So Much for That (6 page)

When the two grabbed their customary sandwiches at a café up the street—Jackson could have lived without all the buffalo mozzarella and prosciutto nonsense, aka ham and cheese—he had to ask: “What was all that mea culpa ass-lick with Pogatchnik?”

Shep was always a contained character, but even for Shep his affect all morning had been inhumanly flat, cooperative to the point of nonexistence. As if you could run him through the paces of a DUI stop and he’d touch his nose for you and stand on one leg and count back from a hundred by sevens and it wouldn’t matter that you weren’t a cop and he hadn’t even been driving.

“Oh, that,” said Shep in a monotone. “When I left Handy Randy on Friday”—the guy never called the company Handy Randy, he always called it Knack; Christ, the poor chump sounded like Paul Newman in
Cool Hand Luke
after he’s been in that tiny sweat box for days and he says,
Yah sir, yah sir
, because his will is broken—“I think I said something like, ‘So long, asshole.’ It was an indulgence. I didn’t think I was coming back.”

“Okay, I can see saying sorry, but did you have to crawl?”

“Yes, I did.”

Jackson thought about it. “Health insurance.”

“That’s right.” Shep took one bite of his sandwich and put it down again.

“Correct me if I’m wrong, but I got the impression that my colleagues were aware that I’d originally planned on an excursion. The fact that I came to work today seemed to be the source of some amusement.”

“Look, I’m sorry. Last week Mark was being sarcastic again, and—I guess I should have kept my trap shut. But I was so sure you were really going to go this time…I’m not making any excuses, but it would have been easier on both of us if you’d kept your grand plan to yourself years ago until you were good and ready to press the Eject button.”

“Years ago there was no reason for me to keep it quiet. It was just what I was going to do.”

“Still, I wish you’d let me tell the staff at Knack, about Glynis. Not let them think you didn’t go to Pemba because you’re chicken, or some loony fantasist. They’d give you a lot less grief.”

“Glynis doesn’t want it out. I got permission to tell you and Carol. But otherwise, it’s her business. I’m not going to use her to make my work life more agreeable. It isn’t agreeable anyway and it never will be, so really it doesn’t make any difference.”

“Why do you suppose she wants to keep it a secret?”

Shep shrugged. “She’s private. And letting it be common knowledge makes it real.”

“But it is real.”

“All too,” said Shep.

“Listen,” said Jackson as they headed back. “You want to swing by the house for a beer before you drive back to Elmsford?”

It was obvious that the prospect of doing anything for fun or for comfort or for any reason that had to do with himself and what he might “want” had become foreign to Shepherd Knacker overnight, but Jackson had asked him to do something, so he would do it. “Sure,” he said.

I
can’t stay long,” Shep warned as he drove them to Windsor Terrace.

“That’s all right. We have to meet with that FD support group at nine anyway. Which i dread. oh, it would be okay if it were only shar
ing info on the side effects of medication and stuff. It’s the whole Jewish thing that gets a bit much. I mean, don’t take me wrong, I’m not one of those ‘self-hating Jews.’ I’m just not especially, well, Jewish.” Jackson was babbling, but with a zombie at the wheel someone had to say something. “My mother isn’t observant, and my father has this Basque thing going, which is kind of cool—not that I’d blow up any Spanish politicians over it or anything. And then Carol, well, she was raised Catholic. She had
one grandfather
on her father’s side who was Ashkenazi. So we get all this pressure at the support group to stuff Flicka full of gefilte fish, and technically Flicka’s not even Jewish.

“And these Orthodox loons…When they get married, the couples refuse to get the DNA test. Even after they’ve had an FD kid, they won’t get amnio. There’s a family in Crown Heights has
three
of them. Perfect punishment for being that stupid. Because, sure, Jews are down on abortion. But despite that, the rabbis in
every
form of Judaism—reform to ultra-orthodox? They all tell you that if the fetus has FD, get rid of it. Like, God doesn’t want them to suffer. It’s that bad.

“It just slays me, you know? Supposedly it’s the Jewish
faith
, and you’d think you could choose, right, what you believe in? But no. These fucking genes have been stalking me, man, one generation after another. It’s like being mugged by a rabbi.” Considering, Jackson shouldn’t be complaining about anything on his own account, and he shut up.

Carol and Shep hugged, and Carol said she was so, so sorry. Settling in the kitchen, Shep explained that he’d spent most of the weekend on the Internet, and told them what he knew. He said he was taking a personal day at the end of the week, to go in with Glynis and meet with an oncologist, after which they’d be better informed. Carol asked how he thought Glynis was taking it, and Shep said that she was pissed off but that she was always pissed off, so it was hard to tell. Then Carol asked how Shep was taking it, and he seemed to find the question irrelevant. Obviously I’m scared, he said, but I can’t afford to be scared, or to be anything else, either. I’m the one who has to keep it together. So it doesn’t matter how I am.
I don’t matter anymore
. It was the first thing he’d said all day with real passion.

