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Cancer Frags


When I was twelve I wrote my autobiography. Middle-school homework—nothing more—but I leaned into it with everything I had. My story was short, but lavished with pre-adolescent exhalations—themselves staggered under the weight of thesaurus-amplified language, and wherever possible, too many syllables. This is a natural tendency in the young and literarily inclined, I’ve since learned—and in me, quite possibly an authentic fatal flaw.

I think of myself at twelve. I think of the Elephant Man, John Merrick, who ended his own life just by laying his heavy head upon a pillow, knowing that his lungs and larynx would be crushed by the weight of his own grotesquely outsized body.

At twelve, I began my story of me with a family anecdote of Hurricane Betsy—how it exploded upon Worcester, Massachusetts, during the week that I was born. Thundering down the ancient Blackstone Valley, laying up moisture and power over Lake Quinsigamond, wreaking misery and ruin even in our safely landlocked city, Hurricane Betsy challenged the "Heart of the Commonwealth" to continue to beat. Apparently.

I wouldn’t know, really. My family was living in North Carolina at the time, so the significance of the Massachusetts hurricane to any story about me is oblique at best. By fortunate accident of the calendar, it merely made a great hook for my essay: personally I enjoyed a vague sense of value added, and I guess I took home some extra credit. I forget. Anyway, I felt it was more Correlation than Causation—that is, not a Lie—and therefore, OK. Noticing correlations. As a strategy, as a key to the cosmos, as a personal alchemy, it can be habit-forming.

Taking stock again now, at midlife, an overview begins to reveal true watersheds— years when my course was bounded, when events fixed inexorable direction, speeding or slowing the flow of the stream, changing the shape of the way.

I think of an arroyo in Arizona where the wash once ran fast and hip-high in springtime—dry now for decades, and red-rock hard— delimiting forever the twists and turns of Arizona Highway 15. Certain turns only, and sometimes a bridge, where the river used to run hip-high with runoff and spring gullywashers.

On a Tuesday afternoon in May, 1997, violent thunderstorms erupted over Central and South Central Texas. Here’s how the National Weather Center records that
"weather event:"

A tragic tornado of unimaginable proportions hit Jarrell, in northern Williamson County, with over 261 mph winds, around 3:42 PM, causing extensive damage and 27 deaths. A tornado warning had been issued at 3:30 PM warning the residents in Jarrell of the impending danger. More than 300 head of cattle were also killed as the twister moved through. The twister debarked trees, pulled the grass from the ground and carried dozens of vehicles more than one half mile away… There was nothing left in the tornado’s wake as it moved south-southeast.

In the spring of 1997, I watched news clips of expressionless neighbors standing in a wasteland that had been their homes. They had come out from their storm cellars like Dorothy in Kansas—like Berliners from their air raid shelters, like September residents of Battery Park City—to face the blighted landscape of their new lives. And they had let it happen. What else could they have done? What choice had they had? Minutes earlier they themselves might have been sucked into oblivion, except for a snap decision, a specific instinct to allow everything other than themselves to be sucked away. Twelve minutes later they would emerge from cover, straining to understand that they had been fitted into the new shape of their lives. Even the things that were exactly the same would be entirely different.

There is always a divide—a moment, an infinitesimal point— between that which has come before and that which will be after. An ephemeral demarcation in time or space, on the other side of which things will never be the same. It is that moment that interests me—when the switch is thrown, when the sky splits, or the earth opens up, and the spirit follows or balks.

I think of Christopher Reeve—actor, family man, activist, sailor, equestrian— steering his chestnut gelding handsomely, confidently toward the hurdle that will break his neck. One day he’s Superman, and before you know it, he can’t move. He can’t even breathe. How do they do it? These human beings, how do they make it across the divide? How do they go on?

In the spring of 1997, a twister touched down in the midst of my own busily untroubled life. And afterward—as a small circle of good and utterly surprised human beings bravely and doggedly dressed my ghastly wounds, and invented things to feed me, and patiently translated my alien noises into useful communication—I listened to news in the media of the traumatized Texans with unexpected empathy.

My personal apocalypse had been not a weather event but a medical emergency—one whose awesome power, like that of the fabled Kansas twisters, seems a knowable, thrilling, even familiar phenomenon—until one day a twister touches down on your house. Suddenly, one day in the spring of 1997, I had cancer. It was nothing like anything I had heard about or ever imagined.

