ANDERS CHUCKED EVERYTHING – wife, friends back home, even his grown kids after they’d helped him straighten out his complicated international paperwork-to marry an Egyptian woman, a registrar at the exclusive international prep school he worked for in Cairo. He was an American, near fifty when he did this. He’d been just a mediocre combatant in the university wars in his own country, too fond of his subject to want to hone it into an effective weapon, and when his application to this foreign school was accepted- and again when he saw how far his dollars would go in the Third World, how well he could live there – he couldn’t believe his redeemed life. His American wife, actually his second, had come along for an adventure of a couple of years, tops; she’d soon had enough of being light-haired in a public full of dark-haired men, and she said so daily, at least once. So Anders hadn’t even brought up the issue of staying until he’d cinched things with Laila, the registrar, and the way he finally informed Ellen of what he’d decided to do was particularly abrupt and ugly. She flew home under sedation, and in their small expatriate community not one person was on his side.
But the expat turnover rate was so high that he and Laila had to miss only about six months of parties and one headmaster’s annual reception, and by their second attendance as a couple they were regulars, with their own set of mocking but fond names for everybody there. The pounds Laila had put on within what seemed to Anders like weeks of their lavish wedding (she had an uncle in a ministry, and her family owned several blocks of Cairo) hadn’t damped her trilling voice or dulled her wit, and back in their Zamalek apartment she made Anders laugh in a way he hadn’t since – well, he didn’t know if he’d ever felt so full and glad. He thought of the years he’d spent in anguish and worry, and though he could remember the reasons why and knew them for good reasons, he couldn’t imagine getting so wrought up again over anything.
“I’ve become an Egyptian,” he sometimes thought with satisfaction, though he had enough cultural sensitivity not to say it aloud, even to Laila. This was before the Gulf War and spectacular acts of terrorism linked to Egyptian groups, but what he meant didn’t really have to do with nationality or politics, anyway, or even religion. Laila had the country’s golden complexion but was Coptic, not Muslim, so he hadn’t even had to convert, though he would have. (He’d been quite taken with a demeanor he thought of as Islamic: a certain clear-eyed patience and proud humility, an invigorated calm.) What he meant by “becoming Egyptian,” though, was another attitude entirely, one somewhere between the Sphinx’s smile and the deep, easy laughter of the legless man who sold him the Herald Tribune, a feeling of having been let in on the vast joke of the world at last.
But when he took his shirt off on the night after their third annual headmaster’s reception, Laila’s laughter stopped.
“What is that?” she said, turning him so he could see something on his right shoulder blade in the mirror of her dressing table: a mole. “Oh, that. I’ve always had it.” He pitched his shirt toward a big wovengrass hamper in a corner of their bedroom.
“Not always of that color.”
The shirt missed, and he thought he must have drunk more than usual that night. He crossed the room to pick up the shirt and drop it in the wicker hamper.
“I’ll get it looked at, Lyle. Next time I see Mustafa I’ll ask him.”
“You must call Doctor Mustafa tomorrow.”
The objection that came to mind didn’t seem important enough to voice, and when he’d set up the appointment he forgot about it, too, until his secretary reminded him on the day itself. Doctor Mustafa’s assistant shaved the mole off for biopsy, but it was the doctor himself who phoned Anders at work a week later with the results.
“Maleegnant,” he said.
“That bad?” Anders quipped, though he knew what the word meant.
“I’m sorry,” Doctor Mustafa said.
Anders shrugged, as if he were speaking to Mustafa in person. Second opinion, he was thinking. Second opinion! Serious medical trouble in this country had been his one great fear. Of course hospitals here saved people’s lives all the time, and babies were delivered smoothly – too smoothly, considering the population – but what leaped to Anders’s mind were the stories about primitive needles, flies in the operating room, confusion between patient and corpse. Mustafa was recommending a procedure, a surgery he described as minor, but Anders barely heard him. RNs, he was thinking. Jell-O. Lysol. Television.