Carol commiserated over Pemba, though Shep knew perfectly well that she’d thought the whole idea was nuts. He said that deep-sixing his “Afterlife” already seemed like small potatoes, like something that happened a long time ago. He said that the only good aspect of this awful turn of the wheel was realizing what was important. Now he didn’t have to decide whether to leave or not, because as soon as Glynis told him there was no decision. There was no Pemba. It was as if the whole island had sunk into the sea. You wouldn’t think it, he said, but I’ve never experienced any other moment in my life in which everything suddenly got so simple. Shep wondered aloud whether this thing happening out of the blue amounted to a sick sort of divine intervention. He hadn’t wanted to go to Pemba without Glynis and Zach. He shouldn’t have gone without them and now he couldn’t. It was neat and clear. So in this sense the game changer was a relief. The lack of hesitation. The great, glaring obviousness of what he had to do. And wanted to do, Shep added emphatically. Glynis needs me. Maybe she did before, too, but it wasn’t as apparent. When Shep said that your wife needing you, it’s a good feeling, Jackson felt a stab of envy that he didn’t understand.

Shep wasn’t commonly this confiding. He wasn’t a heartless person, far from it, but he was like a lot of guys. It was a perfectly decent way of being, in Jackson’s view, a dignified way of being: he tended to let other people take his deepest feelings for granted. He didn’t name them or wear them on his sleeve. So when he spelled out that he loved Glynis and had not realized until now how much, that now he was remorseful about what he had planned to do when only last week he had cast it as last-ditch self-salvation, Jackson was both offended, and moved. Jackson thought about how much Flicka had changed him and Carol, and how some of that change was bad, like getting so under-slept from the late-night feeding regime that they rarely had sex, but how some of the change was good, too. They had an imperative. They were doing something together that was more vital than sex, and even more intimate, it turned out, which had surprised him. So maybe your wife announcing that she could be about to die would have a similar effect of rearranging
everything, focusing everything, and bringing you together in a way that wasn’t totally, hopelessly, and unremittingly terrible.

Still, when Shep went on about how glad he was that he no longer had to take responsibility for “abandoning Glynis” and “abandoning his son,” Jackson was taken aback; he had never before heard his friend use that harsh and unforgiving word when describing his intentions:
abandon
. Shep said that the diagnosis “took this cup from him,” as his father would have said, and Jackson thought, but kept to himself, that the one transformation he was
not
up for was Shep suddenly going all Christian on him. Instead Jackson said that’s funny, you get out of responsibility by having it dumped in your lap wholesale. Shep said yes, but I feel more like myself now. More normal. Doing the right thing. Taking care of my wife. I did think, Carol hazarded, that walking off into the sunset wasn’t like you. No, said Shep, with a tinge of sorrow. It certainly wasn’t like me. Anyway, said Carol. You know what they say about life and making other plans. Yes, Shep agreed, it’s surprising that we bother to make them. In sounding so philosophical he also sounded older, and there was a boyishness in his best friend that Jackson noticed only now that it was gone.

But with your better cut of people, trouble reminded them that everyone had troubles, that there was an everyone. So Shep didn’t stay on Glynis and Pemba, but asked after Flicka—the girls were upstairs doing their homework—and had the decency to ask after Heather, too. He even asked about Carol’s work, which hardly anyone did because it was so dull, and he wondered whether Carol missed landscape gardening. Yes, she did miss it, she said, doing something physical, involved with the earth. Shep said that he felt the same way, that he missed fixing things, making people’s lives palpably better and seeing the results of his labor, instead of arranging to clean up someone else’s botched job over the phone. He apologized, but he couldn’t remember; he knew that Carol went to work for sales at IBM partly because they let her operate from any computer terminal she liked, be that at home or in Tahiti; she could put in whichever and however many hours she wanted, so long she did the work—a policy that they all agreed with a laugh shouldn’t be revolutionary but was, that the criterion for performing a
job was getting it done. Still, the landscaping had been freelance, with flexible hours, too, and she’d not had a problem, as Shep remembered, being home by the time the girls returned from school, ferrying Flicka to therapists, even rushing her to the ER. Had it really been worth the sacrifice, he asked, for a bigger paycheck? Jackson suppressed an irritation; it bothered him that Carol made more money than he did, as it bothered him that she’d had to give up work that she loved for the reason she had, but everything between men and women was meant to have changed, and this stuff wasn’t supposed to bother him.

