My Season of Ativan
I told my mom everything, even when I gave my first blow job. She never shied away from uncomfortable topics; small talk was anathema to who she was. In the nineties, she and I were both in psychoanalysis while she was also in psychoanalytic training. We discussed our transferences, our dreams, our childhoods. When I showed up for an audition with no makeup and an unbleached mustache, that was success neurosis. When she asked Jack Nicholson for a puff of his cigar in a crammed elevator, it was penis envy. No onion went unpeeled. So it was strange not to tell her, last fall, that I’d been diagnosed with cancer.
For many years, I’ve been told that I have “dense” and “busy” breasts—not as a compliment but as a warning that they require extra monitoring. I had been seeing a breast surgeon every six months for checkups. The Friday before Labor Day, I went for what I thought would be a routine scan. Dr. K. usually chatted me up while she examined me, but this time she went silent. She told me that she didn’t like the way something looked on the ultrasound and wanted to perform a biopsy. After the procedure, she said that she would walk the sample over to Cedars-Sinai and hand-deliver it to Pathology. That’s when I knew.
The next morning, I woke up to a text from Dr. K., saying that she had a preliminary report. The tumor “appeared” to be small, but I would need an MRI after the holiday weekend to determine “the extent of disease.” On Tuesday, we would also learn my receptor status, which indicates how tough your strain of cancer is. “It’s like dogs,” she explained. “You have poodles on one end and, on the other, pit bulls.”
I called my two oldest friends, who sped to my house. I called my sister, in Philadelphia, and my husband, David, who had taken our two youngest children—Molly, who was fifteen, and Henry, who was ten—to a soccer tournament. My mom lived in a cottage twenty feet from our kitchen, but it didn’t cross my mind to go tell her because she was in the final stage of Parkinson’s disease. She still recognized me, and sometimes answered “yes” or “no” to my questions, but always reverted to an empty stare.
David made me swear I’d stay off the internet, but it was too late. I had already Googled “lobular breast cancer” and learned that, compared with the more common ductal kind, lobular is “tricky” and “insidious” because it grows in stringlike formations that can read as normal breast tissue. Even if you’re lucky enough to catch it on a scan, its size is often underestimated. And the kicker: “at ten years . . . half as likely to be alive.”
Everything took on a sickening poignancy: the boisterous din at our Saturday brunch place where, just a week before, my girlfriends and I had scrolled through the latest celebrity facelifts and griped about our jowls; the Santa Monica mountains coming back to life after the fires; Henry’s flag-football mouth guard on the kitchen table, imprinted with his teeth; the pissed-off scrawl on the Post-it Molly had left on her bedroom door (“Free first period DON’T WAKE ME UP!!!”); Frankie, our eldest, on the location-tracking app Life360, her face inside a tiny quote bubble floating over her freshman dorm, and her text a while later that nearly did me in: “Mama I need a drawstring bag for my laundry.”
We couldn’t tell the kids yet; there was nothing definitive to say. I braced myself to act plucky when Molly and Henry got home from their tournament, but in the end it didn’t matter. My sister called: our father was about to die. Our parents, long divorced, were both in hospice, on opposite coasts. Our mother’s had started in June, but our father’s was only a week in, so we hadn’t expected him to go first.
I flew to New York. I didn’t make it before my father took his last breath, but I got to see his body before it was taken from his apartment. My sister, who is a doctor and usually the stoic one, wept. I just stood there in a state of morbid fascination. I had never seen a dead body up close before, let alone someone so familiar to me. His hair was still the same—thick, mostly brown—and my sister and I thanked him for our own abundant heads. His signature club thumbs, which were the only fat, brutish things about him, were the same as ever. But his mouth was open and drooped peculiarly to one side, and his skin was sucked into his skeleton like a vacuum storage bag. I felt guilty for not crying, but at least I got a reprieve from guessing how much longer I had to live.
