Appearances

by Sondra Helene

  At the Gordons’, Elizabeth and I collapse onto sofas in the den. Above us hang two framed, twenty-by-thirty-inch, blackand-white photographic prints of Brooke and Lauren, crosslegged at Breakwater Beach on Cape Cod. Two summers ago, they were twelve and nine, their smiles wide with innocence and privilege.

  “They’re all I ever cared about,” Elizabeth says, pointing to her children’s portraits. “I don’t even care about myself.”

  I can’t help but feel a twinge of hurt that she doesn’t add Alexandra and me to this declaration, but I don’t dwell on the slight. I know that there is reciprocity in my sister’s feelings, even without her saying it.

  “Why did this happen to me?” Elizabeth asks.

  “I don’t understand it,” I said. Why her and not me? I am older, after all.

  My cell phone buzzes in my pocket, and I check it. When I see that it’s Richard, I press DECLINE. I didn’t tell him where I was going this morning. This isn’t something that I feel like sharing with him.

  “Richard?” Elizabeth asks.

  “I hung up,” I say. Even so, I can see her anger rise, the way she sets her shoulders.

  “Listen, I don’t want that man to know anything about this, about me,” she says. Her voice is soft but stern. “That man cursed me. This is all happening because of him!”

  Upon hearing this accusation, I go numb. Although I know cancer is not a curse, I actually understand how Elizabeth feels. For years, Richard has been trying to render her invisible.

  Elizabeth’s diagnosis also causes a truth to pulse forth in me: I no longer wonder what to do about my marriage or where my priorities lie. I will spend the days with my sister and her family. I will cook her dinners, drive her kids where they need to go, and navigate her through this illness. I will take Elizabeth to chemo and radiation, laugh, weep, console, and hope to heal her.

  THE TEST RESULTS return within days. A bone marrow biopsy confirms lung cancer, Stage IV. Too late for surgery. The cancerous tumors that spot both lungs have spread into my sister’s bones. After dinner that night, I sit at my marble desk with a glass of red wine, googling metastatic and chemotherapy and survival. The more I learn, the more I drink, searching in vain for something positive or hopeful to read.

  I learn, to my surprise, that lung cancer is the number-one cancer killer of men and women in the United States. It kills more people than breast, colon, prostate, and pancreatic cancer combined. Only 15 percent of people live more than five years postdiagnosis.

  How did my sister get lung cancer? I used to assume that smoking caused lung cancer, but Elizabeth has never smoked a cigarette in her life. In fact, nobody in my family ever smoked cigarettes, so we can also rule out secondhand smoke. The mystery—what feels more like an injustice—compels more research. I discover that there is an epidemic of lung cancer among American nonsmoking women in their forties.

  I find a lung cancer chat room that supports family members. I instantly create a profile and explain my situation. The first question anyone asks is, “How long since your sister’s diagnosis?”

  “Five days,” I type back.

  “I felt the ground give way,” someone types back. As soon as I read that, I feel understood. The ground is indeed giving way, and I am trying not to fall in.

  When I drag myself to bed, it’s 2:00 a.m. Alexandra has fallen asleep with her television on. I slip into her room, turn it off, and kiss her on the forehead. She knows that her auntie has cancer but still doesn’t comprehend the gravity of the situation.

  In our room, Richard is fast asleep. Not that it would matter if he were awake. These days, we barely speak. I know he must sense that something is terribly wrong, but he hasn’t expressed the slightest curiosity or concern. He’s been busy at the office. I can’t bring myself to tell him about the diagnosis, and Elizabeth doesn’t want me to anyway. I crawl onto my side of the bed, careful not to touch Richard.

  My head hits the pillow, and I’m out.

  I have always been an early riser, a lover of the morning hours, but now when I wake before dawn I am on high alert, with a cortisol rush: tense, on my back, my arms at my sides.

  The room is still dark; the bedside clock ticks loudly. Around Elizabeth and Jake, I have tried not to acknowledge how miserable I feel, but my grief runs as deep as the cancer in my sister’s bones. I pull myself from the bed and to the bathroom.

