ON CHRISTMAS DAY IN THE MORNING
Robert N. Seitz
February 20, 1989

..And all the bells on Earth shall ring, On Christmas Day, On Christmas Day...
And all the bells on Earth shall ring....
On Christmas Day in the morning.

    Ring out, sweet bells! In spite of her breast cancer, in spite of the divorce, in spite of seven lean years, Jeannette was happy again. Christmas with Anne and Jennifer was turning out to be so good. Anne's first programming job at Secor Bank had Anne euphoric, and Jennifer had managed to come up with straight A's in electrical engineering last semester at the University of Texas.
    For three women sharing the same bathroom and the same kitchen, they were getting on uncommonly well. It's funny. You think your teenagers are going to spend the rest of their days as unrepentant brats. Then one fine day, they decide it's time to grow up, and suddenly, you find them imitating you instead of sneering at you, and saying "I love you, Mother." And it's delicious! Jeannette had even gone for a month without thinking up some new name to call Frank for running off with his young bunny after her mastectomy. Her Parents Without Partners self-help group would give her a lot of warm fuzzies for working through her anger and separating from him like that. But how can a man abandon two such lovely daughters? What are men made of, anyway, that they're so unfeeling?
    Other than that, Christmas was perfect. Even with Jennifer in college and money tight, the sales at Frost's had yielded some really nice, more-or-less-affordable gifts for the girls-things they'd really enjoy. And they'd had a wide world of fun decorating the apartment, going out singing Christmas carols and visiting friends and tonight, they'd light the Christmas-Eve candles at candlelight service. Tomorrow morning, they'd open their packages, stretching out each golden moment as far as it would go, although for her, the golden moments would go on as long as she could be with Anne and Jennifer.
    It was probably crazy to set up her annual physical at M.D. Anderson on the day before Christmas. Her reasoning had been that there wouldn't be much of anybody around, and she could get in and get out in a hurry. It was so hard to sit there half a day and watch the doomed ones who have "failed treatment". Also, there might be less chance to fret about it if she were surrounded by Christmas. She wasn't really worried. If cancer hasn't returned after seven years, it probably won't. Still, she was tense. Who isn't when they pass under the random guillotine of a cancer exam?
    Jeanette parked Anne's new RX-7 on the first floor of M.D. Anderson's echoing parking garage. In the dim light, she checked her tawny hair and stared into her sapphire eyes in the vanity mirror. No sag, no wrinkles. Not bad for a forty-five year old woman! Frank wasn't only heartless; he was a fool! She carefully put Anne's keys into her purse, locked the car, and entered the clinic.
    Inside, she checked in at Nuclear Medicine and got her infusion of radioisotopes. Then, while she was waiting for the radioisotopes to go where radioisotopes go, she wheeled the car back out of the parking garage and drove to The Mall to kill time . Two hours later, she returned to Nuclear Medicine for her bone scan.
    After twenty cold minutes on that white table, she knew she was in trouble. Big trouble! She could tell by the way the radio-technician kept taking detail shots of her right hip and her spine. He had quit bantering with her and he avoided looking her in the eye. Fear was suddenly electric in her shoulders and the pit of her stomach. She lay there on the examining table, under the huge steel "eye" of the radioisotope scanner like a bug under a magnifying glass. Her agony of suspense went on and on.
    After an eternity of twisting this way and that, she was finally allowed to get off the table. She crept in terror back to the barren little dressing cubical and dressed. As with prior bone scans, the technician told her to wait to see if they needed more photographs. Then she sat in the waiting lounge in unbearable suspense. Right now, some radiologist would be examining her films to determine her latest dispensation in their lottery of death. Finally, she saw a young man coming toward her and...my God! he had a film in his hand! He had obviously found something! He sat down, introduced himself as Dr. Something-or-Other, and said,
    "We've found a region of technetium take-up on this latest bone scan that wasn't there on prior studies. Let's see...you had a mastectomy...seven years ago. Is that right?"
    "Yes," she said, numbly.
    "Of course, this "hot spot" could be something else, but in view of your history, the possibility of recurrent metastatic disease can't be ruled out."
    "Do you think that's it? she said. "My cancer 's come back?"
    He hesitated for a long moment.
    "Yes," he said.
    He paused again. "Of course, I could be wrong. I don't know whether your oncologist will want to start therapy right away or not. I'm sorry. I'm really sorry." He looked genuinely dejected.
