And, in the Pandemic in Manhattan, the Tears Came
A short story à clef, adapted from “Briggs: Love, Cancer, and the Medical Profession” and reset within NYC’s first lockdown
One Saturday morning, Sterling and I were walking hand in hand as usual, when we passed a crying toddler outside Joe’s Pizza on Carmine. Sterling suddenly pulled to a stop to look him in the eye and said, “It only gets worse, Kid.”
Seeing her big blue eyes looking at him and hearing her mellifluous voice, he of course stopped crying. Sterling could cut through anything until it came to her cancer treatment. Even when she was diagnosed, she skipped down Fifth Avenue singing, “I’ve got cancer. I’ve got cancer.”
She was due for her next chemotherapy but she was in bad shape from the side effects of a pain drug. We both thought the trip would be too taxing. She called and left a message that she needed to postpone it.
Within half an hour the oncologist’s nurse called. She said he was insisting that she come in because he was going away for two weeks. He wouldn’t schedule it in his absence. If she didn’t, she’d have to wait till he got back. That would mean over a month since the last one, and it was already on our minds that coronavirus restrictions could soon start delaying her treatment.
After we moved back from L.A., how happy we’d been to find a top-floor apartment in exactly the part of Greenwich Village we’d wanted to live in when we were first dating. Not that you dated Sterling. You got to hang out with her. Now the stairs in this nineteenth-century building were too steep for her to manage. I had to carry her down the last three flights.
By the time we got to the hospital, she was worn out. When she went in for her “bloods,” as she called her check-ins, her heart rate was 140. Normal is no more than 100. They called the oncologist’s nurse. The oncologist wanted an EKG. We had to go up to another floor.
When the results weren’t good, Sterling said, “My heart’s racing because he made me come in,” and the woman laughed. She told Sterling to just lie still and breathe slowly for a while and she’d do another. That worked. We went back down to deal with this doctor, one of the foremost oncologists in his field.
It was obvious to even him how weak Sterling was from the drug reaction and losing weight. He started off by saying he would reschedule her for early the following week with a covering oncologist. So we had come in for nothing. He had also needlessly put me in a hospital environment, where I could pick up the virus and infect Sterling with her chemo-suppressed immune system.
He started in on a drug he wanted to add into her treatment, a monoclonal antibody. I reminded him of our previous visit. I had said I thought I remembered from my research that there were infusional reactions with it. He said there weren’t. I had since checked and there were. Incredibly, he said, “Yes, but” and launched into a specious counter of why they didn’t matter.
Sterling had begun making notes to help other patients and caregivers. One of them was, “How can you make decisions if you have no confidence the information you’re given is correct?”
Our discussion led nowhere as usual. He refused to concede the dangers, including stomach and intestinal holes.
Sterling again raised the prospect of an immunotherapy I’d found in my research. Alerting the immune system to a colorectal tumor protein, it brought complete remissions in stage IV patients in its very first trial. An international pharmaceutical company, which marketed chemotherapy and related drugs, had bought the rights, then let it sit. He had a relationship with the company.
Sterling asked why it couldn’t be an option to pursue. He reflexively raised his voice, caustically telling her she wasn’t going to get it. As I stood up, Sterling caught my eye with a contained motion of her hand. A friend of hers had used her connections to get her the best of care. It killed me to let it go but I did. Saying nothing more, he left the room.
I said, “That’s it, isn’t it? Don’t we have to find someone else?” Sterling said, “Yes. I don’t want to see him again. I can’t believe we have to leave because of him. But we have to.”
We had thought this hospital was paradise compared with the one where Sterling started her care. If I had said something, I may well have brought up two clinical trials I’d found using a treatment regime of his. They’d been interrupted because of death rates incongruously five times higher than he’d reported in his original study.
It was best for Sterling given the circumstances but I know afterward she’d have felt satisfaction that in front of her, and on behalf of how many other patients who’d suffered at his hands, he’d have known how it felt. Satisfaction doesn’t begin to describe how I would have felt doing it.
When we got back to our apartment building, we stopped at the encased radiator in the lobby for Sterling to sit a minute. I could see she was dreading going back up the stairs. I said I was going to carry her back up and there was no point in objecting. She just said, “Alright.”
It was good to be able to do something for her physically, and to have her in my arms and smiling at me. She loved telling people who called later that day that I had carried her “all the way back up to the sixth floor.”
We had set an Off-Broadway play of ours in the same part of Greenwich Village we were now living in. It was about a journalist and a suffragette going up against a presidential aspirant in the three weeks between the Russian Revolution and America’s entry into World War One. On the back of it, we were hired to write a fact-based screenplay in L.A. While there, we also made a film. That night I got a call from the production manager on it.
