Tuesday, May 6, 2008

Stigma, Stigmata


I felt like someone twice marked for assassination. Two days before my 45th birthday, I underwent a triple heart by-pass operation. Not even a year later, or exactly six months and two weeks after my by-pass (26 February 2007 to be exact), I was diagnosed with colon cancer.

Rare is the man or woman who receives a cancer diagnosis with calm aplomb. For me, it was like hearing an airport announcement asking me to board a flight when in fact, at my age, I was not even near the departure lounge. My mind zoomed in all directions like an independence day firecracker exploding and careening into a kaleidoscope of clich├ęs, a series of Sisa emotions (“Basilio? Crispin?!).

At first, I noticed a heightened, paranoiac observation of the ordinary. Eating was no longer just a meal, but maybe “my last meal”. Talking was no longer just a conversation, but the possibility (in the future, with people informed by hindsight, gathered at the wake) that it was my “most important last words”. This thought pressured me into uttering pronouncements more substantial than just, “Please pass me the patis.” Waving good bye to a friend—a seemingly
ordinary action learned by a baby’s innocent act of mimicry and repeated over the years in the course of socialization—suddenly acquired spine-tingling nuances. Even a usually innocuous phrase triggered a slew of ironies. Consider the standard: “See you later, alligator”, which at other times would have been sweet and endearing. To my mind, it echoed the following simultaneous translation: “see you later…don’t forget the Mass card” (when saying it to my friends). Or “see you later…in hell!” (when addressing people I didn’t care too much about). But surprisingly, other than the morbid, I discovered that intimacy with death had another emotional but familiar effect.

Twice confronted by death’s proximity, I awoke to a world transformed into an inimitable, precious, and fragile place—what poet Rolando Tinio aptly described as a “crystal universe”—where everything takes on the nature of a very shiny, rainbow gilded, breakable soap bubble. Colors became so intense, it bled into the outlines of figures. Each day burned into my mind vivid, sensoramic, technicolor memories. I became ecstatic one moment and then sad the next. Fear and hope kept competing for my attention. And I took every opportunity to claim or reward a hug. You might be familiar with this feeling—the first time you took ecstasy… Or so they say. If people didn’t know about my medical condition, they could have sworn I was acting like a teen-ager in love and so wanting to get laid. Could this be the reason why the French refer to an orgasm as la petite mort, the little death?

Having cancer has become so prevalent in the modern age. In my close circle of friends, Mimi, Rose’s mother and I were each diagnosed with a different type of cancer within three months of each other. Much can be said about the cause of cancer. But as to its effect, I hazard a guess that if having cancer were an art form, critics would have officially declared it as an exciting genre. Like the Japanese horror movie, your favorite telenovela, or performance art, the middle class cancer story has evolved its own defining set of expectations and common narratives. For example, no cancer story is complete without the character of the doctor, with the CT scan plates in front of him who, trying to be clinical but failing, fiddles with his eyeglasses before uttering the sentence with the C word in it. A cancer narration lacks a sense of the real without that important family breakdown scene where—in the silence after the news—the lumpen cousin who lives with you tries to be helpful by asking, “Are you updated with your insurance premium payments?” I have heard no cancer story without the usual prayerful friends, doting relatives, or the incompetent resident who is unable to properly insert an intravenous needle. My favorite, of course, is the timely appearance of the mysterious donors who come to the rescue in the nick of time to contribute to the payment of, at least, the first set of medical bills. I guess they wish to remain anonymous because they don’t want to be approached a second time. All these have become the stock and shock in trade of the genre. I am pleased to have made their acquaintance, mannerisms and all.

Once, in the many times that I found myself waiting in a doctor’s office, I would read an article in one of the dog-eared magazines proclaiming that cancer is one of the top three causes of deaths in the world. According to the Journal of Cancer Medicine, the total number of lives claimed by all types of cancer has risen since ten years ago. Moreover, new and baffling cancers are being discovered every year. On the bright side, the advances in medical research has somewhat dulled the dread previously associated with the disease. Nowadays, there are more and more cancers thought to be curable by one drug or another.

