Holidays in Heck

  She was nothing loath. I asked, “What do you think will happen in the future?”

  “You’ll buy me a humongous ice cream cone.”

  16

  A JOURNEY TO . . . LET’S NOT GO THERE

  Summer 2008

  Part 1

  I looked death in the face. All right, I didn’t. I glimpsed him in a crowd. I was diagnosed with cancer, of a very treatable kind. I’m told I have a 95 percent chance of survival. Come to think of it—as a drinking, smoking, saturated-fat-hound of a reporter—my chance of survival has been improved by cancer.

  I still cursed God, as we all do when we get bad news and pain. Not even the most faith-impaired among us shouts, “Damn quantum mechanics!” “Damn organic chemistry!” “Damn chaos and coincidence!”

  I believe in God. God created the world. Obviously pain had to be included in God’s plan. Otherwise we’d never learn that our actions have consequences. Our cave-dwelling ancestors, finding fire warm, would conclude that curling up to sleep in the middle of the flames would be even warmer. Cave bears would dine on roast ancestor, and we’d never experience any pain because we wouldn’t be here.

  But God, Sir, in Your manner of teaching us about life’s consequential nature, isn’t death a bit . . . um . . . extreme, pedagogically speaking? I know the lesson that we’re studying is difficult. But dying is a harder final exam than I was counting on. Also, it kind of messes up my vacation planning. Can we talk after class? Maybe if I did something for extra credit . . .

  Seeing things from God’s point of view is difficult for a mortal. The more so for a mortal who’s just received an updated mortality scheduling memo from the pathology department.

  Seeing things from God’s point of view is the purpose of conventional religion, in my opinion. And I am a conventionally religious person. But I feel the need to think through a few things before I unload my gripes on Father Hoolihan. He’s got a busy parish and he isn’t as young as he used to be. In fact Father Hoolihan doesn’t look well himself. Perhaps, if I can get my thoughts straight, he can unload his gripes on me. I can’t give him last rites, but I can give him a whiskey.

  Why can’t death—if we must have it—be always glorious, as in The Iliad? Of course death continues to be so, sometimes, with heroes in Falluja and Kandahar. But nowadays death more often comes drooling on the toilet seat in the nursing home or bleeding under the crushed roof of a teen-driven SUV or breathless in a deluxe hotel suite filled with empty drug bottles and a minor public figure whose celebrity expiration date has passed. I have, of all the inglorious things, a malignant hemorrhoid. What color bracelet does one wear for that? And where does one wear it? And what slogan is apropos? Perhaps that slogan can be sewn in needlepoint around the ruffle on a cover for my embarrassing little doughnut buttocks pillow.

  Furthermore, I am a logical, sensible, pragmatic Republican, and my diagnosis came just weeks after Teddy Kennedy’s. That he should have cancer of the brain, and I should have cancer of the ass . . . Well, I said a rosary for him and hoped he had a laugh at me. After all, what would I do, ask God for a more dignified cancer? Pancreas? Liver? Lung?

  Which brings me to the nature of my prayers. They are, like most prayers from most people, abject self-pleadings. But praying for oneself has disturbing implications. There’s Saint Teresa’s warning about answered prayers or, for our atheistic friends, the tale of “The Monkey’s Paw.”

  And I can’t be the only person who feels like a jerk saying, “Please cure me, God. I’m underinsured. I have three little children. And I have three dogs, two of which will miss me. And my wife will cry and mourn and be inconsolable and have to get a job. P.S. Our mortgage is subprime.”

  God knows this stuff. He’s God. He’s all-knowing. What am I telling Him, really? “Gosh, You sure are a good God. Good—You own it. Plus, You’re infinitely wise, infinitely merciful, but . . . Look, everybody makes mistakes. A little cancer of the behind, it’s not a big mistake. Not something that’s going on Your personal record. Let’s not think of it as a mistake. Let’s think of it as a teachable moment. Nobody’s so good that He or She can’t improve, so . . .”

