by Janisse Ray
At word of a pandemic, Serena hacked off her hair. She sensed a major and cosmic shift. "I don't understand it yet but I know it's big,” she said.
"So you cut your hair?"
"A ritual," she said. "To mark the shift."
Serena, a slim woman in her mid-fifties with beautiful angles to her face and now-ragged dark-brown hair, had shown up in my neighborhood a couple of years before. She lived alone in my neighbor’s garage apartment. I'm not sure how it all happened.
In June Serena braved a hairdresser visit to fix the haircut. A week later she called to report that she had the virus. She wasn't going to get tested, because she didn't want the government to track her. I told her about Buhner's herbal protocol, and Serena ordered all the herbs, some we'd never heard of, woad and mangafera. She ordered an oximeter and a nebulizer. A week later she was worse. At two weeks she was afraid she was in a "cytokine storm," when a person’s body fights something too hard.
The first time I met Serena I'd called my neighbor to see if he'd help me move a piano into an old church I was restoring. Galen had a tractor with a lift. “Also,” he said, “I’ve got someone I want you to meet.”
Serena was thin, maybe too thin, and quiet. I tried to find out how she had gotten to our forested, out-of-the-way place where no one comes, only leaves. She had lived in Asheville. She wanted to start a community for women who'd been abused. She'd met Galen online.
There was this one moment. Galen had gotten the piano lifted to the open door and we had rolled it inside. He had pulled forward and shifted the tractor into neutral. He called Serena's name. She was standing beneath the pines that drop their russet needles and sienna cones into the grass around the church. Galen half-stood, something in his hands, and made the sudden motion of tossing whatever he held to Serena. A pack of cigarettes flashed through the air. Serena lifted her hands and caught the pack handily.
I psychoanalyze everything. Sometimes I’m right, sometimes not. For example, I tried to figure out why Galen had thrown the cigarettes. I tried to figure out why Serena was now poor, when she had some very nice things, linen pants and gold rings and a name-brand juicer. She had an infrared sauna, a colonics system, a biofeedback machine.
Serena was crazy about health, like me. Detox was something we talked about a lot. She would set schedules for herself, self-run healing retreats, her own patient: 8 a.m., make a smoothie with organic living foods, 8:30 sitz bath with lavender and herbs, 9:30 infrared sauna, 10 a.m. cup of herbal tea. She mapped out mini-tramp bouncing, enemas, oil-pulling, skin-brushing, sunning, grounding, meditations, naps.
But she smoked. There was that paradox. Of course we’re all paradoxical.
Serena and I became friends. We would drive an hour to buy unpasteurized milk from a Mennonite dairy farmer, and because we were both hippie chicks, we were never at a loss for conversation. Serena tore up part of Galen's yard to build a garden in boxed beds, and we traded plants. She gave me moringa, I gave her Malabar spinach. Still she remained a mystery. Some kind of traumatic event had flattened her. It may have been an attack since she walked with a slight limp. Her mail did not arrive directly to her home in Galen's garage apartment, but was forwarded via a victim protection service. Because of whatever had happened, Serena was trying to get disability, and sometimes she returned to Asheville for court. Her car tag said "North Carolina." Serena was not her birth name.
I asked her what her name had been.
She said I could Google it.
When the disability came through, she drove herself to Colorado to do a course of rolfing, living in her little blue car and taking showers at Planet Fitness. She saved her money and flew to Costa Rica for dental work.
Now she had the virus and wasn’t getting well.
On a Sunday morning in July—the 20th, to be exact—she phoned. "I drove myself to the ER last night," she said, voice low. “I couldn’t breathe.”
"Did you get tested?"
"I don't have coronavirus."
I made some small reply, something like "What!" on a sharp exhalation.
"I have cancer,” she said.
There’s no fast way to process information like that. For a long time something in your mind is trying to catch up. Serena was telling me the ER doctor tested her for coronavirus, but the results came back negative, so he ran other tests, including a lung scan. He found cancer, Stage 4, with fluid already backing up. He stuck a long needle in one lung and drained fluid off, then sent her home with a catheter in her chest.
