The Society

CHAPTER 17

EXCELSIUS HEALTH CANCER CENTER

Cancer. The word, while carved into the granite archway identically to the other three words, and highlighted in gold like the others, stood out as if the others did not exist. In spite of herself, Grace Peng Davis paused on the sidewalk and stared up at the letters through a raw drizzle.

Sticks and stones can break my bones, but names can never hurt me. Well, she thought viciously, this one can.

It was Grace’s first day of chemotherapy for the cancerous nodule that Susan Hollister had removed from her breast. Dr. Max D’Antonio, the oncologist, had assured her that there was really no rush to begin the treatments, but both she and her husband wanted the tumor out and gone and any remaining vagabond cells blasted with poison as soon as was possible. IV Adriamycin and Cytoxan every three weeks, Dr. D’Antonio had told them-two drugs that were toxic to every cell in the body, but more so to those that were rapid multipliers, especially cancer cells. In between visits to the clinic, she would be taking oral medication, as well.

God grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And the wisdom to know the difference.

Grace had been exposed to the Serenity Prayer at her first AA meeting more than a decade ago but had never paid it more than lip service until, with Dr. Will Grant’s help, she finally connected with people who helped her get honest with herself about her alcoholism. Now, although her life was in remarkable order, it wasn’t unusual for her to recite the prayer to herself every ten minutes when she needed to get through difficult situations.

God grant me the serenity. .

Mark Davis took his wife’s arm and guided her into the building.

“You’re doing great,” he whispered.

They both knew how fearful she was and always had been of doctors and hospitals. And although the cancer center was a glittering, modern outpatient clinic, with comfortable furniture and dazzling artwork on the walls, it was more of a hospital than she would ever care to see.

Only Mark would ever fully appreciate how anxious she had been about having her surgery done by a doctor she didn’t even know. It was such a blessing that day to have run into Dr. Grant the way they did, and later such a terrible blow to learn that his license had been suspended because of drugs. But Dr. Hollister had helped soften the blow by being kind and patient with both Grace and Mark, and best of all, she unabashedly supported Dr. Grant’s claim that he was innocent.

The receptionist, a prim young Hispanic woman with Carla on her name tag, greeted her warmly, then handed her a clipboard with some forms attached.

“I already filled these out,” Grace said, “when I came here to meet Dr. D’Antonio.”

“Oh, I remember who you are,” the woman said, “but these aren’t our registration forms. They have to do with transferring your insurance from Steadfast Health to Excelsius Health.”

“Transferring my insurance?”

“I guess you hadn’t heard. Excelsius has taken over your insurance company. We were told that the change has been in the works for a long time, and that Steadfast Health had sent out a mailing.”

“We had heard there might be a change when we were initially sent here for Grace’s mammogram,” Mark said, “but we had no idea Steadfast Health had actually been taken over already, and we certainly didn’t get a mailing. You didn’t know anything about this, Grace, did you?. . Grace?”

“Huh?. . Oh, no. No, I didn’t know Steadfast Health had actually been taken over already. We had heard there might be a change.”

Grace, battling a sudden wave of anxiety, was unaware that she had used her husband’s exact words. At three that morning she had been awakened by a similar episode of panic, but after half an hour or so, she was able to fall back to sleep.

God grant me the serenity to accept the things I cannot change. .

She tried to ignore the perspiration in her groin and soaking into her dress beneath her arms. No big deal, she told herself. Dr. D’Antonio had given her medication to help her relax for her treatment. Phyllis, her AA sponsor, had assured her that taking the sedation was definitely the right thing to do. If this was as bad as her anxiety was going to get, she could handle it. Nobody told her getting chemotherapy was going to be pleasant.

“Well, that’s what we’ve been informed,” Carla was saying cheerfully. “As of today, Steadfast Health is part of Excelsius. We have lots of Steadfast Health clients here. All of them are being given the choice of switching to Excelsius or changing to another company. If you choose to go to another company, your chemotherapy will be turned over to whatever doctor your new HMO allows you to select.”

