SOLVING FOR UNKNOWNS | Parisa Thepmankorn
I should’ve known something was wrong when your skin turned an unnatural shade of yellow. That was around the time Ma and Pa started to have whispered conversations about you when they thought no one was listening. Sometimes I would go sit on the peeling red leather couch and watch TV for hours, my legs sticky and splayed all over, and you never came sit beside me. On those nights, the neighbors’ daughter came over to watch me and Ma got back late to tell me that you and Pa are at the hospital in the big city, that I shouldn’t wait up.
It wasn’t until the middle of March, a day sandwiched between two rainstorms, that we find out what is wrong. I come home and instantly I know something is wrong. The house is a soured plum, the house full of people who are soft and bruised and wallowing.
Cancer has turned your pancreas and lymph nodes spotty, you tell me. They scanned your body and found an animal ravaging its new habitat. It is taking what it wants, grabbing your cells in fistfuls, pushing them aside.
I quietly look it up on Google and see the 5-year survival rate: 12%. My parents take us to the temple and after the standard prayers, we prayed and prayed you would be among the chosen twelve in every hundred, Ma bringing offerings of rad na noodles and kai polo stew for the monks. I can hardly understand. How can an organ I’ve hardly heard of be so important that it might kill you?
Ma tells me every night to be a good girl and keep you company. To make her happy — I always wanted to make Ma happy — I fumble through my fractions homework and go sit on the peeling red leather couch with you. The soft buzz of electricity overhead, singing its constant song.
We talk about the shows I watch on the television, the fleshy, misshapen tomatoes Ma grows in the backyard garden. You tell me stories about Ang Tong, the small town an hour outside Bangkok, where you raised Pa and his brother. You tell me to study hard in school, because beautiful, worthwhile things take work. Like the silk I used to sell, you say. To make the fabric, you must boil silkworm cocoons into individual threads, then weave them together with spindles. It takes over a thousand cocoons and tens of hours of labor to produce a mere half kilo of silk. Lustrous, strong, beautiful. And that, you say, is why it’s so precious. Like you.
*
Survival psychologists describe how, in a disaster or a crisis, surviving can be attributed in part to mental fortitude, the will to live — or lack thereof. How some people survive in the same situations in which others die. During World War II, the Japanese referred to it as bura-bura or the “do-nothing-sickness.” Americans called it 'give-up-itis.' When the challenges of survival become overwhelming, some people will opt for death because it seems easier than struggling to survive.
The difference between this and a disaster is that cancer offers a constant threat to your life that, with time, becomes normalized. I am living with cancer. On the other hand, a plane crash makes you question if you’ll make it to the next hour, or perhaps the next day.
Yet both require the same decision to be made. Under the threat of life or death, do you choose to fight? You are forced to answer the question: Yes, I consent to more treatments, more surgery, more IVs, more toxic chemicals, more toxic radiation, more hospital stays. Yes, I want to keep on fighting to live. Or you can choose to quit.
Pa told me the doctor said the cancer was "borderline resectable." Your tumor had just reached nearby blood vessels, but there was still a chance to completely remove it through surgery. The surgeons didn’t know for sure — they would put you under and go in to take a look — but they recommended you try that, along with rounds of chemo and radiation before and after.
Many people are all in. They want every measure possible to try to remove their cancer, want all the chemo, all the radiation, prolong their life at any cost. We expect this of you. When faced with the threat of death, most people immediately start kicking and fighting: Our survival instinct tells us to try to live.
And yet, you are not one of those people. You had told the doctor you needed time to process the diagnosis, and by the time the whole family knows the news, your mind is already made up. When you inform us about what you want to do, Ma and Pa cannot understand. I cannot understand.
No more hospitals, you announce during dinner that night. Ma has made tom kha kai and brown rice for the adults, pizza bagels for the kids. We are halfway through the meal when you bring this up. As though you are talking about my science project due tomorrow. I don’t want surgery. I don’t want any cancer treatment. You only offer a short explanation, saying it would only extend your life for an extra few months or years if at all. That you’ve seen too many people go through cancer treatment just to die too soon anyway. You don’t want a miserable death in the hospital with tubes running in and out of you. You want to die naturally, at peace. At home.
