“There are a few things that Dr. Conrad wants to talk to you about,” the office assistant had told Doreen on the phone, and Doreen knew immediately what it was: her cholesterol. She knew because the truth was she hadn’t entirely been fasting like they’d told her to be before her annual physical the week before, the once-a-year routine of waiting rooms, forms, PAP test, mammogram, and blood testing. She’d forgotten and put a tiny bit of cream into her second cup of coffee, like she always did, even though they’d told her, coffee is okay but no milk or sugar, they’d said that specifically on the phone, but honestly, how could they expect her to come in and go through all of this rigmarole without even a dash of cream to bolster her?
Doreen didn’t like going in for her physical, though she still went every year. You had to do that sort of thing if you were going to be responsible, and Doreen was, generally speaking, responsible. The book-club book she had brought with her to read had stayed closed on her lap. Instead Doreen had stared into space and swung her feet very slightly off of the edge of the exam table while she waited for Dr. Conrad. It was a nervous gesture, the slight swinging of her feet, an oddly childlike one that had still made her feel more in control: she might be essentially naked, clad only in a paper gown, but she still had some semblance of mobility, she could thunk a heel lightly against the drawers of the exam table.
Dr. Conrad, who was new, or relatively new—Doreen had seen her a few times before but still considered her “new”—had come in, and they had talked about Doreen’s health (fine) before going through the whole business with the speculum (endurable). After that, Doreen had let a stranger in a lead apron mash her breasts into an x-ray for the routine mammogram. Then a mostly-competent lab technician, who hadn’t needed more than one try to find her vein but who had left a bruise in the crook of her arm that was still visible one week later, had drawn what Doreen felt was an excessive amount of blood. Doreen had remembered only as the second-to-last vial was being neatly twisted away, and thought about saying, “I’ve just remembered that I actually did put some cream in my coffee.” But Doreen never admitted to having made mistakes as a general rule, and by that time she was more than ready to go home. She’d thought maybe it wouldn’t matter. It wasn’t a lot of cream.
Now, less than a week after her yearly visit, Doreen was back in the office for a “follow-up appointment.” Doreen held her lips together in a straight line and let an underpaid medical assistant wrap a blood pressure cuff around her arm again and waited for Dr. Conrad to come in to tell her about how her cholesterol was really even higher this year than last year.
Dr. Conrad came in, smiled brightly, and proceeded to take almost two full minutes to log into the computer. It was clear, from what Doreen could see over the other woman’s shoulder, that the issue was that Dr. Conrad, who, by the way, looked far too young to be a doctor—and weren’t the young ones supposed to be better than this with the whole computer thing?—just couldn't remember her own password: she would type something, a message telling her that her username or password was incorrect would pop up, then she'd delete, type again, and frown. Finally she got the combination of letters that worked and a little blue wheel started spinning, slowly opening the PDFs and text boxes that were Doreen's medical identity. Dr. Conrad looked up, gave what was meant to be a charming smile, a smile which probably was, Doreen was willing to consider, on other days, quite charming, and said, "I'm sorry, our computer system is extra slow today. Technology doesn’t always make our lives easier, does it?"
Doreen never forgot that. That on the day her doctor walked into the room and ruined her life, she stopped first to apologize, with a wholly insensate banality, for a computer system. Worse still, she had lied about it—making it seem as if it was the system which was slow and difficult, and not just that she was too much of an idiot to remember her own passwords over the weekend, and had to relearn them all over again on Monday morning.
That anger came later, building slowly, carefully tended and banked by Doreen, who would be grateful for its warmth, but in the moment she was only irritated. Dr. Conrad clicked through files, frowned, clicked through a few more, frowned again, then took a deep breath and turned away from the screen to look at Doreen. That should have been the first sign: the full look, the nonverbal cues all indicating a sudden, singular attention. A sign of respect for the moment that Dr. Conrad knew they were approaching. Or maybe it was just indicative of the fact that Dr. Conrad felt that looking any further at Doreen’s medical identity on the computer screen was futile. Wasted time. Beside the point. No longer germane. What’s done is done.