He’d been dead for two hours when the “removal team” arrived from the Greenwich Village Funeral Home: two men in black suits, who put me in mind of the Blues Brothers. They suggested that we step into the other room while they transferred our father out of his rented hospital bed. I wasn’t sure whether this was because there might be bodily leakage or because of how disturbing it would be to see the person who’d raised us—whose shoulders we’d ridden on—zipped into a body bag that looked like it came from the props department of “Law & Order.” We sat on the couch with our stepmother and made small talk—partly, I’m sure, so that we wouldn’t hear the Blues Brothers working away in the bedroom.
As soon as my dad’s corpse was out of sight, I was free to panic about my cancer again. In a few minutes, he would be carted away forever. My mind should’ve been flooded with memories, like the time he pulled the car over to make me and my sister listen to “Bad, Bad Leroy Brown,” followed by a disquisition on why Jim Croce was one of the great American lyricists, or the time he told me, at age eleven, that I should make my own living and never rely on a man for money.
I tried to stop thinking about myself. I flipped through my stepmother’s hospice pamphlet—“Gone from My Sight: The Dying Experience”—in which the end-of-life expert Barbara Karnes outlines the process of “transitioning” week by week, up to the final minutes. I made a mental checklist of which milestones my mom had left to hit. Karnes encourages you to think of your loved one in the throes of death the same way you’d think of a chick struggling to hatch. The last couple of pages listed the rest of her œuvre, including “I Am Standing Upon the Seashore: End of Life Coloring Book.” It annoyed me that the hospice-industrial complex offered such rinky-dink leaflets to the bereaved. My mom’s team had at least given me a heftier brochure featuring tasteful photographs of lilacs; this one was literally stapled together, with cartoonish drawings like the ones on airplane safety cards that show your aircraft making a pleasant water landing.
My dad was six feet two, and his apartment was tight quarters. The morgue techs each held one end of the body bag as they shuffled out of the bedroom, which opened onto a narrow hallway. Watching them try to pivot around the corner without sidescraping the walls was like watching Frankie parallel park—a nail-biter in two-inch increments. It seemed undignified to make my dad leave the building he’d lived in for thirty-five years in the service elevator, but I guess nobody wants to run into a dead body while they’re taking their dog out for a walk. I don’t remember thanking the men or the moment we closed the apartment door, but at some point it was final and incontestable that he was “gone from our sight,” and we were back in the living room with our stepmother, going over her plans. My sister had told her, in private, that I had just been diagnosed with breast cancer and that we were going to need to get back to L.A. right away. A little while later, we said our goodbyes.
When my sister and I left the building, the morgue techs were still parked in the yellow loading zone between Target and Tower Cleaners—our dad’s dry-cleaning place—and just closing the tailgate of the hearse. The sidewalk was bustling, but no one even bothered to rubberneck. This struck me as heartbreakingly lame and, therefore, as a moment of vital consequence. But we just kept walking, as if we were bank robbers fleeing the scene by acting like the people to whom it meant nothing.
My sister flew back to L.A. with me, and for the first time in twenty years David drove to the airport to pick me up. There was a new sense of romance between us—we stole glances, squeezed each other’s hands. All our petty marital grievances evaporated, even when he merged onto the 405 like a lead-footed moron. The rest of the weekend reminded me of the way we were after our first ultrasound, when I had just gotten pregnant with Frankie. The doctor couldn’t find the heartbeat and wasn’t sure if I had a blighted ovum, which is when there is a sac but no embryo inside it. For eleven days, we didn’t know whether to keep hoping or start grieving. “There’s nothing you can do but wait,” my sister said. “You’ll know when you know.” It was wild for me and David to be the only two people in the world on tenterhooks over this infinitesimal ball of cells I was carrying.
While we waited for Tuesday and whatever news it would bring, my mom’s death watch plodded along next door. My sister and I toyed with the idea of telling her that our dad had died, but it was impossible to gauge how much she could comprehend. During the last few years of her decline, our talks had become shorter and shorter until I was only giving her positive, bite-size updates about my life. But there was no way to turn my father dying into a therapeutic fib.
