Relatively little testing was done at Mayo over the weekend, so my dad and I planned to go home for Halloween and two days of normalcy.

Because of my biopsies, however, the doctor recommended we remain in the city over night to avoid excessive movement and possible complications. Homebound Sat.u.r.day morning we planned to return to Rochester on Sunday evening, at which time I would be expected to check into the hospital; Monday's agenda would include surgery. Having exhausted all the other less radical options, an exploratory operation was the only manner available to determine the mystery concealed beneath my flesh.

I was glad to be home. Holidays were made to be spent at home, in my opinion, and Halloween was no exception. That weekend, though, was especially important to me. Like my trip to Colorado before the operation for cancer, coming home was quite possibly my last taste of the life which I had lately enjoyed; I needed not kid myself that the operation's results could change my life in such ways that it would never be the same again. The present was all that was mine, and nothing was certain but the few hours of autumn sunshine and jack-o-lanterns which graced the days. Those were the elements which I embraced with all of my enthusiasm until it came time to leave for Rochester.

The drive was memorable for many reasons. Dad and I were, once again, traveling alone to the clinic; the three of us would have gone, but since Mom had employment obligations in the form of parent/teacher conferences, she decided, for the parents benefit, to remain at home.

It was the year's first conference and no one could have subst.i.tuted.

With my car's heater useless, it was also the first time we drove the truck. Because the truck had a manual transmission, steering and brakes, and Mom's blood pressure rose at the mere thought of having to drive it, we presumed it would nullify her nightmares if she retained use of the family car. Finally, it was the first time we had ever driven to the clinic by way of the prolific back roads that skirted the northern farmland; though we stopped at various intervals to a.s.sure our progress, only once did we find ourselves on the right highway traveling the wrong direction.

All things considered, it made an interesting drive, and between eating lunch in a small town and buying M and M's at a gas station and watching Iowa's flat land slowly transform into the more hilly dairyland of Wisconsin, I did not burden myself with the essence of our trip; I found more importance in enjoying the seven hours than stewing in the ignorance of my health situation.

When we reached the outskirts of Rochester, Dad pulled into a gas station to fill up the tank and I jumped out of the truck for a stretch. It had been a beautiful autumn day. The buildings now etched long shadows upon the sunny landscape; soon shadow would meet shadow until all was covered by darkness. I turned slowly to face Rochester and my eyes locked on the two familiar buildings which towered above the city. The clinic buildings, old and new, represented an integrity in medicine which commanded respect; they could bear the happiest or the most solemn news, and remain untouched, for in those two buildings illness and death were more commonplace than health. Brothers of the same mind and purpose, the buildings formed an ent.i.ty of themselves, daily inhaling and exhaling patients irregardless of whether the patients actually survived.

I took a deep breath to still the sudden, wrenching nervousness which clenched the pit of my stomach. The two buildings defined the reason I was there even if they, as yet, gave me no real answers. It was then that my joy ride ended and the unhappy reality of retiring for the evening in a hospital room created waves in my mental calm. Even my so-called "last supper" was clouded by anxiety.

One's natural reaction is to run from a threat, and to postpone less palatable situations as long as possible. For me, however, there was always a point at which flight and postponement no longer satisfied my emotional needs, but instead created agony in their own right. When I reached that summit, I grew intensely nervous and within minutes made a 180 degree turn which boosted me into an entirely different mode of thought. That which I had fled, I sought, and if I was denied the pursuit of my goal, I would experience an inner explosion of panic. To reverse the feeling that I was the quarry in an unfair hunt, I had to establish for myself that I had complete control over the situation.

In effect I did not "give in" or surrender to a stronger authority; my flight came to an end through a deliberate, conscious decision on my behalf.

And so it was that I finally decided to check in to the hospital and surrender my body to a world of white. Once I was clad in the gown, my ident.i.ty became synonymous with scribbles on a chart, and color, the brilliance of life on the outside, drained away. Hospitals robbed me of something; I could be happy and possess a positive outlook, but the energy and vitality of life was inaccessible. Perhaps this blandness in my soul was a way of coping with adversity, for if I had little pa.s.sion from the outset, no ill tidings could evoke a particularly heated or irrational reaction.

Dad left relatively early for his motel, or maybe my feeling of isolation only made it seem that way. Had I been able, I would have left also; sterile atmospheres are rather nerve-wracking, and I knew Dad was nervous enough without the added pressure of whiling away the twilight hours in a cramped four-bed hospital ward.

The room had no T.V. so I turned my attention toward the window. Tiny dots marked streetlights and houses, but the vast darkness prevailed over most of the scene, creating a solitude which mirrored my own.