“Thank you,” Mark said.

They retreated to seats in the waiting area and filled in the form authorizing the transfer of their coverage to Excelsius.

“Good thing we checked into this last week,” Mark said. “I would have hated to have to change doctors. . Hon, are you all right? You don’t look good.”

“I’m fine, fine. Just a little apprehensive.”

“You should tell the doctor.”

“He already told me to expect this first day to be frightening.”

“I still think-”

“Mark, please! I know you mean well, but I just want to get this over with. Besides, they have a nurse practitioner in there or nearby while the drugs are going in. There’s absolutely nothing to worry about.”

Her husband, generally not at all demonstrative about his feelings, merely nodded that he understood and, after an appropriate pause, looked at his watch.

“You go ahead to work,” Grace said. “Phyllis will be here later on to take me home and fix dinner. I’m fine, honey, really. Don’t worry. Here, gimme a kiss for luck. Not one of those pecks on the lips; I want the wet, juicy kind you’re so good at. Mmmmm. Now, be gone. The students need you. I’ll call you when I get home.”

Grace watched as her husband hesitated at the doorway, then left for his office. Of all the unmerited gifts made possible by her sobriety, he was by far the greatest. She returned the clipboard to the receptionist. The worst thing about all this, she was thinking, was that she wasn’t the least bit sick when this whole nightmare started. Logically, she was grateful for the early detection of her cancer and the fact that the tumor was small and there was no evidence for spread. But emotionally, all she could think about was that she was feeling fine when she was called into the radiologist’s office for the bad news. No symptoms whatsover. How could anyone improve upon no symptoms?

“I know you’re feeling fine,” the radiologist, Dr. Newcomber, had said, “but trust me and this X-ray here, you’re not.”

Grace scanned the waiting area. Who are all these people? she wondered. What’re their stories? How had they reacted the first time they heard the word cancer applied to them?

“Grace Davis.”

The sound of her name startled her. It was Judi, the nurse she had met during her orientation to chemotherapy. They had sat together in a small, windowless room while the woman outlined all of the effects and side effects of treatment. It had not been a heartening conversation. She had started with hair loss, the most dreaded and expected side effect of the drugs. There was no doubt, she said, that Grace would lose her hair. It would probably occur about two weeks after her first treatment. Most women got their hair cut very short before it happened, but, even so, she should be aware that the short hairs would be annoying when they fell out, getting in her mouth and nose.

It would have been okay if the nurse had stopped at hair loss. But there was a litany of side effects to review. Nausea was of course a major topic. Grace would be given an arsenal of drugs to help alleviate that symptom. Judi had patiently reviewed each pill and its potential side effect.

“Ativan works quite well for anxiety but will make you drowsy. Vicodin is good to take if you have pain, but it is addicting if you take it more often than prescribed, and it may make you constipated.”

It seemed like there was a potential side effect for every part of Grace’s body. Her fingernails might become discolored and break easily. Urinating could burn and bowel movements would be painful. Finally Grace just looked up from the myriad of papers Judi had given her.

“Tell me there is at least one upside, please; tell me that my skin will never look lovelier or it will make my eyes shine brightly.”

Judi responded with a weak, ironic smile. No, there was no upside. At best, Grace could anticipate four months of malaise and an assortment of disrupting discomforts.

“Oh I forgot,” Judi had added, “you’ll be extremely sun-sensitive for a while after your therapy.”

So much for the celebratory getaway with Mark to Aruba after all this was over. Maybe Greenland.

Finally, after Judi had pushed back in her chair, her arms folded, her expression indicating that the number of times she had done this might be getting to her, Grace had screwed up her courage to ask the big question.

“How will you and Dr. D’Antonio know that this is working?”

“What?” replied Judi, as if Grace had asked the single most stupid question in the world.

“The chemotherapy-how will you know that it works, that I am getting the expected result?”

“Well, there is no way of knowing. We can certainly tell that it hasn’t worked if you get a bone, liver, or brain metastasis. But we will never know with absolute certainly if it has worked. From a statistical standpoint, we draw the line at five years, but of course there are some patients who do get a recurrence after that.”

