Seven: The Women’s Poetry Salon, April 25th, 2009

Hobee's May 20, 2006

Saturday, I attended the women’s poetry potluck and Salon that I am a member of. It meets every six weeks or so, and people take turns hosting. The group consists of women in their 40s and 50s mostly. Among them, I am one of five whose partner or husband have had cancer. Two lost their husbands years ago; one remarried a few years back, while one recently remarried. Another shaved her head in solidarity with her husband’s chemo. He is doing fine after a second round of treatment. The other has recently started dating again after losing her husband years ago. It was she who hosted the salon.

She was a woman with thin blonde haired who I last saw at one other Salon, and who read erotic poetry. This time, she read a poem called “9 Types of Fog.” It told the story of the cancer her husband suffered and died from.

 I searched her out in the kitchen during the break. We stood near the stove in the cozy room, with walls inside painted a bright yellow, windows facing out to trees.

“What kind of cancer was it?” I asked.

“Colon. It came back after they tackled it, spread to his liver, killed him,” she said.

She explained that she had two sons, now outgrown the house, and so she lived here alone most of the time. She gave me names of two friends who had gone through colon cancer, with bags, both local.

You would never know from the outside of this humble house that so much went on. The yellow kitchen screamed bright cheerfulness. Tibetan Tonkas hung on the walls of the living room. 


As usual, we all read two poems aloud each, testifying of strength within, among copper statues of buddha and built-in bookcases. Eight years after her husband's death, she spoke in the poem of fog, how it infiltrates. And she told of how her son’s hamster, at the time, was preyed upon by the owl which flew by their windows—too close.

I wondered when life became ordinary again after that time in her life when the fog clung to empty webs. 

Six: Dr. Thomas, Kaiser Oncology April 24th, 2009

James Irvine Trail August 2008

Dan was against radiation— how it made the patient sick, weak, nauseous, incurred hair loss and weight loss. Why would anyone willingly submit themselves to it? The poster child for a cancer patient is this, with a wig (think breast cancer.)

The oncologist, Dr. Eva Thomas, met with us across the street at Kaiser’s old oncology department. 

Dr. Thomas was well-dressed, a vision of black, white, and gold, with her skirt and top, and matching jewelry—not flashy, but not stuffy either. She led us into a large examining room which had a bed off to the side and several chairs, as well as a table. We all sat on chairs, at equal height, a first. This was a discussion, not an examination. I felt like an adult, rather than a child being tended to by a parent. My legs were not dangling from a little high bed—they touched the floor firmly.

Dr. Thomas talked to us frankly, echoing Dr. Goetz.

“It’s not standard for someone with stage one to have oncology treatment,” she said.

In the back of my mind, I was still entertaining the idea of a transanal excision, partly because I had read on the CC Connections website rave reviews from people, mainly women, who had success with it.

She spoke clearly, explaining that chemo worked with radiation, augmenting its affects. Radiation would proceed for about five weeks on a daily basis. The chemo is a chemical inserted into a big vein in the neck during radiation. The 5FU chemo, she said, did not result in hair loss. But diarrhea, nausea, abdominal pain, and mouth sores were to be expected. Another chemo option, Xoloda, a pill, could be taken by mouth two times a day.

“Let me know what you decide,” she said, as we shook hands with her.

We walked out of the building and around to the garage to get the car.

“ I don’t want to be a cancer patient," Dan said.

He saw the colostomy now as Dixon presented it to us: Dan was an otherwise healthy, fit man who enjoyed walking and wanted to be able to do a ten mile hike if he wanted, without issue, and no leakage. Dan didn’t want to invest in the medical system physically or emotionally any longer than he had to. He didn’t want to risk the resection, with its ominous potential problems. 

Five: Dr. Goetz at Kaiser, April 24th, 2009

Monterey Coast December, 2008

Where Dixon was brief, his colleague Dr. Laura Goetz was expansive in her explanations. While he described one route, she opened up the map, allowing us the feeling that we were deciding. She was a woman, and whether or not that alone translated into breaking the paternal model, I do not know. Unlike Dixon, she came from a liberal arts background. She and her sister, we read on her Kaiser bio, had spent time helping others in Africa. Her long brown hair was wound on the top of her head. Her dark brown eyes focused on you, the patient. She spoke, and then listened. Actually listened.