During hours such as those in the hospital, I realized how terribly insignificant I was as compared to the entire world. A person could lose himself in this world.

The morning held no delights. I would not even receive a breakfast tray. I looked forward only to a day of antic.i.p.ation in which I was fourth in line to leave for the operating room. I could do little but stare at the walls and wait for the morning to ripen into afternoon.

By mid-afternoon I began to wonder if the operation would be cancelled due to the lack of time, but finally several people retrieved me, whereupon I was taken through the hospital corridors on a gurney and given a different perspective of the building than I was accustomed to seeing. (Unlike some public buildings, I was pleased to note there were no spit-b.a.l.l.s on the ceiling.)

Riding along the hallway, I also perceived a difference in myself. I was in the spot-light, the main attraction in a frightening event. . .

and yet I was not worried. A relaxant had siphoned off my excess nervousness and the remaining anxiety drained away because my waiting was over.

In a partial dream-state, I watched as blue frocked workers rushed about, preparing for my operation until I was wheeled into surgery.

There, bright round lights shone overhead and doctors and nurses craned their necks to see their next patient.

"You're going to feel a stick," the nurse warned.

I watched as the doctor placed the needle in my vein. For the first time I was aware of my surroundings up to the moment I received anesthesia, and it was truly an enjoyable experience. The relaxant had full control of me, and a loaded gun would not have evoked duress. I looked at the kind and gentle nurse and began to drift away, little by little, until reality faded and then plunged into a sea of darkness.

I woke up in a ward which housed three elderly women. My bed was crammed in a corner of the room with a curtain serving as the only form of privacy; from my vantage point, I was able to view an extensive portion of the hospital roof through the window.

The first person I saw was my father who appeared to be stricken with concern for my condition. Immediately I asked, "what is it?" to which I was given a sober reply of "It's cancer again." I was quiet for a moment, and then thought dryly, "It figures."

Reactions to drastic news are manifold and multicolored. To say there is a specific process through which each grief-stricken individual shall pa.s.s parallels the statement that all people look alike. I cannot regard emotional turbulence with simplicity, for each individual possesses different levels of consciousness, or awareness, which likewise renders his ability to cope with a given situation as singular as his character itself. Though one individual's coping strategies may closely resemble those of another, they still are unique.

To avoid categorizing I will remark upon some of the various reactions I have encountered, including those in myself, family, and friends as "possible reactions" rather than referring to them as "steps" and thereby applying on them a more definitive and absolute quality. While it is possible for people to experience each "possible reaction," not everyone shall.

If I was asked to name a frame of mind in which one can best cope with adversity, I would unhesitatingly say, "acceptance," for it is the most pleasant manner of greeting and harboring a potentially grim reality.

Attaining acceptance gives one the ability to objectively view the hardship and cope, in a very real sense, with the final outcome; this means there is no longer a fight for life, but an enjoyment of it.

There are no more bouts of pervasive anger, fear, or depression; when these emotions do occur, they rapidly pa.s.s as do the tides of emotion in the healthiest of people. The problem is seen and understood in realistic terms, rather than as a boogy-man in the night contesting for one's life. There are no more superst.i.tious pleas for help, and while hope is maintained, no more does one cling to blind hope.

Acceptance does not imply that the individual is happy with his health disorder; however, it does allow him to live in peace and embrace those facets of life which he holds meaningful. Once enabled to accept reality, the individual is secure within himself and can similarly project that ease upon those who are close to him.

Unfortunately there is no prescribed method of gaining acceptance; while some individuals can grasp their difficulty outright and begin to redefine their lives, others require time to work through the various stumbling blocks which often accompany trauma. Still others are never able to attain acceptance and die in turmoil.

Two factors which I feel can greatly serve toward the goal of acceptance are awareness and communication. One's reactions cannot be altered unless he is aware of them; once able to note irrational behavior (such as anger directed toward a wife rather than at cancer) he can with time change his actions. Communication's effect on adversity is that of purification, for conversation purges minds of fear and lonliness and gradually filters irrationality from one's thoughts into non-existence. In the following pages I hope to ill.u.s.trate the importance of communication and ironically, perhaps, the few instances wherein communication should be squelched.

"It's cancer again!" A mere three words, and yet the impact is great, and the repercussions greater still. It is strange, somehow, to think so few words could alter the course of a life, and profoundly affect countless others; yet once imparted, dreams give way to reality, and agony can filter deep. Plans once one's own must be fulfilled by another, and the future in which one had pictured himself, shall be clipped short and uncertain. Losing all that one holds dear is rarely a kind image, for despite religion or a lack thereof, death is life's greatest mystery, as it ever shall be.

