Side Effects

by Susan Nash

In our family we don’t get cancer. We get drunk. We take drugs. We smoke. We have a wide variety of personality disorders. We fall down and break bones and have very high cholesterol, but we don’t get cancer.

That’s what I used to think anyway. But I was wrong. I now know that my dad has had prostate cancer, although he claimed at the time that he was just having his appendix out. I’ve had multiple basal cell carcinomas removed, even if those don’t really count. And then my sister got a rare and aggressive lymphoma that irrevocably and unalterably confirmed that Cancer is part of our family.

Still, when I went in for my annual mammogram just over a year ago, I wasn’t worried, and not just because of the decades of clear scans. Besides, life was going well. I had moved to Palo Alto from Los Angeles to attend a mid-career program at Stanford. I was busy. Focused. Taking care of things. I was building a new community, looking forward to the next phase of my life. I flew back and forth to Seattle often, helping my sister and her family. At some level I think I believed that my busy life immunized me from getting any “real” cancer myself.  

Then the doctor called with the news that (i) I definitely needed a second mammogram, (ii) there was an eighty percent chance I’d need a biopsy after that, and (iii) there was a forty to fifty percent chance that the biopsy would show that the weird spots lighting up the first mammogram were cancerous.  

A long-forgotten math competency in my brain insistently spat back the result: a thirty-two to forty percent chance that the weird spots were some form of cancer. 

My immediate response was: No, I don’t think I’ll do this right now. 

It reminded me of when I went into labor with my second son: This hurts a lot and I won’t be having a baby today, thank you very much.

So, I decided, I would not do anything about any biopsies or additional mammograms. I would just get on with my life. Perhaps I would blow my entire nest egg in the next five years and have a whopping good time. Fuck the consequences. Seen chemo, would rather see Rio.  

But of course reason prevailed, and I had the second mammogram, and then the biopsy, and the odds fell on the short side. The Monday after Thanksgiving the doctor called again, with the diagnosis that one of the spots was a Ductal Carcinoma In Situ. DCIS, as it’s commonly known.

A DCIS spot is not invasive or life-threatening, at least not unless and until it leaves the “site” where it starts, which it may never do. But the standard treatment is to remove such spots surgically, to eliminate any potential spread. 

As breast cancer goes, DCIS is the best kind to have, referred to as “Stage 0,” whatever that means. There’s a debate in the medical community over whether DCIS should even be called cancer.

Rebellion over, I dutifully called the Stanford Women’s Cancer Clinic to make an appointment—a moment that, from a patient’s standpoint, makes any debate over whether DCIS is a form of “cancer” seem pretty academic.

In the days leading up to the SWCC visit, I tried not to think too much.

Then I got mad. 

Blindingly mad.

Mad about having to be resilient and a good sport.

Mad about being sixty-three years old and single and having to address even the remote possibility, raised in one of the initial telephone consults, of losing, or voluntarily giving up, my left breast. It’s hard enough to get a date at this age even with two breasts.

Mad that it wasn’t fair to make me deal with this, not right now, not by myself.

Mad that this had happened to me, someone who clearly did not deserve it. Yes, I actually had that thought—while looking down to see if the ground would open up and suck me straight into hell.

This phase was not a good time to cross me . When a leak developed behind the bathroom wall in my apartment, it was not a good idea to tell me, as the tenant and a retired lawyer, to get someone out to fix it. This is not my problem,” I told the landlord. This is your building, not mine. You get someone out here.”

I’m pretty sure I was right on the substantive legal obligations of landlords and tenants, but perhaps a little over the top in explaining my position.

Next, I moved into bargaining mode. Whatever happened, I would not turn into one of those people who wear long skirts and Birkenstocks and do juice cleanses and sport pink ribbons. I would survive but I would not be a “Designated Survivor.” I would have the surgery but it would have to be done quickly. One and done.

           Oh God, I thought, they’re going to tell me to give up wine. I’ll give up one, red or white, whichever. Not both.

           I told my sister and a couple of friends. To my sister, after what she’s been through, the idea of having a lumpectomy probably sounded like going in for a flu shot.

My friends were sympathetic, if tentative. I was bristly. “I need help,” I wanted to say.  “I’m fine,” is what usually came out.

           Sitting in the line of cars at the cancer clinic, it took me a while to label what I was feeling. Pain. Shortness of breath. Tears behind my eyes.

This was actually happening.

I was terrified.

           The physician’s assistant was endlessly patient, unfazed by my crossness. She ordered an MRI to see what further mysteries my breast might yield. She prescribed Ativan to take before the procedure.  

She looked up at me.

“Maybe I should add a few extra?” 

“Yes,” I said.

In my family, our bodies are not temples.

           We didn’t settle on a plan but we made an outline, a plan to have a plan. After the MRI, there would be a consultation about the surgery—how extensive and for what, exactly, were not clear. I felt a breath of something for a minute, as we finished up. I remembered a recent lecture by Roshi Joan Halifax, talking about hope living with uncertainty. For a moment, I thought I understood what she meant.

I picked up the car and managed to thank the attendant, politely.

           I opted to have the surgery in Los Angeles, where my older son lives. The day after New Year’s he drove me to the hospital, around the same time that his younger brother was boarding a plane in New York to fly out. This was the first time in their adult lives that I asked my sons to show up for me. Both leapt to the occasion.

The surgeon had me on the table for four hours as she removed what were eventually determined to be two DCIS spots in the left breast, connected by an unseen line of more Stage 0 (almost-cancer?) material. Then she took a bit of tissue out of the right breast, just to even things up.

Both sons came to see me when it was over.

           The upshot of the surgery was a pair of scarred but perkier breasts, a result that women all over the westside of L.A. pay thousands of dollars for out of their own pockets, without any kind of diagnosis at all. 

