Just as she spoke the words, Jim’s scan results came through on Dr. Kelley’s computer. I studied her face as she examined the images of Jim’s abdomen—the dark circles that I had come to recognize as the liver abscesses.
No change in those. If anything, there were more of them. One way or another there would be no chemo for Jim.
I didn’t have to reach for his hand then. I was holding it already.
On the drive home, I raised the topic carefully. “Maybe it’s not so terrible that you’re not getting more chemo,” I said.
Jim looked baffled.
I hated doing this. I reminded him of the facts that had been laid out for us.
“It is possible,” I said, “that we might have decided ourselves that we didn’t want more treatment. Even if it was an option.”
“I don’t understand.”
I had recently reread an essay in the New Yorker on this topic by Atul Gawande, called “Letting Go.” The essay, which I’d printed and given to Jim, was about recognizing when to surrender. Our friend Bridget had been talking with me about this too.
“Chemo would have made you very sick,” I said. (Very sick. What did that mean now?) “And we already know the story on chemo for Stage 4.”
A look of incomprehension came over Jim then. If he didn’t love me as he did, this might even have been a moment in which he’d have expressed impatience and irritation. Not want chemo? What was I talking about? Getting chemo again was everything we’d been working for.
“Chemotherapy won’t cure a recurrence, sweetheart.” I told him. “Once the cancer comes back, there is no cure.”
It was a fact we’d known since the beginning, but now Jim looked at me less with grief than with astonishment.
“Nobody told me that.”
I had, of course. And he had read it. The doctors had said it. The men in the pancreatic cancer support group. The wives and the widows. It was a part of the landscape we’d inhabited from that first day at the doctor’s office in Walnut Creek, eighteen months and a million years ago, when they delivered the news.
“I guess I didn’t understand,” he said quietly. “I though I’d be getting more chemo soon.”
Oh, Jimmy.
He was driving. Not as well as he used to, but holding on to the wheel, ten o’clock and two, tighter than usual maybe. He, the man with plans to accompany me on the Travel + Leisure trip to Lake Como and the Amalfi coast. The man who had said to me, the week before, when I planted tomatoes in the garden: “We have tomatoes in our future.” How resolutely he had held on to that. The idea of a future. The man who had told our friend Bob, back when he went in for the Whipple procedure, “If I can just get a few more years with Joyce.”
It is hard enough delivering terrible news once. But I had to deliver it multiple times. He kept forgetting he was going to die, and who wants to be the one to remind a person she loves that this is so?
92.
One Thursday, trash day, he said he wanted to push the bins to the road with me, but they were very heavy. I ran out before him, to dump half the contents of his bin into mine. Still, it took twenty minutes for the two of us to get the two containers down our driveway.
“We have to go into the city,” he said. Not for a doctor’s visit this time. He needed to replace his wedding ring. The one that fell off his finger.
“Maybe we’ll get the ring tomorrow,” he told me, a half hour later, suddenly exhausted. We spent the afternoon on our bed—I, still scouring the globe for experimental treatments. Jim asleep. Outside our window, a bird had somehow gotten his wiring mixed up. All day, and all the next, and for a solid week after that, he kept crashing into the glass at one-minute intervals. Smash, smash, smash, he flung his small feathered body against the same window.
Then one day he was gone. We never knew what that was about, though the marks he made remained on the glass, and I never wanted to clean them off.
I called Boston, the office of the great Beth Israel pancreatic cancer team. I thought they should be made aware of where things stood. Someone must be keeping records there. After all those months of monitoring Jim’s scans, not to mention that fourteen-hour surgery, they’d want to know how the story turned out.
It was a naive idea. Dr. Moser was a busy man, of course, performing Whipple procedures four days a week. Two Whipples a day sometimes. There was a whole new group of patients now, sitting anxiously in the waiting room, no doubt, awaiting word on whether the Folfirinox was succeeding in shrinking the tumor enough to make possible the longed-for surgery. A whole new group of husbands with wives at their side, wives with their husbands, filing in two by two.
I left a message asking that Dr. Moser call, because it seemed to me he’d want to know, if only to keep the statistics up to date. I never heard back. Maybe if I’d kept trying long enough, someone would have returned my call, but I let it go.
93.
After all those years of construction, the San Francisco Museum of Modern Art was about to reopen. Jim had been carrying his new membership card in his wallet for months. “We’ll wait a couple of days for the crowds to die down,” he said. “So we can see everything better.”
We made another trip to Parnassus hospital. Another procedure—no more endoscopies for us, but they were still trying to drain those abscesses.
From my familiar seat in that room, checking my watch for the time I knew they’d be bringing Jim back to the recovery room, I spotted Dr. Nakakura, the great Whipple surgeon at UCSF, standing in the hallway in his scrubs, speaking to an anxious-looking woman and a couple of young adults who appeared to be her children.
I recognized this moment. I knew the look. Someone these people loved—mother, father, wife, husband, daughter, son—had just undergone the Whipple procedure. I could barely look at their faces, they were so full of gratitude and hopefulness.
“We got twenty-five lymph nodes,” he was saying. I knew that story, too.
