Written in August 1998, copyright 1998 Beth McNichol
When the lights went down in the icy movie theater and my family surrounded me — all of my family — everything was normal again. Of course it was. Six months had passed. I drew a long, cold sip of Coca-Cola from my straw and thanked God for simplicity, for days of nothingness. I was 19 years old. What did I know? I tossed my feet up on the back of the chair and looked beside me. Her head was covered with more than stubble now, though she still wore the wig, and the angry little bumps that once scattered the baldness, ugly and knee-weakening, had found someone else to pester. The villain was behind her; he had come and he had gone and as far as my father and my sister and myself were concerned, he would never call again. That’s how it works, right? That’s the sequence of events: biopsy, surgery, crying, chemotherapy, health. Cured. That’s how it works.
The nurse in the movie Best Friends inserted an IV needle into Jack Lemmon’s unwilling skin, fishing around for a vein, for some response. My mother shivered. She shivered and her left hand, the swollen one, went to catch the right hand that clasped over her mouth to stop the nausea and maybe the tears, too. Who knew this was what the film was about? I cursed the director, the screenwriter, the cameraman, Lemmon himself. Even as my heart told my hand to find my mother’s in the darkness, I knew that I could not do much to help. Not like Julia.
When you have cancer, you develop a new family. A family related by their common understanding. People who understand. Not your husband, your daughter, your son. It’s the woman who fits and sells you your first wig. The medical supplier who gives you your prosthesis, such an alien thing. The parking attendant at the cancer center garage who smiles and tells you to have a nice day, once a week. And most of all it is your nurse. She didn’t know you before you had cancer, when you were perfect. When you could hang drapes or kick a soccer ball or swing your grandchild around the room. When you could be the woman your husband married. When you could be the child your parents knew. When you could be sexy, when you could be strong. When you were complete. Always, always, who you were. That is the difference. That is the dominant note in the refrain. That is the yin that makes the yang. To Julia, my mother was a woman who just happened to develop cancer; to us, she was different now. A qualifier always followed her name. She was “My mother, who has cancer …”
A perfect stick is an artform. Cancer veins pumped with toxic drugs grow thin, they collapse, they tire, they wish to be left alone. They often dodge the needles seeking them, or let them go straight through to the bone on the back of the hand. But for the patients registered nurse Barbara Cleveland cares for from her pale blue treatment room at the University of Illinois at Chicago’s hematology/oncology clinic, the stick is a way of life. It is just part of the chaos the disease has injected into their lives from the moment they first heard the phrase, “You have cancer.”
Cleveland is the part that makes sense.
This morning she finds what she is looking for. A twist of Grace Harvey’s left arm with a tourniquet and a tap or two in the right place, and the vein pops up. It takes its medicine: a long, slow drip of saline to keep the veins open, followed by Cytoxan, the first of three chemo drugs to fight the 30-year-old’s lymphoma. It is an unforgiving cancer, the fastest spreading.
“How does that feel, Grace? Cold?” Cleveland asks in her deep, resonant voice, rich like chocolate and alive like a spice. It is the voice of a storyteller. “Good,” she reassures. “It should feel cold.”
A 70-degree fluid pulling through a 98.6 degree vein is akin to jumping into an ice-cold swimming pool on a blazing hot day. It is uncomfortable, and it is Antarctically cold in here anyway. Grace shifts her weight, shuffles her feet. Her sister drove her today and spent the morning two feet from Grace’s chair in silence, flipping through an advertising insert for Target. But now she has left the room. Needles, you know. They make her shaky.
“All right, dearheart,” Cleveland says, smiling, “two more and you’re done.”
I don’t want to lead them to believe it’s not going to get worse, she says, I just want to make it better for today. For this minute. For this second. That is her credo.
She pushes a vial of red toxin, Adriamycin, followed by a clear liquid chaser. The whole process takes about 20 minutes. It is the third straight day of the routine for Grace, what is called a chemotherapy cycle. This is her third cycle, which she repeats every 21 days. She has three more cycles to go before chemo ends. Nine more sticks. And some uncomfortable hours ahead. Grace is mentally disabled, cared for by an aging mother who suffers from mild senility and deep concern for her daughter. She cannot always be there for Grace’s treatments. She will send Grace’s younger sister in her stead, but it is often Cleveland who becomes the mother.
“Now yesterday, you got really sick from the medicines, didn’t you Grace?” Grace doesn’t respond. “Your mother called me and told me you were nauseated, vomiting every hour, is that right?” Grace nods, “Yeah, I was pretty sick.”
