The
doctors have found a malignant tumor in Ruby’s gall bladder. They closed her up
and designated her case terminal. Stacy calls me, shocked. She repeats the
prognosis verbatim: the bile ducts are compromised. In the future, and for the
sake of comfort, the ducts can be drained of cancerous cells. There is no
therapy being considered, and pain management will be arranged. An oncologist will
be consulted. “I am sorry,” the doctor said.
“Why
didn’t they just take the gall bladder,” I ask Stacy, ignorant of the ambition
of a malignancy, thinking that Ruby’s tumor can be excised with a knife,
removed from its habitat, and banished to the hazardous waste bin. My mind is
torpid; fear sets in. “Stacy, Stacy,” I call out when her voice trails off. “What
else did he say?” I ask, and she repeats the prognosis.
That
afternoon Stacy, her husband, son, in-laws, and my children and I stand around Ruby’s
hospital bed. Everyone in the cancer ward at Memorial Hospital gets a private
room with a view.
Stacy
is talking on her cell phone. Everybody else in the room paces. We are the
rowdy newcomers to the ward. We do not accept – nor do we plan on accepting –
any of its lethargy, unlike the mother of the young woman across the way, who
watches with patience and concern as her adult daughter tries to get back into
the bed, moving as if her discomfort is the size of the entire room. Even the
nurses are slow when summoned. Maybe they think there is no need to rush any more.
We bring with us the robust outside world and will not accept the ward’s sluggish
pace of feeling, being, and thinking. We resist it all – the children want to
watch television, the in-laws need a soda and go in search of a vending machine,
and Stacy’s husband needs to go home to walk the dog.
When
we look at Ruby, we don’t see her any longer. Instead, we see her cancer.
Initially, we think: “How can this happen to one of us? Yesterday she was …” More
specifically, we look for physical evidence of the cancer, as if it will expose
itself, flip us the finger, stick out its tongue, or howl with laughter right in
our faces. But, what is happening is more ominous and technical than that:
1.
FINDINGS
COMPATIBLE WITH ADVANCED GALLBLADDER CARCINOMA WITH LIVER INVASION AND LIVER
METASIS WITH MASS MEASURING APPROXIMATELY 8.5 X 7.5 CM, EXTENDING THROUGH
HEPATIC SEGMENTS 4B, 4A AND TO A LESSER DEGREE, 5. SEVERAL LIVER LESIONS ARE
DEMONSTRATED IN THE APPROXIMATELY1.5-CM RANGE.
2.
CANNOT
RULE OUT EARLY CARCINOMATOSIS ALONG THE OMENTUM ANTERIORLY EXTENDING TOWARD THE
PELVIS.
3.
DUCTAL
DILATION IS DEMONSTRATED DUCTAL DILATION EXTENDS INFERIORLY TO THE LEVEL OF THE
AMPULLA.
END
OF IMPRESSION
On
the phone, Stacy tells family and friends her mother has Stage 4 Gall Bladder
Cancer. Terminal. Some of them speak with Ruby. Others send their prayers and
well wishes. Still others are frightened by the sudden and tragic twist of
events; they will call Ruby another time. At the moment, the information is too
raw and incomprehensible to process – they were just sitting down to dinner,
watching the evening news, not prepared for this news. Stacy is cordial. She says
she appreciates their support. Any emails, calls, or cards will “lift the
spirits.”
The
only time Ruby cries is when she speaks to Ryan, her close friend from the New
Jersey Shore. Ryan, who has been happily in love with his partner John for
several years now, spends his days making and selling curtains, pillows, and
tote bags from beautiful vintage bar cloth he picks up at weekend yard sales on
the Shore. He sells his wares on eBay and spends the rest of his time buying, gutting,
redecorating, and turning over homes with John, in the gentrified areas of Asbury
Park.
When
Ryan talks to Ruby on the phone he excuses himself because he can’t stop crying.
Later, after he has composed himself, he calls her back. Ruby assures him that
things will be fine. “Yes, I know, Ryan. I miss you too. I understand. Thank
you, Ryan. I love you too,” I overhear her say.
Ruby
handles it all with grace. There is something about the way she greets her
visitors with a gentle smile, something about her composure when she is given
condolences by friends on the telephone. Her demeanor is more in line with hosting
a quiet, intimate, candle-lit dinner with a few close friends. She even smiles
gracefully when her daughter’s loud in-laws talk of a cruise vacation they
purchased, the money it costs, the preparation it will involve. Nothing has
changed for them. Life goes on. Ruby listens to them from far away, already inhabiting
her new world of drugs and pain, knowing she is the only one there, that it is futile
to bring others with her because they cannot conceive of where she is or where
she is going.
Even
though she is heavily sedated with Vicodin, which has been prescribed for pain every
six hours, she is in control. She knows a thing or two about death: she held
the hands of her grandmother, her mother, her third husband’s dying grandmother,
and her son-in-law’s grandfather when they passed. She was present at the
deaths of two ex-husbands, even though their relationships had long been over.
She also slept at the bedside of her dying daughter-in-law. She has seen it all
before: how the body breaks down, how the mind wanders, how nightmares and
fears take over the final hours. The only defense is lucidity, facing down the
culprit, a battle to the end. Not that she intends to be hysterical, sloppy or
even noisy about it. She knows that the most grueling battles take place deep
inside, maybe as far as the soul; this is where she intends to take the fight. The
only armor she needs is information: hard brutal facts about the state of her
condition and the changing countdown. “I
want to know everything … everything,” she says to Stacy repeatedly. “Yes, mommy,”
Stacy responds.
Even
in her hospital gown, Ruby looks beautiful. She is too drugged to care that her
gown hangs down over her chest, almost exposing her naked breasts. You can see
the freckles on her porcelain white shoulders and a glow on her cheeks from her
low-grade fever. It is hard to believe she is so ill.
This
is the beginning of the end of Ruby’s life, but it is more than that. It is
more like a candid mental shot of how she begins her end; regardless of her
terminal diagnosis she is stoic, like she is about all other mishaps in her
life. As a matter of fact, she will continue to deal with the most urgent and
pressing matters – scheduling appointments with specialists, listening to the talk
of more surgery, chemotherapy, prescriptions of morphine, hospice, funeral
arrangements – when absolutely necessary. If terminal cancer is yet another
violent lover, Ruby entertains him with grace, controlling his overwhelming
need to flaunt his possession of her and make public their most humiliating of
tussles. Memoir, "The Continent of Ruby," available at: http://www.amazon.com/dp/B00TT5DDWO
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