Left Turns, Cars, and God: Sixteen-odd years ago, as I'm driving to a grocery store, I make a left turn out of my driveway, and just as I am about to accelerate out of the turn, I hear a voice from the back seat of my car -- a voice unequivocally not mine -- say something so clear and startling that I have to turn over my shoulder to see who is talking. The voice says, "Prayer works." No one is in the car except me. And, apparently, God. It seems that God does not mind being chauffeured around by a woman who has a history of getting into car accidents. The voice of God changes my life.
Two weeks ago Friday, I am making another left turn, this time from a side road onto a rural two-lane state highway. I hear a voice -- this time unmistakeably mine -- and although I am not talking aloud, I hear myself say: "I've got lung cancer." Like that other left-turn voice from 16 years ago, this voice changes my life. I've smoked two packs a day for just under 40 years. All you second-hand smoke exposed johnny-come-lately carpetbaggers can go cheney yourselves; I came by my metastatic small cell lung cancer the honest way. I earned it.
I drive along the two-lane highway until I come to our local not-terribly-highly-regarded hospital, and walk into the ER. I have a sharp pain from somewhere deep underneath my right scapula; every spring pollen-induced sneeze makes me want to faint, and my fits of coughing leave flecks of blood on my hankies. I tell the ER doc all of this, and she listens to my chest. She sends me for X-rays and CT scan. It turns out I have pneumonia, which explains the pain and the blood, and she attaches me to an IV for lots and lots of antibiotics. The x-ray reveals nothing; I can't inflate my lungs enough for an x-ray to be useful. But something in the CT scan doesn't look right; the ER doc refers me to a teaching hospital 35 miles away.
The nice thoracic surgeon there signs me up for a bronchoscopy and biopsy, and I go home so I can properly refrain from eating for 12 hours. I come back, he does his competent thing with his exemplary bedside manner, and I go back home to sleep off the local anaesthetic. Two days later, he emails me the biopsy results. I'm a straightforward, bottom line kinda girl and I truly appreciate the straightforward, bottom line report: positive for metastatic lung cancer, favor small cell.
Instantly, as soon as I have the ER CT scan, all sorts of straightforward, bottom line type people are calling me with arrangements for this test and that consultation; I barely have time to take an increasingly hard-to-manage breath. All things are put into motion by people who've drilled the treatment protocols till they've achieved military precision. All of a sudden, I feel like the car I chauffeur God in is barrelling down the highway at 200 miles per hour.
Speed is the central metaphor for these early days. Everything is moving at breakneck speed, including the cancer itself.
The nice thoracic surgeon explains that all other cancers are tracked in 4 stages, but small cell lung cancer is so aggressive that it is only tracked in two stages. SCLC hits the ground running; it moves so quickly that it is only either limited, meaning that it is still contained within a discrete area that can effectively be treated with radiation as well as chemotherapy, or it is extensive, meaning that it has metastisized beyond an area that can safely be treated with radiation. Stage 2/extensive small cell is treated with chemo, but the cures all come to patients whose initial diagnosis occurs when they are in stage 1. Patients whose initial diagnosis occurs when they've already progressed to stage 2 can be treated by chemo but as a practical matter, they cannot be cured. The average survival for these stage 2 patients is 10 to 14 months. Eighty percent of stage 2 patients will not see two years, and 95 to 99 percent will not see five years. Without any treatment at all, the average stage 2 patient will last about 6 weeks. The nice thoracic surgeon opines that I am probably in stage two. I should be terrified. Inexplicably, I'm not.
I stand over the kitchen sink, look out at the green hills rising from the steep meadow at the back of my house, and I laugh and laugh and laugh. LMAO. RFLMAO. PMPLMAO. The pissing my pants bit is a slight exxageration, but only slight. I laugh at the pure irony of it all: I've been crushingly depressed and suicidal for the past 6-odd years. I've wished over and over again that my life would end. Not only that, but my family has collectively decided to sell the beloved farm I live on, and I've long been the lone, outvoted dissenter. The for-sale signs are up, and it's on the market. It looks like I may have bought the farm after all. I laugh and laugh and laugh. When my therapist asks whether I can keep myself safe until our next meeting, having told her the grim diagnosis and even grimmer prognosis, I laugh and tell her no problem -- I now have a backup plan.