  It’s one universe, entire, God’s creation and all of a piece. There’s a theory about how the fluttering of a butterfly’s wing can somehow eventually cause a cyclone in the Bay of Bengal or something like that. What if the flatulence of me in a radiation therapy session eventually causes . . . I mean, suppose Saint Peter had my fax number and faxed me: “P.J., we did the math. We can get you a 100 percent survival rate instead of 95 percent, but twenty years from now a volcanic eruption in Honduras will kill 700,000 people.” What do I fax back? “Dear Saint Peter, Thank God. That’s a real shame about Honduras. I promise I’ll donate $1,000 to the International Red Cross.”

  I think I’ll pray for fortitude instead and, maybe, for relief from gas.

  No doubt death is one of those mysterious ways in which God famously works. Except, upon consideration, death isn’t mysterious. Do we really want everyone to be around forever? I’m thinking about my own family, specifically a certain step-father I had as a kid. Sayonara, you SOB. On the other hand, Napoleon was doubtless a great man in his time; at least the French think so. But do we want even Napoleon extant in perpetuity? Do we want him always escaping from island exiles, raising fanatically loyal troops of soldiers, invading Russia, and burning Moscow? Well, at the moment, considering Putin et al., maybe we do want that. But, century after century, it would get old. And what with Genghis Khan coming from the other direction all the time and Alexander the Great clashing with a Persia that is developing nuclear weapons and Roman legions destabilizing already precarious Israeli-Palestinian relations—things would be a mess.

  Then there’s the matter of our debt to death for life as we know it. I believe in God. I also believe in evolution. If death weren’t around to “finalize” the Darwinian process, we’d all still be amoebas. We’d eat by surrounding pizzas with our belly flab and have sex by lying on railroad tracks waiting for a train to split us into significant others. I consider evolution to be more than a scientific theory. I think it’s a call to God. God created a free universe. He could have created any kind of universe He wanted. But a universe without freedom would have been static and meaningless—a taxpayer-funded-art-in-public-places universe.

  Rather, God created a universe full of cosmic whatchmajiggers and subatomic whosits free to interact. And interact they did, becoming matter and organic matter and organic matter that replicated itself and life. And this life was completely free, as amoral as my cancer cells.

  Life-forms could exercise freedom to an idiotic extent, growing uncontrolled, thoughtless, and greedy to the point that they killed the source of their own fool existence. But, with the help of death, matter began to learn right from wrong—how to save itself and its ilk, how to nurture, how to love (or, anyway, how to build a Facebook page), and how to know God and His rules.

  Death is so important that God visited death upon His own Son, thereby helping us learn right from wrong well enough that we may escape death forever and live eternally in God’s grace. (Although this option is not usually open to reporters.)

  I’m not promising that the Pope will back me up about all of the above. But it’s the best I can do by my poor lights about the subject of mortality and free will. Thus, the next time I glimpse death . . . Well, I’m not going over and introducing myself. I’m not giving the grim reaper fist dabs. But I’ll remind myself to try, at least, to thank God for death. And then I’ll thank God, with all my heart, for whiskey.

  Part 2

  A diagnosis of cancer raises deep metaphysical questions such as, “Is God a nice guy?” and “Will my bird dog go to heaven or do I flush the quail of paradise with seraphim, cherubim, and putti?”

  But after a while diagnosis wears off. It’s time for an intermission in the self-dramatization of “I Have a Life-Threatening Disease.” I wasn’t able to play the role to its full tragical effect anyway
. The kind of cancer I had was too treatable and too ridiculous.

  It’s not every time you get diagnosed with cancer and it makes you laugh. I’d had a hemorrhoid operation. Two days later the colorectal surgeon called. “I’m sorry to tell you,” he said, “your hemorrhoid was malignant.”

  “Malignant hemorrhoid?” I said. “There’s no such thing as a malignant hemorrhoid.”

  “In almost every case you’d be right,” the surgeon said and paused in a moment of sympathetic hesitation and of unintentional comic timing. “But . . .”

  I laughed but I wanted to argue. “Malignant hemorrhoid” is Rush Limbaugh talk radio. “Malignant Hemorrhoid” is a Dave Barry rock band. But I still had to get treated. Going from the metaphysical to the all-too-physical reminded me of my gratitude to God. You have immediate access to the top specialist in the field when you pray. (Do polytheists have difficulties with this?) At least I had the good fortune to be in Washington, D.C.—a city full of flaccid old guys like myself who spend their time blowing smoke out of you-know-where and being full of you-know-what and sitting on their duffs. Consequently the town is full of medical expertise about the body part in question.

