electrocardiogram (EKG) and would I mind taking off my shirt and putting on the hospital gown with the open side at the front. She asks me to lie on the gurney. She pins glue nodes to my left and right breasts and two more below my chest. She attaches sticky wires that lead to her machine and she starts to take readings of the electricity of my heart. I close my eyes and breathe deep into the area I imagine as bottoming out at my navel. I see the jars of my lungs, two freestanding, tall red clay containers, and I pour air into them in through the twin portals of nostrils and out and in. I picture a bucket that I have fetched from a well and brought back to the house in Airy Hall to pour with a steady tilt into the water barrel at the bottom of the stairs, which leads up to the kitchen.

  All finished, she says, and I open my eyes. She pulls off each of the adhesive nodes and the tape attached to my skin and I ask if she sees anything unusual and she says it all looks good to her eyes but she is not the doctor and she laughs. Just then the doctor walks in. He looks about twenty-five, with the face of a teenager. So fresh and clean and in his light green suit and light blue mask and dark blue gloves. He looks at my chart online and says I appear to be very fit. I nod and smile. Though I remember that the smile is behind my painter’s mask and needs to be exhibited by my eyes. I mention my note. I ask the doctor for a drug to help me with my enlarged breasts. He looks at my chest. I tell him that the subtle growth is around the nipples and on the sides nearest my armpits. He says he will call the resident doctor since he is not qualified to prescribe, only consult. He leaves. I put on my shirt but do not button it, and wait and the doctor appears. She is almost as young and she nods as I explain about my request. She glances at my chest and she says my doctor has to be the one who writes the prescription since he was the one who began the original medication. I nod. The doctor wishes me well and takes her leave with the young intern.

  A nurse tells me to dress and please provide a urine sample and take it downstairs to the place where my blood will be drawn. I know where to go. My blood was drawn there a couple of months ago. She hands me a small container and a clear plastic bag and she steers me to the bathroom. I open the door by pressing on the handle with my elbow and I push the door wide with my foot and scoot into the bathroom. I need to pee. I empty some in the bowl, stop, fill the little container, and complete the process. I seal the container in the plastic bag and wash my hands with copious amounts of soap and water. I dry and use the tissue to open the door and my foot to widen the door for my quickstep exit.

  I summon the elevator with my ballpoint pen. We walk, with quick steps this time, to the pharmacy and blood room. The waiting area has chairs labeled alternately with signs that say do not sit, and empty ones so orderly they might be occupied by ghosts, which create the six-foot barrier that is de rigueur these days. The phlebotomist is so efficient that she answers my question about how things have been in her department and completes the pinch of bursting into my skin and extraction of a capsule of blood in about two sentences. Debbie pulls my urine sample from her coat pocket where she hid it (I don’t have pockets with sufficient space) for the short walk between departments, and some urine has leaked into the bag.

  The phlebotomist won’t touch it. She hands Debbie a clean bag and says to drop the sample in the compartment that’s in the bathroom. Debbie asks for directions to the bathroom and heads there for the changeover
of my urine sample container from a wet to a dry plastic bag. The nurse bandages my arm and I compliment her on her seamless draw of my blood. She says I should tell her supervisor, who happens to be standing outside the compartment where I’m seated with her in close quarters. I say, really, yes, you are an excellent phlebotomist. Debbie returns.

  Next stop the pharmacy. I have to pick up a renewal of my tamsulosin (brand name, Flomax). I call my doctor, and the receptionist who answers for the doctor tells me that he is working from home and she will contact him. I say that I’m in the hospital and live a half hour away and ideally would love to pick up a prescription for the drug to tackle my breast problem. She says she can see in my file, my note to my doctor, and she will page him. She warns me that it may take a while for me to get a response from the doctor. As I queue for the renewed drug, I hope to hear about the new one. Alas, the call comes to me on my drive away from the hospital.

  We decide to stop at the university and pick up some books and papers from my flooded office for my spring course. Two months ago the builders boxed my books and tore up the floor and cut open the walls to remove the insulation. I see an open door. People working on the office next to mine. They promise to get to mine next. I take my leave of the abandoned campus, so many buildings standing vacant as if contaminated and earmarked for demolition. COVID-19 has devastated the city. People have scuttled away from all their stations of productivity.

  We head back to the hospital to pick up the tamoxifen. I am told to wait for twenty minutes. We decide to walk to the local supermarket to buy cat food. The cats have hard food but they tolerate it and prefer soft food. We add bananas and yogurt and yeast, absent from most shops, to the list. Yeast, for some reason, cannot be found at shops. We wonder if everyone in the city has taken to baking bread. Debbie’s daily loaves have filled the house with warmth. The moment each loaf is ready we crowd around it and cut doorstop slices, and slap on butter that melts and runs off, and has to be caught from dripping onto the floor by the outstretched tongue, or by twisting the slice left and right. We leave less than half of the loaf for the rest of the day.

  We collect the tamoxifen from the hospital pharmacy and drive home: a miraculous straight run interrupted by only two red lights. I gear up for my body memory of all lanes in the road full and of sidling into spaces with just enough room for my car. None of that conflict materializes. I could close my eyes and cruise home unscathed in a stricken LA. Horn use is seen as too much remonstrating for an empty road. I notice all the patchy road markings that try to keep traffic orderly, the white and yellow lines, the chevrons, and all the potholes that look so small with plenty of places to go. At the house we take off our coats and shoes outside and step indoors. My son and daughter meet us just inside the door and they want to hear all about the excursion.

