Shut Up and Deal

The hard things that help us learn when to shut up and when to not

It’s crazy to say, but active treatment for cancer is in some ways the easiest part of the process. You don’t have to do the research, make decisions, get second opinions, field all the inquiries, get your ducks in a row. Treatment is an exercise in dealing, there was nothing to do but put my head down and put one foot in front of the other. I concentrated on just getting through it: countdown the infusion bags, endure another injection, prepare for the double mastectomy, finish Herceptin. Each benchmark was another hurdle to brace for and endure. Another day, another thing, another month, another symptom. Shut up and deal. Ah, yes, an old mechanism I know well.

I finally felt done with cancer treatment after the clean-up Phase 2 surgery: nip and tuck, “dog ear” scar correction, lift, areola tweak and, most importantly, I got the port out after 15 long months. The bump in my chest, positioned just so to allow later surgical access to the breast and to pucker under the pressure of the seat belt. The port interfered with bra straps, made tank tops and open neck lines unwearable even in the hottest months, and constantly reminded me of treatment. Getting it out was the last hurdle, more meaningful than my last chemo infusion or Herceptin drip.

One doctor joked about the dark abyss that one encounters after treatment, like falling off a cliff when you thought you had come to the end of a path to safety. Nope, nothing down here but dank coldness and an echo you can’t quite make out.

The dealing part over, I lifted my head up and looked around the dark. Two months after the cleanup surgery, I was crying every day. I had some sort of UTI a couple weeks prior and a lingering sense that my system wasn’t right. I had speckles of tiny bruises on my thighs, and wondered if it’s skin cancer come back. I had a nasty cold sore. Blue feelings. Thin patience and quick anger. The best-case scenario was that I was simply not taking care of myself properly. But I couldn’t shake the fear and mistrust. I learned to live with it.

I saw a friend stomping around in a surgical boot. She was pretty agile with it, having been in it for weeks already and resigned to another month or so. She tore up her foot on her stairs at home, nothing glamorous, but it humbled her nonetheless.

“You take your body for granted until it gives out on you,” she marveled, then caught herself. “Of course you know what I mean.”

Of course I do, theoretically. Yet I have no sense memory of a time when I took my body for granted. I must have, running around like any average kid who doesn’t give a second thought to what her body can or can’t do, just throws herself over puddles and splays in the sunshine uncovered. I was in middle school when my mother fell ill, and my cancerous doom loomed over my head from then on. Breast checks were a norm as soon as I got them. My sisters and I all secretly wondered who would get cancer first, each convinced we were at the head of the line. After age 13, I was waiting for my body to betray me.

My mother was in treatment for more than a year it seemed, following me from middle school to high school. She was in the hospital for weeks at a time, while our hard-working, city-commuting, hot-headed father was the one in charge. I remember the scent of lilies in her hospital room. I can see her in a fluffy white robe, crawling her hands up the wall as her Cancer Society buddy had instructed her. How did we get places when she was too fragile? Who cooked dinner? What did we talk about? Did we talk at all?

Early on, my mother called me to the kitchen phone; she had just been diagnosed and was telling her family back in Philadelphia. I took the handset and heard my Aunt Loretta’s voice: not little Loretta her sister, but big Loretta, her late mother’s sister, now step-mother. I liked to call her Aunt Grandma behind her back.

“You take care of Mother now,” Aunt Loretta seemed to assume I might be lazy without the proper instruction. I’m not sure why she thought referring to my mom as Mother would bring me to heel; how I wished I could have hung up on her right then. “She’s going to need help. You be good to her.”

Did she say this to everyone in the household, or just the youngest of four children?

I can’t fault Aunt Grandma Loretta for looking out for my mom — she was more my mother’s person than mine — but her comment set the Shut Up directive for me. Well, that and the very beginning.

I was the only one around when my mother got her diagnosis. I was watching TV in the family room, at the top of the stairs from the basement garage level. I heard the garage door open and close, heard feet up the stairs, and the opening of the hollow wood door. My mom took a few steps to stand on the edge of the room, I craned my head around to catch her eye.

