How It All Began
“Do you know what it’s like to die?” Sitting on a bed in the busy Emergency Room of the university hospital, Elizabeth willed herself to concentrate as she held her breath and waited for the answer.
“I can explain death from a medical perspec-tive,” said the doctor, “but I won’t conjecture on what is not quantifiable, such as what becomes of us after the last exhalation of breath.”
For a moment, Elizabeth tried to imagine the owl-eyed man in front of her disappearing into thin air, and for a fleeting moment she hoped the horror of her diagnosis would go with him.
The chilly, antiseptic air swirled all around her, carrying with it the sounds of a busy emergency room: beeping monitors, soft crying, and the hurried footsteps. Yet in the vacuum of this conversation, there was the focused silence of a turning-point mo-ment. With her next exhalation, Elizabeth knew that everything in her life would change.
“But it’s not my time to die.” Desperation bubbled up into her throat, and she clasped her mouth to contain it, not knowing if she would laugh or scream. “I have plans.”
“We all have plans that go unfinished,” he of-fered with a pronounced look of discomfort.
Elizabeth hoped the doctor would spare her the litany of his own mislaid plans, as she was having enough difficulty trying not to catalogue her own. She glanced down at her hands in embarrassment. Her knuckles were white from the strain of clenching her favorite fountain pen, which she’d been holding as a talisman ever since they moved her into this small hospital room. She had been competently anchored here with an IV whose purpose had not yet been de-termined, and plugged into beeping monitors that recorded her heart rate and blood pressure.
When she had first arrived, they had immedi-ately sent her for a CAT scan. Afterward, she was ex-iled to this small room and been left alone to wait un-til a specialist could look at the tests and find time to come discuss his conclusions.
Elizabeth had taken out her favorite fountain pen and black Moleskin journal from her purse to keep herself occupied while she waited. But apart from her tight grip on the pen, both items had been left abandoned in her lap.
When the doctor finally came in, she was star-ing blankly across the room, propped against the rigid foam pillows, wearing the light cotton gown they had asked her to change into; the thin blanket and sheet covering her legs did little to keep her from shivering.
“But I don’t want to die,” she whispered.
The doctor peered at Elizabeth over the top of his reading glasses as if she’d just made the most ob-vious, and therefore ridiculous, statement of the day. “Of course you don’t, and that’s the worst part of the-se diagnoses. They come into our lives and knock eve-rything off the rails.”
“I was just thinking that the worst part was dy-ing, but perhaps I’m wrong.”
The doctor sighed. He appeared not to enjoy this flagging bit of repartee. “Elizabeth, I’m not trying to diminish the seriousness of your diagnosis. We’re going to discuss your treatment and what you should expect going forward. I just want you to understand the conflicting emotions you may be feeling. Shock, feeling nothing at all, even the gallows humor you’re entertaining me with, are all normal reactions. At this point, I suggest a second opinion. I’ve discussed your test results with two of my colleagues, and they are willing to speak with you and present their opinions. Or I’d be happy to give you the names of some very fine physicians not affiliated with this hospital.”
“Shouldn’t there be something more?” Eliza-beth tapped her heavy, black fountain pen in time to the pounding of her heart.
“More?” The doctor looked confused.
“Doing. Feeling. Something.” The sickening smell of disinfectant and the dull, white walls gave her no reference point to balance the weight of this dis-cussion. She needed time to figure out how to cope with the black despair that had engulfed her.
“Elizabeth, everyone processes this news dif-ferently,” he said. “Over the coming weeks, your emo-tions will run the gamut—anger, fear, depression, maybe even acceptance. I can never predict how pa-tients will experience the prospect of death. Some-times it mirrors their approach to life. Some people are optimists and fighters. Others, well, they accept their prognosis and go with the inevitable.”
A mirror of her life? She considered his words. Her life had been unremarkable, her approach to it cautious. Would that be how she approached death? Would she be one of those people who just went along with it? If she considered her history, the an-swer was easy—yes.
