In Life

H. Bosch painting backgrounds, Poker and Cancer

“Full name?”

It’s 10:30 and I haven’t had coffee. My mind takes a beat; “Robert Scott Keeney.”

“Phone number.”

“808-555-1212.”

She has the eraser of a pencil in her mouth as she watches her screen. The pencil kicks up and down. She finds me.

“Date of birth?”

“June 16, 1952”

The ground shakes just a little as huge rocks fall into the median across the street, courtesy of a massive yellow earth mover. It whines heavily ding dinging as it backs away to scoop up another. New buildings around the Cancer Center emerge in a reverse whack-a-mole, set in an ocean of condominiums, bad traffic and actual ocean. Above it all, the moon’s blind eye.

She pulls paper from one printer and a plastic strip from another.

I hold my arm out over her computer and she says; “labs, doctor, infusion, right?”

“Yep.”

She straps a plastic wristband on my left wrist, holds my wrist and asks again:

“Full name?”

“Robert Scott Keeney”

“Date of Birth?”

“June 16 1952.”

Another patient takes my place as i walk away to the Waiting Room, a crowded L-shape hallway that wraps around the first floor complex of offices, labs, pharmacists and The Garage.

I check in at the Lab Waiting Room:

“Name.”

“Robert Scott Keeney.”

“Phone number.”

“808-555-1212.”

“Did you fast?”

“Since 10 last night.”

She looks up at me, says “It’ll be about an hour and a half. We’re running late”

“Thank you.” They always run late.

I sit between a young woman on oxygen and a man in a black cowboy hat, sweeping mustache, Johnny Cash t-shirt and fancy, silver-tipped boots. He is reading “The Biggest Bluff.”

I say, “That’s one of my favorite books.”

He takes a beat, turns obsidian eyes to mine, “Eric Seidel, a great in the game.”

Still eye to eye, I say, “I like Konnikova”

He grimaces, turns back to his book and says, “She is small potatoes, yet an acolyte of a great man.”

Fair enough.

“Scott!”

I sit up.

“Scott Keeney!”

It’s Lucy, the Vitals nurse. Lucy has her own little booth in the hallway, complete with motivational signage and pictures of angels.

I stand and walk to her booth. As i step in, drawing the curtain behind, the mirror recognizes me.

Jesus. I, on the hand, barely see me there.

Lucy points to the weight stand. I step in, make the attempt to reduce the metric numbers to Imperial pounds in my famished little brain, and step back to the chair by her computer.

Lucy says:

“How good are you? Have you been eating?”

“I’m good, Lucy. How are you?”

She tut-tuts, takes my left hand and points her barcode reader at my wrist strap.

She asks, “Name and birthday, please”

“Robert Scott Keeney, June 16, 1952”

She frowns at her monitor, “you've lost weight again.” She shakes her head, scrutinizing my arms and face. “Still trying to lose weight.”

I nod, “yes”.

“Ok. You can eat what you want.”  She stands over me applying a pressure cuff to my upper arm, says direct, “you know that, bambino.“

“I’m trying to lose weight.”

My liver cancer came with a deformity called beer belly, or metabolic syndrome, or fatty liver. I was working on losing the fatty.

Lucy inserts my pointy finger into the O2 device, shakes her head again and sits.

We wait.

The blood pressure cuff grips my (remaining) bicep hard, then slowly relaxes. As it deflates, i catch my face again in the little mirror.

It’s me…

There are expressions of all kinds for the elderly face to assume.

Default is the clock face ticking behind the eyes. My face spends most of its time sleeping, doglike. My expression in sleep, whether or not I sleep open-mouthed, is resting bitch face. If i were born an American Indian, that would be my name. The mirror is bleak. I look like I haven’t slept or eaten. I look old. There are those folks whose faces age beautifully. But they are heroes, the exceptions that prove the rule: the face we wear gets worn out.

Time and Physics hang from it like invisible snakes in the Apple Tree.

Galileo posited a New Genesis Version of the law of gravity. The apple that dropped into Adams mouth from the Tree of Knowledge; God and Galileo dropped the same apple. Adam and Eve both bit. Before biting, Eve was always eighteen. After, it was not a snake she heard hissing, it was her body ticking.

“102 over 73, muy bien.”

Lucy checks vitals for most of the patients in FastTrack, a system that assures rapid lab results supporting infusions that have to happen the same day. Her booth is filled with slogans and authentic, pragmatic positivity. It’s a support and a defense; she wears it lightly, like a barrette.

We bump elbows and i leave, rechecking my reflection.

I stop. The mirror….

I ask, “Lucy is this new?”

“Bah!” She pushes against me as she flips the mirror around and it becomes a sign:

“Have a Blessed Day!”

The asshole in me smiles, wrongly. No place i know is further from junior high school judgements. This room is kindergarten. Lucy is teaching survival.

