I remember watching the world series of poker on television with my mom. Our whole family are game players, the kind of family that plays cards after dinner, closets full of board games, cards, backgammon, chess, checkers, go, you name it. My kid sister learned poker at age 8, and later held her own against our dad, a theoretical mathematician who effortlessly counted the cards and probabilities. Mom taught me how to bluff before teaching me how to ask a girl out. In life, my siblings and I are negotiators, and spot zero-sum games from a mile away, and yes, if you're on the other side of the table, we will take your money if you let us. My fiancee isn't a game player, and can't understand why I don't throw games and always play the best I can: what kind of mensch throws games? Dad never did, and it took me 12 years of playing to win my first game of chess, and that's that. But who knows from rude? We're Long Islanders and half chinese and half jewish, or to quote one friend "you're jewish, so you think you know everything-- but you're chinese, so you do." I stared down some famously cruel venture capitalists in the board room, and they flinched, apparently something that's "just not done." But I do know this: people respect you, and that counts for something. But this story is not about respect, poker, or being a Long Island jew living in northern California. It's about watching my mother's brain surgery.
The story starts in December 2002, when mom collapsed while kibbitzing with a friend on the phone, and was rushed to the hospital for emergency surgery to remove a hemorraging brain tumor. In the weeks that followed, we learned that she had glioblastoma multiforme (GBM)-- one of the most aggressive forms of cancer on the market today, with 1% of patients living a year after initial diagnosis. We'd been through this before: dad died of colon cancer back in '97, after two years of the wretched ups and downs. So the mechanics are straightforward: health care proxies, power of attorney, setting up an email list to communicate with extended family, long talks with my two siblings and family about how we want to make decisions, dealing with money and of course, the endless doctor's appointments and logistics of getting everybody where they need to be and when.
First deborah took a year off from medical school to live with mom, an arrangement everybody hated-- seemed like classic mother-daughter cat fights, with the added stress of boredom moving home from the intensity of a top-20 med school. Mom remained the trooper through rounds of physical therapy, speech therapy, occupational therapy, a low-carb diet to better control her diabetes, two rounds of radiation treatments and one round of chemo pills, she only had slight nausea, barely puking even once. We all learned to inject insulin, the rising blood sugar levels an unfortunate side effect of one of the drugs. At one point, she was taking 28 pills per day, but not only took them religiously four times a day-- kvetching the whole time, let me tell you-- but she even insisted on refilling her own pillbox, over a hundred pills a week which she kept straight, even as she struggled with short-term memory loss, confusion, walking problems, loss of driving privilege, and on and on.
But miraculously, the final radiation treatment knocked the disease into remission, an increasingly common result as the doctors improve treatment options. Around the same time, mom's best friend on Long Island moved away to get married and start a life with her new husband in Arizona. I got the call: mom wanted to move back to Berkeley, where she'd lived in the early 70s, and where I had a cute house she loved, and which allowed her to walk to the store. In my family, "shopping" means groceries, not clothes. I could start living full-time out of the Santa Cruz house my fiancee and I bought a year ago. I negotiated a clean exit from the technology company I'd founded three years before, and which had my name on the door. It was my turn.
The move went fine: mom never liked flying but she did it unflinchingly. Her 60s furniture unfortunately survived shipping, and we put her house on the market. You know she's desperate when she sells a house into a down market: we only sell low to cut losses. Mom made the adjustment, quickly making new friends with neighbors, learning her way around the hood. There was even a "senior center" up the street, and while at 62, she resented the association, she appreciated the nearby company. Deborah graduated med school and got a residency at one of the top pediatric hospitals, Oakland Children's Hospital, about ten minutes from mom's new house. She'd be working eighty hour weeks, but at least she'd be close enough to do dinner and could help in a pinch.
All the while, mom got MRI exams every three months, each one giving her another lease on life. Carol and I vacationed to Europe without event. We all traveled to Deborah's graduation ceremony in New York City. Jason came out to visit, as did other friends and family. Mom replaced my housecleaner, then hired a gardener to landscape the yard. Eventually, she got tired of my furniture and had it shipped to Santa Cruz over my own kvetchings. My fiancee and I planned our wedding. Just in case, we moved up the date from February'05 to October'04. Even if mom was alive, who knew if she'd be in good enough health to enjoy it?
The ides of September brought the end of my summer consulting gig, which meant the craziness of a job search while Carol planned our 200+ person at-home wedding. Then the bomb dropped: two weeks before the wedding, mom's latest MRI showed that a new, rapidly growing tumor. The prognosis was even worse: when GBM recurs, patients have few treatment options, none particularly effective. If she's lucky, she's got a year. Radiation treatment would help and the new tumor wasn't in an area of the brain where the treatment would further disable her. Doctors would need to insert bolts into her skull in a separate treatment prior to the radiation, so that her body could be bolted to the table. The whole thing sounds like early lobotomy operations: they're blasting away at sections of the brain without really understanding how the thing works. But the doctors are moving like lightning, going from diagnosis to surgery in a week, a fact I appreciate knowing that GBM tumors can double in size every two weeks. She's going into surgery 3 days before the wedding.
