Publish the Word
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Angelus -- Chapter 24


 The Lord gave the word: great was the company of those that published it. Psalms 68:11

                              Chapter 24



As the anesthetic injected into her lower back wore off during the flight home, Ava twisted in her seat, unable to sit comfortably, even with a pillow compressed against her spine.  The pain was diffuse at first, but gradually the soreness intensified and felt as she imagined a knife wound  would feel.  Pain brought lucidity, as if all the nerves in her back were screaming for triage.  She swallowed two aspirin with a can of warm soda, but found little relief.  The only moment of grace occurred as they left the airport parking lot in Green Bay.  Ava had turned to David and told him she had lunch with Susan Bell.

Really?  Unexpectedly startled, he added, she's leasing space in my new mall.

I know, Ava said.  We talked about her gallery.  She wants more of my paintings.  Ava watched David's eyes react:  an abrupt shift to check the rearview mirror, a prolonged glance out the opposite window at nonexistent traffic, nonchalance in his voice, she thought, as he again said, Oh, really?   He was unconvincing.  She had lived with him too long and was attuned to these subtle cues.

She'll have 2,000 feet overlooking the waterfront, he said.  I guess she's doing all right.

For a moment she considered asking if he had offered her the mistress discount, but his club-footed waltzing around the subject of Susan Bell was amusement enough.  Her more immediate concern was to manage her discomfort until she could sink into bed with her heating pad and a glass of cabernet.

The pain lingered for two days until it evanesced into a purple bruise.  On Friday as she worked on a 40 x 60 canvas of migrating geese over a wind-whipped lake, Dr. Esquival phoned from the Mayo Clinic.  Today there was no equivocation in her voice.

            Mrs. Hall, I'm sure Dr. Lin explained to you about toxicity and collateral effects from chemotherapy, such as nausea and loss of hair and susceptibility to infections, depressed bone marrow.

Yes, he did.

As Dr. Esquival continued, a low-grade anxiety began to seep through Ava, perhaps something in the doctor's tone or how she was speaking in hypotheticals, as if the two of them were discussing an imaginary third party, not this Mrs. Hall, not her cancer, but someone else they would have to break the bad news to.  Dr. Esquival was saying, when blood and marrow tests indicate the presence of what we call blast cells, or myeloblasts, which result in a rapid influx of undeveloped cells into the blood, once we determine a cause, we try to ameliorate damage.  We have several avenues which have proven effective in clinical trials.  Of course, the patient's input is crucial to any intervention.

I'm not sure I'm following you, Ava said.  Can you explain that again?

Certainly, Dr. Esquival said.  Your blood and marrow tests indicate Acute Myelogenous Leukemia.  The genetic coding necessary for normal cell development seems to have been damaged.  In my evaluation, that triggered your high white cell count which we discussed Tuesday.

You said damaged.  What's damaged?

The information which replicates your cells.  The DNA.

Could the actual treatment have caused the damage? Ava asked.

Plausibly so, but the next step is to assemble a team from oncology and hematology to work with you, Mrs. Hall.  Probably as soon as next week, if you can be available.

Yes, I can come back, Ava said, aware of a numbness in her hands and arms, a catch in her voice.  When did you say?  I'm sorry -- what kind of leukemia?

Acute Myelogenous, a proliferation of anomalous white cells.  Dr. Esquival paused as the words settled into silence between them. A dark fissure had opened midway between Rochester and her home, and some kind of mutant fog was escaping into the atmosphere, something anomalous, something vile and black and deadly and anomalous.  Anomalous.  That meant the cancer was in her blood now, didn't it?  Dr. Esquival's voice went on but Ava was sliding into a state of emotional autism, detached from the words which were traveling toward her through hundreds of miles of unbroken filament.  Anomalous.  With proper treatment, Dr. Esquival was saying, we can optimistically bring your blood levels back with normal range.  We can manage any pain you might have.  Why don't you stay on line and I'll transfer you to our scheduling secretary, all right?  Please hang on.