The initial reaction to a terminal illness is often that of undiluted shock, especially cases wherein the patient had demonstrated no drastic changes in health or felt no persistent pain. Perhaps the dismal news was revealed after a slight, but disconcerting health symptom; the doctor was visited with hesitant antic.i.p.ation, with the hope that the abdominal protrusion was only persistent gas, or the cough was merely the stubborn remnants of last winter's cold. Although some poor souls cannot release themselves from the notion that it is "only a mistake,"

or "a dream," most individual's stupification will subside, allowing them to face up to the situation and deal with it as a factual absolute.

Because I had sought an appointment with the doctors at Mayo Clinic of my own accord, I was prepared for any diagnosis which the test results would uncover. Noting that my stomach region appeared lop-sided I knew there was something amiss despite my seemingly good health; thus the result of the exploratory surgery was disappointing, but I cannot say it was a shock.

I felt no need to question the test results or wildly seek second and third opinions. Viewing the pictures taken by the CAT Scan of my liver, I had nonchalantly asked, "Are there supposed to be spots on it like that?" Before the doctor had given an answer, something within my mind yelled, "Of course not, you idiot!" The doctor responded likewise, although considerably less profound.

That which helped me deal with my verdict, coupled with my suspicion that life, for me, had been sailing along a bit too smoothly and the fact that I had cancer previously, was an unusual strength to adapt to adverse situations. From early in my childhood I was able to have the objectiveness to realize that things don't always happen to "the other guy"; actually, if something could go wrong, it probably would. If there was a log poised between two opposing banks of the creek, the odds were that I would fall off of it in crossing. In a world of "other guys" I was just one, yet that in itself proved I was immune to no adversity. Thus, instead of "why me?" my question was generally, "why not me?" I happened to be one of the cancer statistics, and I was far from alone in my plight.

Mine was no easy burden, yet it was mine to deal with as best I could; wallowing in a murky pool of self-pity would accomplish nothing. When I felt a wave of pity tempting me with its utter worthlessness, I would accommodate it for a brief period and then cast it away to pause and reflect upon those whose health involved more horrid complications than my own.

In keeping with some individual's idea that everything happens to the other guy, often the same people will feel that they are alone in their suffering. The person who cannot empty his mind of envious jealousies toward the healthy only further torments himself, and subtracts from his capacity for peacefulness. Although those who yet possess their health should appreciate it, they should not be made to feel guilty for their fortune. Every mortal being will one day find himself confronted by life's ultimate reality, death.

My dad, characteristically pessimistic, was not overly surprised by the news that my cancer had returned. After all, he was quite used to bad news. It was just one more undeserved bombsh.e.l.l to fall upon our family. One might a.s.sume that time and past anguish would have provided a natural immunization to further emotional rending. Still, somehow he felt the pain; I saw it in his eyes. For Mom, the news was emotional heartburn and swept like a roaring fire through her chest.

After Dad phoned her she caught her breath, walked to my old bedroom and stood in the doorway for a long while. Then a feeling of anger added fuel to the fire; she had remained at home for conferences, giving her time and effort for the children of other parents, yet some never bothered to attend their scheduled conferences. It had been a slap in the face; coupled with my poor health report, however, Mom felt victimized, as if by traitors. She stayed home. . . she "should" have been there.

Mom stared at the lime green walls through a transparent screen of tears and remembered me as a little girl, long-limbed and skinny. It was happening again; the impossible had returned to deal its final blow.

The pain of reality is not solely one's own. If an individual's relationships with family members and friends are of foremost importance in his life, the news of his illness will have a profound effect on everyone. Their reactions play a significant role in determining the patient's sense of emotional stability and well-being; he must witness the emotional pain felt by his loved ones, evident through tearful outbursts, inappropriate anger, or pervasive gloom, as each person thinks of the future and the way in which the loss will affect his own happiness. I feel it is crucial to share the internal suffering openly and honestly between family and friends, for a health difficulty, although borne by one, is a burden felt by everyone personally involved.

Though I had prepared myself for whatever the outcome might have been, I had not been certain that the enlargement necessarily predicted the presence of cancer. There were, after all, many other disorders that could cause the liver to enlarge. My haunting emotion that I had not overcome cancer was now parallel with reality; my "balloon of health" was beginning its descent. I focused my eyes on three flower arrangements which were blooming profusely on my nightstand appearing, it seemed, out of nowhere. They formed an odd contrast to the bleak and antiseptic atmosphere, as if to say that life can continue even in such places as hospitals where dim hopes and faltering heartbeats evoke a sense of gloom which permeates entire corridors.

