The first thing you notice as you walk through the two main doors to Oncology is the cleanliness–the purely antiseptic nature of the place. Even with the cheeriness of children’s drawings taped up and down the hallway walls, the place seems too clean–devoid of the dirty things that make up living a life.
Except for the cigarette smoke. That’s the second thing you notice. The unmistakable smell of second-hand cigarette smoke. It comes from the first room to the right of the main doors. That’s Thelma’s room, has been for a while. She’s been in there so long that some people take to calling it Thelma’s home. She’s playing out the string, whiling her remaining days away by watching soap operas and chain smoking from her hospital bed. Why should she stop now? She couldn’t when it mattered. Now she smokes as much as she can, and her room is like an opium den.
Just two doors down, Steve lies back and waits around for nothing. He’s not real old–looks to be about 40 or so. He has the largest and prettiest room of the ward: big screen t.v., a great view of greater Anaheim, and a premium location opposite the central nurse’s station. It’s his for now, but will probably be someone else’s pretty soon.
Enrique is in the room next to Dad’s. He is a thirty-something construction worker stricken with the same illness–at almost at the exact same time–as Dad. You can still tell he was once a ruggedly handsome man, with a thick mane of curly black hair and a bronzed face. The sharpness of the chin is still there, and you can still see the broadness of his shoulders. It’s all disappearing as the ongoing battle beneath his skin intensifies. Enrique is fading fast–we can tell by the shocked, pinched look on his young wife’s face. What she doesn’t know–what no one on the fourth floor seems to realize–is that sometimes fading fast is better than dragging out the pain and torture.
I would much rather be Enrique than Thelma.
The strangest thing about the fourth floor Oncology ward is that everyone I see is no older than 45–almost 25 years Dad’s junior. I always thought old people died of cancer, that the disease spared the young and healthy. I am learning that cancer is, indeed, and equal opportunity tragedy. Young and old alike live in this place I call Cancer City. It is a community inside a hospital, complete with very distinct bylaws and conditions. It’s here Lynn’s wish for more relaxed visiting hours is reality. But it’s also here that latex gloves and paper masks are required accessories. There are two basic rules that must, without fail, be obeyed: Never question staff or specialist and always keep everything clean. One germ equals one death–be sure to wash your hands. Keep your mask on at all times–if I could only show you how many germs float around on your breath.
This is the desperate science, and breaking one of the rules will lead to a compromise of the only goal this place has: help the dying pass away in as much comfort and with as much dignity as possible. Of course, there’s the occasional miracle, but most people don’t count miracles as goals.
We’re not like most people.
We expect a full and complete recovery. To our way of thinking, there is no other option, so what’s the point of considering another option? All we can do is focus on the goal–or miracle–at hand and try to help make it happen.
That’s what Cancer City was missing–the chance for a miracle and what Lynn called the grittiness of the CCU, the backs-to-the-wall, better start praying team work that got things done one floor below. For all it’s technological advantages I now agree with Lynn and Carole, and would pay anything to have Dad back in the noise and life of the CCU. It is the patients that add the life to the place. At the CCU they were never afraid to let it all hang out, whether praying to or cursing God, crying from the pain or shouting for pain killers. In the city, God is a forbidden subject and crying is not encouraged. The nurses and doctors are under orders to keep the cancer talk to a scientific level and the pain to a muffled noise. As a result, even with all the specialists and equipment, this is a place that seems strangely empty of hope. Or perhaps by the time people here whatever hope existed has been wrenched out of patient and family. You’d think the struggle going on in each room would create the impression of hope, but the fight for life remains desperate, private and eerily silent. As it is, there is nothing–the atmosphere is as drab as the rooms are simple and built only to meet needs. Even the appearance of the nurses is starched with enough professional efficiency that it strips away any hint of sexuality. The city is perfect for people to die or get better, but nothing really in between.
But who would want anything in between? Even those who die here would surely rather have that fate than to hold on indefinitely, living off machines and chemicals. And they die in droves here. Everyday. It is of constant amazement that the people who come here voluntarily–nurses, doctors, therapists and even the general staff–can keep it up, what with the heavy gloom of death all around. I will learn that while the fourth floor rooms may seem devoid of hope, in the nurses stations the desire to create real hope is the only thing that matters. It is false hope that is not welcomed in the city, and one of the dangers they fight so hard against. With every new patient there is the chance–however slim–of a remarkable recovery, and the thought of each recovery spurs them to work harder and hope longer.
If that patient can make it, why not this one? We have to find a way.
But there is also the practical side of the work they do. Thelma, Steve and Enrique are not going to make it. Of that there is no doubt. So the nurses laugh and tease, and try to fill their final days with laughter and mirth. This is the time when nurses no longer work toward restoring physical health. Instead, they are assigned the duty of fulfilling inner peace and spiritual wholeness. They are, in moments such as these, the Gatekeepers to Heaven.
This is what makes Cancer City at Martin Luther Hospital a special place, and exactly the kind of place Yvette wants it to be. More than the doctors, more than the patients and families, Yvette controls and creates Cancer City, constantly working on the evolution of one of the best Oncology wards in the county. As the head nurse, that’s her job–and she does it in a strong, quiet and practical way. A tall, spidery woman with a faint Bavarian accent, Yvette is the only one who would dare to tell a doctor what to do–and have the doctor obey without question. The newer doctors fear her because she knows more about cancer; specialists stay on her good side because she has enough clout to ruin careers and destroy reputations. Even Rau defers to her–though entirely different in their manners and approach, Rau and Yvette have carved out an uneasy truce based on mutual respect. Yvette tolerates Rau because he’s one of the best at saving people; Rau appreciates Yvette because she and her army of nurses keep distractions and inconveniences out of the way.