“It’s your choice,” she said.

Beyond paternalism, Goetz broke the model for me on what a good doctor should be—her patience, her focus, her combination of professionalism and down-to-earth ease. I would want her to operate on me, not Dixon, I told Dan after the appointment. He was in love with her too. She blew our minds. She asked Dan what had brought him in to see his doctor in the first place—in other words, how was the cancer discovered. Dixon had not asked. She dismissed Dan’s General Practitioner’s diagnosis of acid reflux with a guffaw. She wanted Dan to tell his story, like a good listener does, drawing him out.

She examined him, the “digital exam,” which means the doctor sticks a finger up the anus. Dan was used to this by now, the literal prodding and the need for more information.

Our questions stemmed from our considerable research on options other than radical surgery. The anal excision did not remove of as much tissue and was an outpatient treatment. That, in combination with radiation was one option.

“No,” she said. “It isn’t typically used for this diagnosis.”

She reminded us of the behavior of the lymph nodes, which direction they spread.

We asked her,” What if we did nothing?”

She said, “You can look at percentages, she instructed, but beyond that you have to make your own decision because you don’t know where you’re going to fall—in the 30% or the 70%. I’ve had five patients who have gone off to Asia or Europe to do alternative cures, all with early stage, and who have all come back with a more advanced disease.”

I asked Dr. Goetz about another surgery I had read about and seen touted on the chat sites, “T.E.M,” excising, different than the transanal excision. T.E.M. takes no lymph nodes—just the area around where the polyp was found. This was another sphincter-saving operation, like the transanal excision. Those muscles at the anus—so valuable, people risked cancer turning to spare them, as tissue was left behind. 


She said we would need to consult with an oncologist and radiation oncologist. After the T.E.M. procedure, she told us, they would do an ultrasound of the anus to see if the lymph nodes had enlarged. This had a 75 – 80% chance for telling the truth. “Close surveillance” meant ultrasound every few months for 2-3 years. The follow up would also involve 1-2 other excisions in the operating room—not just a minor procedure, in other words. T.E.M., she said, takes the full thickness, a segment of the rectum. The upshot: 10% of the cancer returning with a minor operation, and 100% guarantee for return if one did nothing. She also warned that the Kaiser oncologists would most likely resist doing radiation for stage one cancer, as an adjuvant therapy—it was used with stage 2, stage 3, stage 4.

We still had an appointment with the oncologist later that afternoon, which we would keep, but after talking to Dr. Goetz, the lay of the land was clear. I now saw that radical surgery was the 98% solution. I wanted to make amends with it, imagine it. 

Four: Dr. Dixon Second Consultation, April 17th, 2009, Salsa and the Aftermath

While our first consultation with Dr. Dixon did not inspire much confidence in me— his certainty, little discussion, and his sudden disappearance— our second meeting with him proved more auspicious.


Rather than scrubs, he cut style in slacks and a shirt with a tie under his long white coat. We were his last visit for the day, and he was on the verge of his week-long vacation, we knew. But the tie? Bold green and blue, shiny wide stripes, it stood out against the subtle green shirt, the deep blue of the tie reflecting his eyes. Not suitable for a business meeting nor daily business, this tie screamed "social activity." He looked a little swank for the likes of Kaiser. I theorized later that he had a dinner engagement. File the tie under the Lives of Doctors, the encyclopedia.

We asked Dixon if we would be able to take our trip to England as planned at the end of May.

“I don’t see any reason why you can’t do it,” he said, as confident about that as anything else.

We asked about second opinions. Dixon recommended we talk with his colleague, Dr. Goetz, also at Kaiser, formerly of UCSF, almost like an outside opinion. We said we were going to get an opinion from UCSF itself, but would be glad to talk to Dr. Goetz. Additionally, Dixon said he would confer with someone else outside Kaiser, a man named Dr. Garcia-Aguilar.