    She knew! When breast cancer goes to the bone, the game is over. Radiologists don't say a thing like that unless they're sure. In seemingly-perfectly health, she was going to die horribly, and soon. All that was left was putting her affairs in order and enduring the unbearable agony of dying from cancer in her bones. It was like being placed without warning on a high, flat-topped rock in a gathering wind, and knowing that in a matter of minutes, the wind will blow you off and you'll fall to your death. She felt an overpowering urge to call Frank and tell him what had happened, but that would be so weak, it would be sick.
    "If there's anything I can do to help, I'll be glad to," he said. "I'm sorry to have to give you this bad news on such a holiday."
    "Thank you," she said. She picked up her purse and left the Nuclear Medicine waiting area. "Oh my God! This can't be real," she thought. "It just can't be. But it is!"
    She couldn't get over to Oncology fast enough. Not that there would be any comfort there. But just the same, she couldn't wait to get there.
    "My God, this can't be happening," she thought again as she walked down the chalk-white hall toward the elevator.
    She felt an overpowering envy of all the other people here today who would go home to untrammelled futures. They would happily go on living, while she was about to fall into a ravening pit of horror. And now, she began to realize how isolated she would be. It wouldn't be long before people began to write her out of their lives. People might stand by her out of a sense of duty, but now that she had no future, she'd no longer figure in their futures.
    And Anne and Jennifer? Well, they'd be all right. They were old enough to separate from her. And somehow, there went one of her major lifelines. She wasn't really essential to anyone. Suddenly, she felt painfully irrelevant. The world would go its merry way, and her loss would be a drop of water taken from an ocean.
    "What will become of my flowers?" she thought, coming down in the elevator. "They'll die without me!" And somehow, she couldn't get the trivial fate of her flowers out of her mind.
    "The Big Lie," she thought as she walked down the first-floor corridor to Oncology. "We think we're surrounded by Mommies and Daddies we have to please. Comes the moment of truth and we discover they're just a helpless bunch of kids, like us. Nobody really cares what happens to anybody else except insofar as it affects them. We're as good as alone. And we hide the horrors from ourselves, pretend they don't exist, and all the time, they're waiting in the wings to grab us.
    "IT'S SO STINKING UNFAIR! I don't smoke. I don't misbehave, and all around me are dummies running around trying to see how fast they can kill themselves. And they're going to be all right, and I'm going to be tortured to death! It's so damned rotten unfair!"
    Even Christ only suffered for three days.
    She had arrived at Oncology. She heard a calm voice tell Mary Margaret Northington, R. N.,
    "I've just had my bone scan. The radiologist thinks my cancer has spread to my right trochanter."
    She heard Mary Margaret say, "Oh, my!" Then, "Let's get an x-ray of that hot spot. I know your doctor will want it. Here, let me get you a slip to take to radiology."
    Then she was on her way back upstairs.
    There was only one other patient ahead of her in radiology: a scarecrow of a young woman, bone-white, and in a wheelchair. Her arms lay flaccid on the arms of her chair, as though it took monumental effort to lift them. And yet, as sick as she looked, she was wearing a beautiful dress and was coifed like a queen.
    At first, Jeannette was horrified: in another year, it might be her in that grisly chair, feeling weak and sick, facing some hideous "therapy" that would leave her steadily weaker and sicker. Then pity welled up in her like a flood, resounded in her, crescendoed in her, warm in its tenderness, insuperable in its force, until it overwhelmed her and spilled out for herself and for this poor woman and for all the aching world: " O my dear sister, we're the same now, you and I, both sitting in that unspeakable chair. Not for us the grandchildren tall; not for us the Golden Years; not for us the bright, rich plans. For us will be the weed and the wasting away; the terrible grave. And you.. you look so young, with so much life unlived. But it's all gone now.. all smashed to pieces on the operating room floor. And you left alone in this place on Christmas Day. On Christmas Day! How can they do this to you? How can anyone leave you on a day like this? What are people made of, anyway? Is this going to be your last Christmas? And yet, how many times have I walked by your likeness and looked away, afraid for myself?"
    "And seeing you dressed up is more than I can handle. Are you trying to keep a shred of human dignity in your life? Or clinging to some pathetic thread of false hope? Or just desperately trying to bring back a trace of better Christmases? I can't bear to see you living such a waking nightmare.. and having to face it alone! What kind of Christmas will tomorrow be for you? Or for all these other cancer patients?
    "And here I am thinking about no one but me. What does it matter what happens to me? Am I so dear that I should be spared when a million better people are going to be tortured to death? No, I'm a part of you all, and you're all a part of me: we're bound together, how could it be otherwise? How could I walk away from any of you now? So this I ask: not that I be spared but that I live a life worth sparing.. surely, surely, if there's any meaning to life, that has to be part of it."
