I wrote this in March, 2015. Before…

My sister checks in with the woman behind the counter, signing her name and mentioning what she’s there for. It hardly seems necessary to mention this. Everyone who enters this room, unless they are a support person like me, is here for one reason: they have cancer.

The lobby smells like tragedy and sickness today. I look around to see if there are any signs of an accident of a personal nature—orange cones, a bucket and mop, yellow tape—but there is no sign of such a thing. The uniformed guy behind the desk doesn’t look at us and nod the way he usually does; he is engaged in conversation with a woman wearing something around her neck, her ID card encased in plastic and strung on a lanyard. They don’t seem to notice the unpleasant odor that makes me feel like holding my breath until I get to the elevator a few feet away. The air inside the elevator smells normal, safe.

My sister and I ride up to the third floor and enter the doctor’s office. We arrive early for the appointment; for now, we are the only ones sitting on the black plastic chairs, watching the small colorful fish swimming around in the dark aquarium that takes up at least eight feet of space against one wall. The TV isn’t on yet, so we are spared seeing “America’s Funniest Home Videos,” which seems to be playing on an infinite repeat. I try to avoid looking at the TV screen when I’m in that room. I take out my phone instead—only checking email and not having a conversation, which the signs remind me is not allowed in the office.

When there are other people in the room, I try not to look at them either.

My sister checks in with the woman behind the counter, signing her name and mentioning what she’s there for. It hardly seems necessary to mention this. Everyone who enters this room, unless they are a support person like me, is here for one reason: they have cancer.

This is the place we go for her chemotherapy. It’s a three-step process: first, one long day with the IV in her left arm. She sits in the beige chair with her lunch, water bottle, newspaper and a book for the six hour duration of the treatment; she has a few days off, then two visits the following week—once for a two-hour infusion, and once for a shot. We’ve got it down to a science now: I pick her up at her place, we get on the freeway, then turn onto Telegraph and park in front of the building as close as I can get because she is tired and gets winded easily. This is the way it is now with my sister.

She used to work three different jobs, volunteered in the garden at Children’s Fairyland, and attended countless performances both in the East Bay and San Francisco—opera, theatre, readings, dance performances, concerts—always on the go with her wide circle of friends. Now the friends come to see her and bring soup and other forms of nourishment, and they call me afterward in tears.

She used to put on a little makeup and wear nice clothes to work. Now she doesn’t take care of herself the same way. It’s too hard. Taking a shower is too hard. Baths leave her exhausted. She had started losing her hair, so now it is cropped short and you can see her pink scalp through the thin places. She doesn’t go out, except to get her chemotherapy. With this nice weather, she can be persuaded to sit in the sun for a bit. But other than that, she spends her days on the couch, watching movies, napping, or reading. She coughs off and on, so talking is sometimes difficult. The coughing makes her tired too.

Her hair is spikey and uncombed, and she has aged practically overnight. She weighs well under 90 pounds, and her clothes—even the new extra-small things I bought for her—just hang on her thin shoulders and balloon around her stick-like legs. Always thin, she now looks emaciated. Her collarbone juts below her neck, and her hands look too large for her wrists. Her face is tiny, her skin taut. The days after chemo are bad days. “I feel like a sad sack,” she said once, after a spell of coughing. We count the good days, which, for now, outnumber the bad.

It took a while to convince her, but she now carries a card that entitles her to a supply of medicinal marijuana, the kind that comes in a spray. She spritzes it under her tongue two or three times, several times a day, to increase her appetite. Since she started using the spray, she is eating more, but not gaining any weight. She’s holding steady, which is second best. Friends have brought cake, ice cream, Ensure, avocados—anything that tastes good and is high in calories. She is now forced to adopt a way of eating that is the complete opposite of the way she’s been eating for her entire calorie-conscious adult life. She mentioned yesterday that she thinks her stomach is getting bigger. I just looked at her. This is no time to be concerned about a muffin top, I wanted to say, but didn’t.

And this is one more reason I am worried for her. This is lung cancer. It doesn’t just go away. She needs to get through this round of chemo and one more before her doctor orders another scan to see if anything has changed. There are three possibilities: nothing has changed; the cancer has continued to grow and spread; or, by some miracle, the tumors are smaller.

I have been a sister for more years than I have been any other thing. Our parents are both gone, and it’s just the two of us, for several years now. She’s single, has no kids, and so I am it for her in terms of family.

In the back of my mind, I always knew that if anything happened to her, I would be the one she would turn to. Who else? My name is on her health directive and other documents. I know what that means, what it could mean. Though we’ve had our differences over the years, there was never any question that if she needed me, I would be there to help. I just thought I’d have more years—many more years—before something like this happened.

She has Stage IIIB non-small cell lung cancer. I’ve done limited reading on the subject. Five years out—I know what the numbers are.

But for now, these are the numbers I focus on:

She’s begun her fourth round of chemo.

Two more to go before we know what happens next.

I have one sister.

 

The inevitable epilogue: my beloved sister, Susie Elkind, died on May 22nd, 2015.