Learning to ride, falling down, getting back on
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— For K., whose story this is
It begins like this: You drop your son off at kindergarten. His first day of school. You think that nothing in your life will be as big as this: the moment he drops your hand, he who has clung to you since birth, since that first breath of air, first scream, first frantic rooting for the breast. Your breast. His empty hands beating the air, demanding that first nourishment, that first intake of life. Your job: to guide him to it.
In the worst and best of all imaginings there is loss. You take a deep breath. The air as it enters your lungs is starched with August heat. His hand squirms in yours; you make yourself let go. You ache to take it back, but you’ve brought him this far: to the primal launch, the first milestone. You find you are breathing with him without meaning to, in sync with the air as it enters and leaves his lungs. You watch him walk away. The heavy school door swings shut between you, and you are left alone, facing an empty yard that moments before was alive with children. He has left your side. His life is just beginning.
Yours is ending, but you don’t know it yet. All you know is the scent of lilacs on their second bloom, the first faint golding of the leaves, the air that still tastes of summer, of canning peaches and tomatoes, putting away stores for a winter that, when it comes, will require of you nothing at all.
But he is five, and planning for the future is the only thing you have right now.
You drive to work. It’s the first day of your school year, too, a time of new beginnings for you both, here in this moment when the pulse of summer starts to slow. You drive down country roads that wind through the hills where you grew up, went to school, fell in love, earned your PhD, became a mother. Through your open window you can smell the honeysuckle, its scent so thick, so filled with longing that for a moment you forget it’s an invasive species — because how could something that smells so sweet be choking out the roots of everything around it? It’s only doing what its nature demands: establishing its presence.
As you drive, you pass the towers of steel that have come to mark these hills, two hundred feet high and red as blood. The nightly fires, the tanks of water, the men in hard hats with dirt on their hands and faces: the same dirt in which you plant your gardens; the same dirt from which you harvest your food. They dig deep into the ground to find the shale that contains the gas, and when they do, they blast it out with chemicals that leach into the water you drink. This is happening all over the state. Yet they came in so quietly, went to work with such precision, that most of the country has no idea it’s taking place, this covert invasion, this revolutionary extraction process, this bright new fuel source that will save us from foreign dependency, from having to change a way of life to which we have all become accustomed. It started here, but it will spread from hill to hill, from state to state. Once these wells are sunk, there will be no stopping them.
Many things are beginning.
More than you know.
The college where you teach is two hours away from where you live. It is not the job you hoped for, as you labored to earn your PhD, those long hours with Edith Wharton and Henry James, all that anxiety and desire of a dying century. You dreamt of a more prestigious university, but you couldn’t bring yourself to leave these hills, this place where you’d always planned to raise your children. Those better jobs are dwindling anyway, as more and more adjuncts are tapped to perform them, a cheap labor force willing to forgo benefits. Let’s face it: yours is a tenure-track job, and you’re lucky to have it. You’re determined to do it well. You will do it for as long as you can. They will have to wrest it from your grip when the time comes to let it go.
Nervous, you pause on the threshold of the classroom, your heartbeat swift and rabbit-like, and summon up those yoga tapes you listen to. You bring your attention to the breath. Inhale. Exhale. A synonym for inhalation is inspiration. You have always liked this.
You enter the classroom, and the students respond to you immediately: to your humor, to the sharp knife of your intellect, to your clothes. You are a riot of color with your bright fabrics; your bracelets, necklaces, earrings, and scarves; your purple Keds with their ribbon laces. No one taught you to dress like this; it’s an innate skill, your slim form a willing canvas for your artistry.
You teach half your classes online, at your kitchen table, squinting at the screen for hours. Your wrists ache from typing. You bring to this job the same energy you bring to everything: a concentrated fervor; a slow, controlled fire. You make it to every department meeting, every class, every conference. You drive these roads until they are imprinted on your brain, seeded in the neurons that fuel your every thought. This job becomes a part of you, like your husband, like your son, who walked away with his head up. Did he look back before that door fell shut?
He did not look back. This is his life, and he is going into it with everything he has.
He is so like you.
