11. ALOHA OY!

"Tiny bubbles

in da wine,

Make me happy, 

    Make me feel fine ..."

When, on the 16^th of April 2009, ten days after Em’s death, Solitaire’s cousin, Gillian, and her husband, Alex, invited her to spend a week with them at their home on Hawaii, she gratefully accepted, but not without trepidation.  So harrowing were the memories of her last trip to the Islands that her initial impulse was to decline with regret.

By the time he died, Em had been in treatment for five years at the Mayo Clinic in Scottsdale, Arizona, for multiple myeloma , a rare and incurable blood cancer.

During the first two years, he had undergone three sequential drug regimens in an attempt to halt the advance of his cancer.   

The first was a devastating year-long course of Dexamethasone, a malevolent steroid that devours muscles, damages hearing, darkens teeth, destroys inhibitions, and turns one into a species of euphoric werewolf.  After six months, Em had been transformed from a basically cool and complaisant diplomat, into a snarling cripple with legs like stilts and a voice as jagged as a hand saw, a vibrato so vicious that having once been the horrified target of it, one could never erase the memory.  In the family support group meetings that Solitaire sometimes attended, the mere vocalization of the dreaded “DEX” word sent seismic tremors of terror round the room.  When Solitaire pointed out to Dr Adair, his oncologist, that Em could no longer stand up unaided, let alone walk, and suggested that he take him off the drug, which in any case was harming rather than helping him, the doctor seemed, finally, to bring Em into focus, not as a specimen or statistic, but as a human being.  He asked him to walk across the room.

“Hm,” he said, watching with faintly furrowed brow as Em’s six-foot-three inch frame tottered precariously across the floor, “you may be right.” 

Dr. Adair is a kind of “doctor-doll,” a diminutive, dapper man who, through the judicious use of such props as three-piece suits, crisply-starched collars, lace-up ankle boots and a stethoscope coiled neatly round his neck, achieves a look of 19^th century Harley Street propriety and prosperity.

 His manner is formal; he addresses Solitaire as “Mrs…” (that is if he addresses her at all) and Em is always “Mr. Ambassador.”  Though apparently devoted to his mother, he is anything but cozy. Still, Solitaire respects him.  His “hands-on” examinations are exceedingly thorough:  he washes his hands fastidiously for the minimal two (or is it three?) minutes, dries them, then examines the patient’s eyes, ears, mouth, abdomen, lungs, liver and lights, reflexes, etcetera, with fingers that are extraordinarily sensitive and adroit, not to mention free of all known and unknown bacteria.  When he is finished, he once again washes and dries his hands rigorously.

After meeting with his cancer board, Dr. Adair takes his patient off dexamethasone and prescribes a course of thalidomide.  As everyone knows, this is the drug that, when used for morning sickness by pregnant mothers, caused heart-wrenching deformities in babies, but has now been found to be highly effective in curing certain diseases.  The medication is dispatched by a  pharmaceutical company once a month by post, which for some reason hugely reduces the price, but before they will send it the company insists that the patient sign an oath stating he will not become pregnant.  This amuses Em no end.

Despite neuropathy (numbness and tingling) of the hands and feet and a fatigue that verges on the catatonic, the drug works so successfully at reducing Em’s cancer cells that at the end of several months he is deemed a likely candidate for an autolagous stem-cell transplant, meaning that he will be his own stem-cell donor. 

The procedure takes roughly two months.  During this time Em is hospitalized and given booster shots to increase the potency and number of his healthy stem cells, after which the cells are harvested, separated centrifugally, and saved, his entire system blitzed with a lethal chemo-cocktail that nearly kills him (and does, in fact, kill some patients) and when he is delirious and nearly dead, re-injected with his own invigorated cancer-free stem-cells.  This is a brief and very simplistic account of a procedure that is, in fact, indescribably complex. The machine itself is no less than astonishing:  attached to the body at bedside, it removes the blood through one port, whirls it around visibly in the centrifuge, then replaces it through another port.