“Oh, it wasn’t really for a better salary that I took the job with IBM,” Carol explained. “When Randy took over Knack—you know what a corner-cutter he is, what a bottom-liner—he switched to a cheaper health plan. With all our expenses with Flicka, the therapies and surgeries and bouts in the hospital, we couldn’t depend on Jackson’s coverage anymore.

“See,” she went on, “this World Wellness Group outfit is the health insurance company from hell. They levy co-pays on everything, including the meds, and we have to fill dozens of prescriptions every month. With their whopping deductible, you’re out five grand before you’re reimbursed a dime. Their idea of a ‘reasonable and customary’ fee is what a doctor’s visit cost in 1959, and then they stick you with the shortfall. They’re way too restrictive about going out of network, and Flicka requires very specialized care. Then there’s co-insurance on top of the co-pays: twenty percent of the total bill, and that’s
in network.
And here’s the killer: there’s no cap on out-of-pocket expenses. Add to that that their lifetime payment cap—you know, how much they’ll fork out in total, ever—is also pretty low, only two or three million, when someone like Flicka could easily exceed numbers like that before she’s twenty…Well, we had to find other coverage.”

“Gosh, I had no idea.”

“But you should know, Shep,” said Carol. “It’s your insurance, too.”

Shepherd Armstrong Knacker
Merrill Lynch Account Number 934-23F917
December 01, 2004–December 31, 2004
Net Portfolio Value: $731,778.56

W
hile they drove to Phelps Memorial in Sleepy Hollow, Shep kept one hand on the wheel, the other in his wife’s. Their clasp was relaxed; her palm was dry. They both stared straight ahead.

“It wasn’t necessary,” he said, “for you to go through the diagnostics on your own.”

“You were off in your own little world,” she said. “So I went off in mine.”

“You must have felt lonely.”

“Yes,” she said. “But I had been feeling that way for some time.”

By the next exit, she added, “You’re a planner, Shepherd. You always look before you leap. Really, you leap before you leap. In your head, you took that plane to Tanzania months ago.”

He was relieved that she was talking to him at all. He was willing to be castigated, glad for it.

To his horror, Glynis had already been subjected to abdominal X
rays, a CAT scan, and an MRI. Memories fell into place. On two mornings in December she had declined not only breakfast but even coffee, which for Glynis was unheard of. He couldn’t recall the excuse, but it mustn’t have been persuasive, because the refusal of coffee in particular had injured him; she had spurned one of the sacred rituals of their day. On two evenings, she had kept rising for another drink of water, and yet another. So she’d not been quenching a powerful thirst, but rinsing contrast medium from her veins. Likewise one odd, floating memory finally lodged into an orderly narrative: of walking into the bathroom before she had a chance to flush, and noticing that the bowl was red. It had been awfully early in her cycle, but she was fifty, perhaps getting irregular; aware that she was touchy about the approach of menopause, he hadn’t passed comment. Now he realized: that was not her period. He also realized that she had started to wear a nightgown to bed not, as she had claimed, because she was cold; it was to hide the laparoscopy scar on her belly, which he had now seen. Though only an inch long, it alarmed him: a first violation, and not the last. The nightgown had injured him, too. They had slept for twenty-six years skin to skin.

Since that signal Friday evening a week ago, she had shared only bits and pieces about the tests. So her mention that weekend of one small technicality had stood out. Before the MRI, for which all jewelry must be removed, they had to do an extra X ray before sliding his wife into the tube. “Because they learned I was a metalsmith,” she’d said. “The imaging is magnetic. Metal screws it up. You can’t have any fragments or filings stuck to your body.”

He should have recognized why she had told him this: because she was proud. He shouldn’t have asked her, “So did they find any?” An effective but infuriating gambit increasing in frequency, she hadn’t responded to his question at all, which in this case meant no. They found no fragments or filings. She had worked so little in her studio for months that she could have taken the MRI just like anyone else. Even at such a juncture, he’d had to rub it in.

Your own little world
. Her subterfuge would never have succeeded
without his corresponding neglect. If he had noticed that despite the recent fullness around her stomach she’d grown thinner, he had made little of the observation, which was as good as not having noticed. He thought, I’d no idea that our marriage was in such disrepair, and then he remembered that until last Friday evening he was planning to leave her.

“That night,” he said. “You didn’t have to let me go on like that, about Pemba. You could have stopped me.”

“I was interested.”

“It wasn’t nice.”

“I haven’t been feeling,” she said, “
nice
.”

