Games of Chance

Forrest Gump was wrong. Life isn’t a box of chocolates; it’s a finite sequence of lotteries, most of them paying small prizes, few of which will irrevocably change your life and every day I play a dozen of them. On weekdays I play my ticket in the driving lottery, steering my car to work along a winding country road and then onto a busy freeway. The odds in favour of “winning”—where winning is defined in this case, as dying—are one in a hundred over my lifetime. I can change the odds slightly by keeping a distance between cars, obeying the speed limit and staying sober, but I don’t arrive at work and call my wife to announce I have lost the driving lottery, nor do I come home at the end of the day and tell my family that I am a multiple loser because I did not drown, fall, crash my motorcycle, get shot, or inhale acrid smoke that crisped my lungs.

I studied statistics in university and clutch probabilities for comfort the way some children hold toys and blankets as charmed talismans. The chance that I will die of an injury is one in twenty-five. This includes falling off an ill-leaning ladder; plummeting to earth underneath a flaccid parachute; getting smushed by a truck that ignored my right-of-way; being scorched by lightning in an open field; poisoned by poor drug addition, having ignored the cumulative ingestion of OTC painkillers; or mauled by a dog that looked friendly.

Knowing the odds imposes rationality, calms my torrid fears, puts things in perspective, according to a former therapist. Perspective is an illusion, though, when I fly, and only dramamine and a cocktail can calibrate my doomsday clock to dial back an improbable airplane crash. Still, knowing how slim my chances are, how unlikely it is that on any given day the universe will throw the dice and I will lose (or win, spending on how one defines the lottery) helps me accept that life is a well-lit casino run by a house that is reasonable in how much and how frequently it robs you.

Then one day the universe turned on me and churned the stochastic calm. My wife’s surgeon told her she might have the winning ticket for the oncology lottery.

She’d noticed a subtle, growing lump on her upper arm, one of those imperfections on your skin no more significant than the smudge on a stainless steel appliance; a minor distraction, needling with its discordant appearance. The family doctor referred her to a dermatologist who referred her to a surgeon, who sliced it out and referred the clump to a pathologist. She waited for a month before the surgeon’s office called her to schedule a visit and although his receptionist mentioned an oncology referral, my wife measured it as a caution, a “watch your step” rather than “roads closed due to wildfires.”

The word chocolate is redolent with sweet sugary sensations and memories. Saying the word aloud incites a feeling: a smooth wafer melting and flowing on my tongue. Other words evoke a visceral, physical reaction (“snake” is one that I recoil from) and oncology, with its hard c and sharp syllabic rhythm, makes me sick—vomit sick—and scared. It’s a word that blinders you, preventing any peripheral thoughts so that you begin to think of nothing but cancer. “Oncology” narrows your life, reducing it from a wide prairie to a tiny tunnel. You have committed no capital offence, but you are almost always placed on death row.

*

A month after Christmas and two months after the incision, we met with the surgeon. I sat in the waiting room playing with my Blackberry while my wife disappeared into his office. Flicking a button up and down on my obsolete phone reminded me that impermanence is the only permanent quality of existence.

After fifteen minutes she came back into the waiting room. She had blood-donation pallor and her eyes settled on the plastic plant in the corner, without focus.

“Do you want to sit?”

“No.”

She handed me a grocery receipt. I am the one who balances the books, pays the bills, plans our financial future, but I never ask for grocery bills; whatever we spent on food is necessary, not something that I’d cut back before curbing our entertainment expense, or even bother to sum.

“It’s on there. The back of it.”

The surgeon told her the diagnosis twice, slower the second time, so she could write his words on the back of the receipt. Her purse is filled with grocery receipts, along with unchecked lottery tickets.

I read the verdict: B-cell lymphoma or plasmacytoma, two possibilities, to be determined at a later time. She’d have to flip the cancer coin at her oncology referral.

I subsumed my fear within willed ignorance and asked her, “Why do you walk around with lottery tickets that might make us rich and free?” It bugged me that she would tempt fate like that, inviting some disaster to intervene before we had a chance to enjoy financial freedom. Was she afraid of disappointment? Was the fantasy worth more than the truth? “I like to think about the chance of winning for just a little bit longer before I find out that we won nothing,” she answered.