She reached up and touched her scalp. There beneath the skin and bone, burrowed within the folds of her brain, was the thing that was changing the course of her life. She grimaced and wished she could pluck it out with tweezers like an errant hair.
As if asserting the futility of such an action, a dull ache reverberated within her head, a painful echo to her gentle touch, which left her feeling nauseous. She’d lived with recurrent headaches for the past two weeks, but last night’s searing pain had brought her to the doctor’s office. She had thought it would be a simple matter, migraines or an atmospheric disturb-ance, something fixed with the flourish of a pen on a white prescription pad or a move to a milder climate.
Instead, after listening to her symptoms, the doctor had called 9-1-1, and when the EMTs arrived, he had instructed them to take her to the university hospital for a CAT scan and MRI. The immediate rush of activity after they whisked her from his office to the ER had been followed by subsequent hours of wait-ing. Elizabeth had been grateful that she at least had her pen and journal to occupy her thoughts and hands.
How easily your life can change, she though. The landscape can remain the same, but with one word your perception of the landscape is forever altered.
Outside the hospital doors, it was a crisp, sun-ny day in the unpredictable straddle of winter and spring, when the weather would veer from snow flur-ries to bouts of warm sunshine, confusing flowers and sending many young blooms to an early death if they dared poke out their fragile buds too early. A day that, under normal circumstances, she would be enjoying with a walk through the arboretum. Instead, here she sat. The loveliness of the day had remained the same, but she had not. Or perhaps she had, but with con-scious acknowledgment of what already existed, her perception of the day had changed. Since her percep-tion of the world came through her senses and mind, the world, or at least her world, was now altered. For-ever. Amen.
Through a bizarre twist of fate, she was still the same person she had been when she woke up. She didn’t feel any different, yet the reality was that she was dying. She had not changed by any conscious decision or action, yet her life was altered. It was diffi-cult to describe, much less digest, the surreal sensa-tion this realization produced.
Elizabeth considered whether this might be an extension of Descartes’s famous declaration, “I think, therefore I am.” In other words, if she had not acknowledged this thing in her head, would it cease to exist?
Or, could she become Schrodinger’s cat? Where was the line between the reality of this mo-ment and the possibility of denying its genuineness and thereby slipping back into the banal reality that existed before this moment?
Here I sit in this hospital bed. But what if I was sit-ting in my living room at home? Or at my desk at work? What if I had chosen not to come here this morning and instead gone about my usual routine or called in sick and stayed at home watching TV and drinking tea? Could I have changed the course of my own history and denied the unfolding of this conversation?
But then she decided this was not the place for quiet contemplation.
“Are you certain you can’t you surgically re-move it?” Elizabeth asked.
With an efficient gesture, the doctor clicked the results of the MRI onto a monitor that hung from the wall, next to the television. He studied the images for a moment as if confirming his earlier conclusion. He nodded and tapped the image of her bring. “I’m quite certain, the tumor is inoperable.”
Elizabeth’s hands fell to her sides. The doctor continued to speak, but her attention had turned in another direction. Acknowledging the obvious out-come in his eyes heightened her fear, made his words more believable. His demeanor gave credence to the unimaginable.
While he continued to talk, she glanced down at the pen and journal she had been holding in her lap, her few tokens of the familiar. She tucked a lock of her brunette hair behind her ear while keeping her face composed and expressionless, reflecting quiet concentration and not the panic that twisted inside.
Focus. She willed her breathing to slow, her hands to stop shaking. She opened her journal and took the cap off of the pen. The doctor’s words were comprehended, but flowed in the background. Occa-sionally she nodded to acknowledge his presence. When he said something truly disturbing, her eyes met his, she watched him study her face and then avert his eyes.
Once upon a time, she’d been told that she was beautiful. It was unlikely that anyone would re-mark on her beauty now. This morning, as she washed the tearstains from her face, she had noted with sadness that the headaches had taken a visible toll on her. Her green eyes were ringed with dark cir-cles from nights of broken sleep. The rosiness in her cheeks had disappeared. Her skin was very pale, with blue veins on either side of her forehead visible through the paper-white skin.