You find it in the shower. One hand guiding the soap across the thin, small, boyish body that has, until this moment, served you well.
You slide your hand across your left breast, and your breathing stops. How long has it been there, hidden in the ducts, doubling in size, tripling, until its presence can be felt just beneath the surface of your skin? It is so large you can’t believe you haven’t noticed it before. You are thirty-eight years old. Too young even for a mammogram. Were there warning signs you missed?
There are always warning signs. Aren’t there?
The diagnosis comes two weeks after the school year has begun, your son’s and yours. You drive to work with the window down. Around you the leaves are catching fire. Before too long they will set the hill ablaze, their final throes inevitably their loveliest. You keep one hand on your breast, as if your touch will be enough to save it.
It will not save it.
The tumor is estrogen receptor positive. Twenty percent of estrogen-receptor-positive breast cancers are “human epidermal growth factor receptor 2.” This is what you have. They call it HER2.
You find this ironic.
“At least it’s positive,” you say. This is gallows humor. HER2-positive breast cancers tend to grow faster, spread more easily, and be more likely to come back than HER2-negative ones. They have a poor survival rate. There will be great strides in treating this form of cancer in the years to come, as gene-therapy breakthroughs alter the landscape you are entering. A dozen years from now, you could conceivably survive this.
It is not a dozen years from now.
It is now. And you are stuck in it.
This cancer is not hereditary. Doctors do not know what causes it.
Environment, they think.
You get on with things, breathing as best you can. In and out. Life begins with an in-breath and ends with an out-breath. We are born with all the breaths we’ll ever take. You remember reading this somewhere. You tell yourself: Breathe slowly. Make it last.
Our involuntary systems do their work so well. Our bodies are a marvel. What makes them turn on us? And why yours? What random twist of fate dealt you this losing hand? You suspect the fuel industry blossoming around you, its brine ponds full of wastewater, its chemicals seeding the air, its choking hold on these hills you love.
You are not wrong.
It is not your genes, no faulty wiring in this body that you prize.
You are so young. You never imagined it would come for you this soon.
You wander through your fields, your beloved forty acres. Visible just beyond the tree line is a telltale red tower. Your neighbors have leased their land. No wonder they’ve been avoiding your eyes when you meet in the store. Everyone is signing leases. The sound of the drilling is with you every hour of every day. It floods your sleep, invades your dreams. This is the peak. Signing bonuses and royalties are the highest they will ever be.
You wonder, you and your husband, if you should sell out, too, use the money to get away, move to Vermont. You’ve had an offer, so much more than you thought the land was worth. Your land is gold right now, ripe for plunder.
The breeze strokes your face. Around you the last leaves rise and fall with the wind. You lift your eyes to the hills that are so familiar.
You can see their silhouette begin to change.
The doctors want to go in. One surgeon says he’d take both breasts and your ovaries, too. “Male doctors,” you scoff. You know better. Haven’t you dealt with arrogant men every day of your life? Men with little understanding of what you need to be human? “It can spread to my bones, too,” you say emphatically. “Does he want to take them while he’s at it?”
Your feistiness will come back to haunt you in the end.
As a tiny voice inside you tells you it might.
You thought you’d feel nothing when they came for your breast: no emotion, no grief. Your breasts are so small, you’ve always thought of them as inconsequential. You are unprepared for what you feel as the nurses prep you for surgery. It’s as if the fact that this breast nourished your son has slipped your mind. You experience a sudden possessiveness. Surely not all the breast must go; surely some part can stay. But this is the deal you have struck with them: total mastectomy. The least-invasive route, described in the most-invasive terms.
You wake with a drainage tube where your breast used to be, the promise of further surgery to install the port through which you’ll receive your curative drip of poison. They say “install,” as if it were an appliance they were putting in — which, in a way, you suppose it is.
You feel an absence so complete that the modifier they have used — total — finally makes sense. Except for the fluids that ooze from your tube, your breast is totally gone, your chest a blasted landscape.
You hate the phrase, but it’s what you think when you look at what is left: a war zone.
