On a quiet Saturday afternoon in May, while Steve napped on the couch and I sat in the La-Z-Boy watching television, I heard a tinny knock on our screen door. Joey, Steve’s childhood friend, stood on our veranda. “Hey, Joe,” I said, and welcomed him in.
I’d met Joey two years earlier, after a Sunday dinner at Steve’s parents’ house in his hometown of Jackson, Michigan. Joey had noticed Steve’s truck in the driveway and stopped by to say hello. As Joey and Steve shot pool in the basement, I studied Joey—the dirty jeans, the beat-up leather jacket on his slight frame. He was bald on top with a ring of brown hair brushing his shoulders. He reminded me of the townies I’d known growing up in Walpole, Massachusetts—former high-school athletes still hanging around the center square, looking for parties. Or small-time drug dealers who’d never left, only the high-school girls they enticed into their cars changing year after year. Joey worried me; perhaps I didn’t really know Steve if he had friends like Joey. We’d met in New York, both of us working temporary jobs. I fell in love with him quickly, and after two months, I moved with him to Michigan.
That afternoon in Jackson, we perused their high-school yearbook, Joey and I flanking Steve on the couch as we scanned the rows of black-and-white portraits. They’d graduated in 1974, and so everyone’s hair was mashed down. In spite of his mutton-chop sideburns and rippled bangs plastered across his forehead, Steve looked handsome, with his blond curls and sleepy blue eyes, his creamy complexion. Back then, Joey had a full head of hair; the monochrome photography smoothed his acne-pitted skin. They looked so hopeful, all these teenagers, the way the photographer positioned them looking up to the camera, guileless and naive, their dreams and aspirations recorded in the yearbook. Steve touched the headshots of his classmates, pronouncing life sentences. “Divorced . . . divorced . . . in jail . . . dead.” Ten years had passed since they graduated and people’s fortunes could be told.
Steve sat up to greet Joey, which took some effort as he was still sick and weak from the most recent round of chemotherapy. We were excited about a visitor, someone to take our attention away from each other—a live person, not like the television shows or movies we watched for hours each day, an escape from Steve’s dreary circumstances.
“I saw your mother at Motor Vehicles,” Joey said. He looked scruffy in his leather jacket and shaggy hair. “She told me about the cancer. Man, I couldn’t believe it.” Joey sat in the recliner, leaning forward toward Steve. “How you feeling, buddy?”
“Pretty good,” Steve said. “I was supposed to be dead by now.”
Steve’s bluntness seemed to me a brave front for his friend. He recounted his history, the back pain which had begun six months earlier, the chiropractic care that hadn't helped, his diagnosis by an oncologist at St. Joseph's hospital in Ypsilanti, a gleaming, six-story facility, where the doctors had given him two weeks to live (two months at the outside). He described the alternative hospital we’d found, a six-hour drive away, in Zion, Illinois, the experimental therapy that Steve would have there, whole-body hyperthermia, at four thousand dollars per treatment, which his insurance refused to cover.
Joey was quiet. I’d never heard him speak much anyway. I’d only seen him a few times in the couple of years since I had first met him, though often enough to have my impression of him alter from wariness to the kind of affection one has for the runt of the litter. Joey didn’t seem to have much going for him. He worked at Hoyt’s junkyard in the industrial zone of his and Steve’s hometown, where flat-roofed, corrugated-tin warehouses stretched for blocks. A few months before Steve fell ill, he and I had searched for Joey at Hoyt’s one night. Steve needed a radiator for his old jeep. A chain link fence surrounded stacks of cars as far as I could see, maybe five or six cars in each pile, all of them hopelessly flattened and smashed. Nobody was in the small wooden building at the entrance, so Steve and I wandered toward the center of the junkyard. We stopped at a red convertible with its windshield fractured into tiny squares, the engine pushed into the driver’s seat, the shape of a tree or pole formed in the hood as if the car were made of clay. Steve called Joey’s name. There was an echo, then a hush. The junkyard was perfectly still. There wasn’t a living thing in sight. No birds. No bugs. Just dirt and metal and glass and rubber, an unpeopled city of wrecks and discards. We never found Joey that night.
Joey and Steve watched television for a while. In the daytime, nothing aired except for talk shows and game shows and soap operas. But there was no need to talk or fill the silence between them. They’d known each other since they were in Boy Scouts together, and they hung around the same neighborhood, launching UFOs on summer nights. To make UFOs, Steve had told me, they fastened a garbage bag to an empty soda bottle filled with kerosene they’d siphoned from Steve’s dad’s camp stove. Then they strung a wick through a cork plugging the bottle, and lit the contraption. The heat from the flame inflated the garbage bag, which would rise into the dusky sky and drift over the tall pines behind Steve’s house before extinguishing and falling to the ground.
