The doctors found a malignant tumor in Ruby’s gall bladder. They closed her up and designated her case terminal. Stacy called me, shocked. She repeated the prognosis verbatim: the bile ducts were compromised. In the future, and for the sake of comfort, the ducts could be drained of cancerous cells. There was no therapy being considered, and pain management would be arranged. An oncologist would be consulted. “I am sorry,” the doctor said.
“Why didn’t they just take the gall bladder,” I asked Stacy, ignorant of the ambitions of a malignancy, thinking that Ruby’s tumor could be excised with a knife, removed from its habitat, and banished to the hazardous waste bin. My mind was torpid; fear set in. “Stacy, Stacy,” I called out when her voice trailed off. “What else did he say?” I asked, and she repeated the prognosis.
That afternoon Stacy, her husband, son, in-laws, and my children and I stood around Ruby’s hospital bed. Everyone in the cancer ward at Memorial Hospital got a private room with a view.
Stacy was talking on her cell phone. Everybody else in the room paced. We were the rowdy newcomers to the ward. We did not accept – nor did we plan on accepting – any of its lethargy, unlike the mother of the young woman across the way, who watched with patience and concern as her adult daughter tried to get back into the bed, moving as if her discomfort was the size of the entire room. Even the nurses were slow when summoned. Maybe they thought there was no need to rush any more. We brought with us the robust outside world and would not accept the ward’s sluggish pace of feeling, being, and thinking. We resisted it all – the children wanted to watch television, the in-laws needed a soda and went in search of a vending machine, and Stacy’s husband needed to go home to walk the dog.
When we looked at Ruby, we didn't see her any longer. Instead, we saw her cancer. Initially, we thought: “How could this happen to one of us? Yesterday she was …” More specifically, we look for physical evidence of the cancer, as if it would expose itself, flip us the finger, stick out its tongue, or howl with laughter right in our faces. But, what was happening was more ominous and technical than that:
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.
CANNOT RULE OUT EARLY CARCINOMATOSIS ALONG THE OMENTUM ANTERIORLY EXTENDING TOWARD THE PELVIS.
DUCTAL DILATION IS DEMONSTRATED DUCTAL DILATION EXTENDS INFERIORLY TO THE LEVEL OF THE AMPULLA.
END OF IMPRESSION
On the phone, Stacy told family and friends her mother had Stage 4 Gall Bladder Cancer. Terminal. Some of them spoke with Ruby. Others sent their prayers and well wishes. Still others were frightened by the sudden and tragic twist of events; they would call Ruby another time. At the moment, the information was too raw and incomprehensible to process – they were just sitting down to dinner, watching the evening news, not prepared for this news. Stacy was cordial. She said she appreciated their support. Any emails, calls, or cards would “lift the spirits.”
The only time Ruby cried was when she spoke to Ryan, her close friend from the New Jersey Shore. Ryan, who had been happily in love with his partner John for several years now, spent his days making and selling curtains, pillows, and tote bags from beautiful vintage barcloth he picked up at weekend yard sales on the Shore. He sold his wares on eBay and spent the rest of his time buying, gutting, redecorating, and turning over homes with John in the gentrified areas of Asbury Park.
When Ryan spoke to Ruby on the phone he excused himself because he couldn't stop crying. Later, after he had composed himself, he called her back. Ruby assured him that things would be fine. “Yes, I know, Ryan. I miss you too. I understand. Thank you, Ryan. I love you too,” I overheard her say.
it
Ruby handled it all with grace. There was something about the way she greeted her visitors with a gentle smile, something about her composure when she was given condolences by friends on the telephone. Her demeanor was more in line with hosting a quiet, intimate, candle-lit dinner with a few close friends. She even smiled gracefully when her daughter’s loud in-laws talked of a cruise vacation they purchased, the money it cost, the preparation it would involve. Nothing had changed for them. Life went on. Ruby listened to them from far away, already inhabiting her new world of drugs and pain, knowing she was the only one there, that it was futile to bring others with her because they couldn't conceive of where she was or where she was going.
Even though she was heavily sedated with Vicodin, which had been prescribed for pain every six hours, she was in control. She knew 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 had seen it all before: how the body broke down, how the mind wandered, how nightmares and fears took over the final hours. The only defense was lucidity, facing down the culprit, a battle to the end. Not that she intended to be hysterical, sloppy or even noisy about it. She knew that the most grueling battles took place deep inside, maybe as far as the soul; that is where she intended to take the fight. The only armor she needed was information: hard brutal facts about the state of her condition and the changing countdown. “I want to know everything … everything,” she said to Stacy repeatedly. “Yes, mommy,” Stacy responded.
Even in her hospital gown, Ruby looked beautiful. She was too drugged to care that her gown hung over her chest, almost exposing her naked breasts. You could see the freckles on her porcelain white shoulders and a glow on her cheeks from her low-grade fever. It was hard to believe she was so ill.
This was the beginning of the end of Ruby’s life, but it was more than that. It is more like a candid mental shot of how she began her end; regardless of her terminal diagnosis she was stoic, like she was about all other mishaps in her life. As a matter of fact, she would 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 was like another one of her violent lovers, Ruby entertained him with grace, controlling his overwhelming need to flaunt his possession of her and make public their most humiliating of tussles. Read my exciting memoir, "The Continent of Ruby," available at: https://www.amazon.com/Continent-Ruby-Memoir-Because-sometimes-ebook/dp/B00TT5DDWO?ie=UTF8&*Version*=1&*entries*=0
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