11. The Uses of Lumen

Lumen, the word for the PICC line port,

cavity or passage, originally, for a tubular organ–

the lumen of the intestine, for example–

but in his arm a double lumen, plastic, one purple, one red,

for injecting Taxotere and Vancomycin, and for drawing blood.

But also:

a unit of luminous flux equal to the amount of light

given out through a solid angle of 1 steradian

by a point source of 1 candela intensity radiating uniformly in all directions.

What started as blood in his bladder progressed to pain in his kidney,

caused by the pressure of a prostate cancer tumor in his gut,

a stent inserted to open the inflamed ureter, then chemotherapy that invited

MRSA and a fever of 104 and WHAM into the hospital with him

and thence to a SN(i)F, where he lies on a soft September evening,

two weeks into his new institutionalized life,

constipated and sea-bound as the coast of Nova Scotia

(“will you ever heave a sigh and a wish for me”),

when Caroline calls and her voice evokes the loneliness

of corridors slippering past tiny rooms and elderly slumping patients,

the inchoate chatter of the nurses and aides, a retching someone,

a dreaded luminosity more isolating than the dark,

his body a cavity, a lumen, vacant to the searing light.


12. September 11

Cords and wires, tubes, the IV stand dispensing

vancomycin, every time he moves he needs to be aware

of what can trip him up. Bionic klutz. One day he steps

on the catheter tube and almost rips it out of his bladder,

lacerating his penis–his very being–sometimes, it has seemed,

one identical to the other. The nurse this morning

wants to know about his bowel movements. “Life,” she says,

“is about bowel movements.” During the night, the catheter

bag fails and he wakes in a pool of urine. At least

there isn’t blood in it. Down the hall a patient

has a bowel explosion. Or was that the night before?

You’re losing it, your precious consciousness.

Quick, what day is it? We mean, the date.

September something. It’s going to be hot, I know that.

September 11, the most important date

in American history, and you’ve forgotten,

dishonored the memory of the thousands killed,

the falling men and women, thinking only

of your penis and your piss, your bowels.

He was living in Manhattan, Murray Hill, near Bellevue,

and could smell the burn of flesh in the air, the clear blue

empty of anything but fighter jets, and the pictures of the missing

on the walls, at night the sirens, frightened lovers kissing

in the shadows. The woman he was living with went down

to work the pile. She was a nurse but was undone

by what she saw, came home with unquenchable grief

and went to bed and awoke in three days with a fervent belief

in God and the power of prayer, fingering a rosary.

They split. He loved her. 9/11 meant to him how sorry

he was to lose what he thought was the love of his life.

Never mind America. What about me and my vanished wife?

See above how the expression “love of my life”

is meaningless. We can trace its end, in fact,

to 9/11, the bodies falling out of life and love,

exploding on the pavement. Everyone moves

on, finds love again, as you did. The only love

that counts is the love of your own life.

Caroline lies with him on the narrow bed in his cell

and he kisses her, all they can do with the catheter in place.

She is wearing the dress she never wears with underwear.

He kisses her bare pudendum. The nurse arrives to start

the vancomycin drip. Dozing, he hears the IV engine mutter,

“hold the phone” and then “Godzilla, Godzilla, Rapunzel.”

13. Italia

This morning a breakfast burrito on a placemat map

of Italia, coffee as thin as the IV needle in his arm,

blood pulsing into daylight where it doesn’t belong.

He went to Italy, once, for cappuccino, country-surfing

from Annecy in the alps through Geneva and Mount Blanc

in one quick day with a girlfriend long gone, in those years

living in New York on instinct and early slight poems

he’d declaim in any venue, once in the subway corridor

between the Times Square Shuttle and Lex, booming

like Dylan Thomas, but not as drunk, for quarters,

his first book slowly dying. Occupational therapy wants

him to fry two eggs to show he can take care of himself

and not burn down the house. He suggests instead

a frittata, eggs with thin slices of salmon, onion, basil,

tomato, gruyere slow cooked, and the therapist laughs

and hands him a brick of margarine. He slides the cooked

eggs into the trash and she clears him for daily life.

Last night he dreamed he was in a Greek restaurant

where the owner refused to serve him coffee.

He angrily threw a glass of orange juice against the wall

and fled, pursued by Greeks. Woke in a sweat.

Called the CNA to empty his catheter bag, urine

too dark with bits of shredded clot reminding him

that he isn’t going anywhere any time soon.

After breakfast, Caroline leaves for three days on the coast

with her girlfriends, leaving a text kiss :-* on his iPhone.

14. The Normal

 Do you know your body is 90 percent

bacteria and only 10 percent human?

So don’t get too giddy about being released

from the SNF. It doesn’t take a minute

for those bad boys to get out of line again

and fuck you up. Thirty-three of your friends

like your being home but the other

450 are busy bar-b-queing. Update your time line.

Update your life. Tell us a story. Entertain us.

We want to know everything, what you feel,

how your dog is doing, your BP and blood ox.