           I flew back to Palo Alto as soon as I was cleared in the post-op, ready to put the episode behind me. But it turned out that the margins were not quite what the DCIS protocol requires, even though the chances that anything left in the area would turn into an invasive cancer were slim. Also, the chunk taken out of the right breast included a teeny tiny bit of a different kind of breast cancer, or potential breast cancer, that might never have shown up but for the standard technique of testing all tissue removed during any breast surgery.

I tried not to think about the fact that the new spot on the right side was not detected in any of the mammograms.

After another series of appointments and discussions, I returned to LA for an outpatient version of the surgery, just on the left side, to get that last bit of margin. As for the different and impossibly tiny amount of almost-cancer tissue extracted from the right breast, the doctors left it to me to decide whether to take the five years of pills that might, or might not, cause hair loss, weight gain, brain fog, loss of libido, headaches, fatigue and/or nausea. For better or worse, I opted not to go down a medication path that treats against a possible but unlikely recurrence of a possible but unlikely invasive breast cancer that would not have been found but for the evening-things-out surgery.

And then I was done, both breasts reasonably intact, the fortunate beneficiary of state-of-the-art treatment and a deeply researched part of Western medicine.

There was still the small matter of a month of radiation back in Palo Alto to round out the protocol, but I was assured that this would not affect my life, except for the likely need to take naps. Both breasts would be radiated, just in case. Ironically, given the too-little-too-late protective measures I now take against the sun, I was told to expect a sunburn in one of the few places where my skin is lily white.

           The building housing the radiation oncology clinic is quiet. It is not unpleasant but it is a serious place. None of the clientele wants to be there. Everyone is respectful of everyone else. A volunteer piano player often serenades the lobby. Sometimes I sat there for a few minutes before going downstairs to check in.

           Each day the man with the big eyes and one of his helpers would set me up just so, adjusting the positions, calling out fractions to each other. During this process the man’s eyes were inches from my breasts. He was nice and so very kind, but I couldn’t help thinking that he should buy me a drink first. I felt disappointed on the days he was not there.

           I was left alone during the actual radiation, lying motionless, holding my breath and exhaling on command from a voice miked into the room. The machines moved around me like the robot doctors in Star Wars, whirring and clicking in a language of their own. I kept my eyes firmly shut.

At the end of the first day, I made myself a Cosmo. It tasted so much better than the bitterness of my usual white wine. By the end of the week, I had a burning desire for a chocolate cupcake, a craving that I would eventually indulge.

Cosmos and cupcakes almost certainly contribute to cancer.

Occasionally I was annoyed by the new routine, carving out an hour every weekday at 4 pm or so. Most of the time I remained deeply grateful for having this event occur in the 21^st century and not a minute before.

After twenty sessions of radiation, the team gave me a graduation certificate and a blue dot pin. Blue dot pins are the radiation equivalent of pink ribbons. The man with the big eyes and everyone else in the room offered their hearty congratulations and genuine wishes for good luck. I choked up. The odds that l will never have to deal with this again are resoundingly in my favor.

On my way out I found myself wishing that the man I had a drink with two days earlier, a man I last saw forty-two years ago in college, was waiting outside for me. I wanted arms, male arms, surrounding me.

I shook it off and got into the car. Back at home, I pinned the blue dots to my baseball cap.

A few days later it is Sunday, and I walk over to the All-Saint’s Church to listen to chamber music. The quartet will play Haydn, Mozart, and Brahms, exploring the B-flat note that begins the Hunter’s call in a fox hunt. My breasts itch. I have heard from the man from college again, and we will hike in two days’ time.

The building is stark in its lack of ornamentation, and the pews are hard, as if the Episcopalians need a constant reminder that this is a Church. There are no snarling gargoyles or cherubic angels looking down from above. The floors are concrete, unadorned by any covering. And yet it is clear that this is a holy place, or a place, at least, where something holy might happen. A gold cloth drapes over the altar; fragments of a cross float in the open space above.

Four chairs and four music stands sit in a semi-circle—black, steel, simple. Here, at last, is a small rug, possibly to absorb the sound or cushion the players’ feet. Only thirty people have turned out for the concert, in ones, twos and fours, leaving all of us with room to ourselves.

The musicians enter and take a bow. They take a seat and tune their instruments, then wait until the room fills with silence. They lift their bows and play the long first note.

There are many moments during those two hours of music when I am completely, abundantly, at peace.

Susan Nash is a former lawyer who has traded years of writing briefs in favor of chronicling the experiences of older women in our culture. Her work appears on Punctuate, Considerable.com, and multiple websites at Stanford University.

The Texture of Scars

by Karen J. Weyant

At seven, I already had scars. 

The comma-shaped scrape near my left eye was from Chicken Pox. It was a small notch, but deep enough that I could feel the tiny fold of skin with my fingers. A fine white slash on my cheek was from a cut on a barbed wire fence. This smooth scar was nearly invisible, but sometimes, when my fair skin burned and freckled from the sun, the line appeared brighter, a thin white string etched across my cheek.

Outside of listening to the origin stories of these blemishes, I didn’t know much about scars, but somehow I realized that they were undesirable. I wasn’t sure why. Perhaps it was because they never really went away, unlike the other scratches, bumps and bruises I obtained from riding my bike or playing at the local playground.

So that was why the summer before I started second grade, I listened to Nate White, who offered a helpful strategy on avoiding one kind of scar: the alleged mark left over from a mosquito bite that was scratched too much. Nate, who was one year younger than I was, but seemingly far wiser about the world, deemed himself an expert when it came to killing mosquitos.

According to Nate, you waited until a mosquito landed and slid its long needle into your skin. While the mosquito sucked your blood, you pulled your skin tight around the insect. Nate’s theory was that the needle would get stuck, and unable to withdraw, the mosquito would feed until it eventually burst.

This idea fascinated me. Mosquitos caused me great misery, so this tactic sounded like the perfect revenge. During the mugginess of summer, I seemed the food source for every mosquito in the neighborhood. They bit my ankles, my legs, my arms, even my face. I would find mosquito bites in the most unlikely of places, including the skin between my fingers or the space between my shoulders. Once, a mosquito got stuck underneath my shirt, and when, in a fit of shirt pulling and swatting, I was finally able to slap it away, I found a line of bites, red angry and inflamed like a constellation of bumpy stars, sprinkled across my stomach.