There follows a long, dicey period of recovery, during which time they rent, at staggering expense, (it is the high season in Arizona),  a condo in a newly-built, gated community near the hospital in Paradise Valley.  Occasionally, Solitaire spots a car (black with black filmed windows) gliding through the gates and into a garage, but she never sees an actual person and concludes that the cars are driven by zombies.

At last, in March, they are allowed to go home.  They arrive at their house in Tubac in the late afternoon; Solitaire puts Em to bed and takes the dogs for a walk.  She looks at the surrounding mountains, the Santa Ritas and Tumacacoris, at the dusty olive trees and palo verdes, listens to the call of the quail and the  white-wing doves, and cries for joy.  

Em's numbers plummet and he is now pronounced “in partial remission”.  He seems fine:  strong and robust, though still somewhat puffy from the drugs. Friends say he looks like Kojak; his granddaughter Belinda says his bald head is “cool.”  In June, they go east, to Washington and Boston for consultations and Em remains strong.

Two months later, however, his numbers start to creep back up; this is disheartening to say the least because an autologous stem-cell transplant is a one-off procedure.  A cancer patient only has a limited number of useable stem cells and rarely are there enough for an encore.  When they're gone, they're gone forever.  Adair says he will have to put Em back on drugs.  Nevertheless, when they ask him if they can take a little pre-drug holiday, he readily assents.

“Certainly!” he says.  “Why not?”  Why not, indeed?

They make a weeklong trial run – a four-hour drive to San Carlos, a fishing village on the Sea of Cortez.   Em, who has never displayed disease-related symptoms but only drug-related ones, now has numerous reactions to drug deprivation.  His blood pressure rises alarmingly and a corresponding rise in fluid retention causes his appendages to swell.  His feet are pudgy and pink, his bloated hands look like bunches of bananas.  His anxiety is palpable.  He keeps asking Solitaire to take his blood pressure, which hovers like a hot air balloon around 180/90.  What to do?  “I think I should lie down,” Em says. 

“Definitely not!  You should walk – the best thing is to keep the blood pumping.  Also, no salt.  No chips.  And NO margaritas.”

In fact, neither of them has a clue what they should do.  They just keep taking his blood pressure, his pulse, his temperature.   The next morning they decide to go back to the Mayo Clinic.  They head north from Sonora, Solitaire driving, as she always does now, while Em tries to elevate his long legs and feet on the dashboard.  Dr. Adair examines Em’s swollen extremities, then gives him a prescription for Lasix, a diuretic, and says to go ahead and travel.  Why not?

The trial run to Sonora, however, has narrowed their options.  No car trips to exotic beaches with dodgy medical care.  No long airplane flights, no crowded airports with stressful security checks and pat-downs.  Also, no journeys fraught with potential delays and missed connections due to inclement weather.   In sum, no stress.   Ha-ha. 

   

Solitaire has a premonition, not unwarranted, that this may well be their last trip.  She calls a travel agent, who immediately suggests a cruise.  Solitaire recoils.  She and Em love ships, but it is crossings they like.  Together and separately, they have made passages on every sort of sea-going vessel:

Derelict river boat

Sailing ship

Rusted freighter

Troop ship
                                 

Naval destroyer

Departing troop ship 

Inter-island steamship

.

Queen Mary

But not cruise ships.  Nevertheless, when the travel agent
 comes up with a terrific last-minute deal on a Princess cruise going from Los Angeles to Honolulu and back, she decides to take it.  It seems to solve all the problems.  No airports, no bacteria-bearing airplanes, no packing and unpacking; an easy drive to the west coast.  No stress.  Ha-ha.

In Tucson, they rent a car and drive to Palm Springs, listening en route to a recording of Point to Point Navigation, a late-life memoir by Gore Vidal.

