by Rob Rufus
* * *
Through the back windows of the ambulance I watched Mom follow us, keeping pace with our increasing speed. We took the same damn route my friends and I cruised on the weekends: past the park—Fifth Avenue to the viaducts—to downtown—past the buildings, straight toward the river . . .
Only this time, I was watching in reverse, through the small back windows of ambulance doors. I was watching my world be erased before my eyes.
I heard the siren sound. We were going fast now, blowing through red lights and blurring the cars behind us. Mom fell behind, and then she disappeared.
The ambulance shook over the cracked pavement of the Robert C. Byrd Bridge as we ran straight over the Ohio River and out the other side.
As we crossed the river, I watched my hometown fade away. The EMT injected something else into my IV line—I started nodding in and out . . .
Soon, the land was straight and flat.
We sped down an unkempt highway, past landmarks I didn’t recognize. As the dead land stretched all around us, the sun appeared from behind the clouds, glaring through the windows. I could still see the river, running beside the road.
“Where does this road go?” I quietly asked the EMT.
He squinted into the light.
“Hell,” he said, without looking at me. “It goes everywhere.”
With the sun on my skin, I closed my eyes.
2
The last thing I remembered was arriving at the hospital in Columbus. I had fallen asleep in the ambulance (if we can refer to drug-induced unconscious episodes as sleep) and woke as I was being lifted into the air—out of the ambulance and onto the ground. The bigger EMT patted me on the shoulder.
Within seconds, two sets of hands grabbed the end of my gurney and were rolling me inside the hospital—one of them belonged to a man, the other to a woman. Both were dressed in bright purple.
I peered over the tips of my shoes as I rolled through sets of sliding doors and into a large, chaotic room. This was nothing like the hospital in Huntington. This place was full of people, and nothing seemed hidden—now the pain was right in front of me.
Screaming children. Parents rushing around confused and upset, trying to get answers or fill out forms or get their kid to quit crying. The tension in the room was so high, I wondered how anyone could concentrate.
Mom came through the doors behind me. She must have caught up with us somewhere outside the city. When she bent over my gurney, she looked exhausted.
A doctor approached us. He was about my dad’s size, with dark, olive skin. He smiled easy.
The first thing he said was—“Man, I love that Ramones shirt!”
I knew instantly that he was something special.
He introduced himself as Mark Ranalli, the oncologist whom the Huntington doctor had spoken to. He said that they were ready for me.
While he talked to my mom about tests, purple nurses weaved around us expertly. Dr. Ranalli asked if I was still having any pain. The moment I said yes, one of the nurses moved past him and stuck a syringe in the port of my IV.
The room began to swirl around me. I felt like I was going down a drain.
“What’d you give me?” I asked the purple nurse.
“Morphine—for the pain. You try and relax now.”
When she smiled, the teeth in her mouth looked blank and white and empty and then nothing.
* * *
But I woke up alone.
The fluorescent lights above me were dim.
Is it nighttime? There were no windows, so I couldn’t say for sure. I didn’t know how long I’d slept, or what day it was. All I knew was that I was alone.
I tried to sit up, but I was too weak. I rolled onto my right hip. The movement pulled the needle in my hand, ripping at the vein. I yelped like a stray dog.
I flipped onto my back again.
The movement had twisted me up in the sheets. I realized it was my hospital gown—it looked like a giant blue pillowcase. It tangled up under my armpit. I was naked underneath it.
Did I put this fucking dress on? I couldn’t remember.
The thought of someone undressing me embarrassed me horribly. I thought about my gut and my drugged-up dick, flopping lamely on a gurney while some stranger pulled my jeans and underwear off as if I was a goddamn invalid.
* * *
Sometime later, Mom woke me by rubbing my shoulder, the same way she would when I didn’t get up for school.
I saw her hand and nothing else; a delicate hand, with fingers a little too long for the palm. The same pale cream as my own hand, pink around the knuckles, almost translucent where blue veins pushed up against the skin. Her rings were on her fourth finger. Her nails were a bright plastic red.
I asked for my glasses—the words came out in a rasp. Mom slipped them over my ears.
This world came into focus.
Mom wore a paper medical mask over her mouth and nose. She had on the same clothes she’d worn the day we arrived at the hospital. Maybe it was the same day—I wasn’t sure anymore. A laminated blue tag was clipped onto her shirt. It said PARENT in thick black Sharpie.
My eyeballs darted around the room. Everything was white—from the walls, to the bed, to the machines, to the computer. In the corner of the ceiling, a large white tube pumped filtered air into the room. I had my own ventilation system, separate from the rest of the hospital.
There were no windows. There was no door. One entire wall was made of thick, clear plastic. A nurse (also wearing a face mask) approached the clear wall. She put a keycard against the side and the center of the wall slid open. It sealed as soon as she entered. I felt like I was inside a fucking UFO.
“He awake now?” the nurse asked casually.
Mom nodded and kept rubbing my shoulder. The nurse took another needle and injected it into my IV. I felt warm again.