All summer, we’d thought her death was imminent. We’d e-mailed her friends; her beloved younger brother had come from New Hampshire. I have pictures of the kids saying goodbye to her in June before they left for camp. She was still there when they got back. I told them “this is it” so many times that I felt like Lucy faking out Charlie Brown in the “Peanuts” football gag. My mom’s name was Penny, and she had long since put the kibosh on being called Grandma; to her nearest and dearest she was Pen, which is also Frankie’s middle name. Before she left for college, I said, “Frankie Pen, First of Her Name, this could be your last goodbye.” But my credibility was shot. “I’ll see Pen when I’m home over Thanksgiving,” Frankie said. And she was right.
My dad was even-keeled, and nothing if not practical. His death matched up with what the hospice manuals described. My mom had a more poetic temperament. She never let us buy premade Halloween costumes or birthday cards, and wouldn’t abide anything canned—in recipes or otherwise. When we went on family trips, pre-divorce, she and my dad would squabble over what type of hotel we should stay in. My mom thought any place with more than six rooms was a tourist trap. She wasn’t one to do things by the book. Why should her death be any different?
When she entered hospice, we stopped all twenty-three of her medications. She became emaciated and paralyzed. She could move her face and swallow, but nothing more. When we rolled her onto her side, it was like tipping over a wheelbarrow—her legs stuck straight out of her diaper like hardwood handles. She was plagued with all manner of rashes, sores, and ulcers. Her hands looked like the “lotus feet” of imperial Chinese women, whose toes were mashed in the wrong direction. Years before, she’d had deep-brain-stimulation surgery in an effort to stave off wheelchair confinement. Her skin was so thin and translucent that the batteries implanted above each breast—they looked like computer mice with tail cords—were freakishly prominent. The first thing she said when she woke up in the recovery room: “I’m going to need two bras.”
I never really got to know the bedridden, asocial version of my mom who was mesmerized by André Rieu’s stadium concerts. The person I knew had no interest in pomp, celebrity, or anything that smacked of Disney. At the première of “Simply Irresistible,” a Sarah Michelle Gellar vehicle from 1999 in which I had a supporting role, she fell asleep with her mouth wide open. My agent had to elbow her when I came onscreen.
My mom’s longtime aide, Jerome, became the person she was closest to. She was so smitten that she nicknamed him Jeromeo, and from then on that’s what we called him. He was never deterred by her blunted affect, or put off by the way she looked or smelled. I was always waiting for glimpses of who she was in the past, whereas he embraced the person she had become. Sometimes I caught sight of the old her. She would raise one eyebrow a skosh when I asked her if she wanted a glass of wine. The last time my sister’s husband came to see her, David whispered, “I’m your favorite son-in-law, right?,” and she let out an abrupt chortle.
The idea that she was still in there but couldn’t communicate gnawed at me. I thought of Tolstoy’s Ivan Ilyich and how badly he wanted his family to stop pretending that he was anything but doomed. I never told my mom that she was in hospice or used that word in her presence. Whenever the nurses came, I told her that they were wound-care specialists. I never asked her if she knew that she was dying, or if she was scared. I was like Ilyich’s wife, chirping about bullshit while he lay terror-stricken. I would drop by her cottage and try to perk her up with some dessert or a few sips of wine, but my visits were never more than flybys.
That Labor Day weekend, though, I found myself unable to visit her cottage at all. I didn’t have the space in my brain for both her disease and mine. I caught myself thinking of her as subhuman—too far gone to feel my absence, to feel anything at all. I was riddled with guilt, but I told myself it was just until Tuesday, when I would speak to Dr. K. It occurs to me, looking back, that I abandoned her because of the narcissism of small differences; friends always said that we were uncannily similar, in looks and temperament. I couldn’t bear to see her until I knew that I wasn’t going to die right along with her.
On Tuesday, David and I stayed glued to our phones, just as we had a few months earlier, during our evacuation from the Palisades Fire, when we obsessively checked apps that showed the containment line inching ever closer to our home. I sucked on little chips of Ativan all day, but my blood pressure was so jacked they didn’t even register. Then, at 4:42 P.M., Dr. K. texted: “All poodle features!”