As early as the time of Sir Isaac Newton, the human body has been viewed as a living system of cogs, levers and springs no different from any of the machines being invented during that time. Mainstream medicine’s curative philosophy has not drastically changed over the years. In fact, this view has been strengthened by the development of chemical, electronic and radiologic technology that has made it possible to read the human body down to its molecular level. Medicine has inherited the love of surgery from Newton’s view of the body as a mechanical apparatus. If something does not work, the best way to deal with it was to bypass it or excise it. In modern practice, this could easily be done through the slash of scalpels, burning of lasers, or the poison of drugs.

Sadly, most people in the third world who have curable cancers lose their life’s savings paying for the cure. More often, when given the choice of saving one’s self or ensuring the survival of a family, heroism becomes the better option as people make ultimate sacrifices. And for those who don’t have the resources to begin with, faith can be the only medicine.

Manang Celi, for example, is our neighbor’s labandera who thinks she has cancer. Six years ago, she experienced stomach cramps that she explained to herself, at first, as signs of hunger. When one has six kids and an absentee husband, skipping meals can be a daily habit. She hid her perennial diarrhea from her employer for fear of losing her job. At the instigation of a cousin, who worked as a janitress at the Philippine General Hospital, she underwent several medical tests. But the findings on her case remain sealed in a small envelope inside a bigger folder kept in a steel filing cabinet in one of the cramped offices of the hospital’s laboratory department. For lack of resources—like someone who doesn’t have enough cash to retrieve the earrings that were pawned—she remains unable to get the results of her medical tests released. She has tried every ruse in the book (from petty bribery to tears) to get the mousy attendant to let her take a peak at what the medical technologists had to say about her bloody and watery stool. But the attendant remained implacable and as cold as a surgical table: “No cash, No test release.”

To this day, when the cramps come visiting, Manang Celi still doesn’t know what causes them. She finds some blessing in the fact that her medical condition is as ambivalent as her sources of income. To her, the vagueness of the future is not a dark and strange place, but a cozy limbo where she can afford to hope. For now, the only liquid currency that she can exchange is prayer. She attributes the lessening of her pain to the six years invested in Friday visits to the Senor Nuestro Poong Nazareno, the Black Nazarene in Quiapo.

The knowledge of a possible impending death—unlike the suddenness of an accident or the vulgar directness of a coronary thrombosis—brings with it a haze, a stage presence, an attraction we reserve for the mysterious. There is an unavoidable grandiloquence about it, like the sound of a lone snare drum announcing the silent shuffling of a funeral cortege. It brings to mind an 18th Century European opera end-of-Act-II moment, say, where the courtesan, in the height of her beauty, coughs her lungs out and produces a speck of blood on her white, lace handkerchief. Instantly, she and the audience recognize this code: the tuberculosis has set in. Referred to as consumption, it was a disease as romantic then, as some forms of cancer are now.

Cancer, unlike a miracle, can be explained. Nature is sustained by a balance of death and regeneration. The human body is no different. Cancer develops when human cells divide and regenerate unhindered, resulting in the development of a mass or a tumor that upsets the balance. Passages are blocked. Internal organs are displaced. Cancer is regeneration gone haywire. The current treatment for cancer generally involves excising the over-developing cells and then nuking the remainder by way of chemotherapy. Taking chemo is like ingesting controlled amounts of poison. While chemotherapy kills cancer cells, the healthy cells are also damaged, maimed or debilitated. This is why in the process, the body’s immune system gets severely jeopardized. The body of the patient undergoing treatment literally becomes a battleground. It is like a mopping-up operations being conducted by a berserk military where the insurgent is killed along with the innocents.

The inner war is outwardly manifested by a body in decay. I’ve observed that people, after knowing that I’m on chemotherapy (instead of being mortified by signs of putrefaction) generally seem to develop an interest in the degeneration of my body. Am I losing my hair? Do I experience nausea and fatigue? They examine my extremities darkened by the burning happening in the molecular level. They raise their eyes in child-like wonder at the slow and ridged growth of my nails. They look closely at the growing pallor of my face. Cellular division in my body slows down having the effect of thinning the epidermis on my face. My skin develops a new smoothness, exposing fine veins close to the top, coloring my cheeks to a nice blush. Visitors declare that I “actually look good”. I am reminded of tourists admiring the red-orange
brilliance of the Manila sunset without knowing that the spectacular color owes itself primarily to the high level of pollution trapped in the sky.