I bought us three tickets to a Giants game. For me, for Jim, and for his son Kenny. Jim put on his orange shirt and his Giants cap—so did I—and the vintage Giants jacket my son Willy had given Jim the Christmas before. I took a picture of father and son together in the stands—Kenny looking heartbroken, Jim giving the thumbs up. He got a hot dog, not that he could manage more than a couple of bites.
It was a day game—chosen because the ballpark wouldn’t be so chilly then—and the Giants won. We had ridden the ferry to the city, leaving the BMW at a parking lot in Jack London Square, but when we got there, Jim couldn’t locate the keys.
We took out everything in his backpack. No keys. Finally we called Kenny’s girlfriend to pick us up. We’d leave the car overnight and come back for it the next day.
In the old days, I would have made some sharp remark. How could he? I didn’t do those things anymore.
“If only,” I often said, “you could learn the lessons of cancer without having cancer.”
94.
My novel came out. There was a book tour scheduled. Twelve cities across the country, finishing up with a party in New York, a hundred friends invited.
But I couldn’t leave Jim anymore. Not all at once, but one by one, I canceled the stops. First Seattle, then Chicago, then Kansas City, then Philadelphia.
“I’ve ruined your career,” Jim said, the day I pulled the plug on the party.
There had been times, in months gone by—as first one deadline passed to deliver the first of the two novels I’d contracted to write, then the second, and the money from my advance disappeared with no new novel under way—when I had registered my own level of bitterness over what Jim’s illness had done to my own life and work, not to mention my finances. I had not always done a good job of protecting my husband from my sorrow and frustration. One time—a rare occasion when he’d been short with me—I had snapped at him, “I’ve given up my life for you.” When I said that, he’d put his head in his hands, and a look of as much sorrow as I’d ever seen came over his face.
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br /> “You think I don’t know?” he said, the closest he ever came to tears. “All I ever wanted to do was to be a good husband for you.”
I didn’t care about any of that anymore: book tours, publication parties, the Facebook posts I read while on the bed in Jim’s hospital room that made a person feel as though everybody else she knew was having this amazing, glamorous, wonderful life, celebrating anniversaries on Kauai and the births of grandchildren. Writers whose books were being made into miniseries. Couples we’d pass as we drove down Mt. Diablo Boulevard on our way to or from the drugstore for prescriptions, sharing six-dollar ice cream cones, running off to play tennis.
Were they loved as I was?
“I’m glad I’m staying home,” I told Jim. “Hardly anybody even goes to book readings anymore anyway.”
95.
Jim had been home from the hospital a few weeks, but the infection hung on. Three times a day, I lined up the syringes on the glass table next to the box of sterile gauze wipes and rubber tubing and the IV infusion pole. I removed one of the boluses of antibiotic from the refrigerator (warmed it up first) and, after a series of flushes, connected the tubing with the bag of antibiotic. For the next hour then, we sat together while the antibiotic dripped into Jim’s arm. Then I disconnected the bolus from the tube and sterilized again. We did this at six A.M., at two in the afternoon, and again at ten, just before bed. His body had become a site for procedures. Mine I no longer considered.
One night Jim woke me up sometime after midnight.
“I want to give you a massage,” he said.
Not without some effort—everything required effort now—he lit three candles. He must have planned this, because the massage oil was there on his night table: I lay back on the bed with the moonlight coming through the window.
He knelt over my body. I have to believe every inch of him hurt. Slowly … everything was slow … he poured the oil onto his hands. He began to touch me. I lay there on my back, looking up at him in the moonlight—his face, so deeply lined, his hands, familiar to me as my own.
The thought came again, as it often did now. Remember this moment.
Jim’s friend Jay came from Cleveland. His cousin Helen from Ohio, the only child of Jim’s beloved Uncle Al. We ate lunch on the patio under the last of the wisteria, Jim wearing a sweater with a fleece over it, and his Patagonia jacket over that; also a hat. The thermometer read sixty, but he was cold all the time.
He had told me the stories, many times, of fishing trips in Minnesota with Uncle Al, times the two of them rode around in Al’s Ford Falcon convertible. At age eighty-one, following a minor elective surgery, Al contracted mad cow disease from a blood transfusion. Jim had visited him in the hospital. It had been a terrible death.
“Don’t let that happen to me,” he said.
It had been months now since we’d taken the walk we used to go on, just down the road from our house, that required us to climb over a metal gate—miles of open trail up into the hills, with views of Mt. Diablo and hawks circling. It was a good day now when we made it out into the yard and sat in our chairs with our glass of wine, watching the deer graze.
One day our neighbors stopped by to tell us there’d been a rattlesnake sighting on the trail. Next week, the dirt was dug up under a stand of aspen, the work of feral pigs. The week after that, another neighbor’s dog was attacked by a mountain lion. It felt as if the animals were winning here.
The Warriors were in the playoffs and our friends Karen and Tom, who were season-ticket holders, gave us two tickets courtside. I gave mine to Kenny, texting him three times during the game to see if Jim was doing OK. Kenny texted me a picture of the two of them—father and son—in their matching yellow Warriors shirts and Warriors caps.