At first it’s an adventure, a challenge to be surmounted, another chapter in the story of your life’s progression. You drop your son off at school and begin the long drive to the hospital, an hour away. So much driving in this rural, wooded landscape. Everything is so far apart. You stride down the hallway to the infusion center that first day, feeling sure that you will win this battle. Haven’t you won them all so far? Your husband at your side, you take your place in the circle of recliners. Your eyes are bright, your skin radiant as they hook a tube to the port they’ve sunk beneath your collarbone. You question the nurse about the contents of each bag as it’s secured to the pole. You already know the answers; you just want to make sure the nurse does. You are a professor, after all. You’ve done your research. You have brought papers with you to grade. The time in this chair is but a brief detour on your journey. You are not like the others in their head scarves and shawls: shoulders slumped, eyes closed, the weight of their waning lives causing their skin to gray.
You are just like the others.
After the first day it’s rote: the IV connected to the port in your chest; the slow, controlled drip of poisons into your blood. Toxins may or may not have caused this cancer, but one thing is sure: only toxins can save you from it. The careful measurements. The target tattooed on your chest where your breast once was. The focused beam of radiation that will crack those slender threads of DNA inside your cells. The concave space your missing breast has left, shunted and scarred, full of fury and rage. After that first treatment your life is no longer your own. It’s like being drawn and quartered, day after day after day.
Insurance will cover only twelve antinausea tablets per month.
You allot them to yourself like precious gems.
The radiation and the chemo will slow the advance, shrink the tumor, moderate the risk of metastasis. The treatment has its own deadly side effects, but what doesn’t?
The adventure has worn off. You offer up your second breast. A compromise. Maybe these few ounces of flesh will be enough to mollify it.
It comes in waves: torture and remission, torture and remission. You play this game for years.
Always the doctors are clear: This will be the thing that kills you. The best they can do is keep it at bay.
So much is happening in these years. You spend them balancing your identities: Mother, professor, wife, cancer patient. Living person. Person not yet dead.
Daily you pull goutweed from your garden. Its roots are shallow but endless. You cannot see them, but you know they are there and that, for every weed you successfully extract, more will take its place. You can’t let it go; it will overtake your garden, devour your lawn, an advance as confident as a conquering army’s. You dig and pull, dig and pull, but you cannot win this one.
Your friends visit you during your longer chemo rounds. Together you play word games while your husband sits in a straight-backed chair and grades his students’ papers. One day the chemo runs out and you don’t even notice; you’re so intent on the final round of your game. The nurses come to unhook your port, and you protest: “Can’t we finish?” The nurses are delighted. They detach you from the various tubes that are dripping into you, assure you there’s no rush. You lose the game, and all of you laugh. You never lose. You try to blame it on the meds slowing down your brain. “Oh, sure,” your friend says. “Blame the drugs!”
Everyone laughs, even your husband, glancing up from his stack of papers.
You laugh harder than you ever thought you’d laugh again.
You think: This is what it is to be alive. To laugh at death.
It’s crucial that no one but your husband and your sister and your closest friends know what’s happening. Whereas once you dressed for effect, now you dress for battle, every outfit carefully selected to camouflage your changing body. Scarves to obscure the port. Bright colors to boost your spirit. You become adept with cosmetics, pencil in your missing eyebrows, choose your wigs with care. You keep your hands turned toward you so no one sees your red and blistered palms, your swollen left arm.
Your students do not know. They complain the way students always do, the teacher never being fully human to them anyway.
The goutweed in your garden can be traced back to a single plant, and you know exactly which one it was: one that you saw in the corner of your yard and confused with Queen Anne’s lace. You let it bloom. By the time you recognized it, it was too late. Like your cancer. Where did it begin? In what organ did it first take root? Which cells were the first to turn against themselves?
The answer is obvious, if only we could see. We all carry it within our bodies, the potential for our cells to mutate, stage a takeover. There’s nothing new about this story.
When the cancer first hits your bones, you call it “back pain.” Such an equalizer. Eighty percent of the adult population suffers from back pain. Everyone understands this; everyone sympathizes. Everyone has advice for you: acupuncture, chiropractic, massage, physical therapy. You do it all. You do not do what the doctors want. You do not submit to scans. You do not want to see inside yourself what you already know is there.