Please.  Hang on.  She heard the words, their sound in her ear, but they were devoid of meaning.  Paralysis had clamped over thoughts like a spidery, tentacled creature that was oozing down into her mind, swallowing her in inky blackness.  She could feel the world recede about her, a disconnect, the floor dissolving, the air like dark water flooding her lungs, her body gravitational as she leaned against the kitchen counter to steady herself.

How about Wednesday?

Wednesday, she mimicked.  Wednesday she was going back with her overnight bag, with a copy of her insurance policy.  Wednesday.

When she reached David he told her he was tied up for the weekend and so wouldn't be home.  She chose not to use the word leukemia.  Instead, she muted her alarm.  She said the Mayo wanted her back on Wednesday because they found a problem with her blood.

What kind of problem? he asked, his voice breaking up into static..

She could hear country music behind his voice and other voices talking indistinctly.  He was in a restaurant or bar in Bailey's Harbor, less than fifty miles from her.  He was having trouble hearing her, he said, probably with his palm cupped over his ear to block out the jukebox  in the background and billiard balls and then a woman's shrill laughter.  David interrupted himself to speak to someone, his own voice muffled.  Now what were you saying, he asked when he returned.

They want me back on Wednesday.

Don't count on me, he said.  These day trips have set me behind schedule.  I can't.  I just can't on Wednesday.  You said Wednesday?  No, Wednesday's out.  I have a shareholder's meeting.  You'll have to go without me.  Sorry -- next week's no good at all.  Why don't you call Julie?  See if she can get away for the day.  Madison's not that far from Rochester.

No, Ava said.  She missed the first two weeks of classes, David.  I wouldn't impose on her.  I can go by myself.  I don't want to waste your time.  No, no.  I'll call and let you know what happens.  I'll be fine.

And thus begins, she thought, the inevitable, the final aloneness, a miasma to envelop and consume her.  To take possession.  If she would search back in her memory, months from now, she thought, for the exact moment she felt herself surrender, perhaps she would be standing in her darkened kitchen inhaling the faint scent of a toasted cheese sandwich and tomato soup she had burnt for dinner.  The beige wall phone would be nestled against her neck.  She would reach up and feel the trembling under her chin and down into her chest.  Her eyes would mist and shut down.  She would think to herself:  now the cancer was in her blood.  Now it was carrying death throughout her body.  Now she would need to prepare.

Or she might think of the letter she opened on Monday and how afterwards she stood on the deck for a long time crying, letting her tears drip through the redwood slats onto crushed gravel underneath.  Dr. Laura Esquival from the Mayo Clinic, who had acquired her case from Dr. Michael Lin, had written to inform her patients she was accepting a position at the Sloan Kettering Memorial Clinic in New York, and though she regretted her abrupt departure, she was transferring Ava into the capable care of her colleague, a Dr. Virgil Francesca, whose recent paper on "Diagnosis of Multiple Myeloma," which he had delivered at an international conference in Vienna, placed him at the forefront of oncological research.  She and her husband should anticipate hearing from Dr. Francesca shortly, the letter said.

On Tuesday Ava wrote her brother in Paraguay.  Julie is back in school, her letter said. David is busy building his shopping mall which will resemble a New England fishing village.  A nautical theme, she wrote, with whalers, shrimp boats, sea-netting and barnacles.  It will stretch into Lake Michigan on concrete pilings.  The water is freezing, too cold for swimming -- only 60 degrees in July.  Most fishermen will tell you the water is contaminated.  I'm fine, myself.  Already I miss you and Carmela and Evita.  Give them my love.  Tell Carmela I miss her cooking.  Tell Evita that Julie wants her to come up next summer.  I go back in two days for more medical tests.  The doctors think my blood is contaminated.  I hope we can settle all this cancer business soon.  I don't want to upset our family Christmas, about the only time we're all together.  It would be wonderful if you could come for the holidays, and I know you'll laugh out loud when you read this because Wisconsin in December would be like nothing you've ever experienced in the tropics.  Life seems in suspension.  The trees are glazed with ice.  Snow buries everything.  The air is so bitter cold it burns your lungs to breathe.  And the wind, Udo, is merciless, the way it penetrates your bones.  You need to visit in summer or the fall when the trees are decked with russet, scarlet and amber, bent with crabapples and cherries.  Or the spring is lovely.  We're big on tulips.  Daises and violets grow wild all across the county.  Come in May or June.  Please don't think because this letter is brief that I don't have much to say.  I will write more as soon as I put this illness behind me.  I've thought a lot lately about my ancestry, before, during and after Paraguay, but so far it's still a jumble of feelings.  I am grateful you were honest with me.  Like I told you when we left, I respect your musical talent more than I can express.  I love you as much as any sister could love her brother, and I regret all the years I didn't tell you so.  Love and many affectionate hugs, Ava.