He’d become a friend. His parents had both died of cancer and now his grandmother had died of Covid-19 in a nursing home. They were close, and he was struggling with his grief because she was infected after a New York State executive order had resulted in Covid-positive seniors being transferred from hospitals to her facility among others.
He asked if we could afford to lend him money for funeral expenses. He’d had work lined up on a Hollywood film but it was postponed because of the virus. He said he could start paying us back as soon as it went into production. I said I’d send it to him, and to get him away from feeling embarrassed I put Sterling on for them to chat. It was good to hear him immediately start to make her laugh.
While they talked, I looked into the evidence, or lack of, for all I’d been reading and hearing about the virus, projections, precautions, testing, and treatment from journalists, politicians, experts, and celebrities. Well-meaning or not, various aspects didn’t ring true to me, nor a new crop of analyses with an obvious agenda. The most egregious claims reminded me of Charles Darwin’s “Ignorance more frequently begets confidence than does knowledge.” Sterling asked her usual incisive questions about each study I found, and we were both glad to have a clearer perspective.
I spent the next few days looking for a new oncologist. I finally found one I thought might be right for us, at a major New York university. He had found elevated risks of lung and esophageal cancers following breast-cancer radiotherapy and was conducting research into societal aspects of screening and treatment. He was also head of the alternative medicine program. Sterling liked what she read and I called to make an appointment.
My heart sank as I was told he wasn’t taking on new patients because of the coronavirus. We might not be able to switch to any other oncologist. I got a direct number for his office and handed the phone to Sterling. I said, “Everyone loves your voice over the phone.” Sure enough, his assistant gave her an appointment.
The office was like a left-over, if large, room. The oncologist’s face and demeanor and rough-around-the-edges clothes fit the image of what we’d read about him. We exchanged smiling hellos and sat while he looked over Sterling’s records. He took quite a while. When he ultimately looked up at Sterling, he said very sympathetically, “You’ve been through a lot, haven’t you.” I could see Sterling was moved by it and I took her hand.
For almost an hour, we talked about every aspect of her condition. I brought up the immunotherapy, thinking he’d know there’d been a promising renal-cancer trial of it at this hospital. He didn’t, but he wasn’t threatened by my informing him of a study in the department he himself headed. He jumped on his computer to look it up. Another good sign.
I’d said to Sterling one day that doctors can only be as good as their personalities allow. His was difficult to pin down. He thought it wasn’t such a bad policy that the other hospital prohibited switching oncologists. Before I knew that, I’d wasted time finding another one there; an advocate of immunotherapy.
A bigger clue I curse myself for not keeping firmly in mind the next day had also worried Sterling. When we talked about the gastrointestinal-hole-causing monoclonal antibody, he said almost flippantly that he probably would have suggested it too. It was additionally linked to strokes and esophageal fistulas. He was saying that after having pored over Sterling’s severe drug reactions.
I cited its limited potential benefit versus the mounting evidence of fatalities. We sparred over other issues, Sterling occasionally interjecting, but not her usual self. Each time he was more stimulated than anything. After a last, fairly intense discussion, he paused, looking at me, and said, “It’s frightening what you know.” Then he smiled. Sterling and I did too.
With that, he got on the phone. He didn’t want her to miss her schedule. She was due in two days’ time. There was a slot available the next day and then they were going to close the chemotherapy suites for a few days. He didn’t explain why. We agreed that a day early was better than waiting.
The next morning, we took the long subway ride again. It was easier on Sterling without the tunnel delay we’d had the previous day but she hadn’t had time to recover. The travel, registration, tests, the waiting, even the strain of the long consultation. She was tired walking from the subway to the hospital.
The security staff weren’t welcoming. In fact, they made you feel like you were trying to get away with something just by being there amid the coronavirus concerns.
The staff in the chemotherapy suites were better but, as with the oncologist, rough around the edges. They weren’t quite paying enough attention.
Sterling got a corner, fairly roomy curtained-off space. Her male nurse was amicable but offish, maybe heightened by the mask he was wearing because of the pandemic. It was rumpled, and he had on two different-colored gloves. Either way, it was a step away from the cheery professionalism at the other hospital.
Then came a surprise. The oncologist came striding in and over to us. He had coffee and I think a bagel in a paper bag. He was friendly as could be. When he put down the bag, he said to Sterling, “That’s mine. Don’t touch it.” So of course Sterling touched the bag more than once while he was talking.
She looked so happy that he was there. What a difference from the other oncologist, I was thinking, that he would take time to come and see her on her first chemotherapy.
We chatted enjoyably, mid-morning wit abounding. He made a clever play on words about a coronavirus banner that the university-hospital had up outside the window. Mentioning our being in theatre, he talked about tickets his wife had bought for a Broadway show. It was shut down. It would be a symbol of getting back to normal once they could take their two children to it. I knew the director. He didn’t think they’d be in a position to reopen, but I didn’t want to spoil the mood.