  It turns out what I had was a skin cancer, squamous cell carcinoma. Practically every melanin-deficient (let alone Irish) person who spends time in the sun gets this if he or she lives long enough. “I call it ‘adult acne’ when it turns up on the face or arms,” the oncologist said. But why it occasionally turns up where it turned up on me is something of a medical mystery. I mean, I was naked a lot in the 1960s but not that naked.

  There’s a considerable loss of dignity involved in trading the awe-inspiring fear of death for the perspiration-inducing fear of treatment. There are hells on earth. Until a generation ago the cure for anal cancer was a colostomy. Doctors have gotten over that. Most of the time. Now, with God’s grace, the cure is radiation and chemotherapy. Would I have to go to some purgatorial place for this? To Sloan-Kettering in New York, a city I detest? Or out to the Mayo Clinic, although I have a phobia about hospitals named after sandwich toppings? “No,” the oncologist said. “The treatment protocol is standardized and is successfully used everywhere.”

  I named my local New Hampshire hospital (and large animal veterinary clinic).

  “Almost everywhere,” the oncologist said.

  I asked about the Dartmouth-Hitchcock Medical Center, ninety miles from my home but still on the planet New Hampshire. Dr. Marc Pipas at Dartmouth-Hitchcock’s Norris Cotton Cancer Center came strongly recommended. Dr. Pipas is an avid bird hunter and an advocate of reintroducing the prairie chicken to the eastern seaboard. So he and I had something to talk about in addition to my behind. I’d need radiation therapy every day for six weeks. (Every day, that is, Monday through Friday—the radiology department has to play golf, too.) And I would undergo two four-day stints of around-the-clock chemotherapy, carrying a fanny pack of poisonous chemicals to be pumped into my body through a surgically implanted mediport. (Dr. Pipas persuaded the infusions department to install this on the left side of my chest so that it wouldn’t interfere with mounting a shotgun.)

  In theory I could get my radiation treatments elsewhere, within easy commuting distance. But it’s worthwhile to find out what a doctor himself would do if he had your medical problem. And he probably thinks he does. Several doctor friends have told me you can’t get through medical school without being convinced that you have every disease in the textbooks, including elephantiasis, beriberi, and guinea worm infestation. Dr. Pipas immediately said that, for anal cancer, he’d go to the radiologist Dr. Bassem Zaki at Norris Cotton Cancer Center.

  Dr. Zaki is a Coptic Christian who immigrated from Egypt in his late teens. He and I talked about Middle Eastern politics, which, as far as I’m concerned, is the second most interesting blood sport after upland-game shooting.

  Dartmouth-Hitchcock Medical Center is a sparkling edifice, full of light and air and surprisingly good art for a nonprofit institution. The architectural style is higgledy-piggledy 1980s modern—2 million square feet, every one of which is between you and where you have an appointment. Finding your way around is a trial run for Alzheimer’s but a small price to pay for the pleasant surroundings. Even the food in the cafeteria is good. Various scientific studies have shown that patients recover better and faster in cheerful environments. Duh.

  The staff at DHMC is also cheerful, but not too cheerful. The staff members don’t make you feel like a small child at the receiving end of an overambitious preschool curriculum. Perhaps they know better because DHMC is a teaching hospital. The Dartmouth Medical School is the fourth-oldest in the nation, founded in 1797. DHMC is venerable as well as modern. But not too venerable. It doesn’t use leeches.

  Being at a teaching hospital puts a patient in a comfortable equation with the institution. People are expecting to learn something from you, not just do something to you. But let’s not push the idea of equality too far. There’s a current notion that you should “take charge of your disease.” No thanks. I’m busy. I’ve got cancer. I’m willing to face having cancer. I’m not willing to face having cancer with homework. I promised Dr. Pipas and Dr. Zaki that I wouldn’t show up with sheaves of printouts from the Internet containing everything on Wikipedia about malignancies. They each laughed with detectable notes of relief. (Although I suspect my wife has made her way into the health blog ether. Fish oil pills, raw kelp, and other untoward substances started showing up on the dinner plates after I was diagnosed.)