 His weary recounting of the sad descent towards death, a downhill road marked by the usual grim milestones and harrowing switchbacks of old age – the ailments and terminations of friends and lovers, the closing of his glorious cliff-top palazzo in Ravello, the move back to the U.S. –  make for several hours of depressing listening.

Ou sont les neiges and all that ...


How well she remembers meeting Vidal one wintry evening at a
literary gathering in New York.  She is twenty-four and new to

the city; he is in his mid-thirties and impossibly sophisticated.  She thinks                
him the handsomest, wittiest, most charming, glamorous man in the world,
which he is.

"You do know that he's queer?" her escort asks in happy anticipation
of her reaction.

"No!" she gasps.  "Queer?"


"As a coot."

 

Well, so what?  He's still dazzling.  And, secretly, she doesn't believe it anyway.

During dinner at Ichiban, one of those Japanese knife-throwing restaurants in Palm Springs, Em makes scratchy little throat-clearing noises that often signal post-nasal drip and the onset of a cold, but when Solitaire questions him he replies briskly that he “feels fine, just fine.”  As they head out of town early the next morning, the royal palms cast long skinny shadows on the brush-cut lawns and the light shimmers in the sun-baked air.  Em has stopped clearing his throat and everything does indeed seem “fine, just fine.”  Solitaire is singing,

    “Oh we’re goin’ to a huki-lau,

     a huki, huki, huki, huki, huki-lau

      Everybody loves a huki-lau…

                                          Da-de-dum-da-de-dum-de-da-dum-de-dum…

                                          We cast our nets out into the sea

                                          And all the ama-ama come a-swimmin’ to me,

                                          Oh we’re goin’ to a … "

       

It is not until they reach L.A. shortly after noon that things begin to deteriorate.  Princess has put them up overnight at the Airport Marriott, a caravansary situated amid the terrifying maze of stacks, ramps, abutments, cloverleafs, overpasses, underpasses and flying buttresses that constitute the zany engineering marvel of Interstate 405, aka the San Diego freeway.

 Em is the default navigator despite the fact that, as noted earlier, he suffers from acute DDD – Direction Deficit Disorder. (Em, who was in the Air Force during the Korean War, once told Solitaire that he had very nearly joined the Army’s Officer Candidate School when he was in college and ever since then she has had a recurrent nightmare of Em leading a company of men over a hill somewhere in the wintry wastes of the Yalu River, shouting “Follow me, men!” at which point mayhem ensues and the company winds up in Pyongyang.)

Alas, his driving skills are even worse.  He is the sort of driver who has not been behind the wheel two minutes when his eyes take on a contemplative glaze and he begins to ponder the strategic long-range political ramifications of US China policy in the Thirties on the old school Washington Cold Warriors whose thinking shaped our policies in the post-war era and propelled us ineluctably into the Vietnam War.  As he drifts meditatively over into the fast lane, maddened drivers careen past, shouting obscenities and giving him the finger.

So Solitaire is driving and Em is (sort of) navigating.  By the time they have missed the same exit ramp for the fifth time and gone north when they should have gone south, Em, who is never angrier than when he has erred, has a serious case of road rage which he is venting at Solitaire.  She in turn feels so furiously victimized that when at last they arrive, purely by accident, at the hotel she vaults out of the car, elbows the startled bellman in the sternum, makes an end run through a crowded lobby heaving with repulsive, scantily-clad bodies belonging, she suspects, to fellow passengers aboard the Island Princess, and ducks into the ladies’ loo where she hides for the next hour, doing 4-7-8 yoga breathing and “down-dog,”occasionally splashing her face with cold water.

Down-dog

When she finally gets to their room, Em, who would normally have recovered his good humor and be reading and drinking a beer, is lying on the bed, on his back.  She watches him for a moment.  He is breathing noisily, restlessly napping.  She sits down beside him and kisses him lightly on the forehead.  His brow is hot and he rolls away from her without opening his eyes.

