The magical kingdom of Duke: two addendum to dabbling in the occult.

There are a just a couple details regarding my care over the last few days that seem unfortunate not to include in this chronicle—and also in some ways heighten the sense that perhaps this whole experience is teetering a little into a world of powerful magic beyond our understanding (But maybe that’s just Duke? asks this devout yet unmistakably shaken Tarheel).

One goes like this: Dr. Georgiade, my surgeon-to-be and the chief of plastic surgery at Duke, was not in clinic at the cancer center on Friday when we saw him. Instead we were sent to his offices at The Aesthetic Center—a couple miles down Erwin Road from the main Duke Hospital craziness.

I liked Dr. Georgiade when we met him at my first appointment. He is friendly and straight shooting. As my friend Drew has articulated, he has a little bit of that “fighter pilot” vibe that surgeons can sometimes project and he is unnervingly hard of hearing (scalpel? I thought you said apple!), but he exudes competence and kindness.

I liked him even better after our (albeit somewhat traumatic) visit on Friday.

First off, The Aesthetic Center is appropriately brand-spanking-new-looking and very lovely—tucked back among perfectly B-cup-sized little rolling hills in a dappled-shaded medical park with parking for weeks.

From the get-go, the whole scene felt a little Truman Show-y, something we wouldn’t exactly put our fingers on until almost back in Greensboro on the drive home.

We had actually messed up my appointment time and were running an hour late. When we talked to the nurse (who answered the phone!) she had said, “That’s ok! Come on in anyway! Just drive safely!”

So fresh and newly constructed was the whole complex, it almost seemed fortunate that we arrived a little late to give the numerous landscapers time to lay out more pine straw in anticipation of our arrival. A couple boxwoods were hastily planted as we walked down the pathway toward the office.

Once inside, I went to the desk and the receptionist looked up and said, “Nina Riggs?” Yes, I said, I’m so sorry I’m late!

“It’s no problem at all,” she said. “Just take a seat and I’ll tell them you’re here.”

No insurance card. No co-pay. No 43 HIPAA forms. No photo ID.

So John and I took a seat. The waiting room was silent and comfortable. There were two other couples waiting, leafing through magazines, but they didn’t speak or look up or have their names called, and they looked suspiciously like set extras.

Once in the back (after a 2-minute wait), we entered an exam room where a tech was already waiting to take my vitals (heartrate: 114! I guess I was a tad nervous), etc. Then entered the nurse, who introduced herself as Old Dee—she was DEFINITELY straight from central casting. Hilarious and kind and a music-to-the-ears Boston accent (turns out she is from Andover), I loved her immediately.

When Dr. Georgiade came in he said, “So glad you made it! I was worried when you didn’t show!” and Old Dee vigorously nodded in agreement. “Yup, he had me call over to the cancer center to make sure you didn’t go there by mistake!”

Um. That is certainly a first. Perhaps that’s what the Duke web site means by patient-centered care?!

Then we entered the unpleasantness of the tough conversation about where things stand with my current treatment. The occult tumor. The you’ve-sure-thrown-us-a-curveball-here-young-lady bit. John’s already told you all that. Old Dee finished Georgiade’s sentences for him. At one point she might have straightened his bowtie. Then, when all the questions were done, Old Dee pulled out a sample mastectomy drain and the doctor announced that was his cue to leave.

Much later, as we came out into the hallway to leave, Dr. Georgiade was just standing there smiling at us. “You can leave through that door,” said Old Dee, pointing at the back door, “No need to check out.”

And they stood there together waving at us from the hallway. “Have a good afternoon!”

As we drove out away from The Aesthetic Center we saw no other cars on the drive.  I couldn’t make out the name of a single other practice in the complex—too dappled was the shade. The landscapers had gone home, but now that I think about it I may have seen some workers striking the set as we pulled out onto Erwin Road.