Elizabeth followed the doctor’s gaze from her face back to the image of her brain. She followed the doctor’s fingertips as he traced the outline of the tu-mor. On film, it looked grotesquely beautiful, fanning out like a magnificent, translucent starfish. It glowed against the illuminated screen like a sea creature nes-tled in the crevices of tropical ocean coral. Unfortu-nately, this thing was not a harmless starfish, and her brain was not some distant coral formation. The ten-tacles of the tumor had entwined themselves through her cerebral cortex, making it impossible for a sur-geon to extract. Worse, as the tumor continued to grow, it would kill her.
It seemed so sinister and yet charmingly ironic that something so beautiful could be so deadly. She’d always been a fan of the absurd, though at the mo-ment she didn’t feel like laughing because that would mean laughing at herself.
“How long do I have left?”
The doctor hesitated as if carefully considering the right words and switching mental gears from a strict medical prognosis to one suitable for a young woman too young to have a death sentence. And yet, she wasn’t too young. There was no good time to learn that you were dying. He swallowed hard on the truth and came up with the vague, but honest reply, “It’s difficult to predict.”
“Given the late stage of this tumor and what we can surmise by looking at these images, if it is left untreated . . .” he took a breath, “weeks.”
“How many weeks?”
“I don’t know,” he said. “Perhaps a month?”
“That’s four weeks.”
The doctor sighed.
Her eyes flicked to the monitor. How could an image so beautiful could be so deadly, she wondered.
“But with treatment . . .” The doctor contin-ued.
Elizabeth turned her attention back to the doc-tor and watched him carefully, as if studying a subject she intended to draw; this familiar act calmed her. He appeared to be struggling to regain the upper hand, intent on reaching an audience focused on ignoring his judiciously prepared remarks on the efficacy of various forms of treatment. She imagined him as a fat fish twisting on a fishing line, turning back and forth between the image of her brain and Elizabeth sitting on the bed, smiling more serenely with his every twist.
The more she smiled, the more flustered he looked. She imagined the pronouncements he longed to make, like word bubbles drawn above his head: I have important observations to make! My time is valuable! Why aren’t you according me the respect of my position? I hold your life in my hands, don’t you realize that?
Elizabeth turned her attention back to the opened journal on her lap. She drew one large, round circle on the blank, white page.
She drew a second inside the border of the first, almost touching the black lines of the first’s wall but not quite.
The doctor cleared his throat and increased his volume as if the problem was with her hearing. “I recommend a strong course of chemotherapy.”
“Final exams would be rhetorical, I imagine,” Elizabeth replied, not looking up from the page.
His jaw flexed against her pun. “We’ve seen remarkable efficacy going this route.”
She felt lightheaded with the absurdity of bar-gaining for her life. “How much time would this ‘effi-cacy’ buy me?”
“It’s never prudent to make predictions on these matters.”
“Be imprudent, Doctor.” Her mouth closed in a thin smile. “Months?”
“Perhaps two months.”
“Eight weeks rather than four. The treatment doesn’t sound very efficacious at all.”
“We also have a hospice that we can refer you to. They have wonderful counselors.”
Elizabeth’s hand stilled on the page as she pondered this suggestion for a moment and then shook her head. Her parents were no longer alive, and she couldn’t imagine sharing this problem with her few friends. Not that they wouldn’t be comforting, but it seemed disingenuous to reveal so much when she’d kept so much of her life concealed up to this point. Checking herself into hospice would be tantamount to agreeing in advance to share her last days on Earth among well-intentioned strangers. Just the thought made her cringe. It would be the last, sad indication of just how lonely and isolated her life had become in the past few years. No, she was not ready to wave that white flag.
To her great chagrin, a cancer of the brain, a “glioblastoma” the doctor had called it, had now im-bued the simplicity of her life with a dramatic singu-larity.
At the age of thirty-four this should not hap-pen; it was “statistically uncommon” in women her age the doctor had said. How nice to climb to the ranks of the rare, she mused. Before today, her life had been pleasant and undistinguished. The flow of years marred only by a single, tragic event in child-hood. Now, however, her life had taken on an air of tragedy.
