“And I have a fine Madeira,” I imagine her replying while surreptitiously handing me some microfilm.
Instead, she tells me to take a seat where I wait dutifully until an oncology nurse fetches me. It’s my first post-treatment check-up and as with all my doctor’s appointments, bloodletting is the first order of business, something easily and efficiently accomplished via the port buried in my skin under my right clavicle.
After leading me back to a small curtained booth, the oncology nurse first flushes the port (instantly filling my mouth and nose with the smell of Liquid Hospital) then begins taking blood, chatting all the while about her twin sister, a radiation oncologist in another city (“She’s Beam-O and I’m Chemo,” she tells me. “Beam-O and Chemo, get it?”).
After she has what she needs, I go back to the main lobby and loiter until yet another oncology nurse comes out and escorts me into the inner sanctum, where I’m weighed, cuffed (blood pressure not hand) and asked questions about everything from my sex life to my bowel movements.
“I’m a little nervous,” I tell her, after the Q & A is over. “This is my first post-treatment appointment and I don’t really know what to expect.”
I’m lying, of course. What I expect is that my oncologist will take one look at me and hand me a Get Out of Cancer Free card. Or maybe a diploma or certificate or testimonial like the Wizard of Oz gave the Tin Woodsman. I’d be equally happy with a report card stating that I’ve just graduated from Cancer U with all A’s (pending my extra credit Reconstruction homework). I want something, though. Something that confirms that the boob loss, the bone pain, the radiation burns and the hair loss — god, the hair loss! — have all been worth it. That I’ve kicked cancer’s ass. That I’m done.
The look on the nurse’s face indicates that some of these expectations have been spoken aloud. Which is when I start to get the feeling I’m not going to be told “Good job, well done.” In fact, the look on her face makes me wonder if there is such a thing as done.
”The doctor will be in in a minute,” she says, getting up. “She’ll explain everything.”
A couple of minutes later, my oncologist opens the door and we chitchat until I can’t take it any longer.
“So am I cancer-free or what?” I ask. “Am I cured?”
“We don’t really use the C-word around here,” she says, speaking slowly, like you would to a person with a recent head injury. “You remember when we talked about recurrence? When we went over the statistics?”
I remember. The chemo cocktail I chose — taxotere and cytoxan — offered a recurrence rate of 12%. The other cocktail, the one that contained adriamycin (aka the Red Devil) had a smaller recurrence rate (10%), but upped your risk of heart disease. And as they say in Skagit Valley (where I grew up), my family has bad tickers up the ying yang.
“Some of the breast cancer survivors I talk to on Twitter have mentioned something called NED,” I push. ‘”That whole no evidence of disease thing. Can I at least get an NED?”
“You’re low-risk,” she says at last. “I have other patients I’m a lot more concerned about. But really, what you need to do right now is just focus on healing. You have a lot of emotional healing to do.”
She then starts to tell me the lay of the land. I don’t know it at the time, but the country she describes has a name. Limbo Land.
I listen as she talk about how I’ll be coming in every three months for what sounds like the rest of my life. Just like today, they’ll take my blood to look for tumor markers and such. My job will be to tell her if I develop a weird persistent pain. Or become short of breath. Or start coughing a lot.
Metastatic breast cancer, I know, occurs most often in the brain, the bones, the liver and the lungs. (I’d memorized this my first day of cancer class.)
“Your test results will be back tomorrow,” she says, after spending a few minutes checking out my glowing red chest. “I’ll call you when they come in.”
“Okay,” I say, wiping my eyes. Somewhere during the exam, I’d started crying. I always do when reconstruction comes up. Apparently, I’m still mourning the loss of my girls. And praying that I’ll be able to salvage what’s left of them (i.e., my left nipple and skin) although I’m in Limbo Land there, too. I have no idea if my irradiated skin will hold a tissue expander and implant or if I’ll have to have a series of surgeries to build a new left boob. This will be determined by another doctor, another time.
Right now, though, it’s time to leave. Sans diploma.
I blow my nose and get dressed and make my next follow-up appointment with the receptionist out front. Then I lurch out of the office, trying to remember the important things that were said, only half of which I managed to write down, as usual. Once I get back to my neighborhood, I duck into my favorite watering hole and practice coping mechanisms for a couple of hours. Then I go home and try my best to keep my head from exploding.
The next morning, my doctor calls and tells me my white cell count looks great. Ditto for the tumor markers.
“They were 12,” she says. “Anything under 40 is normal.”
I thank her giddily (good news, at last!) and try to hang up but she has more to share. Apparently, she’s reviewed my file and noticed that my CT scan from last March showed something funky on one of my lungs.
“You have a 4 millimeter lung nodule,” she says. “It’s probably just scar tissue but I’m going to have you come back for a CT scan in March.”
Okay, I say and put down the phone.
I was hoping for a testimonial. A report card full of A’s. A certificate I could hang on my wall, telling me that this cancer crap was history. That it was all over. That I’d won and was done. Instead, I got a lung nodule and a cold hard glimpse at my future, a future filled with quarterly blood draws and anxiously awaited test results. A future pungent with the aroma of Liquid Hospital and hot fear. A long, endless mindfuck of a future as comfortless and abrasive as the discount tissue dutifully stocked in each and every exam room.
I’d fought my way through surgery and chemo and radiation to get to the other side. But there was no other side, I realized now. There was only Limbo Land, where there were no answers, no gold stars, no C-word (at least not the one my oncologist was referring to) – not for a very long time.
I stare at the phone thinking about how much I already hate this place, especially the sneaky way it came up behind me, squelching my breathless triumphs with a fat spiteful thumb.
And then I smile. Because it doesn’t matter whether I like this place or not, just like it didn’t matter whether I liked surgery or chemo or radiation or any of the other crap I’ve endured and overcome these last ten months.
Because I’m going to kick Limbo Land’s sorry ass. I am. And then I’m coming back for my goddamned diploma.