I sit in prayer and meditation for long hours; day and night, after prayer and meditation, I can seem to feel only one thing -- a peaceful conviction that I should not seek treatment at all. I have the peaceful conviction that I should say my goodbyes and go to my Father in heaven. The prospect is incredibly poignant and oddly exhilerating. I begin calling family and friends.
I start first with a man whom I love with a ridiculous affection. He is everything that I am not; he is glamorous, urbane, well-travelled, a man comfortable with luxury, and connected to everyone who is anyone by -- at most -- a Bacon or two. Years ago, I sing him a favorite song -- Carmen McRae's version of "Come In From the Rain," and both of us feel our hearts tear a little at the same line: a man like you will always take the long road home. I love to sing to myself in the insomniac late and predawn hours. Now, whenever I sing his song in my bed, into the bleary dark, I think of him and my grin hurts my cheeks.
I call him over the Memorial Day weekend because in my habitual solitude, I've lost touch with people I love and I count on him to find them for me. He does; in a day or two, my lost friends begin calling in. I have a big family and many friends, every single one of whom immediately surrounds me with love -- wedding day love, birth of your first-born love, first kiss from your first real boyfriend love, best sacramental communion ever love. Van Morrison type Crazy Love. Two dear friends, nuns enclosed at a Benedictine Abbey in Connecticut, begin a series of conversations with me; they are unafraid of end-of-life transformations and, in fact, they both insist that I take the prospect of grace-filled transformation seriously. One of the nuns is my own blood sister with whom I've been estranged for years. The old feuds drop absolutely and effortlessly away; what's left is a lifetime of fierce and mutual loyalty, and intense -- sometimes too intense -- love. The conversations are intense, difficult, troubling, searing, enlightening, urgent. Both women, backed by the wisdom of the Mother Abbess and the prayers of the entire Community, are insisting that I step up. I ask one of them if God has allowed me this illness because I have to change. She replies: God has given you what you have because you can change. They are all deeply compassionate but they make no bones about it; the changes I am now called to make are hard, nor have I any excuse for not making them.
Two other good friends, single Bacons from my urbane and glamorous song, immediately offer me practical and material help. One is on the board of Yale New Haven Hospital; he moves heaven and earth, and a week and a day after my initial diagnosis, two weeks to the day after going to the ER, I'm in New Haven, registered into the Yale Cancer Center, being evaluated by a small-cell oncology specialist. A week and a day after my initial diagnosis, I've had a whole-body PET scan, brain MRI, uterine biopsy, first chemo. A week and a day after my initial diagnosis I hear something startling - I'm probably in stage one. The car I chauffeur God in, again picks up speed; these helpers, material and spiritual, these laughing friends, this large, clannish, and loving family, and now the aggregate of my medical status, all impel me to a very different decision. To treat or not to treat? I'll treat.
Tonight, I stand in a pharmacy and laugh and laugh and laugh. I have filled two prescriptions for anti-nausea pills to help me through the chemo. One prescription is for 27 pills; the other prescription is for 3 pills. In addition, I throw in a packet of nicotine patches, having vowed that if I were in stage 2, I wasn't going to bother to stop smoking, but if I were in stage 1, I'd quit. One of my material angels is paying for these medicines, because my prescription drug plan will not authorize these drugs for 10 days or more, and I need them by tomorrow. I laugh, appalled at the obscene price that my angel is paying. The bill for these 30 pills and 14 patches comes to $1,134.88.
If I'm an average initial-diagnosis-in-stage-one person, I'll be around for the next 16-to-20 months. I'll write from time to time about how it's going. And then, I'm outtie. Goodbye cruel world; hello world with the tender, baby soft skin and the tremulous, aching smile of innocent adolescence. Goodbye cruel world; hello world of big hearts and nausea and pain, of mordant humor and hearty laughter, of radical and outrageous hopes, of rapid-spreading, fast-moving, metastisizing, Stage 2 love.