She was familiar with the regiment:  an hour commute to the airport, the claustrophobic flight on a regional airline, requisite paperwork for the rental car, then another thirty minute drive to the Baldwin Parking ramp, followed by a two-block walk along Second Avenue to the Mayo Building.  A woman had phoned Tuesday afternoon and told her to come to Dr. Francesca's office on the eighth floor.  She complied, characteristically early, as she always was, a defect in her character some would see as virtuous.

When she reached the eighth floor, she stepped into subdued light.  The air was solemn, as if hushed by the presence of so much disease or more likely the prestige of such esteemed physicians.  A woman behind a horseshoe desk found Ava's name on a computer screen.  She asked Ava to wait in the small atrium at the end of the corridor.  Ava entered a different light, creamy and palpable with a northern view onto the Methodist Hospital.  Except for an older couple dozing in a parabola of sun, she was alone.  From a magazine rack she selected Woman'sHealth, on whose cover an attractive, grey-haired woman smiled as she jogged toward the camera, an image of ageless health.  Ava skimmed the pages as she waited, pausing to read an article entitled "Cancer's Natural Cures."

After twenty minutes she got up and wandered along the corridor until she found a restroom.  When she saw her reflection in the mirror, she tried to superimpose the magazine cover woman over her face, the other's woman's radiant eyes and wind-washed smile.  The other woman's smooth, taut skin.  Her cascading, lustrous hair.  The perfect genes.   She was probably vegetarian and drank green tea.  Her hormones were docile, had never erupted.  Her labors were painless.  Her two perfect children were in medical and law schools.  Her husband took her to Paris for their last anniversary.  Her sent her roses without provocation.  She would never be that woman.

Ava washed her hands, sponged her cheeks and forehead.  She went back to the atrium and waited another thirty minutes until a young woman she had never seen before came into the sunlit room and announced Ava's name aloud, Ava Hall?, then silently led her down a branching corridor to a suite of offices.  Dr. Francesca was standing in his doorway in a grey, pinstripe suit, not much taller than herself, but his head, she noticed, seemed over-sized because of his coarse black hair, brillo hair, Mediterranean.  She expected him to speak with an Italian accent, but his voice was crisp Midwest.

We're waiting for Dr. Immergut, the hematologist on your team, he said.  He's on his way from the Siebens Building.  Can I get you anything, coffee, soda?  While they waited, Dr. Francesca asked about her family, her husband, how she like Door County, someplace he had always wanted to visit but had never found the appropriate excuse.

Dr. Immergut's arrival spared them further conversation.  He was compact with small, dark eyes, a trimmed mustache.  He transferred a steaming, styrofoam cup to his left hand as he extended his other, a firm, doctor's handgrip.  She felt fluttery with apprehension, as if they were about to pronounce her fate which had already been determined without her.  Dr. Francesca handed a computer printout to Dr. Immergut and said Dr. Lin was the primary oncologist, but unfortunately, when he went on sabbatical Mrs. Hall got shuffled to Dr. Esquival whose sudden departure, I'm sure, has upset her.  Usually we provide a more stable, integrated team approach, he said, but let me assure you, Mrs. Hall, I'm not going anywhere, nor is Dr. Immergut, that I know.  I'll let him explain the intensive treatment we recommend.