“How
do
you feel?” Shep was ashamed. In the last week he’d been solicitous, perhaps annoyingly so. Yet in the months beforehand he could not remember the last time he had asked her how she felt.

She took a moment. “Frightened. For some reason it was easier when you didn’t know.”

“That’s because you can give yourself permission, now, to be frightened.” He pressed her hand, just. “I will take care of you.” It was a big promise, one he would fail. But he would fail valiantly, and that was the promise he made to himself.

D
r. Edward Knox extended a hand to Shep, his clasp firm and generous. The oncologist gave off the astringent tang of antiseptic, as if he were one of those rare physicians who really did wash his hands. It was a smell Shep associated with anxiety. “Mr. Knacker, I’m so pleased that you could finally arrange to join us.”

In this phrasing Shep detected reproof, and his wife’s outrageous misrepresentations. In other circumstances, he would have taken her to task for them. Since now he would not, he sensed that taking her to task for anything was now pretty much a thing of the past.

The familiar air with which Glynis took a chair indicated that she had been in this office before. These two had a history together, and though Shep was “finally” here he felt excluded. He got the peculiar impression that for Glynis this office was a seat of power.

As the doctor assumed his swivel chair, Shep adjudged that the oncologist may have been in his latter thirties, although he’d grown ever less certain about ages. While he could still tell the difference between sixty and sixty-five, lately his juniors all entered an undifferentiated category of Younger Than Me, which was odd, since he had been that age before, knew what it felt like and how it appeared in the mirror. But from the perspective of a greater age it always turned out that you hadn’t, at the time, understood being thirty-seven at all, what it was, what it looked like. Unfortunately for current circumstances, younger people always seemed callow to Shep now, their confidence, which Dr. Knox radiated in pulses, hollow and unjustified—that is, enviably self-deceiving. Still Shep wanted to believe in this man, and rather hoped that with friends he went by “Edward” and not by the flip, less reliable-sounding “Ed.” Fit and trim, Knox probably chose fruit for dessert in the cafeteria and made time for the treadmill in the hospital gym; he practiced what he preached. Personally Shep always had a soft spot for medical practitioners who carried twenty surplus pounds and sneaked cigarettes in the staff parking lot. The hypocrisy was reassuring. From doctors, Shep had always sought less authority than forgiveness.

“I apologize that it’s taken us so long to arrive at a positive diagnosis,” Dr. Knox began, addressing himself to Shep. “Mesothelioma is notoriously difficult to identify, and we had to rule out a host of other more commonplace explanations for your wife’s fever, tenderness, abdominal swelling, and gastric dysmotility.” Shep didn’t know what
dysmotility
meant, but he didn’t ask, because then the doctor would know that this was one more of his wife’s symptoms that he hadn’t known about, or cared about, or noticed.

“After all, as I’m sure your wife has told you, peritoneal mesothelioma is very rare,” Dr. Knox continued. “And I won’t mislead you. It’s also very serious. Because the peritoneum is a very fine membrane surrounding the abdominal organs, almost like Saran Wrap, diseased tissue can be tucked into corners that are difficult or impossible to get at surgically.” Shep admired the doctor’s locution, which at least pretended that of course Shep knew what the peritoneum was; Knox was loath
to imply that his patient’s husband paid so little heed to his own wife’s grave medical distress that he wouldn’t bother to look up her diagnosis in a dictionary. “And I’m sorry to say that symptoms of mesothelioma don’t generally make themselves felt until the cancer is fairly advanced. Nevertheless, we have a range of therapies at our disposal. New treatments, new approaches, and new drugs are being developed all the time. The survival rate has done nothing but improve.”

Shep knew all of this from the Internet, but felt it would appear impertinent for him to say so. Besides, it seemed important to allow the oncologist this formal introduction. Shep had already read enough to have registered that most of the nostrums in Knox’s grab bag of tricks were poisons. In the face of being able to do so little, it must have been comforting to the doctor to seem to be useful in this discursive way. His manner methodical but warm—he smiled encouragingly and looked Shep in the eye—Edward Knox had struck Shep from the start as very kind.

But even when doctors
acted
kind, the extent of their capacity to
be
kind was often out of their hands. However gently put, many a message that physicians were forced to deliver was cruel, and if it did not feel cruel it was a lie and thus was even crueler. Personally Shep didn’t understand why anyone would want to be one. Oh, certainly the tasks of stenting an artery and clearing a bathtub drain were technically akin. Yet a doctor was like a handyman who, some appreciable percentage of the time, had to knock on your door and say, I’m sorry, but I cannot clear your drain. That’s all the acting kind was good for: the
I’m sorry
part. And then he walks away and maybe he waves, leaving you with scummy standing water in your bath. Why would anyone want a job like that.