  My daughter directs a can of spray disinfectant at Debbie, who protests in all seriousness with “Don’t you dare” and “I am not joking” at a volume that restrains Liliana and amuses Nicholas. We tell them that the hospital is being run like a naval ship and that we feel confident the people working there can control the spread of COVID-19. We don’t say that we feel we dodged a bullet and with two more appointments must return to the same space, and hope for the same positive outcome. This is life in a casino at Vegas, as we make the rounds and hope for luck in a gamble designed to strip our asses bare. What convinces us that we can win is the same mindset that makes us set out on the journey in the first place. That we of all people will be spared what so few people evade. That the extraordinary care exercised by us will exempt us. How else do we leave the house? Why would I stay home and give up vital ground to the cancer? I believe I can win this medical tussle.

  Tamoxifen at 10 mg twice a day convinces me of that fact. The drug blocks estrogen production and stops breast growth. It starves those glands that grow because of the drugs I take or due to the spread of the disease up the lymph nodes. Either way tamoxifen is my soldier, even with its many side effects, more hot flashes, headache, stomachache, and risk of hives and swelling of the hands and feet, and difficulty breathing (this last one of some importance to me). With this drug my prostate cancer is fully disclosed as a whole-body affair. It was never just about the prostate anyway. Things started in that place and soon the party spread and enveloped the entire block.

  I feel that any fight between my cancer and me is destined to become a brawl pulling in sympathizers on both sides. It was always my intention to conduct a multifaceted campaign in keeping with cancer’s quantum behavior in my body, leaping from one place to another, and with chemical and biological frontiers to its incursions in me. There can be no decency or gentlemanly antics here. This is a rumble. I knew that the minute I heard it was cancer, with all its permutations and final result if left unchecked or caught too late in its rampage. In my drive to the hospital I see how COVID-19 alters the city and wants to take its inhabitants to the brink, so far in fact that the city cannot recover from the disease. All the busy spaces of the city emptied, to starve the disease and turn back its progress. I throw all manner of pharmaceuticals (plus my planned surgery) at my cancer to starve it, extirpate it, bring me back from my dance to the brink with the disease, leave me scarred but alive.

  The side effect of flatulence is another matter. I live in the age of toilet humor. I deplore it, from PG- to R-rated versions of it. Yet here goes. Nothing should faze me, right? Wrong? There is nothing more discomforting than the urge to expel gas and find that the act must announce itself like the big bang. Thank you, meds. You will cure me of my cancer and kill me with embarrassment. If I make a sudden move, bang. If I stand and pee there is a stream of noisome air to accompany the flow of urine. If I’m in the middle of talk with Debbie or the kids, the urge to break wind mounts in me and I can just about string a sentence together and can’t wait to bring the exchange to an end so that I can find a bathroom to whistle in and release the poisonous side effect of my meds. I feel bloated all the time. As if the meds were inflating my intestines, minute by minute, and I might explode if someone plugged my anus.

  As a teenager I might have enjoyed this condition much more. Back then we tried to manufacture air and grab the nearest person’s hand and thrust it at our bottom in time to collect the blast. After a chemistry class, one friend lay on the ground, arched his legs over his head, and placed a lighter to his school uniform to prove his theory that farts were flammable. The result was a wet firework. Nothing. I should smile more as I fart and deny cancer the pleasure of thinking it has something over me. Maybe I’ll take to lifting one leg or other off the ground to mark the event. Maybe shout something like “Fire in the hole” before a blast.

  It could be worse (it can always be worse), I console myself. I wake in the small hours a lot. I trudge to my desk to write, alternate between sitting and standing, and regard my cancer, pay it the attention it craves and deserves, though not in the way cancer might welcome. At least not in the way I try to belittle it and diminish its importance in my life. My psychological fight with cancer shadows all other fronts shared by us. I feel most empowered at these moments, most in control of what I’m doing to control my cancer, when I confront my mood about my disease. Sleeplessness is a corollary of worry about my disease. I work by standing at my desk (ever since the public notice that said sitting was the new smoking), ready to invite sleep back into my bones with songs of enticement in the shape of these descriptions of my life with cancer.

  More than narratives, enriching as they are, I need to write actual songs. Lyrics for a boom box voice, lines to be belted out at the top of my voice and no room to breathe in my stream of delivery, my ears and pores inundated by a fire hose of stimulus. To declare my energetic opposition to my cancer, my readiness to fight it, let the cornered and caged body and spirit, hemmed in by cancer, sing and dance in a shindig start to my battle strategy. For cancer is a mood in me of gloom, of stasis, of lying down in its tide and allowing it to drown me. Cancer wants me living, but dead in my
fight against it. Cancer thrives in winning my spirit, the best of me, before it wins my body, the rest of me.

  Hence my party mood, rather than a solemn or ponderous outlook, and search for mantras that might literally part the waters of cancer’s onslaught of me. I don’t mean to say that my body is second to my soul and consciousness. Only to acknowledge that cancer stages its onslaught against my body first with secondary attacks on my mood and outlook. Cancer’s main troops are biochemical. I know this from my embrace of a drug regimen and surgery. Also, I know that how I feel about having cancer shapes my ability to recover from it. How I fight with cancer determines my prognosis. Each day with cancer becomes a ritual of battle and choreography, of song and dance. In the middle of an injection into my butt, and among the swathes of cloth of hot flashes that threaten to stifle my breath, reside these songs and dances. The long-needled, stork-on-one-leg dance of the leuprolide (Lupron Depot) injection as it sinks into rump flesh and my ooh-ah song that shadows it. The hot flash twist and partnering shout of a canticle. The bloated boogie-woogie and the boogie-woogie chant. The involuntary windbag sax warm-up, coupled with my Coltrane freestyle whistle.

  9.

  Surely I’m to Be Saved