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I remember that she wore red shoes. Her feet were tiny and she was wearing pantyhose. She examined the lump on my neck for all of 20 seconds before leaning back in her swivel chair and pronouncing: "This is probably a lymphoma."
At some point in that meeting she prescribed me antidepressants, and I think we scheduled a biopsy, but what I mostly remember are her shoes. I stared at them while she talked to me about treatment options and mentioned that pop Christian book, The Shack. She said I was lucky. She said, "You are going to learn some important lessons early that some people never learn." I nodded and pretended I knew what she was talking about.
Afterward, my boyfriend and I went across the street to a diner and ate tuna fish sandwiches and potato chips. I never ate potato chips, but I remember thinking I could eat whatever I wanted now that I was dying. I called my mom. I went to a movie - The Soloist, with Jamie Foxx. During the scene in which Foxx's character has a psychotic break, I went to the bathroom and sobbed in the handicap stall. Then my boyfriend and I went to a park and sat under a crabapple tree that was heavy with pink blossoms. We cried for a long time, and then drove home to our apartment in Oberlin, Ohio, and ate Mexican takeout.
The date was April 29, 2009. I was 25 years old.
Flash-forward six months, and I'm back home in Wisconsin, with my parents in Verona. I awake at dawn. It is a sunny autumn morning, and I am heading to the hospital for my ninth chemotherapy treatment for Stage III Hodgkin's lymphoma.
I throw a baseball cap over the straggly remains of my hair and pull on leggings and a sweater. I know that the hospital will be cold and that, in just a few hours, I won't be able to tolerate anything without an elastic waistband.
When I first began my treatment, I swore to myself that I wouldn't be one of those cancer patients who wore pajamas every day. I also swore that I wouldn't care if I lost my hair. Who has time to be vain when your life is at stake? But I did care, and I do wear a lot of pajamas. It's a matter of choosing your battles.
How did this start? Everyone asks me that question. The truth is, I don't know. When I first noticed flu-like symptoms last spring, I thought nothing of it. I worked in a library and was in constant contact with the public.
I had a similar response when I noticed a lump above my right collarbone. The C-word crossed my mind, but it didn't make any sense. Everyone knows twentysomethings don't get cancer. Twentysomethings get hangovers, crappy jobs and occasional quarter-life crises. Cancer is for old people and little kids and maybe the broccoli-deficient. And as a vegan yoga teacher and longtime health nut, I thought I was immune. Naturally.
As my parents drive me from our house to the UW's Carbone Comprehensive Cancer Center, a familiar queasiness begins kicking around my stomach. "Anticipatory nausea" is the doctors' name for it. I think of it as today's pregame show to the major sickness to come.
I pop a lorazepam to take the edge off. Before I got cancer, I wouldn't even use ibuprofen.
A lot of things were different before I had cancer. I was living with my boyfriend, Ben, in Ohio. Two weeks before my fateful appointment with Dr. Red Shoes, I had been accepted with a full ride into my first-choice graduate school. I didn't have health insurance, but preferred to think of it as the "Yoga Is My Premium" plan.
I was diagnosed with Hodgkin's at the Cleveland Clinic, which offers world-class medical care and a comprehensive financial aid program that would cover the full cost of my care. Yet after the trauma of a cancer diagnosis, I knew I needed to be closer to my family and friends.
My family moved to Madison in 1987 and has lived here ever since. I graduated from Verona High School and worked a number of jobs in Madison after college, including freelancing for Isthmus in 2007 and 2008.
Madison is my home in every sense of the word, and home is where you go when disaster strikes. So by the end of June I had switched oncologists and moved back into the bedroom that had been mine since the age of 14, with no health insurance and no means to pay for the pile of hospital bills that were mounting on the kitchen table.
On the first day it became available, I applied to the BadgerCare Plus Core Plan, but because the program was so new, no one could tell us definitively if the plan would cover the costs of treatment. My family and I crossed our fingers and prayed that this piece of the puzzle would fall into place.
Meanwhile, Ben stayed behind in Ohio with his job, and I put him in charge of smoothing out the logistics of the Cleveland Clinic financial aid. Stress levels were high, and we wondered whether our relationship would survive both the distance and the implications of the disease.
Regardless of money worries, I was glad to be back in Madison, and for the first weeks I reveled in small pleasures - visiting the Farmers' Market, catching up with old friends, visiting the New Glarus Brewery, and eating my mom's famous rhubarb pie.