“Thank you for coming in today,” Dr. Conrad said, though her face didn’t look like she was particularly happy about it. Then, after a few pleasantries that were more non-sequitur than transition, she launched into telling Doreen that she had received the radiologist’s report of Doreen’s routine mammogram, and there was something abnormal that needed further evaluation. Something that probably needed a biopsy, actually. She used the same tone of voice to shape the word “biopsy” as she had for “technology.” Technology doesn’t always make our lives easier, does it? You will probably need a biopsy.
“What?” Doreen said. Her hands wanted to reach up and cup her own breasts, but she felt like that wasn’t the thing to do here, so she gripped her elbows instead. “But what about my cholesterol?”
A part of her was almost annoyed—annoyance being an easy, pedestrian, everyday emotion, both familiar and safe—to be so wholly derailed, when she had marshaled up so many questions about her cholesterol for this visit. It wouldn’t have been the first time her cholesterol was off, and this year, Doreen had been determined to know more. How, exactly, did one raise the good cholesterol, while lowing the bad? It was always so confusing in the letters they sent home, mad-lib-esque forms with questionable grammar that blithely told him/her to “eat well” if certain numbers fell within a certain range, occasionally with a vague suggestion like “talk to your doctor further about the role of medications.” Doreen had been certain she was there to talk about her cholesterol. She was annoyed the way you are when you start to realize you've lost control of your car and you're about to have a terrible accident but what you think first is, Seriously? But I'm late today, I need to get there, I can’t have a car accident right now , before the adrenaline and fear kick in and you realize you might be about to die, in which case it doesn't matter if you don't get to book club on time, the worst-case scenario isn’t giving Ellen the satisfaction of seeing you walk in late again without the Yellowtail you said you'd bring. The worst-case scenario is that you die. Doreen clung to her annoyance like a lifeline, afraid to look down.
Dr. Conrad kept talking, about how it was too early to know what, exactly, they were dealing with, which was why they had to do more imaging, and a biopsy, she’d be referring her to an oncologist who would take it from there, though nothing certain yet, and did Doreen have any questions?
At the end of the visit as if as an afterthought, the assistant handed her a questionnaire to fill out, columns of questions on a purple piece of paper. Do you feel like dogshit never, some days, many days, or most days? Before or after I just got told I have cancer? Doreen filled out only half of the form before abandoning it in a potted plant by the elevator on her way out to her car.
At 56 years old, Doreen was slightly overweight, though not terribly so, and if she dyed her hair, well, what of it? She did it regularly enough that her roots hardly ever showed. She and her husband had split up when their daughter Katie was in the first or second grade, a long time ago, too long ago to even be relevant these days—she lists Katie as her emergency contact if she’s asked for one. Katie lives in a nearby town with her own husband and their daughter Madison, a corn-fed toddler with whom Katie is utterly preoccupied and with whom Doreen is privately unimpressed. Doreen saw them on a quarterly basis and had, to date, refrained from saying anything to Katie about the dangers of juice boxes, an accomplishment in which she took no small measure of pride. Doreen had a steady job in accounting, a 401K, an inoffensive townhouse and a lackadaisical exercise habit. She owned an electric toothbrush and flossed regularly.
As Doreen steered the car away from Dr. Conrad’s office and onto the highway, she wondered if she should call Katie to tell her about the appointment, but discarded the idea almost immediately. It wasn’t just Dr. Conrad’s repetition of “nothing certain yet.” Somehow Doreen didn’t feel like this was the sort of thing she could, or would, talk about with her daughter, but she didn’t want to look too closely at the feeling, not yet, not today.
At home, Doreen took her shirt off, looked at her breasts. They didn’t hurt. There was no lump that she could feel. She had the same smattering of moles she’d always had. Sitting on the edge of the bed in the dark, she cupped her breasts in her hands the way she’d wanted to in the office.
