The Best American Essays 2016 (42 page)

Indeed, everything comes and goes, and if one could take a scan or inner photograph of the body at such times, one would see vascular beds opening and closing, peristalsis accelerating or stopping, viscera squirming or tightening in spasms, secretions suddenly increasing or decreasing—as if the nervous system itself were in a state of indecision. Instability, fluctuation, and oscillation are of the essence in the unsettled state, this general feeling of disorder. We lose the normal feeling of “wellness,” which all of us, and perhaps all animals, have in health.

2.

If new thoughts about illness and recovery—or old thoughts in new form—have been stimulated by thinking back to my first patients, they have been given an unexpected salience by a very different personal experience in recent weeks.

On Monday, February 16, I could say I felt well, in my usual state of health—at least such health and energy as a fairly active eighty-one-year-old can hope to enjoy—and this despite learning, a month earlier, that much of my liver was occupied by metastatic cancer. Various palliative treatments had been suggested—treatments that might reduce the load of metastases in my liver and permit a few extra months of life. The one I opted for, decided to try first, involved my surgeon, an interventional radiologist, threading a catheter up to the bifurcation of the hepatic artery, and then injecting a mass of tiny beads into the right hepatic artery, where they would be carried to the smallest arterioles, blocking these, cutting off the blood supply and oxygen needed by the metastases—in effect, starving and asphyxiating them to death. (My surgeon, who has a gift for vivid metaphor, compared this to killing rats in the basement; or, in a pleasanter image, mowing down the dandelions on the back lawn.) If such an embolization proved to be effective, and tolerated, it could be done on the other side of the liver (the dandelions on the front lawn) a month or so later.

The procedure, though relatively benign, would lead to the death of a huge mass of melanoma cells (almost 50 percent of my liver had been occupied by metastases). These, in dying, would give off a variety of unpleasant and pain-producing substances, and would then have to be removed, as all dead material must be removed from the body. This immense task of garbage disposal would be undertaken by cells of the immune system—macrophages—that are specialized to engulf alien or dead matter in the body. I might think of them, my surgeon suggested, as tiny spiders, millions or perhaps billions in number, scurrying inside me, engulfing the melanoma debris. This enormous cellular task would sap all my energy, and I would feel, in consequence, a tiredness beyond anything I had ever felt before, to say nothing of pain and other problems.

I am glad I was forewarned, for the following day (Tuesday, the seventeenth), soon after waking from the embolization—it was performed under general anesthesia—I was to be assailed by feelings of excruciating tiredness and paroxysms of sleep so abrupt they could poleaxe me in the middle of a sentence or a mouthful, or when visiting friends were talking or laughing loudly a yard away from me. Sometimes too delirium would seize me within seconds, even in the middle of handwriting. I felt extremely weak and inert—I would sometimes sit motionless until hoisted to my feet and walked by two helpers. While pain seemed tolerable at rest, an involuntary movement such as a sneeze or hiccup would produce an explosion, a sort of negative orgasm of pain, despite my being maintained, like all post-embolization patients, on a continuous intravenous infusion of narcotics. This massive infusion of narcotics halted all bowel activity for nearly a week, so that everything I ate—I had no appetite, but had to “take nourishment,” as the nursing staff put it—was retained inside me.

Another problem—not uncommon after the embolization of a large part of the liver—was a release of ADH, anti-diuretic hormone, which caused an enormous accumulation of fluid in my body. My feet became so swollen they were almost unrecognizable as feet, and I developed a thick tire of edema around my trunk. This “hyperhydration” led to lowered levels of sodium in my blood, which probably contributed to my deliria. With all this, and a variety of other symptoms—temperature regulation was unstable, I would be hot one minute, cold the next—I felt awful. I had “a general feeling of disorder” raised to an almost infinite degree. If I had to feel like this from now on, I kept thinking, I would sooner be dead.