“Did your mother give you the suppository? That’ll keep you from getting sick. It will help you keep down the painkillers. Do you know how to insert them? Grace?” Cleveland seeks out her eyes, locks onto them, no matter how far underneath Grace’s black brimmed hat they sink. “Why don’t we go and try it now, Grace, and then I’m going to give you some drugs you can take home so your mother can give them to you.”
She speaks warmly and sternly, so that Grace reluctantly follows.
When they return, Cleveland turns to Grace’s sister. “OK, she’s supposed to take this every eight hours. So she got this at 10:30. She’ll get another one eight hours from now. Count them on your fingers, Grace. Eight hours from now. Put your fingers up and count.”
Grace listens. She always listens to Cleveland. She slowly ticks off the numbers: 12:30, 1:30, 2:30, 3:30, 4:30, 5:30, 6:30.
“OK, Grace,” she says softly. “OK. You call me if you need anything.”
“When you go to nursing school,” says Connie Zanzig of Northwestern Memorial, “you’re taught that there’s a borderline that you’re not supposed to cross. You can certainly be nice to patients and their families and be supportive, but you don’t want to cross over that line and get personally involved. With oncology, that line is almost completely erased. You become a part of the family for some of these people. You have to.”
At first, Andy Hanson is intimidated by Zanzig. Hell, he’s 21 years old and he’s just been told he has leukemia. There isn’t much he’s not afraid of in June 1994. Gregarious, outgoing, Zanzig is matter-of-fact. Caring, yes — very much so, but not cooing. She is young, 27, and her wry sense of humor and flashing green eyes seem to mock the very idea of cancer. Soon, Hanson finds, her sarcasm is a lot like his. They complement one another, like mirror images.
How often the refrain is repeated in oncology nursing, how frequently that nurse finds the other half of you you thought you’d lost.
Instead of playing indoor soccer or basketball, Hanson begins two years of chemotherapy. Every day he puts some form of poison into his body to cancel the poison already there. And the road is long. He is constantly in and out of the hospital, battling the side effects of the medicine Zanzig administers. His fever skyrockets. He develops pancreatitis. He loses his hair. He suffers from severe mouth sores, the lining of his mouth so dry and so raw that he is fed through an IV. It is far too painful to swallow on his own, almost as painful as facing his parents, his sister and his brother.
He is “causing all this havoc in everybody’s life. You could see it in their faces, the disappointment, the hurt that I had to go through this. There were times when I’d suck it up and not put anything more on them than I had to. That’s when I’d call Connie.”
Zanzig takes numerous frantic calls from Hanson, at home, at work. His temperature is high, he’s sure he needs to go to the hospital. What’s the reading? It’s 99.2. Shouldn’t I go now? Andy, stop taking your temperature so much. You’re making yourself crazy. You’re fine.
And he is fine. He is in remission, which is med-speak for, it’s over, we think. You’re cured, we think. But Connie remains his support.
“There were so many times when I called her because emotionally I needed to talk to her that they all kind of blend together,” says Hanson says. “She’s just always been there.” And she still is. Five years later, Connie will have to miss Andy’s sister’s graduation party this weekend — her father is in town — but she will make the drive to Crystal Lake on Sunday to have brunch with Andy.
Ask him. He’ll tell you: The hardest part of the leukemia wasn’t the mouth sores. “It was getting rid of that security blanket, of being on the medicine, of going to see Connie and the doctors. When you stop that, the fear comes back. You miss those people. They become such a big part of your life. This disease should have been the worst thing in the world, but I gained a wonderful friend from it.
“I don’t think I would give her up to have perfect health.”
In the world of medicine, this unique yin and yang that develops, this most unscientific method, this human face, is also the most soothing.
I saw it with my mother, too.
One afternoon in 1992 after chemotherapy for her breast cancer, she tried to crawl head-first into a wheelchair. She was cackling like a comedian. I was paralyzed. Of all the things I’d encountered since her diagnosis and her mastectomy, of all the fear I’d experienced, of all the parallel universes, this perpendicular move was one of the strangest.
Thankfully, Julia Pratt, her nurse at the Raleigh clinic, set her straight and helped me get her to the car. “It’s the Ativan,” Julia told me. “She’s had a strong dose.” Is that a common reaction, I ask. Oh yes, she says. One woman, after taking a nap at home following a treatment, awoke to find a fully furnished fish tank sitting in her living room. She became enraged. “Why did you go and buy a fishtank without asking me first?” she demanded of her husband. “I didn’t,” he replied. “You made me stop and buy it on the way home.”
Julia was my mother’s support in a way that my family often couldn’t be. I was a freshman in college, my sister had just announced she was getting married. We were dealing with beginnings; she was dealing with question marks. Much of her worries she sorted out with Julia as a bag dripped Cytoxan through her body.