Late that night, so as to catch her in the early evening, he called his sister back in the States. Within the next few days she called some people she knew, then called him back. It took many more calls between them, and to the melanoma clinic she’d located, before his appointment was set. This was in the early days of e-mail, before civilian use of the Internet became widespread. Anders was no good with numbers, and every time he phoned he had to refigure the time change: Did you add seven hours or subtract? Had Daylight Savings started yet? One receptionist at the clinic – Debbie, Darcy or Diane, who seemed to take turns answering the phones, unless suddenly his memory was shot, too – told him to bring slides and samples of the malignant tissue with him. Mustafa knew what was needed and how to package it for customs. By hand he wrote a detailed letter for Anders to take to his next doctor, like a formal letter of introduction to his disease, and three weeks after his diagnosis, just into a new calendar year – on Coptic Christmas, after Laila had gone to a midnight mass so she could take him to the airport – Anders boarded a 747 with his tumor in a front pocket of his pants, in a plastic egg that could have come from a gumball machine. His appointment was with a specialist: Marrins, supposedly the best. An American, like Anders.
The institute was famous but – conveniently – located in the small northeastern city where Shelly lived, a former steel city near the town where she and Anders had grown up. In a vague way he’d always known it was here, but he’d never actually seen it before. Now, owing to delayed flights – a day lost in Athens, hours in Paris, a detour to Ireland for cheap fuel – Shelly had to drive him straight to the institute from the airport.
Dry flakes of snow slithered on the highway like sand tossed under their front wheels. It was noon, overcast, the light white. They’d been talking about everything but illness: the logistics of his trip and setting up the appointment; how long it had been since they’d seen each other; Shelly’s new perm. She was younger than Anders but bigger, physically ungraceful, and when she asked him in her serious way what he thought of her hair, he wondered if she’d had it done for his sake, as a gesture of optimism.
“It’s very nice,” he told her, and she nodded, considering the compliment for a mile or two before bringing up her other news. With a man Anders had heard about but hadn’t met yet, she’d been looking to buy a house. The market offered bargains if you were willing to put in some work on a place, and they were; they just hadn’t found the right place yet, though they’d agreed on their neighborhoods of choice. The local references in her conversation, along with his own jet lag and the impression of cleanliness and order that always stunned him on coming home (even the traffic here was so quiet!), made his own contributions to the conversation seem less and less necessary.
At some point he realized that Shelly, too, had stopped talking. At first he didn’t know why. Her grip tightened on the steering wheel, and when he looked out for a reason he noticed that the houses around them had been boarded up, whole blocks of them, in fact, on either side of the highway. Even a church tower had plywood on it. Trash clogged the chain-link between tiny backyards and the highway, which was gradually descending. From a bridge a lone pedestrian looked down as Shelly drove under, arms spread against the rail like some bleak charcoal sketch: a black man, and when white Anders caught a glimpse of the man’s grim face through the windshield, all the tense American connotations of the word color returned. Where he’d just come from his own race was in the minority, but a thousand other differences – in language, dress, outlook, even ways of walking in public, not to mention the difference between a diet of beans and one of meat – tended to diffuse the pressures of otherness.
Shelly was reading from a sheet of directions she’d unfolded against the steering wheel. She took an exit called Locust, and at a light they saw their second pedestrian in some miles: another black man, with a beard and a runny nose, who stepped off a curb and walked inches from their bumper with no turn of his head, no hitch in his stride, no sign of having seen them at all. He wore a fatigue jacket and an orange knitted cap. A sign below some parking regulations read, Economic Development Zone.