  My face is drawn and pale. I splash water on it, rub in moisturizer with the tips of my fingers, and pull on spandex pants and sneakers in the half-light. I find my car keys and slip out of the house.

  I drive to the reservoir. I run once, twice, around the expanse of gray-blue water. Cold air slaps my skin and draws tears. I run harder and faster, until I’m near collapse. But no matter how hard and fast I run, I can’t overtake the terror.

  None of us had any reason to doubt a diagnosis of sciatica. People injure nerves, pull discs, rip muscles, and break bones all the time, especially in their forties and beyond. You live with it. You buy a bottle of Aleve and give yourself time to heal. But this isn’t sciatica. It’s worse than a spot on the lung. I buckle over on the side of the path.

  A filmy mist covers the reservoir today. I feel bitter about Richard’s feelings toward Elizabeth. I’m angry to have wasted precious time allowing my marital problems to be top of mind for so many years, the now-embarrassing frequency with which I compared my marital problems to a cancer spreading.

  I remember a particular argument I had with Richard one morning before he left for the office. “I can’t stand this focus on your family,” he said, as he yanked the knot in his tie and slipped on a sport jacket. “You work too hard at those relationships.”

  “I don’t work—they come naturally,” I said.

  “You want Alexandra and Brooke to be like sisters. They aren’t sisters; they’re cousins.”

  “Yeah, you sure took care of that.” I knew Alexandra was afraid to mention the Gordons in front of Richard. “Brooke and Lauren don’t even feel comfortable in our home,” I said. “You ignore them, you criticize. You even accused Lauren of eating too many pickles one Passover.”

  “You’re always on their side,” Richard said.

  “And you’re always testing whose side I’m on. Come on— they’re children.”

  Richard wanted loyalty—and, as my husband, he deserved it—but it was difficult to be compassionate when he showed so little concern for me. If I shared my feelings, he dismissed them, or he put me on trial like a prosecutor, questioning every word I said. I could not work through my indignation to compromise.

  “I can’t stand how important they are to you,” Richard said for the umpteenth time. “You don’t have to see your brother every time he’s in from New York.”

  “He visits six times a year.”

  “And it’s like the king has arrived, every time,” Richard said. “Your mother? She calls too damn much. When you’re all together, everyone ignores me. They don’t ask me questions about myself. I wish I could just put them all on a plane to California and say ‘see you later.’” For so long, these conversations had felt like a spreading disease.

  At the reservoir, I glance at my watch. I’ve run for an hour. I stand and take a deep breath, drawing strength from this quiet place. The leaves on birches across the water are autumn yellow; they dance in the breeze. I will drive home and make breakfast for my daughter. I will be there for my sister, her husband, and her family. Richard won’t like it, but I’ll do what I have to do. Anything less is inconceivable.

  When I arrive home, Richard is in the kitchen, briefcase in hand. “Where were you out so early?” he asks.

  “The reservoir.” I blurt, “My sister has cancer,” and burst into tears.

  “I knew something was wrong,” Richard says, moving toward me.

  “I’m so upset,” I say, backing away.

  “What kind of cancer?” he asks softly. But his tenderness does not comfort me.

  “We’re not sure yet,” I lie, a
nd wonder if he can already see the gravity on my face.

  “Well, don’t overreact,” he says, turning chipper. “Hopefully, she can beat it. She needs to have a good attitude.” Although another person might take that as encouragement, Richard’s comment makes me feel belittled and blamed. So if Elizabeth doesn’t make it, she didn’t have a good enough attitude?

  I immediately regret having told Richard about Elizabeth’s cancer. If he couldn’t be kind to her in health, I don’t want his kindness for her now, and neither does Elizabeth.

  I can count on one hand those who know the real diagnosis: my parents, my brother and sister-in-law, and Jake. Elizabeth realizes that people will find out she’s sick, but she doesn’t want anyone to know that it’s metastasized, or that it started in her lungs—the cancer of blame. Even Jake’s extended family is still in the dark. The last thing my proud and private sister wants is for anyone to know that she might die.

  Chapter Six

  Eight thirty on a Tuesday morning, and Elizabeth, Jake, and I are tense but hopeful, en route to a string of oncologist appointments. As we file into Beth Israel, it still feels surreal—it will every time—to have crossed the point of no return.