At night you lie still, silent, unable to turn, a sarcophagus of nerve endings. Drugs do not touch this kind of pain.
Once loosed upon your bones, the cancer sends its tendrils all through your skeletal system. The pain is so fierce you cannot hide it. You cannot stand, cannot walk unassisted. Every breath is a knife in your back. You use a cane but still dress for a ball. You walk with your head high. You dare your co-workers to say something.
No one says anything.
It works its way along your spine, breaks you piece by piece. When the school year ends, you let the doctors go in and solder your vertebrae back together with steel plates and screws.
You take every drug they give you now, no questions asked. You open your mouth, your veins, your flesh to any treatment they can devise. You close your eyes and envision each new drug as a superhero, ready to win this fight for you. Herceptin. Gemzar. Xeloda.
These are not superhero names, you think. They are the names of the dead in some Greek tragedy.
In town a woman’s well explodes. The methane fumes have invaded her basement. The gas company tells her to open a window when she takes a bath so her tub will not explode with her in it.
You fire your oncologist. “He looks at me like I’m already in a coffin,” you say, seething. You are so angry. You want to be angry. To be angry is to be alive. To be sad, nauseous, sweating, swelling — all that only drags you toward the grave. You seek out another hospital, travel to another part of the state for care. There is always a new treatment. Something else to try. Some new way to keep the wolf from your door.
Until there isn’t any more.
One hot July day you meet a friend for lunch at a diner near the hospital. You can feel the anemia draining the color from your face, transforming you into the ghost you are determined not to become. You maneuver your way toward her with your cane, noting how puffy your arms have gotten, how soft the flesh, scalded by radiation. You wish you’d worn long sleeves, but you’re in forced menopause now, and you are always hot, so hot. One drug shuts your ovaries down each month; another rids your body of the remaining estrogen. It’s the estrogen that’s killing you, the hormones from those organs you just couldn’t bring yourself to part with. How many pounds of flesh would you give now to win back your life? Both breasts are gone, your ovaries shut down like unused machinery, but in your blood remains that steady leak of estrogen, like a faucet dripping. Your integumentary system. Your skeletal system. Your reproductive system. Your lymphatic system, traitor that it is, provided that first ready conduit. What’s next?
Inhale. Let it out.
Percocet doesn’t touch the pain, which is worst at night when you cannot sleep. Around you, in these hills, an addiction crisis is blooming, but those powerful opiates intended for cancer patients don’t find their way to you.
Insurance is selective in what it covers.
Your skin sweats in the heat.
You will not permit pity or caretaking. You are small and fierce, a child in size but a grizzly bear in spirit. At lunch your friend tells you about an essay she’s been working on; you interrupt to tell her grimly, “Write faster.” Her face pales. You look her right in the eye so she cannot look away. “I want to read it.” There is no time for niceties. “Get it done.” You hold her gaze. You are merciless.
She swallows and promises. Your eyes fill with irritating tears. They do not stop. You cry at the drop of a hat these days. Is it the hormone therapy? It seems unfair that not only do you have to die young, but you have to go through menopause first. This cancer has spared you nothing. You speak of dying now, something you would not have mentioned even a few months ago. You have a paper due for a conference. You decide just to wing this one. In the parking lot you shrug and say to your friend, “I’ll just tell them I’ve got cancer.”
The day is bright and hot. You’re trying out dark humor, here in the blazing sun. Sweat beads along your hairline. Pain dynamites your spinal cord without warning. Your nervous system, at least, would appear to be functioning just fine. You embrace your friend quickly, make your way back to your car with your awkward, jerking gait. Your friend turns away so she will not see that you have to lift your left leg into the car with you. Or maybe she turns away because she has a life to get back to, many years yet to live.
In the darkest part of the night, when your husband and your son are sleeping, you wonder about death: If courage crumples in the face of it. If it comes like an avalanche, carrying with it the debris that was your life. If you’ll sense it in the stillness of things, smell its crisp approach on the air, or if you’ll only hear that terrible thunder telling you that you’re too late, that before you have a chance to turn and see it, it will be upon you, this furious advance of snow and ice and trees and wind, this angry charge that is only gravity, calling you home.