Then they turned into the intersection that was the cancer institute’s address and saw huge wreaths and candy canes hanging from streetlamps above human activity galore. At a steaming hot-dog cart stood a long line of people, some in doctor’s coats or blue scrubs, people of all races, smiling and chatting as they waited. None seemed hurried or cold. A uniformed security officer waved Shelly up a ramp to an open parking space, and when his jacket gapped open Anders saw laundry creases in his uniform shirt. A first-story walkway connected a red brick building to a yellow brick one across the street. Over the door of the main entrance was an art deco visor, like a gigantic cement tiara, and Anders remembered an episode of a TV show he’d once watched with his sons: as a setup for some bad guys, operatives had constructed an unmistakably American town deep inside a glum, repressive country, complete with ranch houses and kids shooting hoops in the driveways. His first impression of the famous cancer institute reminded him of that. But artificial or not, the signs of order, stability, industry, fellowship, good cheer – these were what he’d come home for.
Inside he found more reassurance. Windows and carpets were all clean. Everyone he was directed to – seven people, at reception areas progressively deeper within the complex – smiled and called him Mister. When he was sent for tests, receptionists made sure Shelly knew where the magazines were. Within a couple of hours he’d left her with Newsweek for a windowless, beige-tiled consultation room in the Melanoma and Soft-Tissue Sarcoma Clinic, where two cheerful interns and a nurse practitioner asked him similar questions, almost as many about his life abroad as about his disease. One by one they excused themselves or were beeped. Then Marrins came in, pointed to an ID card clipped to his breast pocket and held out his hand.
“I know you’ve got a million questions, Mr. Anders. With some luck we’ll have about five hundred thousand answers for you.”
He had a meaty hand with blunt fingers, and his wide smile showed spaces between his teeth. He might have been five years older than Anders, and he might have been ten: he was in better shape, but his crew cut was white. An old Navy man, Anders guessed, which he took for a good sign, though he’d tended to think of the military with a combination of mistrust and amusement before this; he himself had never served. When he’d removed his shirt, Marrins fingered the scar where Mustafa’s assistant had cauterized the skin after shaving off the offending mole.
“Shaved!” Marrins murmured. “That will make staging it a bit tricky for us now.”
“What? Tricky? Staging? What?”
“Shhhhhh. It’ll be okay. We’ll take care of you.”
Anders believed him and relaxed. He felt the rest of his back being checked.
Marrins reappeared in front of him, smiling again. “Good news, then?” Anders said.
The doctor waggled a hand: so-so. He sat on a stool in a casual posture, heels drawn in toward the casters, hands propped on his knees. He said he wanted to do the procedure that Mustafa had described. He wanted to do it the next day.
It was the beginning of six months of up-and-down trouble. This first operation took out an oval of skin around the spot where the mole had been removed, to be examined for more melanoma cells. Anders was left with a six-inch scar on his back and a pucker Marrins promised would stretch. In addition, Marrins had done a sentinel-node biopsy, a nuclear procedure that left a smaller scar beneath Anders’s right armpit; it was meant to establish whether the melanoma had spread to his lymph nodes. When the results proved trickier to interpret than expected, Anders called Laila to tell her he’d have to postpone his return.
“I should be with you,” she said, as she’d said since the beginning, but he was firm. “Because I say so” still carried a good bit of weight in her culture. But the notes of her voice over the crackling telephone lines moved him so much that he had to put his hand over the receiver. He didn’t think he could handle seeing her here. Only the older of his two sons had called. Naturally, neither of Ellen’s kids had.
Marrins gave him pamphlets to read, with bibliographies of more books. If the disease hadn’t spread it was considered curable. But survival odds in the other case took a huge dive. The very compilation chilled him – the word survival did.
Shelly finally quit apologizing for being so busy with her job – she evaluated grade schools for the state, and it was spring – deadline time and the minutiae of home financing, but Anders thought something else was going on with her; he had no idea what. Even before he’d moved abroad, their relationship had become distant. She hadn’t responded to his wedding invitation, though he’d offered to pay her airfare. But he hadn’t held it against her then, and whatever her reasons now, he was glad she didn’t want to be more involved. Their parents were dead; at least they didn’t have to worry about him. And the man Shelly lived with, a big, quiet guy who owned a house-framing business, expressed some curiosity about Egyptian food, but they didn’t have much else to say to each other.