  I now identify with my sister’s diagnosis to the extent that, when we walk into the morning’s first appointment, the radiation oncologist asks, “Who’s the patient?”

  Elizabeth says, “I am” and raises her hand with a nervous giggle.

  The oncologist, Dr. Gold, is surprisingly young: braces on his teeth, thick brown hair over his ears, and nerdy—until he speaks and his wonderful personality emerges. His office is painted in warm golds and creams that complement his name and persona.

  “Nice to meet you,” Dr. Gold says, and reaches out to shake Elizabeth’s petite hand. I sit on one side of her, Jake on the other. The doctor takes a seat behind his desk and speaks in a soothing voice. “You need radiation treatments right away.”

  Elizabeth bites her lip, placing her hand on Jake’s knee. I take out my pen and legal pad, knowing he will give us a lot of information.

  Dr. Gold tells us that Elizabeth will receive twenty treat ments over a three-to-four-week period. They will be short and concentrated—no more than fifteen minutes each—but frequent, five days a week. There will be side effects: fatigue, skin irritation, diarrhea, nausea. Elizabeth will be tattooed light green in order to undergo repeat radiation in exactly the same area.

  Having a doctor speak so candidly is more comforting than I’d have thought. We listen intently. Dr. Gold is giving us a plan, a trail to follow out of this chaos. I take fervent notes on my yellow pad. Elizabeth and Jake huddle together, his hand in her lap.

  “I know all of this is very difficult,” Dr. Gold says. “What are your questions?”

  “What can I focus on that’s positive?” Elizabeth asks.

  The doctor pauses and smiles. “You have youth on your side. No other significant medical problems, no lymph node involvement. Your liver and adrenal glands are okay.”

  “What if Elizabeth had had the MRI at the beginning of summer?” I ask. “Would that have made a difference?” I can’t rid myself of seeing my sister at the Cape, limping after our walk on the beach. At that point, Aleve still helped.

  Dr. Gold tents his fingers and shakes his head. “No difference. At that time, the cancer had already spread.”

  “Why no other warnings?” I ask, amazed at such devastation without a trace.

  “Patients are often asymptomatic,” the doctor tries to explain. “No shortness of breath, no coughing up blood, no chest pain.” He says this like it’s a good thing. What he doesn’t say is that asymptomatic really means there was nothing to alert us to Elizabeth’s condition before the cancer progressed to Stage IV. The mutation was stealthy; it took over before we had any chance of stopping it. I feel so helpless.

  Dr. Gold has already asked if Elizabeth has ever smoked, and whether there was any radon in the house in Gloucester where we grew up—also no. I’m afraid he’ll say that the cancer was stress induced, that Elizabeth and I will forever blame Richard, but the doctor doesn’t say anything like that, and I don’t dare ask. According to that logic, I’d be the one with cancer.

  “Elizabeth,” Dr. Gold says, “you belong to a group called Nonsmoking Women in their Forties with Lung Cancer.”

  “Why? How did I get this way?”

  “We don’t know,” he says apologetically.

  “What’s the radiation like?” Elizabeth asks.

  “You’ll feel tired. The effects are cumulative, so the beginning will be a bit easier.”

  “Can I drive?” Elizabeth asks.

  “Yes, depending on your energy.”

  “Will I feel like exercising?”

  “Some of my patients do,” he says. “You look fit.”

  “Will the side effects last a long time?”

  “The skin over your hip that is radiated will turn red.” He describes how Elizabeth should apply aloe to it every day, right from the beginning, to ease what will feel like a sunburn. I make a note to buy an aloe plant, and circle it.

  “What can we hope for?” Jake asks. I notice how carefully he monitors his question, damming up the words that might otherwise spill.

  “I’d say that we can be . . . cautiously optimistic,” Dr. Gold says.

  My eyes widen. Does cautiously optimistic mean that Elizabeth could live a normal life, or that she could survive a year? I don’t press the doctor because I don’t really want to know. For now, I like how his phrase sounds without the qualifiers.