Doreen went to work the next day, walking through the heavy wooden door labeled “Accounts” exactly on time. She sent a cursory email to Ellen about how she would miss book club that Thursday. She told no one about the appointment with Dr. Conrad.
Katie called her later that week to talk about the upcoming holidays. “How’s it going, Mom?” she asked, a routine question that wasn’t really a question.
“Fine,” Doreen said. The single syllable was a clamp.
Less than two weeks after the “follow-up appointment” with Dr. Conrad, Doreen saw the oncologist, Dr. Hu. The visit was appallingly short. Later, when she requested her records, she was shocked to see a long note written about this visit—whole paragraphs about her case, taking longer to read than the visit itself took had taken to conduct. Dr. Hu had a verbal tick, or what Doreen thought was maybe a verbal tick, but which was maybe the equivalent of some sort of "hmmmm" or "ahhhh" in Chinese. Doreen wasn't prejudiced, she had a friend who was Asian, Stacey from book group, though Doreen guessed her name was probably really something else, something harder to pronounce, but really, still. Between hmmmms and ahhhhhs, Dr. Hu told her what she already knew, that the mammogram was “abnormal,” that they need to do “further evaluation,” and that a biopsy of her right breast would get done that same week.
After the biopsy, her breast, which had looked and felt fine before, did, in fact, look and feel different. A lot different. In fact, it hurt like hell. Doreen lay on her bed at home, popping the painkillers they’d sent home with her, and replayed in her head the moment during the “follow-up appointment” when Dr. Conrad, who, on further thought, couldn’t be older than twenty-eight, hadn’t been able to remember her own computer password.
A week later, she was back in the oncologist’s office for the results of her biopsy. Dr. Hu was explaining her options to her, and Doreen began to hear.
Doreen had stage III breast cancer. She would need to have either what Dr. Hu called “breast-conserving surgery,” radiation, or both. So, a mastectomy. Or maybe just a lumpectomy, or a partialmastectomy, he said, though Doreen was having a hard time appreciating the nuance between taking all of someone’s breast or part of it, unless one was doing this symmetrically on both sides for aesthetic purposes. Afterwards, she was told, she could get breast reconstruction surgery, but it’d be better to wait until the radiation was complete. Because there might be radiation. And before that she would need “neoadjuvant and adjuvant systemic therapy,” which was what they were calling chemo these days, though why they couldn’t just call it chemo was unclear to her.
Dr. Hu was talking to her about survival rates and treatment options. He read numbers out loud from his laptop. He’d spent most of this visit reading out loud from the laptop, and Doreen realized she wasn’t sure if he’d looked up at her since he’d walked into the room. She found herself worrying that he had confused her with someone else, that maybe he’d walked into the wrong room without realizing it. She wished that he would look up, make eye contact, in order to assure them both that he knew he was talking about her, Doreen, and not another patient. When he did look up at last, it was only after his recitation was complete.
“Doreen,” he said. He appeared to be waiting for her to say something.
“How much does this all cost?” she asked.
Dr. Hu had no idea how much it cost. He made his verbal tick a few more times, tapped his fingers on the edge of his clipboard, and sighed. He recommended that she speak to the office’s social worker after her visit.
Dr. Hu’s assistant led Doreen to the back area of the office, adjacent to where chemo was administered, into a large room for an “education class” with several other patients, a half-a-dozen women with a haphazard array of winter coats, all clutching fistfuls of paperwork. A nurse in pressed scrubs stood at the front of their group and told them about every possible thing that could go wrong during the course of treatment—loss of hair, loss of appetite, loss of feeling in the fingertips. Radiation would make their skin peel and their bodies exhausted. Many of them would most likely end up in the emergency room a couple of times because chemotherapy lowers your white blood cell count, leaving immunity weakened. One woman, Doreen’s age with reading glasses on a gaudy chain that clashed with her sweater, wept openly into her own sleeve, snot dripping onto the wool in total disregard of the strategically placed boxes of Kleenex.