My mother covered me with smelly bug spray, but I guess mosquitos in rural Pennsylvania are extra sturdy because they bit through the spray. Then, my mother dabbed my bites with Campho Phenique crème, an over-the-counter medication that smelled worse than the spray. When I complained, she tried homemade remedies made with baking soda. No matter what she did, the bites still itched.

And I was not supposed to scratch them.

“You will break them open and cause scars,” she said.

Scars were something I didn’t want, so I tried Nate’s advice. I waited until a mosquito landed on my arm, and I pulled the skin around the insect taut. And then I waited a bit longer.

I don’t remember exactly what happened, except that the mosquito didn’t explode. Maybe it was so hungry it didn’t mind staying for extra food. Maybe I didn’t pull my skin tight enough. All I remember is that the result of this experiment was one of the worst, most inflamed bites I ever had. 

I didn’t listen to my mother’s warnings. I scratched that bite raw, until it broke open, leaving spots of blood smeared on my skin. 

But it didn’t leave a scar.

As a teenager, I learned to wear foundation to cover the thin line on my cheek. My textured bangs covered the chicken pox scar. Still, I earned other scars along the way. I have a thin scratch on the back of my hand from a broken mirror and an oval scar just below my knee from running into a shopping cart in a parking lot.

“Interesting scars tells interesting stories,” a friend once told me, but until I was thirty-five, I didn’t think that any of my scars’ stories were that intriguing.

Then came my diagnosis of thyroid cancer, and two surgeries that left a line of pinched skin on my neck from the removal of suspicious nodules.

At the time of diagnosis, I wasn’t worried about the scar. I just wanted the cancer out of me. But when I got home from the hospital, I stared at myself in the mirror, where black stitches were sewn across my neck. I fingered the string, marveling at how something that looked like it could come out of a sewing kit could help piece me together. 

It was there at the bathroom mirror I realized that while the stitches would be removed, a scar would remain. I could disguise my other scars, but this one would be visible to the world. The only way I could hide it was with a turtleneck sweater.

At the time, I received a lot of advice about how to make the scar less noticeable. “Mederma”, my doctor said, while my friends advised using cocoa butter or Vitamin E. Nothing really worked, however, as the skin pulled and tugged, finally settling in place. 

For the first year or so, I worried more about the cancer than the scar. I worried that my regular scans would pick up a bulging lymph node, one that could suggest that the cancer had resurfaced and spread. I worried that blood tests would find something abnormal. I worried that I would have to undergo surgery again and perhaps undergo more drastic treatments.

But test after test came back clear, and I started to be more concerned about my scar -- a scar that had faded from an angry, red thick line to a thin patch of white skin. I found myself explaining my surgery to complete strangers, such as a waitress who told me that her twin sister had a similar type of surgery to a young neighbor who worried that her little boy had to have neck surgery and she was concerned about the side effects and the pain.

I found myself reassuring my little neice who touched my neck.

“Boo-boo?” she asked, her whole face twisted into a worried frown.

“Yes,” I explained, reassuring her that “It was all better now.”

Now, over ten years later, I barely notice it, even when I look in the bathroom mirror every morning. This scar is now as part of me as my brown eyes or pale skin.

Still, there are days when I remember it’s there. Often, when I meet new people, I feel as if their eyes wander down from my face to the puckered skin. I’m a college professor, so when I know I am going to face a new class of students or when I give a public presentation, I search for creative ways to mask this blemish through turtlenecks, scarves, or beaded chokers.    

But I know the pinched scar is there trying to peek through my disguises. It has joined my other scars, with perhaps a more interesting story to tell.

Still, in spite of my mother’s warnings etched in my memories, I don’t believe that I have a single scar from a mosquito bite.

It’s as if the body itself decides what it wants to mark, and we, even as wearers of our own skin, have little to say in the matter.

Karen J. Weyant's essays have been published in Barren Magazine, Carbon Culture Review, Coal Hill Review, the cream city review, Lake Effect, Punctuate, Solidago Review, and Stoneboat. She is an Associate Professor of English at Jamestown Community College in Jamestown, New York. 

Cancer Scars

by Danusha Goska

          Now, see, if I were a true and deep artist, I would look at my cancer scar and write a poem or sculpt something uplifting. I'd create art like that famous black-and-white poster by poet Deena Metzger, the one where she is naked, arms stretched against the sky. You see her breast cancer scar, now a tattoo. One of the most stunning, generous, and brave images I have ever seen.

          As it is, I look at my scar and think, "Duct tape." I am a spinster with no man of my own. I'm related to lots of men—brothers, uncles, cousins, nephews—who would, in accord with my family's tradition, not pee on me if I were on fire. As a man-less spinster I use a lot of duct tape. It really does fix everything, and anything duct tape can't fix is not worth salvaging. So, yes. I look at this mess of a scar and think, not poem or essay, but, rather, "Duct tape."

~ ~ ~

          I went to the hospital this morning. I waited in the waiting room. I paged through copies of Cancer Today.

          A lovely woman came in with a dog so elegant this dog would put to shame Joan Crawford in an evening gown designed by Adrian.

          "Would you like a visit?" the woman asked.

          I reached out to the dog. It was a black Pomeranian. I've never seen a dog with such perfect fur: lush, thick, sleek, shiny. The Pomeranian's name was Neena. She was wearing a little vest that identified her as a service dog. Her owner told me Neena's story.

          "My boyfriend is a long-distance truck driver and he had Sophie, a black Pomeranian who traveled with him on the road. He had her for eighteen years. After she died, he couldn't stand the idea of a new dog. 'No one can replace Sophie!'

          'Well,' I said to him. 'No one can replace Sophie, but there are so many dogs out there who are lonely and uncared for. We can give a dog a home and some love.'

