“Life is suffering.
“That is the first of the Buddha’s truths. It was also my first sentence.
“Life is suffering.
“As I finished typing those words at three-forty-five on a beautiful Thursday afternoon in autumn, I turned to glance out my study window and frowned at the sight of my fifteen-year-old son, Matthew, staggering across our front lawn. He was doubled over, his left hand pressed against his right chest. I rushed to meet him as he stumbled into the house.
“ ‘I can’t breathe,’ he said. ‘The pain. There’s something wrong with my chest.’
“No doubt I broke several traffic laws, speeding to our family doctor. Really, I don’t remember. A lengthy exam made it seem that Matt had pleurisy, an inflammation of the lining of the lung. Antibiotics were prescribed. The pain went away.
“But as the Buddha says, life is suffering. During Christmas vacation, the pain came back, not in his chest this time but in his back. An X ray revealed that Matt had a tumor the size of two fists.
“And so the horror began.
“Matt had bone cancer, specifically a type known as Ewing ’s sarcoma. We hadn’t detected it sooner because Ewing ’s is sneaky. The pain comes and goes. Often it isn’t at the site of the tumor but rather at various other sites responding to presssure from the tumor. For a brief time, the explanation for the pain seemed to be that Matt had hunched over too long in marathon guitar-practice sessions.
“ Ewing ’s is an uncommon form of cancer, but when it develops, it’s usually in an arm or a leg. In this case, the uncommon cancer had chosen an uncommon spot, the underside of Matt’s right sixth rib. Even so, Ewing ’s had been known to respond to chemotherapy. His chances of surviving were judged to be eighty percent.
“In January, he rapidly learned to familiarize himself with the names of arcane-sounding drugs. Vincristine. Methotrexate. Adriamycin.
“Cytoxan. The last part of that chemical’s name-not its spelling but the way it’s pronounced-says everything. Toxin. These substances were poisons intended to kill the tumor, but unavoidably they hurt healthy tissue as well.
“By early February, Matt’s long curly hair, grown in imitation of his rock music heroes, had begun to fall out in huge disturbing clumps that littered his bed and clogged the drain when he took his morning shower. It’s a measure of Matt’s spirit that he decided to cut this ugly process short by having a party in which his friends ceremonially shaved him bald. Some of them still have his locks. His eyebrows and eyelashes were less easy to deal with. He let them fall out on their own. He never tried to disguise his hairless condition. No wig for him. He displayed his baldness boldly for all the world to see and sometimes stare at and on occasion ridicule.
“It’s a further measure of Matt’s spirit that the weakness, disorientation, and vomiting produced by his medications never slackened his determination to persist at school. A straight A student soon was making grades that a few months before would have embarrassed him.
“But he hung in there.
“Chemotherapy was infused through an intravenous line, a tube surgically implanted beneath the skin of his left chest. You couldn’t see it. But you could feel it. And for sure, every day, Matt was terribly aware the tube was present. The chemicals didn’t take long to be administered, an hour for each, but their damaging side effects to the bladder required a prolonged irrigation of saline solution to flush the chemicals from his system. Thus the beginning stages of Matt’s treatment forced him to stay in the hospital for three days every three weeks and to recuperate at home for another three days. A small price to pay.
“Except that after several applications, it became frighteningly manifest that the treatment wasn’t working. The tumor had continued to grow. More aggressive chemotherapy was called for. His survival chances were now fifty percent. But as the weakness, disorientation, and vomiting worsened, he still didn’t lose his spirit. He began to think of the tumor as an alien within him, a monster whose strength, intelligence, and will were pitted against his own.
“‘But I’ll beat it,’ he would say. ‘I’ll win. I want to be a rock star when I get older.’
“Life is suffering.
“The more aggressive chemotherapy didn’t work either. His physicians moved from chemicals that under ideal circumstances gave cause for hope to agents that are called ‘investigational,’ that is they’d been used so seldom that permission from the hospital’s ethics committee was required before Matt could receive them. Nonetheless, of the twenty-two cancer patients who’d received them, eighteen had experienced dramatic results. Sounds good. But you don’t receive investigational therapy unless you’re in the twenty percent of patients predicted to die.
“Again Matt familiarized himself with arcane names. Ifosfamide. Mesna. VP-16. Now, in April, the length of his stay in the hospital while receiving chemotherapy was five days every three weeks. And the hangover from these drugs took another five days. Between treatments, he had only eleven good days, if ‘good’ is a word that applies here.
“For once, the treatment worked. The tumor shrank fifty percent. Imagine his elation.
“Imagine his equal and opposite distress when the next time he received these chemicals, the tumor-the alien-adjusted to them and began to grow again.
“Surgery was the only option. In late May, four right ribs and a third of that lung were removed, along with the tumor.
“Or rather most of it. Because the alien had spread seeds, and to kill them, the doctors had to use even more aggressive treatment. A pint of Matt’s bone marrow was extracted from his hips. A tidal wave of chemicals was infused, enough to kill all his white blood cells. His healthy bone marrow was returned to him. Eventually it would produce healthy blood. All things being equal, he would regain well-being. The cancer, viciously assaulted, would be killed.
“But all things weren’t equal. Normally harmless bacteria in and on his body bred out of control. No longer held in check by his usually vigilant white blood cells, they stunned him with a rampant infection known as septic shock. The top number of his blood pressure plummeted to forty. His heartbeat soared to a hundred and seventy. His temperature surged to one hundred and five.
“But he hung in there. Antibiotics killed the bacteria. Conscious though struggling against an oxygen tube in his throat, he used a trembling finger and an alphabet board to spell frantic words of conversation. Morphine was used to ease his struggles against the oxygen tube. He was last conscious a week ago Sunday. But even after that, he reflexively gripped the hands of sympathizers with unbelievable strength. Until last Saturday evening, when after eight days in Intensive Care and six months of unremitting ordeal, something in him wore out.
“Life is suffering.
“Only Matt knows how much he suffered. His mother and I, his sister, his relatives, his friends, his teachers, his nurses, his physicians, all of us can only guess. Because he never complained, except to ask ‘When am I going to get a break?’ And even then he’d add, ‘But I’ll beat this damned thing.’
“Maybe he did. Maybe the cancer would never have come back. In the end, not evil cells but normally innocent ones defeated him. As I said at the start, life’s ironies can sometimes kick you in the teeth.”
David had trembled at the lectern in the church. After another agonized gaze toward the urn containing Matthew’s ashes-and the photograph of Matthew in his long-haired robust prime-David had dizzily faced the mourners and struggled not to faint.
“What I’ve just described to you was hard to write and more hard to say. But I didn’t do it out of perversity, out of some horrible need to make you feel my hurt. And his mother’s hurt, and his sister’s, and that of all the rest of you who were close to him. I did it because there were many who saw only the carefree, good-natured, happy-go-lucky pose he bravely demonstrated to his associates. Many had no idea, not the faintest notion, of what he was going through. He wanted it that way. And he succeeded. He even successfully completed his ninth grade of school.