After the “talk,” Doreen had a one-on-one meeting with the office social worker, as if talking about money were somehow more personal and less appropriate to discuss in a group than the possibility of having your nipples peel. This woman told Doreen to get as much of her treatment in that year as possible before her insurance deductibles reset and she would have to pay out of pocket. “But will I be the one making that decision?” Doreen asked.
“Sure, just start as soon as you can. You kind of have to game the system that way.” Doreen did not miss that this hadn’t really answered her question.
Doreen could see that the education classroom was already filling up. Another batch of patients’ names had been called.
No one offered to walk her out.
Doreen moved slowly through the maze of mint-green rectangular spaces, taking everything in as she walked through the oncology suites. Tacky beige paintings on the walls. Under-dusted chairs and over-Lysoled surfaces. Harried people in various shades of pastel uniform scrubs, nearly all with dark circles under their eyes. It looked like every medical office she’d ever been in. Doreen thought about the monthly insurance payments that she had paid unquestioningly over the years, the negotiated percentages deducted from various paychecks. The way she went in for her check-up every year. To keep things like this from happening. To stay—safe.
Doreen rode the elevator down to the medical center’s cafeteria, mostly empty in the mid-afternoon lull, and carefully, methodically, engaged in the kind of gross, self-destructive food behavior that she hadn’t undertaken since Katie was a little girl. She cut eight warm, plate-sized cookies into spoon-sized pieces and ate them all. Then she locked herself into one of the tiny stalls of the adjacent women’s room and puked.
Doreen leaned over the toilet bowl, considering. She could throw up more—she knew there was more cookie in her still—but she couldn’t quite bring herself to do it. Not because she had any discretion about the healthiness of her behavior, but because the muscles of her stomach and throat were too tired. She felt like her gag reflex had run the timed mile. She wondered if this what chemo was going to be like.
Doreen realized that another woman was there in the bathroom, shoes going in and out of the stall next to hers, peeing and flushing, then standing at the sinks, running the tap. After the tap turned off, the other woman spoke, her alto floating over the door towards Doreen. “Are you okay?”
“Yes,” Doreen said. She was surprised her own voice sounded so clear.
Doreen straightened, let herself out of the stall, and looked at the other woman. She was wearing a long batik skirt that Doreen might have made fun of on another day and a belt with an oversize silver buckle. She had an e-cigarette in one hand. “Chemo,” the woman said, sympathetically. It wasn’t a question. “First time?”
“Yes,” Doreen said after a moment’s pause. She didn’t want to tell this woman that what she just lost was fear-binge-shame-puke, spurred by the mere thought of chemo, and not the real stuff. Neoadjuvant and adjuvant systemic therapy, she remembered.
“That stuff will kill you,” the other woman said. She took a drag on the electronic cigarette and regarded the silver tube in her hand while blowing smoke out of the corner of her mouth. Doreen wondered if that was something she should be doing in the ladies room just downstairs from oncology. The woman followed Doreen’s gaze, and shook the electronic cigarette slightly before stowing it in a small beaded purse. “I'm so glad I quit the real ones,” she said. “I’m Betsy.”
“Doreen. Are you also a patient here?”
She nodded. “This is my last day.”
Doreen nodded too, then hesitated. “Are you cured, then?” The question was awkward, and Doreen wasn’t sure if she was using the right words, or if this was a question one even asked.
If it was a faux pas, the other woman didn’t register the breach. “I’m cured of these delusions,” she said, waving her hand around. It was a turn of phrase which, like the skirt, Doreen would have made fun of on another day. From the accompanying hand gesture, Doreen wasn’t sure if she meant the women’s bathroom, the whole hospital, or what, but Betsy was still talking. “This shit is as bad as cancer. You’ll see. I’m doing it naturally.” She handed Doreen a card. “You should read my blog, Healing Cancer Naturally.”
Doreen went home and got on the internet. After reading Betsy’s entire blog all the way through twice, Doreen began following the blogs of other people who had decided to Heal Cancer Naturally.
