A Brief Encyclopedia of My Mother’s Cancer by Anna Leahy
Winner of the 2018 Los Angeles Review Literary Awards, in the category of Creative Nonfiction.
Final Judge: Sarah Cannon
My mother takes anastrozole as adjuvant therapy to reduce her risk of recurrence of breast cancer, and it works. Her breast cancer does not return. It is impossible to know why any cancer does not recur. Or why any cancer does not occur—or does occur—in the first place.
The word benign comes from the Latin meaning well born. My mother was born with bilateral club foot. She remembers the doctor showing her mother x-rays, her bones on the wrong sides of her feet, her toes folding under. She remembers looking through the shoe store fluoroscope to see those bones in her feet, all mixed up even after surgeries that allowed her to walk. Her biopsies—breast, then, later, pancreas—were not benign. Did her childhood exposure to radiation cause my mother’s cancer? The word biopsy comes from the Greek meaning to live and to see.
C is for so many things that it is difficult to list them all. Cancer, of course. Carcinoma, a type of cancer in which epithelial cells gone awry. The chemotherapy—a combination of drugs—to shrink the tumor. The CEA tumor marker in the blood to watch. Oncologists do not use the word cure. They say, cancer-free. Or they don’t. They don’t say that to us. That is not a reasonable goal.
Even before my mother gets the diagnosis of pancreatic cancer, she knows the prognosis. She goes over her assets, makes lists, is very matter of fact with us, her daughters.
My mother stops eating much, even before she is diagnosed. That affects the efficacy of everything else, but there’s not much to be done. Still, we try to entice her. My friend who has colon cancer recommends the clear, fruit-flavored Ensure. My mother asks for the emesis basin—she uses this formal term for the curved, plastic bowl used to collect medical waste. Emesis refers to the process of vomiting.
Because of her club foot, when my mother is in the hospital for the surgery, there is a sign outside her door: fall risk. At first, the chemotherapy is FOLFIRINOX, a blend of five drugs. One of them is 5-FU—yes, FU, yes, say it aloud. My mother keeps a card on her dresser that says, Fuck Cancer. The nurses and all but one doctor approve. After she is discharged from the hospital, she continues chemotherapy because she wants to finish the whole course, because that is the plan to shrink the tumor and reduce the risk of pain in the end. After the second-to-last treatment, my mother goes into anaphylactic shock while sitting alone in a wheelchair waiting for my aunt to pick her up, and she thinks it will be fatal, but someone sees her struggling to breathe, and she is rushed back to the oncologist’s office, where she knows she is still in danger and hopes her sister knows where to find her. When she talked about that day, her fear was not of dying but that she had been alone. On the day chemotherapy ends, while getting her last infusion, she writes an email but doesn’t hit send—it says, I’m free. My sister discovers the email weeks later. Later on that last day of chemotherapy, on her way from the car, her walker leg catches on the carpet in the public foyer of the condo building, her home away from home. I am right behind her. I know what is happening. She falls.
From our perspective, the gallbladder starts all this. This bluish hollow inside my mother leads to the looking for something wrong. The surgeon removes the gallbladder. By then, we know that’s not really the problem. Most of life happens gray areas.
Hospital, then home, but not really home so much as home away from home. Then, the hallucinations that bring her joy. Then, hospital again because she cracks her hip when she falls after that last chemo treatment. Then, rehabilitation and a plan to get back home. Later, hospice at home, but not really home, though we offer to get her there and have a plan, but she resigns herself to the comfort at hand and the floor-to-ceiling window that overlooks the city, and she never gets back to the home she didn’t realize she would never see again when she left it, the home that was hers more than any place on earth. Then, when the end is very close, haloperidol under the tongue to prevent any last restlessness. Going into all this, my mother thinks, then-then-then heaven.
Sometimes, my mother gets dehydrated, and the IV fluids are a relief. I sit with her and see her perk up, and we talk for a while again. When she gets three infections at once, there are antibiotics in the IV too. My father had a respiratory infection in the end, so it was and was not what killed him. We know that some friends are wondering why bother treating infections when she is going to die anyway, but she is not yet so far gone that infection would be an easy way to go, not yet so far gone as my father was at the end, and the antibiotics give some energy back to her. One of the antibiotics is exorbitantly expensive and available only at a pharmacy miles away, and we know that if she were someone else, it might not be prescribed. During chemotherapy infusions, my mother occupies herself with her iPad. Weeks later, it is too heavy for her to hold.
We buy my mother a cozy bed jacket, something she hasn’t considered since her mother wore one in the 1940s. My mother is getting smaller, running colder. By June and July, the man at the airport shuttle desk recognizes me, and the security guards at my mother’s condo building nod and buzz me in. One of them had a mother who died of pancreatic cancer. It feels as if everyone has someone, though that can’t be statistically true. When I think of my mother: jury, judge, justice, jockey, jonquils, joy.
The kitchen is a room she no longer visits. She always feels full. Some days, her fingers are too sensitive to hold anything cold. For a few days, she wants a fried egg, so we cook her a fried egg each day she wants one. And then, she doesn’t have a taste for that anymore. We cannot know how tomorrow will be. Illness is less predictable than weather.
When my mother is diagnosed, she is still practicing law. She hands her remaining clients off to other lawyers she trusts. The day she calls the office and hears the message that it is closed for good, she cries. We realize that she has not been crying all along. This is a lesson in grief. I buy my mother a moisturizing lipstick that she keeps in the cloth bag that she hangs on her walker, which she sometimes forgets to use because she did not use a walker before she was sick. When she forgets it, she laughs when she sees it, as if she forgot her condition for a minute and made a good joke.