I stayed in the hospital for six days after embolization, and then returned home. Although I still felt worse than I had ever felt in my life, I did in fact feel a little better, minimally better, with each passing day (and everyone told me, as they tend to tell sick people, that I was looking “great”). I still had sudden, overwhelming paroxysms of sleep, but I forced myself to work, correcting the galleys of my autobiography (even though I might fall asleep in midsentence, my head dropping heavily onto the galleys, my hand still clutching a pen). These post-embolization days would have been very difficult to endure without this task (which was also a joy).

On day ten, I turned a corner—I felt awful, as usual, in the morning, but a completely different person in the afternoon. This was delightful, and wholly unexpected: there was no intimation, beforehand, that such a transformation was about to happen. I regained some appetite, my bowels started working again, and on February 28 and March 1, I had a huge and delicious diuresis, losing fifteen pounds over the course of two days. I suddenly found myself full of physical and creative energy and a euphoria almost akin to hypomania. I strode up and down the corridor in my apartment building while exuberant thoughts rushed through my mind.

How much of this was a reestablishment of balance in the body; how much an autonomic rebound after a profound autonomic depression; how much other physiological factors; and how much the sheer joy of writing, I do not know. But my transformed state and feeling were, I suspect, very close to what Nietzsche experienced after a period of illness and expressed so lyrically in
The Gay Science
:

Gratitude pours forth continually, as if the unexpected had just happened—the gratitude of a convalescent—for convalescence was unexpected . . . The rejoicing of strength that is returning, of a reawakened faith in a tomorrow and the day after tomorrow, of a sudden sense and anticipation of a future, of impending adventures, of seas that are open again.

Epilogue

The hepatic artery embolization destroyed 80 percent of the tumors in my liver. Now, three weeks later, I am having the remainder of the metastases embolized. With this, I hope I may feel
really
well for three or four months, in a way that, perhaps, with so many metastases growing inside me and draining my energy for a year or more, would scarcely have been possible before.

Notes

1. Antonio Damasio and Gil B. Carvalho, “The Nature of Feelings: Evolutionary and Neurobiological Origins,”
Nature Reviews Neuroscience
14 (February 2013).

2. I also have attacks of “migraine aura,” with scintillating zigzag patterns and other visual phenomena. They for me have no obvious relation to my “common” migraines, but for many others the two are linked, this hybrid attack being called a “classical” migraine.

3. Aretaeus noted in the second century that patients in such a state “are weary of life and wish to die.” Such feelings, while they may originate, and be correlated with, autonomic imbalance, must connect with those “central” parts of the ANS in which feeling, mood, sentience, and (core) consciousness are mediated—the brainstem, hypothalamus, amygdala, and other subcortical structures.

KATHERINE E. STANDEFER

In Praise of Contempt

FROM
The Iowa Review

I
BUY THE
ice cream cone because I want a cold treat, but by the time I hit the underpass on my way west out of town the heat has cracked off the chocolate dip, folding it into my mouth, and what’s left underneath is a white phallus, tongue-slicked into perfect shape. I grin. And deep-throat it. The way I do. The way I always have, since I first did by accident on the train out of Chicago some time in middle school, heading back to the suburbs, sitting next to my suited father in the ill green light of the Metra. I slid the long cone of cream deep into my soft mouth and drew it slowly out. I licked around and around and around its sides, plunged it back in. Then my father leaned over to hiss at me, “Stop, the businessmen are staring.”

“What,” I said. And I meant it, for an instant. Then I felt the color draw into my cheeks. And looked around. What I was tasting was so sweet.

West out of town means the Tucson Mountains, parabolas of dust and cliff. Out here, the warm pavement crumbles to gravel. The car bends through the last dusty strip malls and pops up over a ridge of saguaro cacti. White ice cream drips down my hands; I lick my fingers. I lick at the soft bow of flesh between my fingers; I lick my sticky palm.

This is what happens when I’ve just had sex for the first time in a while: I get lit. My body will not shut up, wants more. I’ve come to the desert to concentrate, to read a book I needed to finish weeks ago. I’ve got to get out of the house, because we know what happens when a girl stays in the house.

What always has.