  Dr. Pipas and Dr. Zaki combined had something like half a century of medical experience. God wants us to have faith in what we can’t see. Therefore He certainly wants us to have faith in what we can. I could see the diplomas on the doctors’ office walls.

  “I’ve got cancer” is more than an excuse for rational ignorance about medicine. It’s an excuse for everything. From niece’s wedding to daughter’s piano recital to IRS audit, you’re off the hook. I even tried my excuse on the Pope. I couldn’t go to Mass because of the effect that germ-swapping Vatican II “sign of peace” handshakes could have on my radiation-weakened immune system. And I continued to employ cancer as an excuse until an exasperated spouse finally shouted, “You’re curable! You can too put your dirty dishes in the sink!”

  The radiation treatments weren’t bad—twenty minutes proped on a machine in a humiliating posture. Most of me was exposed and the nurses were embarrassingly pretty. But it’s interesting, the connection that physical modesty has with physical vanity. Once past sixty you can reasonably abandon both. This was one of the life lessons with which having cancer abounds. I hate life lessons. Consider all the I-hope-you’ve-learned-your-lesson experiences: skinned knees, high school romances, wreckage of dad’s car, flunked college courses, horrible hangovers, failed marriages. I tell my children, “Avoid life lessons. The more important the lesson, the more you should avoid it.”

  The chemotherapy was worse than the radiation. The pump in the fanny pack of poisonous chemicals made a whining whirr every minute or so—not frequently enough to get used to and too frequently to let me sleep. A long plastic tube that attached the fanny pack to my mediport allowed me to bury the pump and its noise in a mound of pillows. But then I’d forget that I was connected. As with all attempts to forget one’s troubles, I was courting disaster. I’d get up in the middle of the night to go to the bathroom and be yanked back to the mattress by the tubing. The fanny pack came with a bag of protective clothing and instructions for dealing with chemical spills. According to these instructions I was supposed to do, by myself, what the entire U.S. government had done during the 2002 national anthrax panic.

  The cumulative effects of the treatments were unpleasant. The loss of my previously full, thick head of ungrayed hair met with no sympathy from my age cohort of males. I developed fatigue, mouth sores, and a rash around my loins as if I’d been dressed in nothing but hip boots and an Eisenhower jacket and turned on a spit in a tanning salon. Suffering makes us question Go
d. My question was: What evolutionary purpose does the itch serve? Indeed, an itch may be an argument for intelligent design. Maybe we itch not for biological purposes but to give us a moral lesson about surrendering to our strongest passions. I had the strongest passion to scratch certain parts of my body. If, however, I had scratched these parts of my body near a school or playground, I would be sent to jail.

  Dr. Pipas, Dr. Zaki, and the Dartmouth-Hitchcock staff were attentive to my complaints and gave me generous doses of things to turn complaints into complaisance. But I was nagged by a concern about the quality of my medical care. Was it too good? I’m well insured and passably affluent. I asked Jason Aldous, Dartmouth-Hitchcock’s media relations manager, “What if I weren’t?”

  “We’re a charitable institution,” Aldous said. “No one will ever be refused care here. On the other hand, we have to keep the lights on. We do try to find any possible means of payment—government programs, private insurance, et cetera.”

  The hospital has a whole department devoted to that. “In about sixty percent of cases,” Aldous said, “people who think they aren’t eligible for any assistance actually are.” Then there are the people who have income but no savings, or assets but no income. Discounts are provided and payment plans worked out. Failing all else, treatment is simply given free—$63 million worth in 2007.

  I asked Aldous about who gets what treatment from which doctor. Do your means affect the hospital’s ways?

  “The doctors,” he said, “don’t know how—or if—you’re paying.”

  What Jason Aldous told me seemed true from what I could see of the hospital’s patients, a cross section of Yankees, flinty and otherwise. The Norris Cotton Cancer Center alone treats more than 5,000 people a year. And we were all amiable in the waiting rooms. Anytime someone new came in and sat down he or she was tacitly invited to spend about three minutes telling everyone what was wrong. Then the conversation was expected to return to general topics. The general topic of choice during the summer of 2008 was how the Democrats would destroy the private health care system that was saving our lives. When medicine was socialized we’d have to sit in waiting rooms forever, if we lived. (The exception to the three-minute rule was for a child patient. Then there was unlimited interest and upbeat chat.)