A snake winds its way up to your second floor, nearly tripping you as you make your way from your bedroom to the stairs.
You kill it with your cane.
Cancer is an “organic” disease, meaning that its advance can be observed, measured, detected by the clinical eye. It’s all so polite, the terminology they use to describe this wholesale slaughter of your body. It’s the same with the shale they are fracking, this mad expanse of methane that spans five states, the very heart of which lies a mile or so beneath the hills and fields where you grew up. The process that produced the gas began nearly half a billion years ago. Every step of that process could have been observed, had we the capacity to look so deep and live so long, through hundreds of millions of years. Its formation was an accident, a combination of pressure and heat. The means of its extraction are much more recent — within your lifetime, within all our lifetimes — and were no accident. This was in the works for decades. The scientist who was the first to see it, the need for the drill to make that turn, run horizontally to crack that wall of shale — his work was the culmination of years of false starts, wrong turns, each one leading to a new direction. This was hard science.
You stop talking about beating the disease and start saying things like “the better part of a year.” They send you home with a prescription for heparin and a box of syringes. Every day you search for an unbruised, unpunctured plot of skin, a new place you can plunge the needle into. You’re running out of spots.
The gas trucks leave as they came, a quiet, rolling exit. In the time that it has taken this cancer to mow you down, an entire industry has invaded, taken root, poisoned everything it touched, and headed for the next state to do it all over again. The abandoned wells lurk in these hills like waiting ports. The industry can come back another time to pump more toxins in.
Your cancer, though — its survival depends on you.
It, like all things, is mortal.
It is you.
On Mother’s Day, your final one, you cannot find it in yourself to get off the couch. Your son asks if he can go over to a friend’s to play. All you want is to spend time with him, but he is twelve now. He is on fire with life, the promise of it, ever changing and evolving. He wants to seize it with both hands, as you did. As you continue to do. He asks if his friend can come over to play. With one hand you indicate your body, this wasting thing you’ve covered with a quilt. “Look at me,” you say.
He looks down instead. His lashes are long and blond, the way yours once were. “Maybe you could go upstairs?” he says softly. Disappear. Problem solved.
You do not go upstairs. His friend does not come over. Your son stays home with you. Your anger with each other is a taut thread between you, an umbilical rage.
This has been his whole life: You getting sicker. Then better. Then sicker again. His earliest memories will be of the Cancer You. He will not remember the Warrior You who carried him, gave birth to him, nursed him. That fierce, whole-bodied love with which you shielded him from danger is just an abstract concept to him. It predates memory. He will remember only this: You on the couch. Beneath a blanket. Too sick to rise. Keeping him from his friends.
You can’t blame him.
You don’t blame him.
But it fillets your heart, spills your blood into your rib cage, where it pools in your chest, slowly turning into grief.
Six months before you die, they biopsy your liver. This organ will be the last to fail you. The biopsy will let them know what direction the cancer has taken. There is still a chance for more treatment. More life. You keep this prospect fixed in your mind, even as they inject the sedatives. You keep it with you throughout the procedure, guarding it fiercely in the last recesses of your consciousness as they cut out a tiny section of your liver, position it on a slide, then close you up and wheel you out.
You wait while the slide, slick with your cells, is sent off to the lab.
It takes a week. In cancer time, this is an eternity.
You pray. You don’t even know what you believe, but you pray anyway. You pray until the moment of your next appointment.
Your prayers don’t work. Your cancer is a trickster, a shape-shifter. It delights in rippling from one form to another, from estrogen positive to negative, and now, in this final twilight hour, to triple negative, the deadliest form, the diagnosis from which there is no return.
Who is this God who takes such delight in breaking us again and again before he gives us up to death?
You can taste the bile your liver used to make. It burns your throat.
Bitterness sustains you in these final months.