Great.

With memories of that first meeting with the nurse roiling in her brain, Grace followed her into the treatment area. The place abounded with plaques and posters with pithy life-affirming sayings. There were even stuffed dolls carrying placards that read things like: Live large, love hard, laugh often. On every surface there were pamphlets and brochures for a myriad of services. Advertisements for cute hats you could buy online, notices of support groups, including one that showed how to do makeup and scarf tying so you could look your loveliest during this difficult period of your life.

There were also notifications of various financial-aid plans for treatments for patients without insurance-low-interest loans for up to $200,000. Grace said a silent thank you to Steadfast Health or Excelsius Health or whoever they were today. She couldn’t imagine going through this hell and having to worry about how to pay for it. She had seen the statements of benefits for the tests and surgery to date, and they exceeded the value of their Saab. She was sure these next four months would approach the cost of their house.

In addition to the literature, there were huge baskets of hard candies in every room.

“You might want a couple of these,” Judi said. “The taste of chemo can be pretty awful.”

“I thought it was intravenous.”

“Oh it is, but your bloodstream carries the medicine throughout your body, including the nerves in your mouth and nose. You can taste it from the inside.”

They entered the expansive treatment room. Toward one end was a long, cherry-paneled nurses’ station. In front of it was a horseshoe of eight leatherette recliner chairs. Each had an IV pole and a side chair for a guest. There was a bank of TVs above the nurses’ station so that patients could try to divert themselves during treatment.

Grace gazed around the room. All but two of the recliners were occupied. In one lay a woman sound asleep under a blanket, the IV tube twisting to accommodate her position. Her bandanna had slipped off her head, revealing tufts of brown-gray hair scattered around an otherwise bald pate. Her pretty gold hoop earrings contrasted sharply with the grayish cast of her skin.

Feeling nauseous even before the treatment began, Grace followed Judi to her designated recliner. How hale and hearty she must look in comparison to the other women here. She still had her hair. Her skin, one of her best attributes, still had its unblemished glow.

By the next time I come, I’ll look like them, she thought.

She managed a sad smile at the sudden notion that the room looked like some kind of weird day spa in reverse-a place that took beautiful women and made them tired, bald hags.

“Spa Toxique,” she thought, and then realized she had said the words out loud.

“Don’t think of it that way,” Judi said, as if she had heard versions of the dark humor before. “Think of the medicine as Pac-Man hunting through your body, munching all the evil cells.”

Judi donned her latex gloves and asked Grace if she was ready. “First, I am going to insert this needle into the port Dr. Hollister implanted during surgery.”

The port was right below Grace’s right collarbone. She could feel it just under her skin.

“Take a deep breath.”

Grace inhaled and clutched the arms of the recliner as Judi passed the needle through her skin and into her upper chest. Surprisingly, it didn’t hurt as much as she had anticipated.

“Now we’re going to draw some blood through this tube to see what your cell counts are. Today is really a formality and a baseline because we’re pretty sure your red and white blood cells and platelets are all present in healthy numbers. But as you go through your chemo, your counts will drop considerably. We can’t start a treatment if the counts are too low. In fact, sometimes you may need medication to bring them up. Otherwise there’s a danger of bleeding or infection or severe anemia.”

Great.

Once the tests were done Judi returned with the drugs-some form of steroid, and one to make her drowsy. Next was a large syringe filled with what looked like cherry Kool-Aid but was, in fact, the cellular poison Adriamycin. In spite of herself, Grace watched the liquid pass into her chest. From within her bloodstream, Grace could smell and taste the powerful medication-a sharp, almost musty odor, reminiscent of some sort of cheese. . a taste like. . like what?

“Just close your eyes and relax,” Judi said.

. . to accept the things I cannot change. .

With the help of the sedative and the Serenity Prayer, she began dozing off, cloaked in the conviction that soon this theater-of-the-absurd production would end and she would find herself back in her life.