The nurse turned to go, but then questions started pouring out of my mouth uncontrollably—Am I quarantined? Am I this contagious?—It all came out as incoherent nonsense. There was a disconnect between mind and body, a divide that grew as the drugs spread through me . . .
. . . I floated down . . .
. . . inside the . . .
. . . empty space.
* * *
On morphine, time and memory had no place.
I existed outside myself, grasping only at random scenes from my days—things would fast-forward and rewind uncontrollably, and I watched my life projected back to me on the wall of an empty room. The film skipped, and reels were missing. There was no sound.
I was too fucked up to understand that all the precautions were to protect me from the outside world. “The mass” in my chest had pushed my lungs to the verge of collapse. One more week of waiting, they said, and I woulda been a goner.
I hadn’t been officially diagnosed yet. Dr. Ranalli had scheduled a series of tests and was conferring with experts and specialists all over the country. Soon, they would pinpoint exactly what was happening inside of me and decide what—if anything—they could do about it.
The one thing that they were sure of was that the illness was extremely progressed. So they locked me in that sealed-off, germ-free room where any and all precautions would be taken until Dr. Ranalli had a game plan.
So there I was in this plastic cell. It made me think of baby pictures—of my brother and me, born premature like so many twins are. I was the smaller one, barely three pounds. We were put into incubators ironically similar to the room I was currently stuck in. I started to think that maybe I was doomed from the very start—born into a body too weak for this world.
3
These morphine-induced periods of waking unconsciousness usually included one of many daily humiliations.
It might have been my mother holding a jug to my crotch while I pissed, because I was too we
ak to get out of the bed. It might have been the sponge baths the male nurse gave me. Once or twice, students from the med school came by, and the room was crammed with Asian kids who looked at me like I was a science experiment.
The rest of those first days were filled with nothing but tests. Too many times a day, they did numerous tests—blood tests, biopsies, X-rays, ultrasounds, shots, scans—more medical tests than I knew existed.
Each test result led to more tests. Soon, I couldn’t keep track of them.
I’d be fitted with a mask, and wheeled from my room to an elevator—it always went to the basement floor, into cold rooms with horrible machines. I was never sure which test I was about to endure. No matter how miserable I was in that hospital room, it was never as bad as the basement.
Most of the tests went something like this: I’d be injected with some sort of contrast, and then scanned by some giant machine. Some injections made me feel hot, some antsy, and some nauseous; but I could always feel the chemicals travel through my bloodstream.
Each test had its own distinctly shitty trademark.
For one scan, I was injected with a contrast that was literally radioactive—the nurse held a comically huge syringe that was encased in an inch-thick protective steel shell.
A squared-off, ominous green machine did one of the scans. It was like a demented MRI, or something—you lay inside it, and then the roof of the machine came down about a half an inch above your nose. When the scan started, the machine would ROAR. You couldn’t move, or the results would be muddled—so you lay there for hours, unmoving, while the machine blasted around you. I imagine the feeling is similar to listening to the sound of a moving train (if you are tied to the tracks beneath it).
The CT scans didn’t require any injections. For those, I had to drink the contrast—it was mixed in with a chalky red substance and masked as Kool-Aid, straight-up Jonestown style. I had to drink a certain amount every half hour. If I couldn’t drink the entire container, or if I puked any of it up, I had to start the entire dose over again.
Through these tests, Dr. Ranalli was getting closer to pinpointing my condition. Clues in the scans and blood work indicated signs associated with testicular cancer, which led to a not-at-all-weird ultrasound on my balls.
From there, it led to the test I thought was the worst—the bone marrow biopsy.
I couldn’t retain much from the conversations between my doctor and my parents about my condition, but I did understand that if the disease had spread into my bones (which was likely, considering the late diagnosis), then it was badterribletragic fucking news. So of all the tests, this biopsy was the one to fear.
I was made to lie on what looked like a massage table but wasn’t. Lying on my stomach made it even harder to breathe. They stuck a long, thick needle into my back, deep enough to suck the marrow from my spine. Goddamn, I’d never felt pain like that before (yet).
* * *
Because of all the dope, I wasn’t aware enough to know that in a room similar to mine, my brother was lying facedown, waiting for his needle to drop.
Dr. Ranalli wanted to make sure Nat’s body wasn’t plagued with whatever biological defect was causing my illness.
Same blood, same genes, same birth, same life, same?
4
The results of the tests came back. Although it felt like weeks, the whole ordeal had actually lasted only days.
No one was expecting Dr. Ranalli when he showed up at my room. It was late in the evening, and the normally chaotic hallways of the ICU were silent. I was awake—Nat was keeping me company. He didn’t mention his biopsy, or any other tests. He sat beside my bed, looking at the tubes and neon bulbs of the machines I was attached to.
The plastic wall opened and Dr. Ranalli entered, followed by my parents. They both looked utterly defeated.
Dr. Ranalli had his diagnosis.
* * *
I’d love to quote Dr. Ranalli’s diagnosis word for word, but I can’t. You see, unless you’ve been diagnosed with cancer, the whole process is hard to understand—everything goes completely over your head.
