Join the #MedHumChat community as we reflect on the many ways in which Forces of Nature shape us. The pieces for this discussion are How It Ends by Louise A. Blum and Cave Spring by Thomas Hart-Benton. Thank you to MHC’s Allison Chrestensen (@allison_tandem) for curating this chat.
We are honored to be joined by special guest Louise A. Blum for this discussion. Blum is the author of the novel Amnesty and the memoir You’re Not From Around Here are You? She is also a MacDowell Fellowship awardee and former teacher in New York.
Louise A. Blum: How It Ends
Selected Excerpts
“You drive to work. It’s the first day of your school year too, a time of new beginnings for you both, here in this moment when the pulse of summer starts to slow. You drive down country roads that wind through the hills where you grew up, went to school, fell in love, earned your PhD, became a mother. Through your open window you can smell the honeysuckle, its scent so thick, so filled with longing that for a moment you forget it’s an invasive species--because how could something that smells so sweet be choking out the roots of everything around it? It’s only doing what its nature demands: establishing its presence.
As you drive, you pass the towers of steel that have come to mark these hills, two hundred feet high and red as blood. The nightly fires, the tanks of water, the men in hard hats with dirt on their hands and faces: the same dirt in which you plant your gardens; the same dirt from which you harvest your food. They dig deep into the ground to find the shale that contains the gas, and when they do, they blast it out with chemicals that leach into the water you drink. This is happening all over the state. Yet they came in so quietly, went to work with such precision, that most of the country has no idea it’s taking place, this covert invasion, this revolutionary extraction process, this bright new fuel source that will save us from foreign dependency, from having to change a way of life to which we have all become accustomed. It started here, but it will spread from hill to hill, from state to state. Once these wells are sunk, there will be no stopping them.
Many things are beginning.
More than you know.”
…
“You find it in the shower. One hand guiding the soap across the thin, small, boyish body that has, until this moment, served you well.
You slide your hand across your left breast, and your breathing stops. How long has it been there, hidden in the ducts, doubling in size, tripling, until its presence can be felt just beneath the surface of your skin? It is so large you can’t believe you haven’t noticed it before. You are thirty-eight years old. Too young even for a mammogram. Were there warning signs you missed?
There are always warning signs. Aren’t there?
The diagnosis comes two weeks after the school year has begun, your son’s and yours. You drive to work with the window down. Around you the leaves are catching fire. Before too long they will set the hill ablaze, their final throes inevitably their loveliest. You keep one hand on your breast, as if your touch will be enough to save it.
It will not save it.
The tumor is estrogen receptor positive. Twenty percent of estrogen-receptor-positive breast cancers are “human epidermal growth factor receptor 2.” This is what you have. They call it HER2.
You find this ironic.
“At least it’s positive,” you say. This is gallows humor. HER2-positive breast cancers tend to grow faster, spread more easily, and be more likely to come back than HER2-negative ones. They have a poor survival rate. There will be great strides in treating this form of cancer in the years to come, as gene-therapy breakthroughs alter the landscape you are entering. A dozen years from now, you could conceivably survive this.
It is not a dozen years from now.
It is now. And you are stuck in it.
This cancer is not hereditary. Doctors do not know what causes it.
Environment, they think.
You get on with things, breathing as best you can. In and out. Life begins with an in-breath and ends with an out-breath. We are born with all the breaths we’ll ever take. You remember reading that somewhere. You tell yourself: Breathe slowly. Make it last.
Our involuntary systems do their work so well. Our bodies are a marvel. What makes them turn on us? And why yours? What random twist of fate dealt you this losing hand? You suspect the fuel industry blossoming around you, its brine ponds full of wastewater, its chemicals seeding the air, its choking hold on these hills you love.
You are not wrong.
It is not your genes, no faulty wiring in this body that you prize.
You are so young. You never imagined it would come for you this soon.”
…
“You thought you’d feel nothing when they came for your breast: no emotion, no grief. Your breasts are so small, you’ve always thought of them as inconsequential. You are unprepared for what you feel as the nurses prep you for surgery. It’s as if the fact that this breast nourished your son has slipped your mind. You experience a sudden possessiveness. Surely not all the breast must go; surely some part can stay. But this is the deal you have struck with them: total mastectomy. The least-invasive route, described in the most invasive terms.
You wake with a drainage tube where your breast used to be, the promise of further surgery to install the port through which you’ll receive your curative drip of poison. They say “install,” as if it were an appliance they were putting in--which, in a way, you suppose it is.
You feel an absence so complete that the modifier they have used--total--finally makes sense. Except for the fluids that ooze from your tube, your breast is totally gone, your chest a blasted landscape.
You hate the phrase, but it’s what you think when you look at what is left: a war zone.”
…
“It comes in waves: torture and remission, torture and remission. You play this game for years.
Always the doctors are clear: This will be the thing that kills you. The best they can do is keep it at bay.
So much is happening in these years. You spend them balancing your identities: Mother, professor, wife, cancer patient. Living person. Person not yet dead.
Daily you pull goutweed from your garden. Its roots are shallow but endless. You cannot see them, but you know they are there and that, for every weed you successfully extract, more will take its place. You can’t let it go: it will overtake your garden, devour your lawn, an advance as confident as a conquering army’s. You dig and pull, dig and pull, but you cannot win this one.”
…
“The goutweed in your garden can be traced back to a single plant, and you know exactly which one it was: one that you saw in the corner of your yard and confused with Queen Anne’s lace. You let it bloom. By the time you recognized it, it was too late. Like your cancer. Where did it begin? In what organ did it first take root? Which cells were the first to turn against themselves?
The answer is obvious, if only we could see. We all carry it within our bodies, the potential for our cells to mutate, stage a takeover. There’s nothing new about this story.
When the cancer first hits your bones, you call it “back pain.” Such an equalizer. Eighty percent of the adult population suffers from back pain. Everyone understands this; everyone sympathizes. Everyone has advice for you: acupuncture, chiropractic, massage, physical therapy. You do it all. You do not do what the doctors want. You do not submit to scans. You do not want to see inside yourself what you already know is there.
At night you lie still, unable to turn, a sarcophagus of nerve endings. Drugs do not touch this kind of pain.
Once loosed upon your bones, the cancer sends its tendrils all through your skeletal system. The pain is so fierce you cannot hide it. You cannot stand, cannot walk unassisted. Every breath is a knife in your back. You use a cane but still dress for a ball. You walk with your head high. You dare your co-workers to say something.
No one says anything.
It works its way along your spine, breaks you piece by piece. When the school year ends, you let the doctors go in and solder your vertebrae back together with steel plates and screws.
You take every drug they give you now, no questions asked. You open your mouth, your veins, your flesh to any treatment they can devise. You close your eyes and envision each new drug as a superhero, ready to win this fight for you. Herceptin, Gemzar. Xeloda.
These are not superhero names, you think. They are the sames of the dead in some Greek tragedy.”
…
“You stop talking about beating the disease and start saying things like “the better part of a year.” They send you home with a prescription for heparin and a box of syringes. Every day you search for an unbruised, unpunctured plot of skin, a new place you can plunge the needle into. You’re running out of spots.
The gas trucks leave as they came, a quiet, rolling exit. In the time that it has taken this cancer to mow you down, an entire industry has invaded, taken root, poisoned everything it touched, and headed for the next state to do it all over again. The abandoned wells lurk in these hills like waiting ports. The industry can come back another time to pump more toxins in.
Your cancer, though--its survival depends on you.
It, like all things, is mortal.
It is you.”
