It took long seconds reading through the many cautionary notations on the label before he understood that what he was looking at was some kind of morphine derivative — serious, serious pain medication. His insides went cold, as though he himself were being numbed. He stared at it a moment longer, then, not entirely conscious of what he was doing or why, dumped his mother's purse out onto the table. A lipstick rolled off and clicked onto the floor but he did not bend to pick it up. The glossy pamphlet, folded and unfolded so many times that the creases were white, had a bar across the top that identified it as a publication of the California Pacific Medical Center. The words on the cover, the typeface careful, almost respectful, read "Pancreatic Cancer: Questions and Answers."
"Why didn't you tell me?"
She gave him a look that was like something he'd expect from Kris Rolle, almost teenage in its sullenness. "I didn't know for sure. They're still not one hundred percent certain until they do a biopsy, but the what-do-you-call-it, the endoscope, showed there was a big tumor." She shrugged. "It wasn't nice, that endoscope. I didn't want to go in for it — I hoped it was nothing."
"This is bad, Mom. We have to get serious about this. This is important!"
For a moment her expression seemed to lighten, but there was an abyss behind her crooked smile. "Yes, Theo. I know."
"Sorry. Jesus. Sorry." He took a deep, shuddering breath. "What did they tell you?"
What they had told her was not good. If the biopsy confirmed it was malignant, as seemed very likely, it was probably Stage Three or Four, she said. He found out the next day, when he used the computer at the library to go online, that they were usually spelled "Stage III" and "Stage IV," as though putting the ugliness in Roman numerals made it distant, somehow, less fearful, a mere historical footnote. It seemed to have gone undetected for a long time already, the doctor had told her, which was often the way with pancreatic cancer since it was seldom noticed until the tumor began to press on the other organs, and the chances were high that it had spread into her lymphatic system, rogue cells sowing the seeds of chaos throughout her body.
"Six months," she said. "A year if the radiation and chemotherapy help."
"Jesus." He stood staring at her awful composure. "Are you telling me it's incurable?"
She shrugged again. "There are some, what do they call them, some temporary remissions. Sometimes with the chemotherapy and all that, people survive longer. It's not usual."
He couldn't understand how she could sit here talking about death, her own death, as though discussing an appliance warranty. "But there's a chance, right?"
"There is always a chance, Theo." She did not have to add what was in her voice. But probably not for me.
"Has this… oh, God, has it been hurting you a lot, Mom?"
She thought about it before answering. She was not in a hurry. He had a sudden insight into how that part must feel, anyway: there was no point in hurrying anything now. "For a while. At first, it wasn't so bad. I thought it was just aching muscles — my back, you know. Sometimes I get that when I carry things around, move the furniture to vacuum."
Another stab of guilt — no, of something closer to pure misery — at the thought of his mother dragging heavy sofas around so she could vacuum a house empty but for him and herself. But what did it matter now? He wanted to laugh at the horror of it all, but even with his mother's strange, detached mood, it didn't seem like the right thing to do. But he had a feeling that she'd like it better than if he started crying. He looked around the empty house, at the clean carpets and unprepossessing furniture, at the small dark-haired woman sitting on a chair in front of him, and tried to think of something to say.
"I wasn't very hungry either," she said abruptly. "But I've never been someone who wanted to eat a lot. Not like your father. He always had a can of nuts next to him, or something like that…" She stopped as suddenly as she had begun, finished with the thought.
"Do you… do you want to come out with me? Tonight? There's an Irish band at the Kennel Club. They're supposed to be good — real Irish music, all acoustic instruments."
She actually smiled, and because it was a real smile, for the first time he could see the pain and weariness. "That would be nice, Theo. Yes, let's go out."
After that, the descent began. What had happened with Cat and the baby had been so sudden that it had seemed more like a brutal mugging — one moment walking down the street thinking about what you were going to have for dinner, the next lying in the gutter wondering if you could manage to crawl to where someone would find you. Watching his mother die was like something else entirely, a sort of terrible, slow-motion accident that went on and on and seemed to have no ending. But there would be an ending, of course.
They spoke a different language in the land of death, he discovered. If he had thought Cat's miscarriage was wrapped around with strange arcana, he had not even begun to glimpse the possibilities. First off, it wasn't just cancer or a tumor they were dealing with, it was adenocarcinoma. They didn't examine his mother, they performed laparoscopic staging or endoscopic retrograde cholangiopancreatography — that last word something you couldn't even fit on a Scrabble board. And there seemed to be no real treatments, just mysteries of which even druid priests would be proud, things like Gemcitabine or Fluorouracil, palliative bypass or even chemical splanchnicectomy. Sometimes the smoke would rise, the curtain part, and someone in a white coat would lean out and breathe, "percutaneous radiologic biliary stent," before disappearing again. It was like someone had opened a hole into Theo's life — his life and his mother's, but she was daily growing more and more distant in her haze of pain-deadeners — and backed up a dump truck full of spiky Greco-Latin terms, then poured them over everything in an avalanche of meaningless but still terrifying syllables.
Unresectable. That was one of the worst.
Metastasized. That was the worst.
He had to quit his job, of course, although Khasigian was kind enough to tell him he could have it back when he wanted it. His mother, frugal by nature, had stashed a bit away out of her husband's pension and Social Security over the years, enough to pay the tiny mortgage payments and put food on the table, especially as Anna Vilmos seldom ate anything now, no matter how much Theo begged her. He was so worried about her not eating that he even got Johnny to bring over a few buds of high-grade weed, which after a great deal of argument they convinced Theo's mother to smoke.
"You're trying to turn me into a dope addict like you," she said, wearily amused, clutching John Battistini's furry arm. It would have been comical, the kind of thing Theo and Johnny would have marveled over forever — "the night we got your mom stoned!" — except that there was nothing funny about the circumstances, about Anna Dowd Vilmos' yellowish skin, the bruised circles under her eyes, the headscarf that she always wore now because the chemotherapy was making her hair come out of her scalp in patches. She had just discontinued the Gemcitabine, declaring in a moment of stubborn determination, "It's not going to help anything and I'm not going to die without my hair."
Marijuana didn't have the effect Theo hoped. In fact, Anna had a sort of bad trip, the kind of thing he had rarely seen even in the most paranoid of first-time smokers. She moaned and cried and began to babble about "the night they took the baby," something that made no sense to Theo unless she was talking about Cat's miscarriage. As he held her, patting her awkwardly and trying not to think about how thin she had become, whispering reassuring nothings, he wondered if something in her own family history had triggered it. It was shocking how little he knew about the events of his mother's life before she had given birth to him.