When we got home, we discussed the meeting. Dan seized on the validity of the colostomy, what Dixon seemed to prescribe over the resection. The colostomy would entail taking the colon and creating an opening, or “stoma” where a bag would attach outside the body, near the belly button. The entire section of the colon, and lowest part called the rectum, would be removed, as well as a "margin" of surrounding tissue, which held the possibly cancerous lymph nodes. The rectum opening, then, would be sewed up, no longer useful since the waste would be re-routed to the “stoma.”

We take the rectum for granted in our daily function was the rectum, with its storage area, and the anus too, which its sphincter muscles. Dan suddenly valued all this now that he was going to lose it. What an amazing system, we thought, and it was funny how we suddenly loved it. The brain controls the sphincter muscles in the anus, one on either side. This keeps the waste produced over time in storage. Without a sphincter the brain doesn’t know where to send its signals, and leakage becomes dangerously imminent. The lowness, then, of the cancer site, was more crucial to our decision than the “stage,” ironically. If the polyp had been found in the sigmoid colon, the curved section next up from the rectum section, or in the colon itself, above the sigmoid, then a resection would have been a certainty and we wouldn't be talking about a colostomy bag.

Dan’s disbelief made sense. When someone tells you need radical surgery, but you have such an early stage cancer it may not even have spread, let alone be causing real symptoms other than what you thought was gastrointestinal burning, how can you not look at them and think they’re crazy? Earlier he had gone in to see his G.P. in February complaining of stomach problems and she prescribed ant-acids. At least she also ordered a sigmoidoscopy, where the two polyps were found—one a tiny pebble-size, the other large enough the for the room full of staff to hush suddenly, and then step in to another room to talk, Dan lying on the table, ears open, heart pounding.

The rest of that week, as our hope of normalcy disappeared, we chose research and second opinions over the trip, and with this decision something to look forward to was lost. I canceled the accommodations I had booked in the Cotswolds, York, and London. In spite of this reality, I still fantasized about even extending the trip for a few days so we could add in the Lake District, a great place to go hiking. I thought, we could go to Amsterdam, then Belgium, then Paris, Normandy, and then fly out of Paris. I wanted to be poetic, dream and write, but I couldn’t really during this time of pragmatism, questions, and research. 


Too many people reassured me it would be okay in the end. This was not useful to hear. I wanted answers, real help. I said to Dan that making the right decision was more important than rushing. We needed time to do this right. Pressure at Dan’s work to be productive was met by the response from me that he needed to make the Kaiser appointments and work from home on those days. They would have to understand. Sometimes he had one test, and sometimes he had two or three appointments in one day. It varied, with blood test, CAT Scans, ultrasounds of the rectum and liver, which I didn’t join him in, and consultations, which I did. The upside— it was a bonus to spend time during the weekdays together, discuss options, make decisions, do this work. And we worked well together.

Dan said he was going to have the radical surgery for his kids and me. Otherwise he would do nothing, he said. I later heard in my partners support group that this is a common statement. But at the time, it disturbed me that he wouldn’t want to do it for his own life. It was hard to hear.

One day, at a lunch break during a busy day full of appointments at Kaiser, we sat at the taco shop nearby.

“We should get married,” he said.

I spilled salsa on his pants leg, the red chunky sauce dripping down the tan material.

We talked about legal rights of partners, of wills, of social security. What if he were to die? This was the implied question lurking underneath. Me, who never intended on marriage, and he, who had been married for twelve years but irreverently, eloping with her because their landlord thought they already were.

The result of this discussion: he put me on his checking account and added my Social Security number to his work’s life insurance policy. Dan said he felt like he was preparing to die, writing a medical directive— getting his “affairs in order,” as he put it. I said it should have been done before anyhow, but it was hard for me to respond to his morbid frame of mind. When we talked about getting married, I wasn’t thinking about doing it because he was going to die. I was responding to him, and that arose out of the legal issues. My mother collected my father’s social security after he died because it was larger than her own. The idea of marriage arising out of something negative bothered me, though, so I had to reassure him.

“You would marry someone with a bag?” he said.

“Not someone—you.” And I responded with a kiss.

