When Breath Becomes Air(39)

“Emma,” I said, “what’s the next step?”

“Get stronger. That’s it.”

“But when the cancer recurs…I mean, the probabilities…” I paused. First-line therapy (Tarceva) had failed. Second-line therapy (chemo) had nearly killed me. Third-line therapy, if I could even get there, made few promises. Beyond that, the vast unknown of experimental treatments. Phrases of doubt fell from my mouth. “I mean, getting back to the OR, or to walking, or even—”

“You have five good years left,” she said.

She pronounced it, but without the authoritative tone of an oracle, without the confidence of a true believer. She said it, instead, like a plea. Like that patient who could speak only in numbers. Like she was not so much speaking to me as pleading, a mere human, with whatever forces and fates truly control these things. There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss.



Doctors, it turns out, need hope, too.

—

On the way home from the appointment with Emma, Lucy’s mom called to say they were headed to the hospital. Lucy was in labor. (“Make sure you ask about the epidural early,” I told her. She had suffered enough.) I returned to the hospital, pushed by my father in a wheelchair. I lay down on a cot in the delivery room, heat packs and blankets keeping my skeletal body from shivering. For the next two hours, I watched Lucy and the nurse go through the ritual of labor. As a contraction built up, the nurse counted off the pushing: “And a one two three four five six seven eight nine and a ten!”

Lucy turned to me, smiling. “It feels like I’m playing a sport!” she said.

I lay on the cot and smiled back, watching her belly rise. There would be so many absences in Lucy’s and my daughter’s life—if this was as present as I could be, then so be it.



Sometime after midnight, the nurse nudged me awake. “It’s almost time,” she whispered. She gathered the blankets and helped me to a chair, next to Lucy. The obstetrician was already in the room, no older than I. She looked up at me as the baby was crowning. “I can tell you one thing: your daughter has hair exactly like yours,” she said. “And a lot of it.” I nodded, holding Lucy’s hand during the last moments of her labor. And then, with one final push, on July 4, at 2:11 A.M., there she was. Elizabeth Acadia—Cady; we had picked the name months before.

“Can we put her on your skin, Papa?” the nurse asked me.

“No, I’m too c-c-cold,” I said, my teeth chattering. “But I would love to hold her.”

They wrapped her in blankets and handed her to me. Feeling her weight in one arm, and gripping Lucy’s hand with the other, the possibilities of life emanated before us. The cancer cells in my body would still be dying, or they’d start growing again. Looking out over the expanse ahead I saw not an empty wasteland but something simpler: a blank page on which I would go on.

—



Yet there is dynamism in our house.

Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.

Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.



If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably.

With little to distinguish one day from the next, time has begun to feel static. In English, we use the word time in different ways: “The time is two forty-five” versus “I’m going through a tough time.” These days, time feels less like the ticking clock and more like a state of being. Languor settles in. There’s a feeling of openness. As a surgeon, focused on a patient in the OR, I might have found the position of the clock’s hands arbitrary, but I never thought them meaningless. Now the time of day means nothing, the day of the week scarcely more. Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don’t know. And so it’s not all that useful to spend time thinking about the future—that is, beyond lunch.

Verb conjugation has become muddled, as well. Which is correct: “I am a neurosurgeon,” “I was a neurosurgeon,” or “I had been a neurosurgeon before and will be again”? Graham Greene once said that life was lived in the first twenty years and the remainder was just reflection. So what tense am I living in now? Have I proceeded beyond the present tense and into the past perfect? The future tense seems vacant and, on others’ lips, jarring. A few months ago, I celebrated my fifteenth college reunion at Stanford and stood out on the quad, drinking a whiskey as a pink sun dipped below the horizon; when old friends called out parting promises—“We’ll see you at the twenty-fifth!”—it seemed rude to respond with “Well…probably not.”