I used to think that cancer was a solid thing, like chicken pox or a broken neck—cancer meant you were rotting from the inside out. Cancer was a definition.
In actuality, cancer is more like a category—housing hundreds of diseases that can manifest in cells, blood, bones, and organs.
The medical jargon was so beyond my seventeen-year-old brain, plus the fucking drugs they kept pumping into me—I was just permanently confused, and crushed by the weight of what was happening as it was happening.
No one had ever explained to me that mass is a safe word for tumor, or that there are a hundred different ways to say cancer. I always thought that getting a cancer diagnosis would be more like a doctor saying, “You have cancer. Sorry, man.”
But that wasn’t the case.
To Dr. Ranalli and his staff, me having cancer was a given—they knew I had cancer as soon as they’d seen my X-ray, before I was even rolled through their doors. What he was focused on were the details of the disease—he wanted to understand its progression and, hopefully, how to cure it.
Dr. Ranalli said that I didn’t have lymphoma, or leukemia. He referred to what I had as germ cell—or embryonic yolk cell—cancer. He said it was very rare.
The disease was similar to testicular cancer. Apparently, it had formed when I was a fetus—only instead of dropping with my testes, the cancer developed in the middle of my body, which explained the dark spot on my X-ray.
“So that mass . . . tumor . . . has been growing inside me . . . forever?”
Dr. Ranalli said no, not necessarily. Diagnosis often occurred in the years following puberty. He said that raging hormones are like gasoline on the infected cells.
Mom wrote down every word he said on a small yellow notepad she kept in her purse. When Dr. Ranalli was done with his explanation, she raised her hand up slightly, like a tentative student might.
“So. What happens now?”
Dr. Ranalli told us that he was working with the best team possible—and that they had a plan.
Yes—my cancer was rare. Worse—it was progressed. But the plus side was that the disease hadn’t spread into my bones.
This gave Dr. Ranalli hope. And although it was anchored in my chest, the genetics of a germ cell cancer were incredibly similar to that of testicular cancer—meaning drugs that successfully treated testicular cancer might show the same results here—which is where Dr. Larry Einhorn came into the picture.
Dr. Einhorn was the head oncologist at Indiana University. He was world-renowned for his research, and most advances in the treatment of testicular cancer over the last twenty years had been due to him. He was also the personal oncologist for Lance Armstrong, who was the fucking Elvis Presley of cancer patients at the time.
Ranalli and Einhorn had been in touch since the day I arrived. Although Dr. Ranalli reached out to other experts, it was Einhorn whom he bounced every play off. Every test result that came in was discussed at length. Dr. Ranalli, Dr. Einhorn, and their collective peers had put together an intensive treatment plan.
“How intensive?” Mom asked.
“Does it matter?” Nat said.
* * *
I was to be moved to the inpatient oncology ward, on the other side of the hospital.
My initial treatment plan consisted of six rounds of intensive chemotherapy—which would start at dawn. Each round lasted a little over a week—with a few weeks off in between for my body to recover.
Between the rounds, I would be allowed to go home.
Once the treatments began, the doses would be adjusted accordingly. If the chemotherapy worked, the tumor in my chest would shrink.
After the initial sessions, I would be sent to Indianapolis, where Dr. Einhorn and his team would remove any of the tumor that wasn�
�t killed off by the chemo. After that, Columbus Children’s would administer a few more rounds of chemo to be sure no cancerous cells remained.
Some questions from my parents followed, but not as many as you might expect.
There was little time for questions or hesitation—what my parents knew (and Nat and I didn’t know) was that the disease had progressed farther along than I could’ve imagined. They didn’t see any reason to tell me that the cancer was already Stage Four—I was lucky if I could be helped at all.
* * *
My family stuck around while we waited for an orderly to come and wheel me up to the cancer ward.
“Did Natty tell you? All your brother’s tests came back negative,” Dad said, trying to sound upbeat through his mask. “Thank Christ for that, at least.”
He rubbed Nat on the back, but Nat shrugged Dad’s arm away and stormed out through the plastic wall with his head down.
I hadn’t even thought about the possibility that he could be sick—if cancer was in my cells, then of course he could be sick—goddamn, we shared the same cells. What were the chances of one of us having something this horrible, and the other one being totally fine?
Dad said good night and went off to find Nat. The two of them were headed back to the hotel. I sat there trying to process what I’d heard.
How would I feel if it was the other way around, I wondered. Guilty? Lucky? Both?
Probably all of those things, but I knew that Nat didn’t want to be lucky—not if I wasn’t. He wouldn’t want to be out there alone. He was with me there in the before; he would be with me in the after.
* * *
The orderly was a skinny black kid with a set of headphones around his neck. He pushed my wheelchair into the staff elevator and pressed 6—up to the cancer ward.
The elevator opened. The walls were purple, just like the nurses’ uniforms. There were two heavy doors ahead. Sheets of clear plastic hung from the corner wall.