So now I'm in a small room in a strange hospital, one of the assistants nervously waiting with us for the neurosurgeon, failing at her attempts to hide her knowledge of mom's prognosis, a lousy poker face. The doctors enter, curtain drawn, and the neurosurgeon unfolds his prepackaged surgical kit. I'm two feet away, with the tools on the table mere inches from my face, the minutes ticking by, waiting for this guy to pick up scalpels and an eight-inch, hand-crank drill to cut into my mom's head, her staring back at me under only local anesthesia, looking for support when the disease is terminal and her condition worsening, and this procedure isn't hope, it's a delayed inevitability. It's about watching the doctor slip 6-inch needles into mom's skull to apply the anesthesia. It's about bluffing the woman who taught me the game, not flinching when the gauze accidentally falls to the floor, revealing the mass of blood on her shaved skull, small drops of blood falling onto her uncovered sweater. I'm putting on my best poker face, the one I normally reserve for venture capitalists looking at my face to see if my company has another funding option when we don't, the one I keep in reserve to look cool when friends hired a sexy dancer for my surprise bachelor party, the look George Bush tries on when John Kerry assaults his handling of the Iraq war, the look Alan Greenspan practices in the mirror before announcing the Fed's latest inflation move. This is the look CEOs give to the press when they're being fired by their board of directors, saying they're resigning "for personal reasons." This look is used all over the world by husbands gazing into their wives' eyes as they experience the birth of their first child. Pilots flash this look in the moments before the plane goes down. The captain's face on the Titanic, trying to manage an orderly exit.
No amount of botox freezes your muscles enough to replace years at the poker table, your own flesh and blood staring you down at the river-- you don't have the full house, I changed your diapers young man, I know you don't got shit, and I'm taking your chips so you have to do the dishes-- keep playing like that, and you'll be doing the laundry too. Only after years of practice can you bluff her, it starts as a teenager, when you have a lot more to hide than a full house, but even then she may not know what you got, but she knows when you got it. That's why I finally won a game of chess in grad school; only then could I hide the fact that I got dad, his attack on the left wouldn't happen as fast as mine on the right, too late to defend by the time he figured it out. He misread my fake-fear face.
The need for this look happens suddenly: you don't have time to practice in a mirror. I'm convinced people spring it on you because it's more likely you'll flinch. Here I didn't realize that I'd be in the room for the procedure. Here I didn't want to believe that skull drilling happened without general anesthesia, or at least laughing gas or something. Here I didn't realize she'd be sitting up. Here I didn't want to believe that a guy would actually pick up a hand crank drill and stick it on someone's skull, let alone my mother's. Here I was still living the fantasy that her cancer was in remission, jolted back to the reality of her imminent mortality. Here I relived the fear of losing her like I lost dad, only this time there's no parents or grandparents left to share the burden. That her life will soon be distilled into our three lives, some photos, a bunch of papers and memories. She's only 62 and I'm 33, too young for this, can't be happening. My brother, sister and I can't use mom as a crutch to stay in touch.
But I'm trying not to think about these things right now. I'm reciting the names of baseball players, nevermind that I'm not a sports fan. I'm trying to remember my schedule, like anything else has priority, even my wedding. I'm trying to guess whether I'll make a job interview in a few hours, or have to cancel. Basically, I'm digging hard for a place where I can be the strong one like everyone expects, living up to the myth of the eldest son. I'm feeling around for the right expression that's not scared, but not stoic. And I can't use the usual trick of overdoing it-- a shit-eating grin makes no sense during surgery.
Then I recall the World Series of Poker that mom and I watched on TV. These guys are playing for small stakes-- $100,000 a hand of other peoples' money, big deal. TJ Coultier, I'll see your emphysema and raise you a brain tumor. You all in? Didn't think so. Next victim. Oh no: it's Analee Sah. She's got no fear at all, charming the nurses with her accent and sprinkles of yiddish. Now she's upping the stakes, the crazy old lady asking for a hand mirror so she can watch the surgery for herself, dropping jaws around the room. I fetch the mirror like the good son, diverting my eyes from hers, hoping that alone doesn't give away anything. I find the best look I can find, and put on the mask. How'd I do, mom?
October, 2004. (unpublished)
© 2004 Adam Sah. This copyright pertains to all text contained as well as to material referenced from this page. Reproduction requires written consent of the copyright holder.