I think of those Bonsai masters who prune and tend and train the branches of their little bushes, so that for a hundred years and more, they will turn toward the sun, or moon, or sea. I think of tortured trunks stranded along a ridge near the tree line on Mt. McKinley, or along the rocky coast of Maine, their spines exposed to punishing prevailing winds, their branches desperately straining for the shelter of the lee. And I think, thus, gently or brutally, are we also fitted into the shape of our lives.

Osteogenic Sarcoma is a vicious bone cancer that appears most often in the long bones of children, and it is savagely aggressive. Its causes are still unknown, with a 59% mortality rate, and when for some reason it recurs, mortality jumps to 85%. On the upside, when the tumor’s site is found to be primary, as it usually is, it is an ideal candidate for surgical resection, with superior opportunity for generous margins, and the survival rate is excellent. That is, when a lesion is found in an extremity—a foot, let’s say—the leg will be removed. Up to the hip. The surgery is undeniably effective, in its way.

When OS is found in adults, or in the bones of the head or neck, it is considered rare, afflicting one in ten million people per year worldwide. There are no reliable clinical trials, and there may never be, because the topography of the skull is as unique as a fingerprint—no two cases are alike. The tumor may cling to the wall of the maxillary sinus, barnacle-like, or it may reach squamous tentacles up through the pores of the occipital floor, into the innocent eye socket. The fossae and cavities and nooks and crannies abound where the cancer may hide, lying dormant, one day to spring to voracious, undetectable and unchecked life.

Here again is an upside: when the tumor site is primary, as they say it usually is, if the individual cranial architecture allows, and if the surgeon is exemplary, the tumor is highly resectable. They can get all the cancer.

They do have to rake out, as well, everything that the tumor is touching, bone and fascia, jot and tittle, and try desperately for the minimum safe margins of four centimeters, without encroaching on a vital structure. Like, say, the trigeminal trunk, with its branches to the facial nerve, the tongue, the pharynx, vocal cords, trapezius. . . . In this terrain of infinitesimal distances, every structure is vital.

Still, bones must go. And teeth go. Eye sockets, eyeballs, noses, cheekbones— identity goes out with the medical waste. "Oh, the zygoma goes," I was told, by one brutally succinct chief of head and neck surgery. But this will be a concern for later. In the highly prioritized days between diagnosis and surgery, every inconvenience of scheduling and failing spirit is shored up by a single bracing assurance. They can get all the cancer.

Every time a surgeon has to sacrifice a patient’s face to this voracious predator, the patient wonders which is which. Which is predator and which is prey? Is this life? Isn’t this death? Some way must be found to rally in the patient—now desperately deformed and not himself at all—the spirit of the game. By hook or by crook, the patient must come to believe that this life is a beginning of a new self—not by any means a refurbished edition of the old. "Oh," said the surgeon, responding carelessly to my halting query, "you can’t be reconstructed." It must be an embarkation, for there is no turning back. I myself have lain awake in endless nights of four-hour shifts, and not turned back, but come forward, against all odds.

When I’m able to turn my attention to reconstruction and quality of life, I’ll lobby for it with all my might. When it’s all over, they will have moved some of my shoulder blade into my mouth, and some of my skull into my cheek, and some of my leg into my neck, and some of my ear into my eyelid. Later on I’ll donate some of an arm to my face as well. And then the calvarial grafts again, and then the auricular transfer again, and again and again. And then again. And I’ll watch twenty four seasons change.

I think of the Bonsai master pruning and tending and breathing mildly, feeling under his fingers the immutable chi of ancient life. Heart beating barely, as though not to disturb the shape in the air of branches yet to be, he finds, without seeking, the will to cut. And when the master is exemplary, he will have made the least number of cuts necessary to remove the impediment that thwarts the flow of the chi. Then, right away, things begin to be different than they might have been.

So by cataclysm and in silence, first hurled sky-high, then driven head first into frozen earth. Cruelly rebuked or tenderly tied and turned. The gale punishes. The lee abides. And in between is the epiphanous divide, where the spirit balks or follows. The exquisitely fragile, endless instant when the spirit tarries in a sepulchral ether, and finds its way.

The first suggestion of Osteogenic Sarcoma must be treated like a tornado warning over the Emergency Broadcast System—gravely and immediately. Time can be spared only to gather loved ones and make for the storm shelter, there to huddle, silent, amazed and alert, marshalling what resources there may be, for the time coming, impossibly soon, when nothing will ever be the same again.


—K.E.Watt, Brooklyn, NY


© 2005, New York City Opera and K. E. WATT. All rights reserved.




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