Scars and scans (Science and hope)

The solar system, which was considered to be a well-oiled cosmic machine running on rigid, deterministic laws, is also chaotic. Chaos lurks in the regular, and the unpredictable is never far from the predictable. This chance and indetermination affect not only the planets, stars, and galaxies, but also our everyday life. – Matthiew Ricard & Trinh Xuan Thuan, The Quantum and the Lotus

The pump of the machine has its own rhythm. It sounds somewhat like a stuck zipper: zzh-zzh-pause, zzh-zzh-pause. Between each pause, three clear drops fall from the bag of saline into a fine transparent tube. The tube, shuddering slightly with each pump, is connected to the port installed in my chest. The fluids flow through the port into another tube that sits invisible under my skin, and from there into a vein that goes straight to my heart. My heart does its vital part: pumping the saline through the rest of my body, through the network of blood vessels, and ultimately to my kidneys where it helps flush out the toxins that have accumulated there.

Since I was first diagnosed with cancer, I have acquired a whole new medical vocabulary – urothelial, immunotherapy, lamina propria. I have learnt the names of my chemotherapy drugs – cisplatin, gemcitabine, paclitaxel – and the drugs that keep me well – dexamethasone, olanzapine, lorazepam. I have learnt many new words that mean something like “scar” – residua, sclerosis, sequela.

Medicine and science can seem cold and technical. They are disciplines to learn because they are useful, not because they are beautiful. And, indeed, I set about learning a new vocabulary because it had utility: I could read the radiologist’s report and understand what they were seeing in the pictures of my organs. I could discuss treatment options with my oncologist, and talk to the nurses about side effects. But these new words – beyond their meaning – also had a poetry of their own, a lyrical cadence. “Residua” flows through the mouth when spoken, a beautiful word compared to the short and harsh-sounding “scar”.

Cancer caused me to give an unprecedented level of attention to my body. I came to understand and even forecast its unique reactions to the cycles of drugs – the rosacea that bloomed on my cheeks every three weeks, the stomach cramps on the fourth night after treatment, the sudden weight drop on the fifth day once the steroids had worn off. While these side effects weren’t beautiful, attention to them allowed me to appreciate the ineffable capacity of my body to process and heal from the poisons and drugs we pumped into it.

But the most intimate form of attention was the regular testing: blood tests and CT scans that revealed what was happening underneath my skin. The fluctuations in my red blood cells, which in turn reflected the health of the marrow deep in my bones. The section of my lungs that appeared on CT scans like ground-up glass. The knitting of my bones in sclerosis as they healed. The fading shadows on my liver – sequela.

I didn’t need CT scans for all my scars: I have four external ones. Two are from the port that they installed in my chest to make the chemo infusions easier. The other two are from my tumors: a pair of purple circles, one just under my right ribs, the second on my left shoulder blade. They were raised and hard and red when they were growing; now they are flat and soft, their color resembling nothing more sinister than a fading bruise. Their vivid color once came from the density of blood vessels. Tumors, I have learnt, are so hungry for blood that they send out signals causing nearby vessels to reproduce rapidly (I have learnt the word for this too: angiogenesis). The unstable, bloody spider web they create is dense and prone to breaking. This is what gives the growing tumors their bright red appearance. That color is fading now, slowly, as the vessels and surrounding cells gradually return to their normal state.

I have found wonder in paying attention to the medicine, the science, of my cancer and its treatment. The evolution of tumors, so perfectly adapted for uncontrolled growth. The intricate balancing act of treatment, trying to kill that part of me that is growing too fast while preserving the health of the whole. The awesome power of my body, from the pump of my heart to the healing of my scars.

I met with my oncologist last week, and he gave me welcome news: that I’ve had my last chemo treatment. Six months’ worth. Fourteen infusions of the magic poisons. As predicted, my body has been struggling to right the balance again – the blood tests show that my kidneys are struggling. And so the saline drips into my port, aiding nature’s filtration process (water and salt: purifying, healing, hydrating).

No more chemo, because my doctor is finally confident that the shadows and spots on the latest scan are just scars (residua, sclerosis, sequela). He is quick to tell me that, of course, the really important scans are the next ones: the one in two months, the one after that, and after that… If my scans are clear for two years, he says, then I will be in remission. The power of medicine and science doesn’t extend to knowing the future: the closest they come is probabilities. Even the fine-grained detail on a CT scan isn’t enough information for us to predict the way the trillions of cells in my body will behave over the months, the days, the seconds ahead.

Right now, though, I am well. My wellness is a miracle borne of medicine, science, my body. My future remains uncertain, and hope still feels hard. But when I pay attention to this moment, I feel wonder at where I am and all that has led me here.

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