Six weeks before you die, you take a break from chemo so your doctors can regroup. The explosive advance of your cancer has been stressful for them; they’ve abandoned euphemisms, resorted to the language of disaster films and comic books. They call the tumor in your liver “gigantic.” Your bile ducts are “destroyed.” The cancer has outwitted them, used the chemo to feed itself, like some heinous supervillain. There’s always a shred of good news, however. Your liver enzyme and bilirubin levels are slightly better, making you eligible for an experimental three-drug combo, which sounds like a menu entrée. But you are so tired. You think: What’s the point? Your family lectures you for giving up hope.
You say: “What about acceptance?”
You say: “This is what it is.”
In private, your prayer is: Make it quick.
You don’t want to linger. You’ve never been one to outstay your welcome. The doctors tell you that if you stop treatment, you’ll have about two months left. If the chemo works, it’ll give you six. But the quality of those six months: chronic anemia, a fatigue so all-encompassing it will turn your bones to lead.
You’re already tired. So, so tired. It’s been eight years. You do not think: It’s been a good run. You think: It’s been hell. All you want to do is stop. Your son has made it to twelve. He’ll remember you. Isn’t that what matters?
You do not allow yourself to think: He’ll remember me as I am now.
You tell your friends you’re not afraid of death.
You’re afraid of dying.
You eschew hospice. You do not want to die at home, because you don’t want your son and your husband to associate the house with your dying. As if you have not been dying in it all along.
Because you haven’t. You’ve been living in it.
You’ve been doing both, living and dying, simultaneously, for your entire life.
This you have in common with the rest of the human race.
Five days before your death, you are no longer well enough to talk on the phone. Your friends call, and you refuse to speak to them. Resentment courses through your bloodstream. The chemo has fed it, too. You get angry when you have the energy, which is less often now as the cancer rages unchecked through your body, devouring your organs one by one. You tell your sister, who leaves her job again and again, who has put her life on hold to care for you: “I don’t think you’re up to this.” The words leave a metallic aftertaste on the tongue. “I can see this is stressing you out,” you say. You see her eyes fill, but you turn away. You have a life to shed. It’s a grim business, this dying.
Your sister asks your son what he thinks will happen after you die. He thinks about it, then says: “The house will get dirty. We’ll get fat.” He thinks again, then adds: “We’ll be OK.”
You hire a cleaning woman, knowing that she will take care of the house for your husband after you’re gone. You don’t want to leave any loose ends. She asks you if she can pray for you.
You tell her you’ll take anything. If a deep clean with Murphy Oil Soap comes at a price, you’ll pay it.
You’ll pay anything.
Your body shrinks to its bones. Your skin yellows as the cancer chews through your liver. Your abdomen swells. You turn orange, like the rocks in the creek that snakes between these hills you love, stained with mine acid. Has there ever been, in the course of your short life, a time when nature was benign?
At night you dream of being dead. You know how it goes once we’re underground. We swell, we explode, we burst. We pass through the mouths of maggots. We are fed upon. We are erased.
There is no mystery to any of this.
When it’s time for that last trip to the hospital, your husband and your sister struggle to get you to the car. You want your purple Keds, the ones with the ribbon laces. They are everything you truly are, the you that is still there, buried deep within this body, obscured by the ravaging advance of your mutant cells. You will not go without them. But your feet are so swollen your sister cannot get the shoes on, even with the laces as loose as they will go. They dangle there, absurdly, on the ends of your feet.
These last days are a haze of morphine and Valium. You hang on to your remaining working systems. You can still breathe, and you do it mightily. When it comes time to say goodbye to your son, you put off the drugs. You pull on your wig. You drag yourself from the bed, make sure your tubes are covered up. He doesn’t want to come in. When your sister brings him in, he will not look at you.
You are smaller than he is now. The surge of pain you feel in your heart when you see him lets you know your cardiovascular system is, for the moment, still intact.
All this time, while he has been growing, you have been shrinking. You are something monstrous now: discolored and malformed, your belly swollen, the skin so tight across your face he can see the edge of every bone. His nose wrinkles. You wonder if he can smell the rot beneath your skin. He focuses on something familiar: the television set.
At the end they say you are unconscious, but you can hear. Your bones protrude through your skin. When a friend kisses your head in farewell, you want to answer, but all you can manage is the slightest fluctuation in your breath, an almost unnoticeable flutter. You last saw her a week ago, when you were still well enough to hug her goodbye. This is happening so fast, what has been dragging on for years.