"God,” I said. “What happens next?"
"They gave me an appointment with an oncologist in a few weeks," she said. Then she ran out of breath and had to go.
I'd never heard of someone driving herself to an emergency room and getting diagnosed with Stage 4 cancer. My husband said it seemed unlikely. I thought like this because Serena was mysterious and sometimes she was wrong, such as thinking the government would track people who tested positive. But no one would joke about cancer.
I went to the computer. In fact, I learned, lung cancer is often diagnosed at the ER. It manifests few symptoms until the latter stages, so by the time most people experience these, they are in an emergency.
"Shit," I thought.
I drove the mile to Serena’s. I let myself in the door and climbed the lustrious pine stairs. The apartment was new and tastefully done. Golden sunlight poured through large windows onto a pine floor. The kitchen, with its stainless appliances, was open to the living room, where Serena lay on a large sofa watching a movie. Two plastic tubes curved into her nose, delivering oxygen from a machine that pumped and hissed in the middle of the floor. She had a smaller metal cylinder to carry around. She wasn’t talking much. She wanted me to help her drain her right lung via a port protruding from a large patch on her chest. We watched a yellowish pink liquid seep out. I could tell she was terrified and angry.
"I can't breathe," she said. "They got a lot more fluid than this at the ER. We must be doing it wrong."
A day later she was back in the hospital. No one could visit because of the virus. She had her cell phone, but mostly she wouldn’t answer it. She had a lot to think about. When she did answer, she'd run out of breath. She wouldn’t say what the doctors were telling her. She wouldn’t say much at all.
Soon she was home again, huddled on a sofa trying to get comfortable, sucking oxygen out of a tube. She kept a movie going so she wouldn't have to think. I agreed to keep her supplied with bone broth, which I soon found was useless—she wasn't going to drink it. She wasn't going to consume anything. Galen and I were trying to figure out if she qualified for hospice. I believe in deep honesty, and time seemed precious, so I asked her, “If the treatment doesn’t work, what do you want us to do with your things?”
She looked at me angrily. "I can't think about it," she said.
"What about your body?" I said. "You should at least tell me where you would want your body to be, when the time comes."
"I really don't care," she said. She was very angry. "Look, I'm trying to hang on to hope here. Now is not the time for this."
After that, I didn't mention death. I helped drain her catheter. I spun up a green smoothie, which melted on her coffee table. I left bone broth in the fridge, but as far as I could tell, she was barely getting off the sofa. She spent her time trying to stay comfortable, piling pillows here and there, and trying to sleep, any amount of sleep.
Soon she opted for the hospital again. A week passed. When she came home this time, she couldn’t climb the stairs. We moved her into Galen’s family room. He was kind like that. He counted her as his family in an odd, roommate kind of way.
She was angry that the hospital had started her on morphine. She didn't want morphine. Whether to take morphine or not was her decision, and they had given it without her permission. They also sent her home with Xanax, which she refused to take because she didn’t want to get hooked on it. The hospital hadn't done anything right. They hadn't told her the things she wanted to hear. She couldn't understand or repeat the things they had told her. She couldn't talk because she had no breath. “Turn the AC down,” she whispered. She could breathe better in bitter cold. Keep the TV on. No, I can’t eat.
I drove her to her first oncology appointment, an event so surreal it seemed a dream, on a Monday.
Serena, hooked to a portable canister of oxygen (extra in the back seat) huddled into the AC vent all the two-hour drive. A few miles from the cancer center I broke an awful silence. “Look, we need to talk about this visit.”
Serena gave the tiniest nod.
"We want to know about treatment," I said. "When you can get started. We want to know about the fluid, if it's going to keep building. And what can be done about that. We need to know about the Xanax, if there's a risk of dependency. How many Xanex you can take in a day and be okay. But mainly we need to know about treatment. Immunotherapy, for example."
"Yes," she whispered.
"We need to ask about life expectancy too," I said.
Finally we were in an examining room with a nurse named Kathy, older than us, short hair dyed blonde. She stared at Serena bent over in a wheelchair.