She listened to Dr. Immergut meticulously detail what was happening inside her, in the blood manufactories of her bones, how the microscopic leukocytes, the anomalous cells, were colonizing among normal cells, like extraterrestrials, she expected him to say.  The doctors wanted to implant catheter tubing in her chest, you'll hardly know it's there, Dr. Immergut said, for easy infusion of anthraculine and cytarabine, and probably cytokines to effect a remission, but the significant decrease in red cells would require transfusions, antibiotics, and down the road, if necessary, transplantation of compatible marrow.

He filled the room with words.  Antibodies.  Natural killers.  Blast cells.  Stem cells.  She heard them, heard his voice rise and fall, the words piling up, consuming the oxygen of the room, the infusion of words, strangely evocative, she thought, of science fiction, how they might strap her to a slanted table and inject her with a foaming, green serum and then fire an atomic ray at her renegade cells to halt the intruders' advance.

He conceded, yes, Dr. Lin's immunotherapy had not met their goals, but he and Dr. Francesca were confident that immediate treatment would offer her a high expectation of remission with a normal quality of life.  We won't sugar coat what lies ahead, however.  Chemotherapy does exact a toll -- but most patients manage the anti-leukemic drugs quite well.

He paused to wait for her response.  Dr. Francesca, who had been nodding agreement to Dr. Immergut's analysis, glanced down at his arm upon the desk, at his watch, she realized, just below the cuff of his powder blue shirt.  Ava followed his eyes, saw the silver watch, the intricate design of the band.  A stray thought flashed through her mind: had her time expired?  Was he ready for his next appointment, his next team?  Was he meeting his wife for lunch?  Were they waiting for her to say something?

And then, anomalous of her entire life, without David's permission or anyone else, she said simply, no.  No.  A definitive no.  No to the 3-D image mapping of her body.  No to the nausea and vomiting.  No to the plastic tubing in her chest.  No to handfuls of her hair and toxic chemicals and nuclear winter inside her body, the alien insurrection and leukocytes and anemia and ulcerated blisters when she swallowed, no no no and no.

Both doctors stared at her.  Dr. Francesca asked pensively if there was something she didn't understand.

No, I understand.

Maybe you should discuss this with your husband before you make any decisions, Dr. Immergut added.

Dr. Francesca spoke again, his voice softly modulated.  We empathize with you, Mrs. Hall, the emotional shock of leukemia, your fears, your concerns about treatment. . .

His voice was seductive, wooing her cancer.

. . . and this is natural, he said, to be confronted with our own mortality, our fears of dying, fear of the unknown. . .

His voice was charming the black cobra coiled below her stomach.

. . . we understand, of course we do, having helped so many like yourself to make tough decisions, but also rational decisions, best for everyone, your daughter and husband, shouldn't you really ask for their input before you decide?

She glanced from one doctor to the other.  She felt suffused with gratitude as they gazed patiently and waited for her, such infinite patience, she thought, the words which drifted about them now flaring into light, filling the room with the golden warmth of their compassion.  They had confessed aloud for her, declared their feelings.  They wanted to help her.  The reprieve was waiting.  Their entwined futures were waiting.  The cancer infiltrating her veins and tissues was waiting.  These doctors, both of them silent, more patient than her husband or children ever were, awaited her response, Ava Hall, reluctant to disappoint them or anyone, even the dead.

Some equilibrium had shifted however, some tilt of the tectonic plates miles underground, a sudden reverse polarity in the upper air currents, she didn't know what or why, but the day felt unexpectedly re-oriented.  As if she had turned the mental photograph she carried of herself inside out and saw a dozen new opalescent facets of herself revealed with clarity, Ava, herself, her alone, her yes or no to decide, not David who wanted everything but her, not Julie who wanted only what Julie wanted -- what did Ava want?