Mother. Mom. Malignant. Medicare and all the ways beyond us that my mother is taken care of when that’s not the case for everyone. Metoclopramide, to trick her stomach into making her hungry, and the one doctor who was worried about the side effects of long-term use when there would be no long term. Mouth sores, and the cool wash to numb and heal them. Later, metastasis. When I arrive for the last time, I think of myself as a baby in her arms all those years ago. I think, Momma, and feel my throat closing around the word.
One of the reasons my mother decides to do chemotherapy is her allergies to narcotics. Much of the pain cancer causes is because the tumor presses on nerves and other organs, and that pain is usually treated with the opioids my mother can’t tolerate. One of the side effects of chemotherapy is neuropathy, a lessening that is nerve damage, numbness and tingling in the hands and feet, which increases fall risk. Another is nausea, but ondansetron takes the edge off, sort of, sometimes. Nausea is also a symptom of pancreatic cancer, so either way, there’s not nothing.
My mother watches election results on the television in her room at the rehabilitation center. She sees Obama elected for his second term. She didn’t expect a Black man to be elected president in her lifetime. This is something she is glad to have lived to see. Her obituary says, “She left behind a legacy of fighting for people who couldn’t fight on their own.”
In the hospital, not long after surgery in the spring, a specialist talks to my mother and to me together, then separately. He asks about priorities. He talks about palliative care. My mother talks about pain and vomiting. The word pain comes from the Latin meaning punishment.
The question about quantity and quality of life is more complicated than it sounds. Rarely is it a simple either/or. Often, they decline together, quantity and quality, hand in hand. My mother is okay with sacrificing quantity for quality at this point, but that’s not exactly the question in the array of decisions or in what happens next.
The risk factors for pancreatic cancer are not well understood. My mother does not smoke, is not obese, and does not work with carcinogenic chemicals. She has no risk factors that she could have changed. Risk increases with age; when she is diagnosed, my mother is the average age of someone diagnosed with pancreatic cancer. My mother’s cancer increases my risk for developing cancer.
My mother has surgery because the tumor looks operable on the CT scan. The surgery is supposed to last most of the day, but, after a couple of hours, we are told that the surgeon will see us. We know what this means. We stare at his fist, which he says is the size of the tumor. The tumor is attached to an artery, and his fist shows us how to imagine that. If it were attached to a vein, he would have tried to remove it. My mother’s sister is there. And my sister is there, and she has to excuse herself to rush to the bathroom. In the months after the surgery, they do most of the caregiving.
T is for tumor, the object that is us. And for trust, which becomes my secret word.
Cancer is uncontrolled cell reproduction, too much of what’s usually a good thing. Too many cells too fast is a tumor. My mother’s tumor is unresectable; it won’t let go. Cancer is not unusual; one out of every two or three people will be diagnosed with some type at some point. The way an instance of cancer plays out in a given life is unique, with each body and each choice and all the chances of day-to-day living. When the end is nearing, a catheter is inserted so that my mother’s urine collects in a bag. The liquid is dark. There’s not much to be had.
I agree to be the task-master about eating, showers, walking the length of the condo lobby. We all know what it means when my mother goes days without walking. Sometimes, we acquiesce with vodka, which we spike with Ensure as part of the bargain. Alcohol consumption risks interaction with medication; she might stop breathing. It dehydrates my mother, which makes bowel movements excruciating, and it doesn’t taste or feel like it used to, which disappoints my mother. Disappointment is an ache that could easily get out of hand, so we keep adjusting. Sometimes, when we clean my mother’s room, we find gummy vitamins under the bed. She smiles like a kid who’s fooled us, who’s been caught, who knows there are worse things to worry about, like vomiting, which there isn’t all that much of in my mother’s case, all things considered.
My mother is wasting. Wasting is not only the result of not eating. The body has changed the way it works, and there’s no going back. No one tells us that wasting cannot be staved off, that eating cannot help much. The cause of death for my father was wasting, more than anything else. The verb waste may be transitive or intransitive. It can be a noun, too. It is a shape-shifter. It is the body left wanting. It is the body after wanting has left too.
The first person to see the tumor is an emergency room physician treating my mother for what she thinks is a gallbladder attack. He sees a shadow on the x-ray. He does not tell her what he is sure it is. He tells her to see a specialist right away. My mother knows from the tone of his voice that he has seen something seriously wrong inside of her. She has known for a while that something is wrong, but her fatigue was such that she knew she would be dismissed or misdiagnosed.
After doing some research, my mother aims to live a year. The vast majority of pancreatic cancer patients don’t survive twelve months. My mother lasts about nine months, leaves before the calendar year is up, all twelves the day she dies.
After she dies, my mother’s body is put into a black bag with a zipper. My aunt and sister are there. I have been awake all night and am too tired to watch, so I close my eyes and listen to the sound of goodbye.
Anna Leahy is the author of the nonfiction book Tumor from Bloomsbury and the poetry collections Aperture and Const
This is so poetically written and heartbreakingly beautiful. Thank you, Anna, for your courage writing this. It brought back the last months of my own mother’s life with such clarity, and I see there is still many tears to shed., it’s such a heSling read.
[…] Editor Anna Leahy won the 2018 Nonfiction Award from Los Angeles Review. “A Brief Encyclopedia of My Mother’s Cancer” was published online this […]