"Are you cold?" she asked.
Serena whispered that she was, and Kathy went away and came back with a heated blanket. "Would you like some water?" The nurse went away again, and when she came back she busied herself with vitals.
"The doctor will be in shortly,” Kathy said, and on her way out she closed the door. The room was silent save for the hissing of the oxygen tubes.
Only three weeks earlier, in a small ER in a rural hospital, Serena had received a terminal diagnosis. Since that date she had been hospitalized three times, but as I understood it, this was her first time she was seeing an oncologist. This doctor would start her on the treatment that, combined with her own detox regimen, would buy her some years. She had come with high hopes, or at least I thought she had. I had.
Two of the parties knew something the third party did not know, and the third party was me. One party, the doctor, knew something that the other two parties didn’t. Then there were two parties, the doctor and me, who could study each other's faces. One party had her head down and her eyes closed.
Something, however, wasn’t making sense. Why had we waited an hour in the waiting room? Why had the nurse been so solicitous? Why was the doctor taking so long—another hour we’d been waiting—to arrive? I got up and opened the door to the hall.
Soon Dr. Abercrombie filled the doorway. He was a tall man, slightly stooped, with a meticulous haircut. He turned and closed the door. He pulled up a stool and made a ceremony of sitting down a couple of feet in front of Serena. He did all of this with something like resignation. He glanced at me.
Here's where the story gets odd. Here's where there were three characters at cross purposes with each other. Two of the parties knew something the third party did not know, and the third party was me. One party, the doctor, knew something that the other two parties didn’t. Then there were two parties, the doctor and me, who could study each other's faces. One party had her head down and her eyes closed.
The doc was close to retirement, with a kind voice and kind eyes. He looked like a man who drove a sports car, who played golf, who lived with his aging first wife, who limited himself to two martinis—a person whom society had rewarded with money and safety and deference. Serena was a woman who drove an old blue Ford and lived in someone else's house and to whom society had not rewarded with money and safety and deference. There was something else I saw in the man, and I knew instantly that I would not want him for my own doctor, because truth, even brutal truth, is essential to me.
From out of a hissing silence, sitting on his low stool, the doctor said something that shocked me, a surreal first sentence that wedged from his mouth in the form of a question.
"So what's the matter?" he said, directing the question to Serena’s bent head.
Serena’s response was equally surreal. "I'm having panic attacks."
"Did you get radiation?" he said.
"Does anything hurt?"
"My heart, during the panic attacks."
"Does it hurt when you take a deep breath?"
"I can't take a deep breath."
"Does anything hurt?"
"My back is sore."
"You have Tramadol for pain? Does that work?"
"And you have Xanax for the anxiety. When I saw you at the hospital you had that prescription."
Panic attacks, pain, anxiety. Why wasn’t the medical community more concerned about getting on with healing? Serena was 53 years old.
The doctor took a long time glancing over papers in his hand. Finally the doctor used the word “treatment” but as soon as he said it, he trailed off. "The best way to treat this…" (He checked his papers.) "Did you ever see the radiation doctors? I guess not." (He sighed.) "The main tumor is in the right lung. It's blocking the airway. The bulk of the disease is right there. The first thing is that you need to see the radiation doc. Then maybe we'll do some chemotherapy. That would help the radiation work better."
(Wait. We weren’t seeing the correct doctor?)
"Dr. Abercrombie," I said. "We’re interested in getting started immediately with the best treatment possible.”
He looked at me as if I'd zoomed in from another planet. He directed himself again to Serena’s crown. "After the radiation, we can try immunotherapy. But you need to see the radiation doc first." (Three precious weeks had passed already. Why were we wasting time here?) "Maybe we can do both chemo and radiation at the same time, a small amount of two drugs once a week. You'll need a port for chemo,” he said. (I was quiet, helplessly quiet.) “Once we see how that works, you can do a bigger dose once a day." He fell into a long and deep reverie.
“When can Serena start radiation?” I said.