The waiting room, an L-shaped hallway, is full of people waiting to get blood drawn or infused. Functional space, at all hospitals it seems, is crowded almost always. The hallways of this hospital’s ER are typically filled with the gurneys of patients, spaced apart only by the doors to actual ER rooms. Contrast that with most medical entry spaces and you see much great empty space unused. This hospital lacks the great room concept, entirely, which probably defines it as a cancer center.  The physician who discovered my cancer (overlooked by one of his radiology colleagues) had worked at MD Anderson (where i worked in ninth grade as a surgical and intake photographer). He classifies Cancer centers as elaborate emergency rooms, level after level; types of and treatment modalities for cancer.

I walk a way down the hall, find an unoccupied seat and sit.

People-watching in a cancer center is less interesting than it might be. Pop stars, thirty somethings, rich, poor, beautiful and gurney-driven shriveled people glide through, wait, get called and disappear. Medical Assistants - MAs - appear, call the name of the next person, then lead them back to an Oncology nurse waiting in the Garage.

My neighbor to the left is a well-dressed man with the yellow tint of jaundice, talking into a Jabra headphone. His briefcase is on the floor between his legs. Across from me, a middle age woman and her twenty-something daughter. The daughter is there for every session, chatting with her mother. The mother recognizes me, smiles. On my immediate left, a beautiful young woman in slippers, blond hair, no makeup, very casually dressed, probably famous. She looks, cocks her head and says; “your port is on the left”.

It’s a bulge underneath my T-shirt, about an inch and a half below my collarbone. I answer, “Yep.”

“I thought they always put it on the right side.”

I shrug. “They put mine in the middle of a tattoo.”

She half-smiles, “of course they did” and turns away.

Hell is heterogenous, full of everybody.

“Scott Keeney!”

I follow the medical assistant into the Garage, a ballroom size maze of rooms; booths divided by paper curtains and nurses stations.

As we pass through a doorway, she asks,

“Name and date of birth?‘

My brain spits out the mantra:

“Robert Scott Keeney, June 16 1952.”

A Nurses station on my left is filled with techs and nurses. The warren of booths crowds everywhere else.

I follow the MA through the Garage, around a corner, down a centre space to an empty booth. We stop. The woman in the booth before mine is terrified, moaning. Two nurses slip inside. I step in and take the big chair in my booth. On the other side of the paper curtain, the woman begins to cry as I sit down. Death is one thing, dying is another. Dying is an all-inclusive resort featuring a spectrum of inconvenience; minimum to maximum. We are all convicted, some in situations less cruel than others. We have all seen the same movie, The Last Horror Show; a movie everyone sees before the real thing that prepares us for nothing but the fear. Here that fear is muted, like notes hushed by the pedal on a piano. In never know when my foot will come off of that pedal. In these waiting rooms fear is obvious, and mundane. But the crying is normal, almost OK. There are performative patients, but not often. This place reminds that your presence here was assigned randomly. There are no levels in Hell.

I take off my t-shirt. The nurse takes my BP, my temperature, by rubbing a thermometer underneath the brim of my ball cap, and caps a finger with a device to measure oxygen saturation of my blood.

“Name and date of birth?‘

“Robert Scott Keeney, June 16, 1952.”

She removes my DYI pain pad; wiping away the Lidocaine gel I lumped on top of the port and then covered with tape and non-absorbent pads. She carefully cleans and disinfects my tattoo and its hidden access port, inserts a primed syringe into a tube connected to a 1 1/2 inch, 28 gauge needle, holds the needle over my port and says, “a little pressure now” and pushes the needle through my falcon’s wing into the catheter tube hanging free in my chest’s superior vena cava.

Now it’s in and she is taking tubes of blood from it for the lab.

I failed to get enough gel on my port once, so I know it doesn’t hurt that much. But every thing done to me here is done for the first time and not everything goes as planned.

The nurse shoots a couple syringes of saline and a third with Heparin. She applies a dressing that keeps it all ready for my infusion session later. I carefully put on my t-shirt, grab a pee cup and head for the bathroom.  My ability to pee - thanks to a Chicago surgeon who removed my prostate (and steel pins shot through the wall of my prostate into my bladder by an Idaho surgeon) - is great. I hand the cup to the nurse, thank the nurse, get my stuff and find my way out.

The Bamboo waiting room to see physicians is never crowded. It’s hallway is deserted. This section of the hallway looks out onto the open air; benches, bamboo, sunlight.

I check in and take a seat. This morning, somewhere in the building above me, The Tumor Board met to decide whether or not to change my meds. I have hepatocellular carcinoma. I’m on ICI immunotherapy; a combination of two drugs, Tecentriq and Avastin. After the removal of a 10cm tumor, i developed other cancerous lesions on my liver. I’m about a year downriver from my diagnosis. It’s just true that the expected value of my health is played for me by a WorldWide Poker Tournament of medical researchers and my Oncologist. I don’t play the game. The strategies are as complex as biochemistry, including my thoughts about it. I am a dirt Odysseus in t-shirt and jeans with a port in my chest. I am the game.

“Scott Keeney”.

They already have my vitals, but I have to verify I am me.

“Robert Scott Keeney, June 16, 1952.”

The MA leads me to my Oncologist’s exam room. I sit. She draws a curtain across the doorway.