“That’s what I have.” She pointed to the scribbles.

“This is skin cancer,” I told her. “But it’s not melanoma. I bet it’s treatable.”

I had no idea what I was saying but brute confrontation seemed better than passive acceptance.

Non-melanoma, I reasoned, promised an easier trip into Cancerland; a topical cream could be applied to banish the offending cells. Radiation, resection and chemotherapy are the big guns brought out for serious cancer- aggressive lung and brain tumours—and surely we were not in that league (I purposely thought of this crisis as collectively owned because cancer is never about just one person, unlike a cold or hemorrhoids). The Gods are crazy, not fickle, and a small bump on your arm cannot be the tip of a malignancy that descends into the dark waters of your soul and swims from lymph node to lymph node.

*

An hour after her diagnosis, she was making lunch for us and our kids and I went to my office to type each disease into Google. I skipped quickly from one source to another, using triangulation to confirm the veracity and accuracy of each site. In the infinite divisions of time between one minute and the next I found the facts and figures for both cancers, with probabilities provided for survival, measured in yearly increments. After ten years of either cancer you were pretty sure to have your turn at finding out if Heaven was real.

I am not religious (except where religion offers a certificate, such as baptisms, weddings, and funerals). I‘d recently read a book proving that Heaven is real, written by a neurologist (as if his credentials alone lent credence to Heaven’s existence). His version of Heaven was multilayered and psychedelic and resplendent with colour and music and omnipresent love. It sounded like a fun version of Chaos, that place created when Heaven and Earth separated, to reveal the Greek gods. The neurologist saw Heaven while he was in a coma, after suffering a tsunamic infection that washed away his conscious mind and left only bacteria-laden cognitive detritus. His coma unexpectedly lifted and he washed ashore, back to earth and a new life dedicated to sharing Heaven with the frightened and disbelieving.

I waited until lunch was finished before telling my wife what I’d learned. We sat on the floor in my office, a little sanctuary, and whispered our sadness and fear. We snuffled and sobbed and talked for an hour. I told her that she had always been a lucky person and that if anyone could flip a coin stamped “life” and “death”, she could make it land on life. We laughed, maybe at something funny, or maybe our laughter was exhaustion, crumbs from grief. We imagined what would happen to the kids. “What will happen to Annie?” my wife asked. Annie was our poodle.

*

When your doctor says that you have cancer and that treatment needs to begin as soon as possible, you do not react with aplomb or grace. You travel through the five stages of bewilderment and panic in an hour and then settle into fear. Why acceptance? Is the doctor omnipotent and infallible, operating outside the known tolerances for human knowledge? A second opinion might be worthwhile, but we aren’t speaking of treatment strategies or calculating possible outcomes in a clinical trial. Is a second opinion any good if the tissue has been cut out of your arm and sent off to two labs for testing? Would you finally accept the diagnosis if they cut off the whole arm and examined every cell?

I remind myself that I have first-world problems. There are days when work is drudge, food is dull, books are boring, and nothing I think is more complicated or interesting than anything I needed to learn in kindergarten. I am not living on the shores of Lake Victoria in Africa, scavenging for discarded heads severed from the fish that are flown out on Russian cargo jets to European cities. I live in a rich country, privileged, enjoying luxurious, incessant self-reflection and all-you-can-eat sushi. The grim reaper waits for me, but isn’t expected though for another few decades (here is a sobering fact: the breakeven age for men is 39 and for women it is 41, meaning that at that age you can expect to continue living for exactly the same number of years) giving me time to recover all the contributions I made to my defined-benefit pension plan.

I have often diminished my wife’s problems by telling her that “someone found out today that they have cancer, so your problem is nothing”. Her problems are rude commuters, sour coffee, demanding mother, uncommunicative kids; these are benign obtrusions in daily life. Every year fourteen million people on the planet learn they have cancer. Twenty-seven people per minute. Fifteen people die of cancer in the same minute. Death almost has a two-for-one deal here, running the mortality casino with house odds that Las Vegas couldn’t legally use. If you live long enough your chance of getting some form of cancer is the same as getting heads on one flip of a penny.