So he spent much of the time between tests and results in a branch library, researching this disease. The more he learned, the less he knew. Every trend in the research data was contradicted by dramatic exceptions: people who should have been dead were alive, and vice versa. As Marrins put it, “We’ve amassed a vast amount of data that in any given case might or might not apply.”
Naturally, Anders had always known that life comes with no guarantees. He’d known he would die. He’d known that. He’d always known that. But this! About this he’d had no inkling.
He discovered the cancer literature of the spirit, human and divine: the connection between attitude and health, between living and wanting to, between life, love and belief. He examined his prediagnosis self. Cancer as character, he thought. Cancer as punishment. The concept returned to him unbidden, with the precise and insistent regularity of a current through tungsten filament, and he couldn’t look at it for long.
Other possible causes, more scientific ones, were genetics and the sun, or some combination of them, though it was too soon to blame the North African sky. The literature most often mentioned sunburn in childhood. Not even constant sunburn – intermittent exposure actually seemed to be worse. And did the depletion of the ozone have a bearing here?
“Very possibly,” Marrins said. Anders waited for him to say more, but he didn’t.
He was walking back to Shelly’s from the branch library one day when he slipped on some ice and sat down heavily in a snowbank. It was old snow, grainy and dirty, and he could feel it seeping through his pants, soaking his underwear. He was deliriously happy. In a passing car with a bad muffler he saw mocking faces. He waved.
Another time he was overcome with the beauty of a radio tune that turned out to be a commercial.
Eventually he had to have another operation: pathologists had found melanoma cells in his lymph nodes – not many, but enough to have to check for more. This operation was bigger. He would have to stay in the hospital for a while.
The morning after his surgery Laila phoned his room at five o’clock. “How are you?” she breathed, her intonation pulling him across eight time zones. “I should be with you.” He said he felt great, and he did, thanks to morphine. “Everything is going to be fine, Lyle,” he said, and in one way it was: no more cancer was found in the nodes that were removed. But the safest course of action then – the standard of care, as Marrins called it, the best recommendation known to medical science – was for Anders to begin treatments of interferon, a protein that would either kill any stray tumor cells that might still be left in his body or else stimulate his immune system to do so (or do both, no one could say for sure) in a seek-and-destroy mission that would last a year, though it significantly altered the survival curve. Anders deliberated for about eight seconds.
He took the first month of intravenous injections at the institute, forty million daily units that left him tired and feverish for the rest of the day. Then would come a series of less frequent, subcutaneous injections, lower dosages he could give himself, and Marrins told him that if he wanted to, he could return to Egypt to finish those. Marrins had recognized Doctor Mustafa’s name from a conference in Geneva, but for overseeing the final treatments he recommended a doctor at the British Hospital, where he called the care “top-notch.” This was a tougher call, but Anders didn’t have too long to make up his mind. Shelly surprised him by trying to talk him into staying, offering him a room in the house they’d decided on. Anders declined, though. He wanted to live out the life he’d chosen.
Now that the worst seemed over, he wanted to choose how he’d interpret this illness, too, which except for the mole had, after all, been symptomless: a matter of test results, research and treatment. He decided it was over now. He’d sought and received the best advice, and in a few months he’d be finished with his adjuvant therapy, which meanwhile would be only a thrice-weekly inconvenience. He’d resume his good life.
But it didn’t turn out that way. The shots were more difficult than he’d imagined. He’d been instructed to pinch the fatty tissue of his thigh before injecting it, alternating thighs each time. The needle didn’t bother him, but the worst he felt all week was on the days when he knew he was going to have to shoot up at night. His anxiety worsened in the evening and peaked when he measured his dosage: his hands would tremble, and he’d sweat. The moment before his injection was like a drug experience itself, nothing he could think himself out of or through. Right afterward he was calm. Then in the middle of the night he’d wake up, drenched in sweat again, clenched in worry.