The second notable craziness: At 6:30 on Saturday morning, when I woke up with my whole face swollen shut and hives covering my body from head to toe, I almost fainted at the sight of my bald swollen splotchy tongue-big dog-lipped self in the bathroom mirror.  I walked out and woke John up and said, “Um, think we need to go to the ER.”

To his great credit, he took one (pretty astonished) look at me and said, “First let’s try a Benadryl.” He knows this drill pretty well. He was right—we avoided the ER, but by 8:30am I still wasn’t a lot better looking, so we decided to call the Duke Urgent Line (why do these things always happen on the weekend?!).

What happened next is still killing me. I dialed the phone, spoke briefly to an operator about what was up, and not 20 seconds later a voice came over the phone, “This is Dr. Cavanaugh.” The Queen herself! In my bedchamber! On a Saturday morning!

She had some ideas—take some steroid pills, try Allegra, go to the ER if the swelling returns. We talked for about five minutes—just one of Time’s Top 100 Most Influential People in the World and me, as I itched my head and every other corner of my body.

[Addendum to the Addendum: Today I called Duke back to follow up on whether I should keep taking the steroids and other meds since the hives are still happening, and this time a nurse ran interference. When I spoke with the nurse again this afternoon, she informed me that the Queen was “decidededly not pleased” that I had not followed her advice more to a tee by not going to ER when the rash returned. The guilt I have felt since that phone call is maybe more crushing than last week’s biopsy blow. I am so, so sorry I was a bad patient, Dr. Cavanaugh. It will never happen again.]

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Dabbling in the occult.

We went to Nina’s surgeon yesterday in Durham. He’s a nice guy, as surgeons go. Affable, friendly, maybe a bit of a personality, but definitely a straight shooter when it comes to patient care. He told us much of what we expected to hear: the additional tumor they discovered means that she is looking at some form or another of mastectomy (apparently there are many options). His recommendation was that she have a single mastectomy on the right side, since that breast is the only one with any indication of malignancy. He also said the surgery is much less extensive and the recovery period shorter if only one breast is removed. On the other hand, removing both breasts may have some added benefit in terms of preventing future cancers, but it is a marginal reduction in risk.

He also talked about reconstruction. Specifically, he said that she ought not to even start thinking about reconstruction yet, because of the uncertainty about her oncological situation. The second tumor didn’t even show up on the initial scans, which he called very strange. Indeed, he didn’t just say it was strange, he used the word “occult.” As in, “that tumor is really occult, it was just hiding back there.” Because one thing you want to invoke in any diagnostic setting is the black arts.

Apart from telling us that Nina’s second tumor is shrouded in hermetic mystery and probably tattooed with pentagrams and adorned with jet black anise-scented candles, he also reiterated what all her doctors have told us, which is that no one will really know anything until they remove the tissue and do a full pathology on the tumors. Sometimes, it seems, they expect to find extensive tumors and find little or none. Other times they anticipate clear tissue and find extensive cancer. If they do the surgery and find that the cancer has spread, they have to do a much more extensive removal of lymph nodes (they call it a dissection, which is nice) and if they find metastasis or that the tumor is bigger than anticipated (the cutoff is about 5 cm) they will have to do radiation even with the mastectomy. If they irradiate, it would likely destroy or damage the reconstructed area.

So there’s no point in starting reconstruction until we really know what is happening.  Which means that Nina will have to have more extensive surgery (the mastectomy instead of the lumpectomy), will still potentially have to have radiation, and will be living with one breast—a minor issue medically but surely one of the oddest and most disfiguring “treatments” a person can have—for a substantial amount of time.

After we discussed all that, Nina asked the surgeon if the fact that the tumor is larger than they thought and that there is this other tumor to boot meant that the chemo isn’t working. He hesitated to give an answer. “I’ll let your oncologist answer that,” he said, “but I’ll give you AN answer. My answer. I’d say it hasn’t worked as well as we would like.”

