A BELL WILL RING

As an oncologist I have seen debate swirl about whether patients completing chemotherapy ought to ring a bell as they ceremonially exit their infusion suite. As with the fighting metaphors of oncology, this is a practice that appeals to some but not to all. Here I envision what it might feel like for a patient who will never have the opportunity to ring the bell when they hear it toll out:

The suite has its ceremonies. Any entrant to this space goes through rituals of intake and preparation: the double- and triple-checking of their identity, the sterilization of the skin over their Port, the broaching of their blood supply with a special needle that curves talon-like for stronger purchase.

But the grandest ceremony of all is reserved for egress: a bell rings out when a patient completes chemo. The sound is as piercing as any sharp instrument, slicing through the nurses’ low chatter and the shrill beeping of the infusion pumps. It is a clarion call, a resounding announcement that a cyclical existence can return to linearity after all. The not-so-merry-go-round of treatment can come to a halt, and then you are granted permission to leave the world’s worst amusement park.

It is meant to be a joyous noise but — Donne and Hemingway be damned — this bell does not toll for me. There is no finish line when the race is endless, or when the runner collapses from exhaustion. Mingling with the good prognoses invites covetousness and resentment, so much so that I almost wish chemo could be administered in separate locations depending upon its intent. But no, the suite must contain us all, raising the stakes of the haves and have-nots to become the will-lives and the will-not-lives, adding jealousy to the crushing burden of the incurable. How pathetic it is to envy another patient who “only” had to undergo a dozen cycles of chemo.

I have learned the medical parlance by which those individuals with discrete endpoints to their chemo are said to be undergoing “adjuvant” therapy. My own treatment is given a different label altogether: palliative. I know the difference in the Latin roots. Adjuvare means to help toward, propelling that group of patients back to normalcy after minimizing their odds of recurrence. Palliare means to cloak. Indeed, during the celebratory chiming, I shrink unseen and unheard in my corner of the suite, where my chemo continues ad nauseam, ad infinitum.

There is only one way out for me, and I will slip away shrouded in silence. I am a man who is an island, separate from the archipelago, lost and muffled in the most impenetrable fog.