When you finish, you return to eating. The rest of us look at you in stunned silence.
What do you mean? We are in America, Pa tries to argue. You can’t just give up. At least let the doctors see if they can cut it out of you.
Grandpa, I start to wail, hoping my cries will garner me your sympathy. I haven’t fully processed your statement quite yet, but even the mention of your death alone is enough to scare me into tears. Ah gong, please stay with me. I don’t want to lose you.
You look solemn, I remember, and I can tell that my tears are doing as I intended. But then you shake your head yet again. No, you say firmly. I love you all, but no. I’m too tired and too old to suffer like that.
*
What do you do when someone you love is going to die and you can do nothing to change that fact?
In the days in between, we keep on living the same way we always do, more out of necessity than want. What other option is there? You play music from your cassette tapes too loudly and rearrange the furniture in the living room. Ma minces garlic in the kitchen, Pa yells at me to study harder and watch less TV. You forget to lock the bathroom door and cut out all the interesting newspaper articles you want me to read, leaving gray scraps in your wake.
Normal, yes, everything is normal.
Yet, at nighttime, a silent undercurrent reveals itself. I hear my parents ferociously whispering when they don’t think anyone is paying attention. Notice how their bedroom door now only swings fully shut after midnight. Catch Pa looking up clinical trials to enroll you in, see the papers he translates into Thai and slides under your door.
In the next room over, I no longer know how to fall asleep. I twist and turn, my muscles wound tight. I do not know how death works. What fraction of your body is still healthy, is still your own? I am worried that at any moment, I will have to spring up to say an abrupt goodbye before you leave us forever. I don’t want you to die, I keep on thinking. I can’t stop thinking the same words, even though I know it is a useless thought. No one can hear me.
I wonder if you're awake too, grappling with your own thoughts. Do you lie in bed, contemplating your choices? Wondering if you should reconsider your options before it is too late, the way we have been begging you to do?
I want to ask, to bridge the gap between us, but every morning, the words are somehow impossible to speak aloud. In our household, silence reigns. I know my parents must have fought with you about it. Sometimes when I come home the tension is nearly palpable, a tightrope I learn to walk.
And still, your answer never wavers. My parents never fully understand.
When your pain worsens, you allow a nurse to come to the house and provide palliative care. For most of your last month or so, the pain meds keep you in a haze in bed. And eventually, a little over a year after your diagnosis, you leave us quietly, in the middle of the night.
*
In math class a few years later, Ms. Krissy wants us to practice thinking of the world through the lens of math. Algebraic thinking, she explains, is the ability to recognize patterns and understand relationships, to analyze how things change.
The worksheets she hands out suggest we calculate the finances behind Sheryl’s pet-sitting business and the cost of ordering flip-flops from a catalog.
This is useless, I think.
If only algebra was practical. If only it could give answers for real life problems.
If only there was some mathematical expression to calculate the optimal time to fight pancreatic cancer, if only math could involve variables like tumor progression, patient health, mental fortitude, and chemotherapy effectiveness. If only math could quantify the joy of your potential extra time on Earth and subtract the exhaustive toll of chemotherapy and major surgery — maybe then, we could have solved for the unknown. Maybe it would have convinced you to choose a different route. Maybe you would still be alive. At the least, maybe I would have been able to console myself in knowing you made the best choice possible.
But of course, that isn’t how math works. Not every unknown can become known, no matter what strategies I might try to employ.
So finally, I’ve stopped trying to understand you through the lens of science and logic and math. Finally, I’ve started to come around to the idea that accepting death is not always a sign of a lack of mental fortitude, not a pathological 'give-up-itis.'
Perhaps, when given a slim chance of survival, some soldiers chose to face death calmly, under their own terms. Perhaps you, too, took account of the unknown variables and possible solutions and decided to put away your pencil and paper. Live your regular life instead. Leave your death up to fate.
So, this is how I will choose to remember you, Ah Gong. Someone who did not give up, but who chose to follow your body wherever it led you.
Parisa Thepmankorn is a medical student at Rutgers New Jersey Medical School. She is a graduate of Brown University, where she earned a BA in English and Biology. Her work has been published in Hobart, Up the Staircase Quarterly and Cosmonauts Avenue, among others.