Optimistic comments on the way I look have been repeated to me several times with so much conviction by hordes of clueless people that it has made me wonder whether my pessimism is a natural reaction. They probably think that happy thoughts will result in early convalescence. (I make a mental note that if ever I become rich enough, I’ll build a cancer hospital that looks like Disneyworld.) All of them invariably end their visit with a firm clasp, a hug and an offer to pray for a fast and full recovery. People smile as they walk out of my hospital room. Satisfied at having done a good deed, they rush back to the embrace of their normal city lives of excitement, deadlines, backstabbing, and bills. It always makes me wonder who, among those who offered, actually had time to pray.

What most do not know is that the thinning of my skin also occurs in that sensitive appendage “down there”. Polite etiquette dictates that this information be reserved to a few, such as my lady oncologist (who declined to look) and my intimate who comes to visit as often as allowed. Given the chance to be alone with me, his fingers slowly run through the straight scar on my chest, sheepishly continuing to the snake that forms around my navel and, sensing that I’m not offering any objections, boldly trace the rest of the scar that ends on my lower abdomen, close enough to where the pubic hair starts to grow into a bush (although now, it looks like a five o’clock shadow after two weeks from having been shaved for the operation.)

His two fingers, like uneven legs, tread gingerly, then turn into a light caress. The fingers amble along the keloid path, observant, respectful, but also highly charged—like walking on sacred ground with a hard-on. Was he trying to seduce me in my hour of reckoning? Or was he, like a crowd in a hanging, fascinated by the horror—and motivated by a sense of charity—vying to be my last memorable experience? I drop my robe and step back for his inspection hoping to appear—like Venus de Milo, with her decapitated arm—sublime in my imperfection. When his eyes take me in, it is half in pity and mostly half in horror. I have lost weight, my complexion is ashen and the muscle tone sags in places where previously it was taut. He notices the blisters on my penis; wondering aloud whether I can have normal sex again after it heals, to which I want to reply, “What is ‘normal’ sex”? I have to evade the question not wanting to lie. At that time, I did not know if this, or indeed, any other part of my body would heal. He says he loves me. A thought crosses my mind about how easy it is to promise anything to the terminally ill. But I catch the negative vibe before it takes root. I force myself to accept that his interest goes beyond charity.

We can trace our awe of pain from the initiation rites in our tribal roots. How much is man’s capacity to bear? Instinctively, we reserve a place of honor for those who can stand up to hardship. On the other hand, our horror fascination with sickness may come from a culture of contrition embedded by 300 years of faux Catholicism. A long suffering mother, a wronged mistress, a boxer in the ring, survivors of catastrophic events, and others who have similarly passed a test of physical and emotional endurance all share various levels of admiration and respect. Suffering, when made public, seems to serve as a magnet for sympathy and esteem.

Also, the personal battle to survive cancer has a special niche. The arbitrariness of disease marks it differently. More so, when there is no reason to be sick, no logic in the attack. When stricken with an unexplainable fate, one is crowned with glory or relegated to a room of repentance.

In my life of moderation, I never smoked; regularly ate my greens; and engaged in dutiful exercise. And yet I’ve been stricken with not one, but two, deadly diseases. Under the circumstances, the manifestation of cancer becomes a baffling, undecipherable sign, a misterio—a stigma or a stigmata? They say cancer happens for a reason. It is either God’s will or one’s just desserts. Depending on the perception, cancer is seen either as a reward for a life of blessedness or a punishment for a life of excess. Cancer leads the sufferer on the road to sainthood or to the front gates of derision.

But when one thinks of cancer as a prize for holiness, what does that say about heaven’s reward for piety? From this premise, can one make conclusions relative to the holiness of septuagenarian cardinals and popes? On the other hand, if it is were some species of retribution, how is it that people who have been tagged to various scams and scandals—whose acts have wrought havoc on the lives of powerless innocents—have not excruciatingly died of it?