“Sorry,” she says.

When Em and Solitaire first met in the early 70’s, the movie “Love Story” was in its heyday and the catch phrase of the time was, “Love means never having to say you’re sorry.”

“Rubbish,” said Solitaire.  “Love means wanting to say you’re sorry – and saying it damned quickly.”

 She knows he must be sick to be so irascible.  And what could be more horrible to contemplate than two weeks of incarceration in a small cabin at sea with a sick, irascible husband?  The very thought of it gives her a wracking headache.

“Let’s call it off,” she says.

“Not a chance.”

“Why not?   We’ve got trip insurance.”

“We cancelled France last summer and Venice over Christmas.  We’re not cancelling Hawaii.  So just forget it.  Besides,” he adds, “I don’t think I’m going to get it.”  The dreaded “It.”  To most people, “It” is just a cold, maybe the flu; to those with cancer, “It” is something of a far greater magnitude, possibly fatal.

She orders up a pot of tea and some sandwiches and they lie on the bed and watch “Little Miss Sunshine.”  The movie amuses them and makes them both feel better. Then they catch part of a documentary about a writer’s colony, probably Yaddo, she can’t remember now.

When it is over she makes the horrible mistake of calling her mother.  Lavinia informs her that she is out of urinary incontinence pads, baby-wipes and “pull-ups,” as though she expects Solitaire to chopper off the Marriott roof, zip over to Safeway and airdrop the goods onto the DZ of her mother’s carport in Green Valley Villages, Arizona.

  She is also, Lavinia says, “dangerously” low on Dewar’s scotch whisky (purchased weekly by the gallon), as well as Fritos and Kongs .  (Kongs are rubber dog toys filled with peanut butter.) This is Lavinia’s basic shopping list, which is another way of saying that the sum and substance of a life, after 96 years on earth, can be reduced to baby-wipes and whiskey.  And Kongs.    

“Are the Kongs for Lavinia or “Lucky?”  Em asks.

Solitaire stands at the hermetically sealed window looking down at the parking lot; the setting sun strikes the steel patchwork of cars squatting below her in their hideously glaring metallic colors.  She feels wretched, trapped.  She suspects that these huge high-rise hotels seal the windows in the conviction that their guests, mostly suicidally depressed self-defenestrators, will fling themselves from the 24^th floor, hurtling head-first onto a representative sampling of the Japanese car industry, splattering the paint jobs of all those marshmallow-white and gunmetal-blue Subaru behemoths with blood and guts and costing Marriott a bundle.  As a matter of fact, Em once sued the Marriott Corporation for gross negligence – and won!  But that, as they say, is another story.  

She wishes she were at Yaddo where casement windows compliantly opened and after breakfast each morning writers picked up their prepared lunch boxes and strolled off to their cottages where they spent the day pecking away at two-hundred pound Underwood typewriters or lay dreaming the hours away on their chaise longues until, along about mid-afternoon, they brewed themselves a pot of lapsang souchong, the only time they ever went near a stove, because the writers at Yaddo never had to cook and they never had to talk to their mothers, either, for the simple reason that there were no telephones and, come to think of it, no mothers.

All night Solitaire lies in bed listening to Em’s dry but ominously percussive cough backed up by the doleful hum of the air-conditioner.  In the morning she doesn’t have to ask him how he feels; she knows.  But she does anyway.

“How do you feel?” she asks.

“Rum,” he replies, looking miserable.  “I’m afraid I’ve got it.”  It…

“So,” she asks brightly, “shall we go home?”

“Absolutely not!”

Solitaire sighs.  Rarely has she felt such a sense of foreboding.  To alleviate her dread, she rolls out of bed and venturing a "sun-salutation," trips and tumbles.  A bad omen?  "Oh the hell with it," she says and goes for a "down-dog" instead.

Down-dog

                                                                   END -- PART I