He sleeps in his own bed after seventeen days

of incarceration in the alternate reality

of medical mind. No one wakes him to check his vitals.

What’s vital? He staggers to the bathroom at 2:00 AM,

forgetting he still has a catheter bag. Empties it,

shakes the tip of the drainage tube as he used to shake his penis,

satisfied with the sound and motion of urinating if not the act.

He and Elena go to a movie and eat pizza.

He drinks a non-alcoholic beer. He embraces

the normal, which is reluctant to commit,

returning his affection with the stiffened spine

and hands patting his shoulders of a man afraid of emotion.

The normal is defined as what everyone

else is doing right now.

There isn’t room for you in it.

The Stellar’s Jays outside are arguing with daylight.

15. The Goddamn Slide into Memory

Merrill mentions Proust several times in The Changing Light at Sandover. Proust never mentions Jimmy but would have if he’d known him. It’s funny how they seem to be talking to one another across the emptiness. The damn catheter is still in, bag strapped to my calf. I get up twice at night to empty it. Today take Dexamethasone, a steroid, to protect me from the Taxotere they’ll stuff me with tomorrow. Do you sense the relationships among these varied things, the drugs, the writers, the books, the goddamn slide into memory. There is no past, I’ve figured that out, but only the memory, which someone said is really the memory of a memory, and not at all like what might have happened. And then think that everyone has memories that don’t match up. Every day begins anew, de novo, and we have to figure it out all over again. What is this cup? Where is the yogurt? Why is that window open? And who is that in the backyard beckoning, that small child who resembles no one and yet is compellingly familiar?

16. Urination

From the sleep alcove and dark of his apartment, Elena asks,

“Were poor people in days of yore”–he hears “your”–”geniuses?

You know, did they have big ideas or philosophy? It seems

they wouldn’t have had time to think if they were poor.”

“My geniuses?” “No, yore, like olden days.” “Artists often had

patrons, rich people who supported them so they could work,

like Michelangelo. His patron was the pope.” She goes to sleep.

David is wearing Depends Real Fit underwear and Tena’s

Ultimate overnight incontinence pads–check out his package–

to contain his leaking bladder and can’t think of anything

but wetting the bed. Can the incontinent be philosophers?

He is zazzed on steroids and lies awake not thinking,

takes a bath at 2:00 AM, reading in the hot tub, returns

to not sleeping. Earlier, kissing Caroline in her apartment,

he worries about taking off his clothes and peeing on her

when they make love. She sits athwart his lap as on the night

they were first were kissing on his couch and refuses

to worry with him. “Everything we do is erotic,” she says,

touches his teeth with her tongue. His ancient penis fills,

he feels the warmth of urine, the urgency of her mouth.

They caress each other’s bald heads in the softening dark.

Forty-seven people, only ten of whom he knows,

like this, but fifty think it’s disgusting. TMI!

You can defriend these people, you know.

You can make them go away. You can depopulate

your world with a click. You can be alone

in your urinated dark. But don’t worry:

we’ll continue to pray for you, like the Virgin

Mary, praying for us sinners at the hour of your death.

He switches off his iPhone but forgets the blinking red light

on his MacBook, monitoring his restlessness, recording

his shrinking body on the futon wrapped as in a shroud.

17. Dancer for the Moon

Their dog chases a bouncing glow ball into the twilight,

snagging it on the short hop, drops it dutifully at Caroline’s

feet. She feeds her a piece of string cheese. “Good girl.”

And throws the ball again. It’s like a small moon, pink

orb, beneath the full moon, and the dog a dancer for the moon,

a conjuror of night. David lies awake with bone pain

and neuropathy in his feet, his Depends swelling with piss.

How nice it would be to chase the ball, to squat in the grass

and pee, mouth and tongue happily gaped in mindless

pleasure at the approach of Caroline, whose face in the moon

light is suddenly beatific, as if someone had lit inside her

a candle. He remembers their early days when she would fill

her bedroom with candles and they would be intoxicated

by the scent of melting wax and she ignited him with her light.

18. What’s On Your Mind

We want to know today whether social media

make us narcissists. Can a collective be narcissistic?

All of us united in one goal of friendship–

how can that be anything but altruism,

a word little used, we know, but you can look it up:

the belief in or practice of disinterested and selfless

concern for the well-being of others. How many

of you have experienced altruism in your lives?

I mean, here, on FB, this reality?

Show of “likes”, please. Let’s take David

as an example. Is he a narcissist for posting

details of his illness for all of us to read? Or is he

an altruist, concerned only for the well-being

of others? Or is he just trying to sell his new book?

What’s the title, anyway? Ah, here, “Chemo Brain.”

Not very uplifting, David, and misleading.

David? What do you have to say? Fifteen of us

like this post and want to know more.

Is “Chemo Brain” descriptive or proscriptive?

David is practicing zazen, something he’s always done

half-heartedly, now seriously. He does not respond. His eyes

are half closed. FB looks more closely at his face, which seems

oddly serene. It’s like that moment in Alien I or II when

the creature dripping acid is nose-to-nose with Ripley.

