The Caregiver

by Samuel Park

  I could see her shading her bright eyes with her flat palms, as wind chimes tinkled, pulsating with the knowledge of her own existence, this Ana who lived in all things and was a part of the whole world. There, in her eyes, all the beauty and loveliness of her. In my memories, there was neither time nor desire for admonition. My mother just kept smiling, loving me, and I finally understood—she was my joy, my joy and my curse. Flawed as she had been, I would be hers and hers alone for the rest of my life. And that knowledge widened me, made me feel unbound. An apotheosis. A pang in my heart.

  The front door opened.

  Kathryn emerged, wearing a silk chemise and a billowing beige skirt. I fought back a shiver. Right away, I could see just how different she looked from the last time I’d seen her. She’d lost her tan, and her natural complexion was a paler shade of ivory than I’d expected. Her blond hair, which once burned parchmentlike in the sun, resembled faded copper.

  I felt my throat clench. I watched as Kathryn walked to the mailbox by the curb. There, she stood only a few yards away from me. Kathryn looked normal, not sick. I thought about calling out for her.

  As Kathryn flipped through her mail, she finally looked up and noticed me. Our eyes locked. After an initial second of confusion and perhaps anger, Kathryn smiled. There it was, recognition. But more than that. A look both rueful and hopeful, embroidered with a hint of longing.

  I realized then who she was and who she wasn’t. As far as anyone knew, we were just two strangers whose glances happened to meet. What did the woman in the house see in the woman in the car? Perhaps the distance between happiness and melancholy was far narrower than people wanted to believe: It wasn’t a continent; it was the diameter of a razor’s cut. Happiness wasn’t necessarily the result of hard work and decent character, but purely a by-product of choice. Did I know that? The stranger wanted to make sure.

  And there, right at that moment, just by looking at her, I knew that I’d found my answer. I turned on the motor, set the engine to drive, and pressed my foot on the gas. I drove away.

  We’re all alive, I said to myself as I left the house in Bel Air. We’re all alive.

  The following was originally published in the New York Times’s Sunday Review section on January 14, 2017.

  I Had a 9 Percent Chance. Plus Hope.

  BY SAMUEL PARK

  Before I got cancer, I used to collect two-dollar bills. They were rare, and I thought that meant they were lucky, but rare and lucky are not the same thing.

  For most of my life I associated low statistical averages with good fortune. I was one of the 20 percent of applicants admitted to my freshman class at Stanford in 1994. When I applied for my first job as an English professor at a liberal arts college, they told me I beat 700 other candidates. And after my second novel was published, one of the hosts of the Today show, Hoda Kotb, unprompted by my publicist, recommended my book on the air to her millions of viewers. I estimated the odds of my experience being something like 0.0001 percent.

  With luck like that, I figured I should be playing the lottery. Soon I did win a certain kind of lottery, but the prize was something nobody wants.

  In the beginning of the spring semester in 2014, I began suffering from severe pain and fatigue, which I originally chalked up to overwork. I had an endoscopy. A few days later, my gastroenterologist called to tell me that my biopsies had tested positive for stomach cancer. The chance of getting this disease was approximately 0.9 percent.

  The typical stomach cancer patient was a nonwhite man in his sixties and seventies. I was an Asian man in his thirties. While I found no hard data on the odds of getting stomach cancer in your thirties, it was certainly a fraction of a fraction of that 0.9 percent.

  I immediately wanted to know my odds of survival. My oncologist wouldn’t say, leaving me to perform the rite of passage of looking up survival rates on the American Cancer Society website. That speaks to an intrinsic characteristic of cancer: It does not kill right away. Cancer is death by promissory note, and the spaces for “when” and even “if,” for those in earlier stages, are left blank.

  It might be fair to say that after I became sick, I stopped thinking of myself as a person and began to think of myself in terms of statistics. I asked my doctors for numbers all the time. How would my odds of survival increase with radiation? And with chemotherapy? And by getting care in an academic hospital? Did I get bonus points for being young? (No, it turned out.) I pored over charts from clinical studies, examining survival odds based on various treatments.

  My surgeon refused to predict my future and told me to ignore my survival odds, which were a low 9 percent. He pointed out a cognitive error that people make when looking at statistics. If you survive, he reminded me, you’ll survive 100 percent. No one survives 9 percent. No one is 9 percent dead.

  The numbers that matter are 0 and 100, dead or alive. To make an analogy to a commonly cited statistic, 50 percent of marriages end in divorce. There’s a part of the brain that therefore mistakenly believes all marriages experience 50 percent worth of divorce, making that number seem relevant to all couples, when it isn’t. For the happy couples, it is irrelevant. That meant that if I survived, it wouldn’t matter, looking back, whether I’d beaten chances of 9 or 19 or 90 percent.