“Sam”, The Doc’s assistant comes in. We touch elbows, make nice. She is sweet n subtle as she works through the last three weeks with me. I’ve never seen her full face. The flu season is back so I probably won’t ever. That is my own EV; I keep the bets small, keep it day to day. But the assumption is maybe another year. If they add a new card to the hand I might live longer. Nonetheless, I’m here for today, now.

Dr B walks in with another specialist and a Medical student. The Student hangs back. I tell him about my sleep, energy levels, diarrhea (a bug of this immunotherapy). I ask him about my blood labs and most recent scans. My scans show three major lesions did not grow much, if at all, so we’ll continue the therapy. My blood cancer markers continue to rise. Nonetheless, my cancer is “stable”. We talk about my moving to another state, I need help doing that. I flew from Hawaii to get care here. Next, my wife and I head inland, North. We shake hands. They all file out.

Sam returns with a paper record of the visit and elbow bumps.

I take the granite stairs to the second floor. I have to amend, its the stuff that is done to me that is always done for the first time. Everything else about having cancer is as far as it gets from new.  My noting issues to myself is repetitious and continual. Not a stair step goes by that my brain fails to note the slow, unsteady motion of my sticks (no quickness, step higher). All of this is all the time; tinnitus in the background, the peripheral neuropathy and tremors that accompany use, any use, and the knowledge I have time to go before my window closes. So I self-correct the mental judgements, tell myself to shut it and keep truckin’.

I grab a chicken sandwich and bottled water. Push the door and step out onto the veranda, an open air island in the building. It’s  umbrella tables are filled with medical students, physicians, plants, techs, and a sprinkling of patients like me. I sit down with my sandwich, chew, drink, people watch.

My son calls, he’s also at lunch. We talk. My sandwich vanishes, son goes back to work. I open Music on my phone to a fresh playlist and make myself a headphone taco, touch the dot and let it Play.

Today, Play is Hendrix and Stevie Ray Vaughn; father and son. Jimi’s  “Born on a Bad Sign” has no lyrics - unlike Stevie Ray’s, or Albert King’s. It’s basic; elegant. Last cycle, I played Bach Partitas. I listen, then I turn down the volume and just sit. I replay Hendrix and emotion fills the balloon in my chest.

I hear Marilyn Monroe singing - my phone ringing. The balloon flags.

“Hello.”

“Mr Keeney are you in the waiting room, we are ready for you in infusion”

“Yes, I’m in the rest room, be right there.”

Shit.

I check in with the scheduler and an MA comes out calling my name.

She takes my name and DOB and leads me back into the labyrinthine Garage, to the far wall; light. She helps me with my stuff, puts me in a lounge chair, covers me with heated blankets. I close my eyes to the pour of sun, not on me, but near me. Close enough.

Hummingbirds croquet their bodies through the trees and bushes outside. Floor to ceiling windows. I don't usually get these out-facing med booths, so its nice. The patois of sensors, timers and chatterers filled in behind the hanging paper sheets. Sunshine: shadow. Lemon trees.

The MA takes my blood pressure, temp, oxygen saturation and asks me about any falls, med changes; the list.

People in lab coats stride along outside the windows. Beyond them a pregnant woman in surgical scrubs stands at the top of the slope, hand to ear, gesturing as she paces in the sun. Behind her, trees and grass slope down and away to a dark tangle of trees. To my right, another medical building flanks my windows. At its base a dog stops, paces forward then runs full out as a blur of dogs race past. They fall on top of the first dog, which had body-slammed the phone woman hard to the grass. The pack swarms. Two men run to scatter them and they too are brought down and all three bodies, color in the grass, are pulled down the slope and into the forest.

Two nurses stood in my booth staring out the window. Security, carts and cops ran down the slope.

“Hey!”

I look up: Pax. My infusion nurse is an ex-New Yorker, surfer-girl pretty, smart.

“Hi Pax, how are you?”

A patrol car rolled over the grass and down the slope. She turned away from the drama. I followed.

“Your meds are ready.”

“Cool. How have you been?”

“Good thank you.” She takes the med bags from another nurse and hangs the first, Tecentriq, on the pole. Pax gently tugs the extension to my port from the neck of my t-shirt, hooks the extension to the chemo dispenser and goes to get another nurse. Pax and the second nurse read my ID out loud, then the ID of the medication and its expiration date and time, comparing it to my wrist strap. Pax watches the liquid flow through the tubes, flicks one tube to dispel bubbles, gives me a look. I give her a thumbs up and she disappears behind the curtain.

Outside, an ambulance sits just outside my window. It’s revolving red light strobes the curtains. I don't feel the infusion. Most of this cancer business is indirect, complex. The drug drips quietly into my chest. Someone on a gurney is pushed into the ambulance. I relax myself, using a method my father taught me after I tried suicide the summer I worked at MD Anderson. I think disease has a reflexive, darkly human basis. Part of the unnatural naturation of humanity. We breed increasing complexity and destructiveness; a flourishing organic defect. The part of hominids that keep us killing off whatever looks at us at the wrong time the wrong way, is part of disease. It is as natural as genocide or rust.

I fall asleep and wake to Pax tidying up. She helps me off the lounger, checks my balance and wishes me well.

Driving home, I put on Hendrix again. My wife calls, I say, “I’ll be home in a minute.”