Then he said to Sterling, in the most portentous moment of her treatment, that he’d been looking over her records. He wanted to add in a drug for her anemia.
I was impressed that he’d put in that effort after we left, but I was immediately uneasy. He began saying what the drug would do for her. I asked, as I had at the other hospital, if it was an erythropoietin-type drug. He said it was. We had already refused a different brand of the same thing.
Sterling and I glanced at each other queryingly. I tried to be diplomatic. I said I “thought” they could be dangerous, when I knew they were. He said it would give Sterling so much more energy. She was functioning on just over half the level her hemoglobin should be.
In my twenties, I’d written articles on nutrition. We’d been able to slowly raise Sterling’s hemoglobin with broken-cell-wall chlorella, algae, when it normally goes down with chemotherapy. Her level was more like two thirds.
I said, what about side effects. He had the gall to actually reply, “What side effects?” As if any drug doesn’t have side effects. I said I knew these drugs were causing deaths when patients’ levels were increased to greater than 12 with them. He said we wouldn’t be going anywhere near that. He emphasized again that Sterling would feel such a huge difference in energy.
In retrospect, and this sickens me, that didn’t make sense. She needed to go from her current 8.6 to indeed somewhere near 12 to see a huge difference. Working against us was that walk from the subway. I think partly out of not wanting to offend him, Sterling said it would be nice to have more energy. A rare quiver of pathos in her voice was fleeting but it went through me. When one of us was in distress the other felt it to the core.
We needed to keep him on our side. I was also conscious of having left two hospitals. I was having to worry how we were perceived while trying to save Sterling’s life. With the pandemic added in, our options were dwindling if we didn’t seem pliant.
I couldn’t not ask a second time about side effects. A touch of impatience crept in at my pressing him. It would make her feel better; there was no downside. 8.6 was still a long way from 12.
Sterling was looking at me. I said did she want to get the one injection to see how it went. She said it seemed like it would be worth trying.
Once we’d acquiesced, he relaxed and chatted a minute or two more. Then he suddenly picked up the paper bag and pulled an abrupt professorial exit to add in the injection. If only it had come into my mind how cavalier he’d been about the monoclonal antibody. My own underlying exhaustion was coming to bear.
That evening after the treatment, Sterling experienced shortness of breath. By morning, she was unusually drained and had no energy for even small tasks. The trip back up for the chemotherapy pump to be disconnected was every bit as hard on her as it was unnecessary. At the other hospital, I’d been given fifteen minutes’ training and kits to disconnect it myself.
We asked the nurse if she had experience with the anemia drug. Sterling told her what had been happening. The nurse just shrugged and said no. With so many less patients getting their treatments because of the coronavirus, which may have been behind the few days’ closing to reassign, or maybe furlough, staff, her focus was on leaving as soon as she was finished with Sterling.
In fact, she was gone before we’d gathered our things. We let ourselves out of the chemo-suites area. At the hospital that we’d in effect been forced to leave, if a nurse hadn’t known about the anemia drug, she’d have more likely said, “Let me find out for you if those symptoms will pass or if they’re a bad sign.”
The oncologist wasn’t in that day. There was every chance he’d attribute the symptoms to the chemotherapy or cancer anyway.
I began looking into it myself and found a damning report within twenty minutes. Several studies on the one we’d refused at the other hospital had been halted. Patients were developing a higher-than-expected number of blood clots. The FDA called an emergency meeting after five randomized trials of these drugs demonstrated decreased survival time. A ‘Dear Doctor’ letter went out, which both hospitals’ oncologists should have read.
By the end of the weekend Sterling was worse. On the Monday, we decided she should call the oncologist’s office. His assistant said she’d tell him everything. She called back to say he didn’t think Sterling needed to come up; that we should wait and see.
Throughout that night, I kept waking up to check on her. Come morning, she had a severe case of oral thrush. Her throat and the sides of her mouth became swollen. A blood clot developed in her left leg. The day after that she was so lightheaded, and now experiencing severe shortness of breath, that we called 911.
By the time the paramedics came, she’d lost consciousness. She had to be given oxygen and saline. As she was coming around, the senior of the two paramedics told me she was out of danger and they weren’t going to take her to the hospital. He said she would die if she got infected there and they needed to be available for Covid-19 emergencies. He thought he was doing the right thing but he was basically giving us no choice.
They left and I carried Sterling into the bedroom. I made her comfortable on the bed. She was half-sitting against the pillows so I could try to feed her but she could barely get anything down.
I said, “I’m so sorry I let this happen to you. All I ever want to do is protect you, to keep you safe.” After a few small teaspoons-full, she started to raise her hand, I thought for me to stop. Then she put her hand over mine and said, “I never thought I would love someone so much as I love you.”