She reached her hand forward and touched the polished wood of Dr. Francesca's desk.  She said, I understand that I did not have this blood problem before your treatments.  And I wonder if your wonderful miracle drugs caused this leukemia?  I read about it.  I'm not stupid.  And I'm not blaming anybody, not your personally.  But today, right now, I don't think I want to give my body to you or anyone else.  No more clinical trials.  No more predictions of how long I can reasonably expect to live, with or without treatment.  I don't want a death sentence and I don't want promises.  I just want to go home and sleep in my own bed without needles or tubes or drugs.  I appreciate your time, I really do, but if you will please excuse me, I would like to leave now.  Nothing personal, but I can't stand being surrounded by so much illness. She rose and turned, composed, she thought to herself, and left with dignity, with graceful dignity.


When she entered her dark foyer at home late that evening, having had to catch a Northwestern jet into Milwaukee and then a commuter flight to Green Bay, she was overwhelmed by the scent of lilies.  She discovered a spray of white blossoms atop the living room coffee table.  Easter lilies, sweeter than perfume, but they were in bloom out of season, she thought, as she bent to examine the milky trumpets overflowing the planter.  From where had they come?  Their fragrance permeated each room, the whole house freshly aromatic even though she had left it closed all day.  They weren't from David.  A florist might have left them on the porch, but not inside her locked up house.

And then she entertained an outrageous thought -- her angel had brought the flowers.  He had, she knew he had as a confirmation of his presence, some sign.  She wasn't sure what the flowers meant, but weren't Easter lilies all about new life, a resurrection?  The new Ava was in charge of her life.  The new Ava felt embraced by the sweetness.

She put a kettle of water on for tea, checked the answering machine and went into the bedroom where the unmade bed reminded her of how she had felt the house in disarray at 6 that morning, worried she would be late for the airport, certain the entire day would catapult into disaster.  She was always prepared for the worst.  But that was old Ava thinking.

She unpacked her bag, its few contents symptomatic of so much that was wrong in her life: white cotton underwear, losing their elasticity at the waist; her floral nightgown, not silk or lace trimmed, designed solely for sleeping, definitely not Victoria's Secret; and then her furry slippers purchased in the children's department at Wal-Mart, and her plastic baggie with its soft nylon toothbrush, travel tube of Colgate with whitener, makeup, chap stick, moisturizing lotion.  She sat on her bed in the middle of the room and pondered if the stillness was contentment or simply exhaustion.

One's life, it seemed, was always drawn toward these proclivities, as dependable as frost in November.  Some inherited brittle bones and the constant threat of breaking them; others bore the tendency toward alcoholism or miscarriage.  She was drawn to long solitudes, those corridors of emptiness between waking and sleeping when she tried to think up cures for silence.  She carried winter expanses inside her.  And in those barren wastes existed a restlessness.  If asked, she could give it a name.  Without warning it would rise inside her like the wind which had buffeted her drive home and which now thrashed the backyard trees in its frenzy, wrenching at the windows and doors.  Sometimes she felt it as a caress, a gentle brush at the curtains, a feminine passion, but now it raged against the roof shingles and tore at the chimney to get in, a bitter and agitated entity which knew her personally as well.  She felt this some days.  She felt it dwelling inside her.  But now, at this moment, it was out there and she was alone in here, safe in her house upon her bed.

David would not expect her home until tomorrow.  She had been told to prepare for an afternoon of tests and a subsequent team conference with her oncologist and hematologist the next morning when they would determine her treatment schedule.  Instead, and to her own amazement, she had left the doctors, had abandoned her team -- a liberation, she thought, or a resignation.  Either way, she was home with her comforter underneath her, water whistling b-sharp on the stove, safe, tired and for now, at peace with the winds.

Had she made the right choice? she asked herself as she sat at the kitchen counter and buttered a raisin muffin.  What was the likely scenario now?  She didn't know.  She recalled the magazine article she had read about natural, less invasive treatments, the promise of phytochemicals and nutraceuticals, plant-derivatives which boosted the body's self-healing mechanisms.  The article had been a fortuitous discovery for her.  If leukemia was an explosion of immature white cells, she would search for whatever naturally occurring substances could aid in restoring her body's balance.  Perhaps that was the message from the angel -- the Easter Lily blooming in the fall, new life in a season of decay.


