When You Don’t Know How

I am in the passenger seat, a bag of kettle corn and a box of chocolate covered cranberries on the center console between us. As we wait in highway traffic just a few miles from our destination, my hand can’t stop going back to that console, grasping for something to fill me up, to bury the feeling rising up out of my gut. If I keep shoving the food in, nothing else can come out. But something needs to come out. A breath at least. I need to bury everything else, but let the breath come out. So after each handful, I grip the inside door handle and sit up a little straighter, trying to create space for air.

Between the line of semi-trucks in the lane next to us I spot an off ramp and urgently declare, “Get over there’s an exit. We’re going to be late. Let’s back road it the rest of the way.” As he seems to hesitate, anxious impatience takes over and I snap, “What are you waiting for? You’re going to miss it.”

In what seems like a miracle, he doesn’t miss it, and then we are off, rolling along country roads shaded by tunnels of trees, a canopy thick with late summer growth. I look over at his hand resting on the bottom of the steering wheel, effortlessly guiding us. His forearm is strong and tan and confident, but I take my gaze higher and his eyes are the eyes of a child. Uncertain. Not in control. Scared. I reach over and place my hand on his forearm, hoping it is not an illusion. It is warm and the heat from his skin radiates into my fingertips and I feel it travel up my arm and smolder inside my heart. He is still here. My sunglasses hide the tears welling up in my eyes.

One stoplight more and we are there. The road we sit on is like a ledge in the middle of a hill. As we wait for a green signal, my gaze falls to the left, to the valley. We are now sitting above the trees that were our canopy just a few minutes before. There is nothing above the expanse of treetops but sky, sky painted blue with lazy, elongated, cotton ball clouds, clouds so light and distinct it seems as if I can reach up and pluck each one down into my pocket for safekeeping. To the right, rising out of the hillside is a smattering of tall, windowed office buildings. The words Cancer Center scream at us from the top of the closest building. We have arrived.

The call from the doctor came late last week. She said, “I have good news and bad news. The bad news is you have Melanoma. That’s the kind of cancer that kills people. The good news is, it looks like we caught it early.”

We park our car in the garage and follow the signs directing us to the Cancer Center. Sign after sign after sign. Cancer Center to the left. Cancer Center straight ahead. Cancer Center check in on level one. Like we needed a reminder of why we we’re here. 

At the registration desk we are directed to the waiting area the next floor up. As we step into the elevator, we join a smattering of others. Most are wearing hats. Delicately hand-crocheted hats, baseball caps, newsboy caps. I suddenly can’t help but feel like a jerk, my thick, blond, curly hair puffed out wide and hanging below my shoulders. Why didn’t I think to pull it back?

We step into the waiting room and for a moment it feels as if we are interrupting. We are sized up by people who look tired, yet also somehow at home. Feet tap impatiently and knees bounce nervously, but no one talks. We sit at the near edge of the room, perpendicular to a wall of windows providing a grandiose view of the landscape. There is no individuality to the treetops at this height. They simply offer a mossy layer of green that recedes into the cornflower blue sky. The view is vast and breathtaking, as if, by design, the setting is supposed to give us hope that whatever goes on here is equally as great, strong, and powerful.

Most everyone sits with their backs to those windows.

His name is called quickly and we are escorted back to the exam room by a friendly nurse. The resident who sees us first explains how Melanoma works, how it penetrates the layers of the skin, and left to its own devices long enough can make its way into the blood stream and lymph nodes. She takes his history, assesses his biopsy site, re-checks his entire body for any additional rogue growths, and feels his lymph nodes for any lumps like “pea-sized marbles”.

Then it’s time for the real show. The chief of the department is his doctor. We hit this jackpot because he’s good friends with our dermatologist. We are lucky. He exudes confidence, but there’s no arrogance. He’s relaxed and personable. He gives us a card and writes both his home and cell numbers on it.

He talks quickly and precisely and repeats the steps the resident took us through just a few minutes before, but it feels different this time. It feels like we are finally getting to what we are here for. When he finishes the exam, the doctor turns to my husband and says, “It’s a good thing your wife made you go to the dermatologist. From the biopsy, it looks like we caught this very early. Less than one millimeter of penetration, which puts you in the very low risk category. We’re going to treat this exclusively with surgery. At your penetration level, there’s only a 1% chance that the cancerous cells have reached your blood stream.”

He is so confident and at ease, in his presence we can believe the 1% is nothing. The worst-case scenarios that had rested unspoken between us for the past few days begin to dissipate. Relief washes over us.

We leave with a folder full of literature and an appointment for his surgery. Summer is almost over, and we aren’t here much longer, so it will take place when we get back to the city. Just in case. Just in case there is a complication or a need for follow up care. The doctor has a friend and colleague who is a surgeon at the premier cancer center in the city. He’ll take care of everything to get the appointment scheduled. “We’re taking a 4-inch football out of the upper back and then trying to sew it back together,” the doctor tells us. “There’s no extra skin here. Something as simple as an elevated heart rate could split it back open. I could do the surgery tomorrow, but it’s better to wait.”

We lose our way exiting the building and ride the elevator aimlessly a few times. There are no signs telling us how to get out.

We finally make our way back to the parking garage. We are walking behind a man maneuvering himself in a wheelchair. He reaches his vehicle, opens the rear door and unfolds the walker that was resting on the seat. As he stands up, his right pant leg hangs limp.

How?

It’s all I can think.

How do you do this alone?

How do you do this, period?

How do I help?

In the days that followed, the urgent fear was gone. We had an answer, for now. For today. But the words that came after the 1% echoed more clearly now.

There’s a 10-20% chance of re-incidence.

If you’re in the 1% and something did get into your bloodstream, it surfaces in the first ten years 50% of the time, and between years ten and twenty 50% of the time.

You need to visit your dermatologist for skin checks every six months.

You need to check your lymph nodes monthly so we can catch anything early.

We are in the car again starting the long trip back to the city. Our home away from our home. I share with him the words I’ve been journaling. The things that needed to come out. The memories I needed to hold onto. Because they were moments I lived. Moments we lived together.

The 1% that is hanging over us spills out. “It’s funny how the 1% always manages to grab the most attention,” I say.

He gives a little laugh and says, “You’ve got that right.”

“But,” he continues, “I’ve been thinking about it, and I’m grateful for the 1%. It’s a reminder. Every time I have to go for a checkup, every time I have to feel my lymph nodes, it’s a reminder that I can’t take anything for granted. I can’t live like I used to anymore. So to me, the 1% is a gift.”

That’s how.