She learned about an all-natural cancer clinic in a country she’d never heard of before. She emailed them and, within a day, they replied. After a week of communications, Doreen mailed them a check and, as instructed, her fingernail clippings. They mailed back canisters of chalky supplements.
“My body is designed to heal itself,” she told Katie. “Something inside me is malfunctioning and affecting my immune system, allowing cancer to grow. But chemotherapy is poison that will hurt my body and destroy my immune system. I don’t want to hurt my body and destroy my immune system, I want to build it up.” Doreen was organizing the new spice cabinet she’d just put together, with curcumin, ginger, and garlic pills alongside the supplements mailed from the clinic overseas. “Did you know that most chemotherapy drugs cause cancer, and that many are so toxic that nurses have to protect their skin from exposure when administering them? Those chemicals will burn through your skin, but they have no problem putting them in your veins! Anyway, cancer is not the cause of a sick body, it is the effect of a sick body, so I’m using therapies that strengthen my body and my immune system so it can heal itself.”
Katie furrowed her brow. She bounced Madison, who was too big for that, in her arms. “Are you sure that’s a good idea? What does your oncologist think?”
Doreen didn’t tell Katie that she’d missed her last two appointments with Dr. Hu. “I’ve been doing my research,” she said instead. “Did you know that the 5-year relative adult survival rate for cancer in Australia is over 60%? The research there shows that chemotherapy only adds 2.3% more to those survival rates. But the expenses involved, and all of the toxic side effects to treatment, it’s a huge moneymaker. In the U.S., chemotherapy earns the medical establishment something like $300,000 to $1,000,000 each year. The oncologists get a commission on those drugs. They’re selling poison! And then they tell us they’re still trying to ‘cure cancer’! I mean, why would they, with a game like that?”
“Where are you reading all of this?” Katie asked. “And, well, what kinds of cancers are they talking about? They can’t be talking about all cancers with those numbers, right? Aren’t there many different kinds of cancer with different, you know, prognoses?”
Doreen shook a canister of ginger at her daughter. “Only a quarter of medical schools teach a dedicated nutrition course,” she said. “You should be putting more of this in your food. And stop drinking coffee with cream. That stuff will kill you.”
At Katie’s insistence, Doreen did go to another appointment with Dr. Hu, though she drew the line at letting Katie go with her. She explained to Dr. Hu about the foreign clinic, her nutrition program, and Healing Cancer Naturally. She was following the “Charlton Protocol.” Dr. Hu scrubbed his hands over his face, and then leaned toward her, telling her that she needed surgery, not supplements. Doreen found that she was less shocked by this display of emotion from him than she would have expected herself to be. Doreen let him talk her into scheduling her mastectomy, but a day later she called to cancel.
The Healing Cancer Naturally clinic was pretty expensive. Really expensive, actually. It was a little surprising, but the more Doreen thought about it, the more it kind of made sense. There was no institutional support for clinics that followed the Charlton Protocol—no recognition from Big Pharma or Academia, nor from any of the government bodies that handled and channeled all of the money. Doreen watched the balance in her bank account, which had been stable for years, dip, the rounded numbers getting smaller every week.
Doreen bristled now when she saw the little pink bracelets on people’s wrists, Fight Cancer printed on cheap rings of plastic. “How much did you pay for that?” She asked the cashier at the grocery store. “Where, exactly, did that money go?” She had let Katie bring her to the grocery store because she was feeling particularly tired. Biting down on her own shame in the checkout line over the fact that she was buying the cheapest possible things, things she had told her daughter never to scrimp on, made her caustic.
“Mom ,” her daughter said, embarrassed. The cashier, a thin woman in her early twenties, looked bewildered and hurt. Doreen couldn’t believe the ignorance around her.
By that time Doreen had stopped driving her car—with the bills to pay to the clinic overseas, bills that weren’t, of course, covered by insurance, she had to save on gas. She rode the bus instead. The bus to work took her through a bad part of town, right past the medical center, something she’d only been vaguely aware of when she driven herself. Why were the biggest hospitals always in the worst parts of town? Near the Emergency Room in particular, it seemed like everybody had something wrong with them – an arm in a sling, canisters of pills rattling in their pockets, identification bracelets still wrapped around their discolored wrists. Doreen clutched her briefcase to her breasts and stared at a passenger whose forehead was covered with a bandage that slowly oozed blood.
