Part 11. Gut Check
If I pulled my intestine from a hole in my body and stretched it out, it would reach twenty feet in front of me, maybe more. This is the length of a fabulous gain by a running back in either pro or college.
This twenty feet of gooey innards is wrapped up inside, crammed into my stomach cavity, like Pillsbury poppin’-fresh cinnamon rolls ready to explode from the tube.
Larry McMurtry’s wonderful western novels include brutal torture scenes in which his cowboy heroes are captured by cruel enemies who poke a hole in the cowboy’s gut, pull out a handful of innards, then give the intestine’s end to a dog. The dog runs until the cowboy’s insides are outside.
That was the first thing that came to mind when I began hearing about the surgery that awaited. It was my intestine, after all, that was the root of my problems.
Near the end of my intestine was a puckering piece of flesh called the rectum. It’s the emergency exit for all the horrifying stuff my body expels.
A week after the train-station phone call from Doctor Martinez, I was in the multi-specialty clinic of the Dana Farber Cancer Center in Weymouth.
I’d met with Doctor Martinez a few days before, mostly so he could discuss his findings with me face-to-face. He showed me a diagram of what he had discovered in his ass exploration. He mostly wanted to talk me through it. He made no effort to brush off the seriousness of my problem or the size of my tumor. To prevent the instrument from entering my ass, the tumor was what we might call — in non-medical terminology – a king-bitch dog-fucker of a tumor.
“But you will be in, uh, good hands,” Martinez said. “I was able to get you in with Doctor Christian Corwin at Dana Farber. I don’t know him, but I have heard, uh, nothing about him that was not excellent. He’s really one of the best and most respected surgeons, with, uh, this kind of surgery.”
With asshole surgery, I thought. What you’re telling me, Doctor Martinez, is that he’s good with assholes.
He handed me a card. “This has my cell number on it,” he said. “I want you to call me any time you have a question or any time you need to talk. Please.”
I told him I appreciated the generosity of this offer.
“If this had to happen,” he said, “well, then. uh, it’s happened in a good place.”
He smiled. “No, no.” He paused a minute to let the smile fade. “I mean here, in this medical community. Boston. Some of the greatest physicians and, uh, the most significant research — it’s happening here.”
True. If you have to get cancer, move to Boston. Hell, maybe I should get in on promoting Cancer Tourism.
But I was even luckier — that some of the great hospitals and research centers had Rorschached all over Boston area, from the North Shore, through Boston and Cambridge, and down to where I lived on the South Shore.
A lot of the big hospitals are in Cambridge or in the Longwood area of Boston, so I lucked out that Dana Farber had a center adjacent to South Shore Hospital in Weymouth, two towns over from my little Norman Rockwell town of Cohasset. That Dana Farber at South Shore was also affiliated with the Brigham and Women’s Hospital was the cherry on the sundae.
This Dana Farber campus was also just 20 minutes from home. Unlike the mothership in Boston, this required no time on the Southwest Expressway, which at rush hour looked like a Walmart parking lot on Black Friday.
I was lucky. I remembered some of those tales of hospital hijinks from my days in Florida — about the medical team that amputated the wrong leg or the healthy ballplayer who’d gone into the hospital for an ACL repair and come out dead.
At least if I had to get cancer, I got it in a great city for treatment.
Growing up in a medical family I was always critical of doctors other than my father and brother. I admired Dad and Charlie and knew how much they cared about their patients, but I rarely saw that level of concern in other physicians. They might smile and mouth the reassuring words, but they practiced what Nicole called “protocol care”: this is how we do it for all patients. They treat symptoms, not people. They didn’t seem to listen to patients much at all.
Most doctors don’t hand out cell phone numbers. That he gave me his personal cell spoke well for Doctor Martinez and his concern for patients. I’d never call him, but I knew that I could.
But now it was a week after the train-station phone call and hearing those three little words. As I settled into the shared waiting room for the Multi-Specialty Clinic and the Breast-Cancer Clinic, it struck me that I was a member of the club now: a cancer sufferer.
I was sent to the Multi-Specialty Clinic on the third floor Dana Farber, which had a shared waiting room. You could easily spot the breast-cancer patients: women in pastel turbans to cover their hair loss, frail, but smiling.
As I looked around, I imagined the backstories. There were husbands there with turbaned wives, some turbaned women alone, some hale-and-hearty women sitting next to visibly shrunken men.