“I have cancer.”

She went upstairs to her bedroom and shut the door.

I’m sure we must have talked about it more, at the very least covered the logistics of what treatment would look like. Hospital, surgery, chemo. Did they say they wanted our lives to remain as normal as possible? Did we make plans for who would drive whom where? How things would work when only Dad was home?

I remember no talk of feelings. I don’t recall being asked how I was. Whatever messages were sent from the adults in the house, all I heard was Shut Up and Deal.

Sometimes I tried to talk about my feelings, but without much practice I didn’t have a great sense of time or place. In the later days of her treatment, I fought back tears while talking with a prospective boyfriend by the lockers at school. I watched him walk away and felt the echo for the first time, the deep chasm I fell off the cliff into. Maybe I had shown I was too raw to be the bubbly, fun girlfriend to take to a party. I had to go back to Shutting Up.

Fear and quiet became my shadow. I took up smoking. Cancer sticks. Now I see the obvious metaphor of the effort to shut up and deal: swallow, process, exhale. Blow it all away.

The stink of Marlboro Lights surrounded me, I walked with it everywhere I went through high school. I got busted, I changed tactics, tried new rituals to hide it. I got busted again. I got Topol “The Smoker’s Tooth Polish” in my Christmas stocking the same year I wrapped up a little frame with a hand-drawn no-smoking sign as a gift to my mother. I was lying.

Smoking. Partying. Boys, boys, boys. Oh, I could Shut Up alright, but I had to take along some vices to help me Deal.

Somehow I stumbled my way through high school intact, through some act of kismet, sheer luck or the grace of God. College was a new challenge for my Shut Up and Deal process. I never felt more alone and unsure of myself. I wandered unsteadily through my academics, found lively friendships that hid their more toxic centers, and bounced from boy to boy trying to find acceptance.

I pined especially hard for one boy in particular; our respective best friends were sort of dating so the four of us palled around a lot. He had a girlfriend for a long time; I waited her out. When I finally was allowed into his bed after a long party, I found myself more raw and vulnerable than ever.

“What’s the hardest thing you ever went through?” I asked him the next morning. We were half-dressed on his futon, still messy haired and bleary.

He hesitated. He looked away, he screwed up his face and averted his eyes. I didn’t give up, I ignored his obvious discomfort. I wanted him to get to his point, so I could get to mine. I had to talk about it, why won’t anyone let me talk about it?

“My parents’ divorce, I guess.” Poor guy. I’m so sorry I pushed you here.

Ultimately I was allowed to say mine out loud. My mother had breast cancer when I was 13.

But it didn’t go much further than that: Really? Huh. That sucks. Let’s go get breakfast.

Not surprisingly, that wasn’t the start of a beautiful relationship. We messed around a couple more times before our lives were caught up in other drama. What is surprising to me is that I thought that moment could bring some sort of release or comfort. Did I really think this poor cornered boy would offer me emotional refuge? Was he supposed to probe the inner workings of my pain and heal me? I shut back up, hidden in a cloud of quiet smoke. I became a master.

In March of 1999, a week after the lumpectomy for my first cancer at 28, we were gathered down a long table, tucked behind dramatic curtains at a vaguely ethnic restaurant we were all excited to try. There were probably a dozen of us, friends who had gone to college together, bringing along dates who were either already spouses or on their way to the altar. It was a festive night, arranged to celebrate the cancer being removed from my body with clean margins.

I had been diagnosed only a few weeks before, cancer treatment moves fast and hard with younger patients. Not only do doctors consider the cancer more aggressive, but patients who are vital and healthy are encouraged to be aggressive in treatment. We know chemo won’t kill you, so let’s go all in. Surgery was about two weeks after the diagnosis, followed by a standard three weeks off to heal before chemotherapy. The in-between called for a night out with friends.

