“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.