That would depend on the schedule of the cancer center, the doctor said. It would probably be in the next couple of weeks. (Did we actually have more time than it appeared?) Someone would call Serena to set it up. I studied my friend, hunched under a white blanket in a wheelchair, air tubes into both nostrils. Why hadn't the radiation appointment already been made?
"We'll need blood," the doctor said. "For the chemistry." He swiveled around to gather his papers.
"Dr. Abercrombie," I said. "On the drive here Serena and I came up with a list of questions, things we need to know. You’ve covered some of them. One we haven't covered is life expectancy."
Serena lifted her head. The doctor was very close to her face, too close for a pandemic and not wearing a mask.
"It's hard to tell," he said, quietly. "Everything depends on how she responds."
"Yes," I said. "But please give us the parameters."
"I'd say without treatment it would be 1-2 months. With treatment, 10-12." He said it matter-of-factly, without saying anything about being sorry.
When he went out and closed the door, Serena looked at me for the first time in days. "Damn," she said.
When I delivered Serena home, Galen followed me outside. Serena would need to go into a nursing home if she didn't have home health care, a hospital bed, a potty chair, an appointment with the radiologist, an appointment for chemo. There was a lot to do. Serena had to do it because she was the patient. He had to leave for work at six. I said I’d come get stuff started.
It was almost noon on Tuesday when I arrived. Serena wasn’t interested in calling anybody. She said she needed to rest. The phone rang and she ignored it. She wasn't answering the phone. "I'm taking the day off," she said, implying that tomorrow would be the day to make all the arrangements that would be needed for a person with 1-12 months left to live. Serena smiled at me. The smoothie I'd left by the sofa the evening before was untouched.
On Wednesday I waited again until late morning, wanting Serena to have all the time she needed. At the door I knocked lightly. I could see Serena through the glass and she did not lift her head. She was in the exact position in which I'd left her 24 hours before. That scared me. The door was unlocked.
She opened her eyes but they weren’t focusing.
"Are you okay?"
"What's going on?"
She didn't answer.
I went to the kitchen phone and called my husband. "She's responsive but barely," I whispered. There is this phrase in hospice work, “actively dying,” as opposed to the passive dying we’re all engaged in. I told him I was pretty sure that Serena was actively dying but I needed his opinion. “I’ll be there in a minute,” he said.
I had to think hard and quick. If Serena were actively dying, she couldn’t be saved. The decision was really where. To transport Serena anywhere at this late and tender stage in her life, possibly in her last hours, seemed cruel. She would want to be home, not in a hospital.
“It’s happening,” Raven said. I wasn't prepared for this sudden turn of events. Two narratives had been in operation, and I had believed one of them even when it stopped making sense. For Serena’s sake and for my own I had propped up that narrative. Now a new narrative had emerged, one that involved a friend and neighbor actively dying and me her assistant. Perhaps it involved agency, the courage to hear “1-2 months” and making a decision.
Although I trained as a hospice volunteer, I had only seen one person through the entire process of dying, and that had been my father, six months earlier, whose death had activated a trauma/stress response in me. I’d have to do what I could.
I rearranged Serena’s pillows. I swabbed her mouth with water and wiped her face. She was completely beyond me now.
In her apartment I’d seen copies of the Bhagavad-Gita. I ran over to the garage and up the stairs. On the same shelf I found the Book of the Dead, the Bible, an entire stack of spiritual texts. I knew Serena was a Christian, although as she had put it, “not your normal Christian,” although I didn’t know exactly what she meant by that. I attended a historic chapel down the road because it offered community, although I didn’t believe much of what was preached there. I invited Serena, who did believe, but she wouldn’t go.
I began to devour the texts, which smelled of stale smoke, especially the Tibetan Book of Living and Dying. I turned to the page I needed, a discussion of bardo, a Tibetan word meaning “suspended in-between.” A space between two worlds opens in dying, a powerful time for transformation. Serena was in the midst of a tremendous opportunity. The text said to imagine God standing above Serena, pouring golden light over her. It said to chant “om mani padme hum,” the bodhisattva of compassion, over and over, the sacred om plus jewel plus lotus flower plus spirit of enlightenment. The book explained how to meditate, how to ask for forgiveness, how to provide hope, how to create an atmosphere of peace, so no one would have to die with resentment and bitterness.