          I worked on him for six months. Finally, he said he'd let me get a dog, but it had to be a black Pomeranian just like Sophie. I went on petfinder.com. I found a black Pomeranian but he rejected that one. Didn't look enough like Sophie.

          I found another. She was a survivor of Hurricane Katrina. They sent me a photo. She looked awful in the photo. I showed the photo to my boyfriend. In spite of how bad she looked, he said, 'Her!' So we flew to New Orleans and picked her up and here she is."

          Neena had to go. I went back to waiting. Thank God for Neena. Thank God for that nice lady.

          I am afraid of medical settings and medical people. I've had some really bad medical experiences. I was chronically ill for six years in the 1990s. The illness I had is rare and little understood. I was subjected to three experimental surgeries. Before every surgery, I was reminded that the surgery might kill me, make me sicker, or it might restore me to a full life after years of crippling poverty. A photo of my innards appears in a medical journal. One test alone was worse than all three surgeries. They clamped me into a chair in a light-proof chamber the size of a phone booth. They placed electrodes on my head. They then sealed the chamber and I was in complete darkness, except for one pinprick of red light. Then someone spun the chair around, in alternating directions, at varying speeds, with no warning. I begged to be let out. They wouldn't. "Just a few more minutes. You can do it."

          You'd think that this information would be on my chart: "This patient fears medical settings and medical people. She's clocked a lot of dicey history. Go easy on her." And you'd think that medical personnel, interested in healing, would heed it. You'd think.

          They called my name and I went into the room and undressed. I assumed the position on the cold table. Yet another person I'd never met before and would never see again who would touch my body in intimate ways entered the room. I shook a little; some tears fell. The woman, who had an unnaturally tan face, loomed over me with a large pair of tweezers. "YOU ARE TENSING UP. THAT WILL MAKE IT WORSE. IT WILL HURT. STOP IT."

          She quickly glanced at my chart, discovered my name and spoke it. "DA NOO SHA! Relax! RELAX RELAX RELAX! You are going to make it hurt!"

          Now, you might think that having a strange woman with an unnaturally tanned face looming over me, yelling in an overtly angry way the word "RELAX" over and over, might tense me up. But I'm from New Jersey, and it worked for me better than any wind-chime-accompanied mantra.

          I obeyed. I imagined walking off through the fields of bruise-blue rye in Slovakia, my Uncle John up ahead. We were walking toward the hills, toward the thickly forested hills, where Uncle John's beehives were. We'd tend to the bees and then hike over the mountain and hear the clear call of the cuckoo high up in the leafy treetops and the heavy panting of wild boar scuttling over the forest floor. He'd give me juniper berries and instruct me to bite them with my front teeth while inhaling their released, cleansing aroma over my tongue. We'd fill a basket with mushrooms he unearthed, where I saw only moldering oak leaves, to bring home to Aunt Jolana to put in the soup we'd have for dinner.

          "Your scar looks good," the woman who never told me her name or her title said. I knew more about Neena, the therapy dog, than I knew about this—part-time nurse? World class surgeon? Jersey Shore tanning addict? Imposter?

          If my scar looks good, I don't want to see the scars that look bad.

          I heard the staples hit a metal tray. She was careful to remove the staples from different parts of the scar so that no one part became irritated. It really didn't hurt. It is so often the case that people who are good at the technical aspects of medicine lack bedside manner. Those with the smooth bedside manner might not know the right end of a stethoscope.

          I was about to venture my duct tape joke when she said, "I'm going to glue you up." And then, "Now I'm applying the tape."

          So, yeah, tape. And glue. My latest accessories. But no spit or carpet tacks.

Danusha Goska is a recipient of a New Jersey State Council on the Arts Grant, and a Stephen King Haven Grant. Her book Bieganski: The Brute Polak Stereotype won the Polish American Historical Association Halecki Award. Her book Save Send Delete was inspired by her relationship with prominent atheist Michael Shermer. Her new book God through Binoculars: A Hitchhiker at a Monastery will appear in 2018.

Living in the Nut House

by Richard Ault

For five weeks last winter, I walked a half mile each morning from the "nut house" to my cancer treatments.

Munson Manor sits at the border of the campus of the Munson Medical Center and the old Michigan State Mental Hospital campus in Traverse City. When the mental hospital officially closed down in 1989, after years of slow decline, it was designated an historic site and preservation efforts resulted in what is currently known as The Village at Grand Traverse Commons. Munson Manor, now a gracious "guest house" for hospital outpatients and their families, was originally just plain "Building 27", built in 1903 for female mental patients.

Although we live only about an hour away, what with the vagaries of a Michigan winter and the potential for hazardous driving, my wife Pennie and I decided we would rather remain near the hospital for the five weeks of my chemo/radiation treatments and chose to stay at the Manor House.

Traverse City is the heart of one of the most beautiful regions on the planet, situated in northwest lower Michigan at the base of Grand Traverse Bay off Lake Michigan and surrounded by beautiful inland lakes and idyllic towns and villages—a tourist mecca and increasingly a magnet for retirees. Among these retirees, my wife Pennie and I live nearby on pristine Torch Lake. However, as a kid growing up in the 1940s about three hours south in Saginaw, I and most of my friends knew Traverse City simply as the "nut house." As the location of one of the three state "mental asylums," it was where they sent the crazy people. "You should be in Traverse," was an insult we used when one of us said or did something we thought a little wacky.

But that was just the beginning of my long experience with this place.

As an undergraduate at Central Michigan University in the late fifties, I was a double major in English and Psychology, taking a class in Abnormal Psych as a junior and Clinical Psych as a senior. Each year the combined classes took the two-hour bus trip from our Mt. Pleasant campus to the mental hospital in Traverse. We first met in a large conference room and were introduced to a few of the "milder" neurotic patients, who were interviewed by hospital staff and then took questions from our group—sometimes fascinating but fairly tame stuff for the most part. But then came the real horrors of the place. We toured some of the most disturbed wards and witnessed firsthand every form of psychoses imaginable—a scene reminiscent of the infamous Bedlam asylum in London. My gut churned. My mind swam. I concluded that I would rather be dead that suffer serious mental disease.