Three: Research Blitz, April 2009

Amtrak to Davis July, 2008

That first consultation gave way to research. This meant books for me, every one that was available in the Alameda County Library system, and medical journals for Dan, the technical mind. I had been a graduate student recently enough that I could be efficient and systematic in going through a swath of information.

More bad news resulted from our research: possible loss of sexual function with trying to connect the large colon down to the rectal area after having taken the rectum out. In pictures, the large colon looked like a vacuum cleaner tube, and it was easy to imagine stretching it down to the bottom of the body because this tube could expand. Even without trying to reconnect it, there would still be loss of bowel function. The bottom line was the reading of the carcinoma by the pathologist. We needed another reading or two.

Ironically, one of the books I got from the library during this frenzy outlined two possible methods of research: one, do things one step at a time; two, do everything at once. The reasons behind the two had to do with time. How much time a patient has is everything because when you find out you have cancer it’s urgent. How can it not be? You respond according to the doctor’s own response to your diagnosis. If you fall down one day in a grocery store, like one member of our support group did, your doctor tells you have stage three colon cancer and you need surgery immediately, the next day. In his case, he wandered around for a couple of days in disbelief before taking it seriously.

For someone like Dan, with stage one, early rectal cancer, there was still urgency, partly because of the word “cancer,” and its serious import. Mostly this urgency was due to our trip to England. If we acted quickly, made the right decisions, and Dan had the surgery and recovered in time, we figured we could still go on our trip at the end of May. We had already re-booked our tickets once because of his daughter’s college graduation, which we found about after-the-fact, incurring a penalty. Besides, rescheduling or canceling the trip would mean the cancer had won something from us. Our mental state and energy revolved around keeping the trip, period. As long as we focused on that as our goal, we were in a research blitz.

By the time I saw these two methods outlined in the book, we had already done most of the work, studied the jargon, knew the terrain of the polyp, how the carcinoma looked, its tree-like growth emanating, the parts of the large colon, the nature of the lymph nodes in that area and how they move out and down, different, for instance, than the breast area, which has lymph nodes that move erratically in any direction.

I called Judy Schwartz, old family friend and daughter of Joanne, who in her 80s had been operated on by the same Dr. Dixon a few years earlier. My mother knew Joanne for 50 years. They met in the library program at Columbia when they were young. Judy spoke highly of Dixon, who, she said, treated her mother as if she was his only patient. Surprised to hear that the doctor went to lunch in the middle of our first consultation, she said, “I guess he’s busier now.”

My reading revealed the relationship between doctor and patient, and how today’s model has moved away from the paternalistic one, where the doctor instructs the patient, and the patient listens. Instead, the patient should aspire to gain knowledge, ask questions, and work towards a two-way relationship with his doctor. A couple of books even provided questions to ask and how to create this healthy interchange. The reality, of course, must vary in the doctor’s styles—who they are as people, which model they were educated in, and what they were interested in now.

The surgery that appealed to me more was the resection. They used metal clamps now in resection, which we learned about from Dixon; much improved from the plastic ones, they enabled the rectum to be functional once the temporary stoma, in a second surgery, was "taken down".

What became clear over the weeks was that because the site of the polyp was so low in the rectum, the resection would not only be difficult, but there wouldn’t be a guarantee that it wouldn’t leak. This could cause an emergency visit to the hospital room during the first few weeks. Or the procedure could not be successful, causing the patient to permanently use a diaper. During one trip to the local grocery store I found myself wandering past the adult diaper section and the reality set in. Why would anyone take a chance and have to wear one?

What struck me, too, was the barbaric nature of these operations, reminiscent of removing a woman’s uterus, the standard treatment for many years. These were strategies for not dealing with the cancer, for evading it. My concern was that radical surgery would alter Dan’s life too greatly. Worse, if we did nothing and the cancer developed, then we would have a bigger, more life-threatening problem on our hands.

Dan did not say he canceled the plane tickets and I did not ask. Dixon said he wouldn’t want to wait until June to do surgery, that if we were going to do it we should do it sooner. I thought what they needed at Kaiser was a health-care coordinator to make all the related areas flow together smoothly, someone who is a people person, friendly, with good energy, and with professionalism.