I ran to the kitchen, where David, my sister, and the kids were hanging out, and said that the grownups had to work on our father’s obituary immediately. The three of us squeezed into our bedroom closet and huddled over my phone. I put Dr. K. on speaker, and she told us that I was hormone-receptor-positive and “HER2-negative.” One of my sister’s oldest friends, a renowned oncologist at Mass General, was standing by in Boston to interpret what all this meant about my treatability. My sister held up her phone to show me his text: “Woooo-hoooo!”
You’d think that I had just taken Ecstasy. I was happier than I’d been pre-diagnosis, when I was just a regular person who didn’t have cancer. But after about ten minutes I remembered that I still needed the MRI and regressed to baseline terror. Dr. K. said that the radiologist would check my lymph nodes, as well as “the left side for any surprise findings” and call with the results within a week. It was dawning on me that cancer diagnoses come in a slow drip.
I admire people who can sit with uncertainty in matters of life and death. I’m not one of them. I suck at mindfulness. I run scenarios, even for minor matters that are not exactly my business and hard to predict—like whether some entitled little lax bro is going to break my daughter’s heart. I know that worrying is a waste of time and that it has no bearing on probability, but I can’t help it. A therapist once gave me wise counsel during a bout of insomnia: thinking is not your friend.
The radiologist didn’t see evidence of lymph-node involvement, but she found a second mass in the same breast. We put my lumpectomy on hold, and she ordered an MRI-guided biopsy, which is when a tumor sample is extracted while you’re inside the big white imaging doughnut. I reported to the hospital in an Ativan haze and filled out the patient-intake forms to remind everybody, for the thousandth time, which breast my cancer was in, when I had received the diagnosis, whether my parents were alive or deceased, and which diseases they had succumbed to. When I entered the windowless operating theatre, I asked the tech what her name was. “Call me Tom,” she said. “I don’t want you to know my real name, because you’re not going to like what I’m about to do to you.” That’s when I realized that I was in the slaughter line without having been sufficiently pre-stunned. My bottle of Ativan was back in a hospital locker room, so I tried to calm myself by focussing on a fake skylight decorated with virtual leaves. If anything, it only reminded me that I was in a doomsday cancer bunker.
Tom helped me lie on my belly and lowered my traitorous breast into a horizontal, doll-size lunette. She injected the pain medication, which was so excruciating that there was no way white-knuckling it could have been worse. Then came an injection of dye, to make the suspicious mass stand out, and finally Tom slowly flattened my breast—while it was hanging in the air—with a barbaric waffle iron, whose latticed squares were numbered to locate the target site for the needle. Tom and my doctor called coördinates back and forth, as if playing a perverse game of Battleship, to confirm the quadrant of interest. Tom had to insure that my breast was pulled completely taut. If the flesh has any give (imagine a slightly deflated balloon), the hollow needle just rebounds. As I left, the doctor told me it was fifty-fifty whether or not there was more cancer.
Two days later, we found out that the second mass was benign, and that I would only need a lumpectomy and radiation, not a double mastectomy or chemo. David and I decided to tell the girls. My therapist said that I didn’t have to appear strong or unfazed or have definitive answers. She said that I’d be surprised by how much children can step up and that calling for all hands on deck can make them feel useful. Molly cried, and Frankie—FaceTiming from her college quad—clapped her hand over her mouth and kept it there until she was able to process the excellent portion of the news: that it appeared I was Stage I and wasn’t going to need chemo. Both of them were afraid that we were still withholding information or sugarcoating my prognosis. I wondered whether I’d become too accustomed to therapeutic fibbing. My daughters were on the cusp of adulthood. If we were going to remain close, to know each other deeply over the course of a lifetime, we would have to learn how to have difficult conversations.
Radiation wasn’t bad compared with Tom’s waffle iron—until the last stretch, when my nipple became charred and blistered, like an over-roasted marshmallow. It was November, and I had visited my mom only a handful of times since that infamous Labor Day weekend. But now my sore nipple brought up the memory of how, during a vacation in Greece when I was eleven, I’d made the mistake of sunbathing topless and burned both nipples. My mom stayed up with me all night in the hotel, passing me cotton pads doused in witch hazel and cold water. I realized how intensely I missed her. She wasn’t the same person she was in 1983, but, unlike my dad, she was still here, twenty steps from my kitchen. I thought of how often, during my childhood, we would be the last two people awake, whispering into the night. Usually, it was because dark scenarios were playing out in my head. As long as she was there and I confessed them to her, I could make it through.