A little over halfway through his treatment, the Gulf War broke out. Tensions in the region ran high: Would the trouble spread this far? How bad was it going to get? Whose information to believe? Strangers, friends and the local press, the BBC and CNN were all spreading rumors, from mail bags floating in the Nile to imminent airlifts, one source apparently as reliable as any other. People in the streets seemed to be going about their business as usual-or were they? Anders couldn’t tell, and he couldn’t tell whether his periodic shuddering was caused by medication, the war or his own loosening grip. He called Marrins, who said that reactions to interferon were indeed unpredictable; some people had more difficulty with it than others. His voice was so clear he might have been next door.
“Difficulty?” Anders said. “You didn’t tell me about that.”
The silence too was clear, but finally Marrins spoke again. “I’m sorry, Mr. Andrews,” he said.
So about the time Saddam Hussein’s retreating forces were setting fire to the oil wells in Kuwait, against the advice of the doctor at the British Hospital, Anders controlled what he could and quit his medicine. But the tremors continued, like a low-grade fever, and though sometimes he felt fine, lucid and happy, those times came to seem like the aberrations to him.
A book in the branch library around the corner from Shelly’s had recommended parties to mark treatment stages, and a month after Anders went off his treatment, Laila threw him one, a surprise. Even the headmaster and his wife showed up, but Anders didn’t speak to them or anyone else.
“Who am I to deserve a party?” he asked the empty room when the guests had left – early, he’d made them so uncomfortable. “What have I done worth celebrating? Does the newspaper vendor get a party for making it through another day with no legs?”
Laila was helping Madiiha, their servant, to clear the table. Anders had spoken in English, but Madiiha’s eyes showed she understood that there was disagreement afoot. It was not his first such outburst. Laila, holding a stack of dirty dessert plates, looked him full in the face for a few seconds, then stepped around him toward the kitchen.
“Excuse me,” she said.
The anguish from the days of his career troubles returned to him tenfold, more and more often and over small, unimportant matters. He’d get furious at students over spelling errors or at Laila over issues such as toast. When he told her he didn’t want any more children – though he’d promised her two, eventually – she divorced him.
Human accomplishments began to astound him in their intricacy, from medicine to television to crossing a street. Third World irregularities he’d have laughed at before-a rickety elevator, a cab with no doors, a wedding ring in a restaurant salad – began to fill him with dread. He was buying lettuce from a blind woman in Tahriir Square when a nail bomb went off in the El Nil Cafe. He heard the explosion and saw the fire and smoke and chaos, and like everyone else in the crowded square he knew immediately who was responsible, more or less, and he knew the gist of their rant: the godless West was craven, sinful, miserable and sick. It was the rhetoric of extremists, madmen. But he began to feel that in his own case at least their charges had some truth to them, and he felt he hadn’t atoned fully yet.
He began drifting off in lectures, in the middle of sentences, gazing out a window with a finger to his lips until the bell rang. Sometimes he’d sleep through his morning class or hand back papers unread, or graded randomly. Other times he’d talk through the bell, expounding on some insight that had just occurred to him. He lived on mangoes and yogurt and boxes of Kentucky Fried Chicken from a franchise that had opened downtown, near the smaller, shabbier apartment where he’d moved. Laila had kept the Zamalek flat, which had a view of the Nile, but now he lived on the first floor, not quite above traffic fumes, in a building where street dogs slept in the lobby and barked when he came home late. He often mentioned the dogs when expressing his regrets for not attending social functions, though he continued to receive invitations. In the expatriate community he’d become something of a legend, and the gossip about him was wild: he’d once been CIA; he’d converted to Islam; he liked boys; he was working for the Egyptian government. Hostesses loved him.
The daily truth of his life was less spectacular. During the summers, which he and Laila had once spent in Crete, he now stayed in Cairo, thinking up errands and then running them: getting a belt repaired, mailing a letter, buying a pen. Students at the international school were paying a lot of money for their educational edge. After he was taken out of the classroom he was shuffled between administrative tasks for a year or so. But eventually the headmaster called him in.
