Another Diagnosis

It sounds beautiful, the way the oncologist describes it. A warm, pulsing, living thing. Organic. Almost musical. If I were an artist, I’d draw it on a field of blue. The lymph system. Thin, pliant tubes, the body’s interstate system, a highway conveying precious lymph-colorless, watery-from spleen to tissue, from farm to market. Think of your nodes as pit stops along the way, bustling with activity, generating cells, an arsenal for the war against infection.

My mind wanders. Why haven’t I ever seen lymph? Cut your finger, you get blood. What happens to lymph when that same paring knife severs a lymph vessel? Where does it go?

Blood also has a verb. Bleed.

Lymph is only a noun. No one ever asks if you’re lymphing.

I’ve never heard of anyone lymphing to death.

It’s a mystery, this lymph. To you, to me, to my mother. But not to the trained eye of the pathologist peering into the microscope, classifying the node cells harvested in the biopsy into a familiar pattern.

The lymph node shows a diffuse lymphocytic infiltrate with occasional residual nonneoplastic germinal centers. The lymphocyctic infiltrate is composed of small cells with scant cytoplasm and irregular, cleaved nuclei (hematoxylin-eosin 40x, x 400 and Wright-Geimsa x 1000).

Wow. Dig that crazy medical lingo, Maynard G. Krebs. Sounds cool to me.

But not to the oncologist reading the report. Not from the look on her face, the slight knotting of her eyebrows.

Lymphoma, she says. Pretty word, I think, meant to be modified by adjectives like languorous or lazy, nice phonetic matches, synonyms of indolent. Indolent lymphoma. All we need to do is Watch and Wait. Odds are better of being killed in a car wreck or a terrorist attack than succumbing to your mutant cells. Right?

Sorry, the oncologist says, the cell pattern indicates adult lymphoblastic lymphoma.

I don’t think I like what all those syllables imply.

An aggressive lymphoma, she explains.

Uh-oh. Aggressive. Rapid action. Carnivorous cells attacking poor, defenseless tissue with their sharp little teeth. Snip, bite, chew, spit. How much have they already eaten? What’s left?

The oncologist asks the receptionist to bring in coffee. There’s Danish left from the morning staff meeting. Please, help yourself. We’re having a tea party, the oncologist, my mother, and me. The doctor slips her stockinged feet out of her pumps. It’s all so cozy in here.

Staging. That’s the next step, she says. Determine the spread. Let’s start with some bloods, draw a little bone marrow, order a CT scan to get a peek inside the body. Now, depending on the results, we may have to consider a laparotomy to…

My mother twitches, a reflex. She must have misheard. She thinks the doctor said lobotomy. No, I assure her. Or maybe I misheard.

…that’s actually a surgical procedure. We make an incision in the belly so we can get to the internal organs. We take little snips to view under the microscope. Not likely we’ll have to go that far. The bloods and marrow hopefully will be sufficient and it won’t be necessary.

The early reviews come in. It’s necessary.

So we pack a little bag, just enough for a night or two, maybe three, and I whisk her away to the hospital.

Should I call my sister? She knows nothing yet. What if my mother dies on the table? What if she never wakes up from the anesthesia? Regina will never forgive me for denying her the opportunity to participate in the death watch, to share the ritual.

But wait a minute. It’s just a test. Just a little exploration, just harvesting a few clippings for the laboratory. My mother will be home in a few days, her biggest worry being the new tinkle in her car engine and whether she remembered to turn off the sprinkler.

But she’s got it.

That much we do know.

Non-Hodgkin’s lymphoma.

It’s just a question of how far it’s gone.

And now we know it’s gone far enough that they need to slice open her belly to determine the spread.

My sister has a right to know.

No, my mother says, no need for her to worry yet. Let’s not give it to her in dribs and drabs. I’ll tell her when I know everything there is to know.

Besides, I think, my sister would never appreciate the beauty of the lymph system. Its silent mysteries are beyond her comprehension. She’s too literal minded. She’s a real estate broker. Only hard facts are meaningful. Mortgage lending rates. Tax assessments. Comparables. There’s plenty of time in the days ahead to reduce my mother’s diagnosis to tangibles-treatments, side effects, diet, support groups-that Regina can grasp with her fist, bite down on, snap in two.

My mother absentmindedly scratches her freshly shaved belly. I tell her I’ll be back in the morning, before they take her downstairs. I kiss her good night. Just a peck on the cheek. Nothing melodramatic. After all, it’s just a test.

She scores four out of a possible four.

Great! That means she’s won!

Sorry, it means she lost.

Stage IV.

The cancer has spread beyond the lymph system. Multiple organs are involved. An aggressive treatment regimen is recommended. Starting immediately. Yes, yes, I say before my mother can speak, answering for her, not allowing her any say in the matter, adamantly refusing to concede the possibility of a world without her.

Certain things are taken for granted; some basic assumptions go unquestioned. The sun will rise in the morning and set at night. The seasons will change. A year will pass and we’ll all be older. My mother will be there, ready to catch me if I fall and lead the charge whenever I’m challenged.

Ma, someday I’ll be ready to stand on my two feet. I promise. As soon as we get through this, all of this, cancer, divorce, scandal. I’m gonna stand by you, support you, be your rock. I can’t say I’m a raging success, but I wouldn’t have gotten even this far without you. And you, being who you are, will be kind and generous enough to pretend that all my efforts are for you when we both know you’re really just the beneficiary of my own fear of being left alone. But my motives aren’t important in the end; it doesn’t matter that I’m not Mother Teresa because I’m going to be here with you, the whole way, right up until the day they tell us you’ve got a clean bill of health and you’ll live to be ninety. I promise.

“It may not be a death sentence, Andy. Even the most aggressive lymphomas are responding to the newer treatment regimens. There’s a little bit of God in medicine these days.”

“That’s weird,” I say.

“Well, disease is a part of the natural order, but it always feels like a disruption of the natural order to those it affects.”

“No. I didn’t mean the disease is weird.”

Matt waits for me to elaborate.

“You’re a priest, you know,” I say.

“Yes, I certainly know that,” he says.

“And I’ve been seeing you since last summer.”

“Right.”

“And this is the first time you’ve brought up the subject of God.”

“You want to go somewhere with that thought?” he asks.

I feel a professional pause coming on, one of those eyes-locked silences intended to draw me out.

“Do you believe in God?” I ask.

“Of course I do.”

“You’ve never doubted?”

“Of course I have.”

“But you still believe?”

“Yes. I do.”

“I don’t.”

“I suspected as much.”

“Doesn’t that upset you?”

“Andy, I don’t make judgments about my patients’ religious beliefs or lack of them.”

“But you’re a priest!”

“Yes, I am. But that’s incidental to our work together.”

“How can that be?” I ask, not really certain why I’m so agitated. “How can you sit there and allow me to continue in my heathenish delusions? I thought it was your job to bring me back to God!”