The Big C

I went looking for Sandy. In the backyard she sat on a bench made from an old wooden railway sleeper in the shade of a tree. She held her head in her hands. I walked up behind her, calling to her as I approached so I didn't surprise her. She straightened and wiped her eyes before turning around to face me.

"How is he?" she asked sniffling.

"He's asleep in his armchair," I said sitting beside her.

"Thank god." Her head slumped into her hands again.

"When did you see the doctor?"

"Yesterday, it was horrible! We weren't expecting the bad news. We were planning a trip to an ashram in India."

"How bad?" I asked with trepidation.

"Six months left, there were two new small tumors on his liver and bowel with another bigger one on his spine. They said they could operate on the liver and bowel, but the one on the spine was inoperable."

"Shit!"

We sat in silence,. Sandy started weeping again, so I put my arm around her shoulders. When she calmed down, I asked another question.

"What was the doctor's plan of attack."

"We didn't get to that. Jack just freaked and stormed out. I caught up with him in the car park. We went to the supermarket and he went berserk buying alcohol, meat, chips, crackers, cheese, and everything we had avoided for twelve months.

We gorged ourselves last night. I woke up with a hangover and when I came out mid-morning he was outside in the sun drinking. He wouldn't listen to reason and that's when I rang you."

She blew her nose loudly.

"Thank god you came...I didn't know what to do."

"I didn't either Sandy. I just winged it. I've seen it before, but every situation is different."

"What do we do now?"

"We act normal, wait until he comes around, and see if his mood has changed. No matter what, we support him. If he wants to drink himself into oblivion, then I don't see why we should stop him. He has to decide himself, the same with the doctor. We can counsel, but in the end it's his decision.

We stayed in the shade for an hour, then went inside. Jack remained passed out, so Sandy made us some lunch while I cleaned up the broken bottles. We were eating when Jack woke up. He groaned and stretched. Then suddenly he was up and running to the bathroom. The hand clamped over his mouth revealed the reason for the dash, as did the loud sounds of Jack's vomiting.

He came back into the room with a sheepish look on his face, walking stiffly. The front of his body looked badly sunburnt as he came and sat down with us.

"Would you like something?" Sandy asked, moving her chair so she could swing her legs out and get up.

"No, no, god no. Finish yours, please."

We ate in silence until Jack spoke again, "sorry guys. I guess I flipped out there for a while."

Sandy put her hand on his and gave a tired smile of forgiveness. He grimaced as she squeezed his sunburnt flesh.

"Sorry, I'll have to get some lotion on you. You must almost have heatstroke."

"I would have if Allen hadn't got me inside. Thanks mate, it's great to know we have a friend like you." He said warmly, a far cry from the earlier abuse.

"Anytime, anytime...Do you mind if I ask what you are going to do now?" I asked cautiously.

Jack thought for a moment, "Well, I'm not going back on that diet." We all gave polite chuckles. "Other than that, I don't know."

"Are you going to go back to the doctor?"

"Not much point. He gave me six months, so I might as well stay home and enjoy it."

"It's up to you, but even if you have decided to die, you are going to need a palliative care plan." It was a cheap trick, but I hoped the stark reality of giving up would make him see sense.

"I don't want to go through all that shit, again: the needles, the radiation, the feeling sick all day and night." Jack shook his head as he spoke to emphasis the points.

"Just go and talk to him. He may have other options, or he can help make the time you have left as comfortable and pain free as possible," I explained.

"He probably won't see me again."

"If you think you are the first patient to walk out on an oncologist after being told they had an expiration date, you're mistaken. Give the office a call. I'm sure they will be worried about you."

"Please, Jack. Let's just talk to him," Sandy added.

"Alright, I'll ring him before they shut today and check when we can see him again." Jack said to the relief of Sandy and me.

As things calmed down, I thought I might be able to head home, but Sandy wanted me to stay.

"Please, Allen. It would be great to have you around after we see the doctor. You have such a level head."

"Best to check when you can see him, again." I replied.

Sandy looked at Jack. He walked stiffly over to the telephone and called the doctor's office. The doctor was very keen to talk to them and arranged for them to come in half an hour before normal consultations started the next day.