The next day she began to paint her Paraguay series.  A rushing torrent of images began to pour from her.  She began several canvases in oil, in acrylics and gouache, painting from memory and from her daybook sketches.  She worked without pause, not even lunch.  She might have remained in her studio until nightfall, but shortly after five David appeared at her door.  He seemed worn and in need of a shave and shower.

I expected you later this evening, he said.

And you're home a day early, she said.

Well, I felt guilty that I couldn't go with you and provide moral support, he replied, glancing over her wet canvases.  They Mayo is an intimidating place by yourself.  How'd it go?

She squeegeed the brush she was using and placed it to soak in a jar of lamp oil, then she wiped her hands with an old towel before she answered him.  It went well, she said.

What'd they say?

He had caught her unprepared.  She lacked his adroitness at lying, but a facile answer or even avoiding what had occurred was deception too, she thought.  She moved the canvas in front of her to a side table, closer to the south window where it would receive first light in the morning.  She allowed herself this time to compose a response.

The doctors said my blood is producing abnormal cells.  She stopped, unable to phrase exactly what she wanted to say next.  After a moment she added, of course they didn't admit it was probably the result of earlier treatments.  They also said I would need to undergo more chemo.

More chemo?  Why?  He seemed alarmed, more than she had expected.

Why?  Because it's there job to give patients chemo, I guess.

David went over to the west window and unfastened the latch to let in the cooler evening air.  The setting sun had left streaks of rose, magenta and cobalt in the sky.  He drew in a breath and turned back to her, his voice firm with resolve.  This is so much like him, she thought, so predictable.

We'll take this one day at a time, he said.  It's a temporary setback, right?  He was rifling his mental file of clichés.  He would offer her problem-solving, too, also like David, a fixable problem with t-squares and logic.  He said, you're relatively young and healthy.  We'll get through this.  These doctors are the best in the world.  When do you start?

I told them I didn't want more chemo, she said softly.

Why would you say that?

Because I don't want more chemo, she said.  I don't like how it makes me feel.  I don't want my hair falling out again, now that it's growing back.  I don't like that it damages healthy tissue.  I simply don't want more chemo and I told them so.

What did they say? he asked.

They said I should discuss it with you, which I'm doing now.  She sat on the edge of her high-backed stool and stared ahead at a canvas of a eucalyptus tree flurried with rainforest birds, the songs of which she could hear in her head if she shut out David behind her, his agitation, the wind escaping into the room, the window suddenly slammed shut.

What's the prognosis if you refuse chemo?

I don't know, she said, startled by the irritation in her voice.  If you want the chemo so much, you go take it and tell me how much fun it is.

He exhaled, the sound of the small wind loose in the room now.  He said nothing, nor did she.  His breath seemed to be a third presence between them its slight crackle, the sound of blistering.  Finally he said, well, let's go get some dinner.  I'll take you to the fish boil.  If you want, we can discuss this later.


Daybook, October 2   

The air about us burns with the residue of the dead.

We move through space they once occupied.

We breathe their words, still vibrating.

We imagine they drift among us as shadow, wind

whorls of light.  They would phosphoresce as we sleep

and spill the afterlife's secrets, if we were not blind

and deaf, if we could read the stars' calligraphy,

bone and pebble, obsidian and ouija.  We might know

or not know, if we could fill their absence with water,

the shape of all things, the tangibles we inherit,

blessing and curse; if we could touch the dead once more

in forgiveness, lightly with out lips, and say:  we will wait

all night for you, in window light, in prayer, in the wind's

mumbled afflictions; we will search for you in mirrors,

in photos and letters, our children's eyes; we will enter

the rooms you inhabited, silent rooms, drained of light;

we will speak your names aloud, the names we bear like scars.

All our days we will carry you in memory like shrapnel,

desiring to hear a father, a mother, a son once more, one vowel, one.

And we will wait for your return until the gathering dust ignites,

until rain falls like napalm and the wind flames upward, incinerating

our skin; until this earth and this heaven pass away, and together,

transformed, we enter hand in hand in hand, the coming Light Ages.