But let me be honest. I was also devastated. A meteor had been dropped into the middle of my tidy life, and in its wake nothing looked as it should. I was supposed to be back in school, teaching classes, improving my earning potential and living in a big city. I was not supposed to be crash-landing back in the nest, working at a coffeehouse for near-minimum wage, hoping for state medical assistance and calculating the odds of my survival.
To my friends and family I maintained a stiff upper lip, crowing that cancer couldn't get me down and that I'd march through my treatment with the discipline of a soldier. It felt so good to say this that I almost believed it myself. But in quiet moments, grief washed over me in sudden torrents, leaving me gasping for air amid a profound sense of loss.
My folks and I arrive at the UW Hospital and skip the valet parking. I check in at the registration desk; the woman there knows me by name, as do other staff. It's comforting, and the tiniest bit flattering. It's like knowing the matre d' at a chic restaurant, except that no amount of cash will get you seated any faster.
"Is Medicaid still your insurance?" the woman asks me. I nod, slightly embarrassed in that unique, middle-class way. My application to the Core plan was accepted, and thanks to that program, along with the extraordinary generosity of family and friends, I should walk away from this saga debt-free...and extraordinarily humbled to boot.
She gives me a plastic buzzer - the kind you get while waiting for a table at Applebee's - and I take a seat in a vinyl chair across from the laboratory door.
I scan the waiting room and flip through the newest copy of People magazine. Each year in the U.S., some 70,000 twenty- and thirtysomethings are diagnosed with cancer, and in all these months I've seen only one person my age here. I used to think I stuck out like a sore thumb - a brightly clothed spring chicken among sick and aging hens. Now, I don't notice much of a difference. I am balding, tired and gray-faced, like everybody else.
Fifteen minutes drag past. The hospital gets top marks from me, except in the "efficiency" category. I get more up-to-date on celebrity gossip than is entertaining or healthy. Finally, my buzzer goes off, and I step into the lab.
"Pick a seat!" says the bearded technician, as if I'm a contestant on a game show. I slide into the nearest chaise and roll up my sleeve, telling him my full name and birth date before he has a chance to ask. This impresses him. It's clear I've been through this before.
He cleans off the crease in my elbow with an alcohol swab and uses his middle and pointer fingers to coax out a vein. "Now, this might hurt for a second," he says.
"Don't worry," I say. I've been through worse. I tell him that, too.
Ah, the memories! Here are a few that have attached themselves firmly:
The smell of alcohol permeating my skin and clothes. It smells like hospital and sterilization and sickness. I have to hold my nose when I give myself injections at home because the cleaning swabs make me queasy. So does hand sanitizer. I have to buy the natural kind at Whole Foods that costs five bucks a pop.
The faint taste of metal as the chemo enters my body. Even as I write these words, a gag reflex kicks in at the thought of the pervasive, disgusting saline flush coating the back of my throat.
The sight of a prisoner, bound by handcuffs on his hands and feet, receiving his chemotherapy regimen in the room across from mine. His only companion is a prison guard, and neither of them says a word.
The sound of a nurse telling me that I "may feel some discomfort" during a bone marrow biopsy, and the harsh, animal-like cries that I realize are coming from my own throat as she plunges the giant needle into the deepest recesses of my hip.
After my blood is drawn, we are led to an examination room to see my oncologist. After all these months, I can only remember one doctor's appointment that my mom has missed, including the ones in Ohio.
The energy she's put into my recovery is staggering. Sometimes this embarrasses me, makes me feel like a burden. I am a grown woman, and my mother cooks for me, cleans for me, and helps me up the stairs when I am too weak to walk by myself. I'm not sure which is more powerful - my need for her or her commitment to meet it.
My oncologist's nurse, Nancy, enters first. The last time I saw Nancy was when she told me two months ago that my CT scan showed 50% of the lymphoma was gone. I'd burst into tears and hugged her then, approximately two minutes after we first met. She gives me a big smile today - an intimacy forged in the trenches.
I receive a perfunctory physical exam to check the lymph nodes in my armpits and neck, and I lie down on the examination table's crinkly paper as my oncologist taps on my abdomen to feel my spleen. Everything looks and sounds good. I know that this is not always the case.
My blood work has come back from the lab, and we look at the results on the computer screen. While my platelets and hemoglobin are a little low, overall my oncologist is pleased with how well my bone marrow has held up through the chemotherapy.