Your friends wish for you safe passage. They wish for you a “next,” another form of “now.”
No one but your husband and your sister will see your body after death. You’ve left specific instructions: No embalming. Box it up in cardboard and bury it. Plant a tree where it lies, so something good can come of this.
It ends like this: In these eight years, these hills where you grew up have come to resemble your body — gutted and pockmarked, poisoned and rendered toxic, then hastily stitched back together in a semblance of normalcy. More wells explode. Cows drop dead. Rashes bloom on your neighbors’ skin like ancient plagues. There is not a corner of the state left untouched.
Same with your body.
The frackers are gone, but in their wake: a deserted battleground, strewn with collateral damage.
The coming decade will bring huge advances in cancer treatment, as well as treatments for Ebola and antibiotic-resistant tuberculosis. But in this moment there is none of this. There is only you, your husband, and your sister. Your life, like your world, is crumbling to ash. You think that you were wrong, that nothing in your life will be as big as this: the moment that you leave it. In this you are correct. You’ve come to the ultimate launch, that final milestone. You take a deep breath; the air as it enters your lungs is starched with August heat.
This is how it ends. The tilting, the precipice. The door slanting open. As your lungs expel that final breath of air, do you look back?
You do not look back. The door swings shut behind you on the room that moments before was lit with the lives of everyone you love, on a world that is filled with the dark and the light of its own dying.
You do not see the door close behind you. You see only that which lies ahead. You see only whatever it is that waits for you beyond these hills you love.
This essay was born of losing a dear friend to breast cancer. I was with her during many of the scenes described in this piece, and she talked to me often, both in person and in e-mails, about what she was feeling. In writing her story, I used her words and thoughts as much as possible, but I had to take poetic license with the more intimate details. I can only guess what K. felt in the darkness of her night, and of course I can’t know what she experienced as she died. Nevertheless, this essay feels like the truest thing I have ever written.
Louise A. Blum
Sixteen years ago my daughter gave birth to her son. He had to be delivered four weeks prematurely so she could start a new, stronger round of chemotherapy. She later had a mastectomy and for the next fourteen years lived similar to how Louise A. Blum describes her friend’s life.
The medications, the sores and blisters, the emotions — they all brought back memories of my daughter. Like Blum’s friend K., she, too, was a Professor of English and a poet. Several times I had to stop reading to catch my breath.
Louise A. Blum’s “How It Ends” [March 2020] thoughtfully explores the years her friend lived with and eventually died from cancer. It brought much-needed tears of grief. I believe it will help others to have more compassionate interactions with loved ones who are experiencing cancer.
When I read “How It Ends,” I was waiting for a follow-up appointment after an irregular mammogram: a week of trepidation and fear.
Louise A. Blum’s essay gives an up-close view of the cruelty of breast cancer, how it eviscerates your life: trying to work while you are sick, enduring years of toxic treatments, bowing to the inevitable.
My follow-up appointment was fine. I am one of the lucky ones for now.
After reading Louise A. Blum’s essay “How It Ends” [March 2020], I thought to myself that life is exactly what it is — the entire range of comedy and good fortune to tragedy and forsakenness. I cried for the earth, which has been fracked, polluted, and disregarded. The suffering and death of her dear friend K., which Blum profoundly captured, went directly to my heart. My consolation was that, holding the magazine, I didn’t feel alone.
After reading Louise A. Blum’s moving essay “How It Ends” [March 2020], I have dried my tears and am ready to toss caution to the wind and be arrested at an anti-fracking protest. I have no other way to express my sorrow for the loss of the author’s friend K.
Louise A. Blum’s “How It Ends” [March 2020] powerfully describes the slow march from vigor to death caused by cancer. When I was nine, I lost my seven-year-old brother to cancer. My wife’s son died of brain cancer two years ago. Even so, I read the essay without tears.
That is, until I read it aloud to my wife. Then the pain of those losses, and many others, choked me. I’m glad Blum was there for her friend, and that she shared with Sun readers her friend’s journey to the end.