And then came my dad.

Several years after those field trips, my mother and father, both in their late sixties, were stricken with serious cases of the flu and had to be hospitalized in Saginaw. My mother emerged without further issues. But not my dad. Mentally he was completely fried and put in the Saginaw County Home. Soon I received a call in Kalamazoo, where I was living at the time, from my brother Chuck to come to the Saginaw facility for a "family meeting." We never had "family meetings", so I knew it was serious.

It was the first I had seen Dad since before his bout with the flu and it was awful. He was completely incontinent, wearing diapers, and hallucinating. We, his five sons, were told he was violent and uncontrollable and would not be allowed to stay there. He had never received a formal diagnosis to explain his condition.  The five of us discussed his options. My four older brothers carried most of the conversation, not a surprise as I look back now given that I was ten years younger than my next closest brother. Finally, we voted reluctantly but unanimously that the State Mental Hospital in Traverse City was our only option. Though my brain was flooded with the haunting scenes I had witnessed there as an undergraduate, I fully respected and agreed with my brothers' conclusions.

I only got up from Kalamazoo to visit Dad twice. The first time I rode from Saginaw to Traverse with my oldest brother Jack. We sat with Dad briefly in his ward, a scene much like I had seen in my previous student field trips—scary but perhaps not quite so extreme—or maybe I was just witnessing the place through less innocent eyes. Jack then arranged for us to take Dad out for a short car ride. Along the way, we stopped for ice cream cones and then parked to enjoy them near a beach with a nice view of East Grand Traverse Bay. Dad was in the passenger seat while I was in the back. Jack—who was so much better at this sort of thing than I was—tried to engage Dad in conversation about old times, old relatives, and other normally familiar themes. Dad seldom said anything, and when he did, his comments were not very responsive. Then suddenly he opened the car door and tried to take off. We got him back in the car but the ride was over. Back to the mental hospital.

The second and last time I saw my father, Pennie (my wife to be) and I drove up from

Kalamazoo for the weekend. On Saturday, I met my brother Jim and his wife Arlene at the hospital and the three of us sat with Dad on an enclosed porch adjacent to his ward. I remember little of what we talked about except that several times he complained that someone had been hurting him physically, maybe an orderly. Given his state of mind, we did not know whether to believe him or not. How could we know—he was crazy after all. At one point, out of the blue, he got up from his chair and stood over me. He stared down with a menacing glare as though ready to punch me. Did he take me for his tormentor? Although I had been on the receiving end of his anger more than once as I grew up and remained afraid of him at that moment, I didn't flinch. I stared back directly into his hate-filled eyes. Thankfully, he backed off and returned to his chair. We took no action on his complaints about physical

abuse.

The weekend was salvaged when on Sunday I took Pennie for a drive around Torch Lake. She fell in love with the shades of turquoise on Torch that day, and though it would take years to make it happen, we had found our future home. Soon after our Traverse visit Pennie and I were married and moved to Atlanta, Georgia, where about a year later we received the call that my dad had died.

---

My niece, Connie Ault Kinnaman, has become a passionate family historian, our own genealogist. She made the unfortunate discovery that it was not just my father who died from an extreme case of dementia, but so too did my great grandfather, my grandfather, and a grand uncle, all at the Traverse City State Mental Hospital. In those days, the disease was most often known as senility or hardening of the arteries. We can’t know  for sure if it was Alzheimer's. As knowledge about the disease has advanced in more recent history, however, we do now know that three of my four brothers were diagnosed with Alzheimer’s, as well as three cousins from my dad's side of the family.

While only a small percentage of Alzheimer's cases are thought to be genetic, with my family history I am not comforted by those odds. Until my very recent journey with cancer, the Alzheimer's specter loomed as my only serious health concern as I have aged. I was known to boast that I was the youngest seventy-nine- year old on the planet—at least that I felt that way, leading an active life with no frequent aging issues such as heart disease, diabetes, or high blood pressure.

Despite my claims to good health and fitness, though, I have had a long, rather unfriendly, relationship with my gut, routinely suffering heartburn before new medications virtually eliminated that problem. However, I continued to have frequent night time bouts of acid reflux. That led me some years ago to get an endoscopy, which revealed that I had a condition known as "Barrett's esophagus," in which the lining of the esophagus changes to tissue which is more like the lining of the intestine. About ten percent of us with chronic GERD symptoms develop Barrrett's, and, while it does increase the chances of developing esophageal cancer, my doctors assured me that less than one percent of people with Barrett's esophagus develop esophageal adenocarcinoma.

Nevertheless, I continued to get regular routine endoscopies every three years with no signs of cancer. Until, that is, in November 2015, when my doctor found a tumor near the juncture of my esophagus and my stomach—esophageal adenocarcinoma. So much for those odds. As my doctor attempted to inform me what I now faced by way of a treatment plan, I could scarcely hear, let alone understand, what he was telling me. My brain and my stomach were swirling. The good news was that the cancer was diagnosed early, before I had experienced any of the usual symptoms such as difficulty in swallowing or unintended rapid weight loss.

The first thing I did when I got home was call Max. Dr. Max Wicha was the founding Director of the University of Michigan Cancer Center and is now Director Emeritus. He and his wife Sheila were once our summer neighbors on Torch Lake, owning the cottage next to ours. Max, a world-renowned authority on breast cancer, is also one of the nicest guys I know, and I have long said that, heaven forbid, if I or anyone close to me would ever develop cancer, Max would be the first person I would call. And I did. He told me that their center had one of the best esophageal cancer groups in the country, headed by Dr. Susan Urba. The next day, I received a call from Dr. Urba, a most informative but gently reassuring call. She arranged for me to meet the next week with her and a surgeon, Dr. Rishindra Reddy, to discuss my options.