God was standing above Serena, gazing down upon her with infinite love, pouring golden light across my friend. He had the kindest look in his eyes. He called her “his child.” The light kept pouring and pouring.
The hours passed. I chanted, low. I visualized golden light, let it pour. If Serena stirred or moaned or mumbled, I spoke to her, in the most comforting and loving voice I could find, “You’re not alone. I’m here with you. This is a big journey, but you’re ready. I’ll go as far with you as I can go.” Again, " I’m right here. I'm watching over your journey. You’ll be stepping from this room into the next room. I'm coming as far as I can come with you.” Golden light poured over my friend in vast, illuminated rivers. “I’m going with you as far as I can go. Your mother will be waiting for you. She will be calling your name. You'll know her voice. Listen for her."
Once I went and stood at the closed door. A black racer almost four feet long was making its way across the leaf-strewn flagstones toward the steps. It passed the concrete steps and slid to a corner, where the house made an L, and buried itself in leaves.
Snakes mean transformation.
Galen came home, absorbed the sadness of what was happening, went to bed early, got up early, and returned to work. I was alone with Serena on Thursday morning when her breath began to cease its regularity, slightly at first. The final moments went quickly. She was breathing, then she was not, then she was breathing, then she was not. And then she was not.
The spirit does not leave instantly. It takes time. So I did something I had not done with my father. I stayed in prayer. I gave my friend some time to gather up her life and move into the next one. Maybe it was enough.
Then I rose, arranged Serena in a resting position, bathed her thin body, dressed her in clean loose cotton clothing, and went to the phone. Within an hour Galen was home, a deputy was on the scene, the coroner had arrived, and a funeral home had sent a gurney. Soon two men in black church suits were bouncing Serena down the steps.
For days I spoke to no one beyond my family. A membrane between my body and spirit had grown so thin it almost wasn’t there. Sometimes I felt my body wanting to disappear, and I’d have to pat my arms or hold my waist. I took careful baths in warm, salty water. I took long walks on the road.
One day I helped a tiny ring-necked snake cross the dirt road in front of the farm. The next day I helped another. One evening a green snake was stretched in the grape arbor when I went to gather fruit. I went back to Serena’s apartment for some things, and a beautiful snake was waiting by the car when I opened the door.
So many facts about Serena I will never know. Mystery arrived with her and left with her. During her dying I had prayed arduously for her healing, not from Stage 4 lung cancer but from whatever had injured her soul, so that she could move forward into the realm of the ancestors without need to repeat traumas. I believed that. I prayed hard for it. I still pray for it.
Serena was correct about the pandemic causing a major shift in the world. The pandemic was a bardo, a suspension in between, a transition; a membrane between the tangible and spirit worlds thinned, and many people slipped through. Some died of the virus, some of other causes—John Prine, my mother’s best friend, my state senator, hundreds in New York City, my first cousin, my second cousin, Barry Lopez, dozens in my hometown nursing home, thousands in India, Serena. It was a powerful time, rife with the possibility of transformation. We were asked to sit with the anxiety of invasion, to come to terms with the inevitability of death, to stop being emotional and start being wise, to be still, to deepen into our places, to notice beauty, to miss each other, to find the meaning in our lives that prepares us for our own deaths. In this bardo we had a chance not simply to pause and breathe deeply but to move ourselves toward enlightenment. For that I am grateful.
Janisse Ray is an American author whose work often grapples with the beauty, intricacy, and heartbreak of the biosphere. She has published five books of literary nonfiction, including the acclaimed Ecology of a Cracker Childhood and The Seed Underground. Her latest is Red Lanterns, a book of poetry. Wild Spectacle: Seeking Wonders in a World Beyond Humans, a collection of essays, is due out from Trinity University Press in 2021. Ray lives and works in coastal Georgia.