“And I do have some good news,” Knox continued. “First, as I assured you last week, Mrs. Knacker, the MRI did not reveal any anomalies in the pleural—in the lungs. Even more critically, I now have the lab report from the laparoscopy. Mesothelioma comes in two flavors, if you will—two types of malignant cells. The epithelioid are less aggressive, the sarcomatoid much more so. In the samples we extracted, only epithelioid cells were detected. That makes the prognosis considerably more optimistic.”

Glynis gave a schoolgirl nod, as if she had done something right. Shep was about to ask, so what prognosis is that? He opened his mouth and it was dry. He closed it, and swallowed. Instead he said, wanting to be grateful, to play his part, to enter into the spirit of gung ho that was clearly expected here, “Yes. That sounds like very good news.”

At once, he could not help but reflect that only a week ago “good news” comprised the value of his Merrill Lynch portfolio increasing by $23,400 without his lifting a finger. Their son finally passing second-year algebra. Randy Pogatchnik playing hooky at some golf resort, so that for three days working at Knack would be, if not quite the same as the olden days, at least collegial. Glynis being in a playful, indolent mood he could barely remember now, and up for watching an old episode of
The Sopranos
. Now on a dime he was expected to enter a world in which “good news” comprised his wife’s abdomen coursing with vicious “epithelioid” cells rather than the even more vicious “sarcomatoid” kind and this information was meant to cheer him.

“As for where we go from here,” said the doctor, “you may want to commission a second opinion. It’s always possible that other specialists will recommend an alternative approach, but I thought I’d prepare you for the standard course of treatment for epithelioid mesothelioma. Assuming the diagnosis is confirmed, Mrs. Knacker, you’ll probably be scheduled for debulking surgery as soon as possible. This is to remove as much of the cancer as can be reached. We’ve located three patches of diseased tissue in the peritoneum. I’m afraid that the surgeons I have consulted concur that one of those patches is inaccessible. Both to shrink the little bit we can’t reach and to discourage further malignant cell growth, chemotherapy will almost certainly have to follow once you’ve recovered from the operation. To that purpose, a thoracic surgeon will install two ports in your abdomen. This way we can deliver intraperitoneal infusions of heated cisplatin that will wash over your organs, rather than administering chemotherapy through your bloodstream. Unpleasant side effects with this direct application should be markedly less pronounced.”

“Does that mean I won’t lose my hair?” asked Glynis, reflexively touching her crown, as if to make sure her hair was still there.

A shadow crossed the oncologist’s face, a sadness, a pitying, into which Shep could read that such a small damage to his patient’s vanity was bound to be the least of Glynis’s problems. “Patients react differently to treatments,” he said gently. “There’s no way to predict.”

“Besides, it grows back, doesn’t it?” said Shep. This was the role. He was supposed to be upbeat.

A second shadow, and this time one that Shep could not decode. “Yes, once treatments are completed, it certainly does,” said Dr. Knox, seeming to rouse himself. “Some patients find it grows back in even more thickly than before.”

Shep had the sudden impression that this visit, if not the whole song and dance from the X rays and the CAT scan to all the scalpels and “abdominal ports” and vile medications to come, was a farce, a macabre charade. As helpful and soothing as this doctor was trying to be, Shep felt distinctly humored. In turn, he also felt co-opted into a collusion with the doctor, whereby together they were humoring his wife. The joke was on Glynis. It was a wicked joke, a despicable joke, for which she would pay with every fiber of her being. He did not want to be a part of it. He would be a part of it.

“But before we go any further?” the oncologist continued. “Because this is such an unusual cancer, I have limited experience with the disease. Phelps Memorial has seen only two cases in the last twenty years. However, there’s a specialist in internal medicine at Columbia-Presbyterian, who works in tandem with a skillful surgeon. They both have extensive clinical experience with mesothelioma, and have a terrific reputation.”

“Are you trying to get rid of us?” said Shep with a strained smile.

Dr. Knox smiled back. “You could say that. Mesothelioma patients come to Philip Goldman from all over the world. You’re lucky, because for you two he’s effectively right next door. Now, he doesn’t come cheap. It’s likely as well that he’ll be out-of-network for your insurance. You’d need to get permission from your insurer if you want them to fully cover an out-of-network physician, and you’d certainly have a good case. But even if your provider declined, I’d urge you to consider Dr. Goldman.
Your insurer would still pick up most of the bill; I don’t know the specifics of your health plan, but you might just be levied a higher percentage of co-insurance. And given the stakes…Well, I assume that money is no object.”