Then, one night, Dan and I were read a book together (literally together, sitting on the bed, turning pages) on a diet which balanced acidic foods with “normal” foods. The book was from his co-worker. We laughed initially, saying the book was hokey, but the ideas made sense, incorporating whole, fresh foods, as well as a few bad ones, a realistic approach. The authors, a husband and wife, dictated to start with a cleanse and then eat whole vegetables and grains. They said they gave up sugar and sugary foods, which happened as a natural matter-of-course with this program. The problem with the book is that it made radical claims about the curative properties of the diet.

First-hand case studies represented success stories. The mistake here would be in thinking that the diet alone could work magic against cancer. Doctors in hospitals aren’t excited about the idea that supplements or diet alone can make cancer go away. The book, however, did make us think more about our diets. I had cut out animal products completely the previous fall, to great success, but sugar was my addiction and my enemy. Dan ate reasonably well also, and was thinner. I was worried about him getting any thinner and dissipating.

I found an ad for a teaching position in Micronesia, and we joked about moving off the map, changing our names, and forgetting about the diagnosis. It was early stage, the polyp not verging beyond the colon wall, only touching it, so we had disbelief that any of the lymph nodes, carriers on the bloodstream highway, could have the cancer. No one had yet told us that denial was healthy, necessary in order for one to function. We thought denial and disbelief were counter to our purpose, unhelpful enemies, so we joked about moving far away. I kept to task. Dan wavered from denial and depression to being motivated to find out more about his condition. In some ways, he was more easy going, less rigid. More distant yet closer. When you don’t know how much time you have left with a person, everything makes more sense. Just like when we first met, when distance melted away.

One evening, I came home to find Dan sitting on the couch staring at the computer screen. This was not an unusual activity, but he didn’t seem to be doing anything. He had found a study pointing to impotency as a result of either surgery because it disturbed the nerve endings in the anus, which communicated with the brain. Dan looked like someone who had been shot, eyes dull, shoulders forward, staring at the computer screen.

Normally full of reassurance, I could say nothing except, “let’s find out more.”

“That’s enough research for now,” he said.

A year earlier, we had sat in the same spot while my cat was given a lethal injection by the visiting vet. I had made the decision through her failing health. She probably had lymphoma, on top of the kidney condition, pancreatitis, and reoccurring fluid in her lungs, the latter which filled even her limbs in the end. Dan had said “she’s perfect.” I thought of this as we sat there on the same couch, without my cat this time, in silence, and in shock.

Two: Dr. Dixon First Consultation, April 10th 2009, or Location Is Everything

With the Badger, 2006

We had our first consultation with the surgeon, Dr. Dixon, at Oakland Kaiser. He was recommended by Dr. Moff of Santa Clara Kaiser, where Dan had the sigmoidoscopy his doctor had ordered and the colonoscopy following it. We had researched Dixon on the internet, and found that he had done extra years of residency in his specialization of colorectal cancer. A hotshot in his field.

We sat in the outer waiting room for thirty minutes, staring at the large fish tank. A couple pairs of smaller fishes with fluttery fins swam by. Eventually, a large fish the size of two fists came out from its hiding place behind a rock. I called it “Figgy,” after Dan’s cat because of the slow trajectory it made in reaching the other fishes and swimming around them. I had two magazines on my lap and gazed, one opened, not read. Finally, a nurse called us in.

“I’m Virgie,” she said. “I work with Dr. Dixon.” She apologized for the wait, and said the Dixon was behind. Virgie was a petite woman with the kind of smile that one wears all the time. At least, this is what I seized on during our dealings with her. Her movements were quick, as if her work was easy, no problem.


“He schedules all his own appointments, she said, as if to explain his lateness.


Why would a surgeon do that, we wondered, rather than having someone below him do it? What was her job? Was she his assistant in some medical way, or did she just show patients to the inner waiting room?


The inner waiting room was tiny, with one bed and one chair computer monitor on a high stand, sink, boxes of neon blue gloves and lighter ones. In plastic slots on the wall, were a stack of brochures about the colostomy procedure, which, we found, leafing through one, showed pictures of men playing golf and a couple ballroom dancing. I put the brochure back in its place. We both sat on the bed, rather than my sitting on the adjoining chair, with hands interlocked.