Was that my future — wasting away?
I always look at the upside: hey, maybe I’ll finally lose some weight on the Cancer Diet.
Next to me, Nicole sat scrolling through her phone, looking for news about midwifery or Kardashian-related bon mots.
“Mister McKeen?” I was being summoned.
“Here we go,” I muttered under my breath as I stood up.
A nurse took me to an examining room for my vitals. When I got on the scale, I told her, “I know you have to do this, but I’d really rather not know that figure. Please don’t say it aloud.” It was my Aunt Edna approach to weight control.
She smiled, recorded the horrifying weight figure, then led me to another exam room across the hall. “Doctor Corwin will be in in just a minute,” she said.
Nicole and her phone were already seated along the wall. I’d barely gotten settled when Doctor Corwin walked in.
He was probably mid-forties, with one of those faces that you can’t conjure ever being angry. He had smile lines and spoke from the side of his mouth, apparently well-practiced from a lifetime of Groucho Marx asides. His hair was short and immaculate. I thought it might’ve been painted on.
“Christian Corwin,” he said, shaking hands. It was a good grip and I looked down. Pretty soon those paws would be inside me. He pulled up a chair and leaned back. We commenced the getting-to-know-you sniffing period.
Mostly this was to find out what we did for a living, where do we work, the usual pleasantries.
“I’m a home-birth midwife,” Nicole said.
“Really? That’s cool.”
That was not the usual response Nicole got from physicians. Most felt threatened by the continuing ascendancy of midwifery and dismissed her with skeptical scorn, though they usually stopped short of calling Nicole and her kind sorceresses. Instead, Corwin seemed genuinely intrigued, which got her attention.
“You know,” he said, after listening to her talk about her training. “It makes so much sense for majority of births to be done at home. Why go to a hospital to give birth? It’s not like you’re sick.”
For the first time that day, Nicole smiled. “Exactly,” she said.
“My wife and I wish we would have had a home birth.” He shrugged. “I mean, you’d think I could handle it, but my specialty is with the other side.” He looked at me and the both of them laughed, my ass the apparent object of mirth.
Nicole did most of the talking. Her midwifery training made her skeptical of most physicians and she grilled Corwin, but he didn’t turn defensive.
“So what is your experience?” she asked.
“Good question,” he said. “Folks do need to know more about these people who are going to cut on them.”
He’d grown up in Connecticut, gone to med school at UConn, and done a residency in Minneapolis. He’d also been a Navy flight surgeon and had been stationed in Guam and the Middle East.
“Flight surgeon? My dad was a flight surgeon,” I said. “Air Force, of course.”
“Really?” Corwin acted like I’d just told him he’d won the lottery. He asked about my father’s background, where we were stationed, where he was trained, how hard he worked.
“I remember in high school, after Dad went into private practice. We’d all get ready for bed, then around 11 the phone would ring and I’d hear Dad go downstairs and back to the hospital. Sometimes, he was just getting home when I was getting up for school. I don’t know how he did it.”
Corwin’s smile dimmed somewhat. “Did you resent it — him being gone so much?”
“Oh, no, not at all,” I said. “I was so proud of him. He’s been dead since 1974, but when I go back home and people hear my name, they ask if I’m his son. They get all teary-eyed just talking about him.”
“My children are little,” Doctor Corwin said. “You worry. I do, at least. Seems I’m gone a lot.”
“I was nothing but proud to be his son. I’m sure your kids will feel the same way.”
We talked some more and I began to feel that the real doctor’s appointment must be some other time. We’d been there nearly an hour and we were still doing the get-to-know-you stuff.
This was a conversation, not an interrogation. He appeared in no hurry to bustle out of the room to meet the other half-dozen patients on other tables in other rooms. It occurred to me that there weren’t a half-dozen other patients on the other side of the walls. This wasn’t assembly line medicine. Doctor Corwin really wanted to get to know us. I suppose if I was going to have to stick my hand up someone’s ass I’d want to know them first.
We ended up talking for nearly an hour without any explicit mention of my asshole, let alone any surgery on it.
“So — after the Navy,” I asked. “What brought you here?”
“One of my buddies settled in a little town around here and suggested I join this place,” he said. “We have a surgical group outside of here too. So we moved to a little town around here, and now he’s my partner and my neighbor.”
“Oh really — what town?”
“We live in Cohasset,” Nicole said. “Who’s your friend?”