. . Courage to change the things I can. . Relax. . And the wisdom to know the difference. . Relax. . Relax. .

The dream she drifted into was at first pleasant. . the lake. . two young girls playing together at the water’s edge. . she and her sister, Charlotte. . their mother, arms folded, back to them, standing on top of the water, gazing off at nothing in particular. . their father, shoulder against a tree, eyes narrowed, watching, watching. . Did he know already what he was going to do to his girls?. . Had he already started?. . The dream became a strange, drug-aided montage of images in which Grace was both a participant and an observer, totally aware she was dreaming, yet completely immersed in the scenes.

When the itching first began, it was as if it were happening to the Grace in the dream. She wondered if somehow, seeing her father like this, watching her, watching Charlotte, knowing what he had done to them, was causing the uncomfortable sensation. The itching increased and now was joined by a burning sensation. . her arms, her belly, her face. Along with the girl in her dream, Grace began to scratch.

Over just minutes, the itching grew more intense and the burning more disturbing. The dream blurred, then faded altogether. Grace opened her eyes and raised her arm. Her fingers were swollen and stiff. Crimson welts with irregular, pale margins interlocked with one another like a jigsaw puzzle, until they virtually covered all the skin on the arm. Her belly, too, was covered, and her other arm. Hives, she thought, remembering something similar from when she was a teen. Similar, but not nearly as bad. Hives. The burning, especially on her face, was becoming quite frightening. Something else was becoming frightening, too-she was beginning to have trouble breathing, a tight sensation in her chest that made it hard to draw air in.

“Hello! Help me, please,” she called out. Her voice was harsh and cracked, and not nearly as forceful as she expected it to be. “Help me. .”

Her lips felt badly swollen-swollen and on fire. The breathing problem was rapidly getting worse. She needed to sit up to get air in. Needed to sit up. . needed to sit up. .

Now there were footsteps. . then voices.

“Oh my God! Grace, can you hear me?” Judi’s voice. “Nod if you can hear me. Get a stretcher out here and get her to the examining room!”

“There’s not much room in there.”

“Just get the stretcher! Run that saline wide open. Grace, you’ve got to lie back. Get oxygen on her, a mask. Five liters or more. Tell Carla to call nine-one-one. Get an ambulance here! Also tell her to call Dr. D’Antonio. Tell him she’s having an anaphylactic reaction. . We need the crash cart stat! Epinephrine, zero-point-five. Draw it up. I’ll give it. Also Benadryl twenty-five IV. Make it fifty!”

“She’s hardly moving any air!”

“Get a blood-pressure cuff on her! Quick. Here, help me lift her onto the stretcher. Jesus. Carla, did you make those calls?”

“She’s not moving any air. I can’t get a BP.”

“Epi is in. Get her into the corridor by the examining room. We need the crash cart. Jesus, this has never happened here. . absolutely never! Grace, can you hear me? Squeeze my hand if you can hear me.”

“No BP.”

“Carla, are they coming?”

Grace’s panic had exploded. It was as if someone had pulled a broad piece of tape tightly across her nose and mouth. No matter how hard she sucked, air just wasn’t getting in. She struggled against the hands that held her, struggled to sit up. She clawed at the oxygen mask. She pounded her fists on the bed. Finally, exhausted, she sank back, still trying with all her strength to get in even a tiny bit of air.

“I’m going to try and intubate her.”

“Have you done it before?”

“In Advanced Life Support class. Never in an emergency like this. What else can I do?”

Grace felt her head being tilted back. A metallic rod was being jammed into the back of her throat.

“Everything’s swollen back there. I can’t make out any landmark. Dammit, where’s the rescue squad?”

Help me, please!. . God, grant me. . grant me. .

Grace knew she hadn’t said the words-knew she couldn’t. She felt herself stop struggling. She felt herself stop trying to suck in air. Overhead, the lights dimmed. Her panic lessened. The words of the nurses became garbled and distant.

A veil of darkness settled over her, accompanied by a growling, low-pitched drone.

The droning sound grew softer.

Softer.

Finally, there was silence.