Joey fished around the coffee table for some matches to light his cigarette. He picked up one of Steve’s brown plastic pill bottles. “Dilaudid. Huh.” Neither Steve nor I questioned Joey’s interest. We’d never heard of Dilaudid, a synthetic opioid, before Steve’s illness.
“These go for forty dollars a pop in the city,” Joey said. “I might be able to get rid of a few of these, get you some cash. Can you spare some?”
“I guess,” Steve said. He twisted the cap and spilled tablets onto the coffee table. The tumors along Steve’s spine caused excruciating pain, so the doctors didn’t stint on pain killers: Dilaudid every four hours for acute pain, morphine twice a day to ease pain over a longer period, Xanax for anxiety, and for sleep, Halcion, which, linguistically at least, promised peace. I didn’t say anything. My mind was slow and stodgy from constant stress and worry. I wasn’t capable of working out the ethics of giving Joey narcotics to sell, even if it was to raise money for Steve’s experimental treatments, to maybe save Steve’s life. My focus since Steve’s diagnosis was limited to the small, unfurling moments of each day, to the enclosed space of our living room.
“Got a baggie?” Joey said.
I walked into the kitchen and returned with one. Joey scooped up the pills with the cover of a match book, leaving one pill on the table. He looped a knot in the bag and stuffed it in his breast pocket, then picked up the pill and walked into the kitchen. I heard him opening drawers, so after a moment I went to see if I could help. I watched as he pulled out a tablespoon and filled it at the sink faucet, then dropped the Dilaudid into the water. He flicked a lighter beneath the spoon and held the flame there until the pill dissolved. He took a syringe from the box we kept on the kitchen table. Steve had a prescription for a gross of syringes, which we used for heparin injections meant to keep clear the Infusaport implanted beneath his clavicle. Joey dipped the tip of the needle into the liquid, drew back on the plunger, then thunked the syringe to dissipate air bubbles, filliping it with his index finger the way the nurses had taught me.
I stood watching. I didn’t quite register what Joey was doing until he rolled up his shirt sleeve and tightened a bandanna just below his bicep. Then he knelt on the green- and yellow-flowered linoleum of our kitchen floor. I could see the top of his head, his bald spot. He rubbed two fingers along the inside of his forearm, then pricked the needle into a vein, his movements fluid and graceful, a cigarette dangling out of his mouth, his eyes crinkling against the curls of smoke.
I’d never seen anyone shoot up. I was stunned but kept quiet. Joey was so casual about the whole matter, as if he’d helped himself to a glass of water. I walked back into the living room, where Steve was lying on the couch. A short while later, Joey came back.
“When you going back to Zion?” he asked.
“Next week,” Steve said.
“Take it easy, buddy,” Joey said. “I’ll see you in a couple weeks.”
Joey and Steve shook hands in that soul-brother way, where the thumbs wrap around each other, like a hug of hands. The screen door in the kitchen clattered. Steve raised his head to look out the window as Joey peeled away in a shiny red sports car.
“Where’d he get that?” Steve said.
“Do you know what he just did? He just shot up one of those Dilaudid. He used one of your syringes.”
“Wow,” Steve said. “He’s worse off than I thought. Poor guy.”
The alternative hospital in Zion was a six-hour drive from our apartment, and on our next visit, Steve was scheduled to undergo the first experimental treatment—whole body hyperthermia. His union, the International Brotherhood of Electrical Workers, had raised two thousand dollars from a raffle of tools they’d organized on his behalf, and his parents’ church had raised the other half through soup suppers. I imagined all those good churchgoing strangers paying a few bucks to eat soup, helping to save Bill and Louise’s son. I visualized the cauldrons of soup needed to raise two thousand dollars, then I realized they must have served other foods, it was just called a soup supper.
To undergo hyperthermia, Steve’s body temperature would be raised to 108 degrees Fahrenheit. The theory was that abnormal, mutant cancer cells sloughed off at 107 degrees, while healthy cells—skin, organs, muscle, brain tissue—began to die at temperatures just above 108. It was a precarious balancing act to reach the right temperature, sustain it long enough to do targeted damage, then lower it again. The evening before the hyperthermia, doctors and nurses described the risks to Steve and me in affectless detail. “Yes, I understand,” Steve said over and over. The hyperthermia consent form listed a jarring litany of possible mishaps ranging from blisters, fatigue, and diarrhea to nerve damage, foot drop, numbness in the fingers, blood clotting, and organ failure. The conclusion: “Any one of these complications could result in death or disability, whole or partial, temporary or permanent.” A curious syntax: the absence of a comma implied a possible return from death.
Steve initialed each page, and signed the last. With a scribble from a pen, he risked his life in an effort to save it.