I was still sore with two strips of stitches, one where the tumor was and one where they dug out the lymph nodes in my armpit. Just below the armpit strip, a single stitch held the drain in place. I only had one drain, which in retrospect was nothing considering I had six after my 2015 surgery. And like much of cancer care, managing the drains changed dramatically in the intervening years between my first and second cancer.

Back then, the single drain was an unbearable burden on both my body and my psyche. It was a small tube, about the width of a pencil, inserted into my right armpit where more than 15 lymph nodes had been removed. Lymph nodes move bodily fluids like a sewer system, sending all manner of trash and badness to the digestive system to be disposed of properly. When lymph nodes are removed, the system backs up for a spell. Other pathways and outlets will be discovered — those lymph nodes are some crafty little buggers, they deserve more respect — but it takes a while, and the extra fluid has to go somewhere in the meantime. Enter The Drain.

Held in place by a tiny thread that constantly crusted and tugged, the drain tube led down to a bulb that could pull apart for emptying several times a day. The doctors wanted to leave the drain in for all three weeks, ensuring there would be no free-flowing lymph surplus before starting chemo. In current day drain management, my surgeon wanted to reach a particular daily fluid level before removal. The beauty of the new benchmark is that if one section has already forged new pathways and isn’t sending excessive fluid out, the drain can come out no matter how much time has elapsed.

In 1999, the drain protocol was to strip the tube into the bulb twice a day. The drain is intended to collect lymph fluid, but occasionally blood clots sneak in and jam up the workings. Like a gutter system on your house with barriers to keep out leaves and twigs and bark but without a plumber’s snake or a power washer to blow through a clog. I had to manually strip the drain.

Try it with me: Take your less-dominant hand and use a few fingers to hold the tube closed and still, around where the crusty stitch holds it into your skin. With your dominant thumb and forefinger, pinch the tube flat and pull down slowly towards the bulb. Feel the zinging shock that comes from the vacuum you’ve just created, that somehow has stabbed your armpit nerves and sent a jolt through your whole body, bringing tears to your eyes. Scream out at the pain, clench your jaw and feel your chin quiver because your fingers have only moved about two inches, and you have about ten more to go. Squeeze your eyes shut as you move your hand the rest of the way to the bulb, withstanding the constant buzz of electricity that whips through your core. Repeat morning and night for more than two weeks until you call your doctor and beg it to be removed.

It hadn’t yet been removed at that celebratory dinner with friends. It was still the bane of my existence, tugging and sore and in the way. There was always a lump on my hip, and pinning it down created more places for it to get yanked. What could I wear to dinner that I could tuck the drain into, that would camouflage the bulb and secure it? I didn’t want my friends to see a cancer patient, I just wanted to be me again. I needed an escape, a night of fun and laughter and sharing dishes of exotic food, raising and clinking glasses together. I didn’t want to feel the presence of the drain with every chair shift and toast of a glass. My pre-dinner time was spent trying on, rejecting, and reluctantly choosing clothing items that didn’t quite capture what I would normally look like, but came closest while strapping the drain into submission.

Most of my non-drain-hiding friends spent their pre-dinner hours at work. But Travis was a teacher and finished mid-afternoon, so was drunk when he arrived, after sipping gin for hours. His wife, Julie, came from work and arrived separately. We exchanged a raised eyebrow as we selected our seats across from each other. It wasn’t shocking that Travis was drunk, but it suddenly made the night unpredictable.

Julie and Travis were our closest friends. I was there when they met, on a park bench in Memphis, where Julie and I had taken a Graceland road-trip for the 4th of July two years before. They didn’t actually meet on the park bench but just after it: We had been sitting on opposite sides of a local man who encouraged the solo Travis to introduce himself to these lovely young ladies on his right. He may not have been a vagrant, he could have been some sloppy artist enjoying a midday sunbath before returning to very important work, but it was funnier when we told people that this future couple was introduced by a bum on a bench.