She traced yet another line inside the circle. Start at point A, find your way to point B.
How long is a week, or even a month, when one is dying? Would time move too fast, like water pouring into an outstretched hand? Would every moment be heightened in its importance by an un-seen ticking clock? Or could it be savored, like the first heady sip of merlot on an autumn night? Would every sight be magnified, every sound amplified, and even the most mundane tasks colored with new signif-icance?
Elizabeth saw herself standing in her kitchen pouring her morning coffee. She inhaled the singular richness of her favorite French roast with new appre-ciation. She heard the splash as it hit the sides of the cup and the hum of the breeze that came through the window; she saw the slant of sunlight enter that same window then bend and flow across the kitchen coun-tertop.
Things to do. Places to go. People to see.
All required time.
Another circle drawn. She’d begun studying mazes after the dreams started. And now this.
Into the mundane comes the unexpected.
The doctor stepped out of the room and re-turned twenty minutes later with a parade of his col-leagues. After perfunctory introductions, they hud-dled around the MRI results. A consensus was reached. They turned as a single Greek chorus and confirmed the first doctor’s diagnosis. The prognosis had not changed. Elizabeth sighed and looked back at the journal she held in her lap.
She drew another circle.
Einstein had posited a circular theory of time, realities existing upon one another like the many lay-ers of an onion. Stick a pin through the skin, and you are in the present, past, and future all at once.
She liked that idea. It suggested a means of escape.
Unfortunately, at the moment she seemed con-strained within the more common, linear view of time. Like walking the length of a diving board, moving heel-to-toe. Past to present to future.
It is your choice whether you advance toward the end of the diving board with galloping delight or timid caution. It is your choice whether you leap into the unknown with squeals of reckless abandon or take hesitant steps, holding your nose and closing your eyes. Either way, Elizabeth always imagined that you could see the end of the board as you approached it, that the length of our lives was somehow predictable or manageable. Or directed.
But not with this random event that came out of the blue. That’s what made it seem so unfair. Eliza-beth had lived a cautious life. By her very choices, she had shunned risk and opted for the safest, most in-conspicuous path whenever possible. She had looked both ways before crossing the street and worn sensi-ble shoes and clothes so unremarkable they would never go out of style. Her hairstyle had not changed since she was ten years old.
Her library books were never overdue. Her di-et followed the government recommended guidelines, with little meat and plenty of greens and fruit. She walked to and from work. She not only had a rainy day fund, she began saving for Christmas on Decem-ber twenty-sixth. Her 401-K was maxed out each year and the money placed in a fund so unadventurous it was recommended for people on the verge of retire-ment, not young women. Shouldn’t such conserva-tism be rewarded with a lifespan of one hundred years?
What would she find at the end of the diving board now?
That would be infinity—the vast, blue water we swim in, ripples trailing in our wake as we move toward some unfathomable horizon. Her mother had taught her to swim. Would she swim forever through those cool, blue depths?
“No dissenting opinions?” she asked.
The doctors chose different corners of the room to stare at.
“I see.” She capped her pen, closed her jour-nal, and folded her hands in her lap.
She had found the edge of the diving board. Time was no longer hers.
The first doctor, sensing her acquiescence, cleared his throat and stepped forward. “You’ll re-main in the hospital overnight. We’ll transfer you to a semi-private room upstairs, and we’ll run further tests.” Now confident that he had conveyed the seri-ousness of the situation and buttressed it with the unanimity of his colleagues, he finished by outlining his plan of attack. “Then we’ll begin chemotherapy in the morning.”
“No, we won’t.”
Elizabeth understood that, on one level, the doctors were conducting a negotiation they expected to win. After all, when the other side has no alterna-tive . . .
“No?” Their collective eyebrows rose at her dissent.
She sighed as if addressing children. “This morning I thought I might need a prescription for a migraine. Now you’re telling me that I’m dying—”
The first doctor interrupted, “I understand your reaction. However, it is in your best interest to start treatment right away.”
“Is that my best or only option?”