Now, it’s not like he said “from what I’ve seen, you really better get your affairs in order,” or “it’s a miracle you made it here from Greensboro today for this visit.” All things considered, he was very positive. But “it hasn’t worked as well as we’d like” is not a phrase you ever want to hear your cancer doctor (or for that matter the doctor treating your athlete’s foot) say. Because he’s not the oncologist, and we really don’t know anything until after the surgery when they can put it all under the microscope and give us the results, we have to take any kind of input at this point with a huge grain of salt. But HOLY SHIT, it’s not working as well as we’d like?!! That was kind of a show stopper.

And the best part was that the discussion with the surgeon was just the start of Nina’s Friday. Actually, it took a turn for the better at first. We got home from Duke, I lit a fire in our fire pit, which we just placed strategically in our new patio, next to our new deck that Nina’s dad built for us. It was a perfect night, just cool enough for a fire, but warm enough to be outside. Nina has been conceiving and concocting this deck/patio combo for months and months, and she’d not only realized her concept, she had also spent the past couple weeks planting flowers and plants all around it, spiffing the whole thing up so much I hardly recognized our backyard. She had a glass of wine. I had a tasty seltzer. The fire was perfect. Perfect flames licking up to the clear night sky. They looked like cartoon flames stenciled on the side of someone’s hot rod. It was lovely.

But then the “WTF is going on oh hey I’ve got cancer joyride” continued, naturally, when she broke out in hives all over her body, literally head to toe. Her face swelled, as did her hands and feet.

So again: HOLY SHIT. Those who know us well or have been around us this past year will recall that I have a chronic hive condition that is only kept in check with monthly injections plus a strict regimen of antihistamines. What Nina had looked very much like me during my worst stages of hives, before we got it under control. And that was awful. Just completely awful. I was miserable. And I didn’t have effing cancer. I will remind you that, as she is breaking out all over in hives and swelling rapidly, she’s also bald from chemo, and only just starting to not feel like absolute physical crap from her last round of treatment. So I’m not exaggerating when I say that the universe was really gilding the cancer lily. I’d also note that seeing her break out in hives in what appeared to be a bizarre mirror image of my condition transposed onto her body did make me question whether occult forces were in fact at work in our lives. Perhaps the Dark Lord was angry that I was no longer worshiping at the altar of anaphylaxis? Punishing us for a lack of recent sacrificial offerings?

Regardless of the cause, we had to give her Benadryl and, when that didn’t work, we called her oncologist who recommended steroids and more Benadryl. That brought the swelling down and beat back the hives. She’s still a little hivey even as I write. Which seems unequivocally unfair and annoying, yet somehow small potatoes compared to what she’s really dealing with.

The various diagnoses that Nina’s had so far have all been a lot to process. Just her having cancer at all is a lot to process, but at first it seemed like a relatively small tumor, a relatively simple surgery. But it was triple negative, so not exactly a low stress situation. And then its two cancers not just one and, hey, they’re quite large, so bonus mastectomy! And, oh by the way just for good measure: hives, because, you know, sadism is actually the guiding force in the universe. Maybe a deal with the devil wouldn’t be such a bad idea? I mean we’re already totally dependent on big pharma and the insurance people, how much worse could things get?

Anyhow, barring some other strange development, or some other occult phenomenon, we’re just here trying to process the latest unreasonableness and wait for the rest of the information about the second tumor to come back. Hey maybe we’ll break out the Ouija board and get them early!

All the marginally bad news that’s fit to print.*

Written by John.

Nina had a second biopsy done on her right breast on Monday as follow up to imaging that revealed “things that the doctors did not like.” Specifically, these things were “microcalcifications,” which are normally an indication of some type of malignancy or pre-malignancy (invasive ductile carcinoma or ductile carcinoma in situ, respectively, in her case). Today she got back partial pathology from the biopsy, which revealed not only a second malignant area, which we pretty much expected based on the films, but an “additional cancer”: one not from the same source as the original tumor.

