These drives from our home in the arid tan hills of the canyon into the smoggy industrial sprawl of the medical center always seemed like a combination of the Bataan death march and a scene from Alice in Wonderland. There was a surreal overlay to these dismal journeys, along with a shaken faith that any minute the nightmare would be broken and we would be just another expectant couple heading up to the hospital for a chatty visit with our obstetrician. In fact, we had made just such a trip once, two months before Isabella was diagnosed, after a drug-store pregnancy test went bright pink. But an ultrasound showed no heartbeat. A day later, she miscarried. It was her second loss in six months. Eight weeks later, when the tumor was discovered, we understood that her body had refused to begin another life because it was already in a secret battle for its own.
Isabella sat beside me, staring out the window, lost behind her sunglasses. The spire of Angel Stadium protruded from the haze in the east. The wide parched bed of the Santa Ana River wound beneath us, testimony to five years of drought, reminder of still another blessing that God seemed to have plucked from our tables. There was a wreck on 1–5, as there always seemed to be each afternoon. We came to a stop, funneled over to the middle lane, and looked at the lights flashing up ahead.
"What if it's big-bigger?"
"It isn't."
"It really isn't, is it?"
"No way. The implants killed it all."
"And half of m-me."
"That's right."
"I deserve some good news for a charge-charge.. change — don't I?"
"You deserve the best news in the world."
We crept around the bang-up. Three cars were off on the shoulder. A woman sat on the asphalt, her back up against the freeway divider, her face in her hands.
"Why do p-people always slow watch and down?"
"It lets them be thankful it's not them."
"Is that why my friends call me?"
"That's not fair, Izzy. Your friends call because they love you. They don't know what else to do."
"My peach-peach… speech is getting worse, isn't it?"
"I think so, baby."
"I can see the word but I c-can't say it."
"You're doing well enough for me."
"It's worse than last week, though. But it m-m-might be the drugs."
"It might be," I said.
Isabella stared at the wreck as we moved past, edged into the newly vacant "fast" lane, and sped up.
She was quiet for a while. "I heard a woman's house in the voice last night. Was I d-dreaming?"
I told her it was Grace.
"Why didn't she j-j-just stay with her m-m-mother?"
"Out of town, I guess," I said.
"Do you want her to stay?"
I told her about Grace's trouble.
Isabella thought for a moment. "She might have turned out all right, if she jaw… just had a mother nother. I mean another mother."
I let that pass. Isabella had always derived comfort from slamming Amber, and it wasn't my duty to deny her that pleasure. The thought came to me again how fundamentally different they were, how opposite.
"Have you seen her re-re-recently?"
"No."
"What about the Fourth of July? You h-had that Amber look at dinner on the d-deck that night."
"No, Izzy. I haven't seen her in months."
"Does Grace want to live with us?"
"No, she just-"
"I don't want her in the house!" Isabella breathed very deeply and her chin shook. A tear flattened under the frame of her sunglasses and smeared her cheek. "I'm sorry," she said.
"It's okay."
"I'm r-r-really afraid they're going to find new growth."
"No. No new growth, Is. Not today."
"We see some new growth," said Paul Nesson, pointing out the dark tumor on the PET scan. "It hasn't been particularly fast. It's about what we expected. Part of it might be mass effect.'
Dr. Paul Nesson was Isabella's neurosurgeon, a young soft-spoken man who managed to be grave, humorless, and warm, all at the same time. Of all the surgeons we consulted Nesson was the only one who said that Isabella's was not hopeless situation. He also said there was no cure. He also was the only one who advised against surgery. Instead, he implanted ten radioactive "seeds" into the tumor on a Monday, and by Friday, Isabella's legs had lost 60 percent of their function, he had sat with us for many of those long hours on the neuro floor while the movement in Isabella's legs ebbed away-starting at her toes and continuing up. Paul Nesson had told us then that the function loss was "probably not irreversible," but by now a year later, we all saw that he'd been wrong. I will never forget the sight of Isabella Monroe, age twenty-seven, lying in that cheerless room, her head wrapped in a lead-lined cap to keep the radiation from damaging anyone but her, trying to move her toes, then her ankles, then her knees. "Well," she said, always thought those wheelchairs with motors were nice. Can you get me one in a hot pink, Dr. Nesson?"
"We'll get one in any color you want," he said quietly.
We settled on black, motorless. When it came time to actually get a wheelchair, the concept of hot pink had lost its charm.
Isabella looked at him now, then back at the colorize PET scan pictures. The tumor was a dark mass outlined in red and yellow. It was no longer round: The powerful radioactive implants had contorted it into a lumpy asymmetrical mess.
"What do we do?" Isabella asked.
"How's your leg function?"
"Pretty bad."
"More weakness?"
"Yes."
"Speech?"
"It's g-g-getting worse. Want to see my tricks now?"
Nesson did his usual neurological exam: reflex in the leg (almost none), nystagmus in the eyes (plenty), facial symmetry (good). He asked to see her walk. Isabella labored out of her chair, took the handle of a quad cane in each hand, and picked her way across the room with excruciating slowness, patience, and concentration. Nesson and I followed on each side of her, ready. She made a turn, came back to her chair, and slumped into it.
"Why don't I feel any better, doctor?"
Nesson said nothing, looked up at the scan pictures again, his hands deep in the pockets of his white coat, his head cocked a little to the left. For a moment, he stood there without moving.
"I think it's time to go in and debulk the tumor, clean out the necrosed tissue," he said.
"Cut my head open?"
"That would be necessary, yes."
"If you d-d-didn't want to operate a year ago, why now?"
"It's a different situation, Isabella. I believe that now we have more to gain."
"You mean less to l-lose."
"I suppose you can look at it that way."
Nesson outlined the procedure, its risks and possible benefits, what we might gain and what we might lose.
"What are my chances of waking up a spat-spat-spit-dribbling vegetable?"
Nesson said that 90 percent of these procedures were done without that kind of damage.
"Well, my chances of getting a brain tumor in the first place were one in about two hundred thousand. Your odds one in t-t-ten. Not g-good, if you're me."
"I'd like you to think about it. Any surgical procedure has its risks. This is not urgent. Yet."
I rolled Isabella back to the car in silence. When we were inside, she turned to me. "Does the insurance cover it?"
"Of course."
"But I don't want them in my head."
"No. That's okay."
"It terrifies me, Russ, worse than anything in the world. I don't think I'd ever out come of it."
"Then I won't let them take you in."
We spilled from the dark parking structure into the dazzling sunshine of early July.
"Will you do me a favor, R-R-Russ? Take us to the grove? We could get some sandwiches, okay?"
"My pleasure," I said, smiling, heart heavy, hands tight on the steering wheel. I wanted to crush things and cry a curse the Maker at the top of my lungs, but this was not the time. It was never the time.