Last Plane to Heaven

The Cancer Catechism

People say there are no atheists in the foxholes, but people are idiots. It’s awfully tough to believe in God when you’re knee deep in mud, blood, and other men’s guts. Combat is the Problem of Evil on the hoof.

But if you really want to feel the stress of divine regard, spend time in an oncology unit. The half-hidden whispers and the strained smiles and the whirring click of the infusion pumps form a choir of pain every bit as agonized as the howls of the damned in some imagined hell.

You enter your days like everyone else. There is an alarm clock sometime before dawn, an electronic voice calling to you through the fragmented wilderness of your dreams. There is a moment of blessed relief as you take the day’s first piss. There is that odd echo of flowing warmth in your shower. You shave, perhaps your face, perhaps your legs, depending on your hormonal balances and grooming preferences. You stumble into hopefully clean underwear and minimally food-stained clothes. You microwave yesterday’s coffee and choke down a pair of brown-sugar-and-cinnamon Pop-Tarts.

Ablutions, evacuations, and alimentation taken care of, you move out into the wider world.

Sometimes you wonder why you do it this way. Two hundred and forty work days a year. Fifty years of a working adult life. Twelve thousand days of this routine, more than half of your allotted twenty-two thousand. Ninety-six thousand hours out of your life, a quarter of the waking hours you will ever experience.

For what? A paycheck? Friday nights spent drinking with your college buddies before they drift off earlier every year, consumed with bleary-eyed guilt toward tired spouses and squalling children?

Still, you do what everyone does. Then sometimes you do it differently. You take a weekend to the coast. You fly away at the holidays to visit aging relatives who still think a sweater vest is a good idea for a gift. You go camping up in the hills and throw out your back sleeping on rocks that were pebbles when you lay down but boulders when you woke up.

Because, really, what else is there? Life is years of sheer, endless boredom punctuated by occasional bouts of the mildly interesting. Not much to do, not much to believe in. Just eat, sleep, shit, breathe, breed, grow old and die.

Somewhere along the way, you acquired your own partner. Or two or three or four, usually in a row with minor overlaps. Serial monogamy is the American way. Changing relationships has become like switching from Cheerios to Rice Krispies. One or two of those partners helped you produce sprogs, either by donating a small amount of warm, sticky fluid to your own efforts, or through dint of nine months of vomiting and backaches and blameful mood swings.

There’s not much to believe in except your kids, and in truth, what are they going to grow up to be? Assuming video games don’t corrupt their plastic little souls and global warming doesn’t drown them in their beds with rising sea levels, they’ll just turn out like you.

Then one day you find blood in the toilet while stumbling around amid receding somnolence. Maybe you ignore it for a while, maybe you dart in immediately to see your doctor in a grip of panic. Still it comes back again and again until you do seek medical advice, that little harbinger of terrible things to come which you cannot yet admit to yourself.

Because that day, you have finally found something to believe in. Something real. Something intensely personal. Death doesn’t play chess for souls anymore, or sit down to an unfriendly game of Texas Hold ’Em. Death approaches along a pathway built from silvery needles and grim lab reports and the hum of CT scanners.

It’s a different game now, and some blood in your morning shit has proven to be your table stakes. You’d best believe you’re playing for your life.

Oncologists must take classes in how to deliver difficult news. Their medical specialty is as devilish and soul-crushing as a loaded pair of casino dice is to a drunk’s last dollar. You can see the distress in the doctor’s eyes as she comes into the room, not quite meeting your pathetic attempt at a frank gaze.

You’ve promised yourself you’ll be open, accepting, strong enough to deal with whatever comes. The blood work was no big deal. The CT scan with its strange bodily warmths and curious surges was almost entertaining. The PET scan was just strange, like a B-list superhero’s origin story writ mundane. The colonoscopy, well, the less said the better, but at least it didn’t hurt. The best way you’ve been able to describe that procedure was as resembling a small-budget alien abduction experience.

Tests, tests, tests, to prove that it’s really all okay.

