Chapter 1: Insane in the Membrane Chapter 1 INSANE IN THE MEMBRANE
“I’m sorry to have to tell you this, Jennifer, but you have a primary glioblastoma in your brain. That’s—”
“Brain cancer,” I whisper, the words a rasp in my throat.
“Yes,” the doctor says. I’ve been told his name, but I can’t remember it for the life of me. He isn’t my regular doctor, just someone in his practice I was referred to when I first came in a couple of weeks ago. The physician I’d seen for years, Dr. Turner, retired last year at the age of seventy-eight, right after my last physical. This new guy looks young enough to date my twenty-five-year-old daughters.
“I have a grade 4 cancer.” The knowledge comes to me, unbidden.
“Yes,” he says gravely. “You have six weeks before…” He shakes his head as if he’s disappointing himself for ending my life.
The world tilts and I grip the arms of the chair I’m sitting in. They’re rounded at the end and slightly worn, as if they’ve been clung to in this way before, and more than once.
A bad-news chair.
The doctor watches me. He has watery blue eyes and a rash of acne scars near his dark hairline. “I’m sorry, Jennifer.”
I squeeze the chair arms harder and focus on a spot above his head. There’s a large tank built into the taupe wall behind him, with a small school of fish in it, flashing silver and red. This is what my taxes are for—fish tanks and doctors who look like the prodigies on medical television shows.
“So all of this…” I say, motioning to the body that’s betrayed me. “It’s going to get worse.”
He clears his throat and looks back to his notes. I might be the first person he’s ever had to deliver this type of news to.
“Yes. The tumor is in your temporal lobe, which regulates speech, memory, behavior, vision, hearing, and emotions. What this means, then, is that you can expect an increase in the headaches you’ve been having, but also potentially issues with your speech, mood, and…”
Half of me listens to him cycle through the symptoms I’m already experiencing—memory issues, achy joints, all the reasons I went to the doctor in the first place—and the symptoms yet to come—behavior and personality changes, seizures, swelling, and then…
The other half of me is focused on the fish and the patterns they’re making in the glowing water. I’ve always thought I’d like to have fish, but somehow in the chaos of raising the triplets I never got around to it. Now I envy them, the fish. They’re oblivious in there, circling the tank, looking for the last remnants of lunch. Do fish hear like humans do? Or is their whole life like when you sink your head under the ocean? That echoey muffled sound of… sound?
The doctor’s stopped talking, waiting for my reaction to a question he might have asked or simply to the information he’s been cataloging methodically. My hands are cramping on the chair, so I let go. The room is still spinning, though. I’m tumbling through space, a satellite off its axis.
I try to think of something to ask. Is there anything more I need to know? And then it hits me: in the litany of signs and symptoms, I didn’t hear anything about treatment.
“And there’s nothing we can do?”
He shakes his head like a sad dog. “There are some good palliative options for when things get worse.”
“Not surgery? Chemo? Radiation?”
“Maybe if we’d caught it earlier.”
“But we didn’t,” I say, and he agrees.
I don’t know how much longer it is until I leave the doctor’s inner office clutching a fistful of papers. Time slips sideways when someone tells you you’re dying.
“Can I help you, Ms. Barnes?” a nurse asks as I stumble into the waiting room.
I search my brain tape and this time her name is available. Who knows for how long?
Her dark brown eyes fill with concern. “Did you need something, honey?”
“I… I don’t know.”
“Did the doctor give you those?”
I look down at the unfamiliar papers in my hand. “Yes. Should I give them to you?”
“Those are for you to take home. Here, let me show you.”
The stares of the other people in the waiting room press into my back. Dead woman walking. Is that what it says on my sweater now, for everyone to see? Or is it the expression on my face that gives it away? Part of me cares, but the other part simply feels lost. How did I get here? I plan everything, and I don’t have to check my calendar to know that dying at forty-eight is not on the schedule.
I hand the sheets to Tiana and try to concentrate on what she tells me as she sorts them into two piles.
“These are your prescriptions,” she says, pointing to the shorter stack. Her nurse’s uniform is crisp and white, like something from the fifties. “You’ll need to go to the pharmacy and fill these. There’s one downstairs if you need it.”
I look at the top page and feel foolish. They’re prescriptions. I even recognize the medications—a steroid to help manage cerebral edema and my other symptoms. Tramadol, an opioid for when the pain gets to be too much for extra-strength Tylenol. Clonazepam to help me sleep. Drugs I’d never take normally, but I guess I don’t have to worry about addiction or the weight I’ll gain.
I see a quick flash of light. I reach up and touch my head. It disappears as quickly as it came, as if the tap to my forehead was an off switch. I doubt it will work much longer.
“Are you all right?”
“Yes, I—I felt a… pain, I guess, but it’s gone.”
“You’ll want to fill these,” Tiana says again, pointing to the prescriptions.
She knows my diagnosis, I realize. Glioblastoma multiforme. Knows that I’m dying. She must’ve known before I did. Was that why she was so nice to me when I checked in?
“Yes,” I agree, though what does it matter? Corticosteroids, benzos, and opioids are not going to cure me, or even necessarily reduce my suffering. They’re the window dressing being put on my tragedy so the doctor can feel as if he did something.
She motions to the larger pile of documents. “These other papers explain about your diagnosis. What you might expect in the coming weeks. In case you didn’t take it all in when Dr. Parent was explaining it to you.”
Dr. Parent? Did he say that was his name? He’s not old enough to be a father. No, that’s not right. It’s the French name, Pa-rent. Only she’s put a twang to it, and—I’m losing it. I am going to lose it in front of these strangers and this smiling, kind nurse and—
No. I can handle this. I can breathe. Yes, I’m going to breathe. That breathing exercise my therapist taught me years ago. I need to breathe in through my nose for four beats and out through my mouth for 1—2—3—4—.
I do this ten times, ticking off the repetitions with my thumb against my fingers, trying hard not to think about how weird I must look. Did I always care this much about other people’s opinions? A side effect of the malignant cells that have invaded my brain and will march onward until they’ve shut it down entirely?
I breathe in and out again. Somatic therapy, that’s what the exercise is called. It engages the somatic nervous system, which regulates anxiety and acts like a natural benzodiazepine. See, brain, you haven’t lost me yet.
When I am done, I feel calmer, though Tiana looks more concerned than she did when I started counting.
“Better?” Tiana asks.
“Yes, thank you.”
“Good. You’ve also got all your test results in here, in case you want a second opinion. And there are two more documents that are important, ones you’ll want to review with your family.”
She pulls two sheets out. Palliative options, the first one says across the top. There’s a list of facilities below it, and one other line at the bottom written in by hand that I recognize from a series of controversial stories in the paper. Alternative end-of-life options, it reads, with a phone number. Assisted suicide, this means, now legal in Canada for cases that are bad enough.
The other document is decidedly legal—a medical power of attorney form. If—when—things get grim, someone has to be able to turn off the lights if I can’t make that decision anymore. I have to choose one person to give this power to, and the choice seems obvious and exhausting.
My eyes sting with tears, muddling my words. I need to leave this horrible room with its quiet classical music and its greige paint. I shuffle the pages together as if I’m going to store them in a folder, only I don’t have one. I didn’t think I’d need transportation for papers. I didn’t think there was anything seriously wrong with me, only fatigue and getting older and—
I’m dying. My life has a countdown clock.
And it starts now.