On December 29, 2015, after a few weeks of tests and further consultations, I had all but the top inch or two of my esophagus removed by Dr. Reddy at the University of Michigan. The procedure also involved stretching and pulling my stomach up to my neck to be reattached to the little bit of remaining esophagus, permanently and radically changing the way I must eat. The surgery was a success and we "celebrated" by spending New Year’s recovering in the hospital. As is standard practice, seven days later I was given a barium swallow test to determine if there were any leaks in the new attachments. I passed with flying colors. No leaks. Normally that would mean hospital discharge and going home the next day; however, the surgical team that appeared at my bedside early each morning noticed that the dressing on my neck incision showed more dampness than they were happy with, a likely indication of some minor leakage. They tried to find a leak by observing me take a drink of grape juice or water each of the next three mornings. No leak. Then, on my soft food diet, one morning I had some yogurt and soft slices of mandarin oranges. When I followed that by drinking some water, my incision let loose and I began to spray through and around my cervical dressing. When I asked Dr. Reddy how it was that I developed a leak despite passing the barium swallow test, he told me it happened about five percent of the time. Those were the odds.

The good news was at least they had determined what the situation was. The bad news was that I had to go home with a feeding tube, able to take nothing in by mouth. Pennie was quickly trained on how to change the dressing twice per day and to provide my medications and nutrition through the tube. We went home the next day with an IV pole and pumps and boxes full of my "formula." In a few weeks, my untrained but loving nurse Pennie got me through. The incision leak healed, and we were ready to move on to the next stage: chemo/radiation at the new Cowell Family Cancer Center at Munson hospital in Traverse City. Just prior to starting chemo I was given a new CAT scan, which showed that I had no signs of cancer anywhere—no lymph nodes, and no other organs. We celebrated by going out for pancakes.

Soon I began five weeks of treatments—chemo each Monday and radiation Monday through Friday of each week. I feared the worst based on stories I had heard about the possible side effects of those treatments. Why, I asked my medical advisors, if my tests showed no cancer, should I go through such an onerous ordeal? Their answer? To increase the odds—the odds of being and remaining cancer free based on probabilities from statistical studies.

So, for five weeks, five days a week, through March and early April 2016, I walked the half mile from Munson Manor to the new Cancer Center across the street from the Munson Hospital: radiation at 8:30 Monday through Friday and a chemo infusion on Mondays.

Thus, I found myself back in the nut house. That is, each of five Sunday evenings we voluntarily checked-in to the old "Building 27", now rechristened Munson Manor, until the following Friday. We slept there and ate our daily breakfasts and other meals there. Beth and Char, the day and night managers respectively, and the rest of the staff could not have been more gracious, professional, and accommodating. The elegant furnishings and quiet halls created a restful atmosphere perfect for patients' families. Because we all fixed our meals in the same kitchen and ate in the same dining room, and because the only televisions were in the public lounge on each floor, we met and got to know other guests.

Richard, with colon cancer, and Bill, with rectal cancer, were there, like me, for chemo and radiation treatments. Women with husbands and men with wives who were in for back or colon surgery. Two new mom's whose premature babies were still in the hospital, breast pumps sitting in the hallway outside their rooms so that they could continue to nourish their little ones. Another mom whose full-term baby was still in the hospital because he was born with pneumonia. Then there was the family of a teenage girl, a high school senior, who was brain injured when, worn out from her day in school and her full-time job, she fell asleep at the wheel of her car and crashed into a tree. Part of her frontal lobe had been removed to relieve pressure and she was put into an induced coma. After a few days, she was taken out of the coma briefly each day and her mother told us how exciting it was the day her daughter first squeezed her hand. The family could not afford the thirty dollars per night to stay long term at Munson Manor, and we and other guests quietly helped them financially as much as we could. The girl's young sister proudly told us how she enlisted several churches in their small town in offering prayers for her big sister.

Each morning I walked from the Manor to the beautiful new cancer center, and, because it was still winter in March and early April, most days I took the short cut through the hospital. As I walked the long main hall, I always mindfully noted the painting at its end—a portrait of James Decker Munson, the first superintendent of the "Northern Michigan Asylum" from 1885 to 1924. He also donated, in 1915, a boarding house to be used as a community hospital, now grown into the regional Munson Medical Center. Every day but Monday, I showed up a few minutes before my 8:30 a.m. radiation appointment. I was in and out in five minutes or so, free for the rest of the day. On Mondays, I hung around for the next few hours for my weekly chemo infusion with Tina, my pretty, funny, and caring infusion nurse. I was usually finished by about noon when Pennie and I went out for lunch. No signs of nausea. No other side effects. Not so lucky to get cancer in the first place, I was, despite my worst fears, very lucky with my treatments.

Each afternoon I took a mile or two walk around the grounds of what once was the asylum, now The Village at Grand Traverse Commons.

My first time back at that place after my father's death was several years ago when Pennie and I tried out Trattoria Stella, then a relatively new upscale Italian restaurant in the old Building 50, which was the central building of the old mental hospital and, which is still called Building 50 in its current incarnation. The restaurant is in a lower level, almost like a rathskeller, in what was once the place where they did lobotomies. As we walked from the parking lot to the restaurant, I looked up at the tall windows of the old building, the one I visited in my undergrad psych class days and the one in which I'm quite sure my father died. My mind was haunted by the horrors I had seen there and what had happened there. My stomach churned all over again. I told Pennie I wasn't sure I could eat at all. But I did. And it was good. Since then, Stella has become one of our go-to spots for special occasion dinners such as birthdays and anniversaries.  

In 2008, I took Pennie to Building 50 for her foot doctor appointment and, as I sat in the waiting room, I tried to stream Tiger Woods in the Monday play-off for the US Open that he won playing on one leg. Building 50 these days also houses the Mercato shops, art galleries, and other offices. We have been to Traverse City Film Festival parties there, on the lawn, in the building, and under large party tents. There is also a yoga studio, a bakery, and other eateries. Nearby buildings have been renovated and made into upscale apartments and assisted living facilities. New buildings have sprung up.