Doreen had become short of breath. She took anti-anxiety medication, some pills that Ellen had been talking about for years. She’d tried a few out of Ellen’s medicine cabinet the last time she’d been at her house, the last time she’d been to book group. Cutting sugar out of her diet and sweetening things only with mashed grape paste made it harder to go out and be social. She went back to Dr. Conrad to ask for a prescription of her own. Dr. Conrad looked sadder and younger than ever, but she had written the script. Doreen popped Valium like it was the candy she wasn’t eating.
The anxiety medication helped but didn’t solve the feeling that there wasn’t enough air. While Katie, who was visiting with increasing frequency, struggled to get Madison into a winter coat with far too many zippers for a child so young, Doreen tried to discretely cough blood into a handkerchief. “Jesus, Mom,” Katie said, as Doreen struggled. “When was the last time you saw the oncologist?”
“Betsy thinks that what I really need to do is get ozone therapy,” Doreen said, dodging the question. “Cancer cells die when exposed to oxygen. They remove part of the blood from the body, saturate the blood with oxygen, then put the oxygen-rich blood back into the body with an IV.”
“Oh Mom,” Katie said. “You're not still sending those people money, are you? God.”
Doreen saw Dr. Conrad again for her next annual appointment, and Dr. Conrad wanted to talk about—of all things—Doreen’s cholesterol. Doreen zoned out during the conversation. She was finding it harder to pay attention to things these days. “I know you’re being followed by Dr. Hu, but it’s still important that we pay attention to all of the other routine things we need to do to make sure you stay healthy. When do you start chemo?” she asked.
“I’m not doing chemo,” Doreen told her. She paused. “Have you heard of the Charlton Protocol?”
“I haven't,” Dr. Conrad said, slowly. She wrote the name down on a post it note. “What does Dr. Hu think?”
“Dr. Hu is…unimpressed.”
“Ok.” Dr. Conrad appeared to be choosing her words from somewhere over Doreen’s left shoulder. “But, Doreen. Even though your oncologist doesn't agree with what you're doing, are you still...seeing them? Even if you're not—even if you’re not doing all of the treatment, exactly as they've advised you to do?”
“Yes,” Doreen lied.
“Okay. Good. I really respect Dr. Hu, but if you ever feel like you just need to talk to someone new, I can see if our referrals department can find you a different oncologist, someone else who also takes your insurance, and connect you to them. Because it's important that you're still seeing someone.”
Doreen would have been touched, but she really just wanted to get more Valium.
Doreen was beginning to feel like she shouldn’t be around people. Despite the supplements and the restorative exercises, the raw diet and the super smoothies, she had begun to feel toxic. She brushed into people on the sidewalk and shuddered, not because she was worried about contaminating them, but because the contact with healthy bodies made her that much more aware that she felt pernicious, not-whole.
She sent more samples—locks of hair and a vial of saliva—away in the mail, and a package returned with more supplements for her to be taking. Have you considered starting a kickstarter to try to fly to our clinic? We think you would really benefit from regressive psychotherapy. The therapy induces a non-ordinary state of mind in which we dive into our subconscious to find the emotional damages created since our intrauterine period. When we pull out these past negative events, we discharge our inner burden, the causes of all symptomatology are dissolved and therefore the illness and its effects are eliminated.
At night Doreen fell asleep to cassette tapes of nature sounds with acoustic guitars, blanketed by Valium. She would ask Katie what “kickstarter” was.
Dr. Conrad got a copy of Doreen’s death certificate from a hospital messenger mid-March. It was late in the evening, but the pile of paperwork next to her desk was still high. She sighed, pressing the heels of her hands against her closed eyes. She read the document through once. Then she signed it, gave it back to the hospital messenger, and moved on to the next form in the stack.