“You cannot imagine how great it was to be sitting there with my son, right down on the floor,” Jim told me after. Steph Curry, the star forward for the Warriors, was a particular hero—master of the three-point shot, dropped in the basket in the last seconds of a game. Steph Curry was six foot three, but because the other players on the team were so much taller, Jim called him a little guy, like himself.
“Next time I’ll bring you, baby,” he told me.
A text message reached me. For a moment I could not recognize the name of the sender, Billy, but then I remembered: He was the young parking valet to whom Jim and I had given the keys and title to our red Plymouth LeBaron. The car that had transported us across Maine, New Hampshire, and Vermont—with the wind in our hair—over the happiest summer of our lives.
He still had the LeBaron, he wrote. He had rebuilt the engine, fixed the dents in the body. That winter, Billy and his buddies had driven the car all the way to Florida with their golf clubs in the back.
With no idea of the cancer, or anything else, he just wanted Jim and me to know that out on the eighteenth hole, he had been thinking about us.
I called up a woman I’d met at a party one time, who’d told me if I ever wanted olive trees to let her know. She had some to give away.
A week later I planted them. Thirteen trees, out on the hillside where we’d always planned to put them. The day we set them in the soil, Jim said he wanted to walk out to see them.
“How long again, till the first crop?” he asked me.
Five years.
Then there was the matter of the fifth season of House of Cards. Over recent weeks we’d gotten through every episode of season four—me, with a sense of dread, as if the conclusion of every episode served as another step in some unnamed but ever-present countdown.
“When does season five start?” Jim asked, as the credits rolled for the final episode of season four.
Next fall.
One Sunday, he wanted to go to church. When it was time for Communion, he got up from his seat on the pew. Later in the service, the priest asked if there was anybody the congregation in need of special prayers that day. I knew Jim would not want to be singled out, and so said nothing. I had been saying special prayers for quite some time by this point. But the only time I said them out loud was when I drove alone into town. Usually to fill prescriptions. Or to call Pam or Deborah—the two friends who understood better than anyone else what it was to watch the man you loved eaten away by pancreatic cancer.
96.
On his desk one day, I found a list. It was written on a scrap of notepaper. The heading: Places I Want to Go with Joyce.
Idaho—all the national parks.
Hiking in the Dordogne.
Hiking in Scotland.
A bike ride. Flatter trails. Cambodia?
Prague of course.
Greece. An island.
A barge in France.
Italy, anywhere.
India. Same.
The Galapagos. Turtles!
The Owens Valley. Stars.
97.
I had exhausted all reasonable options, and all the farfetched ones too. We were looking for magic now.
Not even that. I no longer believed I could find a way to save Jim’s life. But living as we did by this point—with no remaining prospect of chemotherapy—was harder than any surgical procedure, more brutal than the effects of any chemotherapy infusion. Nothing else had been too much to bear, but this was.
Over the eighteen months that had passed since the diagnosis—hard as they’d been—we had been able to hold on to some crumb of hope. And even now I wanted there to be something we could do beyond waiting for Jim to die. It seemed clear that whatever it was would not save Jim’s life, but I wanted him to feel, at least, that we were doing something about this.
A dead duck, he had said. Am I a dead duck?
If there had been a website for ordering magic potions I would have logged in there. As it was, I put a note on my Facebook page—a community that had grown to many thousands of readers over the months I’d been writing about Jim and me. I asked if anyone might be acquainted with a woman who had delivered a baby within the past seventy-two hours who might be willing to send us a very s
mall amount of colostrum—the first thing that comes out of a woman’s breasts, before breast milk, when she begins nursing a newborn.
I had not read any research or articles about this. There were no outlier healers suggesting that colostrum might cure cancer or even infection. It just seemed to me, when I considered what might best constitute a truly miraculous elixir, that colostrum would come the closest to filling the bill.
A dozen women wrote back offering to express mail us their frozen breast milk. One of these women still had colostrum.
The package arrived by FedEx two days later, packed in dry ice. Jim took a picture of me holding the precious vial, and then I took a picture of him doing the same. The quantity no more than what might fill a shot glass.
And what purpose did this vial serve? Almost certainly, none. But if the colostrum served to do nothing more than to offer us a little dream for a moment there, that was reason enough to down the contents. In a single gulp he did.
We returned to Michael Broffman—to the beautiful office with the wall of wooden drawers containing mysterious herbs and dried Chinese mushrooms, the Tibetan prayer flags, the sound of water running over stones.
He had prepared a list of options we might try—the focus no longer on eradicating cancer, only beating back the infection as much as possible.
It had been over a year since we last visited the Pine Street Clinic. Jim had probably weighed twenty pounds more than he did now. But there was more to the change than his weight: His gums were pulling away from his teeth; his eyes had taken on a deep, penetrating gaze—a look I remembered from that National Enquirer photograph of Patrick Swayze in the final days of his struggle with pancreatic cancer, as if his vision now allowed him to see things none of the rest of us did.
No doubt this was not the first time Michael Broffman had sat across from a person with this look. This room had been one of our first stops on our quest to save Jim’s life. Now it would be among our last.
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