“Holy shit,” I said. “He’s our boys’ baseball coach.”
As millions have done before us, we paused to marvel at the smallness of the world, then Doctor Corwin offered his friend a figurative whistle of admiration. “I don’t know how he does it,” he said. “We’re pretty darn busy here and yet when he leaves, he tells me he’s going straight to the ballfield to coach a game. My kids are still little, but I don’t know if I could do what John does.”
As we entered the second hour of the visit, Corwin changed his tone a bit. It was time for business.
“So let’s talk about this tumor,” Doctor Corwin said. “I don’t want you to be discouraged. This is going to be a long road, but we can do this. You can do this. Trust me.”
I did, of course. I’d rarely met anyone with such confidence who did not also reek of arrogance.
It was serious, he told me. Really serious – Stage III serious. I had no idea about the stages, but I could tell from Nicole’s reaction — a mixture of exhaustion and resignation — that it wasn’t good. She’d just spent two years in the miasma of her mother’s cancer and she knew.
“Let me tell you what’s going on here.”
Mine was a deadly and common cancer. There was somewhere in the neighborhood of 140,000 new cases reported every year in the United States. I was a little younger than the usual colorectal cancer patient, and Corwin spun this into a good thing: they caught it when I was young — assuming you define sixty as young.
Assuming the notes he’d gotten from Doctor Martinez were accurate, he offered the probable scenario. First of all, he needed to do his own exam and promised to have his hand up my ass within the hour.
How wonderful, I didn’t think.
“And it’s not like that thing Doctor Martinez used,” he said. “Those guys use flexible instruments, kind of like one of those foam noodles you see at swimming pools. I use a thing called a proctoscope and it’s solid; it’s not flexible at all. But I’ll make it as painless as possible.”
First, they had to be sure what I had — was the cancer in my lower colon or was it in my rectum. He’d need his exam to figure that out.
The cancer’s location would not affect the treatment, which would come in stages. I’d have chemotherapy first, and for that I needed to see another doctor — Doctor Freighter, I think he called him; sounded like a stevedore comic-book hero. We’d do that treatment for a couple of months, and Doctor Freighter would be in charge the whole time.
There would also be daily radiation.
“It’s different for everybody,” Corwin said, “but the one thing all patients have in common is they hate it. You’ll feel like you’re carrying a car on your back or you’ll be puking . . . it’s different with everyone.”
I ran my fingers through my magnificent locks — graying, though otherwise impervious to the march of time. “Will I lose my hair?”
His lower lip puckered as he considered it. “I doubt it, I really do,” he said. “We’ll be aiming all of that nasty radiation down there.”
He pointed at the general neighborhood of Mister Happy. “Don’t know if you have a lot of hair on your back or your butt, but if you lose any hair, it’ll probably be there.”
Nicole scoffed. “He’s like an ape.”
After my body recovered as much as it could from the constant — “and I do mean constant” — chemo and radiation, Doctor Corwin said it would be his turn. That’s when he’d cut on me.
The operation was called a “laparoscopic directed low-anterior resection colonic, with a diverting loop ileostomy.”
“Okay?” I raised my eyebrows, indicating a need for further explanation.
“What that means is that I’m going to cut out the tumor and then take some of your unaffected intestine — and there should be a lot of it — and make you a new butthole.”
“Thanks for using the technical term,” I said.
“No problem,” he said. “Now, that’s going to take some time to heal, so while everything’s settling into place, I’m going to take another section of your intestine and pull it out of a little hole I’m going to cut in your stomach.”
Jesus! I thought. It’s Larry McMurtry torture! We’re gonna rip your guts out, you Nasty Hombre!
“For a while,” Doctor Corwin continued, “all of your poop will be diverted to this little bag and the bag will be connected to you right over that hole.”
“Do you, like, sew it on?”
“Good question. No, there’s an adhesive and it works pretty well.” He reached over and put his hand on my knee. “I know: it sounds gross, and sometimes it is. You’ll have accidents and get stool everywhere …” he shook his head “… it’s a mess. But I’ve done so many of these . . . I can’t even tell you how many. And nobody thinks they’ll make it.”
He was serious, emphatic. But then a smile appeared around his eyes. “But they do.”
I asked, “Are we talking colostomy bag?”