“At this point, it is your only option,” he said. “With chemo, we might be able to slow down the growth of the tumor.”
“Can you guarantee that?”
“No, of course not,” he sighed, then checked himself and added with a note of resignation, as if the thought had just occurred to him, “It is possible that the tumor would continue to grow at its current rate despite our best efforts.”
“And in the end, I’ll still die.” Elizabeth’s heart tightened at the spoken word, and she felt a light-headed wash of giddiness at the truth of her state-ment.
“Yes, but we may be able to prolong your life,” he suggested.
“What about the quality of my life during the treatment?” she countered.
“There are side effects of course.” He paused. “It is common to experience vomiting, hair loss, dizzi-ness, exhaustion.”
“And if I don’t have the treatment?”
“The headaches will continue as the tumor grows,” he said. “Toward the end, your vision will be-come impaired, if not altogether lost. You will have seizures that will grow in intensity.”
Elizabeth swiped her right eye with the pad of her palm and blinked to clear her vision, as if losing her eyesight would be the worst of what she faced. It was simply too much to comprehend what the sei-zures would do to her remaining days.
The doctors knew this terrain far better than she did, and she understood they believed they knew her future far better as well.
“Eventually, you will slip into a coma.”
“And the pain?”
“It will continue as a recurrent headache and eventually get worse,” the doctor warned with a look designed to convey his authority. “Much worse than you experienced last night.”
Unconsciously, Elizabeth uncapped her pen, and opened her journal. As she began to trace the outline of another circle, her hand stumbled on the page. Her stomach recoiled at the memory of the sear-ing pain of the night before. She didn’t want to con-template sleep if it meant waking up to that agony.
This death would demand the deference she denied these physicians. So much for passing quietly in the night.
The doctor asked if she had any further ques-tions. Her hand stopped on the page without lifting the pen from the paper, and she looked into his eyes.
“I need time to think about my options,” she said.
“Elizabeth, you have few options and little time. Either you have the treatment or you don’t.”
Elizabeth looked up at him and watched as he glanced down at the page on which she’d been draw-ing. By the look on his face, she imagined that alt-hough he’d observed many reactions to a death sentence, hers was unique. Perhaps he’d make a men-tal note to bring up her drawings at the next depart-mental meeting. Was there a polite way of asking a patient if he could make a copy of her drawings?
What he didn’t know was that Elizabeth found comfort in these drawings. Art had always been her refuge, and now it represented a key to the dreams, to the mazes that started and ended her dreams each night. She just needed time to sort it out. She was waging a war against attrition. Each internal circle represented a clue, a means to discern what was hap-pening to her.
Mazes represent a journey.
But what sort of journey? Somehow she knew that if she drew the mazes enough times, it would lure their meaning to the conscious level of her mind. She thought of the books she’d been reading; perhaps there were further clues there. Or in her journal. Per-haps through the words she’d written when recording each dream she might discover a phrase or a pattern that would unlock their common theme. Then she would be able to decipher their meaning and figure out what to do.
The doctor asked if there was someone nearby she could call on. Family? A friend? Someone who could talk some sense into her was the unspoken mes-sage. To each question, Elizabeth shook her head. Her parents were no longer alive, having followed each other in death when she was much younger. She had a few close friends, but they lived far away, having left the college town years ago after graduation. Their lives now took on all the hallmarks of an adulthood that had eluded Elizabeth, despite her best attempts. There was no one who she was ready to burden with this news at the moment.
“I want to go home.”
The doctor heaved a great sigh and shuffled the plastic case containing her file from one hand to another. His colleagues looked at him with sympathy and left the room shaking their heads. Surely there were other patients willing to listen to reason.
“I’ll leave a prescription for painkillers at the nurses’ station. Call me when you’ve reached your de-cision.” With a nod of resignation, he walked out.
After he left, Elizabeth swung her legs over the side of the bed, gingerly tugged the IV needle out of her arm, and grabbed the clothes that were folded in a pile on the chair beside her bed. She had no idea what she would decide or when she would call, but she knew she had to get out of there.