Tuesday, August 6, 2013

The Final Round

An excerpt from my memoir:

On my calendar, December the 4th was marked: “Chemo #12 – the last one!”

That day had come.

As usual, I left the house with Metallica’s Of Wolf and Man blaring from my headphones. The morning sun had lifted above the Victorians on tranquil Fair Oaks Street. Birds chirped in the trees. Kids stepped out of their houses with their mothers following behind. While I walked up the hill to the bus stop on 24th Street, my feet didn’t have the determined bounce, the I’m-gonna-fuck-you-up, Hodgkins gusto that they had for the previous infusions. I was tired of that dance. I was going the full twelve rounds. I thought I had fought well. The day before I cycled to and from school, something I never thought my body would have been capable of before I began treatment. I never missed a class during the fall semester. But I was done. Done fighting. Done pushing myself. Done putting on a game face every two weeks, lacing up those imaginary gloves on my way to 4C where I would sit on a chair and rest my arm, clench my hand into a fist—hungry to live, ravenous for rebirth—and stare ahead as though I was toe to toe with Mr. Hodgkins.

Two hours later, I was zonked out from the Benedryl and Ativan. I sat on a reclining chair that faced the doors into the infusion room. An IV was pricked into my right forearm, the inflatable cuff of a blood pressure monitor strapped around my left bicep. Vilma gently nudged my arm. “Juan,” she said. I startled awake and saw her standing beside me.

“You have to sign off on the authorization,” she said with her Filipina accent. She held out a clipboard and pen. “Just sign right there.”

Barely able to keep my eyes half-open, I signed off on the release.

“Thank you,” she said, taking them back. A woozy glimmer of glee surfaced within me. It was the last authorization I would have to sign. No more infusions to schedule. As she scribbled something into my file, I jolted in my chair once I remembered the card I had brought.

“Vilma,” I said, “before I forget, I have a thank you card for you and the nurses.”

Turning her head to the side, she smiled in a you-shouldn’t-have way.

“Oh, thank you Juan,” she said as I handed her the card. She held the white envelope up and said, “Nurses! Nurses, we got a card.”

Vilma walked out of the infusion room toward the nurse’s lounge. I fell back asleep.

An hour and a half later, I woke to find Vilma sitting on the stool beside me. She wore a medical mask that covered her nose and mouth. The inflatable cuff over my left bicep inflated tightly as it automatically did throughout my infusion to ensure my blood pressure was not at a dangerous level. She was attaching one of the chemo push syringes into my IV.

“All right, Juan,” Vilma said. “Your last one.”

I peered down at the syringe, at the clear liquid being pushed into my bloodstream. I managed a grin because I felt I should for The Last One.

My parents were not standing against the wall like they had throughout my other infusions—including Round 11, in which I handed them my digital camera to take pictures of me during my infusion. (I wanted cancer mementos. Photographic documentation of a perilous juncture in my life, a place I did not wish to physically revisit.) They weren’t even in the same area code. At that moment, they were somewhere in Cabo San Lucas of all places. My mom—who didn’t even like to go out to eat because she thought it was too expensive—had found a budget deal for a four-day trip to Sammy-Hagar-Land. Before she bought the tickets in early November, she asked me if it was okay that they left. The deal was only valid during the weekend of my final infusion. I told her, “Of course. You guys should go! I’m going to be okay.” And I was genuinely excited for them. Throughout my life, they had never taken a getaway vacation. (Well at least until the year before when they took a similar package trip to Cancun.) I was pleased my mom was finally allowing herself to use her well-earned pay to indulge herself so she and my dad could see places they had never seen. (Throughout my life, she has worked to send much of her earnings to our grandma and family in Peru.)

The blood pressure monitor deflated as Vilma squeaked her stool closer to my arm.

“You know, I read your card,” she said, raising her head to look at me. “And it made me teary.”


“It’s hard—” she said, before she looked away, then stared down at the syringe. I murmured. I presumed she was referring to her job in response to what I had written.

Here’s what I wrote:

Doreen, Shannon, Vilma, Marva, Consuelo,
Dolores, Raquel, Faina, and anyone else at 4C I’ve
forgotten (forgive me, please)

Where to begin, when words like these will always fall short of what I want to express, namely the gratitude, the deep admiration I have for each of you. I am so grateful for the care, for the support and positivity you’ve given to me and the other patients at 4C. I have always, always known that I can expect this from you; you may shrug it off and think, “That’s my job,” but in this trying time of my life, it has been beyond comforting to know that I could always
count on you.

So this is my teeny-tiny way of saying thank you to each of you. I wish I could give you all a big, big hug. Each of you are sweet and caring in your own ways and I will always wish you much joy. I’m writing a memoir about this strange period in my life and I promise you that after I dedicate it to my parents, you all will be the ones I dedicate it to. I’m devoted to writing this book, getting it published someday so I can give you a copy and more thanks. I don’t think it’s an effect from the chemo (my fix!), but you’re angels to me. Thank you, with all my heart.

Very sincerely,
Juan Alvarado Valdivia

I glanced over at Vilma while she pushed the chemo into me, then turned away. It was always an intensely intimate act to witness—as though man were watching God give him life with a touch from his fingertip. I closed my eyes through The Last One.

Soon after, Connie walked by on her way to attend to one of her patients. She beamed at me, said I was “graduating.” I smiled and bowed my head in the oh-shucks way I had done since I was a boy. Though I felt a quiet woo-hoo inside of me, I didn’t think it was fitting to celebrate my final infusion in front of the other patients: the middle-aged Russian lady; the vigorous-looking Asian man in his mid-forties; the blue-collar guy who was joking with the nurses for his first infusion; or the old Chinese woman with the gray knit hat whom I had seen wheeled into the ward since I began my infusions. I couldn’t celebrate in front of them because I didn’t know how long they had to go with their treatment. Or if they would make it through okay. Though I believed I would survive, I could not be certain at that moment, either, so there wasn’t much to truly celebrate.

Vilma took off the inflatable cuff, the IV needle from my arm, and bandaged it.

“You’re done!” she said.

“Thank you,” I said, as I bent over to slip my shoes back on. I stood and teetered over to the bathroom a few feet ahead of me. Once inside the airplane-sized bathroom, I slid the folding curtain door behind me. I unzipped my fly. I felt a bad cough coming. My stomach felt sour as it always did right after treatment. But I could feel that it wouldn’t be a typical nauseous chemo cough. I bent over the toilet just as I heaved. Some of it splashed on the black slacks I was wearing. It was the one time I vomited right after an infusion. I tried to muffle my post-retch coughs since the other patients or nurses could easily hear through that thin door.

“Are you all right? Did you throw up?” I heard Vilma say.

“I’m okay,” I said, turning the faucet on to splash my face and gargle. Fuck. The new guy must have heard. Quite a welcome to ChemoLand. After I cleaned myself up as swiftly as I could, I looked in the mirror. My face was unhealthily pale. Bags under my eyes. I shook my head and made a faint grin, grateful this nasty-ass shit was over when it was beginning to take a toll.

Once I stepped out, I grabbed my shoulder bag. There were no nurses in sight. I opened the door into the infusion room and closed it behind me. (That was the one time the doors into the infusion room were shut.) In the hallway, I found myself hesitant to leave without saying goodbye to someone. Then Vilma stepped out from the nurse’s lounge at the end of the hall.

“Big hug?” she said.

I walked over to her. During my eleventh infusion—which she also administered—I had learned that Vilma had worked at San Francisco General for twenty years. I embraced her tightly, rested my chin on her shoulder. “Thank you,” I said, then left before I got teary.

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