All I knew about those was a punchline from an early “Saturday Night Live” skit — Laraine Newman saying in a mock-sexy voice, “I know when I reach down and feel a warm colostomy bag that I’m with a real man.”
Doctor Corwin corrected me. “It’s an ostemy bag,” he said. “Colostomy means it’s permanent and your bag is temporary — God willing.”
“You mean it could be permanent?” Clouds darkened my face.
“It’s very, very unlikely,” he said. “I can’t say absolutely no, because there’s always a chance that something could happen.”
Still: I’d apparently be walking around carrying a bag of my waste. Would I have to buy a whole new wardrobe?
“The good news is that eventually that will end,” Corwin said. “Like I say, four or five months, I get you back in the OR and we reconnect you. Ninety-nine times out of a hundred, it goes this way — you wear the bag for a few months, you heal, and then, after you retrain your bowels, you’re back to pooping like a normal person. If the cancer comes back, we’ll worry about that then.”
“How soon until you can get started?” Nicole asked.
Corwin roughed out a schedule for me: I had to have an appointment with Doctor Freighter, the oncologist. Then there was Doctor Borgheit, who handled the radiation.
And there was a woman named Marian Gilmore. “Her title is nurse-navigator,” he said. “She’s the one who keeps track of you and what you need to do. If you have a question, call her first and she’ll get the answer out of the rest of us.”
“Would she mind if I called her a bombardier instead? It reminds me of my happy childhood growing up in the United States Air Force.”
He smiled. “I’m sure she won’t mind.”
Nicole smirked and rolled her eyes.
“So I’d say right after the holidays, we’ll get started on treatment. You’ll need to work with Freighter and his people to get set up.”
I’d hoped to fly home for a weekend to see my mother before Christmas. She was 92 and I didn’t know how much longer she had. She’d always been so strong and stubbornly independent, and hated being where she was. But — though she would not admit it — she couldn’t live alone. Now, she was living at a place I thought of as Sleepy Acres. I hated to think of her there, in the “assisted living facility,” as this place was called.
But I couldn’t tell my mother I was sick; she would worry too much. She needed to be letting go, not holding on. That’s what the hospice nurse had told me.
“Okay,” Doctor Corwin said. “Let’s get you to another room so I can get this exam over with.”
Nicole went back to the waiting area. A regular nurse — not a navigator or bombardier — took me to another exam room, told me to strip, put on a johnnie and lay down on the examining table with my ass pointed toward heaven.
Doctor Corwin came in carrying something that looked like a dart gun from Saturn.
“You want to play a game before we get started?”
He laughed. “Doesn’t look very pleasant, does it? I’ll do this as quickly as I can.”
The nurse held me in position as Doctor Corwin gently worked the uncomfortable metal tube into the heart of darkness. It was like Martin Sheen going upriver in Apocalypse Now. I held my breath, fearing I would lose control, loosing rodents and strange mythical beasts from my rectum. But soon it was over.
“You definitely have a tumor,” he said. “It’s kind of located right on the dividing line, right between the rectum and the colon.”
I slipped off the exam table and began getting dressed.
Doctor Corwin washed his hands, then dried with paper towels. “You’re looking at a long road, and I guarantee you you’ll get discouraged — maybe even depressed — but lots of people have been there before you. It won’t be easy, but you can do this.”
He stood at the door to say goodbye. “It’s too bad we had to meet under these circumstances,” he said. “It’d be much nicer if we’d met over a beer.”
He shook my hand like he meant it.
It was late afternoon when we left. The boys would be home from school now, but Savannah was there to watch them. We stopped at a little tavern near Dana Farber called the Broad Street Diner. We had been too nervous to eat earlier, so Nicole ordered a burger and I got a big bowl of clam chowder.
“Look, I’m sorry about all this,” I said.
Nicole shrugged. “Don’t apologize, except maybe for not taking better care of yourself. If you’d done what I said, we might not be here now. But we can’t change it now. Your doctor’s right — you’ll get through this.”
“I know,” I said, “it’s just so soon after your mother . . . . ”
“Yes,” she said. “It is.”
I’d say we ate in silence for a bit but it’s a Boston bar, which means that the other customers were discussing the intricacies of the New England Patriots pass defense at top volume.
“Listen,” she said. “You’re more than this. Don’t give your life over to this. Don’t let cancer define who you are.”
It had not occurred to me that I would, but I nodded. Looking back, it was probably the best advice she ever gave me.
“I won’t. Promise.”