I began to barrage my father with questions, many of which he was unable to answer since he had not yet conversed with the doctors to any great degree. He could only tell me that the surgeon opened my mid-section and took a biopsy. Seeing that the cancer was widely distributed throughout my liver, he was not able to operate and therefore sewed up the incision with best wishes.

Because the cancer was the same type as I'd previously contracted, the doctors believed that it had never actually disappeared in the first place, and spread without their knowledge to the liver. This might have occurred at an early age, lying dormant, or more probably, spreading slowly until it had touched numerous sites. Leiomyosarcomas, presumably, are considered primarily "older women's cancers" which may spread to the lung; this baffled the doctors to such a degree that they placed me on research after the initial bout, at age thirteen. To find that it had again defied their previous knowledge as to the behavior of the average leiomyosarcoma, recurring in the liver without so much as a trace in the lungs, was considered absolutely mystifying and unique.

Despite the uniqueness of the cancer, the fact remained that I was a young woman with a dreaded disease. . . one that had supposedly been "cured" by the lengthy operation and chemotherapy treatment. I reflected how my oncologist (cancer specialist) had rea.s.sured the permanence of my cure by saying, "There is more of a chance of your being killed on your drive to the clinic than of having a recurrence of cancer." He was that sure.

I do not envy the doctors. Daily they encounter sickness and health, yet are limited in their ability to heal and a.s.sure their patients of continual well-being. They are accused of being incompetent when they cannot act as G.o.d. They are a.s.sumed to be uncaring and detached, when in all actuality they would lose their sanity if they were subject to emotionally react to each individual sadness. When they deliver the truth to a waiting patient, they are often called tactless. They are blamed for finding a health problem and thus disrupting their patient's happy-go-lucky lifestyle. Personally, I'm content with doctors and feel a need to demonstrate that gratefulness. When the surgeon visited my room after the operation, I greeted him with a smile and attempted to make him comfortable. I knew it wasn't easy to face me; we looked at each other like old friends and he took my hand in his own. What could have been said that had not already expressed itself in his eyes?

I questioned Dr. Telander about the various specifics of the operation, and casually inquired as to the reason they did not "simply rip the sucker (my liver) out?" He then informed me that one cannot live without the organ. Slightly embarra.s.sed, I said that I had never been much of a biology student and continued with other questions. I truly was not aware that the liver was an organ of such consequence.

Although I never encountered Telander again, I was a.s.signed to a doctor who made one or two rounds daily to note my progress. I bombarded him with any questions which happened to cross my mind, no matter how stupid they seemed.

Earnest conversation between a patient and those with whom he interacts, whether doctors or family members, is a necessity. Although the truth is often painful and frightening, I am a faithful advocate of knowledge over ignorance, and feel it is to one's benefit if he can receive the news of his illness in a manner which is, at once, tactful and concise.

Rather frequently I have heard accounts of close relatives of a terminally ill patient begging the doctor not to divulge the full implications of the patient's health. The plea, usually something to the effect, "Oh no, Doctor, you can't tell him. . . the truth would kill him!" is somewhat curious in the context it is used, for doubtlessly the patient will die whether he knows all of the facts or not. For those who doubt the beneficiality of telling the truth, let me further ill.u.s.trate my a.s.sertion. After receiving a clean bill of health, a person who has, unknowingly, contracted leukemia continues with increasing difficulty to do the activities which he formerly accomplished with ease. This individual is not ignorant; despite any clever lies that initially might have given comfort, it will be evident that something is wrong as symptoms gain momentum. Withholding information depletes the individual's right to spend his time as he wished and, I might add, to work through the possible stress that is a.s.sociated with such devastating blows.

The most terrifying part of a horror story is when the killer is yet at large, faceless and unknown. This general prefix applies to any fear, I feel, because once the unknown is brought into the light and understood, it can no longer evoke the terror it had when it rampaged through the mind as a veiled monster. A person is not afraid of the dark, but rather, what lies concealed within it. Similarly, illness can evoke feelings of terror as the body degenerates before an unseen attacker. If a person is educated about his illness, I believe a great deal of trauma could be avoided. Instead of presuppositions, one had facts, and as in the horror story, once the killer is recognized, the audience is given the hope that the victim will see and overcome the horrid pursuer. With regard to the patient, this could mean hope instead of futility; when described symptoms do not appear, the patient a.s.sures himself of more time to enjoy his redefined life.