Slim Novel 16 - http://adventuresofkimi.blogspot.com - See Homepage
15. Palliative Surgery.
Nina and Eddie sit together by the surgeon's desk. She is in a patient gown and the surgeon asks her to pull it up to show left breast. Nina has firm but not large breasts. Her nipples are well supported never having suckled. An asymmetry of the breasts can be noted, caused by the bump of growing tumor. The surgeon completes his palpation. As Eddie is chief of pathology and the surgeon is chief of surgery and they meet often socially, he addresses Nina by first name.
"You may be surprised, Nina, at my suggestion, but I advise a simple breast removal." He anticipates her somewhat shocked Why? "It is controversial, You won't find it in the books. It is based on 30 plus years of experience."
He indicates she can drop her gown.
"Doctor, what is going to happen if I decide No to your surgery?"
"The tumor will grow and erode the skin and back into the chest wall and you will be bothered by an increasingly messy, painful draining ulceration with dressing change several times a day. By cleanly removing the local tumor now, you will be saved that at least. The surgery is easy and uncomplicated and you should be in and out of hospital in one day."
"Do it, doctor," Nina says and Eddie nods assent.
16. Radiotherapy & Chemotherapy
Next they go to the chief of radiology. A series of therapeutic x-rays will be given to the areas of important metastases to kill off early cell implants. Nina gets these as outpatient. Eddie accompanies her to each radiation session and personally cares for her in the days when she has nausea and depression from the radiation effects on brain.
A course of IV chemotherapy follows and Nina suffers a loss of hair over a 6-week period and her white blood cell count goes low so she needs antibiotic and relative isolation from everyone except her husband who himself wears a mask in her presence.
Then, 8 weeks after the surgery and 2 weeks after the last chemo treatment, under the guidance of the chief of oncology who has Utopian ideas of treating the dying cancer patient, a decision is made to separate Nina from all medical care.
17. A Philosophy of Life with Incurable Cancer
Nina and Eddie sit together on sofa discussing the rest of their time together. Nina says, "Well, my darling, here I am, sans left breast." She pulls up her blouse showing a flat left chest wall that has a clean diagonal scar where edges of skin were brought together after removal of breast. "Dost still find me desirable as sexual object?"
"Um, Neen, I dost."
Take time out for a bout of strong conjugal sex. Fifteen minutes later, the conversation is rejoined.
"Tell me, Neen, how did the radiation and chemotherapy make you feel? I want to know not out of idle curiosity but for science. You have what I call hands-on experience. In contrast to that, Book l'arnin', although it is important because it contains the scientific knowledge of centuries, unfortunately lacks real person experience. So tell."
"The worst thing about radiation and chemo, Eddie, is the mental depression."
"Yeah, Neen. But it's not mental. Both the radiation and the chemo affect your brain cells and overall that affect leads to dominance of the parasympathetic nerves which are the nerves that control during sleep and illness. They cause depression as a perhaps protective side effect to prevent you from dangerous overactivity when you get weak."
"Well, all I can say, Eddie, is that it is a terrible feeling of hopelessness. I would have jumped out a high window had it not been for you sitting by my bedside constantly." Nina leans over and kisses Eddie on lips. "Thank you, my husband." She sits back, smiles. "OK, I am now feeling bright-eyed but, fortunately I do not have a bushy tail so I would have to ask a squirrel but I think I am also feeling that too. What next on the agenda of the incurable case?"
"I talked it over with Stan, Neen. And of course, I want to get your input. After all you are the case. The idea is we have now given your metastatic cancer what I call the good college try. The primary tumor site has been removed cleanly by surgery, the body has been sprayed with therapeutic x-ray to kill off metastatic cells in bad locations, and chemotherapy has gotten to where radiation fears to tread. There is nothing more medical skill can do except to torment you with tests and doing needless x-rays and having unnecessary poking by doctors. So at this point, you should withdraw from the treatment environment. It does not mean common medical needs are ignored; it means we forget as much as possible about your cancer and concentrate on, first of all, your moment to moment happiness."
Nina interrupts, "But what does moment to moment happiness mean?"
"Stan is the man to answer that best but I've heard him enough to play him back to you. Moment to moment happiness is the background absence of the minor paranoias of every life - the worries about money, the self-consciousness about personal weaknesses, the failures of social relationships, the worry about illness and the vague feeling one is the target of an evil fate."
"Well, I already got the illness so I do not have to worry about getting that. But, hey! Five minutes after a morphine pill dissolves under my tongue I lose all those other worries. But it gets fleeting, going-gone after thirty minutes and seems to be a little weaker each time I take the pill."
"Morphine is important. It is what I call a source of hedonic moments or intervals in your current future, which is going to make your life worth continuing despite the cancer. Before if you knew you had incurable cancer you would never have considered starting the morphine because of the so-called addiction problem."
Nina, suddenly getting a thought, smiles brightly and says, "But now, with incurable cancer, all I can say to the problem of morphine addiction is summed up in the immortal words of Mad Magazine's Alfred E. Neuman, "What? Me Worry?"
Eddie laughs and continues his idea, "Your happiness is not just depending on morphine. What we try for - both of us, you working for yourself and I supporting you - is to remove the unhappinesses."
"Well, the possibilities there are many: I mean the needles, the horrible medications, the hands poking and patting me and all that other jazz."
"So we remove that now," says Eddie with finality. "From now you are not going to see other doctor or go to hospital." He continues. "Then, think about the things you were forbidden socially or for so called good health reasons. You are now free to do anything that's legal and maybe a few that aren't, if you can avoid getting caught," Eddie laughs and Nina does too.
" Thank my atheist goddess, I'm getting the morphine legally."
"If you'd like to try other sex partners, it's OK with me."
Nina looks at him seriously, "It's interesting, Eddie, that precisely because I was nymphomanic, I don't consider that particular activity a happiness. I am content with you, my husband." She leans over and kisses him.Then adds. "Also we do not need to go on vacations to see places I have missed seeing. What I want is right here with you."
"What about your healthy eating? One thing you do not need to worry about any more is your cholesterol."
"That I shall not miss."
"Ok, so let us go from here, moment to moment, hour to hour, day by day, just relaxing into the happiest state we two can manage."
Oh, Eddie, just the idea, I can rely on you being beside me. That is the happiness."
End of Section. To continue next, click 16.(18-19) Descent into the Valley
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