  Dr. Gold’s kindness is brilliant and unending. He stays with us for an hour, answering all of our questions, giving us hope. Then he sends us upstairs to a thoracic oncologist, whom he calls a rock star.

  We take the elevator from the first to the ninth floor. When we check in with the receptionist, she says the doctor is ready and escorts us to a small corner office.

  Dr. Blaz Varghas, five foot ten, with light brown hair, shakes our hands. Even his grip is reassuring. He speaks with a faint Eastern European accent. The doctor’s gaze is direct and steady, and his face is open and kind, not yet hardened by the toll of his profession. I remove my beige linen jacket—the room is warm—and take out my notepad.

  Dr. Varghas treats Elizabeth as if she were his only patient in the world, and all of us as if we were the most important people he knows. He seems a bit younger than we are, and he is patient and tolerant of our questions. I find myself mesmerized. Dr. Varghas spends nearly three hours explaining Elizabeth’s options for treatment and giving us a picture of the near future, taking question after question, no matter how redundant they seem to be.

  “Elizabeth’s cancer is indolent,” Dr. Varghas says, “slowgrowing. But she needs chemotherapy as soon as possible.” He recommends that Elizabeth receive a combination of carboplatinum and Taxol every three weeks for four to six cycles. Two weeks into chemo, she will begin losing her hair. There will also be a monthly infusion of Zometa, a bone-strengthening drug that prevents fractures. Taxol will make her joints feel achy and/or tingly. Seven to ten days after the infusion, she will feel most tired, when all of her blood levels will be at their lowest. “Elizabeth, if your temperature ever spikes to 101.5,” Dr. Varghas warns, “call me immediately. I will give you my cell phone number.”

  As we leave, the doctor’s eyes hold mine for a beat. He seems to understand that even though I am not the patient, I, too, am suffering. I can’t help but glance at his left hand. No ring, but, then again, not all married doctors wear wedding bands. I catch myself, vowing not to fall for this kind man whose voice could melt ice.

  Exhausted with information, Elizabeth, Jake, and I sprawl on the hospital steps and soak in the seventy-degree day. Brookline Avenue is choked with traffic. Medical buildings line both sides of the street, like the campus of a large university. Cars and taxis stop and start, and buses drop off nearby, all those tailpipes polluting the air.

  “I always sort of wanted a ta
ttoo,” Elizabeth says.

  “I’m glad we’re getting started,” I say.

  “We’ll have to make arrangements for the kids,” she then says, turning serious. “Mom and Dad will have to pick them up from school.”

  Even two feet away on the steps, I can feel the adrenaline behind my sister’s plans. Elizabeth’s entire life is her children. She will protect and support their healthy development through this challenging time. She’ll help them cope, putting their needs ahead of her own healing—if I don’t stop her.

  “Only the two of you should come to chemo and radiation,” Elizabeth says to Jake and me. “No friends ever. If David’s in town, he can come. Once in a while, maybe Mom and Dad.”

  Jake stands. “Let’s grab a sandwich.”

  Our next appointment is with a doctor who I know Jake hopes will enroll Elizabeth in a medical trial, but I already feel attached to Dr. Varghas.

  After a couple of soggy food-court sandwiches, we drive to Dana Farber, a cancer center of national repute that we’re lucky to have nearby. An affiliate of Harvard Medical School, the Dana Farber Cancer Institute is known for its cutting-edge research and up-to-the-minute treatments. If there is a medical trial that could save my sister, it will be here.

  As we walk inside, I get an eerie feeling. It’s different entering Dana Farber. Unlike at Beth Israel, a general hospital, everyone treated in this building has cancer.

  We navigate our way to Thoracic Oncology for the proverbial second opinion, from someone named Dr. Stern. He’s tall, about our age, with caterpillar eyebrows like Governor Dukakis. Jake heard that Dr. Stern lives in the Gordons’ neighborhood and coaches a soccer team.

  We sit in Stern’s office and hand over the results of Elizabeth’s MRI, bone marrow biopsy, and CT scan. This newest oncologist reviews the reports at his spotless steel desk, never making eye contact. I try to read him as a defendant might read the faces of jurors filing into the courtroom one last time with their verdict already etched in stone.