Some time later, he swept in, his compact form and slight stature appearing to just fit into the light blue scrubs. He exuded confidence.

“Mr. Dickinson?” he said, shaking Dan’s hand. He shook my hand as well, wordlessly, not asking my name.

Dixon placed himself on the chair facing us, shaking his left leg the way a boy who has too much energy does under his school desk.

We had prepared questions for this appointment. I had brought a notebook to write everything down in.

Dixon did not meet all our questions. He did not know where the site of the polyp was.

"Isn’t it in the record from Dr. Moff?” Dan asked.

Dixon didn’t have it, and had brought nothing to this consultation. He wanted to do a brief sigmoidoscopy to “tattoe” the spot, so it didn’t get lost. This meant marking it with a kind of ink.

Location is everything. We had been looking at the piece of paper from Santa Clara Kaiser enough to know where the site was located in the rectum, and would have brought this evidence if we had known it was needed.

Dixon drew pictures on a piece of paper, demonstrating the area that would need to be cut out. He spoke the words “colostomy” and “radical surgery,” stunted in the small room. “I’ll remove the rectum and surrounding tissue,” he said.

Meaningless, abstract words, they did not apply to us.

He gave us one of the pamphlets and flipped to one of the pictures of the insides of a body, and he circled the area of concern with his pen.

“Why early stage yet radical surgery?” Dan asked.

“It’s because of the nature of the polyp, ‘poorly differentiated,’ a more aggressive type,” Dixon said. This meant a 10% chance of the cancer coming back into the lymph nodes.

When Dan pointed out that the biopsy had yielded the result of “moderate to poorly differentiated,” Dixon said to focus on the “poorly” part. Surveillance of the disease was a constant—who would want to live with that? Dixon said we should go home and discuss it, and consult with him again.

We said we wanted him to order the CT scan as soon as possible so we could schedule the surgery, whichever procedure Dan would decide on. We were intent on doing the trip to England.

Dixon said, “I’ll be back in a minute—just need to check my calendar.” He left the room.

Twenty minutes later we wondered how much longer we’d be waiting. I ventured out into the hallway, realizing I didn’t know which way we’d come in, as good a sense of direction as I have. The place was like a rabbit warren, with two long parallel hallways and numerous perpendicular shorter hallways. I saw a nurse sitting in an office.

“Excuse me. I’m looking for Dr. Dixon,” I said.

She smiled. “Let me find out. Which room are you in?”

I went back to the little room.

A knock on the door. ”He went to lunch,” she said.

I asked about Virgie the nurse. The woman went out to find Virgie.

“She went to lunch too,” she said softly, breaking the news. She apologized and offered to look for his appointment book and see what she could do.

We waited some more. Finally, she returned, saying we would need to get in touch with the doctor ourselves to schedule our next consultation. This seemed to confirm that he scheduled his own appointments, if this nurse couldn’t find the book or decided she couldn’t make the appointment herself without Dixon’s okay.

This was not the last time we would see Dixon, and not the last time we felt blocked in getting work done as quickly as possible. When I spoke to Virgie on the phone later that day, trying to make sure we couldn’t book the appointment through her, she said Dan should talk to Dr. Dixon about it.

Getting the scan done took weeks. It had to happen before the surgery could take place. Scheduling anything at Kaiser was impossible. Working with a large entity like Kaiser is humbling because unless you push hard you don’t get anywhere; at the same time, you don’t have a lot of control. Asking questions and being really nice helps. Even if one desk person is not in charge of a something you are trying to get done, they may know who to call about it.

Doctors, too, have to deal with scheduling, on their end. They are at the mercy of long, complicated surgeries, appointments which last longer than the allotted time, which bleeds into another patient’s time. Not only did Dixon disappear in the middle of our appointment, but he was late for it as well, late enough for Virgie to apologize.