Obviously, my feelings about the place have eased. As I went through those five weeks of treatments and daily walks around those grounds, I consciously tried to look at those buildings through a new lens. Epictetus may have said if first—"It is not what happens to you, but how your react to it that matters," but today that bit of wisdom is even shared by football coaches and golf pros. I decided I would try to put a new, less- haunted frame on my vision: this was no longer Bedlam but a setting for growth, for renewal, for living. Sad to say, I was only partially successful in my reframing.

For me, when I looked up at the Disney-like spires, I still often saw the past. Looking up at those tall windows in which the bars have been replaced by mullions, I still often saw the bars. Despite all the best efforts at transformation I frankly still found it a bit creepy. I will grant renewal—important enough in itself—but not transformation.

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The same might be said of me, of course. My life has been changed by cancer, by the drastic reconfiguration of my digestive tract resulting in a radical change in my eating habits that will last the rest of my life. All observable evidence shows that I am now cancer free. For five weeks, we treated a disease we no longer knew I even had. I had now done everything that I could do, my doctors did everything they can do, and together we did everything that medical science says we should have done to ensure that I am and will remain cancer free for life. But there are no guarantees—despite the odds.

So, things are different for me. I must adjust, they say, to "a new normal." But am I, myself, different? I am grateful, of course, that I no longer have cancer, grateful that I am still alive. I am grateful for the doctors and nurses and technicians who provided such superb professional care. On the other hand, I was already mindfully grateful for my life before any of this happened—for my family and friends, for a creative and meaningful work life, for all the fun and satisfaction I have experienced along the way. It was not new for me that I am in love with life—not just my life but with life itself—with the very idea of life. I want stay around to continue to savor life in all of its manifestations as long as I can. I am grateful that my recent journey will enable me to do that for a while longer.

But am I transformed? Not really, I think. Will I, as I know I should, live each day to its fullest? Probably not. Will I spend more time than a sane man should practicing my golf game against all odds of improvement? Probably. Will I waste too much time on Facebook and watching television? Likely. As I try to savor the present moment, I drag all of my past along with me, for better and for worse. The same might be said of the The Village at Grand Traverse Commons.

Perhaps transformation is just the wrong metaphor. A better notion might be "transition" or "a work in progress." We, these old grounds and my old self, are not what we were and we are not what we are going to be. We don't even know what that is. Buddha taught that all is impermanence.

So, I find myself with a strange, almost ineffable connection with this old place. I also find it a hopeful one. We are both changing for the better, I hope. We are both, in a way, healing. Nearing the end of my chemo treatments, while sitting in my infusion chair, I read an old Time magazine cover story, "The Alzheimer's Pill: A Radical New Drug Could Change Old Age." Maybe Alzheimer's itself will not be with us permanently. This much I know: unlike some of those of my lineage, I was not "sent to Traverse" to die. I went there so that I could go on living

I lost track of Richard, the colon cancer patient I came to know at Munson Manor, but I have spoken by phone a few times with Bill: his rectal cancer is gone but he must wear both colostomy and urinary bags for the foreseeable future. Nevertheless, he expressed happiness that he is cancer free. All the babies who were hospitalized came through healthy and well. The high school senior with the brain damage graduated with her class in June.

One May morning about a month after all my treatments were over and I was feeling fully recovered from my winter's troubled journey, I took my place in "easy seat" on my yoga mat to begin my regular class. Without a thought, without a moment's warning, I began to tear up. It snuck up on me from just below the surface. Pure emotion. Pure sensation. No words attached in that instant, but as the moment passed I realized it was some combination of joy and relief.

I was still alive, and what a wondrous thing that is.

Richard Ault has been a participant-observer in the practice of changing the culture of large organizational systems for most of his working life. Previously he was a teacher and principal at the secondary school level and taught both undergraduate and graduate level courses at the university level. He was principal author of a book on change management called What Works and has published articles, poetry, and short fiction. Consistent with his life's passion for change, he is currently working on a novel about reinventing our political and governance systems. He and his wife Pennie live on Torch Lake in northern lower Michigan. Dick is convinced that he is the youngest eighty-year old, minus an esophagus, on the planet.

Cells

by Marcia Butler

One day in the early 1970s, a friend and I played hooky from conservatory classes at The Mannes College of Music. Diligent, disciplined and hopeful about our future careers in music—mid-semester blues had nonetheless descended upon us. We’d had just about enough of music theory and solfeggio classes for the morning. So on a lark, we left the comfort of the upper-east-side and ventured down to the vast construction site where the Twin Towers were being erected. Somehow we were able to slip into an elevator in the South Tower, punch a very high number and ride up to one of the top floors still under construction. A few workmen were milling about, but no one stopped us or paid any attention to our wide-eyed shenanigans. The site was surprisingly deserted, at least on the floor we happened upon.

Walking out into the yet-to-be-constructed offices, we felt simultaneously inside and outside. The wind was whipping through the open space, because the windows, all stacked up against those now famous thick interior columns, had not yet been installed. Curious and brave, we walked towards those huge gaping cavities, and for a moment we really did feel on top of the world. Hand in hand, we ventured right to the brim, without fear or hard hats. We felt giddy as the building swayed, and we gripped each other more tightly.

The Trade Towers had been controversial, considered potential eyesores in the Wall Street area. No one wanted the towers to be built, just as years later, no one wanted the Time Warner towers to be built at Columbus Circle. But these behemoths ultimately do get built, and eventually everyone gets used to them. We forget about the resistance and drama surrounding new construction in our city and the worries of how it will impact our beloved skyline, which is always changing like cumulus clouds. The New York City skyline is imbedded in our consciousness and yet, it slowly undulates with the gradual and inevitable new construction that is the hallmark of progress.

Through the years, I developed a curious sense of personal ownership of the towers, remembering them as the enormous lumbering babies I met when I snuck into that elevator and walked to the very hilt, looking out onto my vast city. I saw a view that few had yet seen. That view was just for my friend, the construction guys and me. As we looked out of the wide-open holes in the walls, we were inured to the height and the expanse and the potential danger of the tower’s verticality.