We do not yet know anything much about this second malignancy, except that it is different and they are saying it is grade 1, which is ostensibly good. We have to wait for the more complete pathology report to find out if it is hormone-positive or negative and which treatment follows (additional chemo, longer chemo,etc.).

We don’t feel like at this point the new tumor indicates any radical change in Nina’s overall prognosis. It almost certainly means a different approach to surgery. We meet with the surgeon on Friday and each of us fully expects him to recommend a mastectomy instead of a lumpectomy. But in terms of survival and recurrence, we don’t really know, but we also don’t have any reason to think this makes things necessarily worse. We will still have to await the results of the full post-surgical pathology for that kind of assessment. In the meantime, we are anxious to hear what the surgeon has to say and to discuss the full pathology with Nina’s oncologist when it is ready.

I think Nina is really sick and tired of receiving even marginally bad news. Because even marginally bad news is pretty dispiriting when it has to do with her cancer. But, I have to say, she is handling all this about as well as a person could from my vantage. She’s keeping herself active, mentally and physically. She’s reading, working, and doing a lot of gardening, which is a pretty good self-medication. And impressively physical for someone undergoing a chemo regimen as demanding as hers. She has some bad days, but those are the unavoidable “my chemo is kicking my butt” days. And they last astonishingly brief amounts of time with her. I attribute that to a lot of mental and emotional toughness. Still, at the end of the day, everyone needs some objective encouragement when they are going through a rough stretch and that’s the real missing ingredient. C’mon, objective encouragement!! Where you at, fool?!

*I have an R-rated version of this post I’ll share upon request, in which I share my true feelings about cancer, including explicit illustrative pictures of ducks. But it didn’t pass the decency test under Miller v. California. I’m not joking. Go ahead, satisfy your curiosity. Make the request. Just be prepared for federal indecency charges.

Chemo round three, day five.

I woke up pretty crappy this morning. Sore from the biopsy yesterday and steroidy and achy and a night of bad dreams and the terribly oily taste of chemo in my mouth—even the flavor of coffee just slides off my tongue.

I also am feeling like a big cancer fraud—like the only time I write on here is when I have crafted my self into some careful place of having something to say. It’s not totally honest. Most of the time I’m so much more aimless than beastie cats and Molly Pitcher and whatever.

I should hear tomorrow or Thursday with the results of yesterday’s biopsy. The procedure was a non-event, mercifully. It was done at Duke—as an ultrasound-guided procedure, with me on my back and a very attentive attending whose entire job was to stand five inches from my face and hold my boob very still so the radiologist could get in the right place and not puncture my lung. She got in the right place.

My first biopsy, back in January, was stereotactic, since at that point they couldn’t see the tumor on ultrasound. It was done with me up in the air, on my stomach—like a car at the garage—with the radiologist and tech fussing underneath me with all their loud sucking tools. It was also really painful and I bled a lot and developed an awful hematoma that still hasn’t resolved. Yesterday was a dramatic improvement, and I am SO much less sore.

Friday we go back to Duke to talk to the surgeon about whether we need to switch course to doing a mastectomy.

My mom keeps reminding me—and she is a woman who knows!—this will pass. The oily taste, the achies, the limbo, the unknowingness. As clichéd as that is, it is stunningly true. It just always does.

This morning I had to get out of the house—immediately. The kids and John walked out of the door at 7:30 and I knew I couldn’t sit there one more moment feeling awful. It is an incredibly beautiful spring day—windy and clear. So I walked in the woods by the Kathleen Clay Edwards library where it was so brutally green and alive it was almost physically painful and I felt I was being nearly drugged with the scent of wisteria.

Stepping back and growling.

I’m sorry to piggyback right on top of John’s update, but I’m processing. This is my process.

Today was like having a bad memory of a bad memory that in turn reminds you of something hard and beautiful. Today was a bad ultrasound. Or at least not a good one. But maybe I’ll start at the beginning.