You’re young. Sort of.

You’re healthy. Mostly.

You have the love of family and friends. At least, that’s what they tell you.

Whatever this is, you will get through it. Whatever this is, you won’t let it beat you out of all those precious moments that you’ve suddenly realized make up your life.

“I’m sorry,” she tells you, finally locking eyes with you for a moment. “It’s definitely colon cancer. The good news is that there doesn’t seem to be any metastasis. The bad news is it appears to have interpenetrated the colon wall, which means the disease has spread past the original site. I’ll be referring you to a surgeon in the Digestive Medicine group for a resection. After that, we’re probably going to have to prescribe a course of chemotherapy.”

At least she delivers the information concisely, using words you can mostly understand once your sense of horrified denial has settled somewhat. There are so many questions, but you can’t ask them all, not right then. Cancer’s got your tongue.

You feel the demon settling in where it clings to your back. Its long, barbed tail circles your waist then slides into your anus and upward along the Hershey highway to begin the slow, mortal feast that will eat you out from within.

The world is different now. You have something to believe in after all. Your oncologist is your psychopomp. Your surgeon will be your ferryman across that river of dread.

There’s another side of life, and you suddenly realize that you have seen it far too soon.

Surgery takes you strangely. Going in you joke and smile bravely and pretend this doesn’t concern you very much. The surgeon and his assistants have disclosed risks to you, side effects, the various debilitations and deaths which can befall anyone unlucky enough to be splayed beneath the scalpel upon an operating table.

Still, you don’t know what to expect, so you try to expect nothing except a new experience. Cold and naked under a ragged little swatch of oddly printed cloth, smiling strangers wheel you away down vacant corridors into the countries of the knife.

It is the anesthesia that puzzles you most. Even in sleep, you know if you’re warm or cold. Your bladder tells you when to get up for at least a few stumbling moments. Time still passes. A crying child or a lover whispering your name will wake you.

Anesthesia, though… It’s a little death. Not in the sense of the French petit mort, but a preview of finally dying of this dread disease. Like a movie trailer for the blank nothingness that is eternity once consciousness has been extinguished. One minute you are counting backwards to a frowning woman in a surgical mask, the next minute you are swimming in fog, surrounded by curtains, hearing machines peep and bing the measures of your metabolism.

“I’m still alive,” you say. Your aunt chuckles and squeezes your hand and tells you that’s the fifth time you’ve said those words in the last twenty minutes. It must be important, then, is all you can think in reply, but self-consciousness has returned with the rest of your awareness, so you just smile and squeeze her hand.

You lie there laced with needles and tubes and think about the irony that you have for a few hours touched that far shore, and can remember nothing of it except a blankness so profound it cannot truly be called a memory.

Cancer has brought you another lesson closer to finally understanding death.

A few days later, home from the hospital, you slyly enquire how the surgery seemed to other people. Your friends tell you they knew you would be fine. Your mother pretends not to weep. Your spouse rolls their eyes and tells you not to make so much drama of it all. Your kids hide from you, needy and avoidant all in the same moment in that way only children can manage to be.

It takes you a week to be able to get yourself out of bed. Your morning shit turns into hours of sitting, waiting for gravity and intestinal gas to do what peristalsis cannot manage for far too long after the surgical insult to your colon. You have a lot of time to think while perched on the toilet. You think about softer toilet seats and moisturized toilet paper, but you also think about how people don’t tell you so many things lately, how even many adults are as avoidant as the kids, even if they’re more subtle about their abandonment. You think about what it means to go through this, and what chemo will do to you, your family, and your friends.

You think that if you were finally going to find faith in your life, it could have been focused on something more constructive and less disturbing than fucking cancer.

Someone comes into the room because you were yelling without realizing it. You can see the fear naked in their eyes. It doesn’t matter who this is, because that same fear has stripped itself bare and slipped into the eyes of everyone who cares about you.

That is something you can believe in as well.