    An attendent appeared and wheeled the other woman through the double doors for her x-ray, while Jeannette, aloft on a wave of caring, promised herself that she would not slide back into the old ways, but would continue to place these poor others' needs above her own. And all the while, piping and caroling, dipping and soaring, the line from "The Little Drummer Boy" kept echoing through her head: ("I'll play my best for you, tah-rump-a-tump-tum-m-m-m.... Just me and my drum.")
    When her turn came, her rendezvous with the x-ray machine was uneventful. She waited in the now-empty waiting room until her film was ready, then carried it back downstairs to Oncology. The film was taken into custody, and she was remanded to one of the little examining rooms on the right side of the hallway.
    For a few minutes, Jeanette was sustained by her peak experience. But as the adrenalin wore off, the twisting-and-turning-in-the-wind time began. She couldn't help feeling anxious and exhausted. Another half hour passed. By then, she was dulled.
    Suddenly, the door opened. The doctor, a homely, young Indian woman smiled a professional smile at her.
    "Hi! I'm Elizabeth Singh. I'm your doctor today. Dr. Hortabachi is off for Christmas. Let's see," she consulted her chart, "Jeanette Dorfman, isn't it? Well, everything looks good. Your chest x-ray is O.K. and your blood-work's good. I see a 'hot spot' on your bone scan, but other than that, everything's the same as a year ago."
    "The radiologist seemed to think that the spot on the bone scan might be cancer."
    "Yeah, I talked with him. He's a radiology resident. He's not an oncologist," Dr. Singh said.
    "What could cause a positive bone scan besides cancer?"
    "Oh, lots of things. Arthritis. Degenerative changes with aging. Trauma. Have you had any bad falls in the last year? Been in any accidents?"
    "No, I haven't. And I don't have arthritis. Why would I have a positive bone scan this time when I've never had one before?"
    "Old age!...not that you're old of course!...I can see old age isn't it!" (The young doctor looked embarrassed.) "Actually, bone scans are very sensitive. What they pick up is vascularization...that is, places where the little blood capillaries grow. That causes the radioisotopes to be taken up, and shows up as "hot spots" on a bone scan. All kinds of things can do it. Bone scans'll pick up arthritic conditions long before they cause any symptoms. I've got a "hot spot" in the cervical socket at the base of my neck from sleeping on a fat pillow. And, of course, bone metastasis is another cause. But I don't think so. Your blood-work looks very good...unchanged since last time,...and your chest x-ray is unchanged. Since your x-ray and your bloodwork are unchanged, the chance that your positive bone scan reading is caused by metastatic disease is less than 20%. Of course, I could be wrong. We'll try another bone scan in ... let's make it six months. In the meantime, try to enjoy yourself, and try not to worry. I know that's hard to do, but the odds are in your favor. Definitely in your favor. In the meantime, if you experience any symptoms...any symptoms at all...don't hesitate to call us. That's what we're here for."
    "You don't think my cancer's come back?" said Jeannette.
    "No, I don't. Of course, there's always a chance I could be mistaken, which is why we'll schedule another bone scan in six months.. But I don't think that spot is cancer."
    Doctor Singh started out the door. Then she stopped, smiled, and said "And have a very, merry Christmas."
    "Oh, and a very merry Christmas to you, too!" Jeanette said, trying not to laugh out loud. She put on her clothes and left the examining room. But there was one thing she still had to do. She stopped at the front desk.
    "Sue, when I was upstairs in Radiology, there was a woman in a wheelchair waiting to get her x-ray taken. I think she was a cancer patient. I think she had a wig on. Do you know who she was?"
    "Was it a black wig? Did she look pretty thin?"
    "That's right. She was all dressed up." (Jeanette couldn't bring herself to say "She was all dressed up for her last Christmas.")
    "That's sounds like Mrs. Furnace. She has Hodgkin's disease. She'll probably get well. The cure rate's about 90%."
    "Really, Sue! Oh, how wonderful! Oh, that's just wonderful! Thanks, Sue. I hope you have a wonderful Christmas, too!" (And now, her heart was truly, truly singing.)
    As she walked down the hall, it began to sink in. She was free! She was free to go home! She was free to enjoy Christmas! She was free to care for her flowers! She was free to live! She would live to see her grandchildren! She could hardly keep her feet on the floor. And then, on her way to the parking lot and home, laughing and crying, half-skipping, half-flying, she stepped out the hospital door, as all the bells on earth did ring on Christmas Day in the morning.