We hear of trials for various misdeeds—from pre-need companies running away with their subscribers’ matriculation fees to charges of election fraud, to government corruption and military abuse—where the big fish invariably escape the net of justice. If cancer is the physical manifestation of the wrath of the giant Om, why are dirty politicians and crooks alike still living, and living well in palaces? Shouldn’t their various acts of perjuring themselves to the safety of an acquittal deserve some form of irrevocable destiny? Cancer of the tongue, perhaps?

These thoughts cross my mind as I lay sideways on a cold metal table while the doctor, with the help of a thin tube, inserts a microcamera up my ass. It is so very James Bond. Groggily, I look at the monitor and see the inside of my colon in real time. I am amazed by the technology and, under the influence of drugs, find myself on a strange trip. “Look,” I say to an imaginary friend, “A beautiful sight! The landscape of the intestines.” With its dark hues, bright reds and specks of yellow, it is abstract space. The art inside my body. The next frontier. I think other thoughts to distract me from the slow bloating inside. At this point, Dr. Jose P. Rizal, the national hero, appears as a hallucination. Wearing a white lab gown (instead of his usual black overcoat, but still with his bowler hat) he studies the development of our history since his death, as if examining x-rays held against the light. He looks up from the evidence and confirms his findings. “This country is suffering from a social cancer.” In this dream, I ask, “Has the cancer grown? Is it terminal?” And finally, “Which cancer is worse, mine or our country’s?” And Dr. Pepe Rizal answers in the manner typical of the medical community, “Who knows?”

Under heavy sedation, I transform into St. Sebastian, captured in that characteristic, charismatic pose beloved of Michaelangelo—half-naked, arms raised and tied to a post, with arrows sticking out of his white torso and leg—and despite the pain caused by the giant acupuncture needles, still looking sensuously beatific, eyes heavenward, standing fabulously contra-posto. Bravery is the virtue I am supposed to embrace as I fight this cancer into remission, although I know I am no saint, not even close to being a martyr. I look at my agony, not as a chance for heroism, but as my sweet dance with death—a many splendored thing. How else can one describe being alone on the operating table? Aware of the sharps and the clang of metal medical equipment that will be used on me. There is no escape. I welcome fear with a hug I reserve only for intimates. I anticipate the care I will receive from relatives. I bask in their love. With friends, I will celebrate each day with the joy of knowing that hope is a bridge being built everyday. And with God, I hold up my right hand, two fingers forming a V: Peace! But the best thing about being treated for cancer is the blessing that there, in the interruption of normal life, one is forewarned. Most of all, having received a notice of possible eviction, having cancer gives one the chance to write the dying scene.


JUN LANA said...

this is the single best post i've read in any blog. thanks for this, nick. and welcome to the blogosphere! :D

Nick Pichay said...

thank you, jun. you are a friend. see ya in Pundaquit.

entre la noche said...

not just worth reading...worth chewing, swallowing, digesting, big meal for the soul, thank you po for sharing ... true enough, you can see twinkling good where the rest is blinded by pitch black hopelessness :)

wendell said...

mabuhay ka kapatid na nick!!! mahal na mahal ka namin.


Anna Maria G said...
This comment has been removed by the author.
Anna Maria G said...

Nick, this is truly one of my favorite posts. Life is as delicate as the skin "down there." ;) That's why we should always make time for friends.

Love you kapatid.

Liza said...

Your words ring true, my dear. This blog entry (and your other entries) is so well written (tama si Jun Lana). Ang sarap niyang namnamin.

It's rare that we get to "rehearse" that dance with death, whether death dances with the self or with a loved one. I don't want to label it as being lucky or not, but maybe the meaning is for us to define. As the cliche goes, carpe diem (and for some of us, "carpe homme," hehehe). Whenever I see you, I am glad that despite your cynicism, you seem to be full of life, na infectious pa nga. Rest assured, Nick, I do pray for you and hope we can one day visit each other in our respective homes for the aged. :) labya, my friend!

artandlaw.blogspot.com said...

thanks Anna for the the new metaphor of life as being as delicate as that one "down there". ha ha ha.

thanks Liza for dropping by and infecting me with life and love.

Love ya, both. Mwah.

Michael U. Obenieta said...

Bless you, bless you, bless you, beautiful stranger. Thanks for this life-saving post, a holy slap for those writing their suicide letters if only they were blissed enough to find and bask in the glow of your words. Long live, Nick!