Long after her chemotherapy cycles were over, she visited that awful clinic, with all the forgettable memories it sprung, to deliver baby presents and Christmas presents and just-plain-hello presents to Julia.
“So much of the medicine she gave me was medicine of the heart,” she would tell me later.
Much younger than my mother, Julia might have been her daughter, might have been one of us. But she was not, and that is why over those four months she became the half of my mother that was missing in the fun-house mirror. She helped turn her upside-down world right-side up again.
“Families can be the hardest part of going through cancer,” says Connie Zanzig. “Sometimes, being a great support can be just as bad as having no family around to help at all. Even if they’ve always been there to help you throughout your life, you may feel like they view you differently now, weaker. And you don’t want to be a burden.”
Ollie Williams is the last of the patients under Barbara Cleveland’s care today at the University of Illinois at Chicago. She is a frail-looking 72-years-old. Nine years ago, in her first battle with the disease, the doctors removed her voice box. This time around, she fights lung cancer. Her day began at 8:30 a.m., with a bag of saline prep solution that dripped into the port that has been in her vein since she began these treatments in April. Two hours of talk shows pass, two hours of bathroom breaks every 15 minutes. Ollie drinks water ceaselessly, Cleveland’s orders. It flushes out any of the toxins that her body didn’t use to fight the cancer.
I ask her if she has family, children. Her eyes grow bright and expressive, enormous behind the glasses that have grown too large for her naked head. She smiles, begins to mouth the answer, and turns from me to her interpreter, a neighbor who is sitting with her today.
“She has three children, a boy and two girls,” Ellen Lee says. Are they around? Do they ever come here with her? The two girls, she says, they live out of state. And the boy, he lives here in Chicago.
“But you know how boys are. He stops by every now and then. He’s a little uncomfortable around all this.”
Cleveland, a young 49-year-old, doesn’t fuss over Ollie; this is Ollie’s sixth chemo cycle since April, her 18th time sitting in this reclining chair from 8:30 in the morning until 2:30 in the afternoon. Drip, drip, drip. Cleveland knows Ollie is a veteran, and there is reverence in the way she speaks to her in that storytelling voice of hers. There is love, too.
“You’re cold again, huh? Well, I’ll tell you what. You get a load of that humidity when you leave here, and you’ll wish you were back inside with me.” You and me. Rarely does a sentence leave Cleveland’s lips that doesn’t contain both of those words. Rarely does a sentence leave her lips without a huge smile.
And rarely does she leave her work within those pale blue walls. “Many, many, many times I find myself crying for patients. Praying for them, crying for them. Every day you take it with you when you go home. Every day. I go home and I have a little book with all their numbers and every now and then I find myself flipping through it and calling someone just to see how they’re doing. They become like family.”
By 2:10, Ollie is getting antsy. She has watched all her soaps and Ellen, who makes wedding cakes, has turned the television to Martha Stewart. Drip, drip, drip. It is so cold in here, so cold that two blankets are not enough to keep her warm. On her return from a bathroom break, she fiddles with the thermostat. “It’s so cold,” she mouths, but she is smiling, because that bag is now empty, and that machine that makes it drip is beeping, and now Barbara is doing a two-step into the room wearing a smile as wide as the chicken Martha just pulled apart and put back together again in the form of a summer salad.
“Oh I know you are so happy,” Barbara says. “You look like you’d like to get up and dance. Would you like to dance?”
It is her last chemo treatment. Barbara pulls the IV from Ollie’s arm one last time, and when it is gone Ollie raises her arms shoulder-height and takes Barbara in them, tears and grins reflecting in the mirror.
A few minutes later, Ollie is told she can go home. Leaning on Ellen, she disappears down the hallway and out onto Wood Street, pumping her fists triumphantly, happy to be leaving the needles behind, sorry she can’t take Barbara with her. But she’ll be hearing from her soon. Amid the chaos, that is a certainty.
“I’m thinking of this lady who came in today,” says Julia. “I hadn’t seen her in a while. We probably talked for 40 minutes, and not about cancer.
“With your mom, it’s the same thing. We don’t talk about it anymore. That’s in the past. That’s old news. We talk about our families. We talk about our kids. We talk about life. Because those are the things that friends talk about.”
My mother, who had cancer, is 56-years-old. It has been seven years. She has a granddaughter now who just turned three, with curly blond hair and a certain candor that can peel away, with one simple remark, the layers adults build up over time to mask their fears. Pointing to my sister’s chest one day, she blurted, “Grammy has some of these.” Her mother didn’t attempt to correct her. My niece couldn’t understand any more than my sister or my father or me what it is like to be half of a whole; for when we look in the mirror, we don’t see riddles. We are like three-year-olds. Our villains are in movies, and our heroes don’t wear smocks.
Copyright 1998 Beth McNichol