He’d protected his retirement benefits against Laila’s claims in the settlement, but they weren’t enough to live on in the city he returned to, where the cancer institute and his sister were. He found a job clerking in a used bookstore and paid month to month on an upstairs apartment in an Economic Development Zone. The neighborhood reminded him of Cairo, with fewer people in the streets. Shelly and her husband – they’d married and had a child now – asked him more than once to move in, but he said no, though he accepted their invitations at holidays. His older son began accepting, too, with his own wife and child, Anders’s granddaughter, Nell. Anders would bring the stuffing, or a yam dish, or a new kind of sausage he’d discovered how to fry. “I’m a wizard with a skillet,” he’d say. For Nell he’d have candy, toys, books.
One Thanksgiving, he finally just came out and asked.
“Ellen has remarried,” his son said.
Anders had found what he thought was the same church he’d spotted with Shelly from the highway on their first drive to the clinic. As it turned out, only the steeple windows were boarded up, to discourage bats from nesting, and he went to services twice a week. The denomination he didn’t recognize or fully understand: the pastor referred to himself in the third person and threw dice during his sermons, rattling them on his lectern and pulling his arm back in great dramatic gestures at the roof; the yellow silk robe he wore was the brightest thing for several blocks around. On the Wednesdays Anders had off from the bookstore he did volunteer work at a soup kitchen in the church’s basement. He no longer believed the world to be any kind of joke, but he learned to meet it smiling.
By the time the towers fell, he was into his eleventh year without a recurrence. That very afternoon, he saw a woman in the romance-paperbacks section who reminded him of Ellen. Nobody else was browsing. People would wander in off the street to stand around for a few minutes, listening to the radio behind the counter that Anders had turned on when the second plane hit; they’d stare up at him or at each other, maybe say something, then leave. But this woman, after pausing briefly by the radio, had gone straight to the H-L aisle, and Anders sidled down his counter to see her better. Amid the disbelief that was still washing over him, the similarity seemed acceptable, unsurprising, though worthy of note.
Her size and coloring were unlike Ellen’s, but the resemblance in mannerisms was strong: the angle of her neck as she read books’ spines, the way she held her hair against her shoulder. When she came out with three thick selections she kept her eyes down, fumbling in her purse. She’d fixed a hinge of her glasses with a tiny gold safety pin. The books she was buying weren’t to Anders’s former taste-few in the store were, though he didn’t read much now, anyway – but he recognized in her a serious reader, as Ellen had been, as he himself had been once. People on the radio were saying things they’d said before, as if to convince themselves. Anders looked around to make sure neither of the store owners, brothers who feuded over every dime, was within earshot, and when he didn’t see them he told the woman to put her money away.
At first she didn’t understand; she seemed alarmed. Other people looked over. Everybody was jumpy.
“Just take them,” he said, sliding the three books back across the counter. “My gift. Please.”
Then she did take them, though she was hesitant and left without thanking him.
In the weeks afterward, when he thought about her reading those books, maybe on a bus or at a fluorescent-lit break table somewhere while headlines streamed across a screen and coworkers jabbered at her elbows, he felt better. Not great, but a little better. At his counter now the radio was never off, the multiplying accounts of death and loss like the heavy, scalloped curtain that drops in old theaters. More than once, handing back change or asking, “Bag?” Anders looked up into eyes as full as his own. As the grief stretched into war news and the strandby-strand extrusion and examination of causes and possible remedies, Anders heard about the global rages and disparities, duplicities and truths, complexities and misunderstandings he’d experienced as pathologies of his own. Some of what was being articulated now he’d known, and some of it he hadn’t, but he absorbed it all with the growing feeling that what was most important hadn’t been said yet. He watched for the woman who looked like Ellen, but he didn’t see her again.
Ah, well, he thought.