After Jack got back to the table, I again tried to say goodbye, and that I would meet them at the doctor's the next day.

"Nonsense," Sandy blurted out. You can stay here tonight. I'll make up the spare bed."

"Yes, Allen. It's ridiculous to go home now and come back tomorrow. Just stay and you can go home after the doctor's." Jack backed up his wife.

"Alright, alright. I'll stay, then." I said with a smile.

Jack looked a little worse for wear from his morning in the sun. He glowed like a stop light. Sandy pointed to the bedroom.

"In you go, lobster boy, I'll get some body lotion and slather you from head to foot. It might help cool you down."

"I like the sound of that," Jack replied, but as he went to stand up, his face showed just how painful his sunburn was.

The next morning, we were in the waiting room of the doctor's office. He came out and invited Sandy and Jack to enter.

"Is it alright if Allan comes to? He's a close friend."

"Sure," the doctor replied.

He seemed excited that Jack was back, so I think he had something up his sleeve. First, he discussed the impossibility of removing the tumors. In a nutshell, the one on his spine was rooted into the cavity of the spinal cord. Removing it had an unacceptable risk of leaving Jack a quadriplegic without ridding his body of the cancer. Due to the sensitive area, radiation wasn't an option either. The previous chemotherapy hadn't worked. So with tumors as an added boogie, it was out as well. It was similar to my wife's situation and I waited for the palliative care talk. However, he had an ace in the hole.

"There is a trial of a new drug happening through the university hospital at the moment. I spoke to the professor in charge and sent him your case notes. He wants you in the trial." Jack and Sandy sat up straighter. "I must caution you this it is not, I repeat, not a cure. However, this drug has been successful in prolonging the life of others in the late stages of cancer by dramatically slowing the growth of existing tumors and preventing new ones."

Sandy asked the obvious question, "if it's so good, why haven't we been on it before."

"There is a hitch. You have to realize that most of the chemicals we use in chemotherapy are poisons. Basically, we almost kill you to heal you. This is an effective drug protocol but it will kill you before the cancer if you stay on it more than fifteen months. This trial is only for people with a diagnosis of six months or less to live. The professor is trying to work out a way to make it safer."

"So, I'm a guinea pig," Jack said dismissively.

"Yes, but in twelve months' time you will likely be a live guinea pig. Whereas without this drug, you probably won't be."

Jack and Sandy were quiet, holding hands, and looking at each other. I thought they should hear the other side of the equation.

"Doctor, could you explain how the disease will progress without treatment and what interventions would keep Jack comfortable?"

"Yes, that would be a good idea," the doctor said rubbing his forehead. "It is a bit hard to say, but given how quickly the tumor on your spine has grown, I would think that it will start to impact your quality of life within two months. Initially, you will feel pain in your lower limbs as it put pressure on the spinal cord, then pins and needles. Paralysis is possible by four to five months. By then the other tumors will have grown, compromising your internal organs. We would work on pain management. When it got bad, we would operate inserting a morphine pump. With the press of a button, you would self-administer the drug. I suspect you will be in a hospice for the last month, depending on when you become paralyzed."

"If they decide to go on the program, they get an extra twelve months. Then what you just described, the paralysis and such will still occur." I added for clarification.

"Yes, that is likely."

"Something else they might need to know are the side effects of the new protocol?."

"Ah, yes. The doctor went through a file and passed Jack a card. "This lists the side effects of the treatment. Considering the toxicity of the drug, they are quite mild. Still, they are significant and you should consider them. Not every person gets everyone of them. Generally, it's considered that any one patient will only experience a couple of them."

"And lastly, how long will the actual procedures take and what other tests are required?"

"Arr, that's the beauty of it. It's one day per fortnight. The professor mixes it the night before. Then its couriered overnight to the local hospital. You spend one hour on a drip and you're set for the fortnight. You will be very tired for twenty four to thirty hours after the infusion, but okay after that."

"It's a lot to take in,." Jack shook his head. "Can we have some time?"

"Yes, certainly, but I would like to know before I finish today. If I let the professor know, then he can start you next week."

Jack and Sandy looked at me, "let's go and find somewhere to have a coffee." I said.