Travis followed us to Chicago after the Memphis trip, already falling in love with Julie after mere days, and free enough in between Florida jobs that it was a cool adventure. He drove behind us for hours, keeping an eye on my black Mazda sedan with the colorful Phish sticker, while Julie glanced at the rearview mirror and we giggled about the lunacy of letting a stranger follow you to your home. It didn’t seem unsafe, but the kind of impulsive move a passionate twentysomething should do. And the exact opposite thing that either one of us would do on our own. We pulled over to get gas and I forced Julie to join him in his car for the rest of the drive home.

“Jules, this man is driving to a city he’s never been before, in the opposite direction from where he lives to get to know you better.” I love a romantic gesture, and I didn’t mind driving alone anyway. “Don’t make him wait anymore.” After that, they were only apart long enough for him to return to Florida, pack up his belongings, and quit his job. He moved in with her in Chicago. They got married a year later, on the 4th of July at a favorite neighborhood restaurant. I was maid of honor, and gave them a poem as a private toast at the reception.

I knew Travis exactly as long as Julie did, and we had our own friendship, as he did with John. The four of us spent most of our social time together, playing games at home, watching Must See TV, laughing and smoking pot and sharing stories of our burgeoning grown-up lives. We’d been through so much as a foursome already, I expected and needed their presence through my cancer treatment.

When Julie first heard the news, she got busy doing what she does best. She filled a stack of file folders with printed and official information, each neatly labeled with the topic: Research, Treatment, Chemotherapy options. This was before Google, I honestly don’t know how she compiled as much information as she did. She hadn’t yet gone back to school to get her Masters in Public Health, but she was already adept at the healthcare research that would inform her career. Our friends show us who they are, and love us in their own ways. Julie did what she could to take care of me.

Julie was naturally at the heart of my post-surgery dinner celebration, seated across from me where I could catch those raised eyebrows, and rest assured and taken care of in her gaze.

I am not sure who started toasting. Kristin, probably: she’s a natural hostess who knows how to strike the right tone. Randy may have echoed his wife, with a hearty but concise wish of wellness, as he prefers his speeches to be debates and there’d be little controversy in marking my cancer diagnosis. Around the table we went, toasting our togetherness, and assuring each other that this health crisis was just a blip. I don’t remember exact words, but I imagine it was along the line of You look wonderful, Kate, you’re doing great! We love you! You’re a badass! Not necessarily because I am or because I looked wonderful, mind you. But that seems to be what most people say to friends when they are going through something like cancer treatment. Positivity, encouragement, support, love.

“You’re going to get a lot of advice and concern and support from a lot of different people,” Travis held his gin and tonic poised, gesturing slightly at the others whose words had come before him. “But at some point, there will come a time when you need someone to tell you to just shut the fuck up and deal,” he raised his glass and tilted his face with a half smirk. “When that time comes, I’m your guy.”

There was a long stillness before anything happened. Eyes widened and darted around to table for confirmation, Did I hear that right? I let out a loud, single “HA,” shocked by the sneaky construction of the toast, it started so softly and landed so hard on cold profanity. That phrase, where had I heard that before? I deflated a little.

Julie gasped, and turned sharply towards her drunk husband, willing him to take it back, change gears, follow it up now with something better. Something, anything. Make it better. John leaned forward as if to jump across the table, his fist slid over in front of me to build a wall with his forearm.

What did you just say? I’m still not sure if it was verbal or implied.

Travis grabbed his car keys and pushed himself away from the table, stumbling past the velvet curtains out the door to the street. Julie ran after him, and the rest of us watched through the wall of glass only feet from our table. They argued heatedly for a few minutes, it felt like forever as we marveled at how brazenly he had spoken. I don’t care how drunk you are, you just don’t say that.

We weren’t certain then what the sidewalk argument was about, but Julie was desperately trying to ensure Travis didn’t climb in his car. He threw his keys on the ground at her feet, and stormed off to stumble his way home. She returned to the table, pale and mortified.