It’s 2002, September, our first dog’s first trip to the coast.

We let him out of the backseat of the car, and he beelined for the beach—racing circles in the dry sand, sniffing the bite of tidal decay, knots of seaweed, rotting crab shells, a dried black purse of skate eggs.

Eventually he nosed his way to low tide’s edge, the gentle lick of Beaufort Inlet slapping the sand, and then, when the wet of seawater met the wet of nose, he froze, as though only just understanding this was not his backyard water bowl.

We watched as he planted his front paws into the uncertain earth then raised a wary head to scan his surroundings—where the ocean reached in a thousand blue directions, as massive and unknowable as sleep, as bad news.

He took two steps backward, stopped, and growled. The world was even stranger than before. Something grey like grief passed through his eyes before he turned his glance to a faltering gull and chased it.

***

Now it’s 2006, late August, and I’m gooped up in a darkened ultrasound room at UNC Hospital, 18 weeks pregnant with our first kid, John holding my hand, watching the tech—then a doctor who enters from a room somewhere else, then another doctor—wade again and again into the ocean of my belly, find our growing boy there—his spine curving like driftwood, his thunderous heart. It’s the strangest thing we’ve ever seen. We can’t stop watching the screen/ocean. Him.

But they’re taking too many pictures. Too many measurements. His feet. His legs. His brain. His heart. His feet again. They are not talking at all, until suddenly someone says, “Well, I guess by now you know something is not quite right.”

We didn’t exactly, but we were starting to. We’d never been there before. Something grey like grief.

Talipes equinovarus, they tell us—club foot. It sounds like something that has risen from the sea of the Dark Ages. My brain is groping through Beowolf. Ideopathic, they say. Sounds like Greek for a Shakespearean fool, but it turns out this is good news: not part of a larger, scarier complex of issues. Just the foot. The right foot.

Not the world ending, but the world shifting. The world is stranger than before. Will he walk? They are talking about surgeons and casting and braces, cutting his Achilles tendon just after birth. We have only just learned he is a he. Fixable, but a process.

Later at home on the internet, John reads me a list of people born with club feet. It’s not just the Emperor Claudius and Richard the III (who it turns out didn’t even have one—sorry Shakespeare). Troy Aikman. Kristi Yamaguchi. Mia Hamm. Freddy Sanchez—who won the batting title in 2006 for the Pirates and for whom Freddy was named.

That faltering gull—we’re chasing it. There are a number of dark days, but seven years later we’re watching him round the t-ball bases, slide into third.

***

Today at the scan, I’m back on the table. It’s a lot like my dream, dim and goopy, so I tell the radiologist about the tigers. “Hmmmm,” she says. She’s measuring. Then taking pictures—click clicking on the keyboard. Measuring again. Too many pictures.

“Well, I can’t say I love what I’m seeing,” she eventually says. Something grey like grief.

The tumor is still there. It is not smaller. In fact, it is bigger than they first thought. It seems to reach in a thousand directions. And, on top of that, there is another tumor a few centimeters away that has surfaced from some depth previously unseeable.

“We will need to do some more tests,” she says. “This isn’t going to be a straight line, it seems.”

OK. I feel the world shifting. I text John in the waiting room and know now his world is shifting, too. The world is even stranger than before. Still—this time I also think of the last biopsy, and the club foot room, and our dog’s mind blowing wide open on the beach. We’re taking two steps backward and growling. That’s just what we have to do.

That dog, Zilch, never really became a water dog. He was short—a beagle/corgi mix—shorter in the front than the back and stocky as a boulder. But later that afternoon he did chase a gull right out into the shallows and hardly even looked down.

The jackrabbit.

Written by John.