"Some people's numbers just plummet," she tells me. "Yours have stayed consistent." This makes me proud of my sturdy little marrow. Despite the nausea doing back flips in my stomach, despite my fatigue and frustration with chemo's Sisyphean nature, waves of gratitude swell up in my chest.
Why did this happen to me? I've been told it's everything from bad luck to an old case of mononucleosis to low chi and everything between. I've been told to drink kombucha, drink only water, eat raw, eat meat, exercise, don't exercise, and countless other, contradictory advice.
I almost wish that before I had cancer I had led a reckless, hedonistic lifestyle so that I could shape up and convince myself I had control. But I can't do that. I was already living right, and I got cancer anyway. Sometimes there is no why.
A friend of mine who grew up in rural China tells me that Americans have a distorted view of suffering, and that people in the Third World understand better than we do that every life holds a large amount of pain. Americans - or at least, my pre-malignant self - like to believe that if we work off our cellulite, make enough money, or manage enough circumstance, not only will we never get sick or old, we can live forever! I suffer no such illusions now.
This must be what Dr. Red Shoes meant when she told me about learning important lessons. It's true that most of my peers are bewildered when it comes to things like cancer, and this makes me feel very old. On the other hand, I have started eating bacon again, and this makes me very happy. So it's a wash. I had 25 relatively blissful years before life handed me a short straw. In the grand scheme of things, I don't think that's too bad.
Sandy is my nurse today, my personal chemotherapy assistant. She is warm and motherly and has a soothing voice. She takes me to a bay with a window and gives me a plastic cup full of my pre-med pills. I am happiest to see the Benadryl. It will knock me out and turn the hospital into a vague, fluorescent fog.
Ben calls to check in from Ohio. It's been a roller coaster, but the two of us are still together. He made sure the Cleveland Clinic financial aid came through and has driven thousands of miles to visit me every other week. More important, he has learned to listen, and I am learning to not push him away.
I start chugging my giant bottle of Evian. I figure the more I drink, the faster the chemo will leave my system. Sandy bustles in and out of my room, fetching pillows, blankets and magazines. When my chemo cocktail is ready, she returns wearing a paper Haz-Mat suit and gloves. It is a strange feeling, knowing that the nurses wear this gear to protect their skin against liquids that will be going into my primary arteries.
Sandy pulls a chair up to my vinyl recliner and rearranges the tubes attached to a port in my chest. She starts pushing in the contents of a syringe. I'm glad she's in charge of me today.
Often I am assigned nurses who are around my age, and I spend much of the time trying to be chummy with them and pretending the drugs aren't making me quite as ill as they actually are. With Sandy, I drop the pretense. I cry a little - something I rarely let myself do in public. She asks if I'm all right; I tell her I'm just sick and tired of being sick and tired. She pats my arm. I cry a little more. The jig is up. I am a mess.
We sit quietly for a while as she slowly empties the fluids into me. I ask for her opinion: Why did this happen? Sandy tells me she doesn't know. "I see marathon runners, all these healthy people in here," she says. "It doesn't make any sense."
We mull on this, and then it's Sandy's turn to pose a question. "Do you feel like this experience has changed you?" she asks.
I think for a minute. I can't remember what I was like before this, but yes.
Sometimes, I can physically feel the change inside me - this painful expanding and deepening of my understanding of what it means to be human. Sometimes the pain feels good, like stretching a muscle that's always tight, and I sense that things like compassion and maturity might settle into the expanse. But sometimes the pain is excruciating. It's raw and jagged and pulls me further than I'm ready to go, further than I think I can bear.
How do you explain this to people? When people ask how I'm doing, is this what I should say? How do I offer them a chance to walk in my shoes? Struggling to find the right words, I finally tell Sandy, "It was the end of my childhood."
At the end of the day, I am home. I lie curled up on my bed. My dad comes into my bedroom and starts rubbing my back, the way he did when I was little. With the wisdom of his 30 years in the ministry, he has given me the emotional support I've needed during my hardest moments.
"Three more treatments," I tell him, blurred and queasy from the drugs.
"Three more," he says. "Life is good."
"Life is good," I echo.
"This, too, shall pass," he reminds me.
"This, too," I say.
And it did.
Sally Franson is currently in remission for Hodgkin's Lymphoma. She will begin her studies at the University of Minnesota's MFA in Creative Writing program next fall. To read more, visit her blog at www.caringbridge.org/visit/sallyjane.