We left the offices passing more frightened people in the waiting room, poor bastards. We found a little place for takeaway coffee that smelt half-decent. We got three cups and went to a park. We sat at a table. Jack and Sandy on one side, I on the other. I took the side-effect card off Jack and read through them. They were all too familiar: nausea, vomiting, hot flushes, itching, hair loss, dermatitis, impotence, lethargy, loss of taste, loss of smell, and insomnia. The list went on and on.

I asked the unhappy couple their thoughts about the treatments.

Sandy looked at Jack. "Obviously go for it, with the new drug treatment, but it's really up to Jack. He is the one that has to go through it..." she broke down and started crying.

"That's where you are wrong Sandy. You are going through it with him and, in the end, you have to think of a way to carry on." I interjected.

Jack put his arm around his wife and consoled her. "It's not much of a choice really. If it only gave me another week with you, I'd do it. One year...it's like a lifetime."

We were all blubbering now. Once it had subsided, Jack fixed me with a steely stare.

"How bad does it get at the end?"

I stopped and thought for a moment. "There is no getting around it. It's tough, but most people find a peace that makes it easier. My wife struggled with it for a long time, until she met somebody else, a sixteen year old that had only weeks left. The girl was happy and joking with other patients. My wife asked her how she could do it, when she knew the end was so close.

She answered she was lucky. Everybody dies, most don't know when. I've known for four years that I have a date. Other people walk out their front door in the morning, thinking they'll see family tonight or go to Paris next year. Then they get hit by a bus and that's it. I've packed a lot into my sixteen years, my family know that I love them, and I'm ready.

You're tough, Jack. You've fought a good fight, but know it's about living what time you have left."

"You mean a bucket list?"

"Don't get carried away with all that. Sit down and work out your priorities. You don't want to spend too much of your last twelve months in airport lounges and driving across country. My wife and I found spending time with family and friends, giving them a chance to say goodbye was the most important. We did some traveling, but not just for the sake of seeing an object or natural wonder. It was about connecting with those close to us."

We finished our coffee. The sun rose high in the sky and the heat bordered on oppressive.

"I suppose we should go and tell the doctor we are going to do it." Jack said to Sandy.

"I'd better get home. My daughter's coming from Western Australia this weekend." I stood up and stretched.

"Oh, dear. Sorry Allen, you should have said. I feel terrible dragging you away." Sandy, now standing next to Jack, reached over and placed her hand on my shoulder.

"No, it's fine, really. I hope I've been some help. I'll get home and make up some beds before they get there."

"Thanks again Allen," Jack offered his hand for a handshake. "Don't be a stranger!"

"Don't worry. I'll be around so much you will think I'm a stalker." I replied shaking his hand.

Sandy gave me a hug and a kiss on the cheek. Then they walked in the direction of the doctor's office. I found my car and headed for home. The next week was full of family things for me. My daughter and son in law had some great news. They were expecting their first child, my first grandchild. I had quite a shock when I had seen her, because she was already five months along. The ultrasound had shown she was having a girl. They were going to call her Mary, after my wife.

After they left, I rang Jack. He had been to the city to meet up with the professor and have his first treatment. From then on, it would be done at his local hospital. There would still be trips to the city every five weeks to have scans and blood test, so they could assess his health.

Jack gave up any thought of working. His life insurance policy was good, which allowed a payout of seventy percent if you were diagnosed with a terminal illness. It was enough to cover their debts giving them enough money to live on for the next eighteen months, without Sandy working. They were in the process of working out their priorities for the next twelve months and he assured me that there would be time set aside for our fishing.

Even with the assurance, it was six months before we wet a line. In that time Jack and Sandy clocked up a lot of kilometres. The need to get back for the next treatment every fourteen days kept them hamstrung, but they still managed to go to New Zealand, Bali, Hong Kong, Fiji, and a long haul to London to see relatives.

We got the tinny in the river, set the Minn Kota for trolling speed, and put a couple of lures in the water. Then we promptly forgot about them. Opening a couple of cans of beer, I passed one to Jack. In the late winter sun we caught up with what had been happening in each other's life. Jack's treatment had turned out to be even better than the doctor had advised. The tumor on his spine didn't just stopped growing, but shrank slightly. There were no new ones on his internal organs. Side effects had been minimal, mostly just tiredness after the treatment.

