In college I studied abroad in Florence, Italy. I lived in an apartment that was darkened every evening by the shadow of the Duomo and shook each morning with the bells of San Lorenzo. I learned to paint nudes and to appreciate pietàs and frescos. I jumped on the ferry to Elba and standing-room-only trains to Venice and Rome and beyond with just my Walkman and a small leather backpack. I hitchhiked into the Tuscan countryside and careened through the dark streets of Florence with strange boys to buy hash from the North African drug dealers who huddled in the quiet square off the Piazza della Signoria. Age nineteen: I was basically the world’s most worldly person. Oh—and an expert in Chianti and Brunello.
Then, after I’d been living in Italy nearly two months, my mom came to visit.
From almost second one, we fought: my apartment was shockingly messy, my skin was greasy, what are you wearing, why are you upset, oh my God stop looking at the map in public.
We were both devastated by our rift. I’d been counting down the days to her visit for weeks. I’d missed her so badly I ached at night. The highlight of each week had been Sunday calls home—navigating my international calling card on the single payphone in the grungy lobby of my building, savoring and resenting the minutes as they ticked down toward zero.
I was stunned that she did not think I was quite the star of the Italian universe I fancied myself. Also there was this—something we came to understand together much later: her desperately needing to still be my mom, my desperately needing to prove to her how much I didn’t need a mom.
We argued and sniped through the Uffizi, in front of the David, on the Spanish steps, under the baroque fresco in Sant’Ignazio, in a restaurant housed inside a cave in Orvieto, at a Vivaldi concert.
In my midtwenties, I tried to write a poem about the experience: the two of us bickering our way down the ancient, uneven streets of Pompeii with Vesuvius lurking behind us. It’s a weird off-kilter poem, one I’ve never really felt like I have nailed. But years later she told me she wanted me to read it at her funeral.
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See: She is dying.
It is weird to write that—like I’m saying something bad about her behind her back. But it’s true. And no one knows it better than her.
Eight years of cancer. They told her she had five years when she was first diagnosed. New drugs keep coming though, and some of them have worked—for a time. A stem cell transplant. Chemo. She got to see my brother get married and watch my kids grow. Multiple hospitalizations, endless courses of steroids, blood and platelet transfusions, five bone marrow biopsies, daily debilitating nausea and diarrhea, three failed clinical trials. She’s been keeping track: five days of not feeling well to every two where she’s basically okay.
We read Atul Gawande’s Being Mortal together. Its clarity on end-of-life care shakes through me like a summer storm. I give the book to everyone I know. Much of Gawande’s discussion revolves around the decision to stop treatment for cancers that seem to be relentlessly unbackdownable. Many of the stories he tells there—including his own father’s death from a spinal tumor—are hard to read. But what he is working toward in his difficult exploration is unquestionably beautiful: how to distill what matters most to each of us in life in order to navigate our way toward the edge of it in a meaningful and satisfying way.
Unlike the rest of the planet, my mom’s mind isn’t blown. “This is what I’ve been saying all along,” she says. “You just haven’t been ready to listen.”
One of the things Dr. Gawande probes in his book is how to figure out what makes a person’s life worth living in order to make the most sensible choices as the end of life approaches. One man in the book says he is willing to stay alive if he can eat chocolate ice cream and watch football on TV. He will even endure high levels of pain if he can do these things. Others are happy to be alive as long as they don’t have to experience pain. Yet another just wants to do whatever possible to attend a family wedding.
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My mom and I sit on her couch and talk it out. She says for her, it’s about lucidity: she wants to be able to have a conversation, feel a connection. That can help us determine how long we keep pushing blood transfusions and electrolyte replacement to keep her brain as clear-thinking as possible as the myeloma takes over.
She is asked to speak at a pre-triathlon dinner in Washington, DC, for the Leukemia & Lymphoma Society and tells a ballroom of stricken-looking athletes: Sometimes the most important thing is knowing when to quit. Sometimes being heroic is knowing when to say enough is enough. They don’t ask her to come back next year. Maybe they know she won’t be here anymore.
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Her latest news: The current clinical trial she’s on is not working at all. The blood work is all going in the wrong direction. And this week she does say enough is enough. She doesn’t want to do any more treatment.
My mom: my map, my Sistine Chapel, my Lonely Planet, my beautiful ruin, my volcano.
Next week—same day as my mastectomy—she is scheduled to visit Duke to see her oncologist, Dr. Gasparetto, another larger-than-life doctor: nearly six feet tall, tsunami of black hair, stiletto heels, an Italian accent that makes even the most toxic chemotherapies sound like heartbreaking arias—she pronounces the common myeloma drug thalidomide as ta-lidio-MY-da. The plan is to ask her how exactly one goes about dying from multiple myeloma. Whatever she says, it will sound like a song.
And I’ll be five floors above, drifting through the undreaming dreamscape of anesthesia. I keep thinking about my painting teacher in Florence—a watercolor class in a timeless glass ceilinged studio on the Via dell’Alloro.
“You must promise to only follow this advice in watercolor—not in anything else in your life—well, maybe cooking,” she told us. “Intensify slowly. Use lots of water, and lay down a wash of color. Walk away, let the pigment move and bleed and dry on the paper. Then return to it with a slightly deeper hue, again and again until you think you are satisfied. Whatever you do, don’t rush it. The best parts happen when you have stepped away.”
Surgery, anesthesia: a stepping away of sorts. A break from treatment: definitely a stepping away. But leaving treatment: This is something entirely different. She never really told us how to know when the painting was done.
Of course: Only in watercolor she made us promise, a roomful of American girls not yet twenty.
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Thinking about it, Pompeii and cancer actually have a fair amount in common—although we fight far less on this tour. Both places are full of ghosts and surprising, palpable reminders of life interrupted midliving: loaves of bread still in the oven, unfinished art, Vesuvius not quite dormant above the city.
The last couple lines of that failed poem: You reached out to me for balance / even though we weren’t speaking / and a minute later I had to do the same.
6. Pilgrim
Cool spring days, and I head out into the rain from our house down toward the greenway and the park.
Tita and I followed the exact path the other morning. The neighborhood was fierce: blossoms and sunshine and fragrant mulch and my blood coursing with steroids. Our pace was the babble of second opinions, counseling for kids, the possibilities of meditation, single or double mastectomy, disfigurement of the female form and the horror of mirrors, reconstruction: to build again or not.
I was breathless and full and grateful for clear-thinking friendship and conversation.