I was up at 6:30 a.m. the day of the treatment, the sun rising as I drove to the hospital. I held Steve’s hand as he was wheeled to the operating room. “I’ve done over nine hundred hyperthermias,” Dr. Kim told me, his hand on my shoulder. He was a gentle, unassuming man. “Everything will be fine,” he said. He must have seen fear in my face, a slight ruck in my brow. “Come back in an hour,” Dr. Kim said, before slipping through the swinging doors.
A nurse found me reading in the lounge at the end of the hallway and brought me to the operating room to see Steve. He was lying on a table, relaxed with Valium, lulled to sleep with sodium pentothal, numbed by general anesthesia. He’d been stripped naked and wrapped head to toe in gauze, like a mummy. Even his eyes were covered, which disturbed me. I pressed back tears. “He can’t feel anything,” Dr. Kim said, which was not reassuring. A nurse tucked folded sheepskins under the points of Steve’s body which pressed on the table—shoulder blades, elbows, heels. She placed a padded doughnut under his buttocks, and layered on cotton blankets, more pads, more sheepskins.
“It will take four hours to raise his temperature,” Dr. Kim said. “We’ll keep it there two, maybe three hours. We’ll see.” He seemed unfazed by the responsibility before him. “Okay?” he asked.
I nodded and left.
The nurses continued the preparation. They wrapped Steve in a heated plastic blanket filled with 80 percent distilled water and 20 percent ethyl alcohol. The temperature of the water would vary from 120 to 140 degrees Fahrenheit, which would raise Steve’s core temperature—the temperature at the center of his body—to the prescribed limit, where it would then hover. Intravenous fluids would be pumped into his veins so he didn’t dehydrate. All output would be measured. Nurses would carefully monitor Steve’s temperature with a thermometer in his mouth, one in his rectum, and one connected to the Foley catheter. An electrocardiogram would track his heartbeat.
What force ignites the current inside us, keeps our hearts ticking every minute of the day, week in and week out, year after year like a metronome, two-and-half-billion beats in an average life span? We take the heart for granted. We don’t even think about its ceaseless activity, its singular indefatigable mission on our behalf until we’re in love and our heart is fluttering, or we’re frightened and it’s pounding.
I walked to the library, spread my notepad and medical articles on a table, and started to draft a letter to Steve’s insurance company, pleading with them to pay for the hyperthermia. I began with a rational approach: From the information enclosed, it is obvious that hyperthermia is a valid treatment for cancer. I continued in that vein, blending in an emotional appeal: Who knows when the major breakthrough in cancer treatment will arrive? I was influenced by movies, the scientist in the lab shouting “Eureka!”—the cure arriving in a sudden, almost accidental discovery.
Steve and I had high hopes for the hyperthermia. It was our panacea, our godsend. The term “experimental” implied anything could happen, even the heretofore impossible. I remember an experiment in ninth-grade chemistry: coagulation. We filled a pipette with egg white, applied heat. Presto. The substance changed from liquid to solid, clear to opaque, a complete transformation of matter. I envisioned the opposite in hyperthermia: Steve’s tumors melting away, flushing out of his body through the Foley catheter. I drafted another appeal, rhetorically forcing the insurance agents into Steve’s situation, threatening like a malevolent god: If it was you, your child, your loved one (and more than likely it will be, as one in three Americans will get cancer in his or her lifetime) . . .
I put the drafts aside. I’d read them aloud to Steve, to see what he thought.
Noon. Time moved swiftly it seemed, as I lost myself in research and writing. I stopped in the cafeteria for lunch and saw Jane, who called me over to her table. She was in her sixties with unruly white hair and huge blurry eyes behind thick glasses. I thought she was a volunteer when she walked into Steve’s room and offered him a newspaper the day before, but I learned at lunch that her daughter, Bonnie, was sick.
“She’s thirty, my youngest of three. Got two kids of her own.” Bonnie, like most of the patients at this hospital, had traveled to Zion after conventional medicine had failed them.
“She had a vertebra removed from her spine, so she can’t walk,” Jane said. “But she’s doing better now that she’s here.”
Jane herself was robust, with a full-moon belly and wide hips encased in stretchy nylon pants. In a flat, nasally voice, she talked about her house in Iowa: attached garage, kitchen with a dishwasher, cyclone fence around two full acres overlooking the Mississippi. “I have five dogs, two cats, a mallard which is now in my freezer waiting for the Guinness Book of World Records to verify it as the oldest albino duck—seventeen years, as old as my niece—and a pet blue jay that barks like a dog and shouts ‘thief’ every time a stranger comes in my house.”
I was slightly embarrassed sitting with Jane in the cafeteria as she spoke loudly about her life, but I was more annoyed that she chewed while she talked. Chew with your mouth closed, I wanted to say, as my mother reminded me growing up. A slug of half-gnawed sandwich flew from Jane’s mouth onto my cheek. It was all I could focus on. At home, I regularly gave Steve enemas, swabbed the raw pink flesh around his catheter site; none of that perturbed me, but having to eat with Jane seemed like an insurmountable task.