The last time this happened was almost twenty years ago, when I had just brought Frankie home from the hospital. I hadn’t slept in thirty-six hours. My breasts were engorged, but Frankie wasn’t latching, and my anxious brain was already off to the races, wondering whether I was fit to be a mother. I was crying on the guest bed, and my mom lay down next to me. She reminded me about D. W. Winnicott’s “good enough” mother, whose attunement isn’t, and shouldn’t be, constant. She stroked my hair in the dark. I could feel a faint Parkinson’s tremor, the first harbinger of a storm that was still a ways off but set to make landfall.
When I walked back to my mom’s cottage, Jeromeo smiled at me as if no time had passed. He said that she’d still been enjoying a few bites of fruit from time to time but that she’d started “pocketing”—when Parkinson’s patients hold food in their cheeks because they’ve lost the ability to chew and swallow. I knew better than to ask him how much longer she had. Jerome gave her a bird bath, and I tried to blow-dry her hair, but she was so slumped over that it kept falling into her face. I cleaned her teeth with a warm washcloth, and we gave her a Tramadol so that Jerome could unfurl her hands just enough for me to cut her nails. I massaged scented oil into her skin and put on “Duck Soup,” one of her old favorites, as a break from André Rieu.
In mid-January, two weeks after my first clear scan, our hospice nurse suggested that I call the mortuary. She told me that my mom was going to die in a matter of days and that most people find it too painful to make arrangements in the immediate aftermath. She gave me a scrap of paper with a phone number, and I went to my bedroom, closed the door, and called it. After hearing seventy-five thousand menu items and a drippy piano solo, I reached a sales rep who explained the tiered options for transporting, refrigerating, and disposing of my mom’s body. I knew that dying was expensive, but this guy was trying to sell me on the idea that there’s a skybox version of being turned to ash. I fell for it: I chose the premium plan instead of the basic one, and the “simplicity scattering urn” over the temporary plastic option. He asked whether my mom had a pacemaker because, if so, that would have to be removed at an additional cost. I told him that she had two batteries inside her chest and two electrodes in her brain. “Any type of batteries can blow up from the extreme heat in the retort and damage it,” he said. Apparently, no one had told him in sensitivity training not to refer to the client’s loved one “blowing up” in the furnace. The most devastating news was that the crematorium was in Anaheim, home of the original Disneyland. My mom was going to think she’d landed in Hell.
At the very end, she became agitated. She had caught a cold and needed to get the mucus out of her chest, but was too weak to cough. My sister showed me how to perform percussion, and we took turns patting her with cupped hands. Jerome tried using a suction tube, but when he pulled it out of her throat all we got was an undissolved Ativan stuck to it like a barnacle. She wouldn’t stop moaning, and we tried to give her liquid morphine, but she kept biting down on the syringe, so I finally pulled her lip down and inserted the dropper through a gap where she was missing a tooth. Even though Jerome promised me that the biting was just a reflex, it seemed like her last line of defense and made me think she didn’t want to go. This idea was unbearable, but watching her gasp for air was worse.
The morphine was taking forever to kick in, and she was looking at the ceiling and whimpering, so I climbed onto her rented hospital bed to get in her line of vision. We locked eyes and she quieted down, and then she and I continued to stare at each other for what felt like several minutes. I thought of my teen improv class, which she had found for me when we moved back to New York from London. In improv, even if the given circumstances defy logic, you and your scene partner have to stick to them. I wasn’t sure whether my mom knew that she was looking at me or whether I was just a constellation of interesting, disembodied shapes. I said “howdy doodle”—that’s how she often greeted me. But then I realized that she was communing without words, and I followed suit. Time was running out, and, besides, I had already told her everything. ♦