He wants nothing in his mind but the rain that’s ended.

Ok, here are today’s kitty pictures, the cutest

ever, and here one who died after years of caring

for her human, who’s now dying of grief.

And today’s titty picts. Va-va-voom. Plus music,

featuring today the sounds of Neil Diamond

singing “Sweet Caroline,” warm, touching warm,

reaching out, touching you. Breaking news,

Syria. Mass shooting somewhere. You cannot

escape the certainty of mass stuff like shootings

or assemblies or, look, a flash mob is arriving,

someone with a cello and now a piccolo,

the beginning strains of, what is that tune,

the one that is now deeply buried in your fucked

zen head. It’s crowded in here. Hundreds of us

loving you, caressing you, curling around your

sweet tumors. You want us to go, but we don’t leave

until you leave. What’s on your mind, huh?

For a moment, the rain returns, laving the giant maple leaves,

the wash of memory descending, and how it is after rain again

when there is nothing and then there is everything.

19. The Reading List

You’ve been reading nonfiction, haven’t you,

absorbed in Five Days at Memorial, the lives

and sordid deaths of patients after Katrina,

devouring late at night its macabre details,

the stench, the screams, the cats, the dogs,

the nurses with morphine and piety in their hands.

And then The Cancer Chronicles, as if it might

help you figure out what’s killing you or why.

We’ve looked into these books. Here’s what we learned:

Taxol was originally isolated from the bark of the Pacific yew tree.This discovery was not serendipitous but the outcome of a government program to systematically screen thousands of plants to find substances that were cytotoxic but tolerable–even if just barely–to the human body. That is the brutal nature of chemotherapy. The first chemo agents were derived from mustard gas, whose antimitotic effects were discovered in victims of chemical warfare. Mustagen, which is used against Hodgkin’s lymphoma and other cancers, is also called nitrogen mustard and is covered under the 1993 Chemical Weapons Convention. (Cancer Chronicles, 111-112)

Well, juicy. And now what? Nothing. You can’t change

a thing about the crap that’s in you, even if it comes

from the yew. From the yew to you. Thanks, govt.

And what about the books you started to read,

the uplifting literature and memory, the mind’s

palliative care in times of distress you nurtured

in the SNF after vitals were taken and nothing

remained for you but the elm and the click

of the Vancomycin dealing death to staph?

You missed so much, Swann’s jealous love

of Odette, the history of Atlantis (more than one)

in Sandover. You won’t get that back. We have them

here with us. We own all of it, we mean literature,

every single fucking word. A few missed nuggets:

He marvelled at the terrible re-creative power of his memory. (SW, 523)

As if he could do that on his own.

…all the things in life that once existed tend to recur. (SW, 518)

Straight out of Giambattista Vico. Nothing new there.

anything worth having’s had both ways. (CL, 174)

This is probably sexual, given who’s writing.


Pay attention especially to that last pronouncement.

Elena has gone for the evening to drink beer with her cousin.

David is roasting a chicken. He puts Prokofiev on the Bose

and signs out of FB. It is the first night he’s been alone in weeks.

The light on his MacBook continues to blink, recording.

20. Advance Directive

It was not a dream, more like a manifestation, people

in the room–not this one–were those I’ve wanted to be with me

at the end. Elena and I made the list today as part of the Advance

Medical Directive. It wasn’t a hard list to create. No ex-wives.

Do you want pain killers, sedatives, unconsciousness?

How do you feel about feeding tubes? Breathing machines?

Do you want to be resuscitated? Do you want hospice?

I’ve been reading this book about patients trapped

in a hospital in New Orleans during Katrina and how many

had DNR labels on their gowns and were left behind

to die or, some, to be euthanized. I want the option

of assisted suicide. I want to be conscious at the end

and feel and see what’s happening, where I’m going,

look from the lighted world straight into the dark.

There’s no place on the form for that.

Why are you crying? Do the needles hurt?

I was in the room with the people who had gathered

to accompany me into death–the loved ones on my list–

and I asked them to give me time alone with Caroline.

She lay down beside me, as we had planned. I held her.

And then understood I was leaving her and began to cry.

I need a kleenex. I thought I was ok with dying.

You’re not ready to die. You know how much we love you.

You don’t have to go now. You can take your time.

It is a beautiful vision, my love. I will be there beside you.

But think, what if this is a vision of another kind of passing,

a movement onto a higher plane of consciousness,

an image of how both of us are in transition, leaving

but not dying, the body no longer a hindrance.

Laura, his acupuncturist, gives him a box of kleenex.

He is sipping coffee with Caroline at Common Grounds.

During the night he hears knocking in his sleep,

in the midst of a dream he cannot remember, Elena

coming home late after an evening out drinking.

When he stands, his body wobbles, he lurches for the wall,

and feels like he’s about to evaporate. Don’t bring me back.

His diaper soaked and stinking. Is that a spot of blood?