What always has since I became friends with Lexi Alexander in the sixth grade, since we spent summer nights in the air-conditioned cold of her parents’ basement office signed into AOL chat rooms. She taught me to “cyber,” to type dirty things, to give dirty and get dirty in return, whoever it was out there, who they said they were, or maybe not.

A/S/L? we asked.
Age, sex, location?
Were these really men with pants at their knees, or were they middle-school boys like we were middle-school girls, tittering, crossing our legs?

It was my favorite thing. The guttural clicking and grinding sound of the modem as it struggled to connect. The way we pretended to be just pretending. There was a language I was learning there. Once my parents got a second landline and I had my own AOL account, Aryn sent me a picture of six, seven middle-aged men, their faces red, their dicks out, and one slender woman lying beneath all those hard cocks. Cocks in her hands and mouth and cunt. And after I’d looked and looked and looked, I went downstairs to one of the poles that held up the basement ceiling, and I held myself up by the crossbar and slid myself along the pole until I got
that
feeling. Pumping, my legs wrapped around the concrete.

It was a wildness in me, the way I needed this, the way I went back again and again. There was a magnet in my body that drew pleasure toward it.

But listen, I’ve lied; this did not start then. This started so early there is no start. I’ve been humping things as long as I’ve been conscious.

Yesterday I fucked a married man. Have I graduated? He is a military intelligence officer.

At my favorite trailhead, the mountains round and swoop like a woman lying on her side. Cliffs drop off her back. The only sound is the high-pitched worrying of Gambel’s quail in the brush.

I ditch my car, the only one in the lot, and follow the dry wash a few curves into the canyon. There’s a shelf in the rock about six feet up that I clamber to, taking out a dewy water bottle. For hours I read, heat radiating up into my belly through the rock. A few people pass with their dogs, paws crashing into the sand. The light shifts, goes warm against the cliff walls. Then the light goes down.

At some point I text the man I have just fucked, who is on a training base two hours away. Yesterday you could not have told me to drive an hour or two for sex. It is the end of the school year, when papers are due and my grading stack piles up, and I’m leaving the country in a week. Yesterday I would have said I was busy. Now I am texting the offer to drive halfway, saying we could get a hotel room or fuck somewhere in public. I take a deep breath, put the phone away.

In the dark, the owls hoot at each other from opposite sides of the canyon. I can see one settle onto the crown of a saguaro, then swoop, big wings outstretched, to the next. A black whoosh. A bulk of a shadow. Backlit by the moon, I can see how she leans forward to hoot, flipping her tail feathers down for balance. Her body rocks when she hoots,
hoo-HOO
. My phone buzzes. The military intelligence officer’s wife isn’t sure right now, he says. She is in Georgia, the last place they were stationed. She thinks she doesn’t want him to have sex with anyone again until she can. I feel myself slump in disappointment, or maybe desperation. Not about him in particular but for the sex, this brief burst of pleasure. The day before, I’d made him come too quickly by bucking.

These hips don’t lie, etc.

He sends me a picture of his penis, draped flaccid onto his eased-down athletic shorts: a consolation prize.

“Enjoy that while it’s out for me,” I tell him.

The thing about this man is, I don’t really even like him. At lunch the day before, at a downtown restaurant where we sat by the long glass windows and slowly ate salads, I actually thought I might kill him. He was one of those people who had to be right. He talked a lot. He had a funny half-smile he used when he said inflammatory things, as though his being cute, being gap-toothed, could take me off my intellectual guard. Everything I said he needed to tweak, to correct. The bizarre opinions he held are not of importance here. I became blank and drank a lot of water. I tried to determine whether or not, once he shut up, the sex would be good.

I did not invent the Hate Fuck, which makes me feel better about this.

At that point, it had been just over two months since I’d had sex. This was not the worst sex drought I’ve experienced. Not by far. Still, I admit an edge of desperation. There is a kind of madness that sweeps over me when I have been celibate between six and eight weeks, an irritating, distracting hunger, a skin need. It becomes nearly impossible to get my work done. I sometimes pay for a massage, just to feel someone’s hands on my body. If the buildup reaches five months, I begin to make terrible decisions.