It was a relaxing couple of hours, not just for us, but for the fish as well. We hadn't got a nibble. We were in Jack's truck, with the boat behind, driving home when he lobbed me a figurative hand grenade.

"Have you been with another woman since your wife died?"

It was a fair enough question. I'd asked Jack some personal questions about his treatment, so I was surprised by my defensive reply.

"No, of course...not," it sounded like I was still married.

Jack noticed. "It's coming up to three years isn't it? You're not still married you know."

"Yes, of course, I know," I replied testily. Then in a more friendly manner said, "Sorry, still a sore point, I suppose."

"Have you...you know...had any thoughts about...it?"

"Yes, a few times."

"Ever try to do something about it?"

I sighed, "after I got my all clear for my cancer I...I stayed in the city and I got an escort to come to my room."

"You sly dog, how did that go?"

"It was embarrassing really. She was so young, I kept thinking of my daughter. So I paid her and told her to leave."

"Did you, um, do anything?"

"No, I didn't. She took her clothes off, sort of a strip tease. Then she started undressing me and I realized that I couldn't do it."

We were both quiet for some time, as Jack backed the boat into his shed. He stopped and looked at me.

"Is that what you meant in the park that day?" I must have looked unsure. "You know, what you said to Sandy. You have to find a way to carry on after."

"I suppose so."

"Sounds like you're not doing much of a job of that yourself."

"I never said I had all the answers."

We put the boat cover on and then went into the house. Sandy had dinner ready so we ate. After dinner, I said my goodbyes and made my way home. Jack's words, about not carrying on with life bounced around in my head as I drove.

It was true, in many ways I acted as if I was still married. I hadn't made any changes to the house. All the pictures and furniture were in exactly the same place they had been when I carried my wife to the car to take her to the hospice. When I got home I looked around. I sat in my chair and flicked on the television to see what the late movie was. I didn't need change I decided. I was happy here. My wife was still with me in my heart, and that was enough for me.

I continued to see Jack and Sandy every fortnight. I would go to their house on the Saturday, before he had his next treatment. Sometimes, we went fishing. Sometimes, we watched the local team play footy at the oval. Afterwards, I would have dinner and then drive home. It continued like that for five months, becoming something of a ritual.

I guess seeing him regularly, I missed the early signs of Jack's physical decline. He was a tough guy so I suppose he hid it from us. I first noticed he'd developed a bit of a limp. Later he seemed unsteady, unsure of where to place his feet. As I helped him into the boat, he seemed frailer. When he got to his chair on the bow, he sat down heavily with a sigh.

"Are you okay mate? We don't have to do this today if you're not up to it."

"No, no. I might not get many more chances, so let's go." Jack said waving away my concern.

I started the main motor to get us away from the shore and the people at the boat ramp. Then stopped it and drifted with the electric one so we could talk.

"Is it starting to get worse?"

"Yeah, it's not bad, but I'm getting pins and needles in both legs. It comes and goes, sometimes I can't feel them at all."

Shit, I thought to myself, here we go again. My feelings must have shown on my face, because Jack reacted.

"Cheer up Allen, you're not the one dying," he said in a lighthearted, jokey way.

I felt worse. Someone dying, telling you to cheer up puts things in perspective. For the rest of the trip, I talked about everything from politics to Miley Cyrus's raunchy music video. That steered the conversation towards sex and Jack pounced.

"So have you got a girlfriend, yet?"

"No, still celibate." I replied with good humor. He didn't catch me on the hop this time.

Jack pushed his cap back on his bald head and scratched his scalp, then sat forward and said in a low conspiratorial voice. "What do you think of Sandy?"

"She's beautiful, Jack."

"Oh, yes, she is that. I got very lucky there. Definitely punching above my weight when I got her." He grinned. "Would you do something for me, Allen?"

"Yeah sure, Jack."

"Would you sleep with her?"

He definitely had me flustered now. "She's your wife!"

"Yes, she is my wife...unfortunately, um, I haven't been able to be...much of a husband to her, since I started this new drug."