  After I finished my treatments, months passed and my cancer did not return. According to my doctors, the longer I went without a recurrence, the less likely I was to have one. That meant my odds of survival were not a static 9 percent, as I’d thought, but actually increased over time. By November 2015, I had gone nineteen months with no evidence of the disease, and based on the calculations of a physicist friend of mine, my odds of survival were 70 percent. The chances were high—very high—that I would beat my cancer for good.

  Around Christmas of that year, however, I began to have trouble eating. One night, shortly after a small meal, I started to feel the sensation of being repeatedly stabbed in the belly with a knife. I had to go to the emergency room for the first of several hospital stays. Soon, I was no longer able to eat solid foods, only protein shakes, and after a while I couldn’t even drink those anymore. I was living on 700 calories a day, and at 5 feet 10, I saw my weight drop to 105 pounds. Walking took enormous effort, and my starvation coincided with a seemingly never-ending battery of CT scans, ultrasounds, X-rays, procedures, and biopsies, until my cancer’s return was confirmed.

  It had not returned when my chance of recurrence was high but when it finally became low. So the fact that my outlook had become rosy meant nothing in the end. My surgeon had been right to say that the numbers weren’t predictive—neither when they were against me nor, unfortunately, when they were in my favor.

  In retrospect, I’d used survival rates not as a piece of information but as a coping mechanism. I’d used them to measure the amount of hope I could give rope to. They’d allowed for my otherwise unjustifiable optimism to feel rooted in reality. Deep down, every cancer patient wants to believe he is going to make it, and the survival rate is the blunt, messy tool we use to convince ourselves.

  However, cancer does not respect the rational nature of numbers. It operates within its own cruel logic. Nowhere is this truer than in the way cancer is treated today. Stage 4 cancer used to be pretty much a death sentence to all patients; the rise of immunotherapy has turned the battle against the disease into a wheel of fortune in which some people continue to die while others live longer and a few achieve seemingly miraculous long-term remission.

  In one trial, patients with advanced melanoma who received immunotherapy had a response rate of about 50 percent to 60 percent. But that’s not true for most patients with solid tumors. In a recent clinic trial for the drug Opdivo, for instance, only 14 percent of stomach cancer participants benefited.

  My ten-year-old niece recently saw one of the two-dollar bills that I carry in my wallet. She’d never seen one before, and asked me if she could have it. I hesitated, wondering if I was going to have to either dispense with some good luck, or
saddle her with the opposite. But the hesitation passed, and I handed her the note.

  More from the Author

  This Burns My Heart

  about the author

  © RYAN BAKERINK

  SAMUEL PARK was an associate professor of English and creative writing at Columbia College Chicago. He graduated from Stanford University and the University of Southern California, where he earned his doctorate. He is the author of Shakespeare’s Sonnets, a novella, and the writer-director of a short film of the same name, as well as the novel This Burns My Heart. His nonfiction has appeared in The New York Times. Born in Brazil and raised in Los Angeles, he lived in Chicago. Samuel Park died of stomach cancer at the age of forty-one, shortly after finishing The Caregiver.

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  ALSO BY SAMUEL PARK

  This Burns My Heart

  Shakespeare’s Sonnets

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  This book is a work of fiction. Any references to historical events, real people, or real places are used fictitiously. Other names, characters, places, and events are products of the author’s imagination, and any resemblance to actual events or places or persons, living or dead, is entirely coincidental.

  Copyright © 2018 by Samuel Park

  “I Had a 9 Percent Chance. Plus Hope.” by Samuel Park originally appeared in the New York Times on January 14, 2017.

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  First Simon & Schuster hardcover edition September 2018

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  Interior design by Carly Loman

  Jacket design by Lauren Peters-Collaer

  Library of Congress Cataloging-in-Publication Data

  Names: Park, Samuel, author.

  Title: The caregiver : a novel / Samuel Park.

  Description: First Simon & Schuster hardcover edition. | New York : Simon & Schuster, 2018.

  Identifiers: LCCN 2017044640| ISBN 9781501178771 (hardcover) | ISBN 9781501178795 (softcover) | ISBN 9781501178788 (Ebook)

  Subjects: LCSH: Mothers and daughters—Fiction. | Family secrets—Fiction. | Domestic fiction.

  Classification: LCC PS3616.A7436 C37 2018 | DDC 813/.6—dc23 LC record available at https://lccn.loc.gov/2017044640

  ISBN 978-1-5011-7877-1

  ISBN 978-1-5011-7878-8 (ebook)