There’s an amusement park near Pittsburgh called Kennywood. It’s fairly iconic. All the kids in Western PA grow up going to the park. Each school district has a Kennywood Day. It’s been there forever and it has some really cool old fashioned roller coasters. One of them is an old rickety old thing that looks like it was taken from the set of a film about Coney Island in the 1920s. It’s all wood and painted a white that makes it look more like pickets from a fence that someone’s turned into scaffolding than a roller coaster. But it is indeed a functioning roller coaster, and has been since 1920. It’s called the Jackrabbit.

The Jackrabbit is not a serious coaster by today’s standards. It’s big drop is 70 feet, which pales in comparison to the monsters of more recent coaster design vintage. The Jackrabbit only gets up to 45 MPH, which is much tamer than today’s coasters by a wide margin. In a review I read before our most recent trip to Kennywood—when Nina and I took the boys there with my mom during a visit home—it said that the Jackrabbit is considered a coaster for little kids, or for the faint of coaster heart.

Except for one thing: the Double Dip. The Jackrabbit was not just an early coaster, it was a pioneering piece of coaster design. The guy who designed it made the track in such a way that there are wheels both above and below the track (almost all coasters since have been designed this way). This allowed the designer to create a bigger drop than was then usual for coasters back then and to create a Double Dip just after the lift hill. The coaster dips and then dips again, which makes the wheels of the cars actually rise away from the track. Because there are wheels below and above, it’s perfectly safe. But the sensation created is that the riders are flying out of the car. This sensation is designed to be strongest in the last car of each coaster train.  It’s not a big hill. It’s not at high speeds. But it creates the impression in the rider that, not only is the ride at great height, but something has gone horribly awry, the normal function of the coaster has failed, and the rider and ride are being separated by the sheer force of the coaster’s unexpected movement.

Today at Duke Cancer Center, Nina went in for her third chemo treatment. As part of her visit, the doctor ordered an ultrasound. They wanted to see at the halfway point what the status of the tumor was. Nina went in for the scan while I waited on the not uncomfortable couch in the waiting area and drank the not terrible coffee they provide gratis. That’s when we boarded the Jackrabbit. She texted me from back in the radiology area: they want to do more scans. Seems not to be good. Then she texted again: they want to do a mammogram. Then they wanted to do another ultrasound. Then she texted to say that the mass is quite a bit larger than they first thought: about 3.5 cm. And they spotted additional “microcalcifications,” another area of potential malignancy, not in the same place as the first mass, that cover an area over 2 cm. Then, finally, she said they were coming to get me so the doctor could talk to us both about the radiography.

That’s when I felt the sensation. The Double Dip. The first time was months before, at the diagnosis itself. I was in New Orleans at a training for work. Nina called while I was in a session. I knew she’d received her biopsy results, but I really thought at the time they were going to be a confirmation of good expectations. A relief. So when she said it was malignant, the floor really felt like it came away from my feet. But today was worse somehow. It’s not that I thought things were going to be smooth from here on out. She’s only halfway through chemo, hasn’t even had surgery yet, so there’s no real hard confirmation of the diagnostics or biopsy results. And cancer isn’t something you ever sleep on, obviously, even years after treatment, never mind during the initial course of chemo. But we had stabilized, acclimated ourselves, developed the “new normal” of living with chemo treatments, hair loss, survival rates, nausea, loss of taste, the whole gauntlet cancer makes you run. So somehow, even though I knew about the ride we were on, I didn’t see the second dip coming.

We talked to the radiologist, then to her oncologist’s PA (who had already spoken to the Queen of Triple Negative Breast Cancer, or QTNBT, don’t worry). They told us that it was likely that the hematoma from the first biopsy hid the second area of potential malignancy, or that it simply wasn’t visible until Nina started chemo and as the cancer cells died, the necrosis made it visible. They don’t think her tumor has actually grown, it’s just that the first go round they were not able to see it clearly and so the size was a guess (and it still is to some extent). Their input was: we move ahead with treatment as planned, but do a second biopsy on Monday to see what we’re dealing with (as best we can via biopsy). So we don’t really know where things stand. It seems like it may be not really that different than before. But we don’t really know.