They don’t tell you anything ahead of time for these meetings, as if you’re supposed to just go willingly along like a child, trusting in the medical staff completely. I had such anxiety before the whole thing. We were hungry for more information, bringing our questions with us. I ended up looking online later to find out some answers. Dan would need to go in for the “minor” sigmoidoscopy, as Virgie called it, the following week. We could do the scan tomorrow after that appointment, if the doctor would only order it. 

One: Stages, Diagnosis, March 2009

Mills College MFA Reading May, 2006

Stages

Where to start. The diagnosis or before? How a life together takes shape the moment you meet. He stretched out his hand and said, “I’m Dan.” Someone who ordinarily lived in a shell, who saw his brother Pete shake my hand down at the river the previous day, but couldn’t budge from his spot at the Big Rock. The next morning, we met in front of the Lyons’ campsite. I was camping with them, our mutual friends. Then we were both swimming in the river, and he was wearing his scuba mask, and I asked him to hike the next day. Four years later, we have survived his cancer, what has amounted to an experience that was part shared, part not. For months my journal stared up at me, blank paper, until prior to surgery when we joined the support group, and another patient encouraged writing, which was all I needed.

I’ve always resisted classifying the human experience. People have a need to put things into groups, organize thoughts. Sometimes this is a useful endeavor. The self-help books say that when someone dies, those who remain go through stages of grief. I understand organization, indispensable in my life, enabling productivity and sanity in the midst of demands and chaos. But stages, I’ve resisted them, pulled away from the assertion that anything reasonable can be said about grief and loss. The same goes for cancer. These don’t seem like stages, but items, appointments. Here, I’ll put it into the “stages” we went through:

Diagnosis

Consultation

Research

Cancel the trip to England

Consultations with other surgeons

See an ostomy nurse

See an oncologist

Ostomy nurse

Go away for a weekend

Set the surgery date

Second pathology report

wait wait

Ostomy nurse

Patients support group

wait wait

Summer school begins

Surgery

A week in the hospital

Weeks at home recuperating

Partners and Patients Support groups

Working from home

Camping

Back to work

Diagnosis March 31^st, 2009

That day, the day he found out, my life was without meaning. Still in the wake of the death of my cat Cleo a year earlier, my vision was darkened, a shade separating me from the world. That day in particular felt lifeless. After teaching my English classes at Laney College, I got off Bart and went food shopping at the Mexican grocery store. Usually I would walk all the way home from there, but, tired, I took the bus. As I walked up the street from the bus, I saw flashing lights in the distance. Were they near our house? I couldn’t tell. Walking faster. Dark red. As I got closer the light became lights, the emergency vehicle became clear, a paramedic unit. A couple of men in uniform were talking to neighbors up the block. Relief. It was not our house.

Legs shaky, I hurried up the steps and opened the front door. Without missing a beat, I started preparing dinner, jambalaya, one of Dan’s favorites.

I was upstairs when I heard him turn the lock. I came downstairs to greet him. He said, “I have to talk to you. Upstairs.” Why upstairs? Because it was where we spent time during the colder part of the year.

You know how you just know?

He said the polyp was cancerous.

He said, “I don’t know what to do.”

I held him. I told him, “It’s going to be okay.”

What spiraled from that moment, a point of unreal, a lump in my throat too large to digest, was a new reality, undeniable, something I couldn’t ignore.

Everything was shaped by this diagnosis. On Bart the next morning, on my way to school, a guy sat in back of me talking on his cell phone, shouting, “Fucked up! This guy hit me bro!” Then it was the other guy’s turn to talk, this one suddenly quiet. I was still in a state of shock, and like someone who takes a shot of whisky when bad news happens and does not feel the affects of it, the dialogue behind me went through me and left without a trace. Normally, it would have revved me up or at least entertained me.

The weekend following the diagnosis, Dan and I spent a lot of time together, like when we were first involved. We didn’t do much—walked around, ate out. We talked of life insurance and health directives, of wills and trusts, of his kids and me. The health directive would ensure his wishes would be carried out. Since I wasn’t his wife, I would have no power over anything. Sunday night he said, “It felt like a second honeymoon.”

He seemed to be doing okay, but then, later Sunday night right before bedtime, he said “I ran out of positive thoughts.”

“It’s okay,” I said.