I smiled at her as I put my other hand over hers, a smile of loving admiration at how she could always surprise me. I couldn’t even kiss her in case I might be a silent carrier of the virus.
I had gone out and bought garlic tablets as a natural blood thinner, and nattokinase, an enzyme isolated in Japan that could dissolve the clot itself. The typical drug prescribed doesn’t.
The health-food store was in shutdown. Luckily the owner was culling out anything passing its expiry date. Sterling and I were regulars, and he knew about her condition, so he had let me in. I also got some homeopathic candida yeast and it was beginning to get Sterling’s oral thrush under control.
She ate a little here and there in the following few hours, resting, and then needed to go to the bathroom. She couldn’t put pressure on her leg with the clot, so I helped her through and in. I said, “You’re okay?” and she nodded and answered, “Okay.”
A minute or so later I heard things she kept on the windowsill hitting the floor. She had blacked out and fallen. I gathered her up and stood there, not knowing what to do. I was unsteady on my feet from lack of sleep. The only thing I could think was that I had to get her to the nearest hospital. It was half a dozen blocks away; the one where we’d started her care.
I couldn’t wait for a cab even if I could get one, and I knew there’d be none to hail. The roads were empty of traffic. I went straight out the door with her and down the stairs. As I turned onto the first landing, I said softly to her, “Don’t give up, Darling. Keep with me.”
After all the stairs, I had to stop once I got to the street. I leaned against the front of the apartment building for ten long seconds, willing strength into my arms before heading for the avenue. There was hardly anyone in sight as I turned onto it, as Sterling and I had so many times before, hand in hand.
After two blocks, I felt the weight of her in my arms change. I knew she had died but I couldn’t bear to look at her. I kept walking as fast as I could.
At the emergency room, there was another problem with security. I didn’t have a face mask. Normally I would have set him straight. Instead I heard the fatigue in my voice as I said incredulously that I wasn’t coughing or sneezing. I think the other guard was about to tell him to back off, when a nurse stepped in and pulled me past them.
More time was lost when a resident stepped in on her. Feeling for a pulse, he said Sterling was clearly a Covid case and they had to conserve their resources for patients who could survive.
I said I’d looked up what she was given and every side effect, beginning that same day and including this, was listed by the drug company. He said no, he knew the “look” of coronavirus very well and that I may think that but it was just coincidence.
The nurse had meanwhile brought over a doctor she knew would help. A team was soon trying to revive Sterling. It didn’t last long. With the delays, and all her resilience having finally been driven out of her, her last chance was gone.
They left us alone for ten minutes. I must have kissed her a hundred times.
I had to fill out paperwork. Then I did the hardest thing I’ve ever had to do. Leave her there.
Crossing the street from the hospital, I came to a stop in the middle of the road and said, “Sterling dead. Sterling dead.”
I walked down past Washington Square Park. We would often sit on the side of the fountain, hashing out characters or plot points as we looked up through the arch at the Empire State Building.
I kept walking for hours, down past City Hall, where we were married, to the tip of Manhattan. As the view opened up, I caught sight of a parked patrol car. Backing away, I headed over onto dimly lit streets in the desolate Wall Street area to avoid any other cops policing the lockdown.
When I got back to our building, I looked at where I’d leaned against it. Getting out my key, I thought, “She’ll never walk in here again.”
Up in our apartment, I poured a bourbon. I hadn’t had a drink in a month. I couldn’t know when I might need to be clear-headed.
I looked at our armchairs. I didn’t want to sit in one without her. It was midnight. I went in and sat on the side of the bed — and there was her wedding ring. She had taken it off because of swelling in her fingers. It’s a slim $20 wedding band. We’d bought it in a jewelry store in downtown Las Vegas. We hadn’t bothered with wedding rings when we got married, but Sterling wanted to discourage men from hitting on her while we were in the casinos. So we bought one from a guy named Cy.
I hadn’t yet shed a tear as I picked it up and put it in the palm of my hand. I said, “How you loved that twenty-dollar ring.” And the tears came. Soon it was like no crying I’d ever heard. After I got into bed in my clothes, the crying went on for hours until I fell asleep. More tears than I’d shed in the rest of my life. It kept on that way for three days.
When Sterling’s death certificate came, they had listed the cause as Coronavirus Disease 2019. The resident no doubt had something to do with that, facilitated for him by a City directive to include any “probable” case in the death toll.
In a cruel irony, the societal effect of the virus had allowed him and others to contribute to Sterling’s death. I stared at the certificate for the longest time, remembering all she’d been made to suffer.
A month later, when I could bring myself to look through the notes she’d been making, I found one that broke my heart; what there was left to break: “I didn’t think one person had this many tears.” She had cried alone for fifteen months. She had somehow managed to never cry in front of me.