My wife is not old. She is in her early-late forties. She is the generation that believed a tan was safe and sexy. She burned and crisped in the convective Bermuda sun, sizzled under the orange-juice orb in the Florida sky, and even slow-roasted by the coy sun of Muskoka, Ontario. The blistering was hastened by generous lubricants marketed as tanning enhancers. Skin cancer would make sense given her family history, the cruel combination of fair flesh and genetic favour significantly raises her risks, but her diagnosis denies expectations,  and the coin toss for her myeloma is being done with a weighted penny, one that unfairly rewards death. It’s as if God, whom Einstein argued did not play with dice, can’t resist gathering a few souls in an unfair game.

*

It is five o’clock that afternoon when my wife leaves the house to pick up one of our kids from a friend’s place. We have just come back from a pub where we drank beer for an hour and talked about endings. She wants me to landscape the front of the house and she creates a list of other projects (not a bucket list; we both hate the unimaginative container) that could be done within the temporal constraints that cancer imposes. She wants me to write them down on a napkin. While she is out of the house I think about the list and whether or not I would complete any of these tasks. I walk into the kitchen to get a paper pad, to make my own list and I see a light flashing on our phone.

There is a message from the surgeon. His voice is faint, and apologetic. I’m used to doctors occupying physical and psychic space with their omniscience and I don’t quite understand his message so I replay it.

“I’m sorry,” he begins. “ A second test came back and you do not need to worry. You don’t need to worry about what we talked about.”

He has not used the awful word, as if he too gets vomit-sick scared from saying it aloud.

He continues the story, explaining that the first test, from a small, private lab that delivers quick results, strongly suspected cancer and he did not wait for the lab embedded in a large teaching hospital to render a verdict before pronouncing my wife’s fate. He wanted to be expedient and efficient, thwart the damn disease before it got too far, too fast. The second report was misplaced, but he has now found it. A mistake was made, a misdiagnosis rendered, quickly repaired.

This is not as infrequent an occurrence as one thinks. Doctors make mistakes. Limbs are wrongly removed, healthy breasts sliced off, drugs rendered in doses fifty percent too high or low, and images, with their shadowy figures lurking behind the ribs or at the base of the skull, incorrectly picked out of the line-up of possible suspects. Five percent of patients are misdiagnosed, most commonly for heart failure, pneumonia, kidney failure, UTIs and cancer. Fifteen percent of the time a second opinion will change the diagnosis and a third of the time a second opinion will change treatment. Misdiagnosis might be the third leading cause of death. Sometimes the patient is at fault because they are poor story tellers, unable to construct an accurate medical narrative; other times it’s the doctor, who can’t understand the story, misreads test results, or doesn’t order a medical query.

My wife comes in the door. I have held the phone in my hand for fifteen minutes, unable to let go. “You are about to get the best gift of your life,” I tell her. “Listen to this message.” Listen to the surgeon tell you a good story

She listens and cries. I am crying. The kids are in the living room with us, watching us disassemble before we finally get it together to tell them the story of the near-collapse of our family. They are teenagers and I’m not sure they understand mortal brevity. They don’t know the calculus of life and death. I want to write about this day in my journal and I will jot down a title on a blank page, “A Brief History of Time”.

*

There is a casino about an hour from my house. The usual slot machines, wheels, tables, bells and chimes prevail in a place whose sole purpose is to take your money. The mathematics assures me that if I play long enough at any casino, I will lose. Spend a day under the artificial sun of the casino to extinguish hope. For one day we lived without light, playing a game of chance. I found no probabilities to clutch.

I’m ecstatic that my wife beat the house this time, if only for a while. She has settled back into herself without resolutions or epiphanies, the same person she was and will be until death. We know there are more lotteries to come, more dice to roll, more coins to flip. I know that life is a finite game.

 

Photo credit