The thing is, it wasn’t so much the diagnosis of a second potential tumor, or the fact that the tumor is larger than we previously thought that was so upsetting. It was being thrown a second time, unexpectedly, back down the hill, right back into the trough that we’d just risen from. That’s the Jackrabbit. The Double Dip. It isn’t the biggest, baddest thing in the world, but try to tell that to someone riding in the last car on that second dip.

The beastie cats at the end of the path.

I have an ultrasound scan this Friday before I get the next dose of chemo. I’m not totally sure what we hope to see at this point (a smaller tumor? a not-bigger tumor? no lymph-node spreading? I’ll ask The Queen if I see her), but I know it’s a marker for if this course of treatment is working and it will probably determine future treatment.

I had a dream the other night that was so imposing it has kind of replaced my reality (SUCH crazy dreams lately! In one, I was ripping the long, thick, beautiful, golden hair off one of my former students’ scalp to glue to my own bald head. Sorry, Elyse!):

I’m lying in the darkened ultrasound room, gooped up with the ultrasound goop, my right side propped on the foam wedge, my right arm curled above my head, and the doctor is running the transducer all across my chest and into my armpit like a little boy zooming his matchbox car, and I look up at the screen where usually all you see is that strange universe of shadows and ghosts that is allegedly your insides, and instead I just see two tigers pacing the perimeter of my chest wall.

It’s not a totally unfamiliar image. If you’ve raised kids in Greensboro recently, you know about the tigers (or, as Freddy called them for a spell when he was two or three: the Beastie-Cats at the End of the Path.). They’ve probably haunted your dreams, too.

Two startlingly gorgeous 400-pounders, part Bengal part Siberian, rescued from somewhere, maybe the offspring of circus tigers?—that live tucked in the woods that abut Lawndale Ave at the Science Center.

They are one of those Greensboro surprises—like all the insanely good Vietnamese food and the view of downtown from the third-base line of the ballpark.

There are a number of wonderful but disconcerting things about the tigers—the way they hyper-fixate on stroller wheels and errant toddlers, the volume at which they both roar when the male mounts the female (not infrequently) right in front of your preschooler, how some suburban Greensboro subdivision practically backs up to their habitat, how the female keeps incessant watch from her rock lookout while the male naps in the shade, how in some spots there is basically just the equivalent of an elementary schoolyard baseball backstop between you and them.

But the most unsettling thing about the Beastie-Cats at the End of the Path is how they pace. It’s that measured, obsessive, nervous stalking you might recognize from a sleepless night before an exam or your dog during a thunderstorm. I’m headed toward the grassy spot in the corner by the fence, but then no—that’s not right—back to the rocks—but maybe that corner does need investigating—am I thirsty?—I’m going to sit down now—I can’t—I’m definitely going to the rocks!—the grass—the rocks, etc.

The Science Center keepers say the reason the tigers pace is because they are craving human contact—they were bottle-fed as babies, and they miss being close to people, which is why they like the perimeter of the enclosure so much. It’s where the people are.

I don’t know. What is this, really? It reads a little more like madness to me. As Jorie Graham, the author of one of my favorite poems—“Scirocco”—wrote decades before she was diagnosed with breast cancer: “Who is / the nervous spirit / of this world / that must go over and over / what it already knows.”

Maybe that’s not really madness though. Maybe that’s an entirely sane response to being denied human contact. Or a sane response to very many things—including worrying about scan results and treatment protocols and the future.

So, the Beastie-Cats are pacing the chest wall.

Yesterday morning—after a restorative, humanizing walk in the near-rain among many heartstoppingly beautiful blooming gardens and yards with a good friend whose dog just died—I was remembering the dream and thinking: Oh. There are tigers in the woods here, and they are a little off their rockers–but that’s just the kind of town we live in.