Travis’ toast was harsh and flip, deeply against expected norms and traditions. It was shocking, sandwiched as it was between gentle words of encouragement and strong feelings of love. But it was illuminating and real all the same. Travis wasn’t going to stroke my hair and say There, there; it wasn’t in his nature. Shut Up and Deal was his way too. This master met another master.

I can’t tell Travis’ story, I won’t do it justice. I don’t know or understand enough about the pain of his upbringing or the belittling of his feelings that shaped him. But I know he was offering me what he could, it’s all he knew in the face of big emotions and painful strife. Shut up and deal, there is no other way. You keep moving, another day, another challenge, another thing. Complaining or crying or wishing things were different won’t change what’s about to come. We all gotta deal, it’s true. I just didn’t need anyone to tell me so.

I was terrified of having the drains again in 2015, and so very many of them. I graduated to six drains: one in each lower armpit, and two in my torso on both sides. In the ICU I assumed the nurses weren’t stripping them because it was too early, that I was still too tender to put that kind of pressure on me and my wounds. Once I was moved to an intermediate care room, a tiny ancient nurse gave me my first drain zing. She mildly apologized as I cried, unconvinced of my pain or its source.

“It’s not supposed to hurt,” she assured me in her thick broken English. I suspected Mandarin was her first language, and her usefulness was in translating for the local Chinese population. I’m not at all confident that her winning nursing skills got her where she was.

I wanted to take her at her word, that maybe my 1999 drain was placed just so to plink a nerve every time it was stripped. Strange that this fresh placement would happen to strike a nerve again, but hopefully, maybe, possibly it wouldn’t feel like that across five more drains.

I steeled myself. She stripped three more drains without pain. Maybe… maybe… maybe this will be OK. She moved to one on the right side of my belly; she gripped and steadied and flattened and began her slow excruciating pull. It was less a jolt than a blinding white flash of pain, obliterating my vision and sucking every ounce of my fortitude and fighting spirit with it. I cried. She weakly apologized again, miffed perhaps by my over-sensitive nerves. It’s not supposed to hurt.

This nurse returned one more time for drain stripping — and the dual electric zingers — before I was visited by my surgeon’s assistant Candace. She was always awesome and warm and smart but achieved near-sainthood that day.

“You’re healing so beautifully, Kate! How’s it going?” Candace looked steadily in my eyes, willing me to give an honest reply. On the one hand, I aim to be the model patient, I didn’t want to complain. I crack jokes and flirt with x-ray techs and surgeons alike. I ask as few questions as necessary, and put a lot of concentrated energy into stoically tolerating whatever procedure I am enduring. You wanna bring a whole team of residents in to observe my breast exam? Sure, the more the merrier. The man behind the glass in the MRI room will never hear me bitch about how loud it is. The nuclear medicine tech will never know just how much she hurt me when she stabbed her thick needle of radiative dye into my breast without local anesthesia. I am the Shut Up and Deal master. But something about Candace invited honesty.

“I can’t begin to describe how awful the drain stripping is, Candace,” I nearly cried in the retelling, the pain lingers viscerally. “I don’t know why two of them are connected to raw nerves, but it sucks.”

“Wait, what? Who did that?”

I described the wizened little nurse, the same one who would later fail to remove my unplugged IV all day, so that I would watch my veins thicken and raise, a bruise darkening my whole forearm while she ignored me for hours. Yeah, that one. She stripped my goddamn drains and I hate her. Did I say that out loud?

“We don’t actually strip drains anymore,” Candace didn’t grasp yet how monumental her news was. “Now we believe that if the drain is getting clogged enough to strip, then it’s not really doing its job right anymore and we should just remove it.”

Not just the lack of stripping, but actual removal. It got better and better. Candace took a close look at the bulbs, examined the notes of how many MLs of fluid each drain was producing, and foraged through the cabinet of supplies to arm herself. She removed two of the drains right then, and told me I wouldn’t have to strip the remaining four drains at home for the ensuing weeks. I could refuse anytime anyone else tried to strip another drain. That particular bane was removed from my existence.

Sometimes it pays to not shut up.