Chemo is an entirely different chamber of horrors than surgery. You find new fields of pain and loss there, novel revelations to feed your burgeoning faith in cancer. There are needles, of course, but you have rapidly grown accustomed to them. The drugs aren’t so bad the first time or two.

But where surgery dropped you swiftly into a hole which then took a month to climb out of, chemo lowers you slowly, inch by inch, week after week, into a hole which you may never climb out of. Starting with your dignity and ending with your sense of self, chemo takes everything away from you.

Those mornings of yours grow later and later. You begin to miss work and misunderstand your spouse and children. The smallest things become difficult and the largest things become impossible. You never knew how large a thing standing in the shower could be.

You can’t drive, and you don’t have the energy to be a passenger for long, so you stop going out even when people are willing to give you rides. You stop seeing your friends unless they make the time to come to you. Your kids avoid you because you smell funny, like sweat and puke and chemicals. Your spouse doesn’t hold you at night anymore because they are afraid of somehow hurting you.

You become ingrown, a tumor on the body social of your family and friends. Silent, mostly quiescent except for the daily violence of various fluids irrupting. You straddle the line somewhere between deadly and dead.

The worst thing is that chemotherapy robs you of your mind. You lose the ability to focus properly, to create, then to consume. In time you are reduced to watching reruns of old shows on Netflix streaming, because you can process nothing new. You repeat yourself when you speak at all. You feel desperation.

Cancer has covered over your life, a blanket damp with sweat and blood. You are tired beyond measure, like the day after a bad flu combined with the worst hangover you have ever had, and it does not end. Day after day, week after week, month after month, alone with your increasingly muddled thoughts and the whispered gospels of cancer being recited with every beat of your heart and every momentary flow of your blood.

“Memento mori,” it tells you. “Respice post te! Hominem te esse memento!”

“Remember that you will die. Look behind you! Remember that you are only human!”

Death becomes a kind of friend. It rides on your shoulder like a carrion crow. This skeletal bird remains as invisible to the people around you as your tumor ever was, but it affects them just as much. You are branded by its talons, blinded by the peck of its beak, deafened by its silent screeches, but this bird and you become closer than school chums, closer than lovers.

In time it grows into a sort of comfort. One way or another, this will all end. The story will go on, and be seen as a tragedy by some. But the promise of chemo is twofold. In death’s own language it whispers to you that you might survive, or that you might come to an end. That far shore which surgery showed you unremembered glides past the sinking raft of your suffering. You can see all too well its towering black cliffs and crumbling ravines.

Someday, probably someday soon, you will go home to that place you’ve never been before.

There is no devil mocking you. God didn’t give you cancer to punish you. Colon cancer has come to you through a combination of losing the genetic lottery, cosmic rays, and perhaps too much bacon in your younger days.

Coming out of chemo finally, you know these things. Your life has been stripped down and annealed. Some friends have drifted away out of fear or a sense of frustrated helplessness. Your spouse might have left you in the face of the disease. That happens more often than even oncologists want to admit. Your kids cry because they’re afraid you’re leaving them soon. Your parents’ eyes are haunted by this potential reversal of the natural order of birth and death among the generations.

Still, you are alive today.

When a Christian friend in mortal fear for your soul begs you to get right with God before the disease claims you, you want to tell him you have already found another faith. You believe in the end of all things, and though it is bitterly disappointing to face that far shore, you aren’t so frightened as you once were. Death is no longer abstract. It’s now a personal companion. The bird on your shoulder stays with you, and you want to share that with your Christian friend, but this is not a faith for which you can proselytize.

Cancer, like combat, is the Problem of Evil on the hoof. You have met the enemy and he is yourself. Your tumor children may yet claim you, but now you have a dark sort of faith to guide you through these, your darkest hours.

You still dream of that far shore and the blankness that will keep you from ever seeing it. That journey once made will never be remembered except in the echoes you leave behind in other people’s lives.

There are no atheists in the oncology unit. Only the catechism of cancer, and the difficult comfort it brings even amid the worst of times.