To patients and families, Yvette is a benevolent landlord–we hear her name spoken in hushed tones among huddled nurses, see the results of her work, yet only ever meet her twice–on the first day and on the last.
I was the first to experience the honor of meeting the Landlord of Oncology.
“Now I know your Dad is doing better, but I have to make sure you understand what we’re up against,” Yvette announced one night as I sat outside Dad’s room, waiting for his nap to end. “Your Dad will probably die, but if he’s going to make it we need to know what he’s up against. Before he wakes up, I want you to see a movie about Leukemia and then I’ll answer any questions you might have.”
“It’s really quite a good little movie. Somehow they’ve managed to take such a dreadful and complicated subject as Leukemia and make it simple and entertaining.”
The next thing I know I’m sitting on a broken hospital bed in the maintenance closet, watching a fifteen minute documentary that feels like hours. It’s on different treatments and causes, spotlighting chemotherapy and all the possible side effects–with about as much tact as Rau had used in the CCU. By using cute animated characters, it illustrated how an older body gets Leukemia.
Afterward, Yvette demanded to know what I thought, and insisted on reviewing the film and answering all my questions. But I had no questions–all I could think of was the animated characters portraying white and red blood cells.
“Your Dad is doing really well right now, but I’ve got to warn you not to get your hopes up,” Yvette said, purposely crashing my hopes back to earth. “He’s not out of the woods yet–one infection, one little thing that goes wrong and that’s it. So please, for his sake, try to keep an even keel and try to understand what he’s up against. Survival statistics for a man your Dad’s age, at this point of the disease, is less than 20 percent.”
“But he has improved,” I shot back. “So we must be getting better odds.”
“Not really. In the CCU, those odds were against him just getting here. Now we have a whole new game. We have to wait until the chemo treatments, If that takes, and he goes into remission, then you might have a better chance. If not, we would have to try again. Either way, the Leukemia is with him for a long time. This is just the start.”
Perhaps one day, the chemists and specialists and scientists will come up with a better way to treat Leukemia. Perhaps they will devise a way that’s more kind and gentle than ripping out the insides of a person’s body. Our treatment started–and with it, the beginning of the road to recovery–when the night nurse came in with Dad’s special chemical cocktail. She checked his blood pressure, threw the bag up on the stand and started the drip. With each drip I could see it working by the extraordinary look of agony on his face. Chemotherapy wipes out the disease by destroying everything–all the white cells and all the bone marrow. Destroy and rebuild with new cells and platelets, hoping that the new blood will build healthy bone marrow. It takes an infusion of lots of new blood–I swear it must be gallons of the stuff.
After an hour I can’t take it anymore. Dad’s gone back into a comatose state–nothing is getting through to him as the chemo continues to drip into his bloodstream. I retrace my steps to the hidden door Susan showed me so long ago. At least it feels like a long time ago; in real time it was just a week gone by. As I stand out in the chill of early December, I watch the blood man pull up where the ambulances park and swing through the delivery doors with a new batch of blood. I wonder–is that a batch for Dad? And if it is, who’s blood is in that bag? Who gave? Was it a friend or a stranger? Did it matter? I hope it’s not the blood man’s blood. He’s an unkempt lout with three days of growth on his chin and wrinkled clothes that look as though they’ve never seen the inside of a washing machine.
But what can you expect at 3 o’clock in the morning? I stare and wonder if this ragged angel brings life for my father in that box on his shoulder. After the chemo does it’s job, the blood keeps him alive and helps his body rebuild anew. The threat of AIDS or other disease from massive transfusions of blood does not come into the picture–we’ll fight that battle, if we have too, after we win this war. I stand here, look up into the night and catch my breath before going back up to the fourth floor. As always, looking up helps me feel as though someone’s getting all the prayers I’m sending up.
The only thing worse than the chemotherapy is the physical therapy that follows. There is an exercise they try with him every day, and on some days he almost gets it right–sort of like a baby’s jigsaw puzzle. Match the colors and the shapes. Put the pegs in the round holes.
He is unable to do it. His mind knows what to do, but his body is unwilling to follow directions. Each time, his hand goes out to the bright yellow peg and picks it up, and each time he tries to put it in the square hole. But his hand just can’t make it all the way. He does it for awhile until you can see him giving up.
“As you can see, this is tough,” Susan is telling us about the therapy that is so important to his long-term survival. “It’s just as though we’re starting from scratch–and all of you have to help him.” Susan is the therapist assigned to make Dad do the things he doesn’t want to do. The one assigned to help him recover after the Leukemia goes away. It’s amazing how she handles him–with a laugh and a firm hand that belies her small figure. She is barely 5 foot tall–if indeed she is that tall, and not an ounce over 100 pounds. But time and time again I see her hoist him out of bed and into the wheel chair as though he’s a feather. As far as we’re concerned, Susan gets the benefit of our total and complete support, because the therapy is vital to his long term recovery if the chemo works. She walks a tightrope–make the exercises strenuous enough to challenge, but not to exhaust. Exhaustion is a quick way to an infection, so Susan must find the balance to be successful.
“Work with him every night Brian, but only a little at a time,” she tells me. “Move his legs and arms, but if he wants to stop let him stop.”
“He needs rest as well as a work out.”
It is the saddest thing I have ever seen. Here is a master cabinet maker, a man who could create the most beautiful design out of a plain block of ordinary wood. Now it is a man who can no longer hold a drinking glass–and is just now learning to feed himself again. It makes me wonder if there is any hope at all–if we’re just living in a fantasy. But then I see him smile at me, and grip my hand tight as we work on his exercises. And I know that we can make it. It’s a long climb, but we can make it if we just concentrate on putting one foot in front of the other. That’s what we’re doing, no matter how sad and frustrating it might be.
Step by step, Dad is making strides toward recovery.