Out and about in the city, I found myself looking southward often, and feeling comforted; there they were, just as they should be, a solid visual homing beacon. At times, thick moisture laden clouds obscured the tops, and I imaged them as chunky steel legs connected to a robot-like body overlooking the city—protecting its territory. The skies always cleared to reveal spires soaring upward to points unknown.

The Twin Towers were my towers. I loved them so. No matter the weather or my particular day’s coordinates, they grounded me. They were just there, looming over the Woolworth Building and 40 Wall Street, dwarfing those eschewed edifices of the past by dozens of floors.

On the day they fell, imploding a bit too perfectly into themselves, I hunkered down in front of the tube, feeling ghoulish and selfish, watching the horror unfold less than a mile away from my house in Sunnyside Gardens, Queens. I’d endured a yearlong battle with dive-bombing personal terrorists in the form of cancer cells, and was furious that the balm of normalcy through music and those ever-present towers had been ruptured. I had just begun jogging again. My skull was sprouting what would become a fantastic plume of gray hair. The demand of upcoming concert schedules had returned to my life. But with a white hot prick of awareness and then the dulled iron clad concession to fate, all hope of a normal day of rehearsals for upcoming concerts evaporated. All I wanted to do that day was play the oboe—play music.

I’d lobbed a few grenades of my own just a few months before. The target: my oncologist—in charge of pouring toxic chemicals into my body under the guise of saving my life. The treatment felt nonsensical, uncalled for and surely sadistic. Railing into him during one office visit, he took my attack with a grim, knowing smile. He’d heard this rant of “re-transition” before. The next week I sheepishly apologized and accepted the red chemo like a soldier suffering from battle fatigue but willing to follow orders for my greater good.

Anger and grief, for the city and myself, folded onto each other like cake batter and I was once again brought to my knees for my off-target emotions. A grim and selfish thought began to surface at the edge of my chemo-brain. On 9/11/01, what was really on my mind was the appointment scheduled at my radiologist’s office for 9/12/01. At 9 AM I was scheduled to have my brand new baseline x-rays, which would tell the new story of my now non-cancerous breasts. My rehearsals never transpired; all concerts were called off. What if my appointment was cancelled due to the Twin Towers collapsing?

Of course, no one was in the doctor’s office to answer my repeated calls. The phone service all over New York City was sketchy at best. I felt sheepish and embarrassed to even bother with this detail in my small life. My gigantic baby towers were gone and my breasts needed to be photographed. The Towers and The Breasts: like the title of a bad soap opera, just cancelled by the networks.

As the wind shifted into the evening, my house began to fill with the smell of smoke and minute detritus of God knows what. I went to bed that night with the windows closed, trying to ward off that odor of death and pulverized computers, the particles of vaporized documents and other ephemera of life that made up the Trade Towers and everything and everyone trapped inside. The very concrete that I may have stepped on as I emerged from the elevator that day over 40 years ago might have been crossing the East River and seeping into my house in Queens on the night of 9/11/01. As I tried to sleep, I inhaled my baby towers—an odor that I imagined contained my own young and ancient footsteps.

On the morning of the 12^th at 6:30 AM, the call came from my doctor: they would see a few patients who needed crucial scans and I was one. "Come on in, if you can."

Walking to the subway, I sensed a tentative calm in the air, not yet to be trusted. The streets and stores were empty, save for a few stalwart Korean delis. Most people had undoubtedly been glued to the TV all night and were still watching, or were drifting off to sleep into an unwanted day off. Miraculously, the 7 trains were running and I boarded the Manhattan-bound subway with a few others, our eyes meeting, but mostly behaving as if we were going into work as usual.

I sat on the side of the train that faced north. As the elevated subway went into its big turn just after the Queensboro Plaza station, it suddenly occurred to me to turn around and look south. The gesture was an instinct. My southward view had just cleared the Citigroup Building. With this building in the foreground, the Twin Towers would have emerged. But they were gone. What appeared in their stead was the most beautifully sculpted double billow of thick smoke imaginable. They were solidly planted where the towers had been, almost as if they were new structures, and not going anywhere. Casper-like billows: ghostly. Monumental bulbous balloons of grey steely smoke, the wind unable to dissipate their sheer density. The towers had been rearranged into a softer effect; not the huge phallic-like structures that everyone griped about in the 70’s when I was a music student. No, these might be kind and gentle and forgiving towers, because they were now not only made of concrete and steel, but also of lives lost. Mixed up in the chaos of these gentle smoke stacks were countless bodies, pulverized into a massive, vertical sandy compost heap. Is that what I inhaled the night before? This thought roiled in my guts and I bent down to retch onto the floor of the train. My fellow commuters looked away.

The radiologist’s office was on Madison Avenue, a building of solid steel, concrete, granite and glass. The elevator let me out into an intact hallway. Doors to the offices were wide open; a few bald comrades sat, waiting. Angels disguised as doctors in white coats had flocked to this solid building to quell my fears and complete my treatment, taking the pictures that would become my breast’s new baby pictures, to gaze at and refer to in subsequent years.

9/12/01 was the end of my cancer journey. On that day, I began my final stage of healing. I heard the somber music of death knells throughout the city. The killing of my cancer was complete, and my beloved baby Twin Towers had died too.

Marcia Butler’s life has been driven by creativity. For 25 years she performed throughout the world as a professional oboist. She was hailed by the New York Times as “a first rate artist” and performed with such luminaries as pianist Andre Watts, soprano Dawn Upshaw and jazz great Keith Jarrett. In 2002 Marcia switched careers and began her interior design firm, Marcia Butler Interior Design. She has served well over 100 clients in twelve years and her design work has been published in shelter magazines. She resigned from the music business in 2008. The personal essay “Cells” is part of a memoir Marcia is currently writing, whose working title is My Isolde. She lives in Sunnyside Gardens, Queens.